HomeMy WebLinkAboutROBANNA LT 1P-obanna
Lot 1
#051-281-83
U 1.2) UQU U U U Lg_� L
Municipality of Anchorage JAN ZUZZ
On -Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211135 PID Number: 051-281-83
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
DAVID & MICHAELA YOUNG
ABSORPTION FIELD - EXISTING
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
18015 PIONEER DRIVE, CHUGIAK
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3 PG O.W.
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
ROBANNA 1
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
FtZ
Ft.
-Well
100'+
-_
25'+
TANK {o Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
GREER
Capacity
1250 Gal.
Surface Water
100'+
--
Material
HDPE
Number of compartments
2
Lot Line
51+
__
NA
Foundation
10'+
__
LIFT STATION
Manufacturer
Capacity
Gal.
RemarkQRR -ll l
oe� f�1
Alarm location
Electrical installed by
Installer DENALI EXCAVATION
PIPE MATERIAL House to tank 3034 d a afield Tank to 3034
Drainfield CO/MT 3034.
Inspector FWCS
BENCH MARK (Assumed elevation) 100 ft
Inspection 1" 5/20/21 2nd 5/20/21
Location and description
3`d 11/15/21 4'h
TOP OF MANHOLE
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
M� k
�-
orlaw A
Conditional Approval: Date
AM -
TM
.. 4......�.. r
•
% " " " "" " "' • /
Septic System
ApproveO-,-
• Curtis Huffman
Date / t4 2-L
X29' •. W. CE 128991 i�
�0 �JlF�• f/t 1/22 . •-�C��i
PROFESS10Na4"
Note: thisproval does not include well permit requirements.\\•�`1.`�
kmev UD/UL/ 10)
PID: 051-281-83 PERMIT: OSP211135
100' WELL
/ RADIUS
28.7'
o
N LEANTO
29.3' e
DECOMMISSIONED EXISTING
/ S.T. & INSTALLED NEW
J 1250 -GAL HDPE SEPTIC TANK
I' U W WITH NEW DCO.
I
in MH CO DCO
X LO c/) O • E
I LX = LO C D
Y
U
\ W
� 29.3' A
LVED D/W � 00
to C4
/if 11
137. 3' N85046'181)w
A -C=36.2'
B -C=33.2'
A -D=39.3'
B -D=35.9'
A -E=45 0'
B -E=38 9'
CO
149.61'
EXISTING
FIELD
SEPTIC SECTION
SCALE; NTS
ROBANNA LOT 1
PREPARED FOR:
DAVID & MICHAELA YOUNG
18015 PIONEER DRIVE
EAGLE RIVER, AK 99577
FIRST WATER CONSULTING
13030 SUES WAY
ANCHORAGE, AK 99516
907-350-9566 firstwaterAK@gmoil.com
SUPPORT$SERVICES: -do
OF AL4
�*
c 9 TH
DATE: 1/11/22 , rtis Huffman
SURVEY: JLS 1 f� CE 128991
DRAWN: FWCS 1 1/11/2022
SCALE: 1 " = 30' \ �koFEsstoN�•v i
40.00'
CA
N 89'49' 1 0"W Q
-
—_ ,,,� PIONEER DRIVE
0
ANCHORAGE RECORDING DISTRICT, ALASKA
� =FND ALUMINUM MONUMENT
AS -BUILT OF:
ROBANNA SUBDIVISION = FND 5/8" REBAR
LOT I PLAT 87-60
SURVEY CERTIFICATE: 1. John L. Schuller, Have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property lines and no
enchroachments exist other than noted. Under no circumstance should
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
WORK ORDER NUMBER: DATE: SCALE: E -MA L
NOV 15, 2021 1 "=40' schuller0ok.net
21-162 DRAWN BY: CHECKED BY GRID NUMBER: BOOK/PATE
JLS N W0753 210367
AW OF L LAIVD
6 01-A
oo,
,,,7
NN
%
FA FA
?A
. .............................Rd
�•.J HIV L. SCHULLER.- o `• '
LS 10408
� ,,,R, � .sem`"•
1 �' •' • • , • • �� / 1831 Talkeetna Street
nor•°" Cn'�'.? ' 6AW �' � Anchorage, Alaska 99508
a'\ AM
fe o\ L W
. W (907) 227-1455 office
�� ssio�`.,,�•` (907) 274--4992 fax
MUN10PAL ITY OF AN HO AGE
On -S b Date r & Waguwatar Program
R4 Box 196150 4740 Elmeo Road
Anchorage, Alaska 99519-6 50 Phana= (907) 343-7904 Fw: M7) 343-7N7
htts;+ ,muni-orgr.prns1te
On -.bite Wastewater Disposal System Permit
P.L%rmIt Nornher, QS P21 ' 1 �5
Work Type: SeplicTank Upgrade
Tax Cede Kumbl: r; 05128183000
Slto Legal Address= ROSANNA LT 1 0:07$$
$0 Mailing Address- 18015 PIDNEER DR, Eagle River
Owner- YOUN13 DAVID & MICHAFLA
06sign Engineer' F QST WATER CONSULTING
This permit is for the ccnstruc6on of:
13 Disposal Field Q Septic Tank C3 Holding Tank ❑ Privy
Nfective Date;
Expiration Dato,
Lot Size in Sq Ft:
Total Bedrooms:
511212021
5M 212022
52720
❑ Private VV&ll ❑Nater Storage
All constru0on shall be in actor -dance with:
1, The attached approved design.
2. All requirements specified in Anchorage Munlcfipal oode Chapters 15,55 and 15,65 and the State of Alaska
as -&water Disposal Regulations (18AAC72) and Drinking Water RegWatione, (18AAC6D)
3, The WaStewater code requires inspections during the installation- The engineer -hall noffy the Development
ervIces Department per AMC 15 65- Provide noUlieation by calling 1907) 343-7904 (247).
4, From October 15 to April 15, a s+ubsurbaoe soil absorj�ticm 5ystern under Construction during freezing weather
shall be either_
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freeing
Received B)
rss+ued By:
Date=
Data- _
511212021
3
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-281-83
Property owner(s) DAVID & MICHAELA YOUNG Day phone
Mailing address 18015 PIONERR DRIVE, EAGLE RIVER, AK 99577
Site address 18015 PIONERR DRIVE, EAGLE RIVER, AK 99577
Legal description (Sub'd., Block & Lot) ROBANNA LOT 1
Legal description (Township, Range & Section)
Lot Size 52,720 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF)
El
(w/wo ADU)
Septic Tank
Z
Upgrade Q
Duplex (D)
❑
Holding Tank
❑
Renewal ❑
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES
A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(S gnature of property owner or authorized agent)
Permit/Rush Fees: t a a 5 Waiver Fees:
Date of Payment: 5 1 b '�0) Date of Payment:
Receipt Number: '710 1 `i 0 Receipt Number:
Permit No. 0 S P),
� � � 3 � Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
May 7, 2021
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: ROBANNA LOT 1
The owner has requested that we obtain a septic permit to upgrade the existing 1250-gallon aged
steel septic tank on the above referenced lot. We propose to install a 1250-gallon HDPE tank
per the attached design to serve the existing 3-bedroom residence. The lot and area are served by
private wells. The design will not impact any of the neighboring properties. Please contact us if
you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211135, Deb Wockenfuss, 05/12/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211135, Deb Wockenfuss, 05/12/21
MUNICIPALITY OF ANCHORAGE
DE ITMENT OF HEALTH AND HUMAN SER' iS
Environmental Health Division
0 5/_
^ 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720I
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT j
Name
DISTANCES - I
GAc-1,
SEPTIC
ABSORPTION
WELL
Address
FROM
TANK
FIELD
013 .2fris- /eiw�t 955-77
i
rrh r 2,
Phone(s)
Permit No.
No. of Bedrooms
WELL
'J'/Oc7
a�w t
e588 — 3 7y 3
3
LOT LINE
$v 't
LEGAL DESCRIPTION
Lot
.l
Block
I �'A
Subdivision
/�'o b� �
FOUNDATION
-
1/7 '
1 ✓0 �
Township, Range, Section
AS -BUILT DIAGRAM 1Show location of well, septic system, property lines, foundation,
T/5—/L' l oZ to Se i, r
driveway, water bodies, etc.)
TANKS
SEPTIC ❑ HOLDING
t
Manufacturer
Capacity in gallons
Arv'Vcl ya.✓!T
A��v
Material
No. of Compadmems
/
Sal
z
TYPE OF SYSTEM
❑ TRENCH ❑ BED Dd W. DRAIN ❑ OTHER
5
,
J
o r
ST ft•
I 7
Depth to pipe bottom from
Total depth from original grade
original grade -S/FT
- f
w
Fit added above original grade
Gravel depth beneath p
.
fFT
Gravel length
Gravel widthFT
Total absorption area
Distance between linesSOo
]6-
SQ FT
Number of lines
Soil rating
Pipe material
/5 o SQ FT
Tr" 30 3Installer
Date installed
C w/ S tl-,
,S2 -7 9
WELLS
PRIVATE �K;at�f ❑ OTHER (identify)
Classification A.6.C)
Total Depth
Cased to
FT
FT
Installer
Date Installed:
Y
m +✓,' r
REMARKS:
Al/owI^Stk/lu'✓ traN !eSol r�.�L['iC /SO
$ /�✓� a ✓
Scale: C
. InsdRngdrDBsume8ngineeYlag. services
FFFFpp
" 'gI�S•� SEAL
,r,,
P. 0. Box 773294
P 4
�°°° ee oaa•' ] �
ag a Iver, AK 99577
0°' Al • oma' 17
Date: 694-5195
e
° �w o° • ti} `. fid' u• ��
_ celtily That this inspection was performed according to all
�J
l�
uo It °OB — IS UfEfd Iry
c
Municipal and Stale guidelines In elfecl on this dale: 1 �����
�� o ° CE -6735
i
pg' me,So- 60
"e �Q neo•°e�
Health Department Approval: Date:
** Gravel length > 50 feet requires multiple soils tests.
L[FT
S'[ATION: If a
litL station is
installed, a high water alarm
must be
connected
^
ill UNT
AL1:TY f IF
ANCH'ORAGE
SEPTIC
TANK: Minimum
total septic
Department
of Health & Human
Services
must have at least
2 compartments.
Depth to top of septic
825 L Stre
tot. ,Anchorage� A1askail
99501
343-4720
ON
ITE SEWER
PERMIT
ORIGINAL ISSUED 7/1/87
I CERTIFY
Permit Number:
8�0156
1.
I not familiar with
Date Icsued:
07/01/87
wells as set
�orth by the Municipality
`
Owner Name:
JAN CHURCH
2.
I will install
the system in
Day Phone:
Own�r Address:
P.O. BOX 285
and in compliance
with the design
criteria of this permit.
688-3793
3,
EAeLE RIVER,
AK �9577
State o1 Alaska requirements
Wr the set back
distances from
any existing well,
wastewater disposal system
Ur public
Parcel Id:
(i51-281~44
sewerage system
on this or any
adjacent or nearby lot`
4.
I understand that
this permit
is valid [or a maximum o� 3
Lot Legal:
Subdivision:
ROBANNA Lot: LOT 1
Block:
NA
any enlargement
will require
an additional permit.
Section: 25
Township: 15N Range:
2W
Lot Size
1.25A (sq.1t.
or acres)
Max Bedrooms:
This Permit:
3 Total Capacity:
3
SEWER SYSTEMS:
Listed below
are the options available
to you
in designing your
sewei system.
Choose the option
that best fits
your site.
T R E N C H
B E
D
W, D R A I N
Depth to
Pipe Bottom
([t>: 5"5
6,5
5"5
Gravel Depth
(ft): 4.5
O.5
2.5
Total Depth
(Ft): 1O"0
7"0
8.0
Gravel Width
(ft): 2.5
19.0
5,0
Gravel
Length
(/t>: 50.0
36.0
58"0 **
Gravel Volume
(cubic
yds): 23,2
25.4
32.3
Soil Md. ing
Used (sq !t/brm):
150
15O
150
** Gravel length > 50 feet requires multiple soils tests.
L[FT
S'[ATION: If a
litL station is
installed, a high water alarm
must be
connected
to Lhe residence.
SEPTIC
TANK: Minimum
total septic
tank capacity: 1,O00 gallons.
Each septic
tank
must have at least
2 compartments.
Depth to top of septic
11:: (s
{eet
requires insulation
over tank(s),
THIS
IS AN AMMENDED
PERMlT FROM THE
ORIGINAL ISSUED 7/1/87
I CERTIFY
THAT:
1.
I not familiar with
the requirements
For on-site sewers and
wells as set
�orth by the Municipality
o[
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 o1 Alaska requirements
Wr the set back
distances from
any existing well,
wastewater disposal system
Ur public
sewerage system
on this or any
adjacent or nearby lot`
4.
I understand that
this permit
is valid [or a maximum o� 3
bedrooms. I
also un�erstand
that the capacity ototal system is
3 bedrooms and
any enlargement
will require
an additional permit.
August 18, 1987
Mr. Dan Roth
Civil Engineer, On-site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
RE: Lot 1, Robanna Subdivision
Permit #870156
Dear Mr. Roth:
MUNICIPALITY OF ANCHORAGE
DEPT, OF HEALTH &
ENVIRONMENTAL PROTECTION
AUG 1 n 1.987
We are applying for a modification of our original permit
application #870156. The original design called for a lift station
with bed. Our revised design eliminates the lift station, placing the
septic tank at the home elevation with effluent piped to a wide
drainfield at a lower elevation. Soil conditions at this elevation
have been logged and are presented for design along with a sieve
analysis.
I believe that this revised
leachfield area.
If there are any questions
contact me at 694-5195.
Sincerely,
Louis A. Butera, P.E.
LAB:bls
Attachments
design will result in an improved
or concerns, please feel free to
SOILS LOG
'fl �.
MUNICIPALITY OF ANCHORAGE ❑ PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST
825 L. Street, Anchorage, Alaska 99501 . 264.4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: DATE PERFORMED:.
LEGAL DESCRIPTION:
SLOPE SITE PLAN
1
2
oG 65-
O G,
4
5
IVered /S`o f/,fiC
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
S
yU L
C
E
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
MEN -ENNINNI
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND FT _ u
COMMENTS /�eCGarne.✓�i l� IiCC /%✓moi � % !/;� Z/;7 n7 -K 3 G" rs vie (�• `5J /u 0
Eagle River Engineering Services ---7DATE: --I- V 7
PERFORMED BY: P. 0. BIX 773294 CERTIFIED BY:_l
Eagle River, AK 99577
694-5195
-"
L 3�
z
0
z
t LOT
L I
0
SEFTC Vfl7T
M
nam bit S
OaYAli4 `bc� CD
ed. ci
5
of line '
W
HSE IO �
0
z
e4 LOCATED WELL
O G O
CARLISLE N89*54'00"W 3.02' DRIVE
tri
L 59 ^L 58$ -TL A L t
GIL.BERT
SUBDIV
z
0
z
t LOT
L I
0
SEFTC Vfl7T
M
nam bit S
OaYAli4 `bc� CD
ed. ci
5
of line '
W
HSE IO �
0
z
e4 LOCATED WELL
O G O
CARLISLE N89*54'00"W 3.02' DRIVE
tri
L 59 ^L 58$ -TL A L t
t 0 t 551 / r oEAGLE RIVER PP11 S�RIVER,
rvR 294nic 99 Rc seRv,ees
`e °' t T. n..a 8/17/87694-319'3
n0
GIL.BERT
SUBDIV
SEPTIC VENT
a
� V c
gy
p:00000G
ti oceaaevoonoaooaae� o.
SEF
r'+ o Levis A'. °•ur, ra
s o�� CE -5736 o
Oc
00, �
nT
t 0 t 551 / r oEAGLE RIVER PP11 S�RIVER,
rvR 294nic 99 Rc seRv,ees
`e °' t T. n..a 8/17/87694-319'3
n0
GRAIN
SIZE DISTRIBUTION
TEST ,REPORT
.H
c C. e
. 1'V
L '•.
• •H •H •H
1�
H H
•H •H •H. ri
H
•H ".�' !,'•.� 117_
1'-1• 1'y1 I%%J-
-
1� .t
04
90
•
I
I
80
i
�0
i
L ._•o
1
w
LI
Lu 443
U0
t
20
10
LLL
0
L
- 00
100 10.0 1.0 0.1 .01 .001
OPENING SIZE - mm
i+=" ` % GRAVEL SAND
.':_ILT
- us
': 00LLOIDS LL FI Dso D7)0 D10 r_:1_
C1�=•=•i:ficaticln
t;
.PNP
r•aP
5-,
4..,1• 1.529 0.6449
0.7
?.l
MATERIAL DESCRIPTION
f E OF TEST
Cl BROWN GRAVELLEY NAND
ASTM D t4 '2-63(72:I
r'ec lanlccY1 analy-sis
Project No.: 109 B
f,�_mar k -•'
Project: EAGLE RIVER ENGINEERING.SERVIC:ES
kT Location: LOT 1 ROJPANNA
Trate: 8 18
G R A I t",6 E DISTRIBUTION TEST REPORT
ROW -40-11 P. KINNE`I' FISSOCIATES
Plate No. 1
APPLICANT:
ADDRESS:
CONTACT PHONE:
8RLIC. E SWANSC)N
P.O, BOX 285
EAGLE RIVER, AK 99577
W8~
LEGAL DESCRIP: SUBUIVISICIA!
(PROPOSED) FTC! fl! ANNA
'�
1(PROPO) BLOCK:
~
rx
SECTION:
25
TOWNSHIP: 15N RANGE:
2W Z jjr ry
LOT SIZE: 1,25A
(SQ.FT,
OR ACRES)
too
I certify that:
alfw���
^ DEPART!
OF
HEALTH
AND ENVIRONMENTAL
requior on-site
PROTECTION
and wells
as set
forth by the Municipality
of Anchorage (MOA)
and
the State of Alaska"
2. I install the
in
825 L
STREET
ANCHORAGE
AK
99501
accordance with
all
codes and regulations!!
and in compliance
�
�
this
permit,
3^ I will Where to all
MOA
and State of Alaska
264~4720
for the
set back
distances from any
existing
well, wastewater
disposal
system or Public
sewerage system on
this
or any adjacent or nearby
lot.
HEZ
W HE! i��_
PERMIT N1 O: G70132
�ATE ISSUED: 06/12/87
APPLICANT:
ADDRESS:
CONTACT PHONE:
8RLIC. E SWANSC)N
P.O, BOX 285
EAGLE RIVER, AK 99577
W8~
LEGAL DESCRIP: SUBUIVISICIA!
(PROPOSED) FTC! fl! ANNA
LOT:
1(PROPO) BLOCK:
~
:
SECTION:
25
TOWNSHIP: 15N RANGE:
2W Z jjr ry
LOT SIZE: 1,25A
(SQ.FT,
OR ACRES)
I certify that:
1. I am {amilAlai, with
the
requior on-site
sewers
and wells
as set
forth by the Municipality
of Anchorage (MOA)
and
the State of Alaska"
2. I install the
in
MOA
will
systenY
accordance with
all
codes and regulations!!
and in compliance
with
the design criteria o[
this
permit,
3^ I will Where to all
MOA
and State of Alaska
requirements
for the
set back
distances from any
existing
well, wastewater
disposal
system or Public
sewerage system on
this
or any adjacent or nearby
lot.
�~ /Ufi- WVE APPnmmFp Ow-llrt �fivAQ9 P1^P0.vqL ���7,6,7 ly
°^
�
����
���������
* DEPARTMENT
OF
HEALTH
AND ENVIRONMENTAL PROTECTION
825 L
STREET�
ANCHORAGE, AK 99501
264-4720
PERMIT NO:
DATE ISSUED:
APPLICANT:
ADDRESS:
CONTACT PHOWE:
87015� ENGINEERED DESIGN
O7/01/S7
JAN CHURCH
P.O, BOX 285
EAGLE RIVER� AK 99577
688�3793
LEGAL DESCRIP: SUBDIVISION: ROBANNA LOT: LOT 1 BLOCK: NA
SECTION: 25 TOWNSHIP: 15N RANGE: 2W
LOT SIZE: 1.25A (SQ.FT. OR ACRES)
I certi�y thaL:
1, I am {amiliar with :j. sewers and wells as set
�orth by the Municipality of Anchorage (MOA) and the State o{ Alaska.
2, l will install the system in accordance with all MOA codes and regulations�
and in compliance with the design criteria o� this permit,
3. I wil1 adhaskarequirements �or the set back
distances �rom any existingwell, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING COAll ES�
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTHlCALWORK MUST BE DONE BY A LJCENSED ELECTRICIAN.
S�GNED DATE: ^ '
APPLICANT: JAN CHURCH ��
ISSUED 8Y ^ DATE: ����
—~~~~���_.-'..____'_- _--~-___-_~_`_-�
�
June 22, 1987
Mr. Steve Morris
Civil Engineer, On-site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
RE: Robanna Subdivision: Lot 1
Dear Mr. Morris:
On behalf of our client, B.M.B. Construction, we are requesting
the issuance of a 3 bedroom septic system permit. The issuance of
this permit requires a waiver of separation distance to 35' distance
to a +25% change in ground slope.
This minor variation in separation distance will enable us to
place the septic trenches in an area that is ideal for septic
drainage. From my experience and knowledge of the area, this variance
of 15' will not cause a seepage of leachate from the hillside. The
slope in question, is covered with an established vegetation mat and
is limited in height.
If there are any questions or concerns, please feel free to call
me at 694-5196.
Sincerely,
Louis Butera, P.E. k;
LB:bls
' I SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: O ��� �yy u fy wcJ�iar/ DATE PERFORMED: <!// i1£r•7
LEGAL DESCRIPTION: 4o t /L v E' ���� �" 6�� %/��✓ 2 w Se �S
SLOPE SITE PLAN
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IF YES, AT WHAT /rZ� 15/aa/87
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PERCOLATION RATE I-S'o 00? Ary (n+ievtesf rr)
TEST RUN BETWEEN FT AND FT
PERFORMED BY: Eagle River Engineering Services CERTIFIED BY: �. DATE:
ox 713294
Eagle River, AK 99677
°55'00"NV 327.75'
s' woe ixdw
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1
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East. �� �`��OrESS�oe1F
�r
LOT w
UnLM
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TO BE
L I
0
SEPTIC VENT
TED WELL
SEPTIC PERMIT SITE PLAN
EAGLE RIVER ENGINEERING SERVICES
PO RX 773294
EAGLE RIVER, AK. 99577
6 i 694-5195
LEGAL:
SPECIFICATIONS FOR ON—SITE SEPTIC SYSTEM
ROBANNA SUBDIVISION, LOT 1
A. GENERAL
1. The well and septic plan are for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of
Health and State Department Of Environmental Conservation require-
ments.
4. All soil tests are advisory to the design and are to be verified or
modified in the field by the engineer.
S. All excavations and depths are advisory and are to be verified or
modified in the field by the contractor to meet Municipality of
Anchorage, Department of Environmental Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits
or easements and to locate any adjacent multi --family wells.
7. The excavation is to be exactly in the area shown on the site plan,
any deviation requires engineer approval.
a. It is always recommended that a surveyor locate the nearest lot line
position and the location of any easements.
B. TRENCH
1. The trench is to follow the natural land contour to maintain uniform
total depth of the trench bottom.:
2. The bottom of the trench shall be level, plus or minus 1.5".
3. The total depth of the trench excavation is not to exceed 6' at any
point.
4. Connection from the lift station to the leachfield is to overflow into
a manifold, to allow drainback of the delivery line.
5. The trench gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth
of 4' or equivalent is to be placed over the leachfield.
7. The area over the trench is to be finish graded to prevent ponding of
surface water runoff.
8. The septic tank and leaohfield must not be closer than 100' to any
existing private well, 150' to any Class "C" well, or 200 feet to any
community well.
RECOMMENDED LEACHFIELD DIMENSIONS
TOTAL. DEPTH = S' GRAVEL DEPTH = 4' TRENCH LENGTH = 49' TRENCH WIDTH - 5'
Soil Rating = 1.50
Bedroom Capacity -= 3
Septic Tank Size == 1000 (plus 250 gallon lift station)
LIFT STATION TO BE FROM ANCHORAGE TANK PER APPROVED PACKAGE PLANT INSTALLED TO
M.O.A. AND ELECTRICAL CODE REGULATIONS.
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DOC Co. dba
SU L1LMN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759
/ / r/
OWNER OF LAND I .J / i C4,14 JV C :4 DEPTH OF WELL 6a- S �C
ADDRESS Yn r3 CS y -'77 9 j� r= STATIC LEVEL OF WATER FT.
LEGAL DESCRIPTION l 071- Rr) J 4,-J /V A Ly,60 DRAWDOWN FT.
DATE • Started / / / 7 Ended 1/F• �r :z GALS. PER HR S G O
PERMIT NUMBER KIND OF CASING 6 K
KIND OF FORMATION:
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COSA Checklist NEW 2024.docx
COSA Checklist
Legal Description: ROBANNA LOT 1 Parcel ID: 051-281-83
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 6/16/1987 Total depth 60.5 ft
Cased to 60.5 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 5/2/2024
Static water level at beginning of test 26 ft.
Well production at time of test 4.9 gpm
Water storage tank volume NONE gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 4.84 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 5/2/2024
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank 58”
Date of pumping 4/29/24
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 9/10/1987
ALL standpipes present per record drawing
Total measured depth from grade 6.7 ft (max)
Measured depth to pipe invert from grade 3.9 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective. (ED)
If not, state depth into effective 2.5’ of 3.5’ ED
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date 5/2/2024
Results Pass
Fluid depth prior to test 4 in
Water added 730 gal
New fluid depth 11 in
Elapsed time 1440 min
Final fluid depth 2 in
Absorption rate 450 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 42 in (MOA 3.5’ED)
Effective depth used 14 in (Missing ED + Fluid Depth)
Effective depth (ED) remaining 28 in
Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots and
assumes approximately 12” of ED is missing.
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MUNICIPALITY OF ANCHORAGE
Development Services Department p p Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
- �,
Parcel I.D. 051-281-83 Expiration Date:42Z,��- 3
Legal description ROBANNA LT 1
Site address 18015 PIONEER DR Eagle River AK
Current property owner(s) YOUNG DAVID & MICHAELA
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Original Certificate Date: 4/27/2023
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist
Absorption Field Advisory
Tank Age Advisory
Other
X Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
COSA Approval_June 2022
MUNICIPALITY OF
Development Services Department
On -Site Water & Wastewater Section
Phone: 907-343-7904
Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 051-281-83
Complete legal description ROBANNA LOT 1
Location (site address) 18015 PIONEER DRIVE, EAGLE RIVER, AK 99577
Current property owner(s) DAVID & MICHAELA YOUNG Day phone
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass
Age 2 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ® Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ LAD Waiver Fee $
Date of Payment V h 3 Date of Payment
COSA # 03 G 3 3 Waiver #
COSA Application.doc
COSA Checklist copy.docx
COSA Checklist
Legal Description: ROBANNA LOT 1 Parcel ID: 051-281-30
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 6/16/1987 Total depth 60.5 ft
Cased to 60.5 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 3/30/2023
Static water level at beginning of test 45 ft.
Well production at time of test 3.4 gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 1.83 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 4/11/2023
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank 58”
Date of pumping 3/29/2023
Required maintenance completed, if AWWTS
Comments: 1250-gal HDPE tank installed 2021
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 9/10/1987
ALL standpipes present per record drawing
Total measured depth from grade 6.6 ft (max)
Measured depth to pipe invert from grade 3.8 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective. (ED)
If not, state depth into effective 2.5’ of 3.5’ ED
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date 3/30/2023
Results Pass
Fluid depth prior to test 5 in
Water added 500 gal
New fluid depth 7 in
Elapsed time 250 min
Final fluid depth 0 in
Absorption rate 450 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 42 in (3.5’ED)
Effective depth used 12 in (Missing ED + Fluid Depth)
Effective depth (ED) remaining 30 in
Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots and
assumes approximately 12” of ED is missing.
COSA Checklist copy.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 4/26/2023
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
4/26/23
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-281-83
1. GENERAL INFORMATION
Complete legal description Robanna Lot 1
Expiration Date: / 0 _ ! (9, 1 4-
Location (site address) 18015 Pioneer Dr, Eagle River, AK
Current Property owner(s) Church Day phone 696-2595
Mailing address same
Real Estate Agent Rebecca Baker, Rasmussen Prop. Day phone 947-8990
2. TYPE OF DWELLING:
® Single Family (w/wo ADU) U 1i T cy i%Q Q
❑ Duplex _ L
❑ Multiple Dwellings (Single Family and/or Duplex) JUL 0 2 2014
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class C Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Received by: Date: 764p/
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 92--(c
Date of Payment i12�,1 q
Receipt Number 0" 5Y2-91
COSA# 05G1`i12_q�
Date:
Date of
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) 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 NorthRim Engineering Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date
6. DSD TURE
SIGN
#1 Approved for
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms.
bedrooms, with the following
.�y`v `ga®es ery aeP - -
.� L
v
s 3:7
Stever .. k;'. Eng -
H 62-r
il6tions:
By: % Original Certificate Date:
The Mm Ipa of Anchorage Devlopment 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
Septic System Advisory
Well Flow Advisory
COSA blue sheet 9-1-12.dac
X Nitrate Advisory
Arsenic Advisory
Other
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: 6 4AIX/J 1-67- / Parcel ID:O 5 f - 2 el -- 83
A. WELL DATA
Well type P If A, B, or C provide PWSID # Well Log (YIN)
Date completed-6/14LE 7 Sanitary seal (YIN) Y Wires properly protected (Y/N)
Total depth 66, i ft. Cased to a�C1d It. �f Casing height (above ground) in.
FROM WE L LOG
Date of test
jWellStatic water level L f 5 -
Well
production
g.p.m.
WATER SAMPLE RESULTS:
Coliform ! colonies/100 mL Nitrate _-2,_L�mg/L
Arsenic 0.2 Z 7 ug/L Date of sampler
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material ---S9 P411CT (�� KE
Tank size /Z 5y gal. Number of Compartments Z
AT INSPECTION
6'113
3 ft.
g.p.m.
Collected by:
Date installed (U
Cleanouts (Y/N)
Foundation cleanout (Y/N) TY7 Depression over tank/N
(Y ) .� High water alarm (Y/N) Al
Date of pumping Pumper T/' s.
C. ABSORPTION FIELD DATA
Date installed 7 Soilrating g (g.p.d./ftZ or ftz/bdrm) / SU System type C,lY
Length _ 5,4 ft. Width ft. Gravel below pipe ft.
Total depth _kJft. Eff. absorption area a(1C1 fe Monitoring tube _Y__ Depression over field
Date of adequacy test Results (Pass/Fail) � For bedrooms
Fluid depth in absorption field before test _Q in. Water added .$_0 gal. New depth 7_ in.
Elapsed Time: 30 min. Final fluid depth U in. Absorption rate >_d•
9•p•
Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date
D. LIFT STATION N.A
Date installed
"Pump on" level at
Datum
Size in gallons
Manhole/Access (YIN) _
in. "Pump off"level at in. High water alarm level at
E. SEPARATION DISTANCES
WELL ON LOT TO:
Cycles tested
Septic tankllift station on lot �4!?
Absorption field on lot / 00 y r
Public sewer main /V 4
Sewer /septic service line Aid if
Animal containment areas U r�
Meets alarm & circuit requirements?
On adjacent lots 00
On adjacent lots 16L)", -
Public sewer manhoWcleanout NA
Holding tank
Manure/animal excrete storage areas /Dd
SEPTICIHOLDING TANK ON LOT TO:
If
�.
Building foundation Property line Absorption field SLY `f
Water main /V�f Water service line ZS . Surface water /12d "I -
Wells on adjacent lots lae �r
ABSORPTION FIELD ON LOT TO:
Property line /0 r/fi Building foundation Jr � Water main AIA
Water Service liney/ f Surface water /OCr �>F' Driveway, parking/vehicle storage � O
Curtain drain Al.+ Wells on adjacent lots
F. 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 S � 6AJ
Date �_
COSA brown sheet_IO-10-12.doc
....Ir........
�4 R` : Steven W. Eng , <.
ai7,p a FE 6256 >:
in.
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UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBIUTY FOR THE INITIAL TRANSACTION ONLY
AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY.
LISTED DISTANCES PREVAIL OVER SCAUNG. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
LOT=SURVEY TYPE
SYMBOLS
FOUNDAl1aN AS-BULT
D RNA. $McTuRE As-mxr
SET REBAR � � DRAINAGE ` ASPHALT
PLOT FLAN ... As-ew.r . ..m suncr ... ArNY
F� '''
O FOUND REBAR gag ,WOW FENCE '.:: CONCRETE
i A aALr ... Ran o caRrJms sEr
oN As
00 n ASSUMED ELEV. 9t --X w METAL FENCE ® WOOD DECK
PLOT PLANS & LOT SURVEYS
NOTE:
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS,
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED,
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT,
ALL DISTANCES ARE RECORD UNLESS OTHERW9SE NOTED.
SURVEY CERTIFICATION
..�,�rrR�`r1
Prepared by
PLOT PLAN�.•-��
OF••• p�
Robert E. Johns, Jr. & Assoc.
aw ae oa.� as a.Ne.a I..eN .r awl IAi
P.• ".... ��
Professional Land Surveyors
nw. rows s .rrlM.r r a aw let mn..�.••
r Nwen m tlw pm eM m tlw M a mr
♦
7700 Brink Drlva
ANCHORAGE. ALASKA 99504
raa.leee Nw 0en
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Scale:1 n _ 601
Rec, Lot S.F.
Rac Plat File No.
e�w °na imwta
FOUNDATION AS -BUILT
•• •• •• %
Date Sur" d:
�` 04/15/14
Drawn b
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Checked III A K
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Date Drawn:
Grld:
WO
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04/15/14
NW753
14-316
FINAL STRUCNRE AS -BUILT
, , 21 ;'• >aAI
Legal Description:
I, ea.n E Jebw, r, n..nr eerWl tlwt I
Nw e.„w,•we m .rr+t .war a aw
Vol,
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ROBANNA
Pr —4,(�
MUNICIPALITY OF ANCHORAGE
• .k DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
HAA#
1. GENERAL INFORMATION
Complete legal description Lot 1; Robanvui Subdivision
Location (site address or directions) 18033 P.ioneeA Dkive
Property owner -tan Chunch Day phone 384-1573 (w)
P.U. Box 773184 Ea 696-408G
Mailing addressg2e RtiuPJr. AK 99577
Lending agency
Mailing address
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
Day phone
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
Holding tank
Community on-site
Public sewer
NOTE: If 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
Address
S & S ENGINEERING
- - -
Engineer's signature
Eagle River, Alaska 9
6. DHHS SIGNATURE
Approved for1 3 bedrooms.
Disapproved.
Conditional approval for
Additional Comments
Phone 6 9tf� "2 9
Date A�_-
bedrooms, with the following stipulations:
By: � _ (Sim cir, Date / -z - 9 -93
11ITIr
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1 91) Beck MOA k21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: �-c>< ` &o��,jA De S'y7, Parcel I.D. 0 5-1 - ;ZS �k
A. Well Data
Well type PPAycc-�k, If A, B, or C, attach ADEC letter. ADEC water system number
Log present N) �l� Date completed � Driller 4�>J ypo-o-1
Total depth (o b l S V Cased to L.�0` 64 Pf S,F 44-- sO Casing height IZ+(
Sanitary seal O)V) Wires properly protected (Y/N)
+ i
�S .I,r ce GL>En
FROM WELL LOG AT INSPECTION TJ #Aa0s A-
Date of test Lc,'' \ L�" cb -7
Static water level 4,221
Well flow t-eg•p•m•
Pump levell oy1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot \ kz:>� t
Absorption field on lot t o�
Public sewer main
Sewer service line
WATER SAMPLE RESULTS:
Coliform 0 Nitrate
Date of sample: 72 - 3 -
B. SEPTIC/HOLDING TANK DATA
; On adjacent lots 10 0
sewer manhole/cleanout
Petroleum tank
A
a.ia Other bacteria
Collected by: � S S-'4�C �•
Date installed � o ' Tank size 1 -LSC' Compartments Z
Cleanouts&/N) \1 Foundation cleanout (VN) Depressi�r (Y/&
High water alarm (Yr �, Alarm tested (Y/N)
Date of pumping � t" � o < 6" Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot \L-'--6 \� On adjacent lots 1 t�'-0 \ Foundation
To property line \ e Absorption field 1 b Water main/service line
Surface water/drainage \ v 0
S 1�-
\�\k
CONTINUED ON BACK PAGE
72-026 (3/93)' Front
rn
c
C_z
E n
g.p.m.�
r c
Ar
c�c
On adjacent lots
; On adjacent lots 10 0
sewer manhole/cleanout
Petroleum tank
A
a.ia Other bacteria
Collected by: � S S-'4�C �•
Date installed � o ' Tank size 1 -LSC' Compartments Z
Cleanouts&/N) \1 Foundation cleanout (VN) Depressi�r (Y/&
High water alarm (Yr �, Alarm tested (Y/N)
Date of pumping � t" � o < 6" Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot \L-'--6 \� On adjacent lots 1 t�'-0 \ Foundation
To property line \ e Absorption field 1 b Water main/service line
Surface water/drainage \ v 0
S 1�-
\�\k
CONTINUED ON BACK PAGE
72-026 (3/93)' Front
C. LIFT STATION
Date installed
Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent (Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
SEPARATION DIST-AIVCE FROM LIFT STATION TO:
on lot
D. ABSORPTION FIELD DATA
On adjacent lots
Date installed CI - 1\�>- 121 Soil rating (GPD/Ft2)
'Pump
Surface water
�So '� I5(;
Length 5-4 Width 5 Gravel thickness
Total absorption area ebb Cleanout present 6%)
Date of adequa y test �� s 66 .S Results (pass/fail)
J5�'� Uogfv S G(�� Gars f,
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/b
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
System type
Total depth 8 - `1
Depression over field (YA1%)
for Bedrooms
test
If yes, give date
Well on lot k n V �- On adjacent lots 1 O c) Property line k'1 I
To building foundation 1 d t k To xisting or abandoned system on lot VA,
On
P -
On adjacent lots 3 p t Cutbank /k Water main/service line 1
k �
Surface water 1bd Driveway, parking/vehicle storage area 5a
Curtain drain
Date Eagle : ver jarlaska 99577
HAA Fee $ qr)r> . �� Waiver Fee $
Date of Payment j 7✓ 1 13 Date of Payment
Receipt Number t>2 5'VXJ ,3 2--6 Receipt Number_
72-026 (3/93)' Back