HomeMy WebLinkAboutBENJAMINS BIRCHWOOD ESTATES LT 1
Municipality of Anchorage Page I of ~
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~---~ ~ ~o~.,~ PID Number: ~ l~
N.me: ~. ~, ~, Wastewater System: u New ~pgrade
Address:
Phone: No. of~o~ms: ~eepTrench D Shallow Trench D Bed ~ Mound D Other
LEGAL DESCRIPTION Sol, Rating: ~.~PD/Sq. Ft. Total Depth from original grade:/
Lot: j ~~ ~ I ~BI°ck: Subdivision:~~~~Depth to pipe bottom from original~Ft.grade: Gravel depth beneath pipe ~/ Ft.
Township:I~ Range: ~~~ , Fill added above original~ ~Ft.grade: ~ Gravel length: ~[~ ~ Ft,
Number of lines: Distance between lines:
WELL: D New D Upgrade Gravel ~: ~t ~. ~/ Ft. ~ ~ I J ~/ Ft.
~ification (Private. A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ~ [~ ~
Driller: DateDrilled: StaticWaterLevel:Ft, ~t~ ~ ~~.Dateinstalled: ,
Yield: Pump Set at: Casing Height Above Ground: TAN K
GPM Ft. Ft.
SEPARATION DISTANCES ~eptic Q Holding ~ S.T.E.P.
To Septic Absorption Lift Holding 3ublic/Prlvate M~nufacturer: ~ ~apacity in gallons:
From Tank Field Station Tank Sewer Lines ~~~ ~ I~~
Well ~ ~ ~ -- ~1 ~Mater~ Number of Compartments:
Surface
Water ~ 1~'~ ~- ~ ~ LIFT STATION
LineL°t ~ / ~1~ ~ ~ ~ Sizein gallons: IManufacturer:~
Foundation ~' ~, -- ~ -- "Pump on" ,eve~ o,," level at: I High water alarm at:
Cu~ainDrain ~ ~ ~ ~ ~ ~ ~ -- ~ Pu~odel I Electricallnspectionsperformedby:
Remarks: BENCH MARK
Location and Description:
Assumed Elevation:
$ & $ ENGINEERING
Inspections
performed
Department of Hea~ and Human Services approval
Reviewed and approved by: Date: ~-/~ -?2
72-013 (1/91) MOA 25
Permit No. '~J,~ ~ ~ ~ ! ~, ~:~ Page ~ of ~
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
N
72-013 A (2/91) MOA 25
I. SHAFER
No 18215
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW920160
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:SECRETARY OF HUD
OWNER ADDRESS:222 WEST EIGHTH AVE.
ANCHORAGE, AK 99513
DATE ISSUED: 6/30/92
EXPIRATION DATE: 6/30/93
PARCEL ID:05116127
LEGAL DESCRIPTION: BENJAMINS BIRCHWOOD EST. LT 1
LOT SIZE: 43843 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT:
4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ISSUED BY: .....
DATE:
DATE:
June 18, 1992
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER &WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
Anchorage, AK 99519-6650
REFERENCE: Benjamins Birchwood Estates, Lot 1
We request you issue a permit to upgrade the septic system
serving the referenced property.
An adequacy test was performed on the existing system and the
absorption capacity of the system was found to be inadequate.
The existing system is also encroaching the 33' road and power
line easement.
A test hole was excavated and a percolation test performed.
The approximate location of the test hole is located on the
attached site plan.
We do not anticipate any adverse effects on neighboring
properties by the installation of the proposed septic system.
If you have any questions, or require additional information
for your review, please contact us.
Sincerely,
Roger J. fer, P.E.
RJS/LSU/lsu
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
I"= $0'
SCALE
UPGRADE'
PERFORMED FOR:
LEGAL DESCRIPTION:
2
3
4
8
10
12
13
14
16
17
18
2O
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
Township, Range, Section:
DATE PERFORMED:
SLOPE
WAS GROUND WATER
ENCOUNTERED? ~O'
L
IF YES, AT WHAT O
DEPTH? p
E
Depth to Water..J¥'~jMonitoring? Date:
SITE PLAN
Gross Net Depth to Net
ReadingDate Time Time Water Drop
~_.~o~~- ).
~ -) ~:~ ,o ,-d',~J ~'1~" '~1.¢"
I?.', ~ ~ ~[~" ~/~ "
~ ~,.~ ,, ~.1~" y+,,
PERCOLATION RATE '~"~--~ (m,nutes/inch) PERC HOLE DIAMETER
PERFORMED BY' S & S ENGINEERING
· 17034 Eagle River Loop Road NO. 204
ACCORDANCE WITH ~',~N~I~iI~q~,~rjGUIDELINES IN EFFECT ON 3tHIS DATE.
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED iN
NAME
MUNICIPALITY OF ANCHORAGE
DEPARTMENT 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.~.,
IPH. ONE,. I [~NEW
MAILING ADDRESS
--Y'/¢ 7?0-
LEGAL DESCRIPTION
LOCATION
DISTANCE TO:
Absorption area
~.~ ,...,
BEDROOMS
Manufacturer
Liq. IF HOMEMADE: I Inside length
DISTANCE TO: Well /~ /~ [Dwelling
Manufacturer
Width
No. of compartments
Liquid depth
DISTANCE TO:
No. of lines --
/
Length of each line
gra
Length Width
Type of crib
DISTANCE TO:
Class
DISTANCE TO:
Crib
Well
Depth
Building foundation
OTHER
PIPE MATERIALS
SOIL TEST RATING /
PERMIT NO.
Material
Liquid capacity in gallons
Foundation q3
Nearest lot lin~,~) ~..~,~
INSTALLE~/~ ~
R EMAR KS
Tre.~ width
~1 inches
, a~a
PERMIT NO.
Crib depth
Building foundation
Total effective absorption area
Nearest lot line
Driller Distance to lot line
line Septic tank
PERMIT NO.
Absorpt on area(s)
72-~3.,/Rev. 3/7'8) -
[~ & S Engineerir~'
F'ERM! T NO.
FIPPL I CFINT BONN I E J. K I NG :,R BOX '"- '=-
L~]C. H1 IUN MILE 2. 4 SEt. BIRCHWO0[:, LOOP E. R.
I_EGAL ~~
t-IL, I'-.I I C: I r-"~l__ ][ T'T' OF RNCI-'
DEPARTMENT '-IERLTH RND ENVIROI",IMENTRL JTEC:TI ON
,=,.-,.=, ....
,~,.-".~ "L" STREET., HNE. HORREiE., FIK ....
· .'., '.T. _. '7".,-
LOT SIZE 1OOOO0 ~QLIMRE FEET
~"~ IS:
TYPE OF SOIL RBSORPTION _T~TEM TRENCH
MH,:-.,IMUM NLIMBER OF BEDROOM-., = 4
SO I L RRT I NG ("~Q FT,,'BR) =
THE REQUIRED SI..,E OF THE SOIL MB~:RPTION SYSTEM IS'
[:.EF'T~= 1~---4 LEr~GTH= 115 ,3RRt-'EL DEPTH= el
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE
GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET),
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
REL-~.IUI I RE[:.,
PERMIT HFFLI_.RNT HH:, THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE
IN;,THLLHTIAN INSPECTIONS OF 8NY WELLS FIDJRCENT TO THIS PROPERTY FIND THE
, ~
NUMBER OF F..E_,IDENCES THRT THE WELL WILL SERVE.
.......... -['1-.~13 ,:: 2 > I Y-,ISPEE:T IONS RRE F.'EL~LI I RED,
BHL, KFILLING OF RNY :,~:,TEM WITHOUT FINFIL INSPECTION FIND RPPROVRL BY THIS
[:,EPFIR'¥MENT WILL BE ::,LIBJEE. T TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN FI WELL RND ANY ON-SITE SEWRGE DISPOSRL SYSTEM IS
i00 FEET FOR R PRIVRTE WELL OR i50 TO 200 FEET FROM FI PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTRNCE FROM R PRIVFITE WELL TO FI PRIVFITE SEWER LINE IS 25 FEET FIND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS FIND CONSTRUCTION DIFIGRFIMS RRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
F"EF."I".I I T E::--":P I RES DEC:Er~BER 31..
I CERTIFY THFIT
1: I RM FFIMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNICIPFILITY OF RNCHORFIGE.
2: I WILL INSTRLL THE SYSTEM IN RCCORDFINCE WITH THE CODES.
~: I UNDERSTRND THFIT THE ON-SITE SEWER SYSTEM MFIY REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS.
ISSUED E: ~/ [>ATE .....
V4. O
SOl LS LOG
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2-.."~'7'~ Pouch 6-650, Aritho,ag,, Alaska 99502 276-222'l
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:
~0~
1
2
3
4
5
6
7
8
9
~fL- 7-
DATE PERFORMED:
SLOPE /~ SITE PLAN
PERCOLATION
TEST
10
11
12
13
14
15
16
17
18
19,
IF YES, AT WHAT .
DEPTH? '-'---
Reading Date Gross Net Depth to Net
Time Time Water Drop
~ .. ~.',~ lO ~q~ ~,,
/~o 7-7'0 k~ or'
PERCOLATION RATE (minutes/inch)
· TESTRUNBETWE~EN ~" ~ FT`
72-008 (7/76)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # ~)~
1. GENERAL INFORMATION
Complete legal description
Ben~amins Birchwood Estates, Lot 1
Location (site address or directions) 19932 Birchwood Loop Road
Property owner
Mailing address
Lending agency
Mailing address
H.U.D. Day phone
22? W~t Eighth Av~ An~horaqe, AK 99513
Day phone
563-3333
Agent Sandy Hjelmstad/ASSOCIATED BROKERS Day phone
Address6~ w~.~_ 36hh Avc_nn~ Ste. 1, Anchorage, AK 99503
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
4
xx
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site ××
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
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:suo!lelndp, s §U!MOIIOJ eq1 q),!M 'SLUOOJpeq
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~IJnJ.VNSI$ SHHa
euoqd
· uop, oedsu) s?ql jo m,~p @q), uo ~,oejje u! suoilBln6eJ pu~ 'seou~u!pJo
'sepoo el~lS pu~ I~d!o!unlAl I1~ ql!~ eou~!ldLUoO u! s! LUelS~S I~sOds!p jm,~els~ Jo/pu~ ~lddns
Jel~M el!s-uo eql 'uo!loedsu! pu~ uo!l~§p, se^u! ~LU LUOJJ pUB Sel!J e§~Joqou¥ jo ~l!l~d!o!unl~
LUOJJ peu!~lqo UOp,~LmOJU! eq~, uo peseq ~,~q~, ~j!Je^ JeqlJnJ I 'u!eJeq pelso!pu! eJ re, orals,to edX1 pu~
SLUOOJpeq JO JequJnu eql Joj e~,~nbep~ pu~ i~uop, oun~ 'e,tes s! ~um, s~s ISSOdS!p Jm,~els~ Jo/puc
,qddns ~el~M m4S-UO eql ~,~q~ SMOqS uop,~O!ldd~ I~^oJdd¥ ~,poqln¥ qll~eH s!q~, jo uop,~§p, se^u!
,{LU ~,~ql ~j!Je^ I 'MOleq u~oqs e~p uop, ep!l~^ eql ~o se pue oleJeq pex!~je I~eS ~LU ~q pe!J!l~eO s¥
'9
I:F:I:INIDN3 AG NOI.LO:IdSNI dO J. N31N::I.LY/$ 'Cj
( Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~ I Parcel I.D. ~:2~-----~
A. WELL DATA
Well typ""~-'~
Log present (Y~'~
Total depth
Sanitary sea, N)
If A, B, or C, attach ADEC letter.
Date completed
/._.j...
Cased to
Wires properly protectec~)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level
g.p.m.
ADEC water system number
~'[/--'- · Driller
Casing height
AT INSPECTION
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot I~,~ !
Absorption field on lot J
Public sewer main ~.JO ~J.~
Sewer service line
; On adjacent lots
, On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample:
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed
Cleanout~N)
High water alarm (
Date of pumping I'-[/.~
Tank size /~"~'~'"-'~ ~-'~ Compartments
Foundation cleanou~'N~ _+. '"(/ Depression ,Y~_~
Alarm tested {Y~ ~ '
~~~ Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot [~/ On adjacent lots
To property line ~-"~ ~1" / Absorption field
Surface water/drainage
/
Foundation ~'~'
/
water main/service line .
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level ~
Meets MOA electrical codes ~~
SEPARATION DISTanCE FROM LIFT STATION TO:
Well on~.,.,~ On adjacent lots
ABSORPTION FIELD DATA
Date installed
I
Length [I-4 Width ~ /
Total absorption area ] ,'"~
Depression over field (Y/~
Results (pass/fail) ~'--~-~ ~--~"/~'['--~'V-'
Peroxide treatment (past 12 months) (Y~____~
Soil rating
Manufacturer
Manho~
J "Pump off" level at
Cycles tested
Surface water
~).'~t'~ ~"~'~System type ~
Gravel thickness ~ /
Total depth
Cleanouts presen (t~_/N)
Date of adequacy test
for
bedrooms
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water I~ ~'J-
Curtain drain
On adjacent lots [ ~/''~ '~/
Property line .
~"'-~'~' ! To existing or abandoned system on'lot J
Cutbank ~ :--H Water main/service line [ ~:) ' ~'-'--~
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name
Date
ENGINEERING
,.L~4 ~ple River Loop Roa~
~iver, Alaska 995~
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
CHEMICAL & GEOLOGICAL LABORATORY
A DiVISiON Og COMMERCIAL ~T~NG & E~iN~ERING CO.
5033 E STREET ~NCHORAGE, ALASKA g951~ TELFPt-IGNE (9(:;q ~-2~3 FAX: (~07} ~6!-~30t
Collects8 · ~UL ~? 92 e 1~:oo h~, ~?oI :
.... "' :~:: .INSP ...... DAT~= RECEIVED
ECT O. APPOINTMENTS
TIME !
DATE DATE' DATE ' '
'INSPECTOR INSPECTOR ' ~-'[ - I ~1 -(~\
MUNICIPALITY OF ANCHORAGE MUNICtPALI~ OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEAL~ &~
825 L Strut - Anchora~, Alaska 99501 E~IRONMENTAL
ENVIRONMENTAL SANITATION DIVISION APR 1 3 1981
Telephone ~-4720
DIRECTIONS: Complete all parts on page 1. Incomplete r~u"ffi wllJ not be pro~d. Please allow ten (10) days for processing.
PROPERTY RESIDENT {If different fr~ above) ~ ~ PHONE
MAILING ADDRESS .....
MAILING~DRES~
4, REALTOR/AGEnT I P~ONE .....
~AILING ADDRESS
5. "LEGAL DESCRIPTION ....
I' ~TREET LOffi~TION
1 6, TYPE OF RESIDENCE
~SING LE FAMIL¥
[] MULTIPLE FAMILY
WATER
~ INDIVIDUAL*
NUMBER' OF'~ EDRO___~OM_~,,~ ' ' ·
[] One ~ Four [] Other
[] Two [] Five
[] Three [] Six
ATTACH WELL LOG. A well log is required for all wells drilled
[] COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC UTI LITY depth (attach log if available.)
8. SEWAGE DISI~AL SYSTEM ~ ' '
~/IINDIVIDUAL/ON-SITE** ~0 YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) ~1 I,,~,.0
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY "
[] INDIVI.DUAL
THIS SIDE FOR OFFICIAL USE ONLY .
NUMBER OF BEDROOMS
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SIX
ri
PERMIT NUMBER
OTHER
DEPT'H OF WELL
COMMUNITY
PUBLIC UTI LITY
Connection Verified
DATE DRILLED
LOGrR~=CE'i'V ED
3. SEWAGE DISPOSAL SYSTEM
[] I NDIVI DUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or [] Holding Tank
Size' I~t~ If Tank is homemade
give dimensions:
TYPEOF TANK
TOTAL ABSORPTION AREA
~ES
WELL TO:
Absorption Area to nearest Lot Line
r
~'EI~ MIT NUMB'ER
DATE INSTA~LEb
INSTALLER
"SOl LS'RATING
MAN U FACTU R E R ~..¢~._~
JSewer Line J Nearest Lot Line
[~'~PPROVED FOR , ~ -BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE
BY
72-010 (Rev. 6/79)
(8B-529)FO ,'