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Home My WebLink AboutROBIN HILL #3 BLK 4 LT 9Robin Hills Block 4 Lot 9 #017-394-04 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: "'Bu0~'~'OOet O PID Number: O1"7 ~ '~cl'q' -O~t Name: ~O~,~,~ '~-~-~ Wastewater System: D New ~ Upgrade Address: ~ ~,~ ~. ~.,~ ~ ABSORPTION FIELD Phone: ~ --~Z~ IN°'°fBed~°ms: ~ Deep Trench ~ Shallow Trench OBed ~Mound ~Other Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION o. ~ ~sq. ~. / o' Block: Subdiv~ion: -- Depth to pipe bosom from original grade: Gravel depth be~a~h pipe Township:IRa,~: --/s~c,io.:__ FillaOdedaboveoriginalgmde:o.~,_ i' Ft. Gravellength: ~' Ft. Number of lines: Distance ~n lin~: WELL: ~XtS~New D Upgrade Grave~width: -Z .~1 Ft. I '~ Ft. c~assi~icationp~l~ h~~(Private' A,B,C): Total Depth: ~ ~ Ft. Total absorptionlooDarea~ Se. Ft. Pipe~ateria~: Driller: ~~: StaticWaterLovek Installer:Ft. C~O00 ~SO~ g~. Dateinstal,e~ Y~PMIP~mpsetat:Ft. CasingHe,ghtAbovoGround:Ft. TANK SEPARATION DISTANCES ~ s,ptic ~ Ho~di,g ~S.T.E.,. To Septic Absorption LiE Holding 3ublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sawer Lines ~ C~E ~ ~ Number of Compa~ments: ~ LIFT STATION Sudace Water IOo~ I0ot~ IO°~ ~ Size in gallons: Manufacturer: Lot t. +--,~ I~ I ~ -- "Pump on"~[,,levelat:,l"Pumpoff"~,l,level at: High water ~'alarm at: Foundation =umpMake&Model ~Electrical Inspections pedormed by: Drain Remarks: BENCH MARK Location and~escription: A~umed Elevation: ENGINEER'S SEA~ ,nspeotionspedormedby: AtaskaWate''WasteE~es'ls' ~/"/:~ t'''':':7 7320 East Chester His, ~-~,~ ' Depa~ment of Heal~ and Human Se~ices approval Reviewed and approved by: ~~~ Date: ~-]P-P~ PERMIT NUMBER AS BUII T DRtWING p^Ro~ I.o. NUMBER swgs0090 ' 017-594-04 ~ ~. ~FI~L ~DE ~..~o~,~ ~o~,o. ~- ~o,, / ~'~rc~~ OF WATER LINE~ ~ ~ / / ~ ~ ~ ~ +_. '~ ~ ~ PROFILE OF S,T.E.P. SYSTEM FO ~-~/ ~ g~ E ~ HOUSE I j ~ a I c / ~1 41,5' ~0.0' I - ~ ~2 ~ 455' ~s.s' I - q / ~ PROFILE OF DRAINFIELD ] N.T.S. A~S~ WATER ~ WASTEWATER '. ROBIN HILLS ~3~ LOT 9, BLOCK 4, WPE OF WORK: HOGAN SMELKER (907)545-4926 J.L.M. 1 = 40' 2 OF 2 A B C ~1 41.5' 50.0' - ~2 45,5', ~s.5' - VIH 46,5' 28.0' - VtT1 5g.o' 58.75' ~tT2 81.0' 7~.5' - PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM {UPGRADE) PERMIT NUMBER:SW980090 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES OWNER NAME:SMELKER HOGAN H & JENNIE OWNER ADDRESS:12900 MOUNTAIN PL ANCHORAGE, AK 99516 PARCEL ID:01739404 PERMIT DATE ISSUED: 4/30/98 EXPIRATION DATE: 4/30/99 LEGAL DESCRIPTION: ROBIN HILL #3 BLK 4 LT 9 LOT SIZE: 63994 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS {183LAC72) AND DRINKING WATER REGULATIONS (18ALAC80}. 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE EXISTING DRAINFIELD SHALL BE ABANDONED IN PLACE UNLESS IT IS FOUND THAT THE WATER LINE FROM THE WELL IS A MIN. OF 10 FEET AWAY OR THE WATER LINE IS GROUTED WHERE IT IS LESS THAN 10' FROM THE EXISTING DRAINFIELD. iSSUED By: '~/'~~/C~_~ C DATE: Alaska Water & Wastewater 7320 East Chester Heights Circle ~ Anchorage N Alaska 99504 Phone (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers April6,1998 Municipality of Anchorage Department of Health & Human Services DMsion of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Re~ Septic System Upgrade for Lot 9, Bk 4, Robin Hills S/D #3 To whom it may concern: 1. GENERAL: The existing 3 bedroom home is served by a private septic system and well. The existing trench is surcharged and must be upgraded prior to the sale of the house. One test hole was excavated to the east of the existing septic system. The soils are summarized as follows: 2. SOllJ CONDITIONS: The test hole was excavated to a depth of 16 feet, the soils below the organics consist mainly of a silty sandy soil with small quanties of gravel. No groundwater was encountered during the excavation of the test hole. One soil percolation test was performed at the 6.5 to 7.0 foot depth which perked out at 15 minutes/inch. This corresponds to a absorption rate of 0.6 gpd/sf., based on our visual observations we will be using an application rate of 0.45 gpd/sf. 3. DRAINFIELD: We are proposing to install a 63 feet long, 10 feet deep trench with 8 foot. of drainrock. This corresponds to an absorption area of 1008 f~2, or an application rate of 0.45 gpd/fi2 (assuming 450 gpd total ilo_w). This gives a conservative application rate since the allowable absorption rate is 0.6 gpd/ft2. 4. SURFACE WATER: There are no surface waters within 100 feet of the proposed upgrade. 5. TOPOGRAPHY: The surface slope to the north of the proposed upgrade slopes moderately downhill (approximately 10%), from north to south. The surface slope to the south of the proposed upgrade slopes moderately downhill (approximately 5%) from north to south. The trench is proposed to be installed on approximately a 5% slope. There are no slopes greater than 25% within 50 feet of the proposed trench. If you have any questions, please call me a 337-6179, or 244-9612. Silacerely, /James P. Williams, P.E. ~' Civil Engineer O ~ELL~~ CAPPROX> I.S. EPTTC ~_E~ I VACANT (ND [<ND~N WELL DR SEPTIC) ~ELLJ LOT B, BLK 4 RD~IN KIEE~ ~G "x_APPROX. LOGATION DF' ~xi~TING WELL ~EPT!C UPGRadE' R_E]~[N H_[~L:S ~S?~D ~_3, ~_E]_T 9, BL=K 4 PREPARED KI]B: HE]GAN SMELl<ER PREPARED BY; ALASKA WATER & WASTEWATER A~'~RDXIMATE LDCAT~ WELL RADIUS EXISTING TRENCH LOCATION MOA RECORDS AND ASBUILT SURVEY 1.25 INCH SCH 40-~ SERVICE LINE(S) (TYP) PROPOSED 1250 STEP TANK (INSTALL DUAL OUTLETS SO THAT FLOW CAN BE DIVERTED TO THE EXISTING TRENCH OR Tn THE NEV TRENCH) ;TING 1000 GALLON SEPTIC T~ LOCATED UNDER STAIRS/VALKWAY TD BE PROPERLY ABANDONED PER UPC. RETAINING ISE]) TRENCHI 10' DEER, 2,5' WI])E. B' DF ])RAINRDCK? 63' TOTAL LENGTH, TRENCH TO BE INSTALLED PARALLEL TO CONTOUR, NOTE FD~ SIZE. HOLE MT UTIDN PIPE SPACING GARAGE WOOD 3 BDRM HOUSE NOTES~ DISTRIBUTION LINE SHALL BE 1 INCH DIA. SC~ 40 PIPE. 63' LONG WITH 1/4 INCH DIA. HOLES SPACE]) 26 INCHES O,C. (HOLES SHALL BE FACED DOWN). MONITOR PIPE SHALL BE 4 INCH DIA FOIO PERFORATE]) PIPE BELOW ])ISTRIBUTION LINE AND ASTM B3034 SOLID ABOVE DISTRIBUTION LINE. TRENCH SHALL BE INSULATED WITH ~ INCHES OF ])IRECT BURIAL TYPE INSUL. AND HAVE A NINIMUN GROUND COVER OF 2 FEET. --INSTALL 1,25 INCH ])IA, SERVICE LINE UNDER DRIVEWAY WITH 3 FT, MIN, BURIAL DEPTH AND 4 INCHES DF INSULATION 4 FT, VIDE, CONTRACTOR SHALL HAVE THE ADJACENT PROPERTY LINE (NORTHEAST BOUNDARY) LOCATED AND FLAGGED BY A REGISTERED PROFESSIONAL LAND SURVEYOR PRIOR TO CONSTRUCTION, SEPTIC UPGRADE' PREPARED FDR~ PREPARED BY' DATE' 4/3/98 LOT 9, BLK4, ROBIN HILLS S/D fi3 HOGAN SMELKER ALASKA ~ATER & ~ASTE~ATER DRA~N: ~ILLIAMS SCALE: 1~ = 30' *,,James P. Williams.* " CE-960R .*' Municipality of Anchorage. DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~W'~ _~9d..3 LC~ 2 3 4 L 5 6 7 8 10- ... 11 12 13- 14- 15- 16~ B,0' [4 ' 17 18 19 20 DATEF /~ Oi¢//~J ~/~_ q~ Township, Range, Section: SLOPE I~/ ~o~- SP 1 I SITE PLAN t% WAS GROUND WATER ENCOUNTERED? .. IF YES, AT WHAT ~ O DEPTH? p E Depth to Water Alter MoniteriAg? Dale: Reading Date Gross Net Depthd~,,~ Net Time Time Water Drop PERCOLATION RATE ~ ~ (minutes/inch) PERC HOLE DIAMETER PERFORMEDB"~'~' ~ UU~,,'(_,/-,~,,,' I,//~~':,1~'1~' /~/~/~'(~z"~CERTIFYTH~,TTHISTE:TWASPERFORMED;N · '/ /" T ATE AGCORDANCE~iTH ALL STATE AND MUNICIPAL GUIDELIN~IN EFFECT ON THIS DA E. D : 72-008 (Rev. 4/85) ~,~ . ; MUNICIPALITY OF ANCHORAGE ¢~ DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTION ENVIRONMENTAl. ENGINEERING DIVISION ' 825 L Street - Anchorage, Alaska 99501 Telenhone 264-4720 ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WELl. INSPECTION REPORT pHONE [~EW LEGAL DESCRIPTION Well Absorption area~ / Dwelling ~ PERMIT NO. ~ Z Manufacturer G Material5 ~/ No. of compartments2 ~N Liq. capac~t~l~on, IF HOMEMADE: Inside length Wid,h Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O ~ ~ Manufacturer Material Liquid capacity in gallons ~ ~~ Top of tile to finish tirade Material b0neath tile /~ Total effectivo absorption aroa Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO, ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: PiPE MATERIALS SOIL TEST RATING ' ' INSTALLER ~ REMARKS ~ ~~..~ DEFT. O HE~,LTit & [ ~PPROVED DATE LEGAL PERHIT NO. RPF'L I CRNT [:,E::.::TER LFIMOY LOCRTIC~N. F.!C',BIN HZL__, -%. B LE]FiL L9 E4 ROBIN HILLS .:,.[ T'.'r'PE OF '50:r.L REE]F'.'F'TIC$.t SY'_=;TEM !',!R::.:;iI',IlJI','f I'.~IJHE:ER OF EEE:,F.'f]i']MS. ~ _ = _-. .- : ~ ~--. :[: . 'DEPRRTMENT ~..,F' H[RLTH FIND EN',,,':[RONMENTFIL P'¢:OTEC:TZON 82.5 'L'" STREET., RNCHORRGE., FIK. 254-4720 E-' 44 - 45 E[ 6 Lcrr SIZE .E, 2;'9::.a:4 ST.!JFIRE FEET ~E;: TRENCH ':;l-ITl RRTING r,:.,.3 FT,.'"BF.:)= '-"':":' [':,EEF"TH. .... -~','- ~HE F.'E']~_IRED :SIZE OF THE SOIL FiBS'3P.'PTION S"r'S'T'EM IS: THE LENGTH DIMENSION IS ']'HE LENGTH '.'.'IN FEET) OF' THE TRENCF! OR DRRiNFIEL[:'. 'THE DEPTH OF Ft TRENCH OR PIT IS THE: [::ISTRNCE BETklEEN THE SURF'FICE OF THE GROUND RNE..' THE BOTTOH OF THE E:"W:Ff,/FITION (IN FEET.':'· THERE !:F; NO SET NIDTH FOR TRENCHES. THE GRFf,/EL DEPTH IS THE MINIP!UM DEPTH OF GRFI',/EL BETklEEN THE OUTFFIL. L F'iPE FIND TFiE BOTTOM OF THE E;:.:,'CFIVFITION ,::IN FEET::,. PERMIT FIPF'LICFtNT HFIS THE: RESPONS:[B]:LITY TO INFIRM THiS [:,EPRRTMENT DURING ]'HE INSTRLLRTION tNSPECTIL]NS OF FINY NFL. LS F!DJFICEN]- TO THIS FRLPb..F-¢ FIND THE NIJME:ER OF: RESZE:,EI'-,tCES THRT THE klELL WILL SER',/E. BFIC:KFILLING OF FIN'-,' .:,~:Ff_.l I4ITHOUT FINFIL !NSPECTIO!',I RN[:, F. PF'F.'L'VFIL r;,,¢ THIS E c..-HRTI'IENT [,.IZLI_ BE ::, R.TFCT TO PF-']SECUTION. M!f',IIi'dUH DISTRNCE BET.t,.tEEN FI kiEl...[_ FIND FIN"r' ON-SiTE SE!4FIGE [:'ISF'OSFIL :'?,YSTEM iS :I. 00 FEET FOR Ft PR!',,"FITE NELL OR ::L50 TO 200 FEET FROi"! R PUBLIC: WELL DEPENDING LIPON ']''HE T'¢PE OF PUBLIC FIELL. MINI.HUH DISTFINC:E FROi"I FI PR!',,,'R'f'E WELL TO Fl F'R!'¢FITE SE!.,.!ER LINE IS 25 FEET FIND TO R E:OHHUNZT'¢ SE.t4ER LINE tS 75 FEET. .,'-4ELL LOGS RRE REQLIIRED FiND MUST BE RETURi',!ED TO THE DEPFIRTHENT NITHIN :~:0 OFf'ES OF THE WELL. COMPLETION. OTHER REL.qUZF;::EMENTS i"!FIY RF'PLY. SPEE:IFIE:RTIONS FIND CONSTRUCTION DiI:~GRFIP'tS RRE FIVRILFIBLE TO iNSURE PROPER INSTFIL. LRTION. I CERTIFY "rHFIT :L: I .SiM FRMZLIFIR !,.i:[TN THE REE:!UIREMENTS FOR ON-SITE SEWERS FIND 14ELLS FIS ::-.';ET FORTFI B'-r' THE MUNICIPFILITY OF FINCHORRC;;E. 2: Z NZLL i'NSTRLL THE SYSTEM IN RCCORDFtNCE WITH THE CODES. ~:: ! UN[)ERSTFIND THRT THE ON-SiTE SEFIER SYSTEM i'lFi¥ REf_.]UZRE ENt....RF. tGEHENT .'[.F ]"HE RESIDENCE IE~; REHO[:'ELED TO INCLUDE i"10RE THRN 2: BEDROOMS, ISSUE[:, B ~ ....................... Dh! rE ...... MUNICIPALITY OF ANCHORAGE DEPARTIViENT OF HEALTH AND ENVIRONMENTAl- PROTECTION 825 L. Street, Anchorage, Alaska 99501 254-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [~/- PERCOLATION TEST PERFORMED FOR: ~ ~--~,-'~'-~-'(~ ~(~v~O y DATE PERFORMED: LEGALDESCR PTON I[¢'t J ~ - ( I~'/l~ ..... SLOPE 1 2 3 _4 5 6 7 8 9 SIT ~PLAN, 10 --tl 12- 13 14 15 16 17 18 19 2O COMMENTS Gross Net Depth to Net Reading Date Time Time Water Drop (minutes/inch) PERFORMED BY: ~-~O~o~.t'~-~ f ~'~ CO-~ WAS GROUND WATER ENCOUNTERED? ~ O SL O P E' IF YES, AT WHAT DEPTH? PERCOLATION RATE TEST RUN BETWEEN (4 o !h ', MUNICIPALITY OF ANCHORAGE M-W DRILLING, Inc. ;'--? c~ !~v~='~ ~, P.O. Box4-1224 · 1310C International Airport Road ENVl~.,,qh';itl]/. I20 Et:,. ,,l {907) 274-4611 ANCHORAGE. ALASKA 99509 Well Owner DRILLING LOG RECEIVED .Use of Well Location (address of: Township, Range, Section, if known; or distance main road Size of casing Static water level Screen ( Depth of Hole ft. (above) ); Perforated ( Describe screen or perforation ' ::: Well pumping test at gallons per (146hr) of drawdown from static level. Date of completion ~: feet Cased to feet (below) land surface. Finish of well (check one) ). (minute) for hours with open end ( ' WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness ); ft. TO TO _TO _TO _TO _TO _TO _TO _TO _TO _TO _TO ___TO. .TO. _TO. 3--CONTRACTOR . Municipality of Anchorage Development Services Department' '- .' Building Safety DMslon . On-Site Water & Wastewater Program~ ~ ' - -' 4700 ,South Bragaw SL · '' · ' wW~.d.anchorage.ak.us' : ;; ·: '-':' · .' - (907) 34~7904 - - · - '. · CERTIEICATE OF H ALTH AUTHORITY.APPROVAL FOR'A SiNGEE FAHiLY'DWELLING ' '" Parcel I.D. 017-394-04 GENERAL INFORMATION Complete legal description Expiration Date: ROBIN HILLS ~3; LOTg, BLOCK 4 12900 MOUNTAIN PLACE Location (slta address or directions) Current Property owner(s) Mailing address Lending agency JIM AND SAI DUCHANIN C/O BONNIE MEHNER w/JACK WHTTE Dayphone 345-9946 ~ay phone ' Mailing address Real Estate Agent Mailing address BONNIE MEHNER Day phone 762-3111 PRUDENTIAL JACK WHITE Unless o~herwisa requested, HAA wi#be held by DSD for plckup. 2. NUMBEROF BEDROOMS: 5 3, TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAl' Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (It,AA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered In the State of AJas~a. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for prepares served by a single family on-sita 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 prope~es 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. 'i'he Municipality of A~chorege is not responsible for errors or omissions In the professional engineer's wor~. Note:Alaska Water and Wastewater Consultants, Inc. shall be pald $1210.OO at, or pdor to closlng for the engineering sen/ices provfded. . 4. STATEMENT OF INSPECTION BYENGINEER , . " * :- · As certified by my seal affixed hereto ahd es Of ~h'e validati°n date shown below, I vedfy that my invesb'gation, based oh proce~l~Jres outlined in the Health ~ Approval Guidelines for this applica~on, shows that the on-site wa~ter ~upp~' and/or wastewater disposal system is(are) eafe~ functional and adequate forths number of bedrooms and type of sb'ucture Indicated herein. I further ve#~y that based on the Information obtalned from the Municipality of,Anchorage files and from rny Invesggafion and Inspection, the on-site water supp~/ and/or wastewater disposa! system Is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the b'me of installation. Name of Firm ALASKA WATER &: WASTEWATER CONSULTAN3'S, INC. Address 6901 DEBARR ROAD, SUITE 2B * ANCHORACE. AK 99504 Englneer's Printed Name JEFFREY A. (;ARNESS, P.E. Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, consdentious englneadng analysis of the system In accordance v, fth ADEC and MOA DSD Guldefinea & Regulations. The rep~ted results described tho pedonnanse of the system undor tho conditions encountered at the time of the test, and soparation dis~aneas measured to readi~, IdentiEablo features. The oporab'onal lifo of all walls and sepb'c systems depend on tho Iocal solls condition, groundwater levels that may fluctuate dudng tho year, and the water usage of the famliy being serwd by the s~tem. These cond~'ona ere outslde the conYol of the evaluator of tho system. Satisfacto~, test results do not guarantee future pedonwance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, In<: can theroforo not provido any v, arranty or future estimate of how long tho system wfll continue to meat the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the ovmer listed abew. Any reliance upon or use of this report by any other person or pan'y ls not authorized, nor v, fll It confer any legal right whatscover. DSD SIGNATURE L.'''''/ Approved for "~ bedrooms. Phone ,337-6179 Disapproved. Conditional approval for __ bedrooms, with the fllowlng stipulations: ,,~: ~%:., .... . '-*~ ,~ '-.-~ ~; WA~ERAND :¢~ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: /~ - ,2. '7 - O I Municipality of Anchorage Development ServioGs Department On.Site Water & Wastewater Program 4700 ~ Bragaw St. p.o. Box 196650 .Nx~m'age, A~ g9519-6650 HEALTH AUTHORITY APPROVAL CHECKLIST LegalDesc~pflon: ROBIN HILLS 1~3; LOT 9, BLOCK 4 ParcallD: 017-394.-04 WELL DATA Well ~1~ PRIVATE ~ A, B, or 0 I~ PWSID# N/A Well ~ (Y/~I) YES Date completad lO/81 Sanlta~/seal (Y/N) YE:S Wires properly protected (Y/N) YES Totaldepth 300 It. Cased~ 152 It. Casinghelght(abeveground) 16' In. Date of test Static water level Well produclJon 0.5 WATER SAMPLE RESULTS: Coliform 0 coinnles/100 Date of sample: 4./10/01 SEPTIC~OLDING TANK DATA FROM WELL LOG AT INSPECTION ~O/1B/B1 4/10/Ol 150 lt. 123 It. g.p.m. 0.68 g.p.m. Nltrata 0.576 regal.. TanlcType/Mateltel ANCH, TANK/STEEL (STEP) Tank size 1250 gal. Number of Comparlmants Founda~on cleanout fi/N) YES Dote of pumping 4/1 O/D1 C. ABSORPTION FIELD DATA 2 Other bacteria AWWC~ INC. Depression over tank fi/N) NO Pumper 0 colonies/100 mL Dota.=t~ed ~ so, rauno ~ ~r~r=)O.45 Dote Installed 5/6/9B C;eanouta (Y~) YEs High water alarm (Y/N) YES NORTHLAND System type DEEP TRENCH Gravel below pipe B.0 lt. Dopresalon over flald NO For 3 bedrooms New deplh35.7~ln. 450+ g.p.d. NONE KNOWN If yes, give date - Langltl 63 ft. Width 2.5 lt. Totaldept~11.~'-12.glt. Eff. llbsol~ama1008Ira Monll~tube YES Date of adequacy test 4/10/01 Resulte (pa,e,~all) PASS Fluld depth In abeorpflon flald before test 16 In. Wateradded1100gal. Elapsed Time: 159 min. Fired fluid depth 13.5 In. Ab~on rate Any m,luvenatlon tma~nmnt (past 12 mo.) (Y/N & type) D. UFT 6TA110N Date Instelled ~/6/~ q~mp on" level at 41.5 In. Datum BOTTOM OF TANK E. SEPARATION DlSl'ANCF.~ SEPARATION DISTANCES FROM WELL ON LOT TO: Size In gallona ,, 1250 STEP 'Pump orr level at 39.5~n. ,Septic tank/liE atation on lot 100'+ A~n field on lot 100'+ Public sewer main N/A 8ewar Iseptic service line 2,5'+ Manhole/A.:~ :~.a (Y/N) YES High water alarm level at 44 In. Meets alenn & circuit requlmmonte9 YES N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cteanout Hok~ng tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ~ field 5'+ Surface water lOO'+ Building foundafien 5'+ Property line, 5% Water main N/A Water sendce line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundaOon 10'+ Suttece water 100'+ Welle on adjacent Ints 100'+ Water maIn N/A Driveway, parklng/vehlcte storage 2'+ Property line 10'+ Water sewice line 10'+ Curtain drain NONE KNOWN F, COMMF. NI'~ G. ENGINEER'S CERTIFICATION I ce. fUry that I have determined through field inspecUona and rewew of Municipal records that the above aya~ema ere In conformance with MOA HAA guldellnes In effect on this date. Englnee~'$Pdn~edN~jme Jt. FF.EY A. GARNESS HN~ Fee $ ~ . ~:~ Data of Payment Receipt Number ~/-//~ (Rev. 12/00) Waker Fee $ Date of Payment Receipt Number ~!UNICIPALIT¥ OF ANCHORAGE MEMORANDUM WATER'WELL ADVISORY H~T. AUTHORITY A~ROV~ ~0~ HA O / During a recent Health Authority Approval oh~s~te inspect%on and test of the potable water supply well on Lot ~lock ~/ . of ~/~/ H/~ ~S~bdi~ision, the well's productivity was ~etermined to be D, ~ gallons per minute... -' The minimum well productivity re.quired b~ this Depa~h{.'..:''-"-..' '(~C 15.55) for a ~ _ bedroom residence is (~,'~ gallons per minute. Although the subject wel16%r'~e~tly .excee~'~i~ 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 ~f the subject Health Authority Approval. Parcel I.D. # GENERAL INFORMATION Complete legal description J.:o~' MUNICIPALITY OF ANCHORAGE . /~--~, DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmenta Services On-Site Services Section P.O. Box 19665C Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent "~ ~'-- Address ~2-0 Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPEOF WATER SUPPLY: Individual well Community well Public water NOTE: in9 to the legality and status of system. If community well system, provide written confirmation from State ADEC attest- 4. TYI~E oF WA~TEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. ~' 72-025 [Rev. 1/91) Front MOA#21 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 d.ate/6 Name of Firm Alaska Waler & W',a,?te~.,w~. e~ Address, ' An~e, ~ -~ i!c East Chcsi Engineers signature ( ~//./ % 'this inspection. Phone DHHS SIGNATURE Approved for Disapproved. ,,2 ' 'bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments ~lJ~. ,~rr/~'~/£p I,v/'iT'E,~ W,~I.L ADW~,ot~V :., Y;T"JIL*R ,The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates I~ased only upon the representations given in paragraph 5 above by an independent professional engineer' registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct in{pections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back .MOA RECEIVE I IAY 11 Municipality of Anchorage MUNICIPALITY' OF A~ DEPARTMENT OF HEALTH & HUMAN SERVlCESENVlRONMENT^~.$ERV(~jt, Cj~N Environmental Services Division 82,5 L Street, Room ,502 · Anchorage, Alaska ggs01 · (g07) 345-4744 Legal Description: A. WELL DATA Health Authority Approval Checklist Well type Log present ~N) Total depth Sanitary seal (.~/N) Date of test Static water level Well production If A, B, or C, attach ADEC letter. ADEC water system number · FROM WELL LOG ,,, (~) o ~ g.p.m. Date completed Oc"ro~,e¢4 ,~ J~ ~ I Cased to i.¢;Z ~ Casing height (above ground) ~ Wires properly protected (~N) AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform Date of sample: B, SEPTIC/HOLDING TANK DATA Date installed Foundation cleanout (~N) Date of Pumping C. ABSORPTION FIELD DATA Date installed t Nitrate O. z~BO Other bacteria Length ~ Width Effective absorption area Date of adequacy test Collected by: Alaska Water & Wastewater Anchorage, Alaska 99504 Tank size l'Z.~*o Depression (Y/~ Pumper Number of Compartments ~ Cleanouts ~_JN). t,J o High water alarm (~N) Soil rating ~ or.CCfl~'~) O.q~- System type ~'¢4,e¢cPr '~-, ~ Gravel thickness below pipe ~ ~ Total depth ]¢..~"~ l I, I ~ E~ Monitoring Tube present (~N) ~/E..~ Depression over field (Y/~) IkJo Results (P-assCF-a~) ~ For "~ bedrooms Fluid depth in absorption field before test (in.); '~ Immediately after ~gal. water added (in.): Fluid depth *-- (ins) Minutes later: ~ Absorption rate : .g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* ,, · ': . LIFT STATION Date installed Manhole/Access (~) High water alarm level at* Cycles tested p~o,4~ SEPARATION DISTANCES Size in gallons "Pump on" level at* z~! ~/ *Datum ¢~,,~rT,,~ SEPARATION DISTANCES FROM WELL ON LOT TO~. Septic/holding tank on lot ) Absorption field on lot 1'7o Public sewer main ~ Sewer/septic service line "Pump off" level at* I . .O,n adjacent lots Ioo On adjacent lots Jc)o I,+ Public sewer manhole/cleanout · Lift station , SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation I '1 Property line '-/O I Water main/service line ¢Otl~- Surface water/drainage Absorption field ~_~O Wells on adjacent lots SEPARATION DISTANCE 'FROM ABSORPTION FIELD ON LOT TO: Property line ~'~ Building foundation Water main/service line I o~r Surface water ~oo~' Driveway, parking/vehicle storage area Curtain drain .1~ n~'~ ~4~td Wells on adjacent lots ENGINEER'S CERTIFICATION J i ceRify that I~ d~¢mi~ru~ield inspections and recew of Municipal records ¢? Date Date of Payment ~//'2~- Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* ~.'[UNICiPALITY OF ANCHORAGE MEMORANDUM WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO.H~//6 During a recent Health Authority Approval on-site inspection and test of tt~e potable wate~ supply well on Lot ~ Block 4 of ~0~/~ ~/~$ ~ Subdivision, the well's productivity was determined to be .~/ gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 bedroom residence is °3/ 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 ~f the subject Health Authority Approval. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# ¢")~--I - ~c~L\ - t"'~bl HAA# 1. GENERAL INFORMATION Complete legal description Location (site address or directions) / ~,~ ~¢ ~'*'~/-~'/~ /~/~¢d Property owner Mailing address Lending agency Mailing address Day phone ~/~ '~.?,d'-z~'o / Day phone Agent /~tl/ ~'m/~'~.~¢ 80~/ F¢~t/-7/ Dayphone ~7~-&¢p/ Address ~0 D~/~) ~/~ yO~ ~or~ ~ ~3 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: 72-025 (Rev. 1/91) Front MOA#21 Individual on-site ~ Holding tank Community on-site Public sewer If community wastewater system, provide written confirmatio~ from State ADEC attesting to the legality and status of system. 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/orwastewaterdisposalsystem is safe, functional and adequate for the number of bedrooms and type of structure indicated herein, lfurtherverifythat 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 ~'/'¢r~L/'~/¢ ~-~4An/c~/ ~'¢r~'~(~.r Phone Address /~Y-5~3~' ~o1~ .-('~ A~cAor~¢~, /~/< ?~-I[ Engineer's signature "~/~¢'¢---/~-~ ~, ~ Date DHHS SIGNATURE '~ Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: By: ~ 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 th is as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~)25 (Rev. 1/91) Back MOA ~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: ,LoT c:j '~JlJ( /--~ ~O'~1~ ~-L5 ParcelI.D. A. Well Data Well type PR I VATE Log present (Y/N) '7' Total depth 3 o o Sanitary seal (Y/N) Cased to If A, B, or C, attach ADEC letter. ADEC water system number Date completed Io/I ~,/~ I Driller 1.5' :;z. ' Casing height Wires properly protected (Y/N) "/ FROM WELL LOG I / Date of test Io li%'/3' Static water level I 5 o ' Well flow O. 5' Pump level1 SEPARATION DISTANCES FROM WELL TO: / Jo~-/ N,A, Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout C) 0 Petroleum tank NoNE WATER SAMPLE RESULTS: Coliform 4:2 ~//(~,O ).. ,( Date of sample: q / :2 ~ / 9 q Nitrate O, Y,5'- ,',~ ~//--~- Other bacteria Collected by: FLAIl B. SEPTIC/HOLDING TANK DATA Date installed c~ I<~l Cleanouts (Y/N) ';/ High water alarm (Y/N) Tank size I o bo Foundation cleanout (Y/N) Date of pumping C~ A c Compartments 'y Depression (Y/N) Alarm tested (Y/N) N, A, Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I q S On adjacent lots To property line 30 Absorption field Sudace water/drainage ~ !oo >/oo Foundation ~-,5' -1-~ C.O, Water main/service line '7 /o 72-026 (3/93)* Front CONTINUED ON BACK PAGE Co LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at .Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Sudaoe water D. ABSORPTION FIELD DATA Date installed ct/% I Length ~0 Width Total absorption area II :2.0 Date of adequacy test H/2~ ICl ~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Gravel thickness Cleanout present (Y/N) ~/ Results (pass/fail) Soil rating (GPD/FF) o, 52 7 HONE. for After test If yes, give date System type TE'~ Totaldepth ti, Depression over field (Y/N) ~ Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: f Well on lot l o H To building foundation lo On adjacent lots > ~j o Sudacewater ~?o0 On adjacent lots > leo Property line I0 To existing or abandoned system on lot N,/~ T&:,~NCH /~ D.J~CSI'4T T° Cutbank ~,~'¢~-w',~Y F,~c Water main/service line t Driveway, parking/vehicle storage area 3 Curtain drain ~f,~t4~ Of~5¢-~VS'D E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspect/bn. Signature "~-~ EngineeCs Name Date ~y ~/ HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE MEMORANDUM SEPTIC SYSTEM ADVISORY HEALTH AUTHORITY APPROVAL NO.HA940228 Prior to a recent adequacy test on the septic system for this lot, 69 inches of standing water was observed in the absorption field. This indicates that approximately 82 % of the absorption area is inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all c~pies of the subject Health Authority Approval. WATER WELL ADVISORY. HEALTH AUTHORITY APPROVAL NO. /7/~ During a recent Health Authority Approval on-site inspection and tes t~of th% potable water supply well on Lot ~ Block ~ of ~i~ /~' ~/~ ~ Subdivision, the well's productivity was determined to be ~,.~ gallons per minute. The minimum well productivity required by this department (AMC 15.55) for a ~ bedroom residence is O,.~/ 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 noncritical water uses such'as wa~hihg cars and watering lawns and gardens may be required. This advisory must be attached to all copies of t'he subject Health Authority Approval. MUNICIPALI'TY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services 'Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# (~')\,'-~ - '~c~L\ - ~L~ HAA# 1. GENERAL INFORMATION Complete legal description Location (site address or directions) i ~¢ co ~oc~,~ ~¢.,',,~ pin c~ Property owner Go~ ¢ ~,~- ~7',=A~-r¢,~ Day phone Mailing address ~.o, Lending agency ~(o¢ ~f Day phone Mailing address ~o ~. ~ ~, Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: _~ '-4 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, Pr_ovide written confirmation from State ADEC attest- ' ' lng to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: .... Individual on-site . .. Holding tank :.- · Community on-site ~ ~" ...... PuLl c sewer' NOTE: If community wastewater system, [~rovide written confirmation from. State attesting to the legality and status of system. 72-025(Rev. 1/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Engineer's signature Phone Date r}HHS SIGNATURE _,/~, Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~25 (Rev. 1191) Back MOA ~21 .: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST ParcelI.D. A. WELL DATA Well type ?~'[ Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEG water system number Date completed Icl/1~/~ ! Driller Cased to 1 5' ~ ' Casing height Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG g.p.m. AT INSPECTION o.?,~ ~-~ , SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer serVice line ~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Non WATER SAMPLE RESULTS: Coliform O Col /too ~£. Date of sample: ~//8/~] E' Nitrate Collected by: Other bacteria. ~ col /too,~ ~' B. SEPTIC/HOLDING TANK DATA Date installed ~) / Z~ ( Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size iooo ~ ,=1 Compartments '~ Foundation cleanout (Y/N) "r' Depression (Y/N) hi, 4t. Alarm tested (Y/N) N, · ~ / ~1 /9 ~ Pumper Ro/*o Roo/-er' N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot TO property line Surface water/drainage On adjacent lots ~ (oo' Foundation 5'.£' ~ c.o. Absorption field 5-' Watermain/serviceline ~' ~°~ 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION N, ,4-. Date installed Size in cjallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at · Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ¢'0 ' Total absorption area Depression over field (Y/N) Results (pass/fail) Width I t N Peroxide treatment (past 12 months) (Y/N) Soil rating '~,¢,¢ ~"//$~r-~ System type Gravel thickness -~ ' Total depth 1/..~-' Cleanouts present (Y/N) Date of adequacy test for ~ bedrooms ~'~no~ o~ If yes, give date /'~, ~', SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot Io¥' To building foundation On adjacent lots > 3~' Surface water -~ (oo' Curtain drain On adjacent lots ~ fcc' Property line lC' To existing or abandoned system on lot Cutbank~r,v~-,o,,v .¢.,u. Water main/service line -,::- lC,' Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on. the date of this inspection ~,:~i',;:. ':; ~" /'~," '~,:'%, Signature Engineer',,; Name Date HAA Fee $ ~,'/ Date of Payment ~L'"'"~'~)~'"~/~2''''' Receipt Number Waiver Fee: $ Date of Payment Receipt Number Attachment Health Authority Approval #HA920126 March 4, 1992 During a recent Health Authority Approval on-site inspection of the well and septic system on Lot 9 Block 4 Robin Hills #3 Subdivision, the well flow test showed the well's productivity of 0.77 gallons per minute with a recovery rate of 0.76 gallons per minute. The minimum well productivity required by this department to satisfy the requirements of Municipal Codes (AMC 15.55) and Health Authority Approval guidelines, is 150 gallons per day per bedroom. This equates to 0.1042 gallons per minute per bedroom or 0.31 gallons per minute for a three (3) bedroom residence. The recently determined productivity of 0.77 gallons per minute marginally satisfies this requirement. The financing entity and prospective buyers should be made aware of the marginal productivity of the well, and recognize the possibility of an inadequate water supply during certain times of the year. There are measures which can be taken to minimize the adverse impact of the low well productivity, such as: 1. A water storage tank serving as a supplemental reserve reservoir. 2. Curtailment of non-critical water uses (washing cars, lawn and garden watering, etc.). 3. Installation of water saving devices on showers and toilets. 4. Restricted or controlled use of laundry facilities and dishwashers. 5. Self imposed water conserva'tion practices. 6. Connect the new well into the existing water collection and storage facilities for the old well. While the subject well meets the minimum MOA requirements, the comments herein contained should be attached to the Health Au~,h~ity Approv~tification and all copies thereof. Robert W. Robinson Civil Engineer On-site Services ljm:398 3/04/92 ~iAR-- ~--92 T UE 9 : '~ I ~LATTOP TECHN I OAL P . 02 Adequate £or ~_~__ Capacity Adequate for ~ Bdrms 1.¸ ~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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) (b) Location (address or directions) Applicant Name ~...¥b/~__ Applicant Address Business (c) Applicant is (check one): Lending Institution []; Owner/builder [~;';'; Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family [~Multi-Family Number of Bedrooms Other WATER SUPPLY Individual Well [~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISP~OSAL Onsite I~'~Pubiic [] Community [] Herding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (! 1/84) Page 1 of 2 ENGINEERING FIRM PROVIDIN~ ~NSPECTIONS, TESTS, FILE SEARCH, DA, ,-, '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 ~"~t/'~ ~/~)~- Telephone Date /~- Z~~ ~ ~ Engineer's Seal Approved for ~1¢~,~=~'-~ bedrooms b Approved ~ Disapprove~ Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmentat 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 WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: ,~01~ Well Classification .~;J~l 'N/,~"~¢~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ~""/J~/D¢.~ Date Completed ./1¢"//~¢' ¢ ] Yield'~fl~, Total Depth ~/~OO' /Cased to /~'Zi~'~' I Depth of Grouting Static Water Level /,~:~ z Pump Set At - Sanitary Seal on Casing (Y/N) y Depression Around Wellhead Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Welt: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results ; On Adjoining Lots /~'~ /~¢,/,~ I ;On Adjoining Lots To Nearest Public Sewer TO Nearest Sewer Service Line on Lot Comments B. SEPTIC/HOLDING TANK DATA Date Installed~¢_ q'' /~/~/ Size /~2~1~2 .~/~No. of Compadments Z Standpipes (Y/N) T Air-tight Caps (WN) ~' Foundation Cleanout (Y/N) ~ Depression over Tank (Y/N) ~ Date Last Pumped //) - Z¢~ ~ Pumping/Maintenance Contract on File (Y/N) ~/~ ; for ~ Holding Tank High-Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /~/ ~ To Property Line To Water Main/Service Line Course / To Building Foundation ~ To Disposal Field ~ To Stream, Pond. Lake, or Major Drainage Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soil.'; Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area /( '~O Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /'~ :~ / To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~'~--~:::;//~ Type of System Design Length of Field ~(C.) / Depth of Field / Gravel Bed Thickness ¢..~ Standpipes Present (Y/N) T Date of Last Adequacy Test ~'~-- / '~'~"'~ To Property Line /~-~ To Existing or Abandoned System on ;On Adjoining Lots /'~O //k/ To Cutbank~ (if present) D. LIFT STATION Date~ Dimensions . _ Size in Gallons ~· - High Water Alarm Level at Tested for ...... ' ~'"~Ru.~.p. ing Cycles during Adequacy Test. Meets MOA Manhole/Access (Y/N) ~ . _ -- ''Pump O!f~"~ Level-a~f~' .... Vent (Y/N) ** Check P,e/~nitted Be,~room Rating Against HAA Request ** I certify tl~L~aye ch/clOd, verified, or conformed to al'l MOA and HAA guidelines in effect on the date of this inspection. Signed ////~/////~-/~- Date ~' ~ [ ~ ~ Dateof Payment /~" ~ l-c~ Page 2 of 2 72-026 (11/84) CORWlN & ASSOC[~'~.,>:S, INC. 4790 Business Park Blvd. Building D, Suite 1 ANCHORAGE, ALASKA 99503 JOB SHEET NO. CALCULATED BY CHECKED BY OF DATE SCALE 'Clock Time FIELD PU;qPiNG TEST DATA SHEET ..LOCATIQ~I or WELC (L.~.I Description): WELL DEPTH: ~00m FT. CASING: /~Z FT DATE DRILLI~(G COHPLETED:. '~/~ / ~ DRILLER: STAT)C WATER LEVEL {Top of Casing): /~,,~ FT I"Elaps6n Time Since Pumping Started/ Stopped, 14in. :' O Drawdown/ Recovery Pumping Rate, GPH Depth to ?at.er, ft. 40 '45 55 9O 210 RECOVERY o I I 15 I 20 I 25 I I 35 I 40 I DATE OF SCREEN: 0 0 Start Remarks 45 I 5O ,,, 6o (1 hour) iZu (Z hours)/ MUNICIPALITY OF ANCHORAGE Di~ISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECI'ION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date 20 ~nrch 84 (a) Legal Description (include lot, block, subdivision, section, tcwnship, range) Lot #9, Block ~4 Robin Hills Subdivision Location (adc~ess or directions) 13101Mountain Place (b) Applicants Nam~ Dexter Lamoy Telephone 345-7013 Applicants Address 13101 Mountain Place (c) Applicant is (check one) Lending Institution ~; Owner/builder~; Buyer~ ; Other~-~ (explain); (d) Lending Institution 'Co]0nJa] M0rt§a~e Telephone 562-2181 Address 701 5. Iud0r Road, Anchorage, Alaska (e) ~al Estate Co. & Agent Address N/A - Refinance Te le phone _Type of Pesidence Single-Family ~ Number of Bedrcoms Water Supply Individual Well Multi-Family 3 Othe~ (describe) Public Note: If oa~u~nity well system, must have written confirmation f~om the State Department of Environmental Conservation attesting to tbs legality and status. Is the well adequate fo~ the number of bedrooms specified in this HAA (Y/N) y 4. Sewa~e Disposal Onsite ~ Public ~--~ Co~nity ~ Holding Ta~]~ ~--~ - Is the wastewate~ disposal system adequate for the number of b~drocms (Y/N) Y [Page 1 of 2] 2-15-84 5. E_n_gineering Firm Providin~ Inspections, Tests, Data and Information I cartify ~ I have checked, verified, or conforrae, d to all ~,DA ~I~R (~ideli~s in effec~c on~date/~ ~is inspection. ~ Signed...../~/~:~/~.:,//~~~'/ Date 20 March 84 Nam~ of ~irm Ocean TechnkJloqy, Lt~_~ Telephone 248-3888 Address _Z~02 W. Nf~rtt%ern Lights Blvd. Date 20 ~arch 84 ~ ( ENGINEER SEAL) 6. DHEP Approval Approved Approved ~: .-: bedrooms Disapprove. d ~ Conditional ~-~ Terms cf Conditional App~oval _The Municipality of Anchorage Departn~nt of Health a~ Enviroo~nental Protection dc~s not guarantee the continued satisfactory performance of the wateF supply and/or the wastewater disposal system. This approval indicates that, as of the validation shorn above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the p~nnber of bedrcc~s and type of structure indicated. (~PSEAL) 7. 5~il the HAA to the roll, lng ~dress: KB2/d5/s [Page 2 of 2] 2-15-84 MUNICIPALITY OF ANCHORAGE (MOA) HEAL~ AUTHORZTY APPROVAL (~aa) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAO~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAR 2, ,'P. RECEIVED Well Classification Well Lcg P~esent (Y/N) Total ~D~_~D~ Card to Static Water ~1 Casing ~ight ~ Gr~nd /~/I Elec~ical Wiring in ~nduit (Y~) ~/~ ~p~ation Distan~s f~ ~11: To ~ptic~olding Ta~ ~ ~t /~/ If A, B, c~ C, D.E~C. ApproVed(~Y/N) ~)/~ / Date Completed /~-/~-~ / Yield o~Gf/~ / Dept~h of Grouting ~///? ~ Pump Set At /~///~ ~,+~% / · /Sanita~y Seal on Casing (Y/N) Depress ion Alzound We 1 lhead, ( Y/N ) ~,~ / ; On Adjoining Lots~ f,"C~'~</,t'C,~,'7_R To Nearest Edge of Absorption Field on Lot/~ To Nearest Public Sewer Line C leancut/Manhole ~///~ / Water S~mple Collected By Water Sample Test Results ~c~uents B. SEPTIC/HOLDING TANK DATA Date Installed :/3: /~'g/ Size. /~5)'('/5,~ ~/ft/.. No. cf C~nts ~ Standpi~s (Y~)~ Ai=-tight ~ps (Y~)x/~Y Foundation Cleanout (Y~)~ ~pression eve= Ta~ (Y~) //~ Date ~st P~d ~.7/~-~g~ P~ing~aintenan~ ~n~a~ ~ File (Y~)///~' ; for /~/~ Holding Ta~ High-Water ~a~ (Y~) /~/~/~ Te~ra~y Holdi~ Tank Per~t (Y~) ,~2 ~p~ation Distan~s ~ ~ptic~olding Ta~: To Building Foundation ~- To Disposal Field ~(%)' To Stream, Pond, Lake, or Major Drainage To Water-Supply Well /~--/ ' TO Property Line /.~ / To Water Main/Service Line Cour se ////:/ " Con,rants [Page 1 of 2] 2-15-84 ABSORPTION FIELD DATA Soils Rating in Absorption Strata _~ ~ ~/~k/? Type of System Design Date Installed ~£3~ /~/ /Length of Field Width of Field ~d)/t Depth of Field Gravel Bed Thickness _ ~e/ Standpipes Present (Y/N) ~/~ .~> Date of Last Adequacy Test ~~' Square Feet of Absorption A~ea //~ Depression over Field (Y/N) Results cf Last Adequacy Test Separation Distan~ fr~ ~sorption Field: To ~ter-Supply ~11 /~/ To ~o~rty Li~ /~ To Building Foundation ~/ To Existing or ~ndoned System Lot /]/~ ; ~ Adjoining ~ts ~ M~/tJlZ~7//P/ /~61/,~~m>~'~l~ ,., To Water Main/~rvi~ Line To mt~(if ~e~nt) ~7 . TO Stre~ond~ke/~ Majo~ ~aina~ C~se To ~iveway, Parking ~ea, or Vehicle Stgra~ ~ea D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Co~nts ** Check Pec,mitt~d Bedroom Rating Against HAA Request I certify ~at I have checked, verified, or conformed to all ~K)A~.~.. %3~=~.~ .HAA .~lr~' ~ e .... ct on the dare, of this ~nspection. / ~ Signed ~~ ~)/~ Date ~//~'h ~'~ KB1/d5/s ~%9~ % C~-S9 $ ,.' ,/,',: ~ [Pa~ 2 o~ 2] 2-15-84 HEMICAL & G OGICAL LABORATORIES OF ALASKA, TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: ~ I ] (*) See h on back I,D, NO. Water System Name city SAMPLE DATE: ~ MO. Phone No. State Day Year Zip Code SAMPLE TYPE: ;:~_~ Routine Check Sample (for routine sample with lab ref. no. [] Special Purpose [] 'Treated Water [] Untreated Water SAMPLE .o. LocA.o.- Time Collected " 11 TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ,~ Sati,sfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received G~i~ -/y Time Received //'~-O ~) Analytical Method: [] Fermentation Tube [~lembrane Filter Lab Ref. No. Result* Analyst j J 064220 (b) Rev. 1983 BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter: Direct Count Verification: LTB Final Membrane Filter Results Reported By_ ~-~ TNTC= Too Numerous To Count BGB_ Coilform/100ml Collformll00ml Date_ Time: /' ~',~ o a.m. Time ,, Time e Date' Date Date Inspector Inspector Inspector Comments Conditional Approval Date Sewer Installed Permit No. Septic Tank Size ~_ ~:)( Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner -/-~'X ~'~'/~ '~' ,~ F__ ';r"~.~ ~ Z ,--7/¢/2~/v' Chone Buyer. , Address /~)/.~ ' Lending Institutidh~?'l.~~ 7~ /-~'L~'~ '-~/~//~ / ~- 0,'~///-2 Phone Address ~ /,.~ ~,2, /~,~)~T~_/~-/~,/~) Z J ~_,~ ,/7/ 7-,,~) /~/V~-~ ~'~/Di~/'~ ~ /~,/~. Realty Co. & Agent Phone Address Legal Description/~T ~ ~/0~) ~ /~/~.~/A] /Z//Z~.~' Street.. Location ~'~//~ ~¢-/~,//¢~/ p/~/~ C ~ Type ,of~Residence ~TSingle Family [] Multiple Family No. of Bedrooms [] Other Wate~r _Supply ETIndividual ATTACH WELL LOG. A well log is required for ell wells drilled since June [] Community_ 1975. For wells drilled prior to that date, give well depth (attach log if [] Public Utility available./ Sewag~e Disposal '[ ~,~ / ~lndividual ~ Year IndividUal Installed: [] Public Utility When Connected to Public Utility:. [] Holding Tank :; NOTE: THE INSPECTI~ON ~EE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.