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MEADOW RIDGE ESTATES NORTH ADD BLK 5 LT 4
Meadow Ridge Est. North Block 5 Lot 4 #051-531-12 Municipality of Anchorage Development Services Department t \ Building Safety Division .. Onsite Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.d.anchorage.ak.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: — SW030175 PID Number: 051-531-12 "JeJAMES BERNARD Wastewater System: ❑ New ® Upgrade Address: 21249 Meadow Lake Dr. Chualak. AK. 99567 ABSORPTION FIELD phone: Number of Bedroans: ® Deep Trench D Shaft. Trwlch O Bed D Mound 0 other: LEGAL DESCRIPTION Sat RaNy: Total Depth lrom "mi grade: 0.6 cpoxt" 12 FI. Bock: W: SubdM : Depth to ppe broom can alglnal grade: Gravel depth p~h ppe: 5 4 Meadow Ride Est. North .Add. 3.95 Ft. 8.0 Ft. Township PA.": $akroon: F added above ongvua grade: Gravel llngrh: 1.83-2.35 Ft. 66 Ft. Well: ❑ New ❑ Upgrade Gravel wain: Number of area; Dolamo belwroen Pros: I 2 Ft. I 1 NA Ft. Classifaelion (Private. A. S. C): Total Depth Caead b: Taal abaapton arse: Ppe Melenal: Public water — Ft 1056 FIv D3034 & F810 Driver: Date Dread: SMUG water Level: Natalror: Dale hl"led: Ft D.L. Enter 6/3/2003 Yield: Pump Set M: casing Haight Aboe Gd: Ground: TANK nPM Ft. FI SEPARATION DISTANCES ® Septic O Holding ® S.T.E.P. 0 Other. To Septic Absorption Uft Holding Public'Privat "° ww. r Flom Tank Field Station Tank Sewer sine Anchorage Tank 15000al. we" 100'+ 100'+ NA NA 25'+ Melnrol. Number of Comparenena: Steel 2 sa+adewater 100'+ 100'+ NA NA LIFT STATION LotLme 5'+ 6 NA NA �e 1500 Gal. Orenco Foundation 5'+ 10'+ NA NA ump do level alH,ph 44" ump off level at 42' wale alarm aL 48" ti. In. In. Cuvea Drain NA -50'+ 1 NA I NA Pump Make 6 Mode Ebcbael Inape=ns perbmed W. Franklin 24 5040117-1/2h Remarks: *none known BENCH MARK Iron iplron. Bottom of stairs In back of house As u ned Eb to : 100 FL Engineers Stamp OF At Inspections by: KND Engineering, Inc.Dates: 1516120/2003 00 performed 2n0 •N«e• �`: Kenaath M. Dv : F4� Develo meServices De artment APP CE 7116 t ,`1��ppROFESStONVN+ Reviewed and approved by: Date: 03 AS—BUILT SYSTEM DETAILS/SITE PLAN Permit SW030175 MEADOW RIDGE ESTATES SUBD., NORTH ADD., BLOCK 5, LOT 4 PID#051-531-12 "IJ)'tSIE%1577 A -C= 24.0' Roo a CawTTD, OW OA . MCLINTOCK A -D= 26.5' STA MT tcrAURc ALLS F D"�. rKE. A-E= 98.5' ACRD FRC 03044.DWG '108 M0. 03044 B-E= 85.8' W A -F= 98.8' O D s i v S n �r s EXISTING 1500 GAL S.T.E.R.T 'K J W VACANT LOT 4 ------------------ ------1 10' LMUTY ESMT. 7 0 /-----------j- tt — cs ; N I r'd -Tu A n n i SMLF) KI 5P' B -C= 34.3' CawTTD, OW OA . MCLINTOCK A -D= 26.5' STA "O'M- KMD B -D=39.5' CAM 7/15 D"�. rKE. A-E= 98.5' ACRD FRC 03044.DWG '108 M0. 03044 B-E= 85.8' A -F= 98.8' B -F=119.6' 1 S.T.E.P. -.'Dg H / KE 7116 A'b' FESSION�' r,>g 1$ I� FINAL GRADE 07 2 07 2 SEWER ROCK 't.. PREPARED FOR: JAMES BERNARD 21249 MEADOW LAKE DR. CHUGIAK, AK. 99567 (907) 688-3888 FIELD BOOKS CawTTD, OW OA . MCLINTOCK ORAW: STA "O'M- KMD Amur. CAM 7/15 D"�. rKE. ORO.. NW146 ACRD FRC 03044.DWG '108 M0. 03044 SCALE, NTS &\.L 1W ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 111/FAX (907)896-8111 SEP -03-03 05:31 PM D.L.ENTERPRISES September 3, 2003 Re: Lot 4 Block 5 To Whom It May Coree The lift station at the ab And Stata/I.oeal codes. Thank you. Sincerely, Kcvin S. Hombuckdc, O Administration Idcemc: Specialty Contractor Llc i ME 9076967568 Vdiwdeers 06124P P.001 Son )electric, Inc. Woodland Drive River, AK 99577 i22-6777 I referenced propertyhas been wired in accordance with NEC ba 1284 Number 27283 if 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 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade la4.1`Dp L Date Issued: Jun 09, 2003 Expiration Date: Jun 08, 2004 Permit Number: SW030175 Parcel ID: 051-531-12 Legal Description: MEADOW RIDGE ESTATES NORTH ADD BLK 5 LT 4 Design Engineer: 0070 KND Engineering Site Address: 021249 MEADOW LAKE DR Owner Name: James Benard Lot Size: 22530 SO. FT. Owner Address: PO BOX 672548 Total Bedrooms: 4 Permit Bedrooms: 4 CHUGIAK , AK 99567-2548 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 ( 1BAAC80 ). 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 Date: // 0 Date: d3 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 SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D- n51-531-12 Pen -nit Number SW 030/75 Property owner(s) James Renard Dayphone 269-3232 Mailing address (1) 21249 Meadow Lake Drive,_Chuglak. AK 99567 Mailing address (2) Zip Code Legal description (Lot, Block & Sub'da Meadow Ridge Estates, Block 5, Lot 4 Legal description (Section, Township & Range) Lot Size ?_Z f S3D Acres/Sq.Ft. Number of Bedrooms 4 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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. of property owner or authorized agent) Permit Fees: �yp0 Waiver Fees: Date of Payment: tp&163 Date of Payment: Receipt Number: :3LS-oy AN Receipt Number: (Rev. 12!00) 1 K D ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 June 2, 2003 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Sewer Upgrade Permit — Meadow Ridge Estates, Block 5, Lot 4 Gentlemen: The owner has requested we proceed forward to obtain a septic permit on the subject lot. On May 20, 2003 two testholes were performed for the proposed system. The results of these tests are attached. The general slope of this lot is from east to west at a grade of approximately 5-15%. We have designed our system utilizing the existing testholes that were excavated for the existing 4 -bedroom house. The lot is served by public water. We propose to install one T wide deep trench. Water was not encountered during the excavation or during monitoring. There are no public or private wells within 200' of our proposed system location except as noted. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, KH D Eneineerine, Inc. P.E. Attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Logs/ Percolation Tests WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLA MEADOW RIDGE ESTATES SUBD., NORTH ADD., BLOCK 5, LOT 4 2 3 i DESIGN DETAILS 4 BDRM X 150 GPD = 600 GPD 600 GPD/0.6 GPD PER SQ. FT. (19.23 MIN/IN.)= 1000 SO. 1000/(2'(W) X 8'(D)) (8.0' GRAVEL) - 62.5 FT. TRENCH USE 1 TRENCH - 63' (L) X 2' (W) X 8.0' (D) Total depth of system Is 12.0' from original grade. Total depth of gravel below distribution pipe Is 8.0' FT 2. HOLE SIZE = 3/16' = 1.00 GAL. PER HOLE E 30 PSI 3. 30 GALS (PUMP DELIVERY)/1.00 GALS./HOLE = 30 HOLES 4. 63 LF LATERAL/30 HOLES = 2.1' SPACING PER HOLE 5. ALL HOLES SHALL HAVE CAPS INSTALLED PER MANUFACTURES SPECS. Na PUBLIC VM" VI" !00' 6 PBSPOSEB SYSTEM. NO PRIVATE WELLS VIT1 EBB' 6 PROPOSER SYSTEM EXCEPT AS ,OTEa ,O SEPTIC SYSTEMS VnMIM !BO' 6 ►IOPnKo WELL EXCEPT AS MOTET. NOTES, 1. INSTAL 1500 GAL STEP 6 INSULATE TANK IF ( 4' COVER. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM. 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK. 4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE MIN. 3' COVER IF REQUIRED. 5. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS, SEPTICS, LOT LINES, FOUNDATIONS AND ALL OTHER SETBACKS. PREPARED F❑R JAMES BENARD 21249 MEADOW LAKE DR. CHUGIAK, AK. 99567 (907) 688-3888 FIELD BOOKS °dAO"RY' MCLIN' STA"a NA As"AT' NA Dw% TSE ACAD ME ^XAA A CO POM CRAM VBG CMECIOIA KMD DATE: 5/31 / am NW146 " "R= 03044 Scale, 1'= 100' PAGE 1 OF 2 ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 11 WASTEWATER DISPOSAL SYSTEM DETAILS MEADOW RIDGE ESTATES SUBD„ NORTH ADD., BLOCK 5, LOT 4 RETAINING ALLS Ic EXI TING Q I E-TSTIRG—. O SE IC PIPE SEPTIC PIPE�— 7-12% LL t� a w In a LOT 4 27. ----------------------------------L--- 10' UTILITY ES MT. �-ft�Nk Af��. fr 1 ssl �— PREPARED FOR, JAMES BERNARD 21249 MEADOW LAKE DR. CHUGIAK, AK. 99567 (907) 688-3888 FIELD BOOKS 9"o"R" MCLIN' STA"a NA As"A" NA mo. n n ACRD RE ntn„ COYPVTm MAW VBG °com KMD DAIS: 5/,31/ pe0c NW146 " " 03044 10' 13' Scales 1'= 20' PAGE 2 OF 2 1L&ll LW ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 1 UUNID ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 CE SOILS PERCOLATION TEST Performed for. Tames Benard Date Performed: 5/20/i %_%''g Project: Meadow Ridge Estates B5, L4 TEST HOLE N 03-1 Depth (Feet) SEE ATTACHED SITE PLAN 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- is- 19- 20- Org/OL GP/GM-dense, gray, damp angular rock k boulders to 4'+. B.O.II. HOLE PRESOAKED PRIOR TO TEST FOR HOLE LOCATION Was Groundwater encountered? NO What depth? NA Depth to water after monitoring? DRY Date? 5/28/03 Reading Date Gross Time Net Time Depth to Water Net Drop 1 5/21/03 1:00 - 6" - 2 1:30 30 min 46/16" 110/16" 3 1:31 - 6" - 4 2:01 30 min 47/16" 19/16" 5 " 2:02 - 6" - 6 2:32 30 min 47/16" 19/16" " Water Added Percolation Rate 19.23 (min/ in) Pere Hole Diameter 6" Test Run Between 8 feet and 9 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. Performed for. James Bertard Date Performed: Project: Meadow Ridge Estates B5, L4 TEST HOLE # 03-2 Depth (Feet) SEE ATTACHED SITE PLAN 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- Org/OL-w/ topsoil GP/GM -dense, gray, damp angular rock & boulders to 4'+. 18t�1t!!I HOLE PRESOAKED PRIOR TO TEST FOR HOLE LOCATION Was Ground water encountered? NO What depth? NA Depth to water after monitoring? DRY Date? 5/28/03 Reading Date Gross Time Net Time ���D P�.�OF'AC: "��*•' , ENGINEERING, INC. 20441 PTARMIGAN BLVD. 0646 ...L 1., EAGLE RIVER, AK 99577-8736 - 2 NM• 1:30 Kenneth M. DIE 5 3/16" /Jr y CE 7116 ��>,`�9F SOILS PERCOLATION TEST .......... Performed for. James Bertard Date Performed: Project: Meadow Ridge Estates B5, L4 TEST HOLE # 03-2 Depth (Feet) SEE ATTACHED SITE PLAN 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- Org/OL-w/ topsoil GP/GM -dense, gray, damp angular rock & boulders to 4'+. 18t�1t!!I HOLE PRESOAKED PRIOR TO TEST FOR HOLE LOCATION Was Ground water encountered? NO What depth? NA Depth to water after monitoring? DRY Date? 5/28/03 Reading Date Gross Time Net Time Depth to Water Net Drop 1 5/21/03 1:00 - 6" - 2 1:30 30 min 5 3/16" 13/16" 3 " 1:31 6" - 4 2:01 30 min 51/16" 15/16" 5 " 2:02 6" 6 2:32 30 min 5 2/16" 14/16" " Water I Added Percolation Rate -34.28 (min/in) Perc Hole Diameter 6„ Test Run Between 7 feet and 8 feet 1, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. 7/22/2003 Municipality of Anchorage Dfark Btcgich, Mayor Building Safety Dic-ision P.O. Box VXi(i50 • 4700 itnigaic Street Anchonige, Alaska 99519-6(ZO • (907).93-M01 • rwx (907).43-&2(X) Kenneth M. Duffus, PE KND Engineering 20441 Ptarmigan Blvd Eagle River, AK 99577-8736 Subject: Waiver Request for Meadow Ridge Estates North Addition Bl 5 14 Waiver Request #WR030056 Parcel ID #051-531-12 Construction Permit Number SW030175 Dear Mr. Duffus: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is 6.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, PL 67-ri Daniel J. Roth Civil Engineer On -Site Water & Wastewater Program Municipality of Anchorage Development Services Department Building Safety Division On-Sitc Water and Wastewater Program 4700 Bragaw Street s P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorageak.us (907)343-7904 Waiver Review Worksheet WR#: 030056 PID#: 051-531-12 HAM Permit#: S6 O 75' Date Received: 7/16/03 Legal Description: Meadow Ridge Estates North Addition Block 5 Lot 4 Engineer: KND Engineering. Inc. (!��� Sla'[Liill�Tillrl•J Applicant: Kenneth M. Duffus Waiver Requested: 6 feet to oroverty line Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: ........................ me ... .................. .....000.8. ... ................. , Waiver is Granted: X— Waiver is not Granted: List Conditions or Reasons for above: S 9Fe F-44, L 6 r/6'le OF ,l iY721 LA77o-t/ Date: By: 019N Name of Reviewer .............................................................................., Rec#: 36548 Amount: $150.00 Date Paid: 711612003 K.ND ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER. AK 99577-8736 1 /FAX (907)696.8111 July 14, 2003 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 RE: SEWER PERMIT/ LOT LINE WAIVER — Meadow Ridge Est. Block 5, Lot 4 Gentlemen: During the as -built process we encountered a problem with the system being in close proximity to the lot line. The trench orientation was changed due to a rock that was encountered and could not be moved. While the entire trench is not located within the test hole radius, at the time of excavation the soils were visually determined to be consistent throughout the trench. Additionally we do not expect there to be any adverse effect on adjacent lots by the location of this system. We are therefore requesting a waiver to 6.0 feet to lot line at this time. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, KND Enaineerine M. Duffus, P Attachments: As -built Inspection Report .MUNICIPALITY OF ANCHORAGE • Hea and Environmental Protec7�n Fourth Floor West 825 L Street Anchorage, Alaska 99501 279-2511, x 224, 225 NAME LOCA SEPTIC TANK: INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM ING ADDRESS LEGAL DESCRIPTION M C tf- PHONE B✓ DISTANCE/. .�t� NUMBER OF Z FROM WCLLEi� INOMANUFACTURER MATERIAL COMPARTMENTS INSIDE LENGTH `- INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY 0OVGALLONS. ��-+• TOTAL LENGTH DISTANCE FROM WELL-raWLAdrDATION 11 NEAREST LOT LINE OF LINE 7 # of Lines DISTANCE BETWEEN LINES IWA TRENCH WIDTH3GfN. TOTAL EFFECTIVE ABSORPT;O?J AREA 25-lS SQ. FT. LENGTH OF EACH LINE 7 / DEPTH OF FILTER / DEPTI I: TOP OF TILL TO FINISH GRADE �� MATERIAL BENEATH TILE (fid IN. ABOVE TILE IN. SEEPAGE PIT: DIAMETER —OR WIDTH- LENGTH_. DEPTH Log Crib _Rings_ Crib Size:' DIAMETER _DEPTH_DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION_. NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. well Class: ,�'tj5.f;,tq Depth: Well Distanc To: Lot Line Bldg: Sewer Line: Pipe Materials: C ;t # of Bedrooms: Installer: Remarks: DATA- �__� y I I I-T I I I iI _J-�� -�I , , - r cdl- -i-I-� l l +G�1_� - - - 1Jj --`1 71 j 4-1 DATA- �__� y rh U tJ I AC I . FI L_ I IF OA F= Fi r-4 Fe Fi G E • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 279-2511 CAtJ—S} I TE SEWEFS F}EFZM I IF PERMIT NO. ( 77143 ) APPLICANT DON 7IMMFRMRN J2 BOX 596 E.R. LOCATION MEADOW RIDGE DR LEGAL L4 B5 MEADOW RIDGE EST f� L 688-9024 LOT SIZE 21000 SQUARE FEET TYPE OF SOIL ABSOR,BTION SYSTEM IS: TRENCH MAXIMUM NUMBER. OF BEDROOMS = ,3 SOIL RATING CSQ FT/BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: OEF='TH= Ss LEt+IiGTH= 26i Ca FT Fl It E7 L_ E>EF='TH= ts THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). FRECP! U I F2EC• SEF T I G IFFir-JK S 12: E: = 1 9Dc2t0 GFiLILOt-JS. TWQ C 2 ] , I r4�F� EAG IF I CA r4 S FiF2E F2EGU I Fz EC• BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'EFZM I T It FA L_ I C• F= OAFZ CA t4 E= YEFiFQ F= FZCAP1 I SS}LJFEE: I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER. SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS.RFMODELED TO INCLUDE MORE THAN 3 BEDROOMS. c - SIGNED APPLICANT DON ZI ISSUED BY : JWRVA. PGM comsuLTAN rs. INC. so,• co.noYA • •ox Le,> . A.C..o.,.C,L. .I.I.. 1111t • r... St, 111 11.1 • •1.1 t.,p„c-, G.W.4[9Y 01...9.4 yVOVIYO Oy April 9, 1977 Mr. Don Zimmerman Box 596 Eagle River, Alaska 99577 R & M No. 751138 RE: Log Two Test Roles for Sanitary System, Lot 7, Block 6 and Lot 4, Block 5, Meadow Ridge Estates Subdivision Eagle River, Alaska Dear Mr. Zimmerman: we are submitting herewith our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of April 6, 1977, and those procedures outlined in a letter dated July 15, 1975, by Mr. Rolf Strickland of the Muncipality of Anchorage, Department of Environmental Quality. A single test hole was excavated within each lot for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor mounted backhoe and the test holes were extended to a total depth of 16 and 13 feet below ground surface. The final logs of the test holes are presented on Drawing B-03. Groundwater was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R && M� CONSULTANTS, INC. CIA 9� Edward Yarmak, Jr. Geotechnical Engineer EY/pe n ANf NO11A G[ IAIN[ANNT IYNCAV . V. ti WAS,LL• Lot 7, Block G Meadow Ridge Estates T11-1 • MEADOW RIDGE DRIVE • TI1-2 Lot 4, Block 5, Meadow Ridge Estates The test hole locations are approxinate and have not been located by survey methods. M F 0 OWN Y2L LOCATIOtJ DIAGRAPi GRID CKD: EY F &M CCUSULTANT9.SNC DON ZI°,�SL`L1N DATEFRROJ.NO 4 -fl -77 • •• ....... ••••• RAGLE I.I\ ALAStCA 75113:5 SCALE: NTS .. DWG NO A-01 TF1 -1 4-7-77 n -n' ORGANIC MATERIAL - Black SANDY GRAVEL WSO:dE SILT (GM) Moist, Medium Dense �S .Red -Brown --- ---- 3.0' GRAVEL WSOt>E SAND; TRACE SILT (GP) Moist, Mediun Dense Brown Many Cobbles Groundwater Table Not Encountered Lot 7, Block 6 Meadow Ridge Estates T11-2 A-7-77 0.0' ORGANIC MATERIAL B 60 is 0.5' SILTY SAND %I/TRACE SANITARY SEWER TL'ST 110LES ORGANIC MATERIAL (Root3) (SM) r Moist, Medium Dense 1 s- G Brc an — — — — — ' �'boo SANDY GRAVEL CKD: EY WSOME SILT (GM) SANDY GRAVEL — 13.0' Moist, Medium Dense B/TRACE SILT (GN) 4.0' EAGLE RIVEp--,,ALASKA Moist, Mediun Dense Y� SCALE: 1^=3' °•'� Brown, OvIG.No. ' B -OJ L�. •d! P Many Cobbles , 16.0 TD Groundwater Table Not Encountered Lot 7, Block 6 Meadow Ridge Estates T11-2 A-7-77 SANDY GRAVEL VI/TRACE SILT (GR) Moist, Mediun Dense Brown Many Cobbles Occasional Boulder.__ 13.0'TD Groundwater Table Not Encountered Int 4, Block 5 Meadow Ridge Estates 0.0' ORGANIC MATERIAL B — — 0.5' SILTY SAND %I/TRACE SANITARY SEWER TL'ST 110LES ORGANIC MATERIAL (Root3) (SM) r Moist, Medium Dense 1 s- G Brc an — — — — — 2.5' SANDY GRAVEL CKD: EY WSOME SILT (GM) )1 j Moist, Medium Dense - - - - - - - 4.0' SANDY GRAVEL VI/TRACE SILT (GR) Moist, Mediun Dense Brown Many Cobbles Occasional Boulder.__ 13.0'TD Groundwater Table Not Encountered Int 4, Block 5 Meadow Ridge Estates B OWN' t7 c. n /) SANITARY SEWER TL'ST 110LES ` GRID. CKD: EY RSM CONSULTANTS. IN= DON ZI121ERMAN DATE+ 4-5-77 •~��� ^� EAGLE RIVEp--,,ALASKA aROJ.NO 75 13R_ SCALE: 1^=3' - OvIG.No. ' B -OJ <�� � r� MUNICIPALITY OF ANCHORAGE I Development Services Department �' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 051-531-12 Certificate of On -Site Systems Approval Expiration Date: 6/26/2025 Leaal description MEADOW RIDGE ESTATES NORTH ADD BLK 5 LT 4 Site address 21249 MEADOW LAKE DR Current property owner(s) BENARD JAMES & TRACY REVOCABLE X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: %'�JGU 'Scvn rr Original Certificate Date: 7/16/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory X Arsenic Advisory Other COSA Approval_June 2022 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-531-12 Complete legal description MEADOW RIDGE ESTATES NORTH; BLOCK 5, LOT 4 Location (site address) 21249 MEADOWLAKE DRIVE, CHUGIAK, AK 99567 Current property owner(s) 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 907-862-5984 3. TYPE OF WATER SUPPLY: R Private Well R Private Well serving 2 dwelling units F] Private Well serving 3+ dwelling units 0 Community Well or Public F-1 Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic Fj Private Septic serving 2 dwelling units F-1 Holding Tank n Community Septic or Public Sewer 5. SEPTIC TANK: RN Steel ❑ Plastic 0 Concrete R Fiberglass Age 21 -See advisory if steel older than 20 years 6. ABSORPTION FIELD: E] AWWTS E] Bed RN Deep Trench [] Wide Trench R Seepage Pit Waiver request for: Expedited review requested: E] Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment Date of Payment COSA # s, C 2, Waiver # COSA Appricaflon—June 2022 c,hdzy 17 Legal Description: COSA Checklist MEADOW RIDGE ESTATES NORTH; BLOCK 5, LOT 4 Parcel ID: 051-531-12 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 LL DATA ❑ Well log is Date drilled COMMUNITY WATER Onsite (or attached) Well production at time of ft Cased to ft \ ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) Date of flow test for CO Static water I c beginning of test ft. B. TANK DATA Measured operating fluid level in septic tank '43.75° Date of pumping 'd /"6,''+C""" � redo oak ❑ Required maintenance completed, if AWWTS Comments: *IN ST1 / 43.5" IN ST2 D. ABSORPTION FIELD DATA Which system tested (date installed) 6/2003 0 ALL standpipes present per record drawing Total measured depth from grade 15.0 ft (max) Measured depth to pipe invert from grade ft (min) FN N/A — pressurized field. ❑ Per record drawings, field is insulated. X Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Water storage to ume gallons �We�lld' ' cted for coliform test? ❑ Yes ❑■ No liform bacteria is Negative trate mg/L El Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date C. LIFT STATION EM Required maintenance completed Age of lift station 21 years Lift station material STEEL Comments: Adequacy test date 6/11/2024 Results ❑■ Pass Fluid depth prior to test *0 in Water added 893 gal New fluid depth *19.5 in Elapsed time 123 min Final fluid depth *13.5 in Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 96 in Effective depth used 13.5 in Effective depth remaining 82.5 in Comments/Deficiencies: *IN NORTH MT. ADDED WATER TO SOUTH MT. SIMILAR LIQUID LEVELS IN SOUTH MT. COSA Checklist June 2022 E. SEPARATION DISTANCES IF 'vate Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift on Lot > 100' Community Sewer Manhole/C > 100' Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes i ft Pri wer/Septic Line > 25' [:]Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No n Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > Animal Contain 50' ❑Yes if No ft ❑ Yes if No ft Manure/Animal Excreta Storage > Co Sewer Main > 75' [:]Yes if Noft ❑Yes i ft Q N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5'+ ft Surface Water > 100' ❑■ Yes if No ft Tank to Property Line > 5' ❑■ Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' 0 Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *MET SEPARATION DISTANCE AT TIME OF INSTALL. **LOT LINE WAIVER GRANTED (WR030056) DRAINFIELD UNDER A GRAVEL AREA THAT COULD POSSIBLY USED FOR PARKING. G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Gamess Engineering Group LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Garness Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022 LIl NC M #AEGC8a4 MUNICIPALITY -OF DEVELOPMENT SERVICES DEPARTMENT � �� 907-343-7904 Cin -Site water and wastewater Section „ ' �1 Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC241234 Subdivision: Meadow Ridge Estates North Add Block:5, Lot: 4 The septic tank for this property is 21 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more, not including engineering, surveying or MOA permitting fees. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. Wockenfuss, Deborah M. From: ARM Septic Services LLC <armservicesak@outlook.com> Sent: Tuesday, July 16, 2024 1:40 PM To: Wockenfuss, Deborah M. Subject: Fwd: Lift station maintenance for Meadow Ridge Estates North Addition Block 5 Lot 4 Please see email below. Mariah Sent from my iPhone Begin forwarded message: From: ARM Septic Services LLC <armservicesak@outlook.com> Date: July 15, 2024 at 1:29:31 PM AKDT To: "Cogger, Benjamin M." <benjamin.cogger@anchorageak.gov> Subject: Re: Lift station maintenance for Meadow Ridge Estates North Addition Block 5 Lot 4 Hello Ben, We stopped by this property this morning to confirm pump function. We tested it and the pump is working as it should. I'll be in and out of service for the next few hours so please consider this email a reference to the maintenance log. Please let me know if you have any questions. Mariah 907-317-8834 Sent from my iPhone On Jul 12, 2024, at 5:18 PM, Cogger, Benjamin M. <benjamin.cogger@anchorageak.gov> wrote: Robert, Arm Services completed maintenance of a lift station at a property located at 21249 Meadow Lake Dr. Chugiak, AK 99567. On the tog it was noted that the lift station pump could not be tested for lack of liquid. Garness is now trying to complete a COSA for this property, but my department can't sign off on it without the entire lift station being cleaned and tested, including the pump. We request that ARM Services return to the site and test the pump to make sure everything is in working order before we can issue the COSA. If you have any questions, please feel free to contact me at the number provided below. Thank you for your time. Ben Cogger Municipality of Anchorage MUNICIPALITY OF ANCHORAGE Phone: 907-343-7904 Development Services Department Fax: 907-343-7997 On -Site Water & Wastewater Section Lift Station/Pump Vault Maintenance Log J ,l Owner ' c HCStreet Address_ ZL� 9 �-IF Septic Tank: ,,�� -Sludge level •�%/�inches -Pumping: required e no -Pumping completed e no Lift station: -Pump basket cleaned e no -Effluent filter cleaned no -Control floats cleaned e8 no -Proper float settings confirmed 1 no -Operation satisfactory X22 no Alarm System: -Dedicated electrical alarm circuit e no -Audible and visual alarm inside dwellinges no -Alarm system operation atisfactorV not satisfactory Manhole Riser -Ground water intrusion at riser to tank connection yes rro -Ground v✓ater intrusion around pipe penetrations Ves •Weep hole functional 0 no -Manhole lid: Functional e no Insulated 4a no Properly Secured no Other -All manufacturer required inspections and maintenance completed es' no Signature Date of maintenance 0 — 2-a -e to Z-�— li -,, :zoo 40 CIT co C) � V- ,. r ?% Z4 v JYI' sl o w z 3: cl a U) 1 11 0 1 1 WI I Z C) 2: >- 3 z 0 z c/) ai Z PLJL 0 �-- LA 0 U- — Y) C) Li >� )p- c) 6 LL; W- z > C) C, C) ct w x z :fl x C/) C) Cf) Z l ` > x Ww w cn C) -i wwXx 2 Z �— cr I CL X 0 ir U. cn i Q LLJ LLJ Lit L) 10 U) Z 0 w a: o 0 U) 0 z ::) U w 03 t - �o~zzwWmo ) a: w Z cr U-��N�wap,,Zz co> � Z 0 M WW Li LL, I W z Ics(Dz w ,`�o— bu)z< m -1 ��`m Z —��—{.� M 3: () i i �- z0CL ww <wo C) z zw .-J 'te r0 w0 NM- < ffi W T 0 C 0 AzZz`�=�rLo�c L o > ! / MUNICIPALITY ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # C) ,1— Ll 1— 10- 1. GENERAL INFORMATION Complete legal description HAA# ���q',�rnnIn Lot 4; 13£oek 5; Meadow Ridge Eetatea n614h Location (site address or directions) 21249 Meadow Lake D4ive. Property owner Aran t Sha7ron K),bra Day phone 688-2284 Mailing address P.0.13ox 670798 Chugiak, Alaska 99567 Lending agency Day phone Mailing address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well XX Public water NOTE: If community well system, provide written confirmation from State ADEC attest - Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site vx Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-02S (RN. 1/91) From MOA M21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I 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 FirmPhone Address 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 - Engineer's signature IDate 4'— 280( Z 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. 22 Conditional approval for bedrooms, with the following stipulations: Additional Comments • The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-0251Pa wa eK. MOA m Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: t-vT--A Parcel I.D. R1vlt�. EST. A. WELL DATA Well type bN If A. B, or C, attach ADEC letter. ADEC water system number 21� �i3t Log present (Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION 10 Date of test rn g Static water level rni I ro o Well flow g.p.m. co Z; 'A .n ao '" 92 Pump level < 0 SEPARATION DISTANCES FROM WELL TO: O A Z Septic/holding tank on lot 2�ct r ; On adjacent lots Absorption field on lot Zoo ; On adjacent lots — Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK� TA Date Installed 1 Tank size t c"=>o C#eL- Compartments Z- Cleanouts ON) Foundation cleanoutgjN) N Depression (Y© High water alarm (Y& r 1 Alarm tested (Y/N) 'old Date of pumping Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot Zo 0 % On adjacent lots �1d Foundation $ t Topropertyllne to%Y . Absorptionfield "��, Water main/service line tU�} Surface water/drainage t Gb X 72.026 (Rev. 7191) From CONTINUED ON BACK PAGE C. LIFT STATION Date Installed Size in gallons Vent(Y/N) High water alarm levet "Pump on" level at _ Meets MOA'electrical codes (Y/N) SEPARA lot Manufacturer Manhole/Access (Y/ N) Cycles tested . FROM LIFT STATION TO: On adjacent lots Surface water D. ABSORPTION FIELD DATAn 11 Date Installed 1 Soil rating - $S 1k/3c System type 7MG_, ." Length 2 �) t Width 3 L ss Gravel thickness S r Total depth Total absorption area Z -I Cleanouts present &N) Depression over field (Yo& Date of adequacy test g _11 —9Z — Result as ail) _�J�.�� J for 'M bedrooms Peroxide treatment (past 12 months) (Y& 40a.41 !6�4 )i If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO:. Well on lot 1-0c>"" On adjacent lots a' IP Property line n To building foundation t 5 t } To existing or abandoned system on lot -- AIA On adjacent lots 12�N� Cutbank 6'Ltta Water main/service line lot 4 Surface water n0 �} Driveway, parking/vehicle storage area la:z� } Curtain drain a It, E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guide 5 & 5 ENGINEERING „ Signature 77e3n raple River Loop Road No. 264 Eagle River, Alaska 99577 Engineer's Name Date t ems. HAA Fee $ --A7o Waiver Fee: $ Date of Payment Date of Payment Receipt Numbere23(;) Receipt Number 72-026 (An. Yat( Back MOA 21 tion. i Lu ". ;.i DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99503 FOR: S & S Engineering April 22, 1992 PWSID # 211431 WALTER ✓. NICKEL, GOVERNOR (907) 349-7755 My review of the records on file in this office reveals that the Dawn Water Company, Class 'A' Public Water System, is in compliance with the routine coliform bacteria sampling requirements listed in Table C, and with the inorganic sampling requirements listed in Table B of 18 AAC 80.200. Sincerely, Byron Roys Project Engineer BR/Cf 5. LEGAL DESCRIPTION TE RECEIVED _ `1 . - INSPECTION APPOINTMENTS /r STREET LOCATION TIME TIME TIME ❑ One [3Four ❑ Other _42 -SINGLE FAMILY (-h 1 -m DATE DATE DATE l^.• ❑ INDIVIDUAL' II.tA11 INSPECTOR. INSPECTOR INSP TOR �. MUNICIPALITY OF ANCHORAGE PALITY OF ANCHORAGE OF HEALTH & ENVIRONMENTAL PROTEI r6jW DEPARTMENT DEPT. OF,,.ITiIG 1 825 L Street • Anehoraga, Alaska 98501 ENVIRONMENTAL :CTION ENVIRONMENTAL SANITATION DIVISION MAR 2 b 1980 Telephone 2644720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE",,_4,A`Ff9—'yFED DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWN R �r / PHONE _ 0) MAILING ADDRESS PROPERTY RESIDENT Of different from above) PHONE 2. BUYER PHONE MAILING ADDRESS A vre��- L019 It 3. LENDING INSTITUTION '") PHONE MAILING ADDRESS 4. REALTOR/AGENT ' PHONE U o Y8'7l MAILING ADDRESS vwjG -asb 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One [3Four ❑ Other _42 -SINGLE FAMILY ::0" Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY ❑ INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled .71E5, COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM - 7 ❑ INDIVIDUAL/ON-SITE" AOV4 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLICUTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) �� 0' '" 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY THIS SIDE FOR OFFICIAL USE ONLY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS N ' Iw \ It—APPROVED FOR tL BEDROOMS ❑ CONDITIONAL APPROVAL (letter must acco �® DISAPPROVED ny certificate) 17 DATE S. BV rA 72010 (Rev. 6/79) MUNICIPALITY OF ANCHORAGPEAGLE RIVER AREA � oDEPARTME,.. OF HEALTH AND ENVIRONMEN. ._ PROTECTION 825 L Street, Anchorage, Alaska 99501 279-2511, ext. 224 or 225 \� Date Received: August 31, 1977 �d ,,�� 1 6 ' #1: Time 4:30 a.m. #2: Time #3: Time Date 9-6-77 Tuesday Date Date Insp Kennedy Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: United Bank Alaska Mailing Address: 645 G Street 99501 Phone: 278-9526 2. Property Owner: Donn G. Zimmerman, Jr. Phone: 688-9024 Mailing Address: Box 596 Eagle River 99577 3. Legal Description: Lot 4 Block 5 Meadow Ridge Estates 4: Single Family Residence: ( 3 Multiple Family Residence: ( ) Number of Bedrooms: Three Number of Bedrooms: 5. Well System: Individual Well ( ) Community/Public System (x)3 Permit # Construction Depth of Well Well Log on File ( ) Bacterial Analysis 6. Sewage Disposal System: On-site System ( $ Permit # Installed 1977 Septic Tank Size Public Utility ( ) Installer Manufacturer Absorption Area Soils Rate 7. 'distances: Well to Septic Tank to.Sewer Line to Nearest Lot Line Nearest Lot line Material to Absorption Area Absorption Area i n MUNICIPALITY OF ANCHORAGE • C. Department of Health and Environmental Protection,:,;' 3U1 825 L Street, Anchorage, Alaska 99501 'U 279-2511, ext. 224, 225 .,^.^ (� quest for Approval of Individual Sewer and Water Fac litigs 1. Property Owner: Mailing Address: �c w' S�iG �/o �Z:yow-Ak hone: El _` C4 cr5s-77 2. Name of Buyer: 2c1 9 ct a TnP -- 3. 4. 5. M 7. 0 Mailing Address: Phone: Lending Institution: U 1e I ��i, tik A L'S K-5 Mailing Address: Realtor/Agent: MA c %is Mailing Address: Phone: Phone: Legal Description: /VI eo N Street Location: A/0u)4c-lenc4 Single Family Residence: (DZ) Number of Bedrooms: 3 Multiple Family Residence: ( ) Number of Bedrooms: Water Supply: *Individual well ( ) Public/Community System ()Q If Individual Well, well depth If Community System, name of.system Sewage Disposal System: On-site System k Public System ( ) If On-site System, date of installation: 41;;;,7 *:TOTE: A well log is required on ALL wells drilled since 6/75. 3/77 rage Two Department of Iiealth and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 4 Block 5 Meadow Ridge Estates Subdivision Comments: Affadavit Attached: ( ) Approved: Disapproved: Department Worksheet: Letter Attached: ( ) Date: Date: