HomeMy WebLinkAboutROBIN HILL #3 BLK 4 LT 8Robin Hill #3 Lot 8 Block 4 #017-394-05 Municipality of Anchorage P~ge 1 of 5 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW000312 PID Number: 017-594-05 N°me:CATHRYN & TERRY WILLIAMS WastewaterSystem: [] New · Upgrade Address: 12970 MOUNTAIN PL. ANCHORAGE, AK 99516 [NORm/SOUtH] ABSORPTION FIELD[HOR~/sO~H] No. of Bedrooms: Ph°ne:(907) 345--6610 4 []Deep Trench IShollow Trench I-IBed []Mound []Other LEGAL DESCRIPTION 0.6 o.~/s.. ~ 5.05 - 6.88 8 4 ROBIN HILL #3 3.23 MAX. F~ 3.34/3.5 F~. - - - 0.6- 1.8 ~ 57/54 WELL: [] New [] Upgrade~..........'~""/ o=,., wi~: 5/5 Ft.Number of lines:2 [O~"t°"C"lb~W"' Il .... .. A+ HOME SERVICES 8/28/2000 TANK SEPARATION DISTANCES []Septic [] Holding ~E.P. To Septic Absorption •fi Holding Publlc/P~wteMan~facture~' ~'~Man~facture~' Cap~clty In gallons: From Tank Reid Station Tank Sewer IJnes Well 100'+ 100'+ -- -- ~oo'+ ~oo'+ - - - LIFT STATION ~ Surface Water Lot 5'+ '1 '+ - -] Line Foundation 5'+ 10'+ -- -- Drain NONE KNOWN ~e~o~: THE STRUCTU~L ~NTEDR~ OF THE SEPTIC BENCH MARK TANK WAS VERIFIED. TOP OF OLD DOSING BASIN. '1' LOT LINE WAIVER REQUESTED. SEE ATTACHED LETTER. 100.00 F~ ~ OF ~3,~...~.'; ..... ~.'~4(3TH }~ "?~ Inspections performed by:. AWWC, INC. Dates: 1st 8/25/2000 7* : ,'i".'[z / ~.~ !" ......... 3rd 9/1/2000 . i ~ ,, ~ · )~ ; J~ ffrey~/,~. G~mess.. Department of Health and Human Services approval q~?~ ' -.. LJ ..." ~ Reviewed and approved by: ~///~--~"/~A ~:::>~' Date: ~- (~-oo ~'~'~- ' .......... '~'? PERMIT NUMBER: PARCEL ID NUMBER: swooo3,2 AS-BUILT DRAWING 017-394-05 % ST1 7Z.9 50.7 ['/ % ST2 82.7 50.0 2 J ~ OBL1 84.0 50.4 /I I ~ o8~ 84.8 ~o.~ I ~X FD 85.4 51.0 ~~ ~T1 79.7 61.6 ~ / C02 1214 807 -- J I ~O~ ~' MT2 120.2 79.0 ~ ~ / ~ J MT5 81.8 72.0 / _ ~/ ~TEST HOLE PERFORMED I ~1 ~ / / ~ ~STN6 1250 ~ ~ / ~ ~ // USEB AS A RESERVE SEE ~ co~ TOP OF J~5 ~1 ~ BASIN 1OD O0 '~~k A~ACHED L~ER FLOW ~]~ RDIVER~R X X (rs) / DATE: ~S~ ~TER & WASTEWATER K.D.W. ~XY;']. ~Ji,~ j'..~ ~,~,~,.~,,.~,~,,~.,,o,~.~,.,-~,,..,~.,~-~.. ~"= 4o' ?; ........ ~'-'f;~",!? .... ~ ...... OATHRYN · TERRY WILLIAMS (907) 545-6610 2 OF ~ ~ ~J~ffre~.~. LEgal DESCRIPTION: %~, ?. C~7953 .-' ' ~ ~ / % ," ." ROBIN HILLS SUBDIVISION ¢5; LOT 8, BLOCK 4 ~%~. .......... DESIGN DRAWING FOR SEPTIC SYSTEM UPGRADE ALASIU kYATER & -WASTEWATER September 6, 2000 Municipality of Anchorage Department of Health and Human Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Lot Line Waiver for Robin Hills Subdivision #3; Lot 8, Block 4 To whom it may concern: We request that your department issue a foot lot line waiver from the property iine to the new drainfield. On 8/25/2000, we contacted your department and received verbal approval for the waiver prior to the installation of the new drainfield. The adjoining lot is undeveloped and the encroachment will not cause any adverse impact. I am unaware of any adverse impacts this waiver would have on adjacent wells or septic systems. If yin P./E., M.S. contact us at 337-6179. Thank you for your assistance. RECEIVED SEP OG 000 Municipality of Anchorage Dept. Health & Human Services 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6~79 * Fax: (907) 338-3246 * Website: akw~vc.com PERMIT NUMBER: PARCEL ID NU;~BER: swooo3,2 AS-BUILT DRAWING NORTH TRENCH SOUTH TRENCH ~z~[: ~.~' : ~ IINVERT OF TANK I [~ ~J .r. 055 96.39[ ~~ ~C~VE: '_~ ~ ~,I~ ~~ DATE: ~%~%, ........ K.D.W. AI,ASI~ WATER & WASTE~TER ~c,~: GONSOkTANTS, lNG. ~ ......... -~ :* ~' ~ ... ,o,~,o~.,~,..~.o~,~.,~,~,.o~,~,,-,,,,.~,,o~=-~ ~": ~o' ¢',"q"k '/';~ '} .......... . CATHRYN & TERRY WILLIAMS (907) 345-6610 5 OF 3 ~ Z~AL ~ESC.~PT~ON: ROBIN HILLS SUBDIVISION ¢~; LOT 8, BLOCK 4 qb&~%¢_~, ........... WPE OF WORK: AS-BUILT PROFILE OF SEPTIC SYSTEM UPSRADE MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 21,2000 Expiration Date: Aug 21,2001 Permit Number: SW000312 Legal Description: ROBIN HiLL #3 BLK 4 LT 8 Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: Cathryn & Terry Williams Owner Address: 12970 Mountain Place Total Bedrooms: 4 Anchorage, AK 99516- Parcel ID: 017-394-05 Site Address: 012970 MOUNTAIN PL Lot Size: 60564 SQ. FT. Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy Private Well [] Water Storage 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 noti~ DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Date: o~'/:2~///~' Date: -2 I- ALASIG WATER & WASTEWATER August 11, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 9951%6650 Ref: Septic System Upgrade Design for Lot 8, Block 4; Robin Hills S/D #3 To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The existing septic system is surcharged and needs to be upgraded. A test hole was excavated south of the existing septic system. We are proposing that a 1250 gallon septic tank and dual deep trench type drainfield be installed. Comments regarding the proposed design are summarized as follows: 1. SOILS: Attached is a soil log which shows the soil profile, groundwater monitoring, and the percolation test results. Below the organics was a mixture of GM and SM material to a depth of 16.0 feet (bottom of test hole). A pemolation test was performed between the depth of 6.0 feet and 6.5 feet and found the rate to be 24 minute/inch. Groundwater was not encountered during the excavation of the test hole; however, according to MOA records, groundwater was encountered at 11.0 feet below grade on 5/12/92 in a test hole performed by Tobben SpurkIand, P.E. It is assumed that this is the seasonal high groundwater. 2. TRENCH DESIGN: a. Percolation Rate: 24 minute/inch b. Allowable Application Rate: 0.6 gallon/day/ft2 c. Number of Bedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 1000 ft2 f. Maximum depth: 6.5 feet g. Effective Depth: 2.5 feet h. Width: 5.0 feet min. i. Reduction Factor: 0.64 j. Length: 128 feet. (2 ~ 64 feet) k. Effective absorption area = 1008 ft2 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907)337-6179 * Fax: (907)338-3246 * Website: akurwc.com 4. TOPOGRAPHY: As can be seen on the attached topographical dra~ving, the a proposed trenches is to be installed on an area that is relatively flat; in short, there are no slope concerns. The trenches is to be installed parallel to slope contours. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for yom' assistance. Jeffr .., M.S. Presi/tefi~ NOTE: Attached is a site plan drawing, a design drawing, a soils log, a topographical drawing, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907)337-6179 * Fax: (907)338-3246 * Website: akwwc.com II / ! I tl~ ..-. .... --.. I I MD_U. NTAIN_PZ.~E xx ~ I .100 WELL RADIUS. I ~ ~ I I I --I ~ ', \ / i \ ', I / ~ .... %. ~ .\\, .' ~ ..~o_~,~ .,._B 4. LOT ~. B.OCK .~. I ~~I j I I ROB~. H,LLS S/B I I ~----~OT 9, BLOCK 4, I I /"1i I \ '-*- ...... ---7----~--~z-J I . .¢.j~-¢'~ /'~ BEoO~ROOM ~_1 RO,~N N~LLS S/, k X ~ [ ROBIN HILLS /~. x X x / // ~ ', ~ LOT 7, BLOCK 5, AI,~B WATER & W~TEWATER J.W.M./J.L.M. ~¢~' fi//~" PREP~EO FOR PHONE NUMBER: PAGE NUMBER: ~Y )/ 7( t ~"~"~ "~ ...... /"V'"g CATHRYN · TERRY WILLIAMS (907) 545-6610 1 OF 2 ~ .~efjre~ A ~ar~ss ROBIN HILLS SUBDIVISION ~31 LOT 8, BLOCK 4, iJ~qh~ '"' ....... '~ ' ' ~'4 WPE OF WORK: SITE P~N FOR SEPTIC SYSTEM UPGRADE ~ -- ~ ~' NOTE: THE CONTRACTOR SHALL HAVE THE SOUTH I ] / ~" / '""" ~ PROPER?¢ LINE FLAGGED BY A REGISTERED LAND I /i/ ~~ SURVEYOR PRIOR TO CONSTRUCTION. ~ CO--co k ~~EEP (M~IMUM) BY 5 ~ WIBE X % % BY 64 rE~ LO~e ~CH (128 FE~ ~~ ~GTH~ ADD 2~ FE~ OF .,' ~ 8/11/2000 CATHRYN ~ TERRY WILLIAMS (907) 345-6610 2 OF 2 ' ROBIN HILLS SUBBIVlSION ¢5; LOT 8, BLOCK 4 .. DESIGN DRAWING FOR SEPTIC SYSTEM UPGRADE ALASKA WATER & WASTEWATER CONSULTANTS, INC. ~. oF' X PHONe (907) 337-6179 * FAX (907) 33B-3245 [SOIL LOG - PERCOLATION TEST] ~'~co:']4~ ~_ ~ ...'7., LEGAL DESCRIPTION: ROBIN HILLS SUBDIVISION #$; LOT 8, BLOCK4 L..'~ill~ ;f~ ~.~'" PERFORMED FOR: CATHRYN &: JERRY WILLIAMS ~//O;~'~; '.~:~; DATE PERFORMED: 8/5/2000 Y00~¢;:~...t ~_ 7955 -- ORGANICS [TEST HOLE #1] "tw,°,-" ........... I~EPTH feet) 1- SOIL CLASSIFICATIONS SITE PLAN GW"~.:'"~' ~ ORG ~""x : O0 -..:.,..:. ¢~,: ,, 6 P ML x. ~ CL GM ~ \ o~ . · OF CH ~' SM OH , ~l ~-TEST HOLE PERFORMED BY ~ /TOBBEN SPURKLAND, P.E. DEPTH TO DATE ..... GM AND SM GROUNDWATER WITH SILT DRY 8/5/_00 +TH#I · DRY 8/8/00 10 11 DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (HINUTES) READING (INCHES) 12 8/8/2000 - PERC HOLE PRESOAKED FOR 4+ HOURS PRIO_~ TO TEST. 15 1 3:20 6" 14 __ 3 3:51 6" __ 4 4:21 30 MIN. 4 3/4" 1 1/4" 15 5 4:22 6" 16 --- __ 6 4:52 30 MIN. 4 3/4" __ 1 1/4" 17 18 19 PERCOLATION RATE 24 (HIN./INCH) PERC. HOLE DIA. 6" (INCHES) 20 TEST RUN BETWEEN 6.0 FT. AND ~F~ FT. COMHENTS: *WATER NOTED © 11.0' ,BELOW GRADE ON 5/12~, I~1 /TOB, g~SPt :~KLAND, P.E. TEST HOLE BY DA, BOLLES, W,TH B,HS. USE AS S *BONAL PERPOR.ED ~'¥ ALAS~<A WATER ,~ WASTEWAT~R ,, ~' '/ N,..4%._ .~.~_...~ . CERT.~ T.AT THIS WAS PERF~ORM.ED IN ACCORDANCE WITH ALL STAT~'~A~b'//~I fI~ICIP,~.L Gu)'bELINES IN EFFECT ON THIS DATE= ~/~/¢ ///I/ DEPTH TO DATE GROUNDWATER DRY 8/5/_00 *DRY 8/8/00 PERFORMED FOR: 1 4, 5 7 8- g. 10- 11 t2 13 14, 15- 16- 17 18 19. ~o. COMMENTS Munlclpalily of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVIC/~S Township. Range, Section: T I ,~, ~, I~ ~ '~. ~_ ~ (~ SLOPE S~TE eLAN ' -- ~ cJ . ENCC ii.o Oei~th Io Water Time Time Io PERCOLATION RATE ~ (minute~/moh) PERC HOLE DIAMETER __ TESTRUI'~IBI:TWEr:N ~ ~'~..FTAN0 ~ Depth to Net Water Oroo CERTIFY THAT THIS TE~T WAS PERFORMED IN ACCORDANOFWITHALtSTATEANDMUNICIPALGUIOELINESINEFFEGTONTRrSDATE. DATE: _ ~ ~0~ ~ ~ ~ ~ IZ~9 (Rev. 4/~) " Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 2 3 13- 14- 15- 16- 17 18 19 20 COMMENTS Township, Range, Section: T~,t~ ~¢~ ~,, ~,,,._ ~, WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Monitoring? ~ Date: SLOPE SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop ~ ~ - 7 / '/~ PERCOLATION RATE ~% ~ (m~nute~/mch) PERG HOLE DIAMETER __ TESTRUNBETWEEN .~ :LFTAND ~ ~ FT CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICtPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev 4/85~ I I /7 SCAL~: 1' ~ 5~ ...f TDB~£N SPURKLAND P,E, SEPTIC SYSTEM DES Municipality of Anchorage Page 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: ,.~(,/ ~-OI ~t~ PID Number: OJ'7'" Name: Address: ~ [ ~~ ~ Wastewater System: ~ New ~ Upgrade II ~- ~'~ ~.of Be~ooms: ABSORPTIONFIELD Phone: ' I ~eep Trench ~Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION ~o, Rating: Total Depth from original grade: !. Lot: B~ock: Subdivision: 3epth to pips bottom from original grads: Gravel depth beneath pipe Township: ~ Range: Section: Fill added above original grade: Gravel length: Number of lines: D~stance between lines: WELL: U New D Upgrade Gravel~ ~ ~ Ft. ~ JO Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Dr[ller:~[~ D~te~rilJed: Static Water Level: In~~ D(~/ Dateigstallffd: Pump Set at: ~ Casing Height Above Grouno: ~'~: ~ ~,u ~ ~ ,,./ ~ ,,. TANK SEPARATION DISTANCES ~eptic ~ Holding ~ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank SewerLines J ~ %~ Material: ~ ~ .~berofGo~artmonts: Well 12~ I~ ~ s~f~w~ter ~l~ H~ LIFT STATION LotL Size in gallons: Manufacturer: Line ~O CudainDrain ~ ~ Pump Make & ~odel Electrical Inspections pedormed by: Remarks: BENCH MARK Location and Description: lO I Inspections performed by: ~ Dates:lst 7/~ '"~"' ' : ' ~' ' Department of Health and Human Services approval Reviewed and approved by: ~ ~~ Date: 72-013 (1/91) MOA 25 I / / / 5~ \\X L 65,5 I 74 -~ Tes~hole #3 I SCALE; 1' -- 50 FT, 150 TUBBEN SPURKLAND P.E, 20g ~ 15TH. AVENUE ^NCH, AK, 99501 4 SECTIDN ~6, ~I~N N3W ~AMEL C£NST£UCTJDN SEPTIC SYSTEM ASBUILT ])~'rE, NDV, 5, 1992 SHEET, 2/3 GRImm ~838 1250 gal Septic look Monitor Cleon Out Distribution .Box Stondord Trench: 35' LONG TOTAL 6' DEEP 2' OF SEWER ROCK 4' mln, Covet' 97. 1 Monitor Clean NO SCALE I250 GAL SEPTIC TANK ~ 2 feet o¢ Septic Rock TBBBEN SPURKLAND P.E, 803 ~15TH, AVENUE ANCH, AK, 99501 L~lT 8, BLOCK 4 RDt~IN HILL #3 SECTION 26, TISN R3~/ GAMEL CONSTRUCTION DATE, NOV, £ I992 SHEET, 3/3 GRID, 2838 LOCATION OF WELL BOROUGH SUBDIVISION sECTION QTRS SECTION toWNSHIP *. , r-IN CE ~ ~/,¢ ~ 138 FIW LO CATiON/~i(LL--i. C H: .... WELL OWNER: ~ ....,TE OF ALASKA DEPARTMEN1~ OF NATURAL RESOURCES DIVISION OF WATER WATER WELL ~ECORD '{ DEPTHS MEASURED FROM;rqce~ing too I"lground surface WELL ....... Depth'of hole:.. ~c~- ~/ tt' BOREHOLE DATA: Depth Depth of oasin0:~ft Material Type and Color From To DEPTH TO STATIC WATER LEVEL: ~-~ .~ ~ _ft below ~ top of casino Date: DAT~ OF COMPL~rIO" [] ground surface METHOD OF DRILLING: .[~alr rotan' [] cable tool [] other USE OF WELL: ,'~ domestic [] irdgation [] monitor [] public supply [] other. . - CASING STICK-UP; ,~ ft. Diem; ~, in. to~.~t Casing t~pe; ,~;,~-- . i .in. to ft INTAKE OPENING TYPE; CI open end [] screened [] perforated ~ open hol.e Depths Of Openings: ~ to ft :RI;EN TYPE; Diem:. in. Slot/Mesh Size: Length: ft GRAVEL PACK TYI;~ Volume use. d: Depth to top:. GROUT TYPE: Volume: -~ Depth: .from it to ft · DEVELOPMENT METHOD: Duration: ~'. PUMPING LEVEL AND YIELD-' , ~P INTAKE DEPTH: ft Horsepower: W~L DISINFECTED UPON COMPL~ION1 ~YES gpm [] NO ~ CONTRACTOR INFORMATION:, REMARKS.' :.Register4[d Business Name / ?j2¢~ .... ; .... ¢_~ ~%¢~~ ~ '* ¢' ¢ ~-*L~As~ MA~L W.~T~ COPY 0F L0'~ DNR/DIVlSION' OF WATER " PO BOX 772116 Signature of Ad(hodzed Re,present,Ye Date ~GLE RIVER AK 99577-2116 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:SW920104 DESIGN ENG~NEER:TOBBEN SPURKLAND, P.E. OWNER NAME:SLATTERY JOHN D JR & OWNER ADDRESS:il JEFFERSON AVE. PORT LUDLO, WA 98365 DATE ISSUED: 5/27/92 EXPIRATION DATE: 5/27/93 PARCEL ID:01739405 LEGAL DESCRIPTION: ROBIN HILL #3 BLK 4 LY 8 LOT SIZE: 60564 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / 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 (18AACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: CONFIRM SUITABLE SOILS TO -10' AT TEST HOLE #2. DISTRIBUTION BOX TO BE SEALED INSIDE WITH A BITUMINOUS COATING TO PREVENT CORROSION. BOTTOM OF EXCAVATI NOT %0 E×%E¥ ISSUED BY: DATE: DATE: 205 W 15th, Awnue~ Suite 206 ANCHORAGE, ALASKA 99501 (~07) 279-3916 SEPTIC SYSTE~ DESIGN ~'~ LOT ~ BLOC~] ~I~ ROB ~i .~-~ H ! LL ~5 GAMEL cONSTRUCTION ~',1o GroL.u'~d P-Jat:er or ~;:)e~'v:.ous Layer 'k.o 14 -Fi:.,, t}~e Standard Trench J.....5:.. mi n!:i. n = 1 ,, 2gal./sq,, -F't: ,, day F;,'~:,c4t.ci. ¥"~ Area per Bedrc)om: i:=:L ~'~:t sl'~ec~:~(:)or E! evat i on Lowest F:c)undat: 4~ [~ean Out El. t::z, vat i Ground c~:~:~at Absorpi::~on F:ield L. ess 6 -f:ceet ~ 8 Less [:c)~,~- 3 ~ Rock Depth ~ 5 F:"I",, SYSTEH TOTAL LENBTH ~ 50 FT. TOTAL DEPTH X ~ FT. ROCK BERTH ~ ~ FT. SEPTI~NK 1250, ~L. ~,]. (::it'] 'l",he :~r~u[:a:l.].at.:i. or~ o.F thi~s 14mC!.]. and ~e:,p'[:ic: syst~m wi].l not. imF)act. -!'t'l(e i t~,~,'l:.a:t. ]. at.:i.i:~r; c)* t.t'"~:i.~i sep'~::i.~:: ~sys~tem ~,~:i. I 1 riot [.)r'event we:l. 1 ~, (::(::lu r' !~se!!-; on t. h :L q-; c:,r' t h e a d .j ac ei-'~ t. :1. o't s ,, PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 6 7 8 9, 10- 11 12 13- 14 15 16 17 18 19 20 COMMENTS Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? L IF YES, AT WHAT O DEPTH? p E SITE PLAN Depth to Water AflP~,, Monitoring? .~ Date: Gross Net Depth to Net Reading Date Time Time Water Drop o ~ u ~ 7~/~ ¢~ /%/ z o ~ Y,I l '1,t PERCOLATION RATE '~ ~:~ (minutes/inch) PERC HOLE DIAMETER PERFORMED BY: ~1 I ~'---1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~' ~ ¢,t ~ ~ ~:~ '~-~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: 'T I~i~l ~ ~_. '~ ~ .~r._ ~, ~:~ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E SLOPE SITE PLAN Depth to Water Alter Monitoring? Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE / ~ -~ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN ;_~?L FTAND ~:~ FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES ~N EFFECT ON THIS DATE. DATE: A~ T'~' [ I 0[ ~ ~-~ 0 / 0 ~ % 8 VACANT VACANT 5O $£AL£: 1' -- 100 FT, £$0 300 VACANT TDBBEN SPURKLAND P,E, 203 W ]STH, AVENUE ANCH, AK, 99501 (907) P79-3916 [L£T 8BLDCK4RDsBINHILL#S[[ SECTI£N 86~ TiEN RSW GAMEL CONSTRUCTIDN SEPTIC SYSTEM DESIGN DATE, APRIL 14, 199~ SHEET, 1/3 25 5~ 75 lO0 $CA£D Y = $~ FT, SPURKLAND P,E, 803 W I5TH, ~VENUE ANCH, AK, 9950~ IILOT B LOCK4ROaINHILL#311 SECTI£N ~6~ ?i~N RGb~ GAMEL CONSTRUCTION SEPTIC SYSTEM DESIGN Dt~TE, APRIL 14, I99~ SHEET, 2/3 GRID, -~3~ _1 L_ 0 Monitor Cleon Out 3 tondord Trench, 50' LONG TOTAL 10' DEEP 5' OF SEWER ROCK 5' min, Cover 1850 gal Septic ~ank NO SCALE Cleonou~s ~ Exls'~, Ground 4' MIn Co ver ---over 1850 GAL SEPFIC ?ANK j / M~ra£! I40 5 Peet o£ Septlc Rock T[]B~EN SPURKLAND P.E, 203 W15TH. AVENUE ANCH. AK, 99501 LOT 8, BLOCK 4 RDBI/V HILL #3 SECTION ~6, Ti~N R3IV GAMEL CONSTRUCTION ~^ZE. APRIL I~ 199£ 203 W !5th, AYenue~ Suite 206 ANCHORAGE~ ALASKA 99501 (907} 279-3916 LOT SEPTIC SYSTEM DESIGN BLOCI< 4 ROBIN HILL GAMEL CONSTRUCTION I::'FV I !SF['/, ....... HAY ~:':' z.,.,., 1992 Ground Ma'kc-.r at: USE' t~Jide Trel]ch Rat i - (;~ RECEIVED MAY 2 1 1~ feet Municipality CAnohorage Dept. Health & Human Servioe~ [:rom test April 6,~ 1992 1.-5 rain/in = 1.2gal/scl..ft,,day ReqLtired Area I::,E,r Bedroom: F'ir"~i shed Floor E:l.~:.r;,a'ki on Lo~,~est Floor Fc, undatic~n C].ean OLH: t~:ff"c~ur"~d >l..u -ra....e at Absc:)rpti on Fi e~l d Roc I.:: Oep t '~ R,:~))c:h..tct i on F'actor . '7 ! 1 fee'k. !}Say :[0 6 .~: FT. NLt £Ab E~r O'~ }}E-'d r ,9ores 4 I...er~gth of ]"l'-ench 125 x .4 x .7/ 5 = 70 FT USE T'WO 'T'RENCHES EACH 35 FEET. SYSTEf'i CONF I GURAT l' ON ~%DE TRENCH TOTAL LENBTH TOTAL DEPTH ROCK DEPTH SEPTIC T6NK 70 FT. 6 FT. 2 FT. 4- FT. 1250 GAL. !i!;e p't: i c: S y s t e m D e) s i g n ]"he instaltatior'~ c).f: this well and septic system will not impac:t adjacent lo'ks, The well loc:ation confor'ms ~:o (.he siting of ~:.he existing wells in the area~ and will not pr"event the adjacent lot c)wners -~rom developing t:hese ].o~:s or replacing the existing -f'he ins'!::al].at:[on of this sept:i.c system wi].), not pr'even'[: wells ,Frc)m be installed (:)n the ad.jacer-c[ lots. There are no developed or natural surface / sub .sur-Face drainage Thf:.:, proposed septic system ~:i.:i.:l. r',.ot change the general st c:)pe r esu 1 t. f r om t h :i. s i n s'[:: a 1 ]. a'l:', i on. Septic:: System :()esign ---7 well Primary ~ Tes~;hol, e I DINe 50 75 100 1£5 150 SCALE: 1' = 50 FT. REVISED: Moy 25, 199~ TDBBEN SPURKLAND P,E, 203 ~ 15TH, AVENUE ANCH, AK, 99501 SECTION £6, T]2N R3W GAMEL CONS TRUC TION SEPTIC SYSTEM DESIGN DATE, APRIL I4, I992 SHEET, £13 GRID, 2838 ~ Nonltor C(eon Out ~ Moni~or Cleon Out 35 Cleon ZIppi 1 1250 gal Septic tank Cle~n o~i Stondord Trench: 35' LON5 TOTAL 6' DEEP 2' DF SEWER ROCK 4' mm, Cover Miro £i 140 ~ £eet o£ Septic Rock NO SCALE Cleonouts -- d Co vet Nonltor 1250 GAL SEPTIC TANK Exist, Oround 4' Min Cover ~over Tonk REVISED Moy 2%, I992 TDBBEN SPURKLAN3 P,E, ~09 W15TN. AVENUE ANCH. AK. 99501 LZT? 8, BLOCK 4 £LTY?IN HILL SECTION 26, TI2N R3W GAMEL CONS TNUC EON #3 SEPTIC SYSTEM DESIGN DATE, APRIL 1S, 1992 SHEET, 3/3 GRI3, 2838 Municipality of Anchorage On -Site Water and Wastewater Program (907).343-7904: 5 .A F E ;'Y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL . Parcel I.D. 017-394-05 1. GENERAL INFORMATION Expiration Date: ` 1 �Zy �v Complete legal description Robin Hill #3 Block 4 Lot 8 Location (site address) 12970 Mountain Place Anchorage Ak Current Property owner(s) Andrew Angel Day phone Mailing address Real Estate Agent 12970 Mountain Place Anchorage Ak 2. TYPE OF DWELLING: M Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well M Individual Water Storage ❑ Community Class _ Well ❑ Public Water System ❑ WaiverNariance request for: 4 Day phone TYPE OF WASTEWATER DISPOSAL: Individual M Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: Date: COSA to be released to the engineer; unless otherwise requested by the engineer. COSA Fee $ 4 le? 5b ( 60 V I /) - Date of Payment D _12"2 d z0 Receipt Number 007 2 COSA# 05C.20 1 y3,?, Waiver Fee $ Date of Payment Receipt Number Waiver # istance: 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the .information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD EAGLE RIVER-, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 8111/20 Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future'rk: occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist.", s� ....+•.."�f`�.,_ 6. DSD SIGNATURE t� System #1 Approved for ( bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: l -Pas iP s -e S i c 4vvk A -q -P A c.v iyo vv AW-av_,, J 5� P A:Q Z -- v �A�a-a-�- _.---___._ B _ Ir OrigitJ%,J 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 Septic System Advisory Well Flow Advisory COSA blue,heei 10-10-12.dcc Nitrate Advisory . Arsenic Advisory Other �e,pftc -&,tic 4qP agyr Legal Description: Robin Hill #3 Block 4 Lot 8 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 6/14/92 Total depth 324 ft Cased to 240 ft Sanitary seal is functioning correctly ❑ Wires are.properly protected Casing height (above ground) 17 in. Date of flow test for COSA 6/26/20 Static water level at beginning of test 228 ft. Comments B. TANK DATA Age of tank(s) 28 years Tank type/material Sej)tic/Steel Measured operating fluid level in septic tank 49 Standpipes/foundation cleanout per record drawing Date of pumping 6/26/20 D. ABSORPTION FIELD DATA Parcel ID: Structure served by this system 1 017 -394 -OS Well production at time of test 2.5 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes Nc Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 6/26/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Which system tested (date installed)8/25/2000 Adequacy test date 6/26/20 ❑ ALL standpipes present per record drawing Results ® Pass For 4 bedrooms Total measured depth from grade 7.3/7.3 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 4.1/4 ft (min) Water added 600 gal ❑ N/A —pressurized field 0 New depth in Monitor tubes go to bottom of effective. If not, state depth into effective Elapsed time 20 min Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies:. Duel Trench system COSA Checklist yellow sheet E. SEPARATION DISTANCES 0 Yes if No ft If absorption field is under driveway comment below From Private Well on Lot to: (Please enter distances if less than required or if community well) ® Yes Septic Tank/Lift Station on Lot > 100' ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25'0 Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Yes if No ft 0 Yes if No ft Community Sewer Main > 75' 0Yes if No ft Manure/Animal Excreta Storage > 100' ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ®Yes if No ft Property Line > 5' Yes if No ft Wells on Adjacent Lots.- ots:Absorption AbsorptionField > 5' Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ®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' 0 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' 0 Yes if No ft Private Wells > 100' ®Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that l 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 Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 201432 Subdivision: Robin Hill #3 block 4 lot 8 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 28 years old. Typical replacement costs range from $8,000 to $11,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. I Mailing Address P a Box 196650 *Anchorage, Alaska 99519 6650 *www muni org Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343~.744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 017-394-05 1. GENERAL INFORMATION Completelegal description ROBIN HILLS S./D ¢3: LOT 8. BLOCK 4 Location (site address or directions) 12970 MOUNTAIN PLACE ANCHORAGE. AK 99516 Property owner Mailing address Lending agency Mailing address OATHIRYN & TERRY WILLIAMS 12970 MOUNTAIN PLACE ANCHORAGE. AK Day phone (907) 345-6610 99516 Day phone Agent CHARLIE WHITLOCK w/ COLDWELL/FORTUNE Day phone (907~ 265-9165 Address 2525 "c" STREET. ANCHORAGE. AK 99503 Unless otherwise requested, HAA will be held for pickup. 2, NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: ff community weft system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State lng to the legality and status of system, ADEC 72-025 (Rev. 1/91) Front MOA #21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $2435.00 at, or prior to, closing for the engineering services provided. 5, STATEMENT OF INSPECTION BY ENGINEER As cedified 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 vedfy that based on the information obtained fram 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,~d State codes, ordinances, and regulations in effect on the date of this inspection. . ~ ~ Name of Firm ALASKA WA't~ & ~.S'F~T~R CONSULTANTS, INC. Phone (907)337-6179 / ¢1t ~'11/~' Address 6901 DEBARR EOAD,.~S,[rE,2BFANOHORAGE, ALASKA 99504 /I Engineer's SignatureI¢11(,._~. !~Jl~/~ ¢~J¢~ Date_ ~/~'/O° In conducting this evaluation, AWWC, ~n// a~e~ted to ~ a thorough, conscientious engineer{n~ ffnalysis of the system in accordance with ADEC and M~OA ~)H~S Guidelines & Regulations. The reported results described the performance of the system under the c¢)nditions~encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of afl wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DHHS SIGNATURE I,'/Approved for /"iL Disapproved Conditional approval for bedrooms bedrooms, with the 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 engineers work. 72-025 (Rev. 1/91) Back MOA #21 Computer Version RECEIVED Municipality of Anchorage RFp ~ DEPARTMENT OF HEALTH & HUMAN SERVICES ...... Environmental Services Division 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343M~i¢IPALITY OF AN ENVIRONMENTAL SEEVI~ON Health Authority Approval Checklist Legal Description: ROBIN HILLS S/D #3; LOT 8, BLOCK 4 Parcel I.D.: 017-594-05 A. WELL DATA Well Type PRIVATE Log present (Y/N) Total depth 324' Sanitary seal (Y/N) N/A IfA, B, or C, attach ADEC letter. ADEC water system number YES Date completed 6/14/92 Cased to 240' Casing height (above ground) 17" YES Wires properly protected (Y/N) YES FROM WELL LOG 6/14/92 ATINSPECTION 7/21/2000 Date of test Static water level 22.:3' 225' Well production 2 g.p.m. 3.6 g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate 0.5 mq/L Other bacteda 0 Date of sample: 9/1/2000 Collected by: A.W.W.C., INC. B. SEPTIC/HOLDING TANK DATA [NORTH/SOUTH] I'BELOW FINAL GRADES] ~ ~-~_..~ Date installed 7/17/92 Tank Size 1250 Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression (Y/N) NO High water alarm (Y/N) N/A Date of Pumping 7/12/2000 Pumper ISSAC'S C. ABSORPTION FIELD DATA Date installed 8/25/00-8/28/00 Soil rating (g.p.d./ft2 or fl2/bdrm) 0.6 System type DUAL TRENCH Length 57'/54' Width 5' Gravel thickness below pipe 5.,32/3.55 Total depth *6.75/7.55 Effective absorption area 1,028 SQ F-r Monitoring Tube present (Y/N) YES Depression over field (Y/N). NO Date of adequacy test NEW Results~(Pass/Fail) . For .,-----~l~eorooms Fluid depth in absorption field before test (in.); ~ed (in.): __ · reatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/95)* Computer Version D. LIFT STATION in_.~l~~ Date installed ~ ~ .Size Manhole/Access (Y/N) ~at* "Pump off" level at* High wa~ /*Datum ._¢ggles-fested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main 100% 100'+ N/A On adjacent lots_ 100'+ On adjacent lots 100'+ Public sewer manhole/cieanout N/A Sewedseptic service line 25'+ Liffstation N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5% Property line 5'+ Water main/service line 10% Surface wateddrainage 100% SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line '1 '+ Building foundation 10'+ Absorption field 5'+ Wells on adjacent lots. 100% *LOT LINE WAIVERI A'FrACHED .Water main/service line 1 Surface water 100'+ Cudain drain NONE KNOWN F. ENGINEER'S CERTIFI/C¢ I ce/l/fy that I h~ of Municipal ~cc ~ t~a~l wlth MOA H~A g Signature ~ Date C:j/~, Driveway, parking/vehicle storage area sld inspections and review /stems are in conformance this data, JEFFREY A. GARNESS Wells on adjacent lots 100'+ ...' ?~ H,AA Fee $ r_~ ~'45 , Date of Payment ~:~/~ Receipt Number 72.026 (Rev. 3/96) ComputerVerslon Waiver Fee $. Date of Payment ?/~' / Receipt Number AK Water & Wastewater Consukants, Inc. ATTN: Jeffrey Garness, PE 6901 De Barr Road, Suite 2B Anchorage, AK 99504- September 06, 2000 Subject: Waiver Request forROBIN HILL #3 BLK 4 LT 8 Waiver # WR000068 Lot Line Request for Parcel ID 017-394-05 Dear Engineer: Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater disposal system to the lot line has been approved. The approved separation distance is 1 feet. This waiver approval applies to the current on-site wastewater disposal system and lot line separation only. Any future upgrade to the on-site wastewater disposal system and lot line will require all separation distances to be met or another waiver approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Jeff`Poet Engineering Technician III On-Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health & Human Services On-Site Services Waiver Review Worksheet WR#: WR000068 PID#: 017-394-05 Date Received: September 6, 2000 Legal Description: Robin Hills #3, Lot 8, Block 4 HA#: HA000428 Engineer: Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, suite 2-B, Anchorage, AK 99504 Applicant: Cathryn & Terry Williams Waiver Requested: I foot lot-line waiver Permit~: Criteria: 1. Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation 2. Special Conditions: 3. Other: Points: Total: Waiver is Granted: List Conditions or Reasons for above: Waiver is not Granfed: Date: ~' - '~ Rec#: 06247 Amount: $1'15.09 .......... <::::;~ f Reviewer Date Paid: 9/6/00 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. # ~ I"~ - CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) l~'~Of'70 H,~,,~_L,~,,-t ~::~,¢~. 'i)~,- Property owner Mailing address Lending agency Mailing address Agent Address N.~ A- Day phone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site 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. NameofFirm I ~-~'1 ~bg~r~V~Q.~O¢~ '~.~' Phone ~-,7~'--~ J~ I Address ~0 .~ l)/~/ /._~- ,L.¢/ ~ ~ ~ Engineer's signature '"~'-~'. ~-'-~'~_ Date ,111..~ Iq 'L / bedrooms. 6. DHHS SIGNATURE ~ Approved for / Disapproved. Conditional approval for bedrooms, with the 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 DH HS 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 engineeYs work. 72-025 (Rev 1/91) Back MOA If21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L~'J'~iJ~I4. *'~J~i~ J"~[l ~=J~ Parcel I.D. 1~l-7 - ~-e~'- A. WELL DATA Well type '~ - Log present (Y/N) y Total depth .~,Z ~ Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~'/I~l cl~--' Driller Cased to ~, c/C~ Casing height Wires properly protected (Y/N) 7 FROM WELL LOG Date of test ~..O//~/~ Static water level Well flow Pump level g.p.m. AT INSPECTION MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION g.p.m. R,;.CEiVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot J ~ Absorption field on lot J [~ Public sewer main J'~/.,Z...~ Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed '~/~'~/~ 7___ Cleanouts (Y/N) 7 High water alarm (Y/N) Date of pumping Nitrate Collected by: Tank size Foundation cleanout (Y/N) t,,//A._ Other bacteria Compartments Doprossion (Y/~) Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot l~" ~ To property line Surface water/drainage On adjacent lots Absorption field "~lc) Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION "1'O: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~'¢ ~ ~'- Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating /. ,,2- ¢~,/~'t''~ Gravel thickness Cleanouts present (Y/N) Date of adequacy test for ~ System type Total depth If yes, give date __ bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation I,..~ On adjacent lots Surface water Curtain drain On adjacent lots ,~ /¢ Property line To existing or abandoned system on lot Cutbank ~///~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature ~"~~ Engineer's Name Date HAA Fee $ / Date of Payment Receipt Number Waiver Fee: $ Date of Payment -~ [~') Receipt Number