HomeMy WebLinkAboutTRAVIS ESTATES LT 42BTr vis
Lot 42
051-241
-50
MUNICIPALITY OF ANCHORAGE ,.11 r
On-Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
http:/lwww.muni.org/onsite
11151.11-0
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On-Site Wastewater Disposal System Permit
Permit Number: OSP171298 Effective Date: 10/13/2017
Work Type: Septic Upgrade Expiration Date: 10/13/2018
Tax Code Number: 05124150000
Site Legal Address: TRAVIS ESTATES LT 42B G:0954
Site Mailing Address: 17731 BIRCHTREE ST, Chugiak
Owner: TRAVIS RICKIE L & KATHLEEN L Lot Size in Sq Ft: 40962
Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 4
This permit is for the construction of:
0 Disposal Field 0 Septic Tank D 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
Special Provisions: The entire drainfield is not within the 30 foot radius of the percolation test. An additional
percolation test shall be prior to construction of the drainfield. If results require a design change, construction of
the drainfield shall stop pending On-site review and approval. Please submit stamped and signed results with
the inspection report.
Received By:
i" f Date: /0 / 1
Issued By: ' Date: [OBIT
MUNICIPALITY OF ANCHORAGE
Community Development Department iv Phone: 43-7904
Development Services Division FaxAkt/107
On-Site Water & Wastewater Program
OCT (+ ,-/
ON-SITE SEWERNVELL PERMIT APPLICATION
051-241-50
`�l �� 68L�
Parcel I.D.
Property owner(s) RICKIE & KATHLEEN TRAVIS REV. TRUS Day phone 688-3436
Mailing address 17731 BIRCHTREE STREET, CHUGIAK, AK 99567
Site address 17731 BIRCHTREE STREET, CHUGIAK, AK 99567
Legal description (Sub'd., Block& Lot) TRAVIS ESTATES LOT 42B
Legal description (Township, Range & Section)
Lot Size 40962 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(EI all that apply)
Absorption Field Initial ❑
Single Family (SF) on
(w/wo ADU)
Septic Tank 11 Upgrade 09Duplex (D) ❑
Holding Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE I 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 • y =•erty owner or authorized agent)
Per it/Rush Fees: 56i Waiver Fees:
Date of Payment: /0/57/i Date of Payment:
Receipt Number: 01173D Receipt Number:
Permit No. QcSPri'1 gQg Waiver No.
Permit App_9-1-12.doc
p,RcTe,$)Rq
I ARC 1m
ERRA
CONSULTING, INC:
`-fSLI NG \H`S 212 E. 515'Ave,Anchorage,AK.99503
Office(907)868-3791, Fax(907)868-3793
October 3, 2017
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Upgrade Sewer Permit-TRAVIS ESTATES LOT 42B
It has been determined that the absorption field of the subject property is
saturated. Subsequently, the owner has requested we proceed forward to obtain
a septic permit to upgrade the septic system.
The general slope of this lot is from southeast to northwest at a grade of
approximately 5-12% over the septic area. On September 20, 2017 a testhole was
performed to investigate soils and groundwater. The results of this test are
attached for your review. The proposed upgrade will serve the existing 4-
bedroom single-family residence. We propose to install a pressurized shallow
trench. Groundwater was encountered at excavation and at monitoring at 8' and
7.5' respectively.
The property and adjacent lots are served by private water. There is no surface
water within 100' of the proposed system and there are no known curtain drains
within 50'. We do not expect there to be any adverse effect on adjacent lots by the
development of this system. If you have any questions, please contact me at 868-
3791 / FAX 868-3793.
Respectfully submitted,
ArcTerra Consulting, Inc.
4 IMP
411114P111"e#
Kenneth M. Du 41,01P. .
Attachments: On-Site Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
20441 PTARMIGAN BLVD • EAGLE RIVER,AK 99577-8736 • PH(907)868-3791 • FAX(907)868-3793
WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLAN
TRAVIS ESTATES SUBD LOT 42B
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WELL RADII & ASIMENTS
PRI❑R TO C❑NSTRUCTI❑N state: 1'= 100'
to
I DESIGN DETAILS PAGE 1 ❑F 2
NO SLOPES >25% 4 BDRM X 150 GPD = 600 GPD
N W/IN 100' OF 600 GPD/1.2 GPD PER SQ. FT. = 500 SQ. FT
PROPOSED SYSTEM, (500 / 5 x ,70RF (2'ED) = 70 FT. TRENCH
3 USE 2 TRENCHES - 35' (L) X 5' (W) X 2' (ED)
q Total depth of system Is 3.5' max from original grade.
2 Total depth of gravel below distribution pipe is 2' .
• NO PUBLIC WELLS WITHIN 200' OF
O NOTES'
PROPOSED SYSTEM. N❑T E S
o' NO PRIVATE WELLS WITHIN 200' OF
PROPOSED SYSTEM EXCEPT AS NOTED. 1. INSTALL NEW 1500 GAL STEP & INSULATE TANK IF <4' COVER,
a' NEIPROSEPOSEDC WELLEEXCEPT AS NOTED. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM IF < 3' OF FILL.
MIN. 2' FILL WITH INSULATI❑N, >3' COVER NO INSUL REQ.
tr 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INT❑ SEPTIC TANK.
I 4. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
o WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC...
0 ��_`Nk
2, Adr:40'-‘,..%\� OF `' 4` 1 PREPARED FOR: CTE D
L �(51 RICK TRAVIS b �R {L �,
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It
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TRAVIS 17-209 Ax. 99577'
WASTEWATER DISP❑SAL SYSTEM DETAILS
TRAVIS ESTATES SUBD LOT 42B
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DECOMMISSION
EXISTING S.T. &
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INSTALL NEW • .
1500-GAL STEP TEST AT CONSTRUCTION
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NO SLOPES >25Y.
e WIN 100' OF
PROPOSED SYSTEM.
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FLAG PROPERTY LINES
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WELL RADII & EASEMENTS
PRI❑R TO C❑NSTRUCTI❑N state: 1'= 20'
N ��`\, PAGE 2 OF 2
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1 ARCTERRA ���¢ tS
{ CONSULTING, INC Jet/
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'-,. 1. v 17 212 E. 5I' Ave, Anchorage,AK.99503 * 49 TL_� ///\\\\
--IA l', cn. �4'�Office(907)868-3791, Fax(907)868-3793 �7,r1
,..ny,)-ih r_
KENNETH M. Dl,' ,� Al
SOILS PERCOLATION TEST , "1B �.
fT •� Allf
Performed for: Rick Travis Date Performed: 9/20/2017 �; , : sto �-
I...-4:4"
Project: TRAVIS ESTATES LOT 42B TEST HOLE# TH 17-1
Depth
(Feel I SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
1- Org/OL
Was Ground water encountered? YES What depth? 8'
2- .
Depth to water after monitoring? 7.5' Date? 9/29/17
1.V 10111/1
1
SW/sm trace of silt&gp pockets Reading Date Gross Net Depth of Net
Time Time Water Drup
6 1 9/21/17 1:00 - 8" -
2 1:10 10 min 0116" 7 16/16"
8 3 * 1:11 - 8" -
9 4 1:21 10 min 2/16" 7 14/16"
10 5 * 1:22 - 8" -
B.O.H.
I- 6 1:32 1(1 min 1/16" 7 15/16"
12- 7 1:33 8-
13-
13- 8 1:43 10 min 2/16" 7 14/16"
14- 9 1:44 - 8" -
15- 1(1 1:54 10 min 3/16" 7 13/16"
16- 11 * 1:55 - 8" -
17- 12 2:05 10 min 3/16" 7 13/16"
18- * Water Added
19- Percolation Rate 1.28 (min/in)Perc Hole Diameter 6"
HOLE PRESOAKED
20- PRIOR TO TEST Test Run Between 3 feet and 4 feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State
and Municipal guidelines in effect on this date.
'~% 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
MAILING ADDRESS
LEGAL DESCRIPTION
[~UPGRADE
Well Absor~ti area D well i~ g:f_~5~5_
DISTANCE TO~ ¥~¥' f- ~
Manufacturer Material
Lq capacty nga ons Well Jnsidelength Wdth
] ,~--O IF HOMEMADE: Dwelling /
NO. OFBEDROOMS
PERMIT NO.
Liquid depth
PERMIT NO.
DISTANCE TO;
Manufacturer Liquid capacity in gallons
Well
Length of each line"
grade
Material
OD -
Foundation Nearest Jot line
Total leng.th~ O~'°f lines Trench width~ ~.z
inches
Material beneath tile
Depth
DISTANCE TO:
No. of lines
Length
Width
inches
Type of crib Crib diameter Crib depth
Well Building foundation
DISTANCE TO:
Driller
Class Depth
DISTANCE TO: Building foundation Sewer line
OTHER
PERMIT NO. .
Distance betw on tines
Total effective abso ption area
PERMIT NO.
MATER ALS
SOl L TEST RATING
INSTALLER
REMARKS
Total effective absorption area
Nearest lot line
Septic tank Absorption area(s)
Distance to lot line PERMIT NO.
APPROVED ATE LEGAL
72-013 (Rev. 3/78)
~ MUNICIPALITY Of ANCHORAGE~
' Departmeng'-Af Health and Environment~' !Protection
825 .~ Street, Anchorage, AK. ~9501
264-4720
i, * * * HANDWRITTEN PERMIT * * *
Permit #, WELL AND/OR ON-SITE SEWER PERMIT
Applicant: ~[w%/~ ~ Mailing Address: ~-~'~ ~[~ ./~--. ~'
Location: ~A & ~3~ ~l~/~ ~ .. Phone Number: ~
Legal Description: L~/~ -gIJ~ ~/~} '~- / ? Lot Size:
Type of Soil Absorption System Is:
Trench: l~~ Drainfield: Seepage Bed~ __ Holding Tank:
Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
DEPTH ~ LENGTH _~O GRAVEL DEPTH ~C ~
· WIDTH
The length dimension is the length(in fee~) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
· * REQUIRED SEPTIC(HOLDING) TANK SIZE = /.2__~'-~ GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
· * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. SpecificatiOns and construction diagrams are
available to insure proper installation.
· * * PERMIT EXPIRES DECEMBER ~1~ 1 9 8 3 * * *
i certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require£%enlargement if
the r~§~de~q~ is remodeled to include more that 3 bed~obms..
Appt~ ~/ .... Date: '-'~//~/ ~
SWP/024(1/81)
APPLI¢ NT FILLS OUT UPPER HAt' 'ONLY
. ~ ~ Phone
Mailing Address
Address
¢,..,,,~_ ~¢,'r~:, i~'~ ~-~Z.~ (T15N R1W Section 19)
Time Time Time ~_~_ . Time
Date Date Date/(~ ~ ~...~ _..~ % Date)~ ~ ~ ~'~ ~'
Insp~tor Insp~tor Insp~tor Insp~tor
MUNICIPALI~ OF ANCHO~GE
Field Notes: DEPT.
~s~a~e~ 7-~0-83, ~ssue~ 7-Z8-83
for sewer only(Hamann Const, applicant)
RECEIVED
( ~ ) APPROVED BE~R~S 'CONDITIONS OF APPROVAL
( ) DISAPPROVED
{ ) CONDITIONAL APPROVAL*
DATE ~c --~ ~ -~ .
Soils Rating Date ~wo, installed Well To Absorption Area ~ ~ ~ F ~el, Log Received
~-- 20 --8 5 WelltoTank /8¢ SeptioT~kSize
~'~SOI LS LOG
LEGAL DESCRIPTION:
1
4-
5-
6-
7-
8-
9-
13
14
15,_
16
t7
18-
19-
20-
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
82~ L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
SLOPE
· I I I
WAS GROUND WATER ~Er~:_f0 I~
ENCOUNTERED7 pO
E
IF YES, AT WHAT /
DEPTH? f ~
PERCOLATION
TEST
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
72-008 (6/79).
(minutes/inch)
TEST RUN BETWEEN FT AND ' FT~Tf~
/
/ ~ J~ ~V~/ DRILLING, Inc.
P.O. Box 10-378 · 10300 O d Seward Highwa
(907) 349-8535
ANCHORAGE, ALASKA 99511
Well Owner
DRILLING LOG
RICK TRAVIS c/o Ct{AMBEt~ CONSI/1UCi'IP2q
_Use of Well
Domestic
Location (address of: Township, Range, Section, if known; or distance mai{~ roacl
Lot 42 Section 19 T15N R1W Se~mrd ~vidiml
f
Size of casing 6" .Depth of Hole 265 feet Cased to 265 feet
Static water level 60 ft. (~} (below) land surface. Finish of well (check one) open end (xxx );
Screen ( ); Perforated ( ).
Describe screen or perforation None
Well pumping test at 5 'gallons perXtqib'~') of drawdown from static level.
(minute) for 1 hours with 100%
Date of completion Jtx] y 8, !q83
WELL LOG
Depth in feet from .
ground surface Give details of formations penetrated, size of material, color and hardness
0 TO 2 Casing st~cloap
2 _TO 5
5 TO 19 Sand
19 TO. 23
23 TO_ 55
55 TO. 60
60 .TO. 80
g0 TO
15~ TO_
TO
TO
.TO
TO.
TO.
Td
I~ose gTavel & hobbles
Study f~avel
Silty s~nd
MUNICIPALITY OF ANCHORAGE
[NV[RONMEN)AL P~OTEC[ION
Sil~ sand - hard
0OT 1 7 1983
S2~qd stone - sn'~ll l__avers shale
Sm~d stono.
RECE!V[D
3--CONTRACTOR
•
fo
Municipality of Anchorage
On-Site Water and Wastewater Program
(907) 343-7904 SA ETY
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-241-50 Expiration Date: I
1. GENERAL INFORMATION
Complete legal description TRAVIS ESTATES LOT 42B
Location (site address) 17731 BIRCHTREE STREET,CHUGIAK,AK 99567
Current Property owner(s) RICKIE & KATHLEEN TRAVIS REV.TRUST... Day phone
Mailing address 17731 BIRCHTREE STREET, CHUGIAK, AK 99567
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: 4
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 ❑
Waiver/Variance request for: Distance:
Received by: ,4 ,� Date: 0/10/
( d
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ � Waiver Fee $
Date of Payment 7-? ( ? Date of Payment
Receipt Number p Receipt Number
COSA# (7'C_ '3 z-- 3 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 ARCTERRA CONSULTING,INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD.,EAGLE RIVER, AK 99577 /D/f/go�g
Engineer's Printed Name KENNETH M. DUFFUS Date
Engineers Comments:This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use,local soil characteristics,groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. 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,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseenOF
encroachments,deficiencies or discrepancies exist. / %N, 4,s,L` ,s 1
"49"i'.i ( c 1
6. DSD S GNATURE `'� �
System #1 Approved for ( bedrooms.
1 1 eTE��O 76/
System #2 Approved for bedrooms. \ �
hoFESSIO 0
h�
Disapproved.
�,,
Conditional approval for bedrooms, with the following stipulations:
9`6• • �� moo.
fiiQ�
NT s���\G
Original Certificate Date: /D `7
The Municipality of Anchorage Development ServiceDivision (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 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: Travis Estates Lot 42B Parcel ID: 051-241-50
A. WELL DATA
Well type PRVT If A, B, or C provide PWSID# Well Log (Y/N)Y_
Date completed 71811983 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y
Total depth 265 ft. Cased to 265 ft. Casing height(above ground) 18+ in.
FROM WELL LOG AT INSPECTION
Date of test 718183 9-13-2017
Static water level 60 ft. 52 ft.
Well production _ 5 g.p.m. 2.4 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate ND mg/L
Arsenic: ND ug/L Date of sample: 101112018 Collected by: ARCTERRA
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC 1 STEEL Date installed 10130117
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 NA-NEW TANK Pumper
C. ABSORPTION FIELD DATA *SITE INSPECTION 10/1/2018-No fluids noted in any MT
Date installed 51013012017*101112018 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 _ System type SHALLOW TRENCH
Length 12 @ 35') 70 ft. Width 5 ft. Gravel below pipe 2 ft.
Total depth 4.5+ft. (W/insui.) Eff. absorption area 500 ft2 Monitoring tube Y Depression over field N
Date of adequacy test NA-NEW FIELD*1011118. Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0*_ in. Water added 0* gal. New depth 0* in.
Elapsed Time: min. Final fluid depth 0* in. Absorption rate >= g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N &type) N If yes, give date_ _
D. LIFT STATION
Date installed 10/30/2017 Size in gallons 1500 Manhole/Access (Y/N) Y
"Pump on" level at 44 in. "Pump off' level at 42 in. High water alarm level at 48 in.
Datum Bottom of Tank Cycles tested 2 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'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Holding tank 100'+
Animal containment areas 50'+ - Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots_100'±__
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 50'+NONE KNOWN) Wells on adjacent lots 100'+
F. COMMENTS
*Site Inspection and water samples taken on 10/1/2018.All septic monitoring tubes were dry.
G. ENGINEER'S CERTIFICATION
I certify that I 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. .41' 1
'Off` \\
Ar
Engineer's Printed Name KENNETH M.DUFFUS / L� �_ 4
Date 1015/2018fie 4 TIl
COSA canary sheet_2-6-15.doc �M0r.
-a.. KI:NAL•''Ckl �•
4 71
•
• Municipality of Anchorage "p
a
On-Site Water and Wastewater Program
(907) 343-7904 SA C T Y
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-241-50 Expiration Date: 0(f 1 7 2 0 1 F
1. GENERAL INFORMATION
Complete legal description TRAVIS ESTATES LOT 42B
Location (site address) 17731 BIRCHTREE STREET,CHUGIAK, AK 99567
Current Property owner(s) RICKIE&KATHLEEN TRAVIS REV.TRUST... Day phone
Mailing address 17731 BIRCHTREE STREET,CHUGIAK,AK 99567
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: 4
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 ❑
Waiver/Variance request for: Distance:
Received by: /6§j / Date: 7- ! 7-4
COSA to be released to the engineer,unless of ' requested by the engineer.
COSA Fee $ W ' Waiver Fee $
Date of Payment �� ` 1 d Date of Payment
Receipt Number Ce CoLOS Receipt Number
COSA# o -tg\3?< 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 ARCTERRA CONSULTING,INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD.,EAGLE RIVER,AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 6/23/2018
Engineer's Comments:This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use,local soil characteristics,groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. 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,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen OF• OF Az S
encroachments,deficiencies or discrepancies exist.
6. DSD SIGNATURE —44 �ovA./ `��
� .�•
System#1 Approved for `l/ rann�v �bedrooms. 4)�; r,s
System#2 Approved for bedrooms. b., 0 3 Ar"
'•FEs,.ION'
Disapproved. \`��
Conditional approval for _ bedrooms, with the following stipulations:
OFw`•�
J� G
ON-SITE
WATER AND
WASTEWATER
. PROGRAM "
?. c
By: a J ' C� Original Certificate Date: til c
J . � 201
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 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: TRAVIS ESTATES LOT 42B Parcel ID: 051-241-50
A. WELL DATA
Well type PRVT If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed 7/8/1983 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y
Total depth 265 ft. Cased to 265 ft. Casing height (above ground) 18+ in.
FROM WELL LOG AT INSPECTION
Date of test 718/83 9-13.2017
Static water level 60 ft. 52 ft.
Well production 5 g.p.m. 2.4 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/1 00 mL Nitrate ./00 mg/L
Arsenic: / D ug/L Date of sample: 6/22/2018 Collected by: ARCTERRA
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEP/STEEL Date installed 10/30/17
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 NA-NEW TANK Pumper
C. ABSORPTION FIELD DATA
Date installed 10/30/2017 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 _ System type SHALLOW TRENCH
Length (2(a)35') 70 ft. Width 5 ft. Gravel below pipe 2 ft.
Total depth 4.5+ ft. (W/INSUL.) Eff. absorption area 500 ft2 Monitoring tube Y Depression over field N
Date of adequacy test NA-NEW FIELD Results (Pass/Fail) PASS For 4 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) N If yes, give date
D. LIFT STATION
Date installed 1013012017 Size in gallons 1500 Manhole/Access (Y/N) Y
"Pump on" level at 44 in. "Pump off' level at 42 in. High water alarm level at 48 in.
Datum Bottom of Tank Cycles tested _2 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'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Holding tank 100'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
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 50'+(NONE KNOWN) Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 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. i OF44;;
Engineer's Printed Name KENNETH M.DUFFUS .
Date 6123/18 I *?q-• TH <` `e=
WIir
COSA canary sheet_2-6-15.doc # . KENNETH M. kirS
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1 SECTION UNE 1
CENTERLINE (PLAT 83-427)
(N00'32'39"W MEA)
BIRCHTREE STREET
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(OLD BIRCHWOOD LOOP ROAD) $
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ANCHORAGE RECORDING DISTRICT,ALASKA
AS-BUILT OF:
TRAVIS ESTATES SUBDIVISION O =FND 5/8"REBAR
LOT 42B PLAT 83-198 _`"`\
SURVEY CERTIFICATE:I,John L.Schuller,Have conducted a .� OF 4,N\ �� LAND RS,
physical survey of this property as shown on this drawing and that the / `� .•'' <Q ,' `4�` ti0 S
improvements situated hereon are within the property lines and no /�c� • y � G r
enchroachments exist other than noted.Under no circumstance should %*. 49TH I\ *�, 04�' Ai"
enchroachments
any information on this drawing be used for construction of fences, a '0 2
structures,improvements,or for establishing boundary lines. / -� x a' �'
Je_._. / r 2 U r
EXCLUSION NOTES:It is the owners responsibility to determine •p / / t17 0• ��
the existence of any easements,covenants,or restrictions which / �. •.J(IHN L. SCHULLER... / ' Or '',."1
do nota ear on the recorded subdivisionplat. s LS-10408 '�
PP f 1 r. (� / ...• ..,.r
•• J Al 1831 Talkeetna Street
WORK ORDER NUMBER: DATE SCALE: E-MAIL �o ••l4 •( 5/
NOV 18, 2017 1"=40' 11‘-.„...1-:.[..$:.1:7*
oA 1' �, Anchorage, Alaska 99508
1 7—046 DRAW BY:'CHECKED BY GRID NUMBER: BbOK AOE: 1\ to
ofessiono� \�� (907) 227-1455 office
JLS NW0954 170207 \\�:�`�b (907) 274-4992 fax