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HomeMy WebLinkAboutT15N R1W SEC 9 LT 89T15N R1W. SECTION 9 Lot 89 #051-104 - 43 (--;---ThMunicipality fr SEi 1 \ of Anchorage-, m1t�= Development Services Department _' Building Safety Division �„ ,:.� On-Site Water and Wastewater Program, 4700 S. Bragaw St. �/ P.O. Box 196650 Anchorage, AK 99519-8650 Page ` www.ci,anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number SUJOLIC41 Qt 1 PID Number: O€ (- /04' -I- 3 of 3 Name:--t- --J �>`y}rV iLtE•ST System: Wy ❑New 0 Upgrade Address: 2064. catrty etaK RD, Grtxrac,At.4750 ABSORPTION FIELD Ne: ` Number of Bedrooms: O' 1 ,¢39, —24 ("9- Q Deep Trench KShallow Trench 0 Bed 0 Mound 0 Other: LEGAL DESCRIPTION Soil Rating. 1. D GPD/Ft2 Total Depth from original grade: ' 3Ft. BIOW: Lot: A ^ Subdivision: [,v�..,� Depth to pipe bottom from original grade: S FL Gravel depth beneath pipe: D, c Ft. Tovmship: N Range: �. IAS Section: ,v FBI added above miginN grade:<©.r1 Caeva) a k)_ 1\O Ft Well:rl'i l� 0 New ❑ Upgrade Petra-re- Gravel width. Ft. Numbbbet/ryfl�linee: ' "O"�C Dlatan �behaen linea: Ft. Classification (Private, A B, C): Total Depth: Cased to: Total absorption wee: 603 1) F� w PgeSes-M f(r 030{/Fsr 0FL Driller: . - • ed: Stege Water Level: • Ft. Installer: ROW)EKGAV#Tl Date Install d: 12x2104, Yield: GPM Pump Set at Ft. Casing Height Above Ground: Ft. TANK SEPARATION DISTANCES •:1 Septic 0 Holding 0 S.T.E.P. 0 Other To From Septic Tank Absorption Field Lift Station Holding Tank 'obit/Private Sewer Line Manufacturer. etrytt1r�- nor TFC. Capacity. 1 )O) Gal . Well v /(_ /TTTt tF/ . ISO, (/�/ �• �6t� Material: lib �� Number Compartments: 2 Surface Water 1004. XW' .. NA LIFT STATION Lot Line I 110 1.4t2.5 t Size: Manufacturer: Foundation t /�level V t t _ V V Pump on' atGal. in 'Pump Yr level a1' in High water alarm at: In Curtain Drain - N D IQ e K N O 1 I l .. �! Pump Make & • • Electrical inspections perfarmatl by: Remark.: tXtsilv4 Tn.9K. UM'S po,npEr. , BENCH MARK c., 44 O GCVSttSIN eget A utrat . ASawaoNit-o. Location and Description: Tor OF C...oA0e12K--tom a •b s r A • �t yy,, ORt�1(•`,�w.vh,^ne..- co a co*s PfegOrrioni Sir or'-'1f-0 Assumed Elevation: ,C/0r Ft. coni& 7t`Ly. a 1 o,[ M-0.4. A/We ,ico 01H1 I re 1T9ILei 4 Bttt-ow 1d_144..4 deoLK j�ih --"'(S At e \I' Inspections performed by: E ltt i ENGINEERING pates: tat 12///0 t/ r„c� ll r jti 11 ,, „ �„ „� ashRIsrL 1444 eagle Rtvar Loop reoad, _Dates: 7r, Eagle Elver, Alaska 99577 2nd / Z/ Z/DY _ r ROBERT C. COWAN is 4 y Development Services Department Approval ie Reviewed and approved by:([�. P Date: 1 19 -0� ;lit hll'q% CE - 8801 ,*�. t1tIt,. `:'•••.••.,,:-..• �'4 � 11.;„ (Rev r ^•_... -..,.• r PERMIT NO SW040481 PAGE 2 OF 3 Municipalityof Anchora e DEPARTMENT OF HEATH AND HUM9AN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 'Anchorage, Alaska 99519-6650 • Tele hone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 89, SECTION 9, T15N, R1W, S.M. P.LD. 140. 051-104-43 50' PATENT ROW RESERVE F,�—,��++L. �-1 I-�-I ry+ tx F -i ', At A . .. GALLON HOPE SEPTIC TANK E%19T�OARIVEV(AY CO CO T1 TMT` MT3 `` NEW TRENCHES ` ,111 V `MT2 02 MT4 SC .. o o C L- 0 w 0 w a 2 p i la i LE: 1" = 50' . "art* ST f • k DBL2 FS (FLOW SPLITTER) BM A ,.. FCO WI(.LL B nP'EPPLETLY � COMPLEYLY P. ot AGN WE`D oA''�3`r� r"r yjj iy ✓ T th 4 13 it ROBERT f II" CE Z1:Z,, (.'LFL, •41 •••.� 4 .....'• ? ! W t i.4-fv AI =N C. COWAN -8801 iO ....44- i PERMIT NO SW040481 PAGE 3 OF 3 Municipalit of Anchora e DEPARTMENT OF HEALTH AND HUMAN9SERVICES 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 89, SECTION 9, T15N, R1W, S.M. P.I.D. NO. 051-104-43 ST1 ST2 98.5' FINAL GRADE 1-1 2" INSULATION 94.2' C01 MT1 CO2 MT2 NEW 1300 GALLON POLYETHYLENE SEPTIC TANK 93.9' CO3 C01 = 98.7' MT3 C04 MT4 O = 00.' 1161 FCIN2AL GRAD1E6 •��� CO1 = 92.9' 'IIP!1!1 ' CO2 = 92.9'I I€ CO3 = 99.1' C04 = 100.5' A B FCO 10.0' 50.5' ST1 55.0' 100.0 ST2 58.0' 101.5' TMT 61.0' 104.5' DBL1 60.5' 103.5' DBL2 62.0' 104.5' FS 86.0' 1 1 6.5' CO1 74.5' 118.0' MT1 75.5' 1 1 9.0' CO2 106.5' 121.5' MT2 107.5' 123.0' CO3 91.0' 135.5' MT3 92.5' 137.0' C04 114.0' 134.5' MT4 116.5' 136.5' MT2 = 92.4' MT3 = 92.5' • WATER FOUND ® 85.3' 85.3' B.O.H. CO3 = 93.0' C04 = 93.1' N. T. S. t ' r A-�g,,no. i lif 1 t 'd00 is\ ROBERT C. COWAN ,4 (Pf• CE -8801 /41+ 4 e't t '?CFaS �+~r MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW040481 Legal Description: n -15N R1VV SEC 9 LT 89 Design Engineer: 0003 S & S Engineering Owner Name: JEAN PRIEST Owner Address: PO BOX 670405 CHUGIAK , AK 99567-0405 141164 ncon Date Issued: Nov 22, 2004 Expiration Date: Nov 22, 2005 Parcel ID: 051-104-43 Site Address: 020516 WHITE BIRCH RD Lot Size: 108900 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: 0✓ Disposal Field Septic Tank D Holding Tank Ej Privy IJ 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 DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 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. /Jure ; S$ s fri CHAv&e %gene/I 114./7y FRvn, iceer -cep Tv 8oei=,p fcr� Fou.JbartoAt F:pE Per fecon, NOQS.f7 DKtq.ej Cfinece if/wo✓cc,( Received B Date: ut (Z3/©z/ Issued By Date: r'/2 L /v Y Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.clanchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-1041 - yj Permit Number SW Property owner(s)dean/Priest / Day phone �1p/gg-0)1/0 7 I7 Mailing address t",O.Bo X D 7'o 9O.5 /L!'1 u5 !a k� AK- Zip Code ! .567 Site address ©SMD 4W e Birch Raga' Zip Code Legal description (Lot, Block & Sub'd.) LL 0f o_l Legal description (Section, Township & Range) Seef;0111 l0vl 9, 77 94 R 11i, $_M Lot Size /091g00 Acres/Sq.Ft. Number of Bedrooms g THIS APPLICATION IS FOR: Sewer Only 0 Well Only Sewer and Well ❑ Water Storage Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Jacuzzi 0 0 Water Softening Unit 0 0 I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. 21 (Signature of property owner or authorized agent) 8 & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Atoka 995,7 Permit/Rush Fees: IN 6 0. ' Waiver Fees: Date of Payment: // //71ey Receipt Number: 0 i o 8 4 y (Rev. 09/04) Date of Payment: Receipt Number: ineerinq HEALTHALRHORITY APPROVALS SEWER &WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION AROW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN November 17, 2004 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 89, Section 9, T15N, R1 W, S.M. ROBERT C. COWAN, P.E. CIVIL ENGINEERS (907) 694-2979 FAX(907)694.1211 It is requested that you issue a permit to install a septic system upgrade to serve the existing four bedroom dwelling on the referenced property. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation 10/14/04, water was found at 15 feet. After monitoring, ground water was found at 15 feet. 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, Ro6eft C. Cowan, P.E. RCC/bjj Enclosure 17034 NORTH EAGLE RIVER LOOP + SUITE 204 + EAGLE RIVER, ALASKA 99677 1" = 50' SCALE DESIGN SITE—PLAN Uf O> oocnoo r m N v m 0 N <D ® m m D o -o 0 0 0 0 n z :VRTHIPID rnV)A. 00 c' i= �N—0 O II II II 000 000 0�0 1:•1:13.09° O \ v l� p m O 1 A. U O O V zz 0 E rn m 0 tri 0 9 m0 C Zna 00 rnrn NO 501 PATENT ROW RESERVE 0 m C/) tri 0 0 z cri Mz GE OF ROA WHITE BIRCH READ "` Municipality of Anchorage Development Services Department Building Safety Division On-Slte Water and Wastewater Program 4700 South Bragaw St. P.O. Sox 196650 Anchorage, AK 99519.6650 www.munl.ag/onsite (907) 343-7904 Soils Log - Percolation Test Performed For: 'ILi fi-13-155Kr Legal Description: t -sr-- VI; Scc. 9 T S ni lope 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20 - Depth (Feet) k • or ,O rr a) r 0 -c,143 3W\ 5oc4- (P) Y gttu ROBERT C. COWAN CE -8801 4 y� V 11 pA f`gs vol‘+=4� Date Performed: WAS GROUND WATER ENCOUNTERED? i65 1 W YES, AT WHAT DEPTH? iS L Depth to Water After d Monitoring? I r E Date: 60,27/1 Site Plan &vTT 4-T"-4 c ) c; rr 1) Reading Date Groes Time Nat Time Depth to Water Net Drop i D ink/ — — 6" --- I0 (0 ! 0 4, r Li', i0 ZO .-• rr to o (D '— 6'r PERCOLATION RATE S ]„• (Snowman man PERC HOLE DIAMETER TEST RUN BETWEEN LiFT AND 5 FT COMMENTS Mat_ ,40(ttoric,biey ,c MHO (0 Xi /.Nom's. PERFORMED BY: Yo ✓pf 1 J �JvC1 1 "//G. Nfw CERTIFY THAT THIS TEST AS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEL NES IN EFFECT ON THIS DATE. DATE: I a 77 yid y :•:�:' r4 S&S czneezlnc mkt NEALTNNRNORITY APPROVALS SEWERS WATER AVONEIOENSIONS SEWER&WATER INSPECTION ENGINEERINOSTUCIES AND REPORTS WELL INSPECTION SMOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURALS MECHANICAL INSPECTIONS CN SITE WASTEWATER DISPOSAL SYSTEM DESIGN I ., ROBERT C. COWAN, P.E. CIVIL ENGINEERS (907)694-2979 FAX (907) 694-1211 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 89, Section 9, T15N, R1 W, S.M. November 17, 2004 GENERAL: 1. The scope of this project includes the installation of a new 1300 gallon HDPE septic tank and new trenches to serve the existing four bedroom residence located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 17034 NORTH EAGLE RIVER LOOP SUITE204 • EAGLE RIVER, ALASKA99577 Page 2 Lot 89, Section 9, T15N, MW, S.M. November 17, 2004 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 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 89, Section 9, T15N, R1 W, S.M. November 17, 2004 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: Tvve of Pipe Perforated Solid 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, whichever requirement applies. Page 4 Lot 89, Section 9, T15N, R1 W, B.M. November 17, 2004 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: 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 r LOCATION OF WELL (Please complete WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geologiccl 9 Geophysical Surveys Drilling Permit No. either lo, Ib or Ic.) A.D.L. No. a. ij Soro ugh Subdiv ielon Anch Lot 89 Block HZ lie giro. Section No. TownshipN Range E Meridian _ol__ol__of — 9 15 so 1 1Seward -�`7 DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS Street Address and Area of Well Location 3. OWNER OF WELL:Mrs. Jean priest Address P.O. Box 670405 Chugiak, Ak. 99567 2. WELL LOG Material Type -five7tnzrd%n - "Greenstone -tie errsLane—w-ith water CEeenstone with .layers Foot Below g WELLDEPTH: (final) 5. DATE OF COMPLETION Surface _--5fl. — 9 12 - 84 Top Bottom-.------__, cr — 5T uf—p-r-ey—ro-ric 57— G. C7 Coble tool fJRatary J Driven ❑ Dug f7) L7 A qtr, [-] Jelled ❑ gored ❑ other 7. UV/J-3 Demotic n Public Supply L) industry T"r O LL -(01..; 0 Irrigation 0 Recharge LJ Commerical Test Well u Other: R. CASIN'O, Cl Threaded 0 Welded diem. 6 . in. 100 11. Depth Weight _17 1bo./ n lo_ -___ IL Depth Stickup__ It, 9 FINISH OF WELL: MUNICIPALITY -OP AN -DEPT, _ENVIRONMENTAL PR FEB- RAGE TECTIOTF Slol/Mesh Site, Length: Sot belweon _.._ 11. and It. Backfilling Gravel pock ___ 10. STATIC WATER LEVEL: _ 1 50 _ ry, 9 / 1' 8 n Above or XII") Below land surface Date Equipment used: 15. WATER WELL CONTRACTORS CERTIFICATION: II PUMPING LEVEL below land surface and YIELD --_ _--_-fl. altar ^— hrs. pumping __ ft alter hrs. pumpingg. p. m. 12. GROUTING Well Grouted: Li Yes O No Material: n Neat Cement 0 Other: 13. PUMP: (if available) HP Length of Drop Pipe It. capacity g.p.m. Subic. O del 0 Contrition! 0 Other 19. REMARKS: Production of 450 gal per di 15. Wolof Temperature _ Cl F u c This roll wos drilled under my jurisdiction and Ibis report is Irue to the hes' of my knowledge and belief; AA E385 pnuson Drilling ROVlstured Business Noma Conlrocl License Ncmbor )'99577 Address: Box 770504 Engle A'<, J. Dols: Sept. T4, 1984 Authorized H rum 02 (II/SII Copy DisHrbution: WHITE - Slate DeIGS, PINK - O lle,, CANARY- Customer ry oN :pool SSSO . "• I 'i II_ 1 " IC 1r c.]r IF'= P='916''.N C_i: . DI F42.lf-'YI N::. r IL .. DEPARTMENT DF HEALTH AND EENVIRONMEENTAL. PROTECTION la25 L STREET, ANCHORAGE, AK 995c)1.• 641. ..... 4.72 0 IC PN'.0 96 1 'Tr 14IEr1 8...:.. F" '=:Ir o i I "lf' PERM NO: E440746 DATE . ISSUED: 09/05/84 APPLICANT: J.T. PRIEST ADDRESS: BOX 6704405 CHUf3IAKa Al: 99567 CON1AC;T PHONE: ;SSC' 5147 L.E.GAL.. DEr.:SCR1P: ;3HE)DIVLSION: NA LOT: 89 SECTION: 9 TOWNSHIP: :L5N RANGE: 1W LOT SIZE: 2.5A mon. OR ACRES) 64)6 .7-s P - BLOCK: NA 1: certify that..: 1.. I am familiar with the requirements for on—site sewers and wel is as Set. forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2.. I wi.1l install tare syst.earn in accordance with all MOA codes and regulat.ior7<.>a and in compliance with the deasign criteria of this permit. `i. 1 will adhere to ail MOA and State of Alaska requirements for the set.• back distances f. any existing well, wastewater disposal 'system or public sewerage 5i't. Gi?frl on this or many ad.aac::ent. Di' nearby lot. 8 Ii3NEED APPLICANT: 3ST ISSUED E DATE: 5. DAT[_: €x 157--7/VI tS pTec MUNICIPALITY OF ANCHORAGE 421,1 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. 051-104-43 Legal description T15N R1 W SEC 9 LT 89 Site address 20516 WHITE BIRCH RD Chugiak AK Current property owner(s) PETRI E `_ / 2 '1 / -2- Expiration Date: -' / X The On -site system(s) is/are approved for 4 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: Original Certificate Date: 6/18/2024 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 ApprovWjune 2022 MUNICIPALITY OF ANCHORAG Development Services Departmen t 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. 051-104-43 Complete legal description T1 5N R1 W Sec 9 Lot 89 Location (site address) 20516 White Birch Rd Current property owner(s) Michael & Sherryl Petrie 2. ON -SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: A 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: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel X Plastic ❑ Concrete ❑ Fiberglass Age 'Z- C - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench no 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 $ ESQ Date of Payment COSA # Waiver Fee $ Date of Payment Waiver # COSA Application —June 2022 Legal Description: COSA Checklist T15N R1 W Sec 9 Lot 89 Parcel ID: 051-104-43 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑N Well log is filed with Onsite (or attached) Date drilled 9112/84 Total depth 505 ft Cased to 60 ft FE-1 Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 6/3/24 Static water level at beginning of test 15.7 ft. Comments B. TANK DATA Measured operating fluid level in septic tank Date of pumping 6/13/24 Sanitary Pumpers ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 12/2/04 FO-1 ALL standpipes present per record drawing Total measured depth from grade 6.4/8.2 ft (max) Measured depth to pipe invert from grade 5.8/7.7 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. FO-1 Monitor tubes go to bottom of effective. 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 N/A gallons N/A date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Comments/Deficiencies: Fields listed South / North Well production at time of test 7.5 gpm Water storage tank volume None gallons Well disinfected for coliform test? ❑ Yes ❑N No R Coliform bacteria is Negative Nitrate 1.78 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L F Arsenic less than MRL (ND) Collected by FORGE ENGINEERING Date 5/24/24 i ired maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 6/3/24 Results 0 Pass Fluid depth prior to test Water added 662 gal New fluid depth 3/0 it 0/0 in Elapsed time 30 min Final fluid depth 0/0 in Absorption rate >600 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 Effective depth used 0 in Effective depth remaining 6 in In COSA Checklist June 2022 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' Community Sewer Manhole/Cleanout > 100' © Yes if No ft FC Yes if No Neighboring Tank > 100' n Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' 9 Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' ❑N Yes if No ❑o Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' no Yes if No ft © Yes if No ❑ 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 Surface Water > 100' ❑E Yes if No _ Tank to Property Line > 5' Fw� Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' Fol Yes if No ft Private Wells > 100' 5E� Yes if No _ Water Main > 10' © Yes if No ft Community Wells > 200' Q Yes if No _ Water Service Line > 10' E Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS ft ft ft ft ft ft ft ft 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 Forge Engineering Engineer's Printed Name Benjamin Schiller, P.E. Phone (907) 522-7773 Date 6/3/24 Aw • ACq�I� 49 TH �w BenjarrirtSchiller CE 12592 •�`��/ PROFESSION" COSA Checklist —June 2022 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Re-rsscrt Parcel I.D. 051-104-49 HAA# 0S-001 Expiration Date: 7 - a. /- 1. - 1. GENERAL INFORMATION Complete legal description Lot 89: Section 9! T15t1• R 11 Location (site address or directions) 20516 Whirr R 1 rrh Rd Current Property owner(s) Jean Priest Day phone 688-2467 Mailing address Lending agency Mailing address Real Estate Agent PO Box 670405 Chugiak, AK 99567 Day phone Steve Wisnewski Mailing Address Greatland Realty Eagle River Day phone 351-0438 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank 0 Community On-site 0 Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 Health Authority 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 S S s FngjnPPrinp Phone 694-7974 Address 17034 N. Eap1e River Loon Ste. 204 Eae1e River, AR 99577 Engineer's Printed Name P08(4.7- C . C01.1, . Date q l a o /or • c2 ' O A 9 • 5. DSD SIGNATURE t, Approved for Disapproved. Conditional approval for bedrooms. iv▪ 5v ROB 27 C. COV/AN. fr CE -8801 , ",moi Ilii '':•� _:':v`� •• bedrooms, with the following stipulations: Additional Comments QP��`(OF r /ir 0, .z. ON -Si z`: WATER AND • R • WASTEWATER • •PROGRAM . 1/i' LtNI SESCC. , Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: )1,./ Ptet (Rev. 01/02) Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel I.D. 05t-104-41 1. GENERAL INFORMATION Compietelegaldescription- Lot 89: Section 9• Ti 5N: R1W Roil ear. C., Cows,,, HAA # 05-001 Expiration Date: L/' - (9 — QD Location (site address or directions) 211516 whirs Ring! Rnmd Current Property owner(s) Jean Priest Mailing address PO Box 670405 Chugiak, Day phone 688-2467 AK 99567 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA 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 4 TYPE OF WASTEWATER DISPOSAL: Individual On-site] Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HM) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 Health Authority 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. 1 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 S & S Engineering Phone 694-2979 Address 17034 N. Eaa1e River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan Date / //3 0r 4„ti,C¢.YC`y�t' -,/v, ;71u r su• 5. DSD SIGNATURE /� ' S BCE 8801 COWANC. if 17 Approved for '-f- bedrooms. iti; �....... Disapproved. �''Rzwaai-avc•-- Conditional approval for bedrooms, with the following stipulations: Additional Comments \��lt /1 OFAseti •• `y� QQ .c- • : otg.strE WATERAND 1NASTEWA RER • �J �•1•l •••((j,� �J�JJI . %1111tt Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: S • (Rev.01/02) Original Certificate Date: I - / a ^ 0 5 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Ler S9; SEC. `j T/5510; F -(t0 Parcel ID: OS/- io4-'13 A. WELL DATA Well type .IVM'T& If A, B, or C provide PWSID # _ Date completed I- 12 -Wt Sanitary seal ON) qeS Total depth 50S1 ft. Cased to 601 ft. FROM WELL LOG Date of test Static water level /50' Well production 0•3 1 WATER SAMPLE RESULTS: Coliform d colonies/100 mi. Nitrate beg mg./l. Arsenic: mg./I. Date of sample: 12 -1y -o4 B. SEPTIC/HOLDING TANK DATA Tank Type/Material 'SePT-lc/ Ff-WPE- Date installed 1Z-(-Ot( Tank size 13c>o gal. Number of Compartments Z CleanoutseN)Yss Foundation leanoutON) g Depression over tank (Y® High water alarm (Y/N) Date of pumping 1.1640 5V/fPumper C. ABSORPTION FIELD DATA Date installed 12-2-0 Li Soil rating (g.p.d./ft2orft2/bdrm) /.O System type 5&fl-tLO tectU ,t{ Length 1 20 ft. Width S ft. Gravel below pipe 0. 5 ft. Total depth PJB ft. Eff. absorption area 600ft2 Monitoring tube '/E3 Depression over field &)O Date of adequacy test A•1E1/4° SYSTT-4/1 Results (Pass/Fail) Fluid depth in absorption field before test = in. Water added =gal ft. g.p.m: Well LogON) ate • Wires properly protected h) '1Eg Casing height (above ground) I Z"+ in. AT INSPECTION 12 -,q -off 3. N g.p.m. Other bacteria 0 colonies/100 ml Collected by: _ tb Elapsed Time: — min. Final fluid depth = in. Any rejuvenation treatment (past 12 mo.) (YM & type) For bedrooms New depth= in. Absorption rate >= — g.p.d. If yes give date — Date installed ^ Size in gallons — Manhole/Access (Y/N) "Pump on" level at — in. "Pump off' level at = in. High water alarm level at Datum _ Cycles tested — Meets alarm & circuit requirements? —E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: leo Septic tank/lift station on lot �ZnIi On adjacent lots /too r Absorption field on lot 1 WOn adjacent lots !OO /+ Public sewer main N PA Public sewer manhole/cleanout /0 bi- Sewer /septic service line 25'+ Holding tank W SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Sa' Property line t 10 t Absorption field S /4 Water main lV Yl Water service line l0 it Surface water (001+, in. Wells on adjacent lots 100 4 - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line j be 6 r Building foundation V Z / Water main 1314- Water Service line 10 4- Surface water _ / OCD+ Driveway, parking/vehicle storage I0 /t Curtain drain 130106 luxxOe)Wells on adjacent lots l00 it 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 HAA guidelines in effect on this date. lC Engineer's Printed Name oOtt4r C. Co wN.0 Date l /i3/os cr:„...iss4 gy-tests OF 4:'1 k, /� V rano .. ;o i ROBERT C. COWAN1 CE•8801 14:71; ,''',..S..4.le HAA Fee $ Date of Payment Receipt Number (Rev. 12/01) o 6a(pi / ;7'A Waiver Fee $ Date of Payment Receipt Number . V G V .t ASBUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED.IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS,COVENANTS,OR RESTRICTIONS WHICH D0 NOT APPEAR ON THE RECORDED SUBD|- VISION PLAT.UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES,OR FOR ESTABLISHING BOUND- ARY LINES. A SEHARD &ASSOCIATES LAND SURVEYING 694-0829 SCALE so DATE:EOF Dions Mt Saward LS -5918 LandSur A GRID: FB:ros-o6 DRAWN: