HomeMy WebLinkAboutGLENN VIEW ESTATES NORTH BLK 3 LT 1Glenn, V
iew
Estates North
Block 3
Lot 1
#051-811-55
Municipality of Anchorage ;•'' ``
*Z4
,
Development Services DepartmentBuilding
Safety Division
On -Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW030142
PID Number: 051-811-55
Name:
Troy Davis Homes. Inc.
Wastewater System: ® New ❑ Upgrade
Address:
1451E. Parks HYN, #207 Wasilla.
AK 99687
ABSORPTION FIELD
Phone:
Number of Bedrooms:
U Deep Trench ®Shalkrw Trench O Bed O Mound 13 Other:
LEGAL DESCRIPTION
Sol Rating:
Total Depth from original grade:
0.6 GPD/Ft'
6 Ft.
Black: Lot: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe:
3 1 Glenn View
Estates North
2.83 Ft.
3.17 Ft
Township: Range:
Section:
Fill added above original grade:
Gravel Length:
1.65-2.45 Ft.
118 Ft.
Well: ❑ New ❑ Upgrade5.0
Gravel width:
Number of lines:
Distance between lines:
Ft.
1
NA Ft
Classification (Private, A. B. C(:
Total Depth:
Cased to:
Taal absorption area:
Pipe Material:
Public
Ft.
Ft
1017 Fe
D3034 & F810
Driller.
Date Driled:
Static Water Level:
Installer.
Date Installed:
Ft
Mike Cur
9/25/03
Yield:Pump
Set at
Casing Height Above Ground:
TANK
GPM
Ft.
FI
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. O Other:
To
Septic
Absorption
Lift
Holding
Public/PrivateManufacturer;
panty:
From
Tank
Field
Station
Tank
Sewer Line
Anchorage Tank
1250Gai.
Well
200'+
200'+
NA
NA
25'+
Material;
Steel
Numberof Compartments:
2
Surface Water
100'+
100'+
NA
NA
LIFT STATION
Lot Line
5'+
10'+
NA
NA
Size;
Manuldcluref.
Gal.
Foundation
5'+
10'+
NA
NA
'Pump on level at:
'Pump off level at:
High water alarm at:
le.
m.
In.
Curtain Dram
NA
*50'+
NA
NA
Pump Make & Motlot
EleNral Inspections performed by.
Remarks:
*none known
BENCH MARK
Location arcaDescription:
Bottom of siding
Assumed Elevation:
100 FL
Engineers Stamp
i
OF A44 U�
9114
Inspections performed by: KND Engineering.
Inc.Dates: 1 9/25/03
Saaa:'.�.•,.a«•,•.a ,�
•..•.: •
t
2nd 9/29/03
Development Services Department Approval 3"t IlleS163=�
• ..aa, ..... ,
Kennetn7116uf
(
/tom
q CE
F ••
Reviewed and approved by:
lay,.. Iznnl
Date: &
t : o •a• ..
J
� e�\oFES�1�4P.,.•�
AS—BUILT SYSTEM DETAILS/SITE PLAN
GLEN VIEW ESTATES NORTH S/D, BLOCK 3, LOT 1
EfiE
L :`.!
Permit SW030142
PID#051-811-55
Bow house
\ �R\
,���s\\
SCALE) V = 50'
PREPARED FOR:
TROY DAVIS HOMES, INC
1451 E. PARKS HWY, SUITE
WASSILLA, AK 99687
FlELD BOOKS COMPUTED:
90'"m' ANG DRAWN: vBG
STAMa- NA CHECKED: KMD
AMUaT: NA DA1e 11/14
Or- FXE: CMO: Kiun at
118.0' --1
SCALEt NTS 80.6 am
ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
ACAD RE' 03028.DWGI ADD "" 03028 1 (907)696-6111
111
8,25
Y
59
A -C= 32.9'
'
B -C=17.8'
7-dd
A—D= 37.7'
B -D= 23.5'
97.08 FINAL GRADE
96.30
A-E= 47.5'
L
MT"`"'""
B-E = 86.3'
1250 GAL
A -F= 83.6'
SEPTIC
9183
9182
B -F= 44.3'
TANK
'SEWER ROCK
air
PREPARED FOR:
TROY DAVIS HOMES, INC
1451 E. PARKS HWY, SUITE
WASSILLA, AK 99687
FlELD BOOKS COMPUTED:
90'"m' ANG DRAWN: vBG
STAMa- NA CHECKED: KMD
AMUaT: NA DA1e 11/14
Or- FXE: CMO: Kiun at
118.0' --1
SCALEt NTS 80.6 am
ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
ACAD RE' 03028.DWGI ADD "" 03028 1 (907)696-6111
111
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
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
C� InIO3 --
Date Issued: May 21, 2003
Expiration Date: May 20, 2004
Permit Number: SW030142 Parcel ID: 051-811-55
Legal Description: GLEN BIEW ESTATES NORTH BLOCK 3 LOT 1
Design Engineer: 0070 KND Engineering
Owner Name: TROY DAVIS HOMES, INC.
Owner Address: NHN WHISPERING BIRCH CIRCLE
CHUGIAK , AK 99567 -
Site Address: NHN WHISPERING BIRCH CIRCLE
Lot Size: 43376 SO. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
❑✓ Disposal Field Fv Septic Tank Holding Tank E] Privy
All construction must be in accordance with:
1. The attached approved design.
Private Well ❑ Water Storage
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date:
Date: 5-1211,03
Municipality of Anchorage
Development Services Department
Building Safety Division o=
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 SEWERNVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0S/ —18 / / — s.r Permit Number SW U90 /42
Property owner(s) Troy Davis Homes, Inc. Day phone 357.9394
Mailing address (1) 1451 E Parks Hwy., Suite 207, Wasilla, AK 99687
-A4 44"jaddress (2) W H I SPERIUG 81RCH CIRCLE Zip Code 7ZM
Legal description (Lot, Block & Sub'd.) Glen View Estates North, Block 3, Lot 1
Legal description (Section, Township & Range)
Lot Size -43244- Acre q.Ft.
4 3, 376
THIS APPLICATION IS FOR:
Number of Bedrooms 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.
of property owner or authorized agent)
Permit Fees: Y0-0 Waiver Fees:
Date of Payment: s//yl '03 Date of Payment:
Receipt Number: 03Sy7,Sr Receipt Number:
(Rev. 12/00) U � U
KNDD ENGINEERING, INC.
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111 /FAX (907)696-8111
May 14, 2003
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: New sewer permit — Glen View Estates North, Block 3, Lot 1
Gentlemen:
The owner has requested we proceed forward to obtain a septic permit on the subject
lot. On January 28, 2002 Tobben Spurkland (TS), PE dug one testhole for the proposed
system. An additional testhole was performed. on April 30, 2003. The results of these
tests are attached. The general slope of this lot is from south to north at a grade of
approximately 3-25%—the majority of the lot is relatively flat. As you can see on the
attached topo/subdivision testhole data and TS testhole, the legal description on the TS
testhole does correspond to the subject lot. The legal description was changed after the
testhole was performed.
We have designed our system utilizing the existing testholes that were excavated for
proposed 4 -bedroom house. The lot will be served by public water. We propose to
install one 5' wide shallow trench. Water was not encountered during the excavation,
but during monitoring at 11' TS and 12.8' KND.
There are no public or private wells within 200' of our proposed system location except
as noted. There is no surface water within 100' of the proposed system and there are no
known curtain drains within 50'. We do not expect there to be any adverse effect on
adjacent lots by the development of this system.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
IES"'M Engineering, Inc.
K Zn . Duffus, P.E.
Attachments: As noted
On -Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLA
GLEN VIEW NORTH S/D, BLOCK 3, LOT 1
DESIGN DETAILS
4 BDRM X 150 GPD = 600 GPD
600 GPD/0.6 GPD PER SO. FT. (8.88 MIN/IN,) = 1000 SQ, FT
(1000/5'(W)) X .58(RF) (3.0' GRAVEL) = 116 FT, TRENCH
USE 1 TRENCH — 116 (L) X 5' (W) X 3.0'(D)
Total depth of system Is 6.0' from original grade.
Total depth of gravel below distribution pipe Is 3.0' .
PPRROP13SED STs�TEK vtr"t" eoa of N❑TESi
NO PRIVATE WELLS EXCEPT
S N OF
PROPaSED SYSTEM E raTN ETE 1. CONTRACTOR & ENGINEER TO VERIFY INTEGRITY OF SEPTIC TANK AND
NO TT= SYSTEMS OF REPLACE AS REQUIRED. INSULATE TANK IF <4' COVER.
PRDPDSED WELL EXCEPT AS (E1TEA 2• INSULATE TRENCHES WITH 2' HD BURIAL FOAM.
3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK.
4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE
MIN. 3' COVER IF REQUIRED.
5. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
WELLS, SEPTICS, LOT LINES, FOUNDATIONS AND ALL OTHER SETBACKS.
I
PREPARED FOR,
TROY DAVIS HOMES, INC
/ �,• `� 1451 E. PARKS HWY, SUITE 207
WASILLA, AK 99687 Scale 1'= 100'
, PAGE 1 OF 2
,... _
...� ... , . _/ FlELD BOOKS COMPUTED:
1 ZM ENGINEERING
CE -7118 OWNDARr. LANG DRAMN:
STAWNLT NA CHEDXED: KMD 20441 PTARMIGAN BLVD.
'' ASBUILT. NA DATE: 5/13/03—
13 03 EAGLE RIVER, AK 99577-8736
SSIO��' : Dwa FlLECMD
NW1560
ACAD �` 03028.DWG 'ADD M' 03028 (907)696-6111/FAX (907)896-8111
�o
WASTEWATER DISPOSAL SYSTEM DETAILS
GLEN VIEW NORTH SID, BLOCK 3, LOT 1
54; PROPOSED ZABE
2000 SPLITTE
\ PROPOSED 125
\ GAL TANK
m
lillip
� - T
V
1 PROPOSED '
-
BDRM HOUSE'
PREPARED FORS
TROY DAVIS HOMES, INC
1451 E. PARKS HWY, SUITE 207
WASILLA, AK 99687
FlELD BOOKS coNvuim:
BOUNDARY.' LANG
DRAW
STMNc NA
scam.
Asomr. NA
DATE:
DNC. ME:
CRD:
"D"D "`E 03028.DWGl ''DD Nw 03028
Scales 1'= 30'
PAGE 2 OF 2
ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
6-611
111
,firI �F •A�
K
D ENGINEERING, INC. �;* j r '•,f9�0o
20441 PTARMIGAN BLVD. N
EAGLE RIVER, AK 99577-8736 4 ..L �• •���� �• • 0
rn Kenneth h1. D i t+
�e 6.' :� CE
SOILS PERCOLATION TEST �f9'''•........••''•��-�
���PROFESSIONP� �`
Performed for: _ Troy Davis Homes, Inc. Date Performed: 4/30/03
Project: Glenn View Estates North, Block 3, Lot 1 TEST HOLE # 03-1
1-
2-
3-
4-
5-
6-
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20-
Depth
(Feet)
Org/OL-ML —brown silty loam
w/organics
SM— med dense silty sand
w/gp pockets & cobbles 8"
B.O.H.
HOLE PRESOAKED
PRIOR TO TEST
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
Was Groundwater encountered? NO What depth? NA
Depth to water after monitoring? 12.8' Date? 5/7/03
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
5/7/03
1:00
-
6"
-
2
1:30
30 min
2 9/16"
3 7/16"
3
1:31
-
6"
-
4
2:01
30 min
211/16"
35/16"
5
"
2:02
-
6"
-
6
2:32
30 min
210/16"
36/16"
*
Water
Added
Percolation Rate 8.88 (min/ in) Perc Hole Diameter 6„
Test Run Between 4 feet and 5 feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
hpr 22 03 09s02a_ Tr, ---41 Davis Homes 907--157 9395 p.7
Municipality of Anchorage J GINEER•S S7CAL'•
Development Services Department �.;
8vilding, Safety Division '•,
O ".c
On -Site Water and Wastewater Program
Ar 4700 South Braga;v SL P.O. Box 196650 Anchorage. AK 99519.6650:.• . �., . www.ci.anchoraoee., : _ (907)343.7904v.
:Sons t_O g Percolation Test•• '•''?erfrmee Fcr: lam-+ L EN V 1 E 1),'l N 0121 1a :Oatc Performed:•
Leal Oesc:ipt:on: L�"T ` 7j iLt4 Township. Range. Section:
Depth
o26
J ANlc p i
. 6 l . l S - f4- u,..
t4 p
4.
»
5-
6.
6. (II ejrer_t/RA
II
8- H
10-
11-
12-
13-
14 4
15• R ••Eio w, e,-�-
-_ Nolte
17•
18•
10.
20-
COt. VE NTS
&:In a ,_
WAS GROUNO WATER
Date
ENCOUNTERED7
tai p
LL
5
IF YES. AT WHAT DEPTH?
L
Dtpo110Water After
�., D
Monitoring)
12JZ? E
Oak: 1!2 p2_
Reading
Date
Gross Time
Net Time Depth to Water Net Droa
LL
RE
o K
---
1
:2D
30, Int d
_
I•so
3C 9°
a:20
�n Q 7�r,� l o i
PERCOLATION RATE 3�Iminwes& n) PERC HOLE 01"ISTER � 1
TEST RUN UM'EEN FT AND 4 FT
PERFORmEO BY: --- �, S. I
PER"CRWED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIOELINS IN FFECT ON THIS CERTIFY THAT THIS TES- L
E E. DATE: t 2j° Z
,Ab
CI o\\ 1 I ///X/, .I I n1 ,I
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Gtf- J»c�A
Municipality of Anchorage
• Development Services Department
Building Safety Division
,i On -Site Water and Wastewater Program ; r;
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. SSI -Sl f 1- 5S COSA # C)goLl UD
Expiration Date: /a -- 7— 09,
1. GENERAL INFORMATION
Complete legal description °CrLCNrJ VieiA1 FST TPS A)PKTI4 V I (3'3
Location (site address) '9lr—C-4+
Current Property owner(s) ,(AMPS 7onnlnlA 5�pewSDay phone' -3o — ging {
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
(�.o• f5o',c 15017-5 . (3lLL4r'1C7S MT Se1(0S
e
Unless otherwise requested, COSA will be held by DSD for pickup.
Day phone
Dayphone 699 -(c4 -(n4 -
2. NUMBER OF BEDROOMS:
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
a,,
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 F_A(:XL-t= p_t V��- Phone Vl q - St `( S
Address I % JfW ��. #-.101 FN , A14- C�AS'1l
Engineer's Printed Name Date__,gJ!R!T!9*,e200--
0
I CHRISTOPHER R WOOD
5. DSD SIGNATURE CELLA
v '5 F
_j/ Approved for _ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: �G/%/fi, Lt/ Original Certificate Dale:/ -7—!2-7
(Rw IMS)
Municipality of Anchorage
Development Services Department
Building Safety Division '
On -Site Water & 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 CHECKLIST
Legal Description: CTLErJIJ VIEW rJO)e--r4 Parcel ID: 0ff'/—S/l-5,5�
L UT I f3c cc K 3
A. WELL DATA
Well type _ If A, B. or C provide PWSID # _ Well Log (YIN)
Date completed
Total depth ft.
Date of test
Static water level
Well production
WATER SAMPLE
Coliform L
ug/L
Sanitary seal (YIN) _ Wires properly protected
Cased to ft. Casing height ve ground) in.
FROM WELL LOG AT ECTION
V3
g.p.m.
mL Nitrate mg/L
date of sample: _
B. SEPTICIHOLDING TANK DATA
ft.
Other bacteria colonies/100 mL
Collected by:
Tank Type/MaterialSEt�f1C t=�=1- Date installed_
Tank size �, 5 gal. Number of Compartments _L Cleanouts (59N)
Foundation cleanout ON) _&,75 Depression over tank (Y&N &(C High water alarm (YQ nl 0
Date of pumping Pumper be I S
C. ABSORPTION FIELD DATA
Date installed 91,1S.10 Soil rating g.p.d./ft' or ft'/bdrm) 0•6 System type Ske I I oig 7iz ✓uq
Length 11 1� ft. Width 6 ft. Gravel below pipe 3 ft.
Total depth 5� ft. Eff. absorption arealQ-qft' Monitoring tube lt�cS Depression over field -pjn_
Dale of adequacy test Results as Fail) -R� For -tf bedrooms
Fluid depth in absorption field before test j `}-5 in. Water added 00 gal. New depth aL in.
Elapsed Time:)) min. Final fluid depth 14-S In. Absorption rate >= (0 00 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YA" type) OWe P t,1Dt 1Jn I If yes, give date,_
D. LIFT STATION
Date installed
'Pump on" level at _ in.
Datum
Size in gallons Manhole/Access (Y/N)
'Pump off level at _ in. High water alarm level at
Cycles tested Meets alarm &
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot V\v
V
Public sewer main ;ko
Sewer /septic_9rO-ce line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 4- S 1 Property line +5 1 Absorption field + 5
Water main -4-10, Water service line +10 Surface water 4-10 0 '
Wells on adjacent lots +100
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line +10 1 Building foundation +10' Water main +1 C) r
Water Service line t 10' Surface water + 1 n0 3 Driveway, parking/vehicle storage 0
i
Curtain drain +SOI Wells on adjacent lots
-1 ,Z
F. COMMENTS
G. ENGINEER'S CERTIFICATION c�'
49TH
1 certify that 1 have determined through field inspections and ``'
review of Municipal records that the above systems are in r _
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name C hrj n1r) r I klo()rl
Date IZ &J t ..;..
COSA Fee $ L/ ??o
Date of Payment INO 4
Receipt Number lv 6 3
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
in.
Municipality of Anchorage
Development Services Department
Building Safety Division ; • t�:
On -Site Water and Wastewater Program '
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-81111-55 HAA # L22 0 7
Expiration Date: e2-*
1. GENERAL INFORMATION
Location (site address or directions) Whispering Aireh Circle; Chuaiak AK 99567
Current Propertyowner(s) Troy Davie Homes Inc- Dayphone 357-9394
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
1451 E. Parks Hwy., Ste, 207, Wasilla. AK 99687
Day phone
.. .,. .•.
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
4
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
®
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 4 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. (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 KND FNr,[NFFRINr,, Inc- Phone (907) 696-61111
�•• 1 u •.� • .• ; _. ••
Engineer's Printed Name Kenneth M. Duffus Date 111261200-4
Engineer's Comments:
This investigation was completed in compliance with
ADEC and MOA regulations. The assessment of the
condition of the well and septic applies only to the
conditions as of the day tested. The flow and absorption
rates may change due to subsurface conditions that
may not be observed from the surface, changes in
land use, local soil characteristics, groundwater levels
that may fluctuate during the year and the water usage
of the family being served by the system. The operational
life of all well and septic systems are subject to these
various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system.
Therefore, KND can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can KND guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
—LZ Approved for Y bedrooms.
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OF 1A4�h
istai&r11- 1 1
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Kenneth M J
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Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: _ Original Certificate Dater c
Municipality of Anchorage
Development Services Department os -6- Building Safety DivisionOn-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal .: .. VIEW ESTATESNORTH.r
A. WELL DATA
Well type Pubilc
Date completed_
Total depth ft.
Date of test
Static water level
Well production
If A, B, or C provide PWSID #
Sanitary seal (Y/N1—
Cased to ft.
FROM WELL LOG
WATER SAMPLE RESULTS:
Coliform _---colonies/100 ml.
Arsenic: mg.h.
B. SEPTICIFIOLDING TANK DATA
ft.
9 -p.m
Nitrate _Ing./I.
Date of sample: _
Well Log (YIN)
Wires property protected (Y/N)
Casing height (above ground)
AT INSPECTION
ft.
g.p.m.
Other bacteria _ colonies/100 ml.
Collected by:
Tank Type/MateriDate installed 9/252003
Tank size 1250 gal. Number of Compartments-?.-Cleanouts (YIN) Y
Foundation cleanout (YM) Y_pepression over tank (Y/N),_High water alarm (Y/N) N
Date of pumping NA - NEW TANK Pumper
C. ABSORPTION FIELD DATA
Date installed 4/25/2003 Soil rating (g.p.d./fe or felbdrm)�M System type .trench
Length -18 ft. Width S ft.Gravel below pipe 3.17 ft.
Total depth §_ ft. Efl. absorption area 1017 fe Monitoring tube Y Depression over field N
Date of adequacy test NA -NEW SYSTEM Results (Pass/Fail) Pass For _4-- bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in,
Elapsed Time _min. Final fluid depth_ in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date -----
D. LIFT STATION
Date installed NA Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off" level at in. High water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
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
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 10 0'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 1 0'+ Water main 1 0'+
Water Service line 10'+ Surface water 10 0'+ Driveway, parking/vehicle storage 1 0' +
Curtain drain 50'+ Wells on adjacent lots 200'+
F. COMMENTS
cE of Al
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Aw C2
G. ENGINEER'S CERTIFICATION field inspections and * •4 ••L •IR 0 ••••• • '+O/0
I certify that I have determined throughp
review of Municipal records that the above systems are in ••N•
conformance with MOA HAA guidelines in effect on this date.
C�E 71
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Engineer's Printed Name Kenneth M. Duffus 1+1F9 ••• }'•••�C��"�
t`cO/'ROFESSt0�Pe'�
Date Al /26/2003
HAA Fee $375.00 Waiver Fee $ _
Date of Payment 11/26/2003 Date of Payment
Receipt Number Receipt Number
(Rev. 12/01) 010
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HOUSE DETAIL Lot 15
SCALE 1 • - W
15' TELECOM. a
ELECT. EASEMENT
Lor 1
SEPTIC
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Lot 2
PLOT PLAN _ ASBUILT Y- SCALE 10 ' So• GRID ! 15eo Project No.
Lan & Associates, ince 11500 Daryl Avenue, Anchorage, Alaska 99515
9 907 522-6476 Phone
Registered Land Surveyors (907) 522-4625 Fax OF A(
I hereby ovilty that I have .urwy.d the roibwinp dnormed property �`C •. . • • qs
Lot 1. Block 3. GLENN VIEWESTATES NORTN W. (Plat No. 2003-9)
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Anolwro9. Record) oa+a
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Meson are wllhin R+e property Bnuand donut enoroaaoMo 1Mtpraperlyo •••:
odlooent thereto. that no Imprvwmenh on 1M properh MnY 1 1 .
enor000h on 11re surveyed prombn and Mat there are no r� trommisdon/v.. �... .
Bnes or other vbibh eaeemade on eakl properly exoepf o. Mrecn• KENNETH 8. L 0 t
+I^ 1.2511 CAM jn2 _ at Mohorape. Alaska LS -5202 .
Doled Mb 1M 1LO Day of '••.__ _.
N M the respemR+�the owner to determine Me exk%nos Of easements.
, or whlah do not appear on the Hoarded subdhbkm Pk+t.