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KNIK VIEW ESTATES BLK 3 LT 13
Knik View sta Block 3 Lot 13 #05! -043 -15 • c3 913 GO q • Municipality of Anchorage On-Site Water and Wastewater Program (907) 343-7904 S A E MAK QV Certificate of On-Site Systems Approval � Cu 051-043-15o ' 8 ,L-* Parcel I.D. Expiration Date: 1. GENERAL INFORMATION Complete legal description Knik View Estates Block 3 Lot 13 Location (site address) 21921 Rebecca Circle Current Property owner(s) Kenneth &Virginia Glifort Family Trust Day phone Mailing address 2401 Cobblestone Way Sandy, UT 84093 Real Estate Agent Day phone 2. TYPE OF DWELLING: O Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class A Well 0 Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by . a 60s) Date: abalia_ COSA to be released o the engineer,unless otherwi equested by the engineer. COSA Fee $ 5.o2(O / Waiver Fee $ Date of Payment 3)q L Date of Payment Receipt Number 603a100 Receipt Number COSA# O`JC l iO 12 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. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe 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 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 are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 3/8/2018 �''IOFA\`t 1 _coAl . �1— 9�ff 6. DSD SIGNATURE *• \ TM •/\ 0 �* System #1 Approved for bedrooms i :Seven R.••annone System #2 Approved for bedrooms '• CE-8149. �� Disapproved k ENo ssi .....o Conditional approval for bedrooms, with the following stipulations: Sert ov�k l'' . 2-2. y�eci v d A will e- lc zo / afvc dLb N 1411,1eRPSER o '.G WPS,GRMc.! pR �o 2A fit: MEN-SSR By: — ✓1/t (‘' )____.-- Original Certificate Date: 1 Ig 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 r-----S--owJC joNNOt COSA blue sheet r •- c l If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Knik View Estates Block 3 Lot 13 Parcel ID:051-043-15 A. WELL DATA Well type Class A If A, B, or C provide PWSID# 218409 Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height(above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 10/27/1996 Tank size 1500gal. 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/A Date of pumping 3/2/2018 Pumper JR's Pumping C. ABSORPTION FIELD DATA Date installed 10/27/1996 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SF Shallow Trench System type Length 76 ft. Width 5 ft. Gravel below pipe 3 it Total depth 5 ft. Eff. absorption area 655 ft2 Monitoring tube Y Depression over field N Date of adequacy test 3/6/2018 Results(Pass/Fail) PASS For 5 bedrooms Fluid depth in absorption field before test 0 in. Water added 750 gal. New depth 0 in. Elapsed Time: 90 min. Final fluid depth 0 in. Absorption rate >= 750+ g.p.d. N Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ 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 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION ���~��1`N� .�..�OF ACq�1k I certify that I have determined through field inspections and �'eP' ITV review of Municipal records that the above systems are in 7* ��� .1\ .�7 conformance with MOA COSA guidelines in effect on this date. / Nig' f Steven Pannone Engineer's Printed Name i ieveri ..'annorie: Date 3/8/2018 0+� g�, CE-81491 1k' � i Pos .... COSA canary sheet_2-6-15.doc Lot 21 j v t \ 23 \\WOODEN N 90'00'00"E 50.c �NCE� Lot 20 Lot 13 • + 22,236 s.f. CHAIN—LINK--\>, N FENCE + 8.0'x8.0' SHED N / N .$,23 s DECK 213 **4, 1.5' �`'•9' 0co Lot 19 •* ��,��� CANT `. ` p'x� �o ?R '' S\ok��E 's., Lot 1 2 4. �� 2 F 'TA 20 ' .'p Lot 18 rod`• • L,o 2.1' CANT �<y9< d 5.0' PORCH / / / SEPTIC sLo / P / , IPES A/ 4, i ,. / vl ? . ,S O Lot 14 °o- 10' T&E EASEMENT ZGO._�v/ / ' Cj> NOTES: / 1) LOT IS SERVED COMMUNITY wgTERA / / ? /‘_()C"'s 2) DUE TO ICE S/ p. / 4THE LOCATION FNOSY SYS / / �� DRIVEWAY IS gPPROximTgTE. PLOT PLAN AS BUILT X SCALE 1" = 40' GRID NW 1558 Project No. 18-055 R1 11500 Daryl Avenue, Anchorage, Alaska 995 La n g & Associates , inc . (907) 522-6476 Phone ..„,,,o.• ." ,.•.\\.‘3049 (907) 522-4625 Fax ,a4o F Professional Land Surveyors kenOlangsurvey.com v -_,.9 0 4 lq jonathanOlangsurvey.com ,,<s:-.:� ��''' '•.-.7 I hereby certify that I have surveyed the following described property: DO ; • 6) h LOT 13, BLOCK 3, KNIK VIEW ESTATES (PLAT 86-113) p* •: 49TH ,d,‘ ' �� Anchorage Recording District, Alaska, and that the improvements situated thereon are D Q within the property lines and do not encroach onto the property adjacent thereto, that • Q no improvements on the property lying adjacent thereto encroach on the surveyed � KENNETH premises and that there are no roadways, transmission lines or other visible /O_ ETH G• LA . c •'..0 easements on said�property except as indicated hereon. 04 � '.• �Vi(g ci Dated this the 5 Day of N\hn.LtA , 2oWg , at Anchorage, Alaska 0kth ARo�'•- 20� ,.o 50 d 4 N\ SIONAL ti oao P. It is the responsibility of the owner to determine the existence of any easements, AOOp000� covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bregaw St. P,O, Box 196650' Anchorage, AK 99519-6650 www.ci.anchorage.ak,us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1. 051-043-15 GENERAL INFORMATION Complete legal description Location (site address or directions) Current Property owner(s) T.enny Cullip Mailing address 21921 Rebecca Circle Expiration Date: ! O - ~ ~ - O ~. Lot 13, Block 3~ Knik View'Estates 21921 Rebecca Circle Chugiak, Alaska 99567 Dayphone,563-5454 Chugiak, Alaska 99567 Lending agency Day phone Mailing address Real Estate Agent Terri Davis/Next Home Mailing Address 3400 Spenard Road, ~5 Unless otherwise requested, HAA will be held by DSD for pickup. Day phone 727-5130 Anchorage, Ak 99503 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class. A Public Water System Well [] [] [] [] 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of ~Jaska. Certificates of Health Authority Approval are required for the b'ansfer 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 upo. n request to homeowners. Ce~ficates 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 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 wastewatar 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 Pinard Engineerin~ Address PO Box 871347 Wasilla~ Alaska 99687 Phone 357-3647 Engineer's Printed Name Paul E. Pinard Date 10/17/01 Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: /0 ' ~.- 3- ~ / Municipality of Anchorage Development Services Department Bui]dlng Safety Division On-Site Water & Wastewater Program 4700 South Bmgaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (SO7) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ]~ot 1 3, Block 3¢ K.n_tk View Estates Parcel ID: A. WELL DATA Wall type Cla,=,= "A" IfA, B, orCprovidePWSID# 218409 Wall Leg (Y/N) Sanitary seal (Y/N) Cased to __.lt. FROM WELL LOG Date completed Total depth g.p.m. Nil]am Collected by: Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform colonies/100 mi, Date of sample: B. SEPTIC/HOLDING TANK DATA Wires pmberly protected (Y/N) Casing height (above ground) ATINSPECTION g.p.m. 051-043-15 Data ins~led 10/27/96 ~eanouts(Y/N) Yes Hl~wateralarrn(Y/N) Ho Fluid depth in absorption field before test 0 in. Elapsed Time:l..3.5 min. Final fluid depth 0 Any rejuvenation treatment (past 12 mo.) (Y/N & type) Tank Type/Malarial SeDt. tc/Steel Tank size 1500 ~ Number of Compartments 2 Foundation cieanout (Y/N) Yes Depression over lank (Y/N) Ho Date of pumping 10/1 2/01 Pumper ,TE.s t~umptn¢~ C. ABSORPTION RELD DATA Dateinstelled 10/27/96Soilrating (g.p.d./ff2or~/bdrm) 1,2 Length 76 It. Width Total depth 5 It. Eft. absorption area__ Date of adequacy test 10/6/1~1 mg./I. Other bacteria colonies/100 mi. System type, Shallow ~'z'ench .,5 It. Gravel below pipe 3 fl. 655 · Monitoring tubs y Depression over field H Results (Pass/Fal0 ~ For 5 bedrooms Wateradded 900gal. Newdepth 0 in. in. Absorption rate >= 900+ .g.p.d. Ho If yes, give date in. D. LIt=rS'rATION - I~R Date installed 'Pump on" level at in. Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line Size in gallons. 'Pump off" level at in. Cycles tested Manhole/Ac~;~s (Y/N) High water alarm level at Meets alarm & drcuit requirements? in. - ~& (Co.unity #ate~ Syste~) On adjacent lots On adjacent lots Public sewer manhole/deanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 5 ' Absorption field 4 K) t + 10t+ Sudace water 100"+ Building foundation Water main Wells on adjacent lots property line 10" + Water sewice line 10 ~ + SEPARATION DISTANCE FROM ABSORP'F~ON FIELD ON LOT TO: ProperS/line 10" Building foundation 10" + Water main 10" + Water Service line10 ' + Sun'ace water 100" + D~mway. parldngivehlcle Curtain drain N/% Wells on adjacent lots F. COMMENTS 0. cE .F,cATIo. .. that the above s ems ere/n ~ ....... , ~ . o Engineer's Printed Name Date 10/17/01 )j~:,<~..CE 4793 :~ '<'~ .. .... · .' ~.~-,~ HAA Fee $ ~.y,). OC~ Waiver Fee $ Date Of Payment Date of Payment ~ Receipt Number //Z/o ~,~'. Receipt Number (Rev. 12/00) PINARD ENGINEERING P.O. Box 871347 Wasilla, AK 99687 (907) 357-ENGR (3647) ADEQUACY TEST LOCATION: Lot 13, Block 3, Knik View Estates APPUCANT: Leonard & Shannon Cullip 21921 Rebecca Circle Chuglak, Aleska 9956;' SEFXTIC TANK TYPE/SIZE: Steel/1,~0 gallons, per MOA Records ABSORPTION SYSTEM: Shallow Trench, per MOA Records DALLY FLOW: 6 BEDROOMSxISOGAL/~R= ?50gallons TEST DATA dOB NUMBER: 01-184 DATE OF TEST: 10/06/01 FIELD STAFF: P.J. Ploard NUMBER OF BEDROOMS: S SCUM: 0.0' SLUDGE: 0.3' NEEDS TO BE PUMPED: Yes XX CURRENTLY IN USE: Yes XX No Time Flow Volume Cumulative Septic Tank SepUc Soil Absorption System Comments Rate Volume Tank PM (GPM) (GALs) (GALs) Liquid Level ' A Level Monitor ,5 SAS MonJt0r ,5 SAS Tube 1 * Level Tube 2' Level 1:00 6.7 4.0' 0.0' 0.0' Start Test- Meter 244340 I:15 6.7 100 100 4.1' 0,1' 0,0' 0,0' 0.0' 0.0' 2'!'H40 1:30 6.7 100 200 4.1' 0.0' 0,0' 0.0' 0,0' 0.0' 244540 ]:45 6.7 100 300 4,1' 0,0' 0.0' 0,0' 0.0' 0.0' 244540 2:00 6,7 ]00 400 4,1' 0,0' 0.0' 0.0' 0,0' 0.0' 244740 2:15 6.7 100 500 4.1' 0.0' 0.0' 0.0' 0.0' 0.0' 244840 2:30 6,'/ 100 600 4. l' 0,0' 0,0' 0,0' 0.0' 0.0' 244940 2:45 6.7 100 700 4.1' 0.0' 0.0' 0.0' 0.0' 0.0' 245040 3:15 200 900 4.1' 0.0' 0.0' 0.0' 0.0' 0.0' Stop Test 245240 RECOVERY *AU. MEASUREMENTS IN FT. Date T~rne ST MTt SAS MTI TEST: PASSED XXX FAJLED CONEVIENTS: There was no measurable liquid in the SAS prior to or at any time during the test. Reviewed by;, Paul Pinard Date: 10/8/01 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343.-4744 On-Site Wastewater Disposal System and/or Well Inspection ~oport Permit Number: ~q(~O~ PIDNumber:_ O,~1 - Oq~ Name: ~1 ~o ~'~ F ~ Wastewater System: ~New D Upgrade Address: ~ ~l¢~, ~[ 1'~o~5.t ~L~ ¢~ L~,,t ~o. 5~.-~'~zoz ABSORPTION FIELD 'Phone: ~ - I~ Ne. of B~rooms: ~ Deep Trench ~ Shallow Trench D Bed ~ Mound B Other Total Depth from origina~ grade: LEGAL DESCRIPTION Soi.~,in~: I'~ --Lot: t'5 Block: '~ K~I&suboiv~iOn:Vl~ [~'r, Depth to pipe bottomz. Item origintl grads: Ft. Gravel depth be~gh~ pipe Fi. .T°wnship: ~ Range: ~ Section: ~ Fill added above~ ~°rigigal~ ~ grade: Ft. Gravel length: '~ ~ I Ft. WELL: ~x,~,~g~ New D Upgrade / 6r~velwidth: ~ J Ft. Number of lines:t BJstancebetweeCHines:~¢ Ft. Classification (Private, A,B,C): Total Depth: ~: Total absorption area: Pipe material: ~-~ ~etat:'Driller ~~" Date Drilled: Static Water Level:und Installer: Date installed: Casing HeightAbove GroFt:: T~ ~X ~' 1:~ ¢ ~,. ,,. TANK SEPARATION DISTANCES ~s~,tio u ,otdino ~ S.~.~.~. To Seplic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank SewerLines Material:~¢'"O"~ ~ Numberof~om~m~.t~:O~es Sudace Water Io61+ 100t~ ~ _ LIFT S'rATION LineL°t ~ ¢ /0~ ~ ~ ~ Size in gallons: Manufacturer:~ Foundation ~ ' ~0 __ . ,+ ---- -- ~ "~ump on" level~~" level at: H,~h water alarm at: C~rtainDrai~ ~-- 4¢~ ~o~4 ~ ~T~'. m Remarks: BENCH MARK Location and Description: Assumed Elevation: Inspections performed by: S&SENGINEErlN6 Dates: 1st le/~/qt* ~ II · · Eagle EIve~, Alaska ~577 Department of Health and Human Services approval Reviewed and approved by: '~ Date: ~ -~-~ 72-013 (Rev. 9/91) MOA 25 PERMIT NO, SW960286 PAGE 2 OF 2 LECAL LOT 15, BLOCK 3, KNIK VIEW ESTATES P.I.D. NO. 051--043--15 36,0' 36.5' 83.0' 53.5' UNDER · LOT 1 3 ALT. / / / / / / ST1 ST2 FINAL GRAD] CO1 = 89.2' C02 = 89.9u MT1co1 MTaco2 INSI CO1 = 87.0' CO2 = MT1 = * MT2 = 83.8 · 77.8! WATER FOUND 75.8' B,0.H. NEW TRENCH NEW 1500 SEPTIC TANK WATER LIN] KEY BOX SCALE I" = 40' COl Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13- 14 · 15- 16- 17 18 19 2O ¢~ & / SLOPE SITE PLAN WAS ROUND WATER ENCOUNTERED? PERCOLATION RATE "'~ (m~nutesnnch) PERC HOLE DIAMETER - . _ TEST RUN BETWEEN FT AND ~f FT / ~ I GUIDELINES IN ACCORDANCEWITH~4~R~/ EFFECT ON THIS DATE. DATE: ~ ? 72-008 (Rev. 4/85) S L IF YES, AT WHAT ~ O DEPTH? p E Depth to Water Aller ~-, P' / ~ross N~{ Depth to Net Reading Date Time Time Water Drop ~ ,. (~ ;~ g ,.~ /~, ~ ..j q. v, ~ ,, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960286 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:WALDEC ENTERPRISES INC OWNER ADDRESS:iT034 EAGLE RIVER LOOP ROAD SUITE 202 EAGLE RIVER ALASKA 99577 PAGE 1 OF 1 DATE ISSUED 9/10/96 EXPIRATION DATE: 9/10/97 PARCEL ID:05104315 LEGAL DESCRIPTION: KNIK VIEW ESTATES BLK 3 LT 13 LOT SIZE: 22236 (SQ. FT. NUMBER OF BEDROOMS: 5 THIS PERMIT: THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: THE ATTACHED APPROVED DESIGN. 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 (iSAACS0) . THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY!PERMIT) FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: ISSUED BY: DATE: HEAErH AUTHORITY APPROVALS SEWER & WATER MAIN B<TENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELl INSPECTION & FLOWTEST SiTE PLANS ROAD DESIGN SOIL TES1 PERCOLATION 1EST STRUCTURAL & MECHANICAL iNSPECTIONS ONSITE WASTEWATER DISPOSAL SYST E M DESIGN ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. August 30, 1996 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 13, Block 3, Knik View Estates Request you issue a permit to install a septic system to serve %he proposed five bedroom house on %he referenced property. Test holes were excavated and percolation tests performed. The approximate location of the test holes are located on the attached site plan. At the time of excavation, no water was encountered in test holes and after seven day ground water monitoring, the monitoring tube in test hole ~1 was found to be dry and water was found to be at tl feet in test hole t~2. This property has enough area for a future septic upgrade which can be seen on the attached site plan. This property is served by a Community Water System. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns i by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, t c. Cowart, P.E. Rcc/gk Enclosure MUNiCtPALII¥ OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION SEP 04 1996 RECEIVED 17034 NORTH EAGLE RIVER LOOP · SUITE 2040 EAGLE RIVER, ALASKA 99577 F;uk: O~ ©¢ HEALTH AUTHORITY APPROVALS SEWER & WATER SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION 8, FLOW rEST SITE PLANS ROAD OESIGN SOIL rEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SI rE WASTEWATER DISPOSAL SYSTEM DESIGN CONSTRUCTION ?RACTICES and MATERIAL SPECIFICATIONS ~FERENCE: Lot 13, Block 3, Knik View Estates August 30, 1996 ROBERTC. COWAN, RE. ROBERTA. SHAFER, RE. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 ENERAL: 1. The scope of this project includes the installation of a 1500 gallon septic tank and a leachfieldi trench to serve the proposed five 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 approva'i from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic 'Bank 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. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 13, Block 3, Knik View Estates August 30, 1996 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 betwe~n the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists withini the septic tank). These cleanouts shall be located on !Undisturbed soil not more than 10 ft. from the tank. i 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/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed~-up) before gravel (sewer rock) placement. Once the gravel is installed, the distributionlpipe 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) inchl 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. Page Three i Lot 13, Block 3f Knik View Estates August 30, 1996 5. Backfill over the final gravel layer must not be less than twenty-~four (24) inches. Insulation must be installed when the backfJ, ll 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, i MINIMUM MATERIAL SPECIFICATIONS: 2e Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer° ~ The following pipe materials are approved for us~ in septic system installations in the Municipality of AnChorage: TYP~_ of Pipe Perforated Soli!d Cast Iron ASTM D3034 (PVC) ASTM F810 (HDPE) ASTM D2662 (ABS) Yes Yes Yes YeS Yes No Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer° ~ Ins~llation 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, Fernco, or equal!). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield grave], layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the tt~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, whJ_ch ever requirement applies. Page Four Lot 13, Block 3, Knik View Estates August 30~ 1996 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: 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 J. nspection, i 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 trehches, 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 an~d 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~! Page Five Lot 13, Block 3, Knik View Estates August 30, 1996 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 !~ith these construction documents. S & S Engineering's inspecting engineer will not be responsible for 'the construction mean~, methods, techniques, sequence, procedures or the safety precautions incident to this project. ~ CONTRACTOR/INSTALLER Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2 3 4 5 o 7 8 9 10 11 12 13 14 15 16 17 18 19 2O /'VI LT/~,. ,~, I C-T ~'// SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YESi AT WHAT 0 DEPTH? P E Deplh lo Waler Alter ' /,~./ = Monitoring? H gate: Gross Net Depth ;to Net Reading Date Time Time Water Drop fl.'od ~a -- .'o S 5~,,- ~Z' ~ " PERCOI ATION RATE --~ (m,nutes/,nch) PERC HOLE DIAMETER TESTRI. iNBETWEEN ~D ~ E~I ~" P-KII~I'~ t ?o~. Fn?~ River Loo~;ld "0.~204 ~ ~ ' r~~ r,~laska 9~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN~~ ON THIS DATE· DATE: 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH 8, HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O (ENGINEER'S ' DATE PERFORME~~ ,gC/~ff; ;' '-~''' Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, Al' WHAT DEPTH? Oeplh to Water Aller Moniloring? ~1~'~/ Dale: Gross Net Depth to Net Reading Date Time Time Water Drop ,~ lo __ ~ ~" Yz : t S ,o -. ~%" ; ~& lo , · ~'(~" Fy PERCOLATION RA'TE ?~) (m,nutes/,nch) PERC HOLE DIAMETER ~ ' ' TEST RUNBETWEEN~AND ~'~ FT : COM E.TS ('om) 17034 Eagle River L~p Roaa NO.' /~ ~A - PERFORMED BY:E~e Ri~=k= 99577 _~/i/// /~ ~ ~ CERTIFY THAT ~RIS ~EST WAS PERFORMED IN ACCORDANCE WI~H ALL STATE AND MUNICIPAL GUIDELIN~~ ON THIS DATE' DATE: 72-008 (Rev. 4/85)~ Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street PlO. Box 196650 Anchorage, Alaska 99519-6650 343-4744 June 29, 1995 Walde~ Enterprises, Inc. 6208 Staedem Drive Anchorage, Alaska 99504 1628 Subject: Lot 13 Block 3 Knik View Estates Subdivision Permit #SW940215, PID ~051-043-15 The subject permit, issued June 29, 1994 by 'this office for a single family well and/or on-site wastewater system, has expired as of June 29, 1995. i A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, please call this offJ. ce at!343-4744. S-i~cerely, _ 7~es Cross, P.~. Program Manager On-site Services enc: Copy of Permit cc: S & S Engineering MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940215 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:WALDEC ENTERPRISES INC OWNER ADDRESS:6208 STADEM DR. ANCHORAGE, AK 99504 PARCEL ID:05104315 LEGAL DESCRIPTION: KNIK VIEW ESTATES BLK 13 3 LT LOT SIZE: 22236 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 PAGE 1 OF DATE ISSUED:i 6/29/94 EXPIRATION DATE: 6/29/95 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 3 o 4 o THE ATTACHED APPROVED DESIGN. 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 THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY i CALLING 343-4744 (24 HOURS) ~ FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ~ ~ DATE: ISSUED BY: ,~/?-//,.. ? _ ./~ DATE: ROBERT SHAFER, P.E. ROGER SHAFER, P.E. June 11, 1994 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Knik View Estates Subdivision; Block 3; Lot 13 Request you issue a permit to install a septic system tO serve the proposed three bedroom house on the referenced property. Test holes were excavated and percolation tests perf°~med. The approximate locations of the test holes are located on the attached site plan. At the time of excavation no water was encountered and after seven day ground water monitoring water was found atill feet in test hole #1. This property is served by a Community Water System. There are no protective well radii which encroach upon the property. This property has enough area for a future septic upgrade which can be seen oil the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 1" I = 50' SITE PLAN SCALE mm~O ~ 0x N.T.S. SCALE ITRENCH DETAIL DEEP EFF. z 0 ~ GO cz z' ~> ~© © (D ON-SITE WASTEWA'£~ DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MA¥~RIAL SPECIFICATIONS REFERENCE: Knik View Estates Subdivision; Block 3; Lot 13 1. The scope of this project includes the installation of al 1000 gallon septic tank and a five foot wide drainfield to serve the proposed three bedroom residence for 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. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 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 iseptic 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. 3. Ail standpipes on the septic tank shall extend a minimum Of 12 inches above final grade. 4. Septic tanks installed with less than 4' of cover shall be insulated. Page Two Knik View Estates Subdivision; Block 3: Lot 13 June 11, 1994 5. A foundation cleanout shall be installed one to four f~et from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pU?~ping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10' 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. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ~ ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. o 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 (roughed-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 and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be per~orated from the bottom of the trench to the invert of the distributio~ 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. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed Municipally approved septic tank manufacturer. by a Page Three Knik View Estates Subdivision; Block 3; Lot 13 June 11, 1994 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. 3. Insulation shall be at least 2" thick extruded direct buriali polystyrene (Dow Chemical Company Styrofoam HI or equal). ~[ 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" scr~ened 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. INSPECTIONS: Tl/pically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections Will occur as follows: 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 placemen~ of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. ~ Page Four Knik View Estates Subdivision; Block 3; Lot 13 June 11, 1994 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 contractor's activities. The owner shall contract with the contractor to perform the workl outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing ibetween 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 contractor's activities. Final acceptance of the contractor's 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 lthis 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 DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 3 6 7 9 ~0 12 ~.0,~. 13 14 15- 16- 17- 18- 19- 20- WAS GROUND WATER ENCOUNTERED? S ~ L IF YES, AT WHAT O DEPTH? p E Depth Io Water A~ter Monitoring? ~1'~ gale: (I-:N ,INEER~$ SEAL DATE PERFORME[~ ,'l', 17'¢~/: ': Township, Ranoe, Section: SLOPE SITE PLAN ,~ A TEST RUN BETWEEN ~..~----~F T~ AN D ~'~ FT COM,ENTS / 17034 Eagle River Loop Roa~1 NO. ;~')~, /~ --%/ · I ~ ///~-'~ -- CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY:~ , ,.b.~r A~..~.~ ~a.oS~~' ACCORDANCE WITH ALL STATE AND MUNICIPALGUIOELIN N THIS DATE. DATE: 72-008 (Rev. 4/85) PERCOLATION RATE /~) {m,nutes/,nch) PERC ROLE DIAMETER Gross Net Depth to Net Reading Date Time Time Water Drop 12:0% fO" 5 ~ Vfl _ :IS ~0 -, ~, W " '/y _ ; ~ lo ·. ~'/~" Yv _ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG B PERCOLATION TEST DATE 1 5 6 7 8 9 10 11 12 13 14- 15- 16 17 18 19 2O Township, Range, Section: SLOPE WAS GROUND WATER ~65 /,.- ENCOUNTERED? S IF YES, AT WHAT ~ L 0 DEPTH? p E Depth to Water Alter ' /~/ Monitoring? l/ Date: 6 ~/~ SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop Il:Od ~'~ -- .'o S ~,¢,,.- :!?" ~ " ' I ~ ~ " gY~ 1" ' I~ ~ " 3~ ~/~ t'/~ ' : So S PERCOLATION RATE T EST RUN BETW EE N ~_~__.~D f'~ F'f ~- Riwr, Alaska 99571 / PERFORMED BY:;'~gle ~ ~_~'/.~-'-~~_ CERTIFYTHATTHIS'I-ESTWASPERFORMEDIN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN~S~/I~EFFE.~- ON THIS DATE. DATE: 72-008 (Rev. 4/85) Parcel I.D. # 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 CERTIFICATE OF HEALTH AU'FFJ ,ORITY APPROVAL FOR 1~, SINGLE FAMILY DWELLING Lot 13; 05-/- o ¢'$ -- 1. GENERAL INFORMATION Complete legal description HAA# ~ ~C~-] Block 3; Knik View Estates Location (site address or direction:;) Rebecca Circle Chugiak, AK ?, Property ownsr ,.,%~charc,'~ Rene Shafer j ';[, Ma ling address '~. 17034 N. Eaqle River Loop Rd. .Lending agency ":..".Mailing address ' Day phone 694-1373 Suite 202 Eagle River, Day phone AK "Agent __ Address Day phone : 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 5 TYPE OF WATER SUPPLY: individual well Community well XXX Public water i'qOTE: If commur?ity well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. XXX TYPE oF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater System, provide written confirmation from State ADEC att¢~;ting to the legality and status of system. ?2~025 {Rev. 1/91) Front MOA #~-1 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 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 in complian~Ce with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm s & s ENGINEERING Address Eagle River, Alaska 9~577 Engineer's signature DHHS SIGNATURE · ~ Approved for J Disapproved. ConditiOnal approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date I '~he Mu'fii~iP~lity of A~n~orage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent profess~onalengmeerregtstered ntheStateofAlaska TheDHHSdoesthisasacourtesytopurchasersof homes and their lending institutions in order to satisfy certain federal and state requirements, Employes of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA#21 Legal Description: Lo~ ~, ~_oc~ ~ A. WELL DATA Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES ~uN~cm,~Ur ' t~NVi~ONM~NrA~i¥~iO Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-47:44 Health Authority Approval Checklist Welt type Log present (Y/N) Total depth Sanitary seal (Y/N) FROM WELL LOG~~PECTION Date of test static water ' g.p.m. WATER SAMPLE RESULTS: If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to Casing height (above grou~l~ Wires proper]y.~r-ot'b~ected (Y/N) Nitrate Coliform Date of sample: SEPTIC/HOLDING TANK DATA Date installed Collected by: -cIG Tank size 15oo ~i~., Number of Compartments Other bacteria ~, Cleanouts (~N) _ g,p.m. Foundation cleanout Date of PumPing :~ ,/~.) ABSCRPTION FIELD DATA · Date in'tailed IO'2~-] - RfC Depression , Pumper Soil rating ~Or fF/bdrm) Length.: '-']~ I Width .:' ~' ¢ Gravel thickness below pipe -.~ I Total depth Effective absorption area (~S 5, r¢'¢ Monitoring Tube present (~N) ~e~_ Depression over iield (Y~) Date.of adequacy test '/~"¢ ~) Results (Pass/Fail) ~ ~ For_ .~ bedrooms Fluid depth in absorption field before test (in.); Immediately after - gal. water added (in.): High water alarm (Y~ /~Jo Fluid depth -- (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* Absorption rate = ~ g.p.d. If yes, give date -----7-- LIFT STATION Date installed Manhole/Access (Y/N) High water ~ Size in ~..~.--~ "Pu~t* "Pump off" level at* *Datum SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~--.¢¢,~M.=-,r,¢ Septic/holding tank on lot Absorption field on lot Public sewer main S~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation Property line [O' -,,* Absorption field On adjacent lots Public sewer manhole/cleanout Water main/service line 10~¥ Surface wateddrainage lO0"~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water ~OO' Curtain drain ENGINEER'S CERTIFICATION HAA Fee $. '~ ~ Date of Payment ¢//~ Receipt Number ,~ 7,~' 72-026 (Rev, 3/96)* Water main/service line Driveway, parking/vehicle storage area lO Wells on adjacent lots ~.00: ~ certify that l have determined thru field inspections and review of Municipal records t~ '~, ~v~'¢~ms are I in conformance w~h MOA HAA guidelines in effect on this date. ~7.¢~.' "?..,.,~.~ Signature 'D ~/ i ~' X¢~ , ,. C. E Engineer s Name ~8 o¢., ~- ~ e ¢¢~ ~_~/~_.~/~ ~ ~ ~ ROBERT'C. COWAN /~ Date ~ff/~ / ~ 7 ~,% CE-8801 /~ Waiver Fee $ Date of Payment Receipt Number