HomeMy WebLinkAboutBIRCH TREE ESTATES BLK 1 LT 18
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181309 PID Number: 017-141-20
Dwelling: E Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑■ Upgrade
Name:
Keith & Janice Washburn ABSORPTION FIELD
Address ❑ Deep Trench ❑■ Shallow Trench ❑ Bed ❑ Mound
5161 Metz Court Anchorage, AK 99516 ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
748-6556 4 1.2 GPD/SF 3.0 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 2.5 Ft. 0.5 Ft.
Birch Tree Estates 1 18 Fill added above original grade Gravel length
Township Range Section 0.15-0.35 Ft. 2 x 50 Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES 5.0 Ft. 6+ Ft.
To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Tank Line 500 Ft2 2 Ft.
Well >100' >100' N/A N/A >25' TANK ❑Septic I]S.T.E.P. 0 Holding 0 Other
Manufacturer Capacity
Surface Water >100' >100' N/A N/A Anchorage Tank 1500 Gal.
Material Number of compartments
Lot Line >10' >10' N/A N/A Steel 2
NA LIFT STATION
Foundation >10' >10' N/A N/A
Manufacturer Capacity
Curtain Drain None Noted Orenco/Anchorage Tank 1500 Gal.
Pump on level at Pump off level at High water alarm at
Remarks
13 in. 25 in. 11 in.
Pump make and model Electrical Inspections performed by
PF2005 MOA
PIPE MATERIAL House to tank D3034Tank to D3034
Installer drainfield
A+ Home Services Drainfield D3034 CO/MT D3034
Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft
Inspe
ction 1st 9/12/18 2nd 9/12/18 Location and description
da
aro 4th Bottom of garage man door
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL .tt�\\\‘°F ALAI`
kt
Conditional Approval: Date _ A%xT.. •• .. •.4 4--- T
*:49Th f' '*r,/
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•• : Benj. , in Schiller :
i�Fc•. C 12592 .•(` .�
Approve. �/imi _ - Date 7-2-0 le 4k ROFES`OL-
Inspection Report_9-1-12.doc
BIRCH TREE ESTATES, BLOCK 1 , LOT 18
PERMIT # OSP181309 PID # 017-141 -20
o N
LL CO CO
— — f-
1 00.85 —
96.3
�`-- 96.55
2I
95.65 1500 GAL
SEPTIC TANK
1r
�-'--- 91.45
99.45 FINISH GRADE
i/—
99.3 ORIGINAL GRADE
l
,. — INSULATION
96.8 it DRAINFIELD ROCK '1 96.8
- 96.3 50.0' 96.3 -----"") I
�� GROUNDWATER @ 90.3 9/4/18
89.3
co
*k
I
H 99.65 FINISH GRADE
2 99.3 ORIGINAL GRADE 2
ir/
t— INSULATION
96.8 DRAINFIELD ROCK ---- .1
h— 96.8
� -- 96.3 50.0' 96.3 —ter
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/r. B •njam• in Schiller ••:e./
- - PROFILE AS-BUILT , ,, .F�. CE 12592 ���•�.
RGE (NO SCALE) kI�FdPROfESS10`�A`�
BIRCH TREE ESTATES, BLOCK 1 , LOT 18
PERMIT # OSP181309 PID # 017-141-20
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OFS / 1,500 GALLON S.T.E.P.TANK 11
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—I ,--- 6.b ® 1� ,
r:ra T2 EXISTING WELL N,A
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2-5c \L__ONG x 5'WIDE x 6" \
13.2 / EFFECTIVE DEPTH ABSORPTION \ /
/ TRENCHES TO BE CONSTRUCTED \ /
10'FROM ALL PROPERTY LINES. f I \ /
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EXISTING WELL 1//
I \\LOT 19 f f �A
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FORGE ,
fHGHEEPiHG
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,,,,, ��‘\ A B LEGEND
G• ,1/4.41A
sit FCO 26.8 4.4 CO CLEANOUT
Avg.-Avkt: `�, !F9V, EL 35.0 _ 15.0 2C0-DOUBLE CLEANOUT
diR1 /\ *0/ SV1 36.0 , 18.2 FCO-FOUNDATION CLEANOUT
' ••• SV2 43.0 26.0 FS-FLOW SPLITTER VALVE
/ ... ... MH 45.0 28.0
/ : Benja in Schiller • MT1 33.5 29.2 MT-MONITORING TUBE
vO fF••••••
CE 12592 �`�.� 0 50 100 - SV-SEPTIC VENT
vi%l• se9+7z0+e • / - E - - FEET MT2 81.7 71.9
l,epe;•.....
ONP\'�.�r MT3 44.9 48.4 TH-TEST HOLE
`��\"`� 1'=50 MT4 85.5 75.3 EL-ELECTRICAL INSP.PORT
9//z/hs, Bot_( ,F
�,,c'.°_`'ry MUNICIPALITY OF ANCHORAGE VC‘inr
i On-Site Water& Wastewater Program w
yam. PO Box 196650 4700 Elmore Road •
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 , �,
http://www.muni.org/onsite •
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On-Site Wastewater Disposal System Permit
Permit Number: OSP181309 Effective Date: 9/7/2018
Work Type: Septic Upgrade Expiration Date: 9/7/2019
Tax Code Number: 01714120000
Site Legal Address: BIRCH TREE ESTATES BLK 1 LT 18 G:3037
Site Mailing Address: 5131 METZ CT, Anchorage
Owner: WASHBURN KEITH D & JANICE C Lot Size in Sq Ft: 30905
Design Engineer: FORGE ENGINEERING Total Bedrooms: 4
This permit is for the construction of:
0 Disposal Field 2 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
bdat91,.0
11 1% CO # I isest -1-o ST EC 4 PreSS Zed
Received By: Date: � p��
Issued By: Q. CjzU Date: • mf 0
Russco
MUNICIPALITY OF ANCHORA 8 9 zo '' �
RUSH)( rOS2O \
Community Development Department P • •-: 907-343-7904
Development Services Division • =:• 907-343-7997 w
On-Site Water& Wastewater Program h
ON-SITE SEWER/WELL PERMIT A4PL$CATIONF
Parcel I.D. 017-141-20
Property owner(s) Keith & Janice Washburn Day phone
Mailing address 51$1 Metz Court Anchorage, AK 99516
Site address Same
Legal description (Sub'd., Block & Lot) Birch Tree Estates, Block 1, Lot 18
Legal description (Township, Range& Section)
Lot Size 30,905 Sq. Ft. Number of Bedrooms Four (4)
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(EI all that apply)
Absorption Field IXI Initial I I Single Family (SF) X
(w/wo ADU)
Septic Tank n Upgrade U
Duplex (D)
Holding Tank 17 Renewal U Multiple Dwellings
Privy (—I (SF and/or D)
Private Well U
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.
(Signature of property owner or authorized agent)
Permit/Rush Fees: R tom'Lo Waiver Fees:
Date of Payment: q/0/18 Date of Payment:
Receipt Number: OCi 135 Receipt Number:
Permit No. OSP/&13O9 Waiver No.
Permit App__'-: ::...c;
4/
Mop
�) ' GE
E N G I N E E R I N G
PO BOX 240773
ANCHORAGE,AK 99524
522-7773 677-7766(FAX)
September 4. 2018
Municipality of Anchorage
Development Services Dept.- On-Site Water& Wastewater Program
4700 Elmore Rd
Anchorage,AK 99507
Subject: Birch Tree Estates,Block 1, Lot 18—5131 Metz Court
Septic System Design and Permit Application
Dear On-Site Services Engineer:
The septic system on the subject lot is leaking and must be replaced prior to the issuance of a
COSA for the property. The attached site plan identifies the location of the home and the existing
well and septic system along with the proposed septic system. No conflicts exist between the
proposed system and any other well or septic system,whether on this lot or adjacent lots.
The ground surface on the lot slopes toward the west at a shallow grade. Drainage arrows and
surface ground contours are shown on the site plan indicating the grade and direction of flow.
Stormwater drainage will not impact this septic system. The new trenches 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 10' from all lot lines. The trenches will be constructed a
minimum of 6' apart and 6' from the existing absorption trench.
Please refer to the attached test hole log from the system file and the plan and profile sheets for
the septic design.If this design is followed,there will be no adverse impacts to adjacent properties.
Sincerely, r��OF A�gs>,i
•
1
Michael E. Anderson, P.E. *.49 rH %\
r . Michael E.Anderson .
f+PF• 4381-E •••`Q�
$�c�1T„;•. 9/4/18 •��c,���
k). :° 0 pREESSICN+���~
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BIRCH TREE ESTATES, BLOCK 1 , LOT 18 C°4t l
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- ) `\ ( \` LOT 4
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\ \ LOT 17
\\ I� - - - - _ \ \\ 1
10,1\$<E EASEMENT l
v. 1
10'UTILI EASEMENT
\ \
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N
LOT \N
REMOVE PIPES FROM EXIS NG — --Al
ABSORPTION TRENCI
ND T 4-BORN HO
ABANDON IN PLACE. XA TI /
LOCATION UNKF 0 N.1�_ I
// PLACE F60. �` 1' \\\
M -,off r, �� . , H \ \
\ EXISTING 1,250 1 \
N 1 mil MT HV� GALLON SEPTI NK. ( \ 1 LOT 3 \
Q f 1,500 GALLON S.T.E.P. I
FS TANK.CON&TRtJCTA–RII 1 I l
C C OF 5'' FROM DECK SUPPO T. y mo
H / 0 I
d I N I
Mn MT 10' I / EXISTING WELL/ \I\
( I
2-50 LONG x 5',WIDE x 6P
\ /
1 / EFFEtT1YE-D PTH SORPTION I I \
7RENCIJ-IES TO BE CONSTRUCTED I \ /
1 / / 10'FROM ALL PROPERTY LINES. I I /
f/ \ EXISTING WELL //
NOW: \\ LOT 19 I A
DECOMMISSION EXISTING SEPT TNK IN ® // I
= a . 4 ACCPRDANCE WITH MUNICIPAL CODES ` L - 1- , I
;[r ^,j AGE \ ` _ f
'_, `"',,,1 ENGIN[E t t N G ( \ I I /
NbTE: \ /
�,���\mt` NO SLOPES>25%WITHIN 50'OR SURFACE WATER WITHIN 100'OF THE LEGEND
/i P, •�OF •AC,q��iI, PROPOSED SEPTIC SYSTEM CO-CLEANOUT
.9 0 2C0-DOUBLE CLEANOUT
j*:49 ZH /\ .*I, ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS FCO-FOUNDATION CLEANOUT
•• _�••) ••��` ••• •,• / PROPERTY ARE SHOWN.NO CONFLICTS WITH WELLS OR SEPTIC
4 �`�"-"'" SYSTEMS. FS-FLOW SPLITTER VALVE
Michael E.Anderson : / 0 50 100 MT MONITORING TUBE
,rO�F•• 4831-E '�i SV-SEPTIC VENT
1ils�F��oP 9-11-1g..••��� FEET TH-TEST HOLE
‘1���`�`���+ 1"=50' CONTOUR INTERVAL 5'
BIRCH TREE ESTATES, BLOCK 1 , LOT 18
DESIGN FACTORS: SYSTEM REQUIREMENTS:
600 GPD PEAK FLOW 5-WIDE TRENCH SYSTEM
PERK RATE: <5 MIN/IN 1,500-GAL S.T.E.P TANK
APPLICATION RATE: 1.2 GPD/SF
600 GPD/ 1.2 GPD/SF / 5' WIDE * 1.0 REDUCTION = 100 LF TRENCH REQUIRED (100 LF SPECIFIED)
BOTTOM OF TRENCH: 3' BELOW GRADE
FLOW LINE ELEVATION: 2.5' BELOW GRADE
TOP OF TRENCH: 0.5'ABOVE GRADE
6"
1=111=111:=I 61 11=1 11-1 i t—I I(— —
I 1=1 11=1 11=1 11=1 11=1 1 1=115E1 11=1 I 1E111
I-III=III=III=III=Ill=111=III=111=III-1 GEOTEXTILE FABRIC
2, o„ 11l 1 1=111=1I I=111=1I I=II1=II I-1I I— & 2" INSULATION
I= I I—I 11=1 11=1 11=1 11=1 I I-1 11=
I i I-111=111=III=111-1 =
6
6„ '=•='=•='• ' • • • • • ° • • • • •' • ' 1.25" PERFORATED PVC
{ (HOLES DOWN)
15-3/16" HOLES PER
LATERAL @ 3.33' SPACING
5' DRAINFIELD ROCK
AtfoRGE
G t E E P N G
TYPICAL DEEP TRENCH SECTION
(NO SCALE) 3:3/49111._
gecQ:•• 4 91o�
/*:49 N /\
NOTES: �... ... .. f .. . .�.4
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' / . Michael E.Anderson ..
•
WITH 2" OF INSULATION ��'F�isT•. 4831-E• •...*�`cr/
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER IIFpPROF ESSIONP\���
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY \\������~
.4,• (sssesi,�
MUNICIPALITY OF ANCHORAGE ���„:\...• F••........ ♦♦♦
DEVELOPMENT SERVICES DEPARTMENT (').0.' , "••:,y♦♦•
41
4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 j ?' 49th 1 rr 1 j
•
SOILS LOG AND PERCOLATION TEST 00,t.:,,MICHAEL E. ANDERSON l t�;
♦♦,�J,f.. No. CE-4381 r C�=a
LEGAL DESCRIPTION: BIRCH TREE ESTATES BI L18 ♦j♦,S FOp9:6.. ...18.,P��..
PERFORMED FOR: KEITH WASHBURN •,�Ilt.:5:����•
Professional Engineers Stamp:
DATE: 8/28/18 PROJECT No.:
PARCEL ID#: 017-141-20 TECHNICIAN: J. WILLIAMS
DEPTH TEST HOLE 1
(feet)
1 SLOPE SITE PLAN
2.5' OG/PT
5 _'. •' ;i% SEE SITE PLAN
6 ---F:::: ::;;, ' ''l
j
7 Vr:=%'•'f'`^' SANDY SILTY GRAVEL
:;;;:: GM
8 °. ".. .,fY; :
9 :,. ; ; ,',.
:t:, ,
10 .7 y .•.,`,.• WAS GROUND WATER ENCOUNTERED? YE S
B.O.H. IF YES @ WHAT DEPTH? 9'
1 I DEPTH OF WATER AFTER MONITORING' 9'
DATE OF MONITORING: 9/4/18
12-
GROSS TIME NET TIME DEPTH TO NET DROP
13 DATE READING (MINUTES) (MINUTES) WATER (INCHES)
(INCHES)
14 8/28 TEST HOLE PRESOAKED PRIOR TO TESTING:
15 1 7:52/8:02 10 1 4 17 4 5 2
2 8:04/8:14 10 1 417,6 5 A
16
17 3 8:15/8:25 10 14/716 5,s
4 8:27/8:37 10 14/74 52
18 5 8:39/8:49 10 1 4/716 5 s
19 6 8:51/9:01 10 14/716 516
20
PERCOLATION RATE: 1.84 (MIN/INCH) PERC. HOLE DIA. (INCHES)
TEST RUN BETWEEN: 3 FT. and 4 FT.
COMMENTS: TWO TESTS WERE CONDUCTED THEN RESTARTED WHEN RATE SLOWED.
N
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11
Lot 17
I
I
N 79.36'45"E 170.79'
/ 10' T&E EASEMENT
10' UTILITY EASEMENT
L=32.18'
R=50.00'
c,+
• Lot 18 0
ASPHALT 30,905 s.f. -.•
PAVEMENT W
24,8,
,\, '1 — ------ ------- W
45.2' • 2S s 78.7' 9
X39 2 STORY
J RESIDENCE 70'2" WOODEN PATIO
O m
ryo O
COVERED ENTRY o / ^i
8Z N y.... �� 3 OO 4.1' x 10.3' CANT O
O / o
a? 2.0' x 8.0' CANT aili�62" 0
.-.
rn SEPTIC 4.0' x 19.3' CANT m
PIPES
1°Ck tih m
W1.4' CANT 2�0' r
O 6.0' X 16.1'
rn I b0- / WOOD SHED D
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CD `4)
O I CO WELL—\
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30.00' S 89'43'44"W 177.89'
I \
I \ Lot 19
PLOT PLAN AS BUILT X SCALE 1" = 30' GRID SW 3037 Protect No. 18-427/A1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates Inc . (907) 522-6476 Phone
(907) 522-4625 Fax 000p�Op��
Professional Land Surveyors kenOlangsurvey.com — OF Ae �,
Y JonathanOlangsurvey.com 0'`�
I herebycertifythat I haves •
a��P. . ,,.- 4O
surveyed the followingdescribed property: •
Lot 18, Block 1, BIRCHTREE ESTATES (Plat No. 71-215) p p 1* :: 49TH �*�O
Seward Recording District, Alaska, and that the Improvements situated thereon are within a
the property lines and do not encroach onto the property adjacent thereto, that no DA D
improvements on the property lying adjacent thereto encroach on the surveyed premises vA KENNETH G. LANG Q
and that there are no roadways, transmission lines or other visible �, o
easements on said property except as indicated hereon.
o�`%•••. S-520 • J O
Dated this the Day of , , at Anchorage, Alaska Q ,oR �'"•••••' N.0 ,c '
OQ° SIGNAL‘.);„,=,It is the responsibility of the owner to determine the existence of any easements, `Opppoo<z).
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
. ~UNICIPALITY OF ANCHORAGE
Hea .t and Environmental Protec on
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
264-4720
,.LNE~PECTIOI'~ REPORT ON-SITE SEWAGE DISPOSAL SYSTEM .
SEPTIC TANK:
FROM WELL_
INSIDE LENGTH
MANUFACTURER
'NS'~;E W'DTH
MATERIAL
LIQUID DEPTH
NUMBER OF
COMPARTMENTS
__ LIQUID CAPACITY/~r3-QGALLON$.
DISTANCE FROM WELL
FOUNDATION
~ of Lines
NEAREST LOT LINE_.~:; / TOTALoF LINELENC~TH~/'7~:)
~/4___TRENCH WIDTH'~---~IN. T~O, TAL EFFECTIVE
DEPTtt:
7d/
TOP OF TILE 7-0 FINISH GRADE
DISTANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER
/_
f,~ MATERIAL BENEATH TILE IN. ABOVE TILE
IN.
SEEPAGE PIT:
Log Crib Rings
BUILDING FOLJNDATION __
DIAMETER ~ OR WIDTH .....
Crib Size: DIAMETER ....
NEAREST LOT LINE . .
LENGTH _, DEPTH
DEPTH_ DISTANCE FROM: WELL
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA)
,SQ. FT.
Well ~F
Class: /00! Depth:
Well Distance To: Lot Line
Bldg: Sewer Line:
Pipe Materials: ~I. + ¢~~
# of Bedrooms:
Installer:
Remarks:
~ ,,, .~ ~ ~/l/lt-ll_..i.l~f~ ~:: J F'RL J T"'r' ~3F RI'-.IF:HCIE;Fli2iE
j~' ~.~.~F_'RF.:TMENT. C" tERLTH FIND ENVI.??NMENTFIL ~F'r'--'TECTION ~'~L-~
~/" f ~-..,.~25,."L -~TREET, FtNt':HORR~JE, FIK 99.
.... · - .
. I-4ibb RI"-.IE':, ,-JI"4--S Z Ti SE&..IEE: F~~ ~.~..1
F'EF.'NIT [40 ,:' 77663 :' r ,r~
FIF'F'LIr:RNT L',t4~ ROBINSON 2.~eo BLLIEBERRY 9950-1 ~-.z-'r~.
L.C,C:FIT I ON ME-T~ CT ~>..t4~Th R',,,'E / _.._~__ ,
LEGRL L±8 B-1 E:IRCHTREE EST LOT SIZE
,,, ,. , ,,, ,. /
T.rFE ,-,F Sf",IL RBSORBTION S,STEM IS: TREN,"':H
MR',:.-': I MIJM
THE REQUIRED SIZE OF THE SOIL FIBSORPTION SYSTEM IS:
[:, E F"-F H= "--~ L. EN'STH=~ '-~ E: R'-.-' i L [':,E F'-r H= 3:
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRFIINFIELD.
THE DEPTH OF FI TRENCH OR PIT IS THE DISTFINCE BETWEEN THE SURFRCE OF THE
GROUND FIND THE BOTTOM OF THE E×CFIVFITION (IN FEET;,,
THERE IS NO SET N IDTH FOR TRENCHES.
THE 6RRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE EXCRVRTION (IN FEET::,.
E;EL-;-.!I_i I F-."EE:, SEF"T I C: TR/-.IF--':: $ I ZE= :1258 ,SFILL_C~I'-.IS
PR£:~:::Rt]E PLRNT CIPTZIFJt4
R PFICKFIGE PLFIN'f MRY BE INSTRLLED RT THE PERMITTEE'S OPTION SUBJECT TO THE
FOLLOWING CONDITIONS:.
~. EITHER R CLRSS I OR II NSF RPPROVED PLFINT MFIY BE INSTFILLED.
2. R CONTINUOUS MFIINTENFINCE FIGREEMENT IS REQUIRED. IF R MFIINTENFINCE
RGREEMENT IS NOT KEPT CURRENT YOU MFIY BE REQUIRED TO ENLRRGE THE SOIL..
RQSORPTION SYSTEM FIND?OR YOU MRY BE SUBJECT TO PROSECUTION.
T&qC~ (2) I f-~_"~.F"EIDTImD/-~'_-~ REdE E~EI;!IJ I E:E[:,
BRCKFIL.LING OF FINY SYSTEM WITHOUT FINFIL INSPECTION FIND RPPROVFIL BY THIS
DEPRRTblENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTFINCE BETWEEN FI WELL AND RNY ON-SITE SEWRGE DISPOSFIL SYSTEM IS
t00 FEET FOR FI PRIVFITE WELL OR 200 FEET FOR FI PUBLIC WELL.
,WELL. LOGS RRE REQUIRED FIND MUST BE RETURNED TO THE DEPFIRTMENT WITHIN ~0 DFIYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MFIY RPPLY. SPECIFICFITIONS RND CONSTRUCTION DIFIGRRMS RRE
FIVFIILFIBLE TO INSURE PROPER INSTRL. LRTION.
F" EE.' I'-11 'T E:'-=:P I F.'ES [':.,EC:Er. IE:EE' __=-:-:1..
I CERTIFY THRT
i: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FIND HELLS RS SET
FORTH BY THE MUNICIPFILITY OF FINCHORFIGE.
2: I WILL_ INSTRLL THE S~STEM IN FICCORDFINCE 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.
~F'PL I~C:RNT LYNir, e' ROBINSON
V3:. 0
MUNMPAUTY OF
Development Services Department '
On -Site Water & Wastewater Section
Parcel I.D. 017-141-20
Certificate of On -Site Systems Approval
Phone: 907-343-7904
Fax: 907-343-7997
Expiration Date: 11-2—G-2-000
1. GENERAL INFORMATION
Complete legal description BIRCH TREE ESTATES BLOCK 1, LOT 18
Location (site address) 5131 METZ COURT, ANCHORAGE, AK 99516
Current property owner(s) MICHAEL & SHAWNA BRANCATO Day phone
Mailing address
Real estate agent
5131 METZ COURT. ANCHORAGE. AK 99516
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
®
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Distance:
Received by:
Date:
COSA to be released to the engineer, unless otherwise
requested by the engineer.
COSA Fee $ q 1 a 150 cob I t
Date of Payment FS 1 -abO,
Receipt Number 18 1 2Z Receipt Number
COSA # 0 5 CZ,0 1 H y Z Waiver #
Waiver Fee $
Date of Payment
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 FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 8/17/2020
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any estimate of how long a system will function satisfactory /��g�Q:' • . .'�,9 �)�
for current or future occupants or guarantee that no unseen encroachments, deficiencies or f
discrepancies exist can be given by First Water Consulting & FWr.S *� lli •* ��
.... .......:—
DSD SIGNATURECurtis Huffman
System #1 Approved for bedrooms•CE 128991 .�����
F�Fo .8/,1,712_0��
System #2 Approved for bedrooms �`�\ROFESS1*
Disapproved
Conditional approval for bedrooms, with the following stipulation
Y OF�rr��
WATER ANn
Ir
Original Certificate Date:
1
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
Legal Description: BIRCH TREE ESTATES BLOCK 1 LOT 18 Parcel ID: 017-141-20
If more than 1 septic system on lot: COSA Checklist # _of
A. WELL DATA
® Well log is filed with Onsite (or attached)
Date drilled 10/21/1977
Total depth 106 ft
Cased to UNKNOWN ft
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 7/15/2020
Static water level at beginning of test 62 ft.
Well production at time of test 2.5 gpm
Comments
B. TANK DATA
Age of tank(s) 2 years
Tank type/material STEP / STEEL
Measured operating fluid level in septic tank *FLOAT
® Standpipes/foundation cleanout per record drawing
Date of pumping 7/15/2020
D. ABSORPTION FIELD DATA
Which system tested (date installed) 9/12/2018
® ALL standpipes present per record drawing
Total measured depth from grade 3.1+ ft (max)
Measured depth to pipe invert from grade ft (min)
® N/A — pressurized field
® Monitor tubes go to bottom of effective. If not, state
depth into effective
Structure served by this system
Water storage tank volume NA gallons
Well disinfected for coliform test? ❑ Yes ® No
® Coliform bacteria is Negative
Nitrate 0.259 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ® Arsenic less than MRL (ND)
Collected by
FWES
Date of Sample 8/17/2020
C. LIFT STATION
® Required maintenance completed
Age of lift station 2 years
Lift station material STEEL
Comments: *BETWEEN ON/OFF FLOAT LEVELS
Adequacy test date 7/15/2020
Results N Pass For 4 bedrooms
Fluid depth prior to test 0 / 2 in
Water added 600 gal
New depth 0 / 3 in
Elapsed time 30 min
® Code -required soil cover over field Final fluid depth 0 / 2 in
❑ System presoaked Absorption rate 600 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies: F,
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
if No
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No
Neighboring Absorption Fields > 100'
Water Service Line > 10'
® Yes
Animal Containment > 50' ® Yes
if No
® Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
® Yes
if No
ft
Surface Water > 100' ® Yes if No _
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes
if No
ft
Private Wells > 100' ® Yes if No _
Water Main > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No .
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 > 10'
® Yes
if No
_ ft
Wells on Adjacent Lots:
Water Main > 10'
® 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
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that 1 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.
or-
TH
....: .
. .... • ....t..�....
• Curtis Huffman
��� ��c�•.• CE 128991 •. ����
P 0FESS 0W -"--,�
ft
ft
ft
ft
ft
ft
ft
ft
MUNICIPALITY
Development Services Department Phone: 907-343-7904
.. _.. -
On -Site Water & Wastewater Section Fax: 907-343-7997
Owner
Phone
Septic Tank:
-Sludge level inches
Lift station:
Lift Station/Pump Vault
Maintenance Log
Street Address -3-131 m p_-� .2
Legal Desc. PID
Pumping: required
-Pump basket cleaned es no
-Control floats cleaned es no
-Operation satisfactory es no
Alarm System:
-Pumping completed Ono
-Effluent filter cleaned es no
-Proper float settings confirmed es no
!STo .jam
-Dedicated electrical alarm circuit e no -Audible and visual alarm inside dwelling es no
-Alarm system operation satisfacto ' not satisfactorV
Manhole Riser
-Ground water intrusion at riser to tank connection yes no
*Ground water intrusion around pipe penetrationses no -weep hole functional ye no
-Manhole lid: Functional e no insulated ,(esno Properly Securedes no
Other
-All manufacturer required inspections Iand maintenance completed �g no
Comments:
............... .-,_-1--1_111-' ...................................................
..........................................................I.........................
........................................................................I....._
.............................I................................................
......... .............. ........................ ........... I.....................
Maintenance Provider:
Technician _ Lor -f'!,)
Company '5N, Q \j
Date of maintenance j % ,�j ',Z�
__1' I—
Signature Date 7 l)A� rr
MUNICIPALITY OF ANCHORAGE
6344{(((��c; 891077
Development Services Department
'
p p ryIrra ,,. � Phone: 907-343-7904
On-Site Water & Wastewater Section G Fax: 907-343-7997
SEP r 'ZUld
Certificate of On-Site Syst- s Approval ti
6 w
Parcel I.D. 017-141-20 Expi
`;'\
1. GENERAL INFORMATION
Complete legal description Birch Tree Estates Block 1 Lot 18
Location (site address) 5131 Metz Court
Current property owner(s) Janice Sc Keith Washburn Day phone
Mailing address 5131 Metz Court, Anchorage, AK 99516
Real estate agent Brandi Sullivan Day phone 907-232-9504
2. TYPE OF DWELLING:
Ix I Single Family (w/wo ADU)
fl Duplex
7 Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well Private Septic Ix I
Water Storage n Holding Tank ❑
Community Well Community n
Public Water System n Public Sewer
Waiver request for: Distance:
Received by: �/} % ore, Date: "//W f
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ aa.sz Waiver Fee $
Date of Payment 61/113 CGS Date of Payment
Receipt Number Cd 6,8W) Receipt Number
COSA// C��J� j�c�Rq 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 Forge Engineering Phone 907-522-7773
Address 1399 W. 34th Ave Suite 203, Anchorage AK 99503
Engineer's Printed Name Benjamin Schiller, P.E. Date 9/17/18
*6
6. DSD SIGNATURE •�r �• •••• ••
X) System #1 Approved for `f bedrooms Benja In Schiller i
P•. .•moi
� F . c �zsp �r
System #2 Approved for bedrooms `ljl`\\\�UO
Disapproved
Conditional approval for bedrooms, with the following stipulations:
ON-SITE
:13o WATER AND
WASTEvvA R
m
PROGRAM o
v
SERVICCP -IF
_.
By:' v•-•- � / Original Certificate Date: -
20
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
COSA Checklist blue sheet
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Birch Tree Estates, Block 1 , Lot 18 Parcel ID: 017-141-20
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed 10/21/77 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
106 4 Unknown 26
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test 10/21/77 9/13/18
Static water level 56 ft 63 ft.
Well production 5 g.p.m. 2.15 g.p.m.
WATER SAMPLE RESULTS:
Coliform Neg colonies/100 mL Nitrate .386 mg/L
Arsenic ND ug/L Date of sample: 8/10/18 Collected by: Forge Engineering
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEP/Steel Date installed 9/12/18
Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) Y
Date of pumping Pumper New Tank
C. ABSORPTION FIELD DATA
Date installed 9/12/1$ Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 g.p.d./ft System type Trench
Length 2 x 50 ft. Width 5.0 ft. Gravel below pipe 0.5 ft.
Total depth 3.1/3.3 ft. Eff. absorption area 500 ft2 Monitoring tube Y Depression over field N
Date of adequacy test New Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth . in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed 9/12/18 Size in gallons 1500 Manhole/Access (Y/N) Y
"Pump on" level at 13 in. "Pump off" level at 25 in. High water alarm level at 1 1 in.
Datum Top of pump cageCycles tested New Meets alarm&circuit requirements? Y
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot >100' On adjacent lots >100'
Absorption field on lot >100'100' On adjacent lots >100'
Public sewer main '75' Public sewer manhole/cleanout '100'
Sewer/septic service line '25' Holding tank >100'
Animal containment areas 'S0' Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
10' '5' >5'
Building foundation Property line Absorption field
Water main
>10'10' Water service line >10'10' Surface water >100'
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
>10' >10' 0
> '
Property line Building foundation Water main
10'
Water Service line >10Surface water '100 Driveway, parking/vehicle storage '
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION `-��\\�1‘
I certify that I have determined through field inspections and "4:•'. V-%
review of Municipal records that the above systems are in g. 9 vit i• /
conformance with MOA COSA guidelines in effect on this date. ?H
Benjamin Schiller, P.E.
Engineer's Printed NameBenja n Schiller
Date 9/17/18 ,+�l��lFq£OF5�NP . �//
A ROF ,S10 �.�
COSA brown sheet 10-10-12.doc
N
\
\
\` I ► I
Lot 17
I
I
I36'45"E 170.79'
N 79.
/ 10' T&E EASEMENT
10' UTILITY EASEMENT
L=32.18' \jai'l-
R=50.00'
Lot 18
0
ASPHALT 30,905 s.f. -4-
PAVEMENT W
/ -- V)
45.2' - / o
78.7'
2 STORY
/ . WOODEN PATIO 4'
OD
HI m
cs o
COVERED ENTRY O O
Z 'N.'1. / 07'00, 4 -0
O 4.1' x 10.3' CANT O I O
O
m
-I
rn 0
rn 4.0' x 19.3' CANT m
1.4' CANT r
bee'r
W , r
O 2.0' x 8.0' 6.0' X 16.1'
m I 00 / CANT WOOD SHED >
D
0
NJ SEPTIC
N PIPES
I
cn
S
n r0 M N
MANHOHO
LE
0 ACO WELL
Co. \\\1
PJ
\
S 89'43'44"W 177.89'
30.00'
I \ Lot 19
PLOT PLAN AS BUILT X SCALE 1" = 30' GRID _ SW 3037_ Project No. 18-427/A2 _
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates , Inc . (907) 522-6476 Phone �Qoo0p.�
(907) 522-4625 Fax '5::.
o OF A / 0'4
Professional Land Surveyors kenOlangsurvey.com <,9
jonathanOlangsurvey.com , , ::16At,
I hereby certify that I have surveyed the following described property:
Lot 18, Block 1, BIRCHTREE ESTATES (Plat No. 71-215) � *;' 49TH �� ..*�,,
Seward Recording District, Alaska, and that the improvements situated thereon are within VA
the property lines and do not encroach onto the property adjacent thereto, that no Jt
improvements on the property lying adjacent thereto encroach on the surveyed premises •• •I• ; ��
and that there are no roadways, transmission lines or other visible Q�, KENNET G. r o
easements on said property except as Indicated hereon. OQ�s v(l,�•C t$ ••'• ,
•rt OQ,l(b '•.�S-5202.••• GP,
Dated this the _ . ,-` Day of S591-0;"t 'C— 1 , at Anchorage, Alaska Q ,o •••••' foo
40oR0�SSI0NAk-10
It is the responsibility of the owner to determine the existence of any easements, 0�0400�'''
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
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)
Location (address or directions)
(b) Property owner
Mailing Address
(c) Lending Institution
Mailing Address
'~--,~'T- ~ Telephone' (home) :~¥~-o~5G Business
~'~ ~o,/t,~~ Telephone ~/~- ~- ~-~
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to ,;he following address: (or check here Fl, if hold for pick up.)
List contact person and day phone number below:
TYPE OF RESIDENCE
Single-Family ~. Number of bedrooms LT/
WATER SUPPLY
Individual Well 'E~ 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-site ~ Public [] Community [] Holding Tank []
Note: I~ 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 end 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.
NameofFirm %/0~,~1 ~:¢~v-~--~'~-~l~ Telephone
Address ~' ~ ~'~ ~/ / ~'-
Date ~/~
6. DHHS APPROVAL
Appr0,~;ed for ___~---'
Approved ~'~'"-
. Disapproved Conditional
Date
/ /
Terms of Conditional Approval
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
~ MUNICIPALITY OF ANCHORAGE (MOA) ~
I 'A~i,~".~, ,~(~ Health Authority Approval (HAA)
· *,¢ ¢,.\-V~~~' "",,, 5\O~ CHECKLIST - FEBRUARY 1984
.,~,~,o .~ ~';~ ~' 343-4744 ,
~~''0¢~'~' ,,3~~ Legal Description: LOT I~ ~/
If~, B, C, D.E.C. Approved (Y/N~ ~
Well Log Present ( Date Completed Yield ~ ~ _
Total Depth ~ Cased to ~Depth of Grouting ~ H~
Static Water Level ~ ~ ~
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N) Y ~/'"'
SEPARATION DISTANCES FROM WELL: /-
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
115
Pump Set At 74 ~''
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
Y
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by ~,.~
Water Sample Test Results J~ ~'~--~/~',
Comments
To Nearest Public Sewer Cleanout/Manhole N/A,
;Date
B. SEPTIC/HOLDING TANK.DATA
Date Installed ~'/~'7 Size ~ No. of Compartments
Standpipes (Y/N) C~/~/.~ y""- Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (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
...... Foundation Clean/out ()~/N)
Date Last pumped
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~/"~ "~
Width of Field
Square Feet of Absortion Area
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Statndpipes Present (Y/N)
.Depression over Field (Y/N) ~1~ Date of,~~,uacy Test
Results of Last AdequacyL,T__e~s~:Z'~. o~'- '~ ~//~
SEPARATION DISTANCE FROM ABSOR.P~I-ELD:.' ............
To Water-Supply Well I 11~ v ...~- To Property Line
To Building Foundation .~ o ~ To Existing or Abandoned System on
Lot r'///A ~ ; On Adjoining Lots ~
To Water Main/Service Line ~> ~ J To Cutback (if present) ~,~-
To Stream, Pond, Lake, or Major Drainage Course
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 in effect on the date of this
inspection.
Signed
Company
Date
MOA No.
Receipt No. (~' ~//'-~ ~
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Engineer's Seal
Page 2 of 2
~ ' ' MUNICIPALITY OF ANCHORAGE MUNICIPALITY j ~k~,'
.,~,~_~.i~- - : m . ~ ': ''11 , ~I~'~T 0F HEALTH & ~, m
~ DEPARTMENTOF HEALTH~ ENVIRONMENTAL PROTECT~ ' ~ ~ ...... ~, -
// ~ I ~ - - -2-L--tre t --nch ra · -laska 99501 ~IRONMENTAL Pr~l~; ~m
. -. o,
(~1 ~ ~"V' RONME~;~ L EN ~' ~E ER' NG D' V'S'ON aa" 24 1970 I
I'e phone 25 ,-4720
~ EOU EST FOR APPROVAL Of INDIVIDUAL WATER AND S
~lR EC~ON~: 0omptete all parts on page 1. Incomplete reques~ will no~ be preened. Please allow ten {10} days ~or processing.
Steven Kremer I 344-68'65
ERA Box 324 X Anchorage, Alaska 99507
" ' ' ' ' MMON~ ' "
NHN Metz Court- Anchorage, Alaska 99502 ~44-6865
K BbYER ' ........ PHONE '
MAILING ADDRESS , r .
612 W. ~2nd Anchorage, Alaska 99503
The Lomas & Nettleton Co. O~ ~ ~s~) I 274-7661
44~9 Business Park Blvd. Anchorage, Alaska 99503
4. REALTOR/AGENT I ' :
- ~/~ · . . ~ ._ ,
I ' r~ SIN L~ FAMILY [] One ~ Four [] Other
I [] Two [] Five
Ir [] MULTIPLE FAMILY [] Three [] Six
17: WAT.R SU.PLV .........."
] ' [] INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled
I [] COMMUNITY since June 1975. For wells drilled priorto that date, give wel
I ' [] PUB LIC UTI LITY depth (attach log if availab e.)
I 8. SEWAGE-DISI~OSALS+ST'EM~ "..... 1C~' '/~1 .......
[] INDIVI DUAL ON S TE** If ~nd v due/on-s te, gwe nstat at on date
I [] PUBLIC UT L TY b' this De artment
I_ ' Y'~ P '
NOTE: THE INS'PECTION FEE MUST ACCOMPANY EACH' REQUEST BEFORE PRocESsING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
NUMBER OF BEDROOMS
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Sept~ Ta~nk or [] Holding Tank
Size: i~ If Tank is homemade
give dimensions:
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SlX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOl LS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
MATERIAL ~
Septic/Holding Tank IAbsorption Area
[] OTHER
ISewer Line J Nearest Lot Line
5. COMMENTS
~ APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED ~
DATE BY~
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
MUNICIPALITY OF ANCHORAGE
Department of Health and Environmental Protection
825 L Street, Anchorage, Alaska 99501
264-4720
-i.~---'C~equest for Approval of Individual Sewer and Water Facilities
Property Owner: Arnold L. Robinson
Mailing Address: 2100 Blueberry Anchorage~ Alaska
Phone: 277-9032
Name of Buyer: Steven S. Kremer & Anne M. Kremer .~ .... ~----~-%
Mailing Address: 194 Ocean Park Drive Anchorage~ Alaska Pho -'
Lending Institution: First National Bank of Anchorage
Mailing Address: P.O. Box 720 Anchora~e~ Alaska Phone: 276-6300 ex~, 490
Realtor/Agent: NONE
Mailing Address:
Phone:
Se
Legal Description: Lot 18 Block 1 Birch Tree Estates
Street Location: NHN Metz Court Anchorage, Alaska
Single FamilY Residence: (X) Number of Bedrooms:. 4
Multiple Family Residence: ( ) Number of Bedrooms:
Water Supply: *Individual Well ~)
If Individual Well, well depth
If Community System, name of system
Public/Community System ( )
8. Sewage Disposal System: On-site System (X) Public System ( )
*NOTE:
3/77
If On-site System, date of installation:
A well log is required on ALL wells drilled since
K~tty
February 21, 1~J78
m.M H,~. 851505
Robinson Construct io~
2100 Blueberry
Anchorage, Alaska
Attention: Mr. Lynn
Subject: Adequacy 'F~s on ~]xist;ng Sanii. a:y ;~,~.,.~r System, Lot 18, Block
1, Birch 'I:'~..: E's'~!~:; Subdivisi~;~, Anc. i~l'age, Alaska
Dear Mr, Robinson:
At your request of Fei':.l,'uary 6. i978, wr: condL,.::I, ed a test of the new and
unused septic system on r'.:e above described
Prior to performing the test !he dry sy':,tem was filled on February 15,
1978 with clear water by Isae~¢'s Septic Fank Pumplm] Service by entering
water through the septic tank standpipe. A total of 4,000 gallons was
pumped into the system o¥~-;r about a four hour p~'_,riod, filling the 1250
gallon tank and the leachfield..
The filled sys[em was ~.~Ilowed a stabilizat;on period of: 24 hours. Then
on February 16, 1978 we i.~erforn~ed a drainfield aduquac:y test. During
this test the liquid leve,; in t. he septic tank was mo,,itored as water was
added to the system. Thc measurements are summarized in the following
table:
Time Liquid Lc:vel Below Top Total Gallons
o.,f.. ,_',~;_L.? ~_z~d p__i~?_ A d d e d
10:O0 6.9'
lO:12 6.7'
10:18 6.7'
10:30 6.7'
10:41 6.7'
IO:56 6.7'
ll:lO 6.7'
25
5O
lO0
150
225
300
The meter used during the test was a Rockwell 5/8" standard water meter
which had previously been calibrated by R&M Consultants, Inc.
If the 4 bedroom residence on the property is to house 8 people, the
average load on the system can be .expected to be 600 gallons per day or
0.42 gallons per minute. During the test, the system accepted 300
gallons in 70 minutes. This indicates an average effluent acceptance
rate of approximately 4.29 gallons per minute at the tlme of the test.
February 21, 1978
Robinson Construction
Page -2-
The new house on the lot has never been occupied; however, we belleve
that the prior filling of the system established a near normal degree of
saturation. We, therefore, conclude that the system will dispose of
effluent at an adequate rate for a 4 bedroom residence.
We appreciate this opportunity to be of service to you. Please contact
us If you have any questions concerning this test or if we can be of
additional service.
Very truly yours,
I~&M CJ~NSULTANTS, INC.
Gary ~l(. Smith
Senior Geologist
Jim McCaslin Brown, Ph.D.
Head, Earth Science Dept.
GAS/JMB/gld
REKY
SIGNED
DATE J SIGNED
Redi~orm e
4S 469 SEND PARTS 1 AND 3 WITH CARBON INTACT.
~ PolyPak(SOset$)4P469 PART 3 WILL BE RETURNED WITH REPLY.
January 25, 1978
Arnold Robinson
2100 Blueberry Road
Anahorage, Alaska 99503
Subject= Lot 18 Block i Birch Tree Estates Subdivision
Before this department may send approval to the lending
agency, a percolation test will need to be performed
to determine the adequacy of the sewer system.
The two(~) firms in Anchorage who perform the test are,
J.M.L. Engineering, 344-8042, or R & M Engineering,
279-0483.
If there are ~ny further questions, please contact this
office at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Sanitarian
RCP/lJh
Anchorage
(907) 279 25]]
G£Ol?(;f: M .gUALI
MA YOR
D£f'ARTMI~N ¥ Ot Ill]AL 1 tt Arql) t~tqVlt1ON%![!N'¥Al, lqi()lt (:ll()N
O~ber 5, 197/~7
Robinson Construction
2100 Blueberry
Anchorage, Alaska 99503
(825 "l "G1r~et)
S~ject: Lot 18 Block 1 Birch Tree Estates Subdivision
The sewer system located on the subject lot can not be approved
at this time.
Before final approval can be granted several items will need
to be completed'
(1)
The sumps at the end of the trenchs must be solid
pipe above the gravel.
(2)
There must be a cleanout installed between the tank
and the beginning of the trench.
(3)
We never received a letter from the excavator and the
homeowner stating there was no water in the trench
prior to gravel backfill. Therefore, we can not approve
the first(lst) inspection and after the first(lst)
inspection is made and approved, a second(2nd) inspection
will be required.
If there are any further questions, please contact this office
at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Sanitarian
RCP/ljh