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Home My WebLink AboutROBIN HILL #1 BLK 1 LT 1BRobin Hill #1 Block 1 Lot 1 B #017-442-04 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OPS171266 PID Number: 017-442-04 Dwelling: ❑■ Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑■ Upgrade Name: Kyle Gruis ABSORPTION FIELD Address ❑Q Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 6201 Nenana Place ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 0.8 GPD/SF 11.3 Ft LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 3.1 Ft. 8.2 Ft Robin Hill #1 1 1B Fill added above original grade Gravel length Township Range Section 0.4 Ft. 36 Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES 3 Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 576 Ft2 Ft Well >100' >100' >100' N/A >25' TANK ❑Septic I]S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 65' 75' 65' N/A Anchorage Tank 1250 Gal. Material Number of compartments Lot Line >5' 0' >10' N/A Steel 2 NA Foundation >5' >10' >10' N/A LIFT STATION Manufacturer Capacity Curtain Drain None Noted Orenco I a,so Gal. Remarks Pump on level at Pump off level at High water alarm at Waivers in septic permit 44 in. 40 in. 46 in. Pump make and model Electrical Inspections performed by Orenco/PF2005 Capstone Elec PIPE MATERIAL House to tank D3034Tank to D1785 Installer drainfield A+ Home Services Drainfield D1785 CO/MT D3034 Inspector Jake Millette BENCH MARK (Assumed elevation) 100 ft Inspection is' 9/15 2 9/19 Location and description dates: 3rd 9/19 4m Concrete slab left side of garage COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL - En iiketc 0=1 .3. OF �a Conditional Approval: Date �l►•�:;•'' •.4 or. s ' TH 9 • - •v• s 41 0 aMl ,......7 0 to Li �i • Approved 4Date `t Id 1 1__ '1 # )4~• be6 S Inspection Report_9-1-12.doc CAPSTONE 4ELECTRIC LLC COMMERCIAL & INDUSTRIAL September, 21 2017 Forge Engineering 1399 W. 34th Ave Ste.203 Anchorage, AK 99503 Dear Ben, Capstone Electric LLC has completed the electrical portion of work at 6201 Nenana Pl. Anchorage, AK 99516 and certifies that the installation was done in accordance with Local & National Electrical Codes. All alarm systems have been installed and are in working order. Thank you. Devin Rafeedie President/Project Manager info@capstoneelectricak.com 22356 Whispering Birch Dr. Chugiak, AK 99567 Office: 907.688.2751 Fax: 907.688.2752 ROBIN HILL #1 BLOCK 1 LOT 1B PERMIT # OSP171266 PID # 017-442-04 /• I I LOT 1A \ -- - I 10'UNDERGROUND UTILITY EASEMENT / I \ _4 —— L A 10'UNDERGROUND UTILITY EASEMENT- / EXISTING \1 ROBIN HILL II SUBDMSION I E S G WELL BLOCK 1, LOT 1B I 1I SHED I ROM 43 1BLOCK 1 LOT 3 I OLi-- 100'WELL RADIUS I 1 \ / / 2ND STORY DECK \ /. •,::,,_:":� APPROX EDGE OF SWAMPY 11111,► : \ •.�iititi :.,:::�N AREA/GROUNDWATER / 3-BDRM HOME \ / �tf4:1:4.-; +.:; ROBIN HILL #1 BLOCK 1 LOT 1B PERMIT # OSP171266 PID # 017-442-04 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT: 343-7904 4700 ELMORE RD, ANCHORAGE, AK 99519-6655 WASTEWATER DISPOSAL SYSTEM OR WELL INSPECTION REPORT r N u_ U) U 2 - 100.7 - — / 96.7 96.0 1250 GAL STEP TANK 91 1 1= N. 106.9 O.G. / FINISH GRADE / 106.5 f , .. Jam, 103.4 DRAINFIELD ROCK �` 103.4 \ 95.2 95.3—/ 36' - –89.73 ��(�-.0000104.10. oF : ,1 i NO GROUNDWATER 9/4/17 i.<P•'. sf-I0 Be min Schiller : PROFILE AS-BUILT #f#1se9�DPSLZ1p59 ..,.. (NO SCALE) 1�`\\`"1`4� �+N.'..-"""",oR MUNICIPALITY OF ANCHORAGE mcnr On-Site Water&Wastewater Program \O 'Sr; PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone: (907)343-7904 Fax:(907)343-7997 http:llwww.muni,orglonsite is l clrtrtment On-Site Wastewater Disposal System Permit Permit Number: OSP171266 Effective Date: 9/14/2017 Work Type: Septic Upgrade Expiration Date: 9/14/2018 Tax Code Number: 01744204000 Gi!7/1 eZI•-( Site Legal Address: ROBIN HILL#1 BLK 1 LT 1B G:2838 ?mit'? Site Mailing Address: 6201 NENANA PL, Anchorage Owner: GRUIS KYLE D Lot Size in Sq Ft: 79192 Design Engineer: FORGE ENGINEERING Total Bedrooms: 3 This permit is for the construction of: 0 Disposal Field D Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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: PPP l ' Date: !S 1 ) Issued By: / ' cod, Date: •IVI 1 \1\CII( icility of Anchorage �L`c '� : P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.orq/Onsite Development Services Division On-Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV171108 COSA#: Permit#: OSP171266 PID#: 017-442-04 Legal Description: Robin Hill #1 Block 1 Lot 1B Engineer: Forge Engineering Applicant: Kyle Gruis Your request for a waiver of the required 100 feet horizontal separation from the septic tank and absorption field to surface water has been approved. The approved separation distances are 65.0 feet and 75.0 feet, respectively. In addition, your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is 0.0 feet. See engineer's waiver request for justification. This waiver approval applies to the proposed septic tank and absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. n The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. Adjacent properties are not affected by this waiver. Waiver is Granted: X Waiver is not Granted: Date: ?LW 11 Approved by: 120,.iGeAC-0-, eartir-Si Name of Reviewer • **** VARIANCE/WAIVER REVIEW **** 6789 MUNICIPALITY OF ANCHORAGE ti,� '°/,a [lirls a • , , A Community Development Department ." Phone: •: -343-7904 Development Services Division Fax: 9e7-143-7997 ti On-Site Water & Wastewater Program <<° h c 6 8 L 9 9 ON-SITE SEWER/WELL PERMIT APPLICATIO Parcel I.D. 017-442-04 Property owner(s) Kyle Gruis Day phone Mailing address 6201 Nenana Place, Anchorage, AK 99516 Site address 6201 Nenana Place Legal description (Sub'd., Block & Lot) Robin Hill #1 , Block 1 Lot 1B Legal description (Township, Range & Section) Lot Size 79,192 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or 5 7 8 9 70 Private Well ❑ '^Rusk '4),4 Water Storage 111 SEP 13 2011 THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: 1 Ib : 15c�rn ti Tan\Z 4- at11 0 40Sti ,I. At�- tL)a� .l holes 1,64- Dist 15_. 1>� /A I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. "M /1 t're if .roperty owner or authorized agent) Permit/Rush Fees: 15.49 r 41 (46Waiver Fees: ' S 5 ci --- 51 5• 1-1 D tg4451� Date of Payment: q ((IJ ' 13 Date of Payment: 9/15/,?O 11 13'1y.�{0 L1c Receipt Number: /��5� T 0y� Receipt Number: 01 31 i C U Permit No. JZ Waiver No. 0 S V 19 1 1 0 Permit App__-:• ::_-c; FORGE ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) September 8, 2017 Municipality of Anchorage �'4I14 .** ••.r. T7 p Development Services Dept- On-Site Water& Wastewater Programt�j 4700 Elmore Rd s ' 4�; 'r 4 Anchorage, AK 99507 r► " I .4 6�t'�die J Sr�� Subject: Robin Hill#1 Sub, Block 1 Lot 1B � :� - Septic system design and permit application �� , "•.•• �' , � � Dear On-Site Services Engineer: 4i 'lit `' The owner of the above lot has an existing 3-bedroom home on the property, but the absorption bed has failed. We are submitting this permit application for the construction of a new absorption trench for the septic system, along with replacing the septic tank. The attached site plan identifies the location of the home, well, septic tank, and existing absorption bed, as well as the proposed absorption trench location and alternate site. No conflicts exist between this proposed system and any wells, whether on this lot or adjacent lots. Drainage arrows are shown on the site plan showing the grade and direction of flow. The drainage pattern in general will not be changed by the construction. The test holes placed on the lot indicate silty gravel with sand. No groundwater or bedrock was found down to 18'. The percolation rate was determined to be around 13.3 min/in. An application rate of 0.8 gpd/sf was used in the design of the absorption system. We are proposing to place a new 1000-gallon septic tank with a deep absorption trench 3' wide x 36' long x 8' effective depth. The elevation of the distribution line will be 3.5' below the surface for a total depth of 11.5'. Soil will be mounded slightly above the trench. A minimum of 3' of fill will be placed over the absorption trench and 4' over the septic tank. The ground surface on the lot slopes very mildly, almost flat on the lot. The new trench will be constructed parallel to the slope as much as possible. It will be a minimum of 100' from all wells and surface water, and more than 5' away from the septic tank. The alternate site is located more than 20' away. If the system is constructed as designed, it will have no adverse impact: • On the wells in the area or those to be constructed in the future. • On existing septic systems in the area or those to be constructed in the future. • On reserve space, either surface or subsurface, on any lots located in the area. • On drainage patterns inthe area. The current drainage pattern will be maintained. Sincerely, Benjamin Schiller, PE FORGE ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) September 20, 2017 Municipality of Anchorage Development Services Dept- On-Site Water& Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Robin Hill #1, Block 1 Lot 1B Waiver for distance to surface water and to lot line Dear On-Site Services Engineer: The wastewater disposal system on the above lot has failed, and needs to be replaced. We have designed a new absorption trench, and will be replacing the septic tank as well. The property has swampy ground in the back and side of the house with areas of pooling surface water. The current system has a waiver for 60-65' from the tank and absorption field to surface water. We are asking for a waiver to allow the new tank to be installed at the same location. This will necessitate a waiver for the same distance, 65' from tank to surface water. If the tank were ever to leak, the house is between the tank and the swampy area, meaning any effluent would effectively be blocked from the surface water. There is no additional threat to the surface water by issuing this waiver. In addition,we are asking for a waiver for a separation distance of 75' from the new field to surface water.This field is further from the swampy area than the existing field.The shallow ground slopes will prevent effluent from traveling very far toward the surface water. Also, the existing trench is between groundwater and the new trench. Approving this waiver will not cause any significant contamination of the surface water. Finally, we would like to ask for a waiver of 0' to the lot line. This is necessary to keep 16' separation from the existing trench. The ground is a bit higher in the area of the trench (between the two driveways), but it is still slightly lower than the gravel road in front. Any effluent will not flow off property. Additionally,this keeps the trench rc the groundwater, so this waiver will not cause additional threat of contamination. �� df 4111.444 Thank you for considering this request. •4% " ' ;'•••f #I a : 49TH ...-y • s Sincerely, 0 Benjamin Schiller, P.E. ®e+ '••.'/a( (j.••` ea I, I \ I \ / I / I I LOT lA `\ _ I__ _ I 10'UNDERGROUND UTILITY EASEMENT r -- L 10'UNDERGROUND UTILITY EASEMENT / 11111 J EXISTING WELL 1 RO B+L�FILL 1oBD�IVISION 1 SHED ROBIN I-LL I3 i I 100' WELL RADIUS BLOCK LOTS I 1 , I REPLACE 1000-GAL SEPTIC TANS J 2ND STORY DECK /� ' 1 DEMOLISH EXISTING i '-' `..- APPROX EDGE OF SWAMPY �i '`% �'tiSa%�'. ' AREA/ GROUNDWATER / 3-BDRM HOME TANK AND DISPOSE �1.:_.,-•••\ / OF ON-SITE HOME Si'`:-',, '-A / / N. ;.,r. NROME BULL-RUN VALVE / � .. . ' ' `' T• 'LLOW FOR SWITCHING NN. \ y -•' --cad,• : \ BETWE , : NCHES ___ __ ___ _ _ _>\.,,, cutr 2C• .:•-•,-;.i,,,..7•4•.:,'1%+.:*•::i) ti�ww-- \ ////JJ` ..,;�,!_.+.. •1'✓ I 440 • L9CF 1 • ; t j • / MT ~. 1 SLOPES ARE I o4,��, .'�` r CO ' TH#1 1 VERY FLAT �� t'7"-� \ ® F f. 0 INSULATE PIPE UNDER ss,,0 Co:,, :' • TH#2 ADRI'4EWAY - ';;;;1 \ 36' LANG x 3' WIDE, 8' -- \ / EFFECTIVE DEPTH \\ ROBINHILL#1 AyBSORPTION TRENCH / ` ~ BLOCK 2 LOT 1 NOTE: ��N\\ NO SLOPES>25%WITHIN 50'OF THE EXISTING ` - OF; 9kk� SYSTEM. AfkV: *`94— y h oil*:49 TH '.* / NO CONFLICTS WITH WELLS OR SEPTIC 0 SYSTEMS ON ADJACENT PROPERTIES LEGEND Be.--gnjam hiller / MT MONITORING TUBE rI 0'... AEL 592 .1,__,,b' 0 50 100 ga1'i g..5,°;;2017 .` 1 I♦ = = FEET 2C0-DOUBLE CLEANOUT >t\ 1i 0iiis;00 . 1 =50' TH-TEST HOLE �1\�� CO-CLEANOUT ROBIN HILL #1 , BLOCK 1 LOT 1B DESIGN FACTORS: SYSTEM REQUIREMENTS: 450 GPD PEAK FLOW 3' WIDE DEEP TRENCH SYSTEM PERK RATE: 13.3 MIN/IN 1000-GAL SEPTIC TANK APPLICATION RATE: 0.8 GPD/SF 450 GPD / 0.8 GPD/SF / 8' DEEP /2 SIDES = 35.2 LF Trench Length THEREFORE: CONSTRUCT AN ABSORPTION TRENCH 36' LONG x 3' WIDE x 8' EFFECTIVE DEPTH. FLOW LINE ELEVATION IN TRENCHES TO BE 3.5 BELOW ORIGINAL GROUND SURFACE. TOTAL DEPTH TO BE 11.5' BELOW EXISTING GROUND. PROVIDE 3' COVER OVER TRENCHES AND 4' COVER OVER SEPTIC TANK, OR INSULATION WITH 2' COVER. III=1 I I=1 11=1 I I 111 I 1=I=1 I 1=11 - 1I-1 III 1=1 11=1 I I=1 11=1 I I-��1 I I M I I-1 11-111-111111- 3, 1111-111-11-I 1�111-1 III II II iI tL I I 111=1 I F_11111111=111 1=1 11-1 I�I I M I EI I�I 111-11 EI 11-111-11=111 1 -11E11 6" e�=��!. ::::::::::::. :_;=is•is is is i. ':IIP:i:i:i:i=i=i=i i i•':i 4" PERFORATED PVC (HOLES DOWN) r:-r:r:' '=.•"=- •'� '=•'=•'=•'=••• DRAINFIELD ROCK +:+9;9:+:+;•4• �� .9:+:+;!:+•;•4711 •:1:1:1:1:1:/:/:/:&9 1.9 I.'1. :1:1:1:1:1:1:1:1:1:1:/:1:•:•:•. :1:1:1:9;9;9;/:/:1:/:/:/:1 :1:1:1:1. �1: '1;f:/:/:1:1:1:+:1:1�1�1�1 9.• ••:+:+:+:+:+:+ �:+:+:•.� ��. 4' TO GROUNDWATER .4 ,r,i, 6' TO BEDROCK OR IMPERMEABLE LAYER .4 -i=i=• 3' TYPICAL DEEP TRENCH SECTION (NO SCALE) _4:r AQ'fi#I NOTES: irgir`:0• *' `�TM '* GRADE AREA OVER TRENCH TO DRAIN AWAY MIN 6' SEPARATION FROM BEDROCK • Benj nSchiller MIN 4' SEPARATION FROM GROUNDWATER ++9,••, A 12592 . .%/,' s.vo7 70'7 MIN 100' SEPARATION FROM NEARBY WELLS a 'lpROFESSION�l4 MIN 100' SEPARATION FROM SURFACE WATER OR STREAMS `�\\\�� MUNICIPALITY OF ANCHORAGE _��\\\‘, DEVELOPMENT SERVICES DEPARTMENT /��P :gs�'0t 4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 .*..49 TM 1 *fj4 SOILS LOG AND PERCOLATION TEST , ,•, .-- Be 'a r n Schiller LEGAL DESCRIPTION: Pfd �t s 12017 .• FORGE ENGINEERING RINBLOCK I LOT IB �ikk/4.O;ROFESS40N..�� PERFORMED FOR: 1 DATE: 8-25-2017 PROJECT No.: \\\\�� PARCEL ID#: 017-442-04 TECHNICIAN: J. MILLETTE Professional En_ineetsStam.: DEPTH TEST HOLE 1 (feet) 1 ,,,,A, SLOPE SITE PLAN .e 2 � •l` i: 3 • iic3 : As.j.. 4 k :r�C i�yuw :-.'s:t'l', SILTY GRAVEL W/ SAND 5 :.7aa�'':k'• SEE SITE PLAN 6 ate. ji;;if A i; _,: te 8 rc'-Q1-i az. t.ti.. 9 SAND "'"�' ,'••' WAS GROUND WATER ENCOUNTERED? NO 1 O IF YES @ WHAT DEPTH? — L 11 DEPTH OF WATER AFTER MONITORING: — M.--.:.+r... ti;R;�;;>.n'.,,.,'� DATE OF MONITORING:9/4/17 �.i..I y E 12 :€ ' :;; x�1► DEPTH To t 4 GROSS TIME NET TIME NET DROP 13 F'=`gut.?�'�i= DATE READING (MINUTES) (MINUTES) WATER (INCHES) atpy. :1; „ (INCHES) f'e. -,,, ;: SILTY GRAVEL W/ SAND 14 ?e.: .; 8/25 TEST HOLE PRESOAKED PRIOR TO TESTING: �s"` " I 11:19 0 r:�� . �� ;' 2 11:49 30:00 2.00' 2.00" 16 s :,.`? ''•t"`° '``'` BOH 3 11:52 0 1 7 4 12:22 30:00 2.25" 2.25'1 18 5 12:24 0 19 6 12:54 30:00 2.25" 2.25" 20 PERCOLATION RATE: 13.3 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN: 3 FT. and 4 FT. COMMENTS: PERK TEST WAS RUN 6 TIMES. INTERMEDIATE RESULTS ARE NOT SHOWN BUT WERE VERY SIMILAR. MUNICIPALITY OF ANCHORAGE _��N1.\\(‘�, DEVELOPMENT SERVICES DEPARTMENT 4CIF ,,i, Ave...;:r ' �4— ,911 4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 ,:r*:. .� *O 00 SOILS LOG AND PERCOLATION TEST �j�"�,•.. Benj in Schiller 4 LEGAL DESCRIPTION: ROBIN HILL #I, BLOCK I LOT IB fli, c�GzZ1 • .�1/ PERFORMED FOR: FORGE ENG INEERING �l1`FnPROFESSIDNa- DATE: 8-25-2017 PROJECT No.: `�`�� PARCEL ID#: 017-44 2-04 TECHNICIAN: J. Mi LL E T T E Professional Engineers Stamp: DEPTH TEST HOLE 2 (feet) SLOPE SITE PLAN 2 r ;;N i 4WA',..!-1),!.4k;/t 3 4 p r1N iq'f`zi1 rd},.N ice ''"' SILTY GRAVEL W/ SAND SEE SITE PLAN *k.ftii 7 ; ` >�,� t�5r iTgAtt 10 '' 4A• .4} 7 WAS GROUND WATER ENCOUNTERED? NO S 4:i: i•;1::jet IF YES®WHATDEPTH9 S : a�'i?.•WW.ri DEPTH OF WATER AFTER MONITORING:CF 1 1-k_�, ��,��Y� DATE OF MONITORING:9I4I 17 ti 12—'0i�•f▪ 'r ;�'z 'Vil e g DEPTH To � ` !' ' DATE READING GROSS TIME NET TIME WATER NET DROP ^� 13 7.476 ar, (MINUTES) (MINUTES} (INCHES} (INCHES) 14 41.• 4i`r.I t 8/25 TEST HOLE PRESOAKED PRIOR TO TESTING: 15N=;;' - I 12:00 0 r* , , 2 12:30 30:00 3.75" 3.75" I6 - - f•-,�,. �• 3 12:31 0 �,. 4 1:01 30:CC 3.50" 3.50" 4;}`,4 BOH 1 i� -,.;xs..,,, 5 1:02 0 19 6 1:32 30:00 3.50" 3.50" 20 PERCOLATION RATE:8.57 (MIN/INCH) PERC.HOLE DIA, 6 (INCHES) TEST RUN BETWEEN: 2 FT. and 3 FT. COMMENTS: Development Services Department Building Safety Division ®66 8U On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Mark Begich Anchorage, AK 99507 Nke A e T r Mayor www.muni.oro/onsite (907)343-7904 Pump Instillation Log Well Drilling Permit Number: SW_ Date of Issue: Parcel Identification Number: LegalDescriptionProperty,Owner Name & Address:_ Pump Installation Date: Pump Intake Depth Below Top of Well Casing:V Zl feet Pump Manufacturer's Name:ewi� e ref Pump Model: 2?Jv �$ ✓ �Lgj Pump Size 3A hp Pitless Adapter Burial Depth: lh feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: Well Disinfected Upon Conipletion? ; Yes F No Method i� ti Comments: Pump Installer Name: Attention: The pump installer shall pt ANCHORAGE WELL & PUMP SERV 330 EAST 76TH AVENUE ANCHORAGE,AK 99518 PHONE: 907-243-0740 AWPS.COM amp installation log to the DSD within 30 days of pump installation. ✓I P t_ rc'D MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME `` NN I U .. PrHt1ONE__7VK5 ;J "1•{.�.,, C�' NEW ❑ UPGRADE MAI LING ADDRESS y,.. LEGAL DESCRIPTION S� Q LOCATIONNO. 42�7 jr OF BEDROOMS 3 U Y DISTANCETO: yVyell °COQ Absorption area _S G Dwelling PERMIT NO. 'I bc)4-10 F Z Wa Manufacturer EeR Material �'tEE No. of compartments y Liq. capacity in gallons 000 IF HOMEMADE: Inside length y IV i Width N Liquid depth ,, 1 IV 1� =' J0Z DISTANCE TO: Well Dwelling PERMIT NO. = Z F Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: ell 1Z7Q FoundationNearest 8� lot line. .,3s PERMIT NO. 1�o4—ka J LL Z ~ No. of lines t! Length of eachline Total length of lines \\� Trench width 4�, inches Distance between lines ff (�1 CC H p Top of tile to finish grade 4-I ®, Material beneath the o �4 inches Total effective absorption area W U) Length Width Depth PERMIT NO. Q F CLs W Type rib Crib diameter Crib depth Total effective absorption area Lu DISTANCE TO: Well Building foundation Nearest lot line J �ICass� D Depth Driller Distance to lot line _71 IT NO. W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area (s) OTHER PIPE MATERIALS Q��S-v \ Rw vo 1 SOIL TEST RATING J 'zo G• INSTA LER -T REMARKS orf O ej asd 55 to OVED i� DATE LEGAL (k\X(A i P, G Cl p CA d A yy ly ~ V F N 0 O . O O O O O O O O O O O O W >J iv a v� N fn w p :� l•J SO � }�. iyi7'F�i1 nP �i'«� t-1 tJ Pt G'q0 rj tjYD!j ri:�mr(nE Nn: p o1j fv b v G N; p}n o! F✓ foto C) o; ob m; 4 v.41' tl i -4 cD;i (DP� aR� m ti S Sv S F' F Q F h fv 0�1 S Fi ! Hr+ b K tri :7 Su c+fl, Fi : PM lD O (D IJ Nm o t -JC+ e 0 0 Qq 0 0 0 0 0 0 cD 0 0 w 0 - 0 L7 d c 0 z H O H O H O H O H O H O H O H O H O H O H O H O <D c� 1-4 F -E DEPARTMENT' iHEALTH AND ENVIRONMENTA�,,,,,_,,.137F 1 'T, '; . �01't - �J 825 -OL- 'STREET, ANCHORAGE, AK A' I pilA 264-4720 -Ab - � 9. WEEL.1""C-- C-J"`E: I _FE= t4 F="EF- F;.:"Ir I I PERMIT NO. 780470 APPLICANT JIM BUMOARDNER BOX 474E SRA 99507 .44-1933 LOCATION ALPINE PLACE RD LEGAL L10). 81 ROBIN HILLS '51-18D LOT SIZE 78408 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM 15; TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SO FTt,'BR)= 320 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: i_EEF---F"'-=.4 4 lnF--F1'%-'E=_l U--- F�- -Ir =15 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIEL.D. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH 15 THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION IN FEET). K! E= CA LJ I F;'I=- Us U F=* _F I C-3 n L-- L_- 0 V4"Z' PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THr,_`. INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY ANE.'.- THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. _� MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL.; OR 150 Ti 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN '21:0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS '-SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE 11 RESIDENCE IS REM�_'�,—D TO INCLUD MORE THAN 3 BEDROO SIGNED: ------- ----------- APPLICANT JIM SUMOARDNER ISSUED BY � =�3- yJ%%4 �'==_ •_C>ATE_ �T_!� �� _�� < 24 F' EE's: IF I f -D ".,F- V1 F-0 E E 0 Ul I F, E'::E E _= * U BACKFILLINO OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL.; OR 150 Ti 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN '21:0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS '-SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE 11 RESIDENCE IS REM�_'�,—D TO INCLUD MORE THAN 3 BEDROO SIGNED: ------- ----------- APPLICANT JIM SUMOARDNER ISSUED BY � =�3- yJ%%4 �'==_ •_C>ATE_ �T_!� �� _�� r y ® SOILS LOG MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION IN PERCOLATION ES Pouch 6.650, Anchorage, Alaska 99502 276-2221 r f T SOILS LOG — PERCOLATION TEST �i eggs y PERFORMED FOR: _ _^J /m TJGG/Y�GQrcIV1Ff _ DATE PERFORMED: 9— -leg LEGAL DESCRIPTION: LUT DEPTH QOO-YS (FEET) -$ Or�GLrt�G�S CI�tl 1 �arndy 611mss re'd. brn — r�6ida 2 �'Me aeine r-rzta 0 �� 3 N ' r 5 a 6 7 0 9 0 10- 11 0 11 12- 13 14- 15 16 17 18 19 Sandy .�i%mss �v�fh, Lome C/yL-GM) �96 S'� Ni0/60' -/-7P/'ra 4, .rhea of perco/aeon f'e ea me e, 6 WAS GROUND WATER Q bvve ENCOUNTERED? IF YFS, AT WHAT TH Wcfer SeP.Qoye of 74L+ .0.� L>and. Mec/ to ��e �ncJ (atv) ATOM OF Cx6FRIC SLOPE S YEs L 0 P E /5- AITF Reading Date Gross Time ON Depth to Water Net Drop MEN Ell MOIN ■i■�(��■■■■■ 30 1b / ,4- 6.6 ,/ S- /0 min ■■■JL��"If�� ■■ OEM ON ■■ =N■■■■ E am Reading Date Gross Time Net Time Depth to Water Net Drop #3 30 1b / ,4- 6.6 ,/ S- /0 min 20 -{ uPERCOLATION RATE (minutes/inch) TEST RUN BETWEEN �•Jr `FT AND Z'S FT �v j COMMENTS 41,47"eUJo 1"e rC?r 19//P / l IOM a/D!//>C� ar14 fhe oaf Jif' e ewalw.r 35 ;s� y/tywv PERFORMED BY: 14ci arel.Z7 4re(y CERTIFIED BY: DATE: ZT- !7— 2e'7 �— »"nnR nnFl Wening Grey & Associates, Inc. 715 L Street: S.3 Anchorage, Alaska 99001 Subject: Soil Log for Lots Listed Below: 19 ?, & 3 Gontl wen The Steil Loops for: 1. Kasilof 'dills Subdivision Block 2 Lot a Clock. 2 Lot £l Highlands Tar -race Subdivision Eagle {aver PQM 5 Lot 5 3. MY View Subdisivio,n block 2 Lot 18 The above lots soils are adequate for septic systems. Robin Bill Subdivision "lock 1 Lot 1-3 TFti�; Soil Lol of Robin ;till Subdivision, Lot lwa indicates the possibly water table at l3iS feet. you rust be Giect abovo this water table, so the depth of tha trench must be at 7.5 `eet,which is most t'avorablo, due to the rood percolation test in this area. if there are any questions, PIUSO Contact the undersigned. Phone 264-j's,';O or 264-4681 `sincerely, John Lf. Lynn Environmental Enginvoring MUM Zia% • •�1c Municipality of Anc or... ,- On-Site Water and Wastewater Prop -m E SEP Z 0 zo'ik. „Lo ml (907) 343-7904 j ETY tS- 4 Certificate of On-Site Systems Approval `` 01 6 9 L g�� Parcel I.D. 017-442-04 Expiration Date: e C 2'11 a b j rj 1. GENERAL INFORMATION Complete legal description Robin Hill #1 Block 1 Lot 1B Location (site address) 6201 Nenana Place Current Property owner(s) Kyle Gruis Day phone Mailing address 6201 Nenana Place, Anchorage, AK 99516 Real Estate Agent Chris Swires Day phone 830-0073 2. TYPE OF DWELLING: E 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 E Individual Q • Individual Water Storage ❑ Holding Tank n Community Class Well ❑ Community ❑ Public Water System C Public Sewer ❑ WaiverNariance request for: Distance to Groundwater/Lot line Distance:75' 0' Received by: OA 4.---A iii+,reJ Date: CVO-(// 7 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ cia9-(06 Waiver Fee $ (/S'.0 Date of Payment g/o`Z.O/1 ? Date of Payment COO/8 Receipt Number 41W `le- Receipt Number q94-file COSA# 05CI9/01/ Waiver# Q,Dv 0/111 r• ffi= 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 Forge Engineering Phone 522-7773 Address 1399 W34th Ave, Suite 203 Engineer's Printed Name Benjamin Schiller Date 9/20/2017 -�com or. 4144. ✓�:• .�I-ry ,-- -- * 49TH °•o0 6. DSD SIGNATURE System #1 Approved for 3 bedrooms 43,I <=4 t : . • System #2 Approved for bedrooms fid %'., ��•. �•. 1.4m Disapproved �QQD'° c5r o.z, Conditional approval for bedrooms, with the following stipulations: OF Opp-SITE cm " WATER AND PROGRA M WASTEWATER oz 7‘41T SER\I By: 8,1e,Ufk Ca-VX Original Certificate Date: 7/21/10 1 7 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_E . .. If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Robin Hill #1 Block 1 Lot 1B Parcel ID: 017-442-04 A. WELL DATA Well type Private If A. B, or C provide PWSID# Well Log (YIN) Y Date completed 11/02/78 Sanitary seal (YIN) Y Wires properly protected (YIN) Y Total depth 220 ft. Cased to 130*ft Casing height (above ground) >24 in. FROM WELL LOG AT INSPECTION Date of test 11/02/78 9/19/17 Static water level 128 ft. 131 .9 ft Well production 1 g.p.m. 1 .7 g.p.m. WATER SAMPLE RESULTS: Coliform ND colonies/100 mL Nitrate _ND mg/L Arsenic 7.80 ug/L Date of sample: 8/07/17 Collected by: Forge Eng. *CASING DEPTH NOT SPECIFIED ON WELL LOG. BEDROCK NOTED AT 130' B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEP/Steel Date installed 9/15/17 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping Pumper New Construction C. ABSORPTION FIELD DATA Date installed 9/19/17 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 GPD/SF System type Deep Trench Length 36 ft. Width 3 ft. Gravel below pipe 8 ft. Total depth 11 '5 ft. Eff. absorption area 576 ft2 Monitoring tube Y Depression over field N Date of adequacy test New Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: mm. Final fluid depth in. Absorption rate >_ _ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes. give date D. LIFT STATION Date installed 9/15117 Size in gallons 1250 Manhole/Access (Y/N) Y "Pump on" level at 44 in. "Pump off' level at 40 in. High water alarm level at 46 in. Datum Bottom Cycles tested New Meets alarm&circuit requirements? Y E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100' On adjacent lots >100' Absorption field on lot 100' On adjacent lots >100' Public sewer main >75' Public sewer manhole/cleanout >100' Sewer/septic service line >25' Holding tank X75' Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line >5 Absorption field 5' i Water main 10 Water service line 10 Surface water 65 Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line 0' Building foundation �10� Water main X10' Water Service line >10' Surface water Old: 62', New 75' Driveway, parking/vehicle storage ' 0' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS Waivers: Tank to surface water, Field to surface water, Field to property line G. ENGINEER'S CERTIFICATION17<41$ I certify that / have determined through field inspections and a'4Q7.•' 11 •••JN, review of Municipal records that the above systems are in • h,• .""7. ....1, conformance with MOA COSA guidelines in effect on this date. • * • ' q T. 17 I — IP :. A Benjamin Schiller ~V ""••••••� Engineer's Printed Name .. a- 0 Date 9120/17 ?, . l �� :•r r 12592 .• At.. WIZ.'Rsi3.5$00'..4"$0 •'q .� Y�Taj1Mi�4et COSA brown sheet 10-10-12.doc Frontier Surveys, LLC Project No: 17-198 Date:September 19th, 2017 NORTH Ordered By:Chris Swires Plat:70-212 Grid:N/A Scale 1"=60' I ' HOUSE DETAIL 'i- .-2 W F ID -b 38.3' 34.8' CD I'n a LOT 1A rNi N " p,• 26.3' 38.6' IIIII INN SCALE: 1"=25' - r - 589'58'00"W 419.59 10'UNDERGROUND UTILITY EASEMENT' — — —I' 1 • 10'UNDERGROUND UTILITY EASEMEN- r. I 1.0 a, LA N O 00 \ 10'x12'SHED w 0 89.611 I w m Zei 0 0 b I \ 10'x12'GREENHOUSE 0 ui / 2ND STORY DECK s60• ` IIIA r. 00 202.5 ^ 00 I E ai SEE HOUSE DETAIL r`^ ??S 0q c�` '� ''' 11 �� Robin Hill Subdivision `FA, .. Septic Lift Station s7 �� Lot 1B, Block 1 b 4''4•�,q� 79,192 sq.ft. +/- (4Ce N%... 6201 Nenana Place 2 Story Wood Framed House 0iq` w/Attached 2 Car Garage access, 0' . q0 O 440 �° c:,-14 5 '� R.4zp 61 00 S80-00,00" LOT 1 E 89.12 -- ROBIN HILL UNIT 1 '�_ -1 Legend: Electric Meter/Outside Power Gas Meter Deck 0 30 60 120 S Septic Water Well �� Feet General Notes: 1.This document is created for the purpose of a single property transaction and is subject to Federal Copyright Law. 2.Excepting for gross negligence,the liability for this survey shall not exceed the cost of preparing this survey. 3.All measurements/setbacks are to the visual/apparent building footprint. 4.Dimensions to property lines are plus/minus 0.lft. #v.e'giikS;A This survey complies with ASPLS Mortgage Location Standards.The survey represents visible improvements and ~'t C (��. /t -- � V �1 1 conditions at the time of the survey.This document does not constitute a boundary survey and is subject to any ` a inaccuracies that a subsequent boundary survey may reveal.It is the responsibility of the Owner to determine �jr ��% , •♦4�, the existence of any easements,covenants,or restrictions which do not appear on the record plat.Under no 1'N•,, �' '♦� r circumstances should this document be used for construction or for establishing a boundary or fence line. • V- + 4. 0 ..�,.''1•J r;_' i' }• ¢ As-Built Survey of: ,� ' x•0 Lot 1B Block 1, Robin Hill Subdivision 0 7---452, se I,Frederic Wagner,hereby certify that this Mortgage Inspection Survey was performed by me,or ':a •.{R.DE^nIC W. NAGNER i�j t + t,? ••� • LS-9946 .;(i1� under my direct supervision on September 19th,2017. 4.- 4+ -•-',c,c.- �L' '�'4 Frontier Surveys, LLC FRONTIER* li �Pe 650 W.58th Ave.Suite E Anchorage,Alaska 99518 Sure �i`""� 907.460.1686-info@frontiersurveys.com '� PROFESSIONAL SEAL www.frontiersurveys.com 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 FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-442-04 COSA# 6,30 1 a 1. GENERAL INFORMATION Expiration Date: / ® �— Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address 6201 NENANA PLACE * ANCHORAGE, AK * 99516 PAT BLAKE Day phone 561-1591 6201 NENANA PLACE * ANCHORAGE, AK * 99516 Day phone DAR WALDEN W/ KELLER WILLIAMS Day phone 240-2804 101 W. BENSON BLVD #503 * ANCHORAGE, AK * 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well E Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As 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. t 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. Phnna 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 12 Engineer's Comments: in conducting this evaluation, GEG, LID. 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 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, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meetthe operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE __1z Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: r (Rev. 11/5) Original Certificate Date: — 3—/Z Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: _ ROBIN HILL BLOCK 1 LOT 1B Parcel ID: 017-442-04 A. WELL DATA Well type PRIVATE *ASSUMED BASED UPON SURROUNDING WELL LOGS. SEE ATTACHED. If A, B, or C provide PWSID# N/A Date completed 11 /2/1978 Sanitary seal (Y/N) YES Total depth 220 ft. Cased to *40+ ft. FROM WELL LOG Date of test 11 /2/1978 Static water level 128 ft. Well Log (Y/N) YES Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 6/1/2012 134 ft. Well production 1 g.p.m. 1.6+ g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate ND mg./L. Collected by: GEG, Ltd. Arsenic: _ D ug./L. Date of sample: 5/23/2012 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 9/19/1978 Tank size . 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (YIN) N/A Date of pumping 10/25/2011 Pumper NORTHLAND PUMPING C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 9/19/1978 Soil rating (g.p.d./ft`or /bdrm 320 System type TRENCH Length 118 ft. Width 2 A. Gravel below pipe 5 ft. Total depth *10.6 ft. Eff. absorption area 1 180 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 6/1/2012 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 17 in. Water added 660 gal. New depth 56.5 in. Elapsed Time: 120 min. Final fluid depth 49 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — SUMP EXTENDS 49" INTO EFFECTIVE. TOTAL DEPTH AND LIQUID LEVELS NOTED ARE CALCULATED. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N L ump on" level at in. "Pump Off"Hih water alarm level at in. 9 level tu Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lifi station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manurelanimal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water *60'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *1'+ Building foundation 10'+ Water main N/A P Water service line 10'+ Surface water *60'+ Driveway, parking/vehicle storage *0' Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION A�X�. ' 1 certify that 1 have determined through field inspections an ....... review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this.............. o.......... date. e f Gar es.. Engineers Printed Name JEFFREY A. GARNESS aQ� C/E— 3 .• tiro Date 6I26I1y 4��a Professio^oma COSA Fee 0 Fee $ Date of Payment [a %ia Date of Payment Receipt Number �llDSa(� Receipt Number (Rev. 11!05) Municipality of Anchorage P.O. Box 196650 0 4700 Elmore Road Anchorage Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http:llwww.m un i.ora1Onsite Development Services Division On -Site Water and Wastewater Program trent S Department **** VARIANCE/WAIVER REVIEW **** Waiver#: OSPI21170 COSA#:OSC121242 Permit#: PID#: 017-442-04 Legal Description: Robin Hill #1. Block 1, Lot 1B Engineer: Garness Engineering Group Applicant: Pat Blake Your request for a waiver of the required 100 feet horizontal separation from the absorption field and septic tank to the surface water has been approved. The approved separation distance is 60 feet. Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 1.0 foot. This waiver approval applies to the existing absorption field and septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: Approved b . ' Name of Reviewer ................................... 0........ ...•.............................. Rec#: NIA Amount: $0.00 Date Paid: NIA **** VARIANCE/WAIVER REVIEW **** June 25, 2012 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Wouvew pSP0040 VX0 ckary-p iz/a /Iq Ref: Waiver Requests for Robin Hills Subdivision; Block 1, Lot 1B. To whom it may concern: During the course of our initial inspection (6/1/2012), several deficient distances were noted. We requested that the as -built survey be updated to reflect the current condition of the property. Once we received this, we determined the following distances were deficient and need waivers: SEPTIC SYSTEM TO SURFACE WATER: According to our field inspection and the as - built survey, the septic tank and the drainfield are both between 60-65' from the surface water. We request that you waive the distance to 60'+. The following items are justification for this waiver: The house is directly between the septic tank and the surface water. If the tank were ever to discharge effluent, it could not travel toward the surface water. The drainfield is in a highly visible area. If effluent were ever to overflow, it would be recognized quickly and corrected. The area between the drainfield and the surface water is highly vegetated. This would serve to impede and filter effluent that migrated towards the surface water. The slope on the lot is such that effluent would not migrate directly toward the drainfield, but away from it. We believe that even if effluent were to daylight, it would not flow towards the surface water. This means that the actual path of travel to reach the surface water is likely well over 100 feet. • Due to the record breaking snowfall recorded this year (and subsequent runoff), we believe the nominal distance is further than the current distance. The distance has been addressed before in previous HAAs. The distance was listed as 90' on the 3/17/1987 and 11/13/1984 HAA, no waiver was actually submitted or approved. We are requesting that you waive the fee associated with this waiver. 3701 E. Tudor Road, Suite 101 *Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessenginecring.com DRAINFIELD TO DRIVEWAY: The driveway crosses the drainfield in two places. We request that you waive the distance to 0'. The following items are justification for this waiver: • Per the original inspection report, the drainfield was insulated under the west portion of the driveway. Per our field inspections, the drainfield has at least 59 inches of soil cover. • The septic system was previously approved in this condition on 9/19/1978 (inspection report), 11/13/1984 (HAA) and 3/17/1987 (HAA). DRAINFIELD TO LOT LINE: The drainfield is approximately 3 feet to the lot line at the closest point. We request that you waive the distance to 1'+. Based upon the aforementioned facts, we believe there is minimal risk associated with granting these waivers. Attached is a site plan showing the location of the septic system and aforementioned waiver item. If you have any questions, please contact us at 337-6179. Thank you for your ass4tance. P.E., M.S. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com S D 4. 0 < NIN S Q-. D D -u � / 10' UNDERGROUND -UTILITY -EASEMENT zz Ln -Ti T1 O D -- \ — —---------------�-- CD 0 (n cf) (n' m Cn 00� m / I ss ' (c d 0 0 m\ I\ \ m cn oD Z] n S r�� F- \ \I ' Z II C) / \°a i NN \ 1\ fz D i � m \ \ _,.._qtr. o \ c \ \ 24— FZ- y 0To 60• I NN \ o Q( \ \ z NN 'N IO 4 0 \ \ to NN \ I v �6p' \ I� \\ \'y \ m .c \ \ 'N c \ NN N x om \ m NN \NN m NN \ \ NN \ \\\ \\\ NN NN \\\ \ y \ \ \ NN NN r -r7 NN NN NN \ \NN \ \ \y m \\ \ 'N \\ \ \ I I OBIN HILLS OF WORK: 7RAWN BY: A.J.G. GARNESS ENGINEERPNIG GROUP, Ltd. '"ll> •m=-^. CONSULTANTS &GEN ERAL CON TFACTOPS ,•, 3MI E. Mort Rn . WO 101. Aucxo , M. 66em PX E: (601) m-el16^ : (B01) M no wEesnE ...eam....�W�wn iONE NUMBER: PAGE: 907-561-1591 1 OF 1 TH*I ..................... f e A. Garess C A 6-79.,`� e� �s Pie 6f�S•I''"F,c°o 4 cl�'rofesso°oo 4��000�o�a mem r2y (n m�nD m('r z0z � m 0* Nom II OZm A 5=o Q =m70 mo moo 0 Oz 0 m mA z Z Mountain Park Estates c LOT 1 ( °` \ N00006'30"W 80.57 I a 10' Underground Utilib Ease neN 3p ---�—= ° J J /Qa> / ,V o,sa / a C ro 90 b b OC w m \ 0 m m zo \ tleck n. L / / 4. Jrp�' 1. I t / t 11 1 i I / 1 / � a � / Cn mC w 0 o >.4—f S Via„'�A nl 77 lk 2 ) co 10 ry N Iq�os.. 30 m m o y m w d'o ^o o o33m 74 � ;U^dam 000 OOHsmm°00UO < zo�f n�s D(nm °msom <a c Fn 3 <o a y0 0 S Oo�Tama Cny m o m o 3 Co— .0 o— m'mav pm m 0 EF O- n N m 6 m �,Zmj � 0 m 0 3"oDoo'o (nom A m scr z 'm m 'm m m o m y zz a. m 3 a 3 o 'm m � o m Z xym. QEF (Z: w �D m moa.a gd z0 m a� om q-iK -i gn 0 c (n y Ei !Y z'��n 2 m y ti o.o cava°^o m ow o yo'Zo �Qjm O y w N m S m N N r v. D O a 0 m � O m ;r m m w ° o N00005'00"W 258.75 0 C C CD cp 0 c 7 CL C m v w CD m T Z o:) 01 00 0 m W v (D n MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date ff—/16- 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner —Telephone: Home/36 Z Business Mailing Address (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent a� Address ' Telephone, (e) Mail the HAA to the.followino address: or: Check here �, if hold for pick up. List contact person and day phone number below. SZz- /.3k3 2. TYPE OF RESIDENCE Single-Familyx Number of Bedrooms 3 3. WATER SUPPLY Individual Well Community ❑ 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 f Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 IRev 8/861 Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 2 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`L TelephoneZl—/�� Address 5S57-2 Date e7 ZA- s .Ttti OF A(,4 P�l AW h�'''. . rl s' En eers*�' ow :49TH *�r �r ••• HUGH R. BEVAN .7W � CE 7225 • •\��i DHHS APPROVAL (�I Approved for 3 bedrooms by rrrJ��atyv Date Approved Disapproved Conditional Terms of Conditional Approval dhhs CAUTION —/ 7—F7 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. Page 2 of 2 72-025 rRev 8/861 Back A. WELL DATA r1, MUNICIPALITY OF AW161FAMLITY OF ANCHORAGE (MOA) DEPT. OF HE/&TH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTEC*(9CKLIS -FEBRUARY 1984 I'S'01I RECEIVED Legal Description: Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) y Date Completed �� ®�' �� Yield /- O $Z' 6 Z dawn Total Depth Cased to 4�® Depth of Grouting Static Water Level 0,.:2 • Pump Set At has✓ wn Casing Height Above Ground Sanitary Seal on Casing (Y/N) X Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Al Separation Distances from Well: To Septic/Holding Tank on Lot 7 ; On Adjoining Lots /oa t To Nearest Edge of Absorption Field on Lot e!!:� 7A ; On Adjoining Lots To Nearest Public Sewer Line 0/"'� To Nearest Public Sewer Cleanout/Manhole ^�"/V To Nearest Sewer Service Line on Lot Water Sample Collected by ��'%�� ; Date Water Sample Test Results �� Comments B. SEPTIC/HOLDING TANK DATA Date Installed %/9 7y Size A2,00 No. of Compartments Z� Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) Date Last Pumped �'// 51 7 Pumping/Maintenance Contract on File (Y/N) ��/� ; for Holding Tank High -Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Coufse / Comments %O� �Or�r47Son r%is��.��C Q� .��P�� ls�� it ✓cvn� Page 1 of 2 72-026 lRev.-8/861 Front - C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field 7041 Type of System Design Length of Field // o ' Depth of Field 57, l G � Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present (Y/N) Depression over Field (Y/N) f'✓ Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well 10 'L To Property Line f To Building Foundation To Existing or Abandoned System on Lot Nz On Adjoining Lots �0O "� To Water Main/Service Line N� To Cutbank (if present) o Stream/Pond/Lake/or Major Drainage Course Too Driveway, Parking Area, or Vehicle Storage Areae%� Comments 4 /wGin✓J G!/e'G, G�3 oPi O/jo! /iia G'`i��/.Ire 02/-- D. LIFT STATION/,,/ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments le-wcyi Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify thatJI hve checl verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed l Date :5, A/1- f % Company��T ��/` MOA No. Receipt No. (0 00 Date of Payment �d IP 17�.t .7' RAQE Amount: $ �NISION I:NV Page 2 of 2 C 0 (.,$U� 9 �' � IANC l -I 72-026 (Rev a/as) Back S9DIAb3S � ��DVb0H N W 1V 1N3 � 1.11 NOISING V dO x1nV60INp nc -A014 i ° 49TH ••'•add EA%•.v vvv e v v a v eaa v v vv© HUGH RAJEVAN ° o Vii✓ ��f °• CE 7226 •v°•�.A dw BEVAN ENGINEERING Approved Well & Septic Engineers P/3.Box ll2862 Anchorage, A&9951l MUNICIPALITY OF A DEPT. opncao*,ENVIRONtvj,WAL PROTECTION '�^ March 16� 1987 MAR 1��7 Municipality of Anchorage Department of Health to Environmental Protectionr�^\/E�� 825 "L" Street �<\/�� Anchorage, Alaska 99501 Re � Pat Blake, Health Authority Approval (HAA) Application Lot 1B Blk 1 Robin Hill Subd" Gentlemen � (907) 5211383 (907)25&0584 During the period from March 3 to March 11, 1987 we performed research, site investigations, well flow testing and absorption field testing pursuant to Health Authority Approval on the above referenced lot. We performed a well flow test and found the well production to be 1.0 gallons per minute (gpm). This exceeds the required 0,3125 gpm for a 3 bedroom home. We took a water sample for Coliform analysis and the results were negative. We performed an adequacy test on the septic system and determined that it absorbed at a rate of 500+ gallons per day (gpd)^ This exceeds the 450 gpd required for a 3 bedroom home. The septic tank was pumped and the volume determined to be 1.000 gallons. To our knowledge all of the information requested on the HAA Checklist and Application has been assembled. We are submitting this data to you for your review. Please contact us if we can provide any additional information. Sincerely, Hugh R. Bevan P.E. Attachments : HAA Application HAA Checklist Sewer As�built Original Soils Investigation Original Well Log Total Coliform Analysis Septic Pumping Receipt cc Pat Glake E17208 -w. -ii ' A cam., MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date 11-13-84 (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1B-, Bk 1, Robin Hill Subd. Sec 26, T12N, R3W S.M. Location (address or directions) 6201 Nenana Place 345-1362 561-1591 (b) Applicants Name pat Blake Telephone - Home Business Applicants Address rprn Nanana pl. Anchorage, AK 99516 (c) Applicant is (check one) Lending Institution ; Owner/builder ; Buyer ; Other E::l (explain); (d) Lending Institution Alaska Mutual Bank Telephone Ads 601 W 5th Ave., Anchorage, AK 99501 'N nrr,f0 �T g r 0 4 (e) Real Estate Co. & Agent Address Telephone None (f) Mail the HAA to the following address: A-T_;�LAle& I - /S—, / 2. Type of Residence Single -Family Number of Bedrooms 3. Water Supply Multi -Family Three Other (describe) Individual Well! X I Community = 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! 57 Public E::1 Community = Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] A 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 regula- tions in effect on the date of this inspection. Name of Firm Alaska Soil Testing and Engineering Telephone 5617453 Address 6100 A Street, Anchorage, AK 99502 or A, q I 11-12-84 Date tea.." • � t Pia.' Ll.-a�m.eacY rant r r•�•-•e (ENGINEER SEALV••MA•ah• .....a" r ° RK HOLUM kit" CE 6734 d :y 6. DHEP Approval C ; 5>, a•...., ...;.<. ,.. F.' Approved for bedrooms By z Date Approved Disapproved a Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE 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 REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 21 7-19-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 iAJ d1Q,`,'JTY OF APNCHORAGO TAL k'- ITCTION f,10V 13 1934 Legal. Description: Lot 1B, Bk 1, Robin Hill Sec 26, T12N, R3W7 S.M. Well Classification Private If A, B. or C. D.E.C. Approved(Y/N) Well Log Present (Y/N) Y Date Completed 11-2-78 Yield 1 gpm Total Depth ?�n ft Cased to Not listed Depth of Grouting Not listed Static Water Level 1 ? ft (>>_cg4) Pump Set At 200+ ft Casing Height Above Ground 45 in. Sanitary Seal on Casing (Y/N) Y Y Depression Around wbllhead (Y/N) N Electrical Wiring in Conduit (Y/N) pr Separation Distances from Well: To Septic/Holding Tank on Lot 125 ft On Adjoining Lots 100i+ft To Nearest Edge of Absorption Field on Lot 181 ft ; On Adjoining Lots 100+ ft To Nearest Public Sewer Line 100+ ft To Nearest Public Sewer Cleanout/Manhole 100+ ft To Nearest Sewer Service Lire on Lot 100+1 ft Water Sample Collected By Mark Holum, P.E. Date 11-7-84 Water Sample Test Results Satisfactory (Analysis attached) Comments Yield confirmed on 11-9-84 at 450 gal/day per 24 hour drawdown test. B. SEPTIC/HOLDING TANK DATA Date Installed 9-19-78 Size 1000 gal No. of Compartments 2 Standpipes (Y/N) Air -tight Cap Y (One) Air -ti t s (Y/N) Y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped 11-9-84 (Receipt attached) 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 125 ft To Building Foundation 14 ft To Property Line 35 ft To Disposal Field 55 ft To Water Main/Service Line 4o ft- To Stream, Pond, Lake, or Major Drainage Course Comments 90 ft separation distance between septic tank and swamp area. Receipt # Date Paid: Amount: (Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata48 min/in, 320 f6Type of System Design D. Trench Date Installed 9-19-78 Length of Field 118 it Width of Field 2 ft Depth of Field 9 ft Gravel Bed Thickness 5 ft Square Feet of Absorption Area 1180 ft2 Standpipes Present (LM) Y Depression over Field (YM) N Date of Last Adequacy Test 11-9-84 Results of Last Adequacy T6st 756 gal/ day Separation Distance from Absorption Field: To Water -Supply Well 181 ft To Property Line 32 ft To Building Foundation 4o ft To Existing or Abandoned System on Lot None ; On Adjoining Lots 100+ ft To Water Main/Service Line 6o+ ft To Cutbank(if present) None To Stream/Pond/Lake/or Major Drainage Course 90 ft to swamp area To Driveway, Parking Area, or Vehicle Storage Area Ref. Comments Comments The 15 ft wide driveway was rerouted during approx. May 1979 across the absorption f�eld which is 118 ft in length. Tie field currently possesses sufficient P. Anan1ty 7S and /rinv nnrh +'n -n+. +ho lncc of 1 f+ in +ha driveway area does not reduce the field capacity to below the required capacity D. LIFT STATION of a three bedroom house system (450 gal/day). Trench length exceeds 75 ft. Date Installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Comments Manhole/Access (YM) "Pump Off" Level at Vent (YM) Pumping Cycles during Adequacy Test. Meets MOA Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAk�. J! �`'�lt�ain effect on the date of thisinspection. Signed z-aa/il� - Date 11-12-84 Company Alaska Soil Testing and EngineeilMOA NO. ST84-26o KB1/d5/s [Page 2 of 21 9e11 d- fi. s 1L e e > Y cO, ♦y c�b.e cap>.a..4.p40..>9={''./c,. g. MARK JHOLUM < c pe CE 5734 • '9 61 2-15-84 w �-° J93 + MUNICIPALITY OF ANCHORAGE ENVIRON\'ENTAL i'aC: iCTIOK DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 `_ `R' • i 1%:" -AI ® ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 �� 6. TYPE OFF RESIDENCE V NUMBER OF BEDROOMS REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DI RECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERT OWNER U Al CAD IV ,5 v -r 1© A✓ Two ❑ Five PHONE MAILING49,DRESS ^ n O\J /jam\}V 7. WATER SU PROPERTY RESIDENT (If different from above) INDIVIDUAL* PHONE 2. BUYER FC since June 1975. For wells drilled prior to that date, give well PHONE 1 8. SEWAGE DISPOSAL SYSTEM 'INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date� 9 / %j MAILING ADDRESS 3. LENDING INSTITUTION gra F`r�,fi If system is over two (2) years old an adequacy test is required PHONE MAILING ADDRESS NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 4. REALTOR/AGENT PHONE 30Z/— MAILING ADDRESS j IJ 5. LEGAL DESCRIPTIO � �� a�� STREET LOCATION II 6. TYPE OFF RESIDENCE V NUMBER OF BEDROOMS ne ❑ Four E] Other I2 SINGLE FAMILY Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SU 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 'INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date� 9 / %j If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ❑Septic/C Tank or ❑ Holding Tank Size: 7D a& If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL �I 4. DISTANCES WELL TO: -Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS L4" APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE) / BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78) !A .A =� CHEMICAL & G OLOGICAL LABORATORIE., OF ALASKA, INC. ` TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: (•) See h on back I.D. NO. P,aq� T- 44J-,� p� 7-�" s-- /3,SZ water System Name Phone No. Mailing Address /-?,4/ --o G 9 fJ 915 5-/6 City State Zip Code SAMPLE DATE: I) I J Mo. Day Year SAMPLE TYPE: ,9 Routine D Check Sample (for routine sample ❑Treated Water with lab ref. no. ❑ Special Purpose ❑ Untreated Water ` SAMPLE Time Collected NO. LOCATION Collected By t I�XTT— Z' I �iUUit/ 2 3 f 4 5 READ INSTRUCTIONS TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received —A---2 C •Time Received 4-� v Analytical Method: ❑ Fermentation Tube Membrane Filter Lab 3 Result' Analyst FM fn 0-0 FE I m -No. of colonies/100 ml. or No. of Positive pomons. 06.1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1963 Membrane Filter. Direct Count Collform/100ml Verification: LTB BGB Final Membrane Filter Results Collform/100ml BEFORE Reported By Date Time: ! 5 O o a.m. p.m. COLLECTING SAMPLE TNTC = Too Numerous To Count ,o ANCHORAGE CESSPOOL PUMPING Star Route A, Box 144 ANCHORAGE, ALASKA 99502 Phone 344-2632 or 344.2453, R Ain accompanied by this bill. , I e--Tf TELEPHONE A C 8 ®E®LOGICAL LA RATORM ®F AL#18KA, INCe (907) 2794014 P.O. BOX 4-1276 ANCHORAGE, ALASKA 99509 4649 BUSINESS PARK BLVD. r i Drinking Water Analysis Report for Total Coliform Bacteria . TO BE COMPLETED BY WATER SUPPLIER: PUBLIC WATER SYSTEM: I.D. NO. lublic (Nater System Name V7 Meilin Address City State Zip Code SAMPLE DATE: Mo. Day Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected By 3 L 4 � 5 READ INSTRUCTIONS COLLECTING SAMPLE Form No. 18-310 (3-78) TO BE COMPLETED BY LABORATORY LABORATORY: N ADDRESS CITY g Date Received Time Received /3 Analytical Method: ❑ Fermentation Tube Membrane Filter Lab Ref. No. Result* Analy 48 Hours L I m Multiple Tube Report: -" 0 Membrane Filter: Direct Count m Verification: LTB 0 * No. of colonies 1100 ml. or No. of Positive portions. 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date Collected source a.m. Date Received- Time Receives p.m. Lab. No. Presumptive loml loml loml 10ml 10m1 1.Oml 0.1ml 24 Hours I I I I —_ 24 Hours 48 Hours EMB ---`- --- Broth 24 hours: Broth 48 hours: Multiple Tube Report: -" 10MI Tubes Positive/Total 10ml Portions Membrane Filter: Direct Count Coliform/100ml Verification: LTB BGS Final Membrane Filter Res Reported By {Cpliform/100mi Time: 4 a.m.