HomeMy WebLinkAboutKNIK VIEW BLK 1 LT 3
Municipality of Anchorage Page I of
DEPARTMENT OF HEALTH AND HUMAN SEFtVICES
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: ..~'uS~Ol~:"[ PID Number: 05; I - o ~ I- ~
Name:
~2c~ ~o~c~,o~ ~a~ L~ A~ WastewaterSystem: ~New ~ Upgrade
Address:
~,o. ~ ~7~o~ ~~ ~ ~ ABSORPTION FIELD
No. of Bedrooms:
Phone: / ~. D Deep Trench ~ShallowTrenc~ D Bed D Mound D Other
Soil Rating: ~ Total Depth from original grade:
LEGAL DESCRIPTION , ~ ~ t.~ ~,~sq. ~,. ~''
Subdiv~ion: Depth to pipe bottom fto~ original grade: Gravel depth beneat~i~e
Lot: ~ Block: j }~nSeclio ~'~ 7~1 '~~ Ft. Ft.
Townshtp:~ ~ Range: ~ ' : ~ Fill added ab~veo, ~°ri~inal~" grade: Ft. G~vel~ ~length:~l~ ~ ~OI ~ Ft.
I
WELL: sx~,~New ~ Upgrade Gravelwidth: ~ I Number of li~es: Distan~nlin~:
a , Et, ~ I } 0 Ft.
Clarification (Private. A,B,C): Total Dep~ ~sed To: Total absorption ~re~ Pipe material:
// Ft, Ft. ~ ~ ~ SQ. Ft.
Driller: ~ Date Drilled: Static Water Level:Fl. Installer:~e~ ~,~ Date installed:~
~,~u:/ IP~pse,.~:Casing Height Above Ground: TANK
~ GPMJ Ft. Ft.
SEPARATION DISTANCES ~Septic D Holding [3 S.T.E.P.
To Septic Absorption Lift Holding ~ubHc/Private Manufacturer: Capacity ingallons:
From Tan~ Field Station T~nk Sewer Lines A~0~ ~
Number of Compa~ments;
Wel~ Z~I ~ ~OOl+ ~ ~ ~ Material: ~E~
Su~ace
Water I0~1~ ~o='+ ~ ~ ~ LIFT' STATION
LOt ~ ~~acturer:
Line ~2t~ ~[t:~ ~ ~ Si
....~~~High wa it: " : ' er alarm at:
Drain
Remarks: ~ ~1~ ~ ~A~ ~ BENCH MARK
Location and Description:
A~umed Elevation:
ENGINEER'S SEAL
Inspections pedormed by: ~"h~' ~,~o~r~,l~, DateS:2ndlSt ~/=~/~e ~: ~/~" ~:} ~ ~~ ~2~ ~"" ....
DepaAment of Health and Human Se~ices approval ~,'~.',._ ~-
Reviewed and a proved by' ~/~/ ~. ~ Date: ~'/~- ~
72-013 (REv. ~/91) MOA 25
PERMI'I Nt L4RE. R
SW980123
AS-BUILT DRAWING
p^r~r-c ID
051-031 -26
S¥1 / -99,11
96.25- 'ff~-/ NEW 1250 GAl LON
SEP FIC rANK
ST2 -. INSULATION
,--96,6ri
WEST TRENCH
C, O3 ~ ~INAL Of~/tl)L
C0,1 / C05 :: 98.43
· INSUI.A[K)N ~
~OTI'OM OF PiPE
95.50 (L~/EL)
~ 92,50
ALASKA WATER AND WASTEWATER CONSULTANTS, INC.
7320 E, CHESTER HEIGHTS CIRCLE, ANCHORAGE, AK D9504
PHONE: (907) 537-6179/FAX: (907) 538-524-6
~'FiOAI_ DESCRIP]tON:
KNIK VIEW SUBDIVISION, LOT ,5, BLOCK 1,
~'PE OF WORK:
AS-BUILT OF SEPTIC SYSTEM
~REPAREO FOR: PiK)NE NUMBER:
LEROY ALDERMAN W/ M2Cl CONST. 229-8059/223-8100
'[DR^WNI)Y:J'L'M'/A'C'G' [SCAle 1 = [P&O~:
~"Ta8_11_98// I 30' 2 OF 2
TRENCH
CO2 M T1
' FIN^I GRADE
C01 ~, 98.55
fi02 :: 99.1,c
7320 East Chester Heights Circle ~ Anchorage - Alaska 99504
Phone (907) 33%6179 ~ Fax (907) 338-3246
August 11, 1998
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Subject: As-built documentation for septic system: Lot 3, Bk 1, Knik View S/D.
To whom it may concern:
Attached is the as-built package fbr the subject septic system installation. Prior to col~struction of
the septic system the contractor dozed the organic layer off much of the site. He then excavated
to a depth of up to 5 feet below the graded area, which was as much as 6 feet below the original
grade. The total depth of the trench was supposed to be limited to 5 feet below original grade, to
ensure that there was 2 feet ofinsitu gravel below the bottom of the shallow trench. In short, the
trench was over excavated in some areas, leaving less than 12 inches of insitu gravel below the
bottom of the trench (24 inches accepting soil stratum required by code). It is believed that about
50% of the trench length has adequate gravel depth under it. For purposes of this evaluation it
will be assumed that the application rate for the trench bottom is the average fbr the two
percolation rates: (.45 gpd/122+ 1.2 gpd/f~2)/2 = .825 gpd/122 = .8 gpd/fr2
In order to correct the aforementioned problem we modified the trench depth to 3 feet (rather
than 2 feet). The total trench length was changed to 90 feet, making the total absorption area
775 122. An evaluation of the absorption area is summarized as follows:
· The bottom area ora 3 foot deep (effective), 5 foot wide trench accounts for 58% of the total
absorption area, or 450 122.
· The application rate for the trench bottom is .8 gpd/ft2, which equates to a application of 360
gallons/day.
· The sidewalls account for 42% of the effective absorption area, which is 325.5 1t2.
· The soil application rate for the sidewalls is 1.2 gpd/112, which equates to an application of
390.6 gallons per day
· The total application rate for the bottom and sidewalls is 750.6 gpd/122, which is greater than
the required 600 gallons per day.
I believe the existing installation meets the design criteria for a 4 bedroom house. If you have any
questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance.
7320 East Chester Heights Circle - Anchorage ~ Alaska 99504
Phone (907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
June 1,1998
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
RECEIVED
dUN 4 1998
Municipality of Anchorage
Dept. Health & Human Services
Attn: Laura Montgomery
Subject: Status of Septic Syste~n docmnentation for Lot 3, Block 1, Knik View S/D.
A permit (SW980123) was issued to install the subject septic system. This property is
undeveloped and new home is being built. The septic system has been installed, however there
are no points of reference to swing-tie the new septic system on the property. After 'the house is
complete, final grading is done and an as-built survey is done, I will complete the documentation
and as-built of the septic system which will be submitted to your department (DHHS) for review
and approval. Ify,ou have any questions, please contact me at 337-6179, or 244~9612. Thank
you for your assis~l.nce.
Sincerely,///
j~('~ffr .¢¢ ~' ]Uarness, LE., M,S.
Prin6ip~l ~
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Date Issued: May 19, 1998
Expiration Date: May 19, 1999
Permit Number: SW980123 Parcel ID: 051-031-26
Design Engineer: 0041 ALASKA WATER & WASTEWATE Legal Description: KNIK VIEW BLK 1 LT 3
Owner Name: Leroy Alderman / M2C1 Site Address:
Owner Address: PO Box 670,4.5 Lot Size: 20027 SQ. FT.
Chugiak, AK 99567- Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
I~ Disposal Field L~ Septic Tank
i~ Privy ~ Private Well
Holding Tank
Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AACS0 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 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.
5. The following special provisions.
Date:
Date:
Alaska Water & Wastewater
7320 East Chester Heights Circle -~ Anchorage - Alaska 99504
(907) 33%6179 ~ Fax (907) 338-3246
Consulting Engineers
May 5, 1998
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref~ Septic Design for Lot 3, Block 1, Knik View Subdivision
To whom it may concern:
The proposed 4 bedroom house will be served by a private septic system and a community water
system. Comments regarding the proposed design are summarized as follows:
1. SOILS: Attached are logs which shows the soil profile, and the percolation test results. Test
hole #1 (TH#l) will be used for the primary site . The soils below the organic layers are a GW
with some sand to a depth of 7 feet in TH#1 and to a depth of 6 feet in TH#2. The soils below
the GW layers are a SM layer with some gravel (hardpan) to a depth of 13 feet in both TH#1 and
TH#2, which are the bottom of the holes. No groundwater was encountered during the
excavation of the test holes. The percolation tests for TH#1 were performed between the depth of
5 feet to 6 feet which had a percolation rate of <1 minute/inch and between the depth of 7 feet to
8 feet which had a percolation rate of 40 minutes/inch. The percolation tests for TH#2 were
performed between the depth of 3.5 feet to 4.5 feet which had a percolation rate of, 1 minute/inch
and between the depth of 6 feet to 7 feet which had a percolation rate of 40 minutes/inch. No
bedrock, or impermeable soil was encountered. The confining layers at 7 feet in TI-I#1 and at 6
feet in TH#2 should negate the need for a sand filter.
2. TRENCH DESIGN:
a. Percolation Rate: <1 minutes/inch
b. Allowable Application Rate: 1.2 gallons/day/f~2
c. Number of Bedrooms: 4
d. Design Flow: 600 gallons per day
e. Minimum Absorption Area: 500 ft2
f. Total Depth: 5 feet (max.)
g. Effective Depth: 2 feet
h. Width: 5 feet mi~fimum
i. Reduction Factor: 0.70
i. Minimum Length: 2 ~ 40 feet long each = 80 feet total length
j Effective absorption area = 600 ft2' (>500 ft2)
3. S1JRFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
4. TOPOGRAPHY: The average topography of this property is mostly fiat; in short, there are
no slope concerns.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you
for your assistance.
Sincerely, /] ~
Jeffr. ~ ~. ~rness, P.E., M.S.
Prin. >~1 q
LOT 5, BLK 2, ,"/ / / ×
,,'/ / / / LOT 1, BLI'( 1,
/ / /' . KNIK VID, S/D
LOT B, BLK 2,
KNIK VIEW S/D
LOT 2, BLK 1,
KNIK VIEW B/D
LOT 3, BI_K 1,
LOT 7, BLK PROPOSED KNIK VIEW S/D
KNIK VIEW SEF'TIC SYSTEM~
/ / LOT 5, BLK 1,
KNIK VIEW S/D
,/ ,, /,, ~ ~-~-:
/ ,.,, /,,,, ........ ;__ c===:
// /, ;' ALI'ERNA'f E
/ LOI 6, BLK 1, ,¢~ /
/ / ' a-- ,~', I_OT % BLK 1,
,, /// KNIK VIE',',/ S/O L~ / "-/ KNIK VIEW
~ LO'[ 7, BI.K 1,
KNIK VIL~'t S/D
LOT 8, BM< 1,
KNIK Vll~"/
'PREPARED BY:
LOT 2B, SEC]qON 5, T15N, R1W
NOTE: ALL PROPERTIES WITHIN 2OD' OF THE
IPROPOSED SEPI'IC SYSTEM ARE SERVED BY
JA C~OMMUNITY WATER SYSTEM
m
ALASKA WATER & WASTEWATER
LOT E~, BM< 5,
KNIK VIEW EST.
LOT 9, BLK 5,
KNIK VIEW EST.
LOT 7, BM< ,5,
KNIK VIEW EST.
LOT 6, BM< 5.
KNIK Vl~-'./ EST.
..--/
LOT ,5, BLK 5,
KNIK VIEW EST.
LOT 4-, BI.K 5,
KNIK VIEW EST.
I_E(~AL DESCRIPllON:
KNIK VIEW SUBDIVISION; LOT 3, BLOCK 1,
'[YPE OF WORK:
SITE PLAN
PREPARED FOR: PltONI: NUMBER:
LEROY ALDERMAN W/ M2C1 CONST. 229-8059/2275-81'00
DA?E:5/5/g8 IDr~WN I~Y:J.L.M. Isc^LE: 1 = 100' !PAGE:
1 OF2
iNSTALL FI.O',',' SPLI'FIER---/L-~'~- _1
~TH~2 ~ X SEPTIC TANK
_--PR()POSED 5 FOOT WIDE DRAINRELDS
5 FOOT DEEP (MAX) F¢¢ 40 FOOT
I_ON¢~ -ISACll (80 FE~,I,' I'OTAL lENgTH),
ADD 2 FEEl- OF S~,JER DRAINROCK
col %;r / ,
NOTE: ALL PROPERTIES WITHIN 200' OF 'I'FIE
P, ROPOSED SEPTIC SYSTEM ARE SERVED BY A
PREPANED DY:
A ASKA WATER & WASTEWATER
lEGAL DES.RIPIlON:
KNIK VIEW SUBDIVISION, LOT ~i BLOCK 1,
,,
'fYPE OF WORK:
DESIGN FOR PROPOSED SEPTIC SYSTEM
PREPAREO FOR: PHONE NUMBER:
LEROY ALDERMAN W/ M2Cl CONST. 229-8059/223-8100
DATE' I SC~qLE] I PAGE'.
'~/~/9~ I ~ = ~o' ] 2 o~'
BY:
ID~^WN ,LL.M.
L,J
Ltl
KEY BOX
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG m PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
At..~i,~A,,~,j ?_C.1' C..o~J&'"~. DATE PERFORMED:
~ F,, ~la.~T°wnship' Range, Section:
3
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS ..
WAS GROUND WATER
ENCOUNTERED?
SLOPE SITE PLAN
S
L
IF YES, AT WHAT ~, O
DEPTH? P
E
Depth [o Waler After
Monitoring? 0R''Y Dote:
Gross Net Depth to Net
Reading Date Time 'l'ime Water Drop
/~/'~ (m,nutes/inch) PERC HOLE DIAMETER
PERCOLATION RATE
TEST RUN BETWEE '7 FT AND ~' FT
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
PERFORMED FOR:
,~;,~, ~,;.,, ~','o .... 't ..... ifv.~N~,INEER'S SEAL)
, ', ~.. ,¢...,-.,¢~H¢~/~ ~;;r_/ \ '.,.., ~
,,,..,.,..,,,, o, ,,.c,or..e
DEPARTMENT OF HEALTH & HUMAN SERVtC~_¢ .~. J//J/~q(I/~ ,.~
825 "L" Street Anchorage, Alaska 99502-0650~r~ .-~ .~; ~'y.4~~~~.~
' t', ,'~. ', e I
¢" "' .,,I
LEGAL DESCRIPTION: ~4:~'"¢ ~¢ ~:~L.~,~,~ ~I
7
8
9
10
11
12
13
14
15
16
17
18-
19-
20-
g,o.H.
COMMENTS
Township, Range, Section:
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YL:S, AT WHAT
DEPTH? / O
P
E
nepth to Waler After - ~/~,,,/'1
~onitoring? 0~'4 gate:
Gross Net Depth to Net
Reading Date Time Time Water Drop
,,,..~ ,, I~ I ~v4~
p~c. ~/~,JZ~ ~'-,7'
PERCOLATION RATE /t~ (m~nutes/mch) PERC HOLE DIAMETER
TEST RUN BETWEENI~)J~__ FT AND
..__.~.~ FT
72-008 (Rev. 4/85)
Municipality of Anchorage
Development Services Department'
Building Safety Division,~ :
On-Site Water & Wastewater Program
4700 South Bragaw St.
'P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE'OF HEALTH.AUTHORiTY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-031-26
1. GENERAL INFORMATION
· Expiration Date:
Complete legaldescdption KNIK VIEW SUBDIVISION; LOT 3, BLOCK 1,
Location (site address or directions) 22528 KNIK VISTA STREET *
Current Property OWner(s)
Mailing address
Lending agency
Mailing address
'Real Estate Agent
Mailing address
SCOTT AND BONNIE STARK
P.O. BOX 670103 * CHUGIAK, AK.
CHUGIAK, AK. 99567
Day phone 688-1387
99567
Day phone.
DONNA ALDERMAN w/ PRUDENTIAL VISTA Day phone 689-6464
16635 CENTERFIELD DRIVE * EAGLE RIVER, AK. 99577
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 I
Individual Water Storage E] Individual Holding tank
. Community Class. A Well I Community On-site F"I
Public Water System D Public Sewer ['-]
The Municipality of Anchorag~ Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in 'paragraph 4 by an independen, t 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 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 INSPECTIO BY ENGINEER
As certified by my seal affixed hereto and as &f the v~ii~l~'tion'date shown below, I ve~f'fy fha! my
investigation, based on procedures outlined in the Health Auth&rily Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(am) 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 compfiance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS EN(~IN~'i~RINb GRouP, Ltd.
Address 3701 E. TUDOR ROAD, SUffE 101 * ANCHORAGE, AK 99507
Eh~gineer's Printed.Nah~e ; JEFFREY A. GARNESS, P.E.
Phohe 337-6179
Date -~ 7
EngIneer's Comments:
In conducting this evaluation, GEG, Ltd. attributed to provide a thbrOugh, .
conscientious enginee#ng analysis of th~ system in accordahce With ADEC and MOA '
DSD Guidelines & Regulations. The reported results described 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 of all wells and
septic systems d~pend on the local soils condition, groundwater leve/s that may
fluctuate during the year, an~l the water usage of the farnily being served by the system.
These conditions are outside the control of the eva/uator 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 benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever,
5. DSD ~IGNAT(J~E
~ Approved for L[..- . be~l'fSOms.
Disapproved.
Conditional approval for
bed~oor~s, wiih the filowing stipulations:
WATER AND : m
Attachments:
HAA CheckJist
Septic System Advisory
Well Flow Advisory
?. [ WASTEWA'[I::R :
PROGRAM ..'
Manitenance Agreements ' ~'~Z~, ,~'NTb~.~,~,~''
Supplemental Engineer's Reort
Other
(Rev, 17.J01)
Original Certificate Date: ~" ~ 0 ' 0 .~
,A.
MuniciPality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
* P.O. Box 196650 Anchorage. AK 99519-6650
· ' www.ci.anchorage.ak.us
! (907) 343-7904. '
HEALTH AuTHORITy APPROVAL "
CHECKLIST
KINIK VIEW'S/D; !LOT 3, BLOCK 1
:IFA, B, or C Pr°vid.e PWSID#
- Sanitary Seal (¥{N),
Cased to. ~ ~ ft.
FROM WELL LOG -
-:
g.p.m.
Legal Description:
WELL;DATA
Well typ~ CLASS A
Date completed
.Total~Pth "ft.-
Date bf'test
Static Water level
Well producbon
WATER SAMPLE RESU
Coliform'
Nitrate i ;., mg.lL.
Date 'of sample:
D0 mi.
mg.lL.
SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL
Tank size 1250 gal. Numberof Compartments, 2
~ '" (Y/N) 'Y£E "
Foundation cleanout S Depres'sion Over.tank (Y/N) ,,,NO
Ppmper: ". '~:
Date of,pumping * 9/18/2003
Parcel ID:
,[
Well Log (y/N)
wires pr°p~IiY,.
051-031-26
Casing heig ground) in.
g.p.m.
Other t '
ac ena __ colonies/100 mi.
Collected by:
·
-[
Date inst filed 5/27/1998
Cleanoui!L(y/N) YES
High water alarm (Y/N) N/A
JR'S PUMPING
Sys tyPe . TRENCH
~r~!el below pipe 3
Depression over field NO
For. 4 bedrooms
New depth 4 in.
rote >= 450 g.p.d.
ABS, ORp~TION FIELD DATA ~' ~I~E~.O~ EX,S'nN(; CRADEI
.,~,. iI [! . ! ., ..
Date` in~talled '5,/28/'1998 Soil ra~ting ~!ff'/b;drm}..:l.2
Length il 90. .ft. Widih. ,, 5 ft.
Totaldgpth 6.3+ ft. Eft. absorption area 540+ff '.Monitoring tube YES
.:,i'~it ! ..... ~ , I, , :' ! ' ' '
Dat,e of ,adequacy test , 5/11/2004 ,: ,Results (Pass/Fad) PA.SS__. . .
Fluid depth in absorption field before test ~' .0. in' ~i, Water added '614 hal
Elapsed Time: 5 min. Final fluid depth 0 in. Absorptior
Any rejuvenation treatment (Past 12 mo.) iY/~ & ~ype) NONE KNOW.N
] :;I i ' ' ' :r/""*~T~'STED,.. EAST TRENCH
If yes, give date -
'Date in{tall'~d'
,,Pump on" level' ~t ih.
SiZ~ih~il(~i{' ": '. ' ~
"Pumj~ of~~:: ' "in. , High wat6r ~i~rrh i&vel'at ' -
Cycle~ te~i~a " · 'Meets al~r~ ~ c~rcmt ~e~uiremehts?
,, .. cOMMUNI -WELL
s~:PAis, ATiSN DiS~,~,Nci=S F~,OM WELL o~ LOT ?b: ,,
Sei3{ic tafik/ii~t §tati6h' 6'ri I~t ' : ~ : ' ' ' On a~jacent lot§~:"
Public sewer ma~n ,, , .....~--~"'~'"'~'"'"~ Publi(~ sewer manh01~cle~fiout
i~ ' iHolding tank --
sEPAI~TI~N 'DIS~,~Ni:::;i~s' FROM S~:'IS~i~/HOL'DiN~ 'i'ANK ON LOT 'i'Oi', .....
I~uilding fouha~ti6h 5'+ Property hne .5'+ .. ".Ai~sSi-~)'ii0h ~eid
Wa~(~i' main -10;+' Water service line :1 o'-F . suffaci~ ~hter
Well~ 6h a'dj~ceniio{s 200'+ '~ -,., '
SEISA'IS, ATION DISTANCE FROM A~P~'IS~ i~i~cb bh LC~i~ TO: ' i
· Abs0rPtion'field 6h 1'6t '" ': "
1'oo,+
prOp~hy lihe '10'+
Cu~tain'drain ~N~NE .KNOWN
coMMENTS _. ·
Buiiaing founa~.tiafi -,.:1o'4- · .
'sua a
Wells oh ~ljacent lots 2i3o'+'
ENGINEER'S CERTIFICATION
· ! : ~ . :. ~ . . . ' .. ,',~ . -
I certify that I have determtned through fi~id inspecitohs ahd
re~,iew of Mdnicipbl records th'at the abo{/e ~y~terhs -aPe in
confOh'nanco with MOA H~ guidolines ih O~oct On thls date.
Engineer's Printed~a~e JEFFR~.A. OARNESS
F~O $ ~ '
,D~{e ~f'Pay'~e~t '~)~ ~/~
Water fnaih 1°'+
'DriveWay,, i:i~ii'kihg)vehicle st°rag~
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Receipt Number:
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iASEM£NT
KNIK VISTA DRIVE
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 051 -031 -26 \J
1. GENERAL INFORMATION
Complete legal description
Lot 3; Block 1; Knik View
Location (site address or directions) NHN Knik Vista Street
Chu_giak, AK
Property owner H2C1 Construction
Mailing address P.o. Box 67045 Chugiak,
Dayphone__ 229-8059
AK 99567
Lending agency
Mailing address.
__ Day phone
Agent
Address __
Day phone ........
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPkY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from ,State ADEC attest-
ing to the legality and status of system,
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation ~rom State ADEC
attesting to the legality and status of system.
xx
72-025 (Rev. 1/91) Fronl MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
Name of Firm .MaM~~
7320 Ea§t Ctt,este.~
Address An~,,g A~'
Engineer's signature !~/~f447
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 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 in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of thi~-inspection.
/~tewater / ? Phone _
h OO5ff4/ ~ /
ALASKA WATER & WASTEWATER CONSULTANTS,
SHALL BE PAID $ '7~O,Cd AT CLOSING FOR
ENGINEERING SERVICES PERFORMED.
6. DHHS SIGNATURE
/ Approved for ,/:'~ U ~ bedrooms.
INC
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By:
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 purchasem of homes
and their 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 engineeds work.
72~25 (Rev. 1/91 ) Back MOA ~21
D, LIFT STATION
Date in t~led
Size in gallons .__-----~
Manhole/Access (Y/N) ~---'-'
High water alarm level,at~_..--~-~'~-~ *Datum,
Cyclee--tesl~8~----
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
~__ool.f-
Absorption field on lot ~-oo~'f·
"Pump off" level at*
Public sewer main
Sewer
_ On adjacent lots
On adjacent lots
_--~ewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation I O ~ -.~.
Water main/service line
Property line
I
IO -t- Sudace wateddrainage
Absorption field
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line "~. :~'~- Building foundation I ~' ~ ~
Surface water Ioo14,
Water main/service line
_ Driveway, parking/vehicle storage area
Wells on adjacent lots
Curtain drain
c..'r,.c.,:-,o.
,certify that, h~r~ t~ .nspoctions and rev,'ew o, Munic,'pal re¢~,'~"~'~~s are
inconformanCwith~O~g~eli sinoffectonthisdato.
Signature ~,~[~~
Engineer's Name
Date '~'/It/~]~
HAA Fee $ ~ d__.P d_.~. ¢_.7P O Waiver Fee $
Date of Payment ~'~/'// / C~ ~'- Date of Payment
Receipt Number ~)c'/O ~/ ( ~///'~ ~--~ i ):':"': ReceiPt Number
72-026 (Rev. 3/96)*
Municipality of Anchorage AUI3 '1 '1 1998
DEPARTMENT OF HEALTH & HUMAN SERVICES _l~E//~,~]
Environmental Services Division ~u~ c~^u'~¥ o~ ^NC~O~-~--~
825 L Street, Room 502 · Anchorage, Alaska 99501 · (gd~)~.~.~,~.v~c~s D V~' .....
Legal Description:
A. WELL DATA
Well type
Log present(Y/N)
Total depth
Sanitary ~
Health Authority Approval Checklist
/.-~1' ~ ~l-o<.A~ \; ~,~JIF-- ~1~,~ ~/~ Parcel ID.:
If A, B, or C, attach ADEC letter. ADEC water system number
round)
FROM WELL LOG
Date of test
Static water level
Well production
WATER sAMPI'E RESULTS:
Coliform
Date of samPle:
B, SEPTIC/HOLDING TANK DATA
Date installed ~;'Z8":'~8 Tank size
Foundation cleanout ~N)
Date of Pumping
Wires properly protected (Y/N)
AT INSPECTION
g.p.m.
Nitrate Other bacteria
Cbliected by:.
I ZE~ Number of Compartments ~-' Cleanouts (~N)
Depression (Y(~ I~ ~ High water alarm
Pumper
C. ABSORPTION FIELD DATA
Date installed ~..~
Length~'Z~ff~'.) ~O' Width
Effective absorption area ~-~'~O
Date of adequacy test
Soil rating ~r.,ff.~edcm) J ·
Gravel thickness below pipe
System type
· .~ Total depth
Monitoring Tube present(~/N) "t/E'-.~ Depression over field (Y~)
Results (Pass/Fail) - ' For /'~ bedrooms
Fluid depth in absorption field before test (in.);
Fluid depth ----- (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
Immediately after '"--gal. water added (in.):
Absorption rate = ""-' g.p.d.
If yes, give date