No preview available
HomeMy WebLinkAboutSKY HARBOR ESTATES #1 LT 2 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 MAILING ADDRESS PFIONE J~NEW Z? 7-o l?q E U. RADE LEGAL DESCRIPTION LOCATION DISTANCE TO: Absorption area Liq. apacity in DISTANE Inside length IF HOMEMADE: ~. Well DISTANCE TO: No. of lines Top of ti)e to finish Length of e; ch I~e Type of crib ;rib diameter Well TO: Class Building DISTANCE TO: Material No. ~ompartments Width Liquid depth Foundation ~.~¢..~ / i ~_,~,. ,/ Total length~'~ CJ,°f lines~, Trench widtl~)/ inches Material beneath tile '7 Z 1~ Depth Crib depth Driller PERMIT NO. Liquid ~a.~y in gallons PERMIT NO. Distance between lines Total effective absor PERMIT NO. Nearest lot line ~pt line PERMIT NO. f~,,~. ~. Ot,~~ () OTHER MATERIALS SOl L T'~'T R,~-TI N G REMARKS APP~OVED~/ ( ' .DATE 72-013 {Rev. 3/78) ]i!il::U'l :t: 'T NC)x ,'.:~'FF:' :!: S!!i~L,JI!i!:i:) 11600 ¢,4NGE ANCHORAGE, AN. (907) SOILS LOG PERCOLATION TEST SOILS LOG - PERCOLATION TEST PERFORMED FOR:_ LEGAL DESCRIPTION:. 7_. SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 2O COMMENTS THC A. FIS¢?ER Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) FF PER FORMED BY:.' ,~/~'¢,',~,__. ~'~ CERTIFI ED BY:__ DATE: LOCATION OF WELL (Plee~e C'omplele either Io, lb or lc.) 00 rough ~ ~b.~ i v i/~/o/n~f ~ ~. '~/4 q t r I, DISTANCE ANO OlRECTION FROM ~OAD INT[BSECTIONS ~ Sit,gl Addtesl and Areo of Well Locaflon ~ I~ ~ 2. WELL LOG Feel Below Mol°riel Type 'Top WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological 8, Geophysical Surveys Drilling Permfl No. A.D.L. No. Seclion No. TownaMp N~] Range E~ Meridian sE] W0 8oltom 3. OWNER OF WELL: 4. WELL DEPTH: (final) ~COMPLETION 6. [] Cable tOOl ~]"OtOry 0 Driven [] Dug E/Aug,, O~e,led F~ Bo,.d [] o,,,,: ?.USE:~Dom.,i,o OPub.¢S.pp,~ []l.du.l,y [] Te,t Well [] Olher; " 9. FINISH OF WELL: '10. STATIC WATER LEVEL:_ ~ .~ ff. [] Above or [] B~lOW land lurfece Dote . fl, oiler . hrs. pumplng_..~.'.~ g,p.m. IE.GROUTING Well Grouled: [] Yel r~ Ho Material: [] Ne~t Cement [] OIh0r: ...... D~. He___alth & Human 16. WATER WELL CONTRACTOR'S CERTIFICATION: Form O~'WWR (11/81) 15. Wafer Temperalure . .o [] F [] C This well w°~ dr/lied under my ju¢isdlcllon and Ibis report Is Irue lo fhe besl of my knowJedge and belief; Registered Business Nor~e -- Controc/ LIconso Number ,ur ~ Dote; Copy DislributlOn/ WHITE'SlofO OGGS, PINK-Driller, CANARY'Cuslomer I?ebcuacv 16, 1984 Mr., Edv~ar.d Mack '.iTecLonica, Inc, P.O, Box 4~2265 Anchoraqe, Al< 99509 Doa~ Mr We ace holding three of your as-q)uilts for in~;tal.].ation;~ due to omia,~)iona on the diagrams. ?l'm three are: ].) 2) .3) Lot 2 Sky itarbor Estatt)s - no cloanouts shown Lot 15 Block 2 ,Souchpark #1 - nc) cleanouts :.~hown Lof 2 Block 8 Prospect Tteights improper l~ .:talla't. lon; no cleanouts shot.ln Please contact us as soon as pos;;ible to resolve, these S J nr,erel y, Suf3an E o O;3walt Enginoecin9 ?eob IIi SO2/p/r)9 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # L~l~ - ~k~ - ~°1 HAA# GENERAL INFORMATION Complete legal description Location (site address or directions) tt. S41 ¢~--,¢-- ¢LbA-D Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent Address Day phone t Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: '~ "~ TYPE OF WATER SUPPLY: Individual well Community well Public water RECEIVED NOV 2 2 1993 Municipality of Anchora. Dept. Heallh & Human Ser~/gicees NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 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. 72-025 (Rev. 1/91) Fronl MOA ~121 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/orwastewaterdisposalsystem is safe, functional and adequate for the number of bedrooms and typeofstructureindicated herein. I furtherverifythatbasedontheinformationobtainedfrom 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 ~) Address ~.o, Engineer's signature Approved for --~¢¢_~.(.~//4 bedrooms. Disapproved. Conditional approval for DHHS SIGNATURE 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 errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA ~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L ,~. ~F--.¥ J'~C~:)/2---[-E~T-ATE % 5u$Parc~lI.D. A. Well Data Well type I ¢op, v~ ~u ~ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ~%~ Date completed '~q-~5(~) Driller Total depth l arC~ (~ Cased to 1~o ~ ~ Casing height Sanitary seal (Y/N) y,~ q (D , ~ w~res properly protect'ed (Y/N) Sewer service line FROM WELL LOG AT INSPECTION Date of test ~-t~-15~ ~ I I-l~-q ~(E) Static water level ~' ® 7 ~. ~ ® Well flow [ % ~ g.p.m. 7r 5 ~ Pumplevell ~%u~ [o' ~ov~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot t SZ. ~ ' ~ ; On adjacent lots t ~O* Absorption field on Iot t~ ~, ~ ~ .; On adjacent lots [ ~0 Public sewer main ~/~ Public sewer manhole/cleanout ~0'~ ~ Petroleum tank O~ ~o~c~ WATER SAMPLE RESULTS: Coliform ~ (~) Nitrate d_P. I (~ Other bacteria 0 (~ Date of sample: I1~ It~-~ ;5 ~ Collected by: t'A ~.¢-. ~. 6~--( cK.~o,-J (D B. SEPTIC/HOLDING TANK DATA Date installed ~-¢-~ ~ Cleanouts (Y/N) Y~;% © High water alarm (Y/N) ¢/~, Date of pumping Tank size I'z.%c'~-~ Compartments 2-¢ Foundation cleanout (Y/N) ¥¢_% G) Depression (Y/N) r40 6) Alarm tested (Y/N) ¢/,~, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I~'z, I Cb On adjacent lots 150' + © To property line I~' © Absorption field ~%.-3 ' © Surface water/drainage ¢ ~.~ i~ (D n',-E~,Sv,~O¢ / o65EA.Vr~ 65- DR I Foundation ~ ¢. Water ~/service line CONTINUED ON BACK PAGE C, LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Manufacturer ~ Manhole/Access (Y/N) '-- ''Pump on" level at "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 Date installed (~- <~- P~ Length ~'c,' (~ Total absorption area Date of adequacy test Soil rating (GPD/FF) Width 3C," ~ Gravel thickness ~(.,o ~-~ (~) Cleanout present (Y/N) i\_ ~q~.o~ ~ ,(D Results(pass/fail) it - I" F~?~-, ~¢' ~ Ct?g Aftertest System type TC-45,Jc~ Total depth ~ '-~" (~ Depression over field (Y/N) ~o for Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) (..~4~cr.¢- t~,C~-T¢-.~O ~'-x:~¢~©lf yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot tq cc, ff~' ~ On adjacent lots [¢bO,-~ (Z) Properly line To building foundation 5 ~' .'~ ' ~ To existing or abandoned system on lot On adjacent lots [ 5o' ~ © Cutbank ~o¢¢~ d~ ~/service line Surface water ~ o,--,~ Driveway, parking/vehicle storage area Curtain drain ¢/~. E, ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in date of this inspect/on. Engineer's Name [:)ate H~ Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3,'93)* Back ? MMERCIALTESTING & ENGINEERING CO. IltlONMENTAL L,%EIORATOFIY SI~RVICI~ Chemlab R~f,f Client Semple ID ~2 SKY ~BOR E~TATF~5 ~IR~T ~WATER ,'~J33 B ~TREET Client Nam~ :D It I CONSULTIN~ ENGINEERS WORK Order :73302 Ordered By :CARL Report Complete~ P~oJect Nsm~ ~ Collected :11/~6/93 @ 14~15 hfs Pro~ect~ ~ ~eceived :1i/[~/93 ~ 16~10 hfs :UA Tec~te~]. Director~S.TIQ~lEN C, EDE,, S8m~le Relma[-ks: ROUTINw- B~MP[~ COLLECT~I) BY: M. ERICKBON. Q(j Allowable E~t. Arml Parameter Results 0%~1 [],tits Method Limits Date Date Init N~frate-N 0.10 U m~/L EPA 353,2/300~0 10 11/17 LLH See Special InStructions above UA -- unaw~lable See ~mple Remarks Above N~ = Not Analyzed Undetected, Reported value J~ the ~ractical quantificati~ ],lmif. [.T = Less 11r~an Secor~arF di.hltion. GT m ~reater Than ENVIHONM~H~AL ~]ERVICES IN ALASKA, CO{.GFIADO, UTAtl, ILLINOtg, OHIO, MARYLAND, WEgT VIRGINIA. N~W JERSEY..gOt;TH CAROLINA DE0-16-93 TtlU 14:25 [NYESIOR LORN PRODUOTION FhX ~0, 9072653094 P, 03 8KETCH ADDENDUM c~_.~___ Anchef~aqP.~C~J.~n~ 028 sa~ AK ~,,,~- FimiNationalBa~k o! Ahcbqr&qe P q. Box1~720 ^n~]., AK 99~t8-O720 51~.O' 6.5' ~ath Laz~e C~t~ I Sketch Calcul~lions ~L~,uti~n ~DimenMon -'~Area ~'~ 1/2 x 2.0' x 1J]' 1.0 x lO.O' 90,0 15.0' × 6,0' 90.0 36.0' x 50,0' 1800,0 Area 2008.0 46.0' H~n§er/Garai~e DEC-lO-93 ?HU I4:24 [NVES?OR [.O~N PRODUO?[ON Ffi× NO. 9072653094 P, 02 J Alaska Home Value 8~I "N" St, Suite ~03 Anch., AK 99501 258..4300 Lot g Sky H~or Est~te~ ~ivision lm Addition T~ ID No. 015-~72-~ o~ 2,565.69 T~Ye~ 1993 HOA~o. 25 ~Le~U P~y~, PF~DOMINANT Vamml (~%) [] , To: SIQW Snp e 300 H~h 1 5 v~, ~ 250 10 ~.~.~ Fq F;~-I. ~. ~e area is buil[_~[~.~h ~tam mullHeve[ b~es wi~ i~e_~mS.e.~ ~iC81_ ~fs subdiv~ion has and aimtdp, one of fha ~o private aimtrips in ~h~,_wh~h is m~ a~[. Conside~[~p~ne ~n~shi~ .... ~n~L~(~9~. ~ubhj~ Iols do h~ve a go~ m~et ~o s~ll air.aft ~nem. A la~e lr~vol pit is te lhe west, prmo~}~ 100.0 X 195,0 T~y Basicall~ level Si[.~ra 0.45 Acres / 19500 Sr4Ft _ iZ~g C~If~m~ R-6(L_aZgg~L,9.t:.~uburban Dim) HIGHF~T & ~ USE', Pn~m U~ Yes !UTILITIES Publi~ O~h0r .._Omar U~ No o~ Gravel ~ ~ ~k None ~ ~ ~.~ ~hts None ~ ~ s~ ~yerage for area sha~ Rectan~q utar on,~c~ Appe~s ~equ~te ww Good Grovel-snow ~vered [~AT~ 020005 ~60B~one C iOOMMENT~ (Apl~mnt s4wrse e~am,m~ ono~'OL~¢hm~.~L% ~0¢al ~,'-se~rmmt~, ~ride me~, elc.)~, The lei is smaller ti'lOll iyJ;>Jc~J for R-6 zonln~]r but, thi~ PUD ofler~ addilional c~mmon land & a aimt~ip to ~.~uro onougl~ sop_ar~tion of p_tj_v~te_~[!§,.&~.~.eptic systems, The lot is m west oi' the emtrip~ G~__viav~ to the w6~t are prevalent. A gravel pit f~ te the west of c..L~.~q~ RoAd. No other cortditie ns_ Wood/Avg~ LT]F] [] ~9 ~'1 None ~ 0 ~A~on~ ~,mu,e~; Improvemont Features: Compumat, ~ustom w~ndow~, v~u~o~ cei~in~h~out ~t] of Level 2, I~r~e kitchen ~ b~,~th ~ t~, e~ra cg~om winda~, la~, b~y wind~ir~ for ~ereo, rD~h in. ~-~-AIR in ~o~ ~i[t in ~ 8e'~k, 2~te fa~9~Ob~e~er in ~ster¢~sau~, a~'d s~a At.and waleb softener. L~rge c~~ ~[/ga~e, ~o eu~e~r ~ilder u~2 la~] bea~ to ~ui~ thp_h~.~, Tl~e h~nger ha~ce~ for ~l.airpl~e~.that cou~ lan~ at ~ ~s~p ~h 1 O' ~rg~ s 1~ ~ilingu, The hoCn~s in sv~ge ~ndi~on for a~ ~ h~wr h~s a p~!aI~ finishe~ ~5. b~W~una, drai~ a s~nk. ai~',mlt py[[~bCn~yill in bell foE,~jrcrMt repair. ~ ~j~et h~9 ox~leneln~ mlat~el[Stab[e pd~ ~e [~ few yeam..._~be $180,000+ prbe r~e.~_¢~en~ mo¢~ ~ctivity ~ I~n9a & sales'.' Bol~ 81 ~,~o pr[~ ra~o is rol~we~y si~O~wilh tho Iow~ fnte~t rates h~pin~ 1 s1 ~ ~o~-bu~em. Mid ~ prl~ ra.~'~are ex~__~eriencin .... ~st of the new ~ons~Ctio~, IViUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTIO!~ DIVISION OF ENVIRONMENTAL HEALTH \~:'~ ('~(~D-' CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION (a) Application Date Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ~. ~'-'r' % ¢ t("~'~/'-//,?~'~-~¢.~. ~.~..~.-<~ / (b) Applicant Name~ ~ ~_~,~ _ Telephone: Home ~77 --Off ?~ Business Applicant Address ~Sd-I , (c) Applicant is (check one): LendingJpstitution ~; O~ner/builCe¢~Buver ~. Other ~ (explain); (d, Lending Institution ~!¢,%. ¢,'~', ;-' ,~, _Telephone ~*}¢¢ - (e) Real Estate Company and Agent __ ~ ' Address t Telephone (f) Mail th~, HAA to the following address: TYPE OF RESIDENCE Single-Family~:2 Multi-Family [] Number of Bldrooms ~.~ 4. SEWAGE DI Onsit,~,~ Note: If corn attesting to Page 1 of 2 Other WATER SUPPLY well~ Community [] Public [] Individual Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to ti' legality and status. ~OSAL ublic E] Community [] Holding Tank [] unity well system, must have written confirmation from the State Department of Environmental Conservation 9 legality and status. 72-025 (1184) EhK';INI£[!RINf.~ I:IFIM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ~ .~-s ~:{,?? ,,d by my seal afhxed hereto and as of the validation date shown below, I verify that my investigation of this Health ~:~? erst:,, Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate ~o~ dm mm~bur ol bedrooms and type of structure indicated herein. I further verify that based on the information obtained trom the Mumcff)ality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewaler (hsposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on [hu dale of th~s inspeclion, Approved for ,,~/'~Z..,~z'~('~/)bedrooms by . Approved Disapproved Conditional 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 DHEP does this as a courtesy to purchasers of homes and their Fending 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 72-025 (11/04) ~ ~, ~ ~ AGE (MOA) ,-, %'~'&'.~/~'~,~. HEALTH AUTHORITY APPROVAL (HAA) .~,~ .Q ~ ' C~Q 264-4720 ~I. Legal Description: ~ Well Classification "~---A',4~ If A, B, C,,D.E.C. Approved (Y/N) Well Log Present (Y/N) "Y'¢--.-~"~ Date Completed 4¢ /j '7/~' Yield Total Depth ~.(~"~) Cased to 14*~-~ Depth of Grouting ~_/~¥ Static Water Level ~4:~/ Pump Set At Casing Height Above Ground ___[ -~?f Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) ~'"'"~ _ Depression Around Wellhead (Y/N) Separation Distances from Well: , ( ~ ..~ '~) To Septic/Holding Tank on Lot ~ ~ '~-' f. ___,,%On Adjoining Lots ~ \t 74-',) To Nearest Edge of Absorption Field on Lot _ ~l ';~(::3 .-.P-~ ; On Adjoining Lots __ ~ '--~::, To Nearest Public Sewer Line ~ To Nearest Public Sewer Cleanout/Manhole ~,~ i~1[- To Nearest Sewer Service Line onLot Water Sample Collected by ~,~'¥~..,.. ~-'~c.f~6~__ ,'Date Water Sample Test Results '~'~)'"~ ["~-'¢'~.~T~;f-~ Comments _ it~'_?~_. _.,f~%~,Oc-'~ t",~.,m.-k., o__t,,4 ~Z~%~T~¢ SEPTIC/HOLDING TANK DATA Date Installed ~ t~/~_~_~ize ~ ~.¢~:~ _ No. of Compartments Standpipes (Y/N) "-¢'~ Air-tight Caps (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 '~ '~'~ ~ To Property Line ~1~_ "` To Water Main/~ ~ r~ Cou e, , Comments /~/~.¢ ~-~" ~ '~ : Foundation Cleanout (Y/N) ~ .~(~. Date Last Pumped __j~.~--'l,,,~ ;for Temporary Holding Tank Permit (Y/N) ~/'~___ To Building Foundation j~'~ To Disposal Field _ -~;~'~ f To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84} ABSORPTION FIELD DATA Soils Rating in Abs~orptio/n Strata Date Installed ~:~,/C.~ / ~ Width of Field '~;;;~[~-"~ f~ Square Feet of Absorption Area Depression over Field (Y/N) ~--' Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~'"'74.- · To Building Foundation ~ · Lot To Water Mail~~ To Stream/Pond/Lake/or Major Drainage Course Type of System Design ~T~. Length of Field . ~-'~ Depth of Field ~ ~r__~.el Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line _~, To Existing or Abandoned System on ; On Adjoining Lots ~_/¢~. ( ~C-"~ r "~'~ To Cutbank (if present) To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Tested for Electrica~es (Y/N) Com//~nts Dimensions _/ Vent/,/,/ ~_ ~equacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that l have checked, e~rifie'd, or~"Oc pformed to all MOA/and I J/AA guideli nos in effect on the date of this inspection. Signed ~Date Company ~.~'¢r~...t-c'",,-,tr!p.~.,~.-. ~ MOA No. ReceiptNo. _1/~ ~ /~ · Date oi Payment ~/~,/~ ~' Amount:$ ~.4~"-. O [.~ Page 2 of 2 72-025 (11184)