HomeMy WebLinkAboutKNIK VIEW ESTATES BLK 4 LT 5K ni* k View
Estates
Block 4
Lot 5
#051-043-36
Municipality of Anchorage Page �_ of 3.
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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: S�iaQnon7 PID Number: X51 04 i 16
Noma:
Waldec enterprises, . Inc.
Wastewater System: ❑ New ❑ Upgrade
Addreu: 9210 Vanguard Drive
ABSORPTION FIELD
Phone: _ No. of eedrooms:
Oeep Trench XXShallow Trench Q Bad O Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
_
Lot: Stock: Subdivision/� L Ll� .c° 1._
1 .2 GPorsd. Ft.
epth to pipe bottom from anginal grade:
9.5'
Gravel depth beneath pipe
�.1i�K�
Township; Range: Section:
Ft.Ft.
Fill added above original grade:
Gravel length: '
WELL: ❑ New ❑ Upgrade
Ft.
Gravel width: 5
Ft.
Numbero1 lines: Oistancebetweenlinest
Classification (Private. A,S.C): Total OepIn: Cased To:
Ft.
Total absorption area:
— Ft.
Pipe material:
CIZISS A-- Ft. Ft.
Driller. onlled: Slabc'Nater Lavel:
SO -Ft.
In3tauec
ASTM D3034 PVC
Date installed:
Ft.
S inell Homes
3/19/98
Yield: Pump Set at: CasmgrlelgntAboveamund:
GPM Ft. Ft.
TANK
SEPARATION DISTANCES
(Septic 0Holding ❑S.T.E.P.
To
From
seotic
Absorption
lift
Holdingpublic/Prime
Manufacturer:
Capacity in gallons:
Tank
Field
Station
Tank
I Sewer linea
- Anchoraqe Tank
1,250
Well
>200
>200
N/A
I N/A
>200'
Material: Steel
Number of compartments:
MW Q
Surface
Water
> 1 00'
>100'
N/A
N/A
100'
LIFT STATION - N/A
Lot
Line
> 5 1
> 10 '
N/A
N/A
1 0'
Size in gallons:
Manufacturer.
Foundation
> 5 1
> 10 1
N/A
N/A
N/A
Pump on" level at: "Pump off' level at: High water alarm at:
Curtain
Drain
None
n LO tl
Pump Make 3 Model Electrical Inspections performed by:
Remarks:
BENCH MARK
Location and Description:
Top of Deck at NW
Corner of House.
Assumed Elevation:
1 0 0 it,
ENGINEER'S SEAL
;t
B
Inspections performed by: Dates: 1st inn
til WG�LOA �
2nd /19/98
Department of Health and Human Services approval
Reviewed and approved' by:l-
DEPARTMENT OF HEALTH AND HUMAN SERVICES r
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System anti/or Wel( Inspection'Report
Permit Number; SW980007 PID Number: 051 04336
Four Bedroom
House
Wayer
Service
50' Long X
Wide Trenc
4' Eff. De
Ma
C3
C2
C4
oM2
1
rve
e
I
T2
11250 Gallon
T1 Septic Tank
C1
SCALE 1".= 20'
N
A
B
T1
27.9
19.8
T2
33.5
24.3
C2
38.4
29.0
C4
86.8
78.2
M1
45.3
37.5
M2
83.4
75.7
Four Bedroom
House
Wayer
Service
50' Long X
Wide Trenc
4' Eff. De
Ma
C3
C2
C4
oM2
1
rve
e
I
T2
11250 Gallon
T1 Septic Tank
C1
SCALE 1".= 20'
N
municipality of Anchorage Page _3 of 3
:DEPARTMENT OF HEALTH AND HUMAN SERVICES
"'. ENVIRONMENTAL SERVICES DIVISION
P.O. Box''1;196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wostewater Disposal System and/or Weii inspection'Report
Permit Number: SW980007 PID Number: 051 04336
U E- i / E-, U U
N
31
1,250 Ga
Sep Tank
G3 21
^v/ w.
^ E
O.
Drainfield JfRock
s -o'
AS -BUILT PROFILE
SCALE 1" = 10,
9
E U
MEMORANDUM
RECEIVED
JUN 29 1998
DATE: June 29, 1998
Municipality of Anchorage
TO: Jeff Post Dept. Health & Human Services
FROM: Mike Anderson, P.E.
SUBJECT: Lot 5, Block 4, Knik View Estates
Permit No. SW980007
Attached is a soils log completed on soils encountered at the south end of the absorption
trench re6ently constructed on Lot 5, Block 4, Knik View Estates Subdivision. During
field inspections I verified that all soils encountered in the absorption trench was consistent
throughout.
I have also attached a new Health Authority Checklist using the proper form. We are
hopeful the Certificate of Health Authority can now be issued.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: �� IQ NLL DATE
LEGAL DESCRIPTION: ZoTS 13LOCJL `l, Il,urk- Township, Range, Section:
51—Rm1 �Ir^W L—^S"f -ra-5 SLOPE
1 -
2•
3
4-
51
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
WAS GROUND WATER AO
ENCOUNTERED?
S
IF YES, AT WHAT L
DEPTH? O
P
E
Depth to Wrier Afar
MmHminM n.i..
DRm9j
I I t'eRCOLATION RATE (minutesnnw) PERC HOLE DIAMETER
L �.! TEST RUN BETWEEN rT AND FT oti
' I /�
COMMENTS SS C—OILJ co V.JTr='7LCt r,.J f+/j S0 R -0'4"f D of Trm.^ cm W C`1LLe tis I x -Ty" r
—7-4-rw v4 too U 7-
PERFORMED BY:L�TIFY THAT 7HI TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 6/2498
72-008 (Rev. 4/115)
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:SW9$0007
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NAME:WALDECIENTERPRISES INC
OWNER ADDRESS:9210 VANGUARD DRIVE
ANCHORAGE, ALASKA 99507
PARCEL ID:0510433
LEGAL DESCRIPTION':
KNIK VIEW ESTATES BLK 4 LT 5
LOT SIZE: 22773 i'(SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
G A
PAGE 1 OF 1
DATE ISSUED: 1/14/98
EXPIRATION DATE: 1/14/99
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 EA4 INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-41744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 1.5 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
S. THE FOLLOWING'iSPECIAL PROVISIONS.
is
SPECIAL PROVISIONS:
RECEIVED BY:
DATE: ih Iq A°
ISSUED BY: �'� DATE: /` /'9— /y
December 30, 1997
Municipality of Anchorage
Department of Heath & Human Services
825 °L" Street
Anchorage!, AK 99502-0650
Subject: Lot 5, Block 4, Knik View Estates Subdivision
Septic System Design
Impacts to Adjacent Properties
Dear On Site Services Engineer:
We hereby', apply for a permit to construct an onsite septic
system on Lot
5, Block 4, Knik View Estates Subdivision. The attached
site plan and
backup documentation identify the size and location of the
new system to
serve the four bedroom home to be constructed on the lot. The subdivision
is served by community water and all required separation
distances are
easily mete. No conflicts exist with other septic systems in
the area.
Testholes 'performed 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
Systemwith 4' of gravel beneath the distribution piping.
Total depth o f
the system will be 7.5'.
The ground surface of the lot is gently sloping from east to
west at a rate
of 3 to 50/0. The ground surface also slopes from south to
north at a rate
from 3 to 4%. Sufficient surface area exists for both
the primary
absorption; trench and a reserve site. No conflicts were noted between the
new septic system and water services in the area.
Lot 5, Block 4, Knik View Est. Subdivision
December 1.30, 1997
Page Two
If the system is constructed as designed tho following statements 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 served by a
community water system.
2. The lsystem, if constructed
as designed, will have no adverse impact
on existing septic systems
in the area or those to be constructed in
the '':future.
3. The jsystem, if constructed as designed, will have no adverse
impact on reserved space,
either surface or subsurface, on any lots
located in the area.
4. The'system, if constructed
as designed, will have no adverse impact
on drainage patterns in the area. The current drainage pattern w i I I
be maintained.
Sincerely;
l (O J
• • •
Michael E.'Anderson, P.E.
F °i.. •YT`s '. 6,9
s•
h
Attachments
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On
F
AREA PLAN', , MICHAEL E• ANRSCfJ , (;
SCALE 1" = 100'a�p��FO a3e�-E ��
SITE PLAN
SCALE 1" 30'
m
-�.y ; � ♦ X30 �
�,
50' Long- X 5Wi'd X 4'
1, Effective D hr sorption
Trench
1,250 Gallon / L
Septic Tank
e
iL
Ti
l
\ I
r
LOT 5, BLOCK 4, KNIK VIEW ESTATES
SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom Home 5' Wide Trench System
Perc. Rate: LT 1 Min./Inch 1,250 Gallon Septic Tank
Application Rate: 1.2 GPD/SF 4' Gravel Beneath Dist. Pipe
4 Bedrooms X 150 GPD a 600 Gallons Per Day
600 GPD/1.2 GPD/SF /5 SF/LF X .5 (Red. Factor) = 50 LF Trench
Therefore: Construct a 5' Wide Trench System with One Lateral 50' in
Length.', Distribution Piping to be Placed at 3.5' Below Original Ground
Level.
.00
G�erica
5' WIDE TRENCH SECTION
(NO SCALE)
NOTE: Grade Area to Drain Away.
MIN
4381-E
T-
PERFORMED
LEGAL DESCRIPTI
Municipality o1 Anchorage %a�
DEPARTMENT OF HEALTH & HUMAN SERVICES • ' '
625 `L' Street, Anchorage, Alaska 99502-0650 �� • MICHAEL E. ANUFE�°sU d.'b j 'i
SOILS LOG — PERCOLATION TEST
!:?ni ne] ] Hnmes
Lot 5, Block 4, Knik Township, Ranc
View Estates SLOPE
1 ^'
Y ,
2
P
3
o
4
6
0
7
D
8
9-
to -
11 to 11
12-
13-
0
2 13
14 a
15
16 n
�e/--
17
16
19
20
COMMENTS
DATE PERFORMED
Section:
SITE
757 117+?
3o N
• �
4°T [ •
i
�V
S
IF YES, AT WHAT
d
DEPTH?
p0
E
neo to WSW AW nro
Mm=ft? wIPr K-
Municipality o1 Anchorage %a�
DEPARTMENT OF HEALTH & HUMAN SERVICES • ' '
625 `L' Street, Anchorage, Alaska 99502-0650 �� • MICHAEL E. ANUFE�°sU d.'b j 'i
SOILS LOG — PERCOLATION TEST
!:?ni ne] ] Hnmes
Lot 5, Block 4, Knik Township, Ranc
View Estates SLOPE
1 ^'
Y ,
2
P
3
o
4
6
0
7
D
8
9-
to -
11 to 11
12-
13-
0
2 13
14 a
15
16 n
�e/--
17
16
19
20
COMMENTS
DATE PERFORMED
Section:
SITE
757 117+?
3o N
PERCOLATION RATE (mmuteennch) PERC HOLE DIAMETER 2LN
TEST RUN BETWEEN T _ FT AND FT
PERFORMED BY: ICERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALI. STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
WAS GROUND WATER
ENCOUNTERED?
�V
S
IF YES, AT WHAT
L
DEPTH?
p0
E
neo to WSW AW nro
Mm=ft? wIPr K-
ate _ / Z Z 8 =1
PERCOLATION RATE (mmuteennch) PERC HOLE DIAMETER 2LN
TEST RUN BETWEEN T _ FT AND FT
PERFORMED BY: ICERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALI. STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
Municipality of Anchorage
GII�ry.{� YG
DEPARTMENT OF HEALTH & HUMAN SERVICES
O • • . '
�� K. MICHAEL E. ANUCFIS01 '
825 "L" Street, Anchorage, Alaska 99502-0650
f,' `,
���J
SOILS LOC —PERCOLATION TEST
Municipality of Anchorage
. .
p�C
DEPARTMENT OF HEALTH & HUMAN SERVICES
O • • . '
�� K. MICHAEL E. ANUCFIS01 '
825 "L" Street, Anchorage, Alaska 99502-0650
f,' `,
���J
SOILS LOC —PERCOLATION TEST
4381E
.SLI
PERFORMED FOR: Spinell Homes DATE PERFORM
LEGAL DESCRIPTION: Lot 5, Block 4, Knik Township, Range, Section:
J_ View Estates SLOPE SITE
D �
O
2-
3-
0 3°
a
4 o °
5-
67 6-
7
10-I-IdI.I
91
12-
13-
14-1
2 13 94
16
•a
17
18 /✓ D
19
20
COMMENTS—Me L1el e
Ir
WAS GROUND WATER ,
ENCOUNTERE07 _ �v
S
IF YES, AT WHAT 0
DEPTH? ®� P
E
Ileplh to Weer Alla
Manimring? K Batt �z 2
Reading Date Gros
71me
Nat
Time
Depth to
Water
Not
Drop
„o i6,;1 a
7s
o; t L�
i'-
/7,9/
(i, b 40
lo., w :S/
A 5
9 /
6,19
cc // h
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN S_� FT AND L FT
PERFORMED BY: / I� I �14N OERTIFY TH T T IS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: / Z r �Q 7
ON-SITE WASTEWATER DISPOSAL SYSTEM
(CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 5, BLOCK 4, KNIK VIEW ESTATES SUB.
GENERAL:
1.' The scope of this project includes furnishing and installing
a new 1,250 gallon septic tank. It also includes the
construction of a new 50' long by 5' wide by 4' effective
depth absorption trench.
2.1 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.
31 The Contractor shall be responsible for obtaining a I I
underground utility locates and for the layout of the septic
system and verification of the location of all lot lines.
41 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.
5l 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
plans.
Lot 5, Block 4, Knik View Est.
December 30, 1997
Page Two
2., A septic tank is to be constructed by a certified
manufacturer. Construction shall include two
for pumping access.
3.', The septic tank shall be sufficiently beddec
settling or shifting of the tank.
septic tank
4" cleanouts
to prevent
4.'', All standpipes on the septic tank shall extend a minimum of
12 inches above final grade.
5J Tanks installed without 4' of cover shall have a minimum of
2" of direct burial insulation.
611 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.
Z. 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 5, Block 4, Knik View Est.
December 30, 1997
Page Three
5. i 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.;r 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.
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:
1.1 Septic tanks must be constructed
septic tank manufacturer.
by a Municipally approved
2.i 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).
3J 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 5, Block 4, Knik View Est.
December 30, 1997
Page Four
5.
6.
INSPEC
A permeable geotextile fabric (Typar, Mirafi or equal) must
be installed between the final drain rock layer and the
native soil layer.
All drain rock shall be .5" to 2.5" in diameter with less than
3% passing the #200 sieve.
'IONS:
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'i Alaska. The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation
of l 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
construction notes for use in preparing the
of l the completed system.
survey layout and
certified as -built
MUNICIPALITY OF ANCHORAGE
S,t�l y
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-043-36-000
1. GENERAL INFORMATION
Expiration Date: .� ^ i -/' �3
Complete legal description Knik View Est. B4 L5
Location (site address) 21725 Knik Vista Cir., Eagle River, AK 99577
Current property owner(s) Paul & Pamela Finch Day phone 242-3244
Mailing address
Real estate agent
P.O. Box 770753, Eagle River, AK 99577
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone 230-0700
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
❑
Private Septic
F
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
0
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 550
Date of Payment -2-(
Receipt Number q _. T
COSA# 021 125
Waiver Fee $
Date of Payment
Receipt Number
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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Eklutna Engineering, LLC. Phone 406-1058
Address 19162 Mountain Rd., Chugiak, AK 99567 _ J/I /
Engineer's Printed Name Curtis Townsend Date I r! r� , 2
6. DSD SIGNATURE
System #1 Approved for I/ bedrooms
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
tmttia L Tovm:cnd
�'• Date �% f t0?r,4?,S:'r
14o. CE 11904
pFg,�?_ROFESSW`,"
bedrooms, with the following stipulations:
�� WAST'-V`'ATER oz
PRO GKAIVI\�=
T SERv�G�;
v�.. Original Certificate Date: :5--2
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
Septic System Advisory
Well Flow Advisory
COSA Checklist blue sheet
Nitrate Advisory
Arsenic Advisory
Other �S f-ee( hop AdviS� oVy
a
A +A_CU1 ec( I
Legal Description: Knik View Est. B4 L5
If more than 1 septic system on lot: COSA Checklist # 1 of 1
A. WEL �TA
ElWellloth nsite (or attached)
Date drilled
Total depth ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Comments AWWU WATER
B. TANK DATA
Age of tank(s) 23 years
Tank type/material steellseptic
Measured operating fluid level in septic tank 51
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 7/6/2020
D. ABSORPTION FIELD DATA
Which system tested (date installed) 1998
❑ ALL standpipes present per record drawing
Total measured depth from grade 10 ft (max)
Measured depth to pipe invert from grade 6 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced n/a gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 051-043-36-000
Structure served by this system 1
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑ Nc
❑ Coliform bacteria is Negative
I�1itra mg/L E]Nitrate less than MRL (ND)
Arsenic /_L El Arsenic less than MRL (ND)
Collected by '-
Date of Sample
G. t [FT STATION
❑ Requir maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 5/17/21
Results [DPass For 4 bedrooms
Fluid depth prior to test 8/0 in
Water added 736.4 gal
New depth 11/0 in
Elapsed time 15 min
Final fluid depth 8/0 in
Absorption rate 736.4 gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
n/a
�E. SEPARATION DISTANCES'
From'`Prkate Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tankk/Lift on Lot ^> 100' Community Sewer Manhole/Cleanout > 100'
®- es if No ft ❑ Yes if No ft
Neighboring Tank > 100' El Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft
Absorption Field on Lot > 100' E] Yes if No ft I-d-inq Tank > 100' ❑ Yes if No ft
Neighboring Absorption Fields > 100' Animal Containme i 50' ❑Yes if No ft
❑ Yes if No ft ~'~—
Manure/Animal Excreta Storage> Ivy'
Community Sewer Main > 75' ❑ Yes if No ft ❑ Yes i ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑✓
Yes
if No
ft
Surface Water > 100'
n Yes if No
Property Line > 5'
0
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
❑✓
Yes
if No
ft
Private Wells > 100'
Yes if No.
Water Main > 10'
0
Yes
if No
ft
Community Wells > 200'
Q Yes if No
Water Service Line > 10'
0
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
ED
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
0
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'✓❑
Yes
if No
ft
Private Wells > 100' Yes if No
Water Service Line > 10'
0
Yes
if No
ft
Community Wells > 200' Yes if No
Surface Water > 100'
F71
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date. 19! � ',ko,
COSA Checklist yellow sheet
An
06000... .••......
std
k�'ROFESSI4P�
ENGI NE E R83
ft
ft
ft
ft
ft
MUNICIPALITY OF ANCHORAGE '
DEVELOPMENT SERVICES DEPARTMENT 907-343-7804
On -Site Water and Wastewater Section Fax: 343-7997
m/nvvx.mnuni'org/onsite
Septic Tank Advisory
Certificate of On -Site Systems Approval #OSC2112S3
Subdivision: KnikView Estates 84Lot 5
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 23 years old. Typical replacement costs range from $8,000 to $11,000
This advisory must be attached to all copies of the subject Certificate Of On -Site Systems
Approval.
This is an example of what the metal of a 20 -year-old steel tank MAY look like.
Municipality of Anchorage
tt��i i4,q
On -Site Water &Wastewater Program rl
(907) 343-7904
J
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
OF/
Parcel I. D. 945-043-36 Expiration Date:
1. GENERAL INFORMATION
Complete legal description KNIK VIEW ESTATES; BLOCK 4 LOT 5
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
21725 KNIK VISTA CT. *CHUGIAK 99567
GORDON BIRDSALL Day phone 688-1292
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:
Individual Well
❑
Individual Water Storage
❑
CommunityClass_Well
❑
Public Water System
0
WalverNariance request for
Day phone
CCEPT
Per AMC 23,10.164.121
SEN 1
TYPE OF WASTEWATER DISPOSAL:
IndividuW'Of-stfe "" -
Individual Holding tank ❑
Community On-site ❑
Public Sewer ❑
Received by: I Date:
COSA to be released to the engineer, unless otherwise requested by the engineer
COSA Fee $ S2_�, —
Date of Payment– 61
Receipt Number bFS (l
COSA # 05C- q I'AlI
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
Distance: —
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my sea! affixed hereto and as of the validation date shown below, l 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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance 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 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 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
6. DSD SIGNATURE
System #1 Approved for bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
Phone 337-6179
Date `? I t' I Vit(
bedrooms, with the following stipulations:
o���o llllllillii(f((((ff
OF glyCX16
�m
ON-SITE
WATER AND
WASTEWATER
oz;
n PROGRAM
By: It Original Certificate Date: �1 ^ 1 7Z
The Municiliaiity drAofage Develop,emt Services Division (DSD) issues Certificates of On -Site SysMms Approval (COSA) based only
upon the represenata loos 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. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
(Rev. 11105)
c� Nitrate Advisory
Arsenic Advisory
Other
If more than I 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 5 Parcel ID: 051-043-36
A. WELL DATA
Well type
Date completed
Total depth ft.
Date of test
Static water level
Well production
WATER SAMPLE
Coliform /
ug./L.
AWWU WATER
If A, B, or C provide PWSID#
Sanitary seal (Y/N)—
Cased to ft.
FROM WELL LOG
g.p.m.
MI. Nitrate mg./L.
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Well Log (Y/N)
Wires properly protected (YIN)
Casin=TION round) in.
AT IN
ft.
g.p.m.
Collected by:
Tank Type/Material
SEPTIC/STEEL
Date installed
3/19/1998
Tank size 1250 gal.
Number of Compartments 2
Cleanouts (Y/N)
YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A C
Date of pumping / S I i I Pumper_ I S
C. ABSORPTION FIELD DATA BELOW EXISTING GRADE
Date installed 3/19/1998 Soil rating.p.d./ or ft2/bdrm) 1_2 System type SHALLOW TRENCH
Length 50 ft, Width 5 ft. Gravel below pipe 4 ft.
Total depth * 10.71 ft. Eff. absorption area 500 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 9/4/2014 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0.5 in. Water added 838 gal. New depth **4.5 in.
Elapsed Time: 0 min. Final fluid depth **4.5 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date —
*,*THE LAST 661 GALLONS INTRODUCED CAUSED A RISE OF 0"
D. LIFT STATION
Date installed
"Pump on" level at in.
E. SEPARATION DISTANCES
Size in gallons Manhole/Aoc esss
"Pumpugh water alarm level at in.
Cycles tested Meets alar & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankllift station on lot
Absorption field on
Public sewer main
Sewer /septic service line
areas
On adjacent
On adjacent lots
manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO.
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main to lO 1i'
Water service line 10'+ Surface water 100'+ parking/vehicle Driveway, arkin g
y p storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's P 'nteId Name JEFFREY A. GARNESS
Date x,11/1 q
(Rev. 11/05)
4
LOTS
° o
0
6.0 sF a ^o JOp
°8 \ �90 A4
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\ 00 Ni 939 Q�'ry a4°s OHN D. HAYDEN ,r D
2°45'W 3ti05 Q"^ L 12�8
Z 5°dd
`I A �o Y L I Qo�460p� 6+(gyp
bRT
/ NOTE:
THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS
A PLOT PLAN WITHOUT THE EXPRESSED WRITTEN
CONSENT OF LCG LANTECH,
ORDEREDBY: GREG SHEARS WITH COLOWELL BANKER euRVArcxmiFlcATrote tccuNTEai,'.NC HASGONoucrEDAPHrsicAl. aLxrdEvoP
1HE PRC1PEft1YA3 SHDYM DN THIa DPAW IND ANO CENl1ilESr1 gTTHE
LEGAL DESCRIPTION: AS_EJ ILg � oY>:MENrsslnureoTHENcaNnr�wirxwTxe pgcQ�iex Lrres,wowo
9'4 ®419 6 ENLROA41�MSEx.sroTxEreTww xaiEa.
LOT 5, BLOCK 4, e+cwslounavnore:marHEauaNeasl:EsroeamTopErEmnNEae
GIJI6lJ4'EpEANY EA9EMENTB, CWENMfIS, RESTPoCT101$ pR AIGNi-0EiVAY
KNIK VIEW ESTATES SUBDIVISION AHN SWH CH DONOTAP EAHON HERE ORpEDSUBWwS UNP AT. UNOEA NO
CPCUMETANCEB SH W t0 ANY DATA HEAEOH BE USED PCR C0�ffiTRUC1ttNJ. FCR
ESTABLISHING PRGPERtt tJNE3, qi FDR PLOTFiAN PURPOSE&
250 HSt,.t °F+F+�nCSTMDPPE
Anchorage, Alaska 99501 ® Orai�ang: '+":+AepNalt-^m..::•
wAT WEU.
Survey Department
Phone 562-5291 LDRAWN DATE 08R12014 WORK ORDER: 2014-L-145
Inc Ma9nlme DRAWN BY: MH PIAT: 8&113
� "u-019Plxme 243-8985 [CHECKED TE _ LAT
NW15S8
SCALE: 1"=30' - FBIPG: T90fl38T4
Municipality of Anchorage
• " 1 Development Services Department
! Building Safety Division
On -Site Water 8 Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 9951919-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051- D Ll3-%:,Aun
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
COSA# ((0 0 `f !Z&
Expiration Date: ; 9 � i� - D '7/
21725 KNIK VISTA COURT • CHUGIAK. AK 99567 _
CHRISTINE BAILES Day phone - 688i6108
Day phone
DONNA ALDERMAN w/ PRUDENTIAL VISTA Day phone 360i0158
16635 CENTERFIELD DRIVE ' EAGLE RIVER, AK _99577
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"A_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 fine (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may
be reissued with new water 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 engineers work.
4. STATEMENT OF INSPECTION BY ENGINEER
As cerfiried by my seat affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Cerfiricate 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 Finn GARNESS ENGINEERING GROUP, Ltd. Phone
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineers Printed Name JEFFREY A. GARNESS. P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines d 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 Idontifiable features. The operational life of all 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 benefil 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 confor any legal right whatsoever.
5. DSD SIGNATURE
Approved for _hL_ bedrooms.
Disapproved.
Conditional approval for
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
337-6179
Date (atgC'
bedrooms, with the fllowing stipulations:
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Nitrate Advisory Other
By:� //i--t�
1P. 11R 1
ON-SITE
w&^,TFWATER
Original Certificate Date: I — 6— (OG
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water S Wastewater Program
4700 Bragaw Sheet
P.O. Box 196650
Anchorage, AK 995196850
www.muni.orglorrane
(907) 3437904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLISTi
I
Legal Description: KNIK VIEW ESTATES SUBDIVISION, LOT 5, BLOCK 4, Parcel ID: 0.5'I — D `/ 3 --3
A. WELL DATA
Wen type -A-
Date of test
Static water level
Well production
COMMUNITY WATER
If A, B, or C provide PWSID# 218409
Sanitary seal
Cased to ft.
FROM WELL LOG
WATER SAMPLE RESULTS:
Conform oolonies/100 ml.
B. SEPTICIHOLDING TANK DATA
ft.
g.p.m.
Nitrate
Well Log
Casing height (above
AT INSPECTION
Date of sample: Collected by:
in.
00 ml.
Tank Type/Material STEEL Date installed 3/19/1998
I
Tank size 1250 gal. Number of Compartments E Cteanouts (YIN) YES
Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A
Date of pumping 10/8/2005 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA
Date installed 3/19/1993 Soo rating ..d r ftlbdrn) 1_2 System type TRENCH
Length 50 ft. Width 5 ft. Gravel below pipe I 4 ft.
Total depth ' 10.5-10.911. Elf. absorption area 500 ft' Monitoring tube YES Depression over field NO
I
Date of adequacy test 7/13/2006 Results (Pass/Fell) PASS For 4 bedrooms
I
Fluid depth In absorption field before test 4 in. Water added 863 gal. New depth 6in.
I
Elapsed Time: 8 min. Final fluid depth 4 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date
I
D. LIFT STATION
Date installed
'Pump on' level at _in.
E. SEPARATION DISTANCES
Size in gallons
Manhole/Access (Y/N)
"Pump air leveig water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAUl station on M
Absorption field on lot
Public sewer main
Sewer /septic service line
areas
COMMUNITY WELL
On adjacent
On adjacent lots
menhole/deanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 100+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parkinglvehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I car* that I have determined through Reid inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Na a JEFFREY A GARNESS
Date 5 ZZ,
COSA Fee S !4= ?i 0 Waiver Fee E _
Date of Payment — Date of Payment
Receipt Number Receipt Number
(rev. 11/05)
OT -20-06 15:28 FR011-Pudentlal Jack White Eaole River 9076896499
86-113
KNIK VIEW ESTATES
LOT 5, BLOCK 4
22,773 S.F.
T-967 P.002/002 F-104
"=3C
[-I
FINAL STRU=RE AS—BUILT
CASTALDI LAND SURVEYING
Jell A. Gaslaldl. R.L.O.
4726 Wall Both Ave.
Anchora9a. Alaska 09502
PHONE 2485454
GRID DATE
NW 1558 6�J�BB
F. 0. JOB NO.
RR -04 1 KVE54
1 hsreby cafllff that 1 have surveyed /he
property depleud above and that ho
encroachm"le $&let eacept 4e lRdleaced.
1/ Is Ohs responsibility of the owner so
detormlh• Ohs 02151anoe of any 0444"Als.
covenants or restrictions Bhlch do net
appear on the reaofded ►abdlvlt140 plat.
Under no alrcuhatonaes ohould any date
hefeon be used ref conslructlen er far
establishing boundary Of Ione• "nos.
ANCHORAGE RECORDING DISTRICT. ALASKA
NOTE: NO CORNERS SET THIS DATE.
221
• •p
ff
MUNICIPALITY OF ANCHORAGE
o DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
i
Parcel I.D. # _051 04336 HAA # LA Yh t ��
1. GENERAL' INFORMATION
Complete legal descriptionr,nt 5 R1nek Knik pi nw ct ai ac
Location ($ite address or directions)
Property olwner kZaldpc Fnternri soG, Tnn Day phone -�a4_5678
Mailing address 9210 Vanguard Drive Anchorage, AK 99507
Lending agency Day phone
Mailing address
Agent _I
Day phone
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
NOTE: If;i community well system, provide written confirmation from State ADEC attest -
info to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
_a
Individual on-site XX
Holding tank
Community on-site
Public sewer
NOTE: If r�ommunity wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front M�A 021
a. 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 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 this inspection.
Name of Firm Anderson Engineering Phone 522-7773
Address P.O. Box 2
Engineer's signature
d,Laj, c C,
AK 99524
Date
6/20/98
f
t r
6. DHHS SIGNATURE
J _
-� Approved for Uk bedrooms.
Disapproved.
Uonditional approval for bedrooms, with the following stipulations:
Additional Comments
;I
BY -- �— Date � • �2 `lam
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 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 engineer's work.
72-025 (Rev. 1191) Back MOA #21
• � Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: riot 5, Block 4 Xni ky-; ew Parcel LD.:_ 051 o43.36
A. WELL DATA Estates
Well type A
Log present(Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform
Date of sample:
If A, B, or C, attach ADEC letter. ADEC water system number 21 8409
Date completed
Cased to
FROM WELL LOG
Nitrate
Casing height (above ground)
Wires properly protected (Y/N)
Collected by:
AT INSPECTION
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed .3 / 1 9/ 9 f3 _Tank size 1 2 5 n Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N
Date of Pumping_ New Pumper Construction
C. ABSORPTION FIELD DATA
Date installed 3 19 / 9 8 Soil rating (g.p.d./ftz or ft2/bdrm) 1.2 System type Wide Trench
Length 50' Width 5' Gravel thickness below pipe 4' Total depth 9-91
Effective absorption area 650 5I' Monitoring Tube present (Y/N) Y Depression over field (Y/N) N
Date of adequacy test New Const. Results (Pass/Fail) pass For 4 bedrooms
Fluid depth in absorption field before test (in.); Immediately aftergal. water added (in.):
Fluid depth (ins) Minutes later: Absorption rate = o.p.d.
Peroxide treatment (bast 12 months) (Y/N) If yes, give date
72-026 (Rev. 3/96)"
D. LIFT STATION
E.
None on Lot
Date installed _ Size in gallons
Manhole/Access (Y/N) "Pump on" level at*
High water alarm level at* *Datum
Cycles tested
SEPARATION DISTANCES
SEPARATION DIS-FANCES FROM WELL ON LOT
Septic/holding tank on lot
Absorption field on jot
Public sewer main
"Pump off" level at*
TO: - No Well on Lot
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Sewer /septic service line Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation > 5' Property line >5' _Absorption field >5
Water main/service line >101 Surface water/drainage > 10 0 Wells on adjacent lots
>200'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line > 10 Building foundation >10'
Surface water > 10 0 Driveway,
Water main/service line > 10
parking/vehicle storage area >50'
Curtain drain None on Lot Wells on adjacent lots
>200'
F. ENGINEER'S CERTIFICATION
I certify that 1 have,: determined thru field inspections and review of Municipal records ttai�ibbye'&� gems are
in conformance with MOA HAA guidelines in effect on this date. F �, . ' ;`ar€ JI
�
Signature :t44i!!tL_ ��~ .` aP�,`1 r '`, . °>, 4V, sD.
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4
t ,
Engineer's Name Michael E Anderson,_ P.E.
Date 6 29/98
HAA Fee
Date of PE
Receipt N
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number