HomeMy WebLinkAboutKNIK VIEW ESTATES BLK 3 LT 27Knik View
Estates
Block 3
Lot 27
#O51-043-'29
Municipality of Anchorage Page ,, 1
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVlSldN
· P.O. Box 196650 · Anch6rage, Alaska 99519-6650 ~ Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: $W980008 PID Number:, 0510;~329
Name:
Spine].]. Homes Wastewater System:
Address:
921 0 Vanguard Drive ABSORPT
Phone: I NO. of Bedrooms: I~eep Trench Cl Shallow Tren~
344-5678
LEGAL DESCRIPTION So, Rating:
~ ~ GPO/Sq. Ft. '
Lot:. Block: Subdivision: Oapm to pipe bottom from odginal grade:
27 3 Knik View Estates 5.~
Township: I Range: I Section: Fill added above original grade:
!
WELL: N/~J~'j~w J='W'~' '"~ ~.v.,..,dt~:
~ Ft
Classification (Private. A,B.C): Total~ .,.C~ed To: Total absorption ama:
-~ ~I ~ TAi
SEPARATION DISTANCES ~.~tio a Holding
To 8el3tlc A.'-.~,~ 6on Mit Holding ~'-'-~?'-~Pnvate Manufacturer:.
Surface
wa~e~ > > 15c~' ~///4" /~/~ ,> I~'~' LIFT S'i'
Lot
Line ~ ~)' JO~' ~/~' ~/~'¢' ill Size in gallons: Manufacturen
Curtain Drain N/,~" ~ j, Pure, ~ake~e:trical ,ns0ect,,
Remarks: BENCH
Location and Description:
K~ralKe
Inspections performed b Dates: 1st 3/9/98
2nd 3/lO/98
3rd 5/23/98
Department of Health and Human Services approval
Reviewed and approved by: _//~.~-,.-3,//-~'. ~,~w~ Date: ~ -~4; -qoo
of,, 3
· ~"e w [] Upgrade
3N FIELD
ch El Bed El Mound El Other
Total Depth from original grade: · t
Gravel dep~ beneath pipe
Gravel length:
Number of lines: I 0[stance I~elwe~n line,,'
Oats installS:
NK'
Ca~aciN In gallon~
Number of Compa~enm:
rATiON
j
High water alarm at:
pedorm~ b~
MARK
slab
~um~
3 (Rev. 9/91) MOA 25
Permit No.
sW980008 ' ' '"":~'":": ' Page 2 3
M~r;ieiiS/~iitY bi'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
. Le. gaI.Descrip, tion: LT 27, BLK 3, KNIK VIEW ESTATES Subd. PiDNo.' 05104329
-%-
/
/=: , : : ' - ......... 7.
~ / l'.ow&r : ' .,'i Z-'200 ': i i : .
i / ', trenc~ : ~ ; . ,
; ' ' : ' ? Z~+*_Be. dr. oom_Es e ...:
' " ~ ? i : : '
· i upper
-
i . ! ! '
, ,. 1 ,:~5( iCli " :
: 's~ptic , ,
C.?
I .. ......... F,C T¥ ----~ ......
.... , ---. --.;-,~v .~c~M .......
.... ~,~,..~,,~_ -../, ..........
..~. ,:, .,N
-JUDD C'~R.
..... i sP: so.,~s= P?, co.~a.m=e= : I PLAN
C Clean Out .~ ~i --
.......l ~ Idon[tor Tube ' , --
AS-BLT
20'
Pem'~it No.
SW980008 "'"'
3
,..... ,,,. , . ,. ra~e
Mun~mpahty of Anchbrage
DEPARTMENT,OF HEALTH AND HUMAN SERVICES -
ENVIRONMENTAL SERVICES DIVISION
of 3
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater. DisPosai System and/or Well Inspection Report
: LT 27~ BLK 3, KNIK VIEW ESTATES Subd.~ 05104329
· ..Legal Description: PID No.:,
SP1 ~e~t~c Pumg, ¢omga~rt.ment 1
SP2 " 2
C Clean Ou~
MT Monitor Tube
Four Bdr~.
Home
'0
· SITE LAN
Y '~'~,.~ .- SCALE 1" = 30'
MEMORANDUM
DATE:
TO:
FROM:
SUBJECT:
June 26, 1998
Donna/Jeff
Mike Anderson, P.E.
Lot 27, Block 3, Knik View Estates
Permit No. SW980008
RECEIVED
JUN 26 1998
Municipality of Anchorage
Dept. Health & Human Services
Attached is a soils log completed on soils encountered at the north end of the west trench
recently constructed on Lot 27, Block 3, Knik View Estates Subdivision. I verified with
the inspector on the project and also the contractor that all soils encountered in the
absorption trenches was consistent throughout.
I have also attached a new Health Authority Checklist. The typographical error has been
corrected and all information now agrees with the as-built documentation. We are hopeful
the Certificate of Health Authority can now be issued.
Municipality of Al~cJ~rage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage, Alaska 99502-0650
J SOILS LOG -- PERCOLATION TEST
"ERFORMED FOR: 6P,~J ~'C:L. /-~=~
LEGAt. DESCRIPTION= ~'/' Z'7, J~'t,,OC~Z. ,~
(ENGINEF_R'S SEALi~' ' " I
DATE PF.,RFORMED:,
Township, Rang~ Section:
2
4
8 ·
11
12
13
14
16
17
18
19
COaMaWS ~"~ C~
WAS GROUND WATER
ENCOUNTERED?
$
L
IF YES. AT WHAT O
DEPTH? p
E
SITE PLAN
Reading
Time .Time
I
PERCOLATION RATE __ Immures/mc1~) PERC HOLE DIAMETER 'i * "
TF~T RUN B~IWF~ , ~ AND ,
72-008 (Rev. 4/85)
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:SW980008
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NAME:W~ENTERP~ISES INe'~- '
PAGE 1 OF 1
DATE ISSUED: 1/15/98
EXPIRATION DATE: 1/15 _ O_e
OWNER ADDRESS:SPINELL HOMES
9210 VANGUARD DRIVE, ANCHORAGE, AK 99507
PARCEL ID:05104329
LEGAL DESCRIPTION:
KNIK VIEW ESTATES BLK 3 LT =~li~]~, LOT 27
LOT SIZE: 25570 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT:
THIS PERMIT 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:
(PERFORM.SOILS ~LOG ~AT NORTH.END~ OF THE iWEST TRENCH WALL TO'
~RI~?S'O~L~s~!'C~NSiSTENCY 'WITH ~TESTHOLES ~1. AN~D
DATE:
DATE:
December 30, 1997
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject:
Lot 27, Block 3, 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
27, 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 four bedroom home 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 performed on the property revealed silty gravels which
percolated between 30 and 60 minutes per inch. No groundwater was
found in the testholes nor was any noted during the monitoring period. We
have therefore designed a deep trench system with 6' of gravel beneath
the distribution piping. Total depth of the system will be 9.5'. The
trenches will straddle a steep slope and be constructed at different
elevations. A flow splitter will be installed to evenly distribute the
septic effluent.
The ground surface of the lot is gently sloping with a major drop near the
west end of the lot. This slope will be flattened during construction of
the new absorption trenches. The remaining surface of the lot slopes at a
2 to 3% grade from east to west and breaks in the middle and slopes west
to east at nearly the same grade. No conflicts were noted between the new
septic system and water services in the area.
· Lot 27, Block 3, Knik View Est. Subdivision
December 30, 1997
Page Two
If the system is constructed as designed the following statements apply:
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.
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.
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.
The system, if constructed as designed, will have no adverse impact
on drainage patterns in the area. The current drainage pattern will
be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
wEST 270.00 86-11,3
20g.cJ6
3' Secl~elt Line CIm!
l
RANKIN . ,,ts,
lO' rlec& Telecem I:$mt
~o.
2
I
WES'
I
J
/
/
THIS PROJ[
JUDD Circle
LAST 180.00
~j
175.00 ·
W£ST
86-113
AREA PLAN
SCALE 1" = 100' '
· SBg'SB'OO"W
?4Q.QQ (;LQ (t~)
330.06
seg.sB'o7"r 2,...Z78.e._e
[lee · Te~ec~
26'
299.24
25
I
I
115.00
I
I
E?.\
· ii \
0
-/
Four Bdrn~.
Home
(~TH No. 1
TH No
./,
~ON
4381-E
SITE PLAN
SCALE 1" = 30'
Four Bedroom
Home
1,250 Gallon
Septic Tank
ZabeI Flow
Splitter
112' X 3' x 6' Effective Depth
Absorption Trench (2-56' Laterals)
SYSTEM PLAN
NO SCALE
Original Ground
Flatten Slope to.25% .~ I,! ~ Tank
LJ
SLOPEi CROSS SECTION
NO SCALE
LOT 27,
BLOCK 3, KNIK VIEW
SUBDIVISION
ESTATES
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Four Bedroom Home
Perc. Rate: 45 Min.llnch
Application Rate: .45 GPDISF
Deep Trench System
1,250 Gallon Septic Tank
6' Gravel Beneath Dist. Pipe
4 Bedrooms 'X 150 GPD -- 600 Gallons Per Day
600 GPD/.45 GPD/SF /12 SFILF = 112 LF Total Length of Trench
Therefore: Construct a Deep Trench 'System with Two Laterals Each 5 6'
in Length. Distribution Piping to be Placed at 3.5' Below Original Ground
Level.
NOTE:
/.LO" '~
$£0°
I .. '!
TYPICAL 'DEEp TRENCH SECTION
(NO SCALE)
Grade Area to' Drain Away.
PERFORMED FOR:
LEGAL DEECRIPT1ON:
Muni,~pa~ty of An=borage
DEPARTMENT OF HEAL.TH & HUMAN SERVICES
825 'L" Street. Anchorage. Alaska 99502.-0650
SOILS LOG -- PERCOLATION TEST
· 'Spinell' Homes
1
2
3
4
7
8
10
11
12
13
15
.16
17.
18
19
20-
COMMENTS q'~,;f~hnl ~.' Presoaked
y/~',V' ~. s,.OPE.
WAS GROUND WATER
ENCOUNTERED?
Jl
IF YES. ATWHAT
OEPT,? . / o
PLAN
R~dlng Date Gn~ Net Demh to Net
TlrM Time W~
PERCOLATION RATE '~ (mmme~mch) PERC HOLE DIAMETER . ~ II
Pribr to Test. "
ACCORDANCE WITH AU. STATE AND MUNICIPAL GUIDELINE~ IN EFFECT O1{I THIS DATE. DA'rF~ ' /' ~'/"~ P/'~ "i~
PERFORMED IN
PERFORMED FOR:
lEGAL DESCRIPTION:
7
8
9
10
11
12
13
17
18
19
20
COMMENTS
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L' Street. Anchorage, Alaska 99502-0650
SOILS LOG ,-- PERCOLATION TEST
Spinell .Homes
Testhole Presoaked
~,,/~..w~ __c.~7~' SLO,E . s,'rE
ENCOUNTER.ED? ,
/
IF YES. ATWHAT /
~ to mw ~, . i~.l.,~t
Gra~ Net ~ t~ Net
RmdJng ~ 'rum 1';me
I j~/-.~::,'/9.../ ii;+1
, , 19,: ii s,~ ~.1,9 ,~%
PERCOLATION RATE '~
TEST RUN BETWEEN ~'
Prior'6o Te~t.
(muY~_~,~mch) PERC HOLE DIAMETER ,
F"r ^,D ,,,,~, ~r
ACCORDANCE WITH ALL STATE AND MUNICIPAI~ GUIDEUNF~ IN EFFE~'T O1~1 THIS DATE.
PERFORMED FOR:
LEGAl. DESCRIPTION:
2
3
7
8
9
10,
11
12
13
14
15
:16
17,
18
'19
2O
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street, Anchorage, Alaska 99502~:)650
SOILS LOG -- PERCOLATION 'rEST..
spinell Homes
WAS GROUND WATER
ENCOUNTERED?
Township, Range. Section
~n-~ PLAN
S
IF YE;. AT WHAT /
L
DEITTH? ,
ih, ' /_ ' I. .z / Z..]
Grim Net ~[h to Net
Time Time Water Dmp
PERCOLATION RATE "~-~:~ (Imnute~mch) PERC HOLE DIAMETER
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION :AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 27, BLOCK 3, 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 112' total length by 3' wide by 6'
effective depth absorption trench. Two 56' laterals must be
constructed at different elevations. Slope flattening is
· required over the new laterals. A flow divider must be
placed between the two laterals to provide even flow.
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
^ new 1,250 gallon septic tank must be procured from an
approved source and installed at the location shown on the
plans.
Lot 27, Block 3, Knik View Est.
December 30, 1997
Page Two
2. ^ 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
settling or shifting of the tank.
bedded to prevent
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. ^ 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 27, Block 3, Knik View Est.
December 30, 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), ^STM D3034 or P.V.C.
(perforated and solid), ASTM F810 or H.D.P.E. (perforated,
but not solid) and ^STM D2662 or ^.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 27, Block 3, Knik View Est.
December 30, 1997
Page Four
5. ^ permeable geotextile fabric (Typar, Mirafi or equal)must
be installed between the final drain rock layer and the
native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than
3% passing the #200 sieve.
INSPECTIONS:
A minimum of two inspections are required by Municipal
Ordinance. These inspections must be conducted under the
supervision of a professional engineer registered in the State
of Alaska. The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation
of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement
of the geotextile fabric, gravel, distribution piping,
standpipes, cleanouts and insulation. No backfill should be in
place at the time of inspection.
Contractor shall provide a copy of all field survey layout and
construction notes for use in preparing the certified as-built
of the completed system.
Municipality of Anchorage
Development ServiCes!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
Parcel I.D.
0S1-043-29
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
" 'Expiration Date: ,~r-'_
· 1. GENERAL INFORMATION
Compl.ete legal description Knik View Estates= Block 3: Lot 27
LocatiOn (site address or directions) 21925 Judd Cir.: Chugiak: AK 99567
Current Property owner(s) Matt Dorschel Day phone;6BB-2155
Mailing address
Lending agency
Day phone
Mailing address
Real Estate Agent
Les 'Bailey- Prudential Vista Day phone 689-64'64
Mailing Address
16635 Centerfield Drive: Eagle River= AK 99577
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
4
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual Water Storage
Communi.ty Class
Public Water System
[] Individual On-site [~
[] Individual Holding tank []
[] Community On-site [--]
[] Public Sewer ~
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 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 certified by my seal affixed hereto and as of the validation· date shown below, I verify that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines' for this
application, shows that the on-site water sUpply and/or wastewater disposal system is(are) safe, functional
and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all
applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm KND ENGINEERING~"Inc."
Phone (907) 696-6111
Address 20441 Ptarmigan Blvd.= Eagle River; AK 99~;77
Engineer's Printed Name -Kenneth M. Duffus Date 04/30/04
Engineer,~i;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
' Disapproved.
bedrooms.
By:
Conditional approval for
bedrooms, with the following stipulations:
._-
WATER AND
PROG /. :
,. ,,
.Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
.x
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Municipality Chorage .of An
'" Development Services Department'
· i. . ' BUilding'Safety Division
: . ~'.On:Site water & Wastewater Prog~am
........ 4700 South Bragaw St.
-:.i P~Oi'BoXq96650 Anchorage, AK:99519-6650 ..
- · . www. ci.anchorage.ak.us. :
...~ .-: . (907) 343-7904
',i hEALTH'AUTHORITY APPROVAL CHECKLISTii:
Legal Description: KNiK :vIEW.ESTATES BLOCK 3. LOTZ7 !i.. i.p:atr~ei!lD: 0512043_Z9
· . ': Well type 'Public ;~' If AiB;orCproyidePWSlD# ~ :~ , ; ,; ·Well Log(Y/N) '
, c,,,,,,~teu '. ::' ~an',ta~ (YIN) :'~ :. ~ ', Wires'properly protected (WN)
il Total depth, : ft.-.'.." ,~. ~Cased t~ ':',. · -it. ' ; : '~: .Casing height (~bove grOund)_
.. : FROM~WELL LOG : :,: AT.INSPECTION
Da~ of test .. ~
I{ ' , .,, '
Static Water level
Well?reduction =, i;: ',:,.ri.m: .'.;: .i~ ~ ' ' '!i "' g.p.m. '
WATER
RESULTS:
SAMPLE :' . ! : ~ ~' '~"
I· ]! ~ ' , ' ~,
Coliform' ~{t : ;;"![[ ~ .:·[:i:, .;:i ;00 ?. ;" ..... ' ...... mg
~r colOnies/1 mi. ?. N~trate .... t,~ : ./I. J: '~! bacteria t" colonies/100 mi.
,;. ,.. . ~ ;
ArseoiC:' ',.~ ' 'mg./I.:-,:~, :',.' ~~ : uate'otsample:: ', ,, .:~'=. ~ : Collectediby: ~ ,: ._
~. SEPTIC/HOLDING TANK DATA ;:: ,,' ~' :
~(Anch.',Tank~ ~' ~ ~ , ,-Date install [3/9/98
;,._ Tank Type/Material ~'~S'e~tiC/Steel~ '
:,.r Tank raze '~~..:gal. : ,: ~ , Numberer Compadments~ Cleanouts (Y/N)~,; · :
'~ . Foun(lation :cleanou~ (Y/N)~epression [Over tank (Y/N) N High water :alarm ,(Y/N)
. ,. Date of pumping.'4/27/04 , ~.' ,': pumper . J R, s
C. ABSORPTION FIELD DATA .': ', ,,.: .,,, ,:1:,: .:' :: : ,,, ';.~ ,.-.':., - .' ' ~ ~ ,, ,
: Date ~nstal ed~Sod rat ng (g.p.d./ft or fl/bdrm) O.AS, System,type DEEP TRENCH
~ ,.-Lenglh: 117 ~~' '; '~':. fl.,W,dth ~~~']';;_fl.. Gravel below p~pe 6 ·
' ' "' ' t , ,~ . ' ~:. ,:; , '," :, ,',.. ,, 2 ,.., .
; ~,.Total depth ~9 fl..Eft, absorpt on area ,t404:ft Momtor ng.tube ~ Depression oveqfie d N: ' .
:- ,: Date of adequacy test,.4/27/04 . ,., ~ ,, .'Results (Pass/Fad) ~ For ~ bedrooms
"' , . .. ~ , ~, , ~ , . ' I :
~,' :' Flu d depths, n absorpt on field before te~~n.=Water added 6o0 ~gal.' New depth ~4(1~ in.
ir ,~ ' '~ ' ,"~ ':r''h '" ' "" " ~ ' ' ' ' '
~: Elapsed T~me:~'m~n;~'; ,I~nal flu d~depth,~O.75(1)~n., ~ Absorption ~te >= 600 ' g.p.d.
~ Any rejuvenaton treatment (past 2 mo.) (Y/~ & type) · N;. ~., , ~ ': ,~ yes, g ye date .
D. ~.iFT STATION
L~ate'installed NA Size in gallons Manhole/Access (Y/N) ' ~ ::' i- ·
"Pump level at in. ~"Pump off" level at in. High water alarm level at '~ ~ !
Datum. Cycles tested Meets alarm & circuit requir&mer~tS?:.
E, SEPARATION DISTANCES ! ' : .
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic"t~nldlift station on lot On adjacent lots -
Abs'orption field on lot On adjacent lots :-
PUblic sewer main Public Sewer m~nhole/cleanout
SeWer/sup' se'rvice line ' Holding tank'
"SEPAI~TION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building~.f°undation 5'+ Property line 5' + 'AbsorPtion field
: Water main 1 0'+ ~ Water service line I O' + Surface water 100'
~ Wells o~ adjacent lots ! Z00'+
sEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
' Property line 10'+ : Building foundation 1 0'+
~ Water Service line 10'+. . Surface water '1 00' + Driveway, parking/vehiclerstorager, !1 0
. cUrtain al'rain ,50 + ~ Wells on adjacent lots 200 + '
.AIl:600 oal added ,to uDDer trench (MT1 ~. UDoer trench i~ operatino in the-.upper:2
.i., trench was w/~n $" of lateral w/indication of previous water/sludge at COs.
G ENGINEER'S CERTIFICATION
~'' 'l !1 cerfify that I have determined through field inspections and
[~';~, review of Municipal records that the above systems are/n
'~ "confom~nce with MOA HAA guidelines in effect on this date
:: Engineers Printed:Name Kenneth M,
;/ Date 0A'/30/04
i i~;HAA!Fee $430.00 ' Waiver Fee $
Date'of Payment i~/ __ Date of Payment ~ ,,
..... ~ ·., ,t,,.' ~'f- Receipt Number ~ , i.
.
N 00'06'10'%~I' 02.00'
~dO~ :£ '! OOE 'O~.'NnP
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
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-043.29
GEN ~'~,L'iNFORMATION
ComPlete legal d.escription fKNIK VIEW EST. BLOCK 3, LOT 27,
Location'(site adciress or directions) 21925 JUDD CIRCLE, CHUGIAK, AK.
Currerit ProPerty q~. her(s)
Mailing address':'
Lending agency .
JULIE RILEY
P.O. BOX 770618 EAGLE RIvER, AK. 99577
Mailing address
Expiration Date: 7- / ~ .- O ~
Day phone'.229.0829
Dayphone ~'
e
Real Estate Agent
Mailing Address
Unless othei'wise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 4
DayPhone
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 []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon:the representations given in paragraph 5 by an independent professional
civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the
transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal
and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health
Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well
and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a
period of up to one year with valid water samples.) Cedificates are valid for one year for properties served by
Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or
omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify.that my
:'investigation, based on procedures-outlined in the 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.
Phone 696-611
Name of Firth KND Engine'~;in,q
Address 20441 Ptarmigan Blvd, Eaple Riveh AK. 00577
Engineer's Pdnted Name '~z3 ~"fJq. W~. "~Du..--~--~.
DSD SIGNATURE
~"' Approved for ' ~/../L '
Disapproved.
Conditional approval for
bedrooms, with the following stipulatiofi~~~
Additional Comments
Attachments:
' HAA Checklist '
' 'Septic System Advisory
Well Flow 'Advisory
X
Maintenance Agreements ~
Supplemental Engineer'S'Report.
Other
(Rev. l~JC0)
Original Certificate Date:
We{i i~pi.e ~iUBLIC
Date completed
Tot,~l depth · ~'
Da~61of te~ ii: '
Static water level
W6ii Producdon
MuniciPality of AnchOrage
DeveloPment Services Department ::
: .; Building Safety Division ' L ~
' On-Site Water & Wastewater. Program
i'4700 South Bragaw St -~ i:~
PiO. Box 196650 Anchorage, AK 99519-6650, : }
: 'www"ci'anch°rage'ak'us "
i :, (907) 343-7904
:
HEALTH AUTHORI'I'YAPPROVAE CHECKLIST
Knik View ESt. Block 3, Lot 27 '.
~lf A. Bi o~r C provide PWSID #
Sanitary seal (Y/N) '
ft. cased to. ft.
Parcel ID:. 051.043-29
,Well L~3g (Y/'N)
Wi~es prooerly protected (WN)
Casing h'~igh!i(ab0ve ground)
FROM WELL LOG
.,'.
g.p.m.
WATER SAMPLE RESULTS: ~i
ColifOi. m il, :". coloniesll00 mi. Nitrate mg./l.
Date?of s~'mple: i Coilected b~::-
SEPTIC/HOLDING TANK DATA ~ -.
AT INSPECTION
Othe, b e
Tan~Type/Matenal STEEL ' · !~ ~ ,' ', ,.
Date installed.319/98 Tank size i' 1250! :gal. · . Number of Compartments L
.'11I.~, !i~ ' . · ' ....
Cl~ii'o~ut~'' Y. ~Foundation Cleanout ~': D~pression over tank::N:High waterala~ NIA ....
,Date of pumping 7/6101 :~ ;" ' '~ PU~per.J,R,'S .~: ' ,,, '
C.':A~SORP~ION FIELD ~ATA ;- '~: .~ ~.: .... ~ :
D i~ t i~ea~i~0/~S~ So.,ati., ~(g.p.d./..or.~d~)'0.4~ Syst~'typ.- .EEPT"ENc.
.Length ~7 " ~,Widlh 4 . .i. i ~. . · , .
~' ~ ...... -~ff, I i ,Gravelbelo~p~pe ~ . ff, ] ~;
Tot~ :depth 9 '~' ~. Eft. absorption :~ea ~4°4 ' ~' Monitoring tube Y Depression over
Da[e bf a~eq~acy test 71610~ ~Results (Pass/Fail)- PASS · For4 bedrooms
Fluid d~pth in abso~tion field befor~ res{ 6156~5 in;~ Water added 600 gal.'. ~ . New depth7.5/64 in.
Elapsed T, me: ~0m,n. ' Final flui~ depth 6i56.5 in., . ~ Absorption rote >= 600 g.p.d,
Any rejuvenabon treatment (past 12 mo.)~.'(y/N & type) ~N If yes, give date
'ii
:colonies/100ml'
LIFT STATION
Date installed
"PumP on" level at~ in.
Datum
SEPARATION DISTANCES
SEPARATION DISTANCEs FR(~M WELL ON LOT TO:
Size in gallons . : ·
"pump off' level at~
Cycles tested
'~ ' Manhole/Access (Y/N)
in. High Water alarm level at
Meets alarm & circuit requirements?
in.
Septic tankJlift station on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT~TO:
Building foundation 5'+ ' . Property line. 5'+
,Water main 10'+ Water service line
Wells On adjacent lots ,, 200'+
Absorption field 5'+
Surface Water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+
t00'+
Water main '10'+
= Water Service line
Curtain drain 50'+
F. COMMENTS
lO'+r ,
Surface water 100'+ .
Wells on adjacent lots :200'+
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 Pri~ed Name Kenneth M. Duffus
'
Date
Driveway, parking/vehicle storage. 25'+
HAA Fee $ "~E)O
Date of Payment
Receipt Number
(Rev. 1~00) '-': .... ' '.
Waiver Fee $
Date of 'Payment
Receipt Number '
Parcel I.D. # 051 04329
1..:'~.'GENERAL INFORMATION
Complete legal description
MUNICIPALITY OF ANCHORAGE
DEPARTMENT.OF HEALTH & HUMAN SERVICES
' ~Division'Of EnvirOnm&ntalservices . !
On-Site Services Section ' ' '
P.O. Box 196650 AnchOrage, Alaska 99519-6~5i~
;54;54144----"--- -' '
[ :' . ,
, CERTIFICATE OF:HEALTH AUTHORITY ~
APPROVAL FoR A SINGLE FAMILY.DWELUN~i
-
HAA #
Lot 27,. Block' 3, Knik'.Vi~
Location (site address or directions)
· -Property owner Sp:i. nell-Homes
Mailin~ address : · '9210 Vanguard Dr±ye
Lending a~encY,
..Mailing ad, dress
Agent
Address
'DaY
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: Four {4)
TYPE OF WATER SUPPLY:
..... Individual well
Community well
Public water
NOTE:
4: '-:.TYPE OF WASTEWATER DIsPosAL:
NOTE:
If community well system, provide written confirmation frO'm
ing to the legality and Status of system. ' '[
Individual on-site
Holding tank
Community 'on-site
Public sewer
If, community wastewater system, Pro'vide written confirm~
attesting to the legality and stat~s of s~stem. .." i
72-025 (Rev. I/91) Front MOA#21
'tate ADEC
?:~.~.;',;i"i:"i,~/"'-:,~5:'{~:. STATEMENT:~*OF~;INSPECTION BY,ENGINEER:,,=~:, · - .
i:'/?:?':?~' ? '":{:'{!::' i!:i'?~,'~'~'$~tifie~l"6~}n~';~eai'~ffi~ed'here't~',~hd ~s'°f*ihe Validation date shown b~low, I verify that my
~ r*,;~..:'.' ': *':,~.''. .*.':'~ ,; '.~ '. ,. ' :~.~;; ,.~ .;..-~ ." ';.' : -',-':~,: ~f*-:,,',~'%'. '~ ~ "' , ' ,' ,'" ~' . ...... · ' '"
~}~,07 ~:. ~'~ ~, 'X'. ;.' ~.:. ~inveStigation of,th~s H~alth Authon~ '~pprov~l applma!~0n shows ~hat the 0n,s~te wat~[ supply ...
[ '-',,':~ ,[,''::. "?"~ 'i",'~ ~ ,~ ',?.~'* '[*',*'. "~ 2'5 ~*'~J-J4:~, ~' .; ~ ~. ':' ~"'' ' ' '~'".;' ~' ' : .... * ' ..... '
~''-';. ?,': ?:-..: :,',-~. :: and/orwastewater d~sposal system ~s safe, funcbonal and adequate for the number of bedrooms
~';~::.:~¢.~::;~ ~:~'~; ;.:..}.: ~;}~: .}~'~'.d'{y~e*0'f ~h~{'~ i'n~iCated herein; i. fu ~er;veri~ t~at based °'n the informatiOn obtained from
~':~:'{"::"~:~ ~' :. ::.: } ~-:~.';:'~'~tfi~"~nic~iit~:~,0~ AnChorage files an0 from my invostiga~io.n' and inspection, the on-site water.
?,"~,~", ':.::::~ ~...'.~' ).:'..::: ::~:~,p~i~.and);'~asie~i~r.dispo~al system"is in'c~mpliance wi~h all Municipal and State codes, .
~ ,. ',. :.'.:' '~,-..:~ .~ .* ~ .~. ?"ordinances; ~'d regulations in effect on the date of th~s inspeqbon: ' ~ *; .
{." c. '.; , . * :,;,, ;: :;';.'..' .... ~,:- "': ' - ' ' , . .. ' ..
'":' :" '*' ' ~; '~ k~f~i~ ~J': ~n~e~son'~n ~nee~ng ........ Phone ,522-~73 ~ '. '~ ,
; ,:.' "~." ",'* , ..'., r.'. ', ;' , ~ ~ *;' .'~' '" ' . ' ' · . ' ' · *'."
?":':;";'-~: "' %;:,' ~--';:~Add~ess :,;~,~P;o.,, ~ox 240??3 ~ncho~a~e~ ~ 9952~ ~, ' ......
' ~ ' , Date 5/24/98..
,, . , ~, ,.. ~ .~ ~ ,,- . , ~ .... ., .
' ?c',: ~:: ;..'..~.. :,.:- ..... :'~ ?;~:"'""~ '~:';'~'I ~:,'~t''~!~ ',:' ' ...... : ·
;: ,':"' . ,,~ ,~ .... :¥: - .......... ~'."..~.".:~,1},
:. '~'.'," - * ' ,'.'t' I ~,I~. '~ '~*' . ,*!'~ ,, .'.,t, *'~' ' ' ' '. · ' . ' ~ . ~ * i'. t'~ ·
:5:~ ·: '~ ,:, ?'6; '*~ SIGNATURE ' · ~'~'~'-,,~>_ ,--v- ''~'~
:..:, :':..: ;}'.:~".'~ :Approved:for'..'r ~/~' bedrooms. , ~;~(~2~:c:~ '.
· 't',,.;::?;:; ~;' · '~ Di~pp'r0~ed. ' ' · .' ' " ' '. ' . ·
..'O'~n~t~nal approval ~or bedrooms, w~th the ~ollow~ng sbpulabons.
; }'~ ~n~oi~li~'of?~ohora~* D~pa~mant o[ Health and Human 8e~ices {DHH8) ~ues Health ~uthor,~
[: ~':Abor~ai 6e~ifi~at~S';~ased 0nly UpOn the ~e~resentations given 'in' paragraph 5 above by an independent
?~i~'n~l'~n&~n~aistered in the state of Alaska. The DHHS does this as a cou~esy to purch~em of homes.
; ~:a~h~ii~leh~ina institutions in order to ~tis~ ce~a~n federal and state requirements. Employees of DHHS do not.
:~conduct ~nspecbons or:anal~e data before a ce~hcate ~s ~ssued. The Mumc~pah~ of Anchorage ~s not. -
~.;'. 'responsible for errom or oml~ons in the profe~onal eng~neeffs wo~.
'~:i Municip~ali;~y of An~=h0rage
:~, ! DEPARTMENT OF HEALTH & HUMAN SERVICES
.~ [' . ~ .... ~.. · . ' . . . ~ !:
...., , · . Environmental Serwces D~v~mon ~'
i~25 :L ~treet, Room 592 · Ahchbrage, Alaska 99501 · (907)
' , . '~ [ , Health Authority Approval Checklist ,
'=' 'Le-~i Description:; ' o~ 27~ ~oc~ ~,3',,~n~ :~e~ , Parcell D. ~05104329
, :A. WELL DATA ,i, : , · , ~ ~,, . : . ,: .' : -
~,~ :Well~pe A: - ~ IfA,,B,'0rC,,attachADECle~er,:'ADECwatersysl ~mnumber 21
. I_og present
Total depth
Sanitary seal (Y/~I)'i '~
,Date'of test ~,-
Well Iproducbon
, WATER SAMPEE F
:Coliform
:'"" tec mplet ' '
.... Da o ed :
F bM WELL'.LOG
i;
r
Nitrate
' :Casing heigh
Wires p~0perly p
AT INSPECTION
(above ground)!:
~tected (Y/N)
thler bacte~-ia~
iTube present (Y/N) ' i,Depresmon over f,eld ~/,N) 'N
(PaSs/FaiJ) pass !~ !?' ' ~,For . - 4:; I', :.t. bedr
· '::l ' [' , ~, i,J :'.i, ,,::'!'.:"~: t I.: .' :'k,:'. '.
)n re.. (in.);.i~lRi,m,.ediate~¥a~er~,: .*ga~.'wamraaaea tin!;: ', :
~s) M~nutes la ; ~r :. :_. _,' i !:-~ !I I,. ~]:Absorption rate = · g.p.o,
s. Il! ,~,!~ ,l~ l~j,lfyes, g~ve,date
~ystem {YPeDeepl 1 T?er~c:~:
D~.te of adequa res
Resull
· Fluid depth in orpti
Fluid depth
Peroxide treatment (pa
'72-,026 (Rev. 3/9~6)*
Date of sample: l .::; i']:-,. ',:,I ~ 'C611ected~y!i' : .:li.,il:'
SERTIC/HOLDINGTANKDATAi : ~':*i :, . :'~.i,,,.., :i:".:,...!.:i ':,.. . ',: , : '
. l. .t I1
Date installed 3/.9 98 : .... ~ank raze .. ).
F0u ation cie = rD (YIN) ',:"' N: - High,w~ ter alarm ~/N) I
Date of Pumpings'.: NeW :'~ s:':-}~ Pdmper ' ' '
~' .; ~ .i'.l:. ~ '; "
C. AB ORPTION
il~ :' orfF&drm) ~45 '
· ,' Dat~ installed ,
"'"
;g Gravel thickness b~lo~ pipe ' Total de th
Len th 1177,:.
~L. t ~ '" " t
brin
Effective absorptmn'area ~1~ 404 'SF, ~ ni
LIFT,STATION - None on Lot
Date installed ~'
Manhole/Accel;§~ [Y/N)
,High water a!arm level at*
CyCles tested
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
l'! t,c/hol~,n' tank on lot'
sep ' ' 'g ' '
p' ' ' on Iot~
'pUblic'sewer m~in i~ ::
s' ,' it ,
ewer/septicservice' line
Size in gallons
"Pump on" level at*
- No Wel~ on Lot
*Datum
On adjacent lots
On adjacent lots
Public sewer'manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
t-oundation >'5 ! Property line > 5 '
i ~Water main/serVice line > 1 0 ' Surface water/drainage > 1 0 0 '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
"Pump off" level at*
Absorption field > 5 '
Wells on adjacent lots > 2 0 0 '
Building foundation > 1 0 '
Water main/service line > 1 0 '
Driveway, parking/vehicle storage area.
Wells on adjacent lots > 2 0 0 '
Ineers Na
i.
that I have de 'mined thru field inspections and review of Municipal ~itb MOA H~ guidelines in effect on this date.
Date of
~ce~p
72-026
Paym, ent
NUmber !~c~
:'Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number