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Home My WebLink AboutBIRCH HILLS TERRACE #2 BLK 2 LT 5Birch Hills Terrace #2 Lot 5 Block 2 #050-141-35 l ULJ+t�ltllJ U u L' --i JUN 9 2021 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181084 PID Number: 05014135 Dwelling: FillSingle Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Tvio Single Family Project: ❑ New 0 Upgrade Name TIERNEY MICHAEL ABSORPTION FIELD 19 Deep Trench ❑ Wide Trench El Bed Eltvtound Site Address 17744 Lacey Dr ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 622-3617 4 1.2 GPDiSF 12 Ft, LEGAL DESCRIPTION Depth to pipe invert frc,m c;iginal grade 4 Ft. Gravel depth beneath pipe 8 Ft. Subdivision Block Lot BIRCH HILLS TERRACE #2 BLK 2 LT 5 Ful adder above original grade 0 Ft.l (Gravel length 32 Ft. Township Rance Section Gravel viidth )Beds: number of Lines 3 Fl.l - Distande between lines - Fl. SEPARATION DISTANCES To Septic AbsorptionLift Holding Sever Total absorption area Number of trenches Dist, between trenches From Tank meld Station Tank I Line 500 Ft. '" `ell na na na na na TANK K Septic ❑ S.T.E.P. ❑ I-Iclding [DOther hvlanufacturer Anchorage Tank I Capacity 1250 Gas. j SurfacebVrler 100'+� 100'+ na na Adatenal Steel Number of compartments 2 Lot Line 10'+ I 10'+ na na NA Foundation 10'+ 0'+ na na LIFT STATION N-lanufaclurer Capacity Gap. Remarks DV t0 Old S.P. Alarm location Electrical installed by PIPE MATERIAL . House to tank D3034 dTank ;rain(ield o D3034 InsIallGr Dean Drainfield D3034 CQINIT D3034 Inspector NOrthRlm Eng. BENCH MARK (Assumed elevation) 100 it Inspection t t 5121/18 z,.. 5122/18 Location and description dales: Sidewalk ON-SITE WATER AND WASTEWATER SECTION APPROVAL ��Q-amp e�®4 0 0 Conditional Approval: Date 4 .49TH *�4 Steve Eng b�� Septic System cE—s2ss Ar Approved Date .74,7.2 4 S 2� Note: this approval does not include well permit requirements. Decommissioi Septic Tani - PE & Replaced w/ Septic Tank w/ Double C 15% Slope Lot 6 12% Slope dcol A 27 B 42 STI 29 44 ST2 32 50 dco2 35 51 Div Valve 37 54 Cal 45 45 CO2 45 17 MT d5 I9 CQce, r NOR THRIM ENGINEERING SteveEng, com PO Box 770724 Engle River, A/osko 99577 907.694. 7028 . n ..S ��a -max ••; 5•>��3�'21 Flat Slope t 4 Septic rench BIRCH HILLS TERRACE #2 BLOCK 2 LOT 5 WASTEWATER UPGRADE SEPTIC 110% Slope 1" = 50' RECORD LAYOUT Dote: ISHEET. 5/29/21 12 of 3 U Q D d Frl 7u n F-] 7b3-ud fel -0 '—' n V)�� r9 F l - H n D T Z7 71 z = z tj 70 O < ' ' I Z f6- < F ---i I I o (D rF� Im 0 S� ; C F9 y^ZJ \ C+ o yx r Z o v O V :3 r J < Q O (Q T Z f7 H v o \ Q F— I Iv ) A -7Q A 0 m O TI U Q D d Frl 7u n F-] 7b3-ud fel -0 '—' n V)�� r9 F l - H n D T Z7 71 z = z tj 70 O < T F ---i I I rF� Im 70 F9 � C.. 0 N (D 70 � n a M = T < I V VJ H m F— Q F— I Iv ) A -7Q A 0 m O TI Q O Frle II :5 70 cn ro tj Q U1 ro ro D 00 Q 0 �,D � O W t') f) w �J O Fri U1 Z \o ru CD co m ro 7 D fU Q L l c+ mn o S 0 C0 Q - P —Q ro (O O (p :3 ,0 (J1 -1 V) �n Q C+ :3 ro T- ro C-) n O < < 5 3 O 0 :53 Q < 0 rF Q 5 n :5S O C C <+ Z5- < ro 5 Q ro c+ ro Q O 'Q (0 Q Q ro :3 0 U) m < ro Q Q0 _0 00� 0 5 ro 0 (D o n (7� (D Q 0 c+ Ln n Kla < n S < Ln 0 (D m M Q m < 0 r0 go r0 Q S Q -7Q 0 m O TI Q O :5 :5 — ro tj Q U1 ro ro f7 00 Q 0 �,D � � Q W o �J O Q s n 75 n \ co m ro 7 D fU Q L l c+ mn o S 0 C0 Q - P —Q ro (O O (p :3 ,0 (J1 -1 V) �n Q C+ :3 ro T- ro C-) n O < < 5 3 O 0 :53 Q < 0 rF Q 5 n :5S O C C <+ Z5- < ro 5 Q ro c+ ro Q O 'Q (0 Q Q ro :3 0 U) m < ro Q Q0 _0 00� 0 5 ro 0 (D o n (7� (D Q 0 c+ Ln n Kla < n S < Ln C�z C o o — P- t > 3� ' ` o j� # �� Cyd 0 ftl 9nM `0o co � � 1 !' �{ -� m m z 5E m VD -i ;. 1 (n 0 0 i 0 � m r:tn X ` \ mm HT1 � ;u Cte m m < $1! w z T e 00 rri 4 (D Lo> .. flu i a m ti m cn CA 0 n a xof "tlid ' a a a S,J . Al 5/0 l$ a(30 JN,"`""'Y MUNICIPALITY OF ANCHORAGE .- • Or \\\l 11 On-Site Water& Wastewater Program PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 • http:/lwww.muni org/onsite —1� j , L� ■ 1 Dt•pa r t int.tit �h�HORPGE On-Site Wastewater Disposal System Permit Permit Number: OSP181084 Effective Date: 5/16/2018 Work Type: Septic Upgrade Expiration Date: 5/16/2019 Tax Code Number: 05014135000 Site Legal Address: BIRCH HILLS TERRACE#2 BLK 2 LT 5 G:0153 Site Mailing Address: 17744 LACEY DR, Eagle River Owner: TIERNEY MICHAEL P & SARA C Lot Size in Sq Ft: 44671 Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 4 This permit is for the construction of: 0 Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy 0 Private Well 0 Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: c.51e/ Date: /� 7 Issued By: 'f\I e.erCQJUU-Q...Q Date: 3 !le, 18 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water&Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 0 SO - /48- Property owner(s) l y Day phone Mailing address / 7 7412,/ L c EY AR. Site address S`{ Legal description (Sub'd., Block & Lot) 5/?C/-' /,71/GL.1" j e.7/114e(E 162 L,S- Legal description (Township, Range & Section) Lot Size 414, c7/ Sq. Ft. Number of Bedrooms I( APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field , Initial ❑ Single Family(SF) (w/wo ADU) Septic Tank Upgrade Holding Tank 0 Re c ` Duplex (D) ❑ vy 0 ry Multiple Dwellings 0 Pri '� (SF and/or D) A - Private Well ❑ MAY Water Storage El THIS APPLICATION INCLUDES A VARI • ,. 6.•r REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (S • - re of property ow or authorized agent) Permit/Rush Fees: 5-LA- Waiver Fees: Date of Payment: �'r/iCf I S Date of Payment: Receipt Number: O q M P Receipt Number: Permit No. 0 P R11 41 Waiver No. Permit App_9-1-12.doc TSI M ENGINEERING SteveEng.com Steve Eng, PE, PH 907-694-7028 SteveEngPE@gmail.com Date: 5/8/18 Number of Pages: To: MOA On-Site Services Subject: Birch Hills Terrace#2 Block 2 Lot 5 Septic System Upgrade An existing septic system is failing on the subject lot. A new of soil test reveals silty sandy w/gravel soil and no groundwater. The design calls for a new deep trench and a new septic tank. The old concrete seepage pit will be connected via diverter valve. The entire subdivision is on public water and septic systems. The terrain slopes northwest and is flat slope at the trench site. The system size is a single family at 4 bedrooms. Please review the wastewater system design for the existing 4 bedroom home. I have included design plans & specs, design guidelines, & soil test. If there is need for additional information or clarification please give me a call. Thanks-Steve�� • •tcC••,,Sf \CR, ENGINEERING SteveEng.com Birch Hills Terrace41ck "yeo •: 410 SPECIFICATIONS & DESIGN GUIDELINES t4``''°Ho Es'a\",; Wastewater System Sizing: This is an existing 4-bedroom, single family home. This is a developed subdivision. These lots are large and are served by public water. No adverse impacts are expected from trench/tank upgrade.No conflicts to the other lots will take place by this septic system construction upgrade.The easements are located on the drawing and are not encroached upon. A new soil test reveals silty sand w/gravel. An application rate of 1.2 GPD/FT2. Trench Length=500 FT2/8'x 2 =32' trench, 8' effective. A new 1250 gallon septic tank will be installed; Decommission old tank per UPC.New Diverter Valve to be installed, connect to existing concrete seepage pit. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications(AMC)& State of Alaska Drinking Water Regulations and Wastewater Regulations. • Two compartment,New 1250 gallon septic tank. Install Double Cleanouts. • Install Diverter Valve; "ON" to new trench. • Decommission old tank per UPC. • 10' minimum between the tank trench. 10' to property lines, 16' between trench and existing seepage pit. • 3' of cover or insulation is required for trench; 2" Minimum thickness for insulation can substitute for 1' cover. • Tank& solid pipe must be set on well compacted, stable soil. • 4 inch diameter cleanouts with airtight caps are required 1' to 4' from foundation wall,prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field,not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level. • In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. • Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain-rock. • Drain rock to be '/2 inch to 2 inch screened. Drain rock to be distributed uniformly throughout the trench. • Perforated pipe to be installed level with perforations down. • Silt barrier(filter fabric)to be installed above the drain rock. • Smeared trench sides must be raked or scarified before drain rock placement. • The finish grade must be mounded to promote drainage away from trench. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron,PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2%slope. • Septic Tank to be pumped every two years or when required. • Insulation board to be extruded direct burial polystyrene(Dow Styrofoam HI/equal) DESIGN NOTES: 1. Total Depth of Trench is 12'. 2. Sewer Service Line minimum 2% slope. 3. Public Water System. 4. Decommission Old Tank Per UPC. 5. Connect Old Seepage Pit Via Diverter Valve. 6. If No FCO Found, Add DCO Before The Tank. CQcey Drive I a C Decommission Old Septic Tank a° PER UPC & 110/. Slope Replace w/ 1250 Gallon Septic Tank w/ Double Cleanouts tin Slope C 10% Slope 157 Slope Garage FSlope New Diverter lat o Valve Lot 6 Septic oC° �H Flat Slope `I UUU Flat Slope C°2 Lot 4 Septic 4 Bdrrl ew Trench 12% Slope I2% Slope No — Conflicts 10' Utill—� EaSeMen_ ik NORTHRIM der BIRCH HILLS TERRACE 1' = 50' ENGINEERING ‘�P•'.. SteveEng.com * '491Ii #2 BLOCK 2 LOT 5 DESIGN PO Box 770724Uwe Erg ,tr LAYOUT Eagle River. Alaska 99577 • a _. WASTEWATER 907. 694. 7028 UPGRADE SEPTIC 5/15/18 192€Erof 3 Foundation Cleanout Tank Cleanouts Fin ^amide Opposing Cleanouts Between Septic Tank & Trenches 4 Foot Cover or Equal Diverter Valve 1250 Gallon Steel "Anchorage Tank" Mounded Cover To Match Terrain Or Equal Monitor Tube Solid Pipe leanout DESIGN NOTES: 1. Depth of New Trenche is 12'. 2. Septic Tank & Solid Pipe to be Placed on Compacted, Stable Soil, Free from Boulders. Filter Fabric �� 3. Sewer Service Line is Minimum 2% Slope & 3' Cover. _ !-40_,-....-41,- 4. :;_ _;4. Water-Tight Couplings. ! ! ! 5. See Specification Sheet. = 1.•=•='=•='= 6. All Work To Conform to Municipality of Anchorage (AMC) =�` ` �`p` Requirements & Specifications. :! : : ! :: 7, Maintain 3' Cover Over Trench Or Insulate. �'�'�'�'•'•' .--..-_. Drain Rock ' !=!=•=!=!=!= 8. Public Water System. :::::::::::: 9. Install Diverter Valve To Old Seepage Pit & New Trench. !:•'•`•`•' - 10. Match Line Elevation To Existing Line. 11. If No FCO, Add DCO. 3' NOR THRIM ;•-.1- °F ..... -,,P.,... + TRENCH END VIEW ENGINEERING*:49m *�� BIRCH HILLS TERRACE #2 SteveEng. com%, SEPTIC TANK PR❑FILE BLOCK 2 LOT 5 Po Box 770724 t't % st`." 01 SEPTIC C SYSTEM Eagle River, Alaska 99577 141;, f! Dote: raven By SE a 1, = 5 , EET:3 of 3 907.694.7028 UPGRADE 5/8/18 II SH SE S❑ILS LOG - PERC❑LATI❑N TEST N1CRTI- I Date Performed: 5/1/18 ENGINEERING Performed For: Michael Legal Description: Birch Hills Terrace #2 Block 2 Lot 5 DEPTH (FEET) T.H. Location: See Attached Test / Organic 1 Boring Location Map 0 a 2 - 0 0 SM Silty Sand 3 - . 4 - . 0 :.. . W/ 5 - 0 Gravel 6 - Groundwater? None 7 - .. Depth -- 8 - Water Depth 9 - 0.. After Monitoring.None Date: 5/10/18 10 - . . # Date Gross Time Net Time Depth Net Drop 11 - :0. 1 5/1' 0 -- 6' -- 12 - 2 5/1 10 10 min. 2' 4' 13 - 0 3 5/1 20 -- 6' -- 14 - 4 5/1 30 10 min. 2' 4' 15 - 0. 5 5/1 30 -- 6' -- 16 - Q 6 5/1 40 10 min. 2' 4' 17 - 7 5/1 40 -- 6' -- 18 - 8 5/1 50 10 min. 2' 4' 19 - 9 5/1 S0 -- 6' -- 20 - 10 5/1 60 10 min. 2' 4' 21 - Percolation Rate 2.5 min/in Perc Hole Diameter 6" Test Run Between 5' & 6' Comments: Performed By NorthRim Fng. I �<- CERTIFY THAT THIS TEST WAS Performed in Accordant with All State/Municipal Guidelines in Effect ON THIS DATE. DATE: 5//i? -+SC-. ' 4 BIRCH HILLS TERRACE TH1 NORTHRIM 4'`P' ENGINEERING * '49m '' *• #2 BL❑CK 2 L❑T 5 PO Box 770724 VT-4 tEagle River, Alaska 99577TESTH❑LE L❑G907.694.7028 >rr riii GE❑TECHNICAL 5/10/18 �: ANCHORAG. E AREA BOR" GH Department o! Env,ronmental Quality 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~OLf/e/'/O,~ ~J'"'~/~'~/ MAILING ADDRESS ~ ~ /~ PHONE LOCATION ~E~ ~/~ LEGAL DESCRIPTION ~/ ~, ~/~C~ ~/~ SEPTIC TANK: DISTANCE FROM WELL /15 · INSIDE LENGTH NUMBER OF MANUFACTURER ~-R~"~"~" MATERIAL COMPARTMENTS INSIDE WIDTH LIQUID DEPTH lIQUID CAPACITY /~' ~"~) GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER _ OR WIDTH/',;~' LENGTH /7~ t . DEPTH LINING MATERIAL CRIB SIZE: DIAMETER BUILDING FOUNDATION '~"0 /, NEAREST LOT LINE~'/o,/e~l DEPTH DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE CONSTRUCTION BUILDING _"3 ~' I NEAREST FOUNDATION c.,xu LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED NEAREST SEWER LINE REMARKS DEPTH DISTANCE FROM: SEPTIC ~'~?.?~' SEEPAGE /~P~,E~X TANK //~), SYSTEM /~ I PIPE MATERIAL: LOT SLOPE= REMARKS= Form PW-026 DIAGRAM OF SYSTEM GREw,Er ANCHORAGE AREA BONuUGh SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT NAME OF APPLtCANT INSTALLATION LOCATION LEGAL DESCRIPTION PHONE ~/~Z~ '~"'~' 6EEPAGS PIT DRAIN FIELD OTHER TYPE AND SIZE OF FACILITY TO BI; SERVED '/2/* '~-'~"~'~/'/'/ J"/-~/'~-----'~""~"-~//---J'/~ '~"'~'/"/~'"//f'"'/~ COMPLETION DATE ANTICIPATED /~ ~ FINAL INSPECTION~ 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE: BUBJECT TO PROSECUTION. '' · P,T "~' / WATER MAIN TO SEPTIC TANK // / SEPTIC TANK. ~ / SEEPAGE PIT ~'"/~ SEEPAGE AREA SIZE SEEPAGE P'T //)~ ALSO CONSIDER AREA WELLS. SEEPAGE PIT DRAIN FIELD DIAGRAM OF SYSTEM GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE / Municipality of Anchorage Development Services Department Building Safety Division .. On-Site Water and Waste,~rater Prpgram .. ..... 4700 South Bragaw St. '" P.O~ Box 196650 Anchorage, AK 99519-6650' www. ci.anchorage.ak, us " (g07) 343-7g04 CERTIFICATE OF HEALTH AUTHORITY APPROVAL .... "': t:'OR A ~'iN'G[.~:' ~'AMi'LY L)WEELli~i3. -- · ..... Parcel I.D. O ~"O - 14/-' $5' · · .GENERAL INFORMATION Complete legal description _j-Z~/~n_/1/ ' HAA#,' OL'{ 0 I Location (site address or directior~s) "/77/-//-/' Current Property owner(s) Mailing ,address Day phone Lending agency · .. Mailing address . · Real Estate Agent Mailing Address Day phone Day phone Un/ess otherwise requ. ested, HAA will be held by DSD for pickup. .. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY:: Individual Well .... Individual Water Storage Community Class ~ Well Public Water System '~'YPE OF WASTEWATER DISPOSAL: Individual On-site j~ Individual Holding tank ['-I Community On-site [] Public Sewer !-'-I ,~he Municipality of Anchorage Development SeMces Department (DSD) Issues Certificates of Health Authority pp. roval (HAA) based only upon .the representations given in paragraph 4 by an independent professional civil ...... engineer registered in the State of Alaska. Cedificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a singl~family on-site was[ewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Cert~cates of Health Authority Approval are valid for 90 days from 'the date of issue for properties served by a pdvate 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 propedies served by Class A or B we,s or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. STATEMENT OF INSPECTION BY ENGINEER As certified by m~/seal affixed hereto and as'of the validation datelshown below, I verify.that my'investigation, . '-":~'i~:".:.i' - based on p. rocedures outlined in the Health Authority Approval Guidelines for this application, shows that the 6n- .... i'.-'~?::i':'~.'. :. , .. site water supply and/or wast~water'disposal ~stem is(are)' safe; f~hcti~nal and adequate for the number 6f ::':.':.'..":'~' bedrooms and type of structure indicated herein.·! further ve'rify that I~ased on ,the .information obtained from the '..':;:-~", Municipality of Anchorage' files and from my investigation. '.and'inspe. ctionl the on-site water supply and/or .' ' .;;;',~.'" wast°water disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, · "'"' '"': ' and regulations in effect at the time of installation.. . ..'" '":' ':: '"- '" ~" i '. . . . . . ..... .;' .... ..... -.. .. .". · .. · .~,.,,~,%,,%~..~ · . ;:- · . · .... :...-....::...' ~-.....;-;.~;:...,~ ~.....~ ., ... .... · ....::. . .OF.A/,. ~ -. · ... '..:' · ' .'.. . '. . . :" .... .... : '..':"". :... · · : .. ......... :'..".-.'..: -' ........... , · .¥~'[~_--·.'.**'3;~' t,' ." · · ...-.. ............ . .... ;.-'"..- :.'.. -.."...? -.....-.~,.: . .. . :,.-:-~..',;.'~..-~,w'"'~...~l~.."~. , . .,~ ~ · ; · · · ... . . . .. . . . · ...-..........,...-..... -.... ::: ....... :..~.. ~.. ,...' .;.....'.::.~,;..~,.*.:'..'.~'..-~f,.*..~,,?. · ~ ...... .. ...... :.. :' '- ..· .", : '. -"'.; '.'."...... ' . -';.. -33"..-.: · ' ., · · : ~c-.~ ' '. "Co~uwu~,a~ 1"1" :' -':' · :. · : -' '. '" ";.'--.i' ;'?, :.'::'"'~.-'.::': .-" ' ---'~ ·" "'" '" :. ' .... · . . . '......, . :.'.'.'.'-.~ ..,'. ,~.-,-; .,'. ~.= .. . · .. . .... . · . . , ·. . . Additional'comments· Attachments: Septic System Advisory: Well Flow Advisory .. '. -....' '. ',."Maintenance Agreements Supplerfiental .Engineer's Report ·Other Original Certi[icate Date: (Rev. 01~132) Municipality of. Anchorage , · DeVelopment Services Depa ,rtment Building Safety D!vision .. On-Site Water & Wastewater Program " 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 - www.c~.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLiS¥ Legal Description: ,Well type , , / A, B, or C provide PWSID # 'Date completed.. ../ Sanitary seal (Y/N) / Totaldepth ! /.': Cased to ft./ ;?TER SAMPLE RESULTS: / : ?C0iiform colonies/lO0 m/...Nitrate mg./i. Arsenic: mg./I. Date of sample: B.':SEPTIC/HOLDING TANK DATA Tank size ./2~25'O gal.. ' Number of Compartments Foundati6n ¢le~houi {Y/N) 5t :'~ Depression over tank {WN) .A/ Oaie of/pumping: ~: "': Pumper ~('~. C, ABSORPTION FIELD ~ATA Cleanouts (Y/N) ~ ' High water alarm (Y/N) Tot~a, depth//,~, ft. Eft. absorption area-q'~G ft~ Monitoring tube Daie of adequacy test ~r"'/I '?/O f Results (PasslFa,I). Fluid depth in absorption field before test 2[ in. Water added 6'o~ gal. Elapsed Time'~O min. Final fluid depth~.[ Any rejuvenation treatment (past 12 mo.) (YIN & type) System type ..5'~}5 P/~(~' Gravel below pipe ~A//.,'~- ft. Depression over field For ..¢ bedroomS . New del:Jth 7 in. Absorption rate >= !,o/GE If yes, give date Well Log (Y/N)'.. : / Wires properly protected ('~) Casing height (above gFSund) -'! 'in". '' Z[ ' AT INSPECTION /'. '" ' ' ' o i~s/lO0 ¢'~ollected by: Parcel ID:! :,1 D. LIFT, STATION Date i'ns[a'l'l~d - ' /// -pum :p o!: iCY'el at .~in, Datum ii:.: : / i · Size in gallons . "Pump off" level at ', Cycles teste~ SEPARATION DISTANCEs ,' ~ High water alarm/~at .~ ! in. Meets alarm ~f'cuit requirementS? ' i i SEPAR~'TIoN DISTANCES FROM WELL ON LOT TO: Septic t~nk/lift station on lot/ Absorpti,oh field on lot/: Public sewer main~ . Sewer ,S~'pti .~rvice !i!e .'i;-. SEPARATION DISTANCES , ' · Onadja<~c~r~tlots ___i _,' ' ' & ' ' t lots ~ ' , bic se r manholelcleanout /- :Holding t.ank ,/,.,/" ~.~ I ' FROM SEPTIC/HOLDiNG TANK ON LOT TO: I,~ Building' f,oundation /El Property !ine ,, water main ~ //0/'¢-" ;i-:!, Water se~ice iine_/.d' Wells on 'adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD .ON LOT To:. Absorption field Surface water Property !.in° 7/0 ¢,¢- ' ·. ': Building foundation, :/0/',"' .,. ]water. main 'i' !"' ' ' "'0 ;;," ' Water Service line ,/0 :.;" !' Surface water i./¢ . ' ;~ Driveway, Parking/vehicle Storage. curtain c~rain ' ;'.'i Wells on adjac~nt 'lots /00 ' ~i: F. COMMENTS ' " ~ '1 Go ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Mumc/pal records that the above systems 'are in conformance with MOA:HAA g'uidelifies in effect'o/~ this date. EnglneeCs'Prlnted Name ~,~f"~-~/r~'~ Date O -~ . ~ Date of PaCm~nt Receipt ~umber {Rev.' 12t01)il I: Waiver Fee S Date of:,,F'.ayment ReceiPt..N ,umber Water Well Abandonment Birch Hills Terrace #2, Lot 5, Block 2 Concrete-Filled Well sin % - Inch Steel Fabrication Plate ring to Weld Steel Plate on Casing Welding Steel Cap to Casing SCALE, I HEREBY CERTIFY .THAT I HAVE SURVEYED THE /,,,,, , FOLLOWING DESCRIBED PROPERTY: ~'~'3' INDICATED. IT IS THE RESPONSIBILITY OF THE /' OWNER TO DETERMINE THE EXISTENCE OF ANY GRID; EASEMENTS, COVENANTS, OR RESTRICTIONS .,,~'sc//,~'.? ' WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOLLDFB: '~ ~S- 6918...-",qf'~' ANY DATA HEREON BE USED FOR 'CONSTRUCTION ~;~,C,C,~,/ . "'-. OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN~ ARY LINES. ,,~,,,,,,/..,./-" ~,~,'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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description e Location (site address or directions) Property owner /4,/a~q¢~! / Mailing address //~ ~'" Lending agency Mailing address Agent /-' '~//~ Address 177qq /-acey Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: // Day phone Day phone TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing 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 attesting to the legality and status of system. Be 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 Address ,,3 J ?'~-/'/ /~-/-~,-~,,~-,f,~ ,/~lv~/. / ~,.~,,/¢ /~;~,~,,.- I Engineor,s signatur~--~ Date e DHHS SIGNATURE ~ Approved for L./L Disapproved. Conditional approval for bedrooms. ~drooms, 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. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 3z~3c-q~ta,~ Health Authority Approval Checklist LogalDescription:~ ,/~t/~ ~/,'aC¢tt'~/ ~2//-~ earcetI.D.: 4~5~"/z//-~'' A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production / WATER SAM~E/~S: Nitrate Date of sample: If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~ Cased to Casing height (abe Wires pm~d,~,,pr~ed (Y/N) FROM WELL LOG .,,...,,.,*~INSPECTION g.p.m, g.p.m. Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~'~//-.~/T 2. Tank size /~ 2. Foundation cleanout (Y/N) y Depression (Y/N) D eof .ump,og .amper Langt~ /7 ~ W~th /-~ ' Effective absorptloa~rea ...~'~,D =~ Number of Compartments ~- Cleanouts (Y/N) ¥ ~ High water alarm (Y/N) /V' Soil rating (g.p.dJft Date of edequacy test ~ ~//~ ~/~ Fluid depth in absorption field before test (in.): ~//?,- Fluiddepth ///~YP (ins)Minutes later: Peroxide treatment (past 12 months) (Y/N) Gravel thickness below pipe Monitoring Tube present (Y/N) Results (Pass/Fall) System type /,/4 Total depth // _ Depression over field (Y/N) For /'/ Immediately after ~)gal. water added (in.): Absorption rate = ~)~:~ g.p.d. If yes, give date -- bedrooms 72-026 (Rev. 3/96)* D, LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cy~.~cJ~ ~e, t~t~=u E. SEPARATION DISTANCES Size in gallons ~ ~~l~~mp off" level at' 'Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On adjacent lots Absorption field on lot Public sewer main · ~Public sewer manhole/cleanout Se~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation /~/~ Property line /~/.,c Absorption field Water main/service line /D~ Surface water/drainage /P~/'/' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line Sudace water /~)~ Curtain drain /~/.,L. Building foundation /~ t~_ Water main/service line /D/'~ Driveway. parking/vehicle storage area Wells on adjacent lots TO R ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections in conformance with MOA HAA guidJ~ines in effect on this date. Signatul~"-/ ~ Engineer's Name /~;.~ ~///3 Date HAA Fee $ .-~, Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)*