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HomeMy WebLinkAboutSKYLINE VIEW #1 BLK 5 LT 2BSkyline View #1 Block 5 Lot 2B #051-191-35 GREI 'ER ANCHORAGE AREA BOF 'JGH Department of Environmental Quality M 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL. SYSTEM NAME' �-� <r,-�' i/�' ✓"i �,�-r MAILING ADDRESS � �,,/ �%� ` /' PHONE r� LOCATION LEGAL DESCRIPTION/"'%- ?✓�� �' �-�'�–l� `�' �� r %'c,.._ -i <, SEPTIC TANK: DISTANCE NUMBER OF FROM WELL _ MANUFACTURER '� =' `l/���''MATERIAL�,��'!'` -�= COMPARTMENTS INSIDE LENGTH INSIDE WIDTH" / -' LIQUID DEPTH LIQUID CAPACITY/_GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER — LINING MATERIAL: /' l CRIB SIZE BUILDING FOUNDATION NEAREST LOT LINE_- OR WIDTH _Ai_,' LENGTH' L/ DEPTH DIAMETER 'DEPTH DISTANCE FROM: WELL 07Hf�[U►���\%YU li�B7►1 i WELL: TYPE BUILDING FOUNDATION CESSPOOL/ APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED DISTANCES: /d✓=::'%' /'.-„'->. �?; INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS:.° Form No. EQ -031 NEAREST SEWER LINE— _ REMARKS— TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. L19]�J921111a SEPTIC TANK_ DIAGRAM OF SYSTEM DISTA/NCE FROM: SEEPAGE-' SYSTEM Dull 1-kKFHZIE REI --IL P -1-T , TEL 0 t t,'_ J 1, 1 '. :4`- 1-h LOG OF DRILING by A L DRILUNG COMPANY OWNER OF LANDDEPTH OF WELL ..illlp/E ADDRESS....... .... .. ... ........ .... .... ... ...... __ .... ............ 211 WELL SITE ....0, -1,h -6j.....6..,1.. lk ^'.� ............................ ......... . Dmz.-STAUTED... ............... ......... DATE-FINDED KINI) OF FORMATION: STATIC, LEVEL OF WA'I'F Ii, FT.... .Sryo ... .... . .. DRAW DOWN FT . .............. ... .. .A., Hn . ............ 7 M -A 0 .......... ICTNI') OF CASING ....... ......... . 0 TO.,;,4... a .. .... FT, TO.J.4. FROM ....... ...........IT, .. ..... . ... rnom/10 . ....... FT. TO_ ..... FV. .......... FROM. 1"r, TO ... ......... M5��_ 44d, M .. ,..,...._..._..._FT. TO..... .. .... FT - Mlom ... ?,./ ........... FT. TQ� .... sll�'57 ------ &Z 'v e' rT . ........ ....... ..... ..... YT.. FROM .... TO ..... V. ...... mom ......... ........ _.XT, To ...... .......... . I'll, . ........ ... Mom TO ... /_Ro ..... FV;nw sa. ........ ...............1'T. TO ....... .......... .... F T .... ......... .... ... . .. /oS_.FT. T0_10 ... pROM ...... . ...... ....... FT. TO. . .................. FT ..... ............. ... FT. TO ............... rjIOM ........................ I"T, TO ..... .................. F'f .. ...... ........ ........ MISCL. INFORMATION; �taYc_/ / +� /_ �, � � �^! / 'P � t� , 1"e. _("#wftV Rol ltir.Ajil I'i:4 ooi'f I$j RASMUSSON ENTERPRISES Box 770-766 EAGLE RIVER, AK 99577 (907) 688-9110 STATEMENT f�G".:i'OC7ta i 'cyj A YLEASE RETURN THIS STUB WITH YOUR REMITTANCE YOUR CANCMEV CHECK IS YOUR RECEIPT, 111 M11 It g' Frac b00 00 r 0 1;1 JL 0 0 M p oill -L e r" I JA t 11 Y' 11 r.0 :7' F r e9l' Ji A 20 ft 6n a oo ri din 11 W I MEMAI'M . V. RM W__ o 8S874 - PO" PAU (50 SETS) 8P874 I —1 757-50 GREA'T'ER ANCHORAGE AREA BOROUGH ,q of rl n e PERMIT NO. DEPARTMENT OF ENVIRONMENTAL QUALITY O lul TUI n 9 I j ` 3330 "C" STREET ANCHORAGE, ALASKA 99503 � Y f TELEPHONE 274-4501 .r �Ogbnu uM • oe. SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT PUHn I anQs-k----MAILING ADDRESS P. 0 -Bn -. I 1 PHONE INSTALLATION LOCATION LEGAL_ DESCRIPTION __Lot_3,_B nl' /--.J-T�k.ill inP �IiPI�J 7�1 - — INSTALLATION OF: SEPTIC TANK -----X-- JSEEPAGE PIT --X— , DRAIN FIELD , OTHER , TYPE AND SIZE OF FACILITY TO BE SERVED TIJ-L_S'-e hpdrAOm FINANCED THROUGH TO BE INSTALLED BY _-_Ul_ aco-ronSst-j"-uc-t4-on — SOIL TEST RESULTS 85 NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED---A""ki-,--ate-3-- - FINAL_ INSPECTION: 24 HOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL_ QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. 1000 Concrete SEPTIC 'TYPE — SEPTIC TANK SIZE TYPE._ SEEPAGE AREA SIZE MINIMUM DISTANCES, REQUIREMENTS [DIAGRAM OF SYSTEM FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT -_---20' , DRAIN FIELD I SEPTIC TANK TO SEEPAGE PIT WALL _15 —. SEPTIC TANK - 51 , SEEPAGE PIT __.L(L_-, DRAIN FIELD TO NEAREST LOT LINE. 1001 WELL. TO SEPTIC TANK DRAIN FIELD /� 1 SEEPAGE PIT 1 - 00 ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK 101 SEEPAGE PIT —LW DRAIN FIELD -. SEPTIC TANK, 1001 SEEPAGE PIT �lL1L—� DRAIN FIELD - TO RIVER, LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHTREMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER 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 SAIL) CODE. DATE APPLICANT'S SIGNATURE FORM NO. EQ -01 6 -U -- SA' -f �CZ? <1 Q y0 1P 1qj jyyr `uv 1 f( o uOF•444&j , ••w es 9J t �}�eaea•Se••ga,••sye�.• • ANU•.Kor1..Dovr,(rp 0 It is the responsibility of the owner to determin F�o �e�srF'�.;,, tai' s the existence of any easements, covenants, or re o���pNOF•��� •L^ jO strictions which do not appear on'the recorded SUV- division UV division plat. Under no circumstances should any NOTE data hereon be used for construction or for estab- -E-AF We -NTS orREc(>RD, OTHER THAN THOSE 1lshina boundary or fence lines. The surveyor tunes SHOWN ON THE RECORDED PLAT, ARE NOT y SHOWN HEREON. responsibility `or the initial transaction only. _ LEGEND_ LOT 2_ ©LOCi< — �5—_ & BRASS CAP MONUMENT 0 IRON PIPE Q REBAB PRORCOR.M0 ANCHORAGE RECORDING DISTRICT ❑ NUO A TACK - - - IEPARID BY: D WLING a ASSOCIATES -- � - 1426 NYDER STREET ---- — __ ANCHORAGE, ALASKA 99501Prvisari -_ _ I DA ATF:: _ t�Y: SCALE: // wotii<wc)ER: FIELORooK: GR 10: P.� f 41 4 qo / 1P 1qj jyyr `uv 1 f( o uOF•444&j , ••w es 9J t �}�eaea•Se••ga,••sye�.• • ANU•.Kor1..Dovr,(rp 0 It is the responsibility of the owner to determin F�o �e�srF'�.;,, tai' s the existence of any easements, covenants, or re o���pNOF•��� •L^ jO strictions which do not appear on'the recorded SUV- division UV division plat. Under no circumstances should any NOTE data hereon be used for construction or for estab- -E-AF We -NTS orREc(>RD, OTHER THAN THOSE 1lshina boundary or fence lines. The surveyor tunes SHOWN ON THE RECORDED PLAT, ARE NOT y SHOWN HEREON. responsibility `or the initial transaction only. _ LEGEND_ LOT 2_ ©LOCi< — �5—_ & BRASS CAP MONUMENT 0 IRON PIPE Q REBAB PRORCOR.M0 ANCHORAGE RECORDING DISTRICT ❑ NUO A TACK - - - IEPARID BY: D WLING a ASSOCIATES -- � - 1426 NYDER STREET ---- — __ ANCHORAGE, ALASKA 99501Prvisari -_ _ I DA ATF:: _ t�Y: SCALE: // wotii<wc)ER: FIELORooK: GR 10: LOU Ui- /LS! UUMNU Uat Begun 7,L_L__t-�_.— o/, //o__— r, Hewili V. Loun bur; /Issscral.�s Sn >r --� of j Ei;yinecrs — Surr?i✓rs Toror Da:h ----'� ------- '---- — Projact P/ome Locclion Met/lod Used ---- Field PartyL2tr,!�`.J---- _--- Wealhei--- _-. Geo;.ngisr crouna ;%7l yr 7�bi rJTJI/r in F,.. b ?• O � V oo? C - V 6 _ Q � V .. ° t I/7 a �> D'"SL;Hr•'i'/O"/ !.ocol;gn th! s [ Dic ro;r,• scrr., lPr dr/vrr;/ nol's, S dep;ns rirculol;on lr:s/, 75' II 1 n0rr5 On dri,/!n", c'GS_, used, etc. -- -- --- ._—. y 13– Y /9 – 19 �� - •Cl ' ti / ff ILI --------.%�'i�y�-�r'�-�?--adz------------- -----------------___.__..__._ -- ----- ----- -- — - -- --- -- - -- - — -- -- ------ – --- ---- -- – _ ..__.. Ti0J — — – – --- ------ – -- - -- ---- --------- -- _ — _. - --- -- — Olh:'rWif- 170166' Cl/ Samf.1?4 pre /C%.n I✓�%=l ii ✓�/C'n/: L' �CC,'r/G'%:717 ti9^•): ' 77i.'.7 %' rC/:O. r'9• [ .i:/ G! a. Municipality of Anchorage. . � --� Development Services Department '• Building Safety Division On -Site Water and Wastewater Program - 4700 South Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-191-35 PCGERTX7FT6 q�goio I Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 21B Block 5 Skyline View Addn. #1 Location (site address or directions) 22930 Sumac Drive, Chugach, AK 99567 Current Property owner(s) _Ralph & Sheri Tingey Day phone 608$005 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Katherine Donohue/Prud. Vista Day phone 424113 Street, Anchorage, AK 99503 Unless otherwise requested, HAA will behold by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ID Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site ID Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates,of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 044. I IM) 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 Health Authority Approval Guidelines for 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of Installation. Name of Firm Pannone Eng. Svc Phone 272.8218 Address P O Box 102954 Anch AK 99510 Engineer's Printed Name Steven R. aannnne P.E. Date / ZK(Oa Engineers Comments: In conducting an adequacy test, 1 attempt to provide a thorough, conscientious ��*` - - - .. - %4 engineering analysis of the system in accordance with MOA DSD Guidelines R Regulations. The ���'�` /1�/'1• reported results describe the performance of the system under the conditions encountered at the time of �P.••" the test, and separation distances measured to readily identifiable features. The operational life of all GJ;•' �(n�[7, wells and septic systems depend on the local soil condition, ground water levels that may fluctuate �= {r •;° iH during the year, and the water usage of the family being served by the system. These conditions are mow. — . outside the control of the evaluator of this system. All systems eventually fail and satisfactory tat 0 results do not guarantee future performance of the system, nor do they guarantee that there are no h' defects or encroachments PES can therefore not provide any warranty for future performance per &Ve:Steven R. • Panne any estimate of how long the system will continue to meet the operation requeremen of the ADEC or 0, (P - No. CE 8149 MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon ���1�'•.,_-6z `.• or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 6. DSD SIGNATURE ♦a,,,e�� Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Z Attachments: HAA Checklist _ x Septic System Advisory Well Flow Advisory By: Expiratl ate: (RW. IM) Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: lbs Reissue Date: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 20 Block 5 Skyline I law Addn #1 Parcel I.D.: 0551-191-35 A. WELL DATA Well type E If A, B, or C provide PWSID # Date completed 5/1973 + Sanitary seal y Total de�� 1 • It Cased to �ft to (co, FROM WELL LOG Date of test 6/1973 * Static water level 60* ft Well production 1.2 • g.p,m WATER SAMPLE RESULTS: Well Log N Wires properly protected y Casing height (above ground) 2'+ in. AT INSPECTION 7n7nQQ4 97 ft .33 g.p.m UAI Coliform _0._colonies/100 ml Nitrate 1.72 mgll O er bacteria.,, �col ni 100 ml Date of sample: _7/27/2004 -Collected by: _Laura Pannone /;Z�3o�0y B. SEPTIC/HOLDING TANK DATA Tank Type/Material _Concrete Date installed 6/1973: Tank size 1000_ gal Number of Compartments I * Cleanouts Y Foundation cleanout Y Depression over tank M High water alarm N/A Date of pumping 7rnn004 Pumper -Chugach Pumping C. ABSORPTION FIELD DATA Date Installed 6/1973 • Soil rating (g.p.d./ftZ or W/bdrm)10 System type Seepage Pit Length 10.5 • ft Width 10.5 * ft Gravel below pipe _� n Total depth iQ ¢ ft Effective absorption area 511 25 • It2 Monitoring tube y Y V Depressidn ver field1N Date of adequacy test 7/27/2004 Results (Pass/Fail) Paas For a bedrooms Fluid depth in absorption field before test 443 in Water added4 gal. New depths in. Elapsed Time:41 40 min Final fluid depth 443 in Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date (Rev. I IM) D. LIFT STATION Date installed "Pump on" level at _ in"Pump Datum E. SEPARATION i A C)As Manhole/Access at —in High water alarm level at _ in bd Meets alarm fl circuit requirements? _ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 110+ On adjacent tots 100+ Absorption field on lot 115+ Public sewer main 100+ Sewer /septic service line 25+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 20+ Absorption field 5'+ Water main 100+ Water service tine 25+ Surface water I00+ Drainage 100+ Wells on adjacent lots _00+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 20 Water main 100+ Water Service line 35+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain None Observed Wells on adjacent lots _1912__ F. COMMENTS G. O I certify that I have determined through field Inspections and review of Municipal records that the above systems are In conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Steven R Pannone P.E. Date 1=2` —cS— .U310 7 Date of Paymentf O Receipt Number 44 (Rev. 11(98) Waiver Fee $ Date of Payment Receipt Number 0 01-10-05 10:31AM F1614 -CUE ESI, SGS EYV SERVICES SOS Rata 1048289001 Clknt Name Pannone Eng. Sty. Project Nattta'9 L2B. BS Skyline View CllcntSampklD BecLRose Bib Mattis Dridirs Wate: 9075615301 T-494 P.03/03 F-880 All Datetlrlrna are Alaska Standard Time Printed Damming, 01/10/2005 10:19 Collected DatwTIme 12/30/2004 11:00 RecelvedDalwTime 12/30,2004 11:46 Technical Director Stephen C. Ede 14rurcter Rewils POL Mitt Method Contalnn ID A.1k,bk Ptep Analytic _i:, Dee Due Init Private Sndividnal Analysis PH 7.46 0.100 PH units EPA 150.1 C (6.5-8.31 12t3WO4 K.AL Alkalinity 106 10.0 m8lL SM202320B C 01105;05 KAL TotalColirwm 4O8.NoColt COLI Mail. SM2092225 A (o -l) 1213WO4 DKC -PRFLUMINARY- 01-10-05 10:30AV FROlk-ME ESI, SGS ENV SERVICES SGS - SCS Ret.# 1048289001 Client Name Pannone Eng. Srv. Project Nameto L2B. B5 SkvUie View Cheur Simple ID Back /lose Bib btatrix Drinking Water Semple Remarks: 9075615301 T-494 P.02/03 F-880 All DatesfTlmn an Alaska Standard Time Printed Date/Plme 01/10/2005 10:19 Collected Date/Tlme 12/30/2004 11:00 Received Dat&Tlme 12(3 004 11:46 Technical Director Ste n C. Ede Panmcar Rcsohs PQL Cafe Mcdwd AVow4ble Coniine! lD Limits Prep An4lyea Oar Dete Irit Nickel 2.00 U 2.DO ug/L. EP2W.8 D 01/05;05 0IAMS SCL Antimony 1.DO U 1.00 ug/l. EP200.8 D 01105105 OIAX45 SCL Thallium 1.000 1.00 uyL EP200.8 D 01/05105 01/06/05 SCL Selenium 5.03 U 5.00 uyL E•P200.8 D 0I/05.105 01/06/05 SCL Private Individual Aaalyaia Aluminum 20.0U 20.0 uyL EP20118 D 01/05105 OIAWOS SCL Arsenic 5.00U 5.00 uVL EP200.8 D (<-501 01/05.'05 01/06/05 SCL Barium 3.000 3.00 uyL EP200.8 D (<-2000) 01/05105 01/06/0S SCL Cadmium 0.500 U 0.500 uyL E13200.8 D (<-5) 01/05;05 01106/05 SCL Calcium 23000 500 uyL EP200.8 D 01/05.05 01/06/05 SCL Chromium 1.00 U 1.00 uyL EP200.8 D 1<-100) 01105:OS 01/06/05 SCL Copper 26.3 1.00 ug/L EP2011.8 D 1<-1300) 01/05105 OMY105 SCL Iron 250 U 250 uyL E°200.8 D (<-300) 01/05105 OIAM5 SCL Lead 1.53 0.200 uyL EP200.8 D (<-15) 01/05105 01/06/05 SCL Mugnesium 8310 50.0 uyL EP200.8 D 01/05!05 OI/06/05 SCL hlunganese 4.00 1.00 uyL EP200.8 D (<-50) 01/05!05 OIM/05 SCL Phosphorus 200 U 200 uyL EP200.8 D 01/05;05 01106/05 SCL Potassium S00 U 500 uyL EP200.8 D 01/05!05 01106/05 SCL Sodium 2300 500 uyL EP200.8 D (25000(1 01/05105 01/06/05 SCL Silicon 5810 200 uyL EP200.8 D 0I/05.!05 Olic6/05 SCL Silver 1.00 U 1.00 uyL EP200.8 D (<-100) 01/15105 OliCG05 SCL Zinc 314 5.00 uyL EP200.8 D ("5000) GINS/05 01;06105 SCL Mimi& 3.01 0.100 mall. EPA 300.0 B (<-250) 1230/04 DIA Fluoride 0.100 U 0.100 nWL EPA 300.0 B (<-2) 1270!04 BIA Nitrate -N 2.04 0.100 mail. EPA 300.0 B ( 101 1290/04 BIA Nitrite -N 0.100 U 0.100 ne/L EPA 300.0 B (a1) 1270/04 BIA Sulfate 10.2 0.100 malL EPA 300.0 B (<-250) 12130/04 DIA Total I)issohedSolids 134 10.0 mall. SM202540C C (<-500) 01105/05 KAL HCO3 Alkalinity 106 10.0 mall. SM202320B C 01105/05 KAL CO3 ADcalinhy 10.0 U 10.0 m8/L. SM20 23208 C 01!0905 KAL OH Alkalinity 10.0 U 10.0 mivL SM20 23208 C 01105:05 KAL Conductivity 240 1.00 umhos/cm SM202510B C 1296'04 KAL -1'RF.LIMINARY - cv i�ou a t2d G Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program _^ 4700 South Bragaw Street P.O. Box 196650 Anchorage; AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-191-35 HAA # Expiration Date:. — (n O S 1. GENERAL INFORMATION Complete legal description Lot 26 Block 5 Skvline View Addn. #1 Location (site address or directions) 22930 Sumac Drive, Chugach AK 99567 Current Property owner(s) Ralph & Sheri Tingev Day phone 688-8005 Mailing,address P. O. Box 670368, Chugiak AK 99567 Lending agency Day phone Mailing address Real Estate Agent Katherine Donohue/Prud. Vista Day phone Mailing Address 4241 B Street, Anchorage AK 99503 Unless otherwise requested, HAA will be held byDHHS for pickup. HAA picked up by.'_ - 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER bISPL Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent,, professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. (Rev. 11/99) 5. STATEMENT OF INSPECTION BY ENGINEER stigation As certified by my seal affixed hereto and as of the validatioovalaGu'Idel nes fote shown or this vHealth Authorityerify that my Approval based on procedures outlined in the Health Authority App adelquate for the number of bedrooms and type of structure indi indicated htewater erein.lI further ver'fy that basted olnthe ection, the on- s terwaternsupply and/ornwastewaterpd sposalthe Municiaty of lssy temg s chorae fin complian a wis and from, th allsappliicable Munigation and c pal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone En .Svc. Phone 272-8218 Address P.O. Box 102954 Anch AK 99510 Date Engineer's Printed Name Steven R. Pannone P.E. Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious 44, _ • OF engineering analysis of the system in accordance with MOA DSD Guidelines &Regulations. The ��..........,<, S/.r reported results describe the performance of the system under the conditions encountered at the time of V n •. the test, and its describe ion distances measured to readily identifiable features. The operational life of all rr+ �1►, g wells and septic systems depend on the local soil condition, ground water levels that may fluctuate w 49 during the year, and the water usage of the family being served by the system These conditions are 0,,,,,;,, outside the control of the evaluator of this system All systems eventually fail and satisfactory test results ••••..••••• •... ••'• •••.••••••••• do not guarantee future performance of the system, nor do they guarantee that there aze no hidden defect ��,, Steven R. Pannone or encroachments. PES therefore not provide any warranty for future performance or give any �.�c'; estimate of how long the system will continue to meet the operational requirements e the Ar ii or iJ K9q 8149 MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon •• or use of this report by any other person or party isnot authorized nor will it confer any legal right �j�♦'tRCFESS.• ip,.4 whatsoever. V" 6. DSD SIGNATURE _1Z Approved for ___a_ bedrooms. Disapproved. bedrooms, with the following stipulations: Conditional approval for 03 Attachments: HAA Checklist X Maintenance Agreements _--- Supplemental Engineer's Report Septic System Advisory Well Flow Advisory Other By: Expiration Date: (Rev. 11199) Original Certificate Date: / d' (0 - (0 q Reissue Date: Uld d ... b d3 in "" A "sore on rate'5 -+ g:px /N';& 906 No IfyesWgvedate " i D. LIFT STATION m.. „ �. . date installed Siz all Manhole/Access "Pump on" level at _ in"Pump o ev t _ in High water alarm level at _ in Datum Cycles to te_ Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION,DISTANCES FROM WELL ON LOT TO: ' �' `A Septic'tank/lift station ori fot ' 110+ On adjacent lots 100+ Fl Absorption field on lot 115+ Ona�djaeent lots 100+ Publie sewer main 100+ Public sewer manhole/cleanout 1.00+ Sewer /septic service line' 25+ Holding tank 100x0+ SEPARATION,eDISTANCES FROM'SEPTIC/HOLDING-TANK ON LOT TO:Ww „_, Building foundation 10+ Property line 20+ Absorption field 5'+ Water main 100+ Water service Ilne 25+ Surface water 100+ _.,. Drainage '100+ " Wells on; adjacent lots 160+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:, Property line Ai Building foundation 20 Water main 100+ Water Service line 35+ Surface water'" 100+ Dnveway parking/vehicle storage 10+ Curtain drain None Observed Wells on adjacent lots 100+ F. COMMENTS u Indicates info taken from ast HAA. FCO behind access anel in downstairs bathroom 135 Pressure Tank „ u-,,____ Pressure 5gtic. SySfeVy1 ctQQe4tp W,0- f • b l'�/0 c e oc v �d ��:X•OF Q''�♦ G. ENGINEER'S CERTIFICATION�le Fol E -'L O p�F:................9�!♦j♦ w Fp q ♦♦ 1 certify that 1 have determined through field inspecfwns and � _ _ , ,, �: rti j� • • �, ♦� review of Municipal records that the above systems are in _ _ ,,,, - , ;,.,.. conformance with MOA HAA guidelines in effect on this date w _.m._ }�- : j�h' Seven R �anno^,e',4r0 Engineer's Panted Name' ' Steven R Pannone P.E. • No. cL8, 14 Date,: �w HAA Fee $ Waiver Fee $ l Date of Payment Date of Payment ._..,m RReceipt Number Receipt Number* (Rev. 11 /99) -.... - Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Health Authority Approval # 040511 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 5, Lot 2B of Skyline View Addn. #1 subdivision, the well's productivity was determined to be .33 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is .31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. Pannone Engineering Services, LLC P. O. Box 102954 Anchorage, AK 99510-2954 Phone/Fax (907) 272-8218 Cell 227-3522 October 5, 2004 Municipality of Anchorage On -Site Water and Wastewater Attn: Mr. Jeff Poet P. O. Box 196650 Anchorage, AK 99519-6650 Re: Lot 2B Block 5 Skyline View Addition #1 22930 Sumac Drive, Chugiak, AK 99567 Dear Mr. Poet: Request you issue a waiver from septic field to lot line of three feet for the above referenced property. This system was installed in 1973. No adverse effects have been detected on the surrounding properties, nor are any expected in the future. Please call if you have any questions. Sincerely, Steven R. Pannone, P. E. Pannone Engineering Services, LLC OF gC44, �Sy��a I 4 TH ,..... ...........,� STEVEN P. PA NONE w CE -8149 ��9m °Ess\ P � Municipality of Anchorage P.O. Box 196650 Anchorage, Alaska 99619-6650 Telephone a(907) 33-8 301 Pax (907) 343$200 x 4700 Bragaw Street • Anchorage, Alaska 99,507 s a e r v 31C6gor Mark Begich wimniuni.org Building Safety Division 06 October 04 Pannone Engineering Services P.O. Box 102954 Anchorage, AK 99510 Subject: Waiver Request for Skyline View Addition 91 Waiver Request #WR040069 Parcel ID 4051-191-35 Dear Mr. Pannone: Your request for a waiver of the required 10 feet from the Absorption Field to the Property Line is approved. The approved separation distance is 3 feet. This waiver approval applies to the existing Absorption Field to Property Line separations only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Jeff Poet Engineering Tech On -Site Water & Wastewater Program Community, Security, Prosperity M MUNICIPALITY OF ANCHORAGE ° DEPARTMENT OF HEALTH & HUMAN SERVICES Wil, 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. # 0571- 191— 35- HAA # 4 _� P-% C� 2 C ;_i91 Q_ 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner /17'e'"efi Day phone 6b Mailing address Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS, -3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone 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 '\ 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) Front MOA 921 A 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 Co>1s %vac} ^� C- 5 Inectis Phone �,'/ f Address 0 7�Y ,, �r,& 995) � Engineer's signature" Dat a!Y�is--• y 1: 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments QI bedrooms. UJITir e �' Zy'•iti ^: `+,rJuna 22, 1848 z�•� ����AL� bedrooms, with the following stipulations: Date /0 ._ 2 0 -%2 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 021 Municipality of Anchorage , Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST I Legal Description: _L_ -LY'' Parcel I.D. A. WELL DATA Well type (�R1vA_ If A, B, or C, attach ADEC letter. ADEC water system number -1/AlL: t9'l� A} L- >QmL)W(rL6 Log present (Y/N) y Date completed � Driller 6'�" Total depth `',�Ow 1 —Casedto 1I6 Casing height 15 Sanitary seal (Y/N) Wires properly protected (Y/N) y F NI WELL LOG AT INSPECTION 0 Z Date of test 19-73 8-Zo-9 z- t Static water level �t r cn O Well flow ) Z g.p.m. ? S rn c) Pump level Urvti- y�t"I r� 0 0 Sa GO SEPARATION DISTANCES FROM WELL TO: 7 n+ Septic/holding tank on lot Absorption field on lot Public sewer main 1' Sewer service line ; On adjacent lots On adjacent lots — Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: l/ Coliform �9� _ Nitrate I' Other bacteria Date of sample: —9z Collected by: Co. S VOC-A'^4 %nom B. SEPTIC/HOLDING TANK DATA 19'7 3 F�) l - Qo v cert Date installed Tank size QUO Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) . y Depression (Y/N) N High water alarm (Y/N) N Alarm tested (Y/N) N H Date of pumping 8-3z- Pumper _ -T�- 15 +Famp r-1 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot )00 On adjacent lots -4 t oo' To property line w 2 Absorption field 15, Surface water/drainage 41 ub t 72-026 (Rev. 7/91) Front Foundation Water main/service line -r Sb' CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Manufacturer — Manhole/Acte eY/N) L "Pump off' level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FRO LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Cycles tested Surface water (9-73 Date installed c 4""1b q7 Soil rating _ l00 _System type 10 1 ' ICS` L) �1,J Length 11 .uJ Width "dN Gravel thickness VNY-NbVJnf _Total depth Total absorption area UnKNOWN Cleanouts present (Y/N) Depression over field (Y/N) Results (pass/fail) PAss a Date of adequacy test 8- 19-9 Z. for -1-146--6 C5) bedrooms Peroxide treatment (past 12 months) (Y/N) N If yes, give date _ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots , To building foundation -A- On adjacent lots fi l ob Surface water fit` Curtain drain +-tC>" E. ENGINEER'S CERTIFICATION Cutbank -HOO/ Property line —+ 15 To existing or abandoned system on lot Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on �� Signature' Engineer'sName g�da oovDr // re VVW�� gs Date —f' 5� / of this inspection. HAA Fee $ .I �_ Waiver Fee: $ _ Date of Payment Date of Payment Receipt Number Receipt Number 72-026 (Rov. 3/91) Back MOA 21 0-5 -, LK �Y I 7 5 JOEL J MuniCip"t3r r Of Anchone October 15, 1992 BABB & CO INC 574 P02 FEB 16 193 14:03 P. 0, BOX 196650 ANCHOSAGE, ALASKA 99519-6650 (907) 786-8160 TQM FINK, MAYOR DEPARTMENT Of PUBLIC WORKS (350o @As( Tudor ROPd) Liss Reed, Sales Associate Don McKenzie Real Estate 13135 Old Glenn Highway, Suite 100 Eagle River, Alaska 99577 SUB31rC:r: Single Family Determination on Skyline view #1, Lot 2B, BIock 5, 22930 Sumac Drive, t hugiak, Alaska Dear Ms. Reed; This is in response to your request for a determination on the designation of the structure at Skyline Lot % Block . 1 have ee re ation You provided, and on October 133,1992, 1 conducted aron site inspection. I have determined d the following,, Skyline Subdivision #1, Block 5, Lot 2B was Plotted and file on March 21, 1978. The plat number Is 78 -30 - The single family dwelling was constructed in 1973. Where is no record of a Land Use I)ertnit for the construction. ,Che area was zoned RSA, Rural residential district (large lot), on July 12, 1985. The lot contains 47,444 square feet. R5A zoning requires 43,560 square feet for a single family dwelling. $7,120 square feet is required for a two family dwelling in areas zoned RSA, The setbacks in areas zoned R5A are. front yard -25 feet; aide yard -10 feet; rear yard -20 feet. The dwelling conforms to the minimum setback requirements. ,,Dwelling unit" means a structure or portion thereof providing independent and complete cooking, sleeping and toilet facilities for one family. w Lasa Reed October 16, 1992 Page 2 "Dwellfn& age family or single-family" means a detached building constructed on a permanent foundation, designed for long-term human habitation exclusively by one family, having complete living facilities and constituting one dwelling unit. "Dwelling, two family" Means a detached building designed for or occupied exclusively by two families and constituting two dwelling units. It is determined that Skyline View Subdivision #1, .Block 5, Lot 213 contains a single family dwelling and is in conformance with Section 21.40,070 of the Anchorage Municipal Code, Enclosed is that Section for your information. If you have further questions or require additional information, please call me at 786.8336. Sincerely, )'�_.~ `k- V, k.,, Stan Hoofard Laud Use Enforcement Building Safety Division Department of Public Works ReeA.boo MUNICIPALITY OF ANCHORAGE En-( oD DEPARTME OF HEALTH AND ENVIRONMEN L PROTECTION 825 L Street, Anchoraapi. Alaska 99501 �Dld Hao 264-4720 Date Received: February 16, 1978 #1: Time p _ #2 : Time ��;?,[7 0M #3: Time Date _ ( Date (� 1 iu�nS ;�aS�-7� �,is �Date 14149-A ur% Insp p Insp �,��[ Insp,��[� REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: United Bank Alaska Mailing Address: Post Office Box 59 99510 Phone: 276-1911 2. Property Owner: Steve Laposki Phone: 688-2775 Mailing Address: NHN Sumac Drive 99567 3. Legal Description: East 178-79' Lot 26Block 5 Skyline View 01 Subdivision 4: Single Family Residence: (y) Number of Bedrooms: Three Multiple Family Residence: ( ) Number of Bedrooms: 5. Well System: Individual Well (yj Community/Public System ( ) Permit # Depth of Well _ Well Log on File ( ) Construction Bacterial Analysis 6. Sewage Disposal System: On-site System (x) Public Utility ( ) Permit # Installed Septic Tank Size Absorption Area Installer Manufacturer Soils Rate 7. Distances: Well to Septic Tank to Sewer Line to Nearest Lot Line Nearest Lot line Material to Absorption Area Absorption Area Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: East 178-79' of Lot 29Block 5 Skyline View Subdivision Comments: Aff.adavit Attached: Approved: Disapproved: Letter Attached: ( ) Date: 3 > — % D Date: Department Worksheet: �U�r,��T MUNICIPALITY OF ANCHORAGL. Department of Health and Environmental Protection 825 L Street, Anchorage, Alaska 99501 ��. 264-4720 -�equest for Approval of Individual Sewer and Water Facilities 1. Property Owner: Steve Laposki Mailing Address: NHN Sumac Drive Chugiak, AK Phone: 688-2775 2. Name of Buyer: Allen & Janet CRONK 333-9446 hm Mailing Address: 7401 E 6th Ave #4 Phone: 276-6222 wk 3. Lending Institution: Mailing Address: 4. Realtor/Agent: Mailing Address: 5. Legal Description: Street Location: United Bank Alaska PO Box 59 Anch, AK 99510 Phone: 276-1911 Chuck Hylen 4060 B Street Anch, 99501 Phone: 278-9591 East 178-79 Feet of Lot 2 Blk 5 Skyline View Add #1 NHN Sumac Drive Chugiak, AK 6. Single Family Residence: Multiple Family Residence: (x) Number of Bedrooms: ( ) Number of Bedrooms: -3- 7. Water Supply: *Individual Well fix) Public/Conununity System ( ) If Individual Well, well depth ?? If Community System, name of system 8. Sewage Disposal System: 'On-site System (xk) Public System ( ) If On-site System, date of installation: ?? *NOTE: A well log is required on ALL wells drilled since 6/75. **If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77