HomeMy WebLinkAboutKNIK VIEW ESTATES BLK 4 LT 4KnI*k View
Estates
Block 4
Lot 4
#051-043-35
• Municipality of Anchorage Page 1 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number. Sw980086 PID Number. 05104335
Name:
S inell Homes
Wastewater System: E New ❑ Upgrade
Y pg
Address:
9210 Vanguard Drive Anch. , AK
ABSORPTION FIELD
Phone:
No. of Bedrooms:
344-5678
Four
0Deep Trench 0 Shallow Trench peed ❑Mound ❑Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
1 .2 GPD/5 . Ft.
7'
Lot Block Subdivision:
4 4
Depen to pipe bottom bom anginal graft
Gravel depth beneath pipe
KNIK VIEW Ests
3.5 Fr.
4'
Township: Range: Section:
Fill added above original grade:
FL
Gravel langtii:
0 Fr.
65' Ft.
WELL: ❑ New ❑ Upgrade
Gravel width:
Number of lines: Oatanp Der.aan Luc
Gas4tication (Private. A.B.C): Total Depth: Cased To:
I
5 F[
Total absorption area:
— Ft.
Pipe material:
Class A FL
650 P.
Driller.
Date Drilled:
StabdwtterLent
Insfatier.
Date installed:
FL
Yield:Pump
Set at
Casurq Nugnt Above=14
GPM
FL
Ft.
TANK
SEPARATION
DISTANCES
xi septic ❑Holding 0S.T.E.P.
To
From
$*oft
Aboorpoon
Lin
Nw"
wpnwu
Manufacturer.
Capacity in gallons:
Tana
Fele
snap^
Tan*
sa..Lawa
Anch. Tank
1,500
Welt,
>200'
>200'
N/A
N/A
'>10'
Material: Steel
Number of Compartments: Two
Waters
>100'
>100'
N/A
N/A
>10'
LIFT STATION N/A
Lot
Line
>5I
> 10'
N/A
N/A
> 10'
Size in gallons:
I Manufaurer:
r
Foundation
r
>5
r
>10
N/A
N/A
N/A
-Pump on- level at
'Pump air level at
Nign water alarm at
Curtain INone
Drain
n Lot
Pump Make 6 Model
Electrical Inspections performed by.
Remarks:
BENCH MARK
water system.
Location and Description:
Rear Deck
Assumed Elevation:
100.0 c.
EN•*'�iWUW3,SEAL
Inspections performed by. M. Anderson Dates: 1st 5/4/98
2nd 5/5/98
/... .
//S;t.tiC!LR�LE.A':.'SJ'�,•,�
Department of Health and Human Services approval
;• a^t
Reviewed and approved by: o Date: t 2'
Jti
•av 3 IFA, Y..r MVA 25
Permit No. GW460086
Page 2 of 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: LT 4, BK 4, KNIK VIEW ESTATES S/D PIDNo.: 05104445
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW980086
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NAME:SPINELL HOMES
OWNER ADDRESS:9210 VANGUARD
ANCHORAGE, AK 99507
PARCEL ID:05104335
LEGAL DESCRIPTION:
KNIK VIEW ESTATES BLK 4 LT 4
LOT SIZE: 24336 (SQ. FT.)
NUMBER OF BEDROOMS: 5 THIS PERMIT: 5
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1ST rj', BJP M
PAGE 1 Oe as�
DATE ISSUED: 4/30/98
EXPIRATION DATE: 4/30/99
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 DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
ISSUED BY:
DATE • $ !` t
DATE: 14-- 4/ o
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)_
April 5, 1998
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject: Lot 4, Block 4, Knik View Estates Subdivision
Septic System Design
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
We hereby apply for a permit to construct an onsite septic system on Lot
4, Block 4, Knik View Estates Subdivision. The attached site plan and
backup documentation identify the size and location of the new septic
system to serve the five bedroom home to be constructed on the lot. The
subdivision is served by a community water system and all required
separation distances are easily met. No conflicts exist with other septic
systems in the area.
Testholes placed on the property revealed well graded gravels with sand
which percolated at rates less than 1 minute per inch. More than 51% of
the material passes the No. 4 Sieve, however, eliminating the need for a
sand filter. No groundwater was found in the testholes nor was any noted
during the monitoring period. We have therefore designed a 5' wide trench
absorption system with 4' of gravel beneath the distribution piping. The
total depth of the system will be 7.5' below the surface. The total length
of the system will be 63'.
The ground surface of the lot is gently sloping from south to north at a
rate of between 3% and 5%. It also slopes from east to west at a rate
approximating 3%. Sufficient surface area exists for both the primary and
alternate septic sites. No conflicts were noted between the septic
system sites and water services in the area.
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....... AREA PLAN ,
433 -E SCALE 1" = 100'
4OT 4
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MICHAEL E. a`4111SCii.
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SITE PLAN
SCALE 1" = 30'
• Site
Alt'
JUDD DRNE
LOT 4, BLOCK 4, KNIK VIEW ESTATES
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Five Bedroom Home
Perc. Rate: LT 1 MinJInch
Application Rate: 1.2 GPD/SF
5' Wide Trench System
1,500 Galion Septic Tank
4' Drainfieid Rock
5 Bedrooms X 150 GPD / 1.2 GPD/SF = 625 SF of Absorption Area
625 SF/5 LF (Width) X .5 (Red. Factor) = 63 LF Trench Length
Therefore: Construct a 5'. Wide Absorption
Trench
System With One
Lateral 63' in Length with 4' of Drainfleld
Rock Beneath the Lateral.
Distribution Pipe in Trench Placed at 3.0' Below the Original Ground
Surface. _.
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TYPICAL WIDE TRENCH
SECTION='��OFti�\
OF f tit 11
(NO SCALE)
�,�.
NOTE: Grade Area Over Trench to Drain Away.
4�—
Minimum 3' of Cover over Septic System.
....
Minimum 4 Separation From Groundwater.
Minimum 10' Separation o
?�;
From Lot
Line.
69CH4ELE =ERSM:;g
la 4331-E5�.�
Il%
ro.
MwLiapaRty of Anettoaga
DEPARTMENT OF HEALTH S HUMAN SERVICES
US "L* StreeL Anchorage. Alaska 94502-0650
SOILS LOG — PERCOLATION TEST
00*
4�J�H *1r
r ..
r
IE!DIIAEL E ANDERi61:
PERFORMED FOR: __ Sf�INELL l7oMEj DATE
LEGAL DESCRIPTION: LOT- y
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5
6 GW
7 �>SD'�
15
16 1 13arrom op 140t.0
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Ig_Townshlp. Range. Section
SLOPE
WAS GROUND WATER Alp ENCOUNTERED? O
WYES.ATWHAT
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ME'.
COMENTS rSrF%O[.6 �/LEsea�f �lL.o2 -ra Tr ..
PERFORMED 8Y: %NEA t '�"'u� FY THA/j 7T/�IS':F�'T WAS PERFORMED IN
A�ROMCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFEC. ON 71 -JS DATE DATE • `+// L L 9 F, .
. iS�Y1! fRw.4/!S1 •
OF
iCQ ' A vl..
Iit k#uLQty of Anehom9a
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 -L- Suva. AnonoraM Alaska 94502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR:Sh'�INGL[. 140MCj DATE
LEGAL DESCRIPTION: Lor. y. BLOC,e S• IZ,v IIL Towlssldp. Range. SacSo7:
—%'5rraoLeC /Jo. Z-
PASS /a G 40.4
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P'EACM ATION RATE 1
. / Imw"w,wcnl PERC HOLE DIAMETER 8
�'7--� '
.7m RUN BOWEEN . FT AND S F7 -.
COMMENTS IES-r40,1.c f�R.e'SOAm4m -/L2 t_ 4. 0 -M CS7" 50/LS loa-vC.T•p
"'.
PERFoR4ED 9Y: MEA • . ' t -411
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDVJW ES 1N EFFEC. ON THM DA T L OATS: .
'THIS TEST WAS PERFORMED IN
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 4, BLOCK 4, KNIK VIEW EST. SUBDIVISION
GENERAL:
1. The scope of this project includes furnishing and installing
a new 1,500 gallon septic tank. It also includes the
construction of a new 63' total length by 5' wide by 4'
effective depth absorption trench. The distribution piping
must be placed at 3.0' below the ground surface. Mounding
over the trench may be required to provide a minimum of 3'
of protective cover.
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 1,500 gallon septic tank must be procured from an
approved source and installed at the location shown on the
plans.
Lot 4, Block 4, Knik View Estates
April 5, 1998
Page Two
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.
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.
Lot 4, Block 4, Knik View Estates
April 5, 1998
Page Three
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 trenches 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, Fernco, or equal).
Lot 4, Block 4, Knik View Estates
April 5, 1998
Page Four
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:
A minimum of two inspections are required by Municipal
Ordinance. 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 Departme
\ 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
FOR A SINGLE FAMILY DWELLING
Parcel l.D. 051-t)43-35 COSH# ur02qq
1. GENERAL INFORMATION Expiration Date: 7-3-0-7--
Complete
-3—D7
Complete legal description KNIK VIEW ESTATES SUBDMSION: LOT 4, BLOCK 4
Location (site address) 22634 JUDD DRIVE • CHUGIAK. AK 99567
Current Property owner(s) JOHN HEBBERT Day phone 688-9692
Mailing address
Lending agency
Mailing address
22634 JUDD DRIVE • CHUGIAK. AK 99567
Day phone
Real Estate Agent GARY TAYLOR w/ DALL REALTY Day phone 594-4427
Mailing address 555 W. NORTHERN LIGHTS #208 * ANCHORAGE, AK 99503
Unless otherwise requested, COSA 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
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class •e• Well
Community On-site
❑
Public Water System
❑
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 Onsite 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 samples. (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 riles 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 Finn GARNESS ENGINEERING GROUP, Ltd. Phone
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P
Engineers Comments:
In conducting this evaluation, GEG, UD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines 8 Regulations. The reported results doscribed the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life ofall wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole bonerit of the owner listed above. Any reliance upon or use of this report by any
otherperson or party is not authorized, nor will It confer any legal right whatsoever.
5. DSD SIGNATURE
✓ Approved for q bedrooms.
Disapproved.
Conditional approval for
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
M2
337-6179
Date `) Db
bedrooms, with the flowing stipulations:
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
WATER AND
By; Z61 � Original Certificate Date: 7-3-06
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water R Wastewater Program
47110 Bragaw, Street
P.O. Boa 196850
Anchorage, AK 995198650
www.muni.orgtonalte
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: KNIK VIEW ESTATES SUBDIVISION: LOT 4, BLOCK 4 Parcel ID: 0,6'1 -0 93:36-
A.
3-3S
A. WELL DATA COMMUNITY WATER
Well type W If A, B, or C provide PWSIDN _
Date completed S _
otel depth ft. Cased to ft.
FROM WELL LOG
Date of test
Static water level
Well production 9.p -m.
WATER SAMPLE RESULTS:
Coliform colonies/100 ml.
B. SEPTICIHOLDING TANK DATA
Nitrate
Well Log
property protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
of sample: Collected by:
9 -p.m -
Tank Type/Material STEEL Date Installed 5/4-5/1998
Tank size 1500 get. Number of Compartments 2 Ckwouts (YM) YES
Foundation deanout (YIN) YES Depression over tank (YIN) NO High water alarm (YM) N/A
Date of pumping 6/8/2006 Pumper SANITARY PUMPERS
C. ABSORPTION FIELD DATA
Date installed 6/4-4/1998 Soil rating( dJft or ftibdrn) 1_2
Length 65 R. Width 5 ft.
ml.
gyawm " SHALLOW TRENCH
Gravel below pipe 4 ft.
Total depth 7-9.1 R. Eft, absorption area 650 fe Monitoring tube YES Depression over field NO
Date of adequacy test 6/6/2006 Results (Pass/Fell) PASS For 4 bedrooms
Fluid depth In absorption fteld before test RY 1.5 in. Water added 700 gal. New depth JL/12 in.
Elapsed Time: 168 min. Final fluid depth 1211112111 It. Absorption rate " 600+ 9.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN &type) NONE KNOWN If yes, give date —
D. UFT STATION
Date installed Size in gallons Manhole/Access
LDa
mp on" level at _in. "Pump off" High water alar level at h.
tu Cydes tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankd16 station on lot 1001+ On adjacent lots 1001+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main N/A Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC(HOLDING TANK ON LOT TO:
Building foundation 51+ Property line 5'+ Absorption field 50+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service One 10'+ Surface water 100'+ Driveway, parkingNehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent k)ts100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I candy that I have determined through field inspectlons and *! •' - r*
review of Munidpal records that the above systems are In .......... ........ .......
conformance with MOA COSA guidelines In effect on this ..............
date. y
Engineer's Printed Name JEFFREY A GARNESSCEr7p53 Pb•
Data b191�6 � . ••'61.R'l'•. `�
'°P�er...w�d
COSA Feet; 413 n. o o
Date of Payment CU' a le&,
ReceiptNumber."
(FW. IV05)
Waiver Fee $
Date of Payment
Receipt Number
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
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING)
Parcel I.D. 051-043-35 HAA # Q��D is
Expiration Date: % — / 9 - 0.21
1. GENERAL INFORMATION
Complete legal description Lot 4, Block 4, Knik View Estates
Location (site address or directions) 22634 Judd Drive
Current Property owner(s) Steven and Jeanne Kemper Day phone 688-8833
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
22634 Judd Drive Chuaiak, AK 99567
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage '
Community Class A Well
Public Water System
Four(4)
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
❑
Individual On-site
ED
❑
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
engineers work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm Anderson Engineering Phone 522.7773
Address P.O. Box 240773 Anchorage. AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 7!16001
OF A
4�.
" �yGlr5.-R'S
►'
F* WOiAEL E AtiGEi3CT:. �
CE-43SI
5. DSD SIGNATURE
Approved for bedrooms. j�6Ct�.`-�•�v
Disapproved.
Conditional approval for bedrooms, with the following stipulations: .
Additional Comments
A
ON-SITE • •'•�G�-
VVAIERHID' m=
WASTEWATER
PROGRAM
i•• �.�
Ul
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: -7' &
(Rev. 1200)
Municipality of Anchorage
• Development Services Department
IG Building Safety Division `
On-Sfte Water 6 Wastewater Program :
Ik 4700 South Bragaw St.
P.O. Box 196850 Anchorage, AK 99519.6650
www.cianchorageek.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 4 Block 4. Knit View Estates Parcel ID: 05144335
A. WELL DATA
well type 9
Date completed
Total depth ft.
Date of test
Static water level
If A, B, or C provide PWSID #
Sanitary seal (YIN)
Cased to ft
FROM WELL LOG
Well producion
WATER SAMPLE RESULTS:
Coliform colonleslloo ml.
Date of sample:
S. SEPTICIHOLDING TANK DATA
ft.
Nitrate mgJ1.
Collected by:
Well Log (YIN)
Wires property protected (YIN)
Casing height (above ground) in.
AT INSPECTION
Tank TypWaterial SeoticON! Date installed 514n998
Tank size X500 _ gal. Number of Compartments 2 CleanaAs (YM) v
Foundation cleanout (YM) X Depression over tank (YIN) N High water alarm (YIN) N
Date of pumping 81772000 Pumper Sanitary Pumpers
C. ABSORPTION FIELD DATA
Date Installed 5WO98 Son rating (g.P.dJIN or ft=Ibdrm)21 GPDW System type S Wide ShadowTmneh
Length 65 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 7 ft. Eft. absorption area 65012 Monitoring tube Y Depression ever field N
Dated adequacy test 7n4140M Results (Pass/Fed) Pass For 4 bedrooms
Fluid depth in absorption field before test Q in. Water added7S0 gal. New depth0 In.
Elapsed Time: Q min. Final fluid depth Q in. Absorption rate x 750 g.p.d.
Any m*enation treatment (past 12 mo.) (YM & type) N If yes, give date
D. LIFT STATION
Data installed
'Pump on' level at _ in.
Datum
Size in gallons
'Pump off" level at _ in.
Cycles tested
E SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankllift station on lot WA
Absorption field on lot WA
Public sewer main WA
Sewer /septic service line
Manhole/Access (YIN)
High water alarm level at
Moab alarm b okcud requirements?
On adjacent lots WA
On adjacent lots WA
Public sewer manhole/cleanout WA
Holding tank WA
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Budding foundation >S Property line >T Absorption field >S
Water main -IUA- 0, f Water service line >10' Surface water MW
Wells on adjacent lots >200'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10' Budding foundation >1C Water main >10'
Water Service line >111' Surface water >100' Driveway. paftig chide storage >25
Curtain drain None Noted Wells on adjacent lots >200'
F. COMMENTS
111
G. ENGINEER'S CERTIFICATION + P�.
I ceRMy Owl 1 have deterr wd through field inspections and * ; 491Y
review of Municipal records that the above systems are in r0 .... ..... ..... . ..,'
conbrmance with MOA HAA gul Wkws in effect on this date. d �• : Mlcr
OR
Engineer's Printed Name Michael E Anderson. P4 ♦e s:.
Date 71101 fttt0 FE F(S< �`Yy
HAA Fee S Walver Fee $
Date of Payment -7/ 4 Date of Payment
Receipt Number -7Z Receipt Number
(Rev. 12(00)
in.
MUNICIPALITY OF ANCHORAGE' '
• DEPARTMENT OF HEALTH 6 HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. # 05104335
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
HAA #�q��
1. GENERAL INFORMATION
Complete legal description Lot 4, Block 4, Knik View Estates
Location (site address or directions)
Property owner Sg n 11 Homes Day phone 344-5678
Mailing address 9210 Vanguard Drive Anchorage, AK 99507
Lending agency
Mailing address
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: Four (4 )
3. TYPE OF WATER SUPPLY:
Individual well
Community well xx
Public water
Day phone
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest -
Ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site xx
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-02 M".1/91) Fro MOARt
S. 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 of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify 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 in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm Anderson Engineering Phone 522-7773
Address P D Box 240773 Anchorage, AK 99524
Engineer's signature
6. DHHS SIGNATURE
Approved for :024 bedrooms.
Disapproved.
Conditional approval for
Additional Comments
cid
Date 7/30/98
=q.(%
N • .i/ mai+'• , • � ./....
433t.c
bedrooms, with the following stipulations:
Date 7— 3 1- 9 R
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given In paragraph 5 above by an independent
professional engineer registered in the State of Alaska.The DHHS does this as a courtesyto purchasers of homes
and thei r lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-M CFW�. V91) Back MOA a21
Municipality of Anchorage E C E I V E D
DEPARTMENT OF HEALTH & HUMAN SERvIC
Environmental Services Division 1998
�
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 4�Q4
Municipality of Ancnorage
Health Authority Approval ChecklistDept. Health & Human Services
Legal Description: Lot 4
A. WELL DATA
Block 4. Knik View
Estates
Parcell.D.: 05104335
Well" Class A If A. B, or C, attach ADEC letter. ADEC water system number 218409
Log pre sent(Y/N)
Total depth
Sanitary seal (Y/N)
Date of teat
Static water level
Wen production
Date completed
(
FROM WELL LOO
WATER SAMPLE RESULTS:
Coliform
Date of sample:
S. SEPTICIHOLDINO TANK DATA
Nitrate
Casing height (above ground)
Wires property protected (Y/N)
AT INSPECTION
g.p.m. g.P.m.
Collected by:
Other bacteria
Date installed 5/4/98 Tank size 1,500 Number of Compartments 2 Cleanouts (YM) Y
Foundation cleanout (YM) Y Depression (Y/M N High water alamr (YM) N
C. ABSORPTION FIELD DATA
DatekwWled 5/5/98 Sollrating (g.pdMorfF/bdrm) 1 .2 System" 5' Wide Trench
Length 65' Width 5' Gravel thktimessbelow pipe 4Total depth 7'
Effective absorption area 845 SF Monitoring Tube present (Y"-!— Depression over field (Y/N) N
Date of adequacy test New Const. Resufts(PassJFam Pass For 4 bedrooms
Fluid depth in absorption flew before test (In.); Immediately atter_ gat. water added pn.):
Fluid depth (Ins) Minutes later. Absorption rate a a.pd.
Peroxide treatment (past 12 months) (Y/1) N If yes, give data
72-028 (Raw. 3198)•
D. LIFTSTATION - N/A
Date installed
Manhda/Access (Y/N)
Nigh water alarm level at' _
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level ar
'Datum
'Pump ofr level at*
SEPARATION DISTANCES FROM WELL ON LOT TO: - No Well on Lot.
Septic/holding tank on Id
Absorption field on lot
Public sewer main
Sewer /septic service line
On adjacent lots
On adjacent lots
Public sewer manhdeJdeanout
Lift station
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Community Water
System.
Foundation >51 Property line >51 Absorption field >51
Water maintservice line -L1 Surface water/drainage >100' Wella on adjacent lots >200'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line > 10' Building foundation >10' Water maln/service One >10'
Surface water >100' Driveway, parldngNehide storage area >20'
Curtain drain None on Lot Wells on adjacent kits >200'
F. ENGINEER'S CERTIFICATION
I certify that I have determined Mm field inspections and review of MuNdpal�asabAds®R tAaraTikle systems are
In conlonnannoo w1th MORA NAA gtddefines in effect on Ihls date. �,P�'C®"
Signature �' *`� '� a C. L l lvn. '!� TL `
Engineer's Name Michael E. Anderson, P.E. j.
T,'• Mfuil L. E P i
Date 7/30/98 /
♦!t 4361-E .}� i
I�rT6o�a4' �—
HAA Fee
Date of Payment `i-?�-9S,
Receipt Number C') Z --V8 3) 3
72.026 (Rev. 6196)•
Waiver Fee $
Date of Payment
Receipt Number
FROM :GARY TAYLOR
FAX NO. :907 694-4427 Jun. 09 2006 08:41AM P2
KNIK VIEW ESTATES
LOT 4, BLOCK 4.
24,336 S.F.
S 89.56'31"F 179.92'
11130'
♦♦$*n1iis
♦
OF• At �#*b
4s� A�
i�F�49Ll••�;*�
�t ... ..
�Y Jfilay %. GastaFR � r
., L5-6091
•v ........ by em,�♦ PrOrefflandl Lan ♦�
all r%as**
9VMS
OASTAI.DI LAND 6URVETINO
Jeff A. 00.10101. R.L.S.
4716 Weil gain Awe.
AneheN{e, A$a%ha 09502
PHONE 948-6454
IOilNW 1558 I DA 7/ TE 15* I
/.0. JOe N0.
66-10 NVC44
E21
1 hereby certify that I have surveyed the
p Ossify depleted above dad that na
entrewt Howls Owlet aseept al Indicated.
U U the respens tblllly of the owner to
determine the •alliance of any wesneets,
aoeenaate or restrletlene whlth do nu
appear on the recorded eebdlvlelon blot.
Under no straw" lances should any data
Rerun be used for construction or les
establishing boundary or tenet Iloef.
ANCHORAGE RECORDING DISTRICT, ALASKA
NOTEt NO CORNERS BET THIS GATE.