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Home My WebLink AboutROBANNA LT 1P-obanna Lot 1 #051-281-83 U 1.2) UQU U U U Lg_� L Municipality of Anchorage JAN ZUZZ On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211135 PID Number: 051-281-83 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name DAVID & MICHAELA YOUNG ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 18015 PIONEER DRIVE, CHUGIAK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 PG O.W. GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot ROBANNA 1 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line FtZ Ft. -Well 100'+ -_ 25'+ TANK {o Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 51+ __ NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. RemarkQRR -ll l oe� f�1 Alarm location Electrical installed by Installer DENALI EXCAVATION PIPE MATERIAL House to tank 3034 d a afield Tank to 3034 Drainfield CO/MT 3034. Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection 1" 5/20/21 2nd 5/20/21 Location and description 3`d 11/15/21 4'h TOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL M� k �- orlaw A Conditional Approval: Date AM - TM .. 4......�.. r • % " " " "" " "' • / Septic System ApproveO-,- • Curtis Huffman Date / t4 2-L X29' •. W. CE 128991 i� �0 �JlF�• f/t 1/22 . •-�C��i PROFESS10Na4" Note: thisproval does not include well permit requirements.\\•�`1.`� kmev UD/UL/ 10) PID: 051-281-83 PERMIT: OSP211135 100' WELL / RADIUS 28.7' o N LEANTO 29.3' e DECOMMISSIONED EXISTING / S.T. & INSTALLED NEW J 1250 -GAL HDPE SEPTIC TANK I' U W WITH NEW DCO. I in MH CO DCO X LO c/) O • E I LX = LO C D Y U \ W � 29.3' A LVED D/W � 00 to C4 /if 11 137. 3' N85046'181)w A -C=36.2' B -C=33.2' A -D=39.3' B -D=35.9' A -E=45 0' B -E=38 9' CO 149.61' EXISTING FIELD SEPTIC SECTION SCALE; NTS ROBANNA LOT 1 PREPARED FOR: DAVID & MICHAELA YOUNG 18015 PIONEER DRIVE EAGLE RIVER, AK 99577 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 firstwaterAK@gmoil.com SUPPORT$SERVICES: -do OF AL4 �* c 9 TH DATE: 1/11/22 , rtis Huffman SURVEY: JLS 1 f� CE 128991 DRAWN: FWCS 1 1/11/2022 SCALE: 1 " = 30' \ �koFEsstoN�•v i 40.00' CA N 89'49' 1 0"W Q - —_ ,,,� PIONEER DRIVE 0 ANCHORAGE RECORDING DISTRICT, ALASKA � =FND ALUMINUM MONUMENT AS -BUILT OF: ROBANNA SUBDIVISION = FND 5/8" REBAR LOT I PLAT 87-60 SURVEY CERTIFICATE: 1. John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE: E -MA L NOV 15, 2021 1 "=40' schuller0ok.net 21-162 DRAWN BY: CHECKED BY GRID NUMBER: BOOK/PATE JLS N W0753 210367 AW OF L LAIVD 6 01-A oo, ,,,7 NN % FA FA ?A . .............................Rd �•.J HIV L. SCHULLER.- o `• ' LS 10408 � ,,,R, � .sem`"• 1 �' •' • • , • • �� / 1831 Talkeetna Street nor•°" Cn'�'.? ' 6AW �' � Anchorage, Alaska 99508 a'\ AM fe o\ L W . W (907) 227-1455 office �� ssio�`.,,�•` (907) 274--4992 fax MUN10PAL ITY OF AN HO AGE On -S b Date r & Waguwatar Program R4 Box 196150 4740 Elmeo Road Anchorage, Alaska 99519-6 50 Phana= (907) 343-7904 Fw: M7) 343-7N7 htts;+ ,muni-orgr.prns1te On -.bite Wastewater Disposal System Permit P.L%rmIt Nornher, QS P21 ' 1 �5 Work Type: SeplicTank Upgrade Tax Cede Kumbl: r; 05128183000 Slto Legal Address= ROSANNA LT 1 0:07$$ $0 Mailing Address- 18015 PIDNEER DR, Eagle River Owner- YOUN13 DAVID & MICHAFLA 06sign Engineer' F QST WATER CONSULTING This permit is for the ccnstruc6on of: 13 Disposal Field Q Septic Tank C3 Holding Tank ❑ Privy Nfective Date; Expiration Dato, Lot Size in Sq Ft: Total Bedrooms: 511212021 5M 212022 52720 ❑ Private VV&ll ❑Nater Storage All constru0on shall be in actor -dance with: 1, The attached approved design. 2. All requirements specified in Anchorage Munlcfipal oode Chapters 15,55 and 15,65 and the State of Alaska as -&water Disposal Regulations (18AAC72) and Drinking Water RegWatione, (18AAC6D) 3, The WaStewater code requires inspections during the installation- The engineer -hall noffy the Development ervIces Department per AMC 15 65- Provide noUlieation by calling 1907) 343-7904 (247). 4, From October 15 to April 15, a s+ubsurbaoe soil absorj�ticm 5ystern under Construction during freezing weather shall be either_ a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freeing Received B) rss+ued By: Date= Data- _ 511212021 3 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-281-83 Property owner(s) DAVID & MICHAELA YOUNG Day phone Mailing address 18015 PIONERR DRIVE, EAGLE RIVER, AK 99577 Site address 18015 PIONERR DRIVE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) ROBANNA LOT 1 Legal description (Township, Range & Section) Lot Size 52,720 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank Z Upgrade Q Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (S gnature of property owner or authorized agent) Permit/Rush Fees: t a a 5 Waiver Fees: Date of Payment: 5 1 b '�0) Date of Payment: Receipt Number: '710 1 `i 0 Receipt Number: Permit No. 0 S P), � � � 3 � Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com May 7, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: ROBANNA LOT 1 The owner has requested that we obtain a septic permit to upgrade the existing 1250-gallon aged steel septic tank on the above referenced lot. We propose to install a 1250-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. The lot and area are served by private wells. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211135, Deb Wockenfuss, 05/12/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211135, Deb Wockenfuss, 05/12/21 MUNICIPALITY OF ANCHORAGE DE ITMENT OF HEALTH AND HUMAN SER' iS Environmental Health Division 0 5/_ ^ 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720I ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT j Name DISTANCES - I GAc-1, SEPTIC ABSORPTION WELL Address FROM TANK FIELD 013 .2fris- /eiw�t 955-77 i rrh r 2, Phone(s) Permit No. No. of Bedrooms WELL 'J'/Oc7 a�w t e588 — 3 7y 3 3 LOT LINE $v 't LEGAL DESCRIPTION Lot .l Block I �'A Subdivision /�'o b� � FOUNDATION - 1/7 ' 1 ✓0 � Township, Range, Section AS -BUILT DIAGRAM 1Show location of well, septic system, property lines, foundation, T/5—/L' l oZ to Se i, r driveway, water bodies, etc.) TANKS SEPTIC ❑ HOLDING t Manufacturer Capacity in gallons Arv'Vcl ya.✓!T A��v Material No. of Compadmems / Sal z TYPE OF SYSTEM ❑ TRENCH ❑ BED Dd W. DRAIN ❑ OTHER 5 , J o r ST ft• I 7 Depth to pipe bottom from Total depth from original grade original grade -S/FT - f w Fit added above original grade Gravel depth beneath p . fFT Gravel length Gravel widthFT Total absorption area Distance between linesSOo ]6- SQ FT Number of lines Soil rating Pipe material /5 o SQ FT Tr" 30 3Installer Date installed C w/ S tl-, ,S2 -7 9 WELLS PRIVATE �K;at�f ❑ OTHER (identify) Classification A.6.C) Total Depth Cased to FT FT Installer Date Installed: Y m +✓,' r REMARKS: Al/owI^Stk/lu'✓ traN !eSol r�.�L['iC /SO $ /�✓� a ✓ Scale: C . InsdRngdrDBsume8ngineeYlag. services FFFFpp " 'gI�S•� SEAL ,r,, P. 0. Box 773294 P 4 �°°° ee oaa•' ] � ag a Iver, AK 99577 0°' Al • oma' 17 Date: 694-5195 e ° �w o° • ti} `. fid' u• �� _ celtily That this inspection was performed according to all �J l� uo It °OB — IS UfEfd Iry c Municipal and Stale guidelines In elfecl on this dale: 1 �� o ° CE -6735 i pg' me,So- 60 "e �Q neo•°e� Health Department Approval: Date: ** Gravel length > 50 feet requires multiple soils tests. L[FT S'[ATION: If a litL station is installed, a high water alarm must be connected ^ ill UNT AL1:TY f IF ANCH'ORAGE SEPTIC TANK: Minimum total septic Department of Health & Human Services must have at least 2 compartments. Depth to top of septic 825 L Stre tot. ,Anchorage� A1askail 99501 343-4720 ON ITE SEWER PERMIT ORIGINAL ISSUED 7/1/87 I CERTIFY Permit Number: 8�0156 1. I not familiar with Date Icsued: 07/01/87 wells as set �orth by the Municipality ` Owner Name: JAN CHURCH 2. I will install the system in Day Phone: Own�r Address: P.O. BOX 285 and in compliance with the design criteria of this permit. 688-3793 3, EAeLE RIVER, AK �9577 State o1 Alaska requirements Wr the set back distances from any existing well, wastewater disposal system Ur public Parcel Id: (i51-281~44 sewerage system on this or any adjacent or nearby lot` 4. I understand that this permit is valid [or a maximum o� 3 Lot Legal: Subdivision: ROBANNA Lot: LOT 1 Block: NA any enlargement will require an additional permit. Section: 25 Township: 15N Range: 2W Lot Size 1.25A (sq.1t. or acres) Max Bedrooms: This Permit: 3 Total Capacity: 3 SEWER SYSTEMS: Listed below are the options available to you in designing your sewei system. Choose the option that best fits your site. T R E N C H B E D W, D R A I N Depth to Pipe Bottom ([t>: 5"5 6,5 5"5 Gravel Depth (ft): 4.5 O.5 2.5 Total Depth (Ft): 1O"0 7"0 8.0 Gravel Width (ft): 2.5 19.0 5,0 Gravel Length (/t>: 50.0 36.0 58"0 ** Gravel Volume (cubic yds): 23,2 25.4 32.3 Soil Md. ing Used (sq !t/brm): 150 15O 150 ** Gravel length > 50 feet requires multiple soils tests. L[FT S'[ATION: If a litL station is installed, a high water alarm must be connected to Lhe residence. SEPTIC TANK: Minimum total septic tank capacity: 1,O00 gallons. Each septic tank must have at least 2 compartments. Depth to top of septic 11:: (s {eet requires insulation over tank(s), THIS IS AN AMMENDED PERMlT FROM THE ORIGINAL ISSUED 7/1/87 I CERTIFY THAT: 1. I not familiar with the requirements For on-site sewers and wells as set �orth by the Municipality o[ Anchorage (MOA) and the State o[ Alaska. 2. I will install the system in accordance with all MOA codes and regulations... . and in compliance with the design criteria of this permit. 3, I will adhere to all MOA and State o1 Alaska requirements Wr the set back distances from any existing well, wastewater disposal system Ur public sewerage system on this or any adjacent or nearby lot` 4. I understand that this permit is valid [or a maximum o� 3 bedrooms. I also un�erstand that the capacity ototal system is 3 bedrooms and any enlargement will require an additional permit. August 18, 1987 Mr. Dan Roth Civil Engineer, On-site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 RE: Lot 1, Robanna Subdivision Permit #870156 Dear Mr. Roth: MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION AUG 1 n 1.987 We are applying for a modification of our original permit application #870156. The original design called for a lift station with bed. Our revised design eliminates the lift station, placing the septic tank at the home elevation with effluent piped to a wide drainfield at a lower elevation. Soil conditions at this elevation have been logged and are presented for design along with a sieve analysis. I believe that this revised leachfield area. If there are any questions contact me at 694-5195. Sincerely, Louis A. Butera, P.E. LAB:bls Attachments design will result in an improved or concerns, please feel free to SOILS LOG 'fl �. MUNICIPALITY OF ANCHORAGE ❑ PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L. Street, Anchorage, Alaska 99501 . 264.4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: DATE PERFORMED:. LEGAL DESCRIPTION: SLOPE SITE PLAN 1 2 oG 65- O G, 4 5 IVered /S`o f/,fiC WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? S yU L C E Reading Date Gross Time Net Time Depth to Water Net Drop MEN -ENNINNI Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT _ u COMMENTS /�eCGarne.✓�i l� IiCC /%✓moi � % !/;� Z/;7 n7 -K 3 G" rs vie (�• `5J /u 0 Eagle River Engineering Services ---7DATE: --I- V 7 PERFORMED BY: P. 0. BIX 773294 CERTIFIED BY:_l Eagle River, AK 99577 694-5195 -" L 3� z 0 z t LOT L I 0 SEFTC Vfl7T M nam bit S OaYAli4 `bc� CD ed. ci 5 of line ' W HSE IO � 0 z e4 LOCATED WELL O G O CARLISLE N89*54'00"W 3.02' DRIVE tri L 59 ^L 58$ -TL A L t GIL.BERT SUBDIV z 0 z t LOT L I 0 SEFTC Vfl7T M nam bit S OaYAli4 `bc� CD ed. ci 5 of line ' W HSE IO � 0 z e4 LOCATED WELL O G O CARLISLE N89*54'00"W 3.02' DRIVE tri L 59 ^L 58$ -TL A L t t 0 t 551 / r oEAGLE RIVER PP11 S�RIVER, rvR 294nic 99 Rc seRv,ees `e °' t T. n..a 8/17/87694-319'3 n0 GIL.BERT SUBDIV SEPTIC VENT a � V c gy p:00000G ti oceaaevoonoaooaae� o. SEF r'+ o Levis A'. °•ur, ra s o�� CE -5736 o Oc 00, � nT t 0 t 551 / r oEAGLE RIVER PP11 S�RIVER, rvR 294nic 99 Rc seRv,ees `e °' t T. n..a 8/17/87694-319'3 n0 GRAIN SIZE DISTRIBUTION TEST ,REPORT .H c C. e . 1'V L '•. • •H •H •H 1� H H •H •H •H. ri H •H ".�' !,'•.� 117_ 1'-1• 1'y1 I%%J- - 1� .t 04 90 • I I 80 i �0 i L ._•o 1 w LI Lu 443 U0 t 20 10 LLL 0 L - 00 100 10.0 1.0 0.1 .01 .001 OPENING SIZE - mm i+=" ` % GRAVEL SAND .':_ILT - us ': 00LLOIDS LL FI Dso D7)0 D10 r_:1_ C1�=•=•i:ficaticln t; .PNP r•aP 5-, 4..,1• 1.529 0.6449 0.7 ?.l MATERIAL DESCRIPTION f E OF TEST Cl BROWN GRAVELLEY NAND ASTM D t4 '2-63(72:I r'ec lanlccY1 analy-sis Project No.: 109 B f,�_mar k -•' Project: EAGLE RIVER ENGINEERING.SERVIC:ES kT Location: LOT 1 ROJPANNA Trate: 8 18 G R A I t",6 E DISTRIBUTION TEST REPORT ROW -40-11 P. KINNE`I' FISSOCIATES Plate No. 1 APPLICANT: ADDRESS: CONTACT PHONE: 8RLIC. E SWANSC)N P.O, BOX 285 EAGLE RIVER, AK 99577 W8~ LEGAL DESCRIP: SUBUIVISICIA! (PROPOSED) FTC! fl! ANNA '� 1(PROPO) BLOCK: ~ rx SECTION: 25 TOWNSHIP: 15N RANGE: 2W Z jjr ry LOT SIZE: 1,25A (SQ.FT, OR ACRES) too I certify that: alfw�� ^ DEPART! OF HEALTH AND ENVIRONMENTAL requior on-site PROTECTION and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska" 2. I install the in 825 L STREET ANCHORAGE AK 99501 accordance with all codes and regulations!! and in compliance � � this permit, 3^ I will Where to all MOA and State of Alaska 264~4720 for the set back distances from any existing well, wastewater disposal system or Public sewerage system on this or any adjacent or nearby lot. HEZ W HE! i��_ PERMIT N1 O: G70132 �ATE ISSUED: 06/12/87 APPLICANT: ADDRESS: CONTACT PHONE: 8RLIC. E SWANSC)N P.O, BOX 285 EAGLE RIVER, AK 99577 W8~ LEGAL DESCRIP: SUBUIVISICIA! (PROPOSED) FTC! fl! ANNA LOT: 1(PROPO) BLOCK: ~ : SECTION: 25 TOWNSHIP: 15N RANGE: 2W Z jjr ry LOT SIZE: 1,25A (SQ.FT, OR ACRES) I certify that: 1. I am {amilAlai, with the requior on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska" 2. I install the in MOA will systenY accordance with all codes and regulations!! and in compliance with the design criteria o[ this permit, 3^ I will Where to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or Public sewerage system on this or any adjacent or nearby lot. �~ /Ufi- WVE APPnmmFp Ow-llrt �fivAQ9 P1^P0.vqL ��7,6,7 ly °^ � �� * DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET� ANCHORAGE, AK 99501 264-4720 PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHOWE: 87015� ENGINEERED DESIGN O7/01/S7 JAN CHURCH P.O, BOX 285 EAGLE RIVER� AK 99577 688�3793 LEGAL DESCRIP: SUBDIVISION: ROBANNA LOT: LOT 1 BLOCK: NA SECTION: 25 TOWNSHIP: 15N RANGE: 2W LOT SIZE: 1.25A (SQ.FT. OR ACRES) I certi�y thaL: 1, I am {amiliar with :j. sewers and wells as set �orth by the Municipality of Anchorage (MOA) and the State o{ Alaska. 2, l will install the system in accordance with all MOA codes and regulations� and in compliance with the design criteria o� this permit, 3. I wil1 adhaskarequirements �or the set back distances �rom any existingwell, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING COAll ES� THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTHlCALWORK MUST BE DONE BY A LJCENSED ELECTRICIAN. S�GNED DATE: ^ ' APPLICANT: JAN CHURCH �� ISSUED 8Y ^ DATE: �� —~~~~��_.-'..____'_- _--~-___-_~_`_-� � June 22, 1987 Mr. Steve Morris Civil Engineer, On-site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 RE: Robanna Subdivision: Lot 1 Dear Mr. Morris: On behalf of our client, B.M.B. Construction, we are requesting the issuance of a 3 bedroom septic system permit. The issuance of this permit requires a waiver of separation distance to 35' distance to a +25% change in ground slope. This minor variation in separation distance will enable us to place the septic trenches in an area that is ideal for septic drainage. From my experience and knowledge of the area, this variance of 15' will not cause a seepage of leachate from the hillside. The slope in question, is covered with an established vegetation mat and is limited in height. If there are any questions or concerns, please feel free to call me at 694-5196. Sincerely, Louis Butera, P.E. k; LB:bls ' I SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: O �� yy u fy wcJ�iar/ DATE PERFORMED: <!// i1£r•7 LEGAL DESCRIPTION: 4o t /L v E' �� " 6�� %/��✓ 2 w Se �S SLOPE SITE PLAN rr,P,rz,7,j r..X.; I — DR G/t Nrc 1 ; � ' ,:n �` Net Time ■■®■■'■■®■■ v 15- 5 2 rb ✓G� 9 ru L d ii1A c✓P�f� / ; G ¢��C{� 16 CC . JJJer n ■■■■■■■■■■ 4 '�•6. `t o°°ooaoe oa ■■■■■■■■■■ e Lout A. Butercl 18 ®� e CE -6736 MEN MEMNON 6 =10 ■■■■■■■■■■ 7 ��. CG/rr—G/�� Lcyers e•F Net Time ■■®■■'■■®■■ a lel 15- 5 Sa, 9 ru L d ii1A c✓P�f� / ; G ¢��C{� 16 CC . JJJer n ■■■■■■■■■■ ONE ■■■■■■■ Gross Time Net Time ■■®■■'■■®■■ Net Drop 15- 5 16 n ■■■■■■■■■■ ■■■■■■■■■■ o°°ooaoe oa ■■■■■■■■■■ e Lout A. Butercl 18 ®� e CE -6736 MEN MEMNON =10 ■■■■■■■■■■ /2�7 So,W WAS GROUNDWATER yF S L ' r ENCOUNTERED? O 12, . " ' %Dir i71,9 E IF YES, AT WHAT /rZ� 15/aa/87 DEPTH? 13 /z' 6/1q19 7 COMME Reeding Date Gross Time Net Time Depth to Water Net Drop 15- 5 16 n 17 o°°ooaoe oa e Lout A. Butercl 18 ®� e CE -6736 9 19- 20 20 COMME Reeding Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE I-S'o 00? Ary (n+ievtesf rr) TEST RUN BETWEEN FT AND FT PERFORMED BY: Eagle River Engineering Services CERTIFIED BY: �. DATE: ox 713294 Eagle River, AK 99677 °55'00"NV 327.75' s' woe ixdw TM� 1 Ap a rcyd f5q .`3. o /(y 000 o0000000C 000co00_f.O Co']nc:: �:' _ ✓� i 4 Louis A. Buliard V!; 1p o v o CE -6736 e. V �\000 0000000o East. �� `��OrESS�oe1F �r LOT w UnLM 00' R TO BE L I 0 SEPTIC VENT TED WELL SEPTIC PERMIT SITE PLAN EAGLE RIVER ENGINEERING SERVICES PO RX 773294 EAGLE RIVER, AK. 99577 6 i 694-5195 LEGAL: SPECIFICATIONS FOR ON—SITE SEPTIC SYSTEM ROBANNA SUBDIVISION, LOT 1 A. GENERAL 1. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department Of Environmental Conservation require- ments. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. S. All excavations and depths are advisory and are to be verified or modified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi --family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. a. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. B. TRENCH 1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom.: 2. The bottom of the trench shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed 6' at any point. 4. Connection from the lift station to the leachfield is to overflow into a manifold, to allow drainback of the delivery line. 5. The trench gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 4' or equivalent is to be placed over the leachfield. 7. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leaohfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS TOTAL. DEPTH = S' GRAVEL DEPTH = 4' TRENCH LENGTH = 49' TRENCH WIDTH - 5' Soil Rating = 1.50 Bedroom Capacity -= 3 Septic Tank Size == 1000 (plus 250 gallon lift station) LIFT STATION TO BE FROM ANCHORAGE TANK PER APPROVED PACKAGE PLANT INSTALLED TO M.O.A. AND ELECTRICAL CODE REGULATIONS. U G .a Sa d a N W N N t0 u 1.1 N w N 0 +d cdw u U 74 01 a N 3 N 0 N 0 O W N N 'C 'G T k.) w 1p t1 :5 :s4a by 44 44 U U M M O N co r M W O CO rl CV 't o N N 0 cn ai ro 30-i N 1�.� •G 0 W PQ G�� o 44 o•°a3 �> • abs p a zwPCIm0wA DEPTH of EK.cAVA-r 10 N BED CROSS-SECTION s I �T- stews 2 [3A(2R I E•R FLocpC O P O ®l 0 0 0 O o Q O O O V SAND • o GoH RSr= SAND FILTER SPECIFICATIONS Sieve Size (mm) Percent Passing by Weight #4 (4.75) 100 #10 (2) 75 - 100 #60 (0.25) 5 - 75 #200 (0.074) 0 - 15 DOC Co. dba SU L1LMN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759 / / r/ OWNER OF LAND I .J / i C4,14 JV C :4 DEPTH OF WELL 6a- S �C ADDRESS Yn r3 CS y -'77 9 j� r= STATIC LEVEL OF WATER FT. LEGAL DESCRIPTION l 071- Rr) J 4,-J /V A Ly,60 DRAWDOWN FT. DATE • Started / / / 7 Ended 1/F• �r :z GALS. PER HR S G O PERMIT NUMBER KIND OF CASING 6 K KIND OF FORMATION: From f1 Ft. to FL C �� iiv C S t /� v From Ft. to Ft. From - Ft. to Ft. '-J' From Ft. to Ft. From < Ft. to ' Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft r - J C From Ft. w Ft From - Ft. to .' Ft. "r' ' From Ft. to Ft. 01 1 Y `"- r _ From Ft. to Ft. From- _Ft. to Ft. <1 %'��r - From Ft. to F[. From- -_Ft. to Ft. I r / C7 /Z From Ft. to Ft. From Ft. toys Ft. 4 ` - From Ft. to Ft. From ` • `i Ft. to Ft. i=i r- From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft.From Ft. to Ft. T. OF HEALTH y OF HAGE From Ft. to DEP Ft. ENyl DIP •..�&rom Ft. to Ft. IAL PROTECTION From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. 2 5198,jrom Ft. to Ft. -- D �+ From Ft. to Ft. R E l RV EI m Ft. to Ft. From Ft. to Ft. From Ft. to Ft MISCL. INFORMATION: MUNICIPALITY OF ANCHORAGE Development Services Department p p Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval - �, Parcel I.D. 051-281-83 Expiration Date:42Z,��- 3 Legal description ROBANNA LT 1 Site address 18015 PIONEER DR Eagle River AK Current property owner(s) YOUNG DAVID & MICHAELA X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 4/27/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist Absorption Field Advisory Tank Age Advisory Other X Well Flow Advisory Nitrate Advisory Arsenic Advisory COSA Approval_June 2022 MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-281-83 Complete legal description ROBANNA LOT 1 Location (site address) 18015 PIONEER DRIVE, EAGLE RIVER, AK 99577 Current property owner(s) DAVID & MICHAELA YOUNG Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age 2 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ® Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ LAD Waiver Fee $ Date of Payment V h 3 Date of Payment COSA # 03 G 3 3 Waiver # COSA Application.doc COSA Checklist copy.docx COSA Checklist Legal Description: ROBANNA LOT 1 Parcel ID: 051-281-30 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 6/16/1987 Total depth 60.5 ft Cased to 60.5 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 3/30/2023 Static water level at beginning of test 45 ft. Well production at time of test 3.4 gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 1.83 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 4/11/2023 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 58” Date of pumping 3/29/2023 Required maintenance completed, if AWWTS Comments: 1250-gal HDPE tank installed 2021 C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 9/10/1987 ALL standpipes present per record drawing Total measured depth from grade 6.6 ft (max) Measured depth to pipe invert from grade 3.8 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. (ED) If not, state depth into effective 2.5’ of 3.5’ ED Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 3/30/2023 Results Pass Fluid depth prior to test 5 in Water added 500 gal New fluid depth 7 in Elapsed time 250 min Final fluid depth 0 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 42 in (3.5’ED) Effective depth used 12 in (Missing ED + Fluid Depth) Effective depth (ED) remaining 30 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots and assumes approximately 12” of ED is missing. COSA Checklist copy.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 4/26/2023 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. 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, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 4/26/23 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-281-83 1. GENERAL INFORMATION Complete legal description Robanna Lot 1 Expiration Date: / 0 _ ! (9, 1 4- Location (site address) 18015 Pioneer Dr, Eagle River, AK Current Property owner(s) Church Day phone 696-2595 Mailing address same Real Estate Agent Rebecca Baker, Rasmussen Prop. Day phone 947-8990 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) U 1i T cy i%Q Q ❑ Duplex _ L ❑ Multiple Dwellings (Single Family and/or Duplex) JUL 0 2 2014 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Received by: Date: 764p/ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 92--(c Date of Payment i12�,1 q Receipt Number 0" 5Y2-91 COSA# 05G1`i12_q� Date: Date of 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 6. DSD TURE SIGN #1 Approved for System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms. bedrooms, with the following .�y`v `ga®es ery aeP - - .� L v s 3:7 Stever .. k;'. Eng - H 62-r il6tions: By: % Original Certificate Date: The Mm Ipa of Anchorage Devlopment Services Division (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory COSA blue sheet 9-1-12.dac X Nitrate Advisory Arsenic Advisory Other 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: 6 4AIX/J 1-67- / Parcel ID:O 5 f - 2 el -- 83 A. WELL DATA Well type P If A, B, or C provide PWSID # Well Log (YIN) Date completed-6/14LE 7 Sanitary seal (YIN) Y Wires properly protected (Y/N) Total depth 66, i ft. Cased to a�C1d It. �f Casing height (above ground) in. FROM WE L LOG Date of test jWellStatic water level L f 5 - Well production g.p.m. WATER SAMPLE RESULTS: Coliform ! colonies/100 mL Nitrate _-2,_L�mg/L Arsenic 0.2 Z 7 ug/L Date of sampler B. SEPTIC/HOLDING TANK DATA Tank Type/Material ---S9 P411CT (�� KE Tank size /Z 5y gal. Number of Compartments Z AT INSPECTION 6'113 3 ft. g.p.m. Collected by: Date installed (U Cleanouts (Y/N) Foundation cleanout (Y/N) TY7 Depression over tank/N (Y ) .� High water alarm (Y/N) Al Date of pumping Pumper T/' s. C. ABSORPTION FIELD DATA Date installed 7 Soilrating g (g.p.d./ftZ or ftz/bdrm) / SU System type C,lY Length _ 5,4 ft. Width ft. Gravel below pipe ft. Total depth _kJft. Eff. absorption area a(1C1 fe Monitoring tube _Y__ Depression over field Date of adequacy test Results (Pass/Fail) � For bedrooms Fluid depth in absorption field before test _Q in. Water added .$_0 gal. New depth 7_ in. Elapsed Time: 30 min. Final fluid depth U in. Absorption rate >_d• 9•p• Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION N.A Date installed "Pump on" level at Datum Size in gallons Manhole/Access (YIN) _ in. "Pump off"level at in. High water alarm level at E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tankllift station on lot �4!? Absorption field on lot / 00 y r Public sewer main /V 4 Sewer /septic service line Aid if Animal containment areas U r� Meets alarm & circuit requirements? On adjacent lots 00 On adjacent lots 16L)", - Public sewer manhoWcleanout NA Holding tank Manure/animal excrete storage areas /Dd SEPTICIHOLDING TANK ON LOT TO: If �. Building foundation Property line Absorption field SLY `f Water main /V�f Water service line ZS . Surface water /12d "I - Wells on adjacent lots lae �r ABSORPTION FIELD ON LOT TO: Property line /0 r/fi Building foundation Jr � Water main AIA Water Service liney/ f Surface water /OCr �>F' Driveway, parking/vehicle storage � O Curtain drain Al.+ Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name S � 6AJ Date �_ COSA brown sheet_IO-10-12.doc ....Ir........ �4 R` : Steven W. Eng , <. ai7,p a FE 6256 >: in. ■ N89° 55'27' N 328.22' f s. I I a C, s ( M Z W I M d wOx Z w MhLL o ° q M iv I F ti °To ARAVA.'.'OA(A . N" Z N89° 49' 10•W 137.83-1851: 48' 18•Vy 149.81' LOTS U° N b 0 LOT 52 m LOT2 N O 40.00' PIONEER DRIVE "Bs° 491 1°'° UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBIUTY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCAUNG. REPRODUCTION MAY CAUSE ERRORS IN SCALE. LOT=SURVEY TYPE SYMBOLS FOUNDAl1aN AS-BULT D RNA. $McTuRE As-mxr SET REBAR � � DRAINAGE ` ASPHALT PLOT FLAN ... As-ew.r . ..m suncr ... ArNY F� ''' O FOUND REBAR gag ,WOW FENCE '.:: CONCRETE i A aALr ... Ran o caRrJms sEr oN As 00 n ASSUMED ELEV. 9t --X w METAL FENCE ® WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED, WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT, ALL DISTANCES ARE RECORD UNLESS OTHERW9SE NOTED. SURVEY CERTIFICATION ..�,�rrR�`r1 Prepared by PLOT PLAN�.•-�� OF••• p� Robert E. Johns, Jr. & Assoc. aw ae oa.� as a.Ne.a I..eN .r awl IAi P.• ".... �� Professional Land Surveyors nw. rows s .rrlM.r r a aw let mn..�.•• r Nwen m tlw pm eM m tlw M a mr ♦ 7700 Brink Drlva ANCHORAGE. ALASKA 99504 raa.leee Nw 0en wer!rtl I I {(: - • j}. .. Scale:1 n _ 601 Rec, Lot S.F. Rac Plat File No. e�w °na imwta FOUNDATION AS -BUILT •• •• •• % Date Sur" d: �` 04/15/14 Drawn b REJ Checked III A K JM t eee.t E Jere, w. Nnenr aeroy uwt I ..:.... '• •• anwneieoe ma eM,rlon s Yww, Msh ^'•• a AO iaie`""m �r •"� ;,....� • ROBE H ': �` .• AS Date Drawn: Grld: WO '.� c 'P 04/15/14 NW753 14-316 FINAL STRUCNRE AS -BUILT , , 21 ;'• >aAI Legal Description: I, ea.n E Jebw, r, n..nr eerWl tlwt I Nw e.„w,•we m .rr+t .war a aw Vol, �♦ °•''•... •.•••,.• �4t •1 . et.men re ur Nt aM M a We ea, ......... /,, ra �'.�� Lot 1 an.n�w sA aktnwaaf r am Naaen lG99(ana\ ROBANNA Pr —4,(� MUNICIPALITY OF ANCHORAGE • .k 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 HAA# 1. GENERAL INFORMATION Complete legal description Lot 1; Robanvui Subdivision Location (site address or directions) 18033 P.ioneeA Dkive Property owner -tan Chunch Day phone 384-1573 (w) P.U. Box 773184 Ea 696-408G Mailing addressg2e RtiuPJr. AK 99577 Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX 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#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 furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address S & S ENGINEERING - - - Engineer's signature Eagle River, Alaska 9 6. DHHS SIGNATURE Approved for1 3 bedrooms. Disapproved. Conditional approval for Additional Comments Phone 6 9tf� "2 9 Date A�_- bedrooms, with the following stipulations: By: � _ (Sim cir, Date / -z - 9 -93 11ITIr 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. 72-025 (Rev. 1 91) Beck MOA k21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: �-c>< ` &o��,jA De S'y7, Parcel I.D. 0 5-1 - ;ZS �k A. Well Data Well type PPAycc-�k, If A, B, or C, attach ADEC letter. ADEC water system number Log present N) �l� Date completed � Driller 4�>J ypo-o-1 Total depth (o b l S V Cased to L.�0` 64 Pf S,F 44-- sO Casing height IZ+( Sanitary seal O)V) Wires properly protected (Y/N) + i �S .I,r ce GL>En FROM WELL LOG AT INSPECTION TJ #Aa0s A- Date of test Lc,'' \ L�" cb -7 Static water level 4,221 Well flow t-eg•p•m• Pump levell oy1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \ kz:>� t Absorption field on lot t o� Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform 0 Nitrate Date of sample: 72 - 3 - B. SEPTIC/HOLDING TANK DATA ; On adjacent lots 10 0 sewer manhole/cleanout Petroleum tank A a.ia Other bacteria Collected by: � S S-'4�C �• Date installed � o ' Tank size 1 -LSC' Compartments Z Cleanouts&/N) \1 Foundation cleanout (VN) Depressi�r (Y/& High water alarm (Yr �, Alarm tested (Y/N) Date of pumping � t" � o < 6" Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \L-'--6 \� On adjacent lots 1 t�'-0 \ Foundation To property line \ e Absorption field 1 b Water main/service line Surface water/drainage \ v 0 S 1�- \�\k CONTINUED ON BACK PAGE 72-026 (3/93)' Front rn c C_z E n g.p.m.� r c Ar c�c On adjacent lots ; On adjacent lots 10 0 sewer manhole/cleanout Petroleum tank A a.ia Other bacteria Collected by: � S S-'4�C �• Date installed � o ' Tank size 1 -LSC' Compartments Z Cleanouts&/N) \1 Foundation cleanout (VN) Depressi�r (Y/& High water alarm (Yr �, Alarm tested (Y/N) Date of pumping � t" � o < 6" Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \L-'--6 \� On adjacent lots 1 t�'-0 \ Foundation To property line \ e Absorption field 1 b Water main/service line Surface water/drainage \ v 0 S 1�- \�\k CONTINUED ON BACK PAGE 72-026 (3/93)' Front C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DIST-AIVCE FROM LIFT STATION TO: on lot D. ABSORPTION FIELD DATA On adjacent lots Date installed CI - 1\�>- 121 Soil rating (GPD/Ft2) 'Pump Surface water �So '� I5(; Length 5-4 Width 5 Gravel thickness Total absorption area ebb Cleanout present 6%) Date of adequa y test �� s 66 .S Results (pass/fail) J5�'� Uogfv S G(�� Gars f, Water level in absorption field before test Peroxide treatment (past 12 months) (Y/b SEPARATION DISTANCE FROM ABSORPTION FIELD TO: System type Total depth 8 - `1 Depression over field (YA1%) for Bedrooms test If yes, give date Well on lot k n V �- On adjacent lots 1 O c) Property line k'1 I To building foundation 1 d t k To xisting or abandoned system on lot VA, On P - On adjacent lots 3 p t Cutbank /k Water main/service line 1 k � Surface water 1bd Driveway, parking/vehicle storage area 5a Curtain drain Date Eagle : ver jarlaska 99577 HAA Fee $ qr)r> . �� Waiver Fee $ Date of Payment j 7✓ 1 13 Date of Payment Receipt Number t>2 5'VXJ ,3 2--6 Receipt Number_ 72-026 (3/93)' Back