HomeMy WebLinkAboutKNIK VIEW ESTATES BLK 5 LT 13Knik Vi
W
Estates
Block 5
Lot [
#051-043-53
· ' 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.cLanchorage.ak.us (907) $43-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW020304 PID Number: 053.-043-53
Na~:
MM&M Contracting WastewaterSystem: New
Adckess:
P.O. Box 670495 Chugiak, AK 99567 ABSORPTION FIELD
Ph~le: Number o! Bedroems:
688-3.236 Four (4) s' Wide Trench
Soil Rating: Total Depth from ~igthal grade:
LEGAL DESCRIPTION 1.2 *,D~' 8.0
Block; Lot: Subdivisi~ Depth to pipe bottom from original grade: Gcavel depth beneath pipe:
5 3.3 Knik View Estates 4.0 ,,. 4
Tow~shlp: Range:, Secti(~: Fill added above original grade: Gravel Length:
0 ~,. 51 ~,.
Well: Community Water System 5 r,. 3. -
A n. ~, 53.0 ~t' ASTM D3034 PVC
,, MM&M Contracting 8/30-9/4/02
~,M ,,. ~, TANK
S EPAR~TION'DISTANCES Septic
From'~ Septic Absorption . Lift Holding ~ublic/Pflvate I.'~nufac~ec Capec~ty in Gallons:
Tank Field Station Tank S~,~rU,. Anchorage Tank 3.,250
w,, >200' >200' N/A N/A >25' Steel Two (2)
,ot,~.s~'~' Wa,,, >3.00'>5, >3.00'>3.0, N/AN/A N/AN/A ~ s,,.: o.,. ~.~u,.~.LIFT STATION
Fo~,~. >5' >3.0' N/A N/A '"""P ~"'~'''': '"~ ~"'~''': I "~¢'"'"
cu~.orai. None Noted ,.~..&.o~,
"'"~': BENCH MARK
Finished Floor.
100.0 F~
Engineer's Stamp
~\~ ........... .':,.,q ~-, ·
~.~.... ...~e.
· .' ~..'.;.' ,t
Inspections performed by: Tim Kimbrough Dates: 1't 8/30/02 l~tl--";t:""'""w' - '*r'~:~.....~, _
2"" 9/4/02 ~ ~ ~";;~;;;~["[.";:.0,,,o.
Department of Health and Human Services approval ~,?..^~.:..... __,o. ct-,~,,
'**~o ~-: .........
Reviewed and approved by: Date:
STATE OF ALASKA
DEPARTMENT OF ENVIRONMENTAL CONSERVATION
555 Cordova St., Anchorage, Alaska 99501
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number: SW020304
TBM =
100,00 8,3'
92.77' 2.68'
1250 Gcd. ton
~ep'tlc Tank / 4,5
Page 3 of 3
PID No. 051-043-53
96.34'
PROFILE AS-BUILT
Scale: 1' = 10'
Municipality of Anchorage
Development Services Department Page 2 of 3
Building Safety Division
On-Site Water and Wastewater Program
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit No, SW020332 PID No, 051-043-52
1'3
C5
Site
Bedroom
Home
A I~
S1 119.2123.6
S2 1 23.1J 27.9
C4 1 50.0126.7
cs127.7166.6
FROM : QI.INTRY REALTY
PHON~NO, : 90?6881238
F~b. 0~ ~ 09:06AH Pi
AS-BUILT
~e R~ing P~nct, Absk~ and t~at the i~'~v~
. P q Y,
~e(~6~ '.". ..,
MUNICIPALITY OF ANCHORA GE
Devetoprnent 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: Aug 19, 2002
Expiration Date: Aug 19, 2003
Permit Number: SW020304
Legal Description: KNIK VIEW ESTATES BLK 5 LT 13
Design Engineer: 0014 Anderson Engineering
Owner Name: MM&M Contracting
Owner Address: PO Box 670495
Chugiak, AK 99567-
Parcel ID: 051-043-53
Site Address:
Lot Size: 22052 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
[] Disposal Field [] SepticTank [] Holding Tank [] Privy.
r-~ Private Well ~ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. Ail 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: ^. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Issued By:
Date:
Date:
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/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
Permit Number .SWOZ
Property owner(s) MM&M Contractinq, Inc.
Mailing address (1) P.O. Box 670495 Chu,qiak, AK 99567
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd.) Lot 13, Block 5, Knik View Estates Subdivision
Legal description (Section, Township & Range)
Lot Size ~,.,~L_~.~'.~.._ Acres/~.".~ Number of Bedrooms Four (4)
Day phone 688.1236
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
[] Well Only []
[] Water Storage []
[] Jacuzzi []
[] Water Softening Unit []
[]
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees:
Date of Payment: (C.~,
Receipt Number: o~¢ l ~"~ ~
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524 .
522-7773 522-6779 (FAX)
August15,2002
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject:
Lot 13, Block 5, Knik View Estates Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 13, Block 5, 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 proposed home. The attached Site
Plan and backup documentation identify the location and configuration of the new and
alternate septic system and the parameters used in the design. Also identified on the
plans is the test hole location and the locations of the existing systems on adjacent lots.
The subdivision is served by a Class A water system and the approximate locations of
the water service lines are shown. 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 to poorly graded sand with gravel and varying amounts of silt
and a percolation rate of between 1 and 2 minutes per inch. No groundwater was
found during the excavation and none was noted dudng the ensuing monitoring pedod.
We are therefore proposing to construct a 5' wide absorption trench system with 4' of
drainfield rock beneath the distribution pipe. That pipe will be placed at 3.5' below the
surface with a total depth of 7.5'. The total length of the trench will be 50'.
The ground surface on the lot slopes as shown on the attached Site Plan with fairly
shallow to no slope in the area of the new absorption trench. The new septic tank and
absorption trenches will be constructed in a fairly shallow surface slope area behind the
proposed house in conformance with Municipal requirements and parallel to ground
contours where possible. All components of the new trench will be constructed a
minimum of 200' from the well serving the community water system, The system will
also be constructed a minimum of 100' from any surface water in the area and 10' from
the water service line.
If the system is constructed in accordance with our design the following statements
apply:
L~)[ 13, Block 5, Knik View Estates
August 15, 2002
Page Two
]. 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,
Michael E. Anderson, P.E.
Attachments
17
19
4
3
14
15
15
16
AREA SYS_~_TEM PLAN
SCALE 1" = 100'
49th
S89',
;O
Fou~
Hedroom
House
'LOT 13, BLOCK 5, ~
KNIKVIEW ESTATES /.
/
50' Long X 5' Wide.
X 4' Effective Deptl~
· Absorption TrenchI
,250 Gallon
Septic Tank
SITE PLAN
SCALE 1" = 30'
LOT 13, BLOCK 5, KNIK VIEW ESTATES
SUBDIVISION
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
4 Bedroom House
Perc. Rate: LT 1 Min./Inch
Application Rate: 1.2 GPD/SF
5' Wide Trench System
1,250 Gallon Septic Tank
4' Drainfield Rock
4 Bedrooms X 150 GPDI1.2 GPD/SF (Application Rate) = 500 SF of Absorption Area
500 SFI5 LF (Width)* .5(Red. Factor) = 50 LF Trench Length
Therefore: Construct a 5' Wide Absorption Trench With a Total Length of 50'. Flowline
Elevation in Trench to be 9' Below Original Ground Surface. Total Depth to be 3.5' Below
Existing Ground. Total Depth to be 7.5'. Maintain 10' Separation From Water Service Line.
6I!
Natural
Backfill
4 '0" ~
Geotextile
Fabric
4" Perforated
PVC (ASTM 3034)
Drainfield
Rock
,5'0"
.I I
NOTE:
TYPICAL WIDE TRENCH SECTION
Grade Area Over Trench to Drain Away.
Minimum 6' Separation From B~rock. ~.-~-'~['-~~--.~ ......................
Minimum
4' Separation From Groundwater. ~r . _......... }
Minimum 100' From Wells in the Area. ~~- ~.~ ~'
Minimum 10' Separation From Water So.ice Line. ~..
**~>.... .~..'"~F
~'~ '~'"'"~'~x~
PROJECT #:
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 L STREET, ANCHORAGE, AK 99502-0505
SOILS LOG - PERCOLATION TEST
M0238
PAUL HYERS / HM&H CONSTRUCTION
LEGAL DESCRIPTION: LOT 13. BLOCK 5. KNIK VIEW SUBDIVISION
DATE PERFORMED:
8/2/02
I
3I
'5
6--
7--
8--
18
COMMENTS:
TEST HOLE -fi:
OB I OO
SLIGHTLY DENSE
WELL GRADED
SANDY-GRAVELS: OW
TH .1 SLOPE
OX
SITE PLAN
TN 2
0
TH1
O
WAS GROUNDWATER
ENCOUNTERED?
IF YES, WHAT DEPTH?
DEPTH OF WATER
*,~" TE R MONITORING:
DATE:
NO S
L
0
P
E
o%
GROSS NET DEPTH OF NET
READING DATE
TIME TIME WATER DROP
Starl 8/2/2002 10 05 12"
1 10.15 10 2" 10"
Recharge 10.15 12"
2 10.25 10 2" 10"
Recharge 10 25 12"
3 10,35 10 2" 10"
PERC RATE: 1 MIN./INOI PERC. HOLE DIAMETER: 6"
TEST RUN BETWEEN 3 5 FT. AND /..5 FT.
NO IMPERMEABLES ENCOUNTERED / HOLE PRESOAKED PRIOR TO TEST
TEST PERFORMED BY: T.L. KIMBROUGH
I, MICHAEl F. ANDFRSON, CERTIFY THAT TH~S TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: ;~) -J~'--O~.~
PROJECT #:
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 L STREET, ANCHORAGE, AK 99502-0605
SOILS LOG - PERCOLATION TEST
M0238
PAUL MYERS / MM&M CONSTRUCTION
LEGAL DESCRIPTION: LOT 13. BLOCK 5. KNIK VIEW SUBDIVISION
DATE PERFORMED:
8/2/02
I
3--
5--
6--
7--
8--
9--
18
COMMENTS:
TEST HOLE # TH #2 SLOPE
OB / OO
SLIGHTLY DENSE
WELL GRADED
SANDY-GRAVELS: GW
0%
SITE PLAN
TH 2
O
TH 1
O
WAS GROUNDWATER
ENCOUNTERED?
IF YES, WHAT DEPTtt~'
DEPTH OF WATER
AFTER MONiTORiNG:
DATE:
NO
S
L
0%
READING DATE GROSS NET DEPTH OF NET
TIME TIME WATER DROP
Start 8/2/2002 1040 12'
1 1020 10 2" 10"
Recharge 10:20 12'
2 1030 I0 2" 10"
Recharge 10:30 12"
3 10 ~,0 10 2~ 10"
PERC RATE: 1 MIN./INCH PERC. HOLE DIAMETER: 6'
TEST RUN BETWEEN. 3 S FT. AND ~, 5 FT.
NO IMPERMEABLES ENCOUNTERED / HOLE PRESOAKED PRIOR TO TEST
TEST PERFORMED BY: T.I.. K~MBROUGH
I, MICHAFL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: ~ -/5"'- ~Z.,.
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 13, BLOCK 5, KNIK VIEW ESTATES SUBDIVISION
GENERAL:
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 50' long by 5' wide by 4' effective depth
absorption trench also shown on the Site Plan. The total depth of the
trench will be 7.5' below existing ground and the distribution pipe will
be placed at 3.5' below the surface. All components of the septic tank
and absorption trench must be constructed a minimum of 10' from the
water service line on this lot. A minimum of 4' of fill must be placed
atop the septic tank and 3' of fill atop the absorption trench. In lieu of
fill 2" of direct bury insulation may be placed with 2' of fill atop the
insulation.
Construction shall be in accordance with the approve~l site plan,
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 all underground utility
locates and for the layout of the septic system and verification of the
location of all lot lines.
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.
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
pdor approval from D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
The 1,250-gallon septic tank must be procured from an approved
septic tank manufacturer and installed at the location shown.
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.
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 13, Block 5, Knik View Estates
August 15, 2002
Page 2 of 2
A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfleld.
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.
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 drainfleld
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.
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.
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.
A minimum 2' of accepting soil is required below the drainfield rock for
a 5' wide trench. Contractor shall vedfy this condition pdor 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 13, Block 5, Knik View Estates
August 15, 2002
Page 3 of 3
o
A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
Ail 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
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
Parcel I.D.
1,
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
o51-o43-53
GENERAL INFORMATION
Complete legal description
Location (site address)
Expiration Date:
Lot 13, Block 5, Knik View Estates
22500 Judd Drive Chugiak, Alaska 99567 ·
Current Property owner(s)..
Bruce & Theresa Scanes
Mailing address PO Box 671813 Chugiak,
Lending agency
Day phone (907) 688-6256
Alaska 99567
Day phone
Mailing address
Rea.i.E§~t~'A~nt~., Barb Huntiey/Prudentiai Day phone(907) 273-7377
5'~Mailing,Address.,~:;- 3801 Centerpoint Dr, Suite 200 Anchorage, AK 99503
Otl~erwise'fequ~s}~d; ~------ ~"' COSA will be held by DSD for pickup.
TYPE OF WASTEWATER DISPOSAL:
2.- NUMBEROF:BEDROOMS:
3. TYPEoF wA~ER SUPPLy:
Individual Well []
Individual Water Storage []
Community Class A Well []
Public Water System []
Individual On-site
Individual Holding Tank
Community On-site
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, 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 Pinar4
Address PO Box
Engineer's Printed Name
Engineering
871347 Wasiiia, Alaska
Paul E. Pinard~ P.E.
Phone (907) 357-3647
99687
Se
DSD SIGNATURE '
\/ Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
WATER AND
~/ASTEWATER : ~
' ' ~ ...... ee · ~
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: ~L''~- ./~--//
(Rev. 11/05)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Block ~, Knik View Estates
IfA, B, or C provide PWSID # 21 8409
Sanitary seal (Y/N) .....
Cased to ft.
FROM WELL LOG
ft.
g.p.m.
Legal Description: LoS 1 ]~,
A. WELL DATA
Well type A
Date completed ~
Total depth ft.
2
Depression over tank (Y/N)I~o
Pumper JRs Puml3in{~
Date of~test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate ~ mg/L
Arsenic: ug/L date of sample:
B; SEPTIC/HOLDING TANK DATA
Tank Type/Material Sept'ic/Stee'i
Tank size 1 2,50 gal. Number of,Compartments
Foundation cleanout (Y/N) Yes
Date' of pumping .9/2/+/10
C, ABSORPTION FIELD DATA
Parcel ID: 0;51-0/+3-5_3
Well Log (Y/N)
Wires properly protected (Y/N)
casing height (above ground)
AT INSPECTION
in.
g.p.m.
Other bacteria
Collected by:
~colonies/100 mL
Date installed 8/30 - 9/4/02
Cleanouts (Y/N)
High water alarm (Y/N)
Date installed 9/02
Length 51 ft.
Total depth 8 ft. Eft. absorption, area :51 0 ft2
Date of adequacy test 5/2/11
Fluid depth in absorption field before test -34 in.
Elapsed Time:200 min. Final fluid depth .3/+
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
Soil rating (g.p.d.;~t~~ 1.2 System type 5 W'ide Trench
Width 5 ft. Gravel below pipe /+ ft.
None
Monitoring tubeYes Depression over field' No
Results (Pass/Fail) Pass For /+ bedrooms
Water added 6-30gal. New depth-38 in.
~ in. Absorption rate >= 600+ g.p.d.
][noun If yes, give date
D. LIFT STATION NA
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. SEPARATIONDISTANCES NA - PUBLIC 1~ATER SYSTEt4 - NO WELL ON LOT
SEPARATION DISTANCES FROM WELL ON LOT TO:
in.
SePtic tank/lift station on lot
Absorption field on lot
Public sewer main
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Sewer/septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 1 0 ~ + Property line 1 0 ~ +
Water mai~' 10 ~ + Water service line 1 0 ~ +
'Wells on adjacent lots 200 ~ +
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10 ~ +
'Water Service line 1 0 ~ +
Curtain drain None ][no~z~
F. COMMENTS
Building foundation 1 0 ~ +
Surface water 1 O0 ~ +
Wells on adjacent lots 200 ~ +
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 Paul E. Pinard, P.E.
Date 5/9/1.1
Absorption field 10 ' +
Surface water 1 O0 ' +
Water main 10 ~ +
Driveway, parking/vehicle storage 1 0 ~ +
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
PINARD ENGINEERING
P.O. Box 871347
Wasilla, AK 99687
(907) 357-ENGR (3647)
ADEQUACY TEST
LOCATION: Lot 13, Block 5, Knik View Estates
APPLICANT: Gerald & Joy Meaney
PO Box 876067
Wasilla, Alaska 99687
SEPTIC TANK TYPE/SIZE: Steel/1250 Gallons, per MOA Records
ABSORPTION SYSTEM: 5 Wide Trench (4'ED), per MOA Records
DAILY FLOW:
4 BEDROOMS x 150 GAL/BR = 600 Gallons
JOB NUMBER: 11-108
DATE OF TEST: 5/2/11
FIELD STAFF: PJ Pinard
NUMBER OF BEDROOMS: 4
SCUM: 0.0' SLUDGE: Minimal
NEEDSTO BE PUMPED: Yes No XX
CURRENTLY IN USE: Yes XX No
TEST DATA
Time Flow Volume Cumulative Septic Tank Septic Soil Absorption System Comments
Rate Volume Tank
~ (GPM) (GALs) (GALs) Liquid Level A Level Monitor A SAS Monitor ~ SAS
* Tube 1' Level Tube 2* Level
8:15 4.7 4.0' 2.8' Start Flow - Meter 44600
8:30 4.7 70 70 4.1' 0.1' 2.9' 0.1' 44670
8:45 4.7 70 140 4.1' 0.0' 2.9' 0.0' 44740
9:00 4.7 70 210 4.1' 0.0' 3.0' 0.1' 44810
9:15 4.7 70 280 4.1' 0.0' 3.0' 0.0' 44880
9:30 4.7 70 350 4.1' 0.0' 3.1' 0.1' 44950
9:45 4.7 70 420 4.1' 0.0' 3.1' 0.0' 45020
10:00 4.7 70 490 4.1' 0.0' 3.2' 0.1' 45090
10:30 140 630 4.1' 0.0' 3.2' 0.0' Stop Test - 45230
RECOVERY
Date Time ST MT SAS MT
5/2 11:00 4.0'/-0.1' 3.0'/-0.2'
AM
5/2 11:35 2.8'/-0.2'
AM
*ALL MEASUREMENTS IN FT.
TEST: PASSED XXX FAILED
COMMENTS: System appears to be operating satisfactorily. There was 2.8' of measurable liquid in the SAS MT
prior to beginning the test. With the addition of 630 gallons to the system (more than the design daily
flow), the level rose to 3.2', leaving about 0.8' of the ED still available. Recovery measurements
showed a return to the starting condition 65 minutes after stopping the test flow.
Reviewed by: Paul Pinard '~Z--~
Date: 5/6111
flexmls Web · Page 1 of 1
r
- ?
AS-BUILT
I hereby certify that I have surveved the following
:'VroPerty: L~ 7" I ~, ' "
An~:hor~ge R .ec'o. rding Precinct, Alast~a, and that the~
ments'~ituated therebn are ~ithm the property lines a
overlap or encroach'on the Property lying adjacent the
r~d h~npro~,emeh~s 'bn pto?erty lying adjacent thereto
on the premises in-question and t~at there are no r
transmission lines or other visible easements on said
except,as indicated hereod'
http://members.x-mls.com/cgi-bin/mainmenu.cgi?cmd=url+report... 5/2/2011
~ Pumping
PO Box 773415
Eagle River. AK 99577
(907) 694-6454
r
IBillin.q Information
Bruce Scanes
Po Box 671813
Chugiak, AK 99567-1813
(907) 688-6265
i Job Site Information
Bruce
22500 Judd Street
Chugiak, AK 99567
(907) 688-6256
Additional Location Comments Diagram:
Job Description:
P.O. Number:
Terms:
Salesrep:
Map Book:
Cross Streets:
1250g
Service Agreement
Number: 032035
Order Date: 15-Sep-2010
Service Date: 24-Sep-2010 12:0
Technician: Mike & Dan
Net 30 Tax %: 0
Karlia Job Type: Repeat
Map Grid: 13
Knik Vista Street
'Last Serv '10/1512008' 1250g
O'D O/c
Job Comments:
S:~Diaqrams\16305.bmp
Gallons Planned: 1250
#'s on are green home w/dark green
trim, rv in dw
Pipes @ back under deck,
will have board removed to access
Service Type
Septic Serv 1250K
Qty Price Each Tax?
1 $185.00 No
Gal. Actual:
Hose Length: 2
Double Tank: []
Pump System: [] ,.____
Baffles Inlet: []
Baffles Outlet: [] ....
NonTaxable Total Taxable Total Tax Total Grand Total
Estimated Charges: $185.00 $0.00 $0.00 $185.00
Actual Charges:
Customer agrees to the terms and conditions shown. THIS IS A BINDING AGREEMENT.
Signature and Titl~f Customer Repl..e,~e'~'~tive Date
Accepted by ~Rs Pumping Date Accepted
For your added convenience we accept; Amedcan Express, Dicover, Visa and Master Card payments over the phone.
After 30 Days account will be turned over to COLLECTIONS. $30.00 For NSF Checks Returned.
Municipality of Anchorage
Development Services Departme
Building Safely Division
On-Site Water and Wastewater Program
4700 Elmore 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
ParcelI,D. O51-O43-53
1, GENERAL INFORMATION
Complete legal description
Location (site address)'
COSA# b 0LII3
Expiration Date:
Lot 13r Block 5~ Knik View Estates
22500 Judd Drive Chu~iak~ Alaska 99567
Current Property owner(s)
Mailing address
Brett & Tamara Neukam Dayphone(90?) 688-4593
22500 Judd Drive Chu~iak, Alaska 99567
. Lending agency
Day phone
Mailing address
Real Estate Agent
Mailing Address
Les Bailey g Associates Dayphone(90?) 689-6451
Prudential/JW 16635 Centerfield Drive Ea~le River,
Unless otherwise requested, COSA will he held by DSD for pickup.
2. NUMBER OF BEDROOMS:
4
3. TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class A Well []
Public Water System []
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 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 propedies 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.
A~
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage flies 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 inst~,ation.
Name of Firm Pinard Engineering
Address PO Box 871347 Wasilla~ Alaska
Engineer's Printed Name Paul E. Pinard, P.E.
5. DSD SIGNATURE
Approved for /--/ bedrooms.
Disapproved.
Conditional approval for .__
Phone(907) 357-364?
99687
Date -."1~. ~/~' '~0~/;' '.-
· .,,~-.. ..~ ~,
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: /~/L//~) ~'
Municipalily of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
LegatDescription: Lot 13~ Block 5¢ l~ntk Vie~ Estates ParcellD:051-O/,3-53
A. WELL DATA
Well type /[
Date completed
Total depth
If A, B, or C provide PWSID # .2_1..B./,09 Well Log (Y/N)
Sanitary seal (Y/N) Wires properly protected (Y/N)
Cased to ~ft. Casing height (above ground)
FROM WELL LOG AT INSPECTION
in.
Date of test
Static water level ft. ft.
Well production gp.m. g.p.m.
WATER SAMPLE RESULTS:
,Coliform
Arsenic:
coloniesll00 mL Nitrate mg/L
ug/L date of sample:
Other bacteria
Collected by:
colonies/100 mL
B. SEPTIC/HOLDING TANK DATA
.Tank Type/Material 8ept,:te/,C;t, eel
Tanksize 1250 gal. Number of Compartments 2
Foundationcleanout(Y/N).¥ea Depression over tank (Y/N) No
Date of pumping 10/15/O8 Pumper ,TP,.s ~Pump::in~
Date installed 8/130 - 9//-,/02
Cleanouts (Y/N) Yes
High water alarm (Y/N) NA
C. ABSORPTION FIELD DATA
Date installed 9/02
Length 51
Total depth 8 ft.
Soil rating (g.p.d.lft: [-~..~'~ffn~ I. 2 ' System type 5 Wide Trench
ft. Width 5 ft. Gravel below pipe
Eft. absorption area 51 0 ft: Monitoring tubeYe ~ Depression over field No
Date of adequacy test 1 1/28/08 Results (Pass/Fail) Pass
Fluid depth in absorption field before test 16 in. Wateradded6~Ogal.
Elapsed Time: 1.3 5 min. Final fluid depth 1 6 in~.'t'ter-
I
Absorption rate
Any rejuvenation treatment (past 12 mo.) (Yin & type)None Knoun
For 4 bedrooms
Newdepth 25 in.
>= 600+ g.p.d.
If yes, give date
D. LIFT STATION NA
Date installed
'Pump on" level at
Datum
Size in gallons
in. 'Pump off' level at
Cycles tested
Manhole/Access (Y/N)
in. High water alarm level at in.
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELLON LOTTO:NA - PUBLIC WATER SXSTEM _ NO WELL ON LOT
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Sewer/septic service line
Animal containment areas
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10 t ~. Property line. 107 + Absorption field 10't +
Water main 107+ Water service line 107+ Surface water 1OO~+
Wells on adjacent lots .200 ~ -I-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10 ~ +
Water Service line 10 ~ -I-
Curtain drain ti'one Enown
Building foundation .10 t +
Surface water. 100 ~ +
Wells on adjacent lots 200 ~ +
Water main 10 ~ +
Driveway, parking/vehicle storage
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 Paul E. Ptnardt P.E.
Date 12/.3/08
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
PINARD ENGINEERING
Paul E. Pinard
Registered Engineer/AK & ID
P.O. Box 871347, Wasilla, AK 99687
(907) 357-ENGR(3647)
ON-SITE DRINKING WATER AND SEWER SYSTEM
ENGINEER'S EVALUATION
PROPERTYDESCRIPT1ON: LOT t3, BLOCK 5, KNIK VIEW ESTATES
This property is developed to serve a single-family residence with a total of 4 bedrooms.
Owner's Name(s): Bmtt & Tamara Neukam
Ovmer's Address: 22500 Judd Drive
Chugfak, Alaska 99567
BuyeFs Name(s): Bruce & Theresa Scanee
BuyeCs Add.ss:
~?xN-SITE DRINKING WATER SYSTEM:
X This property is served by a Public Water System approved by ADEC.
A recent drinking water sample was tested at an ADEC certified laboratory and was found to meet c~rrent ADEC
drinking water standards for total celiform bacteria.
NOTES:
ON-SITE WASTEWATER DISPOSAL SYSTEM:
A new wastewatar disposal system has been Instatled. Based on periodic visual observations, it appears this system
was constructed in general conformance w~th current 18 A,&C 72 regulations and ADEC policies.
This wastewater disposal system was installed by an ADEC Certified Installer and approved by ADEC.
;KX The existing wastewater disposal system was tested in accordance with cu~ent MOA and ADEC policy and found to bo
^_ _operating satisfactorily. The readily identifiable features of this system were observed and documented.
~ Xx It appeam that this system meets requirements of the ADEC and the MOA, based on record infom,,ation at the
' - ' MOA.
This system does not meet the horizontal separation distance requirements of 18 AAC 72 regulations and
conformance with the vertical separation requirements of these regulations, to seasonal high groundwater and
Impen~eable layers, is unknown. Components are unknow~ end it is undocumented with ADEC.
NOTES:
This report does not constitute e guarantee of any tdnd, explicit or implied, as to the futura peffomtance of this water supply or
wastewater disposal system. It does accurately pork'ay the conditions found on the date they were tested and/or documented.
PINARD ENGINEERING
P.O. Box 871347
Wasilla. AK 99687
(907) 357-ENGR (3647)
ADEQUACY TEST
LOCATION: Lot 13, Block $, K~lk Vlew Estate~
APPLICANT; Brett & Tamara Neukam
22500 dudd Drive
Chuglak, AJeska 99567
SEPTIC TANK TYPE/SIZE: Steblf125~ Galto~s, per MOA Records
A~SORPTION SYSTEM: 5 Wide Trench (4' ED), per MOA Records
DAILY FLOW:
4 BEDROOMS x 150 GAL/~R · ~X) Gallo~m
JOB NUMBER: 08-272
DATE OF TEST: 11/28~08
FIEI.D STAFF; PJ Pina~d
NUMBER OF BEDROOMS: 4
SCUM: 0.0' SLUDGE: Minimal
NEEDSTOBEPUMPED: Yes No XX
CURRENTLY iN USE: Yes XX No
TEST DATA
Time Flow Volume Cumulative Septic Tank Septic Soll Absorption System Comments
Rate Volume Tank
pJ~ (GPM) (GALs) (GALs) Liquid Level ~, Level Monitor ~, ,SAS Monitor ,~ SAS
Tube 1° level Tube 3' Level
6:45 4.7 4.0' 1.3' Start Flow- Meter 370300
7:00 4.7 70 70 4.1' 0.1' 1.4' 0.1' 370370
7:15 4.7 70 140 4.1' 0.0' 1.6' 0.2' 370440
7:30 4.7 70 710 4.1' 0.0' 1.7' 0.1' 370510
7:45 4.7 70 280 4.1' 0.0' 1.9' 0.2' 370580
8:00 4.7 70 350 4.1' 0.0' 2.0' 0.1' 370650
8:15 4.7 70 420 4.1' 0.0' 2.0' 0.0' 370720
8;30 4.7 70 490 4.1' 0.0' 2.0' 0.0' 370790
9:00 140 630 4.1' 0.0' 2.1' 0.1' Stop Test- 370930
RECOVERY
Date T~me ST MT SAS MTt
11/28 9:10 4.0/-0.1' 2.0'1-0.1 '
PM
11/28 9:30 1.8¥-0.2'
PM
11/29 1:00 1.3'1-05'
PM
· ALL MEASUREMENTS IN FT.
TEST: PASSED XXX FAILED
COMMENTS: System appears to be functioning in n normal manner. There was 1..3' of mensurable liquid in the
SAS MT pr~o~ to b~glnnlng the test. ~Rth the addition of ~10 gallorm to the ayetem (mom ttmn the Oeslgn daily
flow), the level rose to 2.0', leaving half of t~e ED of the SAS still available. Recovery meesummen~ ehowed ~
showed ~atlsfactory abeorptiom ~
Reviewed by: Paul PInard ~
Date: '12/2/08
i J !
· ..! ~¢- ....¢.' / '
'VL . .~'.,,~,.-- .- I .
/'~'~; ,, ~-~' ! ~*, ...~_~,-~.. /
! ~.-.~ _.::/ ,'.~
· ' ' ,,~ e~ ~a~f~ ~u~ stmdure(sJas
/ .: / ~%z-¢ "'"' 4/ · ?'"' ~o'""-- o'" --
i'... / '' e~ , -
/ ; ! I i :,/ ,
I . / .~; !
:'' '7'*'' ' "':''
-"'""~ i/ ~
~" ~' ~' D -~ ~ ~~,T I hereby ce~t~y that l have survey, ed the fottowing described
~.~.*~.~X)'X~¥,, w ~ . ~ ~ ,-~ 'T'. Anchor'age Recorc[~8'l~-ech~et, Alaska, and tlut the ird~rove.
I .,e..~ .~ -, /~'~ ~ ~:, menls'Mtuated thereon are w~thin Ihe.propert7 lines and do not
i _'r',L~' ..° ~ % ..-- ,~ overlap or encroach'on the ptopeTty lying adjacent thereto, that
I "'~'~ "'er ~. · ,,~>-~'..: %7 -,t . no improvements'on ptoT~tty 1Ting adjacem thereto enc~oac~
I .. 4gib *'-~, ~, ~:., on th~ premise~ tn quesUon and that ~here are no ~oadways,
· '~' % "~ "~"~ ~.s*~ ~'anSm.tSsion I~es or other visible easements on said
[ 'Sa ~.~,~ Robert C. ~:.h~on .,r.~ ~ ~Z Date~ at'Eagle Raver, AlaSka
I e.~,.'.. . ~a-:z ,,,,4'~.¢,~ this I~ r~ da¥of ~:r_~. 200"~ .
~,x- ',~ ~'~- -'~ oox 77-04~, t.a$1e R~er, Alaska 99577
~t~one (9O7) 694-2.,~43
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.cLanchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
ParcelI.D. 051.043~53
1. GENERAL INFORMATION
Expiration Date:.
Complete legal description Lot 13. Block 5, Knik View Estates Subdivision
Location (site address or directions) Judd Drive
Current Property owner(s) MM&M Contracting
Mailing address P,O. Box 670495
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS: Four 14)
Chuqiak~ AK 99567
Day phone 688-1236
Day phone
Day phone
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class A Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
r'"l Individual On-site []
r"] 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 Enqineerin.q
Address P.O. Box 240773 Anchoraae. AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
DSD SIGNATURE
Approved for 47'
Disapproved.
Conditional approval for
bedrooms.
Phone 522.7773
Date 2/412003
.....
· [7] '''''~'~-~*~ ' ti 'L ~'~-E'/~~'''wk'['~' ..... I...~. ~
~[ MICHAEL E. ANDERS~ ~ ~.
bedrooms, with the following stipulations:
Additional Comments
'Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: ~ /1: /~ 7
Municipality of Anchorage
Development Services Department
Building Safety OMslon
On-Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage,ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ,.L~t 13. BlOck $. Knlk ~lew Estates
A. WELL DATA
Well type ~
Date completed
Total depth , ft.
If A, B, or C provide PWSID #
Sanitary seal (Y/N)
Cased to fL
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform ~,colonlesll00 mi.
Date of sample: ........
SEPTIC/HOLDING TANK DATA
Tank Type/Material ..,~eptlc/$teel.,
Tank size ..1~50 gal.
Foundation cleanout (Y/N) ~
FROM WELL LOG
Date of pumping
C. ABSORPTION FIELD DATA
Date installed gl4/2002
Length ~!
Total depth ?,$ fL
Data of adequacy test
Nitrate ' mgJI.
Collected by:
Number of Compartments
Depression over tank (Y/N)
· , , Pumper NewConstmctlon
Soil rating (g,p.dJft= or ~/bdrm) t.2 GPD/SF
ft. Width ~ ........ ft.
Eft. absorption area 610 ~ Monitoring tube
ResUlts (Pass/Fail)
Fluid depth In absorption field before test ...... In. Water added,
Elapsed Time: , min. Final fluid depth in.
Any rejuvenation treatment (past 12 mo,) (Y/N & type) I~
Parcel ID: 0514)43.53
well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
ft.
g,p.m.
Other bacteria
coloniesllO0 mi.
Date installed 8/30/2002
Cleanouts (Y/N) y
High water alarm (Y/N)
If yes, give date
System type 5' Wide Shallow Trench
Gravel below pipe ~ fl.
Depression over field N
For bedrooms
, gal, New depth in.
Absorption rote >= g.p.d.
D. LIFT STATION
Date installed
'Pump on' level at in.
Datum
E. SEPARATION DISTANCES
Size in gallons
'Pump o~ level at
Cycles tested
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot NIA
Absorption field on lot NIA '
Public sewer main FIIA
Sewer/septic service line
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots NIA
On adjacent lots NIA
Public sewer manholelcleanout NIA
Holding tank NIA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5'
Water main J41A Water service line >10'
Wells on adjacent lots >200'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property/line >10' Building foundation >10'
Water Service line >10'
Curtain drain None I~loted
F. COMMENTS
Lot is serv~ by AWWU water eystern.
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 HAA guidelines in effect on this date.
Engineer's Pdnted Name Michael E. Anderson, p.E.
Date 2/4/2003
Waiver Fee $
Date of Payment
Receipt Number
Surface water >100'
Wells on adjacent lots >200'
HAA Fee $~ .~7~' ~
Date of Payment
Receipt Number ~'~fO ~'~, ,.~ ~.'
(Rev. 12/00)
Absorption field >5'
Surface water >t00'
Water main >10'
Driveway, paddng/vehicie storage >25'
in,