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Home My WebLink AboutBIRCH TREE ESTATES BLK 1 LT 23 Municipality of Anchorage Page \ of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~ I ~:>~ ~ PID Number: (:~ ~,~ ~ ~' ~ ~p,~ .- ~~ ~ Wastewater System: ~ New ~pgrade Address: ~ ~ ~. ~~ ~. ~ ~ ~ ~ ABSORPTION FIELD Phone: ~~ - ~ [~ ]No. of~rooms: ~ Deep Trench ~ Shallow Trench ~ed ~ Mound ~ Other LEGAL DESCRIPTION so,, Rating: ~ ~ GPD/Sq. Ft. Total Depth from~orininal_ grade:~ I Lo~~ ~BI°ck: ~ ~ ~Subdivisi°n:~~ ~ Depth to pipe bottom from originalr grade:, Gravel depth beneath pipe Township~ ~ ~ Range: Section: Fill added above ori~inal grade: Gravel length: I ~ ~ ~'~ Ft. ~ Ft. I ~ Gra~e~ ~ ~ t~ Number of lines: ~Distance between lines: WELL: ~ew D Upgrade ~t~ Ft. ~I ~'~' Ft. Clas~cation (P/ivate, A,B,C): Total Depth:, Cased To: I Total absorption area~? Pipe material: ~ Dri~~~ ~' ~ ~Date Drilled: Static~Water Level:Ft. i Instal~er:~ V f ~~ Date installed: Yield: ~ ~ GPM Pump Set at: Ft.~ Casing Height~,.~Abo~ Ground: TANK SEPARATION DISTANCES ~eptic ~ Holding D S.T.E.P, To Septic Absorption Lift Holding Public/Private ~~: ~~ Capacity in gallons: From Tank Field Station Tank Sewer Lines , ~ ~ I I Material: ~ ~ Number of Compa~ments: Surface Water ~' ~ ~ ~ ~ LIFT STATION Lot ' , Size in gallons: I Manufacture~ ~ Line ~ ~ / / / )~', "Pump °n" level at: I "Pump °ff" level at: I High water alarm at: Foundation ~1 ~ / CurtainDrain ~~ ~~ Pump Make & Model ~ Electrical lnspections performed by: Remarks: ~ ~ ~ ~~~ BENCH MARK Location and Description: Assumed Elevation: ENGINE.S SEAL S & S ENGINEERING ~,~':*~ ,.~~~~': ~' ~:~'~ "~" ~ ~ Inspections pe~ormed by: 37e3~ s~e R~E~ ~dN~: 1st ~-t~-~ I ;~ ,/~~.. ~gle River, Alaska ~5~ 2nd ~- ~ I ,:,. Dep.rtment of Hea~an~ ~~ ~~es approval '~?-":~ ' Reviewed and approved by: ~' -/~ ~ Date: ~- 2 -~/ 72-013 (1/91) MOA 25 Permit No. ~:~ ~ O,_~ ~'"(,=, Page ~' of '~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report 72-013 A (2/91) MOA 25 ENGINEER'S SEAL Permit No. ,c~ 1 C:~ ~ Page ~ of "~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report ENGINEER'S SEAL 72-013 A (2/91) MOA 25 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 WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ROGER SHAFER April 24, 1991 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 £C£1V£D Do~tu. ~iQelit~ of - a/th & Hu~2~¢orage °ervicee REFERENCE: Lot 23; Block I; Birch Tree Estates This letter is to supplement the on-site septic inspection report for the system installed under permit #910056. During our original site visits the property (in particular the surface water drainage course) was covered with approximately 3 ft. of snow. There was no water flowing and the exact location of the creek was not discernable. However, at this time the water within the drainage is flowing and the creek location is b~r defined. A portion of the creek cuts back closer to the septic tank location than originally believed. As a result the septic tank was instated 75 ft. from the surface water source as opposed to the originally waived distance of 84 ft. Because of the special septic tank construction we feel this lesser separation distance of 75 ft. is still acceptable. Therefore, we ask that you waive the separation distance between the septic tank and the surface water source to 75 ft. If you have any questions or require additional information for your review, please contact us. 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SWg10056 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:BOONE SUDIE E OWNER ADDRESS:5215 E 147TH AVE ANCHORAGE, ALASKA 99516 DATE ISSUED: 4/11/91 EXPIRATION DATE: 4/11/92 PARCEL ID:01714115 LEGAL DESCRIPTION: BIRCH TREE ESTATES BLK 23 1 LT LOT SIZE: 20312 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: SEPTIC TANK WILL BE INSTALLED AS PROPOSED BY ENGINEER FOR THE PURPOSE OF MINIMIZATION OF POTENTIAL CONTAMINATION FROM THE SEPTIC TANK MIGRATING TO SURFACE DRAINAGE. ALL LOCATIONS MUST BE VERIFIED PRIOR EXCAVATION OF THE SEPTIC TANK AND ABSORPTION BED. ENGINEER SHALL SUBMIT ONE ADDITIONAL SOILS TEST WITH THE AS-BUILT DOCUMENT WHICH IS A MINIMUM OF SIX FEET DEEPER THAN THE BOTTOM OF THE ABT~ORPTION BED. RECEIVED BY: Tom Fink, Mayor Ntunicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 April 12, 1991 Robert A. Shafer, P.E. S & S Engineers 17034 Eagle River Loop, Suite 204 Eagle River, Alaska 99577 Re: Lot 23 Block 1 Birch Tree Estates, Waiver Request WR910012 P.I.N. 017-141-15 Dear Mr. Shafer: Your request for waiver of the required 100 feet separation between a surface water source and a septic tank has been approved. The approved separation distance is 84 feet. Also, all lot line waivers have been approved for the bed type absorption field to be installed 1 foot from the east lot line and 2 feet from the north lot line. The waiver requested for the separation of the bed type system to the carport foundation does not apply since the carport is not constructed on a foundation but is constructed on pilings and cinderblock piers. Mitigative factors supporting the approval of the septic tank to the surface water separation waiver are: 1. A 10 gauge steel tank is proposed instead of the standard 12 gauge steel Sacrificial anodes will be attached to both ends of the tank to aid in preventing corrosion of the tank itself The tank will be bedded and backfilled with a clean sand material to create a well drained environment around the tank Any portions of the bituminous protective coating accidentally removed from the tank during handling and transport of the tank will be repaired prior to setting or burying tank. This waiver approval applies to the proposed permitted installation only. Any deviations to the proposal or future upgrades to the wastewater system will require all separation distances be met or another waiver approval from this office. Sincerely, Daniel J. Roth Civil Engineer On-Site Services Smith, Frogram Manager On-Site Services. pO o~ ~. A-m/p$ .To ~E£L- ~OT ~'Lo~w ~ ~. !1 ~L I$ ~9 ROBERT SHAFER, P.E. ROGER SHAFER April 3, 1991 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 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 WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ATTN: DAN ROTH 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 23; Block I; Birch Tree Estates Dear Mr. Roth, Subsequent to your site visit to the referenced property on April 2, 1991 we have revised the design of the proposed septic upgrade. The proposed leachfield will be positioned between the carport supported by a pier foundation and the east property line. This location is 100 ft. from the surface water source thereby eliminating the need for a waiver. However, this location will require a waiver of the separation distance to the east property line to I foot. A waiver to the carport foundation to 2 ft. will also be necessary, as well as a waiver to the north property line also at 2 ft. (refer to AMC 15.65.060). With the leachfield in this n~w location only the distance between the surface water source and the septic tank will need to be waived. Th~ distance is proposed to be approximately 84 ft. As mitigating factors the septic tank is to be constructed of 10 guage ste~l with cathodic protection on both ends. All pipe connections will be a Romex type or equal. The tank is to be bedded and backfilled with clean sand to the ground surface. Any portions of the bituminous protective coating accide~ly r~moved from the tank shall be repaired prior to backfilling. Since the waiver from the stream to the leachfield is no longer requested, we ask that you refund the difference of $180.00 between the ~iver fee for a leachfield and a septic tank. S~¢e the property has been sold and the owner is anxious to close the sale and retire out of state, time is of the essence. 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Page Two Lot 23; Block I; Birch Tree Estates If you have ang questions, please contact us. Sincerely, ~BERT A. SHAFER, P.E. RJS/gm 1~= GO~ SCALE O0 ! I I // // /! ,// ! iI ° I i/ o I I - L Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE LEGAL DESCRIPTION: ~'"~'~ ~;~ ~ '~(--.'~[' Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O SLOPE WAS GROUND WATER V~ ENCOUNTERED? I s L IF YES, AT WHAT E Depth to Water Alter i ~.- Monitoring? Date: SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop I ~-~,-~, 2..'.-z.~'~.--- ~'t~.'~ PERCOLATION RATE ~:~ (minutes/inch) PERC HOLE DIAMETER '~ TEST "UN BETWEEN . .~T AND 7 FT / PERFORMEq B~;{ ....... ~ERT FY THAT TH S TEST WAS PERFORMED ACCORDA~I~A[L~~NICIPA~DELiN~E~ECT ON THIS DATE, DATE: 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~.~'-"'~--~. DATE PER FORMED:"'~ LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED7 S IF YES, AT WHAT ~ DEPTH? p E Depth to Water After ~ Monitoring? ~c:::> Date:~--.'~.'~ ~ SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop ~ ~-.~ ~ (~" ~,/~' · . . (minutes/inch) PERC HOLE DIAMETER I TEST RUN BETWEEN /~ FT AND ~ FT $ & 5 ~NGIN~ER,NG PERFORMED BY: -~ . ; ' {~4~~ .... CEF WiTH~.I ' aS a 99577 ' ACCORDANCE ~t'At~ S~NICIPAL GUIDELINES tN%-FFE~T ON THIS DATE, DATE: 72-008 (Rev. 4/85) / CERTIFY THAT THIS TEST WAS PERFORMED IN March 26, 1991 ROBERT SHAFER, P,E. ROGER SHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 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 WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 23; Block I; Birch Tree Estates Request you issue permits to drill a new well and install an on-site septic system on the referenced property. Also requested are separation distance waivers for the distance be~een a septic system and a cutbank, lot line, and stream at approximately 20 ft., 5 ft. and 72 ft. respectively. The stream in reference flows down a creek maintenance easement along the south property line of the reference~ property. The stream (ice) is very minimal in size extending approximately 2 ft. wide and is estimated at 3 inch~s to 8 inches in depth. We have discussed this drainage course with Dan Bolles of your office and even though there is no water flowing at this time, Dan informs us the creek is a surface water source and a 100 ft. separation distance to septic systems must be maintained pursuant to 18AAC72.015. For the following reasons we feel this septic to stream waiver may be issued: I. The surface water source is very minimal in size and apparently nearly non-existent during portions of the year. 2. The ground surface b~tween the septic system and the stream is highly vegetated with an organic layer 2-3 ft. thick. 3. The slope of the surface directly between the septic system and the creek is minimal at 8% to 12%. 4. The proposed septic location is as far from the creek as reasonably possible. In keeping the proposed leachfield as far as possible from the existing cesspool which may cause conduiting toward the "cutbank", we have encroached the east property line. Since we are still maintaining a separation distance of approximately 40 ft. to the n~ighbor's septic system, the two should not influence each other. Therefore, we feel the waiver to the lot line may be issued. 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Page Two Lot 23; Block I; Birch Tree Estates March 26, 1991 The cutbank as shown on our site plan is not an actual cut into the original ground. There is no soil exposed. This is mosty a change in the natural togography. Part of its steepness is due to the fill pushed toward the edge from the house excavation. From the soil logs we see there is nearly 2 ft. to 3 ft. of organics on the ground surface. We fe~l this thick organic layer would greatly d~tour any effluent seeping from the bank. Therefore, the proposed 20 ft. separation distance to the ~ztbank is sufficient. If you have any questions, or if you require additional information for your review, please contact us. ~'~RT AT SHAFER, p.~E. ~'z~"~ R~/~/gm cc: Tom Boone w/enclosures. SCALE ]2:)1 'F. amona St · 99~15 ANCHORAGE~ ALASKA ~14-'??14 SIX INCH WATER WELL DRILLED ........... -OUTTO THE DEPTH OF tUG Fegto ( Ground ,level) DRILLED ATTHE RATE OF ~22.L)0 PER FOOT. Steel casing seate~ to lob feet. PROPERTY OWNER ~'~ · ~'o.n ~:.;.Ol':e Work comF~ete~ through HEFTY L~il!iag. LOCATION OF WELL SITE : DRILLER Ternie Claus of [ampart [:'riiling Works :, ,' WELL LOG: O 16' Silty san~y gravel. - >~ clay binD. er. ~6 - Pg' Coarse g~'avei. 'lp?~. silty material. ~.~et materi, a.L at ~9 feet. 8~ - 1',;5' A silty sandy fine gravel, 4~,% clay binD. er, . ............................ :(.!This water is crystal c£ear .!;~ the Well is ~.rocF~ci. ng i.j-Spm ten feet off ~,~ 'b 0 t t 0 .,~o mobilization or demob cost i:'.lo setup cost iiTotal cost of drilling, test pumping & all materials: ~22.00 x 1US': To Mr, ~, Yrs. ~oone: I'm very glad to have has both, ~ to have worAed for you. May you have a .... ~!i,("*l No charge for the above ground casing.) the opportunity ,t~eet you good t z'ip ~d~¢;~~ COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLE-FION OF L g. S2,376. O0 WRITE CHECK PAYABLE TO RAMPART DRILL. lNG WORKS FOR THE SUM OF THANK YOU VERY MUCH, BERNIE CLAUS OF RAMPART DI:~IT_LtNG 'WORKS Date_April 17, 1991 SERVICE CHARGED F !~%% PER MONTH WILt. IBE: ASSESSED ON PAST DUE ACCOUNT$. PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910094 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:BOONE SUDIE E OWNER ADDRESS:5215 E 147TH AVE ANCHORAGE, ALASKA 99516 DATE ISSUED: 5/10/91 EXPIRATION DATE: 5/10/92 PARCEL ID:01714115 LEGAL DESCRIPTION: BIRCH TREE ESTATES BLK 23 1 LT LOT SIZE: 20312 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM 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 (iSAAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1. WELL DRILLED UNDER PERMIT SW910056 ACTUALLY WAS DRILLED IN R. O. W. ON 147TH. 2. PROPERLY ABANDON WELL IN R. O. W. 3. DWELLING CURRENTLY HAS CONDITIONAL HAA UNTIL JUNE 1, 1991 FOR FINAL GRADING ON NEW SEWER SYSTEM. PRIOR TO GRANTING FINAL HAA, PROVIDE WELL LOG FROM PROPOSED WELL. ISSUED BY: ~ DATE: DATE' Veil Leg Alaska Nov-Vell/¥ern's Driilling 12241 Avion Anchorage, Alaska 9951 (907) 345-4417 Location Of Yell Borough Anchorage Subdivision J Lot J Birch Tree E) 2~J Block Per. #910094 Veil Log Ft. Below Surface Well Depth Iqaterial Type Top Bottom J 105 Drilling Method !r°tary gravely till 0 20 hard pan 20 50 brown hard till 50 78 hard pan, lenses of till, seepage 7B 101 cemented gravel., lenses H20 101 105 7+ GPH Old well Or'out Sealed and Cut off 4' belov ground level as suggested bu state. ~LCl v L~, DAVY 1 5 1991 ..... ,:...~( Anchora(; e r~,., Hn~lth & ~man serv cee Date of Completion Use Jdomestic 1 Casing Tgpe welded Diameter (in.) Depth (ft.) 101 It° Finish of Vell Type Diameter I°Pen h°le I I Statio Yater Level Level (ft .)Date ssi I 5/~/911 Weight (lbs/ft) Pumping Level Below T of C (ft.) After (hfs) H.P. i I Grouting Yes~ Nol~l I Pump I Setting (ft) Material Pumping I Capacity Type Jsubmersible ~ 92' Remarks water cleared while blowing with rig This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief. Authorized Representative Date ! s/,4/*,! I 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 17-/9'1-4C HAA # .,/-/z/~ ~'/(:~ / ~"/'0'"-- 1. GENERAL INFORMATION Complete legal description Lot 23; Block I; Birch Tre~ Estates Location (site address or directions) 5215 East 147th Av~n~ J Property owner Mailing address Lending agency Mailing address S~di~ Boon~ Day phone ~¢7~ E. 147~h Au~. Anchorage, Alaska 99516 Day phone Agent Bruc~ W~bb CENTURY 21/PACIFIC NORTH Address 1120 Huffman Road, Anchorage, Ak. 99515 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Xx Community well Public water NOTE: Day phone 345-1444 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer 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 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINF. ERING _ ,. n~,,~ ! ~o~ Road Address 1/u34 ¢--'~ ............ signatu~-=gteT~ River, Ataska 99577 Engineer's THE CONDITIONS OF THE HEALTH AUTHORITY DATED May 2, 1991 HAVE BEEN MET. DHHS SIGNATURE X Approved for'~"~-~ ('~) Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in 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 enginee¢s work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~r~ ~-'~ ~d_. ~ A, WELL DATA Well type "~\~/~'~ If A, B, or C, attach ADEC letter. Log present (~fD'N) '"/ Date completed Total depth \ c;.~ ~ Cased to ~ ~ I ~ Sanitary seal~_.~N) y FROM WELL LOG Date of test Static water level Well flow Pump level Absorption field on lot Public sewer main SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot !~.~:> i I Public sewer service line ADEC water system number . I"~-~l ~ Driller Casing height ~'Z. Wires properly protected ([~N) AT INSPECTION g.p.m. "7, ~lr '¥' g.p.n~ > ~ r'rl ; On adlacent lots ~., ; On adiacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ ~,~ ~ Nitrate Date of sample: -~ _ ),be --~ \ (:::2~ I~¢' ~ Other bacteria Collected by: ~ ~ ~ ~-----'~--~--', B. SEPTIC/HOLDING TANK DATA Date installed 4 - 'Z.-"~ ~:~ ~ Tank size ~ Compartments cleanout~/N) '-/ Depression (YA~ Alarm tested (Y/N) '----' Cleanouts ~N) High water alarm (Y/N) Date of pumping t~/~undati°n SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I~C)1 \ To property line '~-- ~-~ Surface water/drainage On adjacent lots \ ~ ~Jr- Foundation Absorption field ~.~J Water main/service line 72-026 (Rev. 3/91)Front MOA21 CONTINUED ON BACK PAGE C. LIFT STATION Date i ns~ Size in gallons~ Vent (Y/N) "~ High water alarm level Manufacturer Manhole/Access (Y/N) "Pump off" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots es tested D. ABSORPTION FIELD DATA Date installed Length ~ Width Total absorption area Depression over fiel~ Results(pass/fail) ---/~' Peroxide treatment (past 12 months) Soil rating r._.O, ~ (-"~:;::>/F"I"'~'-/System type ~ Gravel thickness ~ Total depth Cleanouts presen~t~/N) y Date of adequacy test for -~ bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / To building foundation On adjacent lots Surface water Curtain drain , On adjacent lots [ ~ ~ Property line ~/'~ JA-~ V~) To existing or abandoned system on lot Cutbank '~/ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION ~-----~-c~¥--~>O ~"[-~L.k..-~.~:z:>c:> ~--,~c:~-~ I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ,, . ' er Alaska 99577 . Eagle Riv ~ En neers~ame[.[ ~ ( HAA Fee $ / ~ U Waiver Fee: $ Date of .ayme.t tC-a t Date of.ayment Receipt Number ~~ d ~5~'0 Receipt Number 72-026 (Rev. 3/91) Back MOA 21 MAY 07 '91 10:06 C21 PACIFIC HORTH 907 34S1768 P.£×£ ~ .. ~.__// ~~. .RECEIVED MAY 10 19~1 Mu~ c,pali-ty of Anchorage Dept. Health & Human 8ervioe~ .. ~ ~ ~ ~ ~.~'.~ ~ ~ ' .,,, ', ..''--' .... , ..... 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 GENERAL INFORMATION Complete legal description Lot 23; Block I; Birch Tr66 Estates Location (site address or directions) 5215 East 147th Av6nu~ Property owner Mailing address Lending agency Mailing address Sudi~ Boone 5215 East 147th Avant6, Anchora,q~t Day phone Alaska 99516 Day phone AgentBru. c¢ Webb C6ntury 21/Pacific North Address 11 20 Unless otherwise requested, HAA will be held for pickup. Day phone Huffman Road~ Anchorage, Alaska 99515 NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: XX 345-1444 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: XX 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 · )po,v, s,~eeu!§ue i'euo!ssej, o.~d eql u! suo!ss!u. Jo Jo s~o.~Je .~oJ. elq!suodseJ lou s! eD~oqou¥ t.o ,~l!led!o!unlAI eq..L 'penss! s! e3~o!J!lJeo 'e eJoj. eq elep ez~l~u'e Jo suo!l, oedsu! lonpuoo lou op SHHQ j.o sea~oldu. J':q 'slueu. Jeqnbe.~ elelS pue I~Jepej u!'el. Jeo LJ.S!l'es ol JepJo u! suo!l, nl!lsu! §u!puel J!eql pue seLuoq J.O sJeseqo~nd ol ~selJ noo 'e s'e s!ql seop SHHQ eq..L 'e:~s'elV jo el'els eql. u! peJel, s!§e.~ Jeeu!~ue i'euo!ssej, oJd luepuedepu! ue ,~q e^oqe (:j qdeJ§e.~ed u! ue^!§ sUO!l.~luese.~deJ eql uodn ,~lUO peseq sel;eo!j.!:ueo le^o.~dd¥ ~l.!.~oqln¥ qlleeH senss! (SHHQ) seo!/ues u'~LunH pu~ qllSeH j.o l. ueLulJedeQ e§~Joqou¥ j.o/q.!l'~d!o!unlhl eq.I. Sl. Uewwoo I~UO!l.!ppv :suo!l~lndBs §U!MOIIO~ eql ql!M 'SLUOOJpeq 'SUJOOJpeq ~' :itlnlVNOIS sHHo '9 ~o-una e~ans ~oeaTp o~ peuz~o~a~d s~ 6u!p~a6 I~U!~ ~q~ uo!~!puom uo i~Aoadd~ I~U!~ ~senbe~ · UO!l. oedsu! s!ql jo el'ep eql uo loejje u! suo!l, eln§eJ puc 'seoueu!pJo 'sepoo e1~15 pu~ led!o!unlAl I1~ ql!M eOU~!IdLUO0 U! S! uJe~,s~s I~sods!p Jel~Me~,S~M Jo/pu~ ~lddns Jele~ el!s-uo eql 'uo!1oedsu! pu~ uo!l~l~!],se^u! ~Lu LuoJ~ pu~ SelU e§~oqou¥ ~o ~i!l~d!o!unlAI LUOJ~ peu!~lqo UO!I~LUJO~U! eq~ uo pes~q 3~ql ~lpe^]eqlJnt I 'u!eJeq pel~o!pu! eJnlonJls ~o ed~l pu~ SLUOO~peq ~0 JeqLunu eq], Jo~ et~nbep~ pu~ I~UO!loun~ 'e~s s! Lue~,s,~s I~sOds!p ~e],~els~ Jo/pu~ X, Iddns ~e~ e],!s-uo ell1 ],~LI1 S~OLIS uo!l~O!ldd~ I~^oJdd¥ ~l!Joqln¥ qll~eH SILt], ~o uo!l~§!lSe^u! ,{LU ~,~ql ,~l!Je^ I '/~oleq u~oqs e1~p uo!l~P!l~^ eql ~o s~ pu~ oleJeq pex!t~ I~es ,~uJ ~q pe!l!lJeO s¥ -' I:FIgNIgN::I ,kg NOIIO=idSNI 40 IN:IiN:IIVlS 'g Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L ~.,'~-~ ~ ~ A. WELL DATA Well type~'~V//~,~- Log present~_.~) ~ Total depth If A, B, or C, attach ADEC letter. Date completed ~ c.~.~ Cased to Parcel I.D. (-~,'"~ I I ADEC water system number ~ ~"'7 -~1.1 Driller ~. ~ Casing height , Sanitary seal ~N) ~ Wires properly protected~/N) FROM WELL LOG Date of test '&f'- I '~ ' ,c~ \ Static water level Well flow \ Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \ Absorption field on lot Public sewer main Public sewer service line g.p.m. AT INSPECTION ; On adjacent lots ¥ ENViR~-.NMENTAL 51~R/I~Z~3 DiV,;~iOJ',I 29 1991 ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESU/LTS: Coliform ~ ,/~ o,:, ~-t~ Nitrate Date of sample: ,~,--'Z,'~ .--~[ ~, . Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed '~--"~--"~ ~ ~ ~ Cleanouts(f..~TN) ~ High water alarm (Y/N) ij Date of pumping Tank size ~ ~ Compartments ~ ;ndation cleanou~__~N) "] Depression (v,~ Alarm tested (Y/N) ..... SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/d rainage On adjacent lots ~ °c~! '3L' Foundation Absorption field \~ Water main/service line 72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in Vent (Y/N) ~ "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at High water alarm level~ Cycles tested Meets MOA electrical codes (Y/N) ~ SEPARATION DISTANCE FROM LIFT STATION TO: ~ Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~ "'~'~ Length '~ Width Total absorption area ~'7<::> ~=~ Soil rating c:~, ~ ~'~/"~¢-System type ~:;z~--~__~-~ Gravel thickness ~, i Total depth Depression over field (Y~j' Results (Pass/fail) /%//~ ~,,-/ peroxide treatment (past 12 months)(Y~ ' Cleanouts present {5~/N) Date of adequacy test for -~ bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ ~ To building foundation On adjacent lots Surface water Curtain drain On adjacent lots [ ~:=c='t "~ Property line To existing or abandoned system on lot Cutbank ~-c::'~ Water main/service line E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature 17034 Eagle River Loop Road No. 204 ED~ilneer's NaL~!lc .~!;.~_r' _~_!~1~ 99577 ' HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number unicip lity of Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. BOX 196650 Anchorage, Alaska 99519-6650 May 2, 1991 Robert A. Shafer S & S Engineering 17034 Eagle River Loop, Suite 204 Eagle R~ver, Alaska 99577 Re: WR910012, Lot 23 Block 1 Birch Tree Estates Dear Mr. Shafer: In response to your letter received by this office on April 25, 1991, this office has completed another site visit to the subject lot. We have concluded that the additional 10 foot encroachment of the septic tank to the surface drainage, making the total separation 75 feet, can be approved. This approval is granted as a result of the special construction techniques of the s-eptic tank during the recent upgrade of the wastewater disposal system. If there is any upgrade of this septic tank in the future, all separation distances must be met or another waiver approval from this office. Sincerely, Daniel J. Roth Civil Engineer On-Site Services Manager On-Site Services OSS #44 C & V BACKHOE SERVICE P.O. BOX 112826 ANCHORAGE, AK 99511 PH. 907-345-2136 MEMO L E T TER