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HomeMy WebLinkAboutMEADOW RIDGE ESTATES BLK 2 LT 7Meadow Rid Estates Block 2 Lot 7 #051 -461 - 15 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201068 PID Number: 051-461-15 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name BROOKS & JESSICA WARREN ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 20850 COUNTRY VIEW DRIVE, CHUGIAK ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 3 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Fill added above original grade Ft. Gravel length Ft. MEADOW RIDGE ESTATES 2 7 Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area z Number of trenches Dist. between trenches From Tank Field Tank Line Ft Ft. Well 200'+ __ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line ( 10'+ i -- NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks Alarm location Electrical installed by Tank to PIPE MATERIAL House to tank 3034 3034 Installer NORTHERN EXCAVATION d a of eld Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection 1M 9/4/20 9/11/20 Location and description ection 2�c 3 r 4'" GARAGE SLAB ON-SITE WATER AND WASTEWATER SECTION APPROVAL or '�� Conditional Approval: Date��.,••' �. co • •1 ,� TH ... ....•... Curtis Huffman. • • • • r ��� • CE 128991 • w`��' •v Septic System Approved ��/ -- V q Date 1 a� ��a D �s� ' • . 9/14/202P. • • , F�pROF ESSION�`�'�� ESSO Note: this approval does not include well permit requirements. �'0.� ' (Kev Ub/uL/l b) MEADOW RIDGE EST 1 A—C=12.1' B—C=25.7' A—D=16.3' B—D=29.4' A—E=19.1' B—E=31.9' B2, L7 PID: 051-461-15 PERMIT: OSP201068 LOT 7 BLK 2 0 �} E D C o DCO CO MH EXISTING ST DECOMM. & NEW 1000 -GAL HDPE TANK INSTALLED GRAVEL D/W 0 APPROX. WATERLINE LOCATION F .psi �} �S s ,os`F �oovG,� Tq�RS O i GP O / 0 al SCALE; 1" = 30 SEPTIC SECTION SCALE1 NTS MEADOW RIDGE ESTATES BLOCK 2, LOT 7 SUPPORT, SERVICES: - ' qjjjkddP' OF AZ �\ PREPARED FOR: BROOKS & JESSICA WARREN Fwc.6 /"� 20850 COUNTRY VIEW DRIVE J �* 9 TH CHUGIAK, AK 99567 FIRST WATER CONSULTING k-��� DATE: 9/14/2020 /, tis Huffman / SURVEY: JLS 2020 1'rd, CE 128991 13030 SUES WAY DRAWN: FWCS 1 9/14/2020e'V ANCHORAGE, AK 99516 SCALE: 1" = 30' 907-350-9566 firstwaterAK@gmail.com \\��=i 1 �DRI vE 0 _ 5 38. R_330 OO' U �� r N29'a8'25"E _ Y ESMT 20.00' z LOT 7 Ct BE_K 2 a w (3i a SEPTIC o VENTS p (typ) `AIN ED P7 GRAVELco i U1 O/W DECK 38.7' 25.0' 0 vj 9 2 5' z W — P-_ 2.5' co o W Z m a 00 4 5 CAN 20.0' F 47.4' L 36.55' ro' L)TILIrr F_' MT N34'17'00"E 142.07' KEY8ax cA 71 a COUNTRY VIEW DRIVE � ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: MEADOW RIDGE ESTATES SUED = FND 5/8" REBAR LOT 7 BLOCK 2 PLAT 72-251 _ SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Linder no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements. covenants, or restrictions which do not appear on the recorded subdivision plat. _ SEPT 11. 2424 1"=30' 20- 067onew, er o+ra0m a aac ruaerx eaaK �i JL5 NWi3&2 200207 +�. ° F AL1 �? 01 49 JOHN L. SCHULLER.• v` f LS -10408 1►m°fossion6 �tl~ %' n R kyr x� �t7� tn a 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax "`"" `""o. MUNICIPALITY OF ANCHORAGE cnr /� On -Site Water & Wastewater Program ,w s r .*,� PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343.7997 a r � kc' http./Mi .Muni.org/onsite "^cHon>°E - Department On -Site Wastewater Disposal System Permit Permit Number: OSP201068 Effective Date: 4/23/2020 Work Type: SepticTank Upgrade Expiration Date: 4/2312021 Tax Code Number: 05146115000 Site Legal Address: MEADOW RIDGE ESTATES BLK 2 LT 7 G:1362 Site Mailing Address: 20850 COUNTRY VIEW DR, Chugiak Owner: WARREN BROOKS W & JESSICA C Lot Size in Sq Ft: 30962 Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 3 This permit is for the construction of: I] Disposal Field L( Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 1 The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By Date: 7 eq Date: 7 � / c?�o'� H UMC FA Lry OO F ANCHORAGE O n ,tye, Development Services Department ' l Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-461-15 Property owner(s) Brooks & Jessica Warren Day phone Mailing address 20850 Country View Dr, Chugiak, AK 99567 Site address 20850 Country View Dr, Chugiak Legal description (Sub'd., Block & Lot) Meadow Ridge Est Blk 2 Lot 7 Legal description (Township, Range & Section) Lot Size 30962 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Septic Tank © Upgrade (w/wo AD U) Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees - I Co 7 Date of Payment: 4 W Receipt Number: 0 410 IC -i Permit No. QS 0 10 t0 GADevelopment Services\Building Safety\On Site Water and f F � col Waiver Fees: Date of Payment: Receipt Number: �Naiver No. sjClient FormsTermit Application.doc COVED- i9 ZS% Dk'SCUUV-t Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201068, Rebecca Carroll, 04/23/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201068, Rebecca Carroll, 04/23/20 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONIVlENTAL PROTECI'ION ENVIRONMENTAl. ENGINEERING DIVISION 825 I. Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WELl_ INSPECTION REPORT NAME UPGRADE NO. OF BEDROOMS Width .__ PERMIT NO, No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. MAILING ADDRESS LEGAL DESCRIPTION LOCATION ~-- ~[DISTANCETO'-'--' /V/p9 Absorption ar I ~ I Manufacturer ~ / ( ~'~ ~ ' i '/PO0 ' I IF HuMEIwAue: j Inside ~1 ;ISTANCE TO: iI~ . [Dwelling ~ ~-'[ --~ We~ ~ Foundation ~='/ DISTANCE TO: I Al//9 ~E ~ FNo.of Nnes ~ ~ Length of each I~le, ]_ Total lengd~.of I .... ~ ] DISTANCE TO: Building foundation ~- "l~s ' '~opth--~ ~ ] ~ISTA~C~ TO: B~Hdin~ foundation Se~er line Total effective absorption area Nearest lot line Distance to lot Pine PERMIT NO. Septic tank I Absorption area(si OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS DATE LEGAL :!? /l ' · "J'H[!: GFi:F:!',,,'~.i:!.... l:::'J!i:F"!"l"J :[:!!; 'FI'ii:: I"! Z[ H ]: PIUH i)E!:f::'T!'I 0[: !2il'~[:l:::J',,"l!~l... F?,[}f:'T'!.,!IJ~:ECN '!-.I"IE!: (:II..I"I'F::!:::iI...L. J::' ]: l:::'[~: I:::!I'.:iD 'J"H!Z !:)',O"!'TCfi"! OF' 'H'"i!i!i: i~i: ::.", C: !::l ',,,'l::! -J- :1: Oi'.! ,:: :[ i'.,! F:'!iii:EZ"[' ). PERFORMED FOR: LEGAL DESCRIPTION: 1 2 4 5 6 7 8 9 ~_10 11 12 13 14- 15 16 20 COMMENTS PERFORMED BY: 72-008 (6/79) [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, A-r WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop 7 PERCOLATION RATE TEST RUN BETWEEN '~7/~/ (minutes/inch) ~ FT AND ~ FT PO,J(51 t 6..650 ANQI~ORAGE. AL A,%i{,',, (9(//) 264-,'! 11 ! Dill:AR FF','Ii !51 OF ItEAL'IFI AND ENVISOF'!MENF?,,I Pf:OIECIi(;,"! May 19, 1982 TO: Whom It Slay Concern Subject: Lot 7 Block 2 Meadow Ridge Subdivision The above subject property(30,962 sq.ft.) cannot be resubdivided due to no public sewer and there are no plans for construction of same sewer. This property can only be served by on-site septic system with a community water system available. If there are any further questions, please call this office at 264-4'720. Sincerely, John W. Lynn Environmenkal Specialist JWL/ljw Development Services Department On -Site Water & Wastewater Section } �'� _.m t� '#4& � i' u �•a' i;h �: E+.... �67 Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-461.15 Expiration Date: -7 2 1. GENERAL INFORMATION Complete legal description MEADOW RIDGE ESTATES BLOCK 2, LOT 7 Location (site address) 20850 COUNTRY VIEW DRIVE, CHUGIAK, AK 99 Current property owner(s) BROOKS & JESSICA WARREN Day phone Mailing address Real estate agent 20850 COUNTRY VIEW DRIVE, CHUGIAK, AK 99567 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Water Storage ❑ Holding Tank ❑ Community Well ® Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 9 rz, so CDV/ Waiver Fee $ Date of Payment ? b Date of Payment Receipt Number %07 Receipt Number COSA # OSC2 Jul Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN PE Date 9/8/2020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWCS �. 6. DSD SIGNATURE \/ System #1 Approved for —3 bedrooms System #2 Approved for bedrooms w �. ........��� .... • ... ....:` Curtis Huffman CE 128991 pR08ESSOk Disapproved Conditional approval for bedrooms, with the following stipulations: Or ��llttttt(t(((t ON-SITE G� WATER ANu By: VWVTtM .k VA d 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: MEADOW RIDGE ESTATES BLOCK 2, LOT 7 Parcel ID: 051-461-15 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA – CLASS A WATER SYSTEM 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. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes 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 Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) 0 years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NA - NEW Standpipes/foundation cleanout per record drawing Date of pumping NA – NEW C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 6/10/1982 ALL standpipes present per record drawing Total measured depth from grade 9.7 ft (max) Measured depth to pipe invert from grade 2.7 ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field w/ 2” insulation. System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date 8/24/2020 Results Pass For 3 bedrooms Fluid depth prior to test 47 in Water added 500 gal New depth 51 in Elapsed time 1140 min Final fluid depth 45 in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) N If yes, enter date Comments/Deficiencies: E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) NA CLASS A WATER Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ 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 Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No F. ENGINEER’S COMMENTS 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. 9/9/2020 Parcel I.D. fl 1. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519~6650 343-4744 GENERAL INFORMATION Complete legal description JUL ]998 MUNICIPALITY OF ANCHO~GE I!NVIRON,V~ENTAL SERVICES DIVISION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING FIAA# 'Yin"1 /~"~ ~ ..... LT 7 BK 2 Meadow Ridq'e ,.~b Location,(site address or directions) 20850 Country view Drive, Chugiak, AK 99567 Monty and Linda Parrish, deceased, Property owner c/o Terry Calandrelli Mailing address 5520 Lak~ Otis Pk~¢f, Anchorage, AK Day phone 338-1665 9950'7 Lending agency unkno~cn Day phone Mailing address Agent Country. Realty AddressP.O. Box 670495, Chugiak, AK 99567 Day phone 688-!236 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROO~S: 2 TYPE OF WATER SUPPLY: Individual well Community well x Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72q325 (Rev. 1/91) Fron[ MOA~21 STATEMENT OF INSPECTION BY ENGINEER As certified by [-ny seal affixed hereto and as of the valiciation date sl~own below, i vedfy'iha~ m/ investigation of this Health Authority Approval application shows that the on-site water supply and/orwastewater 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 8tare codes, ordinances, and regulations in effect on the date of this inspection. NarneofFirm_ Theta Envit-onment. al F. ngjj:~eer~ng Phone 688-0755 Address 23254 Norbhwoods Dr, .. Chuqiak, AK 99567 -~'-~-i. ' --~' z~' "- ~ / / signature,:';:...{ .~.}-.<~.~-''_ d-r-- .: .(..:p ..... ' _ Date /'/ Engineer's DHHS SIGNATURE Approved for Disapproved. Conditional approval for bed rooms. bedrooms, with the following stipulations: Additional Comments By: Date The Municipali~ of Anchorage Depa~ment of Health and Human Se~ices (DHHS) i~ues Health Authori~ Approval Ce~ificates based only upon the representations given in paragraph 5 above by an independent professional engin~r registered in the State of Alaska. The DHHS does this as a courtesy to purchase~ of homes and their lending institutions in order to ~tis~ ce~ain federal and state requirements. Employes of DHHS do not conduct inspections or analyze data before a ce~ificate is issued. The Municipali~ of Anchorage is not responsible for errors or omissions in the profe~ional engineeYs work. 72K)25 (Rev. ~/91) Back MOA ¢21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description:LT7 BK2 Headew Ridge Sub Parcel I.D.: A. WFLL DATA Well type A Community Water System If A, B, or C, attach ADECletter. ADEC water system number unknown 'L'eg~present (Y/N) Date completed Total~de~t~h Cased to Cas~n he, ht above r add p "~,..,.__. _____ 'g 'g ( g.r,.o )__ Sanitary seal (Y/N) ~'~'""-,.,. Wires properly.[~'~'cted~/N) __ % , FROM~'WEL~G ~~'~CTION Date of test _ "-"'-~_ ~~ Static water level ~'"'/"~ ~ ~_ .... Well production _ ~~ ,i'.p.m. ~"~"~ ...... C.O~ Nitrate .__ __ Other bacteria~'"~ -"~ate of sample: Collected by: g.p.m. El. SEPTIC/HOLDING TANK DATA Date installed 6-1N-R~* _Tank size]C00* Number of Compartments 2* Cleanouts (Y/N) ¥ _ Foundation cleanout (Y/N), N* Date of Pumpin¢', ,~-6'-.-24'98: ~ -..: c, ABSORPTION FIELD DATA Date installed6-10-82. Depression (Y/N) N** High water alarm (Y/N) N/A Pumper JR's Pumping Service Soil rating (g.p.d,/ft~ or ffYbdrm) 297 ft2/BD~ystem type~eep Trench* Length 83ft* ,, , Width 30:Ln* Gravel thickness below pipe Effective absorption area 1__t62 i.-'t2 * Monitoring Tube present (Y/N) Y Date of adequac,/test' 7~2,.98 Results (Pass/Fail) Pass Fluid depth in absorption field before test (in.); 0 Fluid depth0.78ft ~s) Minutes later: 1440 Peroxide treatment (past 12 months) (Y/N) unknown 84" * Total depth 8.23 ft Depression over field (Y/N) N*** For 2 bedrooms 495 5 Immediately after ' gal. water added (~)'2.34lb Absorption rate = 330.33 g.p.d. If yes, give date. N/A 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) N/A High water alarm level at* Cycles tested N/A E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot N/A Absorption field on lot Public sewer main Sewer/septic service line Size in gallons "Pump on" level at* *Datum N/A "Pump off" level at* N/A On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station N/A N/A Date of Payment ? ./7/¢ 2 Receipt Number ~:~-.r.~¢Z~/ ((~7~7 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 7£t+- * Propertyline GT 5£t* Absorption field 5fi+- * Water main/service line+20ft Surface water/drainage +100 '/70 'Wells on adjacent lots commun±ty we[1 SEPARATION DISTANCE FROM _A,,BSORP,TION FIELD ON LOT TO: Property line.~%-,f't-~ * Building foundation 20 ft-+ * Water main/service line C-? 2Oft Surface water GT lO0ft Driveway, parking/vehicle storage area GT loft Curtain drain unknown Wells on adjacent lots commun±ty well · From MOA records F. ENGINEER'S CERTIFICATION **Slopes drastically down. No sign of daylighbing, standing ~¢ater or ponding. ***Slopes away fro~ .~l~c, tank. Adequate I certify that I have determined thru field inspections and review of Municipal reco~,'~t~J~ae, systems are in conformance with MOA HAA gu!defines in effect on this date. drazna _~.~. ~ ,~ ..~ t/ -/? Englneer'sName Ronald 'R. C~od,"].n ~, ~ .~/~/¢'~' Date H~ Fee $ ~ / · A.S .BU,.rLT ~, '1 ' - ~,, . ~... · ~. ,;-~ · ' t&& ~ ' ".- ' 1 ~ ~-'' ~"~ 8CAl,,g:, '" Regl~Wrdd I,~ 8urveyo~ Municipality of Anch'orage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING Parcel LD. 051-461-15 1. GENERAL INFORMATION Expiration Date: Completelegaldescdption MEADOW RIDGE SUBOIV]SION; LOT 7, BLOCK 2 Location (site address or directions) 20850 COUNTRY V~EW DRIVE * CHUGIAKt AK 99567 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address Si'EVEN J. KENDALL Day phone 688-9749 20850 COUNTRY VIEW DRIVE * CHUGIAKt AK 99567 Day phone JILL w,/ DYNAMIC PROPERTIES Day phone 3111 'C' STREET * ANCHORAGE, AK 99503 727-2454 Unlessothe~iserequested, HAAw~beheld~DSD~rpickup. 2. NUMBER OFBEDROOMS: 2 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well B Individual On-site Individual Water Storage Individual Holding tank Community Class 'A' Well ~ Community On-site Public Water System [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 samples. (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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,035.00 at, or pdor to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my in~;estigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastawater disposal system is(are) safe, functional and adequate for the number of bedreoms and type of structure indicated herein. I further vedfy 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. NameofFirm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone 537-6179 Address 6901DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. CARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, AWH/C, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported reeulte described 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 soils condition, groundwater levels that may fluctuate during the year, and the water usage ef the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or 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 any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for ~ bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAP, Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: Municipality of Anchorage Development Services Department 8ul~Ing Safety On-Site Water & Wsstewater Program 4700 Saufe Bragaw SL P.O. Box 196850 Anchorage, AK gg519-6650 www.cLanchorage.ak.us {507) a,~7~o4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Oracrlption: MEA00W RIDGE SUBDMSION; LOT 7, BLOCK 2 Parcel ID: 051 -~,61 - 15 A. WELL DATA Well type ~ If A, B, or C provtde PWSI~ ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform - colonies/100 mi. Nitrate - mg./L. Other bacteria - colonies/100 mi. Arsenic: - mg./L. Date of sample: - Collected by: - SEPTIC/HOLDING TANK DATA ~ t~l L~,~.. ~,A,~,~,~.~ ~..~,~0~-... ~ Tank Typa/Matedal STEEL Date installed 6/10/1982 1000 gal. Tank size Foundation cleanout (Y/N)4~YES. Date of pumping 6/4/2002 ABSORPTION FIELD DATA Date installed 6/10/1982 Soil rating (g.p.d./ft~or(~ 297 Length 85 ft. Width 2.5 fl. Number of Compartments 2 Cleanouts (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Pumpat JR'S PUMPING *HOUSE IS ONLY 2 BEDROOMS/ SEPTIC SYSTEM SIZED FOR 5 BEDROOMS System type DEEP TRENCH --Total depth g.a3 ff. Eft. absorption area 1162 ff~ Monitoring tube YES Date of adequacy test 5/29/2002 Results (Pass/Fail) PASS Fluid depth in absoq~flon field before test 4..4. in. Water added 724 gal. Elapsed Time: 445 min. Final fluid depth 40 in. Any rejuvenation trealment (past 12 mo.) (Y/N & type) Gravel below pipe 7 ft. Depression over field NO For *2 bedrooms New depth 54 in. Absorption rate >= ,%00+ g.p.d. NONE KNOWN If yes, give date - D. LIFT STA'F]ON Date installed Size in gallons ManholelA~WN~'~/ "Pump on" level at in. "Pump ~---~m. ~ ~ter alarm level at in. ~ Cycles tested Meets alarm & circuit requirements?. E. SEPARATION DISTANCES COMMUNITY WATER SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank~lft station on lot Absorption field on lot Public sewer main On adjacent lots ...--~ Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main 10'+ Water service line 10'+ Wells on adjacent lots 200'+ Absorption field 5'+ Surface water 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 10'+ Curtain drain NONE KNOWN F. COMMENTS Building foundation 10'+ Surface water 100'+ Wells on adjacent lots. 200'+ Water main. 10'+ Driveway, parking/vehicle storage 10'+ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspecfions and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Prin~,ed~lame Date JEFFREY A. GARNESS HAA Fee $ ~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number F~ NO. ?. Ol