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HomeMy WebLinkAboutWHITE BIRCH BLK 1 LT 1AWhite Birch Block 1 Lot 1 A #051-104-66 ,qUBMITTAI Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 SUXWTT ON-SITE WASTEWATER INSPECTION REPORT MAY 12 2015 Permit Number: OSP 151099 PID Number: 05110466 Dwelling: N Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New 0 Upgrade Name: Mike Simpson ABSORPTION FIELD ❑ Deep Trench X Shallow Trench ❑ Bed ❑ Mound Address 20632 White birch rd ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 696-3244 3 existingTotal n/a GPD/SF - Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade -- Ft. Gravel depth beneath pipe - Ft. Subdivision Block Lot White Birch 1 1 Fill added above original grade - Ft. Gravel length -- Ft. Township Range Section Gravel width Ft. Beds: Number of LinesDistance between lines - Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft' -- -- Ft. Well +100 t100 n/a n/a TANK %Septic F-1S.T.E.P. ❑ Holding [-]Other Manufacturer anchorage tank Capacity 1000 Gal. Surface Water +100 +100 n/a n/a Material Number of compartments Lot Line +5 +10 n/a n/a steel 2 NA Foundation +5 +10 n/a n/a LIFT STATION Manufacturer Capacity Curtain Drain +50 +50 n/a n/a no lift n/a Gal. Remarks Tank replacement only. Old tank Pump on level at n/a Pump off level at n/a High water alarm at n/a pumped, crushed, and abandoned onsite per inj in in moa requirements Pump make and model n/a Electrical Inspections performed by I n/a Installerdrainfield PIPE MATERIAL House to tank 3034 Tank to 3034 Guaranteed Services Drainfield Unk CO/MT Inspector Charles Balzarini BENCHMARK (Assumed elevation)+100 ft Inspection dates: 18'5/9/15 2n0 Location and description a'° a'^ top of well ®®r`a�otil COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Conditional Approval: Date 4 ; ....® i Ch ries G. Balzarint� 00.. �40A0 0 P, • CE -��3�8�? 0 Approve Date uispeuuun Repo e-'o-i<.uoc LEGEND 0 CLEANOUT • MONITOR TUBE I AppR\ I Tl 5N R1 W SEC9 LT 65 S2 1 SEPTIC AREA EXISTING GRAINFIELD NEW 1000 GAL SEPTIC TANK AND DOUBLE AFTER TANK CLEANOUTS SWING TIES A B B: 46.5 00 C: 49.5 150 D. 17.9 300 E: 107.8 1177 F: 1154 127 G. 138.3 148.5 �. .......•..•..• :HARLES G BALZARINf > CE -13854 ,•\NAW ��i PROFESS00�1 OLD?ANK ABANDONED PER MOA RRQUIREMENTS \WHITE BIRCH BLOCK 1 LOT 4A SCALE: 1"= 40' o..=.vv DOUBLE CLEANOUTS FINISHED GRADE:+97.2 -1 2" EXTRUDED BOARD INSULATION 31 HO C B BM:100 EXISTING WELL +94.2 +89.5 1000 GAL SEPTIC TANK SCHEMATIC SCALE:NTS C&M ENGINEERING SERVICES 907-854-5558 LEGAL DESCRIPTION: WHITE BIRCH BLOCK 1 LOT 1A OWNER: MICHAEL SIMPSON DATE: 05/10/15 1 REV: 0 1 DRAWN: CB I REF: SEPTIC PLAN h Tirn orn Dmr m = Z 00cnI lzo T oo zm z x o m A 2: ;a X n� 0 zom mA o� D 2 r i 0':5 �, •STgll 0 N a coop /y. U s •O/ V m M 01 m C A F � T m z0 N O Y' O ro A o m N U 0 w Mo N00001'30"W 155.36 o N00"05'21"W 155.16 W 0 WHITE BIRCH ROAD Cn D r m If \ 0 r- 0 O Q) CJ) L" Co 8325U On -Site Water and/or Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP151099 Tax Code Number: 05110466000 Work Type: SepticTank Upgrade Permit Effective Dates: May 07, 2015 to May 06, 2016 Design Engineer: C&M ENGINEERING SERVICES Subdivision: WHITE BIRCH Site Legal Address: WHITE BIRCH BILK 1 LT 1A GA358 Owner/Address: SIMPSON MICHAEL THOMAS & LOLITA ROSE 17209 FOOTHILL AVENUE EAGLE RIVER AK 995778147 Site Mailing Address: 20632 WHITE BIRCH RD, Chugiak This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank All construction must be in accordance with: Lot Size in Sci Ft: 46548 Total Bedrooms: 3 N Privy N private Well N Water Storage 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division F,11TA/ On-Site Water & Wastewater Program L APR 302015 ON-SITE SEWERNVELL PERMIT APPLICATION Gretchen Stuller 051 " 14911 -6C Parcel I.D. Day 4 76 - 3'1 4V Property owner(s) MY -kc STvv! t%SoN phone Mailing address Site address vHTTe; t3PIZc (4 Lgw2 Legal description (Sub'd., Block & Lot) wHPLE UTPECH 1A - Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) ❑ Single Family (SF) Absorption Field F1 Initial (w/wo ADU) Septic Tank ® Upgrade Duplex (D). ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: nistance: I certify that the above information is correct. I further certify that this is in accordance with Permit/Rush Fees: `�a 15 Waiver Fees: Date of Payment: Date of Payment: Receipt Number: ,3116 Receipt Number: Permit No. W161001 Waiver No. Permit App_9-1-12.doc C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Alk 99507 RE: Proposed Septic Tank Replacement for White Birch Block 1 Lot 7 A Dear Reviewer, The septic tank serving the above referenced property is severely corroded and needs replaced, it is also within the 1 00'well radius. We are requesting a permit to replace the existing tank with a new 1000 gallon moa approved septic tank. The work will be performed by a certified installer in accordance with MOA standards and the following specifications: The existing tank will be pumped and abandoned properly. The new 1000 gallon tank shall be of MOA approved construction with two 4" diameter cleanouts. The tank shall be installed level, outside of the 100' well radius. The bottom of the excavation shall be level and compacted sufficiently to prevent shifting or settling of the tank. The new tank shall be insulated with a minimum of 2" extruded board insulation meeting moa approval, and 3' of cover. Fill shall be sloped to prevent ponding. The new tank shall be installed in accordance with the separation distances indicated by 15.65.050A. The proposed tank shall be: - Greater than 5' from the property line, building foundation, and drainfield. - Greater than 10' from any water main or service line - Greater than 100' from any surface water. - Greater than 100' from any private well. -Greater than 200' from any community well. Included with this letter is a permit application and a site plan. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzariniCcDgmail. com with any questions or concerns. Sincerely, Charles Balzarini, PE NOTE: LEGAL DESCRIPTION: WHITE BIRCH BLOCK 1 LOT 1A OWNER: MICHAEL SIMPSON DATE: 04/28/15 1 REV: 0 1 DRAWN: CB I REF: LEGEND THE PROPOSED SEPTIC SYSTEM IS GREATER THAN: O CLEANOUT 100' FROM ANY PRIVATE WELLS 200' FROM ANY PUBLIC WELLS 100' FROM ANY SURFACE WATER • MONITOR TUBE / 50' UP-SLOPE FROM ANY STEEP SLOPES Pp I RO 10' TO ANY PROPERTY LINE OR FOUNDATION Tl 5N R1 W SEC9 LT 65 S2 SEPTIC AREA EXISTING DRAINFIELD INSTALL NEW 1000 GAL SEPTIC TANK AND DOUBLE AFTER TANK CLEANOUTS WHITE BIRCH BLOCK 1 LOT 2 SEPTIC AREA OEM01'iSH OR REMOVE EXISTING TANK PERR tAOA REQUIREMENTS �l ............. HARLES G BALZARIW CE -73854 \WHITE BIRCH BLOCK 1 LOT 1A / oolh — / 3 BR -- - \ I HOME I EXISTING I / WELL 5\PR\'o0 \ \wSCC DINS l I � � � \ r NOTES: \ 1. CONTRACTOR SHALL SURVEY ALL EASEMENTS, WELL RADII, AND PROPERTY LINES PRIOR TO CONSTRUCTION. \ 2. TANK REPLACEMENT ONLY C&M ENGINEERING SERVICES 907-854-5558 LEGAL DESCRIPTION: WHITE BIRCH BLOCK 1 LOT 1A OWNER: MICHAEL SIMPSON DATE: 04/28/15 1 REV: 0 1 DRAWN: CB I REF: SEPTIC PLAN 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 NAMEPHONE 1 rho. Iv o. J Gli t„ v �l -1 NEW WUPGRADE MAILING ADD SS � � LEGAL DESCRIPTION LL 6 1 At+e. LOCATION Aiv'ck by' 2 - (e ew-ee- NO. OF BEDROOMS 3 U Y DISTANCE TO: Well Absorption area Dwelling n q PERMIT NO. $o ff 1. WQ Man ufactur§(i Maul No. of compPrtments LigraRacit in51lons IF HOMEMADE: Inside length Width Liquid dep b O '1 J � Z DISTANCE TO: W Dwelling PERMIT NO. Manufac aten LkLujacity in gallons O w= DISTANCE TO: Well a Foundation}(� r -!�gOC) Nearest lot line k r PERMIT NO. �� u Z No. of lines 0 ri -e Length of each n Total length of, esq .S p Trench width �j�o inches Distance between Ines a_ Q F Top of file to finish grade Material beneath file s Total effectiv® rp ion area w Length Width Depth PERMIT NO. Q F w ° Type of cr Cri diameter Crib depth Tot fective abso tion area Lu We DISTANCE TO: Building founds " Nearest lot line J J C Depth Driller Distance to lot line PERMIT NO. w � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS ZD3o3t-/ 4P SOI L TEST RATING INSTQLk.ER+ 3�3" REMARKS re . S 1 M5 LfAD�C4 kk APPROVED DATE LEGAL 72-013 (Re/. 3/78) V 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 NAMEk/Q �C „//A`�s r�'! PHONE ❑NEW ❑UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION /J (,,,,�(�IZ� (,/�/1eC� LCC✓. NO. OF BEDROOMS Uy DISTANCE TO: Well Absorption area Dwelling PERMIT NO. m Q W l.. Manufacturer Material No. of compartments rn Lin. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth 1' JD'Z DISTANCE TO: Well Dwelling PERMIT NO. MZ 4 Manufacturer Material Liquid capacity in gallons O m= DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. W u U JZw P -¢ No. of lings / Length o f each }ine �B Total len th of lines Trench width j((7 inches Distance la een lines e� X I- O Top of tile to finish grade 3 —S- Material beneath tile inches Total effective absorption area w Length Width Depth PERMIT NO. Qf- wa Type of crib Crib diameter Crib depth Total effective absorption area W y DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. w � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PPII�I aM�AnTERIA W QGr �C� , �� ] SOIL TEST RATING INSTALLER REMARKS m� �� Lrnk�t�u/sem a� G/M(AI / g,PEL�lD� /0; , �6rre �.°, a o �o n � cf vr, (/tJt(J� �/��' �!!R� N✓iP.ld> L`AJt' No. G .atPGnf �`i<`�F pi APPROV DATE LEGAL 2e / 72-013 (Rev. 3/78) TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: L*�EF=TH= E3 L-a"C;'TH= :R:3F;Pf=V%?'A=L -- THE LENGTH DIMENSION IS THE LENGTH CIN 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 CIN 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 CIN FEET). F;;'.'E: LA I F;P.* E C4 !E� IE F' -A-• I C" -r f=1 K '-=; I :E E _ -10 1:21 C -D Cwi"L_ L- K-3" 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. S=3F°F=CC -r I o utJ =. HFrF= Fes!U 11- IF --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET 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. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT is 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 THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. IGNED APPLICANT MARTIN ISSUED BY ----DATE-- �/ —u-- V4. 0 t'1 A_A t F I C= a F=' Fl A_ I -F ke Cl F= A A N H RD F;;F=l C3 A= DEPARTMENT HEALTH AND ENVIRONMENTAL ;=�TECTTOPJ x'25 'iL'_�STREET, ANCHORAGE, AK. 99tTgi-I 264-4720 dit L40 -us) f ESA=A.JEE Fs A�EA_ M I T PERMIT NO. 800i33 APPLICANT MARTIN MALL BOX 465 CHUGIAK, AVC LOCATION WHITE BIRCH DR. LEGAL Li Bi WHITE BIRCH S/D LOT SIZE 45000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: L*�EF=TH= E3 L-a"C;'TH= :R:3F;Pf=V%?'A=L -- THE LENGTH DIMENSION IS THE LENGTH CIN 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 CIN 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 CIN FEET). F;;'.'E: LA I F;P.* E C4 !E� IE F' -A-• I C" -r f=1 K '-=; I :E E _ -10 1:21 C -D Cwi"L_ L- K-3" 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. S=3F°F=CC -r I o utJ =. HFrF= Fes!U 11- IF --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET 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. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT is 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 THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. IGNED APPLICANT MARTIN ISSUED BY ----DATE-- �/ —u-- V4. 0 O-& E EN6i7NEERING & DEVELOkOENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 /� ,�j SOIL LOG 688-2280 r� � Performedfor: Name: RE'f IV4Z4- Tel. No. Mailing Address:©' �C7x `T /'C / 4/--` %%J 7 Legal Description: Zor7, .56145U - Depth (feet) Soil Characteristics 0 1 Az 2 3 q� �oA2Sc' S9voy G����, �Db3fiG8S vt eVV44>e/1S 5 To /S /✓'52Y D�'V-4 7 8 9 10 Sf �o/>zQSc :5741Vo 12 13 OF Al �ooeaae sa po e� 14 — AGX',: 15— Geos c°oo�a l s�o ee.o+^-e 16 1 -a t aooe �j JY Ground Water Ei4gt Proposed Installation: Comments: Earl P. His rub NO. 1745-E „e•��® No I-' If yes, what depth OFESSI ®� �ee age Pit— Drain Field PLOT PLAN A(0 Se4ee PERC.TEST Performed by: %G - 1 ;ic &;-,/ Date: -5!' SC/?6 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AiMI-IORITY APPROVAL CERTIFICATE 1. General Information Application Date$ "- (a) Lege iption (incl}ii0.lotjjblor7k, subvis:ion, !� / section, township, range) Location (addressor cj,rectigns) ✓4i®rZi(�/0, / l%6a f -V41, P - jzk (b) Applicants Name 0-Yr-ZZ44f Telephone Applicants Address 1-20 IS 49,K -2-22,f Y9 (c) Applicant is (check one) Lending Institution C n=er/ba!:]de'r Buyer ; Other � (explain); (d) Lending Institution 1�/✓A c Telephone Address W/ Al., s.l Esq (e) Real Estate Co. & Agent /Azo �� L-- Address Telephone 2. TVCe of Residence Single -Family, Multi -Family Number of Bedrooms 3. water Suoply Other (describe) Individual 411 Community F�:j Public Note: If ootTmnity wall system, must have written confirmation from the State Depart ent of Envirommntal Conservation attesting to the legality and . tatus. Is the well adequate for the number of bedrecws specified in this HN/ 4. Sewage ,Disposal Onsite Public Community Holding Tack Is the wastewater disposal system adequate far the number of bedrooms [Page I of 21 2-iG-84 5. Engineering Firm Providing Inactions, Tests, Data and Information I certify that ha e checked, verified, or conformed to all MOA HAA Guidelines in effect on t date Y i pection. Signed / / bate C3 J L! Nate of xrm Telephone Address U - Signed by „iJ, l;, I„ � �� f Dated (ENGINEER SEAL)k i I�s�si° ea 6.DHEP roval e ." Approved for bedroom By — Date - Approved, Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Environmental Protection dces not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date show above, based on the data and information furnished by an ergineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of bedrooms and type of structure indicated. (DHEP SEAL) O 7. Mail the HAA to the following address: KB2/d5/s (Page 2 of 21 2-15-84 ;A r-_ t C. ABSORPTION FIELD DATA / Soils Rating in Absorption Strata /00 Type of System Design /&1ne lam/ Date Installed S�� Length of Fieldp r Width of Field Depth of Field Gravel Bed Thickness - Square Feet of Absorption Axea 3n Standpipes Present 'Yk) Depression over Field Orlo) Date of Last Adequacy Test 5-111,1 Results of Last Adequacy lbst 5�A 7-1,,47A C biz y Separation Distance from Absorption Field: To Water -Supply Wall /0-5— ( To Property Line �� T To Building Foundation To Existing or Abandoned System cn /J Lot / q ; On Adjoining Lots %p a -/ / To Water /Service Line rJ /44"To Cutbank(if present) �G To Stream/PondAake/cr Major Drainage Course I✓ M To Driveway, Parking Area, or Vehicle Storage Area / Ar -! 7 G 0 Comments D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (YIN) "Pump On" Level at_ "Pump Off "Level at High Water Alarm Level at Vent (YIN) Tested for Pumpin Cycles during Adequacy Test. Meets MOA Electrical Codes Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify tha h ve checked, verified, or conformed to all MOA HAA Gu�oelines in effect on the date f ction. P� �'€4 r J, Signed Date O y sem: a Compan^or3w"F afar MOA. No. ` BSie� f��.s�i S � f a• � y KBl/dmW 5/s ' qqn. q [Page 2 of 21 2-15-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHORAGE DEPT. Of HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 MAY 141984 RECEIVED, Well Classification If A, B, Or C, D.E.C. Approved(Y/N) Well.Lcq Present ( N) Date Completed ti % Yield Total Depth Cased to 40 � Depth of Grouting (U Static Water Level _ Pump Set At � ) o s -'t - Casing Height Above Ground _ Sanitary Seal on Casi. (Y Electrical Wiring in Conduit (Y Depression Around Wellhead Separation Distances from %b . _ To Septic/HTank on Lot On Adjoining Lots BUD To Nearest Edge of Absorption Field on Lo>V/dk/ ; Or. Adjoining Lots l00 To Nearest Public Seer Line 14- ) /-' To Nearest Public Sewer �,,, Cleancut_/Manhole N To Nearest Sever Service Line on Lot Af)J)V Water Sample Collected Date Water Sample Test Results -2ry Comments % lc .� .� Cc 0�✓f i/Gk� �f �6y1 J O p ' litOG //f_ �✓!2 % :i -ii-- `t- eaa d B. S IC/HOLDING TANK DATA Date Instal EA/8//0 Size Q ?J No. of Carpartments 2 Standpipes (Y Air -tight Caps Foundati n Cleanou Depression over Tank Date Last Pumped Pumping/Maintenance Contract on File /,(Y/N) ! for �/ Holding Tank High -Water Alarm (YA a Temporary Holding Tank Permit (Y,tfit� Separation Distances from Septic/Holding Tank: To Water -Supply Ntill To Building Foundation To Property Lire ZO To Disposal Field / To Water Main/Service Line o Stream, Pond, Lake, Or Major Drainage Course Comments 'Page 1 of 21 215-84 MUNICIPALITY OF ANCHORAGE ' •\1 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION / ENVIRONMENTAL HEALTH CASE REVIEW WORK SHEET ❑ PLATTING BOARD ❑ PLANNING & ZONING CASE NUMBER S-5956 NAME Lot lA Block 1 White Birch Subdivision DATE RECEIVED October 28, 1981 COMMENT TO PLANNING BY November 16, 1981 FOR MEETING OF CASE OF IE PUBLIC WATER NOT AVAILABLE TO PETITION AREA 5�-�UBLIC SEWER. NOT AVAILABLE TO PETITION AREA REVIEWER'S COMMENTS: %� ! e ©� F S 71-014 (Rev. 2/78) V Time ��';�.,,� Time e `J Date Date Date nZ Inspector Inspector Inspector Comments Conditional Approval �7 0 C0� ( j Approved Bodroom$ Fn!l c v cd I C / Date Sewer Installed Permit No. Septic Tank Size - / £ (' V CA § Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank _ APPLICANT FILLS OUT LOWER HALF ONLY. Property Owner - -I Phone Mailing Address 1 I av'6 Buyer ( Address a ..S Lending Institution/ - 44 - Phone Address V J Realty Co. & Agent Phone Address 'Legal DescriptionC� Street Location _ 1 -7'» ,/ o - Type Residence Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply Individual ATTACH WELL LOG. A well log is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to that date, give well. depth (attach log if ❑ Public Utility available. Sewage Disposal ❑ Individual Year Individual Installed: 4 ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank - NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. H �-/ aflt - A Q Q.:> DATE RECEIVED INSPECTION APPOINTMENTS TIME NUMBER OF,BEDROOMS TIME TIME l� SINGLE FAMILY Q , — ryl- ❑ MULTIPLE FAMILY ❑ Three ❑ Six DATE DATE- DATE *ATTACH WELL LOG. Awell log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY INSPECT O 8. SEWAGE DISPOSAL SYSTEM INSPECTOR INSPECTOR. YEAR ON-SITE SYSTEM WAS INSTALLED. MUNICIPALITY OF ANCHORAGE \ ` MUNICIPALITY OF ANCHORAGE H'_ALTH & OF HEALTH & ENVIRONMENTAL PROTE€S1O�j DEPARTMENT 1VV�NMENT.-,L r.cUi�'_CTION 825 LStreet -Anchorage, Alaska 99501 • ENVIRONMENTAL SANITATION DIVISION FEB J'`08a Telephone 264-4720 rr �� II \/ FP FOR APPROVAL OF INDIVIDUAL WATER AND SEP�9L'ITT REQUEST DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER k c�,lL PHONE °til -`dog5 MAILING ADDRESS LA �D A V, 9 PROPERTY RESIDENT (If different from above PHONE 2. B YE ,. PHONE MAILING AA ESS � - ✓� shJ 3. LENDING INSTITUTION s �jHOXE /86 U \ _ YL '"`'C �-/ I/C_l MAILING ADDRE S D 4. REALTO AGENT PHONE MAILI9 A DRESS 5. LEGAL DESCRIPTION _� 2 t 0 �1� - A Q Q.:> STREET LOCATION ' M L� 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS E] One 0 r E3 Other l� SINGLE FAMILY Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY P INDIVIDUAL* - *ATTACH WELL LOG. Awell 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.) - 8. SEWAGE DISPOSAL SYSTEM I INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY \ ` NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) - 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLEFAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ TWO ❑ FOUR ❑ SIX — ❑ OTHER 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRI LLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED 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 TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS G PPROVED FOR --I-- BEDROOMS CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY 72-010 (Rev. 6/79) SEE v s E $P n y � ? l g 2 g , R ° a3 d S n E 2 a a W m n y i e A, ago a� �O A < oz_ yi'R o a y 00 11 t >y; N J � .. %41 FO rr. I c:� I r n o 1 I a„ ,r r � yG a�ig z ,A. A t�oA <� r �<Zt LAAM ° i AQ�N m� C)lMY )+„ r }Rs �—i—�Z r z } _R G _ OFDWELLING: ' Smgre°Family (w/wo ADU) Duplex Multiple Dwetlings;(Single Family and/or Dupiex) 3ER OF BEDROOMS: 3 OF WATER SUPPLY: TYPE .OF WASTEWATER DISPOSAL: 4dual Well Individual didual Water Storage El Holding Tank ; ❑ tmunity Class . Well ❑ Community ❑, lic Water System ❑ Public Sewer ❑ ince request for: A/pN& Distarce: I' by: Date:_ [eleased to the Effigineer, unless otherwise requested by the engineer. Jr�e' Waiver Fee $ ■ rV 5 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, i verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system !slate) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation.' Name of Firm _� ��NG?�/tcZyy✓G SvGS Phone f491` 97;tf-SSSfi� Address Wqo P/Zypot1lq� /vA>1 I Engineer's Printed Name t f/ 5 ez,�LA,4&Lo_ Date /t/ 94 6. DSD SIGNATURE s y System #1 /approved for bedrooms �I m' S lei: f+alzarini ; am System #2 Approved for _ bedrooms 0�« rti, C I3$5$ Disapproved Conditional approval for. bedrooms, with the following stipulations: it,��cetiun,i J ON-SITE WATERA m� �o TER o PROGRAM i O ,VTS R U�1e�,`` By:� Original Certificate Date: Thpality - I rage Development Services Division (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered In the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory _= Other m5A blue sheet': - c If more than 1 septic system is on the Iqt: COSA Checklist # I of I Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: w 411'7 4H L I Parcel ID:I A. WELL DATA Well type I I'I/A )Z If A, B, or C provide PWSID # Date completed VA K Sanitary seal &N) Total depth -9--Dft. Cased to ±�io_ft. FROGM.WELL LOG'S' Date of test. Static water level �7 J ft. Well production D t, g.p.m. Well Log4(MO Wires properly protected (9/N) yL–S Casing height (above ground) AO in. AT INSPECTION 6 /--'Zo /1S7 mpg g.p.m. WATER SAMPLE RESULTS: Coliform Mf�L, colonies/100 mL Nitrate '27 0 2 mg/L L Arsenic Na ug/L Date of sample: Collected by: (f'I'L�2 fl/UZ B. SEPTIC/HOLDING TANK DATA Tank Type/Material ��L�S7� E L Date installed 7/f/1 5 Tank size gal. v�CNumber of Compartments CleanoutsaYN) YE S Foundation cleanout &N) r � � Depression over tank (Y&N� High water alarm (Yo NO Date of pumping / -//A Pumper /�/,A ,,/ Fii../ ?4/'/ K C. ABSORPTION FIELD DATA Date installeg471 Soil rating (g,pAh or f /bdrm) LOO System type 7R "' r Lengtf�i�� = • • = Vt 'P` Width ft. Gravel below pipe '4 ft. Tot 0l; ft ft+ O EiCA:%orption area f:2 Monitoring tube Depression over field A10 Dqe � � Results Fail) ��✓ For I—bedrooms Flu"epW%1W_, rpQdxgf;kgore test 0 in. Water added 4 10 gal. New depth in. % i, Elapse Tune:V r_ it�ii�� Final fluid depth fF% in. Absorption rate >= V g.p.d. Any rejuvef'i4wjir m (past 12 mo.) (Y6Q type), 61 A(4tf1"" If yes, give date D. LIFT STATION /-/ L��l Date installed Size in gall s "Pump on lev at in. "Pump level at Datum Cy es tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main 1100 Sewer /septic service line 4 �a Animal containment areas 41 00 in. Man ct/Access (Y/N) ZZ gh water alarm level at in. Meets alarm & circuit requirements? On adjacent lots -f 1190 e i On adjacent lots t 184 Public sewer manhole/cleanout +100 Holding tank , 4 7S Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation + 5 Property line h S Absorption field -J= S Water main 4 toe Water service line NP Surface water ±/00 t Wells on adjacent lots 4 too ABSORPTION FIELD ON LOT TO: i Property line 4- to Building foundation * 10 Water Service line + W Surface water _41490 Curtain drain f Jai Wells on adjacent lots -I too Water main -F tri Driveway, parking/vehicle storage az S F. COMMENTS ?A6vsev5 w�u- >7�� Been 01-D f4h, L-1YE! Al C 5XAl6 w4s ��'AIID, ka?�— j'9i719!% Gr ENGIN IFER'S CERTIFICATION I certify that I have determined through field inspections and rdview of Municipal records that the above systems are in conformange with MOA COSA guidelines in effect on this date. Engineer's Printed Name Date C0S,4eXg1l9,1%1Sheet_2-6-15.doc Municipality of Anchorage , Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # 151410 During a recent COSA on-site inspection and test of the potable water supply well on Block 1, Lot IA of White Birch subdivision, the well's productivity was determined to be 0.8 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.3 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval.