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Home My WebLink AboutKNIK VIEW ESTATES BLK 5 LT 9Knik View Estates Block § Lot 9 #051-043-49 Permit Number. HEARTLAND HOMES A~dress: P.O. BOX ,3434 * PALMER, AK 99645 Phone: No. of Redroomg: (907) 746-4525 4 LEGAL DESCRIPTION Block: U3t: Subdivision: 5 9 KNIK VIEW EST. TownIh¥: Range: SecUon: Municipality of Anchorage Development Servlces Department Building Safety Division On-Site Water & Wastewater Program, 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchorage.ak.us (907) 343-7904 On-Site Wastewater Disposal System and/or Well Inspection Report SW020377 PlO Number. 051--043--49 Wastewater System: · New Page 1 of 3 r-i Upgrade ABSORPTION FIELD ri Deep Trench · Shallow Trench 13 Bed 13 Mound E30~her 1.0 ~,o/s~ ~ 9.0 MAX 5.0 MAX r~ 4.0 n. SEE DWG. r~ 61 WELL: 13 New CI Upgrade 5 .. ~ 610 s~. r~ D 3034/ F-810 BAILEYS BACKHOE 10/2/2002 SEPARATION DISTANCES T.n~ ~ ~ ANCHO~GE TANK 1250 rmld Stat]on Well 200'+ 200'+ -- Sudoce Water 100'+ 100'+ -- ~t Une 5'+ 10'+ -- FoundaUon 5'+ 10'+ -- CuAaln Dmln -. NONE KNOWq I Remarks: 25'+ STEEL - LIFT STATION BENCH MARK TOP OF CMU FOUNDATION inspections performed by: AKWWC, INC. Dates: 1st 10/2/2002 2nd 10/2/2002 3rd 10/2/2002 Development S~rvices Department Approval R~viewed and approved by: Dote. I[Re~. 112/01) pERMff NUMBER: SW020577 AS-BUILT DRAWING 051-045-49 APPROXIMATE LOCATION OF' / ~ ~ ~ KE-YBOX AND WATER UNE---~ I ~ / / j NEW 1250 GALLON ~ SEPTIC TANK ~ ~ 4 BENDR%Obl ~Ci-OJ-iST 1 HOUSE D~2/ co!,U- .... + ..... ~ ~NEW DRNNFIELD F------ ...... .~ '~ALTERNATE SITE A B C ST1 24.47 12.13 - ST2 .32.50 11.25 - DBL1 38.61 12.74 58.95 DBL2 38.18 11.57 57.10 CO 23.37 12.72 - C01 53.80 27,86 66.51 MT1 54.43 27.86 66.86 C02 - 57.82 26.93 MT2 - 57.33 27.17 ALASKA'~,~TER & W~TE~TER ~c.J.O. [ff~:~g~,~ ..:~0o~ CONSULTANTS. NC. " O' ~' ~::~ ............. ~'ff'~ HEART.ND HOMES (go7) 746-4525 2 OF 3 ~-~ 'iki;~';;;;; "~ KNIK VIEW ESTATES SUBDIVISION, LOT 9, BLOCK 5, ~._' ~ .... '_~ TYPE OF WORK: AS-BUILT DRAWING OF NEW SEPTIC SYSTEM pERMIT NUMBER: SW020377 AS- BUILT D RAWIN G PARCEL ID NUMBER: 051-043-49 ~ or BUNO SEPTIC TANK ~ or BU~C AT ~ RE3.AT1VE ELL'VA'JlON OF' EIO1TOM OF it'~HOLE - 80.54 (~t,b~HOLE DRY) ALASI~ WATER & WASTEWATER CONSULTANTS, INC, PREPARF. D FOR: PHONE NUMBER: HEARTLAND HOMES 746-4525/252-8796 KNIK VIEW ESTATES SUBDIVISION; LOT 9, BLOCK 5 PROFILE AS-BUILT OF NEW SEPTIC SYSTEM 10/17/2002 DRAWN BY: C.J.G. SCAL~ 1" = 40' PAGE NUMRF. R: 3OF3 MUNICIPALITY OF ANCHORAGE Development Sen/ices Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK ~)9519-6650 (007) 343-7904 ON-SITE WASTE~NATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Sep 30, 2002 Expiration Date: Sep 30, 2003 Permit Number: SW020377 Legal Description: KNIK VIEW ESTATES BLK 5 LT 9 Design Engineer: 0041 AK Water & Wastewater Consultan' Owner Name: Heartland Homes Owner Address: PO Box 0434 Total Bedrooms: 4 Palmer, AK 99645- Parcel ID: 051-043-49 Site Address: Lot Size: 22565 SQ. FT. Permit Bedrooms: 4 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 Wastewatar 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 consb'uction 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: Date: 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 www.ci.anchorage.ak.us (907) 343°7904 Parcel I.D. ON-SITE SEWER/WELL PERMIT ~,PPLICATION FOR .b, SINGLE FAMILY DWELLING 05]- ~) t./~ .-/-1/~ Permit Number ~b,~OZO.377 Properly owner(s) Mailing address (1) Mailing address (2) HEARTLAND HOMES P.O. BOX 3434 * PALMER. AK Day phone 746-4525 Zip Code 99645 Legal description (Lot, Block & Sub'd.) LOT 9. BLOCK 5: KNIK V~EW ESTATES SUBDMSION Legal description (Section, Township & Range) Lot Size ;:::3~-~ ~ Acres/O THIS APPLICATION IS FOR: Sewer Only ~ Sewer and Well Sewer Upgrade [] Number of Bedrooms 4 Well Only Water Storage THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Jacuzzi Water Softening Unit I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. ALASKA WATER & WASTE'WATER CONSULTANTS. INC, (Signaturc of propcfly owncr er outhorizod agcnt) Permit Fees: Date of Payment: Receipt Number, Waiver Fees: Date of Payment: Receipt Number:. ALASKA WATER & WASTEWATER CONSULTANTS, INC. September 20, 2002 Municipality of Anchorage Development Service Department Building Safety Division On-Site Water 8,: Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Design for Lot 9, Block 5; Knik View Estates Subdivision To whom it may concern: The proposed 4 bedroom house will be served by a community well and a private septic system. One test hole was excavated in the area of the proposed septic system. The drainfleld will be designed around the 30 foot radius of this test hole. We are proposing that a 1250 gallon septic tank and a five foot wide drainfield be installed. Comments regarding the proposed design are summarized as follows: I. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that the insitu silty soils should act as a sand filter and that an application rate of 1.0 gallons/day/ft2 should be used. 2. TRENCII DESIGN: a. Percolation Rate: <1 minutes/inch b. Allowable Application Rate: 1.0 gallons/day/ft2 c. NumberofBedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 600 ft2 f. Total Depth: 10 feet (max.) g. Effective Depth: 4 feet h. Width: 5 feet i. Reduction Factor: 0.50 j. Minimum Length: 60 feet long each k Effective absorption area = 600 ft~ 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed design. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com 4. TOPOGRAPIIY: The area for the proposed septic system is mostly flat; in short, there are no slope concerns. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. p~n ~ ~ .~/~k.ac0.oesrell' ~ s, P.E., M.S~ resi':lelt [~ NOTE: ,4ttached is a site plan drawing, a design drawing, one soil log, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com LOT 2. BLOCK 2; KNIK V1EW NOTE: ALL PROPERTIES SHOWN ARE SERVED BY A COMMUNITY WATER SYSTEM AND BY PRIVATE SEPT C SYSTEMS, LOT 3, BLC~K 2; KNIK ~EW $/D II II II LOT 1. BLOCK 1; KNtK V1EW S/O LOT 2. BLOCK 1; KNIK VIEW S/O II II II II II II II II II II II II II II II II II II II LI II II II II II LOT 9, BLOCK 4; KNIK VI['W LOT 8, BLOCK 4: KNIK VIEW ESTATES PROPOSEO 4l BEDROOU I LDT 7. BLOCK V, NIK V1EW LDT 6. BLOCK KNIK ~I~'W E~rATE~ LOT 5. BLOCK KNiK VlE'W I I I I I I MTT 13, BU3CK 5; I I ES'rA~ES I I I I ! ALASKA & WASTEWATER .o. ,,.. HEART.ND HOMES 746-4525/252-8796 LOT 9, BLOCK 5; KNIK VIEW ESTATES SUBDIVISION ~t~%'. PROPOSED WATER LINE AND SEPTIC SYSTEM . ALASiCA ~rATER & WASTEWATER CONSULTANTS, INC. p~co~Rm FOR: 746--4525/252--8796 HEARTLAND HOMES LOT 9. BLOCK 5; KNIK VIEW ESTATES SUBDIVISION DESIGN OF PROPOSED SEPTIC SYSTEM e/ao/aooz Z.T.G. 1" = $0' PA~£ 20F2 ISOlL LOG - PERCOLATION TESTI LEGAL DESCRIPTION: KNIK V1E'W E75'FATES SUBDMSION; LOT g, BLOCK 5 PERFORMED FOR: HEARTLAND HOMES DATE: 9/15/2002 ITEST HOLE SOIL CLASSIFICATIONS ORG ~ GP rTTITFI~ ML GM CL GC OL SW MH SP CH SM OH SC DEPTH TO DATE GROUNDWATER DRY 9/13/2002 DATE 9/15/2002 READING 1 2 4 5 6 CLOCK TIME NET TIME (MINUTES) 1.25 1.25 1.25 PROPOSED 41 ~"'"'-~ WATER LEVEL NET DROP READING (INCHES) O' 6' O' 6' O' 6' PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) 19~ TEST RUN BETWEEN 6.5 FT, AND 7,0 FT, 20 A FOUR HOUR PRESOAK WAS PERFORMED: [] YES · NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: JODY MAUS COMMENTS: THE NATURAL SANDY INSITU SOILS SHOULD ACT AS A SAND FILTER PERFORMED BY AKWWC. INC. Io JEFH~L'Y A. GARNESS. CERTIFY THAT THIS WA~; PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEUNES IN EFFECT ON THIS DATE:~//I ~./0~1, Certificate of On -Site Systems Approval Parcel I.D. 051-043-49 inme l_►�_ ► Q Z41TIFA NJ •► Expiration Date: JA N7 �o 3 01 f Complete legal description KNIK VIEW ESTATES BLOCK 5 LOT 9 Location (site address) 21650 KNIK VISTA COURT CHUGIAK AK 99567 Current property owner(s) GARY & SILVIA WELLS Mailing address Real estate agent Day phone 21650 KNIK VISTA COURT CHUGIAK AK 99567 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ® Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 55 0 Waiver Fee $ Date of Payment % d 1A 0'� �Date of Payment Receipt Number 90 Receipt Number COSA # OS c a I y o '7 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 FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN. PE Date 7/16/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. '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, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. 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, any estimate of how long a system will function satisfactory ��•' • • • !�' for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & Fwr.s , •' 6. DSD SIGNATURE • ' Curtis Huffman ' .. �'cr'•• ••c��'1°� System #1 Approved for bedrooms CE 128991 s�F�FD 2821.`��® System #2 Approved for bedrooms l� PROFESS00 Disapproved Conditional approval for bedrooms, with the following stipulations: OF Ori 0s1 nIT - /' WATER AND m� WASTE ATER z JJI�J FN7 SEOG��,,\ By:S 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: KNIK VIEW ESTATES BLOCK 5 LOT 9 Parcel ID: 051-043-49 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA — PUBLIC WATER ❑ 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. Comments B. TANK DATA Age of tank(s) 19 years Tank type/material SEPTIC / STEEL Measured,operating fluid level in septic tank 50" ® Standpipes/foundation cleanout per record drawing Date of pumping 7/14/2021 D. ABSORPTION FIELD DATA Which system tested (date installed) 10/2/2002 ® ALL standpipes present per record drawing Total measured depth from grade 8_8 ft (max) Measured depth to pipe invert from grade 4.7 ft (min) ❑ N/A — pressurized field 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 of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 7/14/2021 Results N Pass For 4 bedrooms Fluid depth prior to test 25 in Water added 600 gal New depth 31 in ® Monitor tubes go to bottom of effective. If not, state pQ-r depth into effective Elapsed time 1300 min rc4c 5 ® Code -required soil cover over field Final fluid depth 25 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: FIELD OPERATING IN THE UPPER HALF OF THE A' ED — SIMILAR TO 2016 COSA. NE 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' ❑ Yes if No Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑ Yes if No ❑ Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No ft ❑ Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5+ ft Surface Water > 100' ® Yes if No _ Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® 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 —ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *PER CODE AT INSTALL. G. ENGINEER'S CERTIFICATION 1 certify that l 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. Adw .t� TH Curtis Huffman �� 9�c/•. CE 128991 .7119/2) •'<��\ PROFESSO -� ft ft ft ft ft ft ft ft u1b6I 8 9 7,9 77 N • Municipality of Anchorag On -Site Water and Wastewater Program °g DEC 1zD1 (907) 343-7904 '.3. f E T Y 6 CERTIFICATE OF ON-SITE SYSTEMS AP C> 6 R �9C> Parcel I.D. 051-043-49 1. GENERAL INFORMATION Complete legal description Knik View Est. Block 5 Lot 9 Location (site address) 21650 Knik Vista Ct. Current Property owner(s) Thomas & Maria Olsen Expiration Date: bc-C 97, P00,0 - P -mc. Day phone Mailing address 2440 E Tudor Rd #145, Anchorage, AK 99507 Real Estate Agent Unity Home Group Day phone 907-341-3720 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 (tested for 4) TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ❑ Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class _ Well ❑ Public Sewer ❑ Public Water System Waiver/Variance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 6-5-0 Waiver Fee $ Date of Payment /,AIa0lt9 Date of Payment Receipt Number ory ({73,5- Receipt Number COSA # 0:561q/60/ Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen OF A \ 1 encroachments, deficiencies or discrepancies exist. *WV^ KX 10, gTfl 6. DSD SIGNATURE ......._ ._ System #1 Approved for bedrooms. `IrcenE1 7116 F System #2 Approved for bedrooms. t %O zo� 14"s 10 h �� Disapproved. Conditional approval for bedrooms, with the following stipulations: r� ON -81 -FE 0// ATFP o By: \r Original Certificate Date: oC a 7 1 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. �A r 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory vEr�Ir-1 Septic System Advisory Arsenic Ad Well Flow Advisory COSA blue sheet 10-10-12.doc Otherr y t IL �� a , COSA Checklist Legal Description: Knik View Est Block 5 Lot 9 Parcel ID: 051-043-49 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system 1 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. Comments B. TANK DATA Age of tank(s) 17 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 49" ® Standpipes/foundation cleanout per record drawing Date of pumping 1�g7% /� D. ABSORPTION FIELD DATA Which system tested (date installed) 10/2/02 ® ALL standpipes present per record drawing Total measured depth from grade 9'5 ft (max) Measured depth to pipe invert from grade 5'5 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective 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 of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 12/16/19 Results Q✓ Pass For 4 bedrooms Fluid depth prior to test 19 in Water added 600 gal New depth 28 in Elapsed time 10 min Fi ® Code -required soil cover over field nal fluid depth 19 in Absorption rate 600+ ® System presoaked gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) 2000 Gallons introduced gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet 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' 0 Yes if No Community Sewer Manhole/Cleanout > 100' Yes if No ft, !Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' Surface Water > 100' ® Yes Animal Containment > 50' Yes if No ft 'Yes if No ft Manure/Animal Excreta Storage? 100' Community Sewer Main > 75' Yes if No ft Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundati ns >' Yes if No ft Surface Water > 100' 0 Yes if No ft b® Property Line > 5' J' �i' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' ® 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that l 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. COSA Checklist yellow sheet 104 �7) a i 411° q A u 00 .wcni [ 4Mco � l fi m ao�+4°c�J � s KNIK, VI S TA s Ln 0 S� U A •^'ODUA S �o og� d� 0 g 0 cU. fi .U� ftl p . 3 2 .J H b 0� R °06 o v> toaor0 - V)G cd�! • : N > cuU!!i® 4 �l Ln Qcd— F A'C,F ai co �-. 4U. Lfli' SUr V O A : `xt ?- (.� Q RS FL•.� L3L_. C O N ,. r7 ,rim. W CY <t Lo cfl ct> U t— �,S TWO 0 O Lli O 0 Ui i WOOD FRAME ,f 000 ,L, Cn HOME ^' q 0 < Z co U D (D P4 � �0 Z f_ 21.5 14.5 4 }i za LA C CL- W>co �— _.. Y u) r1 � O an a z SEPTIC 0 a t— 0 0o-) m N .-� Q �I Q co 0 `10 cn r t < � i wCQ _-..._.._._ r � N co >� __.. S85 "35 52"E m 0 m 115. g`j __, 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 www.cLanchorage.ak.us (907) 343-7904 Parcel I.D. 1. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAhllLY DWELLING 051-043-49 HAA# /~7/,~ GENERAL INFORMATION Expiration Date: f/~/£~7/ Complete legal description KNIK VIEW ESTATES SUBDIVISION; LOT 9, BLOCK 5, Location (site address or directions) KNIK VISTA COURT * CHUGIAK, AK 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address HEARTLAND HOMES P.O. BOX 3434 * PALMER, AK 99645 Day phone (907) 746-4525 Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class "A" Well [] Public Water System [] 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 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,,privat,e 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 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 instaflation. Name of Firm ALASKA WATER & WA~TEWATER CONSULTANTS, INC. Address 6901 BEBARR ROAB, SUITE 2B * ANCHORAGE, AK 99504- Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AKWWC, Inc. 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. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long the sYStem will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will i( confer any legal right whatsoever. Phone 337-6179 DSD SIGNATURE [// Approved for ' bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the fllowing stipulations: ~ ~. ON-S ~ ~; WATER ~ ; WASTEWATFR .... Manitenance Agreements ~YJ))))) Supplemental Engineer's Reod Other Original Certificate Date: ~.ci.ancho[ag~:.ak[us · Ta,k'~iZ~;::'~!.:25:0 ':'~ga!: Numbe~ Of'Compadments. 2 CleanoutS: (yIN) YES': ~., Fluid :depth .n absoft On f eld ;before tes~.:, .~' ,'.'in: ·Water, added :... "~,;~ga ~"= - Ne~:de'pth',~. ~ in.. ElapSed Time: .~ min. Final, fluid- dePth .-- 'in,. Absorption rate >= ' ;-' ~' g.p':d. Any rejuvenation treatment' (past 12"~o.) (YIN '& type) - If yes, give date -