HomeMy WebLinkAboutMEADOW RIDGE ESTATES NORTH ADD BLK 4 LT 3Meadow Ridge
Estates North
Block 4
Lot 3
#051-531-05
i~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL DESCRIPTION
LO~AT~ON
~ Manufacturer
~ ~ k~q. c allons
0 ~ Manufacturer~ Material Uquid ca~acitg in ~allons
O DISTANCE TO: W~ (~i~ ~) Nearestiot,~ '~ PERMITNO~,~,
~Z~ No. oflines/ Lengtho~hli~ !~__, ~ ~tallo~X,~flines I Trenchwi~ inches Distance between lines ~
~ ~ ~ Top of tile to finish grade / Material beneath tile ~ Total effe,tive absor,Jion area
~ ~ inches
Length Width ~ Depth PERMIT NO.
~ ~ Type of crib Crib diamete Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
m DISTANCE TO:
~ Class Depth, ~ Driller Distance to lot line PERMITNO.
~ ~ ~ ~ ~ Buildin~ foundation Septic tanA Absorption area(s)
~ DISTANCE TO:
OTHER
SOIL TEST RATIN~
I NSTA L LE~
REMARKS
~ AT LEGAL
APPR
~/' $OfLS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
826 L. Street, Anchorage, Alaska 99501 2644720
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
· 3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
SLOPE
DATE PERFORMED;
S~T~ FLAN
WAS GROUND WATER
ENCOUNTERED?
Russell L, Oyster
s
L
P
E
IF YES, AT WHAT
DEPTH?
G:o~a Net Depth to I Net
Reading Date Time Time Water Drop
I
PERCOLATION RATE
TEST RUN BETWEEN FT AND ---- FT
PERFORMED BY: [
{m;nutes/inch }
MUNICIPALITY OF ANCHORAGE
Department ~ Health and Environmenta' ~rotection
825 ~ Street, Anchorage, AK. ~9501
* * * HANDWRITTEN PERMIT * * *
Permit ~ ~ ~ON-SITE SEWER PERMIT
Applicant: ~U~cf-. /%/~"9-'~.,9;//~. _ Mailing Address:
Location: Phone Number:
Legal Description: ~ r ~ a ~ ~~.~, ~J, Lot Size:
Type of Soil Absorption System Is:
Trench: .~ Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: '~ Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
DEPTH "'7 LENGTH _~~_ GRAVEL DEPTH WIDTH
The length dimension is the length(in 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(in 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(in feet).
* * REQUIRED SEPTIC(HIDe'D-lNG) TANK SIZE : /~)0 GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
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 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * *
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) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residen~e is remodeled to include more tha~ 3 bedrooms, ·
Signe~: ~ /~-~ Issued by:~Z,/~
~an~ - d '
Appl'
Date: 7--
SWP/024 (1/81)
Parcel I.D.
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
051531-05
1. GENERAL INFORMATION
Complete legal description
COSA
Expiration Date: �e - .Z _/0
Meadow Ridoe Estate North Addition, Block 4, Lot 3
Location (site address) 21226 Meadow Lake Drive, Chugiak, AK
Current Property owner(s) Brian and Marilyn Hoffman
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Audrey Mason
Day phone 666"5604
Day phone
Day phone 6!2344
76000 Centerfield Dr.. Ste. 201, Eagle River, Alaska 99577-7702
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
❑
Individual Water Storage
❑
Community Class Well
❑
Public Water System
0
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
[Z)
Individual Holding Tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the Slate of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
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 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 Douglas T. Kenley, P.E.
Address 9806 Northstar Cirde, Palmer, AK 99645
Phone 907-746-1073
Engineer's Printed Name Douglas T. Kerley Date _4-17- og
r tv' OF••'A
5. DSD SICaNATURE r :80 1✓
Vf
Approved for _ bedrooms. i!I 81Y•
Disapproved. f
Conditional approval for bedrooms, with the following stipuul
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: Original Certificate Date: ��
(R• 1185)
Municipality of Anchorage
!� ,t Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVALCHECKLIST
Legal Description: Meadow Ridge Estate North Addition, Block 4. Lot 3 Parcel ID: 051-531-05
A. WELL DATA
Well type Public If A, B. or C provide PWSID # _ Well Log (Y/N)
Date completed _ Sanitary seal (YIN) _ Wires properly protected (Y/N
Total depth ft. Cased to ft. Casing height ((may round)
FROM WELL LOG AT I
Date of test
Static water level
Well production
WATER SAMPLE
Coliform colonies/100 mL Nitrate mglL Other bacteria
pr mc: mg/l Date of sample: _ Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SepticlSteel Date installed
ft.
g.p.m.
colonies/100 mL
08/06/83
Tank size 1000 gal- Number of Compartments 2 Cleanouts (Y/N) y
Foundation cleanout (Y/N) Y' Depression over tank (Y/N) N High water alarm (Y/N) NIA
Date of pumping 6/8/09 Pumper JRs PumPors
C. ABSORPTION FIELD DATA
Date installed 08/06/83 Soil rating (g.p.d./fe or fe/bdrm)140 sq Nbdrm System type _
Length 525 ft„ Width unknown ft. Gravel below pipe
Trench
4 ft.
Total depth L6 ft. Eft. absorption area 520•• ftZ Monitoring tube Y Depression over field N
Dale of adequacy test 6/5109 Results (Pass/Fail) Pass For 3 bedrooms yy
Fluid depth in absorption field before test 25.316 in. Water added64? gal. . New depth �!in.
Elapsed Time: 250 min. Final fluid depth 36.1/2 in. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment (past 12 me.) (YIN & type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons
'Pump on" level at _ in. 'Pump off' level at _ in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO/
Septic tankfift station on lot
Absorption field on
Public sewed
/septic service line
Animal containment areas So f o
Manhole/Access (Y/N)
High water alarm level at
Meets alarm &
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas 10 O+FY
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ ft. Property line 10+11. Absorption field 5+ ft.
Water main 10+ ft. Water service line 10+11.1•• Surface water 70+ ft.—..
Wells on adjacent lots 200+ ft.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
in.
Property line
10+ft.
Building foundation 10+ ft.
Water main 10+ ft.
Water Service line
110+ ft....
Surface water 70+ft ••'•
Driveway, parking/vehicle storage 110+ ft.
Curtain dram N—k—be" Wells on adjacent lots 200+ ft*
F. COMMENTS: •From MOA records. "Per 1983 installation record. --Water service line location unknown, see previous HAA.
••"Waiver on rile from 4/2/2001.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Douglas T. Kenley
Date & 41, Dq
COSA Fee $ �T
Date of Payment �o
Receipt Number?
(Rev. 11/05)
Waiver Fee $ _
Date of Payment
Receipt Number,
449 M
•y;,�,•,D011� T K
Municipality of Anchorage
• Development Services Department
Building Safety Division
-= On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D._ Q 51-551-05 COSA
Expiration Date: _ % — Ce — Q 7
1. GENERAL INFORMATION
Complete legal description lot 3 Block 4 Meadow Ride Estates North
Location (site address) 21226 Meadow Lake Drive Chu iak AK 99567
Current Property owner(s) Baan b Marilyn Hoffmann
Day phone 748-7111
Mailing address 21226 Meadow Lake Drive Ch liak AK 99567
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
19
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class A Well
®
Community On-site
1:1Public
Water System
13
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
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 Certificate of Onsite Systems Approval Guidelines for this app
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 Pannone Engineering Services LLC
Phone 272.8218
Address P.O. Box 102954 Anchorage, AK 99510
Date
Engineer's Printed Name Steven R. Pannone P.E.
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions
encountered at the time of the test, and separation distances measured to readily identifiable features. ���..�saa
The operational life of all wells and septic systems depend on the local soil condition, ground water .P`[v A( to ♦..
levels that may fluctuate during the year, and the water usage of the faintly being served by the system.
Thesc conditions are outside the control of the evaluator of this system. All systems eventually fail ;
satisfactory test results do not guarantee future performance of system nor do they g is -00
there are no hidden defects or encroachments. PES can therefore not provide any warranty for future i. 0
performance nor give any estimate of how long the system will continue to meet the operational 0_'. sle e� R. ammo e�
requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed �. ^ 8149
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it a♦,{�, y�
confer any legal right whatsoever. 04444�`" " IC
11P,
DSD SIGNATURE Q
✓ Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: 7— o —06
By:
(RW. 110 1)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Sne Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 9951943650
www.muni.org/onsite
(90) 343.79W
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 3 Bloek 4 Meadpw Rldoe tisias North
Parcel ID: O S'/ — S
A. WELL DATA
Wen type g
Total depth
Date of test
Static water level
Well production
WATER SAMPJ,,E'
TS:
If A, B, or C Provide PWSID #I=
Sanitary seal (YM)
Cased to ft
WELL LOji i
"O"'OM C010nies/100 mL
nic: _ mgfi
B- SEPTICIHOLDING TANK DATA
Nitrate mg/L
Date of sample:
Well Log
Wires p (Y/N)
sing height (above ground) in.
AT INSPECTION
Collected bY:
ft.
oolonies/100 mL
Tank Type/Material _Q ar t3teel
Date installed
3
YM
Tank size �_ gal. Number of Compartments j Cleanouts .
Foundation cleanout �/N ) Y
( ) i Depression over tank (Y/N) y High water alarm (Y/N) w-_
Date of pumping �Og � Pumper JFts Pumelna
C. ABSORPTION FIELD DATA
Date installed 011983 Soil rating (g.p.d./R? or fe/bdrm) j4o_ System type — Isneh
Length 84,5 ft Wkttii
I 3 11ts�ul la ?'revel �e nntrpe 4 ft.
Total depth 1,¢ ft Eff. absorption arae, "ftp Mon ornK4
storing tube Y Depression over field y
Date of adequacy test �@(2pgg Results (Pass/Fall)
Pass For, bedrooms
Fluid depth in absorption field before test 19 in. Water add
eda gal. New depfh!g in.
Elapsed Time: !IN min. Final fluid depth .V in.
Absorption rate >= 40 __ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) A )Q
If yes, give date
STATION
pate in led Sim in gallons
'Pump on" lav - tat,, in. 'Pump off"
Datum
Cycles
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM
Septic tankllift station on lot
Absorption field on lot
Public sewer mai
Sewer f c service line.
mal containment areas
at _. in.
TTO
On
(YIN)
water alarm level at in.
Meets alarm ti circuit requirements?
adjacent lots
Public sewer
Holding tank
Manurelanimal excrete storage areas
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundationJ± Property line 110+ Absorption field
Water main 10+ 1
Water service line 10+J� Surface water +j N 2 U
Wells on adjacent lots 200+ 1� cckn�
l�F•f' ��U1C-Q- sem pCeV
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property One j2t. Building foundation 10► �ttWitter main 10+
Water Service line 1M�' Surface water " �� D parkinphre►�ide garage 10+
Curtain drain None Observed Weis on adjacent lots 2W _
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance wlth MOA COSH guidelines in effect on this date.
Engineer's Printed Name 810190 a Dineene. 1
Date (e (�/O ('
COSA Fee $
0 , �.1 Waiver Fee $ _
Date of Payment
r
3 0 & Date of Payment
Receipt Number
Receipt Number
(Rev. I IM)
7Ve+e� R. Porro
^r c•r:
1A
��. RoLr: t C.
• i�•'r� Gr. uyV.S',
��, �.J/t'�"I.+"�'•aa-rte .
AS -BUILT
I hereby certify that I have surveyed the following described
�, / (, / /-
property: � ... 3� r'r <_G..L__7'} 1V.tdS e1•� _
7 1 LAJfF'fW4
Anchorage Recording Precinct, Alaska, and that the Improve-
ments situated thereon are within the property lines and do
not overlap or encroach on the property lying adjacent there-
to, that no Improvements on property lying adjacent thereto
encroach on the premises in question and that there are no
roadways, transmission lines or other visible easements on
said property except as indicated hereon.
Dated at Eagle River, Alaska
/!
w, '2_7 day of 19 04' K
ROBERT C. JOHNSON S `_�,
SCALE: Registered Land Surveyor No 880•LS
Box 456• Eagle River, Alaska
Phone (907) 694-2543
%,a
N
N
N
tri
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
\ Division of Environmental Services
Onsite Services Section
P.O. Box 196650 Anchorage, Alaska 995196650
(907)343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
Parcel l.D.# 051-531-05 HAA# HAO10114
1. GENERAL INFORMATION
Location (site address or directions)91726 MEADOW 1 AKF DRIVE CHUGIAK. AK 99567
,roFertl,, owner 1:161301 Q W11 SON Day phone 997-5161 /688-1206
Mailing address 91996 MEADOW I AKF DRIVE CHUGIAK- AS 99567
Lending agency
Day phone
.address
Agent FE6tjE STEVENS _W/ pguDFEAL_yL9j� F.R. Dayphone (907) 689-6480
Address 16635 CFNTFRFIFir) DRrVF SUITER103 EAGLE RNER, AK 99577
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
3
xxx
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 xxx
Holding Tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
Ing to the legality and status of system.
72-025 (Rev. 1191) Front MOA021 Computer Version
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid X2120.00 at,
or prior to, closing for the engineering services provided.
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 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 in compliance with all MunicipalAnd State codes, ordinances, and regulations in effect
on the date of this inspection. I llj�A
Name of Firm
Phone (907) 337-6179
Engineer's Signature k�Date
In conducting this evaluation, AWWC, inc. a m ed to pravide a thorough, conscientious engineedn� analysis of the
system In accordance with ADEC and M A H Guidelines & Regulations. The reported results described the
performance of the system under the conditions encountered at the time of the test, end separation distances
measured to re adilyidentiiiabie features. The operational life of all wells and septic systems depend
on the local soils condition, ground water levels that may fluctuate during the year, and the water o�00 O
usage of the family being served by the system. These conditions are outside the control of oo�OF 0
the evaluator of the system. Satisfactory test results do not guarantee future performance C`
of the system, nor do they guarantee that there are no hidden defects or encroachments. pd
AWWC, Inc. can therefore not provide any via rran ty for future estimate of how long the 4
system will continue to meet the operational requirements of the ADEC or MOA DHHS. ;P4* 4
..% ......
The content of this report is for the sole benefit of the owner listed above. Any Q
reliance upon or use of this report by any other person or party is not authorized,
nor will It confer any legal right whatsoever. * •J ffrer A. or ss,
6. DHHS SIGNATURE
Approved for 3 bedrooms
Disapproved
Conditional approval for bedrooJ(h tlli ,j jtgWing
Additional
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.
72425 (Rev.1191) Back MOA #21 Computer Version
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825'/' Street, Rm 602 Anchorage. Alaske 99501 (907) 343.4744
Health Authority Approval Checklist
Legal DeSCrlpboM MEADOW RIDGE ESTATES S/D: LOT 3. BLOCK 4 Parcel I.D.: 051-531-05
A. WELL DATA
Well Type CLASS n" K A. 8, or C, attach ADEC letter. ADEC water "stem number 211431
Log present (YIN) — Date completed —
Total depth — Cased to — Casing height (above ground) —
Sanitary seal (YIN) — Wires properly protected (Y/N)
Date of test
Static water level
Well production
eon" vier r 1 na
WATER SAMPLE RESULTS:
AT INSPECTION
Coliform — Nitrate — Other bacteria —
Date of sample: — Collected by:
S. SEPTICIHOLOING TANK DATA
g.p.m.
Data installed 8/6/83 Tank size 1000 Number of Compartments _Cleanououts (YIN) YES
Foundation cleanout (YM) NO Depression (Y/N) NO High water alarm (YIN) N/A
Data of pumping 6/28/2000 Pumper JR 'S PUMPING
C. ABSORPTION FIELD DATA
*PER INSPECTION REPORT
Date installed 8/6/83 60 rating .p.d r 10bdrn) 140 System type TRENCH
Length 52.5' Width U.K. Gravel thickness below pipe 4' Total depth 7.5' — 8'
Effective absorpilon area •520 SO.FT. Monitoring Tube present (YIN) YES Depression everlleid (YIN) NO
Date of adequacy teat 6/29/00 Results (Peas/Fail) PASS For 3 Bedrooms
Fluid depth In absorption fletd before test (In -Y, 33' Immediately after 700+ gal. water added Qn.} 43.5"
Fluid depth U. (ins) Minutes later. 1074 Absorption rate a 450+
Perwdde treatment (past 12 months) (YIN) NONE KNOWN K yea, give date -------
:Z_= otw• doer cwaw VeMon
D. UFT STATION
Daae installed
Manhole/Access (Y/N) 'Pump on'
High water alarm level at! •Datum
E. SEPARATION DISTANCES
In
'Pump off" level at'
SEPARATION DISTANCES FROM WELL ON LOT M. COMMUNITY WELL
Septidholding tank on lot On
Absorption field on
Public sewer
r -T.=
sewer manhoteldeanout
line Lift
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: .SEE ATTACHED WAIVER REQUEST
Foundation 5'+ Property line 5'+ Absorption field 5'+
Water maiNservice fine "10'+ Surface wateddrelnege '70'+ Wells on adjacent lots 200'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: "LOCATION OF WATER SERVICE LINE
IS UNKNOWN. 10'+ PER PREVIOUS HAA.
Properly line 10'+ Building foundation 10'+ Wader maWservioe fine `•10'+
Surface water *70'+ Driveway. parkingNehide storage area 1'+
Curtain drain NONE KNOWN Wetly on adjacent lots 200'+
F. ENGINEER'S
1 Certify that! i
of Mundypal
w0 MOA N
Signature
Englneeft
Inspections and review
ems are In conformance
Is date.
HAA Feet 300 .00 Walver Fee S 920 •0'
Date of Payment r� - a3 �l Date of Payment 3'R3 "h/
Receipt Number 13 / Receipt Number 13 %
72-02s Ma. aur cmvtftr vwwm
w roico/
ALASKA. WATER & WASTEWATER
CONSULTANTS, INC.
July 17, 2000
Municipality of Anchorage
Department of Health & Human Services
On -Site Services Section
Attn: Dan Roth
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Waiver of Separation Distance from Septic Absorption Field to Surface
Water for Lot 3; Block 4; Meadow Ridge Subdivision
Dear Mr. Roth,
The referenced property has a 3 bedroom house served by a private septic system and a Class "A"
Community Well. During our recent septic evaluation for purposes of obtaining a Health
Authority Approval, we determined the separation distance between the leachfield and a marshy
area next to Meadow Lake is only 71 feet to the cleanout located at the south end of the trench.
When the wastewater system was installed in 1983, the marsh next to the lake was over 100 feet
away. However, since that time the M.O.A. road department has significantly modified roadways
and culverts in the vicinity causing a rise in the "wetlands".
Request you issue a waiver for the separation distance from the leachfield to the marsh
surrounding Meadow Lake to 70 feet. Justification for the waiver is summarized as follows:
1. Enclosed is an asbuilt survey, and a site plan showing elevations of the property. The house is
constructed in such a way that if the absorption field was to fail, it would back into the tank and
then into the crawlspace, alerting the homeowner to the problem prior to it daylighting on the
ground.
2. The ground from the trench to the creek is moderately vegetated, and would provide some
filtration should effluent surface.
3. D.H.H.S. has granted similar type waivers on adjacent properties. Lot 4; Block 4 Meadow
Ridge Subdivision has a waiver of 76 feet to the tank and 78 feet to the drainfield.
4. The property is served by a Class "A" water system
6901 Debarr Road, Suite 2-13 • Anchorage, Alaska 99504
Ph: (907) 337-6179' Fax: (907) 338-3246 • email: info@akwwe.com
Page Two
Waiver request for Lot 3 Block 4; Meadow Ridge Subdivision
Based upon our evaluation of the site, and the limited risk for potential contamination, it is my
recommendation that the separation distance from the trench to the surface water be waived from
100 feet to 71 feet.
If you have any questions, or need additional informaiton, please contact us at 337-6179. Thank
JAG/gd
6901 Dcbarr Road, Suite 2-B • Anchorage, Alaska 99504
Ph: (907) 337-6179' Fax: (907) 338-3246 • email: info@akwwc.com
lkock
LOT
M4W R p�f A:
/ I
EXISTSEPTIC TANK
ING 1000 wuoN
GRAVEL ORWWAY /
to T P OF ELEVATION K /
•//% QO I oO .- 97.00 E%ISITNG D NFIELD
Po TER rnAz PASSED ADEQUACY TEST /
�// j •, p, t't$� ON 8/29/2000. '
ELEVATION OF EA UMP
SURFACE89.31 / PoA'D ,
GRADE ELEVATION J
ATSUMP
OF M SU80
etoc
I
WE: ooh O
7/5/2000 oa pF app
DRAWN BY: ... •• (1VO
V
ALASKA_R._'ATIJR 8 lVASTENVATTR M.
CONSULTANTS, INC. sem' .....
690 DESARR ROAD, SUPE Ire • ANCHORAGE AN 9950. • FHONE 907)377-6179 • FAX 907)375.1246 1 w = 40•
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: A
HAROLD WILSON 227-5161/688-1206 1 OF 1 a p e r A. ..•.•ess:
LEGAL DESCRIPTION: Q ° C 7953 e
MEADOW RIDGE ESTATES S/D/; LOT 3. BLOCK 4 ���� ' •.•• ``�o
MESITE PLAN FOR WAIVER REQUEST. �4�004pp0000�oo
Municipality of Anchorage
Development Services Department
• r Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.snchorage.ak.us
(907)343-7904
Waiver Review Worksheet
WR#: WR010015 PID#: 051.531-05 HAM HA010114 Permit#:
Date Received: 3130101
Legal Description: MEADOW RIDGE ESTATES SUBDIVISION BLOCK 4 LOT 3
Engineer: ALASKA WATER & WASTEWATER CONSULTANTS INC.
13901 DEBARR ROAD SUITE 28, ANCHORAGE, ALASKA 99504
Applicant: HAROLD WILSON
Waiver Requested: 70 FEET FROM THE SEPTIC SYSTEM TO THE MARSHY PORTION OF MEADOW
LAKE
Criteria:
Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Waiver is Granted: V_
Points:
Total:
Waiver is not Granted:
List Conditions or Reasons for above:
S r 1= E.V
/M t`'FK 1,
4 TT /4 <M FO
LEirFr? of V:rr/F/l1v'r14
✓ Q1r410
JULY
/7., 2060
Date: 0/ By: _0,/22/
Name of Reviewer
Rec#: 2137 Amount: 920 Date Paid: 3123101
I
f
�y
_
� �
'1` 1•
yx id �j
♦�
.
^-
.T
' ��
.
.r
y _
r
_.... ... r' i',
�'
�...�,�
_
t �w
ri
n�-_�
1
•� �
,�
r �
�'
�'
.
�
, •
..
��
.
Y
•\
- �il ��
�'i � _� � r '� fir.
\.,\`\I•
!
� \ r
\
.
i �. {
i [ •� •
�\ it r
-�'• 'ti \iJ
� �. ;,.i
.
�+t,�
!
- '.
�>„
1
..
)
...:
.. .. ..r
..
F, ._. .. _ ,� ._ ..
.- _., ..
� ...
,.
_.
�_..., __ __ __
�1 w � ,�
�• y yR
.44 "t
i..
J
r
`4
4
N
l
i..
J
r
04/02/01
Mimicipality of Anchorage r'
George P.11'aerch,Mayor Department or
Public Works
Building Safety Dix inion
P.O. D)x IW. )50 • 4700 S. Dragaw Street
Anchorage, Alaska 99519-rirw0 • (907) 343-5301
h U p://e���e.ci.nnchom �e.ak.us
Jeffrey A. Gamess, PE
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B
Anchorage, Alaska 99504
Subject: Waiver Request for Meadow Ridge Estates Subdivision Block 4 Lot 3
Waiver Request #WR010015
Parcel ID 9051-531-05
Health Authority Approval Number HA010114
Dear Mr. Gamess:
Your request for a waiver of the required 100 feet horizontal separation from the
on-site wastewater disposal system to surface water has been approved. The approved
separation distance is 70.0 feet.
This waiver approval applies to the existing on-site wastewater disposal system to
surface water 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.
Sin
cerely,
� rr;;�r
Daniel J. Roth
Civil Engineer
On -Site Water & Wastewater Program
MUNICIPALITY OF ANCHORAGE
D~VlSiO~ oF ~.~l~O~iL ~TH
1. General Information Application Date
/ / ,
(a) Legal D~scriptton (include lot, block, subdi~ion, sec~n~ co~ship, ra~e)
Loc~tion (address/ or dlrec~ons)
(b) Applicants Name.:~x~. /
Applicants Address
(c) Applicant is (check~on~e~) Lending Institution ~ Owner/builder
Buyer ~--~ ; Other
(d) Lending Institution '~/~.~,~--~~ ~ff~7~, / Telephone
Address
Address
Telephone
(f) Mail..the HAA to the following address:
2. Type of Residence
Single-Family~
Number of Bedrooms
Multi-Family~--~
Other (describe)
3. Water Supply
Note: If community well system, must have written confirmation from the
Department of Environmental Conservation attesting to the legality and
4. Sewage Disposal
Onslte ~ ~u~lie ~q ~ommunity ~--q Holding Tank
Note: If community well system, must have written confirmation from the
Department of Environmental Conservation attesting to the legality and star,Is. 'Z;
[Page 1 of 2]
EnBineering Firm Providing Inspections~ Test.s~ File Search~ Data and Information
As certified by my seal affixed hereto and as of the validation date shown below,
verify that my investigation of this Health Authority Approval 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 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 in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm
Address
Date
DHEP Approval
Approved for
Approved ~
bedrooms
(ENGINEER SEAL)
By ~ //
Disapproved f'/-/ Conditional ''
Telephone
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP 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.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2] 7-19-84
A®
Well Classification
Well Log P~esent ,.(.Y/N)
Total Depth
Static Water Level
Casing Height Above Ground
Electrical Wi~ing in Conduit (Y/N)
Separation Distances f~cm Well:
MUNICIPALITY OFANCHORAGE (MOA)
HEALTH AUTHORITYAPPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description
Cased to
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
,9 1984
If A, B, C~ C, D.E.C. Approved(Y/N)
Yield
Depth of G~outing
Sanitary Seal on Casing (Y/N)
Dep~essionA~oundWellhead (y/N)
; On Adjoining Lots
Date Completed
Pump Set At
To Septic/~Iding Z~ank on Lot'
; On Adjoining Lots
To Near'st Public Sewe~
To Nea~est Sewe~ Service Line on Lot
; Date
To Nearest Edge of Absorption Field on Lot~3~ t./_
To Nearest Public Sewe~ Line
Cleancut/Manhole
Wate~ Sample Collected By
Wate~ Sample Test Results
C~tents
B. SEPTIC/~TANK DATA
Date Instal~ ~/~/~ ~ Size
Standpipes~ . Ai~-tight Caps~
~p~ession o~ Ta~ (~ Date ~st P~d~
P~ing~intenan~ Con.act ~ File (Y~/~ ; fo~
Holding Ta~ High-Wate~ Ala~ (Y~ ~a~y Holding Tank ~rmit
Sep~ation Distance ~ ~ptic~Tank:
To Water-Supply Well
To Property Line /d)
To Water Me~/Se~vice Line
Cour se
Counts
/0
No. of CQ~pa~tments ~
Foundation Cleanout ,(~
To Building Foundation
TO Disposal Field /O
To Stream, Pond, Lake, o~ Major D~aina~e
Receipt
Date Paid:
Amount:
[Page 1 of 2]
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Installed ~/~/~ ~
Date
Width of Field ~f ~i'.
Square Feet of Absorption Area
Depression over Field
Results of Last Adequacy Test
/~ ~/~ Type of System Eesign~
Length of Field ~-~//~ '
Depth of Field ~
~/Gravel Bed Thickness ¢8"
/- Standpipes Present (Y~
Date of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ~--OO ! ~- To P~operty Line /~3 ~
To Building Foundation ~--~ ! To Existing or Abandoned System on
Lot /~o ~;'~ ; On Adjoining Lots _~ f~-
To Water Main/Service Line /d) ! ~ To Cutbank(if present) ,~3~'u'~=
To Stream/Pond/Lake/or Major Drainage Coarse /~d) ! ~
To Driveway, Parking Area, or Vehicle Storage Area /O ! F--
Con~ents ~ ~ ~ ~--
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
, // "Pump Off" Level at
//~// ,~. "' Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
~ets MOA
** Check Permitted Bedroom Rating Against HAA P~quest
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
on the date of this inspection.
KB1/d5/s
[Page 2 of 2]
Date
MOA No.
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA g9501
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-2533
MUNICIPALITY OF ANCHORAQI~
DEPT. OF HEALTH &
ENVIRON~VtENTAL PROTECTIOI'¢
NOV 2 I984
RECEIVED
To Whom it May Concern:
According to records on file in this office the
Water System is in compliance-with the State Drinking
Water Regulations
Sincerely,
APPLIC . IT FILLS OUT UPPER HAl. ONLY
Property Owner Al( Painting & Drywall Phone
MailingAddress941 E Dowling Rd., Anchorage ZipCode 99502 694-9711
Buyer
Unknown
Address Zip Code
Lending I n stitut ion~/t~jS Phone
Address Eagle River Branch, Parkgate Building ZipCode 694-9571
Realty Co. & Agent Commonwealth Area, Inc. Realtors (Helga Larson) Phons
P.O.Box 249, EAGLE RIVER 99577 694-9555
Address Zip Code
Legal Descripti°~ot 3, Block 4 Meadow Ridge Estates
Headow Lane
Street Location
Type of Residence
Single Family
Multiple Family No. of Bedrooms .~.""5 --~,,t
[] Other
Water Supply
[] individual ATTACH WELL LOG. A well Icg is required for aB wells drilled since June 1975.
~ Community ~..,.~/_ "~3,~_ ~. For wells drilled prior to that date, give well depth (attach Icg if available).
[] Public Utility
Se~er Disposal 8 3
~ Individual Year Individual Installed:
~ Public Utility When Connected to Public Utility:
L~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date \ 0
Inspector Inspector Inspector Inspector
Field Notes: --,~r '~ ~1~ g ~.~1~, ~u~
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
DATE _~ ~g' ~ ~
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
J NO ~ --~ ~ ) Well to Tank Septic T~k Size
Ak Pair]ting & Drywall
?~nchorag(:¢ AK 9950Z
be 9ranted ~]ntil the follo%¢in<j ite~s i~avc L~ee~
nt]~nber t~e on-site sewer systen~ ~¢as originally
for. ~¢~ up~jrade will Oe requirect. Prior to .~y u~grc~de,
Sincerely,