HomeMy WebLinkAboutBIRCH HILLS TERRACE BLK 1 LT 3PLsk S
Municipality of Anchorage Page of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report '
Permit Number: ���� G►_3� �`t PID Number:
Name: ,
Wastewater System: ❑ New CR Upgrade
Address:
ABSORPTION FIELD
rg<'L C'1:1 �'-icf ��4-( 1�_kc M ao` %AFL
Phone:
of Bedroo
No. ms:
El Deep Trench El Shallow Trench ®. Bed El Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating: �
Total D}pthfrom original grade:
} GPD/S . Ft.
Le 1�°, _ -._ , 'L ::_l ;
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
m C;;�aa\6 f{�..LS lz�:.-.'e�x..
7 i �:j`. 4't�..� Ft.
Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
Ft.
7� Ft.
WELL: ❑New ❑Upgrade
Gravel width:
Number of lines:
I
Distance between lines:
k�b' Ft.
?
G- Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material:
Ft.
Ft.
t : t -°_; SO. Ft.
h fC�sly ','\
Driller:
Date Drilled:
Static Water Level:
Installed
Date installed:
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
Septic ❑Holding ❑S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
L-
17,
WeIF
4 �
r_
P—
Material:
S � ``L'� -
Number of Compartments:
r
0�
\ b
Watee
�� °+
—`
LIFT STATION
;cc"+
_-
Lot
t
:i '1
..-.
v_
�
Size in gallons:
Manufacturer: __...-
Line
`av
--
Foundation
y 7-
�_
T
"Pump on" level at: -Pump off' level at:
/
High water alarm at:
Curtain
V
Pump..MaCe& Model
Electrical Inspections performed by:
Drain
Remarks: ,-;
BENCH MARK
Location and Description:
t" ' n- (`"1 f, �L'� i �, �_` t i t' \� t �•,7U`7
f
[.i�7'fi6 ...
qq f;
L
Assumed Elevation:
\
� �� Y � �.1`�: �. h\ Jig i✓'`-. \ `-'`-i .���.
i�..
.� �.Ft
EI
~,..�.• qs�•9
3
-
.'�`'',�p`
•
n1�
/ 9t %• S i
``[ 1l
A i a• 1 L S t),, .) F r L Ij w ,J1- 5 i /N S'% a L L E D
_
Inspections performed by: �� � �% �►� •r�Dates: 1st
�'�' • �.. i�wwlrw•
..........—
{' c '%
2nd�
- B{; WRT 'C, COWAN Q
CE-:riot
fit Fo,r,
Department of Health" -an Human Services approval
_�;^��;;;�.��
Reviewed and approved b� --`-, � � `6 Date:
72-013 (Rev. 9/91) MOA 25
Permit No SW9301 45
Page 2 of
PR
WA
20
SCAI
8
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description:
LOT 3, BLOCK 1, BIRCH HILLS TERRACE
050-141-05
PID No.:
A
B
CO
52'
16'
T2
49.5'
48'
BL1
50.5'
50'
BL2
51'
51.5'
01
46'
54.5'
58'
62'
N11r2
6,1 .5'
81 '
DSO
: 62
69.5'
85'
B
FCO
NEW 1250
GAL
J
SEPTIC
ANK
N
NEW
BED
ST
�^ DBL °
U/
MT/2 /
/M T1
/
\
EXISTIN C
CRIB &
ATH
SEPTIC
TANK
02
(ABANDONED
COMPLETELY)
PERTY SERVED
BY COMMUNITY
ER SYSTEM.
0 WELLS WITH114
OF SEPTIC SYSTEM.
AL
ST1
T2
CO
MT2
T1 CO2
FINAL
RADT 94
92' 94'
92'
1/1•'':�'9
�✓tte
v1 ,;
NEW
S.T.
89.7'
C01 = 88.
CO2 = 8
ROSERT C. COWAN • 4
�"�
�' s',a,� a
-_
___ _.
C"Sol
MT2 = 88.1'
MT1 = 8 8.2'
�F�•ti�.•
A
72-013 A (Rev. 9/91) MOA 25
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE ,2c)
DEPARTMENT OF HEALTH AND HUMAN SERVICES c
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650 P
ON -SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW930145 DATE ISSUED: 6/08/93
DESIGN ENGINEER:DAVID R. DAYTON, P.E. EXPIRATION DATE: 6/08/94
OWNER NAME:BAKER SHARON L
OWNER ADDRESS:18126 TEDROW DR
EAGLE RIVER, ALASKA 99577
PARCEL ID:05014105
LEGAL DESCRIPTION: BIRCH HILLS TERRACE BLK 1 LT
3
LOT SIZE: 45302 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
IF THE SAND FILTER IS NOT
THE BED SHALL BE `F�'iVE 5 )
i�/�
RECEIVED BY: G
ISSUED BY:
NG TO BE USED, MAXIMUM DEPTH OF
T: J
DATE •
DATE: 4O — 9 - ??
TO � FROM
David R. Dayton P-E.
20210 Donalar St.
Chugiak, Alaska 99567
SUBJECTr DATE
MESSAGErjG,.��
2
i
-4—+-�s.�—e-=
AWFOW 4S 468
POLY PAK (50 SETS) 4P468
❑ NO REPLY NECESSARY
rerbon/ews
❑ REPLY REQUESTED - USE REVERSE SIDE
-4—+-�s.�—e-=
AWFOW 4S 468
POLY PAK (50 SETS) 4P468
❑ NO REPLY NECESSARY
rerbon/ews
❑ REPLY REQUESTED - USE REVERSE SIDE
I
Awe.)"t;51W
W,54,L('",r JAJ uss)
J is
Obt &
104
fir
LP
T-VA
C-V.$ 7- 7-.#-V,- ,�e eOWOW- 7V,--6 W17-W A,164
1A15rm e- AWA.1,9,477o,%)
A,10 W6F-4 6 rt. lrYIAI /00
A,' 0 0A. OAI APAO%OA.
I,,,
A1
1445 7M<4OOY-F
20210
David L DaytonDonalarStPAL
David i:L
011, .
4k,
Chugiak, Alaska.99W
Goc> -, rd Goo F hA4
— ---------- "J
tl,f LAI A404-,C7. c 42,
, 1,544 _3 /0"Alo 7t> 7VV-`Q4
a" -
0
I
David R. Dayton M
20210 Donalar. St.
Ch4ak, Afasks "567
�O,V.O,
,0000
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
�7- h4t)-s & I
PERFORMED FOR: -IA-1-1:- 5,0 Aj
DATE PERFORMED:
LEGAL DESCRIPTION: L r ;5 �iPUd- /7 uj Township, Range. Section-, �5cc_
DEPTH —14,f SLOPE SITE PLAN
S A'orj D
0_& AAj
'S ; t ?-.e
2-
4
5 -
6 -
7
lz`
Z
10- WAS GROUND WATER
ENCOUNTERED?
11
IF YES, AT WHAT
DEPTH?
Depth to Water After
131 Monitoring? Date:
14
15
16
17
18
19
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
20 PERCOLATION RATE (minutesnnch) PERC HOLE DIAMETER 6P
TEST RUN BETWEEN FT AND FT
COMMENTS
PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
4ENGINEf 'S 'q6EALj
w I
-v,
tkz-
PERFORMED FOR: -Ty6tCL DATE PERFORMED:
LEGAL DESCRIPTION: 60T� &4�t P0;9Q-4* A-ia4- Township, Range, Section: 7-2VA)i
7E
SITE PLAN
DEPTH
(FEET) 7 SLOPE
5,_7,f 4
0 1- 0- A-PJ � C—S
2
3
4
5
6
7
8
9
10
11
13
14
15
16
17
18
19
WAS GROUND WATER
ENCOUNTERED? A,�Q
S
L
IF YES, AT WHAT 0
DEPTH? P
E
Depth to Water After , e'-Z-
Monitoring? Date:
Reading Date Gross Net Depth to Net
Time Time Water Drop
ZU PERCOLATION RATE o' (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
COMMENTS
PERFORMED BY: z 04—y /T .1 )�— I / I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
GAAB-HD- I GR 'TER ANCHORAGE AREA BOROV H
Ot., ARTMENT OF ENVIRONMENTAL QUALI
3500 TUDOR ROAD ANCHORAGE, ALAS 99507 279-8686
INSPECTION REPORT ON -SITE SEWAGE DISPOSAL SYSTEM
MAILING
NAME - PHONE=fi _ADDRESS
LOCATION _�,_ --LEGAL DESCRIPTION
SEPTIC TANK:
NUMBER OF
DISTANCE FROM WELL— MATERIAL ----COMPARTMENTS
LIQUID
LIQUID CAPACITY- > _—GALLONS. INSIDE LENGTH -----INSIDE WIDTH —DEPTH _'
SEEPAGE SYSTBM: SEEPAGE PIT:
NUMBER OF PITS —,--/----- OUTSIDE DIAMETER
OR WIDTH_t , LENGTH DEPTH
LINING M A T E R I A L DISTANCE FROM WELL BUILDING FOUNDATION
NEAREST LOT TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES_
ABSORPTI AREA —
I FO
DISTANCE BETWEEN LINES
SQ, FT. LENGTH OF EACH LINE
REST 'LOT LIN
TRENC`f4 WIDTH
SQ. FT.
TOTAL LENGTH
OF LINES
IN, TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH Tll__�-_—IN. ABOVE TILE
WELL: , " -X/;, -,, � � -,; ' " � �-, " v �Z- � -. �" I � DISTANCE FROM -1 , WATER
TYPE DEPTH , BUILDING FOUNDATION_Z��_ —,SAMPLE NEAREST
.9 — 1, NEAREST SEPTIC �l SEEPAGE — I OTHER
LOT LINE e____ _� — SEWER LINE Z TANK ZJzE2� WJ- , SYSTEM___ , CESSPOOL SOURCES,`! k--,--�
DISTANCES:
k
9A
hi
k k
DATE APPROVED
G.A.A3.
GREY-. i ER ANCHORAGE AREA BOk,)UGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA 99502
TELEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
NAME OF APPLICANT �� �� j `
f
INSTALLATION LOCATION
LEGAL DESCRIPTION
PERMIT NO.
MAILING ADDRESS PHONE
INSTALLATION OF: SEPTIC TANK n SEEPAGE PIT
1
1
TYPE AND SIZE OF FACILITY TO BE SERVED Xkt"'� C-
DRAIN FIELD OTHER
jr _
FINANCED THROUGH bl `� TO BE INSTALLED BY �\�� ` y ``� C- I"
SOIL TEST RESULTS ` `['s`I �%r�' �' `�" {�•-�e\\NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED �
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OAF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECU70N.
SEPTIC TANK SIZE (I 2'S C TYPE
,
SEEPAGE AREA SIZE TYPE_' -
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK -
f
FOUNDATION TO SEEPAGE PIT �DRAIN FIELD
i !
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK SEEPAGE PIT �- DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK `J ` SEEPAGE PIT /C
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK 1 C / SEEPAGE PIT /�• r ,
DRAIN FIELD
SEPTIC TANK, SEEPAGE PIT L( , DRAIN FIELD ,
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS
GRAVEL BACKFILL
CONFORM TO BOROUGH -REGULATIONS REGARDING INSTALLATION
HEALTH AUTHORITY
OR
LICENSED DESIGNER
I CERTIFY THAT
1 AM FAMILIAR WITH THE REQUIREMENTS OF GI'EA
DESCRIBED SYSTEM IS
IN ACCORDANCE WITH SAID CODE.
�..\\\
J
��/
/
DATE I�ti
APPLICANT'S SIGNATURE'S
DIAGRAM OF SYSTEM
■o■■■■.■■■■..■.■■■■■
■■®■■■.■■■■.■■.■■■■■
■■■a®®®.®m®®®mmo®®.■
■■■m■®®m®®omm®®®®.■.
■■■■.®®mm®mommm,m®m®
■■.■■m®mmmommoommmm■
■■■■.■■■■■m®®■■.■■■■
■■■■■■■■■.■■mm®®®®o■
■■■■■■■■■■■.■■m■..■■
■.■■■■■..■■.■■.■.■..
■■■■■■■■.■■■■■.■.■■.
■■■.■■■■■■■■.■■■■■■■
E■■o■■■m.omm■m■m■■■■
■■■■■■■■.■■■■■■■■■■.
■■■■■■■■■■■■.■.■■■■.
.■■■.■■■.■■.■■■■■■.■
■■■■■■■■■■■.■.■■■■■■
■■.■■■■■.■■■■■■■■■■■
■■.■■■■■■■■■■■■■■■■■
TER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
ra
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.# "it -0 S-
1. GENERAL INFORMATION
HAA # V') ( rn
AQn,,)o
Complete legal description Lot 3; Btock 1; Bi,%ch HiU.6 TeAtace
Location address or directions) 18126 Tedkow Dative.
Eagte Riven, AK
Property. owner Sharron Bake.,% - Day phone
Mailing address d'/O Jack White Co. Eacite, RiveA 11823 Qtd Gte.nn Hwy. Eaate. Riv %,
99577
Lending agency Day phone
Mailing address'
Agent :"Zakbata Ckittendejn/ Jack Whi;te Co. Day phone 694-5500
Address
-Unless otherwise requested, HAA will be held for pickup.
I NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water XXX
NOTE: If community well system, provide written confirmation frorn'.Sta'te AdEq attest
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on -site XXX
Holding tank
Community on -site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
AK
72-025 (Rev. 1/91) Front MOA 021
5. STATEMENT OF INSPECTION BY ENGINEER
.1
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 invest!qation 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 L 19-7 17034 ENgto'Kiver Loop asd No. 204
Address Eagle River, Alaska 99577
Engineer's signature Date Oxg
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
By:
OF
S. ROBERT C. COWAN
ors CE - 8801 Z'*A
bedrooms, with the following stipulations:
I
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
F
F
�-� Municipality of Anchorage U ICIPALITY OF ANCHOIRAG
DEPARTMENT OF HEALTH & HUMAN SERI WENTALSERVICES DW
Environmental Services Division
825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-43�
261996
Health Authority Approval Checklist
RECEIVED
Legal Description: "'C 3 ?7,4- ttt,5 Parcel I.D.: 06-0 14, OS
A. WELL DATA,, �y ^
Well type 1- l c> /,
Log present (Y/N)
Total depth
Sanitary seal (YIN)
Date of test
Static water level
Well production
WATER SAMIP RE
Colifor
ate of sample:
If A. B, or C. attach ADEC letter. ADEC water system number
Date completed
Cased to
FROM WELL LOG
Casing height (gbavle ground)
Wires_pKperly protected (Y/N)
g.p.m.
TS:
Nitrate
Collected by:
B.-ISEPTOHOLDING TANK DATA
AT INSPECTION
Other bacteria
g.p.m.
Date installed 1I `12, Tank size 1 b` o Number of Compartments 2- Cleanouts 40k)-*—
Foundation cleanouto� �4 _Depression (YO High water alarm
Date of Pumping (o -15-9LPumper 1]�— , QJ ►Af
C. ABSORPTION FIELD DATA
Date installed 15 11'7 Soil rating (g.p.d./ft' or ft2/bdrm) O J System type 561:)
Length -3tA 1 Width t1$ 1 Gravel thickness below pipe C) �5 Total depth $ ,a 1
Elective absorption area (.`1$ 1 Monitoring Tube presen(&N)� Depression over field (YO .�
Date of adequacy test to - Results klnail) Pahg For bedrooms
Fluid depth in absorption field before test (in.); _� Immediately after 30 gal. water added (in.):
Fluid depth (ins.) Minutes later: Absorption rate = yfD p.d.
Peroxide treatment /
(past 12 months) (Y N n! a14- t4.t)-Ary)es, give date q
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot ; On adjacent lots
Absorption field on lot On adjacenLlnis•
level at*
Public sewer main Public sewer manhole/cleanout
r septic service line Lift station
SEPARATION DISTANCES FROM PTIC/HOLDING TANK ON LOT TO:
fi
Building foundation ''S'1 Property line 30� Absorption field 14
Water main/service line \o Surface water/drainage bozo \.k Wells on adjacent lots l oI> k4-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation `� Z Water main/service line t o L
Surface water k
\�C> —0 Driveway, parking/vehicle storage area S'D
Curtain drain r Vh Wells on adjacent lots 'D o Property line '� 1
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal records t{ CQFef�st re
M ..........,. S in conformance with AIDA 1 4 u elines effect on this date..,.
Signature �-- •�C .�':1�
4 h
Engineer's Name n d .0 i,; 7- l�c�
ROBERT C. COWAN f 4
Date �' t/a ( �c�s CE - 8801
HAA Fee $ 1�>'✓>,C ? Waiver Fee $
Date of Payment (s-, "� (, °I L� Date of Payment
Receipt Number t:-1`l llN Receipt Number
Rev. 8/95 OSS: haa.wk.doc
a