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Home My WebLink AboutRINNER RANCH ESTATES LT 1 L!F:uZIN 'TH(:i' 'F"r'i:::'E ()F i:::'tJE:I... ]; (Z;: !'!E;L.J t"'J;!;~',i;!;!'"!!...ll'"l DZ!;:!!i;TFINE:Ei; F'i:;b:Tr'! F::! PR :[ VFfT'rE!z !,ll:i:J .... T'O f::l F'F;:;(VR'/'E -E,:.ktl_.~-,; L.fi'!E ];;5 ;?:;:!; F;'EIET .:::.I'E) TO .:'~ tX: ?,'ih'il. I?..I '!; '"', ':;!;Ei:J,.t~L(!;i: L. ;i; NE _[ :5 '?!5 I::'E;E')'. P.I[::.I....L. t...OG:~'i; F:!t:;;:tZ I:;;:E;i.;:&.I ;[ !:;:E;!?, l:::ff,![) I"!1 ':::;'!" Ii:i:.}:' !qEZ"fL!I::~:NED 'l'O '.'hie i:::,[~;¢:'l:::!F,~:"J'i"l£~;J'.,!'!' J,t;[ J~--l];ii',J _.~;i;;~i OF '!"bile t.,!!E[ ..L. (:::Oh!i:::'L.E"!" ;[ Y' I'.1. · . I.~..u-.., .i ,.:. O"i"!'"IE;I:;;: ?.I;L~);;¢J ;l; I:;;:E:i'!EENT:E; l"!Fl"r' i::iF::'l:::'L."r'. SF'E:E: ;l; ¢' ;[ "' Fl'f' t' (;ll",j:~; I::!!",![:' E:(;d',!S TI:q:UE:T ]Z O!"l r'- r · ,"~ ¢ i" ,'7 ....... FI?Fl ];. I:::ll::'.i. !~::' "l" ;'l ;i; t',![{i;I.J~;E; F'i;;~:OF'EP. :!: N?};"Ft::I!....LFI"!" ;!; 0t',i. .................. ' ~ Z~; -'~-' ~'"""" * ' ~* ii:T;" ,i;;;;' ,,::;;;;' ~"'" j::;:' ""7 F:::" ~""~ ~:;:1~ i~::;;;:" ij;;~, '*:;;; -'~ ,, 'il ";::::~ ~;'-:q~ - ~ ~-. *; ..~..~ .. ,, _::.=..,~ ....... :, ....~ ........... ¢ - ..... · ........................................ ..~.....--.. ;1_' (;:: E l:;i: "F ;l; ,'/::' "r' 'THFIT :;I..: ;( R!'"t !:::'FiI"!;i;L.;I:F::IFR !:~'OI';~:"t-H E',? THE; 2; ;[ l.,.! :[ L.L ;[ I:.,I:E;7'F!L! .. THE S'.,.'~;-!"E;I"I ;1: !'.,t I:r~E:E:OF;':r!)FiI"4(::E !.,.! Z 'l'H THE: E:E~DES :~; ;~; (:; ?.,! !~: c,.......;. ;:;~;;;.., :7 ".; ;;' ;~' :'.:.: .......... :'.;: 7.' '-" :::' '-' ::: .~;':::' '7.~;:'-' ';:::~" ::x:'~: ;~;;'.;',';;::' ;j~':;~ ~'~;"" '.;~'",."':: ..... MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAl. II'.IF O R E"IATt O N (a) Application Date 37, / E I/~ 5' Legal Description (include lot, block, subdivision, section, township, range) __ _AvF .~./ P,nn~,~ I'~nc/~ --eld Location (address or directions) Applicant Address Iq,~$O ~c~ ~ /3r,'t6~o'~'~,¢'¢' (c) Applicam is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); . ~ ¢/,~' -13,5*,.,fi- Business rd) Lending Institution Telephone Address re) Real Estate Company and Agent Address Telephone Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms ~ Other WA'f ER SUPPLY Individual Well ~ Community [] Public [] Note: II community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite [] Public ('-~ 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. P~r~ 1 ~f 9 72-025{11/8'I) Ef,!GIr~L-:FRI;~G t::IPM PI1OVIf)ING 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/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 wastewmer disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of [his inspection. Date .-~ / ~( (~( Engineer's Seal ~,)prov~d ,or'~-~t~-o~ bed roo ms by/~'¢~'~~' Approved _ _t~__.~ _ Disapproved) ' Condition~, Terms of Conditional Approval CAUTION 'the. t~4uncipatily of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DI-IEP 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 professJol/al engineer's work. MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~,-o WELL DATA Well Classification Well Log Present (Y/N) Total Depth _9 7 .~)~ Cased to Static Water Level If A, B, C, D.E.C. Approved (Y/N) Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Date Completed I¢-/~ /~ / Yield Depth of Grouting N~/~. Pump Set At :.> '?,5 Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ~\i per To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments V'e ; On Adjoining Lots N,/~. On Adjoining Lots N, To Nearest Public Sewer To Nearest Sewer Service Line on Lot '&.J' ; Date ~ / B, SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Size No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026{ 11184~ C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed '~-~ ,~'~ '"'~¢-- Date Company F:~-z/L~/ Receipt No. ~ Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal : -- ' DA i E'~ECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE I NSP ECTO R INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 i ,~,,.'~ ~1~.,~ / ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts ou page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing. 1. PROPERTY OWNER / ': ~ // /' PHONE PROPE~TY~ESIO'ENT(Ifdiffereprf~omabove) p PHONE 2, BUYER / PHONE MAILING ADDRESS 3. LENDINGINSTI~dTION J ~:~ - PHONE 4. REALTOR/AGENT// I PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION ~,~,~_~.' ~_ .: /-~""/ //~ ~ //~ ~ STREET ~OCATION ~/ ~ ' : 6. TMPE'OF RESIDENCE NUMBER OF~BEDROOMS ~ One ~ Four ~ SINGLE FAMILY ~ Two ~ Five ~ MULTIPLE FAMILY ~__. Three ~ Six [] Other 7. WATER SUPPLY ¢4~]'~-I N DI VI DUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Io§ if available,) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** ,{~ PUBLIC UTILITY .YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6179) ~ THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED E~] PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING ,'~ive dimensions: TYPE OF TANK MANUFAC~'URER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS /APPROVED FOB BED.0OMS [] CONDITIONAL APPROVAL {letter must accompany certificate} [] DISAPPROVED 72-010 (Rev. 6/79)