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SHERWOOD HEIGHTS LT 3
v � - � i � `� _ � - - - - �= ;° �� a �� i, Municipality of Anchorage • Community Development Department Page 1 of 3 • On-Site Water&Wastewater Program 4700 Elmore St. .P.O. Box 196650 Anchorage,AK 99519-6650 fittp://www.muni.org/onsite (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number. OSP191039 PID Number: 020-042-24 ❑ New In Upgrade Name: ABSORPTION FIELD STEVEN &JULIE ISABELLA Address: 0 Deep Trench 0 Shallow Trench 0 Bed 0 Mound 15701 ROBIN HOOD DRIVE*ANCHORAGE,AK 0 Other Phone: No.of Bedrooms: Soil Rating: Total Depth from original grade: (907) 632-2340 3 GPDISq.Ft Ft. Depth to pipe invert from original grade: Gravel depth beneath pipe: LEGAL DESCRIPTION FL Ft. Subdivision: Block: Lot: Fill added above original grade: t `Gave gth: SHERWOOD HEIGHTS - 3 -( `�W Ft. f. I owrlshlp: _ Range: - Section: - Gravel wWM ��` Beds Number of lines: Distance between lines: SEPARATION DISTANCES Ft. Ft. Total absorption Number of trenches: Dist.between trenches: To Septic Absorption Lift Holding PublicfPnvate From Tank Field Station Tank Sewer Lines 8D.Ft. Ft Well 100'+ - - - 25'+ TANK • Septic 0 S.T.E.P. ❑Holding 0 Other Manufacturer Capacity: Surface Water 100'+ - - ANCHORAGE TANK 1250 Gal. Material: Number of compartments: Lot Line 5'+ - N/A - STEEL 2 Foundation 10'+ _ _ - LIFT STATION Curtain Drain Manufacturer: C '- NONE KNOWN - Gal Remarks: PER CONTRACTOR OLD TANK DECOMMISSIONED PER UPC -Pump on"level at: "Pump or level at: High water alarm at: Pump Make 8 Mode' Electrical Inspections performed by: PIPE MATERIAL House to tank F628 Tank to F628 drainfield Installer BEEKS CONTRACTING INC. Drainfield EXISTING CO/MT D3034 Inspector GEG, Ltd. BENCH MARK (Assumed elevation) 100.00 Ft. Inspection Dates: 1st 3/8/2019 2nd Location and Description: 3rd - 4th - BOTTOM OF TRIM AT SE CORNER OF HOUSE ENGINEER'S •L Community Development Department Approval 00�0.:\x 0 Conditional approval: Date: _ 0/ .40 . ' - ..'•÷(10 .: 49 tiait, .*.37. Op / /n 'A-P •.J=j" •-. Games-.: 0 v4�. •., VE7. :•A1,p — /^ Opt, 41..0.2,250--- Approved: -��=�:��'�, Date: 3 -ICH/ LICENSE40Qdpro essr000 J #AECC884 OIOOO�o Inspection Report_1-1-12.doc PERMIT NUMBER: PARCEL ID NUMBER: ` OSP191039 RECORD DRAWING 020-042-24 a '\ ��'_ _'�� I ' — ` I-w \ i". "• in 0 \\ ��". •N\ WELL RADAII FLAGGED BY PLS 0 0 \ ,zPRIOR TO CONSTRUCTION I w \ •• I w 1 i A B C 4 `� 3a I / FCO 5.3 16.7 26.2 �• _w O 1 // ST1 19.3 30.4 41.6 w 00 1 / ST2 24.9 38.3 49.5 `\ w w 1/ SEPTIC TANK NOTE:THERE IS O w i/ DBL1 27.9 41.9 53.2 \\ A GRINDER PUMP STATION IN JO Z DBL2 29.6 43.9 55.1 \ THE FOUNDATION.DUE TO t7 /� CO1 30.7 48.6 59.7 \\ THIS FACT,THE SEPTIC TANK I j / CO2 52.9 70.5 81.9 \ SIZE HAS BEEN INCREASED TO 1 ,LU! \ PROVIDE LONGER RETENTION w MT 52.2 70.3 81.5 \ ! / 1 TIME FOR SETTLING SOLIDS. a ! Iw / /00.14/ELL �,• 11 11 I �/ 4O/US • •• • I 5 I/ !':t.:.*: I O /IYI /I •••••t••:•..•• \\‘‘ I •�\\ / fn , i+DRIVEWAY • \P\'` �\ I ~Oix 1 •`0 FOUNDATION CLEANOUT REPLACED ,I w 1\ EXISTING WELL ;".,.ry,~ . \\1\\\\\1� 3 EXISTINGSTC I!GRAVITY FLOW TO NEW SEPTIC TANK =AT A HIGHER ELEVATION TO ALLOW a O \ ••''', , \ HOUSE �` \\ ; ' / NEW SEWER LINE FROM HOUSE TO TANK;/ w 2 `� \ • \\\ C900 THROUGH HOUSE TO FCO;4"ABS FROM =0 s� \ •' / CLEANOUT TO TANK;SEWER LINE FROM w a `�.. \\ :1•' \ `` / HOUSE TO TANK HAS 4"OF INSULATION 5 ce \� \\\\ • % I w w �` ,.•• , �T NEW 1250 GALLON STEEL SEPTIC TANK O O •` . .f ST 4BL1 0 •'!• i 'BL2 • •\ t �:-.. moi' CO • :r \\ �� :} f:tt ---- MT2 02 \\ • i \\ EXISTING DRAINFIELD /f ��` \O� PASSED ADEQUACY f W \,7" TEST ON 2/8/2019. / J `\ '�/ J U \ i - \``` \y0 L 0 — \° f 0 ``\ 0 \\ \'O O \ \"P N SHERWOOD HEIGHTS;LOT 4 5 `� \• WELL IS LOCATED ON �� \\ SOUTH END OF LOT m \ \ SCALE: M \• \ \ Q �� 1".4U 10.74%%* ■III .•-\ OF 4.4 41, ;;* 41 'Ns $ da� ••. ♦♦ GARNESS ENGINEERING GROUP, Ltd f.4L... =• '•• \* V. -..- '''" " ENGINEERING•SALES a CONSULTING 0 • - �'-�-3701 E{TUDOR ROAD.SUITE 101,•ANCHORAGE.AK 99507•PHONE(907)337-6179'FAX(9.37)33194246'WEBSITE.wwwq.ms..9.9“.9.<om _ 0• ,• • • • 1111 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ♦ e STEVEN ISABELLA 907-632-2340 2 OF 3 j ss : �v/ LEGAL DESCRIPTION: DRAWN BY: ♦�/ C 795 •,4 SHERWOOD HEIGHTS; LOT 3 D.J.G. ♦♦j •x••••.31„'. •�0ci� TYPE OF WORK: DATE: • SEPTIC TANK RECORD DRAWINGS 3/12/2019 LICENSE �� ••• j C PERMIT NUMBER: PARCEL ID NUMBER: OSP 191039 RECORD DRAWING 020-042-24 • FINAL GRADE=103.9-104.9 TOP OF TANK ST1 ST2 AT INLET=98.72 = a TOP OF TANK AT OUTLET=98.72 INVERT OF BUNG NEW 1250 GALLON SEPTIC TANK AT INLET=98.48 INVERT OF BUNG I AT OUTLET=98.36 \. AK GARNESS ENGINEERING GROUP, Ltd 147 a. r',Or C7 �\* •• of ENGINEERING•SALES•CONSULTING 0 3701 E.TUDOR ROAD,SUITE 101•ANCHORAGE.AK 99507•PHONE(907)3376179•FAX 19071338-3746•WEBSITE.www.q•m•sssnpnsemy.can • .. • PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0%.4• a ey A.Gar - s STEVEN &JULIE ISABELLA 907-632-2340 3 OF 3 v O • , .........,a LEGAL DESCRIPTION: DRAWN BY: t , •••. � SHERWOOD HEIGHTS; LOT 3 D.J.G. v.:NsE441 ••'. �(2�(,�•P�,:. TYPE OF WORK: DATE: LICENSE 111; `S``��;44 SEPTIC TANK PROFILE 3/12/2019 #AECC884 J ,H,"'""'iv.0 MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program \o 5�; .a,.�r,. PO Box 196650 4700 Elmore Road .Aa 4Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343 7997 httpalwww.muni.orglonsite + . MILLI k3 G< 3 � I)cl�artmcnt 4';.-c-},;;;0 On-Site Wastewater Disposal System Permit Permit Number: OSP191039 Effective Date: 3/4/2019 Work Type: SepticTank Upgrade Expiration Date: 3/3/2020 Tax Code Number: 02004224000 Site Legal Address: SHERWOOD HEIGHTS LT 3 G:3238 Site Mailing Address: 15701 ROBIN HOOD DR, Anchorage Owner: ISABELLA STEVEN L &JULIE Lot Size in Sq Ft: 47614 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy 0 Private Well 0 Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: ��� 1 11, Date: 3/1/19 [ 19 l Issued By: /r/ / di .�i I Date: ,�/�fk? MUNICIPALITY OF ANCHORAG7 8 9 Community Development Department PI: 907-343-790 Development Services 907- 343-4691 t On-Site Water & Wastewater Program Mayor Dan Sullivan ►�p7 b 8 L 9 �h On-Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 020-042-24 Property owner(s) STEVEN &JULIE ISBELLA Day phone 907-632-2340 Mailing address 15701 ROBIN HOOD DRIVE,ANCHORAGE,AK 99516 Site address 15701 ROBIN HOOD DRIVE,ANCHORAGE,AK 99516 Legal description (Sub'd, Block& Lot) SHERWOOD HEIGHTS S/D; LOT 3 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (Z all that apply) Initial Single Family (SF) Absorption Field ❑ (w/wo ADU) Septic Tank ® Upgrade Duplex (D) ❑ Renewal ❑ Holding Tank ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage n THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: N/A Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: o�a�J Waiver Fees: Date of Payment: 0,14I A Date of Payment: Receipt Number: 6tet-(,3(.6 Receipt Number: Permit No. 615 10361 Waiver No. (Rev.01/11) . A ...„......, 4 -- ' ti- GARNESS ENGINEERING GROUP, Ltd ENGINEERING SALES CONSULTING February 15, 2019 Municipality of Anchorage Development Services On-Site Water & Wastewater Program 4700 Elmore Roade Anchorage, Alaska 99507 Phone: (907) 343-7904 Reference: Septic Tank Upgrade for Sherwood Heights S/D; Lot 3 To whom it may concern: The 3 bedroom house on the referenced property is served by a private well and septic system. Per MOA records, the septic system serving the subject property was installed on 8/13/1981 and was sized for 3 bedrooms. The septic system consists of a 1000 gallon steel septic tank and a deep trench type drainfield (23 feet long with 6 feet of effective). The drainfield has recently passed a septic adequacy test, however the septic tank is 37+ years old. Per the MOA policy, septic tanks over 30 years old must be physically inspected and deemed to be structurally sound or replaced. Given the age of the tank, it is unlikely that it is structurally sound, so we have recommended that it be replaced. We are proposing that a new 1000 gallon steel septic tank be installed, and the old septic tank permanently decommissioned. We request a septic tank upgrade permit be issued. It has also noted that the existing drainfield sump did not extend to the bottom of the drainfield. It has likely accumulated dirt and debris over the years. We are proposing that the contractor install a new cleanout at the beginning and end of the drainfield and that at the end of the drainfield, a new monitoring tube be driven to the bottom of the drainfield. The foundation cleanout was also found to be partially clogged during our adequacy test. We are proposing that a new sewer line be ran all the way back to the foundation cleanout and that the foundation cleanout either be jetted or replaced. We would also like to note that the well cap needs to be replaced prior to obtaining a COSA and during our well test, we noted the well flow "sputtered" throughout the test. This may an indication that there may be holes in water line in the casing and is sucking air, and/or that the well pump may be at the end of its useful life. Please do not hesitate to call us at 337-6179 if you require further information. Thank you for your assistanc Since ely i \teff• y`��arnes , P.E., M.S. Pre-i•` t 3701 East Tudor Road,Suite 101 *Anchorage, Alaska 99507-1259 Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com GEG,Ltd.HAS AN 8 PAGE SPECIFICATION LETTER Q cn THAT PERTAINS TO THIS DESIGN.BY PROCEEDING O~z X FORWARD WTH THIS INSTALLATION,THE ———__ ..I w ENGINEER,WELL DRILLER,CONTRACTOR AND . p Z \ PROPERTY OWNER AGREE THAT THEY HAVE NOTE:THE in 0 CONTRACTOR F 0 \ READ THESE SPECIFICATIONS AND AGREE TO SHALL HAVE THE WELL RADIUS x z ACCEPT THE TERMS AND CONDITIONS OUTLINED. \ / \\ STAKED/FLAGGED BY A Et w REGISTERED LAND SURVEYOR I I \\ PRIOR TO CONSTRUCTION w 1 NOTE:WELL CAP NEEDS TO BE REPLACED PRIOR cc O 1 TO OBTAINING A COSA.DURING WELL FLOW rW \\ z z I / TEST,THE FLOW"SPUTTERED"THROUGHOUT ; h ? \ p W / TEST WHICH MAY INDICATE WATER LINE IN \ SEPTIC TANK NOTE:THERE IS 0 z I/ CASING HAS HOLE IN IT OR THE WELL PUMP IS AT \ A GRINDER PUMP STATION IN 9 /I THE END OF ITS USEFUL LIFE.RECOMMEND WELL THE FOUNDATION.DUE TO / I SERVICE COMPANY FIX WELL HEAD AND \ THIS FACT,THE SEPTIC TANK INVESTIGATE WELL FLOW ISSUE. \ SIZE HAS BEEN INCREASED TO w / I \ PROVIDE LONGER RETENTION w TIME FOR SETTLING SOLIDS. cg / / 70 l I l wF<<"olus 1 ;71 p p 'I/ . l��j,' ',J I 1-4-&-1..•S� • / Il '• +' ,,.. . A`1`• I O 1 - 1 DRIVEWAY ` / F z + �i / EXISTING FOUNDATION OJ w EXISTING WELL !.+'.:• :'•+,. CLEANOUT.MAY NEED TO BE o z 4• / EXISTING REPLACED OR JETTED DUE TO 3 BEDROOM '' / PARTIAL CLOG IN CLEANOUT. 1-F \\ !P f HOUSE / / ci7 w \ •','. / / INSTALL NEW 4"SEWER LINE w= \• \ \ i / BACK TO FOUNDATION(FCO) ' x \ \\ ' `\\\�/ PROPOSED 1250 GALLON z• z \ :'�' ° ` // CO STEEL SEPTIC TANK a O \\ -•' /7i,'/) // Ili c0 (SEE NOTE) o z / N\ < • / INSTALL DOUBLE CLEANOUTS \ / INSTALL CLEANOUT \ \ '� • ' i/ AT BEGINNING OF TRENCH \ EXISTING SEPTIC TANK TO BE • � 's. ..••t.•' DECOMMISSIONED PER UPC zr EXISTING SUMP.DOES NOT PASSED ADEQUACY EXTEND TO BOTTOM OF / / \�O EXISTING DRAINFIELD W \\ \ TEST ON 2/8/2019. DRAINFIELD.CONTRACTOR TO J REPLACE SUMP WITH NEW / 0 \ CLEANOUT(CO)AND / \ \O MONITORING TUBE(MT)THAT IS — \\ Pr., SET TO THE CORRECT DEPTH. • \ \po \i-,'4– N fY \(\ SHERWOOD HEIGHTS;LOT 4 LU WELL IS LOCATED ON m \ \ SCALE: SOUTH END OF LOT 2 \ t� 1"=40' A Q .,........141i i 16, • bli: .t\ c J.' ' GARNESS ENGINEERING GROUP Ltd s *�� P 9 • '\ ` ::* vO �0 EN INEER��f(j SALESo�fS�f IN (1 •• 3701 E.TUDOR ROAD,SUITE 101•ANCHORGAGE,An.99507•PNON (907)33617C FAX(907)8 3246GNEBSITE:www gamessenglneedng.corn ; Ilila • •J. ..\ • ,• PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ♦t� I YllA. arnes 4/1 STEVEN &JULIE ISABELLA 632-2340 1 OF 1 •jai 's (YE_79 � PROJECT/LEGAL DESCRIPTION: DRAWN BY: �0� ••. SHERWOOD HEIGHTS; LOT 3 J.L.M. �1 I ••••• �� i.19. •q�: TYPE OF WORK: DATE: REVISED LICENSE It. ES`,��44 DESIGN OF SEPTIC TANK UPGRADE 2/27/2019 LICENSE 4 ....,49 ,.. „...„,_,.,,.,g..C if i i 8 A 3 i I g 2 o.. 7 g (4t„ / ro"� 41046E718Ed8 t 1 Onaa I / r 00001t_ • • OP I' //////////l/ • w /I //// / \\ / / • l 0°41x`O \\ Z 14S 0 Si .Q Q� p:49 RI •;-7;/1 AS-BUILT SURVEY 1” =30' s-,I.',f/ -Dg SNANEA HOLT epT� N.GGMNEM86E1 TMSGATE LS.81• „pi"` I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY QO .......... OF THE FOLLOWING DESCRMED PROPERTY e 4v,k,Od -`eO v 0 1072 snE+r0.730 K.G'+lSAdlAUrm-r7J ANCHORAGE RECORDING DISTRICT.ALASKA.AND THAT THE / VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS MFORNATION RCM.IS FOR TMC URI Or hORIG SH SIITUTIONS CORCAEEV TO NOW MY EXIST OTHER THAN NOTED. CONIUCTS MOM.COSMO STRUCTURES MO T•LAmO LOT UNE II ANDOA MIR ROOM MO IS DATED AT ANCHORAGE.ALASKA THIS 17I DAY OF HOT IO SS DM FOR POSITNMMO.Oano.4.E*TX+C*UNSS.MIROVEMHIT8.ORIENCEUMES /MIIRFN .2019 CRIMES FT1 a RECORD.OTHER TRAY THOSE MPEMTXO OM INE RECORD PUT,Mt TMT MOWN xr)EON I VN LEES RiaCATE01 HOTS FERCEEDIE5}NAT MAY EPROM OR TIRO DAME.ARE ROT TO OE MO TO O.TERROR TOP., VM ]R 'Lot.CM POSIT.OOAN MM OX MAY Ott Y tt MMOE'MATE DUI TO EXCESSIVE N OW MOOR ICI MUTING SURVEYNO \ / ME ANCHOR VER GI AGEAK 916 941.15/8 798-75 MO 3166613 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION \825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 *D-) ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE Chr;$�v her \�� eS ,.�^ (J 1 � �J ^ I D9g UPGRADE MAILING ADDRESS �- GoX AY)nP�( &VV3 LEGAL DESCRIPTION Lo LY,` Sher T- :3 N 11 r / /� LOCATIO_RA,iS(?� NO. OF BEDROOMS I'IQIDt)'1 � o 6 UU fhv)E ) U Y DISTANCE TO: W �� Absorption axea Dwelling PERMIT NO. 1- z Manufacturer Ma.aterial No. of compartments LU aI- rn Liq. rapacity in gallons IF HOMEMADE: Inside length Width Liquid depth DISTANC Well Dwellin PERMIT NO. -" J U ?_ = z Q cturer Ma M al Liquid capayr in gallons DISTANCE TO: Well �^J Foundation k Nearest I line PERMIT NO. , I��O� uNo. of lines Length of each li ai Total length o lines Trench width Distance between lines a _ -e inches-.�,._.�.�__- I- Top of tile to finish grade lj. -- Material beneath the �� Total effective abs Tea +V--1= Length Width Depth PERMIT NO. w Q F- a- Type of c ' Crib diameterrib depth Total effective a s rption area LU i N DISTANCE TO: Well Building foundation Near lot line J Class TN'/v4 D✓ Depth Driller Distance to lot line PERMIT NO. J N CS ru � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area (sl OTHER -- - PIPE MATERIALS ,* SOIL TEST RATING $• p Ulfa INSTALLER`` rr11 _ / _ _ C� S iPF�C XC REMARKS u v1 cdzi n1� �6Vi )'-V7i) JST Yom. " 1- --- Ui 03 - p ` ' hk ' n\0 ILL- 3. >`a 1nOroX.I�aly $- r 1 h �0 Jc ocean �o�•1C!IL..�r1" LEGAL Ffl APPROVED DATE 72-013 (Rev. 3/78) Tol 1.1141 1 C: 1: k:-� IIIL~T oil 14150 0- 1 IT'. RE DEPr"IRTMpNT HE�HLTNVIF!ONMENTAL .�OTECTION ` 825 /LSTREET/ HNCHORRGE. HK. 99501 264~4720 ���� ��� ��A������ ����� ������ �` PERMIT NO. ( 810806 ) /�/ ^ y`. n HPPLICANT CHRISTOPHER T FETES BO� 640] HNNEX ] T) � LOCHTION RH8BIT LEGHL LOTJ. HTS SUB LOT SIZE 47000 SQUH1E TYPE OF SOIL HBSORPTIOW SYSTEM IS: TREMIA MHXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ THE OF THE IS: �Q 141 Cy -r- �����..... �Q 1:1 T, 1-1� � ThA LENGTH DIMENSIOTI IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. TM DEPTH OF H TRENCH OR PIT IS THE BETNEEN THE.':: SURFHCE OF THE GROUND HND THE BOTTOM OF THE EX(":HVHTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE H�D THF: BOTTOM CiF EXCHVHTIOP-4 (IN F'EET). "C' ��1 AD 4- OR P44 hot ��X O-zE �:! �CE'D4 11D PER 5:1 L. L. CR P, I!� PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE IHTII')N IN!i;PECTIONS OF ANY WELLS TO THIS THE NIJMBER OF RESIDENCES THHT THE WELL 1,1I1-1 SEE. 1 VA 7:S" ����� ���������� �~_ B�CKFILLI�G OF HNY WITHOUT FINAL INSPECTION HND HPP�OVHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION MINIMUM DISTH�CE BETWEEN H WELL AND HNY ON�SITE SEWHGE DISPOSHL SYSTEM IS 100 F�ET FOR A PRIVHTE WELL OR 150 TO 200 FEET FROM H PUBLIC W�LL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMuM wSTHNCE FROM H PRIVHTE WELL TO R PRIVHTE SEWER LINE IS 25 FEET HND TO H SEWER LIHE IS 75 FEET. WE�L �O�S HRE REQUIRED FND MUST GE RETURNED TO THE WnnHIN ]0 DHYS OF THE WELL COMPL�TION OT11-iR 1'elHY APPLY. S9ECIFICHTI0NS 1:7111,1D CONSTRUCTION DIHGRHMS HRE HVHILHBLE TO INSURE PROPER INSTHLLHTION, W K 101 P1 Y -T IVE2 X V �C,' �> FEE: E' P-1 Eil Ifl:;? ���.... _1_����L I CERTIFY THHT J. I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE. T I WILL INSTIilLL THE SYSTEM IN HCCORDHNCE WITH THE CODES. ]� I UNDE�STHND THHT THE ONSITE SEWER SYSTEM MAY RERQUIRE IWNLHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. ... .... ... .... ..... ..~ I F - -IPLA T. FETES 0 Or 'Som' AS.-SORPrION ':SYSTF-M 15: TRENCH NFix tr-JUR t #1Jf 18 k tx# I � ;^:s#.�'_s�r:� '�'�..� �� '�_e4� �.�.se.�Sf Tom`"�"�_'•� z:- �—��'? t.`�r�3-!'�;!!'. =�.:._ �,='��3�=' .:q $Y`�S._�I''I � §� 1r'&�.�"`��._ � � '3' 5_.S'�"" �"'Ki �""�'t �-'`•Pi�i��$'�i ��r 1-J& ORA [ p I I-1 0- 1' n 0;,�� TH rte. 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C j41 RND M Ai I-- lM-3I TT; iER '3,t, -sr m p i A y 1,�1strta" r�A.:Hf?+s�i'"r Tii TO CNK:T_ JD_ F Moff' I•}•fAN :? !E,r_".tjRQj"XrS. �f pf-i"i— I i� Ff' °� "!(� �'n T . i't�rS i .� �i r T' „'o•, I � ;^:s#.�'_s�r:� '�'�..� �� '�_e4� �.�.se.�Sf Tom`"�"�_'•� z:- �—��'? t.`�r�3-!'�;!!'. =�.:._ �,='��3�=' _�_.�"� xy ate: rz i a I fir 11,' M-7 M ' 1-1H 1-J& ORA [ p I I-1 0- 1' n 0;,�� TH rte. A T+s :t -P- ti !P P [ T ('3 THE CI US T'r`NI--.3 C TW---: r# Tt-p'_ rl- - l; s t I-IV �'1HD r#� CIOTTOM rF THE � j--'A':�€ITI i +. Crd iii $ if t7r?_ DF -P -M I's I -ice. r'i CN EPIUM (3ETJrH fk 11RAi 0 WD'Lr--,CN r.HF !'.stJ M' 0-1.. 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AAA 4•j` eon Tt3 A PRI'' AM 'E -Et- EV LIME Is 25 FF -1=r .410 t Fap �3�J t AND vo 5 r Rri rijRo- - o ro fw# Ctiuon.q rmm T w r ro Crd `sr3 ! t -4 i4 MAY ! •d I `r'_ 'S '2- C I; f C8 T I 0NS AND 6Vii P,A?n_ : TO M. rt gjji T f +7l:i. i�flr 'r_. �9 �'9 S_ ...y, R -.a9 �'t�' .^�� 8"`a�� ��- i_�.� Te.�.T �'•i�f!_�'. �'S w__ ...i+.. �_+4 +'ems .0.-. - Y r is Typ�i 'i• � a��i�T k- p i .t g,��� r ♦ t�. r �y� 5�-� >� p� �•�v �• A A a F'4111 -trip , 1'i k M f E 7'-n 3 ,:iAi L i s�i• FH t S FUR ON —'s f F� So'kt .7''F..:. i Iia D WC -U -S rfs 'i. 4 - FORM8Y Tse. i'}t N TC IFfL I €''Y QF RWIHORItW�L C WILL _L N I TH FW coc-F-.3k. C j41 RND M Ai I-- lM-3I TT; iER '3,t, -sr m p i A y 1,�1strta" r�A.:Hf?+s�i'"r Tii TO CNK:T_ JD_ F Moff' I•}•fAN :? !E,r_".tjRQj"XrS. �f pf-i"i— I i� Ff' °� "!(� �'n T . i't�rS i .� �i r T' „'o•, $� SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL_ PROTECTION PERCOLATION TEST C\ ! 825 L. Street, Anchorage, Alaska 99501 264-4720 -� SOILS LOG - PERCOLATION TEST PERFORMED FOR T/7 C .�P.f I-9i1[7IJfige 1 DATE PERFORMED:/(g 191 LEGAL DESCRIPTION: QE PT -1 fint'' y� ( SLOPE SITE PLAN Q — �L. T'T' IJLCVT 1 U' ;�b % - / e -P�- lr M 2 c9 (C� 3 U^ (5,r� 4 0 � 5 (^ 0- 6 L t� 7 O / er ft C7 II �- 9 10 w L-0 U b 13 1.0 fl , 14 O 1 � �t} 16� "\\"coo coo rio cn}�S�U n 47 "'J 9 e/ 17 �'i� {y09D r�0�npn1 _ 000<i o �/,/7 18 19 0���' 3rn9i Talhol Nn 6 F 20 COMMENTS PERFORMED BY: 72-008 (6/79) WAS GROUND WATER S ENCOUNTERED? 'D L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop r LZ WAS GROUND WATER S ENCOUNTERED? 'D L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN CERTIFIED BY: FT AND (minutes/inch) — FT DATE:�/'�l(�yl�� Wien Log For.........: ............................... Location ...... .......... a_: .. ........... `x .......� I............... I ...... Date completed........l. Depth of well........ . moi/ r-� 410%! E! Size of casing° '�' Distanceto water.................................................................................................... Distance to water while pumping ............. 7C'.' ................................... at rate of.............!.�' ...........................gallons per hour. ................. DELTA DRILLING COMPANY SRA BOX 394 B ANCHORAGE, ALASKA 99507 ....'.................................... Driller Formation I from I to 41'x! 7 Vii, tip_ . I ' 41I I I ^I I I I ................. DELTA DRILLING COMPANY SRA BOX 394 B ANCHORAGE, ALASKA 99507 ....'.................................... Driller • Municipality of Anchorage 1_ On-Site Water&Wastewater Program (907)343-7904 rSA:u i LLTV CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 020-042-24 Expiration Date: sT 1. GENERAL INFORMATION Complete legal description SHERWOOD HEIGHTS;LOT 3 Location (site address) 15701 ROBIN HOOD DRIVE*ANCHORAGE,AK 99516 Current Property owner(s) STEVEN&JULIE ISABELLA Day phone 907-632-2340 Mailing address 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: TYPE OF WASTEWATER DISPOSAL: Individual Well N Individual On-site U Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for. N/A Distance: - Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee$ SCO. 0 0 Waiver Fee$ Date of Payment 03 t4-J 19 Date of Payment Receipt Number 1 Bf i Receipt Number COSA# °SC") 1 1 6 1 3 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are)in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E.TUDOR ROAD. SUITE 101 *ANCHORAGE,AK.99507 , Engineer's Printed Name JEFFREY A. GARNESS.P.E. Date 3/i2 Iii Engineer's Comments: III In conducting this evaluation.GEG provided an engineering evaluation of the well and/or septic system in accordance with the **SUS■it i guidelines and regulations established by the Municipality of Anchorage and industry practices.The reported results describe the .44 C oF 4 44 condition of the system/s on the dates of the evaluation.Separation distances were measured to readily identifiable features . :St-.......... . 1 .. Hidden defects or encroachments may exist that were not identified during the evaluation The operational life of all wells and septic ' it.. • systems depend on a variety of variables including.but not limited to.soil conditions,groundwater levels(that may fluctuate during • •• ` the year),quality of construction(materials and workmanship).and the water usage of the family utilizing the systems.These A */ 9 ; /\ •.* #0 conditions can vary,and are outside the control of GEG.Satisfactory test results do not guarantee future performance of the • : system/s:therefore,GEG makes no warranty(express or implied)regarding the future performance of the well or septic system. • GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail.The content of this report is for the sole benefit of the person/party who retained GEG Reliance upon theli °O y A. t-mess Of information provided in this report by any other person or party.including but not limited to subsequent property purchasers.is not 0 ( •/ CE 79 3 authorized.In short,GEG disavows any legal duty to anyone other than the person/party who paid for this'eporl. ♦ . ••., • 6. DSD SIGNATURE 41ESS\t 4 LICENSE ,•r „ � `bil. t$AECC88a System#1 Approved for ,3 bedrooms. System#2 Approved for bedrooms. ..„ Disapproved. .�`�( �` I ON-SITE 1) Conditional approval for bedrooms,with the following stipulatiow: WATER AND CO.. ; c:4-, WASTEWATER o PROGRAM �c ,1041 c•: --- 1^....____ Original Certificate Date: -S '—I"F —/ The Municipality or Anchorage Develop,emt Services Division(DSD)issues Certificates of On-Site Systems Approval(COSA)based only upon the represenatations 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. ATTCHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory _ Other (Rev.10/12/12) /-/ti;) COSA Checklist Legal Description: SHERWOOD HEIGHTS; LOT 3 Parcel ID: 020-042-24 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system A. WELL DATA ❑■ Well log is filed with Onsite (or attached) Well production at time of test 2.1+ gpm Date drilled 8:29,1981 Water storage tank volume N/A gallons Total depth 115 ft Well disinfected for coliform test? ❑ Yes • No Cased to 99.5 ft ❑■ Coliform bacteria is Negative ❑� Sanitary seal is functioning correctly Nitrate 1.32 mg/L ❑ Nitrate less than MRL (ND) ❑■ Wires are properly protected Arsenic 5.21 ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 12+ in. Collected by GARNESS ENGINEERING GROUP Date of flow test for COSA 2/8/2019 Date of Sample 2/8/19 Static water level at beginning of test 49.6 ft. Comments B. TANK DATA C. LIFT STATION Age of tank(s) NEW years ❑ Required maintenance completed Tank type/material 5Eo°c,sTee Age of lift station years ❑■ Standpipes/foundation cleanout per record drawing Lift station material Date of pumping NEW Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 813/1881 Adequacy test date 2/8/2019 ❑■ ALL standpipes present per record drawing Results E Pass For 3 bedrooms Total measured depth from grade *10.5 ft(max) Fluid depth prior to test ****14 in Measured depth to pipe invert from grade **7.25 ft(min) Water added 453 gal ❑ N/A— pressurized field New depth 19 in ❑ Monitor tubes go to bottom of drainfield. If not, state 120 depth into effective"'3.25 Elapsed time min E Code-required soil cover over field Final fluid depth 15 in Absorption rate 450+ gpd ❑ System presoaked N/A (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced N/A gallons If yes, enter date N/A Comments/Deficiencies:SUMP WAS LATER REPLACED WITH CLEANOUT AND MONITORING TUBE DURING TANK INSTALLATION'TO BOTTOM OF SUMP"FOR SUMP""25'BELOW SUMP INVERT COSA Checklist yellow sheet 3/i 3/0 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> 100' ❑✓ Yes if No ft ❑D Yes if No ft Neighboring Tank > 100' QYes if No ft Private Sewer/Septic Line >25' D❑Yes if No ft Absorption Field on Lot> 100' QD Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment> 50' ❑D Yes if No ft ❑✓ Yes if No ft Manure/Animal Excreta Storage> 100' Community Sewer Main > 75' 7✓ Yes if No ft ❑✓ Yes if No 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' ID Yes if No ft Property Line > 5' El Yes if No ft Driveway/Parking > 0' ❑,/ Yes if No, comment Absorption Field > 5' OD Yes if No ft Wells on Adjacent Lots: Water Main > 10' 2 Yes if No ft Private Wells > 100' ❑D Yes if No ft Water Service Line > 10' ❑D Yes if No ft Community Wells > 200' ❑✓ Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 1D Yes if No ft Driveway/Parking > 0' E Yes if No, comment Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ❑✓ Yes if No ft Private Wells > 100' OD Yes if No ft Water Service Line > 10' 2 Yes if No ft Community Wells>200' El Yes if No ft Surface Water> 100' ❑D Yes if No ft F. ENGINEER'S.COMMENTS oo600O�. G. ENGINEER'S CERTIFICATION ,`� OF ��ti.'� A I certify that 1 have determined through field inspections and review if i • T 1)\ •-7'0 of Municipal records that the above systems are in conformance with Q • MOA COSA guidelines in effect on this date. QvA D 000 ff :y A. Gar, ess• DV E 7 53 � Q m(1 0 •P ��1.� • . A,c�4 0'' '' 0,0,,,,,\ c,(`O COSA Checklist yellow sheet N.6''13,-o f essio�oo� #AECC884 X0004` viiiiiity • .F�'(11° 4,,15 fah 4 i 8 „i3 C. '7. ,, s en1' /' r' 741/4 7. ,L4.,./ wC : SINGLE FAMILY ( / A r1 FRAME HC + 7 oil LIE(A • --WPC Y)1!4#1'1 IC j/ • • `*� • / j z' 7 a / it t/ 7 ' i VLI: 2 30. C19\65 2O1� Q �51 ti NN moi. 110 0000000040 00 Qcp.. 49 m .-y00O AS-BUILT SURVEY 1" = 30' 05 .i, `0 , . . e Q NO CORNERS SET THIS DATE O o SHANE A.HOLT • O O'N LS-6914 . '• J` ' I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY 'IL d OF THE FOLLOWING DESCRIBED PROPERTY 111 0 /O/e$$Iona•oa� IO1$SIIRWOODHEIGHISSUR(PLA168-731 �040000 ANCHORAGE RECORDING DISTRICT,ALASKA,AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS THE INFORMATION HEREON IS FOR THE USE 01 LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY ` EXIST OTHER THAN NOTED. CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTSI AND IS DATED AT ANCHORAGE,ALASKA THIS 171H DAY OF NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES• EASEMENTS OF RECORD. OTHER THAN THOSE APPEARING ON THE RECORD PLAT . ARE NOT SHOWN hG1RCll ,2019 HEREON ( UNLESS INDICATED) NOTE' FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINEI OR POSITION ADDITIONAL IMPROVEMENTS• ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. HOLT LAND SURVEYING / 9309 GROVER DRIVE / A GE,AK 99507 345-55135-5513 \ 19/3 FR lel-%5;7.0.5-,71 MUNICIPALITY OF ANCHORAGE r • 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 HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # b2 0 HAA # 1. GENERAL INFORMATION Complete legal description Lot 3; Sherwood Heights Subdivision Location (site address or directions) 15701 Robinhood Drive Anchorage, AK PropeFty:owner `Steve & Julie Isabella Day phone 345-5700 Mailing address 15701 Robinhood Drive, Anchorage, AK 99516 Lending agency Day phone Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone NOTE: 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 ' Holding tank Community on-site Public sewer '; , -0. t: NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Hov. 1/91) Front MOA #21 R' 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone G y ' a °1 7 17034 Eagle River Loop Road No. 204 Address Eanle Rlvar Alaska 99,577 Engineer's signature Date 1 1 ,� i `f 7 ZOF E 1� ��5 ROBERT C. COWAN. 6. DHHS SIGNATURE� CE - sso I F1\ Approved for - bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: \ Date 1-2 y- 97 The Municipality of Anchorage, Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates''based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued..The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-M (Rev. "I) Back MOA #21 MUNICIPALITY OF ANCHORAGE CNVIRONMENTALSERVICES DIVISION Municipality of Anchorage JAN Z I 19 A DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division C E I r 825 I_ Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-J44 ' Health Authority Approval Checklist Legal Description: I_{,,- T -j ': k' � o�A F- . Parcel 1. D.: 0 10 0 `/ > — 3 1/ A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number `) D Log present Y&) `/ Date com Igted PEtLF. 4 " SL ' b be Total depth / a Cased to 9 9 '3' " Casing height (above ground) /z'� Sanitary seal (ON) Date of test FROM WELL LOG 0 29 -VI Static water level Well production WATER SAMPLE RESULTS: Coliform 0 Wires properly protected N) Y— Nitrate 0,605, AT INSPECTION bj Other bacteria 0 Date of sample: i / 6 /77 Collected by: S & S ENGINEERING 97934 Eagle River Loop Road N0.204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed I'3 -'31 Tank size looter Number of Compartments 2 Cleanouts QN)--y— Foundation cleanout I) 6 Depression (Yg)_� High water alarm (Y/N) '� IA Date of Pumping l -L�- 57 Pumper /�-i_0Ar{(trt4b C. ABSORPTION FIELD DATA Date installed 13 Soil rating (g.p.d./ftz or ftz/bdrm) �5 �(�2System type Length -Z-S _Width Z.s Gravel thickness below pipe to Total depth /6 Effective absorption area 2,76, Monitoring Tube presentON)-Y_ Depression over field (YQ A) Date of adequacy test /-/6- 97 Result(jNi�Fail) AW For S bedrooms Fluid depth in absorption field before test (in.); D 4 Immediately afte'rYPb gal, water added (in.): O " Fluid depth 64 (ins) Minutes later: Absorption rate =�o* g,p.d. Peroxide treatment (past 12 months) (Ya fA�d,4vl If yes, give date ')/A 72-026 (Rev. 3/96)` �7�5 �� pti PQle%i�e'Q.-s 'T-3 CSS. ���61(,T 1 u J r .� C' bin t") f9Ra. T100' C is dG.GUPI'F_ D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum off' level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 1 po `k On adjacent lots 1 as 1 Absorption field on lot \ ©a On adjacent lots Public sewer main ► Public sewer manhole/cleanout P', _ tk ll Sewer /septic service line Lift station '�I A — l0� SEPARATION DISTA1NCES FROM SEPTIC/HOLDING TANK ON LOT TO: � Foundation 1� Property line to k k Absorption field ►-b t Water main/service line to ► Surface water/drainage 1�� Wells on adjacent lots t b l� SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line k tk Building foundation \ D \�- Water main/service line 10 t.l Surface water \oo kk- Driveway, parking/vehicle storage area Lio ► _ Curtain drain t1e I4_,J6 �JJ Wells on adjacent lots 100 1� F. ENGINEER'S CERTIFICATION I certify that f have determined thru field inspections and review of Municipal records ihp"ten in conformance with MO HHHA�puide pes in effect on this date. Air . �'...... ., , S LA Signature Engineer's Name /\ 6 h.t ;- ! � I-^��� ROBCRT C. COWANy� Date ) �. o °7 ��� u, ` CE - 8A01°�ci�y `Z�A� •wstg-tea" HAA Fee $, Waiver Fee $ Date of Payment 1r'7 Date of Payment Receipt Number l G�7 9 Receipt Number 72-026 (Rev. 3/96)* are S& HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PIANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL. INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN nG ROBERT C. COWAN, RE, ROBERT A. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 WELL FLOW TEST DATA FAX(907)694-1211 CLIENT; �fF�.l&.Jv� fL ,� Ors{ Q, 0, DATE: LEGAL DESCRIPTION: 00 lo, \A -M WELL DEPTH: its" CASING DEPTH: !f9 ,S " PiAte., J'f 'G DATE DRILLING COMPLETED: k- 2 ) -;1 DRILLER: pA � A MISC. DATA: CASING HEIGHT; IZSANITARY SEAL: WIRES IN CONDUIT: _1/ GRADING BACTERIA AND NITRATEA�MPLES`COLLECTED (date): /�lG•97 TEST DATA: CLOCK TIME METER READING (GAL) PUMPING RATE (GPM) DEPTH TO WATER (FT) REMARKS swl o lie d� v RESULTS: WELL CURRENTLY PRODUCES r� FN WITH A 11 " DRAWDOWN TESTED BY: 94r�„m/_ FLOW RATE NOT GUARANTEED --SUBSEQUENT VARIATIONS CAN OCCUR. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE T Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # Qom'' C�Z HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 3; Shenwood Height6 Subdivi4ion; Location (address or directions) 15701 Robin Hood 17n4.ve (b) Property owner A26ned H. 9 Suzanne Launegelephone: (home) 345-6678 Business Mailing Address 15701 Robin Hood Dh,Cve, Anchonage, Ah. 99516 (c) Lending Institution PACIFIC RIM TITLE INS.AGENCy Telephone 274-2562 ATTN: Baenda S.taatb Mailing Address 307 Eut Nonthenn Lights Blvd. Anchonage, Ak. 99503 (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here Qxif hold for pick up.) List contact person and day phone number below: S & S ENGINEERING —17034 Ea(fie Rive, ROOM -1 1110. 204 Eagle River, Alaska 99577 2, TYPE OF RESIDENCE Single -Family CXx Number of bedrooms - 3. WATER SUPPLY Individual Well ❑Cx Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site [XX Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Pagel of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address ?i Date Ingle niver, tesla f ] 99377 Telephone Zc jineer's Seal 6. DHHS APPROVAL. G' < �� ate ---� Approved for �_ bedrooms by ,i_- Approved Disapproved --Conditional Terms of Conditional Approval \IAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 v� �\L�s MUNICIPALITY OF ANCHORAGE (MOA) �5�� • Health Authority Approval (HAA)i CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: �� MF�lat1-lTS S�r'� A. WELL DATA Well Classification "41If A, B. C, D.E.C. Approved ( ffd) A. - Well Log Present (2?N) S/ Date Completed Yield 1 1--1pry r Total Depth1_115 Cased to 9,7 Depth of Grouting __._Z - J7 - 9 ©) Static Water Level Z.`s I Pump Set At __I (:FL Casing Height Above Ground I L'i4- J Sanitary Seal on CasingON) Electrical Wiring in Conduit &N) Depression Around Wellhead (Y/.l j /j SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot 1 Dom' -`_ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line �'�I (�- To Nearest Public Sewer Cleanout/Manhole " r" To Nearest Sewer Service Line on Lot t Water Sample Collected by `� S �—�1bt rJ r- �t,�1 ; Date Water Sample Test Results Comments 7+ P( Zr-0920 G2i_4�r �6o £ S (�' eo" B. SEPTIC/HOLDING TANK DATA Date Installed - j3- '?L Size 1o�c� No. of Compartments StandpipesaN) __ 4 Air -tight Capsq'N) _ _Foundation Cleanout ON) — Depression over Tank (Y& h Date Last Pumped tQ- l0-- l c Pumping/Maintenance Contact on File (Y/N) Holding Tank High -Water Alarm (Y/N) t1 ;for — Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well loe ` r To Building Foundation vy To Property Line 1 p` r To Disposal Field To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments ?')rM0*ti v�A Ar' 1A�PAe- 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 111 �2 - Type of System Design Date Installed f2�) - 13 -S t Length of Field 7_`` Width of Field Depth of Field l o' Gravel Bed Thickness (p Square Feet of Absortion Area 2.1 h Statndpipes Present6pi �( Depression over Field (YQ Date of Last Adequacy Test c) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well To Property Line t C�, `',- To Building Foundation o ` To Existing or Abandoned System on Lot ` �� A< ; On Adjoining Lots To Water Main/Service Line o ` To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course l Do %, To Driveway, Parking Area, or Vehicle Storage Area ---I CD 1 4 - Comments D. LIFT STATION Dame ti led Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/ Comments Dimensions Manhole/Access (Y/N) . "Check Permitted Bedroom Rating Against HAA Request" "Pump Off' Level at Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA,gy(q inspection. r, Signed r Yl.f Company � 8 5 ENt�l�fFu�ln! • ` .., J Date r agle, River, Alaska 99577 MOA No. r % 9Q-- C70.3 Receipt No. Date of Payment /�2 -�a0-_ 90 Amount: $ '70, in effect on the date of this t ,.r Engineer's Seal i,:s,:s•i M Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 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 269-9720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) -- �. �1 / (b) Applicant NameZ2t61 —_Z Telephone: Home Business Applicant Address (c) Applicant is (check one): Lending Institution D; Owner/builder NT; Buyer 0; Other ❑ (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-Famil�X Multi -Family ❑ Other Number of Bedrooms — .- 3. WATER SUPPLY Individual Well �<� Community EJ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public 0 Community ❑ Holding Tank C7 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 Glia 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 watersupply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of thisipspectign. it Name of f=irm �_ �_>" f/_ C Telephone Address :'—__ /—'yC Date -- . .,r.? ii _%�•��_ __ -- Engineer's Seal OF r'qf(l'l,gas�] ci �i ^q 097601 G/On G� i �%1 `r OC�r f309 uaa� P�(�r V3 a R. � v,,:.,nee o�c9 ac ooa na aao oo 9ac 0 0 G. DHEP APPRO Approved for V/Q�-�-bedrooms by'Date Approved _ _-- Disapproved Conditional _ Terms of Conditional Approval 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 a above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) A. WELL DATA L Well Classification MUNICIPALITYOFANCHORAGE (MOA) HELTH MUNICIPALITY OFhL'f11FKL?STRIFE BR APPROVAL 84HAA) DEPT. OF ME L�* 264-4720 L PROTECTION ENVIRONMENTA OEC 1 1985 Legal Description: �� RECEIVED If A, B, C, D.E.C. Approved (Y/N) Well Log PresenteN) Date Completed Z Yield /moo civ Total Depth Cased to 'r' Depth of Grouting Static Water Level -fin Pump Set At ` Casing Height Above Ground Sanitary Seal on CasingON) Electrical Wiring in ConduiON) Depression Around Wellhead (Y 1 % Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots To Nearest Edge of Absorption Field on Lot ��// / ; On Adjoining Lots /oo To Nearest Public Sewer Line �� To Nearest Public Sewer Cleanout/Manhole T To Neares Sewer Service Line on Lot- Water Sample Collected by Date Water Sample Test Results Comments _5e7TE7T/1CJul) Wb"l-t- l� talk (( i l :�j ANY)S�PL� ��T l��dlT} SEPTIC/HOLDING TANK DATA Date Installed GZ_IZ�1 Size No. of Compartments _ Z_ StandpipeAir-tight Cap) Foundation Cleanout YJ) Depression over Tank ( Date Last Pumped �_— Pumping/Maintenance Contract on File (Y/N) _ ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well /l / To Building Foundation To Property Line -/ �� f To Disposal Field To Water Main/Service Line Course PIZ To Stream, Pond, Lake, or Major Drainage Comments 5�__Iv "II -MW W Noe /mfgr Nva W4VtwN �'( PoP�i- Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata > - Type of System Design Z moo j Date Installed Length of Field Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Standpipes Preseno)\l) Depression over Field (10 Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well /// �_ To Property Line To Building Foundation <�' To Existing or Abandoned System on Lot o n ;On Adjoining Lots -7- To Water Main/Service Line To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course ti/<'ti- %sr4�--s' �. To Driveway, Parking Area, or Vehicle Storage Area Comments LiAeb6go fNWc�Tioo WoR-T D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I havechecked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed M Date 12I121 Company i5 MOA No. Receipt No. �� L Loi Date of Payment --A a 3 ?)S Amount: $ 6Q- .CD0 Page 2 of 2 72-026 (11/84) Al *AI�1081B°1iqIj t M'0B d Lai 016190- p NIB A. Pio, 2 Loca tion : Client's Name: Address: BWSE, EPPS & POTTS 2220 EAST 88 AVEJUE mcmpi1GE, AK 99507 (907) 349-6451 WATER WELL TEST Date : subdivision: Lot: Block: Tester: ��/ �'/V / I/ Initial Reading on Meter: .-�-cs TIME GALLONS GPM 4 VOLCJMS GALLONS TOTAL VOLUME Aj p / �:3 -511<1 [H"" 2 -1 -flour Capacity Ga11cna aL'A► 5. LEGAL DESCRIPTION DATE RECEIVED INSPECTION APPOINTMENTS Ids TIME TIME TIME Al C,0 DATE _ DATE DATE 7. WATER SUPPLY r� `&)- / 1C)-,)_'� X�� INSPECTOR INSPECTO 1 lLl`��t INSPECTO --f�IUIN MUNICIPALITY OF ANCHORAGE1-N�1gDEPT. 01 1:�AIJI 18 IINONMENTAI- I' :UIECT10N DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEAVv 825 L Street - Anchorage, Alaska 99501 1 "0 1981 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 - RE CE I\ f E D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPEEITYOWNER C. MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER ` PHONE AILING ADDRESS - - 3. LENDING INSTITUTION -�� PHONE s MAILING ADDRESS ZL 4. REALTOR/AGENT PHONE MAILINGADDRESS / ��� �% r� C✓/CD' ,- PC,L/4Ro 5. LEGAL DESCRIPTION �LJcvej Ids STREET LOCATION -a -L,) c>/�/ CJ . 6. T PE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY 0 Three ❑ Six 7. WATER SUPPLY - 0 INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM 54 INDIVIDUAL/ON-SITE** ZYL_YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX T.. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL — DATE DRILLED LOG RECEIVED Z AA 3. SEWAGE DISPOSAL- SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER (8i❑Septic Tank or ❑Holding Tank Size:--FB_==If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL r-7 r 4. DISTANCES - WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line - 5. COMMENTS ll( APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE s- A U r BY 4 f� I C, 72-010 (Rev. 6/79)