HomeMy WebLinkAboutKNIK VIEW ESTATES BLK 5 LT 7Knik View
Estates
Block 5
Lot 7
#051-043-47
Municipality of Anchorage Page
Department of Health and Human Services
Division of Environmental Se~ices
On-Site Services Section 825 'L' Street Room 502
P.O. Box 196650 A~chorage. AK 99519-6650
www.ct.anchorage.ak.us (907) 343-4744
ON-~IIE WASlE~AIER DISPOSAL SYS'i'~M AND/OR WELL INSPEClION REPORI
Permit Number: SW010254 PID Number: 051-043-47
MM&M Construction WastewaterSystem: New
P.O. Box 670495 Chugiakt AK 99567 ABSORPTION FIELD
~'": ~ "~ ~: 5' Wide Shallow Trench
688-1236 Three (3) ..
LEGAL DESCRIPTION 1.2 c~e 6
5 7 Knik View Estates 2 F,. 4 F,.
2 Ft. 48 R.
Well: Community Water 5 ~.. 1 N/A
Class A ~,. .. 480 ~e ASTM D3034 PVC
~L MM&M Construction 8/17-18/01
~..: ~.~ i~.~s..~F,, ic.~, ,~..c.~..:,, TANK
SEPARATION DISTANCES ~ septic I-I Holding n S.T.E.P. I-I Other..
Tank Field Station Tank SewerU~e Anchorage Tank 1,000
w,, >200' >200' .N/A N/A >25' Steel Two (2)
t,,u..~"'w"~" >100'>5, >100'>10, N/AN/A N/AN/A ~ ~.o: - LIFTc~.STATION,~,~.~,.,: - NONE ON LOT
Fo.O.. >5' >10' N/A N/A ~"0"'~'~'~ ~""~'~
c~.~..~None Noted / \ ~",~'~"°~
"'"~: BENCH MARK
Back Deck - Southwest Corner.
100.0
· EpgineeFa ,Stamp
~, C,).' 2 '.-¢' ~
;., ..' 4 9 _'r.u
Inspections performed by: Mike A.derso. Dates: 1" 8/17/01
' ,. _ 9~ 8/18/01 ....~
Department of Health and Human Services' approva---~ ~'~.~'... CE-43Sl ..'~,-~'~,~'"~
Reviewed and approved by: ~;~J~_____~ate: ] o - I~" o J ~"
Municipality of Anchorage
DEVELOPMENT SERVICES DEPARTMENT
4700 s°uth Bragaw Street Anchorage, AK 99519-6650. ~43.7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number SW010254 PID No. 051-043.47
Page 2 of 3.:
KNIK VISTA
3' Section Line Easement
Three..
~edroom
Home
Sl
S'2 ' ' ~)T~{2 -
C4'
C3 M1
Alternate Site
A B
S1 14.6 50.7
S2 20.4 53.3
M1 46.3 21.8
C3 21.1 48.6
C4 49.0 22.O
S02°15'00-W
102
PLAN AS-BUILT
SCALE 1" = 30'
· Municipality of Anchorage'- Page 3 of 3
DEVELOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK 99519-6650 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number SW010254 PID No. 051-043-47
97_7
'16'
.~f ie ~l~ck
81.0±
,.97.2
4~'
(Trench Length 48')
~ ~..' . ~ '.~/ ~} '
PROFILE AS
-BUILT
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Jul 23, 2001
Expiration Date: Jul 23, 2002
Permit Number: SW010254
Legal Description: KNIK VIEW ESTATES BLK 5 LT 7
Design Engineer: 0014 Anderson Engineering
Owner Name: WALDEC ENTERPRISES, INC.
Owner Address: NHN KNIK VISTA DRIVE
CHUGACH , AK 99577-
Parcel ID: 051-043-47
Site Address:
Lot Size: 22168 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[~ Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well
[] Water Storage
All construction must be in accordance with:
1, The attached approved design.
2. Ail 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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
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
ON-SITE SEWERANELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-043-47
Permit Number SW OI
Properly owner(s) Waldec Enterprises~ Inc.
Mailing address (1) 6208 Staedem Ddve Anchora,qe, AK 99504
Mailingaddress(2)j~/-/~ kNll~ VIST'R ~,~ ; ~'H~ ~t~fH ZipCode
Legal description (Lot, Block & Sub'd.) Lot 7~ Block 5~ Knik View Subdivision
Legal description (Section, Township & Range)
Lot Size 22,t68 Acres/Sq. Ft. Number of Bedrooms Three {3)
Day phone 333-6025
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Well Only [~
Water Storage
Jacuzzi D~
Water Softening Unit
I certify that the above information is correct. I further cedify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 <FAX)
July 3, 2001
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject:
Lot 7, Block 5, Knik View Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 7, Block 5, Knik View Subdivision intends to construct a three-
bedroom home on the lot. We are therefore applying for a permit to construct a new
septic system on the lot to serve the new home. The attached Site Plan and backup
documentation identify the location and configuration of the new septic system and the
parameters used in the design, Also identified on the plans are the location of the
proposed water service line along with the test holes and the alternate absorption site.
Existing drainage patterns are shown and will not be altered by the development of the
lot.
Two test holes were placed near the location of the new absorption trench. These
holes indicate wekk ti poorly graded gravell with sand only small amounts of silt.
Percolation tests in the material revealed rates approximating 1 minute per inch, We
are therefore proposing to place a 5' wide absorption trench with 4' of gravel beneath
the distribution pipe. The total depth of the trench will be approximately 7'. The length
of the new trench will be 38'.
The ground surface on the lot slopes as shown on the attached Site Plan with grades
from south to north that flatten in the area of the proposed absorption trench. The new
absorption trench will be constructed on a fairly fiat surface as much as possible in
conformance with Municipal requirements,
If the system is constructed in accordance with our design 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 currently
served by a public water system,
2. 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,7, Block 5, Knik View
July 3, 2001
Page Two
The system, if constructed as designed, will have no adverse impact on reserve
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.
Sincerely,
Michael E. Anderson, P.E.
Attachments
J
2
VACANT
I0
Under
Constructt,
Unde~
Construc
PROJECT
/J
VACANT
I
I
/4
/5
I
I
/5
AREA MAP
1" = 100'
1/,'/"//
~b<,'///-'
/7
/6
\
/\
2O
/9
/
>
/
/
KNIK VISTA
3' Section Line ~asement ~__
l~a0 '- Utility [
semenr. . I --
000 Calloh
30' )tic Tank
Three
Bedroom
House
38' Lonq X
X 4' Effective
Absorption
~lternate Site
S02'15' O0"W
· SITE .PLAN
SCALE 1" = 30'
LOT 7, BLOCK 5, KNIK VIEW SUBDIVISION
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Three Bedroom Home
Perc. Rate: 1 MinJInch
Application Rate: 1.2 GPD/SF
5' Wide Trench System
1,000 Gallon Septic Tank
4' Drainfleld Rock
3 Bedrooms X 150 GPD 11.2 GPD/SF = 375 SF of Absorption Area
375 SFI5 LF (Width)*.5 (Red. Factor) = 37.5 LF Trench Length
Therefore: Construct a 38' Long X 5' Wide X 4' Effective Depth Absorption Trench.
Flowline Elevation in Trench to be 3' Below Original Ground Surface. Total Depth to be 7'
Below Existing Ground. Mound Over Trench to Provide Minimum of 3' of Cover or Provide
2' of Direct Bury Insulation.
2" Insulation & 2'
or
Fabric &
4I
4" PVC ASTM D3034
Drainfield Rock
5!
NOTE:
TYPICAL WIDE TRENCH SECTION
(NO SCALE)
Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock. ~.
Minimum 10' Sepa~tion From Lot Line.
Minimum 4' Sepa~fion From Groundwater. ~ ~ .' ~
~.: 49~
Minimum 10' Secretion From Water Se~ice Line.
Municipality of Anchorage
of Health & Human Services
Department
825 L Street, Anchorage, AK 99502-0650 V ," ...... ,,, · ~ ,-,
SO LS LOG- PE.COLRT O. TEST
·
Legal Description: Lot 7. BIoCI<5 Knik View Subdivision
SLOPE SITE PLAN
North
OGIOL
GW/GP
Some Silt
South
Was Groundwater
Encountered? No S
If Yes, What Depth? L
1 Depth to Water O
After Monitoring None P
11 Date: 715101 E
See Site Plan
12
13
14
15
16
'17
18
21
Bottom of
Hole
Reading Date Gross Net Depth To Net
Time Time Water Drop
30-Jun 7:50 1.5"
7:55 5 Dry 6.5"
7:56 1.25"
8:01 5 Dry 6.75"
8:02 1.5"
5 Dry 6.5"
Perc. Rate: <1 Min./Inch Perc. HoPe Diameter: 6"
Test Run Between 4 Ft. and 5 Ft.
Comments: Test Cavity was Presoaked Prior to Test. More than 50% of Material Passes No. 4 Sieve.
Performed By: Mike Anderson. I, ~ Certify That This Test Was Performed
In Accordance With Ail State and Municipal Guidelines In Effect On This Date: 715101
....
' "'
~, *. , ...... .~....~"'~"" ~.
Mun~c~pahty OT Anchorage
Department of Health & Human Serwces
825 L Street, Anchorage, AK 99502-0650
SOILS LOG- PERCOLATION TEST
Pedormed For: MM&M Contracting Date Performed: 6/~1~/0'~'~,''"'~'
Legal Description: lot ?. IBtock§. Knik View Subdivision
SLOPE SITE PLAN
North
OG/OL
GW/GP
Some Silt
South
Was Groundwater
Encountered? No S
If Yes, What Depth? L
1 Depth to Water O
After Monitoring None P
11 Date: 715101 E
See Site Plan
12
13
14
15
16
17
18
Bottom of
Hole
Reading Date Gross Net Depth To Net
Time Time Water Drop
30-Jun 8:10 1"
8:15 5 Dry 7"
8:16 1.25"
8:21 5 Dry 6.75"
8:22 1"
8:27 5 Dry 7"
21
Perc. Rate: <1 Min./inch Perc. Hole Diameter: 6"
Test Run Between 3 Ft. and 4 Ft.
Comments: Test Cavity was Presoaked Prior to Test. More than 50% of Material Passes No. 4 Sieve.
Performed By: Mike Anderson. I, J~ Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 715/01
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 7, BLOCK 5, KNIK VIEW SUBDIVISION
GENERAL:
The scope of this project includes the procurement and placement of a
new 1,000-gallon septic tank at the location shown on the site plan.
Work also includes the construction of a new 38' long X 5' wide X 4'
effective depth absorption trench at the location shown. The
distribution line in the trench will be placed at 3' below the existing
ground surface. Total depth of the trench will be 7' below the existing
ground surface. Ail components of the septic system must be placed a
minimum of 10' from the water service on the lot.
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.
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.
=
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.
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 1,000-gallon septic tank must be procured from an approved
source and installed at the location shown.
A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfield.
· . '..Eot 7, Block 5, Knik View
July 2, 2001
Page 2 of 3
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.
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
reck 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.
Contractor shall vedfy the septic tank and drainfleld are a minimum
100' away from any pdvate 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.
A minimum 2' of accepting soil is required below the drainfield reck for
a 5' wide trench. Contractor shall verify this condition prior to
placement of the rock. All pockets of unacceptable materials must be
removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic
tank manufacturer.
2, The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated
and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and
ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
'Eot 7, Block 5, Knik View
July 2, 2001
Page 3 of 3
5. A permeable geotextile fabdc (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:
Municipal Ordinance requires a minimum of two inspections. 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 bacldilled.
The second inspection must be conducted after the placement of the
geotextile fabdc, 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.
CERTIFICATE OF ON-SITE
FOR A
SYSTEMS APPROVAL
S INGL~ ~FAr"llLY DWELLING
Municipality of Anchorage
Development serVices Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Parcel I.D. 051045547
1, GENERAL INFORMATION
cos^ c 10]1
Expiration Date: ~ - '~' ('~ ~ / !
Complete legal description KNIK VIEW ESTATES; BLOCK 5, LOT 7
Location (site address) 2255555 KNIK VISTA STREET *CHUGIAK, AK 99567
Current Property owner(s) ANTHONY FARNSWORTH
Day phone 854-03553
Mailing address
225355 KNIK VISTA STREET *CHUGIAK, AK 99567
Lending agency
Day phone
Mailing address
Real Estate Agent
ANNE ROBERTS W/ PRUDENTIAL
Day phone 689-6464
.. .. Mailing address 166555 CENTERFIELD DRIVE *EAGLE
'Unless otherwise requested, COSA Will be held by DSD for pickup.
2. NUMBER OFBEDROOMS:
RIVER, AK * 99577
3.. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well · ' Individual On-site ·
Individual Water Storage [] t Individual Holding tank []
Community Class 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 title (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 engineer's work.
4. STATEMENT OF ~NSPECT!ON BY ENGINEER
,,=re,,~=,,~ as of the vafidation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of Qn-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. Phone 337-6179
Address .3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Date
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
bedrooms, with the fllowing stipulations:
other person or party is not authorized, nor will it confer any legal right whatsoever.
DSD SIGNATURE
!-// Approved for -~ bedrooms.
Disapproved,
Conditional approval for
Attachments: COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
(Rev, 'i 1/05)
Arsenic Advisor'
Maintenance Agreements
Supplemental Engineer's Report'
Other
Original Certificate Date:..
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
CERTIFICATE OF
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907) 343-7904
ON-SITE SYSTEMS ,PPROVAL
Legal Description: KNIK VIEW ESTATES; BLOCK 5~ LOT 7
A. WELL DATA
CHECKLIST
Parcel ID: O~'-
ICOMMUNITY
Well type CLASS A If A, B, or C provide PWSID# 218409 Well Log. (Y/N)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N)_J
Total depth__ .ft. Cased to ft. Casing height ~nd) in.
FROM WELL LOG ~T.~CTION
Date of test ~. . ~ ~ .
SV~i: Cp~Voa~ rcllieoVnel '~~_ ~ ~ '~ip.m.
Coliform _,.~olonies/100 mi. Nitrate mg./L. Other bacteria . colonies/100 mi.
~ ug./L. Date of sample: Collected by: GE(; Ltd.
Foundation cleanout (Y/N) YES
Date of pumping 9/4/2009
ABSORPTION FIELD DATA
Date installed 8/17-18/01
Length 48 ft.
SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 1000 gal. Number of Compartments ~2
Depression over tank (Y/N) NO
Pumper
~'BELOW EXISTING GRADEI
Soil rating (g.p.d./ft2o~ 1.2
Width 5 .ft.
Total depth *8.29 ft. Eft. absorption area 480 ft2 Monitoring tube YES..
Date of adequacy test 6/10/10 Results (Pass/Fail) PASS
Fluid depth in absorption field before test 28.5 in. Water added 740 gal.
Elapsed Time: 91 6 min. Final fluid depth 28.5 in. Absorption rate >--
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN
Date installed 8/17-18/01
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
JR'S PUMPIN(;
System type SHALLOW TRENCH
Gravel below pipe 4 ft.
Depression over field NO
For 3 bedrooms
New depth 38.5 in.
450+ g.p.d.
If yes, give date -
D=
LIFT STATION
Date installed
"Pump on" level at
Size in gallons
Manhole/Access (Y/._y~
in. "Pump off" lehigh water alarm level at
Cycles tested
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Meets alarm & circuit requirements?
,in,
COMMUNITY WATER
Septic tank/lift station on lot
AbSorption field on lot
Public sewer main
On adjacent lots
On adjacent lots _.-.
~nout
Sewer/septic service line .------~ 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 10'+ Building foundation 10'+
Water service line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
Water main 10'+
Driveway, parking/vehicle storage 10'+
F. COMMENTS *TANK IS INSULATED PER INSPECTION REPORT. DRAINFIELD IS NOT INSULATED.
TANK AND DRAINFIELD APPEAR TO HAVE APPROXIMATELY 24" OF SOIL COVER.
G. ENGINEER'S CERTIFICATION
! 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 Printed Name JEFFREY A. GARNESS
Date c~/~/a
COSA Fee $
Date of Payment
Receipt Number
(Rev, 11/05)
Waiver Fee $
Date of Payment
Receipt Number
AS-BUILT
I hereby certify that I have .Surveyed the following described
property: L- ~ 7 .... ~7 ~ ~;'/~, ~:A-' ~7'
Anchorage Recording Precinct, Alaska, and that the improve-
ments situated thereon are within the prope~y lines and do not
oveylap or encroach on the prope~y l~ng adjacent thereto, that
no improvements on prope~y lyin~ adjacent thereto encroach
on the pre,es ~ quest]on and that there are no roadways,
bansmission lines or other visible easements on said properly
except as indicated hereon.
Dated at Eagle River, Alaska
~is '~' ;'~;-' 't"/Lday of ~" '"'"::~ "t~¥~" '~'' " ~
ROBERT C. JOHNSON %r'~'
SCALE: Registered Land Su~evor No. 880-LS
1" = ~-":/: Box 77-0&56, Eagle River, Alaska 995~
Phone (907) 69~-25&3
Municipality of Anchorage
P.O. Box 196650 ® 4700 Elmore Road
Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997
http :llwww. muni.orqlOnsite
Development Services Department
On-Site Water and Wastewater Program
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: Garness Enqineerinq Group
Legal description: KnikView Estates B-$ L-7
r--'lPermit [~C.O.S,A. [--Ilnspection Report
The attached paperwork has been reviewed and is being returned for the following reasons:
Only 24" cover reported over trench. No insulation was reported on Inspection Report.
36" cover required without insulation.
Name of reviewer: Jeff
Date: 9-9-10
Please supply the necessary information and re-submit your request.
LEA VE THIS FORM ATTACHED TO THE PAPERWORK
Parcel I.D. 051-043-47
Municipality of Anchorage
Development Services Department
Building Safety Division ·
On-Site Water and Wastewater Program
4700 South Bragaw St,
P.O, Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
P.O. Box 670495 Chuqiak~ AK 99567
1. GENERAL INFORMATION~ Z.~')'7 >c~cr...~ ~-
"Complete. le. gal description [,e,~ar~eel~ Knik ~qew Estates
*" Lo~ation (site ~,ddress or'di~'ections) Knik Vista
Current Property owner(s) MM&M Construction
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Un/ess otherwise requested, HAA will be held by DSD for pickup.
Three (3)
2.- NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class A_.. Well
Public Water System
[]
[]
[]
[]
Expiration Date: ! O -/G "~)~-~'
Day phone 688-1236
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tank I'-I
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 cml
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 pdvate or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a pedod of up to one year with
valid water samples.)' Certificates are valid for one year for properties served by Class A or B wells or a public
water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 AnderSon En.qineerin.q
Address P.O. Box 240773 Anchora.qe~ AK99524
Engineer's Printed Name I~ichael E. AndersonT P.E.
DSD SIGNATURE
J/"" Approved for ' '~ bedrooms.
Disapproved.
Conditional approval for
Phone 522-7773
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Odginal Cedificate Date:
(RAY. 12~0)
Legal Deseriptlon:
WELL DATA
Wea type &
Date c~mpleted
Total depth .~
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. BOx 196650 Anchorage, AK 99519-6650
w~v.ci.anchorage, ak.us
(90~) 343-79O4
HEALTH AUTHORITY APPROVAL CHECKLIST
BlOCk 5, Knlk View Estates
Parc(diD: 051~3-47
IfA, B, erC provide PWSID #
Sarma~ saa (Y/N)
Cased te ft.
FROM WELL LOG
wen cog (Y/N)
vv~s prom~' protects.(Y/N)
Casing height (above ground).
AT INSPECTION
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
ColIform c=lonies/100 mi.
Date of sample:
B. SEP'nc4IOLDING TANK DATA
Tank Type/Material Sept]c/SteM
Tank size 1,000 gal,
Foundatr~ dsanout (Y/N) ~
C. AB$ORFRON REID DATA
Date installed ~t18/200~
Total depth 8 fi.
Date of adequacy test
g.p.m.
in.
Nllrate mgJt.
C=llected by:
Pumper New Construction
colonins/lO0 mi.
Date installed ~/17r2001
Cteanc3uts (Y/N) V
High water alarm (Y/N) #
Fluid depth in abserptJon field before test __ in. Water added gal.
Elapsed Time: min. Final fluid depth in. Absorption rote >=
AnyreJuvenaUonlreatmentLsast 12rno.)(Y/N&type) N ' Ifyes. givedate
Soilmflng (g.p.dJ~orfl~/tx:lrm) t2GPD/SF System type 5' Wlde Shallow Trench
ft. ~ArKfth 5 ft. Gravel belowpipe 4 fl.
Eft. absorption area 480 ft2 Monite~ng lube Y Depression over field N
Results (Pass/Fall) For bedrooms
New depth in.
g.p.d.
UFT STATION
Data installed
'Pump on' level at in.
Datum
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tant/tiff station on lot
Absorption field on I~t N/A
Public sewer main N/A
Sewer/septic sewice line
Size in gallons
'Pump off" level at __
Cycles tested
Manhele/Accees (Y/N)
High water elarm level at
Meets atan~ & cimuit mqui~ments?
On adjacent lots FUA
On adjacent lots I~A
Public sewer manhele/cleanout FUA
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Buitding foundation >5' Prepefly line >5' ' Absorption field
Water main N/A Water service line >10'
Wells on adjacent lots >200'
SEPARATION DISTANCE FROM ABSORPTION RELD ON LOT TO:
Pmpe~y line >10'. Building foundafion
WatarSewiceline >10' Surface water >100'
Wells on adjacent lots >200'
Curtain drain None Noted
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have data~mined through field inspections and
rmSew of Mun/c/pe/mcerds ~at the above systems are/n
conJbrmance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Michael F_ Anders0n~ P.F_
Date 10/t5/01
Date of Paymont I~.:~°1~°(~
Receipt Number ~
Surface watar >100'
Water main >10'
Driveway, paddng/vehlde ~tmage >25'
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Wa~ F~ $
Data ~ ~t
~pt Num~