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Home My WebLink AboutSKYWAY PARK ESTATES BLK 6 LT 11 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 AUYHORITY APPROVAL FOR A SINGLf-- FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) /&~ ¢ /---.~.,-~/¢ ~e-_'~ ~-,-'/¢,~ o Property owner Mailing address Day phone Lending agency Mailing address Day phone Agent /~ ¢ ?'~-"~ ' 1/'~ ~,r :~, , ~-i -, ~:-,~ '~:-"~,i Day phone Address ~' ~ ~-~- ~C~/-Z ~ ..~_ o' . 2, NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well ~' Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer 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#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by rny 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 investLgation 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 ~'(-/,~cec_/ A~, /[,-L~¢,,-'~,~,.?, /2L~. Phone Address / '~ ~ ~7,o/~-,-t ~/'~ z~) ~/~c~ //-,~¢-J-L~ Engineer's signature ~~ Date DHHS SIGNATURE ~ Approved for /u~¢)M~ Disapproved. Conditional approval for bedrooms, 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. RECEIVED Municipality of Anchorage JUN 6 998 DEPARTMENT OF HEALTH & HUMAN. SERVICES Environmental Se~¥ices Division MUNICIPALITY OF ANCI-[OP, AGFt~Iai~ · , ' CE8 DIV JSJ~"~-~''"~'~ 825 L Street, Room 502 Anchorage, Alaska 99501 Health Authority Approval Checldist Legal Description: ~o¢' //, A. WELL DATA Well type ~-/4 Log present (Y/N) Parcel I.D.: . If A, B, or C, attach ADEC letter. ADEC water system number Sanitary seal (Y/N) Total depth ~ '~/ Cased to ~ -~ ' Casing height (above ground) y Wires propeny protected (Y/N) AT INSPECTION FROM WELL LOG Date of test Static water level Well production .~- g.p.m. g.p.rr WATER SAMPLE RESULTS: Coliform Date of sample: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Foundation.,Ce ca'ut (Y/N) D~of Pumping C. AB$OFIPTION FIELD DATA Collected by: ,.~, Tank size Number~of~mpartments __ Depress/[on~) Pu~mp ref/ Cie an ~.~Y.~/N):-~ High water alarj3~Y~ Date installed Soil ratir~.p.d./fF or fF/bctrm) __ Sy~e tnl~ype Length .Width ~_ Gravel thickness below pipe / Total depth Effective absorption area Monitoring Tube present (Y/ Depression over field (Y/N) ././?' Date of adequacy tes Results (Pa~jJ)~ For / .bedrooms Fluid depth in a.a~ r~ption field before test (in.); _ / Immediately after gal. wat~ed (in.): FIL __ (ins) Minu Absorption rate =/,/' _g,p,d, .~,e~xide treatment (past 12 ~gths') (Y/N) If yes,~givev~ate 72-026 (Rev. 3/96)* D. LIFT STATION ~i;~h~la~Ve/~l ~ "Pump ~ __ 'Pu~ a~ Cye~s t'ested at* ~.,-~Datum ~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ,'~'//~ Absorption field on lot /'~//~ Public sewer main / Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTAN~TIC/HOLDING TANK~ Foundation / Property line / Absorption field SEPARATION DISTANCE FR~PTION FIELD ON LOT TO: Property line _,,,/ Building foundation _,.~"'"~ Water main/service line Surface wat~ ~eway, parking/vehicle storage_a~ .O~n ~ Wells on adjacen.t-lo~ F. ENGINEER'S CERTIFICATION I certify that l have determined thru field inspections and review of Municipal record,,,s~h..~.c~.~ms are in conformance with MOA HzAA.quidelines in effect on this date. ~,,-,%~. o ,' ~ · .~ ~ HAA Fee $ ~ O~. ~ ~ Waiver Fee $ ReoeiptNumber 03~ ('Z?~ Receipt Number 72-026 (Rev. 3/96)* IIJN-19-1998 17 ..... CT~E ESI ANCHORAGE ,~1~mm~mm~mm~ CT& E Environmental Services the. CT&E Ref.# Client Na~e Project Name/// Client Sample ID Matrix Ordered By PW$1D 981030004 Susm~ Oswalt & Associates 1601 Shore Dr LI1 Bk 6 Skyway Drinking Water ~.48 0.1o0 Client PO// Printed Date/Time 06/19/98 17:46 Collected Date/Time 06115/98 09:47 Received Date/Time 06/15/98 10:25 Technical Director: Stephen C. Ede Released By /~)_ ./f~ .-~ co t/loolnl SM18 92228 06115/98 ?Mi4 rng/t CPA 300,0 ID mox 06115/98 06/75/98 F~MV TOTA[ P. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~J J~'-~..- ~)~_~ OF ON-SfTE SEWER AND WATER FACILITY 264-4744 Application Date J I J q ~¢~ GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ~ol ~ ~.~_ (b) Property Owner~Lv,.4 .&J¢[-~.~,~.,4 Telephone: Home ~¢9~,5'/!~ Business Mailing Address I~,OI ~ [.t., ¢¢-- 'lSw'~ ,a ~. (c) Lending Institution ,~ (¢.'.~'~-.-,- '~- c.C~, Telephone Mailing Address 'q~-~.~4~,:~..~,~/~'" ~'~,~'~ ~:~'.~ (d) Real Estate Company and Agent jx.j (~ Address Telephone (e) Mail the HAA to the followino address: or: Check here'S, if hold for pick up List contact person and day phone number below. TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms WATER SUPPLY Individual Well'~ Community [q Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [] Publics 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 of 2 72-025 fRev 8/861 Front 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/er 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 flies 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 ins e,,~.~n. NameofFirm )'~-'f'~f"~'-.~/~'-~'-~--"', Telephone ~""~]- '~ ~*/~ Address ! ~.0 ate Engineer's Seal DHHS APPROVAL Approved for Approved Disapproved Conditional Terms of Conditional Approval CAUTION 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 DH HS 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. Page 2 of 2 72-025 IRev 8/86) Back WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) /~UNI¢'~P^UTy oP ^I-LE,~LTH AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & ~CKLI ST - FEBRUARY 1984 ENVI~ONM~NTAL P~OT~c~ION 264-4720 EC/IVED Legal Description: Lo"r- l// 14. c_. If A, B, C. D.E.C. Approved fY/N) _ Date Comoleted ~.)tq ~J~,lC~ ~/~4 Yield N Depth of Grouting /%(O(~/]~F Pump Set At /,~.~. Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Cased to Well Classification . Well Log Present fY/N). Total Depth _ /-.,:~ Static Water Level Casing Height Above Groune Electrical Wiring in Conduit Separation Distances from Well: To Septic/Holding Tank on Lot : On Adjoining Lots : On Adjoining Lots To Nearest Edge of Absorption Field on t.ot _ .N~ To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Corements To Nearest Publ c Sewer -- .... -' Nearest Sewer Service Line on Lot ( ~' 1[~ ~/ : Date I/1~/8~'-- B, SEPTIC/HOLDING TANK DATA Date Installed Standpipes (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 To Water Main/Service Line Course Size No. of Compartmems Air-tight Caps (Y/N) Foundation Cleanou[ (Y/N) Date Last Pumped for _ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposa Field To Stream. Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Are Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Abs¢ To Water-Supply Well To Building Foundation Lot )tion FieLd: To Water Main/Service Line Type of System Design Length of Field /' Depth of Field vel Be~taTnh;Cp:;;;Spresent (Y/N, D~/t~~kast Adequacy Test /--~o ~P~perty Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) J "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verifi~', or conformed to a)l M(~A and HAA guidelines in effect on the date of this inspection. Signed ~-"'- -~'¢=~'¢'¢(~. Date / Company MOA No. Receipt No. / ~) ("')// ¢ ~ '¢¢:,'/~ Date of Payment /'/.~//~"~'--- Amount: $ /(~ ¢2 oO Page 2 of 2 72-026 (11/84) Engineer's Seal CONSULTING ENGINEER TELEPHONE: (907) 279 3916 RESIDENTIAL WELL INSPECTION LEGAL: LOCATION: OWNER: TYPE OF WELL: WELL LOG AVAILABLE: INSTALLATION REQUIREMENTS MET: PUMP YIELD: LOT 11, BLOCK 6, SKYWAY 1601 SHORE DRIVE TIMOTHY G. ALTMAN SINGLE FAMILY NO PARK ESTATE ~.~,. oF Ill ~'~ ,':- '-.,. .1 .... YES ~'. 3 GALLONS PER MINUTE WITH' 2 FEET OF DRAWDOWN DATE OF INSPECTION: JANUARY 16, 1987 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 3 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. THE WELL WAS PUMPED TILL THE DRAWDOWN STABILIZED. STATIC WATER LEVEL WAS FOUND AT 53 FEET BELOW TOP OF CASING. TOTAL WELL DEPTH IS 63 FEET. AFTER 5 MINUTES OF PUMPING AT 3 GPM WATER LEVEL WAS 55 FEET. WELL WAS PUMPED FOR 30 MINUTES WITHOUT ANY FURTHER LOWERING OF WATER LEVEL. THIS WELL CAN BE PUMPED FOR MORE THAN FOUR HOURS AT A RATE OF 3 GALLONS PER MINUTE TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON JANUARY 17, 1987. TEST WAS NEGATIVE. TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. MUNICIPALITY OF ANCHORAGE 825 [ Street - Anchorage, Alaska 99501 , _ SEI '1/979 ENVIRONMENTAL ENGINEERING DIVI8ION Telephone 264-4720 RECEIVED flEQUEGT FO~ APPROVAL OF I~DIVIDUAL ~ATE~ A~D SE~E~ FAOI LITI DIRECTIONS= Complete all parts on ~age 1. Incomplete reuues~ will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE MAfEI~¢~DDRESS PROPERTY RESIDENT Jif different from ~ov~) ~AILING ADDRESS NG ApDRESS _ . ~ REALTOB/A6ENT [ ~ ' I PHONE ~ L~GAL DESCRIPTIO~ 6, ~YPE OF RESIDENCE NUMBER OF BEDROOMS ,~ SINGLE FAMILY ~ One ~ Four E] Other_. ~ Two ~ Five MULTIPLE FAMILY ~ Three ~ Six ~ WATER SUPPLY t~T~ INDIVIDUAL* El\ COMMUNITY [] PUBLIC UTILITY =8. SEWAGE DI,~iPOSAL SYSTEM [] INDIVIDUAL/ON-SITE" ATTACH WELL LOG. A well Icg is required for all wells drilled s~nce June 1975, For wells drll ed prior to that date, give Well depth {attach Icg if available,) **fi I ndlv dual/on-site, give installation date f system ~s over Two (2) years old an adequacy test is recu~reo PUBLIC UT L TYO~U~jL.t.~L.~/by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE NITRATED. 72-B10(3/78) THIS SIDE FOR OFFICIAL USE ONLY )ATE RECEIVED INSPECTION APPOINTMENTS TiME TIME TIME DATE DATE DATE I INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SlX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E~INDIVIDUAL/ON -SITE DATE INSTALLED , []PUBLIC UTILITY Connection Verified INSTALLER E~Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. 00MMENTS ^PPBOVE FOB. BEDROOMS [] CONDITIONAL APPROVAL {letter must accompany certificate) [] DISAPPROVED ~ DATE (/~-t~ ~/'~ ~)~') BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 [)ate Received July 19, 1976 Time of In:~pection Date of Inspection / REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Co~v. 1. Approval requested by: Security National Bank % Karen Mailing Address: Pouch 7-777 99510 Property Owner: Mailing Address: Legal Description: Location: 4. 5. 6. William & Louise M. Peters Star Route A Box 199J Phone: Phone: 278-1541 Lot 11 Block 6 Sk w]!~_~y Park Estates 1601 Shore Drive Type of facility to be inspected Well Data: Individual C. Construction Sewage Disposal System: PubZ:Le Ut~l±ty A. Installed B. C. Septic Tank: 1. Size D. Seepage Pit: 1. Absorption Area E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank Sinqle Family No. of bedrooms 3 B. Depth 63' D. Bacterial Analysis 0x/~- . Installer 2. Manufacturer 2. Material , Absorption area , Other contamination , Absorption area , Sewer Lines C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Req t for Approval of Individual S r & Water Facilities Legal Description Lot 11 Block 6 Skyw_ay Park Estates Comments ApProved~ O~-~.c.~ .~.~i'~£-L.m~t~--~ Disapproved 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 subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF EIXlVIRONMI:'NTAL QUALITY 3330 "C' Street, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES MUNICiPALnY OF ANCIIORAG~ DE?F OF HEALTH & I~NVIRONME F,H/',1 PROTECTION JUL 1. ?, lgY8 1. Type of Inspection: CMRO VA 2. Property Owner: William & Louise M. Peters FHA CONV XX Mailing Address:SRA Box 199 J. 3. Name of Buyer: Same-Refinance Day Phone Mailing Address:8. RA Box 199 J. 4. Name of Lending Institution:Security National Bank Mailing Address:Pouch 7-777, 5. Name of Realtor or Agent: N/A Mailing Address: Day Phone Anch. , Ak. , 99510 Phone 278-1541 Phone Legal Description: __Lot 11, Block 6, Skyway Park Estate8 Location: 1601 Sho~e Drive. Anchorage. Ala~k~_~ 99503 7. Type of Facility to be inspected: S~ily RR~f 8. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well 63' 9. Sewage Disposal System Type of System: Public Utility ~n,~ _ If Individual, date of installation No. Bdrms. Individual (on-site) EQ-037 (1/74)