HomeMy WebLinkAboutROBIN HILL #3 BLK 4 LT 5Robin Hills #3 Block 4 Lot 5 #017-394-08 Municipality of Anchorage Page of —4— DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SLJ PID Number: Name Wastewater System: KNew 0 Upgrade C2 LZ-' 0 1-4 6 Address: &qqi rt?,�IT-AZx ABSORPTION FIELD Phone. —P"f 3 4 (o 9 4� 0 Bedrooms 3 E__, Deep Trench *X- Shallow Trench E-1 Bed ED Mound 0 Other LEGAL DESCRIPTION - Soil Rating: Total Depth from ori�nal grade: _4 I .8 GPD So Ft� — Lot: Block: Subdivision LD RV13ij ALj_,S .0-3 I Dep'n to pipe bcItom from or al grade: 1) 2r, -51 Ft. Gravel depth beneath pipe ly Ft. Township: arige Section: — Fill added above original grade: Gravel length: VZ, Ft. - Ft. WELL: XNew 0 Upgrade Gravel width: 5' of lines: Number T D;siance between lines: Ft. Ft. Classification (Privaie. A.B,C): Total Depth: Cased To Total absorption area: Pipe material: P V F, /Z I V A 7-- L::- 7� Ft. S 10 1 Ft. �5 70 SO. Ft. _ Driller: A/1 — �j Datq D�lllecl � 1Z_ / ') 2- Static %Nlaler Level 4 Z- / Ft. Installer: Date installed: 6hb 1qZ_ Yield� 34) I Pump Set at: 1 Casing Height Above Ground 7- TANK GPrA Ft Ft. SEPARATION DISTANCES X Septic E_- Holding 0 S.T.E.P. To Sepnc AbSorp!iori Lift Holding Publ,c.'P,ivate ManufacIurer.-4),,,,,,7,, Capacity in gallons: From Tank Field Sialion Tank Sewer Lines 4/00 VVell 1351 Material: Number of Compartments: Z-1 Surface LIFT STATION Water — Lot po Size in gallons: Manufacturer: I Line "Pump on' level at: Pump off" level at: aler alarm at: Foundation Curtain Pump Make & 101odel Electrical Inspections performed by: Drain BENCH MARK Remarks: 114 Z4 CS Location and Description: AV" &�L:- f A_j, /Vw"j7otJ A'LLA /01- - 5 -t5 2. jd-b. FA C TO I L S (0 r T� �ume Elevation: FIL ENGINEER'S SEAL er� &� 4 0 14 4,N)J G-fL-s CAJ Dates:1st j -u "TM! Inspections performed by: - 2 n d Z 1V ir IUM�O ,J7,0. ml Mai E. Anderson 14; Department of Health and Human Services approval j oXQ.6 4381 - E d -�\,c)(-H\L 1,t I v-� Date: A(�)92- Reviewed and approved by: 72-013- tPe,. 9 �!) r.1,0A 1-5 Permit No. Page Z of 14 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 Permit` No. Page 4 of 4 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: PID No.: 72-013 A (2/81) MOA 25 Permit No. Page 3 of 4 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 * Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description:PID No.: _P i . C ............. .. ..... 0 -irl .10 M -W DRILLING, Inc. P.O. Box 110378 • 10330 Old Seward Highway (907)349.8535 ANCHORAGE, ALASKA 99511 DRILLING LOG vio� Wel Owner �-"'-_�� _•...=5C_. Use of Well Domestic Location (address of: Township, :iange, Section, if known; or distance main road Lot 5 31_c. 4 -.o:)i-i '?i11s No. 3 1_3100 3lount�Tn Size of casing o Depth of Hole 251 feet Cased to 261 fee± Static water level = ft. (alia'8) (below) land surface. Finish of well (check one) open end ( :i ) Screen ( ); Perforated Describe screen or perforation l' / Well pumping test at �0 gallons per;) (minute) for 1 hours with 1C ft - of drawdown from static level. Date of completion June 2 ,; 15:2 WELL LOG Deoth in feet from ground surface Give details of formations penetrated, size of material, color and hardness .'%n TO 2 Tn 15 1- TO 4O 223 TO 251 TO TO TO TO TO TO TO CSv Stickup Organics Silty Gravel: Sandy Sandy Gravel: Occ. Boulders, Cobbly Grave1ly'.Sand; Silty, Brown -:Gray:Till/ Hardpan Silty ^ravel::. Da >ap .: Gravel: Clean, Waterbearino. in bottom "^� �•��� Loncrac:or Certificate :no's. 014 L 073 1 —CUSTOMER TO 70 �.� 143 TO 1/.3 X15 TO 21 S 'T0-2- 3 5 223 TO 251 TO TO TO TO TO TO TO CSv Stickup Organics Silty Gravel: Sandy Sandy Gravel: Occ. Boulders, Cobbly Grave1ly'.Sand; Silty, Brown -:Gray:Till/ Hardpan Silty ^ravel::. Da >ap .: Gravel: Clean, Waterbearino. in bottom "^� �•��� Loncrac:or Certificate :no's. 014 L 073 1 —CUSTOMER MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW920097 DESIGN ENG,INEER:ANDERSON ENGINEERING OWNER NAME:HARRISON GEORGE E OWNER ADDRESS:P.O. BOX 100998 ANCHORAGE, ALASKA 99510-0998 PARCEL ID:01739408 LEGAL DESCRIPTION: ROBIN HILL #3 BLK 4 LT 5 LOT SIZE: 51536 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 PAGE 1 OF 1 DATE ISSUED: 5/22/92 EXPIRATION DATE: 5/22/93 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED ISSUED BY: BY : f DATE: DATE •r-- 2 2 - / Z May 17, 1992 Municipality of Anchorage Dept. of Health & Human Services Environmental Services Division 825 "L" Street, Room 502 Anchorage, Alaska 99501 Subject: Lot 5, Block 4, Robin Hills Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: I have reviewed information available on lots adjacent to the subject property and have conducted an onsite investigation. The terrain of this lot gently slopes as shown on the attached site plan. Soils encountered in the testholes located on the lot were fairly consistent and excellent for an onsite septic system. No groundwater was encountered during testhole excavation nor was any evident as of May 16, 1992. No systems on adjacent properties are within 200'. 1. The system, if constructed as designed, will have no adverse impacts on the wells currently in use or to be placed in the future on lots located in the area. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as impact on reserved space located in the area. designed, will have no adverse either surface or subsurface on any lots 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. Sincerely, Michael E. Anderson, P.E. N�%, ROFE`SSSO ;,, p j r-45- T�A� /,,. _ 4/0 AJU 'S-/-57-CMS A+LE LO C44r c-0 LAJ ►7-N in! Zoo Or 7'1i£ S C' 5vSre—cm $, IN 89'59'47" E 250.24'(M) c N 89'58'24,. W 250.00'(R) 1 r� I 2`i BUILDING SETBACK 'i7R,�,Qos�o 30'-------------------------------------------------- I Y i( I I I I L1 1 i SF=51,536.8' 1 m i i.• _ �— � LOT 5 1 m Ol �; t6 u; j C) O N N 1 1 I r u � 1 - i PROPOSED TWO I _ 26.2' 1 I STORY HOUSE N ., o If cs n Is ' ROOF EAVE' - 53.0 -- - o i tQ cQ O p I 1 0 p L p 7 O I O i � •b 0 G 1 N I L I IC 25' BUILDING SETBACK I S 89'58.24'• E 250.00'(R) ' 250.06(M 30' BASIS OF BEARING S 89' 58' 24') E -- - --------- 310.00(R) 310.06(m) ---- -- r-45- T�A� /,,. _ 4/0 AJU 'S-/-57-CMS A+LE LO C44r c-0 LAJ ►7-N in! Zoo Or 7'1i£ S C' 5vSre—cm $, auu 1V7— J�r— � QS1 r--�W glr.� ALL - SHEET LI._SHEET NO. OF CALCULATED BY DATE CHECKED BY DATE D/>POSAL I�E;Il(-Ol+i'nUIJ uArL /�i M'InI.�NG�. - LLu,a�, x /L; -O 6A4./o.a/ � G t . S' x . �•$ �C4� .: Fp�x-ok. � �. _ S.b " G�v�-) . ° 3z � . G S r -r. �. 326. z7 Fr_ z S Ff. Cr�'Nu{ :.W1Qra, GS.' z " ZS F7. •�• USE L Gt;'G5 3 S I�r, LONA cycN I- s- 0 n Tr. SCGr/D �F 1,00 6ALLonl Scnn�Trw��` To �)r7m r -o2 l5 � �usE CcCA�au —r�rsE JV- V) 5 1 0 ca passeep au®ea�Ve6 3a s C � eooa o a a m eo c E� �y PAMC . /G/; / [ Zir M/N I N w — = ,��� Michael E. Anderson o �� ''// _. _ : (��m 4381-E ,°�E' 7�0 �!)'�%A�. ... �. �5(� F'. L �QEt.�`mamF? moo oamH.Jcmj'o. 750 x -SB = 3S' Fr.zrr. 07 r -r �`� ,Yol-cs U s - z GAGSs,� � (2 0 PERFORMED FOR: LEGAL D Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST 8 - i `�IiA I CV1� Gn Ue� 'lo $rl 9 10 O DATE PER ownship, Range, Section: SLOPE '49XN4 1 a000G66d040"., 00 03 3600000agyd 0.6 0O OB//O'8�0 �0 o tea. Michael E. Anderson o 4 o_ 4381 - E SITE PLAN v/ ` EPT IF ) .. ANN O.11 3 vo 4 r `' • o WAS GROUND WATER 5 D "/ o ENCOUNTERED? 6 V oJpv 7 r /oDe, <� . Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST 8 - i `�IiA I CV1� Gn Ue� 'lo $rl 9 10 O DATE PER ownship, Range, Section: SLOPE '49XN4 1 a000G66d040"., 00 03 3600000agyd 0.6 0O OB//O'8�0 �0 o tea. Michael E. Anderson o 4 o_ 4381 - E SITE PLAN v/ ` I .. ANN O.11 vo `' • o WAS GROUND WATER ENCOUNTERED? 15 16 17 18 19 S�'I/ ✓ r,�y� S IF YES, AT WHAT - `� L DEPTH? OP E sf' W I 4VMiSI I�oeptn to Water After� Monitoring? �J ARY V wtp7 - Date: =Mmm� .. ANN 20 t__jy�� 7/ PERCOLATION RATE ,Lld'�_ (minutes/inc�h)GP_ERC HOLE DIAMETER JW ( r GTEST RUN BETWEEN Ty FTNANDf 51 FT •�1. r COMMENTS V., j,3 ✓C�IiKCI' '1 i'����llf%I� IO i rilYi I CJI PERFORMED BY: 3 �f'P�L / I �` �u�uc' � �uscC&E� THAT THIS T,5� T WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: _Ley! % Z' 72-008 (Rev. 4/85) 0 PERFORMED FOR: LEGAL DESCRIPTION:) 'D F �r 2 �'••=''� aV 3 4 5 6 7 8 9 10 11 1.2 13 14 15 16 17 18 19 20 5M , �4n SM / taw/ tv"6' -� tl A NL �)rTDN f2f Hol DATE PE Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? P E Depth to Water After _ Monitoring? Dale: S 17-92 -(WGtN�F's seaL> h� OQQO V �t?��0 Municipality of Anchorage u o vy� DEPARTMENT OF HEALTH & HUMAN SERVICES' 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST n�S_9ci w, �l E. Anderson 5M , �4n SM / taw/ tv"6' -� tl A NL �)rTDN f2f Hol DATE PE Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? P E Depth to Water After _ Monitoring? Dale: S 17-92 I I PERCOLATION RATE 1% rl LLL__JJJ L (minutes/inch) PERC HOLE DIAMETER 1¢� TEST RUN BETWEEN 51(/ FT AND 6 /y FT 1,e COMMENTS WAt&2 Fr,1V Z X 1f/ PERFORMED BY: Iy N �"�� a—,AL F�1�7 -ter R IFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/851 W .:. I I PERCOLATION RATE 1% rl LLL__JJJ L (minutes/inch) PERC HOLE DIAMETER 1¢� TEST RUN BETWEEN 51(/ FT AND 6 /y FT 1,e COMMENTS WAt&2 Fr,1V Z X 1f/ PERFORMED BY: Iy N �"�� a—,AL F�1�7 -ter R IFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/851 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-394-08 COSA # f)I pM2'P. Expiration Date: 4 —�?_ 6— 06 1. GENERAL INFORMATION Complete legal description Lot 5 Block 4 Robin Hills #3 Location (site address) 13100 Mountain Place Anchorage AK Current Property owner(s) Robert 6 Judy Griffin Day phone 345-0900 Mailing address Lending agency Mailing address 13100 Mountain Place Anchorage AK 99516 Day phone Real Estate Agent Bill Empie/Dvnamic Properties Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services, LLC Phone 272-8216 Address _P.O. Box 102954, Anchorage, AK 99510-2954 Engineer's Printed Name Steven R. Pannone Date 1/12106 5. DSD SIGNATURE ✓ Approved for -3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: ��� Original Certificate Date: ;2'(0-04 (R«. 11,6) Municipality of Anchorage • Development Services Department ` Building Safety Division < Onsite Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 995196650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: . Parcel ID:rte,, A. WELL DATA Well type E Date completed1§Jtl si92 Total depth _Z _fL Date of test Static water level If A, B, or C provide PWSID # _ Well Log (Y/N) Y Sanitary seal (Y/N) Y Wires properly protected (Y/N) Cased to eft. FROM WELL LOG 60992 221 ft. 30 g.p.m. WATER SAMPLE RESULTS: Coliform _Q—oolonies/100 mL Nitrate 1.M mg/L Arsenic: i�s d ill Date of sample: 12H6105 B. SEPTIClHOLDING TANK DATA Tank Type/Material Greer Steel Tank size 1000 gal. Number of Compartments 2 Casing height (above ground) _24 in. AT INSPECTION 12/1612005 215 ft. 5.2+ g.p.m. Other bacteria 0 oolonies/100 mL Collected by: Laura Pannone Date installed SMOM992 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) NIA Date of pumping 912712005 Pumper _Isaacs Pumping C. ABSORPTION FIELD DATA Date installed 6MTn992 Soil rating (g.p.d./fe or fe/bdrm) 0.4_ System type Shallow Trench Length 3T ft Width S ft. Gravel below pipe 3 ft. Total depth U ft. Elf. absorption area JMfe Monitoring tube Y Depression over field N Date of adequacy test 12116H005 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test M in. Water added0i gal. New depthlIQ in. Elapsed Time: jJA min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed 'Pump on' level at _ in. 'Pump Datum Cycles E. SEPARATION DISTANCES Manhole/Access (YIN) at _ in. High water alarm level at SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 125 Absorption field on lot 135 Public sewer main 100+ Sewer /sepfic service line 25+ Animal containment areas 100+ Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manholetcleanout _100+ Holding tank _100+ Manure/animal excrete storage areas 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 25 Property line 100+ Absorption field 11 Water main 100+ Water service line 25+ Surface water 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 110 Building foundation 35 Water main 100+ Water Service line 25+ Surface water 100+ Driveway, parkingHehicie storage 10+ Curtain drain None Observed Wells on adjacent lots 1_00+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone COSA Fee $ �- Date of Payment Receipt Number (Rev. 1IMS) Waiver Fee $ Date of Payment Receipt Number Steven R. Pennone 1I` CE -811r49 r ` . in. SCS ReEN 1060205001 Client Name Pannone Eng. Srv. Project Name/# L5 B4 Robin Hills No 3 Client Sample ID LS B4 Robin Hills No 3 Alatris Drinking Water PWSID Sample Remarks: All Dates/Tim" are Alaska Standard Time Printed Daldrime 01202006 17:44 Collected DateMme 01/122006 11.55 Received Dale rime 01/122006 12:30 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Mcihod Container ID Limits Date Date ]nit Metals by ICP/M3 Arsenic 5.00 U 5.00 ugIL EP200.8 A 01/16/06 0120/06 SCL Gt-03-OS:l5.30 ; SCS ROU 10111=1001 CDeatName Pannone EmS, Srv. Prolee NumeM Lot 5 Bit 4 Robin Milt No 3 Client Sontpk M Lo; 3 3k 4 Rob!n RM No 3 b[atriz Driakinz Water P"TD 1 0 Saroola Remarks: ;607 E51 5201 z i! AD Dnew7imu are Aladca Standard Time hinted Daternme 12292003 11:39 CoCeeted DorNTlme 121182001 "0 RaoWsdDatdrlma 12/192005 939 T@dWaalDireetor StoomC.Y.de Allawable Prep Amtysia Pawaemr Ruulu POL Na1u aatnad Centeloorm L;mda Drs Dam ink Mtrate-N 1.72 0.100 mp/1. EPA353.2 B (a10) 12/19/03 )C A1_emobielooX LaboraLe!X Total ColLrorm 0 eoUl00m1. S=0 9 3 A (o -I) :3/19.'05 TLP The location of the structure(s)as shown on this record drawing m 0 N I " I � • a ,ley,_ ,� <<6'�."aszg •.�•: 4 I �1�dP_'.fP, Iy �1� psu oa ASBUILT SEWARD & AssorTATR4 T.Anm crn I HEREBY CERTIFY -THAT 1 HAVE SURVEYED THE SCALE= FOLLOWING DESCRIBED PROPERTY= y. E, PATE; AND THAT NO ENCROACHMENTS &IST EXCEPT AS' / INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' ANY DATA HEREON BE USED FOR CONSTRUCTION 6 OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN: ARY LINES. OF At"%s�` v �')• �TM•�.. �� ' Du.n. Al4rk S...—,d . ;'. 15-6916 S+ e C0 \\`�^slorulV•� � 1n.-. wsw 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. # 017-394-08 HAA # rA 222 1. GENERAL INFORMATION Complete legal description Lot 5, Block 4, Robin Hills No. 3 Location (site address or directions) 13100 Mountain Place Property owner John & Susan Lincoln Day phone 345-7923 Mailing address P.O. Box 111534 Anchorage, AK 99511 Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: Three (3 ) 3. TYPE OF WATER SUPPLY: Individual well xx Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xx Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 5. C.3 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 Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's signature ffr"� ��b�• ' l L �c�--�—� Date DHHS SIGNATURE Approved for %91RE1E bedrooms. Disapproved. Conditional approval for Additional Comments 10/22/98 bedrooms, with the following stipulations: Date _1D _.2- 7- 13 S 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 engineers work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage E C E I� 1 E D DEPARTMENT OF HEALTH & HUMAN SERVICE d Environmental Services Division l ) 1998 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4ichorag744 e Health Authority Approval ChecklistC�Rt I leaith & Human Sera�ec Legal Description: Lot 5, Block 4, Robin Hills Parcel I.D.: 017-394-08 No. 3 A. WELL DATA Well type Private If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) _ Y Date completed 6 /0 / 9 2 Total depth 261 ' Sanitary seal (Y/N) Date of test Static water level Cased to 261 ' Y FROM WELL LOG 6/2/92 Well production WATER SAMPLE RESULTS: Coliform 0 221' 30 Nitrate Date of sample: 9/3/98 B. SEPTIC/HOLDING TANK DATA Date installed 6/16/92 Tank size 1, 0 0 0 Gum Casing height (above ground) Wires properly protected (Y/N) _ AT INSPECTION 9/.3/98 1,12 mg/L Collected by: 2' Y o -MVICL �-7 5.4 g.p.m. Other bacteria. J. Nicodemus I$] Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N DateofPumping 8/28/98 Pumper A Plus C. ABSORPTION FIELD DATA Date installed 6/16/92 Soil rating (g.p.d./W or ft2/bdrm) • 8 System type 5' Wide Trench Length 37' Width 5' Gravel thickness below pipe 41 Total depth 7 Effective absorption area 370 SF Monitoring Tube present (YM) Y Depression over field (Y/N) N Date of adequacy test 9/3/98 Results (Pass/Fail) P a jjs For Three bedrooms Fluid depth in absorption field before test (in.); 0 Immediately after 4 8 2 gal. water added (in.): 6 Fluid depth 0 (ins) Minutes later: 90 Absorption rate = >450 a.p.d. Peroxide treatment (past 12 months) (YIN) N If yes, give date 72-026 (Rev. 3/96) D. LIFT STATION - None on Lot Date installed Manhole/Access (Y/N) High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot >100, Absorption field on lot >100' On adjacent lots "Pump off" level at* >100' On adjacent lots >100' Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line >25' Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation >51 Property line >5' Absorption field >5' Water main/service line > 10 ' Surface water/drainage >1001 Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line > 10 ' Building foundation > 10 1 Water main/service line >10' Surface water > 10 0 ' Driveway, parking/vehicle storage area > 1 n ' Curtain drain None on Lot Wells on adjacent lots >100' F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal reco "t@@o�e�sj<��ems are in conformance with MOA HAA guidelines in effect on this date. °��e Signature �oon° t oa°e poub ov., Engineer's Name Michael E. Anderson, E. .r. ��'' , MIS F=, AN1Ne Date 10/22/98 d� '°, 4�89_E A ° ° ° °°a°°°^°� ®• HAA Fee Date of Payment �C - A 1-42) _Qylk Receipt Number [� 'a%�') ( 6 1 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number SEP -10-98 11:24 FROM -CTE ENVIRONMENTAL 5615301 T-126 P.02/03 F-180 CT&R Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID Par4meter CT&E Environmental Services Inc. 985010001 Anderson Engmcering Lt 5 Blk H Robin Hills No. 1 1-15 Blk K Robin Hills No. 1 Driaking Water U Client POIf Printed Date/Tithe 09/09/98 09.23 Collected Date/Time 09/03/98 13-15 Received Date/Time 09/03/98 15.20 Technical Director: Stephen C. Ede Released By Allowable Prep Analysis Results PQL Units Mectiod LimitS Date pace blit Total Cotiform 0 cot/100m1 SM18 92228 09/03/98 KAP Nitrate -N 1.12 0.100 me/� EPA 300.0 10 max 09/04/98 09/03/98 ccP ity RIGHT p40 ' 5 Sy P eS4 TS A FOIL NO A+ HOME SERVICES, INC. -` 7501 E. 140th Avenue Anchorage, Alaska 99516 345-1890 CUSTOMER Li=`l{1'.J .V1UunL::.iI1 Place Block Lot INVOICE# 10$ DATE DESCRIPTION AMOUNT 39 _ 00 8-28-98 Piiffip Geoe L DAN, - i ail rri h Time? 7111 �9-'Aj + ^ that we hgt e you #ind helpful and if followed can.he at t Wnznd v of t• a &A. is you t owe any questions or concem5 please do not hesitate to ca]L .. ...:a , .. ..... . .a J �• i'"�si � i1�r �: .-t >^_'.: �yt..._ ..:.5 h:i. ." TOTAL - OTALvezG3 N' o Recs2 L 7. '� '; REMARKS �� 'ir; �r rJi,t n�i� P i`r�n,t� � " rt.'ti , i+•S l ,�; �:•�/'.t '�/ r ;t� i^;-' 'a; it i; t ✓'' 'jj7 ;•� I' /-N / r-7"% %. :a! _ /iyl7i.f .Y �n f. F,.t >�RN �t i!" �l-J�.'rt / �•' .1. �q L•i'� tTi _ r r7�%J. ,Y-< LLei r .i :F r r � � i i�:i^ _ Gallons - XI Septic Leach Area Holding Tank Standpipes = - ` Time ❑ PROBLEM AREA — CALL FOR MORE INFORMATION ❑ NEEDS TO BE DONE AGAIN IN 6 MONTHS ❑ Good Shape El sludge buildup on bottom ❑ Floater on top ❑ Jim cap missing or ❑ Cut standpipe to 1' above ground ❑ Needs Septictrine needs replacing N MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES M� 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 1. D. # C)1-1 - 219 1-1- C-19') 1. GENERAL INFORMATION HAA# IAR�C)�C-)10C1I Complete legal description to l' !9" ix C4 `�r 2-0 13;n➢ h+ I ILL nt� Location (site address or directions) Property owner 6 Cr 026 z /-AnL&isojJ Day phone 3 �5� f�n�1 d 0 Mailing address (09L%1 I~/7-G-ITAG 6a. Ac.44o AAGi Lending agency 1=r / IVI O AT- 4�A G Day phone 2.77-0100 Mailing address LJ • F1,1w ii c -1:n) ^tic Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91( Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I 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 ArjDom_S©n6 L ,Q6)dGi-R..JnIG Phone 3 4q— g55l Address P0goZLI0773 ANGNO/z�4G�� i�iL 99Szq Engineer's signature MU4 (S 01"'Al-�Date 6. DHHS SIGNATURE —X,- Approved for bedrooms. Disapproved. Conditional approval for Additional Comments X��rye 3 11. \�gm009®O mmgt �ti�'� �� ✓e n ee�aamemmeenommu��msf04Bam m fe Michael E. Anderson a 44, c 'm 4381 - E �'` ® s �g �J, ma oma bedrooms, with the following stipulations: By: J G I -i -t L SAIL m4 Date ItITIC 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 #21 Municipality of Anchorage Department of Health & Human Services _ HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 407_S g �-y 1�0$j4 r1111-5 �TParcel I.D. A. WELL DATA Well type P�L)Jo-r= If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed 6'17— Driller DJULLIni6 Total depth Cased to �-� f Casing height Z > Sanitary seal (Y/N) Y Wires properly protected (Y/N) — Date of test Static water level Well flow Pump level FROM WELL LOG �/z h ZZi' SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot IZ5 / g.p.m. AT INSPECTION 10 o 00 tlz� en 2 cD N N o L Om On adjacent lots } Zoo / Z Absorption field on lot /3.15' ; On adjacent lots ZZo Public sewer main ND#JC, Public sewer manhole/cleanout AJo0Ji; Sewer service line /10'JL= Petroleum tank WATER SAMPLE RESULTS: Coliform ® Nitrate d 17 /0 (a Date of sample: g1 adgz Collected by: No /J ie- - Other bacteria 0 10, AA)himsorJ B. SEPTIC/HOLDING TANK DATA Date installed 6 f 1'71q Z� Tank size 4000 64-4- Compartments Cleanouts (Y/N) High water alarm (Y/N) Foundation cleanout (Y/N) PAM Alarm tested (Y/N) Depression-(Y/N) N Z /J Date of pumping Al L -W Co4 S�lUJ Cr d Pumper 1'J 0'0 CD" S-rlw C7'10N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ZS' r On adjacent lots i Zoo r Foundation ZS To property line ll S' Absorption field �� Water main/service line Surface water/drainage A10 "I 5- 72-026 (Rev. 72-026(Rev. 7/st)Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level A], /-p P LIC,A 13 LC-_ "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Length On adjacent lots Date installed _ "Pump off' level at Cycles tested Surface water _ 61t 71q,& Z Soil rating . 5 GPp �System type SMAuOLJ � ��T►(l� -74' r r Width `� Gravel thickness 3Total depth IP Z r Total absorption area G 36 Fr! X Cleanouts present (Y/N) Depression over field (Y/N) Results (pass/fail) T4) S 5 _ Date of adequacy test &6J _C0rJ&4_? J crtoti / for ff " P" bedrooms Peroxide treatment (past 12 months) (Y/N) /V If yes, give date N 8 + 0 i'n+ PZCbVC271DQ F/AMP- FOA- 3 i C�_nI+VCL SEPARATION DISTANCE FROM ABSORPTION FIELD TO: i Well on lot / �1!5 On adjacent lots % 400 � Property line X10 f --ll To building foundation 3 To existing or abandoned system on lot `y0 J _ On adjacent lots AJ0/,Jc. Surface water 1q0 Curtain drain Ajo 4 E. ENGINEER'S CERTIFICATION Cutbank % Water main/service line �Onifr I Driveway, parking/vehicle storage area qo -- 1 certify that / have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this:%r spection. J� Signature Engineer's /t'`,t (ua A-�.. !=� 4-,.r 0 a7uo 1 �, Name ('J Date• � � Uel ` � f4lch �n IP tip„ mss° 1;��17 oJ ` �� HAA Fee $ Waiver Fee: $ Date of Payment i - Ar- 51 Z- Date of Payment Receipt Number 940 6o C �9 Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE # 58062 Chemlab Ref.# 92.4794 Sample # 1 Matrix: WATER Client Sample ID ROBBIN HILLS - LINCOLN PWSID UA Collected SEP 8 92 @ 12:00 hrs. Received SEP 8 92 @ 13:30 hrs. Preserved with AS REQUIRED Analysis Completed SEP 9 92 Laboratory Supervisor STEPHEN C. EDE Released By :�//%�� Client Name :ANDERSON ENGINEERING Client Acct :ANDENGR BPO# : Req# : Ordered By : Send Reports to: 1)ANDERSON ENGINEERING 2) PD# :NONE RECEIVED ............................................................................................................................ Parameter Results Units Method Allowable Limits -------------------------------------------------------------------------------------------------------------------- NITRATE-N 0.73 mg/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: M.E.A. NO INFORMATION ON TAG. Remarks: ........................................`.......p .. _.......... 1 Tests Performed See Special Instructions Above UA -Unavailable ND= None Detected See Sample Remarks Above NAs Not Analyzed LT=Less Than, GT-Greatex Than 1VONSE3S Member of the SGS Group (SociM6 Generale de Surveillance)