Loading...
HomeMy WebLinkAboutKNIK VIEW ESTATES BLK 3 LT 4 & 50 Knik View Estates Block 3 Lot 4 & 5 #051- 043- 59 Municipality of Anchorage Page 1 of 3 Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 5W0xaa� 0 2 D 0 / (o PID Number: est= ' 0.57- 0" - Name: MM&M Contractirl Wastewater System: New Address: P.O. Box 670495. Chu iak AK 99567 ABSORPTION FIELD Phone: Number of Bedrooms: Deep Trench 688-1236 Four 4 LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: .45 GPD/FtZ 10 Ft. Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: 3 4 and 5 Knik View Eotateo 2 Ft. 8 Ft. Township: Range: Section: Fill added above original grade: Gravel Length: 1 Ft. 84 Ft. Well: Community Water Gravel width: Number of lines: Distance between lines: 116 3 Ft. 2 Ft. Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material: Clioo A Ft. Ft. 1,344 Ft2 ASTM 03034 PVC Driller: Date Drilled: Static Water Level: Installer: Date Installed: Ft. MM&M 10/9-15/02 Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other: TO Septic Absorption Lift Holding ublic/Private Manufacturer: Capacity in Gallons: From Tank Field Station Tank Sewer Line Anchorage Tank 1,250 Well >200' >200' N/A N/A >25' Material: 5tee1 Number of Compartments: Two 2 Surface Water >100' >100' N/A N/A LIFT STATION — NONE ON LOT Lot Line >5' >10' N/A N/A Size: Manufacturer: Gal. Foundation >5 >10 N/A N/A "Pump on" level at: in. "Pump off' level at: in. High water alarm at: in. Curtain Drain None Noted Pump Make & Model Electrical Inspections performed by: Remarks: BENCH MARK Location and Description: Finished Floor. Assumed Elevation: 100.0 Ft. Engineer's Stamp �.••'' Inspections performed by: _T_.L..._Kimbro_u�h Dates: 1' 10J_9L02 �;• : f y�9th %.•i.'':':� `..:er::Y"Slt .. 2nd 1n LV./�5L02 4 `�� MICHAEL F. ANDERSON••: t i Department of Health and Human Services approval No Reviewed and approved by: _ Date: 0 —03 %t:, CE_�s8, ••;'��� ## �F AW # �t;,11'FESS`���:��• .;-9 Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: SW020263 Cj `ate : • :_`,' w.* -': . �j Fater. Sen'�oe Page 2 of 3 PID No. 051-054-15 Sate` / 2Tri mF Four Bedroom 2 �a5 Home N J 6� H2a G6 5 e S� TH101 ® / 1TJ 4 �a �a z a` Q o� °o. A B S1 29.3 32.2 3 S2 37.1 38.4 C5 85.0 84.4 / C7 83.0 77.3 M 1 83.2 82.9 / M2 83.4 77.6 49th ... ° .... ... ., r MICHAEL E. ANDERSON G)��' No CE -4381 ' 7� ,• ��� �OFESS��Pi��• �.q PLAN AS -BUILT SCALE 1 = 40 Municipality of Anchorage rage 6 oT 6 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: SW020263 PID No. 051-054-15 TBM = 100.00 102.42' 100.71' 101.13' 101.19' Vi !� � U U 1250 Gallon Septic Tani. 01.246=111111111I■101 Y.1NA v T Ln U F- X: U ID ar, U f U 6.06' 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 SOUTH BRAGAW STREET P.O. Box 196650 ANCHORAGE, AK 99519-6650 PROJECT #: M0312 SOILS LOG PERCOLATION TEST PERFORMED FOR: PAUL MYERS / MM&M CONSTRUCTION DATE PERFORMED: 3/27/03 LEGAL DESCRIPTION: LOTS 4 & 5 BLOCK 3. KNIK VIEW EST. SUED. TEST HOLE # 2 SLOPE SITE PLAN OG - RED - BROWNISH SILTY SANDS W/ GRAVELS Silty Gravel SM : _ 49t WAS GROUNDWATER ENCOUNTERED? IF YES, WHAT DEPTH? DEPTH OF WATER AFTER MONITORING: DATE: C MICHAEL E. ANDERSON 1 f •; No. CE -6387 ,••• ��.pROFESS�ON���•0 1-9 is 10% NO NONE 4/12/2003 S L 0 P E Lot 5 a, tf v G, a TH2 of 0 tV Lot 4 NO SCALE / SEE ASBUILT < 2% READING DATE GROSS TIME NET TIME DEPTH OF WATER NET DROP Start 3/27/03 9:12 8.25" 1 9:42 30 7.5" 2.5" Recharge 9:43 8" 2 10:13 30 7.25" 2.625" Recharge 10:14 7.75" 3 10:44 30 7" 2.5" FERC RATE: 40 MIN./INCH FERC. HOLE DIAMETER: 6" TEST RUN BETWEEN 4.5 FT. AND 5.5 FT. COMMENTS: NO IMPERMEABLES ENCOUNTERED / HOLE PRESOAKED PRIOR TO TEST TEST PERFORMED BY: T.L. KIMBROUGH I, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 7/26/2003 George P. IVzlerch, Hayor 2/3/2003 MM&M Contracting PO Box 670495 Chugiak AK 99567 MwAeh)ahi - ofAnchor age Bundling Safety Division Subject: Expired On -Site Water and/or Wastewater Permit. Permit Number:, SW020016 Legal Description: Knik View Estates'Block 3 Lot 4 & 5 Dear MM&M Contracting : Anchorage All -America City 1 111 . 2002 An On -Site Water/Wastewater' Permit, number SW020016, issued by this office for a single-family system, expired on February 1, 2003. This permit was valid for 365 calendar days. If this was a well permit and the well has been drilled, a well log must be sent to this office for documentation of the installation and to close the permit. If this permit was for a wastewater disposal system, an original as -built inspection report must be sent to this office for review, approval and documentation. This as -built inspection report must be signed by the licensed Professional Engineer who inspected the installation of the system. As -built inspection reports are required to be submitted within 30 days of the completion of the system. If no system was installed under this permit, and you are still planning to install a well or wastewater disposal system, a new permit must be obtained from this office. When applying for a new permit, the fees are: $320.00 for a wastewater permit and $120.00 for a well permit. If you have any questions, please call this office at 343-7904. Sink. y, i J es Cross, PE anager On -Site Water and Wastewater Program Enc: Copy of permit P.O. Box 196650 • fliiehorage, Alaska 99519-6650 • Telephone: (907) 343-5301 (907) 343-5200 4700 South Bragaw Strect • Anchorage, Alaska 99507 littp://x«"1v.ci.anchorage.ak.us 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) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Feb 01, 2002 Expiration Date: Feb 01, 2003 Permit Number: SW020016 Parcel ID: 051-043-59 Legal Description: KNIK VIEW ESTATES BLK 3 LT 4&5 Design Engineer: 0003 S & S Engineering Site Address: Owner Name: ROD METCALF Lot Size: 43880 SQ. FT. Owner Address: NHN REBECCA CIRCLE Total Bedrooms: 4 Permit Bedrooms: 4 ,A fvl r w1 CHUGACH , AK 99567- This prmit is for the construction of: [✓1 Disposal Field 7 Septic Tank Holding Tank 0 Privy Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify 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: a,/j /Q 'L Date: 02 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 05"I — 04 3 " 5'9 Permit Number SW 02 0016 Property owner(s) �-, a & [A ijC CA. c Day phone Mailing address (1) ko 5 A IA AP p C 1L�1 Mailing address (2)C a�� �,�uc.RNK Zip Code (2)Cl 9-S Legal description (Lot, Block & Sub'd.) LA6 AA 5 . B1oc)�' 3, KwK UtA-�' �s�a�tiS Legal description (Section, Township & Range) Lot Size -A�; - kcrts/Sq.Ft. ¢3, MO THIS APPLICATION IS FOR: Number of Bedrooms � C)"F?-- Sewer Only k- Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ 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 (Signature of property owner or authorized agent) 17034 Eagle Fiver Loop eta Eagle River, Alaska 99577 Permit Fees: y U 6) ' Waiver Fees: Date of Payment: Date of Payment: Receipt Number: c Receipt Number: (Rev. 12100) S&S� pnCCRInq ROBERT C. COWAN, P.E. FAGtE CIVIL ENGINEERS APPROVALS (907)694-2979 FAX (907) 694-1211 January 21, 2002 HEALTH AUTHORITY APPROVALS MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 SEWER&WATER Anchorage, AK. 99519 MAIN EXTENSIONS REFERENCE: Lot 4 & 5, Block 3, Knik View Estates S/D SEWER & WATER INSPECTION It is requested that you issue a permit to install a septic system to serve the proposed four bedroom dwelling on the referenced property. AN an, 9` �•� �''yn v ` �''= Tei S T / S J' icrC.i 4.) 7 G IT 'f cc,';'Pi- 1i i 'i J %1)v�"Z,,.,4;. Gi �r r�� c„.c;✓.. ENGINEERING STUDIES A test hole was excavated and a percolation test was performed. The approximate location AND REPORTS of the test hole is located on the attached site plan. At the time of excavation on 1/14/02 no water was found. After seven days of ground water monitoring the test hole was still found to be dry. WELL INSPECTION & FLOW TEST 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 SITE PLANS properties. If you require additional information, please contact us. ROAD DESIGN Sincerely, SOIL TEST 7 Obert C. Cowan, P.E. RCC/jhm PERCOLATION TEST Enclosure STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 SIT1? IAN DESIGN 1 " 60' SCAl F \ m V pyo c> w n:ED \ J\ ® xz DOmm G �F 7o p \ /lam \ oo 3� p+a nA F7 \ \ \ :D � O O \ \ \ a f T IZ O \\ < \ \ ` �\ l 1 1 0 Dom�A co ca co m v) P C� A AFs� r �d--vE5U w u \m \ u O�GG zw t7 .ti �� o© \ \ o \ 4 0 a -.4 y \ \q \ i o ocn rlo- cnv \ M no C� cm \ \ C/) z - ► �\ \ Zoo \\ oho \�`q' " \� tio6O°�� \\ \ z f \ V O ��� -<� \A ? \ y� u>.� D 7J H y� o�� \q r n \ c x aoc O cn V), n \ \A oa o>m� favi �z< \ \J V dpyb �7Pl 00I�cn" Cly q o cn <4, Cf" m co -<1�a > ,_ \q A e o eco � d%T �j Cly Om b7 m� O_ �.. Cl) \ \q \ C�> O C) O :U C00 CD 17" \ a 151\ \ a0� o 0 s si Depth (Feet) .2. 2- 3- C 4- 5- 6- o 7- 8-1°e.:e 17- 18- 19- 20- COMMENTS M6& roe Y WAS GROUND WATER ENCOUNTERED? A10 s IF YES, AT WHAT DEPTH? L Depth to Water After P � F Monitoring? �✓i-y E Date: Reading `, Date Gross Time Net Time Depth to Water Net Drop Municipality of Anchorage (ENGINEER SJ`PL) Development Services Department u wu Building Safety Division a.�. On Site Water and Wastewater Program iiy C. COWAN 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 ROBERT `��.': CE 3301 r =' - c� /v k.us ww (907) �� w 343-7904 ° ' ........... y -o` Soils Log - Percolation Test Performed For: 't- ' �f �= 1 C �rZ j� Date Performed: i - 7— Legal Description: Lff 4 /3L i Xh-V Township, Range, Section: 31_ - Slope Site p n Depth (Feet) .2. 2- 3- C 4- 5- 6- o 7- 8-1°e.:e 17- 18- 19- 20- COMMENTS M6& roe Y WAS GROUND WATER ENCOUNTERED? A10 s IF YES, AT WHAT DEPTH? L Depth to Water After P � F Monitoring? �✓i-y E Date: Reading `, Date Gross Time Net Time Depth to Water Net Drop NERUULAIIUN RAIL -T(,/ (minutesfinch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT PERFORMED BY:dj `_�.�. olf I ! CERTIFY THAT THIS TES WA PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: j.�) �u Z RODERr C. COWAN. P.E. W~LL IL~rEClIC~I CIVIL EFIGINEERS (907) 694-2979 FAX (907) 694-t2t t ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 4 & 5, Block 3, Knik View Estates Subdivision January 21,2002 GENERAL: The scope of this project includes the installation of a 1300 gallon Premier polyethylene (HDPE) septic tank and' new trenches to serve the proposed four bedroom residence located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. o 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 to perform system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 17034 HOrTII I EAGLE RIVER LOO~ ', SUITE 204 · EAGLE RIV~Ft. ALASKA 99577 Page 2 Lot 4 & 5, Block 3, Knik View Estates $/D January 21, 2002 All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Septic tanks installed with less than 4 fi. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 fi. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCIIfDRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion 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. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page 3 Lot 4 & 5, Block 3, Knlk View E.tate. $/D January 2t, 2002 MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: T~vpe of Pi~e Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM FS10 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follo~vs: Page 4 Lot 4 & 5, Block 3, Knlk View Estates $/D January 2t, 2002 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 alter the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre- construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR / INSTALLER Parcel I.D. 051-043-59 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION �!I .tr MAY 15 2014 Expiration Date: Complete legal description Knik View Est. Block 3, Lots 4 & 5 Location (site address) 21862 Rebecca Cir. Current Property owner(s) Shawn Lowrey Day phone Mailing address 60274 Pawnee Ln. Bend, OR 97702 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual F� Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public 'Vater System U Public Sewer ❑ WaiverNariance request Received by: s ` Date:' COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee Date of Payment Receipt Number 6+o`9OIA COSA # 0�4(4 OLD 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. 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 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Date 5/13/2014 • � Seven �`•Fsannone i CE -8149 Conditional approval for bedrooms, with the following stipulations: / � g By: / . Original Certificate Date: Fi ` The ni of Ciorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet : - c If more than 1 septic system is on the lot: COSA Checklist # of 1 Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Knik View Est. Block 3, Lots 4 & 5 Parcel ID: 051-043-59 A. WELL DATA Well type Public If A, B, or C provide PWSID # AWWU Well Log (Y/N) Date completed Sanitary seal (Y/N) _ Wires properly protected (YIN) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level 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 Tank size 1,250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Date of pumping 10/23/2013 C. ABSORPTION FIELD DATA Date installed 10i9 -15i2002 Length 84 ft. Depression over tank (Y/N) N Pumper JR's Pumping Soil rating (g.p.d.lft2 or ft2lbdrm) 0.45 Date installed 10/9-15/2002 Cleanouts (Y/N) Y High water alarm (Y/N) N System type Deep Trench Width 3 ft. Gravel below pipe 8 ft. Total depth 11 ft. Eff. absorption area 1,344 fe Monitoring tube Y Depression over field N Date of adequacy test 5/12/2014 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 19 in. Water added 600 gal. New depth 21 in. Elapsed Time: 160 min. Final fluid depth 19 in. Absorption rate , 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES WELJ_ON LOT TO: Size in gallons "Pump off' level at in. Cycles tested Septic tank/lift station 11000+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 50+ SEPTIC/HOLDING TANK ON LOT TO Manhole/Access (YIN) _ High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ manhole/cleanout 100+ Holding tank Manure/animal excrete storage areas Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 5/13/2014 COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 110+ in. Municipality of anchorage ' L Development Services Department Building Safety Division` On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING a3 5q Parcel I.D. _051-04,-% HAA #J`��a Expiration Date:®�- 1. GENERAL INFORMATION Complete legal description Lots 4 & 5 Block 3 Knik View Estates Subdivision Location (site address or directions) Rebecca Circle Current Property owner(s) MM&M Contracting Day phone 688-1236 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address P.O. Box 670495 Chugiak, AK 99567 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Four 4 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class A Well Public Water System ❑ Day phone Day phone 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 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 Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 7/28/2003 5. DSD SIGNATURE Approved for bedrooms. Disapproved. X Conditional approval for 4 bedrooms, with the following stipulations: At the time of Title Transfer, the new property owner shall sign & record the"Ease- ment for use as a Septic System" and return such document to this office before an unconditional approval is issued. Additional Comments Y OF ,gr�rir rr '• r • �r�„ r r WATER AND WASTEWATER PROGRAM Attachments: J-Jii 4tNT SES HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other By • Original Certificate Date: 7 —03 (Rev. 12100) I / i Municipality of Anchorage Development Services Department A Building Safety Division On -Site Water & Wastewater Program T } 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: Lots 3 & 4 Block 3 Knik View Estates Subdivision Parcel ID: 051-043-59 A. WELL DATA Well type A If A, B, or C provide PWSID # 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./I. Other bacteria colonies/100 mi. Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 10/9/2002 Tank size 1.250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping Pumper New Construction C. ABSORPTION FIELD DATA Date installed 10/9-15/ Soil rating (g.p.d./ft2 or ft2/bdrm) .45 GPD/SF System type Deep Trench 2002 Length 84 ft. Width 3 ft. Gravel below pipe 8 ft. Total depth 11 ft. Eff. absorption area 1,344 ft2 Monitoring tube Y Depression over field N Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N 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 Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot NIA Absorption field on lot NIA Public sewer main N/A On adjacent lots NIA On adjacent lots N/A Public sewer manhole/cleanout NIA Sewer /septic service line N/A Holding tank NIA SEPARATION. DISTANCES FROM 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 >200 SEPARATION DISTANCE FROM 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 >25' Curtain drain None Noted Wells on adjacent lots >ZA0 F. COMMENTS G. ENGINEER'S CERTIFICATION Ar •. I certify that / have determined through field inspections and AN � `49th .. review of Municipal, records that the above systems are in �....r .............. conformance with MOA HAA guidelines in effect on this date. --- -- :MICHAEL E. ANDERSON Engineer's Printed Name Michael E. Anderson, P.E.No. cE-+seg. Date 7/28/2003�9?riTrest� HAA Fee $ ✓ 1LJ Date of Payment"* .0 Receipt Number (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number in. ROM : COUNTRY REALTY PHONE NO. : 9076981238 Jul. 2e 2003 04:50AM P1 EASEMENT FOR USE AS A SEPTIC SYSTEM LEGAL DESCRIPTION A strip of land 65 (sixty-five) feet wide and 80 (eighty) feet long lying in Lot 4 Block 3 Knik 'View Estates Subdivision, as shore on attached Exhibit 1 and more particularly described as follows: Beginning at the northwest corner of said Lot No. 4 thence S41 °29'16" E 10' along the northwest line of said Lot No. 4 to the POINT OF BEGINNING; thence S41 °29'16"E 65 feet to a point thence S48°30144"W 80' to a point; thence N41 °29'16"W 65' to a point thence N48°30'E 80 the POINT OF BEGINNING - STATE OF ALASKA } }ss: THIRD JUDICIAL DISTRICT } Dated: -a3 The foregoing instrument was acknowledged before me this,? day Of. G 2003 by �6e tlp �taY^I(pI.,p�p�`Od'b'AA�� �l A0 BStlll.� b r PV'L/L9� • V OF IQ�♦ R ary Public in and Commission Ext FROM COUNTRY REALTY PHONE NO. : 9076881238 Jul. 28 2003 04:50AM P2 j EXHIBIT 1 LOT 4, BLOCK 3 KNIK VIEW ESTATES � r �r .ver r r r l r �s� r f r r SCALE Z" 40' ["] AS-BU1LT. ereby. certify that surve e • t 1 � !aye y d !he_ following ifescri - PlIpperFy:_ [b bei' A ;ASl �`�,y, • i' .ZN. i. �`• ' rte• ; , . ' ;. J •` +�• •�'.. pfd+ :• N td iLI'��Q.�K1CiLtZn1 ments situated the mon aw thin the an that 'the improve,:.•., r �• '' �'. ,�� . ; oveil3p or;esra�ach <in the ro property .lines'arid do not'--- }mprpverirerits'.on p �'*�'1�''. & adjaceni thereto 'Ehaf `• in adjacent thereto encroach r' Orr the h ��-?'�-�,�� remises " roPem' lY $ 0°no..es acaaaaas� �'X �' �: C1t3eSt2012 and ttrat t ere are Ra i0'a�va S�•,,'.; f4_� ys 135 sssion` lines .or other •visible easement y Robert. �,10 trss:�' exc�ePf as,9niiicated h s .ten. said. prppeKy:. RlQ: S$0 -S w emon.` ^rte ;amu. ya +�•zt~AA Dated at � gee: River,. Alaska . ees % `'� ay of/� s ttT C �SSQ SCALE:.. ' N ;Kr'• �r • . = _' 2•. Registered Lan carve or ,Na.✓agle River AIask' aPhcifie(r97) 99�T 594-Z�43 ;