HomeMy WebLinkAboutGLENN VIEW ESTATES NORTH BLK 1 LT 11Glenn View
Estates North
Block 1
Lot I I
#051-821-24
Municipality of Anchorage ••'� �'°
Development Services Department �'' �•�
Building Safety Division •., ...
On -Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SWO30273
PID Number: 051-821-24
me.
NaTroy Davis Homes. Inc.
Wastewater System: ® New ❑ Upgrade
Address:
Ste.207--Wasilia.
AK
ABSORPTION FIELD
Phone:
Number of Sedrooms:
D Deep Trench ® Shallow Trench p Bad p Mound O Other.
LEGAL DESCRIPTION
Sol Rating:
Total Depth from original grade:
0.45 CPD/Fe
4.0 Ft.
Block: Lot: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe;
1 11 Glenn View
Estates North
1.5 Ft.
2.5
Township: Range:
Section:
FYI added above original grade:
Ft.
Gravel Length:
1.06-1.81 Ft.
132 Ft.
Well: ❑New El Upgrade
Gravel width:
Number of Ones:
Distance between Ones:
5.0 Ft.
2
10 Ft.
Classification (Private, 0.B, C):
Total Depth:
Cased b:
Total absorption area:
Pipe Malenal:
Public
Ft.
Ft
1031 Fe
D3034 & Sch40
Driller.
Date DOW:
Static Water level:
Installer
Date Installed:
Ft.
Mike Cur
12/l/03
Ywld:
Pump Set at:
Casing Height Abe"Ground;
TAN
K
CPM
FI.
Ft
SEPARATION DISTANCES
®Septic []Holding O S.T.E.P. ❑ Other.
To
Septic
Absorption
Lift
Holding
PublicfPrtvat
aoo actwer.
apaaly:
From
Tank
Field
Station
Tank
Sewer Line
Anchorage Tank
1250 cal.
Welt
200'+
200'+
NA
NA
25'+
Material:
Number of Compenmenls:
Steel
2
Surface Water
100'+
100'+
NA
NA
LIFT STATION
Line
LwLn
5'+
10'+
NA
NA
ae.
1250 Get.
amu ac �rnr.
Orenco
Foundation
5'+
10'+
NA
NA
Purnp on level at:
'Pump air level ab;
High water alarm at:
44" in.
42" in.
48" Im.
Cumin Drain
NA
*50'+
NA
NA
Pune Make&Model
Electrical Inspections performed by:
Franklin 2445
0117 Rising Son
Remarks:
*none known
BENCH MARK
Tank, service line & field
insulated
Location and phon:
Bottom of siding
Assumed Elevation:
100 Ft.
En K"VI tamp
w OF
,�
0.•off. op l
•' '•
9
•.:• 4'9'L •;••
Inspections performed by: KND Engineering,
Inc.Dates: 1 st 11/28/2003
• ,..• •••• • /,
2nd 12/1/03
A0 0600406
M. Ct,ir• .' W
Development Services
Approval
.•�• CE 7116
Reviewed and approvedY b
'D'e'partment
�' Date: j � -1 �' �3
��1� pR, @*seeON1''�v?
0
AS—BUILT SYSTEM DETAILS/SITE PLAN Permit SW030273
GLENN VIEW ESTATES NORTH, 131, L11 PID# 051-821-24
eo
KNp 5.
•03�$ IL bA6$ co`��Fo
'po
ti
9
•
01
TH03-2
TH03N
oho '� \
s, SCAL�,\ 1• = so'
A -C= 24.5'
H 99.72 9.2
B -C= 33.0'
arAan aEA,an NDNIT TUBE
A -D= 27.5'
I F 11
IPI1250
B-D=35.0'o
11=11-
A-E= 37.0'
GAL
B -E=43.0'
�N S.T.E.P.
A -F= 91.0'
O1 TANK
B -F= 101.0'
96.2 96.2 9'
A -G= 83.5'
B -G= 53.0'
A -H= 21.0'
B -H=106.0'
�__`�
% ;s> OF ALS 1
� * 91�
L X49 �*. _
—/KENNET M. DU S /
CE -7116 a
1 FAgr
'SSio*10 .w
MEN ITORTUBE
FINAL GRADE 03.
DD
rnTn rum,
vNms
D61AAT)DI
ASSUILT. DATE: 12/9/0,T-
2 9 03
DWG. FILE:
CRID:
SEWER ROCK
TRENCH I
`v
03030
(907)696-6111/FAX (907)696-0111
tff
66'
NONITO
M�) FINAL GRADE I�� II
SEWER ROCK
TRENCH 2
66'
PREPARED FOR:
TROY DAVIS
1451 E. PARKS HWY, SUITE 207
WASILLA, AK. 99687
(907) 357-9394 SCALE, NTS
vmms
ea•
ss.s Ba
FIELD BOOKS
DD
� ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
BOUNDARY. AN DRAWN: RAMN: VQQ
STAKING: CHECKED: KMD
ASSUILT. DATE: 12/9/0,T-
2 9 03
DWG. FILE:
CRID:
NW1361
ACAD FILE: 03030.DWGJW
Nm:
03030
(907)696-6111/FAX (907)696-0111
Dec 10 03 11:20a
Rising bon Electric. Inc.
0916 Wocdland Drive
d Eagle River, AIC. 99577
: (907) 622-6777
December 10, 2003
Troy Davis Homes
1451 E. Parks Hwy - Ste. #207
Wasilla, AK 99654
FAX #(907) 357-9395
Re: Lot 1191 Glenview North
To Whom It May Concern:
The lift station at the above referenced property has been wired in accordance with NEC
and State/Local codes.
Thank you.
Sincerely
Kevin S. Hornbuckle, Owner
Administration License Number 1284
Specialty Contractor License Number 27285
P.1
too'd dGZ 2T £o/oi/ZT LLL9 ZZ9 LOG 'mug o!.AtM013 uos ou13!N
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
Initial
Permit Number: SW030273 Lr3rRfCG
Legal Description:j.Gienn VieAdrtffBlock'1:Lot'11'
Design Engineer: 0070 KND Engineering
Owner Name: Troy Davis
Owner Address: 1451 E. Parks Hwy Suite 207
Willow, AK 99687 -
3:30 f'w�
I Z� 2,)C)3-11:30�t�,
1q E> 103 — I Z 11V
4 P on
Date Issued: Jul 25, 2003
Expiration Date: Jul 24, 2004
Parcel ID: 051-821-24
Site Address: Unknown
Lot Size: 53826 SO. FT.
Total Bedrooms:AY Permit Bedrooms: 3
OiL
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy
All construction must be in accordance with:
1. The attached approved design.
❑ Private Well ❑ Water Storage
2. All requirements specked 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.
//d3 IfEA(ciovi- DFSrGav ro 3
LF,vcrH wG-,twr_FR S rf3 res wlLc ar J28 Fr
RE 123-0 57 -r: --P
Received By:
Issued By:
17/ Date: o v
Date: %-XL - o 3
A
Municipality of Anchorage
Development Services Department r,
Building Safety Division
On -Site Water and Wastewater Program F t
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWERIWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D_051-821-24 Permit Number SW
Property owner(s) Troy Davis Dayphone 357-9394
Mailing address (1) 1451 F. Parks Hwy, suite 207 Wasilla, AK. 99687
Mailing address (2) Zip Code
F_ Sra. r Fs
Legal description (Lot, Block-& Sub'd_) Glenn Viewthlorth Block 1 -Lot-11- - -- - - -- -
Legal description (S�ectiQ_nt Township & Range)
��66
Lot Size 1.213 7_Acres/Sq.Ft.
Number of Bedrooms 4
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.
(Signature of property owner or authorized agent)
Permit Fees: �, �t�I Waiver Fees:
Date of Payment: _ l Date of Payment:
Receipt Number: Receipt Number:
(Rev. 12100)
KND ENGINEERING, INC.
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696.8111
July 18, 2003
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: New sewer/well permit — Glenn View North Block 1, Lot 11
Gentlemen:
The owner has requested we proceed forward to obtain aseptic permit on the subject
lot. On June 24, 2003 three testholes were performed for the proposed system. The
_._-results _of_these -tests _are.attached. ,The general slope -of .this_lot _is_from_southeast_to
northwest at a grade of approximately 1-5%.
We have designed our system utilizing the existing testholes that were excavated for
the proposed 4 -bedroom house. The lot will be served by a public water system. We
propose to install two 5' wide shallow trenches. Water was not encountered during the
excavation, during monitoring water appeared in testholes 03-2, 03-3, 03-4 at 10.5', 12.0',
9.3' respectively. There was one more testhole performed for this property that ended
up being inside the foundation of the house, during water monitoring the water level
was found to be at 8.0'
There are no public or private wells within 200' of our proposed system location except
as noted. There is no surface water within 100' of the proposed system and there are no
known curtain drains within 50'. We do not expect there to be any adverse effect on
adjacent lots by the development of this system.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
II�;�TID Engineering
Kenneth M. Duffus, P.
Attachments: On -Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
(WELL & WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLA
GLENN VIEW NORTH BLOCK 1, LOT 11
1 ..._..._ .. LOT 10 _,. .. .._. ._.. ....
1
OT 19
DESIGN DETAILS
4 BDRM X 150 GPD = 600 GPD
600 GPD/0.45 GPD PER SQ. FT. (40 MIN/IN.)= 1,333 SQ. FT
(1,333/5'(W)) X .64(RF) (2.5' GRAVEL) = 170.62 FT. TRENCH
USE 2 TRENCHES - 86 (L) X 5' (W) X 2.5'(D)
Total depth of system is 4.0' from original grade.
Total depth of gravel below distribution pipe is 2.5' .
PRESSURIZED DISTRIBUTION SYSTEM HOLE SPACING DESIGN
1. RESIDUAL HEAD = 5'
2. HOLE SIZE = 3/16' = 1.00 GAL. PER HOLE @ 30 PSI
3. 30 GALS (PUMP DELIVERY)/1.00 GALS./HOLE = 30 HOLES
4. 172 LF LATERAL/30 HOLES = 5.7' SPACING PER HOLE
NO PUBLIC YELLS VITHIN 200. OF 5. ALL HOLES SHALL HAVE CAPS INSTALLED PER MANUFACTURES SPECS.
PROPOSED SYSTEM.
NO PRIVATE YELLS VITHIN 200' OF
PROPOSED SYSTEM EXCEPT AS NOTED.
NO SEPTIC SYSTEMS WITHIN 200. OF
PROPOSED WELL EXCEPT AS NOTED.
..a, -ft -
Aw OF ALS
Y'�'
_ i49 TE*. _
11
�.� j.
' \ KEN�F DUF U I 4
CE -7116 •V `C Joe
!F AfF
�kNk6�
°ESS1D'1'V AV
NOTES,
1. USE 1250 GALLON SEPTIC TANK, INSULATE IF <4' OF COVER.
2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM.
3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK.
4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE
MIN. 3' COVER IF REQUIRED.
5. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
WELLS, SEPTICS, LOT LINES, FOUNDATIONS AND ALL OTHER SETBACKS.
PREPARED FOR:
TROY DAVIS
1451 E. PARKS HWY, SUITE 207
WASILLA, AK. 99687
(907) 357-9394
FIELD BOOKS
COMPUTED:
BOUNDARY: LANG
DRAW VBG
STAXwc
CMECXED: KMD
ASBUILT.
DATE: 7/18
Owc, FM.
GRID: NW116
ACAD nLE: 03030.DWG
1DB "° 03030
Scale, 1'= 100'
PAGE 1 OF 2
ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
907)696-611
WASTEWATER DISP❑SAL SYSTEM DETAILS
GLENN VIEW NORTH BLOCK 1, LOT 11
----------- S
5200o) 49 „
ro, W 120.98
HO -2 -4 -----__�1/0- O -_TH - -3_-F;7
7
0 p %OpOSED RE
SE E SYSTEM 7 ro
o /
/
o /
ul MT
T _
PROPOSED RI R SYSTE
i lo -
MT /
PROPOSED ZABEL /
rF' 2000 SPLITTER
eo_ Oo
�F--� ROPOSED 1500 0 ��
Q GAL S.T.E.P. TANK o L01
XX� FCO
Aj
IN
`Q.L�s �
10��' �r 1
�* 49�
/-/
1 U
K U. D US;
CE -7116 a
1 \CD ss;o'0' A
PREPARED FOR:
TROY DAVIS
1451 E. PARKS HWY, SUITE 207
WASILLA, AK. 99687
(907) 357-9394
FlELO BOOKS DouruTED:
BOUNDARY: LANG DRAW VBG
sTAaND: CHECKED: KMD
ASBULT. DAM 7/18/0'
DWO. nom: a+'0: NW1161
ACRD ne: 03030.DWG jw N' 03030
Scaler 1'= 20'
PAGE 2 OF 2
MgNI I) ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
907)696-6111/FAX (907)696-8
' OF .�C40p. #I,
D ENGINEERING, INC. j ;t
20441 PTARMIGAN BLVD. i
EAGLE RIVER, AK 99577-8736 �; age.,
.. ........
96
9 Kora.:..;; i1..,.r •
SOILS PERCOLATION TEST kF�pROFESSt��A��
Performed for: Troy Davis Homes, Inc. Date Performed: 6/24/03
Project: Glenn View Estates North, Block 1, Lot 11 TEST HOLE # 03-2
1-
2-
3-
4-
5-
6-
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20 -
Depth
(Feet)
SEE ATTACHED SITE PLAN
Org/OL FOR HOLE LOCATION
SM/GM w/cobbles to 1'
Silt do density increasing w/
depth.
B.O.H.
HOLE PRESOAKED
PRIOR TO TEST
Was Ground water encountered? NO What depth? NA
Depth to water after monitoring? 10.5' Date? 7/1/03
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
6/26/03
1:00
-
6"
-
2
1:30
30 min
51/16"
15/16"
3
1:30
-
51/16"
-
4
2:00
30 min
45/16"
12/16"
5
2:00
-
45/16"
-
6
2:30
30 min
3 9/16"
12/16"
'
Water
I Added
Percolation Rate 40 (min/ in) Perc Hole Diameter 6„
Test Run Between 5 feet and 6 feet
1, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
�- OF Al xt h
KND ENGINEERING, INC.
v [[��q•�r,�� : "9 1
20441 PTARMIGAN BLVD. fear • .••.0 „s �;
i
EAGLE RIVER, AK 99577-8736 � •, ��•�•���.••• �•••:
Ken i _•�
e��•� C iY15 . •
SOILS PERCOLATION TEST�9, •P.TOFESSt.NP.N!4�'�
Performed for: Troy Davis Homes, Inc. Date Performed: 6/24/03
Project: Glenn View Estates North, Block 1, Lot 11 TEST HOLE # 03-3
1-
2-
3-
4-
5-
6-
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20 -
Depth
(Feet)
SEE ATTACHED SITE PLAN
Org/OL I FOR HOLE LOCATION
SM/GM w/cobbles to 1'
Silt & density increasing w/
depth.
B.O.H.
HOLE PRESOAKED
PRIOR TO TEST
Was Groundwater encountered? NO What depth? NA
Depth to water after monitoring? 12' Date? 7/1/03
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
6/26/03
1:00
-
6"
-
2
1:30
30 min
411/16"
15/16"
3
'
1:31
-
6"
-
4
2:01
30 min
413/16"
13/16"
5
'
2:02
-
6"
-
6
2:32
30 min
412/16"
14/16"
'
Water
Added
1-7
Percolation Rate 24 (min/ in) Perc Hole Diameter 6„
Test Run Between 5 feet and 6 feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
• , ,����\fit �
�P�E. 40406"s, i t
� y 4 -0
K D ENGINEERING, INC. 0 00�k
20441 PTARMIGAN BLVD. i
EAGLE RIVER, AK 99577-8736 �" +""" •• ••
J' •• c= 7 116too
SOILS PERCOLATION TEST tit pROFESSIONP���
Performed for: Troy Davis Homes, Inc. Date Performed: 6/24/03
Project: Glenn View Estates North, Block 1, Lot 11 TEST HOLE # 034
Depth
1-
2-
3-
4-
5-
6-
7-
8-
9-
lo-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20 -
SEE ATTACHED SITE PLAN
Org/OL FOR HOLE LOCATION
SM/GM w/cobbles to 1'
Silt & density increasing w/
depth.
B.O.H.
HOLE PRESOAKED
PRIOR TO TEST
Was Groundwater encountered? NO What depth? NA
Depth to water after monitoring? 9.3' Date? 7/1/03
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
6/26/03
1:00
-
6"
-
2
1:30
30 min
413/16"
13/16"
3
1:30
-
413/16"
-
4
2:00
30 min
313/16"
1"
5
2:00
-
313/16"
-
6
1
2:30
30 min
214/16"
15/16"
"
Water
i Added
Percolation Rate 3_ (min/ in) Perc Hole Diameter 6„
Test Run Between 4.5 feet and 5.5 feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-821-24
1. GENERAL INFORMATION
Complete legal description
Expiration Date:
1 Lot
Location (site address) 23375 Northwoods Circle, Peters Creek, AK
Current Property owner(s) Balster, Margaret Day phone 830-7489
Mailing address same
Real Estate Agent Owner Day phone 830-7489
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
Individual Well
❑
Individual Water Storage
❑
Community Class C Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual
Holding Tank
❑
Community
❑
Public Sewer
❑
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $O
Date of Payment
Receipt Number 01 cilD
COSA # 0512-2)1051
Date of Payment
Receipt
Waiver
S. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm NorthRim Engineering Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng
6. DSD SIGNATURE
L,-�' System #1 Approved for <2 bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
Date 1/22/2013
bedrooms, with the following
Original Certificate Date: VS�
The Municipality of Anchorage Devlopment Services Division (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
COSA blue sheei_9-1-12.d.
X Nitratg Advisory'
Arsenic Advisory
Other
If more than 1 septic system Is on the lot:
COSA Checklist #_of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description:
A. WELL DATA tJRGJc
Parcel ID: OS/— 82l- 2t�
Well We if A, B, or C provide PWSID # Well Log (YM)
Date completed Sanitary seal (YM) _ Wires properly protected (Y/N)
Total depth ft.. Cased to iL . Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level fL
Well production g p.m.
WATER SAMPLE RESULTS:
Coliform ., . aolonies/100 mL ; Nitrate mg1L
Arsenic ug/L; : Date of sample:
B. SEPTICIHOLDING TANK DATA
Tank Type/Material
Tank size — O gal. Number of Compartments Z
Foundation cleanowt-F1'!Ni V _nPnmoeim. 4� n &n
Date of pur ;ling, -D/'l /IcA Pumper
ft.
9:p:m.
Collected by:
Date installed li 02
Cleanouts (YIN) W.
C. ABSORPTION FIELD DATA
Date installed SSoil rating (g.p.d./fe or Obdrm)o 41s System type 77 ,<A.
Length 32 ft Width S ft Gravel below pipe Z.S it
sk :. Total depth ft. Eff. absorption area /43! fe . Monitoring tubeY Depression over field
Date of adequacy test 2 3 Results (Pass/Fail) 4 Y '.. 4— Forte bedrooms
Fluid depth in absorption field before test Z in. Water added SCO gal. New depth /Z in.
Elapsed Time: 61 min. Final fluid depth _ 7 in. Absorption rate >= -TQ g,p.d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) _ U��IG If yes, give date .
D. LIFT STATION
Date installed ZZ12SIO3. Size in gallons _/2 S 6 fMantiolelAcc ess (YIN)
`Pump on' level at 4�'.J in. 'Pump ofir level at �,f in. High water alar level at in.
Datum a 1►+ Cycles tested 3 Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELLONLOTTO: AJIJ
Septic tankAift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer menholelcleanout
Sewer /septic service line Holding tank
Animal containment areas Manurelaniinal excrete storage areas
SEPTICIHOLDING TANK ON LOT TO:
Y Building foundation _ Property line /Q Absorption field S�
Water main //J.�4 Water service line 40 �'f'- Surfacewater /d4
Wells on adjacent lots
ABSORPTION FIELD ON LOT TO:
Property line/ a
Building foundation
�� f Water main /40�V_
Water Service line /Y 2 Surface water Driveway, parkingivehide storage AQ
Curtain drain UN6C Wells on adjacent lots 2G�
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that i have determined through field inspections and .
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Zff_EIT�
Date
COSA brown sheet 10-10-12.doc
Dec 10 03 12:05p
N
Lot 12
Qpgf
Lot 4
/ SEPTIC
/ CLEANOUT$
/0.,' CANT,
I.I' X 6.7' CANT--"'
h COVERED PORCH
0 0.6' X 4.2' CAN'
z j
L61:1 1 /
52.837 S.I.
T STATION
X 5.6' CANT
r 2.0' CANT No
a
a3.1'
2.0' X 210 DECK
cn� sTe�uy �
7 owntcs _10
Lot 10
/— 15' TELECOM. a
j ELECT. EASEMENT
PLOT PLAN ` ASBUILT Y- SCALE 1' - 50' GRID NW 1560
Lang & Associates, inc. 11500 Daryl Avenue, Anchorage,
Registered Land Surveyors 907 522-4625 Fax 522-6476 Phone
Y 93
I hereby certify that I have surveyed the following deeMbed property:
Lot
GLENN
0hU(oeeDuaAnchrage Recording s lid. Alaska. and thatteImmprvmnts sited
thereon are within the properly lines and do not encroach onto the property
adjacent thereto, that no Improvements on the properly lying adjacent thereto
encroach on the surveyed promises and that there are no roadways, transmission
lines or other visible easements on said properly except as Indicated hereon,
Dated this the A AAA Day of nwc.etAp Z025- of 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.
Lot 16
Lot 15
P.3
No. 03-141
99515
OF_g4
NATN
LS -9944
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
Parcel I.D. 0_51-R21-24 HAA # `"_jn -71 o
Expiration Date: - l — O �-�-
1. GENERAL INFORMATION
Complete legal descriptio
5 IVOf 00CI<; l rC
Location (site address or directions) hf1�WgBirchDdya
Current Propertyowner(s) Troy Davis Homes, Inc. Dayphone 357-9394
Mailing address 1451 E. Parks Hwy., Ste. 207, Wasilla, AK 99687
Lending agency Day phone
Mailing address
Real Estate Agent Audrey Mason - RF/MAX Dayphone_696-3887
Mailing Address 16600 Centerfield Drive. Ste. #201 Eagle River, AK 9957
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual On-site
Individual Water Storage ❑ Individual Holding tank ❑
CommA Class Well ElCommunity On-site F1
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 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.
Engineer's Printed Name Kenneth M. Duffus Date 12/10/2003
Engineer's Comments:
This Investigation was completed in compliance with
ADEC and MOA regulations. The assessment of the
condition of the well and septic applies only to the
conditions as of the day tested. The flow and absorption
rates may change due to subsurface conditions that
may not be observed from the surface, changes in
land use, local soil characteristics, groundwater levels
that may fluctuate during the year and the water usage
of the family being served by the system. The operational
life of all well and septic systems are subject to these
various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system.
Therefore, KND can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can KND guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
5. DSD SIGNATURE
Approved for
Disapproved.
Conditional approval for
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
bedrooms.
bedrooms, with the following
11l%�o�oaa•ROFESSO'�
�\JYf OFA&?er
go
0,000. L�
ON-SITE
WATER AND ; m'
WASTEWATER ;
PROGRAM go
O
JJ� 0'000.•• \\\
stipulations:
Maintenance Agreements
Supplemental Engineer's Report
Other
By: ly Original Certificate Date. —1/— 03
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program 16 s..
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;SLENN VIEW ESTATES NnRIH. 131. L11 Parcel ID: _051-821-24
A. WELLIDATA j
Well type Public If A, B, or C provide PWSID # _ Well Log (YIN)
Date completed Sanitary seal (Y/N•)— Wires properly protected (Y/N)
Total dfepth ft. Cased to ft. Casing height (above ground)
FROM WELL LOG AT INSPECTION
Date of test i
Static water level ft. ft
Well production 9 -p -m
g.p.m.
WATER SAMPLE RESULTS:
Coliform _colonies/100 ml.Nitrate mg./I. Other bacteria _ colonies/100 ml.
Arsenio: Date of sample: Collected ,by:
I
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material-Septic (STEN/steel (Ancti Tank) Date installed 11 /28/2003
Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) Y
I;
Foundation' cleanout (Y/N)Y_Depression over tank (Y/N)�High,water alarm (Y/N) Y
Date of pumping _ NA - NEW TANK Pumper
C. ABSORPTION FIELD DATA
Date installedl2/1/2003 Soil rating (g.p.d./ft or ftZ/bdrm) 0.45 System type Trenc
Length 132 "• ft. Width ft.Gravel below pipe 2.5 ft,
Total depth 4 ft. Eff. absorption area 1031 ft Monitoring tube Y Depression over field N
Date of adequacy test NA -NEW SYSTEM Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time min. Final fluid depth in. Absorption rate >= g,p,d
An rejuvenation treatment 12 mo.) (YM & type)
If yes, give date .....
Y 1 (past
I
I
. -- ._.........
D. LIFT STATION
Date installed 11 /28/2003 Size in gallons 1250 Manhole/Access (Y/N) Y
"Pump on" level atm in. "Pump off" level at 42 in. High water alarm level aLAfL in.
Datum Bottom of tank Cycles tested 3 Meets alarm & circuit requirements? -Y
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Sewer /septic service line Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5' + Absorption field 5' +
Water main 10'+ Water service line 1 0' + Surface water 100'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 1 0'+ Water main 10'+
Water Service line 10'+ Surface water 10 0' + Driveway, parking/vehicle storage 10 ' +
Curtain drain 50'+ Wells on adjacent lots 2 0 0'+
F. COMMENTS
OF A�
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and ;4 """" ""-" ...
review of Municipal records that the above systems are in 9 i • Konneth M..Dutt•• i
conformance with MOA HAA guidelines in effect on this date. �j c+'t,Xo n2Fi ..Dul
16
CO
Engineer's Printed Name Kenneth M. Duffus ���F9F'�•.:;;;;,..•'"�`c��-�
,1� pROFESSt�N�e'
Date 12/10/2003
HAA Fee $375 00 + $150.00 Rush Waiver Fee $
Date of Payment 12/10120xr03
Receipt Number
4 � `i O�--
(Rev. 12101)
Date of Payment
Receipt Number