HomeMy WebLinkAboutT15N R1W SEC 18 LT 183B1 (BLM)T15N RIW
Sec 18
Lot 18361
#051-232-55
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP231398 PID Number: 051-232-55
Dwelling: M Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 9 Upgrade
Vame
HAINES ABSORPTION FIELD
Site Address
18306 BRICHTREE ST, CHUGIAK ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
❑ Other
'hone Number of Bedrooms Soil Rating Total depth from original grade
2
LEGAL DESCRIPTION
GPD/SF
Depth to pipe invert from original grade
Gravel depth beneath pipe
Ft.
Subdivision
Block Lot
T15N R1 W SEC 18 LT 183 B1
Ft
Ft.
Township Range Section
Fill added above original grade
Grave( length
Ft.
Ft.
Gravel width Beds: Number
of Lines Distance between lines
SEPARATION DISTANCES
To Septic Absorption Holding
Tank Lift Station
Sewer
Ft. Ft.
Total absorption area Number of trenches Dist. between trenches
Field
From Tank
Line
Ftz
Ft.
Well
100'.}.
�0�+
TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Capacity
Surface Water
1001+
ANCH TANK
1000
Gal.
Material
Number of compartments
Lot Line
10'+
NA
PLASTIC
2
Foundation
*(j1+
LIFT STATION
Manufacturer
Capacity
Remarks TANK DEMO PER UPC, *MOA WAIVER,
Gal.
*CRIB IS OUTSIDE FOUNDATION BEARING
Alarm location
Electrical installed by
Installer IPIPEMATERIAL House to tank 3034
MIKE N ANDERSON, P.E. Drainfield
Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 100 -
Inspection ates: 1a 12/21/23 2nd Location and description
3`d 4t' TOP OF MANHOLE 100
ON-SITE WATER AND WASTEWATER SECTION APPROVAL Eagigf-
— G)
.
...........
• WCHAEL N. AN0LR_1c;4
j �� f•. CE- 946-9 • -
�����8 \�.=•�` yam~ y
Approval:
Date
Septic System/
Approved Date
N : this approval does not include well permit requirerr
Tank to 3034
drainfield
CO/MT 3034
ft
ȭ
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP231398
Work Type: SepticTank Upgrade
Tax Code Number: 05123255000
Site Legal Address: T15N R1 W SEC 18 LT 183131 (BLM) G:1054
Site Mailing Address: 18306 BIRCHTREE ST, Chugiak
Owner: HAINES AMBER L
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date:
t»cnr [
:J
Q
t�eharrmenr
Lot Size in Sq Ft:
Total Bedrooms:
11 /29/2023
11 /28/2024
22417
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions:
• The limits of the existing seepage pit are to be located to ensure separation between new tank and pit is
maintained.
Received By:
Issued By: l /
Date:
Date: I i `Z.S Z Z, Z 3
3
MUNICIPALITY OF ANCHORAGE
Development Services Department s Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
izA.'J, ��.
ON -SITE SEPTIC/WELL PERMIT APPLICATION H,
Parcel I.D. 051-232-55
Property owner(s) FRED OWENS Day phone
Mailing address 18306 BIRCHTREE ST, CHUGIAK AK 99567
Site address SAME
Legal description (Sub'd., Block & Lot) T15N R1 W SEC 18 LT 183131 (BLM)
Legal description (Township, Range & Section)
Lot Size 22,417 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑ Initial ❑
Single Family (SF) El
Septic Tank
El_ Upgrade 0
(w/wo ADU)
(D) ElRenewal
Holding Tank
El Renewal❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
[]
Water Storage
❑
THIS APPLICATION
INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: ) (� Waiver Fees:
Date of Payment: Z-0'(A Date of Payment:
Receipt Number: Receipt Number:
Permit No. 0 .S P 2 3 �,Y" Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
Nov. 27, 2023
Municipalities of Anchorage
On-Site Water and Waste Water Section
4700 Elmore Rd
Anchorage, Alaska
Phone 343-7904
Re: New septic tank permit
Legal: T15N R1W SEC 18 LT 183B1 (BLM)
To whom it may concern:
This is a request for a septic tank permit on the above referenced lot. This tank
replacement will not impact any of the neighbors or encroach on any wells, septic or
open water issues. The tank will be decommissioned per the Uniform Plumbing
Code (UPC).
Sincerely
Michael N. Anderson, P.E.
4661 Natrona
Anch, Ak 99516
Ph 727-8864
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231398, Curtis Townsend, 11/29/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231398, Curtis Townsend, 11/29/23
HOUSE DETAIL
Scale: 1 "=30'
3.8'x7.5'
:7'
.2' PORCH
4 25.1 '
3.5
DECK DECK 2 S-fORY v
RESiDLNOE
1231.5'
I
I
CHAIN -LINK FENCE
Lot 184 F—
Z
O
O 8.3'xl5.2' SHED
O "
CA
CC I CHAIN -LINK FENCE
4.7'xII.9'
DECK
Lot 183A
50' TEMPORARY TURN —AROUND
EAST 298,84'
8.1'x13.7FWEL3
GREENHOUSE QUONSET HUT
7'x8' LEAN _TO
12.3'02.1' SHED
cn
Lot 183—B1
O 22,417 S.F.
O
* WEST 298.94'
� L*
VCHAIN-LINK FENCE
Lot 187 Lot 188A
50.0'
ROAD RESERVATION
O
GRAVEL -
SEPTIC DRIVEWAY,
1
O
a
PIPES
O
i.,!
^
l J
F
6.1'
SEE HOUSE
uVi
rn
DETAIL
00
M
VJ
FENCE rq
6 30.0' rl
3' ROAD RESERVATON-I
PLOT PLAN ___ AS BUILT x_ SCALE _1 __40-_ GRID _ NW 1054� Project No. ____ 23-489fA1___
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone �`
ken0Iangsurvey.com �� ``
Professional Land Surveyors jonathan®langsurvey.com s! of At.
travis®Iangsurvey.com
dW
I hereby certify that I have surveyed the following described property: '
LOT 183—B1, SECTION 18, T15N, R1W, SEWARD MERIDIAN, ALASKA (PLAT No. 80-78) ��.*.' 49T
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 0
no improvements on the property lying adjacent thereto encroach on the surveyed J
premises and that there are no roadways, transmission lines or other visible I • KENNETH G LAN • ••o
easements on said property except as indicated hereon.
Dated this the _ L31� _ Day of _ o��o��. _���'_, at Anchorage, Alaska f`c'PFOpkA1i'3'ApS�.��
It is the responsibility of the owner to determine the existence of any easements, OFESSIONNOY
covenants, or restrictions which do not appear on the recorded subdivision plat. State of Alaska AECC963
AS ' 13,;'14 1N{o?P'hf 1,rni A-
wff-:P� STg2A �F 71-A014, (5TCrcAys
ciD3oIVZ/
ALASKA. WATER & WASTEWATER
gym= CONSULTANTS, INC.
May 8, 2003
Municipality of Anchorage
Development Service Department
Building Safety Division
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, Alaska 99519-6650
Attn: Jeff Poet
REFERENCE: TI 5N, RI W, Section 18, Lot 183-B 1: Water Storage upgrade within the
Municipality of Anchorage (MOA).
On 12/20/2002, a site visit was performed on the referenced property in order to perform
a well flow test and septic adequacy test. The well was tested and found to have a
production of 0.15 gallons a minute which does not meet the M.O.A. standards. The
homeowner was then notified that 500+ gallons of storage were needed in order for it to
meet M.O.A. requirements and to obtain a Health Authority Approval. The homeowner
contacted Larry Cool to install 500+ gallons of storage. Neither the homeowner or the
certified plumber were unaware that a permit was required. A new 40 gallon pressure
tank and three 165 -gallon holding tanks were installed by Larry Cool and are N.F.S.
approved tanks. There now is 500+ gallons of storage inside the house which meets
M.O.A. requirements for a 2 bedroom water storage system. We request you issue a water
storage permit for the existing water storage system.
If you have any questions, please contact us at 337-6179.
Sincerely,
Jeffrey A. Garness, P.E., M.S.
President
6901 Debarr Road, Suite 2-B " Anchorage, Alaska 99504
Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: akwwc.com
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
ONSITE WATER SUPPLY PERMIT
Initial
Date Issued: May 29, 2003
Expiration Date: May 28, 2004
Permit Number: SW030162 Parcel ID: 051-232-55
Legal Description: T15N R1W SEC 18 LT 18361 (BLM)
Design Engineer: 0041 AK Water & Wastewater Consultan- Site Address: 018306 BIRCHTREE ST
Owner Name: CHERYL PAYNE Lot Size: 22417 SQ. FT.
Owner Address: 18306 BIRCHTREE ST Total Bedrooms: 2 Permit Bedrooms: 2
CHUGIAK , AK 99567-0674
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 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.
Received By:
Issued By:
Date: 5.30'63
Date:. 2 / 'o3
Municipality of Anchorage
u .w•;,, n?cerr,'�
` 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
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-232-55 Permit Number S 6t/ a TOI 6 2
Property owner(s) CHERYL R. PAYNE Day phone 242-7500 (AGENTI
Mailing address (1) 16635 CENTERFIELD DRIVE * EAGLE RIVER. AK (AGENT)
S ITE
4a4ai4 m"ddress (2) IR C N T k 0 E S 7-J? Er % Zip Code 99577
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range) SECTION 18. T15N. R1W, LOT 183-61,
Lot Size 224417- Acre q.Ft. Number of Bedrooms 2
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
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.
ALASKA WATER & WASTEWATER CONSULTANTS INC.
Permit Fees:
Date of Payment:
Receipt Number.
Aj
Waiver Fees-, / a 00.96
Date of Payment: J`! 2 B %a3
Receipt Number: 3G 1.3'?
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
625 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
DISTANCES
1Tg
SEPTIC
ABSORPTION
WELL
Address
FROM
TANK
FIELD
phones) Permit NO. No. of Bedrooms
WELL
11�j
pp
1� � ti773 e5PI c> t Z
LOT LINE
t
p
t
LEGAL DESCRIPTION
Lot
Block
Subdivision
X63-t31
-�
FOUNDATION
Township, Range, Section
AS-BUILT DIAGRAM
(Show location of well,
septic system, property
lines, foundetwn,
7 C�
driveway, water bodies,
etc.)
TANKS
_
K
Q-SEPTIC ❑ HOLDING j
Manufacturer Capacity in gallons
_ `
Materiel No. of Compartments
Gy(' 2
I
TYPE OF SYSTEM
OTHER
❑ TRENCH ❑ BED ❑ W. DRAIN a
Depth to pipe bottom here Total depth from original grade
original grade t FT
Z
Fill added above original grade Gravel depth beneath pipe
•
FT
Gravel length Gravel width
FT FT
Total absorption area Distance between lines
SQ FT FT
Number of lines Soil rating Pipe material
SQ F
Installer Date Install9d
kfc cods r 6 t7 S3 9
t.
WELLS
�RIVATE ❑ OTHER Ildenlifvl
41.\
\
Classification (A,B,C) Total Depth Cased to
k�1� FT FT
t
Installer Date Installed',
\
REMARKS:
V
Ljl<1k1tA
ii
,yL�� SO, IS: �'Lp
Ji -t JM ( •1' Inspections Performed by.
ENGINEER'S SEAL
A
Pt r=S t tsi Date
,•�,� �9�A
.:R�`,OF
%NmIKIFFRING8q- �¢��
�r,:
o
••s
le River Loop Road No. 204
17034 Eag cattily that thl Inspection was performed according to all
Pae¢° a "1. .4 e°eee
Eagle 1ve ,..u........•
°
,4
Municipal and State guidelines in ellect o Is dale: R !
< A. Shelfa• w�
^f
$�
No. 1457-E
9Fq °1• ~1..'
Health Department Approval: Date:-`
q °e••°"".
72-013 (3/85)
MUNICIPALITY
Department of Health
825 L Street, Anchorage,
DN~SITE SEPT1C
OF NCHORAGE
&Hu n Services
Ala ske� 99501 343~
/
�r�
TANK PERMIT
Permit Number: 890161 Upgrade 6111 Was /
Date Issued: 08/11/89 Engineer Designed
Owner Name: MICHAEL J" AMARAL Day Phone:
Owner Address: 8R1 BOX 2225 688~2773
CHUGTAK, AK 99567
Parcel Id: 051-232.55
Lot Legal: Subdivision: - Lot: - Block: ~
Section: IS Township: 15N Ranges 1W
8LM LOT 183-B1
Lot Size 22117 (sq"ft" or acres)
Max Bedrooms: This Permit: 2 Total Capacity: 2
SEPTIC TANK: Minimum total septic tank capacity: 1,000 gallons" Each septic
tank must have at least 2 compartments" Depth to top of septic tank(s) < 4^0
feet requires insulation over tank(s)"
PER TELECON WITH B. SHAFER INSTALL 45 AFTER FOUNDATION CO AND
SET TANK IN A STRAIT LINE FROM CO" THIS PERMIT IS ISSUED FOR
THE EXISTING 2 BEDROOM SINGLE FAMILY DWELLING ONLY AND EXPIRES
ON 12/31/89. PLEASE NOTIFY DHHS PRIOR TO EACH INSPECTION.
I CERTIFY THAT:
I. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska"
2^ I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.,
S. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot,,
4. I understand th td for a maximum of 2 hedrooms" l
also u the total system is 2 bedrooms and
any enlargem. i will equire an additional permit.
Signed: DATE:
.1 . 1- ;.-....-1,... .. .....' . . ... ... . ..... ..... ..... .~'~_
<Owner> � ^
Issued By: / DATE:
..... ..... --~~---~...... ....~
1 11� Z�r
>a
SAIL a
ga Thr--3�-
0
L ler��5l
kc;;,r1 �-"
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1 Ih-v, t 443
s� -T-o ie;, F�y
QJNtPtrSG P� ��T4� Spr1D i
I� i ea R ��,� �•s�--i fir._
Ory'• m .
.m a
GRE 'ER ANCHORAGE AREA BO' 'UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME WiffAie-115/40 MAILING ADDRESS F0'?W 7-q3/ _�/�VC. ]P"HONEE 699"(2
fr2
LOCATION #1N14 CrM a'"�`-d - LEGAL DESCRIPTION�TITif
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
SEEPAGE PIT:
MANUFACTURER iftfC "7-J5�(' MATERIAL
STacL_
NUMBER OF
COMPARTMENTS Z -
INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /OwGALLONS.
NUMBER OF PITS I. DIAMETER AOR WIDTH LLr, LENGTH -W, DEPTH /Of
{r
LINING MATERIAL O� CRIB SIZE: DIAMETER u DEPTH k DISTANCE FROM: WELL /00/
BUILDING FOUNDATIONI/ , NEAREST LOT LINE Sem
ADDITIONAL ABSORPTION
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) �BS ^ SQ. FT.
WELL: /\��
TYPE %,,ICL �� CONSTRUCTION J'p01)A'I?D DEPTH /60, DISTANCE FROM:
BUILDING NEAREST
FOUNDATION LOT LINE
CESSPOOL
APPROVED
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
6sr 7! p'
LOT SLOPE
OTHER SOURCES
DISAPPROVED
3RE ARKS:
u
Form No. EQ -031
NEAREST SEPTIC . SEEPAGE
SEWER LINE -,TANK SYSTEM
REMA
DIAGRAM OF SYSTEM
GAA8,HD I GR`'ITER ANCHORAGE AREA BOROV FH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
�2-'✓✓'.Gj�f-/ MAILING
NAME
ADDRESS
DESCRIPTIO
SEPTIC TANK:
HONE.i�
NUMBER OF
DISTANCE FROM WELL MATERIAL ���. L— COMPARTMENTS
LIQUID
LIQUID CAPACITY .11Z, GALLONS. INSIDE LENGTH = 4_`
"YNSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT
NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH LENGTH
_�, DEPTH,
LINING MATERIAL �Au�✓�''/'j,G" ���✓G��- . DISTANCE FROM WELL el' BUILDING FOUNDATION,
NEAREST LOT LINE-> TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.'
TILE DRAIN FIELD:
DISTANCE FROM WELL_
NUMBER OF ES
AB RPTION AREA
ON , NEAREST LOT LI
STANCE BETWEEN LINES
FT. LENGTH OF EACH LINE
TOTAL LENGTH
OF LINES_
TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE —DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL; i� DISTANCE FROM_, i WATER '
TYPE /'.��A-t.c. ' DEPTH ,BUILDING FOUNDATION. - SAMPLES � �NEAREST
LOT LINE _� 1-� SEWERNEAREST
SEPTI�TANKC r SEEPAGE / OTHER
of SYSTEM /�/j , CESSPOOL—(— SOURCES __�L—
DIAGRAM OF SYSTEM
DISTANCES:
,- m
soa
DATE
GAAB-nD-2 GREATEN. ANCHORAGE AREA <- OROUGH Case No. IV
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501
279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT} �k) fi'I. �� ICL 1 _ MAILING ADDRESS / PHONE N0. " 226116
RESIDENCE ADDRESS3 �YGh UJ�Jd �l LOO c7 LOCATION OF INSTALLATION/ C Ak)Ood LOe'p_
LEGAL DESCRIPTION _L O I- J$3 71b /l X / W S RLC ' I ff
APPLICATION TO INSTALL: SEPTIC TANK, SEEPAGE PIT , DRAIN FIELD , OTHER
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH Fir, / L TO BE INSTALLED BY
PERCOLATION TEST RESULTS 2,5_4 i1, �&, ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
M/�/� ['
THIS IS TO SERVE AS /--1 r. B Q a PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED g6en 1 r(J�
SEPTIC TANK SIZETYPE E' a SEEPAGE AREPe4.90M9W1__7rTYP rl
DIAGRAM OF SYSTEM
DISTANCES:
Health Authority
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE APPLICANTS SIGNATURE
a +( %I() -
h' 1, 1% tUt nrJL;){
ANCh3C)RA('"<;, A1,f�.`'kP. 9450X
pe.fozrued Aor fj
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cry. aricz Pes,.
a
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FeC,
Soil CII a-.-Z1:;riSu ire
. ,...,..... ...... p+.......
The s�di "YJ enIs
(OOsely Cor„I 00 -cd
a IoW Oi b cz” iPY't
1110 re w(r^e Sonne-
C,0(4 r`es c n A, p e G 61 e
cileo c o
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were
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i.
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I e ),ge-s
!Anila.
War Cround. Water Fncountered?— _ ,,,,,,,,y„
hi>c.3t icJ1`t Si:fltC.ii
�D?a. f'(Z rD i0?t0lR ')f I ..,.��+�m^•^'�"""..
"r.)>�!.'•1EN'.._...,.,...�C,.t..1.....,...G'G�..._...,..si����,.�.�t�L:AL1-_.........,.r.....,_..e..,e.. �......w._..,.m..,.,.,...,...._,.+.-m«..
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MUNICIPALITY OF ANCHORAGE
Development Services Department p P Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-232-55-000
Expiration Date: 1/2/2025
Legal description T1 5N R1 W SEC 18 LT 183B1 (BLM)
Site address 18306 BIRCHTREE ST Chugiak AK 99567
Current property owner(s) MERRYMAN JEANETTA & SULLIVAN D
X The On-site system(s) is/are approved for 2 bedrooms
Conditional approval for
Comments or advisories:
bedrooms, with the following stipulations:
Original Certificate Date: 1/19/2024
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA ApprovaLJune 2022
Gtl�UHD PAU Y OF L' NCHORAGE
Development Services Department 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. 051-232-55
Complete legal description T1 5N R1 W SEC 18 LT 183131 (BLM)
Location (site address) 18306 BIRCHTREE ST, EAGLE RIVER
Current property owner(s) OWEN
2. ON-SITE SYSTEMS SIZED FOR 2 BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: ❑® Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ❑® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ❑® Plastic ❑ Concrete ❑ Fiberglass
Age 2023 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench 9 Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $,/ Waiver Fee $
Date of Payment ( �J Date of Payment
COSA #
0.50
L19r Waiver #
COSA Application—June 2022
COSA Checklist
Legal Description: T15N R1W SEC 18 LT 18381 (BLM)2 Parcel ID: 051-232-55
If more than 7 well and/or septic system on lot, provide separate checklist. Structure served by this system
A. WELL DATA
0 Well log is filed with Onsite (or attached)
Date drilled 1974 Total depth 142+ ft
Cased to 40'+ ft
0 Sanitary seal is functioning correctly
0 Wires are properly protected
Casing height (above ground) 12 in.
Date of flow test for COSA 12/21/23
Well production at time of test "0.15 qpm
Water storage tank volume 500 gallons
Well disinfected for coliform test? ❑ Yes 0 No
0 Coliform bacteria is Negative
Nitrate 0.303 mg/L ❑ Nitrate less than MRL (ND)
Arsenic
Collected by
_ ug/L 0 Arsenic less than MRL (ND)
MNA
Static water level at beginning of test 12 ft. Date 1/2/24
Comments "WATER STORAGE OF 500 GALLONS, EMPTIED, CLEANED AND DISINFECTED
B. TANK DATA
Measured operating fluid level in septic tank NEW
Date of pumping NEW
❑ Required maintenance completed, if AWWTS
Comments: NEW PLASTIC TANK INSTALLED
D. ABSORPTION FIELD DATA
Which system tested (date installed) 6/20/74
0 ALL standpipes present per record drawing
Total measured depth from grade 10 ft (max)
Measured depth to pipe invert from grade 4 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
❑ Monitor tubes go to bottom of effective.
If not, state depth into effective
0 Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced 2000 gallons 12/21/23 date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Comments/Deficiencies:
COSA Checklist June 2022
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
Adequacy test date 12/21/23
Results Q Pass
Fluid depth prior to test 2 in
Water added 300 gal
New fluid depth 0 in
Elapsed time 1440 min
Final fluid depth 0 in
Absorption rate 300 gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 72 in
Effective depth used 2 in
Effective depth remaining 72 in
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'
❑i Yes if No _ ft
Neighboring Tank > 100'❑ Yes if No _ ft
Absorption Field on Lot > 100' ❑ Yes if No *94' ft
Neighboring Absorption Fields > 100'
❑i Yes if No _ ft
Community Sewer Manhole/Cleanout > 100'
Yes if No _ ft
Private Sewer/Septic Line > 25' Q Yes if No _ ft
Holding Tank > 100' ZYes if No _ ft
Animal Containment > 50' Q Yes if No _ ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑� Yes f No _ ft Q Yes if No _ ft
❑ N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑ Yes if No **6 ft Surface Water > 100' Q Yes if No _ ft
Tank to Property Line > 5'
0 Yes
if No ft
Field to Property Line > 10'
Q Yes
if No _ ft
Water Main > 10'
Yes
if No _ ft
Water Service Line > 10'
0 Yes
if No _ ft
F. ENGINEER'S COMMENTS
* SEE WAIVER ** SEE WAIVER
Wells on Adjacent Lots:
Private Wells > 100'
Community Wells > 200'
[j] Yes if No ft
9 Yes if No _ ft
If tank or field is under driveway comment below
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 Mk e, NAW44t risq t t.,
Engineer's Printed Name S w MnG,
COSA Checklist June 2022
Phone 727-8864
Date r
OF
o
� * • 49TH • is
`.
14 MICHAEL N. AND[RXN
CE -4459
HOUSE
DETAIL
Scale:
1 "=30'
3.8'x7.6'
19.2' = PORCH
25.1
3.5'
"' m
DECK DECK
2 STORY
RESIDENCE
CHAIN-LINK
Lot 184 %
Z
D
C6.3'06.2' SHED -P
W
CHAIN-LINK FENCE
4.7'x11.9'
DECK
EAST
Lot 183A `1 50.0' _I
I ROAD RESERVATION
PROS pis 1 50' TEMPORARY
ono GA' 1fl�.riti_ TURN—AROUND
8.1'x13.7 17.5'x8.5'
GREENHOUSE QUONSET HUT
7'x8' LEAN-TO
12.3'x12.1' SHED
% Lot 183—Bl
c I 22,417 S.F.
M
— — — , WEST 298.94'
L * CHAIN-LINK FENCE
I
Lot 187 I Lot 188A
NOTE: DUE TO SNOW & ICE COVER, SOME
SURFACE LEVEL FEATURES ARE APPROXIMATE.
MANHOLE
-SEPTIC 'G VEL. 0
PIPES—', Dl IV1 yyAY.
IiL m
LDE
USE _in
L c
LWOODEN FENCE
30.0'
3' ROAD RESERVATION—
,1 I
n
M
M
PLOT PLAN AS BUILT JL SCALE 1" = 40' GRID NW 1054 Project No. 23-6013/A1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone
ken0longsurvey.com ��1���``i\
Professional Land Surveyor S jonathan0langsurvey.com pF AL l
ryonOlangsurvey.com A.AWW '�1. '� 1
I hereby certify that I have surveyed the following described property:
LOT 183—B1, SECTION 18, T15N, R1W, SEWARD MERIDIAN, ALASKA (PLAT No. 80-78)
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
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on said property except as Indicated hereon.
Dated this the Day of ':'L F , at Anchorage, Alaska
It Is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
• 48TH �•.
KENNETH G. LANG
I+ N Boz .moi
�..i
State of Alaska AECC963
Of
Municipality of Anchorage
.e`
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program , • ; r
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519650
www.muni.orglonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. Ji5/-o?3-55 COSA#�I��
Expiration Date:
1. GENERAL INFORMATION
Complete legal description %%S/lj R(K/
Location (site address) M'3665' R I CC 9 THEE 0 U. f q le
Current Property owner(s) - dlz' Z - Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone
SVZ,4'1%45 COO/ Dayphone e.F?-,C4( !q
Unless otherwise requested, COSA writ be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Z
3. TYPE OF WATER SUPPLY:
Individual Well P
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
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 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 Onsite 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. DSO 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.
Nameof
Address
f Firm —LY A ei"� 111 Phone
1 7.23 % I 1-1� R f 0". r.
Engineer's Printed Name sST'JE Far('
Date S&d/O,<
• • ;µ,?;n :�y a!
5. DSD SIGNATURE' `''
�r U'r'.• PE 6256 ••�
• �.
for bedroomsi 'v ""'••••••'', � .�
Approved .
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By Original Certificate Date: I- ' 11-n
(o
i
fRw \,ash
Municipality of Anchorage
• Development Services Department
Building Safety Division `
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 995198850
www.muni.orglonsite .
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: R/ Ln/ c i07—i,01V /,P 407 -/F3 -B/ Parcel ID: 051 - a 3 eZ- .SS
A. WELL DATA id
Well type -.?—
Date completed 2m
Totaldepth /y2 R.
if A. B, or C provide PWSID # _
Sanitary seal (Y/N)
Cased to
FROM WELL LOG
Date of test ^ ( ?7y
Static water level 4?5 ft.
Well production G -Z S 9 -P.M.
WATER SAMPLE RESULTS:
Well Log (YM) /V
Wires properly protected (Y/N) Y
Casing height (above ground) 1Z In.
AT INSPECTION
3Z710 G
/ z O n.
D. Z S g.p.m.
Coliform __6_ooloniesl100 mL Nitrate O. /O mg&<M'!L Other bacteria 0 colonies/100 mL
Arsenic: 0. (S e#jll MRL Date of sample: 1/2W Collected by. Ali ch( A4
B. SEPTICIHOLDING TANK DATA
Tank Type/Material . LY, n�J Date installed &24(&
Tank sine 1/566 gal. Number of Compartments Cleanouls (YM)
Foundation dearoul (YIN) Depression over tank (Y/N) A( High water alarm (YM) .V
Date of pumping 12 IWOS Pumper
C. ABSORPTION FIELD DATA
Date installed Zlzo 74Y Soil rating j or fe/bdrm) S�r System type C 946
Length 12 ft. Width L7_ ft. Gravel below pipe ft.
Total depth _h' ft. Eff. absorption area Ala
��ft� Monitoring tube Depression over field
Date of adequacy test, Results (Pass/Fad) A4 %i For ? bedrooms
Fluid depth in absorption field before testsi_ in. Water added�1�0 gal. New depth in.
Elapsed Time: e6i min. Final fluid depth Q in. Absorption rate >= . ?S'd f g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN 8 type) _/jA//c if yes, give date
-A N C- S A(o r 047-67-06 FULL 607t/ C2)
D. LIFT STATION
Date installed Size in gallons Wlanhole/Access )
'Pump on' level —in. 'Pump off" I of at _ in. High waterm level at in.
Datum Cycles sted Mee a cir requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanknift station on lot ma �f
Absorption field on lot 9U
Public sewer main
Sewer /septic service line
On adjacent lots / to to t
On adjacent lots / O 0 r 4 -
Public sewer manhole/cleanout /V,�A
Holding tank NP
Animal containment areas _A1,0A4E Manure/animal excrete storage areas Af0Ab0--
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
i
Building foundation S 'f" Property line A40 Absorption field .5,4 -
Water
f•Water main M6 Water service line /0 rt Surface water /44'0'
Wells on adjacent lots /Do't
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line �d rF Building foundation � t
Water Service line O �t Surface water /GQ rt
i
Curtain drain !hf (t Wells on adjacent lots
F. COMMENTS
'M -.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conlormance with MOA COSA guidelines In effect on this date.
Engineer's Printed Name S TF✓C– 1546
Date 3r 2006
COSA Fee $ Y
Date of Payment
Receipt Number
(Rev. I WS)
Water main 11/x4
Driveway, parking/veNde storage S
/Karn drr✓Cm�.y. SCP"r'+ftd
Waiver Fee $
Date of Payment
Receipt Number
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PE 6156
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Municipality of Anchorage
Development Ser0 vices Departmen(t�) t
Building Safety Division
On -Site Water 8 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
Parcel I.D. 051-232-55
1. GENERAL INFORMATION
HAA# 11A -n3 b �Z(
Expiration Date:
Complete legal description
T15N
R1 W SECTION 18 LOT 183 — B1
0
Location (site address or directions)
18306 BIRCH TREE STREET •
CHUGIAK AK. 99567
Current Property owner(s)
CHERYL R. PAAYYNE
Day phone
Mailing address
18306
BIRCH TREE STREET • CHUGIAK.
AK. 99567
Lending agency
❑
Day phone
Mailing address
Real Estate Agent
MONICA
DEVINE w/ PRUDENTIAL VISTA
Day phone 242-7500
Mailing address
16635
CENTERFlELD DR. #103 ' EAGLE
RIVER, AK. 99577
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 2
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
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 samples. (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.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or prior
to closing for the engineering services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verifigustday
investigation, based on procedures outlined in the Health Authority Approval Guidelin
shows that the on-site water supply and/or wastewater disposal system is(are) safe, func -d
for the number of bedrooms and type of structure indicated herein. I further verify that based on
information obtained from the Municipality of Anchorage files and from my investigation and insp
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, AKWWC, inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
XApproved for bedrooms.
Disapproved.
337-6179
Date f; 03
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
�tk(tpLITY o?",
F r
• • f? r
•y=
S=
W,
STFWgNO : nG)
a• M -
�j��JJryT
By: Original Certificate Date: ✓ Z G�
(Rev. 12N1)
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water & Wastewater Program
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK 99519650
www.d.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: T15N R1W SECTION 18 LOT 183 - 61 Parcel ID: 051-232-55
A. WELL DATA
*PER PREVIOUS HAA
Well type PRNATE If A. 8, or C provide PWSID# N/A
Date completed -1 74 Sanitary seal (Y/N) YES
Total depth '142+ ft. Cased to 4Q+ ft.
FROM WELL LOG
Date of test *� 1974
Static water level *85 ft.
A
Well Log (Y/N) NO
Wires properly protected (YM) YES
Casing height (above ground) 12+ in. ?,
AT INSPECTION
12/20/2002
132 ft.
Well production *0.25 g,p,m. *0.15 g,p.m,
WATER SAMPLE RESULTS: **500+ GALLONS OF STORAGE INSTALLED INSIDE
OF HOUSE. SEE WATER STORAGE PERMIT REQUEST.
Coliform 0 colonies/100 ml. Nitrate 0.1 mg./L. Other bacteria 0 colonies/100 ml.
5/16/2003
Arsenic: N/A mgJL. Date of sample: 4/24/2003 Collected by: AKWWC. INC.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
ANCH. TANK/STEEL
Date installed
8/21/1989
Length 12 fL
Tank size 1000 gal.
Number of Compartments 2
Cleanouts (Y/N)
YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (YM) N/A
Date of pumping 4/24/2003 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA
Date installed 6/20/1974
Soil rating (g.pAJft'bt� 85
System type
CRIB
Length 12 fL
Width 12 ft.
Gravel below pipe
6 ft.
Total depth *e•e ft Eff. absorption area 388 ft' Monitodng'tube **YES Depiession over field NO
Date of adequacy test 4/24/03 Results (Pass/Fall) PASS For --&-bedrooms
Fluid depth irr,absorption field before test DRY in. Water added 500 gal. New depth lin.
Elapsed Time: 212 min. Final fluid depth 0 in. Absorption rate >= 300+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE .KNOWN If yes, give date -
**MONITORING TUBE IN CRIB ONLY EXTENDS 1.8 FEET INTO CRIB �~
i
D. LIFT STATION
Date installed
Size in gallons
"Pump on" level at in. "Pump off" �in. High water alarm level at in.
Datu Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
P
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot •94' On adjacent lots 100'+
Public sewer main N/A Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 100+ Surface water 1000+
Wells on adjacent lots 100'+ +
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 's'+ Water main N/A
Water service line 10'+ Surface water 1000+ Driveway, parking/vehide storage 5'+
Curtain drain NONE KNOWN Wells on adjacent lots +97'
F. COMMENTS
G. ENGINEER'S CERTIFICATION G (` of
I certify that t have determined through field inspections and
review of Municipal records that the above systems are in ....... ' """" """"'
r
conformance with MOA HAA guidelines in effect on this date.
A:..... ess* ...
Engineers Printe Na a JEFFREY A. GARNESS QOe E-7953
0 r
Date _�}7 3 e �oteesloo��c
HAA Fee $ 31rJ 1 t 50 4525 !o Waiver Fee $ 100040
Date of Payment 5.2Qr 'Q3 Date of Payment 5/r�. 28['03
Receipt Number 30139 Receipt Number 3b 13y
(Pev. 12o1) 1 ✓O
.. Vv 5.30.03 1r�J�Lo3C�3q •
03/31/03 MON 12:22 FAX 6896499
03/29/2083 12:21 541-779-5498
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•
VISTA REAL ESTATE ER
CRATER ANIMAL CLINIC
C.jU'`••.'.�:{�i.Y:�•9{.cl'<'I,yln'.ai-fY'�.•. _ �• �.•1�
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RECERTIFICATION 8-24-B9
0 orn date_
' SEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE
I herby e■r&Uv that 1 have perlonn64 • Mortollot'■
PLAT ARE NOT SACN IItEON.
LOC 1the lauow le 8deurlbed prprtn8r-BSeC.n1EORDED 1. Ak.
3,T15N,R1WSy
he information hereon in for the uae of lendins
wtt°hori�• a■ratntt rrec:net, Alnah.. and sh%t tba t,npro•
■n■nu ■uvatad tnataan Ota an. nd
anon ■Lh
1ne
notitutione ahoWin the •ralationshi of existing
g D 8
ne prt , 1yrpMoWey
noi' Wrlaa er'enevoaen tm tn• propart;, lyinir ■d�nceat
tiles Improvementa an property Iyi.II e4ieeent u,■r-
itruetures and F�Satted easements and lot lines.
t i& not to be used for positioning add
D 8
Ie. no
■ncreeah on a prern"ef In queAttan end that them ere
raod,rays, Manar"uetan 1tneA or otser visible ea"menta
structures or ,femcalinae.
WA prop�re> t.a:eej•t ass JV%YC.tod hats...+
OeheA • An.ar.he, Neck■
+—•• Re0■IVOd•• 03-18-2007 "Tt•i2�— rat
-
Gcoglc P. 11'rterc•h.
Mayor
6/4/03
Ali icipality of Anchorage
Bttilding Salbty Ditisioll
Jeffrey A. Gayness, PE
Alaska Water & Wastewater Consultants, Inc.
3701 East Tudor Road, Suite 101
Anchorage, Alaska 99507
Subject: Waiver Request for T15N R1W Section 18 Lot 183-B1
Waiver Request Number WR030039
Parcel ID Number 051-232-55
Health Authority Approval Number HA030221
Dear Mr. Gayness:
Anchorage
All-America
�
1 111
2002
Your request for a waiver of the required 100 feet horizontal separation from an
absorption field to two water wells has been approved. The approved separation
distances are the well on the subject lot to the Seepage Pit on the subject lot of
94 feet and the well on Lot 188A to the Seepage Pit on the subject lot of 97 feet.
This waiver approval applies to the existing seepage pit to water wells separation
only. Any future upgrade to the on-site wastewater disposal system will require
all separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call
our office at 343-7904.
Si erely,
70q -
Daniel J. Roth
Civil Engineer
On -Site Water & Wastewater Program
P.O. Ilox 196650 • Anchorage, Alaska S)<)519.6650 • Telephone: (907) 3'13.8301 • Par. (907) 343.8'200
4700 South Ilra(law Street • Anchorage, Alaska 99507
h t t p://a����tci.ancL oragr.ak.us
Municipality of Anchorage
*A1
Development Services DepartmentBuilding Safety DivisionOn-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Waiver Review Worksheet
WR#: WR030039 PID#:051-232-55 HAM 030221 Permit#:
Date Received:5/28/03
Legal Description: T15N R1 W SEC 18 LOT 183 - 81
Engineer: AK WATER & WASTEWATER CONSULTANTS. INC
�Z�71I�1�i � • 7:��I��i).7iP��1iI�;L�I.�'Iei�1;1E�Fi4�7
Applicant: CHERYL PAYNE
Waiver Requested: SEPAGE PIT TO WATERWELL 94 FEET
Criteria:
Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Points:
Waiver is Granted: tx Waiver is not Granted:
List Conditions or Reasons for above: S CE olr?f CHER
Date: V Z 9 6 3 By: J?RAI
Name of Reviewer
Rec#: 36139 Amount: $1.000.00 Date Paid: 5/28/03
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ALASKA. WATER F& WASTEWATER
CONSULTANTS, INC.
May 27, 2003
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Waiver Request and Health Authority Approval for
T15N, R1W, Section 18, Lot 183-B1
The existing 2 bedroom house is served by a private well and septic system. We request you grant a 94
feet separation distance waiver from the well on the referenced property to the crib on the referenced
property; and a 97 feet separation distance waiver from the well on Lot 188A to the crib on the referenced
property. We also request a 6 foot waiver from the existing drainfield to the foundation. The exact
location of the perimeter of the crib is unknown. The following items are justification for the waivers:
The lots are generally flat in the area. There is a slight mound, heavy vegetation, and several small
structures between the wells on the subject properties and the crib. If the septic system was to
overflow, it appears that the effluent would not travel toward the well head.
The location of the septic system is in a very visible area so that if any effluent was to surface, it
would be noticed and the problem corrected.
The other path of contamination is subsurface migration of wastewater. As can be seen on the attached
well logs the average depths of the wells range from 93-252 feet deep. The average static water levels in
these wells vary from 40-75 feet with various layers of sandstone, clay and hardpan soils that have served
to inhibit the migration of untreated wastewater into the aquifer. Recent water sample results were taken
from the well and the results indicated nitrate levels to be 0.1 mg/L and coliform and bacteria results to be
non detected. Based upon the aforementioned facts, it appears that there is minimal risk associated with
the 94 feet and 97 feet separation distance waivers.
The septic system that serves the subject property was installed on 6/20/1974, and the well that serves Lot
188A, was drilled iDecember of 1984. We also request that your department issue a Health Authority
Approval.
If you have agy f lstions, please contact us at 337-6179. Thank you for your assistance.
P.1-:., M.S.
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
--- ---------------------------------------------
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715N, R1W, SECTION 18, LOT 183A.
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4/28/2003
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ALASKA. NVATKR & WASTE AVATKR
C.J.G.
SCALE.
1 — loo,
CONSULTANTS, INC.
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3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE. AN 90307 • PHONE (907)537.6179 • FAX (907)338.3266
G`7h
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PREPARED FOR PHONE NUMBER:
PACE NUMBER:
CHERYL R. PAYNE 242-7500 (AGENT)
1 OF 2
j
4y�h �. ' .
�41��tue�Prore;slono`F�o,`J>
A. Ga ess.=
795
LEGAL DESCRIPTION:
T15N. SECTION 18, LOT 183—B1.
TYPE OF WOR
SITE PLAN WAIVER PACKAGE
~`��•����-��"'
\\ EXISTING 1000 CALLON
SEPTIC TANK
-WE REQUEST A 6
FOOT WAIVER FROM
THE EXISTING
DRAINFIELD TO THE
FOUNDATION.
94 FEET WAIVER
REQUESTED I
I 1 ' •.
EXISTING
WELL
APPROXIMATE LOCATION
OF WATER LJNE
EXISTING 12'x12� ��RNG
HOUSE
LLI
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III FV-)
"WEULLw
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5/21/20030
— • t JxS .�� f DRAWN BY: C VN
ALASJU NVATER R R'ASTLVVATER C.J.G'
CONSULTANTS, INC. SCaLE-
3701
„
A ..... ...:....
5701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE. AK 99507 • PHONE (907)337-6179 •FAX (907)538-3246 1 = 30� � - � � �
PREPARED FOR: PHONE NUMBER: PACE NUMBER: QI Q
CHERYL R. PAYNE 242-7500 AGENT 2 OF 2 ”"'t" ""0
Q ',J r y . Gayness:
LEGAL DESCRIPTION: Qp 7953 epi
T15N, R1W, SECTION 18, LOT 183-B1,o�
TYPE OF WORK: 4��d�'rofesslo���4�
DESIGN FOR WAIVER PACKAGE �O00000p�a
• MUNICIPALITY OF ANCHORAGE y�
Department of Health & Human Services FI '
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # G`51 j� HAA # 0 99L -QLQ
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 183 -BI; Sec. 18; T1 5N, RIW, SM.
Location (address or directions)
066 MINK ROAD
(b) Property owner Mike Ama2a2 Telephone : (home) Business
Mailing Address SRI Bax 2225 Chugiak, AK. 99567
(c) Lending Institution
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
Telephone
(e) Mail the HAA to the following address: (or check hereXX, if hold for pick up.)
List contact person and day phone number below:
17034 Eagle River Loop Road No. 204
Eagle River, Ala*a 97577
2. TYPE OF RESIDENCE
Single-FamilyXX Number of bedrooms 2
3. WATER SUPPLY
Individual Well 8 Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site 1XX Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/8B) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is 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 in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of Firm Telephone
Address
S & 5 ENGINEERING Road No. 204
Eagle River Alaska 99577 / / 1�7
Date /
E
"0 A. Bhtfer
No. I W-6
' TCFESSIO� v'
6. DHHS APPROVAL r ".Z
�/
Approved for � bedrooms by
Date
--Disapproved Conditional
Approved
Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025(R.v. 7/09) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
• Health Authority Approval (HAA)
rr oFEBRUARY 1984
ur, ces uN1310 343-4744
'�IN,�NiAI-kikkV
A. WELL DATA
Well Classification � ntD� I ��l�l— If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/_1V_A— Date Completed L I
Total DepthCased to A�+ Depth of Grouting
Static Water Level
Casing Height Above Ground 12 -4-
Electrical Wiring in Conduit ON)
SEPARATION DISTANCES FROM WELL
Pump Set At
Yield 15- AFA
Sanitary Seal on Casing ql)
Depression Around Wellhead (Y/Q 1`-1
To Septic/Holding Tank on Lot 11 3 ; On Adjoining Lots j -'I-"
To Nearest Edge of Absorption Field op Lot t �z�� ; On Adjoining Lots
/ a
To Nearest Public Sewer Line N A To Nearest Public Sewer Cleanout/Manhole A
To Nearest Sewer Service Line on Lot Ic>=:,l"-
Water Sample Collected by sPs �lxt Ir��(Lrr ;Date B ! Imo-- 09
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed E5- ti-Pfl Size k'000 No. of Compartments
Standpipes(PP/N) yAir-tight CapsCVN)
Foundation Cleanout (PN)
Depression over Tank (Y(9 N Date Last Pumped —NE:5�
Pumping/Maintenance Contact on File (Y/N) ; for `—
Holding Tank High -Water Alarm (Y/N) N A Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
1 I
To Water -Supply Well 1 (" To Building Foundation Zl
To Property Line
To Water Main/Service Line
To Disposal Field
alp
To Stream, Pond, Lake or Major Drainage Course
Comments 1--- 01J1264- RC1
likr'JS& pADt T1o� Nidi I?J�1PF3� �la�G-A1
A.t-17
72-026 (Rev. nee) From Page 1 of 2
1 $�J
Legal Description:
� 1-P�1 .
2 <'
SCS 1�
T S iLl1,J SP't.
1 t
A. WELL DATA
Well Classification � ntD� I ��l�l— If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/_1V_A— Date Completed L I
Total DepthCased to A�+ Depth of Grouting
Static Water Level
Casing Height Above Ground 12 -4-
Electrical Wiring in Conduit ON)
SEPARATION DISTANCES FROM WELL
Pump Set At
Yield 15- AFA
Sanitary Seal on Casing ql)
Depression Around Wellhead (Y/Q 1`-1
To Septic/Holding Tank on Lot 11 3 ; On Adjoining Lots j -'I-"
To Nearest Edge of Absorption Field op Lot t �z�� ; On Adjoining Lots
/ a
To Nearest Public Sewer Line N A To Nearest Public Sewer Cleanout/Manhole A
To Nearest Sewer Service Line on Lot Ic>=:,l"-
Water Sample Collected by sPs �lxt Ir��(Lrr ;Date B ! Imo-- 09
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed E5- ti-Pfl Size k'000 No. of Compartments
Standpipes(PP/N) yAir-tight CapsCVN)
Foundation Cleanout (PN)
Depression over Tank (Y(9 N Date Last Pumped —NE:5�
Pumping/Maintenance Contact on File (Y/N) ; for `—
Holding Tank High -Water Alarm (Y/N) N A Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
1 I
To Water -Supply Well 1 (" To Building Foundation Zl
To Property Line
To Water Main/Service Line
To Disposal Field
alp
To Stream, Pond, Lake or Major Drainage Course
Comments 1--- 01J1264- RC1
likr'JS& pADt T1o� Nidi I?J�1PF3� �la�G-A1
A.t-17
72-026 (Rev. nee) From Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 8S � Type of System Design
Date Installed �?--bo '74N Length of Field tZ,
Width of Field 1'1J Depth of Field
Gravel Bed Thickness W
Square Feet of Absortion Area %8 Statndpipes Present MN)
Depression over Field (YIQ ►-� Date of Last Adequacy Test
Results of Last Adequacy Test C7� t `�� ��{ — 3 rMz-
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well 1 c� , To Property Line I %!D
��
To Building Foundation " e> To Existing or Abandoned System on
Lot � A' ; On Adjoining Lots t "�-
To Water Main/Service Line �'1 To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course I �� T
1 �
To Driveway, Parking Area, or Vehicle Storage Area n
Comments t -z' tc- %` e-" 1S P-prv- 'fes Fyt�- l'
3 4F,-%FN-o3e11r_1
D. LIFT STATION I A
Date In tailed
Size in GaIID
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent(Y/N)
Pumping Cycles during Adequacy Test.
"Check Permitted Bedroom Rating Against HAA Request"
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect
inspection. w1)
Signed S & S ENGINEERING
17034 Eagle River Loop Road No. 204
Company
- EagIsR9 .
Date r 2- %
MOA No. L !!�
Receipt No. o X36
Date of Payment
Amount: $ �D
Receipt No.
Waiver Fee: $
Date of Payment
72-026 (Rev. 7/08) Back Page 2 of 2
.. r,,.,, r::........ r..
R66*1 A. xnwfw at
No. 14675 •%
1
AM.
Tin
ANCHORAGE [p �,/-
MUNICIPALITY OF ANC
MUNICIPALITY OF ANCHORAGE DEPT, T,,
_ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROT ECT01f RONMEN i,
825 L Street - Anchorage, Alaska 99501
O
JAN 3 1 1 0
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264.4720 L i.A IV
S
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SENA R FA LITI
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTYOWNER
PHONE
Gu W. Johnston _
1694_-9766
_
MAILING ADDRESS
% P. 0. Box 334, Eagle River, AK 99577
PROPERTY RESIDENT (If different from above)
NE
Vacant
LN INDIVIDUAL"
2. BUYER
❑ COMMUNITY
MichaelJ. Amaral
279-1130
MAILING ADDRESS
3040 Alder Circle, Anchorage, AK 99504
3. LENDING INSTITUTION
PHONE
""If individual/on-site, give installation date June, 1974
274-3561
If system is over two (2) years old an adequacy test is required
❑ PUBLIC UTILITY
MAILING ADDRESS
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
P. 0. Box 1120, Anchorage, AK 99510�L
c1��ha��
4. REALTOR/AGENT
PHONE
Myrna Johnston, AREA, Inc. Realtors
694-9555
MAILING ADDRESS
P. 0. Box 249, Eagle River, AK 99577
5. LEGAL DESCRIPTION
T1SN R1W Sec 18 Lot 183B
STREET LOCATION
Rusnak Drive, S. Birchwood
Loop, Eagle River _
6. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
❑ One ❑ Four CI Other
® SINGLE FAMILY
® Two ❑ Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SUPPLY
LN INDIVIDUAL"
"ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.) 160
8. SEWAGE DISPOSAL SYSTEM
[3b INDIVIDUAL/ON-SITE""
""If individual/on-site, give installation date June, 1974
If system is over two (2) years old an adequacy test is required
❑ PUBLIC UTILITY
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
0
Myrna Johnston
P.O. Box 334
Eagle River, Alaska 99577
Dear Mrs. Johnston,
DAVID A. SLENKAMP
MECHANICAL ENGINEER
694-9055
February 10, 1980
Reference: Lot 183B; Section 18; T15N, RIW
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ROBERT A.184 ER
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A sewer system adequacy test was performed on the system located
on the referenced property on February 7 and 8, 1980, per your
request. The septic tank was pumped and found to have a capacity
of approximately 1000 gallons. The seepage pit, when first examined
was dry. Approximately 650 gallons was added to the system and at
the end of a 24 hour period the seepage pit was again dry.
From the above survey and test it can be concluded that the system
is adequate for the two bedroom house located on this property.
If we may be of further assistance, please do not hesitate to call.
Sincerely,
T . SHA E , P. E.
RAS/ss
cc: Area Re ty
ATTENTION: Myrna Johnston
S Cav�9�/ e,ev
Municipality of Anchorage a
Department of Health and Enviornmental Protection
SRa 196X EAGLE RIVER, ALASKA