HomeMy WebLinkAboutROBIN HILL #3 BLK 4 LT 2o -ooo
Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP171362 PID Number: 017-394-03
Dwelling: ❑■ Single Family(SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade
Name ABSORPTION FIELD
POWELL FAMILY TRUST
Site Address 0 Deep Trench ❑Wide Trench ❑ Bed ❑ Mound
13001 FLORAL LN ❑ Other
Phone `Number of Bedrooms Soil Rating Total depth from original grade
6 0.8 GPD/SF 11 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 4.0 Ft. 7.0 Ft.
ROBIN HILL#3 BLK 4 LT 2 Fill added above original grade Gravel length
Township Range Section 1.5 Ft. 85 Ft.
Gravel width Beds: Number of Lines Distance between lines
SEPARATION DISTANCES 2.0 Ft. Ft.
To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Tank Line 1190 Ft2 Ft.
Well 100'+ 100'+ 1 550,4., TANK ❑p Septic ❑S.T.E.P. ❑Holding ❑Other
Manufacturer Capacity
Surface Water
100'+ 100'♦ ANCH TANK 2000 Gal.
Material Number of compartments
Lot Line 10'+ 10'+ NA STEEL 2.0
LIFT STATION
Foundation 101+ 1 01+ Manufacturer Capacity
Gal.
Remarks
Alarm location Electrical installed by
PIPE MATERIAL House to tank 3034Tank to 3034
Installer drainfield
MIKE ANDERSON Drainfield 3034 co/MT3034
Inspector MIKE ANDERSON, P.E. BENCH MARK (Assumed elevation) 102.2 ft
Inspection Location and description
dates: 1g, 12-11-17 2"" 12 11 17
yd 4'h BACK DOOR SIL
ON-SITE WATER AND WASTEWATER SECTION APPROVAL 4 e r -Sta7mpk_
Conditional Approval: Date • ' 777 .7 ft,
ia* 49TH i.,;.--4 ..r rt
'4
• 414" ,'
..
. MICHAEL N. ANDLRSCN ,a-. J
e c%,•. CE-94 9
Septic S stei. O ��`�r,.•. • •
Approved Date 3' _1 l 1,4°, • .pc l4,<�;,,, ..
Note: this approval does not include well permit requirements. ��� ca4 s r
(Rev 05/02/18)
Permit No. OSP171362 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: ROBIN HILL #3 BLK 4 LT 2 PID No.: 017-394-03
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eat e9_/ '.MICHAEL N. ANDERSON. -
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sRaaRF \93.1 •4 ,p No. E 7469 \A
SEPTIC SECTION 82 _
N.T.S. DRY 10/2/17 4411„=�\ 44
l
Municipality of Anchorage �`-(�r ;r1 R •�s� E61?) tt;
Development Services Department t,�\.• • i' ,f,
• .•�,,
Building Safety Division �d - t'
• /• On-Site Water and Wastewater Program e 4 9 T`� 'Jr,., �,
4700 Elmore Road i /�
P.O.Box 196650 Anchorage,AK 99507 ir
we' � ' i`
ww.ci.anchorage.ak.us / -.77-,,• MICHAEL N. ANDERSONN
�/ (907)343-7904 �e ,.'� 69 ; ?
!><:.
Soils Log - Percolation Test '0 ,-�e; _ •_ .•• �;;
Performed For: P -z, ( i-_-__-...„,(,, -4.,1,,, i Date Performed: ?—
Legal Description: )kivt hi)/14, ' B 1( Lot- 2 Township.Range,Section:
Slope Site Plan
iz-�DCT Ari---z----
Depth
epth
(Feet)
Loa CtOvt%C S
1-
2-
3- —
4- t" (D►'I
5-
6- lj!'�l/l/v(
7-
8-
WAS GROUND WATER
9- ENCOUNTERED? /ll 0
1 0- IF YES.AT WHAT DEPTH?
Depth to Water After
11- Monitoring? P v1
12- Date: /0/0/
13- (r Pv-c-^ 5.p t- r l• (c--
14- Reading Date Gross Time Net Time Depth to Water Net Drop
:,yIfffig ,'V-�-IMEMENIIIZ?//b
17- ---��11.11M Tv 0,
18- _Oxo N v r, ---_- to ION
19- ---MI
20- ---WM
PERCOLATION RATE / l (minutes/inch) PERC HOLE DIAMETER (p
TEST RUN BETWEEN 1 FT AND S FT
COMMENTS
PERFORMED BY: ji .:t /q_A I CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ///3/245(
-
Municipality of Anchorage • ,�°EPtkGNE R'S SEAL) , lti
an°Development Services Department r • r
Building Safety Division y•• •`d� v!
I.
On-Site Water and Wastewater Program •
* • 4 Q T ','i: I
4700 Elmore Road ✓ °
CI
P.O.Box 196650 Anchorage,AK 99507 ef
r•• • •
www.ci.anchorage.ak.us
(907)343-7904 1 .01.• MICHAEL N. ANDLRSCN ;4 ✓
Ca**.�'••, CE-9469 •° .; ',i
Soils Log - Percolation Test 1dIr�9F•' •.••�L.��;�,"
Performed For: „r / F- M,(y 7 vu k 4• Date Performed: D r
Legal Description: Rip y wit ti,/(c nz 3 (3'--( L. Z Township,Range.Section:
Slope Site Plan
C±i_____4-04 ( )
Depth
(Feet)
(U/C\a n`c-- S
2- 1-7t8 p lk'✓1
3-
4-
5-
6-
7-
8-
M C'7i.v/ WAS GROUND WATER O
9- ENCOUNTERED?
S
10- IF YES.AT WHAT DEPTH? L
Depth to Water After P
P
1 1- Monitoring? ✓ E
12- Date /LS V% .9-
13- PV`-ems- 5 v k, d
14- Rending Date Gross Time Net Time Depth to Water Net Drop
15- WPM IMMO VI ��
16- � �- I✓%r 1 2 t,17- ---_� to i �in
(?
18- ---�_ (vtt MOM T4 t9
19- ---_M ( 1' 'r/1►1M
20- (a°,10 t-,4 , ---E _
ME
PERCOLATION RATE /tel (minuteshnch) PERC HOLE DIAMETER Ce "
TEST RUN BETWEEN FT AND j FT
COMMENTS
PERFORMED BY: n4 i✓C, I CERTIFY THAT THIS TEST�WAS
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /s// 1 9.._
Iz- 7t— ( 7 a
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„,C1PALlr` MUNICIPALITY OF ANCHORAGE ,..c it t
% On-Site Water&Wastewater Program S`:•
PO Box 196650 4700 Elmore Road
'” Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax (907)343-7997 x
I , .s " "%
http://www.muni.orglonsite
4NCMORpc'�
On-Site Wastewater Disposal System Permit
Permit Number: OSP171362 Effective Date: 12/7/2017
Work Type: Septic Upgrade Expiration Date: 12/7/2018
Tax Code Number: 01739403000
Site Legal Address: ROBIN HILL#3 BLK 4 LT 2 G:2838
Site Mailing Address: 13001 FLORAL LN, Anchorage
Owner: POWELL FAMILY TRUST Lot Size in Sq Ft: 60778
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 6
This permit is for the construction of:
El Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: /AA Date: /2/46/ -.-.
Issued By: LA A,CrCi f1. C- Date: )2/0
1
MUNICIPALITY OF ANCHORAGE
IlL
Community Development Department
�' Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water& Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 017-394-03
Property owner(s) POWELL FAMILY TRUST Day phone
Mailing address 1 3 00 1 F 6rat L cine i (kt,c.4, MC 't 951G
Site address Ske)E.
Legal description (Sub'd., Block& Lot) ROBIN HILLS #3 BLK 4, LOT 2
Legal description (Township, Range & Section)
Lot Size 60773 Sq. Ft. Number of Bedrooms 6
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field ❑X Initial ❑ Single Family (SF) ❑X
(w/wo ADU)
Septic Tank ❑X Upgrade .0 __ Duplex (D) ❑
Holding Tank ❑ Renewal ®~
ultlple Dwellings El
Privy CISAI SF and/or D)
Private Well ❑ c( ''
Water Storage CIa ` `201,
a.
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.
/11,-A--.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 5409 Waiver Fees:
Date of Payment: til l I ii Date of Payment:
Receipt Number: Receipt Number:
Permit No. OSPIn" /3(0a- Waiver No.
Permit App__.:• :L.,c
Dec. 1, 2017
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re: New Septic Permit
Legal: ROBIN HILL#3 BLK 4 LT 2
To Whom it may concern:
This is a request for a septic permit on the above referenced lot. A two test holes was excavated
and found poorly graded sand, SP and gravels GM, for the entire depth of the hole. The perc rate
was 14 minutes per inch therefore a deep trench as been designed. From the site plan all of the
surrounding properties are occupied and appear to be functioning well. The slope near the system
is at 5-10 percent with no slopes over 25 percent.
This permit will not impact any of the neighboring properties due to the lot layout.
Please call me if you have any questions.
Sincerely Gfiy. -;
Michael N. Anderson, P.E.
4661 Natrona
Anch, Ak 99516
Ph 727-8864
DESIGN CRITERIA: I MOUND OVER
(TH#1) (TH#2) o GRADE
6 BDRM X 150 = 900 GPDQ _ORG 1.0 ORG f
1SOILS = 900/0.8 = 1125 GPD FILTER FABRIC
1125 GA/15 = 75' �.�4"0 PIPE
SM,GM SM'GM -4.0
\—SE1h'ER ROCK
(1)TRENCH
11.5' DEEP -14 5
7.5' EFFECTIVE
2.0'WIDE 2.0'
75' LONG 19.5 — '80
SEPTIC FIELD SECTION
—1 :// - - - - - �
1
S'
1
I
-MOUNTAIN PLACE- _
–, _ _ _ – it .
w, I I
_i II
—t < II
Si I
LL 1 PROPERTY LINE
i
— � — — _,. JI ,
// i 1- —�� — –t� I •EXISTING WELL EXISTING WELL
EXISTING HOUSE �i 100'RADIUS 100'RADIUS
L_
JI a
1 :� _ _
---} PROPOSED fi16\ i 0
cc
DRAINAGE FIELD \ / �\ EpJ \\ SP�1fc �\ m
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Septic Design Prepared for _�m���mi�I�
POWELL FAMILY TRUST .4� O� .. 44
ROBIN HILL #3, BLOCK 4, LOT 2 .i :' 49T %\ -.
Anchorage, Alaska , i
•Michael N. Anderson, P.E. °O� MICHAEL N. ANDERSON:km
E DATE: 12/7/2017 �4�:, No. 469 '�,:
4601 NATRONA AVE DRAWN: DJR .♦ ••,(.�/7(.::.�'F ���
(907) 727-8864/ FAX: 07) 345-1391 SCALE: 1"=200' X444 "SS,� 44
I ' I
,( . ''..1.‘...:','''''''''''' I I----
I
I 1 `. /
I /
i /
% --- ROBIN HILL#3
BLOCK 4.LOT 1
/
I y ��� - PROPERTY LINE \�`.\ / -J
-• I
�// \• \• \: • 10'UTILITY EASEMENT II
W -- — — ..-•:,,r,�,•._ _ ,.,_+,'t...•.- r'.- - T — — —'-1 LIN HILL#3
/ Z T EXISTING WELL 1 ,I 8 OCK4,LOT8
/ \��� ''•'• \\�- , 100'RADIUS 1ll ' I
x d :.`• ii(JBIN HILL#3 I.
BLQCK4.LOT 2 `
•
WELL J' •
\\
r l I, 1 ..,
\ /
/
J
A
� EXISTINGJ + SECONDARY SITE,
\ 1
;\l L \ r� \ ,%'- N)\ ADVANTEX EFF 30'X5'
\\ t f, EXISTING /,I 'cp. .\ , 3\
\\ TANK TO BE • \\\, O y\ SHED
i �\ \
\ DECOMMISSIONED ��� \ / ► \ 1 \
PER UPC �7: i'
/ :: ' / 7
,• MT
`.�_` `\\
EXISTING SEPTIC SYSTEM TO •/' \\\ \ SEPTIC \1 \
DECOMMISSIONED PER UPC \ \\
NEW 2000 \ \
\ GALLON TANK ) \ \ `�_-�� __ ,
// \ / \\ x EXISTING WELL
N/ \
/ ROBINHILOT / \� 100'RADIUS
BLOCKS,LOT2 1 \ \
1 N _ / /
PROPERTY LINE I
/ .• I \ WELL®
II
11 A \ 11
• \ /
\ \ II
Septic Design Prepored for �iosswi�%�_
POWELL FAMILY TRUST ••-� OF q A4
ROBIN HILL #3, BLOCK 4, LOT 2 ;' 49TH %\' = *.%
Anchorage, Alaska •, •
• r
••
':MICHAEL N. ANDERSON;
Michael N. Anderson, P.E. DATE: 12/7/2017 No. E 9469
4601 NATRONA AVE DRAWN: DJR -;,..•11-
ANCHORAGE,
,�
N HORAGE ALASKA 99516 •�O. s `�• !/• �,\P-i6•
A C
(907) 727-8864/FAX: (907) 345-1391 SCALE: 1"=50' 444:���5;4444
Municipality of Anchorage . �1o'� s (!4S 6A
Development Services Department .
•t`', ;'
Building Safety Division 0 y• v
4\ On-Site Water and Wastewater Program •d *; 49T `'.�
) 4700 Elmore Road d1
P.O.Box 196650 Anchorage,AK 99507 , e
www.ci.anchorage.ak.us i MICHAEL N. ANDERSON .v ei
(907)343-7904 �?i-:''..�' CE 9469 •"1/4;
Soils Log - Percolation Test ��t�,• �.........•,:,:"
Performed For: P tfv,,,.c I/ Faun) ly 'T vv it 4.-- Date Performed: 0 GT2 Zu(
47.
Legal Description: p.,L7 Na t n 14,1(4 P 3 f3,-4 L Z Township,Range,Section:
Slope Site Plan
41 alliMIIP
Depth
(Feet) •
1 _U,WC\onL. S
`
2- 12r p(kvl
3-
4-
5-
6-
7-
8- . A
'~
r G2,4 WAS GROUND WATER /
9- ENCOUNTERED? t O
10- IF YES,AT WHAT DEPTH?
U
Depth to Water After P
11 Monitoring? P/_ E
12- Date: (v/,w/ /�
13- RI\-r✓^ S vel it, d .A'
14- Reading Date Gross Time Net Time Depth to Water Net Drop
15- Mai IMO VI MIN
16- M-EMI I'll ' ' ,,2 �
18- ---M- b �
19- ----M (O ,' ��:ll►a
20- (3.O141Uw► . ---OM
Mil
PERCOLATION RATE /Pt (mmuteshnch) PERC HOLE DIAMETER CO '
TEST RUN BETWEEN L{> FT AND ^"- FT
COMMENTS
PERFORMED BY: P/1/ ..A.t I CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: -/s// rpyt 9._
Municipality of Anchorage .d"cI R' e k)*
Development Services Department ��P;
~'-'L)~ MUNICIPALITY OF ANCHORAGE
" DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
N AM I. HONE
MAILING ADDRESS ,/1
LOCATION
DISTANCE TO:
Manufacturer
Liq, c
DISTANCE TO:
Manufacturer
IF HOMEMADE:
Well
Well
DISTANCE TO:
Length of, ae~.~h line
No. of lines ~
Top of tile to finish grade ~.~
Length
Width
Inside length
Dwelling
Foundation
Material beneath tile
Depth
Type of crib Crib diameter Crib depth
Well Building foundation
DISTANCE TO:
Class Depth Driller
DISTANCE TO: Building foundation Sewer line
OTHER
PIPE MATERIALS
INSTALLER
NO. OF BEDROOMS
PERM,T
No. of art nts
Liquid depth
PERMIT NO.
Material Liquid capacity in gallons
Nearest lot linc, PERMIT NO,
Trench,v~ Distance be~wpe~ lines
~ ~) inches
~// Total~tion area
Total effective absorption area
Nearest lot line
Distance to lot line PERMIT NO.
Septic tank I Absorption area(s)
IAP[~I~OVED//~ DA~E LEGAL
~'~'% MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
EW
[] UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
l Well
DISTANCE TO
Manufacturer -
Liq. capacity in gallons Well
/~) IF HOMEMADE:
,STANC T&
Manufacturer
DISTANCE TO; Well
No. of hnes .~ Length of each lin~
Top of tile to ~inJsh gradel X/~
Length
Width '
Type of crib Crib diameter
DISTANCE TO: Well
Class Depth
DISTANCE TO: Building foundation
NO. OFBEDROOMS
Absorption~r~ea Dwelling ,~ ~ PERMIT NO.
I nside length
IDwelling]
Foundation
Total length of lines
Material beneath tile
Depth
Sewer line
Material
~:.t-~
Width
Material
Nearest lot line
Trench width, s~
~_~ ~¢~/ inches
inches
No, of compartments
2.
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Distance between lines
Total effective absorption area~
~'O 0/x
PERMIT NO,
Crib depth I Total effective absorption area
Building foundation I Nearest lot line
Driller Distance to lot line PERMIT NO,
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
LER
REMARKS
DATE LEGAL
ALASKA n i onm nTAL conmoL
~n§Jn¢¢r'inq 8 I~nuJronmcnlctl
S I UICES,
InC.
October 15, 1983
Department of Health & Environmental Protection
825 L. Street
Anchorage, Alaska 99501
Attn: Robbie Robinson
Dear Mr. Robinson:
On October 12, 1983, I inspected the septic system installed in Ro~in
Hills Subdivision, Block 4, Lot 2. Although I was able to measure many
things, I have no idea as to whether or not the system is adequate,
since I did not do the first inspection. I don't know if the soil the
trench was built in was rated correctly, nor whether it was the proper
depth, nor whether it was free from any seeps, nor whether the bottom
was level. I also don't know how much gravel is in the trench now. I
attempted to measure this by dropping a tape down the standpipe, and the
tape stopped going down when it was only 24 inches below the top of the
sewer rock level. This does not preclude the possibility that'rocks
fell down the standpipe and the tape got hung up on them rather than
measuring the true gravel depth, of course. At any rate, here are all
the measurements I took on the final inspection. The tank and sewer
pipes were all level. I have left blank the spaces for "Material
beneath tile" and "Total effective absorption area" since these are
unknown to me.
Sincerely,
Dar~y~vevens
Engineering Geologist
~MUNICIPALITY OF ANCHORAGEs,
Environmenta ~protection
-~ Department,[if Health and ~
" 825 ~ Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * * *._~
Permi't
WELL AND/~iI~ ON-SITE SEWER PERMIT I;5¢
l~ '.~0
Applicant: ~ 0V% 0]W% ~&~ Mailing Address:
Location: Phone Nu er: = N a
Legal Description: ~ ~ ~ ~0 ~ l~J~ Lot Size:
Type of Soil Absorption System Is:
Trench: /Drainfield: Seepage Bed': Holding Tank:
Soil
Rating (sq. ft/br)
I
Maximum Number of Bedrooms:
The Required Size of the Soil Absorption System Is:'
DEPTH 9.C LEN6TH
__. GRAVEL DEPTH --~ WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = I ~)-~d GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
***
* * * TWO(2) INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection.and approval by this departmen~
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * *
Z certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
th~id~nc~ ~emodeled to include more that 3 bedrooms.
App~i~a~
Date: ~ ~ ~ --
SWP/024 (1/81)
LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST J~/~0~
PERFORMED FOR:
LEGAL DESCR,PTION:
SLOPE
SITE PLAN
1
2
3
4
5
6
7
8
9
10-
11
12
13
14-
15
16
17
18
19
20
/
/
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
/ e/./7-~ ~;,-/7 /e~,~.~ ,,--/'¢ ,~Z
~ ~,~7/0~ ~
PERCOLATION RATE ~¢'~ (minutes/inch)
co~.~s ~~ s -~3..~ ~~ /
ALASKA en 'onmenTAL' COnTgOL $~RUIcd$, INC.
~n~ineerinc~ G ~nuironmental Studies
PERCOLATION TEST DATA SHEET
zip cODE
LEGAL LOCATION
TOTAL DEPTH OF HOLE
ZONE TESTED
5,5 f': To ~
TH Il J
READING# CLOCK TIf4E NET TIME DEPTH TO NET DROP !RATE (min/'in)
DATUM
j -t. tJ,~u I0:00
,
.
_ .o 10:,.5o tomlSq . ~'z
FINAL PERCOLATION RATE
PERFOR"ED BY J.-,?-_.~
" /~ (min/in)
ghee) zofe.
12oo U.l,:st 33rcl Auen~, Sui,Z,o~- Anchora§e.'Alaska 99503 *, (907) 276-1361
SOILS LOG' CASING LOG
' Total
Time ~ ] Depth · Materials and Remarks Length Len~lth
No. Depth ~mple De~ription -
633 EAST 81ST AVENUE
ANCHORAGE, ALASKA 99502
SUBSUEF^CE EXPLORATION
Shift Re¢ort of Operations
Depth-Begin Shift
Dep'~h-End Shift
Depth Drilled
Drilling
Pumping
Surging
TIME DISTRIBUTION HOURS
Pull Casing
Standby
lABOR
Name
EQUIPMENT
Item ~ Hours
Crane
Drill-Rig
Flatbed
Pickup
Truck
Welder
Pump
Notes:
MUNICIPALITY OF ANCHORAGE
' DMSION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECITON
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
Application Date
(a) I~gal D~p~i?tionf~/~.. 4;_. (include~i~ ~t,/ block ~O~3subdivisi .on,. ,~i~~--secti°n'z tcwnshSp ,j r. ang.e )
Location (ad~ss~ ~o~e~~
Applicants Add~ess
(c) Applicant is (check one) Lending Institution ~-~ ~ Owner/builder~;
Buyer ~ ; Other ~ (explain);
(d) Lending 'Institution_/~, ·
(e) mai sstate co.
Address
Telephone
2. T_~ of l~sidence
Single-Family~
Numbe~ of Bedrooms
3. Water S~
Individual W~ll~
0
M~lt i-Family ~
O~er (~s~i~)
Community ~ Public ~-~
Note: If ~nity ~11 system, must have written confirmation frc~ the State
Department of Environmental Conservation attesting to the legality and status.
Is the ~11 adequate fo~ the number of bedrocms specified in this HAA (Y/N)
_~_~Ge Disposal.
OD~ite ~ Public I--~ Co~,¥~nity ~ Holding Tank ~
Is the wastewater disposal system adequate for the m~mber of bedrooms (Y/N)
[Page 1 of 2]
2-15-84
5. Engineering Fi~m P~oviding Ins~ctions, Tests, Data and Information
I o~tify that I have checked, verified, or confo~d to all ~'OA [{~A Guid~lir~s in
effect on the date of this inspection.
6. DHEP Approval
Approve d for -~ bedrocms
Approved ~ Disapproved F-~.
Terms of Conditional Approval
Conditional~
Date
'Fne Municipality of Anchorage Depa~tmsnt of ~ealth and Envirorm~ntal P~otection does
not guarantee the contimled satisfactory ~erfo~mance of the water supply and/or the
wastewater disposal system. This approval indicates that, as of th~ validation date
shc~n above, based on the data and information furnished by an engineer registered in
the State of Alaska, the water supply and wastewater disposal system is safe and func-
tional for the number of bedrcc~s and type of structure indicated.
(D~EP SEAL)
7. Mail the HAA to the following address:
!
K~2/d5/s
2-15-84
MUk ~,LITY OF ANC~OP,~
DEPT. OF H~ALTH &
MUNICIPALITY OF ~C~GE-~--~NMENTAL
PROTE~IO~~
H~ ~O~TY ~PROV~ (~)~,Jlll 9 1~R4
C~LI~ - F~RU~Y 1984
Legal Doscr~p~[i~'~ ~t*/~
Well' Classification ~
Well Log P~esent~.Y~.)
Total Depth ~fEP~O/ Cased to
Static Water Level /7~/'
Casing Height Above Ground /, ~
Electrical Wiring in Conduit ~N)
Separation Distanoes f~om Well:
To Septic/Holding Tank on Lot /0~/ ~
To Nearest Edge of Absorption Field on Lot
If A, B, c~ C, D.E.C. ~p~ed(Y/N)
Date Completed ~ 7' , Yield ~/~/~q
~p~O/ ~pth of ~outing -~/~ ~
~ ~t At ~~
Sanit~y ~al on Casing ~)
~pression ~ound ~l~ead (Y~
; On Adjoining Lots
7~5~/~)~; On Adjoining Lots~/O~)
To Nearest Public Sewer Line ~ j ~c- To Nearest Public Sewer
Water Sample Test Results ~.'~/~~z4 ~
SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes ~/N)
Depression over Tank (Y~
Air-tight Caps ~N)
Date Last Pumped
No. of Cc~pa~tmmnts ~
Foundation Cleanout ~/N)
P%~ping/~4aintenance Contract on File (Y/N) ~3J~% ; for
Holding Tank High-Water Alarm (Y/N) ~3 J'/~ Temporary Holdirg Tank Permit (Y/N) 4///9
Separation Distances f~om Septic/Holding Tank:
To Building Foundation
To Disposal Field ~"
To Stream, Pond, Lake, c~ Major D~-ainage
To Water-Supply Well
To Property Line
To Weter Main/Service Li~
[Page 1 of 2]
2~15-84
C. ABSORPTION FIELD DATA
De
Soils Rating in Absorption Stmata /~--~2~ Type of System Design
Date Installed /d)/~.~ Length of Field ~,~.~,4~ /g~5
Width of Field ~'~4~ ~"f'~C~_ Depth of Field ~/ ~/~
Square Feet of Absorption area ~---~j~) Standpipes PIresent ~N)
Depression over Field (Y~ Date of last Adequacy Test
Results of last Adequacy Test
Separation Distance frcm Absorption Field:
To Water-Supply W~ll //~/ To P~operty Line ~'
To Building Foundation ~ ~) To Existing or Abandoned System on
Lot /l//~- ; On Adjoining Lots ~ '~ ~O !
To Wate~ Main/Service Line JJ/~- To Cutbank(if present)
To Stream/Pond/Lake/c~ Major D~ainage Course
To D~iveway, Parking Area, o~ Vehicle Storage A~ea ~ /DO/
Date Installed
Size in Gallons
"Pump On" Level at
High Water AlarmLevel at
Tested fo=
Electrical Codes(Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
Meets MOA
Co~n~nts
** Check Permitted Bedroom Rating A~ainst HAA Request **
I ce=tify that I have checked, verified, o~ conformed to all MOA HAA Guidelines in effect
on the date of this inspection.
Company ~.C~ ~ ~"~ ~'"
KB1/dL/s
[Page 2 of 2]
Date
2-15-84
MUNICIPALITY OF ANCHORAGE
1-Th
!sitDevelopment Services Department it Phone: 907-343-7904
On-Site Water & Wastewater Section \� Fax: 907-343-7997
Certificate of On-Site Systems Approval
Parcel I.D. _017-394-03 Expiration Date: p 12-!
1. GENERAL INFORMATION
Complete legal description _ROBIN HILL#3 BLK 4 LT 2
Location (site address) 13001 Floral Lane,Anch Ak
Current property owner(s) Powell Family Trust Day phone
Mailing address same
Real estate agent Day phone
2. TYPE OF DWELLING: 123456
® Single Family (w/wo ADU) <2+ 'e9
❑ Duplex <':n9 : o
❑ Multiple Dwellings (Single Family and/or Duplex) F 4-/
3. NUMBER OF BEDROOMS: 6
co
e9 9 Z
4. TYPE OF WATER SUPPLY:
TYPE OF WAS DISPOSAL:
Private Well • ® Private Septic
Water Storage ❑ Holding Tank ❑
Community Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Waiver request for: Distance:
•
Received by: Wijic Date: ,//t (Q'
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 280. °O Waiver Fee $
Date of Payment oa-1411 Date of Payment
Receipt Number CA)2tk.4)0 8 WI Receipt Number
COSA# 0sClal DS-2- 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. I acknowledge that On-Site staff may visit the site to verify the information submitted.
Name of Firm MICHAEL N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE.ANCH AK 99516
Engineer's Printed Name MICHAEL N ANDERSON, P.E. Date 2-4-19
:49TH 7' 3
6. DSD SIGNATURE •••.• ••.• ,i
)6 System #1 Approved for bedrooms •. •••.hucHAEL
N. ANDERSON
System #2 Approved for bedrooms � ice . CE- 46
zt,.•'
Disapproved R?tO F•;•_ .
‘ •:dr;;e;=
Conditional approval for bedrooms, with the following stipuTatit3 °—'
ort-SITE
WATFR AND
o WASTEWATER oz
` PROGRAM
SER
By: _ /L — Original Certificate Date: 1 2!1
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
COSA Checklist
Legal Description: ROBIN HILLS#3, BLK 4, LOT 2 Parcel ID: 017-394-03
If more than 1 septic system on lot: COSA Checklist# of Structure served by this system 1
A. WELL DATA
❑� Well log is filed with Onsite (or attached) Well production at time of test 4.5+ gpm
Date drilled 10'1983 Water storage tank volume na gallons
Total depth 200 fttest? �u
P Well disinfected for coliform [ Yes No
Cased to 200 ft Coliform bacteria is Negative
❑■ Sanitary seal is functioning correctly Nitrate 111)2 mg/L 0 Nitrate less than MRL (ND)
0 Wires are properly protected Arsenic A/1/ ug/L 0 Arsenic less than MRL(ND)
Casing height(above ground) 16 in. Collected by Vt (�
Date of flow test for COSA 12.17.17 Date of Sample 2- I - 19
Static water level at beginning of test 166 ft.
Comments
B. TANK DATA C. LIFT STATION
Age of tank(s) 2017 years ❑ Required maintenance completed
Tank type/material steel / ►C Age of lift station years
Measured operating fluid level in septic tank new Lift station material
El Standpipes/foundation cleanout per record drawing Comments:
Date of pumping new
D. ABSORPTION FIELD DATA
Which system tested (date installed) ,2-I -17 Adequacy test date new
0 ALL standpipes present per record drawing Results Q✓ Pass For 6 bedrooms
Total measured depth from grade nev Oft(max) Fluid depth prior to test in
Measured depth to pipe invert from grade 4.5 ft(min) Water added gal
❑ N/A—pressurized field New depth in
❑l Monitor tubes go to bottom of effective. If not, state
depth into effective Elapsed time min
❑■ Code-required soil cover over field Final fluid depth in
❑ System presoaked Absorption rate gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months)
date of test)
Gallons introduced new gallons If yes, enter date
Comments/Deficiencies:new system Installed in Dec 2017
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> 100'
p Yes if No ft ✓0 Yes if No ft
Neighboring Tank > 100' E Yes if No ft Private Sewer/Septic Line>25' 0✓ Yes if No ft
Absorption Field on Lot> 100' 0✓ Yes if No ft Holding Tank > 100' 0 Yes if No ft
Neighboring Absorption Fields> 100' Animal Containment> 50' ✓0 Yes if No ft
❑✓ Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main> 75' 0✓ Yes if No ft ❑Q Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations> 10' 0 Yes if No ft Surface Water> 100' 0✓ Yes if No ft
Property Line > 5' ✓0 Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' 0 Yes if No ft Private Wells> 100' ✓0 Yes if No ft
Water Main > 10' ✓0 Yes if No ft Community Wells>200' 0✓ Yes if No ft
Water Service Line> 10' 0 Yes if No ft If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' Q✓ Yes if No ft If absorption field is under driveway comment below
Property Line> 10' 0✓ Yes if No ft Wells on Adjacent Lots:
Water Main > 10' ✓❑ Yes if No ft Private Wells> 100' ID Yes if No ft
Water Service Line> 10' 0 Yes if No ft Community Wells> 200' 12 Yes if No ft
Surface Water> 100' ✓0 Yes if No ft
F. ENGINEER'S COMMENTS
• ���t®moo
G. ENGINEER'S CERTIFICATION &Y:.•' '•, d1t,
ple
1 certify that/have determined through field inspections and review �, �r :49TH . _� �
of Municipal records that the above systems are in conformance with 4,71.eRW
dMOA COSA guidelines in effect on this date. �••• 'S
/vs-.MICHAEL N. ANDERSON ..(" r
c' ' 7944,
rIieF�.• 1151144.S ?
COSA Checklist yellow sheet ,vii...1`,-`' ww
GRAPHIC SCALE: 1 Inch = 40 Feet
. ] 20��0 20 80
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30 ' S 89'58'00" E. 290.00 I e
I
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30 -T \` I o o
TWO STORY `
/ HOME
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bC 41110:41116:1b‘.1"
A) A% oF At;\
CURVE CHART
NO. RADIUS DELTA LENGTH 4 ��. . _ � ,�
® O 172.78 53°08'37" 130.26 / * 4 .!! * /
12) 280.00 14°08'23' 69.10 ' /
BOBBY :BURNETT//\ ° WELL I3-4 z -�/ . .
Date Scale Legal Description
�
2/5/2019 1" = 40' I hereby certify that the property described hereon has been surveyed
BOBBY F. BURNEryL l Grid LOT 2, BLOCK 4 by me, or at my direction, and that the improvements situated thereon
2941 Carriage Drive SW 2838 AS-BUILT ROBIN HILL SUBDIVISION are within the property lines and do not overlap or encroach on the
Anchorage, Alaska 99507 property lying adjacent thereto unless otherwise shown. That no
(907) 350-5541 Drawn by Field Book UNIT NO. 3 improvements on the property lying adjacent thereto encroach on the
premises in question and that there are no roadways, transmission
\..-
BFB AS B2017 PLAT # 74-56 lines or other easements on said property except as shown.
