HomeMy WebLinkAboutKNIK VIEW ESTATES BLK 4 LT 60
KnIK View
Estates
Block 4
Lot 6
#051-043-37
Municipality of Anchorage Page i of 3
Development Services Department
On-Site Water and WasteAeter Program
4700 South Bragaw Street
• P.O. Bar 196650 Anchorage, AK 995196650
www.ci.anchorage.ak.us (907) 3437904
ONSITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. 5W020463 PID Number. 051-043437
Mare
Wastewater System: New
MM&M Contractinel
Address:
P.O. Box 670495., Chu6ilak, AK 99567
ABSORPTION FIELD
Phone: Nu Dar of Bedrooms:
5' Wide Trench
688-1236 Four 4
LEGAL DESCRIPTION
Sal Rating
Total m al Depd, r oonWna fired:
8
1.2 GPDIFIs
Ft.
Bloat: Lot Subdivision:
Depth to pipe bodom iron original Wade:
Gravel depth beneath pipe:
4 6 Knik View Estates
4 Ft.
4 Ft.
Township: Rage: Section:
FII added above original Wade:
Gravel Length:
0 Ft.
50 Ft.
Well: Community Water
Gravel width:
Number of lines:
Distance between fines:
5 Ft.
1
— FL
Classification (Private. A, 0. CL
Total Depth:
Cased b:
Trial absorption tiros:
Prye Material:
Clase A
Ft.
Ft.
500 Fe
ASTM P3034 PVC
Driller.
Dale Drilled:
Static Water Level:
Installer.
Date Installed:
Ft
MM&M
12/20-21/2002
Yield:
Pump Set at
Casing eight Above Cxota,d:
TANK
CPM
Ft.
Ft
SEPARATION DISTANCES
0 septic ❑ Holding ❑ S.T.E.P. ❑ Other:
To
Septic
Absorption
Lift
Holding
blitlPrivate
Manufacuer.
pacayin Gaims.
From
Tank
Feld
Station
Tank
Sewer Line
Anchorage Tank
1250
Well
>200'
>200'
N/A
N/A
>25'
Material.
Steel
Nunoer al Companme ss:
Two 2
Sutacewater
>100'
>100'
N/A
N/A
LIFT STATION — NONE ON LOT
.
Lot Une
>9
>19
N/A
N/A
�.
cal.
r. actae
Fou,dalan
>9
>10'
N/A
N/A
'Poop on' level at:
'Pune off' level at
W0 water alarm at:
In.
rt
In
curtain
None
Noted
P=p Make S Model
Electrical Inspections pedortned by,
Drain
Remarks:
BENCH MARK
nsu a ion Over ep Ic I ank.
Locatm"Deacnpuor:
Finished Floor.
Assured Elevation:
100.0 FL
Engineer's Stamp
OF
Inspections performed by: MEA Dates: tat 12/20/02
��th�. fV� lw•«•
Q 19/21/02Ir
Department of Health and Human Services approval
MICHAEL E. ANDERSON f W
s CE-4381
�O.
Reviewed and approved by: Date:•♦��ItO
..... Peel,
(P—.19)
0"9
aBaaaisks
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT Page 2 of 3
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
n
Permit Number. SW020463
A 1 8
S1 51.9 35.6
S2 59.6 42.0
M1 69.6 63.2
C4 77.9 42.7
C5 68.0 66.1
'o
�a
SITE AS -BUILT
SCALE V = 4V
6
Alternate Site
)TH1
®TH2
S2
Four
Bedroom
Home
ry
LOT 6, BLOCK 4, KNIK VIEW ESTATES
PID No. 051-043-37
49m
MICHAEL E ANDERSON
No. mow
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: SW020463
TBM=1
In
U Y U
Page 3 of 3
PID No. 051-043-37
U l.J
PROFILE AS -BUILT 'v 49th
/.....r .«.............. ....
Scale: 1" a 10'
;� ;MICHAEL E. ANDERSON
�� fA., No. CE -4381 i
MUNICIPALITY
MUNICIPALITY OF ANCHORAGE ) 2. 2 d 2 i f O J
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: Nov 18, 2002
Expiration Date: Nov 18, 2003
Permit Number: SW020463 Parcel ID: 051-043-37
Legal Description: KNIK VIEW ESTATES BLK 4 LT 6
Design Engineer: 0014 Anderson Engineering Site Address:
Owner Name: WALDEC ENTERPRISES Lot Size: 22856 SO. FT.
Owner Address: NHN KNIK VISTA COURT 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 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:
/I—lF-6 L
Date: /8 GZ
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 SEWERMELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 6S ,[ — 04 3 —3:Z Permit Number SW 020¢ 6,7
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
6 4
Legal description (Lot, Block & Sub'd.) Lot 1, Block jf, Knik View Estates Subdivision
Legal description (Section, Township & Range)
Lot Size Z 20 193_6 Acres/Sq.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms Four (4)
Sewer Only ® 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.
(Signature of property owner or authorized agent)
M
Permit Fees: x4 qj7 o Waiver Fees:
Date of Payment:
//—/3—OZ
Date of Payment:
Receipt Number: �r �� /' Receipt Number:
(Rev. 12100)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
November 8, 2002
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 6, Block 4, Knik View Estates Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 6, Block 4, Knik View Estates Subdivision intends to construct a 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 new home on the property. The lot is
currently served by a community water system. 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 alternate site, test
hole locations and septic systems on the surrounding lots. Drainage arrows are also
shown and current drainage patterns will be maintained after construction.
The test holes placed near the location of the proposed and alternate absorption
trenches indicated well graded gravel with sand and some silt. The percolation rate on
the material was measured at slightly more than 1 minute per inch. No ground water
was found and none was noted during the monitoring period. We are therefore
proposing to place a new 1,250 -gallon septic tank with a new 50' long by 5' wide
absorption trench with 4' of gravel beneath the distribution pipe. The total depth of the
trench will be 7' below the surface with the distribution pipe at 3' below the surface.
The ground surface on the lot slopes at shallow grades from east to west. The
absorption trench will be constructed parallel with the slope as much as possible in
conformance with Municipal requirements. All components of the new septic system
will be constructed a minimum of 10' from the water service on the lot. The system will
also be constructed a minimum of 100' from any surface water in the area.
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.
Lot 6, Block 4, Knik View Estates
November 8, 2002
Page Two
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,
A --cam
Michael E. Anderson, P.E.
Attachments
49th
uiC,'MAEL E. ANDERSON j ti � ✓
4
No. cE_a.ai
AREA SYSTEM PLAN
SCALE 1" =100'
sp
I
?°/o 6
Alternate Site
N
20 ®TH1
cv 10, ® H2
50' Lon
rn x4'Ef.I
10, 1,250 Gallon Abso tic
Septic Tank
Four
CO Bedroom
Home
'o.
48,
SITE PLAN
SCALE 1" = 40'
5' Wide
LOT 6, BLOCK 4, KNIK VIEW ESTATES
DESIGN FACTORS:
4 Bedroom House
Perc. Rate: 1.2 Min./Inch
Application Rate: 1.2 GPD/SF
SYSTEM REQUIREMENTS:
5' Wide Trench System
1,250 Gallon STEP Tank
4' Drain Field Rock
4 Bedrooms X 150 GPD11.2 GPD/SF (Application Rate) = 500 SF of Absorption Area
500 SF/5 LF (Width)" .5(Red. Factor) = 50 LF Trench Length
Therefore: Construct a 50' Long X 5' Wide Absorption Trench With a 4' Effective Depth.
Flow Line Elevation in Trenches to be 3' Below Original Ground Surface. Total Depth to be
7' Below Existing Ground. Maintain 10' of Separation From Water Service Line on the Lot.
I r Natural
296" I Rackf ill
6"
4'0" 1 1 1 00t
•5'0"
Geotextile
Fabric
4" Perforated
PVC (ASTM 3034)
Drainfield
Rock
TYPICAL WIDE TRENCH SECTION
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 100' From Wells in the Area.
Minimum 10' Separation From Water Service Line.
_ 49th
MICHAEL E. ANDERSON
No. CE -4381 i
49tn 1K
... _. _.... _ff........
�
Municipality of Anchorage 0'G^
♦ fq 1 L"C"AEL E. AA7ER:
Development Services Department/On-site Water & Wastewater Program ��� ., �.0
4700 South Bragaw Street, Anchorage, AK 99519-6650 # LP %..
SOILS LOG - PERCOLATION TEST 't- 0 a�:,7�..... '
Performed For: MM&M Contracting Date Performed: 11/4/02
Legal Description: Lot 6_ Block 2. Knik View Estates Subdivision
SLOPE SITE PLAN
1
3
4
5
6
7
8
OG/OL
TESTHOLE NO. 1
Loose Well
Graded
Gravel with .
Sand
3W"
10
11
12
13
14
15
16 Bottom of
Hole
17
18
Was Groundwater
Encountered?
If Yes, What Depth?
Depth to Water
After Monitoring
Date:
2%
South
No
None
11/18/02
S
2%
L f
6 -Nov 11:43
D
1"
P
10
E l
I
Reading Date Gross
Time
Net
Time
Depth To Net
Water Drop
6 -Nov 11:43
1"
11:53
10
Dry V.
11:54
1.25"
12:04
10
Dry 7.75"
12:05
1"
12:15
10
Dry 8"
Perc. Rate: 1.2 Min./Inch Perc. Hole Diameter: 6"
21 Test Run Between 3 Ft. and 4 Ft.
Comments: Test Cavity was Presoaked Prior to Test. More than 50% of Material Passes No. 4 Sieve.
Performed By: Mike Anderson. I, Michael E. Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 11/8/02
L-1
Municipality of Anchorage
Development Services Department/On-site Water & Wastewater Program
4700 South Bragaw Street, Anchorage, AK 99519-6650
SOILS LOG - PERCOLATION TEST
Performed For: MM&M Contracting Date Performed:
Legal Description: Lot 6. Block 2. Knik View Estates Subdivision
SLOPE SITE PLAN
1 OG/OL
2
3
4
Loose Well
5 Graded
Gravel with
6 Sand
GW
Was Groundwater
9 Encountered?
If Yes, What Depth?
10 Depth to Water
After Monitoring
11 Date:
12
13
14
15
16 Bottom of
Hole
17
18
South
1114/02
No S
L
O
None P
11/18/02 E
2%.
Perc. Rate: 1.2 Min./Inch Perc. Hole Diameter: 6"
21 Test Run Between 3 Ft. and 4 Ft.
Comments: Test Cavity was Presoaked Prior to Test. More than 50% of Material Passes No. 4 Sieve.
Performed By: Mike Anderson, I, Michael E. Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 11/8/02
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 6, BLOCK 4, 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
and the construction of a new 50' long by 5' wide by 4' effective depth
absorption trench also shown on the Site Plan. The total depth of the
trenches will be 7' below existing ground and the distribution pipe will
be placed at 3' below the surface. All components of the new
absorption trench and septic tank must be constructed a minimum of
10' from the water service line on the lot and 100' from any surface
water.
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 a certified
septic tank manufacturer.
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.
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.
Lot 6, Block 4, Knik View Estates
November 8, 2002
Page 2 of 2
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.
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, Femco, or equal).
Lot 6, Block 4, Knik View Estates
November 8, 2002
Page 3 of 3
5. A permeable geotextile fabric (Typar, Mirafi 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.
Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-043-37
1. GENERAL INFORMATION
Expiration Date: ` 7 — 1
Complete legal description KNIK VIEW ESTATES BLK 4 LT 6
Location (site address) 21713 KNIK VISTA CT, Peters Creek, AK
Current Property owner(s) Cameron, Crosby Day phone 261-7625
Mailing address same
Real Estate Agent Peggy Kelly Day phone 261-7625
2. TYPE OF DWELLING: -
® 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
Individual Water Storage
❑
Holding Tank
❑
Community Class C Well
❑
Community
❑
Public Water System
®
Public Sewer
❑
Received by
ti
Date:
COSA to be released to the engineer, unless otherwise requested by the engineer
COSA Fee $ 5J//c,2( -
Date of Payment 41/2 be/
Receipt Number 6qt_?W
COSA #_ t9s /cI"(Q
Date of
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 NorthRim Engineering Phone 694-7025
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng
6. DSD SIGNATURE
_1� System #1 Approved for bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
Date 4/7/2014
bedrooms, with the following stipulations:
By: Z-11/1 Original Certificate Date: -/ Q -! ;f
The Municipality of nchorage Devlopment 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 blue sheet 9-1-12.doc
X Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # _of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: /K /U g of- [-J ESr/4rc c B y
L 6 Parcel ID: Q 510 q 33 7
A. WELL DATA Pv8/4c wA7E2
Well type 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/L
Arsenic ug/L Date of sample:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material ��%� S 1 FEL
/
Date installed / 2 f Z a/ oz
Tank size / ZSO gal. Number of Compartments Z
Cleanouts (Y/N) y
Foundation cleanout (Y/N) V Depression over tank (YIN) �(
High water alarm (Y//N) /lo
Date of pumping / Pumper 5Anlr 7 -A,2
-y
C. ABSORPTION FIELD DATA
Date installed2 2/ O L Soil rating (g.p.d./ft2 orft2/bdrm) �_ Z System type w iQ E
Length 50 ft. Width 5 ft. Gravel below pipe !_ ft.
Total depth _r ft. Eff. absorption area 5100 ft2 Monitoring tube Depression over field
Date of adequacy test % / Results (Pass/Fail) For !� bedrooms
Fluid depth in absorption field before test in. Water added 60
al. New depth in.
Elapsed Time: K16 min. Final fluid depth in. Absorption rate >_ +yrs g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) LIA%k- If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
Size in gallons
Manhole/Access (YIN) _
in. "Pump off level at in. High water alarm level at in.
Cycles tested
E. SEPARATION DISTANCES
WELL ON LOTTO: Pv8LfC �ftTf�
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
Animal containment areas
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation f Property line� Absorption field Js-
water
Water main / 6 `7 Water service line / D `t Surface water / OG
Wells on adjacent lots D `7 -
ABSORPTION FIELD ON LOT TO:
Property line /D 'f' Building foundation / 'r' Water main
Water Service line d `'r' Surface water /Dd' �'t Driveway, parkinglvehiclestomge � S
f
Curtain drainytiA Wells on adjacent lots /40 .,r
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
Date
COSA brown sheet_10-10-12.doc
ok& - 611t(
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
Parcell.D. _t)61 -04_6-Wl COSA#��Q� q
Expiration Date: le - l j - O 7
1. GENERAL INFORMATION
Complete legal description kallK k/T Lj 657 T6-5 L 6 3 4
Location (site address) 2 1 7/ 3 /CA1L"e- t/ t Si A- C -7 -
Current
j
Current Propertyowner(s) DEhNN/k 1,JAStf9uRnJ .Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Po 6oX OC> Z 73 G N � �L.4 �� Alt `79567
Day phone
6LA%4brA- MomrCUPMC2.Y Dayphone 6SS5^27_7-6
4o*. +ro R t A -G. 63 i PrTL
Unless otherwise requested, COSA will be held by DSO for pickup.
2. NUMBER OF BEDROOMS:
L _
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
[91�
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site 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 and/or 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, 1 verify that my investigation,
based on procedures outlined in the Certificate of Onsite 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.
Eagle River Engineering SerAm
Name of Firm ..10421 UPM Rd. r -;o -r26_ Phone G9y-S/i
Address Eagle River, AK 99577
Engineer's Printed Name cr i"7),r7aPrfs2 R, aoot> Date S102-106
5. DSD SIGNATURE
Approved for �_ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
,,G,,LQ.
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
BY �V- Original Certificate Date: 6,
(R". 11105)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 995198650
www.muni.org/onsits
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: kA,1L4- ULC J t Sihfit 5 L 6 g y Parcel ID: (136l - 0'/ 3- 3 7
A. WELL
Well type �-
Date completed
Total depth ft.
Date of test
If A. B. or C provide PWSID # _ Well (Y/N)
Sanitary seal (YIN)
FROM WELL
to ft.
_\rJ
Static water level >� ft.
Well production Q`r g.p.m.
WATER SAMPL SULTS:
Coliform colonies/100 mL Nitrate mg/_
enic. _ mgA Date of sample: _
B. SEPTICIHOLDING TANK DATA
Tank Type/Material iFNGN•TAAX f S76-eL
Wi roperly protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
ft.
9 -
p.m -
Other bacteria colonies/100 mL
Collected by:
Date installed I2/ Zo Io Z
Tank size 1 2 SO gal. Number of Compartments ?_ Cleanouts 6;kq Y4-5
Foundation cleanout &N) o'r> Depression over tank (Y& NO High water alarm (Y/) No
Date of pumping 10 27 o Pumper 5-a' 5
C. ABSORPTION FIELD DATA
Date installed MIZ1 Z Soil rating (g.p.d.W or !Abdnr) /-Z System" w1tE D&tDyr-4-23.D
Length S0 ft. Width S ft. Gravel below pipe V _ ft.
Total depth % ft. Eff. absorption area oo ft Monitoring tube l $ Depression over field NO
Date of adequacy test `i12'1 6 Results(Pas ail) Pkv For q bedrooms
Fluid depth in absorption field before test, in. Water added gal. d(" New depth /l_ in.
Elapsed Time: 12LO min. Final fluid depth In. Absorption rate >= &0 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) P'C.) If yes, give date w/14
D. LIFT STATION
Date installed Size in gallonsII
0 Lam'
'Pump on' level at _ in. 'Pump ofr IeVel at _ in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
M o e/Access (Y/N)
High water alarm level at
Meets alarm 8 circuit requirements?
On adjacent lots
On adjacent to
�,;LPbd is sewer manhole/cleanout
D
Sewer /septic service line Holding tank
Animal conjakww areas Manurelanimal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOtDM TANK ON LOT TO:
Building foundation +5- r Property line 5 -
Water
Water main +' /D / Water service line
r/D
Wells on adjacent lots ')' rv0
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorption field I- 5
Surface water 1' /0,0 '
In.
Propertyline +/0 / Building foundation 4/0 / Water main '>- /o r
Water Service tine 1 - to Surfacewater 't' /Csd r Driveway, parking/vehide storage t 2 r
Curtain drain t" 5-0 ' Wells on adjacent tots -J-/06 '
F. COMMENTS
72
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 6#eZS70P0tR (L. Inloo9
Date S/v 2 /v 6
SEEN
COSA Fee $ 44-3,0— Waiver Fee $ _
Date of Payment &/-%%(O Date of Payment
Receipt Number 81yy:? Receipt Number,
(Rev. 11M)
w gyp:
Tv 7e57-
(Rev.
ESi
04/26/2006 14:54
JR9 Pumping
PO Box 773415
Eagle River, AK 99577
(9071 694-6454
9873449821
81111ng information
Deanna Washburn
Po Box 670273
Chugiak, AK 99567-0273
(907)688-2418
J 1 otnlgrm Ion
Deanna
21713 Knik Vista Court
Chugiak, AK 99567
(907) 688-2418
JRS SEPTIC
Job Descrlpdon:
12509
P.O. Number.
Order Date:
Terms:
Net 30
se'«rep:
Nikote
Mop Book:
crone sane!::
Obert Road
Job Comrnenta:
Additional Location Comments DI9r.re ¢2Da9nmaHs56 J mo
#'s are on sign post at start of dw - •; �'
For Sale sign In front yard. 0-7 Tmk
2 story T1-11, bluish gray house w/ •
dark blue trim.
Septic in back of home. • •
PAGE 01
Service Agreement
Number.
018586
Order Date:
21 -Oct -2005
ServiceDate:
27 -Oct -2005 12:00
Technician:
Butch
Tax 'A 0
Job Type: Repeat
Map Gild: 13
t service unknown
and pumped tank - levels normal
Service Type City Price Each Tax?
Septic Service 15K 1 $130.00 No
Gallons Planned: 1250
Gal. Actual:
Hose Length:
Double Tank: ❑
Pump System: 8
Baffles Inlet: ❑
Baffles Outlet: ❑
Extension Actual
$130.00
Nonlrasable Total Twobla Toth Tax Total Grand Total
Estimated Charger. $130.00 $000 $0.00 $130.00
Actual Charges;
Custornsr o rnan to the terms and eorditons shown. THIS IS A BINDING AGREEMENT.
Signah,re and TMs of Cusiorr or Rapresentetw.
Accepted by JRs Pumpeq
Date
Date Accepted
For your added converdencs we accept, American Carves. Mover. Visa and Master Card psyrents war the phone.
After 30 Days accounts will be turned over to coAec4ona. $25.00 For NSF Checks Returned.
4 t AS-BUI[.T
1 hereby certify. that 1 have surveyed the following described
property: LoT.6 /*I
N Anchorage Recording Precinct, Alaska, and that theimprove-
ments situated thereon are within the Property lines and do not
overlap or encroach on the property lying adjacent thereto, that
no improvements on property lyingg adjacent thereto encroach
on the premises in question and tf�at there'pte no roadways,
transmission lines or other visible easements on said property
except as indicated hereon.
Dated at Eagle River, Alaska
this Z rr day of V F.• . ` tg Z co'3 ..
ROBERT C. JOHNSON �yj '
SCALE: Registered Land Surveyor No LS `
Bux 77-0456, Eagle River, Alaska 99577
Phone (907),694-2543
w
a
J
4 t AS-BUI[.T
1 hereby certify. that 1 have surveyed the following described
property: LoT.6 /*I
N Anchorage Recording Precinct, Alaska, and that theimprove-
ments situated thereon are within the Property lines and do not
overlap or encroach on the property lying adjacent thereto, that
no improvements on property lyingg adjacent thereto encroach
on the premises in question and tf�at there'pte no roadways,
transmission lines or other visible easements on said property
except as indicated hereon.
Dated at Eagle River, Alaska
this Z rr day of V F.• . ` tg Z co'3 ..
ROBERT C. JOHNSON �yj '
SCALE: Registered Land Surveyor No LS `
Bux 77-0456, Eagle River, Alaska 99577
Phone (907),694-2543
w
4 t AS-BUI[.T
1 hereby certify. that 1 have surveyed the following described
property: LoT.6 /*I
N Anchorage Recording Precinct, Alaska, and that theimprove-
ments situated thereon are within the Property lines and do not
overlap or encroach on the property lying adjacent thereto, that
no improvements on property lyingg adjacent thereto encroach
on the premises in question and tf�at there'pte no roadways,
transmission lines or other visible easements on said property
except as indicated hereon.
Dated at Eagle River, Alaska
this Z rr day of V F.• . ` tg Z co'3 ..
ROBERT C. JOHNSON �yj '
SCALE: Registered Land Surveyor No LS `
Bux 77-0456, Eagle River, Alaska 99577
Phone (907),694-2543
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program A F�.
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. 051-043-37 HAA # f C)q
Expiration Date: O — D �
1. GENERAL INFORMATION
Complete legal description Lot 6. Block 4, Knik View Estates Subdivision
'Znt3
Location (site address or directions) Knik Vista Court
Current Property owner(s) MMBM 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 811412003
5. DSD SIGNATURE
L$7 V
49th
AEL E. ANDERSON
No. CE -1961 .
t/ Approved for bedrooms. 1�,�:=?
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
WASTEWATER
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: Gv. Original Certificate Date:
(Rea. IM
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-8850
www.ci.anchorage.ek.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 6. Block 4. Knik View Estates Subdivision Parcel ID: 051-04337
A. WELL DATA
Well type Class
Date completed _
Total depth ft.
If A, B, or C provide PWSID # 210409
Sanitary seal (Y/N)
Cased to ft.
FROM WELL LOG
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
Date of test
Static water level ft.
Well production
g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrate mg./t. Other bacteria
Date of sample: Collected by.
B. SEPTIC/HOLDING TANK DATA
ft.
g.p.m.
colonies/100 ml.
Tank Type/Material Septi . trel Date installed 1212012002
Tank size 1.250 gal. Number of Compartments Z Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) U High water alarm (Y/N) N
Date of pumping Pumper New Construction
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d.W or ft2/bdrm)1.2 GPD/SF System type V Nde trench
Length 50 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 8 ft. Eff. absorption area LC00 fI2 Monitoring tube Y Depression over field N
Date of adequacy test Results (Pass/Fall) 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.) (YM & 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 in.
k
y Datum Cycles tested
Meets alarm & circuit requirements?
E E. SEPARATION DISTANCES
J
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot WA
i.
On adjacent lots NIA
Absorption field on lot WA
On adjacent lots WA
!' Public sewer main NIA
Public sewer manhole/cleanout WA
I' Sewer /septic service line WA
Holding tank NIA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ;PT Property line >9
Absorption field 4
Water main >10' Water service line >,V Surface water >100'
Wells on adjacent lots >200
1
i SEPARATION DISTANCE FROM ABSORPTION FIELD
ON LOT TO:
Property line >70' Building foundation >10' Water main >10'
Water Service line >70' Surface water >100' Driveway, parking/vehicle storage >29
Curtain drain None Noted Wells on adjacent lots >200'
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I ce that I have determined through field ins �� '
rtify g pedions and : �` ° 49th
review of Municipal records that the above systems are in .......... + ..
conformance with MOA HAA guidelines in effect on this date. P., .,
;MicwEL E. w+aEesaiI p
Dage gf1gI2003 Printedineees Name Michael E. Anderson. P.E. �j��,ti� o No CE ... i •:
HAA Fee $ a 16
Date of Payment S I)4.)C)3
Receipt Number
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number
COUNTRY REALTY
PHONE NO. 9076891238 Jul. 28 2003 06:36AM P2
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