HomeMy WebLinkAboutBIRCH TREE ESTATES BLK 1 LT 22~ ~
1)
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP231337 PID Number: 017-141-16
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
CYNTIA & LAWRENCE BELISLE
ABSORPTION FIELD — ADVANTEX FAP 2.0
❑ Deep Trench ® Wide Trench ❑ Bed ❑ Mound
Site Address TH
5201 E 147 AVENUE, ANCHORAGE
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
2 GPD/SF
3 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2.5 Ft.
Gravel depth beneath pipe
0.5 Ft.
Subdivision Block Lot
BIRCH TREE ESTATES 1 22
Fill added above original grade
VARIES 0.8'— 1.8 Ft.
Gravel length
45 Ft.
Township Range Section
Gravel width
5
Beds: Number of Lines
Distance between lines
SEPARATION DISTANCES
Ft.
Ft.
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Pump Basin
Tank
Line
225 Ftz
1
-- Ft.
Well
50'+
50'+
50'+
255'+
TANK 0 Septic ❑ S.T.E.P. ❑ Holding ® Other ADVANTEX
Manufacturer
ORENCO / ANCH. TANK
Capacity
1500 Gal.
Surface Water
50'+
50'+
50'+
Material
Number of compartments
--i
Lot Line
51+
5'+
5'+
NA
COMPOSITE PLASTIC
2
Foundation
10'+
10'+
101+
ADVANTEX FAP 2.0
Manufacturer
ORENCO / ANCH. TANK
Capacity
Gal.
Remarks DECOMMISSIONED OLD SEPTIC SYSTEM & INSTALLED
NEW AX FAP 2 & FIELD AMMENDED PER MNA & MOA — SEE IR
Alarm location
FIRST FLOOR
Electrical installed by
RISING SON
BALLAST USED —AX FAP 2 TANK ANCHORED WITH CEMENT
Installer MIKE N ANDERSON, PE (MNA)
PIPE MATERIAL House to tank 3034 Tank to 3034
drainfield
Drainfield 3034 CO/MT 3034
Inspector MNA & FWC
BENCH MARK (Assumed elevation) 100 ft
Inspection ddates: 1" 4/9/24 2nd 4/10/2024
Location and description
3`d 4/10/24 4" 4/11/24...
TOP OF MANHOLE MH
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Conditional
pF�11
• "'
Approval: Date
Aw
i g�P
TM
.....
... .......:..
Septic Sy t
A rov �
pp L C �/
Date I
•• Curtis Huffman
�� ��� • CE 128991 • ��
�� �s�F��. 04/17/24• . •��C��_Aw
l,l� pROFESSIO�
Note: this approval does not include well permit requireme ts.
PID:017-141-16PERMIT:OSP231337
FIRST WATER CONSULTING
BIRCH TREE ESTATES B1, L22
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 Wastewater Disposal System Permit
Permit Number: OSP231337
Work Type: Septic Upgrade
Tax Code Number: 01714116000
Site Legal Address: BIRCH TREEESTATES BLK 1 LT 22 G:3037
Site Mailing Address: 5201 E 147TH AVE, Anchorage
Owner: BELISLE LAWRENCE & CYNTHIA
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
Effective Date
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
»cnt
�o '_4" s
l�ehartment
4/3/2024
4/3/2025
25263
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ 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: 1 S5 L4P D TO C Date:
Issued By: Date: y 2 e/
3
/\ kl C H O % /\ G
Development Services Department r Phone: 907-343-7904
On -Site Water & Wastewater Section --_, Fax: 907-343-7997
ON -SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 017-141-16
Property owner(s) LAWRENCE & CYNTHIA BELISLE Day phone
Mailing address PO BOX 112455, ANCHORAGE, AK 99511
Site address 5201 E 147TH AVE, ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot) BIRCH TREE ESTATES BLOCK 1, LOT 22
Legal description (Township, Range & Section)
Lot Size 25,263 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN: TYPE OF DWELLING:
(N all that apply)
Absorption Field
E]
Initial ❑ Single Family (SF) 0
Septic Tank
El
Upgrade X (w/wo ADU)
Holding Tank
El
Renewal El Duplex (D) El
Privy
❑
Multiple Dwellings ❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A 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: 5q.Waiver Fees:
Date of Payment: O u Z Date of Payment:
Receipt Number: Ci l 1(000 Receipt Number:
Permit No. 0_5223 1337 Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
!
October 3 , 2023
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC SYSTEM UPGRADE PERMIT
LEGAL: BIRCH TREE ESTATES BLOCK 1, LOT 22
The documented septic system has been found failed in groundwater and will be
completely decommissioned and per the owner we request a septic permit to
upgrade the existing septic system on the above referenced lot. We propose to
install a shallow trench with an Advantex system to serve the existing 3 -bedroom
residence per the attached design. The design is based on the recent test hole
conducted in the fall of 2023. Groundwater was observed at excavation and at
monitoring of this test hole per the attached.
The slopes are moderate at 2-7% at the proposed upgrade location. The lot and
area are served by private water with no known private wells within 50’ of the
proposed septic system. Based on visual observations and review of available
information, the design will not impact any of the neighboring properties. Please
contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231337, Curtis Townsend, 04/03/24
FIRST WATER CONSULTING
DESIGN CALCS:
NO WELLS WITHIN
50' OF PROPOSED
SEPTIC SYSTEM.
NO SLOPES >25% WITHIN 35'
OF PROPOSED FIELD.
STAKE 50' CREEK, 5' PL, 10' FOUNDATION
...SETBACKS AS REQUIRED OR NEEDED.
BIRCH TREE ESTATES BLOCK 1, LOT 22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231337, Curtis Townsend, 04/03/24
FIRST WATER CONSULTING
DESIGN DETAILS:
BIRCH TREE ESTATES BLOCK 1, LOT 22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231337, Curtis Townsend, 04/03/24
13030 Sues Way - Anchorage, Alaska 99516
Tel. 907-350-9566 firstwaterAK@gmail.com
SOILS LOG - PERCOLATION TEST
LEGAL : BIRCH TREE ESTATES B1, L22
PERFORMED BY: FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT
ON THIS DATE. DATE: 10/03/2023
DEPTH
FEET OG
SOILS
1
2
ORG/OL
3
4
5
6
7
SM
8
9
10
9 BLUISH SW
11
BOH
12
13
14
15
16
17
18
19
20
Reading Date Gross
Time
Net
Time
Depth to
Water
Net Drop
10/3/23 30 min 6 11/16
6 11/16
6 11/16
PERCOLATION RATE 44 (MIN / INCH)
TEST RUN BEWTWEEN 3 & 4 FT
PERC HOLE DIAMETER 6
PRE-SOAKED PRIOR TO TEST & ALL READINGS TO
THE 1/16TH.
GROUND WATER ENCOUNTERED: YES
IF YES, AT WHAT DEPTH: 8
DEPTH TO WATER AT MONITORING: 7
DATE: 10/03/23
TESTHOLE # 23-1 DATE PERFORMED: 9/25/23
SEE SITE PLAN FOR SLOPE & LOCATION
COMMENTS:
VERIFY GROUNDWATER MT
AT TIME OF CONSTRUCTION
PERFORMED FOR: CYNTHIA BELISLE
10/03/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231337, Curtis Townsend, 04/03/24
WOODEN FENOE-
Lot 23
La
EASEMENTS (PER PLAT) - -~ yl
EDGE OF STREAM Lot 36
Lot 37
i
MORTGAGE SURVEY _X_ SCALE _ �_= 4�GRID __SW 303_7Project No.
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone �"\ `
ken®langsurvey.com "09 � ,
Professional Land Surveyor s jonathanolangsurvey.com G OF A �k
trovis®langsurvey.com i �1
��P- •'. r
1 hereby certify that I have surveyed the following described property: /C.• :9
LOT 22, BLOCK 1, BIRCH TREE ESTATES (PLAT No. 71-215) *; 49 TH * ��
Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a • • • • • . •
representation of the conditions that were found on the date the survey was performed.
This survey does not constitute a boundary survey and is subject to any inaccuracies
that a subsequent boundary survey may disclose. The information contained hereon shall • '
KENNETH G. LANG
not be used to establish any fence, structure, or other improvements.
f , • q No.5202 0�/
%Dated this the �Day of _ �` �+ , �� at Anchorage, Alaska ,F'PFO R f � \)AP AW p f�ssbtaa� 4�.
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 plat. State of Alaska AECC963
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this Day of '15 6 of 204zby and between
herein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment 5 stems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as
located at (legal description)
AN ADVANTEX SYSTEM
BIRCH TREE ESTATES B1, L22
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
__4Z Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
V"' Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Page 1 of 3
Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
�i Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
1/ Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
OWNER:
L
By: . - J �> _�i' % ) (signature) Date: 1
/ j�
��/ A/ 2 i-�11A . `-���= CJS rent name)
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT
The foregoing instrument was acknowledged before me this �� day of ,
20 jK, by r1 U j)j±jQ k ' .
EJASMINE CLARINO
NOTA Y PUBLIC R ALASKA Notary Pubic
tate of Alaska
My Com ion ex ires: Oq-� sion Expires Sep 9, 2026
MUNICIPALITY:,
By: EL — (signature)
7Q x ✓,,,S FivQ (print name)
Date: Ll A 2 y
Title: C (V i L
(rev. 05/18/2018) Page 3 of 3
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
ILEGAL DESCRIPTION
LOCATION
IPH~NE J~NEW
INO. OF BEDROOMS 3
No. of compartments.~..~.
Liquid depth
DISTANCE TO: Foundation Nearest lot line3 / ~
No. of lines j Length of each ,ir~/,.~ Total length Trench ~1" inches
Top of tile to finish grade.~j I Material beneath tile.~l__ &O l' inches
Length Width 3th
PERMIT NO,
Distance between lines
Total effectiv~sc
PERMIT NO.
Crib diameter Crib depth Total effecti 3tion area
~JCE TO:
DISTANCE TO:
Depth Driller
Building foundation Sewer line
line
Distance to lot line PERMIT NO.
Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
INSTALLER
(Rev. 3/78)
DATE
LEGAL
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of 6eo{o§[col & Geophysical Surveys
Drilling Permit No.
LOCATION OF WELL (Please complete either la, lb or I¢.) A.D.L. No.
~ Above or ~Below land surface Dote
~ ~ fl. oiler hrs. pumpin~
DEPT. O~ V~ ~I.Td 8, I~,GROUTING Well Orouled:
.~:
16. WATE~ WELL CONTRACTOR'S CERTIFICATION= 15, Weler Temperelure
[:,EF"FIR]"MENT .F' HEFtLT'H FINE:, Er',!'v IRONMEN"r'FfL ,-'ROTECTION ~E~
..... 825 "L '" :~5"['REET. FINCH()RF~GE;., F!K. ~4,.951;3:i. ~ I
26.4 -4720
PtF F L I C:FthFr LRNRENCE: R. ', - ' ,- t- E:::.:: ~/-~
'" '"' E, ELI=,L~: F'C. 4.-Z~:4Z RNCH RK E~:~3 2 :IG:-5(D~:!. ~
L 3C:FIT ! ON E:,EF!RME JN RE:, RREf3
LEGRL LT. ;:2.2 BLK. :l. 8ZRCH TREE E2?T. S,.."[:, LOT ~;Z;EE: .:2'SE~E~ :5(;:!URRE FEET
MR;:.:;IMIJM NUME:ER OF EIE[:,ROOMS = ~j: SOIL R~FTING,. ('Er3. Fl,, =,R')' ' "F' '". = 85.
THE F:EQU ............ .
.IF..- -'E OF THE '=.:F~II F~BSORF'T~L~'¢STEM I:E;'
T'HE L. ENGTH DIMENSION IS THE LENGTH (IN FEET:, OF THE TRENCH EE' [:,RRINFIEL[:,.
'T'HE [:,EPTH OF R TRENCH OR PIT I~ 'F~E [:,I:STRNCE E:ET~~ OF THE
GROLtND F~N[:, 'THE: BOTTOM OF THE E,..=:E:R,,,RT!ON ,::
.? ;,-. ~,~ ...
THE bRPt,,EL. [)EF'TH IS THE MINIMI..IM DEPTH OF GRFIVEL E:ETklEEN THE uu'fPHLL" ~i".[F'E
RN[:, THE EHDTTOM OF THE E::'::CRVRTION ,:~ iN FEET).
PEF.:H I T FIF'F'L I CRNT HRS 'THE F::ESPONS I E: I L I T'.r' TO I NFOF,.:M TH I S [.',EPRF.:TMENT [:,UR I NG THE
i?.,I:!~TFtl LFFT'IF'H IN'}..:PECTIFLN::='; OF F~H"r' HEL_S FIE:,JFtE:ENT TO TH'r:-= FF...FEF. TY .RNE.:, f .....
NLIMBER ,OF REZ, tDENCES THRT THE NEL. L. NILL SE;R',,,'E.
.... :,~.:,.~:.', 1.4tTHOLFF F:'!NRL IN'=,F'E"TI-N .aND RPF'F.:OVFtL E,? THIS
[:,EF'RRTHENT NIL. L. BE 'SUS.IE'.':T TO F'ROSECUTION.
MINIMUM DISTRNCE DETNEEN R HELL. FIND FIN"r' ON-SI-FE ~.;E!,4FtGE D!SPOSFtL. S?STEM
±0(iI F:EE'.r' FOR .Fl PRIVRTE !,,.!EL.L OR t58 TO 288 FEET FROM Ft PUBLIC WEL. L [:,EF'EN[:,iNG
UPON THE T'¢PE OF F'LIBLIC WELL.
MINIMUM [)IL:;TRNCE FROM R F'RIVRTE I.,.IEL. L TO R F'RIVRTE SENER LINE IS 25 FEET RND
TO 1~ COMMUNITh" :~]E!,4EF,: [..:[NE IS 75 FEET.
NELL LOGS RRE REQUIF.:Er.) FIND MUST' BE RETURNE[:, TO THE [:,EF'RRTMENT NtTHIN
OF ']'FIE HELL CC)MPL. ETiON.
'OTHER RE('::!UIREMEN'T'S MR'-r' F!F'F'L.'Y'. "SF'ECIF!E:FtTIONS FIND C:ONSTRUCTtON [:,IRGRRMS RRE
R',,,'F~tLRBL..E TO INSL.IRE PROF'ER INSTRLi_RTION.
I C:ERTIF'9 THFtT
:.t_: I l:~M F'Iq. M I[_IF~F.: NI"f'H THE F.:EQLIIREMENTS FOR ON-SITE SE.t,.tERS ¢~ND I.,.IELL.$ RS SET
FORTH DY THE ML!NICIF'FtLIT'¢ OF RNCHORRGE.
2: I I.,.IILL !NSTFtL. L THE Sh-'~STEM IN RCCOR[:,RNCE t.4ITH THE CODES.
::~:: :[ UNE:,ERSTRN[:, TF!FIT THE ON-~;ITE 2~;E:NER S'¢STEM HFW REQUIRE ENLRRGEMENT IF THE
0
aF,:'L I CI::tNT LF, I.,.tRENCE R/ E:E:L t SL.E ~.. ~
XSOILS 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
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED? ~ ~
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time ~;11~ Time ~1~ Water Drop
$" ~"17/~ o o / z" o
~,"' I I II'/ I"
/~ " ~ ~ ~ /o" z"
i~,, ii ii ~" ~0
PERCOLATION RATE (minutes/inch)
· . TEST RUN BETWEEN ~' FT AND ~ FT
PER :O~ME; By: J~~~~~ CERTIFIED BY: DATE:~~~.~
(6/79)
CHEMICAL & G1 '~OGICAL LABORATORIES, 'ALASKA, INC.~
TELEPHONE (907)-279,4014 ANCHORAGE INDUSTRIAL CENTER
274-3384 5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY L~BORATORY
WATER SYSTEM:
LD. NO.
Water System Name Phone No.
Mailing Address
City i, State .,4
Mo. Day Year
Zip Code
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no. ,)
[] Special Purpose .
[] Treated Water
[] Untreated Water
Analysis shows this Water SAMPLE to be:
[]i-Satisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample.
Date Received
Time Received
Analytical Method:
E] Fermentation Tube
,....ID Membrane Filter
SAMPLE
NO.
1
2
3
4
5
LOCATION
I
I
I
1
I
Time Collected Lab Ref. No. Result* Analyst
Collected By /'
*No, Of colonies/lO0 mi. or NO, of Positive oortlons
06-1220 (b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Date Collected Source,
Time Received ~.m.L.Ib. No.
Presumptive 10mi 10mi 10mi 10mi 10mi 1.0mi 0.1mi
24 Hours
48 Hours
Confirmatory
24 Hours
48 Houri
EMB
Multiple Tube Report:
Membrane Filter: Direct Count
Verification: I_TB
Final Membrane Filter Results
Reported By
Broth 24 hours:
Broth 48 hours:
10mi Tubes Positive/Total 1omi Portions
Collform/100ml
BGB
Date
, Collform/100ml
Time: , "' a.m.
p.m.
MUNICIPALITY O CHORAL
o,
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 017-141-16-000
Expiration Date: 4/11/2025
Legal description BIRCH TREEESTATES BLK 1 LT 22
Site address 5201 E 147TH AVE Anchorage AK 99516
Current property owner(s) BELISLE LAWRENCE & CYNTHIA
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: 4/19/2024
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 Approval June 2022
MUNICIPALITY OF ANCHORAGE
Development Services Department c 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. 017-141-16
Complete legal description BIRCH TREE ESTATES, BLOCK 1, LOT 22
Location (site address) 5201 E 147TH AVENUE, ANCHORAGE, AK 99516
Current property owner(s) CYNTHIA & LAWRENCE BELISLE Day phone
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: ® 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 ® Plastic ❑ Concrete ❑ Fiberglass
Age NEW - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ® AWWTS ❑ Bed ❑ Deep Trench ® Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested:
Distance:
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 $ Waiver Fee $
Date of Payment / Z� Z Date of Payment
COSA # S 2 `% (� Waiver #
COSA Application.doc
COSA Checklist.docx
COSA Checklist
Legal Description: BIRCH TREE ESTATES BLOCK 1, LOT 22 Parcel ID: 017-141-16
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 5/23/1982 Total depth 71 ft
Cased to 71 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 9/1/2023
Static water level at beginning of test 61 ft.
Well production at time of test 6.4 gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 4/11/2024
Comments
B. TANK DATA
Measured operating fluid level in septic tank NEW
Date of pumping NA – NEW ADVANTEX FAP 2.0
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 4/10/2024
ALL standpipes present per record drawing
Total measured depth from grade 4.8 ft (max)
Measured depth to pipe invert from grade 3.8 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective (ED).
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date NEW SYSTEM
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – NEW SYSTEM
Effective depth (per record drawings) 6 in (MOA 0.5’ ED)
Effective depth used 0 in (NEW – NOT TESTED)
Effective depth (ED) remaining 6 in
Comments/Deficiencies: APPROXIMATE TOTAL MEASURED DEPTHS FROM EXISTING GRADE. NEW ADVANTEX FAP 2.0
SEPTIC SYSTEM TANK & ABSORPTION FIELD INSTALLED APRIL 2024. PLEASE SEE ATTACHED INSPECTION REPORT.
COSA Checklist.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100’
Yes if No *50+ ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No *50+ ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No *5+ ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No *50+ ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No *50+ ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
*MAY MEET CONVENTIONAL SEPARATIONS, BUT SYSTEM MEETS CATIII SEPARATION DISTANCE
REQUIREMENTS PER NEW ADVANTEX FAP 2.0.
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 4/16/2024
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 or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
4/16/24
AN ADVANTEX SYSTEM
OWNER:
(signature) Date: `� �5 r% 0o tl
(print name)
U
STATE OF ALASKA )
)ss.
T141RD JUDICIAL DISTRICT )
The foregoin r instrument was acknowledged before me this K -day of ,
20A. by 0,10-A(•
L/ SABRA GILULAND
NOTARY PUBLIC FOR ALASKA Notary Public
State of Alaska
My Commission expires: l — a-7 - ')�D D--1 My Commission Expires Jan 27, 2027
;nature) Date: V/n(/'�
R\ I
nt name) Title:
(rev. 05/18/2018) Page 3 of 3
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Lot 37
MORTGAGE SURVEY X SCALE 1" = 40' GRID SW 3037 Project No. 23-453N
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone
kenOlangsurvey.com
Professional Land Surveyors jonafhanOlongeurvey.com OF Al., kkk�
frovisOlongsurvey.com ' P• , • ,
I hereby certify that I have surveyed the following describedrop":
LOT 22, BLOCK 1, BIRCH TREE ESTATES {PLAT No. 71-215)
Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a
representation of the conditions that were found on the date the survey was performed.
This survey does not constitute a boundary survey and is subject to any Inaccuracies
that a subsequent boundary survey may disclose. The information contained hereon shall
not be used to establish any fence, structure, or other improvements.
Dated this the -1 Day of "Lc'LA, , at Anchorage, Alaska
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 plat.
*.49TH
KENNETH G. LANG ••
c ' 0202. 5AW
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State of Alaska AECC963
