HomeMy WebLinkAboutKNIK VIEW ESTATES BLK 4 LT 3
Municipality of Anchorage' Psge 1 of
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:. SW970188 'PID Number:. ' 05104334.
Waldec Enterprises~ Inc.
9210 Vanguard Drive
Pno~
344-5678
No. of Bedroom~
Four
LEGAL DESCRIPTION
I.oc Bloct~: Sul~dlvLsion:
3 4 Knik View Estate*:
R~ge:
..
WELL: r'l New
C~:-,!~¢auon (Pdvata. A.B.O~:
Class A System
Wastewater System: 0 New 1'3 Upgrade
· ABSORPTION FIELD .
r'l Deep Trench I~ShallowTrenoh OBed mMound r=lother
8oil RaUng: I Total OePUl from orfgirml gra~
Yie~t:
. Well
Surfac~
Water
Lot .'
Line
Foundation
Curtain
Drain
Remarks:
GPM
I-I Upgrade
Total Dapm: Cuecl
Ft.
Data
Ft.
SEPARATION DISTANCES
>200 N/A N/A
>100 N/A N/A
> 10 ' N/A N/A
>10' N/A N/A
on Lot
7.5'
Gmvm cloth be~eam pipe
4
OravM lengm:
' IN~"rofli"~ /~-~
I PI~ m~ed~:
so. rtl ~nm~ nxnx~
RII a,M~l ~ove odglrml
'5
Tom~ a~rptton area:
TO
'97
TANK
Holding 0 S.T.F-P.
.Anc. Tank 250
Num~ of Compmtme~~'
LIFT STATION - N/~
Size in gallo~: Manufa~turen
'~p on" IMI ~ ~mp o~ IMI I~ . High ~mr al~ ~
BENCH MARK
an-o~__~_,tpt~om Top of Foundation Wall
100
ENGII SEAl.
Inspections performed by: A. Harala Dates: 1st_ 7/22/97
2nd-- 7/23/97
· ' 3rd 11/8/97
Department of Health' and Human Services approval
.eviewed and approved byi z"~,,~,~/// ~
MICHAEL E. ' ~'
AI,F)ER~ON
4381oE
......... f.,'-.o.,,; ',~, ,~..~,~'~G~G Page /, Of ,,,
DEPARTMENT OF .
HEALTH AND HUi~IAN SERVICES ...
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519.-6650 · Telephone: 343-4744
.. On-Site. Wastewater Disposal System a.nd/or ,Well Inspection RePOrt
Permit.Number: SW970188 . ~ ~:PID Numbec~'~0:51
PLAN 'AS'BUILT
SCALE 1" -- 20'
STI
ST2
CO4
C05
MT1
A
29.2
37.4
61 .;
59
57 ..~
o
o
'13
~) (3)
O
o
B
34.0
37.5
39.8
70.5
70.0
Driveway
C04
TH
NO.
i-1,I
CO5 .~
MT1
ST1
ST2
C02
CO3
D££f'O~,E;O. UaquJnNaid.-3.. ggLOL6MS ueqtunN;'lUJJed
~Odel:! uol;oed'sUl ile~ JO/pt~e me;s,{s lesods!Cl Je;e~Ae;se/IA'ellg-uo '
F,x/.t~'t,~ :euoqdele.L e 0999-6Lg66 a)lSmlV 'eSr,.Joqouv · 099961. xog 'O'd
S=~DIAt~JS NvINnH ONV I-LL'IV--JH :10 J.N~lit',lJ.l:lYd~lO
PAGE 1 OF
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 (UPGRADE) PERMIT
PERMIT NUMBER:SW970188
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NA_ME:WALDEC ENTERPRISES INC
OWNER ADDRESS:9210 VANGUARD DRIVE
ANCHORAGE, AK 99507
DATE ISSUED: 7/15/97
EXPIRATION DATE: 7/15/98
PARCEL ID:05104334
LEGAL DESCRIPTION:
KNIK VIEW ESTATES BLK 4 LT 3
LOT SIZE: 25637 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDb_NCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY 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: 7/~ 1~ 7
DATE:
July 3, 1997
MunicipalitY of Anchorage
Department~ of Heath & Human Services
825 "L" Street
Anchorage,: AK 99502-0650
Subject:
Lot 3, Block 4, Knik View Estates
Septic System Design
Impacts to Adjacent Properties
Dear on Site services Engineer:
We hereby apply for a permit to construct a new septic system on Lot 3,
Block 4, Knik View Estates Subdivision. The attached Site Plan and backup
documentation identify the size and location of the new septic tank and
absorption trench to be constructed on the lot. The subdivision is served
by community water 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, so a filter is not required.
.Groundwater was not encountered in either of the testholes nor was any
noted during the monitoring period.
The ground surface of the lot slopes from southeast to northwest at
varying degrees. The slope at the location of the proposed absorption
trench is less than 4%. Property to the north and south of this lot is
currently ?acant. If the system is constructed as designed the following
statement~ apply:
1. The?system, if constructed as designed, will have no adverse impact
on the wells in the area or those to be constructed in the future. The
subdivision is currently served by a community water system.
· 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.
,,Lot S, Block 4, Knik View Estates
July 3,' 1997
Page Two
The §ystem, if constructed as designed, will have no adverse
impaOt on reserved space, either surface or subsurface, on any lots
Iocatbd in the area.
The System, if constructed as designed, will have no adverse impact
on drainage patterns in the area. The current drainage pattern w il
be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
~69' 56'2".'",v $59,,]S
\
\
\
//
/2
LOT 3,-BLOCK 4, KNIK.
VIEW ESTATES
'THIS PROJECT
179.92
/
/
,,,I~
WE S~.. 179.26
/
/
/
/
WEST 278.55
27
JUDD Circle
175.00
/
/
/8
AREA MAP
SCALE 1" = 100'
12
LOT 3, BLOCK 4, KNIK
, E-STATES, ' ~
1'1
I I
50' LONG X,5' WIDF X 4'
EFFECTIVE DEPTH TRENCH
1,250 GALLON ! :
=PTIC TANK
I-I i
; /
.I
i
.i
FOUR BEDROOM
ALTERNATE SITE
.i
F- :
'WATER
LOT 3, BLOCK 4, KNIK VIEW ESTATES
SUBDIVISION
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Four Bedroom Home
Perc. Rate: I Min./Inch
Application Rate: 1.2 GPD/SF
5' Wide Trench System
1',250 Gallon Septic Tank
4' Drainfleld Rock
4 Bedrooms X 150 GPD / 1.2 GPD/SF = 500 SF of Absorption Area
500 SF/$ LF (Trench Width).5 (Red. Factor) == 50 LF Trench Length
Therefore: Construct a 5' Wide Absorption Trench With One Lateral 50'
in Length. Distribution Pipe in Trench Placed at 3' Below the Original
Ground Surface. Place 4' of Drainfleld Rock Beneath Distribution Pipe.
-~- . .,, t//~~
A6o~J 'c ~'~
NOTE:
TYPICALWIDE TRENCH sEcTION
(NO SCALE)
Grade Area Over Trench to Drain Away.
Minimum 3' of Cover over Septic System.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street, Anchorage, Alaska 99502.0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION; ~-'~ ~-- ~ /~/__/% '~-- Township, Range. Section:
6
8
9
10
11
12
13
14
15
16
17
18
19
2O
..t
I
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SITE PLAN
G~ Net I~,pi h to Net
R~dlng Ottl Time ~me Wat~ D~
PERCOLATION RATE ~ / . I. mmute~mcl~) PERC HOLE DIAMETER
PERFORMED : / /
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alasks 995024650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
7
8
9-
10
11
:.
12
13
14
15
16
17-
18-
19-
__ DATE PERFORMED:
Township, Range, Section:
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES. ATWHAT
DEPTH?
&
/
/
Gr~ Net ON.ti to Net
Reading Da~e Time · Time Water Drop
PERCOLATION RATE ~ (mtnute~lncfl) PERC HOLE DIAMETER
TE~T RUN BE~NEEN ~ FT AND ~ F'r
PERFORME~ IN
72-008 IRev. 4/85}
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 3, BLOCK 4, KNIK VIEW ESTATES SUBDIVISION
GENERAL:
1. The scope of this project includes the the procurement and
installation of a new 1,250 gallon septic tank. It also
includes the construction of a new 50' long X 5' wide X 4'
effective depth absorption trench. Minor clearing and
grubbing will be required in the area of the new
installation.
2. Construction shall be in accordance with the approved site
plan, design drawings, Municipal Permit with any special
provisions or conditions, and all applicable State and
Municipal Wastewater Disposal Regulations.
3. The Contractor shall be' responsible for obtaining all
underground utility locates and for the layout of the septic
system and verification of the location of all lot lines.
4. Unless specifically agreed otherwise, the contractor shall
be responsible for final grading areas subsequently
depressed from soil settling. Property owner shall be
responsible for revegetation of affected areas unless
specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must
be certified by the Municipal Department of Health and
Human Services for system installations. Owners installing
their own systems must receive prior approval from D.H.H.S.
before beginning sYstem installation.
SEPTIC TANK INSTALLATION
1. A new 1,250 gallon septic tank must be procured from an
approved source and installed at the location shown on the
Site Plan.
Lot 3, Block 4, Knik View Estates
July 2, 1997
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 3, Block 4, Knik View Estates
July 2, 1997
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
watertight couplings (Caulder, Fernco, or equal).
with
Lot 3, Block 4, Knik View Estates
July 2, 1997
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.
•
• PGE epi
Afte Municipality of Anchorage
On-Site Water and Wastewater Program I I]I i
\ (907) 343-7904 SA ETY
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-043-34 Expiration Date: a-7r(9
1. GENERAL INFORMATION
Complete legal description KNIK VIEW ESTATES BLOCK 4,LOT 3
Location (site address) 22700 JUDD DRIVE,CHUGIAK,AK 99567
Current Property owner(s) DANIEL & NICOLE TRAXINGER Day phone
Mailing address PO BOX 670383,CHUGIAK,AK 99567
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ® Public Sewer ❑
Waiver/Variance request for: Distance:
Received by: Date: //I 7
COSA to be released to the en . r, unless otherwise requested by the engineer.
91
COSA Fee $ 594 Waiver Fee $
Date of Payment gLI�112 Date of Payment
Receipt Number A2(p9 Receipt Number
COSA# Q J��� $a Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377
Address 4640 SHOSHONI DRIVE,ANCHORAGE,AK 99516
Engineer's Printed Name MICHAEL N.ANDERSON,PE Date 09/11/2018
"" :A
.•
*.:49TH VC -`: -_`a
....... .. ..,,a
J s
I', ....e... ........ ..... .
6. DSD SIGNATURE F m%MICHAEL N. ANDERSON ..„"
KSystem #1 Approved for y bedrooms. �� f• CE-94 9
1 �/
System #2 Approved for bedrooms. k'P/S\\\
Disapproved.
Conditional approval for bedrooms, with the following stipula 'ons:
,
...r•mi. i c C.S i ii•eCtr ,/ , 41.
-�r a ca 1
/ L. 'r 'IC I`S 7('� �dit,
,�Y�i� Nti_ ON-SITE °�'v�WATERAND m'' ASTEWATER z
1'° PROGRAM �o
,off o�
_ �'rSERVIC
By: J (-..,, (. Original Certificate Date: `7 -"/I-t 0
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory,.,;-'
Septic System Advisory Arse is Ady;sory;
Well Flow Advisory Other J'.'
COSA blue sheet_10-10-12.doc '
If more than 1 septic system is on the lot:
COSA Checklist#_of_
Structure served by this system _
Certificate of On-Site Systems Approval Checklist
Legal Description: KNIK VIEW ESTATES BLOCK 4.LOT 3 Parcel ID: 051-043-34
A. WELL DATA - PUBLIC WATER
Well type If A, B, or C provide PWSID# Well Log (Y/N)
Date completed Sanitary seal (Y/N)_ Wires properly protected (YIN)
Total depth ft. Cased to ft. Casing height(above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic: ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC I STEEL Date installed 7/22/1997
Tank size 1250 gal. Number of Compartments 2 Cleanouts(Y/N) Y
Foundation cleanout(Y/N)Y Depression over tank(Y/N) N High water alarm (Y/N) N
Date of pump•ing 9—7 e Pumper SANITARY
C. ABSORPTION FIELD DATA
Date installed 7/22/1997 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 System type SHALLOW TRENCH
Length 50 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 7.5 ft. Eff. absorption area 500 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 9/5/2018 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 0 in.
Elapsed Time: 1 min. Final fluid depth 0 in. Absorption rate >= 600 g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N &type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO: - NA/PUBLIC WATER
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10' Property line 10'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 200'+
ABSORPTION FIELD ON LOT TO:
Property line 10' Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain 50'+{None Known) Wells on adjacent lots 200'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION \1?" • OF ...sit
I certify that I have determined through field inspections and h.•' • :
i Wit-. ' Il
review of Municipal records that the above systems are in
/ * :4 9TH /c . •. * j
conformance with MOA COSA guidelines in effect on this date. /
Engineer's Printed Name MICHAEL N.ANDERSON.PE /
vs• MICHAEL N. ANDERSON :,
r �• CE-9469 :4.c;'
�
Date 09/11/2018 ilv>.•• ( ••it tip
COSA canary sheet_2-6-15.doc
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. 051-04B-34
1. GENERAL INFORMATION
Expiration Date:
Complete legal description Knik View Estatea, Block 4; Lot 3
Location (site address or directions) 22700 Judd Drive, Chugiak.. AK 99567
Current property owner(s) ~;ue Farria
Mailing address
Day phone 688-0494
Lending agency
Mailing address
Day phone
e
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 4 '
Day phone
e
TYPE OF WATER SUPPLY:
Individual Well
· Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site
[] Individual Holding tank
[] Community On-site
[] Public Sewer
I
The MuniciPality of Anchorage Development Services-Department (DSD) Issues Cedificates 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.
STATEMENT OF INSPECTION BY ENGINEER
As icertified by my seal affixed hereto and as lof 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 ENGINEERING; Inc.
Address 20441 Ptarmigan. Blvd., Eagle
· Engineer's Printed Name Kenneth M. Duffus
River= AK 99.577
'Phone (907) 696-6111
Date 0~;/10/04
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.
DSD SIGNATURE
~ Approved for J..jL bedrooms.
Disapproved..
Conditional approval for
bedrooms, with the following stipulations:
.
~ · ON.SITE . ~=
g~ j..WATERAND .: m~
~ ~ WASTEWATER : ~
By:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow AdviSory
X
~ ; PROGRAM..-'
~ <~..'. ..
Maintenance agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
· ,Mumclpahty of Anchorage f i'
t l)i · Development Services Department ii F i,
~.k.~,.~,)'l .' i ' i ' .Building Safety DiviSion ' ' ~ : :i :I~
'"'~/-/! I : ! ', On-Site Water &'WastewaterP~:Ogram : !; : ii
:. i , .. ' :' 4700.S°uth Bragaw.St. : ' :~. ; ~.
i -i :, , P.O. Box 196650' Anchorage; AK 99519~6650;.' I
! Iii . ; i, i '-:www.ci.anchorage.ak.us . : . ~
,, . ,~ . (907 343-7904 .... ~ . .
'~[ :'~ , : ...... ."r~!,r
· 'ii , :HEALTH AUTHORITY APPROVAL CHECKL, IST'
Legal Descnpt,on: KNIK VIEW 'ESTATES. BLOCK 4. LOT 3 ". "lPl~cel lB' 0 5'1 ;.043-3 4
Well .type ,,Public .: i IfA, B, or C provide PWSID #, i ' 'Weft Log (Y/N)
· ' ;'":"I ;"' : ' i ' : ,
Date~ o leted ' ,r . Sanitary seal (Y/N) Wires properly protected (Y/N)
Total ldept? ' · ft. · i . - CaSed to : ft: Casing height (above ground)
~.. Date,of te'st
~::' S¢iti~ Wat~er level*
-[
FI~OM WELL LOG
Well ;prodoction ' ~'
.:: SAMPLE RESULTS:
WATER
Nitrate mgJI; ,~'
AT INSPECTION
g.p.m.
ColOnies/lO0 mi.
: Tank;TyPei/MateHai: .... septic/steel ;.rAnch.. . _ Tank)_ ' i -Date~i~'s'~a[ll~d 07/22/97
.Tank.~ize ~: 1250" gal.', .
Foun~a~io.n~clean0ut. (WN~ Y Depression over tank
:Date:installed 7/22/97,~',::'' Soil ting (g.p.d./ft~orfl~/b'd'rm)1.Z: 'S ~ype TRENCH
Total 'depth 1,S . absorption are~ SO0 ft~ Monitoring '[ub~ Y epression Over,field N
Date '0f adequacy test 5/6/04 ', 'ResUlts (Pass/Fail). Pass "F°r.~ bedrooms
Fluid ;depth~m absorption ~eld before test (DRY) 0 in. Wate~ added 610~;~ga~. New.'depth~in:
Elapsed Tl~e.~mm.' .; , .. Final ~fluld depth (DRY). 0~in'.. . ~:. Absorption, , ,rate '>= 600+: '- 'g.p.d.,
Any rejuvenation treatment (past 12 mo )'(YIN & type N :: ~" ~ :: -: Il ~es hive date
D. LIFT STATION
\
.Da~e installed NA
;Pump on- level at
Datum.
E.
in.
SEPARATION DISTANCES
Size in gall'°ns,
"Pump ofF' level at
· Manhole/Access (y/N).
in. High water alarm level at
Cycles tested
Meets alarm & circuit reqtJirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/liE station on lot
Absorption field on lot
:
public seWer main
SeWer/~e'p{ic Service line '
On adjacent lots,
On adjacent lots
Public sewer manhole/cleanout.'
Holding ta~k'
~ SEPARATION DISTANCEs FROM sEPTIC/HOLDING TANK ON LOT TO:
Building foundation '5,+ Property line 5 ' + ' Absorption field 5 ' +
Water main 10'+ ' ' Water service line 1 0'+ Surface water
'Wells on adjacent lots ZOO'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+
water Service line 10'+
Curtain drain 50'+
'Building foundation 1 O' + Water main 1 O' +
Surface water I 00 ' +
100'+
F. COMMENTS· "." '
Wells on adjacent lots 20 O' +
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, Printed Name
Date 05/10/04
Kenneth M. Duffus
in.
Go
Driveway, parking/vehicle storage 1 0 ' +
HAA Fee $430.00
Date' of 'Pa'yment 05111/04
Rec~iPt Number'
(Rev: 12/01) U
waiver, Fee $
Date of Payment
Receipt Number
-;~o .en~p or.e~ on me l~'OlX'tty'iy*n3.1~.aaiac~n, t* there,.., tha. t - I
...,unpmvememt~ .on: .prol:~!]q~; adjacent.~emlo ent~roach. I
.on. me .pre_ mi~,~_ .. in~,questi. 'on and that..ti!ere :ar~'r'nb'ti:md,,~;s~... I
lzansmi~ion lin'es of 6the~ vts~le.easements on:s~id property.. I
e~cept as indicated hereom i" .- - ," '! ".'*: "'... · '"1
:--' :r~;' ..-~:'. .... '-.: ,:.:-~P'z~ne.{9(~ 6g~_~;: ?::.:.:- ~.'-...:'?':~.',r..
.._- · ':-.. ' . - ~..::..t'...: .. o -. ' '.°- - -'!~ ' ".'." ':" : ~.-i ~
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
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
05104334 HAA#
1. ,,.GENERAL INFORMATION
Complete legal description
Lot 3~ Block 4, Knik View Estates
Location (site address or directions)
Property, owner
Mailing address
Lending agency
Mailing address
Wa]d~c Enterprises: IqC. Dayphone 344-5678
9210 Vanguard Drive Anchoraqe, AK 99507
Day phone
Agent
Addres's
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: Four 4 )
'3.
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
xx
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
XX
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
?
72-025 (Rev. 1/91) Front MOA ~21
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/orwastewaterdisposalsystem is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein, lfurtherverifythatbasedontheinformationobtainedfrom
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 Engineerinq Phone 563-7155
Address P.O. Box 240773 Anchorage~ AK 99524
DHHS SIGNATURE
Approved for '¢
Disapproved.
Conditional approval for
bedrooms.
6 ~'. MICHAEL E. ANDERSON
bodrooms, with the followinO stipulations:
Additional Comments
The Municipality of An%~Orage 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 their lending institutions in o¢der 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.
72-025 (Rev, 1/91) Back MOA~¢21
Municipality of Anchorage n D(/~
DEPARTMENT OF HEALTH & HUMAN SERVICES~ E C ~. IV E
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 34{~4't42_ 1997
Municipality o,
Health Authority Approval Checklist Dept. Health & Human ~
Legal Description: T,ot 3,
A. WELL DATA
Well type A
Log present (Y/N)
Total depth
Sanitary seal (WN)
Block 4, Knik View Est, ParcelI.D.: 05104334
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed 7 / 22 / 97
Foundation cleanout (Y/N)
Date of Pumping :' New
C, ABSORPTION FIELD DATA
Date installed 7 / 2 3 / 9 7
Length .50 ~ Width
21R409
Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
g.p.m, g.p.m.
Nitrate Other bacteria
Collected by:
Tanksize 1 ,250 Number of Compartments 2 Cleanouts(Y/N) ¥
Y Depression (Y/N) N High water alarm (Y/N) N
Pumper Construction
Effective absorption area 500 SF
Date of adequacy test New Const,
Fluid depth in absorption field before test (in.);
Fluid depth (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev. 3/96)*
Soil rating (g.p.d./fF or fF/bdrm) 1 . 2
Gravel thickness below pipe
Monitoring Tube present (Y/N). ¥
Results (Pass/Fail) ;Pass
Immediately after
Absorption rate =
If yes, give date
GPD System type ~ 5'Wide Trench
4 ' Total depth 7.5 '
__ Depression over field (Y/N) N
For 4 bedrooms
__ gal. water added (in.):
_g.p.d.
D. LIFT STATION -
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
' Size in gallons
None on Lot
"Pump on" level at*
*Datum
- Public Water
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation > 5 ' Property line > 5 ~
Water main/service line > 2 0 ' Surface wateddrainage > 1 0 0 '
SEPARATIQN DIS'lANCE FROM ABSORPTION FIELD QN' LOT TO:
Property line > 1 0 ' Building foundation > 1 0 '
Surface water > 10 0 '
Curtain drain None on Lot
"Pump off" level at*
System
Absorption field > 5
Wells on adjacent lots
>200'
>20'
Water main/service line
Driveway, parking/vehicle storage area > 50
Wells on adjacent lots > 2 0 0 '
ENGINEER'S CERTIFICATION
I certify that l have determined thru field inspections and review of Municipal rec~ ~.~,.F,e,.Z~o~stems are
in conformance with MOA HAA guidefines in effect on this date. ,~, ,~ ~.~. r. ' '
s n ,ur
Engineer's Name Hichael S, Anderson, ~,g,
HAA Fee $ ~-~_~",~%,~-~
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number