HomeMy WebLinkAboutROBIN HILL #3 BLK 3 LT 1BL\ Lk
Municipality ®f Anchorage
Department of Health and Human Services CIhr15
Tom Fink, 825 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
January 8, 1990
Bill Schlansker
3724 Aldren Circle
Anchorage, Alaska 99517
Subject: Lot 1B Block 3 Robins Hills S.D #3
Permit #890174, PID #017-443-06
The subject permit, issued by this office for a single family
well and/or on-site wastewater system has expired as of December
31, 1989.
Permits are issued on a calendar year basis by authority of the
Municipal Code of Regulations. A new permit must be obtained
from this office for an well and/or on-site wastewater system
not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this office for documentation of the installation and to close
the permit.
If a private engineer inspected the installation of the on-site
wastewater system, the original as -built inspection report
(three-part form) must be sent to this office for review,
approval and documentation.
When applying for a new permit, the fees are: $90.00 for an
on-site wastewater permit; $50.00 for a well permit; $140.00 for
a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
Sincerely,
John Smith, P.E.
Program Manager
On-site Services
JW/ljm:200
enc: Copy of Permit
"Kids Are Our Future"
/ MUNICIPALITY
OF ANCHORAGE
Day Phone:
Department o{ Health
& Human Services
CIRCLE
. ' 825 L St
99501
343-472O
99517
ON-SITE SEWER & SEPTIC TANK & WELL PERMIT
RN\���/�J
Permit Number: 890174 ���rx /��^ /��
Date Issued: 08/24/89 Engineer Designed
Owner Name:
BILL SCHLANSkER
Day Phone:
Owner Address:
3724 ALDREN
CIRCLE
562~2058
ANCHORAGE� AK
99517
Parcel Id:
017-443~06
Lot Lega1:
Subdivision:
RDBIN HILLS
#3 Lot: 1B Blo�k:
3
Section: 26
Township: 12N
Range: 3W
Lot Size
2.6A (sq.�t.
or acres)
Max Bedrooms:
This Permit:
5 Total
Capacity: 5
SEPTIC TANK: mum total septic tank capacity: 1 500 gallons, Each septic
Lank must have at least 2 compartments" Depth to top o� septic t�nk(s) < 4,0
�eet requires insulation over tank(s)"
WELL: Log must be submitted to Municipality o� Anchorage Department of Health
and Human Services within 30 days oA well comp1etion.
[NFORM f) 11 PRIOR TO INSPECTIONS BY ENGINEER. IF AFTER
H3URS� CALL 343�4681 AND LEAVE A MESSA8E^
CONSTRUCT PER ENGINEERS ATTACHED APPROVED DESIGN.
THIS PERMIT EXPIRES 12/31/89 AND VALID FOR A SINGLE FAMILY HOME,
I CERTIFY THAT:
1, I am familiar with the requirements or on-site sewers and wells as set
�orth by the Municipality of Anchorage (MOA) and the State o� Alaska.
2" I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria oF this permit.
3, I will adhere to all MOA and State o4' Alaska requirements or the set back
distancesfrom any existing well� wastewater disposal system or public
sewerage system on this or an� adjacent or nearby lot"
4" I understand that this permit is valid I*or a maximum of 5 bedrooms" I
also understand that ihe capacity of the total system is 5 bedrooms and
aI y enlargement will require an additional permit"
Signed: DATE:
.... ..... ..... ... �..... �������..... ��.... . ���~�. ..... -����~
(Owner) BILL SCHLANSKER
Issued B�: DATE: ��_.
-~~' -�-..... ..... ... ..... -~�~~'-^--
ICIVUIINCCfS JCNLf
Municipality of Anchorages_y ;
0*:
DEPARTMENT OF HEALTH & HUMAN''
825 -L" Street, Anchorage, Alaska 9952- 6
SOILS LOG — PERCOLATION. rn n 9� .:jA
'Web 00
PERFORMED FOR: /6� // Sak?{') SK -G/— �515,966 OF ED: /B9
LEGAL DESCRIPTION: LOT �B . a / r9//jTOWnship, Range, Section: Secy.
SLOPE SIT PLAN
DEP H -7�--
(FEET)
1
2-
3-
4-
6-
7-
9-
10-
11 34 6 79 10 11
12-
13-
14-
15-
16--
17-
18-
19
2131415 16171819
20
e;m
CP
1VL
eol=f' T. J!.
WAS GROUND WATER
ENCOUNTERED? —
S
IF YES, AT WHAT ,c1 L
O
DEPTH? P
E
Depth to Water After r�
Monitoring? D 2V mte:
PERCOLATION RATE 1/2 (minutes/inch) PERC HOLE DIAMETER
rue RU-B-ETTW-E'EN I11A FTANO �FT f/ L
COMMENTS ' -ru (GGA/ �i/% �/P�94,-7 S, 5 CIh7 /
PERFORMED BY: �e ' I � / "�Ce ��CERTIFY THAT T /IS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: _T `
72-008 (Rev. 4/85)
N�
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-2¢-89
SEWER SYSTEM LOCATION PLAN
LOT BLOCK SUBDIVISION
ft
/B 3 ,eo611'j 1-71/L` S D-
sec{ WNS RANGE
/Z/U 23H/ S, /trl i�%tJa
m•
l
SCALE � //
NOTE -THE ACCURACY LOCATION OF EXISTING
f� � PROPERTY CORNERS,
ELLS P AND SE TIC
DRAWN BY r SYSTEMS INDICATED S NOT EXACT.
NORTH , 43 L DIMENSIONS INDICATED. HAVE BEEN
DETERMINED BY USE OF CLOTH TAPE AND
�° °O ••� ^L HOT BY SURVEYING TECHNIQUES.
• • coR'./N1
y�lp. PREPARED FOR• -+
V8��eLCasfQff°� emor+"..,rf� :'�' rsi�in#ii'r.. ' .. /✓/ �� ✓G/lQ/'I.SICF'/-
DATE+ �j/�g/89 I SHEET OF
6 :1747 C
DC—i"A (L—
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-2¢-89
SEWER SYSTEM LOCATION PLAN
LOT BLOCK SUBDIVISION
ft
/B 3 ,eo611'j 1-71/L` S D-
sec{ WNS RANGE
/Z/U 23H/ S, /trl i�%tJa
m•
l
SCALE � //
NOTE -THE ACCURACY LOCATION OF EXISTING
f� � PROPERTY CORNERS,
ELLS P AND SE TIC
DRAWN BY r SYSTEMS INDICATED S NOT EXACT.
NORTH , 43 L DIMENSIONS INDICATED. HAVE BEEN
DETERMINED BY USE OF CLOTH TAPE AND
�° °O ••� ^L HOT BY SURVEYING TECHNIQUES.
• • coR'./N1
y�lp. PREPARED FOR• -+
V8��eLCasfQff°� emor+"..,rf� :'�' rsi�in#ii'r.. ' .. /✓/ �� ✓G/lQ/'I.SICF'/-
DATE+ �j/�g/89 I SHEET OF
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH
AND HUMAN SERVICES
Environmental
Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
DISTANCES
SEPTIC
ABSORPTION
WELL
Address
7�l'�' la��� �%� ���� �
FROM
TANK
FIELD
.4
WELL
100'
14-o'
Phone(s)
Permit No.
No of Bedrooms
�
_SCRIPT--
LOT LINE
'Iry
LEGAL DESCRIPTION
Lot
block
Subyy5qs��lon L�S �
/��//<% H/
FOUNDATION
'
62
'
$
l0.cS��1L/,_
Township, Range, Section
n !,{ / Cj� /7 f_
/v !/V cJ C✓ !
AS-BUILT DIAGRAM (Show location of well, septic system. property lines, foundation,
/C/ (�
driveway, water bodies. etc.)
ANKS
SEPTIC ❑ HOLDING
Manufacturer
Capacity in gallons
y �'
Material
No. of Compartments
TYPE OF SYSTEM
TRENCH ❑ BED [IW. DRAIN ElOTHER
\
- $
Depth to pipe bottom from
original grade
5
Total depth from original grade
G/ —0
—cJ
.4,_ FT
Fill added above original grade
Gravel depth beneath pipe
7 FT
-
Gravel length
Gravel width
�
FT
FT
Total absorption area
Distance between lines
�7
/ 70 SO FT
/J?q FT
r
'
Number of lines
Soil rating
Pipe material
, I ,
50SIS FT
P116,
'a
Installer
`T F LVY�LG �✓C%/ Vt
Date installed
il5lL15 D
WELLS
�CPRIVATE ❑ OTHER (Identifv)
Classification (A,B,C)
Total Depth
Casetl to
�r
A =q-7 5
FT
FT
Installer
Dale Installed:
REMARKS:'
_
1, V_ r
S ale: ✓r.. ( ENGINEERS SEAL
�xa
til/
Inj6/��Qct�lo�n>syP�erform;,eo by: t ,
t
Date.
�i✓i�f
I w certil that this
i pection was performed according to all
s,
Municipal and Stale guidelines in effect on this d. e:
Health Department Approv
to
_ -�t7�/�^i
VA
nn ^
—��
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`lf �.PF'��pf 2
/
\
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(L+sC f E D ETA f
Jj
_ -�t7�/�^i
VA
nn ^
r
- "'PROVED
Ar -
9 -2 ¢ -3'9
:S1NER. SYSTEM LOCATION PLAN
SUBDIVISION
�B BLOCK
,SOB //J /"/Z- L sUCLi
SECTION/T. WNSHIP/RANGE
, Sect
,® 9
e4 2� 7`/2AJ 23N/ S, M. AI�rT�a
J SCALE, / p0 NOTE
THE ACCURACY OF LOCATION OF EXISTING
/
a 0 PROPERTY CORNERS, WELLS, AND SEPTIC
DRAWN BY' SYSTEMS INDICATED IS NOT EXACT,
DIMENSIONS INDICATED HAVE BEEN
NORTH
/•./ .e•� ��� DETERMINED BY USE OF CLOTH TAPE AND
NOT BY SURVEYING TECHNIQUES.
op, 2wdp z PREPARED FORS
'ORR pfv� Con llc%iggless�'mcers / Jac 4i S
- - DATE+ 8/�8�89 SHEET OF
\
r
- "'PROVED
Ar -
9 -2 ¢ -3'9
:S1NER. SYSTEM LOCATION PLAN
SUBDIVISION
�B BLOCK
,SOB //J /"/Z- L sUCLi
SECTION/T. WNSHIP/RANGE
, Sect
,® 9
e4 2� 7`/2AJ 23N/ S, M. AI�rT�a
J SCALE, / p0 NOTE
THE ACCURACY OF LOCATION OF EXISTING
/
a 0 PROPERTY CORNERS, WELLS, AND SEPTIC
DRAWN BY' SYSTEMS INDICATED IS NOT EXACT,
DIMENSIONS INDICATED HAVE BEEN
NORTH
/•./ .e•� ��� DETERMINED BY USE OF CLOTH TAPE AND
NOT BY SURVEYING TECHNIQUES.
op, 2wdp z PREPARED FORS
'ORR pfv� Con llc%iggless�'mcers / Jac 4i S
- - DATE+ 8/�8�89 SHEET OF
�. ;i, 1-1 ICIVUIIYCCr1J JCH4i
y. ypy(�q
fes' 41 \ 'i ,
Municipality of Anchorage ,� �' .p•
• +r
� t DEPARTMENT OF HEALTH &HUMAN & .. ;� �••• -z
825 "L" Street, Anchorage, Alaska 995 -P6 -
O •CO
SOILS LOG — PERCOLATION. ~� ;i iCerwb
PERFORMED FOR:
LEGAL DESCRIPTION:
,0-01f/ 7 ////,Township, Range, Section: 1-f
SLOPE SITE PLAN
DEP H
(FEET) I
2-
4-
6-
7 467 -_
9 -4
10-
11
0 11
12-
13-
14-
15
213 1415 4 .
16--
17-
18-
19
6171s19
20
45;�/v
luo
/a 41
v �
W x�
v` WAS GROUND WATER
/til L
BoH, T.N•
ENCOUNTERED? /1G0
S
L
IF YES, AT WHAT ,v/A 0
DEPTH? P
�Depth to Water Atter G �� E
Monitoring? D P -d Date: .
Reading Date Gross
.- Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION PATE (minutesiinch) PERC HOLE DIAMETER 1604
TFS RU �BETWEEN FTAND elq- / FT
COMMENTS
/l�'oyuYjrl�eGr
PERFORMED BY: J� I �/ e (—`� kCERTIFY THAT T/IS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: `
72-008 (Rev. 4/85)
C @FW'0fl
& associates,inc.
Consulting Engineers
P.O. Box 230608 • Anchorage, Alaska 99523-0608 • (907) 279-8866 • FAX: (907) 279-2882
September 17, 1989
MOM
ii600t L I c�.:i
Mr. Robbie Robinson
Municipality of Anchorage N011031o21d 1VIN3WNONIAN3
Department of Health & Human services V 1411V3H 40 'id30
On -Site Services Department 30001 DNV d0 1,1►lVdl7lNnW
825 L. Street, Fifth Floor
Anchorage, Alaska 99501
SUBJECT: FINAL COMPLETION OF SEWER SYSTEM FOR LOT 1B, BLOCK 3,
ROBIN HILLS SUBDIVISION
Dear Mr. Robinson:
On Saturday, September 16, 1990 final work was completed on the
replacement trench for the above referenced property. An
as -built of the completed system is enclosed.
We ask that the original as -built submitted on this property by
our firm be replaced with the one attached. We also believe
that this takes care of any problems which existed with 'the
previous system as an entirely new system has now been
constructed.
Should you have any, questions or need any further information,
please let us know.
enclosures
21
IN
'LI
It
CO4 'I Cl
3
4 1253 112601 -9,4 6300 NFN
JOI
5901 5915 /0 5 00 12621
6
5900/ V,
6001 8 4
4 5920/. 6015 641
5 5940/ X6031 5
116 /6 12701 1 12750
20 1 /9 1 7 /,Po
SAKE
�4 2
18 6020 6
5801 5821 5841 17 8 6040 12721
16 9 12.7417 2A
58001 12800
1 15824 5846/ 59411 14 /0
2 3 11 6001 / I C� 128018 4
4 5934 "1, 13 0
16021 9 28 3 i4
12821 12901 12921
%6041 MOUNTAIN Pl-
22 6
12921 i 21 8
12435 20 7 - 12850 12900 12941
12901, i
12947/ 6061 4
129001 1 -9
2924 19 8 ir
13001 0
'12 16 6060 LLJ 1?930 12940
944, z
11 13021 9 6
3 /13 066
"��1061 <j 1293-134 5 1?.961
8
17
8 1 1 7 7 13030 12970
5801 ; 5&31 1 6, 13037 13000 IBOOI 4A
13001
9
HOLDEN DR. �g 15047 130155 2 713000 130011
0 16 13024
5800i 5830 1 5900 13040 0 12 13—W-1— 7 000 oil I
1 2 1 3 4 13101 6 13000
8
13021
9
15 Z 13100
m I
13041 6 8
13100
5 14 13101 7, 13021
13020
z 13121
9 13120 —
131158 z
8
6 13101
21 13110 4
KAL 5841/ 5 z 913100
48 5 13151 13100 13100 :3
9 0
586111111
0. If
q, 0 1
DeArmoun Area Reference Map—P14
232
lk
243 245
Y
254
GR. 2838
244
COPYRIGHT 1985 JMR
MUNICIPALITY OF ANCHORAGE
UNIFORM SUMMONS AND COMPLAINT
DISTRICT COURT FOR THE STATE OF ALASKA
THIRD JUDICIAL DISTRICT AT ANCHORAGE, ALASKA _
CASE NO.
The undersigned, being duly sworn, upon his oath deposes & says:
ON THE DAY OF - 19 AT
r
'
P.M.
t
NAME
Last First Middle
F
STREET ADD.
r, e
MAILING=ADD.
CITY,'- STATE'
y
DATE OF BIRTH
IN THE MUNICIPALITY OF ANCHORAGE, STATE OF ALASKA DID THEN
AND THERE COMMIT THE FOLLOWING OFFENSE;
{
SECTION:
i
DESCRIPTION OF OFFENSE:
LOCATION OF OFFENSE_ ,
IN VIOLAtION OF THE ANCHORAGE CODE OF ORDINANCES. THE UNDER-
SIGNED FURTHER STATES THAT HE HAS JUST AND REASON-
ABLE GROUND TO BELIEVE AND DOES BELIEVE THA'L--THE PERSON NAMED
ABOVE COMMITTED THE OFFENSE HEREIN SETFORTH, CONTRARY TO LAW.
OFFICER'S SIGNATURE,,
DEPT_s ' PCN# OFFICER NAME
SWORN AND SUBSCRIBED BEFORE ME
THIS -
DAY OF ` % X19
NOTAIaY PUYLL,C
[j Fhf�Z
You must appear within lays 0 y+ - between 8:00 A.M. and 4:30 P. M. O
{ Da"
ADDRESS OF COURT 941 FOURTH AVENUE
ANCHORAGE, ALASKA
I PROMISE TO APPEAR IN SAID COURT ATTHE TIME INDICATED ABOVE:
SIGNATURE X
70-005 (10/81)
tr1VFR1
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
DISTANCES
'1311 A,Tp
FflOM
SEPTIC
TANK
ABSORPTION
FIELD
WELL
Address
,
I
t'
Phones) Permit No. o. of Bedrooms
WELL
�1
LOT LINE
r7o
LEGAL DESCRIPTION
Lot,
Block
Subdivision 1 '
I KA -41:5
FOUNDATION
Township, Range, Section
TI it
AS -BUILT DIAGRAM
driveway, water bodies,
tShow location of well,
etc.)
septic system, property
lines, foundation,
TANKS
SEPTIC ❑,sHOLDING
162A
_ +
Manufacturer
Capacity in gallons
-i/
c)oAl
Material'`�
No of Compartments
5 1 m
TYPE OF SY,W EM
1_
IDS t o
TRENCH ❑ BED W. DRAIN ❑ OTHER
Depth to pipe bottom from'/1{i,'
Total depth from original grade
original grade
FT ,+. i
� FT
�I' _
L
+
Fill added above original grade
Gravel depth beneath pipe
FJ:
FT
( t
D�
•
( )7
Gravel lengthI
Gravel width
4-7 FT
FT
4-11
Total absorption area
Distance between lines
I)
M
li: . SQ FT
[2 FT
t LI u
Number of lines Soil rating
Pipe material
Zr
SO FT
'PV e,
,;
InstallerVC{O�'�L,
t �461-i es-
Date Installed
\
WELLS
Iz
/
�PRIVAT ❑ OTHER (Identifv)
4
Classification (A,B,C)
Total Depth
FT
Cased to
FT
M i
REMARKS:
t -
Scale: Iity 601 ENGINEER'SSEAL: - -.-
Inspections Performed by:
4
Date:
G/ I ' - ceXy t this inspeion was performed according to all
Municipal and Stale guidelines in effect on this date:J
`
ie
Date:
Iaonlu, no.aN�,ar,f Aeernvalo
~
"
MUNICIPALITY OF ANCHORAGE
` ' Department o� Health & Human Services
825 L Street, Anchorage, Alaska 99501 343-4720
ON-SITE SEWER
Permit Number: 90OO96
Date Issued: 05/11/90 Engineer Designed
Owner Name: BILL SCHLANSKER
Owner Address: 6446 WEST CIRCLE
ANCHORAGE, AK 99516
Day Phone:
-
_ t1? 2-9^9
Parcel Id: 017~443-06
Lot Lega1: Sub(Iivision: ROBIN HILL SPENSI). Lot: 1d 81ock: 3
8ection: 26 Township: 12N Range: 3W
Lot Size 2.6A (lo q"[L" or acres)
Max 8edrooms: This Permit: 5 Total Capacity: 5
�3E�lIC TANK: Minimum total septic tank capacity: 1,500 gallons. Each septic
tank must have at loast 2 compartmshnts, Depth Lo top o[ septic tank(s>
1eet reguzres insu1ation over tank(s).
INFORM 0.H,H.S. PR1OR !D INSPECTIONS BY ENGINEER, IF AFTER
OFFICE HDURS, CALL 343~4681 AND LEAVE A MESSAGE"
C'hit lHUC[ PLR ENG1NEERS ATTACHED DESIGN.
THIS 1010111 EXPIRES 12/31/90 AND VALID FOR A SINGLE FAMILY HOME.
l CERTIFY THAl:
1. l am familiar with the requirements {or on-site sewers and wells as set
forth 11 the Municipality o{ Anchorage (MOA) and the State M Alaska.
2. I wi1l instal the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria oA this permit,
3, I wi1l adhere to all MOA and State o{ Alaska requirements �or the set back
distances from any e�isting well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot"
4, I understand that this permit is valid for a maximum o{ 5 bedrooms" I
also understand that the capacity o� the total system is 5 bedrooms and
any enl t l ifo dditi nal permit`
Signed: DATE: �
~
(Owner) ER
1ss:ed 8y:
Municipality of Anchorage �®
DEPARTMENT OF HEALTH & HUMAN _. Y
825 -L" Street, Anchorage, Alaska 995 `
SOILS LOG - PERCOLATIO ` T J. Comin
y goy �
PERFORMED FOR:
LEGAL DESCRIPTION: i //, r//'AOwnship, Range, Section: SP`r.�6, T/2�✓ ?✓
�� SLOPE SITE PLAN
_&.' ..-
(FEET) iO�$C// Fes/ i
2
�I/✓�
3
_
4
5-
6
6-
7
7
`-
G
g
_G
avr
10-
0
11
11
12-
213141516
13-
14-
15-
16
,
17-
7ML
A4 L
18-
19
e07V. T. /l.
WAS GROUND WATER A/�
ENCOUNTERED? /1�
S
L
IF YES, AT WHAT /J/,4 O
DEPTH? P
E
Depth to Water After
Monitoring? Q U Date:
20
t_j
PERCOLATION RATE T (minutes/inc//h)l!PERC HOLE DIAMETER
RUNBETWEEN N/� FT AND r FT
COMMENTS e!71?
PERFORMED BY: v Pr�J I ,� � CERTIFY THAT T IS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: _ ���
72-008 (Rev. 4/85)
A
x-
cr
DF -TA (1—
A;
tj
ck�-p y 4-7
yo
A
7 -
;SEWER SYSTEM I
LOT
A SECTION/T'
SCALES
NORTH DRAWN BY,
OCATION PLAN
SUBDIVISION
'447flq
407E
THE ACCURACY OF LOCATION OF EXISTING
PROPERTY 'CORNERS, WELLS, AND SEPTIC
SYSTEMS INDICATED IS NOT EXACT.
DIMENSIONS INDICATED HAVE BEEN
DETERMINED BY USE OF CLOTH TAPE AND
NOT By SURVEYING TECHNIQUES.
PREPARED FOR,
DATE. SHEET OF
Parcel I.D. 01.7-443-06
li mikipaiity of Anc
On -Site Water and Wastewater
(907) 343-7904
Certificate of On -Site Systems
1. GENERAL INFORMATION
/err Z a cbi; k
Expiration Date:—/
Complete legal description Robin Hill #3, Block 3, Lot 1 B
Location (site address)
6536 Nenana PI.
Current Property owner(s) William & Madelyn Schlansker Day phone _
Mailing address 1600 E Tudor Rd. Anchorage, AK 99507
Real Estate Agent Day phone
2. TYPE OF DWELLING:
Fx� Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
E
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for:.
Received by:% �'�/ Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ /'5A(" -
Date of Payment ql leo
Receipt Number
r
COSA#j('o
Waiver Fee $
Date of Payment
Receipt Number
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)ika(e'fuhct1ojZI 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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations. The reported results describe 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 soil
condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC
Address P.O. Box 100217, Anchorage Ak. 99510 -
Engineer's Printed Name Steven R Pannone
6. DSD SIGNATURE
System #1 Approved for S bedrooms
System #2 Approved for bedrooms
Disapproved
Phone (907) 272-8218
Date 3/14/2015
W(
Steven R.•0ariri
CE -8149
Conditional approval for bedrooms, with the following stipulations:
Original Certificate Date:
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.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory . Other
COSAbluesheet E :, c
If more than 1 septic system is on the lot:
COSA Checklist # + of
Structure served by this system i
Certificate of On -Site Systems Approval Checklist
Legal Description: Robin Hill #3, Block 3, Lot I B Parcel ID: 017-433-66
A. WELL DATA
Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y
Date completed 9/11/1989 Sanitary seal (Y/N) Y Wires properly -protected (Y/N) Y
Total depth 228 ft. Cased to 93.55 ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
bate of test 9/11/1989 3/2/2016
Static water level 81 ft: 90 ft.
Well production 4 g.p.m. 4.2 g.p.m..
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrate 0- mg/L
Arsenic N ug/L Date of sample: 1 f / 7 0 < to Collected by: �� S
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 9/15/1990
Tank.size 1,500 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression,over tank (YIN) N High water alarm (Y/N) N
Date of pumping 6/3/2015 Pumper A+ Home Services
C. ABSORPTION FIELD DATA,
9/15/1990 2 150 SF/BR Deep Trench -
Date installed �• Soil rating (g.p.d./ft or ftz/bdrm) System type
Length 55 ft.: Width 3 ft. Gravel below pipe 7 ft:
Total depth.l?,3 ft. Eff. absorption area 770 fl? Monitoring tube Y Depression over field N
Date of adequacy test 3/10/2016 Results (Pass/Fail) _Pass For 5 bedrooms
Fluid depth in absorption field before test 0 in. Water added 772 gal., New depth 5 in.
Elapsed Time: 180 min. Final fluid depth 0 in. Absorption rate >= 750+ g,p.d:
No
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at - in. "Pump off' level at in. High water alarm level at in. .
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+ On adjacent lots 1001
Absorption field on lot 100+ On adjacent lots 100+
Public sewer main 75+ Public sewermanhole/cleanout 100+
Sewer /septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent Ibts 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+ -
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage, 10+
Curtain drain 50+ Wells on adjacent lots 1001
T. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven Pannone
Date 3/14/2016
COSA canary sheet 2-6-15.doc
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PREPARED FOR,
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AS -BUIL T
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/ hereby certify that an ffewpVte survey Of the
fo//ow/np described property-
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12�D/'V /7/lL45 51-.8,D_ '/N// -&S
pas "Ode en Z /5 .9Q and that the
Improvements situated thereon are wlthln the
property lines and do not overlap or bacroach
on the property /ymp odldcatt thereto, that no
knprovemenlson property IrinO adlaceat thereto
encroach oa the premises /n question . and that
there are oo roodways, Ilanamiss/aa llnes or other
visible easements on sold, property areept ds
Indicated hereon. /A
Dated at Aachorope,. Al�aoc, tbtbls7 day, of
L.S No, 4(/09.'�r
PREPARED BY
CORWIN a ASSOCIATES
1000 E. DIMOND BLVD,
SUITE 205
ANCHORAGE, ALASKA 99515
(907) 522 -/J// _
M -w DRILLING, Ina 89-ibi
P.O. Sox 110379 a 10330 Old Seward Highway
(907) 349.8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Well Owner BILL SCRL&4SY.ER lfse Of Well- stic
Location (address of: Township, Range, Section, if known; or distance main road
Lot 1-B_ Block 3. Robin Hill Subd.. Anchorage
Size of casing 6„ Depth of Hole 230 feet Cased to 93.55 feet
Static water levet 81 ft. (il'B M.6 below) land surface. Finish of well (check one)
Screen Perforated ( ,g
Describe screen or perforation 3 'towa of 1.5" x .25" slots . 87 - 90'
well pumping test at 4 gav6s per (Mix) (minute) for--L--hours with 100% h,
of drawdown from static level, i
i
Date of completion .3eptember it ,:1989
open end ( X );
WELL LOG
Depth in feet from : z >
ground surface Give details of formations penetrated, size of material, color and hardness
0
O
To -----!-
22
2
To -----L
3
TO
24
24
TO
36
36
TO
49
—.43_TO 60
Organics
��2T0 88 Sandys31t- -
88 TO 90 Sandq gravel : wet - 1-2gpm
90 TO 230 Bedrock gray siltstone argillite, small water leaps in
TO - sporadic fractures
TO
TO
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K '9 jv k2o1 j Certificate No's, 814 & 973
3—CONTRACTOR
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