HomeMy WebLinkAboutKNIK VIEW ESTATES BLK 3 LT 9KnI*k View
Estates
Block 3
Lot 9
#051-043-10
Municipality of Anchorage
Page 1 of 3
Development Services Department
Onsite Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 9951 M650
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SWO50090
PID Number: 051-043-10
Name'
Mil Contracting, Inc.
Wastewater System: New
Address:
P.O. Box 670495 Chu iak AK 99567
ABSORPTION FIELD
Phone:
Number of Bedrooms:
5' Wide Trench
688-1236
Four 4
Soil Rating:
Total Depth from original grade:
LEGAL DESCRIPTION
1.2
7
GPD/Fl?
Ft.
Block: LnL Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe:
3 9
Knik View Estates
3 Ft.
4 Ft.
Township: Range:
Section:
Fill added above original grade:
Gravel Length:
1-2 FL
50 Ft.
Well: Municipal Water System
Gravel width:
5
Number of lines:
1
Di stance between lines:
Ft.
FL
Classification (Private, A. B, C):
Total Depth:
Cased to:
Total absorption area:
Pipe Matenal:
Ft.
FL
500 Fe
ASTM 3034 PVC
Driller.
Date Drilled:
Static Wafer Level:
Installer.
Dale Installed:
Ft.
MMU Contracting, Inc.
8112105
Yield:
Pump Set at:
I
Casing eight Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P.
❑ Other:
To
Septic
Absorption
Lift
Holding
ublirJPrivate
an a urer:apac
y m e ons:
From
Tank
Field
Station
Tank
Sewer Line
Anchorage Tank
1,250
Well
>200'
>200'
NIA
NIA
>25'
t e.
Steel
am er ompadmeMa:
Two (2)
Surface Water
>100'
>100'
NIA
NIA
LIFT STATION — NONE ON LOT
Let Line
>5'
>10,
NIA
NIA
rze.
an rer:
Gel
Foundation
>5'
>1O'
NIA
NIA
'Pump on" eve a:
ump eve
:
ig wa ra rm
in.
In.
in.
None
Noted
Pump Make B Model
Electrical Inspections performed by:
Curtain Drain
Remarks:
BENCH MARK
oca ion and Description:
Finished Floor.
Assumed hiervation:
100.0 Ft.
Engineer's Stamp
of q<�S•O�i
Inspections performed by: T.L. Kimbrough Dates: 1st 8112105i
49th
�.................. ..........�
2nd 8112105
......
Department of Health
and Human Services approval t ::_
`M ` AEL E AN°ERS°"
��.
-..:_:.......
��T•y No. CE-4381
��j
Reviewed and approved by:
Date:i (!�'" - 5-
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Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number: SWO50090
PID No. 051-043-10
N
V 2 Irl
U I- E U
SUN 0Q
PROFILE AS -BUILT
Scale: 1" = 10'
El
E. ANDERSON
MUNICIPALITY OF ANCHORAGEOF
DEVELOPMENT SERVICES DEPARTMENT •••..•,. 44,
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650c��.
49th°.
SOILS LOG - PERCOLATION TEST ' ..... rs.
%_:,HICHAEL E. ANDERSON :�Q
LEGAL DESCRIPTION: LOT 9, BLOCK 3, KNIK VIEW EST. S/D 0�i •.. No CE -4381
PERFDATE: 8/12/2005
8/12/2005 U1 MYFRSPROJECT No. M0473 •%@���� E��••
PARCEL ID#• TECHNICIAN: T. L. KIMBROUGH Professional Engineers Stamp:
DEPTH TEST HOLE # 2
(feet)
ORGANICS/OB SLOPE SITE PLAN
2
3 ry;
4
SEE SITE PLAN
6
7 '
8 WELL GRADED SANDS
9
10
11
14
IS
16 BOH
17
18
19
20
PERCOLATION RATE:1 .0 (MIN/INCH) PERC. HOLE DIA.�INCHES)
TEST RUN BETWEEN: 4.5 FT. and 5.5 FT.
WAS GROUNDWATER ENCOUNTERED? NO IF YES @ WHAT DEPTH?
DEPTH OF WATER AFTER MONITORING: None DATE OF MONITORING: 9/15/2 05
COMMENTS: NO IMPERMEABLE LAYERS ENCOUNTERED. TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE:
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH of
WATER
(INCHES)
NET DROP
(INCHES)
8/12/04
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
12:40
12.0"
CHARGE
2
12:50
10
2.0"
10.0"
3
12:50
12.0"
RECHARGE
4
13:00
10
2.0"
10.0"
S
13:00
12.0"
RECHARGE
6
13:10
10
2.0"
10.0"
MUNICIPALITY OF ANCHORAGE ..���������,'
DEVELOPMENT SERVICES DEPARTMENT P.�E.OF+4�•
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650 !`�`�.
49th
SOILS LOG -PERCOLATION TEST
i..,..... .,��
:, MICHAEL E. ANDERSON j
LEGAL DESCRIPTION: LOT 9, BLOCK 3, KNIK VIEW EST. S/D •••f No. CE -4381 'tib
PERFORMED FOR: PAUI MYERS ,��
DATE: 8/12/2005 PROJECT No.- M0473 •�%%5:���••
PARCEL ID#• TECHNICIAN:
T. L. KIMBROUGH Profasslonal Engineers Stamp:
DEPTH TEST HOLE # 1
(feet)
1 ORGANICS/OB SLOPE SITE PLAN
2
,x
3 y;
4
5 SEE SITE PLAN
6 ?r
8 WELL GRADED SANDS
SW
9
11 0
12
14 "•• .`.
�.:'.
15
16
17 ' BOH
18
19
20
PERCOLATION RATE:1 .01 (MINANCH) PERC. HOLE DIA.—f--(INCHES)
TEST RUN BETWEEN: 4.5 FT. and5 5.FT.
WAS GROUNDWATER ENCOUNTERED? NO IF YES @ WHAT DEPTH?
DEPTH OF WATER AFTER MONITORING: None DATE OF MONITORING: 9/15/2 05
COMMENTS: NO IMPERMEABLE LAYERS ENCOUNTERED. TEST HOLE PRE SOAKED PRIOR To TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 4/14/2005
GROSS TIME NET TIME DEPTH of INET
DATE
READING
(MINUTES)
(MINUTES)
WATER
(INCHES)
DROP
(INCHES)
s/12/05
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
12:35
12.0"
CHARGE
2
12:45
10
2.25"
9.75"
3
12:45
12.0"
RECHARGE
4
12:55
10
2.125"
9.875"
5
12:55
12.0"
RECHARGE
6
13:05
10
2.125"
9.875"
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: SW050090
Legal Description: KNIK VIEW ESTATES BLK 3 LT 9
Design Engineer: 0014 Anderson Engineering
Owner Name: MM&M CONTRACTING, INC
Owner Address: 21925 ARMAS DRIVE
CHUGIAK , AK 99567-
Date Issued: Apr 19, 2005
Expiration Date: Apr 19, 2006
ParcelID: 051-043-10
Site Address:
Lot Size: 64796 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
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.
5. The following special provisions.
NEED TO DO AN ADDITIONAL 2 TEST HOLES DURING CONSTRUCTION FOR THE PRIMARY AND RESERVE
FIELDS. THE TEST HOLES NEED TO BE SUBMITTED WITH THE AS -BUILT INSPECTION REPORT.
Received By: ' IJ4L
Date:
Issued By: _ ( )(` Date:
</- ao - as—
Municipality of Anchorage
1'�44GE g4i
Development Services Department z ::
Building Safety Division
On -Site Water and Wastewater Program s A E r r
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. 051.043.10 Permit Number SW
Property owner(s) MM&M Contracting, Inc. Day phone 688.1236
Mailing address (1) P.O. Box 670495 Chugiak, AK 99657
Mailing address (2) 21925 Armas Drive Chugiak, AK 99657 Zip Code
Legal description (Lot, Block & Sub'd.) Lot 9, Block 3, Knik View Estates Subdivision
Legal description (Section, Township & Range)
Lot Size 64,796 SF Acres/Sq.Ft. Number of Bedrooms Four (4)
11:16'7_11l>4[aaAIII [ePl14381-1;
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)
Date of Payment:
Waiver Fees:
Date of Payment:
Receipt Number. f fl'l( Receipt Number:
(Rev. 12100)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 FAX
April 14, 2005
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 9, Block 3, Knik View Estates Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer
The owner of Lot 9, Block 3, Knik View Estates Subdivision intends to construct a new
four-bedroom home on the lot. We are therefore requesting a permit be issued for the
construction of a new septic system to serve the new home. The subdivision is
currently served by a community water system. No conflicts exist with adjacent septic
systems or wells and the proposed septic system on this lot. The attached Site Plan
and backup documentation identify the location and configuration of the proposed
septic system and alternate site. The current drainage pattern is identified on the Site
Plan. The drainage pattern will be maintained after development of this lot is complete.
Test holes recently placed on the lot indicated well graded sand with minor amounts of
gravel in the area of the absorption trench and alternate site. The accepting soils were
tested and found to have a percolation rate of slightly more than 1 minute per inch. The
system is designed with an application rate of 1.2 GPD/SF. No groundwater was found
in either test hole during placement and none was found during the monitoring period.
Our design includes the placement of a new 1,250 -gallon septic tank along with a 50'
long and by 5' wide by 4' effective depth absorption trench to collect and treat the
sewage generated in the house. The bottom of the trench will be 7' below the surface.
The distribution pipe will be 3' below the surface. A minimum of 3' of cover will be
placed atop the trenches and a minimum of 4' of cover will be placed atop the new
septic tank.
The ground surface on the lot slopes at varying grades from south to north as shown on
the Site Plan. The absorption trench will be constructed parallel with the slope of the
ground surface as much as possible in conformance, with Municipal requirements. The
Lot 9, Block 3, Knik View Estates Subdivision
April 14, 2005
Page Two
new septic system will be constructed a minimum of 10' from the water service
proposed for the lot and on adjacent lots. It will also be constructed a minimum of 100'
from any surface water in the area.
If the system is constructed in accordance with our design the following statements
apply:
1. The system, if constructed as designed, will have no adverse impact -on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
-n�
Michael E. Anderson, P.E.
Attachments
e 49th
MICHAEL E. ANDERSON j��
%. No. CE -4381 1,•'_=.
57815
241"W 297.21 (NR1
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ALL LOTS SERVED
BYCOMMUNITYWATER
g+' SYSTEM.
BHwre
9
Armas
SB9°4T21°E 393.75 Drive
F los
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�..AREA MAP
MICHAEL ......E...
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No. CE4381 *J
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LOT 9, BLOCK 3, KNIK VIEW ESTATES SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS
Four Bedroom House 5' Wide Trench System
Perc. Rate: 1-5 Min./Inch 1,250 Gallon Septic Tank
Application Rate: 1.2 GPD/SF 4' Drainfield Rock
4 Bedrooms X 150 GPD/1.2 GPD/SF (Application Rate) = 500 SF Absorption Area
500 SF/5 SF ` .5 (Red. Factor) = 50 LF Trench Length
THEREFORE: Construct a 50' Long x 5' Wide x 4' Effective Depth Absorption Trench.
Flow Line Elevation in Trenches to be 3' Below Original Ground Surface. Total Depth to be
7' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Trench.
2'6"
IN
4'0"
Natural
Backfill
5'
II
3' Cover
Over Trench
Geotextile
Fabric
4" Perforated
PVC (Holes Down)
Drainfield Rock
TYPICAL 5' WIDE TRENCH SECTION
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Wells in the Area.
Minimum 10' Separation From Water Services.
Minimum 100' Separation From Surface Water or Streams.
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 9, BLOCK 3, KNIK VIEW EST. S/D
PERFORMED FOR: PAUI MYFRS
DATE: 8/12/2004 PROJECT No•M0473
PARCEL ID # TECHNICIAN: T. L. KIMBROUGH
DEPTH TEST HOLE # 1
(Fee[)
1 ORGANICS/OB SLOPE
2 n
3
4 ..
5
6
7
8
9
10
11
12
14 +�
15
16
17 '
Ii
15
WELL GRADED SANDS
SW
:a.
SITE PLAN
SEE SITE PLAN
m
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH of
WATER
(INCHES)
NET DROP
(INCHES)
8/12/04
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
12:35
12.0"
CHARGE
2
12:45
10
2.25"
9.75"
3
12:45
12.0"
RECHARGE
4
12:55
10
2.125"
9.875"
5
12:55
12.0"
RECHARGE
6
13:05
10
2.125"
9.875"
PERCOLATION RATE: 1.0 1 (MINANCH) PERC. HOLE DIA.-6—(INCHES)
TEST RUN BETWEEN: 4.5 FT. and 5.5 FT.
WAS GROUNDWATER ENCOUNTERED? NO IF YES @ WHAT DEPTH? .
DEPTH OF WATER AFTER MONITORING: None DATEOFMONITORING: 9/15/2 04
COMMENTS: NO IMPERMEABLE LAYERS ENCOUNTERED. TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY VETECH ENGINEERING TECHNICAL SERVICE. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 4/14/2005
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 9, BLOCK 3, KNIK VIEW EST. S/D
PERFORMED FOR: PAUI MYERS
DATE: 8/12/2004 PROJECT No•M0473
PARCEL ID#- TECHNICIAN: T. L. KIMBROUGH
DEPTH TEST HOLE # 2
(feet)
1
2
3
4
5
6
7
8
9
10
11
14
15
16
17
18
19
_� ORGANICS/OB SLOPE
SITE PLAN
SEE SITE PLAN
`x
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH OF
WATER
(INCHES)
NET DROP
(INCHES)
8/12/04
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
12:40
12.0"
CHARGE
2
12:50
10
2.0"
10.01,
3
12:50
12.0"
RECHARGE
4
13:00
10
2.0"
10.0"
5
13:00
12.0"
RECHARGE
6
13:10
10
2.0"
10.0"
PERCOLATION RATE: 1 .0 (MINANCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 4.5 FT. and_5_5FT.
WAS GROUNDWATER ENCOUNTERED? NO IF YES @ WHAT DEPTH?
DEPTH OF WATER AFTER MONITORING: None DATE OF MONITORING: 9/15/2 05
COMMENTS: NO IMPERMEABLE LAYERS ENCOUNTERED. TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY VETECH ENGINEERING TECHNICAL SERVICE. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 4/14/2005
MUNICIPALITY OF
f
Development Services Department
On -Site Water & Wastewater Section
ANCHORAGE
Certificate of On -Site Systems Approval
Phone: 907-343-7904
Fax: 907-343-7997
Parcel I.D. 051-043-10 Expiration Date: 10- ( � ^2 V 2.0
1. GENERAL INFORMATION
Complete legal description KNIK VIEW ESTATES BLOCK 3, LOT 9
Location (site address) 21925 ARMAS DRVIE, CHUGIAK, AK 99567
Current property owner(s) ANTONIO & ANITA TARDUGNO Day phone
Mailing address
Real estate agent .
21925 ARMAS DRVIE, CHUGIAK. AK 99567
2. TYPE OF DWELLING:
K Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
Private Well
❑
Water Storage
❑
Community Well
❑
Public Water System
Public Sewer
Waiver request for:
Received by:
Day phone
TYPE OF WASTEWATER DISPOSAL:
Private Septic
Holding Tank
❑
Community
❑
Public Sewer
❑
Distance:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $550-6D Waiver Fee $
Date of Payment Date of Payment
Receipt Number ��d��� Receipt Number
COSA # 63GIq t; 13 Waiver #
e Ran
5. 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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377
Address 4661 NATRONA AVENUE, ANCHORAGE, AK 99516
Engineer's Printed Name MICHAEL N. ANDERSON, PE Date 10/23/2019
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. 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,
OF A \
A�
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
&
rcC
construction (workmanship materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
/ 6.1;'
* 49 LH*
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any estimate of how long a system will function satisfactory
:
/ /�
for future that deficiencies
current or occupants or guarantee no unseen encroachments, or
discrepancies exist can be given by FIBS and Anderson Construction & Engineering.
•?QCHAEL N. ANDERSON.-
NDERSON.No.
No.CE 9489
6. DSD SIGNATURE
-.19/23/1.. - _4
1\
System #1 Approved for bedrooms\�►��
�" 33IO �
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the followina stiwlations-_..
By: Original Certificate Date: j 0
The Municipality of Anchorage Development 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 X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
11 111 1 IM-Mviff,
Legal Description: KNIK VIEW ESTATES BLOCK 3 LOT 9 Parcel ID: 051-043-10
if more than 1 septic system on lot: COSA Checklist # _of
A. WELL DATA — PUBLIC WATER
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth _ft
Cased to _ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) _in.
Date of flow test for COSA
Static water level at beginning of test _ft.
Comments
B. TANK DATA — 8/12/2005 1250 -Gal
Structure served by this system _
Well production at time of test _gpm
Water storage tank volume_ gallons
Well disinfected for coliform test? ❑ Yes ❑ Nc
❑ Coliform bacteria is Negative
Nitrate _ mg/L ❑ Nitrate less than MRL (ND)
Arsenic _ ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
C. LIFT STATION
Age of tank(s) 14 years ❑ Required maintenance completed
Tank type/material SEPTIC / STEEL Age of lift station years
Measured operating fluid level in septic tank 49" Lift station material
® Standpipes/foundation cleanout per record drawing Comments:
Date of pumping 10/17/2019 /
D. ABSORPTION FIELD DATA — 50'L x 5'W x 4'ED — 1.2 GPD/SF = 600SF
Which system tested (date installed) 8/12/2005
® ALL standpipes present per record drawing
Total measured depth from grade 7_8 ft (max)
Measured depth to pipe invert from grade 3.8 ft (min)
❑ N/A — pressurized field
® Monitor tubes go to bottom of effective. If not state
Adequacy test date 9/30/2019
Results N Pass For 4 bedrooms
Fluid depth prior to test 0 in
Water added 700 gal
New depth 11 in
depth into effective Elapsed time 1350 min
® Code -required soil cover over field Final fluid depth 0 in
® System presoaked Absorption rate 600+ gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N
date of test)
Gallons introduced 1990 gallons If yes, enter date
Comments/Deficiencies: 6" drop after the first hour of the 700 gallons added. WEE
COSA Checklist.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well) NO WELL - PUBLIC WATER
Septic rankJLift Station on Lot > 100'
Community Sewer Manhole/Cleanout? aQO f
® Yes if No ft
"Yes if No ft
If absorption field is under driveway comment below
Property Line > 10'
Neighboring Tank > 100' -9`Y-es if No ft
Private Sewer pis Li�' ® Yes if No ft
Absorption Field on Lot > 100' ® Yes if Noo
ding Tank > 100' ® Yes if No ft
Neighboring Absorption Fields > 100'
Animal Co rtainment > 50' ® Yes if No ftw.Y-e-s
if No ft
ft
Private Wells > 100' ® Yes if No ft
Manure/Animal Excreta Storage_? 100'
Communityevv r Main > 75' ®Yes if No ft
Y' if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ® Yes if No ft Wells on Adjacent Lots:
Property Line > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft
Absorption Field > 5' ® Yes if No ft
Water Main > 10' ® Yes if No ft
®
Water Service Line > 10' ®Yes if No ft Community Wells > 200' Yes if No ft
Surface Water > 100' ®Yes if No ft If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
® Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' ® Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No ft
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that l 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.
COSA Checklist.docx
OF AZ4
'49 Tx
MICHAEL N. ANDERSON -
No. CE 9469
10/23/19.
FESSIOt; '
Municipality of Anchorage AN�
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite (907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Location (site address) 21925 ARMAS DRIVE, CHUGIAK, AK 99567
Current Property owner(s) MATHEW & JENNIFER HAZL= Day phone
Mailing address 21925 ARMAS DRIVE, CHUGIAK, AK 99567
Lending agency
Day phone
Mailing address
Real Estate Agent LES BAILEY & ASSOC.
Day phone 694-1234
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:. ' .
TYPE OF WASTEWATER -DISPOSAL:
Individual W611 ❑
Individual On-site
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 On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions intheprofessional 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. l further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State°codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ARCTERRA CONSULTING INC. Phone 868-3792
Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 02124/2012
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. Thi
r'iSSP.SSMPnt nf#h[a cnnrirfinn nffk. au.al .,..d .: a:
a,.,u..n,rw,},uun rakes may mange. que:;to subsurface conditions ;that n
changes inland use, local .soil ch6ractenstics, grow n'"ater``levels #hat
water usage of the family being served by the system. The operationa
subject to these various and dynamic characteristics and are outside the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how tong a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
5. DSD SIGNATURE
f Approved for
t
Disapproved.
_ bedrooms.
—Y ,iuuauatC uummy me year ana:tne
fife of all well and septic systems ares
rtnntmi of ih A
Conditional approval for bedrooms, with the following stipulations:
4
....
�O IENTE�
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: V�7
(Rev. 1, 05
Original Certificate Date:
Municipality of Anchorage A8.�
• '� Development Services Department
Building Safety Division a
On -Site Water and Wastewater Program S A E T Y
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite (907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: KNIK VIEW ESTATES BLOCK 3, LOT 9 Parcel ID: 051-043-10
A. WELL DATA
Well type PUBLIC If A, B, or C provide PWSID #
Date completed Sanitary seal (Y/N)
Total depth ft. Cased to ft.
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100mL Nitrate mg/L
Arsenic: mg/I Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 8112/2005 Tank size 1250 gal.
Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
High water alarm (Y/N) N Date of pumping 7/7/2011 Pumper .IRs
C. ABSORPTION FIELD DATA
Date installed 8/12/2005 Soil rating (g.p.d.e or ft2/bdrm)1.2 System type 5' Wide Trench
Length 50 ft. Width 5 ft.
Eff. absorption area 600 ft2
Gravel below pipe 4 ft. Total depth 8_4 ft. (Measured 2/23/12)
Monitoring tube Y
Date of adequacy test _2/23/12
Depression over field N
Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 26.4 in. Water added 720 gal. New depth 33.6 in.
Elapsed Time: 1155 min. Final fluid depth 26.6 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) _If yes, give date
D. LIFT STATION
Date installed Size in gallons
Manhole/Access (Y/N)
"Pump on" level at in. "Pump off" level at
in. High water alarm level at in.
Datum Cycles tested
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
On adjacent lots
Absorption field on lot
On adjacent lots
Public sewer main
Public sewer manhole/cleanout
Sewer /septic service line
Holding tank
Animal containment areas
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 51+ Property line 51+
Absorption field 51+
Water main 101+ Water service line
101'+ Surface water 1001+
Wells on adjacent lots 2001+
SEPARATION DISTANCE FROM ABSORPTION FIELD
ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water Service line 101+ Surface water 1001+
Driveway, parking/vehicle storage 101+
Curtain drain 501+ (None Known)
Wells on adjacent lots 2001+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that / have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name KENNETH M. DUFFUS
Date 02/24/2012
COSA Fee $490.00
Date of Payment ala llo
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage JJ
Development Services Department
• � r' a
Building Safety Division
On -Site Water and Wastewater Program °
4700 South Bragaw St. SA ""
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-043-10 HAA #_ 615qQ °-
L GENERAL INFORMATION Expiration Date: to - 0 O re
Complete legal description _Lot 9. Block 3. Knik View Estates Subdivision
Location (site address or directions) col..S ARMRS Z),evle z�6&'
Current Property owner(s) MM&M Contractina Day phone 688-1236
Mailing address P.O. Box 670495 Chualak
AK 99567
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
Four 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
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 5 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 less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 9/27/2005
5. DSD SIGNATURE
Approved for _ bedrooms.
Disapproved.
MICHAEL E. ANDERSON
Conditional approval for . bedrooms, with the following stipulations:
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: ."z, A,/•( Original Certificate Date:
(Rev. 17106)
Municipality of Anchorage
' Development Services Department °
Building Safety Division "
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 9. Block 3. Knik View Estates Parcel ID: 051-043-10
A. WELL DATA
Well type _
Date completed
Total depth ft.
in.
Date of test
Static water level
If A, B, or C provide PWSID #
Sanitary seal (Y/N)
Cased to ft.
FROM WELL LOG
Well production
WATER SAMPLE RESULTS:
Coliform colonies/100 ml.
Date of sample:
B. SEPTIC/HOLDING TANK DATA
ft.
9 -13 -m -
Nitrate mg./I.
Collected by:
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground) .
AT INSPECTION
Other bacteria
f1i
colonies/100 ml.
Tank Type/Material Septic/Steel Date installed 8/12/2005
Tank size 1.250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping Pumper New Construction
C. ABSORPTION FIELD DATA
Date installed 8/12/05 Soil rating (g.p.d./ft2 or 6bdrm)1.2 GPD/SF System type 5' Wide Trench
Length 50 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth B-10 ft. Eff. absorption area 500 ft2 Monitoring tube Y Depression over field N
Date of adequacy test Results (Pass/Fail) For _ 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.
Any rejuvenation treatment (past 12 mo.) (WN & type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at _ in. "Pump off" level at _ in.
Datum
E. SEPARATION DISTANCES
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main N/A
Sewer /septic service line
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >& Property line >& Absorption field >6
Water main N/A Water service line >10' Surface water >100'
Wells on adjacent lots >200'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation >10' Water main >10'
Water Service line >117 Surface water >100' Driveway, parking/vehicle storage >25'
Curtain drain None Noted Wells on adjacent lots >200'
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 r 49th
}A� ......J........ r...
conformance with MOA HAA guidelines in effect on this date. `
MICHAEL E. ANDERSON
Engineer's Printed Name Michael E. Anderson, P.E. 0::'c��c,No. CE-
RLFc43a1
Date 9/27/2005
��'ti_fP1Z
HAA Fee
Date of Payment
Receipt Number
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number
in.
11
I- L nr g ~ �j
lop
I
A KmA's
dfitIva
AS -BUILT
I hereby certify that 1 have surveyed the following described
I
property: L
_':�z..r_Tr or,}, lF- r' f j %J i F? f '/•�? Si�!1..
1
Anchorage Recording Precinct,'Alaska, and that the' Improve•
menta situated thereon are within the property lines and do'not' . .
overlap or encroach on the property lying adjaceni.thereto, that .
no improvements on property ly mnty adjacent thereto encroach'
on the premises in question and that there are no xoadways, -
transmission lines or other visible. easements on said property,
except as indicated hereon.
Dated at Eagle River, Alaska
this S Zk. ....day of
ROBERTC.')OHNSON','
SCALF: Re�gutered Lend Sur—
veyor o.. .S.
(�O' �oR'77-0456, Eagle River, .Alaska 995y.I
', ,•
Phone (907) 694-250. .. .