HomeMy WebLinkAboutKNIK VIEW BLK 3 LT 9Knl*k View Block 3 Lot 9 #051-031-62 certifieb jDdtting log by 00Co.am SUIVA�/L�/L�WN[`MW��A� yT��ER WELLS L 4' ADDPAM I.�nl. Dtrtot� k "1t x. ;tri rip _ _ - �� t>e---2 life Z 11 PI3t1MT M7Ni ud 0 Daied h9ue-�!� - ECJ iAXIDt3YfIPICKf10NNEMdt t ekill 1sweRbabdoappoodpMebealT w Irime filo Ntamw d oriArm &wfi; v a mhb tops Daptlrofwot X1,0 ' I,.IflBrTWK 0LIgVj*VAbomG=n A- %d stmwawupjak a last Flewuar R wt fi 9wm MwkwafTesaw -A,4 Vmhl ft0pwftT m 4469 w aqmhotb is=_ Sart--pat Sto�fpell int 3 Pwaraoaat Sbd t0 * g oat•type % O yT �04 VAIs Depnr km V teat, to au -t teat Waq Dji,(a j p t7P0m C=Vk i g files Cl M 1�isthoadobitae Ct�c.ore�...te 5"a ���" Gei s4�1'~c"•�- � it AfthmW pDspWV e 9 of s H~ Sw he PMWLY km andV D i fot���'Dcamw ation. Maft e 79parenont of awkaraftI Cawovam. S0 39Vd NVAi- ns GGZZB89 Z0.00 666T/TB/T0 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 WATER SUPPLY PERMIT Upgrade Permit Number: SW040028 Legal Descriptior4laM.VBLK, S;LT 9 Date Issued: Mar 10, 2004 Expiration Date: Mar 10, 2005 070 - 03t- 6Z Parcel ID: 051-04344). Design Engineer: 0003 S & S Engineering Site Address: Owner Name: MARIE WARNKE Lot Size: 53981 SQ. FT. Owner Address: 22030 BIRCH CREEK DRIVE Total Bedrooms: 4 Permit Bedrooms: 4 CHUGIAK , AK 99567 - 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 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. Received By: Issued By: Z" Date: 3 1( / 0,/ �• �7� Date: .3 .00104 Municipality of Anchorage Development Services Department s' Building Safety Division w On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.ancho rage. ak. u s (907) 343-7904 rCIN-SITE SLYJER/L": LLL PERMIT APp':_tC-ATIOIN' FOR A SINGLE FAMILY DWELLING 05-1 - 631 - �Z Parcel I.D. v'"'��" Permit Number SW 0447028 Property Mailing address (1 Mailing address At 2 203v � Legal description (Lot, Block & Sub'd.) !� Day phone Legal description (Section, Township & Range) Lot Size 5 J, ! 9/ Acre /Sq.Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only 19 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 Single Family Dwellin (Signature of propefty o/ner or, Permit Fees: P f�s-; w nation is correct. I further certify that this application is being made for a is in ccordance with applicable Municipal Codes. Date of Payment: 212041 Receipt Number: (Rev. 12100) UV agent) s-� Waiver Fees: Date of Payment: Receipt Number: ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX(907)694-1211 February 19, 2004 HEALTHAUTHORITY APPROVALS MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 SEWER&WATER Anchorage, AK 99519 MAINEKTENSIONS REFERENCE: Lot 9; Block 3; Knik View Subdivision SEWERS WATER INSPECTION It is requested that you issue a permit to drill a new well to serve the existing four bedroom dwelling on the referenced property. The existing well contains silt and will not clear up with use. ENGINEERINGSTUDIES ANDREPORTS We do not anticipate any adverse effects on neighboring septic systems, reserve areas or drainage patterns by the installation of the proposed well. The construction of this well will not prevent any future development on any of the adjacent properties. WELL INSPECTION &FLOW TEST If you require additional information, please contact us. Sincerely, NS SITE PLA/ ROAD DESIGN � �:/ RCC/ J Enclosure SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 1" = 50' WELL DESIGN \ A b _1 sniava 1GM .00� � \ SITE -PLAN Nfk, \o H co W �A ti Mm \ rA T�AZA n y ~ m DSO W o Z A < j L m5o L DDD <yC ymA �m 00 y A t x \q o \ I(� ✓ti A \o n m \ \ X N x � \ OO 9 nA ✓itiD A \ \ v iLo\\'v\mz\ \q O \ A b _1 sniava 1GM .00� � \ SITE -PLAN Nfk, \o H co W Mm T�AZA n y ~ m DSO W o Z A < j L m5o L DDD <yC ymA �m 00 y A t x O o K I(� ✓ti A n 2-06-1996 6:33AM FROM p,t j s STATEMENT OF NON -OBJECTION FOR ENCROACHMENT jiI WITHIN UTILITY EASEMENT i Matanuska Electric Association, Inc. (MEA) has no objection With the location of i a welt within the platted transmission line easement located in the seat WWUn = of the following property; + Lot 9, Block S, KnIk View Subdivision, Anchorage Recording District, State of { Alaska. ii Section 3, T1SN, R1W, S.M. < i This non -objection is granted with the Cult understanding and agreement by all parties having an interest in the above property that thistML cricrosiohmerill will In no restrict or limit the current or future ability of MEA to fully eNoy the enefits of the ay easement for any and all WRY purposes that it presently enjoys under the easement. i This non-ol�eotlon Is further coriffoned by the stipulation that MEA will be held harmless from liability for any and all damages to the encroachment that may result from the U126119 and future use of said easement by MEA, its contractors, successara, agents, licensees, or assigns, i r Matanuska ElectricAssocistlon, Inc. s. i By: �, General Ma ager or his Representat a X4 roste c MEA ACKNOWLEDGMENT STATE OF ALASKA. ) i THIRD JUDICIAL DISTRICT j The A N(Y ag foregoing agreement was acknowled ad before ms this --,day of dj ,by, Notary Public for the My commission expires: " /_ 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: J � I03C / PID Number: 3 1-_� 2, Name: +5 00'k�bu, l 1�5 Wastewater System: tK New ❑ Upgrade Addresvp '13ok5-:215- 77Ri<bike �g� jr ABSORPTION FIELD Phone:- P"') o f3 410 Nmber of Bedrooms: [3Deep Trentlp Shallw TrexV/h� Dead ❑ Mond KOther]✓N LEGAL DESCRIPTION Soil Rating: rD Total Dph from original grade: �fSFL GpO/F' Block:3 Lot: Subdlvisia¢ , ' , / �S�: �eW Depth to pipe bottom from onginal gra^de�: `f/�s'�f t' Gravel depth beneath pipe: \\ fGP + p5mr Township: Range: Fill added above original grade: G esag Ft. Well: UR New ❑ Upgrade Gravel width: Number tlnes: Distance be en Ynes: Ft. Clpl;fi adan (Pnv le, A. B, C): Total Depth: casedIv. / ��� ��� ^� Total absorplion area: ��O P (Hb;7 �'// (�o�, S��{�/FFt. �O� " / ' " ( Ft. Ft. FO JV f� / / 1 Driller: 1 1 „ Y //�/�J� lG�t ! �1 Data Drilled: s 30 0< Stagc Water Level: /1 Ft. I s Iter: J r wCe� F CC{UaTrA Dale Installed: �!-`�-O Yield: 1,7 GPM Pump B/el aC_ Pump Cl/ G� Fl. Casing Height 7Above Ground: G Ft. TANK SEPARATION DISTANCES ❑ septic ❑ Holding KS.T.E.P. ❑ Other: To From Septic Tank Absorption Field Lilt Station Holding Tank PublidPrivat Sewer Line M�^�ranarac / PJ er { `C capacity; �{.+tJ Gal. Well ©^ , 3 .� t ') r— t d) J + Material: HDPF r� YC Number of Compartments: Sudace Water ©D �Qfi �I - LIFT STATION Lot Line t ��\ `75 \ 5 Size: 5 aL ManWacluren 0 em/ i GS Foundation g 'Pump on' level at. "/ � in. "Pump og' level at: y(ry High water alarm al: _3 in. 418 In. Curtain Drain _ �/ O/�, OW Pump Make B Model �Gr Eleclncal lnspeccl'iJ�Ga/p dorm by: T Remarks BENCH MARK Lowgon and Deaviplion: (� eo Ttow oT 51, / n ry t9q%% med Elevation: to© Ft. E p S & 5 ENGINEERING 17034 Eagle River Loop Road, at 'I— 1 -0-a Inspections performed by: 1� ra-a •' '' '""` ° telile River, AlasVad 2nd§,n. .£. .. Development Services Department Approval A. �'Yn . lar{ r Reviewed by: Gt°.• Date: rx and approved PERMIT NO. SWO1 0367 PAGE 2 OF 3 Municipalityof Anchora e DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 9, BLOCK 3, KNIK VIEW P.I.D. NO. QS_ j,0 (a,2 BLM LOT 46 ALT. SITE F_ I I I I J TH NEW LDS MT FV1 —FV8 (FLUSHMC VALVES) NEW 550 GALLON FAT ALBERT HDPE TANK W/ S.T.E.P. NEW 1300 GALLOP HDPE SEPTIC TANK BURIED LOT / / / / / -7 / ASPHALT / DRIVEWAY i 10 / 31L 011IN&W 441117d PERMIT No. SWO10367 PAGE 3 OF 3 MunicipaJt of Anchora e DEPARTMENT OF HEATH AND HUI`�AN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 •Anchorage, Alaska 99519-6650 • Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL, LOT 9, BLOCK 3, KNIK VIEW P.I.D. NO. °r/_ 0 31- (,2 FINAL GRADE 96.5' 9 6.1' 97.0' INSULATION ELECTRICAL CONDUIT 92.8' NEW 1300 GAL. IY." DISCHARGE PIPE POLY. TANK 92.5' _ 550 GALLON FAT ALBERT WITH PUMP ASSEMBLY FINAL GRADE MTI=94.5' MT1 ORIGINAL GRADE INSULATION PEA GRAVEL 9' VNUER LATERALS PIL1'6RJ. ALR LINE - 13AN0 DIST. LINE=92.2' MT1=91.9' BOTTOM OF SAND=89.9' N. T. S. ENGINEI•;R _STAMP FCO 20.0' 2.5' GROUNDWATER AT 86.4' '� ST1 ST2 19.0' 19.0' 10.5 14.0' 81.4' B.O.H. K Y TMT 22.0' 12.5' ° MH 20.0' 19.0' FV1 32.5' 33.5' —TV 8 48.5' 47.0 +� MT1 48.0' 48.0 �L e Jun.16 '03 23:45 FAX P. 1 Certttteb OrIth(tig 'Log by ooc co. oo, SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2750 OWNER OF LAND:fn....— ADDRESS: LEGAL DESCRIPTION: DATE:.h.1 PERMIT NUMBER: _0/0 34 3Date of Issue- - /.!Z - 01 1AX IDENTIFICATION NUMBER: Is well located at approved permit location? &Ws� _j No Method of Drilling: Mary L cable tool Depth of well:. Casing Type ,WallThickness�V#Z� inches Diameter inches, depth feet Llner Type:` Casing. Stickup Above Ground:. -feet Static Water Level: /5!_ Poet Recover Rate: / I gpm Method of Testing: _JILA2 Well Intake Opening Type: G-epiri end U open hole a Screened; Start feet Stopped _, __._., feet iJ Perforations Start feet t feet C1 0 Grout Type: ie.�T"a`u�r� Volume Depth: from Q feet, to _..........feet Well Disinfected Upon Completion? b -715s ❑ No Method of Disinfection: C him a rt 4, 44 To fo�0'ri - Comments: d f`sIC-C'm- � aylz�4'�.✓_�.0r b l T I a4.7 S g4. i df S.4r R47990 Driller's Name . (A:&g ArrENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. Matsu Borough: Department of Environmental Conservation. 08/17/03 TUE 10:21 FAS 907 3733833 Jim or Teresa Nelson TJ Electric 2750 Donovan Dr., Wasilla, Alaska 99654 (907) 376-0173 or 357-0173 R&S Construction PO Box 521577 Big Lake, AK 99652 (907)892-3511 June 17, 2003 Dear Roger, 3 Please be advised that the lift station at Lot 9 Block)KKnik View, Birchwood, was wired to the directions of the schematics on the control, in conjunction to the National Electrical Code (NEC). All work was performed by a licensed journeymen electrician, under the direction of an Electrical Administrator. If you have any further questions about the above mentioned lift station, please feel free to contact me at the numbers listed above. Thank you, James C. Nelson, Owner Electrical Contractor - #16873 Electrical Administrator - #719 Cc: S&S Engineering - 694-1250 Tweed Excavation - 694-1211 fa 0 01 E ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT MEMORANDUM OF UNDERSTANDING BETWEEN �M,,UNICIPALITY OF ANCHORAGE AND ih&9L AAN 14—e THIS MEMORANDUM OF UNDERSTANIANI(i thadc and entered into as of ti,is day of ane l0 2025, by and between �{t�+R hVftl+ke herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Memorandum of Understanding agree as follows: 1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as h Si= located at kot ',_k Vre,a Anchorage, Alaska. 2. Definitions. A. Alteration. Any change to the design or function of an AWWTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Prior to performing any alterations to an AWWTS the owner must obtain a Wastewater Disposal System Construction Permit from the Municipality pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65 B. Certificate of On -Site Svstems :approval. An approval by the Municipality of existing water and �Nastewater disoosal Svstems given at the time of property sale and title transfer in accordance with AMC Page I of 5 4. Term. The term of this Memorandum of Understanding shall be for the life of the AWWTS. The term begins on the date of approval by the Municipality of the installed system and shall continue while the AWWTS system is in use or operational or.until the property is .;.. . j l:_.ry-rS::Ssued- tc -*a_" sold or title rs trans en•edby owr3er aril a view certr�..,t � -< *h new owner or transferee of the property. 5. Alterations, Installation and Removal of Additional ]Equipment. Owner agrees not to make any alterations, removal of parts or additions to the AWWTS without a Construction Permit from the Municipality. 6. itilaintenance and Repairs. A. Throughout the term of this Memorandum of Understanding, the Owner shall maintain AWWTS in good repair. In addition, it shall be the responsibility of the Owner during the term of this Memorandum of Understanding, and any extensions or renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. Further, owner agrees to comply with all applicable ordinances, laws, regulations, rules and orders for the AWWTS. & Owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system pursuant to the terms and conditions contained in the Owner's AWWTS Operating Permit. This schedule shall be submitted to the Municipality annually upon the renewal of the permit. The schedule of maintenance and repair contained in the Owner's AWWTS Operating Permit is: Pate 3 of 5 B. For the purposes of any amendment modification or change to the terms and conditions of this contract, the only authorized representatives of the parties are: Owner: Mftmi Y 1AS44 __ Anchorage: Purchasing Officer C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of Understanding shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Memorandum of Understanding. 10. Severability. Any provisions of this Memorandum of Understanding decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Memorandum of Understanding. (1WNFi R• MUNICIPALITY: By: -- Title. ( o Date�i 6 Date: C Y: STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The forevoins instrument was 1rrq SO40C 0 A&mb . the Ylunicipality of Anchorage. Page 5 of 5 me this/,ff day of J tAru 20Qi by of b�ii'`�i3half of .utf FOR ALASKA �*PUBLVO 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 WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Permit Number: SWO10367 -- --jam i V Design Engineer: 0003 S & S Engineering Owner Name: Ted Schmelzer Owner Address: PO Box 999 Neches , WA 98937 - ?1710 z ZP" �//D1-z Date Issued: Sep 12, 2001 Expiration Date: Sep 12, 2002 Parcel I D: 061_03(_ 62 Site Address: Lot Size: 64796 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: 0✓ Disposal Field ❑✓ Septic Tank E] Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑✓ Private Well ❑ Water Storage 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: Date: / -12 ' �� 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 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0 3 ( — G -2- Permit Number SW 010367 Property owner(s) I f la 5 C 4M t L -z- 't R Day phone G 1' 91 Mailing address (1) yO- D • 3 o X 9 �l j /}�'� -5 w .4 Mailing address (2) p I f Zip Code Legal description (Lot, Block & Sub'd.) L O t�/ b 1_ OG K 3: Kn; t V ,'BuJ- Legal description (Section, Township & Range) /' Lot Size I, -a �1`T Acres q.Ft Number of Bedrooms &6/ 7141 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: i 'y yo • J - Waiver Fees: Date of Payment: S—/?o /O / Receipt Number: 0 of'o G 3 (Rev. 12100) 5 & S ENGINEERING 17034 Eagle River Loop Road No. 204 Date of Payment: Receipt Number: S& May 15, 2001 ROBERT C. CIVIL ENGINEERS (907)694-2979 FAX(907)694-1211 APPROVALS MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK. 99519 SEWER&WATER MAIN EXTENSIONS REFERENCE: Lot 9, Block 3, Knik View S/D INSPEcnONTER It is requested that you issue a permit to install a well and a septic system to serve the proposed four bedroom dwelling on the referenced property. Two test holes were excavated and percolation tests performed. The approximate locations ENGINEERINGSTUDIES ANDREPORTS of the test holes are located on the attached site plan. At the time of excavation 5/2/01 rlcioi water was found at 8 feet. After monitoring, ground water was found at 8 feet. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve WELLINSPECTION BFLOWTEST areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. SITEPLANS If you require additional information, please contact us. Sincerely, ROADDESIGN /J SOIL TEST Robert C. Cowan, P.E. RCC/bjj PERCOLATIONEnclosure TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 N �o O w 0 - CD CD 30 o a ~z O f=O Y r Q f F p�0,5, n K a Vl 0 M OME O W os O) a_ M W K M N N W ~ rr1-�-I � J d m N �l > N � C, a� ow r p4 Z> OLL ZY O z �a 0 v �a �> ao <� W OV Q oa m W Z r N U p o of C� U O N s w� z m 0 M m W ~ m N O W o-�Ln O ~ U�O a 0EL00 O II II o N U NI Q m u 0 D W d a rIL W w w 0 J� Q m w m O .�z z o Q� Ln O Of U a� W W iti o^\�s H d > j • !2 {.44N \ a' uj co (n U Ei o r \ \ 0 0 3 0 N3 a\ ti N Q_ DL W 11 o r N �o O w 0 - CD CD 30 o a ~z O f=O Y r Q f F p�0,5, n K a Vl 0 M OME O W os O) a_ M W K M N N W ~ rr1-�-I � J d m N �l > N � C, a� ow r p4 Z> OLL ZY O z �a 0 v �a �> ao <� W OV Q oa m W Z r N U p o of C� U O N s w� z m 0 M m W ~ m N O W o-�Ln O ~ U�O a 0EL00 O WIMMIM a 0 NOIS34 ofM II II o N U NI Q m u 0 D W d a rIL W w w 0 J� Q m w m O .�z z o Q� Ln O Of U a� W W iti H d > WIMMIM a 0 NOIS34 ofM mm- u 0 D W d rcmm rIL W w w ><�^ W �_ Z p300 wm�m i .�z ^In Q 00 a� WIMMIM a 0 NOIS34 ofM D W d 7-1 J W w 0 Z eel "` •v C)WE-4 z cn TZp i w��a c7 �awz's p IP — I O N S ISA - a N W o 9 2 a ra-d %a GL 3 Moo MA c' S�U m ci o F CJ ci 0 s O U � LL: �(n fw a WN °!� N U �m.63 s N CD W W ppFw w \ n 6 6 L �v b'm W�° IILD II Cf) o m g II O U O-0 W m O cf ; ae rc-t ON tOO �a [If W W z F > wn jy N � ow W � �w y NNN H pYpi LyJ LJ` r_ ./� W oh1 >6�^ W Q Z w wpm O O o0 npa4 � d,N^ a ow Awn'; 311JONcl NOIS30 S '1 "N N � V �j O W r' 3 \ gc 0 5i pc M� .s�s� .oe }1 �_K V p OJp WW Z <V GSJ KF S �Z �Ww O Uw (ENGINEER'S SEAL) e Municipality of Anchorage R �r DEPARTMENT OF HEALTH &HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650'` SOILS LOG - PERCOLATION TEST PERFORMED FOR: q/�C-V`I%r`�iL' DATE PER FORR4da�'+��D) LEGAL DESCRIPTION:_ 1 3 ^"I IL V. Township, Range, Section: tit aq .,, DEPTH SLOPE SITE PLAN (FEET) 2 �, d�/Mie N 3 �✓ 5� 1 4 7[l rf.r C t.,,,/,y j 5 i'J Gross Time Net Time '.6 a� Net Drop 6 '. Lk) 7 r 8 9 �r 7 C, 10 11 12- 13- 14- 15- 16- 17- 18- 19 213141516171819 20 �Ze]SI7d�+7b9 WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT Q t L DEPTH? D Depth to water Agerr _ Monitoring? �' Date: `� J D 1 Reading Date Gross Time Net Time Depth to Water Net Drop "1 •+ 7' � �1 S ]—Y4 "J n V N N 1 „ 7h to PERCOLATION RATE Z- (mmutesrinch) PERC HOLE DIAMETER b- TESTRUNBETWEEN 4/6— FTAND 'r -r FT S & 5 ENGINEERING PERFORMED BY: 1 70J4 begie yer +_ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITIEatle8LW41F+AI&I0t R007L GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) PERFORMED LEGAL DESC 1 oe, 2 Depth to Water Net Drop d J 0 3 r, 4 g .Y 1 S'IU-�^I{� a r 7 8 s � " N IN - B. 11 12 i 13 .r. '.a.11. 14- 4151617 L' 15- 16- A 17 s192018- 19- 20 COMMENTS o(E`G,IINREER SaSEAL) Municipality of Anchorage DEPARTMENT OF HEALTH R HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST +a'_P"-•,%E - 8801 DATE PERFORAr� le- lb- c SLOPE WAS GROUND WATER 1,.. ENCOUNTERED? N� S IF YES, AT WHAT /-ll A' L DEPTH? •T5 O P E Depth to Water Alter Monitoring? Dater O I SITE PLAN S Z Reading Date Gros Time Net Time Depth to Water Net Drop 0 1 S'IU-�^I{� r N N IN � a„ 2ft i Le •1 L' j?, A PERCOLATION PATE .2 — (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN J1� FT AND 5, t FT PERFORMED BY: S -$.S F=169EEP NG / L/Zv�� 77034 Eag e ( � CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WIT1ag6 ft� Af0k1ILM;f7AL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) CC 88 ^ Municipality of Anchorage • Development Services Department Box 521577, 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 Rt,ERTIFICATE OF HEALTH AUTHORITY APPROVAL R FOR A SINGLE FAMILY DWELLING t Parcel I.D.. O 5—T-0 3 l -(ate- Expiration Date: 9 - l fj - O 3 1. GENERAL INFORMATION Complete legal description Lot 9: Block 3: Knik View _ -Z _ Location (site address or directions) NHN Birch Creek Drive, Chugiak, AK 99567 _ Current Property owner(s) R & S Homebuilders Day phone 232-0242 Mailing address PO Box 521577, Big Lake, AK 99652 __ 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: 4 3. TYPE OF WATER SUPPLY: ' TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site F 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 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. f, 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, basbd 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. Namo of Firm S & S Engineering Phone 694. 2979 Address 17034 N. Eagle River Loop RD. Eagle River, AK 99577 Engineer's Printed NameRobert Shafer Date June 17, 2003 S. DSD SIGNATURE _AZ Approved for 4 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: �W. �o P// Original Certificate Date: (Rev. 01102) Municipality of Anchorage ' Development Services Department e 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: 9 T ' &YI 06K 3; T 11 14 V[�h/ Si Parcel iD: U S 1' L A. WELL DATA Well type if A, B, or C provide PWSIDI# Well Log (YIN) Date completedd_ Sanitary seal (Y/N) `7 Wires properly protected (Y/N) / Total depth 6/ft. Cased to —ki—ft. Casing height (above ground) _A8_'1' in. FROM WELL LOG AT INSPECTION Date of test i Static water level Well production.. —1 g.p.m. ____ 9.p -m. WATER SAMPLE RESULTS: Coliform _ colonies/100 mi. Nitrate O• l mg ./I. Other bacteria colonies/100 mi. Arsenic: mg./l. Date of sample: Collected by: S & S INGINRtRINO B. SEPTICIHOPM6 TANK DATA/ / L 17034 Eagle River Loop Read N0.404 Tank Type/Material �(�iIG 1 t` Dateeinsta River, Alaska 995 O 2 Tank size/ 300 gal. Number of Compartments Z Cleanouts (Y/N) % Foundation cleanout (Y/N) / Depression over tank (YIN) n� High water alarm (Y/N) Date of pumping 1XI&I- I Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ftZ or ftzlbdrm) G• System type Length ft. Width l I? ft. Gravel below pipe ft. Total depth ft. Eff. absorption area �W ftZ Monitoring tube % Depression over field Date of adequacy test IV61 Results (Pass/Fail) //! SS For bedrooms Fluid depth in absorption field before test Q in. Water added gal. Newdepth —in. Elapsed Time: _ min. Final fluid depth = in. Absorption rate >= 1007 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) Al, _ If yes, give date D. LIFT STATION Date installed 10 0 "Pump on" level at 44 in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) i "Pump off"level at _3& in. High water alarm level at 46 in. Cycles tested k — Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot / o o r+ Absorption field on lot 1 00 1+ Public sewer main pJ S er /septic service line '9 On adjacent lots _ / O® 14 - On adjacent lots /00 f+ Public sewer manhole/cleanout /V /a Holding tank ti A SEPARATION DISTANCES FROM SEPTIC/HO12t1VG TANK ON LOT TO: Building foundation r� Property line _��� Absorption field i 1 Water main Water service line / © F Surface water /00 / t - Wells on adjacent lots 100 / t SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line t t0 i•/- Building foundation _ 10 � Water main 0 t+ Water Service line 1tZ Surface water / 00 /'t- Driveway, parking/vehicle storage Curtain drain f V Dnl� m o w Wells on adjacent lots 100 f F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in , conformance with MOA HAA guid in in effe t on i dat . ^r"'" Engineer's Printed Name n Date 6_/21d3,. t+ert AI ti fi HAA Fee $ '� 25� i` 15-0 X✓14 Date of Payment �to7 - 1-2 - Q 3 ? Receipt Number % 1 (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number N 00°03' I I "W 73.38' N W N _ � m �ti• a � — W � x m , A � m n `� �e0 ��Is � ICk a �03g.d�^�C,\ 27.6' %1 'tri � °pNCyi ` . N , n ti "1..,, ,,, � • i?� 9j � r o e2 S R. m 3 EFk D °° b �O n io mON t o-RRZ f js o v� x Sn 30as° o5 � lol- co a 0 o � S/ ••��� C 110 M 2L C7 34a 5 Ta8� �. 7. f • • / x �o.•�w gin (lq•• n n o ao ao o a v R3 pOc.'