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Home My WebLink AboutKNIK VIEW BLK 3 LT 3KnI*k View Block 3 Lot 3 #051-031-51 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.d.anchorage.ak.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SW040151 PID Number. 051-031-51 Nan`Dewey Smith Wastewater System: ®New ❑ Upgrade Address: PO Box 672444 ChuoTak, AK, 99567 ABSORPTION FIELD Plow: 688-1211 NumberolB.doanw: 13 Dep Trench H Shallow Trull Cl Bed D Mowll ❑ Oduer: LEGAL DESCRIPTION Sol Reurq. Told Depth kon original grade: 1.2 GPDIFr 10 Ft. Block: Lot: SuAaWNbn: Depth b pipe bonan born onp.w Rade: Gnome depth Doweth pipe: 3 3 Knik View 8.46 Ft. 1.54 FL To.nav: Rage: Seddon: Fi addsd.bw.odprW Peds: Greed Length: -0.10 Ft. 81 Ft. Well: ❑New El Upgrade Gravel wgln: NwnWr d Ones: Dataro* between aye: 5.0 Ft. 1 — FL classification (Printe. A S. C): Total Depth: Card b: TOW ebeapo that: pp. Meter W: PUBLICFl. 519 Fr D3034 & F810 color. Osw Dried: Spec Web, L.vd: asteau: Data auelbe: Ft Strata 6/10/04 vwd: PerSal at p M D.Wq Height Moo. Grand: L$05-0149 9 TANK GPM FL Fl SEPARATION DISTANCES 0 Septic ❑ Holding ❑ S.T.E.P. ❑ Other; To Septic Absorption Lift Holding PubliciPmat g, sty: from Tank Field Station Tank Saw Urml Anchorage Tank 1250cd. I W04 200'+ 200'+ NA NA 25'+ M'�er'W Ntmber dccmpwner,a: Steel 2 surface water 100'+ 100'+ NA NA LIFT STATION tatukw 5'+ 10'+ NA NA ` w. G Gal Foundation 5'+ 10t+ NA NA levol Vep O" 'L -tan, qA wWer aWm.t: a b In, Cwwn Drdn NA *S O'+ NA NA p'•"p tww ` Ea`°"" bp°`ee"' psrbnned by: Remerks: *none known BENCH MARK Top of cement (slab '--' electrical. box Aaaaned EW -60T 1 100 FL Engineers Stamp Frqk q l �P•(E••.......to� r*i s Inspections performed by: KND Engineering. Ine.Dates:1st 6/10/04 :4 91m - . ..e „��*• Development S rvices 2"d �L1]LSZ4 Department Approval 3d 9/19/05 ......... ctL• Kenneth fus by: �Reii2M)ed and approved Date: 11/�/xY� 4i 9E�p (' ��o. P\! Age AS -BUILT SYSTEM DETAILS/SITE PLAN KNIK VIEW S/D, LOT 3, BLOCK 3 Permit SWO40151 PID#: 051-031-51 MT- - - - - 1 / TH04-1 / E 1250 ST \cr� p o. I /Ce co \e / TH04-2 / C G T I A �A- .. W: I ~7. KEY BOX A F �F '�i\' 1 PREPARED FOR: �4 'I y DUEY SMITH V POB 8724!1 * . a a * , CHUGIAK, AK 99567 C{j.�i` tAr a ql�l/`�Q/}'r FINAL GRADE FILTER FAJZ IC SEWER ROCK B1' FlDD BOOKS cowunv: SURFACE SETBACK WATER-' \ A -C=39 C"KO'M- KMD 100.45 100.2 B -C=11 cm NW155 ACAO rst 04035ASB J'e "" 04035 A -D=65 B -D=30 �n A -E=70 I n"' B -E=32 IL A -F=86.5 a lzW GAL B -F=54 obi SEPTIC TANK A -G=27 B -G=60 aerx 93.80 C A F �F '�i\' 1 PREPARED FOR: �4 'I y DUEY SMITH V POB 8724!1 * . a a * , CHUGIAK, AK 99567 C{j.�i` tAr a ql�l/`�Q/}'r FINAL GRADE FILTER FAJZ IC SEWER ROCK B1' FlDD BOOKS cowunv: BdlI1pMY: MIAMI: MMp STA"** STAKING C"KO'M- KMD AswATASQUILT . GALE: ora RIE, cm NW155 ACAO rst 04035ASB J'e "" 04035 SCALE: NTS SCALE: V - 50' To.S' 1.54' 82.33 BOH PAGE 1 of 1 END ENGINEERING, Inc. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 TEL (907)888-3791 / FAX ASSUILT I HEREBY CERTIFY -THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENCROA�HMENTSr EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SEWARD SCALE: DATE: GRID- �yu�iss� FB: /oJ-os DRAWN: ls�- MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM ) WATER SUPPLY PERMIT Initial Permit Number: SW040151 L Legal Description: knik Via Block'3 L`ot 3 7 Design Engineer: 0070 KND Engineering Owner Name: Duey Smith Owner Address: P.O. Box 672444 Anchorage . A 9567 - `1/10 1ou- II Date Issued: May 26, 2004 Expiration Date: May 26, 2005 Parcel ID: 051-031-51 Site Address: 21440 Alderieaf Court Lot Size: 66820 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit Is for the construction of. F] Disposal Field 0 Septic Tank ❑ Holding Tank E] Privy 0 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 Date: S 0 Date: j Zo e 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 l.D. 05-1-031-37/ Permit Number SW Propertyowner(s) Duey Smith Mailing address (1) POR 677444, Chugiak, Day phone GRR-1211 AK 99567 Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd) Knik View #T, Block R, Let R Legal description (Section, Township & Range) Lot Size & ('/ SL o 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 0 Therapy Pool ❑ 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. of property owner or authorized agent) Permit Fees: SV�P6 - � Date of Payment: �/ 0 Receipt Number: Z 6 Z (Rev. 17/00) Waiver Fees: Date of Payment: Receipt Number: KN D ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 May 21, 2004 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: New Sewer Permit – Knik View lt2, Block 3, Lot 3 Gentlemen: The owner has requested we proceed forward to obtain a septic permit on the subject lot. On May 4, 2004 two test holes were performed for the proposed system. The results of these tests are attached. The general slope of this lot is from northeast to southwest at a grade of approximately 2 – 5%. We have designed our system utilizing the testhole we excavated for the 4 -bedroom house. The lot will be served by public water. We propose to install a 5' wide shallow trench. Water was not encountered during the excavation or monitoring in TH04-1, however during monitoring of TH04-2 groundwater was measured at 14.2' below grade on May 11, 2004. 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, KNID Engineering, In�— P.E. Attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/ Percolation Test Contractor/ Owner Specs 129 WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN KNIK VIEW S/D #2 LOT 3, BLOCK 3 12 13 NO PUBLIC WELLS Willa tar 6 PRWOSED SYSTEM NO PRIVATE WELLS WITHIN 200. 6' PROPOSED SYSTEM EXCEPT K NOTE& NO SEPTIC SYSTEMS WITHIN tar Ir PROPOSED WELL EXCEPT AS NOTE& 120 ti 0 LTO OF AL�� *+, CE -911u y� )ESS1OAw R M Bk 255 PD 316 Esnt DESIGN DETAILS 4 BDRM X 150 GPD = 600 GPD 600 GPD/1,2 GPD PER SQ. FT. = 500 SO. FT (500/(5')) X 0.78(RF) (1.5' GRAVEL) = 78 FT. TRENCH Total depth of system Is 10.0' from original grade. Total depth of gravel below distribution pipe Is 1.5' . NOTES: 1. USE 1250 GALLON SEPTIC TANK. INSULATE TANK IF (4' COVER. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM.. 3. CONTRACTOR WILL ENSURE MAXIMUM 2% SLOPE INTO SEPTIC TANK. 4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE MIN. 3' COVER IF REQUIRED. 5. ALL LOTS SERVED BY PUBLIC WATER. PREPARED FOR: DUEY SMITH POB 672444 CHUGIAK, AK 99567 nELD BOOKS lku mr.80UNC DTNUM& STAKIP ASOUILT.' SEWAF DM ICL: Am ILEI FILE COUPUTM. ORAWN; JG C"EO`M- KMD DATE: 5/21/ tle° NW155 Ax "° 04035 Scale: 1'= 100' ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 I WASTEWATER DISPOSAL SYSTEM DETAILS KNIK VIEW S/D #2 LOT 3, BLOCK 3 2C�jl ` 10' .9 K N D Z COS l 250 ST Lli o C j MT P 21.6' O 1 .7 o FCO F� v a w zoo �J� PROPOSED 4 -BEDROOM HOUSE M 04-1 C H04-2 2 W 3Q W OF �s 1 PREPARED FOR: HERMAN KROENER P.O. BOX 670394 9 TE * / CHUGIAK, AK 99567 I (907)688-2728 ...AAA KE FIELD BOOKS cowulm. CE -7116 �'� 90ummt. BOUNOAgy DRAM,: OR r Slm"Q STAKING CErxm: CHE 4omT- ASBUI T DAME DAl fESSIONN' DRG nc QM GRI( Am FLL FILE jDe N' JOB Scale) 1'= 20' }��y PAGE 2 OF 2 END ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 KFIDD ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 .r SOILS PERCOLATION TEST Performed for: Duey Smith Date Performed: 05/04/04 Project:_ KNIK VIEW #2, B3, L3 TEST HOLE # 04-1 Depth (Feet) FILL (ORG/GM/SM/OL/111L) SW/gp —brown/gray coarse sand increasing w/ depth IN-SITU MATERIAL 15 -SUITABLE AS FILTER ,6_ 17- B.O.H. 18- 19 - HOLE PRESOAKED 20- PRIOR TO TEST SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Groundwater encountered? NO Whatdepth? NA Depth to water after monitoring? NA Date? 5/11/04 Percolation Rate < 1 (min/in) Pere Hole Diameter 6„ Test Run Between _ 9 feet and 10 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. t t s�■� Percolation Rate < 1 (min/in) Pere Hole Diameter 6„ Test Run Between _ 9 feet and 10 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. At KND ENGINEERING of 20441 PTARMIGAN BLVD. tool EAGLE RIVER, AK 99577-8736 Kenneth M. CE 711 SOILS PERCOLATION TEST Performed for: Duey Smith Date Project: KNIK VIEW x2, B3, L3 TEST HOLE # 04-2 Depth FILL (ORG/G111/SM/OL/ML) G W/SP —brown/ gray coarse sand increasing w/ depth IN-SITU MATERIAL 15 SUITABLE AS FILTER 16- 17- B.O.H. 18- 19 - HOLE PRESOAKED 20- PRIOR TO TEST SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Groundwater encountered? NO What depth? NA Depth to water after monitoring? NA Date? 5/11/04 Percolation Rate < I (min/in) Pere Hole Diameter 6„ Test Run Between 9 feet and 10 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. a�MOM .. see Percolation Rate < I (min/in) Pere Hole Diameter 6„ Test Run Between 9 feet and 10 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. J ,CM ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER. AK 99577-8736 696-6111 / FAX (907) 696-8111 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES AND MATERIAL SPECIFICATIONS LEGAL DESCRIPTION: Knik View :2, B3, L3 GENERAL: 1. The scope of this project includes the installation of a septic tank and/or drainfield to serve a single family residence on the referenced property as delineated on the attached Municipality of Anchorage (MOA) permit and site plan. 2. Construction shall be in accordance with the approved site plan and design drawings; MOA permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. KND Engineering Inc (KND) assumes no responsibility of the accuracy of the as -built survey provided by the owner or owner's representative. 4. The owner or contractor is responsible to notify the engineer of any discrepancies noted on the design plans or drawings prior to commencing work. These discrepancies could be, but not limited to, possible encroachments, surface water, varying soils, unplatted easements, types or use of dwellings on or adjacent to property, nearby public wells, etc. 5. The contractor shall be responsible for locating any necessary underground utilities, easements, property lines and surface water. The owner and/or contractor shall ensure, if deemed appropriate, that a registered land surveyor prior to construction flags all setbacks. 6. The contractor shall be responsible for verifying all pertinent separation distances and component layout. 7. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 8. The MOA Development Services Department On -Site Water & Wastewater Program must certify contractors installing wastewater disposal systems. Owners installing their own systems must also receive prior approval from said MOA Department. SEPTIC TANK / HOLDING TANK / LIFT STATION INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded with proper material and compacting to prevent damaging, settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above the final grade. 4. Septic tanks installed with less than 4 foot of cover shall be insulated. The contractor will ensure that the fill over the tank does not exceed the burial depth rating. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 feet from the tank. The second cleanout, in line, shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. Reference: Knik Vw. A2 B3,13 Date: 05/20/04 Page: 2 of 3 7. All H.D.P.E. tanks shall have a vertical length of 4 -inch perforated drainpipe besides the tank extending to the bottom of the tank to above grade to monitor ground water. 8. All tanks shall be anchored when there is not enough adequate soil cover to resist buoyancy forces in high -groundwater areas. 9. All holding tanks and lift stations shall have an audible and visual alarm inside the residence. 10. All lift stations shall be wired in compliance with the Uniform Electrical Code and all MOA guidelines. 11. The contractor shall remove the old tank, or abandon it in compliance with the Uniform Plumbing Code. The contractor is solely responsible for the abandonment procedure. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavaction become smeared, they must be raked or scratched (roughed -up) before gravel (sewer rock) placement. 2. Once the sewer rock is installed, the distribution pipe is installed level with the perforations facing downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitoring tubes shall be four- (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. 6. All advanced technology waste water disposal systems (Advantex, Biocycle, Intermittent Dosing Sand Filter, etc...) shall be constructed, installed, maintained and monitored per manufacturer's specifications and MOA requirements. MINIMUM MATERIAL SPECIFICATIONS: 1. A MOA approved septic tank manufacturer must construct any septic tank proposed for installation. 2. The following pipe materials are MOA approved for use in septic system installations: Type of Pike Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3770 passing the #200 sieve. If deemed necessary, a sieve analysis should be performed. 7. When sand is being used as a filter material, its gradation specification must conform to current MOA or DEC requirements. Reference: Knik Vw. t2 B3,13 Date: 05/20/04 Page: 3 of 3 INSPECTIONS: Typically there will be three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the sewer rock, distribution lines, standpipes, and cleanouts, but before the placement of the silt barrier, insulation, or any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required, especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. The inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The owner shall contract with the contractor to perform the work outlined in these specifications and attached plans and in accordance with the attached MOA permit. All materials, components, and construction practices shall comply with the MOA's and the State of Alaska's latest ordinances, regulations, or policies regarding wells and septic systems. The failure of the inspecting engineer to notice a material or construction non-compliance does not relieve the contractor of his/her responsibility to correct such deficiency. There will be no contractual arrangement existing between the contractor and KND Engineering, Inc. KND shall be the owner's representative and will inspect the work as stated above to document the contractor's activities. Final acceptance of the contractors work rests with the owner and the MOA. KND shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. KND's inspecting engineer will not be responsible for the construction means, methods, and techniques, sequence, procedures or the safety precautions incident to this project. BY PROCEEDING FORWARD WITH THE INSTALLATION OF THE WATER AND/OR WASTEWATER SYSTEM (S), THE PROPERTY OWNER, CONTRACTOR, AND WELL DRILLER ACKNOWLEDGES HAVING READ AND ACCEPTED THESE SPECIFICATIONS. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Brr.14- !,/uthls'. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I. D. S 1-031-51 COSA# /1I. nhr)Q 1. GENERAL INFORMATION Expiration Date: — : / % - O 7 Complete legal description KNIK VIEW RI O K3, l OT 3 Location (site address) 27335 INI FT VI4TA t^r r Current Property owner(s) nFWFY R cwoi r.. �•'ITH Mailing address PO ROX R7 444 (' 'l ILIA Lending agency Mailing address Real Estate Agent _MARGARET RI IINCER Mailing Address 351 W PARKS H "^�, ACI I Ak y Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 4 Day phone R8&1?11 Day phone TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site ❑ Individual Holding Tank ❑ Community on-site ® Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an Independent professional civil engineer registered In the State of Alaska. Certificates of 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 In the professional engineer's work. A- STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my this applicationasshowsthate he on sitees nwatered In tsupply and/or wasstewatehe Certificate of On -Site rdisposaltems A'p' m sval uI(are) esafe. functional and adequate for the number of bedrooms and type of structure Indicated herein. 1 further verify that of and based spection theon-sitewateon rsupplyand/or wasteined from the water disposal system) s(are) ies andn complianceom withla I applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Phone Name of Fir LE Address IGANBLY Date Engineer's Printed Name '' i. ni IFFt Ic Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of he condition of the well and septic applies only to the conditions as of the day tested. The flow and surface, hbsorrptionanges irates nland use, local soil gre due to oundwater leveons ls thaat t may fluctuate duray not be riing the stem. The l well a year systems are subject to these of the e ariousmily iand dynamic served chars the teristics and are outside onal Ithe contife of rol of the d evaluator of he well and septic system. Therefore, OF A�'11 KND can not give any estimate of how long a system will function satisfactory for current or future �P"��.. ��....,q . 11 occupants or can KND guarantee that no unseen encroachments, deficiencies or discrepancies exist. �t i�gT►t OA ------' 5. DSD SIGNATURE Approved for _ bedrooms. Disapproved. Conditional approval for Attachments: COSA Checklist �— Septic System Advisory Well Flow Advisory Nitrate Advisory bedrooms, with the following stipulations: Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other / 1Al �a Original Certificate Date By: 6 Municipality of Anchorage Development Services Department ' Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907) 343-79W CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: KNIK VIEW BLOCK r OT _ 0 5 1_ [ g�� A. WELL DATA Parcel ID: Well type-EMWE If A, B, or C provide PWSID # Well Log (Y/N) Date completed Sanitary seal (Y/N) Wiresro P PeriY Protected (Y/N) Total depth ft. Cased to ft, Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. Well production �— ft. 9.p -m. WATER SAMPLE RESULTS: g.p.m. Coliform colonies/100mL Nitrate mg/L Other bacteria 0olonies/100 mL Arsenic: mgA Date of sample: Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Material nti /cre.r Date Installed 6/10/2004 Tank size Number of Compartments Cleanouts (Y/N)Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) jy High water alarm (Y/N)-I_Dats of pumping NA -New S tem Pumper C. ABSORPTION FIELD DATA Date installed 6/1 D/04 Soll rating (9•P•d./ffz or fe/bdrm) 1.2 System type Shallow Tren h Length ,$]_ ft. Width ft. Gravel below pipe 1.54 ft. Total depth jUfi ft. Eff. absorption area 519 ftr Monitoring tube Y Depression over field ly Date of adequacy test Fluid depth in absorption field before test_, in. Elapsed Time:_min. Final fluid depth_1n. Results (Pass/Fall) mss For -1– bedrooms Water added_, gal. Absorption rate >_ Any rejuvenation treatment (past 12 mo.) (YM & type)NIf yes, give date ..... New depth—In. g.p.d. D. LIFT STATION Date installed __Size in gallons -Pump on' level at in. Datum E. SEPARATION DISTANCES -Pump ofr level at in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot Absorption field on lot Public sewer main Manhole/Access (YIN) High water alarm level at In. Meets alarm & circuit requirements9 On adjacent lots On adjacent lots Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5 ' + Absorption field Water main 101+ Water service line, 0'+ Surface water 1 00'+ Wells on adjacent lots—Ifft_ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation10'+ Water main 1 0' + ' Surface water 1 00'+ Driveway. paridng/vehicie storage �Q� Water Service line_ Curtain drainWells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION 1 cert(/y, that I have determined through field inspections and % y j 4 72! ••� review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this .• ,.. date. % s, Engineer's Printed Name """Nero u n11FFLIS_ It, yF r,; ,a,.4. X A`�+ Date COSA Fee E 5!7. 5�) Waiver Fee E _ Date of Payment t /J y/a b Date of Payment Receipt Numbers Receipt Number, (Rev. t1M5)