HomeMy WebLinkAboutBIRCH TREE ESTATES BLK 1 LT 21Birch T
sta
Block
Lot
21
#017-141-17
Municipality of Anchorage
Development Services Department ~
Building Safety Division
On-Site Water and Wastewater Program, 4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507 Page of
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: S~'OcIOlc~ PID Number: Oiqr- i~--i'~'
Name: N~¢t~tC~ ~C ~ ~t~ Wastewater System: ~ New ~ Upgrade
Address:
5i~$ ~ ~} A~~).A~ ABSORPTION FIELD
Phone: ~Number of Bedrooms: ~ D Deep Trench D ShaIDw Trench ~ Bed ~ Mound
Other:
Soil Rating: Total Depth from original grade:
LEGAL DESCRIPTION ~[~ ~.
I Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe:
Township: Range: Section: Fill added above original grade: Gravel Length:
Ft. Ft.
' I
Well:~i3~) ~ New ~ Upgrade Gravelwidth: Ft. I Numberoflines: Distancebe~eenlines:Ft.
Classification (Priv~A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material:
Ft. Ft. Ft2
Drillen Date Drilled: Static Water Level: Ft. Installer:~l~ ¢l~U,~ ~,g~;~ Datelnstalled: jlOj~] 'zoo1
Yield: GPM Pump Set at: Casing Height Above Ground:
,~. F~. TANK
SEPARATION DISTANCES ~Septic D Holding D S.T.E.P. D Other:
Man~acturer: Capacity:
To Septic Absorption Lift Holding 'ubli~Private
Tank Field Station Tank Sewer Line An&~ ~ Gal. j'~
Material:
j ~ Number of Compa~ments:
Su~a~ Water i~['~ ~ LIFT STATION
Lot Line 5 I~ Size: Man~a~urer:
GaL
Foundation ~ I.~ "Pump on" level at: "Pump off' level at:IHigh water ala~ at:
in. in.I in.
~/ Pump Make & Model Electri~l Inspections pe~ormed by:
Cu~ain Drain
Remarks:
~x/5-~i~ ~ ~&~,~ P~ ~o.A BENCHMARK
Assumed Elevation:
j OO Ft.
Inspections peRormed by: , ¢¢ Dates: 1st [~q %~ ~.~F.
Development Se~ices Depa~ment Approval ~ Z ~'~ L-~ .....
Conditional Approval Date:
~,~i,~Ted and approved by:, Date: ~ -/~ / / '~XXx~
~ ~ ~ ~ LLTT~O I I I
-- ?, ~,-\ I I
~ ~"~. ~ ~ COOE ~EOUIREWEN~ ~ '
~ i
~ ~~- %,.. ~ / ~ AINTO EXIS~N~ TRENCH I
~ ~'. ~ ~/~ ~ p~T/ I I
x ~-~~ INSTAL~O NEW 1250 GALLON STEEL SEPTIC
LOT ~ ~ ~ S~N~ .ES / ~ ~ I
X ~ ~ e/ ~ I I
~ ~ LOT 21 0 ~.~: e~.o' :r~ '
~ ~ E 55.~,e5.0~ ~ ~ I I I
F ~.4 92.0 ~E ~ '
DEPARTWE~I7 DOCG~'~';/~TIL%~ ~,. ! LOCATiOA~S SHO~iV ,,iRE ~
4 FEET CDVER
CLEANDUTS ~ ' I'
Te~ -~7~'~" ........
CDNNEC 1~50 GALLDN SEPTIC TANK ~
~ L~SPURKLAN~ _~,~
~'-.. ....
JJ~k~
A~U~ED E~VA~ON l~ FE~
SPUNK~ND ENGINEERING ~I~ ~ ~~ ~ 1 ~ ~1 SEPTIC SYSTE~ ASBUILT
20~ ~ ISTH. A VENUE
ANCH. AK. 9~501 NormoD ~COl~e DATE: 00~ ~2, 20~0
{907) 279-~916 5~75 WETZ COURT SHEET: ~/~ GRID: ~0~7
PERMIT ~ SW090194 PID ~ 017-~4~-17 Birch TreeEs$o
A B
C 52.0' 82.0'
O 53.3' 85.0'
E 55.4' 85.0'
F 65.4' 92.0'
G 65.5' 94.0'
H 66.6' 95.0'
I ~4-.$'I97.0'
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anch~age, AK gg51g-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Sep 30, 2009
Expiration Date: Sep 30, 2010
Permit Number: SW090194
Legal Description: BIRCH TREE ESTATES BLK I LT 21
Design Engineer: 0007 SPURKLAND ENGINEERING
Owner Name: NORMAN MCATEE
Owner Address: 5175 METZ CT
ANCHORAGE, AK 99516-4252
Parcel ID: 017-141-17
Site Address: 005175 METZ CT
Lot Size: 37507 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and dosed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Municipality of Anchorage
Building Safety Division
On-Bite Water and Wastewater Program
4700 Elmore Road
P,O. Box 196650
Anchorage, Alaska 99507
www.muni.org/onsite
(907) 343-7904
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. OI7° I'tt- I~
Property owner(s) ,,A,/~ ¢.¢'~ ~,.m ,/~ (.o.~ Day phone
Mailing address ~1'~5 /ViE T~ ~0~ Zip Code
Site address ~ ,~m~ ~ Zip Code
Legal description (Sub'd., Block & Lot) ~[rc~ ~Ce~ ~A~ ~
Legal description (Township, Range & Section)
Lot Size .3 ~..¢-0 7 Sq. Ft.
Number of Bedrooms,
THIS APPLICATION IS FOR (~;~ all that apply): THIS APPLICATION IS AN:
Absorption Field [] Initial []
Septic Tank [~ Upgrade ~
Holding Tank [] Renewal []
Priw []
Private Well []
Water Storage []
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature oflpropen'y owner or authorized agent)
Permit/Rush Fees: '~'~ O
Date of Payment: q/~ ~'/0 q
Receipt Number: ~ ~' ~'~
(Rev. 11/05)
Waiver Fees:
Date of Payment:
Receipt Number.
Environmental Consulting and Design
I
Municipality of Anchorage
Development Services Dcpartment
Building Services Division
On-site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
I
September 23, 2009
Subject:
SEPTIC TANK PERMIT APPLICATION
B1RCII TREE ESTATES BLOCK I LOT 21
Ladies and Gentlemen:
We are submitting an application to upgrade the septic tank for this lot. The existing septic tank serving the
above referenced property is 27 years old and the owner would like to replace it. The submittal consists of
one (I) drawing showing the present improvements on the lot and. the proposed improvements of the lot, of
which only the septic tank is subject to this permit application.
There arc no wells within one hundred feet of the proposed replacement site. The installation of this septic
tank will not prevent wells and septic systems from being installed on the adjacent lots. There are no
developed or natural surface / sub surface drainage courses within 100 feet of thc proposed septic tank
location. The proposed septic tank will not change the general slope of the area. Ponding and/or
concentration of surface runoff will not result from this installation.
If you have any questions or are in need of additional information please contact me at 279-3916.
Sincerely,
Lara"~purkland', P.E.
203 West 15ts Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (907) 276-6013, SpurklandEng(~gci.net
E. 147TH AVE.
'1
~. LOT £8 I
I I
LDT £2
LDT £
N
S£ALD I' = 58 FT,
SPURKONO ENG~NE£m~6-'k~--FI BIRCH TREE ESTATES BLK 1 ~ SEPTIC SYSTEM DESIGn
203 IV 15TN. AVENUE [ I DATE: SEPT. 23, 2009
ANCH. AK. 99501 ] ] Norman Mcafee ]J SHE"T: 1/I GRID: 3037
(907) 279-3916 J_J 5175 I,I~7'Z COURT --
PE£NIT # SVOgOXXX Plfl # B/rchTreeEstatesE1L21B2.B~g
Environmental Consulting and Design
I
Single Family On-site Wastewater Disposal System
Construction and Material Specifications
Subject Property:
Date:
BIRCHTREE ESTATES BLOCK 1 LOT 21
September 23, 2009
General:
e
e
e
5.
6.
7.
The owner shall contract with a contractor to perform the work outlined in these
specifications and plans in accordance with the attached MOA permit. There is not
contractual arrangement between the contractor and the Engineer. The Engineer shall be
the owner's representative and will Inspect the work to document the contractors
activities. Final acceptance of the contractors work rests with the owner and the MOA.
The scope of the work includes the installation of a new 1250 gallon septic tank. The
location of the drain field is shown on the attached site plan drawings. All components of
the proposed septic system must be constructed a minimum of 100 feet from any surface
water or water wells in the area. A minimum of 4 feet of earthen cover is required over
the septic tank. If less than 4 feet of cover is available, 2-inch thick, 40 psi, direct bury
board foam shall be Installed directly over the septic tank and all installed piping.
Construction shall be in accordance with the approved site plan and design drawings and
any spedal provisions noted on the Municipal well and/or septic permit. All materials,
components, workmanship and construction practices shall comply with the Municipality of
Anchorage's latest ordinances regarding wells and septic systems, as well as MOA,
Development Services Department, On-site Water and Wastewater Program (DSD)
polities.
The contractor is responsible for obtaining all underground utility locates, layout of the
proposed system, and verifying and maintaining all required separation distances to lot
lines, surface water, wells, steep slopes, etc.
The property owner shall be responsible for final grading any depressions formed from
settlement of backfill material. The property owner is also respons~le for vegetation of all
areas disturbed by septic system installation activities.
Contractors installing wastewater disposal systems must be certified to do so by the MOA
DSD, On-site Water Wastewater Program. Property owners installing their own systems
must receive advanced approval from I~IOA DSD prior to system installation activities.
The contractor shall ensure that ALL materials being used are in compliance with the most
current guidelines established by the Municipality of Anchorage. Refer to"Standards and
Specifications for Component Parts and Materials Used In the Construction of On-site
Wastewater Disposal Systems", Dated December 2000, as provided by MOA DSD, On-site
Water and Wastewater Program.
203 West 15.h Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland~gci.net
Environmental Consulting and Design
I I
Septic Tank Installation: ~
1. A new septic tank, of the size specified in the design drawings, shall be procured from a
qualified manufacture/supplier if the existing septic tank is found to be defective.
Construction shall include two 4" diameter deanouts for pumping access.
2. The burial rating of the tank shall be adequate for the actual burial depth encountered.
3. The tank shall be level and sufficiently bedded to prevent settling of shifting of the tank.
4. AIl standpipes on the tank shall extend a minimum of 12inches above the final grade.
5. Tanks installed with less than 4 feet of cover shall be insulated.
6. The sewer service line from the house to the tank shall have a minimum slope of 2%
unless prior approval is obtained from the engineer.
7. The inlet and outlet lines from the tank shall be bedded in drain rock or the soil shall be
sufficiently compacted to prevent future settlement of the soil.
8. Septic tank inlets, cxJtlets and cleanouts shall be fitted with water tight couplings.
9. A cleanout shall be installed ! to 4 feet from the foundation.
20. Post tank cleanouts shall be installed per I~IOA requirements. Does not apply to
pressurized lines.
:1.~.. In areas with high ground water, the septic tank shall be sufficiently anchored to resist
buoyancy forces when there is not adequate soil cover to resist uplift force. The
contractor shall refer to the engineer for direction regarding this matter.
~.2. The tank backfill shall be graded sufficiently to ensure positive drainage away from the
tank.
~.3. All holding tank and lift stations shall have an audible and visible alarm inside the
residence being served.
24. All lift stations shall be wired in compliance with all MOA guidelines and the Uniform
Electrical Code. A munidpal electrical permit and inspections must be obtained where
required by the HOA.
25. The contractor shall verify that the septic tank/lift station is a minimum of t00 feet from
any residential water well, !50' from any class 'C' well and 200 feet from any community
water wells. Additional separation distances must also be maintained.
The contractor shall remove or abandon the existing tank in compliance with the Unform
Plumbing Code.
Inspections:
e
e
A minimum of one inspection b required by the Hunicipality of Anchorage. These
inspections must be conducted under the supervision of a Professional Engineer licensed
to practice in the State of Alaska.
The septic tank may be set in place, but may not be bad(filled.
The contractor shall provide a legible copy of all field notes relating to system layout and
construction to the engineer for the use in preparing the record drawings.
The contractor shall coordinate all Inspections with the Engineer. A minimum of 24 hours
notice is required prior to the start of construction. If necessary, a preconstruction
meeting will be held on-site.
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland~.gci.net
.?':~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONIVIENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME 1PHONE Ei;~EW
~AILI~ ADORE88
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
~ ~ DISTANCE TO: /00 / / / t 3~
Manufacturer
~ ~ Material No. of compartments
Liq. capacity in gallons Inside length Width Liquid depth
/ OO~ IF HOMEMADE:
Well Dwelling PERMIT NO.
DISTANCE
TO:
~ ~ ~ Manufacturer Material Liquid capacity in gallons
O Well ~ ~00 / Foundation / Nearest lot line / PERMIT NO.
~ ~ DISTANCE TO: ~ /'O
~ ~o. oflines ~ Length ofeachline Totalle of lines Trench~idth ~istancebet~eenHnes
~ ~ ~O' ~i ~ 7 ~¢ inches
~N Top of tile to finish grade ,// Material beneath tile / Total effecti~t~ area
= - ¢ nc. s '
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class~~__~u ~ Qepth, , Driller [ Distance t9 lot line PERMIT NO
Building foundation Sewer line [ Septic tank f Absorption area(s)
~ DISTANCE TO: ~.~/~. .1 f'}~ /~)d
OTHER
PIPE MATERIALS ~
SOIL TEST RATING ~0k
INSTALLER
REMARKS ~1-
I'
APPROVED ~ DATE LEGAL
(Rev. 3~78)
[:,EF'FIF.':TP'IENT ' HEFIL. TH FIN[:, ENV
E L:"5 '" L'" STREET., FIN T":HOF.'FIGE.,
:::!:64.- 47;F:0
~..,..U E£ L_ L_ ~--4 ~'-.I E.'.:, C'.'~ t"-.~ ...... .=:.,? Z T' EC .".=_:; EZ ~.-..I E'"' FE: F" i. ~ ... th'It Z -'t ....
PEF. FF:'t ~; T NO. ,:; 8;2051.2 ',
tRF'PL. I CRNT 'EHE:F.:P'tFtL CONST I NC q.L~.SO FFt I F.:E:RNKS S'T'
L. OCFtT I ON
L..EGRI... L2t B± BIF.'.CH TREE E:::;'F LOT SIZE 222222 SQUFIF.".E FEET
T'¢ F' E O F 2; O I L FI E: S O lq.' F' T I O I'.,t S'¢ :~, T EFt I S ' T F:: E N C: H
hlR'.:,::[HJI',! t'.]LtI',1E~EF~:: OF EEr.':,F..'EFF:t',IS = Z.: SOIL F. tRTING ,':5~. FT,.."BF.:::,=
THE REQUIRED SIZE OF THE SOIL RBS;OF.'.P"FION SYSTEM IS:
THE LENGTH [:.',I["IENSION IS THE LENGTH ,.'.' IN FEET::, OF THE TRENCH OR [:,RFI!NF'IELD.
THE DE'"PTH OF ia TF.'.ENCH OR PI'I" IS THE DISTRNCE BET[4EEN ']''FIE SURFFICE OF 'THE
GROUND RND THE BOTTOFI OF THE EXCFI',,,'F!TICIN <IN FEET>.
THERE I.'.E; NO SET I.,.!IDTH FOR TRENC:FtES.
THE GRR',/'EL E:,EF'TH IS THE FtINIP'tU!"I DEF'TH OF GF-.'FtVEL BETHEEN THE OLITFFILL PIPE
laNE:, THE BOTTOP1 OF THE EXC:Ft',?I~TION '.'.IN FEET::,.
PERMIT RPPL!C:FINT I-.IFIS THE RESPONSIBIL. IT'9 TO INFORM THIS DEPFtRTMENT DURING 'T'FIE
IN?].'FILLRTION INSPECTION:E; OF RN'.? 1.4ELLS RDJ'FIC:ENT 'TO 'THIS PROF'ERT"r' RND "!"HE
NUPIBER OF RESIDENCES ]"HRT THE 14EI. L. HILL SERVE.
............... "T I..-..t C~ ,::: 2 ::, I ~'-,I :_-3;.. F' E: (": "f" z C~ 1"-.! _'2.2.; R F::: E: F: E E...:! L.I :ir: f;'.' E
BFtCKF'ILLING IT.IF taN~.r' S'¢STEP1 I.,.IITHOLIT FINFIL INSPECTION RN[:, P,F'F'RO',,,'F~,L B'¢ THI:~::
DEPF~RThlENT f,.IIL. L BE:.:' :5UB..IECT 'TO PROSECUTION.
I'"! t N I P1LII"I E:, I S'TRNCE BETI4EEN Ft FIEL. L. FIND FtN"r' ON-S I TE SE:I,.IRGE E:' t SPOSF:IL SYSTEP1 I S
t00 FEEl' FOR R F'F.:I',,,'FITE HELL OR ±50 TO 200 FEET FRCffd Fl F'UBLIC HELL DEPENDING
UF'ON THE T"r'F'E OF' PUBLIC HELL.
h'IINII'dLIP1 DISTRNCE FROP'I Ft PF.:I'v'FITE I.,t["'"L.L TO ta PRI'v'F'tTE SE[4ER LINE IS 25 FEET FINE:,
"t"0 R COPI!"1UNiT'¢ SEHEF.'. L. INE liE; 75 FEET.
HELL LOGS RF.:E REQUIRED [:~NE:' P'!UST BE RETURNED TO THE DEPRRTt'IEN'f 1.4ITHIN 30 E:'Ff¢S
OF' THE HELL COhlPLE'TION.
OTHER REQLJIF'.EfdENTS f'dR"r' FIPPL"r'. SF'EC:IFIC:RTIONS AND C:ONSTRUC:TION DIRC~F~:Rrd'.:.!; RF.:E
RVR];LRBLE TO tNSURE PROF'EF.'. INS'T'RLLRTION.
I C:ERT I F"r' THFIT
t: .'[ F~P't F'RPIlL. IFIF.': I.'.IITH THE REQUIREhIENT':; FOR ON-SITE SENER~; t'3ND I.'.IELLS FIE; SET
FORTFI B"r' THE hIUN I C.1: PRL I T"r' OF' RNCHOF.:RGE.
;:2: I I.,.IILL Zf',I'.~;"I'FIL. L THE; S"r'STEhl ZN FtCCORDlaNC:E .[,.IITH TFtE CODES.
3:: I UNDER'.STFIND 'T'HFFr THE ON-SITE SEI.4ER S"r'STEP1 P1R'¢ F::EQUIRE ENLFtRGEf'"IENT IF THE
F.?E.:31 £. EN.:.E I :~ REI"!ODEI._ED TO I N l L JE,E' PIOF.:E THFIN 3: E:EE:'F.':OOP1S;.
::2; I G N E D ·
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR:
DATE PERFORMED:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
-s;l+
:5uk. ~lock ut . L~+ 2~-
SLOPE SITE PLAN
WAS GROUND WATER S
ENCOUNTERED? L
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time I'~ t~o Water Drop
I""lz° ~o.lq.Ir2.2:~/~,4~~' / ~o ~.o~ i.~ ~/ .o.~
PERCOLATION RATE
(minutes/inch)
72-008 (6/79)
APPLIC ~IT FILLS OUT UPPER HAL ONLY
Property Owner / ,, /,~ Phone
Ma,,,ngAddre. '-/'- .X?'X? . . ,pCode
Buyer
Address - Zip Code
~ Phone
Realty Co, & A~nt Phone
Address "..~_ Zip Code
Street Locatl~
Ty~
~ Single Family
~ Multiple Family No. of Bedroo~~..
: Other
Water Supply
clndivldual '~ ~- A~ACH WELL LOG. A wal log Is required for all wells drilled since June 1975.
ommunity ~ ~ ~ For wells ~llled prior to that date, give well depth (attach log if available).
: Public Utility
Se~e~tsposal
~lndlvldual ~ ~~ Year Indlv~ual Installed:
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE. EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time
Date Date
Inspector Inspector
Time
Date
,
Inspecto~,,.~
Time . /
Date \/
Inspecto~)~ ,~~
Field Notes:
( ) APPROVED BEDROOMS
( ) DISAPPROVED
('~#) CONDITIONAL APPROVAL*
DATE
BY:
MUNICIPALITY OF ANCHORAGE
DFPT Or: r'F,' U",t ,~,
ENVIRONM,':I',~iA.. ', .,.~, :CTION
Soils Rating
Date Sewer Installed
Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72.023 (3182)
•
• UE 80.
• Municipality of Anchorage .,7-- mr
On-Site Water and Wastewater Program N.11
(907) 343-7904 1112 ,
3 AUG V "1 )4.
Certificate of On-Site Systems Approva
Parcel I.D. 017-141-17 Expiration Date: b
1. GENERAL INFORMATION:
Complete legal description BIRCH TREE ESTATES; BLOCK 1, LOT 21
Location (site address) 5175 Metz Court"'Anchorage 99516
Current Property owner(s) Norman &June Mcatee Day phone 602-5215
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ 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 Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: Date: 7/ //
COSA to be released o the engineer,unless otherwise requested by the engineer.
COSA Fee $ Waiver Fee $
Date of Payment gl 1 I Ill Date of Payment
Receipt Number OZ$ ] Receipt Number
COSA# 05C-11 l3/ 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101-Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: ejlG//
4a�Qo4p4
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o OF A 'N
in accordance with the guidelines and regulations established by the Municipality of Anchorage and �unnn
industry practices. The reported results describe the condition of the system/s on the date/s of the QO -. _
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or �+ D
encroachments may exist that were not identified during the evaluation. The operational life of all wells ,�,� TH, �*
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
1
groundwater levels (that may fluctuate during the year), quality of construction (materials and "�
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary,and / ...... ��d�
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the Q e r A..orn ss,
system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of /Q m CE-7953 a �
the well or septic system. GEG makes no representation whether an alternative well or septic system 9s�
can be installed on the property in the event either of the current systems fail to perform adequately in J.P,. • • •:"J. - °joc�Q
the future, The content of this report is for the sole benefit of the person/party that retained GEG to ���Profess• 0°Q
perform the evaluation. Reliance upon the information provided in this report by any other person or �p��000a
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE
System #1 Approved for , bedrooms
System #2 Approved for bedrooms -v
Disapproved _ 4
1 ON-SITE ,,.
Conditional approval for bedrooms, with the folloiting\gigVii0OC r.
WASTEWATER
Ver L.att`j.ill Y
By: _ r , Original Certificate Date:_X-1� � 9
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 Nitrate Advisory
Septic System Advisory / Arsenic Advisory. . • . -
Well Flow Advisory Other •
COSA blue sheet 10-10-12.doc
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 21 Parcel ID: 017-141-17
"WELL IS IN PIT(VERTICAL CULVERT)WITH
A. WELL DATA 'DEEPEND IN 2005 FUNCTIONAL DRAIN (SEE ATTACHED PHOTOS)
Well type PRIVATE If A. B. or C provide PWSID# N/A Well Log (Y/N) YES
Date completed "1982 &6/1/05 Sanitary seal (YIN) YES Wires properly protected (YIN) YES
Total depth 126 ft. Cased to 126 ft. Casing height (above ground) "18+ in.
FROM WELL LOG AT INSPECTION
Date of test 6/1/05 7/7/17
Static water level 70 ft. 70.1 ft.
Well production 20+ g.p.m. 3.9+ g.p.m.
WATER SAMPLE RESULTS:
Coliform ND colonies/100 ml. Nitrate 0 155 mg./L. Collected by: GEG, Ltd.
Arsenic: ` 5 0 ug./L. Date of sample: 7/7/17
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 10/9/2009
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 7/10/17 Pumper ISAAC'S PUMPING SERVICE
C. ABSORPTION FIELD DATA 'BELOW EXISTING GRADE AT MT ""SEE INSPECTION REPORT
Date installed 8/4/82 Soil rating (g.p.d./ft2c /bdrm 300 System type TRENCH
Length"'88+20+23+6=137 ft. Width 3 ft. Gravel below pipe 4 ft.
Total depth "7 8+ ft. Eff. absorption area 1096 ft2 Monitoring tube `""YES Depression over field NO
Date of adequacy test 7/7/17 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test '"""20in. Water added 490 gal. New depth ""20in.
Elapsed Time 0 min. Final fluid depth ""20 in. Absorption rate >= 450+ g.p d.
Any rejuvenation treatment (past 12 mo ) (Y/N & type) NONE KNOWN If yes. give date -
AS DEPICTED ON LARS SPURKLAND. P.E 2010 RECORD DRAWING, THERE IS NO CLEANOUTS. SUMP, OR MT AT
THE SOUTH END OF THE DRAINFIELD
"MT ONLY EXTENDS 38" BELOW THE INVERT
—LACK OF RISE IS INCONSISTENT WITH A"300"SOIL RATING
HOUSE WAS VACANT SINCE 7/2/17
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off" level at — '• a er alarm level at in.
Datum-------- Cycles tested Meets alarm &circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout '100'+
Sewer/septic service line 25'+ Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field UNKNOWN
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line '10'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
'PER 1982 INSPECTION REPORT
NO SURFACE WATER WAS OBSERVED IN CREEK EASEMENT ALONG THE SOUTH LOT LINE
i.
G. ENGINEER'S CERTIFICATION `�y
• 10,‘...
`` ...v....(1 .♦
I certify that I have determined through field inspections and * 4 1 r �1 * �•
•
review of Municipal records that the above systems are in • ~//f"f '�" •
•
conformance with MOA COSA guidelines in effect on this • _t1/�1� •r , •••• •
date. s� Je f A.
•mess :,,Lu.
Engineers Printed Name JEFFREY A. GARNESS �. d>,•.. CE-79 3 ' ":
•,(np_•i..... j`11: 1.}• Ci r
♦ 'cb ll •
Date 1� /�'' *.*II /6F'ESS\ �•4
LICENSE Ili asssive
RAECC884
(Rev 10/12/121
j ( 7891
0 1
N I Lot 20
H
UJ
� N70°33,
9"W
E. 147th Avenue ^h� • *8
Ne
O ` SN 1
461
.fence
O
�h0 c o house F
Q` y \#o .�.� ,.
°weop8cawro�
a
‘....., kVIIP 11110P
. co
0
y Lot 21
Lot 22 I-) cci
, Lot 2
0
in
vs-
�� ..,encs
o ra=
o
c.d� _�
O =
Y
0 03
a
Il
— _
utili I —
Lot 36 I N7 Easement — — - I
Lot 1
8°53'52"W
160.00
Lot 37
RECERTIFIED 7-17-17/ REVISED 8-08-17,Added septic ve�its r,-
'/Y. AS-BUILT NO CORNERS SET THISDATE
���OFw ` I I hereby certify that I have performed a Mortgagee's inspection
.` . • • • •';�(•,�,,�I of the following described property: LOT 21. BLOCK 1.
, Q•.• •til, I, BIRCH TREE SUBDMSION
(17. 49th ••90
*'. .'�f / Anchorage Recording District Alaska,and that the
••• . / improvements situated thereon are within the property lines
% ..._..1•2.,,.•
• and do not overlap or encroach on the property lying
adjacent thereto,that no improvements on the property lying
/ '�,:Fred Wa I a t k a: adjacent thereto encroach on the premises in question and
SCALE: 1"= 40' ��'�'' 3255• — S ••• '" that there are no roadways.transmission lines or other
to• V �, visible easements on said property except as indicated
A3/4.1-5:s. • hereon.
rorIN
Dated at Anchorage.Alaska
EASEMENTS OF RECORD,OTHER THAN ' ,%\\��� this2nd day of JULY 1982.
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON. FRED WALATKA&ASSOCIATES
Engineers and Surveyors
FB 82-2, pg 1 BE (907-248-1888)
ALPINE DRILLING & ENTERPRISES
Permit Number: #SW Date of Issue: Parcel Identification Number:
Date Started: 6-1-05 Date Completed: 6-1-05 Is well located at approved permit location?® Yes ❑ No
Legal Description: Birch Tree Est. Blk 1 lot 21
Property Owner Name& Address: Norm McAfee
5175 Metz Ct
Anchorage, Alaska 99511
Borehole Data: Depth (ft) Method of Drilling® air rotary ❑ cable tool
Soil Type, Thickness& Water Strata From l o
Casing type: steel
Existing well 0 80 Wall Thickness: .250 inches
gravelly silt wet 80 120 Diameter: 6 inches Depth: 126 feet
silty water sand& gravel 120 123 Liner Type:
water sand&gravel 123 126 Diameter: inches Depth: feet
Cuing stickup above ground: 2 feet
Static water level (from ground level): Qfeet
Pumping level: 126 feet after
2 hours pumping 20+gpm
Recovery Rate: 20+gpm
Method of Testing: air lift
Well Intake Opening Type:
Open End ❑ Open Hole
❑ Screened Start feet Stopped feet
❑ Perforations Start feet Stopped feet •
(rout Type: Volume:
ficpth: Start feet Stopped feet
Pump: Intake Depth feet
Pump size hp Brand Name
Well Disinfected Upon Completion? ® Yes ❑ No
Method of Disinfection: chlorine tablets
• Comments:
Well Driller: Alpine Drilling & Enterprises
4EPAR1MtEMT OF PO Box 110496
MATURA\iRESOURCFS Anchorage AK 99511
ON.OF MIMtN, I dki °• 'tit`EA
DEC 7 cuU5
C�11'S ofFtt•
ANtHINAGF
Attention: The well driller shall provide a well log to the propert) owner within 30 days of completion and the property