HomeMy WebLinkAboutBIRCHWOOD ACRES LT 5
~ MUNICIPALITY OF ANCHORAGE
" ~ DEPARTI~ENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME I1' I '
-
LOCATION
NO.~ BEDROOMS
~ D,STANC~ mO= I W")~O ' J Abso~Pt,o~ ~[ Dw.,,~ , P E~O~
~ ~ Manufacturer ~ ~~ MX~ No. o~mpartments
Liq.~~ gallons IF HOMEMADE: Inside length Width Liquid depth
~ ~ Well Dwelling PERMIT NO.
~ ~ Z DISTANCE TO:
O ~ ~ Manufacturer Material Liquid capacity in gallons
Q~ DISTANCE TO: Well .... ~ /~ Foundatio Nearest~jine
~~Z~ No. of line)l ' ken~ch line Total~to~ines Trench ~i~ ,riches Dist~nc~e.n I,nes
~ ~ ~ Top of tile to finish ~raOe Material beneath tile Total effe~i~e absorption area
Q ~ ~ inches
Length Widfh Depth PERMIT NO.
( ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO,
~ DISTANCE TO: Building foundation Sewer line ~ Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST R~I~
INSTALLER
REMARKS ~
APPROV~ DATE LEGAL
72-013 (RevJ
F:'ERM l T
F'I P P L. I C: f:t. t",f T
L 0 C I:::! T I 0 N
L E. (.".i FIL.
H I LFIR'¢ I'"t I E:HL I G
L5 [."i: ! RCHI.,.IOOD RCRES
'T".r'I:::'E OF SOIL RE:E;OF;.'.F'TIOIq ::~;'¢STEH .IS: t)RR:[I",!FIEL[:,
LOT :E;tZE 9999:~;'~9 :.:.'i;E:!LtF~F{ FEET
11
t',IRXIP'tLIM NLII','IE:ER OF [E[:,ROOM:::; ;:, ::~!: SOIL [4.':FIT':[t'.,!G ,::~::.;~:.:! FT,-'E:R)=
THE F.:E(;!U t RE[:, 25 1 2.'E OF 'THE 50 ! L. I:IB~::_.;ORPT.f. ON S'E;TEH :['::;:
']''FIE LENGTH [:,IP1EI'.,I'..:.;ION I~; ']''FIE LEI'.~GTH (:[t'-,I FEE]') OF THE TRENCH OR [:,RRI. f'.4FIE!...[:,.
TFIE [:,EF'TH OF 1::t TREt'.,ICH OR F'IT I:~.; 'THE [:,I;:.,TRNCE BET.tqEE!'-4 THE :.:];URFFICE OF' THE
G.F.:OLfI'.,I[) FIN[:, THE BOTTOH OF THE E;-'4C:FI',,,'FITIOI'..! ,:.']:N FEET).
'T FI1 E: T' I1:;: IE tf"..4t C: IHt t..,..tl ][ [:, T' !-! I :.5 ~.:tl .. ~Z.~ (~ (E, F' E:: iE
THE (3 F,: FI ',,,' [.:.t L .F.:{PTFI :[:~; THE I','!tN.'[t',ILI!','I E:,EPTH OF' (~F.'.'RVEL BET!.,.IEEf'.,I "['HE OUTF.¢::IL.L. P].'PE
f:ih~t) THE BOTTOM OF THE E:C:FI',,,'F:IT :I.' 0t'.,! ,:: ! N FEET ).
F:'EF.:!'4 t T F:IF:'F:'L ! F:F:iI'.,tT l.-tFIf; THE RESF'ONS :[ B I L I T'-,-' TO I t'.,IFORf,'t TH I E; [:,EF:'RRTI"!EIqT DUi;.: I 1'-,!~3 '!"HE:
l' NSTFtLi..F:IT ! 0.1'.,t t I'.,ISPE. CT ! OIqS OF f:lN"r' 1.'.tELLS t::ID..TF'ICEF~T 'I"0 "Ft"'t t S PROI:'EF?'].'"r' FIN[) THE
~',!t...IHE~E:F,.': OF I:;-'.E:':.;tDEt",ICES '].'HFtT THE !.'.fELL I.'.!ILL
.~'1!' !",t I ?ILI?i F;, t :.~.';"FRf'-4CE BET[qEEt'.,! Ft !.,iELL .~.~[-', Rl"4"r' ON--.S I TE SEt.,.tFtGE [:, I ."_:;I::'OSFIL :~;'¢.'-;TEI"1 :[ S
:J..e,;.:.'~ F'EET FOR I-:~ F'F.".:[',,,'FITE tqELL. OF,:: t..50 TO 2~.~O FEET FROI"I FI. PUBLIC [,-ELL. [:,EF:'EI",![:,II",t(]i
UF'O.I'.,I THE 'T'.r'F:'E OF' F'UBLIC !.,.tELL..
t"t!t'-,!It"ll...ll'"l [)IS't"FtI'-..tCE FROt"I FI PF.:I',..,'RTE f.,.IEL. L TO R PRI'i,,'RTE SEI.,.IER
TO i::l E:(]I'iI'"IUNi'I"¥ ~:];EI.,.tF'R LIf'.4E IS '7.t][ FE:ET.
['.!E.:.LL LOGS F¢.E F.:E(;!UIF..'EL'.', FIN[:, I"ILtS'? E:E I'4:E'TIjI.~:!'.4E[:, '].'O THE [:'EF:'RF;tTt'"IEht'].' !.,.!!'1"1.4!1",t ::ii:(:.'~ [)F~"r'S
OF THE I.,.IELL COI'"IPLETIOt'.,t.
OTHER RE(.:!LIIREI'"IEt'.,ITS I"tR'T' RPPL.'T'. SPE(":ZFICRTIOI'.,!S FIN[)
FI',,,'R I LF~[!!~LE 'TO ! NSURE F'F.:OPEF: I f.-~!S'FFILLRT I ON.
I (.'.:ERTI F"r' THRT
::L: t !=!}t FI:hl'"III....IF!R !-,.fITH THE RE(;!U:[RE.r'IE't'-,ITS FOF.: ON-SITE :i;E!.,.tEI:;5 RI'q[:' t.4ELI....S R:'.:!; :!ii;ET
IF::'OI:;.:TH BY THE HUN I (::: .'[ PFtL ]: "1]-' OF' Ftt'qCHOI';.'.RC:iE.
2: :t; I.,.I :t: LL :[ I'-,tSTF'iLL THE ':.-.','¢STEH ! N FtC:COF:[:,FII'-4CE 1.,.! I 'TH '['HE: C:O[:,E:~;.
:2_'.':: I t...tt'-,![:,ER:E;TFtN[:, 'T'HFaT 'THE ON-'SITE '_'E;EI.,4ER S?STEH I"'IFI? F.:EE:!UIRE Et",IL. RF~::(:~EMEf.,!"I' IF:' THE
i:~..~::.:,i,..,Ei!L:[: I:.; REI'"IOt.'.:,[:_"LE[:, ]"O i I'.,tC!J. [,E MOF,.':E TH.R.I'.,I :2: E Ei£,.P:':: '.:I'"!S,.
January 4, 1982
Hilary Michlig
SR I Box 2383
Chugiak, AK 99567
Permit ~ 811064
Subject: L5 BIRCHWOOD ACRES
A permit issued by this department for a well and/or sewer
system has expired as of December 31, 1981.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log should be sent to
this department to document the installation date.
If an engineer inspected the installation of the on-site
sewer system, please have them send us the as-builts for our
files.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
Sewer and Water Program
Enclosure: Copy of Permit
PERMIT NO~
[:'EF'FIF;.:TMENT 0c' HEFt!...]"I..~ RN[:, EI",IVIRCff'~MENTF!L ~'"::"JFI"Er':TION ~ ~
812'! ..... S T R E E T. .8 N C H E F? 8 ~ F.'. f~ K~ 9 :i:- :1.
264-47:20
~-,...~ E: ~_ ~_ ~:-=~ ~"-,,ff E::, C., ~"-,.~ ---. :~: :E "T' [7.-2: ,.z:_:; E: ~--~ E: F: F" EzE ~-~:: ~,,'~ % 'q ....
,:: 8:1.:]..064 )
F~PF'LICRNT !"IILRR'.r' MICHL..IG SRI BOX ~:.:~]:8:~:
L. OC'.'FtTION PIERRE ST. ,.'"S. BIRCHNO0[:, LOOP
LEGRt... L5 BIRCHHOOD RCRES L. OT '::;ZZE
T?F:'E: OF SOIL RSSORF'TZON S'T'STEM IS: DRRINF'IEL[:,
21::':SE~E~ Sf::!URRE FEE'F
MFtXIMUM NUMBER OF: BEDROOMS = :ii: SOIL RRTING ,::SQ FT,.."BR)= 85
]"HE RE6!UIF.:ED SIZE OF THE SOIL RBSORF'TION S'T'E;TEM IS:
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF 'THE 'I"RENC:H OR D.RF~INFIE':L[:,.
THE [:,EPTH OF' F~ TRENCH OR F'I]" IS THE: DI':;TRNCE BETHEEN THE 'SUF.~FRCE OF THE
GROLIND FIN[:, THE BOTTOM OF THE EXC':FtVRTION ,.'.'IN FEET).
]- H EE .... IF F~." FE~] I"-.! C: ~.~ ~-.,I -1[ L-.:, ']"" ~--!
THE GRRVEL DEPTH IS THE MINI.MUM DEPTH OF' GRFt'v'EL E:ETHEEN THE; OLITF'FIL. L PIPE:
BND THE BOT'T'OM OF' THE EXC:R',/RTION ,.': IN FEET';,.
F:'ERMIT RF'PLICFINT HRS THE RESPONSIDILIT'¢ 'TO INFORM THI2; DEPRF.:TMENT DUF,:ING THE
INETFILLRTICN INSF'ECTInN'Z.; OF FIN"r' HE:L. LS R[:'JRCENT TO THIS F'RAPERT'¢ f~Nt} THE
NUMBER OF:' RESIDENCES THR'T THE HEL. L HIL. L SEF.:',/E.
.................... T' ~..--~ C) "::: P£: > ii l'-,I ;.E; F' E C: T I C) i'..,l f~.; f:t F-: Fz: F,".: E] C.,:.:.~ b~ ]:: ]:E". EE ,f.:},
BFICI<F I L.L I NG OF RN"r' S"r'E;TEM 1,41THOUT F I NRL. INSPECT I ON RND RPPRO'v'FIL F..:.Y¢ TH I S
DEPRI~:'.TMENT HILL. E',E Lz, UE:JECT TO PROSECUTI'ON.
MINIMUM DISTRNC:E BETHEEN F~ HELL FthlD RN'T' ON-SITE SEt.qRGE DISF:'OSFIL :SMS'I'Et"'I IS
:I.E'~E~ FEET FOR R PRI'v'RTE HELL. OR :.tSE~ TO 20¢~ FEE]' FROM FI PUBLIC HELL [)EPENDING
UPON THE T'¢F'E OF PUBLIC HELL...
MINIMUM r_':,ISTRNCE FROM R F'RIVF~TE HELL. TO R PRI',,,'FITE SEHEF.: LINE IS 25 FEET
TO F! C:OMMUNIT'T' SEHER LINF' tS ';:'5 FEET.
HELL LOGS ~RE REC!UIRED RND MUE;T BE RET'URNED TO ]'HE: DEPFIRTMENT HITHIN 30 DR'.FS
OF THE: HELL. C'OMPL. ETION.
OTHER REC!UIREMENTS MFI"r' RPPL'T'. SPECIFICRTIONS RN[':' CONSTRUCTION DIRGF. IFIME;
FI¥~FII LRBLE '1"0 !NE;LIRE F'ROPER INS'f'RI_.LFtTION.
F' E£ F~: D,] ][ -r E;2 .'=-::; F' ]:; E: E E:_.; E:, E C: E r.1 E: EE F.:.'.'. :~!: :.'l ......::].,. :Z~.: ;ED ::]...
I CERT I F"T' THR"['
:1.: t F:ffl FRMILIRR HITH THE REC!UIREMENTS FOR ON-:E;ITE '=;EHERS fiND HELLS RS SET
FORTH B'T' THE MUNICIPRLI T¥ OF' FtNCHORflGE.
;:2: I HILL INSTFIL. L THE S'T'S"['EM IN FICCORDRNCE HITH THE CODES.
3' T UNE:'EF~::..--.,TFIN[} 'f'HR"t" THE ON-SITE :,u. HER :,,..,'rEM MR'T' F.':EC!UtF-:E ENL. FIR. GEMENT ;IF' THE
RESI[:,ENCE !Ei F.~:MOE:'ELED~'T'O ZNCLL.IDE MOF.:E THFIN 31: BEDROOMS.
sIr')NED
E'.' .... " "' - ':
I SSIJEE:, . ~ ........................................ L.,H'[ E ............... 4¢- V4. Ei
GrEATEr ANCHORAGE ArEa BOrOUgh
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT
INSTALLATION OF: SEPTIC TANK Z/ SEEPAGE PIT ~
0 '
FINANCED THROUGH TO BE INSTALLED BY
COMPLETION DATE ANTICIPATED
PERMIT NO.
~' DRAIN FIELD __ ~_~_~
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPT, TANK SI= /Soo
TYPE SEEPAGE AREA SIZE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK ~
FOUNDATION TO SEEPAGE PIT
SEPTIC TANK TO SEEPAGE PIT WALL ~'~'
DRAIN FIELD
SEPTIC TANK , SEEPAGE PIT
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK /{~0 DRAin FIELD
WATER MAIN TO SEPTIC TANK .
DRAIN FIELD
SEPTIC TANK, i / ~6 ~ SEEPAGE PITi
TO RIVER, LAKE, STREAM.
, DRAIN FIELD
SEEPAGE PIT /~ r
ALSO CONSIDER AREA WELLS.
SEEPAGE PIT
/~'O . DRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
GRAVEL BACKFILL
CONFORM TO I=IOROUGH~ c~EGULATIONS
G,A.A.~.
OR
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITh AIRTIGHT REMOVABLE CAPS.
LICENSED DESIGNER
TYPE
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2B-68 AND THAT THE ABOVE
DATE ?--3"'--'}") APPL'CA.T'S S,GNATU.E _ . .
FORM NO. EG-01 6
LOG OF TEST HOLE NO. 2
Scale: 1"=3'
YR~D~ ~ soME SILT
SOME GRAVEL
0.5'
SANDY GRAVEL (GW)
Brown, Dense, Slightly
Moist '
3.0'
' 'dk~-J (s~7--) .....
Gray~b~own, Slightly ~¢~.t0,
GRAVEL w/ SOME SAND (GW)
Brown, Dense,
Slightly Moist ~%
..... 9.0'
/~]D (SP)
Fine, Brown, Moist, Dense
.... 10.5'
SILTY SAND w/ S0~IE GRAVEL (SM)
Gray, Moist, Dense
ll'T.D.
Groundwater was not encountered.
LOG OF TEST HOLE NO. 3
Scale: 1"=3'
ORGANIC SAND w/ SOME
SILT, SOME GRAVEL
0!
0.5'
SANDY GRAVEL
Cobbles,
Brown, Moist, Dense
10.0'
SAND (SP)
Fine, Gray-brown, Moist, Dense
15' T.D.
Groundwater was not encountered.
These logs depict subsurface soils
observed within the test holes at the
locations shown.
See Drawings B-01 and B-02 for
explanation of symbols.
TEST HOLE LOGS
MICHAEL QUAP~E
A-02
r~-W DRILLING, Inc.
P.O. Box 10-3L8 · 10300 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
Well Owner .
r Location
DRILLING LOG
Hilary MfehliE Use of Well D0me.~ttC
(address ~of: Township, Range, Section, if known; or distance main road ....
5 Birchwood Acres ~/~r?.-,. ~ /:~..r?i.:,-,.'t, ~ ~, ~4~ // /
6" 29 5 4"
Size of casing Depth of Hole 242 feet Cased to , feet casing to 241',
Static water level 60 ft... (..i~'0'9~.' (.b~low.) .1._an.~._s~u.rface. Finish of well (check one) open end ( "· )' '
Screen ( ); Perforated ( ,,. ).
Describe screen or perforation
Well pumping test at 4 gallons per of drawdown from static level.
Date of completion October 1.5: 1
220' of 4" PVC (Top ra 21
(minute) for 1 hours with
WELL LOG ~
Depth in feet from
ground surface
0TO
2TO
20To
23.TO
26TO
" 180To
TO
,TO
· ,_TO
TO
, TO.
TO
TO
2
20
23
26
180
2~2
Give details of formations penetrated, size of material, color and hardness
Casing s tickup
Loose sandy Kravel
~oose sandy Eravel
Silty hard pan
(we t ~
].avers v?lich sean,q w._ter
TO
.TO
3 -- CONTRACTOR
Municipality of Anchorage •
,, On-Site Water and Wastewater Program o
(907) 343-7904
.,d1�
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I,D. 051-231-40 Expiration Date: oC — I 62— l ' }
1. GENERAL INFORMATION
Complete legal description Birchwood Acres Lot 5
Location (site address) 19217 Beverly Avenue, Eagle River, AK
Current Property owner(s) Mendias Day phone 280-9005
Mailing address same
Real Estate Agent Tim Whitney Day phone 280-9005
! s zo
2. TYPE OF DWELLING: _ \4�
® Single Family (w/wo ADU) ti
El Duplex E NOV 13 2017
❑ Multiple Dwellings (Single Family and/or Duplex
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class C Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Received by: Date: '( /1 77/ 7
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ Z Date:
Date of Payment /1/j /17" Date of Payment
Receipt Number 0 1(J g57;) Receipt Number
COSA# 035C0-X53/ 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.
Name of Firm NorthRim Engineering Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 11/14/2017
6. DSD SIGNATURE L2
System #1 Approved for J bedrooms.
System #2 Approved for bedrooms.
Disapproved. `r if •
Conditional approval for bedrooms, with the following stipulat e'hs:
p-t-L i ovvk is S VettICS o
v c h6,2 ts. 2 0 rctvs OLP
t` 0,1l44/0.yC3
=J� ON-Slit
WATER AND m
Ti 4 WASTEWATER z=
Lido,
PROGRAM _
�TER � E5
gY `�— 1-�— Original Certificate Date: / .1-1.1411P.
The Municipality of Anchorage Devlopment 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
COSA blue sheep 9-1-12.tloc
• If more than 'I septic system is on the lot:
COSA Checklist# of
Structure served by this system
Cerrtff cafe of Oce-Sts Systems ApprevaD CheckH t
Legal Description: 8/t4 e I 400A 4-c iz 6_,J Z o r S Parcel ID:05123 (1/6
A. WELL DATA
Well type P If A, B, or C provide PWSID# Well Log (YIN)
Date completed/a///5/CY-2 Sanitary seal (Y/N) 7/ Wires properly protected (Y/N)
Total depth 2 6/2ft. Cased to 24//ft. Casing height (above ground) 2 V in.' '
P Ex"tended 8 y , 3 1.,,JP
FROM WELL LOG AT INSPECTION
Date of test /0(/St?2 /O/Z0 7
Static water level ‘01 ft. 20 / ft.
Well production / _ g.p.m. O '/— g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate 4/. mg/L
Arsenic /t/i U ug/L Date of sample: 70/2P7/ 7 Collected by: /1/7''i•-i-
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material / \ orf c_/J'f r4 . Date installed /0// 1///cft2
Tank size loo o gal. Number of Compartments 2 Cleanouts (Y/N)
Foundation cleanout (Y/N) y Depression over tank (Y/N) Al High water alarm (Y/N) Ail
Date of pumping .2/24( 7 Pumper ,....4k +2 is f( icy Se A t
C. ABSORPTION FIELD DATA
JD c.,",
Date installed /(O//8/d 2_ Soil rating (g.p.d./ft2 or ft2/drm) (Ps System typed .,c 4
Length 32- ft. Width S ft. Gravel below pipe 3 ft.
Q
Total depth 7- / ft. Eff. absorption area 2. -5ft2 Monitoring tube 7 Depression over field A/
Date of adequacy test AO. lel/ 7 Results (Pass/Fail) I l For bedrooms
Fluid depth in absorption field before test 0 in. Water added SO gal. New depth 5 in.
Elapsed Time: (G min. Final fluid depth (6 in. Absorption rate >= L{3-0 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N &type) ///t/A. If yes, give date
D. LIFT STATION /l/4
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off" level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot /0 0 it— On adjacent lots / r�
_ ` d 0
Absorption field on lot f0 a On adjacent lots_ fG 0 '1-
Public
Public sewer main AO 0 II Public sewer manhole/cleanout /00 ri
Sewer/septic service line 2 5 `-f- Holding tank /Qo r F
r
Animal containment areas 5ra 4Manure/animal excrete storage areas f74
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation C '+ Property line /6 =t Abso-ption field .S f
Water main f Q '14 Water service line /4" fi Surface water /e.:20-
Wells
DGWells on adjacent lots /
ABSORPTION FIELD ON LOT TO:
Property line Building foundation /e.i Water main
i � t
Water Service line 761 7 Surface water / 'O i Driveway, parking/vehicle storage d
Curtain drain Wells on adjacent lots / 0
F. COMMENTS
G. ENGINEER'S CERTIFICATIONr.�
l certify that l have determined through field inspections and - •. . �_
review of Municipal records that the above systems are in •f.. •
conformance with MOA COSA guidelines in effect on this date. -_
Engineer's Printed Name
Date
/f//y/f,
4
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MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744 ~
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lOt, block, subdivision, section, township, range)
LOT 5, BIRCHWOOD ACRES
Location (address or directions)
Birc/~ood Loop ~ Beverly
(b) ProperS, owner
Mailing Address
(c) Lending Institution
Mailing Address
Frederick Murphy Telephone.(home~88-0425
Telephone
Business
Margaret
2~9~2~
(d) Real Estate Company and Agent ~E/MAX of
Address
Telephone ~g4-4
(e) Mail the HAA to the following address: (or check herO,q, if hold for pick up.)
List contact Person and day phone number below:
EAGLE RIVER ATTN~ Bob WamSol~
201~ Eagle_ RJ.u~.~ A~ 99577
$ & $ ENGINEERING
1.7.034 Eagle River Loop Road No. 204
£agle River, Alaska 99577
TYPE OF RESIDENCE
Single-Family ~ Number of bedrooms
WATER SUPPLY
Individual Well,~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
SEWAGE DISPOSAL
On-sitej~(' Public [] 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.
72-025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION -
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 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 Telephone 6'~t4'¢~--~ F/~ ~
Address
Date
S & S ENGINEERING
17034 ?--.3~c '~: ....
Eagle River, Alaska 99577
6. DHHS APPROVALb~
Approved for ~ bedrooms
Approved ~"~Disapproved Conditional
Terms of Conditional Approval
Date
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.
72-025 (Rev, 7/88) Back
Page 2 of 2
/~--~A~.G~U~.ICIPALITY OF ANCHORAGE (MOA)
('~~,~ Health Authority Approval (HAA)
.~,~,\'~ .'~,~ CHECKLIST- FEBRUARY 1984
A. WELL D
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Well Classification ~_~"~ ~--. If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y~.N) ~' Date~ompleted ./0 - f~-- ~ ~ Yield
Total Depth P-z~.~ Cased to~ _.~z¢ f Depth of Grouting - -
Static Water Level ~ ~ '~
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot /' OO
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line ~'/f3r
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments -% ~,O' ~
Pump Set At L) (~"
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
! /'
; On Adjoining Lots / OO
/ OC) ~'/'' -' ; On Adjoining Lots /
To Nearest Public Sewer Cleanout/Manhole ~/~r
B. SEPTIC/HOLDING TANK DATA
Date Installed ./O- 1 I~ - ~?.Size
Standpipes (Y/N) ~
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
/00~ No. of Compartments ~-- ~'
Air,tight Caps (Y/N) ~ Foundation Cleanout (Y/N)
t
Date Last Pumped
; for
Holding Tank High-Water Alarm (Y/N) ~v/li~ Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well
To Property Line
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments
To Building Foundation ~'~ I
To Disposal Field
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata (~::~ ~"- ~/~/~¢~ Type of System Design
Date Installed [ ~ / ~ "- ~ ~ /'' ~
'- Length of Field
Width of Field (p ID
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
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
Lot ~/~
To Water Main/Service Line
/ (DO f ¢'~ /' To Property Line
!
/b
f o/-f-
To Stream, Pond, Lake, or Major Drainage Course
To Existing or Abandoned System on
; On Adjoining Lots' ._~ O / -~ --'"'
To Cutback (if present) ~J//~
! /
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION~
Date Installed "-....,,,,~.,~,~
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines
inspection.
Signed 17034 E~I~ Eider L~p Road No. 204 _~..__
Company
MOA No. ~ ~b~,;.~ ~/~.~.
Receipt No.
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
FEDERAL TAX ID # 92-0040440
ANALYSIS REPORT BY SAMPLE for Work Order t 14564
Date Report Printed: JUL 4 89 { i4:36
Client Sample ID:L5 BIRCHWOOD tCRES Client Name : S &
PWSID :UA Client lcct: SNSENGP
Collected JUL 3 89 { 10:40 hrs. P,O.! NO{~ REC'D
Received JUL 3 8g { 15:20 hrs. Req !
Preserved with :AS REOUIRED Ordered By
Analysis Completed :JUL 3 89 Send Reports to:
Laboratory Supervisor :STEPHEN C. EDE 1)S & S ENGR
Released By : //~../ffff 2)
Special
Instruct:
Chemlab Roi #: 6085 Lab Smpl ID: 3 Matrix: WATER
Allowable
Parameter Tested Result/Units Method Limits
NITRATE-N 4.1 n~/1 EPA 353.2 10
Sample ROUTINE SAMPLE
Remarks: SAMPLE COLLECTED BY RJS.
1 Tests Performed ' See Special Instructions Above UA-Unavailable
ND= None Detected *' See Sample Remarks Above
NA- Not Analyzed LT-Loss Than, OT-Greater Than
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
Anchorage, Alaska ;99518
TO BE COMPLETED BY WATER SUPPLIER
[] PUB.C W^TE. SYSTm ~.D.#
Name / No.
Mailing Address
S & S ENGIHEERING
17034 EBsle RWer Loop Road N~
City ~gie kiYer, Ai..k- 7'~fa{----e Zip Codo
SAMPLE DATE: ~ ~ ~
Mo. Day Year
SAMPLE TYPE:
/~ Routine
Check Sample (for routine
with lab ref. no.
[] Special Purpose
sample
.) []. Treated Water
/.~Untreated Water
SAMPLE
NO.
2 I I
31 I
4 I I
Time Collected
Collected
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
[~ Satisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received
Time Received
Analytical Method:
Membrane Filter
* No. of colonies/100 mi.
Lab Ref. No. Result*
I ~
I I-~
I ICI
Analyst
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS RECORD
Membrane Filter: Direct Count
Verification:
Final Membrane ~t7 RTults
TNTC = Too Numberous To Count
BGB
Date
Time:
Collform/100ml
O ~.~oliform/lO0 mi
a.m.
pom.
OB = Other Bacteria
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date .
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lo~ _~ I~,i.ae_b.wnod Ae_~o_a
Location (address or directions)
(b) Applicant Name ~J£.a~J MJob£Jg Telephone: Home ~,~8-3409
Applicant Address __q.R.7 LRn~ 93,~?; ~.bun_,,(.ab.. A.~a,~ba
(c) Applicant is (check one): Lending Institution []; Owner/builderJ~; Buyer []; Other []
Business
(explain);
(d) Lending Institution P.~'~y hloh;f'~dLg~ Telephone
Address ,
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
S-&-SENGINE ING
--SRB-I-96X
E GLEI VER K 995?.
TYPE OF RESIDENCE
Single-Family/~ Multi-Family
Number of Bedrooms ~)
Other
WATER SUPPLY
Individual Well,~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite~ Public [] 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.
72-025 [11/84)
Page 1 of 2
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
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 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 Telephone ~¢ ~:.- ,Z.-~ ~ ~'
Address SRB 196X
Date EAGLE RIVER, AK 99577 ,,,
14
DHEP APPROVAL_,____
Approved for c. -rr,~¢_¢.~. bedrooms by
Approved j~ Disapproved
Terms of Conditional Approval
~/-~%¢~' ~'- ~(~ ¢~6'¢'~i Date
Conditional ('--j
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representaUons given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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
WELL DATA
Well Classification
Well Log Present ((~)N)
Total Depth ~'~'2-'- '
Static Water Level
Casing Height Above Ground
Electrical Wiring in ConduitdCF/N)
Separation Distances from Well:
To Septic/Hc!di~rg'Tank on Lot
To Nearest Edge of' Absorption Field on Lot
MUNICIPALITY OF ANCHORAGE (MOAt
HEALTH AUTHORiTY'APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
MUNICIPALITY OF A~ \~.--OT ~
DEPT. OF HEALTH &L~,~ Description:
F~IRONMENTAL PROTE~..~O~ ~ ~ ~
MAY 5 1986
Date Completed [ ~- ~ ~ ~ ~ Yield
Cased to ~ ~ Depth of Grouting
Pump Set At
~ ~ Sanitary Seal on Casing~N)
Depression Around Wellhead (Y/,~
I
'On Adjoining Lots
\ ~ 62 1 ~. ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on
To Nearest Public Sewer Line
Cleanout/Manhole ~'~ I/'~
Water Sample Collected by ~' '~ ~
Water Sample Test Results
Comments ~ \/J_~, 9!~¢"~t:~
B. SEPTIC/H4~L-BtN~ TANK DATA
Date installed I~- t ~ ~ ¢2,- Size I ~ No. of Compartments ~
Standpipes((~)/N) Air-tight Caps~N) Foundation Cleanout (Y/,~.
Depression over Tank (Y~J~
Pumping/Maintenance Contract on File (Y/Ng/~
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/l~[Cdk=~ Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
Date Last Pumped
/
~.b, · for --
Temporary Holding Tank Permit (Y/N)
To Building Foundation ~
I
To Disposal Field ~
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
To Water-Supply Well
To Building Foundation
To Water Main/Service Line [ ~ I ,~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field
Depth of Field ~ /
Gravel Bed Thickness
Standpipes Present.N)
Date of Last Adequacy Test
Square Feet of Absorption Area
Depression over Field (Y~D
Results of Last Adequacy Test
Separation Distance from Absorption Field:
I
To Property Line ~"\
To Existing or Abandoned System on
; On Adjoining Lots ~ ~/'4'
To CutbCnk (if present)
! /
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
//"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certifyjl~t~~l~ted, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed$~ ~ ~,?~v.~ Date MAY I/I 1986
MOA No.
Receipt No. '_3~'L\ ~1. O('.~
Date of Payment
Amount: $ Lo~'
Page 2 of 2
72-026 (11/84)
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
TELEPHONE (907) 562-2343 5633 B Street
Anchorage, Alaska 99518
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
[] PUBLIC WATER SYSTEM I.D.#
~ PRIVATE WATER SYSTEM
Name f Phone No.
Mailing Address
City State
Mo. Day i Year
Zip Code
SAMPLE TYPE:
JEt--Routine
[] Check Sample (for routine
with lab ref. no.
[] Special Purpose
sample
Treated Water
Untreated Water
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
' ~[~-s;tisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
qot be over 30 hours old at examination
t~ Indicate reliable results. PJease send
r~ew sample via special delivery mail.
Date Received
Time Received
Analytical Method:
Membrane Filter
* No} of colonies/100 mi.
SAMPLE
NO. LOCATION
4 I
5 I
Time Collected
Collected
Lab Ref. No.Result*
I 17-1
' I I-F1
I
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
'BEFORE
COLLECTING SAMPLE
Membrane Filter: Direct Count
Coilformll00ml
Verification: LTB BGB
Final Membrane Filter Resu~~ Collformll00ml
Reported By ' " .... Date ~_~~~~.~-__
TNTC - Too Numberous To Count
OB = Other Bacteria
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date /~//~'/0~''
1. GENERAL INFORMATION
(a) Legal D~cription (include lot, block, subdivision, section, township, range)
Location (address or dil:ections) ~' '~ ~
(b) Applican~ Name~ Telephone: Home ~-~ ~ ~ Business ~
Applicant Address' ~- ~ 72~ 2~ ~ ~ ¢¢~2
(c) Applicant is (checg one): Lend~g Institution ~Owner/builder~; Buyer ~ · Other ~ (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f)
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family~ Multi-Family []
Number of Bedrooms ~ .,
Other
3. WATER SUPPLY
Individual Well [~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite~ Public [] 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 72-0~5
5o
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA Ai~ INFORMATION
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 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 dis posai system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection ....
, ,, '~.~ '~.-*'~:,.).:..,:~ ..,~ .~,~, ~ Telephone
Name of Firm ....
Address ........
Date
Approved f~r [~¥C'~' ~ bedrooms by _
Terms of Conditional Approval -
CAUTION
The Muncip~iility of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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