HomeMy WebLinkAboutROBIN HILL #3 BLK 1 LT 2Robin Hills #3 Block 1 Lot 2 #017-443-04 MUNICIPALITY OF ANCHORAGE On -Site Water 8^Wastewater Program POBox 19885O 4rOOElmore Road Anchorage, Alaska SS51S'§U5O Phone: D^ Fax: (907)343-7997 Permit Number: OSP201295 Work Type: VVnUGnpUc|nitia| Tax Code Number: 01744304000 Site Legal Address: ROBIN HILL #3BLK 1LT 2 G:2838 Site Mailing Address: G3O8HUFFMANRD, Anchorage Owner: ST/NGLEYKATHLEEN &4&RANDLEJ Design Engineer: GAFiNESSENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 8/25/2O20 8/25/2021 193881 2Disposal Field Z Septic Tank [lHolding Tank [] Privy 0Private Well [] Water Storage All construction shall beinaccordance 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 VVoatevveher Disposal Regulations (18AAC73)and Drinking Water Regulations (18AAC8O) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65.Provide notification bycalling (8O7)343-7QO4(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: a. Opened and Closed onthe same day, ur b. Covered, sealed, and heated toprevent freezing Received By: Issued By: Date: Y) '� (' / _ Date: a On -Site SewerNVell Permit Application For A Single Family Dwelling Parcel I.D. 017-443-04 Property owner(s) KATHLEEN STINGLEY Day phone 907-350-8780 Mailing address 6300 HUFFMAN ROAD *ANCHORAGE, AK 99516 Site address 6300 HUFFMAN ROAD *ANCHORAGE, AK 99516 Legal description (Sub'd, Block & Lot ) ROBIN HILL #3; BLOCK 1, LOT 2 Legal description (Township, Section & Range) Lot Size Sq. Ft. Number of Bedrooms APPLICATION IS FOR: ( ® all that apply) Absorption Field Septic Tank Holding Tank ❑ Privy ❑ Private Well 0 - Water Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ 4 THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: N/A TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Y°.2 Receipt Number: ©U Z -j I G Permit No. ()S P 2 ©1 2-95 Date of Payment: Receipt Number: Waiver No. (Rev. 01/11) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201295, Deb Wockenfuss, 08/26/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201295, Deb Wockenfuss, 08/26/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201295, Deb Wockenfuss, 08/26/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201295, Deb Wockenfuss, 08/26/20 w c 0 m 4)1 — — — — ----- — — — — — — --- ------------- :--- --- ——------------- --- :— 0) Ci CL to vs m a) tp ca ce) CN LO 0 -o -o C\l to, , a a m m I I (D 10 E N m 'It I N M CN cR m 16 U. 16 41 N m CD F- C) C) C> CD co 2 0 OOZ# 0 OOL# N# 09# OG# M 017# OE# OZ# 9L# O2#L# U) 17# 41 0 Z 0 0 .1Z ----------- ------ - — — — — — — — — — — — — — — — — ----- — — — — — — --- ------------- :--- --- ——------------- --- :— C) 0 0 (0 U') C 0 ji46ieM Aq OUISSBd WOO.10d w U- 11 N I- 00 0) In0 C\l r - CD 0) C) LO 0) Rf (n O 0) N 0 -C a) C) w CL E uj tB cu Toll Free: 800 770-8265 r[Kf[i PO Box 190708 ( ) �,-� Anchorage Alaska 9.9519 Phone: (907) 243-2455 ¢r -n Fax: (907) 248-9212 JASTITUTE SOLD TO: ARROW PUMP AND WELL DAVE CUSTOMER PO SHIP VIA SHIP TO: ARROW PUMP AND WELL DAVE 242-0735 PAGE#: 1 INVOICE #: 0037661 -IN INVOICE DATE: 8/5/2014 PAYMENT TYPE: CC 2406 ORDER #: 0021874 ORDER DATE: 8/4/2014 CUSTOMER NAME: WALKIN Item Number - Unit Ordered Shipped Back Ordered Price Amount PE50OWW EACH 1.000 1.000 0.000 835.0000 835.00 POLYWATER 500 GAL 83 x 48 x 29 CUST WILL CALL Net invoice: 835.00 Less Discount: 0.00 Freight: 0.00 Sales Tax: 0.00 Invoice Total: 835.00 Less Deposit: 835.00 Invoice Balance: 0.00 ALL Claims and returned goods MUST be accompanied by this bill. ALL RETURNS ARE SUBJECT TO A 10% RESTOCKING FEE PAST DUE BALANCES MAY BE SUBJECT TO .875% MONTHLY SERVICE CHARGES (10.5% ANNUAL), LIMITED BY STATE USURY LAWS. INVOICE PLUMBING & HEATING, INC. ! 1 212 E. Int'1 Airport Rd. Anchorage AK 99518-1214 TEL: (907) 562-2511 FAX: (907) 562-2578 SOLD TO: - CASH SERVICE ACCOUNT ANCHORAGE, AK 0-0 INV BYDVC CUSTOMER P.O. SHIP VIA -- RYAN CLARK, KRI '.. ITEM NO. DESCRIPTION 'W INSTALL OWNER SUPPLIED WATER STORAGE TANK PER CONTRACT. 00085100 CONTRACT IN FULL /CUSTMR DEPOSIT ON CONTRACT INV # 0502201 JASON K. 08/19/14: VISIT SITE TO GET SCOPE OF WORK NEEDED. JASON K. 08/20/14: DEMO OLD GALV TANK (HAD '.. TO CUT IN HALF TO REMOVE), CUT OUT OLD TANK PIPING, MODIFIED & DISCONNECTED ELECTRICAL, SET NEW TANK, STARTED NEW PUMP PIPING. - JASON K. 08/21/14; FINISHED PUMP PIPING, INSTALLED FLOAT SWITCH & WEIGHT, WIRED SWITCH TO WELL PUMP, LOCATED AVAILABLE POWER SUPPLY, HAD TO REWIRE @ U/S BREAKER PANEL (CONVERTED FROM 240 TO 120), WIRED GFCI OUTLET FOR PUMP POWER, FILLED SYSTEM TO TEST, RAN WELL DRY @ APPROX 300 GAL, CYCLED WELL PUMP & JET PUMP WHICH CAUSED INTERMITTENT AIRLOCK @ JET PUMP, LEFT SYSTEM OFF TO ADDRESS NEXT DAY. JASON K. 08/22/14; MODIFIED WELL LINE/TANK CONNECT TO SEPARATE POINT FROM JET PUMP TO AVOID AIR DISTRIBUTION TO JET, FINISHED FILLING TANK & ADJUSTED FLOAT SWITCH, TESTED FUNCTION (OK), REPLACED 400 A F/M SEAL IN D/S TOILET (LEAK). INVOICE NUMBER: 0503298 -IN INVOICE DATE: 8/25/2014 ORDER NUMBER: W47968 ORDER DATE: 8/18/2014 SALESPERSON: Cooper, Debbie CUSTOMER NO: 0000020 SHIP TO: KRIS RYANCLARK 6300 HIJFFMAN ROAD 223-3877 Anchorage, AK 99516 FOB TERMS CASI-ISALE UNIT: ORDERED SHIPPED BO PRICE. AMOUNT EACH 1.00 _ 1.00. 0.00 0.00 0.00 FEE 1.00 : 1.00 0.00 3,950.00 3,950.00 EA 1.00- ! 1.00- 0.00 1,975.00 '.. 1,975.00 - Continued INVOICE Invoice: 1,975.00 Less Discount: 0.00 INVOICE NUMBER: 0503298 -IN PLUMBING Fe HEATING, INC. INVOICE DATE: 8/25/2014 212 E. Int'1 Airport Rd. 0.00 Anchorage AK 99518-1214 ORDER NUMBER: w47968 TEL: (907) 562.2511 ORDER DATE: 8/18/2014 FAX: (907) 562-2518 SALESPERSON: Cooper, Debbie CUSTOMER NO: 0000020 — SOLD TO: :SHIP TO: CASH SERVICE ACCOUNT KRIS RYAN -CLARK ANCHORAGE, AK 0-0 6300 HUFFMAN ROAD 223-3877 Anchorage, AK 99516 INV BY DVC CUSTOMER P.O.. SHIP VIA FOB TERMS RYAN -CLARK, KRI CASH SALE ITEMNO DESCRIPTION UNIT ORDERED SHIPPED ,BO PR14CE: AMOUNT . JEFF C. 08/19/14; PERMIT APPLICATION AT MUN OF ANCH, LAY OUT OF JOB. x*"NOTE: HAD TO FLUSH DEBRIS FROM FAUCETS & TOILETS TO ADDRESS LEAKS CAUSED FROM 7 SOLIDS IN OLD TANK*'* PERMIT # RETROP141775; INSPECTION t_10 r REQUESTED FOR 08/26/14, PM. E-MAIL INVOICE TO: akkristanya@hotmail.com; &jeff@gttarnessengineering.com; lindsay@kw.com rsi at,'s5 %F,ee Pv :t>y <wi 4`fi¢-f Ea z> . RG3 t�-�k£ t?F N0 RE'Ti wtF4 ON CH[,!:YICALS. E LTECTRIC AL ITE N -IS E; F2A'7Y':DE s 11L Ol )EIR NO R ER, RN F ER 00 DAYS �i^PI)NET? E 'iI,F F}EN ,rNet Less Payment: 1,975.00 1.5% Service Charge on all accounts 30 days past due Payment Type: CC REF: 0411 Invoice Balance: 0.00 2 Invoice: 1,975.00 Less Discount: 0.00 Freight 0.00 Sales Tax: 0.00 aro si,ar,ue Invoice Total: 1,975.00 Less Payment: 1,975.00 1.5% Service Charge on all accounts 30 days past due Payment Type: CC REF: 0411 Invoice Balance: 0.00 2 Permit Number: OSP141376 Tax Code Number: 01744304000 On -Site Water System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Work Type: Well Upgrade Permit Effective Dates: September 03, 2014 to September 03, 2015 Design Engineer: Subdivision: ROBIN HILL #3 Site Legal Address: ROBIN HILL #3 BILK 1 LT 2 G:2838 Owner/Address: CLARKE JEFFREY K & RYAN-CLARKE KRISTANYA 6300 HUFFMAN ROAD ANCHORAGE AK 995162441 Site Mailing Address: 6300 HUFFMAN RD, Anchorage Lot Size in Sq Ft: 193881 Total Bedrooms: 4 This permit is forthe construction of: N Disposal Field N Septic Tank N Holding Tank N Privy N Private Well Y 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By - Issued By: �N�iv�q ✓Je✓w��f (re}�o�lf) nu��� a�Sl). MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERIWELL PERMIT APPLICATION Parcel I.D. 017 - q q3 - O Property owner(s) �rt!5 Y6- " C-44 k Day phone 2Z3— 3V-7? Mailing address fp 6 3 oO lil, ff ", /C , Site address Legal description (Sub'd., Block & Lot) 1 2 /,rf Z LA :.,, 61% U 3 Legal description (Township, Range & Section) Lot Size APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage 0 Ft. Number of Bedrooms Ll APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) Upgrade K (w/wo ADU) Duplex (D) El F] Multiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE ! WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. property owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: Permit No. Permit App_9-1-12.doc Waiver Fees: Date of Payment: Receipt Number: Waiver No. ,, Ll 'rs.1 re KA5s '}'} ,'J, I'{ tea) 4 LJ ©,4A -U— t -m kir PVI INDUSTRIES, LLC. FT. WORTH, TX 817-335-9531 • 800-784-8326 • FAX 800-346-8426 • www.pvi.com NSF Certified Products - Public Water Supply System Components http://www.nsf org/Certified/PwsComponents/Listings.asp?TradeName... NSF Product and Service Listings These NSF Official Listings are current as of Monday, January 21, 2013 at 12:15 a.m. Eastern Time. Please contact NSF International to confirm the status of any Listing, report errors, or make suggestions. Alert: NSF is concerned about fraudulent downloading and manipulation of website text. Always confirm this information by clicking on the below link for the most accurate information: http://www.nsf.orLJCertified /PwsComponents/Listines.asp?TradeName=Dow+DPDA%2D3220+NT+7-i-lli +Density+Polyethylene+Resin& NSF/ANSI STANDARD 61 Drinking Water System Components - Health Effects NOTE: Unless otherwise indicated for Materials, Certification is only for the Water Contact Material shown in the Listing. Click here for a list of Abbreviations used in these Listines. Dow Chemical Company (The) 1803 Building Midland, MI 48674 United States 989-638-6231 Facility: Red Deer, Alberta, Canada Potable Water Materials Trade Designation Potable Water Materials Dow DPDA-3220 NT 7 High Density Polyethylene Resin Protective (Barrier) Materials Trade Designation Tank Material Dow DPDA-3220 NT 7 High Density Polyethylene Resin Number of matching Manufacturers is 1 Water Water Contact Contact End Use Temp Material A,F,P Water Contact Size Restriction >= 5 gal. D. HOT PE Water Water Contact Contact Temp Material D. HOT PE 1 oft 1/21/2013 11:33 AM GR —ER ANCHORAGE AREA BO'''UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME J01 -11V Jni�'W� MAILING ADDRES Ss ri>� /'75i' Q/7c/! q93 297 PHONE .3`l.4 -7 6 LOCATION �UCF/Yrn�J Ri)�ELEGAL DESCRIPTION _L -07=G //l i�'O% SEPTIC TANK: DISTANCE/1� NUMBER OF �n .� FROM WELL _ MANUFACTURER ' 1)01t. MATERIAL �' COMPARTMENTS. INSIDE LENGTH INSIDE WIDTH_- LIQUID DEPTH - _LIQUID CAPACITY "Q"' O GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER .OR WIDTH LI//, LENGTH _3®, DEPTH (r%tllYr=e"i F LINING MATERIAL VLonr CRIB SIZE: DIAMETER DEPTH ID Y DISTANCE FROM: WELL BUILDING FOUNDATION <3_�"� , NEAREST LOT LINE '20 I�EFFECTIVE ABSORPTION AREA (WALL AREA) C'J _SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE bk lkld _CONSTRUCTION_DEPTH BUILDING NEAREST FOUNDATION ) 1_, LOT LINE/ - CESSPOOL 0) APPROVED ly OTHER SOURCES DISTANCE FROM: NEAREST I SEPTICSEEPAGE i SEWER LINE /6 4- , TANK �C)O'SYSTEM 1009 Al A DISAPPROVED _ _REMA DISTANCES: 4S-`,/J0"kN INSTALLED BY: PIPE MATERIAL a4- O �� 1 POA) LOT SLOPE: REMARKS: J )d Gank�r.io Form No. EQ -031 DIAGRAM OF SYSTEM a7_ -_ — __ .— Lmg rjL° Icy 4 6"fraw, 0 I b US B- i�3 Cor�sll-, -- / IC JYLY ner°n,-Jl DATE APPROVED L NAME OF APPLICANT _— !2LR.t/ INSTALLATION LOCATION LEGAL DESCRIPTION GREATER ANCHORAGE. AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL. QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 2..74-4561 -` PERMIT NO. SEWAGE DISPOSAL SYSTEM '-- APPLICATION AND PERMIT MAILING ADDRESS J"'"� 7/PH0NF INSTALLATION OF: SEPTIC TANK I/ ____ SEEPAGE PIT TYPE AND SIZE OF FACILITY 'To BE SERVED DRAIN FIELD _— ' , OTHER FINANCED THROUGH _ _ --- TO BE INSTALLED BY NOTE: THIS PERMIT IS N09' VALID WITHOUT SOIL TEST SOIL TEST RESULTS COMPLETION DATE ANTICIPATED _ ✓IL�L���K'" /�// —. FINAL. INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENT'A1. QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE TYPE --TYPE _ZXA_ F%-�-'a-'PAGE AREA SIZE --___—_--_. TYPE. __ 4Z �� J MINIMUM DISTANCES, REQUIRFMENTS FOUNDATION TO SEPTIC TANK FOUNDATION "f0 SEEPAGE PIT / DRAIN FIELD ._~� SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC T"ANK —� _, SEEPAGE PIT _, DRAIN FIELD _ / TO NEAREST LOT LINE. WELL TO SEPTIC TANK �(rr/ / SEEPAGE PIT DRAIN FIELD___.- —_--.—__-_, ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC, TANK —L // ---. SEEPAGE PIT DRAIN FIELD SEPTIC TANK, loll/ SEEPAGE PIT DRAIN FIELD/-/�� TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF: EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT" REMOVABLE CAPS. GRAVEL SACKFILL CONFORM TO BOROUGH REGULATIONS REG(ARDING INSTALLATION. LG�LLA.A- B. OR LICENSED DESIGNER e;/'zz/0 1 CERTIFY T14AT I AM FAMILIAR WITH TIME REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 26-66 AND THAT THE ABOVE DESCRIBED SYSTEM IS INACCORDANCEWITH SAID CODE. �,LT�� /L DATE '"�` l APPLICANT'S SIGNATURE CLILL� tA -6— FORM NO. EQ -01 6 ES Municipality of Anchorage On -Site Water & Wastewater Program (907) 343-7904 CERTIFICATE OF ON—SITE SYSTEMS APPROVAL Parcell.D. 017-443-04 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: Expiration Date: / a _ 3 14 ROBIN HILLS #3 BLOCK 1 LOT 2 6300 HUFFMAN ROAD *ANCHORAGE AK 99516 JEFF & KRIS CLARKE Day phone 223-4925 6300 HUFFMAN ROAD *ANCHORAGE, AK 99516 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site !ndividi in] Water Storage ❑ Individual Holding tank ❑_ Community Class Well ❑ Community On-site LJ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: n/g Distance:= 1 `t Date: Received by: r COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Receipt Number n 3�1 ul COSA# 0�&I "I Waiver Fee $ _ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, i verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, RE Engineer's Comments: fn conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater 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. GEG, LTD, can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. 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. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. Phone 337-6179 Date 1�12 //4( (F bedrooms, with the following stipulations: +CE—.'9 3 9.�Z j� Pro f e F tioo°1 (t0F (A / V6, �= ON-SITE WATER AND =� VvASTEWATER r,_ By: Original Certificate Date: j._ The MLWcipattty oL,°Anc�ge Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) ba =d only upon the represefjafations 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. ATTCHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other In— Ilmsi If more than 7 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: ROBIN HILLS #3; BLOCK 1 • LOT 2 Parcel ID: 017-443-04 A. WELL DATA *PER GEG INSPECTION. **BASED UPON SURROUNDING WELL LOGS AND PAST COSA'S. ***WATER STORAGE INSTALLED. SEE ATTACHED RECEIPT. Well type PRIVATE If A. B, or C provide PWSID# N/A Well Log (Y/N) NO Date completed 1974 Sanitary seal (Y/N) YES Total depth *99+ ft. Cased to **40+ ft. FROM WELL LOG Date of test — Static water level — ft. Well production — 9 -p.m WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: 5.96 ug./L. Nitrate ND mg./L. Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 5/28/14 99 ft. ***0.30 g.p.m. Date of sample: 8/22/2014 Collected by: QFG, I td B. SEPTIC/HOLDING TANK DATA *SEE ATTACHED INVOICE FOR FCO INSTALL. Tank Type/Material SEPTIC/STEEL Date installed 9/30/74 Tank size 1250 gal. Number of Compartments 1 Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO Cleanouts(Y/N) YES High water alarm (Y/N) N/A Date of pumping 8/2014 Pumper ISAACS PUMPING C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE SEEPAGE PIT ONLY HAS ABOUT 3 FEET OF SOIL COVER. Date installed 9/30/74 Soil rating (.p.d./ft r ftlbdrm) 225 System type SEEPAGE PIT Length 30 ft. Width 19 ft. Gravel below pipe 10 ft. Total depth *11.58 ft. Eff. absorption area 980 ft2 Monitoring tube **YES Depression over field NO Date of adequacy test 5/28/14 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test **66 in. Water added 7100 gal. New depth ***105 in. Elapsed Time: 230 min. Final fluid depth ***79 in. Absorption rate >= 600+ d. 9 P. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — **MT IN SEEPAGE PIT ONLY EXTENDS 108 INCHES (9 FEET) BELOW SEWER LINE COMING INTO THE SEEPAGE PIT. ***3 INCHES FROM BEING 100% FULL. D. UFT STATION Date installed Size in gallons - Manhole/Ac pass "Pump on" level at in. "Pump ofr level Cycles E. SEPARATION DISTANCES level at Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main Sewer /septic service line 25'+ Public sewer manholetcleanout N/A Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Properly line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parkingfvehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS SEPTIC TANK IS 40 YEARS OLD AND NEAR THE END OF ITS USEFUL LIFE. 00 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 JEFFREY A. GARNESS Date 9 (Rev. 11105) MWiNAM Uy' A. Garness: CE7s 79 3 �f2 41 Municipality of Anchorage Development Services Department ' Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # 141462 During a recent COSA on-site inspection and test of the potable water supply well on Block 1, Lot 2 of Robin Hills #3 subdivision, the well's productivity was determined to be 0.3 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is 0.41 gallons per minute. _ all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. v-im 5:0m D m 3 x0r mm. z 0 z OZC =0; z mj M ;u X0C 007 ?0 m 0� z e r- 0 r 839 A 50 I o, I C U) OD ca -n D N00002'00"W 390.33 Z s dO. dJ_. D N O N O. � O o_ S I O 0 rn n 0 0 0 6 0 S corn A N m D '�' o0 3 (n m � °p 0fmmo�1D f.z N 10 y 0 N d C 0 a N S fl - m YI (1 n O i — DJ -I a o f p c d (. m ay�o.��0 am(n 0 a l0 O n Z ^ J sJD a=' Z D mJ � Jw m mo m r' N D ry R S f N ? d N Ill r nnLo Ra O. T� t— 2 W m y �D a��azas O m CDSD o fn O A �i O m O o. � _ •� '� 05 m m mn a �o 839 A 50 I 50 1 I I C U) OD ca -n D OD ao Z A m O I O 0 rn corn 50 1 P excavattv,g serAzes, uc f _J `017441 Alatna Ave. Anchorage, Alaska, 99507 907-230-1578 dtexcavating@gmail.com Bill To: Kris Ryan -Clark 6300 Huffman Road Anchorage, Alaska 907-223-3877 kris@thedogpack.com Date i Invoice No. P.O. Number Terms Project 08/12/14 L 193 Invoice Item Description Quantity _ Rate Amount Foundation This is an invoice for a foundation clean out @ 6300 2,300.00 2,300.00 Clean Out Huffman Road. Drain Masters Inc located septic line prior to excavation (This cost is added into the invoice ($300.00). We excavated down to septic line and installed a foundation clean out. We poly wrapped vertical standpipe to help prevent frost jacking of the pipe. The invoice includes all the labor cost, material, and equipment involved in the construction process. We compacted and backfilled excavated area. For any questions feel free to contact Luke Duffy @ 907-230-1578 Thank you for your business. Total $2,300.00 MUNICIPALITY 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. # Of 7 kYAy 3 -01y tv 1. GENERAL INFORMATION HAA #—Lam,OL1LZ�Sln_n �r_5n� Complete legal description _1-0 h 2, 6/oc be Iy dab;^ If1/l 43 Location (site address or directions) _6300 fluJ�f"'Q^ )Rd Property owner .ToAn j ElU t/le Sly r^^, Day phone3 `) s-- o 3 75 _ Mailing address 6.700 /�u�man i�/}nr�or4g�Gc 99s-16 _ Lending agency --- �Day phone ----_ Mailing add Agent Se1 e c e__ Day phone Address 'y `l3 E ^ctiGr e frees Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. 4. TYPE OF WATER SUPPLY: Individual well Community well Public water —Y1.1- NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NO'T'E: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Ftm 1191) 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 ) /,2L�e ZecAAIea1 St(s Phone 34/s - 13ss Address l"/S3c Ectic:) St., cAorQgP A4- 99S/� Engineer's signature Tsar s 2n�- Date ✓ u l; 1999 T 000alee ose ees eiv�r,+p� o n .....eelloo oe0e0 o60 THEQoo,voorsE X5893 3 E 1 6. DHHS SIGNATURE —� Approved for _FOU 2 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 1l1TIC Date 2-2, 1 " q1 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 orderto 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(Pw1191) Back MOAf21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICE L 19 Environmental Services Division , b&UNIC;IPAI 11 UIF ANV il�KAUI 825 L Street, Room 502 • Anchorage, Alaska 99501 ary "4CEs Drvrsi Health Authority Approval Checklist Legal Description: hof z B/)_Ir fro 1, l' hir // t* 3 Parcel I.D.: 017 - AYq3 - :__ A. WELL DATA Well type _Pri If A, B, or C, attach ADEC letter. ADEC water system number—_ Log present (Y/N) _N_ _ Date completed _ 19 7 'Y Total depth 265l ' Cased to > yo _ Casing height (above ground) !z Sanitary seal (Y/N) _ Y __ Wires properly protected (Y/N) _ Y FROM WELL LOG AT INSPECTION Date of test -7 / 12 -13 ��--- Static water level __--%---- Well production ___g -p -m. ___0.50 __—g•p•m• WATER SAMPLE RESULTS: Coliform Dcol ZiG ©,n=Q __ Nitrate _ O. 6'71 Other bacteria None Date of sample: __6_1_1_8U 9 ____ Collected byT__L/G F% _ e `l7 "' e r, B. SEPTIC/HOLDING TANK DATA Date installed 9/ 3 0 / 7Y Tank size 126V Number of Compartments __j_ Cleanouts (Y/N)_ Y _ Foundation cleanout (Y/N) _ N — Depression (Y/N) N _ High water alarm (Y/N)_tel_//__ Date of Pumping _jL / 99 _ Pumper _. Q C. ABSORPTION FIELD DATA Date installed / 3 0 ! 7�_ Soil rating (g.p.d./W or ft2/bdrm) ??s r?'- System type cofL 41 �• S4%'• P; i7o�t7 Lengfli!^3 0, _Width __L_9 ' Gravel thickness below pipe . t o' _ Total depth _ 1 z' m eaj • 7/99 Effective. absorption area 280 p' -Monitoring Tube present (Y/N) Y _ Depression over field (Y/N) _ At Date of adequacy test -2-L Results (Pass/Fail) _ Ee-ri —For _ bedrooms Fluid depth in absorption field before test (in.);IV9 _ Immediately afterf6a2 gal. water added (in.): 89.5_ Fluid depth _788 (ins) Minutes later: 12 33 - Absorption rate = 6Or.7_g.p.d. Peroxide treatment (past 12 months) (Y/N) _ e 1< n o w n If yes, give date _ N • t}___ 72-026 (Rev. 3/96)* )4 r i� / e r u., aJ S /•, t r 7a 7%e b e,n� �dscP i"hruouf -t"h iJ /0 D. LIFT STATION N - 4. 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: "Pump off" level at* Septic/holding tank on lot z 1 zo ' On adjacent lots > 100 Absorption field on lot /A/ Public sewer main Sewer /septic service line > 25'' On adjacent lots > 1 oo ' Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: 17M Foundation 1 o ' - Property line > 10 ' Absorption field '20, Water main/service line >to ' Surface water/drainage > 10o Wells on adjacent lots > r ao SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line > to' Building foundation 3 w' Water main/service line Surface water > loo' Driveway, parking/vehicle storage area '> Curtain drain lgc)Ae Se en Wells on adjacent lots F. ENGINEER'S CERTIFICATION i certify that / have determined thru field inspections and review of Municipal records in conformance with MOA HAA guidelines in effect on this date. oeoi / / 0 oe Signature i�000eo Engineer's Name i heo amore F. i`-+oo �e �� oeoeo 6 0000't AO ee0" 600a0Cee ob 199' Date J ��i, l6 V o YHSODORF E F. Lai u /� j e°e CE -3589 HAA Fee $ 3ao -�e Date of Payment7h JZZ� cr/ Receipt Number ff el �� D 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number n are MUNICIPALITY OF ANCHORAGE M E M O R A N D U M WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL N0. f 9 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Lot Block _1 _ of -k4/LA/ ZLSubdivision, the well's productivity was determined to be 0,6-0 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a�1 bedroom residence is 0.4 -?, gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the su'ject Health 2uthority Aporc�,a1. CT&E Environmental Services Inc. L JLi��✓'/.:�E/vl.���al�vuvcr��s1.�./.�'��/. /v.4 CT&E Ref.N Client Name Project Name/N Client Sample ID Matrix Ordered By PWSID 992888001 Flattop Technical Srv. N/A Lot 2 Blk I Robin Hills N3 Drinking Water Ell Client PON Pre -Paid Colis/NO3 Printed Date/Time 06/22/99 11:45 Collected Date/Time 06/18/99 15:00 Received Date/Tune 06/18/99 17:40 Technical Director: Stephen C. Ede Released By Sample Remarks: Allowable Prep Analysis Parameter Results PDL Units Method Limits Date Date Init Total Coliform 0 col/100mL SM18 92228 06/18/99 KAP Nitrate -N 0.671 0.500 mg/L EPA 300.0 10 max 06/18/99 06/18/99 SCL MUNICIPALITYOF ANCHORAGE ( C� DEPARTMENT HEALTH &HUMAN SERVICES A4a of Division of Environmental Services r 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. II I} "- q'} du — HAA # 0 P� 9 `'I:1 —_ 1. GENERAL INFORMATION /'3 O6/A/ I Complete legal description Location (site address or directions) Property owner Fly W M4 t41 Day phone 03 Z�✓ Mailing address 70 Lending agency �l lam- [ t ��a v Day phone c- 5'7 — Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: q 3. TYPE, OF WATER SUPPLY: Individual well Community well Public water — 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 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) FroM MOA H21 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 Address Engineer's signature 6. DHHS SIGNATURE X Approved for bedrooms. Disapproved. Conditional approval for Additional Comments 0 1l1TIC Phone Date l bedrooms, with the following stipulations: Date 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 courtesyto 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. 7M25 (Rev. 1191) Beck MOA R21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST L J/ > I Legal Description:_ Cal Parcel I.D. 7 A. Well Data Well type _ �` - If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) _ N Date completed 12 7'-/ Driller Total depth>l NU Cased to Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump levell SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Casing height Wires properly protected (Y/N) 7�- c AT INSPECTION 74 I.P.M.rri _ g.p.m. rri �� N > J �f C� C� C . z On adjacent lots �1 1 _ ; On adjacent lots (/ Public sewer main iw F\ Public sewer manhole/cleanout ly /k Sewer service line '7 _-; i> Petroleum tank N WATER SAMPLE RESULTS: Coliform _ Nitrate 0,11 _Other bacteria Date of sample: r' i /,13 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed q1?0 " __Tank size _I-- 6 C> Compartments f (\(_( J -L Cleanouts (Y/N) Foundation cleanout (Y/N) _ Depression (Y/N) High water alarm (Y/N)/���/ Alarm tested (Y/N) Date of pumping-��;-d`r .4 Pumper��J c SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots _ / {_' __Foundation _ To property line s Absorption field t Water main/service line Surface water/drainage 72-028(3/93)'Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Manufacturer Manhole/Access (Y/N) "Pump off" Level at tested Surface water Date installed rt1)(7'i Soil rating (GPD/Ft2) Systemtype r/ Length C% Width Gravel thickness Total depth ( .7 Total absorption area `(, Cleanout present (Y/N) Depression over field (Y/N) Date of adequacy test �/� j Results (pass/fail) F` forBedrooms Water level in absorption field before test Z ( After test Peroxide treatment (past 12 months) (Y/N) N If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots ), /s- C) Property line :� " `_� To building foundation To existing or abandoned system on lot On adjacent lots :>", r- Cutbank N G W tIE� Water main/service line % Surface water Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION l certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signa Engin Date t ure— eer's Name HAA Fee $ / w ' Date of Payment b 16 -2 z2 ) Receipt Number -2�Z7 �7 72-026 (3/93)' Beck Waiver Fee $ Date of Payment Receipt Number SINCE 1900 c1wrolcill COMM 1--RCIAL,rESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES '.):-1 .2488- 1 J./A3 R011111H WILL WATV'R RNPORT of ANAUSTS 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 U1101A Nalac. A'001*14 MOORMAN-), P.N. WORK Order :60674 wdorcd By 6)PURITAIIF) Report: CburhJ.e'ted 06/07/93 Pj,o'J f,,ct Waite i: COLIC-c"Led 06/01/93 @1 13: 1, 0 Iji:s N.")joct 1! Received 06/01/93 141'15 hv; C UA Technical Dar I, ci or C kle.l.erlsuld BY 7 1';I:1lf1f7J L14-juit It: k -s -s- i ­F R-0-14 QC A-Ilovjabh, Ext. Anra1. lzeslu'Uf; Qual'. TJIIU;i llelthcld I'Amil::3 DIAC-) Dal C! Init .... ...... -- ------------- - - ---- ...... --- N 0,12 wig/r, EPA 353.2/300.0 10 06/03 CIAU F0 6's i � S —1 : : --. = -. - '—. -� -.4�-. :._ .. Ser.'f Spec.itt'l, n-tructkm-s Al-iov(, IlA Lee Sample Reirwo.-ks Ahove NIA Anal-yzod 0 1.111deLocicod, Reported valku is !I,(, pf-aeti"wd, ".Chao y GT G'.cuei'LFL 'Phar': QN13GSMember of the SGS Group (Soci6t6 36n6rale do Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA