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HomeMy WebLinkAboutSKYWAY PARK ESTATES BLK 5 LT 3Skyway Park Estates Lot 3 Block 5 #019-151-15 Municipality of Anchorage Page ~ of "~-~- DEPARTMENT OF HEALTH AN[) HUMAN SERVICES ENVIRONMENTAl_ SERVICES DIVISION P.O. Box '196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater r)isposal System and/or Well Inspection Report Permit Number: ~'-,~ t ¢;z~'-4:~___ PID Number:. 4~))q ~'~ ~.- U'~''-~ , ~ ~ .t Wastewater System: B New pgrade ~, ~ t~O~ ABSORPTION FIELD ~~.~ IN°'~°°ms: ~DeepTrench E] Shallow Trench ~Bed ~Mound ~Other~.. LEGAL DESCRIPTION ~oi,.~.ng: ~'~GPD/Sq, Ft, Total Depth from original grade:l Subdivision: 3epth to p~ bottom from original grade~ Gravel depth beneath pipe Ft Number of tines: Distance belween lines: Driller: DateDdged: Static W,ter Level: Installer: ~=-O/~¢ *' II ._' ~. Yield; ~Pump Set at:iHeight Above Ground: GPM Ft. Ft, TANK SEPARATION DISTANCES ~.~ic u Ho~n¢ U S,T,~,.. To Sepbc Absorption Lift Holding 'dblic/P,iv,le .~.facturer: ~ ~ Capacity in gallons: Wa.r ~ I¢ ~-- ¢~ ~ LIFT STATIO~ Li.eL°t ~ ~ ..... IP ' ~ ~ .~ Size in gallons:.. I Manufacturer: ~/' Foondation ~1 ~¢~ ~ "Pump on" level mb ~.¢~evel at: I High water alarm at: C.rtainDrain ~M ¢ '~[ .¢ ~4 O ~t~ ~ -~ Pomp Ma~ I Electrical Inspections performed by: Remarks:~ ¢ ~ ~¢~ l~%;~ BENCH ~ARK ENGI~iEAL Inspections performed by: ~ 4:~ %~ ¢*~~: lst~ J~ ~ Department dFHealti~ and Human Services app[o~al, q~'2?..,......t~ Reviewed and approved by/~ ~-~ Date: ~ ' ~%~O~SSt~}~ 72-013 (1/91) MOA 25 Permit.o. ~'...P~-~ I~l~'~ Page- ~"' of~"'~.-~-'--'-' Municipality of Anchorage 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 N Permit.o. '~-~ ~ [ d~2:~ Page '"~-__of~ Municipality of Anchorage DEPARTMENT OF HEALTH ANI:) HUMAN SERVICES ENVlF:IONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report 72-013 A (2/91)MOA25 PERFORMED FOR: ~,~r LEGAL DESCRIPTION: 1 2 3 4 5 8 9 ~3- 17- 20- COMMENTS~'~ ~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SI--RVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: Township, Range, Section: '~,~..,~ SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Waler AIIp~- MoniterinD? SITE PLAN Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ (mmutes/~nch) PERC HOLE DIAMETER __ TEST RUN BETWEEN '~ FTAND ~ FT PERFORMED BY: S 8, S ENGINJEFRIN(,_ i ~_-_ 17034 Eagle Eive~' Loop Road No, 204 ACCORDANCE WITH ~J~I~T~/~i~i~a/~JI~Pb-~GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: '~ I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910329 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:HANNI SUSAN OWNER ADDRESS:P.O. BOX 190228 ANCHORAGE, ALASKA 99519-1380 DATE ISSUED:10/14/91 EXPIRATION DATE:10/14/92 PARCEL ID:01915115 LEGAL LESCRIPTION. SKYWAY PARK ESTATES BLK 3 5 LT LOT SIZE: 72000 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS ]PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALi, 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 FOLLOWING SPECIAL PROVISIONS. 1 SPECIAL PROVISIONS: DATE:/~-t4 -~/ _ SEWER&WATER MAINEXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAO DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL ~NSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESI(3N ROBERT SHAFER, P.E. ROGER SHAFER, P.E. October 9, 1991 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Stre~ P.O. Box 196650 Anchorage, Alaska 99519-6650 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION' OCT 10 1991 RECEIVED REFERENCE: Lot 3; Block 5; Skyway Park Estates Request you issue a p¢~it to upgrade the septic system serving the referenced property. The property owner is currently e×pe~ncing problems with his ~×isting system and wishes to upgrad~ to a five (5) bedroom residence. The attached site plan d~pi~ts the location of the upgrade with an alternate site. Du~ to th~ large lot sizes in thc ar~a we do not anticipate any advers~ ~ff~cts on neighbo~ng properties. If you have any questions, or r~quire additional information for your review, pl~as~ conta~ us. Sincerely, ROGER J. SHAFER, P.E. RJS/gm 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 SCALE PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PEFICOLATION TEST 5 6 7 8 9 10 11 2 13- 14- 15- 16- 17- ~'~ 18- 19- 20- COMMENTS .. Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WRAT O DEPTH? p E gepth Io Monitoring? ~/~"-'~/ Dote: _[,O~ Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE '~""/ (minuteshnch) PERC HOLE DIAMETER TEST RUN BETWEEN ('4¢ FT AND _'~ _ FT ~ & S ENGINEERING ?034 Ea{]le River Loop Road No~ ~O4 ,,~:~ ~ ~J ,~ ACCORDANCE WITH ALL STATI-~ AND MUNICIPAL GUIDELINES IN EFFECT ON TNJS DATE. 72-00B (Rev. 4~85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: \ J(~:>'"' ~'~ ----c'~1 / GAAB-HD. I GPEATER ANCHORAGE AREA BORO'IGH HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279.2511 INSPFCTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL__('~' / LIQUID CAPACITY // __ M A T E R i A L (,~.~,~ b/~,/,1~, ~--,~.Z~- NUMBER OF / ~ COMP~RTMENTS ~GALLONS. INSIDE LENGTH INSIDE WIDTH -- ~DEPTH SEFPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PiTS / OUTSIDE DIAMETER "~ OR WIDTH___A~'___ LINING MATERIAL ~' C ~ - (~l/(Zf, .,~,",I.,'~-~ .. ~,S~NC~ ~o~ w~u ~f 2 TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) / / , BUILDING FOUNDATION '~ o Bo. ET. TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FRONt WELl .-=~F..OUNDATION , NEARES~..-ECIT LINI=~"~--...~...~ , OF LINES ~ NUMBE .-~ ,-""' DISTANCE BETWEE1,:tN4I~L~S_......=__ TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTION AREA__ SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE__ p E~ E~j~/ DISTANCE FROM ! WATER /,~ WELL: TY ~-'~'~.') , DEPTH ~- ,BUILDING FOUNDATION. 1'"~,,~' ~'-~SAMPLE , NEAREST NEAREST ,.:~ ? SEPTIC ! SEEPAGE ~ OTHER LOT UNE ~ , SEWER LINE__? '~, TANK_ ~".~ ,SYSTEM /r/~) ,CESSPOOl "~-" ,SOURCES. DISTANCES: DIAGRAM OF SYSTEM GAAB-HD~2 GREATEr' ANCHORAGE .AREA ItEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 OROUGH SEWAGE DISPOSAl. SYSIEM - APPLICATION & PERMIT~..77_-~5-~ NAME OF APPLICAN //'~Z-,~- MAILINO ADDRESS~Td ~' ~/~* PHONE NO. RESIDENCE ADDRESS ~g:- LOCATION OF INSTALLATION APPLICATION TO INSTALL: SEPTIC TANK_ L~ , SEEPAGE PIT &~ .,DRAIN FIELD ,OTHER_ TO SERVE THE FOLLOWING FACILITY [~ ~, FINANCED THROUGH ~W~fiT~g~'z~-- TO BE INSTALLED BI:iLOW TO BE FILLED OUT BY HEALTH DFPARTMENT THIS IS "1'0 SERVE ASL~' ~.,'~ '/~-1~/,/~'~' __. ,PERMIT TO INSTALL A ~'~"?,~~-'~'~'"~,2-~ ~"~ ?" '/' ,. AS DESCRIBED BELOW. SIZF OF UNIT TO BE SERVED _'~,~ .)~,'~-- . SEPTIC TANK SIZE ~ ~"~ ,.TYPE ZY) /C F?gEEPAGE AREA ~.'~-~l¢)(g )"~2~-TYPE DIAGRAM OF SYSTEM I certify that I am familiar with the requirements of Great~r Anchorage Area Boron)ch Ordina~nce No. 28-68 a~l above described system i~ in accordance with said code/~/ /~ ~ / ..~ ~ ~.~ that the GREATER ANCNORAGE AREA BOROUGH HEALTIf DEPARTMENT 327 EAGLE STREET ANCHORAGE, ALASKA'§§SO1 CASE # ,.' ,, Date Performed c · P6~ formed For 7'21r /),,t~/,,-- ' '~ ' - ~ - ¢ } Desezlptlon LotR Block .4~ bU)d~vlslon Leoa.~ · ~ - · ' Th s Form {epo>~s a: bo~s bog ~ -geroo%atz~n res1: Depth Feet Soil Characteristics Location Sketch Reading Date Gross Time Net T~me Depth To H20 Net Drop Z /f P ropol~ e d InstalZat~on: Seepage Pit ~- DPain Field Depth Of Inlet ,.i 1. Approval requested by: Mailing Address: 2. Property Owner: _ , Mailing Address: GREATER ANCHORAGE AREA BOROUGH Department of Environmenta.1 Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Phone: 4. Location: ~.~,L~_~~~-~-~._.~ _. ~-- ~ ..... ' Fv ' - ' ~ ~/'~ No, of bedrooms 5. Type of facility to De inspected _~~, . 6. Well Data:~ C. Construction ~~ D. Bacterial Analysis 7. Sewage Disposal Systom:_~&~ ~~'-~ ~D/~'/Q~ A. Installed _:)/¢~0~ B. Installer C, Septic Tank: l. Size ~00() 2. Manufacturer ~~ D. Seepage Pit: 1, Absorption Area J,lxl~x~ 2. Material E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank __~__~ _, Absorption area Nearest lot line , Other contamination Bo Sewer Lines ___, Foundation to septic tank __L<o._ , Absorption area C, Absorption area to nearest lot line EQ-O3q (1/74) Page 1 of two pages 3330 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality "C" St., Anchorage, Alaska 99503 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO VA FHA CONV 2. Property Owner: _~_~_~_~_~-~F: ' __ : ~t ~-,~ Mailing Address'. _~._~._,.2 /~Das Phone_ 7 8. Mailing Address: Da~ Phone Name of Lending Institution: Mailing Address: ~'? ~_F q~ _ Phone Name of Realtor or Agent: ~:c~_--w/__ Mailing Address: ~:~_~ Legal Description: ,~ ~ ,_ _ _ 7 Type of Fac~'lJ¢~ ¢o be ~nspecCed: ~~,N~Bdrms. ~a~ep Suppl] Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation Individual (on-site) EQ-037 (1/74) Page 2 o~ two pages -Request for Approval of Individual . ,er & Water Facilities Legal Oescription Comments 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 HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CEF:ITIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address _ L. ending agency Mailin. g address V 'A L.T' N.t Day phone ~,~,/"/B -- IB~O Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well NOTE: Community well Public water ~V/ If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. 'rYPE 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-O25(Rev. 1/91) Front MOA#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. Name of Firm To ~o ~ 4.v~ % ~t) ~-~%~ '~E Phone Address ~o'~ ~ /'5'-/-¢4 Engineer's signature Date DHHS SIGNATURE ~ Approved for -~ ,~ 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. Municipality of Anchorage APR 1 0 Department of Health and Human Services Division of Env ronmental Services MU~'4tCJIiC/\LII¥ ~Jl AiNL. I-iL.)I<AI}I On-Site Services Section 825 "L" Street Room 502 .... ' *~ ~:~wc[= ........ P.O. Box 196650 Anchorage AK 99519-6650 www. ci.anoho rage.a~;.us (907) 343-4744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Descriouon: A. WELL DATA Well type Date corr pleted __ Total depm AC/Cc'L) If A, B, or C provide PWSID # S~itary seal .... ft///Cased to fl ~(OM WELL LOG Parcel I.D.: o~,-.-t51-~15 Well Log / Wires prop~y protected C a SA;~ gN hse~ g h,,.~EC T i O/Zfl~lV e ground) in. Date of test ./ Static water level /// ft Well proeuction WATER SAMPL~ESULTS: / Coliform colonies/100~ / Date of sample:_ ./ B, SEPTIC/HOLDING TANK DATA Tank Type/Material ~zo ~&e~ ! Date installed _"?/¢'lq ~ Cleanouts_ ~ Foundation cleanout Date of pumping 6~J.~© ~cic~ C. ABSORPTION FIELD DATA g.p.m Nitrate _ Collected by: mg/I ft g.p.m Oth e~/'~c:)J~nies/100 mi Tank size J ~o'C) gal Number of Compartments '7/ Depression over tank _b',~ _ High water alarm ____ Pumoer A~k, ~¢'¢~¢o Date installed ~'7,7,7/~/¢~. Soil rating (g.p.d./ft2 opft24m~) O,, L.~ System type Length ~ c{ ft Width -'-~ ft Gravel below pipe ~:) ft Total depti~ ~ ~ ft Effective absorption area 124;¢ fF Monitoring tube_ "// Date of adeauacy test /'~_,//~/o'O Results (Pass/Fail) . "~ Fluid depth in absorption field before test <~) in Water added"7 Elapsea Time: '~O mtn Final fluid depth ~,,/~,~// in Any rejuvenation treatment (past 12 mo.) (Y/N & type) Depression ever field '~ For -~ bedrooms gal. New depth. ~ ¢'-f/_ in. Absorption rate >= 7,-¢0 g.p.d. _If yes, give date. ~/ 72-026 .Rev. 01t00)* LIFT STATION Date installed "Pump on" level at __ Datum Size in SEPARATION DISTANCES in Manhole/Access High water alarm level at __. in Meets alarm & circuit requirements SEPARATION DISTANCES FROM WELL ON....L-(DT TO: Septic tank/lift station on lot J On adjacent lots Absorption field on lot ,//' On adjacent lots Public sewer main J Sewer/septic ser~e Holding tank Public sewer manhole/cleanout SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property line I ;D Water service line Wells on adjacent lots Building foundation Water main Drainage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line ~O Building foundation I/¢,..~ Water main Water Service line ~ ~' Curtain drain I~ ¢ vi & F. COMMENTS G. ENGINEER'S CERTIFICATION Absorption field Surface water Surface water ~c,¢ ~. Driveway, parking/vehicle storage Wells on adjacent lots I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name '1"-~ Date HAA Fee $ ' ~ Date of Payment Receipt Number ¢0'7'~~'' Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 01/00)*