HomeMy WebLinkAboutKNIK VIEW BLK 3 LT 5Knik View
Block 3
Lot 5
#051-031-53
Mtl►ticlpalily of Anchorage Page t of
bLP`AhTMMt Or HEALTH ANb HUMAN SLRVICES
ENVln0NMr=NTAL SEIIVICES DIVISION
P.O. box 0665d s Anohtltage, Alaska 09519-6650 4 telephone: 343-4744
bh-Sllti WasteWalet blspdaal $j►stehi and/ot Well Inspection Report
Penult Numbet: j✓W o0o a5 q Pib Number: 0_571-031—S3
Name: -red
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Wastewater System: N New O Upgrade
Addr SsAUCq LjA 9Qg3`7
ABSORPTION FIELD
a e
Phone: LA $��
(J a 6 � � g
No. of Bedrooms:
❑ beep trench ,IA Shallow Trench ❑Bed ❑Mound O Other
LEGAL bEtthlPtION
soil Bating I
total Depth from original grade:la
a eL GPD/Sq FI
Lot: Block: Subdivision: `
a V
Depth to pipe botlom from original grade:
Gravel depth beneath pipe
0
r CaaJ
• FI.
a/e FI.
Township:
Range:
Section:
Fill added above original grade:+
a
Gravel length:
loo
FI
FI.
WELL! UNek (]Upgrade
Gravel width: s^
sJ
Number of lines: Distance betwwo Rees
F1
FI.
Claaslllcetlon IPrlvale. A,B.CI:
P� r vete
Total Depth;
3 Ft.
Cased To:
tl.
Total absorption avec M
5COSG. Ft.
PI
a malerblr �
M 03D3 81(0
Duller•.
5ti rvn
Dale Drilled:
S 3-Cri
slalic wale, Level:
-f Ft.
Installer:
so'a -A Ford
Date brslsiled:
- —00
Yield;.pump
j cbtA
Sqqt at: Casing /kight Above Ground'
Unknewrl tL 3 kI.
TAN
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SEPANAT10N
b15TANCES
aSeptic 0Holding 0S.T.E.P.
To
From
Smile
tank
Ab"poon
FLIs
Lle
Station
Tank
MeldhrgM..
Manufacturer.
�lC/j �l a
Capacity In gallons: ,a
1300
Well
1 ao`
lis,
1 301
^—
Material; H 0 P /
(I GLIFT
Number of Compartments:
Water
100+
100+
14c+
STATION
Lot
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7
Size InRnOnns: Manufacturer:Line
1 reSt;oundAlion
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Electrical Inspections by:
N/ 0 E1.ECTAPIC
hematks:
BENCH MARK
Location and Description: .r+ G
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Assumed Elevation:
00 Ft
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17034 Eagle River Loop Roed, No.
Insp6bt1on§ pettotMed by:E bates: is} $ I°I-OD
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n 0oal v2S-00
II pt^ \ ROBERT C. COWAN �2
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10'\TELECOM & ELECTRIC
EASEMENT _______
_ _ _ _ _ _ _ _ _ _ _ _ _.
4SEMENT
KNIK VISTA DRIVE
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PERMIT NO. SW000254 PACE 3 OF 3
Municipalityof Anchorage
DEPARTMENT OF HEATH 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 LOT 5, BLOCK 3, KNIK VIEW S/D P.I.D. NO. 051-031-53
FINAL GRADE
S ST2 C01
TOP 2'
98.2,
INSULATED
2" INSULATION
ttTtutNT OUTLET
NEW
96.5'
1300 GALLON
POLYETHYLENE
SEPTIC TANK
I
9 6.2'
MT1 MT2
MT2 = 99.5'
MT1 = 99.0'
FINAL GRADE
A B
2" INSULATION
FCO 6.5 22.0
ST1 11.0 24.5
ST2 14.0 26.0
96.7'
DISTRIBUTION PIPE
C01 16.5 27.5
SR
MH 18.529.5
MT1 47.5 51.6
MT2 11 5.0 89.5
MT1 = 96.2
MT2 = 96.2'
N. T. S.
PRESSURE DISTRIBUTION SYSTEM:
........... EsT�?.
PUMP = BLASTER 20EBOS
C` ,„ `ice a
1 LATERALS — 100' LONG
i ! 1•
25 HOLES (46" O.C.)
th ;
'" "'•'•"'«"
3{16"fe HOLES FACED DOWN
,•«
� r+
1 0 LATERAL
.
/ « ••22
WATER FOUND ® 92.2'
p PBERT C. COWAN
ti� ���� JCE
86.2' B.O.H.
e401 4
Night Electric
Date:=3/01
To whom it may concern,
Ile septic system wiring for the house [ocatedat Lot SBlock 3-Knik View was installed and complged by
Night Owl Eloctric{licensed bonded,and insured}
sincerily,
Troy Houston,
Owner of Night l7wt Electric
License Number AA21252
P.O. BOX 770755 • EAGLE RIVER, ALASKA 99577 • (907) 688-1594
Diane or Bill Sullivan 907-688-2259
CzlErfiriva Pri C C1 X1409
by
"a" db.
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 89567 • TELEPHONE 688-27S9
OWNER OF LAND `r&a SC-4iWF4 2!*'L
ADDRESS
LEGAL DESCRIPTION
Zat S,
PERMIT NUMBER Date of Issue ,Q
TAX INDENTIFICATION NUMBER OSI - 0 31 - ,g-,
Is well located at approved permit location? es Q No
Method of Drilling: 64 r rotary Q cable tool
Depth of well: 7A
CasingType,Cr§&, Wall Thickness • .,?1 Z inches
Diameter 611 inches, depth 7,a. feet
Liner Type: Al,Wt;
Casing Stickup Above Ground: feet
Static Water Level (from ground level): 3 feet
Pumping level: feet after hrs. pumping wpm
Recover Rate: . pm
Method of Testing: J41 Z
Well Intake Opening Type: 43pen End Q Open Hole
Q Screened; Start feet Stopped feet
Q Perforations Start f�ee//et Stopped feet
Grout Type: AGckJ7'="t1`_�/r�lumme %Si1 t(2S
Depth: from V jeet. to �� feet
Pump Intake Depth: feet
Pump Size hp Brand Name
Well Disinfected Upon Completion? gages Q No
Method of Disinfection: d4t R..Ji G% M21-
Comme ts:
F) 3/.2Q4r(J
E HOLE DATA
DEPTH
P.1
O J E•e SJ 04
SiAnjo I" 644Jre-
J
� ��13fr7��3r�-
Siti i ✓ 40-4
l,� r4Tex�
Drillers Name 19A -I,
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.
HEALTHAUTHORITY
APPROVALS
SEWER&WATER
WVNERTENSIOM
SEWERS WATER
INSPECTION
ENGINEERNGSTUDIES
ANDREPORTS
WELLNSPECTION
S FLOW TEST
SITE PIANS
ROAD DESIGN
SOS TEST
PERCOLATION
TEST
STRUCTIXVLS
AECIWACAL
INSPECTIONS
S&S\
pneexing
ROBERT C. COWAN. P.E.
ROBERTA. SHAFER, P.E.
CML ENGINEERS
(907) 694-2979
g_ `� (/ .-OQ FAX (907) 694-1211
Date: '�C 7
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: LatS, P I�f� 3. (x/71 K VI -1
The septic inspections for the referenced property were
performed on _-0-00 and Prior to submitting
the On-site Wastewater Disposal System and/or Well Inspection
Report we are waiting for the AS-6ui11L 5VL" to be
completed.
If we may be of further service please contact us.
Sincerely,
Robert C. Cowan, P.E. '
0
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER ALASKA 99577
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 / WATER SUPPLY PERMIT
Initial
Permit Number: SW000254
Legal Description: KNIK VIEW BLK 3 LT 5
Lrlo�.ccti �,
bop opn"
Date Issued: Jul 24, 2000
Expiration Date: Jul 24, 2001
Parcel ID: 051-031-53
Design Engineer: 0003 S & S Engineering Site Address:
Owner Name: Ted Schmelzer Lot Size: 49400 SQ. FT.
Owner Address: PO Box 999 Total Bedrooms: 4 Permit Bedrooms: 4
Naches , WA 98937 -
This permit is for the construction of:
❑,/ Disposal Field n✓ Septic Tank El Holding Tank ❑ Privy Z✓ Private Well ❑ Water Storage
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
(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
Issued
Date: fl
Date: 7— 24-1!10
S&
1EALTHAURIIOP7V
APPROVALS
SEWER&WATER
M&NOMNSIONS
SEWER& WATER
INSPECTION
ENG. NEERNGSTLAIES
ANOREPORTS
wELLNSPECNON
& FLOW TEST
SITE PANS
ROAD DESIGN
SGNLTEST
PERCOLATION
TEST
STRUCTMALA
MECHANIC&
INSPECTIONS
ON SITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
ROBERT C. COWAN, P.E.
CML ENGINEERS
(907)694.2979
FAX(907)694-1211
June 29, 2000
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AY, 99519
REFERENCE: Lot 5, 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 . monitoring, water was found at 5.0 feet.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns 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,
V&24,
Robert C. Cowan, P.E.
RCC/bjj
Enclosure
17034 NORTH EAGLE RIVER LOOP + SUITE 204 c EAGLE RIVER ALASKA 99577
m
LOT 5, BLOCK 3, KNIK VIEW S
B.J.J
Pring DE S'
4 BDRM
SOILS =
600/ 1.2
74 EAGLE RI VCR LOOP ROAD I
GLE RIVER, ALASKA 99577
•HONE/ (907)694-2979
FAX/ (907)694-1311
DRAINF 4.LD CR
1.0' DEEP
0.5' EFFECTIV (R - 1.0)
5.0' WIDE
100' LONG
R.C.C.
CRITERIA: LOT 2
600 GPD
2 GPD/SQ.FT. �UNDI
500 SQ.FT. REQ'D.
6-29-00 1 1 OF 2
CONTRACTOR IS REQUIRED
OBTAIN UTILITY LOCATES
PRIOR TO ANY EXCAVATIOI
WORK.
LOPED LOT 1
ATH'6 LOT 6
UNDEVELOPED
ATH j7A
EASEMENt
Qp00�0JS�
• NOTE: IF THE SEWER LINE ELEVATION
1-1
THROUGH THE FOUNDATION IS HIGH ENOUGH,
WZ
A LIFT STATION MAY NOT BE REQUIRED.
�I
RIA.
IW
J
\
Ih
PROPOSED 1500 GALLON
.4
POLYETHYLENE SEPTIC TANK
W�
rINSTALL ECD
Ul
PROPOSED PVWI BASIN
/
~I
U
. 5 O
WI
ATH'6 LOT 6
UNDEVELOPED
ATH j7A
EASEMENt
Qp00�0JS�
� �
^I I K
F
IW
IW
J
\
Ih
ROBERT G COWAN
cr CE -8801
W I
Q I
I
F
't� OFA CILr RIA •L�,�
LOT 7 E� �`G SIV E •
>x
UNDEVELOPED �yCC,g, Q
I
UNDQEV, --PED LO
' /1
ALL PORTIONS OF SYSTEM
WITH LESS THAN OS' OF
COVER REQUIRE INSULATION.
Q
ME EW+fr9 w. vuN M
[utt O.rwS�R•S u9IXYA
r.w•rrt.s + NK nR. r
NrnssNN, ro 1KU srt
ro.aros
5. BLOC
B.J.J. I R.C.C.
ng DESIGN CRITERIA:
4 BDRM = 600 GPD
SOILS = 1.2 GPD/SQ.FT.
600/1.2 = 500 SQ.FT. REQ'D.
17034 EAGLE RIVER LOOP
DRAINFIELD CRITERIA:
1.0' DEEP
0.5' EFFECTIVE (R = 1.0)
5.0' WIDE
100' LONG
INSULATION--,,
Z MT
0
N
Ed FINAL GRADE
0
2" INSULATION
w -T 1.0' DEPTH
SE
0.5' EFFECTIVE R CKR
O
(L j
a jh~5'�
All. PORTIONS OF SYSTEM
WITH LESS THAN 3 S' OF
COVER REQUIRE INSULATION.
FINAL GRADE
1300 GALLON
POLYETHYLENE
SEPTIC TANK
1' LATERAL
DISTRIBUTION
PIPE
',MIN.
I- COVER
IK VIEW S D
OAiE:
6-29-00
2 OF 2
CONTRACTOR IS REOUIRED TO
OBTAIN UTILITY LOCATES
PRIOR TO ANY EXCAVATION
WORK.
PUMP BASIN ASSEMBLY — 30- DIAMETER
NOTE: BLAMER UNIT TO BE INSTALLED IN HEATED
AREA/CRAWL SPACE OR GARAGE.
BLOWER SWITCH TO BE INSTALIED ON
OUTSIDE OF HOUSE.
0 T 1-M
DEN
SCM b M TEES
SDN 40 PVC
4. 0
ORIGINAL
GRADE
r
1-1/4• CNE" VALVE
-1/4• ilii
DISCHARGE ASSEMOL
�1-1/4• "" V1 w
—� urWENT WHET
NOIE
11
FLOAT TREE
(AWN, W. "r)
MM SET ON ort no4T TO l oN ". u 1 t
a E to UNU • 14 M .lul 11 4..L / rVr I=t
DISTRIBUTION SYSTEM:
1 LATERAL* 100' LONG
25 HOLES (46" O.C.)
3/16" DIA. HOLES FACED AOL+•EI✓
V DIAMETER LATERAL
Af` ROBERT C. COWAN
C t CE -8801
M lwNrr4 w. v.Rv 1K
!u[r M.r54.5 xq OlLfil
r.+n-rrta3 w M w[tD.
rtcrssun. 10 aln art
DQp1pq.
CA
PERF,
LEGA
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
TEST RUN BETWEEN FT AND FT
COMMENTS
17034 Eagle River Loap Road No. 204 CER7IFY THAT THI TEST WAS PERFORMED IN
PERFORMED BY: I ���
e rer, Alask a
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON HIS DATE. DATE: 1%
72008 (Rev. 4/85)
PERFO
LEGAL
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
TEST RUN BETWEEN ms's FTAND W'S FT
COMMENTS ?•� #�
PERFORMED BY: S R S ENGINEERING j Ns Me �� a p
�L
CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH /Qly�d. HV4XNb?*dMS9XMUIDELINES IN EFFECT ON THIS DATE. DATE: 6A -96'
724)08 (Rev. 4185)
S&
FEALTHALRIORIN
APPROVALS
SEWERS WATER
LWN E CTENSIM
SEWER& WATER
NSPECRON
ENGINEETro13STDDIES
ANOREPORTS
wELL asPECTTON
&FLOWTEST
SITE FL.MIS
ROADDESIGN
SM TEST
PERCOLATION
TEST
STROCRIIUL&
MEcHnam
NSPECTIONS
ONSITE
WASTEWATER
OISPOSALSYSTEKA
DESIGN
ROBERT C. COWAN P.E.
CML ENGINEERS
(907)694-2979
FAX(907)694-1211
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Lot 5, Block 3, Knik View S/D
June 29, 2000
GENERAL:
1. The scope of this project includes the installation of a 1300 gallon Premier
polyethylene septic tank, a pump basin, and a pressurized five foot wide
drainfield to serve the proposed four bedroom residence located on the
referenced property.
2. 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.
3. The contractor shall be responsible for obtaining any necessary
underground utility locates.
4. Unless specifically agreed otherwise, the property owner shall be
responsible for final grading areas subsequently depressed from soil
settling.
5. 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:
1. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
2. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577
Page 2
Lot 5, Bock 3, Knik View S/D
June 29, 2000
3. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
4. Septic tanks installed with less than 4 ft. of cover shall be insulated.
5. A foundation cleanout shall be installed one to four feet from the building foundation.
6. Final grading over the septic tank shall be such that a positive slope exists away from
the septic tank.
ABSORPTION TRENCH/DRAINFIELD 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.
2. Once the gravel is installed, the distribution pipe is to be installed level with the holes
faced downward. The distribution piping is to be of PVC (ASTM D3034 or equal).
All joints are to be solvent cemented. Gravel is then to be placed over the distribution
pipe to provide a minimum of 2 inches of cover over the pipe.
3. A silt barrier must be installed between the final gravel layer and the native soil
backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill.
4. 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 of the monitoring tube extending through the gravel shall be perforated
from the bottom of the trench to the invert of the distribution pipe. This is equivalent
to the effective depth of the gravel as noted on the design.
5. Backfill over the final gravel layer must not be less than twenty-four (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.
MINIMUM MATERIAL SPECIFICATIONS:
Pape 3
Lot 5. Block 3. Knik View SID
June 29, 2000
1. Any septic tank proposed for installation must be constructed by a Municipally
approved septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
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.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco,
or equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi MON, or equal) must be
installed between the final leachfield gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
7. 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 specifications applies.
Papa
Lot 5, Block 3, Knik View SID
June 29, 2000
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of
the wastewater disposal system. These inspections will occur as follows:
1. The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may
be set in place, but may not be backfilled before this inspection.
2. The second inspection must be conducted after the placement of the 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 construction. If necessary, a
pre -construction meeting will take place on-site. The inspecting engineer will not coordinate,
direct or control in any way the 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 arrangement 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
•
• 61 8 9 /0 77 8,,
8,,Municipality of Anchors i °
On-Site Water and Wastewater Progra f '' %' • LA
(907) 343-7904E T Y
E Si.? 0 5 'Z0113
E
Certificate of On-Site Systems Apr:••val �w
051-031-53 01 6 a � pec 11) .1010
1, n 018
Parcel I.D. Expiration Da'-.
1. GENERAL INFORMATION
Complete legal description Knik View Block 3 Lot 5
Location (site address) 22230 Birch Creek Dr
Current Property owner(s) Elizabeth Arend Day phone
Mailing address P.O. Box 672101 , Chugiak, AK 99567
Real Estate Agent Kevin Sigafoos Day phone (907) 244-3212
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well LI Individual 0
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by:ilAtittetaiWIPPe Date: RI,I/10
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 5a to Waiver Fee $
Date of Payment (MO MD I(8 Date of Payment
Receipt Number 0336;-,D Receipt Number
COSA# & C1?t(-465 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 Forge Engineering Phone (907) 522-7773
Address PO Box 240773 Anchorage, AK 99524
Engineer's Printed Name Benjamin Schiller, PE Date 9/04/18
OF Att,,g`kk
4 • t4
44
• TM /\
6. DSD SIGNATURE o*-49 .* /m
v/
System #1 Approved for bedrooms ""' f.
Y pp Benjan r}Schiller .
•
System#2 Approved for bedrooms �� %r 9/4/1892,. '����/
�,i '®agod
Disapproved ��
co-
Conditional approval for bedrooms, with the following stipulations:
,`, PCO
O � e,F), S.
�� PN
By: ' / i - Original Certificate Date: /
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 blue sheet j •• '. c
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 3 Lot 5 Parcel ID: 051-031-53
A. WELL DATA
Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y
Date completed 8/3/00 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 73 ft. Cased to 72 ft. Casing height(above ground) 18 in.
FROM WELL LOG AT INSPECTION
Date of test 8/3/00 8/28/18
Static water level +3 ft. +1 'S ft.
Well production 25 g.p.m. 5.95 g.p.m.
WATER SAMPLE RESULTS:
Coliform Neg colonies/100 mL Nitrate ND mg/L
Arsenic ND ug/L Date of sample: 8/23/18 Collected by: Forge Engineering
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/HDPE Date installed 8/22/00
Tank size 1300 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 11/01/17 Pumper Sanitary Pumpers
C. ABSORPTION FIELD DATA
Date installed 8/23/00 Soil rating (g.p.d./ft2 or ft2lbdrm) 1 .2 System type Shallow Trench
Length 100 ft. Width 5 ft. Gravel below pipe .5 ft.
Total depth 3 ft. Eff. absorption area 500 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 8/28/18 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 1 in. Water added 608 gal. New depth 1 in.
Elapsed Time: 5 min. Final fluid depth 0 in. Absorption rate >= 600 g p d
Any rejuvenation treatment(past 12 mo.) (Y/N &type) None If yes, give date
D. LIFT STATION
Date installed 8/23/00 Size in gallons 165 Manhole/Access (Y/N) Y
"Pump on" level at 43 in. "Pump off' level at 47 in. High water alarm level at 39 in.
Datum Top of Man Hole Cycles tested A+Home Services Meets alarm&circuit requirements? i
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot >100' On adjacent lots >100'
Absorption field on lot >100' On adjacent lots >100'
Public sewer main >75' Public sewer manhole/cleanout >100'
Sewer/septic service line >25' Holding tank >75'
Animal containment areas >50' Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
7' >5' >5'
Building foundation Property line Absorption field
>10'
10' >10' >100'
Water main Water service line Surface water
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
>10' >10
10' >10'
Property line Building foundation Water main
Water Service line >10' Surface water >1��� Driveway, parking/vehicle storage >10'
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION .`�0���\\\
of ALgllt
I certify that I have determined through field inspections and ......4 .
4 Ft.k
review of Municipal records that the above systems are in ��P'•••• .,I,-•
conformance with MOA COSA guidelines in effect on this date. J*:'49 N , *�9
Benjamin Schiller, PE % �• ' ' • '°' '
Engineer's Printed Name
9/11/18 � " " " "'
Date �6 Benja• chiller :
TOf`' CE 12592 •�`tr
q �J'f•.• 9/11/18 •'v��
11i PROFESSIOO4.��'
�\\\\�1�
COSA brown sheet 10-10-12.doc
MUNICIPALITY OF ANCHORAGE
s ,.�. ..+=•www
Phone: 907-3,:3 7904
Development Services Department
On-Site Water & Wastewater Section Fax: 907-343 7997
lie � j Lift Station/Pump Vault
Maintenance Log
,n 5j Street Address ;�2 � 0 -beck_%�s'�K �`'► Y
Owner_. � �r, �c�n5 _�..�—
�- 3 Lok 5 P1D--
Phone�. 2y'�•�2 l- Legal Desc. 1<f).% y e�J P�lo� _
Septic Tank,
-Sludge level .,inches -Pumping: required yes no ` -Pumping completed _.t•�4
LifigatiQM 11)
-Pump basket cleaned pct WI -Effluent filter cleaned
-Control floats cleaned - ' IQ -Proper float settings confirmed
-Operation satisfactory no
Alarm System,
-Dedicated electrical alarm circuit n4 -Audible and visual alarm inside dwelling
-Alarm system operation Satan^for not sat��factory
Manhole Riser
-Ground water intrusion at riser to tank connection yam-g)
-Ground water intrusion around pipe penetrations y_es �,0 1
-Weep hole functional , nn
•Manhole lid: Functionalcp„ 4.
Insulated yes_O Properly Secured s r
Other
-All manufacturer required inspections and maintenance completed yes �t.19
comment$
Maintenance Provides
Technician Lankl eAk5 Date of maintenance_6..5(1)I
nn
Company _tet (i),\V-s OVlV
Signature Date..Sep Is'
- - . ..�.�: { .. ..
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water 8 Wastewater Program C4
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsit/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 05- 5'.3 COSA# :7
1. GENERAL INFORMATION Expiration Date: l 2 I — O !
Complete legal description
KNIK VIEW,
BLOCK 3, LOT
5
Individual Water Storage
❑
Location (site address)
22230 BIRCH
CREEK DRIVE *
CHUGIAK. AK 99567
Current Property owner(s) KYLE SKALISKY Day phone 509-888-2944
Mailing address 2059 BROADCREST COURT * WENATCHEE, WA
Lending agency Day phone
Mailing address
Real Estate Agent DONNA ALDERMAN w/PRUDENTIAL Day phone 244-3392
Mailing address 16635 CENTERFIELD DRIVE * EAGLE RIVER, AK 99577
Unless otherwise requested, COSA will behold by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
a
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
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 wasterwater 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 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 8 wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work.
4. STATEMENT OF INSPECTION BY ENG114EER
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 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.
Address 3701 E. TUDOR ROAD. SURE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS. P.E.
Engineer's Comments:
In conducting this evaluation, GEG, VD. attempted to provide a thorough,
conscientious engineering analysis of he 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 he water usage of the family being served by the system.
conditionsThese outside evaluator
tem. Satisfactory
results do not guaranteefutu a performance of thesysm, nor doof the s they guarantee that test
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
listedthe sole benefit of the owner reliance this
other person or party is not authorized, nor will it confer legal right whatsoever. any
5. DSD SIGNATURE
1/ Approved for bedrooms.
Disapproved.
Phone 337-6179
Date �h° a9
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
o10F
`j :• ON-SITE
WATER AND :R'=
WASTEWATER
PROGRAM :
By:
Original Certificate Date:
(Rw 11105)
Municipality of Anchorage
Development Services Department
\ Building Safety Division
On -Site Water 8 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
e
Legal Description: KNIK VIEW, BLOCK 3, LOT 5 Parcel ID: Oso -,731-53
A. WELL DATA
Well type PRNATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 8/3/00 Sanitary seal (Y/N) YES Wires property protected (Y/N) YES
Total depth 73 ft. Cased to 72 ft. Casing height (above ground) 24 In.
FROM WELL LOG AT INSPECTION
Date of test 8/3/2000 7/22/2009
Static water level +3 ft, +3 ft,
Well production 25 g.p.m. 3.0 g.p.m.
WATER SAMPLE RESULTS:
Coliform '�Q� colonies/100 mi. Nitrate L=mg./L. Other bacteria 0 colonies/100 ml.
v/�
Arsenic: r v ugA. Date of sample: 7/23/2009 Collected by: GEG Ltd.
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SEPTIC/HDPE Date Installed 8/22/00
Tank size 1300 gal. Number of Compartments 2 Cleanouts (YIN) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (YIN) YES
Date of pumping 7/22/2009 Pumper SANITARY PUMPERS
C. ABSORPTION FIELD DATA PBELOW XISTINcRADE
Date installed 8/22/00 Soil rating (g.p.d./ft'o /bd 1_2 System type TRENCH
Length 100 ft. Width 5 ft. Gravel below pipe 0.5 ft,
Total depth $3-3.41 ft. Eff. absorption area 500 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 7/22/2009 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth In absorption field before test DRY in. Water added 840 gal. New depth DRY In.
Elapsed Time: 0 min. Final fluid depth DRY in, Absorption rate >= 600+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (YM 8 type) NONE KNOWN If yes, give date —
D. LIFT STATION
Date Installed 8/22/2000 Size In gallons 165 Manhole/Access (YIN) YES
'Pump on' level at 43 in. 'Pump off" level at 47 in. High water alarm level at 39 in.
Datum TOP OF MANHOLE Cycles tested 3 Meets alarm & circuit requirements? YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main N/A Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 1000+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage '10+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+ � '
F. COMMENTS
G. ENGINEER'S CERTIFICATION
o ��.I • �• , q X90.
I certify that I have determined through field Inspections andU�
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines In effect on this ...... .)ess..*-'
. .....0
date. QQ e G
Enineees Printed Name JEFFREY A. GARNESS 0Q". . CE -7953
s' p��c,' e�to
Date g �l �D�dProleesione\
��OO0000� ;!
aU
COSA Fee R 0 Waiver Fee $
Date of Payment 0 Date of Payment
Receipt Number n L 2 % 07 Receipt Number
(Rev. 11/05) .
8
d
8
E
33
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SGS ReEN
1093613001
Client Name
Gamess Engineering Group, Ltd
Project Name/H
Knik View B3,L5
Client Sample 11)
Knik View B3,L5
Matrix
Drinking Water
Printed Date(1'ime
Collected Datefrime
Received Daterrime
Technical Director
08/042009 ► I:18
07232009 7:50
07232009 14:11
Stephen C. Ede
Sample Remarks:
Allowable
Prep Analysis
Parameter
Results
PQL
Units
Method Container
ID Limits
Date Date
Init
Metals by ICP/MS
I lardness as CaCO3
ND
5.00
mg/L
SM20 234011
C
0729/09 0810309
NRB
Waters Department
Total NitmtcRTitrite-N
ND
0.100
mg/L
SM204500NO3-F
11
0728/09
LCE
Private Individual Analysis
Aluminum
ND
20.0
ug/L
EI1200.8
C
0729/09 08/03/09
NRB
Antimony
ND
1.00
ug/L
EP200.8
C
(<6)
0729/09 08/03/09
NRB
Arsenic
ND
5.00
ug/L
EP200.8
C
(<10)
0729/09 08/03/09
NRB
Barium
ND
3.00
ug/L
E1,200.8
C
(<2(HI))
0729,'09 08/03/09
NRB
Cadmium
ND
0.500
ug/L
EP200.8
C
(<5)
0729109 08/03/09
NRB
Calcium
ND
500
ug/L
EP200.8
C
0729.x09 08/03/09
NRB
Chromium
ND
2.00
ug/L
EI1200.8
C
I<100)
0729.'09 08/03/09
NRB
Copper
19.3
1.00
ug/L
EP200.8
C
(<1300)
0729'09 08/03/09
NRB
Iron
ND
250
ug/L
EP200.8
C
(<300)
0729'09 08/03/09
NRB
Lead
0.263
0.200
ug/L
EP200.8
C
(<15)
0729/09 08/03/09
NRB
Nlaggcsium
ND
50.0
ug IL
EP200.8
C
0729/09 08/03109
NRQ
Manganese
ND
1.00
ug/L
EP2010.8
C
(<50)
0729/09 08/03/09
NRB
Chloride
7.89
0.100
mg/L
EPA 300.0
D
(Gt50)
0724,'09 0724/09
LCE
Fluoride
ND
0.100
mg1L
EPA 300.0
D
(Q)
0724.'09 0724/09
LCE
Selenium
ND
5.00
ug/L
EP200.8
C
(<50)
0729/09 08/03/09
NRB
Sodium
95400
500
ug/L
EP200.8
C
(<250000)
0729/09 08/03/09
NRB
Silver
1.03
1.00
ug/L
EP200.8
C
(<I00)
0729'09 08/03/09
NRB
Thallium
ND
1.00
. ug4.
EP200.8
C
IQ)
0729/09 08/03/09
NRB
Sulfate
14.7
0.100
. mg9.
EPA 300.0
D
(6250)
0724,'09 0724'09
LCE
Zinc
7.51
5.00
ug1.
EP200.8
C
(<5000)
0729'09 08103/09
NRB
SGS ReLN
1093613001
Client Name
Garness Engineering Group, Ltd
Project Name/H
Knik View 133,1_5
Client Sample ID
Knik View F33,L5
Matrix
Drinking Water
Printed Date(I'ime
08/042009 11:18
Collected Date/Time
07232009 7:50
Received Datc/Time
07232009 14:11
Technical Director
Stephen C. Edc
Allowable Prep Analysis
Parameter Results PQL Units Method Container ID Limits Date Date hot
Private Individual Analvsis
Total Dissolved Solids
219
Nickel
ND
I ICO3 Alkalinity
176
CO3 Alkalinity
ND
Of Alkalinity
ND
Conductivitv
398
PH
7.90
Alkalinity
176
Colony Count
0
Total Coliform
0
Pccal Coliform
0
10.0
mg/L
SM202540C
D
(<500)
0724109
OLT
2.00
ug/L
EI1200.8
C
(<100)
0729!09 08/03/09
NRB
10.0
mg/L
SM202320B
D
0724'09
MPL
10.0
mg/L
SM202320B
D
0724/09
MPL
10.0
mg/L
SM202320B
D
0724/09
MPL
1.00
umhoscm
SM202510n
D
0723/09
OLT
0.100
pl I units
SN120 4500.11 B
D
(6.5-8.5)
0723/09
OLT
10.0
mg/L
SM20 23206
D
0724/09
MPL
col1l0i
SM209222B
A
0723/09
DLC
col/100mL
SM209222B
A
(<1)
0723/09
DI -C
col/100m1.
S%120 922211
A
0723/09
DLC
Municipality of Anchorage
Development Services Department 1P
Building Safety Division t '•" _
On -Site Water and Wastewater Program `
4700 South Bragaw, St.
P.O. Box 196650 Anchorage. AK 99519-6650
www.ci.anchorage.ek.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 051-031-53 HAA# 144010066
Expiration Date: .4g_0
1
1. GENERAL INFORMATION
Complete legal description Lot 5, Block 3, Knik View Subdivision
Location (site addressordirections) NHN Knik Vista Driv
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
112C1 Inc./Leroy Alderman
Day phone
PO Box 670045, Chugiak, AK 99567
Day phone
Day phone
223-8100
Unless otherwise requested, HAA will be held by DSD for pickup. ? 3��� 07
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
El
Individual Water Storage
❑
Community Class 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 Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 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 sample results less than 30 days old. (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 " r'
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. 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 ls(are) in compliance with'all applicable Municipal and State codes, ordinances,
and regulations in eff tt tthheP ffigstallation
17034 Eagle Rtver loop Road No. 204 'Phone 6614 -;IL-4 -7 9
Name of Firm Plate River. AlasRe 1995
Address
EngineersPri' 'ed ' 'me''ltobert C. Cowan, P.E. DateOF 44
By: �jf� / / ��y t _ Original Certificate Date: 3' �
(Rev. 12100(
NGIN
P/, c .
R03ERT C. COWAN f�Q
1 c
5. DSD SIGNATURE
.CE-t3E01
/ ;,,��„
Approved for,, �_ bedrooms.
......... ;; r
Disapproved.
_.
Conditional approval for � bedrooms, with the following stipulation .
ttY UF//�`
_
`S �,V f��
•�
IZ : WATER AND m!
WASTEWATER :
' PROGRAM
Additional Comments
J����t'•
���\
Attachments:
HAA Checklist X
Maintenance Agreements
Septic System Advisory
Supplemental Engineer's Report
Well Flow Advisory
Other
By: �jf� / / ��y t _ Original Certificate Date: 3' �
(Rev. 12100(
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bregaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
www.ci.enchomge.ak.us
(907) 3437904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: l o t S k 3 )rm r Ky i t w 510 _ Parcel ID: O s/ -"I -t 3
A. WELL DATA
well type Nps* r 11 A, B, or C provide PWSID # = Well Log &N)
Date completed q00 Sanitary seal ®/N) Y� 1 Wires Properly protected&M) Y4 f
Total depth 7 3 ft. Cased to ft. Casing height (above ground) __LF ; In.
Date of test
Static water level
Well production
FROM WELL LOG
S15/ao
WATER SAMPLE RESULTS:
+ 3 ft.
a 9- g.p.m.
AT INSPECTION
Coliform ! colonies/100 mi. Nitrate 0-r mg.A. Other bacteria 9 colonies/100 mi.
ori/Z 3/O I Collected S 1. S ENGINEERING
Date of sample: �' r r Loop Roado
204
B. SEPTIC/HOLDING TANK DATA Layla River, Alaska 99577
Tank Type/Material S' * r' c. 1 o 0 P E Date installed
Tank size 3 e 0 gat. Number of Compartments a Clem (9N) Y E r
Foundation cleanout CO/N)J Depression over tank (YI fJ)) !ti) High water alarm (Y/N) +r a„ % i r-4 714. -
Date
r4.•Date of pumping NIA - N E a Pumper
C. ABSORPTION FIELD DATA
Date installed 8/-4y1o0 Soil ratingg.p.d r ft'Ibdrm) )_1
Length /00 ft. Width S ft
SOA. &0w
System type T -A a" cN
Gravel below pipe O's- ft.
Total depth 3 ft. Eft. absorption area Soo IF Monitoring tube Y!J Depression over field **JO
Date of adequacy test J4A ' ^'E Results (Pass/FaG) For —1 bedrooms
Fluid depth in absorption field before test
Elapsed Time: _ min. Fi depth _ in.
added_ gal. New depth_ in.
Absorption rate >= g.p.d.
Any rejuvenation treaUAWT(past 12 mo.) (YM 6 type) If yes, give date
D. LIFT STATION
Date installed fib x /oo Size in gallons ! `W Manhole/Access &N)
High water alarm level at 3 9 In.
"Pump on" level at 13 in. "Pump off" level at '17 in.
yt I
Datum 'SOP 019 AA.wr-0-4 Cycles tested �1- Meets alar d circuit requirements? Y4
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot /004
Public sewer main
Sewer /septic service line a' S +
On adjacent lots
On adjacent lots
i
Public sewer manhole/deanout N 14
Holding tank V `A
SEPARATION DISTANCESFROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 7 Property line 4 NN Absorption field
lO �
Water main 9 Water service line Surface water
Wells on adjacent lots / 0 0 �
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ) a Building foundation ?C + w t
Water Service line / 0 4' Surface water
/00 4 -
Curtain drain Nerd- K ,vowO Wel$ On adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through Feld inspections and
review of Municipal records that the above systems Bra in
conformance with MOA HAA gpuidelines In effect on this date.
Engineer's Printed Name /� d ER T C ° wA.✓
Date -a/a,
HAA Fee $ 4, -3(A -
Date of Payment L / / 1 n
Receipt Number —T / /7*6
(Rev. 12mo)
a er main
/✓AA
Driveway, parkingivehide storage SO
Waiver Fee $
Date of Payment
Receipt Number
f: ...
AMEbwAN f a
CE-88of
