Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
MEADOW RIDGE ESTATES BLK 1 LT 3
_ L I k Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201243 PID Number: 051-461-05 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New K Upgrade Name Ab,SORPTION FIELD Jennifer Danigole ❑�DTrench E] Wide Trench E] Bed E] Mound Site Address 21050 Meadow Lake Dr ❑ Other Phone Number of Bedrooms Soil RatingTotal depth from original grade 907 390 0845 3 _""'�FD/SFi Ft. LEGAL DESCRIPTION Depth to pipe invert. from origina ade Gravel depth beneath pipe Ft. Subdivision Block Lot MEADOW RIDGE ESTATES 1 3 Fill added above original grade Ft. la vel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines 01s ance between lines Ft. SEPARATION DISTANCES ToTotal Septic Absorption LiftStation Holding Sewer absorption area Number of trenches Dist. betwee trenches From Tank Field Tank Line FF Ft. Well zooNA > 1f1A� r� NA NA NA ❑® S.T.E.P. Holding Other TANK Septic El Manufacturer Greer Capacity 1000 Gal. Surface Water > 100 ' NA NA NA Material Number of compartments Lot Line >10' NA NA NA NA plastic 2 Foundation >10' NA NA NA LIFT STATION Manufacturer Remarks 2" insulation over new tank, old tank backfilled :7!�Gal. with concrete and COs cut off below grade ck�_te,r5N larm location Electrical installed by n, r a --- Tank to PIPE MATERIAL House to tank D3034 drainfield D3034 Installer JRS Septic Drainfield CO/MTD3034 Inspector Curtis Townsend BENCHMARK (Assumed elevation) 100 ft Inspdeact sn 1�t 7/20/2020 7/22/2020 Location and description 2�d 3rd 7/25/206 4111 BOTTOM OF SIDING, POINT A ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp Conditional Approval: Date ��G .Q5�� *Y49 TH eseosttj {— 4/2, • - �'� i Septic Syste Approved (if/ Date-0/1 Zv ,Daw �',��•nso cE f��a �a����� 0 8sw�T Note: this approval oes not include well permit requirements. (Rev u5iu2n8) THERE ARE NO STEEP SLOPES WITHIN 50' OF THE PROPOSED TANK. / / NEIGHBORING SEPTIC k IS > 10' FROM / PROPERTY LINE '115" �°'` 2 Oki EXISTING 45' x 40" x 60" + / EFFECTIVE DEPTH TRENCH MT + /DOUBLE 02 CLEANOUTS DECK SUPPORT IS 5' + AWAY FROM TANK Q } /NEW 1000 GAL o \ C01 SEPTIC TANK WITH MONITOR ST2B �- TUBE ST1 ° FCO / M A O / BR � Q 0/ / `HOME�- 127 �I WATER LINE ENTERS POINT B IS OUTSIDE / } / HOUSE AT THIS POINT EDGE OF DECK SUPPORT % NEIGHBORING SEPTIC IS > 10' FROM/ / PROPERTY LINE SCOPE OF WORK / / / 1. EXISTING SEPTIC TANK WAS BACKFILLED WITH A CONCRETE SLURY. THE TANK CLEANOUTS WERE CUT OFF BELOW GRADE. 2. PLACED NEW 1,000 GALLON SEPTIC TANK AND / THIS LOT AND ALL NEIGHBORING TIED INTO EXISTING ABSORPTION SYSTEM. THE / LOTS ARE SERVED BY A TANK WAS PROVIDED WITH A MINIMUM 20" 0 / COMMUNITY WATER SYSTEM AND MANWAY RISER SERVING THE FIRST THERE ARE NO WELLS WITHIN COMPARTMENT. 100' OF THE SEPTIC SYSTEM 3. ALL CONSTRUCTION WAS IN ACCORDANCE WITH ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65. Septic As Built Drawings Prepared for JENNIFER AND BRIAN DANIGOLE ��P�E,OF q��s��♦♦ 21050 Meadow Lake Dr Chugiak, Alaska 99567MIA �,.�'' ••''�� MEADOW RIDGE ESTATES BLOCK 1 LOT 3 49TH OSP201243 a ' .. ............................. .� s..........., V. ..................... ���yy..: EKLUTNA ENGINEERING, LLC DATE: 8/12/2020 /'.CURTIS TOWNSFND 4 Ar 19162 MOUNTAIN ROAD �% ' No. CE 11.904` ♦ :,. DRAWN: CLT ��+ �Ife CH UGM, ALASKA 99567 SCALE: 1" = 40' 1+;U.���'"'•�~•%'� p� ��0 (907) J55-9820 PID: 051-461-05 SHEET 2 OF 3IL MARK A B STI 12'-11 „ 8,-4„ ST2 18'_9„ 10.-8„ DCO 20'-11" 11'-4„ col 18'-I" 8'- I " zF- 0 D 1,000 G PLASTIC TANK 2" INSULATION OVER TANK BM IS BOTTOM OF HOUSE SIDING AT POINT A, ASSUMED ELEVATION 100' Septic As Built Drawings Prepared for JENNIFER AND BRIAN DANIGOLE .•••�� DF + 21050 Meadow Lake Dr Chugiak, Alaska 99567 MEADOW RIDGE ESTATES BLOCK 1 LOT 3jo :' 49TH * �`•' I� OSP201243 �............. :1..................::.....* 1 EKLUTNA ENGINEERING LLC..............................................� DATE: 811 212 02 0 CURTIS TOWNSEND. 00-. No. L 11904 19162 MOUNTAIN ROAD DRAWN: CLT �j�s �•. ��(z�,��1,�4p CHUGIAK, ALASKA 99567 SCALE: 1 112" = 1' ��;+U ""•••••••`���� (907) 355-9820 PID: 051-461-05 SHEET 3 OF 3 �Z ¢iJ Q LLJ w J J U U O O J W Li U Y J Z <0 m �a 0`-1 0 U 1,000 G PLASTIC TANK 2" INSULATION OVER TANK BM IS BOTTOM OF HOUSE SIDING AT POINT A, ASSUMED ELEVATION 100' Septic As Built Drawings Prepared for JENNIFER AND BRIAN DANIGOLE .•••�� DF + 21050 Meadow Lake Dr Chugiak, Alaska 99567 MEADOW RIDGE ESTATES BLOCK 1 LOT 3jo :' 49TH * �`•' I� OSP201243 �............. :1..................::.....* 1 EKLUTNA ENGINEERING LLC..............................................� DATE: 811 212 02 0 CURTIS TOWNSEND. 00-. No. L 11904 19162 MOUNTAIN ROAD DRAWN: CLT �j�s �•. ��(z�,��1,�4p CHUGIAK, ALASKA 99567 SCALE: 1 112" = 1' ��;+U ""•••••••`���� (907) 355-9820 PID: 051-461-05 SHEET 3 OF 3 (D cle) U') 4t 00 N.. Ap CP 'Al 10 0 V SCALE: V= 40' N�6 0 60.1 510 pf? '00V EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. UNLESS OTHERWISE NOTED FB 20.3, pg 56 FB 17-21 pg 31-32 )0 00 401f BE 8453G I OF ANW AW AM 0 ter 00 ow Do 49 th 0 0 0 a 0 !• 04,7 00 `�o 0000 a 0 • 0 ® ID a 10• op o- izabeth L. alatka .• ' 00 a 0 0 0 41 AW X�� 4ftW '?01 Ess 1 4%*. � ► � R®R�►�'` RECERTIFIED 7-24-20�w--,o AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: LOT 3, BLOCK 1, MEADOW RIDGE ESTATES Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 3rd day of APRIL 2017. FRED WALATKA & ASSOCIATES, L.L.C. Engineers and Surveyors 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used fora single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. MUNICIPALITY OF ANCHORAGE On-Site {:Jgl & Wastewater program Anchorase,o,,i"on?'JJ%%luoopl?nu,pdti3.?TS6ri.#'oor,,or_rnn, http://www. runi.org/onsite On.Site Wastewater Disposat System permit Permit Number: OSp201243 Work Type: SepticTank Upgrade Tax Code Number: 0S146105000 SitC LEgAIAddTESS: MEADOW RIDGE ESTATES BLK 1 LT 3 G:1362 Site Maiting Address: 210S0 MEADOW LAKE DR, Chugiak Owner: DANTGOLE JENNTFER Design Engineer: EKLUTNA ENGtNEERING, LLC. This permit is for the construction of: Effective Date: Expiration Diate: Lot Size in Sq Ft: Total Bedrooms: 7t16t2020 7/16t2021 27422 J ! Disposal Fietd EI Septic Tank ! Holding Tank n privy E private Well ! Water Storage a, Opened and Closed on ihe same day, or , sealed, ano neaieolo'lr-.i'"nit ""=ing field willbe met.ratlo"nb_e_twe_e-n_th-e_tank_an Received By: Date: Date: cl)zrrttrent lssued By: MUNICIPALITY OF ANCHORAGE Development Services Department r° Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-461-05 Property owner(s) DANIGOLE JENNIFER & BRIAN Day phone 504.439.8928 Mailing address 21050 Meadow Lake Drive Site address 21050 Meadow Lake Drive Chugiak AK 99567 Legal description (Sub'd., Block & Lot) MEADOW RIDGE ESTATES BILK 1 LT 3 Legal description (Township, Range & Section) Lot Size 27,422 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank El Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Fami ASF) 0 (w/ o ADS Upgrade D ❑ Renewal El Duplex (D) Multiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: I certify that the above informa applicable Municipal Codes. Distance: Fis correct. I further certify that this is in accordance with 11'Z2,, (Signature of property owner ofvauthorized agent) Permit/Rush Fees: 276 Date of Payment: Z 3�ZO Receipt Number: f>CI'B"36,D Permit No. b S 2 01 2q 3 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and WastewaterTorms\Cllent FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201243, Deb Wockenfuss, 07/16/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201243, Deb Wockenfuss, 07/16/20 MUNICIPALITY OF ANCHORAGE Y DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ❑ NEW 0& C07 /' ❑ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS Well m DISTANCE TO: Absorption ar [ Dwelling .--- ( PERMIT NO. U Y h Z Manufacturer Ma t No, of compartments Li r, achy in gallons Z �0 C)IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. O E= 'q Manufacturer —� J -- Material / Liquid capacity in gallons y DISTANCE TO:C�`�lG�/'✓�G'Z W I FOUndatl .� �� v_ Nearest lot lin PERM O. Z LL,F, No. of lines / Length YkaOh YT Total le U of liyy Trenc i th /I Distance between lines to ( inches Top of til n fi1)ish rade trial ber th!til 2 Total effective absorption area I Z -7 I L i'.� inches Length Width Depth PERMIT NO. ua C7 Q I-- ° a LU Type of crib Crib diametep, GG Crib depth Total effective absorption area to ti DISTANCE T0: Well Building foundation Nearest lot line _j Class D th Driller Distance to lot line PERMIT NO. W $ DISTANCE TO: uilding foundation Sewer line Septic tank Absorption areas) OTHER PIPE MATERIALS '` V C SOIL TEST RATING If yy-°,� 4 So INSTALL REMARKS Iz n. a �>1 3 Y. i tFf �.i :rJ APPROVED DATE 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE Department if Health and Environments Protection, 825 Street, Anchorage, AK. 99501 /Jo re� 264-4720 HANDWRITTEN PERMIT Permit 4 E// f WELL AND/OR ON-SITE SEWER PERMIT Applicant: cc_ 3 (�.%t,lS (`>_ Mailing Address Location: _ /�q {, f Legal Description : / Uyc Type of Soil Absorption System Trench: /\/-- Drainfield: _ Maximum Number of Bedrooms: PhVine Number: ,� a. Lot Size: Is: Seepage Bed: Holding Tank: Soil Rating (sq.ft/br)/ 4�_O The Required Size of the Soil Absorption System Is: DEPTH 2� LENGTH _ `/ GRAVEL DEPTH -5 WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence .s remodeled to include more that 3 bedrooms. Signed: Issued by/✓��, _�!: c,!",/r�� -- pplicant _ Date: _ t. SWP/024(1/81) 50! S L OG I C I —COLAIION I r! f L'IiP011 1 C`D M-CR;,IL D. aL iiP: ;Ili Ir I I , i L � , i v - I� •; r I i I I � I I II I I r i f I : l PF PCOI.A 10P! P I- r l', Development Services Department = ' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-461-05 1. GENERAL INFORMATION Expiration Date: 62 _r- ZO2 Z Complete legal description Lot 3, Block 1, Meadow Ridge Estates Location (site address) 21050 Meadow Lake Drive, Chugiak, AK 99567 Current property owner(s) Brian Danigole Day phone ( 907) 202-0053 Mailing address Real estate agent 21050 Meadow Lake Drive, Chugiak, AK 99567 RAL Inspection Services Day phone -(317) 867-7688 X366 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: _ 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Water Storage ❑ Holding Tank ❑ Community Well ® Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ -1 d 5b Waiver Fee $ Date of Payment CAC)/'?" Date of Payment Receipt Number NQ * 38515 Receipt Number COSA # 05 C 2012-g!a 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 b6drooms 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 Pinard Engineering Phone (907) 232-1347 Address PO Box 871347, Wasiil-a, Ag 99687 Engineer's Printed Name Paul- E. Pinard Date /26/20 .0 Co�w `SOF -.0m wmmmme@ _(1mh % 6. DSD SIGNATURE �,* ;f -�,h System #1 Approved for bedrooms -�� System #2 Approved for bedrooms 7 r ' .Paul E, Pi........... ard � Disapproved `[y�'j�� CE-47934��6/ / 0604'e ��� Conditional approval for bedrooms, with the following stipu�"1�0 ��$1�\L II t(( ON-SITE WATER AND m G O PROGRAM '!%,���TrSER\]NI�`���� 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet X Nitrate Advisory Arsenic Advisory Other COSA Checklist Legal Description: Lot 3 Bk 1 , Meadow Ridge Estates Parcel ID: 051-461-05 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA - COMMUNITY WELL ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ff ❑ 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) - 3LP- years Tank type/material S� Measured operating fluid level in septic tank..3e [l Standpipes/foundation cleanout per record drawing Date of pumping 6� pq /,(L �•.�S% D. ABSORPTION FIELD DATA Which system tested (date installed) -4J-J-983 DtALL standpipes present per record drawing Total measured depth from grade - _ft (max) Measured depth to pipe invert from grade 3 . 5 ft (min) ❑ N/A - pressurized field ElMonitor tubes go to bottom of effective. If not, state depth into effective ElCode-requiredsoil 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 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- NA ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 6/8/20 Results ® Pass For _3- bedrooms Fluid depth prior to test 4 in Water added 450 gal New depth 8 in Elapsed time 136d min Final fluid depth , in Absorption rate 0+ gpd Any rejuvenation treatment (past 12 months)None If yes, enter date mown E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than Septic Tank/Lift Station on Lot > 100' [3 Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' El Yes if No ft required or if community well) Community Sewer Manhole/Cl> 100' Manhole/Cleanout _ Yes if No Private > Sewer/Se tic Line 25' Sewer/Septic _ 25'D Yes if No Holding Tank > 100' ❑Yes if No Animal Containment > 50' ❑ Yes if No — ft ft ft ft Community Sewer Main >75' ❑Yes if No ft _ From Septic/Holding Tank on Lot to: (Please enter distances Building Foundations > 10' ® Yes if No ft Property Line > 5' ® Yes if No ft Manure/Animal Excreta Storage > 100' El Yes if No if less than required) Surface Water > 100' — ®Yes if No Wells on Adjacent Lots: ft ft Absorption Field > 5' ® Yes — Water Main > 10' ® Yes Water Service Line > 10' ®Yes if No ft if No ft if No ft Private Wells > 100' ®Yes if No Community Wells > 200' ® Yes if No If septic tank is under driveway comment below ft ft From Absorption Field on Lot to: (Please Building Foundation > 10' M Yes Property Line > 10' ® Yes enter distances if less if No ft if No ft than required) If absorption field is under driveway comment below Wells on Adjacent Lots: Water Main > 10' ED Yes Water Service Line > 10' ® Yes " Surface Water > 100' ® Yes if No ft if No ft if No ft Private Wells >' 100 _ ®Yes if No Community Wells > 200' ®Yes if No ft ft F. ENGINEER'S COMMENTS beneath -a deck which has a supporting 'Post directl over/ the /tan/k. Tank appears ears to be leaking. Tank sha M—f � upgraded. Ve..J fJlis er l�rvK 1rjj&k1Q �tn�, 7.eza ol` nit ti+ ri 6, G-kg—Q+Ws". Pe- i 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 -o -i m 8453G o �3zr-=> m o �cn c El ID DCl)�cnm Co C7 �3�22' w o O� z = z-1 > - s m =pO-cn r a � ! XC (/) -n m X536 X MOX CD C) m5CD 6 -i �go z zm0 P, fib' O Qo � �m:U0 - \\ 7�' C, OX o 0611, a 0 o O to = v QN 70mm y oEF o o = \ 19/N, \ \ = ° a z per, \ \ �f \ \ o_v9.. \ \ o o W -n "n \ \ \ \ 03 o m W Mp'V �O \\\ ^ f \ a o (p O ;, N W (D -a M % C 'a N TEr m ca 7 O °w m N CN ° -n �. n �C� m Q -•o \ \ o m 1� 0O a p0 C v 'T N ��, O o 0 2 -n o o p0 • m m ° 70\\ c m <Qf ID C o Ufi/r,\ \ p pZ� 2 v �. (D a p 4J � � t' r p p m O m N��° X29°� CL Cn CD Cc = OO O Eo \ 0 N C 00 m m �\ mo mff 0z y �0m mfDN' amMN'�o COD- o Qmvmm WpX CL ID �\w p6 -coD C) CD moa n CD oaa(m�co�mmm�O omm 0 a> � �-q50�° �m <0 C) m Tm (D CD r- °°� -oN CD \ o a-3 -io oo��ma 0�3 ®®�� vCL -- ma m y_ CL:'1-m vm000l.o m OT 11 o •� yS�. .�(..•S i m N m o a� s '� m to -ism n o ®��"� (ao• mo o �oov o�� -I 9 :U lea. o U S m (p � CD o< D m MCL , rZn 0 o• ao m C.O (cn o o r 3v o m pQC }B� � o �CD � 00 o=m D xcn W CD Cpmo r CL -i m v cn o' i oma c00 aom0ooa -�=ro �ro •�� moa NCD CL cn FCC Cl) � o �oNo=•om �m D �4SGp•.�;.•,��� Nva ��o DM cc (4) 4k roR �� (D CD � m \� ®®® F m �• m 00 Cl) fl N � F G) • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Parcel I.D. 051-461-05 1 Certificate of On -Site Systems GENERAL INFORMATION Expiration Date: /-Ce� APR 0 7 l-7 Complete legal description MEADOW RIDGE ESTATES 131 L3 Location (site address) 21050 MEADOW LAKE DRIVE, CHUGIAK AK 99567 Current Property owners) JAMES & PENNY SPELL Day phone Mailing address Real Estate Agent 21050 MEADOW LAKE DRIVE, CHUGIAK AK 99567 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone WaiverNariance request for: Received by:�i' COSA to be released to the engineer, unless COSA Fee $ S Z (a Date of Payment HI,o)1-, Receipt Number o rjoi-s-y Sa COSA# OSC 0I I I I tP Date: by the engineer. Waiver Fee $ Date of Payment Receipt Number Waiver # 3 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well 0 Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by:�i' COSA to be released to the engineer, unless COSA Fee $ S Z (a Date of Payment HI,o)1-, Receipt Number o rjoi-s-y Sa COSA# OSC 0I I I I tP Date: by the engineer. 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Alk. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE -Ml System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Date 4/7/2017 *W,*, TM .rt l .. :Stever k. Par no, n E-8149` Conditional approval for bedrooms, with the following stipulations: 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 Stale 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 r - c If more than 1 septic system is on the lot: COSA Checklist # I of Structure served by this system I Certificate of On -Site Systems Approval Checklist Legal Description: MEADOW RIDGE ESTATES 131 L3 A. WELL DATA Well type Community If A, B, or C provide PWSID # Date completed Sanitary seal (YIN) Total depth ft. Cased to ft. FROM WELL LOG Date of test Static water level ft. Well production g. p. m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: B. SEPTICIHOLDING TANK DATA Tank Type/Material Steel Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (YIN) Y Date of pumping 4/18/2016 Parcel ID: 051-461-05 Well Log (YIN) Wires properly protected (YIN) Casing height (above ground) in. AT INSPECTION 17 Collected by: Date installed 04/1983 Cleanouts (YIN) Y Depression over tank (YIN) N High water alarm (YIN) Pumper Sanitary Pumpers C. ABSORPTION FIELD DATA Date installed 4/1983 Soil rating (g.p.d./ftz or ft2/bdrm) 150 sqft/br System type Deep Trench Length 45 ft. Width 3 ft. Gravel below pipe 5.0 ft. Total depth 9.0 ft. Eff. absorption area 450 ftz Monitoring tube Y Depression over field N Date of adequacy test 20MAR2017 Results (Pass/Fail) P For 3 bedrooms Fluid depth in absorption field before test Dry in. Water added 490 gal. New depth Dry in. Elapsed Time: 100 min. Final fluid depth Dry in. Absorption rate >= 450+ g,p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date Ir��l�tb��i[il. Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off" level at in. High water alarm level at Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 200+ 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/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 10+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. 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. Engineer's Printed Name Steven Pannone Date 4/7/2017 COSA canary sheet _2-6-15.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage110+ CE -8149 W AW in. M V 00 �o Z SCAT C V'= 40' ' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT 'E NOT SHOWN HEREON. FB 17-2 pg 31-32 BE 8453G OF ACgAw S cl) 49th 9 00 *: 00 00 �. '00 00 .... 'Y 00 00 l%'.Fred Wall atka. sib • 3255 - S 04- e _ I�"p , , •map _ I I�FESSIONA� AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection of the following described property: LOT 3 BLOCK 1 MEADOW RIDGE ESTATES SUBDIVISION Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 22nd day of March 2017. FRED WALATKA & ASSOCIATES Engineers and Sr- vors (907-248-1666) (-50 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 Parcel I.D. # ri1,�,1 — L%I n \ - KlZ-) HAA It 01��1L1 n�1 1. GENERAL INFORMATION Complete legal description _ Lot 3; B.2ock 1; Meadowtidge Eatate Location (site address or directions) 21050 Meadow Lake D)tive Eagle R.ivuL AK Property owner Az6oci.atu Retocati.on �' J- �ay phone Y\ Mailing address 1325 "G" StAee-t NW, Suite 600 Washington D.C. 20005 Lending agency Day phone Mailing address Agent Pat Cneab/Reatty Center. Day phone _ 344-0501 Address 8400 HaktzW Road Anchorage AK 99507 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well XXX Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX 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 021 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/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 S & 5 ENGINEERING ,�) Phone 17034 Eagle Address Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. =l Conditional approval for Additional Comments No. 204 bedrooms. Date � bedrooms, with the following stipulations: lt]Tir,, 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. 72425 (Rev. 1/91) Back MOA N21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: t '22 3ty_ \ t\LA,-k;,,_- �Iti,FParcel LD A. Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Wires properly Casing height FROM WELL LOG AT INSPECTION MUNICIPALITY Or Ah:' HO,tA(,k: e, Date of test ENTAL SERVICES DIVISION Static water level JAN 5 19.94 Well flow g.p.m. pp�� p'g.p.m. Pump levels C E I V D SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot lob ; On adjacent lots Absorption field on lot 2�vv ; On adjacent lots — Public sewer main Public sewer manhole/cleaaou Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate tank Collected by: Other bacteria Date installed L�'�3 Tank size \ cryo 11 Compartments Z Cleanouts &N) Foundation cleanout (Y/% r ` Depression (Y/&1 N High water alarm (Y) Alarm tested (Y/N) Date of pumping 16-X73 Pumper Th. G� s Pvo SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot -7---L> On adjacent lots r-1 l,, Foundation To property line /0 / Absorption field Sr 4 Water main/service line Surface water/drainage /J o / �- S tf /"") / f 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANC7E FROM LIFT STATION TO: on lot D. ABSORPTION FIELD DATA On adjacent lots Manufacturer Manhole/Access (Y/N) Date installed Soil Soil rating (GPD/Ft2) / 4 "Pump of-f=LZvel at tested Surface water 15-0 0 e14 Length Z_' S- Width 41D Gravel thickness Total absorption area 4So � Cleanout present (9/N) Sr System type T/L� C-/-/ _Total depth 5 Depression over field (YQ 4 Date of adequacy test / — f - `I ¢ Results tkaigail) for .5� Bedrooms Water level in absorption field before test 2_4 It After test 2-1 ,, Peroxide treatment (past 12 months) (YO) /,Z, /J 0 «lJ If yes, give date 'J//t SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ?�D r On adjacent lots a Property line /b r To building foundation /o / To ez sting or abandoned system on lot J 4 On adjacent lots 3 n I Cutbank 174- Water main/service line / I� 3or� Surface water Driveway, parking/vehicle storage area Curtain drain 'd A E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conform>e t all OA and HAA guidelines in effect on the date of this inspection. 5 19< 5 ENGINEERINGV , Signature r, -ZU3 • o. 204 Engineer's N m`Ie River, Alaska 577 Date J XZ HAA Fee $ �. f / Waiver Fee $ Date of Payment I C J` �i�'P Date of Payment Receipt Number Receipt Number 72-026 (3/93)' Back 13 MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services}j On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 051-461-05 1. GENERAL INFORMATION HAA # 0 L)q /-)'LIncj Complete legal description Meadow Ridge Estates Lot 3 Block 1 T15N R1W Section 11 Location (site address or directions) 1050 M adow ak Driy Eagle River Property owner AHFC Day phone 561-1900 Mailing address 520 E. 34th Avenue, Anchorage, AK 99503 Lending agency N/A Day phone Mailing add Agent Ed Smoot/Heritage Real Estate Day phone 694-4994 Address 18990 Facile River gnarlFacile River AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 V 3. TYPE OF WATER SUPPLY: Individual well Community well Public water X NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X 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 021 N 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/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 Faqle River Engineering Services Phone 6()4-5195 Address P.O. Box 773294, Eagle River, AK 99577 Engineer's signature Date 6120 Additional Comments IHTIC 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 021 J' J , 2j .0., V � ♦ Ui2�bifi P u �. ' .. .' ]p IJI •40C 11 K) y'74� i.OUli 19f^ ..�d735 - 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments IHTIC 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 021 u Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST h5 Legal Description: ILeADDW 4/D6 x:57., /07r3, &k/ Parcel I.D. 05/'4b/ "D6 'T / 5N e/m .SECT/ON // A. WELL DATA Well type �— Log present(Y/N)_ Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level If A, B, or C, attach ADEC letter. ADEC water system number 2 // � 3 / — Date completed Cased to FROM WELL LOG SEPARATION DISTANCES FROMAVELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer servic ine i ;for TSAMPLE RESULTS: m Nitrate ate of sample: Driller Casing heig Wires properly protected /N) T INSPECTION �- e N O ,,✓ w C G 2 On adjacent lots On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria B. SEPTIC/FIOL-DING TANK DATA Date installed Oz//F3 -' Tank size lao0 Compartments Cleanouts (Y/N) y�S Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) /uf \ Alarm tested (Y/N) /U%moi Date of pumping 0 /O 9 / i9CA klr 5/NCE) Pumper T,4_0 S J� SEPARATION DISTANCES FROM SEPTIC/1#101 DING TANK TO: i Wells) on lot /V/,4 On adjacent lots Foundation i To property line 5 Absorption field 5 / Water main/service line Surface water/drainage N/A 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level Meets MOA electrical "Pump on" level at .,IAS — Manufacturer Manhole/ ss (Y/N) SEPARATION-DiSTANCE FROM LIFT STATION TO: on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water Date installed 021/9 3 ( Soil rating /50 0Z /.312 System type Tl2ENCd/ - � Length if 5 Width u i Gravel thickness Total depth Total absorption area 450 Cleanouts present (Y/N) Y55 Depression over field (Y/N) /V U Date of adequacy test 9_/9 2 Results (pass/fail) PASS for 3 -- bedrooms Peroxide treatment (past 12 months) (Y/N) N//a If yes, give -date L/ 1A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot N /A � l On adjacent lots ZOL) Property line %D To building foundation 131 To existing or abandoned system on lot /VJ 4 On adjacent lots 70' —3DB Cutbank N/fl Water main/service line �- /D x Surface water 71- /D0 " Driveway, parking/vehicle storage area k / D 1 Curtain drain /V, A E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect op-theYdate 9f this inspection. Signature�z� r Engineer's Name 1. r ri:ua,,. Date �z.?uZ51 � • HAA Fee $vY Waiver Fee: $ �- Date of Payment Date of Payment ��� Receipt Number Receipt Number 72-026 (Rev. 3/91) Back MOA 21 SENT BY:ADEC ANCHORAGE --18-92 ; 1:41PM ;ANGHQRAQE/WE5TEP--UQ4 �r� � �' � i 1 �' !r � (� I I 1 f 1�1I � , I 1 fy, I , � 1, ,�M bi, vftfc'�.()FNt,NvinOItNNIF4NIdILCONscnvitTION � C � DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, AK 92603 May 18, 1992 FOR; Eagle River Engineering 0V4JZV'1 il; Z WALTER J, NICKEL, GOVERNOR PWSID # 211431 My review of the records on file In this office reveals that the Down Water Company Class "A" Public Water System is In compliance with the routine coliform bacteria sampling requirements listed in Table C, and with the Inorganic sampling listed In Table 8 of IS AAC 80.200 only. At this time, they are not In compliance with either the volatile organic chemical sampling or the radiological sampling listed In Table B of IS AAC SO.200, Sincerely, 06VLWS4Zf� Rachel Clark .College Intern 11 Parcel I.D. It 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 051-461-05 HAA# 1. GENERAL INFORMATION Complete legal description Meadow Ridge Estates, Lot 3, Block 1 T15N Rlw Section 11 Location (site address or directions) 21050 Meadow Lake Drive, Eagle River Property owner AHFC Day phone 561-1900 Mailing address 520 E. 34th Avenue, Anchorage, AK 99503 Lending agency N/A -- Day phone - - - Mailing address Agent Address Ed Smoot/Heritage Real Estate Day phone 694-4994 18550 Eagle River Road, Eagle River, AK 99577 Unless otherwise requested, HAA will be held for pickup. 2.. NUMBER OF BEDROOMS: 3 ti 3. TYPE OF WATER SUPPLY: Individual well Community well X Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X 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 a21 5. 6. M 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/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 Eagle River Engineering Services Phone 694-5195 Address P.O. Box 773294, Eagle River, AK 99577 Engineer's signature Date DHHS SIGNATURE _ Approved for bedrooms. Disapproved. Conditional approval for Additional Comments A'� L 1 �,l sso naeao a��sao�scsss, eaooai.' `l> V Ii QFESSIO�',R y bedrooms, with the following stipulations: If Mr 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 & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /t1 %/lel✓ /Z/Ur>C F"ST, 40-3 l?/KParcel I.D. 10 7-151V /, OAy se_(tr�A, A. WELL DATA Well type /I If A, B, or C, attach ADEC letter. ADEC water system number %//'/ j / Log present(Y/N) Date completed Driller Total depth Cased to Casing heights ' Sanitary seal (Y/N) Wires properly protected (Y/N) — FROM WELL LOG AT`INSPECTION 4 s` 0 0 Date of test z U a c}y Static water level a V) va ¢ Well flow g, -P.M. g.p.m.< w ` J O J> Pump level — SEPARATION DISTANCES FROM WEI L TO: Septic/holding tank on lot ; On adjacent lots Absorption field on lot Public sewer main Sewer service line WATER SAMPL Coliform/ Date sample: E RESULTS: Nitrate ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria B. SEPTIC/MOLDING TANK DATA Date installed 011A� Tank size ZUDU Compartments Cleanouts (Y/N) y Foundation cleanout (Y/N) A/ Depression (Y/N) /"/ High water alarm (Y/N) /Y,� Alarm tested (Y/N) 4ZZ Date of pumping r –i o -- 9 i T re /I Pumper -,)-R 5 _ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: �/ 7 Well(s) on lot Z A On adjacent lots �2�C� Foundations Topropertyline •o�2S9 _Absorption field s Water main/service line Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: -Well on lot On adjacent lots D. ABSORPTION FIELD DATA Manufactrer– hole/Access(Y/N) "Pump off' level at — Cycles tested Surface water _ Date installed �y��� Soil rating rU /! ��R System type 223C/UC/ Length 145 Width/(% r7 Gravel thickness J / Total depth Total absorption area Cleanouts present (Y/N) Z Depression over field (Y/N) AJ Date of adequacy test _/ _'J_ Results (pass/fail) 1/Iafi for 3 bedrooms Peroxide treatment (past 12 months) (Y/N) 2/✓KN0/n)AI If yes, give date _ V SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot � / On adjacent lots J�� Property line To building foundation — To existing or abandoned system on lot A/A On adjacent lots /3u Cutbank ^'lam Water main/service line ;4i0' Surface water —AZ /^�Driveway, parking/vehicle storage area tio' Curtain drain /V�A E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on thg date`of this; inspection. Signature Engineer's Name `�h ✓�' `may Date 12-,/ice/54 zvr( v c, HAA Fee $ / 20 ' Al Waiver Fee: $ Date of Payment ./ 2,'-1 V Date of Payment Receipt Number & 3 AJ$ !N4 % Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Eagle River Engineering Services 11940 Business Blvd, Suite #205 694_5195 'P.O. Box 773294 Eagle River, A. 99577 Fax 694-3297 Legal: L1!f11,r / Owner: A H. F,c , Date: Type of test: U Well Flow Test "0Septic Test Only U Well & Septic Test ❑ Other; Meter Monitor Well Tank GPM PSI Remarks Time Reading Level Level Level J/k /N M K a 7 O 3.30 41,9 3 �o vos<!l-ti bt /'� 3 0 3 DEPT. OF ENVIIIONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 "C" STREET, SUITE 322 ANCHORAGE, ALASKA 99503 FOR: Eagle River Engineering December 9, 1991 PWSID # 211431 WALTER J. HICKEL, GOVERNOR (907) 563-6775 My review of the records on file in this office reveals that the Dawn Water Company Class "A" Public Water System, is in compliance, for the month of December 1991, with the routine coliform bacteria sampling requirements listed in Table C, and with the inorganic sampling requirements listed in Table B of 18 AAC 80.200. Sincerely, 7�44�� Byron Roys Environmental Engineer BR/cf MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES p j 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 Parcel I.D. # l)" -,)i - L\,Lpl- (C) 'IQ 1. GENERAL INFORMATION Complete legal description Location (site address or directions) HAA # Lot 3; Btocli 1; Meadow Ridge,Subd vfision; 21050 Meadow Laze Dt ve Property owner Frantz 9 Etizabe-th Pratt Day phone 688-4110 Mailing address HC 79 Rr,x 6277 Chug,iak, A.PaLka 99567 Lending agency Pac i. is AEaaska Mon.tgage Day phone ATTN: Wendy Mailing address AgentML.tch Fautkner TOWN 9 COUNTRY REALTY, INC. Day phone Address 115 We. -t Non-thenn Lights Rtvd., 0208 Anchorage, Ak.. Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 ~ 3. TYPE OF WATER SUPPLY: Individual well Community well XX Public water 276-2233 99503 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX 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 H21 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/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 ENGINEERING Engineer's signatUf9le River, Alaska 99.577 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for E Additional Comments Phone Date bedrooms, with the following stipulations: 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 orderto 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 921 o Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: U_=- 5L -V-- 1 MrA<DT)y�'i�V 4arcel I.D. A. WELL DATA Well type A If A, B, or C, attach ADEC letter. ADEC water system number 2t \ 431 Log present(Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level Date completed Cased to Driller Casing height Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION ENb(k�NbSENI; �; ;;_ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 2�L' Absorption field on lot Public sewer main Public sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA n Nitrate g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria MAY 14 1991 RECEIVED g.p.m. Date installed Tank size /boo Compartments Cleanouts 61\1) Foundation cleanout (Y®j /J Depression (Ya PJ High water alarm (Y&N Alarm tested (Y/N) 'J/� Date of pumping S--ID'C1/ rQ. 61:S PC)oL Pu MF'/,1b SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ,r Well(s)onlot �-Oo On adjacent lots ^11,4Foundation ./ -r I � Topropertyline /D Absorption field .S Water main/service line Surface water/drainage /Do 7Y 74 S 0 72-026 (Rev. 3/91)Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level — Meets MOA electrical cod "Pump on" level at — Manufacturer Manhole/Access (Y/N) eve[ Cycles tested SEPARA a'g-DISTANCE FROM LIFT STATION TO: I on lot D. ABSORPTION FIELD DATA On adjacent lots ENVIk6,N LJi ;,���,;.. MAY 141991 Surface war Date installed -�" 6 3 Soil rating /Sa System type %k9'..f6w Length 45 Width Gravel thickness 5 Total depth i Total absorption area �} S�b Cleanouts present O/N) y Depression over field (Y,(O /11 Date of adequacy test S- l0 -1j / Result a s�fail) 1�i1SS for T4a6-p W bedrooms Peroxide treatment (past 12 months) (Y& t]n Jte"Jo If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: �r Well on lot �C' On adjacent lots J/, Property line /0 / F To building foundation .5y To existing or abandoned system on lot Ili /4 On adjacent lots 30 ' Cutbank �� Water main/service line /c�, Surface water /OD �- Driveway, parking/vehicle storage area 30 Y Curtain drain E. (ENGINEER'S CERTIFICATION 1 certify that i have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature 1r50, 204 Engineer'sNamg,.,;Te roe., lel s',..91�/7 Date/( HAA Fee $ l 70 Date of Payments — 7 Receipt Number /�7 72-026 (Rev. 3/91) Back MOA 21 © S a.� 7 Waiver Fee: $ Date of Payment Receipt Number WALTER J. NICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 April 25, 1991 FOR: Roger S & S Engineering PWSID #211431 Dawn Water Company Eagle River/Chu. iak My review of the records on file in this office reveals that the Dawn Water Company's Class A Public Water System is in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations. SC e. i. ' /Z4 --c) Keven K. Kleweno Lead Engineer -rime APPLIG'-ANT FILLS OUT UPPER HAL- ONLY Time Property Owner /� �'_- . - , .f ;' _-�'- • :,t {_ _ Phone r - Dale .. Inspector Inspector Inspector Field Notes: Mailing Address_- i�. / I�< I ;' - Zip Code ( ) COND11IONAL APPROV ' Buyer DATE ____ ) _ ! O BY: Address Soils Rating Zip Code Area Lending Institution Phone 1 Address'/ ---{,;,.- ., --..ice Zip Code -� Realty Co. & Agent - _ ,- / _ }< .:- t_-- Phone Address [.-' ; -: - i. ;. i� - ; _ ! �,, �- _ , �C Zip Code Legal Description _—_— Street Location,. --,-.- Type of Residence Single Family -- U Multiple Family No. of Bedrooms U Other Water Supply U Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. W --/Community For wells drilled prior to that date, give well depth (attach log if available). U Public Utility Sewer Disposal - - M- Individual Year Individual Installed: ' ❑ Public Utility When Connected to Public Utility: _ U Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. -rime Time Time Time Date Date Date Dale Inspector Inspector Inspector Inspector Field Notes: ( APPROVED BEDROOMS` 3 ( ) DISAPPROVED 'CONDITIONS OF APPROVAL ( ) COND11IONAL APPROV ' DATE ____ ) _ ! O BY: Soils Rating Date So�we�r,I stalled Area Log Received_ =WollToTAbsoription FWell Septic Tank Size ou 72023 (31W