HomeMy WebLinkAboutKNIK VIEW ESTATES BLK 3 LT 20 Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191125 PID Number: 051-043-22
Dwelling: Single Family (SF) Duplex (D) Multiple (SF and/or D) Project: New Upgrade
Name:
NICOLE JO DAVIS ABSORPTION FIELD - EXISTING
Address (Deep Trench Shallow Trench Bed Mound
22633 JUDD DRIVE, CHUGIAK, AK 99567 Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
4 0.6 GPD/SF 12 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 2 Ft. 10 Ft.
KNIK VIEW ESTATES 3 20 Fill added above original grade Gravel length
Township Range Section VARIES 0.33 - 2.91 Ft. 50 Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES 2 Ft. Ft.
ToSeptic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches
From
Tank Field Lift Station Tank Line 1000 Ft7 1 -- Ft.
Well NA NA NA NA NA TANK Septic S.T.E.P. Holding Other
Manufacturer Capacity
Surface water 100'+ 100'+ 100'+ NA ANCHORAGE TANK 1500 Gal.
Material Number of compartments
Lot Line 5'+ 10'+ 5'+ NA STEEL 2
NA
Foundation 10'+ 10'+ 10'+ NA LIFT STATION
Manufacturer Capacity
Curtain Drain NA *NA NA NA ANCHORAGE TANK 1500 Gal.
Pump on level at Pump off level at High water alarm at
Remarks Existing septic tank decommissioned-G -
*None known. V 44 in. 42 in. 48 in.
Pump make and model Electrical Inspections performed by
Franklin 2445040117- 1/2HP Power Lightning & Control
PIPE MATERIAL House to tank 3034 Tank to
grainfield 3034
Installer NORTHERN EXCAVATION
Drainfieldp5tf co/MT 3034
Inspector FWCS / MNA BENCH MARK (Assumed elevation) 100 ft
Inspection
1'` 6/7/19 2"' 6/7/2019 Location and description
3'0 6/8/2019 4'° 6/12/2019 BOTTOM OF SIDING
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL .....
Ar �� OFA
.... ......� 1
Conditional Approval: Date ,A, ...".:9:1..
ioxi..",„m4-,4
MICHAEL N. ANDERSON.
1`G� No. CE 9489 /
r '� •6/.18/19 •'• G�
App`ro7ed - 4- Date Cn�/ ( I' I;SSIO�t i
Inspection Report_9-1-12.doc
PID: 051-043-22
PERMIT: OSP191125
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INSTALLED NEW ,•�, FO \l
1CS 1500-GAL STEP
EW/TING GT&O • 37,
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70
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O• pA' •
LOT 20 >,
MTH2
i MT
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SCALE: 1' = 30'
A—D=18.0'
B—D=16.3' if FCO Co1MN fMT MT-Nil.
A—E=26.1' C \ 2 I- r FINAL GRADE ;19_&41
B—E=2 2.3' IORIGINAL GRADE
Di
B—F=10,6' �6 FILTER FABRIC 1,0 —ORG/OL
C—F=42.1' 92-41/ 1.500-GAL \so 9z� GM
STEP SEWER
B—G=4 6.1' STEEL TANK ROCK
C—G=13.2'
e7.51
SEPTIC SECTION 79,5_1/21/1999
SCALE: NTS
PREPARED FOR: ��_\\
NICOLE JO DAVIS ii�� OF
�1
KNIK VIEW ESTATES B3, L20 ,<C,' -,t,..i—
22633 JUDO DRIVE, CHUGIAK, AK 99567 * 49TH �� *�/
Michael N. Anderson P.E. MICHAEL N. ANDERSON i DATE: 6/18/2019 `1 t , No. CE 9489
4661 Natrone Ave. DRAWN: FWCS N 6/18/19 '/
Anchorage, Alaska 99516 ' ' asloKa' i
(907)727 8864/FAX: (907)345 1391 SCALE: 1" = 30' ��`__4111P
.0,,,,,,,f7,0, MUNICIPALITY OF ANCHORAGE
On-Site Water&Wastewater Programoff...voent s;,
PO Box 196650 4700 Elmore Road ° ;.
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax (907)343.7997 ,, r.
. 1 f' htto:l/www.muni.org/onsite �, N
! 11)8rtin en(
On-Site Wastewater Disposal System Permit
Permit Number: OSP191125 Effective Date: 5/1012019
Work Type: Septic Upgrade Expiration Date: 5/9/2020
Tax Code Number: 05104322000
Site Legal Address: KNIK VIEW ESTATES BLK 3 LT 20 G:1558
Site Mailing Address: 22633 JUDD DR, Chugiak
Owner: DAVIS NICOLE JO Lot Size in Sq Ft: 22840
Design Engineer:__f -- - - _ ,. - . - Total Bedrooms: 4
/1-A: r.eX2 0 Ce'. 9t. 4rl
This permit is for the construction of: J
Q Disposal Field Q Septic Tank 0 Holding Tank ❑ Privy ❑ Private Well 0 Water Storage
Al! construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day,or
b. Covered, sealed,and heated to prevent freezing
Received By: (1. "
// Date: SPO/P7
Issued By: moi/. .— Date: //D�
f
EPui146
MUNICIPALITY OF ANCHORAGE
ts)r
Development Services Department \\ " Phone: 907-343-7904
On-Site Water & Wastewater Section \ Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-043-22
Property owner(s) NICOLE JO DAVIS Day phone 9078545796
Mailing address 22633 JUDD DRIVE, CHUGIAK, AK 99567
Site address 22633 JUDD DRIVE, CHUGIAK, AK 99567
Legal description (Sub'd., Block & Lot) KNIK VIEW ESTATES B3, L20
Legal description (Township, Range & Section)
Lot Size 22840 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(Z all that apply)
Absorption Field -X Initial ❑ Single Family (SF) PS
(w/wo ADU)
Septic Tank ® Upgrade
Holding Tank ❑ Renewal Duplex (D)
111 ❑
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
Brent Western - FWCS
(Signature of property owner or authorized agent)
Permit/Rush Fees: 395 Waiver Fees:
Date of Payment: lagl/9 Date of Payment:
Receipt Number: 6(QQ3o� D Receipt Number:
Permit No. D5P1 q 11. 5 Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
Michael N. Anderson, P.E.
Civil/Structural Engineering and Construction
4661 Natrona Ave. Anchorage, Alaska 99516
Phone 345 -3377 / Fax 345 -1391
Support Services
Brent M. Western
907-440-4601
May 7, 2019
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
RE: SEPTIC UPGRADE PERMIT
LEGAL: KNIK VIEW ESTATES BLOCK 3, LOT 20
To whom it may concern:
The owner has requested that we obtain a permit to upgrade the existing septic system. The
septic field is saturated and it has been determined that the original reserve site will be used and a
lift station installed.
The lot and area is served by public water and this system will not impact any of the neighboring
properties due to the lot layout. Please contact Brent M. Western or me if you have any
questions.
Sincerely,
Michael N. Anderson, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191125, Deb Wockenfuss, 05/10/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191125, Deb Wockenfuss, 05/10/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191125, Deb Wockenfuss, 05/10/19
Municipality of Anchorage Page 1 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 e Anchorage, Alaska 99519-6650 0 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW990015 PID Number: 051-043-22
Name: Spinell Homes, Inc. Wastewater System: 42� New ❑0 Upgrade
Address:
9210 Vanguard Drive Anc., AX 995117 ABSORPTION FIELD
Phone: 344-5678 1
No. of Biyrocims: M Deep Trench 0 Shallow Trench 0 Bed 0 Mound 0 Other
LEGAL DESCRIPTION soil Rating: .6
Total Depth from original grade:
14
GPD/Sq. Ft.
Lot: Block: !4trivVqn: Depth to pipe bottom from original grade:
20 3 Kn1 lew Est. 410
Gravel depth beneath pipe
- Ft.
Ft.
Township: Range:
Fill added above original grade:
Gravel length:
1
1 Ft.
52 Ft.
WELL: PWS FINew 0 Upgrade Gravel width: 3
Numberoflines:
1
I Utstance between lines:
N/A
Ft
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To: Total absorption area:
Pipe material:
A
Ft.
Ft. 1,040 SO. Ft.
ASTM D3034 PVC
Driller:
Date Drilled:
Static Water Level: Installer:
Spinell Homes
Date installed:
8/12-14/99
Ft.
Yield:Pump
Set at:
I
Casing Height Above Ground: TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES M Septic 0 Holding 0 S.T.E.P.
To
Septic
Absorption
Lift
Holding [ding
Public/Private Manufacturer
ity in gallons:
Capacity
From
Tank
Field
Station
Tank
Sewer Lines Anchorage Tank
1,250
Well -Two
>500'
N/A
N/A
>5001 Material: Steel
Number of Compartments:
Two
Surfac
>100'
>1 00
N/A
N/A
N A57 LIFT STATION - N/A
Watere
Lot
> 10 1
'> 10 1
N/A
N/A
N/A size in gallons:
Manufacturer.
I
Line
Foundation
>5 1
> 10
N/A
N/A
N/A "Pump on" level at:
"Pump off, level at:
High water alarm at:
Curtain
None
bted
n Lo
Pump Make & Model
Electrical Inspections performed by:
Drain
Remarks: BENCH MARK
Location and Description:
Garage Slab
Assumed Elevation:
L
100 0
E a 4tsE 11 A
WN
Inspections performed by: A. HaralaDates: 1 sL8/12/99
-
8/13/99,
2nd
Department of Health and Human Services approval
by: U Date:
Reviewed and approved
c7ZL
72-013 (Rev. 9/91) MOA 25
`Permit No. SW99001 5 Page 2 of 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O: Box 196650 s Anchorage, Alaska 99519-6650 e Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report.
Legal Description: ..Lot 20, BLK 3, Knik View Ests.. SD PID No.: 05i-043-22
f,
4 - -
r C2
C3y
S2, MT
XS1 1,250
gall
1 C
s
Qo�� ankc 1
4 BR A
House
Alternate
Site
Swing Ties ,
��..
S1 22.5' 16.7' k
r
S2 28.0' 24.3' Tx 2{
A.„
C2 31.6' 28.6'
C3 32.5 29.5' w . .
C4 30.7'. 44.9';
MT 30.6 41.3
Legend rQ` ,
:..
�gK A. -Bit.
C5 52.5' 35.8' �.
C clean out I
SP septic stand pipe
1" = 20'
MT monitor tube
Permit No. SW 9 9 0 01 5 Page 3 of 3
M nilcipality of Anchorage
DEPARTMENT /bF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 a Anchorage, Alaska 99519-6650 e Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Lot 20 BLK 3 Knik View Ests. Subd.
Legal Description: ' PID No:: 051-043-22
C1.04' S 103$ 2 C; C 3 5 ,
103-
o .. 9$3
73/ 1-i 250 gal.
i 97- septic 975 97
tank
93 C
MT TH
1
9v ,
1.1.7 3+4?.
7.
106.
C5
101
wQ geotextile fabric
TEE '� a" 97 '
973 ,` 6 ,
b
0n r °e s e, p t i c` o r o c" k a
a s
•�O i! ♦ p D Q O �p O O d a• . a e' a i b !° W a
- 871 .
25-
0
520
F�° h� ..
LEGEND 5
MT = monitor tube
C cleanout
ELEVATION As - Bit
o -w ke g
SP = stand pipe
� ►�15 QL��o�1s
MUNICIPALITY OF ANCHORAGE �? _ I Z • ��� 1 O✓�L
Department of Health and Human Services
\� On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
\� J� (907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Permit Number: SW990015
Legal Description: KNIK VIEW ESTATES BLK 3 LT 20
Design Engineer: 0014 Anderson Engineering
Owner Name: Spinell Homes, Inc.
Owner Address: 9210 Vanguard Drive
Anchorage , AK 99507 -
Date Issued: Feb 18, 1999
Expiration Date: Feb 18, 2000
Parcel ID: 051-043-22
Site Address:
Lot Size: 22840 SQ. FT.
Total Bedrooms: 4 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. 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
(907) 343-4744 (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.
5. The following special provisions.
Maximum depth at the uphill end of the trench shall be 14 feet.
Received By:
Issued By:
Date: -3
Date: �v ��
January 21, 1999
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject: Lot 20, Block 3, Knik View Estates
Septic System Design
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
We hereby apply for a permit to construct an onsite septic system on Lot
20, Block 3, Knik View Estates Subdivision. The attached site plan and
backup documentation identify the size and location of the new septic
system to serve the four bedroom home to be constructed on the lot. The
subdivision is served by a community water system and all required
separation distances are easily met. No conflicts exist with other septic
systems in the area.
Testholes placed on the lot revealed silty gravels with percolation rates
ranging from 24 to 30 minutes per inch. No groundwater was encountered
during testhole placement nor was any noted during the monitoring period.
We have therefore designed a deep trench system for the lot. The trench
will be 50' in length and 3' wide. It will have an effective depth of 10'
and the total depth will be 14' from the existing ground surface.
The surface of the lot slopes from east to west at varying grades. The
back half of the lot is fairly steep and probably not acceptable for system
placement. The lot is also very narrow so the trench will be placed
parallel with the 1% slope. Sufficient room is available for the primary
and alternate sites if the lot is developed as shown on the site plan.
Lot 20, Block 3, Knik View Estates
January 21, 1999
Page Two
If the system is constructed as designed the following statements apply:
1. The system, if constructed as designed, will have no adverse impact
on the wells in the area or those to be constructed in the future. The
subdivision is currently served by a community 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.
3. The system, if constructed as designed, will have no adverse
impact on reserved space, either surface or subsurface, on any lots
located in the area.
4. The system, if constructed as designed, will have no adverse impact
on drainage patterns in the area. The current drainage pattern w i I I
be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
Septic System
ng X 3' Wide
Effective Depth
,rption Trench
Subdivision Served
by Community Water
System.
SCALE 1" =
Four Bedroom Home
Monitor Tube
Cleanout
50; Long X 31 Wide
X 0Effective Dep
Absorption Trench
0S)
--J� TH 1
1,250 Gallon
Septic Tank
SYSTEM PLAN
SCALE 1" = 20'
on
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom Home Deep Trench System
Perc. Rate: 20 - 30 Min./inch 1,250 Gal. Septic Tank
Application Rate: .6 GPD/SF 10' Drainfield Rock
4 Bedrooms X 150 GPD / .6 GPD/SF = 1,000 SF of Absorption Area
1,000 SF/20 SF/ LF of Trench = 50 LF Trench Length
Therefore: Construct a Deep Absorption Trench System With One Lateral
50' in Length with 10' of Drainfield Rock Beneath the Lateral.
Distribution Pipe in Trench Placed at 4' Below the Original Ground
Surface.
Natural Backfill
31-611
6 4" PVC
(Holes Down)
.5—Drainfield Rock
11
101-0ice.
31-011
N
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away. 49 I -H
Minimum 3' of Cover over Septic System. iv,
A - A
Maintain 10' Separation From Lot Line.
MCMEIMIRM"WN.
438MI -E
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 -L" Street Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: Spinell Homes DATE
LEGAL DESCRIPTION: Lot 20, Block 3,
PTtL Knik View Estates
(FE Ti I OL
2 -
4-
6-
7 -
8��-
9-
10 -
Cs
11 -
12-
13
14-
15-
42
16-
17-
18
19 -
GM
Testhole No. 1
Township, Range, Section:
WAS GROUND WATER
ENCOUNTERED?
IF YES. AT WHAT
DEPTH?
SLOPE
� I
No
S
L
N/A 0
P
E
Depth to Water After
Monitoring? None oaw- 1 / 21 /9 9
1- 9 K11WLjW1d-
SITE P
0
Reading
Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
JII
311
—
Z-
.30
Yv-
-
/,/for
EMS
YV4
NEI
I
0
Reading
Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
JII
311
—
Z-
.30
Yv-
-
/,/for
YV4
__ uPERCOLATION RATE Z-_ PERC, HOLE DIAMETER
TEST RUN BETWEEN 40 FT AND 7 FT
COMMENTS Testhole presoaked prior to test.
PERFORMED BY: MEA I I Mi6hael 'Fs AnderSCiPTiFY THAT T TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.' DATE--' — /�JH7917
72-008 (Rev. 4/85) 1
Municipality of Anchorage
DEPARTMENT OF HEALTH 86 HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: Spinell Homes DATE PER
LEGAL DESCRIP T ION: Lot 20, Block 3, Township, Range, Section:
94PTld- Knik View Estates SLOPE SITE PLAN
a Testhole No. 2
10-
Q
I Net
Time
AS GROUND WATER
NO
1-4 rq
,� O.
ENCOUNTERED?
11
6
2
3
v%
S
to
I 30
IF YES, AT WHATNIA
4
�• /
I
s
I
5
6
7
• /v
•.
O
GM
E
13
'
n /
Depth to Water After
Monitoring? None
Date 1 / 21 9 9
I
8
/
I
9
a Testhole No. 2
10-
Q
I Net
Time
AS GROUND WATER
NO
1-4 rq
ENCOUNTERED?
11
6
30
3 3V
S
to
I 30
IF YES, AT WHATNIA
0
12
DEPTH?
P
I
I
I
I
E
13
'
n /
Depth to Water After
Monitoring? None
Date 1 / 21 9 9
14-
16-
17-
18-
4-16 1718
19
Reading I DateGross
Time
I Net
Time
( Depth to
Water
Net
Drop
1-4 rq
ZbZ
�i: CO
30
3 3V
/!/Y'r
to
I 30
Y `s I
1 ji1- I,
I
I
I
I
I
I
20 Q N
PERCOLATION RATE Z s (minutesimch) PERC HOLE DIAMETER P
TEST RUN BETWEEN FT AND ti FT
COMMENTS Testhole presoaked prior to test.
PERFCRMED BY: MEA I -Mi ha 1 F.: And2=SdSATIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. OATS /
72-008 (Rev. 4/85)
E-P U+NS
MUNICIPALITY OF ANCHORAGE
Development Services Department 's /% Phone: 907-343-7904
On-Site Water & Wastewater Section / Fax: 907-343-7997
Certificate of On-Site Systems Approval
Parcel I.D. 051-043-22 Expiration Date: Ce,—(2-1 -2 C Z
1. GENERAL INFORMATION
Complete legal description KNIK VIEW ESTATES BLOCK 3, LOT 20
Location (site address) 22633 JUDD DRIVE, CHUGIAK,AK 99567
Current property owner(s) NICOLE DAVIS Day phone
Mailing address 22633 JUDD DRIVE CHUGIAK, AK 99567
Real estate agent Day phone
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: 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: Date: -
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ a30 Waiver Fee $
Date of Payment 1el(a It 9 Date of Payment
Receipt Number 1J I g23O Receipt Number
COSA# Q`� C 1 (02�S 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 ANDERSON CONSTRUCTION&ENGINEERING Phone 345-3377
Address 4661 SHOSHONI DRIVE,ANCHORAGE,AK 99516
Engineer's Printed Name MICHAEL N.ANDERSON,PE Date 6/14/2019
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 changeO
due to subsurface conditions that may not be observed from the surface,changes in land use, Y• " ."...
local soil characteristics,groundwater levels that may fluctuate during the year,quality of c
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 * ::4 9 TH /\ *
+I
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 Firs and Anderson Construction&Engineering. ".MICHAEL N. ANDERSON."
No. CE 9489
6. DSD SIGNATURE 1 ••• 6/14/1.9.." e,„
System #1 Approved for l bedrooms JJ'A'oPEsstalt'IA -fir
.�+
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
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By: Original Certificate Date: 61-1( l
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 blue sheet
COSA Checklist
Legal Description: KNIK VIEW ESTATES BLOCK 3, LOT 20 Parcel ID: 051-043-22
If more than 1 septic system on lot: COSA Checklist#_of_ Structure served by this system
A. WELL DATA—CLASS A#05103141
❑ Well log is filed with Onsite (or attached) Well production at time of test gpm
Date drilled Water storage tank volume gallons
Total depth ft Well disinfected for coliform test? ❑ Yes ® No
Cased to ft ❑ Coliform bacteria is Negative
❑ Sanitary seal is functioning correctly Nitrate_mg/L❑ Nitrate less than MRL (ND)
❑ Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND)
Casing height (above ground) in. Collected by _
Date of flow test for COSA Date of Sample
Static water level at beginning of test ft.
Comments
B. TANK DATA—6/8/2019 - 1500-gal STEP C. LIFT STATION
Age of tank(s) NEW years ❑ Required maintenance completed
Tank type/material STEEL Age of lift station 0 years
Measured operating fluid level in septic tank Lift station material STEEL
® Standpipes/foundation cleanout per record drawing Comments: NEW STEP TANK
Date of pumping NEW
D. ABSORPTION FIELD DATA—50'L x 2'W x 10'ED—0.6 GPD/SF= 1000 SF
Which system tested (date installed) NEW Adequacy test date NA— NEW SYSTEM
® ALL standpipes present per record drawing Results ❑Pass For_bedrooms
Total measured depth from grade 12+ft (max) Fluid depth prior to test in
Measured depth to pipe invert from grade_ft(min) Water added _gal
N/A—pressurized field
New depth _in
® Monitor tubes go to bottom of effective. If not, state
depth into effective Elapsed time min
® Code-required soil cover over field Final fluid depth in
❑ System presoaked Absorption rate gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months)
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies: F �S
COSA Checklist copy 3.docx
•
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)CLASS C WELL
Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> 0
® Yes if No ft es if No ft
Neighboring Tank> 100' Z Yes if No ft Private S- - eptic Line > 25' ® Yes if No ft
Absorption Field on Lot> 100' ® Yes if No 1 Holding Tank> 100' ® Yes if No _ ft
Neighboring Absorption Fields > 1 I r' Animal Containment> 50' ® Yes if No ft
4 Yes if No ft
Manure/Animal Excreta Storage > 100'
rr
Corr 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 Foundations > 10' ® Yes if No ft Wells on Adjacent Lots:
Property Line> 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft
Absorption Field > 5' ® 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
Surface Water> 100' ® Yes if No ft
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' Z 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' Z Yes if No ft
F. ENGINEER'S COMMENTS
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ice . i .
G. ENGINEER'S CERTIFICATION *49 ;� *+
I certify that I have determined through field inspections and review I 11/�'� r
of Municipal records that the above systems are in conformance I MICHAEL N. ANDERSON. ii
with MOA COSA guidelines in effect on this date. �1 No. CE 9489
6,'18,19 4
k,
-FESS1OT1�
COSA Checklist copy 3.docx
, PLAT NO. 86-113
KNIK VIEW ESTATES
LOT 20, BLOCK 3
21840 S.F.
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REVISED 6/14/2019 ADDED 2 STAND PIPES.
AS -BU I L T I HEREBY CERTIFY THAT I HAVE SURVEYED THE
PROPERTY DEPICTED ABOVE AND THAT NO � �11114
GASTALDI LAND ENCROACHMENTS EXIST EXCEPT AS INDICATED. ' OF '♦
SURVEYING. LLC IT IS THE RESPONSIBILITY OF THE OWNER TO •••-\�•••••••Q44 •.
JEFF A. GASTALDI, R.L.S. 1�..•• `r,
DETERMINE THE EXISTENCE OF ANY EASEMENTS, � �; 9•
2000 E. DOWLING RD.. SUITE 8 COVENANTS OR RESTRICTIONS WHICH DO NOT a ic: 49TH ••••; *•
ANCHORAGE,ALASKA 99507 APPEAR ON THE RECORDED SUBDIVISION PLAT. ••. ,A.yiutr-�oI 0
PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA 0 :" e ... •1
Jeffery A.Gastoi0. .• g N
GRID DATE HEREON BE USED FOR CONSTRUCTION OR FOR 0�o LS-6091 ; r+
• 6/14/2019
NW1558 6/13/2019 ESTABLISHING BOUNDARY OR FENCE LINES. 0.\,.••••••.•••••�e'"'••
F.B. JOB NO. ANCHORAGE RECORDING DISTRICT,ALASKA . •
.,f;;s'� :_4
NOTE: NO CORNERS SET THIS DATE
99-11 KvE203
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
051-043-~2 HAA#
1. GENERAL INFORMATION
Complete'legal description
Lot 20, Block 3, Rnik V~w E~m~
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailin. g address
Agent
Address
Spinoll Homes, Inc.
9210 Vanguard Drive
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: Four ( 4 )
TYPE OF WATER SUPPLY:
Individual well
Community well XXX
Public water
NOTE:
Daypgone 344-5678
Anchorage, AK 99507
Day phone
Day phone
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
xxx
If community' wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's signature 2~/~<-~',-zt-c~ ~ ~ Date
DHHS SIGNATURE
A.pproved for ~
Disapproved,
Conditional approval for
bedrooms.
bedrooms, with th'e following stipulations:
Additional Comments
¥-¥
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-.~5(Rev. 1/<J1] ~acl< MOA~I
Legal Description:
A. WELL DATA -
Well type A
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744
Health Authority Approval Checklist
Lot 20, Block 3, Knik View Pa~elI.D.: 051-043-22
Estates
Public Water System
[fA.B, orC, atte~ADECle~en ADECwater~em number 05103141
Date completed
Cased to
FROM WELL LOG
Casing height (above ground)
Wires properly protected (Y/N)
Date of test
. Static water level
Well production
WATER 8AMPLE RESULTS: -
Co~form
Date of ~ample:
B, SEPTIC/HOLDING TANK DATA
Date installed 8/12/99
Foundation cleanout (Y/N)
Date of Pumping New
C. ABSORPTION FIELD DATA
Date installed 8/12-14/99
Length 52 ' Widlh
ATINSPECTION
N/A
N~rate
g.p.m.
Collected b~.
Other basterta
Tank size I, 250 Number of Compa,bfer~ 2
Y Depression (Y/N) N High water alarm (Y/N)
Pumper Construction
Soil rating (g.p.dJfta or fF/Ixlrm) .6
3 ' Grovel thickness below pipe
Effectlve absorption area I, 040 SFMonltorlngTubeprasant(Y/N) Y
Date of adequacy test New Const. Results (Pass/Fall)
Fluid aleph% In absorption field before test (in.);
Fluid depl~ (ins) Minutes laten
Peroxide treatment (past 12 monlt~) (y/N)
7~-o26 (Rev, w96)-
Immediately after
Absorption rate =
If yes, give date
Cleanoute (y/N). ¥
N
g.p.m.
System type Deep Trench
1 0 ' TOt-I dep~ 1 4 '
Depm_~_~lon over field (Y/N) ~
For
· gal, water added (In.):
g.p.d.
bedrooms
D. UFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
F.
- None on Lot
Size in gallons
"Pump on" level at*
*Datum
No Well on Lot
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM iNELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic sen4ce line
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation > 5 ' Property line > ~; '
Water mai.n/service line > 1 0 ' Surface water/drainage > 1 0 0 '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line > 1 (I ' Building foundation > 1 0 '
Surface water ~ 1 n n '
Curtain drain None Noted cm T.nt-
Absorption field > ~ '
Wells on adjacent lots
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
"Pump off level at*
7200'
Water main/service line > 1 o '
Driveway, parking/vehicle storage area > 1 0 '
Wells on adjacent lots > 2 0 0 '
ENGINEER'S CERTIFICATION
~ ~n~ ~ MOA ~ ~ldelines in eff~ on ~ls ~te. --~--~--~~ ~ ~ /, ~.~,
Dam
W~er ~e $