HomeMy WebLinkAboutKNIK VIEW BLK 4 LT 2Knl*k View
Block 4
Lot 2
#051-031-58
\u\ Municipality of Anchorage
Development Services Department iF 7 Yr -
Building Safety Division
On -Site Water and Wastewater Program, 4700 Bragaw SL
P.O. Box 196650 Anchorage. AK 9951M650 Page of3
www.ci.anchorage sk.us (907) 343.7904
ON-SITEASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
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Permit Number: S V �� PID Number: ()Sz -6F 1--��
Na"" Nk
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Wastewater System: ❑ New Upgrade
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ABSORPTION FIELD
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Total Depen Iran alPrul W11011/'1
LEGAL DESCRIPTION
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Gravel deph ale ppe
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SEPARATION DISTANCES
14 Septic ❑ Holding ❑ S.T.E P. ❑ Other.
To
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Inspections performed by:17034 Eagle River I* Read dsEmes:
Eagle River, Alaska 99577
2nd!j��
Development Services Department Approval
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Conditional Approval Date:...
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Reviewed and approved by:_NAC-d,Date:
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PERMIT NO.SW070078
PACE 2 OF 3
Municipalit of Anchorage
DEPARTMENT OF HEZTH 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 2 BLOCK 4 KNIK VIEW S/D P.I.D. No. 051-031-58
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PERMIT N0. SW070078 PACE 3 OF 3
Municipalit of Anchora e
DEPARTMENT OF HEATH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Bax 196650 •Anchorage, Alaska 99519-6650 • Telephone 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 2 BLOCK 4, KNIK VIEW S/D P.I.D. No. 051-031-58
FINAL GRADE
100.7'
DBLFT00. & DQL2 100.2'
n 100.4-
INSULATION
97.8' ' I NEW 1300 GAL.
POLY. TANK
DIST. LINE=98.8'
97.5
fY: DISCHARGE PIPE
550 GALLON FAT ALBERT
WITH PUMP ASSEMBLY
GRADE
INSULATION
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GROUNDWATER AT 94.5'
92.5' B.O.H.
CRADE
BOTTOM OF SAND=96.5'
A
B
C
FCO
-
1 15.0
33.0
ST1
-
1 26.5
40.0
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-
1 29.0
42.5
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30.0
37.0
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-
30.5
44.5
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-
31.5
45.5
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-
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46.0
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34.0
42.5
-
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24.0
35.0
-
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22.5
34.0
-
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47.0
1 33.5
-
97.5
fY: DISCHARGE PIPE
550 GALLON FAT ALBERT
WITH PUMP ASSEMBLY
GRADE
INSULATION
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GROUNDWATER AT 94.5'
92.5' B.O.H.
CRADE
BOTTOM OF SAND=96.5'
MUNICIPALITY OF ANCHORAGE tiC
Development Services Department O
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
`��
P.O. Box 196650, Anchorage, AK 99519.6650 �\
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: May 29, 2007
Expiration Date: May 28, 2008
Permit Number: SW070078 Parcel ID: 051-031-58
Legal Description: KNIK VIEW BLK 4 LT 2
Design Engineer: 0003 S & S ENGINEERING Site Address: 022145 BIRCH CREEK DR
Owner Name: ROB ROBINSON Lot Size: 46100 SO. FT.
Owner Address: PO BOX 672288 Total Bedrooms: 4 Permit Bedrooms: 4
CHUGIAK , AK 99567 -
This permit is for the construction of:
❑✓ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specked 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 dosed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By
Issued By.
Date: 6
Date: 6/12,1.-7
Municipality of Anchorage .
Development Services Department ..._:
Building Safety Division
-� On -Site Water and Wastewater Program :. .,.
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
ON-SITE SEPTIC/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
Property owner(s) Rob ICO
� IV15 )n
Day phone
Rox 67ZAS
Zip Code
Ji 7
Mailing addressAO
Site address a21 15- LA
Iteet bink
Zip Code
Legal description (Sub'd, Block & Lot) Zo_;-C Pi fog
% 11s
Legal description (Township,
Section & Range)
/ 1
—7
Lot Size , fob
Sq. Ft. Number of Bedrooms
THIS APPLICATION IS FOR (®all that apply):
THIS APPLICATION IS AN:
❑1
Absorption Field
Initial
Septic Tank
❑
Upgrade
❑
Holding Tank
❑
Renewal
Privy
❑
Private Well
❑
Water Storage
❑
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.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Waiver Fees:
Date of Payment:
Receipt Number. 0E3� Receipt Number:
(Rev. 11/05)
PEALTNALRHORRY
APPROVALS
SEWERSWATER
IAWNEMENSIONS
SEWERaWATER
NSPECRCN
ENGINEERINGSTUpES
ANDREPORTS
WELLINSPECRON
i PLOW TEST
SREPLANS
m
SOATEST
PERCOLATION
TEST
STRicNRALi
LECHNFCAL
WSPECTIONS
CN SRE
WASTEWATER
DSPOSALS"TE4
DESIGN
ROBERT C. COWAN. P.E.
ROBERTA. SHAFER, P.E.
CML ENGINEERS
(907)694-2979
FAX(907)694-1211
May 23, 2007
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK 99519
REFERENCE: Lot 2; Block 4; Knik View Subdivision #2
It is requested that you issue a permit to install a septic system upgrade to serve the
existing four bedroom dwelling on the referenced property.
A test hole was excavated and a percolation test performed. The approximate location of
the test hole is located on the attached site plan. At the time of excavation 4/18/07, ground
water was found at 4 feet. After monitoring, ground water was found at 4 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,
Robert C. Cowan, P.E.
RCC/bjj
Enclosure
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Municipality of Anchorage
Development Services Deparllnenl
Building Safely Division
On -Site Water and Wastewater Program
4700 South Dragaw SI.
P.O. Dox 196650 Anchorage, AK 995196650
w•�'w S1.4PSrh2@94_Ek,u3
(907) 343.7904
y j ROBERT C. COWAN W
1 f` CE -8801
1.1��~�'•........ .i
�&ott oc� -Percolation Test ����''-���
Performed For: 7-)07'
OBIIV60rV Dale Performed:
Legal Desclipllon: Township, Range, Section:
,/ Slope
Depth
1 -EEA -0124,AMICS
7-
0-
9-
10-
11-
12.
13-
14-
15-i7f �ef!
COMMENTS
S
WASGROUNDWAIER
Dale
ENCOUNTERED?
IE�J
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Depth to Water
Net Drop
IF YES, AI WIIAi DEP1117
y, L L
Depth to Water Allero
a
1010,11100"g?1
E
Dale:
j ]f
F
Reading
Dale
Gross Tyne
Nei TWO
Depth to Water
Net Drop
owK
5 a
v
a
9"
a
zi
)Y "
F 11
4V
D
141"
ab
YZI
r5
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l
PERCOLATION RATE a _Ird.ml•.w ) PERC IIOLE DIAMCIER b..
TEST RUN BETWEEN a FT AND '3 1 rT
PERFORML'DDY: S� 1 1�.., CERTIFY TI IAT HITS 1 EST WAS
PERFORMED IN ACCORDANCE- Willi ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT Oil 111ts DATE. DAl E:
S&
1EAURA THOTSTY
APPROVALS
SEWER& WATER
MAN E CTE1aaNS
SEWER & WATER
MPECTION
ENONEERYlGSTUOES
ANOREPORTS
WELLHSPECTION
& FLOW TEST
SITE PLANS
SOIL TEST
PERCOLATION
TEST
STRUCTURAL i
MECIWaCAL
R SPECTIONS
ONSITE
WASTEWATER
DOPOSALSYSTENI
MIGN
nOBERTC. COWAN, P.E.
nOBERTA. SHAFER, P.E.
CML ENGINEERS
(907)694-2979
FAX(907)694.1211
INTERbIITTANT DOSING SAND FILTER SPECIFICATIONS
Lot 2, Block 4, Knik View Subdivision #2
May 23, 2007
GENERAL STATEMENT OF WORK
The work and plans covered by these specifications consist of furnishing all labor,
materials, tools, transportation, and equipment necessary to complete an Intermittent Dosing
Sand Filter system as described herein and on the attached drawings.
All work under this project shall comply with current Municipality of Anchorage (MOA)
Regulations.
The scope of this project includes the installation of a new 1300 gallon HDPE septic tank, a
550 gallon Fat Albert S.T.E.P. tank, and a new I.D.S.F. septic system to serve the proposed
four bedroom residence located on the referenced property.
SITE INVESTIGATION
The Contractor must carefully examine the project documents, have full knowledge thereof,
have investigated the site, and be satisfied with the conditions affecting the work.
Conditions include, but are not limited to those bearing upon transportation, disposal,
handling and storage of materials, availability of labor, water, electric power, roads, and
uncertainties of weather, physical conditions at the site including all underground utilities,
the conformation and condition of the ground, the character of equipment and facilities
needed preliminary to and during prosecution of the work. The Contractor must be satisfied
with the character, quality and quantity of surface and subsurface materials or obstacles to
be encountered. Any failure by the Contractor to become acquainted with the available
information will not relieve him/her from responsibility of performing the work as stated in
these specifications and drawings.
Location of utilities will be the contractor's responsibility.
Page 2
Lot 2. Block 4, Knik View Subdlvislon 02
May 20, 2007
SEPTIC TANK / LIFT STATION / AIR COMPRESSOR
A. General
The work under this section consists of the performance of all operations pertaining to
furnishing and installing the septic tank/lift station, air compressor and piping to the sand
filter.
B. Materials
1. Tank
a. Septic tank shall be a two compartment tank of at least the minimum size
indicated on the drawings and MOA approved.
b. First compartment shall have a separate 4" pump -out riser. The second compartment
shall have a separate 4" pump -out riser.
2. Manhole Riser or Lift Station Tank
a. An additional second compartment manhole riser shall be capable of being equipped with
the following:
1. A junction (Nema 4x) box or equal, bonded or attached to
the pump basin.
2. UL listed electrical cord grips, installed in the J -box.
RM
b. An additional tank (M.O.A. approved) may be provided for the
effluent pumping assembly and the items in (a.) above.
3. Effluent Pumping Assembly, Controls, Alarm & Piping
a. Effluent pumping assembly shall be of approved materials, including the following:
1. A 110 volt or equal U.L. Listed effluent pump.
2. High-density PVC cylinder housing the pump, with level
controls and screen, serving as a baffle to prevent the screen
from clogging.
Pape
Lot 2, Block 4, Knik View Subdivision 02
May 23, 2007
3. All piping shall be PVC or other non -corroding material.
b. Pump controls and alarm system shall be an approved system with the following options
consisting of:
1. Event counter
2. Elapsed time meter
3. Program timer
4. 10 watt heater
5. Remote alarm panel option with a minimum of 80 DB
sound pressure at 24", operating temperature 30AC to
65AC, continuous sound to be located in the home.
6. Oil -tight visual alarm with push -to -silence feature.
Automatic audio -alarm reset.
7. 15 amp motor rated toggle switch, double pole, double
throw with three positions; manual (man), automatic (auto)
and center (off) (H.O.A.).
8. Nema 4x -rated, fiberglass, or equal, enclosure with hinged
cover.
9. All controls to be installed as per manufacturer's
recommendations.
10. Control panel to be installed on outside wall of home within
sight of septic tank/lift station.
c. Piping from the septic tank to the sand filter is to be 1 1/4" PVC schedule 40 solvent weld
piping properly bedded as described in Materials Specifications and sloped to drain back
to the lift station. Insulation board 2" thick and 2' wide centered over pipe is to be placed
where soil cover is less than 4' depth over pipe.
d. The airline from the house to the filter is to be HDPE arctic insulated pipe 3/4"-2" SDR -
11. The compressor will have a gauge (0-10 psi) and be extended into the living area or
garage for easy monitoring by home occupants.
Page 4
Lot 2, Block 4, Knik View Subdlvlslon 02
May 23, 2007
4. Air Compressor
a. Air compressor shall be a THOMAS LtrtEAR SERIES model number 5060-A or 507OV-A or
M.O.A. approved equal.
CONSTRUCTION SEQUENCE
In order to insure proper installation, the system is recommended to be installed in the following order:
I. Sewer line from house to tank
II. Septic tank/lift station
III. Sand filter
IV. Leachfield bed (if required)
V. Final grading
CONSTRUCTION
1. Construction Instruments
Contractor shall provide instruments such as transits, or levels, for establishing proper
elevations and levelness of pipe or materials.
2. Pipe Laying
All pipe shall be laid with material free of large or sharp rocks and organic matter.
Each section of pipe shall be handled carefully and placed accurately. The spigot end shall
be fully inserted pointing in the direction of flow and glued in place to make a water tight
seal.
Each section of pipe shall be properly supported to insure true alignment and an invert
which is smooth and free from roughness or irregularity.
At all times, when work is not in progress, open ends of pipe and fittings shall be closed
so that no undesirable substance will enter the end of the pipe or fittings.
Pape 5
Lot 2, Block 4, Knik View Subdivision 02
May 23, 2007
3. Bedding of Pipe for Sewer Lines
The pipe should be bedded with materials free of large or sharp rocks and organic matter,
compacted. Native materials may be used as back fill material above the pipe, provided it is
free of large rocks and organic matter.
All lift stations shall be installed in accordance with the manufacturer's recommendations
and standards. Electrical installation is to be in accordance with the National Electric Code
(latest adopted edition) by a licensed electrical contractor, with M.O.A. inspection where
required. If MOA inspection is not required, a licensed electrician is to provide a letter to the
Engineer stating that the system meets or exceeds all applicable codes.
4. Excavation
Excavate to proper depth to allow gravity flow, install tank level, tolerance 0.05 foot, on
undisturbed or compacted classified sand fill material.
Create a level sand surface over the tank and add 2" burial foam +35 PSI directly over
tank. Mound unclassified soil over tank with a minimum of 2 feet of cover and anti -flotation
weights that maybe required in areas of shallow ground water.
5. Connections
All connections to be as per MOA requirements, PVC 3034 piping with Caulder or
equivalent couplings for inlet riser pipes.
All tank connections are to be completely water tight.
Pape 6
Lot 2, Block 4, Knik View Subdlvlalon 92
May 23, 2007
SAND FILTER
The work under this section consists of the performance of all operations pertaining to famishing and
installing the sand filter.
A. Materials
1. Sand Filter
a. Liner (if required - not required for bottomless sand filter) - OSI Model LI or
equivalent. 30 mil PVC cut and fabricated to provide water tight enclosure of
filter sand volume. Seams to be permanent as per Manufacturer's
recommendations. All connections, such as boot flanges, through sand filter to
be permanently bonded to the liner.
b. The Contractor shall provide a washed sand to meet ASTM C-33 Concrete Sand
Specifications with the additional requirement that all but 1% of the materials
passing the #100 sieve be removed. All aand shall be approved for use by the
Municipality of Anchorage (M.O.A.). If the sample does not meet specifications,
all sand will be removed and replaced.
c. The Contractor shall be responsible for providing pea gravel that shall be a
washed material containing no fines (0% passing the #100 sieve) and a
maximum size of 1/4" diameter.
d. The Contractor shall provide the manifold assembly. The manifold assembly
shall be of approved materials with orifice shields and flushing assembly. All
drilled holes to be cleaned of burrs and pipes flushed, prior to assembly.
Flushing valve to include riser to finish grade. Lateral distribution piping is to be
laid level (@ t 0.05').
e. Sidewalls and top of the filter box to be insulated with 2" direct burial polystyrene
insulation.
f. The Contractor shall be responsible for providing filter fabric.
g. Air coil in sand filter to be geoflow WF16-4-24 150 LF placed 6" above bottom
of sand.
Page 7
Lot 2, Block 4, Knik View Subdlvlalon 92
May 20, 2007
Construction of Sand Filter
The sand filter construction is to follow procedures as outlined below, as applicable to this
design.
Pea gravel and filter sand are to be hand leveled to proper depth (tolerance within 0.05 feet)
in filter, taking care not to allow mud or fine soil material into the filter or gravel layer. This
would include any soil material picked up by excavation machinery buckets while loading
specified material. The Contractor should estimate filter material volumes such that
allowance is made for wastage of material in contact with the ground at site.
The area over the sand filter to be finish graded with a minimum of 2 feet of cover and to
prevent ponding of surface water runoff. Side slopes shall not exceed 3:1.
The Engineer will reject any sand or pea gravel that does not meet specifications or is
contaminated in transit or while handling. If such material is placed in the filter, all soil
material maybe required to be removed and replaced with new material.
CONTRACTOR/ INSTALLER
Municipality of Anchorage
Development Services Department
Building Safety Division ,
On-Site Water and Wastewater Program, 4700 S. Bragaw Sl.
P.O. Box 196650 Anchorage. AK 99519-6650 Page I Of 3
www.cl.anchorage.ak.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM ANDIOR WELL INSPECTION REPORT
Permit tfumber: S LJ010 1 oZ PID Number: 051 — 031— S51
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El System: )KNew Upgrade
Adis..
Co 130x q99 OctJv%.WA V37
ABSORPTION FIELD
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LEGAL DESCRIPTION
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we C i'
YeNO Purylarr'
Cn.gIMQVA1wwGw.tl
TANK
a0 WM V K rt.
of rL
SEPARATION DISTANCES
N Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
Tok8eAbsorption
Lin
Holding
Pubnwdvat
M xtu.r , (�
Ce y
From
Field
Station
Tank
Sewer Line/'e
I i'Q ICS
3 QOr
105 `
--
--
a5 +
Mr«w H D AE
r Dw p«,meN,
`*9
WeL
3.1Kw„«
100.
LIFT STATION
fDLLw
Un.��LH
rw..ar�w.
'poop «rrw r. •pup em ..
IlpM1 vm«r«m«
in .,
w
None
Kh0
p"pMM.aMoOr «per mp.Ubn.p.namMw
APFRavao 14N40
BENCH MARK
Laaowl r1a a.wwa+:O
.
j
)nSr,�lL-ILA Vt-04.2 S,wt2 R.Grt
G
.{.
ON (.a I
II 11 A..u11M EM•r.'.
100 rl
Engineer's Stamp
F
5R S ENGINEERING
�t
11t 1Q-1 „O1
Eagle River Loop Road, NO.River,
Inspections
l� ,r vY�VT-� •.�
.
performed by:'170le Alaiike 995=
Eag
2nd 10-17-01
'��.�.- • •• .. �,,�"-�..•.....
Develdpmeltt ervices Department Approval
pec, ItOBERT C. CAN
E E801
�OZ�sr�ti.,
+':J�•�
Reviewed Date:awed and approved by: .�
•,�ti-
PERMIT N0. SWO101 28
PACE 2 OF 3
Municipalit of Anchorage
DEPARTMENT OF HEA�TH 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 2, BLOCK 4, KNIK VIEW S/D P.I.D. No. 051-031-58
LOT 3
� n
/ II II
/ II II
/ THN4J�' I I
Xz
u u
u u
✓� O� A TBM
O
FCO cot
e«0�° h7
V - V"I
NEW 1300 GALLON ♦ i
PERMIT No. SWO10128
PAGE 3 OF 3
Municipalit of Anchorage
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 REPORT
LEGAL LOT 2, BLOCK 4, KNIK VIEW S/D P.I.O. NO. 051-031-58
WATER FOUND ® 91.1'
88.1' B.O.H.
N. T. S.
ST1 S
100.1'
FINAL GRADE
2" INSULATION
NEW
96 $�
1300 GALLON
POLYETHYLENE
96.5'
SEPTIC TANK
CO1
CO2
MT1 CO3
6IT3
COl = 99.4'
MT2 C04
MT4 CO2
= 100.3'
CO3 = 100.3'
C04
= 100.2'
FINAL GRADE
2" INSULATION
-V
g
'
CO1 = 96.0'
CO2 =
96.4'
CO3
11 ND4.„=;
= 96.0
SR
:.
i
C04 =
96.5'
MTl = 95.1'
MT3 = 95.1'
(SAND';;;
hIT4 =
95.9'
MT2 = 95.9'
WATER FOUND ® 91.1'
88.1' B.O.H.
N. T. S.
Certf f f eb �rltttng log
by
nnc CO. ew
SULLIVAN WATER WELLS
P.O. BOX 670272, GHUGIAK• ALASKA 99567 • TELEPHONE 588.2750
OWNER OF LAND: X e /_f M&_4 ZE_i
ADDRESS:
LEGAL DESCRIPTION: —jrn] i IG U I E W _fi/ Vn
I►3�e g .� n 7~ot
DATE:? /J
PERMIT NUMBER: d/o /ale DateofIssue3__a7j_'e�4_Qj
TAX IDENTIFICATION NUMBER: on 5'1 - 03 L-_-�e
Is well located at approved permit location? "s U No
Method of Drilling: 4 -dT -rotary a cable tool
Depth of well: C J
Casing Type 7 E L Wall Thickness Inches
Diameter inches, depth % feet
Liner Type: /d �J I^ 9E
Casing Stickup Above Ground: oZ feet
Static Water Level: a feet
Recover Rate: VO gpm
Method of Testing: 4-11L
Well
"/1-
Well Intake Opening Type: 4 e -n end 3 open hole
U Screened; Startfeet Stopped feet
0 Perforations Start _ fee(( opped feet
4=01;1r!1
Grout Type: p�"JiTis Volume l.Sil[�S
Depth: from feet, to feet
Well Disinfected Upon Completion? lyres O No
Method of Disinfection: f A -
Comments:
MULL UAIA
Driller's Name
OJ�rL B41QD
.S�iry SA -JO S�6.tA✓cL
J -Pc T r J,4./IU S/x .0,4 d6e
&Ll0 7 K tr*.J llz �d 4z
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.
T8 39vd NdnITT6 65ZZ869 E0:86 666T/T8/T0
` //5
MUNICIPALITY OF ANCHORAGE /0
Development Services Department
On -Site Water&Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM /WATER SUPPLY PERMIT
Initial
Permit Number: SWO10128
Date Issued: May 23, 2001
Expiration Date: May 23, 2002
Parcel ID: 051-031-58
Legal Description: KNIK VIEW SUBDIVISION BLOCK 4 LOT 2
Design Engineer: 0003 S & S Engineering Site Address: NHN BIRCH CREEK DRIVE
Owner Name: TED SCHMELZER Lot Size: 46100 SQ. FT.
Owner Address: NHN BIRCH CREEK DRIVE Total Bedrooms: 4 Permit Bedrooms: 4
CHUGIAK , AK 99567 -
This permit is for the construction of:
❑,/ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy
All construction must be in accordance with:
1. The attached approved design.
❑✓ Private Well ❑ Water Storage
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 By:
Issued By:
Date: `%' O
Date:
Municipality of Anchorage.
.. Development Services Department s® •;
Building Safety Division
On -Site Water and Wastewater Program • • .
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.enchorage.ek.us
(907) 343-7904
ON-SITE SEWERIWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0-5-1- 0 3 I — S8 Permit Number —SW—OLD/V8
Property owner(s) -t" I` D S f+m t L 'Z_ 'L 2 Day phone
c -
Mailing address (1) N e S 1✓A R 3 7
_SI�T
Mailing address (2)WHY D I RC N CREEK DRIVE Zip Code 99567
Legal description (Lot, Block & Sub'd.) L o T- a (3 L o c K 4 ko r K
Legal description (Section, Township & Range)
Lot Size _1.1. �S—/Acre
Sq.Ft.
Number of Bedrooms /
46 10010-it-
oo10-ir.THIS
THISAPPLICATION IS FOR:
El
Only
❑
Well'Only
❑
Sewer and Well
®
Water Storage
Sewer Upgrade
❑
THIS PROPERTY CONTAINS:
ElHot
Tub
13Jacuzzi
❑
Swimming Pool
❑
Water Softening Unit
Therapy Pool
❑
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.
S & S ENGINEERING
17034 17034 Eagle River Loop Road No. 204 / Z.
(Signature of property owner or authorized agent)
{( 1, qO co
Permit Fees: -/ •Y
Date of Payment: s/ $ /a f
Receipt Number: 00 '( Oa -1
(Rev. 12100)
Waiver Fees:
Date of Payment:
Receipt Number:
ROBERT C. COWAN. P.E.
CMLENGINEEFtS
(907)694.2979
FAX(907)694.1211
May 7, 2001
AALSNOPor
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
SEWER&WATER
M4 OMNSKM
REFERENCE: Lot 2, Block 4, Knik View S/D
SEWER& WATER
MSPECTION
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.
Two test holes were excavated and percolation tests performed. The approximate locations
ENaNEEMIGSTIAIES
ANOREPMS
of the test holes are located on the attached site plan. At the time of excavation 8/1/95
water was found at 6.0 feet. After ground water monitoring, water was found at 7.0 feet.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
WELL06PECTION
&nOWTEST
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.
SITE RAMS
If you require additional information, please contact us.
Sincerely,
ROADOESKM
SOIL TEST
Robert C. Cowan, P.E.
RCC/bjj
Enclosure
PEFCWT*N
TEST
STRUMPRAL &
EECKMICAL
MPECTIONS
ONSITE
WASTEWATER
CISPO6N.SYSTEM
MtGN
17034 NORTH EAGLE RIVER LOOP • SUfTE 204 • EAGLE RIVER. ALASKA 99577
O
LD
z
U
to
W
LOT 2, BLOCK 4, KNIK VIEW S D
B.J.J. I R.C.C. 1 5-7-01 1 OF 1
nginerring DESI�T CRITERIA:
4 BDRM - 600 GPD
SOILS = 1. GPD/SQ.FT. /
600/1.0 = 0 SQ.FT. REQ'D. / Q
17014 EAGLERIVE RIVER LOOP ROA577 LOT 7 _` '/ /
EAGLE HO IE# ( ALASKA 99577 /
PNONE/ (907)69!-7979 �
iA%/ (907)69!-1711 � / % /Q
DRAINFIELD CRITERIA: /
3.0' DEEP (ADD 1' M.O.A. APPROVED SA
EFFECTIVE
5.0' EFFE
120' LONG (2 ® 60' EACH)///
Q
UNDEVELOPED
LOT 8 /f7
�GC / PROPOSED iH ! LOT 1
1100 WLLOR
PMTEENYLENE / y,
/
SEP rIC TAN% I I
A Q/ ALL co u U �UNDEVEIOPED
DOUBLE
/4 CLEANOUT
A, Q / Z�p� DE OT
// / / M �•p MSA
Q SLOW
rur: : srunER
/ LOT 3 / 700• N=
W C
Op R rur:
/ / OSfOJ rUs
UN EVELOPED
Q
SY EFL
D O
1. CUTIOY.
BLM LOT 57
UNDEVELOPED
�, o
(kl... ......
ROBERT C COWAN
Flo CE -8801
++ lfa'' .. .•• +'
CONTRACT R IS
OBTAIN UTILITY
PRIOR TO ANY
WORK.
W I
I
c�
I
>
io
a
C
PEAK
LEGAI
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
16
19
2C
TEST RUN BETWEEN 7 FT AND 7 FT
COMMENTS
PERFORMED BY: 1 IVBS S ENGINEERING I trl �, CERTIFY THAT THIS TEST WAS PERFORMED IN
Eagle a' 00(7 08 O. )/910
�� G
ACCORDANCE WIlF"f*RTWTQ AkMb&.MiFAL GUIDELINES IN EFFECT ON THIS DATE DATE:
72 -MB (Aft. 4/85)
C
PERFO
LEGAL
1
2
3
4
5
6
7
6
9
10
11
12
13
14
15
16
17
18
19
20
TEST RUN BETWEEN S FT AND 'I FT
COMMENTS ?• H. # 3A
PERFORMED BY: S S $ ENGINEERING -
11034 49 YeY-` CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH A",T6TAAmpAIWk6 5VjIDELINES IN EFFECT ON THIS DATE. DATE g �4 Sr
72-008(Rev. 4/85)
EIgmeek
ROBERT C.COWAN,P.E.
CMLENOINEERS
(907)694-2979
TffiG
FAX(907)694-1211
ON-SITE WASTEWATER DISPOSAL SYSTEM
W_kn41tfH0FM
CONSTRUCTION PRACTICES
kTAOV&s
and
MATERIAL SPECIFICATIONS
SMRAWATER
I4NEXTENSI0N5
REFERENCE: Lot 2, Block 4, Knik View S/D
July 7, 2000
$MnLWATER
Irnenw
GENERAL:
1. The scope of this project includes the installation of a 1300 gallon Premier
polyethylene septic tank and .A drainfield trenchsto serve the proposed four
tNaWVW4Sn"M
bedroom residence located on the referenced property.
ANOREPoRTS
2. Construction shall be in accordance with the approved site plan and design
drawings, Municipal permit with any special provisions or conditions, and all
WMMKCTION
applicable State and Municipal Wastewater Disposal Regulations.
A FLOW TEST
3. The contractor shall be responsible for obtaining any necessary underground
utility locates.
SITEMAM
4. Unless specifically agreed otherwise, the property owner shall be responsible
for final grading areas subsequently depressed from soil settling.
hDADDESM
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
&M tEST
Department.
SEPTIC TANK INSTALLATION:
kKoLATION
TEST
1. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
hTMOMPAI
2. The septic tank shall be sufficiently bedded to prevent settling or shifting of
AL
04PEOTIONS
the tank.
ONSITE
WASTM4TEA
bwFack"TW
OESION
i7o34 NORTH tAGLt RNEri LbOP I SURE 204 + EAmi RIVER, ALASKA 99577
Papa 2
Lot 2, Block 4, Knik View SID
July 7, 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. In
the line between the tank and the leachfield there shall be two adjacent cleanouts (unless
an effluent pumping system exists within the septic tank). These cleanouts shall be
located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line,
shall be to clean toward the leachfield. The second cleanout shall be to clean toward the
septic tank.
6. Final grading over the septic tank shall be such that a positive slope exists away from the
septic tank.
ABSORPTION TRENCIUDRAINFIELD 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 sidewalis 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
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.
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.
Pago 3
Lot 2, Black 4, Knik View SIO
July 7, 2000
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Tyne of Pipe Perforated olid
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 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 M.O.A. or D.E.C. requirements, which ever requirement applies.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of the
wastewater disposal system. These inspections will occur as follows:
Paye 4
Lot 2, Block 4, Knik View SID
July 7, 2000
The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
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.
CONTRACTORANSTALLER
Parcel I.D. 051-031-58
Certificate of On -Site Systems Approval
Expiration Date: Ll(- 2-1
I
1. GENERAL INFORMATION
Complete legal description KNIK VIEW BLK 4 LT 2
Location (site address) 22145 Birch Creek Dr
Current pro Senn
property owners)
Day phone 227-8709
Mailing address
Real estate agent owner
Day phone
8 9 10 77
2. TYPE OF DWELLING:
rb V i
QSingle Family (w/wo, ADU)
e.
r_1 Duplex
Q JAN
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
ce" cu
Zz C�"N
01
6 9 L'�
4. TYPE OF WATER SUPPLY: TYPE
OF WASTEWATER DISPOSAL:
Private Well Z
Private Septic ED
Water Storage D
Holding Tank 0
Community Well E71
Community D
Public Water System D
Public Sewer 0
Waiver request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ S-0
Date of Payment 11 161,;z el 2 6
Receipt Number Ontiz -
COSA # d I n6-4
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 NorthRim Eng. Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng
6. DSD
/SIGNATURE
X System #1 Approved for � bedrooms
System #2 Approved for bedrooms
Disapproved
Date 119 /2fl
Conditional approval for bedrooms, with the following stipulations:
Original Certificate Date: �" �— ?O 2-C�
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
Septic System Advisory
Well Flow Advisory
COSA Checklist blue sheet
X Nitrate Advisory ;
Arsenic Adv'isory`
Other
f
Legal Description:
�ei7+�4gTI 77t
KNIK VIEW BLK 4 LT 2
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is riled with Onsite (or attached)
Date drilled $/27/01
Total depth 61 ft
Cased to 61 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 36+ in.
Date of flow test for COSA 12/30119
Static water level at beginning of test 9 ft.
Comments
B. TANK DATA
Age of tank(s) 10/01 years
Tank type/material HDPE
Measured operating fluid level in septic tank 53
OR Standpipes/foundation cleanout per record drawing
Date of pumping 12/19
D. ABSORPTION FIELD DATA 6/19/07
Which system tested (date installed) 6/19/07
❑ ALL standpipes. present per record drawing
Total measured depth from grade 5 ft (max)
Measured depth to pipe invert from grade ft (min)
❑ N/A —pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
Parcel ID: 051-031-58
Structure served by this system
Well production at time of test 5+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes ❑ N
9) Coliform bacteria is Negative
Nitrate 7_?mg/L ❑ Nitrate less than MRL (ND)
Arsenic N -b ug/L in Arsenic less than MRL (ND)
Collected by NRim Eng
Date of Sample
C. LIFT STATION
❑ Required maintenance completed
Age of lift station 6119107 years
Lift station material HDPE
Comments:
Adequacy test date 1213019
Results ❑✓ Pass For 4 bedrooms
Fluid depth prior to test 0 in
Water added 600 gal
New depth 2 in
Elapsed time 30 min
❑ 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) no
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies:
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less
than required or if community well)
Yes
if No
Septic Tank/Lift Station on Lot > 100'
If absorption field is under driveway comment below
Property Line > 10'
Community Sewer Manhole/Cleanout > 100'
Yes
Q✓ Yes
if No
ft
2 Yes
if No
ft
Neighboring Tank > 100' M Yes
if No
ft
Private Sewer/Septic Line > 25' M Yes
if No
ft
Absorption Field on Lot > 100' ❑✓ Yes
if No
ft
Holding Tank > 100' M Yes
if No
ft
Neighboring Absorption Fields > 100'
ft
Animal Containment > 50'✓Q Yes
if No
ft
M Yes
if No
ft
Community Sewer Main > 75' � Yes
if No
ft
Manure/Animal Excreta Storage > 100'
�✓ Yes
if No
ft
From Septic/Holding Tank on Lot to: (Please enter distances
if less than required)
Building Foundations > 10' 0 Yes
if No
ft
Surface Water > 100' Yes
if No
ft
Property Line > 5'✓(7 Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5' []✓ Yes
if No
ft
Private Wells > 100' Yes
if No
ft
Water Main > 10' M Yes
if No
ft
Community Wells > 200' F./I Yes
if No
ft
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'
V
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
✓0
Yes
if No
ft
Private Wells > 100' ❑ Yes if No ft
Water Service Line > 10'
M
Yes
if No
ft
Community Wells > 200' ❑ Yes if No ft
Surface Water > 100'
✓0
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that l 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.
COSA Checklist yellow sheet
ASBUILT
N�y�S37 y"'.tt/. /Y66J
I HEP.EBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
.f%a/,t- ���k/ 1✓� DoT z ,.e,� y .
AND THAT NO ENCR6A'CHMENfS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THr EXISTENCE OF ANY
EASEMENTS, COVENANTS~ OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
SEWARD & ASSOCIATES LAND SURVEYING
SCALE: ,
DATE - OF A
'
GRID r.... ... .....::..
.• DV en. Dari: Sew.rd
Fs: t �.� • Ls • � > x
4.y f,�"✓'
DRAWNiarn.
Rf.sz�
D
-I-': 9(j -
,Intermittent Dosing Sand Filter
Maintenance Log
;4) -
Owner Street Add -es
Phone Desc. PID
0
,Sludge level inch s -Pumping: required yes nd -Pumping completed Ye no
Absorption Field: Dee- �
-Liquid level inches -Flushing valves per approved design (I ae no
-Al( flushina valves opened, distribution liner, flushed, and flushing valves closed (I �__ _nG
Lift station:
.Pump basket cleaned Yes '10 J\O -BiOtLILIe effluent fftter cleaned ves no -
.Timer float settinc2 0 inches -High level float setin inches -RefferenCe point T''41 �-J' �'Z'
-Pump onseconds-PurnD off -minutes
*Cumulative lifetime cycles- *Cumulative run fime hours
-C)r%;ar:41;rNn satisfactory
Air System:
-Air purr p fifter cleaned(-Airoressure �5 ��) _rIO
*Date.oflatestins,t'allorrebuild 10
-- , -.1,P_-Air system operation satisfy ctorv% not satisfactory
Alarm System:
-Dedicated electrical circuit es no -Audible and visual afami inside dwelling
n Q y1a&O'
it settinnrh_
-Alarm system operation satis-iffiac'eni
g if -q,
Comments:
A
................ .......
g-_
............ .......
Maintenance Provider:
Technician
Date of maintenance
Cornpany
Signatu=re Date
MUNICIPALITY OF ANCHORAGE
,• ,, s ,;
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this _Day of�ti� ��- of 20 :�-c), by and between
herein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Svstems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as C r t c -7"
located at (legal description)
\'A SE ON
Y
2. Maintenance. Rermirs and Alterations.
A (Owner is required to read, understand and initial each section)
Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018)
Page 1 of 3
f Owner acknowledges that the Municipality palzty may request records of maintenance and
repairs fi•om the manufacturer's representative or maintenance provider.
411L Owner acknowledges that the fine for failing to maintain and repair an AWWTS maybe
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
M Owner agrees that the AWWTS installation and maintenance requirements.asrov'
p zded
by the AWWTS vendor/installer and approved by the Municipality are the governing
° guidelines for the construction, maintenance and repair of the Owner's AWNVTS.
Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or -unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018)
Page 2 of 3
OWNERt
By: (signahue) Date: -�411�27-0
ffffff-
(print name)
STATE OF ALASKA )
THIRD JUDICIAL DISTRICT ) ss.
MUNICIPALITY:
(signature) Date: -2 2- )—C9 0
--_(print name) Title:
(rev. 05/18/2018)
Page 3 of 3
c
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and 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
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0 51- 0 31- 55 COSA # 070,391
Expiration Date: 1/09
1. GENERAL INFORMATION
Complete legal description Lot 2: Block 4' Knik View subdivision
Location (site address) 22145 Birch Geek Dr.
Current Property owners) Rob Robinson
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone 2403386
'73ot old 16rwr A -id -4=e, A 0J9"
Unless otherwise requested, COSA will be held by DSO lorpickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
0
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site IZI
Individual Holding Tank ❑
Community On-site ❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal andlor water
supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation,
based on procedures outlined In the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water
supply and/or wastewater disposal system Is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations In effect at the time of Installation.
Name of Firm S s S Engineering
Phone 6942979
Address tss_ S. Birchwood Loop , CI1 ' k, AK 99567
Engineer's Printed Name
Date �
_ etc OF, il�r
S. DSD SJGNATURE
w A� F••
✓ oe tu7.s r
Approved for bedrooms. ✓'e,
a ••......••
Disapproved. t �pMtJt�a;e�,,,,t.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist _� Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By:
Original Certificate Date: q u
(R.. 11)05)
Municipality of Anchorage
• Development Services Department
Budding Safety Division
On -Sim water 6 WsV8 tffWT"9ram
4700 Bragaw Street
P.O. Box 198850
I. Anchorage, AK 99519-6850
L www.muni.orglonsits
�Y
(907)343-7904
'i CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
i
Legal Description: �T m It Parcel ID: O S' f
Ipp A. WELL DATA
C Well typeIVf4'I7✓ If A, B, or C provide PWSID #= Well Lo (&'N)
k
Ans
r
Date completed sanitary seal�l) �L3 wires properly w®+
otected)
p r + rr
Total depth �ft. Cased to I_ft. Casing height (above ground) %g + in.
FROM WELL
Lr
AT INSPECTION
Date of test Z� 0
Static water level �. O' ft. 5• t7 I ft.
Well production aD g.p.m. �.5 g.p.m.
i
y WATER SAMPLE RESULTS: �,(
Coliform �coloniesN00 mL Nitrate � mglL Other bacteria i� coloniesil(SmIL _
Arsenic: mgA Date of sample: e9 Collected by. g4—� �+WfRIIU6
B. SEPTICIHOLDING TANK DATA T'zi/o7
TankType/Material 1 C Date installed
Tank sine _IX -06 gal. Number of Compartments 'I_ Cleanouf�)
Foundation de ) _* Depression over tank (Y(%)t� High water alarm (Y®__A,.20_
t Date of pumping 3 Pumper � ZIS �t)MPIA)a
E C. ABSORPTION FIELD DATA - r C
Date installed I Soil rats (g.p.dlfe felbdnn) Re 0 System type +-.>.'9.1
i
Length _ft. Width ISI ft. Gravel below pipe tne as ft.
Total dept ft. Eff. absorption area 24L&ft Monitoring tube _k Depression over field _&�p
a
Date of adequacy test kkk-) —9-gismoi Results (Pass/Fall) G For 4 bedrooms
Fluid dept in absorption field before test = in. Water added= gal. New dept __� in.
Elapsed Time: min. Final fluid dept = in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM 6 type) If yes, give date
D. LIFT STATION
Date installed Size in gallonssr�c l .-ter Manhols®1) 7�
n �e �r n
"Pump on" level at W in. "Pump off"level level at X in. High water alarm level at in.
9
Datum CR>m Cycles tested Meets alarm &circuit requirements? \ r - J
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
t '
Septic tankAift station on lot /Q q On adjacent lots
Absorption field on lot j i g
Public sewer main QI/f
l�
Sewer /septic service line a*� S
r
Animal containment areas so f
On adjacent lots _ 100 /t
Public sewer manhole/cleanout
Holding tank _ SIJ.ZR
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation .5 tt Property line _Sr Absorption field S ,-+-
Water main A-) Water service line !O f Surface water
Wells on adjacent lots /� f
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
qI t
Property line Budding foundation 1:9C2 Water main
! Water Service line O t Surface water /!JO /-/- Driveway, parking/vehicle storage
An
Curtain drain _ "AlF KA)C+liIll) Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I car* that I have determined t
review of Municipal records (hat
conformance wdh MOA COSAfvuic
Engineer's Printed
Date
COSA Fee
Date of Payment _ `7 ( µ'!U// `1
Receipt Number
(Rev. 11105)
d field inspections and
above syste= 4m in
Waiver Fee $
Date of Payment
Receipt Number
6erl A. Not&
Mw 1411741
0
Municipality of Anchorage
.� Development Services Department
Building Safely Division
On -Site Water and Wastewater Program
4700 South Pragaw 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
Parcell.D. 051-031-58 HAA# H40Z035(0
Expiration Date: lv7lz l z_
1. GENERAL INFORMATION
Complete legal description , r Block r. va•k Viaw S,rbai 's:
Location(siteaddressordirections) NHN Birch Creek Dr.
Current Propertyowner(s) Ted Sphmclzer Day phone 227-6749
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
Day phone
Day phone
2 6, 7/2-4 /, z
TYPE OF WASTEWATER DISPOSAL:
R
Individual On-site
Ra
❑
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 S 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 dale 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 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,
,ean`d regulations In effect at the time of Installation.
�1 Name of Firm S & S Engineering Phone 694-2979 " K
Address17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577
Engineer's Printed Name Robert C. Cowan Date 7/7-G A Z
5. DSD SIGNATURE
v
Approved for 4—
_ Disapproved.
Conditional approval for
Additional Comments
C.
y, ROBERT C. COWAN
;Q, CE•8801
bedrooms.
bedrooms, with the following stipulations:
f)N-Ct7c '• Py
WATER AND NAE D m:
PROGRAM
oA,.
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By:' Original Certificate Date: Za [OL
J
1R" 12M)
Municipality of Anchorage •�
Development Services Department
Building Safety Division
On Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196850 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L-OY Krl c y/it W Parcel ID: O r / — 0 31 -.rb'
A. WELL DATA
Well type PAO v 01- t It A, B, or C provide PWSID # = Well Log &N) Y =
Date completed It -N -do I Sanitary seal &N) It—! Wires property protected ®/N) Y d !
Total depth _L—fL Cased to 6 / R Casing height (above ground) /g f in.
Date at test
Static water level
Well production
FROM WELL LOG
fL
WATER SAMPLE RESULTS:
W
Conform q colonies/100 nil.
Arsenic g
B. SEPTICIHOLDING TANK DATA
9.p -m.
Nitrate 0')- mggA.
Date of sample? hL10 s
Tank Type/Matertal SGprr (- Ago P E
Tar#K size 130o gal.'-., Number of Co,npMI rents
Foundation clesnout&) �Yt f Depression over tank me ^ o
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed
Length ) i o "rm, fL
AT INSPECTION
}
tJ R
g.p.m.
Soil rating (g.p.d.fe or R /bdrrn) _0
171"
S R
Other bacteria O colonies/100 nd.
Collected by¢ a 3INGMURING
17034 ZnWAlwr Loop Read Isla 2ft
£ogle Rlwr, Alarka !9377
Data Installed /0//7/01
Cleanouts&N) Ytl
High water atarm (Y!® #- D
5"4j,""/
System type '..4 4(« G N
Gravel below pipe 0 • r 1t.
Total depth _�L— R ER. absorption area 6 ao fe Monitoring tube Yt JJ Depression over field WO
Date of adequacy test Results (Pass/Fail) For � bedrooms
Fluid depth in absorption field before test i Water added_ gal. New depth_ in.
Elapsed Time: _ min.
depth _ in. Absorption rate >= g.p.d.
Any rejuvenatlo ment (past 12 mo.) (YM & type) If yes, give date
D. UFT STATION
Date installed
'Pump on" level at _ in.
Datum l
E. SEPARATION DISTANCES
Size in gallons
'Pump off level
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankMft station on lot /0 3 r
Absorption field on lot / 0 S' r
Public sewer main N 14
Sewer /septic service One. 3S
Manhole/Access
alarm level at in.
Meets alemr b circuit requirements?
On adjacent lots
On adjacent lots
/00
1pp 04
Public sewer manhole/cleanout P)4
Holding tank r✓�A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 16 Property ane 4N r Absorption field S
r
Water main Water service line / O t Surface water l 0 0
Wells on adjacent lots /00 14
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /0 Building foundation ar r . Water main At 1A
r
Water Service ane 10 f Surface water /00 r4 Driveway. parking/veNcle storage
Curtaki iirahi >evt>oawswr Wells on adjacent lots o0 +
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I car* that I have determined through field brspectlons and )141,
review of Municipal records that the above systems are in
conforman a with MOA HAA/guidelines in effect on this date.
AN
Engineer's Printed Name
Data -7/a 6 /0-1- it. ...... t
HAAFes $ 3 7S:°" +- rls'o (R..rH L
Date of Payment -71a-r, lo -z-
Receipt
Receipt Number 0 �t 3 2'17
(Rev. toot)
Waiver Fee $
Date of Payment
Receipt Number
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