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HomeMy WebLinkAboutROBINDALE LT 17 Onsite File Robindale Lot 17 #051 - 053 - 19 ki wv / Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181198 PID Number: 051-053-19 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New M Upgrade Name FRANK CLIFFORD ABSORPTION FIELD FI Deep Trench El Wide Trench ❑ Bed El Mound Site Address 24034 Sunnyside Dr ❑ Other Pho-no Numbor of Bedrooms Soil Rating Total depth from original grade 561-2227 4 GPDISF1 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft, Gravel depth beneath pipe Ft. Subdivision ROBINDALE LT 17 Block Lot Fill added above original grade Ft, Gravel length Ft. Township Range Section Gravel width Ft, Beds: Number of Lines - Dislance between lines - Ft SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sever Total absorption area Number of trenches Dist, between trenches From Tank Field Tank Line Ft= Ft. Well 100'+ na na na TANK IN Septic I] S.T.E.P. [:]Holding ❑ Other Manufacturer Anchorage Tank 9 Capacity 1250 Gal. Surface Water 1 QQ'+ I I na na � Ytaterial Number of compartments Lot Line 10,+ na na i NA Steel 2 Foundation 1 p'+ na na LIFT STATION Uanufacturer Capacity Remarks Public Water, Neighbor Well Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank D3034 Tank to draintield D3034 Stuart Gilbert Drainield c01tUsTD3034 Inspector NorthRim Eng. BENCH MARK (Assumed elevation) 100 It Inspdection 1- 8117/18 8!22!18 Location and description 2' Deck 3" 4" ONSITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date g++�.� xOFor Ar :* :49T o•• •t s f j Septic Syste Approved Gv Date Z zZ neve ♦�� cE-sass?� 8'/'22/1 �' Note: this a pproval oes not include well permit requirements. ki wv / A B ST1 18 13 ST2 27 16 DCO 37 23 SUNNYSIDE DRIVE NORTHRIM .-+'~I'"44 4 ENGINEERING AE. - N-4 , SteveEng.com PO Box 770724 7910 River, Alaska 99577 CE -SM lkv - *'* * . jw Dn-7 X:Z0,1 -7n'?S:? 4 21;��il'2 111.70' Lot 2 ROBINDALE LOT 17 WASTEWAT�DTTfR I 10 r-- 0 A n U <�'- ey ox Lot 18 1' = 30' RECORD LAYOUT RETAINING WALL V 4-13DRM RESIDENCE Lot 16 A co STI ST2 `New 1250 Galton DC[] Septic Tank w/DCO' Decommissioned Old Septic Tank PER UPC NORTHRIM .-+'~I'"44 4 ENGINEERING AE. - N-4 , SteveEng.com PO Box 770724 7910 River, Alaska 99577 CE -SM lkv - *'* * . jw Dn-7 X:Z0,1 -7n'?S:? 4 21;��il'2 111.70' Lot 2 ROBINDALE LOT 17 WASTEWAT�DTTfR I 10 r-- 0 A n U <�'- ey ox Lot 18 1' = 30' RECORD LAYOUT 0 -0 rt QZ � ;D Z o Q0 o O 3 � +�,.oa�Mpppp 00 1-1:� :s N:• � co 0 O w m 3 X P hn cos Q- M M orO go C+ r- o ro Ul ro -1 < D m p z � C o H :3 h ro o 00 � z OD z Q m z o m c` F ro � F- N m n o c+ S O Q oM w -3Q OD co " j F— /70 /70 N 0 F'l M td n OD z o rD �D D m :n mrD M M m 0 O w m 3 X P hn cos Q- M M orO go C+ r- o ro Ul ro -1 < O p C o :3 h ro o 00 OD Q O m c` F ro � N n o c+ O Q oM -3Q v co v< Q 0 pC rD �D Ln m mrD M < �P QLto oC+:5 o�� °° Ln .� W (DN 00 OD D r0 Q O c C+ Ln td rp C+ r0 w ro O _0 C+ -i n r :3 Q n s � 90 ro n 3- Lot 16 'N 89'55'25"E .-111.70' r -SEPTIC PIPES Ir E S 89'55 :N FENCE 4z' ID - 17.6' 31.0' Lot 17 w 16,476 S.F. T N O ' O -....o Lot 18 /CHAIN-LINK FENCE NOTES: 1) THE LOT IS SERVED BY A COMMUNITY WATER Lot 2 SYSTEM. 2) DUE TO SNOW & ICE COVER, SOME SURFACE LEVEL FEATURES ARE APPROXIMATE. PLOT PLAN ___ AS BUILT _X_ SCALE _ 1" __ 30' _ GRID _ NW 1561 Project No 22-072/ Associates, 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lan & A S S o c i a t e S inc. (907) 522-6476 Phone 9 (907) 522-4625 Fax Professional Land Surveyors ken®langsurvey.com OF Jonathan®langsurvey.com ©'`� '' '9514 1 hereby certify that I have surveyed the following described property: LOT 17, ROBINDALE SUBDIVISION (PLAT No. P-591) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the _ 11 _ Day of ___ at Anchorage, Alaska 1 It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. '(,A, Q' . I- V1 '49TH �* KENNET G. L4 G o ---LA202.­* y o 44��h�'�E'SSIONAG � as AECC963 G RETAINING WALL)/ 4.0'x8.1' PORCH 16.0 Z 20.4' o O .0" O G� . SPLIT—LEVEL ao RESIDENCE 34.4' 18.8' COVERED DECK v in 2.3'x8.8' CANT r -SEPTIC PIPES Ir E S 89'55 :N FENCE 4z' ID - 17.6' 31.0' Lot 17 w 16,476 S.F. T N O ' O -....o Lot 18 /CHAIN-LINK FENCE NOTES: 1) THE LOT IS SERVED BY A COMMUNITY WATER Lot 2 SYSTEM. 2) DUE TO SNOW & ICE COVER, SOME SURFACE LEVEL FEATURES ARE APPROXIMATE. PLOT PLAN ___ AS BUILT _X_ SCALE _ 1" __ 30' _ GRID _ NW 1561 Project No 22-072/ Associates, 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lan & A S S o c i a t e S inc. (907) 522-6476 Phone 9 (907) 522-4625 Fax Professional Land Surveyors ken®langsurvey.com OF Jonathan®langsurvey.com ©'`� '' '9514 1 hereby certify that I have surveyed the following described property: LOT 17, ROBINDALE SUBDIVISION (PLAT No. P-591) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the _ 11 _ Day of ___ at Anchorage, Alaska 1 It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. '(,A, Q' . I- V1 '49TH �* KENNET G. L4 G o ---LA202.­* y o 44��h�'�E'SSIONAG � as AECC963 .,N! '°__ip•(4 MUNICIPALITY OF ANCHORAGE ,,renr • On-Site Water&Wastewater Program co �, ifr . •�r PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 r; S •c I http:l/www.muni.orglonsite ' Depart Mull( On-Site Wastewater Disposal System Permit Permit Number: OSP181198 Effective Date: 7/18/2018 Work Type: SepticTank Upgrade Expiration Date: 7/18/2019 Tax Code Number: 05105319000 Site Legal Address: ROBINDALE LT 17 G:1561 Site Mailing Address: 24034 SUNNYSIDE DR, Chugiak Owner: FRANK CLIFFORD H Lot Size in Sq Ft: 15000 Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: O. // Date: 7/'i /d 1 . 6VL. / /Issued By: 'i X,e-CQ7 Date: !�� MUNICEPALEITY OF ANCH �AGE • Community Development Department �= Phone. 'S.1343-,,°44 Development Services Division '' F- '":67-343-7•• On-Site Water & Wastewater Program cv ON-SITE SEWER/WELL PERMIT APPLICATION JUL 11 2018 I. c ti Parcel I.D. 0374 5.3/9 6 8 Lei Property owner(s) t�A�t/� Day phone 3 • - z 77.z Mailing address Zcf034t 8,-- Site address �►^t_ J Legal description (Sub'd., Block & Lot) ,epjridc (4- L l7 Legal description (Township, Range & Section) Lot Size A.5 066 Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (E)all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. PE f property owner or a orized agent) (Signature p p Y 9 ) Permit/Rush Fees: it2AS• 00 Waiver Fees: Date of Payment: 7M /1g Date of Payment: Receipt Number: on Receipt Number: Permit No. OST 181 Icy?,D Waiver No. Permit App_9-1-12.doc TF-�1 M ENGINEERING SteveEng.com Steve Eng, PE, PH 907-694-7028 SteveEngPE@gmail.com Date: 7/12/18 Number of Pages: To: MOA On-Site Services Subject: Robindale Lot 17 Septic Tank Failure The subject septic tank has failed-a new tank will replace the old one. The existing trench appears to be working OK. Please issue a permit so the tank can be replaced. The existing trench will remain. Please review as soon as possible. If there is need for additional information or clarification please give me a call. Thanks-Ste \ RTT—SIM ENGINEERING SteveEng.com Robindale Lot 17 SPECIFICATIONS& DESIGN GUIDELINES Wastewater System Sizing: This is an existing 4-bedroom home.Most of the neighboring lots are developed. The current septic tank has failed-the trench still functions. These lots are served by public water&private wells.No adverse impacts are expected from tank replacement.No easements are present on the lot. The slope is indicated in the area of the septic system. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC)& State of Alaska Drinking Water Regulations and Wastewater Regulations. • New 2-compartment, 1250 gallon septic tank. Watertight couplings on inlet&outlet. • 5' minimum between the tank and trench. 10' to property lines&house. • 4' of cover or insulation is required for tank; an equivalent of 1" insulation for 1' foot soil cover. Minimum of 2' soil with insulation. Tank&solid pipe must be set on well compacted, stable soil. • 4" diameter cleanouts with airtight caps are required 1' to 4' from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field,not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level. • In solid pipe runs,ASTM D-3034 may be used in lieu of cast iron. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron,PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2%slope. • Septic Tank to be pumped every two years or when required. • Insulation board to be extruded direct burial polystyrene(Dow Styrofoam HI/equal) oF Steven W.Eng •• 4P� 6256p • �� ft:SIGN NOTES: 1 . Existing Trench R-mains In Place. 2. Sewer Service Lin - minimum 2% slope. 3. Decom - • '- - e _ _ • - _ _ _ Sunnyside Dr Connect New Tan To 1 xisting Trench. ey 4. Lot Served by P bl c ater. � box 5. No Conflicts Wit in 20'x'. 6. Check Condition Of S_wer Service Line— Replace If Nece-.sa y. 7. Add Double Clef no is Before Tank If No F O. 2 Well boa Flat Slope Flat Slope 4-Bdrm 1111.1 Septic Area Ap DCD New 1250 Gallon Septic Tank w/DC❑ 's Flat CLocation Decommission Old Trenh Septic Tank PER UPC Flat Slope Septic Area NORTHRIM R❑BINDALE ENGINEERING . \*\49 SteveEng. com �m � \ L❑T 17 ( DESIGN PO Po Box 770724 = LAYOUT Eagle ,c1-emb.... WASTEWATER UPGRADE 907.694.7028 71/111 l�( l REPLACE SEPTIC TANK DeM1i18 EEo f 3 Foundation Cleanout Tank Cleanouts Fin aade Opposing Cleanouts Between Septic Tank & Trench 4 Foot Cover or Equal t— I---� 1250 Gallon Steel To Trench 'Anchorage Tank' Or Equal lid Pipe Match Elevations To DESIGN NOTES: Existing FC❑ & Line 1. Use Existing Trench. 2. Septic Tank & Solid Pipe to be Placed on Compacted, Stable Soil, Free from Boulders. 3. Sewer Service Line is Minimum 2% Slope & 3' Cover. 4. Water-Tight Couplings. 5. See Specification Sheet. 6. All Work To Conform to Municipality of Anchorage (AMC) Requirements & Specifications. 7. Decommission Old Septic Tank Per UPC. 8. If No FCC', Install DC❑'s. NOR THR/M _4,. of A + ENGINEERING ;, . +++ SEPTIC TANK PROFILE R❑BINDALE SteveEng.com 1* :4913:1 *; Po Box 770724 • SUN, • t L❑T 17 Eagle River, Alosko 99577 +• asa - s 907.694.7028 '+1 7fl�� ' TANK REPLACEMENT DOtE 7/11/18 'Drawn BY: SE (Scope: 1• = 5 ' I SMEET:3 of 3 SE I *, LOT 3 x \ I x N LOT 19 N. I 4- q 6o} x I w<o .� 4.1c,~W c q ��D`� in ri, ,..., LEGEND: o=o in Z NO (C)=CALCULATED DATA �. C4 Y (M)=MEASURED DATA (R)=RECORD DATA PER PLAT P-591 W W _0 O (R1)=CALCULATED DATA PER PLAT 84-10 4 1:11I - ohu=OVERHEAD UTILITIES (Ni 4., Z c CO Cl) (TYP.)=TYPICAL 0 0 d z W� LOT 18 to co a� H 3> N00'07'00"W 147.50'(R&C) O 20' z U) w 4 x (t) U x CV cJ s GRA VEL 0� \ I 37'± SWAY a ®u���` ._ 50'± Z 48.3' J U S _ w c O x4.� J Z O t\ (c.,- -4.6-2 Z 18.o' x W O 5 __ ,'� `�" " x it ^' m `L 0 w o °°\ I— OO� z11-1 LO x GRA VEL 2s.s'._.\ x rns DRIVEWAY r/—A \ Q °i w Q aJ C1 Q_ 1 \\ --J Q' Z a0 3 Z \fn Q_ W Q' m 6<< YW LOT 17 ' � Z ���• U cn W 0 (n W V) 0w 16,476 S.F. ixw >-,Y N00'07'00"W 147.50'(R&C) 0-3° LOT 16 NOTES: 1. EXCEPTING FOR GROSS NEGLIGENCE, THE LIABILITY FOR THIS SURVEY SHALL NOT EXCEED THE COST OF PREPARING THIS SURVEY. 2. THIS SURVEY REPRESENTS VISIBLE IMPROVEMENTS & CONDITIONS ON THE DATE OF SURVEY. 3. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY & IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. 4. THIS SURVEY SUBSTANTIALLY COMPLIES WITH ASPLS MORTGAGE STANDARDS. 5. TIES TO PARTIALLY MONUMENTED OR UNMONUMENTED PROPERTY LINES ARE ±1 FT. 6. THIS SURVEY PERFORMED FOR CLIFFORD FRANK, IT SHOULD ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION. REUSE OF THIS DRAWING FOR ANY PURPOSE NOT STATED ABOVE WITHOUT THE EXPRESS WRITTEN CONSENT OF ALASKA RIM ENGINEERING, INC. IS A VIOLATION OF FEDERAL COPYRIGHT LAW. 7. THIS LOT SERVED BY A COMMUNITY WATER SYSTEM. EXCLUSION NOTE: IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. loNut1111111 AS-BUILT ALASKA RIM ENGINEERING, INC. �� `�•OF• !44 gips 9131 E. FRONTAGE RD., SUITE 1 ��� P•.•° °•'9�� � PALMER, ALASKA 99645 �� S;° ' PH: (907)745-0222 : FAX: (907)746-0222 .: °•°••9 �� "°°"'°'° °` EMAIL: akrim®alaskarim.com : WEB: www.alaskarim.com 5 ./ T ° • 49 — /� ~ WO: 1500299 .... . ...°°°°°°°. FB: 15-06 1:..... PAGE: 1 of 1 GRID: NW1561 OW i p• • O Engineers: Planners: Surveyors SCALE: 1 " = 40' FILE: 1500299AS o A: RJ. Farmer •�o .. Ir0,,'•• 10615-S ...V.A..: •;JQ-'�. I HEREBY CERTIFY THAT A MORTGAGE INSPECTION WAS PERFORMED t�/�I9111... R�FESSIUNpL�; �`' B NDALE SUBDIVISION,UNDER MY DIRECTION N LOT 17THE L PLAT No.LOWING EP-591,D PROPERTY: 111111������� ANCHORAGE RECORDING DISTRICT, ANCHORAGE, ALASKA. I //4if SURVEYED ON THE 11th OF MAY, 2015. ©2015  MUNICIPALITY OF ANCHORAGE , DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage. Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE [] NEW MAILING ADDRESS . LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS ~ ~ Manufacturer Material ~o. of compar~ents Li~. capacity in gallons inside length Width Liquid depth ~ O IF HOME.DE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O Z ~ Manufacturer Material Liquid capacity in gallons ~ Well Found¢~n Nearest lot line PERMIT ~ DISTANCE TO: /~ ~ ~____ /~ w ~ ~ ~ ~ No. of lines Length of ~h~e ~ Total length of lines Trench wid~ Distance between lines _ J 7~ ~ ~ inches ~ ~ ~ Top of tile to finish grade· ~ ~ Material beneath tile ~ ~ ' inches Total effective~absorption~ea Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line m DISTANCE TO: ~ Class ~ '~ Depth Driller Distance to lot line PERMIT NO. ~~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATING / ¢0 ~ ~<'' R EMAR KS Al R~4 ~~ DATE LEGAL ........... 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MUNICIPAL ITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch ~-B50, Ancqoragr, Alaska 9950~ ~76-22u-I SOILS LOG - PE ~;COLATION TES" SOILS LOG PERCOLATION TEST \ 5 Il T~ 'm/u,) ~ :6' i/xx \ WAS GROUND WATER ~ O ~'/~' /~/'/ ~/i'~ ENCOUN1 ERED IF¥=S,A W~,~ ' DEF.-H? 2 3 5 6 7 8 9 10 /1 12 13 14 1! / Date G ss Net Deoth zo Net Reading T no Time Water Drop 008 {7/7G) ' ' '~" DATE RECEIVED " " INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE I NSP ECTOR INSPECTOR I NSP ECTOR MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 i~) ENV, RONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. I PHONE 1. P~ERTYOWNER E~~ PROPERTY R ESI DENT (If different from above) PHQNE 3 LENDING INSTITUTION 0 / ~ / ~ ~ PHONE MAILING A~RESS , 4, R~LTOR/AGENT ~, / . ~~ PHONE MAILING ADDRESS w ,~ , 5. LEGAL DESCRIPTION ST R.F~B.T LOCATION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One ~ Four [] Other~ [] SINGLE FAMILY [] Two [] Five ~ MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY INDIVIDUAL* COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM J~ INDIVIDUAL/ON-SITE** /9 ~ ~ YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev, 6/79) THIS SIDE FOR OFFICIAL USE ONLY I. TYPE OF RESIDENCE NUMBER OF BEDROOMS PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL  DATE DRILLED COMMUNITY PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ~'TNDIVIDUAL/ON -SITE DATE INSTALLED Connection Verified INSTALLER Size: /_% ~"'~:) If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holdin9 Tank Absorption Area ISewer Line I Nearest Lot Line I I Absorption Area to nearest Lot Line 5, COMMENTS [] CONDITIONAL APPROVAL {letter must accompany certificate) I~ DISAPPBOVED Inspector Inspector Inspector Co~ments ~ /~ '~. ~ ~~ ConditionalApproval Date ~e~r Installed Permit ~o. Septic Tank Size t~ ~ '~ ~ Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY A dd Realty Co. & Agent Phone Legal Description ~ ~~ z / , Type of Residence  Single Family Multiple Family No. of Bedrooms ~ ~ Other Water Supply lndividual' A~ACH WELL LOG. A well log is required for all wells drilled since June Oommunity 1975. For wells drilled prior to that date, give well depth (attach log if ~ Public Utilit~ available.) Sewage Disposal / ~ ~ ~ Individual Year Individual Installed: When Connected to Public Utility: / ,~ Public Utility ~-, ~ Holdin~ Tank ~ NOTE: THE INSPEOTION FEE MUST AOOOMPANY EAOH REQUEST BEFORE PROCESSING CAN BE INITIATED. MUN,C.PAL,TV OF ANC.O.A E ....  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES i DIRECTIONS: CompLete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER I PHONE Ira E. WalkerI 333-6025 MAILING ADDRESS 6208 Staedem Drive 99504 PROPERTY RESIDENT (If differeet from above) PHONE 2. BUYER PHONE James O. Stephens 688-3250 MAILING ADDRESS Post Office Box 698 99577 3, LENDING INSTITUTION J PHONE Lomas and Nettleton CompanyI 274-7661 MAILING ADDRESS 4449 Business Park Boulevard 99503 4. REALTOR/AGENT I PHONE Chugiak--Eagle River Realty, Inc. % Betty J. FieldsI 694-3355 MAI LING ADDRESS Post Office Box F 99567 5. LEGALDESCRIPTION Lot 17 Robindale Subdivision SIREET LOCATION Sunnyside Drive - Chugiak 6. TYPE OF RESIDENCE [] SINGLE FAMILY :~× MULTIPLE FAMILY NUMBER OFBEDROOMS [] One [] Four [] Two ~ Five [] Three [] Six [] Other 7. WATER SUPPLY [] INDIVIDUAL* COMMUNITY [] PUBLIC UTILITY *ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~× INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS -TIME TIME 'rIME -DATE DATE DATE INSPECTOR INSPECTOR i INSPECTOR DIRECTIONS: 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E~ INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified iNSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCESwELL TO: Septic/Holding Tank _Abs°rpti°n Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ~ APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED LEGAL DESCRIPTION ~ 72-010 (Rev, 3/78)  MUNICIPALITY OF ANCHORAGE 'Dep rtment of Health and Environmental Prote~t'zon /[~~ 825 L Street, Anchorage, 99.~.01 -'i~-- ~equest for Approval of Individual Sewer and Water Facilities 1. Property Owner: g~zL.g~ Mailing Address: 6208 $~ D~ /~~,~.9~50~ Phone: ~33-6025 e Name of Buyer: Mailing Address: ~.O. Box 698 ~ ~,~.99577 Phone Lending Institution: ~oms~ ~ Re~ Co. Mailing Address: 4~49 Bu~.~A ~.~m!~,~.99503 Phone: 27~-766~ Realtor/Agent: Chag~-~g~ P~D;~ ~e~L~,~ac./Be~ ~.7;~i~ Mailing address: P.O.~ox "~" ~,~£.99567 Phone: 69~-3355 Legal Description StreW% Location: $~ Single Family Residence: ( Number of Bedrooms: Multiple Family Residence: x) Number of Bedrooms: _~ {~'~) Water Supply: *Individual Well ( ) If Individual Well, well depth If Community System, name of system Public/Community System (x) 8. Sewage Disposal System: On-site System If On-site System, date of installation: ~ * Con/car.~ ?auZ ~ 694-2408 S~ ( ~ Public System ( ) *NOTE: A well log is required on ALL wells drilled since 6/75. If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77 N 47. 50 ~0 144. Il 664.0 "1~" 147. 50 147,42 I 4 7. ;54 147.1B 0 ¢ Lo 0 144.50 147=10~ MUNICIPALITY OF ANCHORAGE Development Services Department t "J Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-053-19 1. GENERAL INFORMATION Expiration Date: _ 2_-1 � -2 0?_ Ll Complete legal description ROBINDALE LT 17 Location (site address) 24034 Sunnyside Dr Current property owner(s) Goulet Day phone 230-1196 Mailing address Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Private Well ❑ Water Storage ❑ Community Well ❑ Public Water System El Waiver request for: TYPE OF WASTEWATER DISPOSAL: Private Septic Fx_1 Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $_ -550 Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number COSA # OSG 2210.E Waiver # Distance: S. 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 2/10/22 :cl)�P�� 6. DSD SIGNATURE s f♦ st4k Eng_ System #1 Approved for bedrooms �4f ct_=szset :. �� -- System #2 Approved for bedrooms _. �i® %` 1.0 / 2 Disapproved Conditional approval for bedrooms, with the following stipulations: 1,6 ��o RQGF,q ER FN v J))))))))))1"\, B)'= t,.`-- Original Certificate Date:�"Z� z2 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Ct ec%list blue sheet Legal Description: ROBINDALE LT 17 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments B. TANK DATA Age of tank(s) 2.5 years Tank type/material Stl Measured operating fluid level in septic tank 51 ❑ Standpipes/foundation cleanout per record drawing Date of pumping new D. ABSORPTION FIELD DATA 9/26/78 Which system tested (date installed) same ❑ ALL standpipes present per record drawing Total measured depth from grade 11 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 ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 051-053-19 Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 2118122 Results Q✓ Pass For 4 bedrooms Fluid depth prior to test 6 in Water added 600 gal New depth 12 in Elapsed time 30 min Final fluid depth 6 in Absorption rate 600 gpd Any rejuvenation treatment (past 12 months) no If yes, enter date 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' L!J Community Sewer Manhole/Cleanout > 100' E] Yes if No ft 0Yes if No I, Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25E3 Yes if No fi Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' n Yes if No f1 Neighboring Absorption Fields > 100' Q Animal Containment > 50' n Yes if No f1 n Yes if No ft if No ft Community Wells > 200' Cj Yes if No ft Surface Water > 100' Manure/Animal Excreta Storage > 100' Yes Community Sewer Main > 75' [:1 Yes if No ft E] Yes if No fl From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' E,]-Yes,.Yes.-if No ft Surface Water> 100' Iv- Yes if No ft Property Line > 5 L!J Yes if No ft Wells on Adjacent Lots: Absorption Field > 5* Q Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10* Q Yes if No ft Community Wells > 200' Yes if No It Water Service Line > 10' Q Yes 'if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if toss than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 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' Cj Yes if No ft Surface Water > 100' Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION / certify that / 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. .... .... .... .... stew E. CE -62569