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HomeMy WebLinkAboutROBINDALE LT 6Onsite File Robindale Lot 6 #051-053-01 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201382, Rebecca Carroll, 09/23/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201382, Rebecca Carroll, 09/23/20 ~~ .. . . MUN,C,.AUTV OF ANC.OR^GE ~ DE.ARTMEN~ OF .EALT. ~ ENVIRONMENTAL .ROT~CT, ON I~* ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE J~NEW LEGAL DESCRIPTION LOCATION Well I DISTANCE TO: ~ Z I Manufacturer u~ Liq. capacity in gallons ' ~Ooo ,r DISTANCE TO:'~Well ~ Manufacturer Q I [ Well ~= I O~STA~CETO: I ~ m Z [ No. of lines ~ ] Length of each line ~ ~ Top of tile to finish grade ~ ~ Length Width~ ~ Type of crib ~d ~ ~ I We, " DISTANCE TO: ~ ~ss ~ Depth ~ DISTANCE TO: Building foundation AbsOrption area Dwelling ("4~ Material I nside ~.~%g~ Width Dwelling- ' - Material Foundation Nearest lot line I Trench width Total length of lineh(~ ~ inches Material beneath tile ._.~ (~U inches Depth Crib depth Building foundation Driller Sewer line NO. OF BEDROOMS PERMIT NO. No. of compartments Liquid depth ~ PERMIT NO. Liquid capacity in gallons PERMIT NO. Distancebetwaen,nes ~411~ Tota, effec,,,e ab (r o&erea PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line Septic tank PERMIT NO. Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS WELL F~ ~-4 [:~ PERMIT NO. < 780_g60 ) DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 ~L~ STREET, ANCHORAGE, AK. 9~sel 264-4720 Iz~r-t--SZTE SE~,JER PE~:f-1 WALT KURKA RAMBLERS LANE L6 ROBI NDALE APPLICANT PO BOX 2i4 EAGLE RIVER LOCATION LEGAL LOT SIZE TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ~ 69-4 ,~LaOE S6!LIRRE FEET -'=" ' R 28E'~ -,UIL F..RTIN.'~ (S¢~. FT,-'"BR::,= q"-- 4 IS: THE REQUIRED SIZE OF THE SOIL ABSORPTION _~=.TEf [:~EF"TH= '.1.8. 5 LEI".IGTH= 68. 4 7'HE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF 8 TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRL. L PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F-:EtZ4. U I F-:ED SEPT ! L--: TRf-.IK S I ZE= F'ERMIT RPPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE '-- ' I"'l ' ~ INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIT:, FR_FERT~ RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. TL.-IO r.j 2 ::, I I'-.ISPE,~:T I OI"-,IS RF~'E I:~'EQU I REI~, ....... BACKFILLING OF ANY _,~_TEM WITHOUT FINAL INSPECTION AND RPPROVRL E:Y THI'- DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SENRGE DISPOSRL SYSTEM IS i00 FEET FOR A PRIVATE WELL~ OR ±50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY RPPLY. SPECIFICATIONS RND CONSTRUCTION DIAGRAMS RRE AVAILABLE TO INSURE PROPER INSTALLATION. F'ERM I T E;-4F' I RES [)ECEr'18ER ~;2L., ::L'_~ 7 :E: I CERTIFY THRT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH 8Y THE MUNICIPALIT'T' OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3.: I U~DERSTRND Tt-JBT THE ON-SITE SEHER SYSTEM MAY REG~UIRE ENLRRGEMENT IF THE RESIDENCE I~ ,RE~ED'~O INC:~E ~RE THAN ~ BEDROOMS.'- . O ~ E GE(.. ,'ECHNICAL ~ DEVELOPMENT CO. Russell Oyster 694-2774 Soils Et Foundations Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 ~ SOIL LOG Performed for: Legal Description: Depth (feet) 0 2 Name: Hatltng Address: Tel. No.__ $ol] Ch~_~_acteKtstlc). 5~ 6~ 7 10~ 11~ 3_2__ E~d Ellis Land Development Ground Water Encountered: Yes , . Proposed Installation: Seepage Pit , Comments: No_.~.___ If yes, what depth._._._ Drain Field_ Performed by: Date: M-W DRILLING, INOv..,u' [PALITYOF ANCHORAGE EPT. OF : 'LT; & ENVIRONiv',E, ] .... fl'ION Well Owner WALT KURKA DI~I LLING LOG RECEIVED _Use of Well DOM. Location (address of: Township, Range, Section, if known; or distance main road Lot 6 Robindale, Anchorage Size of casing 6" Depth of Hole 190 feet Cased to ] gq. ] feet Static water level ft. (alY~ (below) land surface. Finish of well (check one) open end ( ]EX Screen ( ); Perforated ( ). Describe screen or perforation N/A Well pumping test at 7 gallons per of drawdown from static level. (minute) for. 1 .hours with 100% Date of completion 10/3/78 WELL LOG Depth in feet from ground surface 'Give details of formations penetrated, size of material, color and hardness 0 TO 2 Casing stickup TO 15 TO. 25 TO 55 TO 78 TO_ 105 TO 135 TO. 175 TO 190 TO TO TO. TO TO ); 15 25 55 78 105 135 175 Silty cobbles Sandy gravel Gravelly till Sandy gravel Gravel till Loose gravel Grave-1 till Water gravel TO Mu.lcipality of Anchorage Developmenl: Servlces De~di'tment: BuEding Safety Division On-Site Wa(er and Was(ewaler Program 4700 South Bragaw SL P.O. Box '196650 Anchorage, Al( 995t9-6650 www.cl.anchomge.ok.us (907) 34:~-7904 Parcel I.D. 1. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE ,FAMILY DWELLING GENERAL INFORM~,TION ,~om~l~t~l~aldes~ripl[Sn l,n~ 6; ~obindala ~to~.hon (rote address or dlrectlons) 24014 Rambler Road '~ilifig address .' ~0 ~m~ t~/O ~ Lending agen~ Expiration Dale: Subdivision Day phone Day phone Mailing address Real Estate Agent Fin~ qhpldnn Day phone 229-5593 Mailing Address ~0 Bo× 671087 Cbugiak,' AK 9956'1 Un/es= otherwise requesfed. HAA will be he/d by DSD for plckup. '~'12. L '7 / ~ r/,, ¢- 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individu:~l Well Individual Waler Storage Community Class. Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site ~ ~E] Individual Holding lank ~E] Community On-site [] Public Sewer [] 'rhe Municipality of Anchorage Developmenl Sen/Ices Depadmenl (DSD) Issues Certificales of Health Aulhority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered In the State of Alaska. Cerfificales cf Heallh Aulhorily Approval are required for the transfer lille (except be(ween spouses) for propedies served by a single family on-site wastewa~er disposal and/or water supply system. DSD also Issues HAAs upon request Io homeowners. Cedilicales of Health Authority Approval are valid for 90 days from Ihe date of issue for properties sen/ed by a private or Class C well and may be reissued wilh new water sample results less than 30 days old. (Cedificales may be reissued for a period o~' up to one year wilh valid water samples.) Ced(tic, les are valid for one year for properties sen/ed 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 cerlilied by my seal at'fixed hereto and as 0J' the valkJaflon da[e shown below. I verify Ihat my Inves{lga(ton, based on procedures outlined In the Health Authority ,Jk,oproval Guldellnes for this applicalion, shows that Ihe on-site water supply and/or wastewater disposal sy~terri Is(are) safe, functional and adequate for the 'number o1' bedrooms and lype of structure Indicated herein. I furlher Verify tha[ based On Ihe 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 ~vlth all applicable Municipal and State codes, ordinances, and regulafions In effect at Ihe time of installation. NameofFirm S & S Engineering Address lT034 N. Eagle River Loop Sce 204 Robert C. Cowan Engineer's Prinled Name DSD SIGNATURE t-'"'/ Approved for Disapproved. Conditional approval for bedrooms. Phone 694-2979 Eagle River, AK 99577 bedrooms, with the following stipulations: Additional Commenls Attachments: HM Checklist Septic SysJem Advisory Well Flow Advisory Maintenance Agreements SUpplemental Engineer's Repod Other By: Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anohorage.ak.us (~07) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A~ WELL DATA Well type ¢~ Date completed ~0_0~ f'~ Total depth"l~O fl' .' ~-r-(~ i ~ ihj .,-yf-¥L~ ~lo Parcel ID:_ FROM WELL LOG Date of test Static water level U,--.J ~'- lt. Wall production ~ g.p,m. WATER SAMPLE RESULTS: Coliform .~._oolooi~/100 mL Nitrate ~.7~- rog./1. Collected by: ~' B. SEI~TIO/}'IOLDINO TJ~IK DATA TankType/Material ~.~r',4../~~ T?nk size ~ gal Number of Compartments ~ouodation cieanout (Y/N) Depression over tank (Y/N) '?ate of pumping ~/*'/~ ~" Pumper J /-~" C. I~S~R~'FION FIEI.~ DATA Olher bacteria ~.~ colonies/100 mi. Date Installedcteanouts (Y/N) II/~~ /~ High water alarm (Y/N) '~ Depression over field For '~ bedrooms New depth'~'~ in. Absorption rate >= ¢z~.~ g.p,d. If yes, give date Total depth ~ ft. Eft. absorption ama~)ft2 Monitoring tube Date of ed,uacy test ¢/~-~:~/~/~..- Results (Pass/Fail, ~ Fluid depth in absorption field before mst I~ in. "~'Water added'~3C~al. Elapsed Time: ~__ min. Final fluid depth ~ in. Any rejuvenation treatment (past 12 mo.) (YIN & type) Length ' ~1~ It. Width ~'' ~' fl. Gravel below pipe ~ fl. D. UFT ~rATION Date installed 'Pump on' level ay in. Datum Size in gallons "Pump off' level at Cycles tested Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? E. SEPARATION DI~FI'ANCE$ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tenk/lilt/,,~t,-I~"o[1-on lot /~ ! ~' Absorption field on lot /0{~) /'~" Public sewer main Holding tank SEPARATION DISTANCES FROM SEPTIC/HOJJ~G TANK ON LOT TO: Building foundation ~' ~ Property"'line ~- //~ Absorption field main /"J/,~ Water service line /' O r.~. Surface water Water Wells on adjacent lots//~{~ f -~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Pr open'y line / ~) / -' '~ Building foundation /(~) ~ Water main On adjacent ]ots On adjacent lots Public sewer manhole/cleanout / OO Water Service line /0 ! //~0 *''¢'- ~ Surface water Driveway, pa~ng/vehicie storage. Curtain dra'u~e~J~)¢~ Wells on edlec~rit lots ,/~0 '*'- ' '' · F. COMMENTS G. EN GIN EER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems am in conformance with MOA HAA guidelines in effect on this date. //o Date HAA Fee $ Date of Payment Receipt Number (Rev. 12/00) 275'. Waiver Fee S Date of Payment Receipt Number in* .4~T~. CT&E Envlmnmentni ~rvlces Inc. CT&E Ref.# 1024336001 Client Name S & S Engineet~g i'roJed Nem~ Robindale S/D, L6 Client Sample ID Eobindale S/D, L6 Matrix Drinking W~tcr Ordered By PWSID 0 Sample Remarks: All Date~flme~ are Alaska Stnndm-d Time Printed Date/Time 07/18/2002 8:16 Colleded Dlta/'l'lme 07/15/2002 !0:00 Received Date/Time 07/15/2002 10:55 Technical Dire~l~r · Stephen C, Ede Relea~i ~ Ni~ate-N 3.72 Al~,.ble p~ep Ana~)~s ttn~lB D~te D~te Init 0.200 ~ EPA 300.0 (<10) 07/15/02 JDT H~.crob$olog~ l, abor&tor~ Totni Colitom~ eol/100mL SMIg 9222B 0Wl5/02 RAP -4 J4 Hereby tbrtl the followingfiereCertify" have's surveyed t I- described" Pi Aiidhoitk6AWcbrdlns PretdiAl. "Alaska, and that the' I improvementsthereon axe I witilin A . the property. lines.6nd. do rdt overt or encrokh on thd proptrt� A lying fidjAcent thereto t2t'no mprpvenentson prop- erty lying- adjacent thereto (encroach oft ;the premis6q in o roadWR tfansmission stlon- arid. that there are, no y aue nes"or othmvigible easements on'baid.propertv-except h as indicated hereofl.' Datei �t Eagle River,* Alaska thi�1-),ItL day o'f�C 19- y ROBERT C. JOHNSON 4 A Surveyor o. Owl$, SdAt&' Registered La n$ 456 EggleT A A,er,: Ahksk 7- one 6 4- / "MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date Nov~b~. 19_. 1997 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lo~ 6..- Robind~ SubdivZsion Location (address or directions) Darl~n~. S~r~. (b) Applicant Name VcJ:.: A~ln. Applicant Address 9_~z; E. 8.f'h (c) Telephone: Home Business Ano_hn~ag~_: A,Pa.s~a 99~01 Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution I~_ f-lnu.to- I/~:t'. Arlm~'~., Address Telephone (e) Real Estate Company and Agent Address ~../05 Tele phone (f) Mail the HAA td the following address: S & S ENGINEERIN~ Eagle River~ ~aska 995~ Ord~r&d'bq TYPE OF RESIDENCE Single-Family [] Multi-Family [] .- Number of Bedrooms 3. ;.WATER SUPPLY Individual Well [~ Other Gommunity [] attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality ano status. 72-025 (11/84) Page 1 of 2 Note: if community well system, must have written confirmation from the State Department of Environmental Conservation ENGINEERING FIRM PROVIDING SPECTIONS, TESTS, FILE SEARCH, DA'I .ND INFORMATION As certified by my sea[ affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water suppJy 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 $ &_~ E~c-INEERING 17034 Eagle Ri'cer Loop Road No. 204 Address Eagle River~ Aiaska :~;~x ~, Date Telephone DHEP APPROVAL ... Approved for ~~drooms by Approved ~ ' Disapproved Terms of Conditional Approval Conditional CAUTION . The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF AN~''IE~Eq;H AUTHORITY APPROVAL (HAA) EKWtp, ONMENTAL SERVICES DP(~I~KLIST - FEBRUARY 1984 264-4744 NOV 0 1987 Legal De..,~87cription: ~ RECEIVED Well Classification lb-) ~\'~1 ~, )/~"L..-. If A, B, C, D.E.C. Approved (Y/N) Well Log Present~¢~l) y Date Completed \ 6;~,/~/7 l~ Yield Total Depth \~c~ / Cased to t, ~, \ Depth of Grouting ~ -- Static Water Level \'~'~ ~ / Casing Height Above Ground Electrical Wiring in Conduit~N) Separation Distances from Well: Pump Set At O,¢--. Sanitary Seal on Casing (1~1) ~/ Depression Around Wellhead (Y/4~ ~.D / To Septic/He~ Tank on Lot / -C;~U¢ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot I ~7'[ ; On Adjoining Lots To Nearest Public Sewer Line I~/~ To Nearest Public Sewer Cleanout/Manhole r-3.//~' TO Nearest Sewer Service Line on Lot Water Sample Collected by ~ ~.~ 1~....~, .~---.~::¢., ~ ; Date Water Sample Test Results ~/"~'~'¢"~:~r:-¢?)-:¢'~' ~ ~/~~,~ Comments ~ ~ ~. ~ ~ ~ ~ B. SEPTIC~G TANK DATA Date Installed //-'7~(~"1¢ Size Standpipes~_~N) y Air-tight Caps ~N) Depression over Tank (Y~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) r'~/,/~' Separation Distances from Septic/HoMif~ Tank: / To Water-Supply Well To Property Line To Water Main/Service Line Course Comments Foundation Cleanout (Y/~-) Date Last Pumped /,~- ; for -- - / Temporary Holding Tank Permit (Y/N) r~~/, To Building Foundation t To Disposal Field To Stream, Pond, Lake, or Major Drainage Page I of 2 72~026 fRev 8/86) Front C. ABSORPTION FIELD DATA Width of Field Soils Rating in Absorption Strata Date Installed ~ / -- ~-~. Square Feet of Absorption Area Depression over Field (Y/~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes PresentC~N) Date of Last Adequacy Test To Property Line To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Existing or Abandoned System on ; On Adjoining Lots "~c::~ / To Cutbank (if present) Comments D. LIFT STATION Date Inst Ila~d Size in Gallons~"~"~.~ "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at '"---.-, Vent (Y/N) -~'P-um-'"~'~'np' ~cles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. g ~7034 Eagle Ri~er Company . Eagle Rwer, Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 IRev 81861 Back CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. / APPLI( NT FILLS OUT UPPER HAL. i ONLY Property Owner Fred & Nedra Olson Phone 688-9182 Mailing Address SI~/~2 Box 7130 Rambler, Chug~ak. - ,. : ZipCode 99567 Buyer Willi~ & S~an Holick Address 21513 ~mon Ave Apt H Elmndorf ~ zip Code 99506 Lending Institution- Akasla Prank of C~nmrce Phone P.O. ~ox 1185, ~gle River 99577 694-5548 ~ddress Zip Code Rea~y Co. a Agem T~y's geal Estate Je~ Br~n Address P.O. ~x 279, Chugi~ Zip Code 99567 6883999 Legal Descript~n ~t 6 Robindale Su~ mr, e~ LocaU~ ~//~%~ }'~l Darlene St. Type of Resi~nce ~ Single Family ~ Muttiple Family No. o~ Bedroo~ 3 ~ Other Water Supp[y .... ~ Individual A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June i975. ~ Community For wells drilled prior to that date, give well depth (attach Icg if available). ~ Public Utility Sewer Disposal ~ ~.dividua~ Year~ndividua~ ~ns~a,ed: 1978 ~ Public Utility When Connected to Public Utility: ~ Holding TanR NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INiTiATED. Time Time Time Time [Jate Date Date Date Inspector Inspector Inspector Inspector Field Notes: ( ~ APPROVED BEDROOMS~ 'CONDITIONS OF APPROVAL~i~a ( ) DISAPPROVED DATE Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received [ ~:~ We[ltoTank Septic T~k Size EXCAVATION ROBERT A. SHAFER WORK May 21, 1983 CIVIL ENGINEER 694-2979 Today's Realty ATTk~NTION: Jerry Braman P.O. Box 279 Chugiak, Alaska 99567 Dear Mr. Braman, Reference: Lot 6t Robindale Subdivision A sewer system adequacy test was performed on the system located on the referenced property, as you requested. The septic tank was pumped and verified to have a capacity of 1000 gallons. The absorption trench was tested by a continuous flow of water over aperiod of 48 hours without any adverse effect on the system. It can be concluded from this test that the waste water disposal system serving the three bedroom residence located on this property is currently functioning adequately. However, the system cannot be guaranteed against subsequent failure. A water sample was taken from the hose bib on the front of the house and submitted to Chemical and Geological Laboratories of Alaska. The test results were reported to be satisfactory. The well casing wiring and seal on the top of the well were also examined at this time and determined to be adequate. If we may be of further service, please do not hesitate to contact , Sin~y/~ ~R~/~/s s cc: ?.'!unicipality of Anchorage Department of Health and Environmental Protection SRB 196X EAGLE RIVER, ALASKA DATE RECEIVED INSPECTION APPOINTMENTS ATE DATE D~PT. O~ H~ALTH MUNICIPALITY OF ANCHORAGE ENYI~ONMENTAL P~OTECTION  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 LStree,- Anchora,e, Alaska 99501 SEP 2 ~ 1980 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed, Please allow ten (10) days for processing, 1' PROPERTYOWNER ~ IPHONE MAILING ADDR ES~ 2, BUYER ~ / PHONE ~ LENDING INSTITUTION [ I PHONE MAILING ADDRESS ~A LTO R/AG E NT ' } ' PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE ,~'- SI NG LE FAMILY MULTIPLE FAMILY 7. WATER SUPPLY ~/~ INDIVIDUAL~ COMMUNITY [] PUBLIC UTILITY 8o SEWAGE DISPOSAL SYSTEM ~;~. INDIVIDUAL/ON-SITE** / E] PUBLIC UTILITY NUMBER OF~BEDROOMS [] One [] Four [] Other [] Two [] Five ,/[~ Three [] Six * ATTACH WELL FOG. A well log is required for all wells drilled since June 1975, Fo~' wells drilled prior to t~at ~f~te, give well depth (attach log if a~ailable.) ~-'-~ ~ · ~_ "~::> YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79)..~-~D THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] iNDiviDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED E~ PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank ,~,~¢. ~ . Size: ~ (~)~¢~ (~) If Tank is homemade SOILS RATING ' give dimensions: __ ~ ~ ~:.._-~ TYPE OF TANK. MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DiSTANCESwELL TO: Saptic/Holdiag Tank Absorption Area 8ewer Line Nearast Lot Line Absorption Area to nearest Lot Line 5, COMMENTS ~APPROVED FOR % BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY ~" ' MUNICIPALITY OF ANCHORAGE ~UNICIPALITY OF ~NCHORAGE~j~ .~~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. O,' 825 L Street - Anchorage, Alaska 99E01 ENVIRONMENTAL pM./i'ECTIOiXi ENVIRONMENTAL ENGINEERING DIVISION DEO ? 1978 Telephone 26~4720 BIBECTIO~S: Complete all pa~s on page 1. Incomplit~ raqu~ will ~ot bt proc~. Please allow ten {10) days for processing. I. PROPERTY OWNER I PHONE I ~AILIN6 ADDRESS ~ 95?7 '~'~ ' ~OS~ O~&ce ~ox 2 -' :9 ' PROPERTY RESIDENT (tf different from. above) ., . PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION I PHONE ~aska ~a~k o~ Co~ence .....I 279-56~ ~AILIN6 ADDRESS 3230 C -Stneet. -99503 ..... 4. REAL~OR/AGENT I PHONE Virginia ,Koh-fietd ................ .I 694-9555- MAILING ADDRESS Post' Off-ice BOX 249~ V~99577'' .... ''?-. ' ,-.~_ .-.-. .... 5. LEGAL DESCRIPTION Lot 6 Robindale Subdivision ~ .... ' STREET LOCATION Meet virginia at A~ea' 'R~&lt~o~s, Ea'gl~T;RiVer 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS ........-- ; ......... ....... '- [] One [] Four ~ SINGLE FAMILY - [] Two [] Five r-I' MULTIPLE FAMILY ' ' ............. ~ Three [] Six [] Other 7. WATER SUPPLY ~ INDIVIDUAL~ ....... * ATTACH WELL LOG. A well Icg is req wired for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY .................. depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM :1~ INDIVIDUAL/ON-SITE** *'If individual/on-site; give installation date If system is over two (2) years old an adequacy test ~s required [] PUBLIC UTILITY - bV this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78} THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] .FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL ,. DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY ,, Connection Verified LOG RECEIVED . 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVI DUAL/ON -SITE DATE INSTALLED~,, []PUBLIC UTILITY ' -' ..... Connection Verified INSTALLER []Septic Tank or [] Holding Tank ................................... Size: I C)c~© If Tank is homemade SOILS RATING give dimensions: "~ "' .... TYPE OF TANK . MANUFACTURER . -: - , -i.:'-~.- ~ '"-~:~ ~ '~ '~ '.? ';~i ' TOTAL ABSORPTION AREA , , MATERIAL 4. DISTANCES , Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: ~z;/~j~ ' / I Absorption Area to nearest Lot Line . · 5. COMMENTS ..... , · ......... ' '.i '~"~-',:- '-~ ':" [~'~PPROV ED FOR --.0 BEDROOMS , [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE ' ' ,.. BY Title LEGAL DESCRIPTION · _ . _ . REALTORS ,.~UNICIPALITY OF ~qCHORAGE I:NV(RONMENTAL Fff:~ ~ ECTIO,N REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES DEC '7 1978 RECEIVbD CONV 1. Type of Inspection: CMRO VA FHA 2. Property Owner: Mailing Address: ~. 3. Name of Buyer: Mailing Address: Day Phone '4. Name of Lending Institution: Mailing Address: ~ 5. Name of Realtor or Agent: Mailing Address:~_EZ/~$~ Legal Description: .~//~ Location: .~--U',~/,~-~' ~'f~-~--/-' 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility ~ If Individual, date of installation: No. Bdrms. Individual (on-site) [B AREA, INC. REALTORS E] Anchorage "C" St. Office [] East Anchorage [] Eagle River Eastgate Office Parkgate Office 5437 E. Northern Lights P.O. Box 249