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HomeMy WebLinkAboutSKYWAY PARK ESTATES BLK 6 LT 1ASkyway Park Estates Block 6 Lot IA #019-151-13 Municipality of Anchorage Development Services Department Buildi~g Safer,! Division On~ite Water and Wastewater Program 4700 South Bragew St. P.O. Box 196650 A~chora;e, AK 99519-6650 ?~,~v.cLanchorage.ak.us (g07) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ParcelI.D. el? - 15'1 t. GENERAL INFORMATION Complete legal description t- ,. ¢ Location (site address cr directions) Expiration Date: / - '~ cO - O ~ Current Propertycwner(s)g/'~n/e7 ~ /~n~e Mailing address Lending agency Mailing address Real Estate Agent Day phone Day phone ~- Day phone Malting Address Unless ctherwise mques'.ed. HAA will be held by DSD fcr picku~. 2. NUMBER OF BEDROOMS: '~ 3. TYPE OF WATER SUPPLY: ' Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Indivi(3ual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAP,) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the Stats of Alaska. Certificates of Health Authcdty Approval are requirc=d for tile transfer of title (except between spouses) for properties served by a single-family on-site wastew=.ter disposal anolor water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authodt7 Approval are valid for 90 days from the date of issue for pmJeerties served by a pdvate or Class C well and may be reissued with new water sample results. (Certificates may be reissue.,, for a period of up to one year with valid water s=mples.) Certificates are valid for one year for prope.,!Jes sewed by Class A or B wells or a public water system. The Munic!pality of Anchorage is not respcnsible fcr errcrs or omissicns in the professional enginee.ea 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 ~ystem is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further vedfy that based on the information obtained from the Municipality of Anchorage flies 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. ,{ · NameofFirm ~l~h/'c,p 'T'~'c ~e¢,~[ _C~,c.r Phone ~'~/&"*/:~' Address I¥.C~0 ~:c4c~ _q/; ,~r~c4or~'V~x ,'~: Engineer's Printed Name T/~'o~:~'o~ F. ~c,~,-~ Date DSD SIGNATURE Approved for ~ Disapproved. Conditional approval for __ bedrooms. bedrooms, with the following stipulatioi'is:.: :.. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Cedificate Date: ! 0 - ~ 0 - 0~- (Rev, 01~2) M-nicipality of Anchorage Development Services Department Sull~iog Safety DNis~on On-Site Water & Wastewater Program 4700 South Bmgaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchomge.ak, us (g07) ~,..~7~04 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA We, ~pa Date completed ~' Total depth &'~ f. If A, B, or C provide PWSID # . Sanitary seal (Y/N) ~' Cased to ~>'~ ff. FROM WELL LOG Date of test Static water level ff. Well production g.p.m. Wet~ Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION ff. 0 g.p.m. y, WATER SAMPLE RESULTS: Coliform ~ colonies/lO0 mL Arsenic: h/.4L rog./1. Dataofeam SEPTIC/NOLDING TANK DATA Tank TypedMaterial ~'e~, ~ c Tanksize (OO~ gal. Number of Compartments LAnk' Foundation cleanout (Y/N) /~ '* Depreasio~ over tank (Y/N) Date of pumping IO/Z~/oZ. Pumper ~ t- Nitrate ~*~,2 mg.A. Other bacteria __ fie: IO~'lgloa. Collected by: O colonies/100 mi. Date installed ~/',~ ,~ Cleanouts (y/N) High water alarm C. ABSORPTION FIELD DATA Date installed ..~__~'.4' Soil rating (g,p.d./~ or It=/bdrm) Length ~,e k. ff. Width ~',~ e ff. Total depth I~, ~ It. Eft. absorption ama ~'t/~ ~ Monitoring tuba · Date of adequacy test I0 / IA/o 7. Results (Pass/Fail) SYstemtype ~' c~/c,-~ Gravel below pipe ~'e ~" ft. ~ Dapmssion over fi~,ld Np ,~,~cf For ~' bedrooms Fluid depth in absorp~n t~eld before test ~,~.~ in. Water edded/~Kg gal. New depthgo I~in. Elapsed Time: ID Z min. Final fluid depth ~in. Absorption rate >= ~5",,O g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & ty~e) No,~a' ~,o~,,'~ If yes, give date /~/. A, O. UFT ~I'ATION iV./k Date installed 'Pump on' level at Datum E. SEPARATION DISTANCES · Size in gallons in. "Pump orr level at Cycles test~l Jrt. Manhole/Access (Y/N) High water alarm level at Meets almm & ,,;,~,it requkements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift, station on 10t Ta"' ~, ¢. o. . Absorption field ovn lot I0 Z' ~ ¢.o.. Public sewer main ~, (o0' On adjacent lots ~, Io O' On adjacent lots > t~a:> · Public sewer manhole/cleanout Sewer/septicsewicellne ~' ?.~" Holdtngtank 6f. ,4. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main f,,/. Wells on adjacent lots Pmperty line .~'~' Water se~ce line Absorption field ~ ~ ' Sun'ace water ~ (oo' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~' .Y'~" Building foundation ~ 5~,' Water main Water Senace line ~ ~o' Surface water ~, Curtain drain A/oa¢ $~,~ Wells on adjacent lots Driveway, pad~r,g~hide storage · ,S'o ' conformance with MOA HAA guidelines in effect on this dale. Engineer's Printed Name "r'A~o ,=/o ~' F=. /'.t'oo ~ Date 1~ / ,~.¢-/oT. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal mcon~s that the above s)~ems am in ,': Waiver Fee S Date of Payment HAA Fee $ Date of Payment Receipt Number (Rev. 12/0t) Receipt Number CItE Environmental Services Inc. '!y ~T.; .... := C~r o Lab.o,~a~ Dtvislon ~t~~t~t~~g~t~t~~ Drinking Water ysis Repo~ for Total Coliform Bacteria R~D INSTRU~ONS O~ ~$E SlOE ~EFO~E ¢O~NO S~ ~00 W. Po~or Drivo MUST BE COMPLETEED BY WATER SUPPLIER PUBLIC WATER Sy$ 'TEM ID# .¥, PRIVATE WATER sYSTEM Send Results jj Send Invoice SAMPLE TYPE: Date Received: Time Received:. Analysis Began:. Anchorage, AK 99518-1605 Tot. (q~71 TO BE COMPLETED BY LAB~ILaJ~i~R.~1.5301 lysls shows ~is Wa~r S~PLE ~ ~: ~s~ Un~ Sample ~ ~g ~ b~iL Sa~le ~ld no~ be ~r Analytical Method: ~./Membrane Filter Lab Ref No. Result* Analyst Routine Treated Water Sent to ADEC: ANC FBK JUN i.--' Repeat Sample (refer to lab no. ,-~ Untreated Water ) Date: T~me: Client notified of unsatisfactory rBsults: i~ Special Purpose Time Collected [] Location Collected from: Collected: by (Initial): e~3ae MOO w"~ BACTERIOLOGICAL WATER ANAYSIS RECORD MMO-MUG Result: Total Coliform Membrane Filter:. Direct Count ~/' Verification: LTB BGB Fecal Coliform Confirmation: Final Membrane Filter Re~ult~: C~mments: E. Coil Colonles/100ml COUFORM Collforr~l OOml Date:~C,)/\'-~ ILJ''L- Time: ~SGS Member of the SGS Group (Socl~t~ G~n~mle d~ Surveillance) CT&E Environmental Services Inc. CT& E Ref.# Client Name Project Name~0 Client Sample ID l%latrtx PWSID 0 Sample Remarks: 1026997001 Flattop Technical Sty. Lot IA, BIk 6. Skyway Park Est Lot IA, BBc 6, Skyway Park Est Drinking Water All Dates~Tlmes nre Alaska Standard Time Printed Datefrlme 10/21,2002 8:52 Collected Date/rime 10/16,2002 12:45 Received Date/Time 10/16,2002 14:00 PQL Units Mc~od Allowable Prep Analysis Limits Date Date Init Waters Department Nitrate-N 0.200 U 0.200 mg/L EPA 300.0 (<=10) 10/17/02 JS Microbiology Laboratory Total Colif0~n 0 col/I OOmL SMI8 9222B 10/16/02 BAG ..I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P,O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEAl. TH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ParcelI,D.# ~)~J- ~\-\~;~ HAA# 1. GENERAL INFORMATION "'" '::' ~ .... :"~ :' ' Complete legal description Lot IA; Block 6; Skyway Park Estates Location (site address or directions) 12310 Skyway Drive ,~ .~- ·,.",. Anchorage, AK ~'~ F" .~ ........ ."~'~ ~ ,.,~P~opeAy owner . Floyd Day phone 522-4160 ~.. ~;~Madmg.address ..... ~12310 S~yway Drive Anchorage, AK 99515 .~7~-.: Lending agency [' Day phone ~'[;"~' 'M~iiing ~ddres~/~~ -~ . '~nt "~'Larr~ Ma~den/ Jack Whrt~ -:~,...~.Address_ ~ ~ _ ~ u _ _ _ . 3. - ~PE OF WATER ~UPt LY ~ -,...~::...~-,,.,~ :.:~,.., Individual well,:', .... XXX -'~_ ..-"?' ~ ;. ?.,,., mmunl well ',":~0'~ Pubhc water ~,- -.':~,~ ,,- .-," ' ' NOTE: If cornmunity well systom, provide written _ lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL.: Individual on-site XXX 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. 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 verifythat 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. S & S ENGINEERING Ea{.ile River, Alaska 99577/ Phone Date. Name of Firm Address Engineer's signature 6, DHHS SIGNATURE ," Conditional approval for bedrooms, with the following st~pulabons: ,,,.~'i/>',/ / '/ 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 ragistered in the State of Alaska, Th~ 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 condoct 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, MUNJCIRALITY OF ANCHORAGE ~NW~ONMmT^~ S~WC~S O~WS~ON Municipality of Anchorage AU( DEPARTMENT OF HEALTH & HUMAN SERVICES 825 L Street, Room $02 · ^nehorage, Alaska g@501 · Legal Description:~'~' A. WELL DATA Health Authority Approval Checklist ,/~£~c~- g' , ~.~'y'~/4-y' ,~°,4,'zk Parcel I.D.: ~/c/'~ ~- ~-~ --' 4/'xy, Well type ,,,~,~.~u',~ Log present (y~2 ~,"O Total depth Sanitary seal ~N) Date completed Cased to ~2/~J ' ~ If A, B, or C, attach ADEC letter. ADEC water system number ,,-~, /¢, Casing height (above ground) Wires properly protected ~'Y-/~) FROM WELL LOG Date of test '"'"'~,_..~- Static water level ~' '"'~'~/~ Well production /'/ ~'~'~-....~ g.p.m. WATER SAMPLE RESULTS: AT iNSPECTION g.p.m Coliform Date of sample: ~' ] q'~/~/to TA.K DATA Nitrate ~. ~ 0 ( Other bacteria Collected by: S & S ENGINEERING 17034 Eagle River I.aop Road No. 204 Ea!lle River, Alaska 99577 Date installed Foundation cle~anout (Y~ Date o!, pumping C, ABSORPTION FIELD DATA' Tank size/~'c'~','~z- Number of Compartments~',,,',~/~"~leanouts Depression (Y/~ _/¢'? High water alarm Dat~!installed ~,/,/.z-/~,,c¢~,,,,/~'C'~//vZC Soil rating (g p d/ft~ or ft2/bdrm)4?/,/,¢2,/¢"~/¢ System type ,¢~;~"..~ · , ¢- "/'?/z' Length,, ¢,,v/~,9¢,,,.J Width ¢/~,~/,'o,,,.~ Gravel thickness below pJpe/,->-'/~,,~',¢-~ Total depth Effective absorption area ~/,',~ Monitoring Tube present~N)Y~'~ Depression over fielO Date of adequacy test ~--/9 -¢~ Results ~/Fail] //~'~ For -~ bedrooms Fluid depth in absorption field before test (in.); '~ Immediately after¢~Ygal, water added (in,): _('~. Fluid depth '~ (ins) Minutes later;. //3 ~ Absorpuon rate = (~'~ ~ .g,p,d, Peroxide treatment (past 12 months) (Y~. ~ ~'~¢~ If yes, give date ~ /~- ~- 72-026 (Rev. 3/96)* D, L~~ Date installed Manhole/Access (Y/N) __ ~'~r~ t*_ High wa~ *Datum - ' ' ' ..~wet~tested Size incg~alJons~-~-~-'~ "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~-~-b-~'~-~)holding tank on lot / Absorption field on lot Public sewer main /~'/- Sewer/septic service line /,/. ,4../.~' '~- On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FRO~OLDING TANK ON LOT TO: Foundation ~' '/' Property line ~ "'~ Absorption field Water main/service line Surface water/drainage ./~' ~-¢' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /~/~ Building foundation / ~-~ "r Water main/service line Surface water /~ ~'~ ' Driveway, parking/vehicle storage area Curtain drain /0 s'~ Wells on.adjacent lots F. ENGINEER'S CERTIFICATION I certifythatl have determined thru field inspections and review of Municipal recor~t~'E~sare in conformance witt~ M~)A HA~ gui. d~elines in effect on this date. - . , C C bnglneers Name __ /v,,a,~_~ , -a~v¢~ ~ RO~ERTC, CQWAN /~ ' HAA Fee $ ~ ¢ ~ Waiver Fee $ Date of Payment F/~//~ Date of Payment Receipt Number ~/g¢~ ~ Receipt Number 72-026 (Rev. 3/96)* HEALTH AUTHORITY APPROVALS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPEC]ION & FLOWTEST SOIL1EST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE W~SIEWATER DISPOSAL SYSTEM DESIGN August 2~, 199(:, MUNICIPALITY OF ANCHORAGE Department of Health and Human Services 825 "L" Street #502 Anchorage, Alaska 99501 REFERENCE: ROBERT C. COWAN, EE. ROBERTA. SHAFER, RE. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694- 1211 RECEIVED AUG 29 1996 MUnicipality of Anchora e Dept. Health & Hu g' Lot lA Block 6 Skyway Park Estates manServlces Dear Mr. Robinson, Attached are soils logs in the vicinity of the referenced property. These are being submitted in lieu of an actual test hole to monitor groundwater. As can be seen, no groundwater is being found at a depth of 18 feet. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP , SUITE 204 o EAGLE RIVER, ALASKA 99577 "%'1 6 -2§-7'3 0.0I SILT WITH SOME ORGANICS ~o' SILT WITH TRACE SAND AND CLAY (ML) I I .O' SAND~ FINE TO MEDIUM GRAIN WITH TRACE SMALL GRAVEL (SP) SAND, ~,.E G.A~N w~T. LAYERS OF SANDY SILT~ Grey NO Woter Toble TO Note ~ Tes~ hol,~ ~xcav<Hed with Iroctol' mounted bockhoe. leedngE~Geologlcol Consullonts Rober! Dryden Properly ALASKA ~u.,^,, LOG OF TEST HOLE Anchor~]go Alosko '3r"-- ow~ n',' G ^ W c~o la,,' W E D r,~toj I.~o .36526 ~)wo NO, A-OI ~" DEP'AI{T~.I~T OF HEALTH AND ENVIRONMEN'II'/~ ~RO"i"ECTION Pouch 6.850, Ancho~,~e, Ah, ski 99502 276.2'22f SOILS LOG -- PERCOLATION TEST PERCOLATION TEST ! ' 2 2O SLOPE ENCOUNTERED? [~.' .~.'] /.' '- ! '- IF YES. AT WHAT ¢./.,..j ~. ~....;~? DEPTH? DATE PERFORMED: SITE PLAN P PERCOLATION RATE TEST RUN BETWEEN LJ,~'~'~OI LS LOG MUNICIPALITY OF ANCHORAGE OEPARTMENTOF HEALTH AND ENVIRONMENTAL PROTECTION SOILS LOG -. PERCOLATION TEST TEST 'S L ~;~'~ 2 3' ~4 5 6 ? 9- -10 11 12 13 14 DEPARTMENT OF HEALTH & HUMAN SEI-IVICES PERFORMED FOR: LEGAL DESCRIPTION: 3 4 ? tO'~ 13- 14- 15- 16 17 18 19 2O COMMENT~ '~ Municipality of Anchorage 825 "L" Street, Anchorage, Alaska 99502~0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: SLOPE___ SITE PLAN WAS GROUND WATER ENCOUNTERED? Depth lo Wala~ I~lonitorigg? Dale: Gross Net Depth to Ne~ Reading Date Time Time Water Drop ~__ --z_:z~-~- [~ ~, &'~/+' .. PERCOLATION RATE ~ Unmules/inch) PERC HOLE DIAMETER TES~ RUN 13ETWEEN __7 FT AND ~ FT PERFORMED BY: $ & 5 ENGINEERING ~ 17034 Eagle River Loop Road NO, 204 ^CCO~ANCE W~TH L~M~t~I~,~Z~ U~DEUN ES ,N 72-008 (Rev 4~85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG ~ PERCOLATION TESI" LEGAL DESCRIPTION: ~'~ ~ '~'-'"-/~.-)~*'-~ 3- 4- 5- 6- tO- 11 13- 14- 15- 16- 17 18 20- COMMENTS Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Waler~ ~ / l~lonlloriflp? SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE '~'~ {minutes/i~ch) PERC HOLE DIAMETER (~ H TEST RUN BETWEEN _ (~' FTAND_~ --ET $ & $ ENGINEERING 17034 Eagle Rh'er Loop Road Pi-'RFORMED BY: ~.t~R!.~-_.,'~-Ab~E~ · I'~ ! ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. CERTIFY THAT THIS TEST WAS PERFORMF-D ~N 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE o£VISION OF ENVIRONMENTAl, .HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAl, PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. _General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or direct:tons) _. lZ31~ £1r,z ~-~w O,~ ., /t.~ct, a~-,~,,~ /~.1= (b) Applicants Name_~{~ ~-~/ ~'t'~'~ ta.z. Telephone - NomeSlYf~/~/Buslness ~.?_ Applicants Address__/~ 3l~ .A"f~/~.~,~M ~)~.~ /~v,c/~.,.~.f~. /~-/-r (e) Applicant is (check o_on_~ene) Lending .Institution ~7; Owner/builder~; (d) Lending Ins~itution Telephone A~ss .... (e) Real Estate Co. & Agent... Address : 'Telephone. "(f) Mail the HAA to th~ following address: 2. Typ,e of Residence Sfngle-Family.~ Number of Bedrooms 3. W__ater Supply Multi-Family E~ Other (describe) Note: If community well system, must have written confirmation from the Stats Department of Environmental Conservation att~sting to the le§ality and status. Sewage Disposal 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] ,E,n$ineerin$ Firm Provldin$ Inspectious~ Tests~ File Search; Data and Information As certified by my seal affixed hereto and as of the validation date shown below, verify that my investigation of. this Health Authority Approval shows th~t 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 based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply end/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and re§ula-, .tions, in,el, feet on, the 4ate 9,f this inspection. ~1-~'~/~¢ ~'~,'~/-~ Na"me of Fi~.un__~/~;~--" ~-¢~4~f ~'~'"¢'~Z -- Telephone ~ Date ~h I~, /~ ~ ." ~ '.~*~, Approved ~ Dieapproved CoMttiona~' ' / Te~s of Condition~ Approva! CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BYi~AN ]/~DEPENDENT PROFESSIO~-~ ENGINEER REGISTERED IN T~ STATE' OF ALASKA. THE DEEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DEEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE M~JNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN T}~ PROFESSIONAL ENGINEER'S WORK. (DEEP RR4/eJ/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNIC ~ALiT'( OF ArqCHORAGE DEPT. OF HEALTH & £NVlRONMENTAL PROTECTION t:.L 2 0 264-4720 Legal Descripuon: . {-.-,"/' /.~/=~.~.~.F~'t''cvO~/'D WELL DATA Well Classification Well Log Present (Y/N) IV Total Depth _ ~' i'~ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding -rank on Lo~ If A. B C, D.E.C. Approved (Y/N) Date Completed I ~ ff_,,¢' Yield Depth of Grouting ~1,/i Pump Set At _'~ 8'~ Sanitary Seal on Casing (Y/N) Deeresmon Around Wellhead (Y/N) Oil Adjoining LOIS ') fOCi To Nearest Edge of Absorption Field on Lot JO0',,, I~'/ ' ; On Adjoining LOIS '~ To Nearest Public Sewer Line ~,.4. To Nearest Public Sewer Cleanout/Manhole /'~/J, To Nearest Sewer Service Line on Lot Water Sample Collected by '~ ~=~ : Date ~ ~/l~/~' Water Sample Test Results _ ~'¢ f~c~- ~ Comments fifo ~o~t~lh~ o~ ~'(O0~r,~ O~dr c~el( ~'~¢~ ~t~ SEPTIC/HOLDiNG TANK DATA Date Installed _&' / Standpipes (Y/N) ~" Air-tight Caps (Y/N) _ Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) N~ A · separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line i~' ..5'O ~ To Water'Main/Service Line H,/I,. Course ~ lO0 ' Size IO00.¢~(zl No. of ComDartmems _ (.dp Foundation Cleanout (Y/N) Date Last Pumped '~/'!'~/~o/ : for N, ~ - Temporary Holding Tank Perrnit (Y/N) TO Building Foundation ;~ ' To Disposal Field ~E¢ ' To Stream. Pond Lake. or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed (~" / Width of Field Square Feet of Absorption ~rea Depression over Field (Y/N) I'~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water. Supply Well I O0 To Building Foundation Lot N/!~'. To Water Main/Service Line N¢~- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness U..1 Standpipes Present (Y/N) Date of Last Adequacy Test Ils/,¢ 6' To Property Line ~' lO ¢ To Existing or Abandoned System on ; On Adjoining Lots '~ 3d ~ To Cutbank (if present) A~,,4, Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ,~,..,~...4.¢~..~ Company ~ (~ Date of Payment Amount: $ 0 ~-' ~~:"'"TH~~ ..;~.~ Engineer's Seal Page 2 of 2 72-026 (11/84) ~:---- DA, ~ RE'~CEIV ED INSPECTION APPOINTMENTS ~ME 'rIME TIME ) ENVIRONMENTAL SANITATION DIVISION NO~ ~ ['~ '~981 Telephone 264.-4720 BUYER ~' PHONE ~AIL/NG ~b~EsS LE ~ING INSTITUTION PHONE ~ LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE ~G LE FAMILY ~ MULTIPLE FAMILY NUMBER OF,BEDROOMS [] One r-] Four []...Two [] Five E~/' -hree [] Six [] O[ner 7, WATER SUPPLY [Z3~--I~iVIDUAL* * ATTACH WELL LOG. A well log is reouired for all wells drilled [] CQMMUNITY since June 1975, For wells drilled prior to that date, give well [] PUBLIC UTI LITY aepth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [~DIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTI LITY NOTE; THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: z/~-~,D If Tank is homemade 8OILSRATING give dimensions: TYPE OF TANK MANUFAOTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCESwELL TO: 8eptlc/Holdin9 Tank Absorption Area 8ewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS E~'~APPROV ED FOR _~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 {Rev. 6/79) 2,, "1 .~IRI F1 x,rl(.I ()R/\(,~., Al /",.%I<A 90!(J1 I!.'.l)/i 2(~4 ,11 J l November 20, 198] John/Sandy Broccoli Star Route A Box 199.~L Anchorage, Alaska 99502 Subject: Lot iA Block 6 Skyway Park Estates Subdivision Approval for the individual cannot be granted until the completed: sewer and water following items facilities have been The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. (2) The seal on the well head needs to be tightened so that it is water tight. (3) Exposed wJ~res to the well head are in violation of Municipal of Anchorage codes and needs to be placed in conduit. X~-.~'~( 4 ) The septic tank pumped with a receipt submitted to this office. An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to Nationa]. Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this office for our review. Please notify this office for a reinspection when the noted descrepancies have been corrected. If there are any further questions, please call this office at 264-4720, Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw ALASKA elqUIROllmeFITAL cOrlTROL SeRUICeS, II'lC. ~n§ineeri~§ ~- ~nuJronmcnldl ~luclJe$ RECEIVED 12/10/81 FIRST NATIONAL BANK / JULIE P.O. BOX 3128 ANCHORAGE AK 99501 SELLER - JOHN & SANDY BROCCOLI SUBDIVISION-SKYWAY PARK ESTATES BUYER- BLOCK-6 LOT--iA ADEQUACY TEST FOR SEWER SYSTEM [~HE TYPE OF ABSORPTION SYSTEM IS A PIT WITH AN UNKNOWN AREA. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 600 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME THIS 3 BEDROOM HOUSE, OF 1250 IS ADEQUATE FOR 1220 ~Jcsl 25th Au¢,m~ "/~nchera§¢, Alaska 99503 "{907) 276-136] GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality "C" Street, Anchorage, Alaska 99503 274-4561 Date Received August 26, 1976 Time of Inspection __ Date of Inspection REQUEST FOR APPROVAL OF FOR Cony. l. Approval requested by: National. Bank of ~laska % Marva Mailing Address: Post office Box 3~3859 Phone: 279-2506 2. Property Owner: Garland & Margaret Stephens Phone: 344-3037 Mailing Address: Star Route A Box 19.9L 3. Legal Description: Lot lA B_:bsck 6 Skywa~ Park Estates 4. Location: 12310 Skyway Drive 5. Type of facility to be inspected _Single Family No. of bedrooms 3 6. Well Data: Individual C. Construction z~/~ 7. Sewage Disposal S~stem: On-site system~ A. Installed Unknown I~. Installer C. Septic Tank: l. Size /~002~ 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material 62' D. Bacterial Analysis E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines __., Nearest lot line Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line __ EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Req st for Approval of Individual ~ ~r & Water Facilities Legal Description Lot lA Block 6 Skyway Park Estates Comments Approvedl?~//3 ~~~\ .Disapproved __ __ App~Va]id for one year from date signed Greater Anchorage Area Borough, Department of Environmental DIAGRAM OF SYSTEM Q ua 1 i ty certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) MUNICIPALITY OF ANCHORAGE DEI'ARTMF-NT OF ENVIRONMENTAL QUALITY -3330-"C" Str~.'t, A ~ ;horage, /~la~ka 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES MUNICIPALITy OF ANCHOP~AOE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION AUG 2, 6 1976 RECEIVED 1. Type of Ir~spection: CMRO VA ._ FHA CONV 2. Property Owner: __)~4..~ q~ '~ ~/~,,(//tC~_-- Mailing Address'. ~/2.~_._~/¢~/_ ~~~_ Day Phone ,~ ~ . ,, ---- 4. Name of Lend in9 Institution: ~~,,~;~ g ~~ 5. Name of Realtor or Agent: Mailing Address: Phone Legal Description: /0: /.,~L ) Location: ~-~-~ ~-~ 7. Type of Facility to be inspected:. 8. Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well Sewage Dispo~l System Type of System: No. Bdrms. ~ Individual Public Utility If Individual, date of installation ~///bL,c,u~'-~--', Individual (on-site) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality "C" Street, Anchorage, Alaska 99503 274-4561 Date Received May 24, 1976 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF ~DIVIDUAL SEWER & WATER FACILITIES FOR Cony. 1. Appl ~val requested by: Alaska Mutual Savings BAnk Mailing Address: Post Office Box 1120, 99510 Phone: 2. Property Owner: Garland & Margaret R. Stephens Phone: Mai]i~'g Address: Star Route A Box 199-L 344-3037 Legal Description: Lot iA Block 6 Skyway Park Estates Subdivision Location: Klatt Road, see map on back 5. Type of facility to be inspected 6. Well Data: Individual A. Type ~)~.2~-~ C. Construction ~/~/[u-~-~ 7. Sewage Disposal System: On=szte Single family No. of bedrooms 4 system B. Depth 62' Bacterial Analysis A. Installed C. Septic Tank: D. Seepage Pit: E. Disposal Field: :L965 B. Installer 1. Size /~3 2. Manufacturer 1. Absorption Area~;~k~~ 2, Material Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 Of two pages Page 2 of two pa§es - Rea~ t for ADDroval of Individual SE ~ & Water Facilities Legal Description Lot lA Block 6 Skyway Park Estates Approved Disapproved Date Approv~(~])~alid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) l'/~UlqlC. JlYq I~t~02; ,"dqCI I©I!AG[ MUNICIPALITY OF ANCHORAGE[ bi. Pr, oi: Ii ,-,LiH & DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION rJNVIROi,,MI Ni>,L ;;:3 iLCIION 2510 East 'rudor Road, Anchorage, Alaska 99504 276-2221 [,,WI' g ,( i970 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIE~ CONV ~/' 1. Type of Inspection: CMRO. VA_ .FHA 3. Name of Buyer: Mailing Address:_ 4. Name of Lending nst tution: Mailing Address:_ 5. Name of Realtor or Agent:_ ,/?~/V£' Mailing Address: 6. Legal Description: ,~'~I~d?~,,I', (.~, Location'. ~,A'[ ~' Day Phone: S LI- V l t,,,' m..~; !"! A A,' ~: ,.Phone:_ Phone:_ ,~ :' ~- ~' ,,.~'"t-~''~ 0 Type of Facility to be Inspected:( ¢/ Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served _ If Individual, depth of well, Individual Sewage Disposal System Type of System: Public Utility If Individual, date of installation ~])(fl'/i/a ~:::~" Individual (on-site)_ 72-003(3/76)