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HomeMy WebLinkAboutBIRCHHAVEN LT 1LT 1 Birch Wumods Lot 5 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221344 PID Number: 051-243-14 Dwelling: FE-1 Single Family (SF) El with ADU El Duplex (D) El Two Single Family Project: [_ffil New El Upgrade Name Kourosh Partow ABSORPTION FIELD El Deep Trench 9 Wide Trench F-1 Bed El Mound Site Address 17610 Birchtree Street El Other Phone Number of Bedrooms Soil Rating I depth from original grade I Three (3) 1.0 GPD/SF JTotal 0.0 / -0. 1 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade -0.5/-0.6 Ft. Gravel depth beneath pipe 0.5 / 0.5 Ft. Subdivision Block Lot Birch Woods 5 Fill added above original grade 2.9/2.6 [pending topsoil] Ft. Gravel length 45/45 Ft. Township Range Section Gravel width 5.0/5.0 Ft. Beds: Number of Lines N/A Distance between lines N/A Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches 2 Dist. between trenches 6< From Tank Field Tank Line 450 Ft2 Ft. Well >100' >100' N/A N/A >25 TANK 0 Septic ❑® S.T.E.P. E] Holding [] Other Manufacturer Infiltrator Capacity 1,530 Gal. Surface Water >100' >100' N/A N/A Material Plastic Number of compartments Two (2) Lot Line >51 >11* N/A N/A NA Foundation >10' >10' N/A N/A LIFT STATION Manufacturer Orenco Capacity STEP Tank Gal. RemarksTrenches listed east/ west *See waiver request Alarm location Back exterior wall I Electrical installed by Dependable Electric PIPE MATERIAL House to tank D3034 drainfie[dTankto D3034 Installer Precision Excavation Drainfield D3034 CO/MT D3034 Inspector B. Schiller BENCH MARK (Assumed elevation) 100 ft Inspection Im 6128/23 6/29/23 Location and description dates: 2 nd rd th Fop of foundation @ Point A 3 4 ON -SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF k Conditional Approval: Date , 49 TI-11 ;1101 ...... _5 . ... . c ........ 7.8enja On chiller Septic System Approved Date. Z- 1/ CE112592 12/18/23 AS" PROFESSOW Note: this approval does not include well permit requirements. (Rev 05/02/18) FCO CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FD - FLOW DIVERTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND PERMIT # OSP221344 PID # 051-243-14 A B FCO 47.5 MH1 50.0 MH2 53.7 A B MT1 169.6 MT2 211.2 MT3 176.4 MT4 215.0 7.6 15.9 25.5 128.5 165.7 137.3 171.21"=50' 1530-GAL STEP TANK FEET 0 50 100 Benjamin Schiller CE 12592 R E GISTEREDPROFES S I O N A L E N G INEER BIRCHHAVEN LOT 1 BI R C H T R E E S T R E E T 15' T&E EASEMENT 10' T&E EASEMENT 19 0 195 200 205 TH#4 100' SEPARATION FROM SURVEYED CREEK LOCATION 18 5 3-BDRM HOME 2x 45' LONG x 5' WIDE x 0.5' EFFECTIVE DEPTH ABSORPTION TRENCHES ALT SITE: 20' LONG, 0.5' EFFECTIVE DEPTH, CAT III SYSTEM MT4 MT2 MT3 MT1 12/20/23 PLAN AS-BUILT MH1 MH2 TH#3 BM EXISTING WELL PROFILE AS-BUILT (NO SCALE) PERMIT # OSP221344 PID # 051-243-14 BIRCHHAVEN LOT 1 96.0 FINISH GRADE 45' TH # 3 GROUNDWATER @ 87.7 4/5/22 93.1 85.2 93.1 ORIGINAL GRADE 1530 GAL INFILTRATOR STEP TANK Benjamin Schiller CE 12592 R E GISTEREDPROFES S I O N A L E N GINEER 12/20/23 95.3 FINISH GRADE 45' TH # 3 GROUNDWATER @ 87.7 4/5/22 92.8 85.2 92.8 92.7 ORIGINAL GRADE EAST TRENCH WEST TRENCH 96.4 96.9 99.4FC O MH 1 MH 2 92.3 4" INSULATION MT 1 MT 2 MT 3 MT 4 93.1 93.6 93.3 2' MOA APPROVED SAND 2' MOA APPROVED SAND 2" FOAM INSULATION 2" FOAM INSULATION 91.1 90.8 (PENDING FINAL TOPSOIL AND GRASS) (PENDING FINAL TOPSOIL AND GRASS) LEGAL DESCRIPTION: PERFORMED FOR: DATE:PARCEL ID#: SOILS LOG AND PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 DEPTH (feet) TEST HOLE 4 DATE READING START TIME NET TIME(minutes) DEPTH toWATER NET DROP PERCOLATION RATE: (MIN/INCH) (inches)(inches) DATE OF MONITORING WAS GROUND WATER ENCOUNTERED? DEPTH TO WATER AFTER MONITORING IF YES @ WHAT DEPTH? .09 6/26 1 2 3 4 5 6 SW/SM (SILTY SAND) Professional Engineers Stamp: NO BIRCHHAVEN LOT 1 6/26/2023 051-243-14 KOUROSH PARTOW 2:501 2 3 4 5 6 3 0 16 OB 00:16 Benjamin Schiller CE 12592 R E GISTEREDPROFES S I O N A L E N GINEER 7/11/2023 PERC TEST LOCATION TECHNICIAN:B. Schiller 9 0 16 N/A - - COMMENTS: 6" DIAMETER PERK HOLE SITE PLAN 6 0 16 00:22 00:21 00:24 00:26 00:31 3 0 16 9 0 16 6 0 16 3 0 16 9 0 16 6 0 16 3 0 16 9 0 16 6 0 16 3 0 16 9 0 16 6 0 16 3 0 16 9 0 16 6 0 16 Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road Z: P.O. Box 196650 a c Mark Begich Anchorage, AK 99507 s " E T r Mayor www.muni.oro/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW osP Date of Issue: Parcel Identification Number: Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Wheaton Water Well, Inc. 1190 N. Wasilla-Fishhook Road Wasilla, AK 99654 Name: Kourosh Partow Address: City: Chugiak State: AK Zip Code: 99567 Well Site: Birchhaven Lot/Block: L 1 Additional: 17610 Birchtree St. Well Depth: 225 ft From: To: Formation: 0 3 Sand and Gravel Below Ground: 223 ft. 3 41 Silt and Gravel Above Ground: 2 ft. 41 51 Hard Grey Rock Gal/Min: 4 51 73 Shale, Coal 73 210 Hard Grey Rock Static Level: 2 ft 210 225 Coal Casing: 40"ft. of 6 in. x .25in. steel" Liner Pipe: N/A Screened: N/A Perforated: N/A Grouted: Yes Depth: Develop. Method: Air Use of Well: Residential Drilling Method: Rotary Misc: Commercial Cap Other: Chlorinated to 50ppm The well was pumped 5' off the bottom with 100% draw down for 2 hours and recovered at 4gpm . Date Drilled: 6/21/2023 Driller: Ben Mattson / / N 88'59'54"E 127.89' 0 10 25 50 10o SCALE- 1 "=40' Lot 2 Ii i N ro SEPTIC PIPES ry Lot 3 _ AD � o ' • �+ A I 50.0' �'- 15' T&E m EASEMENT \ a) \ / N 88'59'54"E 215.79' D Lot 1 SEPTIC PIPE m rn I \ 67,426 S.F. MANHOLES 1 1n rn ry I 33.7 n WELL FIRE CREEK II \\ 4,4' PORCH p 5.5' Tract A �'�. I � Ln in W 106.5' u'_ � — w 22.0 rn 1 STORY 2.o rn as '. \• '. WETLANDS aout�oARY RESIDENCE N GRAVEL DRIVEWAY 10.2'x12.2' DECK 48.2' 50' STREAM \ SETBACK 10' T&E EASEMENT / K&R STREET S 89'42'37"W 407.22' l Unsubdividad I PLOT PLAN ___ AS BUILT _X SCALE 1'� =40' GRID _ NW 0954Project No. _�_23=1891B5 _ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone Aft.; Professional Land Surveyors jonothan*langsurvey.com �.OF travis®langsurvey.com I hereby certify that I have surveyed the following described property: ,..9 LOT 1, BIRCHHAVEN SUBDIVISION (PLAT No. 2022--64) * 49 TH * �� 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 9 KENNETH G. LANG easements on said property except as indicated hereon. No.5202 •.'���/ Dated this the _ �'� _ Da of ___r T='` _, at Anchorage, Alaska �FD� ?� p5�� --- y -- — � ''R4FESSIONA����•� 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 plot. State of Alaska AECC963 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 Water & Wastewater System Permit Permit Number: OSP221344 Work Type: WellSeptic Initial Tax Code Number: 05124314000 Site Legal Address: BIRCH WOODS LT 5 G:0954 Site Mailing Address: 17620 BIRCHTREE ST, Chugiak Owner: PARTOW KOUROSH Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft Total Bedrooms: o%_Cnt Department 9/23/2022 9/23/2023 70270 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Q 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 Received By: Issued By: Date: Date: gZZ3 Lzz- 3 MUNICIPALITY OF /ANCHORAGE �t Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-243-14 Property owner(s) Kourosh Partow Mailing address 19507 Richner Road, Chugiak, AK 99567 Site address NHN Birchtree Street Day phone Legal description (Sub'd., Block & Lot) Birch Woods, Lot 5 (Proposed Birchhaven, Lot 1) Legal description (Township, Range & Section) Lot Size 70,270 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑X Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ElDuplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑X Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. y (Signature of property owner or authorized agent) Permit/Rush Fees: 32-0 Waiver Fees: Date of Payment: k2Z-42 2 Date of Payment: Receipt Number: 7d Receipt Number: Permit No. 0-15P-11, 2- 1 �% L% Waiver No. Permit App_;;- : ,_.mac September 13, 2022 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 9/13/22 Subject: Birch Woods, Lot 5 (Proposed Birchhaven, Lot 1) Septic system design Dear On-Site Services Engineer: The owner of the above lot intends to build a 3-bedroom home on the property, so we are submitting this permit application for the construction of a new well and septic system. The attached site plan identifies the location of the home as well as the proposed well, septic location and alternate site. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. The slopes on the lot are relatively mild throughout the property. The new septic system is located towards the rear of the lot. (There are no slopes greater than 25% within 50 feet downslope of either the primary or alternate site.) Contours are shown on the site plan showing the grade and direction of flow. Stormwater drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the septic tank. The alternate site is located more than 6’ away. Please refer to the attached test hole logs, plan and profile pages for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221344, Deb Wockenfuss, 09/23/22 BIRCH WOODS, LOT 5 (PROPOSED B I RC H H AV E N LOT �� On site Water and Wastewater SEWED FOR CODE COMPLI� OSP221344 Deb Wockenfuss, Of (PROPOSED LOT 2) \ PROPOSED NEW LOT LINES LOT 100' SEPARATION FROM SURVEYED -LOT4 TH#1 e Q5TH#2 ITE: 20' LONG, 015' : FFECTIVE DEPTH;•. EXISTING LOT LINE \CAT III SYSTEM -I FOR LOTS 1 & 5 ------------------- :MT MT ��` '• "T\ 1 CREEK LOCATION \ M j \ WETLANDS BOUNDARY PER MOA MAPPING �\ PLATTED CREEK LOCATION W/ \ MAINTENANCE EASEMENT \ ; \ SURVEYED w CREEK \\ LOCATION N()TF•_ � Benja i Schiller 1,�'F���P• gu 2592 nz.••��<�r PRO* FESSI6' ------------- I i 15' T&E EASEMENT J 2x 45' LONG x 5' WIDE x 0.5' EFFECTIVE DEPTH ABSO I PTION TRENCHES LOT 5 \ (PRO"ED LOT 3) I / 100' WELL RADIUS // /m EXTENT OF MOUNDED SOIL I / \` rRQPOSED WELL LOCATION--- I-- I \ m --------------------�— �'� \ \ m Lu (PROPOStD LOT 1) I o I 1250 -GAL STEP TANK 10' T�E EASEMENT ry 0 m M NO SLOPES >25% ARE WITHIN 50' OF THE PROPOSED SEPTIC SYSTEM. NO SURFACE WATER WITHIN 100' OF THE SEPTIC SYSTEM. ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. 0 50 100 GE FEET lNGI NE E RI NG 1"-50' LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOU& 2RCO - FOUNDATION CLEANOUT FD - FLOW DIVERTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE BIRCH WOODS, LOT 5 (PROPOSED BIRCHHAVEN LOT 1) NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEERSep 13, 2022 DESIGN FACTORS:SYSTEM REQUIREMENTS: 450 GPD PEAK FLOW PERK RATE: <1 MIN/IN (SAND) APPLICATION RATE: 1.0 GPD/SF 5' WIDE TRENCH SYSTEM 1250-GAL STEP TANK BOTTOM OF TRENCH: AT EXISTING GRADE FLOW LINE ELEVATION: 6" ABOVE GRADE TOP OF TRENCH: 3' ABOVE GRADE 450 GPD / 1 GPD/SF /5' WIDE = 90 LF TRENCH REQUIRED (90 LF SPECIFIED) TYPICAL TRENCH SECTION (NO SCALE) 1 1 4" PVC w/ 15 - 3 16" HOLES PER LATERAL, SPACED @ 6' APART (HOLES DOWN) DRAINFIELD ROCK 5' 2" INSULATION & GEOTEXTILE FABRIC MINIMUM 2' SOIL COVER W/ INSULATION 2' SAND LINER 6" 2' August 25, 2022 2'-6" 1 3 TOPSOIL AND SEED ARE REQUIRED ON SLOPES Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221344, Deb Wockenfuss, 09/23/22 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 DEPTH (feet) TEST HOLE 3 DATE READING START TIME NET TIME (minutes) DEPTH to WATER NET DROP PERCOLATION RATE: (MIN/INCH) (inches)(inches) DATE OF MONITORING WAS GROUND WATER ENCOUNTERED? DEPTH TO WATER AFTER MONITORING IF YES @ WHAT DEPTH? <1 3/24/22 1 2 3 4 5 6 SW/SM (SILTY SAND) Professional Engineers Stamp: NO BIRCH WOODS L5 (proposed birchhaven L1) 3/24/22 051-243-14 KOUROSH PARTOW 9:401 2 3 4 5 6 0 9:42 9:44 9:46 9:48 9:50 1' OB 00:35 Benjamin Schiller CE 12592R EGISTEREDPROFE S S I O N ALENGINEERMay 5, 2021 PERC TEST LOCATION TECHNICIAN: J. MILLETTE 6 0 16 N/A 5.0' 4/5/22 COMMENTS: 6" DIAMETER PERK HOLE SITE PLAN 6 0 16 ML/CL (SILTY CLAY) 00:41 00:38 00:38 00:40 00:38 0 6 0 16 6 0 16 0 6 0 16 6 0 16 0 6 0 16 6 0 16 0 6 0 16 6 0 16 0 6 0 16 6 0 16 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221344, Deb Wockenfuss, 09/23/22 cz N � O T � ID fu d CD 0 z � � a I �to N C co N 0 E =o N N �v L0 to � = D cnle R. Cdo � C .r En 'Soca c 3 'n , cd t � � � in o in 06, eo C Q 3 d o SbN o w a r,20 79 n. t;L 0 3 cq DnpO Ni �}OWo ts v, N O w . .� -v OFM c:o O 3 w aai ,� � � •� o a � o � g o= o 3 o a •cacn ` fid, ¢• yI.� na pp C U ch O DO .r -- QU„ k c m �' S °� H o �' •r' � «s ° '� V � _ Q • � � a .yCi W Q T• 'a U �” rte'" ���i�ia�`S• • - ����, \O O i�7 N 07 +q A ►���►uurrwW� 9 01 aoicv `O O4Q r •o• r f v r 15' T&E EASEMENT POWER LINE EASEMENT a (WIDTH VARIES) Lot 2 43 36.48 , 00'Nr 1 84.561 S.F. N 7 \ SE EASEMENT ENT .y y,r�\ N Sj 8 SEPTIC e \ SETBACK Tract A ° Z ory STREAM MAINTENANCE EASEMENTS 8 \ 103.88' - EXHIBIT A Lots 1 & 5, BIRCH WOODS SUBDIVISION (PLAT No. 83-427) SCALE: 1"=100' I �S I t PUTTED THREAD \ OF STREAM Lot 4 ! N 89.01'09*E 230.51' I I w ` to M rn + rn Lot 5 70.270 S.F. Iii pAl Itq rq 10' T&E EASEMENTS Municipality of Anchorage P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program Waiver#: OSV231065 COSA#:OSC231485 Permit#: P I D#: 051-243-22 Legal Description: BIRCHHAVEN LT 1 Engineer: Forge engineering Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 1.0 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on - site wastewater disposal system will require all separation distances be met or another approval from this department. ■■mvmmmvmmmmvmmmmmvvmvmvvmvmvmvmmmmmvsmmmvvmmmvmmvvmvmmvmvvvvavmmvammmmvvvvmmm� Waiver is Granted: X Waiver is not Granted: 20 23 (. , /-- NameDate: 1 Approved by: � of Reviewer ■■mvmammmmmmmmmvvmmvmmmvmvvmmvvvmvmmmavmmvmmmmmmmmamvmmmvmmmmmmmvmvmmvvmvvammm� December 21, 2023 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Birchhaven Lot 1 – 17610 Birchtree St Absorption Field to Lot Line Waiver Dear On-Site Services Engineer: During the installation of the septic system on this lot, the trenches were inadvertently placed too close to the lot line. This appears to have been due to the contractor’s attempts to avoid taking out several large trees. This location for the trenches meets separation from the neighboring well and septic system. It doesn’t affect the foundation of the building at all. The trenches are mounded, but the cover on top was placed and the side slopes constructed while the builder owned all lots, so there was no objection to the fill crossing lot lines, and it has been blended in with the grading around so that any future owner wouldn’t reasonably be able to cut down the grading without creating a large depression in their yard. We do not see any adverse effects from this location of the absorption field. We respectfully request that a waiver be issued for a 1’ separation from the trenches to the lot line. Sincerely, Benjamin Schiller, PE Certificate of On -Site Systems Approval Parcel I.D. 051-243-22 Legal description BIRCHHAVEN LT 1 Site address 17610 BIRCHTREE ST Chugiak AK Current property owner(s) PARTOW Expiration Date: ! Z�o -Z y t X The On -site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: Z Z l 2-, 2-_3 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 ApprovaIjune 2022 MUNICIPALITY OF ANCHORAGERU5H N, 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. 051-243-22 Complete legal description B i rch h ave n Lot 1 Location (site address) 17610 Birchtree Street, Chugiak, AK 99567 Current property owner(,) KOurOSh PartoW Day phone (907) 310-2501 2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: 0 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 X Plastic ❑ Concrete ❑ Fiberglass Age < I - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑■ Wide Trench ❑ Seepage Pit Waiver request for:Absorption Field to Lot Line Expedited review requested: ❑■ Distance: 1' 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 $ 9 130 Waiver Fee Date of Payment COSA # 0 5G2 3 l H 8 S Date of Payment Waiver # 05 V 2.3106 5 COSA Application —June 2022 Birchhaven Lot 1 051-243-22 4 6/21/23 225 N/A 40 0.057 24 1.3 2 8/15/23 N/A N/A New installation N/A N/A N/A > Benjamin Schiller, P.E.11/17/23 (907) 522-7773