HomeMy WebLinkAboutKNIK VIEW ESTATES BLK 5 LT 5K n 1* k View
Estates
Block 5
Lot 5
#051-043-45
Municipality of Anchorage Page 1 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Doxlili
196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744
On-Sitel
Wastewater Disposal System and/or Well Inspection Report
Permit Number:
SW990031 PID Number. 051-043-45 _
Wastewater System: MNew ❑Upgrade
Nama:JOHN
THOMS i
N
Address:
17343 SANTA MJJA,,RIA
�-
DR, EAGLE RIVER, AK 99577
ABSORPTION FIELD
Phone: (907) 240020/696-5070
No. of Brooms:
p Deep Trench ■ Shallow Trench 13 Bad ❑ Mound E3 Other
i
Soll Rating:
1.2
Total Depth from original gods:
8
LEGAL DESCRIPTION
Val F.
Lot: Block: Subdivision:
Depth to pipe, bottom from original grade:
Drawl depth beneath pipe:
4.0
5 5 KNIK VIEW ESTATES
4.05 FIL
FL
Township: Mange:
I
N/A
Section:
N/A
Fill added above original tirade:
0.38 — 0.63 FIL
Orawl length:
50
N/A
Number of lines:
1
Distand between (Ines:
N/A
Gravel width:
WELL: b New ❑ Upgrade
5 FL
Ft
ckusilkalbn Private, A.D,C):
Total De -
Cased To:
Total absorpilon ane,:
500
Pipe material:
ASTM D-3030/F-810
wEL Ft
P
sQ, FL
prggn pate Ddu W:
lv
statin water Level:
Installer. RCP EXCAVATING
Date Installed: 4/12-14/99
O`4'—Ij�`v\�
l�
F L
Yield: lump set At:
Caeinq Height Above Ground:
TANK
aP1A Ft.
R
SEPARATION
DISTANCES
■ Septic ❑ Holding ❑ S.T.E.P.
Manufacturer: Capacity In gallons.
ANCHORAGE TANK 1250
To
Septic''
Absorption
Lift
Holding
Pumla/Prwate
From
Tank'.
Field
Station
Tank
sewer IJnee
Material: Number of compartments:
Well
200' h
200'+
N/A
N/A
25'+
STEEL 2
Surface
100'+,
100'+
N/A
N/A
N/A
LIFT STATION
Water
Size In gallons: Atanufacturen
5'+'',I1
10'+
N/A
N/A
N/A
LLot ine
Pump on level at: Pump N at: High water alarm at:
Foundation
5'+ !
10'+
N/A
N/A
N/A
Curtain
Pump Alake al: Deatrlcal Inspections performed try:
Drain
�—
NONE KNOW
BENCH MARK
Remarks:
II
Location and Deeariptlon:
t'1t T1fz�SN ol.l0
gAG� �eo2
II
Assumed Elevation:
10C) E> Ft,
eNalNEEfrs a
A�
0�
Inspections performeda�red by: AWWC, INC. Dates: list 4/12/99
, —
a* It
....... ....... ..:..
4/992nd 4/1
0
3rd 6/28/99
0 f
Department of Health and Human Services approval
�Q04 �e^., '7953 c�\�oo�
Reviewed and al?proved by: Date: "� 3 "19
�OO" Orofessla�°oma
OO4p��0o
2-013 Rev. 9/91) AIM 25'1
•
PERMIT NUMBER:
PARCEL ID NUMBER:
AS-BUILT DRAWING 015-043-45
SW990031
II
II
i�-
I
NEW 1250 GALLON DBL1
SEPTIC TANK DBL2
NEW DRAINFILD
I
�
(50'x5')
----
A
TH2 / j01 i
Lij
! DRIVEWAY
7MT1
NEW / / /
ALTERNATE SITE
I
4 B D R M / /
/ /
Q
HOUSE /
/ /
/�MT2�
W
Y
�
/ FCO
J
CO2 TH#1
(oI /
If
WATER SERVICE LINE.
� _ �__� B
(APPROX. LOCATION)
8 143.7 11.4_
I
ST22_ 36.8 19.6
D_B_L 1 3_5.7_ 22.5
WATER KEY Box
ASSUMEDDB
LOCATION. (WATER MAIN
_L2 35.5 _24.5
IS IN;IKNIK VISTA STREET)
CO1 37.6 54.7
CO2 59.0 20.0
_
NA_ 40.5_ 52.5
MT2 44.4 54 4
ALASKA WATER & WASTEWATER CONSULTANTS, INC.
000�0000
OT
6,901 DEBARR ROAD, SUITE 20. ANCHORAGE, AK. 99504
','
d c •,� 01
O w,•'• ••••�: V4
PHONE: (907) 337-6179/FAX: (907) 338-3246
�O O
•..
LEGAL DESCRIPTION: -I
KNIK VIEW
EST..SUBDIVISION; LOT 5, BLOCK 5
0�* .. .
TYPE OF WORK:
AS-BUILT
DRAWING OF SEPTIC SYSTEM UPGRADE.•
••• • .......P
0000 s 2 • C —7953 ,• S c�O�O
PREPARED FOR: PHONE NUMBER:
JOHN THOMSON'j (907)240-2020/696-5070
4Q4P� d P • • • • • • • • • • o� pApO
e �O
��Opoo>o�'&
DATE: DRAWN BY:
6/29/99 K.D.W.
SCALE:
1 = 30'
PAGE:
2 OF 3
PERMIT NUMBER: PARCEL ID NUMBER:
SW990031 A S- B U S T DRAWING 051-043-45
INPL 6PA17i - 99.72
511 5f2
fOP OF fW fop a fANK
AT IVf - 94,61 Af 01.=f - 94,61
NSW 1250 6& ON
rnoF
N VIC TANK �N��foFP
Af IR ff - 94.08 Af an f - 9383
Mf CO
FINAL 6m - 97.92 - 96.17
OPJGINN 6m - 97,54
7
h
h
a
I"Rf OF PIK
_ - 93,49
POffom c F
T)TNCN - 69.49
ALASKA WATIER & WASTEWATER CONSULTANTS, INC. 000�000
6001 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK. 99504
� PHONE: (907) 337-6179/FAX: (9D7) 338-3246 Ov S400
LEGAL DESCRIPTION: DO H •'�-�000
TES SUBDIVISION; LOT 5, BLOCK 5 � * :. * O
KNIK VIEW ESTA , , . . ...........
TMP ASF BUILT PROFILE0
OF SEPTIC SYSTEM UPGRADE ••• ••• •••••••0
PREPARED FOR: 'I, PHONE NUMBER: Q •'• f r 7953 ess,
JOHN THOMSON'j (907) 240-2020/696-5070 Q�°s �0p
DATE: DRAWN BY: SCALE: PAGE: 44pa� ry P • " • o\ �Ao
6/30/99 i K.D.W. 1 = 30' 3 OF 3 ��4p4000����
Permit Number: SVA
Legal Description:
KN
Design Engineer:
00�
Owner Name:
JO
Owner Address:
17;
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
10031
VIEW ESTATES BLK 5 LT 5
AK Water & Wastewater Consulta
ITHOMSON
I SANTA MARIA DRIVE
.E RIVER , AK 99577 -
P rn
t (2 cy\
Date Issued: Mar 11, 1999
Expiration Date: Mar 10, 2000
Parcel ID: 051-043-45
Site Address:
Lot Size: 22062 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
❑✓ Disposal Field [✓] Septic Tank ❑ Holding Tank ❑ Privy
All construction must
1. The attached app
2. All requirements
Wastewater Dispi
3. The engineer mu:
(907) 343-4744 (
4. From October 15
must be either:
Received By:
❑ Private Well ❑ Water Storage
in accordance with:
ved design.
ecified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
al Regulations ( 1 SAAC72 ) and Drinking Water Regulations ( 18AAC80 ).
notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
i hours ). ( Not required for a Water Supply Permit only ).
April 15, a subsurface soil absorption system under construction during freezing weather
Open and closed on the same day.
Covered, sealed, and heated to prevent freezing.
Date
Alaska mater & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 213 — Anchorage — Alaska 99504
(907) 337-6179 — Fax (907) 338-3246
Consulting Engineers
March 3, 1999'
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Septic Design for Lot 5, Block 5, Knik View Estates Subdivision
To whom it may concern:
The proposed'',14 bedroom house will be served by a private septic system and a community water
system. Two',, test holes were excavated on the property. Comments regarding the proposed
design are suit#marized as follows:
1. SOILS: Attached are logs which shows the soil profile, and the percolation test results. The
soils below the organic layers are a GW/SW to a depth of 16 feet in TH#1 and to a depth of 15
feet in TH#2 (bottom of test holes). No groundwater was encountered during the excavation of
the test holes, The percolation tests for TH#1 and TH#2 were performed between the depth of
6.0 feet to 6.5!'feet which both had a percolation rate of <1 minute/inch. It is our opinion that due
to the high percentage of sand, the insitu soils will serve as a sand filter. A grab sample can be
provided if deemed necessary.
2. TRENCH DESIGN:
a.
Percolation Rate: <1 minutes/inch
b.
Allwable
oApplication Rate: 1.2 gallons/day/ft2
c.
Number
I
of Bedrooms: 4
d.
Design Flow: 600 gallons per day
ft2
e.
Minimum
Absorption Area: 500
f.
Total
Depth: 5 feet (max.)
g.
Egective
Depth: 4 feet
h.
Width: 5 feet minimum
i.
Reduction Factor: 0.50
Length: 50 feet long
i.
Minimum
ft2
j
Egective absorption area = 500
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
4. TOPOGRAPHY: The average topography of this property is mostly flat; in short, there are
no slope concerns.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you
for your assistance.
Jeffr4 A. Dai Less, PT.—.—,M.S.
NOTE: Attached is a site plan drawing, a design drawing, two soils logs and a 4 page
construction specification letter which are all part of the design package for this septic system.
LOT 1 BEE 1,
LOT B, ULK 5,
KNIK VIEW S/D KNIK VIEW EST. LOT 9, HIX 5,
C KNIK VIEW ES'f.
`,'�y4f LOT 10, BLK 5,
G KNIK VIEW EST.
7/LOT2, HLK 1, C I SRO
KNIK VIEW S/D,i
LOT 11, BLK 5,
- KNIK VIEW EST.
LOT 7, BLK 5.
KNIK VIEW EST.
51
ur
rz, Li J LOT 12, OLK 5,
�r ie � &- � 11_1-1 KNIK VIEW ESf.
LOT Qi, BLK 5,
UT KNIT( VIEW EST. I
- <
LOT 13, BLk( 5
(n
S KNIK VIEW EST.
nLrE NATE SITE /
e.. orc�-h 1 n,
TNI}1 U LOT 14, EILI( 5,
KNIK VIEW EST.
r'
PROPOSED SEPTIC SYSTEM -
SEE DESIGN, PAGE 2 OF 2)
LOT 4, dLK 5, ei
n KNIK VIEW EST.
W '
c� LOT 15, BLK 5, Lu
KNIK VIEW �EST.
N L01 3, E3LK 5,
F KNIK VIEW EST.��
O
LOT 16, BLK 5.
I.OT 1, 81_K 5, KNIK VIEW EST. ._
LOT 2, BLK 5, KNIK VIEW EST.
KNIK VIEW EST.
ALDER L_E-AF DR�VC NOTE: ALL PROPERTIES WITHIN 'LOO' OF TWE
PROPOSED SEPTIC SYSTEM ARE `iERVED [3Y
_ �A COMMUNITY WATER SYSTEM
ALASKA WATER l ER L1 I) WASTEWATER lsl.lNS LTAN S9 XNC' �yyy6���OO
6601 DERARR ROAD SURE 213, ANCHORAGE, AK 99504 ca q Q�0
PHONE: (907) 337-6179/FAX: (907) 3313-3246
L,EGAI_ DESCRIP1lON:
KNIK VIEW ESTA.. TES SUBDIVISION, LOT 5, BLOCK 5, Q. .. .. .... ..... .....I
- o rte: -v 0
TYPE OF WORK:
SITE PLAN FOR JSEPTIC DESIGN QOO Je fr A. Gorness,-
PREPARED FOR: PHONE NUMBER: m E-7953 v O
JOHN THOMSONI'; 240-2020/696-5070
DATE: 3/2/99 DRAWN BY:.I.L.M. 1 OF 2 SCALE: PAGE: uprof®ssio�o\ a�
1 = 100' QVO000�d��
NOTE: THE CONTRACTOR IS RESPONSIBLE FOR THE
FLAGGING OF THE NORTH OR SOUTH PROPERTY LINE
IS PERFORMED BY A REGISTERED LAND SURVEYOR
PRIOR TO CONSTRUCTION,
INSTALL DBL CO
V
PROPOSED
4 DDRM
HOUSE. co
CO
1
PROPOSED 1250 GALLON
SEPTIC TANK. ----
PROPOSED WATER SERVICE
LINE LOCATION.
WATER KEY BOX
LOCATION. (WATER MAIN
IS IN KNIK VISTA STRECf)
ALASKA OSA'
TTH#1
.—PROPOSED DRAINFIELD
EXCAVATE 5 FEEL WIDE
BY 50 FEET LONG BY
8 FEET DEEP. ADD 4 FEET
OF CLEAN, WASHED SEWER
DRAINROCK.
l 1
'1 1 —ALTERNATE SITE
1 1
1 1
1 1
1 1
11
1 1
1 1
11
1
1 �
L.
L AND WASTEWATM CONSULTANTS, INC -
1 DEBARR ROAD SUfTE 29, ANCHORAGE, AK 99504
PHONE: (907) 337-6179/FAX: (907) 338-3246
KNIK VIEW ESTATES SUBDIVISION, LOT 5, BLOCK 5,
TYPE OF WORK
DESIGN FOR SEPTIC SYSTEM
PREPARED FOR: I PHONE NUMBER: I
JOHN THOMSONI;240-2020/696-5070
3/2/99 ,I.L.M. I ...._-' — S0, 1
2 OF 2
offmWiNIN
r� A. tarn' ss•- •••
7953 ' `e�
;E'rofeesiono_�d
AWWC Inc., February 1999
Alaska 'Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B — Anchorage — Alaska 99504
Phone (907) 337-6179 — Fax (907) 338-3246
Onsite w!rstewater Disposal System Standard Construction Specifications
I. REFERENCE PROPERTY: Lot 5, Block 5, Knik View Estates Subdivision
II.
1. Property owner: The legal property owner or his/her representative.
2. Engineer: Alaska Water & Wastewater Consultants, Inc. or AWWC, Inc.
3. Contractor: The company hired by the property owner to install the septic system.
4. DHHS: Municipality of Anchorage, Department of Health & Human Services
5. M.O.A.: Municipality of Anchorage, Department of Health & Human Services
e Property Owner Responsibilities:
1. The property, owner shall contract with the contractor to perform the work outlined in these
specification's and plans, in accordance with the attached DHHS permit. There is no contractual
relationshipbetween the contractor and the engineer. The engineer shall inspect the work as, required by
DHHS to document the installation. Final acceptance of the contractor's work rests with the owner and
the DHHS. '!
2. This well and/or septic system design is for a single family residence only. The homeowner is
responsible for notifying the engineer if the residence is used as a duplex, business, or multi -family
dwelling. In such cases, the installation permit must be obtained from the State of Alaska, Department of
Environmental Conservation.
3. The validity of the design site plan is limited by the accuracy of the as -built survey provided to the
engineer byi the property owner or his/her representative. The property owner shall notify the engineer
regarding any known inaccuracies associated with the as -built survey. The engineer assumes no
responsibility for the accuracy of the survey.
4. The property owner is responsible for notifying the engineer of any unplatted easements, not shown on
the as-built';Survey, which the new well or septic system may encroach into.
5. The property owner shall notify the engineer of any seasonal groundwater or surface water runoff
conditions,] known to him/her, which could potentially effect the operation of the septic system. The
proposed septic system must be at least 100 feet from any streams, ponds, creeks, swamps, bogs, or any
other surface water as defined by the DHHS.
6. The property owner is responsible for notifying the engineer if, to his/her knowledge, any of the
adjacent properties are used as a duplex, business, or multifamily dwelling. The new septic tank and
leachfield must be at least 100 feet fi•om any private well, 150 feet from any class "C" well, and 200 feet
from any community well, unless appropriate waivers are obtained.
1 of 4
7. The In
would put
S. Unless s
areas which
to the coni
are aaaresse
necessary fw
AWWC Inc., February 1999
rty owner and/or his contractor shall report to the engineer any observed condition which
septic system in violation of State or Municipal regulations.
cifically agreed upon otherwise, the property owner is responsible for final grading of the
ttle after construction. Prior to awarding the contract, the homeowner should communicate
ctor any expectations regarding, but not limited to, post construction site clean-up,
;, and restoration of any asphalt, fences, trees, decks, ect. that are effected by the
If the property is being sold, the property owner shall ensure that the aforementioned items
with the buyer, and, if the work is to be completed after the sale of the property, that
Is are escrowed to fund the completion of the work.
9. If the property owner intends to install the septic system he/she must first have obtained approval from
the Municipality of Anchorage, DHHS (343-4744). Homeowner installations typically require more time
for engineer, inspections. The homeowner should discuss the additional costs, associated with such
inspections, [with the engineer, prior to starting the project.
10. The property owner is responsible for payment of all the engineer inspection charges. The number of
inspections will vary depending on the actual field conditions encountered and the construction methods
used.
® Contractor Responsibilities:
1. The co}tractor is responsible for locating all buried utilities, easements, property lines, and surface
waters; and' shall ensure that all setbacks are flagged by a registered land surveyor prior to construction.
2. Construction shall be in accordance with the approved site plan and design drawings, and any special
provisions noted on the municipal sewer permit. The contractor is responsible for notifying the engineer
of any discrepancies noted on the design plans or drawings, prior to starting work. The installation,
materials, and workmanship shall comply with all applicable State & Municipal regulations.
3. The contractor is responsible for field verifying the separation distances to all adjacent wells and septic
systems, shown on the design drawings, prior to starting construction. Any encroachments that would
effect the installation, for which waivers do not exist, should immediately be brought to the attention of
the engineer.
4. Ensure trat all materials being used are in compliance with the most current guidelines established by
the Municipality of Anchorage. This includes, but is not limited to, the following:
a. I;uramrocx
b.':IiSand filter material for conventional beds, trenches, or mound systems.
C. ''Sand filter material and pea gravel for Intermittent Sand Filters (ISF).
d. Il, Anchorage Sand and Gravel (AS&G) "block pea" material for Upflow Filters.
It is recommended that the contractor provide the engineer with current sieve analysis' from the
sand/gravel supplier to document the suitability of the material. The engineer assumes no responsibility
for ensuring that the materials delivered meet the MOA requirements.
5. The col tractor shall ensure that the septic tank, lift station, or holding tank purchased has a burial
depth rating suitable for the actual installation.
6. Notify] the engineer at least 24
preconstrudtion site visit shall take
hours prior to starting construction. If deemed necessary, a
place. The contractor shall coordinate with the engineer any
2 of 4
AWWC, Inc., February 1999
inspections which will be required during weekends, holidays, or before/after normal working hours (8:00
am to 5:00 PM). The property owner may incur additional charges for inspections which do not occur
during normal business hours. It is the contractor's responsibility to notify the engineer a least 2 hours
prior to any inspection.
7. The contactor shall report to the engineer any observed condition which would put the septic system
in violation of State or Municipal regulations.
8. Any rem�lining test hole excavations shall be filled and mounded. Unless instructed otherwise by the
engineer, the old test hole groundwater monitoring pipes shall be removed.
9. The contl-actoris responsible for final grading so as to ensure that surface runoff does not adversely
effect the septic system constructed, adjacent septic systems, or adjacent structures.
10. The cojttractor is responsible for obtaining approval from the property owner for any additional
constructionjcosts associated with design modifications or changing field conditions, prior to doing the
work.
• Engineer Responsibilities:
1. The engineer is responsible for inspecting the installation of the septic system and preparing as -built
documentati�n, to the satisfaction of the M.O.A.. Inspections are performed as necessary to document the
construction of the system to the satisfaction of the M.O.A. In all cases, the following inspections shall be
performed:
• The bottom of all trench/bed excavation
* Top of sand on all sand filters
* Top of drainpipe
* Septic tank, or lift station, or holding tank prior to backfill
* I lacement of filter fabric and insulation
* t fter final grading is completed
Additional
the type of
2. The ins
Should the
work be sti
notify the 1
3. The en
re -use. If
IV. CONI
m Gene]
ions may be required depending on the construction methods used by the contractor and
being installed.
engineer has no direct authority over the contractors activities or construction practices.
^er identify conditions which dictate a design change, he or she may recommend that
and/or the design be modified. If design modifications are necessary, the engineer shall
r owner or his/her representative.
:er shall inspect the condition of the existing septic tank and determining its suitability for
engineer determines the septic tank to be structurally unsound, it must be replaced.
GUIDELINES:
Construction shall be in accordance with the approved site plan and design drawings, and any special
provisions' noted on the municipal well and/or sewer permit. All materials, components, and construction
practices shall comply with the Municipality of Anchorage's latest ordinances regarding wells and septic
systems, as well as DHHS policies. The failure of the inspecting engineer to notice a material or
3 of 4
AWWC, Inc., February 1999
construction',,'ron-compliance does not relieve the contractor of his/her responsibility to correct such a
deficiency.
o Septic Tank, Holding Tank, or Lift Station Installation:
1. The burial rating of the tank shall be adequate for the actual burial depth encountered.
2. The tank shall be level and sufficiently bedded to prevent settling or shifting of the tank.
3. All standpipes on the tank shall extend a minimum of 12 inches above final grade.
4. Tanks in$talled with less than 4 feet of cover shall be insulated.
5. The server service line from the house to the tank shall be sloped a minimum of 1/4"
per foot, l�nless prior approval is obtained from the engineer.
6. The inlet Find outlet lines from the tank shall be bedded in drainrock or the soil shall be adequately
compacted to prevent future settlement of the soil.
7. A foundation clean-out will be installed, 1-4 feet from the house, if one does not currently exist.
S. Post tankiclean-outs shall be installed per MOA requirements. Does not apply to holding tanks or lift
stations with pressurized lines.
9. All tank shall be anchored to resist buoyancy forces in high groundwater areas. This applies when
there is rot adequate soil cover to resist buoyancy forces. Engineer shall make this determination.
10. The final soil cover shall be graded so that there is positive drainage away from tank.
11. All holding tanks and lift stations shall have an audible and visible alarm inside the residence.
12. All lift stations shall be wired in compliance with all MOA guidelines and the Uniform Electrical
Code. I
13. The contractor shall remove the old tank, or abandon it in compliance with the Uniform Plumbing
Code (UPC). The contractor is solely responsible for the abandonment procedure.
• Installation of Conventional Absorption Bed & Trenches:
1. Excavate the proposed bed/trench to the dimensions shown on the design. The bottom of the
excavation shall be within 2 inches of level (2 inch maximum variation between high and low spots). If
the sidewaljs or bottom of the excavation become smeared, they must be raked or scarified before
placement Of the filter sand or drainrock.
2. The trenO or bed should be at least 5 feet from the test hole excavation.
3. All soil tests and excavation depths are advisory to the design and are to be verified in the field by the
engineer. If design changes are necessary, and the changes effect the contractor charges to the property
owner, the contractor shall obtain approval from the property owner prior to proceeding with the work.
4. Once thg drainrock is installed, the distribution pipe is to be placed level (0.02 feet difference between
high and low shots) with the perforations faced downward. Drainrock is then to be placed over the
distribution pipe, to provide a minimum of 2 inches of cover over the pipe. The drainrock shall not be
pyramided over the drainpipe but shall be the same elevation over the entire trench/bed width.
5. A silt barrier must be installed between the final drainrock layer and the native soil backfill. The silt
barrier shale cover the entire drainrock surface.
6. Monitor'jtubes shall be installed at the locations shown on the design drawings, and extend a minimum
of 12 inches above final grade. The portion of the monitoring tube extending through the drainrock shall
be perforated from the bottom of the trench/bed to the invert of the distribution pipe.
7. Backfilljover the final drainrock layer must not be less than 2 feet. Insulation must be installed when
the backfill depth is less than 3 feet. The insulation shall cover the entire width of the trench/bed. the
contractor shall "shoot' the final grades to ensure cover depth is adequate, prior to notifying the engineer
that the work is complete. The final cover over the drainfield must graded so that there is no potential for
water to pond over the trench/drainfield.
ALASKA WATLIL & WASTEWATER CONSULT,
732 9504
PHONE (907) 337-617 CLE FAX (907) 338-3246
SOIL LOG o PERCOLATION TEST
LEGAL DESCRIPTION;! KNIK VIEW ESTATES SUBDIVISION; LOT 5, E
PERFORMED FOR 'JOHN THOMSON
TEST HOLE 11
SOIL CLASSIFICATIONS
o
GP
GROUNDWATER
DATE
PERFORMED
2i
DEPTH
T
CL
v;
(feet)
–
OL
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13"
14
15-
5
16
16—
B.O.H.
17
18
TEST HOLE 11
SOIL CLASSIFICATIONS
o
GP
GROUNDWATER
ML
W.
2/23/99
GM
T
CL
v;
GC
OL
--- --
c
SW
SP
P'
MH
CH
os o
J (j`�f
QUO
"
SM
' ' ,'
OH
SC
DEPTH TO
DATE
GROUNDWATER
NET TIME
(MINUTES)
DRY
2/23/99
DRY
3/3/99
INC.
ammUMAmm
�Jr �rIA. Gayness;
`rrEV/t' 7953
'��na pr o f easlon��"�
Sl E PLAN
W—
i CY'
cn
ALTERNATE SITE
U)
NSW
. Y - h4aip 11 111
nom.
Y THIN
PROPOSED SEPTIC SYSTEM--
(SEE DESIGN, PAGE. 2 OF 2)
DATE
READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
-
— ---
--- --
P'
19 PERCOLATION RATE _
20 TEST RUN BETWEEN _
COMMENTS: DUE,TO HIGH PERCEfAGE OF SAND, INSITU
<1 (MIN./INCH)4AA
ERC. HOLE DIA. 6" (INCHES)
%I,
T/// AND FT.
91N�iUL SAND FILTER.
PERFOMED BY ALA ISKA WATER & WASTEWATER 1,L_,;CERTIFY THAT
THIS WAS PER FOR IN ACCORDANCE WITH ALL STATE N 1 ICIPAL GUIDELINES IN EFFECT ON THIS
DATE. DATE: —7 —
ALASKA WATER & WASTEWATER CONSULT
-� 7320 CHESTER HTS. CIRCLE a ANCHORAGE, AK. 99504
P11ki E (907) 337-6179 + FAX (907) 338-3246
SOIL LOG -PERCOLATION TEST
LEGAL DESCRIPTION'S KNIK VIEW ESTATES SUBDIVISION; LOT 5, E
16
17
E
iE
20 ' I
COMMENTS: DUE
TEST HOLE #2
SOIL CLASSIFICATIONS
v c
bvv
GP
GM
• I�
PERFORMED FOR:_:!_, IOHI
DATE
PERFORMED:DEPTH
DRY
7%/
GC
SW
SP
SM
(feet)
'
-
��o Nbl
1
_. =
ORGANICS
2
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°
3
_o _`
4
`'o'v
o'
am::,
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o
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6--
7—
B_
B
';
GW/SW
9
o
c
10
ou I„
C'i-:"
2
12-
13-
1314
14
15
°`
B.O.H.
16
17
E
iE
20 ' I
COMMENTS: DUE
TEST HOLE #2
SOIL CLASSIFICATIONS
v c
bvv
GP
GM
GROUNDWATER
vr<V
ML
CL
"
"~
DRY
7%/
GC
SW
SP
SM
OL
MH
CH
OH
'
"`°" °
��o Nbl
SC
DEPTH TO
DATE
GROUNDWATER
NET TIME
(MINUTES)
DRY
2/23/99
DRY
3/3/99
�•
of a or
essf
a ' C 7953
%'h&'y Pr o f a ssloro\ ��
P�oN
L.�l L
LiJ
cn
ALTERNATE SITE—
_ wTp�\ N
i NKtn
c ;1
Ile
PROPOSED S0 TIC SYSMMd-
(SEE DESIGN, PAGE 2 OF 2)
DATE
READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
PERCOLATION RATE <1 (MIN,/INCH) RC. HOLE DIA. 6" (INCHES)
TEST RUN BETWEEN 6.0 F.T. AND FT.
HIGH PERCETAGE OF SAND, INSITU SOI L ASA SAND FILTER.
PERFOMED BY ALASKA WATER & WASTEWATER I, CERTIFY THAT
THIS WAS PERFOR� IN ACCORDANCE WITH ALL S A CIP IDELINES IN EFFECT ON THIS
DATE. DATE: _?/)/ 9 r7--
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program, 4 [ T,
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 C
Parcel I.D. 051-043-45 COSA N t'1 p 6)0055
Expiration Date: 3 '?, D — D Cr
1. GENERAL INFORMATION
Complete legal description Knik View Est, Block 5 Lot 5
Location (site address) 22501 Knik Vista St
Current Property owner(s) !anis Smoke
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
9400 Star Ln, Boze,an, MT 59715
Day phone
Day phone
Rona Florio Day phone 748-4500
717 Barrow St
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 A Well
Public Water System
RX
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.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. 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 Pannone Engineering Services, LLC Phone 272-8218
Address P.O. Box 102954 Anchorage, AK 99510
Engineer's Printed Name Steven R. Pannone, P.E. Date 3/18/08
Engineers Comments: In conducting an adequacy test, l attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with hIOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions
encountered at the time of the lest, and separation distances measured to readily identifiable features.
The operational life of all wells and septic systems depend on the local soil condition, ground water
levels that may fluctuate during the year, and the water usage of the family being served by the system.
These conditions arc outside the control of the evaluator of this system. All systems eventually fail and
satisfactory lest results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. PFS can therefore not provide any warranty for future
performance nor give any estimate of how long the system will continue to meet the operational
requirements of the 100A DSD. The content of this report is for the sole benefit of the owner listed
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it
confer any legal right whatsoever.
5. DSD SIGNATURE
_IZ Approved for L- 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
riuow,
By: Original Certificate Date: ',0 - `0
(Rw.,,M+
N
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) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Knik View Est, Block 5 Lot 5 Parcel ID: 051-043-45
A. WELL DATA
Well type Class A AWWU
Date completed _
Total depth
Date of test '
Static water level
If A. B, or C provide PWSID N 218409 Well Log (Y/N)
Sanitary seal (Y/N) _
ft. Cased to ft.
FROM WELL LOG
Well production
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate
mL
ft.
Arsenic: ug/I Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic / Steel
Wires properly protected (Y/N)
Casing height (above ground) In.
AT INSPECTION
ft.
g.p.m.
mg/L Other bacteria colonies/100
Collected by:
Date installed 4/19/1999
Tank size " 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Yes
FoundatioI n cleanout (Y/N) Yes Depression over tank (Y/N) N High water alarm (Y/N) No
Date of pumping 3/19/2008 Pumper J.R.'s Pumping
C. ABSORPTION FIELD DATA
Date installed 4/19/1999 Soil rating (g.p.d./f? or fe/bdrm) 1.2 System type. Trench
Length 50 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 8.7 ft. Eff. absorption area 500 fe Monitoring tube Ygs Depression over field No
Date of adequacy test 9/11/2006 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test OL7 in. Water added481gal. New depth0/7 in.
Elapsed Time: 0 min. Final fluid depth 0/7 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons N/A Manhole/Access (Y/N) _
"Pump on" level at_ in. "Pump off' level at _ In. High water alarm level at
Datum
E. SEPARATION DISTANCES
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on tot N/A
Absorption field on lot N/A
Public sewer main N/A
Sewer /septic service line 50+
Animal containment areas 100+
Meets alarm & circuit requirements?
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank 200+
Manure/animal excrete storage areas 100+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Properly line 10+ Absorption field 5+
Water main 100+ 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 50+ Wells on adjacent lots 200+
F. COMMENTS
for
in.
G. ENGINEER'S CERTIFICATION r �:• """' "" •.41 e++
I certily that t have determined through field inspections and O0 ,q,„ ' \*,00
review of Municipal records that the above systems are in Steveno nog �j c = _�
conformance with MOA COSA guidelines in effect on this date. 0
Engineer's Printed Name Steven R. Pannone, P.E. % +4 No. cl: ei 9r%U�
+...�•.
Date 3/18/2008 +�+i4901v64`- °
COSA Fee $ Waiver Fee $
Date of Payment ����/O Date of Payment
Receipt Number Receipt Number
(Rev. 11/05)
Municipality of Anchorage
' Development Services Department
Building Safety Division
On -Site Water 8 Wastewater Program
4700 Bragaw Street
P.O. Box 196650 l
Anchorage. AK 99519-6650 (_^J
www.muni.org/onsite ( /
(907)343-7904 v
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
�� FOR A SINGLE FAMILY DWELLING �/1
Parcel I.D. OSI—L/)`/J—Z1J COSA# Arng6y)
1. GENERAL INFORMATION Expiration Date: 01-27-07
Complete legal description KNIK VIEW ESTATES SUBDIVISION* LOT 5. BLOCK 5.
Location (site address) 22501 KNIK VISTA STREET ► CHUGIAK, AK 99567
Current Property owner(s) TWAIN do DONNA TIPTON Day phone 688-7439
Mailing address P.O. BOX 771163 • EAGLE RIVER, AK 99577
Lending agency Day phone
Mailing address
Real Estate Agent BROOK STILTNER w/ REMAX PROPERTIES Day phone 694-4804
Mailing address 16600 CENTERFIELD DRIVE * EAGLE RIVER, AK 99577
Unless otherwise requested, COSA will be held by DSD for pickup. SEPTIC SYSTEM SIZE
FOR 4 BEDROOMS
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑
Individual Water Storage ❑
Community Class "A* Well
Public Water System ❑
Individual On-site
Individual Holding tank
❑
Community On-site
❑
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 Onsite 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 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.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
Investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the
on-site water supply andlor 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. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date cy h4 06
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis or the system in accordance with ADEC and MOA
DSD Guidelines 6 Regulations. The reported results described the performance ofthe
system undor 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
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
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
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will it confer any legal right whatsoever.
S. DSD SIGNATURE
l� Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
JQr.........: •Lye
ON-SITE
WATER AND
WASTEWATER
�PRbt—'
—L� Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
� ��'`' ` Original Certificate Date: l —� 7 '-06
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
47W Bregaw Street
P.O. Box 19MM
Anchorage, AK 99519.66M
www.muni.orglonalte
(907)943.79M
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: KNIK VIEW ESTATES SUBDMSION: LOT 5. BLOCK 5. Parcel ID: 0 5 / — 0 // 9
A. WELL DATA
well type x_
Date completed
Date of test
Static water level
Well production
COMMUNITY WATf.R
if A, B, or C provide PWSID#21 g'yv Well Log
Sanitary seal
Cased to ft.
FROM WELL LOG
R.
p.p.m.
WATER SAMPLE RESULTS:
Coltform colonies/100 mi. Nitrate
Date of sample:
B. SEPTICIHOLDING TANK DATA
properly protected (YM)
Casing height (above ground) in.
AT INSPECTION
ft.
g.p.m.
ml.
[07-ZI ?Ts�'A
TankType/Material STEEL Date installed 4/12-19/1999
Tank sae 1250, gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (YM) YES Depression over tank (YM) NO High water alarm (YM) N/A
Date of pumping 5/17/2006 Pumper SANITARY PUMPERS
C. ABSORPTION FIELD DATA
Date installed 4/12-14/1999 Soil rating . ftr)bdrrn) 1_2
Length 50 ft. Width 5 ft.
System we TRENCH
Gravel below pipe 4 ft.
Total depth •axs ft. Etf. absorption area 500 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 9/11/2006 Results (Pass/Fall) PASS For 3 bedrooms
Fluid depth In absorption field before lest .21-7 in. Water added 481 gal. New depth 0/7 in.
Elapsed Time: U min. Final fluid depth 9,/7 in. Absorption rate >z 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN K yes, give date
SEPTIC SYSTEM SIZED FOR 4 BEDROOMS
D. LIFT STATION
Date Installed
lump on' level at _in.
E. SEPARATION DISTANCES
Size in gallons
1711
Manhde/Acoess
water alarm level at
Cycles tested Meets alarm & circuit requirements?
-
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tants station on lot
Absorption field on lot
Public sewer man
Sewer /septic service
areas
COMMUNITY WATER
On adjacent
On adjacent
sewer manhole/deanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 50+ Absorption field 51+
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 100+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehide storage _ 0'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I car* that / have determined through field inspections and
review of Munidpal 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
COSA Fee • t0 "
Date of Payment 2 Z d 6
Receipt Number 6 2 0 9% 3
(Rev. 11/05)
Waiver Fee S
Date of Payment
Receipt Number
11101"ez
ASBUILT
1 HEREBY CERTIFY THAT I HAVE SURVEYED THE
SCALE''e.
FOLLOWING DESCRIBED PROPERTY,
v �sr,�..seer.r. 4
AND THAT NO ENCR04CitA(ENTS !(IST EXCEPT AS
kill
1
�
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED 8UBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
•� • �� � �• rte.
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES OR FOR ESTABLISHING PWND-
•
�1 al• �
DRAWN,
�/lam ��//
f•
11101"ez
ASBUILT
1 HEREBY CERTIFY THAT I HAVE SURVEYED THE
SCALE''e.
FOLLOWING DESCRIBED PROPERTY,
v �sr,�..seer.r. 4
AND THAT NO ENCR04CitA(ENTS !(IST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
GRID
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED 8UBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
FB'
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES OR FOR ESTABLISHING PWND-
ARY LINES.
DRAWN,
.ftW"h••
IF
UVJ .' •tMMy�.7
po
•DVM. M.r4 {.on.J .
LS -6918
� �CyrtkXU1 Va".'r
I
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
OIL—
Parcel I.D. # 051 -043 -
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
HAA # �Qg,\ CS \ (/)
Complete legal description Knik View Estates S/D; Lot 5, Block 5,
Location (site address or directions) Knik Vista Street
Property ov,
.john Thomson
Day phone 240-2020/696-5070
Mailing address 17343 Santa Maria Drive Eagle River, AK 99577
Lending agency _ Day phone
Mailing address
Agent _ Day phone
Address
Unless oth6rwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well
Community well XXX
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
inF to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
j Individual on-site XXX
Holding tank
Community on-site
Public sewer
NOTE: If`community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev.1/91) Front MOAM21
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 of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of �Itructure 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 in compliance with all Municipal and State codes,
ordinances,'land regulations in effect on the date of this inspection.
Name of Finn ALASKA WYA,T�R & W ATT; Phone 5' 3 %-67�
Address _
Engineer's signature _
6. DHHS SIGNATURE
Approved for
Disapproved.
3�
0l/ bedrooms.
Conditional approval for
Additional
The Municipali
Approval Certii
professional en
and their lendin
conduct inspe(
responsible for
Date — 12 -
bedrooms,
bedrooms, with the following stipulations:
Date _7 - 13-21
Anchorage Department of Health and Human Services (DHHS) issues Health Authority
s based only upon the representations given in paragraph 5 above by an independent
r registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
:itutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
or analyze data before a certificate is issued. The Municipality of Anchorage is not
s or omissions in the professional engineer's work.
72-025 (Pe . 1/91) Back MOA x21
Municipality of Anchorage
JUL 0 2 1999
0* t:
DEPARTMENT OF HEALTH & HUMAN SERVZESPALITY OFANCHURAD
Environmental Services Division ENVIRONMEN7'ALSERVICES DIVIS
8215 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Legal Description:
A. WELL DATA
Well type Gras
Log present (Y/I�Q_
Total depth
Sanitary seal
Health Authority Approval Checklist
iI\1IeLd sl() Lo -r S Parcel I.D.: 0 L 3
pLOCK. S�
)+IN - If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
to
FROM WELL LOG
Date of test
Static water level
Well production g.p.m.
WATER SAMPLEiESULTS:
Coliform r� Nitrate
Date of sample:
Casing height (above ground)
Wires properly
Collected by:
AT INSPECTION
Other bacteria
g.p.m.
B. SEPTIC/';TANK DATA
Date installed L1l/-12 - 14 Tank size 1260 Number of Compartments 2-- Cleanouts ON) YES
Foundation cleanout &N) _ %des Depression (Y/IAS High water alarm (Yin � o
Date of Pumping. 11i 1 Pumper _
C. ABSORPTION FIELD DATA
Date installed `41' 12 -I'fi 99 _ Soil ratingg.p.d./ft or ft2/bdrm) 1 • 2 System type �%E,k--H
I I �
Length 50 _Width S Gravel thickness below pipe `'i Total depth (AQ&-)
Effective absorptio'j� area S° a 0 Monitoring Tube present (-VN) *9 Depression over field (Yo fjo_
Date of adequacy test t� BUJ Results (Pass/Fail) For Li bedrooms
Fluid depth in absgrption field before test (in.); Immediately after= gal. water added (in.):
Fluid depth (ins) Minutes later: `W Absorption rate = g.p,d.
Peroxide treatment (past 12 months) (Y/N) If yes, give date
i
72-026 (Rev. 3/96)1
II,
D. LIFT STATION
Date installed
Manhole/Access
High water alarm
R
_ Size in
level at*
*Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: CoNlmursTY
Septic/II tank on lot -Z 00 k On adjacent lots
Absorption field or lot 'Zoot •f- p adj cent lots
"Pump off" level at*
WF�L_
Public sewer main' Public sewer manhole/cleanout
Sewe service line Lift station
SEPARATION DISTANCES FROM SEPTIC/H1O TANK ON LOT TO:
Foundation Property line Iof Absorption field_ �) +
Water main/serviceline _I a 4 Surface water/drainage I oo I _ Wells on adjacent lots _
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
I t
Property line _';li1 o t Building foundation 10 t Water main/service line _
Surface water i� I dot f Driveway, parking/vehicle storage area
Curtain drain Wells on adjacent lots Z°oI1
F. ENGINEER'S CEI, TIFICATION
i P.A.'`�aoq sos
1 certify that I h e in ru f Id inspections and review of Municipal recon f1 b b
in conforman a wlt A guid lines in effect on this date.i;, ,
5� 'Gf <�.M3' CC •
Signature
Engineer's Na e'� V���` f yc
e
Date 7 7 107
HAA Fee $ N /
Date of Payment
Receipt Number 61)
72-026 (Rev. 3/96)* f
Waiver Fee $
Date of Payment
Receipt Number
260 {
to f
so1-t-
-79-53
