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HomeMy WebLinkAboutROBIN HILL #3 BLK 4 LT 3 Municipality of Anchorage Page / of -~ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · TelephOne: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: '-~'W/ ~'(~"]~ PID Number: O/ ,~- Name: ~,~,L//~ U,,,/~/ . ~ ~ ~ y ~ L(~. ~ ~J~ ~ Wastewater System: ~New ~ Upgrade ~cH~M~ ~ ~ ?~/~ ABSORPTION FIELD Phc,e: ~ ~ ~)7 INo. of Bedrooms: 3 ~ Deep Trench ~ Shallow Trench ~Bed ~Mound ~Other LEGAL D ESCRI PTI O N so, Rating: ~. ~ GPD/Sq. Ft. Total Depth fro~riginal, grade: Subdiv~ion: ~ ~ ~ Ft. ~ Ft. J J Fill added above original g rede: Gravel length: Tow,ship~ Range: __ Secti~ / Ft. ~ ~ = ~ Ft. Number of lines: Distance belween lines: WELL: ~ New D Upgrade Grave~id~h: ~ R. ~ /0 FL material: ClassJlication~ J d~(Private' A.B.C): Total~Depth: Ft. Cased~To: Ft. Total absorption area:~j SQ. Ft. PIpe~ ~O~// Driller: Date Drilled: SlaticWaterLevel: Inslaller: Date installed: Yield: P.mp Set at: O~sing Height Above Gtc.nd: TAN K SEPARATION DISTANCES a Septic ~ Holding ~'S.T.E.P. From Tank Field Sl.flon Tank Sewer Lines ~'~O ~G~ ~a"~ Matelial: Number of Compartments: Sudace w.te~ /00. /~oL* /oe % j LIFT STATION Lot ' , ~/ Size in gallons: Manufacturer: "Pump on" leve at: "Pump off:level at: High water alarm . Pump Make & Mad~l J ~lectrlcal Inspections pe~ormed Remarks: ¢ w,+,v~ R~c~ ~ ~, BENCH MARK Location and Description: ~ " J Assumed Elevation: /O0. O FI. Department of Health.and Human Se~ices approval *"h~,,~:~?,~,~.~~' ........ ' ~'> Reviewed and approved by: ' ~ ~ ~ / 72-913 (Rev. 9/91) MOA 25 PERMIT NO SW980032 PAGE 2 oF 3 M u n_.l,..c I p, ,o,~i ~ y_,_o, -F Anchor(~c~e DEPARTMENT uP HImAL/I-I AND HUM'AN SERVICES ENVIRONMENTAL SERVICES DIVISION P,D, Box 196650 OAnc¼op(19e, A[o, sk(~ 99519-6650 O TeLephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 3, BLOCK 4, ROBIN HILL #3 S/D P.I.D. NO. 017-394-02 LOT 2 NEW TRENCHES LOT 8 WELL NEW 1250 GALLON S.T.E.P. SYSTEM \ \ TH#2 \ \ LOT 7 SITE \ \ \ \ \ \ \ \ SCALE 1" = 40' \ LOT 3 ROBERT C. COWAN CE-8801 PERMIT NO SW980032 PAGE 5 OF 5 MunicipaU~~y oF Anchora.qe DEPARTMENT OF HEALTHAND HUIV[AN SERVICES ENVIRONMENTAL SERVICES DIVISION P,EI, Box 196650 eAnchorage, Alask~ 99519-6650eTe~ephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT ,3, BLOCK 4, ROBIN HILL #5 S/D P.I.D. NO. 017-394-02 STI ! ST2 96.0' ~' I tag GAL I '%-95.8' A B !FC0 11.5' 27.0' ST1 17.0' 58.5' ST2 21.0' 44.0' MT1 5,3.0' 67.0' MT2 75.0' 97.5' MT,3 8,3.5' 101 ' MT4 65.5' 71.5' MT1 = 107.5' MT3 = 107.6' FINAL GRADE MT2 = 107.~'7 ~-MT4 = 107.9' ~ MT! / ~ MT3 ~MT2 / \ M~z} · NO WATER FOUND 88.5' B.O.H. SCAL~ 1" = 40' v~o,~, ~o, B~OC~ ' s~o,,o.~..~ BOROUGH I .. ' " ~N ~E ~ ~: :~-.. 3, ~":. - ." '~.. .~ ~ ' - LOCATION/SK~CH: . '"' WELL'OWNER:~~' · ' ' ' ~A~ ~/~Y . .._. .:: ?:. :. :, .:-.- --.- · .'-. , ... DEPTHS ~8URED FRO~asing top Dground surface WELL DEPTH: _ DATE OF OOMPL~ION Depth of hole:~ ~ ~t .o~..o~. D~: D~.t, ~..t, ~ ~i.~~ ~t Material Type and Color From To ~-- ~ 0 ~' ~ ~t. ft below~ top of casing ~'ground su,ace ~~ ~ /y . Date: Z ~.other -. · , · ' .. t. 1.-.~ - ' ' ' - ' -" ' ' ' · · USE OF WELL: ~ domestic D irrigation ~ monitor ~ A& 30 ~ public supply ~ other ~Z- ~ ' ~/ · ' 'CASING STIC~~ ' ft. Diam: ~ .in. t~ ~.~ "~'~. ~/ Casing type:~ . ~i.n. to~t - ~ ' - - . - . ', ~ ;¢ · -, '., - , . . · -. : - . ? .~ · ,~ -. ~-~ ~.., :...-, ~ ..... ; . ?-.. ~WELL: NTAKE..OP~ NG.TYPE. open end ~ screened. . ...~.: ?.-',..::L~'~..."~.': :.~_: ~-.:.?,'_: ; ..... ~' : ..... . .',.' ....... .~. '~...':... ':'.'. ..... . .... , /~~ Depths of openings: to ft  ~CREEN TYPE: Diam: in. ~ ~ Slot/Mesh Size: Length: ft . · GRAVEL PACK TYPE: ., . , Volume used: - GROUT TYPE: ~~lum~ Depth: from ft to ft RECEIVED Duration: MAY 5 1998 PUU,~.~ L~EL AND YIELD: ~ ~ ft after ~, hrs pumping /~ ,opm Municipali~ of Anchorage Oept. Health & Human 8e~ic~ s PUMP INTAKE DEPTH: ft Horsepower: __ WELL DISINFECTED UPON COMPL~tON? ~YES ~ NO CONTRACTOR INFORMATION: . .' - : ... , REMARKS: Regj.ist[~(ed Business Name- · ,,'Y.~ - ' .~,~ ,! · '. '~ ;, .. ~m~' PLEASE· MAIL WHITE COPY OF LOG TO: (-J'~"~*"~'~-~ /'.~ ~ -~"~",~ ~'~ DNR/DIVISION OF MINING & WATER MGMT Signature of Authorized Resf~resentative ~ 3601 C St, Suite 800 ' , . ANCHORAGE AK 99503-5935 ' ' ' , ' Phone (907)269-8639, Fax (907)562-1384 10/01/98 THU 12:48 FAX 907 349 2814 P~IC ~]003 -1VIUNICD~ALrTY OF ANCHORAGE -- gUILDi~N'G SAFETY DIVISION 3500 EAST ~VUDOR .ROAD, A~CI~O~GE, ALASI~ NAME: MOORE?? ADDREXS': 1304t FLORAL 'LN LOT: 3 BZOCK: ~. SUil~II.7$iON: "RGBI,.,' ' ~'~ H.~,I" ~' ..... e COMMEArl,~ l O,~2vl This is a re. inw~ect ff box ~* checke4. ~ C,O. approved [_] c.c.o, approved (commits below). · AKT~ :,ME. STOP 'rIME; INSPECTOR: ," UA P/t~N CORREC TION,5 A.RF. MAD[L PLP£4SR: (.24LL DO/VO T l~f3.LO ~'57 ~fY~iflS NOT/CT. PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW980032 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:BRAUNER DAVID A & CHRISTINE M OWNER ADDRESS:13041 MOUNTAIN PL ANCHORAGE, ALASKA 99516 PARCEL ID:01739402 DATE ISSUED: 3/13/98 EXPIRATION DATE: 3/13/99 LEGAL DESCRIPTION: ROBIN HILL #3 BLK 4 LT 3 LOT SIZE: 75661 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS } {NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE FINAL AS-BUILT INSPECTION REPORT OF THIS PROPOSED WASTE- WATER SYSTEM SHALL NOT BE APPROVED UNTIL THE AREA DESIGNATED BY THE ENGINEER TO BE, FIgED RECEIVED BY: ~/~L ~ COMPLETED. DATE: DATE: ROBERT C. COWAN, P.E, ROBERT A. SHAFER, P.E. HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER iNSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE W,~TEWATER DISPOSAL SYSTEM DESIGN March 2, 1998 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 3, Block 4, Robin Hill S/D #3 Request you issue a permit to drill a well and install a septic system to serve the proposed three bedroom house on the referenced property. Two test holes were excavated and percolation tests performed. The approximate location of the test holes are located on the attached site plan. At the time of excavation no groundwater was encountered and aRer seven day groundwater monitoring, the monitoring tubes were found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. There are no points of contamination within the proposed well radius which can be seen on the attached site plan. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/jm Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 1" = 100' ' SITE PLAN . DESIGN °~o>cm~ ~o mZ 02. ~ Z~ o~ =n ~ · · ~ o~ ~ ~0~ FLORAL LANE ~ ' ~/g)~ ,~ MOUNTAIN PLACE ~.~ I"S=L40'CAE ' DES GN DETAIL 0 ~ . ,~ I~~ ~N'X / N.T.S. 'SCALE ~"-- -'1 oI I ~:1 -~1 I DESIGN PROFILE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, AJaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: /-J~7~'~ ~/~ '~ ~c,/~ ~/~Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15- 16- 17, 18- 19- 20- L IF YES, AT WHAT O DEPTH? p E Deplh t° Water A~ezr MonilorJng? ~ o,~ ~ Dale: COMMENTS Gross Net Depth ~t(r-o~ Net Reading Date Time Time Water Drop I I~l~,-e'~ I..~ ~ ~n ~ / ~'~.- ~,o/ PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN ~'~- O FT AND ~' ~) FT PERFORMED BY: ~", ~, I (~'~-/~, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: [ '?~///1 {~/. ~- 72-008 (Rev. 4/85) PERFORMED FOR: LEGAL DESCRIPTION: /~'7[ ''~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2 3 4 5- 6 7 8 10 12 13- 'i4- 17 19 2O WAS GROUND WATER /V CJ ENCOUNTERED? IF YES, AT WHAT DEPTH? SLOPE SITE PLAN Depth to Water Alter Monitoring? t.[o h c.-. Dale: Gross Net Depth .t~d3E Net Reading Date Time Time Water Drop , I~ ~,~.. ~o ~-q~ ~I~" PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN /' ~)~ FT AND ~ '~'' FT COMMENTS .ERFORMEO. : I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85} Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: (FEET} 1 2 3 4 5 6 7 9 10 11 12 13 14- 15- 16- 17- 18- 19- 20- COMMENTS DATE PERFORMED: Township, Range, Section: ~ 2.--/'2-~- WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Deplh to Water Alter Monitoring? Date: SLOPE SITE PLAN Gross Net Depth ~t~ Z~- Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN __ (minutes/inch} PERC HOLE DIAMETER __ FTAND '7'~ ET ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ROBERTC. COWAN, RE. ROBERT A. SHAFER, RE. HEALTH AUTHORITY APPROVALS SEWER&WATER MA~N EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION &FLOWTEST SiTE PLANS ROAD DESIGN SOILTEST PERCOLAT[ON TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 3, Block 4, Robin Hill S/D #3 March 2, 1998 GENERAL: The scope of this project includes the installation of a 1250 gallon S.T.E.P. system and a five foot wide drainfield to serve the proposed three bedroom residence or the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for £mal grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 ° EAGLE RIVER, ALASKA 99577 Page Two Lot 3, Block 4, Robin Hill S/D #3 March 2, 1998 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. o A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. Page Three Lot 3, Block 4, Robin Hill S/D #3 March 2, 1998 The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leach field gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Page Four Lot 3, Block 4, Robin Hill S/D #3 March 2, 1998 Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/OWNER hUG-31-98 MON 12:65 KING ChREER CENTER FhX NO, 9072786669 FROM: DATE; RE: Kelly or Sean Klingbeil August 31, 1998 PERMIT SW980032 LOT 3, BLOCK4 Robin H~lls#3 Please accept this notification that we will be doing Owner/Builder on the septic system My father, Mark Machkovich, doing business pre'~iously as MAM Contracting has done systems before as a builder, including systems with lift stations. Bob Cowan with S & S Engineers will be doing the inspections. Mr. Cowan will also be working closely with my father to install the system. I would also like to mention that there was a special provision that the fill area was to tx; completed to be approved. This area has been filled to the designated area. RECEIVED /UJG 3 ~ 1998 IVh.'lf~Otr~811$,, Az- 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description f.nt ~,, Bloc. k 4, Robin f-]i'l'l~ Location (site address or directions) 13041 Floral Lane Property owner Mailing address Lending agency Mailing address Shawn & Kelly Klingbeil Day phone 11740 Canqe St. ¢ Anchoraqe¢ Ak 99516 Day phone 267-2717 Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well xxx Community well Public water If community well system, provide written confirmation from State AD£C attest- lng to the legality and status of system. 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. 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/orwastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein, lfurtherverifythat 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. S & S ENGINEERING Name of Firm Address Engineer's signature Eagle River, Alaska 99577 Phone DHHS SIGNATURE Approved for '-~ bedrooms. Disapproved. Conditional approval for bedrooms, with th-e following stipulations: Additional Comments 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 enginee¢s work. 72-025 (Rev. 1/91) Back MOAIFZ1 Municipality of Anchorage ........ DEPARTMENT OF HEALTH & HUMAN SERVI~^L"r u~ ,~,~u,_,,~ Environmental Services Division ' ¢"~L S~V~C'~s ~V'~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist LegalDescription: to'K 5 /3~.~-~ /~/~J i~u~J'~/~ ParcelI.D.: 017 A. WELL DATA Well type ~o/~ Log present Total depth IfA, B, or C, attach ADEC letter. ADEC water system number Date completed ~ / 2. 3 / ~/ ~' Cased to ';x 3 $- Casing height (above ground) Sanitary seal ~.)N) ¥ 'f-' 5 Wires properly protected ~/N) V£ ~' FROM WELL LOG AT INSPECTION Date of test $ / ~3/~ ~ Static water level ~ O ! , ] ./)-/ Well production ! © g.p.m. ~ g.p.m. WATER SAMPLE RESULTS: Coliform (~ Nitrate Date of sample: ct [ ~ '5 / ¢)' ~' B, SEPTIC/HOLDING TANK DATA Date installed c~ / $ / c/ ~, Tank size Foundation cteanout (~/N! ¥ ~¢-"- Depression (Y~J~ Date of Pumping /J/g- - ''/~ ~' Pumper -- C. ABSORPTION FIELD DATA Date installed ~/ $ W ~ Length ~-~-~ q0 '-- $0 Width Effective absorption area 3~ ? I ~:r Date of adequacy test ~//4 - ,'/re ~,.~ Collected by: Other bacteria S & S ENGINEERING 17034 ~--' Eagle River, Alaska 99577 Number of Compartments ~-- Cteanouts(~/N) ~ o High water alarrr~/N) Soil rating '~or fF/bdrm) ~). -~ Gravel thickness below pipe '~' Total depth 5-- Monitoring Tube present(~/N) Results (Pass/Fail) -~ For ~ bedrooms Fluid depth in absorption field before test (in.); Fluid depth (ins) Minutes later: Peroxide tr~atmen~i.(l:~a~t~s) (Y/N) __ Immediately after__ gal. water added (in.): ._--~---~'-~ Absorption rate = .g.p.d. If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (~N) High water alarm level at* /~ ~ *Datum Cycles tested E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: t IO0 Septic/holding tank on lot Absorption field on lot / 0 o ~L Size in gallons "Pump on" level at* ~ ~ 4 "Pump off" level at* On adjacent lots On adjacent lots t /oo Public sewer main Sewer/septic service line Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ! 0 ~- Property line / o -~- Absorption field Water main/service line [ 0 4-- Surface wateddrainage / 0 o .~ Wells on adjacent lets /oo Property line Surface water Curtain drain SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: I (~4.~-!,,,.) Building foundation Water main/service line / 0 ~ -/- Driveway, parking/vehicle storage area. /v 0 ~/~L ~ *J ~ ~J ~ Wells on adjacent lots / r¢ 0 F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections in conforrnance ~4¢~guidel~s in effect on this date. Signature Engineer's Name Date / are HAA Fee $ ' Date of Payment ~,/~) /~/Y 2 Receipt Number ~ ¢~ J~ d~''~ 73 h 72-026 (Rev. 3/96)* Waiver Fee $ //'/'~ ~*-'"' Date of Payment /"~ Receipt Number ,¢:~ z~Z5 ,~,~/~ Rick Mystrom, Mayor 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 http://www.ci.anchorage.ak.us October 8, 1998 Robert C. Cowan, P.E. S&S Engineering 17034 N. Eagle River Loop Road Suite 204 Eagle River, AK 99577 Subject: Waiver Request for Robin Hill #3 Block 4, Lot 3 Waiver Request #WR980071 Parcel ID #017 394 02 Health Authority Certificate #HA980339 Dear Mr. Cowan: Your request for a waiver of the required 10 feet horizontal separation from the on-site wastewater disposal system to property line has been approved. The approved separation distance is 1.0 foot. This waiver approval applies to the existing on-site wastewater disposal system to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Donna C. Meats Civil Engineer On-Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR~ 980071 PID# 01739402 HA# 980339 Date Received: 10-5-98 Legal Description: Robin Hill #3 Block 4, Lot 3 Engineer: Robert C. Cowan S&S ENgineering Permit ~ SW980032 17034 North Eagle River Loop, Suite 204 Eagle River, AK 99577 Applicant: Shawn & Kelly Ktingbeil Waiver Requested: 1 foot between the absorption field trench and the north property line. Criteria: 1o Geology: A. Water Table B. Soil Sorption Co Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Special Conditions: Points: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Date: Rec #: 04089/5873 By: Amount: $ 115.00 Nam~ of Reviewer Date Paid: 10-5'98 ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. October 02, 1998 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH ALIT HOR~TY APPROVALS SEWER & WATER M.~N EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 3, Block 4, Robin Hills/t3 Request you issue a Health Authority Approval on the referenced property and grant a waiver for the separation distance between the north the property line at 1 foot. We do not anticipate any adverse effect on the adjacent properties. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/skh 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, AI_A~KA 99577 ~t~, CT&E Environmental Services Inc. CT&E Ref.# Client Name ProJect Name/# Client Sample ID Matrix Ordered By PWSID 985511001 S & S Engineering Lt 3 Blk 4 Robin Hills No 3 Lt 3 Blk 4 Robin Hills No 3 Drinking Water 0 Client PO// Printed Date/Time 09/30/98' 17:32 Collected Date/Time 09/23/98 11:30 Received Date/Thne 09/23/98 11:50 Technical Director: Stephen C. Ede Released By~ Sample Remarks: ResuLts PQL Units Atto~ab[e Prep AnaLysis Hethod Limits Date Date Init Total CoLiform Nitcate-H o 0.9~5 cot/lOOmL SM18 9222B 0.1QO mg/L EPA 300.0 09/23/98 KAP 10 max 09/23/98 09/23/98 GCP