HomeMy WebLinkAboutBIRCH HILLS ESTATES ADDN 1 BLK 1 LT 1Birch Hills Estates Addn Block 1 Lot 1 #050-131-07 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191233 PID Number: 050-131-07 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: CHARLES PURVIS ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 11722 LUGENE LANE, EAGLE RIVER ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Fill added above original grade Ft. Gravel length Ft. BIRCH HILLS EST. ADDA 1 1 Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Ft -- -- Ft. Well 100'+ NA NA NA NA TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ other Manufacturer GREER Capacity 1000 Gal. Surface water 100'+ NA NA NA Material HDPE Number of compartments 2 Lot Line 5'+ NA NA NA NA Foundation 10'+ NA NA NA LIFT STATION Manufacturer Capacity Gal. Curtain Drain NA NA J NA FNA Remarks Existing septic tank decommissioned Pump on level at in. Pump off level at in. High water alarm at in. per Code. Pump make and model Electrical Inspections performed by Tank to PIPE MATERIAL House to tank 3034 d afield 3034 Installer NORTHERN EXCAVATION a Drainfield CO/MT 3034 Inspector FWCS / MNA BENCH MARK (Assumed elevation) 100 ft Inspection 1" 8/21/19 8/23/2019 Location and description 2�d 3rd 4th BOTTOM OF SIDING COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL A `\\ s OF Conditional Approval: Date ®* 49TH *� 15 MICHAEL N. ANDERSON.- G No. CE 9469 •' r 8/23/19 ,. " �ti�'� Af .- J s® Approved _t Date ��sslolzAL Inspection Report_9-1-12.doc BIRCH HILLS ESTATES ADDA B1, L1 a 16. 1, S7 o SHED X \ k\`30 k\ k DECOMMISSIONED EXISTING k k�'k \k\ \ 194 S.T. & INSTALLED NEW 1000 -GAL k� 40 SEPTIC TANK W/ DBL. COs. X oLOT 1 COs ® C FCO q8 , 2 CAN l �i BLK 1 o CO MH a r\ E'(/S ��~�� e M '3&RSE z N 1� A -C=27.3' B -C=28.3' A -D=32.2' B -D=33.0' ASPHALT GRAVEL PID: 050-131-07 PERMIT: OSP191233 WELL SCA] F: 1' = gin' SEPTIC SECTION SCALE NTS PREPARED FOR: SUPPORT SERVICES: CHARLES & ROSIE PURVIS AV�, OF AL�`!� BIRCH HILLS ESTATES ADD.1 81, L1 �TH 11722 LUGENE LN., EAGLE RIVER, AK 99577 49 Michael N. Anderson, P.E. DATE: 8/23 2019 MICHAEL N. ANDERSON 4661 Natrona Ave. / / `�� N. CE 9469 DRAWN: FWCS E Anchorage, Alaska 99516 p 8/23/1 ' (907)727 8864/FAX: (907)345 1391 SCALE: 1" = 30' pESSTDN MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP191233 Work Type: SepticTank Upgrade Effective Date: Expiration Date T ax C, ode Nu rn ber: V5V 131 V7 VVV Site Legal Address: BIRCH HILLS ESTATES ADDN 1 BLK 1 LT 1 G:0253 Site Mailing Address: 11722 LUGENE LN, Eagle River Owner: PURVIS CHARLES H Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ��rent S 0 n l)el>artrnent 6/21/2019 6/20/2020 Lot Size in Sq Ft: 27833 Total Bedrooms: 3 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 7 TN.. ..i.......i...-.... de ..i:....... .J.. ... ih..-.l_II_i:_.- TL_ _hall i_ U. I lie wastewater coUC regUlres IllspelalUllb UU1111 1110 IIIJIdlldtlUll. I llU I Ilglneel Jfldil nUUly the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date; 2< f7 Issued By: Date: MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-131-07 Property owner(s) CHARLES & ROSIE PURVIS Day phone 2283656602 Mailina address 11722 LUGENE LANE, EAGLE RIVER, AK 99577 Site address 11722 LUGENE LANE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) BIRCH HILLS ESTATES ADD. 1 B1, L1 Legal description (Township, Range & Section) Lot Size 27,833 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo AD U) Septic Tank ® Upgrade ® Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Y- �•.' 1 �� - 1�� ham: � 1 i 1r , ��� �� tom; F (Signature of property owner or authorized agent) Permit/Rush Fees: '� 25 - Date of Payment: 611al/q Receipt Number: 0v5'3D Permit No. osplg1p33 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345 -3377 / Fax 345 -1391 Support Services Brent M. Western 907-440-4601 June 12, 2019 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: BIRCH HILLS ESTATES ADD. 1 BLOCK 1, LOT 1 To whom it may concern: The owner has requested we proceed forward to obtain a septic permit to upgrade the aged septic tank on the subject lot. The proposed upgrade will serve the existing 3- bedroom house. The lot and area is served by a private water and this upgrade will not impact any of the neighboring properties due to the lot layout. Please contact Brent M. Western or me if you have any questions. Sincerely, Michael N. Anderson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191233, Rebecca Carroll, 06/21/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191233, Rebecca Carroll, 06/21/19 GRE,.'ER ANCHORAGE AREA BOR�JGH 1 Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION /jREPORT ON-SITE SEWAGE/DISPOSAL. YSTEM NAME -i yl MAILING ADDRESS �'� C .� �'t PHONE LOCATION //JQ,� Q �LEGAL DESCRIPTION ��I/d'�<- SEPTIC TANK: DISTANCE /• NUMBER OF FROM WELL ed MANUFACTURER ..+�XJ� MATERIAL COMPARTMENTS INSIDE LENGTH_____! INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY �d'IyGALLONS. TILE DRAIN FIELD: / �I ��//rr I TOTAL LENGTH DISTANCE FROM WELL Ile/ FOUNDATION NEAREST LOT LINE�OF LINES ' / NUMBER OF LINES DIST„NCE BETWEEN LINES TRENCH WIDTH 3 IN. TOTAL EFFECTIVE ABSORPTION AREA 76 SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER / J DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE _7_•A ' ABOVE TILE IN. WELL: TYPE /c+ CONSTRUCTION DEPTH DISTANCE FROM BUILDING NEAREST NEAREST SEPTIC � SEEPAGE / FOUNDATION_, LOT LINE SEWER LINE TANK 0U , SVSTEM�/t_! CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED -REMARKS DISTANCES: S /r DIAGRAM OF SYSTEM INSTALLED BY: -6- SEWER LINE DEPTH: PIPE MATERIAL: r L�_ LOT SLOPE: REMARKS: Form EQ -032 <-,2;7 /40 lu u DATE "//-Z"-T APPROVED , G.A.A.B. M)';Z/1 DEPARIME W O NERLTH AND EN I.RONMMENTRL PROTECTION 2510 E. TUDOR RD., ANCHORAGE. AK. 99507 276-2221 WELL F=l r4E> Or+l—S I TE SEWER PERM I T PERMIT NO. C 76127 ) APPLICANT DON ZIMMERMAN JR BOX 596 — E. R. c, 694-2947 LOCATION 'OFF EAGLE RIVER LOOP LEGAL L1 B1 BIRCH HILLS EST SUBD LOT SIZFAg0 29000 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: 44+ MAXIMUM NUMBER OF BEDROOMS 3 SOIL RATING (SO FT/BR>- 85 r THE REQUIRED SIZE OF THE SOIL A8SORPTX_0N,SYSTEM IS: C?EPTH� LENGTH= � GRF=I�EL_ oEP'TH= ? THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF EACH SIDE FOR A SEEPAGE PIT. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). REQU I RED SEPTIC TFlNK S I ZE= 10010 GAL-L_OIVS BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T Vf=lIL I E> F= OR ONE YEAR FROM I SSUE I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED APPLICANT ISSUED BY ZIMMERMAN JR 6 4- .�1, v1 • T.H.1 Log Represents Location of Test Hole 'Lot 1 Block 1 Birch Hills Estates , T.H.1 SILT, SOME GRAVEL _ TRACE SAND (ML) 4.0' SANDY GRAVEL TRACE SILT With Cobbles (GW) INo Water Table OWN: K41 " O Don 2immerson F.B. CKD� WED D .I 4-26-76 1 r-) wb mLog of Test HoleOA7E: PROJ.NO. Eagle River, Alaska SCALE- 1"v3# RCM CONSULTANTS, INC. DwG.NQ A-Ol n C0NSULTANTS. INC. ANCHORAGE FAIRBANKS JUNEAU 249 EAST 7197 AVENUE • P•0. !OX 9097 • ANCHORAGE. ALASKA 99503 . TELEPHONE 907.279-0493 . TELEX 090.35419 April 28, 1976 Mr. Donald Zimmerson P.O. Box 596 Eagle River, Alaska 99577 R & M No. 656227 RE: Test Hole and Soil Log Report for Sanitary System Lot 1 Block 1 Birch Hills Estates Dear Mr. Zimmerson: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at..the subject site. This investigation was performed in accordance with your request of April 28, 1976 and those procedures outlined in a letter dated July 15, 1976, by Mr. Rolf Strickland of the Municipality of Anchorage, Department of Environmental Quality. A single test hole was put down within the Lot 1 area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a truck mounted bachoe and the test hole was extended to a total depth of 15.0 feet below ground surface. The final log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M CONSULTANTS, INC. James W. Roone Vice President JWR/pe xc: Municipality of Anchorage Ij t J!PPI°T� 2T��7 trt I Vit, 0�,��T; Iiot V369, STAtz &Lounru A ANCUOTZAGu, AT,A:-3IZA SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 545 feat* DRILLED AT THE RATE OF 120600 PER FOOT. LOCATION OF WELL SITE_IS. I Plk- i H rr h I1 Fdtatos_,Fagle_R1sar- DRILLER _�e3D�4�lalt—Q�iaAPart �rr�� WELL LOG: O- ?3_'Gravol with sovoral small boulders 0 clay bidder. Fo mins of water, 23-351 Soft bedrock. Conglcasarate. 3 _2101 Ssdiment_+T rock. 210.5350 Gra.-dte Rock. Vzry hard. 535-538' A Porcus &ular recti producing 2000 to 2700 galloan of water per daJ. This wellshould improve to somewhat over 3000 gels per day* 150 foot head of water stands 538-545' Granite rook, Charge for 500 foot of drilling: $10.000,00 No Charge for 45 extra foot of Drilling: $900,00 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF 510.000,00 THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPARTQRILLING WORKS DATE June 27th,76 C ,, 'SERVICE CHARGEOF :y,% PER MONTH WILL DE ASSESSED ON PAST DUEACCOUNTS. - U7V OF /%VICHORAGE Development Services Department v 14 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-131-07 1. GENERAL INFORMATION Expiration Date: I -L/ -/% Complete legal description BIRCH HILLS ESTATES ADD.1, BLOCK 1, L Location (site address) 11722 LUGENE LANE, EAGLE RIVER, AK 99577 Current property owner(s) CHARLES & ROSIE PURVIS Mailing address Real estate agent 11722 LUGENE LANE, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 3. NUMBER OF BEDROOMS: 3 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 $ Waiver Fee $ Date of Payment 8 ��1 (I� Date of Payment Receipt Number �C p® Receipt Number COSA # V ,r---'� t 90 I 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 ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377 Address 4661 NATRONA AVENUE, ANCHORAGE, AK 99516 Engineer's Printed Name MICHAEL N. ANDERSON PE Date 8/16/2019 Comments: This investigation was completed in compliance with MOA guidelines, regulations,-ft 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 OF A , 4 due to subsurface conditions that may not be observed from the surface, changes in land use, /"��1 1 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 / ,• 1� system and maintenance. The operational life of all well and septic systems are subject to * :•� Q ' these various and dynamic characteristics and are outside the control of the evaluator of the . v / well and septic system. Therefore, any estimate of how long a system will function satisfactory If Ice 0040 for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by FWG and Anderson Construction & Engineering. MICHAEL N. ANDERSON.' No. CE 9469 + 1� 6. DSD SIGNATURE 1 System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: M 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 X Other COSA Checklist blue sheet Legal Description: BIRCH HILLS ESTATES ADD. 1 BLOCK 1 LOT 1 Parcel ID: 050-131-07 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 6/1976 & 3/1977 Total depth 545 1355 ft Structure served by this system Water storage tank volume 500 gallons Well disinfected for coliform test? ® Yes ❑ No ® Coliform bacteria is Negative Cased to 545 / 40+ ft Nitrate 2.14 mg/L F1Nitrate less than MRL (ND) ® Sanitary seal is functioning correctly Arsenic ug/L ® Arsenic less than MRL (ND) ® Wires are properly protected F;, Casing height (above ground) 12+ in. Collected by �- Date of flow test for COSA 6/10/2019 Date of Sample 8/13/2019 & Static water level at beginning of test 170 / 341 ft. Well production at time of test 0.41 / 0.18 qpm Comments 907 Water Well Services chlorinated water system & took second coli sample. B. TANK DATA —8121119 - 1000 -gal Age of tank(s) 0 years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank ® Standpipes/foundation cleanout per record drawing Date of pumping NA — NEW TANK C. LIFT STATION - NA ❑ Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA — 27'L x 3'W x 7'ED — 85 SF/BR = 378 SF Which system tested (date installed) 11/9/1976 ® ALL standpipes present per record drawing Total measured depth from grade 10.2 ft (max) Measured depth to pipe invert from grade 3_9 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective 6.3' ® Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Com ments/Deficiencies: COSA Checklist copy 2.docx Adequacy test date 6/10/2019 Results N Pass For 3 bedrooms Fluid depth prior to test 44 in Water added 450 gal New depth 50 in Elapsed time 110 min Final fluid depth 45 in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) N If yes, enter date ES 1� �yAXa T=t, el11D W-AlLlIaCK 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 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 *93' ft Holding Tank > 100' Yes if No Neighboring Absorption Fields > 100' Water Service Line > 10' 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' Yes if No _ Property Line > 5' Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft 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) ft ft ft ft iii iii ft ft 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 ft Surface Water > 100' Yes if No ft F. ENGINEER'S COMMENTS *Well #2 — Waiver 86-081. 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. COSA Checklist copy 2.docx OF .AL�q 49TH %MICHAEL N. ANDERSON. s No. CE 9489 8/23/19. '- ��sslozs�.0 Tract A-1 WI 10.4' x 16.1' SHED SEPTIC MANHOLE SEPTIC PIPES 83' x 16.0* GREENHOUSE 2.0' CANT --P1 6.0' x 8.0' PORCH `--WOODEN FENCE 10.3' x 28.3' SHED 1� 0 OP Lot 1 27,833 s.f. GRAVEL Q 0 PROTECTIVE WELL RADIUS a�'?-.--WOODEN FENCE 70 PLOT PLAN AS BUILT -1- SCALE 1 40' GRID NW 253 , Project No, 19-476ZE1 11500 Daryl Avenue, Anchorage, 'Alaska 99515-3049 Long & Associates, inc. (907) 522-6476 Phone (907) 522-4625 Fax kk Professional Land Surveyors ken0langsurvey.com OF A lonafhon*langsurvey.com I hereby certify that I have surveyed the following described property: Lot 1, Block 1, BIRCH HILLS ESTATES SUBDIVISION, ADDITION #1 (Plot No. 67-81) 1*0 - 4 9 1 H ............ .. ......... Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed K.EN. I . ... ..LAN ... ...... FH promises and that there are no roadways, transmission lines or other visible VV easements on said property except as Indicated hereon. r %520g Dated this the Day of A-Q&0S1 of Anchorage, Alaska It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plot. AECC963 14 � Lot 2 10' UTILITY EASEMENT PLUS ----__�_ 5' TREE CUTTING PERMIT 6' 194 2.0' x 24.2' CANT 4a, WIRE FENCE :6 S'rORY WITy SlDcfvc WALj< E N &AS&W O(UJ7- WELL .2' ASPHALT PAVEMENT Lot 1 27,833 s.f. GRAVEL Q 0 PROTECTIVE WELL RADIUS a�'?-.--WOODEN FENCE 70 PLOT PLAN AS BUILT -1- SCALE 1 40' GRID NW 253 , Project No, 19-476ZE1 11500 Daryl Avenue, Anchorage, 'Alaska 99515-3049 Long & Associates, inc. (907) 522-6476 Phone (907) 522-4625 Fax kk Professional Land Surveyors ken0langsurvey.com OF A lonafhon*langsurvey.com I hereby certify that I have surveyed the following described property: Lot 1, Block 1, BIRCH HILLS ESTATES SUBDIVISION, ADDITION #1 (Plot No. 67-81) 1*0 - 4 9 1 H ............ .. ......... Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed K.EN. I . ... ..LAN ... ...... FH promises and that there are no roadways, transmission lines or other visible VV easements on said property except as Indicated hereon. r %520g Dated this the Day of A-Q&0S1 of Anchorage, Alaska It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plot. AECC963 Well Water Advisory Certificate of On -Site Systems Approval # osc191387 Subdivision: Birch Hills Estates Add. 1, Block: 1, Lot: 1 This well's productivity was determined to be .59 gallons per minute. The minimum well productivity required under (AMC 15.55) for a 3 -bedroom residence is .31 gallons per minute or 150 gallons per day per bedroom. Although the subject well currently exceeds this minimum requirement, the production capacity can fluctuate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Nt�x��96�50��n�i'% Pd� Bpi • -� Municipality of Anchorage ° On -Site Water and Wastewater Program ; (907) 343-7904 E Certificate of On -Site Systems Approval -7 Parcel I.D. 050-131-07 Expiration Date:2-1 -1 1. GENERAL INFORMATION Complete legal description Birch Hills Estates, Addition 1, Bock 1, Lot 1 Location (site address) 11722 Lugene Lane Eagle River, AK 99577 Current Property owners) BIII &Tina Martin Day phone Mailing address Real Estate Agent 11722 Lugene Lane Eagle River, AK 99577 Day phone 2. TYPE OF DWELLING: Q Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three 4.. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for. Received by:�/y/li/ UI,%f� `�/ Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number OS' 39 Z Ci Receipt Number COSA # (?V U. IS 2-1 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 Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE KSystem #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the followi Date 11/2//2016 ih MICHAEL C. AIQERSWM NO CE -43e1 . B Original Certificate Date: �� I The Municipality of Anchorage Development Services Division (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Nue sheet f - If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system' Certificate.of On -Site Systerns, A,pp,rovalJChecklist ,, sip 3, Legal Description: Birch Hills Estates Addn. 1, Block 1, Lot 1 Parcel ID: 050-131-07 A. WELL DATA lei i,�'1'-•. !�a,y Well type Private If A, B, or C provide PWSID # ,; F , Well Log (Y/N) Y --sns &ani -- __ ;,; Y _ _� __._. _._ ; ..Y Date completed Sanitary seal (Y/N) _ Wires properly protected (Y/N). 5.45._'_ --= = - 545 Total depth ft. Cased to ft. Casing heighb(above ground) -- 355-- .� 1.. •,.n•t.: , X40; FROM WELL LOG AT INSPECTION bate of test"`- 6/76 &-3/77 Static water level Unknown Well production 1.0 & 0.69 g p m (oq K WATER SAMPLE RESULTS -' ...I ...,:ilk Coliform - _0 - colonies/100 mL Nitrate 3 62 . m9/L ND 10/17/16 -And.'En neenn Arsenic ug/L Date of sample: Collected I by: g g ,:.. _ ; B. SEPTIC/HOLDING TANK DATA • - - ---- —•- ----- TankType/Material Septic/Fiberglass**,.'_>=Date installed 11/9/76: Tank size, 1,000 gal. Number of Compartments 2' "i cleanouts(Y/N) Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N _ Date of pumping 10-25-16 Pumper JRs Pumping �- - - - -'--**Septic Tank-is'more;than ,40'years old avid may be neap failure. C. ABSORP.TION.FIELD.DATA - `__. _ __-. _ ;r . _ _ _ , . ,' Date installed 11/9/76 Soil rating (g.p.d./ft2 or fethdrm) 85 SF/BDRM System type Deep Trench Length 27 ft._ Width 3 ft. Gravel below pipe 7 ft. Total depth 10'5 ft. ''Eff. absorption area 378 •`fe `I; Monitoring;tube rY#. Depression over field Ni" 10/25/16 Pass 3 "' Date of adequacy test Results (Pass/Fail r : ;1 For _ bedrooms Fluid depth'in absorption field before test 0 rn. Water added 650- gal �� , New depth 15 in. 1 440 0 ---'in.- - .._ .... - ----.450- Elapsed Time: min: Final fluid depth Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) N If yes, give date, *Absorption Trench Pre Soaked on 10/24/16. _,.:_ t:,_ _ . 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 E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Meets alarm & circuit requirements? Septic tank/lift station on lot >100' Absorption field on lot >100' Public sewer main >75' Sewer /septic service line >25' Animal containment areas >50' SEPTIC/HOLDING TANK ON LOT TO On adjacent lots >100' On adjacent lots >100' Public sewer manhole/cleanout >160, Holding tank >75' Manure/animal excrete storage areas > 100' Building foundation >51 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 >10' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above, systems "are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E-. Anderson, P.E. Date 11/2/2016 COSA brown sheet 10-10-12.dm 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.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # OSC161521 During a recent COSA on-site inspection and test of the potable water supply well on Block 1, Lot 1 of Birch Hills Ass #1 subdivision, the well's productivity was determined to be .34 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is .31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orgtonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 0_2z -131-67 COSA# nl h535 Expiration Date: _l — 31-0-7 1. GENERAL INFORMATION Complete legal description Lot 1; Block 1; Birch Hills Estates Addn. /11 Location (site address) 11722 Luxene Ln. Eagle River, AK 99577 Current Property owner(s)Esta t o of Ron Schultz Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 3zgl ZIs+ Aue. tJG Nutt Ila, MU 57yAI14-`lyyX Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well (2 ) Individual Water Storage Community Class Well Public Water System 3 Day phone Dayphone TYPE OF WASTEWATER DISPOSAL: R 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 Stale of Alaska. Certificates of Onsite 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 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 S S S Engineering Phone 694-2979 Address 17034 N FaPle RJvPr Loon s 904 Friple River, AK 99577 Engineer's Printed Name Robert A. Shafer 5. DSD SIGNATURE Approved for _� bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments WATER ANDVVASTEWffER Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other_ By: Original Certificate Date: � (, (Rev. 11/05) Municipality of Anchorage ' Development Services Department Building Safety Division Ort -Site Water a Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onske (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lr //, arc 1!-&,. 4, c Fes-. 201LIAM yp I Parcel ID: /_07 A. WELL DATA Well tyPQ11ME &z, If A. B, or C provide PWSID # Date completed 16/lk-C3/771 Sanitary Total depth 5Vs r ft. l Cased toamx (b55') rtt �2 Well Log (Y/N) c Aa0 Wires properly protectedcft) bs Y:3> Casing height (above ground) 16( . FROM WELL LOG AT INSPECTION Date of test "47 d 3 7 // Z O Static water level ^ UtW - I - ft. 92 s CZIo'% ft, Well production LD d.(o.rog� g.p.m. 0-704-00409 P•m. - t IZO rap, 0W 60*7ro. 4-1Vr ,*_ T*Ovr- WATER SAMPLE RESULTS: IK7 dAstJ4t t - Coliform OL��0 colonies/100 mL Nitrate 2.15 mg/L Other bacteria O o colonies/100 mL c,�� gn lls gyp( (l� hE Y Arsenic: m Date o sam e: to r i flatted b : _� S fA* IIl7EiEret B. SEPTIC/HOLDING TANK DATA to/11,4 to�r(./o(p Tank Type/Material _ E1C IFIBE!4� Date installed I l Tank size _/000 gal. Number of Compartments 7 CleanoutsON) `-(y f Foundation cleanout 6k _*A Depression over tank (Ye �9 High water alarm (Y® _ No Date of pumping I I I t 0 Pumper —.11-22., Pu --(s C. ABSORPTION FIELD DATA Date installed 1j 111-7 Soil rating (g.p.d./ft' or � $s System type , Length X9t ft. Width 3 ft. Gravel below pipe _ _ ft. Total depth % ft. Eft. absorption area eft= Monitoring tube qs'C6 Depression over field 21 Date of adequacy test /0 4&(a Results as ailj ] s For 3 bedrooms Fluid depth in absorption field before test Dleyin. Water addedl2gal. New depths in. Elapsed Time: 31$ min. Final fluid d/epth .� in. Absorption rate >=t A� 9.p.d. Any rejuvenation treatment (past 12 mo.) Qq type) _ /j 0 If yes, give date D. LIFT STATION t4l#} Date installed Size in gallons 'Pump on' level at _ in. 'P p Datum Cycles tested E. SEPARATION DISTANCES at _ In. High water alarm level at in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankilift station on lot IAO +- a 6CV Absorption field on lot Public sewer main `). p Sewer /septic service line 25 "-[ZS +') Animal containment areas 66 '+ 60 +) Meets alarm & circuit requirements? -W I p 7- 7(o 7(o a-('-7'7) On adjacent lots /00 /� e t 1001.- ) On adjacent kits /00'+ (100 4.) Public sewer manhole/cleanout Holding tank 10 18 Manure/animal excrete storage areas /00 '+ - /Co SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property line $ '4 Absorption field 5't Water main N In Water service line /O'r• !Surface water loo'f Wells on adjacent lots 00 f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: I I Property line /0+ Building foundation !O / Water main N A I I Water Service line /O •f- Surface water /00 i Driveway parking/vehicle storage /D i I Curtain drain WVOLE -9AXWN Wells on adjacent lots ICO 4 F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipalcords that, above systems are in conformance with MOA;COSH id 1i sin fled 0 { ... Engineer's Printed Name e/ A t&% Date /0 COSA Fee S Waiver Fee $ Date of Payment �� Date of Payment Receipt Number `f Receipt Number (Rev. 1IM) a NA y01 Fo N N• S�Sy0 S 00 z 1b��9 69� 1 N 00 ro SA I 1 � 1 m 0 r � )1-J3a o m m zm to .J $ O O W J `O N u +s � rn LAo $ A rm ri r4 r D a3Ms N o g$ m Q A Z.vrl .0y.0 W W m it o u to A* A* O $-IRF f E yAn li O N,vp ----------- -------------------------------------------------A NA 10' UTILITY EASEMENT PLUS S' TREE CUTTIING PERMIT 7•� < N 23'14'10"E 188.31' (R) • m. LUGENE LANE ' m v p ° n �+ oco, v'e Z m r � o � rn v Z Z O All 7p �e�'•n�_rm `•_ — m- Fn 0 0 0 0 0 0' Y RI ch nm _ _ • • — 2 E; IA /A rm g• � <•° ON2.2 000 0. Io n o C: C) v - /oo7 .2 , o: of, (D It '..uVV�11 �• •V ��'Ti1/// 46 Z y r m w iii' n. "� A 1 y Or �� •% �� 0 0 8 �^ �^•'v yp o. to • �� m U O E' Y' O °+ W 0 R i Y 0 CO X Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw Sl. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.a k.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING / 0 Parcel I.D. 0 GENERAL INFORMATION Complete legal description Lot HAA # dbao/-li9 Expiration Date: / Zs o 1; Block 1; Birch hills Est. �S/D Location (site address or directions) 11722 LugeneAve, Eagle River, AK 99577 Current Property owner(s) James Willer Day phone 694-8824 Mailing address Same Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be / held by DSD for pickup. ZC�j�i+-- fi( / 2y/ o 2 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Kj Individual On-site IV 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 less than 30 days old. (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 dale shown below, I verify that my Investigation, based on procedures outlined In the Health Authority 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 S & S Engineering Phone 694-2979 Address 17034 N. Eagle River LP RD, E.R., AK Engineer's Printed Name Robert C. Cowan Date 06 / 1 a / o z E OF n 5. DSD SIGNATURE 3' ` ROEERT C. COWAN t-1-11toc.% CE -8801 Approved for bedrooms. fl •: •., _ _ lilt'' •�.«,Sw�I�` Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory By: + (Rev Ii�p07 Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: d •+' f Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: �J I �f�H �yLGs! Parcel ID: A. WELL DATA (2 W Cr -t.." Well type !iF (�- / If A. B, or C provide PWSID # = Well Log (YIN) LN,� Date completed d 33/"'9anitary seal (YIN) Wiles property protected (YIN) Y_ Total de Cased Casing height (above ground) Z in. FRQM WELL L G AT INSPEC ION , Date of test 8 Static water level u� uN� fL I ft Well production �• 0 0•G9 g.p.m. ai 8 • P. M. WATER SAMPLE RESULTS: k7-?6t(.JG'u.b r P TD OA/t= ssuru� 'rq..r I� Coliform �a colonies/100 ml. Nitrate . �� mg -A. Other bacteria 0 colonies/100 mi. Arsenic: � mg.A. Date of sampleP3/19/0?/ Collected by: 5 46 B. SEPTICIHOLDING TANK DATA TankType/Material / Date installed 1/ 17 Tank site l O ,JL gat. Number of Compartments Cleanouts (YIN) y / Founda�on cleanout (YIN) • ~Depression over tank ((YIN) Al High water alarm (YIN) A - Date of pumping / OSI! Pumper L d I S C. ABSORFnON FIELD DATA Date installed I r Soil rating (g.p.d.Atz or�n)ES System type x&ye ft 1 / r Length R Width 3 ft. Gravel below pipe rt ft/. Total depth �. S ft. Eft. absorption area �ft2 Monitoring tube Depression over field Date of adequacy test 2 b Results (Pass/Fail) � � For —3— bedrooms Fluid depth in absorption field before test 2, in. Water added gal. New depal if% Elapsed Time: 1:&1in. Final fluid depth LQ-r1n. Absorption rate >= 45-b g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed ' 'Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off level at Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/ ift station on lot 10D14 490 r�') Absorption field on lot 1190 r /- Public sewer main N r /septic service line Z �r __ Manhole/Access (YIN) in. High water alarm level at in. __ Meets alarm & Circuit requirements? -k f (g -g-) On adjacent lots /AO 14 - On 4 -On adjacent lob 1� BD / r Public sewer manhole/cleanout NJ Z& Holding tank SEPARATION DISTANCES FROM SEPTIC/H LBtRG TANK ON LOT TO: r + Building foundation �J f' Property line ,�'1' Absorption field 5 Water main �� )-r- Water service line �� t Surface water __ I't` Wells on adjacent lots 100 14, SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 1 + Building foundation / 01_{- Water main / 0 , + Water Service line 014- Surface water 1 Driveway, parking/veNcle storage t7 tt Curtain drain 0,lvV_4_r035Lj Wells on adjacent lots 1-4- F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and .i.. review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. �, a,,,,N Engineer's Printed Name Ro/Uar C_ Date HAA Fee $ J1 7 S`. Vv Date of Payment Y /? 2 /a x Receipt Number © 7A Y S'S' Y , (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number 04. - e r �.t,( ,•r tiY r '!.' ,Mlu.- try.'. ♦f ,�,.+, yx yrs- t , 1R 4 P) ""F;1 wu6 ♦ . i': ' %. x k !1yMrl +�;� t. -{.� J ti.'Mf ,.� } •S: f 1 , .A LJi Ar , J,.�r { . '!'.,4 ,k yt '. ).'i'- .. ,:'•.. 1'+x.1 L,n N � , ry �= p ,r1 r `t,}, ,�. MUNICIPALITY OFtANCHORAGE'r DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH s CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 1264-4720v 1 . Application Date 1. GENERAL INFORMATION f (a) Legal DQscription (include lot, block, subdivision, section, township. range) 1 or directions) (b) Applicant NameeMht,'Z- ffZL1CA1-';-J Telephone: Home Business (c) Applicant Address Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Address (e) Real Esta Address Telephon Telephone (f) Mail the HAA to the following address: s 2. TYPE OF RESIDENCE Single Family Multi -Family 13Other 1 , Number of Bedrooms 3. WATER SUPPLY ) -individual Well Community ❑ ' Public ❑ " Note: If communitywell system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4..' SEWAGE DISPOSAL Onsite) Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11,84) Page 1 of 2 . 1 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA1.. AND INFORMATION 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 shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate: forth e number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipallty,of;Anchorage files and fromrmy fnvest(gatlon'and,inspection; the on-site water supply and/or " wastewater disposal system is incompliance with all Municlpai avid Statecodes,`ordinances, and regulations in effect on; the date of this Ins"SrENGINEERING Name of Firm —SR B 196X Telephone�Z��� Address EAGLE RIVER AK 99577 "'r n Date A., v ,• i . r , : � . ' {' f. �. t j l.. r i9 '', a r .. t ',• , ✓ � �1 4 1 ,. , A w w .. •yWrt A. fAeiwA• J.� . -.5 r J, .�Ni. 14 ,...'S`l.�• , f 6 DHEPAPPROVALi Approved for, bedrooms by h -Date Approved ` Disapproved, Conditional •. a ,y 1 •, .., L d ] 1 l Terms of Conditional Approvals { ..s1 ,'r ,. , 5-• rt .-: 'i r✓ a „�•,3( k 1� 1 r }�•. tlr r [ • , n1 r ! 9'• w '•' i�'t7; iaj 1 iF i 1 ,-; a '� YY 1 ' c .,+Yti� �' J��i a''. air •� a er .1..! ., "l r , L. r.: vt , r t 4 ' ,Y y >r, a•r r ` f t .. t r ♦ t r. 1 't , , 1 1 r I 1 r y < CAUTION r` , The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) Issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP, does this as a courtesy to purchasers of. homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do nt conduct inspections or. analyze data before a certificate Is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional; engineers work ' ' t ( rr4 t+l t'•f �✓ " ,✓y -tw . , r: t n, Jn +' '.i 'Page20f2l t6 'it 72-025(111`84). ... ..1 ..a. ..r.�.., .n. _.�,... .,-C—.r ...—.., .c:... °... _. .4 „�1.....'.t... .., t.+!'. i... ./ lvr.'... _Jr .rr.�'K�. �'r.Y.. r1.l...w.l.;[r. •.i �u r. MUNICIPALITY OF ANCHORAGE (111,1110�1 A A -*4Z 0A Ole, HEALTH AUTHORITY APPROVALIH y '16 'tec�, CHECKLIST - FEBRUARY 1984 -tleco 1,01V 264-4720 A. WELL DATA7� Well Classification Well Log Present (Y/N) Date Compel 5451 ased to Total Depth ) $1 Static Water Level 2-�q 46 ( Casing Height Above Ground — Electrical Wiring in Conduit (Y/N) Legal Des on: "!:r- x wa=e�_\ 141L -L' If A, B. C. D.E. C. Ap7lroved (Y/N) — d Yield �th of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) cinA Separation Distances from Well: I To Septic/Wakhrq Tank on Lot I C10 On Adjoining Lots orption Field on Lot 11 On Adjoining Lots To Nearest Edge of Abs To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot 2:5 Water Sample Collected by -.Date 15 -so- L9.5 Water Sample Test Results �UV%�M�.Q =!ZM1111l nmva - - a Im B. SEPTIC/MGMYM TANK DATA Date Installed 11 -!Z- 7-5 Size Z Z>L�D No. of Compartments �Z_ Standpipes69N) — Air -tight Caps &N) Foundation Cleanout (YdP— Depression over Tank (Y�% ate Last Pumped -J') - Pumping/Maintenance Contract an File (Y/N) :::::�14 — ; for Holding Tank High -Water Alarm (Y/N) — IOLA Temporary Holding Tank Permit (Y/N) Separation Distances from Septi 10D ank: .1 'C' y To Water -Supply Well — To Building Foundation J. To Property Line — lb '4 1, To Disposal Field To Water Main/Service Line Course Comments Page 1 of 2 72-02601/84) To Stream. Pond. Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed Length of Field 27 Width of FieldDepth of Field 'liter/ 1 3 Gravel Bed Thickness 7 Square Feet o1 Absorption Area 3 7 Of Standpipes Present JVN) Depression over Field (Yrp— .. Results of Last Adequacy Test Date of Last AdequacYTest S'31 --6b Separation Distance from Absorption Field: To Water -Supply Well X131 Tnt G�oSFr! To Property Line 45- r To Building Foundatigp Lot ►J ; On Adjoining Lots To Existing or Abandoned System on .71>1.4 r � To Water Main/Service Line >D TQCutbank (if present) To Stream/Pond/Lake/or Major Drainage Course !J/� To Driveway, Parking Area, or Vehicle Storage Area ' Comments D. LIFT STATION Date Installed Size in Gallons 1.. Dimensions Manhole/Access (Y/N) "Pump On" Level at ..Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments •• Check Permitted Bedroom Rating Against HAA Request •• 1 certify!lgt IIpMaheclw�ygplied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. SignedSR.B bb��1lVVttttRR1111VVGG Date JUN 16 1986 Compaf-AGLE!VIER, *K 99577 MOA No. J S` —t !)&P S_ Receipt No. Sri O $(q ? C •,..• ACAS`' Date of Payment a' ••q��AII Amount: $ �� '••:•• Ub..r A. SA•hr N-. W7-6 Page 2 of 2 72.026 (11,84) Municipality of Anchorage July 10, 1986 P.O. BOX 6650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNO WLES. MAYOR DEPARTMENT OF HEALTH 6 HUMAN SERVICES Robert A. Shafer, Y.E. S & S Engineering SRB 196—X Eagle River, Alaska 99577 Subject: Lot 1 Block 1 Birch Hills Estates Subdivision O1 Waiver Request, WR86-081 Dear Mr. Shafer: This department concurs with your assertion that the 100 foot horizontal separation between the well and leachfield on the subject lot is not necessary in this case. Available information indicates that the possibility of well contamination is remote. The required separation has been waived to 93 feet. This waiver is valid for the existing three bedroom single family dwelling only. Sincerely, Step(U�hen S. Morris Civil Engineer On—site Services SSM/ljw n it. June 14, 1986 ROBERT A. SHAFER CIVILENGINEER 694-2979 NEALTHAUTHORITY municipality 9 lit of Anchorage APPROVALS Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 SEWMAIN EX ENSIOWATE MAIN EXTENSIONS ATTENTION: Steve Morris REFERENCE: Lot 1; Block 1; Birch Hill Estates #1 Request you issue the attached Health Authority Approval and grant a SEWER& WATER INSPECTION `- waiver t0 the horizontal separation distance between the absorption field and the well at a distance of 93 feet. In addition to the information provided with the health authority application the following information is provided: ENGINEERING STUDIES AND IIEPORTS A. Site plan showing the relative location of all wells and septics on this and adjoining properties. WELL INSPECTION B. The well is currently at approximately the same elevation on BFLOW TEST the surface as the septic system and there is no noticeable gradient between the well and septic system. The original well was drilled in 1976 and due to the low production SITE PLANS (1.2 gpm) the owners applied for a new well under Municipal permit #770959 in October 1977. At the time the well permit was issued, Joe Blair, a member of your staff, granted a waiver of 92 feet to the seepage area. Rampart Drilling Works drilled the second well as shown on the site Plan. It is this well that requires the waiver. A flow test performed ROAD DESIGN by our office indicates the second well to produce approximately 2.4 gpm. Rampart Drilling, though they acknowledge drilling the well, has been unable to produce a well log, however, based upon information which they were able to provide us and measurements of static water level SOILTEST in both the well casings indicates that over a 1000 gallons of water is in storage when the system is at rest. Using the existing well log and infromation taken from your files on PERCOLATION the on-site wastewater disposal syste, it is our opinion that the horizontal TEST separation distances prescribed by 18AAC72.021 are not required in this case. If we may be of further service, please contact us. STRUCTURAL& MECHANICAL INSPECTIONS .il ere / A ONSITE FRAS/ss-A• SHAFER, P.E. WASTEWATER DISPOSALSYSTEM DESIGN SRB 196X EAGLE RIVER, ALASKA 99577 r U \ n 9 7 la - t, 4 Q r u 3 � I �•or �C r U \ n 9 7 la - t, 4 Q r u 3 �