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HomeMy WebLinkAboutMEADOW RIDGE ESTATES BLK 1 LT 4• fix' € - `�`�" F� � _:� x ��.. � €;� �� � x � � �� � � �� � =Q�� �,�� 7,.€, yam• x INN 2 b J. MIR Septic reported tested and f ailel'.i �a< N``_'P""'�o MUNICIPALITY OF ANCHORAGE cnent 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 epartment 9NCMU0.No" On-Site Wastewater Disposal System Permit Permit Number: OSP181230 Effective Date: 8/2/2018 Work Type: SepticTank Upgrade Expiration Date: 8/2/2019 Tax Code Number: 05146106000 Site Legal Address: MEADOW RIDGE ESTATES BLK 1 LT 4 G:1362 Site Mailing Address: 21030 MEADOW LAKE DR, Chugiak Owner: KAUFMANN JOSEPH K & SABINE A Lot Size in Sq Ft: 28143 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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 41 Received By: lie Date: 6 Atli Issued By: , Caltfart, Date: I 'IIf Municipality of Anchorage ,:F :', a: irtutuoir 1)c,parimeni P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.orq/Onsite Development Services Department On-Site Water and Wastewater Section **** VARIANCE/WAIVER REVIEW ** ** Waiver#: OSV181055 COSA#: Permit#: OSP181230 PID#: 051-461-06 Legal Description: Meadow Ridge Estates Block 1 Lot 4 Engineer: Garness Engineering Group Applicant: Joseph & Sabine Kaufmann Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 0.0 feet. Requested tank to foundation waiver is not needed as long as tank is outside the soil bearing prism of the foundation. Drainfield to driveway waiver is not needed because drainfields were allowed under driveways when it was installed. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: 8/-2/1.? Approved by: taibte,CA GULAbe Name of Reviewer **** VARIANCE/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE ., ,r - Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On-Site Water& Wastewater Program Mayor Dan Sullivan On-Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 05 1 - J 1 - O (� Property owner(s) JOSEPH &SABINE KAUFMANN Day phone 240-6823 Mailing address P.O. BOX 671016, CHUGIAK,AK 99567 Site address 21030 MEADOW LAKE DRIVE, CHUGIAK,AK 99567 Legal description (Sub'd, Block& Lot ) MEADOW RIDGE ESTATES S/D; BLOCK 1, LOT 4 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (®all that apply) Initial I I Single Family (SF) Absorption Field I I (w/wo ADU) Septic Tank ® Upgrade Duplex (D) ❑ Renewal I Holding Tank ❑ Multiple Dwellings El Privy ❑ (SF and/or D) Private Well n Water Storage THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: 5EiFetft DRAINFIELD TO LOT LINE 803Fgvtt4re4€EEBZINDSREDRtVEWA.Y Distance: 0 FEET I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: �5 Waiver Fees: it.. 1 5 Date of Payment: W Zvia Date of Payment: • 18 Receipt Number: O 714 Receipt Number: 0 g 1 7& Permit No. QS P(71 a3v Waiver No. CSV 1E 1 O 55 (Rev.01/11) 1\ GARNESS ENGINEERING GROUP, Ltd ENGINEERING SALES CONSULTING July 25, 2018 Municipality of Anchorage Development Services On-Site Water & Wastewater Program 4700 Elmore Roade Anchorage, Alaska 99507 Phone: (907) 343-7904 Reference: Septic Tank Upgrade Permit Request, Conditional COSA Approval, and Lot Line Waiver Request for Meadow Ridge Estates S/D; Block 1, Lot 4 To whom it may concern: The 3 bedroom house on the referenced property is served by a community water system and a private septic system. Per MOA records, the septic system serving the subject property was installed on 4/12/1983 and consists of a 1,000 gallon steel septic tank and a deep trench type drainfield (47 feet total length — 1 @27' & 1 20' x 3 feet wide with 7 feet of effective). We have recently performed a septic adequacy test on the drainfield and found the absorption rate to be adequate for a 3 bedroom house. However, due to the age of the steel septic tank (35+ years), your department is requiring the septic tank to be upgraded. We are proposing that a new Infiltrator 1060 two-compartment plastic septic tank be installed next to the old septic tank. The old septic tank is to be decommissioned per UPC. The current owners are in the process of selling the house and we are requesting a septic tank permit be issued, as well as a conditional COSA. The owners are obtaining 3 bids from contractors and will pick a contractor to perform the work. Monies will be escrowed based on the contractors bid to insure the new septic tank is installed per the design. Monies will also be escrowed for the engineering fees for the record drawings and the obtain final approval on the COSA. TANK TO FOUNDATION WAIVER REQUEST: The space is very limited to install a new septic tank and in order to maximize the distance to the drainfield, we are requesting the septic tank be allowed to be installed 5 feet from the foundation. The existing septic tank is currently only 7 to 8 feet from the foundation. The existing tank currently only has 19-22.5" of cover over the tank. GEG consultant, Jody Maus, has went into the crawlspace and found where the sewer line exits the foundation. It appears the sewer line exit the foundation wall just above the foundation footer. We 3701 East Tudor Road, Suite 101 *Anchorage,Alaska 99507-1259 Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com Page 2 of 2 have performed a profile drawing showing the foundation elevation in relation to the septic tank. It appears that the 45 degree angle of repose extending outward from the base of the footing passes below the septic tank; therefore, it appears there should be no issues with the new septic tank being 5 feet from the foundation. LOT LINE WAIVER REQUEST: During the septic tank design process, it became apparent that the existing sump for the drainfield is extremely close to the south property line. According to the 1983 inspection report, the drainfield was 5 feet from the south lot line. However, based upon our swing-ties from the corners of the house to the sump standpipe, the pipe is only approximately 0.5 feet from the south lot line. We are requesting a 0 foot lot line waiver from the south lot line to the existing drainfield. The neighboring septic system is over 10 feet from this lot line, so it appears there is no conflict with the granting of this waiver. We are requiring the contractor to have the south lot line flagged/staked by a registered land surveyor prior to construction to verify the standpipe is on property. It is possible that a small portion of the subsurface portion of the drainfield is over the property line, but without excavating, this cannot be confirmed. DRAINFIELD UNDER DRIVEWAY WAIVER: Another item we would like to bring to your attention is the eastern 20 foot segment portion of the drainfield. Based upon our field measurements of the 27 foot long portion of the drainfield, the eastern portion of the drainfield appears to have 6+ feet of cover. Also, we have obtained an email statement (see attached) from the owner stating they have not had any issue or freezing issues with drainfield in the 22 years they have lived there. We are requesting a 0 foot waiver for this drainfield being under the driveway. Please do not hesitate to call us at 337-6179 if you require further information. Thank you for your assistance. Sint ly, ite regiGa '.E., M.S. Presildip I 3701 East Tudor Road, Suite 101 *Anchorage,Alaska 99507-1259 Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com From: Sabine Kaufmann To: )odv Maus Subject: Kaufmann septic Date: Wednesday,July 25,2018 8:59:40 AM Hi Jody, We have never had any issues with the septic or drain field freezing in the 22 years that we lived at 21030 Meadow Lake Drive. Thanks, Joe&Sabine Kaufmann / // // / //// / //// / //// / //// / / /// / //// / //// / //// / //// / \ , , / / / / / / / / / / • ' MEADOW RIDGE EST. i / / // / // // / //// / // // / //// \� / BLOCK 1,LOT /� / / ///// ///////////////////// // /// ' /' \\ / / / / / / / / /� •/ / / ./ / / \ , / / // / / // / / / / // / /, \ //// / //// // •// / ///// / / \ % / / / // / • O / / // // / / �' / / / / ///// ////O ////// /// , ' / ' / ////// /�`�/// //// // / MEADOW RIDGE EST. / L'' / // / / /� / // / / ' / BLOCK 1,LOT 3 1 / ��/ / 'F / / / / / / / / / /' / / m i LU I— //// // ////// // / i '/��/ /�/O / ' ce c4 3 U / / // / / // ' / ASSUMED WATER /�/ /isr.."15' �/ / o O / / / // / / / / • ; LINE AND KEY ;�.�/ �,� m ////// ////// ; ��2 / BOX LOCATION /$/ / / / \\ / / / / / , /*. / / / / / / $. / / / 0 / / / ' / , /Li T / / / / // / / / i i e / / i // / / // SHED pS�pQ yQ'/, %/ ; /"- / / ////////// , ' / �'p ZO�' / / / / MEADOW RIDGE EST. �•,•a•' BLOCK 2,LOT 3 // / / /I r .. • / ; / / / / , , . / / NOTE:ALL PROPERTIES IN / / , d'' / t.0 •;'`a�P;!":44):,-+/-, •••••-. / / MEADOW RIDGE ESTATES SID / // / / / / / 4,6...A "p?p ` ' / / ARE SERVEDBYA / // ; % R�:4:` / /`� COMMUNITY WATER SYSTEM / / EXISTING SEPTIC TANK • / / // , '411414 / i \ / EXISTING DRAINFIELDS / \ / / ' APPROX.LOCATION , / / \ / / / // // / j / PROPOSED / / \\ ' 1000 GALLON / , \ ' / / HDPE/PLASTIC ' \ / MEADOW RIDGE EST. / / SEPTIC TANK. / / \ \s. / / BLOCK 1,LOT 5/ SEE DESIGN, / ; / / PAGE 2 OF 2 / ' / / / , / / / ' MEADOW RIDGE EST. N / \ \ \ i ' \ i / / / / / MEADOW RIDGE EST. � / / ,[ / S ALE: / BLOCK 1,LOT 6 7 /`/ / / / / / it .AVO VOL" " I I444 '4�� • 41 W , GARNESS ENGINEERING GROUP, Ltd i if 4" 'e CIVIL&ENVIRONMENTAL ENGINEERS •• 1 • 3701 E.TUDOR ROAD.SUITE 101•ANCHORAGE.AK 99507•PHONE(907)3378179•FAX(907)338-3246'WEBSITE:www.gamessengheerIng.eom •• PREPARED FOR: PHONE NUMBER: PAGE NUMBER: � • ��'� 'y Gam-.s aLiJ� JOSEPH &SABINE KAUFMANN 240-6823 1 OF 3 ' JJ,' C 795- ,/, � PROJECT/LEGAL DESCRIPTION: DRAWN BY: �♦ ' •..�� 2J •l '� � MEADOW RIDGE ESTATES SID;BLOCK 1, LOT 4 J.L.M. 1� • ,�pp����•l•,,11,, �P�, �� TYPE OF WORK: DATE: LICENSE,1 1�����_"••• SITE PLAN FOR SEPTIC TANK UPGRADE 7/25/2018 #AECC664 )/ GEG,Ltd.HAS A 8 PAGE SPECIFICATION ASSUMED WATER LINE AND KEY BOX / LETTER THAT PERTAINS TO THIS DESIGN.TO LOCATION.GEG CONSULTANT,JODY / / OBTAIN A COPY OF THE LETTER CONTACT MAUS, FOUND WATER LINE IN / GEG.BY PROCEEDING FORWARD WITH THIS CRAWLSPACE ON NORTH SIDE OF INSTALLATION,THE ENGINEER,WELL DRILLER, HOUSE AND KEY BOX IN THIS AREA. CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE CONTRACTOR SHALL HAVE WATER LINE hiliiiisi4: SPECIFICATIONS AND AGREE TO ACCEPT THE PROFESSIONALLY LOCATED TO INSURE / TERMS AND CONDITIONS OUTLINED. WATER LINE LOCATION IS ACCURATE. / / CONTRACTOR NOTE:THE EXACT LOCATION ////// OF THE TRENCH TO THE EAST IS UNKNOWN. //1,�. / SPACE IS VERY LIMITED.NEW SEPTIC TANK 111 �M- SHALL BE PLACED 5'FROM FOUNDATION TO �N' MAXIMIZE DISTANCE FROM DRAINFIELD/S. tO / �� SEPTIC TANK MUST BE INSULATED WITH 4 / INSHESULA OFIO INSULATION EXT AND THE / INSULATION MUST EXTEND PAST THE PERIMETER OF THE TANK. . / 1111 ` / _� , 0 /ii ‘ it R "4 / J\ N • t/ / SCALE: / 1"=20' / / / • •No ; ; / O REQUcSTING S FQ• • `‘ WAR1Ef2 TQ FQUNDA ION FENCE �.p .I ::. .:;. / ' ��op.- •• INSTALL FOUNDATION CLEANOUT EXISTING SEPTIC TANK TO BE ��\\` '' '' J4i"Q DECOMMISSIONED PER UPC. .,,.A.:" . / '•/ ':.OQY�,� AO • • / •• i ... / . t. EXISTING SUMP.LOCATION OF STANDPIPE • t PROPOSED 1060 GALLON WAS SWING-TIED INTO CORNER OF HOUSE • &SHED.SUMP APPEARS TO BE JUST INFILTRATOR PLASTIC A__44/ INSIDE PROPERTY LINE.CONTRACTOR ,':. .. *,.:. •....•••'••'. SEPTIC TANK.THIS PORTION SHALL HAVE THE LOT LINE FLAGGEDOF THE DRIVEWAY SHALL PRIOR TO CONSTRUCTION.WE HAVE ,. ABANDONED. REQUESTED A 0 FOOT LOT LINE WAIVER. INSTALL DBL CO'S v �EXISTING 27'LONG DRAINFIELD APPROX.LOCATION / /c? INSTALL CLEANOUT AND / MONITORING TUBE IN THIS DRAINFIELD / EXISTING 20'LONG DRAINFIELD.APPROX. / / V� / LOCATION.DRAINFIELD APPEARS TO HAVE 6+ / FEET OF COVER OVER TOP OF PIPE BASED / UPON FIELD MEASUREMENTS OF 27'LONG / / / / DRAINFIELD.REQUESTING 0 FOOT WAIVER. ....\/\-�S� 11, A. b.. miummomminumunimaillaillimiiiimmummininiannew GARNESS ENGINEERING GROUP, Ltd , CIVIL&ENVIRONMENTAL ENGINEERS ---. > - - 1.�� 0 3701 E.TUDOR ROAD,SUITE 101•ANCHORAGE,AK 99507'PHONE(907)337-6179'FAX(907)336-3246•WEBSITE.www.gamessengineenng.com '•• PREPARED FOR: PHONE NUMBER: PAGE NUMBER: �. y A. •- SS JOSEPH &SABINE KAUFMANN 240-6823 2 OF 3 .�-- ;l.�CE-795 //�� ' � PROJECT/LEGAL DESCRIPTION: DRAWN BY: .. „ ll �•i L►''•(` MEADOW RIDGE ESTATES S/D; BLOCK 1, LOT 4 J.L.M. .• 0 O'•�"V1��F (�\, .4. TYPE OF WORK: DATE: LICENSE•44� FE �� • DESIGN OF SEPTIC TANK UPGRADE 7/25/2018 #AECC884 ������� c • 4"SEWER LINE ASSUMED AT 2%SLOPE PROPOSED FINAL GRADE=100.75 EXISTING GRADE AT BEGINNING OF NEW SEPTIC TOP OF CMU FOUNDATION=100.24 TANK=100.40 TOP OF GARAGE SLAB=100.00 ST2 ST1 up me • • • • • • -` • c:g i. + ' •r tiF�ih�:�.-. .tax+- •t. •�S;f• •: � • 3 �!:t� rt :1::.r i jti:i b�rii :�:aa . s.r :R;"::' !%•.P.::4:1t1:7%.' ?..;•. . 4k r71.2 to �s t,•qs �:. Ytii��•1r••y'1';T•.'• *y�.4rXl:,a•.y51� i•f'••'•r,..:t'+.a{...l:i:;Y.a.T" 5'FROM pl:r n. --rt-•••• • •,:_:i; :•{��-1'• e•'^t:i a;. ,1` `'t h3t.3 fo',•}%•.�" „ U FOUNDATION liii r t; `�•r.. ,.v. S (•w� f 1;,+ r• t•1 f ?i:": }'.•s r ; g r i. MI .� l •i l••:Y'i+4' C:1`.: •ia'�• :•:••`t• ger i,i':-• .....'.:........11.-•-:<:-4,`,-4::f>•L:. :ar:•: �O�i/ BOTTOM OF FOOTER=96.24(VERIFIED 48"FOOTER IN CRAWLSPACE) `�/ INVERT OF 4"PIPE EXITING FOUNDATION=98.16— P/ b�/ PROPOSED 1060 GALLON INFILTRATOR 2-COMPARTMENT SEPTIC TANK PROFILE VIEW OF NEW SEPTIC TANK TO FOUNDATION WAIVER SCALE: 1"=5' ��,1j% ,.i. 4 !' ,4♦♦♦♦ GARNESS ENGINEERING GROUP, Ltd(• • CIVIL&ENVIRONMENTAL ENGINEERS#---, -: / 3701 E.TUDOR ROAD,SUITE 101'ANCHORAGE,AK 99507'PHONE(907)337.6179'FAX(907)338-3246•WEBSITE www.gamessengineenng.com ••• 4 , PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0(11 ;V e i. Ga 'ass : a• JOSEPH &SABINE KAUFMANN 240-6823 3 OF 3 ♦j0 ' C1-7913 PROJECT/LEGAL DESCRIPTION: DRAWN BY: ♦ • ♦♦ � Z� � ••• � MEADOW RIDGE ESTATES S/D; BLOCK 1, LOT J.L.M. LICEN♦•FO••'''• •• ( fir TYPE OF WORK: DATJ:. E: ♦♦1 "VOFESS�" • PROFILE VIEW OF SEPTIC TANK UPGRADE 7/25/2018 I • #AECC884 ,1I%swis�� J / / / / / / / • 111 ]�.� Acy / / . -1 .o / / Lot 3 o /Tract B-1 ' • / 6N 6',5. S3, / SOF / <10 O / 10' UTILITY / / No / EASEMENT t14/ / Lo / yam, 20' SEWER / Lot 4 .9 / // ;V to EASEMENT / 28,143 s.f. / �ii 2.0'x5.3' / CANT / • / 1.5' CANT `') `��G�" i �2•i ao/ N G3 � �. WOODEN FENCEJ � �. . es� Q / / ,O4OZV8.3'x12.3' SHED � ti <v/ . 03 • JwP/ ^ e3S/ � 3 , V" / Lot 5 ifr /. / SEPTIC PIPES QO / N . / / 30•0 441 / / NOTE: LOT IS SERVED BY A COMMUNITY WATER SYSTEM / / / PLOT PLAN AS BUILT X SCALE 1" = 40' GRID NW 1362 Project No. 17-298/A2 11500 Daryl 64venu Phone Anchorage, Alaska 99515-3049 Lang & Associates , inc . (907) 00000040 Professional Land Surveyors (907) 522-4625 Fax o OF ALoao ykenolan curve cam 9 jonathanOlangsurvey.com .vP•. S p0 I hereby certify that I have surveyed the following described property: 0°C: 49L " SOV LOT 4, BLOCK 1, MEADOW RIDGE ESTATES SUBDIVISION (PLAT 72-261) * • *VO Anchorage Recording District, Alaska, and that the improvements situated thereon are VA within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed � KENNETH 0 premises and that there are no roadways, transmission lines or other visible �, o easements on said property except as indicated hereon. OQ ' Z LZ• tt Q° �)A','••.LS-520?.••' eJ O Dated this the Day of , , at Anchorage, Alaska Q ,o Ngo 'W°PESSIONAA-'' It is the responsibility of the owner to determine the existence of any easements, 040000�� covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 /~~ MUNICIPALITY OF ANCHORAGE ! 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 '~'A M E '" PHONE I ~NEW MAILING ADDRESS P.o, . 1:3 o LEGAL DESCRIPTION LOOA~IO)'~O~O~ ~'~ Absorptio~ PERMITNO'OF BEDROOMS~ ' ,, _ DISTANCE TO: / ~ NO.~ ~ Manufacturer A"~O~ '~"" ~, Materials'~'~il'l No, of compartment, ~ N Liq, capacity ia gallons InsMe length Width Liquid depth 1~O~ IF HOMEMADE: ~ ~ DISTANCE TO: We[l D'welling "' PERMIT NO.' O ~ ~ Manufacturer Material Liquid capacity in gallons u~--O No. oflines_ Length of each l[qe ~ Totallen~thoflines Trench width, Distance between lines Ma{er~al ben~] tile ~ To~al effective absorption area Lengt'h Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption areals) OTHER PIPE MATERIALS ~OI L TEST RATING REMARKS · , .~1 APPROVED DATE LEGAL 72-013 (Rev. 3/78) F'EF.:H I '1' NO. DEF'FI~;:TI"tENT L NEIaI._TH I:]N[:, EN',,,'I RONHE:NTFIL . .OTECT I ON ':.:.:25 "L..'" '.~:TI-;.'.EET, FIh,tCI...IOF'.RGE., Rk::. '=-.,956~'.t.. 26,;1.....4. ~:21~ FtPPL I CRNT L.C,--:FI'f' I 01'.,I LEGRL GEOI_R~: L,:I.B::L. I'"IEFIDOI.,.IR I [:,GE ESTFITES F'O L::O'X :;L2:E~2 E. R. LOT SIZE T'¢F'E OF SOIL RE:SOF..'PTION S'¢2.';'I'EH t:S: TF4:Ei'.,IC:H HFIXIHUI'I NUHBEF.': OF BE[:,RO01"IS = Z.': 5OIL F.:RTII'4G ,::~-.16! FT,VBR:)= Z5R THE RE~.~;!U.~F..:ED :5IZE I_-IF TFIE :SOIL FIBSORF'TIOI"..! L:;"r'5;TEH IS: THE LENGTH DII'"IENSII:II'4 I:5 TFtE L. EI"4G-I"H ,::IN FEET::' OF' 'I'NE TF.'.EI",ICH OR E:,F.:FIII",IFIEL. I:::,. TNE DEPTH OF FI "FREI",ICH f'lR PIT :[:.::; THE E:' ]: '-=,TI=II",ICE E:E'f'I.,.IEEN THE.'-.' :5URFFICE OF -I"FIE GF:OUI'4D FINE:, TNE E:OTTOH OF THE E::'::E:Ft',,,'FIT I O1",1 ,:: I i",1 FEET ::'. TFIERE I2; NO '_":,ET I.,.IiE:'TH FOF.: "i"RENCNEE';. THIE GF::FI',,,'EL E:,EPTH :['.-.:, THE I'"I.'[NIHUH B, EPTN OF GF.:R',,,'EL E',ET!-,.IEEN THE OUTFFILL F'IF'E RI",IE:' THE BOTTOH OF' THE E'?-','CFI',/FIT I 01",1 ,:: I N FEET ::'. PEI:~:I"t I T F=~F'F'L I CRNT HI:I~; THE RE:..-T,F'OI'4':; I E: I L. I T"r' TO I i",IFORI"'I ]"FI 12.'; DEF'FIRTI'IENT B, UI:,:! i NG THE INSTFiLLFITION It",IL:;PECTIONS OF FIN"? !.,.IELLS FIE:,._'fFICENT TO THIS PROF'EE:T'¢ FIN[::' THE i",ILIHBEF.: OF F.'.ESIDENCEL=; THFIT THE I.,.IELI_ I.,.IILL SEF.:","E. BFIC:I':::FILL. ING OF' Rl",l"r' S;'¢':_:;TEH I.,.!ITIdOLIT FINRL INSPECTION FIND FIF'PRO',,,'FIL Bh" THIS; DEF:'FII:;?.THEI",IT !.,.tILL E',E SLIB.ZEE:T '1'0 PF. tOL:.',ECUT:[ON. I"tIl",lIi"lLIl"l [:,ISTRNC:E 8ET!4EEN Fi klELL Ri",ID I'"rtlq'¢ 1.31'.,I-:SITE .?:;EI,-!FIGE DISPOSFtL '_:;'¢$TEI'"I IS d..E~C~ I::EE"F FOR FI PF:IVFITE NELl_ OR J. SE~ TO ;;.%"-":'~ FEET F'REII'"I R PUBLIC [,.IEI....[_ I::,EF'EN[:,It",IG UF'ON TFIE T"r'F'E: OF PUBLIC I.'.IELL i"'III",t]:FIUI'"I E.',ISTFINCE FF.'.OH FI F'F.'.'I',,,'RTE NELl_ TO FI PF.:I',,,'FITE SEL,.IER LIhlE IS 2":5 FEET FIND TO FI C:OHHLINIT'¢ "-:;E:LqER LINE :[2'; 75 FEET. EITFI[:_'R I',i:EqUIF..'EHEI",tTE; I'"tR'?' FIF'PL'¢. SPECIFICRTION2'; RND CCINS'i"F4'.UCTION D:[RGF:I=II"IS I:'IRE FI',,,'RILFIBLE TO II",ISUF..'E PF..'OF'EF.': II",ISTFILLRTION. I CERTIF'¢ ]"HFIT ::L: I FtI"I FI::II"I:I:L]:I:II~: I,.IITH TNE REQUIREI'"IENTS FOF.: ON-.-L=;I]"E SEFIERL=, Ri",tE:, .L,IELLS RS SET FORTH B"r' THE I"IlJN I C I F'FIL I T"r' OF FINCHOF:'.RGE. 2".: I !.4ILL IN':;TFtLL "['HE '-:;.,'¢9TEH IN F'ICE:OR[:'FII"~CE .L,.IITH TFIE CODE'-:;. Z: I LIN[:,EF.'::STFIN[:, TNFIT THE OI",I-'L=;ITE :gE!4EF-': '.5"r':Ef'EH IdFl"r' F.'tE6!LII,~.i:E ENLFIF.:GEHENT IF' THE RE'.:JIB'IENCE I2; F.:EHOI)EL. EE:' ]'0 INCLU[:'E I'"IOF'?E THFIN 3: E:ED~:OOt"'IS. ',,,',:$. El SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 ~'1 1 12 13 14 15 16 17 18 19 2O SLOPE SITE PLA WAS GROUND WATER ENCOUNTERED? IF YES, ATWHAT DEPTH? Gross Net Reading Date Time Time PERCOLATION RATE COMMENTS PERFORMED BY: /O?;l,~./'ry/ //00¢'),.'.,~5~7-~' CERTIFIED BY: (minutes/inch) TEST RUN BETWEEN FT AND FT .4'P.c~,.4 ,d'e:T~.,.'~c~ ?4.4 Z~(pT:.~l O'H,,q(. ~. J?~- 72-008 (6/79) CCDt.,Th 01\ OK fil--- Municipality of Anchorage - _` On-Site Water&Wastewater Program r (907)343-7904 6 ? 8 9 10 ,, CERTIFICATE OF ON-SITE SYSTEMS r''P1 / ,g �018 1-4. 2018 X81 \ S -L 1,ao1 � Parcel I.D. 051-461-06 Expiration ,_Ur os`' 1. GENERAL INFORMATION Complete legal description MEADOW RIDGE ESTATES S/D; BLOCK 1,LOT4 Location (site address) 21030 MEADOW EREE LAKE DRIVE,CHUGIAK,AK 99567 Current Property owner(s) JOSEPH&SABINE KAUFMANN Day phone 240-6823 Mailing address P.O. BOX 671016, CHUGIAK,AK 99567 Real Estate Agent HEIDI CLEMENT Day phone 727-0816 2. TYPE OF DWELLING: U Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site U Individual Water Storage ❑ Individual Holding tank ❑ Community Class A Well I Community On-site ❑ Public Water System ❑ Public Sewer ❑ waiverNariance request for: DRAINFIELD TO LOT LINE Distance: 0 FEET Received by: Date: 8/4S COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee$ 2 05.•-'- Waiver Fee$ VA Date of Payment '41gZo1 iW Date of Payment Receipt Number OO5Z96)) Receipt Number COSA# 00C1 2 136,q 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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E.TUDOR ROAD,SUITE 101 *ANCHORAGE,AK,99507 Engineer's Printed Name JEFFREY A.GARNESS, P.E. Date --7/ ‘›/ `a Engineer's Comments: In conducting this evaluation,GEG provided an engineering evaluation of the well and/or septic system in accordance with the .vi\�\\ 11 1 guidelines and regulations established by the Municipality of Anchorage and industry practices.The reported results describe the •11- � OF e 4t] condition of the systems on the date/s of the evaluation.Separation distances were measured to readily identifiable features. ��P ., , 4 -.A Hidden defects or encroachments may exist that were not identified during the evaluation.The operational life of all wells and septic i \.••••••��....• a systems depend on a variety of variables including,but not limited to,soil conditions,groundwater levels(that may fluctuate during •�• ••••••'t the year),quality of construction(materials and workmanship),and the water usage of the family utilizing the system/s.These ° *;�• 49Ini I j\ * *o o conditions can vary,and are outside the control of GEG.Satisfactory test results do not guarantee future performance of the ■ 1 •f , system/s;therefore,GEG makes no warranty(express or implied)regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the L ei ,1, / • current systems fail.The content of this report is for the sole benefit of the person/patty who retained GEG.Reliance upon the 0 information provided in this report by any other person or party,including but not limited to subsequent property purchasers,is not v CE-79&3 Ar authorized.In short,GEG disavows any legal duty to anyone other than the person/party who paid for this report. * t!' 6. DSD SIGNATURE ♦�.. 41 ;FD.P ..2� i� '�4A. A ROFESS\c I4' Cly #LAECNCtjE 111 \\\sit�� G System#1 Approved for bedrooms. 84 > ON,c�\�E �` , System#2 Approved for bedrooms. SER p.,\\10 R c Disapproved. p��N ROGRP Conditionaliapproval for 3 bedrooms, with the following stipulations: • 1!n� ��,`r\ Sj-►'c 71a.rl k shall be r laced and errnr >,��A1T r~ � � � 'f � SP 9� 1230 eL)sed ou.f (wI , upola4ed as-built sure ) .b Ser-b 1) O ! . By: 7g�0 A 6Original Certificate Date: 0 1S). The Municipality or Anchorage Develop,emt Services Division(DSD)issues Certificates of On-Site Systems Approval(COSA)based only upon the represenatations 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. ATTCHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other • (Rev.10112112) If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: MEADOW RIDGE ESTATES SID; BLOCK 1, LOT 4 Parcel ID: 051-461-06 A. WELL DATA COMMUNITY WATER SYSTEM ' S lo_v,.Ac0- Well type CLASS"A" If A, B. or C provide PWSID# 210401 Well Log Y/ Date completed Sanitary seal Y/i Wires properly protected (Y/N) Total d-• • -. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production Illig g.p.m. Ial g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate mg./L. • :. ••. -• ••. . Date of sample: B. SEPTIC/HOLDING TANK DATA •NEW HDPE/PLASTIC TANK TO BE INSTALLED.REQUESTING CONDITIONAL COSA APPROVAL. -CLEANOUT IN CRAWLSPACE;HOWEVER,FOUNDATION CLEANOUT TO BE INSTALLED WITH NEW TANK Tank Type/Material *SEPTIC/STEEL Date installed `4/12/1983 Tank size *1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout(Y/N) **NO Depression over tank (Y/N) NO High water alarm (Y/N) NO Date of pumping 8/5/2017 Pumper SANITARY PUMPERS C. ABSORPTION FIELD DATA 'BELOW EXISTING GRADE AT SUMP AT END OF DRAINFIELD Date installed 4/12/1983 Soil rating (g.p.d./ft2or ' /bdrm 150 System type DUAL DEEP TRENCHES 47( 1 @ 20' Length & 1 ©27') ft. Width 3 ft. Gravel below pipe 7 ft. Total depth `11.7+ ft. Eff. absorption area 658 ft2 Monitoring tube YES Depression over field NO Date of adequacy test **7/12/2018 Results(Pass/Fail) PASS For 3 .bedrooms ,••0I ***1 1 / Fluid depth in absorption field before test 0 in. Water added 2,548 gal. New depth 45.5 in. *"*0/ Elapsed Time: 645 min. Final fluid depth 16 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) NONE KNOWN If yes, give date - **HOUSE HAS BEEN VACANT SINCE OCTOBER OF 2017 WITH ONLY INTERMITTENT USE PER THE OWNERS. ***MONITORING TUBE( MT) /SUMP. NOTE:THE MT DOES NOT APPEAR TO EXTEND TO THE BOTTOM OF THE DRAINROCK. TESTED 27'TRENCH SEGMENT.CONDITION OF 20'TRENCH SEGMENT IS UNKNOWN. D. LIFT STATION Date instal e. Size in gallons Manhole/Access ► "Pump on" level at in. "Pump off' leve .i High water alarm level at in. Datum Cycles tested Meets alarm &circui r-..' - -. ? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: COMMUNITY WATER SYSTEM Septic tan'. '- .tion on lot On adjacent lots Absorption field on lot On adjacent . . Public sewer main '•= ' sewer manhole/cleanout Sewer/septic service lin- Holding tank A w.ntainment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation "5'+ Property line 5'+ Absorption field **5'+ Water main * 10'+ Water service line *"*10'+ Surface water 100'+ 100'+TO PVT./ Wells on adjacent lots 200'+TO COMM. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line **0' Building foundation **10'+ Water main 4.k 10'+ Water service lin ' 10'+ Surface water 100'+ Driveway, parking/vehicle storage ****0' Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS * AS c04-1 ED *MET SEPARATION DISTANCE AT TIME OF INSTALLATION **5'PER JAMES L.THODE'S 1983 INSPECTION REPORT; HOWEVER, REQUESTING A 0 FOOT LOT LINE WAIVER WITH ISSUANCE OF SEPTIC TANK UPGRADE PERMIT. ***WATER SERVICE LINE IN CRAWLSPACE ON THE OPPOSITE SIDE OF HOUSE FROM THE SEPTIC SYSTEM. ****PORTION OF DRAINFIELD UNDER DRIVEWAY. SEE WAIVER REQUEST IN TANK DESIGN PACKAGE. G. ENGINEER'S CERTIFICATION •,/•.p*.- - OF1 ••� — v.... 1 0 .. ♦ I certify that I have determined through field inspections and 4' �• • review of Municipal records that the above systems are in ,'I • conformance with MOA COSHguidelines in effect on this • date. •r^'• -f . c.rness .H ♦ cam- =2� Engineer's Printe Name JEFFREY A. GARNESS �♦ S] / CE 795 Date 1 g • ROFESS�� 4* LICENSE •'lII%"`lt%'S #AECC884 (Rev. 10/12/12) Charity Wilkinson United Title Guaranty Agency,LLC Escrow Officer 3350 Midtown Place,Suite 102 T/Ad Anchorage,AK 99503 (907)257-0479 Phone • (865)348-0994 Fax UNITED TITLE GUARANTY charity.wilkinson@utgalaska.com Reference 21030 Meadow Lak•`grive Chugiak,AK 99557 Owners: Joseph K. Kaufmann & Sabine A. Kaufmann At the request of the Municipality of Anchorage, this letter is written to show the intent of paying the attached, received invoice for the work to be done on 21030 Meadow Lake Drive Chugiak,AK 99567 United Title Guaranty is in receipt of the attached invoice from Flinstone Enterprises, LLC dated 7/30/2018. United Title will disburse payment for this invoice at time of closing 1 recording,which is currently contracted to close on or before August 8th, 2018. Should the transaction extend past the 8th of August, 2018, the disbursement of funds will be held until the file closes I records. In the case that the transaction cancels or the deal terminates, United Title Guaranty will not be held responsible for the payment of the invoice. `i, ' L 8/1/2018 United Ttt'•terran; .1!ency;LLC 3350 Midtown Plac-, Ste 102 Anchorage,AK 99503 ATTN: Charity Wilkinson charity.wilkinson@utgalaska.com (907)257-0479 PHONE (866) 348-0994 FAX File Number: 01314-23502 Page 1 of 3 •Ttintstone Enterprises LLc Division Jr's Septic Pumping Phone#694.6454 P.O. BOX 773415 Fax 344-9821 EAGLE, RIVER ALASKA 99577 Date:730/18 Email:nlerodavid@gci.net PROPOSAL SSrh miKcd To'Joseph.Knufmaryft Phone# 240-6823 230.1149 Job Location:21030 Meadow lake drive Chuglak.Alaska J4D ac#.olieA: lnstelLft i.059 1!lnhltmtrzA18stictank PRICE INCLUDES 1. Pump and Abandon old take nor code. 2. Install new 1060 elastic tank Per design 3. Locate water ine by Professional!neater 4. Remove fence In septic lank area 5. fiove shed if necessary and relocate to west end of driveway 6. Insulate new lank with 4 Inches o‘`dlae board 7. Install double cleaa..2LLs.._ 8. L4nund tank or otaca tin bardcrs in front of tank to prevent vehicles dnvinng over tank 9. Grade all disturbed area's PRICE DOES NOT INCLUDE. 1. SURVEY TO BE DONE BY OTHER 2. BEIRSIeLI..EESCF-TA_D01EBYotHFR 3. PPOJFC"-I AY OU' 4. =NC;INFEPINO FEE'S 5. Irl FOTR,CIAI 6. TOPSOIL ANN SFFnHt10 7. jJTIITIFS NOT LOCATFD nY 10OATF OFN7F3 8. Removal of any material from silo unles3 stated in bid ESTIMATED COST BASED CN 1 HE ABOVE WORK: $5,400.00 A CREDIT OF$250.00 WILL BE ISSUED IF WE DO NOT HAVE TO RELOCTE SHED. Bid Specifications 1. Project layout with be the responsibly of the Engineering firm or a license surveyor A.Bid amount includes Instagaion,materials,and labor and equipment to install the septic system as designed. Unless stated otherwise,the bid amount does not Include engineering services such as design fess,inspection,foes. B.Unless slated otherwise,tho bid amount does not Include export of overburden or trees,stumps,will be disposed of on the property C.Final grading will consist of backfilling the construction area with onsite native soils so as to create a rough construction grade teat meets the minimum • M.O.A.soil cover requirements and provides drainage away from,or around.the septic system.Prior to landscaping,most excavation sites will require hand raking and stcveling to remove larger rocks,slicks and debris.This vrorrl Is not Included In the bid.And unless stated otherwise landscaping Is not Included In the bid. D.There are limitations regarding the quality of final grading.Typically(here Is some settlement that may occur.Flinistone Enterprises LLC will not be reasonable for any ground settlement. B.Unless staled otherwise,the bid does not include reconstruction or restoration of decks fences,driveways,and asphott,troes grass that must be removed or disturbed as part of the construction. All work wit be in accordance with M.O.A.and Stale Guidelines Ail Material is guaranteed to be as Specified All work will bo performed as per Engineering Plans and Specifications Any alterations or deviations Iron above specifications Waiving extra cost will be executed only upon written orders or verbal and will become an extra charge over and above the estimate. All work will be done in a workmanlike manor in accordance with standard Construction Practices Eamon( •. O. lr(1A r • '14": •1 .4 1 l: , 1., •: lt, F ' is a toga!bidding contract between owner and Flintstore Enterprises LLC Al!collection foes and Attorney's cost,late fee's plus o 15%rate of Interest will bo applied to ail Accounts pass 30 days Both parties acknowledge this Is right to lion the property. This Proposal may bo withdrawn if not accepted In 15 days • ha. •rl: . . .1 JA .•.• • " ,, „• '41.,i.,,,,,,, I. 1, :C ,,, • .l /It vie. , , OS ' .. ! I '♦• Accept of Proposal/Contract Owners Signature Date: ii 8/1/2018 11:47:27 AM AKDT Sa�lUt.L fi-0U4t it. Contractors Signature ` Date: �GW1d IM u" 8/1/2018 12:39:15 PM AKDT David E Mero (Jqe. 3 of 3 rt•r $ 1 - r EX '!'C7 f....� ». ^'0V6i lk ^4111611111116111111 ___........ . i 4 .."^VIVONSSIIIIIIIII60100‘00., ' C. V tI Lir iv K 506461 ' `o , is _i Lot Y --;"___ iii 7 DWW- Water System Details http://dec.alaska.gov/DWW/JSP/WaterSystemDetail.jsp?tinwsys_is_... Skip to content State of Alaska • myAlaska • My Government • Resident • Business in Alaska • Visiting Alaska • State Employees Alaska Department of Environmental Conservation DEC 0 State of Alaska DEC>Drinking Water Watch>Water Systems>Water System Details Drinking Water Watch Water System Details Help with this page Water System Facilities Source Water Assessment Results Non-Coliform Samples/Results Colifomi/Microbial Sample Results Source Water Assessment Web Map Non-Coliform Samples/Results by Analyte Coliform Sample Summary Results Lead And Copper Sample Summary Results Violations/Enforcement Actions Sample Schedules Site Visits Milestones Current Monitoring Summary System Water System No.: AK2210401 Water System Name: MEADOW RIDGE ESTATES Federal Type: Community Principal County Served:ANCHORAGE Primary Source:GWP Status: A Activity Date: 01-01-1978 Points of Contact Name Job Title Type Phone Address Email 21008 Country View Drive, STRODA,DAVID HOA PRESIDENT AC 907-830-3341 CHUGIAK, dstroda @mac.com AK-99567 Annual Operating Periods& Population Served Service Connections Start Month Start Day End Month End Day Population Type Population Served Type Count Meter Type Meter Size Measure 1 1 12 31 R 350 RS 48 UN 0 Sources of Water Service Areas Name Type Code Status Availability CC UNTREATED GW FROM PWS 211431 CC A P Code Name WELL#I WL I 0 R AK-SUBDIVISION WELL#2 WL I 0 R SUBDIVISION Water Purchases Seller Water System Seller Facility Seller State Asgn ID Buyer Facility Buyer State Asgn ID No. Water System Name Type No. Type No. AK2211431 ALPAT WATER-HOMESTEAD DS DS001 CC CC001 DIV. 1 of 2 7/26/2018, 1:07 PM ..rLIN-ma-98 Mom lc) ;:!i. An xNIo. ENGINEER" ws 'err 6,8 e;1 1 1 _ r' mc _ '-___-- _-_ —_----_'---- —_-------_'_—__� r _________-------'-----.- ^^S x� * / .tl ! � — \ / I 1 1 � 111 } » � �� � LIA ! I 'ti � 1'^~ � "i ! •• � *^ i ` Pi � . � | � Pl. . Q | li k 11 2 ` ` < . —\�^ / ' U�' { ,.X } R. I . -^ 1_,...: --I., ..t.: ft; /•/ / k ga � . ' | } .x. \ • il - [7l; i g ri i . .i - \.. 1 lit i ] i ,•:‹E.,,,,z\i ) -.. ._.:1-,..1. -,..,•-- __,..:?.7'7:,, '"'"''--—- . -1'FI, - ::..... .._"-IS:,_....‘ -I „ Ill . i „ ' „' 3. II'72:7.,F .17--'7.-44:11:.LIT: l'.:::,,..,):--.."---,. - : I ^ L • illti" , • - /-.,,..,L. .,ti„.,.....;1 \ r.: . fiq . 0 . ..1 4.• i I .1/*>•:t4....„' 1 \ ....L; ...." 1,..: h. �_` ` 3—~ -' z1. = i , I z iF.r] E.:747.1 I .11-7Ti r.71 171-L-111 a \i': . / ,r, --. I---.----1 -___.i.. ' , ' 1 _----�— —' ' ' ' ���i.-_�' ~— ��� � 777-7-1 -,- . r"Tnr1-1-177 IV-- Ill.....1'.77 \\!-N-1 1 • • -~~'/ | -`` 1 r —_— � q� !' � � , | -4.. ]_ N`~_1':._‘_-- 1^_1...- -!..~_'� _______________, _ -._____________~__ -______ -__ '�_—_______-_�___'—___� � � ' • �\/ : -' ..� ^ 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 1. GENERAL INFORMATION Complete legal description Lot 4; Block I; M~adow Ridge Estates Location (site address or directions) 21030 M6adow Lake Drive Property owner Mailing address P~z C~k. AK C/'0 REAL ESTATE SUPPORT Greg Garr~tt/ SVC. Attn~ Ro44 Day phone 8200 Humboldt Ave. S. Minneapolis, MN 55431 Lending agency Mailing address Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 = TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX NOTE: Public sewer - ,', If community well system, provide written confirmation from State ADEC attest- Holding tank' If community wastewater system, provide written confirmation from State attesting to the legality and status of system: .... , ~ . . 72~325 (Rev. 1/91) Front MOA~I 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. _¢ ~¢. $ ¢./v¢lN~.¢,4¢,v¢- Phone Name of Firm Address )703¢ ¢/~L~ ~/v¢.,4_ ~-¢oP ,~/:). ,,~r)-o¥,, Engineer's signature ~ ~. '"~---- '..- Date DHHS SIGNATURE X' Approved for -'~ Disapproved. Conditional approval for bedrooms. CF' - 8301 ,,",:~/,-/ bedrooms, with the following stipulations: Additional Comments , , · t . .c . ! , *~ ,The Mume~pahty p~.~nchorage Department of Health and Human Services (DHHS) issues Health Authority ";.~Approval ~ertific~a(~ based only upon the representations given in paragraph 5 above by an independent "-~' '~pru~ess,u, rml' ' ' ....... eng' ~'i~er're. g istered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes. ar~8'the'i~: i~nding i&stitutions in order to satisfy certain federal and state requirements. Employees of DHHS do no[ 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, I/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) ¢"t~ o,L/ Parcel I.D. ¢-, ~ ~ ¢--~'r If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Total depth Sanitary seal (Y/N) Cased to Casing height FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot -~o ,- Wires properly protected (Y/N) g.p.m, g.p.m. nt lots J ; On adjacent lots Public sewer manhole/cleanout Absorption field on lot %-,, o Public sewer main Sewer service line WATER SAMPLE Coliform ~ Dat~of sample: Petroleum tank Nitrate Other bacteria Collected by: B. SEPTIC/I"J6[--DE, t6 TANK DATA Date installed Cleanouts(~N) High water alarm (Y:~ Date of pumping Tank size /,¢ o~ Compartments ~-- Foundation cleanout (Y/~ /~ Depression.(Y/l~P .,..-( Alarm tested (Y/N) ~/A //- 'O, -? z/ Pumper ..~---~. SEPARATION DISTANCES FROM SEPTIC/PtETEBIN6 TANK TO: Well(s) on lot /' On adjacent lots To property line / ~ ~ 'P- Absorption field /-/~ Sudace water/drainage, / ~ ~ Foundation "' Water main/service line 1o 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "~el at High water alarm level Meets MOA electdca~ ANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 4-/.2 - ~ Z Length /7/7 "?'-;pz",4-g Width Total absorption area ~' 5'-9 / Date of adequacy test //' / ~ ~ ~ t Water level in absorption field before test Peroxide treatment (past 12 months) (Y~ Soil rating (GPD/FF) Gravel thickness Cleanout present.~/N) Result~fail) / ~'-~ ~//~ System type 7" Total depth /.c-- Depression over field (Y~ for ..~ Bedrooms After test ~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ^~1/~/ To building foundation / On adjacent lots ~o ~ ~- /-/- Surface water /z~ ¢ Curtain drain "//~ E. ENGINEER'S CERTIFICATION On adjacent lots 7-o~ ' -k Property line ¢ ~ / ,.,'/.~. To ex)sting or abandoned system on lot '"[/.4 Water main/service line Cutbank Driveway, parking/vehicle storage area I certify that l have checked, verified, or conformed to all MOA and HAA guidelin~":)~' effect on of this inspection. Signature L ~ Engineers Name /~0 ~4,,LF- (~. ~'O~A~ Date h /~ ~ / c~ HAA Fee $ ,:-~ · r_JE~ Date of Payment Receipt Number 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number APPLI( NT FILLS OUT UPPER HA[ ONLY Property Owner /:~ [_.t:~y]/( L~/~_i'-(-' .t> L.J ' ~+. ~ L ~ ..... / ~/-~..I ? ~:;¢~'I Phone Buyer j~,:~,' (':,'~//';: ( F ,, i:],L~.: /. ~,,;, ~/ )' Address '~{ ~(~ .~"]'~'~: /¢~*/>::~" . ;~,? ,:;;,/¢' ¢. < ¢2 ,~);:,z/ ZipCode ': ' Phone Lending Institution / ~ /i~// / F 4 *~, Address Zip Code Phone Realty Co. & Agent 7~27c:;~'~? /:~.:::/7~.-/ O~ ~ddress (/~. p . /.~;:);~, ,¢ // ~;-;;,/:~:/ (. /./(/:.,/. /)/_. Zip Code Legal Description Z-'~.)~" ¢4~. / / Street Locati~ ~ ///t ) /~l,:~q ~,:)/2 ) .~: /:1 //z~ , ?:~[ ~ Type of Residence Single Family Mulliple Family No. of Bedrooms~¢~) ~ Other Water Supply r; ~ Individual . ¢~, ¢;~ ,¢~ ¢.,~ A~ACH WELL LOG. A well Icg is required for all wells drilled since June 1975. Communily For wells drilled prior to thai date, give well depth (attach Icg if available), Public Utility Sewer Disposal ~lndividual Year Individual Installed: ~ ~' ('tF)? :2 ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Oate....'-~. _ . ..~j'/ ~ / Inspector Inspector Inspector Insp~tor Field Notes: ¢:L 0 e MUNICIPALITY OF ANCHORAGE * ~, DEPt. OF t4Ef'.LTH & ENVIRONM2NTAL PROTECTION ¢ E, MAY I '7 .RECEIVED ( ) DISAPPROVED Soils Rating Date ~wer Inslalled Well To ~sorption Area Well Log Received ~/~> Well to Tank Septic T~k Size ~ 72-023