HomeMy WebLinkAboutBIRCH HILLS ESTATES #1 BLK 1 LT 7Ai ch Hills
states
lock I
Lot 7A
050-082
-04
Permit Number:
Tax Code Number:
Work Type:
On-Site Wastewater Disposal System Permit
OSPl11053
05008204000
Septic
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Upgrade
Permit Effective Dates: May 04, 2011 to May 03, 2012
Design Engineer: DOUGLAS T KENLEY
Subdivision: BIRCH HILLS ESTATES #1
Site Legal Address: BIRCH HILLS ESTATES #1 BLK
Owner/Address: GAINES PHILLIP & MARGARET
12137 DEE LANE EAGLE RIVER AK 995777901
1LT 7A G:0253
Site Mailing Address: 12137 DEE LN, Eagle River
Lot Size in Sq Ft: 25033
Total Bedrooms: 4
This permit is for the construction of:
N Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with: 1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By:
Date:
Date:
J UNICIPALITY
Community Development Department
Development Services Division
On-Site Water & Wastewater Program
Mayor Dan Sullivan
OF ANCHORAGE
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
Property owner(s)
Mailing address
Day phone
Site address /-¢_1 '_~-7 ,~ ~-~,r~,
Legal description (Sub'd., Block & Lot) ~.31 ¢or~ ~,'(f ~7~<Y~¢
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms
THIS APPLICATION IS FOR:
(~ all that apply)
Absorption Field
Septic Tank
Holding Tank
Privy
Private Well
Water Storage
THIS APPLICATION IS AN:
Initial []
Upgrade ,/~'
Renewal []
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
I certify that the above information is correct. I further certify that this application is being made
for a Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of p(operty ~¢rr~r or authorized agent)
Permit/Rush Fees:
Date of Payment: _~,~'/~,/,~/
Receipt Number: ~ ~d~ t ~_~
Permit No. _(~ ~;~ J%!
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
G:\Building\On Site\Forms\Client Forms\Permit App_010411 .doc (Rev. 1111 )
Douglas T. Kenley, P.E. 9860 E. Northstar Circle, Palmer, Alaska 99645 (907) 746-1073
REQUEST FOR PERMIT TO REPLACE TANK
LEGAL:
Birch Hills Estate S/D, Block 1, Lot 7A
LOCATION:
12137 Dee Lane, Eagle River, Alaska 99577.
OWNER:
Phillip Gaines
RESIDENCE:
Single Family, Four Bedrooms
WELL:
Private
SEPTIC SYSTEM:
From Municipal iRecords:
Tank: Steel, Two Compartment, 1,250 Gallon
Absorption System: Crib
Dimensions of Crib: 12x12, 6' effective depth
Soil Rating: 85 square feet per bedroom
Installation Date: tank, 9/21/7 l
DATE OF PUMPING: 9/22/10, McDonald's Pumping
On July 13, 2010, an adequacy test was performed by Jeffrey A. Gamess of Garness Engineering Group
for the purpose of obtaining a COSA so that Phillip Gaines could purchase the home on the above-
mentioned property. The system passed the adequacy test on the well and septic. In approximately March
of 2011, the septic tank collapsed and the owner contacted Bob Dean of Dean Construction to replace the
tank. Mr. Dean contacted Douglas T. Kenley, P.E. to do the engineering and obtain the permit that we are
requesting at this time.
The existing tank was within the 100' well radius. The new tank will be placed outside the 100' radius
and the old tank abandoned. This will have no effect on adjacent properties.
If there should be any questions concerning this matter, please phone either Douglas T. Kenley, P.E. at
746-1073 or Fred W. Kenley at 243-5372.
Sincerely:~ ~
Douglas T.
Civil Engineer //8176
SPRING
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cains, Phinip '1.~:'. CE-8176 -~
Birch Hills Estate ~1 S/D, Block 1 Lot 7~,~
..... ~ ~ ,~. ~,~ ~v~. ~ I~: " ...... o~o-o~-o~ I
~x~x~ I ........ ~T~ I .... ~ ~.= ~oo,I ........
?~'X 1 2'~
/EXISTING
CRIB
4/E
SI~qGLE
RESIDENCE
\
\
/
/
RETAINING WALL
SHED Lot
/
SHED~Lot 7A / / ~
/ /
/
/
/ /
EMPTY LOT
EMPTY LOT
h
X£PTIC
Lot 5
Lot 4
EXISTING FCO
EXISTING TANK TO BE ABANDONED
OLD 4" LINE TO CRIB
NEW 4" UNE TO CRIB
PROPOSED NEW 1250 GALLON SEPTIC TANK
NEW DLBE. CO'S
DOUGLAS T. KENLEY, P.E. civil Eng' ....
CUENT:
Ga~nes, Phillip
DESIGN
L~ Birch Hills Estates #1 S/D, Block 1, Lot 7A
~DRESS:12157 Dee Lane, Eagle River, AK
~*.' 49~ ~ ".*'~
GR"~TER ANCHORAGE AREA BOROL'"'H
DI:rARTMENT OF ENVIRONMENTAL OUALIi f
3S00 TUDOR ROAD ANCHORAGE, ALASKA ggS07 27D-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
SEPTIC TANK:
ADDRESS ~'. ~",
/
DISTANCE FROM WELl
LIQUID CAPACITY
NUMBER OF
-~'~ ~r ~? MATERIAL ~ ~x'~= ~'~ ~/' COMPARTMENTS
LIQUID
GALLONS. INSIDE LENGTH INSIDE WIDTH DEP~H~
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
NEAREST LOT LINE
OR WIDTH /~ ' LENGTH /,c~ /
~ ~ DEPTH (~ ~'
DISTANCE FROM WELl /z)~";~,-, ') /~ ~ ~'T' BUILDINO FOUNDAIION ~ /,
. TOTAL EFFECTIVE ABSORPIION AREA ~ALL AREA) ~ ~ SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL FOUNDATION
NUMBER OF LINES ,/'~ISTAN~ BE~S
ABSO"PTION AREA //' SO. FT. LENGTH
DEPTH: lOP OF TILE TO FINISH GRADE
., NEAREST LOT LINE
1RENCH WIDTH
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
OF LIN,~S
/
,"IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL:
LOT LINE
TYPE
DISTANCE FROM WATER
DEPTH ., BUILDING FOUNDATION SAMPLE
, TANK
SEWER LINE ~,'~VS~, -~E~SPOOI
,, NEAREST
OTHER
. SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE
c//?1/7/
GrEaTer ANCHORAGE aREA BOROUGH
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
INSTALLATION OF: SEPTIC TANK
so,L 'rssT RSSULTS /,"'_~.-~'~'/,.'C/,~
PERMIT NO. / ~J/~
SEEPAGE PI? ~ DRAIN FIELD
NOT~ THIS PERMIT IS HOT VALID WITHOUT SOIL
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCrS. REQUIREMENTe~
FOUNDATION TO SEEPAGE PIT '~'~ / DRAIN FIELD
SEPTIC TANK .
TO NEAREST LOT LINE.
SEPTIC TANK,, ~/' SEEPAGE PiT
ALSO CONSIDER AREA WELLS,
DRAIN FIELD
DIAGRAM OF SYSTEM
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
_ - i.i EALTH/Ai;~.H6R iTy'
Performed For O~rner: Garrison
Legal Description: Lot 7 Block,,,!
This Form Reports Soils~g, x'
3500 TUDOR ROAD /
ArlCHORAGE, ALASKA. 99502.'
Ji~s Landscaping ~ .
Date Performed
CASE
9/17/71
Subdivision Birch Hills Estate - Unit
Percolation Test
Depth
Feet Soil Characteristics
Was Ground
If Yes, At
Gray sandy gravel
(c~)
Water Encountered?
What Depth?,,
Reading Date i Gross Time ),,Jet Time
)Depth to H20 Net Dro~
Percolattnn
Proposed Insta'llation: Seepage Pit Drain Field
Depth Of Inlet Depth lo Bottom Of Pit Or Trench
COMMENTS: ' --
85 sauare feet 9f drainaRe area is required per bedroom.
lest Performed By, R. E. Carlisle Data Certified By: NaCZonai Testing ~vs. Inc.
Date: ~
September 23, 1980
Jack White Company
3201 C Street
Anchorage, Alaska 99502
Attention: Mr. Clarke
OCT 8.
RECElY -
Re:
Adequacy Test on Existing Sanitary Sewer System; Consisting of a
septic tank with a seepage pit, Lot; 7, Block 1, Birch Hill Estates
Subdivision ~1, Eagle River, Alaska
Dear Mr. Clarke:
Per your request of September 8, 1980, Dan Cooper of R&M Consultants con-
ducted a test of the sanitary sewer system on the above described property.
The test indicates acceptance rates determined under conditions at the time
tested. Actual system performance over long periods of time depend on
factors which cannot be evaluated by this test thus our office cannot
warrant the suitability or fitness of the system for either an extended period
of time or for user demand in excess of the expected flow noted herein.
Factors affecting system performance include:
o
o
o
Actual use demand on the system;
Flucuations in groundwater levels;
Physical conditions of the septic tank, leach field, trench or
seepage pit and soil.
It should be noted that while a septic'tank and leach field disposal system is
one of the most reliable methods of sewage treatment and disposal it is
nearly certain that the leach field or seepage pit will fail sometime during
the useful life of the structure. Studies indicate leach fields, trenchs and
pits have a life expectancy of ten to twelve years under optimum conditions.
All septic systems have a finite hydraulic loading capacity which can be
expected to decrease with time.
Because the house on the lot is not occupied, we assume that the seepage
pit was not at its normal degree of saturation. Because the house was not
occupied, 650 gallons of water was added to saturate the system. During
this test the liquid level in the septic tank was monitored as water was
added to the system. The measurements are summarized in the following
table.
Jack White Company
R&M No. 051001-72
· September 23, 1980
Page 2
DATA & CALCULATIONS FOR SEEPAGE PIT TEST
SUBJECT: Four Bedroom = 600 GPD Required Flow
DATE: September 19, 1980
1. TIME OF PUMPER ARRIVAL: 9:00 a.m,
SEPTIC TIME SEEPAGE TIME GALLONS GALLONS GALLONS TIM~
TANK PIT REMOVED REMOVED ADDED
LE~)EL LEVEL FROM TANK FROM PIT TO PIT
2. 4,0 9:00 6,25 9:00 750
3,
4. 4.0 9:10 7,5 9:10
5, 650
6, 4,0 9:18 6,5 9:18
7. 7.3 9:30 6.5 9:30 1000
Calculated specific capacity =
DATE: September 18, 1980
8. 7.3 10:10 6.8
750 = 50 gal./in.
1.25x12
19:10
(6.8 feet - 6.5 feet) (12 inches/foot) (50 gallons/inch) = 180 gallons
From: September 17, 1980 To: September 18, 1980
9:30 a,m, 10:10 a,m. = 24 hr. 40 min. = 1480 min.
1440 min./day 180 gallons
1480 min.
'175 G~llons'Per Day
9. 7.3 10:34 6.25 11:26' 220 11:26
Calculate measured effluent acceptance rate =
220 Gallons From: 9:00 a.m. Sept. 17, 1980 TO: 11:26 a.m. Sept. 18, 1980
Time = 26 hrs. 26 min. = 1586 min.
220 Gallons X
1586 min, 1440 min.
220 gal, X 1440 rain/day = 200 GPD
1586 min.
Jack White Company
R&M No. 051001-72
· September 23, 1980
Page 3
SEPTIC TIME SEEPAGE TIME CUMULATIVE TIME METER
TANK PIT GALLONS ADDED READING
LEVEL LEVEL TO SEEPAGE PIT
7.3 3:15 6.25 3:15 0 3:15
7.3 3:23 6.0 3:23 50 3:23
7.3 3:33 5.9 3:33 100 3:33
7.3 3:41 5.75 3:41 150 3:41
7.3 3:49 5.7 3:49 200 3:49
7.3 3:58 5.6 3:58 250 3:58
7.3 4:07 5.5 4:07 300 4:07
7.3 4:15 5.4 4:15 350 4:15
7.3 4:23 5.3 4:23 400 4:23
7.3 4:31 5.2 4:31 450 4:31
7.3 4:38 5.1 4:38 500 4:38
7.3 4:46 5.0 4:46 550 4:46
7.3 4:54 4.9 4:54 600 4:54
7.3 5:03 4.8 5:03 650 5:03
DATE: September 19~ 1980
7.3 1:45 6.6 1:45 0 1:45
7.3 2:10 6.25 2:10 150 2:10
7.3 4:09 4.8 4:09 910 4:09
DATE: September 20~ 1980
7.3 3:15 6.25
3:15
Calculate measured effluent acceptance rate =
910 Gallons
FROM: 5:03 p.m. Sept. 18~ 1980
TO: 4:09 p.m. Sept. 19~ 1980
Time = 23 hrs. 06 min. = 1386 min.
910 Gallons X
1386 min. 1440 min. 910 gal. X 1440 min/day = 945 GPD
1386 min.
Jack White Company
· R&M No. 051001-72
September 23, 1980
Page 4
If the four bedroom residence on the property is to house eight people, the
average load on the system can be expected to be 600 gallons per day or
0.42 gallons per minute. During the test, the system accepted 910 gallons
in 1388 minutes. This indicates an average effluent acceptance rate of
approxi~nately 0.68 gallons per minute at the time of the test.
We can therefore conclude that the system is disposing of effluent at an
adequate rate for a four bedroom residence.
We have appreciated this opportunity to be of service to you. Please contact
us if you have any questions concerning this test or if we can be of addi-
tional service.
Very truly yours,
R&M CONSULTANTS, INC.
Richard S. Giessel
Senior Engineer
RSG/j/atsi/o
UMMPAU7Y OF ANCHORAGE
( n
tF
Development Services Department ` :,' Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I. D. 050-082-04
1. GENERAL INFORMATION
Expiration Date
Complete legal description BIRCH HILLS ESTATES #1 BLOCK 1, LOT 7A
Location (site address) 12137 DEE LANE, EAGLE RIVER, AK 99577
l -/s z0Z(
Current property owner(s) ERIK J. NOSICH Day phone
Mailing address
Real estate agent
12137 DEE LANE, EAGLE RIVER. AK 99577
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
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 $ 412.50 COVID
Date of Payment � 2 - 31 `Z. Q
Receipt Number LI I 1 1 1 `3
COSA # OSC201704
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. 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 12/30/2020
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 •�(i
well and septic system. Therefore, any estimate of how long a system will function satisfactory g�Q:•' • •. �9���
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
•J
discrepancies exist can be given by First Water Consulting & FW CS *� iTH • . • ••:* Ij
6. DSD SIGNATURE/
Curtis Huffman
System #1 Approved for bedrooms �0 �F�*.• CE 128991
��i ,��cQFO .11 2/30/,Z r
System #2 Approved for bedrooms 11
V1\\\\ROFESSIO
�~�
Disapproved
Conditional approval for bedrooms, with the following stipulations:
�/
44
By: �^^— �r 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 Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
Legal Description: BIRCH HILLS ESTATES #1 BLOCK 1, LOT 7A Parcel ID: 050-082-04
If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled PRE -1973
Total depth 78+ ft
Cased to 40+ ft
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 12/31/2020
Static water level at beginning of test 35 ft.
Well production at time of test 4.1 gpm
Comments
B. TANK DATA
Age of tank(s) 9 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 49"
® Standpipes/foundation cleanout per record drawing
Date of pumping 12/30/2020
D. ABSORPTION FIELD DATA
Water storage tank volume NA 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
FWGS
Date of Sample 12/30/2020 & 1/6/2021
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
Which system tested (date installed) 9/21/1971
Adequacy test date 12/31/2020
® ALL standpipes present per record drawing
Results Z Pass For 4 bedrooms
Total measured depth from grade *8 ft (max)
Fluid depth prior to test 4 in
Measured depth to pipe invert from grade *4 ft (min)
Water added 600 gal
❑ N/A — pressurized field
New depth 6 in
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective *4 INTO 6' ED.
Elapsed time 45 min
®Code -required soil cover over field
Final fluid depth 4 in
❑ System presoaked
Absorption rate 600 gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) N
date of test)
Gallons introduced gallons
*MT
If yes, enter date
WE
EXTENDS 48" BELOW TOP
OF CRIB. -x
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
® 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
l certify that 1 have determined through field inspections and review
of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date.TH
'1��
....1......
Curtis Huffman
����Fc��T , • •CE 128991
}t��iD� OFESS ONA�'4,AW
ft
ft
c, 6 7 ..9_.10
77
•
•
a
• Municipality of Anchor. -\/
On-Site Water and Wastewater Progra 7 j14 2041 .'•• L�I
(907)343-7904
Cv
6 ti
CERTIFICATE OF ON-SITE SYSTEMS A :6 9 5"
Parcel I.D. 050-082-04 Expiration Date:
1. GENERAL INFORMATION
Complete legal description BIRCH HILLS ESTATES#1 BLOCK 1, LOT 7A
Location (site address) 12137 DEE LANE, EAGLE RIVER,AK 99577
Current Property owner(s) STEVIE & BUCK BROWN Day phone
Mailing address 12137 DEE LANE, EAGLE RIVER,AK 99577
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY: Individual
Individual Well ® Holding Tank ❑
Individual Water Storage ❑ Community ❑
Community Class Well ❑ Public Sewer ❑
Public Water System ❑
WaiverNariance request for: Distance:
Received by: d0f/.1// // �/_• Date: ///
!9
COSA to be released to the engineer,unless oth ydsikquested by the engineer.
COSA Fee $ Sc'o. D° Waiver Fee $
Date of Payment [bc{t t 9 Date of Payment
Receipt Number OgO(l Receipt Number
COSA# ()CCM DOO Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ARCTERRA CONSULTING,INC. Phone 696-6111
Address 20441 PTARMIGAN BLVD.,EAGLE RIVER,AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 1/8/2019
THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED
WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with
ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested.
The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use,
local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the
system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function
satisfactory for current or future occupants or can ArcTerra guarantee that no unseen Nek
encroachments,deficiencies or discrepancies exist.
Air v
6. DSD SIGNATURE '
System #1 Approved for LI bedrooms. — '�
` r KENNETH N1. 4 .
System #2 Approved for bedrooms. ` �
;� ';6
1 �r
Disapproved. ` PiiopEs,,o �\'
Conditional approval for bedrooms, with the following stipulations:
ON-SITE G110%.� N►ATER AND
E
WASTEWATR o
c`2T pROGRA-N►—l'
lip s FR 1\v:
By: 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 Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10-10-12.doc
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: BIRCH HILLS ESTATES#1 BLOCK ", LOT 7A Parcel ID: 050-082-04
A. WELL DATA -PER MOA RECORD DOCUMENTS
Well type PRVT If A, B, or C provide PWSID# Well Log (Y/N) N______..____
Date completed PRE-1973 Sanitary seal (Y/N)Y Wires properly protected (Y/N)Y
Total depth 78+_ft. Cased to 40+ ft. Casing height(above ground) 18 in.
FROM WELL LOG AT INSPECTION
Date of test .. 10.23-2017
Static water level •• ft. 35 ft.
Well production -- g.p.m. 4.2 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 6.78 mg/L
Arsenic: ND ug/L Date of sample: 01/02/2019 Collected by: ARCTERRA
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC 1 STEEL Date installed 5/6/2011
Tank size 1250 gal. Number of Compartments 2 Cleanouts(Y/N)Y
Foundation cleanout(Y/N)Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 01/031019 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA—MT EXTENDS 46"BELOW TOP OF CRIB=3.8'OF SOIL COVER
Date installed 9/21/1971 Soil rating (g.p.d./ft2 or ft2/bdrm) 85 System type CRIB
Length 12 ft. Width 12 ft. Gravel below pipe 6 _ ft.
Total depth 7.6 ft. (Measured 10/23/17) Eff. absorption area 288+ftMonitoring tube Y Depression over field N
Date of adequacy test 10.23-2017*INSPECTED 112119 Results(Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 4 in.
Elapsed Time: 15 min. Final fluid depth 0 in. Absorption rate >=600 g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N &type) N _____ If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at - in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ _ Holding tank 100'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation _ 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 5'+
Curtain drain 50'+(NONE KNOWN__ Wells on adjacent lots 100'+
F. COMMENTS
*Field inspected on 01/02/2019 with no visible signs of change from observations at testing 10/23/17.
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. �+ \
Air OFAI,q \
Engineer's Printed Name KENNETH M.DUFFUS /<S, 111
Date 0110812019 " * 9*
iirimpowe
COSA canary sheet_2-6-15.doc • � - r�/�
% KENNET!
•a
>kitz.» /P w G`/
'%P.Essto�a�'
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT �[`�.7 ) 907-343-7904
On-Site Water and Wastewater Section \ Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory
Certificate of On-Site Systems Approval #0SC191OO8
Subdivision: birch Hills Estates , Block: 1, Lot: 7A
A water sample revealed a nitrate concentration of 6.78 milligrams per liter (mg/L).
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. 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
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids,and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using'a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Mailing Address: P.0.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org
•
• GG/
Municipality of Anchorage
On-Site Water and Wastewater Program
(907) 343-7904 5 . „
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-082-04 Expiration Date: c2 - 13`tS
1. GENERAL INFORMATION
Complete legal description BIRCH HILLS ESTATES#1 BLOCK 1, LOT 7A
Location (site address) 12137 DEE LANE, EAGLE RIVER,AK 99577
Current Property owner(s) SEC. OF HOUSING&URBAN DEV. Day phone
Mailing address 2401 NW 23RD Street, Ste#1d, Oklahoma City, OK 73107
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
0 Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY: Individual
Individual Well ® Holding Tank ❑
Individual Water Storage ❑ Community ❑
Community Class_Well ❑ Public Sewer ❑
Public Water System 0
WaiverNariance request for: Distance:
Date: II�
Received by: I � J�7
COSA to be released to,efFraneer, unless otherwise requested by the engineer.
COSA Fee $ 5 Waiver Fee $
Date of Payment 1 ! !�jIj7 Date of Payment
Receipt Number 0611D Receipt Number
COSA# OSCIe416 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER,AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 11/7/2017
THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED
WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with
ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested.
The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use,
local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the
system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function
satisfactory for current or future occupants or can ArcTerra guarantee that no unseen
encroachments,deficiencies or discrepancies exist. Air '
/� �tSt1 '
6. DSD SIGNATURE ' ;
* 4 9 1I 11 / „rib
System #1 Approved for I' bedrooms. KENNETH �
.�t
System#2 Approved for bedrooms. ,4 s^�� ` 7116 ��;� /
Air
e, / 7 is
Disapproved, 11 PAOPF.; to � Air
Conditional approval for bedrooms, with the following stirm4ations:
1 OF
'. ON-SITE %.
WATER AND '
WASTEWATER
PROGRAM
o�`�SERUA-��a
By: L 'I / Original Certificate Date: I /44/1- I ` 1 7
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 Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10.10.12.doc
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: BIRCH HILLS ESTATES#1 BLOCK 1, LOT 7A Parcel ID: 050-082-04
A. WELL DATA -PER MOA RECORD DOCUMENTS
Well type PRVT If A, B, or C provide PWSID # Well Log (Y/N) N
Date completed PRE-1973 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 78+ ft. Cased to 40+ ft. Casing height (above ground) 18 in.
FROM WELL LOG AT INSPECTION
Date of test -- 10-23-2017
Static water level -- ft. 35 ft.
Well production g.p.m. 4.2 _ g.p.m.
WATER SAMPLE RESULTS:
Coliform MEG colonies/100 mL Nitrate 7.82 mg/L
Arsenic: ND ug/L Date of sample: 1.0123117 Collected by ARCTERRA
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SEPTIC I STEEL Date installed 516/2011
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 10123/2017 Pumper One Stop
C. ABSORPTION FIELD DATA — MT EXTENDS 46"BELOW TOP OF CRIB= 3.8'OF SOIL COVER
Date installed 912111.911 Soil rating (g.p.d./ft2 or ft2/bdrm) 85 System type CRIB
Length 12 ft. Width 12 ft. Gravel below pipe 6 ft.
Total depth 7.6 ft. (Measured 10/23/17) Eff. absorption area 288+ft2 Monitoring tube Y Depression over field N
Date of adequacy test 10-23.2017 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 4 in.
Elapsed Time: 15 min. Final fluid depth _0 in. Absorption rate >= 600 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N &type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons _ Manhole/Access(YIN)
"Pump on" level at in. "Pump off" level at _ in. High water alarm level at_ in.
Datum Cycles tested Meets alarm &circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 1001+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Holding tank 100'+
Animal containment areas 50'+ Manure/animal excrete storage areas 1001+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ _ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 5'+
Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 100'+
F. COMMENTS
CRIB PRESOAKED PER CODE PRIOR TO TESTING.
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 COSHuidelines in effect on this date.
g �, OF 9j �
Engineer's Printed Name KENNETH M.DUFFUS �. •l- `
Date 11/7/2017 ,t:/49TH
'Ai
A WWW
yf�
COSA canary sheet_2-6-15.doc / '
• ter KEN/NE:T' ► /
•%,„ /f 7 <,°Al
I %.st -
```.411f
•
• Municipality of Anchorage
s
Development Services Department =°,444
Building Safety Division
51. T
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
N itrate Advisory
Certificate of On-Site Systems Approval # OSC 171525
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 1, Lot 7A
of Birch Hills Estates #1 subdivision. This inspection revealed a nitrate
concentration of 7.82 milligrams per liter (mg/L) was reported for the
property's well water sample. 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.
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.
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble
in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass
rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is
in the form of ammonia or protein first, which through contact with oxygen and certain
bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from
wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also
result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or
three years, but is associated with a potentially fatal infant disease called
methemoglobinemia. In the digestive system of young children, nitrate converts to
nitrite, which can pass through the intestinal wall into the blood stream. There it
combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The
EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The
standard has been lowered from a previous level of 45 mg/L set by the US Public Health
Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and
other common home water treatment systems such as softening or iron filtration does not
readily remove nitrate. The best method for limiting nitrate in well water is source
control. This can include avoiding overdosing of fertilizer near the well and maintaining
good separation distances between septic tank leach fields and the well. A special anion
exchange filter that contains a media with a strong affinity for negatively charged ions in
water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical"
methods using a spectrophotometer to read the final color endpoint. Specific ion
electrodes also can be used to detect the activity of nitrate in water. This laboratory uses
several different wet chemical methods approved under the public water supply
laboratory certification program. They also have test kits available, which the laboratory
uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test
kit results against a certified analysis from the lab occasionally to verify the accuracy of
the kit. We recommend using a specially prepared bottle that has been rinsed in
hydrochloric acid for collecting samples.
Parcel I.D.
1.
CERTIFICATE
FOR A
GENERAL INFORMATION
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
47.00 Bmgaw. S.:tre¢t
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
OF 0N-SITE SYSTEHS
SINGLE FAIVlILY DWELLING
Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
BIRCH HILLS ESTATES #1 BLOCK 1, LOT 7A
12157 DEE LANE *EAGLE RIVER, AK 99577
THOMAS POLOQUIN & CHRISTINA TOWNSEND Day phone
12157 DEE LANE *EAGLE RIVER, AK 99577
Day phone
BOB RINK W/ DYNAMIC PROPERTIES Day phone
5111 C STREET *ANCHORAGE~ AK 99503
C/O AGENT
261-7619
UnlesS otherwise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 4
3" TYPE OF wATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
IndMdual Well · Individual On-site ·
Individual Water Storage [] Individual Holding tank []
Community Class__Well [] Community On-site []
Public Water System [] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
v,~,,u~,,u,, ~,=,~ o,,~,wn below, I verify that
As cerlified by my seal affixed hereto and as of the "-""-"~ .,.,A ~^. , · ..~ ,
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 t,ge Municipafity 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 GARNESS ENGINEERING GROUP, Ltd.
Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Phone 537-6179
Date. .~/~!,C~
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the.time of the test, and separation
distances measured to readily identifiable features. The operational life of afl wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG,. LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
DSD SIGNATURE
Approved for ~
Disapproved.
Conditional approval for
bedrooms.
ness..-'
WATERAND ·
[ WASTEWATER
bedrooms, with the following stipulations: ~"..
..
Attachments: COSA Checklist
Septic System Advisory
Well Flow Advisory
(Rev. 11/~)
Arsenic Advisory.
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Municipality of Anchorage
Development ServiCes Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 1.96650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS
Legal Description: BIRCH HILL ESTATES #1 BLOCK 1
APPROVAL CHECKLIST
LOT 7A Parcel ID:
WELL DATA *PER GE(; INSPECTION.
Well type PRIVATE If A, B, or C provide PWSlD# N/A
Date corn pleted PRE- 1975 Sanitary seal (Y/N) YES
Total depth *79+ ff. Cased
Well Log (Y/N)
Wires properlY protected (Y/N)
Casing height (above ground)
NO
YES
12+ .in.
FROM WELL LOG
Date of test
Static water level ~..~!~'~.~~ ft.
Well production / g.p.m.
AT INSPECTION
7/13/2010
55 .ff.
4.37 g.p.m.
WATER SAMPLE RESULTS:
Coliform ~ colonies/100.ml.
Arsenic: .~-ug./L
Nitrate(e. I Omg./L.
Date of sample: 9/13/10
Other bacteria(~
Collected by:
colonies/100 mi.
(;E(; Ltd.
SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 1250 gal. Number. of Compartments 2
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO
Date of pumping 9/22/2010 Pumper
Date installed 9/21/71
Clea. nouts (Y/N) YES
High water alarm (Y/N) N/A
MCDONALDS PUMPIN(;
ABSORPTION FIELD DATA
Date installed 9/21/71
Length 12 ft.
Total depth *7,45 ft. Eft. absorption are~*288+ft2 Monitoring tube YES
Date of adequacy test 9/15/10 Results (Pass/Fail) PASS
Fluid depth in absorption field before test 0 in. Water added 761 gal.
Elapsed Time: 7 min. Final fluid depth 1.0 in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
NOTE: MT ONLY EXTENDS 46" BELOW TOP OF CRIB.
**SEE NOTE ON 1996 HAA BY MOA.
~*BELOW EXISTINGGRADEI
Soil
85
rating (g.p.d./ o~,
Width 12 ft.
System type CRIB
Gravel below pipe 6 ft.
Depression over field. NO
For 4 bedrooms
New depth 2.5 in.
600+ g.p.d.
If yes, give date -
3.6' OF SOIL COVER.
Absorption rate >=
NONE KNOWN
DRAINFIELD HAS
D. LIFT STATION
Date installed
"Pump on" level at~.in.
E. SEPARATION DISTANCES
Size in gallons Manhole/Access (Y/_~ J
"Pump off" level ~ High water alarm level at
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot 100'+
Public sewer main N/A
Sewer/septic service line 25'+
Animal containment areas 50'+
'90'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
N/A
100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+
Water main N/A Water service line 10'+
Wells on adjacent lots 100'+
Absorption field
Surface water,
5'+
100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+
Water service line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots. 100'+
Water main N/A
Driveway, parking/vehicle storage
10'+
COMMENTS *WELL AND SEPTIC TANK WERE INSTALLED PRIOR TO 1975.
PRE 1975 SEPARATION DISTANCE REQUIREMENT WAS 50'+.
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 JEFFREY A. GARNESS
Date
COSA Fee $ ~ c~ 0
Date of Payment C~ _
Receipt Number _(~ ~.
(Rev. 11/05)
2-?--/0
Waiver Fee $
Date of Payment.
Receipt Number
in,
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On-Site Systems Approval # 101227
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 1, Lot 7A
of Birch Hills Estates #1 subdivision. This inspection revealed a nitrate
concentration of 6.1 milligrams per liter (mg/L) was reported for the
property's well water sample. 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.
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.
Page 1 of 1
Andrew Gray
From:
Sent:
To:
Cc:
Jim Sullivan [apw@gci.net]
Tuesday, September 21,2010 3:29 PM
andrew@garnessengeneering.com
bobrink@alaska.net
Subject: 12137 Dee Ln
Andrew
I verified the casing in the well on this property with a camera, it is 40'+ with no perforations
there is a S-50 pit less adapter at 12.5' static is 33'
If I can be of any further assistance please call
Thanks
Jim Sullivan, CPI
Arctic Pump & Well, Inc.
PO Box 770197
Eagle River, AK 99577
(907) 688-2510
(907) 258-2510
(907) 745-2510
9/22/2010
/
/
/
SEPTIC '--
CLEANOUTS
Lot 8A
RETAINING
WALL
2 STORY
WOOD FRAME
RESIDENCE
I
/
/
/
LEVEL
COVERED
DECK
Tract A-2
Lot 7A
'"'~--12.2' x 24.3' SHED
/
/
/
/
/
/
/
/
/
/
/
Lot 6
PAD
SHED
PLOT PLAN AS BUILT X SCALE 1' = 30' GRID SW 1627 Pro]ecl No. 07-149
Long &: Associates, inc. 11500 Beryl Avenue, Anchorage, Alaska 99515-5049
(907) 522-6476 Phone
Registered Land Surveyors (907) 522-4625 Fax
kglangleOalaeka.nef / ]clangls~alaska~nef
I hereby certify fhafl have ,u~eyed the following described p~ -- ~'"" ..'~~h
Lot 7A, Block 1, Birch Hills Estates, Unit No. 1 (Plat No. 2000-7~1 ~." ~TH ~ ~"~,
Ant · * ~ ~ ~o ~ ~ -,
horag Recording District, Alaska, and that the Improvements situated thereon are
within the prope~ lines and do not encroach onto the prope~ adjacent thereto, that
no Improvements on the p~pe~ lying adjacent fhe~fo encroach on the Bugeyed
premises and fhaf them am no roadways, transmission lines or other visible v~:~>~"j~"~"~";'~
easemen~ on said prope~ except as Indlcafed hereon.
-~h~ '..:~..~-.~{~, '~.~.~...
Dated this the Day of
~ , , af Anchorage, Alaska
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska '99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
e
Location (site address or directions) /~*/*.,~* z~'~,~ L.-~,<J~_, .~"'.-~'~-'~',,~'-'~'~:~,,
Property owner ,~:4~.~,4~, ~',~-..,,,,..,..~J~,.,~ Day phone ~'~'-.~'~'.z: ~
Mailing address
Lending agency Day phone
Mailing address
Agent
· Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBE~ OF BEDROOMS: ,~/
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOfE:
If community well system, provide written confirmation from State ADEC attest-
lng 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 writte~ 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 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 typ? of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Address ~,~,~
Engineer's signature. D:~te
DHHS SIGNATURE
Approved for z~
Disapproved.
Conditional approval for
bedrooms.
I ......
b~rooms, with the following stipulations:
Additional 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality' of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
. Municipality of Anchorage ~.C~
DEPARTMENT OF HEALTH & HUMAN SERVICES.
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 ·
Health Authority Approval Check~t
A. WEU. DATA
Well ~
Log present (Y/N)
Total depth
Sm~W ~e~ (Y/N)
Date of test
Staflo water Imml
Well production
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ,"~"~"~',~ ~,~ -
Cased to ,~/~ ,'~'/ Oaring height (above ground)
y, Wires property p,uag~mcl (Y/N) Y'
FROM WELL LOG AT INSPECTION
WATER SAMPLE RESULTS:
SEPTIC/HOlDING TANK DATA
I:)~minstefled .P~-~,'-'~'/ .Tankstze /,~.e--~ Number of Gompe,'lmente .~- . Cleanouts(Y/N)
FoundAtion cieanout (y/N) ~/ Depression (Y/N) x.~ High w~ter 8lann (Y/N) ,~,.-v'
C. ABSORPTION REID DATA
Date installed ~'=~-,-'2.- ~/ Soil rat]no (g.p.d./fff or.flMxlrm)
length /';¢' / Gravel ~ below pipe
~ /
EffecUveat~orp~onama ,.~-.~'~'/"/~Monlt~tng Tubepmsent(Y/N) Y'
Fluid dep~ in atmoq~m field before test On.); ~
IRuiddepth ,~//~" (ins)Minutes later:. ,.~z;
Peroxide treatment ([mst 12 months) (Y/N) /c/
System type
' Total depth
DepmsMon over field (Y/N)
Immediately after ~:2'~,,~ai. water added (in.):
Absoq~on mm - ~ '~ ~ g.p.d.
D. UFT STATION
Date installed Size in gallons
Manhole/Access (Y/N) *Pump on" I,eyel at' o level at*
C~ed
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
~"~'%~'/ On adjacent lots
AJ:~oq3flon field on lot
Public ~wer main
Public ~ewer manhole/cleanout
Sewer/septic sen~ce line
SEPARATION DISTANCE~ FROM SEPTIC/HOLDING TANK ON LOTTO:
Foondatlon ~',z-'/. Property line .~--'..~,c-/ Absoq~on field /
Water main/~endce line ~unace wamr/armnage ~ Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIL~n ON LOTTO:
Properly line ~- ~ +.~'* Building foundafion --~ ~' '*'~'/ Water main/sero line
Surlace water ~'"~,~'~'~t~~*/~'"'~'~ Dray, parking/vehicle storage ama ~','~'/.
Curtain drain ~'~ '" ~' Wells on adjacent lots / ~
F. ENGINEER'S CERTIFICATION
I certify that I have detem'Sned thru field inspecUons and mSew of Mzaticlpal ~'~t~e~eystem~ are
- ~.. .
DBI~ of P~¥ment /-~Lt~ Date of Plym~m
Receipt Number ~'~.aC~ ~'/J [(~) Receipt Numbe,
'01-23-00 lO:03 FR0g-CT£ EHVIROHt~HTAL 5615301 T-342 P.01/$2 F-608
~lr~/l~ CT&E Environmental Se(vices InC.
CI'&£ Ref-n 1060262001 Client POn
Client blame Douglas Kenl~ P~. printed DalrdTime 01/23/2000 19:03
Collected DatedTime 01/20/2000 14:52
Project Namt,W L7 Bio t Girch Hills £st Reech, cd DatetTlme 01/2.0/2000 16:45
CUent Sample Il) L7 ak I Birch H~ls
MatrL~ Drinking ~'av~t Technical Director
Orclered By ReleaSed
PWSID 0
Sample
Prep ,~t~aLysls
I~T[RS D~PT
giTrmte'g
O COLI1OOnV. S~I8 9Z22e
ToTaL CoLiform
01/20/Z000 JOT
MUNICIPALITY OF ANCHORAGE
t" DEPARTMENT OF HEALTH & HUMAN SERVICES...
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage Alaska 99519-6650
343-4744
Parcel I.D. if
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
3.
Location (site address or directions) / ~/.-~ ?' ~'~'/'~'~'~' ~-'~-~ ~ ~"~"~.
Property owner ,z-~.,:,,~ ~'y~,-~,~ ~, Day phone.
Mailing address .,'.,~./.,, ~' ~',~'-~,.~'.~-- ~-~=-~,~,,r.~=,-,~' .'~'.,~/, ~P.~'
Lending agency
Mailing address
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
Day phone
Day phone
MUNICJPALITYOFANCi-IORAGE
[NVIRON/V, ENTAL,SERVICE$ DIVISION
RECEIVED
If community well system, provide written confirmation from State.A. DEC 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.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below. I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe. functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my inves.ti.,gation 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.
F~. I~ ~'~) bedrooms.
DHHS SIGNATURE
~ Approved for
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
By:
Additional Comments
I Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does 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.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVlCF:b~:~,~urv
Environmental Se~ices Division
825"L" Street, Room 502 · Anchorage, Alaska 99501· (907)
Health Authority Approval Checklist
A. WELL DATA
Well type
RECEIVED
l)am of test
Ssmic wat~ level
We. il Imxtuction
WATER SAMPLE ~:
B. bT. JrriC/ltOLDING TANK DATA
g.p.m. ,> '/. a~
g.p.m.
D. LIFt STATION
Dat~ inmalled Size in ~a~llrms
M~d~ol~Acccss (~/N) ~Pump on' level al* ~
·
E. ,~I~PARATION DISTANCES
SEPARATION DISTANCES FROM W~I ON LOT TO:.
Sep~c~ldins t~.~ on Im ~',.~' "'~'~
Abso~ion fiekl on ioI /~
Public sew~ n~i. ~./O.~4W' ~,O .~',,~'
~'wer/s~ptic sen'ice line .~ ~ ~ ~'~
SEPARATION DISTANCES FROM SEi~TICA-IOLDING TANK ON i.OT TO:
Wa~' ,r,~i-/se~dce ~ .~.4'~/'/Su~ac~ wamr/drninn~ ~t/*.s~- Wells on a~cem lots
SEPARATION DISTANCE FROM ABSORFI~ON FU~ r~ ON LOT TO:
B,,ildin_o fmmd~ion .ff.~' ,.'-~-',,~ pmpe~ Line .g o ~'~"/Wa~. ~in/se~4ce lin~
Cu~indrain ~'~ ~,~',';.'"' Wellsonndjac~ntiots /'~//~'~
F. ENGI~K~S CERTIFICATION
I certify that I have determined thrufl~id ln.vpeciior, s wd
,. conformance .th MOA .IL4.4 ~,deline. In effect on thi~ d~e.
l~,'~_pt Number
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee S
Da~ of Payment
CT&E Environmental Services Inc.
Laboratory Division
200 W. Potter Drive
Anchorage, AK 99518-1605
Tel: (907) 562-2343
Fax: (907) 561-5301
CT&E Ref.# 963755001
Client Name Dougla.~ Kenlcy P.E.
Project Name/# N/A
Client Sample 1D L7 BI Birch Hills Est. #1
Matrix Drinking Water
Ordered By
PWSID
Sample Remarks:
Client PO#
Printed Date/Time 08/19/96 16:36
Collected Date/Time 08/13/96 14:30
Received Date/Time 08/13/96 16:45
Technical Director
AiLo~abte Prep Anatyel$
Parameter Resutts P~L Units Method Limits Date Date Init
Nitrate-N 2.98 0.$00 mg/L EPA ~53.2 08/16/96 ESC
#itrite-N O.IOOU 0.100 mg/L EPA 353.2 08/15/96 ESC
Total Cotiform 56 OB ~/ COLI SM18 92228 08/13/96 TAV
~~ Member of the SGS Group (Soci~t~ G~n~rale de Surveillance}
ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN. MISSOURI. NEW JERSEY, OHIO. WEST VIRGINIA
Do~cjlas T. Kenley Civil Engineer State of Alaska C.E. 8178
Legal Description
WELL & SEPTIC SYSTEM ADEQUACY TEST
~. 2,.~',~'/ ~..~x,,,/-,-,-~,-~ ~--~,--..,;,~-..s-
System Data
TEST DATA
TIME VOL. DIFF. FLOW TANK TUBE DIFF. WELL DIFF.
(ga~ (~lprn) LEVEL LEVEL LEVEL
System Passed f System Failed
Comments ~ ~',.-~,~,~-~, ~/.e,/--~.~-.o ~_.~ ~'9o--"-/~,~"'-- ~'o~'~,s,z. --~,--.<,/_.
APPLI(-'N'i' FILLS OUT UPPER HA:'"~ONLY
~flle Family
Water Supply
Inspector Inspector Inspector tnspect~
( ) APPROVED ~DR~MS 'CONDITIONS OF APPROVAL
Well Io Tank Septic T~k Size
November 29, 1982
Marvin Moore
P.O. Box 1433
Eagle River, AK
99577
Subject: Lot 7 Block 1 Birch Hills Estates
Approval for the individual set;er and %~ater facilities cannot
be granted until the following items have been completed:
/ of the Municipality of Anchorage codes and must be encased
~ in conduit.
~ The~/ water analysis report needs to be submitted to this
office from the Chem Lab, 5633 B Street, for our revie%~.
./~ The septic tank pumped with a receipt submitted to this
L~/department.
~.~.~ An adequacy test needs to be performed on the existing
leaching area. This test %{ill determine if the system is
adequate according to ~ational Standards. A listing of
private firms performing the test is enclosed. This report
needs to be submitted to this office for our review.
Please notify this Department for a reinspection'when the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 264-4720.
Sincerely,
nP237/p/Ell
Enclosure
Robert C. Pratt
Associate Environmental Specialist
EXCAVATION
ROBERT A. SHAFER
WORK CIVIL ENGINEER
694-2979
January 9, 1983
Red Carpet/Anchor Realty
520 East 4th Avenue
Anchorage, Alaska 99501
Reference: Lot 7: Block 1; Birchwood Estates; Marvin Moore
property
A sewer system adequacy test was performed on the system
located on the referenced property as your agent requested.
The septic tank was pumped and verified to have a capacity
of 1250 gallons. The seepage pit was tested by charging
the system with 1000 gallons of fresh water and after
a period of ~4 hours all the water which had been added
to the crib had percolated out.
It can be concluded from this test that the waste water
disposal system serving the four bedroom residence located
on the property is currehtly functioning adequately.
However, the system cannot be guaranteed against subsequent
failure.
If ~e may be of further service,
to call.
since~e.~r,
P
E
/ s/ss
cC: Municipality of Anchorage
Department of Health and Environmental
please do not hesitate
Protection
SRB 196X EAGLE RIVER, ALASKA
· ~. MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
82S L ~t~et - Andm~, Al~k~ ~9501 MUNICIPALITY OF ANCHOP.,~GE ~
DEPT OF I"ALTII & ~
ENVIRONMENTAL ENGINEERING DIVISION ........ ,.'- , ' . ; ~
=~w~UNM~NTAL r:Ol=~I~ ~
Teli~ ~7~ ~ ~
REQU~T FOR ~PROVAL OF INDIVIDUAL WATER AND SEW~ ~1~
PROPERTY OWNER
PROPERTY RESIDENT (If different from ~oove)
PHONE
PHONE
E. BUYER
MAILING ADDRESS
[ ~NDING I~IT~ION
PHONE
LEQAL DEICRIPTION
~TREET LOCATION
TYPE OF RESIDENCE / NUMBER OF BEDROOMS
[] One [] Four
· [] MULTIPLE FAMILY [] Three Six
[] Other
7. WATE ~R
~ INDIVIDUAL*
~r-q COMMUNITY
[] PUBLIC UTILITY
!~ IEWAGE DiS ~F~--~L BYITEM
/~ INDIVIDUAL/ON-SITE*'
[] PUBLIC UTILITY
· ATTACH WELL LOG. A well log is required for ail wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
/
.....
If ~nd~v~dual/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.
,~ THIS SIDE FOR OFFICIAL USE ONLY ,J * '
DATE RECEIVED
INSPECTION APPOINTMENTS
)ATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
~ DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE ;-I OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
2. WATER SUPPLY PERMIT NUMBER
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLEO
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] 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 A~SORPTION AREA MATERIAL
5. COMMENTS
[] APPROVED FOR 8EDROOMS
[] CONDITIONAL APPROVAL (letter must aco0mpany certificate)
/-~DtSAPPROVED ~
LEGAL DESCRIPTION ,-. . .... :,.
72-010 (Rev. 3/78)
· \\
Anchorage
825 "L" STREET
ANCHORAGE° ALASKA 99501
(907) 20,1 4111
'";'/
June 18, 1980
Jon D./Vicki L. Smith
Star Route Box 241A
Eagle River, Alaska 99577
Subject: Lot 7 Block 1 Birch Hills Estates Subdivision #1
Approval for your individual sewer and water facilities
can not be granted until the following items have been
completed:
(1)
The water analysis report be delivered to this
department from Chem Lab, 5633 B Street, for
our review.
(2)
A four(4) inch cast iron cleanout needs to be
installed to the septic tank. This will need
be re-inspected by this department.
to
(3) The septic tank pumped with a receipt submitted to
this department.
(4)
An adequacy test be performed on the existing leaching
area. This test will determine if the system is adequate
according to National Standards. A listing of private
firms performing the test is enclosed. This report
needs to be submitted to this department for our review.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: Alaska Statebank Mortgage Loan Department
310 East Northern Lights Boulevard
99503