HomeMy WebLinkAboutKNIK VIEW BLK 2 LT 6•t t tKev uwuzri u/ 7 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201249 PID Number: 051-031-37 Dwelling: V Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑Q Upgrade Name Jason Stanley A RPTION FIELD ❑ D Trench ❑ Wide Trench ❑ Bed ound Site Address 22546 Inlet Vista Dr. Other. Phone Number of Bedrooms Soil Rating Total depth original grade 3 /SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original Gravel depth beneath pipe Ft. Subdivision Block Lot I{nilc VieFv 2 6 Fill added above original Ft. Gr length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dist between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total orption area Number of trenches Dist. between t hes From Tank Field Lift Station Tank Line Ft2 Well 100+25+ TANK 2 Septic ElS.T.E.P. ElHolding ElOther Manufacturer Capacity Surface Water 100+ I Greer 1000 Gal. Material Plastic Number of compartments 2 Lot Line 5+ NA Foundation 10+ ATION Manufacture Capacity Gal. Remarks Alarm location Electn f led by PIPE MATERIAL House to tankTank to D3034 drainfield D3034 Installer Northern Excovation Drainfield CO/MT D3034 BENCH MARK (Assumed elevation) 100 ft Inspector Arcterra Consulting Inspection 1�Location dates: 9/15/20 Zhd 9/15/20 and description 3,d 9/16/20 4th Door frame/Building foundation ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp . OF Conditional Approval: Date ,.'r""'""";, 44. s A. f3Yi - ft�'lkilY� y� rCsti�klu Septic System Approved Gf% Date tAl z ��.. Note: this approv nes not include well permit requirements.►>� w tKev uwuzri u/ 7 AS—BUILT SYSTEM DETAILS/SITE PLAN Permit OSP201249 KNIK VIEW BLOCK 2 LOT 6 PID# 051-031-37 X6'7 �7 ' /SEPTIC \ VENTS7 k/ \ 6 k / SHED x\� `32�a• A0�2.1 NEW 1000 0 X 5.2 �c Q GAL TANK FP CANT Nr / / mow PECK EXISTING WOOD FRAME HOUSE A.C. A -C=22,72' B -C=51.54' A -D=27,17' B -D=54.18' A -E=28,51' B -E=54,78' A -F=29.32' B -F=55,27' v COVERED PORCH 5833, LOT 6 061, B LK 2 x 11 1 . 11 .11, 0 1000 GAL SEPTIC TANK EL cn ad ()F A lk s PREPARED FORT JASON STANLEY 22546 INLET VISTA DR o H * CHUGIAK, AK KENNEi'Fi S FIELD BOOKS COMPUTED: S CE Awa BOUNDARY: N A DRAW: KSD �~$ 10 sTAKING: N A CHECKED: KMD ASBUILT DATE: 10/2 SS DWG. FILEGRID: NW15i ACA° R�: FILE ''0B No' 20171 D/W All co A� 4v SCALE:/l' = 30' SCALES NTS MUNICIPALITY OF ANCHORAGE On -Site Water &Wastewater Program `) PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite Department H,„C,, OR ,Gly On -Site Wastewater Disposal System Permit Permit Number: OSP201249 Effective Date: 7/21/2020 Work Type: SepticTank Upgrade Expiration Date: 7/21/2021 Tax Code Number: 05103137000 Site Legal Address: KNIK VIEW BLK 2 LT 6 G:1557 Site Mailing Address: 22546 INLET VISTA DR, Chugiak Owner: STANLEY JASON P & OLIVIA S Lot Size in' Sq Ft: 20000 Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date: Date: ZZ 20 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-031-37 Property owner(s) Jason Stanley Day phone Mailing address 22546 Inlet View Vista Dr. Chugiak, AK 99567 Site address 22546 Inlet View Vista Dr Legal description (Sub'd., Block & Lot) Knik View Blk 2 Lot 6 Legal description (Township, Range & Section) Lot Size 20,000 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑'` (w/wo AD U) Septic Tank F"I Upgrade FAI Duplex El (D) Holding Tank FIRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: / 6g, �S Cc? vl'Gl 19 Waiver Fees: Date of Payment: 7AJ Ao Date of Payment: OC Receipt Number: Cia65C, Receipt Number: Permit No. OS P ZQ/ 2 yq Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201249, Deb Wockenfuss, 07/21/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201249, Deb Wockenfuss, 07/21/20 Municipality of Anchorage Page t of a DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 a Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 5LJ94040a PIDNumber: 0510513-7 Name, t4MT=L�e Te SC'rZ Wastewater System: N ❑ Upgrade �ew A°oro" taO3a S. -70 -A; —TL HO A 50 2 44 ABSORPTION FIELD Phone: g g — p I (03 No. of Bedrooms: 3 C3 Deep Trench ❑Shallow Trench XBed ❑Mound C3 Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: 0.7 GPD/S . Ft. 50 Loc Block: ^ Subdivision: Capin to pipe bottom from original grade: Gravel depth beneath pipe e` Kmiv- V!ww '.!..51 Ft. 0. Ft. Township: Range: Section: Fill added above original grade: Gravel length: 1 6.51- 1. 5, Ft. y3 Ft. WELL: ❑ New ❑ Upgrade Gravel width: 1151 Numberir linea: 01st, abe ween ling: IST Ft Ft CMs•lhcatlon (Pnvate. A.B.C): Total Depth:Ca Total absorption area: Pipe material: vkSTM Ft. b S o. Ft. F:, D.3 3, Driller. D sled: Static water Level: Installer. Date installed: Ft. �OVT/f i.r,4'K Covvf T. 3 Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES 'Septic ❑Holding ❑S.T.E.P. To Septic Absorption Manulacturor. Capacity in gallons: From Tank Field Lina. 4 �' 1000 Welt aZ OO+ aU0} 14 Material: STCNumber of COmpertmenta: Wate'e loo'+ 100`4- LIFT STATION Z,,L1"b1WPr1,adva,o Lot / 31 sSize 1OFoundation in gallons: Manufacturer.Line 0 1 1 "Pump on" level at: 'Pump oft" at: High water alarm at: CurtainPump Massa Electrical Inspections performed by: Drain Remarks: BENCH MARK lAr ST�1.a.t0 OE�ou s[ w[rt !.'c C,[ Location and Description: T of -Ds<K ',2>A4r. oc �OvSE Assumed Elevation: t00 -O , ENGINEER'S SEAL OF *, et S L S ENGINEF_R!NG 17034 Eagle, ?livor Loop Road, No. 204 Inspections performed b&. Dates: 1st 2nd o,,zs tir .-._.-................. Department of HealtHUm 2rvices ap r oral T ROURT C. COWAN 1��%s, CE -8801 / y , �I Reviewed and approved b"-- Date: 30 — 44✓Ii��`r�; 72-013 (Rev. 9191( MOA 25 Permit No. SW940402 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH 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 Description: LOT 6, BLOCK 2, KNIK VIEW S/D 05103137 PID No -- 72-013 A la«. vail Moi n col CO2 FINAL C DE 98.1' CO3 MTI MT2 i nCO 94'8 FINAL GRADE NEW 92 .1' 10 00 GAL 91.9' SEPTIC INSU ATION TANK 8 .5' AB ' NO NATER FOUND 9-24-94 FCO 40' ST1 2' 51' ST2 14' 7' 54' C01 1 57' W ABSO PTION BED " CO2 2' 58' C04 7' 56' MT1 3' 76' AMT'2 MT2 .9' 47' ca i0 SE MlC ANI � O A PROPE TY SERVED 3 �d BY D NO WE (THIN 200' OFL 1 SEPTIC SY 4X� sCAIE r - 40• ~� 70 "CRT C. COWANfQ ��CE-6801 J 72-013 A la«. vail Moi n – PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE I�3I�`I�RS c (1:30P1i DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940402 DATE ISSUED:10/17/94 DESIGN ENGINEERS & S ENGINEERING EXPIRATION DATE:10/17/95 OWNER NAME:SCHMELZER FAMILY TRUST OWNER ADDRESS:P.O. BOX 799 WASHINGTON 98270 PARCEL ID:05103137 LEGAL DESCRIPTION: KNIK VIEW BLK 2 LT 6 LOT SIZE: 20000 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING -343=4744 (24 HOURS) . 4. FROM OCTOBER -.15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVEREDO SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: -'- RECEIVED BY: - ISSUED BY: Z7 DATE • it /_' ;1.7 y DATE: 49 "/ 7— W- C /9LGE0 19-^'0 RPV151_rp OR le, ia-I¢G S 1, T-' 4 v I Sf v 0F'?5/9 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940402 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:SCHMELZER FAMILY TRUST OWNER ADDRESS:P.O. BOX 799 MARYSVILLE, WASHINGTON 98270 7 PARCEL ID:05103139 LEGAL DESCRIPTION: KNIK VIEW BLK 2 IT LOT SIZE: 20000 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: (] THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: /%o 7 F PAGE 1 OF DATE ISSUED:10/17/94 EXPIRATION DATE:10/17/95 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) . 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ' /" DATE • /0 h 7 /01 ISSUED BY: _�Lt�J y' `%'�T' lf� DATE: M -I %meq¢ IN September 28, 1994 ROBERT SHAFER. P.E. CIVIL ENGINEERS (907)694.2979 FAX 694-1211 HEALTHAUTHDRITY APPROVALS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 ILI Street P.O. Box 196650 SEWER WATER Anchorage, Alaska 99519-6650 MAIN EXTENSIONS REFERENCE: Lot 6; Block 2; Knik View Estates SEWER 6 WATER NSPECTgN Request you issue a permit to install a septic system to serve the ENGINEERING STUDIES proposed three bedroom hawse on the referenced property. ANDREPORTS A test hole was excavated and percolation test performed. The approximate location of the test hole is located on the attached site plan. WELLNSPECTION a Plow TEST This property has enough area for a future septic upgrade which can be seen on the attached site plan. SITE PLANS This property is served by a Community Water System. There are no protective well radii which encroach u property. p upon the pe yro rt We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. ROAD DESIGN If you have any questions, or require additional information for your review, please contact us. Sin�ncc/eerreely, SOILTEST (' • 125 C/•' r•"' Robert C. Cowan, P.E. PERCOLATION TEST RCC/JA/gk STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER OISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP SUITE 204 EAGLE RIVER. ALASKA 99577 1" = 50' I SITE PLAN I SCALE pp ZQ.ZUM 2 N;Ny Cy 0z tz ti FZ ro�rs-rmi C/� �i o m �;�rmr=irv0 0 $ n AVIrmVIN�L V " $ � Uoz�~i � '"3 � �✓ w C)os�_� A > z x Mao 0 v \ 0 < � C m O m C .o m G :0 Af G) M N o O CO N y�o.aa 2 o •a m Vj O o 0 � o ` � o �Slq U) \ n 0 > v y f nUl r , K C O .m OVI0~ Z=m 0ti0 Z y < y OC mNy m O A K-niNKAZGZN '9mm o>DmC) 4'i' N v vmZTJ<Inm < m Z NOao OLni= Kmm M* FMO rZ .00�f ZO rC-nNZym =Z z r'10 Mm mmm K m< Y0 Z nmC) ' o OZ m (A> �p�N =_ vv O O O y Z Z Z O O (A A Z O i 9 0 A W o xb I�I I A O m m x ---I ' ANO ZCM CH`L iKLI) xJx� 0 mr '+1 >>0 tnWO >mC N m H Z o O H y L`1 i; O O x a O .m OVI0~ Z=m 0ti0 Z y < y OC mNy m O A K-niNKAZGZN '9mm o>DmC) 4'i' N v vmZTJ<Inm < m Z NOao OLni= Kmm M* FMO rZ .00�f ZO rC-nNZym =Z z r'10 Mm mmm K m< Y0 Z nmC) ' o OZ m (A> �p�N =_ vv O O O y Z Z Z O O (A A Z O i 9 0 A W o xb x A A O '� Z D oyO m x ANO ZCM CH`L iKLI) xJx� 0 mr '+1 >>0 tnWO >mC N m H Z o O H y L`1 i; O O x v r zr Z r `z Z D < ri U7 rrl N O z m N D O ,m m r, N m f'I !O PERFORMED LEGAL Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 `L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST Ga"GL 4 S> Q (.(774.1_ To t1gFv%y LoecIts Q, DEEP not.� V.Am IV WIDE. tX,nwi C--XCAW1W'- -- 9u5. iv CLAW Wj1J .. WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT _ L O DEPTH? P E Depth to Water Atter Monitoring? oky' pNc 9� LU y ' A e, lu1 PERCOLATION RATE L (m,nuteymtn) PERC MOLE DIAMETER a C, TEST RUN BETWEEN FT AND FT f _ COMMENTS `-"�I t'S �2C�1 TJzI� %f�f�N /UIN ,I'rv. S E S ENGINEERING r&910 River Loop Road No. 204 PERFORMED 8Y: E+9111RIv11r At--k-M;7 1 0j9&Z CERTIFY THAT T IS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: C1 7?- [ ay 72-008 (Rev. 4185) PERK LEGAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 TEST RUN BETWEEN 3 FT AND y FT COMMENTS -AI LS H&6 V we WMEA J7ur'um Ohgi v / A4$N /IAX9. I PERFORMED BY: Z&6rpdGjNE CERTIFY THCA�T/TJ'�IS TEST WAS PERFORMED IN ACCORDANCE WI79�fIIFERintm?IIeIMCRAiJ�fES IN EFFECT ON THIS DATE. DATE: -/ ( /9 a�4. Y 72-008 (Rev. 4185) Eagle River, Alaska 99577 MUNMPAUTY OF ANCHORAGE 1}w Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-031-37-000 1. GENERAL INFORMATION Complete legal description Knik View 132 L6 Location (site address) 22546 Inlet Vista Dr. Current property owner(s) Jason Stanley Mailing address 22546 Inlet Vista Dr. Real estate agent Laurra Davis 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Expiration Date: J 2 — 6 -Z D Z 3 Day phone (530) 802-1166 Day phone 406-0250 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well El Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ J o Waiver Fee $ Date of Payment _ I a ItOT'Zov Date of Payment Receipt Number B61,501 Receipt Number COSA # ©cS C 2- 11 r% 1 D Waiver # 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 Eklutna Engineering, LLC. Phone 406-1058 Address 19162 Mountain Rd. Chugiak AK 99567 Engineer's Printed Name Curtis Townsend Date Z 2,D Z 6. DSD .�.L.SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms 49 TH ••a�:VtVtBL.TOWq&..... end �' nate Z F �iJl • No. 1 f • h F��•-.......�`Aw � ��! PROFf55lON��' bedrooms, with the following stipulations: L0� Original Certificate Date: ' 2- - (� —Z, 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 COSA Checklist Legal Description: Knik View B2 L6 Parcel ID: 051-031-37-000 If more than 1 septic system on lot: COSA Checklist # of 1 Structure served by this system 1 A.DATA ElWell log is i ith 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 Community Water System B. TANK DATA Age of tank(s) 1 years Tank type/material Plastic Measured operating fluid level in septic tank 48.5" ❑ Standpipes/foundation cleanout per record drawing Date of pumping new D. ABSORPTION FIELD DATA Which system tested (date installed) 3/25/95 ❑ ALL standpipes present per record drawing Total measured depth from grade 4.5' ft (max) Measured depth to pipe invert from grade 4' ft (min) ❑ N/A - pressurized field no Monitor tubes go to bottom of effective. If not, state depth into effective Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Ars er' - ug/L ❑ Arsenic less than MRL (ND) Collected by ` ~� Date of Sample ,3 IUAN 9 Will ❑ Requi mainti Age of lift station Lift station material Comments: nance completed years Adequacy test date 12/6/21 Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 010 in Water added 453.7 gal New depth 0/0 in Elapsed time 46 min FillCode-requiredsoil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 453.7 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) ....... date of test) Gallons introduced n/a gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Pn`vaa Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on a > 100'Community Sewer Manho if No ft Neighboring Tank > 100' ❑Yes if No Private Sewer/Septic Line Absorption Field on Lot? 100' ❑ Yes if No ft Hol ank > 100' Neighboring Absorption Fields > 100' Animal Containment _ ❑ Yes if No ft Manure/Animal Excreta St Community Sewer Main > 75' ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) le/Cleanout > 100' ❑✓ 7 Yes if No ft ft > 25' ❑ Yes if No ft Property Line > 5' r_1 Yes if No ft if No ❑ Yes if No ft Water Main > 1.0' Absorption Field > 5' ❑✓ Yes Storage > 10 ft Private Wells > 100' ❑ Yes if No _ ft Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 1.0' Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' M 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' 21 Yes if No ft Wells on Adjacent Lots: Water Main > 1.0' ✓❑ 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' n Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that 1 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 yellow sheet NINEE'S t 1 PLOT PLAN —_— AS BUILT _X_ SCALE _1"=_40GRID _ NW 1557Project No. 21-799VR1____ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & A s s o c i a f e s inc. (907) 522-6476 Phone (907) 522-4625 Fax Professional Land S u ry e ors ken®langsurvey.com o OF A �4 Y jonothan0longsurvey.com 1 hereby certify that I have surveyed the following described property: AP, ' V LOT 6, BLOCK 2, KNIK VIEW SUBDIVISION (PLAT No. 85-162) p �: ' 49TH Anchorage Recording District, Alaska, and that the improvements situated thereon are "� """"""' . ............. within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed Q • . • . • • • • • • • • • • • • • G KENNETH G. LA premises and that there are no roadways, transmission lines or other visible 0- Q G easements on said property except as indicated hereon. QQ ��F 1�.'� x( Dated this the 4 �F L — 202. ' SJ0� 2 " -- Day of ---� �� _:�;� _Gu �j} D _, at Anchorage, Alaska `�£SSIONAI- � �� It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plot. AECC963 • GE BU • cD C)71 1$ ) . 'c �^1 Municipality of Anchorage '� •,'1sstt '� � >> x `l am 0.—;!%rii;,• '.,•1 a'-, On-Site Water and Wastewater Program .,,i;;; • I.`.. (907) 343-7904 '% a% APR 2 2018 Certificate of On-Site Systems Approv. ^-&3, Expiration Date:!`01 6 8 9 0 i 0°,2^1 52 x Parcel I.D. 051-031-37 p 1. GENERAL INFORMATION: Complete legal description KNIK VIEW; BLOCK 2, LOT 6 Location (site address) 22546 Inlet Vista Drive*Chugiak 99567 Current Property owner(s) Brian Jolly Day phone 687-1910 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ' ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ® Public Sewer ❑ WaiverNariance request for: Distance: :7Received by: ` ,�� Date: Lf 1 COSA to be released to the en neer, unless otherwise requested by the engineer. COSA Fee $ 2.-'(.0 — Waiver Fee $ Date of Payment � —2,3--coG Date of Payment Receipt Number 014 a G Receipt Number COSA# oscg ll Lt Waiver# 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. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: / //19/i S a000pp�, In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o OF A , 004 in accordance with the guidelines and regulations established by the Municipality of Anchorage and .`�•.•••" xi industry practices. The reported results describe the condition of the system/s on the date/s of the p S f) evaluation. Separation distances were measured to readily identifiable features. Hidden defects or O .• . �.'�;rt •�0 encroachments may exist that were not identified during the evaluation. The operational life of all wells �' * ; A 9�IH '' •.7 VQ and septic systems depend upon a variety of variables, including but not limited to, soil conditions, ' / VA groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and j of are outside the control of GEG. Satisfactory test results do not guarantee future performance of the Q '••J-f r- •. Gorn ss.: 0 system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of vh 9� '. CE— - • , OO the well or septic system. GEG makes no representation whether an alternative well or septic system ‘10 s •' .(ep can be installed on the property in the event either of the current systems fail to perform adequately in op ,.Pa �/ /*/$6. c,-, -c'a'j. �Qo the future. The content of this report is for the sole benefit of the person/party that retained GEG to 0 b o o1esslo 0 perform the evaluation. Reliance upon the information provided in this report by any other person or 004Op000 party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. \Z \-S OF A/v9li ,pCC884 6. DSD SIGNATURE �y J ON-SITE �, System #1 Approved for S bedrooms :Z WATER AND • System #2 Approved for bedrooms '.o WASTEWATER O Disapproved PROGRAM �� l�4 C . Conditional approval for bedrooms, with the following stipttt''f' flora p\l\C. 't- 'D 14- / G -- awl K i S e 61--D -1k-wAgfe Lk f oir.\cA -cet2e sf- -lc -]-- t,„\lc. is ze lectv . C2d,, :y. \,,,\,".".___ I or = Original Certificate Date: ` [ / Zn-/ 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 Nitrate Advisory Z.- Septic System Advisory / Arsenic Advisory . . , Well Flow Advisory Other COSA blue sheet 10-10.12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: KNIK VIEW; BLOCK 2, LOT 6 Parcel ID: 051-031-37 A. WELL DATA COMMUNITY WATER SYSTEM Well type If A, B, or C provide PWSID# Well Log (YIN) Date completed Sanitary seal (Y/N) Wires properly protected (Y/N Total depth ft. Cased to ft. Casing height (abo - •round) in. FROM WELL LOG AT I . ' CTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RES Coliform colonies/100 ml. Nitrate mg./L. Collected by: e enic: ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 3/24-25/1995 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout(Y/N) YES Depression over tank (Y/N) NO /High water alarm (YIN) N/A Date of pumping S I -7 Ji 1' Pumper 'n: Au•/a Put. p-e,5 C. ABSORPTION FIELD DATA I-BELOW EXISTING GRADE AT MTI Date installed 3/24-25/1995 Soil rating •.p.d./ •rft'/bdrm) 0.7 System type BED Length 43 ft. Width 15 ft. Gravel below pipe **0.5 ft. Total depth *5.5 ft. Eff. absorption area 645 ft2 Monitoring tube YES Depression over field NO 4/10/2018 Results (Pass/Fail) PASS For 3 bedrooms Date of adequacy test Fluid depth in absorption field before test 0 in. Water added 820 gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate>= 450+ g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) NONE KNOWN If yes, give date - **MT EXTENDS APPROXIMATELY 8"BELOW THE INVERT D. LIFT STATION Date installed Size in gallons Manhole/Access(Y/N) "Pump on" level at in. "Pump off" level at wa er alarm level at in. •- Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES COMMUNITY WATER 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 -i• is sewer manhole/cleanout Sewer/septic service line Holding tank Ani i- -. ainment areas._ Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 6+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ PVT 200'+COMMUNITY SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 104 Surface water 100'+ Driveway, parking/vehicle storage 104 Curtain drain NONE KNOWN Wells on adjacent lots 100'+PVT 200'+COMMUNITY F. COMMENTS 44-7V_ OF �•4 G. • ENGINEER'S CERTIFICATION �P,.••• '• " ..5 �.. •I certify that I have determined through field inspections and 4•. .. .•fig •• • review of Municipal records that the above systems are in • conformance with MOA COSH guidelines in effect on this • -. •• • date. o : E • ~' Municipality of Anchorage On -Site Water and Wastewater Program `f (907)343-7904 Certificate of Orr -Site Systems Approval 7 Parcel I.D. 051-031-37 Expiration Date: -,c f `17 1. GENERAL INFORMATION Complete legal description KNIK VIEW; BLOCK 2, LOT 6 Location (site address) 22546 INLET VISTA DRIVE'CHUGIAK 99567 Current Property owner(s) BRANDON CANADY Day phone 223-5241 Mailing address 22546 INLET VISTA DRIVE'CHUGIAK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class A Well ❑ Public Water System ❑ Waiver/Variance request for: N/A Received COSA to be released to COSA Fee $ 6dG - Date of Payment 211-11(6- Receipt 11.1�1(6-Receipt Number 036 -To o a COSA # c5c-1513�.I ���7�i73Tir7•F'�irXTir/3��:77F7%�9_L>� Individual 51 Holding Tank ❑ Community ❑ Public Sewer ❑ Date by the engineer Waiver Fee $ _ Date of Payment Receipt Number Waiver# 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. Name of Firm Garness Engineering Group Ltd. (GEG) Phone (907) 337-6179 Address 3701 E. Tudor Road Suite 101 Anchorage AK 99507-1259 Engineer's Printed Name Jeffrey A. Garness Date 7 6 ( - In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industrypractices. The reported results describe the condition of the system/s on the data/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions,, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail. The content of this report is for the sole benefit of the person/party who retained GEG. Reliance upon the information provided in this report by any other person orparty, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the person/party who paid for this report. 6. DSD SIG System ##1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the following ``�ill\aU+y ltll. OF AN& �= ON-SITE �R% WATER AND =c� WASTEWATER 0 PROGRAM Original Certificate Date: 3 :ertiricates 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other CO&kbluesheet &1-12doc If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: KNIK VIEW; BLOCK 2, LOT 6 Parcel ID: 051-031-37 A. WELL DATA CLASS A WELL Well type If A, B, or C provide PWSID# — Well Log (Y/N) Date completed Sanitary seal (Y/N)_ Wires properly protected (Y/ Total depth ft. Cased to ft. Casing height a ground) in. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. g.p.m. WATER SAMPLE Coliform colonies/100 ml. Nitrate mg./L. Collected by: Ar c: ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 3/27/1995 Tank size 1000 gal Number of Compartments E Cleanouts (YIN) _ YES Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 6/29/2015 Pumper SANITARY PUMPERS C. ABSORPTION FIELD DATA • ELOW EXISTING GRADE Date installed 3/27/1995 Soil rating (OE./ r ft�/bdrm) 0_7 System type BED Lengthft. Width 15 ft. Gravel below pipe 0.5 ft. Total de th _ft. Eff. absorption area 645 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 6/29/2015 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 983 gal. New depth Ein. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date MT1 ON 1995 INSPECTION REPORT IS ACTIVELY A CLEANOUT. MT2 IS A FUNCTIONING MT; HOWEVER, IT APPEARS TO EXTEND DEEPER THAN 6" BELOW THE INVERT OF DRAINPIPES. D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump off"level at.�' . —High water alarm level Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service CLASS A WELL On adjacent On adjacent lots sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ 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 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that t 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 JEFFREY A. GARNESS Date 9131 r (Rev. 11/05) F',¢t.✓r 4/fsmev 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 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D. 051-031-37 COSA # 0(d) � Expiration Date: Y -2U-07 1. GENERAL INFORMATION Complete legal descriptio.. VVIV V501 s Current Property owner(s) ADAM W ISS NB R , R Day phone 68848131 Mailing address 9810 KIMRFRLIF CT., ANCHORAGE, AK 99508 Lending agency Day phone . Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System 0 Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite 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 weft 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 pAunicipafity of Anchorage Is not responsible for errors or omissions in the professional engineers work. I 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat 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. 7:U7d;[eTlad t7T:f •ITM . • . . Engineer's Printed Name KENNETH M. D IFF IS Date 04/17/06 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, KND can not give any estimate of how long a system will function satisfactory for current or future occupants or can KND guarantee that no unseen encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE X Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: riginal Certificate Date: y-20-06 (Ra.,,us) i Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6850 www.muni.org/onsite (907) 3437904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description. KNIK VIEW f BLOI K 2. LOT 6 Parcel ID: OSI -031-37 A. WELL DATA Well type2UUM If A, B, or C provide PWSID 0 Date completed Sanitary seat (Y/N) Total depth ft. Cased to ft. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: g.p.m. - Well Log (YIN) Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION ril Cottform colonies/100mL Nitrate mg/L Other bacteria 0olonies/100 mL Arsenic: mg/I Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 3/27/1995 Tank size 1000 gal. Number of Compartments Cleanouts (YM) Y Foundation cleanout (YIN) Y Depression over tank (YM) H High water atarm (YM) A -Date of pumping 4/12/06 Pumper J R' a C. ABSORPTION FIELD. DATA Date installed7/1, 9�5 _Soil rating (g.p.d./fe or fefbdrm) -QJ— System type -0" Length _43_ ft. Width JJ-ftGravel below pipe -QS—ft. Total depth JrL,5 ft. Eff. absorption area 645 ftr Monitoring tube Y Depression over field j( Date of adequacy test 4/13/06 Results (Pass/Fail) Pass For 3_ bedrooms Fluid depth In absorption fleld before test D— in. Water added 450 gal. New depth,2_Jn. Elapsed Time:2 min. Final fluid depthD-in. Absorption rete >- 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date ..... D. LIFT STATION Date installed 'Pump on" level at in. Size in gallons Manhole/Aooess (Y/N) 'Pump ofr level at in. High water alarm level at in. Datum Cycles tested Meets alarm b circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manurelanimal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ 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 10'+ Surface water 100'+ Driveway, parking/vehide storage 2 Curtain drain 50'+ (None None) Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certlfy that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. t VI l Aiat7.milil Date 4/17/2006 COSA Fee Date of Payment 4 j o u Receipt Number (Rev. 1105) Waiver Fee $ Date of Payment Receipt Number T Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 South Bragaw SL 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. 051-031-37 HAA# Z /-4 /0 2 0 li 1. GENERAL INFORMATION Expiration Date: I/- -7- O 3 Complete legal description KNIK VIEW ESTATES SUBDIVISION; LOT 6, BLOCK 2 Location (site address or directions) 22546 INLET VISTA DRIVE • CHUGIAK, AK 99567 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address BRAD & KIM HYNDMAN Day phone c/o LYNN SWANSON w/ PRUDENTIAL VISTA Day phone LYNN SWANSON w/ PRUDENTIAL VISTA E. R. Day phone 16635 CENTERFIELD DRIVE • EAGLE RIVER, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 242-2212 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ie 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 samples. (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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid 5 at, orprior to closing for the engineering services provided. 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. 1 further verify that based on the information obtained from the Municipality of Anchorage rites 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 AKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBARR ROAD, SUITE 28 ' ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date f t �}' C Engineer's Comments: In conducting this evaluation, AKW WC• Inc. attempted to provide a thorough, MOA 000 conscientious engineering analysis of the system in accordance with ADEC and DSD Guidelines 8 Regulations. The reported results described the of the o0 q 4 ``•. • QO performance system under the conditions encountered at the time of the test, and separation _ distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may .... • .. • .. • • • • • • • • • ..... fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test DO results do not guarantee future performance of the system, nor do they guarantee that Pef re A. or s 9 > there are no hidden defects or encroachments. AKWWC. Inc. can therefore not provide Q —7953 : p Ore any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for pOe Prof rofesslocO\ 00 the sole benefit of the owner listed above. Any reliance upon or use of this report by any esslocO\ other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the flowing stipulations: ,\``kt\l`�YtOF gNCr, _S ON-SITE WATER AND WASTEWATER PROGRAM �o• Attachments: �iiOPJENT Agreements Manitenance A /y�yy��/lltlt11111 HAA Checklist g Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other By: (/ ir/ A /C• -C74' Original Certificate Date: Co 2— (R.. 12101) Municipality of Anchorage Development Services Department Building Safety Division On -She Water & Wastewater Program 4700 South Bragaw St. P.O. Box 19665D Archorege, AK 99519.6850 www.danchorage.ak.us (907) 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: KNIK VIEW EST. S/D: LOT 6. BLOCK 2 Parcel ID: 051-031-37 A. WELL DATA PUBLIC WATER Wen type PUMX If A, B, or C provide PWSID# _ Well Log (YM) Date completed Sanitary seal (YM perly protacted (YM) T Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level uetion g.p.m. — 9 -p.m -WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate mg./L. Other bade IM Arseni a of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank TypelMaterlal STEEL Date installed 3/27/1995 Tank size 1000 gal. Number of Compartments 3 Cleanouts (Y/N) YES Foundation cleanout (YM) YES Depression over tank (YM) NO High water alarm (Y/N) N/A Date of pumping 10/4/2002 Pumper CHUGACH PUMPING C. ABSORPTION FIELD DATA Date Installed 3/27/1995 Soil rating 4E> WhAr n) 0_7 System type BED Length 43 ft. Width 15 R. Gravel below pipe 0.5 ft. Total depth 05.5 ft. Elf. absorption area645 ft' Monitoring tube YES Depression over field NO Date of adequacy test 101412002 Results (Pass/Fan) PASS For 3 bedrooms Fluid depth in absorption field before test 3 In. Water added641 gal. New depth 3 in. Elapsed Time:<1 min. Final fluid depth 3 In. Absorption rate >- 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date - D. LIFT STATION Date installed Size in gallons "Pump on' level at _in. E. SEPARATION DISTANCES High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankilift station on lot Absorption field on lot Public sewer main line On adjacent lots On adjacent sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Budding foundation 3'+ Property line 3'+ Absorption field 3'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Weds on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspectlons and t';' 1+ 1 review of Municipal records that the above systems are in • • • • • . • • ... conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS -7933 ` Date f1 4�/b� ssaP• ......• aF �ofsssWs HAA Fee E Waiver Fee $ Date of Payment -4-02- Date of Payment 2231 Receipt Number 2 Receipt Number (Rev. 12/01) 10/03/02 ?NU 10:53 FAX 6896493 v1sT_ s lL LH A if 51 0 �t #5 l �t Q Wars. s. l�/• L 1 r [13 Ito =k� 1 tl 10003 . rc�^•_ -: . w�. /. 7' .T7 T.? nr ... a _1— r �T v .,•. YS"�.1t-F t�M^ .T fit. i� t- l•� ♦ _ �.: ] .. � { "..:tea.: ..,:�....L arw.,Y .../.-.rA .,+ _.v-,. t,<,' _. _. .:_ -.. :_.. .:..-vo mow, -.,.moi. .., ... ..-.: w��_�-a..::ib. a'Ta KSc. fw.. -...:• U +•• -• = MUNICIPALRIOFANCHORAGE T .`t•, '„' "tit + , ftp ,i;�t : • aDEPARTMENT OF HEALTH & kiUMAN SERVICES r, a.t„irr. dd t,' Division of Environmental Services .V x i lr`•))r r ^'r a. R r'1 i /1 .. i.. , - - �„ ;,� - ; �• _On -Site Services Seaton 4 ..11 1 t' i=» / YC`tr57♦. tket`:f•:t ,.,a..._... _ ..w•..td a. ,e', .. �S g _f L`- %='P O BOX 196650 Anchorage. -Alaska 99519-6M -•fi � .�-4 ,"Ltr 'p'14f'._�F^. r.�li -{.i .il .�i.3-4%4i 1:i1:,:..r�1•.1:. 1 � f{. t tatl- �l. rsi' •r _;7 • .'.+.iIL .S.na.•.:�1:+,. i\.SOW i'i ... ;1., v 1 .:..b ".O :v:> r ..L vn.. arv-•:.+.. }}1 OF HEALTH AUTHORITY _•- .,„ ,;>. ,-, t`.._-.”APPROVALFOR ASINGLE FAMILYDWELLINGrt.c�€•�y;;t S`c7r{ r tOS�af OSI .37 • 4l61g5,6-2) f y t Parcel I D ti �'arA3 HAFS�t, 106 GENERAL INFORMATION,. t t Complete legal description Lot 6:, Stock 2 r' Knck View r iirectioris) NHN 1ntet V.ed.ta Diu,ve -- - id Schtn'etien ' 'Day phone """`""` ` If commdrilty 1.i wen.....,.._. ..� i.ae-r.a,rv._ a � `�''x=•�-t.i 'fir -_ yell system, provide wntten wnfirmatlori from State'�DECatsf 7tyandstetusofsystem M. :, ��;t0(�[{�r\���ti�r t R DISPOSAL-' ,on -sit ,;.r;cXXXay ler. t .•e 4.•.••^}r„.wr. nrt7.1 F r ty on-site Ver trtt..: t: i'S file-rl,aL. � , 3 Ih': •. l J♦ ryn,�y� : ♦ .�,�_ �• %a^L�!'. L'..CI^J!1!:'t.. �:.� 81'�tB1� L. Li+1;4�•. ...1^ .'.. _..v:��e 1S -""'" � , ,. . attesting to the legality and status of system freM_YOA r27 _ ..:.. .l..,aw .s-Pa.S_�- ik r. r."1:. � i.— ,A_. _ -: .t./M..^r.._..• ... c'11.Y�-'. _.. ._. 5 - STATEMI_W.OF INSPECTION BY-ENGINEER .._.- ..'.... .. :.._... ...icy. ;. _..^ .. .. ..... _. _ As certified by my seal affixed hereto and as of the validation date shown below; [verify that my investigation of this HealthAuthority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the numb erof bedrooms and type of structure Indicated herein. If urther verity that based on the information obtained from the Municipality of Anchorage files and from my invest!9ation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this Inspection. 2:979' . Name of Finn .;.__s t s fNcit4ffRlNaPhone 17034 faits Rivw Loop Read N0. !04 Address , Engineers signature ' Date101 Z� --- – - OF CX r Rosea c So 01 ow' o —6.-=OHNS:SIGNATUREzz FOr r , wr r ,e Approved for bedrooms Disapproved Lam:. r�.labre._r.. ..�t-' • <. `. .-_4 4 :. t 4 } f" }- c a ^^r �. ♦ F �ri Y til +with the- IV he fOliowi..3 stf UiaUOnx Condltionat approval. for rooms;." P � bed .riR-�\Li1 G17/ "T'�a )l'.R , ♦i } 1 4 r.• ,- 0 ',a.,�� 4•YF d L I �FjiCt J � r3 - t J ♦ - T t, - .. �Iat Z� .f�^ . ��'.tT • A .. Lr v • .:S ty, )i'` ye y'' ,. tl♦ r``1.i n � ...ai'.) L L..'.� C. .. "•�� 4 J .. `r;: By: • Dated .• CAUTION i 1 ". The Municipality of Anchorage Department of Health and Human Services (DHHS] Issues Health Authority J-.r-.._. a.. Approval Certificates based only, upon the representations given In paragraph above by an independent Professional enginwmgistered in the State of Alaska. The DHHS does this as a courtesyto purchasersW homes and their lending institutions in orderto satisfy certain federal and state requirements. EmPloyees of DHHS do not „conduct-inspe rid or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer s work .724slMcvn) 9. -uwm _ - Municipality of AnchofageMUNIOPAUTY OF ANO1OkAOt DEPARTMENT OF HEALTH & HUMAAk§58UAGESRVICESDIVISION Environmental Services Division i 825"L" Street, Room 502 • Anchorage, Alaska 99501 • r,�g� 2"41995 Health Authority Approval Checklist RECEIVED Legal Description: Lor /o, $t.uck, 2, KNi K Vi" F57. Parcel l.D.: �� 10313 A. WELL DATA Well type1, e)"Mo u, y 1013, or C, attach ADEC letter. ADEC water system number Log present (YRJ) . Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE Coliform D of sample: Date completed Cased to FROM WELL LOG B. SEPTICIIIOLDING TANK DATA Nitrate Casing height (above ground) Wires properly Collected by: Other bacteria Date installed 3 --JX-r15' Tank size 1000(,&L Numbcr of Compartments �- Cicanouts 01T)YiL Foundatipn cleinoc ut tN YE5 Depression (YO No High water alarm (Ye QO Date of Pumping Q, i - t� Pumper sys1�- C. ABSORPTION FIELD DATA Date installed 3 -gra hS Soil roti (g.p.d./@- r W/bdrm) 0•7 System type `F'6C> Length ' • y j Width t't l S Gravel thickness below pipe O •S ' Total depth .15 r ERcctivc'abs.o if on arca •Lt i5 Monitoring Tube present N) Depression over field (Y© IJo T,11 Date of adequacy test "A- NELI) Results (Pass/Fail) For bedrooms SYSTE% \ Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.) - F1 uid in.):Fluid depth PSIt. Minutes later: (in.) Absorption rate R.p.d. Peroxide treatment (past 12 months) (Y If yes. give date ✓ ),A D. LIFT STATION Date installed Manholc/ACCOSS iN High water alarm level at' E. SEPARATION DISTANCES Size in gallons "Pump on" level *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off" level at* Septictholding tank on lot ;200,+- ; On adjacent lots It Absorption field on lot 20014- ; On adjacent lots Public sewer main lA Public sewer manhole/cleanout Sewer /septic service line /� Lift station SEPARATION DISTANCES FROM SEPTICA4QLt#0G TANK ON LOT TO: Foundation Q01 Property line 31 Absorption field 7 Water main/service line 10'+ Surface water/drainage 100' Wells on adjacent lots 1J1A SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation :2 9 Water main/scrvice line Surface water 1 oo t + Curtain drain F. ENGINEER'S CERTIFICATION Iv t+ Driveway, parking/vehicle storage area So' Wells on adjacent lots N /A 1 certify that 1 have determined thru field inspections and review of tfunicipal in conformance with AJ 1A ui Ieffect on this date. Signature Engineer's Name E.2T �• c� r✓f Dates - HAA Fee $ c:U . q Date ofPayment 1 Rcccipt Number a07p!iy/ Rev. 8/95 OSS: haa.ivk.doc Waiver Fee 5 Date of Payment Receipt Number 1l ROBERT C. COWAN �t vcJt\ CE -8901 V !7j It 4. are