HomeMy WebLinkAboutMEADOW BROOK BLK 2 LT 3Meadowbrook
Block 2
Lot 3
#050-191-42
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page of
ON -SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP251399 PID Number: 050-191-42
Dwelling: Z Single Family (SF) El with ADU El Duplex (D) n Two Single Family Project: n New Z Upgrade
Name
REMER DONNIE & MARY
ABSORPTION FIELD
Z Deep Trench n Wide Trench n Bed El Mound
Site Address
18323 KANTISHNA DRIVE, Eagle River
El Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
1 3
1.2 GPD/SF
ITotal
**12 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
5 Ft.
Gravel depth beneath pipe
7 Ft.
Subdivision Block Lot
MEADOW BROOK 2 3
Fill added above original grade
VARIES V-1.21 Ft.
Gravel length
27 Ft.
Township Range Section
Gravel width
2 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
378 Ft2
1
Ft.
Well
200'+
25'+
TANK 9 septic EJ S.T.E.P. ❑ Holding [] Other
Manufacturer
EXISTING
Capacity
Gal.
Surface Water
100'+
Material
Number of compartments
Lot Line
*V+
NA
Foundation
10'+
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks *MOA Waiver #OSV251048. "Able to keep
field at 12'.
Alarm location
Electrical installed by
Installer NORTHERN EXCAVATION
PIPE MATERIAL House to tank Tank to 3034
drainfield
Drainfield 3034 CO/MT 3034
Inspector FWC
BENCH MARK (Assumed elevation) 100 ft
Inspection 1st 11/24/25 Id 11/25/25
dates: 2
Location and description
3'd 12/01/2025 4 th
IBOTTOM OF SIDING
ON -SITE WATER AND WASTEWATER SECTION APPROVAL
M
OF A
Conditional Approval: Date
AW
Septic System
Approved
Curtis Huffman . %
-
Date
CE 128991
.
V
.12/03/25.
�F0PROFESSO�,,11ft—_
Note: this approval does not include well permit requirements.
(Rev 05/02/18)
66.1'
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SHED
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3 BED
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FIRST WATER CONSULTING
PID:050-191-42 PERMIT: OSP251399
MEADOW BROOK BLOCK 2, LOT 3
6 6 .1 '
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R E S I D E N C E
LEGEND
UTILITY PEDESTAL
DECK
CONCRETE
FENCE
EDGE OF ASPHALT
RECORD DATA PER PLAT #72-51
SEPTIC PIPE
WATER VALVE
TIMBERLINE SURVEYING AND MAPPING
17035 BARONOFF AVE
EAGLE RIVER, AK 99577
907-242-5320
ryan@timberlinealaska.com
FILE NO.: 25.229
SCALE: 1" = 20 FEET
DATE: 11/26/2025
SHEET: 1 of 1
MOA GRID: NW0153
SCALE: 1" = 20 FEET(11"x17")
20'0' 40'
AS-BUILT OF:
ADDRESS: 18323 KANTISHNA DR, EAGLE RIVER, AK
LOCATED IN: ANCHORAGE RECORDING DISTRICT
LOT 3, BLOCK 2MEADOW BROOK SUBD.PLAT #72-51
Permit Number:OSP251399
Tax Code Number:05019142000
Work Type:Septic Upgrade
Effective Date:
Design Engineer:
Site Legal Address:MEADOW BROOK BLK 2 LT 3 G:0153
Owner:REMER DONNIE L & MARY K
Site Mailing Address:18323 KANTISHNA DR, Eagle River
Lot Size in Sq Ft:11721
Total Bedrooms:3
This permit is for the construction of:
Disposal Field Septic Tank Holding Tank Privy
Non-Public
Water 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)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Coodinate with On-Site staff regarding preferred method.
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
11/5/2025
11/5/2026
FIRST WATER CONSULTING
Expiration Date:
þ ¨¨¨¨¨
Issued To:
Issued By:
Date:
Date:
11/5/2025
11/5/2025
FIRST WATER CONSULTING
Isatou B Njie
MUNICIPALITY OF ANCHORAGE
On-Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On-Site Wastewater Disposal System Permit
WCHORAGE
Phone: 907-343-7904
Building Permit Number Not Applicable F01
APPLICATION IS FOR: APPLICATION IS AN:
(Z all that apply)
Disposal Field FRI Initial
Septic Tank Upgrade
Holding Tank ❑ Renewal
Privy
Well
Water Storage
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
< I lf—cyv Y -b C c Distance:
1574
Permit/Rush Fees: t) Waiver Fees:
Date of Payment: 10 C/ /' — Date of Payment-, 1110175
Permit No. C J waiver No. 0011510'4(e'
May 2025
Municipality of Anchorage
P.O. Box 196650 ⚫ 4700 Elmore Road
Anchorage, Alaska 99519-6650 ⚫ (907) 343-7904 ⚫ Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On-Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSV251048 COSA#: Permit#: OSP251399________
PID#: 050-191-42
Legal Description: MEADOW BROOK BLK 2 LT 3
Engineer: First Water Consulting
Your request for a waiver of the required 10 feet horizontal separation from the disposal field to
the property line has been approved. The approved separation distance is 1.0 feet.
This waiver approval applies to the existing disposal field only. Any future upgrade to the on-
site wastewater disposal system will require all separation distances be met or another approval
from this department.
Waiver is Granted: ____X_______ Waiver is not Granted: ______________
Date: __________________ Approved by: _________________________________
Name of Reviewer
**** VARIANCE/WAIVER REVIEW ****
11/5/2025
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
!
!!
October 31, 2025
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC SYSTEM UPGRADE PERMIT
LEGAL: MEADOW BROOK BLOCK 2, LOT 3 WITH PL WAIVER
The property owner has requested we obtain a permit to upgrade the failed septic absorption crib
of the above referenced lot. We propose to install one deep trench with diverter and reconnect
to the 1000-gallon Premier Plastic tank to serve the existing 3-bedroom residence. The design is
based on the recent test hole conducted on October 24, 2025. No groundwater was observed at
test hole excavation or monitoring.
The waterline will be required to be crossed to make connection to the proposed leach field. A
solid D3034 pipe positioned and centered on the staked waterline location will be installed along
with maintaining a 2’ vertical separation crossing and 10’ from this waterline and the proposed
absorption leach field.
With this leach field upgrade, we request a waiver to lot line of 1’ be issued. The adjacent lot’s
water line is 10’+ away from the proposed leach field and will be located and staked prior to
installation. The adjacent lot’s septic system is 20’+ from the proposed leach field. This justifies
the allowance of the requested waiver.
The slopes are moderate at 10-15% at the proposed upgrade location. The lot and area are served
by public water. The design will not impact any of the neighboring properties. Please contact us
if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251399, Isatou Njie, 11/05/25
3030 Sues Way - Anchorage, Alaska 99516
Tel. 907-350-9566 firstwaterAK@gmail.com
SOILS LOG - PERCOLATION TEST
LEGAL : MEADOW BROOK BLOCK 2, LOT 3
PERFORMED BY: FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 10/31/2025
DEPTH
FEET OG
SOILS
1
2
ORG/OL
3
4
5
6
GM/gw
7
8
9
10
11
12
13
14
15
16
17
18
19
20
BOH 19.5’
Reading Date Gross
Time
Net Time Depth to
Water
Net Drop
10/24/25 10 min 6” 4 9/16”
“ 6” 4 8/16”
“ 6” 4 7/16”
“ 6” 4 8/16”
“ 6” 4 7/16”
“ 6” 4 7/16”
PERCOLATION RATE 2 (MIN / INCH)
TEST RUN BEWTWEEN 5 & 6 FT
PERC HOLE DIAMETER 6”
PRE-SOAKED PRIOR TO TEST & ALL READINGS TO
THE 1/16TH.
GROUND WATER ENCOUNTERED: NO
IF YES, AT WHAT DEPTH: NA
DEPTH TO WATER AT MONITORING: DRY
DATE: 10/31/2025
TESTHOLE # 25-1 DATE PERFORMED: 10/24/25
SEE SITE PLAN FOR SLOPE & LOCATION
COMMENTS:
VERIFY GROUNDWATER MT
AT TIME OF CONSTRUCTION
PERFORMED FOR: DONNIE & MARY REMER
10/31/25
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251399, Isatou Njie, 11/05/25
6 6.1'
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3 BR RE
S
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DENCE
FIRST WATER CONSULTING
MEADOW BROOK BLOCK 2, LOT 3
DESIGN CALCS:
SITE & AREA SERVED BY
PUBLIC WATER W/ NO WELLS
WITHIN 200' OF PROPOSED
SEPTIC FIELD.
NO SLOPES >25% WITHIN 50'OF PROPOSED FIELD.
STAKE PROPERTY LINES, WATER LINE, WELL RADII,
ESMTS, OR OTHER SEPARATIONS... PRIOR TO CONST.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251399, Isatou Njie, 11/05/25
66.1'
2
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24.1'
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3BR RE SI DENCE
FIRST WATER CONSULTING
DESIGN DETAILS:
MEADOW BROOK BLOCK 2, LOT 3
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251399, Isatou Njie, 11/05/25
6 6 .1 '
2
8
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1
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2 4 .1 '
4
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R E S I D E N C E
LEGEND
UTILITY PEDESTAL
DECK
CONCRETE
FENCE
EDGE OF ASPHALT
RECORD DATA PER PLAT #72-51
SEPTIC PIPE
WATER VALVE
TIMBERLINE SURVEYING AND MAPPING
17035 BARONOFF AVE
EAGLE RIVER, AK 99577
907-242-5320
ryan@timberlinealaska.com
FILE NO.: 25.229
SCALE: 1" = 20 FEET
DATE: 10/15/2025
SHEET: 1 of 1
MOA GRID: NW0153
SCALE: 1" = 20 FEET(11"x17")
20'0' 40'
AS-BUILT OF:
ADDRESS: 18323 KANTISHNA DR, EAGLE RIVER, AK
LOCATED IN: ANCHORAGE RECORDING DISTRICT
LOT 3, BLOCK 2MEADOW BROOK SUBD.PLAT #72-51
Municipality of Anchorage
� Development Services Department�-
Building Safety Division '
On -Site Water and Wastewater Program, 4700 Bragaw St. Page of3
I
P.O. Box 196650 Anchorage, AK 995196650 S
wwvY.cl.anchorage.ak.us (907) 343.7904
ONSITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTIONREPORT
Permit Number -5—W070-0-39 PID Number: QSO-01--1-D
NacosWastewater System: ❑ New ❑ Upgrade
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Inspections performed by:
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? •'
2nd
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uYY.N •.. •
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and approved by:
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PERMIT No. SWO70O39
PAGE 2 OF 3
Municipo.lit of Anchorage
DEPARTMENT OF HEA�.TH 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
LEGAL LOT 3 BLOCK 2 MEADOW BROOK S/D P.I.D. No. 050-191-42
LOT
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LOT 6
/
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METAL
I
SHED
6X �oR�pM
3 g�OVSE
NEW 1000 GALLON
HDPE SEPTIC TANK
DBL1'& D6L2
11
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V /
EXISTING]
CRIB
Y�PSE�`�` RjS,lr
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/
LOT 2
/
SCALE: 1" - 30'
A. Ndft
"►.
PERMIT NO. SW070039
PACE 3 OF 3
Municipalit of Anchora e
DEPARTMENT OF HEA�.TH AND HUM9AN 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
LEGAL LOT 3 BLOCK 2 MEADOW BROOK S/D
ST1 ST2
FINAL GRADE
P.I.D. No. 050-191-42
99.1'
2" INSULATION
---- NEW -_
94.3' 1000 GALLON
POLYETHYLENE 94.0'
SEPTIC TANK
A-,01 -1_9B-
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MUNICIPALITY OF ANCHORAGE
Development Services Department
Onsite Water 6 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SW070039
Legal Description: MEADOW BROOK BLK 2 LT 3
Date Issued: Apr 25, 2007
Expiration Date: Apr 24, 2008
Parcel ID: 050-19142
Design Engineer: 0003 S & S ENGINEERING Site Address: 018323 KANTISHNA DR
Owner Name: JIM BRUNDAGE Lot Size: 11721 SQ. FT.
Owner Address: 18323 KANTISHNA DRIVE Total Bedrooms: 3 Permit Bedrooms: 3
EAGLE RIVER. AK 99577.8233
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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
- (EMERGENCY TANK REPLACEMENT) - SEPTIC TANK INSTALLATION MAYBE LOCATED NO LESS THAN
FIVE FEET FROM ANY PROPERTY LINE OR BUILDING FOUNDATION; TEN FEET FROM ANY WATER
SERVICE LINE; ONE HUNDRED FEET FROM ANY SURFACE WATER; AND ONE HUNDRED FEET FROM ANY
PRIVATE WELL; AND THE SEPARATION DISTANCES REQUIRED BY 18AAC72 FROM WATER SUPPLY
WELLS.
Received By:
Date: 146D
Issued By. Date: ' v
\ Municipality of Anchorage
-.
Development Services Department
Building Safety Division ;
i On -Site Water and Wastewater Program , ° ° r;
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
ON-SITE SEPTIC/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.D
RRO' 1q 1-y a'
Property owner(s) f j; ✓✓) U rNhdn e e Day phone
Mailing addresslg3a� Kgni�shA �rye Zip Code
Site address S'a Me/ 2 � Zip Code
Legal description (Sub'd, Block & Lot) Lofi3, Aloe /'/eAW b/'0o 51
Legal description (Township, Section & Range)
Lot Size l , Sq. Ft. Number of Bedrooms
THIS APPLICATION IS FOR (®all that apply): THIS APPLICATION IS AN:
Absorption Field ❑ Initial ❑
Septic Tank 19 Upgrade (�
Holding Tank ❑ Renewal ❑
Privy ❑
Private Well ❑
Water Storage ❑
I certify that the above information is correct. 1 further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
S -4 5- 6"-C- - E,f/d.—CG
�' y 6 d. ° y Waiver Fees:
Date of Payment: y / yS-/O % Date of Payment:
Receipt Number:
(Rev. 11/05)
053470
Receipt Number:
HEALTHAUTHORITY
APPMNALS
SEWERS WATER
MAINEXTENSIONS
SEWERS WATER
INSPECTION
ENMNEERSNi STLXM
ANGREPORTS
WEUTNSPECTION
t ROW TEST
SITE PLANS
SOILTEST
PERCOLATION
TEST
STRUCTURALS
WCNANICAL
14PECTXM
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
ROBERTC. COWAN, P.E.
ROBERT& SHAFER P.E.
CMLENGINEERS
(907)694.2979
FAX(907)694.1211
April 23, 2007
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK 99519 '
REFERENCE: Lot 3; Block 2; Meadowbrook Subdivision
It is requested that you issue a permit to install an emergency tank replacement. The
existing tank serving the existing three bedroom dwelling on the referenced property
has collapsed, and will be replaced with a minimum 1000 gallon septic tank.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic tank. The construction
of this system will not prevent any future development on any of the adjacent properties.
If you require additional information, please contact us.
Sincerely,
Obert C. Cowan, P.E.
RAS/bjj
Enclosure
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FEALTNVJTHOaTY
APPROVALS
SEWERS WATER
LpNEXTEEbO15
SEWERS WATER
INSPECTION
ENGNEERNGSTLIDMES
ANO REPORTS
WELL INSPECTION
SFLOWTEST
SITE PLA S
SOL TEST
PERCOLATION
TEST
STRUCTMALS
MECHANICAL
INSPECTIONS
ON SITE
WASTEWATER
DSPOSALSYSTENI
DESIGN
ROBERTC. COWAN, P.E.
ROBERTA. SRkFER, PE.
CML ENGINEERS
(907) 694.2979
FAX (907) 694-1211
bN-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Lot 3; Block 2; Meadowbrook Subdivision
April 23, 2007
GENERAL:
1. The scope of this project includes the replacement of the existing 1000
gallon septic tank with a new 1000 gallon septic tank to serve the existing
three bedroom residence located on the referenced property.
2. Construction shall be in accordance with the approved site plan and 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 any necessary
underground utility locates.
4. Unless specifically agreed otherwise, the property owner shall be
responsible for final grading areas subsequently depressed from soil
settling.
5. Contractors installing wastewater disposal systems must be certified by the
Municipal Development Services Department or ADEC if required, for
system installations. Owners installing their own systems must also receive
prior approval from the respective agency.
SEPTIC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
'q'.iPa.•,.. �. _. .__ .. ..:Mil,.. ..w �„ _ ... u.
Page 2
Lot S; Black 2; Meadowbrook Subdivision
April 23, 2007 -
2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank.
3. All standpipes on the septic tank shall extend a"minimum of 12 inches above final
grade.
4. Septic tanks installed with less than 4 ft. of cover shall be insulated.
5. A foundation cleanout shall be installed one to four feet from the building foundation.
In the line between the tank and the leachfield there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic tank). These cleanouts
shall be located on undisturbed soil not more than 10 ft. from the tank. The first
cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be
to clean toward the septic tank.
6. Final grading over the septic tank shall be such that a positive slope exists away from
the septic tank.
111INII%ItMt MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Type of Pipe Perforated Solid
Cast Iron
Yes
Yes
ASTM D3034 (PVC)
Yes
Yes
ASTM F810 (HDPE)
Yes
No
ASTM D2662 (ABS)
Yes
Yes
Use of a type of pipe other than listed above must be approved by the inspecting
engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco,
or equal).
pa9. S
Lot 3; Block 2; Maadowbrook Subdivision
April 23, 2007
INSPECTIONS:
Typically there will be a minimum of two (2) inspections required during the installation of the
septic tank. These inspections will occur as follows:
The first inspection must be conducted after the septic tank is set in place, but
may not be backfilled until after this inspection.
2. The final inspection is to occur upon final grading of the property.
The inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If
necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not
coordinate, direct or control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these
specifications and plans and in accordance with the attached M.O.A. permit. There will be no
contractual arrangement existing between the contractor and S & S Engineering. S & S
Engineering shall be the owner's representative aqd will inspect the work as stated above to
document the contractors activities. Final acceptance of the contractors work rests with the
owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor
to carry out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR / INSTALLER
nGRE ANCHORAGE AREA BOP"'�H
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME 4�Ni(- kT0 /IYIjC)7T MAILING ADDRESS "'OX "(21 (g�4 ktlel`4 PHONE
LOCATION
SEPTIC TANK:
LEGAL DESCRIPTION �� ✓ ��aCl� ✓✓/G '/\ ���
DISTANCENUMBER OF
FROM WELL MANUFACTURER J« ` `��P�l MATERIAL t `�Q I —COMPARTMENTS
Jit L i'�L 0 2- 0 Dc7 0!NSIDE LENGTH INSIDE WIDTH ---LIQUID DEPTH LIQUID CAPACITY GALLONS.
SEEPAGE PIT:
NUMBER OF PITS / DIAMETER OR WIDTH r , LENGTH/—L, DEPTH 6�1
f�' � I
LINING MATERIAL _10 _ CRIB SIZE: DIAMETER V DEPTH DISTANCE FROM: WELL .
04 �7 .29f TOTAL EFFECTIVE
BUILDING FOUNDATION s7 ' NEAREST LOT LINE_ ABSORPTION AREA (WALL AREA) %Z SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE CONSTRUCTION
BUILDING NEAREST NEAREST
FOUNDATION—,LOT LINE SEWER LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES:A62 'Tr- �C7,9b
INSTALLED BY: _
614 cie' t �
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form No, EQ -031
DEPTH
SEPTIC
TANK_
DIAGRAM OF SYSTEM
DISTANCE FROM:
SEEPAGE
SYSTEM
DATE flkll J APPROVED �—f 7 ~'
B.
GRE -AT: -f- Ar4c_-,HORA`c ARI=_A BOROUGH
DEPARTMENT OF CNV11':ONMENTAL DUALITY PERMIT NO
I70AD 1x.:_4111, 51
ALASKA 951,.^�P
SEWAGE DISPOSAL SYSMA m— APPLICATION AND PFRM41 i7
NAME OF APPLICANT
INSTALLATION LOCATION —
LEGAL DESCRIPTION
... _.__.. MAILING AUDk ESS
PHONE
INSTALLATION OF SEPTIC TANK __L� /�yf S FFF-PAGE PIT
TYPE AND SIZE OF FACILITY TO BE SERVED __—._`✓__�[l-tet' "��--�
IN FIELD—____—, OTHER
TO DE INSTALLED BY
SOIL TEST RESULT!i NOT'_: THIP% PF.RM1•e' IS NOT VALID WITHOUT E3,011 Yr -ST
ST
COMPLETION DATE ANTI CCIP ATEB-
__ PFJ3MT7
MNAL IPInpCC'YIONI �s'a3 HOUR P40TICE P21_(?LJII7Ir D. BACKri LuKic, OF ANV Mlr3i2'CP'.9 VkITYPl G) IT FINAL INJOP CTION BY THE
Hi ALY•H DE:PArlYNIENY AUY•HOPYITV t?dILL. DFP SUPJJECT TO PDOSECUYIONi.
SEPTIC 'TANK SIZE /Om'�---_ TYPE.it(.'.a Or__MnC_re_L.f'.SEEPAGE AREA S17E
MINIMUM DI$STANCE.M F7EOUIDE MENTS3
5 ft°
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
20 ft
SEPTIC TANK TO SEEPAGE PIT WALL
DRAIN FIELD __:O _ft" _
SEPTIC TANK r °—. SEEPAGE PIT 20 f _.—. DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
DRAIN FIELD __
S17EPAGF P11
ALSO CONSIDER AREA WELLS,
WATER MAIN TO SEPTIC "TANK _ ft°—. SEEPAGE PIT
DRAIN FIELD-_ 30 ft. __..
SEPTIC TANK, _ 25
ft -SEEPAGE PIT 100 _Ft.—, DRAIN FIELD _50 —f -
I'D RIVER. LAKE, STREAM.
m
TYPE
DIAGRAM or SY'i on...,. vi
4CASs I1 I
"Ililc r"UE 6'!TIIICII AgT5IGNTPON CRIB
f / c1 P6
16
If
A
CAST IRON
IGTO _
UNDIS'f I: a, sou.
A S' -T I—
'IINII:'J:'I
�R AYELPA(!'f 11l �T .
a ird :Le P@9000 CRIB.
C I
In nrver Ilne era. Se. (CRIB a' Ci1111ffI". ABOVE NATER
umlcr Jr i,av, TACIT)
IJ
I•!tl IE L'rll I L r L!r CT ILLI S.
CAST IRON INTO AND OUT OF SEPTIC 'TANK AND IN -i0 CRIB CROSSING GAP OF ' - - II .Ci I T v;.I .1-Gi 100 BASED ON
.011.
EXCAVATION 9 FEET INTO UNDISTURBED SOIL.
Ili HT IfW
L0 S;.I'IC LIGE- IO
A INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGB PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
lit TR•'(_ Pt"
I?,'
i.n II -r- nn'
G."AVEL nACIdt'r11,1_, c:•- -.!r' I
.✓., 51 V.'P V„T Ir0ll,
CONFORM TO BOROUGH REGULATIONSL
REGARDING IN5TALAYION. 1':TO I
rl,cLlEif
cull
I .
HEALTH AD ORI Y
OR
L-ICENSL'D DESIGNER
cr 1/A” p r tun- - I
ex<cpt I)' precr.,ainq
IIOUSE - tank E Lna. sLoulJ
not evcceJ L.
6- peg IPO nn flet
-- terrains.
SEPTIC
•Cllr
d ILCN
CAS' �IRON SINION PIPE j SCCPAGE PIT
CRID
- LBI.V[L UACkEILL
70' HIUIIUN
BE APE ST ITT 1.!,r
I CER"fIFY THAT I AM FAMILIAR Wll"H THE REQUIREMENTS OF GREATER A ORAD F. An f3CSROVV-HORNCE NO. ?.B -BH AND THAT THE ABOVE
DESCRIBED SYSTEI.E If, IN ACCORDANCE WITH SA10 CODE,
DATE APPLICANT'S SIGNATUFlL"
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Certificate of On -Site Systems Approval
OSC251523
Parcel ID 050-191-42 Expiration Date: j 7
Legal description MEADOW BROOK BLK 2 LT 3
Site address 18323 KANTISHNA DR
Current property owner(s) REMER DONNIE L & MARY K
The On -site system(s) is/are approved for bedrooms
_ Conditional approval for
Comments or conditions:
- bedrooms, with the following stipulations:
This Certificate of On Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
Development Service Department (DSD) issues COSAs based upon representations provided by an
independent professional engineer. The Municipality of Anchorage is not responsible for errors or
omissions in the professional engineer's submittal.
ATTACHMENTS:
COSA Checklist
Absorption Field Advisory
Tank Age Advisory
Other
X Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
MUNICIPALITY OF ANCHORAGE
Development Services Department - Phone:907343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 050-191-42
Complete legal description MEADOW BROOK BLOCK 2 LOT 3
Location (site address) 18323 KANTISHNA DRIVE EAGLE RIVER, ALASKA 99577
Current property owner(s) REMER DONNIE & MARY
2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: F-1 Private Well serving # dwelling units
El Other Non-public well as regulated by MOA 0 Water Storage
FN Community Well or Public
4. TYPE OF WASTEWATER DISPOSAL: nN Private Septic E] Private Septic serving 2 dwelling units
R Holding Tank R Community Septic or Public Sewer
5. SEPTIC TANK: F-1 Steel ril Plastic E] Concrete F-1 Fiberglass
Age 18 _See advisory if steel or fiberglass older than 20 years
6. ABSORPTION FIELD: E]AWWTS []Bed 0Deep Trench RWide Trench FlSeepage Pit
Waiver request for:
Expedited review requested: R
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On -site staff
to verify the accuracy of the information provided.
COSA Fee$ S 7 6
Date of Payment I/ Z160 5
COSA # 05621152,1
Waiver Fee $
Date of Payment
Waiver #
COSA Appficaflon—Apr2025.doc
COSA Checklist_May2025 copy.docx
COSA Checklist
Legal Description: MEADOW BROOK BLOCK 2 LOT 3 Parcel ID: 050-191-42
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA - PUBLIC &/OR CLASS “A” WATER
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
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank 42”
Date of pumping 11/19/25
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. DISPOSAL FIELD DATA NEW FIELD
Which system tested (date installed) NA- NEW
ALL standpipes present per record drawing
Total measured depth from grade 13.2 ft (max)
Measured depth to pipe invert from grade 6’ ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective. (ED)
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date NA – NEW FIELD
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate 450
FIELD STATUS – NEW FIELD
Effective depth (per record drawings) 84 in
Effective depth used 0 in
Effective depth remaining 84 in
Comments/Deficiencies: NEW SEPTIC ABSORPTION FIELD INSTALLED.
COSA Checklist_May2025 copy.docx
E. SEPARATION DISTANCES
From Well on Lot to: (Please enter distances if less than required)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Disposal Field on Lot > 100’ Yes if No ft
Neighboring Disposal Fields > 100’
Yes if No ft
Sewer Line/Main > 100’ Yes if No ft
Sewer Manhole/Cleanout > 100’
Yes if No ft
Sewer Service/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
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required)
Tank to Foundation > 10’ Yes if No ft
Field to Foundation > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No *1 ft
Water Main/Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
*MOA WAIVER #OSV251048
G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 12/02/2025
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 or NO 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 &
12/02/25
First
G [} N S U L T f N G
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / FirstWaterAK@gmail.com
November 17, 2025
Municipalities of Anchorage
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: CONDITIONAL COSA - CCOSA
LEGAL: MEADOW BROOK BLOCK 2, LOT 3
Due to seasonal winter conditions, site location and other factors, we are requesting a
Conditional COSA for the above referenced property. The permitted OSP251399 3-bedroom
absorption field upgrade has been impeded due to these conditions and other factors with no
specific known date on when the septic field will be installed. It is expected that the septic
system will be installed soon.
The system has been working for the occupants and granting of this Conditional COSA
(CCOSA) will not impact any of the neighboring properties or pose a public health risk.
Attached are three absorption field install estimates and the escrow letter from the title /
mortgage company for the pending installation. Please contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Fr51
L
!i'4 I iA!I'I I!VG
• Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 050-191-42 Expiration Date:
1. GENERAL INFORMATION fr\" ° 'J
Complete legal description Meadewbreek S/D, Block 2, Lot 3
Location (site address) 18323 Kantishna Drive, Eagle River, AK 99577
Current Property owner(s) James E., Jr. & Cheryl Brundage Day phone 1-210-540-9190
Mailing address
Real Estate Agent Audrey Mason, ReMax of Eagle River Day phone 622-3344
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
WaiverNariance request for:
Received by: yr:. s' �� Date: ' '=
•r
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ '"ID -
Date of Payment (o l l 13
Receipt Number 6313
Waiver Fee $
Date of Payment
Receipt Number
COSA# CSC-i31;(�y Waiver#
3
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual
F-71
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
U
Public Sewer
❑
WaiverNariance request for:
Received by: yr:. s' �� Date: ' '=
•r
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ '"ID -
Date of Payment (o l l 13
Receipt Number 6313
Waiver Fee $
Date of Payment
Receipt Number
COSA# CSC-i31;(�y 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 Douglas T. Kenley, P.E. Phone (907) 746-1073
Address 9806 E. Northstar Circle, Palmer, Alaska 99645
Engineer's Printed Name Douglas T. Kenley
6. DSD SIGNATURE
t System #1 Approved for 3 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for
Date 4 I $ 13
bedrooms, with the followin
By: Original Certificate Date: 9 -3 -1 -3 -
The
-3J/-3The unicip y c orage 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.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet � ..
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
brio _
Meadow /D, Block 2, Lot 3
050-191-42
Legal Description:
Parcel ID:
A. WELL DATA
Well type Public 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 (a ground) in.
FROM WELL LOG
AT I CTION
Date of test
Static water level
Well production g.p.m.
9.p -m.
WATER SAMPLE RES .
Coliform colonies/100 mL Nitrate mg/L
Ars'enic ug/L Date of sample:
Collected by--
y_B.
B.SEPTICIHOLDING TANK DATA
Tank Type/Material *Septic/Plastic HDPE
Date installed *5/7/07
Tank size *1000 gal. Number of Compartments 2
Cleanouts (YIN) Y
Foundation cleanout (Y/N) Y Depression over tank (YIN) N
High water alarm (Y/N) N
Date of pumping 6/18/13 Pumper 3 R's Pumping
C. ABSORPTION FIELD DATA
Date installed *9/21173 Soil rating*Unknown Seepage PWCNb
(g.p.d./ft or ftz/bdrm) System type
Length *17 ft. Width *14 ft. Gravel below pipe *6 ft
Total depth _f12 ft Eff. absorption area *372 ft? Monitoring tube Y Depression over field N
Date of adequacy test 6/14/13 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 58 in. Water added 493 gal. New depth W3/4 in.
Elapsed Time: 80 min. Final fluid depth 60-1/4 in. Absorption rete >= 450 g p d
Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date -----
D. LIFT STATION
'rinstalled Size in gallons Manhole/Access (YIN) _
ump o vel at� in. "Pump ofr level at in. High water alarm level at
Datum Cycles tested Meets alarm & circuity
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tanktlift station on lot
Absorption field on
Public sewer main
s
O�adjiaoent
O
Public sewer ma
Sewer /seoe-fervice line . Holding tank
containment areas
Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ ft. Property line 10+ ft.
Water main 10+ ft. Water service line 10+ ft.
Wens on adjacent lots 200+ ft.
ABSORPTION FIELD ON LOT TO:
Property line 10+ ft. Building foundation 10+ ft.
Water Service line 10+ ft- Surface water 100+ ft.
Curtain drain None Known Wells on adjacent lots 200+ ft.
F. COMMENTS
From M.O.A. records.
G. ENGINEER'S CERTIFICATION
l certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Douglas T. Kenley; P. E.
Date to • Vil - V;
COSA brown sheet 10-10-12.doc
Absorption field 5+ ft.
Surface water 100+ ft.
Water main 10+ ft.
Driveway, parkingNehide storage 5+ ft.
in.
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date
(a) Legal. Description (include
, block, subdivision, section, township, range)
Location (address or directions)
�LrA ✓J 3 -2-//
(b) Applicants Name.ZL0 // Telephone --Home Business
Applicants Address :a2�1 ��% J / /i '_t
(c) Applicant is (check one) Lending Institution
Buyer = ; Other •t� (explain); _
(d) Lending Institution
A) KJ A_
; Owner/builder ;
Address - -- _/�-J J\..J r -
(e) Real Estate Co. & Agent
Address
Telephone
/�DL
(f) d ail the HAA to the following address:
tSACIIN[.L rliN
2. Lvye cf Residence
Single -Family. Multi -Family r-7 Other (describe)
Number of Bedrooms
3. Wates" Supe
Individual Well = Community = Public
hone
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewage Disposal
Onsite Public Community Holding Tank
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
5. Engineering Firm Providing Ic, lspecttonsL-TestszFlit Search Data and Information
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 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, t:he on-site water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this ins ectioi
Name of Firm
Address
SKIT 106111:
/h.R..Al Ata'
Telephone
Date
�.• F 11P
(ENGINEER SEAL)
6. DHEP Approval
Approved fori'Lr (75)bedrooms
Approved �_- Disapproved
Terms of Conditional Approval
?;, .r _ "`
�'�, ; ,;:� / �'t x
.,� Won A. `h,%
1
By /f.,l. c J-9-
L
Idu. 14i7r "
vl_ C(.' r ( �
�v.
7Ja re a T
Conditiona].8�
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
PROTECTION
REPRESENT -
REGISTERED
HOMES AND
REQUI:RE-
BEFORE A
FOR ERRORS
[Page 2 of 2] 7--19-84
Llr,
Ci\VI,':ONi/�EUTAL P�:`-l�C fiON
MUNICIPALITY OF ANCHORAGE (MOA) r
HEALTH AUTHORITY APPROVAL (HAA) �'� `r �� 1984
1984 CHECKLIST - FEBRUARY '
L V 4
tt��,-;� Legal D scription: Z
A. WELL DATA--
/
Well Classification A- If A, B. or C. D.E.C. Approved(Y/N) —_
Well Log Present (Y/N) _ Date Completed Yield —m
Total Depth —_ Cased to Depth of Grouting
Static Water Level `� _ Pump Set At --
Casing Height Above Ground`_ Sanitary Seal on Casing (Y�
Electrical Wiring in Conduit "ICY -M) ~� Depression Around Wellhead (Y/N) _
Separation Distances f;,"11: `
To Sept ic/Holdi g.TanK�on Lot _�60 On jc3 inni�ing Lots
To Nearest Edd of Absorption Field on Lot h �- On Adi-0-1ran.9 Lots
To Neare Public Sewer Line � To Nearest Public__�6we�
Cle out/Manhole To Nearest Sewer Service Line on Lot
Wa r Sample Collected By Date
Water Sample Test Results _
Comments
B. SEPTIC/HOLDING '.LANK DATA
Ikate Installed 'GLIA% Size No. of Ccapartments
Standpipes (Y Air -tight Caps ( /} Foundation Cleanout
Iepression over Tank (X Date Last Pumped 3 --
Pump ing/Maintenance Contract on File (Y & for _
Holding Tank High -Water Alarm (Y/N)w_ Temporary Holding Tank Permit
Separation Distances from Septic/Held4rq Tank:
To Water -Supply Wb11 _009 To Building Foundation
—S/ToTo Property Line _— `O r� To Disposal Field __S/-
To
Water t>'Service Line '3O To Stream, Pond, Lake, or Major Drainage
Course !J 1) .1�j (F --
Commnts N 0 0 Iz --
Receipt #)M
;�
Date Paid: 1,-I_
Amount: r�__
[Page 1 of 21
2-15-84
C. . ABSORPTION FIELD DATA -x,
Soils Rating in Absorption Strata Type of System Design %
Date Installed U�t G/ > -- 0,/ ' s Length of Field
Width of Field Depth of Field /Z
Gravel Bed Thickness -
Square Feet of Absorption Area J/ _3/2_�'Standpipes Present (Y
Depression over Field (3l Date of Last Adequacy Test
Results of Last Adequacy Test ,Sig T/,SFA C Zb
Separation Distance from Absorption Field:
To Water -/Supply 4\b11 21.E To Property Line /d
o ndation J-�
To Build2mg E'�
g To Existing or Abandoned System cn
Lot /�%`� /� On Adjoining Lots
To Water Main/Service Line 3� i¢ To Cutbank(if present) ,WJ y AJ
To Stream/Pond/Lake/cr Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area ._ D2i v�= c✓vt y
Commnts A./ -O iJ
D. LIFT STATION
Date Installed Dimensions
Size in Gallons Manhole/Access (YIN)
"Pump On" Level atOff" Level at
High Water Alarm Level at Vent (YIN)
Tested for Pumping QyclIs during Adequacy Test. Meets MOA
Electrical Codes(Y/N)
Comments
** Check
Permitted Bedroan Rating Against HAA Request **
I certify
that I have checked,
verified, or conformed to all
MOA HAA Guidelines in effect
on the date
of this inspection.
Signed
�Ngt�lE EiIN
Date BL,/
;�ZL RIVER. v
Company
PH. X94-��7
MOA No.
KBl/d5/s
(Page 2 of 21
r�
�-
�,:� , UL -wt A. 5ha•;vr
�\ ..fir.. .y1Y •.�J� l
2-15-84
Time
APPLI� Ni FILLS
OUT UPPER HA, ONLY
`-
Property Owner
-I-�/ / ,!�� =
Jf``) C..J `(.. )�, J
Date
Phone
Dale
Zip Code
Inspector
Mail'.:ig Address
Inspector
Inspector
Field Notes:
ry 1
r
c�
Buyer
�2III
APPROVED BEDROOMS �1�-(�- 'CONDITIONS
OF APPROVAL
Address
%i/:... Zip Code
Lending Institution
/-�'. j i',".. ,y
Phone
Address
Soils Rating
Zip Code
Well To Absorption Area
Well to Tank
Realty Co. & Agent
Well Log Received
Septic Tank Size (% U O '
Phone
Address
"Zip Code
Legal Description
Street Location/.../:-
—
lypeJ-Residence
Cif Single Family
-
❑ Multiple Family
No. of Bedroorns ,
❑ 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).
R�T'Publlc Utility
_
Sewer Disposal
EY Individual
Year Individual Installed:
❑ 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
Timle i
Date
Date
Dale
Da`�
CJ
Inspector
Inspector
Inspector
Inspector
Field Notes:
ry 1
r
c�
AUG 2 91933
"Municipality of Ar;'.::;; .'
( "Dopt, of Ilea;fh &
Fnr,lfonmOIL��l�r�too „
�2III
APPROVED BEDROOMS �1�-(�- 'CONDITIONS
OF APPROVAL
( ,"��aPROVED
t ) CONDITIONAL APPROVAL'
DATE
Soils Rating
Date Sewe`r� Installed
Well To Absorption Area
Well to Tank
Well Log Received
Septic Tank Size (% U O '
12-029 (9182)
P
EXCAVATION
WORK
1
September 7, 1983
ROBERT A. SHAFER
CIVIL ENGINEER
694-2979
OP
GE
M0NICk?P'0 Y
F._ANiCHO�ON
I E' ,,of PKCic
ENV IROS, v,
Tom Williams
3211 Kanti.shna
Eagle River, Alaska 99577�� .
Dear Mr. Williams,
Reference: Lot 2; Block 3; Meadowbrook Subdivision
A sewer system adequacy test was performed on the system located
on the referenced property as you requested. The septic tank
was pumped and verified to have a capacity of 1000 gallons. The
seepage pit was charged with 800 gallons of fresh water and after
a period of 24 hours all the water which had been added to the
crib had percolated out.
It can be concluded from this test that the waste water disposal
system serving the three bedroom residence located on this property
is cufrently functioning adequately. However, the system
cannot be guaranteed against subsequent failure.
If we may be of further service, please do not hesitate to contact
US.
4Si er 1
,
RE.
E
s/ss
cc: Municipality of Anchorage
Department of Health and Environmental Protection
SRB196X EAGLE RIVER, ALASKA
64, �• } �� ,
/Ili /�.. •: t
i
A
EXCAVATION I
ROBERT A.SHAFER
WORK
Tom W 1=1 -i -ams l C <
3211 Y.antishna
Eagle River, Alaska 99577
September 7, 1983
Dear Mr. Williams,
Reference: Lot==2; Blcsck 3; Meadowbrook Subdivision
CIVIL ENGINEER
694-2979
A sewer system adequacy test was performed on the system located
on the referenced property as you requested. The septic tank
was pumped and verified to have a capacity of 1000 gallons. The
seepage pit was charged with 800 gallons of fresh water and after
a period of 24 hours all the water which had been added to the
crib had percolated out.
It can be concluded from this test that the waste water disposal
system serving the three bedroom residence located on this property
is cufrently functioning adequately. However, the system
cannot be guaranteed against subsequent failure.
If we may be of further service, please do not hesitate to contact
use
Si er 1
R, E.
S/ss
cc: Municipality of Anchorage
Department of Health and Environmental Protection