The URL can be used to link to this page

Home My WebLink AboutSKYWAY PARK ESTATES BLK 8 LT 12A3 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 Water System Permit Permit Number: OSP231052 Work Type: Well Initial Tax Code Number: 01910224000 Site Legal Address: SKYWAY PARK ESTATES BLK 8 LT 12A G:2728 Effective Date Expiration Date: �I�1Cit� Cl t)C rtInent 4/7/2023 4/6/2024 Site Mailing Address: 1610 SHORE DR, Anchorage Owner: BLOCK JOINT REVOCABLE TRUST Lot Size in Sq Ft: 109420 Design Engineer: Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well Q 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 Special Provisions: 1. Water storage is for the well located on the eastern side of the property. 2. Storage tank to be NSF certified. 3. Tank to be marked POTABLE WATER. Received By: r' S �tCD 7.0 Issued By: Date: Date: l 7 Zp 2 Development Services Department _ r� Phone: 907-343-7904 On -Site Water &Wastewater Section ^- ' Fax: 9D7-343-7997 ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. -019-102-24000 Property owner(s) BLOCK JOINT REVOCABLE TRUST Day phone 907-575-8077 Mailing address 2627 C STREET STE 100, ANCHORAGE, AK 99503 Site address 1610 SHORE DR, ANCHORAGE, AK 99515 Legal description (Sub'd., Block & Lot) SKYWAY PARK ESTATES, BLK 8 LT 12A Legal description (Township, Range & Section) Lot Size 109,420 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial Single Family (SF) 0 (w/wo ADU) Septic Tank ❑ Upgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage [X] 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 Munici al Codes. 1 & r (Sign roperty owner or authorized agent) l9 Permit/Rush Fees: -1 YC_ Waiver Fees: Date of Payment: y A6�2 -� Date of Payment: Receipt Number: O 316 60 Receipt Number: Permit No. i)is f Z 3 /,JS Z Waiver No. GADevelopment ServiceMBuilding Safety\On Site Water and Wastewater\Forms\Cllent FormsTermit Application.doc )Lo § Y � \ � _\{� )k ]! as -5 »fk#®k# f;®E f #§kro k)2 ) §)%/§22 ® § k m;§k � 2 G � % , \B'l0 . l m ��.\2 Y � \ � _\{� )k ]! as -5 »fk#®k# f;®E f #§kro k)2 ) §)%/§22 ® § k m;§k ANCHORAGE Certificate of On -Site Systems Approval Parcel I.D. 019-102-24 Expiration Date: Legal description SKYWAY PARK ESTATES BLK 8 LT 12A Site address 1610 Shore Dr Anchorage Current property owner(s) Block Joint Revocable Trust Phone: 907-343-7904. Fax: 907-343-7997 X The On-site system(s) is/are approved for 6 bedrooms Conditional approval for bedrooms, with the following stipulations: ETA Original Certificate Date,242242�023— This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality ot Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory____.,__ Nitrate Advisory Tank Age Advisory Arsenic Advisory X Other COSA ApprovaIjune 2022 MUNICIPALITY OF ANCHORAGE r Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907.343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 019-102-24 Complete legal description SKYWAY PARK ESTATES; BLOCK 8, LOT 12A Location (site address) 1610 Shore Drive Anchorage Current property owner(s) Block Joint Revocable Trust 2. ON-SITE SYSTEMS SIZED FOR 6 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank 0 Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ G'��D Waiver Fee $ Date of Payment a �(U /g() Date of Payment COSA # 0 5 0- 93 1oa9 Waiver # 0gg23 y COSA Application—June 2022 COSA Checklist Legal Description: SKYWAY PARK ESTATES; BLOCK 8, LOT 12A If more than 1 well and/or septic system on lot, provide separate checklist. EASTMEST . /Parcel ID: _ !�+n� fO Z J'6)Z3 `T I 019-102-24 served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 4+/4+ gpm Date drilled issa?n97o?Total depth 45.6+/55.9+ ft Water storage tank volume N/A gallons Cased to UNKNOWN ft f ected for coliform test? ❑ Yes No ❑■ Sanitary seal is functioning correctly Colif m cteria is Negative ❑■ Wires are properly protected NitrI 4.35 mg/L [] Nitrate less than MRL (ND) Casing height (above ground) '18+/'°is+in Arsenic 13.4 ug/L Arsenic less than MRL (ND) Date of flow test for COSA 9-8-22 / 9-8-22 o y GEG LTD. Static water level at beginning of test 42.9/45.4 ft. Date 9-8-22 / 9-8-22 Comments 2 WELLS ON PROPERTY - TESTED SEPARATELY 'PER GEG TESTING DATA "CASING EXTENDED - SEE ATTACHED PHOTO AND EMAIL WITH MOA (ATTACHED) B. TANK DATA C. LIFT STATION Measured operating fluid level in septic tank ❑ Required maintenance completed Date of pumping Age of lift station years ❑ Required maintenance completed, if AWWTS Lift station material / Comments: Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or feel of used for more than 30 days prior to date of st) Gallons introduced gallons date Any rejuvenation tre ent (past 12 months) If yes, enter to Comrne is/Deficiencies: COSA Checklist June 2022 Adequacy test e Results Pass Fluid d h prior to test in W er added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) Effective depth used in Effective depth remaining in in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100'Community *NSA Sewer Manhole/Cleanout > 100' ❑Yes if No ft ❑Q Yes if No ft Neighboring Tank > 100' ❑o Yes if No ft Private Sewer/Septic Line > 25' ❑■ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No NSA ft Holding Tank > 100' ❑■ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft ❑■ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft R Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' Yes if No ft Tank to Property Line > 5' ❑ Yes if No ft djacent Lots: Field to Property Line > 10' ❑ Yes if ft Private Wells > 100' ❑ Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200' ❑ Yes if No ft ervice Line > 10' ❑ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *100'+ TO LIFT STATION THAT TRANSFERS WASTEWATER TO AWWU SEWER G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Garness Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Garness Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry 4o6o0p0 practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may o 44 exist that were not identified during the evaluation. The operational life of all wells and septic systems depend o upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing * 9 H the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not : • • • • . • • • • • • • • . • • • • . • •, • guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regardin the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform J fr A. rness.G . adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG Q —795 p� to perform the evaluation. Reliance upon the information provided in this report by any other person or parry 09 (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 4�4 e LICENSE�Q frofession�oo COSA Checklist -June 2022 EC 884 000 00 0 2%023 A M jF,O &_D Arsenic Advisory Certificate of On -Site Systems Approval # OSC231029 Subdivision: Skyway Park Estates, Block: S, Lot: 12A A water sample revealed an arsenic concentration of 13.4 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. EASEMENTS OF RECORD, OTHER THAN WEST 289.97 THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON TURNAGAIN ARM UNLESS OTHERWISE NOTED. This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to FB 22-5, pg 25 establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, FB 21-6, pg 24 the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. FB 19-6, pg 61-65 FB 05-7, pg 20-21 8292B SCALE: V= 50' OF • q�; qs l AW Aw'40- 49 th00 , •. lizabeth L. Walatka .'.2 oo �� s� • • 8036 — LS , • • , O,�'CssloNm•�`� 2-2-2x23 RECERTIFIED 2-01-23 W' Revised 9-28-21 Added distance from deck to Easerly property line RECERTIFIED 9-21-21 AS -BUILT NO CORNERS SET THIS DATE 1 hereby certify that I have performed a Mortgagee's inspection of the following described property: LOT 12A, BLOCK 8, SKYWAY PARK ESTATES Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and d not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 16th day of October 2019. FRED WALATKA & ASSOCIATES, L.L.C. BE 1 907-248-1666 Engineers and Surveyors David Garness From: Townsend, Curtis L. <Curtis.Townsend@anchorageak.gov> Sent: Wednesday, December 14, 2022 4:09 PM To: David Garness Cc: Erik Widger; Wockenfuss, Deborah M.; Jeff Garness Subject: RE: 1610 Shore Drive - Well Clamps This is my summary of what we were most interested in knowing: • Nitrates are at 3.8. No nitrates or bacteria. • The well head is not protected by a roof eave, but the house protects the well head from substantial amount of surface runoff • The ground slopes away from the house and concrete form. • There is minimal surface area inside the concrete form to collect water. The intent of the code is being met. We will accept this current condition. Please include the above justifications in your COSA application. Thanks for reaching out to us regarding this situation. Curtis Townsend, PE Onsite Water and Wastewater Municipality of Anchorage 907-343-7908 From: David Garness <David@garnessengineering.com> Sent: Friday, December 9, 2022 3:02 PM To: Debra Echavaria <deb@awps.com>; Townsend, Curtis L. <Curtis.Townsend@anchorageak.gov> Cc: Erik Widger <erik@garnessengineering.com>; Wockenfuss, Deborah M. <deborah.wockenfuss@anchorageak.gov>; Ecklund, Timothy J <timothy.ecklund@anchorageak.gov>; Jeff Garness <Jeff@garnessengineering.com> Subject: RE: 1610 Shore Drive - Well Clamps [EXTERNAL EMAIL] Curtis, Attached are the water samples. Nitrates are 3.87 mg/L when they were pulled on 9/8/2022. From: Debra Echavaria <deb@awps.com> Sent: Friday, December 9, 2022 10:34 AM To:'curtis.townsend@anchorageak.gov'<curtis.townsend@anchorageak.gov> Cc: David Garness <David@garnessengineering.com>; Erik Widger <erik@garnessengineering.com>; 'Wockenfuss, Deborah M.' <deborah.wockenfuss@anchorageak.gov>; 'Ecklund, Timothy 1'<timothv.ecklund@anchoraReak.gov> Subject: RE: 1610 Shore Drive - Well Clamps Hello Curtis, Please see the responses from Mark below. He performed the work on this property. The responses are listed in red. NJ Skyway Park Estates Block 8 Lot 13 #019-102-12 i Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 019-102-12 1. GENERAL INFORMATION HAA # C 5 nti-G3 Expiration Date: 2 — - Oro Complete legal description Skyway Park Estates, Block B. Lot 13 Location (site address or directions) 1620 Shore Drive. Anchorage Current Property owner(s) Edward v& Judith Demers Day phone sil Mailing address _ AK t ggtcl0 -OQq Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ 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 4 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) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. 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. (Certificates may be reissued for a period of up to one year with valid water samples.) 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. 4. 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 application, shows that the on-site water 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 Watkins Engineering, Inc. Phone 349-1851 Address P.O. Box 110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis Date 11/9105 5. DSD SIGNATURE 1dy W. Ellis ✓ Approved for 3 bedrooms. �► `'••. CE -1o577 Disapproved. ssp'ini Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: A Original Certificate Date:—/1-9-05, (rw.01=) Municipality of Anchorage ' Development Services Department Building Safety Division O"Ite Water & Wastewater Program ' • ' 4700 Sotto Bragaw St. P.O. Box 196650 Anchorage, AK 99519.8050 www.muni.orglonsite (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Skyway Park Estates Btk 8 Lot 13 Parcel ID: 019-102-12 A. WELL DATA Wen type Pd If A, B, or C provide PWSIO 0 _ Well Log (Y/N) no Date completed 1970 Sanitary seal (Y/N) V Wires property protected (YM) Y Total depth E* R. Cased to b3+ R. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test NA Oct 19, 2005 Static water level NA ft. 42 ft. Well production NA g,p,m, 4.8 g.p.m. WATER SAMPLE RESULTS: Conform oolonies/100 ml. Nitrate 3.69 mg A. Other bacteria 0 colonies/100 mi. Arsenic: NA mg./I. Date of sample:10.1-06 Collected by: Rocky Trainor B. SEPTIC/HOLDING TANK DATA Tank Type/Material NA - ASU sewer service Date installed Tank size gal. Number of Compartments _ Cleanouts (YM) Foundation cleanout (YM) _ Depression over tank (YM) _ High water alarm (YM) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed NA Son rating (g.p.d.M' or fe/bdnn) _ System type Length R. Width ft. Gravel below pipe R. Total depth R. Eft. absorption area R' Monitoring tube Depression over field Date of adequacy test Results (Pass/Fall) For _ bedrooms Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in. Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. UFT STATION Date installed NA 'Pump on' level at _ in. Size in gallons `Pump o1P level at _ in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot NA Absorption field on lot NA Manhole/Access (YIN) _ High water alarm level at Meets alarm & circuit requirements? On adjacent lots NA On adjacent lots NA Public sewer main ISO'* Public sewer manhole/cleanout IW* Sewer /septic service line W Holding tank NA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation NA Property line Absorption field Water main Water service line Surface water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property fine NA Building foundation Water main Water Service line Surface water Driveway, parkwWwohide storage Curtain drain Wells on adjacent lots ._ ' F. COMMENTS .YOF ~it+ G. ENGINEER'S CERTIFICATION I car* that I have determined through field inspectlons and t review of Municipal records that the above systems are in Ct dy W E1118 ;! conformance with MOA HAA gtddellnes in effect on this date. CE.low 1' Engineer's Printed Name Cindy W. Ellis Aa...... Date 11/9/05 HAA Fee $ 14.S0 . aD Waiver Fee S Date of Payment l I i Date of Payment Receipt Number :7 I n°S'h� lA((1 _ Receipt Number (Rev. 12101) In. LOT 14 82926 �rieOry�e ` R,3p0 0 130 00 0000 � 143 �4 (Comp) ` • (Rrd) o LOT 13 33' Right of Way Easement West 130.00 (Record & Held) EMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOHNN HEREON. Fb 05-7. p920.21 `!ty F "' �asern. 5• LOT 12 SCALE: 1e= 49 AS.SUILT NO CORNERSSETTM DATE 971 .-7*vwWPV=wvw""""`°d""°°"'a" W" *vwWPVWP«-'-"trreto, tnet ro knpevemabMretn and Fred ercrwch e s ro roses Me. ker wee on..kl P� dyY•Alm l�:� ArohoraDe. —FREDwALATKA&ASSOCIATES E�pwe, ud SWAYas Wdadat t1O. Ylyb t r� i ~-----'~7 HOT LINE Greater Anchorage Area Borough Department of Enviroumental Quality COMPLAINT AND ACTION FORM HOUSING AIR POLLUTION CASE NO. PUBLIC FACILITIES JUNK AUTOS DATE _7~NOiSE NUISANCE INVEST: _ ~__ SEWER & WATER -- ~ OTHER / - RESP, oONSIBLE PARTY . ADDRESS PHONENUMBER - hZ.-' tg ~ RECORD OF CONTACTS AND CORRESPONDENCE Date Time Comments / ~ . .- , . TIME & DATE COMPLAINTANT CALLED BACK Eq-045(9-74) Use Reverse Side of Form for Further Comments MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES_ Division of Environmental Services . 0n-S!te Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTN AU'rHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# O/C~'~ }0~.-I'~ NAA# ~.~L~f(:~[~ 1. GENERALINFORMA'rlON Completelegaldescription _/,~/' i~ g'/oc/~ ~.., _C/~,y~Jo, y /~rAr ~,~. Location (site address or directions) Property owner r~o ~r'l- Mailing address. ¢/o R~/W~.,~ Lending agency. ,4/~'k'~ Mailing address ~0o0 Address ~dO0 Cor~ ~/.,. ~c4o~. Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: _ Day phone _ Day phone '7~d"- 2~'-~ _ Day phone 3. TYPE OF WATER SUPPLY: Individual well Community Wel 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: "' NOTE: Individual on-site Idlng HO tan k ........ Community; on;site " Public .sewer. , '~ If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system, ;'2-025 (Rev. 1/81) F~ont MOA 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 comp(lance .with all Municipal and State codes, . ordi.nanc~s, and r.,egulat!ons in effect on the date of this inspection. NameofFirm /~/¢'¢-/~/¢ 7-~c.~c,~/ ..C~¢~. v~,c~ Phone~,C~-F ' Engineer, s signature ~-¢.~~ j~'. /n.y{.~.~ ,~.~. ...... . ~.' bedrooms. ~/ Appr, oved, for bedrooms, with the ~OIIowing stipulations: Disapproved. Conditional approval for Additional Comments By: The Munic pa ty of A, nchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representat ons g~ven m 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 om ss 0nsn the Profess ona eng neer's work :~ ~;/*i~,;~'.;'~,.?~'~:,?~ii:'~ ':~'~ ~ ?'~-~ ''~ :}i:i Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~,o'f I ~') ~//'~ ~ .,C~-? ut, a? Par/c Parcel I.D. A. Well Data Well type Log present (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Total depth .5'o,,.6' /¢~,.C~h~,a/-er _Cased to Sanitary seal (Y/N) ~ 5~O' Casing height Wires properly protected (Y/N) AT INSPECTION FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /N. ,4. Absorption field on lot /q, A. Public sewer main '~ I Oo' Sewer service line ;> ~' g.p.m, ,,5', ~/ + ; On adjacent lots /V. ,¢. ; On adjacent lots /V. ,4. Public sewer manhole/cleanout -~ f co ' Petroleum tank I~/on ¢ s~ ¢~ WATER SAMPLE RESULTS: Coliform 0 col Date of sample: ? / B, SEPTIC/HOLDING TANK DATA Nitrate '¢, Ig tn,,? / ~ Other bacteria Collected by: 0 ct.,! Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size Compartments Foundation cleanout (Y/N) Depression (Y/N) Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Sudace water/drainage On adjacent lots Absorption field Foundation Water main/service line 72-026 (~93)' Front CONTINUED ON BACK PAGE C. LIFT STATION N, ~r. 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 D. ABSORPTION FIELD DATA IV. ,4, 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) Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested On adjacent lots Soil rating (GPD/FF) Gravel thickness Cleanout present (Y/N) Results (pass/fail) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lets To building foundation On adjacent lots Surtace water Surface water System type Total depth Depression over field (Y/N) for After test if yes, give date Bedrooms Property line To existing or abandoned system on lot Cutbank Water main/service line Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I cerllfy that I have checked, verified, or conformed to all MOA and HAA guidelines in Signature ~-~ Engineer's Name T,~ Date ~'¢,~)/- /,.~ CE-3589 HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)° Back / Waiver Fee $ Date of Payment Receipt Number HOT LINE Greater Anchorage Area Borough Department of Environmental Quality COMPLAINT AND ACTION FORM HOUSING PUBLIC FACILITIES __ NOISE ~ -- SEWER & WATER COMPLAINTANT: ADDRESS: NATURE OF COMPLAINT: AIRPOLLUTION CASENO. JUNK AUTOS DATE NUISANCE INVEST: OTHER d / LOCATION OF COMPLAINT: RESPONSIBLE PARTY ADDRESS PHONE NUMBER '~/' RE~0~D oF CON~TACTS AND CORRESPONDENCE Date Time Comments ~ ~ ' , .1~ / ~ , :~, ' TIME & DATE COMPLAINTANT CALLED I~ACK Use Reverse Side of Form for Further Comments EQ-045(9-74) /~--~ HOT LINE HOUSING PUBLIC FACILITIES NOISE SEWER & WATER COMPLAINTANT: ~ ADDRESS: Grehter Anchorage Area Borough Department of Environmeutal Quality COMPLAINT AND ACTION FORM AIR POLLUTION CASE NO. JUNK AUTOS DATE NUISANCE INVEST: OTHER NATURE OF COMPLAINT: LOCATION OF COMPLAINT: ,.-, · /i PHONE NUMB, ER RESPONSIBLE/_~PARTY ADDRESS ?~'~--~ '~f > ~ 7,/' /' /) /' '~ '~ - "-- RECORD OF C(ffNTACTS AND CORRESPONDENCE ~' ~/ ,/ ' __ Date Time Comments ~ ~ ~/~-.... ~ - . __ _'.>.;,: , :,:.. :...., .,.., ,, ,.? ,.,. ~,.,.,..: .:/:. ,::::.: :-/:........,<::.,/ TIME & DATE COMPLAIN'rANT CALLED BACK Use Reverse Side of Form for Further Comments EQ-045(9-74) September 25, 1975 GREATER ANCHORAGE AREA BOROUGH 3330 C STREET ANCHORAGE, ALASKA 99503 DEPARTMElqT OF ENVIRO~IENTAL QUALITY Z74-4561 C L e A Mr. and Mrs. Robert Rasmussen Box 10-199, Klatt Station Anchorage, Alaska 99502 Dear Mr. and Mrs. Rasmussen: It has been brought to our attention that public sewer is available to Lot 12, Block 8, Skyway Park Estates Subdivision. W A T E R According to Greater Anchorage Area Borough Ordinance, Chapter 16, Article 16.45, Section 16.45. 050: "Septic tank-seepage system sewage disposal facilities shall not be installed or used on any premises where sanitary sewers are available within seventy (70) feet of the nearest lot line of said premises..." . The Greater Anchorage Area Borough Public Works Department has checked their records and they indicate that your structure(s) is not connected to the sanitary sewer. Would you please check your records to verify that the structure(s) is or is not connected and notify us immediately if your records indicate that a connection has been made. C 0 M M U N [ T Y If we do not hear from you within seven (7) days, we will assume that our records are correct. We, therefore, request you connect any and all structures located on the subject property to public sewer by October 25, 1975. You must apply for a connection permit from the permit officer for the Greater Anchorage Area Borough, 3500 East Tudor Road. If you have any questions regarding the above, please do not hesitate to contact the permit officer at 279-8686, extension 259 or the Department of Envzronmental Quality at 275-4561, extension 141. Sincerely, Robert Neale Principal Environmental Control Officer RN/lw September 25, ,'1.975 File No.: 4-1 Mb.. o,nd Mrs. Robert Rasmussen Bo× 10-'199, Ktati Station Anchorage, Alaska 99502 Dear Mr. and Mrs. Rasmuosen: It has been brought to our attention that public sewer is available to Let 12, Block 8, Skyway Park Estates Subdivision. According to Steerer Anchorage Area Borougl~ Ordinance, Chapter 16, Article 16,4§, Section 16. "Septic tank~seepage system sewage disposal facilities sb~l not be ln0talled or u~s~a~d_ on ~y p~emtses wher~ s~tt~ ~ewe~s al'e syllable within sevenW (70Y feet of tho nofwe~t lot line of ~aid promises..." The Greater Anchorage Area Borough Public Works l)ep~rtmcnt h~ checked their records and they indicate that youp structure (s) Is not connected to the s~ta~ sewer. Would you pleane check your records to ver{~ that tho structure(e) is or Is not connected and notify us ]~mcdtately if your records indicate lha~ a ~nn~ilon has b~en made. If we do not hear from you within s~even (7) days, we will assume that our record~ ars corre~. We, therefore, request you connect any and all 8truetuveo looated on the subject propm~ to p~bli, e sewer by October 2~, 1975. You must apply for a connection po~mlt from the permit officer for the Greater Anchorage Area Borough, 3600 East Trader Road. If you have any questions r~gardinff file above, please do not hasl~te to contae~ theDe~mit officer at 279-8686, oxtemston 259 or the Dopa~mont of En~ronmentd Qut~iW at 275-4561~ e~ension 141:. Sincerely, Robert Neale P]:ineipai Environmental Control Officer RN/Iw