HomeMy WebLinkAboutBIRCH HILLS TERRACE BLK 2 LT 7Birch Hills
Terrc ce
Block
Lot 7
#050-141 - 14
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND]OR WELL INSPECTION REPORT
Permit Number: OSP101280 PID Number: 050-141-14
N .... Shane Jolin WastewaterSystem: [] New [] Upgrade
Address:
11347 Terrace Hills Drive~ Eagle River~ AK 99577 ABSORPTION FIELD
Phone: Number of Bedrooms:
~ [] DeepTrench [] ShallowTrench [] Bed [] Mound []
LEGAL DESCRIPTION Soil Rating: Total Depth from origina!f
EXISTING GPDiFt2 i ~.f' Ft,
Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel d~iffi pipe:
2 7 Birch Hills Terrace Ft. .~"
Township: Range: Section: Fill added above original grade: ¢f~l Length:
· '.!~ Ft.
Well: [] New r~ Upgrade G .... Iwidth: ~" Numberof xes I Dstanoebet~n ines:
J .... Ft. I -- Ft.
ClassificatiOnExiSTiNG(Private, A, B, C): Total Depth: ,; : ,::¢'::: Total abscrptionl~'~ '" Ft: Pipe Material:
Driller:
Date Installed.
Ft. Ft.
' : Casing Height Above Ground:
, Ft. TANK
SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other:
· TFmm~~ Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity:
Tank Field Station Tank Sewer Line Anchorage Tank 1250 Gal.
Well 100r't' .... NA 25'+ Material: Number of Compartments:
Steel
Lot Surface WaterLine 100'"l- 5 "~" .... .... NANA ~ Size: Manufacturer:LIFT STATION
-- Gal·
Foundation 5~'~' .... NA/~ "Pump on" level at: '
Curtain Drain NA NA .... ~,!~: :,:i~ ~ '~ I in.
.... Electrical Inspections performed by:
Remarks:
Existing septic tank decommissioned in place per code. BENCH MARK
Septic tank insulated and connected to existing crib. Location and Description:
Cement Landing
Installed by RPC. Assumed Elevation:
Engineer's Stamp
Inspections performed by: krcTerra Dates: 1sT 12/09/10 i :~;~:
2ND 5/17/11 :i
Development/q/./'Senfiqes Departmel .t Approval
Reviewed and approved by /-~, .~'&~ate: ~f-./,~' /~
(Rev. 12/00)
AS-BUILT SYSTEM ])F-TAILS/SITE PLAN
~ BIRCH HILLS TERRACE SUB]]IVlSIBN BL[]CK 2 LDT 7
~A_C=39,9,
~A-D=44,B' ~ FINAL GRADE
~ ~ OS ~ ~ SCALE, NTS
~ ~ nn ..............
PREPARED FOR:
SHANE JDLIN
11347 TERRACE HILLS DRIVE
EAGLE RIVER, AK 99577
FIELD BOOKS couPu'~.
.ou.o,,~¥: BOUNDARY ~^~: BMW
ST~.e STAKING c.£c~,=n: KMD
ASBUILT: RCJ o^m 5/31/11
~ NW153
/ ~ No.: 10--203
/ ,cAz) ~_= FILE .
Permit Number:
Tax Code Number:
Work Type:
On-Site Wastewater Disposal System
OSP101280
05014114000
Septic
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 EImore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Upgrade
Permit Effective Dates: December 02, 2010 to December 02, 2011
Design Engineer: ARC TERRA CONSULTING INC
Subdivision: BIRCH HILLS TERRACE
Permit
Site Legal Address: BIRCH HILLS TERRACE BLK 2 LT 7 G:0153
Owner/Address: JOLIN MITCHELL SHANE
11347 TERRACE HILLS DRIVE EAGLE RIVER AK 995778282
Site Mailing Address:
11347 TERRACE HILLS DR, Eagle River
Lot Size in Sq Ft: 41382
Total Bedrooms: 3
This permit is for the construction of:
N Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N Water Storage
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 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.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www. muni.org/onsite
(907) 343-7904
ON-SITE SEWERNVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-141-14
Property owner(s)SHANE & HEIDI MITCHELL
Mailing address 11347 TERRACE HILLS DRIVE, E.R., AK
Site address 11347 TERRACE HILLS DRIVE, E.R., AK
Day phone
Zip Code 99577
Zip Code 99577
Legal description (Sub'd., Block & Lot) BIRCH HILLS TERRACE BLOCK 2, LOT 7
Legal description (Township, Range & Section)
Lot Size41,382 .Sq. Ft. Number of Bedrooms -~
THIS APPLICATION IS FOR ([~] all that apply):
Absorption Field []
Septic Tank []
Holding Tank []
Privy []
Private Well []
Water Storage []
THIS APPLICATION IS AN:
Initial []
Upgrade []
Renewal []
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
ARCTERRA
(Signature of property owner or authorized agent)
Permit/Rush Fees: $200.00
Date of Payment: f,~--~ "" ¢.~ ~ ,~Z2/~)
Receipt Number: / '~_~.)-~'~'3 H
(Rev. 11/05)
Waiver Fees:
Date of Payment:
Receipt Number:
CONSULTING~ INC
212 E. 51st Ave, Anchorage, AK. 99503
(907) 868-3791, Fax (907) 868-3793
December 1, 2010
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Septic Tank Upgrade Permit - Birch Hills Terrace, B2, L7
The owner has requested we proceed forward to obtain a septic permit to
upgrade the failed septic tank on the subject lot. The proposed upgrade will
serve the existing 3-bedroom house.
The adjacent lots to the east and north of this lot are served by public water.
There is no surface water within 100' of the proposed tank. We do not expect
there to be any adverse effect on adjacent lots by the development of this tank. If
you have any questions, please contact me at 868-3792/FAX 868-3793.
Respectfully submitted,
~KennethLMc, Duffus, P.E.
Attachments:
On-Site Sewer Application
Wastewater Absorption System Details/Site Plan
20441 PTARMIGAN BLVD · EAGLE RIVER, AK 99577-8736 · PH (907) 868-3791 · FAX (907) 868-3793
WELL & WASTEWATER
JO'
B'r~CH HTI LS
/ ,u.uc
~ / WATER
30'
DISPFISAL SYSTEM DETAILS/SITE
TERRACE SUBDIVlSIFIN BLBCK ;E LFIT 7
PUBUC
WATER
Lxm '
16.0' /
INSTAU- NEW FLAG ~IELL ~o.~
250 GAL S.T. RADIUS /
EXIS'RNG
TO
47.0'
s~c .c,,, /
~-~TS ~ FRAME ~ o
(~) ~ HOUSE
7.0' 26.0' /
EXISTING S.T.
PER COOE
D/W
PLAN
PUBUC
WATER
FLAG
WELL
!PRIF1R
PRDPERTY LINES
RADII & EASEMENTS
TD CDNSTRUCTIDN
ADJACENT LDTS TD THE NDRTH & EAST
ARE SERVED BY PUBLIC ~/ATER
Scod, e: 1"= 50'
PAGE 1 OF 1
ND PUBLIC WELLS WITHIN EO0' OF
PROPOSED SYSTEN.
ND PRIVATE WELLS WITHIN EO0' DF
PRDPDSE9 SYSTEN EXCEPT AS NOTED,
NO SEPTIC SYSTEHS WITHIN ~00' OF
PRDPDSED WELL EXCEPT AS NBTED.
NDTES,
1, INSTALL 1250 GAL ST & INSULATE TANK IF <4' CDVER,
2, RESIDENCE IS 3 BE - DWNER HAS REQUESTED 1250 GAL ST
3, CDNTRACTDR ~/ILL ENSURE MINIHUM 2% SLDPE INTD SEPTIC TANK,
4, CDNTRACTDR ~/ILL ENSURE ALL SEPARATIONS TD ADJACENT
~/ELLS, SEPTICS EASEMENTS, PRDPERTY LINES, ETC,,,
PREPARED FDR:
Jori & Rachae[ Pope
16938 Park Place #1
Eagle River-, AK 99577
907-622-8900
FIELD BOOKS
~ou.o~ BOUNDARY
ST,~.e STAKING
ASaUlLT: Rd
FILE:
^c~a REa FILE
DI~WN: BMW
CHEC~. KMD
12/01/201('
N WI 5,:3
~ N~.: 10-205
De Pa rt me nt ~ 3E;;irs~{~: ntal Ouality
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME~'C/ .,~' f'O_~_/ MAILING ADDRESS Fl// ~ /~'/~/~.~f~/~ PHONE
SEPTIC TANK:
DISTANCE
INSIDE LENGTH
NUMBER OF
COMPARTMENTS
INSIDE WIDTH . LIQUID DEPTH
IIQUID CAPACITY /O~O GALLONS.
SEEPAGE PIT:
NUMBER OF PITS / DIAMETER ('~'~'OR WIDTH
LINING MATERIAL/~Je//4~¢~' ~;.~/~RIB SIZE: DIAMETER
BUILDING FOUNDATION NEAREST LOT LI~E_ ~~/·
ADDITIONAL ABSORPTION
LE,GT, /3. DEPT, ~'
DEPTH , DISTANCE FROM: WELL
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) '~"~-~'-
WELl-:
· YPE CONSTRUCT,ON
BUILDING NEAREST NEAREST
FOUNDATION LOT LINE SEWER LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED REMARKS
INSTALLED BY:
PIPE MATERIAL:
DEPTH DISTANCE FROM:
SEPT,C ?q/ SEEPAGE //q'
TANK SYSTEM
DIAGRAM OF SYSTEM
LOT SLOPE:
REMARKS:
~Z.A.A.B.
· ".. - /nc, nF DRILLING' bv A & L .DRILLING .COMPANY:. ,..., ..:,,,,...
. ~s~ .................. ,~.. .~, ...................
.. ~ ..,. : ~ ~ .' : · ~ '. ~,,~ .: . ,. · . ~.~.,
. · · ~ - :.,'> " ~ ~ , ~..~/ ".', ..'".,',. - t'.":~.,~ ~' ,. :: '~
· . ~~ ...... ~ ......... ~.~..~ ........ r~-.~: ............ ~,. ~ ,
· . . ~ ....... , ~ ~ .'
. ___ , J~ ..~,~ ,~.~ : ~ , , .. ,~ . , · .. .. .. . . .~ ~ .
/ ~. TO ~,~...~.......~. -~--- ---' -2--.---.;--:-----' .'.' ............. '"'~ ................. ~ .~ 7~'~ ........... ~
F~O~ .......................... ~ ~ '" .' · ' · "'- ',' ~' / "~"
. .. . . :,.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O.,Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(9O7) 343-79O4
CERTIFICATE OF HEALTH AUTHORITY APPRO /AL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. tg~'O /t/! it/
GENERAL INFORMATION
,~omplete legal description
Expiration Date: _~ _ _~ L~ _ O ,~
· ,'Location (site address or di'rections) //.~/7
'Current ProPerty ow~er(~),-
;Mailing addres~ .
Lending
Day phone _?O,¢- [,'11-
Day phone
Mailing address
Real Estate Agent
Mailing Addres~
Unless otherwise reqde.sted, HAA will be held by DSD for pickup.
2. NUMBER'OF BEDROOMS: ~
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ~
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
~ Individual On-site ~
[] Individual Holding tank []
[] Community On-site .D
[] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage flies 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 installafion.
Name of Firm Eagle River Engineering Sewices
Address Ea.qle River, AK 99577
Engineer's Printed Name
DSD SIGNATURE
Approved for ~'
Disapproved.
Conditional approval for
Phon~ ~ {/- 5'/~ 5'
Date
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:~.~
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST '
Legal Description: ~/~'g'/-/ HI'LZ% 7-~z~f~ /ET" 7 ~J'Z~.. 2.. Parcel ID: ~E'E lq~ /~.t
A. WELL DATA
we, type
Date completed
Total depth ~ ~'O ft.
Date of test
Static water level
Well production
IfA, B, or C provide PWSID #__
Sanitary seal (~)
Cased to I),~ ft.
FROM WELL LOG
/--//7S
g.p.m.
Well Log ~'N) ~
Wires properly protected ~N) ~
Casing height (above ground) Z 4/ 't' in,
AT INSPECTION
ffV ft.
/. 7-g.p.m.
WATER SAMPLE RESULTS:
Coliform ~ coloniesll00 mi.
Arsenic: ~ mg./l.
Nitrate ~.7...5'"' mg./L
Date of sample:
J
Other bacteria ,.~ coloniesll00 mi.
Collected by:
For ,,~ bedrooms
New depth ~'/-/f in.
~'¢_~ g.p.d.
If yes, give date ~
Any rejuvenation treatment (past 12 mo.) (Y~J~& type)
B. SEPTIC/HOLDING TANK DATA
Tank Ty~ p.z.c,~ Date installed ,~//~'/
Tank size ~ gal. Number of Compartments ,=,2_ Cleanouts (~N) /'/~.-
Foundation cleanout ~)N) ~ Depression over tank (Y~) ~ High water alarm (Y,~
<7 .
Date of pumpino ~ Pumper ,v//~ ~' --~/~l~ .
C, ABSORPTION FIELD DATA
Date installed ?/l&/'?..¢ Soilrating (~orft2/bdrm) ~ Systemtype
Length. I '~ ft. Width o¢ ft. Gravel below pipe ~:~ ft.
Total depth ~ ft. Eft. absorption area ~__~ ft~ Monitoring tube ~ Depression over field
Date of adequacy test .,.g/~/.,o_<;" Results ~[~Fail) ~
Fluid depth in absorption .... field before test ._~ in. Waler added I~'o0 gal.
Elapsed Time: ~70min. Final fluid depth ~ o/ in. Absorption rate >=
D. LIFT STATION
Date installed Size in gallons
"Pump on~t_.~
Datum Cycles tested
E. SEPARATION DISTANCES
High water alarm level at in.
Meels alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
',~{~eptic tanldlift.~e~ on lot -f' c~O ~
Absorption field on lot '/- /~0
Public sewer main /,.///,,,'~'
Sewer/septic service line -/'-..~' /
On adjacent lots 'h/ED ~
On adjacent lots -/-/~,O /
Public sewer manhole/cleanout
Holding tank ~' / ~0
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation -/" ~ / Property line -t ~ ~ Absorption field
Water main ~/O / Water service line "f- ic3 / Surface water
Wells on adjacent lots ~ lEO
· 'Y/oc3 /
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ...t- JO ~ Building foundation -r j~ I
Water Service line '~/O ' Surface water ~' J~O '
Curtain drain ~V'd, VE' ~Oz,,./~ Wells on adjacent lots -,'lEO/
Water main ~{0 /
Driveway, parking/vehicle slorage
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name
Date 5-'///~'/~ F
HM Fee $
Date of Payment
Receipt Number
(Rev. 12i01)
Waiver Fee $
Date of Payment
Receipt Number
AS-BUILT
I hereby certify that I have surveyed the followidg described
property: /-07' '7.~ ~/ e,c. ~ ~. ,~
C,F-,,:u ri;Il., T.~,--r,.,.,.,
Anchorage Recording Precinct, Alaska, and that the im~.rove-
ments situated thereon are within Ihe pn'*perty lines and do not
overlap or encroach on lhe property lying ad acent thereto that
no improvements on property'lyin~ ad'acent thereto encroach
on the premises in question and ti{at there are no roadways,
transmission lines or other visible easemenls on said propehy
except as indicated hereon.
Dated at E~$gle River, Alaska
this '~ ~ day of ht',a~..y 2(X)~.~__
ROBERT C. JOIlNSON -~o..~,'
SCALE: Registered Land Surveyor No. 880-LS
1" - 1.~ ,~' Box 7'7-0456, Eagle River, Alaska 99577
' Phone (907) 694-2543
Cl~ntName
~r~e~Nam~
Cl~ntSamp~ID
1052511001
Eagle River Engineering
Birch llills Terrace LT. B2
Birch Hills Terrace L7. B2
Ddnklng Water
AIl Dare.Times are Ablsko Stnnderd Time
?tinted DotetTlme 05/16/2005 1~:13
Co~ted Date~e 05~9~005 16:00
Recel~d Dat~lme 0~/1~5 16:19
Techn~al Director St~ ~ Ede
Sample Rcmarks:
~atmrs Depot tm~n~
Ni~a~-N
Rcs~hs
2.25
PQL
Uni~, M~d
Allowable Prep Analysis
Container ID Limits Dato Dam Init
0.100 mg/L EPA 300.0 B ¢<-I0) 05/10/05 .,'.lB
Nic=obiology ~-~boratozy
Total Coliform 0 col/100mL SM20 9222B A (<-I) 05/10/05 TLF
05/13/2005 ]0:1G
9B7344982!
JRSSEPTIC
PAGE 82
JRsPumping
PO Box 773415
E.~glcRive~ A~ 99577
(907)694-6454,
Eag'al River Engineering
10421 VFW Rd Sm 201
Eagle I~ver. AK 99577
(9O7) 6~4-S195
Job De~cdpllon: lO00g
P.O. N~mbar.
Terms~ Net 30
Map e0e~:
Chria
Eagle R~er. ~ 9~77
(~7) 6~.5195
242.27t7
S~lce ~
Wi~r
Tan ~e ~ I~t ~ue ~m.
~ 0~ ~nk wi ~,
Job
Tax Percent:
0
I NO
Service Agreement
Number: 016570
O~'der Date: O9.May-2005
Sa~ca Date: 11-May-2005 12:00 am
Tachs;dan: Butch
Job Type Recall
Map Odd: 93
N Eagle River Loop
.~'~'~-06/i'~02 1500g .........
P~ ~k. ~o dear
I
T~
No
Na
No
E,~tanslon Actual
Gallons Planned: 1000
Hose Length:
Double Tank: r']
Pump System: [s~
Bases Inlet:
Baffles Ouaet: U
NonTaxebta Total Taxable Total
EsUmeted Cherges;
,~u al Chmge~:
Customer aw'aMI Io ~e ~l a~ ~i~ns p~t~ ~ ~e Oa~. ~lS IS A BINDINO AGREE~.
TI][ TMal Grand Totnl
Slg~ature and Title of Cuatom~' Repm~eetalive
Accapled by dRs pumping Dale A~cepted
For ~u~ a~ed ConvKlenca ~ accagl; AmeriCan Express, D~ov~r, Visa and MaaW' Card payrnsnt~ over Ihs pho~e.
Altar 30 Daya account~ writ be turned over Io ooilecflc~a. $25.00 For NSF Chec~ Returned.
. ~ 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
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
Lot 7, Block 2, Birch Hills Terrace
Location (site address or directions)
11347 Terrace Hill Drive
e
Property owner .,Ralph Noreno Day phone 696-1013
Mailing address" 11347 Terrace Hill D~ive, Eagle River, ~ 99577
agenc~"Creataland Mortgage/Dalton Clark Day phone 563-3889
Lending
Mailing address 3201 c Street, Suite 406, Anchorage, /~ 99503
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3 '~
TYPE OF WATER SUPPLY:
Individual well xxx
Community well
Public water
~OTE: If community well system, provide written confirmation from State ADEC attest-'
lng to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attes!ing to the legality and status of system.
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and 8s 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 & $ ENGINEERING
17034 Eagle R;ver Loop Road No. 204
Address ..-.-,~l,, r~;v,.,-, Al~,k~ 99~77 ; '
Engineer's signature' "~~' /~./'~
Phone
Date
DHHS SIGNATURE
v'"'/ Approved for'~'~G
~ Disapproved.
__ Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority
Approval Certificates based only upon the representations given In paragraph 5 above by an independent
professional engineer registered in the.State of Alaska. The DHHS does this as a courtesy tO purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
RECEIVE,u
Municipality
of
Anchorage
APR 2
DEPARTMENT OF HEALTH & HU_M. AN SERVICES 6 99
Environmental Services Division .. MUNIOPAU~ O~ ANC~u~
825 L Street, Room 502 · Anchorage, Alaska 99501 · [~6~~vr-r~
Health Authority Approval Checklist
Legal Description: Lo r '7 Beat,,< ~ 61A. c/~ h~'$ T',~,,'C44c4_
Parcel I.D.:
A. WEll DATA
Weft type
Log present4~N) "/'~'J
Total depth
If A, .B, or C.., attach ADEC letter. ADEC water system number
Date completed /'f / ~' ~
Cased to l('o /(' Casing height (above ground)
Wires properiy protected ~N)
FROM WELL LOG AT INSPECTION
Static water level L,/ i ~ O
Well production (o g,p.m. /' ~'
g.p.m.
WATER SAMPLE RESULTS:
Coliform O
Date of sample: ~t / I r /q q
B. SEPTIC/HOLDING TANK DATA
Date installed ~ / [ & / 7 ~ Tank size
Foundation.cteanb~3fN) ¥6 $
Date of Purr, lng
Nitrate
Collected by:
Other bacteria ~
$ & $ ENGINEERING
IA)a~ Eagle mYer Leap Read Ne. 204
Eagle Ri~r, Alaska 99~77
/o~O Number of Compartments ,'~ Cleanoute (~q)
Depression (Y4~ /~' ~ High water alarm (Y~
Pumper (~-,4~ $
C. ABSORP11ON FIELD DATA
Datelnstalled ~'///6/~J' 'Sollratlno (g.p.dJfFo~ ~'5-' Systemtype c.,,~,~
Length ( ~ Wio'th ~ Gravel ~iclmess below pipe ~ Total dep~
Effective absorplton area ~' ~'-~ /~ ~' Monitoring Tube present (~/N)'Ye J Depression over field (Y~ '~ O
Date of adequacy test t~ / ~-")-'/(~c? Results ~(~/, ~F/, all) ~/~'$-g For .-~ bedrooms
Ruiddepthlnabsorpflonflaldbeforetest(in.); ~ 6 Immedlatelyaffer~-~gal. wateradded (in.): :~ /o
Fluid depth '~ / ~" (ins) Minutes later: 30 Absorption rate = Lt' 5-~ ~- g.p.d.
Pemxidetmatment(past12months)(Y/N) /v~vL. /c~;o~,~ Ifyes, givedate ~
72-026 (Rev. 3f96)°
UFI' ~TATIO N
Date Inet~lled
Manhole/Access (Y/N)
Size in gallons
*Pump on' level et* m/'~~p ~ I~1 at*
High water alarm level at* ~ '
Cycles test~
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot ~ 0 -'/-
Absorption field on lot / o 0
Public sewer main ,v//~
Sewer/septic service line
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation .,c' -?- Property llne ~ ~ Absorption field
Watermain/sen, icellne /o --F Surlacewater/drainage/o0 -/- Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line / 0 -f- Building foundation ]o ¥- Water main/service line '
Surlace water ,/00 -/.- Driveway, parldng/vehicle otomge area O
Curtain drain ~o,~ ~',,,o~',~ Wells on adjacent lote JO0 /-~
JO
F,
I certify that I have detemltned thru field ~nspec~ons end review of Municipal rec~'~e a~ 'e~ are
/n cenforrnance with MOA,H,a~4 gu/deJ/ne$ /n effect on th/$ date.
. .
Date
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev, 3/96)*
APR-Ig-gg 15:43 FR0i,~ZTE E~VIR0t~k~TAL
CT&E
Environmental Sen'ices Inc.
T-Il4 P.02/03 F-BT8
CT&E Rtl.#
Project Name/#
Se~upluP,~mu~uks:
~lient
Printed l]~e/Timc 04119/99 13:21
Collet~edDatei'Fime 04/15/09 16:$5
Rectived Date/Time 04115/99 16:55
Teclmkal Dir~lor:. Stephm C, Ed~
Released B~
£P300 Nhrate: Method blank was detectable [or ~ilra~e (0.61Stag/L). Sample value u~y b~ bias high.
At Io~te Prep A~eI~IS
LIMITS O~te · O_~te {nit
Totat Cotlform 0 cot/1OOmL ~q18 97,Z7.6
#itrate-# 3.3~ 0.$00 I~g/L EPA {0O.O
0~115/99 0~.115199 $Ck
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Servlces
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, sub~.i,sion, section, township, range)
Location (address or directions)
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
/'/34?
(b) Property owner
Mailing Address
(c) Lending Institution C/7'/
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
~'~'/-/',-~ :~-- ///~Y.5 B/~ - ~FF Efl47~ ~ ~
~ '~~ Telephone: (home) ~'~/~ Business
(e) Mail the HAA to the following address: (or check here 1-1. if hold for pick up.)
List contact person and day phone number below:
I{~Z ~o~,~ ~l~J
2, TYPE OF RESIDENCE
Single-Family ~< Number of bedrooms 3
3. WATER SUPPLY
Individual Well ~
Community [] Public ri
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 ~ Public 1'3 Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality.and status,
Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FIL.E SEARCH, DATA AND INFORMATION ,' ·
AS certilied by my seal alfixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe.
functional end 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 Ar~chorage files and from my investigation and
inspection, the on-site water supply and/or wastewater dispos~,l system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date o! this inspection.
Name of Firm ~-'~O"6~<' ~/~"
Address ~2~-~4)//
Dat; '//- 5'-
6. DHHS APPROVAL
Approved for ~'~--e(~/~edrooms by
Approved ~' Disapproved
Terms of Conditional Approval
Conditional
Date //-..2. x
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.
Page 2 of 2
~ MUNICIPALITY OF ANCHORAGE (MOA)
(,',~j~"~,~:,? ~,,';cW:Heaith,Authorlty Approval (HAA)
t,',u~,t~_.~. 5;.?,',,~5~:$ [:CHEC'KLIST - FEBRUARY 1984
~.~lt,';.C~' . · 343-4744
~, ;r'~; - 9 '[~,9 Legal Description: / 7 ~2 Z~//"~./-~
WELL DATA
Well Classification ~ '" ' ' If A. B. C. D.E.C. Approved
Well Log Present (Y/N) ~ Date Completed ~3r7/ I~ Yield
Total Depth ~ / ' ~ -- Cased to ~ Depth of Grouting
Static Water Level Pump Set At
Casing Height Above Ground ~ / Sanita~ Seal on Casing (Y/N)
Electrical Wiring In Conduit (Y/N) ~ Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot ~ '/ ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ~/~ ' ; On Adjoining Lots
To Nearest Public Sewer Line ~/~ ' To Nearest Public Sewer CleanouVManhole
To Nearest Sewer se~ice Line on Lot
Water Sample Collected by ~/~rg~/ ; Date /~)/~ ~
Water Sample Test Results ~ ~
Comments ~-- ~/~ /~ ~0~ ~/~
SEPTIC/HOLDING TANK DATA
Date Installed ~'-/~'-7,.~ Size /O'D'O No, of Compartments
Standpipes (Y/N) Y' ~/) Air-tight Caps (Y/N) y Foundation Cleanout (Y/N)
Depression over Tank (Y/N) /'~ Date Last Pumped
PumPing/Maintenance Contact on F!le (y/N) /'I)~r ; for
Holding Tank High-Water Alarm (Y/N) /~/~f Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well ~ °° / To Building Foundation ~- ;7_-0
To Property Line f-- 7.-O" To Disposal Field
To Water Main/Service Line -/"'--'~"~ /
To Stream, Pond, Lake or Major Drainage Course "~ /~"
Comments
Page I of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field '~' '
Square Feet of Absortion Area
.Depression over Field (Y/N)
Results of Last Adequacy Test
Type of System Design
Length of Field /,~ /
Depth of Field /<:~ ·
.Gravel Bed Thickness /~ ·
Statndpipes Present (Y/N)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation .../: .~"C7/ ·
Lot A)//~
To Water Main/Service Line --B~O ·
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Property Line '"/- ~- O
To Existing 6r Abandoned System on
; On Adjoining Lots ~'/0~ ·
To Cutback (if present) -~-/O-~'
D. LIFT STATION F.)g) T'
Date Installed
Size in Gallons
"Pump Oh" Level at
High Water Alarm Level at '
Tested for
Meets MOA Electrical Codes (WN)
Comments
Dimen,~ions
Manhole/Access (WN)
"Pump Off" Level at
Vent (WN)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Reques!°*
I certify that I have checked, verified, or conformed to all MOA and HAA'guid,
inspection~/]~ //~/, ,/!
Signed ~//'~ 'trO'°x'Pz'c'"--'
the date of this
company
Date
MOA NO.
Receipt No.
Date of Payment
Amount: $
//-
/
Receipt No. · ·"
Waiver Fee: $
Date of Payment
Page 2 of 2
NORTHERN TESTING LABORATORIES, INC.
600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS, ALASKA 99709 907-479-3115
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907-277-8378
Edward T. Israel
11432 Business Blvd.
Anchorage, AK. 99577
Date Arrived: 10/31/89
Time Arrived: 1403
Bate Sampled: 10/30/89
Time Sampled: 1700
Date Completed: 10/31/89
Sample ID#: A103189-16
Parameter Unit Result ADEC MCC*
Nitrate-N mg/1 3.1 10
d By' · 11/01/89
Reporte . ate.
Francois Rodigari, Anchorage Operations Manager
* MCC = Maximum Contaminant Concentration
NORTHERN TESTING LABORATORIES, INC.
600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS. ALASKA 99709 907~479.3115
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907.277-8378
Quality Control Report
Client: Israel
ID#: A103189-16
Listed belo~ are quality control assurance reference samples with a known
concentration prior to analysis, The acceptable limits represent
a 95~ confidence interval established by the Environmental Protection
Agency or by our laboratory through repetitive analyses of the
reference sample. The reference samples indicated below were analyzed
at the same time as your sample, ensuring the accuracy of your results.
Sample # Parameter Unit Result Acceptable Limit
EPA 284-4 Nitrate-N mg/1 1.50 1.28 - 1.56
Francois l~odigari, Anchorage Operation Manager
NORTHERN TESTING LABORATORIES, INC.
600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS, ALASKA 99709 907.479.3115
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 g07.277-8378
Constructing Engineers
9601 Buddy Werner Dr.
Anchorage, Ak. 99516
Attn: Ed Israel
Date Arrived: 11/18/89
Time Arrived: 1500
Date Sampled: 11/18/89
Time Sampled: 1000
Date Completed: 11/20/89
Sample ID#: Al11889-1
Parameter Unit Result ADEC HCC*
Nitrate-N mg/1 3.0 10
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
Francois Rodigari, Anchorage Operations Hanager
* MCC = Maximum Contaminant Concentration
NORTHERN TESTING LABORATORIES, INC.
600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS, ALASKA 99709 907479.3115
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907.277-8378
Quality Control Report
Client:
ID#:
Constructing Engineers
Al11889-1
Listed below are quality control assurance reference s~r~ples with a known
concentration prior to analysis. The acceptable limits represent
a 95% confidence interval established by the Environmental Protection
Agenc~j or by our laboratory through repetitive analyses of the
reference sample. The reference samples indicated below were analyzed
at the same time aa your sample, ensuring the accuracy of your results.
Sample # Parameter Unit Result Acceptable Limit
EPA 284-4 Nitrate-N mg/1 1.53 1.28 - 1.56
Reported By: Date: 11/20/89
Francois Rodigari, Anchorage Operation Hanager
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
3. Legal Description:
4. Location:
5. Type of facility to be inspected
6. Well Data:
A. Type Drilled
C. Construction Standard
7.Sewage Disposal System:
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received 3/12/74
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & I~ATER FACILITIES
FOR
Cony.
Coast Mortgage
Suppok, Regis
Gen. Del. Eagle River AK
Lot 7, Block 2 Btrchhtlls Terrace
Sinqle
Phone:
Phone:
3:30 pm
3/12/74
694-2125
No. of bedrooms
B. Depth 296'
D. Bacterial Analysis
Satisfactory
A. Installed 1973 B. Installer
C. Septic Tank: 1. Size 1000 Gals
D. Seepage Pit: 1. Absorption Area
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
C. Absorption area to nearest lot line
2. Manufacturer
2. Material Concrete
169' , Absorption area 169' , Sewer Lines
, Other contamination
, Absorption area
25'
36'
EQ-034 (1/74) Page 1 of two pages
Pa~e 2 of two pages - Req..st for Approval of Individual ~'~ar & Water Facilities
Legal Description
Comments
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ-034 (1/74)