HomeMy WebLinkAboutBIRCH TREE ESTATES BLK 2 LT 1
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
NAME IPHONE ~NEW
~O~,~ ~[-~--~ J~ ~-~ J ~ UPGRADE
MAILING ADDRESS
J _ J Absorption area Dwelling PERMIT NO.
~Z Manufacturer ~~.~ Material ~ No. of compartme~t~
~ ~ Liq. capacity~ ~ ~in gallons IF HOMEMADE: Inside length ~ ~ Width Liquid depth
~ DISTANCE TO: Well ~ ~ Dwelling PERMITNO.
~ Manufacturer Material Liquid capacity in gallons ~
Q Well ~ Foundation Nearest lot line PERMIT NO.
~= DISTANCE TO: ~0 ~
~ ~Z ~ ~ NO. of lines ~ Length of each line Total length of ,ines~ ~ Trench width(~o inches Distance between lines
~ ~ Top of tile to finish grade ~t Material beneath tile Total effective abs~t~n area
Length 'Width Depth PERMIT NO,
~ ~ Type of crib Crib diameter Crib depth T~tal/~ ~)effec~ve'abs°rpti°n~ a~ ~ area~)~t ~
m ' DISTANCE TO: Well Building foundation ~a~est I~ line ~
~ Class Depth Driller Distance to lot line PERMIT NO.~ -
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption are~(s)
OTHER ~, ~ ~
PIPE MAT~IALS ~5 ~t{
SOIL TEST RATING ~
INSTALLER
REMARKS , ;~ / ~
DATE LEGAL
72-013 (Re
L., E (3 i:::l I...
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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. # 017-141-35
HAA# HA890009
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lOt, block, subdivision, section, township, range)
Lot 1 Block 2 Birch Tree Estates Subdivision
Location (address or directions)
5138 Metz Court
(b) Property owner A.H.F.C.
Mailing Address 520 East
(c) Lending Institution
Mailing Address
34th Avenue,
Telephone: (home)
Anchoraqe, Alaska
Telephone
Business
99504
(d)
Real EstateCompanyandAgent Nancy Bergh-Pollock % 2001 Realty
Address 1345 West 9th Avenue #201, Anchoraqe, Alaska
Telephone
276-2001 :"~.
(e)
Mail the HAA to the following address: (or check here [], if hold for pick up.)
List contact person and day phone number below:
S & S Enqineerinq
17034 Eaqle River Loop Road
Eaqle River, Alaska 99577
9204
2. TYPE OF RESIDENCE
Number of bedrooms three(3)
Single-Family:~
3. WATER SUPPLY
Individual Well ~x
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~2<x Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify.that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional and adequate 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 Engineering Telephone 694-2979
Address 17034 Eagle River Loop Road, ~204, Eagle River, Alaska 99577
Date
Engineer's Seal
Approved ,for - Deorooms by , Date ,
-~ , XXXXX
Approved ' Disapproved Conditional
Terms °f Conditional Approval
July 10, 1989
This office has received written notification from the engineer,
S & S Engineering, that the conditions placed on this property
on January 16, 1989 have been corrected. This property n~W meets
with MOA codes and standards. This property is now approved. If
there are any questions, please call our office at 343-4744.
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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. 7/88) Back Page 2 of 2
ROBERT A. SHAFER
June 16, 1989
CIVIL ENGINEER
694-2979
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Lot I, Block 2, BIRCH TREE ESTATES
Please be advised, the septic tank clean-out has been located and
extended on the referenced property as per the conditional approval
issed on January 16, 1989.
The septic tank ms pumped on June 16, 1989 by A+ HOME SERVICES.
Request you issue final Health Authority Approval.
WELL INSPECTION
& FLOW TEST
SITE PLANS ~~.
~ l~JS/gm
ROAD DESIGN ~
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
JUf,! 1 6 1989
RECEIVED
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
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. # 017-141-35
HAA# HA890009
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 1 Block 2 Birch Tree Estates Subdivision
Location (address or directions)
5138 Metz Court
(b) Property owner
Mailing Address
A.H.F.C.
520 East 34th Avenue,
Telephone: (home)
Anchorage, Alaska
Business
99504
(c) Lending Institution
Telephone
Mailing Address
(d) Real Estate Company and Agent Nancy
Address 1345 West 9th Avenue
Telephone 276-2001
Bergh-Pollock %
~201, Anchoraqe,
2001 Realty
Alaska
(e) Mail the HAA to the following address: (or check here [], if hold for pick up.)
List contact person and day phone number below:
S & S Engineering
17034 Eagle River Loop Road ~204
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Number of bedrooms three (3)
Single-Family:,C~
3. WATER SUPPLY
Individual Well 5]~x
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:[~x Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th is
Health Authority Approval 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.
NameofFirm S & S Engineering Telephone 694-2979
Address 17034 Eagle River Loop Road ~204, Eagle River, Alaska 99577
Date
Engineer's Seal
6. DHHS APPROVAL
~e~K~×xxx~ xxxxxxxxxxxxxxxxxxx
Conditional
R~rd~erd~xxxxxxx× Disapproved xxxxxxx
Terms of Conditional Approval
Date June 5, 1989
Placed on Conditional Approval on January 16, 1989 to be
completed by June 1, 1989. This Conditional has not been
met and this property is now Disapproved. ~
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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. 7/88) Back Page 2 of 2
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. # ~/"~-//'//""'-~" HAA# ~\ OAo~ . 1~7_363c~
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 Address
(c) Lending Institution
Telephone'(home)
Telephone
Business
Mailing Address
(d) Real Estate Company and Agent '~6:::~4::~\ '~::J;~'~L~¢~V
Address \'~ ~"~ ~::~31~2~ ~'
Telephone '~-""'~ ~:' ~ ~O ~
(e) Mail the HAA to the following address: (or check herel:J;~-if hold for pick up.)
List contact person and day phone number below:
17034 Eagle River Loop Road No. 204
Eag;e River, A;aska
2. TYPE OF RESIDENCE
Single-Family,S' Number of bedrooms
3. WATER SUPPLY
Individual Well ~ - Community [] Public []
Note::lf community weii 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 []
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
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as ol the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional..and adequate 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.
Telephone
.5 & $ ENGINEERING
Address 17034 '-=_~g!e _glvm- Loop. Road N_~_ ')_nd. < ~&:~--/,~
Eagle River, Alaska 99577
Date
Name of Firm
Approved for ~.~ bedrooms by ,/ Date
~ _~d, Conditional ~
Terms of Conditional Approval. ~~~.~z~ ~ -~
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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 condu(~t 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. 7~88) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (NAA)
).,,,~.,,,/..c:.,,',o.'.Ao~ CHECKLIST - FEBRUARY 1984
A. WELL DATA ~. ,~*,~ ~ ''~ l. ~ ~,~ ~: ~)
Well Classification ~ ~d ~~
Well Log Present (Y/~ ~ Date Completed
Total Depth 0~ Cased to ~'~
Static Water Level ~ /
Casing Height Above Ground ~ ~
Electrical Wiring in Conduit ~N) ~
Legal Description: L~. \
Depth of Grouting
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Fiel~j?n Lot
To Nearest Public Sewer Line ~'/J~
If A, B, C, D.E.C. Approved (Y/N) i"~/~r-
Yield ~,'Z--(~/r'~ -~ -~
Pump Set At L.~
Sanitary Seal on Casing ~;N) ~
Depression Around Wellhead (Yfl~
; On Adjoining Lots
\ ~c;::~ ; On Adjoining,Lots
To Nearest Public Sewer Cleanout/Manhole
I
To Nearest Sewer Service Line on Lot
Water Sample Collected by '~.~) ~t/~(~~'~. ;Date
Water Sample Test Results ~
Comments \.~'"~L,- ~~
B. SEPTIC/HOLDING TANK DATA
Date Installed ~'""~[-'~ Size
Sta nd pipes(-(Y~;]~ ~
Depression over Tank
Pumping/Maintenance Contact on File (Y/N)i~ ~
Holding Tank High-Water Alarm (Y/N)
SEPARA~I.ON DISTANCES FROM SEPTIC/HOLDING TANK:
I
To Watet~S,:u,Pply~¢ell~.... (~ W To Building Foundation
To Proper{'y"Line:.? ', \ ~ To Disposal Field
To Water Main/Serv'ice Linc~ , I ~ ~
To Stream, Pond, Lake Or Maj0'rDrainage Course ~, ~ I .~
Comments-'~)~ ~'~~ '~"~-~ ~.~)c::,~ ~ ~E~;Or-~t~,
\'~/_~c> No.. of Compartments '2_-.-- "~
Air-tight Caps (Y/N) ~ Foundation Cleanout~N)
I'~ Date Last Pumped '~
~/J~ ; for
Temporary Holding Tank Permit (Y/N)
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~"-""~ \ - "'7
Width of Field
Type of System Design
Length of Field
Depth of Field
ed Thickness '7-...
Square Feet of Absortion Area ~~/'~ Statndpipes Present4¢i~::/~)
Depression over Field (Y/~;~ r-~ Date of Last Adequacy Test
Results of Last Adequacy Test .~/~'?t ~ ~ '~ ~ ,,,-"~:::~--.-3t..-,~.~,
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well ~ ~"~
~ To Property Line ~ ~:~
To Building Foundation~ '~
-~ To Existing or Abandoned System on
Lot ~/~' ; On Adjoining Lots '~~
¢/.
To Water Main/Service Line ~ ,c~ J¢ To Cutback (if~present)
To Stream, Pond, Lake, or Major Drainage Course ~ ~ ~
To Driveway, Parking Are~r Vehicle ~?>C:>' W_
Comments /~ ~'~X~.~.~5... ~ ("/'~Z', ~,-,.~z./~j'-~-_
D. L~NDate Installe~/~
Size in Gallons ~
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
~Vent (Y/N) ~...~
Pumping C~est.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in ef~_'~i'l' .'t~a~te of this
inspection. .,,.~-
Signed
Date
MOA No.
ReceiptNo. 03-- ~OgqO ~79 9 ReceiptNo.
I
II
Date of Payment -- ~ ~-[ Waiver Fee: $
Amount: $ [~¢~ -~ Date of Payment
72-026 (Rev. 7/8e) Back Page 2 of 2
TELEPHONE (907) 562-2343 5633 B Street'
Anchorage. Alaska~,9518
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
pR BLIC WATER SYSTEM I.D.,
IVATE WATER SYSTEM
Name
S & $ ENGINEERING
17034 Eagle RiYer Loo_~ Road No. 204
Mailing Ei~l~River, Alaska 99577
Phone No.
City State
Mo. Day Year
PLE TYPE:
outine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
Zip Code
[] Treated Water
[] Untreated Water
TO BE[COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
[~ SatiSfactory
[] Unsi~tisfactory
[] Sardpletoo long in transit; sample should
n0t~be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received
Time Received
Analytical Method:
Membrane Filter
* No. of colonies/100 mi.
SAMPLE
NO. LOCATION
5
Time Collected
Collected By
Lab Ref? No. Result*
I
I
Analyst
7~(~ ./
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS RECORD
Membrane Filter:. Direct Count
; lei iall c~ tei~nir aLnTeB F i~1 t ~ ~s u lY
TNTC = Too Numberous To Count
OB = Other Bacteria
'BGB
Coilform/100ml
Date
Time:
!.
Coilformll00ml
PART ! OF 2 REMAINDER T° FOLLOW
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ~
FEDERAL TAX ID # 92-0040440 '"'
· '" 0.~ NO}lb', t',~',C' [.
:. ~el ,.fi ~ ~.
omp. It~' i ~-{ai.r.ix:
·" DATE RECEIVED
TIME ~ INSPECTION APPOINTMENTSTiM~ ~~~"~_~L-c~)TIME
DATE DATE ' ~/ DATE
MUNICIPALITY OF ANCHORAGE MU
~IclPALI~ OF ANCHO~GE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOND~pi' OF H~ALIH
825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PEOTE~ION
ENVIRONMENTAL SANITATION DIVISION ~0V
Telephone 264-4720
DI R ECTIONS: Complete all parts on page 1. Incomplete requests will not be proceed. Please allow ten (10) days for processing.
PROPERTY RESIDENT (If different from above) PHONE
. PHONE
MAI LING ADDRESS !
3, LENDING INSTITUTION I PHONE
MAILING AbDRESS I ~
4. REALTOR/AGENT PHONE
MAI LING'ADDrESS .... / --
5. LEGAL DESCRIPTION
LoT \
STREET LOCATION
6o
TYPE OF RESIDENCE ~ SINGLE FAMILY
[] MULTIPLE FAMILY
7. WATER SUPPLY
INDIVIDUAL*
COMMUNITY
[] PUBLIC UTILITY
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
NUMBER OF~BEDROOMS
[] One [] Four [] Other
[] Two [] Five
Three [] Six
ATTACH WELL LOG, A well log is required for all wells drilled
since June 1975, For wells drilled prior to that date, give w~ll
depth (attach log if available.) I ~_~ ~ I~ ~~J~e~ \C[~
~" '~it YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE
[]PUBLIC UTI LITY
Connection Verified
[]Septic Tank or [] Holding Tank
Size: !o~,~%--L~ If Tank is homemade
give dimensions:
TYPE OF TANK
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
NUMBER OF BEDROOMS
[] ONE
[] TWO
[] THREE [] FIVE
[] FOUR [] SlX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOl LS RATING
MANUFACTURER
MATERIAL
Septic/Holding Tank IAbsorption Area
Sewer Line
[] OTHER
JNearest Lot Line
5. COMMENTS
PPROVEDFOR t~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE
72-010 (Rev. 6/79)
