HomeMy WebLinkAboutKNIK VIEW ESTATES BLK 5 LT 1Kn'*k View
Estates
Block 5
Lot 1
#051-043-41
Municipality of Anchorage Page t of 3
Development Services Department
On -Site Water and Waste rater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 995196650
www.cl.anchorage.ak.us (907)343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. 5W030035 PID Number: 051-043-41
Nd11e
Wastewater System, New
MM&M Contracting
"'
P.O.BSORPTION
POBox 670495., Chu ink AK 99567
FIELD
prion, Nunber of Bedrooms:
5 WideTrench
688-1236 Four 4
Soil Rabrq
Total Depth lan
n oCgLmelgade:
LEGAL DESCRIPTION
1.2 GPD/Fl=
8 Fl.
Block: Lot Subdivisiam
Depth to Pipe bottom from original pada'
Gravel depth beneath pipe:
5 1 Knik View Estates
4 Ft.
4 Ft
Township: Range: Section:
Fill added above original grade:
Gravel WOW.
0 Ft.
50 Ff.
Well: Community Water
Gravel width:
5
Number of gnus:
1
Distance between tinea:
Ft.
Ft
Classification (Private, 0. B, CX
Total Depth:
Caned W.
Total absorption rear
Pipe Matenal-
Claes A
Fl.
Ft
500 Fly
A5TM 03034 PVC
14/1012003
onller
Date Drilled:
Static Water Level:
Installer:
Date Metalled:
Ft.
MM&M
Ywid:
PmpSelat:
Casing t eight Above Grourn2
TANK
GPM
P.
Ft
SEPARATION DISTANCES
0 Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
Septic
Absorption
Lift
Holding
blic(Pdvate
a`c're`
pecdyM llcm:
From
Tank
Feld
Station
Tank
Sewerune
Anchorage Tank
1,250
well
>200',
>200'
N/A
N/A
>25'
Material:
Steel
N=ber of C=Parunems:
Two 2
Suface Watt
>100'
>100'
N/A
N/A
LIFT STATION — NONE ON LOT
Lot Line
>9
>10'
N/A
N/A
Sim.
Gat.
MarAxectirer.
Foundation
>5'
>10'
N/A
N/A
•Pump ori' level aC
'Poop oar' level et
High water alarm at
M.
t"
In.
curtain Drain
None
Noted
Pmp Make d Model
Electrical Inspections performed by.
Remarks:
BENCH MARK
Location and Dewtpticm
Finished Floor.
• Assumed Elevatiom
100.0 Ft
Engineers Stamp
♦ OF
ti
#i
7
��,
Inspections performed by: T.L. Kimbrough Dates: 1" 4/10ML5
; ? _49th
2'd 4/10/03
MICHAEL E. ANDERSON
Department of Health and Human Services approval
.
•� sf, No. CE -4,81
Reviewed and approved by: Date: g a "D 3
••����� OFESS00! :— •
(Ree I099)
,��\N•O••♦
.
Municipality of Anchorage
Page 2 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number: SW030035
PID No. 051-043-41
N81 55'49"E
130.00
A 1 e
St 20.5 40.1 Altemate Site
S2 28.5 43.0
M1 44.4 69.6
C4 52.1 36.5 TH 2
C5 44.1 69.3 TH 1
®
W :W
O q Mt r
LOto
q C7FourG S F
"q4
cc
N Z N
1
i • —
i�r
10' Udliry Easement 3
JUDD DRIVE,
— _
�..•�EwoF .................
,�{ J
♦i
4stn':.'�
■..... ............... ... .......�
SITE AS-BUILT
�.;; :: MICHAEL F-MVERSON
SCALE 1"= 40'♦1•,bFES„�•i�
♦ d, b, No. CEAU1 •' i
LOT 1, BLOCK 5, KNIK VIEW ESTATES
Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number. SW030035
TBM
..
v x
v r x U v
PID No. 051-043-41
PROFILE AS -BUILT;
Stole: 1` m 10' No. a -47e1 j
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
MEMORANDUM
DATE: August 20, 2003
TO: Jeff Poet
FROM: Mike Anderson, P.E.
SUBJECT: Lot 1, Block 5, Knik View Estates Subdivision
Septic System As -Built
Certificate of Health Authority Approval
The test hole locations shown on the septic system as -built are accurate. No survey
control was available when the test holes were originally located and shown on the site
plan. The locations shown on the site plan were placed to the best information
available. The absorption trench was constructed around the location of the test hole
and is within the allowable 30' radius.
Please let me know if you have any questions.
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
Permit Number: SW030035
I,Legal Description: Knik View Estates Block 5 Lot 1
Design Engineer: 0014 Anderson Engineering
Owner Name: MM&M Contracting
Owner Address: PO Box 670495
Chugiak , AK 99567-
Y -/1D _ os 0 3: �s
Date Issued: Mar 05, 2003
Expiration Date: Mar 04, 2004
Parcel ID: 051-043-41
Site Address: nhn
Lot Size: 23551 SO. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
❑✓ Disposal Field R✓ Septic Tank Holding Tank 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 ( 1BAAC80 ).
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:
_4�
Date:
3 -i z- 03
2 Date: 03
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. 051-043-41 Permit Number SW 03170 35.
Property owner(s) MM&M Contracting Day phone 688.1236
Mailing address (1) P.O. Box 670495 Chugiak, AK 99567
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd.) Lot 1. Block 5, Knik View Estates Subdivision
Legal description (Section, Township & Range)
Lot Size 2a22 / Acre q.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms Four 14)
Sewer Only ® Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
certify that the above information is correct. I further certify that this application is being made for a
Sirgle Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: Waiver Fees:
Date of Payment 2 tzd[a3
Receipt Number. 31913
(Rev. 12/00) U fu
Date of Payment
Receipt Number.
ANDERSON ENGINEERING
P.O. BOX 240773,
ANCHORAGE, AK 99524
522-7773. ' 522-6779 FAX
February 26, 2002
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 1, Block 5, Knik View Estates Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 1, Block 5, Knik View Estates Subdivision intends to construct a new
four-bedroom home on the lot. We are therefore requesting a permit be issued for the
construction of a new septic system to serve the proposed home. The attached Site
Plan and backup documentation identify the location and configuration of the new
septic system and the parameters used in the design. Also identified on the plans are
the location of the water service line to be constructed on the lot and the test hole
locations. Existing drainage patterns are shown and will not be altered by the
development of the lot. Surrounding lots are served by a community water system and
separation distance requirements are easily met.
Two test holes were placed near the location of the proposed absorption trench. These
test holes indicate clean well -graded to poorly -graded sands with varying amounts of silt
and gravel. Percolation tests in the material resulted in rates of 1 to 2 minutes per inch.
No groundwater was found during the placement of the test holes and none was noted
during the monitoring period. We are therefore proposing to place a 50' long 5' wide
shallow absorption trench system with 4' of gravel beneath the distribution pipe. The
total depth of the trench will be 8'. The distribution pipe will be placed at 4' below the
ground surface to provide sufficient drop from the septic tank to the absorption trench.
The ground surface on the lot slopes as shown on the attached Site Plan with very little
to no slope near the proposed septic system site. The new absorption trench will be
constructed on a fairly flat surface in conformance with Municipal requirements and
parallel to ground contours where possible. All components of the new septic system
will be constructed a minimum of 10' from the water line to be placed on the lot.
'Lot I,' Block 5, Knik View Estates Subdivision
February 26, 2002
Page Two
If the system is constructed in accordance with our design the following statements
apply:
1. The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely, p
Michael E. Anderson, P.E.
Attachments
AREA MAP
SCALE 1" =100'
YICKAn E M10ER90N
NO. CE -4381
LOVI�W ESTAT�SNIK
Ng1 '"E
0030.X 39
3l
Altemab Site
TH 1 TH 2
3xI �s
W
o
ro cC
O CD
O N
M
151
1
10• U104Y
W Lora x S• V%de:4• En.
Absorption Trench
1.250 Galon 3°x
Septic Tank �
NV-
o
2
Four
Bedroom
Home
11w,
JUDD DRIVE _ •a
SITE PLAN
SCALE V - 40•
MiCMEL E. ANDERSON
No. CE -4381
LOT 1, BLOCK 5, KNIK VIEW ESTATES
SUBDIVISION
DESIGN FACTORS:
Four Bedroom Home
Perc. Rate: 1-2 MinAnch
Application Rate: 1.2 GPD/SF
SYSTEM REQUIREMENTS:
5' Wide Trench System
1,250 Gallon Septic Tank
4' Drainfield Rock
4 Bedrooms X 150 GPD 11.2 GPDISF = 500 SF of Absorption Area
500 SF15 LF (Width)•.5 (Red. Factor) = 50 LF Trench Length
Therefore: Construct a 50' Long X 5' Wide X 4' Effective Depth Absorption Trench.
Flowline Elevation In Trench to be 4' Below Original Ground Surface. Total Depth to be 8'
Below Existing Ground. Mound Over Septic Tank to Provide a Minimum of 4' of Cover or
Provide 2" of Direct Bury Insulation and 2' of Cover.
3'6"
6"
4'0"
Natural Backfill
Geotextile Fabric
4" Perforated PVC
Drainfieid Rock
X1
TYPICAL WIDE TRENCH SECTION : �;f'' '"'y'�
(NO SCALE) :_', 49th s,
NOTE: Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock. VAI .M10tAEL E. ANDERSON
Minimum 4' Separation From Groundwater. -;rsO%, No. cE-,se,
Minimum 10' Separation From Water Service Line. •♦�����ESSt::'
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT/ON-SITE WATER AND WASTEWATER PROGRAM
4700 SOUTH BRAGAW STREET, ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
PROJECT #: M0303
PERFORMED FOR: PAUL MYERS / MM&M CONSTRUCTION DATE PERFORMED: 1/29/03
LEGAL DESCRIPTION: LOT 1. BLOCK 5, KNIK VIEW SUBD.
TEST HOLE # 2 SLOPE SITE PLAN
OG - RED -BROWNISH
I LOAMY SANDS W/ GRAVELS
2
3
4
5
6
7
8
9
K
11
15
16
17
v"
.n•
WELL GRADED SANDS
0%
< 10%
> 25%
0%
WITH GRAVELS & LITTLE SILT OR FINES - SW
WAS GROUNDWATER
t.
` ENCOUNTERED? NO
Ic =;
w
:y i IF YES, WHAT DEPTH?
.' DEPTH OF WATER
NONE
AFTER MONITORING:
A DATE: 2/15/03
S
L
P
E
THP TH
N
NO SCALE
READING DATE
GROSS
TIME
NET
TIME
OF q� •y
• =
'c��P'''`'''i
12:35
th
12.0"
0-n
1
......-..
MICHAEL E. ANDERSON 1 W
• .: -
�� fj•.• No. CE -1381
•
ah;
12:46
BOH E551�.�
S
L
P
E
THP TH
N
NO SCALE
READING DATE
GROSS
TIME
NET
TIME
DEPTH OF
WATER
NET
DROP
Start 1/29/03
12:35
12.0"
1
11:45
10
9.625"
Recharge
12:46
11.5"
2
12:56
10
1
9.625"
Recharge
12:57
12.0"
3
13:07
10
PERC RATE: 1.04 MIN./INCH PERC. HOLE DIAMETER:_ 6"
TEST RUN BETWEEN —FT. AND 5.5 T.
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: 2/25/03
1
2
3
4
5
6
7
8
9r
I(
I I
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT/ON-SITE WATER AND WASTEWATER PROGRAM
4700 SOUTH BRAGAW STREET, ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
PROJECT #: 110303
PERFORMED FOR: PAUL MYERS / MM&M CONSTRUCTION DATE PERFORMED: 1/29/03
LEGAL DESCRIPTION: LOT 1 BLOCK S. KNIK VIEW SUBD.
TEST HOLE # 1 SLOPE
OG - RED - BROWNISH
LOAMY SANDS W/ GRAVELS
17
d
� A •
.f
WELL GRADED SANDS
o%
10%
r:
WITH GRAVELS & LITTLE SILT OR FINES - SW
NET
TIME
'• �•
WAS GROUNDWATER
NO
S
12:30
ENCOUNTERED?
11.5"
<
1
L
."
IF YES, WHAT DEPTH?
0
•
12:41
P
'
DEPTH OF WATER NONE
2
12:51
AFTER MONITORING:
E
• A
DATE: 2/15/03
12:52
12"
OF
t
y 49th
LJ
} MICHAEL E. ANDERSON (�i
BOH #.c :,_ ti- fC-•tAl 2i
SITE PLAN
THP THP
N
NO SCALE
o% _
READING DATE
GROSS
TIME
NET
TIME
DEPTH OF
WATER
NET
DROP
Start 1/29/03
12:30
11.5"
1
12:40
10
10.0"
Recharge
12:41
12"
2
12:51
10
1
9.825"
Recharge
12:52
12"
3
13:02
10
PERC RATE: 1.02 MIN./INCH PERC. HOLE DIAMETER' 6'
TEST RUN BETWEEN 4.5 FT. AND 5.5 T.
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: 2/25/03
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 1, BLOCK 5, KNIK VIEW ESTATES SUBDIVISION
GENERAL:
1. The scope of this project includes the procurement and placement of a
new 1,250 gallon septic tank at the location shown on the Site Plan.
Work also includes the construction of a new 50' long X 5' wide X 4'
effective depth absorption trench at the location also shown on the
Site Plan. The distribution line in the trench will be placed at 4' below
the existing ground surface. Total depth of the trench will be 8' below
the existing ground surface. The new absorption trench must be
placed a minimum of 10' from the water service line to be placed on
the lot.
2. Construction shall be in accordance with the approved site plan,
design drawings, Municipal Permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater
Disposal Regulations.
3. The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the
location of all lot lines.
4. Unless specifically agreed otherwise, the contractor shall be
responsible for final grading areas subsequently depressed from soil
settling. Property owner shall be responsible for revegetation of
affected areas unless specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must be certified
by the Municipal Department of Health and Human Services for
system installations. Owners installing their own systems must receive
prior approval from D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,250 -gallon septic tank must be procured from an approved
source and installed at the location shown.
2. 'A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
" Lot 1, Block 5, Knik View Est. Subdivision
February 26, 2003
Page 2of3
4. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
6. A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfield.
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
2. Distribution piping must be placed level with perforations down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield
rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated.
5. Contractor shall verify the septic tank and drainfield are a minimum
100' away from any private water wells in the area, 150' from a Class
"C" Well or 200' from any community well.
6. Direct bury insulation must be placed over the distribution system if
less than 3' of backfill depth is available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
8. A minimum 2' of accepting soil is required below the drainfield rock for
a 5' wide trench. Contractor shall verify this condition prior to
placement of the rock. All pockets of unacceptable materials must be
removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic
tank manufacturer.
' Lot 1, Block 5, Knik View Est. Subdivision
February 26, 2003
Page 3 of 3
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated
and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and
ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
5. A permeable geotextile fabric (Typar, Miraft or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing
the #200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These
inspections must be conducted under the supervision of a professional
engineer registered in the State of Alaska. The first inspection must be
conducted after the excavation of trenches, beds or pits and before the
installation of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement of the
geotextile fabric, gravel, distribution piping, standpipes, cleanouts and
insulation. No backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction
notes for use in preparing the certified as -built of the completed system.
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Municipality of Anchorage
Development Services Departmentme
o,:
Building Safety Division
On -Site Water and Wastewater Program A
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-043-41. HAA #
Expiration Date: — ;. O , O
1. GENERAL INFORMATION
Complete legal description Lot 1. Block 5, Knik View Estates Subdivision
?,P I is
Location (site address or directions) Judd Drive
Current Property owner(s) TMM&M Contracting Day phone 688-1236
Mailing address,., R.0.13 ox 670495 Chugiak, AK 99567
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
Day phone
Day phone
2. NUMBER OF BEDROOMS:
Four 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well .
❑
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class A Well
®
Community On-site
❑
Public Water System
❑
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 8/1312003
OF A4q re+s
*' 4918
O sw - MK AEL !. ANDERSON
5. DSD SIGNATURE oIO�Jf CE -4381 Ar
Approved for bedrooms. 00000 .0. 4*
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
VVAIERAND . m_
PROGRAM
J
Maintenance Agreements
Supplemental Engineer's Report
Other
By: "/ G(% Original Certificate Date: g - a O - 03
(R�.12/M
r.........,. ..............
Municipality of Anchorage
• Development Services Department
Building.Safety Division "
On -Site Water & Wastewater Program ' " ` 8'
!. 4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6850
www.d.anchorage.akus
j (907)343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ,Lot f lock 5, Knik View Estates Subdivision Parcel ID: 051-043.41
A. WELL DATA
Well type GLass
Date completed
Total depth ft.
Date of test
Static water level
Well production
9.p -m.
If A. B. or C provide PWSID # 2'8409 Well Log (Y/N)
Sanitary seal (YIN) _
Cased to ft.
FROM WELL LOG
WATER SAMPLE RESULTS:
ft.
Coliform colonies/100 ml. Nitrate mgA.
Date of sample: Collected by:
B. SEPTiCIHOLDING TANK DATA
Tank Type/Materlali ggtlg(S(gel
Tatrk size _,L25 gala ' -Number of Compartments $
Foundation cleanout (Y" y Depression over tank (Y/N) N
Date of pumping Pumper New Cogstructlon
C. ABSORPTION FIELD. DATA
Wires properly protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
Other bacteria
_ ft.
g.p.m.
colonies/100 ml.
Date installed 4110/2003
Cleanouts (Y/N) Y
High water alarm (Y/N) N
Date inStallect. 4 /1 O IOC Soil rating (g.p.d.fie or ft2/bdrm)1.2 GPDI§ System type S Wide Trench
Length 10 ft. Width ft. Gravel below pipe 4 ft.
Total depth j1 ft. ' Eff. absorption area J00_ft2 Monitoring tube y Depression over field N_
Date of adequacy test Results (Pass/Faio For _ bedrooms
Fluid depth in absorption field before test _ in.
Elapsed Time: _ min
Final fluid depth
Water added_ gal. New depth_ in.
In. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) d. If yes, give date
D. LIFT STATION
Date installed
'Pump on" level at _ in.
Datum
Size in gallons
"Pump ofr level at
Cycles tested _
in.
Manhole/Access (Y/N) _
High water alar level at
Meets alarm 6 circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot WA On adjacent lots NIA
in.
Absorption field on lot WA
On adjacent lots WA
Public sewer main WA
Public sewer manhole/cleanout WA
Sewer /septic service line NIA
Holding tank WA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >S'
Property line >S
Absorption field >S
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, parldng/vehicle storage >25'
Curtain drain None Noted
Wells on adjacent lots
>200'
F. COMMENTS
G. ENGINEER'S CERTIFICATION 1Q:''•`rf-�j
1 certify that I have determined through field inspections and * 491'N •..� *irk
review of Municipal records that the above systems are in \�� ~ .\• \�\
conformance with MOA HAA guidepnes in effect on this date. 0I goo lyQIPl 0
Engineer's Printed Name Michael E, Anderson, P.E. : •o`er AV
Date 8113/2003 ♦•, 11111i ,
HAA Fee $ 31 Waiver Fee $
Date of Payment 's 13 03 Date of Payment
Receipt Number -' Receipt Number
(Rev. 12/00)
FROM COUNT
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YREALTY PHONE NO.
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