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HomeMy WebLinkAboutBIRCH NORTH ESTATES LT 1Birch North Estates Lot 1 #015-501-38 Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water & Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907)343-7904 ONSITE WASTEWATER INSPECTION REPORT Permit Number: OSP141403 PID Number: 015-501-38 ❑ New ®Upgrade Name: AMY SIMPSON ABSORPTION FIELD Address: ® Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 10400 BIRCH ROAD *ANCHORAGE, AK 99516 ❑ Other Phone: No. of Bedrooms: Soil Rating: Total Depth from original grade: (907) 229-7716 3 LEGAL DESCRIPTION Manufacturer. Caoaaita: Subdivision: BIRCH NORTH ESTATES owns Ip: onge: Block: — ec ion: Lot: 1 SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station Holding Tank Public/Privy Sewer Line Well EXISTING 100'+ — — 25'+ Surface Water EXISTING 1Do'+ — — Lot Line EXISTING 10'+ - - N/A Foundation EXISTING 101+ Curtain Drain NONE KNOWN 1.0 GPD/Sq. n.I SEE DW To pipe im rt from original grade: Gravel depth beneath pipe: Flt added above original grade: SEE DWG. Grovel width: 2.5 Dotal absorption area: 451 TANK ® Seotic EXISTING Grovel Zeno: Ft. 41 Beds Number ofJUMMW.ESQ. umber of trenc 1 ❑ S.T.E.P. ❑Holding between *9.5 ❑ Other 'WAIVER GRANTED TO OLD TRENCH & >25Z SLOPES (OSP141402) pomp Make k Mode tdcal Inspections perfoi PIPE MATERIAL House to tank EXISTING Installer WILCO Drainfield D3034 Tank to D3034 drainfield CO/MT D3034 Inspector GEG, Ltd. BENCHMARK (Assumed elevation) Inspection 100.00 Dates: 1st 9/26/14 2nd 9/29/14 Location and Description: 3rd — 4th — DOWNSTAIRS DOOR THRESHOLD UNDER DECK Community Development Department Approval ENWMEER9+wer Conditional approval: Date: VZ iP. GaAness ', / V vCE— a �� Z it f/ / —+ moi O - 4�K ofes i 0 cwo Approved � Date: /"� 44ad Profession° 4��-- —moo LIFT STATION Manufacturer. Caoaaita: 'WAIVER GRANTED TO OLD TRENCH & >25Z SLOPES (OSP141402) pomp Make k Mode tdcal Inspections perfoi PIPE MATERIAL House to tank EXISTING Installer WILCO Drainfield D3034 Tank to D3034 drainfield CO/MT D3034 Inspector GEG, Ltd. BENCHMARK (Assumed elevation) Inspection 100.00 Dates: 1st 9/26/14 2nd 9/29/14 Location and Description: 3rd — 4th — DOWNSTAIRS DOOR THRESHOLD UNDER DECK Community Development Department Approval ENWMEER9+wer Conditional approval: Date: VZ iP. GaAness ', / V vCE— a �� Z it f/ / —+ moi O - 4�K ofes i 0 cwo Approved � Date: /"� 44ad Profession° 4��-- —moo PERMIT NUMBER: PARCEL ID NUMBER: OSP 141403 AS -BUILT DRAWING 015-501-38 104TH AVENUE EXISTING DRAINFIELD TO BE USED AS RESERVE SITE, EXISTING 1000 GALLON SEPTIC TANK n /— --Tol�- of- et-- DBL1&2 EXISTING 3 BEDROOM HOUSE Well TOP OF BLUFF 5f-- ( a%" ';LOPF- / C E E N Wood d w Service B r m DBL1&2 EXISTING 3 BEDROOM HOUSE Well TOP OF BLUFF 5f-- ( a%" ';LOPF- C E E N Wood d w Service B ;p2 Poles m \fl{1 0 \ NEW DRAINFIELD GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS 3)01 E. 1000R ftOM. SURE 101 9NLXORACE. N( 99507 • PHONE (907) 331-8:79 • FM (907) 339-3248 Yke511E: www.99mamn9inNYm9.99m PREPARED FOR: PHONE NUMBER: PAGE NUMBER: AMY SIMPSON 229-7716 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: BIRCH NORTH ESTATES; LOT 1 PNB TYPE OF WORK: DATE: AS—BUILT DRAWING 9/30/14 Eg A_ ar ess.f: PERMIT OSP 141403 AS -BUILT DRAWING FFILTER FABRIC ORIGINAL GRADE (TOP OF MT CO FINAL GRADE ORGANICS BELOW FILL) ©= 98.25 TO HIGHEST POINT = 95.58 98.94 WHEN TRENCH WAS BEING INSTALLED THERE WAS CONSIDERABLE FILL (3+/—) ENCOUNTERED OVER THE TOP OF THE NATIVE ORGANIC LAYER. THE TOTAL DEPTH WAS BASED UPON THE TOP OF NATIVE ORGANIC LAYER. INVERT OF PIPE = 88.59 BOTTOM OF TRENCH = 83.09 RELATIVE ELEVATION OF BOTTOM OF TESTHOLE = 77.08 (DRY) GARNESS ENGINEERING GROUP, Ltd f. CIVIL & ENVIRONMENTAL ENGINEERS 0 3101 E. SUDOR R , SURE 101 • MIOXO E, W 99507 r p11pryE (90) 337-61n • FM (907) 338-3218 • WE880E: wwx.gomwnn9ineMng.com ;,, PREPARED FOR: PHONE NUMBER; PAGE NUMBER: AMY SIMPSON 229-7716 3 OF 3 LEGAL DESCRIPTION: DRAWN BIRCH NORTH ESTATES; LOT 1 PNB TYPE OF WORK: DATE: � PROFILE AS—BUILT DRAWING o /zn /l A PARCEL ID NUMBER: 015-501-38 ORIGINAL TOP OF ORGANICS BELOW EXISTING FILL CE— f%R EF SSIOPi GARNESS ENGINEERING GROUP, Ltd ---• �� » OMI &ENVIRONMENTAL ENGINEERS October 1, 2014 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Waiver Request for Separation Distance Between Drainfields @ Birch North Estates; Lot 1 To whom it may concern: SEPARATION DISTANCE BETWEEN DRAINFIELDS WAIVER: Due to site constraints, we are requesting a 9.5 foot waiver between the old 1995 drainfield and the new 2014 drainfield. Justifications for this waiver are below; • During excavation of the new 2014 drainfield the old 1995 drainfield was completely surcharged and at no point during excavation was there any water intrusion in the new drainfield. • A flow diverter was installed so that only one drainfield will be in operation at a time, this will allow for the other drainfield to "rest' while the other one serves the property. • During installation of the new drainfield GEG employee Rob Campbell and MOA engineer Jay Crewdson, P.E., had initially determined a waiver to 11 feet would suffice, however, that needed to be amended to 9.5 feet. We are unaware of any adverse impacts this waiver would have on adjacent wells or septic systems. If you have a7y cNstions, please contact us at 337-6179. Thank you for your assistance. .E., M.S. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907)337-6179`Fax: (907)338-3246"Website: www.garnessengineedng.com Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http:/Iwww.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program went S h + 1. � Y n epartment **** VARIANCEIWAIVER REVIEW **** Waiver#: OSP141402 COSA#: _ Permit#: OSP141403 PID#: 015-501-38 Legal Description: Birch North Estates, Lot 1 Engineer: Garness Engineering Group Applicant: Amy Simpson Your request for a waiver of the required 50 feet horizontal separation from the absorption field to the 25% or greater slope has been approved. The approved separation distance is 20.0 feet. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ,A 15o o_�6e�rftie.eh e-,, ('itnf 4n�lleW 0t✓2lh ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: X_ Waiver is not GrantL?d: — Date: &02 Approved b . Name of Reviewer ........................................................................... On -Site Wastewater Disposal System Permit 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 Permit Number: OSP141403 Tax Code Number: 01550138000 Work Type: Septic None Permit Effective Dates: September 22, 2014 to September 22, 2015 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: BIRCH NORTH ESTATES Site Legal Address: BIRCH NORTH ESTATES LT 1 G:2537 Owner/Address: SIMPSON AMY T & BRANDON L 10400 BIRCH ROAD ANCHORAGE AK 995166605 Site Mailing Address: 10400 BIRCH RD, Anchorage This permit is for the construction of: t2G C/ZGI/�/ `f-"ef' Lot Size in Sq Ft: 38720 Total Bedrooms: 3 Y Disposal Field Y Septic Tank 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 001 VA Ups k1" d 4�_* Id _�o Le y ( (v vj� f 6. MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 015-501-38 Property owner(s) AMY SIM Mailing address 10400 BIRCH ROAD *ANCHORAGE, AK 99516 Site address 10400 BIRCH ROAD *ANCHORAGE, AK 99516 Legal description (Sub'd, Block & Lot) BIRCH NORTH ESTATES; LOT 1 Legal description (Township, Section & Range) Lot Size Single Family (SF) Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: (all that apply) Multiple Dwellings Initial ❑ Absorption Field Septic Tank ® Upgrade ❑ Renewal ❑ Holding Tank Privy ❑ Private Well ❑ Water Storage ❑ Day phone 3 THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) DRAINFIELD TO SLOPE >25% Distance: 20' 1 certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fee: Date of Payment: Receipt Number: vu.W16W 19 Permit No. 0s19 1g190-3 Waiver Fees: a/51 l d q :' 3 yy ' Date of Payment: C1 B19 /I Receipt Number. O IT Q,5' b, Waiver No. 0 lL?J y p o3 (Rev. 01/11) 'W ' Qu nic GARNESS ENGINEERING GROUP Ltd -- - CIVIL & ENVIRONMENTAL ENGINEERS September 18, 2014 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic System for Birch North Estates; Lot 1 To whom it may concern: The existing 3 bedroom house is served by a private well and a septic system. The drainfield is in a state of failure and needs to be upgraded. We are proposing to install a new deep trench type drainfield and a new 1000 gallon septic tank. One test hole was excavated on the property. The drainfield will be designed around the 30 foot radius of this test hole. Comments regarding the design are summarized as follows: 1. SOILS: See the attached 2014 log which shows the soil classifications, groundwater monitoring, and the percolation test results. We are proposing to use the native soil as a sand filter (grab sample provided to your department). This insitu soil layer will serve as a filter for the downward migrating effluent. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface water concerns. 4. TOPOGRAPHY: The average topography in the area of the proposed drainfields is relatively flat. However, there is a cutbank (slopes in excess of 25%) located 20 feet from the proposed drainfields. 5. SLOPE WAIVER: Due to site constraints, we are requesting a 20 foot waiver to slopes in excess of 25%. See attached topo drawing and profile drawing. The existing trench is surcharged and does not appear to be day] ighting. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. .E., M.S. 3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com NUMBER OF BEDROOMS: 42 GALLONS PER DAY (GPD): 450 GPD PERCOLATION RATE/S: <1 MIN/INCH PROPOSED APPLICATION RATE: 1,0 MINIMUM DRAINFIELD SQ.FT.: 450 FEET' MAXIMUM DEPTH OF EXCAVATION: 12.5 WIDTH: 2.5 FEET LENGTH: 35 FEET M.O.A. APPROVED SAND FILTER: NATIVE EFFECTIVE: 7 FEET ACTUAL SQ.FT.: 490 FEET' LETTER THAT PERTAINS TO THIS DESIGN, TO OBTAIN A COPY OF THE LETTER CONTACT GEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND 104TH AVENUE SHALL HAVE THE NORTH & EAST LOT LINES, AND ALL WELL RADII FLAGGED BY A IEGISTERED LAND SURVEYOF PRIOR TO CONSTRUCTION. r TOP OF BLUFF EXISTING DRAINFIELD TO BE I ESTABLISHED BY USED AS RESERVE SITE , ILEE KARABELNIKOF EXISTING 1000 GALLON SEPTIC TANK TO BE DECOMMISSIONED PER OF PROPOSED 1000 GALLON SEPTIC TANK WITH DOUBLE 1 OINSTALLED PRIORORT TO AND AFTER TANK. D D-' a� Wood ////` Service v`�;-, Poles `-� �/ F \ PROPOSED F DRAINFIELq. GANESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS Ml E. IDWR ROW. SUI 101 • MICHORACE, M 99W7 • PHONE (907) 337-8179 • FAX (907) 338-3248 - WEBSOE: xwwgameamngineen PREPARED FOR: PHONE NUMBER: PAGE NUMBER: AMY SIMPSON (9O7)XXX-XXXX 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: BIRCH NORTH ESTATES; LOT 1 PNB TYPE OF WORK: DATE: �, SEPTIC SYSTEM DESIGN UPGRADE 9/18/14 I / /r / / II l 1 CE -7J ti ) rv1 / / / I LETTER THAT PERTAINS TO THIS DESIGN, TO OBTAIN A COPY OF THE LETTER CONTACT GEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND 104TH AVENUE SHALL HAVE THE NORTH & EAST LOT LINES, AND ALL WELL RADII FLAGGED BY A IEGISTERED LAND SURVEYOF PRIOR TO CONSTRUCTION. r TOP OF BLUFF EXISTING DRAINFIELD TO BE I ESTABLISHED BY USED AS RESERVE SITE , ILEE KARABELNIKOF EXISTING 1000 GALLON SEPTIC TANK TO BE DECOMMISSIONED PER OF PROPOSED 1000 GALLON SEPTIC TANK WITH DOUBLE 1 OINSTALLED PRIORORT TO AND AFTER TANK. D D-' a� Wood ////` Service v`�;-, Poles `-� �/ F \ PROPOSED F DRAINFIELq. GANESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS Ml E. IDWR ROW. SUI 101 • MICHORACE, M 99W7 • PHONE (907) 337-8179 • FAX (907) 338-3248 - WEBSOE: xwwgameamngineen PREPARED FOR: PHONE NUMBER: PAGE NUMBER: AMY SIMPSON (9O7)XXX-XXXX 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: BIRCH NORTH ESTATES; LOT 1 PNB TYPE OF WORK: DATE: �, SEPTIC SYSTEM DESIGN UPGRADE 9/18/14 I / /r / / II l 1 CE -7J ti ) rv1 GARNESS ENGINEERING GROUP, Ltd -- -- - CIVIL & ENVIRONMENTAL ENGINEERS - -- 3701 E. TUI E R O, SUITE 101'ANCHp E, AK0 W7'PHONE [.D 3176:19-W CE(l 3183246'WESSITE_w.wegemesxengmeanng,wm SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: BIRCH NORTH ESTATES S/D; LOT 1 PERFORMED FOR: AMY SIMPSON DATE: 9/8/2014 itr (fe 3 4 5 6 7 s 9 10 11 12 13 14 15 16 17 18 19 20 NICS TEST HOLE #1 UPPER BENCH SP DEPTH TO GROUNDWATER SOIL CLASSIFICATIONS 9/8/2614 DRY GW GPML DRY 9/18/2014 oRG GMWOH CL PERK HOLE ABSORBED & OF WATER IN 4 MINUTES OR LESS, 4 TIMES INA ROW GCOL °o 0°° o SWMH ':�'•: SPCH SM SC SP DEPTH TO GROUNDWATER DATE DRY 9/8/2614 DRY 9/12/2014 DRY 9/18/2014 TE DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL NET DROP READING (INCHES) 9/12/2014 PERK HOLE ABSORBED & OF WATER IN 4 MINUTES OR LESS, 4 TIMES INA ROW PERCOLATION RATE <1 (MIN./INCH) TEST RUN BETWEEN 5.0 FT. AND A FOUR HOUR PRESOAK WAS PERFORMED: PERC. HOLE DIA. 6 (INCHES) 6.0 FT. ❑ YES ONO SOILS LOGGED BY: ROB CAMPBELL PERCOLATION TEST PERFORMED BY: ANDREW GRAY COMMENTS: PERCOLATION READINGS ARE WITHIN 1/16 OF INCH. PERFORMED BY GEG, Ltd, I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PE OR AED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: `) r�`� 0y +FARNESS ENGINEERING GROUP, Ltd -- CIVIL & ENVIRONMENTAL ENGINEERS.- 3701E.7"WR ROAD, SHITE 101' ANCHORAGE AK 000)' PHONE(El0 IS', I19-.(.I3E SM-WEBSITE'.'1A�'1.Be,neesenpineennq com SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: BIRCH NORTH ESTATES S/D; LOT 1 PERFORMED FOR: AMY SIMPSON DEF (fe( 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DATE: 9/8/2014 ORGANICS TEST HOLE #1 LOWER BENCH sM SOIL CLASSIFICATIONS 9/8/2014 ORG ML CL OL MH CH ON SW GP GM GC SW SP SM SC DRY 9/18/2014 a:::;!ft. ': �'• : SM TO SP SOILS LOGGED BY: ROB CAMPBELL DEPTH TO GROUNDWATER DATE DRY 9/8/2014 DRY 9/12/2014 DRY 9/18/2014 I"= 100' DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) 9/12/2014 PERK HOLE ABSORBED 6" OF WATER IN 4 MINUTES OR LESS, 4 TIMES IN A ROW PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 6.5 FT. AND 7.5 FT. A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ENO ROB CAMPBELL PERCOLATION TEST PERFORMED BY: COMMENTS: PERCOLATION READINGS ARE WITHIN 1/16 OF INCH, PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PE OR ED IN ACCORDANCE 1 WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: X1 Municipality of Anchorage Page / of _ate DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SV/ I's 0Z3% PID Number: OIs -SO— fzR Name: evecv c Wastewater System: ❑ New ❑ Upgrade yvrv9eNaeaRomer V 2 a.a IITu Amew AK 99.501 ABSORPTION FIELD Phone: No. of Bedrooms: 4CDeep Trench ❑ Shallow Trench 0 Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: GPD/S Ft Total Depth from original grade � Z Lot, Block: Subdivision. _ Q 1 IQ ew Ta Ofd Depth to pipe bottom from original grade. .SR FI Gravel depth beneath pipe 7A Ft Township: Range: Section: Fill added above original grade: (J — Ft Gravel length:.3 o �Ft WELL: ❑ New ❑ Upgrade Gravel width: Z Z. Ft Number oflines: t Delancebetweenlines. Ft Classification (Private. A.B.C): Total Depth. Ft Cased To: Ft. Total absorption area: 4S3Ja' SO FI lerial: Tia zr- 303y Aran T'810 Driller: Date Drilled: Static Water Level: Ft. Installer: I411Ce A.47tk&)pss...+ Date installed: Q-IS'fS- Yield. GPM Pump Set at: Ft Casing Height Above Ground. Ft. TANK SEPARATION DISTANCES LSFSeptia ❑ Holding ❑ S.T.E.P. To From Septic Tank Abae,pt on Fmid 411 Station Holding Tana Pubhcllinvam Sewer tinea Manufacturer: Gq e. Capacity In gallons: I /OOC well�. lOS log "'[A Material: S -ram. P_ I- Number of Compartments: Z SWatere tev+ /vo'r ^Y/. ^�ia "'�i. LIFT STATION Lot Line BO' Gt7' .N/A V j N!A I Size in gallons: Manufactu Foundation LSF 6 0 M�Q ^/ / /o N/a "Pump on" level at: "Pu 1D o 1" level at: High water alarm at: curtain.V/A pump Make & Model Electrical Inspections performed by: Drain Remarks: BENCH MARK Location and Description: c6 -0ASe. iia QLAY T S L iti ev Assumed S'Elevation: OFt ENG1NOFFIIp" ;a.�rz F��i yle% ' Inspections performed by: Dates: lst 4-M—Enr 2nd 't -t LIX Department of Hea hand an ervices approval Reviewed and approved b . Date: 11.1r4 4C 9 Flavin a Purlma Q rc CE • 8149. 44 Of 72-013 (Rev. 9/91) MOA 25 W AS -BUILT z� WASTEWATER ABSORPTION SYSTEM Lot 1, Birch North Estates r 104th Avenue Cu Bunk Existing Faded System ti ek~ e.o ,fftAcY• New 1000 Exist Well Lot 2 Existing 3 BR House I trench type kbsacption SYS,. IQ See Sheet X of 4 for system y-ot 0 0 K U U i Design: Perc. Rote of 8 min/inch 3 Bedroom House 563 SF of Absorption Required ••.,,",,,' Use Deep Trench 7' Deep, 41' Long 7. 4L 49LH x e Revised 8-21-95 .�-- PREPARED FOR: STEVEN R. PANNONE, P.E. %Steven R. Pannone 0 Evelyn Coleman .• . y P. ❑. BOX 142025 C;) 8149 • ANCHORAGE,' ALASKA 99514 No. CE C/o Poneers Home o£ Alaska 923 West 11th Ave ��♦�D "� ••• ••• Anchorage, AK 99501 274-0308, 272-8218 Fox 4�� X55;• • (907) 258-0700 DATAE: 10-1-95 AS -BUILT AS -BUILT DETAILS 31y WASTEWATER ABSORPTION SYSTEM Lot 1, B;rch North Estates A6=74.8 B1=23.0' C1=12.8' A7=73.8' B2=22.6' C2=14.6' A8=73.6' B3=62.8' C3=78.0' A9=79.2' B4=64.9' C4=80.8' B5=65.0' C5=82.8' B6=65.3' C6=84.0' B7=64.7' C7=83.8' B8=67.6' B9=81.0' \ �x e 7 -'0 \ \ 43.4 LF 63.3 LF 1 \ \ \ 9 \ C-WELL=26.4' D-WELL=13.5' z u.z Lr C B D A Well OF 4 r i 49TH [� �•�� i 1. 1LSteven R. Pannone/ �`, o PREPARED FOR: Evelyn Coleman STEVEN R. PANNONE, P. O.- BOX 142025 P.E. 0. y No. CE 8149 =i ( r•,r{�� fr C/o Pioneers Hone of Alnsko 923 West Ilth Ave ANCHORAGE, ALASKA 741003 272-8218 99514 FAX ��'• Ancho 99501 08, � 258-0700 DA NOT T A AS -BUILT AS-BUILT DETAILS y/y WASTEWATER ABSORPTION SYSTEM Lot 1, Birch North Estates o 1nONV3lJ ra w d a' y A l a Y � iD f • a ` z J •• r 38ni nOlINON y 20 • z ID 0:f v n 3 a ° r Imo- W 7.6' U t~ W LLJ a 7 _j J J o_ s C3 LK 1nONV3lJ Ce m CL O� v 1nON313 1nONV7lJ � e 1nONV3l3 � o J � 7 u� 1nONtl3lJ W'o i OF �ppf l� � #. `(�(`H13 NOI1tlUNn0! xt C 'j 49TM �� -_-•+:— P ♦�ySteven R. Ponnone PREPARED FOR: STEVEN R. PANNONE, ,P.E.• No. CE 8149 �� a Evelyn Colenon P. 0. BOX, 142025 ti�o_1�gs��� 1� C/o Pioneers Hone of Alosko ANCHORAGE, ALASKA ; e =� Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST St"m IL Pomwne CE"8149 PERFORMED FOR: FV fs LYaJ O LLM Anl DATE PERFORMED`--"LFr-H'TiC —ms ♦I��tiC�.ML' LEGAL DESCRIPTION: L I-Bt12c0 1-1 Township, Range, Section: DEPTH SLOPE SITE PLAN (FEET( C�Q4AN(cS rI 1 2 3 1 t.AL. 4 5 6 SILTS 7 SP SAND 8 Tv -rRAC,a SILTS 9 Srt WAS GROUND WATER �- 10 ENCOUNTERED? � S 11 IF VES, AT WHAT p T DEPTH? P 12 E 13 Depth to Water Alter Monitoring? Data: 14 15 16 17 18 Bo Fl 19 20 U PERCOLATION RATE (mmutevmchl PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS ' T F±O L(L --ro V'mir'•' S -r t -el? TNS AetATi M! .�iA�e t2 I" A' ell At PERFORMED BY: S "t?SP 'g elver ice• li . I S•R •�{aNNON tarQ,la- CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE- 72-008 ATE72-008 (Rev. 4185( PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE )IALo DEPARTMENT OF HEALTH AND HUMAN SERVICES 01_'s_c16 P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950236 DESIGN ENGINEER:STEVEN R. PANNONE OWNER NAME:COLEMAN EVELYN J OWNER ADDRESS:10400 BIRCH RD PARCEL ID:01550138 LEGAL DESCRIPTION: BIRCH NORTH ESTATES LT 1 LOT SIZE: 38720 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 8/23/95 EXPIRATION DATE: 8/23/96 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED ISSUED BY CSL (1 �J� DATE: DATE • O8 DESIGN WASTEWATER ABSORPTION SYSTEM Lot 1, Birch North Estates c 104th Avenue 7 49TH ♦♦ Revised 8-21-95 rrrrttl�^^^^• PREPARED FOR: CiSteven R. Ponnon , Evelyn Colemon c No. CE 8149C/o Poneers Hone of Alosko ��S�R21a• c�� 923 West 11th Ave r0 ��, �• Anchoro e, AK 99501 ♦�1� tU :�� (907) 258-0700 Design: Perc. Rote of 8 min/inch 3 Bedroom House 563 SF of Absorption Required Use Deep Trench 7' Deep, 41' Long r V41' STEVEN R. PANNONE, P.E. P. O. BOX 142025 ANCHORAGE, ALASKA 99514 274-0308, 272-8218 Fox NTE: 8-5-95 DESIGN -Ai r.i•_sn• DESIGN DETAILS WASTEWATER ABSORPTION SYSTEM Lot 1, Birch North Estates 1n0NV313 0 a Y l a as a k$ 9 h a J 3en1 MOIINOH U 7 N LLJ ' J P. 1n0Nv313 ED m _ n 1nONV313 1noNV3l3 _u 4 CY 1nONV3l3 V V � NV ii < V u Y 8 v 1nONV313 .\ ()F NOIlVaNnoi 491H- 9TH-Steven StevenR. Pannone p PREPARED FOR: STEVEN R. PANNONE, P.E. No. CE 81a9,rf� Evelyn Coienon P. O. BOX 142025 C/o Pioneers Hone West of Alaska ANCHORAGE, ALASKA 99514 ���ESSt�••. • 923 Anchorage,lAK 9501 Ave 274-0308, 272-8218 FAX DATE: 8-5-95 TA%\\\\��� (907) 258-0700 NOT TO SCA DESIGN Steven R. Pannone, P.E. Consulting Enginccr P.O. Box 142025 Anchoragc, Alaska, 99514 (907) 274-0308 (907)272-8218 Fax August 21, 1995 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 1, Birch North Estates S/D Upgrade permit Gentlemen: NOTE tS1r�� t �S . I; �'-o My firm recently conducted a site visit and soil/percolation tests on the above property in preparation for an upgrade to the existing failed system. A single test hole was dug; results are attached. Based on the testhole results, we are requesting a permit for a three bedroom upgrade. The lot is approximately an acre in size. The southern portion is generally flat; the remainder of the lot slopes to the north at a rate of approximately 5%. An irregular cutbank exists along the northern border on 104th Street; a second cutbank is present along a portion of the eastern lot fine on Birch Road. The well is located just west of the dwelling, thereby necessitating the system be placed closer to 104th Street. We believe that the system as designed will be 40 to 44' from the edge of the cutbank. We are requesting a separation waiver of 10' from the planned system to the cutbank. There is no evidence of any surface water, including ditch water, within 100' of the proposed installation. Existing wells are located greater than 100 feet from the proposed system. The lot on the north side of 104th is undeveloped. Lot 2's well, to the west, is located along the western property line of Lot 2. The existing septic tank and absorption field will be properly abandoned during construction of the new system. If you have any questions about the proposed installation, please contact me at 274-0308. Sincerely, teven R Pannone P.E. 7 Steven R. Pannone, P.E. Consulting Engineer P.O. Box 142025 Anchorage, Alaska, 99514 (907) 274-0308 (907)272-8218 Fax August 11, 1995 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 1, Birch North Estates S/D Upgrade permit Gentlemen: My firm recently conducted a site visit and soil/percolation tests on the above property in preparation for an upgrade to the existing failed system. A single test hole was dug; results are attached. Based on the testhole results, we are requesting a permit for a three bedroom upgrade. The lot is approximately an acre in size. The southern portion is generally flat; the remainder of the lot slopes to the north at a rate of approximately 5%. An irregular cutbank exists along the northern border on 104th Street; a second cutbank is present along a portion of the eastern lot line on Birch Road. The well is located just west of the dwelling, thereby necessitating the system be placed closer to 104th Street. We believe that the system as designed will be 40 to 44' from the edge of the cutbank. We are requesting a separation waiver of 10' from the planned system to the cutbank. There is no evidence of any surface water, including ditch water, within 100' of the proposed installation. The existing septic tank and absorption field will be properly abandoned during construction of the new system. If you have any questions about the proposed installation, please contact me at 274-0308. Sincerely, 41 Steven -Pannone, P.E. CE•0149 f-- .SZ{9 Q , r - ~ ED � l L Municipalityof Ane k� � r DEPARTMENT OF HEALTH 8 HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST...... 8toven R Pam re w ?yf,/n^f QtSc,�a3 ''•u PERFORMED FOR: 6VArLM4 COLt2 .N rte/ DATE PERFOAIg&'T -- LEGAL DESCRIPTION: Le -rt tact), VA C:4 -r Township, Range, Section: SLOPE SITE PLAN 1 a L Oe4AN• [$ 2- 3- 111E $sLYs `/sKweo cA • b 4- 51-1 6 7- 8- -S'P' To 9- 1011 to - 11 12 13 14 15 16 17 18 Beµ 19 SANb3 t"'/Cv%ttL7z S-0Md SCLT WAS GROUND WATER ENCOUNTERED? ti1b S IF VES. AT WHAT L O DEPTH? P E OCPN b Water Mer p maritaring? 4000, Oak _.R=3_ Reading Data Gross Time Net Time Depth to Water Net Drop Z m S s ' 3 Iit / M 2 / /b 6 147 ba 3 / l6 2 6 1 2 G'/CI t y 20 -I I k Q Q 1 r• L i%E `„ vY 11_11 PEAaOLATION RATE � Iminuteymchl PER HOLE DIAMETER TEST RUN BETWEEN FT AND SFT COMMENTS 'A�tt7 SyNtz 17:7 e -S PERFORMED BY: 5 •OSLOAG-C 1 GA AjON LA CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE 72-008 (Rev. &85) DESIGN WASTEWATER ABSORPTION SYSTEM Lot 1, Birch North Estates 104th Avenue -a 0 0 u u L M Design: Perc. Rate of 8 min/inch 3 Bedroom House 563 SF of Absorption Required Use Deep Trench 7' Deep, 41' Long r [r4 2' IREPARED FUR: STEVEN R. PANNONE, P.E. Evetyn Coleman P. 0. BOX 142025 C/o Pioneers Home of Atosko ANCHORAGE, ALASKA 99514 923 West 111h Ave � ' - � " 1: • -^.- Anchorage, AK 99501 274-0308, 272-8218 Fax (907) 258-0700 DATE: 8-5-95 DESIGN V'AI r. 1'eSfY MUNICPALITY OF ANCHORAGE Development Services Department "' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approva Parcel I.D. 015 501 38 1. GENERAL INFORMATION Complete legal description BIRCH NORTH LOT 1 Location (site address) 10400 BIRCH Current property owner(s) KIRK / STOJAK Mailing address Real estate agent 2. TYPE OF DWELLING: Fx_1 Single Family (w/ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Expiration Date: qry "- Z I Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic El Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: NONE Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ S 5 v Date of Payment 5 Z6 1.2 Receipt Number. © �2 A COSA # O SC q 11 8 �l 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. Name of Firm C&M ENGINEERING Phone 8545558 Address 20182 TULWAR Engineer's Printed Name CHARLES BALZARINI Date 5/20/21 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved Conditional approval for T-7--vt4 t K g -e✓' Aow '� • i 49 TH 3•�G bedrooms r CHARLES G BALZARI1 / bedrooms ��F���. CE -13854 ,�ll� PROFE5510�P?� bedrooms, with the following stipulations: V.wtgta/ A(( s �� -.s 2,01,- --I— ,0v —r - tN, w.x r r- ���`ll pNLITY p�(6i/ '�� o � qrE ATF � = n►^ e� 14 B Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other S cc (ayj4 &Aq(- i4dV( u Legal Description: BIRCH NORTH ESTATES LOT 1 If more than 1 septic system on lot: COSA Checklist # 1 of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 8/11/62 Total depth 122 ft Cased to U N K ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) +18 in. Date of flow test for COSA 5/17/21 Static water level at beginning of test 81 ft. Comments B. TANK DATA Age of tank(s) 26 years Tank type/material SEPTIC STEEL Measured operating fluid level in septic tank 50 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 10/7/20 TANK LEVEL MEASURED PRIOR TO PUMPING D. ABSORPTION FIELD DATA TRENCH Which system tested (date installed) 1995 ❑ ALL standpipes present per record drawing Total measured depth from grade 14.5 ft (max) Measured depth to pipe invert from grade 6.5 ft (min) ❑ N/A — pr e5 rizzed ield-- ❑ 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: LINE BETWEEN HOUSE AND TANK REPAIRED COSA Checklist yellow sheet Parcel ID: Structure served by this system 1 015 501 38 Well production at time of test 1.33 gpm Water storage tank volume.- gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic 1.657 ug/L ❑ Arsenic less than MRL (ND) Collected by C.BALZARINI Date of Sample 5/18/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 5/18/21 Results [D Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 0.5 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date NA M 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' F/ Yes Community Sewer Manhole/Cleanout > 100' ft r- Yes if No ft 2✓ Yes if No. Neighboring Tank > 100' ED Yes if No ft Private Sewer/Septic Line > 25' ❑✓ Yes if No. Absorption Field on Lot > 100' F✓ Yes if No ft Holding Tank > 100' Yes if No. Neighboring Absorption Fields > 100' Animal Containment > 50' Yes if No. ✓� Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' [✓ Yes if No ft 0 Yes if No. From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Fv Yes if No ft Surface Water > 100' ®✓ Yes if No. Property Line > 5'✓1 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' [D Yes if No ft Private Wells > 100' F✓ Yes if No Water Main > 10' 1771 Yes if No ft Community Wells > 200' 0✓ Yes if No. Water Service Line > 10' F✓ 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' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' F/ Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' ✓0 Yes if No ft Community Wells > 200' F/ Yes if No Surface Water > 100'✓0 Yes if No ft F. ENGINEER'S COMMENTS THE 2014 SYSTEM WAS FOUND TO BE MOSTLY FULL. SUGGEST BUYER OBTAIN VALVE HANDLE TO SWITCH BETWEEN SYSTEMS. REPAIRS MADE TO LINE BETWEEN HOUSE AND TANK. ALL STANDPIPES PRESENT PER RECORD DRAWINGS 2014 COSA INDICATED WEST C/O ON 1995 TRENCH WAS MISSING. BASED ON PAGE 3/4 OF THE1995 RECORDS, A C/O WAS NEVER INSTALLED AT THE WEST END OF THE 1995 TRENCH, LIKELY DUE TO PROXIMITY OF DUAL AFTER TANK C/Os. G. ENGINEER'S CERTIFICATION l 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. 611121 COSA Checklist yellow sheet OF ' 4.,q *: 4-9 TH •. . • CHARLES G BALZARINI • , ��� •. CE -13854 .• �`� �� e pROFESS`O�P ft ft ft ft ft ft ft ft ft ft EcIdund, Timothy J From: CHARLES Balzarini <cgbalzarini@gmail.com> Sent: Monday, June 7, 2021 4:21 PM To: Ecklund, Timothy J Subject: Re: Upload confirmation for OSC211284 [EXTERNAL EMAIL] Hey Tim, You had a note regarding driveway and missing cleanouts. The cleanouts are all there as shown on the inspection report drawings. In the 1995 drawings, The West CO for the trench isn't shown in plan, but is in section. Safe to say it was never installed as there are swing ties to every other pipe. The asbuil on file didn't scan in that great, hope the hard copy is in better shape. The driveway is shown more or less correctly on the 2014 survey. The area where the driveway used to wrap around the house is now a grassy yard. Here is a pic from the double cleanouts right by the house. You can see the tank to the Septic 'Wank Advisory Certificate of On -Site Systems Approval #OSC 211284 Subdivision: Birch North Lot 1 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 26 years old. Typical replacement costs range from $8,000 to $11,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 -year-old steel tank MAY look like. 1i11aihng Address P O Box 196650 Anchorage; Alaska 9956650` winrw muni or Municipality of Anchorage On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-501-38 Expiration Date: i 1. GENERAL INFORMATION Complete legal description BIRCH NORTH ESTATES; LOT 1 Location (site address) 10400 BIRCH ROAD *ANCHORAGE AK 99516 Current Property owner(s) AMY SIMPSON Mailing address Real Estate Agent Day phone 10400 BIRCH ROAD *ANCHORAGE AK 99516 Day phone 2. TYPE OF DWELLING: n � i; it� �' � Single Family (w/wo ADU) ❑ Duplex j L ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: 229-7716 TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site Individual Water Storaoe ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by: / COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ dtG- q Date of Payment Receipt Number oci'o G\ COSA # OST «l o Date: Waiver Fee $ _ Date of Payment Receipt Number Waiver # Disler..: — 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. /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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E 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 all 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. 6. DSD SIGNATURE i� System #1 Approved for 3 bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. Phone 337-6179 Date f 1 q o OF.:ACU4�0 o ..; .. i ..... 90, r •� 1.-.. `Jeffrey A:_Gorness, CE -7953 c0 ,1Profession& bedrooms, with the following stipulations: ti il,UiUUI�(�,! ON-SITE WATER AND WASTEWATER oz K0U— CO �7lJl)%)) Original Certificate Date: /0 - / - /Y" TheicipaGfy dr Anch tie Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatatio s 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. ATTCHMENTS: COSA Checklist j Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other reo, runs) 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 NORTH ESTATES; LOT 1 Parcel ID: 015-501-38 A. WELL DATA *PER SURROUNDING WELL LOGS Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 8/11/62 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 122 ft. Date of test Static water level Well production Cased to *40+ ft. FROM WELL LOG 8/11/62 72 ft. 4 —9 P.M. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 1.81 mg./L. Casing height (above ground) 12+ in. AT INSPECTION *8/7/14 77 ft. g.p.m. *PERFORMED BY ARCTERRA (SEE ATTACHED EMAIL) Collected by: GEG. Ltd. Arsenic: ND ug./L. Date of sample: 9/12/14 B. SEPTIC/HOLDING TANK DATA *DOUBLE C/O'S PRIOR TO TANK Tank Type/Material SEPTIC/STEEL Date installed 9/15-16/95 Tank size 1000 gal. Number of Compartments 2 C!eanouts (Y/N) YES Foundation cleanout (YIN) **NO Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping SEPTEMBER 2014 Pumper MCDONALDS PUMPING SFRVICE C. ABSORPTION FIELD DATA *BELOW FINAL GRADE Date installed 9/26-29/14 Soil rating (g.p.d./ftor � 1_0 System type DEEP TRENCH Length 41 ft. Width 2.5 ft. Gravel below pipe 5.5 ft. Total depth *15.16 ft. Eff. absorption area 451 ft2 Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test = in. Water added =gal. New depth =in. Elapsed Time: = min. Final fluid depth = in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off' level ate+ =' . High water alarm level Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM 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 N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main 5'+ Wells on adjacent lots 100'+ Property line 5'+ Absorption field 5'+ Water service line 10'+ Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation 10'+ Water 100'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Welts on adjacent lots 100'+ F. COMMENTS WAIVER ON FILE WITH MOA TO EXCESSIVE SLOPES AND SEPARATION DISTANCE BETWEEN DRAINFIELDS. wc--t i O—Jo txf "QE,,(,N i S /vo-T- pRJ�E�S' 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 )0/8 /V� (Rev. 11/05) CE -79P3 •.%iJ(1 T. �{� pct Pio f P s sio�o�o LOT 2 N I SCALE : 1" = 30' 0' 15' 30' 60' 104TH AVENUE Clean Out (TYP•) Wood "A" Frame Residence w/day Light Basement on Conc. Block Foundation -7,4 A 74A OWell 202. LOT 1 Wood Shed & Steps (No Foundation) a a� E m 0 Wood `d rice Q =s w Wood Deck & Steps .3' Link _ 0 5' 35' i'Wood Gravel Drive Shed (No Foundation) y 1.4 m 9.9' ro N N 141.94' N 589'56'39"W 35' 2.2' U LOT 2 Plastic Sided Shed on Wood Foundation NOTES: 1. Distances to the house are to the concrete foundation_ 2. Distances to the out structures are to the side walls. Recertified September 30th, 2014 I hereby certify that an accurate survey of the following described property: BIRCH NORTH ESTATES (78-25) LOT 1 was made on September 3 2014 and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Easements other than those shown on the record plat may not appear on this drawing. Anchorage Alaska, this 30th day of September 2014 Jeffarness From: Amy Simpson <mrsamysimpson@gmail.com> Sent: Wednesday, August 20, 2014 11:05 AM To: Dea Duff us Cc: Jeff Garness; Brent Western Subject: Re: Birch Drive well flow results L ��_ CI C u C `/ ,J c Ftl On Toe, Aug 19, 2014 at 3:07 PM, Dea Duffus <dea arcterra.net> wrote: Amy, On 8/7/14 we preformed a well flow test in conjunction w;'h the septic adequacy test. The static water level was 77' at the beginning and dropped to 100' in 50 minutes at a pumping rate of 2.4 gpm then we slowed the rate to 1.47 gpm for an additional 75 minutes with the wu'ar level holding steady at 99'. We averaged the well flow rate to 1.7 gpm and pumped approximately 210 gallons of water into the septic system before it started backing up and the test was terminated. dea From: Amy Simpson Municipality of Anchorage Development Services Department Building Safety Division j On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL . FOR A SINGLE FAMILY DWELLING Parcel I.D. D15- 501-38 COSA# 01,00315' Expiration Date: /O — ?— 1. GENERAL INFORMATION Complete legal description Lot 1 3irch North Estates Location (site address) 10400 Birch Road Anchroage AK 99516 Current Property owner(s) Cheryl & Wally English Day phone 346-4430 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 10400 Birch Road, Anchorage, AK 99516 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of 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 Onsite Systems Approval are required for the transfer of We (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 sample results. (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 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 Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box 102954, Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date Engineers Comments: In conducting an adequacy test, l attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. Thte operational life of all wells and septic systems depend on the local soil condition, ground water ••�,•pF &a00a levels that may fluctuate during the year, and the water usage of the family being served by the system. :.`p, These conditions are outside the control of the evaluator of this system. All systems eventually fail and C satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there arc no hidden defects or encroachments. PES can therefore not provide any warranty for future 10 -- performance performance nor give any estimate of how long the system will continue to meet the operational 00, requirements of the MOA DSD. Thte content of this report is for the sole benefit of the owner listed ♦ to�� s even R. onnone above. Any reliance upon or use of this report by any other person or party is not authorized nor will it �CE conrcr any legal right whatsoever. �* �`� 5. DSD SIGNATURE tale t�:••• _z Approved for -3_ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: (/c/�z/ %t%• / — Original Certificate Date: (Rm. 17 Municipality of Anchorage Development Services Department Building Safety Division On Sde Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 1 a. yDlrch North Estates Parcel ID: A. WELL DATA Well type P Total depth _jX_ft. Date of test Static water level Well production If A, B, or C provide PWSID # _ Well Log (YIN) Y Sanitary seal (Y/N) Y Wires property protected (Y/N) Cased to _'—+ ft. FROM WELL LOG 8111"982 n ft. 4 g.p.m. WATER SAMPLE RESULTS: Coliform _Q_colonies/IW mL Arsenic: Nj -_ mgr B. SEPTICIHOLDING TANK DATA Nitrate 0.00 mg/L Data of sample: 5RIN Tank Type/Material Omer Steel Tank size ,,000 gal. Number of Compartments 2 Casing height (above ground) 12+ in. AT INSPECTION 5"7@008 79.5 ft. 1.97 g.p.m. Other bacteria colonies/100 mL Collected by: Laura Pannone Date installed 9"5"995 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (YM) N High water alarm (Y/N) WA Date of pumping 5111/2008 Pumper Northland C. ABSORPTION FIELD DATA Date installed 9"8"995 Soil rating (g.p.d./ft= or ftalbdrm) U System type Deep Trench Length 43 ft. Width 2.0 ft. Gravel below pipe 7.5 ft. Total deptitILPA5 Eff. absorption area M&fe Monitoring tube Y Depression over field N Date of adequacy test 813012008 Results (Pass/Fail) Pass For I bedrooms Fluid depth in absorption field before test ! in. Water addec*A gal. New depth7j in. Elapsed Time: J440 min. Final fluid depth j) in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION \ Date installed 'Pump on' level at _ in. Datum 'Pump ofr E. SEPARATION DISTANCES / r SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAlft station on lot _ 105 Absorption field on lot 108 Public sewer main 100+ Sewer /septic service line 25+ Animal containment areas 100+ Manhole/Acoess (Y/N) in. High water alarm level at in. *, Meets alarm 3 circuit requirements? On adjacent lots 100► On adjacent lots 100* Public sewer manhole/deanout lop+ Holding tank WA Manure/animal excrete storage areas 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 8S Property line —Ift Absorption field 10 Water main 100+ Water service line 60+ Surface water 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 30+ Water main 100+ Water Service line 25+ Surface water 100+ Driveway, parkinghrehide storage 25+ Curtain drain None Observed Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and r review of Municipal records that the above systems are in � �. Conformance with MOA COSA guidelines in effect on this date. Steven R. Ponnone� Engineer's Printed Name Steven R Pannone, RE. �i •. ♦% o.CE 8149 +� Date COSA Fee Date of Payment 276 U Receipt Number V3,174 (Rev. 1IM) Waiver Fee E Date of Payment Receipt Number TLL-12-1995 10:18 RE/MAX PROPERTIES INC. Certified Well 907 276 1584 P.02 Date Depth of Size of "S Distance to waier-4 Distance to. water -while purnping-444-4-1le— --atrate . . . Jule- ....gallons per hour. Description of FoFM2on, ti from to AAe 6;6 Akg V v.M1 f o'' nor 1p;wi aclvke you at deed. TOTAL P.132 SCS ReEN 1062330001 Client Name Pannone Eng. Srv. Project Name/® Lot I Blk 2 Birch N. Est Client Sample ID Lot 1 Qlk 2 Birch N. Est Matrix Drinking Water PWSID 0 Sample Remarks All DateJrimes are Alaska Standard Time Printed Daterrime 05/22/2006 9:54 Collected Daterrime 05/11/2006 14:00 Received Daterfime 05/11/2006 14:15 Technical Director Stephen C. Ede Parameter Results PQL Units Method Metals by ICP/MS Arsenic 5.54 5.00 ug/L EP200.8 Waters Department Nitrate -N ND 0.100 mg/L EPA 353.2 Microbiology Laboratory Total Coliform 0 Allowable Prep Analysis Container ID Limits Date Date ' /nit C (<=10) 05/12/06 05/17/06 SCL fl (r-10) coVI00mL SM209222B A (<=1) 05/11/06 ALR 05/11/06 TLP Lot 2 A v e n u e '48" E 202.73' SEPTIC o cb 0 Lot 1 O N I W 1 •s i, V -1 0 4 t h •lush NVRK OItDOt NUM w,te '1 - eb. 6, 2003 1' - 30' aenteeOgetnet macrata responsibility b therY top of kaodation Fade and °� • d em�ent. ylpat 3-1362 zs37 n O EXIST. SHED I N I N 89 Lot 2 A v e n u e '48" E 202.73' SEPTIC o cb 0 Lot 1 O N I W 1 •s i, V Lot 3 S 89'56'39" W 141.94' .rr 5ENTEC Inc LAND SURVEYING *MAPPING *PLANNING SURVEY CERTIFICATION: SENTECInc. hucendmnd I physiat wrvcy of this ptopeny u shown on this drawhy and 2102 CLEVELAND AVENUE TEL.# (907) 243-9966 that dw mprowee n siwnd theteonue.rithin the popery ANCHORAGE, ALASKA FAX.# (907) 243-9967 1 tins me no Coat °<" s cant ower Dw "ed LOT I y o BIRCH NORTH ESTATES- LAT #78-2 thaaalsteacaofmysm'eeo°•eovm>ntkWFINVie"eea"hk C/o C%o not appear on the recorded subdivbloo plat Nott It is the •lush NVRK OItDOt NUM w,te '1 - eb. 6, 2003 1' - 30' aenteeOgetnet macrata responsibility b therY top of kaodation Fade and °� • d em�ent. ylpat 3-1362 zs37 O EXIST. SHED I N I 51' I N oil ;',�:s' 75,7,. I 6 ® of , I Lot 3 S 89'56'39" W 141.94' .rr 5ENTEC Inc LAND SURVEYING *MAPPING *PLANNING SURVEY CERTIFICATION: SENTECInc. hucendmnd I physiat wrvcy of this ptopeny u shown on this drawhy and 2102 CLEVELAND AVENUE TEL.# (907) 243-9966 that dw mprowee n siwnd theteonue.rithin the popery ANCHORAGE, ALASKA FAX.# (907) 243-9967 1 tins me no Coat °<" s cant ower Dw "ed LOT I y o BIRCH NORTH ESTATES- LAT #78-2 thaaalsteacaofmysm'eeo°•eovm>ntkWFINVie"eea"hk C/o C%o not appear on the recorded subdivbloo plat Nott It is the •lush NVRK OItDOt NUM w,te '1 - eb. 6, 2003 1' - 30' aenteeOgetnet macrata responsibility b therY top of kaodation Fade and °� • d em�ent. ylpat 3-1362 zs37 75,7,. I 6 ® I Lot 3 S 89'56'39" W 141.94' .rr 5ENTEC Inc LAND SURVEYING *MAPPING *PLANNING SURVEY CERTIFICATION: SENTECInc. hucendmnd I physiat wrvcy of this ptopeny u shown on this drawhy and 2102 CLEVELAND AVENUE TEL.# (907) 243-9966 that dw mprowee n siwnd theteonue.rithin the popery ANCHORAGE, ALASKA FAX.# (907) 243-9967 1 tins me no Coat °<" s cant ower Dw "ed LOT I EXCWSION NOTES:R Is the owners neponsibiGry to dewmim BIRCH NORTH ESTATES- LAT #78-2 thaaalsteacaofmysm'eeo°•eovm>ntkWFINVie"eea"hk C/o C%o not appear on the recorded subdivbloo plat Nott It is the •lush NVRK OItDOt NUM w,te '1 - eb. 6, 2003 1' - 30' aenteeOgetnet macrata responsibility b therY top of kaodation Fade and °� • d em�ent. ylpat 3-1362 zs37 I I I I I I I Ii I I II I I _I I I I I I I I I I I I LEGEND: ♦,��..\ \ NO. YKNRVEm- • OFA( � 0 *:491-", DECK- ECK- C/o C%o O YIC.-n . momr. / �, Na LS -5318 •� � ♦�� �`•ESSIW�•t' � !�✓ MUNICIPALANCHORAGE O DEPARTMENT HEALTHEALTH8 HUMAN SERVICES of Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. p O ISS — So - /3 oe 1. GENERAL INFORMATION 1-TA.We 1_1 Complete legal description I- o , I � 12 c M- Iy m -r-# f -ST-. Location (site address or directions) Property owner C% CL -Y.4 A'0 Day phone ZSF _ o?�oy Mailing address ci L w A vcr FA I'Lcµ . AV- 90) <-c I Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site K Holding tank Community on-site — Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 JR" 1/91) F,on1 MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm-'I'Aa^20A.) = P -A;6;• Eve Phone 22'2 -ERIE Address a-0.4ox 14i(2c7_r ANch1ca.:4Q AK VS?,57 { Engineer's signature �� N Date 79,S 6. DHHS SIGNATURE n Approved for -2 bedrooms. Disapproved. Conditional approval for Additional Comments °.ta.n R P:nnxa C!: -at:; bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 22425 (14v. 1,91) 81 MOA Rt Municipality of Anchorage R E C E I V E D DEPARTMENT OF HEALTH & HUMAN SERVICET Environmental Services Division�747t 91995 ( 825"V Street, Room 502 • Anchorage, Alaska 99501. 907) 343 7471 Municipality of Anchora0 Dept. Health 3 Human Services Health Authority Approval Checklist Legal Description: 1.0-r 11a'Re H M ao.Tll a s r Parcel I.D.: A. WELL DATA Well hype ^PR WA•r'a If A. B, or C. attach ADEC letter. ADEC water system number Log present (YM) Date completed $ -a- &-t Total depth 12.2 Cased to S'O' Casing height (above ground) ;10 Sanitary seat (YM) Dam of lest Static water level Well production FROM WELL LOG �2 t At g.p.m. WATER SAMPLE RESULTS: Wires properly protected (YM) Y AT INSPECTION lv-Z-T'4S }� a Z Coliform - O — Nitrate h1 • D. Other bacteria -- O Dateor sample:IeCollected by: 5 • (2 Q Aw N a nic C B. SEPPIC/IIOLDING TANK DATA Dam luslalled 01 - r Sr -4S' Tank size / CraQ Number of Compartments Z Cleanouts (YIN) he Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) -^ Date of Pumping A1o.+✓ Pumper C. ABSORPTION FMLD DATA Dam installed 9 -IS -TS- Soil rating (g.p.djLor ft2/bdrm) O. B System type -b- T Length Ki = Width Z Gravel thickness below pipe ? Total depth /0-M' Effective absorption area 653 Z SP Monitoring Tube present(YIN) Y Depression over field (Y/1) A-,' Dam of adequacy test P4 QA o-) Results (Pass/Fail) CASs For 3 bedrooms Fluid depth in absorption field before test (in.): Immediately after—gal. water added (in.): --- Fluid depth -� (ins.) Minutes later: Absorption rate = a.p.d. Peroxide treatment (past 12 months) (YIN) If yes, give date D. LIFT STATION -4// Date installed A Site in gallons Manhole/Access (YM) "Pump ori' "Pump off' letcl at* High water alarm level at* *Datum C ed E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot / OS ` : On adjacent lots 100 Absorption field on lot /001, ; On adjacent lots / 0 o It- Public sewer main N�A Public sewer manhole/cleanout A t Sewer /septic service line Z 8 Lift station ,�/4 A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation C. S' Property, line gaI Absorption field S t Water maintservice line 'r57' Surface water/drainage / 00 t Wells on adjacent lots /colt* SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation $- t Waw main/service line /00"I Surface water / MC,? r Driveway, parking/vehicle storage area C. -0 t Curtain drain / op rt' Wells on adjacent lots -_ /(PC -F- Propene' line 4 a t F. ENGINEER'S CERTIFICATION / certify that ! have determined thru field inspections and review, of,Numctpal recordv in conformances vvith,NO.a /fA-1 Ruideltnes in effect on this date. Signature Engineer's Name S•Rt.�A.v.ve.vss�W d. ' /�, tYw� It Penney GF-8149 .Date NAA Fee S `�� Waiver Fee S Date of Payment Date of Payment Receipt Number _ 0 ly�%D/ Receipt Number Rev. 8/95 OSS: haa.wk.doc CTLE Ref.# Matrix Client sample ID client Name Ordered by Project Name Projects PMSID ME Environmental Services Inc. Laboratory Division 95.4719-1 Laboratory Analysis Report NATER OUTSIDE ROSS EIB PANNONE ENG SRV. WORK Order 19111 STEVE PANNONE Printed Data 10/21/99 a 10i1S bra. Collected Data 10/22/95 a 16730 bra. Received Date 10/23/95 a O5s45 bra. UA sample Remarkal SAMPLE COLLECTED EYs SRP Technical Director STEPREN C. ttDE Released Dye— - f,'.,�y�.n...r•, QC Allowable Ext. Anal Parameter Results Qual Unite Method Limits Data Date Init ....................................................... CKR Nitrate•N 0.10 U Ag/L EPA 353.2 30. 10/23/9% --..•--Ses Special instructions Above r••••_•••••_•_•_•••_••••••__••••_•_•••• -•••••••-_•-_•UA ' Vhavailable •_••••_••• .. See Sample Remarks Above RA Not Analyze4 Or. Undetected, Reported value is the practical quantification limit. IT - Less Than GT • Greater Than A . secondary dilution. 200 W. Potter Drive, Anchorage, AK 99518.1605 —Tel: (907) 562.2343 Fax: (907) 661-5301 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS. MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA