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SKY RANCH ESTATES #2 BLK 3 LT 5
5 kyranch Estates #2 Block 3 Lot 5 #015-302-02 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221173 PID Number: 015-302-02 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name GLENN & BRIJON ROOSE ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 11721 PADDOCK LANE, ANCHORAGE ❑ Other Phone Number.of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot SKY RANCH ESTATES #2 3 5 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line FtZ Ft. Well 200'+ __ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other: Manufacturer GREER Capacity 1250 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 5'+ __ NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks Alarm location Electrical installed by Installer MIKE N ANDERSON Tank to PIPE MATERIAL House to tank 3034 d ainfield 3034 Drainfield 3034 Co/MT 3034 Inspector MNA/FWC BENCH MARK (Assumed elevation) 100 ft Inspection 15t 7/25/22 2nd 8/8/22 Location and description 3`d 4'h TOP OF MAN HOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL ' • ' • Conditional Approval: Date •M , *: 49 7H ....�:* r.� . . � SAep�ptic System Curtis HuffmanOV Date CE .8/2428991 �l F,pFo ....•••ti�0AW PROFESSIO�� Note: this approval does not include well ermit requirements.1t`V p�\\\1� (Rev uwuuiu) P I D: 015-302-02 I_ PERMIT: OSP221173 9.98' p R_g0 r — x_44 9j,. Lot 6 z O 0 :RED STORAGE FOR I N OT 6 ENCROACHES ONTO LOT 5 10' UTILITY I EASEMENT A -C=31,2' B -C=27.9' A -D=32.1' B -D=32,1' A -E=29.7' B -E=33.2' R�50.00, 6 Lot 4 Lot 5 rn SURVEY: LANG 16,124 S.F. FWCS EXISTING 1 " = 30' FIELDS Iy CO X MT X •�� 36.3' INSTALLED I I I 1250 -GAL HDPE CO SEPTIC TANK p N N 4 BED a') 1, \ I x & WCODFCO NN CONNECTED X t�H W HOME �'' 1.7'x4.1' CANT TO EXISTING SEPTIC. IDFCCO BM: MH TOP �36.3' I X 8.1'x12.1' SHED W/ lx�5.2'x10.2' LEAN TO p 8.0'x13.5' DECK CHAIN-LINK FENCE 00 N 89'59'32"W 181.37' 15' WALKWAY SEPTIC SECTION SCALES NTS SKY RANCH ESTATES #2, BLK 3 LT 5 PREPARED FOR: BRIJON & GLENN ROOSE 11721 PADDOCK LANE ANCHORAGE, AK 99516 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 FirstWaterAK®gmail.com rS DATE: 8/24/22 SURVEY: LANG DRAWN: FWCS SCALE: 1 " = 30' �0 OF Azo 9 TI 0, tis Huffman CE 128991 6P 0 Atf 8/24/2022e I PADDOCK LANE O fSEPTIC 89'59'33"E a .98' R,80 / — — — — — —L'4¢90, / / R-50.00, PIPESI ! ;-57.66 z 16,1024 SEPTIC m. - .. PIPES O RETAINING WALL ` o I-- -o x x --I x _ Lot 4 Lot 6 ti �LA 81.3' COVERED STORAGE FOR I N_ x xw t STORY SEPTIC Y SEPTIC PIPESONTO LOT rn RESIDENCE N FLOT 6 ENCROACHESODAYLIGHT w1.7'x4.1' CANT MANHOLE-�* BSMT. 10' UTILITY SEPTIC PIPES 36.3' �\ � CHAIN-LINK FENCE EASEMENT 8.1'x12.1' SHED _w/ I j'�CHAFN 5.2'x10.2' LEAN TO 0 8.0'x13.5' DECK -LINK FENCE 0_0 -----� 15' WALKWAY N 89'59'32"W 181.37' '~----- ---- "-------------------I---------- CHAIN-LINK FENCE I Q I Lot 3 Lot 4 + Lot 5 I NOTE: THIS LOT IS SERVED BY A COMMUNITY WATER SYSTEM. PLOT PLAN AS BUILT X_ SCALE –.1" = 40=_ GRID ---QW– 2737 Project No. 22=491 Al 4, Associates, � 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lan & K S S 0 c i a t e S inc. (907) 522-6476 Phone (907) 522-4625 Fax a*- Professional Land Surveyors ken0langsurvey.com o a F jonathan0longsurvey.com 't� I hereby certify that I have surveyed the following described property: d�T�04 LOT 5, BLOCK 3, SKY RANCH ESTATES – UNIT No. 2 (PLAT No. 71-290) * 49TH QG Anchorage Recording District, Alaska, and that the improvements situated thereon are""""""""' """""""G within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed '.CEN ETH ...LAN . ....� premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. �O s�� �Q op •.LS -5202. ' c,J4� Dated this the 1 �1Day of ��at�u5 i _�_ at Anchorage, Alaska a aoo �FESSIONAI-1AI-`o It is the responsibility of the owner to determine the existence of any easements, �40ppa covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 MUNICIPALITY OF ANCHORAGE On -Site W3t8■ $, W:M6towai&r Pr4209THM PO Box lOG660 4704 Elmore Road Anahorege_ Alaska b19-fiW Phony (947) 343-79M Fax: (W?) 3! 49-FGg7 hllpNwnw.muN .orgtansAe Ori -Sita Wastewater Disposal System Permit Perini t N umber. OS P221173 Work Type, ftpticTank Upgrade Tax Code Number 01 W202000 Site Lega l Address; SKY RANCH ESTATES 02 BLK 3 LT 5 0737 Site Malling Addre&5. 11721 PADDOCK LN, Anchorage Owner, RODISF OXENN A & BRIJON E Design Engilneer; FIRS i YVATER CONSULTING This permit is for the ccnstructlon af: Effective Date, Fxpliration Date: Lot Vzo In -Sq Ft, Total Bedroom: 59)2022 M12023 16124 ❑ Disposal Field Ef Septic Tan k 0 Holdl rig Tank ❑ Priv} ❑ Private well ❑ Vvater Storage All construction shall be in aocordanca with - 1 _ The attarhed apprpved design. 2- All requirements speaFed In Arr;horage Municipal code Chaptors 15,66 grid 15.65 and the State of Alaska Wastewater Disposal Regulations (13AA 72) art d Drin king Water Reg ulallons ( 1 AC8D) 3- Tha wastewaler code requires inspections during the Installation_ The eng inear shall nolify the Dew lopment Services Deparlment per AMC 15.65. Provide notification by calling (907) 343-7904 {24f7). 4. From October 15 to April 15, a subsurface soil a bsorptim system Linder conatruction during freeziN woather shall be either- @. Opened and Dresed -on the same clay, or In. Covered, sealed. and heated to prevent freezing Received By: Issued By:I� Date_ 619122 Date: 4 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel 1. D. 015-302-02 Property owner(s) GLENN & BRIJON ROOSE Day phone Mailina address 11721 PADDOCK LANE, ANCHORAGE, AK 99516 Site;;ddress 11721 PADDOCK LANE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) SKY RANCH EST. #2 133, L5 Legal description (Township, Range & Section) Lot Size 16,124 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field F-1 InitialEl Single Family (SF) El (w/wo ADU) Septic Tank 0 Upgrade Q Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ 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 Municipal Codes. Nature of property owner or authorized agent) Permit/Rush Fees: 12. ?_, Date of Payment: ��(! � 02 a Receipt Number: `� 61 0&_3 Permit No. OS P'2-'2-1173 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com June 1, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: SKY RANCH ESTATES #2 BLOCK 3, LOT 5 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1250-gallon HDPE tank per the attached design to serve the existing 4-bedroom residence. The lot and area are served by public water The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221173, Deb Wockenfuss, 06/09/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221173, Deb Wockenfuss, 06/09/22 Municipality of Anchorage ' .r Development Services Department,} Building Safety Division — On -Site Water and Wastewater Program, 4700 S. Bragaw Sl. P.O. Boz 196650 Anchorage, AK 99519.6650 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: CW/0201-710 PID Number. Na" GAe1401% 1 Wastewater System: [3New Upgrade Adaass ABSORPTION FIELD Prone NunWm M B°drpp'a° 747— P-7/7 LA 'Deep Trm,rn O Shall" Trenrm 0 Bed O Mound ❑ Dlnm Sod Rama' TMa h Iran Dept woo' l grade LEGAL DESCRIPTION P SFr I z F• su0 vex,:TA Depth up P" Opnan ft. dr'gal trade G" depth wooth Poe Z✓• 1 I -f Fl. F1 Townan�p Range. Sedwn FA added abere WrW trade Gr" Levh GIavN hv,dlh Ph~ of MMa, o,alamoll en lwF Well: ❑ New ❑ Upgrade Fl, X I — Class&d am P.810. A. B. C) TOla Depth', LaaMb Taa absoMW area n 1;200 P,pe M~m o a Y 0- y Fl. Ft F.' 10 D'.ner I JC Data DMNd. SINK WSIM lera. Ft. Maul!e'r� id'Y/ r e � Dau Malaned O v z YiNd Pump Solaf. cafmgldngMA Grand TANK GPM Fl. Fl SEPARATION DISTANCES []Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding Public/PrivateMredac'hrar Gapac,ly From Tank Field Station Tank Sewer Line G+' Aulana Ex151 Nunbm Of cempanmenls Wes Sudarewaer Nlo N�b LIFT STATION 5,u MaMeM,rm Lpl4ru '3o Ga. 'Pum° W. M+el m 'Furry OK lav i N,gn waer aurin al FOWhd~ 3� M n 'n curl.. ora. N10 t\I1D Pump Ma -e a ModN .earhpa MapKI,O.a pedOrmaO OY R°ma"a L BENCH MARK Edrspo. w Dearnpl,on l r tar Aaaeme0 En+men U� Ft Joe Engineer's ;tamp 7- Inspections performed by: Dates: let5 o 2 Md 2Md s o Z Development Services Department Approval Reviewed and approved by: Date: %'�. O :;I - STANDARD SEPTIC SYSTEM. STANDAR 1250 GAL. TANK K STANDARD TRENCH.• TOTAL LENGTH: 75 /T IPT C� ? ^ TOTAL ROCK T? it [TTICTYX NE ROCK OCPTH. 6 !T hG` N C \ SW/NC AES AD J2 FT 00 35 ° 'Cs - AE 39 BE 30.2 I © C! 10 I 4.�� .. •:-.. ; BF 39 CC 55 f \00 45 CH 79 am 59 C DISP0114L PIT ; a CK T°T OK 77 OW LOG CRIB v \ ABANDONED ® . ° BENCH4RKD°`A CORNER 90TT0'Y C I YmnED INTEGRITY OF TANK \ II— _ ABANDONED LAST. TRENCH \ 1 �L LS 0 LS w 45 60 75 90 SCALEi 1' = 30 FT. L 1 ` 49th (i MIN SPURKLAND No. CE -2225 R[Y15ED DRAWING JUNE 23. 1072 I TOBB£N SPURKLAND P.E. I I SKYRANCH ESTATES BLOCK 3 LOT 5 11 SEPTIC SYSTEM AS BUILT 203 W 15TH. AVENUE 11711 PADDOCK LANf 10n7197o_TOIL DATE: JUNE 26, 2001 ANCH. GARY KUTIL SHEET. 2/3 GRID. 2737 ��rof� PERMIT # SVO20176 PID # 015-302-02 SRE03052.DVG Clean Out Standard Trenches, Clean Out 3' wade 75 Ft Total Length 12 FT DEEP 8' Sewer rock 3' Cover NO SCALE Clean •O O O 1250 gal Septic tank 49th JEN SPURKLAND No, CE -2225 BENCH MARK. ASSUMED ELEV. 100.00 TUBBEN SPURKLAND P.E. SEPTIC SYSTEM AS BUILT 203 w15th Ave SKYRANCH ESTATES BLOCK 3 LOT 5 Anchorage Ak 99501 11721 PADDOCK LANE DATEi _UNE 26, 2002 e�e_b�c SHEETS 3/3 GRID, 2737 PERMIT 0 SV 020176 PID # 015-302-02 SRE03053.dwg i i ' /D' LIT/L//Y • 1,EtM cJ"- �.. ... �F i5V.woIkAl 890591.5'?.. iraanr. -ra ncunt i LoT .5TAKev ACCEyrr1F/EG ! 6-Z 7-o Z ek --./eecerf:%ied 5-a-78(�jYY•7-a71/7)Y. , I hereby certify that I have surveyed the following described property LOT .-5, az'(- .3 Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines,and do not over or encroach on the property lying adjacent thereto, that no!m movements on propp-- erty lying adjacent thereto encroach on the premises in question and that there are.no roadways, tranam!s.ton lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 29aday of ',q4r �2Us)— Ip 9.3 FRED WALATKA & ASSOCIATES Engineers and Surveyor Fouti✓ /lea,r,e worm Vel/.w Pk, -)fie Cnp At. r rovers Sef . _ .•� p 49 i i.. �.. . ............t: i t�, ��•. - NO. 32S � i i 'HOSE SHOWN ONTHE �ASEMZNTS OF RECORD, OTHER RECORDED i PLAT 4" NOI SHOVIN HEREON, _ __.FB -73" -5 /7 Z. , Lq- ,l tc 1,.11 r 1 vser S1e",?eBAR • � ' 8 L3EP '��sp• . _. ' I . � �r7.fo�O 00 5eor2 lrzS�Ofy' n p8 ,� W i ' /D' LIT/L//Y • 1,EtM cJ"- �.. ... �F i5V.woIkAl 890591.5'?.. iraanr. -ra ncunt i LoT .5TAKev ACCEyrr1F/EG ! 6-Z 7-o Z ek --./eecerf:%ied 5-a-78(�jYY•7-a71/7)Y. , I hereby certify that I have surveyed the following described property LOT .-5, az'(- .3 Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines,and do not over or encroach on the property lying adjacent thereto, that no!m movements on propp-- erty lying adjacent thereto encroach on the premises in question and that there are.no roadways, tranam!s.ton lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 29aday of ',q4r �2Us)— Ip 9.3 FRED WALATKA & ASSOCIATES Engineers and Surveyor Fouti✓ /lea,r,e worm Vel/.w Pk, -)fie Cnp At. r rovers Sef . _ .•� p 49 i i.. �.. . ............t: i t�, ��•. - NO. 32S � i i 'HOSE SHOWN ONTHE �ASEMZNTS OF RECORD, OTHER RECORDED i PLAT 4" NOI SHOVIN HEREON, _ __.FB -73" -5 /7 Z. , Lq- ,l tc 1,.11 r iviunicipality of Anchorage George P. Wuerch. Mayor Building Safety Dillision P.O. Box 196650 A 4700 S. Braga«• Street Anchorage, Alaska 99519.6650 A (907) 343.8301 h ttp://wit�e.ci.ancltomgc.ak.tis 7/2/2002 Tobben Spurkland P.E. 203 W 15ei Ave. #203 Anchorage, AK 99501 Subject: Waiver Request for Sky Ranch Estates #2 Block 3 Lot 5 Waiver Request #WR020029 Parcel ID #015-302-02 Dear Mr. Spurkland: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is 0.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Jeffrey W. Poet Engineering Technician On -Site Water & Wastewater Program Municipality of Anchorage Development Services Department 0 Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 995196650 www.d.anchorage.ak.us (907)343-7904 Waiver Review Worksheet WR#: 020029 PID#: 016-302-02 HAM Permit#: SW020176 Date Received: 6124102 Legal Description: Sky Ranch Estates #2 Block 3 Lot 6 Engineer. Tobben Sourkland P.E. Applicant: Gary Kutli Waiver Requested: 0 Feet from Drainfleld To Lot Line Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Points: Waiver is Granted: Waiver is not Granted. List Conditions or Reasons for above: Date: 7 - 2 — O 2 By: ........................................ Rea: 21692 Amount: $160.00 Date Paid: 6/2412002 MUNICIPALITY OFANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Permit Number: SW020176 Legal Description: SKY RANCH ESTATES #2 BLK 3 LT 5 Design Engineer: 0007 Tobben Spurkland, PE Owner Name: Gary Kutil Owner Address: 1825 Academy Dr. Anchorage , AK 99507-0000 dIN1 z I G1p$10 Z /Z:30 P"1 Date Issued: Jun 18, 2002 Expiration Date: Jun 18, 2003 Parcel ID: 015-302-02 Site Address: 011721 PADDOCK LN Lot Size: 16124 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 6I20I0Z- EN6. CAII-LEP 1A1F01?11E-,0 TN T CUNST/Pci�T/G�v D pi,/S (vAS F_AvlvulvTFRjFD IN 0466IVC- TIeEM!4/!_=S TKGS LIr- 1,IL4 tiro- Pr9F , HPRE SOIL$ TCSTiUC /(sRauNO! /iT'crf A4Av1toA'/A,6* 190,11 ,5l!19Af17- A ,VFty Pr- s l� N 71) r1415 41141OZ 7W ENG // fN(r, Cl/AA/bf0 OF64i,v TO /9 SP/tt 0vEle FROM 7fA*Crr0v&,sarliar of ON EAST 3r>E OP Jo rNE Sh�ctERAOR�vEr. Aj; Date: I i '? IO'L Received Issued Tv6 L.4,C&A01 Date: O 2 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.ci.enchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Df5— 302— � Z Permit Number SW OZ01 Parcel I.D. Property owner(s) &AV --q V,V 7-11-- Day phone ];-7— a= Mailing address (1) Zip Code '07 Mailing address (2) _ _ r—IT Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) 4 Lc; Size���/ Acre q.F Number of Bedrooms THIS APPLICATION IS FOR: 11 Sewer Only ❑ Well Only C Sewer and Well ❑ Water Storage Sewer Upgrade 4zti THIS PROPLRTY CONTAINS: HotTub ❑ Jacuzzi' ❑ Swimming Pool ❑ Water Softening Unit Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Sicnature of property owner or authorized agent) Permit Fees: T/�� Waiver Fees: Date of Payment: �(0 / t O L Dale of Payment: Receipt Number: .2 Receipt Number: (Rev. 12%00) Q T.3PUR J,AND P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Far (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 5 BLOCK 3 SKYRANCII ESTATES 11721 PADDOCK LANE Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street Anchorage, Alaska 99519-6650 June 23, 2002 We are submitting a revised application for the upgrade of the septic system for this lot. The design submitted on June 16 had to abandoned due to construction problems. The old log crib was found intact as well as buried trees and construction debris from the original development of the lot. The new design is based on the soil conditions found in test holes #2 and #3. Community Water System No Ground Water or Impervious Layer to 18 ft. Use Standard Trench Soil Rating. From Test holes 06/16/02 and 0621/02 20 min/inch and 25 min/inch = 0.6 gal /sgftday No. of Bedrooms 4 Required Area per Bedroom: 150106 - 250 sq.ft. Total area required: 250 x 4 = 1000 sgft Testhole depth 18 feet Bottom Rock At 12 feet Top Rock At 4 feet Rock Depth 8 feet Minimum Trench Length 1000 / 16 = 62 ft. SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 70 FT TOTAL WIDTH 3 FT TOTAL DEPTH 12 FT ROCK DEPTH 8 FT COVER 4 FT SEPTIC TANK 1250 GAL EXISTING CHECK INTEGRITY The installation of this septic system will not prevent septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. I I I LOT IS �, 16 PADDY LAW — — 4 I I .5 I 6 ® 12?-Vl" L3A4rQ -- --- __� --- ►.S FLV6LK�✓AY -- --- Emmon 50 0 50 1w 150 200 250 900 SCALE, I' = 100 FT. ' 49th 3BE� SPURKLAND NO. CE -2223 •: 22 I/0J W S 7H. AVND P.L. (I SKYRMCH ESTATES BLOCK 3 LOT 5 I I SEPTIC SYSTEM DESIGN I 203. 15TH. AVENUE 11721 PADDOCK LANE DATE: JUNE 5, 2002 ANCIL AK. 99501 (9071 279-3916 GARY KUTIL SHEET. 1/3 GRID. 2737 I PERMIT # SV020XXX PID 11 015-302-02 SRE03051.DVG STANDARD SDIW SYSTEM: fi •`-.'::s.::• txaTW rlso GAL. TANK STANDARD TRENCH: TOTAL LENGTH.• 70 FT tpr trdv�, - : •• ^ TOTALDEM.rs rr w r LA �� :::-•'--:'- \ crrrcrTvc axx DEMa Fr I w � r a 1 DISPU L PIT �' \ OLD LOG CRIB ® •�•:.' �,.. � \ I ABANDON O : *.•' � .`'.. ; \ ,:... •'+ 1 RIR' iV/EGRHY OE LANK \ 1 ABANDON DUST. TRENCH \ 1 Y 15 0 15 30 45 60 >5 90 SCALEt 1' = 30 FT. F ,.• 1 . AAAA ..................... 9 's, TOBB SPURKLAND N . CE -2223•.• � i REY= DRAWING JUNE 23. 2001 IT0/om) 970-140198BEN 5PURKLAND P.E. I I SDWMCH ESTATES BLOCK 3 LOT 5 (I SEPTIC SYSTEM DESIGN I 103 W 15TH. AVENUE / 171 / PADDOCK LANE DATE.• JUNE 23, 1002 ANCH. AK. 99501 GARY KUTIL SHEET.• 2/3 GRID: 2737 I PERMIT 1/ SV020XXX PID # 015-302-02 SRE03052.DVG Clean Out Clean Out Standard Trenches: 3' wide 70 Ft Total Length 12 FT BEEP 8' Sewer rock 4' Cover NO SCALE 1250 gal Septic tank Z 200 FLOV SPLITTER ° 49th ' 3`EN SPURKLAND No. CE -2225 /Yu JLHLG BENCH HARK. ASSUMED ELEV. 100.00 I TOBBEN SPURKLAND P.E. I I SKYRANCH ESTATES BLOCK 3 LOT 5 I I SEPTIC SYSTEM DESIGN Anchorage orage Ave 11721 PADDOCK LANE DATE: JUNE 23, 2002 A ac"oKnge Ak 99501 SHEET. 3/3 GRID. 2737 I PERMIT # SV 020176 PID # 015-302-02PERMIT SV 020176 PID 015-302-02 SRE03053.dwy I Performed For: _(2 Legal Description: t11 Depth ¢ASS 1' F�e1 2 COMMENTS i3orru N o F 14 O L.t= TH #f/ Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage. AK 99519.6650 wwwci. a nchorage. ak.u5 (907) 343-7904 Soils Log - Percolation Test I 1 1 Date Performed: Township. Range. Section: srATC—s cT L Site Pian WAS GROUNDWATER ENCOUNTERED? Reading O Gross Time 5 IF YES. AT WHAT DEPTH? L Depth to Water After Monitoring? D V E Date: L 6 —!&a Reading Dale Gross Time Net Time Depth to Water Net Orco ILL Ifl3 :5 t- 76 1D'/4 "" 30 I r_ f / vtR6 HOLE DIAMETER �� TEST RUN BETWEEN j(, FT AND 7 FT PERFORMED BY; ` - (' S CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. (o p x Municipality of Anchorage Development Services Department Building Safety Division j • ��.1 On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.d.anchoraae ak u, (907)343.7904 Solis Log - Percolation Test •.LCa.4 ^.w.r .enao• Performed For: 6AQ_--1 V V t L Date Perk Legal Descripton: _ 1-0 e 5 1314 "S S VC l V-A N L!-} Township, Range, Section: Depth 2llMIsM���� Sa.xD/ 8- Scmett) S:f I Net Time 9- Net Orco WAS GROUND WATER �Q SDA - M1- ENCOUNTERED? -�" s tp- 2,0 IF YES, AT WHAT DEPTH? L 11. Depth to Water After 0 tl r/ l J Monitoring? f 12 3 Date: iD ZL 0Z 13-1 1 �jp 3 COMMENTS 130T-6004 or 141 - ., a::'ani • ,� � rf' tsr � rG'ry Reading Date Gross Time Net Time Depth to Waver Net Orco �Q SDA - 2,0 f dol- 10;20 tl r/ l J 0w1i gti/ 3 11 3� It :7v �jp 3 �1 z 2:20 3v 3 �' ib eee —"'—'• u_ v "'e ) PERU HOLE DIAMETER �6_ TEST RUN BETWEEN_ FT AND FT PERFORMED BY. � C 1 —r, CERTIFY THAT THIS TEST AS PERFCP,,%IEO IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 14 13 Municipality of Anchorage ,: A;x" iENGwEC>R'S S: Development Services Department rt '?° -' '•.' j r Building Safety Division +• ��T`! j �•�; T - e. ; • ��.e On -Site Water and Wastewater Program o•: "' ••'^•••^••^ ! 4700 South Bragaw St. If \ P.O. Box 196650 Anchorage. AK 99519.6650 w vwti.anchoraae.ak uT ��'!o Sa•:•e!o� • (907)343-7904 v. • CL'.225 'c,3-`, •.., •,., " � .> Soils Log - Percolation Test Perp-med Fcr _-- C� AV—%i U T l L Date Performed: — d /'b 2► Le_ al CescriotLon: Leo4 S r3V 3 S I_`iA4r eN Township. Range. Section: Donn !(Feed dM6ANtCS •'I 2.1 M L16 LLq 6- 0- . 0- 2 CC"•:ENCS WAS GROUND WATER h 1 ENCOUNTERED? Net Time Depth to Wale, Net 0= j 5 IF YES. AT WHAT DEPTHn L Depth to Water After 0 Monitoring? E E Date `� Reading Date Gross Time Net Time Depth to Wale, Net 0= j F1,LL TV E so t L 4, �o Z y:be `� ! 10 o t! a _ I S 30 3Q0 361 Z :Do Q /p"/ yl -•.•-.•••--•� 1f >e4+ ., FERC LL HOLE DIAMETER _ TEST RUN BETWEEN -r •-vFT AND �FT -_R=CRS•ED BY IQ�� CERTIFY THAT THIS TEST C:.c _R=CP.SIED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. /O 3 O i- �l V.o rrr_ f, MUNICIPALITY OF ANCHORAGE / •- DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 LStreet - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME�t --- --�� PHONE [I NEW (JCJ'>CJVA,UPG13ADr MAILING ADDRESS LEGAL DESCRIPTION LOCATION 1 NO.OFBEDROOMS ` Well Absorption area Dwelling PERMIT NO. DISTANCE TO: Uy E Q Manufacturer ca _ Material No. of compartments w Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. Iz F Manufacturer Material Liquid capacity in gallons m= DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. (< J LL Z No. of lines Length of each line Total length of lines Trench width Distance between lines {v Z W ` r� 1 .% inches JI CC Top of rile to finish grade _ Material beneath rile Total effective absorption area p inches Length Width Depth PERMIT NO. w QI— Type of crib Cr b meter Crib depth Total effective absorption area W a W II Building foundation _ Nearest lot line DISTANCE TO: J W Class De h Bu din foW Attnim Driller Sewer line Distance to lot line PERMIT NO. Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATING ) o r ,- .fir__—sL� _.__,__,..-(i INSTALLER f`i W =Xc't1v -A �_•? _.__' e 1=u1 rc, JW\ WC, r REMARKS a C -= APPRON,E � DATE LEGAL t `� (i�'\\i���� Zit✓11 1 c���11 i 5 -- �.�.—,� 72-013 (Rev. 3/78) June 29P 1973 Ron Todd :star Routo A BOX 1C, II G Auchorayc,, Alaska 99507 Subjects Lot 5 Block 3 Sky nanah natatess 02 subdivision The percolation test performed on the subject lower syatossl has failed. Therefore, before We may grant approval, an u} grade of the system will be: required. The upgrade include c t fifty -none (51) Eoot of drain trench with coven (7) foot of gravel below the drain pipe. A permit must be obtained through this department before any construction begins. If there are any further questions, plearsc contact this office at:. 264-4728. 3inrrroly, Robert C. Pratt, R.S. sanitarian RCP/ljla cc: Peoples Bank And Trust Mortgage Loan Section Pouch 7-007 99510 ��PA I C_: 1: F�'� Fi1 �� ��������� DEPARTMENT OF HEALTH AND ENVIRONMENTHL FROTECTION ` 925 'L' STREET, ANCHORAGE, HK. 99501 264-4720�)�0 � ��_���� ����� ������� ������..�/ PERMIT NO. ( 780569 ) 8. .iid st-11_ &/----_- APPLICANT RON TODD SRH BOX 1628G 344 0030 LOCATION PADDOCK LONE LEGAL L5 B3 SKYRHNCH EST 02 LOT SIZE 16000 SQUARE FEET TYPE OF SOIL H8SORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)- 240 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ��1=11-0-1— �A. 13fL F nv' FE. 0__ �0 to -1- 1-i ... To' THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND HND THE BOTTOM OF THE EXCHVRTION (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). 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 --------- -IF 14 CA < 01 -A T 0�.o ".S., 1�'m "I" Of: RD, PA '.1E., �r',' r�*-r�Kc-n_u Or��� BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL/ OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL, OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. �E! Ir"T Or 1 EE 14 Fn 3. F1 EE S5 EF C::.-. . �: I jr ngy' nL AP 1" E3 I CERTIFY THAI 1: / HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF 8NCHORRGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. I: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. . .. .-`rzv-��- APPLICANT RDN �ODD ISSUED BY_- GRF 'TER ANCHORAGE AREA BO )UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM > NAME p, i'�}Pod _ MAILING ADDRESS cS_k l�i COcer '�/D C� l�� PHONE - LOCATION c. `�- -t.kl GvVt,l LEGAL DESCRIPTION & vc:& - --� f N c-. SEPTIC TANK: V� DISTANCE G NUMBER OF FROM WELL\ MANUFACTURER. ����� MATERIAL r�-•CZ"��" COMPARTMENTS_ 5 INSIDE LENGTH^ INSIDE WIDTH _LIQUID DEPTH _LIQUID CAPACITYA000 GALLONS. SEEPAGE PIT: 35 NUMBER OF PITS DIAMETER -- OR WIDTFI2—I, LENGTH_, DEPTH co') Ca" $ / LINING MATERIAL P (106 LCRIB SIZE: Ox9)IAMETER_DEPTH -7— DISTANCE FROM: WELL ( TOTAL EFFECTIVE BUILDING FOUNDATION �, NEAREST LOT LINE U ,I . ABSORPTION AREA (WALL AREA) 7S _SQ. FT. ADDITIONAL ABSORPTION WELL: / � b TYPE CCC,,, CONSTRUCTION BUILDING NEAREST FOUNDATION—__, LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DISTANCES: NEAREST SEWER LINE °V INSTALLED BY �. Fri PIPE MATERIAL:c.cCLOT SLOPE: �"___ REMARKS: _.. _ r1ATF - e -11 DEPTH _ _ DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM DIAGRAM OF SYSTEM G.A.A.B. Farm No, EQ -031 JD NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCRIPTION GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF' ENVIRONMENTAL. QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK _ • SD __ SEEPAGE PIT TYPE AND SIZE OF FACILITY TO BE SERVE[ ILING ADDRESS DRAIN FIELD PERMIT NO. PHONE .3 OTHER FINANCED THROUGH —_.- _— TO BE INSTALLED BY ----- SOIL TEST RESULTS - NOTES THIS PERMIT 15 NOT VALID WITHOUT SOIL COMPLETION DATE ANTICIPATED TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKI'ILLING OF ANY SYSTEM WITHOUT FINAL. INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE 7 ST)'FYPF. _-- � p SEEPAGE" AREA SIZE: d-.--- TYPE MINIMUM DISTANCES, RECQUIR15MCNTS FOUNDATION TO SEPTIC TANK a t FOUNDATION TO SEEPAGE PIT _-- DRAIN FIELD -- SEPTIC TANK TO SEEPAGE PIT WALL _ 1 SEPTIC TANK _ . -, SEEPAGE PIT -_, DRAIN FIELD 'FO NEAREST LOT LINE. WELL TO SEPTIC TANK __Q`-=_.. ---... SEEPAGE PIT d..tTJ DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK DRAIN FIELD SEEPAGE PIT SEPTIC TANK, -_- , SEEPAGE PIT ___-__, DRAIN FIELD TO RIVER, LAKE. STREAM. CAST IRON INFO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDIS'FURDED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. <r-RVEL 13AGKPILL Ti RflFT OROUGFI REGULATIONS REGARDING INSTALLATION, G.A.A.B. OR LICENSED DESIGNER DIAGRAM OF SY'S'TEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2B-66 AND 9'HAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE �---8= APPLICANT'S SIGNATURE - FORM NO. EQ -016 "Ono test is worth a thousand opinions" 13Od9 TLIIJOR ROAD, ANCHORAGE. AL.ACKA 90507 9 TCLRPKoric 333.0479. Performed For Glacier Excavating pate Performed 8-6-73 I.ecial 0escrintion: t.ot 5 Block: 3 Subdivision Sky Ranch Estates _._ .- __--.._. -- ----- - — — _ - 'Phis r=or•m Reports Soils Lon Yes Percolation -Gest tenth !eet Soil Characteristics 1 �— Mixed layers of Sand(SW & SM) _ and Silt (ML) n ( Average of 225 sq.£t./bedroom 7 1 n --- _------ Bottom _- .Bottom of Test hole minus 15 ft. Was Ground Water t:ncounterri'? no - It Yes, At what Denth? Readinq Date I Gross Time WALE t I A_.__� Net Time Depth to H,0 I Net Dro ------------- colation Rate rlinute I'1,ocrosed Installation: SeeDaoe Pit Drain Field )Doth of Inlet _ Depth Tn Bottom Of Pit Or "french HITS: 22 s ft. drains e area re uiredper bedroom no bedrock or water table 4 ft. below seepage pi --- — -- _-- =F :3ritt?F.l f3yFJim Mack Data Certified Q Construction Pestlab Lab Manager Date: 8 :-9:773 I I < I L I I � I - I i i I - I -- t I A_.__� Net Time Depth to H,0 I Net Dro ------------- colation Rate rlinute I'1,ocrosed Installation: SeeDaoe Pit Drain Field )Doth of Inlet _ Depth Tn Bottom Of Pit Or "french HITS: 22 s ft. drains e area re uiredper bedroom no bedrock or water table 4 ft. below seepage pi --- — -- _-- =F :3ritt?F.l f3yFJim Mack Data Certified Q Construction Pestlab Lab Manager Date: 8 :-9:773 MUNICIPALITY OF ANCHORAGE f Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I. D. 015-302-02 1. GENERAL INFORMATION Expiration Date: Complete legal description SKY RANCH ESTATES #2 BLOCK 3, LOT 5 Location (site address) 11721 PADDOCK LANE, ANCHORAGE, AK 99516 Current property owner(s) GLENN A & BRIJON E ROOSE Day phone Mailing address Real estate agent 11721 PADDOCK LANE, ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Water Storage ❑ Holding Tank ❑ Community Well #212916 ® Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 5U Waiver Fee $ Date of Payment (a 6 Date of Payment Receipt Number D Receipt Number COSA # 05 C) Q 1 'J 9 o` Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 7/8/2022 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to y�i11 these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory ��Q:• • • • . �) for current or future occupants or guarantee that no unseen encroachments, deficiencies or g•• •9 `� discrepancies exist can be given by First Water Consulting & FWr ' *• Q TH ••* �. .: ........r 6. DSD SIGNATURE Ir••• •••' ••'�"' / • • Curtis Huffman System #1 Approved for bedrooms ����F49s•. CE 128991 ••.��� System #2 Approved for bedrooms �ilPRO8ESS �P��4� Disapproved Conditional approval for bedrooms, with the following stipulations: O Original Certificate Date:_ 9- -3(i 2? ►N' The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: SKY RANCH ESTATES #2 BLOCK 3 LOT 5 Parcel ID: 015-302-02 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA – PUBLIC / COMMUNITY WATER – PWS ID#212916 ❑ Well log is filed with Onsite (or attached) Well production at time of test _gpm Date drilled Water storage tank volume allons Total depth _ft Cased to _ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) _in. Date of flow test for COSA Static water level at beginning of test _ft. Comments B. TANK DATA Age of tank(s) NEW TANK years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NEW ® Standpipes/foundation cleanout per record drawing Date of pumping NEW TANK D. ABSORPTION FIELD DATA Which system tested (date installed) 6/25/2002 (E)* ® ALL standpipes present per record drawing Total measured depth from grade 9_5 ft (max) —9 Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate _mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by_ Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 5/25/22 Results M Pass For 4 bedrooms Fluid depth prior to test 39 in Measured depth to pipe invert from grade 5 ft (mm) Water added 750 gal ❑ N/A – pressurized field New depth 53 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 1430 min depth into effective IR 8' – MEASURED 4.5' ED ®Code -required soil cover over field Final fluid depth 39 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: MT/CO AT GRADE. TESTED *EAST TRENCH. WEST TRENCH WAS DRY SIMILAR TO 2009 COSA OPERATING IN THE TOP VED. Fwr5 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' ❑ Yes if No ❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑Yes if No ft ❑ Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ft ft ft ft �� ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑ Yes if No **9.5 ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No *0 ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No *** ft Private Wells > 100' ® Yes if No _ ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *MOA WAIVER #WR020029 SHOWS 0' TO PL AND OTHER COSAS/HAA SHOW 4'. **PER OBSERVATIONS & 2009 LETTER IN MOA FILE. ***PER OBSERVATIONS MNA STAKING & MOA FILE / IR G. ENGINEER'S CERTIFICATION / certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Aowy� �... . ..• ....•.......`...� Curtis Huffman �$ �'�c�•.. CE128991 d'f 8/25/22 F ft i Municipality of Anchorage • Development Services Department i Building Safety Division „ t On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onslte (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-302-02 COSA# 050 385' 1. GENERAL INFORMATION Expiration Date: ` 0 , "7- 6 — / O Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SKY RANCH ESTATES #2: BLOCK 3, LOT 5 11721 PADDOCK LANE • ANCHORAGE. AK • 99516 JEFF PIASKOWSKI Day phone 947-6882 11721 PADDOCK LANE • ANCHORAGE. AK • 99516 Day phone KEVIN CROSS W/ KELLER WILLIAMS Day phone 865-6529 101 W. BENSON BLVD, #503 • ANCHORAGE, AK * 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class A Well 0 Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site N Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 samples. (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 cerfirled 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 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SURE 101 " ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readilyldentifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the contra of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone 337-6179 Date 1D IZo V9 Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Nitrate Advisory / �Other B 67 (Rsv. 1185) G`' PYr ON-SITE •:��: WATER AND . ; rK WASTEWATER �•,. PROGRAM Original Certificate Date: / D - a fo — O Cl Municipality of Anchorage °, T (� • -- 4 Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SKY RANCH ESTATES #2; BLOCK 3, LOT 5 Parcel ID: O/ 02, —O,2 A. WELL DATA COMMUNITY WATER Well typecOuuUNrtt If A. B, or C provide PWSID# 212916 Well Log (YIN Date completed Sanitary seal Wires property protected (Y/N) To Cased to ft. Casing height (above ground) In. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate mg./L. O onles/100 ml. Arsenic Date of sample: Collected by:' *DOUBLE CLEANOUTS B. SEPTICIHOLDING TANK DATA PRIOR TO SEPTIC TANK Tank Type/Material SEPTIC/STEEL Date installed 9/7/1973 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) *NO Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 10/14/07 Pumper AROUND THE CLOCK 1PUMPING C. ABSORPTION FIELD DATA QELOW EXISTING canoe Date Installed 6/25/2002 Soil rating (g.p.d./ft'o /bd 0_6 System type DEEP TRENCH Length' 75 (50 + 25) ft. Width 3 ft. Gravel below pipe 8 ft. •11.75 - Total depth _J2,0—ft. Eff. absorption area 1200 ft' Monitoring tube YES Depression over field NO Date of adequacy lest 10/12/2009 Results (Pass/Fail) PASS For 4 bedrooms Fluid, depth in absorption field before test 8 In. Water added 875 gal. New depth 46 In. Elapsed Time: 1130 min. Final fluid depth 43 In. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date - NOTE: TESTED EAST TRENCH. WEST TRENCH WAS FOUND,DRY. D. LIFT STATION Date Installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off" leve High water alarm level at in. Cycles tested Meets alarm & circuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service COMMUNITY WATER On adjacent On sewer manhole/cleanout Holding tank areas Manure/animal excrete storage areas _ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 50+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line '4' Building foundation "9.5' Water main 10'+ Water service line ***10'+ Surface water 100'+ Driveway, parking/vehicle storage 1' Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS *WAIVER NUMBER #WR020029. "MEASURED FROM FOUNDATION TO EDGE OF PIPE **PER INSPECTION REPORT DATED 7/2/2002. G. ENGINEER'S CERTIFICATION ted(`......... I certify that I have determined through field inspections and review of Municipal records that the above systems are in 0' ........... • ' • •"•" •'" conformance with MOA COSA guidelines in effect on this Q date. '•.Je f Garness: Engineers Printed Name JEFFREY A. GARNESSX004 J E-7953 ' 10 Z a O C) p4° A p• ...... • o logo Date COSA Fee $ �i q 0 Date of Payment /0— ;Z 0 - 0-11 Receipt Number (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number �ApOOG� ,Cf,>NE I r s/r ReBAA �h.0,14 ' — i SET i . N �0 9./ ii:�✓ !'8! 3%� w•ra yell -3 Pkrof i Ca LoG S re /5''� w4IKWay Fe ,J s-:�rcenc Ar 'F.•uct e..�..•eR , . .. i Zor 5rAt4 EReC4, 77,COP Recevi,'rW �U/ S � N° C.nrnert Se I hereby certify that :I have surveyed the follow1u. OF 41 \\ .described property' Lo7 .S, dei scribed Y • • : • • • • • •JJ Ali— Anchorage ;Precinct.s� and that •the Improvements situatedhereonate ch -'0n the property • • • • • .. • • ... • • • . Ihiea end do hot ovtt, lip 76r MSrSWth 'on the property P p N0.3255 S •• C7 �g adjacent therbto,'.thit n4. jm�pprovements ,on . P • .�� erty lying adjacent thereto encroach on:3be praraler "•� .• :. •: , i ueatioa and that .then¢ :are.no xoadwaya, `fa'anamiaslun �t JJ� • •. • . • • 0� A" Minae or other visible eIsomanta on acid property e%ept f• • • • �' D as indicated hereon. L� DDatedat Anchorage, Alaska SzACE / 3D' .IRV, 29'3 4Gt�U3J" is 9.3 thl, TPS RECORD, OTHER THAN ,FRED WALATKA & !ASSOCIATES PHASEHOSE SHOWN ON THE RECORDED Engineers and Surveyor PLAT GQt N07 SHOYlN HEREON. Engineers' Ai- 73,5' /7 Page 1 of 1 Poet, Jeff W. From: Jeff Garness [Jeff@garnessengineering.com] Sent: Friday, October 23, 2009 10:14 AM To: Poet, Jeff W. Cc: Sonja Garness; Andrew Gray Subject: Sky Ranch Estates #2, B3, 1-5 Hello Jeff, I had my field technician Andrew Gray make a site visit to re -verify the separation distance between the cleanout pipe (on east end of 50 foot trench installed in 2002) and the foundation. The distance from the edge of the building to the edge of the pipe is 9.5 feet; however, the vertical pipe may be slightly leaning towards the house. It is not possible to confirm whether the drainfield is 10 feet from the foundation without excavating down to the edge of the drainrock and physically verifying the separation distance. Per the inspecting engineering in 2002, Toben Spurkland, P.E., the separation distance is 10 feet. The existing separation distance has been in existience for over 7 years, and we are unaware of any adverse impact associated with it. Jeffrey A. Garness, P.E., M.S. President Garness Engineering Group, Ltd. 3701 East Tudor Road, Suite 101 Anchorage, Alaska 99507-1259 Ph: 907-337-6179 Fax: 907-338-3246 email: Jeff@garnessengineering.com website: www.garnessengineering.com 10/26/2009 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 O www.ci.anchorage.sk.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 016-304-0,?- HAA# o2L7o�ga Expiration Date: i —.2- - 0_ 1. GENERAL INFORMATION Complete legal description I—o i 5 1314. 6. g1L`l P-4Ne- 14 LISTA i t *Z Location (site address or directions) 11721 {7A,DDOGIL L_A14 t= Current Propertyowner(s) C7,4P_%-/ ILU i IL Dayphone `727-0.7/'7 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address A of S A L h -t Nn,, r t r i v-e— Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: `7 Day phone Day phone 3. TYPE OF WATER SUPPLY:' TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank Community Class A_ Well Community On-site ❑ Public Water System ❑ 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 Municioatity of Anchorage is not responsible for errors or omissions in the professional encineer'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_ Iolilotcr hL Phone - Address Engineer's Printed NameJ obber ',;pu rV_LeL-,D Date _ �O/2 Lilo 2— S. S. DSD SIGNATURE 17a Approved for bedrooms. Disapproved. &'t•�,, :; :,;. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: •7 — 2- - c (Rw, O1102) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw, SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorege.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST u� Legal Description: Lv-r 5E FW,77S %ICS! RAW. u ka i Parcel ID: D16-30;2- o 2- A. A. WELL DATA Well type A Date completed _ Total depth R , Date of test If A. B, or C provide PWSID # gL1fi 13 Well Log (Y/N) Sanitary seal (YIN) _ Wires property protected (YM) Cased to R Casing height (above ground) in. FROM WELL LOG AT INSPECTION r Static water level Well production WATER SAMPLE RESULTS: Coliform oolonies/100 ml. Arsenic: _ mgA. B. SEPTICIHOLDING TANK DATA F11 g.p.m. ft. Nitrate 1 mg./1. Other bacteria oolonies/100 ml. Date of sample: _ Collected by: TankType/Material S--rL. Sett Date installed IQi1 Tank size 12nU gal. Number of Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression over tank (Y/N) High water alarm (Y/N) _tA Date of pumping �O f �- Pumper LQvse.lr Ct�g Aei 1 C. ABSORPTION FIELD DATA Date installed %4d Soil rating (g.p.d./e or*bdmr) • to System type b"we Lr Length 75 ft. Width ft. Gravel below pipe _� ft Total depth 1?„ R Eff. absorption area LVO fe Monitoring tube ,L Depression over field I` Date of adequacy test N/A- Results (Pass/Fail) For, bedrooms Fluid depth in absorption field before test on. Water added tjai. New depth -I![— Elapsed Time: ✓ min. Final fluid depth "'in. Abso tion rate >= ✓ g.p.d. Any rejuvenation treatment (past 12 moa (YIN & type) If yes, give date +� D. UFT STATION Date installed 'Pump on' level at _ in. Datum E. SEPARATION DISTANCES SEPARATION DISTANCES Septic tankAlft station on lot Absorption field on lot Public sewer main Sewer /septic sepfice line size, in gallons 'Pump off at Cycle sted _[ )M w6l. ON LOT TO: (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent On Publicp6wer manhole/cleanout tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 30 Property One 3 O Absorption field 1 bO Water main 1&0 Water service line I t7 Surface water N t7 Wells on adjacent lots I &e' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line �i Building foundation 10 Water main 30 Water Service line Surface water N D Driveway, parking/vehicle storage O Curtain drain N Wells on adjacent lots _ i" F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 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©bb<<l`- Date to HAA Fee $ Waiver Fee $ Date of Payment Gll4flO L Date of Payment Receipt Number A19q L Receipt Number (Rev. 12101) in. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL i,1Sj� -i�Gl OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date /—(o —5�7 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Z-2-- Location y Location (address or directions) (b) Applicant Name �C�h/ % Eii'G-�/T u //°^� Telephone: Home — Business Applicant Address Iku L° 3,,`c;� 14A/61 /I`Y 05 (c) Applicant is (check one): Lending Institution ❑ ; O, w_ner/builder; Buyer ❑ Other ❑ (explain); �if5 NL T % Sc 3 (d) Lending Institution �" Telephone 3s 4" Address 3e'p D ST.- Jahr /03 /6(" /rH�a3 (e) Real Estate Company and Agent f1,9 eP 7*Al C�G71L E T/ti� — c/ �C/G i�vi�ii%uE Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms -3 3. WATER SUPPLY Individual Well ❑ CommunityX Public ❑ Note: If 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. Page 1 of 2 72-025(11,94) 5. ENGINEERING FIRM PROVIDII.., INSPECTIONS, TESTS, FILE SEARCH, D,.. A 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. _ t/ Name of Firm A Telephone Address /I—�'a l,l jj =✓J /�i'c` juiT� Date 1-6 --y 7 6. DHEP APPROVAL � Approved forbedrooms by Approved — Disapproved Terms of Conditional Approval Conditional CAUTION Or N,�% �9�`eee•ee een /�la� ••• ••• �yee �e es•y°l.� • Y l.. KCIV, JK. ll � •• CE - 2251 m Date /--S'-8-F- The Muncipality 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 DHEP 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. Page 2 of 2 72-025 (11/64) A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Descriptjon: X0 r �� SOL E5 • Z T/' :�3a1 scG Z7 Well Classification — 6/110J17_1 — If A, B, C, D.E.C. Approved(Y ) WS /1 It � 17-9'1e Well Log Present ( ) —— Date Completed -- — Yield Total Depth Cased to Depth of Grouting Static Water Level — — Pump Set At Casing Height Above Ground __ Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Seal on Casing (Y/N) — n Around Wellhead (Y/N) On Adjoining Lots kdjoining Lots — To Nearest Pu To Nearest Sewer ervi ine on Lot Date — Date Installed `7' 73 Size - /07r_0 No. of Compartments — Z- Standpipes (Y ) Air -tight Caps' Y/ ) — _ Foundation Cleanout ( Depression over Tank (YOI -_ Date Last Pumped 1_&l Pumping/Maintenance Contract on File (Y/N) ; for 101A Holding Tank High -Water Alarm (Y/N) Temporary Holding 'rank Permit (Y/N) Ate X Separation Distances from Septic/Holding Tank: i To Water -Supply Well —_yam �` To Building Foundation To Property Line A'0 To Disposal Field /9 9Tila4 A_ -13 Ccri9,l T. To Water Main/Service Line —/_� 7` To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) LS OJ 9*YX41af e -57T 1/2- C. /Z C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Z7 d Type of System Design Date Installed 7" 7 -y' -7,r Length of Field 5-/ _ n Width of Field Square Feet of Absorption Area ® 7/ Depth of Field Gravel Bed Thickness ® /l >ER AAWRI7 7 �47e Pt1RA)/T Standpipes Present&) Depression over Field (Yd)—Date of Last Adequacy Test Results of Last Adequacy Test AgigUAT� - TeZs r1JwzWA 'Z2f[tL-F5 Separation Distance from Absorption Field: To Water -Supply Well L&a f To Building Foundation Lot LO / % S'WeAvA6 On Adjoining Lots To Water Main/Service Line _�P 75 %3ok - To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course /&V �f_ / To Driveway, Parking Area, or Vehicle Storage Area Id 71- D. t To Property Line — To Existing or Abandoned System on / _30, S7704/f- T 57WbP1,4.= !A D. LIFT STATION Date Installe Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off' Level at Vent(Y/N) ping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that ha he ed, ve ified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date o -87 Company AF45 MOA No.d o P® of A4 4 � �y ao•o•••oe�r�� ReceiptNo.- O(� ����.•�� T . .• Date of Payment d Amount: $ �� ee e •11.1•• o o• • ZERO C REID, JR..: /4o �°�.ko%¢G �e'c �•. = 2251 d Page 2 of 2 z.Lcauae> 7�sr ��'su`rs �4� �Professi�tc��{` 72-026(11/84) 60660 ALASKA CI dROnMenTAL COnTROL SCRUIC65, InC. enymeerinq & l3nuironmenlal Studies 01/07/87 KATHERINE DONOHUE SELLER—DEN.ALI FED CREDIT UNION KATHERINE, DDNOHUE MARSTON REAL ESTATE MARSTON REAL ESTATE 2804 WEST NORTHERN LIGHTS 2804 WEST NORTHERN LIGHTS ANCHORAGE. ALASKA 99517 ANCHORAGE AI:ASKA 99817 LEGAL:SKY RANCH ESTATES *2. LOT 5 BLOCK 3 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE 01/05/07 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 714 SOFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 662 GALLONS. BASED UPON 171E TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME, SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 TS ADVOCATE POR THIS 3 BEDROOM HOUSE. THE SEPTIC TANKiPACKAGE. PLANT WAS PUMPED ON 01/06/87 . THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER SUPPLY OR WASTEWATER SYSTEM. Who Tv"1110j.09 C. REID, JR. -2251 1200 West 33rd Auenue. Suite � • Anchorage. Alaska 99503 •(907) 561-5040 � r- �'i I f f 1 1 Ilf10i 6 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 DATE: PWS I.D.Ik A�— To Whom it May Concern: According to records on file in thi< A%—�-ZE=_ Water System is Water Regulations BILL SHEFFIELD, GOVERNOR Telephone: 19071 Address: 274-2533 office the in compliance w th the State Drinking Sincerely, ALASKA ENVIRONnIGNTAL CONTROL SERVIC. , INC. SHEET NO.— OF 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 CALCULATED BY /� G✓�E _ DATE _ (907) 561.5040 CHECKED BY y _— DATE ra;r. r.I.. -:. ... LQD d to: . r L -,V -W MUNICIPALITY OF ANCHORAGE - hot 5 Block 3 Sky Ranch DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION STREET LOCATION - - _ - 825 L Street • Anchorage, Alaska 99501 5. TYPE OF RESIDENCE —� - NUMBER OF BEDROOMS ENVIRONMENTAL ENGINEERING DIVISION ❑ one ❑ Four ❑ Other Telephone 264.4720 _' 9 ) Three ❑ Six REQUEST FOR APPI30VAL OF INDIVIDUAL WATER AND SEWER FACILITIES - DIRECTIONS: Complete all parts on -page -1. Incomplete requests wilt not be processed. Please allow ten (10) days for processing::: * ATTACH WELL LOG. A well log is required for all wells drilled 1. PROPERTYOWNER since June 1975. Fol wells drilled prior to that date, give well PHONE depth (attach log if available.) Ronald Carol Todd _ 344-0030 **If individual/on-site, give. installation date_i;_.: MAILING ADDRESS --- -- ----- - -- -C� -- PUBLIC UTILITY _ Sfax` Route A Box 1628-G_-9950'7 - -_ PROPERTY RESIDENT(ifdifferent from above)- -- - - -PHONE. 2. BUYER -- -- - P 50 -- Rod/Mary Dangall 276-7383 -MAILING ADDRESS -- 4745 Piper Street, #5 3. LENDING INSTITUTION ____PHONE_ Peoxsles Bank and Trust Company 79-7511 MAILING ADDRESS - - - Ei44 West 8th Avenue 99501' 4. REALTOR/AGENT--- — PHONE --- Michell Decker, Executive Realty ____t76-7777 MAILING ADDRESS - - - - - - - 2410 C Street 99503 5.LEGAL DESCRIPTION - - - hot 5 Block 3 Sky Ranch Estates #2 ' STREET LOCATION - - - - - 5. TYPE OF RESIDENCE —� - NUMBER OF BEDROOMS Xti7 SINGLE FAMILY ❑ one ❑ Four ❑ Other ❑ ` Two ❑ Five ❑ MULTIPLE FAMILY ) Three ❑ Six 7. WATER SUPPLY _ - _ ❑ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled XX COMMUNITY since June 1975. Fol wells drilled prior to that date, give well 17 PUBLIC UTILITY depth (attach log if available.) S. DISPOSAL. SYSTEM - _SEWAGE x INDIVIDUAL/ON-SITE** **If individual/on-site, give. installation date_i;_.: If system is over two (2) years old an adequacy. test is required -C� -- PUBLIC UTILITY _ by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONL. - - INSPECTION APPOINTMENTS DATE RECEIVED TIME - TIME - - TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS - ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMITNUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER UJ&,V1ic Tank or ❑ Holding Tank Size: I000 If Tank is homemade give dimensions: SOILS RATING q0 TYPE OFTANK MANUFAC',TO Eji -Y/IL ,t ^ CJ��'lN--a_-MVI TOTAL ABa.ORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS R7, -'APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATEE/1 (` LEGAL DESCRIPTION 72-010 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ' 2610 -East Tudor�Road; AnchoraW-Alaska99604--276-2224 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA FHA_ CONV. �- 2. Property Owner: Len �t C__- ,4o Mailing Address: &A 1Io Day Phone:— 3 /^v 0,3rr 3. Name of Buyer: Mailing Address:— {f �'� ��� -�'—Day Phone: 7— f 4. Name of Lending Institution:' G r'f Mailing Address: F /�� Phone:— S. Name of Realtor or Agent: Mailing Address: "�'//0 e —-I; —e 777 J — 6. Legal Description:_ .J-1T�c-- d/fit �c7ivcniti Go�iCts`�2.J Location: 7. Type of Facility to be Inspected:_ No. Bdrms. 3 8. Water Supply Type of Supply: Public Utility---] nclv'/ ividual_ �. 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 installatio(7��L Individual (on-site-)_J�� 72-003(3/76)