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HomeMy WebLinkAboutSKYWAY PARK ESTATES BLK 8 LT 1>,_ l 0 � L.states INSTALLATION LOCATION LEGAL DESCRIPTION ~ INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE ,SERVED FINANCED THROUGH SOIL TEST RESULTS GRE:.n :R ANCHORAG~ AREA BOF ~GH DEPARTMENT OF ENVIRONMENTAL QUALITY ~::~~-/VF-- APPLICATION AN[) PERMIT .AIL, SEEPAGE PIT- -- dN ~rlELD . ., OTHER THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLIN DF ANY SYSTEM WITHOUT FINAL INSPECTION bY THE DEPARTMENT OF ENVIRC)NMENTAL QUAL:ITY AUTHORIT 3JECT TO PROSECUTION. SEPTIC TANK SIZE TYPE MINIMUM )ISTANCEfl, REQUIREMENTS FOUNDATION SEPTIC TANK % FOUNDAT}ON ePagE Pit ,DRAIN flE~I SEPTIC TANK TO Pit WALL SEPTIC TANK SEEPAGE Pit TO NEAREST LOT LINE WELL TO DRAIN FIELD WATER MAIN TO , DRAIN FIELD , SEEPAGE PIT , ALSO CONSIDER AREA WELLS. , SEEPAGE PIT ., DRAIN FIELD ~ND INTO CRIB CROSSING GAP OF 4 INCH DIAMETER CAST IRON SIPHON PIPES ON S~TIC TANK AND SEEPAGE Pit FITTED WITH Airtight REMOVABLE CAPS. TYPE [ CERTIFY tHAt l Am FAMILIAR WITH THE REQUIREMENTS OF gRl[ATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2S-68 AND THAT THE ABOVE DATEDESCRIBED~'A /~'SYSTEM ISS_IN/ A~CORDANCE/~/'7~J~PLICANT'SWITH SAiDsiGNATUREOODE. ____~ y~~~ FO O. WATER WELL LOG FOSS DRILLING 1336 Ingra Street A~chorage, Alaska 99501 ' ~ HOLE.~FT. CASED TO SIZE OF CASING_~DEPTH OF _ STATIC WATER LEVEL. ~ ~ ~T. YIELD__~GAL.PER.MIN. FEET OF REMARKS PUMP TO BE SET AT ~: 1:~'~ WATER W~:LL LOG FOSS DRILLING 1336 Ingra Street Anchorage, Alaska 99501 SIZE OF CA~I~O~" ~E~H OF ~O~,~?_PT. CASED TO~'~ PT. STATIC WATER LAYEL_~.__.FT. YIELD__~GAL.PER.MIN. WITtt~ ~-~ FEAT OF DRAWDOWN. REMARKS DATE COMPLETF~_?~ ~__~.PUMP TO BE SET AT__~.~_..I~___~~ 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.# ~Ob~ 1. GENERAL INFORIVIATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent '~zc~& ~--- Address Day phone_ 5LIL(- ~8~ _ . Day phone Day phone 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 Stats 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 ~ewer If communTty wastewater system, provide written confirmation from State AD£C attesting to the legality and status of system. 72-025{Re¥.1/91) Fronl MOA #21 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 qf 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 _ "~¢.~'¢"~ Address ,.~ ¢) ~ Engineer's signature Phone Approved 'for /~,=-/ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments _ t %'7//~ ?' '~/x-J.X_ ,,¢¢~¢~.,-- Date The Municipality of Anchorage Depadment 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. 72~225 (Rev. 1191) Back MOA #21 MUNICIPALITY OF ANCHORAGE DFPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description ¢2_. -7-7 Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Day phone Add ress Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, 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 ~ewer NOTE: If communTty wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-02§ (Rev. ~/91) Front MOA 1~21 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. NameofFirm -~--~'~"/ ~-u ¥' ~''~'~'~'~'~? 'ib~ Phone ,~?l.'~-~,/ ~ Address, Engineers signature DHHS SIGNATURE Approved'for Disapproved. Conditional approval for Date c/'/z-¢ /~-~ - bedrooms. bedrooms, with the following stipulations: Additional Comments By: _/~'~"~"'~-~ ~,.-,cJ~ [)ate 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 courtesyto purchasers of homes and their lending institutions in order to satisfy certain federa and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L.~-/-- A, Well Data Well type Log present (Y/N) '"/ Total depth Sanitary seal (Y/N) Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~'~-~ ' ?'f~-- Driller ~'~ .~ .5 Date of test Static water level Well flow Pump level1 ~- ~ SEPARATION DISTANCES FROM WELL TO: Cased to ,,~ 7 Casing height Wires properly protected (Y/N). y FROM WE, LL LOG AT INSPECTION ~ g.p.m, ~ .g.p.m. ; On adjacent lots )""////~ ; On adjacent lots Public sewer manhole/cleanout Petroleum tank /"1//0 WATER SAMPLE RESULTS: Coliform / Nitrate Date of sample: ill/ ,~.p~. [c]_~ B. SEPTIC/HOLDING TANK DATA '~,/z~ Date installed Tank size C[eanouts (Y/N) ~ High water alarm (Y/N) Date of pumping 0oio Collected by: Other bacteria _ Compartments Foundation cleanout (Y/N) Depression (Y/N) Alarm tested (Y/N) _ Pumper SEPARATION DISTANCES FROM SEPTIC/HOI.DING TANK TO: Well(s) on lot To property line On adjacent lots Absorption field Foundation Water main/service line Surface water/drainage 72-026 (8/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA :~/?~ Date installed Length _Width Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain Soil rating (GPD/Ft2) Gravel thickness Cleanout present (Y/N) Results (pass/fail) Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested On adjacent lots Sudace water .System type Total depth Depression over field (Y/N) for After test If yes, give date Property line To existing or abandoned system on lot Cutbank Water main/service line Driveway, parking/vehicle storage area Bedrooms E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to afl MOA and HAA guidelines in effect on the date of this inspection. Date HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number 'CHEMICAL'& ,GEOLOGICAL LABORATORY TELEPHONE (907) 562-2343 5633 B Street \ Anchorage, Alaska 99518. ~ Drinking Water Analysis Report for Total ~ 31iform Baeteda TO BE COMPLETED BY WATER SUPPLIER ~-R~IVATE WATER SYSTEM SAMPLE DATEili~i~t [/'~-~ ~ SAMPLE TYPE ~2 :''~' [] el k~:~(forr ampe%, "*"" with lab rsf. no. '~ : ) : [] Treated Water [] Special P6:i~oap,. ' SAMPLE '~ ,~ ~me ~lleet~ LoCA~ON . .~ . ~ll~t~ ~ ~ COMMERCIAL TESTING & EINEERING CO. AK DIV TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mall. Date Received Time Received I"~ l © Analytical Method: Membrane FlEer * No. of co on es/100 mk ~' Lab Ref. No. Result* BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Verlllcatlon: I.SB Fecal Coliform Confirmation Final Membrane Filter Results BGB Colltorm/lO0 mi Coliform/100 mi Reported By TNTC = To? Numerous To Count OB- - Othe~'Bacterla Member ol the SGS Group (S PART ONE OF TWO: REMAINDER TO FOLLOW s~ncE,o,,. REPORT of ANALYSIS Chemlab Ref.B :93.4801-1 Client Sample ID :1/8 SKYWAY PARK EST. OUTSIDE FAUCET Ma'trix :WATER 5633 8 STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Client Name :TOBBEN SPURKLAND, P.E. WORK Order :70928 Ordered By : Report Completed :09/16/93 Project Name : Collected :09/14/913 @ 11:41 hrs. Project~ : Received :09/14/93 @ 1'7:10 hrs. PWSID :UA Technical Director:STEPME~ C. EDE Sample Remarks: ROUTINE SAMPLE COLLECTED BY: STUART. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate.-N 0.10 U mu/[, EPA 353.2/300.0 10 09/15 DJS * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U := Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than Member of the SGS Group (Soci,~t~ GOnOrale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received July Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 15, 1976 2:30 p.m. 7-16-'76 Friday Pratt 1. Approval requested by: Mailing Address: 2. Property Owner: W.D, Mailing Address: t Reeve Phone: Phone: C,~ ~-~' //5w ~ Legal Description: Lot 1 Block 8 Skyway Park Estates Location: 1100 Shore Drive, see attached map 5. Type of facility to be inspected 6. Well Data: Individual A. Type Single family C. Construction Sewage Disposal System: A. Installed ~]>^~o]b~ C. Septic Tank: 1. Size D. Seepage Pit: 1. Absorption Area E. Disposal Field: Total length of lines No. of bedrooms B. Depth D. Bacterial Analysis Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank 2 B. Installer 2. Manufacturer 2. Material , Absorption area , Other contamination , Absorption area C. Absorption area to nearest lot line ., Sewer Lines __ EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Rec. ;t for Approval of Individual S ~r & Water Facilities Lega~ Description Lot 1 Block 8 Skyway Park Estate__s Comments Approved _ -~ Disapproved Date Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) July 14, 1976 Municipality of Anchorage Department of Health & Environmental Protection 2516 Tudor Road Anchorage, Alaska 99507 Attention: Laura Harrison Dear Ms. Harrison: This is to request a water test be made on the water well at Lot 1, Block 8, Skyway Park Estates. The location 'is 1100 Shore Drive (map attached). The resulting health certification will be used for bank loan purposes. The well WDR:njg Attachment serves a single family, two (2) bedroom home. Very truly yours, W. D. Reeve 06-1220[a) ~ev. 1973 DATE ALAS. DEPARTMENT OF HEALTH AND SOCIAl. SEt 'ES DIVISION OF PUBLIC HEALTH Lob No. iNDIVIDUAL AND SEMI-PUBLIC BACTERIOLOGICAL WATER ANALYSIS OFFICE INDIVIDUAL [] 4AME SEMI-PUBLIC [] CHLORINE RESIDUAL PPM [JEPORT RESULTS TO ADDRESS CITY ' ~ - ADDRESS ~C)F SOURCE ' , ." ' ZiP CODE Analysis shows lids Water SAMPLE to be: [] Satisfactory [] Jnsatlsfactory ~ Questionable [] Sample too long in transit; sample should not be over 48 Imurs old ol examinalion 1o Tndicate tellable results. Please SANITARIAN'S RFMARKS COMPLETE THIS SECTION ONLY IF WATER IS .AN INDIVIDUAl. SUPPLY SAMPLE COLLECTED ]¥ ' - ] DATE COLLECTED TIME COLLECTED LOCATION: MATERIAL: Building Sewer- [] Cc*si Iron [] Wood [] Tile [] Fibre [] Asbestos GENERAb Does Wc~ler Become Muddy or Discolored? [] Yes [] No When? ~ E] Of Well [] Other PURPOSE OF EXAMINATION: Illness Suspected? [] Yes READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE [] No [] Yes ~] No Signature 06 1~2o (bi BACTERIOLOGICAL WATER ANALYSIS RECORD Rev, 1973 dose Broth 10cc 10cc 10cc 10c¢ 10c¢ 1.0cc 1,0c¢ 24 Hours illJanl Green 24 Hours 48 Flours iO~T~ LI Ty ,3' LOT SURVEY CE?__TIFLCATION _. Lot ]¥. , Block Anchorage Recording Precinct, Alaska / 'S'Ho~,e AN CHOI:{ It Is the responsibility of the owner or bu!ldcr, prior to constrtlction, ~o verify p~ot×~,e(I building grade relative to fJll- is,~Ted g~ade and utkiiW connections and to detern-,ine the exCtence ol any ease- I~c~iM, covenants, or re'-trlet!ons whWh do not appear on the recorded subdlvb sion plat, LEGEND: Brass Cap Monument Iron Pipe Steel Pin Survey Hub ~ Tack REVISIONS Residencer of: ~ ~ ~- T~: ~ ~, -~,~.. ..........