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HomeMy WebLinkAboutSKY RANCH ESTATES #2 BLK 3 LT 1Sky Ranch Est. #2 Block 3 Lot 1 #015-302-06 kI\GV VJIVL/IVJ Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221302 PID Number: 015-302-06 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑I Upgrade Name David and Rita Ridge AORPTION FIELD ❑ Trench ❑ Wide Trench F1 Bed El Mound Site Address 11601 Paddock Lane Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 D/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original de Gravel depth beneath pipe Subdivision Block Lot Sky Ranch Estates #2 3 Ft. Fill added above original grade Gr I length Township Range Section Ft. Ft. Gravel width Beds: Number of Lines Dista a between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between tr ches From Tank Field Tank Line Ft2 Well >100' NA NA NA NA TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water >100' NA NA NA green 1250 Gal, Material Number of compartments Lot Line >5' NA NA NA NA plastic 2 Foundation >10' NA NA NA L TATION Manufacturer Capacity Remarks Gal. Alarm location Elects tailed by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield JRs septic Drainfield CO/MT3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspdectes:ion is' 8/22/2022 Location and description 3'° zea 4"' bottom siding near point B ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp -4F.At Conditional Approval: Date .q�1� .. ............... urns L,... +t� �F•. Dee c L1 427v Septic System / Approve Date IZZ2 "Z` +tgslF�`►yo.c .. 0" l� �PROFESSI��4 Note: this approval does not include well permit requirements. kI\GV VJIVL/IVJ .\ � WATER WELL 1S-/ \ DO' 10 \UTILITY FASEkJFNT \ FROW PROPERTY '/ � | / ` QF lpL��ED NE� v.25U Q�LL�m T�0-COWP�RT@EmT FROW FOUND4110M AND T�m� AB�ORP�ON STE� YSTANK �AS P�DNDED vwT* A M|N|v,UM 2O^ D|A R|3ER SERWN� THE RRST CDWPRTGEwr < | '/ \ I �L� CON�TRU�T|ON w�� /m _ccnnn�mr' vmr� ___��'~- -� . AL� REDU!RBWENTS |N �NCHORA�E / wUn|C|PAL CODE CAPTERS X- / ^ / i T DRIVEWAY �— �'�� LL { '.--- ------------ /| � | / ~ / , | DICK / j/ / / | / / / | / 4 BR HOmE ~--- 5LOPE )6% � \ ` SUMP ---------����-^--~--. -___ ./ DCO EFFECTIVE DEPTH TRENCH co | Lot 2 SERVED BY PUBLIC WATER SYSTEM | | | ScpUc Took Reco*/ D, vi^n Prepared for DAVID AND R|TA RIDGE 11601 Paddock Lane Anchorage, Alaska 99516 SKY RANCH ESTATES #2 BLOCK 3 [OT 1 OSP2213O2 EKLUTNA ENGINEERING, LLC DATE: 8/30/2022 PID: 015-302-06 SHEET 2 OF 3 SzHED 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 Permit Number: OSP221302 Work Type: SepticTank Upgrade Tax Code Number: 01530206000 Site Legal Address: SKY RANCH ESTATES #2 BLK 3 LT 1 G:2737 Site Mailing Address: 11601 PADDOCK LN, Anchorage Owner: RIDGE DAVID P & RITA R Design Engineer: EKLUTNA ENGINEERING, LLC' This permit is for the construction of: ❑ Disposal Field R] Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date Lot Size in Sq Ft Total Bedrooms: r o, S' v Department 8/12/2022 8/12/2023 18125 ❑ Private 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. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received B� Issued By: Date: Z Z Z Date: �Z Z 4 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 01530206000 Property owner(s) RIDGE DAVID & RITA Day phone Mailing address 11601 PADDOCK LN ANCHORAGE, AK 99516 Site address 11601 PADDOCK LN ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) SKY RANCH ESTATES #2 BLK 3 LT 1 Legal description (Township, Range & Section) Lot Size 18,125 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field F] Initial 1:1 Single Famil ) Q (w w A U) Septic Tank El Upgrade X Duplex (D) El Holding Tank El Renewal El Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property wrier or authorized agent) Permit/Rush Fees: 02 5 Date of Payment: Ti,;,) 0.2 Receipt Number: dy/ g/6 Permit No. OS P)a1 SO a 1-y/2,0 2 E_ Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\FormsUient FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221302, Deb Wockenfuss, 08/12/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221302, Deb Wockenfuss, 08/12/22 Ar 272008 ;6a A-yerciage'flel& -:.:rnp Sot 90724'30742 r, Pump Installation Log Well Drilling Permit Number; S�'W'___._.__. Date of Issue: Parcel Identetrciation Numher: .Ll .L_[5 " 302- O �, Legal Description Properh, Owner NsrqiL4, Address: ��z=-�-........,«.�...-......_<a�s:�-: �.--�n:rr----a�-sx...r�. =__�r� ---_ � _• :=_M.____"=.._. —-__-�.rtx...--crrn�:acsvuurrtr I'Mcap InAR1121tiora late' 3''etmp Intake Orptn BOOM Top 01 "ell C2Sin„: � ) ieLt Pump I ode]: PURIlx Size hp Pitless Adapter Burhi) Depth: � �' ta�Cr I'itless Adapter Nfartufaeturer's Name: Pitless Adapter lnsta)ler: Well Disinfected Upon .'tiu Method �)f Disinfection- Comments: Pump Insu ler Name: Altkntfow `Phe 7umip iastatler ;Nall rroa•ide a io the. DSD within 30 dat;s of insrallatixn. i a,a��'iw��i ilFir n�i� �Ci+`i��l LZr�� slur 4:•!n�i,'�rt �y''+'l��•y� Cdr' ��.• 1+ 7i..1i ,,P� d.. n�(7�.� .°�, i�,�{ar ....... V y k u 4."00 Emiorr2 S+ocd y i6k OFA P. s .- > r vim' ,tisarr� Ci:�grl� �y'.'1C''tyri��L"", =:.iti .-,�•�r� Pump Installation Log Well Drilling Permit Number; S�'W'___._.__. Date of Issue: Parcel Identetrciation Numher: .Ll .L_[5 " 302- O �, Legal Description Properh, Owner NsrqiL4, Address: ��z=-�-........,«.�...-......_<a�s:�-: �.--�n:rr----a�-sx...r�. =__�r� ---_ � _• :=_M.____"=.._. —-__-�.rtx...--crrn�:acsvuurrtr I'Mcap InAR1121tiora late' 3''etmp Intake Orptn BOOM Top 01 "ell C2Sin„: � ) ieLt Pump I ode]: PURIlx Size hp Pitless Adapter Burhi) Depth: � �' ta�Cr I'itless Adapter Nfartufaeturer's Name: Pitless Adapter lnsta)ler: Well Disinfected Upon .'tiu Method �)f Disinfection- Comments: Pump Insu ler Name: Altkntfow `Phe 7umip iastatler ;Nall rroa•ide a io the. DSD within 30 dat;s of insrallatixn. �.tr ..... A IP G �� .. MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL. SYSTEM AND/OR WELL INSPECTION REPORT NAME IPHONE I 41NEW C3UPGRADE rJ MAILING ADDREfS(S j / 11-_L�C.� — LEGAL DESCRIPTION LOCATION � p 0CiIL 4 t�kt NO. OF BEDROOMS `f _ We c �p �/ Absorption arga Dwelling DISTANCE TO :=- G7,.X(Jl ,a— _ PERMIT NO. . Z10 LI Y Manufacturer MaLEli; /� No. of camper cots r, n„ �L u2 ul F- h Width—"' — LiqcaffaeirtyIF HOMEMADE: � ,in ya Ions Inside le ti�l./ f d-rJ� Liquid depth Well Dwelling ❑_102 DISTANCE TO; 1_ PERM11" NO. Z .1 _ Material Liquid in 2 N Manufacturer}-- capacity gallons ❑ wjo v^ DISTANCE TO: Well � , , Foundation 4- Nearest lot line PERMIT NO. .- _. V J LL Z z w No. of li a Length of each I' n e/ "fatal length of line Trench width q-- inches Distance betwegn Ijrigs f I It'l� ❑ Top of file to finish grade -,. L �� Material beneath file Qinches Total effective abs0", fir® /� Lengtho Width Depth PERMIT NO. ua c� a N wa Type of crib Crib diameter Crib depth Total effective absorption area w w DISTANCE TO: Well Building foundation Nearest lot line Depth Wt+ Driller Distance to lot line PERMIT N /i J w Building foundation TO: Sewer line Septict ( w - r AbsoTrption area(s) •O UDISTANCE t OTHER PIPE MATERIALS SOIL TEST RATI NG INSTALLER REMARKS -IP3w m - _ f= -EllI APPROV� DATE LEGAL 72013 IRev. 3 781 Lf ( j DEPARTMENT ( HEALTH AND ENVIRONMENTAL OTECTIOI'd r d 825 `I_' STREET, ANCHORAGE: FTI:. 99bul- � 14En'"rN__L _ F"0C3 Jr -4 e I -VE-E. _:FE14F.EF? F" FF FlT'"I T:.T... PERMIT NO, ( 780455 ) 1)I1 fC�6lo APPLICANT COWDERY EXCAVATING 8120 LAKE OTIS PKWY. 243-5695 � LOCATION PADDOCK LANE LEGAL. L I B 3 SKYRANL":H ESTATES 4E:'. LOT SIZE 18125 S6lLq-IRF. FEET' TYPE OF SOIL. ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOM$ = & =OIL RATING (50 FT/BR)= 1.50 THE REQUIRED SIZE OF THE SOIL. ABSORPTION SYSTEM IS: :: F. g' -Fu W.__ C: F' -•W C -i -lF Fi == Ate_" A. r,. -a f=C f=l r_,�- t_ �� I B =' P.' W Y =:: ^.; THE LENGTH DIMENSION IS THE LENGTH (:IN FEET) OF THE TRENCH OR DRAINFIEL.D. THE DEPTH OF A TRENCH OR PIT IS THE DISThIhA.".•E BETWEEN THE:: SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION 0N N FEET ). THERE 15 NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH 15 THE MINIMUM DEPTH OF GRAVEL. BETWEEN THE OUTFAL.L.. PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F,; A -F N.,.N :F IE :. W_.e Y= F T F 1 v F F 1 M F F T f : F_. '• + I: A. n N =0 W_ .._ F .... ICA PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS; PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL. WILL SERVE, _._.....�_ i-IE>dC_A Ir .8 :F. F A oW ="FE1 - f T B=AF's'_. F-IYZF' B,= IE(AWJ .W. FREE[> BACKFILLING OF ANY SYSTEM WITHOUT FINAL I:NSPE:C TION AND APPR.OVAL.. BY THIS: DEPARTMENT WILL BE 'SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL. AND ANY ON-SITE SEWAGE:: DISPOSAL SYSTEM Is 100 FEET FOR A PRIVATE WELL, OR 150 TO 200 FEET FROM A PUBLIC HELL, DEPENDING UPON THE TYPE: OF PUBLIC WELL... WEL_L.. LOTS ARE REQUIRED AND MIST BE. RETURNED TO THE: DEPARTMENT WITHIN 30 DAYS OF THE HELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS FIND CONSTRUCTION DIAGRAMS HESE:: AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAI' 1.: I AM FAMILIAR WITH THE REQUIREMENT'S FOR ON-SITE SEWERS AND WELLS 05 SET FORTH BY THE: MUNICIPALITY OF ANCHORAGE. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE: CODES. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE: MORE THAN 4 BEDROOM_. SIGNED ISSUED wo_ ___.__.____...._ ._...... FEP'LI[:AtdT P�_.OdG Y EXjAVATl G N 4 SOILS LOG *_w0)MUNICIPALITY OF ANCHORAGE PERCOLATION DEPARTMENTOF HEALTH AND ENVIRONMENTAL PROTECTION ❑ TEST Pouch 6650, Anchorage, Alaska 99502 2762221 SOILS LOG - PERCOLATION TEST PERFORMED FOR: I �I, C'A P ll r\ I DATE PERFORMED: / LEGAL DESCRIPTION: %, I 1. �� �> I� ��-�i\1C.1,I SLOPE SITE PLAN 17 - 18- 19- 20 DEPTH Gross Time Net Time (FEET) Net Drop i r- 1, i I - 2- 3 4 1 5 o 7 8- 9- 10 11 - 12 13.- 14 -- 16 -1- - PERFORMED 72-008 (7/76) C :- WAS GROUND WATER S ENCOUNTERED? rc U L O P E IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time I Net Drop i r- 1, i I - WAS GROUND WATER S ENCOUNTERED? rc U L O P E IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN CERTIFIED BY: (minutes/inch) FT AND --- FT DATE: WELL CONSTRUCTION LOG Drilling Co.._ V / N ri __, USCS no. ---- Driller�nAN _,,e_Type of rig,..(I La2'V /i/ Y Date viol completed Zfl — 75' v / Well owns r_(Z,r '//� It -7 / Neatest community _ Well l are t ii air,:, ,(address �& legal descripl ion)�_r�zr / l7 �oC�� Location sketch or remarks ---- L5 MUNICIPALITY OF ANCHORAGE Depth of well a Q J it. Casing: depth_, 1/,6�__ft. diem. _4_�_ j n. DEPT. OF RSALTH& //—/Y Static water level�� J/ it. (above, below) land surface. Date J—/ 7� ENVIRONMENT,'1 ;-,, f[CTION- � Finish of well: (6op, eo-ems screen, perforated, open -hole, other) _ JAN 9 1979 Describe intervals and size: _--- —�_. RECEIVED Well yield tested by (pumping, bailing, air) al_ -10 —go l/min. far .hours wilhIQ —ft. of drawdown from static level. DRI LLER'S MATERIAL LOG Depth below land surface in feet Give description of strata penetrated (size of material, color, hardness of drilling, and water content) t o v � , S /f N c1 I /I v. /f -- -- _;'?Z— t o L0 0 S/ N�� I I A V 5� A) C/ (�_IA .froW ti /,v CC /0 — -- 10 ca J I5 to 60 50.to ZCato o7DJ� —t a- �jz/LILCr_c Pv /N Cc/ar — �r+dN/ sr/% r_YN Ai- 1(J�Te- rY _j/<(i`U�(°Y o - —t --t --t o— ------ o --t —t o ---- ---- —— —1 o ---- t o -- t o -- — -- --to -- to— o—to -- to -- --- a- —t --t----- -- — 10 RJ FwP X Cl JE F I L. X "I- kw' C3 1:7 Fl PA C� U I k & Fl CA E-] DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 /L' STREET/ ANCHORAGE, HK. 99501 264-4720 b I.. & K���� PERMIT NO. ( 781048 ) APPLICANT RILL COWDERY 8020 LK DTIS PKWY 344 2407 LOCATION OFF BIRCH LEGRL 1_1 B7 SKYRRNCH EST S/D LOT SIZE 43000 SQUARE FEET MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL/ OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPORTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. Fm&l?V13Ll- 20J.' ���SE.". I CERTIFY THAT i: l RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. SIGNEI) CANT GI Parcel I.D. 015-302-06 8 Municipality of Anch®rmag On -Site Water and Wastewater Prograa( 90 fl �7 j 1 (907)343-7904 r. Certificate of On -Site Systems ApprovaT�!' _8 4 1. GENERAL INFORMATION Expiration Date: 1 - 2(� —Ij Complete legal description Sky Ranch Estates No. 2, Block 3, Lot 1 Location (site address) 11601 Paddock Lane Anchorage, AK 99516 Current PrOPertv owner(s) Dennis Albert Dav phone Mailing address Real Estate Agent P.O. Box 90602 Anchorage, AK 99509 2. TYPE OF DWELLING: F] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual 7 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by: Date: /04 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ S2- 6.0 0 Date of Payment /D — 2-/ —Al� Receipt Number COSA# 05C Waiver Fee $ 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,yveter 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. Name of Firm Anderson Engineering Phone Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. D�IGNATURE System #1 Approved for _Y_ bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, 522-7773 Date 10/21/2016 - iIUCHA.EE�E.>-ANDERSON � F CIE -4381 92,1 with the following stipulations: By: Original Certificate Date: 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet C c If more than 1 septic system is on the lot: COSA Checklist # of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Sky Ranch Estates #2, Block 3, Lot 1 i:A4TGYA0H_11111011 Well type Private If A, B, or C provide PWSID # Date completed 11/16/78 Sanitary seal (YIN) Y Total depth 205 ft. Cased to 205 ft. FROM WELL LOG Date of test 11/16/78 Static water level 140 ft. Well production 20 g.p.m. WATER SAMPLE RESULTS Coliform 0 colonies/100 mL Nitrate Zy/ mg/L Arsenic N 6 ug/L Date of sample: 9/26/16 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,250 gal. Parcel ID: 015-302-16 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) >12 in. AT INSPECTION 8/26/16 139 ft. 5.1 g.p.m. Collected by: And.' Engineering Date installed 9/7/78 Number'of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 7/14/16 Pumper McDonald's Pumping Service C. ABSORPTION FIELD DATA Date installed 9/7/78 Soil rating (g.p.d./ft2 or ftz/bdrm) 150 SF/BDRM System type Deep Trench Length 74 ft. Width 3 ft. Gravel below pipe 5 ft. Total depth 9 . ft. Eff. absorption area 740 ft Monitoring tube Y Depression over field N Date of adequacy test 8/26/16 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 45.5 in. Water added 680 gal. New depth 46 in. Elapsed Time: 120 min. Final fluid depth 45'5 in. Absorption rate >= 600 g p d Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off' level at Cycles tested Manhole/Access (Y/N) in. High water alarm level at Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >100' On adjacent lots >100' Absorption field on lot >100' On adjacent lots >100' Public sewer main >75 Public sewer manhole/cleanout >100' Sewer /septic service line >25 Holding tank >75 Animal containment areas >50 Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: r Building foundation >5' Property line � 5' Absorption field � ' Water main >10 Water service line 0 Surface water Wells on adjacent lots >1'00' ABSORPTION FIELD ON LOT TO: 1 � 0' X10 � ' Property line Building foundation Water main >10' � 00 � 10' Water Service line Surface water Driveway, parking/vehicle storage Curtain drain None Noted Wells on adjacent lots >100' in. F. COMMENTS Septic Tank and Absorption Trench are more than 37 years old and may be nearing the end of their useful lives. G. ENGINEER'S CERTIFICATION / 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. Engineer's Printed Name Michael E. Anderson, P.E. Date 9/29/2016 COSA brown sheet 10-10-12.doc OF A/ tl C °.MICHAEL CE E43t3 UISOM ®$4 Z PROFESS\q 01 G�a�as?o VI �I EAST KLATT ROAD THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALL Y TO SHOWANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES EASEMENTS OF RECORD, OTHER THAN THOSEAPPEARING ON THERECORD PLAT, ARE NOT SHOWN HEREON (UNLESS INDICATED) NOTE FENCELINES THAT MAYAPPEAR ON THIS DRAWING ARE NOT TD BE USED TO DEERMNE PROPERTY LINES OR POSITIONADDITIONAL IMPROVEMENTS ANY PAVING SHOWN HEREON MAY HEAPPROXIMA TE DUE TO EXCESSIVE SNOW AND/OR ICE AS-BU/L T SURVEY 1"=30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 1, BLOCK 3, SKY RANCH ESTATES UNIT 2 ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS _26 TH DAY OF _AUGUST , 2022 HOT T LAND SURVEYING 9309GROVER DRIVE ANCHORAGE,AK 99507 345-5513 375QGCT NET EAST KLA TT ROAD THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS. AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. A5 -BUILT SURVEY 1" =30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 1, BLOCK 3, SKY RANCH ESTATES UNIT 2 ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS ZOTH DAY OF SEPTEMBER . 2016. HOLTLANO SURVEYING 9309 GROVER DRIVE ANCHORAGE.AK 99507 345-5513 G,m MLINICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES y / Division of Environmental Services On -Site Services Section 1�e" - P.O. Box 196650 Anchorage, Alaska 99519-6650iEh 343-4744 CERTIFICATE: OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# oIS- 302-0{0 HAA#'h cC r )r, S?> 1. GENERAL INFORMATION Complete legal description S eg ia, Es4nks -7t Z %33f L 1 Location (site address or directions) /16D/ 'Oaddo"l_ C{rtic Property owner 1 oiala' 7o Day phone Mailing address NaO( Pud4ctf taet,r Lu_IAK 2? -260 1 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, MAA will be held for pickup. 2. NUMBER OF BEDROOMS: r �' 3. TYPE OF WATER SUPPLY: Individual well _x 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: Individual on-site —K_ 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. 72-025 troy. V81) Front MOA 1127 - _ 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 KNO Phone ro9LLII Address 2-()W( P'ww✓hr7W ^ RIVFF . 15 44 XW' 4,1- 95'5'7 7 Engineer's signature 6. DHHS SIGNATURE Approved for 1 OU2- bedrooms. Disapproved. Conditional approval for Additional Comments M WTIC Date bedrooms, with the following stipulations: Date /.Z9, ZB, 7 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 DH HS 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(Ray.1M) Beck MOA021 RECEIVED JAN 26 1999 Municipality of Anchorage uNICIPALITY of ANC DEPAFITMENT OF HEALTH & HUMAN SERVIC41RCINMEWALSERVICE *0 - Environmental Services Division 8215 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: S_y gantk Esr 3 #t 2 7?3 I _: Parcel l.D.:_W S � 3 02Z" ©lam A. WELL DATA Well type —ILIA If A, 13, or C, attach ADEC letter. ADEC water system number Log present (Y/N) —_ Date completed 11-16-76_ _ Total depth _ 2- 05Cased to _ 2 0 S Casing height (above ground) Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test 11 "- 12 - 7Y _ /op "a `� - 9 0 _ Static water level _ y0 r _ /Vo Well production -9 -P.M. _ 8 3---g.P.M. WATER SAMPLE RESULTS: Coliform _ d __—_ Nitrate _ �. 3 1! Other bacteria 0 Date of sample: _I a _aS --_ Collected by: /CND B. SEPTIC/HOLDING TANK DATA Date installed Dq` 07 - 76_ Tank sizeza s0 Number of Compartments —2 _ Cleanouts (Y/N)_�_ Foundation cleanout (Y/N) ---)LDepression (Y/N) —N— High water alarm (Y/N) Date of Pumping-�05 - -Pumper v��c!n, r st/V C. ABSORPTION FIELD DATA J Date installed 09-0 1- 76 _ Soil rating (g,pAdft2 o z/bdr _ f S� _ System type _ 17P�,a /ztie-A Length7 c/ Width -3 —_Gravel thickness below pipe ___ Total depth _� Effective absorption area __J�O f Monitoring Tube present (/Y�/N,)__ Depression over field (Y/N) Date of adequacy test _ Loi •��� Results (Pass/Fall) _�fS —For- '___bedrooms rI _ u Fluid depth in absorption field before test (in.); _ Immediately after/34D gal. water added (in.): d _ Fluid depth �Y 1!— (ins) Minutes later:_ O Absorption rate =._LaO + _g.p.d. Peroxide treatment (past 12 months) (Y/N) _ Al — If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES "Pump on" *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /1-114 �� Absorption field on lot Public sewer main /Oo r,- Sewer /septic service line 2 S Size in gallons On adjacent lots On adjacent lots "Pump off" level at* Public sewer manhole/cleanout /0 a I-/- Lift rLift station pA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation /e /4- Property line /0 Absorption field Water main/service line 2 S + Surface water/drainage /190 r� Wells on adjacent lots /Oo rr SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /0 4- Building foundation I , Water main/service line 2 f Surface water /00 Driveway, parking/vehicle storage area Curtain drain /O° r -IL F. ENGINEER'S CERTIFICATION Wells Wells on adjacent lots /06 "- I certify that l have determined thru field inspections and review of Municipal in conformance with MOA HAA guidelines in effect on this date. Signature / // Engineer's Name � Date HAA Fee 2— q Date of Payment ReceiptNumber 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 2 '- -t- are