HomeMy WebLinkAboutBIRCHWOOD ACRES LT 2
Municipality of Anchorage Page 1 of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISIO'N
. P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: swgRo247 PIDNumber: 051 -231 -29
Name:
MM&M Contracting Wastewater System:
P.O. BOX 670495 Chugiak, AK ABSORPT
Phone: I No. of Seclrooma:
688-1236, Thre9 r'l D~p Trench ~allow Tren
LEGAL DESCRIPTION soi,
LoC Bloc~: Su~ivmion: OeOffi m ~ige ~om from odgina gm,e:
2 N/A Birch, oDd Acres
Township: I Range: ~ S~tion: F~oove original gra~e:
WELL: ' ~ew ~ Upgrade ~a~ w~et~:
~ Ft
Cl~fi~aon (P~vate, A.a,C): · Total D~: ~ To: To~'~aon
Private 61 F~ 61
w~: Sullivan ~ater 7/22/9 25 ~ ~
SEPARATION DISTANCES ~.,,c ~ Holding
Sudace
w~te~ ~1~' ~lf~' F~ ~/*
Lot ~I ,
Remarks: m~~10 ~UY,'~ /~,*U/~ BENCH
[~suZa[~o~ placed ove~ east e~d o~
t~e~ch pe~ co~t~acto~.
Inspections performed by: Dates: 1st 8/31/98
2nd R/~1/98
Depadment of HealtAand Human
.e ,ewe ..rove.
mew [] Upgrade
ION FIELD
ID Bed I'1 Mound I-1 Other
Total Depth from original grade:
Gravel depth beneath pipe
,(D Ft
Gravel length:
~-~ ~.
Number of lines: J Distance between lines:
Date installed:
8/31'/9B .
K ,-
ID 8.T.E.P.
Capecit~ in gallons:
Number of Compartments:
~TION
I
High water alarm at:
per/ormed by:
MARK
~/_~
72-013 (Rev. 9191) MOA 25
Permit No. SW0980247 Page 2 of 3
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: LT 2~ ]~rchwood Acres Subd~vi.~o.
PID No.: 051 -231 -29
O
SP2 " ,,
C Clean/Out
MT Monitor Tube
10' Otilit7 E~mt.
compartment 1
Permit No. SW980247 Page 3 of 3
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: LT 2, Btrchwood Acres Subd~.v~.s~.o~ PID No.: 051-231 -29
$P2
C
MT
ELEVATION AS-BLT
1" = 10"
Septic P,,ump, compartment 1
Clean Out
Monitor Tube
FROM : MMM CONTRRCTING PHONE NO. : 6881258
NOV.
ooo ~o.
SULLIVAN WATER WELLS
~.O. ~O~ 6T0~72, CHUGIAK, A~ASKA ~S87 · TELEPHONE 688-~T~9 ' '
06 1B~ 11:22~M P1
'OWNER OF LAND
8,0RE HOLE DATA
,DEPTH
ADDRESS ,,..
.
TAX I,NDENTIF!CATION NUMBER la'31 '
'Is Well located at approved pe~it location? ~'~ No
Method of Drilling'. ~ta~: ~ cable tool
C,~ing ~ype ~'7~.~Wa[I Thickness ~
' q~erType: ~. , "' ' ' ........
. Cas/no 8~lckup Above Ground: ~' feet
Static.Water' Level (from ground level')', _:, ~ 'foot
Pumping level: ....... feet a~e~ ..... hrs. pumping gpm
Recover Rate: .... ?~ gpm
Well Intake Opening Type: .~ Open End ~ Open H01e'
0 Screened; Sisal ', feet Stopped. .feet
~ Pe~orafions Sta~ feet S{Opped .... feet:
Grout Type: ~T~'~ ._Volume'.'
Depth', from ~ feet, t° / feet
Pump Intake Depth: feet',
P~p Size hp Brand Name
Well Disinfected Upon Completion? ~" ~ No
Name
es onsibilit of the 'property owner to submit a oopy of the well log to the proper authority. Munlclpalit
ATTENTION: It is the r 13... ,Y. ...... .__.; .....-'-- ,,-.-~-~-,,, ,,~ Environmental Conservation. MatSu Borougl'
of A~ohorage; Department ot Mealtl~ ii Human ~erv.oe~ a~u~u. ~=~.= ............
Department of Environmental Conservation,
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
· 2
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Date Issued: Jul 17, 1998
Expiration Date: Jul 17, 1999
Permit Number: SW980247
Legal Description: BIRCHWOOD ACRES LT 2
Design Engineer: Anderson Engineering
Owner Name: MM&M CONTRACTING
Owner Address: P.O. BOX 670495
CHUGIAK, AK 99567-0495
Parcel ID: 051-231-29
Site Address:
Lot Size: 23088 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] SepticTank [] Holding Tank [] Privy
[] Private Well [] 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Date:
July 8, 1998
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject:
Lot 2, Birchwood Acres Subdivision
Septic System Design
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
We are hereby applying for a permit to construct a new well and septic
system on Lot 2, Birchwood Acres Subdivision. The lot is currently vacant
with no development to the east. The attached site plan and backup
documentation identify the size and location of the new absorption trench
to serve the home. It also shows the location of the proposed well and the
100' protective radius.
Testhole No. 1 which was placed near the area of the proposed absorption
trench consisted of silty to poorly graded sand which percolated at a rate
of 3.3 minutes per inch.. Groundwater was noted during excavation at the
12.5' level and remained at that level during the monitoring period. We
are therefore proposing to construct a 5' wide trench system with 4'
effective depth. Total length will be 40' with the distribution piping at 4'
below the existing ground surface. Total depth of the trench will be 8'.
The surface of the lot slopes from north to south at varying rates with
grades ranging from 2% to 5%. The slope in the area of the proposed
absorption trench is fairly flat with a minor slope from east to west. The
lot is relatively small, but sufficient area exists for the placement of the
new and reserve site and the well radius. No conflicts exist between the
septic system area and other wells or septic systems in the area.
Lot 2, Birchwood Acres
July 8, 1998
Page Two
If the system is constructed as designed the following statements apply:
The system, if constructed as designed, will have no adverse impact
on the wells in the area or those to be constructed in the future.
The system, if constructed as designed, will have no adverse impact
on existing septic systems in the area or those to be constructed in
the future.
The system, if constructed as designed, will have no adverse
impact on reserved space, either surface or subsurface, on any lots
located in the area.
,.
The system, if constructed as designed, will have no adverse impact
on drainage patterns in the area. The current drainage pattern will
be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
no well or
wit'hin
septic
50' ~1
135
no well or~
septic area
within 100'
/ Birchwood
no well or septic area
within 100'
Loop '~ Rd. 33 '
AREA MAP
SCALE 1" = 100'
EN lS (10/78)
BY
CHKD. BY '
JOB NO.
40'I~ X 5'
X 4' Eff. De'
,~,',~,'~, %,.',~' ,,~ z~'
.... "~ .......... ""'~" ~"~ PLAN
488 I-E
-/
LOT 2,
DESIGN FACTORS:
Three Bedroom Home
Perc. Rate: 3 MinJlnch
Application Rate: 1.2 GPOISF
BIRCHWOOD ACRES SUBDIVISION
SYSTEM REQUIREMENTS:
$' Wide Trench System
1,000 Gallon Septic Tank
4' Drainfield Rock
3 Bedrooms X 1S0 GPD / 1.2 GPDISF = 37S SF of Absorption Area
37S SFIS LF (Width) X .$ (Red. Factor) = 40 LF Trench Length
Therefore: Construct a $' Wide Absorption Trench System With One
Lateral 40' In Length with 4' cf Drainfieid Rock Beneath the Lateral.
Distribution Pipe in Trench Placed at 4.0' Below the Original Ground
Surface. .
458i
Slope Surface to' Drain Away
-
Natural Backfill
NOTE:
.TYPICAL WIDE TRENCH SECTION
(NO SCALE)
Grade Area Over Trench to Drain Away.
Minimum 3' of Cover over Septic System.
Minimum 4' Separation From Groundwater.
Minimum 10' Separation From Lot Line.
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Aiasl~a 99502-0650
SOILS LOG -- PERCOLATION TEST
MMM Contracting, Inc.
Township, Range, Section:
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
SLOPE
IF YES. AT WHAT
DEPTH?
SITE PLAN
3~
Gro~ Net Def~n to Net
Time Time Water Dr~
PERCOLATION RATE __
TEST RUN BETWEEN __
PERFORMEDBY:~ I ~~'"' L~""~.~IFYTHATTHIS3'EST
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEUNES IN EFFECT ON THIS DATE. DATE:' "7/' ~'~ / ~' ~!~
WAS PERFORMED IN
PERFORMED FOR:
LEGAL DESCRIPTION:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street, Anchorage, AlasKa 99502-0650
SOILS LOG -- PERCOLATION TEST
MMM Contracting, Inc.
Township, Range, Section:
g ~/~ . SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
DEPTH?
De,th to /
Re,ding Drm Gro~ Net Dep~ to Net
Time Time Wirer Drop
COMMENTS /~' '~ Y"~' ~.~'V/'~// ~,/.,G2 ~
/ /
PERFORMED BY: ~ I~ ~y
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DAT[ DAT~
72~ (Rev, 4/~)
PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER
THAT TH/IS TF~fiT WAS PERFORMED IN
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 2, BIRCHWOOD ACRES
GENERAL:
1. The scope of this project includes the procurement and
placement of a new 1,000 gallon septic tank. It also
includes the construction of a new 40' long by 5' wide by 4'
effective depth absorption trench at the location shown on
the site plan. The distribution piping must be placed 4'
below the original ground surface. The total depth of the
trench must not exceed 8'.
2. Construction shall be in accordance with the approved site
plan, design drawings, Municipal Permit with any special
provisions or conditions, and all applicable State and
Municipal Wastewater Disposal Regulations.
3. The Contractor shall be responsible for obtaining all
underground utility locates and for the layout of the septic
system and verification of the location of all lot lines.
4. Unless specifically agreed otherwise, the contractor shall
be responsible for final grading areas subsequently
depressed from soil settling. Property owner shall be
responsible for revegetation of affected areas unless
specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must
be certified by the Municipal Department of Health and
Human Services for system installations. Owners installing
their own systems must receive prior approval from D.H.H.S.
before beginning system installation.
SEPTIC TANK INSTALLATION
A new 1,000 gallon septic tank must be procured from an
approved source and installed at the location shown.
Lot 2, Birchwood Acres
July 8, 1998
Page Three
5. Contractor shall verify the septic tank and drainfield are a
minimum 100' away from any private water wells in the
area, 150' from a Class "C" Well or 200' from any community
well.
6. Direct bury insulation must be placed over the distribution
system if less than 3' of backfill depth is available. Finish
grade over the trench must be mounded to prevent
settlement or depressions.
7. Grade area surrounding the absorption trenches to drain
away.
8. A minimum 2' of accepting soil is required below the
drainfield rock for a 5' wide trench. Contractor shall verify
this condition prior to placement of the rock. All pockets of
unacceptable materials must be removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a Municipally approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C.
(perforated and solid), ASTM F810 or H.D.P.E. (perforated,
but not solid) and ASTM D2662 or A.B.S. (perforated and
solid).
3. Insulation shall be at least 2" thick extruded direct burial
polystyrene (Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted
watertight couplings (Caulder, Fernco, or equal).
with
Lot 2, Birchwood Acres
July 8, 1998
Page Four
5. A permeable geotextile fabric (Typar, Mirafi or equal)must
be installed between the final drain rock layer and the
native soil layer.
6. All drain'rock shall be .5" to 2.5" in diameter with less than
3% passing the #200 sieve.
INSPECTIONS:
A minimum of two inspections are required by Municipal
Ordinance. These inspections must be conducted under the
supervision of a professional engineer registered in the State
of Alaska. The first inspection must be conducted after the
excavation of trenches, beds or I~its and before the installation
of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement
of the geotextile fabric, gravel, distribution piping,
standpipes, cleanouts and insulation. No backfill should be in
place at the time of inspection.
Contractor shall provide a copy of all field survey layout and
construction notes for use in preparing the certified as-built
of the completed system.
Development Services Department j Phone: 907-3435904
On -Site Water & Wastewater Section Fax. 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-231-29
Expiration Date: S--'Z'Cl rZ OZ Z,
1. GENERAL INFORMATION
Complete legal description Birchwood Acres Lot 2
Location (site address) 18733 S. Birchwood Loop Rd, Chugiak, AK 99567
Current property owner(s)
Mailing address
Real estate agent
Yvonne Marie Mason Day phone (907)350-6479
18733 S. Birchwood Loop Rd
Wendy Bringhurst
2. TYPE OF DWELLING:
❑Q Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone (907)854-1236
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
Q
Private Septic
❑E
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Dista
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ 550 Waiver Fee $
Date of Payment ?A2_ 3/2 Z Date of Payment
Receipt Number. Receipt Number
COSA # 05G 22 )O5h Waiver #
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 is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering (MJ) Phone (907) 522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller, P.E.
6. DSD SIGNATURE
i System #1 Approved for 3
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
bedrooms
Date 2/2/2022
of Ar
.4,9
i `'�P-9
49TM •*r
Benjarkrv5chiller
C2 2 2292 ..�`���'
ll`F�pROFESSIQ0
bedrooms, with the following stipulations:
�lll((rrrrr
40 �Qp,�1TY OF'�,����
.� 40
0AI- do
M
VV TER ANDVVA
m
94
mT
PRGG� Q n ER A-
�^� 1 G� Original Certificate Date: Z ^zi — ZZ
The Municipality of Anchorage 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 4i6
COSA Checklist blue sheet e— tdily
COSA Checklist
Legal Description: Birchwood Acres Lot 2
If more than 1 septic system on lot: COSA Checklist #
A. WELL DATA
®❑ Well log is filed with Onsite (or attached)
Date drilled 7/22/1998
Total depth 65 ft
Cased to 65 ft
FE -1 Sanitary seal is functioning correctly
0 Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA 10/12/21
Static water level at beginning of test 8.5 ft.
Comments
B. TANK DATA
Age of tank(s) 23 years
Tank type/material Septic/Steel
Measured operating fluid level in septic tank. 49
RI Standpipes/foundation cleanout per record drawing
.Date of pumping 1/27/22 Sanitary Pumpers
Parcel ID: 051-231-29
of Structure served by this system
Well production at time of test 4.3 gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by Forge Engineering
Date of Sample 1/31/22
. FT STATION
❑ Require aintenance completed
Age of lift station ears
Lift station material
Comments:
D. ABSORPTION FIELD DATA Shallow Trench
Which system tested (date installed) 8/31/98
Adequacy test date 10/12/21
0 ALL standpipes present per record drawing
Results O Pass For 3 bedrooms
Total measured depth from grade 5.4* ft (max)
Fluid depth prior to test 23 in
Measured depth to pipe invert from grade 3.6* ft (min)
Water added 726 gal
❑ N/A — pressurized field
33
❑ Monitor tubes go to bottom of effective. If not, state
New depth in
Elapsed 1440
depth into effective z.s`
p time min
❑ Code -required soil cover over field
Final fluid depth 25 in
❑ System presoaked
Absorption rate '450 gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months)
date of test)
Gallons introduced gallons
If yes, enter date
Comments/Deficiencies: •1.0' final grade difference measured between cleanout and monitoring tube.
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
Yes
Community Sewer Manhole/Cleanout > 100'
dQ Yes
if No
ft
M Yes
if No ft
Neighboring Tank > 100' Yes
if No
ft
Private Sewer/Septic Line > 25' ✓M Yes
if No ft
Absorption Field on Lot > 100' Yes
if No
ft
Holding Tank > 100' 0✓ Yes
if No ft
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' p Yes
if No ft
✓0 Yes
if No
ft
less than required)
Building Foundation > 10°
✓
Yes
if No
Manure/Animal Excreta Storage > 100'
If absorption field is under driveway comment below
Community Sewer Main > 75' ✓� Yes
if No
ft
0✓ Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' F71 Yes if No ft Surface Water > 100' U Yes if No ft
Property Line > 5✓�
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
F✓
Yes
if No
ft
Private Wells > 100' Q Yes if No ft
Water main.>.10'....
Q
Yes
if No
ft
Commu.n.ity dells > 200' Q Yes if No ft
Water Service Line > 10'
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on
Lot to: (Please enter distances
if
less than required)
Building Foundation > 10°
✓
Yes
if No
ft
If absorption field is under driveway comment below
Property Line:> 1.0'
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'✓Q
Yes
if No
ft
Private Wells > 100' ' Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
ft
Community Wells > 200' Yes if No ft
Surface Water > 100'✓Q
Yes
if No
ft
F. ENGINEER'S COMMENTS
System passed but is more than half full. Monitoring tube should have debris cleaned out for more accurate testing in the future.
G. ENGINEER'S CERTIFICATION
l certify that / have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
OF AC11
49 TM
Benjani i5chiller p'
CE /12592
�kkF, PROFESSI
�la
Q
v
m
VOTf.
SU+GDUIG SE (b:i:^,!(L;rVES,Ij
Sr-L'Jt"Al r."✓ fii± CCIA rL i /
EAST 14851
EAST 148.51
OF q
!HW(
sf SHANE A. HOLT �G
�4P LS -6914 - O
4�a ....... ao
%Q1 jessiona\ Loo
SURVEY ORDERED BY:
AS-BUILTSURVEY I" =30,
:renrivCnnghmsf NO CORNERS SET THIS DATE
JxcOer"'Aur"s I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 2, BIRCHWOOD ACRES SUB. ( PLA TP - 643)
THE INFORMATIon t{EREON
IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICkLLY TO SHOW ANY ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EASEMENTS OF REC0RD'0R ANY LEGAL ENTITY, OTHER THAN THOSE APPEARING ON THE RECORD PLAT EXIST OTHER THAN NOTED.
ARE NOT SHOWN HEREON( UNLESS INDICATED) DATED AT ANCHORAGE,ALASKA THIS 15 Tl -I DAY OF
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE NOVEMBER , 2021
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE.
THE SUR VfYDATA ON THlS DRAVJINGIS PREPARED FOR THE OWNER OF RECORD ONLY HOLT LAND SURVEYING
9309 GROVER DRIVE
ANYCOPYINB, OR UT/(/ZING THE DA TA HEREONTS PROHIRITfD (/ADERCOPYRIGt m/ ANCHORAGE,AK 99507
15293• F8219-27 345-5513
DEVELOPMENT SERVICES DEPARTMENT
On -Site Water and Wastewater Section
www.muni.org/onsite
IL 0 907-343-7904
,.^ Fax: 343-7997
S"fic Tank Advisory
Certificate of On -Site Systems Approval #OSC 221056
Subdivision: Birchwood Acres Lot 2
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property i's 23 years old. Typical replacement costs range from $9,000 to $12,000
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of what the metal of a 20 -year-old steel tank MAY look like.
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
1. GENERAL INFORMATION
Complete legal description
Lot 2, Birchwood Acres
Location (site address or directions)
Mile 1.8 Birchwood Loop Road
Property owner MMSM
Mailing address 9.O.
Contracting Day phone 688-1 236
Box 670495 Chugiak, AK 99567
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
NOTE:
Three (3)
Individual well
Community well
Public water
XXX
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:
XXX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev, I/91) Front MOA#21
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 Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's signature
Date 11/16/98
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
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 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
Legal Description: Lot 2,
A. WELL DATA
Well type Private
Log present (Y/N) Y
Total depth 61 '
Sanitary seal (Y/N)
Municipality of Anchorage i ~I~1[~~
DEPARTMENT OF HEALTH & HUMAN SERVICES R E ¢ E
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-47~0V 2 0 1998
Health Authority Approval Checklist MUNICIPALITY Of ANCHORA(~,
ENVIRONMENTAL SERVICES DIVISION
Birchwood Acres Parcel I.D.:, 051 -231 -29
If A, B, or C, attach ADEC letter. ADEC water system number
Date of test
Static water level 2 5 '
Well production 5
WATER SAMPLE RESULTS:
Coliform 0
Date of sample: I I / 1 2 / 9 8
B. SEPTIC/HOLDING TANK DATA
Date installed 8 / 31 / 9 8 Tank size
Foundation cleanout (Y/N) ¥
Date of Pumping New Pumper
C. ABSORPTION FIELD DATA
Date installed 8 / 31 / 9 8 Soil rating
Length 3 9.5 ' Width 5 '
Effective absorption area 3 9 5 SF
Date of adequacy test New Const.
Fluid depth in absorption field before test (in.);
Fluid depth (ins) Minutes later:.
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev. 3/96)*
Date completed 7 / 2 2 / 9 8
Cased to 6 ! ' Casing height (above ground) 2 '
¥ Wires properly protected (Y/N) Y
FROM WELL LOG AT INSPECTION
7/22/98
g.p.m.
g.p.m.
Nitrate .1 7 mg/L Other bacteria
Collected by: MEA
I, 0 0 0 Number of Compartments .. 2 Cleanouts (Y/N)
Depression (Y/N) N High water alarm (Y/N) N
Construction
Y
(g.p.d./ft~ or fta/bdrm) I. 2
Gravel thickness below pipe
Monitoring Tube present (Y/N) ¥
Results (Pass/Fail) P a s s
Immediately after
Absorption rate =
System type 5 ' Wide
4 ' Total depth 8 '
Depression over field (Y/N) __
For 3
' gal. water added (in.):
g.p.d.
Trench
N
bedrooms
If yes, give date
D. LiFT STATION ~ None on Lot
Date .installed "i'
Size in gallons
Manhole/Access (Y/N)
"Pump on" level at*
"Pump off" level at*
High water alarm level at*
*Datum
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
N/A
>100'
>100'
On adjacent lots > 1 0 0 '
On adjacent lots > 1 0 0 '
Public sewer manhole/cleanout
Sewer/septic service line > 2 5 ' Lift station N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation > 5 ' Property line ;> ,%, Absorption field.
Water main/service line > 1 0 ' Surface water/drainage > 1 0 0 '
>5'
Wells on adjacent lots > 1 0 0 '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line > 1 0 ' Building foundation > 1 0 ' Water main/service line
Surface water > 1 0 0 ' Driveway, parking/vehicle storage area > ,5 '
>10'
Curtain drain None on Lct
Wells on adjacent lots
F.
ENGINEER'S CERTIFICATION
I certify that l have determined thru field inspections and review of Municipal rec~JXl~'~p.t,~e.f~l~-,~ rems are
in confo~ance with MOA H~ guidelines in effect on ~is dam.
Signature *
Engineer's Name Michael R_
Date ' ' 11/16/98
HAA Fee $. ~/~/- ~
Date of Payment /'//'~//~ ~
Receipt Number /~ ~;I~'~"'~':~Y~)/)
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*