HomeMy WebLinkAboutKNIK VIEW ESTATES BLK 3 LT 23Knik View
Lot 23
Block 3
#051-043-25
Municipality of Anchorage Page 1 of~ ·
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISIO'N
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SN970089 PIDNumber: · 05104325
~am.: Waldec Enterprises Inc. Wastewater System: ~ D Upgrade
Addre~: 9210 Vanguard Drive ABSORPTION F~ELD
No. of Bedrooms:
Phone: 344-5'678 Four [] Deep'Trench ~Shallow Trench [] Bed [] Mound [] Other
LEGAL DESCRIPTION so,, Rating: . ~ GPD/S~.. Ft. Total Depth from original~ grade:/zD '
Subdivlelon: Depth to pips ~om from original grade: Gravel depth beneath ~ipe ~ Ft.
Township:lJ Range: ~ Section: Fill adaed above original grade: Gravel length:
WELL: S New D Upgrade Gravel wldth: ~FL '~' /~ Ft
Clarification ~r~vate, A,B,C): Total Depth: C~ed To; Total abso~tion area: ~e matetlat~ ~.~
' : Date Drilled; S~tioWater Level: Installer:
~.~ ~,. ~. TANK
SEPARATION DISTANCES '~pt,~ s Ho,di~ S S.T.~.P.
TO Septic ~ Ab~o~tion LI~, Holding )ubll~dvate Manula¢tu~e~
Frorn Tank Fie,d Station Tank Sawer Lines /~~ ~k' Capaci~ in gallons:
Wel~ ~'~O ~>~ ~ ~ >~/ Mstedal~/ Number0fCompa~ments:~,,
,
w,t.,. >~ 2~ ~ ~ >~ LIFT STATION
Line ~ / ~ SIzeln gallons: Manufacturen
Cu~ain /~ / / / / Pump~ - I ~ I~specti°ns Ped°rmed bY:
Drain ..
Remarks: See lot li~e waive~. BENCH ~ARK
L~tion and Description'. /
Elevation:
....... ENGINEER'S SEAL ,
Inspections pe~ormed by Dates: lsL~°~¢/~
Department of Health, nd Human ~,ce, approva,
Permit No.
SW970089 Page 2 _of 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description:
FI,
'7
LEGEND
SP1 Se,p, tic P,u, mp, compa,r, tment 1
SP2 2
C Clean Out
t4T Monitor Tube
/
/
/
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PID No.:_Q51 04325
Permit No, SW970089 Page 3~of 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL S'ERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System 'and/or Well InspectiOn Report
Legal Description:~r'ot23r Block 3, Knik View Ests. PIDNo.:_IL5104325
4/?
LEGEND
SP1 Se,p, tic P,u, mp, compa,r, tment 1
SP2 2
C Clean Out
· ----. -.
Rick Mystrom,
Mayor
Mun tcipality of Anchorage
Department of Health and Human Services
625 "L" Street
P,O. Box 196650 Anchorage, Alaska 99519-6650
September 23, 1997
Michael E. Anderson, P.E.
Anderson Engineering
PO Box 240773
Anchorage, Alaska 99524
Subject: Waiver Request for Lot 23 Block 3 Knik View Estates SUbdivision
Waiver Request #WR970058, PID #051-043-25, HA970438
Dear Mr. Anderson:
Your request for a waiver of the required 10 foot separation
between an on-site wastewater disposal system and a lot line has
been approved. The waived distance is 3 feet from the absorption
field to the east property line.
This approval applies to the existing on-site wastewater disposal
system lot line separation only. Any future upgrade to the on-site
wastewater disposal system will require all separations be met or
another approval from this department.
If there any further questions or concerns regarding this waiver,
please call our office at 343-4744.
Sincerely,
Donna C. Mears
Civil Engineer
On-site Services
ljw #7
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR# WR970058 PID# 051-043-25
Date Received: September 16, 1997
Legal Description: Lot 23 Block 3 Knik View Estates Subdivision
Engineer: Michael E. Anderson, P.E., Anderson Engineering
PO Box 240773, Anchorage, Alaska 99524
HA# HA970438 Permit #
Applicant: Waldec Enterprises~ Inc.
Waiver Requested: Lot line waiver of 3 feet from the absorption field to
3he east property line
Criteria: 1. Geology: Points:
A. Water Table
Bo Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
Special Conditions:
3. Other:
Waiver is Granted: ~ Waiver is NOT Granted:
List Conditions or Reasons for above:
Nam~o f Reviewer
Rec #: #03303/3223
Amount: $ 115.00
Date Paid: Spetember 16. 1997
September 16, 1997
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject:
Lot 23, Block 3, Kmik View Estates Subdivision
Lot Line Waiver Request
Dear On Site Services Engineer:
The attached As Built Plan shows the location of the absorption trench and the alternate site. Due
to the small size of the lot it was necessary to crowd the lot line to provide as much effective ,'u'ea as
possible for both the primary and alternate sites. We are therefore requesting a lot line waiver be
issned allowing this encroachment.
Soils on the lot ate conducive to an onsite system and no groundwater was noted during the
testhole and design phase of the project or during the construction phase. No e~ements exist
along the eastern property line and no development is within 50' of the line on the lot to the east.
Placing the absorption ttench within 3' of the line will have no adverse impact on systems currently
in place or to be placed in the future.
The lots in the subdivision are served by a commtmity water system so impacts to wells ate not an
issue. We therefore recommend a waiver be issued to allow construction of the absorption trench
to within 3' of the lot line.
Please let me know if you have additional questions.
Sincerely,
Michael E. Anderson, P.E.
Attachments
MUNICIPALITY OF ANCHOP, AGE
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:SW970089
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NAME:WALDEC ENTERPRISES INC
OWNER ADDRESS:9210 VANGUARD DRIVE
ANCHORAGE, ALASKA 99507
PARCEL ID:05104325
LEGAL DESCRIPTION:
KNIK VIEW ESTATES BLK 3 LT 23
DATE ISSUED: 5114/97
EXPIRATION DATE: 5/14/98
LOT SIZE: 27313 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PEt~IT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
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 (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:
DATE fi?
April 21, 1997
Municipality of Anchorage
Department of Heath & Human Services APr 1997
825 "L- Street Municipality/of~nchorage
Anchorage, AK 99502-0650 Dept, Health//& H~rr~n Services
Subject: Lot 23, Block 3, Knik View Estates Subdivisio~ E ~'~iV E D
Septic System Design
Impacts to Adjacent Properties APR 22. 997
Mun c pality °f Anchorage
Dear On Site Services Engineer: Dept Health&Hurnan_Se_rvi¢_e~
We hereby apply for a permit to construct an onsite septic system on Lot
23, Block 3, Knik View Estates Subdivision. The attached site plan and
backup documentation identify the size and location of the new system to
serve the house to be constructed on the lot. The subdivision is served by
a community water system and all required separation distances are
easily met.
A percolation test completed on the soils in th(; area of: the new
absorption beds indicated a rate of between 15 and 30 minutes; per inch.
We propose to place 5' wide absorption trenches with a total length of
100'.. Total depth of the system will be 7.5' below the surface. No
groundwater was noted during the excavation of the testholes nor was any
noted during the monitoring period. No surface water was noted in the
area.
If the system is constructed as designed the following statements can be
made:
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 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 23, Block 3, Knik View Estates Subdivision
April 21, 1997
Page Two
The system, 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 will
be maintained.
Some surface grading may be required to assure a minimum of 100'
separation between surface water and all components of the septic
system. Grading and filling will not impact the current drainage patterns.
Sincerely,
Michael E. Anderson, P.E.
141.42
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VACANT
LOT 23, BLOCK 3, KNIK VIEW EST.'
............ · SITE PLAN -,:
SCALE 1" = 30' _ VACANT
PROPOSED 4 BEDROOM HOME
(EXACT LOCATION TO BE DETERMINED)
1:_250 GALLON SEPTIC TANK
SYSTEM PLAN
NO SCALE
LOT 23, BLOCK 3, KNIK VIEW ESTATES
DESIGN FACTORS:
Four Bedroom Home
Perc. Rate: 27 Min./Inch
Application Rate: .6 GPD/SF
SYSTEM REQUIREMFNTS:
Wide Trench System
1,250 Gallon Septic Tank
4' Drainfield Flock
4 Bedrooms X 150 GPD / .6 GPD/SF = 1,000 SF of Absorption Area
1,000 SF/5 LF X .5 (Red. Factor) = 100 LF Length of Trench
Therefore: Construct a Wide Absorption 'Trench With Two Laterals, Each
50' in Length. Distribution Pipe in Trench Placed at 3.5' Below the
Original Ground Surface.
qLO"
NOTE:
TYPICAL WIDE TRENCH SECTION
(NO SCALE)
Grade Area Over Trench to Drain Away.
Bottom of Trench to be 4' Above Groundwater.
Minimum 3' of Cover Over Distribution Pipe.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG ~ PERCOLATION TEST
PERFORMED FOR: DATI~ PERF(
LEGAL DESCRIPTION:[~'~/ ~;2~'~I I(NIK, VIeW ~.~T, Township, Range, Section: SLOPE
I
9
10
11
12
13-
15-
16-
2O
WAS GROUND WATER _~/i~N
ENCOUNTERED?
S
IF YES, AT WHAT ~ 0L
DEPTH? p
E
OepUI In W~" Al~r ~° :~//~/~'"'~
Monil~rlng? ~ ,-"' __ ~
Gross Net Depth to Net
Reading Date Time Time Water Drop
~,~; "7 "~,'~ ~.,~' ,'1~'
'COMMENTS /'~ ~'~'
/
PERFORMED BY:
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
:
PERCOLATION RATE ~ (m~nutes/,nch} PERC HOLE DIAMETER
TEST RUN BETWEEN .~.~----- FT AND .~. FT
jf~HIS TEST WAS PERFORMED IN
PERFORMED FOR:
LEGAL DESCRIPTION:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG ~ PERCOLATION TEST
6 /~' ~"
7 Oc~ ,
8
9
10
~ ~. ~f~/~-.
11
12
13
14
15
16
17
18
20-
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT 0 ~
DEPTH? p
E
Deplh to Water Nar
Monitoring? __ ~ Dale:
sI'r'E PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE. / ~ {m~nutes/~ncl3) PERC HOLE DIAMETER .~' ~1
, FT AND ~:~ FT
TEST RUN BETWEEN
ON-SITE WAS'rEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: Lot 23, Block 3, Knik View Estates SubdiviSion
GENERAL:
1. The scope of this project includes furnishing and installing
a new 1,250 gallon septic tank. Work also includes the
construction of new 5' wide absorption trenches a total of
100' long at the location shown on the Site Plan: Two
parallel trenches each 50' in length will be required.:
2. Construction shall be in accordance with the approw.~d site
plan, design drawings, Municipal Permit with any speciat
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 23, Block 3, Knik View Estates Subdivision
April 21, 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 41 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.
DRAINFIEI. D CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown
on the design. The bottom of the trenches shall be within
2" of level.
2. Distribution piping must be placed level with perforations
down atop alevel 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 23, Block 3, Knik View Estates Subdivision
April 21, 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.i Finish
grade over the trench must be mounded to prevent
settlement or depressions.
7. Grade area surrounding the absorption
away.
trenches to drain
8. A minimum 2' of accepting soil is required below the
drainfietd 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 I-tl or equal).
Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
Lot 23, Block 3, Knik View Estates Subdivision
April 21, 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.
SITE GRADING:
The entire area must be graded upon completion to aSsure a
minimum of 100' separation distance is obtained from any
surface water and the septic tank and the absorption trenches.
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Certificate of On -Site Systems Approval
OSC241501
Parcel ID 051 -043-25 Expiration Date: 9/9/2025
Legal description KNIK VIEW ESTATES BLK 3 LT 23
Site address 21930 JUDD CIR
Current property owner(s) GOMEZ JOSEPH ANDREW &
X The On-site system(s) is/are approved for 4 bedrooms
By:
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
No comments
Original Certificate Date: 12/10/2024
This Cei`tificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
syst m(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
D elopment Service Department (DSD) issues COSAs based upon representations provided by an
independent professional engineer. The Municipality of Anchorage is not responsible for errors or
omissions in the professional engineer's submittal.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory X Arsenic Advisory
Other
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 051-043-25
Complete legal description Knik View Estates Block 3 Lot 23
Location (site address) 21930 Judd Circle
Current property owner(s) Joseph Andrew & Natasha L. Gomez Day phone
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑■ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ■❑ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑■ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 27 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ Waiver Fee $
Date of Payment/2- �7 �� Date of Payment
COSA # 0 1 Q- ` Waiver #
COSA Application—June 2022
COSA Checklist_June 2022
COSA Checklist
Legal Description: Parcel ID:
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (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.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
COSA Checklist_June 2022
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F.ENGINEER’S COMMENTS
G.CERTIFICATION & 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, indicates that the on-site water supply
and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation, unless noted otherwise.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with ADEC & MOA guidelines and regulations. The reported results describe 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 soil condition, ground water 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 this system. All systems eventually fail, and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore, we
cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this
report is for the sole benefit of the owner listed above.
Name of Firm
Phone
Engineer’s Printed Name
Date
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
On -Site Water and Wastewater Section
www.muni.org/onsite
Septic Tank Advisory
Certificate of On -Site Systems Approval # OSC241501
Subdivision: Knik View Estates Block:3, Lot: 23
907-343-7904
Fax: 343-7997
The septic tank for this property is 27 years old. The average life of an asphalt
coated steel septic tank is 20 years. Typical replacement costs are $15,000 or more,
not including engineering, surveying, MOA permitting fees or site restoration.
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 30 year old steel tank MAY look like.
MUNMPAUTY OF ANCHORAGE
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. 051-043-25
1. GENERAL INFORMATION
Complete legal description KNIK VIEW ESTATES
Expiration Date: l / - 5r- 0 2,3
BLK 3 LT 23
Location (site address) 21930 Judd Cir Chugiak AK 99567
Current property owner(s)
Mailing address
Real estate agent
MCCAIN GAIL
PO Box 670429 Chugiak
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
AK 99567
Day phone
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well j Private Septic 0
Water Storage ❑ Holding Tank ❑
Community Well ❑ Community ❑
Public Water System 0 Public Sewer ❑
Waiver request for: Distance:
+bio-,•*•^a-cr�*a c o -ca
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 5 5 O
Date of Payment f 2 0 g D 1
Receipt Number 0 3 5 `-{ 0 D
COSA# OSC o2 11 70 o�
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
Address 19162 Mountain Rd Chugiak AK 99567
Engineer's Printed Name Curtis Townsend, PE
6. DSD SIGNATURE
System #1 Approved for 4— bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms,
Phone 907.406.1058
20 �s
Date
��•��� OF
AW ��P,..• .• •••�:s0.i
49 TH � • /
I`
�' •••
•;•CURTIS TOWNSEND,:
# :, No . CE 1190,
with the following stipulations:
ON -SST
T_VVgs R IV rn
J�o PRO q R p
BY `�-- Original Certificate Date:
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 - 4ee ,S i 0 I'll
Legal Description: KNIK VIEW ESTATES BLK 3 LT 23
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (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 A
Static wa r -i vel at beginning of test ft.
Comments
B. TANK DATA
Age of tank(s) 24 years
Tank type/material septic Steel
Measured, operating fluid level in septic tank 51
❑Standpipes/foundation cleanout per record drawing
Date of pumping 12/14/2020
D. ABSORPTION FIELD DATA
Which system tested (date installed) 1997
❑ ALL standpipes present per record drawing
Total measured depth from grade 10.9/11.3 ft (max)
Measured depth to pipe invert from grade 6.917.3 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 2000 gallons
Comments/Deficiencies: MT1/MT2, all standpipes were verified to be present.
COSA Checklist yellow sheet
Parcel ID: 051-043-25
Structure served by this system
Well production at time of testawpm
Water storage tank vov gallons
Well disinfe or coliform test? ❑ Yes ❑ No
o iform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
C. LIFT STATION
❑ Required maintenance
Age of lift station
Lift station materia
Comment
Adequacy test date 11/5,2021
Results ✓Pass For 4 bedrooms
Fluid depth prior to test 23/23 in
Water added 600 gal
New depth 26/26 in
Elapsed time 1440 min
Final fluid depth 17/17 in
Absorption rate ' 600 gpd
Any rejuvenation treatment (past 12 months) no
If yes, enter date
ording to record drawing
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
❑ Yes if No ft
Neighboring Tank > 100' ❑ Yes if No ft
Absorption Field on Lot > 100' ❑ Yes if No ft
Neighboring Absorption Fields > 100'
��75'
— es if No ft
Commi�Main❑ Yes if No ft
ft
Private Sewer/Seer�t -bli—e> 25' ❑ Yes if No ft
,H it�iaing Tank > 100' ❑ Yes if No ft
Animal Containment > 50' ❑ Yes if No ft
Manure/Animal Excreta Storage > 100'
❑ Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' [l Yes if No ft Surface Water > 100' Q Yes if No ft
Property Line > 5
Cj Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Q Yes
if No
ft
Private Wells > 100'
❑✓ Yes if No
ft
Water Main > 10'
0 Yes
if No
ft
Community Wells > 200'
❑✓ Yes if No
ft
Water Service Line > 10'
F-1 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'
❑ Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
❑ Yes
if No 3
ft
Wells on Adjacent Lots:
Water Main > 10'
❑ Yes
if No
ft
Private Wells > 100'
Yes if No
ft
Water Service Line > 10'
F-71 Yes
if No
ft
Community Wells > 200'
Yes if No
ft
Surface Water > 100'
✓❑ Yes
if No
ft
F. ENGINEER'S COMMENTS
lot line waiver WR970058
G. ENGINEER'S CERTIFICATION
l certify that / 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.
P
..........
COSA Checklist yellow sheet L. T ' .........
ern.. Date �� tD 2�j"tpc
No.ce11904
���� ��QFESSfON����-
;ENGINEER'S
Septic Tank Advisory
Certificate of On -Site Systems Approval #OSC211702
Subdivision: Knik View Estates BLK 3 Lot 23
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 24 years old. Typical replacement costs range from $9,000 to $12,000
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.
Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org
Parcel I.D, #
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P,O. Box 196650 Anchorage, Alaska 99519-6650
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
051-0~5-25 HAA# n~ OOO,~"'T~
1. GENERAL !NFORMATION
Complete.legal description KNIK VIEW ESTATES SUBDIVISION: LOT 23. BLOCK 5
Loca;~'ion (site address or directions) 21950 JUDD ClRCLI~ CHUGIAK. AK 99567
Property owner RAFA[L- CHANZA
Mailing address 21950 JUDD CIRCLE
Lending agency
Mailing address
Day phone
CHUGIAK. AK 99567
Day phone.
6~8-2491/727-1725
Agent CONNIE HETTINGA w./ COLDWELL BANK Day phone 229-4785/786-8989
Address 2525 c STREET ANCHORAGE. AK 99503
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
XXX
If community well system, provide wdtten confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site xxx
Holding Tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
lng to the legality and status of system.
72-025 (Rev. 1/91 ) Front MOA #21 Computer Vemion
Note: Alaska Water and Wastewater Consultants,/nc,. shaft be paid $810.00 at,
or prior to, closing for the engineering sen/ices proviae(z
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 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 vedfy 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
on the date of this inspection.
Name of Firm ALASKA
Address 6901 DEBARCROAI
Engineer's Signature ',-
In conducting this evaluation, AWWC, In
system in accordance with ADEC and
with all
,tad
)al and State codes, ordinances, and regulations in effect
~,TER CONSULTANTS, INC. Phone f907) 337-6179
_CHORAGE, ALASKA 99504 /i /~
Date tl ~ 0
~vide a thorough, conscientious enginoanng analysis of the
t'~D~ 'S, GUide//nes & Regu/ations. The reported rasults described the
performance of the system under the condition, encountered at the time qf the test, and separation distances
measured to readily identifiable features.~ The (:)erational life of all wells and septic sYStems depend
on the local soils cpndition, ground water levels that mayf/uctuate 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 tho system, nor do they guarantee that there are no hidden defects or encroachments.
AWWC, /nc. can therefore not provide any warranty for future est/mate of how long the
system wi//continue to meet the operational requirements of the ADEC or MOA DHHS.
The content of this report/s for the sole benefit of the owner listed above, Any
re/ianca upon or use of this report by any other person or pady is not authorized,
nor will it confer any legal right whatsoever.
6. DHHS SIGNATURE
-,~ Approved for 4
Disapproved
__ Conditionalapprovalfor
bedrooms
bedrooms, with the following stipulations:
Additional Comments
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 courtesy to 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. 1/91 ) Back MOA fY21 Computer Version
RECEIVED
Municipality of Anchorage /C~
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division NOV 1 3 2000
825 %" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744
MUNICIPALITY OF ANCHORAGE
Health Authority APproval Check~l~® SERVICES DIVISION
Legal Description: KNIK VIEW ESTATES; LOT 25, BLOCK 5 Parcel I.D.:
051-045-25
A. WELL DATA
Well Type CLASS "A" If A, B, or C, attach ADEC letter. ADEC water system number· 218409
~ Date completed ~
Total depth Cased~to Ca~.~sing height (above ground)
FROM WELL LOG AT INSPECTION
Date of test J J
Static water level ,.-*// J
Well production J g.p.m. ~
g.p.m.
WATER SAMPLE RESULTS:
Coliform - Nitrate - Other bacteda -
Date of sample: - Collected by: -
B. SEPTIC/HOLDING TANK DATA
Date installed 6/11/1997 Tanksize
Foundation cleanout (Y/N) YES
'Date of Pumping 11/6/2000
1250 Number of Compartments 2 Cleanouts (Y/N)
Depression (Y/N) NO High water alarm (Y/N) N/A
Pumper JE's PUMPING
YES
C. ABSORPTION FIELD DATA
Date installed 6/11/1997
Length 100' TOTAL Width
Soil rating ~or ft2./bdrm) 0.6
5' Gravel thickness below pipe
*MEASURED IN FIELD
System type 5-WIDE
4' Total depth '11'+/-
Effective absorption area 1,000 SQ.FT. Monitoring Tube present (Y/N) YES Depression overfield (Y/N)
Date of adequacy test 11/2/2000 Results (Pass/Fail) PASSED For
370/344
Fluid depth in absorption field before test (in.); 4"/0" Immediately after 714
Fluid depth 4"/8" (ins) Minutes later: 1245
Peroxide treatment (past 12 months) (Y/N) N/A
72-026 (Rev. 3/96)* Computer Version
Absorption rate =
If yes, give date
NO
Bedrooms
gal. water added (in.): 11 "/15"
600+
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Size in gallons ~
"Pump o~p off" level at*
· ~~' Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
COMMUNITY WELL
~ adjacent lots
Public sewer manhole/cleanout
Liffstation
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: .200'+ TO THE COidMUNflY WELL
Foundation 5'+ Property line 5% Absorption field 5'+
Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots '100%
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property line
Surface water
Curtain drain
F, ENGINEER'S CERTIF,~(
I certify that/h)~:fat~A
of Municipal r~corci~
with MOA HA~ gui~//~
Signature
Engineer's Na?e
Date ,,
*3'
Building foundation 10'+
*SEE LOT LINE WAIVER #WR970058
*'200'+ TO THE COMMUNITY WELL
Water main/service line 10'+
100%
NONE KNOWN
field inspections and review
systems are in confon'nance
on this date.
JEFFREY A. GARNESS
Driveway, parking/vehicle storage area 1 o'+
Wells on adjacent lots *'100%
..
Date of Payment //- / ~- d)~
Receipt Number ~4/~ ~-~ ~
72-026 (Rev. 3/96)* Computer Vemlon
Waiver Fee $
Date of Payment
Receipt Number
Parcel i.D. #
1.
DEPARTMENT OF HEALTH & HUMAN SERVICE..,.q, o,~
Division of Environmental Services ~'-*~.
On-Site Services Section ~ 's~Vlc~o ~'~
P.O. Box 196650 Anchorage, Alaska 99519-6650 ~"~O 1~' 343-4744
A HO,, Y
APPROVAL FOR A SINGLE FAMILY DWELLING
051 04325 TM
GENERAL INFORMATION
Complete legal description
HAA #
Lot 23~ Block 3,
Knik View Estates
Location (site address or directions)
Property owner
Mailing address
Waldec Ente. rprises Inc. Day phone 344-5678
9210 Vanguard Drive Anchorage, AK 99501'7
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: Four 4)
TYPE OF WATER SUPPLY:
Individual well
Community well XX
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
XX
72-025 (Rev. 1/91) Front MOA ~21
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
STATEMENT OF INSPECTION BY ENGINEER
As certified by myseal 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 typeofstructureindicated herein. I furtherverifythat based on the [nformation obtained from
the Mugicipality 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
Address P.O. Box 240773 Anchoraqe, AK 99524
Engineer's signature
563-7155
Date 9/16/97
D~/~S SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
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 courtesy to 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.
72K)25 (Rev. 1/91) Back MOA ¢21
Legal Description:
A. WELL DATA
Municipality of AnChorage
DEPARTMENT OF HEALTH & HUMAN SERVICES [~ [~C E IV [
Environmental Services Division
825 b Street, Room 502° Anchorage, Alaska 99501 · (907) 343~44~ '6 1997 ~
Health Authority Approval Checklist Municil~ality of Anchorage
Dept. Flea[th & Human Services
Lot 23, Block 3, Kn'[k View Estparceli.D.: 05104325
Well type PWS
Leg present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to Casing height (above groUr d)
Wires properly protected (Y/N',
Date of test
Static water level
FROM WELL LOG
g.p.m.
AT INSPECTION
: 218409
Well production
WATER SAMPLE RESULTS:
Coliform
Nitrate
Other bacteria
g.p.m.
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed 6/11/97 Tank size 1 , 250
Collected by:
__ Number of Compadments____
2 cleanouts (Y/N).__
Y
Foundation cleanout (Y/N)
Date of Pumping New
Y Depression (Y/N) N High water alarm (y/N)
Pumper Construction ;
N
C. ABSORPTION FIELD DATA
Date installed 6 / 12 / 97
Soil rating (g.p.d./fF or fF/bdrm) .6
System type
Wide Trench
Length 1 00 ' Width 5 ' Gravel thickness below pipe
Effective absorption area 1 , 000 SF Monitoring Tube present (Y/N) ¥
Date of adequacy test New Const. Results (Pass/Fail) Pass
Fluid depth in absorption field before test (in.); 0 Immediately after
Fluid depth (ins) Minutes later:
4' Total depth 10'
__ Depression over field (Y/N) __
For 4
--. gal. water added (in.):
Absorption rate = > 600 ~ _g.p.d.
N
bedrooms
Peroxide treatment (past 12 months) (Y/N) _
72-026 (Rev. 3/96)*
If yes, give date
LIFT STATION -
Date installed
Manhole/Access (Y/N)
High water alarm level at*
None
on Lot
Size in gallons
"Pump on" level at*
*Datum
Cycles tested
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
- Public
Water
"Pump off" level at*
System
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 12 ' Property line 39 ' Absorption field
Water main/service line 40 ' Surface water/drainage > 200 ' Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 3' **
Surface water > 200 '
Building foundation 30'
Curtain drain None on Lot
13'
>200'
Water main/service line > 50 '
Driveway. parking/vehicle storage area 50 '
Wells on adjacent lots > 200 '
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
ar~
Waiver Fee $ \ \ ~'~(2:(. ')
Date of Payment
Receipt Number
Date 9/1 6/97
Engineer's Name Michael E. Anderson, P.E.
ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal re¢i~dsti~a,(,ttle.,,, 'abovesystems
in conformance with MOA HAA guidelines in effect on this date.
:,
Signature '~q'c(-/]~rz'--L'¢-~ eL