HomeMy WebLinkAboutBIRCH HILLS TERRACE #2 BLK 4 LT 4 o6o- q\
--60
GRE -,..R ANCHORAGE AREA BOR
Department of Environmental O. uality
3330 C Street
Anchorage, Alaska 99503
SH
tf~. I~NS, P.E/CTION REPORT ON-SITE SEWAGE DISPOSAL SY.~ST, EM
LOCATION . . ,~,,....~.. ~ ~. ~ _- ~.~ ,
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
MANUFACTURER ~MATERIAL
INSIDE WIDTH LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID C A PAC I TY/'~Z' '~'"~(~A L LO N S.
TILE DRAIN FIELD:
/ .,,
DISTANCE FROM WELL /~'-~) FOUNDATION ~1~ ~g~_NEAREST LOT LINE_ /~
?
NUMBER OF LINES / DISTANCE BETWEEN LINES TRENCH WIDTH j
IN.
ABSORPTION AREA ,~/~,~,Tp SQ. FT. LENGTH OF EACH LINE
,~ ! DEPTH OF FILTER
'¢
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH~
OF LINES
TOTAL EFFECTIVE
W L':
TYPE _
BUILDING
FOUNDATION__
CESSPOOL
APPROVED
..CONSTRUCTION DEPTH
NEAREST NEAREST SEPTIC SEEPAGE
LOT LINE__, SEWER LINE__, TANK , SYSTEM
OTHER SOURCES
DISAPPROVED REMARKS
DISTANCE FROM:
DISTANCES:
SEWER LINE DEPTH:
LOT SLOPE:
REMARKS:
./
DIAGRAM OF SYSTEM
#
DATE
APPROVED ! G.A.A.B.
Form LQ-032
PERMIT NO.
APPLICANT
LOCATION
LEGAL
~ILIN I C I PAL I T"f OF 8f~C:HORRGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 E. OR RD., ANCHORAGE,
276-222"1
ON--'--~ I TE SEWER
76"167 >
MnNTF ~nnn
L4 B4 ~i'K~H HILLS TERRACE
BOX 4~8 E.R.
AK. 9r ?~ ~P'~
PERMIT ~/~
99577 694245~
LOT SIZE 5866~ SQUARE FEET
TVPE OF SOIL ABSORBTION SVSTEM IS' TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4
SOIL RATING (SQ FT?BR>= 100
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
C'EF'TH= ~ LENGTH= ~ GRAVEL
DEPTH= e
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 OUTFRLL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
~EQUIRED SEPTIC TANK SIZE= 1258 GALLONS
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN 8 WELL AND ANV ON-SITE SEWAGE DISPOSAL SVSTEM IS
100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC NELL.
SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
INSTALLATION.
PE~:M I T VAL I D FOR ONE YEAR FROM ISSUE
I CERTIFV THAT
i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BV THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SVSTEM IN ACCORDANCE WITH THE CODES.
~: I UNDE~ THAT THE ON-SITE SEWER SYSTEM MAV REQUIRE ENLARGEMENT IF THE
RESIDE~
SIGNED:-~
~S ~M~ID~ED TO INCLUDE MORE THAN 4 BEDROOMS.
IP~IC~NT RA~ STITH
"Onet~sttsworthalhousando~inlons"
220~ C~e~eland ~¢~ora~e~ ~l~sk~ 99~03'
Performed For Klondike-Wallace Date Performed 5/10/76
Leaal ~escriDtion: Lot_ 4 Block 4 Subdivision Birch Hill Terrace
This Korm Renorts Soils Loq Yes Percolation Test
De~th
Feet
Soil Characteristics,
4--
6--
8--
10--
12--
14 ,
16
18 -
~20 ....
...... TOpsoil
Slightly Silty Sandy
Gravel (GP+)
Bottom of test hole
Was Ground Water Encountered?
Yes, At what Depth?
No
Readinq Date Gross Time Net Time Depth to H20 Net Dron'
i i,
[ ,,
Percolation Rate Plinute
Proposed Inst~tlation: SeenaQe Pit Drain Field
Deoth of Inlet Depth To Bottom Of Pit Or Trench
CnMFENTS: 100 S~u~re feet,drainage area required per bedroom
Test Performed By_ James D. Mack
Data Certified BY:
CONSTRUCTION TEST
b/lU/'/~ LAB
PERM I T NO. ,:: 760t'£ :)
LOCRTI ON GLENN HN"r'
27'6-222'!
L--IE~LL F" E F-.' I"-1 I 'r'
Bo,:':, 4-,.-.,=, E.R. 6942453
LEGAL L4 84 BIRCH HILLS 7'ERR ~2
L.O'T' SIZE 58663 SQFT
1'4INIhlUM E~IS"I"RNCE FROM NEL. I~ TO RN'T' SEPTIC TANK/PACKAGE PLANT OR SOIL ABSORPTION
S'¢S'f'EF1 IS 188 F'T' FOR R PRI',,,'RTENELL AND 288 FT FOR R PUBLIC NEL. L
NELl_ LOGS MUST BE RETURNED TO THE DEPARTMENT NITHIN ~0 [:,A¥S OF' THE NELL
COMPLETION.
SPECIFICATIONS AND CONSTRUCTION [:,IAGRRMS ARE AVAILABLE TO INSURE PROPER
I NSTRLLAT I ON.
I F:ERTIF¥ THAT I Rf'l FAMILIAR NITH THE REQUIREMENTS FOR ON-SITE SENERS AND NELLS
.... r" ',- B~r' · ~ .... ,-.
AS 5E 1F JR FH THE r,IUNZCZPALIT¥ OF ANCHORAGE AND NZLL ZN:,THLL ZN RCCURE:,RNCE
NITH 1"HE CEE,E.
LOG OF DR- ',LING by A & L DRII ,ING COMPANY
ADDRESS ..................................................................................................................
DAT --ENDED ............. ..................................................................
DEPTH OF WELL ...... l.-~-.~.. ...........................................................
STATIC LEVEL OF WATER VT ...... /.../..0.. .................................
·
DRAW DOWN VT ........ L.O.. ..............................................................
~ALS. PER HR .......... iZ~..? ........................................................
, '~
KIND OF CASING ....... .~.'..~'-_...~.--.~... ............................................
KIND OF FORMATION:
FROM ...... ~ ............... FT.
FROM ...... .i.o. ............. FT.
FROM.....,~...S.--.. ......... FT.
FROM....3-g .............
PROM ...... 7~--. ..........
FROM ...... .~.:] ......... FT.
PRoM ...... .~.. ........... FT.
FROM ......
FROM.....Ij.7- .......... FT.
FROM .......................... FT.
FROM .......................... FT.
FROM .......................... FT.
FROM .......................... FT.
FROM .......................... FT.
FROM .......................... FT.
FROM .......................... FT.
FROM .......................... FT.
FROM .......................... FT.
TO.../...q.i .......... FT...~...~...d...~.~ ~ ~tr~
FROM .......................... FT.
TO .......................... FT ...................................
TO .......................... FT ...................................
TO .......................... FT ...................................
TO .......................... FT ...................................
TO .......................... FT ...................................
TO .......................... FT ...................................
TO .......................... FT ...................................
TO .......................... FT ...................................
TO .......................... FT ..................................
TO .......................... FT ..................................
FROM .......................... FT. TO .......................... FT .........................................
FROM .......................... FT. TO .......................... FT ..................................
FROM .......................... FT. TO .......................... FT .........................................
FROM .......................... FT. TO .......................... FT ...................................
MISCL. INFORMATION:
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
1. GENERAL INFORMATION
Complete legal description
Block 4..' Birch Hi~s T~_r~e.~_ #2
Location (site address or directions)
Property owner
Mailing address
Carol Stith
17707 Monte Drive
17707 Monte Road
Ea¢le River, AK
Day phone 694-~45¢
Eaqle River, AK 99577
Lending agency
Mailing address
Day phone
Agent
Address
Day phone
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
4
NOTE:
XXX
Individual well
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer X×X
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Phone ~,~Z'~?¢.rt.~7 ~
Name of Firm S & $ ENGINEERI~/'-~
Address
EngineePs signat~ ~'-
DHHS SIGNATURE
~-~ Approved for
Disapproved.
bedrooms.
Conditional approval for
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 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, I/91) Back MOAi~21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~oT' Z~ ~y._Z.~ l'~ti~'~ ~
~.~s"i"~/.-~ Pamel I.D.
A. Well Data
Well type ~12--~1
Log present ~;~N) ',/
Total depth \
Sanitary seal ~N)
FROM WELL LOG
Date of test
Static water level \
Well flow
Pump level1 ~,.~----
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~.--\\ ~/[, Driller
Cased to Z~'~'~ Casing height
Wires properly protected ~N)
AT INSPECTION
g.p.m.
SEPARATION DISTANCES FROM WI~LL TO:
Septic/holding tank on lot r~\/~
Absorption field on lot ~{I ~
Public sewer main t ~ ,.~
Sewer service line "Z.~' \ ~'
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample: ~ -- L~ ~ ct ~
'~, ~ Other bacteria
Collected by: ~--~ ~ ~'~ ~-~--~,.-~
B. SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
SEPARATION DIST~G TANK TO:
We~ A_bO~,~rap~i~l IdOtS
Tank size Compartments
Foundation cleanout (Y/N) Dep~
Alarm
~pe~re~
Foundation
Water main/service line
Sudace water/drainage
72-026 (3/93)° Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N.)..-.-
SEPA~E FROM LIFT STATION TO:
Well"on lot On adjacent lots
Manufacturer
Manhole/Access (Y/N) ~
~vel at
~ tested
Surface water
D. ABSORPTION FIELD DATA
Date inStalled
Length
Total absorption area
.,; ;
Date of adequacy test
Width
Soil rating (GPD/FF)
Gravel thickness
Cleanout present (Y/N)
Results (pass/fail)
System type
Total depth J
D~(Y/N)
for Bedrooms
Water level in absorption field before test er test
Peroxide treatment (past 12 months) (Y/N) ..-/ If yes, give date
SEPARATION DISTANCE FROM ABS O:
Well on lot j./'~n adjacent lots Property line
To building foundation To existing or abandoned system on lot
On adjacent Iots_~/''' Cutbank Water main/service line
Su~ Driveway, parking/vehicle storage area
C_.~rtain drain
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified~ MOA and HAA
Engineer's N angelic River' A?~.....~9~7~ .
HAA Fee $ ,~,).
Date of Payment
Receipt Number
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
'14:0G CT&E ENUiRONHENTRL_ LRB SERUiCES
1'40,498 DOt
Commercial Tooting ~ l;;ng;rleoring Co.
Fnvirnnmental Laboratory Services
Drinking Water mlysis Report for I'otal Coli brm Bacteria
~9 INSTRUCTIONS ON .R~Vt~RSE SIDE BEt.'ORE' COLLECTING Strl.3¢[PLE
5633 6 Stre,.-
Anchorage, AK 9951B-160
r~l; {907) 562.2~,:
, rsi'"-'-
DF f'OI~.* ETED ~Y ~,VATt~R ST_rl;PLI'gR
PUBLIC WATER SYSTEM I.D. ~
PRIVATE WATER SYSTEM
U ... $~nd R~u~ ~ Sing
S,~,,fl:'LE DATE,:
Month
SA.~PLE TYPE:
Router
R~peat Sample (for murine sample
~Sth lab ref. un. )
Special Purpose
Year
u
Treated Water
Untreated Water
'Cormment~:
Time Collected
5AN'2PLE LOCATION Collected By
'-T'F.,X.~, -,~ v..-- ..............
TO BE CO.k~Lg'fgD BY L.td30ILi. TOI~.Y
3o.a!ysis shows ~ Water S~LE to
~-"" 'Saqs~acto~
U .,~ple over ~0 ho~s old, re,niB may
Sample tan long m ~sit; amnple should
not be ov~ 4g ho~s old ~t
to Ndicate reh~ble re,uks. Pt~as~ send
~ew ~mple via special delivew m~l.
Received ~ ' /
JUL 0 6 1994'
Date
Time Racoived
Anal?',, Began
Analytical Nletbod: ,z' Membr.~.qe Filter
t~ MMO-,~JO
"N"-w..ber ofcoion.i, es/100
Lab Relr, No. Result" Anal.vst
Client notified or un*atisfactoo' results:
f£i []
}'honed Spoke *,5th Fa.~ed
Dg~: Time; .: ~:"'
BACTERIOLOGICAL WATER ANALYSIS RECORD
MMO-,~IUG Result: Total C,ljrorm
Membrane Filter; D~ect Count ........
Fecal Coliform ConFection ~'
F~al Membrane Filter' R~ulm
PART ONE OF TWO:
t~[~AIND£R TI} FOLLfW
ENVIRONMENTAL FA~.IL1TIE$ IN ALASKA ............ ..-. , -... ..................... , ,-,~r,, c.~,.~,, ,~'_~ .,=~e,~- ~. ~.,r.O. UTAH, W,-."ST VIR~!NI~,
Commeroial Testing & Engineering Co.
LABORATORY ANALYSIS REPORT
CT&g Kef,# 94,338%3
Cli~t Smnple ID L4134 BIRCII IIILL TI.ER.
Matrix WATER
Sample
SAMI'I.E COLt.ECTED BY: RAY.
WORK O,,der 80133
I~, ;,.t,..l D~,t~ 0 .q./rltl.t0 ~1 I[~ I3,33 J~.
Collected D'~4c ['}?t0fi/g4 ?~: 09:15 hrs,
Receiv ~ gaie 07/06/94 ~2~ 15:05 t~s.
P~amc, tcr
Nitratc.-N 3.4
Restflt. s qual Units Metho.t Limits Date Date
mg/L I'",PA 353.2/300.0 i0 07/06/94
* See Special In,tructions Above UA=
** See $,mtple l~m~ks Abo
U - Uli&i~i~ ~el~
5633 B $lreet, Anohor,ge, AK 99518-1600 .--._Tel: (907) 562-2345 tax: (907} §61-!5301 .
I llit II IIItill IIIl'llfl IIIrl 'rill [rnrnr FIIIIi~ tlTl~il i,~IiiTlrlJfilllllfi