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HomeMy WebLinkAboutSKY RANCH ESTATES #2 BLK 3 LT 4ky Ranch Block 3 Lot 4 #01§-302-03 Municipality of Anchorage Page 1 of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,O. Box 196650 Anchorege, Alaska 99519-6650 Telephone: 545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SWO00.~15 PID Number: 015-302-05 Nome: KELLY POSTON Wast°water System: [] New · Upgrade Address: 11711 PADDOCK LANE UPPER/LOWER ABSORPTION FIELD Ph°ne:(907') 545--5568 No. of Bedrooms: ,,~ · Deep Trench [] Shallow Trench [] Bed [] Mound ~ Other LEGAL DESCRIPTION so,, ,o~.,: To,o, D.,~ ,.m o,0,.o, 0.45 cpo/s,. ~ 9.64/9.64 Lot:4 Block:5 SKY RANcHSUbdlvisl°n:ESTATES #2 ~""~ ~° "~""4.56/4.57b°~tor" f~m o,g~,om g~d,:F~ O=v,I ,,p~ ~,,,°m "1""'~.08/5.07~.u / 0 ~. 101 (50 + 51)~, WELL: [] New [] Upgred~ 2.5 n. 2I 15'+ ~,~- F~ ~. 1 000+ S~. ~. ASTM D-3054/SCH40,F-810 ~ A+ HOME SERVICES 9/21/2000 SEPARATION DISTANCES [] Septic [] Holding To Septic Absorption Uft Holding Public/Private Monufamtumn Cajxlclty In From Tank Reid Station Tank So~o~ U~o, ANCHORAGE TANK 1250 Well N/A N/A N/A - 25'+ STEEL 2 Surface Water 100'+ ~00'+ ~00'+ -- -- LIFT STATION Line 5'+ 1'+ 5'+ -- - 1250I ANCHORAGE TANK Foundot~on 5'+ 10'+ 5% - '""""" °"' "~" °~: I'".rn. o.' ,~,,, o~: I',.~ ,,°~,. o,°r~ ~ - 41"I ~1" I 45" Cu~ain Drain NONEi KNOWNi #20 OSI 05 HHF M.O.A. Remorks: BENCH MARK OLD SEPTIC TANK WAS ABANDONED PER UPC. BOTTOM OF' SIDING ON GREENHOUSE ON SOUTH EAST HOUSE CORNER 100.00 Ord 9__~/~00 ~' V ~. uornes~... ~ Department of Health and Human Services approval v~)~... C~ -7953 ...'~.~:~ Reviewed and approved b /-/~/. ~---~ Date:/O__q2_Lo O~ ~ ~ ' PERM UM6ER, AS--BUILT DRAWING SWO00142 050-,:321-78 I LLJ I ^ 8 I DBL2 5.4 28.9 ST1 7.8 29.0 ~ I I ST2 13,4 31.0 ~ J MH 14.7 31,6 ~ ~ MT1 28.3 38.6 ~ ~T2 1~.~ 22.~ I ~ MT4 63,8 54.0 - ~' I I ~ S/~ S.T.E.P. TANK ~~~ ~N~ D~INFIELDS -- -- -- [~ ~mEOJORE r. MOORE, P.E. TH~I - 6/29/1995 lO/~/2ooo ~ 0~. KELLY POSTON (907) 786-0223 2 OF 3 ;'~Z~;~' ~PE OF WORK: res AS-BUILT OF SEPTIC SYSTEM UPGRADE '~%~ PERMIT NUMBER: AS BUILT D~W~G PARCEL I0 NUMBER: SWO00515 - 015-~02-05 fCT~ OP lANK '--~ = : BW 12¢0 5 LON o/s/ ooo ::? CONSULTANTS, INC. SCA~} 6901 DEBAR RO~, SUITe 2B ' ~CHORAGE, ~ 9~50& ' PHONe (~07)~$7-6179 · F~ (907)$$8.~Z6~I : 40' ~ ~ ..... KELLY POSTON (907) 786-0223 3 OF 3 SKY RANCH ESTATES ~2; LOT 4, BLOCK 3 PROFILE AS-BUILT Of SEPTIC SYSTEM UPGRADE p~ 3s or ~ INSPECT[ON RI~Y)RT MUNiC~ALiTY OF ANCHORAGE ~' BUILDING SAFETY DIVISION 4700 SOUTH Bi~GAW ST~h~ET, ~MNC~tGRAGE, ~ASKA INSPEC2JO~g: ~iee: (90D 343~300 ~:: OOD 343~235 lz~"Ot6k~TJON: (90D 343~2.1J ~4ME: EDS ELEC ~e~rmt~u~: 00-9097 ~DD~'S'X: 11711 P~DOCK I.~ f'110~5~ ~I: 272-4591 PtlO, N~ ~2: INSPECTION: Electrical Final /~7k No non-compliance observed. [~] Con'ectioszs essenUM ms extnamed below. .1_~7] C.(J. approved. [~ Wgl re-eTaanine at next umpeclion. ~ Do not conceal unlil ~e&tsp~ctcd. 17-i C.C.©. app~oYgd (¢onnncnts bdowL COMMEN~: RECEIVED OCT 1o 2000 Municipality of Anchorao8 Dept. Health & Human 8er¥ioo8 tl~PECTOR: ~47~ MUNICIPALITY OF ANCHORAGE Deparlment of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-66'50 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 22, 2000 Expiration Date: Aug 22, 2001 Permit Number: SW000315 Legal Description: SKY RANCH ESTATES #2 BLK 3 LT 4 Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: Kelly Poston Owner Address: 11711 Paddock Lane Anchorage, AK 99504- ParcellD: 015-302-03 Site Address: 011711 PADDOCK LN Lot Size: 17882 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposa F eld [] Septic Tank [] Holding Tank [] Privy [] Pdvate Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. ALASI WATER & WASTEWATER August 10, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade for Lot 4, Block 3, Sky Ranch Estates #2. To whom it may concern: A permit for the proposed upgrade was issued by ygur office in August of 1995 and expired without the installation ever occurring. The property owner is selling the property and now wants to proceed with the upgrade. The only modification to the design will be the inclusion of the AWWC, Inc. standard specifications (copy attached). AWWC, Inc. will inspect/document the installation. The $320.00 permit fee was submitted with this application. I am unaware of any negative impacts that this installation would impose on adjacent wells, or septic systems. If_y~ have any questions, please call us at 337-6179. President 6901 Debarr Road, Suite 2-B * Anchorage, Alaska 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825"L"Street P,O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 August 12, 1996 Bobbiejean Simpson 11711 Paddock Lane Anchorage, Alaska 99516 2319 Subject: Lot zSZBlock 3 Sky Ranch Estates Subdivision #2 Permit #SW950208, PID #015-302-03 The subject permit, issued August 10, 1995 by this office for a single family well and/or on-site wastewater system, has expired as of August 10, 1996. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. Ail inspection reports must be submitted within 30 days of construction completion. ~en applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Siq.oe~Tely, Program Manager On-sits Services enc: Copy of Permit cc: Flattop Technical Services PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OP HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950208 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:SIMPSON BOBBIEJEAN OWNER ADDRESS:llTll PADDOCK LN ANCHORAGE, AbASKA 99516 DATE ISSUED: 8/10/95 EXPIRATION DATE: 0/10/96 PARCEL ID:01530203 LEGAL DESCRIPTION: SKY RANCH ESTATES #2 BLK 3 LT 4 LOT SIZE: 17882 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT lis FOR THE CONSTRUCTION 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 (18AA072) AND DRINKING WATER REGULATIONS (iSAACS0) . 3. THE ENGINEER MUST NOTIFY DHNS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AN[} HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: 6~ Rick Mystrorn, Mayor Munic pality of Anch¢ age Department of Health and Human Services 825 "L" Street P,O. Box 196650 Anchorage, Alaska 99519-6650 August 15, 1995 Ted Moore, P.E. Flattop Technical 14530 Echo Street Anchorage, Alaska Services 99516 Subject: Waiver Request for Lot 4 Waiver Request ~WR950034, Dear Mr. Moore: Block 3 Sky Ranch Estates #2 PID #015-302-03, SW950208 Your request for a waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 1 foot from the leachfield to the common lot line of Lot 4 and Lot 5. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Services DR/ljm WR# WR950034 Date Received: MUNICIPALITY OF ANCHORAG! Department of Health and Human Services On-site Services Section Waiver Review Worksheet PID~ 015-302-03 HA~ July 26, 1995 Permit Legal Description: Lot 4 Block q Sky Ranch Estates Subdivision ~2 Engineer: Ted Moore, P.E., Flattop Technical Services 14530 Echo Street, Anchorage, Alaska 99516 Applicant: Bobbiejean Simpson Waiver Requested: Lot line waiver leachfield 1 foot from the lot line con, on to Lot 4 and Lot 5 Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: _ ~ Waiver is NOT Granted: List Conditions or Reasons for above: Date: ~- 7-- ~D-- By: ~/ ~A/ Name of Reviewer Rec ~: 01138/1783 Amount: $ 115.00 Date Paid: July 16, 1995 · , ~, :; · ~MUNICiPALiTY OF ANCHORAGE ~ '~ ;~:¢¥ : · ,; ' : ',~: ~:i~!~,~,;4:~ I~ONMENTALSERVICES DIVISION TECHNiCAL.'. SERVI : : TtfEODORE F. MOORE, P.E. 14530 ECHO ST. I'H: (907) 345-1355 July 26, 1995 ANCItORAGE, ~KA 99516 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dem' Sh's: The purpose of this letter is to provide the mquh'ed design narrative ill support of our application for a permit to upgrade the wastewater disposal facilities on Lot 4, Block 3, Sky Ranch Estates, Unit #2, located at 11711 Paddock Lane. The present system failed to pass a recent adequacy test because it was found to be operating in a sm'charged condition. Soils logs, perc test results, a site plan, design da'awings and specifications m'e enclosed for your review. The proposed system will be consu'ucted in the vicinity of test hole #1. As can be seen from the soil log, the native material between 5' and 16' below ground level is a silty sand or sandy silt with a measured percolation rate of 32 minutes per inch. Using the soil application rate of 0.45 gpd/sq, ft. specified in the wastewater ordinance, tlris 3 bech'oom residence requkes a total absorption area of (3 x 150)/0.45 = 1000 square feet. The proposed design consisting of two parallel 50 foot long trenches with 5 feet effective sewer gravel depth in each has a total absorption area of 1000 square feet. The topography of the lot slopes down towards the northwest at approximately 10%. Since the soils in test hole #2 appeared visually to be, less suitable than the soils in test hole #1, the proposed system is crowded into the south corner of the lot. In order to optimize the use of the limited suitable area on Lot 4, a lot line waiver is requested allowing the system to be within 1 foot of the west property line, common with Lot 5. Because this unit of Sky Ranch Estates is served by a community water system, granting the requested waiver should not have arty significant impact on the ability to construct replacement soil absorption systems on Lot 5. The proposed project is not anticipated to have any significant impact on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. LOT 16, BLK. I I I I Lo'r 3 ', · I ~ F [g l/i?- {TO SE ASAN~ONE~) ~ ~ ~ ~ ~ ~ , ~ EXIST, 1000 GAL SEPTIC TANK ~ ~ D~O ~ ~ ~: (TO BE BAOKFILLED IN PLAOE) ~) ~ ~ ~ ~ t i EXISTING SEEPAGE PIT LOT~ % T.H. ~%j,~ (TO~E*~*NDO,ED) o ~ ~ ~ NEW 1250 GAL S,T.E.P. TANK 2 NEW PARALLEL 50' LONG~ o HOUSE SOIL ABS. TRENCHES WITH ~ N ~ ~ T.H." UNSUBDIVIDED ................................................... 15' WALKWAY ~ o -- SYSTEMS HOUSE ¢ HOUSE HOUSE LOT 4, BLK. 4 LOT 5, BLK. 4 ~ LOT 6, BLK, 4 S~ RANCH EST ~*~,'" .,,,;&~?.~:~. LOT 4, aLK. ~, SKY RANCH ~ST. ~2 ~ . IH~OOO~ F~ ~AOOR~ ? ~ 14530 ECHO ST~ET DRAWN BY TFM ~a ~:~ '. c~ o~o ,, ~, ~' ANCHO~GE,~ASKA99516 JULY, 1995 ,~r¢~i~.t~¢.,~: ~,, NOTE: THIS IS NOT A SURVEYED PLAT. ..~.~..~,~: ALL LOCATIONS SHOWN ARE APPROXIMATE. 50 ~__50' LONG SOIL ABS. TRENCHES WITH 5.0' GRAVEL BELOW DIST. PIPE INVS. 1.25" DIA, SOHED, 40 PVO W, 3/16" DIA HOLES DRILLED IN BOTTOMS SPACED 3' C.C. 4" DIA ASTM D-3034 -~1~. NEW 1250 GAL. S.T.E.P, TANK --% ~- MONITOR TUEE PLAN VIEW SCALE: 1" = 10' - 0" 1.25' DIA SCHED 40 PVC )NITOR TUBES -- 1.25" Lb J0 PVC ORIGINAL GROUND FABRIC -- 10 1,25" SCHED 40 PVC W. 3/16" HOLES 3' C.C. 2 1/2" GRAVEL 3TTOM OF EXCAVATION SECTION "A" - "A" SCALE: 1" = 5'- 0" LOT 4, BLK. 3, SKY RANCH EST, #2 PROPOSED SEPTIC SYSTEM PLAN AND CROSS-SECTION FLATTOP'I~CHNICALSERVICES~[ SCALE: AS SHOWN 14530ECHO STREET / DRAWN BY: TFM ANCHORAGE, AK, 99516 / JULY, 1995 / Flattop Technical Services 14530 Echo Street, Anchorage, AK99516 Phone (907) 345-1355 Lot 4, Block 3, Sky Ranch Estates, Unit ][1711 Paddock Lane Wastewater disposal system upgrade Specifications 1.0 General: 1.1 The scope of the project includes abandonment of an existing septic tank located under a concrete slab itl the garage as well as an existing log crib seepage pit. The new construction includes installation of a 1250 gallon S.T.E.P. tank which pumps effluent up into two pm'alle150 foot long soil absorption trenches containing 5 feet of sewer gravel beneath the horizontal distribution pipe. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or requh'ed by the en~,qneer conducting the inspections. All c. onstruction procedures and material specifications shall confo~zn with Municipal and State requn'ements. All separation distances shall be in confmxnance with Muuicipal requirements, unless specifically waived. 1.3 The conta'actor shall be responsible to obtain any necessm3, utility locates, and to work around auy buried utilities. 1.4 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the conta'actor shall minimize damage to trees and existing lawn areas. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the consU'uction. 1.6 Prior to the start of construction the homeowner shall arrange for a land surveyor to locate and mark the two southerntnost lot cornet's attd also to set laths tnarking the location of the east attd west lot lines approximately 50 feet north of these two cortters. 2.0 Septic Tank: 2.1 The existing septic tm~k (located all or pm'tially within the garage) must be properly abandoned by thoroughly pumping, and backfilling with sand or gravel. The new waste line shall be connected upsta'emn of the existing septic tank and shall be laid on undisturbed, or fnlly compacted soil. The existing seepage pit shall be properly abandoned by thoroughly pumping, removing its top and backfilling with soil. 2.2 The new 1250 gallon, 2 compartment S.T.E.P. tank shall be Municipally approved and shall be set level oil undisturbed soil. The location may have to be field adjusted to avoid conflicts with the present seepage pit. Each compartment shall be equipped with a watertight manhole cover and a 4" cleauout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved bm'ial type, rigid insulation. 2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The aste line tom the residence to the septic tank shall have a rrdnimum slope of 1/4" ~ shall be installed within 5 feet of the building foundation, t pe~ root. A cleanout 3.0 Lift station: 3.1 The lift station shall be installed in the second compartment of the S.T.E.P. tank which has an additional 250 gallon capacity, and shall be an "Orenco" system as supplied by Anchorage Tank. 3.2 The contractor shall be responsiNe to obtain the uecessary Municipal electric permit and inspection, and shall provide a copy of the electrical inspector's report to the engineer overseeing the consh'uction of the wastewater disposal system. 3.3 The lift station shall be equipped with a watertight, insulated manhole riser and cover extending a minimum of 6" above final grade with positive sm~face drainage away from the manhole. The contractor shall be responsible for determining the necessary length of the manhole riser. 3.4 The on, off, and alarrn floats shall be set at the elevations specified by the lift station supplier, and their proper operations shall be verified by the contractor. 3.5 The discharge line from the lift station to the soil absorption system shall be 1.25" dia. Sched 40 PVC. All pipe connections in the distribution system shall be glued, and the ends of all pipes capped. 4.0 Soil absorption system: 4.1 The soil absorption system shall be constructed by excavating two parallel 50 foot long n'enches to a depth of I0 feet below originai ground level. The trench alignments shall roughly parallel the naturai contours of the original ground, however some variation may be allowed as necessary to fit the system into the limited available area. 4.2 The bottom of the excavations shall be level. Any compacted or smeared sat'faces shall be raked to allow proper infiltration. 4.3 A total of 5.4 feet of approved sewer gravel shall be placed in the bottom of the excavation with the perforated distribution pipes laid level such that the pipe inverts are no less than 5.0 feet above the bottom of the sewer gravel. The horizontal distribution pipes shall be 1.25" diameter schedule 40 PVC with 3/16" diameter holes drilled in the bottoms spaced 3 feet on centers. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the//200 sieve. 4.4 Monitor tubes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 4.5 Approved filter fabric shall be placed over the entke top sat'face of the sewer gravel. A nfinimum of 2 feet of soil cover is to be placed over the filter fabric. 4.6 The top surface of the cover material shail be raised a minimum of 12 inches higher than the sun'ounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Care shall be taken to ensat'e that water and snowmelt will ddrain away from the area of the soil absorption trenches. Fill slopes shall be no steeper than 3:1. 4.7 Unless specifically agreed othelwvise the homeowner shall be responsible for arrangiog to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of all areas distat'bed by the construction. 5.0 Inspections: 5.1 A minimum of 4 engineering inspections will be requh'ed during the course of the project: (1) initial stakeout with the conu'actor to establish the location of the system and to discuss the plans, specifications and constraction procedures, (2) after the native material has been excavated to expose the infilU'ative surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of filter fabric, and (4) after rough backfill and grading is complete, The S.T.E.P. tank requires one inspection after it is set level and the piping connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 5.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently fa' in advance to ensure the availability of the engineer, TESTltOLE# 1 ] LEGAL DESCRIPTION: DATE PERFORMED: PERFORMED FOR: DI:PTH (feet) FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAG E, ALASKA 99516 SOILS LOG -- PERCOLATION TEST Lot 4, Block 3, Sky I>,aech Estates, Unit #2 June 29, 1995 Bob l-[eym Pt. SM Reddish sandy lomn SLOPE ML Gray gravelly silt Dense, cohesive SM/ML Dark brown silty saad or sandy silt Many cobbles, fairly bard digging variable - lenses of cleaner matT 16- 17- 18- 19- 20 COMMENTS: Depth to Groundwater Date No Grouedwater _ 6~'_29/95 M.T. Dry 7~_6/95 Clock Net Time Percometer Net Drop Date Reading Time (minutes) Reading (inches) _-~J.2~9 12" soak 11:34 --- 27 1/2 SWat 12:37 23 7/8 #1 12:57 20 23 14/~ 5/8 #2~ 1:17---- 20 225/8 __ 5/8 Add water 1:17:15 23 5/8 ___ #3 __ 1:37:15 2_0 23 ..__ 5/8 Becomes harder digging below 14 feet B .It. PERCOLATION RATE 32 (minutes/inch) PERC HOLE DIAMETER 6" TEST RUN BETWEEN 7.0 FTAND 7.5 FT Measured perc rate should be represeatative of soils in the S MflvIL stratum PERFORMED BY FLA'FfOP TECHNICAL SERVICES. I_ ~".~..~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7/' TEST HOLE LEGAL DESCRIPTION: DATE PERFORMED: June 29. 1995 PERFORMED FOR: Bob Heym DEPTH (feet) Pt. FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST Lot 4, Block 3, Sky Ranch Estates, Unit #2 SM Reddish smldy loam GP/GM Silty sandy gravel ML Light gray gravelly silt Dense, hard digging Sidewalls smear SLOPE #1 Depth to Groundwater Date No Groundwater 6/29/95 COMMENTS: Clock Net Time Percometer Reading Time (minutes) Reading PERCOLATION RATE (minutes/inch) PERO HOLE DIAMETER TEST RUN BETVVEEN FT AND FT The soils itl tiffs test hole appear less suitable for a soil absorption system than tile soils in T.H. #1. No monitor tube installed. Net Drop (inches) PERFORMED BY FLAil'DP TECHNICAL SERVICES. I ~ '~'¢[~.¢.~_ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7 (' ~ 5'"" / 4),5-  MUNICIPALITY OF ANCHORAGE ( · DEPARTMENT OF HEALTH & ENWRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ~] NEW MAILING ADDRESS LEGAL DESCRiPTiON ~ ~ Manufocturor Materla] ~o. o~ compartments ~ ~ Liq. capacit~in gsIIons IF HOMEMADE: Inside length Width Liquid depth ' ~ We~ Dwelling .~ ~ ~ DISTANCE TO: O ~ ~ Manufacturer ~-L Material Liquid capacity in gallons ~ Well Foundation Nearest lot line ~R~ ~ ~ ~ No. of lines Length of each line Total length of lines Trench width Distance between lines OTHER ~ SOIL TEST RATING 72-013 (Rev. 3/78) L.. 0 C FI T ;[ 0 N LEGF:I[.. RCFIESON E'N'T'. F'FIDDOCK LFINE LOT' 4 ELf,. .... LET SIZE 'FYF'E OF '"' IIE:]F.F I IuN ':'":' ''' :,-IL. : "" ""'' - ~,~-,'fErl IS: TRENC:H h'IRXIM[..IM NUHBER OF BEDROC~MS =' :,OIL RFIT:[NG '::SC,! F I,'E,P...$ .... 1"HE RE~]IJIRE[) :,lx.l:. OF ]"FIE: .:,UIL HE,...,L{F:.F ] ILN .... T_.,TEfl I.S : THE LENGTH DIMENSION IS; THE L. ENGTH (IN FEET> OF TFIE TRENCH I]R DRFIINF'IEL, D. THE DEPTH OF FI 'T'RENC:t4 OR F'IT :IS THE DISTBNCE BETNEEN THE SLIRFFICE OF THE GROLIN[:, RND THE BOTTOM OF ]'HE EXCRVR'I"iON (IN FEET). THERE IE; NO SET P.IIDTFI FOR 'TRENCHES. THE GRRVEL E:,EPTH I'S; THE MINIM[JM DEPTH OF GI:;;:RYEL 8EI'NEEN TF'IE OUTFFILL PIF'E RND THE BOTTOM OF THE EXCFI',,,'F~TZON (IN FEET). "',' T -:'' .... - - ItlI..., [:'EF'f~RTMENT [:'LIRING TFIE FEF;.H_T HF F L, IL. if,II HFrE; THE RESPONSIE II ITY TC INFORM "'~ ': INSTF:ILLRTIaN IfL. FE_.[I_N:, OF RNY [Ir:LL.:, RDJFiC:I~EN'F TO THI~ FE.,FE~4 ['r F:IND THE NUMDER OE~ F,'ESZ[:'ENCES:; THFIT "['FIE: I.'.tELL. P.III_L, SER",,'E. E, HL. KFILI..INL~ OF FINY..,~--,TE. rl P.lZTHOI_IT FINFIL IN....FEL. I' '=' ' - ..... ZuN RNDMFFI'.._' ;,I-',"¢F1L. BY THIS E:'EPRRTMENT' I.,~ZI_L. E,E..':,UEJELT 1"O FF..LL, LL.I...IrILN. PIlNIMUH DISTRNCE BETI.,.IEEN R NELL FIND RNY ON-SITE SEI.qFIGE DIE;POSRL. SYSTEF1 IS ~L~.~ FEET FOR B PRI'¢RTE NELL OR ~50 TO REIC; FEET FROH FI PLIDLIC NELL [:,EPENDING UPON ]'FIE TYPE OF PUP.,LIC WELL. MINIMLIH DISTRNCE FROM FI PRI',,,'FITE NELL TO R F'RIVRTE SE[,.IER LINE I5."; 25 FEE:-[' FIN[:, TO F-1 COMMUNITY SEP.IER LINE :IS 75"; FEET. OTHER RE6!UIREME. NTS:; MRY FIPP[..Y. ~;PECZFII_-:RTIONS Rf',IE:, CONS'TRL~CTION DZFIGRFIMS FIRE: F:I',,"FIZLFIBLE 'FO INS-]IJRE PROPER INS;TRLLRTION. F:" E.' F;:-;: f,'~ ..T. -r E::=-:: F:' :E F.~.', E :.:_-; [,.',., E: i:]: IE~: I~,I E: EE F;: D.'::: ::'L .,, I CERTIF'?' THFII' :L: I RM FFff'IZLZF~R P.IITH THE I:~:EL.-,'UIREMENTE; FOR ON-SITE E;E[,.IERS FIN[,', [,.IELL$ FIS E;ET FORTH BY THE HUNICIF'FILITY OF' FINC:HOREICiE. 2: I NILL, IN';SI'F~LL THE SY'.::;TEH IN F~CCORDFINCE NI'FH TFIE CODES. 3:: I IJNI}ERSTFIND 'I"HFIT THF_' ON-SITE :-3,EI,~ER S'¢STEH MFIY RE6!LIIRE ENLRF,.'tGEMEN'r IF: THE RESIE:,ENCE IS'; REMCIDE[.ED TO INCLLIE:,E HCIF.:E THFIN 2: BE[:,ROOH'_-'S. J., ,_,,:,~. 51;]LIFiRE FEET GRr,~ER ANCHORAGE AREA Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM ~-~ ~ PHONE NAME (¢"~f'. ,/-/~0¢~ MAILING ADDRESS-~}/~ ~)0~ L//O ~ SEPTIC TANK: DISTANCE FROM WELL l' MANUFACTURER ~¢.L. ~/ NUMBER OF COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH ~ .LIQUID CAPACITY /c'~(~ 0 GALLONS. SEEPAGE PIT: /~. NUMBER OF PITS / DIA~4ETER OR WIDTH/~/~. . LENGTH 'C:(DEPTH ~ / LINING MATERIAL C'¢Z4¢~'¢L, CRIB SlZE¢'¢DIAMETERIDEPTH ~ DISTANCE FROM: WELL }f E () .~..~,.~ .o..~A=,O. ~d/, .~A...= ~OT .,~ ~0 '* TO=A...~CT,W ~.. ABSORPTION AREA (WALL AREA) ~2- ~ SQ. FT. ADDITIONAL ABSORPTION WELL:(~0 ~/~ tYPE ~ ~ ~ CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE SEWER LINE TANK SYSTEM CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: INSTALLED BY: ~' PIPE MATERIAL::~(Z~/l/?:fq-/// ~ LOT SLOPE: ~',~/(~'~' REMARKS:. Form No, EQ-031 DIAGRAM Of SYSTEM GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C"STREET ANCHORaGE, ALASKA 99503 SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT PERMIT NO, MAILING ADDRESS '~'~' ~- ~3~ ~'~3~', ~0~% INSTALLATION OF: SEPTIC TANK ~ TYPE AND SIZE OF FACILITY TO BE SERVED SEEPAGE Pit DRAIN FIELD , OTHER FINANCED THROUGH. SOIL TEST RESULTS TO BE [NSTALLED BY COMPLETION DATE ANT[CIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY Will BE SUBJECT TO PROSECUTION. TYPE ~ TO NEAREST LOT LINE, WELL TO SEPTIC TANK ~J~O DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, , SEEPAGE PiT TO R~VER, LAKE, STREAM. , SEEPAGE PIT ALSO CONSIDER AREA WELLS. SEEPAGE PIT , DRAIN FIELD GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING [NSTALLATION. I CERTIFY THAT [ AM FAMILIAR W~TH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SA]D CODE, ~~ /~/ /~ FORM NO. EQ-016 · fo~med For Lecal ~escrintion: Lot Yh(s Form Re~orts Soils "One Mn is ~h a ~h~m.d o~imioms" Glacier Excavating Co, Date Performed ~ Block 3 Lo~ yes 8-6- 73 __Subdivision Sky Ranch Estates Percolation Test ~eoth Feet Soil Characteristics 5 6-- 7 Mixed Silt-Sand-Coarse Rock (22~) Mixed Silt-Sand- fine rock (2 0) Bottom of Tes0 Pit @ -14 ft. Was Ground Water Encountered? NO ~?o^ I¢ Yes, At what Denth? Readinq Date Gress Time Net Time Depth to H20 Net Dron ion Rate Hinute p~osed Inst~on: Seenaqe Pit yes Drain Field -Deoth °f Inlet Depth To Bottom Of Pit Or Tren( 'ft. drainage area required per bedroom No or water table 4 ft. below seepage pit Mack get Data Certified By:Cons Date: l 5 Municipality of Anchors eVy 11 rY On -Site Water and Wastewater Program - CERTIFICATE OF ON -S -ITE SYSTEMS APPROVAL Parcel I.D. 015-302-03. Expiration Date:-- 8!p r� .21 4 -,g G� % 1. GENERAL INFORMATION Complete legal description Sky Ranch Estates #2 Block 3 Lot 4 Location (site address) _ 1171.1 Paddock Lane, Anchorage AK Current Property owner(s) Christopher McHugh Day phone Mailing address 11711 Paddock Lane, Anchorage AK Real Estate Agent Day phone 2. TYPE OF DWELLING:. ® Single Family (w/wo ADU) ❑ Duplex:-., ❑ Multiple -Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class A Well Public Water System 0 Waiver/Variance request for: Received by: TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Vl Date of Payment c20.2 D Receipt Number d � 3 52 G Date: Waiver Fee $ Date of Payment Receipt Number COSA # O SC 21512 Waiver # Distance: STATEMENT -OF -INSPECTION -BY ENGINEER-- As NGINEER- As certified by my sea( 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 thaf 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. ofInstallation .___ ____ Name of Firm ARCTERRA CONSULTING INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AIC 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 20 Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rales may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year. and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future aa� a occupants or can ArcTerra guarantee that no unseen Oil encroachments, deficiencies or discrepancies exist. j ii n TT -177 1 6. DSD SIGNATURE v/ System #1 Approved for bedrooms. System #2 Approved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: STtJ. IATER o PROG By: Original Certificate Date: g 1 ,20.26 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 COSA blue sheet_ O-10-12.dx COSA Checklist Legal Description: Sky_ Ranch Estates #2 Block 3 Lot 4 Parcel ID: 015-302-03 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system 1 A. WELL DATA og is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary sea[ 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) 19 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 41 ® Standpipes/foundation cleanout per record drawing Date of pumping 8126120 D. ABSORPTION FIELD DATA Which system tested (date installed) 9/21/2000 ® ALL standpipes present per record drawing Total measured depth from grade 9.5 ft (max) Measured depth to pipe invert from grade 4.5 ft (min) ❑ NIA — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective ® Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ® Nc ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) is ug' ❑ Arsenic less than MRL (ND) Collected Date of Sample C. LIFT STATION ® Required maintenance completed Age of lift station 19 years Lift station material Steel Comments: Pump level set at 41". Adequacy test date 8/31120 Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 24 in Water added 600 gal New depth 35 in Elapsed time 1260 min Final fluid depth 24 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date t From Private Well on Lot to: (Please enter distances if less than required or if community well) Se Lift Station on Lot > 100' ® Yes if No ft Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' o ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No olding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' ® Yes Animal Con a > 50' ❑ Yes if No ft ❑ Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > Community Sewer Main > 75' ❑ Yes if No ft ❑ Yes if ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required)' Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® 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 ft Water Main > 10' Yes if No ft Community Wells > 200' Yes if No ft 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 ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No " ft Wells on Adjacent Lots: Water Main > 1.0' ® 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 ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *: Waiver exist on file for lot line to leachfield for minimum of 1' separation. 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 COSA guidelines in effect on this date. COSA Checklist yellow sheet MUMMPAUTY OF ANCHORAGE Development cervi.Qcs [?epa lm.e - 4`1 Phone, 007-.343--7904Orn-Site Water & ti astewater Section Fax: 907-343.7997 Lift StaflOrtIPUMP V@ u It Maintenance Log Owner_ moi, Phen [ Legal Desc.— Se trc Tank: Street Address -L + fc� PILI -Sludge level inches aP u mpi ng' req u i rel 4a no lift station: •Pump basket cleared es no • nrrtr I'hats GI ea n edes na ,Operation sartisfactory es no •PunPing completed es no A 401,;M - E:rtiu an t fi Itur cleaned es no • P roper f: c �t scttings confirm€ es n a Alarm System: -Dedicated electrical alarm ciao u it s no-Audi:dle and iris cal alarm inside dwell irlg es ro -Ala rm systiem operation atrS @ cte rVj not ,;.a 15 ac:tory Ma nh o r$ Riser - rour]d water intrusion at riser to lank connectrr}n yes f nF .Ground water intrusion -arcF,nd pipe Penetrations' Yes -Weep hole functional jet na -Manhole lid. Functional yes no Insulated c ne Properly Secured no Other -All monufaeturor required JnspecUons and maintenanoe comPlcted aesno C!Q iMrnents; MaMenance Presider_ Technician Lc r -t- Company DWe of maintenance &P(W Date Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and 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 FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-302-03 COSA# Expiration Date: GENERAL INFORMATION Complete legal description Lot 4, Block 3, Sky Ranch Estates Subdivision No. 2 Location (site address) 11711 Paddock Lane Anchorage, AK 99516 Current Property owner(s) Robert Abad & Vilma Whitehead Mailing address 11711 Paddock Lane Anchorage, AK 99516 Day phone Lending agency Mailing address Real 'Estate ,Agent Mailing AddresS. Unloss otherwiso reqi/estod, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: Three (3) Day phone Day phone 3. TYPE OF_ WATER suPpLy: Individual Well ins~iquaI-Wate~ ~torage . Community Class ~ Well Public Water System TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] ' ~-indiv~cJ~al Holding Tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSM) issues Ce. rtificates 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 Qn-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. DSM 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 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 Municipality of Anchorage is not responsible for errors or omissions in the professional engineer'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 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 Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Pdnted Name Michael E. Anderson, P.E. DSD SIGNATURE t~Approved for "~ bedrooms. Disapproved. Date 9/13/2010 Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory By: Well Flow Advisory Nitrate Advisory (Rev. 11/05) X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage 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: A. WELL DATA Well type : Date completed Total depth Lot 4, Block 3, Sky Ranch Estates Subdivision No. 2 If A, B, or C provide PWSID # Sanitary seal (Y/N) Cased to f. FROM WELL LOG Parcel ID: 015-302-03 Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform colonies/100 mL Arsenic: mg/I SEPTIC/HOLDING TANK DATA Tank Type/Material SepUc/Stee; Tank size l~SO gal. Foundation cleanout (YIN) Y Date of pumping 9/14/2010 ABSORPTION FIEED DATA Date installed 9/21/2000 Length 101 ,ff. Total depth 9.5 ft. Date of adequacy test 9/12/10 g.p~m. Well Log (Y/N) Wires' properly protected (Y/N) Casing height (above ground) AT INSPEC'nON Nitrate rng/L Date of sample: g.p.m. Number of Compartments Two Depression over tank (y/N) N Pumper Denali Pumping Other bacteria Collected by: Fluid depth in absorption field before test Date installed 9/21/2000 Cleanouts (Y/N) Y Highwater alarm (Y/N) System type Deep Trench Elapsed Time: 1,440 min. Final fluid depth 10.0 Any rejuvenation treatment (pest 12 mo.) (YIN & type) in. colonies/100 mL Soil rating. (g.p.d./ft2 or ft21bdrm) .45 GPD/SF Width 2.5 ft. Gravel below Pipe 5 ft. Eft. absorption area 1,010 ft2 Monitoring tube' Y Depression over field N Results (Pass/Fail) Pass For 3 bedrooms e.5 in. water added 620 gal. New depth 24 in. in. Absorption rate >= 4.5o g.p.d. N If yes, give date LIFT STATION Date installed 9/21/2000 Size in gallons 250 "Pump on" level at 41 in. "Pump off" level at 41 Datum Bottom of Tank Cycles tested 5 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: in. Septic tank/lift station.on lot N/A Absorption field on lot N/A Public sewer main N/A Sewer/septic service line N/A Animal containment areas N/A Manhole/Access (Y/N) Y High water alarm level at 45 in. Meets alarm & circuit requirements? Y On adjacent lots >lOO' On adjacent lots >100' Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Water main N/A Water service line >10' Wells on adjacent lots >1oo' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1"-* Building foundation >1o' VVater Service line >1o' Surface water >lOO' Curtain drain None Noted Wells on adjacent lots >1oo' *** Lot Line Waiver Issued. AbSOrption field >5' Surface water >1oo' Water main >10' Driveway, parking/vehicle storage >25' F. COMMENTS: G. ENGINEER'S CERTIFICATION mw~w of Municipal m~ that the above sy~ems am in ~n~ance w~h MOA COSA gui~lines in effe~ on this date Engineer's P~nted Name Michael E. An~mon, P.E. D~e 9/3~10 COSA Fee $ ~ ~ ~ Waiver Fee $ Dat~ of ~aym~nt ~ ~ D~ of ~ym~nt Re~ipt Number 0 7~1 Re~ipt Number (Rev. 11/05) N 89°59'44''N 114.65' z S 89°59' 32" E. 53.00 LEGEND $ SEWER VENTS LS LIFT STATION THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCELINES, EASEMENTS OF RECORDr OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON(UNLESS INDICATED) NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BB USED TO DETERMINE PROPERTY LINES OR LOCATE STRUCTURES. ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS, AS-BUILT SURVEY NO CORNERS SET THIS DATE 1" = 30' I HEREBY CERTIFY THAT l HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 4, BLOCK 3, SKY RANCH ESTATES SUB., UNIT NO, 2 ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS 30TH DAY OF AUGUST 20~ 0__. HOLT LA-~-D SURVEYING 8078, FB90-19 TEL. 345-5513 Municipality of Anchorage Development Services Department 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. 015-302-03 GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date: Z.~- ~/ L/Z _ ~:~ Z.~ Completelegaldescription SKY RANCH ESTATES SUBDIVISION #2; LOT 4, BLOCK Location (site address or directions) 11711 PADDOCK LANE * ANCHORAGE, AK Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address LISA & ROBERT RAY Day phone~868-3133 11711 PADDOCK LANE * ANCHORAGE, AK 99516 Day phone RANNA w/ PRUDENTIAL JACK WHEE Day phone 441-5815 3201 'C" STREET, SUITE 200 * ANCHORAGE, AK 99503 ~ Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class "A" Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site [] 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 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. INote: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, orpdor to closing for the engineering services provided. 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 forthis 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/er 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 ALASKA WATER &: WASTE'WATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUITE 2B * ANCHOEAGE, AK 99504. Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 337-6179 Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering 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 t/me of the test, and separation distances measured to readily identifiable features. The operational lite of all we/la and septic systems depend on the local soils condition, groundwater levels that may fluctuate durfng 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. Satisfactoq/ 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 est/mate of how long the aystem 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 authorfzed, nor will it confer any legal right whatsoever. DSD SIGNATURE ~ Approved for' ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the fllowing stipulations: ~: WATERAND : rn: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory '~ :. PROGRAM .., 4 .. ..- ~'.~, ~/~ '.. .... - ~_~. ~ Manitenance Agreements x/)/~ t ~ ~ t ~ ~ ~'" Supplemental Engineers Reo~ Other (Rev. Original Cedificate Date: Municipality of Anchorage Development Services Department Building Safety Olvlslon On-Site Water & Wastewafer Program 4700 South 6ragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ct.anchorage.ak, us · (go7) 343.?e04 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SKY RANCH ,F_b'rATES S/D ~!2; LOT 4~ BLOCK 5 Parcel ID: 015~302-03 ,~ WELL.DATA COMMUNITY WATER · ,, . 21 831 Welltype ct~ss x IfA, B, orCprovldePWSID# · 212.16 WelILog(Y/N) Cased to .........._fL Casing height (above.ground) ........_.__in. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform - colonies/100 mi. Arsenl~ -, mgJL. SEpTIC/HOLDING TANK DATA / ..... g.p.m, Nitrate - regaL. Date of sample: - Tank Type/Material , STEEL/S.T.F..P. Tank size, .~250 gal. Number of Compartments Foundation deanout (Y/N) YES Depression over tank (Y/N) NO, Date of pumping 3/27/2003 Pumper ....... AT INSPECTION ~ g.p.m. Other bacteria . - colonies/100 mi. Collected by:. - Date installed 9/21-26/2000 Cleanouts (Y/N) , YES High water alarm (Y/N) , YES ,DENAM PUMPING ABSORPTION FIELD DATA ~ **DUAL 11~ENC~ IN~)'A'rHF. AST/SOU~W~¥i Date installed ~e/21-2s/2ooo Soil rating~r fl~bdrm) 0.45 System type **DEEP, ,TRENCH Length ~, 50/51 fL Width 2.5 fL Gravel:below pipe 5.08/5.07 fL Total depth ,*&8/s.7 ,fL Eft. absorPtion areal000+ff= Monitoring tube, YES, Depression over field NO Date of edequaw test 3/27/2003 Results (Pass/Fall) PASS Fluid depth in absorPtion field before test 14/16.5 in, Water added 396/200'gaL Elapsed Time: 1230 min. Final fluid depth 12.5/16 in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) ,, NONE KNOWN For ,, 3, bedrooms 24.5/ New depth 22.5 in, 450+ g.p.d. If yes, give date - D. LIFT STATION Date installed 9/'21-26/'2000 Size in gallons . 1250 "Pump on" level at 4.t in. "Pump off" level at 4.1 in. Manhole/Access (Y/N) YES High water alarm level at 45 in. Datum BOTTOM OF TANK Cycles tested. 3 Meets alarm & circuit requirements?. YES SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: COMMUNITY WATER Septic tank/lift station on lot Absorption field on lot. Public sewer main On adjacent lots On adjacent lots ~manhole/cieanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main 10'+ Water service line 10'+ Absorption field Surface water. 5'+ 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line '1 '+ Water service line 10'+ Building foundation 10'+ Water main. 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ COMMENTS *SEE WAIVER ~WR950054 G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Munidpal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed,Name Date '~ /'"., /0.'~ JEFFREY A. GARNESS HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number (Rev. 12/01) Parcel I.D. # MUNiCIPALiTY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-8650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING o15- o2-o HAA# / 1. GENERAL INFORMATION Complete legal description SKY RANCH ESTATES #2: LOT 4, BLOCK :5. Location (site address or directions) 11711 PADDOCK LANE ANCHORAGE. AK 99516 Property owner Mailing address Lending agency Mailing address KELLY POSTON 11711 PADDOCK LANE Day phone ANCHORAGE. AK 99516 Day phone (907) 786-0223 Agent AINSLEE PHILLIPS W/PRUDENTIAL VISTA Dayphone Address 4241 "B" STREET ANCHORAGE. AK 99505 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: (907) 562--6464 5 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx Hotding Tank Community on-site Public sewer NOTE: If community wastewater system, provide wdtten confirmation from State ADEC /ng to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 Computer Version Note: Alaska, Water. and Wastewater Consultants, Inc. shaft be paid $1,200. O0 at or prior to, closirtg for the engineering services provided. 6. 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 ap¢ication 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 Municip~IJand State cedes, ordinances, and regulations in effect on the date of this inspection. , ,,.~/~,~ Address 6901 DEBARR R~AD, ?U/T~ ~.,~ORAGE, ALASKA 99504 i / In conducting this evaluation, AWWC, Inc. ¢tte~npt d ,o ,rok~de a thorough, conscientious engineering analysis of the system in accordance with ADEC and MO.~ DHHS 2uidelines & 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 readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water 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. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA D/IHS. 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. 6. DHHS SIGNATURE P'"' Approved for ~-~ bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy cedain 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 engineeffs work. 72-025 (Rev, 1/91) Back MOA//21 Computer Version Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744 Health Authority Approval Checklist Legal Description: SKY RANCH ESTATES #2; LOT 4, BLOCK 5 Parcel I.D.: A. WELL DATA 015-302-03 Well Type CLASS "A" Log present (Y/N) Total depth If A, B, or C, attach ADEC letter. ADEC water system number 211831 & 212916 Date completed Cased to ~~e ground) Wires properly protected (Y/N) Date of test Static water level Well production FROM WELL LOG AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate B. SEPTIC/HOLDING TANK DATA Date installed 9/26/2000 Foundation cleanout (Y/N) Date of Pumping NEW C, ABSORPTION FIELD DATA Date installed 9/21/2000 Length 101 ~50 + 51)Width Effective absorption area 1000+ Date of adequacy test NEW Fluid depth in absorption field before test (in.); Fluid depth - (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* Compater Version Collected by: i Tank size YES Depression (Y/N) Pumper N/A '~BELOW ORIGINAL GRADES Soil rating (g.p.d./ft2 or ff2/bdrm) 0.45 2.5 Gravel thickness below pipe 1250 Number of Compartments 2 Cleanouts (Y/N) YES NO High water alarm (Y/N) YES Monitoring Tube present (Y/N) YES Depression over field (Y/N) Results (Pass/Fail) - For_ 3 - Immediately after - gal. water added (in.): - - Absorption rate = - NONE KNOWN If yes, give date System bjpe DUAL TRENCH 5 Total depth '9.64 NO Bedrooms D. LIFT STATION Date installed 9/21/2000 Manhole/Access (Y/N) YES High water alarm level at* 45" Cycles tested NEW Size In gallons 1250 "Pump on" level at* 41" "Pump off' level at* *Datum BO'FFOM OF TANK E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main ICOMMUNITY WELLI On adjacent lots sewer manhole/cleanout Liffstation SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Water main/service line 10'+ Surface water/drainage 100'+ 1'2OO'+ TO PUBLIC WELLS] Absorption field Wells on adjacent lots 5'+ '100'+___ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 1 '+ Building foundation 10'+ Water main/service line 10'+__ Surface water 1 oo'+ Driveway, parking/vehicle storage area 5'+ Curtain drain N(] 4E KNOWN F. ENGINEER'S CERT~ICA,~ I certify that,l~ ~ ~el~r~ir~¢th ?eld inspections and review of Municipe~ re( ~1~ ~i~ th~bo ~ systems are in confo~ance Signature Engineers Nan ~ ~ JEFFE~ A, GARNESS Wells on adjacent lots '100'+ l..,' ..... A, Garness.. HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Computer Version Waiver Fee $ Date of Payment Receipt Number ~_p MUNICIPALITY OF ANCHORAGE [~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SiTE SEWER AND WATER FACILITY 264-4720 Application Date~--~ ~["~J~ GENERAL INFORMATION (a) Legal Description (include lot, block, subdiyision, section, township, Location (address or directions) (b) Applicant Name /¢'Y~¢\_{ C/~'-l~)c~rtcJeleph°ne: Home _~. 9,~';-/I~1'~ Business 3¢,~',_~) "~7.Z~/ ApplicantAddress PO ~-~C~ [/ / ,~ ] ? ¢(/)~ /,,I Applicant is (check one): Lending Institution []; Owner/builder/~; Buyer []; Other [] (explain); (c) (d) L~nding Institution Address Telephone (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: Single-Family1'1 Multi-Family[] Number of Bedrooms _ Other WATER SUPPLY ~uPub ~neividual We I [] Community lic [] Note: If commumty well ~ystem, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAG E,~t~'POSAL Onsite E~' Public [] Cgmmunity [] Holding Tank [] ~ Note: If commumty well system, must have written confirma!ion from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (t 1t84) Page 1 of 2 ENGINEERING FIRM PROVIDIN~NSPECTIONS, TESTS, FILE SEARCH, DA'3'~ 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, functionar 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 i.~pection.(~0 ('(~'t~ Name of Firm '¢ ~~ Telephone Engineer's Seal DHEP APPROV_~ Approved for ~*'¢''L~/ bedrooms ¢::r:V::con d,:~ Approva:isapprOv~ '~¢ J?..'~ ~(-'~C7- ~"~Dat e Conditional CAUTION 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 e courtesy to purchasers of homes add 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 (1 MUNICIPALITY OF ANCHORAGE ~'~9 DEPT, OF HEALTH & MUNICIPALITY OF ANCHORAGE (M ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 JUN 0 3 198 ' 284-4720 Legal Desc[i~ipn:~)~ WELL DATA Well Classification ~J(~/')/~ (./~ ~LJ l( A, B, C, D.E.C. Approved (Y/N) I Well Log Present (Y/N) Date Completed YieJd Total Depth Cased to Static Water Level 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 Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Comments ,.~ Date Installed Standpipes (Y/N) Depression over Tank (Y/N) SEPTIC/HOLDING TANK DATA Size Air-tight Caps (Y/N) Pumping/Maintenance Contract on File (Y/N) ./~J/J~ Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ,~-00 TO Property Line ~ To Water Main/Service Line Course ~J IA Comments No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) TO Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 1 ~'7~..~/ Width of Field Square Feet of Absorption Area · ~'~'(~'~ .~.¢ /~OO~ "~ Type of System Design Depression over Field (Y/N) Results of Last Adequacy Test Separation Distanca from Absorption Field: . To Water-Supply Well /'~/~)"~'~ ~¢ ~¢ Properly To Building Foundation Lot ~/~ ; On Adjoining Lots Length of Field Depth of Field /O Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Line /'3 ! '~"~ To Existing or Abandoned System on To Water Main/Service Line '~O' To Cutbank (if present) ,/~/A To Stream/Pond/Lake/or Major Drainage Course /~/~ To Driveway, Parking Area, or Vehicle Storage Area Comments ~ ~¢'or'(1 ~'~ ~,i~ ;¢'% ~i)~V~-~ ~ ~(~)~ bX/ ~'~., ?)O~J"~. D. LIFT STATION Date Installed ~X~,% Manh~yDimensi°ns ~ % "~) Size in Gallons /N) "Pump On' Level at High Water Alarm Level at Tested for ~ q y . , ac Test Meets MOA Electrical Codes (Y/N) Co m _m e~Bts..~-~'~ / ** Check P~¢~hitted Bedro~m Rating Against HAA Request ** //4 //-/ I certify thC J~ ~,q¢ c h e c k,¢'c~, ve ri fie d.~ or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed /////~¢ /// . ~Date CompZy ~q-,~f-~'//~// 0~dL~.< MOA No. Receipt No, C/~..~ Date of Payment Amount: $ ~ ~.,¢~ Engineer's Seal Page 2 of 2 72-026 (11/84) ~ WONICIPALITY OF ANCHORAGE %-~/ DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHOKIT~ A~PROVAL CERTIFICATE 1. General Information Application Date (a). (b) Applicants Name~/n~-~/6M~ Applicants Address F~O-Z~o-*/ (c) Applicant is (check one) Lending Institution Buyer~; Other~__~(explain); Legal Description (include loC, blo'ck, subd.?ision, section, township, range) Location (address or directions) Telephone - Home Business (d) Lending Institution Ad~. ss (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: Telephone 2. Type of Residence $ingle-~amily~-[ Number of Bedrooms 3. Water Supply Individual Well F--~ Multi-Famiiy~--~ Other (describe) Puhllc -'-[ 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 Note: If 'co~unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] En~ineerin~ Fi~Providin~ Inspectio~'Tests~ File Search~ Data and Infomation 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 tha= the on-site water supply And/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of s=ructure indicated herein.- I further verify that, based on the information ob=ainad 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 regula- Date /. 6. DF_E~',AI~i~roval' '.. Approved 'for (ENGINEER SEAL) bedrooms Approved · ~ ' , ;~ Disapproved Conditional __ CA~fION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON TH~ REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT P~OFESSIONAL ENGINEER REGISTERED IN T~U~ STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIE LENDING INSTITUTIONS IN ORDEE TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- HENTSo EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS 0R ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/eJ/D18 [Pa§e'2 of 2] 7-19-84 A. W]ELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALT~,~ AUT~{ORITY APPROVAL (HAA) cHECKLIsT - FEBRUARY 1984 % /',,'tUNICIPALITY OF ANCHORAiDI~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION~ NOV 3 0 1984 RECEIVED Well Classification Well Lcg Present (Y/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Cased to Legal Description: ,~/~7 ~ ./~/d)&/,C. If A, B, cr C, D.E.C. ~p~omd(Y~) ~te ~leted Yield ~pth of ~outing. Pump Set At Separation Distan~s from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line C leanout/Manhole Water Sample Collected By Water Sample Test Results Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on LOt ; Date C~t~nts Be s .P IC/HO ZNS DATA Date Installed f~/~//~ )~z ~_ Size /~'~ ~ No. of C~nts Stan~i~s (Y~) /~ Al=-tl~t Caps (Y~)~ Foun~tion Cleanout (Y~) ~ ~essi~n o~ Ta~ (Y~) ~ ~te ~st P~d ~ ~ P~ing~intenan~ ~n~a~ ~ File (Y~) ~ ; for //~ Holding Ta~ High-Wate~ ~a~ (Y~) ~ ~r~ Holdi~ Tank ~t (Y~) ~ ~p~ation Distan~s ~ ~ptic~olding Ta~: [Page 1 Of 2] Receipt Date Paid: Amount: 2-15-84 Ce ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design · Length of Field Depth of Field /{3 Gravel Bed Thickness ~ Square Feet of Absorption Area //~ ~ Standpipes Present (Y/N) Depression cvs= Field (Y/N) z%/~ Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from A~sorption Field: To Water-Supply Well //;~ To Property Line /: ~ ' ~' To Building Foundation -~ /~' To Existing or Abandoned System Lot /v//~ ; On Adjoining Lots /~z/f To Wate~ Main/Se=vice Line ,., W ~,W~, TO Cutbank( if present) j//~ To Stream/Pond/Lake/or Majo= Drainage Course z~ To Driveway, Pa~king Area, or Vehicle Storage Area ~,_~-~.? De LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested fo= 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 Bedrocm Rating Against HAA Request ** ~ ~/~- I certify that I have checked, verified, o= conformed to all MOA HAA Guidelines in effect on the date of ~pection. Signed ~ Date //~ ~/~ KB1/d5/s [Page 2 of 2] ENGINFJ.~P~ 2-15-84 BRUST & ASSOCIATES Engineers - Planners - Surveyors 1610 Dimond Drive Anchorage, Alaska 99507 (907) 562-7878 November 30, 1984 Mr. Keith Bandt~ Anchorage Department of Health and Environmental Protection Pouch 6-650 Anchorage~ Alaska 99502 Dear Mr. Bandt~ An adequacy test was performed at Lot 4~ Block 3~ Skyranch Estates #2~ on Nov. 24~ 1984. The test showed the system is fully capable of handling the hydraulic load. However~ certain seperation distances are not met by the system. ~c/~~ ~ Part of the septic tank is under the garage floor. This does not meet the ~tfmot building foundation criteria. ~.,~'¢~.~ Q~ The trench standpipe is 1.3 feet from the property line. ~ O~1~ 3. The crib cleanout is within 20 feet of the property line. ff~~. 4. Since the south east corner of the building is sh own to be 20.6 Ofeet from the property line~ the trench is either within the 20 foot seperation dLstance from the garag~ found~tion~ or on the propert~ to the ~ · east. , , ~ ' ~ '~nl.'~O .I. The r' y ~,~ 5~_ d mvewa serving the garage addition appears to pass over or ~4o~ withzn 10 feet of the trench. /~ The soil absorption system is in the 10 foot utility easement at 0 ~l&lg the~aast property line. According to DHEP records the septic tank and log crib were constructed in 1973. The garage addition was constructed in 1975 or 1976. The septic system was upgraded in 1981 and was aproved by DHEP on 6/1/81 in its present configuration. The trench appears to be deep. The bottom of the standpipe was 14.5 feet below ground level and the liquid level in the standpipe rose to the 10.5 foot level. The bottom of the crib was 12.5 feet below ground level. No liquid level was noted in the crib. This is because it is in a slightly higher area. Mr Keith Bandt ~j Page 2 The system appears to have operated satisfactorily since the upgrade, and no freezing or structural problems are apparent. Since the property to the east is unsubdivided~ since the easement is unreserved and unlikely to be used (this neighborhood is already served by all utilities except sewer) and since these clearances do not appear to have created a health problem or adversly impact the waste disposal system it is recommended that your office approve this system. Enclosed for your information and use are the following. 1. Application for Health Authority Approval Certificate 2. DHEP Checklist 3. ADEC approval of community water system 4. As-Built survey 5. Sketch of cleanout locations 6. Copies of DHEP inspection reports and permit Please let me know if you require additional information. Sincerely Stanley Brust~ PE DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: Address: 274-2533 PWS I:D.# Zlg. qllm To Whom it May Concern: According to records on file in this office the~~ ~ ~.]~- ~~Water System is in compliance-with the State Drinking Water Regulations I¢ 30' h .~',,~...' !::,,_ '0:~ ,.? ~.: ~::~:? -, ~ CHEWED BY~ A~ 60.$ , 114. ~b ~28 ' 9 N £PTA T£$ UN/T ,v~ /8,3 i NO. CUSTOm,rS O*~).R NO, R~C'~ ~ KE~P THIS SUP FOR REFERENCE ~tFOI~MI® 5S 280 1.981 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Box 1628 D Anchor: age, Alaska 99507 Ivl^Y 2 9 1981 RFCEIVFD Trench Inspection Lot 4, Block ~ Skyranch Estates ilk'ar t4r. Ache.qon; A; per your reqtlest~ ! inspected the trench on May 28, i981 on h~e above legal!y described lot with the purpose oF deten~:ihin9 any wate~ encountered. This tet'cer se}~'ves a8 varification Lhet no water was present at the end of the trench to a depkh of t6 feet he!ow o>:] sting gro'.tp.d. Wil: sa 2820 "C" Street, 8uJ. te ~3, Ancho~'age, Aiask 99503 276-'4855