HomeMy WebLinkAboutBIRCHHAVEN LT 1LT 1
Birch Wumods Lot 5
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON -SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP221344 PID Number: 051-243-14
Dwelling: FE-1 Single Family (SF) El with ADU El Duplex (D) El Two Single Family Project: [_ffil New El Upgrade
Name
Kourosh Partow
ABSORPTION FIELD
El Deep Trench 9 Wide Trench F-1 Bed El Mound
Site Address
17610 Birchtree Street
El Other
Phone
Number of Bedrooms
Soil Rating I
depth from original grade
I Three (3)
1.0 GPD/SF
JTotal
0.0 / -0. 1 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
-0.5/-0.6 Ft.
Gravel depth beneath pipe
0.5 / 0.5 Ft.
Subdivision Block Lot
Birch Woods 5
Fill added above original grade
2.9/2.6 [pending topsoil] Ft.
Gravel length
45/45 Ft.
Township Range Section
Gravel width
5.0/5.0 Ft.
Beds: Number of Lines
N/A
Distance between lines
N/A Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
2
Dist. between trenches
6<
From
Tank
Field
Tank
Line
450 Ft2
Ft.
Well
>100'
>100'
N/A
N/A
>25
TANK 0 Septic ❑® S.T.E.P. E] Holding [] Other
Manufacturer
Infiltrator
Capacity
1,530 Gal.
Surface Water
>100'
>100'
N/A
N/A
Material
Plastic
Number of compartments
Two (2)
Lot Line
>51
>11*
N/A
N/A
NA
Foundation
>10'
>10'
N/A
N/A
LIFT STATION
Manufacturer
Orenco
Capacity
STEP Tank Gal.
RemarksTrenches listed east/ west
*See waiver request
Alarm location
Back exterior wall I
Electrical installed by
Dependable Electric
PIPE MATERIAL House to tank D3034 drainfie[dTankto D3034
Installer
Precision Excavation
Drainfield D3034 CO/MT D3034
Inspector B. Schiller
BENCH MARK (Assumed elevation) 100 ft
Inspection Im 6128/23 6/29/23
Location and description
dates: 2 nd
rd th
Fop of foundation @ Point A
3 4
ON -SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
OF k
Conditional Approval: Date
,
49 TI-11
;1101 ......
_5
. ... . c ........
7.8enja On chiller
Septic System
Approved Date. Z- 1/
CE112592
12/18/23 AS"
PROFESSOW
Note: this approval does not include well permit requirements.
(Rev 05/02/18)
FCO
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FD - FLOW DIVERTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
PERMIT # OSP221344 PID # 051-243-14
A B
FCO 47.5
MH1 50.0
MH2 53.7
A
B
MT1 169.6
MT2 211.2
MT3 176.4
MT4 215.0
7.6
15.9
25.5
128.5
165.7
137.3
171.21"=50'
1530-GAL STEP TANK
FEET
0 50 100
Benjamin Schiller
CE 12592
R
E
GISTEREDPROFES S I O N A L E N G INEER
BIRCHHAVEN LOT 1
BI
R
C
H
T
R
E
E
S
T
R
E
E
T
15' T&E EASEMENT
10' T&E EASEMENT
19
0
195 200
205
TH#4
100' SEPARATION
FROM SURVEYED
CREEK LOCATION
18
5 3-BDRM HOME
2x 45' LONG x 5' WIDE x 0.5' EFFECTIVE
DEPTH ABSORPTION TRENCHES
ALT SITE: 20' LONG, 0.5'
EFFECTIVE DEPTH,
CAT III SYSTEM
MT4
MT2
MT3 MT1
12/20/23
PLAN AS-BUILT
MH1
MH2
TH#3
BM EXISTING WELL
PROFILE AS-BUILT
(NO SCALE)
PERMIT # OSP221344 PID # 051-243-14
BIRCHHAVEN LOT 1
96.0 FINISH GRADE
45'
TH
#
3
GROUNDWATER @ 87.7 4/5/22
93.1
85.2
93.1 ORIGINAL GRADE
1530 GAL INFILTRATOR
STEP TANK
Benjamin Schiller
CE 12592
R
E
GISTEREDPROFES S I O N A L E N GINEER
12/20/23
95.3 FINISH GRADE
45'
TH
#
3
GROUNDWATER @ 87.7 4/5/22
92.8
85.2
92.8
92.7 ORIGINAL GRADE
EAST TRENCH
WEST TRENCH
96.4
96.9
99.4FC
O
MH
1
MH
2
92.3
4" INSULATION
MT
1
MT
2
MT
3
MT
4
93.1 93.6
93.3
2' MOA APPROVED SAND
2' MOA APPROVED SAND
2" FOAM INSULATION
2" FOAM INSULATION
91.1
90.8
(PENDING FINAL TOPSOIL AND GRASS)
(PENDING FINAL TOPSOIL AND GRASS)
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
DEPTH
(feet)
TEST HOLE 4
DATE READING START TIME NET TIME(minutes)
DEPTH toWATER NET DROP
PERCOLATION RATE: (MIN/INCH)
(inches)(inches)
DATE OF MONITORING
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING
IF YES @ WHAT DEPTH?
.09
6/26 1
2
3
4
5
6
SW/SM (SILTY SAND)
Professional Engineers Stamp:
NO
BIRCHHAVEN LOT 1
6/26/2023 051-243-14
KOUROSH PARTOW
2:501
2
3
4
5
6
3 0
16
OB
00:16
Benjamin Schiller
CE 12592
R
E
GISTEREDPROFES S I O N A L E N GINEER
7/11/2023
PERC TEST LOCATION
TECHNICIAN:B. Schiller
9 0
16
N/A
-
-
COMMENTS:
6" DIAMETER PERK HOLE
SITE PLAN
6 0
16
00:22
00:21
00:24
00:26
00:31
3 0
16 9 0
16 6 0
16
3 0
16 9 0
16 6 0
16
3 0
16 9 0
16 6 0
16
3 0
16 9 0
16 6 0
16
3 0
16 9 0
16 6 0
16
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
Z:
P.O. Box 196650 a c
Mark Begich Anchorage, AK 99507 s " E T r
Mayor www.muni.oro/onsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW osP Date of Issue:
Parcel Identification Number:
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
Wheaton Water Well, Inc.
1190 N. Wasilla-Fishhook Road
Wasilla, AK 99654
Name:
Kourosh Partow
Address:
City:
Chugiak State: AK
Zip Code: 99567
Well Site:
Birchhaven
Lot/Block: L 1
Additional:
17610 Birchtree St.
Well Depth:
225 ft
From: To:
Formation:
0 3
Sand and Gravel
Below Ground:
223 ft.
3 41
Silt and Gravel
Above Ground:
2 ft.
41 51
Hard Grey Rock
Gal/Min:
4
51 73
Shale, Coal
73 210
Hard Grey Rock
Static Level:
2 ft
210 225
Coal
Casing:
40"ft. of 6 in. x .25in. steel"
Liner Pipe:
N/A
Screened:
N/A
Perforated:
N/A
Grouted:
Yes
Depth:
Develop. Method:
Air
Use of Well:
Residential
Drilling Method:
Rotary
Misc:
Commercial Cap
Other:
Chlorinated to 50ppm
The well was pumped 5' off the bottom with 100% draw down for 2 hours and recovered at 4gpm .
Date Drilled:
6/21/2023 Driller:
Ben Mattson
/
/
N 88'59'54"E 127.89'
0 10 25 50 10o
SCALE- 1 "=40'
Lot 2
Ii
i N
ro SEPTIC PIPES
ry
Lot 3 _
AD � o
' • �+ A I 50.0'
�'- 15' T&E
m EASEMENT \
a)
\ /
N 88'59'54"E 215.79'
D
Lot 1 SEPTIC PIPE m
rn
I
\ 67,426 S.F. MANHOLES 1 1n rn
ry I 33.7 n WELL
FIRE CREEK II \\ 4,4' PORCH p
5.5'
Tract A �'�. I � Ln in
W 106.5' u'_ �
— w
22.0
rn
1 STORY 2.o rn
as '. \• '. WETLANDS aout�oARY RESIDENCE N GRAVEL DRIVEWAY
10.2'x12.2' DECK
48.2'
50' STREAM
\ SETBACK 10' T&E EASEMENT /
K&R STREET
S 89'42'37"W 407.22'
l Unsubdividad I
PLOT PLAN ___ AS BUILT _X SCALE 1'� =40' GRID _ NW 0954Project No. _�_23=1891B5 _
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone
Aft.;
Professional Land Surveyors jonothan*langsurvey.com �.OF
travis®langsurvey.com
I hereby certify that I have surveyed the following described property: ,..9
LOT 1, BIRCHHAVEN SUBDIVISION (PLAT No. 2022--64) * 49 TH * ��
Anchorage Recording District, Alaska, and that the improvements situated thereon are % • • • • • • • • • • • • • • • • •
within the property lines and do not encroach onto the property adjacent thereto, that /
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible 9 KENNETH G. LANG
easements on said property except as indicated hereon. No.5202 •.'���/
Dated this the _ �'� _ Da of ___r T='` _, at Anchorage, Alaska �FD� ?� p5��
--- y -- — � ''R4FESSIONA����•�
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plot. State of Alaska AECC963
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Water & Wastewater System Permit
Permit Number: OSP221344
Work Type: WellSeptic Initial
Tax Code Number: 05124314000
Site Legal Address: BIRCH WOODS LT 5 G:0954
Site Mailing Address: 17620 BIRCHTREE ST, Chugiak
Owner: PARTOW KOUROSH
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date
Expiration Date:
Lot Size in Sq Ft
Total Bedrooms:
o%_Cnt
Department
9/23/2022
9/23/2023
70270
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Q Private Well ❑ 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:
Issued By:
Date:
Date: gZZ3 Lzz-
3
MUNICIPALITY OF /ANCHORAGE
�t
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. 051-243-14
Property owner(s) Kourosh Partow
Mailing address 19507 Richner Road, Chugiak, AK 99567
Site address NHN Birchtree Street
Day phone
Legal description (Sub'd., Block & Lot) Birch Woods, Lot 5 (Proposed Birchhaven, Lot 1)
Legal description (Township, Range & Section)
Lot Size 70,270 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑X
Initial ❑X
Single Family (SF) ❑X
(w/wo ADU)
Septic Tank
❑X
Upgrade ElDuplex
(D) ❑
Holding Tank
❑
Renewal ❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑X
Water Storage
❑
THIS APPLICATION
INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
y
(Signature of property owner or authorized agent)
Permit/Rush Fees: 32-0 Waiver Fees:
Date of Payment: k2Z-42 2 Date of Payment:
Receipt Number: 7d Receipt Number:
Permit No. 0-15P-11, 2- 1 �% L% Waiver No.
Permit App_;;- : ,_.mac
September 13, 2022
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
9/13/22
Subject: Birch Woods, Lot 5 (Proposed Birchhaven, Lot 1)
Septic system design
Dear On-Site Services Engineer:
The owner of the above lot intends to build a 3-bedroom home on the property, so we are
submitting this permit application for the construction of a new well and septic system. The
attached site plan identifies the location of the home as well as the proposed well, septic location
and alternate site. No conflicts exist between this proposed system and any other well or septic
system, whether on this lot or adjacent lots.
The slopes on the lot are relatively mild throughout the property. The new septic system is located
towards the rear of the lot. (There are no slopes greater than 25% within 50 feet downslope of
either the primary or alternate site.) Contours are shown on the site plan showing the grade and
direction of flow. Stormwater drainage will not impact this septic system. The new trench will be
constructed parallel to the slope as much as possible.
Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all
wells and surface water, and more than 5’ away from the septic tank. The alternate site is located
more than 6’ away.
Please refer to the attached test hole logs, plan and profile pages for the septic design. If this design
is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221344, Deb Wockenfuss, 09/23/22
BIRCH WOODS, LOT 5 (PROPOSED B I RC H H AV E N LOT �� On site Water and Wastewater
SEWED FOR CODE COMPLI�
OSP221344 Deb Wockenfuss, Of
(PROPOSED LOT 2) \
PROPOSED
NEW LOT LINES
LOT
100' SEPARATION
FROM SURVEYED
-LOT4
TH#1 e
Q5TH#2
ITE: 20' LONG, 015' :
FFECTIVE DEPTH;•.
EXISTING LOT LINE
\CAT III SYSTEM -I FOR LOTS 1 & 5
-------------------
:MT MT ��` '•
"T\ 1
CREEK LOCATION \ M
j \ WETLANDS BOUNDARY
PER MOA MAPPING
�\ PLATTED CREEK LOCATION W/
\ MAINTENANCE EASEMENT
\ ; \ SURVEYED
w CREEK
\\ LOCATION
N()TF•_
�
Benja i Schiller
1,�'F���P• gu 2592
nz.••��<�r
PRO* FESSI6'
-------------
I i
15' T&E EASEMENT J
2x 45' LONG x 5' WIDE x 0.5' EFFECTIVE
DEPTH ABSO I PTION TRENCHES
LOT 5
\ (PRO"ED LOT 3) I /
100' WELL RADIUS //
/m
EXTENT OF MOUNDED SOIL I /
\` rRQPOSED WELL LOCATION--- I-- I \ m
--------------------�— �'� \ \ m
Lu
(PROPOStD LOT 1) I o
I
1250 -GAL STEP TANK
10' T�E EASEMENT
ry
0
m
M
NO SLOPES >25% ARE WITHIN 50' OF THE PROPOSED SEPTIC SYSTEM. NO SURFACE WATER WITHIN 100' OF
THE SEPTIC SYSTEM.
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH
WELLS OR SEPTIC SYSTEMS.
0 50 100
GE
FEET
lNGI NE E RI NG 1"-50'
LEGEND
CO - CLEANOUT
2CO - DOUBLE CLEANOU&
2RCO - FOUNDATION CLEANOUT
FD - FLOW DIVERTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
BIRCH WOODS, LOT 5 (PROPOSED BIRCHHAVEN LOT 1)
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
Benjamin Schiller
CE 12592R
EGISTEREDPROFES S I O N ALENGINEERSep 13, 2022
DESIGN FACTORS:SYSTEM REQUIREMENTS:
450 GPD PEAK FLOW
PERK RATE: <1 MIN/IN (SAND)
APPLICATION RATE: 1.0 GPD/SF
5' WIDE TRENCH SYSTEM
1250-GAL STEP TANK
BOTTOM OF TRENCH: AT EXISTING GRADE
FLOW LINE ELEVATION: 6" ABOVE GRADE
TOP OF TRENCH: 3' ABOVE GRADE
450 GPD / 1 GPD/SF /5' WIDE = 90 LF TRENCH REQUIRED (90 LF SPECIFIED)
TYPICAL TRENCH SECTION
(NO SCALE)
1 1
4" PVC w/ 15 - 3
16" HOLES
PER LATERAL, SPACED @
6' APART (HOLES DOWN)
DRAINFIELD ROCK
5'
2" INSULATION &
GEOTEXTILE FABRIC
MINIMUM 2' SOIL COVER
W/ INSULATION
2' SAND LINER
6"
2'
August 25, 2022
2'-6" 1
3
TOPSOIL AND SEED
ARE REQUIRED ON
SLOPES
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221344, Deb Wockenfuss, 09/23/22
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE: PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
DEPTH
(feet)
TEST HOLE 3
DATE READING START TIME NET TIME
(minutes)
DEPTH to
WATER NET DROP
PERCOLATION RATE: (MIN/INCH)
(inches)(inches)
DATE OF MONITORING
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING
IF YES @ WHAT DEPTH?
<1
3/24/22 1
2
3
4
5
6
SW/SM (SILTY SAND)
Professional Engineers Stamp:
NO
BIRCH WOODS L5 (proposed birchhaven L1)
3/24/22 051-243-14
KOUROSH PARTOW
9:401
2
3
4
5
6
0
9:42
9:44
9:46
9:48
9:50
1' OB
00:35
Benjamin Schiller
CE 12592R
EGISTEREDPROFE S S I O N ALENGINEERMay 5, 2021
PERC TEST LOCATION
TECHNICIAN: J. MILLETTE
6 0
16
N/A
5.0'
4/5/22
COMMENTS:
6" DIAMETER PERK HOLE
SITE PLAN
6 0
16
ML/CL (SILTY CLAY)
00:41
00:38
00:38
00:40
00:38
0 6 0
16 6 0
16
0 6 0
16 6 0
16
0 6 0
16 6 0
16
0 6 0
16 6 0
16
0 6 0
16 6 0
16
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221344, Deb Wockenfuss, 09/23/22
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O4Q r •o• r f
v r 15' T&E EASEMENT
POWER LINE EASEMENT
a (WIDTH VARIES)
Lot 2
43
36.48 , 00'Nr 1 84.561 S.F.
N 7 \ SE
EASEMENT ENT
.y
y,r�\ N
Sj 8 SEPTIC e
\ SETBACK
Tract A °
Z ory STREAM
MAINTENANCE
EASEMENTS 8
\ 103.88' -
EXHIBIT A
Lots 1 & 5, BIRCH WOODS SUBDIVISION
(PLAT No. 83-427)
SCALE: 1"=100'
I �S
I t PUTTED THREAD
\ OF STREAM
Lot 4
! N 89.01'09*E 230.51'
I I w
` to
M
rn
+ rn
Lot 5
70.270 S.F. Iii
pAl
Itq
rq
10' T&E EASEMENTS
Municipality of Anchorage
P.O. Box 196650 ® 4700 Elmore Road
Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
Waiver#: OSV231065 COSA#:OSC231485 Permit#:
P I D#: 051-243-22
Legal Description: BIRCHHAVEN LT 1
Engineer: Forge engineering
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is 1.0 feet.
This waiver approval applies to the existing absorption field only. Any future upgrade to the on -
site wastewater disposal system will require all separation distances be met or another approval
from this department.
■■mvmmmvmmmmvmmmmmvvmvmvvmvmvmvmmmmmvsmmmvvmmmvmmvvmvmmvmvvvvavmmvammmmvvvvmmm�
Waiver is Granted: X Waiver is not Granted:
20 23 (. , /--
NameDate: 1 Approved by: � of Reviewer
■■mvmammmmmmmmmvvmmvmmmvmvvmmvvvmvmmmavmmvmmmmmmmmamvmmmvmmmmmmmvmvmmvvmvvammm�
December 21, 2023
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Birchhaven Lot 1 – 17610 Birchtree St
Absorption Field to Lot Line Waiver
Dear On-Site Services Engineer:
During the installation of the septic system on this lot, the trenches were inadvertently placed too
close to the lot line. This appears to have been due to the contractor’s attempts to avoid taking out
several large trees.
This location for the trenches meets separation from the neighboring well and septic system. It
doesn’t affect the foundation of the building at all. The trenches are mounded, but the cover on top
was placed and the side slopes constructed while the builder owned all lots, so there was no
objection to the fill crossing lot lines, and it has been blended in with the grading around so that
any future owner wouldn’t reasonably be able to cut down the grading without creating a large
depression in their yard. We do not see any adverse effects from this location of the absorption
field.
We respectfully request that a waiver be issued for a 1’ separation from the trenches to the lot line.
Sincerely,
Benjamin Schiller, PE
Certificate of On -Site Systems Approval
Parcel I.D. 051-243-22
Legal description BIRCHHAVEN LT 1
Site address 17610 BIRCHTREE ST Chugiak AK
Current property owner(s) PARTOW
Expiration Date: ! Z�o -Z y
t
X The On -site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Original Certificate Date: Z Z l 2-, 2-_3
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA ApprovaIjune 2022
MUNICIPALITY OF ANCHORAGERU5H
N,
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 051-243-22
Complete legal description B i rch h ave n Lot 1
Location (site address) 17610 Birchtree Street, Chugiak, AK 99567
Current property owner(,) KOurOSh PartoW Day phone (907) 310-2501
2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel X Plastic ❑ Concrete ❑ Fiberglass
Age < I - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑■ Wide Trench ❑ Seepage Pit
Waiver request for:Absorption Field to Lot Line
Expedited review requested: ❑■
Distance:
1'
By applying for this entitlement, this property is subject to inspection by municipal On -site staff
to verify the accuracy of the information provided.
COSA Fee $ 9 130 Waiver Fee
Date of Payment
COSA # 0 5G2 3 l H 8 S
Date of Payment
Waiver # 05 V 2.3106 5
COSA Application —June 2022
Birchhaven Lot 1 051-243-22
4
6/21/23 225 N/A
40
0.057
24 1.3
2 8/15/23
N/A
N/A
New installation
N/A N/A
N/A
>
Benjamin Schiller, P.E.11/17/23
(907) 522-7773