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HomeMy WebLinkAboutBIRCHWOOD SOUTH BLK 2 LT 4Birchwood South Block 2 Lot 4 #051-294-19 72-013 (Rev. 3/78) 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 n -T- PHONE ❑UPGRADE MAILING ADDRESS CSU5PGNAfLQ RD fZ LA S K S`b LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS DISTANCE TO: Well GC Q0 Absorption area 0 / PERMIT NO, --) V Y t� "�/htd.TT E >j wW Z Ma ufacturer Material No. of compartments v l Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth zl�� Y DISTANCE TO: Well Dwelling PERMIT NO. J(7Z O Z < Manufacturer Material Liquid capacity in gallons D DISTANCE TO: Well—IQV 41 Foundation!,Nearest I t line PERMIT NO. w= J LL Z No. of lines Length of ach line Total length o lines Trench widt}t Distance between lines FZW / +S Q H Top of tile to finish grade Materal beneat tile Total effective absorptj gn.area GRAVEL inches S Length Width Depth ERMIT N C7 a F- Type Wa of crib Crib diameter Crib depth Total effecti rption ar a� W DISTANCE TO: Well Building foundation Nearest lot line Class G, Depth Driller Distance to lot line PERMIT NO. J WBuilding 3:DISTANCE TO: foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS Du E PV G f T SOIL TEST RATING INSTALLER REMARKS OFIPTH -7 nF g dW,k, a tAC ® re�9� e •®;�p � I eo♦eeeerrreoeeweoei• OF o'r[ jo ;®ee*see ca®rog r® wen D {� ® N °e° CE -6123 °eG .�°.�►ys Lp gOFESSI o APPROVED DATE LEGAL 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE P13 Department of Health and Environmental Protection " 825 L Street, Anchorage, AK. 99501 264-4720 # # Permit # HANDWRITTEN PERMIT # # � �( ��;',' j c �-OR-ON-SITE SEWER PERMIT 1� 6 Applicant: /� Q /-� c'_ .� Mailing Address: 3-%U Q pf'rl� Location: Phone Number: S(' - p Legal Description :y �-�!J `_ } 1J 6c) CJ Size: Type of Soil Absorption System Is: Trench: Drainfield: _ Seepage Bed: Holding Tank: s. Maximum Number of Bedrooms: Soil Ratin g(sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH L LENGTH L 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 = &( C) 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(Z) INSPECTIONS ARE REQUIRED # Backfilling of any system without final inspection and approval by this departmei will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fe( 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 available to insure proper installation. # # # PERMIT EXPIRES DECEMBER 31, 1 9 3 3 I certify that: (1) I am 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 codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bedrooms. Issued by. Signer.�" ` x':. �. Applicant - t �' � Date: iCA r / j SWP/024 (1/81) .,F :,wj^..�:� c. iI ( / r. MU^`:IPALITY OF ANCHORAGE —� DEPARTMENT OI r ­ION AND ENVIRONMENTAL PROTL ION PERCOLATION TEST 825 L Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST :RFORMED FOR: TiZIRD FNeltg KING DATE PERFORMED: c,�645Z �7 n t :GAL DESCRIPTION: EKLL7rNA RIPCNV o D SOlr1rp Sl)RnI�L510N i,I.00K. Z TFC' T FAoj—E � L}- DEPTH i SLOPE SITE PLAN (FEET! nARk�. ge.o-AJnt P6_hT, PT 1 he_o�En1 To i . O' 2 ' geowlN G2Avfuyv 6Anta, 6D -6M , r4orST 3 4 i 6env�W/ Deet info - 5 6 7 8 9 10 V1 12 13 14 15 16 17 18 19 20 beOWM sil-T4 SFHNDV GQAVC-_L,GM, MOiS-' ,-AJF-LLY DIJLL_1NG- LGEC 9;!f7FL)5AL_ /N _r 15.5" '0 TA L DSP TP V= BpC nJ(J IS.5' CP-INO OPEN To 00'AFTEZ OCiLI-1WJ VC I h16TALLC O TO 93 10' o FLEE- WATT re5EPvZo WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? S L O P E Reading Date Gross Time Net Time Depth to Water Net Drop S 1Z 2 9:2S So Z 9:55 3orr,l/1 ZIV4856 ? . 10 : 0m 5-7/?_14-7' 8 / L{ I O: Sur n 57'/z "-3/16 9 II:10 I ; 11 2 I m PERCOLATION RATE (minutcsrnch) TEST RUN BETWEEN 3' y FT AND 5 FT )MMENTS R F 0 R M E D 8Y: rie' C.vAG/C N !� CERTIFIED BY: DATE: -- - ---- ,� �t _ _. I � � .� �1 I 00 00co L. L,L L" Lt. 44 A-4 r-4 0 0 0 0 0 0 0 0 ce F-, F- F- i-- F- F - Lu LL. LL. L LL. VA cd C4 C4 U U 0 0 0 0 0 0 0 0 0 0 0 0 0 od ce. 0; C-1 C4 W C4 :4 LL. W LL. LL. LL. < 'm '< D z—i Qri WI Cd cr Q Cd Lu X uj LL) ap LL. LL All axcl M: $4 (33 v): bD cl CIL CN o c), o 0 0, 0 o 0 o 0 o o 4-% Eq ci ct cl cl C) Q Com( a\ M wc>. Cl) Lu LL. 0 o o 00 US ce. C4 w w w ce C� C4 cl: ce w , w w w LLI LL. W. Ll� LL. U. LL. U. Z V) o Municipality of Anchorage Development Services Department Building Safety Division ` Onsite Water & Wastewater Program 4700 South Bragaw SL 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 p Parcel I.D. D 5 � - aG 11-16 HAA# n C�05ZAR 1. GENERAL INFORMATION Expiration Date: 7 AB �Jle Complete legal description BIRCHWOOD SOUTH SUBDMSION, LOT 4, BLOCK 2. Location (site address or directions) 16177 CARLISLE STREET ► EAGLE RIVER, AK 99567 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address BUCKMAN, DOUGLAS do JENNIFER Day phone 646-0204 16177 CARLISLE STREET • EAGLE RIVER, AK 99577 Day phone DONNA ORR W/REMAX Day phone 2600 CORDOVA STREET " ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class 'C" Well 0 Public Water System ❑ 240-7493 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 samples. (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, f 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 verify that based on the information obtained from the Municipality of Anchorage riles 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG. Ltd. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines d Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone 337-6179 Date Conditional approval for bedrooms, with the following stipulat#.y, . •' " •' • .;YG"'�, rye . ,�'��G •,•tC �.. Attachments: HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: r (R". 17101) ' ',WSJ Municipality of Anchorage Development Services Department Building Safety Division On -She Water b Wastewater Program 4700 South Bragaw St. P.O. Box 198650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907)343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: BIRCHWOOD SOUTH SUBDIVISION, LOT 4. BLOCK 2, Parcel ID: A. WELL DATA Wed type "Co Date completed _ Total depth Dateof test Static water level Well production COMMUNITY WELL If A, B, or C provide PWSID# 2 1M56 Sanitary seal (YIN) ased to ft. FROM WELL LOG ft. — g -p.m - WATER SAMPLE RESULTS: Coliform A _ oolonies/100 ml. Nitrate J&R mgJL. Web property protected (Y/N) Casing height (above ground) in. AT INSPECTION ft. g.p.m. Other bacteria 1�) oolonies/100 ml. Arsenic: mg./L. Date of sample: 9/12/2005 Collected by: GEG. LtD. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 6/14/1983 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 8/5/2005 Pumper SANITARY PUMPING C. ABSORPTION FIELD DATA Date Installed 8/14/93 Soil rating (g.p.d.t t'or� 85 System type TRENCH Length 61 ft. Width 7 ft. Gravel below pipe 1 ft. Total depth 6-6 ft. Eff. absorption area 342 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 9/9/2005 Results (Pass/Fail) PASS For .3 Fluid depth in absorption field before test DRY in. Water added 600 gal. New depth DRY in. Elapsed Time: 0 min. Final fluid depth DRY in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) NONE KNOWN If yes, give date D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main line COMMUNITY WELL On adjacent Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line ' Surface water 100'+ Wells on adjacent lots 150'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 10'+ Water main 10'+ Water service line ' Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 150'+ F. COMMENTS a SEE ATTACHED DRAWINGS G. ENGINEER'S CERTIFICATION /9K<1f-J 4 -TV I certify that I have determined through field inspections anda 4 '•74 review of Municipal records that the above systems are in "" "' "' . ...... conformance with MOA HAA guidelines in effect on this date. .. . f ... ................ Engineers Printed Name JEFFREY A. GARNESS rj6,� X853 Date to JHi/os f•.; tol hi..• Pr..r��.1eQ HAA Fee $ Li-�o Date of Payment 1U -Il US Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number A IT /IrJ I1rn Y^l Im I Pi 4 9 ZH .............................. a SHANE A. HOLT. 0 LS -6914 L G / AS -BUILT SURVEY NO CORNERS SET THIS DATE SCALE. 7'•50 FC. Cc B.O..ARPRO%. NC.E. I HEREBY CERTIFY THAT I HAVE PERFORMED A MOR TGAGEES INSPECTq OF THE FOLLOVOM DESCRIBED PROPERTY LOT 4. BLOCK i. BIRMMOO SOUTH SUB THE IMPAOERECORpNG TED THEREON ME DTHAT THE IMPROVEMENTS SITUATED E EMKO ARE YATNN THE PROPERTY UNES AND NONSIBLE ENCROACHMENTS EKISi OTHER THM NOTED EASEMENTS OF RECORD. OTHER THM THOSE SM%YN ON THE RECORDED PLAT. ME HOT SHOWN HEREONI DATEDATAHCHORAGE.PTAUSKATHIS 11TH_ DAYOF _SEEMSER TSB&= NOTE ANY FENCEUNES S.OUH ME UO TEDMPROUMATELY ANO ME MY TO BE USED TO DETERMINE PROPERTY UNES HOLT LAND SURVEYIM—W-5.�i OR UO TE STRUCTURES TEL 34&5511 N B9*41'26AE 222.31' S / s / / / • • e S j / a j • � Zt ORAVCL DRIVEWAY •a o / / / O/ N / N / W / ^• p 7 / I a 4+ A/ / � N O°N N / � N / 0 2 / / ti i / / / / / / / I Pi 4 9 ZH .............................. a SHANE A. HOLT. 0 LS -6914 L G / AS -BUILT SURVEY NO CORNERS SET THIS DATE SCALE. 7'•50 FC. Cc B.O..ARPRO%. NC.E. I HEREBY CERTIFY THAT I HAVE PERFORMED A MOR TGAGEES INSPECTq OF THE FOLLOVOM DESCRIBED PROPERTY LOT 4. BLOCK i. BIRMMOO SOUTH SUB THE IMPAOERECORpNG TED THEREON ME DTHAT THE IMPROVEMENTS SITUATED E EMKO ARE YATNN THE PROPERTY UNES AND NONSIBLE ENCROACHMENTS EKISi OTHER THM NOTED EASEMENTS OF RECORD. OTHER THM THOSE SM%YN ON THE RECORDED PLAT. ME HOT SHOWN HEREONI DATEDATAHCHORAGE.PTAUSKATHIS 11TH_ DAYOF _SEEMSER TSB&= NOTE ANY FENCEUNES S.OUH ME UO TEDMPROUMATELY ANO ME MY TO BE USED TO DETERMINE PROPERTY UNES HOLT LAND SURVEYIM—W-5.�i OR UO TE STRUCTURES TEL 34&5511 it '�Yu Juru -------—-- _. — .0 .. Oe b LIXA ,; t Y Pjos :Jllll a o o ' N• TM m G1 °T �c tea. Cj N r H -bI "2 1 C r N t. co L PO' -T co PO' i -A "d b 11 '4 W co COMMUNITY WATER S � wVe W Lar .4 HSE 7W arlf�iSE�. w 9 WELL HOUSE DETAIL LOT 3 14 La: BIRI /N1 1tion %r\ (%I ITI 1 c. vrltvvvv vvtn KEY Box - % Surnc %V4T - o ie.- m u r _c» 19e7245:54 P.01 . � G§§ � 2 Olf /& e .�p$.#f ca .K � 7 2§§ OU QV� 7 � CO k U�\ ie.- m u r _c» 19e7245:54 P.01 i2 290eN ' 9n in4 suwg@a3ee2§ w;�pHge i 'A% OU ® ® 0 2 z u` C4. ..� % .y §/ \� lu ` �► k°`'� `3 t\� e.LLJ 2 !`�G \:q �22§l�� CU i2 290eN ' 9n in4 suwg@a3ee2§ w;�pHge i 'A% 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. # C-1>1 cit\ - IGl 1. GENERAL INFORMATION HAA # Complete legal description Lot 4; Block 2; Birchwood South Location (site address or directions) 16177 Carlisle Drive Eagle River, AK Property owner James Chich Day phone 696-0287 '.,Mailing address Lending agency Day phone Mailing address Mark Soquet/WHY U.S.A. Soquet Realty 16177 Carlisle Eagle River, AK 99577 'Agent Address 4155 Tudor Center Suite 208 Anchorage, Day phone 229-0045 Unless otherwise requested, HAA will be held for pickup. 3 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water AK MgP.94..kLay Of ANLmuRAGE ENVIRONMENTAL SERVICES DIVISION JUN 2 7 1997 RECEIVED 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 021 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 S & S ENGINEERING Phone 64 11- ?-c? 7 / 17034 Eagle River Loop Road No. 204 Address Eagle River.A,las�C9 577 Engineer's signature Date /a. �Q 7 `~fie•' •• ROBERT C. COWAN CE - 8801 F'� . DHHS SIGNATURE it _ ,•c . Approved for 3 bedrooms. `4-•• .,�"'? Disapproved. Conditional approval for bedrooms, with the following stipulations: By. Additional Comments Date 7—/ 7 —97 CAUTION 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 ENi /!?Q � 1PALnyo DEPARTMENT OF HEALTH & HUMAN SERVICES NMENtAI SSR Environmental Services Division ,111!! 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-47M 2? 19g7 Health Authority Approval Checklist RECEIVED Legal Description: OM 4k Parcel I.D.: A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number -2/SW6 Log present (Y/N) Date completed Total depth Cased to Casing height a Sanitary seal (Y/N) Date of test Static water le production g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate FROM WELL LO properly protected (Y/N) AT INSPECTION g.p.m. Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 6 ` k'3 Tank size / OOQ Number of Compartments 2 Cleanouts ON) t1 S Foundation cleanout t) . "Li S Depression Ott N 0 High water alarm (Y/N) ktf,Ai Date of Pumping t Pumper 5Qn t It tY FI Yh r5 C. ABSO FTION FIELD Date ietalled `Soil rating (g.p.d./ft2 '/ Length -:.. Ii/ / f Width Gravel thickness below pipe l,? N Total depth qi Effective absorption area 350 ft- 2 Monitoring Tube present/N) Depression over field (1(9 Date of adequacy test 0//91 Results (Pass/Fail) P5 For 3 bedrooms Fluid depth in absorption field before test (in.); 0 Immediately after 63Ogal. water added (in.): 6 Fluid depth Cj (ins) Minutes later: Q Absorption rate = V57, � g.p.d. Peroxide treatment. (past 12 months) (Ye Nb If yes, give date ,¢ 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) "Pump • " level at* "Pump off" level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On adjacent lots Absorption field on lot Public sewer main Size in gallons p/4- cd is el trA - wN 7 2 Public sewer manhole/cleanout Sewer /septic service line / Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation Property line 1.S Absorption field i Water main/service line 10 /4' Surface water/drainage /Oa/f Wells on adjacent lots d SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line (n i + Building foundation ?9 / Surface water /001+ Curtain drain AJ/A F. ENGINEER'S CERTIFICATION Water main/service line /0 Driveway, parking/vehicle storage area /0 Wells on adjacent lots I certify that I have determined thru field inspections and review of Municipal rec, in conformance with MOA HAA uidelines in effect on this date. 1'PI f ': ./..4, ROO 14 OF Az,? ms are Signature Engineer's Name /G /id 7 C- Co��„�,� Date j3'/a7 k ROBERT C COWL 46. HAA Fee $ .3 Date of Payment X9/9 Waiver Fee $ Date of Payment Receipt Number .:P. -4,#-6a& Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE • -- Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # Q_2D I -al 'LI N1 HAA # �. C'Nq�ab L �kp 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 4; Btock 2; BIRCHWOOD SOUTH SUBDIVISION Location (address or directions) 16177 Cakti.s.2e Dntive (b) Property owner Q F C 6025k Telephone: (home) Business Mailing Address 520 Ea4t 34th Avenue Anchon.age, Ataska 99503 (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent TACK WUTUE CO SPA 1V ATT -N• Kathi Oemstead Address 10928 Eagte Rivvt Road, Egate Riven., AK. 99577 Telephone 694-5500 — (e) Mail the HAA to the following address: (or check herR)7, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING IM14 Engle Rinner Loop Read Ale 904 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-FamilyXX 3. WATER SUPPLY Individual Well ❑ Number of bedrooms '�4 Community X Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site.QX Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th is Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date Telephone 4j4, -'",f !Z % E S & S ENGINEERING 17034 Eagle Rivet Loop Road NO. LW4 Eagle River, Alaska 99577 DHHS APPROVAL Approved for bedrooms b =r ate Approved —_ Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (HAA) U) /,'; d, .VJ( 'GUECKLIST - FEBRUARY 1984 p'rVIC S DlVlSION 343-4744 h L su" Legal Description: :Soo f A. WELL DATA RECUV EP Well Classification _ C If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Total Depth Cased to Static Water; Level Casing Height Above Ground Date Completed Electrical Wiring in Conduit (Y/N) Depth of Grouting SEPARATION DISTANCES FROM WELL: Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot l (k ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot � `3c:;'( '- ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by �Z4-S <f^T� c c r1nT ; Date ( Ct Water Saml Comments B. SEPTIC/HOLDING TAN 'DATA L/ Date Installed Size O- No. of Compartments Z Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) ! Date Last Pumped f3 /Nov E57 Pumping/Maintenance Contact on File (Y/N) IJIA ;for fdit Holding Tank High -Water Alarm (Y/N) ti Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HO,LDING TANK: To Water -Supply Well �'f �� To Building Foundation (n To Property Line J �� I fi To Disposal Field y To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course !J �IA Comments 72-026 (Rev. 7/88) Front Page 1 of 2 tel. C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed IU Length of Field (0 l Width of Field Depth of Field Gravel Bed Thickness ! Square Feet of Absortion Area Z2'5_070— Statndpipes Present (Y/N) ..II % Depression over Field (Y/N) N Date of Last Adequacy Test Results of Last Adequacy Test ��`f"t c.�� f�c� t/ o ©a►� SEPARATION DISTANCE FROM ABSORPTION FIE�,D: To Water -Supply Well � + To Property Line I f r To Building Foundation IL To Existing or Abandoned System on Lot ; On Adjoining Lots To Water Main/Service Line (o t To Cutback (if present) A) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area 0 Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effeq inspection. Signed S & S ENGINEERINGt�� ... Engle II';iver Loon Road yup, Company Eagle River, Alaska 99577 r R Date 2 S A yp a. MOA No. Receipt No Date of Payment Amount: $ Cor � a' -' Receipt No Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 �2��, is � �S. pis.• a e,esa+ ,.s•" s Seal 14d7�e ° STEVE COWPER, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775 3601 C STREET. SUITE 1334 ANCHORAGE. ALASKA 99503 DATE: September 7. 1988 PWSID: CLASS C WELL To Whom It May Concern: According to the records on file in this office, the LOTS 1. 3 & 4,__ BJ__OCK2. BI_RCHWOOD SOUTH SUBDIVISION Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, /ruce E. Erickson District Office Supervisor BFE:Pkk CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street —4. Anchorage, Alaska 99518 j` Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER (�Q PUBLIC WATER SYSTEM I.D.# 1P I ❑ PRIVATE WATER SYSTEM Phone No. Name S & S ENGINEERING g e Iver oop oa O. _ Mailing Address Eagle River, Alaska 99577, City State Zip Code SAMPLE DATE: EMI 51� Mo. Day Year SAMPLE TYPE: ❑ Routine Check Sample (for routine sample with lab ref. no. II - I 3T--) El Treated Water ❑ Special Purpose E3445— 'I— Time Untreated Water SAMPLE Time Collected NO. LOCATION Collected BY 2 3 1 4 1 5 I READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received _ /� f Time Received / / C-117> Analytical Method: Membrane Filter No. of colonies/100 ml. Lab Ref. No. Result" Analyst Ell ED ELI J m BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Verification: LTB BGB Collform/100ml (� Final Membrane Filter Results Collform/t00mlq Reported By Date Time: a.m. p.m. TNTC = Too Numberous To Count OB = Other Bacteria CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92.0040440 ANALYSIS REPORT BY SAMPLE for Work Order # 18156 Date Report Printed: NOV 13 89 @ 18:52 Client Sample ID:L4 B2 BIRCHWOOD SOUTH S/D Client Name S & S ENGR PWSID :UA Client Acct SNSENGP Collected NOV 7 89 @ hrs. P.O.# NONE RECEIVED Received NOV 8 89 @ 14:00 hrs. Req # Preserved with :AS REQUIRED Ordered By : S & S ENGRS. Analysis Completed :NOV 10 89 Send Reports to: Laboratory Supexvi or :STEPHEN C. EDE 1)3 & S ENGR Released By : G-2) .................................................................................................................................... Special Instruct: Chemiab Ref #: 8445 Lab Smpl ID: 3 Matrix: WATER Allowable Parameter Tested Result Units Method Limits NITRATE -N Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY R.J. 1.2 mq/l EPA 353.2 10 .............................................................................................................. 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 Time APPLIC..AT FILLS OUT UPPER HAL ONLY Time Property Owner ` (; r ll.r� l / a I %_ Date Phone Mailin; Address Date Zip Code Buyer Inspector Address Inspector Zip Code Lending Institution \'f) ; L %`%r.+' ; ,. i" r. Phone Address . F. 1 . 17 • Zip Code Realty Co. &Agent41, .; / ( Phone I cl 1-1 0 Address- f' Zip Code ( ) DISAPPROVED Legal Description /` �y-, y c`,� 0v 1 c c > TH - e / . Z— �f Street Location DATE 3 Type of Residence Soils Rating Single Family 7 Well Log Received ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply ❑ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal .Sk' Individual Year Individual Installed: i •' ' ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time n IlJ LIAA._) Date Date Date Date Inspector Inspector Inspector Inspector �. L) �� A Field Notes: I cl 1-1 0 () APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE 3 BY: -- Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank 72023 (3182) DEPT. OF ENVIRONMENTAL CONSERVATION SOUTHCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 June 1, 1984 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 P.O. Box 1234 Eagle River, AK 99577 Dear Sir: No11�71��'�d �V1.i'r'Pli{poll�N� 38 H11VIO ��21QHa�l7 �C� All l'/dl�lN(iW Subject: Wastewater System, Birchwood South Subdivision, 3L 33BB Eagle River, Alaska (8421 -DA -332) We have reviewed the plans and specifications for the subject project. The plans are approved, conditioned on adherence to the following items: 1. screened rock back fill in deep and wide trenches (3/4" - 3"). 2. screened rock back fill in absorption bed (3/4" - 1 1/2"). 3. sufficient area plotted on as -built for replacement system. This letter constitutes the permit required by A.S. 46.03.720(a) for plan approval of sewerage systems. It should be remembered that final approval will necessitate the submission of Engineer As -built Plans to include photographs as indicated on page 13 of enclosure. This will consequently mandate that a professional engineer conduct basic inspection of this project so as to be able to sign off on as -built plans. Arrangement for this inspection work is the responsibility of the developer. Sincerely, V James F. Hayde Environmental ield Officer JFH/msm Enclosure cc: Robbi Robinson (MOA Health) CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of y public water system located Alaska, submitted in accordance with 18 AAC 80.100 rf have been reviewed.and are approved. d. q. ' !' ' 1 ❑ conditionally approved (see attached conditions). x. BY ,) TITLE DATE ll If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change (contract order no. Approved by Date or descriptive reference) The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE The construction of the public water system was completed on (date). The system is hereby granted interim approval to operate for 90 days following the completion date. BY TITLE DATE As -built plans submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. BY TITLE 1 .'.. DATE [. 7n'. i'y � d'n *xd' : it 4 of z t h te':i.r : r.: .a .•,Ir ain 1', i.�� w e�An`i�4 li .. t7y'; MUNICIPALITY OF ANCHORAGE Department of Health and Environmental Protection 825 L Street, Anchorage, AK. 99501 264-4720 # # # HANDWRITTEN PERMIT # # # Permit # I R -ON-SITE SEWER PERMIT 503 Applicant: E p CQ -7h Mailing Address: 37U O Spe.1a r Location: Legal Description: Type of Soil Absorpti Trench: k Drai Maximum Number of Bedr The Requ DEPTH ' LENGTH Phone Number: J�(o �0 c, ro CJ 60 c) J0L 6/bt Size: System Is: eld: _ Seepage Bed: Holding Tank: s: Soil Rating (sq.°ft/br)., Size of the Soil Absorption System Is: GRAVEL DEPTH; ZWIDTH The length dimension is th ength(in feet) of the trench or drainfield. The REQUIRED SEPTIC(HOLDI TAN SIZE = a�� GALLONS Permit applicant has the responsibi "ty�'`o inform --this d partment during the installation inspections of any wel jacent his operty and the number of residences that the well will ser # # # TWO (Z) I NS C A R UI -RE # # # Backfilling of any system without nal s et and pproval by this departme will be subject to prosecution. depth of a trench or pit is e distance bet 'e en the surface of the ground and the bottom of the excavation feet). Th e is no set width for trenches. The gravel depth is the minim depth of avel between the outfall pipe and the bottom of the excavation (i feet). Minimum distance between a we nd an sewag disposal system is 100 re for a private well or 150 to fee from a lic w 11 depending upon the type of public well. Minimum d' ; nce om a pri e wel to a private sewer line is 25 feet and to a communi se line is 75 et. Well logs are required and must be returned to thi artment within das of the well completion. Other requirements may app Specifications an o struction diagrams are available to insure grope installation. # # RMIT EXPIRES DECEMBER 31 9 3 3 I certify that: f- (1) I am famil''' with the requirements for on ite sewers and wells as set forth: the Municipality of Anchorage (2). I will i all the system in accordance wit codes. (3) -I unders nd that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bedrooms. SigneZL: o �(.� ✓;�. Issued by: _..\ Applicant ' Date: -_---- - SWP/024(1/81) Cr'y«ail � 71c ,.Ov.. jam; ,f0 74 Coati u� TOP Municipality of Anchorage January 4, 1984 POUC;I , 6 W ) 0 ANCHORAGE, At ASIKA ) 1502-06,')(1 (907) I64-41 1 1 TONY KNOK,/ 1,S. MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Mr. David Yanoshek, P.E. Arctic Engineers, Inc. 1506 W. 36th Avenue Anchorage, AK 99503 Subject: Septic Systems Inspections, Lots 1-4, Block 2, South Birchwood Subdivision Dear Mr. Yanoshek: I have finished review of the submitted as-builts and additional submitted information and the results are as follows: Lot 1: The concrete septic tank does not meet Uniform Plumbing Code (and this department's) specifications for a septic tank. The first compartment is not large enough and there appears to be problems with the inlet and outlet baffles. The specifications are listed in the appendix of the U.P.C,., pages 179 to 181 (a copy is attached). Lot 2: The tank is not approved. A possible solution will be to add an additional 500 gallon (approved type) septic tank after the concrete tank; however, amit will need to be obtained prior to installing it. ter,,-, fie- Lo -t I) Lot 3: The trench absorption area is adequate for 2 bedrooms. If additional bedrooms are desired then an upgrade will need to be completed and a permit obtained. Lot 4: As-builts are acceptable. Thank you for your assistance and for providing the additional information. Sinc�rec�� ly, '-\ . Cory Willis, R.S. Acting Sewer & Water Program Manager CW86/ej/E1 cc: Larry Maulden Jack White 3201 C Street Anchorage, AK 99503 Lot 2 Enclosed is a blueline of the septic tank installed on this lot and lot 1. One foot (1') of sewer rock was installed below the drain tile. The total effective absorption area for the system is based on a seepage bed design allowing a 20% reduction factor. 62x 7x .8 = 347 S.F. Lot 3 One foot (1') of sewer rock was installed below the drain tile. A perc test was conducted between the 6.9 feet and 7.3 feet level. The soils rating is 154 S.F./B.R. The effective absorption area is 58 x 7 x .8 = 325 square feet. Lot 4 One foot (1') of sewer rock was installed below the drain tile. The effective absorption area is 61 x 7 x .8 = 342 square feet. If you have any further questions pertaining to this matter, please do not hesitate to call. Sincerely, ARCTIC ENGINEERS, INC. David YanAlhek, P.E. Project Engineer