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MEADOW BROOK BLK 2 LT 14
Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211260 PID Number: 050-191-61 Dwelling: V Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New © Upgrade Name STEVEN MERTZ A ORPTION FIELD ❑ D Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 18213 SANCUARY DR. Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 /SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original a Gravel depth beneath pipe Subdivision Block Lot Meadow Brook 2 14 Ft. Fill added above original grade Gr I length Ft. Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dist a between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between t hes From—— - - - - Tank Field Tank Line 2 Well NA TANK 21 Septic ❑ S.T.E.P. ❑ Holding El Other Manufacturer Capacity Surface Water 100+ GREER 1000 Gal. Material Number of compartments Lot Line 5+ NA PLASTIC 2 Foundation I 10+ TATION Manufacturer Capacity Remarks Gal. Alarm location Elec r alled by Installer PIPE MATERIAL House to tankTank to D3034 drainfield D3034 Highland Excavating Drainfield CO/MT D3034 Inspector Arcterra BENCH MARK (Assumed elevation) 100 ft Inspection1� dates: 9/1/21 2nd 9/1/21 Location and description 3rd 9/2/21 4'h 9/9/21 GARAGE FOUNDATION ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date •�yaw�aaa� �.►•�P� "`'�+.� ♦♦ ♦♦ 49 Ili '� * ♦� %.mss I<E[JN GTH M. 7116 s¢ f AV A♦s�'+` Septic System l� Approv Z -G� Date �- �r ♦♦♦ + Note: this approval does not include well permit requirements. fE a�� AS -BUILT SYSTEM DETAILS/SITE PLAN Permit ESP211260 MEADOW BROOK BUCK 2 LOT 14 PID# 050-191-61 ' A -C=33.6' B -C=45.9' N A -D=35.9' ti F B -D=49.3' Q o A -E=37.2' m B -E=51.0' o A -F=37.9' A B -F=51.9' o � y O •t PAVED D/W KEYBOX SCALE: NTS OF. AL cl? * :�49 TH KENNY _ S •` CE— pp��SSLO�pU a SEPTIC o VENT (typ) PREPARED FOR: STEVEN MERTZ 18213 SANCTUARY DR. EAGLE RIVER, AK 99577 RELD BOOKS BOUNDARY_ NI JA. STMNG N/A AMUILT: JLS M. FILE: ACRD n F— FILE COMPUTED: DRAvm. KSD CHMED: KMD DATE: 8 /16� 6 GRO: N W01 E " No' 21053 U O SEPTIC % VENT (typ) SCALE: 1' = 30' SCALE: NTS 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 Permit Number: OSP211260 Work Type: SepticTank Upgrade Tax Code Number: 05019161000 Site Legal Address: MEADOW BROOK BLK 2 LT 14 G:0153 Site Mailing Address: 18213 SANCTUARY DR, Eagle River Owner: MERTZ STEVEN A Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: �Z�enr o 'S" DeI)artIII ell t 7/12/2021 7/12/2022 17432 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: Issued By: =�tlou' &'UA' Dater 3 MUNICIPALITY - Development Services Department On -Site Water & Wastewater Section Parcel I.D. 050-191-61 Property owner(s) ON-SITE SEPTIC/WELL PERMIT APPLICATION Steven Mertz Mailing address 18213 Sanctuary Drive, Eagle River, AK 99577 Site address 18213 Sanctuary Drive, Eagle River, AI{ 99577 Legal description (Sub'd., Block & Lot) Meadow Brook Block 2 Lot 14 Legal description (Township, Range & Section) Day phone Phone: 907-343-7904 Fax: 907-343-7997 Lot Size 17,432 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo AD U) Septic Tank N Upgrade ■ (D) El Holding Tank El Renewal ❑ Renewal Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees:Waiver Fees: Date of Payment: _ 7�6�21 Date of Payment: Receipt Number: 6yZ1 G Receipt Number: Permit No. 05P21 1260 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211260, Rebecca Carroll, 07/12/21 WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE MEADOW BROOK BLOCK 2 LOT 14 a 4 X. 6 4 tl _ a '¢ 4 pC'¢ti J�J n • e e � �� f_ �v NO PUBLIC WELLS WITHIN 200' OF PROPOSED SYSTEM. NO PRIVATE WELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPTIC SYSTEMS WITHIN 200' OF PROPOSED WELL EXCEPT AS NOTED. 9� F HC]LJSE INSTALL NEW 1000 GAL TANK >xn 000 EXISTING TRENCH , 1. DEC❑MMISSI❑N EXISTING SEPTIC TANK PER CODE. 2. INSTALL NEW 1000 GALLON TANK PER C❑DE, 3. INSTALL 2 POST TANK C❑'S PER CODE. 4. TANK TO HAVE MIN. 20' MANWAY RISER. 5. MAINTAIN 101+ FROM FOUNDATION & 51+ EXISTING FIELD. 6. MAINTAIN 1001+ FROM PRIVATE WATER WELLS. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE ComtUANCE P L &11260, Rebecca Carrol 07/12/21 PID# 050-191-61 SCALES 1' = 20' NOTES NO WELLS ON ADJOINING LOTS ARE WITHIN 100' OF PROPOSED TANK PLACEMENT, NO SURFACE WATER NOTED WITHIN 100' OF PROPOSED TANK PLACEMENT. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INT❑ SEPTIC TANK, CONTRACTOR WILL ENSURE ALL SEPARATI❑NS TO ADJACENT I WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC... I* :49TH *� CE -711 w� . ■ eAWF 'L�►+E5510v; AV PREPARED FOR: STEVEN MERTZ 18213 SANCTUARY DR. EAGLE RIVER, AK 99577 FIELD BOOKS BOUNDARY N/A SFAgNG: N /A ASBUILT: _ DWG. FlLE: AOAO FlLF- FILE COMPUTED: DRAWN: KSD CHECIOD: KMD DATE: 7I1 I2 GRID: NW015 JOB No- 21053 RCrTER, c� D o n X �.SIJI.TI NG 6 L k R AK. 99577 ��� Municipality of Anchorage Page DEPARTMENT OF HEALTH 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 Permit Number: (::~D~)~C) PIDNumber: 020-I~/'l Name: ~ ~ ~L~ ~~;~ Wastewater System: D New ~Upgrade ~ ~ ABSORPTION FIELD Phone: ~--J~'Z~ N°'°~edr°°ms: g Deep Trench ~ShallowTrench DBed gMound DOther_ ,~ Total Depth from original g~ade: Soil Rating: ~ ~ __ LEGAL DESCRIPTION ~.~ ~,sq. ~. ~'~' ~[ock: Subdiv~ion: 0eplh to pipe bottom from original grade: Gravel depth beneath pipe ~ot: ~ Z ~~,~ ~/-~'~' ~ ~,.~,o~ = ~,1 F~. Section: Gravel length: Township: ~ ~, Range: ~ I~ ~1~ Fill added a~ove original grade: Gravel width: Number of lines: Distance be waen lines' ~~ D New ~ Upgrade /' ~, Ft. [ , ~sification (Priv~~' Tqtal Depth: - ~To: Total absorption area: Pipe material: - Date installe~: / / -- ~~ SlaticWaterLevel: installer: ,~'d: / Pump Set at: Casing Hei~round: ~/ ~PM Ct. ~. -- '/ SEPARATION DISTANCES ~soptio~ Holding a S,T.E.P. To Septic AbsorpUon Lift Holding ~/Pdvat8 Manufacturer: Capacity in gallons: From Tank Field Station T..k Sawer Lines ~' ~ ~ -- Material: Number~ompartmenls: su,~ce ~% ~t~* ~/F ~ LIFT STATION W~;;, Size i~ gallons: Ma~ r Drain .... ' BENCH MARK Remarks; ~ ~ ~~/ ~pe~~ Locatio~ a~d Oescriptiom ~ ~0 Assumed Elevation: Inspections performed by: ~' ~~ Dates:2st~/¢~ ~ Department of Health and Human Services approval ,~:¢~z,. 72.013 (Roy. 0191) MOA 25 AS-BUIL'r DRA WING GARAGE RETAINING EX/STING 3G CRIB. TOP CRL AND FILLED TH 1250 C~AL. SEP TIC TANK. DOUBLE C/O--~ "G" C,/O VALVE BOX~ WATER LINE. LOOATED BY PACIFIC REHAB CO. (KEN IDHE) FEBRUARY OF '1906. CONTFfACTED BY HOMEOWNERS. NEW TRENCH INSTALLED 10 FEET AWAY FROM LOC,ATE STAKES (MIN,). SEPTIC UPGRADE: LOT 14, BK 2, MEADOW BROOK PREPARED FOR: MARK & DARLA TANNICH ALASKA WATER & WASTEWATER SERVICES DATE: 3/27/96 I DWN: GARNESS , SCALE: 1" = 20' HOUSE EXISTING CIO UNDER WOOD WALKWAY. "B" "E" ~'F" M.T 0/0 30 FOOT SEGMENT 23 FOOT SEGMENT AC = 45.1 AE = 59.1 BO = 42.5 BE = 18.9 AD = 52.9 AF ~ 60.7 BD = 47.3 BF = 18.6 AG = 80.2 BG = 73.1 AS-BUILT DRAWING FINAL GRADE OVER TANK IS AT EI. EV. = 101.3. COVER ~ 5.9 FT. TANK IS RATED FOR 5.5 FOOT BURIAL, WITH A FACTOR OF SAFETY OF 2.0, PER ANOH. TANK. SHOULD BE OK. F'Xh~ TIN~i GALl_ON SEPTIC TANK. MO VED INVERT OF SEWER LINE JUST PAST THE FOUNDATION 0/0 IS 95.2. ,26 FEET TO SEPTIC TANK, DROP IN ELEVATION OVER 26 FEET ~ .5 FEET. SLOPE VARIES FROM 1-5%. TANK INLET INVERT = 94.7' TAN/( OUTLET INVl'~RT = 94.5 TOP OF TANK LIDS = 95.4 M.T ORIGINAL GROUND VARIED FROM 99.;3 TO 103.5. FINAL GRADES VARY FROM 09.9 7'0 f03.3. FILTER FABRIO )BENGHMARI'~ IS GAFtAGE. FLOOR. ASSUMED ELEVATION = 100.00 A. INVERT OF DRAINPIPE = 94.4 B. BOTTOM OF TRENCH ~ 92.34 (AVG.) C. DEPTH OF GRAVEL BELOW PiPE = 2.06 O. BOTTOM OF TH = 95.29 E. NO GROUNDWATER IN TH (3/26/96). F. TRENOH LENGTH ~ 50 FEET. G. TOTAL ABSORPTION AREA = 380 SQ. FT. TF?ENOH DETAIL: LOT 14, Bt( 2, PFYEPAFtED FOF~': MARK & DAIRLA ALASKA WA TEFt & WAS'I"EWA TEll I DATE: 3/27/96 [ DWN: GARNESS qickMystrom. Mayor Mumcipali of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 March 29, 1996 Jeff Garness, P.E. Alaska Water & Wastewater Services 8471 Brookridge Drive Anchorage, Alaska 99504 Subject: Waiver Request for Lot 14 Block 2 Meadowbrook Subdivision Waiver Request #WR96007, PID #050-191-6 l, HA#960018 Dear Mr. Garness: Your request for a waiver of the required 10 foot separation between an on-site wastewater disposal system (leachfield) and a lot line has been approved. The waived distance is 8 feet. The approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from tNs department. lfthere are any questions, please call our office at 343-4744. Sincerely, Daniel J. Rott~ Civil Engineer On-site Services DJR/Ijm ~t~TA~t 70 ~.Z/JF7 5~/9~ ~/~'~_~/~ ~f :~AOq~ ~Og SUOS~H ~O SUOT~TpuoD %ST~I :suol%lpuo3 '[~loeds 'Z uol%~des I~%UOZllOH 'a %uelp~D elqe~ ~e%eM 'G ~%lllq~e~e~ 'O UOT%d~os TTOS '~ elq~& ~e%~ '~ :s%ulo~ :~BoIoeD 'l 8471 Brookridge Drive - Anchorage ~ Alaska Phone (907) 337-6179 ~ Fax (907) 338-3246 Consnlting Engineers March 27, 1996 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Sewer As-Built Package, and HAA for Lot 14, Bk 2, Meadow Brook S/D. To whom it may concern: The subject property is served by public water, and a private septic system. The septic system was upgraded, and a copy of the asbuilts are attached. Comments regarding the upgrade are summarized as follows: 1. Lot Line Waiver Required: During the process of digging the new trench, the excavator inadvertently dug it too close to the property line. Based upon my field measurements, the separation distance appears to be around 8.5 feet. I obtained a verbal approval fi'om Dan Roth on 3/27/96 prior to proceeding with the installation. There are no nearby wells or septic systems which would be affected by this encroachment, therefore, I am requesting that you waive the separation distance to 8 feet. Attached is the $115.00 waiver fee. 2. Water Service Line: The 1250 gallon septic tank (originally installed in September of 1991), and the new trench were installed at least 10 feet away fi'om the locate marks for the water service line. Clearly, our ability to maintain the 10 foot separation to the water line is limited by the accuracy of the locate marks. We did the best we could with the information provided. If you have any questions, please contact me at 337-6179, or on my digital pager at 1-800-481-1162. Thanky¢ ~. Since~7 , ~ /~---/' Own6r/Cc~sult ant Tannich3 .wps PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.Oo BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960030 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES OWNER NAME:TANNICH MARK A & DARLA O OWNER ADDRESS:18213 SANCTUARY DR EAGLE RIVER AK. 99577 DATE ISSUED: 3/07/~)6 EXPIRATION DATE: 3/07/97 PARCEL ID:05019161 LEGAL DESCRIPTION: MEADOW BROOK BLK 2 LT 14 LOT SIZE: 17432 (SQ. FT. NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 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 (iSAACS0) . 3° THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PR~ISIONS. RECEIVED BY: ISSUED BY: DATE Al[ l lk, W llt:er & W,atSl eW ll er 8471 Brookridge Drive N Anchorage ~ Alaska Phone (907) 33'7-6179 - Fax (907) 338-3246 Consulting Engineers March 2, 1996 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Sewer Permit for Lot 14, Bk 2, Meadow Brook S/D. To whom it may concern: The subject property is served by public water, and a private septic system. The existing crib will not pass an adequacy test and needs to be upgraded prior to the sale of the house. Ideally, they would like to close by March 25, 1996. Comments regarding the proposed upgrade are summarized as follows: 1. Soils: The test hole revealed that the soils were primarily gravel underlaid with clean sand. The percolation rate of the gravel was determined to be 3.1 minutes/inch. Visually the soils in the vicinity of the perk test hole appeared to be tighter than the surrounding soils. In short, ! believe the test is conservative. In areas where the soil does perk faster than 1 minute per inch, there is no reason for concern, because of the underlying sand. 2. Trench Design: a. Percolation Rate: 3.1 minutes/inch b. Application Rate: 1.2 gallons/day/fl2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 375 ft2 f. System Type: 5 foot wide trench g. Effective Depth: 2 feet h. Reduction Factor: .7 i. Length: 52.5 feet minimum 3. Surface Waters: There are no surface waters within 100 feet of the proposed septic system upgrade. 4. Slopes: The lot slopes downhill from north to south at approximately 6-8% grade, and from east to west at approximately 5%. The new trench will run perpendicular to the slope contours. See the site plan. 5. Existing Septic Tank is Too Close to Water Service Line: Thc existing 1250 gallon septic '7 tank was installed in September of 1991. According the water line locate done by Pacific Rehab Co. (February of 1996), the water tine runs right next to the septic tank. In order to correct this I am proposing to relocate the tank at least 10 feet from the water line. Based upon Pacific Rehab's locate, the water line and sewer line run right next to each other were they enter the house. There is no easy way to correct this, however, I think the health risk associated with it is ~.. extremely minimal. With your approval they will be left as is. , I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or on my digital pager at 1-800-481-1162. Thank you. Sincerely, Tannich 1 .wps LOT 4, BK 1, SIROH HILLS TERRAOE BID. PRIVATE SEPTIO & PUBLIO WATER (AWWU). LOT 5, SK~, BIRDH HILLS TERRACE BID. PRIVATE WELL & SEPTIC SYSTEM, GREATER THAN 100 FEET FROM WELL TO SEPTIO UPGRADE ON LOT 14, BK2 LOT 16, SK 2 BROOK BID. SEPTIC & WATER (AWWU)* MEADOW BROOK SEPTIC & PUBLIC EATER (AWWU), LOT 7, BI( 3 'OW BROOK SEPTIC & WA TER LOT ~, SK 3, MEADOW BROOK BID. PRIVATE SEPTID AND PUSLIO WATER (AWWU). NOTE: ALL ADJACENT Lo'rs ARE ON PRIVATE SEPTIC SYSTEMS AND PUBLIO WATER, UNLESS NOTED OTHERWISE. THERE ARE NO SEPTIC BY~TEM~ WITHIN 50 FEET OF THE pROPOSED UPGRADE ON LOT 14, BK2, MEADOW BROOK THERE AR~: NO SURFAOE WATERS WITHIN 100 FEET OF THE PROPOSED SEPTIC SYSTEM UPGRADE. SEPTIC UPGRADE: LOT 14, BK 2, MEADOW BROOK PREPARED FOR: MARK & DARLA TANNICH ALASKA WATER & WASTEWATER SERVICES DATE: 3/2/96 DWN: GARNESS SCALE: lO0' PROPER? Y LINE / EXIS TING/250 MO VED/ / FiE 1 AtNING VVALI GARAGE ROUSE NEW O/O GENERA 1 VICINITY OF ,/ , / TEST HOLE .% C/O ./ /' / ' EXOA VA TION 7 "" / ",..' .~'~.~ /o~ / / ,/,,: .... /> ' NATURAL OAS LINE/RUNS ~' ,, LON~ THF WEST/SIDE OI ' ' ' ' / A - " I ....... 'x ' /'"' THE DRIVEWA . I '~ ~' - ' y -- -. , 7'~/ , / / ~2--~/:>," ~- DOUBLE C/ ,' " ~ -- ., .. ,- / ~K :¢~ M.~- %~ 9 TO BE FILLE~ PROPERTY LINE, DECK, ~ ~40~ / AND WATER LINE. ~ ¢~H~ ~. NO TEE SFWER LINF TO N~W TANK I_OOATION SHALL BE D3034 PVC SLOPED A~ 1/4 INCH " ~ ' SEPTIC UPGRADE: I_O'F 14, BK 2. MEADOW B~OOK PRFPAHED FOR: MA~t( & DARLA TANNICH ALA,:KA WA'I-E~ & WAST~:'~/ATEFf GE~VIOEG DATE: 3/2/96 D~/N: GARNESS SOALE: 1" = 20' THE TRENCH SHALL HAVE A MINIMUM LENGTH OF 52.5 FEET, AND A TOTAL EFFECTIVE ABSORPTION AREA OF 375 SQUARE FEET. MONITORING TUBE (TYP.) ~ PERFORA'FED IN DRAINROCK, / EXISTING GROUND ELEVATION OVER PROPOSED TRENCH SITE VARIES FROM (APPROX.) FROM 100.00 TO 104.00. BACKFILL WITH NATIVE SOIL AND MOUND. TOPSOIL & RESEEDING SHALL BE RESPONSIBILITY OF HOMEOWNER. IF HOUSE IS BEING SOLD, SELLER SHALL O00RDINATE WITH BUYER. PROVIDE 2 INCHES OF BOARD INSULATION IF SOIL COVER IS LESS THAN 3 FEET, INSULATION SHALL COVER THE ENTIRE WIDTH OF THE TRENCH, ----FILTER FABRIC SI~.T BARRIER DRAINROCK SHALL SCREENED PER M,O,A SPECIFICATIONS. - 92.50~ BOTTOM OF TH = 85,£9 EXISTING TANK OUTLET ~ 95,15 NO 'rE: ~DRAINR'O~CK~ ' ~, ..... ~ - . L 5 FEET WIDE 4 INCH DIA., ASTM F810 PERFORATED PIPE. HOLES DOWN. PLACE £ INCHES OF DRAINROCK OVER TOP OF PIPE, AND ACROSS ENTIRE WIDTH OF TRENCH. PiPE SHALL BE INSTALLED LEVEL (WITHIN .01 FEET). 1. TRENOH WILL RUN PERPENDICULAR TO THE SLOPE CONTOURS, 2. FOR LOCATION OF CLEAN-OUTS AND MONITORING TUBES SEE THE SITE PLAN. 3, CONSTUOTION PRAOTIOES, AND MATERIAL SPEOIFIOATIONS SHALL COMPLY WITH ANCHORAGE MUNICIPAL CODE "WASTEWA TER DISPOSAL REGULATIONS". 4, INSTALLATION SHALL COMPLY WITH SPECIAL PROVISIONS NOTED ON THE SEWER PERMIT. 5. SMEARED BOTTOM AND SIDEWALLS SHALL BE RAKED. 6, BOTTOM OF TRENCH SHALL BE LEVEL. 2 INCH MAXIMUM VARIATION BETWEEN HIGH AND LOW SPOTS. TRENCH DETAIL: LOT 14, BK 2, MEADOW BROOK S/D. PREPARED FOR: MARK & DARLA TANNICH ALASKA WATER & WASTEWA TER SERVICES DATE: 3/2/96 DWN: GARNESS SCALE: NTS ~BENOHMARK IS GARAGE FLOOR. ASSUMED ELEVATION ~ 100.00 PERFORMED FOR: LEGAL DESCRIPTION= 1 2 3 4 5 6 7 8 9 13 14 20 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFOdMED Township, Range, Section: · ." SLOPE SITE PLAN ' WAS GROUND WATER ENCOUNTERED? J~O __ IF YES, ATW,AT DEPTH7 Monitoring? Gross Not Dopth to Net Roadino De~e Time Timo Water Drop ~V~, ~ ,, a,o ~o ~ ~" ~ ,' ~o *~ ~" . PERCOLATION RATE '~'* } TEST RUN BETWEEN ¢/' 1' ~ (minutes/inch) PERC HOLE DIAMETER ,, FT AND~z' ''~ FT PERFORMEOBY: '%-~?cF"J::;:~ ~"~J""I~--"~C'~ I'"~ ~"~~ CERTIFY THAT THIS TES'T WAS PERFORMEO IN 72-008 (Rev. 4/85) Alaska Water & Wastewater Services "Preserving The Last Frontier" MEMO PHONE: 337-61'79 FAX: 338-3246 DATE: TO: NUMBER OF PAGES: (Including Cover) COMPANY: SUBJECT: MESSAGE: Sincerely, Telephone: (907) 337-6179 · Fax: (907) 338-3246 . 8471 BrookridgeDrive · Anchorage, Alaska 99504 10' UTILITY S EPT'.I C LEGAL', OWNE;R; (;ONT' A .SITE PLAN 'r 14 BLO.CK 2~ 'MEADOW BROOK 91 DATE: 08 SCALE I" '.O, Box 773294 SLING I000 0 L, . ' TANK STINO 18'x18' PAGE PIT N~R- 4-96 NON 12:12 AWWU FA× NO, 907552542? ?,01 }' ~' I:' 17. ,c.;ili:, I:.;, tS j, C I:.', ~ I(!i::YI;RI X L.(.,C, E tq l..i L. Ii:'. It :t' V I"..~ P, ¢: I/, 99 ~!'i ? 7,92. 2'..fl I,,, 0 1'; 1 .",~ &' L': I.;'t~.' kJ & 9' ]:?'4 0,00 r41' f'ROP I..I.t,!li: ~ 0,00 l,)l::l"i'll ,:":il' N¢I'I'N: O,';?.O :ql' I'>P, OP I ]:NI::: 'O,OO I]t,!E ~31'OP LO/:; ',':; 3: Z ti:; ~ kJA )'1.~i R Ol:"l:' I .. H OUR,S ~ .............. MUNICIPALITY OF ANCHORAGt5 DE;PA R TMENT OF HEA £ TH & HUMAN SERVICES .~e_ Serv.~es ~_l~ittaf Sh~t the following Discrepancy j.n legal de$cr~ptlon and/or owner name. Disc[epancy in number of -~ Signature ~nd/or stamp mis~.ing on ~~~. Show measu[e~ d~.~tanc~ to .~ewer~/w~lls, curtain and ~r~ams witl%fn 200 fe~t o~ proposed ~ystem. Replacement disposal s~te not shown and/or Calculation error in design. ---' Show 1. ocBtion~ of 811 so~ls, percolation ~ wa~r tabl~ ~ ?~opos~d system too deep for Boil test submitted, ...... Topo~aphic inform~tion mia~in~ or Narrst;ive mis~inW or inadeqoate. Additional soil/parc test Sand filter rDquirem~nhs not satisEied. ~ w~ter monitoring re~%tlhs missin~ or inadequate bec8use ........ ~ncomplete; missing_ Well log required. water sample unacceptable because .......... Please supply tt~e necessa[F information and re-submit your Rev ~ c, ~o, ~ ..... ~__~,.IL ~JLL-I~.~41-~-- ~- ..... "tdk,~,.~CJ.! i .................. f2O3~rev- 4t93 Municipality of Anchorage Pace DEPARTMENT OF HEALTH 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 Permit Number: -~} ~)10¢-/'/'] PID Number: --/'2 ~¢2 - /¢/ - (~/ ;.m~: Wastewater System: u New B Upgrade Address: ABSORPTION FIELD Phone: I No. of Bedrooms: ~,¢1¢ ~ //¢ /[ ~}~ ~ Deep Trench B Shallow Trench B Bed B Moun~/, ..~'Other LEGAL DESCRIPTION Soil Rating: Total Depth from oriDinalgrade: GPD/Sq. Ft. - Block: Subdivision: Depth to pipe boltom from original grade: Gravel de¢~h beneath pipe ~ownship: Range: Section:/~ Fill added above original grsff:~ ./ gravellength: Gravel depth: ~, Number of lines: WELL: ~ New ~ Upgrade / FL Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absor~f~a: Pipe material: GPM Ft. Ft. SEPARATION DISTANCES ~s.ptio ~ Holding u S.T..,.. TO Septic Absorption Lift Holding Pubgc/Privale Manufacturer: Capacity in gallons: From Tank Fiold Station Tank Sewer Lines ~ ~/~ Material: Number of Compadments: Surface Water ¢/~¢ ~/~¢ ~l/~ ~¢// ¢/¢¢ LIFT STATION/,. Lot Size in gallons: Manufacturer: ~ , "Pump on" level at: ¢~ '~Pu~p off" level at: High water 8Jarm ~t: Curtain Drain /'J/~ /,//~ ~,J/~ ~/1~ ://A Pump Ma~ EMode, ~'~ Electrical Inspections pedormed by: BENCH ~ARK Location and Description: Assumed Elevation: ENGINEER'S SEAL Reviewed and approved by: ate:. .. 72-013 (1/91) MOA 25 Permll No. j ,~, ~x ~.~-~, ? Page ~ of ..9. Municipality of Anchorage DEPARTMENT OF HEAL'rH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Waslewater Disposal System and/or Well Inspection Report GAS LINE lO' UTILITY EASEMENTI 150,00' N- 89°57'i0' W__ --REPLACEMENT ]~50 GAL, SEPTIC TANK ..... EXISTING l~'X12' SEEPAGE PIT SCALE ~ ]' = 40' ELEVATIBNS BENCHMARK GARAGE FLDDR = 100,0' TANK INLET = 91,1' TANK BUTLET = 90,9'~ 33.4' ENGINEER'S SEAL 72qM3 A (2191) MOA 25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910247 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:CAIN CARL E OWNER ADDRESS:lB213 SANCTUARY DR EAGLE RIVER ALASKA 99577 DATE ISSUED: 8/23/91 EXPIRATION DATE: 8/23/92 PARCEL ID:05019161 LEGAL DESCRIPTION: MEADOW BROOK BLK 2 LT 14 LOT SIZE: 17432 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: SEPTIC TANK SYSTEM 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THIS PERMIT IS ISSUED FOR TANK REPLACEMENT ONLY. RECEIVED BY: ISSUED sY: l, ouis Butora, P.E. Registered Civil Engineer August 23, 1991 DHHS Staff Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Lot 14, Block 2, Meadow Brook Subdivision Dear DHHS Staff, At the request of our client, Mr. Carl Cain, we are applying for an emergency permit to replace a septic tank for the above referenced property. The owner desires to upgrade the leachfield portion, but would have to wait for monitoring and design. As the old tank has collapsed, he needs and immediate replacement permit to allow use of the system. We would like to submit the upgrade design next week under the same permit. The leachfield has not failed and will accept effluent. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. MJNIC~PALiTY OF ANCHORAOE EN¥1RC~NMENTAL SERVICES DIVISION 2 1991 RECEIVED P.O. Box 77329,1 · Eagle River, AJaska 99577 · Telephone {907) 694-5195 · Fax (907) 69,1-3297 SPECIFICATIONS FOR SEPTIC TANK REPLACEMENT LEGAL: Meadow Brook, Lot 14, Block 2 A. GENERAL The drawings shall be a part of this specification. All materials and workmanship shall meet the requirements of Anchorage Department of Health and Environmental Protection Permit. B. THE SEPTIC TANK o Septic tank construction shall be a +1,000 gallon steel 2 compartment tank approved by the Municipality of Anchorage. Septic tank is to be installed level on compacted base material. All connections are to be made with caulder couplings. The existing talk is to be pumped, removed and properly disposed of. Hole is to be backfilled with a base of pit run gravel to prevent settlement. New tank to be provided with two cleanouts after tank as per current regulations. A foundation cleanout 1-4' from home is to be installed prior to tank. Tie into existing leachpit. 10' UTILITY EASEMENT _ ~o,oo' L~___ /~ .... N_SS~ -- ~GAS LINE ~ ,/ ~ - TEST HOLE · - MONITOR TUBE o - SEWER CLEANOUT -~ - WELL m~m- PROPOSED L~CHFIELD NO K~OWN CURIAIN ~RAIN9 EASEMENT SEPTIC SITE PLAId ,.-, .. LEGAL'. LOT 14 BLOCK 2 MEADOW BROOK SUB. - OWNER: CAIN ~ .~ ,:. CONTRACTOR: N/A , ,-: '--', '.: ~?B ff 91-1191 DATE: 08/21/9/I SCALE 1~ : ¢0' ~'~~~: . a EAGLE RIVER ENGINEERING SERVICES ',:.:'.':.:: ~: -'.~' P.O. Bo~ 773294 ,: · ' EACLE tHVEI~, AN. 99577 GREI iR ANCHORAGE AREA BOR Department of Environmental (~uality 3330 C Street Anchorage, Alaska 99503 16H INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL MANUFACTURER MATERIAL NUMBER OF COMPARTMENTS INSIDE LENGTH INSIDE WIDTH __LIQUID DEPTH__ LIQUID CAPACITY /~0~2 GALLONS, SEEPAGE PIT: NUMBER OF PITS / DIAMETER L/g! OR WIDTH /'~'/, LENGTH/~2/, DEPTH /OI LINING MATERIAL ~ . CRIB SIZE: DIAMETER DEPTH DISTANCE FROM: WELL BUILDING FOUNDATION~L/~I TOTAL EFFECTIVE , NEAREST LOT LINE -)_,il . ABSORPTION AREA (WALL AREA) ~2(~~) SQ. FT. ADDITIONAL ABSORPTION WELL: BUILDING FOUNDATION __ CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED NEAREST SEWER LINE · REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK ___., SYSTEM DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAl · LOT SLOPE: REMARKS: Form No. LQ-031 DATE APPROVE[ G.A.A.B. G= Q` • '- Municipality of Anchorage On -Site Water and Wastewater Program .16k ore (907) 343-7904 s: t E T Y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-191-61 _ Expiration Date: 2z©Z3 1. GENERAL INFORMATION Complete legal description Meadowbrook Block_2 Lot 14 Location (site address) 18213 Sanctuary Dr. Eagle_River, AK 99577 Current Property owner(s) Steve Mertz Day phone Mailing address Real Estate Agent 18213 Sanctuary Dr. Eagle River, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ❑ Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class _ Well ❑ Public Sewer ❑ Public Water System WaiverNariance request for: Distance: Received by: _ Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ S ,5Q Date of Payment _ 3h.q h= I _ Receipt Number _00_q5C) G COSA# 05GZ__l18I 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. Name of Firm ARCTERRA CONSULTING, INC. Phone 696-6111 Address _20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date y�ag Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future 4-��*N, \ occupants or can ArcTerra guarantee that no unseen �. OrfL \ encroachments, deficiencies or discrepancies exist. ,� �. 6. DSD SIGNATURE System #1 Approved for bedrooms. .r KENNETHM. DUFF`''` _ . j System #2 Approved for bedrooms. < i Disapproved. ss o`''�` �► Conditional approval for _ - bedrooms, with the following t��tttVfi4Eil(Y���� OF -- - ---SITE 6 – — WATER AN mG�,—PRpGF0 �JJJ CoA ��Q�`1 Original Certificate Date:—/ ---C— (10—P-4 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 blue sheet 10-10-12.doc Legal Description: Meadowbrook Block 2 Lot 14 Parcel ID: 050-191-61 If more than- 1 septic system on lot: COSA Checklist # of Structure served by this system ELL DATA ❑ Well to ed 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 B. TANK DATA Age of tank(s) New years Tank type/material Septic/Plastic Measured operating fluid level in septic tank New Standpipes/foundation cleanout per record drawing Date of pumping New tank installed 9/1/21 D. ABSORPTION FIELD DATA Which system tested (date installed) 3/27/96 11 ALL standpipes present per record drawing Total measured depth from grade 7.7 ft (max) Measured depth to pipe invert from grade 3.9 ft (min) [1 N/A — pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective 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) ug/L ❑ Arsenic less than MRL (ND) Collected Date of Sample FT STATION ❑ Requl ainb Age of lift station Lift station material Comments: ce completed nears Adequacy test date 6/29/21 Results Q✓ Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 0 in Elapsed time 10 min Code -required soil cover over field Final fluid depth 0 in F]System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) _ date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) nk/Lift Station on Lot? 100' ® Yes if No ft Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' EO]Yes if No Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' ft Animal Con t > 50' ❑ Yes if No ft ❑ Yes if No ft if No ft Community Wells > 200' ® Yes if No ft Manure/Animal Excreta Storage Community Sewer Main > 75' ❑ Yes if No ft ❑ Yes I ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No 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' ® Yes if No ft Water Main > 10'-' ® Yes if No ft Community Wells > 200' ® Yes if No ft 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No 8* ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *Waiver #WR96007 granted 3/29/1996 G. ENGINEER'S CERTIFICATION / certify that l 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 LOT \�F ANCHORAGE RECORDING DISTRICT, ALASKA —x—x—x—x—x N89°51' (N89°57'1 °pO AS -BUILT OF: MEADOW BROOK SUBDIVISION LOT 14 BLOCK 2 PLAT 72-243 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to detennine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. SEPT 23, 2021 1 1"=30'_j. schuller®ok.net 21-143 1-- B9 --E— BY —. NUMBER: 860K/PAGE JLS I NW0153 1 210323 OO = 5/8" REBAR �* 49TH ..........� ..... JOHN L. SCHULLER.• �se' Ls -10408 �•tofessiona\ Lo 'O 0 �ADL iVDRP�� 0 a t'' ilk . 0 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax Parcel I.D. # 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING o -o I / 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Agent /~--,~2'"'""~ Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: --~ ~ Ftc _V'~ ~-. ~-~ ~'3-¢¢~-"~ Day phone TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. MUNICtPALI I'l Ur ENVIRONMENTAL SERVICES DIVISION RECEIVED Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev 1t91) Fronl MOA /f21 Health Authority Approval Checklist Legal Descriptiou: [.-ol- {~-~ ~-2.~ gO~O~ Parcel I.D.: A.~LL DATA ~ ~, or C, attach ~EC letter. ~EC water ~stem nunlb~r ~__ Log present~ ' ~ Date completed Totl ~ a depth ~~Cased to ~ Casing height (above ground) Sanita~'seal (Y~) ~~ Wires properly p~ Date of test Stattc water level Well production ~ g.p. nl. ~ WATER SA~~ Coli~ Nitrate _~ Otl~ b~ia ~ of sample: , Collected by: B. SE~ICmOLD~GTANKD~ O~l~,~c~ t~ [qql Date installed Tat~ size I Z~D Number of Compaamems Foundation cleanout (Y~) ~ Depression (Y~) ~ ~gh water alarm (Y~) Date of Pu,nping :3f 2.$/9 ~ C. ABSORPTION FIELD DATA Date installed '~ ~3; Length ~'~ Width Effective absm'ption area ~ ~ Pumper ~t:~5 ~o,/~7 ~r'M>~ Soil rating (g.p.d./ft2 or ft2/bdrm) /' 2 System type Gravel thickness below pipe 2, 0 (~ Tot'll depth _ Monitoring Tube present(Y/N) k/ Depression over field (Y/N) o~,q~s~-- Results (Pass/Fail) For _ ~- Date Fired depth _ (~s.,~mnt~-'Fater:~ '"'"~Absorptioo rate ~ "-'-------.-.._~.o.d. Perone, ' ero,~ttx (p'tst 12 months) (Y/N) If yes, give date 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 o5' GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Day phone Mailing address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAl.: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA/~21 STATEMENT OF INSPECTION BY ENGINEER As certified by myseal affixed hereto and as of the validation date shown below, l 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, lfurtherverifythatbasedontheinformationobtainedfrom the tvlunicipality of Anchorage flies 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. David R. Dayton Name of Firm. 2~lar St. Address Chuglak?~Alaska Date DHHS SIGNATURE ~ Approved for Disapproved. bed rooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments Ely: .~"--- ~(~-'~"---/~ Date 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· 724)25 (ROY, 1/91) Back MOA ~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type Log present (Y/N) Total depth Parcel I.D. (~..5--/--) ,/¢/~ / ~,U~P~ If A, B, or C, attach ADFC letter. ADEC water system number Date completed Driller Cased to Casing height Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) Fligh water alarm (Y/N) Date of pumping Tank size / Z-,~Zj Compartments "~ Foundation cleanout (Y/N) ')/ Depression (Y/N) /'~//,'¢' Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /'-/,Z/f"/-- To property line Surface water/drainage On adjacent lots "~/,///-- Absorption field ~ .~ Foundation Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed /~'~//~ / Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed .~,~,-.¢ /973 Soil rating (GPD/Ft Length / ?..-- Width / ~ Total absorption area iY/~'¢¢ Cleanout present (Y/N) Date of adequacy test /~J2./~ ~'~ Results (pass/fail) t / Water level in absorption field before test ~'~-¢'// Peroxide treatment (past 12 months) (Y/N) /V' Gravel thickness System type .%,=~,~,7~' Total depth ~/ Depression over field (Y/N) ,4/ ,'¢~,¢~; for ~-~ Bedrooms After test ,¢.¢ '" ,?/~ Z If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot X.) o ,,-, To building foundation On adjacent lots Surface water /&O Curtain drain On adjacent lots /~ ¢~z~ Properly line ~ To existing or abandoned system on lot Cutbank /~.//.,¢~ Water main/service line Driveway, parking/vehicle storage area ~" E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to ali MOA and HAA gu/defines in effect on the date of this inspection. Davlcl E. Dayto, P.E. 20210 Dona]ar St. Chug/ak, Alaska Signature Engineer's Name ..... Date HAA Fee $ ~c/~/"~ / ~'~--~' Date of Payment //~/~ '- ~'~...:~ Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number O. R. DAYTON, P,E., R.L.s. ~ Chugiak, Alaska 99587 (907) 20210 Donalar 696-2417 October, 23, 1993 ADEQUACY TEST Lega~ Description: Lot 14, Blk 2, Meadowbrook Subdivision Date Iof Test'. October 21., 1993 Septic Tank: 1250 gallon steel tank Abso~tion Ststem: 12' x 12' x 6' effective depth seepage pit Requirements: 3 BR - 450 gallons per day Test: Water waspumped into the seepage pit while measuring time,volume, and water level rise. After pumping was stopped, the water level drop was measured at timed intervals. ~ The results were plotted on a graph of time and gallons absorbed and extrapolated to 24 hrs. Results: The absorption system is currently functioning adequately for a 3 BR home. Note: There were 65" of water standing in the pit before the test. After 24 hrs. there were 63" of standing water in the pit. The large depth of standing water in the pit may indicate the seepage pit is near the end if its useful life. D E PARTMEI 825 MUNICIPALITY OF ANCHORAGE OF HEALTH AND ENVIRONMENI PROTECTION L Street, Anchorage, Alaska ~99501 279-2511, ext. 224 or 225 Date Received: April 22, 1977 Date Insp #3: Time [)ate c/-~9-7 7 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lomas and Nettleton Company Lending Institution Request: Mailing Address: 4449 Business Park Boulevard Phone: 274-7661 Property Owner: Larry L/Gay L. Foster Mailing Address: 3].31 Sancturary Drive Phone: 3. Legal Description: Lot 14 Block 2 Meadow Brook Subdivision 4: Single Family Residence: (x) Multiple Family Residence: ) Number of Bedrooms: Number of Bedrooms: Well System: Permit It Construction Public/Community System: (x) Individual Well.: ( ) Depth of Well Well Log on Fi. lo ( ) Bacterial Analysis Permit # Septic Tank Size Absorption Area Sewage Disposal System: On-site System (x) Public Utility ( ) Installed Installer Manufacturer Soi].s Rate Material Distances: Well to oept',~c Tank to Sewer Line Nearest Lot line to Nearest Lot Line to Absorption Area Absorption Area P~ge Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 14 Block 2 Meadow Brook Subdivision Comments: Affadavit A~7.ched :() (.')_ Approved: ~/i~ Letter Attached: ( ) Date: Disapproved: Date: Department WorkSheet: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 i[, Street, Anchorage, Alaska 99501 279-251.1, ext. 224, 225 REQUEST FOR APPROVAL OF INDIVIDUAl_ SEWER and WATER FACILITIES ~UNICIPALITY OF ANcHo~r.( D£PT, OF HEAL ENVI'~OKr' fL't:,, ~ TH ~ , ~ L PROTEcflCN .RECEIVED I. Type of Inspection: VA_._~_ ..........FHA ...CONV Property Own e r :/[~L/~_r/: .... ~,,~ ____~_.. __._7~'_~_L~_ Mailing Address: ......~:_,/~/___~~~,/~ay Phone: 5. Name of Realtor or Agent: Mailing Address: .................................. Phone: .... Location: ~ __( ....... fid ......... (~ 7. Type of Facility to be Inspected:,. ~'*~-R" No. Bdrms._ '~ 8. Water SuPl)lY Type of Supply: Public Utility .... Individual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site)_ _~_~ .... If Individual, date of installation ......... 72 003(3/76)