HomeMy WebLinkAboutBIRCH HILLS TERRACE #2 BLK 2 LT 4
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP81004 PID Number: 050-141-36
Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade
Name:
SHIRLEY A. BENNETT ABSORPTION FIELD - EXISTING
Address ® Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
17812 LACEY DRIVE, EAGLE RIVER, AK ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
4 GPD/SF Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot Ft. Ft.
BIRCH HILLS TERRACE #2 2 4 Fill added above original grade Gravel length
Township Range Section Ft. Ft.
Gravel width 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 Tank Line Ft2 -- -- Ft.
Well 200+ -- NA NA NA TANK ® Septic 0 S.T.E.P. ❑ Holding ❑ Other
Manufacturer Capacity
Surface Water 100'+ -- NA NA Greer 1500 Gal.
Material Number of compartments
Lot Line 5'+ -- NA NA Steel 2
NA LIFT STATION
Foundation 10'+ -- NA NA
Manufacturer Capacity
Gal.
Curtain Drain NA -- NA NA
Pump on level at Pump off level at High water alarm at
Remarks New 1500-gal S.T installed per code.
Existing 1250-gal S.T. decommissioned per in. in. in.
code. Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank 3034 drTa ne od3034
Installer Dirtworks
Drainfield CO/MT 3034
Inspector ARCTERRA BENCH MARK (Assumed elevation) 100 ft
Inspdates: ..2/17/18 2nd 2/17/18 Location and description
3'd 4th Garage slab
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engin
OF AL \
Conditional Approval: Date j r <Sy `4tS 1
/ * 49Th i - -
r. diarvwf
op, xi
IIIIIIL ...Ai
'� KENNETH MEr us /
1 7116 cs�
Approved I'Q C1Lr& 'rim 4/ i d Date_____47 111/4 fife,,,,,% ,to: `' a/
eer's Stamp
Inspection Report_9-1-12.doc
AS-BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP181004
BIRCH HILLS TERRACE #2 B2, L4 PID# 050-141-36
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COVERED ./&/ ,44." `o
nrn1/ N SCALE: 1' = 40'
N
ak
ri
o (97.31 97.10-
I-
t A-C=55.5
B-C=37.5' I
=A-D=66.5' IFINAL GRADE
I
B-D=47.0' & - i
o -J1500 GAL °'
N SEPTIC
,t' , TANK EXISTING FIELD
91.88 (91.63
U
0 _�F`� I I SCALE! NTS
41 (s. •. . •` 1Q 1 PREPARED FOR gClE R
L ,A 1 SHIRLEY A. BENNETT it. �� �� �s17812 LACY DRIVE .4'
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N * Tom.- * / EAGLE RIVER, AK 99577 j ��,'/ rFIELD BOOKS COMPUTED: XBOUNDARY:BOUNDARY DRAM" BMWZ STAKING: STAKING C"Ea(ED: KMD1• 5 4t ' ASBUILT: DATE • •� i ^�
; 1 / �, LANG 02/23/18 �y 0�
\ N\\�� '
E F'ESSION= DWG.FILE: GRID: NW0153 '‘‘Tc' �'p 1.ti.C",-s�
Z \�\� ACRD TILE;FILE p9 No.: 18113 R/1-FR• AK.S99577-�36
MUNICIPALITY OF ANCHORAGE
• On-Site Water&Wastewater Program \° ea
* r� ,�% PO Box 196650 4700 Elmore Road
K4 . Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
'r / http://www.muni.org/onsite ' f
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.;__ rt
/ iepartment
NCHotto /
On-Site Wastewater Disposal System Permit -Z ! 174 T^ k
Permit Number: OSP181004 Effective Date: 1/19/2018
Work Type: SepticTank Upgrade Expiration Date: 1/19/2019
Tax Code Number: 05014136000
Site Legal Address: BIRCH HILLS TERRACE#2 BLK 2 LT 4 G:0153
Site Mailing Address: 17812 LACEY DR, Eagle River
Owner: BENNETT SHIRLEY A Lot Size in Sq Ft: 43969
Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 4
This permit is for the construction of:
❑ Disposal Field Q Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: � 1 . Date: /—
Issued By: f?QIA ' Date: MA/ •
MUNICIPALITY OF ANCHORAGE
Et______
Community Development Department Phone: 907-343-7904
Development Services DivisionFax: 907-343-7997
On-Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D.
050-141-36
Property owner(s) SHIRLEY BENNETT 351-0861
Day phone
Mailing address
17812 LACEY DRIVE, EAGLE RIVER, AK 99577
Site address 17812 LACEY DRIVE, EAGLE RIVER, AK 99577
Legal description (Sub'd., Block & Lot) BIRCH HILLS TERRACE #2 BLOCK 2, LOT 4
Legal description (Township, Range & Section)
Lot Size 43,969 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(E)all that apply)
Absorption Field I I Initial Single Family (SF) x
(w/wo ADU)
Septic Tank > Upgrade I
Duplex (D)
Holding Tank n Renewal Multiple Dwellings
Privy (SF and/or D)
Private Well ❑
Water Storage
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of-pro ertycaner or authorized agent)
L.79
Permit/Rush Fees: i 15 - Waiver Fees:
Date of Payment: 1/ ,1D`/ ' Date of Payment:
Receipt Number: C)?-/C) it) Receipt Number:
Permit No. DSP/2 /U()! Waiver No.
Permit App_9-1-12.doc
I
m,y ARC 1 ERRA
x
, CONSULTING, INC
% . 0 j 212 E. 51g Ave,Anchorage,AK. 99503
/ Office(907)868-3791, Fax(907)868-3793
bf9'L�SLt TI NG• bNLl�'
fA' K•YS,7:°
January 15, 2018
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Septic Tank Upgrade Permit—Birch Hills Terrace #2 Block 2, Lot 4
The owner has requested we proceed forward to obtain a septic permit to
upgrade the 39-year old septic tank.
We propose to decommission the existing 1250-gallon septic tank per code and
install a new 1250-gallon tank in the same location to serve the existing 4-
bedroom house.
The subject and adjacent lots are served by public water. There is no surface
water within 100' of the proposed tank. We do not expect there to be any
adverse effect on adjacent lots by the development of this tank. If you have any
questions, please contact me at 868-3791 / FAX 868-3793.
Respectfully submitted,
ArcTerra Consulting, Inc.
B - M. Western
ner's Representative
Attachments: On-Site Sewer Application
20441 PTARMIGAN BLVD • EAGLE RIVER,AK 99577-8736 • PH(907)868-3791 • FAX(907)868-3793
\ MUNICIPALITY OF ANCHORAGE
�) a 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
NAME PHONE .FJ•NEW
kAAvN itcq (,68_2813 0 UPGRADE
MAILING ADDRESS
R C604, \\`15 CX.VIG LAK
LEGAL DESCRIPTION
\_.—4 %-2 %t rc}\ WI-LS 71.RRACE. 61)
LOCATION NO.OF BEDROOMS
ttr,- c.. PPGL-.E 1SZ WE0. ‘Noo Q A--
Well Absorption area Dwelling PERMIT NO.
DISTANCE TO: \00 5 4.'3 ,g04-Io°
Uy
P z ManufacturerMaterial No.of compartments
Ill
'- �YVC`1}c�RE % 6L..
Liq. aappaci yyirJ i7 in gallons IF HOMEMADE: Inside length 1 1 Width (, 1
Liquid depth IN1 ' ri
a Y DISTANCE TO:t ix
Well1)...\ic; Dwelling PERMIT NO. {
J02
S�4 Manufacturer Material Liquid capacity in gallons
0 Well Foundation Nearest lot line PERMIT NO.
w= DISTANCE TO: \\5 5a \'Z. 1 604-QA
-u 2 No.of lines Length of each lie Total length of lines Trench width Distance between lines
—Z w % �8 ^�-cQ� 30 inches
`41�. Top of tile to finish grade , is Material beneath rile \ ,t Total effective absorption area
G .k 0 (0 d inches -5-1 es
• ' PERMIT NO.
2018 SEPTIC TANK UPGRADE:
Total effective absorption area
Decommission existing septic tank per Jndation Nearest lot line
code&install new 1250-gallon septic Distance to lot line PERMIT NO.
tank and two post-tank cleanouts per
Septic tank Absorption area(s)
code, maintaining 5'+ from foundation &
existing field, and 10' + from water line. - ,
I 4 % PN
WATER LINE LOCATION WILL BE RE- S V ,D
VERIFIED PRIOR TO CONSTRUCTION.
Gos
4 1 do
?03s4
CONTRACTOR TO VERIFY SEPARATION I - .
S 4iQO
TO WELLS, PROPERTY LINE,WATER LINE, `F 4,"tO
Co
ETC...PRIOR TO CONSTRUCTION.
a Ze4.61.1"'Iti.41.4 .1
NOTES wr P``"
1. Lot is served by public water. . gA fIL.
2. No wells on adjoining lots are
within 200' of proposed tank
placement.
3. No surface water noted within LEGAL
100' of proposed tank placement.
72'3YRev.3/78)
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
NAME PHONE I ~NEW
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
I Well [ Absorption area Dwelling PERMIT NO.
DISTANCE TO: k OO 5 ~ ~ ~O
~ ~ Manufacturer
~ ~ ~~ ~ Mat°rial ~o. of compartments
Liq. capacitg in ~,llons Inside length ~idth ~iquid do~th
,OZ~ ' DISTANOETO: Well __ ,~~ ~ Dwelling PERMITNO.
O Z ~ Manufacturer Material Liquid capacity in gallons
a~ DISTANCE TO: Well XX~ Foundation E~ Nearest lot linek~ PERMIT NO. '1
~ ~ Z No, of lines Length of each ~ Total length of lines Trench width Distance between lines
-- ~ ~ ~~ ~ ~ inches
Material bene tile / ~ ~ Total effective absorption area
~ ~ ~ Top of tile to finish grade ~ O t~t~ U inches ~ ~
Length Width Depth PERMIT NO.
< ~ Type of crib 'b diameter Crib depth Total effective absorption area
m DISTANCE TO: ~ Building foundation Nearest lot line
~ ~lass ~ Depth Driller Distance to lot line PERMIT NO.
m " Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS ,
SOl L TfiST
I~STALLE~
R EMAR KS ,[~
72
· ; DEPFtRTit~NT ( .... HEAL'TH FIND EN~iIRONMENTFIL ~'~OTEOTION
LEQfll.. L4 82 BIRCH HILLS TERRRCE 8D~2 t...OT SI~ 4~9~L!RRE
'r~PE OF SOIL RBSORBTION SWST~ri IS: TRENCH
HAY~IMLIt'I NUMBER OF BEDROOMS ;: 4 _OIL RATING
REQUIRED SIF.~E OF THE SOIL,, ABSORPTION SYSTEM I~%'
THE LENGTH DIHENS!ON IS THE LENGTH <IN FEET) OF THE 'FRENCH OR DRAINFIELD.
'THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFFICE OF 'THE
GROUND AN[) I'HE BOTTOI1 OF THE EXCHVATION (IN FEET).
THERE IS NO S;E'T WIDTH F'OR 'TRENCHES,
THE GRAVEL DEPTH IS; THE f, lINItILtfl DEPTH OF GRAVEL DEl'WEEN THE OUTFFtLL PIPE
FIND THE BOTTOM OF THE EXCAVFtTION (IN FEET),
PERHIT FIFPLI.,FtNI HFIS THE RESF'ON$IBIL. IT~ TO INFORN THIS DEPFtRTMEN'T DJRING THE
INSTRL. L. RTION INSPECTIONS OF RNV WELLS HDJACENT TO 'THIS PROPERTY' AND THE
'~ .... ~ z,E.R/E.
NUMBER OF REsiDENCEs, THAT THE NELL W~LL, '~ ' ~ '
......... 'f I.-.I~L.'). < ;~.~ ::, INSPECT I (..-)Nb"~ FIRE RE~LI ,][:RE[.':,
BFICKF][L, LING OF AN',/ SYSTEFI WITHOUT FINAL INSPECTION AND APPROVAl.. BY THIS
[)EPARTHENT W ILL BE SUBJECI" TO PROSEC':UT I ON.
MINIMUM DISTANCE: BE/THEEN FI NELL AND ANV ON-SITE SEHFIGE [:,ISPOSHL S'~S;TEM IS
~m. OC~ FEET FOR 8 PRI'4RTE WELL,.,~ OR
1.58 TO ~ FEET FROM 8 PUBLIC HELL DEP~NE:,ING UPON TH[ TMP[ OF PUBLIC WELL.:
NEL. L~ LOGS 8RE RE~)UIRED AND MLtST 8E RETURNED TO THE DEPARTMENT HITHIN 3~ DAMS
OF THE WELL COMPLETION. ~-'~:':~L~
OTHER REQUIREMENTS M8~ 8PPLM. SPECIFICATIONS 8ND CONSTRUCTION DIAGRFIHS 8RI
AVAIL. ABLE TO INSUR[ PROP[R INSTALLATION.
I CERTIFY THAT
1,: I AM FMMILIFIR WITH THE REQUIREMENTS FOR ON-SITE .SEWERS FIND WELLS AS SEl'
FORTH BM THE MUNICIPAI_ITY OF ANCHORAGE.
i~?:, [ WILL INSTAll THE S~T[M IN ACCORDANCE WITH THE CO~ES
, 3.?~,~i~,?~DER,,1RND THRI T~ ON-~ITE 5EWER ~Y,~IEM HR~ RE~4UIRE ENLHR(.~E. MEN~ IF' THE
]~E~eE: IS REMODELED TO INCLUDE MORE THRN 4
APPLICANT HARRY MAC:KEY
't
/
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6650, Anchorage, Alaska 99502 276-222~
SOILS LOG - PERCOLATION TEST
~ SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR: H P' Y f _,14 Y
DATE PERFORMED: ~)" ~)° 7D0
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
WAS GROUND WATER
ENCOUNTERED? N~)
IF YES, AT WHAT
DEPTH?
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
COMMENTS
R A T F_~i?~i~.,~,~I~ l~/L/O
PERCOLATION . _ (minutes/inch)
TEST RUN BETWEEN FT AND FT
-
CERTIFIED BY:
DATE:~
72-008 (7/76)
Lot 4, Blk 2, Birch Hills Terrace , Add. # 2
Eagle Miver, Alaska
Driller: Harry A. Mackey
Owners: Dave and Fay Elliston
0-4 feet soil. 5-27 feet conglomerate of soil, gravel,
sand, clay and large boulders° 28-31 feet more boulders.
32-58 feet more boulders mixed with gravel and clay.
59-67 feet hardpan. 68-82 feet more hardpan 82 feet a
small amount of water. 88 feet a small seam of gravel
and large boulder . 91 down more hardpan. 98 feet gravel on
dark gray shale with water about 4 gal per minute. Gravel
108-112 with water. Hard rock at 113. Stopped drilling°
at 118. Cased to 112 feet 70 feet static level.
APPLIC NT FILLS OUT UPPER HAl ONLY
Address Zip Code
Realty Co. & Agent ~ Phone
Address ~' Zip Code
~ Other
Water Supply
ividual A~ACH WELL LOG. A wall Icg is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach Icg if available).
Sewer~osal
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Date Date Date D,te ~//0~,~)
Inspector Inspector Inspector Inspector
r
F,e,d Notes: 4~ d'~',
~ JUN 2 0~983
"Mtmic~pat~ly of Amhorago"
( ~PPROVED BEDROOMS ~ *CONDITIONS OF Envh-ol~men'tal Protection"
( ) DISAP~OVED
( ) CONDITIONA~APPROVAL*
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
Well to Tank Septic T~k Size
72,023 (3182)
EXCAVATION
ROBERT A. SHAFER
WORK
June 30, 1983
CIVIL ENGINEER
694-2979
Kaye Elliston
c/o Municipality of Anchorage
P.O. Box 754
Eagle River, Alaska 99577
Dear Mrs. Elliston,
Reference: Lot 4: Block 2: Birch Hill Terrace Subdivision
A sewer system adequacy test was performed on the system located
on the referenced property, as you requested. The septic tank was
pumped and verified to have a capacity of 1250 gallons. The absorption
~5-f~h-ch was tested by a continuous flow of water over a period of
72 hours without any adverse effect on the system.
It can be concluded from this test that the waste water disposal
system serving the four bedroom residence located on this property
is ~urrently functioning adequately. However, the system cannot
be guaranteed against subsequent failure.
If we may be of further service, please do not hesitate to contact
US.
~r~ey
Sine' ~ /~/,.~/
.Ms/ss
cc: Municipality of Anchorage
Department of Health and Environmental Protection
SRB 196X EAGLE RIVER, ALASKA
_ - MUNICI~AEITYOF ANCHORAGE MUNiCiPALI~YOF ANCHO~AG
~ DEPARTMENT OF HEAL3'HS~ ENVIRONMENTAL PR~TEC~ -OF H~LTH
~ ~ ~ - 4 ~ NOV
- Telephone 26 .-, .720 _
_REQU A" INDIVIDUAL wATER
DI HECTIO~= Completeall Darts oh pa~ 1.1neomple~' requ~ will not b. proc~.d. Pl~se allow ten (I0) ~s for processing,
1~ PHOPERT~ OWNER , ~ - ' I PHONE
MA~J~"AD'DRESS ~ -' ~ · ~ - - - _~ '
"~ROPER~VRESJDE~T4[f~irff~ent fromabove) ' ~ ' ' - - '
[~_ "- ._ ' ,~ - - ' .... ' PHONE
MAI El NGADDR ESS
.MAIL] NGADD R ESS ~/ ~ - ' .~
~MAI LING ADDRESS - - ·
TIME
THIS SIDE FOR OFFICIAL USE ONLY
INSPECTION APPOINTMENTS
TIME
DATE RECEIVED
TIME
DATE DATE DATE
INSPECTOR INSPECTOR
INSPECTOR
31RECTIONS:
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
WATER SUPPLY
---I INDIVIDUAL
-~ COMMUNITY
[] PUBLIC UTI ~ITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE
F-1 PUBLIC UTI LITY
Connection Verified
I-]Septic Tank or [] Holding Tank
Size: t ~'-~ If Tank i-s homemade
give dimensions:
TYPE OF TANK
TOTAL ABSORPTION AREA
4. 'DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
NUMBER OFBEDROOMS
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SIX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOl LS RATING
JSewer Line
MANUFACTURE~
MATERIAL~ ~
Septic/Holdi ng Tan k
[] OTHER
DATE
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
[~'~CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
•
• -�-� Municipality of Anchorage pj z'e,,
On-Site Water and Wastewater Program
(907) 343-7904 SA CTY
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-141-36 Expiration Date: r 10 J 3 , 2O. 2 0
1. GENERAL INFORMATION
Complete legal description BIRCH HILLS TERRACE#2 BLOCK 2, LOT 4
Location (site address) 17812 LACEY DRIVE, EAGLE RIVER,AK 99577
Current Property owner(s) SHIRLEY A. BENNETT Day phone
Mailing address 17812 LACEY DRIVE, EAGLE RIVER,AK 99577
Real Estate Agent Day phone
2. TYPE OF DWELLING:
[Si 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 El
Individual Water Storage ❑ Holding Tank ❑
Community Class_Well ❑ Community ❑
Public Water System ® Public Sewer ❑
WaiverNariance request for: Distance:
Received by: ,oul/ f/ , Date: d l�
COSA to be released to the engineer,unless of : e requested by the engineer.
COSA Fee $ 5.2f. Waiver Fee $
Date of Payment 2,f.2.11 is Date of Payment
Receipt Number OCo 1050 Receipt Number
COSA# 6SC/3/O156- 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 2/20/2018
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 OF A
occupants or can ArcTerra guarantee that no unseen L
encroachments,deficiencies or discrepancies exist. Amor
if-,
/ *1A9Til . Y
%
6. DSD SIGNATURE -� _sY
KENNE+. VS sz /
System #1 Approved for y bedrooms. ' �s, "'s 17�`/
System#2 Approved for , bedrooms. orEsON
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
F ANCH
.�I qo
v N-5 KIA
? oOk .EFL o
SPS o�RPM
MPwr�F
By: O.4.1). C L-c..r,Q !mac l•i Yv, &.LJui cI Original Certificate Date: a/a 3/20 1 of
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: BIRCH HILLS TERRACE#2 BLOCK 2, LOT 4 Parcel ID: 050.141.36
A. WELL DATA—PUBLIC WATER
Well type If A, B, or C provide PWSID# Well Log (Y/N)
Date completed Sanitary seal (Y/N)Y Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height(above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic: ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC I STEEL Date installed 2/17/2018
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) N
Date of pumping NA-NEW TANK Pumper
C. ABSORPTION FI LD ATA
9/0a erg
Date installe Soil rating (g.p.d./ft2 or ft2/bdrm) 140 System type DEEP TRENCH
Length 48 ft. Width 2.5 ft. Gravel below pipe 6 ft.
Total depth 9.6 ft. (Measured 1/10/18) Eff. absorption area 576 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 1/10/2018 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 605 gal. New depth 0 in.
Elapsed Time: <1 min. Final fluid depth 0 in. Absorption rate >= 600+g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N &type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access(Y/N)
"Pump on" level at_in. "Pump off' level at_in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES - PUBLIC WATER
WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
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 200'+
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 200'+
F. COMMENTS
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.
.c' OFAz,Z\>t
Engineer's Printed Name KENNETH M.DUFFUS / `S
Date 2/20/2018 * 4• TH ll, ,
�.,�J0
P
KENNETH
COSA canary sheet_2 6 15.doc , 711 /$ -
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Lot 4 s 63`32',
43,969 s.f. f
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SEPTIC .
PIPES Q
10.2'x12.0' \ .
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2.0' CANTSr•— ,g;CHAIN—LINK FENCE Q
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Lot 3 ` ;sS ooN 2c333
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8.0'x 14.7' 0
-ZiDECK at' . ' CO Lot 5
CHAIN—LINK FENCE
8.0'x 12.0'
6.3'x8.3' PLAYHOUSE w/ / GREENHOUSE �Q
1.8' BALCONY & 2.0' DECK �1
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COVERED 4.4,
STORAGE
-- ,_ 10' UTILITY 16.5'x40.5' CARPORT
_ .� / EASEMENT
N 77'24 30 �-
'W 130,0p. _
NOTES: Lot 4
1) LOT IS SERVED BY A PUBLIC WATER
SYSTEM
2) DUE TO SNOW AND ICE COVER, THE Lot 3
LOCATION OF THE DRIVEWAY IS
APPROXIMATE AND SOME LANDSCAPING
FEATURES ARE NOT SHOWN
PLOT PLAN AS BUILT _X SCALE 1" = 60' GRID NW 0153 Project No. 18-055/A1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates , inc . (907) 522-6476 Phone oopOO�‘O
(907) 522-4625 Fax o Q
Professional Land Surveyors kenOlangsurvey.com ol �F A ��rII�p
y jonathanOlangsurvey.com d'`�!•'' :7QQ n
I herebycertif that I have surveyed the followingdescribed property:
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LOT 4, BLOCK 2, BIRCH HILLS TERRACE SUBD. ADDITION No. 2 (PLAT No. 81-202) 0* 49TH �� • *Opp
Anchorage Recording District, Alaska, and that the improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that Q �'` 0
no improvements on the property lying adjacent thereto encroach on the surveyed il''1' KENN G.
premises and that there are no roadways, transmission lines or other visible 0 �"�, �400.1
0easements on said property except as indicated hereon. O0 • °:ice.1t •� l .LS-520?. cJ
Dated this the _ Day of roV) A�-`�- , '-:- , at Anchorage, Alaska �p4,,oRo'•--•-- �N��
�Q FESSIONAL o
It is the responsibility of the owner to determine the existence of any easements, DOpp000d
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963