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Home My WebLink AboutROBINDALE LT 16Onsite File Robindale Lot 16 #051-053-18 (Rev 05102118) Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211363 PID Number: 051-053-18 Dwelling: K Single Family (SF) El with ADU F1 Duplex (D) El Two Single Family Project: F-1 New X Upgrade Name HEMENWAY ABSORPTION FIELD n Deep Trench F-1 Wide Trench El Bed [] Mound Site Address 24012 Sunnyside Dr 0 Other Phone Number of Bedrooms Soil Rating depth from original grade 398-0457 13 GPDfSF ITotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. iFill Gravel depth beneath pipe Ft. Subdivision Block Lot Robindale L16 added above original grade Ft. Gravel length Ft Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines - Ft. SEPARATION DISTANCES Tot Septic Absorption Holding Sewer Lift Station Total absorption area Number of trenches Dist between trenches From Tank Field Tank Line Fe Ft. Well na II na naTANK Ut Septic C1 S.T.E.P. C3 Holding El Other Manufacturer Greer Capacity 1000 Gal. Surface Water = 100'+ na na Material Plastic Number of compartments 2 Lot Line 10'+ -fi na nNA a Foundation 10'+1 na na LIFT STATION Manufacturer Capacity Gal, Remarks Septic Tank Replacement- Alarm location Electrical installed by Previous Waiver Approved 90' to PIPE MATERIAL House to tank D3034 Tankdrainfiele D3034 Installer JRS Drainfield COIMTD3034 inspector NorthRim Eng. BENCH MARK (Assumed elevation) 100 It Inspection it, 10/14/21 10/15121 Location and description dates: 2r,' Deck 3-11 41t, ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp Conditional Approval: OF Al %k Date At -4 Septic SystemSteve Approved Date 10.26 Eng CE —6256 1#\44 10/25/. Note: this approval does not include well permit requirements. (Rev 05102118) C)° Z v �o coo 0 rn (D � o %4 rTl o a(0 �z -0 O _0 Q 0 =ron Q 5 O Q 14 14 co u O < ro .d� C om D -� rp N 0 o ro < Q O _0 D p <+ T1 F71 O c+ I n D O -0 O _0 Q 0 =ron Q 5 O Q :5 O :5 7- < co u O < ro fTl A O ro W Cil W n rp F71 < r0 Q Q O 0 cF 0 O O U1 fo �,p o (O Op (� C� N Q 5 O c-� W ro c -F ro ro V) ro c -F n ro n s pc DC7 � D � d FT fTl D V FTI fel H D z P W ru R 09 w F— F-1 0� 0 td z d D F9 Q-�� n ro 0 Mvv 0 U1 ry. rn " ' �l O cD Z CO Z � x rT, ril v p I � NJ (o z 00 N N v pc DC7 � D � d FT fTl D V FTI fel H D z P W ru R 09 w F— F-1 0� 0 td z d D F9 Q-�� n ro 0 Mvv 0 U1 CD," rU . .� pc DC7 � D � d FT fTl D V FTI fel H D z P W ru R 09 w F— F-1 0� 0 td z d D F9 Q-�� n ro 0 Mvv 0 U1 <� aty ,g Anchorage x P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section ri�ent S Uc partnwot �G�CX/ xX Waiver#: WR86-127 (reissuance) PID#: 051-053-18 Legal Description: Robindale Lot 16 Engineer: North Rim Engineering Applicant: Galen Hemenway COSA#:OSC211636 Permit#:OSP211363 Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 90.0 feet. See engineer's waiver request for justifications. In addition, water samples submitted for COSA OSC211636 are favorable for granting this waiver. This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ■oneoeaaae a mvmm�aeosam■ananaae■aatom■m®®■■ann®■■o®®e®aeaen®m®aaomsemaes®®0aom, Waiver is Granted: X Waiver is not Granted: Date: 0,2 Approved by: Qt" -4 dq�/ Name of Reviewer ■®eoe■m®msaa■■■amain®®■■o®■oama■■anon®®■oon■a®a®■■®aenmaa0aa®a®m0®®a0a®amnmm®mo, SteveEng.com Steve Eng, PE, PH 907-694-7028 SteveEngPE@gmail.com Date: 10/26/21 Number of Pages: 1 To: MOA On-Site Services Subject: Robindale Lot 16 Well to Septic Tank Waiver Reissuance In August 1983 the original septic system was installed for the subject property. The MOA Inspection Report approval states in the Remarks section “Waiver From Well To Septic Tank 85- feet”. An 8/26/86 letter from S&S Engineering formally requests a waiver based on favorable slope away from the water well, favorable soils & water table gradient, & no evidence of impacted water quality samples. A 9/9/86 MOA letter approves the requested waiver between well & septic tank @ 90-feet. A Permit was recently issued by the MOA to upgrade the septic tank to plastic, at over 100-feet distance from the well. The contractor did not meet the requirement for 100-foot separation. This was discovered after construction had taken place. Attempting to move the tank could result in possible damage. The previous site conditions that allowed the waiver to be approved @ 90-feet are still valid. The new plastic septic tank is bedded on a sand liner. The tank will not corrode & should be water-tight. We feel that the waiver reissuance should be granted. If there is need for additional information or clarification please give me a call. SUNNYSIDE DRIVE 147.50' 8.2' x 13.8' PORCH WELL E, 8.1' x 11.7 GRAVEL 2,0' CANT WOODSHED 46.7' rJ 1.6' %0 1 STORY p RESIDENCE u \ 4.0' x84.0' m 24.7 ie((ile. In `GARAGE WITH COLLAPSED ROOF zz• x HED7.2'Lot 6 SHED GRE x OUS GREENHOUSE ED 21,750 s.f. m \ � SEPTIC PIPES / SEPTIC MANHOLE WOODEN FENCE WOODEN S 89'55'00"W 147.50• I Lot 2 I 6 N \ Lot 17 MORTGAGE SURVEY X SCALE 1" 3' 30GRID NW 1561 Project No. 21-661/AM1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, in c , (907) 522-6476 Phone 000OO O (907) 522-4625 Fax c��0 004 Professional Land Surveyors kenOlangsurvey.com ! F q Y jonothanOlongsurvey.com OoP ` 5440 I hereby certify that I have surveyed the following described properly: LOT 16, ROBINDALE SUBDIVISION (Plat No. P-591) .... 49?H.•••.�*�0 Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a representation of the conditions that were found on the date the survey was performed. Q This survey does not constitute a boundary survey and is subject to any inaccuracies t7'A :; ' KENNETIi G. G that a subsequent boundary survey may disclose. The information contained hereon shall 0 G not be used to establish any fence, structure, or other improvements. aQ' La'�+"Zl Q� OPS' ..LS -5 02.•.• 500 Dated this the 2r� Day of v�.re� a v' at Anchorage, Alaska Q4 xp�Ra ��oo , \\lx EFSSIONPt-_o— It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211363 Work Type: SepticTank Upgrade Tax Code Number: 45105318000 Site Legal Address: ROBINDALE LT 16 6:1561 Site Mailing Address: 24012 SUNNYSIDE DR, Chugiak Owner: HEMENWAY GALEN R Design Engineer: NORTH RIM ENGINEERING This permit is for the construction of: Effective Date: Expiration Date \n th t; r Dcpartmenr Lot Size in Sq Ft: Total Bedrooms: 8/27/2021 8/27/2022 21780 ❑ Disposal Field 10 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with - 1 . ith: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 Disposa€ 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 &/-�)'7 / � ) Date: Date: 7'1 �� M MUNICIPALITY OF ANCHORAGE Development Services Department ,_ IJ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-053-18 Property owner(s) HEMENWAY Day phone 398-0457 Mailing address 24012 Sunnyside Dr Site address same Legal description (Sub'd., Block & Lot) Robindale L16 Legal description (Township, Range & Section) Lot Size 21,780 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 Septic Tank El Upgrade Q (w/wo ADU) (D) El Holding Tank ❑ RenewalDuplex ❑ 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. ` (Signature of property owner or authorized agent) Permit/Rush Fees: $225- Waiver Fees: Date of Payment: s1- J Date of Payment: Receipt Number: Receipt Number: Permit No. QSf 7 11363 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc SteveEng.com Steve Eng, PE, PH 907-694-7028 SteveEngPE@gmail.com Date: 8/24/21 Number of Pages: To: MOA On-Site Services Subject: Robindale Lot 16 Septic Tank Failure The subject septic tank has failed- a new tank will replace the old one. The existing seepage trench appears to be working OK. Please issue a permit so the tank can be replaced. Please review as soon as possible. This lot has no nearby neighbor conflicts. Elevations in vicinity close to flat. If there is need for additional information or clarification please give me a call. Thanks-Steve Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211363, Rebecca Carroll, 08/27/21 SteveEng.com Robindale L16 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: The current septic tank has failed- the seepage trench still functions. This lot is large with nearby wells drawn on plan sheet. No adverse impacts are expected from tank replacement. No easements are present on the lot. The slope is indicated in the area of the septic system. No conflicts to neighbor properties. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations.  New 2- compartment, 1000 gallon septic tank. Watertight couplings on inlet & outlet.  5 minimum between the tank and trench. 5  to property lines & 10  to house.  4 of cover or insulation is required for tank; an equivalent of 1  insulation for 1 foot soil cover. Tank & solid pipe must be set on well compacted, stable soil.  No large rocks for tank bedding. Plastic/fiberglass tanks require special bedding per MOA- sand or pea gravel.  4 diameter cleanouts with airtight caps are required 1  to 4  from foundation wall, prior to any 90 degree bend in 4 inch line, in 2 nd tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10  from the tank positioned to provide cleanout access towards the tank and towards the absorption field. Manhole Riser required in 1 st tank compartment.  All cleanouts must extend to at least ground level.  In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.  Insulation must be placed over any pipe installed under driveways or parking areas.  Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661,  Sewer Service Line is minimum 2% slope.  Septic Tank to be pumped every two years or when required.  Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211363, Rebecca Carroll, 08/27/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211363, Rebecca Carroll, 08/27/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211363, Rebecca Carroll, 08/27/21 " 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 llA PHONE ~NEW ~ ~,~,~.~'~t~ %U, ~t ~ ~ ~ UPGRADE MAILINGADD~ '~ ~ S ~e~~~ LOCATION NO. OF BEDROOM8~ ~ DISTANCE TO: Well ~ /~ Absorptio~r~ /~ Dwelling ~ I~ PERMIT NO. ~, ~ ~(P ~ Manufacturer ~~ Mater~l~~ ~o. of compartments ~iq.r~n ~allons IF HOMfi~DE: Insid~len~t~. ~idth ~- kiquid depth ~ ~ DISTANCE TO: Well ~ Dwelling PERMIT NO. ~ -- ~ Manufacturer~ Material Liquid capacity in gallons ,~ DISTANCE TO, iw , l~ Foundation ¢~ /~ ~j;~ [_~ Top No. of of tile lines to finish / grade Length~1 ~ of, ea~el~ Total Materiallengt~¢s~ beneath tile Trench '~* w~/-- i,ches inches Total Distance effective ~ between absor~n ~ lines "~ A~ area Length Width Dept~ PERMIT NO. ~ ~ Type of crib Crib diameter ~ t Total effective absorption area ~ Well Nearest lot line ¢ DISTANCE TO: B~ilding foundation ~ Class ~ ~1 ,~ ~?~ Driller Distance to lot line PERMITNO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s} OTHER PIPE MATERIALS INSTALLER / F~UNICIPALITY OF ANCHORAGE .... Department ~ Health and Environmenta.~ ~rotection 825 L Street, Anchorage, AK. 99501 264-4720 Permit ~ ~/ ~ ~ ~ HANDWRITTEN PERMIT*** WELL AND/4AR~0N-SITE SEWER PERMIT ~ Applic~t: ~/~ .~L~fl~~ Mailing Address~.. ~ Location: Phone Nu~er: ~ ~ Oescr t on: S ze: - Type of Soil ~sorption System Is: Trench: ~ , Drainfield: Seepage Bed: Holding Tank : Maxim~ N~ber of Bedrooms: ~ Soil Rating(sq.ft/br) DEPTH The Required Size of the Soil Absorption System Is: ' LENGTH ~:~-" / 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(H ~D/~I,'~G)/ TANK SIZE = /~ GALLONS Permit applicant has the responsibility to infor~ 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 department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 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 ~ ~ ~ I 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 ~e system in accordance with codes. 'i (3) I ~rstand t~ the on-site sewer system may require enlarge~nt if ~e ~den~//~s remodeled to include more that, 3 be~drooms/~ ///~h Signe~,/~~?/~/~// Issued by, ~.-7~~ ~~ ///~p~ii~ant Date: ~/~/~/~D ~ ' SWP/024 (1/81) [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 ;264-4720 SOILS LOG- PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: '~CH DATE PERFORMED: SLOPE SITE PLAN I0 11 WAS GROUND WATER ~ SL ENCOUNTERED? ~ O p- E -- )~O~(~'-~..~V~ O~' ~ IF YES, ATWHAT DEPTH? 12 13 14 15 16 17 18 19 2O No. 1457-E Gross Net Depth to Net Reading Date Time Time Water Drop I '7.-~1-~ I1', Z_x~g ' JJ "'"'-'--' PERCOLATION RATE '?~'~(~ (r~inutes/inch) TEST RUN BETWEEN 4 FT AND 5~' FT CERTIFIED COMMENTS PERFORMED B~Y!,~? ' MUNICIPALITY OF ANCHORAGE Development Services Department J 3 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-053-18 1. GENERAL INFORMATION Complete legal description Robindale L16 Location (site address) 24012 Sunnyside Dr Current property owner(s) HEMENWAY Mailing address Real estate agent 2. TYPE OF DWELLING: F-1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Expiration Date: JoLn atb d� Day phone 398-0457 Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic E Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ �Vo Date of Payment Receipt Number COSA # O Sc. 9,11(0 3 (o Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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 NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 9/28/21 A� 4 tv Ar A, 9 a* 6. DSD SIGNATURE System #1 Approved for 3 bedrooms 9 `h CE System #2 Approved for bedrooms —6256 &SRVAF Disapproved ��/ 2 � TAw Conditional approval for bedrooms, with the following stipulations: WATER AND WAS71Y —DARAM S By. fl op.s Original Certificate Date:10 a0Q I �g6L 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 C9 P*,,d bluc- -Jee! COSA Checklist Legal Description: Robindale L16 Parcel ID: 051-053-18 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled pre76* Total depth >181 ft Cased to 40+ ft ❑■ Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 8/23/21 Well production at time of test 4+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑■ No ❑R Coliform bacteria is Negative Nitrate mg/L ❑■ Nitrate less than MRL (ND) Arsenic ug/L ❑■ Arsenic less than MRL (ND) Collected by NRimEng Date of Sample 9/21/21 Static water level at beginning of test 168 ft. Comments * Date drilled, well depth, casing depth reported from MOA website B. TANK DATA Age of tank(s) new years Tank type/material spf'stc Measured operating fluid level in septic tank na ❑■ Standpipes/foundation cleanout per record drawing Date of pumping new D. ABSORPTION FIELD DATA 8/4/83 Which system tested (date installed) same ❑■ ALL standpipes present per record drawing Total measured depth from grade 7 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 3 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 10/25/21 Results Q✓ Pass For 3 Fluid depth prior to test 0 Water added 450 gal New depth 6 in Elapsed time 30 min bedrooms in ❑E Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: Retested On 10/25/21 w/Rebar Probe- Fluid Line on Rebar Used For Measurement 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' * 90 Yes Community Sewer Manhole/Cleanout > 100' Yes if No ft [7 Yes if No Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' E] Yes if No Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' 0 Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' ❑✓ Yes if No n Yes if No ft if No ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' [D Yes if No ft 0 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' ❑✓ Yes if No. Property Line > 5' F,1 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' I] Yes if No ft Private Wells > 100' Q Yes if No. Water Main > 10' El Yes if No It Community Wells > 200' Q Yes if No. Water Service Line > 10' ll 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' Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS * Existing Waiver Utilized. A greenhouse is present next to the new septic tank - the greenhouse is moveable with no foundation- photo available. G. ENGINEER'S CERTIFICATION I certify that / 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. COSA Checklist yellow sheet ft ft ft ft OF Ar i �� * ,49TH cn Steve Eng CE-6256� 10/2,6/1 MUNICIPALITY OF ANCHORAGE 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 Parcel I.D. # ~ -~\ - (~-~ - '~ ~ HAA # ~ ~::~ (~-~)"-~- ~ 1. GENERAL INFORMATION Complete legal description Lot 16; _ Ro bindale Subdivision Location (site address or directions) NHN Sunnyside Drive Chugiak, AK Property owner Mailing address Lending agency Mailing address Richard Holmstrom 22149 Deer Park Drive Agent Kathy Geraei/ Greatland Re~z~y Address 11411 01d Glenn Hwy. Eagle River, Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 5 '~ TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: Day phone 344-0044 Chugiak, AK 99567 Day phone (w) Day phone AK 99577 694-9125 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 Holding tank Community on-site NOTE: XXX Public sewer 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 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 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm iiu~ ..... --"- ~ Phone ~E'~ ~/>z/~ ~--~ ~ ~agm Idver ~oop R~d No. 2~/ ' E ngineeds signatu re / ~~~ Date -~ ~ DHHS SIGNATURE Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ~ 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) Back MOA Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVIC~t~x::iPALrr~' .... Environmental Services Division ~NViRONMENTAL SERVICES DlVl$~J~[~Jl~ 825 L Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Legal Description: A. WELL DATA Well .type ~¢-x,~ Log present (Y<.~ Total depth __ Sauitary seal ~N) Health Authority Approval Checklist ~Ofi, ~ gP<l ~r~ Parcel I.D.: IfA, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to .t4o lk- FROM WELL LOG Casing height (above ground) Wires properly protected (~N) AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform t5> Nitrate Date of sample: 2-- 2-~1 -c1 ~. B. SEPTIC/HOLDING TANK DATA Date installed ~ ~3'5 Tank size Foundation cleanout ~N) ',~ Date of Pumping 7,,~ 2-q ~ ~ C. ABSORPTION FIELD DATA [, '2~g, Other bacteria Collected by: S & $ ENGINEERING 17034 Eagle River Loop Road Eagle River, Alaska 99577 Number of Compartments 'L- Cleanouts Depression (Y~ ~ High water, alarm (Y~ Pumper ~'--_k~ ~O~3v,,~e~ ~q -Date installed ' B - c}~ Length ~ 'g- ~ Widdi Effective absorption area Date of adequacy test Soil rating (g.p.d./fi2 or ft2/bdrm). 'Z~/~g-System type 'Z.~" I Gravel thickness below pipe Monitoring Tube presentl~2q) Results~ail) Fluid depth iu absorption field before test (in.); O lnunediately after~a~ gal. water added (iii.): Fluid depth ] 3 '/4" (ins.) Minutes later: 7~ Absorption rate tf/5~c~ = g.p.d. Peroxide treatment (past 12 months) (Y/~ ~x. J0~0/'~- /'/-~)o ~Ifyes, give date h/I Total depth ~ t .. Depression over field (Y~, ,J For .~ bedrooms /qo D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level tit* Size in gallons '~Pump o11" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line hk~q~l,~ ; On adjacent lots : On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation t~ ~' ~ Property line '2--'5- ~ Absorption field I ~- I Water main/service line \t> ~ k- Surface water/drainage [ c~ ~4-- Wells on adjacent lots ~o~ ~ Jr SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Bnilding foundation {a ¢, t Water main/service line Surface water Curtain drain lo 0 t ,P Driveway, parking/vehicle storage area ~ Wells on adjacent lots ]0o t k- Property line F. ENGINEER'S CERTIF!yATI(J~? I certij. P that I have d6termined tbrufield inspections and revie;~ of Municipal records thatth~above ~y~'tems are in conJbrmance w{ ~40A HzM~guidelines in ef~ct on this date. ..................................HAA Fee $ ~ ~ ~ .............................................................. Waiver Fee $ Date of Payment ~/P~ Date of Payment ReceiptNumber /~fp &~¢4j -- Receipt NumBer Rev. 8/95 OSS: haa.wk.doc MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SiTE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant NamelZ. r~4¢¢4~. ~:~.l~,~'l~Telephone: Home I,~-. ~1~, Business Applicant Address ~'~¢~ ~ 1i~'/~ "7 ~.(,¢,~ ~..t--~"~..!,g~'CL-~ ~ (c) Applicant is (check one): Lending Institution []; Owner/builder J~; Buyer []; Other [] (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone Telephone (f) Mail the HAA to the following address: S & $ ENGIN~i~ING EAGLE RIVEE, AK 99577 TYPE OF RESIDENCE Single-Famil~. Multi-Family [] Other Number of Bedrooms WATER SUPPL~' Individual Well ~, Co, ~nm'unity r-I Public [-I Note: If community well(system, must have written confirmation from the State Department of Environmental Conservation attesting to the leoal,i'tY and status. '/ i/I Ii.~'~ SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ', As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. $ & $ ENGINEERING Name of Firm Telephone Address SR B 196X Date E~G[E RIVER, .~( ~295~7' ,~,~/Z- ~,//~ 6" DHEP APPROVAL Approved for Approved bedrooms by Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST ~ FEBRUARY 1984 264-4720 NiUNJCiPAI-I-?/ OF , ~I-~O,,AG~ DEPT. OF I:E/',L[H & E --x. ~,-'q~,' ~ WELL DATA Well Classification Well Log Present (Y/~) Total Depth | 'I' '2~ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (~'N) Separation Distances from Well: To Septic/M~ Tank on Lot To Nearest Edge of Absorption Field on L~ot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by ~ Water Sample Test Results Comments ~ ~:~..L_ ~ / Cased to /WI IfA, B, C, D.E.C. Approved (Y/N) Date Completed '~ c~,¢.-- 1'~l'~ Yield Depth of Grouting ~ Pump Set At O ~ Sanitary Seal on Casing (~'N) Depression Around Wellhead (Y/4~) "~"~(~)/ ~J~';u'~"~"' ; On Adjoining Lots ~ c:~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot B. SEPTIC/~ TANK DATA Size ~. ~c~o No. of Compartments ~ Foundation Cleanout~N) Date Last Pumped ~ ~. _¢;z~ ; for Temporary Holding Tank Permit (Y/N) ~//~' Date Installed Standpipes~)'N) Air-tight Caps 4~7N) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Ide~ Tank: To Water-Supply Well fl ¢'~ ~ To Property Line To Water Main/Service Line Course To Building Foundation Pr~ I To Disposal Field ~, ~' To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 'Z.-~..~' ~'/~'"~' Date Installed ~ ~t~ ~"~ Width of Field Square Feet of Absorption Area Depression over Field (Y/~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot L) ~,L- To Water Main/Service Line Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present ~/N) ·-;;4:: · Date of Last Adequacy Test · .-,%.:..... To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ! To'Property Line' To Existing or Abandoned System on ; On Adjoining Lots ~-~ To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify th.~t~h~v~l~f~le~E~j~lr~[~, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S~ ~CX Date ~/ ~/ ~ C°mpan~L~ ~""" A~ MOA No. ~--~o ~* Receipt No. Nob I -00 ~ Date of Payment ~" ~ "~ Amount: $ ~ Page 2 of 2 72-026 {11/84) P.O. b,.J~( 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES September 9, 1986 Robert A. Shafer, P.E. S & S Engineering SRB 196X Eagle River, Alaska 99577 Subject: Lot 16 Robindale Subdivision Waiver Request, WR86-127 Dear Mr. Shafer: Your request for a waiver of the 100 foot separation required between the septic tank and well On the subject lot has been granted. This distance has been waived to 90 feet. This waiver is valid for the existing three bedroom single family dwelling only. Sincerely. Stephen S. Morris Civil Engineer On-site Services SSM/ljw HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON StTE WASTE WATER DISPOSAL SYSTEM ROBERT A. SHAFER AuguSt 28, 1986 CIVIL ENGINEER 694-2959 Mu~i~pality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 ATTENTION: Steve Morris REFERENCE: Lot 16; Robindale Subdivision Dear Steve, Request you approve the attached Health Authority Approval application and grant a waiver to the horizontal separation distances §~tween the septic tank and the private well of 90 feet. Attached for your review in addition to the information provided with the HAA application is a site plan showing the relationship between the well and the septic tank and the slope of the ground. In accordance with the risk analysis work sheet, attached for your information, it is our opinion that the horizontal separation distances pr~scribed by 18AAC021 are not required in this case. Since a well log is not available for the we~ located on this property, the w~ll log for the adjacent property has been provided to reflect the characteristics of soils and w~ll depths in this area. If we may be. required to provide additional information, please D^TE RECEIVED: ENGINEER: DEPARTMENT OE HEALTR AND HUNA~ SERVICES ~RB 196X ~GLE R~VER~ AK ~7 WAIVER REQUESTED: ~3!_~ '~~'~ I CRITERIA: 1) Geology: Points: A. Water Table B. Soil Sorption C. Permeability ~_~_~__ D. Water Table Gradient E. Horizontal Separation " TOTAL: WAIVER iS: granted, with coudicions listed below: not granted for reasons iiste, d below: ApPLI¢ 'NT FILLS OUT UPPER HA( . ~.. ~ . . ~.: Zip Code Address , ~ Lending Institution ~CO~, '{~ , Realty Co. & A~nt Phone Address ~ Zip Code · Type of Resi~nce Single Family Multiple Family ~o. of 8edroo~ lpg_ ' ~ Other Water Supply Individual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility - Sewer Disposal ~ Individual Year Individual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank ' NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE iNiTIATED. Time Time Time Time Date Date Date ~ ' .r Date ./~ ~...~ . Inspector Inspector Inspector Inspector ~ ~ :2 0 DEPT, O[: HEALTH '& RECEIVED ( ~ CONDITIONAL APPROVAL* Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received Well to Tank Septic T~k Size L REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Triplicate) Baci-e~ial b. Detergent. We]_l dar a: ao Type e. Casing Size de Distanze from well to closest existing ov proposed: 1. Sewer linc 2. Septic tank 3, Seepage Area 5. Property Line . Other sources of possible contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc. , .... · 7. Sewage disposal system. a. Age of system b. Septic tank capacity in gallons. c. Name of septic tank manufactu~e~ 1. If "home made" show dia?ram on reverse side of this form, Disposal field or seepage pit size and type ~ ~_~29~_~/ 1. Distance to proper~y-line ~o house foundation . e, Percol~tic~ Te~t ~results f. Percolation Test performed by ....... · Use the reverse ,side of this form ro show dia£ram. Diagram should include ~he following infor~nation: ~roperty llnes;.well location, house locatlon~ '~p~le tank location, disposal area locatlon~ locatzon of percolation test, a~ direction of ground slope. 9. The ~nf-ormation on this form is true and correct to the best of my knowledge. Signature of Applicant "' Da~e Signed TO BE FILLED OUT BY HEALTH DEPART{-JENT PERSONNEL ~'he above described sanitary facilities are hereby approved, su~ject to the .......... ~611~owin~ con~.~ons: - The above described sanitary facilities are disspproved for the following ''~ig '~ffi%f~ ........ Date nature of :y ~,..... r,,. ~..~, . ., Approval is valid for one year following the date of approval. CPJ:ow Deco,abet 2, 1970 Federal llousing Administration F.O. Box 480 An~lorage, Alaska 99501 SUBJaCT: TISN, RIW, 5ac. 3, Parcel 28. Willard $. Barber, Case No. Pear Sirs: U~on inspection of the ~Ject let, a cesspool ~as discovered to be sarving as the s~er sys~a~. It ~as also noted that the ~ell coini was below ground and ~hat the ~ell ~as only 58* from the cesspool. The ~ell casing needs to be brou~lt above ground and the ~ell pit filled. A se~or syste~, consisting of a septic tank and seepage pit, ~ill also need to be installed .ith proper distances fro~ the well before ~e can give our approval to the systems. A per. it £ro~ this o££ice is needed before ~ork is begun on the seaer'SySte~. Sincerely, Lynn 5. Coad ~anitarian cc~ Willard $. gar~er