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Home My WebLink AboutBIRCH HILLS TERRACE #2 BLK 2 LT 8 GRE~ ER ANCHORAGE AREA B0F Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 'JGH INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM ('/ ,F ~, ~ PHONE · OCA~,O./.~ /~ X,,/~bll ,;/-,,, ~=A, =~.,~,o~ ~/~/? ~k'z ,¢~//?/~ SEPTIC TANK: DISTANCE FROM WELL /~/ INSIDE LENGTH. //~/7~-o~2 COMPARTMENTS_ / INSIDE WIDTH LIQUID DEPTH __.LIQUID CAPACITY /~ GALLONS. SEEPAGE PIT: NUMBER OF PITS / . DIAMETER LINING MATERIAL /~/gY /(~//~/~ CRIB SIZE: BUILDING FOUNDATION ¢0! , NEAREST LOT LINE / I I ~.-~l OR WIDTH__, LENGTH__, DEPTH DIAMETER__DEPTH DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ADDITIONAL ABSORPTION SQ. FT. WELL: TYPE ~)~///{o~ CONSTRUCTION BUILDING /~_! NEAREST NEAREST FOUNDATION /(~ , LOT LINE , SEWER LINE DEPTH DISTANCE FROM: SEPTIC /~/ ! SEEPAGE / TANK , SYSTEM ~-~ CESSPOOL APPROVED , OTHER SOURCES DISAPPROVED DISTANCES: ~ INSTALLED BY: ~ i~ PIPE MATERIAL: LOT SLOPE: REMARKS: Form No. EQ~031 REMARKS DIAGRAM Of SYSTEM GREATEr ANCHORAGE ArEa BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C"STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 PERMit NO.. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERM:IT~L~,~:~;×/ INSTALLATION LOCATION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS ~ cOmPLETION DATE ANTICIPATED OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST -FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BA~C:KFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE /_~_EPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. TYPE DIAGRAM OF SYSTEM MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK ~ SEPTIC TANK TO SEEPAGE Pit WALL ~'~*- ~/ SEPtiC TANK ;~ , SEEPAGE Pit ,~---~'~ DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPtiC TANK ~/~-~)~ , SEEPAGE Pit ~ DRAIN FIELD /~ / ALSO CONSIDER AREA WELLS. SEEPAGE PIT WATER MAIN TO SEPTIC T~K DRAIN FIELD /~ / SEPTIC TANK, ~., SEEPAGE PIT ~ , DRAIN FIELD ~ CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GaP OF FOUNDATION TO SEEPAGE Pit ~ , DRAIN F,ELD ,~ TO RIVER, LAKE, STREAM. 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 CONFORM TO BOR EGULATIONS REGARDING INSTALLATION. LICENSED DESIGNER CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-88 AND THAT THE ABOVE ~ESCRIbED SYSTEM lB IN ACCORDANCE WITH SAID CODE. / /~O APPLICANT'S SIGNATURE ~ ,M .O. ~16 0 '- ~ ' F~~ ' ~ --' 0 &' E EAi~/NEERING ~t DEVELOf lENT CO. Russell Oyster 694-2774 Civil Engineering Soils 8 Foundations Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 333-5240 Earl Ellis 333-5240 Surveying Land Development SOIL LOG Performed for~<yz~/~-y-' /¢U, zr/~/V'/q~¢~j /¢¢¢' Legal Description: Lot ~ Block .~ Subdivision Date Depth-Feet, Soil Characteristics 3 4 5 6 7 8 9 10 Ground Water Encountered: Yes__No ~ If yes, what Depth Proposed Installation: Seepage Pit ~'/ Drain Field Comments: Date DEF'RRTHENT OF HERLTH RND ENVZ~:ONI"IENTRL PROTECTION :~:25 '"L"' STREET., RNCHORFIGE, RK 264-47;2E~ : RNCHORRGE ~;~4-2~;~:~ : ERGLE RIVER F'ERHZT NO. RPF'LICRNT: SYDNEY HUFFNRGLE PHONE: 634-9746 RDDRESS: PO BOX ERGL. E RIVER., RK :~2~577 L. EGRL DESCRIPTION - SUBDIVISION: BIRCH HILLS TERRRCE2 BLOCK: 2 LOT: 8 LOT SIZE 6~ SCL FT. 'TOHNSHIP: E~ RRNGE: E~ SECTION: I CERTIFY THFIT: :.t... I RM FRMILIRR HITH THE REL."'~U:CREHENTS FOR ON-SITE SEI.4ERS RND HELLS FIS SET FORTH BY THE I"IUNICIPRLITY OF RNCHORRGE RN[:, THE STATE OF FILRSI--'.';R. ,.--..:. I HILL iNS'FFILL THE S'T'STEH IN FIC. COF.:E.,FINCE HITH THE CODES FIND HFIVE RECEIVE[:, R COPY OF THE CODE SUt'dHFIRY FIN[.., [:,IFtCiiRRI','I FITTFtCFIHENTS HHICH IS PFIRT OF THIS PERH I T ~_.".. I UNDERSTFIND 'THFIT THE Cd'.,t--.SITE SEI4ER SYSTEh'I h'lR'-r' REC4LIIRE ENLI-'-"IRGEHENT IF THE RES IDEI'4C.'E IS REHOE:,ELED TO I NCLLIDE hlORE THRN I.':"~ BEDROOHS. F'-'ERM'IT FIIF'PL. ICFIN'r' FIFIS ]'FIE RESPONSIBILITY TO INFORI'I PERSONNEL [:,URIt",IG 'THE II'.,ISTFILL. FiTIC.~N INSPECTIONS OF' FII'.,tY HELLS RD._'rFICENT TO THIS PROPERTY FIND THE NUi'dBEF.: OF F.:ESIE:,ENCES THFIT THE I,.IELL HILL SERVE. IF R LIFT STFITIOi'.,t IS INSTFII..LE[:,, FIN ELECTRICFIL PERHIT FINE.', INSPECTION I',IUST BE OBTF~II'.,IED. FIS-..BUILTS CRNNOT BE RPPROVE[:, HITHOUT Bt'4 ELECTRICFIL INSPECTION F.:EF'OF.:T. THE ELECTF.-:ICFIL I.,.f¢~F..:K "lUST BE [.,ONE BY FI LICEI'.,ISE[:, ELEC:TF.:IC:IRI'.,I. i=,=,IJ[-.L., E,T . ~ [// ~.~,(j~ ........ [:,ATE ' 03,.- 2'_-9.,.':~,2. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 8, Block 2, Birch Hills Terrace ~2 Location (site address or directions) 11423 Fireball StrEet, Eagle RivCr¢ A~ q9577 ProPerty owner Mailing address Lending agency Mailing address_. Agent Address " Robert LuDo Day phone 694-5678 Po Box 773166, Eagle R~ver, AN QQ577 5~=~v= riq~_ Ann Morris Day phone 12832 Old Glenn Hwy., Suite C-2, Eagle River, AK 99577 Day phone Unless otherwise requested, HAA will be held for pickup. NUI~/IBER OF BEDROOMS: 3 ' TYPE OF WATER SUPPLY: Individual well Community well _ Public water xxx NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S&SENGINEERING Phone (:-. ':i ~ - }.c~ ?~ Name of Firm i~4 Eagle i~iYer Loop Road No. 204 Address Eagle River, Alaska 99577 Engineer's signature ,/4.~?/'I ~ ... ~.'?~.'r.--- Date .... ? /e/~ ~ DHHS SIGNATURE (/ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments ~/? //,//? ' ×?,, - The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS 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 .:<ECEIVED Municipality of Anchorage AU(~ 0 ,5 1998 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MUNICIPALITY OF ANCHORAGE 825 L Street, Room 502 * Anchorage, Alaska 99501 ', (~J~/'~Z'~4~~ D~/b,~.. Legal Description: A. WELL DATA Health Authority Approval Checklist Well type ~ ~ Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production '. ~ e[;M~of sample: If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to Casing height (abo.~/~nd) . W~ted (Y/N) FROM WELL LOG ~' AT INSPECTION g.p.m, g.p.m. Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA C= Date installed Foundation C!p. anout (Y~ ABS~I;IP. tlON FIELD DATA Dat~ installed '7 - 7"~ ..... Length ' ~"~'~ Width Effective absorption area Tank size \~c~-(::> Number of Compartments t Cleanouts (~N)~ Depression (Y~) Pumper Soil rating (g.p.d./fForfF/bdrm) ~,.~c:~/~ System type ~'4~--, ~5 '[ 5' i Gravel thickness below pipe I~! Total depth ~ c>~ Monitoring Tube present ~N)~ Depression over field (Y/I~). ~ Date of adequacy test '~ ,'2,.g' -~ ~ Results~Fail) ~ 5 For "~ Fluid depth in absorption field before test (in.); Fluid depth ~ ' (ins) Minutes later: Peroxide treatment (past 12 months) (Y~) Immediately aftei~/ o' gal. water added (in.): Absorption rate = cl,6~4' g.p.d. ~0o,.) ~ If yes, give date f3~A- bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* -.-.----~ump off" level at* High water alarm level at* ..-----~ *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On adjacent lots Absorption field on lot On adjace~ Public sewer main ......~--~- Public sewer manhole/cleanout S~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~O Property line ~G Absorption field Water main/service line to ~k- Surface water/drainage ~o~''¥ Wells on adjacent lots F. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line \~ ~,.k- Building foundation ¥o ~ Surface water lo ~ Curtain drain ~,-" Wells on adjacent lots Water main/service line Driveway, parking/vehicle storage area'" ENGINEER'S CERTIFICATION · . I certify that I have determined thru field inspections and review of Municipal re re in conformance with lVJ~P/ H~A guidelines in effect on this date. Signature"~/~ Engineer's Name ~,~,.~ 7'- Date ~ / ~ ~ ~ ~ ~ ....,. ,, ~,',~ - -',~ ,,, ."~? HAAFee $. ~0(~).(~0 Date of Payment ~"/~/~ ~ Receipt Number Oc/0 / ~_ (~ <::~..~- Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMEN~ OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description {~nclude 1~, block/ sub. dj[vision, section, township, range) Location (ad4r~ess or directions)./ ~.~/ ,~. . /_~, (b) Applicants Name~ ~(l/g~t~~~l~ Telephone - Home~., ~usiness Applicants adress / ~O ~o~ 77 ~ /oL ~ ~/~ (d) Lending Institution ~/~d i<~, 171~b ~Xi Telephone Address .~~ ' (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single-Family.~ Number of Bedrooms Multi-Family ~-~ Other (describe) 3. Water Supply' f--] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal 0nsite~ Public ~ Community ~ Holding Tank 1----~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation~ attesting to the legality and status. [Page i of 2] 5. En~ineerin~ Firm Providin~ 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 regula- tions in effect on the date of this inspection. Name of Firm Telephone Address Date // DHEP Approval Approved for Approve,d 'J/, bedrooms Disapproved__ /z'1/7 Co~ition~ Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABO%~ BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OblISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 As Well Classification Well Log Present (Y/N) Total Depth Static Water Level MUNICIPALITY OF ANCHORAGE (MOA) HEALTH ~/3THO~TY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Cased to Date Completed 03A!333 NOIlg~lO~d I¥1N3WNO~IAN~ '~ HII¥3H ~0 ~ o If A, B, C~ C, D.E.C. Ap~~ AIllVdlDINnY~ Yield Pump Set At Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distancss frc~ Well: To Septic/Holding Tank on Lot Depth of Grouting Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~ '-~ To Nearest Public Se~r Line Cleanout/Manhole Water Sample Collected By Water Sample Test Results Cc~ments ; On Adjoining Lots TO Nearest Public Se~r To Nearest Se~r Service Line on Lot ; Date Be SEPTIC~ TANK DATA Date Installed 7//~/7~ Size /~ No. cf Ccmpartm~nts Standpipes~_---- Air-tight Caps(~ Found~tiqn Cleanout ~ Depression Over Tank ~._.. Date Last ~, d ~ 7/~.//~j~ Pumping/Maintenance Contract on File (Y/~) ; for - Holding Tank High-Water Alarm (Y/N) ~J4 Temporary Holding Tank Permit (Y/N)'~ Separation Distances f~cm Septic~%g Tank: / __ TO Building Foundation ~-~ . To Disposal Field 30 / To Water-Supply Well ~/~- TO Property Line /d9 /~ To ter Mai /Se .v Line 8D Co~ ~ . To Stream, Pond, Lake, or Major Drainage Comrents [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption S,t~ata Date Installed Width of Field square Feet of Absorption A~ea Depression over Field ~ Results of Last ~equacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness ?/7- ~ Standpipes P~esent ~~ Date of Last Adequacy Test8/~ Separation Distanc~ f~om Absccption Field: To Water-Supply Wall 7~ /+ To P~operty Line /~ To Building Foundation ~ / To Existing or Abandoned System cn Lot .; On Ad)oining Lots To Wate~ Main/Service Line ~) /-7~ To Cutbank(if ~esent) TO Stream/Pond/Lake/cc Majo~ Drainage C4x~cse /(3~ To Driveway, Pa~king A~ea, cc Vehicle Stccage A~ea ~'- / Ccmm~nts D. LIFT STATION Date Installed Size in Gallons "Pump On" Le~l at High Water Alarm Level at Tested fo~ Electrical Codes(Y/N) Comments Dimensions Manhole/Access (Y/N) "Pu~ Off" Level at ._/~___/__ .__ Vent (Y/N) P~mpT~s du~ing Adequacy Test. Meets MOA ** Check Pez~mitted Bedroom Rating Against HAA Request I certify that I have checked, verified, cc confccm~d to all MOA HAA Guidelines on the date of this inspection. Signed ' :8 'l~ e ENGINEERING[ Date ~,. d~ I.~ uHu I~0X Companyi~mBIVE. R. ALASKA G°,gb'/~ MOA NoJ' / / KB1/d5/s [Page 2 of 2] 2-15-84