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MEADOW BROOK BLK 2 LT 9
Meadow Brook Block 2 Lot 9 #050-191-56 Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: S""18o4 o PID Number: DSO — 19 1 --Sb Name: 5 a �L CI��ITSMarJ El Wastewater Systern: New l&Upgrade Address: l 34 Rt CIRGLE �A1�1,& QIJb'K Aiclwrl ABSORPTION FIELD Phone: L 6- obl - r-687_8 I No. of Bedrooms: D� Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: I 7— Total Depth from original grade: GPD/Sq. . Ft. S•98 "' 10.07. Lot: q Block:/ Subdivision: Z E 911 Depth to pipe bottom from original grade: 1.110— z qLf Gravel depth beneath pipe S I I•I-,t Doul Ft. {• Ft. Township: Range: Section: Fill added above original grade: Gravel length: 1 —' _ ..66 -- 7_.8 c Ft. 3 6 Ft. WELL • El New El Upgrade Gravel width: I Z Number of lines: Dis ance be ween lines: N Ft. Ft. Classification (Private, A,B,C): Total Depth: o: PJSL I Total absorption area: Pipe material: G Ft. Ft. .54ZI SO. Ft. ASTM 93034 SC Lrb We_ Driller: ate Drilled: Static Water Level: Installer: Date i ailed: Ft. 'r r. F-0 U --%C 3 5 — 8 Yield, Pump Se at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES Ja Septic 13 Holding J19 S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines I�w1 (� F 1500 wel rl A u�A A — IJ A Material: Number of Compartments: Surface Water water loolt 1001tloot-} LIFT STATION Lot 14- II I l �. "-" Size in gallons: Manufacturer: Mc,TANK Line t II l50In 02g O28NC0 SySTan+ Foundation •71•�• 8 I .7 I } ,�. "Pump on" level at: "Pump off' level at: ''F311 A13u High water alarm at: 4&; Is CurtainfJa� �� Pump Make & Model Electrical Inspections performed by: Drain zo 0&1 os, 14414 Remarks: `AY Ude o s 1 •s. G¢q,,rev BENCH MARK Avie.Y L E: AJEvt Li Pee- I WAVER t$ 41R`I8006 7`4- 8 WAtfevL T -n Location and Description: / � lye m -T.P F Coe1e _IA& w ?UP- ISSOFACE OF N "AIT SYS?eM LWAS f�p r' of MA,Doo f�sIGrFCO (=oR f{ gEDReO 5• iiodeVE2 TkE Assumed Elevation: /00.0 ENQIiJF��� L VAodse cA-i awl.•? %r RATep Fol 3 erzoeoams urJYlL. k ��� �L ✓ e� b $eQ r*efi o at, -r2 • ef r-1, W06graftooOFA m tE IIS RP �p IIISJt1°rRF Pae CeNlltn[ooq. Inspections performed by: I Dates: is 3 r ,' ; `:"• «. 'a" L. 2nd 3 5- - 5/$/q9 .G ... Nra .ca X953 ��ta Department of Health and Huuman Services approval f,��V-� i^+.>r+i• •. Reviewed and approved by: Date: 3-1A-99 ft�.��*�' 72-013 (Rev. 9/91) MOA 25 PERMITNUMBER: AS -BUILT DRAWING PARCEL 10 NUMBER: SW9 _ SW980400 050-191-56 1� 1 � FENCE 1 1 m 1m NEW ORAINHELO NEW 1500 GALLON S.T.EP. SYSTEM I (WITH DUAL OURETS) � MT1 KEY BOX MT TH#1 .4T/CO ER LINE CATION) � FENCE EXISRNG CRIB '1 TO BE USED AS A RESERVE SITE. f [WGi -99As 59 512 MM�q.E r[P OF TANK IANC a N Cf -95A4� a 0=&- "DO NEW 1500 GALLON NVwcfv Y 5f,e?. 5Y5SM o Af N&-94.50 ( WITH t9LPL OUTLETS) aolm�r-95.30 BJ34UVGJ ALASKA WATER AND WASTEWATER CONSULTANTS, INC. 6801 OEBARR ROAD SURE 2B. ANCHORAGE. AK 99504 , PHONE (907) 337-6179/FAX: (907) 338-3246 MEADOW BROOK SUBDIVISION, LOT 9, BLOCK 2, TYPE OF WORK: AS -BUILT OF SEPTIC SYSTEM UPGRADE Q SHERYL CLINTSMAN 696-4061/279-6828 3/9/99 ly J.L.M. I 1= 30' I 2 OF 2 i 4 ti e Garn ss.- C 7953 8P9 t:LEGTR SC vpr amv��sassm ;,u ANCHORAGE 3169 mc-pCIA4T3PlVE Fax:(,9071272.4506 AWHOSA,OE+ALASKA 89601, • e r ??Os �. Liar? dti z.imla al a rf�c �% +R �wc .rte i 40401 iin�-tee r e - TWEED EXCAVATING tik & CQNSTRUMON 4071 N. YAG Le RIVER LOOP ROAD, GOITY 106 EAOLA AIV OR. ALABKA roan T E L E7 H O H S( 9071 4 2979 OR 04-1373 I- 6) 1-5 Z M o ".4 X101. J I" I�i SC�'wn ot✓�, "l J k���,. 1�I� V S rc. � ��f rw%.m] D" b tn�d�—rz is y, Al C RECEIVER MAR 15 3999 Municipality of Anchorage Dept. Health & Human Servlres Permit Number: SW980400 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 Z�sQe��S 3-5 -99 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Oct 08, 1998 Expiration Date: Oct 08, 1999 Parcel ID: 050-191-56 Legal Description: MEADOW BROOK BLK 2 LT 9 Design Engineer: 0041 AK Water & Wastewater Consulta Site Address: 018349 KARTA CIR Owner Name: Dale & Sheryl Clintsman Lot Size: 16142 SQ. FT. Owner Address: 18349 Karta Circle Total Bedrooms: 3 Permit Bedrooms: 3 Eagle River, AK 99577-8227 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. This system design is for 4 bedrooms, however the house can only be rated for 3 bedrooms until a 4 bedroom upgrade site is approved. Lc1 Ls,1� l�'c„veti�"WR98Gb6�{ +a Received By: Issued By: Date: d GJ Date: to -F-176 • Municipality of Anchorage Department of Health and Human Services Rick Mystrom, 825 U' Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 http>/www.ci. anchorage. ak. us October 8, 1998 Jeffrey Games, P.E. Alaska Water & Wastewater Consultants, Inc. 7320 East Chester Heights Circle Anchorage, AK 99504 Subject: Waiver Request for Meadow Brook Subdivision Lot 9, Block 2 Waiver Request #WR980064 Parcel ID #050 191 56 Permit #980400 Dear Mr. Gayness: Your request for a waiver of the required 10 feet horizontal separation from the on-site wastewater disposal system to property line has been approved. The approved separation distance is 1.0 foot. This waiver approval applies to the existing on-site wastewater disposal system 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 343-4744. Sincerely, Donna C. Mears Civil Engineer On -Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR#!t j A' 1 C 1,_1.0A PID# 050-191-56 HA# Permit # Date Received: Sept 24, 1998 Legal Description: Lot 9 Block 2 Meadow Brook Subdivision Engineer: Jeff Garness, P.E., Alaska Water & Wastewater Consultants, Inc. 7230 East Chester Heights Circle, Anchorage, Alaska 99504 Applicant: Dale & Sheryl Clintman Waiver Requested: Lot line waiver of 1 foot from the proposed trench to the northwest lot line. (8 foot waiver from the proposed trench to foundation) Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Points: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Date: In - Name of Reviewer Rec #: ount: $ 115.00 Date Paid: 9-24-98 Alaska Water & Wastewater Consultants, Inc. 7320 East Chester Heights Circle — Anchorage — Alaska 99504 (907) 337-6179 — Fax (907) 338-3246 Consulting Engineers September 8, 1998 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic Upgrade Design for Lot 9, Block 2, Meadow Brook Subdivision. To whom it may concern: The existing 4 bedroom house is served by a private septic system and by public/community water. The existing crib is surcharged and must be upgraded prior to the sale of the house. One test hole was excavated to the north of the existing septic system. We request you issue a 1 foot lot line waiver from the proposed trench to the northwest lot line. We also request you issue a 8 foot waiver from the propsed trench to the foundation. As can be seen in the attached soils log, the soils are very porous and the chance of effluent reching the foundation is minimal. Comments regarding the proposed upgrade design are summarized as follows: 1. SOH S: Attached is a log which shows the soil profile, and the percolation test result. Below the organics, the soil is a GW/SW material to a depth of 16.5 feet (bottom of test hole). No groundwater was encountered during the excavation of the test hole. One soil percolation test was performed at 7.0 to 7.5 feet which perked out at a rate of <1 minute/inch. The insitu soils is believed to have a enough fines to act as a sand filter. A grab sample has been taken and is being submitted for your review. 2. TRENCH DESIGN: a. Percolation Rate: <1 minutes/inch b. Allowable Application Rate: 1.2 gallons/day/ft2 c. Number of Bedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 500 ft2 f Effective Depth: 7.5 feet g. Reduction Factor = N/A h. Width: 2 feet i. Minimum Length: 36 feet j. Effective absorption area = 540 ft2 (>500 ft2 OK) L Maximum depth = 10.5 feet 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: The general topography of this lot is mostly flat. There are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance. , Sincerely, trio J 6 1e$rei . Gaihess.E. M.S. c� Ld `9 >I �< LOT 6, BLOCK 1, \� of BIRCH HILLS TERRACE \ LJ Z Z- �I \moo VI \oma w� . \10 3I I LOT 5.\BLACK 1, HImoo � ( BIRCH HILLS TERRACE i i � � I ------------- --------------- A__ _ _ All �i °LOT 70, BLOCK 2,'MEADOW BROOK S/DUPGRADE ROPOSE SEP G OF2 Op B (SEE DESIGN, PAGE 2 OF 2) 1 00 l •F 9 I � 1{ II w O I---- C SYSTEM SFING $<$ , / I�______________ P S„F / / ; < ___ °A i � ISI PG ¢ Q _ mp p o I O ,, LLQ ---- Lo N; $o w NOTE: I` ALL PROPERTIES SHOWN IN MEADOW BROOK S/D p - _ ARE SERVED BY PUBLIC COMMUNr[Y W ER. ALASKA WATER AND WASTEWATER CONSULTANTS, INC. 0000p 7320 E CHESTER HEIGHTS CIRCLE, ANCHORAGE, AN 99504 PHONE (907) 337-6179/FAX: (907) 338-3246 DO ••• •••• S �pp LEGAL DESCRIPTION: � ;' O MEADOW BROOK SUBDIVISION, LOT 9, BLOCK 2, o * :: H ....... TYPE OF WORK: SITE PLAN ..... +. ••••• •••••• PREPARED FOR: PHONE NUMBER: O A e TCE 7953 s•opo DALE AND SHERYL CLINTSMAN 696-4061/279-6828 0 DATE: ^2 WN fY. SCALE:`-=A?;F: �f��e ''•. •.••••• %Oo 9/8/98 J.L.M. 1 = 100, 1 OF 2 ��pp4p0000d\ 1. PRIOR TO CONSTRUCTION, THE NORTHWEST PROPERTY LINE IS TO BE FLAGGED BY A REGISTERED LAND SURVEYOR. 2. THERE ARE UTILITIES IN THE AREA OF THE PROPOSED UPGRADE. THE CONTRACTOR IS RESPONSIBLE FOR ARRANGING RELOCATION OF ANY UTILITIES DURING CONSTRUCTION. \ S 1 1 I \ o 11 \1 1 y PROPOSED PRESSURIZED TRENCH 36' LONG EACH BY 2' WIDE BY 1 10.5' DEEP (MAXIMUMI. ADD 7.5'OF C, WASHED NK. I Z USE 1/4N OLA. HOLES (14'—O.C.) 11 Rp 'ryjD FACED DOWNWARD. 1.25' DIA. LATERAL 1 I I / / I 04 0 T TH¥1 ?J ^ / S� ( ° c i � 1 y .y�. NSTALL FCO 1 $ 1 / I / ° C T7ApNpKp, 7GpALLgp� it ..-KEY BOX EX IN fMTER UNE ��_ N/ It ANEU COMPLETELY � � � / 'PROX. LOC.) PROPOSED 1GALLON S.T. E.P. SYSTEM I (WITH DUAL OUTLETS) -1 1IN11 I EXISTING CRIB TO BE USED AS l -------_ A RESERVE SITE I i ALASKA WATER AND WASTEWATER CONSULTANTS, INC. OF 1 7320 E. CHESTER HEIGHTS CIRCLE, ANCHORAGE, AK 99504 A pQ/r'4 PHONE: (907) 337-6179/FAX: (907) 338-3246 DA�K'' .j.. y.. �' MEADOW BROOK SUBDIVISION; LOT 9, BLOCK 2, DESIGN OF SEPTIC SYSTEM UPGRADE PREPARED FOR: PHONE NUMBER: DALE AND SHERYL CLINTSMAN 696-4061/279-6828 9/8/98 1 J.L.M. 1 1= 20' 1 2 OF 2 �� Gayness; ;E 7953 ALASXA WATER & WASTEWATER CONSULTANTS, INC. o�'OF quo 7320 E. CHESTER HTS. CIRCLE • ANCHORAGE, AK. 99504 P.` ......... • u�� PHONE (907) 337-6179 • FAX (907) 338-3246 0 SOIL LOG — PERCOLATION TEST 0 LEGAL DESCRIPTION: MEADOW BROOK SUBDIVISION, LOT 9, BLOCK 2 ' "•'• .. • .. • """ ... PERFORMED FOR: DALE AND SHERYL CLINTSMAN �. .. ... .... .:... DATE PERFORMED: 9/1/98 Q4 ®' Je re A. Ga s; C –7953 ROTO ((feet) _- ORGANICS TEST HOLE #1 4p04.............. oofe . "o\ � 2 -SOIL CLASSIFICATIONS fJ o GW ORG 3 b;lpoo GPML GM_LL 1 CL - -------- , 1 o 4 0 GC OL 1 $W MH 1 00 ° � 1 'oo t $M OH it , 6 " °"° + Sc , 7 o°a c l :o°o°° i• v q / - o ° GW/SW 9 W/ SOME COBBLES SITE PLAN 0 lo - 00 0 a°o --- I" 100' 0 ° 00 ° 00 o b°" 00 ° °o° !"oo° 13 ° °°° °p ° po° 14- 5 o 0 p._p o -[ ob ° 15 "`b°0 16 " b°o B.O.H. 17 18 19 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6" (INCHES) 20 TEST RUN BETWEEN 7.0 FT. AND 7.5 FT. COMMENTS: NO PRESOAK REQUIRED. INSffU SOILS SHOULD ACT AS A SAND FILTER. GRAB SAMPLE TAKEN. PERFOMED BY ALASKA WATER & WASTEWATER I, , CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: DEPTH TO DATE GROUNDWATER NET TIME (MINUTES) DRY 9/1/98 DRY 9/2/98 DRY s/4/sa DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 9/2/98 1 2 4- 5 6 B 1:10 MIN. 1:20 MIN. 1:30 MIN. 1:40 MIN. 1:50 MIN. 1:50 MIN. 6„ 0" -0" - 0" 0" 0" 0" — 6" 6" 6" 6" 6" — 6" 10 it 12 GRE4*R ANCHORAGE AREA BO(OGH Department of Environmental Quality �N 3330 C Street Anchorage, Alaska 99503 SEEPAGE PIT: NUMBER OF PITS ✓' DIAMETER 4g 1 OR WIDTH I , LENGTH_U/. DEPTH 6 / / LINING MATERIAL " CCRIB SIZE: DIAMETER r DEPTH 6 DISTANCE FROM: WELL . BUILDING FOUNDATION 3a' , NEAREST LOT LINE ABSORPTION Z8 ON A EA (WALL AREA)FECTIVE Z g SQ. FT. TOTAL ADDITIONAL ABSORPTION WELL: C6mkw','i TYPE BUILDING FOUNDATION CESSPOOL APPROVED— DISTANCES:– INSTALLED PPROVED_DISTANCES:_ CONSTRUCTION DEPTH NEAREST NEAREST SEPTIC LOT LINE—,SEWER LINE—,TANK_ OTHER SOURCES DISAPPROVED INSTALLED BY: O- Oacfm txcarrQtluc /'� t PIPE MATERIAL: (1(t T120k) LOT SLOPE: REMARKS: excel%-, GnAUE4 Form No. EQ -031 4 w REMA DIAGRAM OF SYSTEM DISTANCE FROM: SEEPAGE SYSTEM INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME 4S50CCIAFF 9N/LOEKf MAILING ADDRESS n0'9"9( firo/ C-4(1-- I PHONE - LOCATION 4A2TA (f) LCtE' LEGAL DESCRIPTION / loT 7 /blOCe( 2 Xled 'yjdeOCK SEPTIC TANK: uL# 4y41*0 DISTANCE FROM WELL ((�� MANUFACTURER_ S%Cic JiEEL NUMBER OF �2' MATERIAL 'Cr COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /0170 GALLONS. SEEPAGE PIT: NUMBER OF PITS ✓' DIAMETER 4g 1 OR WIDTH I , LENGTH_U/. DEPTH 6 / / LINING MATERIAL " CCRIB SIZE: DIAMETER r DEPTH 6 DISTANCE FROM: WELL . BUILDING FOUNDATION 3a' , NEAREST LOT LINE ABSORPTION Z8 ON A EA (WALL AREA)FECTIVE Z g SQ. FT. TOTAL ADDITIONAL ABSORPTION WELL: C6mkw','i TYPE BUILDING FOUNDATION CESSPOOL APPROVED— DISTANCES:– INSTALLED PPROVED_DISTANCES:_ CONSTRUCTION DEPTH NEAREST NEAREST SEPTIC LOT LINE—,SEWER LINE—,TANK_ OTHER SOURCES DISAPPROVED INSTALLED BY: O- Oacfm txcarrQtluc /'� t PIPE MATERIAL: (1(t T120k) LOT SLOPE: REMARKS: excel%-, GnAUE4 Form No. EQ -031 4 w REMA DIAGRAM OF SYSTEM DISTANCE FROM: SEEPAGE SYSTEM 0 bei (® Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 s „ I r I . Certificate of On -Site Systems Approval Parcel I.D. 050-191-56 Expiration Date: I. GENERAL INFORMATION: Complete legal description MEADOW BROOK; BLOCK 2 LOT 9 Location (site address) 18349 Karta Circle *Eagle River Current Property owner(s) Allen & Jennifer Oliver Day phone 907-982-9410 Mailing address 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: 3 4. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class_Well ❑ Public Water System Waiver/Variance request for: TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank Community Public Sewer Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ -&-eO Date of Payment 5 5 '�O� Receipt Number DSS 7"6 COSA # _03C-211220 Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group Ltd (GEG) Phone: 907-337-617 Address: 3701 East Tudor Road Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrev 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. 6. DSD SIGNATURE q 'i`y'r— System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the followin '� •Th � S i'i L �-� v� � c� ci ti e I d i �nt�i-c�Q�r� tj•, � �I �(� c.�n.� Size beAriwms. _The reserve si iz w�l A` w��1 J.. A rifle. Corneas-' CE— ... ... G i O f e 5 Sion°vo #AECC884 OF ON-SITE )NATER AND ul6!-_-VATER _o 1 M G, i 'O \ moi, .O _rQ �\Tv\er �U� O. 2tY1CVCct ar�� r Ince cf I`I`l`I ;tsQ�� aztk o Cold be \,L( d is `►�� oto (�� V �wc ed L s �e � a T�e,��nne vt� o wt . ' C pp By: Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist_ Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other Tar k � Ude i SO► -1 X COSA Checklist Legal Description: MEADOW BROOK; BLOCK 2, LOT 9 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments B. TANK DATA Age of tank(s) 22 years Tank type/material STEP/STEEL j Vsr—� 5A I'ZI Parcel ID: 050-191-56 Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes O No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample AWWU WATER Measured operating fluid level in septic tank 0 Standpipes/foundation cleanout per record drawing Date of pumping 12/16/20 D. ABSORPTION FIELD DATA Which system tested (date installed) 3/8/99 FN ALL standpipes present per record drawing Total measured depth from grade 10.0 ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field 0 Monitor tubes go to bottom of effective. If not, state depth into effective C. LIFT STATION 0 Required maintenance completed Age of lift station 22 years Lift station material STEEL Comments: Adequacy test date 4/30/21 Results 0 Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 935 gal New depth 13 in Elapsed time 60 min F-1Code-requiredsoil cover over field Final fluid depth 0 in 01 System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) * N/A Gallons introduced 2011 gallons If yes, enter date Comments/Deficiencies, pre-soaked on 4129121 TESTED 1999 TRENCH ONLY, 1985 SEEPAGE PIT HAD 52"OF LIQUID UPON ARRIVAL, SYSTEM WAS FULL AFTER APPROXIMATELY 60 GALLONS COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No *5+ Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5+ ft Surface Water > 100' ❑ Yes if No ft Property Line > 5' E] Yes if No ft Wells on Adjacent Lots: Q Yes Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100'✓❑ Yes if No ft Water Main > 10' ✓❑ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No ** ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' ❑ Yes if No `6 1ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' ✓❑ Yes if No ft F. ENGINEER'S COMMENTS `MET CODE AT TIME OF INSTALL - TANK IS PARTIALLY UNDER DECK STAIRS (SEE PHOTO)**WR#980064 ***WR#161008 THE BOTTOM OF BOTH MONITORING TUBES IN 1999 TRENCH WAS MEASURED AT THE SAME ELEVATION. A PORTION OF THE SEEPAGE PIT IS LIKELY UNDER THE DRIVEWAY 1999 TRENCH TESTED AND SIZED FOR A 4 BEDROOM HOME. 1500 GALLON S.T.E.P. TANK ADEQUATE FOR 4 BEDROOM HOME. Qo�SOpp O G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review Do S�Q of Municipal records that the above systems are in conformance with CO: H yVd MOA COSA guidelines in effect on this date. .......... Qn '.J f e A. Gar ss:' V E C 4��4 ^e•.• �-7� zJ.-•��A000 COSA Checklist yellow sheet �Q a " o f e s s"O(" #AECC884 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Septic Tank Advisory Certificate of On‐Site Systems Approval # OSC211220 Subdivision: Meadow Brook Block:2, Lot: 9 The septic tank for this property is 22 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $7,000 to $11,000. 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. Sonja Blewett From: AkJen <akjen32@gci.net> Sent: Thursday, May 06, 2021 11:36 AM To: Sonja Blewett Subject: Re: 18349 karta Hi Sonja, We have not had any freezing issues with our septic system. Thank you, Jennifer Sent from my Phone On May 6, 2021, at 10:45 AM, Sonja Blewett <Sonja@garnessengineering.com> wrote: Hello, in order to finalize COSA at the Muni, we are just needing an email from you stating you have not had any freezing issues with your septic. Thanks! Sincerely, Sonja Blewett Corporate Secretary/Treasurer Garness Engineering Group, Ltd. 3701 E. Tudor Road, Suite 101 Anchorage, Alaska 99507 Phone: (907) 337-6179 Fax: (907) 338-3246 Website: www.garnessengineering corn <image001.jpg> <image002.png> <image003.jpg> 1 Parcel I.D. 050-191-56 N ppmW FEB 1.2 N16 Municipality of Anchora On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: 'z — ( ( - 19 Complete legal description MEADOW BROOK; BLOCK 2, LOT 9 Location (site address) 18349 KARTA CIR EAGLE RIVER, AK 99577 -- -- -----Current-Property owner(s)--US BANK ___ Mailing address Real Estate Agent Barb H 2. TYPE OF DWELLING: (] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 rx� 4. TYPE OF WATER SUPPLY: ❑ Individual Well ❑ Individual Water Storage ❑ Community Class_ Well ❑ Public Water System WeiverNariance request for: N/A Received _ Day phone--_ _.- __ . Day phone 907-227-5228 TYPE OF WASTEWATER DISPOSAL: Individual rx� Holding Tank ❑ Community ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ �Jr.` _ Date of Payment ot/ t Receipt Number DTI -I COSA# ocpCI('tD--59i MGA Date: 2/22/ I (v Waiver Fee $ Date of Payment Receipt Number Waiver# 05V I(,. 5� 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Garness Engineering Group, Ltd. (GEG) Phone (907) 337-6179 Address 3701 E. Tudor Road, Suite 101, Anchorage AK 99507-1259 —— Engineers Printed Name Jeffrey A. Garness Date f b 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 systems on 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 on 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 systemh 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. The content of this report is for the sole benefit of the persomparty who retained GEG. Reliance upon the information provided in this report by any othe person orparty, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the person/party who paid for this repor yr . 6. DSD SIGNATURE 5��y ILC System #1 Approved for bedrooms ♦alp System#2 Approved for bedrooms VVPc CIJtrt�� C .fir lj •�'�.`7� ^ t`'4['+4, �1 � Disapproved p, r ,r Conditional approval for bedrooms, with the following stipulations: [� Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 9-1-11doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: MEADOW BROOK; BLOCK 2, LOT 9 Parcel ID: 050-191-56 A. WELL DATA PUBLIC Well type If A, B, or C provide PWSID# _ Well Log (Y/N) Date completed Sanitary seal (Y/N)_ Wires properly protected (Y/N Total depth ft. Cased to ft. Casing height (ab round) in FROM WELL LOG AT I CTION Date of test Static water level ft. ft. Well production g.pm. g,P.m. WATER SAMPLE RES . Coliform colonies/100 ml. Nitrate mg./L. Collected by: enic. _ ug./L. Date of sample: B. SEPTICIHOLDING TANK DATA *PANEL IS IN GARAGE Tank Type/Material = STEP/STEEL Date installed 3/5-8/1999 Tank size 1500 'gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N)NE High water alarm (Y/N) *YES - Date of pumping 2/4/2016 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA ' *BELOW EXISTING GRAQ Date installed 3/5-8/1999 Soil rating.p.d. orftz/bdrm)1•2 System type DEEP TRENCH Length 36 ft. Width 2 ft. Gravel below pipe 7.5 ft. Total depth *9.3+ ft. Eff. absorption area 540 ft' Monitoring tube YES Depression over field NO Date of adequacy test 1/28/2016 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test E in. Water added 500 gal. New depth 0 in. Elapsed Time: E '' min. Final fluid depth E in. Absorption rate >= . 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes,,:give date — TESTED 1999 TRENCH ONLY TEST WAS PERFORMED IMMEDIATELY AFTER 2000 GALLON PRE-SOAK. CONDITION OF OLD SEEPAGE PIT IS UNKNOWN *SECOND COMPARTMENT OF 1500 GALLON STEP TANK D. LIFT STATION **PER ED'S ELECTRICAL INC. IN MOA RECORDS Date installed 3/5-8/1999 Size in gallons *500 Manhole/Access (Y/N) YES "Pump on" level at 69 in. "Pump off" level at 73 in. High water alarm level at 66 in. Datum TOP OF MANHOLE Cycles tested 3+ Meets alarm & circuit requirements? **YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanktlift station on lot — Absorption field. on Public sewer main Sewer /septic service line Animal On adjacent On adjacegti sewer manhole/cleanout Holding tank Manure/animal excrete storage areas .SEPAPkATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Properly line A 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ PVT & 200'+ PUBLIC SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *11 Building foundation *8' Water main 10'+ Water service line '**61 Surface water 100'+ Driveway, parkingNehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ PVT & 200'+ PUBLIC F. COMMENTS *WR#980064 **1974 CRIB APPEARS TO ENCROACH ON WATER,SERVICE LINE, SEE ATTACHED WAIVER REQUEST ***A PORTION OF THE SEEPAGE PIT IS LIKELY UNDER THE DRIVEWAY 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 JEFFREY A. GARNESS Date i /a 4 (Rev. 11105) Municipality , of Anchorage m e51t. S, c r A N epart�t`nt *** VARIANCE/WAIVER REVIEW **** GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS February 5, 2016 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650, Anchorage, AK 99519-6650 (907)343-7904 Ref: Meadow Brook; Block 2, Lot 9 — Waiver Request for Separation from Water Service Line to Old Seepage Pit To whom it may concern On 1/21/2016 Garness Engineering Group, Ltd. (GEG) completed a site visit to inspect the water line locates completed by One Stop Services (see attached sketch). During our site visit, it was observed that a possible encroachment exists between the private water service line and the 1974 seepage pit. The separation distance appears to be approximately 6.75 feet. It should be noted that the exact orientation of the pit system is unknown, and this possible encroachment is likely based upon a worst case scenario. We would like to request a variance from your department based upon the following justifications: The encroachment has existed for approximately 42 years. The uniform plumbing code allows for a horizontal separation distance of 5 feet from water service lines and drainfields (see attached). We are unaware of any adverse impacts associated with the granting of this waiver. At this time we request that your department grant a variance for a six foot separation from the water service line to the existing seepage pit. If you have any ques#ons, please contact Jeff Garness or Rob Campbell at (907) 337-6179. M.S. 3701 E. Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com 15 Do Iv.,T 0014 v AwAy NEI 4 TWnJ l '= O O r 00 W� C ii 0 L 0 Li 1 1 '- "Co`5 1 .o Lot 10 4ec oh ti �� 50 S Cone. block ret. wall 0. ©0 . r p.P•� P c0 �� �, c 5� eptic vent O 1 50 1� ood ret. wall tc0 � pip o :ta sy *0-1SN W *c 'Loi o rt ram gWood fence (/ Storag shed �� l N84023'30" J W 121.31 Lot 8 AFF •OF ' At %SI i 49th''00 y . Fre .. . . f ,t+ �"'A • • 3255 - S� SCALE: 1"=30 /o' •...•,o`.� EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. FB 15-14, pg 73 BE 8432D � 1 fi G 1 O O v� L 50 I 1 AS -BUILT _ NO CORNERS SET THIS DATE I hereby certify that I have performed a mortgagee's Inspection of the following described property: LOT 9. BLOCK 2. MEADOW BROOK SUBDIVISION Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property tying adjacent thereto, that no improvements on the 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 Anchorage, Alaska this let day of February ,2016. FRED WALATKA & ASSOCIATES Engineers and Surveyors (907-248-1666) MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH 8 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.# 050-191-56 HAA# 1. GENERAL INFORMATION Complete legal description Lot 9 • ?flock 2 • Meadow 1:�rook Subdivision Location (site address or directions) 18349 Karta Circle Eagle River, AK Property owner Sheryl Clintsman Day phone 696-4061 Mailing address 18349 Karta Circle Eagle River. AK 99577 Lending agency Day phone Mailing address Agent Ron Denney/ Fortune Properties Day phone 265-9187 Address _ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water XX - 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 XX 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. 72-025(Re,1/91) From MOAN21 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 Municipal and State codes, ordinances, and regulations in effect on the date opois inspection. ALASKA WATER g WA T , pTER �3 Name of Firm (, �E Phone - , Address 6901 E 7RWA14 28 Engineer's signature Date -3h _O ` 7 Alaska Wats OFAC Wastewater Consultants, Inc. Shall be PAID $ 224• fZ or prior to, closing for the Engineering Services Provided, 6. DHHS SIGNATURE X Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments L0 M ITIr. 'ap<<SS�God bedrooms, with the following stipulations: 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 thei r lendi ng institutions in order to satisfy certain federal and state requirements. Employees of DH HS 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 -MS (Rw. 1/91) Beck MOA 621 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES RECEIVE Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 34?}AR4$ 5 1999 Municipality of Anchorage Health Authority Approval Checklist Dept. Health & Human Services Legal Description: )-o'` .gi.1YCK Z Mmoow Parcel I.D.: o60 — 191 —56 62ceK -� 11 A. WELL DATA Well type PJ 9Ll G- If A, B, or C, attach ADEC letter. ADEC water system numbe Log present (Y/N) Date complete Total depth ased to Casing height (above ground) Sanita N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well production g.p.m. g,p,m, WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTICANlikkONSTANK DATA o `u Date installed 3 q Tank size 1S0o Number of Compartments Z Cleanouts &N) YF -S Foundation cleanout<VN) 'YCS Depression (Y® 1�0 High water alarm &_N) CIEs � Date of Pumping NE0 Pumper C. ABSORPTION FIELD DATA Date installed 3L!5 –6/qS –6/Soil ratingg.p.d./ft ori) I . Z FA cti System type DeEP "1`4Nc4 m Length 3(I Width 21 1 g Gravel thickness below pipe %•.� Effective absorption area 940 0 Date of adequacy test r'4 F- J Total depth I f • 9 f Monitoring Tube present ON) YES Depression over field (YQ ti)o Results (Pass/Fail) For 3 bedrooms Fluid depth in absorption field before test (in.); Immediately after= gal. water added (in.): Fluid depth (ins) Minutes later Absorption rate = g.p.d. Peroxide treatment (past 12 months) (YM) If yes, give date 72-026 (Rev. 3/96)` `U X D. LIFT STATION Date installed 3 /t, / `j °1 Size in gallons 1 S6 Manhole/Access &N)N) `f `, E5 "Pump on" level at' Lfn 1 "Pump off" level at` 11 High water alarm level at` 4S 'Datum 901-rom eF TAr1 Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer lsept servo- ice line i uBL1 L On adjacent lots n ad' cent lots Public sewer manhole Lift station q SEPARATION DISTANCES FROM SEPTIC/I TANK ON LOTTO: 431 r 4 i �Foundation 7 r Absorption field ± F z Water main/service line iCl Surface water/drainage I e0 I� Wells on adjacent lots )001 fi �aN NQ 4 SEPARATION DISTANCE FROM ABSORPTIO FIELD ON LOTTO: t,rAWEtt A; year *+ BY w w t< WR9800G�t l Ct56unr« eF Peacnt?� E Property line i Building foundation S Water main/service line( o 1 vi I Surface water l o t Driveway, parking/vehicle storage area 354 Curtain drain IJorJc kNodP� Wells on adjacent lots lo(0n' GorJt2Acrort_ Oto NOr HA)u fzs- cAYIeN OG �JA7e2- LINE PtIERP-Mev. R ENGINEER'S CERTIFICATION PA2FtYtoa Ots-rAacr-s Fpm raE aEW oaruNF,gu A.+n S.r.E.P. ThAK -ro 'Iq E VrA E� VINE WPS OeNE BY LeGRTte1 500Wr1 Oa S16A. ! certify that I hay�fetjr�in ru fi Id inspections and review of Municipal records.t(1 lrp ai vstems are in conformanc wi guide Ines in effect on this date. a C _...e..r. A 11. Signature ' Engineer's Name sf 3 // o /99 ! y A. Date Gar . qet ��,e<, a! HAA Fee $ 7)CC._t"K Date of Payment Q -\ - �1�t Receipt Number 72-026 (Rev. 3/96)' Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERT i ICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date __U26Z85_____— , GENERAL INFORMATION (a Legal Description 5 -elude lot, block, subdivision, section, township, range) _Lot 9 n-,1- 2-,Jeadowbrook Sub. T14Ny 126, Sec.12 _ _�_�ticn ..rest rdi:ections) K. �rS Kaa Circle (b Ap heart Name 7c_;__la.u, us Telephone: Home __ N/A _Business 552-3423 s 16 Karta Circle Eale River AK_ 99577 Lending Institution ;Owner/builder}LE; buyer ;Other 11 (explain); Q; _arm+ �'a. c _-- Telephone —_ 6503 -- Address U3__'-'7, Eagle River Ak. 99�---.--- -- ,e r:ea Estate Cor::.:ran,: and Aaent -address address: _. TYPE OF RESIDENCE -- Farr, L- roily ❑ Other P1 -f Bedrooms WATER SUPPLY Ir_`,:. al V,'=I' C rns unity 0 PUbleU MOA fico iteom.^,:eni-we :i system, must have written confirmation from the State Department of Environmental Conservation ay ar:d status. SEWAGE DISPOSAL Onr,:'e D Fublie ❑ Community ❑ Holding Tank ❑ Pdcte.:ifCC; rnrnunityrre�i., stem, rnust have written confirmation from the State Department of Environmental Conservation -:g ,o tl iga.i,y and status. P -'- , r -� 72-02E iwo4) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As cert rieo^ by my sea affixed hereto and as of the validation date shown below, I 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 n,arnber 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 d sposa system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of tits inspection. Name of F= _ — Telephone__— Address _ EAGLE RIVER ENGINEERING SERVICES Lb , AK 99577 Date6----- 694-5195 G- DHEP APPROVAL bedrooms by�✓✓�/ Disepprov ____ Conditional cna! App.mva; CAUTION Engineer's Seal ,j Date ', he t `u ..-_: ::a -ity of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority ApproYa+ cer:':cafes based solely upon the representations given in paragraph 5 above by an independent professional crg!:,eer registered In the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending ins!itaticns i order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze da:a cefore a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the pm'.esc_ or_=4 e imneer s work. Page 2 2 • MUNICIPALITY OF ANCHOIRAC;9 DEPT. OF HEALTH 2, MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL P,ROTECT1orq HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 i 1985 264-4720 Legal Description: ° t y R"'^ EA Ua,fuw T/HN lea W` Sc' -c, j-) A. WELL DATA Well Classifications ay c If A, B. C, D.E.C. Approved (Y/N) Well Log Log Present (Y/N) Date Completed Yield Total Depth Static Water Level Cased to Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) — Depression Around Wellhead (Y/N) On Adjoining Lots On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Date Date Installed �9i5� Size 104cJ 6�1 No. of Compartments -2 Standpipes (Y/N) Y Air -tight Caps (Y/N) % Foundation Cleanout (Y/N) Jr /✓ Depression over Tank (Y/N) IV Date Last Pumped N>'-< /IS 5- Pumping/Maintenance Contract on File (Y/N) ; for iy%i Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) A4 Separation Distances from Septic/Holding Tank: To Water -Supply Well ?VO t To Building Foundation To Property Line �v t To Disposal Field �� A To Water Main/Service Line /a To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) E C. ABSORPTION FIELD DATA 9 Soils Rating in Absorption Strata �S Type of System Design mei 43 'ec" Date Installed / i L/ Length of Field Width of Field y� / Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present (Y/N) y Depression over Field (Y/N) JV Date of Last Adequacy Test Akr.,,r;1L 5&j Results of Last Adequacy Test 2L'.r ,7,- Separation Distance from Absorption Field To Water -Supply Well D00:i To Property Line /a f To Building Foundation 30 r To Existing or Abandoned System on Lot lvh�- On Adjoining Lots 3v To Water Main/Service Line To Cutbank (if present) � To Stream/Pond/Lake/or Major Drainage Course /U""4 - To Driveway, Parking Area, or Vehicle Storage Area % ' 021, r Comments 11F7y 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 ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I he checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection Signed/ �z� 7 Date1- Company .1 r MOA No. S'T-..2!,f- Receipt No. Date of Payment Amount: $ Engineer's Seal `�J r ,� e .... —_ f _ 7.ouis r.. hotera Page 2 of 2 ce.6736 72-026 (11/84) Time APP L NT FILLS OUT UPPER Ho ONLY Time RbpertY Owner Time ( y Date Phone Date Date Mailing Address p Zip Code < J'J- < L9Y--9Y� Buyer ` Field Notes: 1�J�1 — -�" � IIi�JZ'�ls✓— I ��C�. -{C�Y -_� t\� Address Zip Code Lending Institution A) Phone JUN 011983 Address I A 4 k Zip Code 'CONDITIONS OF APPROVAL E,nVlfonntental Realty Co. & Agent Phone Address Zip Code Legal Description DATE r Street Location 7 j 4 C ( r��(; Type of Residence Date Se/v�er Intied Well To Absorption Area Well Log Received 10,Zingle Family `j Well to Tank ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply ❑ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). U'Public Utility Sewer Disposal 41—thdividual Year Individual Installed: ) 9 ] ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time ( y Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: 1�J�1 — -�" � IIi�JZ'�ls✓— I ��C�. -{C�Y -_� t\� l�\�c�.%.I'� JUN 011983 "MunlO±paiity of AnC:'-ilup" ( APPROVED BEDROOMS 'CONDITIONS OF APPROVAL E,nVlfonntental Protection" ( ) DISAPPROVED ( ) CONDITIONALAPPROVAL' DATE BY: Soils Rating Date Se/v�er Intied Well To Absorption Area Well Log Received [ Well to Tank Septic Tank Size I'L VL5�I1(C�