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HomeMy WebLinkAboutBIRCH HILLS TERRACE #2 BLK 4 LT 6Birch Hills Terrace #2 Block Lot 6 E, #050-141-48 ` ` ` lug', C{PALITY OF ANCHORAGE l3rttttn DEPT. OFt. `L7ri 8wrri tfi� L I ECTION RONMENT/� [DOC Co. dba_ AUG 13 1980 SULLIVAN WATER WELLS C E I V E P. O. BOX 272, CHUGIAK, ALASKA 99567 a TELEPHONE 688-2759 E OWNER OF LAND DEPTH OF WELL ADDRESS` STATIC LEVEL OF WATER FT. LEGAL DESCRIPTION - DRAW DOWN FT. DATE - Started Ended = GALS. PER HR PERMIT NUMBER KIND OF CASING KIND OF FORMATION: From Ft. to -Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to - - Ft. _ ` ` From. _ Ft. to Ft. From Ft. to Ft. = = From Ft. to -Ft From Ft. to Ft. - -_' E. From -Ft. toFt. From Ft. to Ft. _ From Ft. to Ft. From Ft. to Ft. �: r__ From Ft. to Ft. From Ft. to Ft." =° ` From Ft. to Ft. From Ft. to Ft. From Ft. to - Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. - = From Ft. to - Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. a". ; _ - From Ft. to - Ft. From Ft. to Ft. - From Ft. to Ft. From Ft. to Ft. From - - Ft. to Ft. From Ft. to Ft. From' Ft. to Ft MISCL. INFORMATION: MUN I IZ- I Fz'*nL_I -rV ��r-- nNC"OF.�.nCiEE DEPARTMENT r HEALTH AND ENVIRONMENTAL r ]TECTION 825 'L STREET, ANCHORAGE, HK. 99,-,1 264-4720 PERMIT NO ( 800]62 ) APPLICANT TRAVIS BARBER PO BOX 66 E.R. 694_9408 LOCATION FIREBALL LEGAL NLOT SIZE 29926 SQUARE FEET MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM I5 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION' OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ���M I -r �X F=" I F-t �e 0 a M e e V-.' a -1L" -1 L -"=: 4�f___ I I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. SIGNED: ---------------------------------------- APPLICANT - TRAVIS ------ HPPLICHNT TRHYIS BHRB| ISSUED BY____-`=� Y4.0 rim 264-4720 < =3 x33 2 ? vv -i 8AFwR PC Sox 66 E- 9- L lw .Ltti ff I I� ILL. iRt I LOT SIZE '.aGpjARC FEET'' M I N G ropi-H 0 3 TFkNr;F- OUNEEN 13 I- .a. ANO MW QN --S t TE SEPDX D I S 'S"SrW IS f L .FEET FOR F FRIVArE WELL QA V113 TO �tN* PlEeT FROM A PfJOLIC 14ELI. D= iW, spm rw- T'ew oF Ff... to vo-u I- tl[Nt"JM Dl*5TRNCC f=P' M A RRIYATE WELL TU A PRIVATE SE14CER LINE I.a 2-S FECT tM io R CioMpo-W I T B 4" L I NEt FEE T. E WELIL LOS fV�C REQU t RED FV40 "-1,3T BE RETURWO TO THE DEPARTMENT WITHIN 30 D'e'w U -IF TW 140-L '-,0llM-Crf0N- AYArt-ASUE TO t='€ OPW IN55 M ,.L.AT ION. ccR r try niAT I AM FRMEL IPR 14 I H THE 3."U I REPfENT a FOR ON - t T E EWM3 F;)R T`j# By Tj tlJlN tj f Pfq I rt OF AWH#3RWJF— ;2. 1 WILL IW-5,TALL TW SYSTEM IN WIN THE f [�- i r _ �� T 'RAVIS ORR8ER C 1 'ON K� rim 264-4720 < =3 x33 2 ? vv -i 8AFwR PC Sox 66 E- 9- L lw .Ltti ff I I� ILL. iRt I LOT SIZE '.aGpjARC FEET'' M I N G ropi-H 0 3 TFkNr;F- OUNEEN 13 I- .a. ANO MW QN --S t TE SEPDX D I S 'S"SrW IS f L .FEET FOR F FRIVArE WELL QA V113 TO �tN* PlEeT FROM A PfJOLIC 14ELI. D= iW, spm rw- T'ew oF Ff... to vo-u I- tl[Nt"JM Dl*5TRNCC f=P' M A RRIYATE WELL TU A PRIVATE SE14CER LINE I.a 2-S FECT tM io R CioMpo-W I T B 4" L I NEt FEE T. E WELIL LOS fV�C REQU t RED FV40 "-1,3T BE RETURWO TO THE DEPARTMENT WITHIN 30 D'e'w U -IF TW 140-L '-,0llM-Crf0N- AYArt-ASUE TO t='€ OPW IN55 M ,.L.AT ION. ccR r try niAT I AM FRMEL IPR 14 I H THE 3."U I REPfENT a FOR ON - t T E EWM3 F;)R T`j# By Tj tlJlN tj f Pfq I rt OF AWH#3RWJF— ;2. 1 WILL IW-5,TALL TW SYSTEM IN WIN THE f [�- i r _ �� T 'RAVIS ORR8ER C 1 Parcel I.D. 050-141-48 -- Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: 7r 1 3 Complete legal description Birch Hills Terrace #2, Block 4, Lot 6 Location (site address) 11215 Fireball St Current Property owner(s) Gayle &Marc HOffineister Mailing address Real Estate Agent 11215 Fireball St 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer 0 WaiverNariance request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ ��l O^ Waiver Fee $ Date of Payment �JII13 (' Date of Payment Receipt Number 09>1tk'X G\ Receipt Number COSA# ©SC.13j03 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 Onsite 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 Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineers Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 272-8218 Date ZZ / Conditional approval for bedrooms, with the following stipulations: BOriginal Certificate Date: The Municy3 iEmations rage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the repreiven in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAbluesheel f '- 1, c If more than 1 septic system is on the lot: COSA Checklist # 1 of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Birch Hills Terrace #2, Block 4, Lot 6 A. WELL DATA Parcel ID: 050-141-48 Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 8/6/80 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 135 ft. Cased to 40 ft. Casing height (above ground) 18 in. FROM WELL LOG AT INSPECTION Date of test 8/6/80 3/26/13 Static water level 105 ft Well production 9-5-K iO g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 5.44 mg/L Arsenic ND ug/L Date of sample: 3/18/13 B. SEPTIC/HOLDING TANK DATA Tank Type/Material 107 ft. 4.0 t g. p. m. Collected by: Nick Curtis Date installed Tank size gal. Number of Compartments Cleanouts (Y/N) Foundation cleanout (YIN) Date of pumping Depression over tank (Y/N) _ High water alarm (YIN) Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./f:2 or ftz/bdrm) System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Elf. absorption area fe Monitoring tube _ Depression over field_ Date of adequacy test Results (Pass/Fail) For _ bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons _ "Pump off"level at Cycles tested _ WELL ON LOT TO: Septic tank/lift station on lot./ UO + Absorption field on lot i G 0 k Public sewer main '754 Sewer /septic service line )-S4 Animal containment areas 10 0 E SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Water main Water service line Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line _ Water Service line Curtain drain F. COMMENTS Building foundation Surface water Wells on adjacent lots Manhole/Access (Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 0 O } On adjacent lots I O 0 '{' Public sewer manhole/cleanout r G O f Holding tank 1004 Manure/animal excrete storage areas ! 00 { G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date COSA brown sheet 10-10-12.doc Absorption field Surface water Water main Driveway, parking/vehicle storage 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.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. . DSO- lN/ - J191 #�C� (a t� Expiration Date:9-730-05 1. GENEFu1L1NFORMATl0(d Complete legafdevcflptiort , �r �ln�� Y9 i %/ TnB 5� ae (o . .- Location (site addressor directions) //,I- /S pl. Current Property owner(s) c` �.u.r,� (�Lwc,�. Day phone Mailing address Lending agency' Day phone Mailing address Real Estate Agent _�iu L f1fA_4Vk� Day phone y24A - 1p-..3 Mailing Address Unless ofherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF.WATEkS UPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 TYPE OF WASTEWATER DISPOSAL: Er 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. 1 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. Eagle River Engineering Services Name of Firm Address Eagle River AK 99577 Engineer's Printed Name 5. DSD SIGNATURE _ z Approved for _ bedrooms. Disapproved. Phone VII-S/'7S Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By:('OO-P_� _ Original Certificate Date:4�0�- rRev 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.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: JZneL A/13 TAA412.4 -2*PZ9flif Jelg Parcel ID:_&!52- /#//- yg A. WELL DATA Well type If A. B, or C provide PWSID # _ Date completed 2/1a/go Sanitary seal &N) _(v4:d Total depth /15L ft. Cased to / 3S ft. FROM WELL LOG Date of test Static water level Well production V& / gy 105, ft. /0 WATER SAMPLE RESULTS: Coliform _0—colonies/100 ml. No} Arsenic: Tes mg./I. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Well Log ®N) Wires properly protected (9N) r/iw Casing height (above ground) ' 7Z�in. AT INSPECTION /06.9 ft. g.p.m. S g.p.m. Nitrate 4, (q mg./l. Date of sample: 6���1o5 Other bacteria O colonies/100 ml. Collected by: Chgrle; 6g lzarl,i Date installed Tank size gal. Number of Compartments _ Cleanouts (YIN) Foundation cleanout (YIN) = Depression over tank (YIN) _ High water a� Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Length Total depth Date of adequacy te<. Fluid depth 1� N _ Soil rating (g.p.d.lft2 o rm�`o ft. Width 0 5� ft. Eff. abs on area :0—fe Monitoring tube Time: _ min. Yt System type Gravel below pipe ft. Depression over field Results (Pass/Fail) For _ bedrooms field before test _ in. Water added_ gal. New depth_ In. Final fluid depth _ in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) 'Pump on' level at —in. 'Pump off" level in � �� High water alarm level at in. Datum 'ycles tested �l Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot __L Mfi21AOn adjacent lots fi 100 r — Absorption field on lot - . g Public sewer main -f-76 Sewer /septic service line t SS On adjacent lots i 100 Public sewer manhole/cleanout t1OO Holding tank + 100 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption field Water main Water service line Surfa r Wells on adjacent lots SEPARATION DISTANCE FROM ABSORP101 FI�C6_DV�dT TO: erty Propline dinr�fq*1 datSiiK 0� Water main Water Servi Surface water Driveway, parking/vehicle storage ain drain Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that t 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. pfOPFER Engineer's Printed Name .,��/s%ORI'i'Eie... ll?• D �� Date .."". HAA Fee $ Date of Payment Receipt Number cO (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number 06-17-05 03:30PM FROU-CTiE ESI, SGS ENV SERVICES J SGS RrEN 1053500001 Client Name Eaglc River Engineering Project Name/N Birch }tills Teruce 02 Ctkni Sample 10 Birch Hills Terruce 02 E14 L6 Menta TlrinkinR Water Sample Remattlis: 300.0 - Result represents total nitrate plus nitrile. 9075615301 T-195 P.01/04 F-771 All Datc ETImes are Alaska Standard Time Printed Datefrime 00/27/1005 12:50 Collected DateMme 00/17/2005 10:15 Reerired Daterrime 06117/2005 12:42 Technical Director Stephen C. Ede -- AttowaWe PEEP Amlyril parameter RCraIU IQL Unite Medved Container ID Limle Date Date )nit Waters Department Nitrate -N 4.19 0.100 mWL DPA 300.0 0 (<-10) 06/12/05 Jill Microbiology Laboratory Total Coliform 0 col/IWmL SM209222D A 06/17/05 TLF 3oe ,S ,8 0 0 ASBUILT-NO CORNERS SET THIS DATE. %Z .s1a tlrb- ' el%.Vv 0 A N 1 HEREBY CERTIFY .THAT 1 HAVE SURVEYED THE `E v--wean 8 ASSOCIATES LAND SURVEYING 6 ' - FOLLOWING DESCRIBED PROPERTYe AND THAT NO ENCROACHMENTSEXIS�EX EC RT ASy ��•''•'' OF Z ,INDICATED. IT IS THE RESPONSIBILITY OF THE ... TH OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RF_STRICT10N9 BRIG �y " WHICF{ DO NOT APPEAR Olrl THE R!'CORDED SuBDi- ifs VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD F& : Cues, Mole s.w,.s ANY DATA HEREON BE USED FOR CONSTRUCTION LS -691B { � OF FENCE LINES, OR FOR ESTABLISHING Mum. �: �►. '•... ui AAV 1 lure _ 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. S & S ENGINEERING 17034 Eagle River Loop Road No. 204 6 R 2 2-q 7 Name of Firm Phone Eagle Iver, Alaska 99577 Address Engineer's signature je& z,-— Date �d- �I l g 7 6. DHHS SIGNATURE 2; 1 Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments ,o - � By. `��, ,: ° bate rO6 f u.. CAUTION • _ 9 The Munici al) f4Anchora e D epartment of Health and Human Services (DHHS) issues Health Authority P tY,. pproval,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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze 'data before "a` certificate is issued. The Municipalityof 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 ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage JAN 3 0 1997 DEPARTMENT OF HEALTH & HUMAN SERVICES p C' Environmental Services Division 1C L VE& 825 L Street, Room 502 *Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: Low &,Ocy, H &kr-A Parcel I.D.: © S-0 " /14 A. WELL DATA Well type PIK0 At< If A, B, or C, attachADEC letter. ADEC water system number Log present ON) Its -5. Date completed 8 6 Total depth {35� Cased to Casing height (above ground) Sanitary seal O/N) YES Wires properly protected (DN) yES FROM WELL LOG AT INSPECTION Date of test 8 (6go 1 - Z4 - Z7 Static water level 105 t 1 f) Well production /0 g.p.m.. S g.p.m. WATER SAMPLE RESULTS: Coliform 91 Nitrate 1+. Z2 Other bacteria 0 Date of sample: 1 Z23 41'7 Collected by: �' ,RNOIN�ISRINO --T—",iw+A-�iia�{a oi..... Loop Reed. No. 204 B. SEPTIC/HOLDING TANK DATAEagle River, Alaska 99577 ML)r4lCIFAL- jI tjarzZ Date installed Tank size - Number of Compartments Cleanouts (Y/N)— Foundation cleanoyt-(Y/N) Depression Y/ water alarm (Y/N) Date ofPumper C. ABSORPTION FIELD DATA 1J 1 C ► A (_ Date ),stalled Soil rating (g.p.d;/ft2 or ft2/bdrm) System type Length' Width Gravel thickness below pipe - Total de Effective lbsorption'area Monitoring Tube present (Y/N) ession over field (Y/N) Date of adequacy test Results P I For - bedrooms Fluid depth in absorption field bef (in.) immediately after gal. water added (in.) Fluid depth (ins) Minutes later: Absorption rate = g.p.d. Per treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in Manhole/Access (Y/N) 4a oevel at* "Pump off" level at* High water ael at* *Datum C cles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot e>SF On adjacent lots >Je Absorption field on lot E On adjacent lots Public sewer main "1 S -F Public sewer manhole/cleanout 100 I f" i Sewer /septic service, line 2 S fi Lift station SLA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation Property line sorption field W me Surface water/drainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building 'foundation ater main/service line Surface water Driveway, parking/vehicle storage area Curtai m Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that 1 have determined thru field inspections and review of Municipal 1 in conformance with OA HAA guidelines in effect on this date. Signaturela,4 YzZ Engineer'sName C— �o w.4, Date % °► 7 HAA Fee $ 3 M 0 Waiver Fee $ Date of Payment/3a js� ) Date of Payment Receipt Number d� 02 / Receipt Number 72-026 (Rev. 3/96)* u, 77s are LJl HI IU IU JiLiL _, �7U(UJ41c'lI AML CT&E Environmental Services Inc. CT&.E Ref.# Client Name ;Project Name/M Client Sample TD Metrix Ordered By PWSW Parameter Nitrate•N Total Coliform 970397001 S & S Hoginouring LG B4 Birch Hills Terr. #2 L6134 Birch Hills Teri. #2 Driuking Water C Hu. 6u— Client PON Printed Date/Time 01/28/97 1.4:25 Collected pate/Time 01/23/97 11:30 Received Date/Tlrne 01/24/97 09:30 Technical Director; Stephen C. Ede Released By Allowable Prep Analysis Results PQL Units Method Limits Date Date Init 4.22 1.00 mg/L SM10 4500-µ03f 10 Max, 01/24/97 J8L 0 col/100mL SM10 9ZZZ0 01/Z4/97 TAV 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 Parcel I.D. # 0�3p- Till- HS HAA # Q Q q 20\�� 1. GENERAL INFORMATION Complete legal description Lot 6• Block 4• Birch Hills Terrace Subdivision 4 Location (site address or directions) 11215 Fireball Street, Anchorage, Alaska Property owner Mailing address Lending agency Mailing address Travis Barber Day phone 694-9408 686-4849 wk Mrs Barber, Day phone Agent Ray Heberer - RE/MAX OF EAGLE RIVER Day phone 694-4200 Address 16600 Centerfield Drive, Suite 201, Eagle River, Alaska 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 -\� XXX 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 XXX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm a aJEN04NcisNrPhone Address 17034 Eagle River Loop Road No.Eagle River, Alaska 995// 20 Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments bedrooms. Date -) 1 -11- bedrooms, with the following stipulations: By. _� O �t4 &-1 I "1H Date 3 l8 9' Z — 111Tlr 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 orderto 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 k21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Llc� %o 'C I,K., Parcel I.D. A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present/N) y Date completed 16' - LE'.- OE" Driller , ZL' Total depth f Cased to 1 '27y I Casing height k2 K�- Sanitary seal 69N) y Wires properly protected (7N) WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate • \ "0 Q Other bacteria � '512-2 --,2 B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Collected by: _t_>A S �lle_r�t P1 L)ryl6_1F,6.� Tank size Foundation cleanout (Y/N) Compartments Depression (Y/N) Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wells) on lot To property line Surface water/drainage 72-026 (Rev. 7/91) Front On adjacent lots Absorption field Foundation Water main/service line CONTINUED ON BACK PAGE FROM WELL LOG AT INSPECTION R, Date of test S - (P ' 8c_-) 2— 3 oC Static water level oS 1 13 r -n ,. m y -Z-1 r Well flow4. g.p.m. to g.p r�"lii "'I 0 o Pump level l)tl�-- < rM T A < SEPARATION DISTANCES FROM WELL TO: �� 1 Septic/holding tank on lot On adjacent lots Absorption field on lot d�� ; On adjacent lots Nbf �`'� Public sewer main Public sewer manhole/cleanout Sewer service line 25 -�— Petroleum tank N C,K(L Y: t` (,k� ►�-� WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate • \ "0 Q Other bacteria � '512-2 --,2 B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Collected by: _t_>A S �lle_r�t P1 L)ryl6_1F,6.� Tank size Foundation cleanout (Y/N) Compartments Depression (Y/N) Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wells) on lot To property line Surface water/drainage 72-026 (Rev. 7/91) Front On adjacent lots Absorption field Foundation Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer. Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Date installed Length Width Total absorption area Depression over field (Y/N) Results (pass/fail) On adjacent lots "Pump off" level at Cycles tested Surface water Peroxide treatment (past 12 months) (Y/N) Soil rating —Gravel thickness System type Cleanouts present (Y/N) Date of adequacy test for SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain E. ENGINEER'S CERTIFICATION On adjacent lots Cutbank Total depth If yes, give date Property line To existing or abandoned system on lot Water main/service line Driveway, parking/vehicle storage area bedrooms I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. OF S & S ENGINEERING �,' ����y� E 7034 Eagle River Loop Road No. 204 c Signature % ,.1e e River, Alaska 99577 % Engineer's Name Date C 5 tl,bZI E." 59 HAA Fee $ o Waiver Fee: $ Date of Payment ��� �� 1.— Date of Payment Receipt Number �35� �^ �� %�' Receipt Number 72-026 (Rev. 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE # 51599 Chemlab Ref.# 92.0824 Sample # 7 Matrix: WATER Client Sample ID L6 B4 BIRCH HILLS TERRACE S/D PWSID UA Collected MAR 2 92 E 10:20 hrs. Received MAR 3 92 ! 14:45 hrs. Preserved with AS REQUIRED Analysis Completed : MAR 4 92 Laboratory Supervisor HEN C. EDE Released By : el Client Name :S & S ENGINEERING Client Acct :SNSENGP BPO# Req# Ordered By Send Reports to: 1)S & S ENGINEERING 2) PO# :NONE RECEIVED .................................................................................................................................... Parameter Results Units Method Allowable Limits ------------------------------------------------------------------------------------------------------------------------------------ NITRATE-N 3.1 mg/l EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: M. REEFER. Remarks: .................................................................................................................................... 1 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected " See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than 1�'% SGS Member of the SGS Group (SociAtd GBndrale de Surveillance) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 9 - \ a - g� 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L O T CO 2> L C C.1L 4 91 f2t_6k TF 9rZ AdJ5 Location (address or directions) °LZrzM,r_r_ of 91 rI Ro€ BaCz- (b) Applicant Name I—AA%4 t-2 7B��Q.86e- Telephone: Home �y ��-`>�� �1 Business Applicant Address '2 S 1 S FLn.w/n -e s S'/L BL 96 pc F a rfj-7) If 01 U (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder 0,; Buyer[]; Other ❑ (explain); (d) Lending Institution ALI 01 ?^-' Telephone Address (e) Real Estate Company and Agent ALl0 A -f F Address Telephone `0 (f) ,Wae -the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well Community ❑ Public ❑ 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 Onsite ❑ PublicX Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 0 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of 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. 1 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 Address Date 6. DHEP APPROL'� Approved for be rooms by Approved rove Terms of Conditional Approval Telephone Conditional CAUTION PIA 0 4k 4 �1 vp R.b.n A. shakr ;• Date The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above 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 requirements. 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 omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) OF ANCH_�AGE D.TY HEALTH Nt EpT& MUNICIPALITY OF ANCHORAGE (MOA) EPTOF EWl,ONN1ENTA6 PROTEC7tOHEALTH AUTHORITY APPROVAL (HAA) N - CHECKLIST - FEBRUARY 1984 J U 2 2 06 264-4720 �, / �D Legal Description: R:ECE A. WELL DATA N�Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log, Present Date Completed. $'" y a Yield &w_fa4r>S Total Depth 135 Cased to ' 4y'+- Depth of Grouting Static Water Level lPump Set At LkK Casing Height Above Ground IZ' } Sanitary Seal on Casing 044 Electrical Wiring in Conduit O/W Depression Around Wellhead Pho 01PSeparation Distances from Well: To Septic/Holding Tank on Lot N b ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots AJ 1A+ To Nearest Public Sewer Line t To Nearest Public Sewer Cleanout/.Manhole /Db f- To Nearest Sewer Service Line on Lot Z.S� Water Sample Collected by Date�'`�� Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size No. of Compartments Standpipes (Y/N) Air-tight Caps,(Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) for Holding Tank High-Water Alarm (Y/N) ,tTemporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Building Foundation To Property Line To Disposal Field To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comments V'V_tUlcr,lLQ 8QQA _ aN '7 t9-gis Page 1 of 2 72-026(11/64) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Property Line To Building Foundation To Existing or Abandoned System on Lot ; On Adjoining Lots To Water Main/Service Line To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments VFcOL►Irl E.b �Aooic. Up _ C), -j 7-/9- £3S" D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed 840 021 MIUM Date 7 z4 ?i o��. ' j`�1V MOA No. G�3 'r►1"i Comp�t - ` Receipt No. �0 OF qC�O Date of Payment ZZ_ OO '�►�,.•'•••• '•••• r tj ••? Amount: $ 4rj , 0-0 01 ...... � Umrt A. Sha%r v Page,2 of 2 1 `nom �• No. 1457-E F •. .•' a� 72-026(11/84) ����p6X!, «a" ° 5, LEGAL DESCRIPTION - L R 2i STREET LOCATIO IDENCE S. TYPE-7SINGLE NUMBER OF+BEDROOMS `FAMI LY 13 One 13 Four ❑ Other wo ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six T. WATERS PLY INDIVIDUAL* *ATTACH WELL LOG.A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) B. SEWAGE -DISPOSAL SYSTEM ❑❑% INDIVIDUAUON-SITE** 1490 YEAR ON -SITE -SYSTEM WAS INSTALLED. L�f PUBLIC UTILITY NOTE; THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY. 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY MULTIPLE FAMILY NUMBER of BEDROOMS ❑ ONE ❑ THREE ❑ FIVE C❑ OTHER ❑ TWO ❑ - `FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade -give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line - - 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY 1% iuc�pafity of Anchorage rLs 41-1kl-91 8219 "1_" ST R E ET 0-10 14 ANCHOR GE, AL.ASKA99501— L-L�`LJ W- (907) 2644111 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION April 7, 1981 Travis L/Barbara S. Barber Post office Box 66 Eagle River, Alaska 99577 Subject: Lot 6 Block 4 Birch Hills Terrace Subdivision #2 Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: (1) The water analysis report needs to be delivered to this office from the Chem Lab, 5633 B Street'. for our review. (2) The top of the well casing needs to be sealed with a sanitary seal so that it is water -tight. If there is one there, it needs to be tightened and reinspected by this office when completed. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. 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