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HomeMy WebLinkAboutBIRCH TREE ESTATES BLK 2 LT 9Onsite File Birch Tree Estates Block 2 Lot 9 #017-141-40 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201070 PID Number: 017-141-40 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New © Upgrade Name Harry Ross EST. ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ound Site Address 5274 E 147th ❑ Other Phone Number of Bedrooms Soil Rating Totaldepth original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original gradee Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Birch Tree Est 2 9 Fill added above original Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft, SEPARATION DISTANCES To Septic Absorption Holding Sewer Total orption area Number of trenches Dist, between trenches From Tank Field Lift Station Tank Line Ft2 Ft. Well 100'+ , 1001+ TANK ElSeptic Q S.T.E.P. [I Holding El Other Manufacturer Capacity Surface Water 1001+ 1001+ I I GREER 1500 Gal. Material Number of compartments Lot Line 51+ 5'+ NA Plastic 2 Foundation 10'+ � 101+ r LIFT STATION Manufacturer Capacity Remarks Orenlco 1000 Gal. Alarm location garage Electrical installed by Capstone Electric Installer PIPE MATERIAL House to tank Tank to D3034 drainfield D1785 A+ Home Services Drainfield CO/MT D3034 BENCH MARK (Assumed elevation) 100 ft Inspector Areterra Consulting Inspection dates: 1s 5/15/20 2°tl 5/15/20 Location and description 3w 5/18/20 4"' 5/18/20 NW corner building foundation ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date ar Hl MiMY6 ' Y6YlYHl ,lH Y 0 MIYHfHit J 1H Y . KE,tN>*��: rFsx Septic System Approved Date .) ® 4 � 4i FO Note: this approval does not include well permit requirements. 11% ESSS krNcv VJlVG! IOf _7 CD T_ o O O ►� O r A -C=37.2' B -C=35.7' A -D=41.9' B -D=36.4' A -E=44.7' B -E=37.4' A -F=48.9' B -F=39.2' AS -BUILT SYSTEM DETAILS/SITE PLAN BIRCH TREE EST. BLOCK 2 LOT 9 DECK DECK 4 BEDROOM BUILDING DECK \1M 500 GAL SEPTIC iOFAZ,4 IIIIIII,� PREPARED FOR: HARRY ROSS EST. / "1l 5274 E 147TH / * 49 Tx * ANCHORAGE, AK / KENNETH DUF I FIELD BOOKS CwpUTED: BOUNDARY: DRAWN: CE -711 004 N/A KSD STMING: N/A CRECKED: KMD G~� ASBUILT: — DA E: 5/22 '1`2OFESSIollp'' Awr DWG. MM- GRID: SW30 '%k ACAD nom: FILE " No' 20111 olumes/ArcTerro Shared/Storage/WELL &-SEPrIC — Filed By Legal/Birch Tree Est/Bl o STEP Permit: OS P201070 PID# 017-141-40 •�J�I SCALE: 1"= 30' SCALE: NTS 0 5 Q n � 0 0 � (D z — cn �' x 0 N c — O N (D Q. — v_ a 6 c 3 m< °a—oc> �•zCD (D po:Dom'g D � a o � � o• M a O ("- CD < O m o' �. Gja 151 Utility Easement C]7 � o D nm e-+ T p -cow 3— z 0 (D cn a -P CD O IDO C) o QNB < p an (D Q o M (D 11J e -t CD = < ID (D `< n 6 '-.- fes' ✓ r C o O o-Ct •< r.- N fT N. 0 CD N o 0- o - -0 cn o a m — O O 0 o O (D 3 a -- O `O K -I = (D 35 (D- DDCD D CDco O03 Q014.1' n N O CJS f Tl z 0 _- -Ti ::E O -u C/) :�E (D O < O (D (D D 0 D < O = O Q3 N o G> D o 0 3 n o (D � w C) J O 0 cn w QVpri`v N0'16'16"W 190.00' Gja 151 Utility Easement -- --- - -- ----- c� (D Q I C o 30' ID N N N O0Z O03 Q014.1' n f Tl z 0 =i 56.5 ' co 1 98 w P w m w �i �I _ � P x w_ m Lo 6.0 0 �- a rv_ O O r D (D O 6.0' ®® n O c c T CD O O N CD O �t 56.5' - 30' o I 3 d O 9� NO'16'16"W 190.00' 0 0 0 cn MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program - PO Box 196650 4700 Elmore Road 3 Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 L\l httpJ/w .mani.crglonsite `4� 2hpntn�ent r On -Site Wastewater Disposal System Permit Permit Number: OSP201070 Effective Date: 4/22/2020 Work Type: SepticTank Upgrade Expiration Date: 4/22/2021 Tax Code Number: 01714140000 Site Legal Address: BIRCH TREE ESTATES BLK 2 LT 9 G:3037 Site Mailing Address: 5274 E 147TH AVE, Anchorage Owner: ROSS HARRY Lot Size in Sq Ft: 28500 Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy 11 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 requiresinspections 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: _ Issued By: Date: / v Date: MUNIcIPALITY oF ATcHoRAGE Development Services Department On-Site Water & Wastewater Section Phone: 907-343-7904 Fax: 907-343 -7997 ON-SITE SEPTICAA/ELL PERMIT APPLICATION Parcet t.o. 017-141-40 .eProperty owner(s)rroperry owner(sl Day phone Maiting address Po Box 2024-EZ Site address -' Legal O".rr,O Legal description (Township, Range & Section) Lot Size 28'5oo Sq. Ft.Number of Bedroor. 4 APPLICATION IS FOR:APPLICATION IS AN: 1fi1all thatappty) Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage n tr nI u f lnitial Upgrade Renewal tr tr tr n tr n TYPE OF DWELLINGI Single Family (SF) (wtuo ADU) Duplex (D) Multiple Dwellings (SF and/or D) THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is conect. I further certify that this is in accordance with applicable Municipal Codes. PermiuRush Feer,fi-ffF I b tr -1 Waiver Fees: Date of Payment: Receipt Nurnber: Permit No. G:\Development Services\Building Safety\On Site.Water and Wastsvater\Forms\Clierrt Application.doc \D - rq, 2_5'lu 00v of Payment: ipt Number: Wtan Discoun-lt Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201070, Rebecca Carroll, 04/22/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201070, Rebecca Carroll, 04/22/20  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 MAILING ADDRESS LEGAL DESCRIPTION ~ ; * - LOCATIQN ~=__. j:~?._._._.~...[. ~.~._.~ ~ ~~~ NO. OF~BEDROOMS ]Well ~ Absorption area Dwelling / PERM~~ ~ DISTANCE TO: ~i ~ / ~~ Manufacturer~~ ~~ ~. ~ ~~ ~ Material~~ No. of co~partments~ ~ Liq.~capacity i ~allons IF HOMEMADE: Inside length Width Liquid ~epth ~' D ISTANCETO: Well ~/~ Dwelling PERMIT NO. ~ ~ ~ Manufacturer Material Liquid capacity in gallons Q~ DISTANCE TO: Well ~1 Foundation~,~ / Nearestl~i~ ~ PERMITNO. ~ ~ No. of lines Length of e~ch line Total I~ngth ~ lines Trench width Distance between lines / ~ ~ ~ -- ~ -- ~/~ ~ ~ ' ~ Total effective absorption area ~ ~ ~ Top of tile to finish grade I ~ Mat~,,~J )~eath tile ~ -- ~* ~ Length Width Depth PERMIT NO~ ~<~ Typeofcrib Cribdi~y~ Cribdepth Total effective absorption area ~ - m DISTANCE TO: Well Building foundation Nearest lot line ~ Class Depth __. ~ Driller Distance to lot line ~ kl /~ .~M,~No. ~ Buildin~ f~a~o~ Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER _ __~ ~ .... PIPE MATERIALS ~ ~ / ~I~ ~ ~' r--~ ~ ___ ~ ..... -~ SOIL TEST RATING ~ ~ ~ ~ ,~' I~ ~(~ ~~/~ (,~-~') ~ ~ ..... , -~: ...'~"., INSTALLER ; ' ---- :~ "' ~ :',', REMARKS ' ~ :~ , ~ ~ I / ..... ., APPROVED DATE L~GAL ~ ~ .~' '. /78) SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVlRONIVlENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 :264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: · J SLOPE SITE PLAN DEPTH ,Pa/IT (rT) ' (i:lEri S l LT UA__C) 1 F¢~ b!51' LT. I CT, 19- 20 72-008 (6/79) WAS GROUND WATER ~//~) ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time 'rime Water Drop IP 13.3 -"-...~ PERCOLATION RATE (minutes/inch) .I -- T'-~ DE]:::'F'IRTMENT OF' I-tEFIL'TH AN[:, ENYIRONMENTFIL. PF.:OTECTICII'.~ :.:.!:;2:5 t... STREET., FtNCt..~OF.'.FIGE, FIK 264-472e~ PERM I T NO: DFITE ISSLIED: 84 El;;.:.':25 ENGINEERED [:,ES I Gl'.4 E'I 4,-." ;=]: El,.." 84 FIPPL. I CFINT: FIDDRESS: CONTFICT F'HONE: NFINcy DONER :i.."..:C151.3 OL.L':, SEI.,4RI';.:D HP.IY FINCHORFICqlE., FIK 2.": 44- 25 E~:I.. [..:EGFIL DESCR I F': LOT SIZE: SUBDI',,,'I S I ON BIRCHTREE ESTFITES SECTION: ;24 .TO[qNSHIP: :LAN 28E~E~.-'] ,.'; SL-]. FT. OF.". FtCRES ::, LOT: 9 BLOCK:, 2 F.:RNGE: Z.': 1.4 C:ERTIFY THRT: J... 'I FIM FFII'"I.T.[...IFIR WITH THE REI.T.!I_IIF.:EMENTS FOR ON-S;ITE SEWERS FIND 1.4EL. LS FIS SET FOF.:TH BY THE I'dUNICIPRLITY OF FINCHORFIGE (MOA> FIND THE STFtTE OF RLRSKFf. ;2'. I WILL. INSTFILI .... TFIE S"r'S;TEM IN RC:C:ORDFINCE WITH FILL, MOA CODES FIND REGULATIONS., FIN.F:, IN COMPL. IFINCE I.'.IITH THE DESIGN C:RITERIR OF' THIS PEF.'.MIT. .]:. I WILL R[.':'HEF.:E: TO FILL MOFt FIN[:' STFITE OF FILFISKR RE6!UIREMENTS FOR THE SET BFICK DiSTFINCES FROM RIqY EXISTING WELL., [4FISTEI.qFITER D, ISPI]SFIL SYSTEM OR PUBLIC SEI.,.IERFIGE SYSTEM ON THIS OR FiIq"r' RD,IFICENT EIR NEFIRBY LOT. IF' FI L. IFT STFITION IS INSTFILLED IN FIN FIREFI C:Cr,,,'EF. iE[:' BY MOFI BUILE:'ING CODES., THEN (::L> FIN ELECTRICFIL F'ERMIT FIN[:' INSPECTION MUST BE OBTFIINE[:,.~ I,.t ILI .... NOT BE.,.,,.¢:'~"F" F,. p.. ,,, ,..,.F-'r', P.I I THOUT FIN EL.ECTR I CAL. I NSF'ECT i ON F.:EF'OF.:T.~ I:".i:LE:CTR I. CFI[.. I.,.IORK MUS']T E:E DONE BY R L. I C:ENSED ELEC"I"R I IS: I AN. S I GNED FIPF'L. I CFINT: I SSI...IED BY ( 2 ::, FtS-BU I LTS FIND ,:: S ) THE: N ;~ [:, O ~.4 E R ........ ~.e... 2 ..... ....~_ _~__ .................. [:,A T E · HUN!CIPAL!TY OF ANCHORAGE Department = Health and Environmenta3 ~rotection 825 ~ Street, Anchorage, AK. .9501 264-4720 ~'°'fO/----~"~x''~ * * * HANDWRITTEN PERMIT * * * Permit ~ ON-SITE SEWER PERMIT Applicant:/~/4~-,4/ ~9~/L~<. Mailing Address: ~d?~<~ Location: ~ ~ ~/~~ C~7- Phone Number: ? Legal Description: ~ ~ ~.~ ~ ~/J --/~ ~ Lot Size: T.Ype of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: / Holding Tank Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) The Required Size of the Soil Absorption Syst~em Is~: ' DEPTH /~ LENGTH ,.4.~'- GRAVEL DEPTH ~ WIDTH "~ The length dimension is the length(in feet) of the trench or drainfield. 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 = 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 departmen~ will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee~ 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 a.~allable' to insure proper installation. ~'~,'"~ ',~ t~ ~"~"'1' L-- I:)J~'1~'V..,~.~ I certify that: ' (1) I ~ f~iliar with the requirements for on-site sewers and wells' a~ set forth by the Municipality of ~chorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if  led to include more ~t 3 bed~s. Signe~: . Issued Applicant Date:. SWP/024 (1/81)~ ~C ~,7 ~,z/ ~ ~,~v~rwvz~j NORTHERN LIGHTS OF ALASKA, INC. ECtI~C.~ CON~F'<AC~ ~NC~ Commerc~c.~ · Re~dc-~ha/ ~-" May 24, 1984 GHB Construction 18140 Norway Anchorage, Alaska 99507 345-5213 345-5878 Attn: Mr. Gary Bliss Gentlemen, In reference to our phone conversation on the electrical hook-up for the Sewer Lift Station, Lot 9, Block2, Birchtree Estates. All Electrical work on this job was done in compliance with the National Electrical Code and Municipality of Anchorage Electrical Code. Sincerely, NORTHERN LIGHTS OF ALASKA, INC. BLH:dek CC: A.Donner File ALASKA E IiLJlROIqmE IqT^L COF1TROL SeRulC $, IF1C. (~nqincerinq $ Enuironmcn1~l Stu~Jics June 7, 1984 Department of Health & Environmental Protection 825 L. Street Anchorage, Alaska 99501 Attn: Keith Brandt Dear Keith: On June 5, 1984 this office re-inspected the well conduit on Lot 9 Block 2 Birchtree Estates. The conduit has been properly installed and sufficiently burried to meet requirements. This office requests that the "conditional" be removed and approval granted. Sincerely, ~rry ~ontgormr7 Engineer 1200 LUes~ 33rd Aoenue, Sui,e B · Anchoro§e. Alosh 99503.{907) 561-50/40 ALASKA erldlRO[lmenTAL CO[1TROL SeRulCe$, I[1C. I~n§in¢¢rJnq 8 ~nuJronmcnlal SludJcs May 07, 1984 Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99501 Attn: Keith Bandt Legal: Birchtree Estates Lot 9 Block 4 Dear Keith: A flow test was performed on the well at the above property on May 4, 1984. The static water level was at -79.55'. Over 600 gallons of water was pumped at a rate of 2.7 gpm with a drawdown of 6.37'. The recovery time was 70 minutes. I consider this well adequate for domestic useage. Please contact me if you have any questions. Sincerely, en Turner Et ~ironmental Scientist 1200 LUcsl 33rd Aucnu¢, $ui1¢ ~ · Anchora% Alaska 99503 · {907) 276-1361 ALASKA e dlROrlm6llTAL CONTROL SElf, dICeS, I[1C. ~nqineerincI ~ i~nuironmental Studies SPECIFICATIONS FOR SEEPAGE BED ALTERNATIVE WASTEWATER TREATMENT SYSTEM- LOT 9, ELK 2, BIRCH TREE ESTATES S/D 1.0 GENERAL 1.i THE DRAWINGS SHALL BE A PART OF THIS SPECIFICATION. 1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE, THE CONDTIONS OF THE PERMIT, AND ALL APPLICABLE RULES AND REGULATIONS CURRENTLY IN EFFECT. 1.3 ALL EXCAVATIONS AND DEPTHS ARE ADVISORY AND ARE TO BE VERIFIED OR MODIFIED IN THE FIELD BY THE ENGINEER. 1.4 IT IS THE RESPONSIBILITY OF THE OWNER OR INSTALLER TO OBTAIN ALL NECESSARY PERMITS, EASEMENTS, OR WAIVERS REQUIRED FOR INSTALLATION OF THE SYSTEM. 2.0 SEEPAGE BED 2.1 THE GRAVEL FOR THE BED SHALL BE SIZED BETWEEN 0.5 TO 2.5 INCH AND FREE FROM SILT OR SAND. 2.2 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" WITHIN LEVEL. 2.3 THE DISTRIBUTION PIPE SHALL BE 4 INCH RIGID PVC OR POLYETHYLENE. THE PIPES SHALL BE LAID LEVEL. 2.4 AN OBSERVATION PIPE SHALL BE PLACED AS SHOWN IN THE DRAWINGS. IT SHALL BE RIGID PVC, ASTM 3033 D-3034.. THE SECTION BELOW GROUND LEVEL MAY BE EITHER DRILLED 0.5" HOLES @ 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE OR A REGULAR SECTION OF PERFORATED DISTRIBUTION 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 THE PIPE. 2.5 THE GRAVEL SHALL BE COVERED WITH A LAYER OF UNTREATED BUILDING PAPER, A NONWOVEN FABRIC (SUCH AS MIRAFAR FIBRETEX 200 GRAOE, POLY-FILTER X, OR EQUAL.), OR A LAYER OF VISQUEEN. 2.6 IF INSULATION IS USED RATHER THAN MOUNDED BACKFILL, THE INSULATION SHALL BE DOW EXTRUDED BLUE STYROFOAM BOARD OR ARCO GEOFOAM EMBANKMENT INSULATION BOARD OF THE REQUIRED THICKNESS (1" PER FOOT OF SOIL LESS THAN 4 FEET OVERLYING THE BED). 2.7 THE TOP OF THE BED SHOULD BE PLANTED WITH A WHITE CLOVER AND RED FESCUE MIX. 2.8 IT IS CRUCIAL THAT CARE BE TAKEN IN CONSTRUCTION OF THE BED TO ENSURE PLACEMENT INTO THE PROPER SOIL STRATUM FOR PROPER OPERATION OF THE SYSTEM. 1200 LUesl 33rd Auenue, $uii¢ B. J~nchoraqe, Alaska 99503 .{907) 561-5040 SPECIFICATIONS FOR LIFT STATION: LOT 9 Block 2, BIRCH TREE ESTATES S/D 1.0 THE LIFT STATION 1.1 THE STOCK MATERIAL FOR THE LIFT STATION SHALL BE EITHER GALVANIZED STEEL (ASTM A-4444-76), OR ALUMINUM CULVERT, CAPABLE OF BURIAL TO 10 FT. 1.2 THE 36" DIAMETER PIPE FOR THE LIFT STATION SHALL HAVE A WELDED WATER TIGHT BOTTOM OF THE SAME THICKNESS AND COMPOSITION AS THE CULVERT. 1.3 ALL PENETRATIONS OF THE LIFT STATION SHALL BE WELDED AND WATER TIGHT. ALL WELDS SHALL BE CLEANED OF SLAG. WELDS ON GALVANIZED STEEL WILL BE SPRAYED WITH ZINC RICH PAINT OR COATED WITH BITUMASTIC. 1.4 THE TOP CAP SHALL BE RAIN TIGHT AND SECURELY FASTENED WITH SCREWS. A TWO INCH LAYER OF POLYURETHANE FOAM SHALL BE GLUED TO THE INSIDE OF THE TOP CAP. 1.5 ALL ELECTRICAL FITTINGS AND CONNECTIONS IN THE LIFT STATION SHALL MEET THE REQUIREMENTS FOR A WATER TIGHT SERVICE. 1.6 THERE SHALL BE A HIGH LEVEL ALARM,PEABODY BARNES 6147 OR EQUAL SET AT THE LEVEL OF THE SO£L PIPE FROM THE SEPTIC TANK. THE BUZZER SHALL BE LOCATED NEAR THE ELECTRICAL CONTROL PANEL OR IN A LOCATION DESIGNATED BY THE HOMEOWNER. 1.7 THE SUMP PUMP SHALL BE CAPABLE OF DELIVERING 10 GPM AT A HEAD OF 20 FEET. 1.8 PROVIDE A CALDER COUPLING AT THE CONNECTION OF THE 4" SOLID PVC INFLUENT PIPE AND 4" STEEL NIPPLE. 1.9 THE PUMP SHALL BE CONTROLLED BY A DIFFERENTIAL MERCURY FLOAT SWITCH, ADJUSTED TO ALLOW A TWO FOOT SPAN BETWEEN 'ON' AND 'OFF', AS SHOWN IN THE DRAWING. ALL RELAYS AND ELECTRICAL CONTACTS SHOULD BE LOCATED OUTSIDE THE CHAMBER TO PROTECT THEM FROM CORROSION, PREFERRABLY IN A DRY LOCATION WITHIN THE HOME. 1.10 COAT THE INTERIOR OF THE CHAMBER WITH BITUMASTIC PAINT OR TAR TO APPROXIMATELY 3.5 FEET ABOVE THE BOTTOM. 1.11 MOA BUILDING CODES: WHEN LIFT STATIONS ARE INSTALLED WITHIN THE MUNICIPALITY, AN ELECTRICAL PERMIT AND INSPECTION ARE REQUIRED. IN AREAS NOT COVERED BY MOA BUILDING CODES, THE SYSTEM SHALL BE INSPECTED BY A LICENSED ELECTRICIAN TO INSURE THAT THE ELECTRICAL INSTALLATION IS IN ACCORDANCE WITH APPLICABLE CODES AND REGULATIONS. ALASKA ENVIRONMENTAL CONTROL SERVICEe INC. 1200 West 33rd Avenue ,uite B ANCHORAGE, ALASKA 99503 Phone 276-1361 CALC"L,'"EDS¥ /.Z~'"'>' DA"E '"//~'~"/' CHECKED BY DATE SCALE ALASKA ENVIRONMENTAL CONTROL SERVICF' INC. 1200 West 33rd Avenut Suite B ANCHORAGE, ALASKA 99503 Phone 276-1361 SHEET NO. OF CALCULATED BY L~-O~'~ DATE CHECKED BY DATE / / / / ~///- 4 PROOUCT 2114-1 ~lnc, Or~o.~ ~,~. 01471 ALASKA ENVIRONMENTAL CONTROL SERVICE*'* INC. 1200 West 33rd Avenue ,uite B ANCHORAGE, ALASKA 99503 Phone 276-1361 SHEET NO CALCULATED BY CHECKED BY, DATE ALASKA ENVIRONMENTAL CONTROL SERVICE? INC. 1200 West 33rd Avenue ,uite B ANCHORAGE, ALASKA 99503 Phone 276-1361 .,o,/. q 8.~ 8,e¢.kTtzr.... ~kt (_ ,,-,,~,,,-,o. ,5' ,:,,. ¥ OA'O,''.T"D"¥ Zr~l DA,E CHECKED BY DATE SCALE ---- I  MUNICIPALITY OF ANCHORAGE DEPARTIVIENT OF HEALTH & ENVIRONMENTAL PROTECTION ( ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/~~fl. INSPECTION REPORT NAME -IPHONE -T [] NEW LEGAL DESCRIPTION LOCATION - '- ~. DISTANCE TO: I //~ ~ Absorption ~ < ~--C~ ~ Material ~__~ No. of compartments ~ ~ ~iq. ~apacity in~allons IF HOMEMADE Inside length j /~ : Width Liquid depth ~ ~ DISTANC~ Well ~ ~O. Liquid cap~~~ns D STANCETO. ~ _ .~ ~.. ~ Foundation Nearest IotlJne /.~ PERMITNO. ~ m ~ No. of lines ~ ~ Length of each lin~ ~, TotaJ length 0f lifies~ - ~ I Trench Widt~ Distance betwe lop of tile to,inCh grade ' ~ ~ ~ Material beneath ti~ ~ ~ ~'~ /~') ~'~ ~ inches ) Tota~ effective absoKption~ea Typeofc' Crib diameter ~ Cribdepth Totalef~, ~ ~ ~ e~ption area / DISTANCE TO: , Building foundation N~a~ otFine ~ C~ass Depth Driller Distance to Jot line ~ ~Y~v-/~O ~ PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) - OTHER PIPE MATERIALS ~OIL TEST RATING REMARKS -- APPROVED DATE LEGAL 72-013 (Rev. 3/78) ' PERMIT NO. RPPLICRNT LOCRT I ON LEGRL t'"1 LI1 I'-,,I I C: :It: F" F~ I1_ ][ '-Il'" "'r" r'~ ~.., , ,-, _ ,. [:,EF'FIRTMENT ~:' HERLTH RN[:, EN, I ,~,~.._ '"L" :STREET., RNC:HORAGE., AK. 264-4'7;:28 /DLO/S~. ON--.S I 'rE '_.-~E&.-IElr~: LIF"13E: f-4[)E F"E E'.~"l I T' -' r~ , ~/.. CRF.:L '" S E.,.-,L.R,,, HT I NG _,R~ BOX t ,..:.4 3:.'$4.-0L~4-4~ j -w L-~ t47TFI ST. I(_~ L2~. B2 BIRCH TREE ESTRTES LOT SIZE 20000 St:'4URRE FEET' TYPE OF' SOIL RBSORPTION SYSTEM IS: DRRINFIELD MRXIMLIM NUMBER OF BE[:,ROOMS = 4 SOIL RRTING (SQ FT?BR)= 85 THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: [::, E F' ]- I-t = 2-~: L E I'-.! C~ T H = ~-3 ,.]~ F-: R %." E L [:, E F' T t,-I == 5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET;). THE TF:E~4IZ:H I-,-lI [:,TH IS 3:. ~]4~Zl~Zl F'EET'.. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE E~CRVRTION (IN FEET). lr4:E,.7:.:!L! I REE:, '=;EF"T' I ,-: TRI%II<: '_:; I ZE= :t. 2-'2_;~-Z~ PERMIT RPPLICRNT HRS 'THE RESPONSIBILIT9 TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF RN~¢ NELLS RDJRCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. ............. T'B,4C, ('.2) ~ ~-~5]F'EC:T'I C,r-~S REdE ~E~;!LII ~:E[:, BRCKFILLING OF' RN*¢ SYSTEM WITHOUT F'INRL INSPECTION RND RPPROVRL BY THIS DEPRRTMENT WILL BE SLIBJECT TO PROSECUTION. MINIMUM DISTRNCE BETNEEN R NELL RND ANY ON-SITE SENRGE DISPOSRL S'¢STEM IS :100 F-'EET FOR R PRIVRTE NELL OR 150 TO 2RF~ FEET FROM IR PUBLIE: NELL DEPENDING UPON THE TYPE OF PUBLIC WELL. ¥1INIMUM DISTRNCE FROM R PRIVRTE WELL TO IR PRIVRTE SEWER LINE IS 25 FEET FIND '0 R C:OMMUNIT'T' SEWER LINE IS '?5 FEET. rFHER REQUIREMENTS ~'1R'¢ RPPL'T'. SPECIFICRTIONS FIND CONSTRUCTION DIRGRRMS FIRE ',,,'RILRBLE TO INSURE PROPER INSTRLLRTION. F"F2F-:I--1 ][ T E>,:F" I F.:E5 [:,EE:Et'IE:EF..: 2~:±., CERTIFY THRT I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET' ~RTH B'¢ THE MUNICIPRLIT'¢ OF RNCHORRGE. I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. I UN[)ERS~D 'FHRT THE ON-SITE SEWER S'¢STEM MR'¢ REQUIRE ENLRRGEMENT IF THE 5I[:,ENCE I~ REMOD~D TO INCLU[:,E MORE THRN 4 BEDROOMS. ~., ~¢ ./~ ' ~NED:__ ' ~ - d~ ~'~ ~ RF'F'L I C:RNT CRRL S E,..,L.H, HT I NU ~ ~ ~f~ ~ UED E,~ _._[:,~TE_ ~~ owUZ~ V4. 0 GRE/. 'R ANCHORAGE AREA Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~//,~'~,f~/'V' ,~/~--~,,~,/~'--f MAILING ADDRESS ,'~"~ LOCATION /'~'" ~ ,~ ' LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER C¢~' MATERIAL NUMBER OF COMPARTMENTS INSIDE WIDTH LIQUID DEPTH LI QU ID CAPACITY//~'-;'?-~'~' GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL_-//~/ ' FOUNDATION. /--/'~'' NUMBER OF LINES [2,/'//~-:-- DISTANCE BETWEEN LINES ABSORPTION AREA SQ. FT. DEPTH: TOP OF TILE TO FINISH GRADE,~';' z TOTAL LENGTH c;~ ~ "" NEAREST LOT LINE_ J'~"~'~'" OF LINES .,/4,~//~,~ TRENCH WIDTH~¢¢~' IN. TOTAL EFFECTIVE LENGTH OF EACH LINE / ~ ~";~;~ /~J'~-' DEPTH OF FILTER ~ ~ MATERIAL BENEATH TILE IN. ABOVE TILE IN. WELL: T Y P E CONSTRUCTION DEPTH ,/"~'~¢ .. DISTANCE FROM: BUILDING ~-~ ,~' / NEAREST / NEAREST SEPTIC SEEPAGE /Z~ ? ..Z? 5~ //~'-' FOUNDATION~ LOT LINE , SEWER LINE TANK , SYSTEM CESSPOOL,/O/~/~/z~' , OTHER SOURCES APPROVED __ DISAPPROVED DISTANCES: -,~, INSTALLED BY: SEWER LINE DEPTH: ,:-,'~-? / PIPE MATERIAL: LOT SLOPE: REMARKS: ~'~'~ ~'g~'"/'/~ /"~'""'~'~'~ Form LQ-032 DIAGRAM OF SYSTEM G.A.A.B. GRE;ATEr ANCHORAGE AREA Be. ~JGH ~ DEPARTMENT OF ENVIRONMENTAL QUALITY SE~GE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. INSTALLATION OF: SEPTIC TANK ~ SEEPAGE PIT TYPE AND SIZE OF FACILITY TO BE SERVED ~ ~ DRAIN FIELD, ~.~'~""~' , OTHER FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED TO BE INSTALLED BY NOTEz THIS PERMIT I$ NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. ,. · . _ : .... MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK ~ FOUNDATION TO~~"~J/SEEPAGE PIT p SEPTIC TANK TO ~ SEPTIC TANK ~"'* , SEEPAGE PiT TO NEAREST LOT LINE, DRA,N F,eLD I0~ ' WATER MA,N TO SEPT¥C TANK DRAIN F,eLD I~ SePT,C TANK, (O~ , SEEPAGE P,T ~r DRAIN FIELD ., DRAIN FIELD (0 SEEPAGE PIT ALSO CONSIDER AREA WELLS. SEEPAGE PiT , DRAIN FIELD DIAGRAM OF SYSTEM CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PiT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL TO BOROUGH REGULATIONS REGFDIN~ INSTALLATION. CONFORM / / G .A ,A ,S · OR I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER /~NCI/ORAGE AREA BOROUJ~l~ OR~NA~NCE NO. 28-68 AND THAT THE ABOVE FORM NO, EQ-01 6 ._ATER ANCFInRAGE AREA BORO[ DEPARTMENT OF EN\/IRONMEN'IAL Qb. _IT¥ 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 CASE # This ~orm Reoorts Soils Log X[ Percolation Test Oenth Feet Soil Characteristics Was Ground Water Encountered? ,~ If Yes, At what De~th? ~,~' Readin~ Date Gross Ti me Net Time Depth to H20 Net Dropl Percolation Rate Minute Proposed Installation' SeeDame Pit Drain Field De~,th of Inlet Depth To Bottom Of Pit Or Trench CnM~ENTS:___~[~A~ ~~__~(~_ ..... _~~ ~ ~e~___o-~- ~ ~ ~ ~ .... Test Performed BV ~~ Pata CertifiedDate:,_ pC $ j lY unic>ipaHty of Anchorage x y I On -Site Waterand�Wastewafer Program (907) 843-7904 ,.j CERTIFICATE OF ON-SITE SYSTEms APPROVAL i I Parcel l.D.017-141-40 ExpirationDaie, ,LJ '�Odo 1. GENERAL INFORMATION Complete legal description__ Birch Tree Estates Blk 2 Lot 9 Location (site address) 5274 E 14r Ave. Anchorage Current Property owner(s) Hany Ross Estate Day phone Mailing address . PO Box 202415 Anchorae AK 99520 t Real Estate Agent Day phone 2. TYPE OF DWELLING, ® Single Family (wlwo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family andlor Duplex) 3. NUMBER OF BEDROOMS: % TYPE OF WASTEWATER DISPOSAL: (. 4. TYPE OF WATER SUPPLY: Individual j Individual Well Holding Tank [ Individual Water Storage ❑ Community ❑ Community Class —Well ❑ Public Sewer ❑ Public Water System ❑ r WaiverlVariance request for: pistance: Received by: COSA to be released regmstea: Dy we enginser. COSA Fee_ %i111 <J b Waiver Fee Date of Payment � $ i --- Date of Payment Receipt Number 61153 9 G_ Receipt Number COSA# oLo1,;J?- Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING INC. _ Phone _ 696-6111 Address 20441. PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M._DUFFUS Date 5/26/20 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen ,� OF' A L� a encroachments, deficiencies or discrepancies exist, 6. DSD SIGNATURE J System #1 Approved for bedrooms. KENNETH ;' F 's�� System #2 Approved for bedrooms. Disapproved. ��►.�.�'� Conditional approval for bedrooms, with the following stipulations: �= ON-SITE G, r V WATEK t: '.r R z= VVrz PROGRAM By: Vt�, Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA blue sheet 10.10-12.doc Nitrate Advisory Arsenic Advisory Other 4.4 Municipality of Anchorage Development Services Department Building ~Safety Division On-Site Water and Wastewater Program '4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 ' CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-141-40 1. GENERAL INFORMATION Expiration Date: Complete legal description Birch Tree Estates, Block 2, Lot 9 Location (site address or directions) 5274 E. 147th Ave., Anchorage Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Edward Lee & Ann Gorsuch Day phone 345-6065 5274 E. 147th Ave., Anchorage, AK 99516 Day phone Beth Simpson I Dynamic Propedies Day phone 727-2384 3111 C Street, Suite 100, Anchorage, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: 4 e -TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class ~ Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations.given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served bY Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further vedfy 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 Watkins Engineering, Inc. ~ Address P.O. Box 110443, Anchorage, AK '99511-0443 Engineer's Printed Name Cindy W. Ellis DSD SIGNATURE [,-'"' Approved for ~ Disapproved. Conditional approval for bedrooms. 'Phone 349-1851 Date ............. bedrooms, with the following stipulations: Additional Comments By: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ~ - ,,Q.. O- ~/74. (Rev. 01/02) ,MUnicipality of AnchOrage.= DeVelopment Services DePartment Building Safety Division on-site Water & Wastewater Program` .4700 South Bragaw St. P.O. BOX 196650 Anchorage, AK 99519-6650 ' '~ www.muni.org/onsite . ' (907) 343-7904; Legal Description: Birch Tree Estates, Block 2, Lot 9. A. WELL' DATA , ' , ~ . ' , ~ . · ,~ r ~ rWell type Pr ~i IfA, B, or C provide PWSID # : ~ ' Sanitary seal (Y/N) Y . Date eted unk Total ~eP!h :>.93 ft. ., ~ Cased to->40 . ff. ~ ~ f :;: , i FROM WELL LOG ' "': F !: ' x : Date Of test . :.: stat,c water level · ft. Wel product on . g.p.m. : . .WATER SAMPLE RESULTS: .. :~ - .'; Coliform i 0 colonies/1001 mi. :Nitrate '0.173 mg.fl. "Arsehi~:' Ii NA mg./i' ; Date of sample: 5-4-04 B. SEPTiC/HOLDiNG TANK DATA :* Tank.Ty'p~/Material steel ~ :' i ~ ~ i :: 'Tank~si'z~ !:1250 ; .gal.:: ." .'Number of C0mpartments 2 Found~{i~)f~ cleanout (Y/N) Y:' ''~ "' Depression over tank (Y/N) n . i',r .... '8-5-0~-- ; :'.!i ' Rot0;Rooter:' Date of pumping. : PumP, er C. ABSORPTION FIELD DATA .' Date installed 4-27-84 Leng!h 45.' fl.' HEALTH AUTHORITY APPROVAL CHECKLIST., Par~el~lD: 017-141-40 Well L6gr(WN) N Wires properly;protected (Y/N) Y Casing height (abo. ve ground), 23 '3.16.04 AT INSPECTION 82 4.6. High water ala?rn (Y/N) NA .Soil rating _(g.pld./fl2 or ft,~/bdrm) 105 ,Syster~'tY~e mound : , ,~. Width ~22 ~ ', ,, ff.' ' Gravel below pipe'Z.u-- in. g.p.m. Other bact(~ria 0 colonies/100 mi.' Collected b~tl;~ ' . ~,Watk;ns Engineering, Inc. Date install~d 17-15-81 Cleanouts (Y/~) Y Total'~JePth 3.92 ft. Eft.:absorption area;, g90 · ft2 : Monitoring tube Y ' Depression over field n Date~f~r~equacytest '3.16.04~. :i'. i ':iResults (Pass/Fail)LPASS i!':.~ I" .For 4. bedrooms Fluld'd~pii~'in absorptiofi field befor~ test 19'! "in.". i'. water added 885 gal.[ i i.i [~' New depth 23 in.. :!':'. ;[i'i . ; ;; ' '; ' '';'~ ~ Elapsed ilime: 229 min.~ ' Final fluid dipth as.?s in.. : ', AbsOrPtion~ rate [5= 600 g.p.d~' ~'mo. & type)'.n.one knq '~ Jfy~s, give date - Any rejuvenation treatment (past 12 ) (Y/N . ~..! I ~" ' i~'i' .~' "~;':. ~ De LIFT STATION Date installed 4-27-84 "Pump on" level at 27 in. Datum Bottom of culvert Size in gallons 100 "Pump off",level at 7 Cycles tested >10 ' in. Manhole/Access (Y/N) Y High water alarm level at 34 Meets alarm & circuit requirements? Y Ee SEPARATION DISTANCES SEPARATION DISTANCEs FROM WELL ON LOT TO: Septic tank/lift station 'on lot i15 · on adjacent lots 100+ Absorption field on lot 130+ On adjacent lots 100, Public sewer main 100+ Public sewer manhole/cleanout 100+ . Sewer/sePtic Service line 80+, Holding tank NA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ' Building foundation 25 Water main 100+ Property line 45 water service line 80+ -AbsorptiOn field 10+ Surface water 100+ Wells on adjacent lots ~100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT T0i Property line 12 Water Service line 100. Building foundation 40 ;Surface water 100+ Water main 100+ .~ . Driveway, pa~king/vehicle storage 80 Curtain drai~~ none known COMMENTS Wells on adjacent lots 100+ ENGINEER'S CERTIFICATION ,- " '1 certify that i have determined~through field inspections 'and review of Municipal records that the above systems are in 'conformance with MOA HAA guidelines in effect on this date: Engineer's Printed Name Cindy W, Ellis Date ,5' ~i"7.' ~ ~' Waiver Fee $ Date of Payment Receipt Number 0 0 0 o 0 N BB°43'44"E 1 so. OD LIFT o WrLL N 139 4:3' 44" E 150.00 EAST 1 4'7TH AVEN U E 0 o AS-BUILT SURVEY ( NO CORNERS SET THIS DATE ) 1'=30° THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATFED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCELINES. EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED PLAT. ARE NOT SHOWN HEREON(UNLESS INDICATED NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES OR LOCATE STRUCTURES. ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS. I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 9, BLOCK 2, BIRCH TREE ESTATES ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS 8TH DAY OF MAY 2004 . HOLT LAND SURVEYING 9340, FB 111-66 TEL. 345-5513 · ,. 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 IPALIT¥ OF ANCHOP, AGE ¢.NVIRONMENTAL SERVICES DIVISION S EP 3 0 1996 Parcel I.D. # Of 7- IHI - WO 1. GENERAL INFORMATION Complete legal description Lot CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING R E C E i V E D HAA # ~'~C~ ~ ~q ~.~ 9; B'Iock 2; 'B'irch Tree E.~tates Location (site address or directions) 5274 E. 147th Avenue AK ~nc,,ora~e, Property owner% Gordon & Carol Goldsmith Day phone Mailing address :~'~ P.O. Box [ending agency Mailing 'address' > ~ Agent Beth Simpson/ Simpson Co. Address 345-5640 Day phone Day phone 345-1020 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 'v TYPE OF WATER SUPPLY: Individual well NOTE: Community well Public water .' '. ' "-..~. . . .."' ~'~,1 ol ~,.:- If community well system, provide written confirmation from State ADEC,.'~ttest- . ing to the legality and status of system, .,?: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank, Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91} Front MOA #21 ~. :' STATEMENT OF INSPECTION BY ENGINEER. As certified by m~,' 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 ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. s & S ENGINEERING Name of Firm ]7034 Eagle River Lo~p Road No. 204 Address Engineer's signature .-- ~ .~~ Phone G°/h, - ~-~/7 ? Date o//gL ,~ /' ~ (. J DHHS SIGNATURE ?~' ^PproYed for Disapproved. Conditional approval for bedrooms. bedrooms, with the folloWing stipulations: Additional Comments " Date 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 DH HS 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. 72-02~(Rev. 1/91) Back MOA~Z1 Municipality of Anchorage i~NLaP~U~' ~ DEPARTMENT OF HEALTH & HUMAN SERVib=~_.~ ~,~§ ,~=~,,~.,_~=,~,a' ~ =nvironmental Services Division S~-P ~) 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist LegalDescription: /-O'/- c~ ~oc~< ~ 8~.c~+ 7-/~.~.. F_. & /'. Parcel i. D.: 0~7-- t,~/- 'YO A. WELL DATA Well type PR Log present (Y~ ,A/o Total depth 0 Sanitary seal ({~/N) If A, B, or C, attach ADEC letter. ADEC water system number Date corn pleted u ! k' ! Cased to ~ ~ y- Casing height (above ground) I Wires properly protected (~/N) "/~ J FROM WELL LOG AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: g.p.m. Coliform 0 Date of sample: c~ //~ (~ B.~SEPTI~HOLDING TANK DATA Nitrate Collected by: Other bacteria ~ S & S ENGINEERING ;,'G$4 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Date installed g / ~ ~ j ~: / Tank size Foundation cleanout (~/N) ¥ Date of Pur~ping..~/~'~''/¢] C, ABSORPTION FIELD DATA Date installed ~ / ;3 -7 /~;/"/ Length ff 3- Width. 1~3' o Number of Compartments ~ Cleanouts {~/N). Depression (Y,{~i ~, 0 High water alarm (Y~ ,,, c~ Pumper R- -/-- /-/o~ $4,~ v/ce;5- Soil rating (g.p.d./fF oriffe/bdrmj I o Gravel thickness below pipe Effective absorption are~ . q cio ~'T~' Momtonng Tube present (~/N) Date of adequacy test '~/~ (~ / ~ (o System type ~ o ,., ~, D " Total depth /'/ '/~ Depression over field (Y/N) Results([~s/Fail) /0 4- J'$ For /"J bedrooms Fluid depth in absorption field before test (in.); Fluid depth ~ ~' '/~' (ins) Minutes later: Peroxide treatment (past 12 months) (WN) K ~ Immediately after ~-, 5'~°gal. water added (in.): ~ ~ '/~-" Absorption rate = G o o Y- g.p.d. If yes, give date '"- 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access D/N) "/~- J High water alarm level at* ~- ~ Cycles tested -~ Size in gallons "Pump on" level at* i ;~ *Datum 80 r x, ~ "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~holding tank on lot Absorption field on lot Public sewer main ! o o '/"- On adjacent lots On adjacent lots Public sewer manhole/cleanout t )o /4. ~ /,~ Sewer/septic service line S' 0 + Lift station / (~ o SEPARATION DISTANCES FROM~HOLDING TANK ON LOT TO: Foundation ~o + Property line +' Absorption field Water main/serVice line ~'0 '+- Surface water/drainage ) 0 o Wells on adjacent lots / 0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: / .X / Property line I ~ Building foundation ~ 5- + Water main/service line Surface water t o o ~--,- Driveway, Parking/vehicle storage area Curtain drain "'~ ~ "' ~ w.. ,., ~ ,.v ,.,, Wells on ,~,q,~,.~ ,-'~-""n~ lots / o u -/--- F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records in conformance with MO~ H~A guidelines in effect on this date. Signature -~~.~ Z` ~ Engineer's Name /~ i) ~/, ~. ~ ~. ~o ~W~ Date ~ / ~ [ ~ ~ HAA Fee $. Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description LoT el, BL~ :Z~ B~C~ TI~' Location (site address or directions) = Property owner Mailing address Lending agency Mailing address Agent Address Day phone 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: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4, TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~025 (Rev. 1/91) Front MOA ~21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~L~TToP T'ECH. _~v'C~ Phone Address IHS3o Echo ~'r. A~¢/~. AK Engineer's signature ~'-~ ~. ~ DHHS SIGNATURE Approved for Disal~proved. Conditional bedrooms. Date 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 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type ~'RIV',~T E Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number N./~, /~?~/ ~ Date completed VNK- /~ /~ Driller Cased to UNI<, I'Z ~3~) Casing height 2 ¥ Wires properly protected (Y/N) Date of test FROM WELL LOG AT INSPECTION Static water level Well flow Pump level g.p.m. '7' $. ~ g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main 7/oo' Sewer service line ~'~ ; On adjacent lots P ; On adjacent lots ~'/oo ' Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ col / ~'o0 Date of sample: Nitrate Collected by: Other bacteria ~ t_c,/ F'z. ATTOP TEcf/. 5~'¢~, B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size I '~ 5~ Foundation cleanout (Y/N) G/)/. Compartments ~-, "/ Depression (Y/N) h~ Alarm tested (Y/N) H./J, Pumper /~NCI~. ClS~l"OoL F~ut~P~HG SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot [ iS 'F.l~o~ C..O, On'.a.d. jacent lots Topropertyline "~ ~' Absorption field Surface water/drainage Foundation '3~ F~*~ C,O. Water main/service line 72-026 (Rev. 7t91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed //~wize in gallons ,-,cO0 · Vent~)/N) t4~tNHOLe NoT "Pump on" level at High water alarm level 2~" FR~t ~oTT01"I Meets MOA electrical codes (Y/N) "/ ~ ?~"R $/2~/S~/ Lg'r'r6~ o~ SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot 1 SO~ On adjacent lots ~'/°ol Manufacturer ~NK, Manhole/Access (Y/N) Y F~'o~ 15oTTo~4 "Pump off" level at Cycles tested ,~ 20 F~L~= ~ DHH.~ Surface water ~ F,~ot~ i~OTTO~4 D. ABSORPTION FIELD DATA Date installed z'//2, o Length H$ I Width Total absorption area c~ Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) System type Soil rating Gravel thickness ~ Cleanouts present (Y/N) Date of adequacy test for ~ NoNE KNo~vr~ OF If yes, give date E£zo~ ?ff'£ Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: I Well on lot ~ '58 To building foundation On adjacent lots Surface water Curtain drain On adjacent lots '~/o o' Property line ~o'+ To existing or abandoned system on lot Cutbank >./o~ Water main/service line ~:: Driveway, parking/vehicle storage area '~$ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and'HAA guidelines in effect on the date of this inspection. OF' ..~;,..%~...,.,.. ~..,,~ Signature ~~ ~~ Engineer's Name ~$ ~o ~ ~ ~ ~ o ~ ~"........,~' ~ 5~H~O90~ ~. ~OO~E · HAA Fee $ / 7 Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev, 3/91) Back MOA 21 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND flN%fI~TAL PROTECTION APPLICATION FOR HEALTH ALVITqORITY APPROVAL CERTIFICATE 1 General Information Application Date (a) Legal Description (include. lot,~lock, subdivision, section, township, range) , , ~:, ~ <?Z./,'. ',:: " "' . ,I Location (adck~ss o~. directions) :,C /'.i7 (b) Applicants Nam~ *t::,?~::~.., i Applicants Address_ (c) Applicant is (check one) Lending Institution ,~-~; Owner/builder ~; Buyer ~; Other ~explain); ./'~.,2 ~/~,~C , (d) Lending Institution Te le phone. Address (e) Neal Estate Co. &Agent Address Telephone 2. ~ of N~sidence Single-Family ~' Number of Bedrooms 3. ~ater Supply Individual Well Multi-Family ! Other (describe) Con~nunityr--q Public~_/ Note: If coamunity %~11 system, must have written confirmation fr~n the State Department of Environmental Conservation attesting to the. legality and status. Is the w~ll adequate for the number of bedrooms specified in this HAA 4. Sewage Disposal ? Onsite ~ Public ~ Conm~unity ~--~ Holding Tank ~ Is the wastewater disposal system adequate for the numt~r of bedrccras ~(,~N)__ [Page 1 of 2] 2-15-84 5. Engineering Firm P~.oviding Ins~ect%o.n.s ,. Tests, Data and Information I oertify that I have checked, verified, c~ conformed to all MOA HAA Guidelines in effect on the date of this inspection. Telephone., ~../ - ) ~_. Signed by Date ( ENGINEER SEAL) 6. DHEP Approval Approved for Approved ~ Disappro~=..d ~-~ Conditional ~ Terms of Conditional Approval The Municipality of Anchouage Department of Health and Envi~or~ental P~otection dces not guarantee the continued satisfactory perforn~anee of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewateu disposal system is safe and func- tional for the number of bedrccms and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following add~ess: KB2/d5/s [Page 2 of 2] 2-15-84 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR. HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal,Description (include lot, block, su~bdivision, section, township, range) /'% / / i ' I Location (ad.d~ess or directions) (b) Applicants Name Applicants Address (c) Applica~qt is (check one) Lending Insti~u~tion~: ~-~ ; Owner/builder ~--]; Buyer ~ ; Other ~ (explain); f"~,;~ ,: ' ,, (d) Lending Institution Address (e) ~al Estate Co. & Agent ..... Address Te 1.e phone. 2. T_ype of ~sidenee Single-Family ~ Numbe~ of Bedrooms 3 o Water Suppl~ Individual Vbll ~ Multi-Family~ Coar~nity Other (describe) Public Note: If community ~11 system, must have written confirmaticm, frcm the State Department of Environmental Conservation attesting to the legality and s~.atus. / / Is the ~11 adequate for the number of bedroons specified in this HAA/~) 4. _,Sewage Dispersal CZ] Is the wastewater disposal system adequate fc~ the number of bedrocmscd~?~]) [Page 1 of 2] 2-15-84 5. Engineering Firm Providinq Inspections, Tests, Data and Information I oertify that I have checked, verified, c~ conforn~d to all MOA HAA Guic~lines in effect on the date of this inspection. Signed Name. of Fi~m Add~ess Signed by Date ( F~GINEER SEAL) 6. DHEP Approval Approved fo~' Approved ~ 7/ bedrocks Disapp~o~d ~--~ Terms of Conditional Approval The Municipality of Anchorage Depa~t_~ent of Health and Environmental Protection does nct guarantee the continued satisfactory ~erfommance of the water supply and/c~ the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and infc~mation furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of bedrooms and type of structure indicated. (DHEP SEAL) 7. Mail the FAA to the following address: ' ~ ~, ' '~' i'. "t ' ~ ' ~ 't, , ~, '.-, ,~,-'~, ~;9' q of 2] 2-15-84 ae MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification -~%N~~_ Well Log P~esent (Y~_ .Date Campleted Total Depth ~ou~ Cased to Static Water Level ... '7~,~/ . _ Pump Set At Casing Height Above Ground Electrical Wi~ing in Conduit ~N) Separation Distances f~om Well: To Septic/Holding Tank on Lot ~\~ o To Nearest Edge of Absorption Field on Lot \~5 NIUINJCIPADTY OF ANCHORAGE DEPT. OF HEALTH & EI',,,NIRONMENTAL PROTECTION. 1984 RECEIVED Legal Description: ~ q ~_C~C~ If A, B, o~ C, D.E.C. Approved(Y/N) k~c~ Yield ,~. '"7"~i'P,'.~'~ Depth of G~outing. .... Sanitary Seal on Casing Depression A~ound Wellhead ~ On Adjoining Lots ~ ; On ~djoining Lots To Nearest Public Se~ Line ~//~ To Nearest Public Se~r Cleancut/Manhole ~//~ To ~est ~= ~vi~ Li~ on ~t Wate~ S~le Colle~ed By ~_/~ ; ~te +/~ /~.. Wate~ S~le Test ~sults ~~ ~~~ B. SEPTIC/HOLDING TANK DATA Standpipes (~N) Depression ove~ Tank (Y~ Air-tight Caps ~.,) Date Last Pumped No. of Compartments ~ Foundation Cleanout ~N) Pumping/Maintenance Contract on File (Y/N)~/. J~; for Holding Tank High-Water ~%la~n~ (Y/N) ~//~, Temporary Holding Tank Permit "i~Y/N)' separation Distances f~cm Septic/Holding Tank: To Water-Supply W~ll ll~ To Property Line To Water Main/Service Line Course To Building Foundation To Disposal Field To Stream, Pond, Lake, c~ Major D~ainage Comments [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~/.~/~ Width of Field ~ ! Square Feet of Absorption A~ea Depression over Field (Y~) Results of Last Adequacy Test Length of Field ~ / Depth of Field ~..~. / . Gravel Bed Thickness ~.~. ! ~q:~- Standpipes P~esent ~YN') Date of Last Adequacy Test '~/~. Type of System Design__~:~~ Separation Distanc~ f~cm Absorption Field: ? To Water-Supply Well ~,~>~ !. . . To P~operty Line . '-~ / ~ To Building Foundation ~. '-/' To Existing or Abandoned System cn Lot ; On Adjoining Lots To Wate~ Main/Service Line ~/~ To Cutbank.(.if ~.esent) To St~eam/Pond/Lake/c~ Majo~ D~ainage Course To D~iveway, Parking A~ea, c~ Vehicle arc, age A~ea D. LIFT STATION Size in Gallons ~(50 ~%,, 63 . Manhole/Access ~N) "Pump On" Level at ~._.~ ~%~. ~"I~ Off" ~1 at 1 / ~~ ~~ High ~te~ ~ ~1 at ~.~ ~ ~ ~~ Vent ~) ~N~ ~~~' Tested fo~ ~/~ ~~ ~ing Cycles ~ing Adequa~ ~st. ~ets ~A Electrical Co~s(Y~) ~ ~ ~s~~ ~ ~~k~ '~ C~nts ~ ~ ~ ~~~ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, c~ oonfom~ed to all MOA HAA Guidelines in effect on the date of this inspection. -~~- ~ Signed Company [Page 2 of 2] 2-15-84 ~.. ~'-.~ DEPARTMENT OF-HEALTH& ENVIRONMENTAL PROTECTI(J~N~J'L~'~.~,  REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWERF~-I~I~ DI RECT1ONS: Complete all parts~on Page 1. Incomplete requ~ will not be proc~d. Please allow ten (10) days for processing, k PROPERTY OWNER .. .~ '1 PHONE~ .... MAI~ING ADDR~ - ~ / : PROPERTYRE~IDE~T (If~iffe~nt fromabo~) ~ ~ ~/ / ~ ~ ~ ~ ' ~ PHONE' 2. BUYER ~ ~ ~ PHONE MAILI ~G ADDRESS ' ' / ' ..-. - _ -. I .... MAI LING" ADDR ESS 4. REA~T~/AGENT / __ ' ' ~ ~ ~ 't ~HONE _- _1--I MULTIPLE FAMILY ~ Three E~] Six ~7. WATER SUPPLY --' ' ~ INDIVI DUAL* * ATTACH WELL LOG. A well Icg is required for all wells drilled [] COMMUNITY Since June 1975. For wells drilled pr orto that date, give well - [~ PUBLIC UTI LITY dep~ rh (attach log if available.) : THE INSP CAN BE INITIATED; THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. sEWAGE DISPOSAL SYSTEM []IN DI VI DUAL/ON -SITE []PUBLIC:UTILITY Connecti6n Verified []Septic Tank or [] Holding Tank Size: ].,~1~., If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SiX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER INSTALLER SOl LS RATING MANUFACT~t~ MATERIAL ~ Septic/Holding Tank IAbsorp er Line [] OTHER iNearest Lot Line [~APPROVED FOR -.~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE LEGAL DESCRIPTION 72-010 (Rev. 3/78) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "¢" Street, Anchorage, Alaska 99503 274-4561 Date Received November 1, 1976 Time of Inspection 11: O0 a.m. Date of Inspection 11-2-76 Tuesday REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Buchholz Cony. l. Approval requested by: Coast Mortgage Mailing Address: 4450 Business Park Boulevard Phone: 274-9504 Property Owner:. Mailing Address: Gibson & Shirley A. Parks Phone: 3. Legal Description: Lot 9 Block 2 Birch Tree Estates 4. Location: 5. Type of facility to be inspected 6. Well Data: A. Type Individual C. Construction~~~_~_ 7. Sewage Disposal System: A. Installed C. Septic Tank: 1. D. Seepage Pit: 1. Single Family No. of bedrooms 4 B. Depth D. Bacterial Analysis On-site system B. Installer Size 2. Manufacturer Absorption Area 2. Material E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank , Absorption area Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line , Sewer Lines EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Req ;t for Approval of Individual S Jr & Water Facilities Legal Description Lot 9 Block 2 Birch Tree Estates Comments Approved ~J._ (/r_~~Lj-~~ Disapproved Date Approv~ Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO 2. Property Owner: (m~¢.' ~ ~, fiw~. ~ Mailing Address: 3. Name of Buyer: Mailing Address:. Name of Lending Institution: Mailing Address: .VA FHA CONV '~'" Day Phone: 5. Name of Realtor or Agent: Mailing Address: 6. Legal Description: Day Phone: Phone: Location: O'y~ ~- Type of Facility to be Inspected: No. Bdrms. ,"?/ Water Supply Type of Supply: Public Utility. If Individual, number of dwellings presently served If Individual, depth of well ~ ~-~~ Individual Sewage Disposal System Type of System: Public Utility If Individual, date of installation ~ Individual (on-site) 72-003(3/76) TO _) 0 SEND PARTS I AND 3 INTACT - ~T~o--Ofi~-)® 4S 472 PART 3 WILL BE RETURNED WITH REPLY. DATE / POLY PAK (50 SETS) 4P"' DETACH AND FILE FOR FOLLOW-UP JML I John M. Lambe, P.E. 4303 North Star Street I I Anchorage, Alaska, 99503 907.279-8056 NEW PHONE NUMBER 276-4113 SOIL ABSORPTION SYSTEM TEST PERFORMED FOR: ~o.~-,'~ t~w~-~-~ ..... L~.~ DESCRIPTION: ~-~'~- ~ , ~ ~< ~, NO. OF BEDROOMS:,,, ~ RECORDS ON FILE: CRIB , DRAINFIELD ~/~ O~ER TELEPHONE: ~_~, ?~,,-,7777 ,, DATE OF TESTS: ~/~ , TEST PERFORMED IN ACCORDANCE WITH JML STANDARD PROCEDURE ACCEPTED BY MUNICIPALITY OF ANCHORAGE; DEPT. OF ENVIRONMENTAL QUALITY ON ,-~,/~/wM WITH THE FOLLOWING MODIFICATIONS: SURGE CAPACITY: SOIL ABSORPTION SYSTEM (SAS) SEPTIC TANK PLUS SAS ABSORPTION RATE STEADY STATE ~, , . _~ RISE OBSERVATIONS: ~ A~~ ,~~/ ~ ~,~, ~/q .... NOTES: TEST DATA ATTACHED ~j%..~z' /~,/,, Z ~3 JML John M. Lambe, P.E. 4303 North Star Street I I II Anchorage, Alaska, 99503 907-279-8056 NEW PHONE NUMBER 276-4113 SOIL ABSORPTION SYSTEM TES,T' PERFORMED FOR: TELEPHONE: LEGAL DESCRIPTION: ~--~-~ . ,~' NO. oF B~.~OO~S: Z~ ~CO~DS ON CRIB~ ./ , DRAINFIELD _/OTHER /~'" ' TEST PERFORMED IN ACCORDANCE WITH JML STANDARD PROCEDURE ACCEPTED BY MUNICIPAl, lTV OF ~NC~O]~G~ DMPm o~ ~VI_~ONMENT~~L OU~T,ImV ON "7/~.4t/~-.~ ' WITH THE FOLLOWING MODIFICATIONS: SURGE CAPACITY: SOIL ABSORPTION SYSTEM (SAS) SEPTIC TANK PLUS SAS ABSORPTION RATE AVERAGE 24 hrs OBSERVATIONS: -I-'Z,~. ~, . . RISE STEADY STATE~'~D~ @ // '/ NOTES: JML I John M. Lambe, P.E. 4303 North Star Street I Anchorage, Alaska, 99503 907-279-8056 NEW PHONE NUMBER 276-4113 SOIL ABSORPTION SYSTEM TEST PERFORMED FOR: LEGAL DESCRIPTION: TELEPHONE: ~__7~..- 7'77'~ SURGE CAPACITY: SOIL ABSORPTION SYSTEM (SAS) SEPTIC TANK PLUS SAS ABSORPTION RATE ~//~ AVERAGE 24 hrs , OBSERVATIONS: STEADY STATE RISE NOTES: NO. OF BEDROOMS: ~ _ RECORDS ON CRIB / DRAINFIELD ~ / ~THER , , TEST PE~ED IN ACcoRDANc~E WITH ~L STANDARD PROCEDURE ACCEPteD BY MUNICIPALITY OF ~NCHO~AGE, DEPT. OF ENVI~O~EN~AL QU~T,T~V OW JML John M. Lambe, P.E. 4303 Nor'lb Star Stn~ Anchorage, Alaska, 99503 EXISTING DRAIN FIELD TEST._- PERCOLATION ADSQUACY LEGAL D~8 0RIPTION: Z~'F-~'7, -DEPTH BRT4)W METER READING GALLONS PUMPED TIME / Y i ~ , ,, . , .... . , . , ~ ' ,, "~"' ~ s~ 3- _~ - ~ I , , 7 -? .' 7 JML ,OF I .. I John M. Lambe, P.E. 4303 North Star Street Anchorage, A~a~ka, 99503 907.279-8056 EXISTING DRAIN FIELD TEST - PERCOLATION ADEQUACY REFERENCE:, x, ., , ,, DATE~/7r/~%-' PERFORMED BY: LEGAL DESCRIPTION: DEPTH BELOW METER READING GALLONS PUMPED ' TIME ~E~-~C~ .... (,,, GAL~Z~S ) ....... ( ~'~, ) 3 ' - 2 '/ ~do , , ~ , ,7 ;/, ~. I1 / *~// ~ 7.,~ JML Sohn M. Lambe, P.E. I I I 4303 North Star Stn~ Anchorage, Ala~a, 99503 907.279-8056 EXISTING DRAIN FIELD TEST - PERCOLATION ADEQUACY DATE_~ PERFORMED BY: ~,~4 ,~,~,, ~ e LEGAL DESCRIPTION: /-~' ~ ,~'/F ~ /~,~m,F ~",~"'K"' DEPTH BELOW METER READING GALLONS PUMPED TIME ~E~C~ ,, (,, ~LO,~S ) ( ~E~ ,) , q '-/",';' ~...,~ .... .~ /z,,~' 4 '- 0 " ., .,; .1 .~ ~'o ~"G'., ;~ ,'-/0"4 f, ~oo -' "" .i ~o t~o ? _ ~ ~ 20(3 /Z :3'7 ~, '-/~-~,." q~' ~' z3'.~- . ,,.'aZ -,.- ,e~:,, :~ :~ ~" ~'¢,"1,~,o ,, , [¢"""~' J: ¢ ~ ;; q4 4¢0 , a ~,I .'./2 ~,.. .. F ~ a'O~ ...... ~ ,, I: I~' ( 6o ,,, s ;j ........... ~'1~ ~ ........" 3'" 3 p.~. ,,'t,.q 700, >. '- 3. Y,;".. 4.¢ 7J'.o . ~,'~,'o. ~'. ,,'./7 3"-~ %* 44~00 (G'O 2:28 3'c 3/"~" 4¢8~0 .... JML o, John M. Lambe, P.E. 4303 North Star Stre~ Anchorage, Ai~ka, 99503 907.279-8056 DEPTH BELOW METER READING GALLONS PUMPED TIME ,,R,,EFERENCE , (_GALLONS) (NET,,,) , , ~, : ' ' ~ ) 'Zo ,