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HomeMy WebLinkAboutMEADOW RIDGE ESTATES BLK 1 LT 5Meadow Ridge Estates Block 1 Lot 5 #051-461-07 Municipality of Anchorage Page 1 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 o Anchorage, Alaska 99519-6650 a Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW970278 PID Number: 051 461 07 Name: MM&M Contracting, Inc. Wastewater System: [eNew ❑ Upgrade y Address: P.O. Box 670495 Chugiak, AK ABSORPTION FIELD Phone: 688-1236 No. Three Bedrooms: T Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other _ LEGAL DESCRIPTION Soil Rating: a Total Depth from original grade: ,. • GPD/Sq. Ft. Lot: Block: I- w, Subdivision: - L ' t) �G/V��xv Depth to pipe bottom from original grade: ' Gravel depth beneath pipe Q ITX-aFi i. S Ft. V Ft. _5 Township: Range: —_ Section: Fill added above original grade: Gravel length: O Ft. Ft. WELL: p �7 ❑ New ❑ Upgrade Z'��ol Gravel width: Numberoflines: I Distance between lines: o Ft. �'Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe materiel:/,jS,7-M 2>-30-1 s Ft. Ft. SO. Ft. P—SI 0 Driller: Date Drilled: Static Water Level: Installer. MM_A KA Datq installed: Ft. GbN G 9 $ P% Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES septic 0 Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Pubttctinyivate Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines /,U/6Ys,,— /C welN S 3 00 > n� 3 r A1A1114— N/14 c _ � MelenS14� Number of Compartments: Surface i r 9111111 IVU. aMz_U 6 / O Page ? of — 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION. P.O. Box 196650 • Anchorage, Alaska 995196650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: Lot_ 5. Block 1 , Meadow Ridge Estates PID No.: 05146107 -- ------- - -- - -- -- A i_--� LEGEND SP1 Septic Pump, compartment 1 H u n SP2 2 C Clean Out MT Monitor Tube ' i -- -T I I 1(1.1 I I � I � ' y aa Tiq fICHFlC� 7kN Til------• — i �� �,• 1 I PLAN AS—BLT _ 30' Permit No. SW970278 Page 3 — of 3 Municipality of Anchorage DEPARTMENT OF I4EALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 a Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: Lot 5, Block 1 , Meadow Ridge Est. 051 461 07 -- PID No.: — I - - - ELEVATIONf AS—BLT - 1" = 10' - ---- -- - O�`'q H ----Ll'sGEND SPS Septic Pump, compartment 1 r. SP 2 tt �t 2 ;n', MICHAEL E. ANDERSON ,' 'gj C Clean out ¢ti 43D1 low MT Monitor Tube +4IUy �/\\��\\/ i! % ih\���� /11\%. / % \I 7MT\Ii\\\\V" \9iPi .1Y ' (✓ n ! if� o , D r \i o e o n • t .O- its - -- -- (�� I mor rae o'Icr— k c,� _ / 10 I r I � T - i i I - - - ELEVATIONf AS—BLT - 1" = 10' - ---- -- - O�`'q H ----Ll'sGEND SPS Septic Pump, compartment 1 r. SP 2 tt �t 2 ;n', MICHAEL E. ANDERSON ,' 'gj C Clean out ¢ti 43D1 low MT Monitor Tube Municipality of Anchorage .. DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOC - PERCOLATION TEST PERFORMED FOR: ff ��JI�I r� T�JyGi DATE LEGAL DESCRIPTION: L% I%f\17(%�%>Township, Range, Section: SLOPE ',(FEET t O � b 2- 3-. 3 i• e 4- 6- 7 6 , a ,o 9 0 10 V 6 WAS GROUND WATER Al ENCOUNTERED? 11 ° L IF YES. AT WHAT / O 12 ° DEPTH? P / E 13-/. Geo to WeerAller Mn =rtg? But 14 ° T� ReadingI Date Gross Time 15 /b h p 16 J`/ 17 j 18 °/ 19 f 20 -NNN'\N. s1, 497th P, MICHAEL E. ANDERSON ,'617 4381E OW SITE PLAN NetDapth to Time Water PERCOLATION RATE '� (minutes/inch) PERC HOLE DIAMETER J TEST RUN BETWEEN FT FT AND FT / COMMENTS So 1 /� ��� �Ttry�1 1�' f%l 65-1/-4dlC– S _7Lft ml� o7e­ YV Li � e_ %i Xt/� S r�I �n�1 / C / / '�6T 7/ _ PERFORMED By." I �rY�!�d -� I ��^=PL1't1ERt1FY THAT THIS EST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: — Z, - _ N il* apf MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON—SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970278 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:M M & M CONTRACTING INC OWNER ADDRESS:P.O. BOX 670495 CHUGIAK, AK 99567 PARCEL ID:05146107 LEGAL DESCRIPTION: MEADOW RIDGE ESTATES BLK 1 LT 5 LOT SIZE: 27439 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 8/26/97 EXPIRATION DATE: 8/26/98 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 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1. THE ALTERNATIVE SITE SHOULD BE RELOCATED, SO THAT, GREATER AREA IS ENCOMPASSED IN THE TH #2. 2. PER AMC 15.65.060, THE SEPTIC SYSTEM NEEDS TO MAINTAIN 100 FT SEPARATION DISTANCE FROM MEAN ANNUAL FLOOD LEVEL OF ANY SURFACE WATER. / J RECEIVED BY: f'�C�c e—�"`C�-"i DATE: CA ISSUED BY: 44,�� DATE: g J� August 14, 1997 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 5, Block 1, Meadowridge Estates Subdivision Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: We hereby apply for a permit to construct a septic system on Lot 5, Block 1, Meadowridge Estates Subdivision. The attached site plan and backup documentation identify the location, size and components of the new septic system proposed to serve the new 3 bedroom home to be constructed on the lot. Testholes placed in the area of the proposed absorption trench revealed a slightly silty sand with gravel material with a percolation rate of 6 minutes per inch. No groundwater was noted during excavation nor during the ensuing monitoring period. The ground surface of the lot slopes from east to west at a grade ranging from 3% to 5% toward Meadow Lake. The surface of the ground in the area of the new trench is fairly flat. The lot is served by a community water system and all separation distances are easily met. If the system is constructed as designed the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The lot is currently served by a community water system. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. Lot 5, Block 1, Meadowridge Estates August 14, 1997 Page Two 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern w i I I be maintained. ifs 1 J� S Sincerely, ' ' I'+�fK.4l.L�+ �.f(B��✓�-� Y 2 <v� .cry '`nL s rAGu C f.: Michael E. Anderson, P.E.'<' 4 0� Attachments I I I AKE TRACT e-/ I I 1= i // 3 � 6 , �8 eo. 14<5 00, op 4•e +e• / >- 9 tir M AREA MAP ,.,1•�4� SCALE 1 = 100 `���• e s f99. of 40.7 0. F 47' w MONITOR TUBE I _ o 36' LONG X 8' EFFECTIVE DEPTH ABSORPTION TRENCH , CLEANOUT (TYP.) ° 1,000 GALLON o SEPTIC TANK 3 BEDROOM HOME SYSTEM PLAIN NO SCALE LOT 5, BLOCK 1, MEADOWRIDGE ESTATES SUBDIVISION DESIGN FACTORS: Three Bedroom Home Perc. Rate: 6 Min./inch Application Rate: .8 GPD/SF SYSTEM REQUIREMENTS: Deep Trench System 1,000 Gallon Septic Tank 8' Drainfield Rock 3 Bedrooms X 150 GPD / .8 GPD/SF e 562.5 SF of Absorption Area 562.5 SF/16 SF/LF (Absorption Area) = 36 LF Trench Length Therefore: Construct a Deep Absorption Trench With One Lateral 36' in Length with 8' of Drainfield Rock Beneath the Lateral. Distribution Pipe in Trench Placed at 3.5' Below the Original Ground Surface. 3,o b,i a �"aaRu. 6" e P }9 RO CA" ,O TYPICAL DEEP TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. Minimum 3' of Cover over Septic System. I M 12 13-/ D 14- is- 16- 17 - 2 = 80, 4t616 17 2=8i 19 WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH?. Meamahl0? 9. W1t Reading Date Grow Time Net -- Tina Depth to Water Not Drop Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 TEST px>= v ic- 3 ! o (o SOILS LOG -- PERCOLATION PERFORMED FOR: M_ _t� GD mr N& _ _ DATE PERFORMED--: LEGAL DESCRIPTION: �.,z1 I . MLY/V�I Township, Range, Section: —rte M 12 13-/ D 14- is- 16- 17 - 2 = 80, 4t616 17 2=8i 19 WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH?. Meamahl0? 9. W1t Reading Date Grow Time Net -- Tina Depth to Water Not Drop 3;vpoo Z3 ic- 3 ! o (o 20 -L 1�11 _ PERCOLATION RATE A' (mmev utineh)�P�ERC HOLE DIAMETER TEST RUN BETWEEN � � FT AND L /4 FT COMMENTSAzis PERFORMED BY:/ _ 1 L ��'�ERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 1;� ", 7 R Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES a25 "L" Street, Anchorage, Alaska 99502-0850 SOILS LOG v PERCOLATION TEST PERFORMED FOR: �1M GDI�i�"IV�TI NG'f GATE LEGAL DESCR 1 0 2- 3- 4 - ID 34 .d /L) 7 /v 8 0 9 � ,/ 0 17 18 19 l 201 1 Ili Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Dead to WSK Dur Mukdwiq? =y-;Al2r- Det 11 j1 { t Reecinp Dan Gran Tlrrw p Net Time Depth to Water Net Drop —FIT 'I : i' , v 9,q,: 00 Reecinp Dan Gran Tlrrw p Net Time Depth to Water Net Drop —FIT 'I : i' , v 9,q,: 00 x,33At 18 ao 1 r D: 14P ion Zo. 5'0 3-ftn! 31zcp 150 1? - 2 1 1 no z0 . o 17, 9 I 8, PERCOLATION RATE –4A— (mrnutwuuh) PERC HOLE DIAMETERt - TEST RUN BETWEEN. �- FT AND Le FT COMMENTS PERFORMED BY: I C IFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 5, BLOCK 1, MEADOWRIDGE EST. SUBDIVISION GENERAL: The scope of this project includes the the procurement and installation of a new 1,000 gallon septic tank. It also includes the construction of a new 36' long by 8' effective depth deep absorption trench. The distribution pipe in the trench to be placed 3.5' below the existing ground surface. All components of the septic system must be installed a minimum of 100' from the edge of Meadow Lake. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining a I I underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION A new 1,000 gallon septic tank must be procured from an approved source and installed at the location shown on the Site Plan. Lot 5, Block 1, Meadowridge Estates August 14, 1997 Page Two 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. Lot 5, Block 1, Meadowridge Estates August 14, 1997 Page Three 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Lot 5, Block 1, Meadowridge Estates August 14, 1997 Page Four 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: A minimum of two inspections are required by Municipal Ordinance. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-461-07 1. GENERAL INFORMATION Expiration Date: 10-6 -j / Complete legal description Meadow Ridge Estates Block 1 Lot 5 Location (site address) 21010 Meadow Lake Drive, Chu&k, AK Current Property owner(s) O'Dowd Day phone 244-1930 Mailing address same Real Estate Agent Cindy Wilson, Partners Day phone 244-1930 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex l/^! ❑ Multiple Dwellings (Single Family and/or Duplex) a 5cr' �6 3. NUMBER OF BEDROOMS: 3 c 0.E3ua5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPO Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ® Public Sewer ❑ Received by: Date: /0/7/6 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ J 2 6 a Date of Payment Receipt Number Date: Date of Receipt Number, COSA # Waiver #. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name _ Steve Eng Date 9./23/`2016,- 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: BY =2�=t — e+�-�� Original Certificate Date: The Municipality of Anchorage Devlopment 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 COSH blue shwt_9.1-12.doc If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served' by,,this system Certificate ®f ®n -.Site Systems Approval Checklist Legal Description: 4e%dFzf.Q,fJ ES% E/ G S Parcel I D:Q514 C/O 7 A. WELL DATA Well type If A, B, or C provide PWSID # Well Log (YIN) Date completed Sanitary seal (Y/N) _ Wires properly protected (Y/N) Total depth ft. - Cased to ft. Casing height (above ground) in. FROM WELL LOG Date of test. Static water level Well produ�fion;, WATER SIMPLE RESULTS: Coliform colonies/100 mL ft. 9.p -'n• F," Nitrate mg/L .Arsenic ug/L Date of sample: - B. SEPTIC/HOLDING-TANK DATA '. -- -- Tank Type/Material AT INSPECTION ft. g.p.m. Collected by: Date install€d Tank size A= gal. Number of Como6iftments Cleanouts (YIN) %,` -5 1/ Foundation cleanout (Y/N) Depression over tank (Y/N) _,,Al High water alarm (YIN) �— Date of pumping $ Pumper—* 101e / C. ABSORPTION FIELD DATA- " -y©�� Date installed;*? ( 7 Soil rating 9.p:d./ft2 r ftp/bdrm) 0, if System type e — Length 13C,ft"`liVldth L�/ ft. Gravel below pipe_ ft. Total depth./ ft. Eff. absorption area Sxe Monitoring tube �/ Depression over field -Al— Date ,ALDate of adequacy'tesY9/ Q�,�� Results (Pass/Fail) T _...T For bedrooms Fluid depth habsprptyn f' d -Yore test in Water added ZS'QO gal New depth ILI in. Elapsed Time: %.2b min, ` Final fluid depth i_ in. Absorption rate >= T g.p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) zy If yes, give date D. LIFT STATION 441 Date installed "Pump on" level at Size in gallons _ in. 'Pump off" evel at Datum Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: P6/6/6/ -^- Septic (/6G/C Septic tankilift station on Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas Manhole/Access (Y/N) in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation "f' Property line �O rf Absorption field 5 r{' Water main �D rf Water service line /D �y- Surface water /DO rt Wells on adjacent lots zoo =F ABSORPTION FIELD ON LOT TO: Property line ,fid 4- Building foundation Water main /D t Wate? $`ervio .jive Surface water _ a � ` "Driveway, pad(InVvehicle storage / (- Curtain drain U�r'K Wells on adjd6ant lots 2-00 1�7 F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that i have determined through field inspections_ and review of Municipal records, that the above systems •_ale; iP conformarice with MOA COSA guidelines in effect on this date. Engineer's PrintedName Date t COSA yellow. sheet 2-6-15.doc �fot: Nw�n W PE 643 r •4J��v in. M Municipality of Anchorage Development Services Department Building Safety Division On -Site water4700 Wastewater B agaw SetProgram 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. on-chi:2 COSA# �go3�lD Expiration Date:— 3 O —/ O GENERAL INFORMATION �&Q Complete legal description Meadow Ridge Estates Block i Lot Location (site address) 22010 Meadow Lake Drive Chv iak AK 6 Current Property owner(s) Colton Seale & Jeanne Carlson Day phone 26S-8104 Mailing address 21010 Meadow Lake Dr. Chu iak AK 6 s: 4 y• li• COSA# �go3�lD Expiration Date:— 3 O —/ O GENERAL INFORMATION �&Q Complete legal description Meadow Ridge Estates Block i Lot Location (site address) 22010 Meadow Lake Drive Chv iak AK 6 Current Property owner(s) Colton Seale & Jeanne Carlson Day phone 26S-8104 Mailing address 21010 Meadow Lake Dr. Chu iak AK 6 'Day phone Lending agency Mailing address Real Estate Agent Sally Carman Cal Century 21 Day phone 22�-oso6 Mailing Address salt c c22ak.com Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual On-site ❑ ❑ Individual Holding Tank Individual Water Storage ® Community On-site ❑ Community Class A Well ❑ Public Water System ❑ 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 engineers 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 Pannone Engineering Services LLC Phone 272-8218 Address P.O. Box 102os4 Anchorage, AK og510 Engineer's Printed Name Steven R. Pannone, P.E. Date g/zz/og Engineers Comments: In conducting an adequacy test,l attempt to provide a thorough, conscientious engineering analysis of the system in accordance with h10A 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. The operational life of all wells and septic systems depend on the local soil condition, ground water C) as 44 levels that may fluctuate during the year, and the water usage of the family being served by the system. •»., �P . These conditions are outside the control of the evaluator of this system. All systems eventually fail and : Q satisfactory test results do not guarantee future performance of the system, nor do they guarantee that a C \ >}•oo there are no hidden defects or encroachments. PES can therefore not provide any warranty for future 49n. ......1.,,,,00 performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by j fit WSteven R. Ponnone f sic any other person or party is not authorized nor will it No CE 8149 +f : confer any legal right whatsoever.�# +6y: ♦It#�a 5. DSD SIGNATURE q�E55IQ ��••• ___IL..••' Approved for _� bedrooms. . . Disapproved. Conditional approval for bedrooms, with the following stipulations: _ 1tYAs7EWATER Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other— By' t -X Original Certificate Date: — 3 0 — O 9 ,n«. ,,,os Municipality of Anchorage 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 APPROVAL CHECKLIST Legal Description: Meadow Ridge Estates Block s Lot Parcel ID: o5z-46i-o7 A. WELL DATA Well type A Date complete Total depth ft. Date of test Static water level Well production If A, B, or C provide PWSID #i3 o4o1 Well Log (Y/N) Sanitary seal (Y/N)_ Cased to ft. LLOG WATER SAMPLE RESULTS• Coliform nies/100 mL Nitrate mg/L Arlen' _ ugA Date of sample: _ B. SEPTIC/HOLDING TANK DATA Tank Type/Material Anchorage Tank Steel Wires properly pr teed (YM) Casing ght (above ground) in. ft. Other bacctck colonies/100 mL Collected by: _ Date installed 914/aao7 Cleanouts Y/N Y Tank size i000 gal. Number of Compartments � ( ) Foundation cleanout (YM) Y Depression over tank (YM) N High water alarm (Y/N) N/A Date of pumping o/a8h009Pumper R's septic pumping C. ABSORPTION FIELD DATA Date installed 91 r� Soil rating (g.p.d./fO or ft=/bdrm) o.8 System type DeepTrench Length 36 ft. Width o ft. Gravel below pipe a ft. Total depth d1S ft. Eff. absorption area SZk ftp Monitoring tube Y Depression over field LI Date of adequacy test 912212009 Results (Pass/Fail) Pass For 3bedrooms Fluid depth In absorption field before lest Pt in. Water added&5o gal New depthPry. in. Elapsed Time: o min. Final fluid depth per C In. Absorption rate >= &50. g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) No If yes, give date D. LIFT STATION Date Installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES SEPARATION DISTANCES I Septic tank/lift station on lot _ Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas Size in gal s "Pump ofP v a in. ON LOT 70: J Manhole/Access (YIN) High water alarm level at in. Meets alarm 8 circuit requirements? lots On adjacent lots Pr Pu r J ' s Holding manhole/cleanout Manure/animal areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation so+ Property line zo+ Absorption field ;+ Water main NIA Water service line ao+ Surface water ioo+ Wells on adjacent lots zoo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line so+ Building foundation >.o+ Water main NIA Water Service line zo+ Surface water soo+ Driveway, parking/vehicle storage i+ Curtain drain gone Observed Wells on adjacent lots zoo+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field Inspections and t+ 497y review of Municipal records that the above systems are In ;•„ conformance with MOA COSA guidelines In effect on this date. i {'� {>leven F. Yonnon Engineer's Printed Name Steven R. Pannone. P.E. e# I • W CE s 14't ; Date ©4042.2 •�e �h.�EsstQ:. COSA Fee $ q e7 0 Date of Payment — Ll -01 Receipt Number 7 7 O 6 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number , RoRe:e �: r.�.rsor. la•''� 4S I 2ja\ - /Jo TE - A rPRoX, ri t✓s'Y`y c ova t -a fl rc� J AS -BUILT I hereby certify that 1 have surveyed the following described LST'- Bt1�cK- \ t �t,l ProPMY' � - 1 0-4w F t=crAxEn' S St1.1 l0 VA t N A C r Anchorage According 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 thereto, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmisswn tines or other visible easements ori Said property except as indicated hereon. Dated at Eagle River, Alaska pp `� this Ll ST day of (3c:TCzSz 19�c ROBERT C. JOHNSON SCALE; Registered Land Surveyor No. 880 -LS t{o' Box 77-GL56, Eagle River, Alaska 99577 Phone (907) 694-2543 _ MUNICIPALITY OF ANCHORAGE ar'3' 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. # 051 461 07HAA # �n�11 0���it 1. GENERAL INFORMATION Complete legal description Lot 5, Block 1, Meadow Ridge Estates Location (site address or directions) Meadow Lake Drive Property owner MM&M Contracting Inc. Day phone 688-1236 Mailing address P.O. Box 670495 Chuaiak, AK 99567 Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Three (3) Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. h. 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 (Rev. 1/91) Front MOA #21 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 Firm Anderson Engineering Phone 563-7155 Address P C) Box 214077" Anchorage, AK 99524 Engineer's signature A w-�"�`^'Date 12/3197 6. DHHS SIGNATURE / Approved for HME bedrooms. Disapproved. Conditional approval for Additional Comments 0 C- ItITIC ®F 44. 49 TH�� .. WCHAEL'E ANDERSON. 4381•E bedrooms, with the following stipulations: Date 12 "/5,17 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 orderto 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. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage ICE C 9 V D DEPARTMENT OF HEALTH & HUMAN SERV Environmental Services Division DEC 611997 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Municipality of Anchorage Health Authority Approval Checklist ept. Health & Human Services Legal Description: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production Lot 5, Block 1 , Meadow Ridge Parcel I.D.: 051 46107 If A, B, or C, attach ADEC letter. ADEC water system number 21 0 4 01 Date completed Cased to FROM WELL LOG WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate Casing height (above ground) Wires properly protected (Y/N) Collected by: AT INSPECTION Other bacteria 9 - p.m - Date installed 9 14 / 97_ Tank size 1 , 000 Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) Date of Pumping New _ Pumper Construction C. ABSORPTION FIELD DATA Date installed 9 /8 /97 Soil rating (g.p.d./ft2 or ft2/bdrm) .8 gpd System type Deep Trench Length 36' Width 4' Gravel thickness below pipe 8' Total depth 1_.5' Effective absorption area 576 SF Monitoring Tube present (Y/N) Y Depression over field (Y/N) N Date of adequacy test New Const. Results (Pass/Fail) Pass 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) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION - None on Lot Date installed Manhole/Access (Y/N) High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: - Septic/holding tank on lot Absorption field on lot Public sewer main Sewer /septic service line "Pump off" level at* Public Water System On adjacent lots >200 On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation >51 Property line >5 ' Absorption field >51 Water main/service line > 10 ' Surface water/drainage > 10 0 ' Wells on adjacent lots > 200 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation > 10 1 Water main/service line > 10 1 Surface water >100' Driveway, parking/vehicle storage area 2' Curtain drain None on Lot Wells on adjacent lots > 200' F. ENGINEER'S CERTIFICATION i certify that 1 have determined thru field inspections and review of Municipal recd Rot A.4 tems are in conformance with MOA HAA guidelines in effect on this date. cft 0 I -W CO0.40 Signature Engineer's Name Michael R Ands-rGnn _ P F. • MCHAFL E. ANDERSON •�/ Date 1 2 / / A 43!31-E pi HAA Fee $ Waiver Fee $ Date of Payment L",A • �) `11 Date of Payment Receipt Number CY-) \ � �o� Receipt Number 72-026 (Rev. 3/96)*