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HomeMy WebLinkAboutMEADOW BROOK BLK 2 LT 10oGRr ER ANCHORAGE AREA BO Department of Fnvironmental (~uality 3330 C Street Anchorage, Alaska 99503 JGH INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME j/~OCjl~'rl~ ~)'¢IIDJ)~(~ MAILING ADDRESS PHONE LOCATION LEGAL DESCRIPTION SEPTIC TANK: ~ L" '~ DISTANCE FROM WELL __ MANUFACTURER MATERIAL NUMBER OF _COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY I DOD GALLONS. Sl--EPAGE PIT: NUMBER OF PITS LINING MATERIAL BUILDING FOUNDATION DIAMETER U~I:~! OR WIDTH IL' ; · LENGTH I"~. DEPTH I ol CRIB SIZE: DIAMETER~7~ DEPTH (¢I _ DISTANCE FROM: WELL TOTAL EFFECTIVE NEAREST LOT LINE ABSORPTION AREA (WALL AREA) ~'~8 SQ. FT. ADDITIONAL ABSORPTION WELL: BUILDING FOUNDATION CESSPOOL APPROVED _CONSTRtJCTION NEAREST LOT LINE__ OTHER SOURCES DISAPPROVED DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE TANK SYSTEM REMARKS DISTANCES: DIAGRAM OF SYSTF-M INSTALLED BY: PIPE MATERIAl - LOT SLOPE: REMARKS: Form No. EQ-031 ~/ G.A.A.B. MUNMPAUTY OF ' 4 Development Services Department On -Site Water & Wastewater Section Parcel 1. D. 050-191-57 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: Phone: 907-343-7904 Fax: 907-343-7997 Complete legal description Meadow Brook, Block 2, Lot 10 Location (site address) 18341 Karta Circle Eagle River, AK James & Karen Burnett 227-0772 Current property owner(s) Day phone Mailing address 18341 Karta Circle-_ Ea le-River-,-AK-99577 -----.-.----_. - Real estate agent 2. TYPE OF DWELLING: © Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 727-6025 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Fn� Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment 5WCbulT�- WIP / ._ Receipt Number d U 6 0 b COSA# 05C lb1503 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 Forge Engineering Phone (907) 522-7773 Address 1399 W 34th Ave, Anchorage, AK Suite 101 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 8/13120 6. DSD SIGNATURE - - System #1 -Approved for-rjedrooms cr�o� No. CE -4381 Zv bedrooms 060 ,1.••, 8i13i20 . • ��� SFO%.•+O..• Q•• �,�`' m SSk o® _ bedrooms, with the following stipulations: System #2 Approved for Disapproved Conditional approval for a 49th •: E. ANDERSON jpjr v�,ATER � �- Original Certificate Date: 'Zn ' Z z r✓ 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 engineers 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, Block 2, Lot 10 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments Lot is served by AWWU Water System. B. TANK DATA Age of tank(s) 8 years Tank type/material Septic/Steel Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping Alaska Sewer & Drain - 6/8/20 D. ABSORPTION FIELD DATA Absorption Crib Which system tested (date installed) 10/21/74 ❑ ALL standpipes present per record drawing Total measured depth from grade 10.6 ft (max) Measured depth to pipe invert from grade 4.6 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 ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced _gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 050-191-57 Structure served by this system 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 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Gravity Flow System. Adequacy test date 6/16 Results MPass For 3 bedrooms Fluid depth prior to test 54 in Water added 451 gal New depth 77.5 in Elapsed time 1440 min Final fluid depth 55 in Absorption rate '450 gpd Any rejuvenation treatment (past 12 months) No If yes, enter date System remained in service during the 24 hour recovery period. Water continued to enter the absorption pit. E. SEPARATION DISTANCES Lot is served by AWWU Water System. From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Yes Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft p Yes if No Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' ❑ Yes if No ❑ Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No ft 0 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' ft ft ft ft ft ❑✓ 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'✓❑ Yes if No. Water Main > 10'✓❑ Yes if No ft Community Wells > 200'✓❑ Yes if No. Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓❑ Yes if No ft Private Wells > 100' El Yes if No Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS Lot is served by AWWU water system. 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 �®oma©atiti�a r. L9th `�• 0� ................................................ G MICHAEL E. ANDERSON No. CE -4381 GO® t�,��'•.,•�•�9/23/20�:.••� u, ft ft 1 Tat 5 \ 1 a S 89'67'1 O*E 185.37' 10' UTILITY p EASEMENTS d f.3XX4.,V C�orry POTTING1 0 9.8'x8,1' SHED — SHED 14,881 S.F. "g O Let 11 1g' DECK w/DORY RESMEN AYUCHiC CHAIN-UNK FENCE- -10' UTILITY EASEMENT .e. ,>t • 6. 1'x8.2' SHED A.7' CAWA- PORCH^Y PIFESC Lot 9 0 NOTE: LOT IS SERVED 8Y A COMMUNITY WATER SYSTEM. PLOT PLAN _ AS BUILT X SCALE 1" = 40' GRID NW 0153 Prolect No. 20-493/R1 Lang Associates, � , 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang A S S o ri ! a t e S 9 inc. (907) 522-6476 Phone90-4625 Fox Professional Land Surveyors ken®longsurvey corn : O F A. Q ionothan®lanasurvev.com �'��! '' • • 'qs i hereby certify that 1 have surveyed the following described property: LOT 10, BLOCK 2, MEADOW BROOK SUBDIVISION (PLAT No. 72-243) Anchorage Recording District, Alaska. and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto. that no improvements on the property lying adjacent thereto encroach an the surveyed premises and that there are no roadways. transmission lines or other visible easements on sold property except as indicated hereon. Dated this the �,it\ Day of pvC7-VT% tl�110 , at Anchorage, Alaska It is the responsibility of the owner to determine tho existence of any easemflnts, covenants, or restrictions which do not appear an tho recorded subdivision plat. ............49 , fCEWNEhI G. !LANG;? AECC963 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1O; Block 2; Meadow Brook Subdivision, Location (address or directions) 18541 Karta Circle (b) Property owner Mailing Address (c) Lending Institution Mailing Address Beckha~a 10111 Lee Street, Telephone:(home) Ea~le River¢ Alaska 99577 Telephone Business (d) JACK WHITE COMPANY ATTN: Barbara RealEstate Company and Agent 10928 Eagle River Road Eagle River, Ak. 995~7 Address Crittenden Telephone 694-5500 (e) Mail the HAA to the following address: (or check here,~, if hold for pick up.) List contact person and day phone number below: ~NGtNF. ERING ~70?,~4 Eace River Loop Road No. River, Alaska 97577~ 2. TYPE OF RESIDENCE Single-Family,~:~( Number of bedrooms .. 3. WATER SUPPLY Individual Well [] Community [] Public.~XX Note: If community 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. 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 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, 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 S & S ~NGINEERING . _ , ~: .... I'~c, Road NO_ 204 17034 ~ag'~ ' ...... ' Date Eagle River, Alaska 99577 Telephone Approved fo bedrooms Approved ~/~"~D i~a p p roved Conditional 'Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated 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 MunicipalityofAnchorageis not responsibleforerrorsoromissions in the professional engineer's work. 72 025 IBev 7/88) Back Page 2 of 2 o8~ MUNICIPALITY OF: ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKL,ST- E..UA.¥ 498. ~o ~_~'~ "--'~ ~"'~ 343-4744 A. WELL DATA We~ C~a~sificatio%~ %~~ ~ *, ~, C, D.~.C. *~roved Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: .Date Completed Depth of Grouting Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot To 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 ,.~,.¢;:~1~.~ ; On Adjoining Lots ~ I~¢.~ ' On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date SEPTIC/HOLDING TANK DATA Date Installed ~¢-/'7'~ Size ~ ~ No. of Compartments Standpipes~::~ig'N) ~/' Air-tight__ Caps CC?N) '7';' Foundation Cleanout CC/N) Depression over 'rank (V~¢~,) t'~ . ,, ~.ate Last Pumped ~"-- Pumping/Maintenance Contact on File (Y/N) r'--'~ · for Holding Tank High-Water Alarm (Y/N) ~"~/,¢~ ' · Temporary Holding 'Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments ~:3~ ¢ To Building Foundation To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed t '~/"~f Width of Field ~, ~ Square Feet of Absortion Area Depression over Field (Y/~ Results of Last Adequacy Test ~/'/~,z..- Type of System Design l r~/~-//-// Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present ~¢~/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundatiop Lot ~//5 To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots / To Cutback (if present) Comments D. LIFT STATION Date Installed ,S,,be~ 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) ~--~-~.-. ~cles 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. Signed cS, & $ _FNGINEERING 17034 Eagle River Loop ~oad No, 204 Company Eagle Rive~._Al,.a~ka MOA No. (7~ ~ Receipt No. Date of Payment Amount: $ 72-026 (Rev 7/88) Back ............. ?.--- '., Receipt No. ~~;~ ., Waiver Fee: $ Date of Payment Page 2 of 2 PART? MUNICIPAI.II'Y OF ANEHORAP' i' OF IlEAL'i'll AND ENVIRONMEI, ~[_ PROTECI'ION L St:]"eeh, A~chorage, Alaska 99501 279---2511, ~;,(i:,, 224 or 225 lin s p REQUEST FOR APPROVAL O'F I~D][ViDUAL S[t:WER AND WATER P'ACILI'Z'IES ABM Escrow, % Maxine ]., Lending Ins'hitLltion Ret{t/est: A.d] e ...... · Phone: Mailing -]:-~,',-' 640 West 36th Avenue 99501 272-4581 Property Owner M a i ]. ;i n g Ad d r e s Jim/Carol Makar Phone: 694-2443 3209 Karta Circle 99577 3. Legal Description: Lot 10 Block 2 MEADOWBROOK Subdivision 4:. S.inglc Fami.'!y Residence: (x) Number o:E Bedrooms: Three/Four Iam_ly Residence: ( ) Number of Bedrooms: !5. We]'l_ Sys%em: Individual. Well ( ) C(mmmnihy/Public Sysi.:em Permi h ~ _ We._ l Depth oZ ' 1 Well Log on F.i.].c~ ( ) ('.o ~sitruchion Baci:e~?iaL AnaJ. yol,:, Distances: We.l]. to Septic '3?a]}k .................. to Abso:_rpt::i. on Area to Sewer Line ................. . ...... Nearesh .13oh Ii]lc ........................... Absorption Area Lot ]',l_ [~o l)e}partn~ent of [{aa'l,th and Environmental Protection RequesL .for Approval of ][ndi'vidua]. Sewer and Wa'her Facilities Description: Lot 10 Block 2 Meadowbrook Subdivision