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ROBINDALE #1 BLK 2 LT 4
Robi*ndale #1 Block 2 Lot 4 #051-052-56 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME�e� �� ©/V �' PHONE �`--�• NEW ❑ UPGRADE MAILING AD ESS 0c 6q7 !`.i/ LEGAL DESCRIPTION � / /a� LOCATION -/J NO.'OF BEDROOMS S r• DISTANCE TO: Well 6(0( Absor tion aF7_ Dwelling if PERMIT NO ��� � U y ` f� I- H Manufacturer 4(? Material „/l �1 No. of c partments rn i gallons Liq. Mob IF HOMEMADE: Inside length Width Liquid depth y DISTANCE TO: Well Dwelling PERMIT NO. JOZ 02 <- Manufacturer Material Liquid capacity in gallons 0Well f— Foundation f Nearest to% in ��� PERMIT N w= DISTANCE TO: 90Lu / �� w No. of lines Le h W each I' e`K Total n th o, lines Trench width Distance be , e�n lines hz ` inches s Top finish Material beneath Total tive H of tile to grade/ tile 5 12 effe absorption area 0 { s inches Length Width Depth PERMIT NO. W Q F Type of crib Crib diameter Crib depth Total effective absorption area as LU Lu Well Building foundation Nearest lot line DISTANCE TO: J Class 4)epth Driller 0 Distance to lot line PERMIT NO. J W DISTANCE TO: / Building foundation Sewer line y Septic tank Absorption area(s) OTHER PIPE MAT IALS U' SOI L TEST R TI NG INS LLER , MA S / RE&tie fc 10 ITa AP. OV ED i��� .YCo�'�(-`���Coa✓ �v�A�/!J / ,MUNICIPALITY OF ANCHORAGE,- Department, Health and Environmenta: 3rotection 825 L Street, Anchorage, AK. 99501 264-4720 /� n LDEwl HANDWRITTEN PERMIT WELL AND/OR ON-SITE SEWER PERMIT���.' Applicant: Mailing Address: C/—/ v Location: tc,�7�77.` Phone Number: %- Lj "�. „'. lr�+� N.�'fc .. e`l 440 0L7(�I Legal Description:1, i =%mss % Lot Size: i, Type of Soil Absorption System Is: Trench: Drainfield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: y Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Ids: DEPTH / LENGTH GRAVEL DEPTH �� � •� F�'='s WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a 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 outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ Z GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. # # TWO(2) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 1'50 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 1 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if :theZrsidence is remodeled to include more that 3 bedrooms. Signed: Issued by: plic t 2- � Date: SWP/024(1/81)= a O & E ENL.NEERING & DEVELOt MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 r� SOIL LOG 1 688-2280 Performed for: Name: ��,/� /¢��®�%l�7+++n el. N0.'- '� Mailing Address: /� �' %� 41-31 AOOE, &, 994 -:? 7 Legal Description: Lor .4. 1.4L.0014 2, 11�/ Depth (feet) Soil Characteristics 0- 1 2 3 A/RYSe: 6 7 8 9 10 11 12 13 14 15 16 ger f PLIM , PERC. TEST � �`y°o soa°a ea°tl o Ground Water Encountered: Yes k"" No If yes, what depth :f > a49 ®° �aa a.a°aae oa�rauaQeae ae Proposed Installation:. Seepage Pit_ Drain Field - g �.: .. . ... Earl P. Ellis r:nmmonTs ��� � /�/�f� �LC�i�'[ /�/t�l�4 AC) ®ski NO. 7745_F Performed by: Date: �/ Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services j On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING (_' -/ - OS'L -SC HAA# iAW\1 AQSL12- 1. GENERAL INFORMATION Complete legal description Z_4 jg a 1e0&ti�>L1g7 4 IMoZ Location (site address or directions) P061eSO.J ID Property owner Doti) Mm'l LLry Day phone Mailing address Z2(./Z ,000it-6, �, <W6 Ak Lending agency Mailing address Day phone Agent njo Day phone Address 6 - Unless Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 13 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site —_ Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 021 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 David R. Dayton P.E. Phone 2U21ona ar t. Address C!!1 iak Alaska 99567 Engineer's signature 6. DHHS SIGNATURE " 'F Approved for bedrooms. Disapproved. 2A Conditional approval for Additional Comments Date bedrooms, with the following stipulations: Vim.. �s. ,fIT:Ir 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 engineer's work. 72-025(Rw. 1/91) Back MOA 921 6a -1V /5/X ev-� / ((-<4- � f s_ r; S ilk IN Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L �Jz Parcel I.D. A. Well Data Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed W10 Driller Gum Total depth Cased to Casing height jS Sanitary seal (Y/N) Wires properly protected (Y/N) WATER SAMPLE RESULTS: Coliform 0 Nitrate 31 `% Other bacteria Date of sample: Z��4 Collected by: �II/I�J`SG B. SEPTIC/HOLDING TANK DATA`r3 �S Date installed A/ Z Tank size /oegp Cleanouts (Y/N) Y Foundation cleanout (Y/N) Compartments Z_ _Depression (Y/N) Al High water alarm (Y/N) OZIL Alarm tested (Y/N) 4 J� Date of pumping Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot lo.- On adjacent lots /06,/— Foundation To property line le� f Absorption field Water main/service line Surface water/drainage /610f - /ea .7e- 72-026 (3/93)• Front - CONTINUED ON BACK PAGE FROM WELL LOG AT INSPECTION Date of test 7///A/ o n Static water level / �� r. rn Well flow g.p.m. �6` 9 -P.M. D m O Pump levell �1 n n N S SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot On adjacent lots is d d- C+ g m Absorption field on lot On adjacent lots to avx Public sewer main N%9 Public sewer manhole/cleanout A/ Sewer service line Petroleum tank N�e.IL WATER SAMPLE RESULTS: Coliform 0 Nitrate 31 `% Other bacteria Date of sample: Z��4 Collected by: �II/I�J`SG B. SEPTIC/HOLDING TANK DATA`r3 �S Date installed A/ Z Tank size /oegp Cleanouts (Y/N) Y Foundation cleanout (Y/N) Compartments Z_ _Depression (Y/N) Al High water alarm (Y/N) OZIL Alarm tested (Y/N) 4 J� Date of pumping Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot lo.- On adjacent lots /06,/— Foundation To property line le� f Absorption field Water main/service line Surface water/drainage /610f - /ea .7e- 72-026 (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 D. ABSORPTION FIELD DATA On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Surface water Date installed A/ Soil rating (GPD/Ft2) ��� ���' System type 2-5- M &5 Sifc�GQh! �n 11 iUs}-i)SY�,Nr,J t Length � Width Gravel thickness /k/- /vine Total depth Z,s iNSrrt� Afo,V,'XdV&r Y� Total absorption area Gy Z_ —Cleanout present (Y/N) A/ Depression over field (Y/N) 411, Date of adequacy test 7 I &I Results (pass/fail) for i Bedrooms Water level in absorption field before test C) e / / � After test (9 ,44C U- 4/,/M 0,,.i)",cr Cy zy,t Peroxide treatment (past 12 months) (Y/N) 4.1 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 110 7'�On adjacent lots /o a Vv Property line /U If— To building foundation Z_v = To existing or abandoned system on lot On adjacent lots % o 71'— Cutbank r✓,/its Water main/service line Surfiace water Driveway, parking/vehicle storage area / Curtain drain eA,l J E. ENGINEER'S CERTIFICATION All ! certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effecti r' the date:_of this inspection. s. David R. Dayton P.E. 20210 Donalar St. " Signature Chu iak Alas! a 99567 Engineer's Name Date HAA Fee $ r)OU 0/21 Date of Payment -7—//— 2!� Receipt Number %f% r-!5�tn Waiver Fee $ Date of Payment Receipt Number %"I vag-6454 • Municipality of Anchorage On -Site Water and Wastewater Program 3 y } 1 (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-052-56 1. GENERAL INFORMATION Complete legal description ROBINDALE #1 BLOCK 2 LOT 4 Expiration Date: � • D�1 I I Location (site address) 22612 ROBINSON ROAD, CHUGIAK AK 99567 Current Property owner(s) KEVIN & LORI ROYSTON Day phone Mailing address Real Estate Agent PO BOX 672474 CHUGIAK AK 99567 2. TYPE OF DWELLING: ® 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 Individual Water Storage ❑ Holding Tank ❑ Community Class —Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: COSA to be released to the engineer, unless gt66rwl�e requested by the engineer. COSA Fee $ 521O•00 Date of Payment (I1 (�%���D Receipt Number 0 31 v D COSA# 05GII0 I5 LP 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. 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 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 11/15/16 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 occupants or can ArcTerra guarantee that no unseen �. t; ! \ encroachments, deficiencies or discrepancies exist. � cSV OF ALIQ ,e Tli fi , 6. DSD SIGNATURE C IF System #1 Approved for bedrooms. 4 t"rcei" M. ° e vie / System #2 Approved for bedrooms. 1 �fT\�o / Zo Disapproved. Conditional approval for bedrooms, with the following stipulations: PROGRAM C) Spm,, •, ccy�.SE By Original Certificate Da 6", 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA roue sheet 1a10-12.dM If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: ROBINDALE #1 BLOCK 2 LOT 4 Parcel ID: 051.052.56 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # Date completed 1011011981 Sanitary seal (Y/N) Y Total depth 169 ft. Cased to 169 ft. FROM WELL LOG Date of test 10/1011981 Static water level 135 ft. Well production WATER SAMPLE RESULTS: Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 24 in. AT INSPECTION ft. g.p.m. 6.45 g.p.m. Coliform NEG colonies/100 mL Nitrate 3.7 mg/L Arsenic: ND ug/L Date of sample: 1112116 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC / STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping 71612016 Pumper Sanitary C. ABSORPTION FIELD DATA Collected by: ARCTERRA Date installed 8/2112001 Cleanouts (Y/N) Y High water alarm (Y/N) Y Date installed 812012001 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 System type SHALLOW TRENCH Length 118 (2x59') ft. Width 5 ft. Gravel below pipe 1.57 ft. Total depth 4.75 - 4.6 ft. (Measured 11/3/16) Eff. absorption area 750 ft2 Monitoring tube Y Depression over field N Date of adequacy test 1113116 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 517 in. Water added 710 gal. New depth 9113 in. Elapsed Time: 1410' min. Final fluid depth 4.5/7 in.' Absorption rate >= 600+g.p.d.. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off' level at in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 25'+ Animal containment areas 50'+ SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 1001+ Public sewer manhole/cleanout 100'+ Holding tank 100'+ Manure/animal excrete storage areas 100'+ Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line t* .7 Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 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 KENNETH M. DUFFUS Date 1111512016 COSA canary sheet_2-6-15.doc OF AZ 4 X 7h"- \v IQTFi in. ' P KENKBTH M. � / 1 Municipality. of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage Alaska 99519-6650 a (907) 343-7904 • Fax (907) 343-7997 http://www.muni.orn/Onsite Development Services Division On -Site Water and Wastewater Program lrc oM41"'i az'� 49 )eparnnell t * * * * VARIANCEIWAIVER REVIEW * * * * Waiver#: osvl61144 PID#: 051-052-56 COSA#: osc161566 Permit#: Legal Description: Robindale#1 Blk 2 Lot 4 Engineer: Arc Terra_ Applicant: Kevin Royston Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 8 feet. This waiver approval applies to the Existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. X The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ❑ Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: Approve7-q— rn �1 f4drne of Reviewer�� ............................................................................... 04 �RcTER,? F - ARC ERRA CONSULTING, INC `,. ✓ 4F 212 E. 51" Ave, Anchorage, AK. 99503 H�pp"Office (907) 868-3791, Fax (907) 868-3793 November 28, 2016 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 RE: LOT LINE WAIVER — ROBINDALE #1 BLOCK 2, LOT 4 Per the recently submitted as -built survey dated 8/19/206 by Shane A. Holt, LS - - the septic field is within the required 10' separation distance to the lot line. The measured distance is approximately 8.5' from property line to the monitoring tube and we are therefore requesting a waiver to 8' to lot line at this time. This field has been in operation for 15+ years with no known issues and we do not expect there to be any adverse effects. If you have any questions, please contact me at 868-3791 / FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. Kenneth M. Duf E. MUNICIPALITY OF ANCHORAGE e Community Development Department - Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program Mayor Ethan Berkowitz 11-28-16 To: Affected property owners adjacent to Robindale #1 Blk 2 Lt 4 Subject: Waiver Notification Notarized Confirmation To Whom It May Concern: The Municipality of Anchorage On-site Water & Wastewater Program (On-site) regulates private drinking water wells and septic systems for single family residences in accordance with Anchorage Municipal Code (AMC) Chapters 15.55 and 15.65. The Chapters include minimum separation distance requirements for private drinking water wells and septic systems. The requirements represent a conservative approach to protecting public health. Occasionally, the construction or upgrade of a property's well or septic system cannot be accomplished without reducing the code required separation distances. In these situations, a waiver to the required separation distance may be approved if an Alaska licensed civil engineer can successfully show that the public health will be maintained. The code requires a septic system drainfield to be located a minimum of ten (10) feet from any property line. The subject property owner's engineer has formally requested a waiver be granted to allow the existing septic system drainfield to be less than the required separation distance from a property line located on Robindale#1 Blk 2. Lt 3. AMC 15.65.140 requires all adjacent property owners be notified seven (7) days prior to issuing a separation distance waiver. This letter and a copy of the as -built survey have been sent to you in accordance with this requirement. Please sign and notarize this letter to acknowledge you have been 1111110/11 notified. %% AERR/C,F,,�� On-site Water & Wastewater Prograrr�� �,............... , '.� 60e rblu Encl.: as -built survey :c; p - y `A Mthe96 —dayof NcAe _ Q �; 2 •��rsonally appeared before me Owner - Robindale#1 Blk 2 Lt 3 •:°oy �8 Q�e`y en to me to a rson(s) who algned 'ice Print Name•�ilrsv- /���.�/. S'T. i; 'E11 Signature Notarya-= My commission expires 23 jO Mailing Address: P.O. Box 196650 • Anchorage, Alaska 99519-6650 • http://www.muni.org rA F0� 49 TH y,OO CONFLICTS BETWEEN HEREONEXISTING 15 G ST THEUSEOF LEND TIED L INSTITUTIONS SPECIFICALLY TS. AND ANY [OT TO BE BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES ANO/OP EASEMENTS:AND IS NOT OF FOR POSITIONING THAN TH05E ADDITIONALSTRUCTURES,ON THE RECORD PLAS, ORT, ARE FENCENOTS INES WN ^•,1. ,�,/{J EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON (UNLESS INDICATED) SHANE AA. HOLT: NOTE'. FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE LBAi91a ,.^00 0 PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCE5SIVE 5NOW AND/OR ICE. A5 -BUILT SURVEY V = 40' AU CORNERS SET THIS GATE m I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 4, BLOCK 2, ROBINDALE AVD -N. M. I ANCIRTRAGE RECORDING DISTRICT, ALASKA, AAV THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS 7TH DAY OF SEPTEMBER , 2016. HOLT LAND SURVEYING 600 HIGLYIEW DRIVE 4NCNORAOEAK 99515 5447, FB 177-66,181-2 3A5 5513 Municipality of Anchorage . Development Services Department' - Building Safety Division + t= On -Site Water and Wastewater Program " 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051.052.56 HAA #A Expiration Date: 1. GENERAL INFORMATION Complete legal description__Robindale #1. Block 2. Lot 4 Location (site address or directions) _22612 Robinson Drive, Chugiak, AK 99567 Current Property owner(s) Mike Luger Day phone 688.2628 Mailing address Lending agency Mailing address Day phone Real Estate Agent Bonnie King Day phone 6882276 Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 4. 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 Health Authority 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 KND Engineering Phone 696.6111 Address _20441 Ptarmigan Blvd. Eagle River, AK. 99577 Engineer's Printed Name Kenneth M. Duffus Date 09/05/2001 5. DSD SIGNATURE Approved for _ bedroorr Disapproved. NGINEER S STAMP Conditional approval for bedrooms, with the following stipulations: Additional Comments ^)TF VW ER ANC PROGRAM ;' J •• Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: (� Original Certificate Date: ! 0 (Ra 12W) 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.enchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: _ Robindale 91. Block 2. lot 4 Parcel ID: 051-052-56 A. WELL DATA Well type gito If A, B, or C provide PWSID # Date completed 1011011981 Sanitary seal (YM) y Total depth 169 ft. Cased to 169 ft. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: ft. 9 -p.m Well Log (YM) Y Wires properly protected (YIN) Y Casing height (above ground) 30• AT INSPECTION 143 ft. 8.33 g.p.m. Coliform -1-colonies/100 ml. Nttrate 1.79 mgA. Other bacterta4colonies/100ml Date of sample: 09104!2001 Collected by: KND Enaineerina B. SEPTIC/HOLDING TANK DATA Tank Type/Material _Anchorage Tank - Steel Data installed 06121101 Tank size 1250 gal. Number of Compartments 2 Cleanouts Y_Foundation cleanout Y_Depresston over tank ELHigh water alarm MA Date of pumping New Tank Pumper C. ABSORPTION FIELD DATA Date installed 08120101 Soo rating (g.p.d.lftr or felbdnn) U System type Trench Length 118 ft. Width 5 ft. Gravel below pipe 1.57 ft. Total depth A&J ft. Eff. absorption area Z§JfI Monitoring tube Y Depression over field N Date of adequacy test New System Results (Pass/Fall) Pass For 4_ bedrooms Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in. Elapsed Time: _ min. Final fluid depth _ In. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) 'Pump on" level at _ in. 'Pump ofr level at _ In.High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 1001+ On adjacent lots 1001+ Absorption field on lot 1001+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer /septic service line 251+ Holding tank 1004 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line __T+ Absorption field 51+ Water main 10'+ Water service Ane 10'+ Surface water 1001+ Wells on adjacent lots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parkinglvehide storage 25+ Curtain drain 50'+ Welts on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION s!y'�r.•' •••'�fq1( I certlly that I have determined through field inspections and •. »».•ww»»•e. }... review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. �1• K t•- W Engineers Printed Name Kenneth M. Duffus �1 s'� c- A4,i i' r Date 0910512001 f ti 9�d p»M�Np a\� ROFF% HAA Fee $300 Date of Payment 09/10/2001 Receipt Number 54093 (Rev. 12W) Waiver Fee $ Date of Payment Receipt Number SEP -10-01 11:14 FROM -CUE ENVIRONWNTAL SRV ME Environmental Services Inc. �• �rrirrrrrrirrrrrrr� Cf&E Retil Client Name Project Name/# Client Sample ID hlatrix Ordered By PWSID 1015972001 KND Engineering N/A Rohindale # I a2, Li Drinking Water 9015615301 T-042 P.02/06 F-131 Client POM Printed Date/Time 09/10/2001 9:32 Collected Date/time 09/04/2001 14:00 ReceivedDate/rlme 09/04/2001 17:0000 Technical Director rephen C. Eyle7�i+'w` Released B . fJ�J Sample Remarka. Panmetcr Resohs PQL Units Method Altowshlc Prep Analysis Limits Data Dale lnit Waters Dena Nitrate -N 1.79 0.500 m8/1. EPA 300.0< ( 10) 09104/01 SCL Microbiology Le6orllmxy Tom] Coliform 0 0 Will00mL SN18 9222B (<1) 09/04/01 KAP SEP -10-01 11:15 .�T� FROM-CTdE ENVIROMENTAL SRU 9075615301 T-042 P.04/06 F-131 ME Environmental Services Inc. Laboratory Division Drinking Water Analysis Report for Total Coliform Bacteria Ancho200 o Porter Drive rage, AK 89618.180b READ LVSTRUCTIONSONREVERSESIDE BEFORE COLLECTING SAMPLE Tel: (907) 562-2343 Fax: 19071 SAt.F9ns MUST BE COMPLETED BY WATER SUPPLIER o PUBLIC WATER SYSTEM I.D. a PRIVATE WATER SYSTEM Send Resufrs 13 Send Invoice G.k,"T w1 rrY wWr .m WW., A.W e�b8 -375'/ 8G� � 1713 zotll!/ t°fsiaV CAQ LI.wwA ... (t �Ve ; Ar- 11C"77 ., Cl Send Resufrs O Send lnvoire W�wpY MK WYYI IWY .4 A4&N "Y w SAMPLE DATE: EE M m Month Day Year S,,A/MPLE TYPE: �S -'Routine }QOM 1r SAC£ D Treated Water CI Repeat Sample (for routine sample 0 Untreated Water with lab ref. no. O Special Purpose Time Collected SAMPLE LOCATION Collected By 2 PAI 7AI 11) rk. Mat Analysis shows this Water SAMPLE to be: Satisfactory O Unsatisfactory • Sample over 30 hours old, results may be unreliable O Sample too long in transit; sample should not be over3lDhours old at examination to indicate reliable results. Please send new sample via specie delivery mail. Date Received Time Received Analysis Began �, U Analytical Method:Membrane Filter MMO-MUG 4 Number ofcolonies/IOOmi. • Analyst 1015972 b� i Jun ❑ Fated Date: Time: Client notified of unsatisfactory results: Phoned Spoke with Fat d Date: Time: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result: Total Coliform & Coli Membrane Filter. Direct Count l l Colonlet/100 ml verification: LTB BGB COLIFIRM rVTC. Tie N�s re C"m Fecal Coliform Confirmation os-ounsewene Final Membrane Filter Results Coliform/100 ml Reported ByU 1 Time brs Comments: EIMMember of the SGS Group (Societe Generale de Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, IWN0IS, MARYLAND, MICHIGAN, MISSOURI. NEW JERSEY, OHIO, WEST VIRGINIA Municipality of Anchorage Development Services Department BuildingSafety Division On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 Page of www.cl.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWO10251 PID Number. 051.052.56 76 Luger Wastewater System: ❑ New ® Upgrade re;E32 Robinson Drive. Chugiak. AK 99567 ABSORPTION FIELD Pna»: Nu bwa .2628 4Betooam: O Deep T ad ® shabow Tromh 0 Baa O trona ❑ omx. LEGAL DESCRIPTION S" Raano: Teel Depth ban agna orae•: 0.8 GPD*? 4.61.4.31 Ft. 8w La: saatmam: Depen W W» eaten ". wig a ones: Gravel depth tureen pipe: 2 4 Robindaie 01 3.06.2.74 Ft. 1.55-1.57 Ft To p: Rance: so a x Fr weed Sbwe arena Waea: Gr L.rpm: 0.1+1- Ft. 59.0.59.0 Ft. Well: ElNew ❑ Upgrad crave roam: 5.0 wnbtoaw.: Dalom* uasn arra: Ft. 2 10.0 Ft. C1aUd"tm (Pmau, A B. C): Tea Depen: Ca«d b: Taal abwpom toes: Poe MaaW: Private Ft. Ft 750+ Fr D3034 & F810 DHler )/ Dae Drava: subs WSW Lava: Y W Data htWlea: L�ti'ti Ft RPC Construction 8120/2001 Pang Set ac Cat" hoot,wwe Grand: TANK GPM Ft. Ft SEPARATION DISTANCES O septic ❑ Holding ❑ S.T.E.P. ❑ Other. To I Septic Absorption Lit Holding PublWPrival- 'teas: r From Tank Field Station Tank Sewer Line Anchorage Tank 1250 Ga. WON 100'+ 100'+ NA NA 25'+ MMOML Steel to^oor a canptom : 2 sr+acowalto 100'+ 100'+ NA NA LIFT STATION La tar 5'+ 10'+ NA NA a aa. a�lato: Ga. Faalda� 5'+ 10'+ NA NA Pines r at 11arpar Hyhwater at Caen Dren NA '50'+ NA NA Pa"p "'a"' ° E"ar�' "r-p.`ba"` °"'""'°° w Ram W: 'none known - septic tank was abandoned in place per code BENCH MARK trench material consistent r o (A .CA leo ;.. L.. W Lwab w gyp. House entrance - concrete slab va 100 Ft Engineers Stamp OF 4eq�11 Inspections performed by: KND Engineering Dates: 1 8/20/2001 i 91 t 2nd 812112001 Development Services Department Approval «Kenneth M. Dul • j Reviewed and approved by' Date: —%�-O � �� �.• Ce 7116 v��i l�`*'�''� 90F v AS -BUILT SYSTEM DETAILS/SITE PLAN Permit SWO10251 ROBINDALE #1, BLOCK 2, LOT 4 PID#051-052-56 INTERMITANT TRA RSE POINT 'A• PRIMARY B_A•27.7 �I AI_A..2.7 DRIVE WAY K D I� C DIVERTER 1000 OTING MT 1� SEP TAW C M A E ISTIN RBDRM 100' EL R USE 4 A -C= 22.9' SCALE, 1' B -C= 7.3' A -D=17.1' B -D= 15.3' ' 00.2 9.9 4.2 ill A -E=15.4' 0.TAp1 nI"aT C TuK `~ FINAL GRADE Ia1TOR TY 93.11 B -E=20.0' pqi IMIE31 TT V TV A -F= 66.7' g ,IR.,AMK / IYpL11p YYMf GA B -F=89.7' dN ,SEP ICL 8000 9.9 90.0 A -G=69.7' :r TANK SEWER ROCK B -G= 76.0' TRENCH I ffY A -H= 128.9' 96.5 96.3 88.54 88.50 B-H= 133.6' TOR TUK S9 MONITOR ?UK yp OUr A -I=121.5'4.9 FINAL GRADE 3.6 SCALE, NTS B-1-122.7' A -J=64.0' B -J=63.4' 89.8 > <99.8r SEWER ROCK u> TRENCH 2 882 882 ft_L OF AZ4.1 S9 79 Ta 1 PREPARED FOR: BONNIE KING 22612 ROBINSON RD. *j49 �[ * CHUGIAK, AK. / SCALE, NTS K FIELD BOOKS COWUTEM M ID ENGINEERING ea Mo DRAM: tCE-7118 �I,4: HOLT sTAMMG CHIM 20441 PTARMIGAN BLVD. ��' HOLT . KMD EAGLE RIVER, AK 99577-8736 Aw AST' HOT OAR p 01 / � _. : �-.... "kpkFESSIO'W" ,- :::::::::::::::: 011e. ME CF -01. N W1561 ..... . -::::::::::::::::...........-.......... Am "' 01028.DWG Joe M" 01028 (907)696-6111/FAX 907 698-8111 MUNICIPALITY OFANCHORAGE Development Services Department On -Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Permit Number: SWO10251 Legal Description: 'ROBINDALE #1 BLK 2 LT 4 Date Issued: Jul 18, 2001 Expiration Date: Jul 18, 2002 Parcel ID: 051-052-56 Design Engineer: 0070 KND Engineering Site Address: 022612 ROBINSON RD Owner Name: Mike Luger Lot Size: 48580 SO. FT. Owner Address: 22612 Robinson Rd. Total Bedrooms: 4 Permit Bedrooms: 4 Chugiak , AK 99577 - This permit Is for the construction of: 0 Disposal Field 0 Septic Tank E] Holding Tank [:] Privy El Private Well El 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 notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 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. Received By: Issued By: Date: O V / Date: $ to I Municipality of Anchorage Development Services Department �;: 1 Building Safety Division :` On -Site Water and Wastewater Program 4700 South Bragaw St. ' P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-052.56 Permit Number SW 171 02S1 Property owner(s) Mike Luger Day phone 688.2628 Mailing address (1) 22612 Robinson RD Chugiak AK Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) Lot 4. Block 2. Robindale subd. Addn. #1 Legal description (Section, Township & Range) Lot Size 1.16 Acres Acrgs F Number of Bedrooms HTS90 ��- THIS APPLICATION IS FOR: Sewer Only ® Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application Is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: �V 6 (Rev. 12=) Waiver Fees: Date of Payment: Receipt Number: MD ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 11/FAX (907)696-8111 June 28, 2001 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Sewer Upgrade — Robindale #1, Block 2, Lot 4 Gentlemen: The owner has requested we proceed forward to obtain a septic permit to upgrade and replace the existing septic system and tank for the subject lot. The existing septic tank will be abandoned in place and in accordance with municipal standards. On June 20t°, 2001 we dug one testhole for the proposed system. The results of this test are attached. The general slope of this lot is flat. We have designed our system utilizing the testhole we excavated for the 4 -bedroom house. The lot is served by an individual well. We propose to install a 5' wide shallow trench. Water was encountered during the excavation at 8.5', after monitoring the water level was at 11.5'. There are no public or private wells within 200' of our proposed system location except as noted. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, MUD Engineering Kenneth M. Duffus, P.E. attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLA ROBINDALE #1, BLOCK 2, LOT 4 NO PUBLIC WELLS WITHIN 200' K ►N( EP SYSTEM NO PRIVATE VCLLS WITHIN 200' Dr PNOVOSC0 SYSTEM EXCEPT AS NOTE& NO SCPTIC SYSTEMS WITHIN ?W O PROPOSCB WELL EXCEPT AS NOTED. A e� OF AL9 � �* 4P H* If 1 �?ice �FSSION - ./ DESIGN DETAILS 4 BDRM X 150 GPD = 600 GPD 600 GPD/.8 GPD PER SO. FT. 06.67 MIN/IN.)= 750 SO. FT (750/5'CW)) X .78(RF) C1.5' GRAVEL) w 117 FT. TRENCH USE 2 TRENCHES - 59 CL) X 5' (W) X 1.5'CD) Total depth of system is 4.5' from original grade. Total depth of gravel below distribution pipe is 1.5' . NOTES: 1. CONTRACTOR TO INSTALL 1250 GAL SEPTIC TANK AND INSULATE TANK IF (4' COVER. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM. 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK. 4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE MIN. 3' COVER. 5. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS 6 SEPTICS. PREPARED FOR: BONNIE KING 22612 ROBINSON RD. CHUGIAK, AK. FIELD BOOKS COMPUTED: Vmf* Tr. HOLT DRAW. S' ""G HOLT acaro: AlIOUtt HOLT DATE: DNc. ME: DRO: '"'D ^E` 01028.DWC JOB": 01028 Scale 1'= 100' PAGE 1 OF 2 ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 -all 111 WASTEWATER DISPOSAL SYSTEM DETAILS R❑BINDALE #1, BLOCK 2, LOT 4 R O❑p I TH#200 30/ LITTER PRIMARY FIELD 2 2' Ica 6::�C❑ T /-"� 35/ PROPOSED DIV XIS C (TO o o 0 A / XIST CO o PROPOSED 1250 / GAL SEPTIC TANK SLOPE = FLAT A���� OF ALqPREPARED FOR: BONNIE KING 22612 *�yy. q . a a * �j CHUGIAKO AK.SON RD. CE -711 � �,N\ VA FIELD BOOKS Comm". sawfw - HOLT on' ST- HOLT O'CO`M. KMO AST: HOLT BA": 7 17 B"a ME: ao: NW15E AfD ..: 01028.OWG JOB K": 01028 F EXISTIr HOUSE Scale: 1'= 20' PAGE 2 OF 2 Ltl" LW ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)698-6111/FAX (907)696-8111 KND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 SOILS PERCOLATION TEST Performed for. Bonnie King Date Performed:6/20/01 Project: Robindale B2, L4 TEST HOLE p 2001-1 Depth (Feet) 14- 15- 16- 17- 18- 19- 20 - SEE ATTACHED SITE PLAN ORG — brown, moist FOR HOLE LOCATION GM— Med dense w/cobbles, some boulders, moist Seeps at 8.5' B.O.H. 1iOLE PRESOAKED PRIOR TO PERG TEST Was Groundwater encountered? YES What depth? 8.5' Depth to water after monitoring? 115 Date? 6/27/01 Reading Date Gross Time Net Time Depth to Water Net Drop 1 6/20/01 1:00- 2 1:10 10 min 74/16" 312/16" 3 1:20 10 min 52/16" 22/16" 4 1:30 10 min 310/16" 18/16" 5 • 1:31 - 11" - 6 1.41 10 min 77/16" 39/16" 7 1S1 10 min 56/16" 21/16" 8 2:01 10 min 312/16" 110/16" 9 • 2:02 11" - 10 2:12 10 min 7 6/16" 2 10/16" 11 2:22 10 min 54/16" 22/16" 12 2:32 10 min 1 312/16" 18/16" • Water Added Percolation Rate 6.67 (min/in) Perc Hole Diameter 6" Test Run Between 3 feet and 4 feet i This test was performed byMELOL& 6j9DF0tE7 I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. i�n '��1+•+�.3��1+_F.��:i�.i+�R-1'�JJVi�It�'Y. .i�:. w Fa— P ►Ad �'�� I)LL•Si�1F=�•Jl>"�7+i � +... ��1r,Gi�•I�ur i : + i�SSaC.el ���' aKi�,a'xliL�'I�Gy�ii • n+al��'•: � .,+.fl>. ti !� ' t_ f"•a•u•�C1�i1�: � .+++t:l.a�i� Ga-C_+:!z-DII �Mr.�i*GYt:IR1C•Ii"�ilII:wa� •� b �: Ar �� �yF'r�+14i,`�•.1�-71�,.I•wrwJ`�I��IL4��Y'A'1'.rllM.11�y'.;FT-`1=11. C.d�'�'.a`,Y�.'�r�.'.�.�d'�.�1!:1•J1Lf r'�.11.�'�:�' +°-�+1'I<'"�.4'1w1'�+14'�IfJ! ,C�'r��'i•J�3-'� :ci�i++r•-� GT�CIF-%11�i'u •++'s i.j'►� �,,,: JE:�+I:TS�t7'rG•1'� �:]r,•i'� �-'�i�;i rI ,_ Op l � 'i4h ,x{ t ,x s � � rf ''•r 3 lot sit 4 r -ERR V' F ! r 3 \afI`+:�'fi Stf;iifr t! rI oC! 'HOME 6?Fi21-�' r � CN DEPTH 'fA'i IC �,LVlL OF H I l 7� low t W ,, h +( "w, i 5 (..Man GAPS PEA Fid I j j t3 KF A f r l 7� low t W ,, h +( "w, i 5 (..Man Commercial Testing & Engineering Co. Environmental Laboratory Services SINCE 3C8 �iiiiiisir®s®®®sarosiroaiiesisrsiiiiis LABORATORY ANALYSIS REPORT CT&ERef.# 94.3386-1 Client Sample ID L4 B2 ROSINDALE S/D Matrix WATER Client Name DAVID DAYTON, P.E. Ordered By DAVID DAYTON Project Name Project# PWSID UA Sample Remarks: SAMPLE COLLECTED BY: DRD Parameter Nitrate -N Results 3.9 WORK Order 80131 Printed Date 07/08/94 @ 14:29 hrs. Collected Date 07/05/94 @19:30 hrs. Received Date 07/06/94 @15:05 hrs. Technical Director STEPHEN C. EDE Released%—F�--� QC Qual Units Allowable Method Limits Ext. Anal Date Date Init m -./L EPA 353.2/300.0 10 07/06/94 CMR * See Special Instructions Above UA=Unavailable ** See Sample Remarks Above NA Not Analyzed U=Undetected, Reported value is the practical quantification limit. +-41: D = Secondary dilution. GT c 0 5633 B Street, Anchorage, AK 99518-1600 — Tel: (907) 562-2343 Fax: (907) 561-5301 'egg s•.:_ .-_ COMMEERCIALTESTING & ENGINEERING CO. D1 10 v'Yl Cti ,=irGIV1S 1 C?Oi'_ '_C1 �' iC o 7Bar, 'C110 S1�O.O=R=CLLECT%1G5.=••.�?�_ CO.A- -FD_1=7-77D _�— .." _M i r Se-_ t?>s.`; ❑ Se.^c Irvocce I 1 - i i --I � David R. Dayton P_�E. •--'-_ --- � 10 Dor• ':-,r Cf —� --� Chugiak, Alaska "567 S = _ _. = D _ _ •�i ET 1tOII_i, Day Year ROue:P.e ❑ Tr_ -aced }Y 2iei Repeat S?iupie +0: COultlle c; _➢;e e t. ct eated Water iyith lab i ei ::o. J SCeCial P":—DOS- -1 7.E LO 1;Me Col%ec-ed Collected By :i0 !L':'.`- j:: is L_. to ;-`ca-_-Ga:e : _ _. _ .eG=e ]- _ Daze Re.,ei.ed — � Z " t TSWe Received �2 p_is L Began AU2 Im, _ \ _.,_: ai cc!c-.eS/100 . Lab ReE No. Re;uit" av alvs; ' t40 764 ( i i I l_/ ill Nfe=, mme Fiice,. Direr Co -__-t Coioz,es/100 ml Client noti:led of u' Satisfa_c_o; j• B ,CTERIOL0GICA.L N71 A, TER AN .LYSIS RECORD NL'Vj0-�'fuc- Result: Total Colic, W �. COL" ill Nfe=, mme Fiice,. Direr Co -__-t Coioz,es/100 ml N ,. Z'e tacit LT3 cOLEHRlj- �' -®r ,_- ::cam : sem, ] _i^ COu :.'_'2.1^_� -- cal COiIONl6 a^' ,•- Esc y-�X J � _. Fi al `e �an_ae ;ltt_-Res=1s Y� Coiiao.^/100 ml 'o :� Re��-_ 3..rtm I z, � ;<: 7—r3_gy Ti=e ((oC)a -S LU J �m z(D a r SGS alft COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES Drin-ing Water Analysis Report for Total Coliform Bacteria == 3 STREET READ INSTRUCTIONS 01; REVERSE SIDE BEFORE COLLECTING SAI'IPLE TE -L: (907) 5,32.2-- PAX: (sc,) MUST BE C0.'vPLETED BY NVA iLR SUPPLIER ❑ PUBLIC WATER SYSTEM LD. g 171-1-1 PRIVATE WATER SYSTEM ❑ Send Resuk� ❑ Serd Invoice W.,- $ r= N =ec=?. Iy NL- G Ynortc: usocr taz: ego% Send Resuu ❑ Serd Invoice -7z.y kz:.c c -=-t ra=c 20210 Donalar St. Lhugta as a i z:, co;:_ SAkIPLE DATE: Month Day Year SAMPLE TYPE: P<. Routine ❑ Treated Water ❑ Repeat Sample (for routine sample untreated Water with lab ref. no. ) ❑ Special Purpose Time Collected SAIMPLE LOCATION Collected By 4*�Z 46Wa': to 5� 73 Cor:.ment<: TO BE CO�LETEED BY LABORATORY Analysis shows this Water SA ?.SLE to be: ff Satisfactory ❑ Unsatisfactory ❑ Sample over 30 hours old, ret*s may be unreliable ❑ Samule too long in t:c^.ci;: shot—Id T ot be over 43 hours old a: ezv: nage: to indicate reliable res'•s. !ease ce,d new sample yia specie I. Date Date Received Time Received < AnaltsisBegan n 6 1994 Anal} -tical Method: Number of colo ies/100 m-1. Lab Ref. Nn Result*:U'ialyst Sent to.-LD.E.C. ac.-! Date -1 �PPT i -e: Client notified of unsatisfactory results: Phoned Spoke with . zzcd Dare: BACTERIOIOGIC_-j5,I. NATER A_\ALYSIS RECORD tiL410-MUG Result: Total Co!iform E. Cou Membrane Filter: Direct Cour: Colonies/100 al Verification: LTB _ hI�,,j1 In COLIFHz-M Fecal Coliform Confirmation ry lI y'J Final Membrane Filter Results /) Coliform/100 ml Reported By T. W. (A) -Oto —�� Time '�> hrs PART ONE OF TWO - REMAINDER TO FOLLOW �7C= rcc U3 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, townshi Lot 4; Block 2; Robindale Subdivision Location (address or directions) �JL- 11-7 October 15, 1986 4t\\ (b) Applicant Name Dan Markley Telephone: Home 688-3126 Business Applicant Address SR 31 Box 7127, Chugiak, Alaska 99567 (c) Applicant is (check one): Lending Institution D ; Owner/builder [!� ; Buyer D ; Other D (explain); (d) Lending Institution Security Pacific Telephone Address 2550 Denali Street, Suite 615, Anchorage, Alaska (e) Real Estate Company and Agent none/refinancing Address Telephone D (f) the HAA to the following address: S & S Engineering SRB 196X Eagle River Road Eagle River, Alaska 99577 2. TYPE OF RESIDENCE, Single -Family IR Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well ZX CommunityEl Public ❑ Note: If community well system, must havewritten confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite [X Public D Community D Holding Tank D Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDINu INSPECTIONS, TESTS, FILE SEARCH, DA I w AND INFORMATION 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 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 S & S ENGINEERING Telephone 6 7 i Address SR B 196X EAGLE RI E ,AK 99577 o a 4e;G Date i I Of tb �r 7 ��.� r9y n s SetA ll ,ea m _ {ao aea °4 to Z �V rr ° plroa 6. DHEP APPROV L �) �} Approved for bedrooms by �,�>2� Date Approved Disapprove Conditional Terms of Conditional Approval 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) CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street" Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY F ❑ PUBLIC WATER SYSTEM I.D.# Analysis shows this Water SAMPLE to be:- CYPRIVATE WATER SYSTEM Satisfactory 5 d 15 L kJl�iV�ZZ(N[. ElUnsatisfactory Name I Phone No. - S�� /F� k El Sample too long in transit; sample should not be over 30 hours old at examination Mailing Address to indicate reliable results. Please send L );Z, 7- new sample via special delivery mail. City State Zip Code / D -v�) _ 10, 6 Date Received SAMPLE DATE:FTI Z v, a � Mo. Day Year Time Received /r°i,p D SAMPLE TYPE: CYF�outine ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE NO. LOCATION yl,� I 2 I f/os� iia 3 4 5'I ! i i Time Collected Collected By 35 _V41 -r Analytical Method: Membrane Filter No. of colonies/100 ml. Lab Ref. No. Result" Analyst ��s 1 FTa L U� m U� m it U [Zl j BACTERIOLOGICAL WATERANALYSIS RECORD READ INSTRUCTIONS Membrane Filter. Direct Count BEFORE C; Verification: LTB COLLECTING SAMPLE Final Membrane Filter Results Reported By___� / 7 TNTC = Too Numberous ;To Count OB 1= Other Bacteria Coilforml100m1 / Coilforml100m1 Date Time: a.m. p.m. �J� MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANcAMAWH AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & CHECKLIST - FEBRUARY 1984 ENVIRONMENTAL PROTECTIO 264-4720 7 1986 Legal Description: Lo! /�nr-/L c3/nt fJlfC ci S�/� A. WELL DATA RECEIVED Well Classification �S `l If A, B, C, D.E.C. Approved (Y/N) n Well Log Present (Y6 Date Completed u•/if Yield Total Depth Cased to7 y� Depth of Grouting a� Static Water Level /Yo Pump Set At C-/ /C - Casing Height Above Ground If Sanitary Seal on Casing 6)N) Electrical Wiring in Conduit &N) Depression Around Wellhead (Y/ ID Separation Distances from Well: To Septic/Holding Tank on Lot /0� t ;On Adjoining Lots &) F To Nearest Edge of Absorption Field on Lot !L'0e4 ; On Adjoining Lots To Nearest Public Sewer Line N/",q To Nearest Public Sewer / Cleanout/Manhole ZQ To Nearest Sewer Service Line on Lot Z f Water Sample Collected by Date /62 - Z0' 0 L Water Sample Test Results S Comments We -L- .SN&y4a.6 B. SEPTIC/HOLDING TANK DATA Date Installed //- /Z -B/ Size 1060 No. of Compartments N Standpipes (Y)N) Air -tight Caps Y/ 1) Foundation Cleanout OSN) Depression over Tank (Y/&I Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) `v/11 Separation Distances from Septic/Holding Tank: To Water -Supply Well /OCU To Property Line /0,4 To Water Main/Service Line !c) '4 - Course /A Comments Page 1 of 2 74 Date Last Pumped /D -ez -gff& ;for Temporary Holding Tank Permit (Y/N) Al— / To Building Foundation To Disposal Field/ To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata / 3� 37z Type of System Design Date Installed /�'�z " f31� Length of Field 3�- Width of Field �� / Depth of Field S / Square Feet of Absorption Area Depression over Field (Y/O — Results of Last Adequacy Test Gravel Bed Thickness M 5 A7rt S i-1'tc i s Ir- -/ Separation Distance from Absorption Field: To Water -Supply Well (001+ — Standpipes Present (Yo Date of Last Adequacy Test R fz � 532.. To Property Line /yr -F To Building Foundation 'ac To Existing or Abandoned System on LotA ; On Adjoining Lots 3or f To Water MaiiqFService Line To Cutbank (if present) / Iii To Stream/Pond/Lake/or Major Drainage Course N To Driveway, Parking Area, or Vehicle Storage Area �5 Comments lsc t�> 15 , msu4 A:D="% %,V r ir{ Z of r n -C uUCA-Tiotir l9�1_ � GJ/�-S /tiSzl9Gc_i�p D. LIFT STATION Date Installed Dimensions Size in Gallons �A Manhole/Access (Y/N) "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify I e V4 ed, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed EN Date /_0 zZ %SR 13 1 96X Compares MOA No. Receipt No. 1�00 Date of Payment /0 �%kJTY OF ANCHORAGE pU DEPT. OF HEALTH & o ! irit Amount: $ �� gWIRONMENTAI PROTECTION e r<° c3F ( i`�.p JV 1)9 EeT iR%HOp4S J..il! (' Page 2 of 2 72-026 (11/84) OCT 27M RECEIVED acct A. 'Shwfwr NO. IA47-C -•eye �'�rorF 5. LEGAL DESCRIPTION DArERECEIVED (�j�✓�� INSPECTION APPOINTMENTS 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS <SINGLE FAMILY TIME TIME Two O Five FAT�E O Three El Six 7. WATER SUPPLY :INDIVIDUAL* *ATTACH WELL LOG. Awell log is required for all wells drilled O COMMUNITY since June 1975. For wells drilled prior to that date, give well O PUBLIC UTILITY DATE DATE INDIVIDUAL/ON-SITE** .. ` l�G YEAR ON-SITE SYSTEM WAS INSTALLED. tip - -,R) )'\ \\- -(�'\ 1 SPECTOR INSPECTOR INSPECT MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST 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. PROPERTY OWNER C_1'.^lis I' wre r PHONE 228 3 MAILING ADDRESS �1 k (1 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE TGrlcle MAILING ADDRESS 3. LENDING INSTITUTION PHONE 6� -moo MAILING ADDRESS a 4. REALTOR/AGENT PHONE MAI LING ADDRESS l7 IBbx C—a4IE PiV-er igk 99,5-7'L 5. LEGAL DESCRIPTION STREET LOCATION (�j�✓�� 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS <SINGLE FAMILY El One O Four ED Other Two O Five ED MULTIPLE FAMILY O Three El Six 7. WATER SUPPLY :INDIVIDUAL* *ATTACH WELL LOG. Awell log is required for all wells drilled O COMMUNITY since June 1975. For wells drilled prior to that date, give well O PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** .. ` l�G YEAR ON-SITE SYSTEM WAS INSTALLED. El PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified_LOG PERMIT NUMBER DEPTH OF WELL DATE DRILLED RECEIVED - nc��1 , 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑SepticTank or ❑Holding Tank rJ()A Size_ If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER. TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS \ , PPROVED-F6R`"BEDROOMS ❑ CONDITIONAL APPROVAL (letter mu 4accompany certificate) ❑ ISAPPR E DATE BY A CHEMICAL & GEULOGICAL LABORATORIES G. ALASKA, INC. TELEPHONE (907)-279.4014 ANCHORAGE INDUSTRIAL CENTER 274-3364 5633 B Street Drinking Water ,Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY WATER SYSTEM: I I A Analysis shows this Water SAMPLE to be: I.D. No. f � � ❑Satisfactory /r. G,, ;✓�7 t ; p„� ❑ Unsatisfactory Water System. Name Phone Noy f . ❑ Sample too long in transit; sample should not be over 48 hours old at examination Mailing Address - to indicate reliable results. Please send new sample. City ;. _ .., State. _ . Zip Code Date Received SAMPLE DATE: L_`121 Mo. Day Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose [I Untreated Water SAMPLE Time Collected NO. LOCATION Collected By 3 a 5 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Time Received Analytical Method: ❑ Fermentation Tube O"Membrane Filter Lab Ref. No. Result' Analyst I i CII 1 m m I. I CD *Noof colonies/100 ml. or No of Positive portions. 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date Collected Source a.m. Date Received Time Received p.m. Lab. No. Presumptive loml loml l Oml10m1 20ml l.Oml O.lml 24 Hours 48 Hours EMB Broth 24 hours: - - Broth 48 hours: Multiple Tube Report: 10M] Tubes Posltive/TOtal 10ml Portions Membrane Filter: Direct Count Collform/looml Verification: LTB BGB Final Membrane,Fllter Results - Coliform/looml Reported By - Date - Time- a.m.