HomeMy WebLinkAboutBIRCH TREE ESTATES BLK 1 LT 10Birch T Estates Block Lot 10 #017-141-28  Municipality of Anchorage / Development Services Department :~ Building Safety DMs~on On-Site Water and Wa~tewater Program. 4700 EImo~e Road ~ P.O. Box ~96650 Anchorage, A.K 99507 Page of www. ci.anchomge.aKus (907) 343-7904 ON-SITE WASTEWATER DISPOSAL S~'fSTEM AND/OR WELL INSPECTION REPORT Permit Number: 0sP10104/9 PID Number: 017-141-28 mrs,: SHANNON POWERS Wastewater System: [] New [] Upgrade ~444s eUFFALO ST. ANCHO~aE, A~ 995~e-4207 ABSORPTION FIELD LEGAL DESCRIPTION 2,0 ~,~, ~,0 ~, 0_,AS' Well: [] New [] Up 12.0 ~, 4 3.3 Fi. TWEED EXCAVATING ~=. ~ TANK . SEPARATION DISTANCES [] septic [] Holding [] S.T.E,P. /[] Other: BENCH MARK TOP OF DECK NEAR POINT ~ Inspections performed by: l.r,A~! ~;. I~irchwoad b3. ~Dates: 1~ 6/3/2010 ~ ~, ~-'~" ~ ~ Conditional Approval Date: .~.~.~.e= PERMIT NOOSP1 01 049 PAGE 2 OF 3 MunicipaLity of" Amc,homage DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, /-,,700 BRAGAW STREET P,O, Box 196650 eAnchorage, At(~ska 99519-6650 eTeLephone~ (907) 343 7904ewww,ci,anchoraRe,ak,u ON-SITE WASTEWATER DISPOSAL SYSTEH AND/OR WELL INSPECTION REPOR' LEGAL LOT 10; BLOCK 2; BIRCH TREE ESTATES P.I.D. NO. 017--141--28 LOT 9; BLOCK 1; i LOT 8; BLOCK 1; BIRCH TREE EST. TRE_E_ E_S_T_. _ 10' UTILITY ESMT. [s~O/ BLOCK 1; BIRCH TREE EST. NEW SHUTOFF VALVES ON DISCHARGE LINE~ LOCATED INSIDE MANHOLE-- ~1 , ELL RADIUS EXIStiNG 100 ~ PERMIT NO OSP1 01 049 PAGE S O? 5 ~unicipoLJly oP Ancho~oge DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PRO6RAM, 4700 BRA6AW STREET P~, Bo..,x 1966.5,O,eAncho~-cge, A~o~sk~ 99519-6~50 e Te[ephone, (907) 343 7904 ·www,ci,o. ncho~ge,(~k,us N-:;:::ClTE WASTEWATER UISPOSAL UYSTEM AND/OR WELL INSPECTION REPOR' LEGAL LOT 10; BLOCK 1; BIRCH TREE ESTATES P.LD. NO. 017-141-28 A B MT1 37.7'70.3' MT2 48.0'49,4' FV1 38.7'71.0' FV4 29.2'63.4' FCO 51 MT1 GRADE MT2 GRADE = 101.0' MTi=102.1 DIST. LINE · GROUNDWATER AT 97.5' B.O.H. Permit Number: Tax Code Number: Work Type: On-Site Wastewater Disposal System Permit OSP101049 01714128000 Septic MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Upgrade Permit Effective Dates: June 02, 2010 to June 02, 2011 Design Engineer: S & S ENGINEERING Subdivision: BIRCH TREE ESTATES Site Legal Address: BIRCH TREE ESTATES BLK 1 LT 10 G:3037 Owner/Address: POWERS SHANNON J 14445 BUFFALO STREET ANCHORAGE AK 995164207 Site Mailing Address: 14445 BUFFALO ST, Anchorage Lot Size in Sq Ft: 30314 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field N 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 Apdl 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 By: /~~ Date: Date: Muaicipality of Artcltorage Development Services DepaE~ment- Building Safety Division On-Site Water and Wastewater Program 4700 EImore Road P.O. Box 196650 Anchorage, Alaska 99507 www.munLorg/onsite (907) 343-7904 O ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING ParcelI.D. Property owner(s) . .~,/¢O/d , , Mailingaddres, /Z7/7LO , C'//,'/eF Site address /~/-/-~- ~4'- ~x-/o ~'/'~.~' Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) Day phon _¢C C-- zip Cede Zip Code Lot Size .Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR ([~ all that apply): Absorption Field ~ Septic Tank Holding Tank [] Privy [] Private Well [] Water Storage [] Date of Payment: Receipt Number: (Rev, 11/05) THIS APPLICATION IS AN: Initial Upgrade Renewal I certify that the above info~t. I further certify that this application is being made for a Single Family Dwelling/azf~is in accordaTe with applicable Municipal Codes. / (Signature of propari/~authff/zod a~ PermiYRush Fees: ~' '2~O Waiver Fees: ~.//,/'~c/~ Date of Payment: C'~ ,c2"--;~;f~ ~ Receipt Number: HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN ItlE~Rln~ Rober[ A. Shafer, RE, CIV[L ENGINEERING June 1, 2010 PH: 907-694-2979 FAX: 907-694-1211 vlUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 10; Block 1; Birch Tree Estates S/D It is requested that you issue a permit to install a new I.D.S.F. septic system to serve the existing two bedroom house. The existing I.D.S.F. was influenced by breakup and could not pass a adequacy test. Efforts will be made to direct runoff away from the existing system and the alternate site will be used to construct a second bottomless sand filter. Each filter will be valved in the lift station so alternate system can be used. Two test hole was excavated and percolation tests performed by Alaska Water and Wastewater. The approximate locations of the test hole is located on the attached site plan. At the time of excavation on 5/24/00 water was found at three feet. After monitoring ground water for seven days water was found at three feet six inches. The existing I.D.S.F. will be saved for future use. We do not anticipate any adverse effects on neighboring septic systems, reserve areas or drainage patterns by the installation of the proposed innovative septic system. The construction of this system will not prevent any future development on any of the adjacent properties. ditional information, please ,/~x-~"~p.E. contact us. 15861 S. Birchwood Loop Road, Chugiak, Alaska 99567 z~ z O1VJJ 08 NDISq(] x ~-w~ OP-x ~ N¥gd-311S OZ Z ,09 = ,,~ .33 UIS"~qVJJ FI8 N91S3~1 LLI NY-Id -:]115 NOIS3a 'S 'I 'N Municipality of Anchorage Page 1 of 5 JUL OS ~{~{~ARTMENT OF HEALTH AND HUMAN SERVICES Mun~oiFtRFt,,,,a.^~. ~__.i · '- ENVIRONMENTAL SERVICES DIVISION P.O. B-o"x-LfS~6'~5-'O'°ra~L~chorage, Aaska 99519-6650 Teephone: 54,3-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW000559 PID Number: 017--141--28 Name: CURTIS BURNHAM WastewaterSystem: [] New · Upgrade Address: 14445 BUFFALO ANCHORAGE, AK 99516 ABSORPTION FIELD No. of Bedrooms: ***2 Ph°ne:k907/( '~ 544--7780 [] Deep Trench [] Shallow Trench · Bed [] Mound Other* LEGAL DESCRIPTION so,, RoUng: Total Depth from odgTne, glade: 2,0 GPD/Sq. P~ 1.0 (MAXIMUM AT ANY POINT)R. Lot: Block: Subdivision: Depth to pipe bottom from or~rnal grGde: Grovel depth beneath 10 1 BIRCH TREE ESTATES 1.8 - 3.0(,ABOVE GRADE)e. pice: 0.25 - - - 5.9 - 5.2 ~ 30 Grovel width: Number of line~: JDletance b~$n lines: WELL: [] New [] Upgrade_ 12 ~ 5J 2.4 / ~ Ft. 360 so. F~ D 3034/F-810/SCH 40 PVC F~ WOOD AND BEEK EXC. 9/21/00 - 9/22/2000 SEPARATION DISTANCES [] Septic [] Holding · S.T.E.P. -rom Tank Reid S[aUon Tank Sewer Line. ANCHORAGE TANK 1500 Well 100% 100% 100% - 25% STEEL 2 sa,ace ~oo'+ ~oo'+ ~oo'+ - LIFT STATION Water Line 5'+ 5'+ - 1500 ANCHORAGE TANK/ORENCO SYSTEMS Foundation 5'+ 10'+ 5'+ -- -- TIMER AC, TIVATED 'I 46" Drain NONEi KNOWNi ~20 OSI 05 HHF M.O.A. Remarks: *THIS IS A BOTTOMLESS INTERMITTENT SAND FILTER. BENCH MARK 2.12' - 4.0' OF M.O.A. APPROVED SAND FILTER ADDED TO TOP OF FOUNDATION DRAIN SUMP (CULVERT) TOTAL DEPTH. TOTAL DEPTH WAS LIMITED TO THE REMOVAL AT SOUTHEAST CORNER OF HOUSE. OF ALL ORGANICS. 100.00 Ft. · '1' LOT LINE WAIVER GRANTED UPON ISSUANCE OF PERMIT. ('~ 00~)0~ 2nd 9/22/200 [ '"'- 3rd ~ 0/26/2000 ' · .......... · Department of Health and Human Serviq.es approval. .~72~,...~' ....... .~.~ Reviewed and approved by:/~~ /~/,/c::D~ate: ~ //~' 0/ .ERratUM.ER: AS BUILT DRAWING SWOOO,T, 59 -- 017-141-28 IN~ ~UN~~ I ~N~ IN~ ~ FA~F / - I0~,~ (AV~,) / ~ ~lb~ ~IU , , / ~fOM ~ 5YS~M ~ ~ 2/~/2ooo ~~ WATER a WASTBWATgR x.~.w. ~3'~[ - CONSULTANTS, INC. Sm~: ~i ~.~.~ ~o.: ..o~ ~u~.~: ~*~ ~""~": ~ :~. ~"~"~%'F":'"'~ CURTIS BURNHAM (907) ~44-7780 $ OF 3 ~ ,,,~, ~,~ ~,~ ~u,~,~,~,o~= ~o~ ,o. ,~o~, "~'...'-~..I ........ .f~ AS-BUILT PROFILE OF SEPTIC SYSTEM UPGRADE PERM,TN..BER: AS BUILT DRAWING PA.OEL,D SW000559 -- O17-141-28 I THE REQUIREMENTS FOR ~ ST1 37.7 33.9 A 4 BEDROOM HOUSE. ST2 42.4 40.0 NOTE: THE 100 FOOT S~BACKS FROM MH 44.3 41.8 SURFACE WATER WERE F~GGED ~ A MT1 51.3 81,7 ~EGI~ERED ~ND SURV~OR PRIOR TO 20NSTRUCTION' MT2 58.1 87.3 M ........ EXISTING HOLDING TANKS WERE '~ ~'~ '"" ~E~ ~ P~CE UST~L ~E MT4 69.6 79.5 ] L HI~ORY OF THE ISF IS *MT5 EXTENDS N~R ~ ~l BOSOM OF SAND. NEW 1500 GALLON ~ S T E P TANK ~/ . ~/ X / ~ / ' ; i ~ - ~ 1 FOOT LOT UNE UND T S PO~ON OF THE ¢~ ~ / ~ INTERMIWENT SAND / ~  F'LTER ('SF).~ ' ~ 4 ~ ~t t~,, ~ ~R~M CONSULT~ ~. / ~ ~V~INU~ T~ST HO~ (1976) A B ST1 37.7 33.9 ST2 42.4 40.0 MH 44.3 41.8 MT1 51.3 81,7 MT2 58.1 87.3 MT3 63.2 71,9 MT4 69.6 79.5 *MT5 61.0 90.5 NO BEDROCK TO 17,0' DATE: 12/27/2000 - CONSULTANTS, INC, 1" PREPARED ~R: PHONE NUMBER: P~E NUMBER: CURTIS BURNHAM (907) 544-7780 2 OF 5 · ,c[- BIRCH TREE ESTATES SUBDIVISION; LOT 10, BLOCK 1 ~PE OF WORK: '~ AS-BUILT OF SEPTIC SYSTEM UPGRADE GRACE COMMUNITY CHURCH Fax:907-544-7187 Dec i '00 11:52 P. 01 INSP£CTION REPORT I,~JNIGIPAUI'Y OF ANCHORAGI~ BUILDING SAFF_TY DIVISION 3500 EAST TUDOR ROAD IN~PEC110N: lfO~'*E SG3.3484 IHgPECTION: F.M( (90_F)343,.82.3S INFO: WHEN COR/;~OTIONS ARE IV~ADE PtJEA~E CALL FOR REINSPECI~ON DO HOT REMO~ T~S MUNICIPALITY OF ANCHORAGE Department of Health and Humeri Sen4ces On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 995'19-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date issued: Sep 07, 2000 Expiration Date: Sep 07, 2001 Permit Number: SW000359 Legal Description: BIRCH TREE ESTATES BLK 1 LT 10 Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: Curtis Burnham Owner Address: 14445 Buffalo St. Total Bedrooms: 4 Anchorage, AK 99516- ParcellD: 017-141-28 Site Address: 014445 BUFFALO ST Lot Size: 30314 SQ. FT. Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: issued By: Date: Rick Mystrorn. Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 http://www.ci.anchorage.ak.us September 8, 2000 Jeffrey Gamess Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2-B Anchorage, AK 99504 Subject: Waiver Request for Birch Tree Estates, Lot 10, Block 1 Waiver Request #WR000060 Parcel ID #017-141-28 SW000359 Dear Mr. Garness: Your request for a waiver of the required 10 feet horizontal separation from the on-site wastewater disposal system to property line has been approved. The approved separation distance is 1.0 foot. Tlxis waiver approval applies to the existing on-sitewastewaterdisposal system to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 34%4744. Sincerely, Daniel J. Roth Civil Engineer On-Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health & Human Services On-Site Services Waiver Review Worksheet WR#: WR000060 PID#: 017-141-28 HA#: Date Received: August 22, 2000 Legal Description: Birch Tree Estates, Lot 10, Block I Engineer: Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2-B, Anchorage, AK 99504 Applicant: Curtis Burnham Waiver Requested: I foot lot-line waiver from the east property line. Permit~: SW000 ~ Criteria: 1. Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation 2. Special Conditions: 3. Other: Total: Waiver is Granted: )(, Waiver is not Granted: List Conditions or Reasons for above: Rec#: 06221 Amount: $115.00 Name of Reviewer Date Paid: 8122100 ALASI WATER & WASTEWATER July 11, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade for Lot 10, Block 1, Birch Tree Estates Subdivision (Bottomless Intermittent Sand Filter-ISF) 1. GENERAL: The existing 2 bedroom house is served by a private well and a holding tank system. The existing holding tm~k system consists of a 1000 gallon tank and a 3000 gallon tank. They are proposing to upgrade the house to 3 to 4 bedrooms. One test hole was excavated east of the existing house to determine am area suitable for a septic system upgrade. Due to drainage in the ditches both north and south of the existing house, only a small area was found to be suitable for an on-site septic system. Given the limited area around the test hole, the setbacks from wells and water; it is our opinion that a Bottomless Intermittent Sand Filter (ISF) system is the most viable option. We are proposing that a 1250 gallon S.T.E.P. tank and a immvative Bottomless Intermittent Sand Filter (ISF) system be installed. Comments regarding the proposed upgrade are summarized as follows: 2. SOILS: Attached are logs which show the soil classifications, groundwater monitoring, and I' the percolation test results. In TH#l, the soils below the organics are a ML material with some ~ SM to a depth of 3.5 feet (bottom of test hole). Groundwater was encountered at about 3.0 feet ' during excavation. The monitoring tube was checked on 5/31/00 & 7/6/00 and found ~ groundwater to be at 3.5 feet.. A percolation test for TH#1 was performed about 15 feet north of the test hole at a depth of 1.75 to 2.25 feet which had a percolation rate of 8 minute/inch. A second percolation test was performed about 15 feet south of the test hole at a depth of 1.5 to 2.0 feet which had a percolation rate of 60 minutes/inch. It is our opinion that due to the overall appearance of the soils, a application rate of 2.0 gallons/day/sq, ft. should apply for the proposed ,, bottomless intermittent sand filter (ISF) system. 3. DRAINFIELD DESIGN: Bottomless Intermittent Sand Filter (ISF) a. Percolation Rate: 8 & 60 minute/inch b. Allowable Application Rate: 2.0 gallon/day/ft2 c. Number of Bedrooms: 3 to 4 d. Design Flow: 450 to 600 gallons per day e. Minimum Absorption Area: 225 to 300 ft2 6901 Debarr Road, Suite 2B ~ Anchorage, AK 99504 ~ (907) 337-6179 ~ Fax (907) 338-3246 ~ akwwc.com f. Effective Depth below pressure pipes: 2.5+ g. Effective Depth: 2.5+ inches h. Width: 12 ft. i. Length: 30 ft. j Effective absorption area -- 360 ft2 k. Air Supply: Thomas Industries, Model 5070, "Aa~chorage Tank". 1. Air Supply Line: "Wasteflow" emitterline, 1/2 inch I.D, "Anchorage Tank". m. Sand material: In accordance with M.O.A. latest standards n. Pea Graves: 100% passing 3/8" sieve, less than 20% passing the 1/4" sieve, and less than 1% passing the #8 sieve. We are proposing to excavate down to a depth of 1.0 feet (maximum - remove all organics), place a minimum of 24 inches of sand, install the air supply line, and cover it with 18 inches of sand. On top of the sand, we will place 6 inches of 3/8 inch pea gravel, with the pressure laterals midway in the layer. We will use a conventional lift station (Anchorage Tank), equipped with a programmable timer so that flow can be intermittently dosed to the ISF. 4. SURFACE WATERS: There are two ditchlines with surface water, one to the north of the proposed septic system upgrade and the other to the south. The 100 feet setbacks will be flagged pr/or to construction. 5. TOPOGRAPHY: We are proposing to install the bottomless ISF at the toe of a slope that ends approximately at the property line. There is a bench that is generally flat at the base of the slope; in short there are no slope concerns. 6. MATERIALS AND CONSTRUCTION PRACTICES: The mater/als used, and the construction practices will comply with DHHS' "Intermittent Sand Filter Design, Installation & Maintenance Manual". The contractor should read this document prior to construction. Copies are available at the Municipal Onsite Services office (5th floor, 9th & L St.) 7. LOT LINE WAIVER REQUEST: We request that a 1 foot lot line waiver be granted from the east property line to the proposed bottomless ISF. We are unaware of any adverse effects this waiver would have on the adjacent property. ~-~;~' ~! :, !~:~ i , t~. :~.~,~o~?: ;~',',~ ~; :,x~-~,,~ 8. CLOSING: I am open to any suggestions from your department, which would be an improvement to the proposed design. I am 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 ?/Du for your assistance. 'Je m~s~; P.E., M.S. Pre~d~nt N NOTE: Attached is a site plan drawing, a design drawing, a detail drawing, two soils logs, a topography drawing, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B ~ Anchorage, AK 99504 ~ (907) 337-6179 ~ Fax (907) 338-3246 ~ akwwc, com I RIVERTON COURT I LLh BIRCR TREE ESTATES I BIRCH TREE ESTATES BIRCR TREE ESTATES LOT 9, BLOCK 1 ! ~ LOT S, BLOCK 1 LOT 7, BLOCK Lo~L~ORBELoSc/KD8 * , ~ NO ENCROACHMENT J NO ENCROACHMENT ! NO ENCROACHMENT , i i ~r)~ CONCERNS I I CONCERNS CONCERNS NO ENCROACHMENT i CONCERNS I ] I <:~ I DEA NAGE DITCH~ ~ LJ- ........... ' EXISTINC PROPOSED SEPTIC UPCRADE ~HOLDINC /--~see DESIGN. PACE 2 Of 3) '] \\T TANKS 100 FEET SETBACKS ] I \~ / /IALTERNATE SITE FROM DRAINAGE DITCHES~I , ~ ~, / / ' ---~----~ / ~PROPOSED SEPTIC UPGRADE LOT 12, BLOCK ELMORE S/D [ ' / SEE I .o ENCROACB.E i I ,( B,RC. TREE ESTATES CONCERNS ] ] ,/ j ~<11 .... ~, ~... ~..~+.~ L~ LOT 11 BLOCK 1 i ,~{ ~ ~/.,o~ WELL RAD,US_I ~x E. I45 AVENUE 'w?~. --,.'~- ~'-----/-.~---~- .... -<-----.-~---.z. ....... 7/15/2000 .~7-- "~ DRAWN BY: ~:."t~l//,~' CONSULTANTS, INC. SCAL1E:' ' ¢~/' 4J~ CURTIS BURNHAM (907) 344-7780 1 OF 5 ¢,& L~L DESOR,~,ON='u 9~ ~' r ~-795~ ,' BIRCH TREE ESTATES SUBDIVISION; LOT 10, BLOCK 1 ~,~¢... u .. SITE P~N FOR SEPTIC SYSTEM UPGRADE (BOTTOMLES ISF) ~ ......... THE AIR COMPRH$$DR ,SHALL BE LDCATE:D 'W'ITHIN THE CRA'eL SPACE / THIS SEPTIC SYSTEM MEETS NOTE: THE CONT~CTOR SHALL HAVE THE 100 FE~ ~ELL ~DIUS, THE ~ST PROPER~ LINE AND THE j 100 FOOT S~BACKS FROM THE DITCHLINES TO THE ¢,= WORTH ~ SOUTH F~GGED BY A REGISTERED ~ND ~ HOLDING TANK TO BE SURV~OR PRIOR TO ANY CONSTRUCTION. / ABANDONED COMPL~ELY. / ~EXISTING 1000 G~LON ~ (SEE O ~ CT E. 145 AVENUE  7/13/2000 J.W.M./J.L.M. ALASI ' Vi'ER & WASTEWATER SCAL1E:' CONSULTANTS, INC. 6901BEBARR ROAD, SUITE 2B' ANCHORAGE, AK 9950& * PHONE (907)~'7-6'79 * F~ (gO7)'58-'Z&{ : 30 ....... BIRCH IREE [SIAI[S SUBDIVISIOn; LOT 10, BLOCK 1 DESIGN FOR SEPTIC SYSTEM UPGRADE (BOTTOMLESS ISF) F /NR blN~ COIL ~?CCP Al' ~/4" P A, 5CH, 40 ?VC LA¢CRAL5 , "W~FLOW" ~B PEOVI~P V~5 P~R ~NCO ¢~¢IGN)~ / NO LINDE ON PY ~ fkqK,~ % / PIFINd PB~IdNBP PY O~NCO / ~¢P f~K ~P ~IfCP iN~, (¢Ribt I/4 INCH PlA PLAN VIEW f¢o~s.~~ rKUFILE VIEVV , CURTIS BURNHAM (907) 344-7780 ' OF , ~¢(~ y LEGAL DESCRIPTION: 'O~B/J%". :E-~' ." BIRCH TREE ESTATES SUBDIVISION; LOT 10, BLOCK 1 u~,....: ..."qx~ DETAIL OF BOTTOMLESS INTERMITTENT SANF FILTER (ISF) ~.~%%~ ALAS~ WATER & WASTE:WATER CONSULTANT$.II~.... ~ OF.x,~ FHONE (907) 557--6179 * F~ (gD7) 338-5246 DATE PERFORMED: 5/24/2000 DEPTH i ~ TEST HOLE ML DARKER Wl~ MO~E SM PERK~I ~ ';~'~: i ,' SiTE 4-- GC '~ OL SW MH 5-- ~ SP CH SH ~ ~ OH SC 7-- DEPTH TO SROUNDWATER DATE ~.s' ~/~/oo ! 11 -- DATE READING CLOCK NET TIME ~ATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) 2 2:02 30 MIN. 1 1/4" 4 3/4" 13~ 3 2:02 6" ~ 2:32 30 MIN. 2 1/4" 3 3/4" 5 2:32 6 3:02 30 MIN. 2 1/4' 3 3/4" 15~ 16-- 19-- PERC~ATION RATE 8 (MIN./INCH) ~ PERC. HOLE DIA. 6" (INCHES) ~ : L25 PERFORMED BY A~SKA WATER · ASTEWATER , x .... ~ , CERTI~ THAT THIS WAS PERFOR~ED/IN___~ ACCORDANCE WITH ALL STATE?~AI~/~JNICI~AL ~IDELINES IN EFFECT ON THIS DAT~. DATE: 7/7/~C DEPTH TO SROUNDWATER DATE 3' 5/24/00 3.5' 5131100 3.5' 7/6/00 LEGAL DESCRIPTION: BIRCH TREE E~ATES SUBDIVISION; LOT 10, BLOCK 1 ~ "~'/i PERFORMED FOR: CURTIS BURNHAM [. ,. ,~[~. ~. OAYE PERFORMED: 5/24/2000 ~.J ~[-7953 .." [ ] ..... (r..t) ~;;~;~j ORgANiCS TEST HOLE ~1 u~[f.~_ · .... 2--i] I;~'[ ML WITH SOME SM SOIL C~SSIFICATIONS r ~ ~ , , r ........... , [SITE P~N ~ ~ GM~/ Cl ..................... ~- ~ Gc ~%~ OL ~ SW }~ HH 5~ ~~ CH SH OH 6~ SC ~ 3.5' 5/31 3.5' 7/~/oo 10-- 11 -- DAlE READING CLOCK NET TIHE WATER LEVEL NET DROP TIHE (HINUTES) READING (INCHES) 12 -- 7/6/00 1 1:31 6" 2 2:01 30 MIN. 5 5/8" 13-- 3 2:01 6" 4 2:51 30 MIN. 5 1/2" 1/2" 14-- 5 2:31 6" 15-- I ........... 6 3:01 30 MIN. 5 1/2" 1/2" 16-- 17-- 19-- PERCO~TION ~TE 60 (NIN./INCH) PERC. HOLE DIA. 6" (INCHES) 20-- TEST RUN BETWEEN 1.5 FT. AND r~¢ FT. COMMENTS: // / PERFORMED BY A~SKA WATER · 'ASTEWATER I,( /~/*(.:~ (% :-~-- , CERT,~ THAT THIS W~ ,ERFOR~E~. IN ACCORDANCE WITH ALL S.TE~ M¢I~L.,GUIDELINE, IN EFFECT ON THiS 'V DEPTH TO DATE GROUNDWATER 3.5' 5/~/oo 3.5' 7/6/00 MUNICIPALITY OF ANCHORAGE DEi~ TMENT OF HEALTH AND HUMAN SER~tS Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 26&4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAme Address Phone(s) LEGAL DESCRIPTION "°' t''°°k '' Township Range Sechon TANKS SEPTIC ~ HOLDING /?'~/'~'~'t~~' i s oD ~.' TYPE OF SYSTEM TRENCH ~ BED [] W. DRAIN [] OTHER FI! FT so Iti WELLS DISTANCES TANK WELL LOT LINE '~' FOUNnATION . ABSORPTION FIELD WELL L~ PRIVATE OTHER fldentifv) FT ENGINEER'S SEAL Municipal and ~ guidelines in eflecl on this dale: HealthDepartmentApproYal'.~A~._ ~L~ ~ (Date: 72 013 (3/85J ALASKA JlROF/meFITAL COFITROL S~l~lCeS, IllC. ~lltlJ~eerint~ [~ ~moronmental SI, dies DEPT. OF HEALTH ,ENVirONMENTAL PRO,r ECTiOi' ~ECEIVED 1200 LUcst SSrd Aucnu¢, $ui1¢ [~, Anchora§¢, Alaska 99503 ~'(907) 561-5040 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: (ENGIN~SEAL) LEGAL DESCRIPTION:~'~'/~' ./~/~? 4 5 7 rs'~ 10 11 12 13 14- 15- 16- 17 18 19 20- Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Oeplh to Waler After c.~ ! Monitoring? SiTE PLAN RECEtVED COMMENTS Net Time PERCOLATION RATE __ TEST RUN BETWEEN -- Depth to Water (minutes/inch) PERC HOLE DIAMETER FT AND FT Net Drop ~EREORMEOB¥: '~'~ xhhx' ~,=,, i ~-~/~X CERT'E¥*"A'T"'STESTWASPEREORMED,. ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/851 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: (ENGINE%EAL) LEGAL DESCRIPTION:~x?/~'¢ ¢~/~¢~,4',/ ~//~,,~'~'~'-' Z2~C~Township, Range, Section: ,j 2 3 4 5 6 7 8 9 11 12 13 14 15 16- 17- 18- 19 2O SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 0eptlt Io Water After I~oniloring? , v 1986 RECEIVED Date PERFORMED~Y: ~> ~ ~ , ~X2' CERTIFY THAT THIS TEST WAS PERFORMED iN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72 008 (Rev. 4/85) Gross Time Depth to Water PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) PERC HOLE DIAMETER __ FT AND FT Net Drop ALASKA ENVIRONI~NTAL CONTROL SERVII~ INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 561-5040 SHEET ~ CALCULATED BY CHECKED BY SCALE OF-- ANCHORAGE AREA BOR ,GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL 5~,,YSTEM · SEPTIC TANK: DISTANCE FROM W LLt.~:_':::~ INSIDE LENGTH 4[ NUMBER OF __ MANUFAC1URER .-~L~'~ 2?4, __ MATERIAl . COMPARTMENTS INSIDE WIDTH __LIQUID CAPACITY/_ ........ GAL, LONS,~. TOTAL LENGTHP ~) '~'~,' / TILE DRAIN FIELD: DISTANCE FROM WELL '~/~:~ .O NArlON .~ / / DEPTH OF FILTER 5 '/' b" WELL: TYPE L 2 ...... CONSTRUCTION DEPTH BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LO1 LINE SEWER LINE _. TANK ___ SYSTEM CESSPOOL ....... OTHER SOURCES APPROVED DISAPPROVED DISTANCE FROM: DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL' LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM Form EQ-032 September 2, 1976 R & M No. 656296 Mr. Tom Stewart 7102 E. 17th Avenue Anchorage, Alaska 99504 RE: Test Hole and Soil Log Report for Sanitary System Lot 10 Block 1 Birchtree Estates Dear b~ Stewart: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This in- vestigation was performed in accordance with your request o~ August 31, 1976 and those prodecures outlined in a letter dated July 15~ 1975, by Mr. Rolf Strickland ofthe Municipality of Anchorage, Department of Environmental Quality. A single test hole was put down within the subject site area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with an auger type drilling rig and the test hole was extended to a total depth of 17 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 while drilling. A percolation test was performed from a depth indicated and reflects average infiltration from that depth to the bottom of the 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. ~Cr~.,'~. ~.,~;, "- James W. Rooney Vice President JWR/pe Mc: Munici_~ality of Anchorage TH-1 9-1-7~ 0.0~ TH-1 t 145th St. ORGANIC MATERIAL SILT W/TRACE SAND AND TRACE GRAVEL 6.0t SILT W/SO~ SAND ..... 7.5t SILT SAND W/SOME GRAVEL No Water Table W.D. This log represents sub: soil conditions within Block 1 Birchtree Estate~ SANITARY SEWER TEST HOLE TOM STEWART ANCHORAGE, ALASKA PERCOLATION TEST TOM STEWART R & M NO. 656296 TI~ 11:15 11:16 11:17 11:18 11:19 11:20 11:21 11:22 11:23 11:24 11:25 11:30 11:35 11:40 11:45 11:55 12:05 12:15 ELAPSED TIME 0 1 1 1 1 1 1 1 1 1 1 5 5 5 5 10 10 10 60 minutes INCHES 19.5 20.0 20.5 20,75 21.0 21,0 21.25 21.5 21.75 22.0 22.0 22,5 23.5 24.0 24.5 25.75 26.75 27,75 DROP INCHES 0 0.5 0.5 0.25 0.25 0 0.25 0.25 0.25 0.25 0 0.5 1,0 0.5 0,5 1.25 1.0 1.0 8,25" 7.27 min/inch. It is the responsibility of the owner,prior to construction to verify proposed building location on lot,grade,and utility connections , also aetermlne the existence of any sosementl ,covenants,or restrictions which do flol appear on the recorded plat. I hersby certify that o .urvsy of woe mede by me under my direct supervision and the property corners morked as indicated. CONTRACTING ENGINEERS 212 E. International Airport Road Anchorage. Alasho 99502. Phone: 278- 377:3 SEAL DRILLING, INC. Well Owner DRILLING LOG Construction Use of Well Dom. Location (address of: Township, Range, Section, if known; or distance main road Lot 10, Block 1 Birch T~e Estate Size 0f casing 6" Static water level 70 Screen ( ); Describe screen or perforation Well pumpiug test at 20 gallons per ~ of drawdown from static level. Date of completion 10/30/76 .Depth of Hole 93 ' feet Cased to 93 feet ft. (~//~) (below) land surface. Finish of well (check one) open end ( XX Perforated ( ). (minute) for 1 hours with 1OO% Depth in feet from ground surface WELL LOG Give details of formations penetrated, size of material, color and hardness ); © 2 4 10 45 52 TO_ 2 TO_ 4 TO_ 10 TO. 45 TO 52 TO_ 82 TO 92 TO TO TO TO TO .TO .TO .TO Casing Stickup Organics SAlty Gravel - Brown Silty G]~avel - .31~e Sand Sil'~y G~r~ avel S~dy Gravel ~,qate r Gravel NV~WA Cer~/~ed Conh'a~n~ Certificate No's. 814 & 973 2--STATE Municipality of Anchorage On-Site Water & Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 017-141-28 1. GENERAL INFORMATION Expiration Date; /..~L _ ¢ ¢ /~ Complete legal description Location (site address) Current Property owner(s) Mailing address Real Estate Agent BIRCH TREE ESTATES S/D; BLOCK 1, LOT 10 14445 BUFFALO STREET, ANCHORAGE, AK, 99516 MARTIN MILLER Day phone 14445 BUFFALO STREET, ANCHORAGE, AK, 99516 382-5630 FSBO Day phone TYPE OF DWELLING: [] Single Family (w/wo ADU) [] Duplex [] Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Individual Well [] individual Water Storage [] Community Class Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer Received by: . /.-'/'~'4~ / ~/' COSA to be re[eased lo thor, UllleSs otherwise~uested by the engineer'. COSA Fee $ Dateo, Payme,,t Receipt Number Date: 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 Qn-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 an-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. Phone 337 6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, GEe, LtD attempted to provide a thorough, DSD SIGNATURE !J System #1 Approved for System #2 Approved for bedrooms, bedrooms Disapproved. Conditional approval for ~ 1JeEreyA, Gamess ¢,~ ~/~ /. CE-7953 WA ERAND bedrooms, with the following stipulations:: O W~S%~WA~ER O~ - ,,, Original Certificate Data:__ issues Cer:ificates of On-Site Systems Approval (COSA) based only upon the represenatations 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 Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist fi: of Structure served by this system __ Certificate of On-Site Systems Approval Checklist Legal Description: A. WELL DATA Well type PRIVATE Date completed Total depth 93 10/30/1976 BIRCH TREE ESTATES S/D; BLOCK 1, LOT 10 Parcel iD: 017-141-28 Date of test Static water level 70 Well production 20 WATER SAMPLE RESULTS: Coliform ~ colonies/100 mi. Arsenic: /k) ~'t~g./L. B. SEPTIC/HOLDING TANK DATA IfA, B, or C provide PWSIDfi: __ Sanitary seal (Y/N) YES Cased to 93 ft. FROM WELL LOG 10/30/1976 N/A Well Log (Y/N) YES Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 12/17/2014 ft. 68 ft. g.p.m. 7.51+ g.p.m. Nitrate O- tl "/'mg./L 12/16/2014 Date of sample: .,.~J..'~,4 BAC YES 12+ .in. Collected by: GEG, Ltd. Tank Type/Material S.T.E.P./STEEL Date installed 9/21-1012612000 Tank size 1500 gal. Number of Compadments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES '~...~ Date of pumping Pumper IDSF - SEE MAINTENANCE INSPECTION REPORT --~ C. ABSORPTION FIELD DATA ~BELOW F~XISTING GRADE J . '-_~ Date installed 6/3/2010 Soil rating (~p.d./fl--'~or ft2/bdrm) 2.0 System type IDSF Length 12 ft. Width 30 ft Gravel below pipe 0.25 ft. Total depth '2.4-2.8 ft. Eft. absorption area 360 ft~ Monitoring tube YES Depression over field NO L"" Date of adequacy test 12/17/2014 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test DRY/DRY in. Water added 1380 gal. New depth 1.5/2.5 in. Elapsed Time: 205 min. Final fluid depth DRY/0.25 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date SOUTH/NORTH MT. SEE ATTACHED LETTER REGARDING ADEQUACY TEST AND MT ELEVATIONS. NOTE: 2000 IDSF IS CONNECTED FOR USE AS A RESERVE SITE. DOCUMENTATION IS ON FILE W/DSD. 2000 IDSF WAS NOT IN USE AND DRY AT TIME OF INSPECTION D. LIFT STATION Date installed 9/21-10/26/2000 "Pump on" level atTIMER in. Datum BOTTOM OF BASKET *SEE ATTACHED MAINTENANCE INSPECTION REPORT. Manhole/Access (Y/N) High water alarm level at 46 Meets alarm & circuit requirements? Size in gallons 1500 "Pump off" level atTIMER in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot lOO'+ Absorption field on lot 100'+ Public sewer main N/A YES YES On adjacent lots 10o'+ On adjacent lots lOO'+ Public sewer manhole/cleanout N/A Sewer/septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field *'5'+ Water main N/A Water service line. 10'+ Surface water, lOO'+ Wells on adjacent lots 100'+ Property line 10'+/'1' Water service line 10'+ Curtain drain NONE KNOWN SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 10'+ Surface water 100'+ Wells on adjacent lots 100'+ F. COMMENTS 100'+ Water main N/A Driveway, parking/vehicle storage 10'+ *RESERVE ORAINFIELD IS 1' FROM PROPERTY LINE. WAIVER #WR000060. *'PER JUNE 2010 INSPECTION REPORT G. ENGINEER'S CERTIFICATION / 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 I'~ I "~O/I ~ (Rev. 10/12/12) GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL December 18, 2014 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Birch Tree Estates S/D; Block 1, Lot 10: Adequacy Test and Elevations of Monitoring Tubes. To whom it may concern: The septic system on the subject lot consists of two intermittently dosed bottomless sand filters. The 2000 IDSF was in use at the time of our inspection and was therefore tested. Elevations were inspected to verify the correct placement of the monitoring tubes. The listed elevations (using the benckmark noted on the 2010 S&S Engineering inspection report) for fire monitoring tubes (south/north) were 102.1' & 102.0'. Our elevation shots for the bottom of the monitoring tubes were 102.36' & 102.15'. Because the original benchmark (Top of deck near point 'B', - 100.00') is susceptible to frost action, exact elevations cannot be certified with 100% certainty. Also, the 2010 inspection report does not clearly state the elevation of the top of sand or invert of drainpipe. At the beginning of our adequacy test, both monitoring tubes were dry. After introducing 1380 gallons, the south monitoring tube had 1.5" of liquid in it and the north monitoring tube had 2.5" of liquid in it. After 205 minutes, the liquid level in the south monitoring robe completely subsided and the north monitoring tube had only 0.25" of liquid in it. At no point was water seen backflowing into the S.T.E.P. tank. In short, although we cannot be absolutely certain of the elevation of the system monitoring tubes, the system does appear to currently be capable of absorption in excess of 600 gallons per day. if you have any questions, please contact us at 337-6179. / Prell& ~Garne)Fs, P.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 ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this ~5' Day _ ' .3 by andbetween here~ the "O~ER," and the Municipali~ of Anchorage, here~ the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Maintenance and Repair Agreement agree as follows: Advanced Wastewater Treatment Systems. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as located at (legal description). Alteratioa. Any change to the desi~ or function of an AWWTS that includes the installation or removal of any pa~ts, components or pieces not included ~ the orig~al construction pe~it and design. Certificate of On-Site Systems Approval (COSA). An approval by the Municipality of exist~g water and wastewater disposal systems given at the time of propeay sale ~d title transfer h accordmace with Anchorage Municipal Code (hereinafter, "AMC") 15.65. These approvals certi(v that the systems are adequate for the homes that they support and meet the codes that were in place at the thne of system construction. Damage. Any man-made or natural change in a system that would inhibit the system frown performing as designed. Maintenance and Repair. rlhe scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perfbrm as designed. Permit. An On-Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AWWTS. 3. Term. The term of this Maintenance and Repair Agreement shall begin on the date of approval by the Municipality to operate the installed system or issuance ora COSA, and shall continue while the AWWTS is in use or is operational or until the property is sold or title is transfen'ed by tbe owner and a new COSA is issued to the new owner or transferee of the property. 4. Alterations, Installation and Removal of Additional Equipment. Prior to perfo~Tning any alterations to an AWWTS, the owner agrees to obtain an On-site Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65. 5. Maintenance and Repairs. A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall maintain their AWWTS in a satisfactory condition capable ofproduciug treated septic effluent in accordance with the equipment's approval for operation in the Municipality. The owner shall enter into a service agreement with an AWWTS service and maimenance provider approved by the municipality and the manufactm'er of the AWWTS for the entire term of the AWWTS. In addition, it shall be the responsibility of the Owner during the term of this Maintenance and Repafl' Agreement, and any renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules and orders for the AWWTS. C. Upon request by the Municipality, the owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system. When a record of maintenance is documented and maintained by the system vendor, the owner agrees to allow the Municipality access to this infbr~nation. D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60 for improper discharge. E. Owner agrees that only maintenance and repair persom~el approved by the Municipality will inspect and make any necessary maintenance, repairs or pe~nitted alterations to the system. F. O~vner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. G. Owner agrees that any sale or transfer of title of the property will not occur without a new Ce~:ificate of On-Site Systems Approval. H. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. 6. Nonwaiver. The failure of either party al any time to enforce a provision of this Maintenance and Repair Agreement shall in no way constitute a waiver of the provisions, nor in any way afI;ect the validity of the Maintenance and Repair Agreement or any pant hereof, or the right of such pm'ty thereafter to enforce each and every provision hereof. 7. Amendment. A. This Maintenance and Repair Agreement shall only be mnended, modified or changed by a writing, executed by authorized representatives of the parties, with the sanne formality that this Maintenance and Repair Agreement was executed with, and such writing shall be attached to this Maintenance and Repair Agreement as an annendment. B. For the purposes of any annendment modification or change to the terms and conditions of this agreement, the only authorized representatives of the parties b. Municipality: Director, Community Development or desi~gnated anthority C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or m~authorized mean~s shall be void. 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repair Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State o[Alaska shall govern the rights and obligations of the pm'ties under this Maintenance aud Repair Agree~nent. 9. Severabilit¥. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Maintenance and Repair Agreement. OWNER: STATE OF ALASKA ) THIRD JUDiCiAL DISTRICT ) The foregoing instrument was acknowledged before me this ~'~' day of~,;3iql N~AR? PUBL~ FOR AL~kA ~, My Commission expires: ~ ] 4~ b ] t~ MUNICIPALITY: By: (signature) Date: (prh,t nan~e) Title: 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repak Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights aud obligations of the parties under this Maintenance and Repair Agreement. 9. Severabilitv. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Maintenance and Repair Agreement. OWNER: By: ~&-~c~. //~/~;7----(signamre) Date: ~¢gh, }~-&{-~L¢~\ V. I~(OX%y ¢¥~' (print name) STATE OF ALASKA ) ) SS. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this £~ day of , I, . , ' . .? ', NOTARY PuBLi~ FOR ~LAS~ ~ wj My Commission expkes: MUNICIPALITY: By: (signature) _(print name Date: Title: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 wwwmuni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING ParcelI.D. (')~' ~'¢-_ /C[f- ,~ 1, GENERAL INFORMATION iD , I Complete legal description Lot,. UlOC ~; Expiration Date: Birch Tree Estates Subdivision Location (site address) 14445 Buffalo st. Current Properly owner(s) Shannon Powers Mailing address 12740 Silver Spruce Dr. Anchroage, AK 99516 Day phone 345-9105 Lending agency Mailing address Day phone Real Estate Agent Mailing Address Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class __ Well [] Public Water System [] 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. Cedificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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 Engineering Address 15861 S, Birchwood LoopRd. Chugak, AK99567 Engineer's Printed Name Robed A. Shafer Phone 694~2979 Date 5. DSD SIGNATURE ~'~ Approved for L~ Disapproved. Conditional approval for bedrooms, bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X By: Arsenic Advisory Maintenance Agreements Supplemental Engineer's Repod Other . Original Certificate Date: (Rev 11105) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST LegalDescription: Zc'~lb; ~iJ~-,.~; '~';c(l,'Tcz-.,. ~'~-, A. WELL DATA Well type jDriJ~-~ Date completed __ Totaldepth ~'~ ft. IfA, B, or C provide PWSID # __ Sanitary seal (Y/N) ~ Cased to ~-~ ft. / FROM WELL LOG Date of test Static water level "~ C) ft. Well production '~...O g.p.m. WATER SAMPLE RESULTS: Coliform (~ colonies/100 mL NitrateO,Zl~ m/g/L date of sample' ~' ~/~ lc) Arsenic: /t//D ug/L .~_~/I, B. SEPTIC/HOLDING TANK DATA Tank Type/Material ~ep¥; ~ / ~O ~e~ / Tank size ,~,~-EO al [ g . Number of Compartments "Z- Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION ~,' "~ ~ g.p.m. Other bacteria ~' colonies/100 mL Collected by: Date installed Cleanouts (Y/N) Foundation cleanout Date of pumping C. ABSORPTION FIELD DATA Date installed Soil rating Length "zD~ ft~' ' . Width /'Z- fl. Depression over tank (Y/N) A,J High water alarm (Y/N) ~ Pumper A'f '~0,~n-e "~C'O;'c~._$, ~(~/(._, New depth=--~ in. /-~O g.p.d. If yes, give date ~ Total depth ft. Eft. absorption area'~,'O ft2 Monitoring tube / Date of adequacy test /J/,~ Results(Pass/Fail) vOc~,~' $~,5,~-(_r:(~ For -~ bedrooms Fluid depth in absorption field before test --~"- in. Water added ~- gal. Elapsed Time: ~ min. Finalflu[d depth '~ in. Absorption rate >= / Any rejuvenation treatment (past 12 mo.) (YIN & type) System type '~ '~ 5 ~ Gravel below pipe ,, '~ ~' ft. D. LIFT STATION Date installed ~ t ~ S~ze in gallons /'~ 0 c; / / T~'~,-- c,c¥,' "Pump on" level at in. "Pump off" level at__ in. Datum ~p Cycles tested E. SEPARATION DISTANCES Manhole/Access (Y/N) High water alarm level at Z//'~ ' t in. Meets alarm & circuit requirements? ~(?~, SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main ~//~ / Sewer/septic service Pine ~_,~-- Cf Animal containment areas '~'-0 ~-~ On adjacent lots [COO /-I- On adjacent lots Public seWer manhole/cleanout ,,c,/,~,--- Holding tank / Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/~ TANK ON LOT TO: Building foundation --~ ~ Property line %- L~ Absorption field <~- /-~ Water main /~ c! Water service line /o ~f: Surface water ~/~O ~d- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water Service line /~) ''-/' Curtain drain ~-~-e. Building foundation Surface water Wells on adjacent lots Water main /O L/ Driveway, parking/vehicle storage F. COMMENTS G. ENGINEER'S CERTIFICATION / / , [ I ce~i~ that l have determined ~h field inspections and confo~ance with MOA COSAIu~Zs Engineers Printed N~me I ll;n / Waiver COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Date of Payment Receipt Number · WELZ. e~ · e~ ee~ e.e ..LOT SURVEY CERTIFICATION 8*le /"= ,~0' . 05T LEGEND Bross or Aluminum capped monument 0 iron pipe end/or rebar recovered. 2 x 2 hub & tack recovered 5/8"x ~O" rebar set this survey Doth4 '/ o~-/0 Prepared by: (907)279-6200 © t~. L BUTFON Registered Land Surveyor 519 ~ £ighfh Ave. Anchorage Al~dro 99501 Property of:: C'~L 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.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 017-141-28 Parcel I.D. GENERAL INFORMATION Complete legal description Location (site address) COSA # Expiration Date: Lot 10~ Block 1, Birch Tree Estates Stbd~visinn 14445 Buffalo, Anbbora~e, Ak. qqBl6 Current Propertyowner(s) ~,~a~ &i~Carv Namath Mailing address 6251 West Lending agency Mailing address Dayphone 644-2714 Tree Dr., Anchorage, Ak. 99507 Day phone Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2, NUMBER OF BEDROOMS: 2 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well 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 On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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 ~;n~ineering Phone 694-2979 Address 17034 EaRle River LD. Rd., Eagle iRiver, Ak. 99577 Engineer's Printed Name ~obert ¢, C~w.Zb,., Date C/~7/Of 5. DSD SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL DATA Well Date oompleted Totaldepth ~ ft. If A, B, or C provide PWSID # -- Sanitary seal~3q) ~% Cased to ~ ~ ff. Well Log (~1~) '~ · Wires properly protected~--~N) ~/~'~'~ Casing height (above ground) /~-'~ ~+ in. Date of test Static water level Well production ,2(D, 4.3 WATER SAMPLE RESULTS: Coliform /~.)~ colonies/100 mL Arsenic: ~?'~ mg/I FROM WELL LOG g.p.m, Nitrate O~ { ~ ] mg/L Date of sample: AT INSPECTION ~/~' g.p.m. Other bacteria ~ coloniesll00 mL Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material ~-'J~, ~., ~. / Tank size J~ gal. Number of Compartments'~ Foundation cleanout~N) "~'~ Depression over tank (Y~)) Date of pumping ~flT_./O~' Pumper J~ + C, ABSORPTION FIELD DATA Date installed Cleanout~N) High water alarm t~l) Dateinstalled'~/~ -,~/~//~zSoilrating~r ft=/bdrm) "~"~ Systemtype ~"o ~- ''~- ~' Length ~ ~ ft. ft. Width 1 7_- ~ ft. Gravel below pipe o .2G ~ Total dept~l?' ~'' ~. Eft. absorption area '~-~ fi2 Monitoring tube ~'¢>5 Depression over field ~ Date of adequacy test ~/t'?~/O~' Results~ail)~'~ For /-/ bedrooms Fluid depth in absorption field before test'~l~ in. Water added ~'~?{'~' gal. New depth ~¢-~in. Elapsed Time: ~ min. Final fluid depth ])~-¥ in. Absorption rate >= ~C~E~'-t' g.p.d. Any rejuvenation treatment (past 12 mo.) (Y~& type) b-~r--) If yes, give date ~ D. LIFT STATION Date installed ~I~P.~O/~/O0 Size in gallons "Pump on" level at 7 in. "Pump off' level at" in. Datum T'C,?' Cycles tested Manhole/Access(~) High water alarm level at Meets alarm & circuit requirements? in, E. SEPARATION DISTANCES Public sewer main Sewer/septic service line Animal containment areas SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanldlift station on lot Absorption field on lot IE:~D On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main Io / P~ Wells on adjacent lots Property line ~ '~'/'- Water service line Absorption field Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line j.~'* ~ "~t~uilding foundation ,/D Water Service line I0 ~ Surface water t~/.~L Curtain drain ~,.~.~t~- /~..,~u.3~ Wells on adjacent lots Water main ~/~ Driveway, parking/vehicle storage 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 ~'~d~'-~ (~'. ~'~..//~-~ Date COSA Fee $. Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number 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.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FANILY DWELLING Parcel I.D. 017-141-28 1. GENERAL INFORMATION Expiration Date: Complete legal description BIRCH TREE ESTATES SUBDIVISION; LOT 10, BLOCK 1 Location (site address or directions) 14445 BUFFALO BRIVE * ANCHORAGE, AK Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address CURTIS BURNHAM Day phone 344-7780 14445 BUFFALO DRIVE * ANCHORAGE~ AK Day phone KEN CURRY w/ COLDWELL BANKER Day phone 2525 "C" STREET * ANCHORAGE, AK 99503 884-1090 Unlessothe~iserequested, HAA w#lbeheldbyDSD~rpick~. 2. NUMBER OFBEDROOMS: 2 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well I Individual On-site [] Individual Water Storage [] Individual Holding tank [] Community Class Well [] Community On-site [] Public Water System [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water end Wastewater Consultants, Inc. shall be paid $ ~ at, or pdor . to dosing for the engineedng services provided. 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 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 or, rained from the Municipality of Anchorage fi/es 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 557-6179 Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MQA DSD Guidelines & Reguletions. 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. AKWWC, Inc. 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 parson or party is nat authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. x Disapproved. Conditional approval for 2 bedrooms, with the fllowing stipulations: At the time of title transfer the new property ox~r ~h~11 ~4gn th~ ~tt~¢B~H maintenance agreement which shall be returned to this office before a unconditional approval is issued. Attachments: HAA Checklist Septic System Advisory Well Flow Advisory. X Manitenance Agreements X Supplemental Engineer's Reort Other Original Certificate Date: 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.ci.anchorage.ak.us (907) 343-7904 Legal Description: A. WELL DATA Well type PRIVATE HEALTH AUTHORITY APPROVAL CHECKLIST BIRCH TREE ESTATES S/D; LOT 10, BLOCK 1 Parcel ID: 017-1~-1-2B If A, B, or C provide PWSIDC¢ N/A Well Log (Y/N) YES Date completed 10/,30/1976 Sanitary sea (Y/N) YES Total depth 93 ff. Cased to 9,.3 ff. FROM WELL LOG Date of test 10/30/1976 Static water level 70 ft. Well production 20 g.p.m. WATER SAMPLE RESULTS: Coliform r~ colonies/100 mi. Arsenic: N/A mg./L. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL/S.T.E.P. Tanksize 1500 .gal Number of Compartments __ Foundation cleanout (Y/N) YES Date of pumping 7/15/2002 Pumper C. ABSORPTION FIELD DATA Nitrate 1~3,~ mg./L. Date of sample: 7/15/2002 2 Depression over tank (Y/N) NO Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 7/15/2002 76 .fi. 3.0+ .g.p.m. Other bacteria Collected by: YES 12+ in. .~ colonies/100 mi. AKWWC, INC. Date installed Cleanouts (Y/N) High water alarm (Y/N) ROTO-ROOTER TO TOP OF SAND FROM FINAL GRADES. 9/21-22/2000 YES YES Date installed 9/21-22/2000 Soil rating Or ft~/bdrm) 2.0 Length 30 ft. Width 12 ff. Total depth 2.5 ft. Eft. absorption area 360 ft2 Monitoring tube YES Date of adequacy test 7/15/2002 Results (Pass/Fail) PASS Fluid depth in absorption field before test O in. Water added '327ga1. Elapsed Time: 0 min. Final fluid depth 0 in. Any rejuvenation treatment (past 12 mo.) (YIN & type) *INTRODUCED IN SOUTHEAST MT. ALL OTHER MT'S DRY O END OF TEST. New depth Absorption rate >= 300+ NONE KNOWN If yes, give date System type BO'FrOMLESS I.S.F. Gravel below pipe 0.25 ft. Depression over field NO For 2 bedrooms 0 in. g.p.d. D. LIFT STATION Date installed 9/21-22/2002 Size in gallons "Pump on" level at TIMERin. Datum BOTTOM OF TANK Eo SEPARATION DISTANCES 1500 "Pump off" level at TIMERn. Cycles tested N/A SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Manhole/Access (Y/N) YES High water alarm level at 46 .in. Meets alarm & circuit requirements?. YES N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank 75'+ Absorption field 5'+ Surface water 100'+ Water main N/A Driveway, parking/vehicle storage 10'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATtON DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line '1 '+ Building foundation 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *WR#000060 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 HAA guidelines in effect on this date. Engineer's Printed Name JEFFREY A, GARNESS Date ~ "//~: ~.//~'2. HAA fee $ ~,~75°" Date of Payment 7/,~/~.~..- Rece,pt Number (Rev. 12/01) Waiver Fee $ Date of Payment. Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# C,i '7 -t~/ - ~ 1. GENERAL INFORMATION Complete legal description HAA# Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: Individual well X Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: · Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER· As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my 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. S & $ ENGINEERING Name of Firm 17034 RaCe ~;w. I n~,..o..__.~ ;.,~. 2C4 Phone (~ q ~ - ~- 9 '/ ~/ Eagle River, Alaska 99577 Address · / / Engineer's signature ~-~'¢~ /~/~--- Date l//~ / ~Tb DHHS SIGNATURE · ~ Approved for ~2 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date //- 20- ~:~' The M~nicipality of Ar~chorage 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. MU~c~^UT'r O~,~C~o~ mv~o~m-r^~ S~WC~s ~V~O~ Municipality of Anchorage J~0¥ 03' 1~)9~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division RECEIV 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744 Health Authority Approval Checklist ~[~ £s'r4r*JParcell.D.: O~7-~/-3c Legal Description: L,~- ~o ~.~: I ~c~ 'F ' ' ' A. WELL DATA Well type Log present Total depth Sanitary seal If A, B, or C, attach ADEC letter. ADEC water system number -- Date completed )o/ }~/7~ / / Cased to ~0 ~ Casing height (above ground) / Wires properly protected ~_)N) ¥£ Date of test Static water level Well production WATER SAMPLE RESULTS: FROM WELL LOG AT INSPECTION ? o --I .C AO g.p.m. g.p.m. Coliform O' Nitrate Date of sample: ii / ~ / q ~ B. ~DING~I'ANK DATA Date installe~C/~*/~///~/~/Y ~ Tank size Foundation cleanout ~N) ¥~ ff Depression (Y/~ Date of Pumping ~'/~G Pumper Collected by: Other bacteria 0 S & S ENGINEERING Eagle River, Alaska 99577 Number of Compartments g- / ! Cleanouts ~N).__ /v ~,, High water alarm (~N) ¥~: $ C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./fF or fF/bdrm) System ~pe- Length Width Gravel thickness below pipe ~ Total depth Effective absorption area Monitoring Tube presen~t~YY )1~ Depression over f e d (Y/N) __ Date of adequacy test ~/Fail) For Fluid depth in absorp~est (in,); Immediately after gal. water added (in.): Fluid depth ~ (ins) Minutes later: Absorption rate = g.p.d. Pe~ent (past 12 months) (Y/N) If yes, give date bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on"~a~'~~'Pump off" level at* High water alarm level at* ~'~-~*Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic~ank on lot Absorption field on lot IV Public sewer main tv /',4 Sewer/septic service line Lift station On adjacent lots On adjacent lots Public sewer manhole/cleanout SEPARATION DISTANCES FROM SEPTI~ANK ON LOTTO: Foundation Property line '¢ ¢- Absorption field Water main/service line SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Building foundation Surface water ~gA, ehicle storage area Cu~ Wells on adjacent lots Wells on adjacent tots I o o ~e F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records in conformance with MOA I-IAA guidelines in effect on this date. Signature ~5~a'~'-~ Engineer's Name ~ o & ~,',, r ~', Date ~*i / '7* / '~ ~ HA,& Fee $. Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # GENERAL INFORMATION Complete legal description Location (site address or directions) \z~ 4-%-- qq 5--I/ Property owner Mailing address Day phone Lending agency f',//A- Day phone /~'./~- Mailing address Agent ~¢//A- Day phone 'V/,4, Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. · NJOt~ s,Jaau[Bue leUO!SSe¢oJd 8LI~ u[ suo!ss!uJO Jo sJOJJ8 JOlt alq!suodseJ ]ou s! ebeJOMC)u¥ ~o X]!led!o!un~ eq/ 'penss! s! e~eo!~!Ua3 e eJo~eq e~ep ezXleue Jo suollo@dsu! ~3npuoo ]ou op SH HQ jo SeeXoIdLU3 's]u@u~a]mb@J e~e~s pub leJape~ u!e]Je3 ~ts!~es o~ J@pJo u! su o]~n],!]~su! bu] puel J!@q] pub SeLUOq JO sJeseqoJnd o], Asa~ noo e se s!q~ saop SHHQ eq/'~SelV jo @iBiS aq] u! paJa]s!b@J Jeau!6ua leUO!SSajoJd ]uepuedapu! ue ,~q a^oqe 9 qdeJ6e]ed u[ ua^!5 suoi~e]uaseJdaJ eq~ uodn XlUO peseq sa~ea!Jl]JaO le^oJdd¥ ~l!Joq~n¥ q],leaH sanss! (SHHQ) saopJaS ueuJnH pub q],leaH 1o ]UaLU]~edeQ eSeJoqauv ~o ,~]!led!o!unLq eqJ. s~uaw woC)leUO!~!pp~' :suol~elnd!~s 6U!MOIIOj aq~ q~!M 'sguooJpeq JOJ le^oJdde leUO!~!puoo 'pe^oJddes!Q 'SLUOO~peq Jo~ pa^oJddv ~x2 ~l:ln.l.¥Ngl$ SHHO '9 I:FI3NION3 ),8 NOIJ.~)=idSNI =10 ..LN=II~::IJ.~/..I.S  Municipality of Anchorage Department of Health & Human ServicesR E HEALTH AUTHORITY APPROVAL CHECKLIST NOV 1 6 1992 Legal Description: ~l~-~H- q"C2~-F: ~___g ~-'-~q--~.~LJParcel I.D. ~ Mun~cipaIRy of Anchorage A. WELL DATA ~ept. Health & Human Servic~ Well type ~tV~' If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y~ Date completed . / /7~ Driller Total depth ~ ~ Sanitary seal (Y/N) ~% Cased to Date of test Static water level Well flow Pump level FROM WELL LOG SEPARATION DISTANCES FRQ,M WELL TO: Septic/holding tank on lot Absorption field on lot /',/./,z~ Public sewer main f'~ / Sewer service mine ~ ~ c~ ~ Casing height Wires properly protected (Y/N) AT INSPECTION g.p.m. ~ ,R~ g.p.m.~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank i'J g/~ ~- / ~ tOL~ WATER SAMPLE RESULTS: Coliform ¢ Nitrate Date of sample: ///~---/~ 2_ B. 72-026 (Rev 7/91) Front Collected by: Other bacteria SEPTIC/HOLDING TANK DATA ' r~ ~P~F'--- /~/~'~/"/ lOoO ~,~.'.~.~ Date installed /~-'~ -- '7/~/~-, Tank size ~ ~c,c~ ~.~ Compa~ments Cleanouts (Y/N) ~ Foundation cleanout (Y/N) ~/~ ~ Depression (Y/N) High water alarm (Y/N)____ ~--/ Alarm tested (Y/N) ~ ~ Date Of pumping /~/~I/"~ Z~ t~ / ~//~/~~ ~~ ~ ........ · / Pumper SEPARATION DISTANC~FROM SEPTIC/HOLDING TANK TO: ~ Well(s) on lot //~ / ~ On adjacentlots ~ 100 / ~ Foundation_ To property line ~/~ ~bsorpt,on field ~ Surface water/drainage ~F) r~ P~ 0/~~ CONTINUED ON BACK PAGE C. LIFT STATION Vent (Y/N) High water alarm level Manufacturer ~ Manhole/Access (Y/N) ~.i- Pump o'o'o'o'o'o'o'o'o'~t _ -'~Pdr;n'p off" level Cycles tested Meets MOA electrical codes (Y/N)-~: - -~ ' ' '~ ~'~'~--~ SEPARATION DISTANGEFROM LIFT STATION TO: Well~a4crr R~aTION FIELD DATA lied _ _ __ Length ~'~ Width Total absorption ar'~ea~'~-, On adjacent lots Soil rating Gravel thickness Cleanouts present (Y/N) Date of adequacy teSt'~ for '"' at Depression over field (Y/N)~"--,. Results (pass/fail) ~ bedrooms Peroxide treatment (past 12 months) (Y/N) ~ SEPARATION DISTANCE FROM ABSORPTION~FI~LI~'T-O~_ Well on lot To building foundation On adjacent lots Surface water': ~?_~i n drain .... If yes, give date Qna~Jj~cent lots '""%-, Property line To existing or abandon'ed, system on lot Cutbank Water ma'n/se~'~c~e line Driveway, parking/vehicle storage area "% .~. E. ENGINEER'S CERTIFICATION certify that I have checke~, verified, o~t~nformed to all MOA and HAA guidelines in effect on I / \ Signature ~..~ Date /! the date of this inspection. HAA Fee $ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number System type Total depth_. Surface watei'-- MUNICIPALITY OF ANCHORAG~ Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# 9200B6 PID~ 017-141-28 HA# 92077S Permit # Date Received: 12/23/92 Legal Description: Lot 10, Blk 1~ Birch Tr~ E~_ Engineer: Alaska Water and Wastewater Services Applicant: Chuck Alderdice & Gloria Thomas Waiver Requested: Holding Tank to Surface Water, Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: Points: 3. Other: Waiver is Granted: List Conditions or Reasons Waiver is NOT Granted: for above: ~ ~F~p Date: By: N~ewer~-~ Rec #: 24333 Amount: $~N~NN Date Paid: 12/23/92 Tom F,,nk. Department of HeaJ h and Human Services 825 %' Street PO Box 196650 ·Anchorage, Alaska 99519-6650 343-4744 January 8, 1993 Jeff Garness, P. E. Alaska Water & Wastewater Services 8471 Brookridge Drive Anchorage, Alaska 99504 Subject: Waiver Request for Lot 10 Block 1 Birch Tree Estates S/D Waiver Request %WR920086, PID %017-141-29, HA920778 Dear Mr. Garness: Your request for a waiver(s) of the required 100 foot horizontal separation of a septic system to the surface water has been approved. The approved separation distance(s) are: holding tank to the surface water along north property line at 60 feet and the west property line at 70 feet. This waiver approval applies to the existing septic system to surface water separation only. Any future upgrade to the septic system will require all separation distances be met or another approval from this department. Should the operation of the subject wastewater disposal system cause any contamination or degradation of the subject surface water, this waiver will become void. Daniel J. Roth Civil Engineer On-site Services Concur: ,, John Smiih~ P.E. Program Manager On-site Services ljm:#5 TtVE / lDO ,00 f::q"', MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner Mailing'Add/ess (c) Lending Mailing Address Telephone: (home) 3~'~' I3>-'~ Business Telephone (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here",~ if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family"'~ Number of bedrooms 3. WATER SUPPLY Individual Wel~;~. Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4, SEWAGE DISPOSAL On-site [] Public [] Community [] Holding Tank"'~i~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status· 72 025 (Rev 7/88) Page 1 of 2 '~JOM s,Jaeu!6ua leUOlSSejoJd aql u! suo!ss!mo Jo sJoaaa ao¢ alqisuodsa~ 1au s! aSeaoqauv jo,qiled!o!un~ aqJ. 'panss! s! a~eai,tipeo e eJo,taq elep azXleUe Jo suo!~aadsu! lanpuoo lou ap SHHQ ,to saeXoldLU3 's~uawa~inbeJ ale,s pue la Jape; u!elJao X;si~es ol Japao u! suoRnl!lsu! 6u!pual a!aq~, pue SaLuoq ~0 s~aseqaJnd ol XselJnoo e se s!ql seop SHHQ aqJ. 'e~selv jo a~elS aqi u! peJe~s!6eJ aaau!6ue leUO!SSejmd luapu@dapu! ue Xq a^oqe S qde~Seaed u! ua^!8 suoBeluese~daJ eq~ uodn ,~lUO paseq palea!,tpea le^oJddv Xlpoqlnv q~leaH sanss! 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Am mo4 pue Sel!1 eBeJoqouv 1o Xl!led!olunR eq1 moJ1 paum~qo uo!l~mJoju! eql ua peseq leql A1peA ~eqlmJ I 'u!eJeq pe~eo!pu! eJnlon~ls ~o edA~ pue smooJpeq Jo Jeqmnu eq~ Jo¢ alenbepe puc I~uo!~ounJ 'ejes si melsAs lesods!p Jel~MelSeM Jo/pue Alddns ~eleM a~!S-UO eql leql BMOqS leaoJddv A~poqlnv qlleeH NOI~V~MOdNI tiNY wva 'HOMV~S ]lid 'S~S~ 'SNOI~OidSNI 9NIQIAOMd ~MId 9NI~]]NION] 'g ~ MUNICIPALITY OF ANCHORAGE (MOA) ,~ ~0N' CIpAL ~('e~l~"'~-©,~\o~ Hea th Authority Approval (HAA) ~ ~'~s D~V ~;~ONCHECKLIST ' FEBRUARY 1984 ~Nvt~ON~M~A~'' 343-4744 ,o,, 1 4 t989 Legal Description: ~O~ /~ ~ A. WELL DATA Well Classification ~/~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present ~N) Date Completed /O -~o ~-?G Yield ~' ~ Total Depth ~' ' Cased to ~ Depth of Grouting Static Water Level ~ Pump Set At Casing Height Above Ground ~ ~ Sanitary Seal on Casing ~N) Electrical Wiring in Conduit~N) Depression Around Wellhead (Y/~ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot /~-~ To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results ~,~-~t 7" --~--- Comments ~J~"g4. r~v,J -/~" To Nearest Public Sewer Cleanout/Manhole ; Date /' ?-~'? B. SEPTIC/HOLDING TANK DATA Date Installed 7-5-~'(o Size ~¢'"~0 No. of Compartments / StandpipesbN) Air-tight Caps~)N) ~ Foundation Cleanout (Y,(~) Depression over Tank (Y~_~ Date Last Pumped ~ ; for Pumping/Mainte. nance Contact on File (Y ('~ Holding T~nk Hi,gh-~.A'[e~ Ala~rm,~/N) Temporary Holding Tank Permit YIN · :,. ,... ( ) SEPA~T!.?,~ ~I.~TAN'C'~;~.a?O.,M SEPTIC/HOLDING TANK: TO Wi~tk.l~upp~" ' /¢r'~ '~ TO Building Foundation To Disposal Field To Property Line To Strew, ~%~,~ke.~'r Dramage Course 72-026 (Rev 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA ..~ls Rating in Absorption Strata Daf~L~led __ Square Feet of ~sortion SEPARATION DISTANCE FROM ABSORPTION FI~'~ To Water-Supply Well To Pro~pe~ Line To Building Foundation _'"r'o-F~ting or Abandoned System on Lot ; On Adjoining Lots To Water Main/Service Line To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments_ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test D, LIFT STATION  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** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines the date of thi~ inspection. ~ ~L//,t~- Signed Company Date 4-/~ MOA No. 0.2-4 Receipt No, Waiver Fee: $ Date of Payment 72-026 [Rev 7/88) Back Page 2 of 2 Well' Classification well Log P~esent (Y/~') Total Depth Cased to Static Water L~vel Casing Height Above Grcund E!ect~ical Wiring in Conduit (Y/N) Separation Distances f~cm Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Neares~ Public Sewer Line Cle a nou t/Ma nho le Water Sample Collected By Water Sample Test P~sults MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 L-cal Description: AQ'7~- /'' If A, B, c~ C, D.E.C. Approved(Y/N) Date Ccmpleted Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (~/N.! ' D~n~:;~ Around" ......... ' (Y/N) ; On ;djoining Lots ; On A~joining Lots To Nearest Public Se~er To Nearest Sewer Service Line on Lot ; Date SE?£'IC/HOLDING TANK DATA, Date Installed '~1--~' ~ Size ,~ ~'¢30 NO. of Ccr~Daz, tments Standpipes ~'-/~N) Air-tight Caps ~/N) Founda'tion Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pumped Pumping/Maintenance Contract ~n File (Y,,?~) ; for Holding Tank High-Water Alarm (Y/N) Tem~ra~y Holding Tank Permit (Y/N) Separation Distances f~cm Septic/Holding TaDk: To Wate~-Supply Well ' To Building Foundation To P~-operty Lime To Disposal Field TO 9later Main/Service Lir~ To Stream, Pond, Lake, or Hajor Drainage (?ape 1 of 2] 2-15-84 kBSORPTI~ FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of AbsorDtion A~ea Depression over Field (Y/N) Results of last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present .{.Y/N) Date of last Adequacy Test Separation Distanoe f~cm Absorption Field: To Water-Supply Well T~ 3u_l-_~!ng F~nda~io!~ Lot To Water Main/Service Line To Property Line TO Existin9 o~' Aba~dor~ed Sysnem cn ; On Adjoining Lots To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course To [k~iveway, ParkinG A~ea, or Vehicle Storage Area Con~nts D~ LIFt STATION Date Installed Size in Gallons Pur~=, On" level at High Water Alarm L~vel at Tested for Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Ptumping Cycles dtming Adequacy .Test. ~ets MOA Conments ** Check Permitted Bedr°cra Rating AGainst HAA Request ** I cectify that I have checked, verified, or conforn~d to all MOA HAA Guidelines in effect on the ~d~e of this inspection. Si~ned '~,~ ~e,~-~ Date /7~/~_?~'~ KB1/d5/s [PaGe 2 of 2] ENGINEERS SEAL 2-15-84 Qual i ty 39503 274-4561 .'JO November 10, 1976 Approval Mailing Address: Property Owner: INDI of Inspection 2: Date of Inspection APPROVAL OF & WATER FACILITIES Cony. requested b · y. Alaska Bank of Commerce 712 West 4th Avenue tion: Tom Mc Garry "Friday Phone: 7100 Lake Otis Pa .~way Lot 10 Block 1 Birchtree Estate~: BufSalo Road off De Armoun Single Family No. of bedrooms to be inspected ion A; Imstal l ed ~pt~c Tank: ~). Seepage Pit: '.E. Disposal Field: Individual B. Depth D. Bacterial Analysis System: On-site system 1976 B, Installer /Y~ 1. Size -2. Manufacturer Absorption A~a 2. Material 1. Total length ~f lines 93' ; Distances: A. Well to: Septic tank Nearest lot line , Absorption area Other cpntamination ., Sewer Lines B. Foundation to septic tank , Absorption area C. Absorpti%n are)~{o nearest lot line EQ-034 Pa ] ~qf tw~ pages Page 2 of t~ pages - st for Approval of Individual ~m~r & Water Facilities Legal Description Lot 10 Block 1 Birch Tree Estates Approved Approval,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGP~AM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (]/74)