HomeMy WebLinkAboutKNIK VIEW BLK 3 LT 7Knik View Bi�ck 3 Lot 7 #051-031-55  Municipality of Anchorage o Development Services Department Building Safety Division ~ On-Site Water & Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 ~ www.ci.anchorage.ak.us (907) 343-7904 Page 1 of On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW00025,~ PID Number: 051--051--55 Nome: ROB WANNER WastewaterSystem: · New [] Upgrade Address: PO BOX 6265 *JBER, AK ABSORPTION FIELD Phone: No. of Bedrooms: (525) 829-5090 4 i-1 Deep Trench · ShQIIow Trench [] Bed [] Mound [] Other LEGAL DESCRIPTION ,Sol, Rating: Total Depth f .... dginal grade: '1.2 GPD/Sg. rt. SEE DWG. Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: 3 7 KNIK VIEW SEE DWG. Ft. **'0.83/1.12 Township: _ Range: _ Section: Fill added above original grade: Gravel length: SEE DWG. rt. *(2@44)=88 Pt Gravel width: Number of lines: Distanc~ between lines: WELL: [] New [] Upgroae *5 Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: PRIVATE 120 rt. 120 rt. ***505+ so. rt. D 5034/ F-810 Driller: Date Drilled: Static Water Level: Installer: Date installed: SULLIVAN WATER WELLS 5/16/04 24 rt. UNKNOWN POST 6/50/00 Yield: [Pump Set At: Casing Height Above Ground: 24 GpuI UNK rt. 2 rt. TANK SEPARATION DISTANCES ** Sept c [],o,d ng [] S.T.E.P. []Other TFrom~ Septic Absorption Lift Holding Public/Private Manufact .... Capacity in Tank Field Station Tank Sewer Lines UNKNOWN ga"°*">~"* 1 250 Well 100'+ 100'+ -- -- 25'+ Material: **STEEL Number of compartments: 2 Surface Water; 100'+ 100'+ - - - LIFT STATION Lot Line 5'+ 1 0'+ _ _ _ Size in gallons: J Manufacturer:. I Foundation 5'+ 10'-J- _ _ _ "Pump on" level at: "Pump ~er alarm at: Curtain Drain ' NONE KNOWN ~ ~icol inspections performed by: I I Remarks:*ALL MEASUREMENTS ARE BASED UPON SAS DESIGN BENCH MARK Location and Description: **SAS DESIGN CALLED FOR A 1300 GALLON PREMIER TANK. BOTTOM OF SIDING AT POINT A PER GEG INSPECTION TANK APPEARS TO BE A 1250 GALLON STEEL TANK. ***ASSUMED PER GEG INSPECTION. Assumed Elevation: ~ 00.00 rt. ENGINEER'5 ~EAL Inspections performed by: OEO, Ltd. Dates: 1st 8/24/11 Development Services Department Approval ~.;""~4~-T~ 'j/~.~ "-.?~ Reviewed and approved by: (Rev. 't/06) PERMIT NUMBER: AS-BUILT DRAWING PARCEL ID NUMBER: 051 -031 -55 100' WELL RADIUS C04 C02 MT2 I EXISTING ~ EXISTING DRAINFIELD ~ MT1 01 ' DBL2 DBL1 FLOW SPLITTER WAS NOT PRESENT, ASSUMED TO BE INSTALLED PER S&S EXISTING 1250 ST1 GALLON SEPTIC TANK. EXISTING 4 BEDROOM HOUSE. A B FCO 2.95 25.49 ST1 8.42 27.73 ST2 16.48 ,.32.59 DBL1 2,3.42 ,37.25 DBL2 26.06 39.26 C01 32.57 50.21 MT1 32.95 51.65 C02 76.,33 87.59 MT2 76.02 87.98 C03 33.33 40.35 , MT3 34.12 39.55 C04 76.09 82.21 MT4 76.20 81.48 GARN ESS ENG IiN'E'EiR ING GiR. O.U P, Ltd. GOIMS~LTAN~T$ & GENEF~AL CONITRAGTORS E. IUDOR ROAD, SUITE: 101 * ANCHORAGE, AK 99507 * PHONE (907)337-6179 ' FAX {907)338-3246 * WE~ffE: www.cJamesa~ngln~erlng.com PREPARED FOR: I PHONE NUMBER: ROB WANNER ~1 325-829-5090 LEGAL DESCRIPTION: KNIK VIEW; BLOCK 3, LOT 7 TYPE OF WORK: AS-BUILT DRAWING (Rev. 01/05) PAGE NUMBER: 2 OF3 IDRAWN BY: DATE: PNB 8/26/11 A. 6omess- PE~MITNUMBER: AS BUILT DRAWING PARCEL ID NUMBER: SW000255 - 051-0,.31 -55 *BASED UPON BOTTOM OF TANK SHOTS BY GEG. GEG FIELD INSPECTION & MEASUREMENTS WERE AN ATTEMPT TO DOCUMENT THE SEPTIC SYSTEM DESIGNED AND INSPECTED BY SAS ENGINEERING (BOB SCHAFFER, P.E.). ALL MEASUREMENTS ARE APPROXIMATE & MANY ASSUMPTIONS ARE MADE. MR. SCHAFFER IS NOW DECEASED AND DOCUMENTS OF THE SYSTEM HAD NEVER BEEN SUBMITTED TO THE MOA. THE MOA HAS ACKOWLEDGED S&S HAD CALLED IN FOR INSPECTIONS DURING THE INSTALLATION OF THE SEPTIC SYSTEM. ASSUMED INSULATION--~ /--FINAL GRADE = 100.20+ --\ ST1 / ST2 TOP OF TANK -~ ~ ~ I ~ /-- TOP OF TANK AT INLET = 98.20 ~ ~ [- ~ ~ / AT OUTL~ = 98.25 ~MED 1250 GALLO~ *INVERT OF BUNGJ I I SEPTIC TANK I I ~INVERT OF BUNG IWEST TRENCH *GEG FIELD I ~S~ ~,~,C.] ,~,,,,,~S. I--s' · " - oTToM OF TRENC, = .9s.73 I' I 10'- t co f-FINAL GRADE = *99.27 I~ //_ ASSU M ED iNSU LATiORN FABRic '"",-~NVERT OF PIPE = *96.72 5'~ ~BOTTOM OF TRENCH = *95.89 NO ORIGINAL GRADE SHOTS ARE AVAILABLE TO GEG. TESTHOLE WAS 15 FEET DEEP WITH GROUNDWATER @ 7.2 FEET ON 10/9/98. S&S DESIGN CALLED FOR 3 FOOT MAX EXCAVATION. GARN'ESS ENGINEERING GROUP, Ltd.. CONSULTANTS. & GENERAL CONTFLACTORS 3701 E. TUDOR ROAD, SUIT~ 101 * ANCHORAGE. AK 99507 * PHONE (907),337-6179 * FAX (907)338-324~ * WE~SlTE: www.gamessengineedng.com PREPARED FOR: PHONE NUMBER: I PAGE NUMBER: ROB WANNER 325-829-5090 I 3 OF 3 LEGAL DESCRIPTION: IDRAWN BY: KNIK VIEW; BLOCK 3, LOT 7 IDATE: PNB TYPE OF WORK: I 8/26/11 PROFILE AS-BUILT DRAWING A. Gorr{ess.. ( erti[iei ri[[ing Kog by DOC CO. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2750 OWNER OF LAND: ,,,; , ,..,,,~; ,?~ ....BORE HOLE DATA DEPTH \DDRESS: From To _EGAL DESCRIPTION: ~.'~.,,.~:; /~ PATE: r~ IDENTIFICATION NUMBER: s well I~ated at approv~ ~it location? Q,.~' ;~ No ~eth~ of Drilling: .Q,ai~ ~0ta~ J cable t~l )epth of well: ,?;:: ~ ¢ ,~ ,:'...:~ ,,;.., Wall ~ickness 3iameter :;~? inch., depth 2::;?:( f~t ,iner Type: ';%) ";) Casing Stickup Above Ground: ,:;;::; feet Static Wat~ Level: d ~;~,;;::~ ,,.,:;, .:,;~ , :;,,, ,:~? ,~,,~',:;~"~;'~ f~t R~over Rate:. gpm Meth¢ of Testing: Well Intake Opening Type: ~0~n end ~ open hole :2 Scr~n~; St~ f~t Stop~d feet :2 Pedorations Stad Jeer,, Stop~ feet ::-~:" ;;" feet Depth: from + ....... f~t. to Well Disinf~t¢ Upon Completion? Meth~ of Disinfection: C ~,;:/.'~.~,,,,,,,.:,,," Comments: Driller's Name ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of'Environmental Conservation. MatSu Borough: Department of Environmental Conservation. SEWER&WATER MAIN EX I El~lOlxe3 ,SEWI:R &WA1Efl I~SPECIION EIqOIHEEIllta3 Sl UDtES Ha:) rJEPOItT $ WELL INSPECTION &FLOWtES! SI I E PLA~IO SOILTES! IESt L,~c~c/~ IIISPECTIOtJS C~ISUE WASTEWAI Erl DISPC~AL SYSIEL4 t~SlO~J ROBERt C. COWAN, P.E. ROBERT A. SItAFER, P.E. Date: CIVIL ENGINEERS (go?) 694-2979 FAx(go?) 694-12t t Munictpali%y of Anchorage DEPARTMENT OF IIEALTII AND ItUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage~ Alaska 99519-6650 REFERENCE .' The septic inspections for the rgferenced property were performed on [~i-0~ and ~-Jq-O~ · Prior to submitting {he On-site Wast~wat.e,r 'Disposal System 'and/_p.r Well Inspection Report we are wa~tlng for the ~$-~'~S~fV~ to be completed. If we may be of furbher service, please contact us. Sincerely, Robert C~ Cowan, P.E. ' I' 7034 NORTIt EAGLE RIVER L6OP & SUHE 204; EAGLE RIVER. ALASKA 9957 MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Renewal Date Issued: Jul 24, 2001 Expiration Date: Jul 24, 2002 Permit Number; SW010260 Legal Description: KNIKVIEW BLK 3 LT Design Engineer: 0003 S & S Engineering Owner Name: Ted Schmelzer Owner Address: 12032 South Tomi Dr. Phoenix, AZ 85044- Parcel ID: 051-031-55 Site Address: Lot Size: 51380 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [~ Disposal Field r~ septic Tank [~] Holding Tank [] Privy [-~ Private Well r--] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: ~~ ~ Date:'~ ~ ?'''c/-'0 ( Issued By: Date:. 7 '- ~'~ -I~/ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw~St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0 ~'1 -031 Permit Number SWO! Property owner(s) Mailing address (1) :!t::;~: ~ ~ ;~'-'-':: ...,Co g 7- H Mailing address (2) Legal description (Lot, Block & Sub'd.) 'LO 7' Day phone -i-o,'~ I O,~ ,v ~ / P/Jo ,~,,:, x~ , ~) 7_ Zip Code ~3-o 't ~ "7 BL~(.~ 3 ;~,,~ v,,~ ~' S/z) Legal description (Section, Township & Range) Lot Size S- t , .'.3 3'0 Acr~s~ Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only r'-I Well Only I--I Sewer and Well ~ Water Storage [] Sewer Upgrade ~--] THIS PROPERTY CONTAINS: Hot Tub D Jacuzzi [] Swimming Pool [] Water softening Unit [] Therapy Pool E] I certify that the above information is correct. I fudher certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. S & S ENGINEERING (Signature of property owner or authorized agent) Permit Fees: Waiver Fees: Date of Payment: Receipt Number: (Rev. 12/00) Date of Payment: Receipt Number: 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 I WATER SUPPLY PERMIT Initial Date Issued: Jul 24, 2000 Expiration Date: Jul 24, 2001 Permit Number; SW000253 Legal Description:~ KNIKVIEW BLK 3 LT 7 Design Engineer: 0003 S & S Engineering Owner Name: Ted Schmelzer Owner Address: 12032 South Tomi Dr. Phoenix, AZ 85044- Parcel ID: 051-031-55 Site Address: Lot Size: 51380 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: r~ Disposal Field ['~ Septic Tank [] Holding Tank E~ Privy ~-~ Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. Ail 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 (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day, B. Covered, sealed, and heated to prevent freezing. Received By: Date: "~'"'7---~f~---- ~:~ ROBERT C. COWAN, P.E. June 30, 2000 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 SEWER&WATER MA~N EXTENSIONS SEWER &WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION. & FLOW TEST SITE PLANS SOIL TEST PEROOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE'WATER DISPOSAL. SYSTEM I~glGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 7, Block 3, Knik View S/D It is requested that you issue a permit to install a well and a septic system to serve the proposed four bedroom dwelling on the referenced property. A test hole was excavated and a percolation test was performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation 7/20/95 water was not found. After seven days of monitoring, water was found at 7.2 feet. We do not anticipate .any adverse effects on neighboring wells, septic ~ystems, reserve areas or drainage pattems by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional informatiOn, please contact us. Sincerely, Robert C. Cowan, P.E. RCC jj Enclosure 17034 NORTH EAGLE RIVER LOOP . SUffE 204 · EAGLE RIVER. ALASKA 99577 PERFORMED FOR: Municipality gl Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 16 17 18 19 2O COMMENTS SLOPE SITE PLAN WAS GROUND WATER ~'1 ENCOUNTERED? t IF YES, AT WHAT DEPTH? / Depth to Waler Aiter ~ f Monitoring? Date: -I N Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~zp FT AND S & S ENGINEERING PERFORMED BY: _ _ , ~', .... , ... I~,R I~L ~1~4~. ~, ~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WI~H AL~~~~IDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ROBERT C. COWAN, P.E. Cl~qL ENGINEERS HEN.TH ALffHORffY APPROVALS SEWER &WATER MNN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUOIES AND REPORTS WELL INSPECTION & FLOW TEST SnE~ RoAD DESIGN soILTEST ~ERCOL~TION TEST lUECt~NICN. INSPECTIONS (907) S94-2979 FAX (907) 694-121 t ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 7, Block 3, Knik View S/D June 30, 2000 GENERAL: The scope of this project includes the installation of a 1300 gallon Premier polyethylene septic tank and ~ drainfield trench~to serve the proposed four bedroom residence located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas Subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 17034 NORTH EAGLE RIVER LOOP ~ SUITE 206 ~ EAGLE RIVER, ALASKA 99577 .Page 2 Lot7, Block 3, Knlk View S/D June 30,2000 '6. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/D~NFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion ofthe monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. .Page 3 Lot7, Block 3, Knik View 5/D June 30,2000 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the//200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of thc wastewatcr disposal system. These inspections will occur as follows: ~P,~ge 4 Lot 7, Blocl; 3, I;ni~( View S/D June 30, 2000 The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of constmetion. If necessary, a pre- construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual an'angement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINOLE FAMILY DWELLING Parcel I.D. 051-051-55 1. GENERAL INFORMATION COSA# O Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency KNIK VIEW; BLOCK 5, LOT 7 22144 BIRCH CREEK *CHUGIAK, AK 99567 ROB WANNER PO BOX 6265 JBER, ANCHORAGE, AK Day phone 525-829-5090 Day phone Mailing address Real Estate Agent Mailing address Unless otherwis~ requested, COSA will be het NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well · Individual Water Storage [] Community Class .Well [] Public Water System [] The Municipality of Anchorage Development Servi Approval (COSA) based only upon the representa engineer registered in the State of Alaska. Certifk of title (except between spouses) for properties se water supply system. DSD also issues COSAs up Approval are valid for 90 days from the date of iss Day phone dby DSD ~rp~kup. 4 TYPE OF WASTEWATER DISPOSAL: Individual On-site · Individual Holding tank [] Community On-site [] Public Sewer [] 3es Department (DSD) Issues Certificates of On-Site Systems :ions given in paragraph 4 by an independent professional civil :ates of On-Site Systems Approval are required for the transfer rved by a single-family on-site wastewater disposal and/or on request to homeowners. Certificates of On-Site Systems Je for properties served by a private or Class C well and may be reissued with new water samples. (Certificate.¢ may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for pn)perties 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 Municipafity 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. Phone 337-6179 Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the 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 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. DSD SIGNATURE ~'/""Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: ON-SITE ATER AND WASTEWATER PROGRAM · .. .... Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ~ ~ c'~ ~_ / / Municipality of Anchorage Deve!opment Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road 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; BLOCK 5, LOT 7 Parcel ID: 051-031-55 A. WELL DATA *APPEARS TO HAVE A "PACKER" IN THE WELL HEAD Well type PRIVATE Date completed 10/2/01 Total depth 61 ft. IfA, B, orC provide PWSID# N/A Sanitary seal (Y/N) YES Cased to 61 ft. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 24+ in. Date of test Static water level FROM WELL LOGIC 10/2//ot GROUND LEVEL ft. ATINSPECTION 8/24/11 *UNK Well production WATER SAMPLE RESULTS: 2O g.p.m. 5.8 g.p.m. Coliform 0 colonies/lO0 mi. Nitrate ND mgJL Arsenic: 6.8 ug./L. Date of sample: 8/25/11 Collected by: GEG, Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material ***SEPTIC/STEEL Tank size 1250 gal. Numberof Compartments 2 Foundation cleanout (Y/N) YES Date of pumping ABSORPTION FIELD DATA Date installed AFTER 6/30/00 Length **44/**4-4 ff. Total depth*5.45+/5.54+ ff. Depression over tank (Y/N) NO Pumper ~'F '-,~ ~/~ r'~ }/'~~RE I'BELOW EXISTING GRADEI EAS NCH/WEST Date installed AFTER 6/50/00 Cleanouts (Y/N) YES High water alarm (Y/N) N/A TRENCH Soil rating (g.p.d./ft~or~**l.2 System type DUAL TRENCHES Width **5 ft. Gravel below pipe *'1/*'1 ft. Eft. absorption area**505 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 8/24-/11 Results (Pass/Fail) PASS For 4- bedrooms Fluid depth in absorption field before test 0/5 in. Water added 4-12/4-59 gal. New depth 0.5/5.5 in. Elapsed Time: 0/885 min. Final fluid depth 0/2.25 in. Absorption rate >= 600+ .g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date **PER S&S DESIGN 6/50/00 ***S&S DESIGN CALLED FOR A 1500 GALLON PREMIER TANK. PER GEG INSPECTION THE SEPTIC TANK APPEARS TO BE A 1250 GALLON STEEL TANK. D. LIFT STATION Date installed "Pump on" level at__ Datum ~ E. in. Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons Manhole/Access ~ ~ "Pump off" level_a~nT~---. High water alarm level at Meets alarm & circuit requirements? Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/^ Sewer/septic service line 25'+ Animal containment areas 50'+ 100'+ in. On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5' + Property line 5' + Water main N/A Water service line 10'+ Absorption field 5' + Surface water. 100' + Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10' + Building foundation. 10' + Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ Water main N/A Driveway, parking/vehicle storage 10'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number SGS Reft# 1114075001 Client Name Garness Engineering Group, Ltd Printed Date/Time 08/31/2011 16:48 Project Name/# Knik View, B3, L7 Collected Date/Time 08/25/2011 8:01 Client Sample ID Knik View, B3, L7 Received Date/Time 08/25/2011 14:19 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: 4500NO3-F - Total Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to LCS for accuracy requirements. Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic 6.80 5.00 ug/L EP200.8 C (<10) 08/25/11 08/30/11 NRB Waters Department Total Nitrate/Nitrite-N ND 0.100 mg/L SM20 4500NO3-F B (<10) 08/25/11 AYC Microbiology Laboratory E. Coli Negative I 100mL SM20 9223B A 08/25/11 DLC Total Coliform Negative 1 100mL SM20 9223B A 08/25/11 DLC 688-25; ~ C or 258, :25 $ 0 745~251 © apw ~a~ 9ci, net [)isirib~lo r ~9577 Please pay by ~n~oice.: Ail account Past Due will be charged 825 second biliin9 char:ge t~HANK YOM