HomeMy WebLinkAboutKNIK 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
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}��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
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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)