HomeMy WebLinkAboutBIRCH HILLS TERRACE BLK 1 LT 3
Municipality of Anchorage Page I 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:
PID Number: O~O -- IHI - o$
LEGAL DESCRIPTION
Subdivieion:
WELL: E:IL~s_~, ,.~3~.N ew ~ade
Cla,ihcation~dvata. ~B.C/ TOal Depth: ~ TO:
Ft. Ft.
Ft.
SEPARATION DISTANCES
Wastewater System: [] New
l~Upgrade
ABSORPTION FIELD
m Deep Trench n Shallow Trench ~i[Bed nMound t~Other
LIFT STATION /
"Pump on' le~mp Off" level at: I High water alarm at:
~m,~%fl~"& Mod~l I Electrical Inspections performed by:
BENCH MARK
LOCation and Description:
Reviewed and approved ~~~
Remarks:
Surface '
Water
Lot
Foundation
Cu~ain
Drain
Total absomtion are~m~ ~ Pipe material:
TANK
Soil Rating: Total Depth from original grade:
Gravel width:
P~rmlt No.SW950145 Page 2 of 2
· 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
LOT $, BLOCK 1. BIRCH HILLS TERRACE
Legal Description:
050-141-05
PID No.:
NEW
x~[ {~ SEPTIC TANK
(ABANDON[D COMPLETELY)
PR~P[E~ SERVED BY COMMUNI~
WA-ER SYSTEM. ~0 WELLS WITHIN ,
20(' OF SEPTIC
8 1~50 GAL
A B
--CO 52' 16'
~,T1 47' dO ~'
_ST2 49.5' 48'
3BL1 50.5' 50'
3BL2 51' ' 51.5'
801 46' 54.5'
~IT1 58' 62'
~,11~2,..' 61.5' 81 '
~02 69.5' 85'
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L# STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW930145
DESIGN ENGINEER:DAVID R. DAYTON, P.E.
OWNER NAME:BAKER SHARON L
OWNER ADDRESS:iS126 TEDROW DR
EAGLE RIVER, ALASKA 99577
DATE ISSUED: 6/08/93
EXPIRATION DATE: 6/08/94
PARCEL ID:05014105
LEGAL DESCRIPTION: BIRCH HILLS TERRACE BLK
3
1 LT
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 (iSAAC80).
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.
"'SPECIALPROVISIONS:
IF THE SAND FILTER IS NOT GO_~NG TO BE USED, MAXIMUM DEPTH O~
RECEIVED BY. ~ ~- ~~' DATE:
DATE: - 73
"TO FROM
r~.Dl~.r.~.~. 4S 468 ~
~OLY eAU I~0 S~T$1 ,m~a L~ NO REPLY NECESSARY
F'] REPLY REQUESTED - USE REVERSE SIDE
-'T'
'ri
David R. D~yto~
'E AL DESCR,.T(ON= /'' '5
(FEET)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
SLOPE SITE PLAN
10 - WAS GROUND WATER
ENCOUNTERED?
11- s
L
IF YES, AT WHAT O
12 DEPTH? p
I-~u~ Oep~ b, Water Mler.. '
13-
Monitoring? ,,~ d'
14 - Reading Date Gross Net
Time Time
Depth to Net
Water Drop
16-
18-
20-
PERCOLATION RATE ~' ~ (minutes/tach) PERC HOLE DIAMETER
TEST RUN BETWEEN ~'~ FTAND ~' FT
COMMENTS
ACCORDANCE WITH ALL STATE 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
PERFORMED FOR:
LEG^L DESCR PT,ON: I
2 -
Township, Range, Section: ~c
SLOPE SITE PLAN
10-
11-
12
13-
WAS GROUND WATER
ENCOUNTERED? ~[/~
S
L
IF YES. AT WHAT O
DEPTH? p
E
Moni~ring? Oat~ .
14-
15-
Reading Date Time Time
Depth to Net
Water Drop
16-
17-
18-
19-
20-
COMMENTS
PERFORMED BY;
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATF~
72-008 {Rev. 4/85)
PERCOLATION RATE O, ~ (mmutes/mch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~' ~I~FT AND ~FT
CERTIFY THAT THIS TEST WAS PERFORMED IN
GI~'""'~TE R
ANCHORAGE AREA
D~.,ABTMENT OF ENVIFIONMENTAL QUALI~
3500 TUDOR ROAD ANCHORAGE, ALASKA gg507 27!)-8685
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME j/'~'~//P,'d--,~ J~/'
MAILING
ADDRESS
LOCATION ,c~/~'~ ..,~--,,,~- ,~--~O,.~ ,.,'"~_~,~.'~
SEPTIC TANK:
/ ~//,~_¥..)/j/, NUMBER OF
DISTANCE FROM WELL 7'~ MATERIAL ~'~"-~-/~d... COMPARTMENTS ~
LIQUID ~.._.
LIQUID CAPACITY /,,~.~"'~ GALLONS. INSIDE LENGTH ~'"'~INSIDE WIDTH ~-' DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS // OUTSIDE DIAMETER ~ OR WIDTH
LINING MATERIAL -~:~ ~---'~'~' --~"~/"~'"~/ . DISTANCE FROM WELL /z~
NEAREST LOT LINE '~,~ / . TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
TILE DRAIN FIELD:/V'/~
· LENGTH /.Z-- DEPTH
DISTANCES:
· BUILDING FOUNDATION
FT.
TOTAL LENGTH
OF LINES
DISTANCE FROM WELL · FOUNOATIt~ NEAREST LOT LINE
NUMBER OF LINES / DISTANCE BETWEEN LINES IN. TOTAL EFFECTIVE
ABSOR~ SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TiLt IN. ABOVE TILE
WELL: / "~'~; ~ '/~ ' '"~ ~'*'~' DISTANCE FROM
TYPE ~/~ DEPTH ~/, , BUILDING FOUNDATION.
NEAREST SEPTIC / SEEPAGE
LOT LINE ~ ~ SEWER LINE /~ ~ , TANK ~/~., SYST~
DIAGRAM OF SYST~
, ~ :~ :~ ~:~:: ~: .... : ........ ,.
: ....... ~ : ~ -~ ~ .........~ . ~ , ; . .~ ....
-- ~-;-,~ :, ~ , . ~ ;..~. ;. ::- ..:-..:
~ . -T ~,,~V~-~--~,~. ...;'..,;.~.:,
~ :: ' : ~'} ~L:~'~
x :---:
WATER
SAMPLE -Jl,/~?'~-- , NEAREST
OTHER
· CESSPOOL /[/'/'/('J,·~", SOURCES~''~'~l
DATE
G.A.A.B. ~
GREA,ER ANCHORAGE AREA BOROUGH
PERMIT NO.
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
LEGAL DEsC...,o. U'r ~ ~/~. /
FOUNDATION TO SEEPAGE PiT
$£PTIC TANK TO SEEPAGE PIT WALL
DRAIN FIELD
SEEPAGE PIT
/~ ' . O.A...ELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
GRAVE[. BACKFILl.
:,::::,I,::::;:;;.",::."'AL'O;L''.'::O;":,;7.U'AT:'::,".: O' ~'''" ^NC".~.,GE ^":'~"ORF" O"O'TA"CE "0.
AND THAT THE ABOVE
Parcel I.D. # c~'o -;,~t
1. GENERAL INFORMATION
Complete legal description
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 AL~THORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Lot $;
Location*(site address or directions) 181 ~6 Te.d~om
........ ql ~
, ~ .. .... ~. E~ ~ u~, AK
~ * / Pro~.own~r- *'~ S~o, 8~e~ Day phone
-. Mailing address 0/0 ~c~ ~. o. E~e. ~u~.~ 11823 O~d
' '" ' ' ' Day phone
~ .. Le~dmg agency
,h':M~tling add[es~ '
Agent ' ~-~rba~a C~.~d~/ Jack W~. Co.
· Addre~
h:i ~'~Unle~ othe~ise ~uest~, ~ will be held for pickup.
.. ... ~.. ?.,.
~_ NUMBER OF BEDROOMS: .
Eagle'.
99571
Day ph0n.e .694-. _5500..
3. TYPE OF WATER SUPPLY: .....
: ............ Individual well ..... - ....... .
· Communit~ well -; ,- ..... :' ...... .
· , HI.!',~ '..
Public water XX× . . . ,~,*'~\\X'., .. ." ~, ,;..~.~..
Hom.SMte A~EC.a~est-.,- :
~OTE: If communl~ well s~tem, provide wH~en confi~atlon
[ng to the l~ah~ and status of system.-- ~ C~ ~ ~ ~, ~
4. ~PEOFWAS~R~ISPOSA~ ~ e '. ~ · I .. ~?
Individual on-site ~X '.. %¥,.._ _,,~ ,,
· . ~'1 ~'.~," ,~
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.
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 westewater 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 inves.ti..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.
S & S ENGINEERING
Phone
Name of Firm t7034 ~ Rl~er Leep Koad No. 2~4
Address tql. Rl~u., AlasEa 995~
Date
DHHS SIGNATURE
Di.~a~proved.
Conditional approval for
b~drooms.
bedrooms, with the following stipulations:
Additional Comments
,
Date ~_//~/~'
The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to setisf'/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.
Municipality of Anchorage ...__..__ _ ~J=x
DEPARTMENT OF HEALTH & HUMAN SERV~Nt~r~saw.... 3=~
Environmental Sewi~s Dlvi~on ~ ~'~
8~%" S~et, R~m 502 · An~omge, Nas~ 995010 (90~ ~ ~ 6 1996
Legal Deseriptio.:
A. WELL DATA
Well type ~J~ ~
Log prcscm (Y/N)
Toal depth
*samtan** seal (Y/N)
Health Authority Approval Checklist
Date of t~sl
Static water level ~
WeU production
WATER SAMP, J,E~SULTS:
Co~o~ Nitrate
Da~ of ~nple:
RECEIVED
If A. B. or C. attach ADEC letter. ADEC water system number
Dat~ completed Casing~
Cased lo
Wi~perly protec~d (Y/N)
FROM WELL~ ~-''/'~ AT INSPECTION
g.p.m, g.p.m.
Collected by:
B.'~'I'rI~HOU)ING TANK DATA
NumberofCompanmems '2- Cleanouts4;~)
Hi~ wa~ alarm
LIFT STATION
Date instnllIs{: :'
Size in gallons
Manhole/Access (Y/NI
High water a~arm |eve| al*
· 'Pump on" level at*
rump off" level al*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
S~tic/hoidm~ tnnk on lot
Absorption field on lot
; On adjacent I,',** ~
Public sewer main
Public sew~ manliol~Yck~lnma
S~l"~tic service linc Lilt station
SEPARATION DISTANCES FROM~,='{~'-C~HOLDING TANK ON IOT TO:
Building fou~d~!~on "~'1 ~ ~ linc ~od' Absorption field
Wa~' nmin/se~'ice linc ~o xJ~'' surface water/drainage ~,o~ ~''¥' Wells on adja~nt lots
SEPARATION DISTANCE FROM ABSORPTION F}I~I n ON L.OT TO:
Building found~mon
Surface water
Curtain drain
Driveway, patkingA~hide storage
Wells on adjacem lois ~oe %'~
F. F. NGINF:I:IR'S C~,RTI~CATION
I ceftin, that I have determined thru field inspectfons and review of Municipal record~
in conformance with M~A ~/L4~el,7 effect on this d~te.
Si?-mre ~ g~
Engineer's Name /~OLtr ~.
Dam of ~:
Receipt Numbcr ~ ~c~t4~
I~ipl Nu~t~r
Rev. 8/95 OSS: ham.wit.doc