No preview available
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 E. 147th AVENUE CA 0 — _ _ _ _ N 89.43'44"E .. 105.00' o Q � 3.9x11.0' C" �. S 89.48' 11 50.00' l 1 SEPTIC : 9J PIPES CJ WOODEN FENCE // TREATMENT POD '--MANHOLE M N; Lot 23 89.5' /'cHuce ELECTRICAL) / Skc. a sox _ E�-- 12.2'x12.2' Lot 3C � � SHED � 1 N co -m00, 7 '�• l��S 00, ORCH-7 �0 N WELL 0 PRO��� Y 39.5 rLlk.l" z sroRr COUT SMT. / Ul e� Lot 21 Lot 22 25,263 S.F. "W rCHAIN-LINK FENCE S 89.48' 11 50.00' i 68,85lo' LrrILrry. Lot 35 EASEMENTS 15' CREEK MAINTENANCE EASEMENTS (PER PLAT)`~+~ _ EDGE OF STREAM Lot 3C 1 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 ' �co. sate•• Q'% A �11i'_fopf;s 10NA� State of Alaska AECC963