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HomeMy WebLinkAboutBIRCH HILLS TERRACE #1 BLK 1 LT 2Birch Hills Terrace #1 Block 1 Lot 2 #050-141-22 Municipality of Anchorage Page of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: PID Number: 050-141--�07 Name: DD }� 81 //+ Dawn 61r05-5- Wastewater System: ❑ New 09 Upgrade Address: ( O 0 f SCR %! (e �r`�e��.a eq°6 7 ABSORPTION FIELD Phone: 51�, 41 _ � �fCJ, �� _/ No. of Bedrooms: ❑Deep Trench 'Shallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: i • GPD/S . Ft. Total Depth from original �raade:, Lot: �-•�/ Block: CJC Jubtlivi'sI'on: 6.�G �f rt r ((!? ICIfL{�'C"I Depth to pipe bottom from original g�rajve: Gravel depth beneath pipe t d Ft. Ft. Township: Range: Section: Fill added above original grade: D Gravel length: O FL �i Ft. WELL: ❑New ❑Upgrade Gravel width Number of lines: Distance between lines: Class "fication (Private, A,B,C): Total D Cased To: 1 I c Wafer FL Total absorption area: I Ft. Pipe material: Ft. Ft. -500SQ. Ft. A5TM D3Q3 P-gt(} Driller: Date Drilled: Static Water Level: Installer: Date installed: Ft L/ PN Ql�f FCA •On L Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES lKseptio ❑ Holding ❑ S.T.E.P. To From Septic Tank Absorption Lift Holding Public/Private Manufacturer: ✓+ Capacity in gallons: Field Station Tank Sewer Lines Well' If'l l..r. `oo\ •-- r--. .�� Material: �O( Number of Compartments: ( e/� ewe SurfacWater (I" 11aDt't LIFT STATION Lot Line �Lj� bb (�®� _I Size in gallons: Manufacturer: Foundation "Pump on" level at: "P " level at: High water alarm at: Curtain Drain K/i W {� Pump Make el Electrical Inspections performed by: Remarks: BENCH MARK Location and Description: top to Ffoor' eoTlr !'a e AssumedElevation: lay Ft ENS *� S & S ENGINEERING Jp� 17034 Eagle River Loop Road, No. 204 �_a_� Inspections performed by: Dates: I t q th :..i »..• ��" a Eagle River, M.A. MOM 2nd f -3 -qg jj y ` ROBERT C, COWAN 'k- 0'.., gsy CE -8801, Department of Health and Human Services approval �:�s _�f>4,..,w _•„, Reviewed and approved b : Ili. PP Y Date: S'3 cv 3 (R— Val) h4GA CO PERMIT No. SW990223 PAGE 2 OF 3 DEPARTMENT pHEALTH ANDhHUkXN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D. Box 196650 •Anchorage, Alaska 99519-6650 • Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 2 BLOCK 1 BIRCH HILLS TERRACE #1 P.I.D. No. 050-141-22 O'er OPOLE \ KeyB� � p 7 11 1" = 40' ROBERT C. COWAN CE -8801 PT0'tESs"Sl;;h��, 10' UTILITY EASEMENT r- ---------------------------- I I I I I I I I SHED z I I I I z I EXISTING Lj HOUSE SE I B W I QQ I DELI 6 D11_2 THM A W W I 25%+ 1300 GALLON STI PREMIER 44 ° } } I ` SEPTIC TANK ST2 O - <- \ 4 ° H I DBL3 S DBL4 Cpl I MTI \ H ti THA 4 \ O O I ~I N �� � ° ° - + O \� F - a POLELA MT2 a m L� Cot I (n I I 4 \� I ° � O'er OPOLE \ KeyB� � p 7 11 1" = 40' ROBERT C. COWAN CE -8801 PT0'tESs"Sl;;h��, PERMIT NO. SW990223 PAGE 3 OF 3 DEPARTMENT ANDhHUM9AN SERVICES ENVIRONMENTAL SERVICES DIVISION RII. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 2, BLOCK 1 BIRCH HILLS TERRACE #1 P.I.D. NO. 050-141-22 AL GRADE /-- 99.2' l vsvI.AT)Ory 95.5'- I NEW 1300 GAL. POLY. TANK 95.3' CO1 MT2 CO2MT1 C01 = 98.7' CO2 = 93.4' FINAL GRADE C01 = 89.9' SR CO2 = 89.9' MT2 = 85.8'J '-- MT1 = 85.8' NO WATER FOUND 79.7' B.O.H. N. T. S. ROBERT C. COWAN CE -8801 1 S - Soxr MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 28, 1999 Expiration Date: Jul 27, 2000 Permit Number: SW990223 Parcel ID: 050-141-22 Legal Description: BIRCH HILLS TERRACE #1 BLK 1 LT 2 Design Engineer: 0003 S & S Engineering Site Address: 018015 EAGLE RIVER LPN Owner Name: Bill & Dawn Cross Lot Size: 55827 SQ. FT. Owner Address: 18015 N Ealge River Loop Total Bedrooms: 4 Permit Bedrooms: 4 Eagle River, AK 99577-8203 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 (24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: .99 Date: SCJ S& HEALTHAUTHORITY APPROVALS SEWER&WATER MAIN0aENSIONS SEWER&WATER INSPECTION ENGINEERINGSTUDIES ANDREPORTS WELLINSPECTION 6 FLOW TEST SITEPLANS ROADDESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER CISPOSALSYSTEM DESIGN ROBERT C. COWAN, P.E. CIVIL ENGINEERS (907)694-2979 FAX(907)694.1211 7'u,v � � 2#1999 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 2, Block 1, Birch Hills Terrace #1 Subdivison It is requested that you issue a permit to install a septic system to serve the four bedroom dwelling on the referenced property. One test hole was excavated and a percolation test was performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation 4/23/99 water was not found. After seven days of ground water monitoring the monitoring tube was dry. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, 1 114 - Robert C. Cowan, P.E. RCC/jhm Enclosure 17034 NORTH EAGLE RIVER LOOP s SUITE 204 • EAGLE RIVER. ALASKA 99577 1" = 50'I UPGRADE I SITE PLAN SCALE 003 >WW O O Z x 'H Wy« arc xI OCH H y MKS" z� pa ]L.J yyv ro nzr<� a ro OJ .< =-d Hcy qday oo. azo c-_ '.J zyz L.j �,tv Md Y n/ Ww mo— 'o m y 7J 9H� b Ox > o0-3 Z p O H Hvon yAAmz (V\ NNa ozol g a mOmK �Zm V O A j � n£awm-Iv-�r� I o%uAa .In < mx A D I m H DZ P1a � ONNA �O- ,�gromr� o Gn .A to O� U1 �A I, >➢ O 77 �T7 (7 ob 1.FFy��-II N 0 Ids N�b9 D0 2� C7 p u L'l CA IrIk� oUkym m o Im IZ mw� pNp i N M 03 1 1 -i -3 rnZO II rn II I Z CV I 0 N h yOm 0 3 Q J morn o (� Z o o4)0 � I . ) 0 I -� I --I Po ^3 0 � O b 10' UTILITY EASEMENT •'V -- -- -- - 10' UTILITY EASEMENT -------------------- D -----------------1 �O 1 N m aDo m � 3dOlS 111AI %SZ + � ti< fl O 1 \ Oy A 1 <oF o a / 0 m Z A ovg �O zN oo? a v ly ► 3� If r m VIA in mmn Dcl ,�, O m< Z D m I arm -4r000 Oowz z oCy H app X�x1 n z d z OFo O n r• to n£awm-Iv-�r� I rtimD ry rn-. x mmmwvti mx A D I m H DZ P1a � zm�bm.pl rmm m Ir ,�gromr� U. I N f*lb rl'-'�10 Z 'AZcZ.T 77 �T7 (7 ob t'� rl�Qlt1 iod D0 2� in mmn Dcl ,�, O m< Z D m I arm -4r000 Oowz z oCy H app X�x1 n z d z OFo O n r• to I mx Ir U. I D0 2� �p IrIk� i3 Amm Im IZ mw� pNp y I rnZO I Z CV I CInK N yOm 0 3 Q J r Z PERFORMED FOR LEGAL DESCRIPTI DEPTH F E Pff), 1 / 2 3 F U oiW 5 6- 7 q f i' 0 ENCOUNTERED? 8 9- 4 , S IF YES, AT WHAT ._ L O DEPTH? 11) 10- 2 E 11 11 L I 12- 2 i / 13- 13 14 14- _ ly 15- 15 a 0 6 16- ie l 17 17 C p 8 18- 19- 1920 20 COMMENTS WAS GROUND WATER q f i' 0 ENCOUNTERED? /l1 Net Drop S IF YES, AT WHAT ._ L O DEPTH? P 2 E Depth to Water After �,�� Monitoring? Date: L I Reading Date Gross Time Net Time Depth to Water Net Drop `AIw — -- 2 q'33o 6172L 3 i / r _ ly �ey s/1/� q : 7/V ie l _ /e s/ 6_'C- SOP)KC tJ PERCOLATION RAE (minutes/inch) PERC HOLE DIAMETER v jr TEST RUN BETWEEN FT/AND �O 7 FT r TG[viG �xPt7✓c' A q /> 9 T7JCrd9!/ fu %i' �icT( � � Li o �,�Ti . S & S ENGINEERING PERFORMED BY: - / - - CERTIFY THAT THIS T ST WAS PERFORMED IN ACCORDANCE WITH.ItfAyRrAPIMM�#J"ISRGUI DELI NES IN EFFECT ON THIS DATE. DATE: �+ c 72-008 (Rev. 4/85) a1%11LL7 ROBERT C. COWAN, P.E. -lu CIVILENGINEERS ON-SITE WASTEWATER DISPOSAL SYSTEM (907)694-2979 CONSTRUCTION PRACTICES FAx(907) 694-1211 and MATERIAL SPECIFICATIONS 7ArPPRovALs EFERENCE: Lot 2, Block 1, Birch Hills Terrace #1 Subdivision May 20, 1999 ENERAL: SEWEq & WATEfl 1. The scope of this project includes the installation of a 1250 gallon septic tank and INSPECTION leachfield trench for the existing four bedroom house located on the referenced property. ENGINEERING STUDIES 2. Construction shall be in accordance with the approved site plan and design drawings, ANDREPORTS Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. WELLINSPECTION 3. The contractor shall be responsible for obtaining any necessaryundergroundutility &FLOWTEST locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final SITEPLANS grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal RDAnDESIGN Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: SOIL TEST 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction PERCOLATION shall include two 4" cleanouts for pumping access. TEST 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. STRUCTURAL& 3• All standpipes on the septic tank shall extend a minimum of 12 inches above final MECHANICAL INSPECTIONS grade. ONSITE - - WASTEWATER - - DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page 2 Lot 2, Block 1, Birch Hills Terrace #1 S/D May 20, 1999 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page 3 Lot 2, Block 1, Birch Hills Terrace #1 S/D May 20, 1999 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforate Soli Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: Page 4 Lot 2, Block 1, Birch Hills Terrace #1 S/D May 20, 1999 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER - jN1aN\L!TY( I -V M -W DRILLING, INC. DRILLING LOG Well Owner Use of Well Location (address of: Township, Range, Section, if known; or distance main road "lil.-I uo--I. . i x, I Size of casingDepth of Hole 1,50 feet Cased t feet Static water level ft. (46M) (below) land surface. Finish of well (check one) open end Screen ( ) ; Perforated ( Describe screen or perforati Well pumping test at = gallons per ( r) (minute) for 1 hours with J, O ft. of drawdown from static level. Date of completion WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness TO Casing Sticktip — 2 - STATE TO TO— Edltty CKayel TO an (ly G17 a%,TQ 1 TO ,edrock TO 5AItstane, broum TO TO i- I ji- t on P dark TO I 7i 'i nj zc' TO TO TO TO Nm'j-�'j 't —TO— TO 2 - STATE ���I (:�-- I, .,=I L I lr--, V' " r-4 F1 0 E: DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ^r 2516 E. TUDOR RD., ANCHORAGE, HK. 99507 276-2221 PERMIT NO. ( 76796 ) APPLICANT HARRY WHITMAN SRH BOX 247 E.R. 694-2387 LOCATION BIRCH HILLS DR LEGAL L2 81 BIRCH HILLS TERR #2 LOT SIZE 58080 SQUARE FEET MINIMUM DISTANCE BETWEEN H WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ����1 -T �" L_ 11 r--* ��F-i! ��E_ �FF_ " ���1 -1 �!! -. 7, R - - H F_ �. I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL/THE,,,,,m_--YSTEMTHE CODES. SIGNED:____ ---°-- -�_�_-����_-------- RPP CHNT>RR ITMHN ISSUED B c��~��������_DHTE��___������__�-�, January 18, 2978 Harry Whitman Star Route A Box 247 Eagle River, Alaska 99577 Subject: Permit Expiration .?1►► permit issued by this department for well and/or on -situ sever installation on Lot 2 Black 1 Birch dills Terrace Subdivision #1 has expired since the issue date exceeds one(l) year, in the event you still plan to install the well and/or on- site sewer system, a new permit is required. The original soil test may be used to obtain a current permit. if the well has been drilled, a well log should be sent to this department to document the installation date. if you have any questions regarding the above matiter, please contact this office immediately at 264-4720. Sincerely, Lee No Buchholz, R.S. Sanit Sanitarian x1ljh PI Li PA 3: C! 1: FT F1 L. 1 0 r- �� o"I r1j L; k_1 R-A Inc 1-0 Rai R=- DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2516 E [UDOR RD., ANCHORAGE, HK 507 276-2221 / ( L�� k:1 01__10 :10- EE ST EE 1_4 K RAI Ill"RE! RAI 1-1 1-1 PERMIT NO. ( 77000 ) APPLICANT HARRY WHITMAN SRH BOX 247 694-2387 LOCHTION BIRCH HILLS DR LEGHL 1_2 B1 BIRCH HILLS TER #1 LOT SIQ 10080 SQUARE FEET TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEI IS: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) uF THE -REwDH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS T E DISTANCE BETWEEN -HE SURFACE OF THI:,.-.': GROUND AND THE BOTTOM OF THE EXCAVA-ION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL �11E MINIMUM DE'"Th 0-- GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOI'y , OF -F z EXCAVATION :1 120 PEI 12) Ulf f"IK_K_K3K4A 43 tJ 3C FQ EE E:::-- PPCKFILLINO OF AND APPROVAL BY THIS DEPARTMENT WILL BE U|1U� / MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRI09TE WELL OR 200 TEET FOR H PUBLIC WELL. SPECIFICATIONS AND USTRUCTION DIAORAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. IMIE04101 1: 0- %AFIL. K I CERTIFY THAT 0 I HM FAMILIAR WITH- HE FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPAL I HORHGE. 2: I WILL INSTALL THE SYS77 IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE BEDROOMS. SIGNED -�-�'�-- ,2 '1 ,^ 0 & E GEC ECHNI CAL & DEVEL RMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Soils £t Foundations Land Development Performed for: Name: *1z-•-) W N0, t*% Tel. No. 49-1 ` 7 s Mailing Address: f Legal Description: o 7– Ale e-- . .z r' 7e � Death (feet) 0 1 2 \ 9 r 4 5 6 Soil Characteristics 7 8 �1 10, 11 15 16 Ground Water Encountered: Yes No �' If yes, what depth Proposed Installation: Seepage Pit Drain Field Performed by: Date: �„"" N Municipality of Anchorage �£ 8 Development Services Department Building Safety Division a$ On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-141-22 COSA# OSCI(a,I _ RS Expiration Date: b - /!V 1. GENERAL INFORMATION Complete legal description BIRCH HILLS TERRACE #1 BLOCK 1, LOT 2 Location (site address) 18015 N EAGLE RIVER LOOP, EAGLE RIVER, AK 99577 Current Property owner(s) BILLY & OPHELIA CROSS Day Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 18015 N EAGLE RIVER LOOP, EAGLE RIVER AK 99577 Day phone Day Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 (TESTED FOR 4) TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site M ❑ Individual Holding Tank ❑ Community On-site ® Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 868-3792 Address 20441 PTARMIGAN BLVD. EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 08/22/12 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 . encroachments, deficiencies or discrepancies exist. .; 5. DS, D SIGNATURE V Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: ---^ /Arsenic Havisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other BY �^ �o Original Certificate Date: (Rev. Wo Municipality of Anchorage e=°` Development Services Department ° Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/6nsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: BIRCH HILLS TERRACE #1 BLOCK 1, LOT 2 Parcel ID: 050-141-22 A. WELL DATA Well type PUBLIC If A, B, or C provide PWSID # _ Date completed Sanitary seal (YIN) Total depth ft. Date of test Static water level Well production Cased to ft. FROM WELL LOG WATER SAMPLE RESULTS: ft. 9 - p.m - Well Log (YIN) Wires properly protected (YIN) Casing height (above ground) in. AT INSPECTION ft. Coliform _colonies/100mL Nitrate mg/L Other bacteria colonies/100 mL Arsenic: mg/I Date of sample: Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Material Septic/HDPE Date installed S 91999 Tank size 1300 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) N Date of pumping S 17 2012 Pumper .IRR C. ABSORPTION FIELD DATA Date installed 8/9/1999 Soil rating (g.p.d./ftz or ftp/bdrm)1.2 System type Shallow Trench Length 50 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 12.2 ft. (Measured 8120112) Eff. absorption area 500 le tube Y Depression over field N Date of adequacy test 8/20112 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 18 in. Water added 800 gal. New depth 30 in. Elapsed Time: 1290 min. Final fluid depth 19.2 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFTSTATION 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. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line 51+ Absorption field 5'+ Water main 101+ Water service line 30'+ Surface water 1001+ Wells on adjacent lots 2001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 10'+ Water main 10'+ Water Service line 101+ Surface water 1001+ Driveway, parking/vehicle storage 101+ Curtain drain 501+ (None Known) Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION t 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. Engineer's Printed Name KENNETH M. DUFFUS Date 08/22/2012 COSA Fee $490.00` Date of Payment g 12q�1a C� o -L Receipt Number ©OSObT3 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number N8 '57'00"W (REC & HELD) 00.46' (199.96' REC 10' UTILITY EASEMENT PAVED —� WALK • J VENT w" (typ) =W O_ O m U N w00 z W N O ch� N of N (Wil P W W>_ A/WLd wU0 O O J u7 N C6 � WUCD O O N o O Z � I LOT 2 BLOCK 1 N8 '57'00"W (REC & HELD) 00.46' (199.96' REC 10' UTILITY EASEMENT PAVED —� WALK • SEPTIC VENT •• (typ) CONC PATIO EXISTING HOSE 3.1' 4.4' —E !-27.61 HEDS a ' 6.3' SHED a M .2 9gs�S1 SS A ^h OF 6 RO FgRiNc�2O� /VO���RF6 \ Loo A4, ANCHORAGE RECORDING DISTRICT \'b AS -BUILT OF: BIRCH HILLS TERRACE SUBD ADD #1 LOT 2 BLOCK 1 PLAT 69-211 SURVEY CERTIFICATION: I, John L. Schuller, have conducteda physical survey of this property as shown on this drawing and that the improvements situated thereon are within the property lines and no enchroachments exist other that noted. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. OCT 5, 2012 1 1"=30' 12-031 DRAWN BY: I CHECKED BY GRID NUMBER: BOOK/PP JLS NW 153 120165 O =FND 1" IRON PIPE OO = FND 5/8" REBAR OF..AL"Ns>,11 9 /JOHN L. SCHULLER. 0 to LS -10408 ' ,1�Pa 'E:p., �.� '. a5'i 30' 30' 4 � 0 P LAIV D �� 41 x� �t74 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax W O_ O m N O of P A/WLd wU0 WUCD O � .2 9gs�S1 SS A ^h OF 6 RO FgRiNc�2O� /VO���RF6 \ Loo A4, ANCHORAGE RECORDING DISTRICT \'b AS -BUILT OF: BIRCH HILLS TERRACE SUBD ADD #1 LOT 2 BLOCK 1 PLAT 69-211 SURVEY CERTIFICATION: I, John L. Schuller, have conducteda physical survey of this property as shown on this drawing and that the improvements situated thereon are within the property lines and no enchroachments exist other that noted. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. OCT 5, 2012 1 1"=30' 12-031 DRAWN BY: I CHECKED BY GRID NUMBER: BOOK/PP JLS NW 153 120165 O =FND 1" IRON PIPE OO = FND 5/8" REBAR OF..AL"Ns>,11 9 /JOHN L. SCHULLER. 0 to LS -10408 ' ,1�Pa 'E:p., �.� '. a5'i 30' 30' 4 � 0 P LAIV D �� 41 x� �t74 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax