Loading...
HomeMy WebLinkAboutKNIK VIEW ESTATES BLK 5 LT 2Knik Vi Estates Block 5 Lot 2 #051-043-42 Municipality of Anchorage .-':~ ?:~. ~i:~'~ Development Services Depadment Bu d~ng Safe y D'vlslon On-$ite Water and Wast~ater P~ram, 4700 ~. Bragaw St. P.O. Box 19~50 Anchorage, AK 99519-6650 Page ~ of~ ~ ~.an~o~age.ak.us (907) 34~7904 Pe,mitNumber: ~ OlO~ PIDNumber: "" ~0~ ~e~aal~ WastewaterSystem: ~New ~Upgrade ~ ~ee~ ~;~ ~e/e ~; 0~ ~ ~ 5~ 7 ABSORPTION FIELD w..: DNew Dupg~ade ~"~' ~. ~ ,,. I ~ ,, ~9 ,' -"- · ~ ~ s..:~. c~~t TAN K SEPARATION DISTANCES ~ se~ic ~ Holding D S.T.E.P. D Ome~ Septic Absorption LEft Holding s'~=w" I~ JO0; ~ / LIFT STATION ,.,. m' lo' V '"' "~" BENCH MARK Engineer's Stamp S & S ENGINEERIN~ Reviewed a~d approved by: Date: PERMIT NO.sw010455 PAGE 2 OF 3 Municip. otit o¢ .A.n_c h.o F 9 9.e. DEPARTMENT OF HEA~_THAND HUMAN SERVICES ENVIRONHENTAL SERVICES DIVISION P.O. Box 196650 eAr~cho,"o, ge, Atosko~ 99519-6650e Tetephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL iNSPECTION REPORT LEGAL LOT 2, BLOCK 5, KNIK VIEW ESTATES P.I.D. UO. 051-045-42 I ' LOT 3 I ' i , I I , ~ MIN. · J I ,C02 I ~11 MT2 ,< - ~ S[PJlC TANK , ~I I , EN I ~ , ~.~: .... J JUDD DRIVE ~,:~,~ c~.~o, PERm? NO. SWO 10455 PACE 5 OF 5 Municip. otit; oF A n._c h.o.r'o g?. DEPARTMENT OF HEALTHAND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION p.n. Box 196650 IAnchopo. ge, Ale, sko. 99519-66501TeJephone, 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LOT 2, BLOCK 5, KNIK VIEW ESTATES P.LD. NO. 051-043-42 ST1 ST2 /99.4' I SEPTIC TANK J CO1 =99.1' /-C02=99.1' FINAL GRADE-/ C01=93.8' C02=93.8' MTl=87.8'J MT2=87.8' · NO WATER FOUND 81.8' B.O.H. A B C FCO 48.0' 25.0' - ST1 57.0' 21.0' - ST2 64.0' 22.5' - DBL1 70.0' 25,0' - DBL2 71,0' 26,0' - C01 72,5' 26,5' - MT1 74.0' 23.0' - C02 - 46.0' 65.0' MT2 - 43.5' 63.0' MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7004 ON-SITE WASTEVVATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Oct 31, 2001 Expiration Date: Oct 31, 2002 Permit Number: SW010455 Legal Description: KNIK VIEW ESTATES BLK 5 LT 2 Design Engineer: 0003 S & S Engineering Owner Name: Rod Metcalf Owner Address: 654 Harp Circle Eagle River, AK 99577- Parcel ID: 051-043-42 Site Address: 022407 KNIK VISTA ST Lot Size: 22267 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage Ail 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. .. B. Covered, sealed, and heated to prevent freezing. Received - Date: Issued By: Date: Parcel I,D. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-79O4 ON-SITE SEWEPJWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLI'NG Permit Number SW 0 IO ~l..,~',.~' Property owner(s) Mailing address (1) Mailing address (2) Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size '7..~ ) 1 o~ O THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Not Tub Swimming Pool Therapy Pool Day phone Zip Code c~c~ ~..~ Number of Bedrooms Well Only Water Storage Jacuzzi Water Softening Unit I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. 17034 Eagle River Loop Road, No. ~U4 (Signature of properly owner or authorized agent) Eagle River, Alaska 99577 Permit Fees: ~ ~.. O, * '~ Waiver Fees: Date of Payment: ]0 /~'")//~/ Date of Payment: Receipt Number: O 11 r ~ ~ ~, Receipt Numbe~ (Rev. 1~00) October 16, 2001 ROBERT C. COWAN, P.E. CML ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 2, Block 5, Knik View Estates S/D It is requested that you issue a permit to install a septic system to serve thc proposed four bedroom dwelling on the referenced property. Also, we request a lot line waiver from the proposed leachfield to the east property line at 1 foot. A test hole was excavated and a percolation test was performed. The approximate location ofthe test hole is located on the attached site plan. At the time of excavation on 9/25/01 no water was found. After seven days ofground water monitoring the test hole was still found to be dry. 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. lfyou require additional information,please contact us. Sincerely, RCC 3Bm Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 ' EAGLE RIVER, ALASKA 90577 Performed For:. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Ancflorage, AK 99519-6650 Www.d.a nchor-aee.ak.us (907) 343-7904 Soils Log - Percolation Test LegalDesc~pfion: /~._.~.[ [~ .~ ~/~'/( Vd40 ~.57. Township. Range, Section: Stope 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- )H WAS GROUND WATER ~cou~E~? ~ 0 IF YES, AT WHAT DEPTH?. 0 Depth to Water After p Monitoring? 'J~:)~ E z I Site Plan Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (m,nutes/~,~) PERC HOLE OIAMETER ~:~ '* TEST RUN BE3WEEN FT AND ~ FT S & S ENGINEERING -///~'~ // ROBERT C. COWAN. P.E. CML ENGINEERS (907) 694-2979 FAX (907) 694-12! ! ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 2, Block 5, Knik View Estates Subdivision October 16, 2001 GENERAL: The scope of this project includes the installation of a 1250 gallon septic tank and a new absorption bed to serve the proposed four bedroom residence located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit or ADEC Authority to Construct with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall b~ responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed f/'om soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department, or ADEC if required, for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" clcanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 7034 NORTH EAGLE RIVER LOOP · SUR'E 204 ,, EAGLE RIVER, ALA.~ KA 99577 Page 2 Lot 2, Block 5, Knik V~ew Estates October 16, 2001 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. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts. These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. LEACitFIELD BED INSTALLATION: Excavate the proposed Bed Area to the depth shown on the design. The bottom of the excavation shall bo within 2 inches of level. If the bottom of the excavation becomes smeared, it must be raked or scratched (ruffed-up) before gravel or sand placement. Ifa sand layer is required, place sand over entire excavation to the required depth shown on the design. The top of the sand layer must be within 2 inches oflevel. Sewer rock shall be placed uniformly throughout the entire bed. Perforated distribution pipe must be installed level with perforations down. Gravel depth below the perforated pipe shall be a minimum of six (6) inches. Gravel depth above the perforated pipe shall be a minimum of two (2) inches. The total gravel depth throughout the entire bed shall bo a minimum of twelve (12) inches. The perforated distribution pipes must be no more than six feet apart. The distance between the outermost perforated distribution pipes and the sidewall of the absorption bed must be no more than three feet. Silt barrier material must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed at 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 depth shall be perforated six (6) inches below the bottom of the horizontal distribution lines. The monitoring tube should not extend below the bottom of the gravel surface. 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 finished grade over the bed must be mounded to prevent the formation ora depression after settling. Page 3 Lot 2, Block S, Knlk V~ew Estates S/D October 16, 2001 8. A mound system is to have the upper six inches oftop soil and be seeded for vegetation. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must bc constructed by a Municipally approved septic tank manufacturer. 2. The follo~ving 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 F$i 0 (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 140N, 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 MOA or ADEC requirements. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the x~stewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation ofditches, pits, trenches, or beds and before the installation ofany gravel. A septic tank may be set in place, but may not be backfilled before this inspection. Page 4 Lot 2, Block 5, Knlk VTew Estates S,'D October 16, 2001 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 them 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 MOA permit or ADEC Authority to Construct. 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. 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 Engineefing'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 am MUNICIPALITY y24 Development Services Department -- Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-043-42 1. GENERAL INFORMATION Expiration Date: /- l2-2Dz�/ Complete legal description KNIK VIEW ESTATES BLOCK 5, LOT 2 Location (site address) 22407 KNIK VISTA STREET, CHUGIAK AK 99567 Current property owner(s) RALPH & TERRI VERNACCHIO Day phone Mailing address PO BOX 670369, CHUGIAK, AK 99567 Real estate agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ® Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Date of Payment /// 6/ -2- Receipt Receipt Number 510/575 COSA # Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 1/14/2022 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & _ FWC5 6. DSD SIGNATURE System #1 Approved for bedrooms System#2 Approved for bedrooms Disapproved z— __ ofsi�� fig. I% Curtis Huffman CE •'�i PROFES510NP Conditional approval for bedrooms, with the following sti rY(OFIr�i WATER AND m^ WAST] VIATER 0 -"" SERV B V� Original Certificate Date: ' M 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 Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other ^ Ir a4 p A CL J i s C DW] � Legal Description: KNIK VIEW ESTATES BLOCK 5, LOT 2 Parcel ID: 051-043-42 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system A. WELL DATA — PUBLIC WATER ❑ Well log is filed with Onsite (or attached) Date drilled Total depth _ft Cased to _ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) _in. Date of flow test for COSA Static water level at beginning of test _ft. Comments B. TANK DATA Age of tank(s) 20___ years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 50" ® Standpipes/foundation cleanout per record drawing Date of pumping 1/12/2022 D. ABSORPTION FIELD DATA Which system tested (date installed) 11/7/2001 ® ALL standpipes present per record drawing Total measured depth from grade *11.1 ft (max) Measured depth to pipe invert from grade *5.6 ft (min) ❑ N/A — pressurized field Well production at time of test _gpm Water storage tank volume_ gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate _mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station _. years Lift station material Comments: Adequacy test date 1/12/2022 Results R Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 600 gal New depth 0 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time <1 min depth into effective **5.7' OF THE 6' ED ®Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons . If yes, enter date Comments/Deficiencies: *MEASURED AT GRADE. **PER ELEVATIONS MEASURED AT NORTH MT/CO. FE E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No Neighboring Absorption Fields > 100' From Absorption Field on Lot to: (Please enter distances Animal Containment > 50' ❑ Yes if No ❑ Yes if No ft ft If absorption field is under driveway comment below Property Line ,> 10' Yes if No Manure/Animal Excreta Storage > 100' Wells on Adjacent Lots: Community Sewer Main > 75' ❑Yes _ if No ft ❑Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ft ft ft ft ft ® Yes if No ft Property Line > 5 ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells >' 100 _ ®Yes if No �niatArnal., >. 1n ®Yes If No CprmiVVallc > n'2Yes if No Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line ,> 10' Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. AW '•tq��l� ... •....... ..•,.• ..........�.... • �.. Curtis Huffman •: .1114/2922 PROFESSIONS' ft ft DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite 907-343-7904 t Fax: 343-7997 Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 2210101 Subdivision: Knik View Estates Blk 5 Lot 2 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 20 years old. Typical replacement costs range from $9,000 to $12,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 -year-old steel tank MAY look like. Mailingdress AdP O 13ox 196650 *Anchorage, Alaska 99519 6650 *www muni Municipality of Anchorage ® Development SetylcoS Department Building Safety Division On -Site Water and Wastewater program 4700 South Bragaw St. P.O. Box 196650 Anchorage, Ak 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O S`/ —0 1 3—'Y I HAA # . 11W0,20160 Expiration Date: �/ - 3 0 - O _--3, -I. GENERAL INFORMATION Complete legal description. Lot 2; Block 5; Knik View Estates Location (site address or directions) Knik Vista & Judd Drive Current Property owners) Rod Metcalf Day phone 862-2676 Mailing address 654 Harp Cir. Eagle River, AK 99577 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. - . Ai -- .113010. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site t❑= Public Water System 0 Public Sewer ❑ Erma 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 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 is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S Engineering Phone 694-2979 Address 17034 Eagle River Leep Eagle —R:U er, 99577 Engineer's Printed Name Robert C. Cowan Date �o �- 5. DSD SIGNATURE Approved for bedrooms. Disapproved. �C;ENGINEE !� ROEERT C. COWAN i �y tic;•.t CE -8801 ;°�•,�`' Conditional approval for bedrooms, with the following stipulations: Additional Comments �tttttfrt�rrrrr, J ON-SITE a 'TER m` ti AND A TFTC : v m PROGRAM - 4 oo \\ ✓ o a ap a ✓-� !0 aaaaaa �1 �� Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: { Orioinal Certificate Date: �7�' — ©' �• (Rev. 12/00) Municipality of Anchorage SAGE e Development Services Department Building Safety Division On -Site Water & Wastewater Program S A E 7 Y 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: )-,D, -T c-) 13LCCtC S knir1C v/i9c,..• A�-Sr,+rgs Parcel ID: OS 1 -003-ti".2 A. WELL DATA �� L) /3 1-1 L Lv,+-r Well type If A, B, or C provide PWSID # Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires proper otected (Y/N) Total depth ft. Cased to ft. sing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production WATER SAMPL SULTS: 13-0• colonies/100 ml. Nitrate mg./I. epic: mg./I. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Ste I' T ' e- L Tank size I a S-0 gal. Number of Compartments �2- Foundation cleanout O/N) Y'�-S Depression over tank (Yt9 Date of pumping N t A - Pumper C. ABSORPTION FIELD DATA Date installed /1 h /0 / Soil rating g. .d./ z or ft2/bdrm) ' Length a- ft. Width a- ft. Other bacteria _ colonies/100 ml. Collected by: Date installed ///-7/0 / Cleanouts (SG/N) 'Y -'L f High water alarm (Y/Lqj �� p6iL/- System type 7-4 t- `K Gravel below pipe 6- ft. Total depth 1 ft. Eff. absorption area Soy ft2 Monitoring tube Y&j Depression over field *' Date of adequacy test W14 Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in. Water dded' gal. New depth in. Elapsed Time: min. Final fl d-de}5t in. Absorption rate >= g.p.d. Any rejuvenation treat past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum in Size in gallons "Pum em Cycles tested _ in. Ulaahoi€/-Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot Qn-a -' cent lots Public sewer main Public sewer manhole/cleanout Sewer /septic ruiee ine Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation t Property line t `t Absorption field S /� Water main /0 �f Water service line lo 4- Surface water J c 4 - Wells on adjacent lots �' f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line )d / Building foundation � Water main y '4 - Water Service line 1 f Surface water /00 f Driveway, parking/vehicle storage a- O Curtain drain Wells on adjacent lots a(9 0 f F. COMMENTS G. ENGINEER'S CERTIFICATIONAV ,> r�P;;.`� •r;���$�J4 1 certify that / have determined through field inspections and �1�y1 i �f• ,:• =• %�' E� review of Municipal records that the above systems are in ��•••� ` - -+ conformance with MOA HAA guidelines in effect on this date. 0 Engineer's Printed Name C cro -a POBWAN ^ p Date HAA Fee $ 3 ? S', y Date of Payment `f 3 S-- Receipt `Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number O ty) 25 1 S 00010'12'E 65.17'(M) S 00002'03"E 105.05' (M) S 00007'26"E 65.10' (R) S 00005'06"E 105.03' (R) I O tY3 KNIK VISTA STREET 12/31 /01 AS BUILT 53-75 9/19/01 PLOT PLAN 52-68A DATE FLD. BK. ,tit;.• •' � X48 •. *i •. •��.e.ee�vV.p e.s*i 0 Willi D. Fleming ���, •'.• i 5-5773 � 01 a s%1fias►onox �►�`•� NOTES: Easements not appearing on record subdivision plat are not shown unless description of easement is provided by client. It is the responsibility of the owner or builder, prior to construction, to verify proposed building grade relative to finish grade and utilities connections, and to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Elevations based on assumed datum unless otherwise indicated, and bearings and distances are record data. sas SS Engineering 17034 EAGLE RIVER LOOP ROAD ngineneering EAGLE RIVER, ALASKA 99577 (907)694-2979 LEGAL DESCRIPTION LOT 2, BLOCK 5, KNIK VIEW ESTATES I PLAT 110. 1 SCALE I GRID I 86-1 13 1"=30' I NW 1558 BASIS 206.00' (R) S 00005'06"E 206.07' (M) 1 KeyB. M 1 4" PVC SEPTIC o 0 r STD -PIPES (TYP)•--• o Q 2.0' x 8.8' N 1 t o CANT. 1 2 O ' DECK o i a� 110 o t N N LI)cn 72.0' O ; ULLJ rn°� CP J Lit UJ W N N EXISTING HOUSE N CT 1 00 Co W a 0 5.5' 1 V a) a) J Co Co 'y 5 .a cu 37.5' ( O $0 DECK 68.1 ' t - 3 I �1 7J c 1 Q �; I � m / —E---- --—— — — — — — — —————————————————.--——————————————— / —- - _LINE ESMT_ 10' ELEC. 8 TELECOM. ESMT._\- O ty) 25 1 S 00010'12'E 65.17'(M) S 00002'03"E 105.05' (M) S 00007'26"E 65.10' (R) S 00005'06"E 105.03' (R) I O tY3 KNIK VISTA STREET 12/31 /01 AS BUILT 53-75 9/19/01 PLOT PLAN 52-68A DATE FLD. BK. ,tit;.• •' � X48 •. *i •. •��.e.ee�vV.p e.s*i 0 Willi D. Fleming ���, •'.• i 5-5773 � 01 a s%1fias►onox �►�`•� NOTES: Easements not appearing on record subdivision plat are not shown unless description of easement is provided by client. It is the responsibility of the owner or builder, prior to construction, to verify proposed building grade relative to finish grade and utilities connections, and to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Elevations based on assumed datum unless otherwise indicated, and bearings and distances are record data. sas SS Engineering 17034 EAGLE RIVER LOOP ROAD ngineneering EAGLE RIVER, ALASKA 99577 (907)694-2979 LEGAL DESCRIPTION LOT 2, BLOCK 5, KNIK VIEW ESTATES I PLAT 110. 1 SCALE I GRID I 86-1 13 1"=30' I NW 1558