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Home My WebLink AboutROBANNA LT 2Onsite File Robanna Lot 2 PID# 051-281-84 The original well was decommissioned. Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201342 PID Number: 051-281-84 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name ROBANNA LOT 2 ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 18035 PIONEER DRIVE, EAGLE RIVER ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 5 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot ROBANNA 2 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 z Number of trenches Dist. between trenches From Tank Field Tank Line Ft Ft. Well 100'+ -- 25'+ TANK 2 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1500 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ -- NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks Alarm location Electrical installed by Installer DENALI EXCAVATION PIPE MATERIAL House to tank 3034 d Tan n k to 3034 ld Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection 1s` 9/14/20 2nd 9/16/20 da Location and description 3rd 4'n BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL ,w <. Conditional Approval: Date AW ' ' •:�,�� • •• TSI '•�� • ' ' ' ' ' ' ' '�� ' ' Septic System Approve - Curtis Huffman • CE 128991 Date t/- Zx ( U �s • • • •.��`�®®� �� lFR . ,9/18/202Q. �� Aw OPROHSSIONA Note: this approval does not include well permit requirements. tKev uoiuzi_10) PID: 051-281-84 PERMIT: OSP201342 Z O O N c TTI 1 9� DCO CC O '' O EXISTING FIELD MT® CA O FCO C D NEW 1500 -GAL HDPE SEPTIC TANK ®MT WgLC WALL �o .0 'Rtiro Y , ?.0, EXISTING ^^ate 5BR HOUSE ow LOT 2 N89'49'10"W X285.93' PIONEER DRIVE _ SCALE, 1' =30 SEPTIC SECTION ROBANNA LOT 2 PREPARED FOR: KURT & ANNA SMOLE 18035 PIONEER DRIVE EAGLE RIVER, AK 99577 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 firstwaterAK@gmoil.com SCALEt NTS SUPPORTS SERVICES: Ar. OF At"1 lis ® DATE: 9/18/2020 i�. Huffman.i SURVEY: JLS , CE 128991Atf �`� DRAWN: FWCS ,' 9/18/2020, AW SCALE: 1" = 30'FEsslo��' 9/4/2020 MUNICIPALITY F Development Services Department On -Site Water & Wastewater Section Parcel I.D. 051-281-84 ON-SITE SEPTIC/WELL PERMIT APPLICATION Phone: 907-343-7904 Fax: 907-343-7997 Property owner(s) KURT & ANNA SMOLE Day phone 907-223-4733 Mailina address 18035 PIONEER DRIVE, EAGLE RIVER, AK 99577 Site address 18035 PIONEER DRIVE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) ROBANNA LOT 2 Legal description (Township, Range & Section) Lot Size 45,345 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (IE all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank 0 Upgrade Q (D) El Holding Tank El Renewal 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. (Signature of property owner or authorized agent) Permit/Rush Fees: I6�'s. 75 o9w o Date of Payment: .) Receipt Number: Permit No. 05 P ZO)3y 2 Waiver Fees: Date of Payment: Receipt Number: 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 August 24, 2020 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: ROBANNA LOT 2 PHYSICAL: 18035 PIONEER DRIVE, EAGLE RIVER, AK 99577 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1500-gallon HDPE tank per code to serve the existing 5-bedroom residence. The lot and area are served by private water. 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 OSP201342, Deb Wockenfuss, 09/03/20 FIRST WATER CONSULTING ROBANNA LOT 2 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201342, Deb Wockenfuss, 09/03/20 SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688.2759 OWNER OF LAND LEGAL DESCRI~ION PE~IT NUMBER / DEPTH OF WELL ~ ~ STATIC LEVEL OF WATER FT. ,'~ ~ DRAW DOWN FT, GALS. PER HR 4,,,F~ '~3 KIND OF CASING ~ ~ O~ KIND OF FORMATION: From ,/ & Ft. to -3 From ,'~ Ft. to 7 From '7 Ft. to ~'~ From '~ ~/~" Ft. to From ~-)~' Et, to / From'~ / Ft. to 64, From__ Ft. to From Ft. to From Ft. to____Ft. From Ft. to -- Ft. From Ft. to -- Ft.. From Ft. to Ft. From__Ft. to Ft From__Ft. to Ft. From__Ft. to___Ft. From. Ft. to Ft. From Ft. to Ft. From__Ft. to__Ft. From Ft. to Ft. From Ft. m Ft, From__Ft. to Ft Fmm Ft. to Ft. Fmm__Ft. to Ft. From__Ft. to.__Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to_ .Ft. From__.Ft. to Ft._ From__.Ft. to Ft. From__Ft. to.__Ft. From Ft. to Ft, M!SCL. INFORMATION: ~i t0 DRILLER'S NAME /2~d'~ ~ Z I I I I I CARLISLE N89'5~'OO"W GILB£RT I IlIII Il' I LOT 2 8.02 ~uiv£ L A I' L WELL PERMIT SITE PLAN ,. ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT JPHONE I E3~EW MAILING_~A/DDRESS~L"'~' i ¢'~'~ ~ ~ DISTANCE TO: W~r~ / Abso~on~rea Dwe,]i~ ~ ,~,¢ ~ Z Manufacturer ~ ~ Mat~ / ~ of compa~nts Liq.cap~ in gallons Width Liquid depth .~ ~ '~ ~ Inside length I /~ ~ ~ IF HOME.DE: ' , ~ ~ DISTANCE TO: Wall Dwelling PERMIT NO. O ~ ~ Manufacturer Material Liquid capacity in gallons ~ W~0 / Foun*t~ NearT~ linc~ P ~_ N°' °f I~s~ Le~ f~t of*a 'li~ / Total I~¢lin* Trench¢~¢~ //inches Distance 'e*~een ~es ~ ~ ~ Top of tile to f~ Cdc / Material beneath tile r( Total e~t~a~orptiCarea Length Width Depth PERMI'T NO. ~ / <~ Type of crib Crib diameter Cr~lde~th/-- Total effective absorption area /~/~ ~ Well Building ~undatfon Nearest lot line ~ DISTANCE TO; ~.. --~ ~Cl~//~ De~ .... ~ . ,~r]~ Distance to lot line PERMIT NO. ~ ~'~t5 //- ,~- ~ ~ / DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) PIPE MATERIALS , / ~OIL TEST RA -- APPROVED ~ g~ ~* E:'ISINEZRD~¢4 ' // / z,c'r,M 1' '1" xu"~ - DATI::: 1' c!: CCd?FACT' c:', ..~, c'. Al.,,. I::i:ASMUBS 01',! % S&S EI'.IE'JINEERII\IG !EAGLE RIVER~ AK 995}~'7 694-;T:7977 L..EGAL ¥'~::( "' ' :" J OT c~"[TF:'~ SUBDtVISION:~ NA SECTION: 25 TOWNSFIIF:': 15N 5A (SQ~ I:::"I",, OR ACRES) BLOC]I< .~ NA l...isted be:Lot,...' are "~ t ....... opt ions av~x:L lab l,:e 'Lo yc:n..t :~.n ....... your ~.,~:..:: :i. g n :i: n g s ep t i '::: svs'tc->m. . Ct'~(::ose~, '~'~.,~''~,,= opt. ion thai'., best' f i'Ls your si'Le,, ¥' ""'~' ""' .... 4.5 .0!:. Id 'T'n r::"fl::': ~:, ....... ..'.~ 0 z~ 0 ........... :,L) ~..~t'! (F:T ) ,~ ..:-' ,~ ..~ ..... ~i, ~.,- , F-, ( F' '1' ,,." /',. () 0 ,, 5 3 ,, 5 'T'OTAL DE?TH (F'T~) .,.~("~..- ~ 0 .'.'5 ,, .'"~.. "> ..... ,, ...,: G,~..~vI:.L.. WIDTH (I:::"1",,) 2. !5 .LB,, ') 5,, 0 , I-u...~vE::l ........ c. NG 1 r, d~' q ~ ) 2!;6 ~ .") ":rz. ,"~ .-'~ ,:. ") ~':z 7,/~ .,i::u ~ .)L,-. ~... (CU. ~;~]~ ~ ~:.' :[ ,, '7 O.'l ,"~ '1 , ,-. I-.,. ....... z ....,u:,r.L~:~, .L. 500. 0 .~-.X. =';'" (', '"~ .~.'.~.e ~ 500 ~ '"' '~"~' SL':) I I .... F I ..... ~::['t F:'T ,, /B!q'. ) o,= .... certify tha'L: I aiii famil:i, ar' ~.~J.'t.h 'Lh,E.:~ r'equ:i.r'ement, s {'ctr' on.-..si'Le se?.~epE~i and ~x~e:l.].~ as set fE:i"'[.h by the Mur'iicip~'.l. ity c)f' Anchopag~ (MOA) and 'Lhe:, State ~:~{ Alaska. 2, I wJ.].], ins'Lal], the sys'[.(~,!m-:i.n ac:c:opdar'~c:[.:e' v¢:Lth a].l MC)A cc)des ar'id r'egLt].atJ, cJr'is~ a':u']d J.r'I cc)mpJ.:i, ance ~/~:i.'l:.h the design c::pitepia c)f '?.his permJ.'L,, ~B(.:.?t.,,]~z~r'ag(.:~.) SyD't..E.)fii on tl-~:i.s of any adjacent or' near'by lot. 4. I ~...tFideps'l:..ar'~d 'Lha'L 'k.h~s p~,r'.mi.t :i.s vaJ.:Ld fc)p a max:i, mumc:{' ~ b~)(:Ji'gcims and any enJ. apgemer'It ~,.~.].]. r'equip~.) an addit:i, onal pE.n'm:Lt. .,.'r!::'~ (."i ~ ]:Fr']"` ¢~'¥'/~"-Tf]l\1 ]:S ' k c?"/~ z'~', r- 't ,c'i:',~:~ EiY " ~::,~ I r-~'~r~'z'c:. ,.-. .... ~, ....., ~,.1,,t~.., .... 1 ....IN AN AREA ,.,[J v,..., u....D MOA ,....,.,!I...DIIqG ...,.,,.,I...~,.. THEN ( '~ ~ AN ~:: ~:: ....... ' ..... zx ~'~, c:'z,,:r ........ m,* A ::'""r"~[ ........... R]...,,-.,~.~ PIEFRI'JIT AND .... ~,.,~ t ...... ] .....MLJST BE 't~::,n",x'i'm~zn ,'"~ .......... r, ............ ~; ,,=) .,.~ .... :tiL. TS I,t,,,..~..,~ .... NOT BI:::' APF:'F;'O 1N~''xL n~ n''., ,, .,.~.., , AN tEL. E: ]TP]:CAL. . ]:NSF'ECTZ~, ,t" '~' ,"ur"r"r'Pr""r'., ..,,~, j; AND :'~..., ...... :: ..... :'",..,..,,~..."~t !/,J(]RI':: BY A I...]: ::'~:'","r':."r,"z~. ~ .i. Si,Il= .... ~.,A i 1:::. ,, PERFORMED FOR: :4Z LEGAL DESCRIPTION: SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST SLOPE SITE PLAN ¥ 10 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER ENCOUNTERED? 0 P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop , PERCOLATION RATE ///,~ (minutes/inch) TEST RUN BETWEEN FT AND , FT COMMENTS ~ & ~ E~EiINEERIN~ PERFORMED BYi ~ '~RB 19~,~ · PH, 694-2979 UMC�PAU7V OF Development Services Department On -Site Water & Wastewater Section Parcel I.D. 051-281-84 ANCHORABE Certificate of On -Site Systems Approval fiRrT�l�Ile��1►1;�1:��CTtJ Complete legal description ROBANNA LOT 2 Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: 12 -'N_2D zo Location (site address) 18035 PIONEER DRIVE, EAGLE RIVER, AK 99577 Current property owner(s) KURT & ANNA SMOLE Day phone . Mailing address Real estate agent 18035 PIONEER DRIVE, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family*(w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ t_1 '12. 50 r-ou r0 Date of Payment cl �0 Receipt Number 2-16 l q 3 COSA # C%,C Z0150_.6 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER . As certified by my seal affixed hereto and as of the validation date shown below, 1 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 9/15/2020 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. septic.system....Therefore,.any- estimate. of how_long.a.system..wi11.fun ction satisfactor for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWc5 6. DSD SIGNATURE System #1 Approved for �� bedrooms System #2 Approved for bedrooms Disapproved -49 Curtis Huffman % �'Ec •. CE 128991 Conditional approval for bedrooms, with the following stipulations: _IiIII(fill,. Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other COSA Checklist Legal Description: ROBANNA LOT2 Parcel ID: 051-281-84 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 6/17/1987 Total depth 64 ft Cased to 64 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 8/10/2020 Static water level at beginning of test 25 ft. Comments B. TANK DATA Age of tank(s) 0 years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NEW ® Standpipes/foundation cleanout per record drawing Date of pumping NA - NEW D. ABSORPTION FIELD DATA Which system tested (date installed) 11/12/1984 ® ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A - pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective Structure served by this system _ Well production at time of test 4.7 gpm Water storage tank volume_ gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 9.94 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by_ FICS Date of Sample 8/10/2020 - C. LIFT STATION ❑ Required maintenance completed Age of lift station _years Lift station material Comments: Adequacy test date 8/10/2020 Results El Pass For 5 bedrooms Fluid depth prior to test 6 in Water added 770gal New depth 13 in Elapsed time 15 min ® Code -required soil cover over field Final fluid depth 6 in ❑ System presoaked Absorption rate 750 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons FW'rs Comments/Deficiencies:. `` E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Surface Water > 100' ® Yes Animal Containment > 50' ® Yes if No M Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ft ft ft ft ft ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No —ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ®Yes if No —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION\,, I certify that 1 have determined through field inspections and review AW . _... of Municipal records that the above systems are in conformance �g . •:� with MOA COSA guidelines in effect on this date. % *: •� iH /J• Curtis Huffman �( �F�, •• CE 128991 .• �`�i �� ;'�'lF • 908/202Q . •'\G�i ►��PROFESSIONP��.r ft i0i N00'38'31 "E 150.44' 15' T&E ESMT WELL 0 ro to. p• � I LOT 2 �I- LO n 00 M Z GRAVEL L6 00 3 CV PAVED D/W Ld J C � y.Q ry,� 4p. gl•° � e0, C9't'T 0 W 4P?� s° 3P O 50.7' OF 0- 0. -p T 0) F 50.2' 00 z 00 ° o r- O tib 9,yr GQ2 � I O 61 MH :t • • SEPnC 0) V VENT D0 (b'P) to Z • EKLUTNA I WATER LINE 30' N00'12'18"E 161.00' I ANCHORAGE RECORDING DISTRICT, ALASKA AS-BUILT OF: 'Q� = FND ALUMINUM MONUMENT ROBANNA SUBDIVISION @) = FND 518" REBAR LOT 2 PLAT 87-60 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a i \� �D S D [� /� �F AL \e,1 1 �ti0 LAND physical survey ofilris property as shown on this dmuvtg and that the // fi . • .. ... •.9� t j improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should % * 49� any inrormation on this drawing be used for construction offences, r a b c C structures, improvements, or for establishing boundary lines. U !-' / .1..�..... / to EXCLUSION NOTES: It is the owners responsibility to determine �'� ' :"' � the existence of any casements, covenants, or restrictions Rfiich / '+IOkN L. SCHULLER: 0 do not appear on the recorded subdivision plat. �, of LS-10408 WORK ORDER NUMBER; ah: SCME E-YA¢: tt; P '•• .�� ,zz* gJ%� 1831 Talkeetna Street SEPT 18, 2020 1-=30' `01 na / Anchorage, Alaska 99508 20-070 DPAM ar. a�EaEo a rnm Kwars eoa��a ,�rOfession°l L°c (907) 227-1455 office JLS NW0753 200215\\\�`�� (907) 274-4992 fax M U H� C 0 PL' 7 V O F A N CC -� 0 Fti 621E DEVELOPMENT SERVICES DEPARTMENT On -Site water and wastewater Section - www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC201506 Subdivision: Robanna, Lot: 2 907-343-7904 Fax: 343-7997 A water sample revealed a nitrate concentration of 9.94 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~"~'~ / -- ~:~ / -- ~'~\ NAA# ~:>~\ ¢~. c;'~ ,:;: (' ,-_,~, ,~ 1. GENERAL INFORMATION Complete legal description Location (site address or directions) ,,/~ ~;.~' /~/4',~2~¢~" ~ Prope~y owner ~,'~¢ ~~¢ ~,~¢¢~d~ay phone Mailing address Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of theva]idation 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. KND Engineering Name of Firm 2044t P,,a~m~gan 81vd. Add ress Eagle Rive~./~,K 99577.873,3 EngineeCs signature Phone DHHS SIGNATURE '¢/ Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. There are ~iL~Lu~ ~L. IL i~ ~ugg~Led ~hat periodic uesuing be performed to insure the wells continued suitability. Current nitrate concentratzon zs ~.~ mg/±. ~FA maximum concentration is 10.0 mg/1. More information on nitrates is available from the On-site Services Program, DHHS, 343-4744. Addition~ Comments 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-O25(Rev. 1/91) Bac[ MOA~21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: ,,'¢¢~,--/-¢/'2~ .~/~- Parcel I.D.: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to ~,/1/ I Casing height (above ground) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well production 7 g.p.m. ~', ~ g.p.m. WATER SAMPLE RESULTS: Coliform Date 'of sample: Nitrate B. SEPTIC/HOLDING TANK DATA Date installed 11//'2'////~¢ Tanksize Foundation cteanout (Y/N) Date of Pumping C. ABSORPTION FIELD DATA Date installed /I/~/~¢ / Length .~ ~c~ t Width Other bacteria Ct2 Collectedby:/~/f,//~--~g'~/~ 15-00 Depression (Y/N) /~ Number of Compartments ~- Cleanouts (Y/N) Y High water alarm (Y/N) ,~//~ System type ~ Effective absorption area z/.5-/_~ Monitoring Tube present (Y/N) Y Depression over field (Y/N) / Date of adequacy test Results (Pass/Fail) ,'~ ~<_~ For :~ bedrooms Fluid depth in absorption field before test (in.); ~ Immediately after/~r~gal, water added (in.): ~ 3///7//' Fluid depth 'E~)r~ (ins) Minutes later: ~,~) Absorption rate = ~',~ .,L, g.p.d. Peroxide treatment (past 12 months) (Y/N) /g'/ If yes, give date Soil rating /~*~ o~ ~4::) ' ~ Gravel thickness below pipe Total depth LIFT STATION Date installed ~' Size in gallons J Manhole/Access (Y/N) "../~Pump on" level at* .../~"Pump off" level at* High water alarm level at* ~ *Datum J Cycles tested ~ ~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /d.~ C) 4~ Absorption field on lot /D O ' '~ Public sewer main /d)~ ~ On adjacent lots On adjacent lots Public sewer manhole/cleanout Sewer/septic service line · /D~ ''~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: / Foundation /~) -~ Properly line ./~9 & Absorption field / -// Water main/service line ,2 5 + Sudace water/drainage /E)~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: / ! / Property line /~¢) '~ Building foundation ,/~:) ¢- Water main/service line ~:~ '~ Surface water / tgD ~4-- Driveway, parking/vehicle storage area /D 4~ Curtain drain /d¢~. ',/f'r'/cccOr/ /¢)~) 4- Wells on adjacent lots /,:¢'¢ 4- F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records in conformance with MOA HAA guidelines in effect on this date. Engineer s Name Date /~.//~'~/~ Date of Payment '~/~z~ ,/~7~t~ // Receipt Number E¢//~,~7'/ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number APPLIC ',IT FILLS OUT UPPER HAL'' ',ONLY Property Owner /'---~ ~ . . - Phone / Mailing Address .~r~" ,~ ,/~.~,,~' ..-~ ~ .... X/,~ : .,~', ....... :'? .~ ~.~ Zip Code Buyer /':~_~ ,~L,~..~,? ~' :~ : .: . -:- ..f ~/' Zip Code Address ·., ;~ ~,~.,~ ? ~ ~,, ( / /,, .~ '~,, (~ / j ,,:; ,~; z, ...... ~,. ~ // · ~ Phone Lending Institution ~.~ - ~' ~ z /. /~.~.~, .~ ..~. Address Zip Code · Phone Realty Co. & A~nt /,~ ~ /.'/'~ _, ,~-~,/ ~ /:/~ . ~ ~_. Address .... '/':: ?.~ -' ,( ;"-" /¢ '3. /~ ¢ ,~ '.!,~ ~:-' ;~¢ Zip Code Street Locati~ Type ~ Resi~nce ~/Single Family ~ Multiple Family No. of Bedroo~ ~ Other Water Supply ~lndividual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that d~te, give well depth (attach Icg if available). ~ Public Utility ~ndividuai . - Year Individual Installed: B Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OOESSlNG CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: ( ~ AP.ROVED BEDROOMS ~ 'CONDmONS OP APPROVAL (') DISAPPROVED ( ~} CONDITIONAL~.P~ROVAL,* .-..~ ~,,-/~ ,~_/~.~ ~~ ' Soils Rating Date Sewer Installed Well To Absorption Area Weft Log Received Well to Tank Septic Tank Size