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Home My WebLink AboutSKYWAY PARK ESTATES BLK 3 LT 9Skyway Park Block 03 Lot 09 #019-151-07 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201343 PID Number: 019-151-07 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Q Upgrade Name RICHARD CONNOLLY ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bedound Site Address 1341 WOO BLVD *ANCHORAGE, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth original grade 907-306-6971 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot SKYWAY PARK ESTATES; BLOCK 3, LOT 9 Fill added above original gr 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 orption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well _ _ TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer TANK Capacity 1250 Gal. Surface Water 100'+GREER Material HDPE Number of compartments 2 Lot Line51+ I ' NA . Foundation *10 1+ LIFT STATIONManufacturer Capacity Gal. Remarks OLD TANK FILLED WITH CONCRETE '5' TO DECK PILES Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 Installer A+ HOME SERVICES Drainfield 03034IEXISnNG Co/MTD3034 Inspector TIM ECKLUND AND GEG BENCH MARK (Assumed elevation) 100.3 ft Inspection 1s:10/14/2020 - Location and description 2rvtl - - - ----- - - TOP O F M H 3'° - 4m - ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp _oc�oop�4 Conditional Approval: Date o's?.• �s�� -3;7 — — TII — . '-= .................. � Q J f A. Garne s: — -- ---- - ---- Septic Syste -�7-2C� CE—. JJ c QO ��sf� Approve Date (I e� Note: this approval does not include well permit requirements. •� �� 4Q�4p rofesss'%O ate d #AECC884 �p0 (Rev 05/02/18) PERN11T NUMBFfR: OSP201343 RECORD DRAWING 515 35,5 19.1 STI 54,8 37,5 21�4 DBL3 54,1 36 .8 2�F24.7DBL4 533 35.9 25, i EXISTING DRAINFIELD S E R V E D EI Y A',lv'AU VVA T _E R Il NEVV 1250 GALLON HOPE SEPTIC TANK DSLl&2 f 41H. 0 EXISTING 3 BEDROC'M HOUSE APPRO'XINAIATE KEYBOX LOCATION PER CONNECT CARD- 'IjA-,;:R UNE Locikfi!ON IS UNKNOVtAl W60 �o PARCEL ID NUMBER. 019-151-07 -APPROXIMATE LOCATION OF WATER ",CAIN PER AVv%AAJ RECORD DRAWINGS 1�� T T 37 17 jD T M, Mui UK, ul bi A RN Eliq �<53 E 4 ki I j E c I Ltd ENGINEERING SALES CONSULTING PREPAIRED OR- PHONE NUNTBER RICHARD CONNOLLY 907-306-6971 LEGAL r'F-:SCQ!P NON SKYWAY PARK ESTATES; BLOCK 3, LOT 9 TYPE OPVjOIRK, L SEPTIC TANK RECORD DRAWINGS PAGE NUMBER, 20F3 DRA%Vol 3Y D.J.G. DATE 11/3/2020 OF ... . ......... * ...... 0 0. 7 . .......... CL- 0 Garnes k e - y gg c=__953 4 �mp L 1111111 c I SES -AE 884 tit lb:� r=RNflT NLf%l8ER PARCEL ID NUMBER OSP201343 019-151-07 75z� RECORD DRAWING TOPOFMiANHOLE = !00,35 FINAL GRADE = 99 7-99,8 INIH ST2 INSULATION PER CONTRACTOR TOP OFF TANK AT !NTLET 96 46 TOP OF TANK AT OUT LET = 95,46 It NEW 1250 GALLON !NVER7 OF BUNG Al INLET = 95 77 H.D.P,E. SEPTIC TANK - INVERT OF BUNG AT OUTLET = 95,64 OVERSIZED FOR 3 BEDROOMS 04, % 21 Q 0 .12 A Tr 111"llf TINT I df R J� . . .......... . ...... ..o ENGINEERINGSALES CONSUMNIS ......... .......... PREPARED FOR PHONE NUMISER PAGE NUMIBER 0 dff e Garness :: C��Jvw RICHARD CONNOLLY 907-306-6971 3 OF 1!em - CE-79 7z__ 0 LEGAL DESCRIPTION DRAVV14 BY SKYWAY PARK ESTATES; BLOCK 3, LOT 9 D.J.G. T,ePOF V'0ORK DATE, LICENSE 4410WESR�"" 11/3/2020 # EC 884 z W W O WOJ wZd ^-P�7 Oy6>/// x m QLLJ ��W n'W OQ mQU p W 0 -v .., x <mw >-LLa �: :o, w m~No N m� Za °O� ice: S I �"i� > F- �0- E-F' N Z } U�F-I Z) F- cn U AZO¢ W W d Zr W z=m // �: ,.•Q2•.: J W W W R�F_Za U Fz Opp umiv�Fi~ /�� _ ��F�� m ¢ptr NU) > pg 0 wzW (t, `S G\S�` x� a °zzw z E _ a c9 m� zw¢ zO0 I�F�ttttt��R``�� Q pW Q o�r� p = u ° LL m W ~ x . 10 O �Wp z0m mWW v �Wp `'' cl mz _=¢ W Oma rc'Z`Z U W W W UO U C0 J WS NO N woZ O>•O zZ W < �% �' w3 m ONZO p�O in /j C6 x>- QLu xx x» zwao =0 o zi~z ¢z X W F- In F- (!7 (n 0 m - LL J < F W ° ¢ O .L9'£OW M ,.00,OZoOZ S 00. I S• p I I 8 W I I S I , F- w I I w b 30' i w O O Z I I oce) I � I L I > w I z M I Z U I Lo °; W m Li! w rn O~ I 7d 0S . Jap sts N 0 nl 0 % 05 p _ > (fl O J J� 0. �c� O v a O X65 VV9 a m I m a G-n2 -ry co � gw z wz / I Ng �SdO I _ I V I w I w m N (0: rn I I I I ( I i I L— — — — — — — — — — — — — — — — — — — — — — — — 1N3W3Sb•3 Alnun .m 30• ,00'OOZ 3 X0,OZ.OZ N 0 o I J I MUNICIPALITY OF ANCHORAGE On -Site Water& Wastewater Program POBox 18O85Q 47n0Elmore Road Anchorage, Alaska g8519-6G5O Phoma:04 Fox: (9O7)343 -78B7 Permit Number: OSP201343 Work Type: SepUcTankUpQnade Tax Code Number: 01815107000 Site Legal Address: SKYWAY PARK ESTATES BLR 3 L 9 8:2729 Site Mailing Address: 1341WOO BLVD, Anchorage Owner CONNOLLYRICHARD J&GAIL A Design Engineer: GARNE88ENGINEERING GROUP LTD This permit isfor the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: Q/3/2O2O 9/3/2O21 r_1 Disposal Field 21 Septic Tank 0 Holding Tank 11 Privy M Private Well 13 Water Storage All construction shall beinaccordance with: 1. The attached approved d 2. All requirements specified in Anchorage Municipal code Chapters 15,55 and 15.65 and the State of Alaska VVaatevvmhar Disposal Regulations (18AAC72)and Drinking Water Regulations (1QAAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.S5.Provide notification bycalling (9O7)343-7904(24/7)� 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: a. Opened and Closed onthe same day, or b. Covered, sealed, and heated toprevent freezing Received Date - Issued By: aba-|ssumdBv: Oahe 3 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I. D. 019-151-07 Property owner(s) RICHARD CONNOLLY Mailing address 1341 WOO BLVD *ANCHORAGE, AK Site address 1341 WOO BLVD *ANCHORAGE, AK Day phone 907-306-6971 Legal description (Sub'd, Block & Lot) SKYWAY PARK ESTATES; BLOCK 3, LOT 9 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 3 (4 -BEDROOM TANK) APPLICATION IS FOR: Single Family (SF) (® all that apply) (w/wo AD U) Absorption Field ❑ Septic Tank Multiple Dwellings Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: N/A TYPE OF DEWELLING: Single Family (SF) (w/wo AD U) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: / 6 g. 75 COUID Date of Payment: 9-2-G `"Z Receipt Number: Op(20 a Permit No. O5 P 2013(4 Z2 Waiver Fees: Date of Payment: Receipt Number: Waiver No. (Rev. 01111) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201343, Rebecca Carroll, 09/03/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201343, Rebecca Carroll, 09/03/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201343, Rebecca Carroll, 09/03/20 Municipality of Anctlorage Page _ I of"'~--- DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SEFiVlCES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Name:~ [L~ [ ~ --~ ~¢~'~ Wastewater System: ~ew U Upgrade INc. of Bedrooms: ~eep Trench U Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTIO N so, Raft.g: ¢~ GPD/Sq. Fb Tots1 Depth from original g~e~ Township: ~ Range: Secti~m Fill added above origin I grade: Gravel length: WELL: ~ New ~ Upgrade Gravel~/~ ~ /Ft. Number of lines:/,IDislance betweenlines:~ Ft. Classification (Private. A.8.C): Total Depth: Cased To: Total absorption area: Pipe material: ¢~ SEPARATION DISTANCES ~Septic U Holding U S.T.E.P. To Septic Absorption Lift Holding Public/Privat(~ __M nufacturer: ~r~ pacity in gallons: From Tank Field Station Tank Sewer Lines ~C ~,~ ~¢ '~ /~ Surface Foundatio, ~, t~[ --- -- ~ "Pump on" level at: __~: I High water alarm at: Remarks: BENCH MARK Location and Description: Assumed Elevation: ~ ~ ENGIN E~'~AEAL nspect ons performed by _ 1st .~ i~/' Department of Health and Human Serv,ces approval / '~%. 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 Legal Description: ~-'~'"/ b~J4~"-/ ~-q~__~ ~ ?~::~:~_~;::~, I....C.:)-F' (:Dj PID No.: N 72-013 A (2/91) MOA 25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW920060 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:HURST WILLIAM D & OWNER ADDRESS:2948 BASS STREET D-64 ANCHORAGE, AK 99507 PAGE 1 OF 1 DATE ISSUED 4/~/92 EXPIRATION DATE: 4/17/93 PARCEL ID:01915107 LEGAL DESCRIPTION: SKYWAY PARK ESTATES BLK 3 L'r 9 LOT SIZE: 59850 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 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. 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 (18AACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE ABSORPTION FIELD MUST BE THE APPROVED ENGINEER,S DESIGN DATED 04/10/92. RECEIVED ISSUED BY: INSTALLED IN ACCORDANCE WITH DATE HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PSRCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERESHAFER. PE ROGERSHAFER, P.E. April 10, 1992 CIVIL ENGINEERS (907) 694-2979 FAX 694 1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 REFERENCE: Skyway Park Estates, Block 3, Lot 9 Request you issue a permit to install a septic system on the referenced property. Two test holes were excavated and percolation tests were performed. The approximate location of the test holes are located on the attached site plano The monitoring tubes within the holes have been checked and found to be dry. This property will be served by a-~m~ water system. The water service will enter the property from Woo Boulevard. As can be seen from the site plan this lot is large enough for future upgrades. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic upgrade. If you have any questions or require additional information for your review, please contact us. Sincerely, ROGER J. SNAFER, P.EJ RJS/lsu APR 1 19'32 D Iviuaic~¢~.~hty of/',nchora~e ep[. Health & Human Ser¥Ticea 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 /"= #0' SCALE ~oo])~Jo9 ueu. nfl "'9 tl:~lUabl ']cio('] o 7'0 Y DR/VE Municipality of Anchorage DEPARTMENT OF HEEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, AIBska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: SLOPE SITE PLAN LEGAL D E SC R I PTI O N: ~_~./? !..-/~-'2~,~'~ L/- 3 4- 7 iO 11 12 13 14 17 20- WASGROUNDWATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Oepth to W.a.le~4~fle~'? Monitoring? Gross Net Depth to Net Reading Date Time Time Water Drop ~ ~"~ ,, _ ~'/~,' ~,, ~ ~,~ ,, ~,/~', _~" PERCOLATION RATE ~'~ {m~nutes/~nch) PERC HOLE DIAMETER ~ I/ TEST RUN BETWEEN ~ ~ FT AND ~ FT 17034 Eagle Rive~' Loop Ro~d I~aglo Rivet,, Alaska 99577 PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL 1 2 3 4- 5- 7- 8~ 9- 10- 11 12 13 I~K52~"- '~ Townshl, Range, Section: SLOPE 15 16 17 18 19 2O WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop ~ :z~ ,, ~" PERCOLATION RATE ~,,~ .~..~m,nutes/inch} PERC HOLE DIAMETER FT PERFORMED BY: 17034 Eagle R~ver Loop Rnr~ N~.1204 Eagle River, Alaska 99577 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. CERTIFY TNAT THIS TEST WAS PERFORMED IN 72-008 (Rev. 4/85) Municipality ol Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~..C~ ,~,"~ ~-.-.-.-.-.-.-.-.-.~//\/~Z~/ 1 2 3- 4- 7- 8- 9- 10~ 11 12 13 14 15 16 17 18 19 20 Township, Range, Section: WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTFI? p E Depth Io Water Alter I~onitoring? Dale: SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop ¢r'. ¢' "~o ~4,~ ~ ~/~' ~'" . ~ ~ ~-~- ~,,/~ - ~ ~..~ ~ ,, ~/~ ~')~" PERCOLATION RATE \ O (minutes/tach) PERC HOLE DIAME~'ER ~ COMMENTS 72-~8 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE MEMORANDUM April 24, 1992 TO: Accounting & Budget, DHHS FROM: On-site Services, DHHHS SUBJECT: Request for Refund - Account ~2570 9426 Please make the necessary arrangements for the following refund. The applicant paid for a on-site wastewater and well permit. The subdivision is served by public water and the property will be connecting to this supply therefore the well permit is not required. This refund is for the well permit portion only. Thank you. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Receipt #23600/1596 Amount $75.00 Account # 2570 9426 Lot 9 Block 3 Skyway Park Estates Permit #920060 Subdivision Laura J. Montgomery On-site Services cc: File G F • Municipality of Anchorage On -Site Water and Wastewater Program G (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 019-151-07 1. GENERAL INFORMATION: Expiration Date: CO r 2 0 2 - Complete legal description SKYWAY PARK ESTATES: BLOCK 3, LOT 9 Location (site address) 1341 WOO BLVD. *ANCHORAGE, AK 99516 Current Property owner(s) RICHARD CONNOLLY Day phone 306-6971 Mailing address Real Estate Agent 1341 WOO BLVD. *ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ® Public Sewer ❑ WaiverNariance request for: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ ��lZ CvtJI� Waiver Fee $ Date of Payment f,�- Z D -20 Date of Payment Receipt Number Receipt Number (/ COSA # -S C 201 2 (�2 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. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the fol L`• � lin lt. f�.................. f r pf A.';Ilrnoss 1- ? ess:o ^tip #AECC884 /V ,Iili sti�(�i t1)tsra6P q >� 1 Original Certificate Datej 1 7^Z 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/ _ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc Legal Description: SKYWAY PARK ESTATES: BLOCK 3.LOT S Parcel ID: 019'151-07 if more than I septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA UWell log is filed with Onsite (or attached) Date drilled Total depth_______r1 Cased torit M Sanitary seal is functioning correctly MWires are property protected Casing height (above ground) I n. Date of flow test for COS Static water at beginning of test ft. B.TANK DATA Ago oitaok(s) NEW years Tanh\ype/nnaLeria| Measured operating fluid level inseptic tank NBN 01StandpipestfounUaboncleanout per record drawing NEVYSEPTIC TANK On�oofpumping Well production at- time of Water storage tank volurne �Qgallons E] Yes RE No 17 oli, ateria is Negative 7VKrahamg/L RNitrate less than MRL (ND) Arsenicug/L E] Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION FlRequired maintenance completed Age of lift station years Lift station material Which system tested (date installed) 1992 Adequacy test date 6/4120 FIR ALL st2ndpipes present per record dr2VVing Results E]Pass For bedrooms Total measured depth from grade 11 ft (max) Fluid depth prior totest 49 in Measured depth hopipe invert from grade 5.5+ f {m.n� VVato[edd8d\612 gal FlN/A—pressuhzedfie{d New deptin FlMonitor tubes goiobottom ofeffective. |fnot, state Bap�edtime 120 mm depth into effective ^»'� -�= «�'��/ ----— ----� ` ��Code-required soil cover over field Final O 58 fluid in ----' �lSyshsmpnaso�k�d 450+ Absorption rate gpd ----' (Required ifvacant for greater than 3Odays prior to Any rejuvenation treatment (past 12months) no date of test) Gallons introduced n/o gallons' If yes, enter date »/a Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES F-71 YesifNoft PUBLIC WATER If absorption field isunder driveway comment below Surface Water >1OO' From Private Well on Lot to: (Please enter distances if less then required or if community well) Property Line >5' El Septic Tank/Lift Station on Lot > 100' ifNoft VVabarK8ain>1O' Community Sewer Manh0lelCle > 100' Yes if No it ifNoft Yes if No ft Neighboring Tank > 100' Yes if No ft Priva' erlSeptic Line > 25' 17-71 Yes if No ft Absorption Field on Lot > 100' Fl Yes if No- Water Service Line > 10' Holding Tank > 100' 1771 Yes if No ft Neighboring Absorption Fields > I |fseptic tank inunder driveway comment below Animal Containment > 50' El Yes it' No ft Yes if No Manure/Animal Excreta Storage > 100' Commu ` ewer Main > 75' 1771 Yes if No ft R Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances it' less than required) Building Foundations >1O' F-71 YesifNoft ft If absorption field isunder driveway comment below Surface Water >1OO' f_lYos ifNoft Property Line >5' El Yes ifNoft VVabarK8ain>1O' Wells onAdjacent Lots: Absorption Field >5' Fv1Yes Private Wells >1OO' 121 Yes if No ifNoft k1 Private Wells >1OO' F71 Yes ifNo8 Water Main >1D' F-11 Yesi[Noft r1 Yes Community Wells >20O' f_/�Y8S ifNnft Water Service Line > 10' [J Yes ifNoft |fseptic tank inunder driveway comment below From Absorption Field onLot to: (Please enter distances if less than required) Building Foundation >1U' Yes if No +* ft If absorption field isunder driveway comment below Property Line >10' / certify that / have determined through field inspections and review Yes ifNoft ofMunicipal records that the above systems are /nconformance with Wells onAdjacent Lots: VVabarK8ain>1O' �]Yes |fNo� Private Wells >1OO' 121 Yes if No Water Service Line> 10' k1 Yeo if No ft Community Wells >2O0' P1 Yes if No____ Surface VVate/>1O0' r1 Yes ifNoft coSxChecklist yellow sheet ` F.ENGINEER'S COMMENTS `5'+TODECK PILES -EXACT DISTANCE FROM DRA|NF|EUDTODECK PILE |SUNKNOWN - DECK WAS PROPOSED ON 1992 INSPECTION REPORT G. ENGINEER'S CERTIFICATION / certify that / have determined through field inspections and review ofMunicipal records that the above systems are /nconformance with MCACOSA guidelines ineffect onthis date. coSxChecklist yellow sheet ` :^scCoo^ ft O Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Services Division Telephone: 343-4744 ON-SITE SERVICES FEE DOCUMENTATION Date Paid: _~Z//-/~ - ~~-'~ Name of P~.yer: (.~a~hec) Mailing Address: (Off of ch~ed~. . ~/ ¢~.. / Legal Description(s): X ~ ~ ~ 2 .~ ~.~.(, Permit Number: OS-- 23600 .Cheek /O,Z¢( /?¢ Type of Payment: (Indicate A~m~ount Paid) ~.~ealth Authority: /7~ / _ Excavator Permit: Sewer & Well Permit;. f¢ c) Engineer Permit: WAIVERS: Lot Line: Well to Tank: Well Permit: _ Pumper Permit: ~---~¢. ~'.-¢~¢ '~Vell Driller Permit: .-- Sewer Permit: ¢~0~/ O0 ~0 ~o_. Copy Request: Tank Manufacturer: - (Waste Treatment) 72-034 (Rev. 10/87) DISTRIBUTION: Well to Field Field to Surface Water . Tank to Surface Water wHrrE--MASTER FILE CANARY--PROGRAM FILE MUNICIPALITY OF ANCHORAGE Department of Health & Human Services On-Site Sewer/Well Permit Application _~ NOTE: Application mus, be 'illed t compl I ~, N ~=~r~l LY DWELLING Mailing Address -'~"~ Legal Description LO1 Block Parcel Identificalion Number Day Phone ~' /~ . zi, Lot Size will be conducted b NiCi?ALF~Y O~ ANCRU I nsp~ns Y I~d ..... ~¢'~.5 OtV~$tOt'l ~ Approved Enginee~l~~)r~rn~'~ AL ~ ~ ~ Number of Bedrooms: Acres/Sq F~ /_-~0~ C¢~ bz%t_ r-~¢.~' Municipality (permit fee in¢~ed) Hot Tub, Swimming Pool, Therapy Pool. Jacuzzi. Does your house contain any of the following: if yes. which one? ~b-~I~ ~/~"~ or Water Softener Unit? -- This application is for: Sewer Only _ ,X\ ~~ Sewer Upgrade -- Well Only la Cn ~I, YatchcS; rtdhaen~be cv~ ,i ihn fa(~rp ,n~ ca~ ~,~ i~ t~°nr, rc~, 'cf~dr tehs~r ...... F~_ee~.~,'~ ' Receipt~¢ O0 .~.~)~_ Permit# ,7.~"~-?..~ ¢~.~ f/"~ ~ ~) Municipality of Anchorage · r) evelopment_S er~.~ces_Depad, men~¥ Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Parcel I.D. 1. 019-151-07 GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING ' Expiration pate: '7- /- O Complete legaldescription SKYWAY PARK SUBDIVISION; LOT..9, BLOCK 3 Location (site address or directions) 154i WOO BLVD. * ANCHORAGE, AK Current Properly owner(s) Mailing address Lending agency Mailing address Real E~tate Agent Mailing address DAVE HURST Day phone.257-5236 1541 WOO BLVD. * ANCHORAGE, AK 99516 Day phone Day phone. Unle~sothetwise~queste~ HAAwillbeheldbyDSD ~rp~kup. 2. NUMBEROFBEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class.~Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site IndMdual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Depadment (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. Cedificates of Health Authority Approval are required for the transfer of title (except between spouses) for propedies 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 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 o As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Health Authofity 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 ~ime of installation. Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone Date 337-6179 Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineertng analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the b'me of the test, and separation distances measured to readily identifiable 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 control 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. AKWWC, Inc. 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. DSD SIGNATURE Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the fllowing stipulations: ~2 uN-SiTE ~: WA~ER AND ~ ~ WAS1~WATER Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental EnD,needs Other (Rev. 12/0~) Original Cedificate Date: 7-1-03 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South 8ragaw SL P.O. Box 196650 Anchorage, AK 995196650 www.ci.anchorage.alcus (9O7) 343-7~04 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA ,SKYWAY ,PARK SUBDNISION; LOT 9,, BLOCK 5t Parcel ID: 019-151-07 Weld type , , Date completed ~ ~ Cased to . . ft. FROM WELL LOG ~ g.p.m. PUBLIC WATER If A, B, or C provide PWSID# Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform - colonies/100 mi. Arsenic: , -' ,, mg./L. SEPTIGIHOLDING TANK DATA Tank Type/Material . in. Total depth .lo.2 ft. Eft. absorption area 570 fi2 Monitoring tube YES Date of adequacy test . 6/16/2005 Results (Pass/Fail) ,,P,,ASS .. Fluid depth in absorption field before test ~__~.25in. Water added 885 gal. Elapsed Time: 258 min. Final fluid depth .59.5 in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) ~_ i NONE ,KNOWN Date installed 6/11/1992 Cleanouts (Y/N) YES High water alarm (Y/N).. N/A ISAAC's PUMPING System type DEEP TRENCH Gravel below pipe 5 ft. Depression over field NO. For 3 bedrooms New depth 64..0in. 4-50+ g.p.d. If yes, give date - Absorption rate >= ABSORPTION FIELD DATA Date Installed ,, ~s/~ ~/~eg2 length 57, L L fl. Soil rating ~r ft~:Klrm) 0.8 Width .. 3 . . ft. STEEL Tank size. 1000, gal. Number of Compartments 2, Foundation cleanout (Y/N) .YES Depression over tank (Y/N) NO Date of pumping 6/14/2003 Pumper Nitrate - mg,/L. Other bacteria - colonies/100 mi. Date of sample: , -, Collected by: - D. LIFT STATION Date installed Size in gallons ~ __ "Pump on" level at in. "Pump off' n. High water alarm level at in. Da...~tum~ 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 PUBLIC WATER On adjacent lots ~ Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10°+ Surface water. 100'+ Wells on adjacent lots 100'4- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation~ 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage . Curtain drain NONE KNOWN Wells on adjacent lots 100'+//200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION 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. JEFFREY A. GARNESS Engineer's Printedpam~ o.ta 30'+ Date of Payment e/~,,4- lb.5 ,, Recei 5 G ?. (Rev. l:~OS) Waiver Fee $. Date of Payment. Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4'744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING '1. GENERAL INFORMATION Complete legal description Lot 9; Block 3; Skyway Park Estates Subdivision Location (site address or directions) Property owner Dennis Smith dba DAYSHOO CORP. ENT. Day phone 376-1493 Mailing address 2970 Cottle Road, Wasilla, Alaska 99687 Lending agency Mailing address Day phone Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 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. 72-025 (Rev. 1/91) Fronl MOA ~'21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature DHHS SIGNATURE ~,~ Approved for Disapproved. 7034 Eagle River Loop Road Phone ,,~~ bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional 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 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 Department of Health & Human Services HEALTH AUTHOFIITY APPROVAL CHECKLIST Legal Description: L¢~"¢ ~:~ I:~L~.~ % A. WELL DATA Well type M, 0, /~, If A, B, or C, attach ADEC letter, ADEC water system number Log present(Y/N) Date completed Driller Total depth _ Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL, LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot g,p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer main Public sewer manhole/oleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Tank size \ ~¢"~'~¢=' ~- Compartments "¢ '--' Depression (Y,(~ Alarm tested (Y/N) "----' '""~,,~'~ ~'~"~ Pumper CleanoutsCCTN) "7/ _ Foundation cleanoutdC~N) High water alarm (Y~.r~ Date of pumping ~'~:::::;\/'--~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /kj O/~1¢~ On adjacent lots To property line I O I.~. _Absorption field Surface water/drainage \ ~c~ Jf~ Foundation Water main/service line 72 026 {Fiev. 7/91) Fronl CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~"7 Total absorption area Depression over field (Y/¢~ .. /"'-/ Results (pass/fail) Peroxide treatment (past 12 months) (Yz~;~>. Soil rating (~' ~ ~ System type_~'T'~¢(--,~ Gravel thickness ~5- ~ Total depth Cleanouts present.TN) ,~ ~ Date of adequacy test for ~ If yes, give date bedrooms SEPARATION DISTANCE / __ we, on lot To building foundation On adjacentlots '"~:::~-P Surface water / ~:>c:::- Curtain drain /X/Or,J~ FROM ABSORPTION FIELD TO: On adjacent lots ~ i_~. Propertyline /C, I '/- I "'~ ~ ,...._t To existing or abandoned system on lot /V ~ Cutbank /'J' ~ Watermain/serviceline ~ I.,c Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to ali MOA and HAA date of this inspection. Signature Engineer's Name Date $ & S ENGINEERING Ea~le River, AJaska HAA Fee $ '" ,~'j~) Date of Payment Receipt Number 72*026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number