HomeMy WebLinkAboutSKY RANCH ESTATES #1 BLK 4 LT 7Sky Ranch
states
Lot 7
Block 4
#015-3O 1 -O5
Municipality of Anchorage Page / of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~/°lFf OlO~gl PIDNumber: ~)1~'- '~,o I-O.5
~m~: ~ ~/ i~ ~ t~ Wastewater System: D New ~ Upgrade
~ I~ ~'~'~5 ~ ABSORPTION FIELD
Phone: ~ No.lof B~drooms:
~ ~ Deep Trench ~ShallowTrench D Bed ~ Mound ~ Other
I
Total Depth from original grade:
LEGAL DESCRIPTION SoilRating: ~ GPD/~
L~t: Block: Subdiv~ion: ~ ~ Depth to pipe boEom from original grade: Gravel depth beneath pipe
Township: Range: Section: Fill added above original grade: Gravel length:
J -- 0 Ft. ~ Ft.
Number of lines: Distance be~een lines:
WELl.: . D New ~ Upgrade Gravel width: ~ Ft. ~ '~ Ft.
Classification (Private, A,B,C): Total Depth: Cased TO: Total absorption area: Pipe material:
~ill~r: Date Drilled: StalicWaterLevel:Ft. InstaL]er: ~e~'~ Date installed:
~ GPM Ft. Ft.
SEPARATION DISTANCES ~ s~ptic ~ Ho~di.g ~ S.T.E.P.
TO Septic Abso~ptlon Lift Holding ~ublic/Private Aanufacturer: Capacityin gallons:
From Tank Field Station Ta~k Sewer Lines ~J~C ~ ~- ~
Material: ~. , Number of Com~ments:
Sudace
Water b o N E LIFT STATION
Lot Sizein gallons: Manufacturer:
Cu~ain Pump Make & Model I Electrical inspections pedormed by:
Remarks: B~H MARK
Location and Description: }
~ ~ Assum~ Elevation:
Eh
ENGinEER,S'sEAL: ,
Depadment of Health and Human Se~ices approval .~'., ~
72-013 (Rev. 9/91) MOA 25
I- ~ANDARD 5-WIDE T£ENCH ~ SWINO tiES'
I ~o Er LONO ~ AC .~2 'ET
AFT TOTAL DEPTH ~ BC 17
I 12~INCHE$ SEWER ROCK ~ AD 48.5
ABANDONED ~
EXISL
I BED C{
~ A 500
~ ~ ~000 GAL
BD 54
EL P//TH BIOCYCLE \
TANK, LEFT IN PLACE
25 50 75 1~
~,Ii~
25 0
I25
BENCH I~ARK: CONCRETE SLAB
ASSU~FED ELEVAtiON 100.00 Fl'
TOBBEN SPURKLAND P.E.
205 Y/ 15TN. AVENUE
ANCH. AK. 9950!
· (907) 279-5916
IIST(Y RANCH ESTATE BI( 4
5611 WISPERINO SPRUCE
JAY BONK
LO'./' 7
II SEPtiC SYSTE$t AS BUILT
DATE: AUG. 2, 1999
SHEEL' 2/5 GRID: 2757
L PERMIT # S~/990199 PI]) # 015-,?0~1-05 SREO407£,DIF6
4-INCH INSULATION
A~COMPRESSOQ
1-I/4 PVC WITH i/8" HOLES AT $0"
STANDARD 5- WIDE TRENCH
40 FT LONG
4 FT TOTAL DEPTH
1.0 FT EFFECTIVE ROCK
5 FT COVER
97,8't'
6" A/IN
SAND BACKFILL
5'-2" I/IN
G'-O" WAX
BIOCYCLE 6000
95. I~
TOP ROCK 94.2~
ND SCALE
(>
SILT BAR£/ER
II~PBRVIOUS SOIL
LEGEND:
I. PR/MARY TREATMENT, SEPTIC TANK
2. AERATION TANK
5. CLARIFICATION TANK
4. DISCHARGE TANK
5. SOIL ABSORPTION
Anchoraqe Ak 99501
.27,9-,f97~
PERk/IT # sw99o199
TOBBEN SPURKLAND P.E.
205 W15th Ave
£KY£ANCH ES?ACE ?K 4 L/77
PIE]CYCLE I(ASTE IYATER SYSTEM
WASTEWATER SYSTEM SCHEMATIC
DATE: AU$. 2, i999
SHEEl~ 3~/5 OR/D: 2737
MLJNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 995~9-6650
¢07) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Upgrade
Date Issued: Jul 16, 1999
E-'xpiration Date: Jul 15, 2000
Permit Number: SW990199
Legal Description: SKY RANCH ESTATES #1 BLK 4 LT 7
Design Engineer: 0007 Tobben Spurkland, PE
Owner Name: Jay Bonk
Owner Address: 5611 WHISPERING SPRUCE DR
ANCHORAGE , AK 99516-2314
Parcel ID: 015-301-05
Site Address: 005611 WHISPERING SPRUCE DR
Lot Size: 19572 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] SepticTank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same (lay.
B. Covered, sealed, and heated to prevent freezing.
Date: 7, l~-99
PROPERTY OWNER AGREEMENT
FOR THE MAINTENANCE OF AN
ON-SITE WASTEWA.TER DISPOSAL
SYSTEM
This agreement, dated -.~ ~[~ 02 ~ 199_~_, is made between the Municipality of
Anchorage Department of HeMth and Human Services (DttHS) and the property
owner(slof: .
This agreement is made for the purpose of maintaining an on-site wastewater disposal
system on the subject property.
The property owners agree to th, e ~" ' ·
ouowmg,
Submit to the Municipality of Anchorage, on an annual basis, an inspection and
operation statement from a registered professional engineer. This inspection and
operation statement shah verify that the engineer has inspected all effluent and air
pumps, timers, and alarms, and that any deficiencies have been repaired and that the
system is functioning as designed.
Q~/ ~'J iSignature)
(Signature)
(Printed Na~e)
(Printed Name)
................................ Notarize Here .........................................
personally appeared before me,
__ who is personally known to me
x~ whose identity I proved on the basis of
__ whose identity I provdd on the 5ath/affirmation of
, a credible witness
to be the signer of the abov,? document, and he/she~nowledge~bat he/she signed it.
Notary Public
My commission expires
203 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907) 27%3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
LOT 7 BLOCK 4 SKYRANCH ESTATE
JAY BONK
S/D
Municipality of Anchorage
Department of Health and Social Services
820 1 Street
Anchorage, Alaska 99501
July 2, 1999
We are submitting an application for the upgrade of the septic system for this lot. The submittal
consists of three (3) drawings showing the present improvements on the lot and the adjoining
properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is
subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil
logs and percolation tests of applicable testholes are also enclosed. The septic system design is
based on the following:
Ground Water at 9Ft.
Use Standard 5-Wide Trench with BioCycle
Soil Rating. From Testhole 09/19/97 James Williams P.E.
3 rain/in = 2.4 gal per sq.ft/day
No. of Bedrooms 3
Required Area per Bedroom: 150/2.4 = 62.5 sq.ft.
Total area required: 62.5 x 3- 187.5 sqft
Bottom Rock At 4 feet
Top Rock At 3 feet
Rock Depth 12 inches
Trench Reduction Factor .87
Total Trench Length 187.5 * .87/5 = 32.6
USE 40 FT
SYSTEM CONFIGURATION
BIOCYCLE
STANDARD 5-WIDE TRENCH
TOTAL LENGTH 40 FT
TOTAL WIDTH 5 FT
TOTAL DEPTH 4 FT
ROCK DEPTH 1 FT
COVER 3 FT
The installation of this septic system will not prevent wells fi'om being installed ou the adjacent lots.
There are no developed o1' natural surface / sub surface drainage courses on this or the adjaceut lots.
The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface
runoff will uot result from this installation.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TES'r
11
12
13
14-
15-
16-
17-
18.
19
20
COMMENTS ~"~"~
PERFORMaD BY
ACCORDANCE
:72-(]06(Rev. 41~)
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
DEPTH?
Manitoring? 0ate: . .
SITE PLAN
Reading Date Time Time Water ' :. "~ Drop
~ / )of 3 ~ ~P,~I~'~{~'IW;~''
PERCOLATION RATE '~ (rmnute$/[nch) PERC HOLE DIAMaTER '~"'
N
TOBBEN SPURKLAND P.E.
205 W 15TH. AVENUE
ANCH, AK, 99501
· (907) 279-5916
I?
RANCII ESTATE BI( 4 LOT
5611 WISPERING SPRUCE
JAY BONK
SEPTIC SYSTEM DES/ON
DA TE: TODAY
SHEET: I/5 GRID: 2757
i PE£MIT # S~/9900XX PID # XX S££04071,DI~G
£EALD I' 50 FT,
STANDARD 5-WlD£ TRENCH ~ .... ~
40 FT LONG ~
,¢ FT TOTAL DEPTH ~ XX
12-MCHES SEWE~ ~OGK ~
REP~CE 500
WITH BIOCYCLE
10D0 DAL LE4VE IN PLACE
,
TOBBEN SPURKLAND P.E.
203 W 157H. AVENUE
ANCtL AK. 99501
· (907~ 279-5916
SKY RANCH ESTATE BI( 4
5611 WISPERING SPRUCE
JAY BONK
LOT 7
SEPtiC SYSTEM DES/ON
DATE: JULY 1, 1999
SHEET: 2/5 GRID: 2757
i PEE'MIT ii SW9900XX PI]) // XX SI~EO407~BW5
4-INCH INSULATION
40 FT LONG
4 FT TOTAL DEPTH
i.O FT EFFECTIVE ROCK
$ FT COVER
[~ AIRCOMP£ESSOB
AID LINES
V _~_ V
S4ND BACKFILL
5'-2"~flN I L-- SILT BARRIER
N~ SCALE
B/OCYCLE 6000
-d
5 FT
GW
£ECEND:
I. PR/MARY TREATWENI, SEPTIC TANK
2. AERATION TANK
5. CLARIFICATION TANK
4. DISCHARGE TANK
5. SOIL ABSORPHON
TOBBEN SPU£KLAND P.E.
205 WlSlh Ave
Anchoroc~e Ak 99501
279-~9¥6
BIDCYCLE b/ASTE ~/ATE[~ SYSfEM
WASFEWATER SYSTEH SCHEMAtiC
DATE; JULY 2, 1999
SHEET: 5~/5 OR/D: 2757
PERMIT # sw99ooxz PIP tt O],~-~OJ-O~ SREOdO73, D~/G
'~AME
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WELL INSPECTION REPORT
~3 r~EW
" ~.UPGRADE
MAILING ADDRESS
EGAL DESCRIPTION
LOCATION
I W~II
DISTANCE TO: [ r~O ~C
Manufacturer ,//~ fl. ~. ~,,e, f'4~/ ~
Liq. capacity in aliens
,~ ~-~g~ IF HOMEMADE:
DISTANCE TO: We
JAbsorption area ~.~ Dwelling
Material
Inside length Width
S1%e (
NO, OF BEDROOMS
PERMIT NO.
/.~ ~,~ ~ ~ n
No, of compartments
Liquid depth
Dwelling PERMIT NO.
Manufacturer Liquid capacity in gallons
Foundation
DISTANCE TO:
Total length f Ii
Material beneath tile
Material
Trench wi th
· ~' inches
PERMIT NO. ~..,.~/cj~_/7~,~l
Distance between lines
Length of each'line
Top of tile to finish grade
Length Width
Type of crib Crib diameter
Well
Total e f fectiv~-~r~o~e~
Depth PERMIT NO.
Crib depth Total effective absorption area
Building foundation Nearest lot line
DISTANCE TO:
Class Depth Driller Distance to lot line PERMIT NO.
DISTANCE TO: Building foundation Sewer linc Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
DATE
LEGAL
Permit $
Applicant
MUNICIPALITY OF A, NCHORAGE ...~. ,'
Department ' ~ Health and Environmental rotection /~ , '.,,//'
825 ~. Street, Anchorage,
264-4720 L/'
~ ~ ~ HANDWRITTEN PERMIT
,,r~ .~/-~ Mailing Address .~//
Legal Description:
Type of Soil Absorption System Is:
Trench: Drainfield:.
Maximum Number of Bedrooms: ,~
Lot'Size:
Seepage Bed: ~.~ Holding
Soil Rating(sq.ft/br)
Tank:
t~_,~The Required Size of
DEPTH LENGTH
the Soil Absorption System Is:
GRAVEL DEPTH g WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel, between the outfall pipe and
the bottom of the excavation(in feet). ~-~ ~]:~,~'o~'~
* * REQUIRED SEPTIC(~) TANK SIZE = .-~c,'g;~ GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by 'the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may r~uire enla~rgement if
the residence is ~e~d~ed to include more tha~bedroo~f
Signe~: ~ (.~~~ Issued by: ~/~/~__~ ~
sw /o2 (¥8].) - _
OL
SOILS LOG ~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
82§ L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
SLOPE
SITE PLAN
10-
12-
13-
14-
15
16
17
18
19
2O
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE (minutes/inch)
TEST RUN BETWE~EN . FT AND F
CERTIFIED BY: D A T E: ~ ~_
72-008 (6/79)
GRE/
ANCHORAGE AREA BO[ ' GH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME -:~n'~'~ ~P~bSt)~) MAILING ADDRESS ~,D, ,/~ Z~/--.2g'? ~=~ PHONE
LOCATION
LEGAL DESCRIPTION ZgT' 7 ~'Z-O£~/~' ~-/ .~/~'~' ,~/y~/~Z
SEPTIC TANK:
DISTANCE [~ / ~0¢~'/~
FROM WELL~/E~¢O/~2 MANUFACTURER ~-~'P//t.fo ~.~
INSIDE LENGTH
__ INSIDE WIDTH
MATERIAL
LIQUID DEPTH.
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY /~) GALLONS.
SEEPAGE PIT:
/..¢x /
NUMBER OF PITS / DIAMETER __ OR WIDTH LENGTH___, DEPTH
LINING MATERIAL//~/~I'~,.~' qq -~%/~RIB SIZE: DIAMETER__DEPTH ¢/ DISTANCE FROM:
,~ TOTAL EFFECTIVE
BUILDING FOUNDATION
WELL
SQ. FT.
ADDITIONAL ABSORPTION
WELL: ;0~.o/,oo.~ ~------------------~
TYPE '~_ ~/4) ~ ~2 .CONSTRUCTION
BUI LDI NG NEAREST
FOUNDATION_ _, LOT LINE
CESSPOOL OTHER SOURCES
APPROVED ~ DISAPPROVED
NEAREST
SEWER LINE
· DEPTH DISTANCE FROM:
SEPTIC ~ , / ~EPAGE /t~r~ /
TANK /~) , SYSTEM
REMARKS
/
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
G.A.A.B.
(~REATER ANCHORAGE AREA BOROUGH
PERMIT NO,
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
THIS PEI~MIT IS NOT VALID WITHOUT SOiL TESZ
MINIMUM DISTANCE$, REQUIREMENTS
FOUNDATION %O SEPTIC TANK ,
FOUNDATION TO SEEPAGE PIT ~ ~ -, ~I~AIN EIELD
SEPTIC %ANK ¥O SEEPAGE PIT WALL
SEPTIC TANK/~--* SEEPAGE PIT
~EEPAOE AREA SIZE ,//'¢~"'~/"'"~-~--~-~ - TYPE
L,'>caiSon Sket;ch
i
]:ep th To
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
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
A* ROVAL A S,N LE FAM,LY DWELL,N
1, GENERAL INFORMATION
Complete legal description
· ~-F --7, 1~ L~ ~W.V ~ANCH ~=5~TeT¢
Location (site address or directions)
Property owner
Mailing address
Day phone
Lending agency
Mailin. g address
Address
Day phone
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 sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, [ 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 fur[her 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 ~ o[~oe,q ~'~- Phone ~7~-
Address ~ o~ U/__-/ 15--l-% ~ ~o 7~ ~ ~ ~.~ . ,~
Engineer's signature ~ ~_ Date
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following
stipulations:
Additiona~ Comments
By:
Date
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 tile 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 error~ or omissions in the professional engineer's work.
RECEIVED
Municipality of Anchorage D~.(~ 10 999
DEPARTMENT OF HEALTH & HUMAN SERVIC[~iCiPALi-fy OF ANCHO~
Environmental Services Division ENVIRONMENTAL SERVICES
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
iq.
g.p.m.
If A, B. or C, attach ADEC letter. ADEC water system number
Date completed I c~ ~ ~/
Cased to > I ~D Casing height (above ground)
Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
g.p.m. ~,_'-~
Nitrate ~. ~--~ Other bacteria
Collected by: ~ S,
Tank size J ~ ~'~ Number of Compa~ments ~ Cleanouts ~/N) ~
High water alarm (Y/N) "7/
~'-
system type
Legal Description:
A. WELL DATA
Well type ~
Log present (Y/N)
Total depth ,~
Sanitary sea[ (Y/N)
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform
Date of sample: ~"/~"/
B, SEPTIC/HOLDING TANK DATA
Date installed '"~/z ~/~ 't
Foundation cleanout (Y/N)
Date of Pumping
C, ABSORPTION FIELD DATA
Date installed
Length L-/O .Width ..~
Effective absorption area
Date of adequacy test
Depression (Y/N)
Pumper
Soil rating (g.p.d./ft~ or ft~/bdrm)
Gravel thickness below pipe Total depth L~
Monitoring Tube present (y/N) ~/ Depression over field (Y/N) __
Results (Pass/Fail) '-~ For ~
Fluid depth in absorption field before test (in.); ~ Immediately after gal, water added (in.):
Fluid depth (ins) Minutes later:. Absorption rate = g.p.d,
Peroxide treatment (past 12 months) (Y/N)
If yes, give date
bedrooms
72-026 (Rev. 3/96)*
LIFT STATION "~
Date installed
Manhole/Access (Y/N)
High water alarm level at*, ~L y~..
Cycles tested I'"J/
Size in gallons.
"Pump on" level at*
*Datum
"Pump off" level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septio service line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LO']'TO:
Foundation ] 7 Property line ~C) Absorption field "~
Water main/service line .~ dD Surface water/drainage N l o Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Surface water
Curtain drain
r-
Building foundation L~ ~ Water main/service line
_ Driveway, parking/vehicle storage area
Wells on adjacent lots "~ /~
I-', ENGINEER'S CERTIFICATION . ~i:;:;~,?t!'~;:' ~it.-~
I certify that I have determined ti ru field inspections and rewew of Municipal recor~that~the aJ~3ve,syst~em~ dre
in confo~ance w~th MOA H~ guidelines/n effect on th/s date. ,, , ? ~::- :~' ~ : ~;
Engineer's Name ~-~ [~[~ ¢'~ ~ ~ o -~ ~,4~_ ,~ ~,- r~
Date
Waiver F'ee $
Date of Payment.
Receipt Number
72-026 (Rev. 3/96)*
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # 1(~'3 ~~-~-'~ \ - {(~" HAA#
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Lot ~5~ Block 4, Skyranch Estates '~i
Location (address or directions)
5611 Whispering Spruce
(b) Property owner .A. HFC ¢51633
Mailing Address 520 E. 34th, Anchorage,
(c) Lending Institution
Telephone: (home).
Telephone
Business
Mailing Address
(d) Real Estate Company and Agent . 2OR1 R¢~li-y/ Nan,~y Rc, r-gh-P~ll(~r:k
Address 1.~4% W- qhh¢ Ap~h~;~g¢~ Al~k~ qq~f%l
Telephone 77~-?¢~01
(e) Mail the HAA to the fo owing address: (or check here.~, if hold for pick up.)
List contact person and day phone number below:
$ & S ENGINEERING
17034 Eagle Ri,vet Loop Read
· Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single-Family ~ Number of bedrooms 3
3. WATER SUPPLY
Individual Well E~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site [~ Public [] Community [] Holding Tank Lq
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025(Rev.?/88) Page 1 of 2
5. 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/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.
Address
Date
Name of Firms & S ENGINEERING
17034 EagJe River Loop Road No. ')04
~ag|e River, Alaska
Telephone
Approved for -~ bedrooms by
Approved--//~' Disapproved Conditional
Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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. 7/88) Brick Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
MUN~OF ^NCHO~,GIC~ECKI. IST - FEBRUARY 1984
ENVIRONM-'"~AL SERVICES DIVISION 343-4744
]~, Legal Description:
APR 1 $ .989
WELL DATA
Well Classification
RECEIVED
Well Log Present (Y/:[~ ~ Date Completed
If A, B, C, D.E.C. Approved (Y/N)
\ '~ ~'¢¢ Yield ~",/¥ (~ ¢t---1, --~
Total Depth L~V.--~' Cased to ,¢fc:>~.V-- Depth of Grouting
Static Water Level ~ ~ Pump Set At
Casing Height Above Ground ~."2-.~' 3r-' Sanitary Seal on CasingL~N)
Electrical Wiring in Conduit~N) '-} Depression Around Wellhead
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot ~ c:::~:' ~ ¢¢ ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot / ~ ~ ; On Adjoining Lots
To Nearest Public Sewer Line . ~ To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot ~-~'~ ~
Comments
B. SI'-' PTI C/H O L D I" G~TAN K ,D~ .
Date Installed ' .. Size'~No. of Compartments
Standpipes ~5~) ~ _ Air-tight Caps~N) '-~
Depression over Tank (Y(~
Pumping/Maintenance Contact on File (Y/f~)/
Holding Tank High-Water Alarm (Y/N) _ /
Foundation Cleanout (Y,~,~ r,~
[)ate Last Pumped
Temporary Holding Tank Permit (Y/N) _
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well
To Property Line
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
To Building Foundation
To Disposal Field
Page 1 of 2
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absortion Area
Depression over Field (Y~.N~
Results of Last Adequacy Test
Type of System Design
Length of Field
Depth of Field ~' ' ~'
Gravel Bed Thickness
Statndpipes PresentcC~N)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation
lot
To Water Main/Service Line
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutback (if present) ~/~'/
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments''¢v¢ '~k~b~,~4~.~ \~,.~..~:~
Date Installed
Si~n Gallons
"Pump Of CLL-evel at
High Water A~
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**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
inspection.
Signed
Company
Date
MOA No. __
S & ~ FNGINEERING
17034 Eagle River Loop Road No. 204
Eagle ~lv/er, ~:,~.-a-~9][77
of this
Receipt No 0 5
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
~-¢//_.~c~ Receipt
Waiver Fee: $
Date of Payment
Page 2 of 2
MUNICIPALITY OF ANCHORAGE
DIVISION OF }'~./%!VIRONMENTAL }~'N%LTI~
DF~Xa. Fff~ENT OF H'EAL"J.H AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HE;JJTH ;~YIHORITY APPROVAL CERTIFICATE
1. Gsneral Info~u~ation
Application Date June 7, 1984
(a)
Imgal Description (include ].et, block, subdivision, section, to,reship, range)
Lot 7, Block 4, 81(~ Ranch Estates
Location (address or directions)
5611 Whispering Spruce Dr:ire
(b) Applicants Nar~
Applicants Address
(c) Applicant is (check or~) lending Institution
(d) lending Institution FJ rst In&e__rst__%qte Sank
Address 7]6 W. 4th Ave
Day 277.-95~76
Bil]. Peters T~_l_e~pJo~.~gr~. , !{.mo_34__5-437__9_
!561]. Wh:isperJuj~j?uce Drive
(e) Psal Estate CO. & Agent__
Address 42] 7 Mounta:in View ])r~ ve
Te le phor~
2. ~ of ggsidenoe
Single-Family ~_~[
NtiS)er of
3. Water Su~
Individual Well ~[
Multi-Family
3
Other (d~scribe)
Ccr~unity ~[ Public
Note: If eormunity well system, must have written confi~tion fr~n the State
Depar~nr~nt of ~_hvironrcental Conservation attesting to ~ legality and status.
Is the v~ll adequate fo= the number of bedrccms specified in this HAA (Y/N) Y
4. _Se_~wag9 $~is_~q.~Qsal
Onsite [_~[ Public ~_-~ Corm~anity ~ Holding 'rank
Is the wastewater disposal system adequate fcr tile number of ~drocms ~Y~)
2-15-84
5. E__~.ineering Firm Providing_![no~_~qt_i?%s, Tests, Data and Information
I ~rtify that I have checked, wDrified, or conformed to all ~DA HAA C~idelinee in
effect on the date of this inspection.
Sigr~d Date
Address 2502 W.Northern Lights B].wl.
S~gned by_ --~
Date ~. ff~'
(ENGINEER S~L)
Appr o~ d fo ....
Disapproved ~
Te~ms of CDnditional Approval
'Ihe Municipality of Anchorage Departmant of }~alth and Envircr~ntal Protection does
not guarantee the continued satisfactory performan~ of the wate~ supply and/ct the
wastewater disposal system. This approval indicates that, as of the validation date
sho~n ~x~ve, based on the data and information furnished by an engireer registered in
the State of Alaska, the ~ter supply and wastewater disposal system :is safe and func-
tional fo~ the number of hedrco~ and type of structu~re indicated.
(DHEP SEAL)
7. Ma].]. the HAA to the following address:
KB2/d5/s
[Page 2 of 21
2-15-84
A®
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
~LINICII~A[rs, OF
DEP]'. OF' HEALTi~{
EIqVIRONMENTA[ PROTECTION
RECEIVED
WELL DATA Legal Description:
Well Classification .7~/~//~T(~, If A, B, c~ C, D.E.C. ~p~oved(Y~)
Well ~ ~esent (Y~) ~/D ~te ~leted /~/ Yield,~/~
Total ~p~,.~/~6~3~ Card to J~/w~6~.3/o ~pth of G~outing
Static Wate~ ~1 ~{~II(~D~J~ ~ ~t At.
Casing Height Above Ground ~
Electrical Wiring in Conduit (Y/N)
Separation Distances f~om Well:
To Septic/Holding Tank o~ Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public seWer Line
Cleanest/Manhole ~//~
Water Sample Collected By
Water Sample Test Results
Sanitary seal on Casing
Depression A~ound Wellhead (Y/N)
; On Adjoining Lots /D~' ~'
; On Adjoining Lots /~' ~*
To Nearest Public sewe~
To Nearest sewe~ Service Line on Lot ,~.,~,<'['~ m
/'~//~/~.,/,1{~ · ; Date ~/~
CQ~ents
B. SEPTIC/HOLDING TANK DATA
Date Installed //~ ~,~ Size /~ ~,/Tg~ No. of Cc~pa~tn~nts
Standpipe (Y~) ~5 Ai~-tight Caps (Y~) ~.~-,c~ Foundation Cleanout (Y~)
~p~ession o~ Ta~ (Y~) ~(> Date ~st P~d ~. /---~-/
P~ing~intenan~ ~n~act ~ File (Y~) ~/1~ ; fo~
Holding Ta~.High-Wate~ Ala~ (Y~) ~ ~a~y Holdi~ Tank ~r~t (Y~)~/~
~p~ation D~stan~s ~ ~pti~ol~ng Tank:
To Water-Supply Well
To P~operty Line
To Water Main/Service Line
To Building Foundation //
To Disposal Field ..
TO Stream, Pond, Lake, c~ Major D~ainage
C~nments
[Page 1 of 2]
2-15-84
Soils Rating in Absorption Strata .
S~a~e Feet of ~so~ption ~ea ~IIIA'A/~)~ ~ Stan~i~s ~esent
~p~ession ove~ Field (Y~) ~ ~ ~te of ~st A~c~a~ Test
Results of ]~st ~ac~ ~st
Separation Distan~ f~ ~so~pti~ Fi.eld.
To Building Foundation ~' ~ TO Existing or ~ndo~d System
To Wate~ Main/~vi~ Line .~' ~ To ~t~Jif pre~nt)
To St~e~ond~ke/~ ~jo~ D~aina~ C~s~
To ~iveway, Pa~ki~ k, ea, ~ Vehicle St~a~ ~ea _~' *
C~nts
. Type of System Design
D. LIFT STATION
Date Installed
Size in Gallons
"P~np On" Level at__
High Wate~ Ala~mLevel at
Tested fox
Electrical Codes(Y/N)
Dilre~sions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles dl~ing Adequacy Test..
Meets MOA
Co]~nents
Check Permitted Bedroom Rating Against HAA Request
certify that I have checke, d, ve~.ified, or confo~n~d to all MOA HAA~C~~4n~ ~ %)~ /4, . ~ effect
, p0lrick A, Beaugar~
[Pa~ 2 of 2]
2-15-84
APPLI( ~IT FILLS (:)UT UPPER HAl ONLY
Pror ~rty Owner J/L/, / J/~;'~" ..~'
Buyer
Zip Code
[.ending Institution
Address ?)
Bealty Co. & Agent
Address
z,p Code ~¢2., 'S
Phone
Zip Code
Multiple Family NO. of Bedrooms
Other
Water Supply
Community
[] Public Utility
Sewer DJsposaJ
[] Holding Tank
For wells drilled prior to th~l d,.a)e, give well deDth,(att~ch log if~a~ailable),
ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975.
Yea,,.d,v,dua,,...,,.d,_
When Connected to Public Utility;
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN SE INITIATED.
Time Time Time
Date
Inspector
Date
InspecJor
Date
Inspector
Inspeolor
Field Notes:
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECfION.
RECEI_VED
~.~ ) APPROVED BEDROOMS
( ) DISAPPROVED
( ) CONDIT~O, NAL APPROV..~[ *~.~
DATE
*CONDITIONS OF APPROVAL
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well to Tank
Well Log Received
Septic Tank Size
AUgt~st '3~ 1983
.M~A Box ].622-X
Anchorage, AK 99507
Subject: Lot '7 Block 4 Sky Ranch Estates ~1
Approval for the individual sewer and water facilities cannot
be granted until the followin9 items have been completed:
of the Municipality of Anchorage codes and faust
in conduit.
.... , ~"~' submitted to this
o The s(~ptic tank pum}~ed with a r~.(.¢...~[ t '
department.
Please notify this Department for a reinspoction when the
noted discrepancies have been corrected. If there are any
f~rther questions~ please call this office at 264~-4720.
.].ect~.~cal wires to the well head are in violation
Exposed ~, " ~'"
be encased
Si. ncerely,
nP24/p/n
RobeL't C. Pratt
Associate ' "
l~nvlronmcntal
,%pecialist