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MEADOW BROOK BLK 2 LT 7
Meadow ook lock 2 Lot 7 050-191 -54 Municipality of Anchorage '--0:~ Development Services Department ,~.~---= ::=-%?' Buildin9 Safety Division On-Site Water & Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: aSP 1111 4.3 PID Number: 050-- 1 91 --54 Nome: SUSAN LOWE Wastewater System: [] New [] Upgrade Address: 18338 KARTA CIRCLE *EAGLE RIVER, AK 99577 ABSORPTION FIELD No. of Bedrooms: i_iOU~../'~ Ph°ne:[,907}/~ 696-3294 2 [] Deep Trench [] Shallow Trench [] Bed I-IMound LEGAL DESCRIPTION ~i, Rating: Total Depth from GPD/Sq. Ft. / FL Block: Lot: Subdivision: Depth to pipe bottom from orlglnol grade: Grovel d~eneath pipe: 2 7 MEADOW BROOK_,,,, .,~-\~---2 Ft. / Township: _ Range: _ Section: _ ~_l ~C~'~.~7~~ Gravel length: Ft. Gravel width: Number of llne~: Distance betw~n lines: WELL: [] New [] Upgrade Ft. Ft. Classification (Private, A,B,C): Total Dep.~b~-.'''~ Cased TO:(BEDROCK) T~on area: Pipe material: ~ Ft. Ft. SQ. Ft. iiIiIir:- Dote Drilled: Stotlc Water Level: Installer:. Dote installed: Ft. DAN JANKE Pump Set At: Casing Height Above Ground: Ft. Ft. TANK GPM SEPARATION DISTANCES ~Sept~c [] Ho,d~ng [] S.T.E.P. [] Other* T~o Septic Absorption Lift Holding Public/Prlvote Manufacturer:. Capacity in gallons: Tank Field Stotlon monk Sewer Unes ANCHORAGE TANK 1000 Material: Number of comportments: Well N/A - - - 25'+ STEEL 2 Surface Water 100'+ .... LIFT STATION i Foundation 5'+ .... 'Pump on' level at: 'Purer alarm at: Curtain Drain " NONE KNOWN , Pump Mo~cal Inspections performed by: I I Remarks: BENCH MARK Location and Description: OLD TANK WAS PUMPED AND COMPLETELY REMOVED. CONCRETE STEP AT BACK DOOR. Assumed Elevation: 1 00.00 Ft. ENGINEER'S SEAL Inspections performed by: CEO, Ltd. Dates: 1st 8/-3/1 1 2nd - ~.k¢... ..... 3rd - ~, _~ / Development Services Department Approval ~.co." !49~U~)~ ,,,~-... :.. ,¢ .... · :,,~i ........ ~; ,....:~...! ~.,, ~ F;,~, ..... Conditional approval: Date: ~ .... :.,..,. ....... Reviewed and approved by: , '~/~"~/~//~, e: c/,_ S ~'/! / / PERMII~NUMBER: AS BUILT DRAWING PARCELID NUMBER: OSP111143 - 0,50-191 -,54 MEADOW BROOK S/D LOT 9, BLK 2. A B FCO 16.76 21.16 ST1 17.99 22.06 ST2 21.05 24.42 DBL1 22.55 25.28 DBL2 20.21 42.94 /- I EXISTING 2 BEDROOM HOUSE FCO ST2 MEADOW BROOK S/D \ LOT 6. BLK 2, ~ / MEADOW BROOK S/D LOT 8, BLK 2, = 30' GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS E. 1UDOR ROa~, SUITE 101 ~' ANCHORAGE, ~ 99507 * PHONE (907)557-6179 * F~X (907)558-3246 * ~/EBsrI~ J~m.gom~englneering.com PREPARED FOr: I PHONE NUMBER: SUSAN LOWE I 696-5294 LEGAL DESCRIPTION: MEADOW BROOK; BLCOK 2, LOT 7 PAGE NUMBER: 20F5 ID~WN BY: DATE: 8/,~/1 ~ TYPE OF WORK: ASBUILT DRAWING (Rew 01105) AS BUILT DRAWING OSP111143 - 050-191-54 / - INSUbATION / l-FINAL GRADE = 98.56-98.67 ST1 / ! ST2 TOP OF TANK ---% "-" / I ~ /'- TOP OF TANK ' ///, '///////////////// '///////l ~SEWER LINE TO ~' 'r ' , ,~ / DRAINFIELD COVERED ~F-/--/T7-/I~ ~ W/ 2" INSULATION PER SEWER LINE FROM~ ~---' I_T_~ CONTRATOR. HOUSE TO DRAINFI.ELD /' I NEW 1000 GALLON 1% CO~VNECuEL~T~O/N 2 / "~ SEPTIC TAN~z~'~ ~"-,NVERT OF BUNG PER CONTRATORo ~ j AT OUTLET = 94.68 INVERT OF BUNG---/ ~'J ~} AT INLET = 94.89 $701 E. TUDOR ROAD. SUITE 101 · ANCH PREPARED FOR: ...... SUSAN LOWE ." ,¢~/ ,.,-c~ DEsc,,,:,',-,o,.,: D~w. ,.,.: V ,&:/'..:/oE~T9~3 .: ~/ ~p EMoE)wBoOR KW.BROOK; "LcOK 2' LOT 7 DATE 'NB ~~?r/!} e~(i~_~/ PROFILE: DRAWING 8~4/1 1 '"~,~'~<~ (Rev. 01105) Permit Number: Tax Code Number: Work Type: Permit Effective Dates: Design Engineer: Subdivision: Site Legal Address: Owner/Address: On-Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 OSPl11143 05019154000 Septic Upgrade July 14, 2011 to July 13, 2012 GARNESS ENGINEERING GROUP LTD MEADOW BROOK MEADOW BROOK BLK 2 LT 7 G:0153 LOWE SUSAN R 18338 KARTA CIR EAGLE RIVER AK 995778227 Site Mailing Address: 18338 KARTA CIR, Eagle River Lot Size in Sq Ft: 10258 Total Bedrooms: 2 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Date: Date: MUNICIPALITY OF ANCHORAGE Community Development Department Development Services On-Site Water & Wastewater Program "~ Phone: 907-343-7904 Fax: 907- 343-7997 Mayor Dan Sullivan On-Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 0..~0'-- ic~ ~' ~'~ Property owner(s) SUSAN LOWE Mailing address 18558 KARTA CIRCLE, EAGLE RIVER, AK 99577 Day phone 696-3294 Site address 18558 KARTA CIRCLE, EAGLE RIVER, AK 99577 Legal description (Sub'd, Block& Lot) MEADOW BROOK SUBDIVISION; BLOCK 2, LOT 7 Legal description (Township, Section & Range) Lot Size Sq. Ft. Number of Bedrooms 2 THIS APPLICATION IS FOR: ( [] all that apply) Absorption Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage [] THIS APPLICATION IS AN: Initial [] Upgrade [] Renewal [] THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: N/A I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) 'Rush Fees: Date of Payment: Receipt Number: Permit No. liver Fees: Date of Payment: Receipt Number: Waiver No. (Rev. 01/11) GARNESS ENGINEERING GROUP, Ltd. July 6, 2011 Municipality of Anchorage Development Service Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic Tank Upgrade for Lot 7, Block 2, Meadow Brook Subdivision To whom it may concern: We have been hired by the owner to obtain a permit to upgrade the septic tank at the referenced property. Based upon the information by the pumper, the existing septic tank has rocks in the tank and is believed to be collapsing. We have recently checked the liquid levels in the drainfield and found the sump to be dry. We are proposing that the existing septic tank be excavated, pumped, and crushed in place and a new 1000 gallon septic tank be installed. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assista~. Sincerely, ,,,, i! Presi~ P.E., M.S. NOTE: Attached is a site plan drawing, a design drawing, one soil log, which are all part of the design package for this septic system. (Contact G.E.G. Ltd. for 7 page construction specification letter.) 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com \ INOTE: ALL SURROUNDING PROPERTIES) \ ~\ ~ mARE SERVED BY PUBLIC WATER AND I ~ ~/~ PR~ATE S~ERS. \ _ _:IL ................ I SCALE: 2 BEDROOU HOUSE I ~EXISTINO SEPTIC SYSTE~) ~ I ' ~ m m k ~ ~ m GA~RNESS ENGI'NE~ERING GROUP, Ltd. PREPARED FOR: PHONE NU.B[R= I PAOE NUMBER: 1.i SUSAN LowE m 6gc-3294 m 1 OF 2 ~EABOW BROOK SUBDIVISION; LOT 7, BLOCK 2 J.C.~. SITE P~N FOR SEPTIC TANK UPGRADE 7/6/2011 PROPOSED 1000 GALLON SEPTIC TANK-- INSTALL DOUBLE WATER KEY GEG, Ltd. HAS A 7 PAGE SPECIFICATION LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT GEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND CONDITIONS OUTLINED. LINE (APPROX. LOCATION) ~TALL FOUNDATION CLEANOUT SEPTIC TANK TO BE EXCAVATED. PUMPED, AND CRUSHED IN PLACE. DRAINFIELD SCALE: I 1" = 20' GARNESS ENGINEERING, GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS ~. TUDOR RO~D. SUIT[ 101 *ANCHORAG[. AK 99~07 * PHONE (907),~7-617g * FAX (g07),~8-3246 · tllEBSff£: mm~.garne~en~;neerin~.com PREPARED FOR: I PHONE NUMBER: I PAGE NUMBER: SUSAN LOWE I 696-5294 2 OF 2 LEGAL DESCRIPTION: IDRAWN BY: MEADOW BROOK SUBDIVISION; LOT 7, BLOCK 2 I J.L.M. I DATE: TYPE OF WORK: ] 7/6/2011 DESIGN OF SEPTIC TANK UPGRADE (Rev. 01/05) 3mess..' 7955 ..' : GREi °" ANCHORAGE AREA DOE .,'"H Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SIT'E SEWAGE~ DISPOSAL SYSTEM MAILING ADDRESS LEGAL DESCRIPTION PHONE SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH __ MANUFACTURER 5d~;~[ INSIDE WIDTH NUMBER OF ~(~k W-1~5 MATERIAL ~--~ ~ ~ b(.~ ~ J COMPARTMENTS ~ LI(~UID DEPTH LIQUID CAPACITY )~(~(-~ GALLONS. SEEPAGE Ei¢~%(~^~-~t NUMBER OF PITS I DIAMETER 7~i OR WIDTH '~[ LINING MATERIAL ~O(.(Q CRIB SIZE: DIAMETER BUILDING FOUNDATION ~)_~)t NEAREST LOT LINE~-~)~ ADDITIONAL ABSORPTION LENGTH~W', ! DEPTH ~ DEPTH (¢~ DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) _SQ. FT. WELl_: TYPE .b [1~f~t¢,'¢. L BUILDING FOUNDATION __ CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES . DISAPPROVED NEAREST SEWER LINE DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM REMARKS DISTANCES: INSTALLED BY: PIPE MATERIAl LOT SLOPE: REMARKS: ' Form No. EQ-O31 DATE DIAGRAM OF SYSTEM 1 APPROVED //~.A.A.B. GREATER ANCHORAGE AREA E~OROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 'iCl' STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274~456 l PERMIT NO. __ SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT NAME OF APPLICANT PHONE INSTALLATION OF: SEPTIC TANK L,// TYPE AND SIZE Of FACILITY TO BE SERVED FINANCED THROUGH COMPLETION DATE ANTICIPATED SEEPAGE PIT / - TO BE INSTALLED BY OTHER_ -- NOTE: THIS PERMIT IS NOT VALID WITHOUT BOIL TES~' FINAl. INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE ~/'~f~"~ , DRAIN FIELD SEEPAGE PIT ., DRAIN FIELD MINIMUM DIBTANCES, REQUIREMENTB FOUNDATION TO SEPTIC TANK ~-- FOUNDATION TO SEEPAGE PIT __ '~(~) SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK ~ TO NEAREST LOT LINE. WELL TO SEPTIC TANK -- DRAIN FIELD WATER MAIN TO SEPTIC TANK _ DRAIN FIELD ~ SEEPAGE TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CR~O~S~i~G, GA~~ EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 ~-~?i/~IET~ER~CasT IRON SIPHON PIPES ON SEPTIC TANK aND SeEPAge Pit fittED WITH AirtigHT RemOVAblE GAPS. G I:lAVE L BACKFILL SEEPAGE AREA S'ZE ./Z Y/, Z 5 CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. / / -- DIAGRAM OF SYSTEM MUNICIPALITY OF ANCHORAGE Development Services Department �= P p Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-191-54 1. GENERAL INFORMATION Complete legal description Meadow Brook B2 L7 Expiration Date: Ll —2-d2�S Location (site address) 18338 Karta Cir., Eagle River, AK 99577 Current property owner(s) Katrina Truesdell Day phone 252-9692 Mailing address 18338 Karla Cir., Eagle River, AK 99577 Real estate agent The Mason Team 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 2 Day phone 622-3344 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic R Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System 0 Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $5 5 O Date of Payment 3 f 9 —2— Receipt 2Receipt Number 67 COSA # 0S G 21 1115 Waiver Fee $ Date of Payment Receipt Number 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 Eklutna Engineering, LLC. Phone 907-406-1058 Address 19162 Mountain Rd., Chugiak, AK 99567 Engineer's Printed Name Curits Townsend Date r AW 6. DSD SIGNATURE •TH '•�� .....,>............ P System #1 Approved for Z bedrooms�^L • .......... System #2 Approved for bedrooms �� ��c•.°ate ROFESSIEliO� �a Disapproved � a Conditional approval for bedrooms, with the following stipulations: �i,t(i((iiifri ON-SITE WATER AND PROGhAM 010. SE?,N By Original Certificate Date:_ The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Meadow Brook B2 L7 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DXFA ❑ Well log is filed with p ite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments This property is served by a public water system. B. TANK DATA Age of tank(s) 10 years Tank type/material septic SgC) Measured operating fluid level in septic tank 49.5° ❑ Standpipes/foundation cleanout per record drawing Date of pumping 3/4/21 D. ABSORPTION FIELD DATA Parcel ID: Structure served by this system 1 nrn_1 Q1 _-,;d Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative ate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. T STATION ❑ Require aintenance completed Age of lift station years Lift station material Comments: Which system tested (date installed) 5/29/75 Adequacy test date 3/4/21 ❑ ALL standpipes present per record drawing Results ❑✓ Pass For 2 bedrooms Total measured depth from grade 7.7 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade *2.3 ft (min) Water added 630.4 gal ❑ N/A — pressurized field 6 New depth in ❑ Monitor tubes go to bottom of effective. If not, state 30 depth into effective Elapsed time min ❑ Code -required soil cover over field Final fluid depth 2 in ❑ System presoaked Absorption rate 420.3 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) Gallons introduced 630.4 gallons If yes, enter date Comm ents/Deficiencies: *Refer to the letter from Gamess in the 4/27115 COSA. The adequacy test form this date is nearly identical even during cold weather wintertime conditions. COSA Checklist yellow sheet E. SEPARATION DISTANCES From P-ri-vat` Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift St t oma Lot > 100' ❑✓ Yes Community Sewer Manhole/Cleanout > 100' '70Yes if No ft 7 Yes if No ft Neighboring Tank > 100' ❑ �ifoft Private Sewer/Septic Line > 25' ❑ Yes if No ft ✓❑ Yes if No ft Community Wells > 200' 0 Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft�=Iding' Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' Yes Animal Contai r t > 50' ❑ Yes if No ft ❑ Yes if No ft Yes if No ft Manure/Animal Excreta Stora _ 100' F. ENGINEER'S COMMENTS Community Sewer Main > 75' ❑ Yes if No ft ❑ Ye filo ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 5'+ ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' r -V1 Yes if No ft Water Main > 10' ✓❑ Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' F/-1 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓❑ Yes if No ft Private Wells > 100' ❑✓ Yes if No Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' M Yes if No Surface Water > 100' Q Yes if No ft 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. COSA Checklist yellow sheet ��NGIE�'S ft ft • •11c-" Municipality of Anchorage o ` On-Site Water and Wastewater Program zK ' wide.: r. r (907) 343-7904 '�'�''Y Sn, r CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-191-54 Expiration Date: ) 2-3- 1C( 1. GENERAL INFORMATION Complete legal description _MEADOW BROOK BLK 2 LT 7 Location (site address) _18338 KARTA CIR, EAGLE RIVER AK Current Property owner(s) _MEGAN BEITH Day phone Mailing address _PO BOX 140142 Real Estate Agent Day phone 2. TYPE OF DWELLING: 6 5 6 7 8 9 ® Single Family (w/wo ADU) �ti �o ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) OCT 0 ; ' 2018 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WAST: I �'9� LOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class A Well ❑ Community ❑ Public Water System ® Public Sewer ❑ Waiver/Variance.request for: Distance: marmunggpm Atuommimiguiremsomom Received by: '14+/b— Date: e 1/4// COSA to be released to the engineer,unless otherwise requested by the engineer. • ... .. ... .. ... COSA Fee $ 52(0 ' Waiver Fee $ Date of Payment 10-1-ig i caL Date of Payment Receipt Number 23oqg0 Receipt Number COSA# USC t(/52 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 MIKE N ANDERSON,P.E. Phone 727-8864 Address 4661 NATRONA AVE. Engineer's Printed Name MIKE N ANDERSON,PE Date 9/29/18 ;Z.�' ' G `i e o c,o o n o c,o o. .>•.u c c to + MICHAEL N. ANDc&SC:1 6. DSD SIGNATURE � °° CE-9 O System #1 Approved for 3 bedrooms. (1 4 ',/Z11 y•° System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: \C,\, 6/z_ o !ifq r.617- w tr. pS7• ., ' No m UGly -11) SERVICES BY • � Original Certificate Date: 10-3— The 0-J—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 Advisory,', • Well Flow Advisory Other c , COSA blue sheet_10.10.12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system _ Certificate of On-Site Systems Approval Checklist Legal Description: MEADOW BROOK BLK 2 LT 7 Parcel ID: 050-191-54 A. WELL DATA -eL) I i L. Well type If A, B, or C provide PWSID# Well Log (Y/N) Date completed Sanitary seal (YIN) Wires properly protected (Y/N) Total depth _ft. Cased to ft. Casing height(above ground) _ FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic: ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL/.epf,c Date installed 8.3.11 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N)Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 6-21-18 Pumper Sanitary Pumpers C. ABSORPTION FIELD DATA ��JJ Date installed 5-29-75 Soil rating 1100 V7tti°\_ System type DEEP TRENCH Length 34 ft. Width 3 ft. Gravel below pipe 5.0 ft. Total depth 7.75 ft. Eff. absorption area 340 ft2 Monitoring tube Y Depression over field N Date of adequacy test 8-29-18 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 500+gal. new depth 8 in. Elapsed Time: 1350 min. Final fluid depth 0 in. Absorption rate >= _500g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off' level at in.High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5' Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10 Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(None Known) Wells on adjacent lots 200'+ O 4i F. COMMENTS #:,":,_(-)• . . . �, e MICHAEL N. ANDERSON• G. ENGINEER'S CERTIFICATION c• CE-9 69 r I certify that I have determined through field inspections and @ 4"`D U a •" ,s review of Municipal records that the above systems are in �(�; conformance with MOA COSA guidelines in effect on this date. ��'ti�►��:°-�� Engineer's Printed Name MIKE N.ANDERSON, PE Date 9130/2018 COSA canary sheet_2-6-15.doc 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 7; Block 2; Meadowbrook Subdivision Location (site address or directions) 18338 Karta Circle Eagle River, AK Property owner Mailing address Northland Mort,qa,qe Day phone 274-5150 2605 Denali Suite #100 Anchorage, AK ~ Lending agency Mailing address Agent Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: 2 %1 Public water XXX If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: XXX Individual on-site Holding tank Community on-site Public sewer 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/orwastewaterdisposalsystem is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm . ,/~ / Phone O"~ ~ c//'"Z- ¢' 7.¢ :~ & $ ENGINEERING j / / Add ress 17034 Eagle River L~,~,. ~...,J~,_ ~ / Engineer's signature z./7/~./.~//'.c-~~Date ~//~'/¢ ¢ DHHS SIGNATURE Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72*025 (Rev 1/91) Back MOA .21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-¢<"7 6~-- ~-- t~F~t> o,,~ ¢/¢-oo ~- Parcel I.D. A. Well Data Well type f'~o/~ Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to ~'h~ Wires pro...~rotected (Y/N) FROM WELL LO~ AT INSPECTION Static water Pump level1 g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ¢'o '~ ; On adjacent lots RECEIVED g.p.m. ~lUri~cip~:ht~ oi Anchorage Dept, Health & Human Services Absorption field on lot ~-o c~ ; On adjacent lots Public sewer main Public sewe~ Sewer service line PetrjCeurfftank WATER SAMPLE RESU~'I'~~ Coliform ~ N~trate Other bacteria Dat~ Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~-~'~-'~ - '7¢- Tank size Cleanouts(~/N) 7/ High water alarm (Y/~'~ Date of pumping Compartments Foundation cleanout ~f~) ~ DepressionCY/~ Alarm tested (Y/N) 'J/-~ ~"U/~ ~ ?¢ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK T¢: Well(s) on lot '7--o c, On adjacent lots To property line /~ Surface water/drainage Foundation Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at ~vel at High water alarm level ~._~sted Meets MOA electrical codes (Y/N) SEPARATION ~TATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed ~--' 2.-q - ~ ~ Soil rating (GPD/Ft Length ~4' s Width .5 J Gravel thickness Surface water System type Total depth Total absorption area 3¢c, ¢ Cleanout present/N) Date of adequacy test --<~¢ / ,~ ~ ~ ¢ Results~fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y~) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ::Zo ~ s ~ On adjacent lots '~/,~ To building foundation On adjacent lots ~ ~ ~ ¢ Surface water /DC) Curtain drain '"/~ ,¢ Depression over field (Y,~ ,~ ~¢d~' for ~ '-~ Bedrooms After test ~,~ If yes, give date /J/'~ Property line To existing or abandoned system on lot "J',//~ Cutbank ~J//¢ Water main/service line /o Driveway, parking/vehicle storage area --<~ / ~ E. ENGINEER'S CERTIFICATION I ced/fy that I have checked, ver~all MOA and HCA guidel/nes in e - ' ~f:this/nspection. Engineer's Name 17034 E~ Lo~ Road No, 204 '.: ' HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) LOT 7; BLOCK 2; MEADOW BROOK Location (address or directions) 18338 Karta Circle. (b) Property owner Marga~¢.t G~'ego Telephone: (home) Mailing Address (c) Lending Institution Mailing Address CERTIFICATE-- OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ,,LTh[-';- t(~ /- .%.'~ HAA# ~-,i~%tC~ ~ 18338 Karta Circle Eagle Riven: AK. 99577 Telephone Business (d) Real Estate Company and Agent /?E/MAX 0F FAR/F Address l~[,flfl ~.~¢~f/a~d P~Jue ¢¢fll F~gPa R/u~; A~. qq~77 Telephone 694-4200 (e) Mail the HAA to the following address: (or check here~, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle River Loop Road Eagle River, Alaska 99577 2. 'rYPE OF RESIDENCE Single-Family E] Number of bedrooms 3. WATER SUPPLY individual Well [] Community [] Public AE]X Note; If 9..?~munity well system, must have written confirmation from the State Department of Environmental ConserVatiOn attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~ 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. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE 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 th is 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. [ further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone S & S ENGINEERING Address , ',~,o,~ :*.~,~ ~; .... , ~- ~ ..... Date Eagle R|ver, Alaska ~9577 6. DHHS APPROVAL Approved for/~--~.>/ bedrooms by Approved .. "~ Disapproved Terms of Conditional Approval Conditional Date The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph S above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHSdo not conduct inspections or analyze data before a certificate is issued. The MunicipalityofAnchorageisnot responsible for errors or omissions in the professional engineer's work. 72-025 (Rev 7/88)Back Page 2 of 2 A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Flectrical Wiring in Conduit (Y/N) SEPARATION DISTANCFS FROM WELL: To Septic/Holding Tank on Lot 1-o Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ~ O ~ . MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) ,m¢/,LitY CCFiE~N~'I!BFT. FEBRUARY 1984 Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Legal Description: /O-t, 9 , If A, B, C, D.E.C. Approved (Y/N) ~ Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING I'ANK DATA Date Installed ~--¢~- ~5~_Size Standpipes (Y/N) Y Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: ! C)©O No. of Compartments Air-tight Caps (Y/N) Y Foundation Cleanout (Y/N) ~ _ _ ~ Date Last Pumped ~ ~.,~ k)/~ ;for ~J/~ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field _ To Water-Supply Well ----c~. © To Property Line To Water Main/Service Line / To Stream, Pond, Lake or Major Drainage Course Comments ~) ~ O-r-'lc 72-026 (Rev 7/88) From Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed '~ -,---~ ~ - Width of Field / (~C) ~/~'<: ("~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Square Feet of Absortion Area .3 /q/C) ~ Statndpipes Present (Y/N) Depression over Field (Y/N) ~ Date of Last Adequacy Test Resultsof Last Adequacy Test .-~I~5%'~C~-o/'~' - .~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ?©O ~ To Property Line ~ To Building Foundation ? © To Existing/or Abandoned System on Lot f'J/~ ; On Adjoining Lots ~-~¢-~ ~ To Water Main/Service Line / O 1~ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course / (...3(~ ~ To Driveway, Parking Area, or Vehicle Storage Area ,Z¢ 7 ~ ~ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & $ ENGINEERING Signed ~7034 Eagi~ ~]ver Loop Road No, 26-. CompanyEa.qie Rive~ Alaska Date ~//~ ~ MOA NO. /____ Receipt No. r~ Date of Payment Amount: $ 72-028 (Rev. 7/88) Back Waiver Fee: $ Date of Payment Page 2 of 2 DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Des_cr)ption (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Properly Owner ~ Mailing Address Lending Institution (c) Mailing Address ~~.' ,~~ ~~~/ ~~ ~ (d) Real Estate Company and Agent Telephone / (e) Mail the HAA to the followin~ address: or: Check here~if hold for pick up. List contact person and day phone number below. ' ' Eagle River, TYPE OF RESIDENCE Single-Family [] Number of Bedrooms __ WATER SUPPLY Individual Well [] Community [] Public ~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite'l~ 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 72 025 fRev 8/861 Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seaJ 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 redly 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 Address Date S&5 ............... 17034 Eagle River Loep Road No. 204 Eagle River, Alaska 99577 Telephone DHHS APPROVAl. Approved for '~/'~-~'~ bedrooms by ,~'"'~, ~' ~~ Approved Disapproved Conditional Date Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements, Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 fRev 8/88) Back WELL DATA MUNICIPALITY OF ANCHORAGE (MO~l HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF ANCHOI~ECKLIST - FEBRUARY 1984 DEPT. OF HEALTH & 264-4720 ENVIRONMENTAL PROTECTION ,$EP 2 2, 1987 RECEIVED Well Classification Well Log Present (Y/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ~-'~:~::~ To Nearest Edge of Absorption Field on Lot '~-'~::~ To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ~"~' ~:;:~: If A, B, C, D.E.C. Approved (Y/N) Date Completed Cased to Depth of Grouting Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/144)L'O~G 'rANK DATA Date Installed ~ ~Z~'¢~. -'"/~" Size ~- No. of Compartments ~ Standpipes ~N) Air-tight Caps~',l) Foundation Cleanout (Y~) Depression over Tank (YLI~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarrn (Y/N) Separation Distances from Septic/Melding Tank: To Water-Supply Well To Property Line To Water Main/Service Line _ Course \ Comments ~'~ i--k/~Date Last Pumped; for ~¢-~'~/,~ , Temporary Holding Tank Permit (~/N) '-'~//~ To Building Foundation ~:~ To Disposal Field '~ To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C./~BSORPTION FIELD DATA Soils Rating in Absorption Strata Width of Field ~ Square Feet of Absorption Area Depression over Field (Y/~]~' Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness ~' Standpipes Present d~/N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments "~ '"~ D. LIFT STATION To Property Line '~ To Existing or Abandoned System on ; On Adjoining Lots % ~¢' To Cutbank (if present) ~"~/P' Date Installed Size in Gallons / "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all ,IVl/~.A and HAA guidelines in effect on the date of this inspection. Earl8 River, Aiaska Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84)