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Home My WebLink AboutSKY RANCH ESTATES #2 BLK 2 LT 21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAl_TH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telepl~one 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LI;GAL DESCRIPTION lOCATION ~o Width Well )tion area Dwelling DISTANCE TO: Manufacturer Material NO. OF BEDROOMS PERMIT NO. St No. of compartments IF NOMEMADE: inside length Liquid depth Well Dwelling PERMIT NO. DISTANCE TO: Manufacturer Materia] Liquid capacity in galJons Well Foundation DISTANCE TO: No, of lines I Length of each~lline Top of tile to finish grade Material beneath tile Depth Nearest lot lin~//,) Trench width L P RADE Length Width PERMIT NO. Distance Total effective absorption area PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line IPEPERMIT NO, DISTANCE TO: Building foundation Sewer line Septic tank A~)~o~area(s) L OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER -~--" REMARKS APPROVED 72-013 (Re~. 3/78) DATE LEGAL PEffRi'"I]]T ?',ICL ( '~3::1.::I.;:I.:;t.5 F:!F'P I... I CF:fi'IT LOCI:::~ T I ON i...E GI::II :~_;l..7'd.d. SI.IE'FL.I::!N[:, FITS. LOT ?::L 13 ;~: Sl'("r' [;?.FII",IC:H EST. 'T'"~"F'E Ol::' SO :[ L.. I::I~3SO[~'.F'T :[ Ot",1 S'T".;?I"EI"I :[ ~:~;: 'I"RENCH I'"!F:I?,'];i'"ILII"I I",IUI'"IBEF?. ()F E:E[>Fi~C~Cff"I'.~!; ~: ;}i: SO t k F;?.FrlT ][ I",fEi ( ':_:;Q F::"I'?E',I~: ) '~ ;253 THE[ LIEI",IEiTH [:, I i'"IEN~.:;;[ O!q ;[ ~[':; THE L..E'I",!E~fTH ,( ;[ i",1 FEET ) OF I"HE~ 'i'I:;?.ENCH O!:,i: DI:RF:I ;[ NF:' [ EI..J3, THE E:,Ii]i;F'TH 0F:' I'"t TI:;~rEI",IC:t'I O1".'~ I-::'1'1" IS THE DI:STFII",IC!{ I'~ff2'l"t,.l[{t]!:[t",! THIi; SU!:RF!:::ICE OF THE (]~I:,:'rOUF,II') FIF,I[:, THE; E~O'I"TOI'! OF '!'I'IE E;;'~iCF:IVFITi[OF,I (.[!',1 't"HIi!!]I',~'.E :[:~:; ?'~!O SEF I~I;!:D"I'I~! FOR TREi",tCHE;S. THE GRI::IVE[I... DE[PTH :[:~; 'r!.l[E 1,11[ F,! i I-,'ILII-,1 DEPTH OF' E, il.~'.la',,,'[:.!.. E~ETI,.ItFJEI.,! THE C)UTI:::'I~L.I... F:iI',,IIJ) 'I'I--I1:~] EIO'I"TCIi',I OF Tt..II]{ E;~.~',C;FIVI::ITL[OI'.,I (IF,I r.:EE'I"). PEI:;?.M]~"I' I'::IF'F:'I_.ICRI',,IT I.II:::iS '!"lifE[ l:;d-'i[St:~'EIi",!':ii; ]i l?, ;[ L, IT"r' 'T(;) lt'qFOFd'"l '!-Hi'.i~:; !)FZ:I:::'I::It:i?.'I"t"IEt",!T DIJF?.~t".!G 'I"HE I!'.,1L:?'rI:::ILL. I:::!T];Cff,! 'it'.~ISF'!~i;CT-TOI~.,I'E; OF' !:'ll"!"r' I,IEL. L.t~'~; i:I[>J'i:::ICEI",IT '1'0 TF'I;[S F:'I:,~IOPIE?.T'.r' I",!I..fI"IEi~EI::~'. Cfi;;' RESI[;,EI",!CES 'T,~IF:IT THE HE]J.,. t.,l:[IJ..,. i"!It".1:[t"tU1"1 [:,I'.i~,TI::INC:E 13ETI,IEEI",t f::l I,.IE:LL Fit',![::' F!F,i'¥' CIN-.-5:[TE SI:::I,.If:IGE :LE!I~;~I FEET F'(~!i~t I::! I::'RI',,,'FITE I,.IE[.L OB: :J. SEI TO ;T:CII~:.t FEET F;'RCIP'I I::1 I...[PON TI"II!~: 'r'.r'PE: OF F'LIE',L:[C I,.!EL.L I"! :I: N :I:t'"11.1]"1 [:, I ST FINC:E F:'I-~Ot"I I::! F'R Z ',,,'FITE t,]ELL TO fa PI:;?. :[ ',,,'FITE :::;EF!iE[;~: L..[ t",IE: Z S 25 F:'EE: I' l::lf.-![:, TO Ft COI"lt'll..II'.,I :!: '['¥ SEI.,.IER !.. :[ NE :[ _~; T".5 FEI( T. CrT'HER I:',?.I]i:(;:!L.I .'1: REI',IE:I'.,I]' S P'IFI'~.' FIF'F'L.'.r'. SI::'EC :1: I-:' :[ C:FI'T :[ ONS FIND t::?,/I:::I:[LF![ii:!....[~ 't'0 :[N:~;I..II:;~E F'f;~:CiP[~:I:;~'. :i: CERT:[!::'~'r' 'Tt..IFYr ::!_: ]: !'::11',1 FFIMIL.:[FIR I,!:[TH THE: RE(;!UIRE:I',IENTS FOR CiB!--SITE SE].,.IEI:-:'.:::~ l::llq[:, I,.!ELL..:[~ FIS :ii;E[' F'ORT!.I E?,'.? THE: i',ILIN:[(:::lt::'IaLZT'.? ;?: :[ I,I l L.I._ t N:i?['F:ILI.. 't'HE '.[i;'~-'STEI"I :[ I'.,I I::'ICC:OFi~[:,FIBICIE 141 '['1..I THE COl>ES. :ii:: :1: LIi'.,I[:,E:RSTF:IN[:, 'THFIT 'THE ON-..S:I:TE[ :'_:.;EI.,.IE:I;?. S"r'~?l"li:l'"l f'lFl"r' REQUIRE [E[",ILF:ff;?.GEPIEN'I" ](1:::' THE F?.ES:[D!:~:I",ICE: :1::~ REI"'IO[)ELE[:' TO ZI'.~!CL.I...I[)E. I"ICff;~tE THFllq [!~ E:E:DF.:CK3FIS. t~T .;' ':: ':; [: I":' '.-~' [~ SOl LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 925 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST '~,/S L~ P E 5'~ SITE PLAN 3 5 6 7 8 9- [~'~/P E R CO LATIO N TEST 10- 11 13- 14- 15- 16 17 18- 19- 20 COMMENTS PERFORMED BY: 72-008 (6/79) WASGROUNDWATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE DATE: ~)~Q (minutes/inch) ~1 ~ FT AND ?~"-- FT GRE' ER ANCHORAGE! AREA BOF 'UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~'/~g~ ,,~¢..~.~,O~/ _ MAILING ADDRESS ~2 ~2L~'~//~. EC~:~/~C'/pT~HO~NE ,:;3~-/~--'~2~¢¢ LOCATION ~'~/ ZCf/.~.<:(~ LEGALDESCRIPTION ,~-¢ ~' .~! /~t_<~3/¢ 2 ,~,~'g/~g~2~./'/ SEPTIC TANK: DISTANCE NUMBER OF FROM WELl /~//¢ MANUFACTuRER_(~/~/~- MATERIAl_ ~/~,¢¢/'¢~24~%/~ COMPARTMENTS INSIDE LENGTH _ INSIDE WIDTH __LIQUID DEPTH LIQUID CAPACITY /~ GALLONS. SEEPAGE pIT:i , ., NUMBER OF PITS / : DIAMETER OR WIDTH ~2"',/ --. LENGTH 2~,! DEPTH /~ '/ LINING MATERIA¢~//¢¢~ /~¢~_ CRIB SIZE: DIAMETER__DEPTH g] ! DISTANCE FROM: WELL BUILDING FOUNDATION ~¢!¢', NEAREST LO'r LINE ~2 /'/~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) q p SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE (~ ¢ .d4, t'~ CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL OTHER SOURCES APPROVED ~'~ DISAPPROVED NEAREST SEWER LINE REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK __, SYSTEM _. DISTANCES: INSTALLED BY:. PIPE MATERIAL: LOT SLOPE: REMARKS: Form NO, EQ-031 DATE DIAGRAM OF SYSTEM G.A,A.B. GREATER ANCHORAGE AREA BOROUGH DEPARTMI:':NT OF ENVIRONMENTAL QUALITY .ERMl'r NO 3330 "C"STREET ANCHORAGE, ALASKA 99503 TELSPHONE Z74'456~ /(/~--~ ~j ~, SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT SEEPAGE Pit DRAIN FIELD , TO .E INSTALLED .¥ Z ~- / NAME OF APPLICANT LEGAL DESCRIPTION SOIL TEST RESULTS FINAL INSPECTION: 24 HOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTM~.NT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE /~ TYPE SEEPAGE AREA SIZE TYPE FOUNDATION TO SEEPAGE PIT ~ ., DRAIN FIELD SEPTIC TANK TO SEEPAGE Pit WALL /J~ / SEPTIC TANK ., SEEPAGE Pit DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS, WATER MAIN TO SEPTIC TANK / / DRAIN FIELD SEPTIC TA NI(, /~) SEEPAGE Pit ., DRAIN FIELD TO R,VER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRlI3 CROSSING GAP EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST [PON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITh AIRTIGHT REMOVABLE CAPS. GRAVEL BACEI-"ILL CONFOrm TO BOROUGH REGULATIONS REGARDING INSTALLATION. OR LICENSED I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. GREATER ANCHORAGE AREA BOROUC" Department of Environmental qu, ty 3330 "C" Street Anchorage, Alaska 99503 SOILS LOG .- PEROLATION TEST Performed for ~/~-~- mis Torm reports: 3oils log___~ -- Depti~ Feet 2 - 3- 5- 8~ 10- 1'1 - i2- 13-- Was ground water encountered? ..27~0_. ......... If yes, at what depth? Reading Date Gross Time Net Time Depth to Water Net Drop Percolation rate mi nute. Proposed installa-t~-~o-n-:"~-S--~fe~a--ge Pit Drain Field '0epth of Inlet ................... . Depth to bottom of pit or trench COHMEIITS: ....................................................................................... EQ 040 (6/74) 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 C. ERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Location (site address or directions) i I"~ 1, ~.t~..'~l~.,~¢~ ~.~.~ ~-~¢- Property owner Mailing address Lending agency Day phone Day phone Mailing address Agent ~°'~cx~ Address 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, prowde written confirmation from State ADEC attest- ing to the legality and status of system, 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system, ~.,: :~, ,, ~.,~l~7~,~25 ........................................... (Rev. 1/9~ Front MOA #21 ~-- ................ ,~*,~*~' . 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, I verify that my investigation of this Ftealth 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. NameofFirm_/'"-'~,,~-¢~ ---~dC'k~'L~ ~.1,~ Phone ~-~/~ Address ~ O ~ ~ /O~ ~ ~ Engineer's signature ~ ~ _ Date DHHS SIGNATURE /~' Approved for ~/'~¢-~ ('~) bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for eCrors or omissions in the professional engineer's work. 72-025 (Roy. 1/91) Back MOA ~21 Parcel I,D. A. Well Data Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL. CHECKLIST Well type /4%, Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C. attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires properly protected (Y/N) Date of test Static water level FROM WELL LOG AT INSPECTION MUNICIPALllY OF ANCI K)RAGE [NVIP, ONMENI'AL SERVICES DIVISION OCT 1 8 1993 Well flow Pump level1 g.p.m. g'P' ,ECE JVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ; On adjacent lots Absorption field on lot Public sewer main ; On adjacent lots Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/I'J~E~tNG TANK DATA Date installed ../~¢'~_ - '7" ~ '_'~J-~ Cleanouts (Y/N) \/ / High water alarm (Y/N) Date of pumping Tank size [ o-o-~.~ Compartments Foundation cleanout (Y/N) y Depression (Y/N) P'J//k- Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: N/ Well(s) on lot To property line _ Surface water/drainage On adjacent lots ,,~/J~E) Foundation Absorption field ') _~ Water main/service line 72-026 (3/93)" Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manhole/Access (Y/N) "Pump off" Level at .Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D, ABSORPTION FIELD DATA '7~/~,/1 'o//~ /~ Soil rating (GPD/FF) Date installed y,.) 5 / Length ¢.,~¢ k, z.~- Width ¢--~ Gravel thickness Total absorption area ~-~/¢ e~ Cleanout present (Y/N) Date of adequacy test ~O/~ I ~J ~ Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) System type Total depth i'f Depression over field (Y/N) for ~ Bedrooms After test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot d//,~ On adjacent lots ~ /0"' L.P Property line To building foundation / 7 ~ To existing or abandoned system on lot On adjacent lots ")/b-'-¢~ Cutbank ~ 0 ~ ~ Water main/service line Surface water Curtain drain Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidel/nes in e~ec! On the date Of th/s inspection. HAA Fee $ ~-..-)0~': Date of Payment Receipt Number 72-026 (3/93)* Sack Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SEFIVlCES 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 lot, block, subdivision, section, township, range) Lot 21~ Block 2~ Sky Ranch Subdivision #2 (b) Location (address or directions) 11751 She. tZand He. Lg~tS. Anchorage, Alaska Property owner .lo6'c& Mu.r~2Jl. y Telephone: (home) Mailing Address 12531 Old Seward Highway, Anehorag6, Alaska _ Business 345-1515 (c) Lending Institution Telephone Mailing Address (d) Rea[ Estate Company and Agent _~E/MAX PROPERTI~S - Carol Kil,qor6 Address ~600 Cordova, Anchorage,, Alaska 99503 Telephone 276-2761 . (e) Mail the HAA to the following address: (or check here O, if hold for pick up.) List contact person and day phone number below: ~ & ~ ENRINEERINR/~94-2979 17D34 E~g~¢ ~'Ju~.~ In~p Rnad; ~uJ,/'~. 204 2;TYPEOFRESIDENCE Single-Family¢ Numberofbedrooms 3. WATER SUPPLY Individual Well [] Community,~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4, SEWAGE DISPOSAL On-site [~ Public [] Community [] Holding Tank [] Note: If community 'well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, 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 Name of Firm Address __ Date State codes, ordinances, and regulations in effect on the date of this inspection. $ & ,, ,-NGiNF. ER"'~4G Telephone ' 17034 Eagle River Loop Road No. 204 6. DHHS APPROVAL Approved for O ,__bedrooms by Approved '¢~ _ Disapproved Terms cf Conditional Approval Conditional The MunicipalJty 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 engJneer 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. MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHFCKLIST - 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) Date Completed Depth of Grouting If A, B, C, D.E.C. Approved(l~;;~N) ~ Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot '"~..¢24:> 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 '~.td'.~ ~:~ __ ~ '""~ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date To Water-Supply Well To'Prope~;!y En¢ SEPTIC/HOLDING TANK DATA Date Installed ~.~,/q¢3¢ Size t d;:A¢~O No. of Compartments \ Standpipes ~¢~N) '¢ Air~tig~.~Caps(:~N) '~ Foundation Clean out 42t~'/N) Depression over Tank (Y/.~ D/ate Last Pumped Pumping/Maintenance Contact on File (Y/~ ~ ;::: Holding Tank High-Water Alarm (Y/N) Try Holding Permit (Y/N). SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: I ~l 4-' To Building Foundation ~ \ To Water Main/Service Line To,Stream, Pond, L~tke,or Major Drainage Course Comments, /~-.~ To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 ABSORPTION FIELD DATA Soils Rating in Absor.~otion Strata '~'~"~ "=~/'¢'~'~'~ Type of System Design ~ Width of Field ~,~ Depth of Field /¢ ~ ~ J //Cz/ Gravel Bed Thickness ] Square Feet of Absortion Area ~ ~~ Statndpipes Present.N) ~' Depression over Field (Y~ ~ Date of Last Adequacy Test Results of Last Adequacy Test ~~~ ~ ~ ~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ ~ ~ To Property Line ~ ~J To Building Foundation/ ~t ~ To Existing or Abandoned System on Lot ~/~ ; On Adjoining Lots To Water Main/Service Line ~ ~ ~ ~ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course ~ ~ To Driveway Parking Area, or Vehicle Storage Area Comments~ ~¢~ ~ ~ Tested for Meets MOA Electrical Codes (Y/N) Comments LIFT STATION Date Installed Dimensions Size ~ons Manhole/Access (Y/N) "Pump On" Lb'~.at..........~ "Pump Off" Level at High Water Alarm 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 guidelines in effect on the date of this inspection, Signed Company Date MOA No. Receipt No. Date of Payment Amount: 72-026 (Rev 7/88) 8~ck Receipt No Waiver Fee: $ Date of Payment Page 2 of 2 d DEPT. OF ENVIRONMENTAL CONSERYATION / ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 October 20, 1989 STEVE COWPER, GOVERNOR 563-67'75 Mr. Roger J. Shafer S & S Engineering 17034 Eagle River Loop, Eagle River, AK 99577 Suite 204 PWSID: ~212916 According to the records on file in this office, the Sky Ranch Estates II Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, VEC:bas 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 1, GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) 'N"~,~T~I'-- '~ ",~?.oH r ~',~. (b) Applicant Name ~ _~'tZ;~ C_..-~-' ~ : Home Business ~'~-' ApplicantAddressI -1 .1 ..'¢~4~¢t,..,~ w,,~ ¢J--.~.z_, (c) Applicant is (check one): Lending Institution F1; Owner/buiider'l~ Buyer []; Other [] (explain); (d) Leoding Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the lollowing address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Other Number of Bedrooms "~ ~ ~-~,'Vw. WATER SUPPLY Individual Well [] Community.~ Public [] Note: If community well system, must have written confirmation from the State Department ot Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite,~ 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 ol 2 72-025(H,84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMAl'ION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Healti~ 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 4)n-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 ~',-"~\¢P\1'~:'c..~/'~['O~"L- ~(.,~f-/~ ~'4Sl~--Telephone '"~C"J..tz7'-- ~ ~Y~ Date l/*~/~ Engineer's Seal Approved bedrooms b yO ~"-I'Lc" Disapproved Conditiona(I] Terms of Conditional Approval Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based aolel¥ 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 the professional engineer's work. Page 2 of 2 78-025 (11/84) WELL DATA Well Classification Well Log Present (Y/N) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) G~ A ~L~I~I~T - FEBRUARY 1984 ,..I ! t/~J~264-4720 ~6~ ' ~ ~J~ Legal Descripuo.: NoliD~iO~d ]VIN3WNO~ ANJl ~ HilV~H ~O 'idea ~ ~1~ If A. B, G ~.E,O. Approved (Y/N) __ D~te Oompleted Yield 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 Cleanout/Manhole Water Sample Collected by Water Sample Test Results Depth of Grouting Pumo Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead [Y/N) On Adlommg Lots . On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed n ! 1%/7 '-size NO. of Comear,mems _ [ Standpipes (Y/N) __~'-~5%'~ Air4ight Caps (Y/N) ~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well 'Z.,~,I:~I To Property Line _ ( ~ / .'"~"""' To Water Main/Service Line _ Course ~ ! ~ Date Last Purr aeo ~'.'.'.'.'.'.'.'.'.~'~'J~"~- ~ O, '~ ¢~' 'L~;Z_~_- _ Temporary ~o~alng Tank Permit (Y/N) _ To Building Foundation To Disposal Field _.'..~:J~5~_ .~..... To Stream. Pond. Lake. or Major Drainage Comments Page 1 of 2 72 026(11184) ABSORPT ON FIELD DATA Soils Rating in Absorption Strata 'Z,5'(~ Date Installed ,%~-"PT '~ ? ~:~1 "~ Width of Field Square Feet of Absorption Area / Depression over Field (Y/N) ~"~'~' Results of Last Adequacy Test ~/~'~' Separation Distance from Absorption Field: To Water-Supply Well '~-~ ( TO Building Foundation ~_,0 / Lot ¢~'~5'¢,¢n~' '~ / ~"¢o,.,.. To Water Main/Service Line I ~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ,-~,' ¢r5.~,.,,~!~ \-~,, Type of System Design Length of Field Depth of Field Gravel Bed Thickness -'~ p~,~ -~c~ Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line J To Existing or Abandoned System on 'T~ ;F'~n Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at)/ Tested for ,,/ Electrical Codes ¥t~1) Comments Dimensions nhole/Access (Y/N) "Pump Oft" Level at Vent (Y/N) ~ PC~ Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Re uest ** I certify ~ cbecke~or ;onformed to alTMOA and HAA guidelines in effect on the'date of this inspection.~ ".~.----~f~ Signed ~ ~ t-~ Date Company L.4.',-*r',,f'~.'-',---cr~..'-,L- ~ ~ No. Receipt No. ~ Date of Payment Page 2 of 2 Stephen Morrds D.H.H.S. Municipality of Anchorage 214186 Health Authority Approval/ Septic Adequacy Test Lot 21 Block 2 Sky Ranch Estates I inspected the septdc system on lot 21 on 1/29/86 and it appears as though the system has been upgraded. The original system was an absorption pit with an area of 900 sq. feet. The documents in your files suggest that the system might have been upgraded (look on the back of a letter from A.E.C.S. to Jeff Stoner dated 9/16/81). I found a cleanout over the 1000 gallon tank, one cleanout over the pit. and a third cleanout approx. 21' away from the pipe connecting the tank and pit. This would matoh the drawing in your file, which appears to be an inspection. I was requested by the owner DR.Joyce Murphy to check the adequacy of the septic system for a 2 bedroom house. I performed the adequacy test in the thdrd cleanout and found the system plenty adequate for a 2 bedroom house. '~ Should there be any questions please contact me at 345-7008 WHITEWATER ENGINEERING CONSTRUCTOR 11600 CANGE ROAD ' ANCHORAGE, ALASKA ' 99516 ' PI-I. 345-7008 ' DATE RECEIVED ME INSPECTION APPOINTMENTS TI TIME TIME DA'rE DATE DATE INSPECTOR INSPECTOR INSPECTO ~ [UNICIPAUTy OF ANCHORAGE MUNICIPALITY OF ANCHORAGE Dl:p7, OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION~NV~RoNMENTAL ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW D ~xS~x~x~U~ Jeff and Linda S~oner 345-4720 ~ BUYER PHONE __not ap~abl~ at t~ig time MAILING ~ REALTOR/AGEN'r~_ PHONE 501 W. Northern Liqhts Blvd., Anchorage, Alaska ~'. LEGAL DESCRIPTION Lot 21, Blk 2 Skyranch Estates ~,2 TREET LOCATION 11741 Shetland Heights Circle E. TYPE OF RESIDENCE NUMBER OF~BEDROOMS E] One [] Four [] Other__ ~ SINGLE FAMILY [] Two [] :ire [] MULTIPLE FAMILY LL~ Three [] Six WATER S PLY · INDIVIDUAL- * ATTACH WELL LOG. A well Icg is reuuired for all wells drilled ~- COMMUNITY since June 1975, For wells drilled prior to that date, give wel [] PUBLIC UTI LI'¥Y depth (attach Icg if available.) [] INDIVIDUAL/ON-SITE** \C~,'~L~ YEAR ON-SITE SYSTFM WAS INSTALLED. [] PUBLIC UTILITY NOTE:.: TH E INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE E~]~-SI NG LE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] ONE F~.~-TH R EE [] FIVE [] TWO [] FOUR [] SIX [] OTHER 2. WATER SUPPLY [;~"/IN DI VI DUAL [] COMMUNITY [] PUBLIC UTI LITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [~[NDIVIDUAL/ON -SITE E~] PUBLIC UTILITY Connection Verified []Septic Tank or E~]Holding Tank Size: /~x;~ If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4, DISTANCES WELL TO: Absorption Area to nearest Lot Line PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATEINSTALLED INSTALLER SOILS RATING MANUFACTURER MATERIAL Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line ,...~l~]" APPROVED FOR -"~'BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE 72-010 (Rev. 6/79) P,L^SKP, enulRorimenTAL COnTBOL SeRUICI $, IFIC. 9/16/81 RECEIVED JEFF STONER SRA BOX 1621-U ANCHORAGE AK 99507 SELLER - JEFF STONER SUBDIVISION-SKY RANCH ESTATES ~2 BLOCK-2 LOT-ZI ADEQUACY TEST FOR SEWER SYSTEM 'Ig_E TYPE OF ABSORPTION SYSTE~4 IS A PIT WITH AN AREA OF 900 SQFT. THE SYSTEM IS CAPABLE OF ACCEi~PING 300 GALLONS OF WATF2~ PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 102 GALLONS. BASED UPON THE ~ST DATA ~E SYSTEM IS NOT ACCEPTABLE FOR A HOME OF 3 BEDROOMS. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF THIS 3 BEDROOM HOUSE. 1000 IS ADEQUATE FOR 1220 LUcst 251h Auenu¢ · Anc~or~§~, Al~sb 99503 · {9o7) 276-1361 825 "[" ,% i I1[{[ I' ANCIIOI~AG;., I/',, I~,A ~Jo~ (907) '644Ill September 14, 1981 Jeff/Linda Stoner % Connie Yoshimura Dynamic Realty 501 West Northern Lights Boulevard Anchorage, Alaska 99503 Subject: Lot 21 Block 2 Sky Ranch Estates Subdivision #2 Approval for the individual sewer and water facilJ_ties cannot be granted until the following items have been completed: (1) The septic tank pumped with a recelpt submitted to this office. (2) An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A ~_isting of private firms performing the test is enclosed. This report needs to be submitted to this office for our review. If there are any further questions, please call this office at 264-4720. Sincerely, James S. Roberts Associate Environmental Specialist JSR/ljw GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received _ // Time of Inspection Date of Inspection 1. Approval requested by: Mailing Address: 2. Property Owner: 4. 5. 6. REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES Phone: ~""~~ ~~ Phone, Legal Description: ~0~/~ -'~-/ ~.~_~ _ '~ype of fac'ility to be inspecte~ ,~...,..:.,,..~~. No. of ~e~rooms .____.__.__.__.__.__.__.__..~, . / Well Data:. A'. Type ~--~.~-~-~.~/~.~ B. Deoth C. Construction ~/ D. Bacterial Analys~s 7. Sewage Disposal System: A. Installed C. Septic Tank: D. Seepage Pit: E. Disposal Field: B. Installer Size~o~. 2. Manufacturer/~~~ Absorpti on ~</rea (~90 ~ 2 2. Ma'terial Total length of lines Distances: ~ A. Well to: Septic tank , Absora~ion area Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area. C. Absorption area to nearest lot line ~ ~'~ , Sewer Lines , EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Re~ st for Approval of Individual ~ ~er & Water Facilities t, egal Description ~ I Comments Approved approved Date .//~'¢ Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the suoject sewer and water facilities and these facilities are operating satisfactorily, SIGNED Date EQ-034 (1/74) 3330 GREATER ANt, HONAGE AI.,L~, BOROUGH Department of Environmental Quality "C" St,, Anchorage, Alaska 99503 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO VA FitA CONV 2. Property Owner: . ~//d/~ ~)~/~_~ ~4c.1<%~.~2~.Z--- _ " ~:;~'; Nailing Address: ~D~%)_~ Phone Nailing Address: O~y phone 4, Name of Lending Institution: Nailing Address: ~g -~ ~ ./l(Z~/, 4~4#4~' trone 5. Name of Realtor or Agent: ~4[fs~i_~A'A6 6. Legal Description: Location: _ 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Public Utility If Individual, number of dwellings presen'~ly If Individual, depth o.i~ well ~-!, Sewage Disposal. Sys'~em l'yl~e .of S~stem: Public Utility If Individual, date of installation No. Bdrms, ~_ Individual served Individual (on-site)