HomeMy WebLinkAboutROBIN HILL #3 BLK 3 LT 5Eix
AANWF
7-rO17 394 13
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O it �,� .
Certified Drilling Log
OWNER OF LAND: Craig Graff & Katherine Tepas
ADDRESS: PO BOX 110596 Anchorage, AK 99511
LEGAL DESCRIPTION Robin Hills #3 Block 3 Lot 5
DATE: 6-8-15
PERMIT NUMBER: OSP151103 DATE OF ISSUE: 5-8-15
TAX IDENTIFICATION NUMBER 01739413000
Is well located at approved permit location: Yes No
Method of Drilling: ®air rotary ❑cable tool
Depth of Well: 400'
Casing Type: Steel Wallthickne<,
Diameter: 6
Liner type
Static Water Level:
Recovery Rate
inches, depth
.250 inches
104 feet
67 feet
.7 gpm gph
Method of Testing Air
Well Intake Opening Type: U open end open hole
❑ Screened Start feet Stopped
❑ Perforations Start feet Stopped
Grout Type: Bentonite Volume: 50 lbs
Depth: from 2 feet, to 42 feet
Well Disinfected Upon Completion: Eyes =no
Method of Disinfection: Chlorine 50 PPM
Comments:
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority.
Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation.
MatSu Borough: Department of Environmental Conservation.
Data
pth
To2
?61oreole
Casing Stickup
4
Overburden
14
Silty Sand & Gravel
14
85
Silty Sand & Gravel w/ Clay
85
88
Broken Bedrock
88
195
Bedrock Gray
195
205
Bedrock Olive
205
378
Bedrock Gray
378
387
Bedrock w/ Quartz & Fractures
387
400
Bedrock Gray
i(Of171, _'C IV100rnL
co*AA
trot - C --
Manic
---UOL—
Drillers Name: Cole Sullivan
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority.
Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation.
MatSu Borough: Department of Environmental Conservation.
DOC CO dba
'I ULLIVAN WATER WELLS
vRO. Box 670269, Ohugiak, AK 99567 686-2759
www.suilivanwaterwells.com
Pump Installation Log
Well Drilling Permit Number: SW OSPIS1203
Parcel Identification Number: 01739413000
Legal Description
Robin Hills #3 Block 3 Lot 5
11 Pump Installation Date: 1-29-16
11 Pump Intake Depth Below Top of Well Casing: 390
11 Pump manufacturer's Name: Grundfos
II Pump Model: SSQE15-450
11 Pump Size: 1.5
11 Pitless Adapter Burial Depth: 10
IIPitless Adapter Installer: Pomraning Excavation
Disinfected Upon Completion? ® yes ❑ no
11 Method of Disinfection: Chlorine 50 PPM
11 Comments: Pitless Manufacturer: Martinson
Pump Installers Name: Sullivan Water Wells
Date of Issue 5-8-15
Property Owner Name & Address
Craig Graff & Katherine Tepas
PO BOX 110596 Anchorage, AK 99511
feet
hp
feet
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
On -Site Water System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP151103
Tax Code Number: 01739413000
Work Type: Well Upgrade
Permit Effective Dates: May 08, 2015 to May 07, 2016
Design Engineer:
Subdivision: ROBIN HILL#3
Site Legal Address: ROBIN HILL #3 BLK 3 LT 5 G:2838
Owner/Address: GRAFF CRAIG J &
TEPAS KATHERINE H 12941 MOUNTAIN PL ANCHORAGE AK 995160000
Site Mailing Address: 12941 MOUNTAIN PL, Anchorage Lot Size in Sq Ft: 89744
Total Bedrooms: 4
This.permit is for the construction of:
N Disposal Field N Septic Tank N Holding Tank N Privy Y Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions: a exis mg we is to be decommissioned. Submit a Well Decommissioning
Log along with the Well Log, Pump Install Log and water sample results.
Received
Issued By
717115/pw^er Caflcdz neev Wef ilof prz�GlKcinq dell. H� t�/���
k,,, b0A cvefls / J
2 -5-
Received
5
a , sMR9 ::Yi, M - f 0- .1F
Community Development Department
Development Services Division t
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT
Parcel I.D. ®r7' 3`741– f3
Property owner(s)
Mailing address _
Site address (Z'
Legal description (Sub'd., Block & Lot)
Dayphone >0�306-
Legal description (Township, Range & Section)
Lot Size Sq. Ft.
APPLICATION IS FOR:
(® all that apply)
Absorption Field
❑
Septic Tank
❑
Holding Tank
❑
Privy
❑
Private Well
�—
Water Storage
❑
Number of Bedrooms
APPLICATION IS AN:
TYPE OF DWELLING:
Initial ❑
Single Family (SF) f�
(w/wo ADU)
Upgrade fR
Duplex (D). ❑
Renewal ❑
Multiple Dwellings ❑
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
—
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
Permit/Rush Fees: Zls
Date of Payment: .
Receipt Number: &1 —15p
Permit No. 05t0161105
Permit App_9-1-12.doc
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
o 173 C7(,/i.�1 A
li,h _ AR TWE
9661 9 F.�ly
NoMma AM"s Maxim
WkMWayr 10 4pd1o.mu i
saP-f; Gs.
_Seno
IJ N89'50'00' E 23400
10_ UTILITY fISEHEMfLOT 4 I
I
LEGEND
0 FOUND 21/2' B.0 MON.
O FOUND 5/8' REBAR
2XS FP CANT
H` m
CPU9HEf1 ASPHALT ? '
DRIVEWAY . n' rQ LOWER OECW
20.00 e.
03m
L d COVERED ENTRY 6 g
o'
V
G ; SEPTIC VENTS_ 11.0 ff,El
2. .I m Ityp.3 13.0
C7 9 O E 92.3
jt 62.1
I-36.0
LOT 6
50 25 0 50 100
SCALE i"=50'
as The loea#lor Or the s#rLrc#urefs
(as,b- , 1� by Chis r. )
�upy,�i.eswl#hPora rewlsay
�o iltle 27, ,
A1Wc'
...........
FOR: BETHARD CONSTRUCTION
WELL
H
Recert Update
04/05/95
Date
09129/95",50'
Scale
Le al Description
Lot s Block 3
Grid
A5—Built
340 Pettis Rd.
2838
XXXXXXXX
Subdivision
Anchorage, Alaska 99515
ROBIN HILL
Drawn by
Field Book
(907) 349-1488
S.L.
#$5%#59
ST1FiT1TVTCTf1u rnarmu�
I hereby certify that the property described hereon has been surveyed
by me, or at my direction, and that the improvements situated thereon
are within the property lines and do not overlap or encroach on the
property lying adjacent thereto unless otherwise shown. That no
Improvements on the property lying adjacent thereto encroach on the
premises in question and that these are no roadways, transmission lines
or other easements on said property except as shown.
It is the responsibility of the owner or builder, prior to
construction, to verify proposed building grade relative to finish grade
and utility connections and to determine the existence of any easements,
covenants, or restrictions wnlch do not appear on the recorded
subdivision plat'
Listed distances prevail over scaling. Reproduction may cause
distortion.
�. OF, A
*CO q.QTH�
CHARLESE.�FOROES�.' :.a
LS - 7326 A
qn
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Municipality of Anchorage Page I of Z
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW9y027L' PID Number: O/739y/3
Name:
Wastewater System: ArNew ❑ Upgrade
o , z2) /= / 7'TZ/CA q ,2Smo
Address: M -
/2O0 L S- AfET' / \\
ABSORPTION FIELD
r
H�vcrtoi�� K 9950/
No., f Bedrooms
4
'Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION-
Soil Rating:
Total Depth from original grade:
�
.(o GPD/Sq. Ft.
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
`,.
S 3 20a/X r/ILLS
3 Ft.
Ft.
Township:
Range:
Section:
Fill added above original grade:
-2-1—
Gravel length:
2-5 Ft.
Ft.
WELL: XNew ❑ Upgrade
Gravel width:
of lines:
�
Distance between lines:
2 -rFt.
Ft.
Ft.
Ft
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material: FF/d SERF•
pR/vATS-
7/ Ft.
(9 Ft.
00f So. Ft.
4S'7-'W D?C-?q
Driller:
M-W D12N�iN� TA)C.
Date Drilled:
$ qy
Static Water Level:
37 Ft.
Installer. j, - -
erre cider �,cecfua rs
Date installed:
, 9 - /z -9y
Yield:
Pump Set t:
Casing Height Above Ground:.
- TANK
F GPM
v Ft. I
Ft.
SEPARATION
DISTANCES
peseptic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lin
Holding
Public/Private
Manufacturer:
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
Ac#ex e-x -7—,4A4L
/ZCO
Well,
23y'
/PLI
2S'k
Material:
STEEL
Number of Compartments:
Surface
rf.
LIFT STATION
Water
/f17
/OO
Lot
�-
Size in gallons:
Manufacturer:
Line
/� r
"Pump on" level at:
I? off' level at:
High water alarm at:
Foundation
/o�
/ �
�--
�'
—�
Curtain
A)OA
15
OWN
Pump Mak el
Electrical Inspections performed by:
Drain
BENCH MARK
Remarks:
Location and Description:
7SM -7b? Or- F41062 1-T/OW
Assumed Elevation:
/OU.00
ENGIN L
OA �
SA• �s'7
JfP��•
�� l P
!It
&SEN I
17034 Eagle River Loop Road, No. 204
Inspections performed by: Eagle River Alaska 99577 Dates: 1st 9 -9 - 9y
fl
:
2nd -9y
, .. �......:.... ».... ;.
~
Vt r ROBERT C. COWAN ft!
• CE-8801
4��i'f'<��
Department of HHum s approval
ealth ervice
w••.•••• r, `tip
Reviewed and approved by: Date:
Permit No.SW940278 Page 2 of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal DescriptiorFBIN HILLS SUBD.#3; BLOCK 3, LOT 5 PID No.: 01739413
2
APR— 6-95 THU 9:58
'�\ •`\ LOT f
�•� N 89.30'00' C 33a 00
LOT d
LEGEND
0 FOUND 9I13' B.0 .a.9.
• To" Va' REaM
P.02
\ • I.. he j
onm... -. .i I., lata an I i
eat
O
rg6u.n
'0 rS l pr i
r 2 � nsa.i
9 I n 9 1 B an,
3Ji.13
Z I S aSaT OT i
LOT 6
1
50 25 0 50 100
SCALE 1'•S0'
FOR: BFTHW CONSTRUCTION
Aecert Update 09/05/95 Date Sc
09/29/95 I',
Grid Aa
340 pettla ad- 2838 X
Anchorage, Aloaka 99515 Drawn by F!
1907) 349-1480 #
1 hereby citify that the property dceerlbed hereon has been avrvcyed
by me. or a my dip.celon, and that the tnpro Ycrenta situated thereon
are•Rhin eh. ........ lln.a and do not a .t I., oroath .. she
•ttY AYin9 •dj.r..t In .... h volt es otnervIDe shaw. That he
1�pl.vet•e nta er the prep •fry lying ad)ae. nt there.o a ath on the
,7 ra In qupatton and that there are no ro.d•e Y,, irrn.n+••lop 11,
r
other • pante a ead Property t cep[ n ,h°•..
It is •the topomibillty e[ the owner or builder, prior to
eon,truotlon, 1. verify vrppo red bvMlnq 9r.d. re latsys to flnl,h 91.41
and utility eannectlona and to detetrinv the ezi,:.nce of any easements,
ant,, .Ptdct tans whith do or aee,,r to th. ....rd.a
subdivlelon Pl te.'
blx.d d1.Oneo. ..... 11 over ...1J.v. peptodvu Aon ray Laos.
dlatoalcn.
Y
p.ot 5 1 B1oc14 9
Sa»dl�ieion
ROBIN BILI,
Perr'nit No.SW940278 Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description OE -IN HILLS SUBD.#3; BLOCK 3, LOT 3 PID No.: 01739413
CO1CO2
H ,90.7' N
MT1)
MT
STRUCTURES, EASEMENTS1 OR ENCROACHMEI
SHOWN ON THIS SITE PIAN ARE AS SHOWN
TO
4 BDRM
HOUSE
LINES PRIOR TO
SCALE >" ao. �, 11 ROBERT C. COWAN fes!
CE - 8801��`'
94 1,�:LiO :233 zCl TEL 907-7745-2354 P. 2
i MaW DRILLING, Inc,
AA. Box 110378. 10330 Old Seward Highway
(907) 349.8535
ANCHCRAGE• ALASKA 98511
DRILLING LOG
Well Owner 1h & irs^ Use of Wen Dcallestic
Location (address of: Township, Range, Section, if known; or distance main road-
Int 5 I37�c,r � ���#� �,1 s 129�,,,1`1nl�r,ain�lr• n�hnrn AK
Sire of Cased to 6932 feet
Static water level - 97 rt. QWQW {below) land surface. Finish of well (check one) open end ( XX );
screen ( ); Perforated
Describe screen or perforotion N/A
Well pumping teat 0 3 gallona per flW) (minute) for-8--hours with 16 ` ft.
of drawdown from static �vel'l
Note; well dry grouted with 1 sack•of
Date of completion 9 127/914 bentoate chips
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
---Q—T02..._ cag S1ggz
........ _TO___5__
_A .TO._12..- -01-8°n�
28 TO fl- _,grayel dirty. wi�t .
..... �LTO�� C1 �)��� Qt1 t • o AVP113L.�ef1137S, ter@t,- i'1.:7i'1{'
67 TO 7]- atim ravel
To
TO
GZr .•.' ,1
Tn
...W..__ _TO n ,
Certificate 140's. $Li 4c 0173
.�._ oO W
TO '
t—•CUSTOMER
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES 1U( if
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650 ov- 'q 9
q IvON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PRM T`� iI
PERMIT NUMBER:SW940278 DATE ISSUED: 8/05/94
DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 8/05/95
OWNER NAME:KORSMO RONALD F & PATRICIA D
OWNER ADDRESS:1200 I STREET
ANCHORAGE, AK 99501
PARCEL ID:01739413
LEGAL DESCRIPTION: ROBIN HILL #3 BLK 3 LT 5
LOT SIZE: 89744 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 (24 HOURS) .
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED
ISSUED BY
le- ve
DATE: S
DATE: s
Iu g fjt --
r
July 22, 1994
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
CIVIL ENGINEERS
(907694-2979
FAX 694-1211
HEALTHAUTHORITY
APPROVALS
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 'L' Street
P.O. Box 196650
SEWER &WATER
Anchorage, Alaska 99519-6650
MAIN EXTENSIONS
REFERENCE: Robin Hills Subdivision; Block 3; Lot 5
SEWER &WATER
INSPECTION
Request you issue a permit to drill a well and install a septic system
to .Serve the proposed four bedroom house on the referenced property.
ENGINEERING STUDIES
ANDREPORTS
Test holes were excavated and percolation tests performed. The
approximate locations of the test holes are located on the attached
site plan. The monitoring tubes within the test holes have been
WELLINSPECTION
checked and found to be dry.
& FLOW TEST
This property has enough area for a future septic upgrade which can be
seen on the attached site plan. We do not anticipate any adverse
effects on neighboring properties by the installation of the proposed
SITE PLANS
septic system.
If you have any questions, or require additional information for your
review, please contact us.
ROAD DESIGN
Sinc ely,
e
SOILTEST
IYIJ�rt A. Shafer, P.E.
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
jk
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
2: 01
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ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Robin Hills Subdivision; Block 3; Lot 5
GENERAL:
1. The scope of this project includes the installation of a 1250 gallon
septic tank and a leachfield trench to serve the proposed four bedroom
residence located on the referenced property.
2. Construction shall be in accordance with the approved site plan and
design drawings, Municipal permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater Disposal
Regulations.
3. The contractor shall be responsible for obtaining any necessary
underground utility locates.
4. Unless specifically agreed otherwise, the property owner shall be
responsible for final grading areas subsequently depressed from soil
settling. On all leachfield mound systems, the property owner shall be
responsible for ensuring a satisfactory vegetation growth over the
mounded area.
5. Contractors installing wastewater disposal systems must be certified by
the Municipal Health Department for system installations. Owners
installing their own systems must also receive prior approval from the
Municipal Health Department.
SEPTIC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
2. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
3. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
4. Septic tanks installed with less than 4' of cover shall be insulated.
Page Two
Robin Hills Subdivision; Block 3; Lot 5
July 22, 1994
5. A foundation cleanout shall be installed one to four feet from the
building foundation. In the line between the tank and the leachfield
there shall be two adjacent cleanouts (unless an effluent pumping system
exists within the septic tank). These cleanouts shall be located on
undisturbed soil not more than 10' from the tank. The first cleanout,
in line, shall be to clean toward the leachfield. The second cleanout
shall be to clean toward the septic tank.
6. Final grading over the septic tank shall be such that a positive slope
exists away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
1. Excavate the proposed trench to the dimensions shown on the design. The
bottom of the excavation shall be within 2 inches of level. If the
sidewalls of the excavation become smeared, they must be raked or
scratched (roughed -up) before gravel (sewer rock) placement.
2. Once the gravel is installed, the distribution pipe is to be installed
level with the perforations faced downward. Gravel is then to be placed
over the distribution pipe to provide a minimum of 2 inches of cover
over the pipe.
3. A silt barrier must be installed between the final gravel layer and the
native soil backfill. Ensure the silt barrier covers the entire gravel
surface before placing backfill.
4. Monitor tubes shall be of four (4) inch diameter and installed
approximately in the locations shown on the design. The portion of the
monitoring tube extending through the gravel shall be perforated from
the bottom of the trench to the invert of the distribution pipe. This
is equivalent to the effective depth of the gravel as noted on the
design.
5. Backfill over the final gravel layer must not be less than twenty-four
(24) inches. Insulation must be installed when the backfill depth is
less than thirty-six (36) inches. The finish grade over the trench must
be mounded to prevent the formation of a depression after settling.
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be constructed by a
Municipally approved septic tank manufacturer.
Page Three
Robin Hills Subdivision; Block 3; Lot 5
July 22, 1994
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Type of Pipe
Perforated
Solid
Cast Iron
Yes
Yes
ASTM D3034 (PVC)
Yes
Yes
ASTM F810 (HDPE)
Yes
No
ASTM D2662 (ABS)
Yes
Yes
Use of a type of pipe other than listed above must be approved by the
inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal)
must be installed between the final leachfield gravel layer and the
native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel
with less than 3% passing the #200 sieve.
7. When sand is being used as a filter material, its gradation
specifications must conform to current M.O.A. or D.E.C. requirements.
Typically there will be a minimum of three (3) inspections required during the
installation of the wastewater disposal system. These inspections will occur as
follows:
1. The first inspection must be conducted after the excavation of ditches,
pits, trenches, or beds and before the installation of any gravel. A
septic tank may be set in place, but may not be backfilled before this
inspection.
2. The second inspection must be conducted after the placement of the silt
barrier, gravel, distribution lines, standpipes, cleanouts, and
insulation, but before the placement of any other backfill.
Page Four
Robin Hills Subdivision; Block 3; Lot 5
July 22, 1994
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required, especially with the
installation of multiple trenches, sand filters, pressurized distribution
systems, etc. Thus, the inspecting engineer is to be contacted at least 24
hours prior to the start of construction. If necessary, a pre -construction
meeting will take place on-site. The inspecting engineer will not coordinate,
direct or control in any way the contractor's activities.
The owner shall contract with the contractor to perform the work outlined in
these specifications and plans and in accordance with the attached M.O.A.
permit. There will be no contractual arrangement existing between the
contractor and S & S Engineering. S & S Engineering shall be the owner's
representative and will inspect the work as stated above to document the
contractor's activities. Final acceptance of the contractor's work rests with
the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or
omissions of the contractor or any other persons performing work on this project
or the failure of the contractor to carry out the work in accordance with these
construction documents. S & S Engineering's inspecting engineer will not be
responsible for the construction means, methods, techniques, sequence,
procedures or the safety precautions incident to this project.
CONTRACTOR/INSTALLER
+.� Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: P>t \ 1 W sco DATE PER
(ENCpINE,€{t'SSEAL)
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LEGAL DESCRIPTION: SSI ' RBfN ALS(D Township, Range, Section:
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PERFORME't'7 Eagle Rivar 1 cop Road No. A�
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ACCORDANCE WITH ACL STA�EV 4UNICIPAL GUIDELIN
CERTIFY THAT THIS TEST WAS PERFORMED IN
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Municipality of Anchorage
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DEPARTMENT OF HEALTH & HUMAN SERVICES
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COMMENTS �t � Sr%E04� S[DE CEjg05�"D tbLAg.E
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PERFORMED BY: nNIS33NION I CERTIFY THAT THIS TEST WAS PERFORMED IN
agl Iver, Alaska 917577
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
ANDREPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSALSYSTEM
DESIGN
August 11, 1994
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 'L' Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Robin Hills Subdivision, Block 3, Lot 5
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
On August 5, 1994, permit #SW940278 was issued to drill a well and install a
septic system on the referenced lot. Well drilling was attempted in the proposed
well site location, however, no water was located and the site was abandoned.
We have depicted a new location for an on-site well (see attached site plan).
There are no points of contamination within the proposed well radius and the
adjacent lots to the East of the referenced property are vacant.
If you have any questions, or require additional information for your review,
please contact us.
0
S/LSU/lsu
P.E.
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
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Municipality of Anchorage
Development Services Department I:
Building Safety Division
' On -Site Water & Wastewater Program
4700 Bragaw Street %
P.O. Box 196650Or✓�l/{✓
Anchorage, AK 99519519.6650 n
www.muni.orglonsite j
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
ParcelLD. Dl;--�A'4' 13 COSA# 2-14(v
1. GENERAL INFORMATION Expiration Date: 0 — %
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
ROBIN HILLS #3: BLOCK 3, LOT 5
12941 MOUNTAIN PLACE 'ANCHORAGE. AK
RON KORSMO Day phone 345-6620
12941 MOUNTAIN PLACE 'ANCHORAGE. AK
Day phone
Real Estate Agent BOB BAER W/ DYNAMIC Day phone 261-7505
Mailing address 3111 C STREET *ANCHORAGE, AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
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. I further verify that based on the
information obtained from the Municipality of Anchorage riles 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 Finn GARNESS ENGINEERING GROUP, Ltd. Phone
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
337-6179
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date G I I :) O :) ou `?
Engineer's Comments:
In conducting this evaluation, GEG, LtD. 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 meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole bene(f of the ownerlisted 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
Approved for 14 bedrooms.
Disapproved.
J 'f A. or ss:
9 �_ L �wie��Fp4
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
bell
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
y,0
ON-SITE
WATER AND •:
WASTEWATER :
PROGRAM
O •,
By: w Original Certificate Date:
(R". I IMS)
\ Municipality of Anchorage
_Y1 Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: ROBIN HILLS #3; BLOCK 3, LOT 5 Parcel ID: 61 % ,3q q /3
A. WELL DATA
Well type MOTE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 8/27/94 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 71 ft. Cased to 69.82 ft. Casing height (above ground) 18+ in.
FROM WELL LOG AT INSPECTION
Date of test 8/27/94 6/4/08
Static water level 37 ft. 40
Well production 3 g.p.m. 1.23 g.p.m.
WATER SAMPLE RESULTS:
Coliform' O colonies/100 ml. Nitrate Alamg./L. Other bacteria 0 colonies/100 ml.
Arsenic: J�2Qug./L. Date of sample: 6/4/08 Collected by: GEG Ltd.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/ STEEL Dato installed 9/9/94
Tank size 1250 gal. Number of Compartments E Cleanouts'(Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 6/5/08 Pumper ISAACS
C. ABSORPTION FIELD DATA
Date installed 9/9/e4 Soil rating (g.p.d./ft'o t /bd 0_6 System type TRENCH
Length 63 ft. Width 2.5 ft. Gravel below pipe 8 ft.
Total depth * 13.91 ft. Eff. absorption area 1008 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 6/4/08 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test DRY in. Water added 607 gal. New depth 8 in.
Elapsed Time: 700 min. Final fluid depth DRY in. Absorption rate >= 600+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
D. LIFT STATION
Date installed Size In gallons Manhole/Access (Y/N
"Pump on" level at in. "Pump off' Ievei High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM 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
N/A
Public sewer manhole/cleanout N/A
Sewer /septic service line
25'+
Holding tank N/A
Animal containment areas
50'+
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING
TANK ON LOT TO:
Building foundation 5'+
Property line
5'+ Absorption field 5'+
Water main N/A
Water service line 101+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD
ON LOT TO:
Property line 10'+
Building foundation
10'+ Water main N/A
Water service line 10'+
Surface water
100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and p e'! I�e ao
review of Municipal records that the above systems are in Q""""' .. ' ' ........ """"�
conformance with MOA COSA guidelines in effect on this Q
date. f r A. rness:'
JEFFREY A. GARNESS Q CE -7953
Engineer's Printed Name Q •.• FoO
Date �� U UO%
Prof as o 000
��40�000�
i
COSA Fee ►y�� _ Waiver Fee $
Date of Payment ' 1� �g Date of Payment
Receipt Number Receipt Receipt Number
(Rev. 11/05)
16/09/2008 17:23 FAX 907 345 6620 Rorsmo's Fax 001
APR -25-95 TUE 10:11 P.02
.LOT 4
.LEGEND" '
FOUND :1/7• l.c NOM.
�• FOUND 6/a' RF/ae
a
be R ext
s.
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e
11.1 Ileo
ne
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/r•t : at al O1 11
LOT 0
50 25 0 bo 100
SCALE to -50'
FOR: BETHARD CONSTRUCTION
RoCert Update /0
005/95 Date Scale
o/29/9y r -so'
7 MIN9 Grid ks
340 Pattie Rd. 2838 X:
Anchorage, Alaska 99SIS Dram by ri
(9071 349-1480
I hereby Certify that the property d.serebod hstaon %As baso .Wevoy04
oy as. or at my dlroeclen, and that the I-ptevements sit Wst-d thereon
•re Within the property lines and se net Overlap ac enaeaesh on eh.
property lylnq ad1e...t %%.rote unless othot-19, who -n. ' That no
lapcoveosptl an the property lying adjacent thereto encroach on the
premises In quostlon and that thaw aro no teeJ-qs, trono-Inion line■
at other aa.emooto on 941J rrorarty a -wort es Chown.
It 1s the rnpenstbility of the owner or bulld.r, prior to
sensttuce Len, to verify prorated building prods relative to finish grade
cad-elliey sonnectl•ne Cad %o determine the existence of any sa■trents,
eoyenint■, or testrlctlone Whieh do not appear an Cho saeerdod
subdeviston plat:
Llsto4 dtataheos pravall over e0411ng. Itwproduction may caves
distortion.
L
Val,
1
. 1
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In
Lot S 91ock 3
Subdivision
FLORIN HILT.
stmrlmsion UN T 3 1.1
09 '14/9?y}�r�'•�9#
I
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� l ' �'�sslofa�� •�
•
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel l.D.# 017 -31'/-13 HAA#
1. GENERAL INFORMATION -
Complete legal description Lot 5; B. och_ _-3; Robin Hi E 23 Subdivision #3
Location (site addressor directions) 12941 Mountain n PPccce
Anchorage, AK
"Day phone
owner Ronad 9 Patk cia KoumoPro
Mailing address 1200 "1" StAeet Anchorage, -AK' 99501
Lending agency Day phone
Mailing address
Agent _ ' . _. , Day phone
x
Address
=:
Unless otherwise requested, HAA will Be held for pickup. ` A y
a rte'
1
2. NUMBER OF BEDROOMS: 4 R7
9
O
3. TYPE OF WATER SUPPLY: rn A
m -
r
v
Individual well XXX
rn Ca
o0
Community well 'O
Public water
Z T
=" NOTE: " if community well system, provide written confirmation from State ADEC attest-
`
ing to the legality and status of system.k_
4. TYPE OF WASTEWATER DISPOSAL: .
JiI
Individual on-site XXX
Holding tank
Community on-site
-_-Public sewer
NOTE: , It community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system. `
72-025 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify 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 5 $ s EntawEERING Phone 6 y _ a 9 -7
17034 Eagle River Loop Road N0.
Address
Engineer's signature Date y /0 %ar
By:
Additional Comments —
MISELVIV
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 theirlending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025(Rw. 1/91) Back MOA #21
r.
Municipality of Anchorage
Department of Health and Human Services 44
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:l2ag) Aus- A. 'a----LO`�3, GoT S Parcel I.D. 017399/3
A. Well Data
Well type /21Zi vf+TE If A, B, or C, attach ADEC letter. ADEC water system number N/A
Log present &N) Y6S Date completed —p1gy Driller A -X DQ11-1iN6-
Total depth 71 r Cased to G,Q Casing height Z
Sanitary seal (ON) YES. Wires properly protected&N)
FROM WELL LOG
Date of test P 9y
Static water level 3T
Well flow g•p-m-
Pump levell 01Ig--
SEPARATION DISTANCES FROM WELL TO:
AT INSPECTION
Septic/fig tank on lot 7-71-t' ; On adjacent lots /00 r�
Absorption field on lot /iU ' ; On adjacent lots /ov 'f
Public sewer main 7 L `�" Public sewer manhole/cleanout /0t)
Sewer service line 1c'f- Petroleum tank �rJB
WATER SAMPLE RESULTS:
Coliform
WNW -
a
w
cry
Nitrate • /40 Other bacteria $—
S & S ENGINEERING
Date of sample: /f�6/9� Collected by:
r
Eagle River, Alaska 99577
B. SEPTIC/G TANK DATA
Date installed q-/2 -9'/ Tank size 12 -SO eWt. Compartments Z-
CleanoutsQY N) Yes Foundation cleanout (22)N) VEs Depression (Y® AJO
High water alarm (YO No X)14- Alarm tested (Yo l%
Date of pumping &/,+ tigW 7WA4- Pumper X)
SEPARATION DISTANCES FROM SEPTIC/KGEBTR&TANK TO:
Well(s) on lot 2.34/ ' On adjacent lots /44) , 4, Foundation /0'
To property line //6 ` Absorption field
Surface water/drainage /00 1
01�
a.?I Water main/service line )6'1 -
c
72-026(3W)•Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons -
Vent (Y/N)
allonsVent(Y/N)
High water alarm level
Manufacturer
"Pump on" level at
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE
Well on lot
D. ABSORPTION FIELD DATA
Date installed q - /Z-" Fy
"Pump off" Level at
tested
LIFT STATION TO:
On adjacent lots
Surface
Soil rating (GPD/Ft2) d. System type 49,04PT/OAJ 7A& *
Length (o? Width Z•S Gravel thickness yTotal depth /.?•S'
Total absorption area OF � Cleanout presentON) yfS Depression over field (Y(I /Jo
Date of adequacy test ,j/& IJEU) SySTUM Results (pass/fail) _ y hag for Bedrooms
Water level in absorption field before test N, �%-—Aftertest _%g=
Peroxide treatment (past 12 months) (Y&___,00 If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /&'O ' On adjacent lots 900 ' 4 Property line f1G
To building foundation //' To existing or abandoned system on lot
On adjacent lots /DCutbank sty '� Water main/service line Jd
Surface water /an T Driveway, parking/vehicle storage area S)
Curtain drain .douE ieWdWIJ.
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name Pd w6 &1a Co w, -}f✓
s
;; a, .T ••
a C'
F c;
Date
Cr
�
HAA Fee $?�
Waiver Fee $
Date of Payment �'/��
Date of Payment
F7� G7
Receipt Number U (�7�'�
Receipt Number
