Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
BIRCH TREE ESTATES BLK 1 LT 26
Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP171280 PID Number: 017-141-12 Dwelling: [' Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ■❑ Upgrade Name: ABSORPTION FIELD Kristopher Tolson & Anastacia Smelova Address ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 5261 E 147th Avenue Anchorage, AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. Birch Tree Estates 1 26 Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field i Tank Line Ft2 Ft. Well >100' >100' N/A N/A >25' TANK El Septic ❑S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 80' 80' N/A N/A Greer Tank 1000 Gal. Material Number of compartments Lot Line >5' 10' N/A N/A Plastic 2 NA Foundation >5' >10' N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain None Noted Gal. Remarks Tank replacement only Pump on level at Pump off level at High water alarm at Waivers on file for separation distances in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank D3034Tank to D3034 Installer drainfield Denali Excavating Drainfield CO/MT D3034 Inspector Mike Anderson BENCH MARK (Assumed elevation) 100.0 ft Inspection 151 10/02/17Location and description dates: 2nd 3rd 41^ Bottom of siding COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp 44 1.44 Vx4 I Conditional Approval: Date ,:�> ':'••'""' 4/ A r 00s, ., o IS °i� P% CE-12 42 '" Approved _ 1 i1 . ( f t. Try} Date 10/1 L/2o II �tori� s'I+ o?,�� S la End -t zowa Inspection Report_9-1-12.doc BIRCH TREE ESTATES, BLOCK 1 LOT 26 PERMIT # OSP171280 PID # 017-141-12 - E 147TH AVE _� — SURFACE WATER WELL Illt co w 1- z 1 / EW SEPTIC TANK (PLASTIC) 3-BDRM HOME w / ti2 I / A B r I J/ 100' WELL RADIUS oE�K-t} sv2 wi �'"" f MT 2COz w w V---] , u) Iw n 0 BiRCH TREE ESTATES - BLOCK 1 LOT 26 EXISTING ABSORPTION BED ❑ 1 15 CREEK MAINT ESMT LOT 27 10'UTILITY EASEMENT LOT 25 LOT26 ( LOT31 + 32 0I A B 4���\\mek SV1 10.0 37.8 �,1 ;4Cq�1j1 SV2 14.4 39.0 it:-'' �- } 2C0 15.8 38.4 jCIO*:49TH *�0� MT 16.8 41.9 6 . Be in Schiller : f `6,1' •. CE 12592 ••,%?....i srF.• Oa 042017 ••ac;, LEGEND 1,kiii*Xx��y�4 MT-MONITORING TUBE SV-SEPTIC VENT 0 40 80 2C0-DOUBLE CLEANOUT on gm = = FEET 1"=40' BIRCH TREE ESTATES, BLOCK 1 LOT 26 PERMIT # OSP171280 PID # 017-141-12 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT: 343-7904 4700 ELMORE RD, ANCHORAGE, AK 99519-6655 WASTEWATER DISPOSAL SYSTEM OR WELL INSPECTION REPORT O r cv O LUL Cr) CI) N X98.9 — — - 95.6 �,... .. INSULATION vo «cmonv:an('> • 95.1 1000 GAL SEPTIC TANK 1 1 90.9 :14.11k kk r*• 49 TH 1" •9*`t� law k / PROFILE AS-BUILT i Schiller (NO SCALE) �II;E.-pROFESS10,'" °-= MUNICIPALITY OF ANCHORAGE cOn-Site Water &Wastewater ProgramPO Box 196650 4700 Elmore Road Anchorage.Alaska 99519-6650 Phone:(907)343-7904 Fax: (907)343-7997 http:llwww.muni.org/onsite WI jar" On-Site Wastewater Disposal System Permit Permit Number: OSP171280 Effective Date: 9/27/2017 Work Type: SepticTank Upgrade Expiration Date: 9/27/2018 Tax Code Number: 01714112000 Site Legal Address: BIRCH TREE ESTATES BLK 1 LT 26 G:3037 Site Mailing Address: 5261 E 147TH AVE, Anchorage Owner: TOLSON KRISTOPHER D & Lot Size in Sq Ft: 28207 Design Engineer: FORGE ENGINEERING Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: 114(L1I Date: Issued By: C Date: • Z7 .2017 • nt Municipality of Ani° io p ae o,.,, 5 :r.. ` 1 eparlment P.O.Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 . Fax (907) 343-7997 http:llwww.mun i.org/Onsite Development Services Division On-Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW ** ** Waiver#: OSV171115 COSA#: Permit#: OSP171280 PID#: 017-141-12 Legal Description: Birch Tree Estates Block 1 Lot 26 Engineer: Forge Engineering Applicant. Kristopher Tolson &Anastacia Smelova Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the surface water to the north has been approved. The approved separation distance is 80.0 feet. See engineer's waiver request for justifications. In addition, tank cannot be relocated to provide required separation, as there is surface water along the south property line also and well separations to maintain. This waiver approval applies to the proposed septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. (1 Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. Waiver is Granted: X Waiver is not Granted: Date: Vc27/2af 7 Approved by: /72di-C c4 t ytivr.e'CY Name of Reviewer **** VARIANCE/WAIVER REVIEW **** 400 61 R 9 l0 7jMUNICIPALITY OF ANCHORAGE 2 b 2017 1' Community Development Department Phone: 'II, -343-7904 ti Development Services Division Fax: 907,--:3-7997 w\c' On-Site Water & Wastewater Program `L-.9i 6 8 I- ON-SITE ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 017-141-12 Property owner(s) Kristopher Tolson & Anastacia Smelova Day phone Mailing address 5261 E 147 Ave, Anchorage, AK 99516 Site address 5261 E 147 Ave Legal description (Sub'd., Block & Lot) Birch Tree Estates, Block 1 Lot 26 Legal description (Township, Range & Section) Lot Size 28,207 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (El all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) t (w/wo ADU) Septic Tank ❑X Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: 1 Tcu k it. Sl �a, t,Jo:#er- Distance: i I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. <--&or (Sig Lure property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: glasf l7- Date of Payment: Receipt Number: G Co?' _C Receipt Number: Permit No. r/i /9/942,26 Waiver No. Permit App_ - ,_._:c, FORGE ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) September 26, 2017 Municipality of Anchorage Development Services Dept- On-Site Water& Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Birch Tree Estates, Block 1 Lot 26 Septic tank replacement permit application Dear On-Site Services Engineer: The septic tank on the above lot has failed, requiring a replacement. The existing home is a 3- bedroom. We are submitting this permit application for the placement of a new septic tank. The attached site plan identifies the location of the existing home, well and septic system, as well as the location of the new septic tank. The drainage pattern in general will not be changed by the construction. The existing tank will be pumped dry and decommissioned per code. The new tank will then be placed outside the 100' well radius, with 2" of insulation and 2' of soil for frost protection. After the new tank, we will install a double-cleanout and connect into the existing absorption bed. The records for the property indicate the presence of surface water on the lot, with a 15' creek maintenance easement along the east and south property lines. No standing water was seen in the drainage ditch on the east side of the property on 9/7/17,nor on 9/26/17. However,there is a stream running down just along the south property line. Records indicate that the septic tank is further than 100' away from the historic surface water boundary, and it is 100' from the stream to the south. However, records also indicate water in the roadside ditch to the north. Further investigation reveals that a mapped creek has been diverted through culverts and directed to the stormwater ditch to the north. This ditch is approximately 80' north of the septic tank. We ask that a waiver be granted for this 80' distance to the running water in the ditch. This would replace the existing waiver in the file. A new septic tank will do more to prevent effluent reaching the ditch than the older, failed one. We have specified that the new tank be plastic, for more protection and less corrosion in case of higher groundwater. There is no additional threat to public safety by granting this waiver. If the system is constructed as designed, it will have no adverse impact: • On the wells in the area or those to be constructed in the future. • On existing septic systems in the area or those to be constructed in the future. • On reserve space, either surface or subsurface, on any lots located in the area. • On drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, . E OF A 74 i ' I*. 49 'N • • y Benjamin Schiller, PE :6611; ,11• + til �,: 00 Cl;� "' '••a a&(c7 '4:` STREAM DIVERTED INTO DRAINAGE DITCH ALONG DRAINAGE DITCH PROPERTY LINE (DRY il 9/26/17) — — E 147TH AVE ® _____ __ _ F- 1 , 1 w I I_Ecl I 3-BDRM HOME W W V En 100' WELL RADIUS F COr* i/V, OEC- , , _MT F- _ z REPLACEMENT PLASTIC 1000-GAL SEPTIC TANK 1 ku W/ DOUBLE CLEANOUT I w INSTAL _INSULATION AND 2' COVER F NI o BIRCH TREE ESTATES - BLOCK 1 `\I LOT 26 EXISTING ABSORPTION BED ID \ WELL> 100'FROM VIEW _. 15'CREEK MAINTESMT \ LOT 27 10'UTILITY EASEMENT 4 — LOT1 5 LOT 26 1 LOT 31 + 32 WELL> 100' FROM VIEW ® i I I RUNNING STREAM NOTE: _�������\\1 NO SURFACE WATER WITHIN 100'OF THE �G '4 kki PROPOSED SEPTIC SYSTEM *• ' I . 1\ '*• V, NO CONFLICTS WITH WELLS OR SEPTIC % f SYSTEMS ON ADJACENT LOTS • , ,,, LEGEND Benja A Schiller MT-MONITORING TUBE �#f9�,•... C 1252 ..• %.1•• ,' 0 40 80 sre •: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT [] UPGRADE 'L55 d Ftnc nor0 e, Iqta'. ,c qqs03 LEGAL DESCRIPTION LOCAT~N ~ NO. OF BEDROOMS DISTANCE~ell I Absorption are~, Dw~ ,o: 105' ~ Z Manufacturer ' No. of co~rtments ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O Z ~ Manufacturer Material Liquid capacity in gallons Tren~d~h Distan~}tween li~s ~o. of lines~ ten,th o~l~e Total lengthens ~ ToooftHetofin,sh~rade ~ MaterialBeneathtile ~ inches Totateffe~iveabsorp~area ken,th ~idth Depth Pfi~MIT ~O. ~ ~ Tg~e of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PiPE MATERIALS_~ -- SOIL TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL 72-013 (Rev. 3/78) WELL LOG Date Drilled: Static Water Level 77 feet Gallons Per Minute !0 Draw Down ~I^ feet Total Feet of Casing t00 Type Material Drilled: 0 feet 1 f~ 'Feot' to 9~ 'Fce~ (;-~-;~vC?' ?0 F~ei to 6¢1 f~:?t Cemei~t to 63 feet FLqnd to 11l~¢), , f~et,,, ,Cr~ve'-: , ~/ ~-!I,* ter .... Hefty Drilling S.R.A. Box 1553 H Anchorage,Alaska 99507 Department 825 L Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT * * * Permit ~~._. ~-'_'"-/-~-ON.-SITE SEWER PERMIT Applicant:~ 1 ) ~ ~~_~ ~ ~~ (/d~-~) Mailing Address: /2~0 ~/ Location: t~ - ~ ~ Phone Number: Legal Description: L~'~ ~X / &~ ~/~ ~"/2~:~'~ LOt Size: Type of Soil Absorption System Is: Trench: Drainfield: Maximum Number of Bedrooms: MUNICIPALITY OF ANCHORAGE ,f Health and Environment~ Protection Seepage Bed: Holding Tank: Soil Rating (sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH LENGTH ~q GRAVEL DEPTH WIDTH The length dimension ls the length(l~ feet) of the trench or dral~fleld. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall Pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE TM /ddd GALLONS * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * * I certify that: (1) I am familiar with the requirements.for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if include more tha,~/, b~d~~ . Signe~: Issued by:~ Date: the residence isfremode~ed %o Applicant ,~// SWP/024 (1/81) ALASKA b IUIROFlmEFITAL COFITROL SE dlCES, If'lC. SPECIFICATIONS FOR ELEVATED BED ALTERNATIVE WASTEWATER TREATMENT SYSTEM- LOT 26, BLOCK 1, BIRCHTREE ESTATES SUBDIVISION 1.0 GENERAL 1.1 THE DRAWINGS, SHEETS 1 THRU 1, SHALL BE A PART OF THIS SPEC IFICAT ION. 1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE REQUIREMENTS OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERMIT. 1.3 ALL EXCAVATIONS AND DEPTHS ARE ADVISORY AND ARE TO BE VERIFIED OR MODIFIED IN THE FIELD BY THE CONTRACTOR. 2.0 THE LIFT STATION (NOT USED) 3.0 SEEPAGE BED ~ 3.1 THE GRAVEL FOR THE BED SHALL BE SCREENED TO THE SIZES INDICATED; 0.5 TO 2.5 INCHES. 3.2 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN COMPACTED DURING EXCAVATION. THE BOTTOM ELEVATION SHALL BE PLUS OR MINUS 2". 3.3 AN OBSERVATION PIPE SHALL BE PLACED AS SHOWN IN THE DRAWINGS. IT SHALL BE RIGID PVC, ASTM 3003 D-3034. THE SECTION SHOWN WITH HOLES MAY BE EITHER DRILLED 0.5" HOLES @ 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE OR A SECTION OF REGULAR PERFORATED SEWER PIPE MAY BE CLAMPED TO THE SOLID SECTION WITH A NO HUB COUPLING OR SOLVENT JOINT. A RUBBER RAIN-CAP (JIMCAP OR EQUAL) SHALL BE PLACED ON THE TOP OF THE PIPE. 3.4 IF INSULATION IS REQUIRED THE INSULATION SHALL BE DOW EXTRUDED BLUE STYROFOAM BOARD INSULATION BOARD OF THE THICKNESS SHOWN ON THE DRAWINGS. 3.5 THE TOP AND SIDES OF THE BED SHALL BE PLANTED WITH A WHITE CLOVER AND RED FESCUE MIX OR BLUE GRASS. 3.6 THE SEPTIC TANK OF BED MUST NOT BE CLOSER THAN 100 FT. TO ANY EXISTING WELL OR BODY OF WATER. 3.7 THE GRAVEL SHALL BE COVERED WITH A LAYER OF UNTREATED BUILDING PAPER OR A NONWOVEN FABRIC SUCH AS MIRAFAR FIBRETEX 200 GRADE, OR POLY-FILTER X OR EQUAL. 3.8 THE DISTRIBUTION PIPE SHALL BE 4 INCH RIGID PVC OR POLYETHYLENE. THE PIPES SHALL BE LAID LEVEL. 3.9 THE BERM AROUND THE SEEPAGE BED SHALL BE CONSTRUCTED OF IMPERMEABLE MATERIAL, AND ON A SLOPE OF 1 FOOT VERTICAL PER 3.0 FOOT HORIZONAL. 1200 UJcsl 33rd Aucnu¢, 5uii¢ [~ · Anchora(]¢, Alos[o 99503 · (907) 276-1361 ALASKA ENVIRONMENTAL CONTROL SERVIC , INC. 1220 West 25th Avenue Suite B ANCHORAGE, ALASKA 99503 276-1361 279-2917 SHEET NO, OF CHECKED BY DATE SCALE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOt LS' LOG .~ .... : "'~ [] PERCOLATION TEST t LEGA,_DESOR,PT'O"= ht'('r'" "[r~c...:.::.'L:~'~ ~ k.'CC ., I LC~'I' SLOPE SITE PLAN 6 ? 8 9 10 11 12 13 14 15 16 17 18 19 20 I Gross Net Depth to Net Reading Date Time Time Water Drop P E IF YES, AT WHAT DEPTH? AGE• $b �� Municipality of Anchors • r `% On-Site Water and Wastewater Program ,\73 * 4#11\ (907) 343-7904 ;ViE T Y ii OCT 04 2017 Certificate of On-Site Systems Ape a al �w 017-141-12 0' 6 9 zf Parcel I.D. Expiration Da . cJ jot oL6F� 1. GENERAL INFORMATION Complete legal description Birch Tree Estates Block 1 Lot 26 Location (site address) 5261E 147th Ave Current Property owner(s) Kristopher Tolson &Anastacia Smelova Day phone Mailing address 5261 E 147th Avenue, Anchorage, AK 99516 Real Estate Agent Mary Cox Day phone 907-440-9820 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for:Well to animal containment area Distance: 5' Received by: Date: W ite I t? COSA to be released to the engi er,unless otherwise requested by the engineer. COSA Fee $ 5R(o Waiver Fee $ aS� Date of Payment /O/57( Date of Payment /6/51/ Receipt Number 63 M S,e Receipt Number 0 377,7C COSA# 65C-0/01 Waiver# 65 Vf1/da 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave. Suite 203 Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller Date 10/02/17 • 4 �, .• •. 7.. 4.� 41 OP Clt oMt AY; +•:::"Fge �a• * 49TH •to y1 6. DSD SIGNATURE '° ./ System #1 Approved for 3 bedroomsschmer17 dr �e •� � System #2 Approved for bedrooms i ® � a Disapproved Avot. •••j�•Y,`���•��,y'�y••` Conditional approval for bedrooms, with the following stipufane;3 toi n,�rlf fQNt 'rr W SKEW p1, ER oF W -, OGRPM ra'= 1' NT,, (a.NSIIIIIBY: 1`vrl ECk.(,( d Original Certificate Date: 10/!2./2.0 1 7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory • Well Flow Advisory Other COSA blue sheet E c If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Birch Tree Estates Block 1 Lot 26 Parcel ID: 017-141-12 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (YIN) Y Date completed 6/21/83 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 100 ft. Cased to 100 ft Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 6/21/83 9/07/17 Static water level 77 ft. 83 ft. Well production 10 g.p.m. 6.1 g p.m WATER SAMPLE RESULTS: Coliform ND colonies/100 mL Nitrate 0.346 mg/L Arsenic ND ug/L Date of sample: 9/07/17 Collected by: Forge Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Plastic Date installed 10/01/17 Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N Date of pumping Pumper New construction C. ABSORPTION FIELD DATA Date installed 7/021$3 Soil rating (g.p.d./ft2 or ft2/bdrm) 115 SF/BORN System type Shallow Bed* Length 29 ft Width 21 ft. Gravel below pipe 0.5 ft. Total depth 3 ft. Eff. absorption area 609 ft2 Monitoring tube Y Depression over field N Date of adequacy test 9!07/17 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 601 gal. New depth 0 in. Elapsed Time: 90 min. Final fluid depth 0 in. Absorption rate >= 450 _ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) N If yes, give date *Deck extends out over the bed, However, it is set on blocks on the surface of the ground, and does not extend into the bed. There is no impact on the bed's absorption. D. LIFT STATION Date installed Size in gallons Manhole/Access(YIN) "Pump on" level at in. "Pump off level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >100' On adjacent lots >100' Absorption field on lot >100' On adjacent lots >100' Public sewer main >75' Public sewer manhole/cleanout >100' Sewer/septic service line >25' Holding tank >75' Animal containment areas 5 Manure/animal excrete storage areas >100 SEPTIC/HOLDING TANK ON LOT TO: >5' >5' >5' Building foundation Property line Absorption field Water main Water service line 10 Surface water 80 Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: 10' 101 >101 Property line > Building foundation > Water main Water Service line Surface water 80 Driveway, parking/vehicle storage >10' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS *Waivers for surface water on file: Tank-OSV171115, Field-WR970072 **Waiver pending for separation of well and neighboring horse corral. G. ENGINEER'S CERTIFICATION ,�goixt�►at . 4 i,Lw•9E•A` ito I certify that I have determined through field inspections and w`•-;;..g •••;4 review of Municipal records that the above systems are in • i"• ••Vic_ + conformance with MOA COSA guidelines in effect on this date. r tF; 49 ,;, " •.-7 # 0 Benjamin Schiller ""•'"••,�: Engineer's Printed Name I �••.» d Date 10/02/17 ♦ =, J'' j i r,`r,2.1,11 441. COSA brown sheet 10-10-12.doc I\1U111cipa_Il~\T of AB1 cf iorag r5,1_u� P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http:llwww.muni.org!Onsite Development Services Division On-Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV171122 COSA#: OSC171471 Permit#: PID#: 017-141-12 Legal Description: Birch Tree Estates Block 1 Lot 26 Engineer: Forge Engineering Applicant: Kristopher Tolson & Anastacia Smelova Your request for a waiver of the required 50 feet horizontal separation from the animal containment area to the private well has been approved. The approved separation distance is 5.0 feet. This approval is based on clean water samples results. Should water quality change in the future, separation between well and animal containment area shall be increased to a minimum of 50 feet. This waiver approval applies to the existing well only. Any future upgrade to the on-site systems will require all separation distances be met or another approval from this department. [] The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ❑ Adjacent properties are not affected by this waiver. Waiver is Granted: X Waiver is not Granted: Date: /0 11 .2.0/7 Approved by: atfee4 rrLc�� Name of Reviewer **** VARIANCE/WAIVER REVIEW **** FORGE ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) October 4, 2017 Municipality of Anchorage Development Services Dept- On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Birch Tree Estates, Block 1 Lot 26 Waiver: Well to neighboring animal enclosure Dear On-Site Services Engineer: The owner of the home at 5261 East 147`" St is selling their home. During our well and septic inspection,we noticed that the neighbors had built a horse corral on the neighboring lot. The corral is less than the required 50' from the well. We would like to request a waiver for a 5' separation. We have spoken with the neighbor about their corral, but they are not motivated to move it, and the homeowner has no manner of forcing them to do so. The neighbor has stated that the corral has been on the property for several decades now, although the verbal discussion indicated the well (drilled on 6/21/1983) likely pre-dates the building of the corral. The neighbor admits that there has never been a permit for the building of the corral. Any sort of municipal enforcement action against the neighbor will become a lengthy and possibly expensive process, which will delay or stop the sale of the home. We have received the lab results for the water sample, and there is no contamination by bacteria nor elevated nitrates. Several tests done since 1997 indicate the same results. These historical water records indicate that there is no threat to the health and safety of the occupants by granting this waiver. bc: 9f.. Sincerely, a,��:•• '••;4_q. 1 to IF.*'. . • TN 7 •�'y # —*+, : e d / �.r 1 •....,......� Benjamin Schiller, P.E. ,, .. *jfr. eii - - - - - EAST 147TH - - - - - - - __- F FND I 1a'ALUM CAP CO P TED POSSITONM Al 89 43' 44" E 6 0.9 4 L 67.02 WELL`-, iv 78 lJ 16' >45" w 2,03 0. • s r ' E dIM• • 0 ‘ W i 3 . . . ......... I , 1 fif '4-147--14, tioG,, 070.; s i36.6 _.-.. _.. t 3-- 31.3 - DECK 0 r DECK O G) 0 y 0 00 ",f] 0 I 1 I cci IN r.. M W O O c ti.,' 2 O L W O U W W J 0 m, FCC Vo 15' CREEK MAINT ESM'T 10' UTILITY EASEMENT N 89 48' 11" E 150.00 o _ OFA ,N 49THoD AS-BUILTT SURVEY 1" 20 OS/ �f NO CORNERS SET THIS DATE V �./ I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY V/�O . SHANE A. HOLT . z OF THE FOLLOWING DESCRIBED PROPERTY V �4,, LS-6914 •'• co�� LOT 26, BLOCK 1, BIRCH TREE ESTATES r°fessiona\ _,__.� ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE �D \ -od VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY EXIST OTHER THAN NOTED. CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS;AND IS DATED AT ANCHORAGE,ALASKA THIS _5TH DAY OF NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES,IMPROVEMENTS,OR FENCELINES. OCTOBER 2017. EASEMENTS OF RECORD,OTHER THAN THOSE APPEARING ON THE RECORD PLAT,ARE NOT SHOWN — HEREON(UNLESS INDICATED) NOTE; FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. HOLT LAND SURVEYING ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. 9309 GROVER DRIVE ANCHORAGE,AK 99507 11826, FB 150-10, FB 185-16 345-5513 Parcel I.D. # 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 017-141'-12-000 - RELEASE 1. GENERAL INFORMATION Complete legal description Lot 26; Block 1; Birch Tree Estates OF CONDITION Location (site address or directions) 5261E. 147th Avenue Anchorage, AK Property owner Mailing address Lending agency Mailing address Agent Address Tom Barrett Dayphone 561-5700 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 2 TYPE OF WATER SUPPLY: Individual well XX 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 O~= '~]ASTEWATER D~SPOSAL: 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. 1191) 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 ~-~A~ ~J/~¢¢.¢_. ~ (J~)~ ,'~'¢~~ ¢J0~5'4c"~,-~--~' [,,,/C. ~ .... r'none 2'7 7- ~/7'~ Engineer's signature("//~,)~ '~ ~ L / \~j~____._~ Date ¢~/Cup PLEASE RELEASE CONDITIONAL ALL REQUIRED WORK HAS BEEN DHHS SIGNATURE Approved for Disapproved. HEALTH AUTHORITY APPROVAL // // SATISFACTORILY COMPLETED.~.~_ 0~/~%L '~h~// bedrooms. %~.~,~uhbb~ ~ Conditional approval for 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 engineer's work. 72-025(Rev. 1/91) Back MOA~21 Ftick Mystrom, Mayor August 6, 1998 9epartmen'~ o~: ~'~ea~'th a~d ~-~uman Services 925 "L" Street P,O. Box 196650 Anchorage, Alaska 99519-6650 http:,,,, www.cL,mcho '~c,¢.a<.:m Jeff Garness, P.E. Alaska Water & Wastewater Consultants, Inc. 7320 East Chester Heights Circle Anchorage, Alaska 99504 Subject: Waiver Request for Lot 26 Block 1 Birch Tree Estates Subdivision Waiver Request #WR970072, HAA# HA970494, PID #017-141 - 12 Dear Mr. Garness: Your request for waivers of the required 100 foot horizontal separation of an on-site wastewater disposal system to the surface water has been approved. The approved separations are as follows: 1. The septic tank to running water on the north side of the lot in the road ditch of 80 feet. 2. The absorption bed to creek on the south and west lot line of 80 feet. This waiver approval applies to the existing on-site wastewater disposal system to surface water 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. Should the operation of the subject wastewater disposal system cause any contamination or degradation of the subject surface water, this waiver will become void. If there are any further questions or concerns regarding this waiver, please call our office at 343- 4744. Sincerely, Daniel J. Rot~ ~ Civil Engineer On-Site Se~ices Program Alaska Water & Wastewater Consultants, linc. 7320 East C~nester Heights Ci le ~ An horage ~ Alaska 99504 Phone (907} 337-6179 ~ Fax ~907) 3383246 August 3, 1998 Municipality of Anchorage Department of Health and Human Services Attn: Dan Roth P.O. Box 196650 Anchorage, AK 99519-6650 RECEIVED AUG 5 1998 Municipality oi Anchorage Dept. Health & Human ,Services REFERENCE: Lot 26; Block 1; Birch Tree Estates Release of Conditional Health Authority Approval A Conditional Health Authority Approval was issued on the referenced property on December 5, 1997, (HA970494). Please be advised, all conditions have been met. Adequate fill has been placed along the west lot line and along the south end of the lot. All surface water is 81'+ from the on-site wastewater disposal system,, Please release the Conditional HAA and issue a full HAA at this time. If you have any Jeffr.e~A~/G~ar~ Presidenf ~J concerns, please contact me. ~ss, JAG/gk Rick Mystrom, Mayor Mu _icioali, , of Department of Health and Human Services 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 December 8, 1997 Jeff Garness, P.E. Alaska Water & Wastewater Services 7320 East Chester Heights Circle Anchorage, Alaska 99504 Re: Surface Water Waiver Request For Lot 26 Block 1 Birch Tree Estates, Waiver Request Number WR970072, P.I.N. 017-141-12 Dear Mr. Garness: Your request for waiver of the required 100 feet separation from an on-site wastewater disposal system to surface water has been conditionally approved at this time. The requested separations are as follows: 1. The septic tank to running water on the north side of the lot in the road ditch of 80 feet. 2. The absorption bed to creek on the south and west lot line of 80 feet. To satisfy the conditions of this waiver request, adequate fill must be placed on the south and west side of the house to eliminate or push the ponding surface water into the creek channel on the south and west lot lines. This work must be completed by no later than June 15, 1998. If you have any questions of the above requirements of this conditional waiver approval please call me at 343-4761. Sincerely, Daniel J. Roth Civil Engineer On-Site Services Program WR% WR970072 PID% 017-141-12 Date Received: October 27, 1997 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet HA# HA970494 Permit Legal Description: Lot 26 Block 1 Birch Tree Estates Subdivision Engineer: Jeff Garness, P.E., Alaska Water & Wastewater 8471Brookridge Drive, Anchorage, Alaska 99504 Applicant: Tom Barrett Waiver Requested: Septic tank ot surface water on the west lot line 58 feet drainfteld approximately 64 feet from the ponded area near She south lot line Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Special Conditions: 3. Other: Waiver is Granted: ~ Waiver is NOT Granted: List Conditions or Reasons for above: Rec %: 03353/4305 Amount: $ 920.00 Name of Reviewer Date Paid: Oct 27~ 1997 Alaska Water & Wastewater 7320 East Chester Heights Circle ~ Anchorage - Alaska 99504 Phone (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers December 5, 1997 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 REVISED Attn: Dan Roth Subject: Conditional HAA for Private Well & Septic System. Lot 26, Bk 1, Birch Tree Estates Dear Mr. Roth: Per your direction the homeowner is going to place fill along the west lot line so as to ensure that there is no surface water present. In addition, fill will be placed along the south end of the lot so as to ensure that any overflow from the septic system would not reach standing surface water. The septic tank will be approximately 80 feet from the drainage ditch along the north property line, and will be greater than 100 feet from all other surface waters. The drainfield will be approximately 80 feet from the drainage ditch (parallels the north lot line), and at least 80 feet from any surface waters near the south and southwest portions of the lot. After the fill is placed, the topography will be such that overflowing wastewater could not reach the creek without first traveling over the ground surface at least 80 feet. The homeowner has obtained 3 bids to perform the subject work, and is requesting that your department issue a conditional HAA so that the property transaction can close. The work will be performed prior to June 15, 1998. If you have any questions, please co atact me at 337-6179, or 244-9612. Thank you for your assistance. Since/~,/// /~ Jeffrey'AY G rpess, P.E., U.S. Principal u c.c. Tom Barrett '1 4 O,'tCt,r.,~,(,,Tt:r.; D~I,,.~L~G & Alaska Water & Wastewater 8471 Brookridge Drive ~ Anchorage ~ Alaska 99504 Phone (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers October 23, 1997 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Subject: HAA for Private Well & Septic System. Lot 26, Bk 1, Birch Tree Estates To whom it may concern: The subject lot has a 2 bedroom house on it which is served by a private well and septic system. The results of the field investigation and adequacy tests are summarized as follows: A. WELL: The static water level on 10/10/97 was 83' BTC. Water was pumped from the well at an average rate of 6.46 gpm for a total of 115 minutes (743 gallons). Within the first 10 minutes of the pumping period the water level dropped 4 feet, to a 87 feet BTC. The level stabilized at that level throughout the rest of the test. In short, the well was recovering as fast as the water was being pumped out. Based upon our test results, it was determined that the capacity of the well exceeds the Municipal requirements for a 2 bedroom house (300 gallons per day). This well produced 743 gallons in 95 minutes, which exceeds the FHA requirement of 720 gallons in 4 hours. B. SEPTIC TANK: The existing septic tank was installed in July of 1983 (approx. 14 years old). According to theM. O.A records, it is 1000 gallons, has two compartments and is made of steel. Most tanks of this type typically have a structural life of approximately 20 years. No warrantee is made regarding the future life of the septic tank. The tank has only about 12 inches of soil cover on it. It is unknown whether there is insulation board over the tank. C. SEPTIC SYSTEM ADEQUACY TEST: The drainfield is a bed type system that is 21 feet wide and 29 feet long. Per the homeowner the house had been vacant since the 3rd week in September. The adequacy test was performed on 10/10/97. Prior to the start of the test the monitoring tube was moist, but had no standing water in it. Water was introduced into the MT at an average rate of 6.8 gpm for 94 minutes (639 gallons), which caused the liquid level to rise to 4.25 inches. The last 253 gallons introduced only caused a rise of .75 inches. This corresponds to 338 gallons per inch. Twenty-one (21) minutes later the liquid level had dropped 1.25 inches, indicating that greater than 250 gallons had been absorbed. Based upon this data, it was determined that the absorption rate of the bed exceeds 300 gallons per day, as required for a 2 bedroom house. NOTE: The adequacy of a septic system is influenced by numerous factors, including, but not limited to, seasonal surface water infiltration, groundwater variations, septic ,system maintenance (frequency of septic tank pumping, usage of biological additives), condition of drain pipe and pipe joints (which can be damaged by seismic activity and deteriorate with age), type of substances deposited in septic system (cigarette butts, sanitary napkins, misc. objects), and the amount of water being introduced on a continual basis. Consequently, the results of this adequacy test are only valid for the specific day of the test. Furthermore, because of the limited nature of this investigation, it is possible that there are hidden defects which may not have been detected No warrantee is made regarding the future performance of this well or septic system D. SEPARATION DISTANCE FROM SEPTIC TANK & ABSORPTION FIELD TO SURFACE WATERS: Attached is a copy of the as-built survey on which the field engineer (Jim Williams, P.E.) has sketched the location of nearby surface waters. In addition he identified the slopes from the septic system to the surface waters. There is a creek which runs along the south property line (and a duck pond), ponded water near the west lot line, and a stream running in the drainage ditch near the north property line. The septic tank is approximatel~v 58feet from the surface water near the west lot line. The drainfieM a.q~roximatel~v 64 feet ~om the ponded area near the south lot line. In each case, it is downhill from the septic system to the surface waters. In short, daylighting wastewater would flow towards the surface waters. There is nowhere on the property to locate the septic system and meet the 100 foot setback requirement to surface waters; And, because of the topography, it is not possible to regrade the lot, so that daylighfing wastewater would not run towards the surface waters. The only possibility would be to build an earth berm immediately downhill from the septic tank and drainfield, which would contain any overflowing wastewater; however, such a berm would also trap surface runoff, possibly creating ponds immediately next to the septic system. In short, there is no easy solution. Given the fact that the septic system is functioning properly, and that the condition has existed for over 14 years with no adverse impact, it is my recommendation that your department issue waivers for the aforementioned separation distances. I am open to any suggestions from your department. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance. Tom Barrrett HAA on 147th Ave. wps ~u$ F MUNICIPALITY OF ANCHORAGE ~../~t LiT¥~ DEPARTMENT OF HEALTH & HUMAN SERVICES ~N,~.~..~,.~.^L Division of Environmental Services ~ . DIVISION On-Site Services 8eotion P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # Olr)c-lq{- IZ-DO© \l HAA# 1, GENERAL INFORMATION Complete legal description LOT ~(a, ~..lc. I , &lRd~r OCT 2'? 1991 Location (site address or directions) Property owner Day phone 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 Community well Public water NOTE: lng to the legality and status of system. If community well system, provide written confirmation from State ADEC attest- 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 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that rny 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, effect of/~this inspection. ordinances, and regulations in on the date Name of Firm ......... : .' =. ~ Phone $47' ~ro ' Address ~ /~/ Engineer's signature ~'///~ ~ Date ,/o f¢ ~¢ DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for XXXXXXXXX bedrooms, with the following stipulations: Money shall be put in escrow to place fill in accordance with the engineer's attached letter and drawings dated December 5, 199~.to eliminate ponding surface water. This work shall be compla~ad hy n~ l~r ~h~n .T,n~ ~5. 1998. Money in escrow shall not be rel~ased until this office has approval. Additional Comments given final Date / 2- -~-'- ¢ 7 The MuniciPality of AnChorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Legal Description: A. WELL DATA Well type Log presen~,~/N) Total depth { 00 Sanitary seal (~/N) EN.M_. U~'~'ALITy 01~ ,~,~.. '~IVIRON/HENTAL 825 L Street, Room 502 Anchorage, Alaska 99501 Health Authority Approval Checklist ~ I. ~¢o~T~6~ ~T, Parcel I.D.: If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~ I:;L.t l S.~ Cased to I, O0 Casing height (above ground) /,2. -/- Y~_,5 Wires properly protected Y(~) ~/~F~ Date of test Static water level Well production FROM WELL LOG AT INSPECTION I0 g.p.m. ~o,~ g.p.m. WATER SAMPLE RESULT(~ Coliform Nitrate Date of sample: , ~. ~./~ (_NIJ))Other bacteria ~' Collected by: -~--, i:), ~-)~ B. SEPTIC/HOLDING TANK DATA Date installed ~ {~/~ Tank size Foundation cleanout ~___~N) /V~.5~ Date of Pumping C. ABSORPTION FIELD DATA Date installed (00~ GAL Number of Compartments ~ Cleanouts~)'N). ~ Depression (Y/(~I,~ ~ High water alarm (Y/N) /,u//:/ Pumper ~ ~'~¢.,.V~/r._¢:: -~ Length ~( ' Width ,~. t' Gravel thickness below pipe Effective absorption area (,Off c~ ~, Monitoring Tube present ~1) ~ Depression over field (Y/I~__ Date of adequacy test 1.0 / ~.o~.~t q- Results (Pass/Fail) ~'~L~55 For T-~ Fluid depth in absorption field before test (in.); C) ~ Immediately after ~-~':/gal. water added (in.): Fluid depth ~" (ins) Minutes later: ~,3.,{ Absorption rate ~= ~.~ ~' .g.p.d. Peroxide treatment (past 12 months) (Y~ J~-t Y-.~,,~ If yes, give d~te Soil rating (g.p.d./ft~ o(~/bdrm~ //.~ System type Total depth bedrooms 72-026 (Rev. 3/96)* Manhole/Access (Y/N) ~~~~' evel at* __ "Pump off" level at* High water alar~ ~ E. SEPARATION DISTANCES ~ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station Sewer/septic service line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation + Water main/service line lO J- Property line Surface water/draina Absorption field Wells on adjacent lots /C%~ ~L SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line { O ~L Building foundation ~Surface water ~/'/ Water main/service line Curtain drain ~o~_ ~-.,,~e~r~ Wells on adjacent lots ENGINEER'S CERTIFICATION ~ ~ I ce~ify that I ~ de~ ~n~ ~ld inspections and review of Municipal inconforma~ewi~~~ineffectonthisdate. Driveway, parking/vehicle storage area ioo records Waiver Fee $ /,~ Date of Payment Receipt Nu mb er 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Locaiion (address or directions) (b) PrbpertY'Owner ~ ,,i..~ ~) Telephone: Home Business '. Ma!ling Address (c) Telephone (d) Lending Institution Mailing Address ' Real Estate Company and Agent Address Telephone ~//¢¢"' ? 717 Mail the HAA to the followina address: or: Check here [-I, if hold for pick up. List contact person and day phone number below. (e) TYPE OF RESIDENCE Single-Family'~ Number of Bedrooms WATER SUPPLY Individual Welling. Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite'~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRev 8/861 Front ')JJOM S,JSeU!J~u8 leUO!SS@,toJd eql u! SUO!SSiUJO JO sJOJJG JOJ. @lq!SuodseJ ~,ou s! ebeJoqou¥ ,to ,gJl~d!o!unl/~ @H.L. 'panss! s! a~,~oi~.!peo e 8Joj@q e~ep ez41eue Jo suoiloedsu! ~,onpuoo ),ou op SHHQ ,~o saeXoldUJ-~ 'siueuJeJ!nb@J e,tei, spue leJepe~, u!l~iJeo Xj.s!j~,s o), JepJo u! suoBn),p, su! 6u!puel Jiaq~, pue S@LUOq ~.O sJaseqoJnd ol Xsapnoo e se s!q~, seop SHHCi eqJ. 'e~tSel¥ ,to m,e~,S eq~, u! peJm, s!beJ J@@uibu@ IBUO!SS@~oJd ~,u@pu@d@pu! ue Xq @^oqe ~; qde~§eJed u! u@^ib suop, e~,u@saJdaJ @q), uodn /~lUO peseq s@p~o!,tipeo leAoJdd¥ ,qpoqinv q~,leeH senss! (SHHQ) s@o!^JeS uet.unH pue q~leeH ~.o ~,ueuJMedecI elbeJoqouv ~to X~,!led!oiunl/N eq.L NOIJ. nVO leAoJddv I~UOll!puoo ,~o suJJeJ. leUO!l!puoo peAoJdd~s!c] ,~/' ps^oJddv '9 NOIJ. VlNEIO-INI aNY V.LYa 'HOt:IV=IS 3'11=1 'SIS:II 'SNOIJ. O:ldSNI ONlalAOl:td I/il:lid ONIId:I=INION=I 'g ~cY~O_?,~N~IClPALITY OF ANCHORAGE (MO~.,, -,( O~ j~ . ~(~.~H AUTHORITY APPROVAL (HAA) ..~\C\?~-\~ ~, S~.%",/\C~'~ CHECKLIST-FEBRUARY 1984 t~u~' ~,~-~'~ ~"' 264-4720 ~.~q\~.O ~L ~ ~ Legal Description: ,E.~'7"-~(,, WELL DATA Well Classification *~~/1/''~'')~-~'' If A, B, C, D.E.C. Approved (Y/N) Well Log Present CN) Date Completed ~ ~/'~',~ Yield Total Depth /g~:) / Cased to /~r~) / Depth of Grouting ,~/~ Static Water Level {~D ~'3 / Pump Set At ~J//~ Casing Height Above Ground / '~ "/' Sanitary Seal on Casing (~IN) Electrical Wiring in Conduit CN) Depression Around Wellhead (Y(~ Separation Distances from Well: · To Septic/Holding Tank on Lot ~/~"~ ~ · On Adjoining Lots To Nearest Edge of Absorption Field on Lot /P'F.) -'f' · On Adjoining Lots To Nearest Public Sewer Line //,'~ To Nearest Public Sewer Cleanout/Manhole /J/,~' To Nearest Sewer Service Line on Lot Water Sample Collected by ,~""~-~ /~, /'*J/~:'/~' ;Date Water Sample Test Results ~/~-~ ''~ '~ ~-)/~/~'~"~Y ~' Comments ~ f-~J~-'~' ~ 7"~?'"' ~"~'~'- B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes(~N) Air-tight Caps ~)'N) Depression over Tank (Y~___.~ Pumping/Maintenance Contract on File (Y/N) ,I Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: / Size /~';9 No. of Compartments Foundation Cleanout{~)N) Date Last Pumped ~-,~.~--E~' /$,~¢ ;for Temporary Holding Tank Permit (Y/N) To Water-Supply Well To Property Line To Water Main/Service Line Course To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /, Width of Field Square Feet of Absorption Area ° Depression over Field (Y~::}) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field ~--~ / Depth of Field ~f~ ~' /' Gravel Bed Thickness (::2/...~"" Standpipes Present~N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on · On Adjoining Lots //~ To Cutbank (if present) ,'~"//,~¢ ,/~-~ ~..~ Comments LIFT STATION ~ /(..//"4i¢ Dimensions Size in Gallons ~ Manhole/Access (Y/N) Tested for ____ Pump~ Adequacy Test. Meets MOA Electrical Codes (Y/N) ~ Comments ~ ..... ** Check Permitted Bedroom Rating Against HAA Request ** , certify t hat, .~/~h~7~ed~..vlri~ed, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed /_/6¢¢.~.~, ,, ,~,'t..,//..-..--~ Date Company ~ MOA No. Receipt No. Date of Payment ~/7 0 Amount: $ Page 2 of 2 72-026 (11/84) APPLIC'NT FILLS OUT UPPER HAl ONLY Property Owner r" Phone ~ ...... Zip Code /"/ '" Buyer - - /f ' / ' /[ Zip Code Lending institution " , z- .. / ' ,, ,. /, / Phone Address Zip Code Realty Co. & Agent Phone / Address '~ Zip Code Legal Description Type of Residence ~(~ngle Family/ IJ Multiple Family No. of Bedrooms :~ _ ~ Other Water Supply ~ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ' ~' Community For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal / ., Individual Year Individual Installed: .' , Public Utility When Connected ~o Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED. Time Date Inspector Time Date Inspector Time Date Inspector Time )ate Inspector Field Notes: ~ &~ '~x'~"/'/~" ~]~ *CONDITIONS Soils Rating Date Sewer Installed · ?-/- ¢ 3 Well To Absorption Area /' ~O .~ Well Log Received Well to Tank____ / (5__.~:~__ Septic Tank Size 72-023 {3/82) a i. ~: ~:; / <_,....} / ix )