HomeMy WebLinkAboutMEADOW RIDGE ESTATES BLK 1 LT 6Meadow Ridge
Estates
Bloc,k 1
Lot 6
#051-461-08
Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181369 PID Number: 051-461-08Cf�6Z4#� '
p
Dwelling: ® Single Family (SF) El Duplex (D) El Multiple (SF and/or D) Project: E] New Upg e
Name:
BRANDON NICHOLAS BUSH
ABSORPTION FIELD - EXISTING
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
20948 MEADOW LAKE DRIVE, CHUGIAK
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
-- GPD/SF
-- Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
-- Ft.
Gravel depth beneath pipe
-- Ft.
Subdivision Block Lot
MEADOW RIDGE ESTATES 1 6
Fill added above original grade
-- Ft.
Gravel length
-- Ft.
Township Range Section
Gravel width
-- Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
-- Ft2
--
Ft.
Well
200'+
--
__
__
__
TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
ANCHORAGE TANK
Capacity
1 1000 Gal.
Surface Water
100'+
--
--
__
Material
STEEL
Number of compartments
2
Lot Line
10'+
__
__
__
NA
Foundation
5'+
__
__
__
LIFT STATION
Manufacturer
Capacity
Curtain Drain
NA
--
NA
--
-----------------
Gal.
RemarksExisting septic tank decommissioned
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
per code. New tank placed in same location
& connected to system. Deep -Burial Tank.
Pump make and model
Electrical Inspections performed by
Tank to
PIPE MATERIAL House to tank D3034 D3034
Installer ,f RS
drainfield
Drainfield -- CO/MT D3034
Inspector ARCTERRA
BENCHMARK (Assumed elevation) 100 ft
Inspection 1" 10/19/18 10/24/18
Location and description
god
3rd 4 th 113ottom
of Siding
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
,,�,,,�►`'��
..s�
Conditional Approval: Date
9 TH
KENNEM S, 10(
'
. CE 116
AWr
Approved°lA (�V(
,®�.••R.
Date 1 05 ao1$
Inspection Report ST copy 3.doc
s
D3
AS—BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP181369
MEADOW RIDGE ESTATES BLOCK 1, LOT 6 PID# 051-461-08
' NA
R OVED & REPLACED TUBES
1 00—GAL S.T. IN (TYP)
AME LOC. TO MAINT. yy
M
5'+ TO FIELD/FOUND. O
103"
IV. B
co 3—BR
)T 6
OCK 1
m
i;
w A -C=15.9'
B -C=13.9'
o
.3 A -D=13.8'
O
B -D=21.2'
Qf
a
A
D3
m
i
� VF
�o
10,
UTILITY
EASEMENT
000—GAL TO EXISTING FIELDS
SEPTIC
PREPARED FOR:
Brandon & Haylea Bush
20948 Meadow Lake Drive
Chuglak, AK 99567
FIELD BOOKS
BOUNDARY: N /A
STAKING: NSTAKINC: N /A
AMUiLr. RJF
DWG FILE:
ACAD FILE` FILE
COMPUTED:
DRAW BMW
CHECKED: KMD
DATE 10/24/18
GRID: NW1362
roe Na: 18191
\s�
SCALE, 1' = 30'
SCALES NTS
Municipality of Anchorage
P.O. Box 196650 0 4700 Elmore Road
Anchorage, Alaska 99519-6650 a (907) 343-7904 0 Fax (907) 343-7997
hftp://www.muni.org/Onsite
DevelqnM.2������
On -Site Water and Wastewater Section
11 jn,!�q 1�1� 10 0 1
"i % to
W I M 0 i
Waiver#: OSV181091 COSA#: Permit#: OSPI81369
PID#: 051-461-08
Legal Description: Meadow Ridge Estates Block I Lot 6
Engineer: ArcTerra
Applicant: Brandon Bush
Your request for a waiver of the required 10 feet horizontal separation from the septic tank to the
building foundation has been approved. The approved separation distance is 5.0 feet. See
engineer's waiver request for justification.
This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site
wastewater disposal system will require all separation distances be met or another approval from
this department.
a 2 a 2 a a a a M a a a a B a® a a 0 ff 2 a R a a a n a a a a a a a a a U a a M M M a a a a 0 a a 2 a Z a X 0 a a a 2 N 0 a a a a a a 0 0 n a 2 a M a a a U I
Waiver is Granted: X
Waiver is not Granted:
Date: If/05 1/9018 Approved by: ",CJ4 d,0&
Name of Reviewer
a a 2 2 M M a a 0 0 a U a a a a a a a a 0 a a Z a a X 2 2 a a a a a M M M a a a 2 1
L �F JE y
ti s
cif CO `�G 9 l
gryFNSULTI NG sul
N A'. 99519-�
October 24, 2018
AP.cTr,,RRA
CONSULTING, INC
212 E. 515' Ave, Anchorage, AK. 99503
Office (907) 868-3791, Fax (907) 868-3793
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Septic Tank Upgrade Permit — Meadow Ridge Estates B1, L6
Os\J 11810 1
12�cs 02 5 21 t
Due to site constraints (fields and foundation) and per permit provision — the
new tank was installed in order to maintain 5'+ to both the field and the
foundation. Backfilled soils were compacted and the previous tank had no
known issues for 35 years. We respectfully request a waiver of 5' to septic tank
and foundation. If you have any questions, please contact me at 868-3792 / FAX
868-3793.
Respectfully submitted,
ArcTerra Consulting, Inc.
Kenneth M. D fus
Attachments: On -Site Sewer Inspection Report
20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793
0„op""T,oF MUNICIPALITY OF ANCHORAGE mens
r ' On-Site Water&Wastewater Program N0 `se
• r
-1 ,.� PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
"R http://www.muni.org/onsite
epartment
4NCHOP P'E
On-Site Wastewater Disposal System Permit
Permit Number: OSP181369 Effective Date: 10/15/2018
Work Type: SepticTank Upgrade Expiration Date: 10/15/2019
Tax Code Number: 05146108000
Site Legal Address: MEADOW RIDGE ESTATES BLK 1 LT 6 G:1362
Site Mailing Address: 20948 MEADOW LAKE DR, Chugiak
Owner: BUSH BRANDON NICHOLAS & Lot Size in Sq Ft: 28696
Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field Q 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
Special Provisions: If tank cannot be located outside the soil bearing prism of the foundation, a waiver will be
required.
Received By: Date:
Issued By: � / ,G'{'�
6.71.reiti Date: /Off/
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D.
051-461-08
BRANDON & HAYLEA BUSH 727-6291
Property owner(s) Day phone
Mailing address
20948 MEADOW LAKE DRIVE, CHUGIAK, AK 99567
Site address 20948 MEADOW LAKE DRIVE, CHUGIAK, AK 99567
Legal description (Sub'd., Block & Lot) MEADOW RIDGE ESTATES B1 , L6
Legal description (Township, Range & Section)
Lot Size 28696 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field Initial n Single Family (SF)
(w/wo ADU)
Septic Tank 1>1 Upgrade I>I Duplex (D)
Holding Tank I I Renewal
Multiple Dwellings
Privy I I (SF and/or D)
Private Well
Water Storage n
THIS APPLICATION INCLUDES A VARIANCE 1 WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signatu pr7.-rty owner or authorized agent)
Permit/Rush Fees: ZI S. op Waiver Fees:
Date of Payment: 1010-110 Date of Payment:
Receipt Number: O31B4O Receipt Number:
Permit No. DC p Waiver No.
Permit App_9-1-12.doc
�RCTE RRq
ARC T ERRA
CONSUL'T`ING, INC
'.� % 1 j 212 E.51st Ave,Anchorage,AK.99503
'w Office(907)868-3791, Fax(907)868-3793
„
fq��SU.T7 NG• se
R, Y.90577-Rr
October 11,2018
Municipality of Anchorage
Development Services Department
On-Site Water& Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Septic Tank Upgrade Permit-Meadow Ridge Estates B1, L6
The owner has requested we proceed forward to obtain a septic permit to
upgrade the failed septic tank on the subject lot. The proposed upgrade will
serve the existing 3-bedroom house. Due to elevations, surface water and only
having 16' between the foundation and the existing absorption fields, we
propose to removing the existing septic tank and reinstalling the new one in the
same place in order to maintain 5'+ to both the field and the foundation. The
existing data shows good, stable, compactable soils and reinstalling the tank in
the same location should not impact foundation stability. The existing septic
tank has existed for 35 years with no known issues.
The adjacent lots are served by public water as noted on the design. There is no
surface water within 100' of the proposed tank. We do not expect there to be any
adverse effect on adjacent lots by the development of this tank. If you have any
questions,please contact me at 868-3792 / FAX 868-3793.
Respectfully submitted,
ArcTerra Consulting, Inc.
Kenneth M. Duffus •
Attachments: On-Site Sewer Application
Wastewater Absorption System Details/Site Plan
20441 PTARMIGAN BLVD • EAGLE RIVER,AK 99577-8736 • PH(907)868-3791 • FAX(907)868-3793
WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLAN
MEADOW RIDGE ESTATES BLOCK 1, LOT 6
/
LOT 5
cr
FAI
• •...moi o . I A
TUBES
aREMOVE & REPLACE (TYP)
�<v 1000—GAL S.T. IN PED
fit., SAME PLACE MAINT.
4/Nr 5'+ TO FIELD/FOU ''911- '
•
4,0 co
ryp Co 3—BR
LOT 6 I
BLOCK 1 �"sST.ADD DBI-
• G,pgIt 'y�
c e ° A"
Fo ti 10' R
P UTILITY ♦ O
cr EASEMENT �Q"
0
��" ��'
co ct,
co LOT7 <0
0
J
`vC Scale: 1'— 50'
co
/ PAGE 1 ❑F 2
o FLAG PROPERTY LINES
W WELL RADII & EASEMENTS
PRIOR TO CONSTRUCTION
•c
0
0
a
DESIGN DETAILS
NO PUBLIC WELLS WITHIN 200' OF
o PROPOSED SYSTEM.
0' NO PRIVATE WELLS WITHIN 200' IF
. PROPOSED SYSTEM EXCEPT AS NOTED. 1. INSTALL 1000 GAL & INSULATE TANK IF <4' COVER.
>, 200' O
PROPOSED WELLEMS EXCEPTHIN AS NOTED. 2. MAINTAIN 5'+ TO FOUNDATION AND EXISTING FIELDS.
3. CONTRACTOR WILL ENSURE MINIMUM 27. SLOPE INT❑ SEPTIC TANK.
4. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
I WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC...
C.)
0.
w 40160.
,6 OF AL\
/���. - - 4 t PREPARED FORI CTE Q
3 / .. . 1 Brandon & Haylea Bush AR ,IliC ,o • • 1 ` 7 20948 Meadow Lake Drive ;401,(1
� °��,0 * :L� TH . * Chuglak, AK 99567
2 / 0.1111,47
KE D T FS FFIELD BOOKS COMPUTED: ca Of ' <o ` �� / BOUNDARY:N/ADRANRi: BMWZ �I \
CE-71,6
1 �' '' ti' Af STAKING: N/A CHECKED: K M D l �'1 n°j
•/ 8� ' ASBUILT: RJF DATE: 1011 X18 ,�••...-'. 0�o �l\`\_� DWG. FILE GRID: NW1362 G4'/ OL T I G \�G�ao��
ACRD FILE`FILE 'Moe No.: 18191 f'' AK.99577-v-
WASTEWATER DISP❑SAL SYSTEM DETAILS
MEADOW RIDGE ESTATES BLOCK 1, LOT 6
LOT 5
»..,r
<� : a A
3
TUBES
/
REMOVE & REPLACE (TYP)
4<v/ 1000—GAL S.T. IN
..,-
<c, SAME PLACE MAINT. O\ •
5'+ TO FIELD/FOU ? 0 wP�R 0,<<, oX•
vac.
70,3,* �, 'Q- ; •
1, • PppR
<<, 1I0
•
�� �• co FCO 2
co .: 3—BR s
1/
0
LOT 6
F ADD DBL. COS C
BLOCK 1 �<5> & DIVER TER • �,9�j
Y 4,c F< o
,*
FO10'
,0
�"
UTILITY (4--/
EASEMENT ��
0
FLAG PROPERTY 1 : ► 40
2 WELL RADII & EASEMENTS
I
PRI❑R TO CONSTRUCTION Scale: 1'= 30'
N ��_\\ PAGE 2 OF 2
�� oy `1'6,,f. PREPARED FOR: CTE
LI , 1 Brandon & Haylea Bush ti AR RRA
o „ai/07 �)� 7 20948 Meadow Lake Drive �o 1 ���
8 * •4• TH /\ * + Chuglak, AK 99567
(‹)
/ • � � 0, I z' 14 \ 1
I • .� D i v .' • I FIELD BOOKS CDI�IPUTED: ;
t / CE-711: . Alwa BOUNDARY:N/A DRAWN: BMW a"� .l
o '� Al STAKING CHECKED: a
1 /o/N/!g- •
• •� N/A KMD % \ ,:1111k / �'1�
/ AS JILT: RJF DATE 1 0/1 1/18 ••••�F-• A 6e'
p�n,,` Ay
I
\\_ ESSIO�= D . FILE GRID: NW1 362 \. O NG oi;
o .. 0
`_ ACRD FILE FILE •Ge No.: 18191 R/SFR AK.99577'$��
Municipality of Anchorage Page I of a
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SWgSootoa PIDNumber: 051W(o)08
Name:
'BILL
Wastewater System: ❑ New 0 Upgrade
AS
Address: AhICHb2Aret� F�iC.
x.0.3®x
ABSORPTION FIELD
Phone:
� gam- WbS a
No. of Bedrooms:
3
.Deep Trench ❑Shallow Trench []Bed ❑Mound ❑Other
DESCRIPTION
Soil Rating:
Total Depth from original rade
^
8 GPD/Sq. Ft
LEGAL
Lot: Block: Subdivision: _ -
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
to 1 1
q Ft.
3• ip Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
--�
1,
. 7 Ft.
�,' Ft.
Gravel width:
Number f lines:
Distance between lin
WELL: ❑ New ❑ up gra
5 Ft.
I
Ft.
Classification (Private, A,B,C):
Total lh:
Cased To:
Total absorption area:
Pipe material: AS-r"
CLASS A
Ft.
Ft.
�- 6 S SO. Ft.
�: 91 U D3039
Driller:
Date Drilled:
Static Water Level:
Installer: -Pt JQZ1j X
Date installed:
�^ qS
Ft.
Yield:
Pump Set at:
I
Casing Height Above Ground:
�c'X!S-rlKj TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
❑ Septic ❑ Holding S.T. E. P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
Material:
Number of Compartments
Well:
Surface
,
'
--
LIFT STATION
i0q
io I
—
LotI
I
I
Size in gallons:
Manufacturer:
Line
3b
Foundation
I
to
_—
,.
___-
"Pump on" level at:
"Pump off' at:
High water alarm at:
(o
I
Curtain
�
Pump Make&Mod ectrical Inspections performed by:
Drain
S-40
C
BENCH MARK
Remarks:
Location and Description:
or- FU�N pATION i1'r
n u
CUtQUI�`f2 A
Assumed Elevation:
W•U
E"It EAL
c� 'd
kN
\
1(;
;tc; E:iviar Loop R®Det No. 204
l�°"'•;' ,
t7J
r, a.3 ttIVBYr tol ii5iC8 ��JO�
5����i5
Inspections performed by: 1 Dates: st �
2nd s'a`gs
-.��� • _ .•�'��.z.�.�,�!r'�r
1,02ERT C. COWAN
f
Cr: -88 st'
Department of Heal and Human Services approval
Reviewed and approved by: Dater
72-013 (Rev. 9/91) MOA 25
Fermit No.
SW950062
Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
LOT 6, DLOCK 1, MEADOW RIDGE EST. 051 46108
Legal Description: PID No.:
EXISTING 1000 -
GAL. TANK
VERIFIED 5-0-95
94.7';
co
7J' BE
SR 90.0'
86.4'
A 80.7' NO WATER FOUND
13
A
FCO
24'
3:0'
C01
21'
34'
CO2
20'
39'
CO3
20'
41 '
NEW; TRENCH C04
20'
42'
G05
70'
2.5'
G06_
22'
501
MT1 MT1 69'
I DIVERTER INSTALLED
72-013 A (1/93) `
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW950062
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:BYAS WILLIAM E & PENSRI
OWNER ADDRESS:20948 MEADOW LAKE DR
CHUGIAK, AK 99567
PARCEL ID:05146108
LEGAL DESCRIPTION:
MEADOW RIDGE ESTATES BLK 1 LT 6
LOT SIZE: 28696 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
o SYS
c�ED
DATE ISSUED: 4/27/95
EXPIRATION DATE: 4/27/96
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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PR
RECEIVED B
ISSUED BY:
DATE:
DATE:
s&s\
�in��nrnG
HEALTH AUTHORITY
APPROVALS
Apr%e. 20, 1995
ROBERTC. COWAN, P.E.
ROBERT A. SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCHORAGE
Department o6 Hea?.th and Human SeAv.ices
P.O. Box 196650
SEWER &WATER
Anchorage, AK 99519
MAIN EXTENSIONS
REFERENCE: Lot 6; Btock 1; Meadow Ridge Ebtatu
SEWER&WATER
Request you dsbue a perm.ct to upgaade the septic Ay6tem beAv.ing
the.I,
INSPECTION
hue bedreoom house on the 4ebeaeneed ptopekty.
A test hote was excavated and a pehcotation test pmJormed .in the
area
o6 the proposed upgrade. The approximate tocati.on o6 the test hate
is
ENGINEERING STUDIES
tocated on the attached site p tan.
AND REPORTSORTS
At the time ob excavation no water was encountered and aater seven
day
ground waters monitoring, the. mon.ito)Ling tube. way Uound to be dry.
WELL INSPECTION
& FLOW TEST
Attached is the proposed upgrade dez ign.
Th,ib propehty i,5 benved by a Community Water. Sy6tem. There ane no
protective we,2 radii which encroach upon the, property.
SITE PLANS
Ib you requ,i.re additionat in�ormat.ion, ptease contact u6.
S.ineere,e y,
ROAD DESIGN
2/, ��
O Z
n
SOILTEST
Robert C. Cowan, P.E. ti
r
N c
RCC/gk
Encto,sure d
y
PERCOLATION
TEST
z
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
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Municipality of Anchorage ; t
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650vo;
SOILS LOG - PERCOLATION TEST
-
�� •, ,_ aOeeeT C. rOWAN c'«
PERFORMED FOR: \I, S DATE PERFO�4( - � "^ I �• � J _
LEGAL DESCRIPTION: `—'T 'k�5L_V- tAtjV,,•,) Township, Range, Section:
T ,' b � ,p 0 SLOPE SITE PLAN
,tea. 1 Fir TT ------ I I—�
1
2 /
3 /
4
�Ji10 5 v
C0 6
7
o'
9
v
10
15
16-
17
1s
19
20
COMMENTS
WAS GROUND WATER
ENCOUNTERED? f1c>I S
IF YES, AT WHAT L
DEPTH? p
E
Depth t Water Aller ,I
Manilo�yIt 7 '9"0
ale:
ILLI]
Reading
Date Gross Net
Time Time
Depth to Net
Water Drop
P(�F oz,
LS lu rt,J
3
zS
t.1
— I°I
N
PERCOLATION RATE ' (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND L-0 FT
PERFORMED BY: 's � S �rl�rl,�� .,�a I yl�jwwtk> STAN -V;61 CERTIFY THA�Ty THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
s&S�
Jineekinq
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER, P.E.
ON-SITE WASTEWATER DISPOSAL SYSTEM CIVILENGINEERS
CONSTRUCTION PRACTICES (907) 694-2979
and FAX (907) 694-1211
MATERIAL SPECIFICATIONS
HEALTH AUTHORITY
APPROVALS
REFERENCE: Lot G; Block 1; Meadow Ridge Estates
GENERAL:
SEWER & WATER
MAIN EXTENSIONS
1. The scope ob tk s project includes the. .instaUati.on og a Give
boot wide d4a.in4.ietd to serve the existing thne.e be.dnoom
aes.idence on the, nebenenced pkopenty. The, ex.i,5ting septic tank.
SEWERBWATER
,is to be excavated to ve.hi. y .integ) ity. 16 o� poor integiL ty,
INSPECTION
.the, tank is to be pumped, cAushed and abandoned and a new 1000
ga.Uon septic tank .instaUed. The existing system .is to be
abandoned such that it may be used .in the 6utuhe..
ENGINEERING STUDIES
2. ConstAuct.on shall be .in accordance with :the approved site. plan
AND REPORTS
and dezign dnaw.ings, Muni.c,ipat peAm t with any special
pnav" ions on conditions, and a t appP.icable State and
Munici.pa2 Wastewater. Disposal Regutations.
WELL INSPECTION
3. The, contnacton shall be xes ons.ibte on obtaining an necessan
p � 9 y y
aELowTEsr
undengnound utitity locales.
4. Unless speciiccatty agreed othenw.ise, the pn.opeaty owne.n shall
be n.e.spons.ible, bon b.inat grading areas subsequently depressed
SITE P -ANS
bn.om soil senting. On all teaeh6ie ld mound systems, the
pnopetty owner shall be responsible 6ok ensu ing a sat zs actoky
vegetation growth oven. the mounded area.
ROADDESIGN
5. Contn.actou instal Ping wastewater, disposal systems must be
eejLtibied by the Municipal He.atth Department dor. system
instaPlat.ions. Owners instal ing their, own systems must also
nece i.ve pk on approval 4n,om the Muni.cipat Health Department.
SOILTEST
SEPTIC TANK INSTALLATION:
PERCTEST OLATION
1. A septic tank is to be co"Ptucted by a ceAti6ied septic tank
manugactuneh. Constnuetion shall .include, two 4" cteanout6 bon
pumping access.
2. The septic tank shaU be. su46ici.ently bedded to pnevenat
STRUCTURAL&
MECHANICAL
settling ot sh.i6ti.ng ob the tank.
INSPECTIONS
3. All standpipes on the septic tank shaU extend a minimum o6 12
.inches above 6inal ghade.
ON SITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
Page Two
Lot G; Btoeh 1; Meadow Ridge. Estates
4. Septic tanks ,instaUed with tens than 4' o4 cover shatt be insutate.d.
5. A 4oundation cte.anout shatt be .instaUed one to 4oun fleet 4rom the.
building 4oundat.ion. In the .eine between the tank and .the te.ach4.ie2d
there shaU be two adjacent cteanoutrs (untms an e44eue.nt pumping system
exists within the septic tank) . Theee cteanouts shaU be, tocated on
und.istunbed soil not mane. than 10' 4nom the tank. The 4.inst cleanout,
.in tine, shat be to clean toward the teach4ield. The. second cte.anout
shall be. to clean towan.d the septic tank.
G. F.inat gnarling oven, the septic tank shall be. such that a positive slope
exists away 4nom the septic tank.
ABSORPTION TRENCH/DRAINEIELD INSTALLATION:
1. Excavate the. pcopose.d trench to the, dimensions shown on .the design. The
bottom o4 the excavation shall be within 2 .inches o4 tevet. 14 the.
sidewa-z 04 the excavation become smeared, they must be naked on
scAatched (roughed -up) be4one. gravel (sewer rock) ptaeeme.nt.
2. Once .the gnavet .is .insta.11e.d, .the. distkibuti.on pipe is to be. ,installed
level with the pe.n4onatCoa 4aced downward. Gravel .is then to be placed
oven the. distnt.bution pipe to pnov.Lde a minimum o4 2 inches o4 coven
oven the pipe.
3. A silt barni.eA must be, iataUed between .the 4i.nat gravel layeA and the
native soil back6i..11. Ensure the silt banr.CeA covens the entire gravel
suA4ace be4one placing back6iU.
4. Monitan tubes shall be o4 4oun (4) .inch d.iameten and i.nsta.11ed
approximately ,in the locations shown on the, dezi.gn. The, portion o4 the
monitaning tube extending through the gravet sh.aP,2 be. pen4onated 4rom
the bottom o4 the trench to the invent o4 the distribution pipe. This
is e.quivatent to the e44ective depth o4 the gravel as noted on the
design.
5. Bacfz4i oven the flint gnavet .layer must not be. .fuss than twenty-4oun
(24) .inches. Insulation must be instaUe.d when the. back4itt depth is
.less than thirty-six (36) inches. The 4inish grade over the tAench must
be mounded to prevent the. 4onmati.on o4 a depression a4teA settting.
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed 4or insta.11ati.on must be constructed by a
Municipally approved septic tank manu4actureA.
Page, Three.
Lot G; Block 1; Meadow Ridge Estates
2. The 4ottow,ing pipe mate.ki.aTA ane approved bon use in septic system
.ivwta tations .in .the Mun.ici,pa2i.ty o4 Anchorage:
Type o4 Pipe
Per4orated
So.Pid
Cast
lron
yeas
Yes
ASTM
D3034
( PVC)
veers
veers
ASTM
F810
(HDPE)
yes
No
ASTM
D2662
(ABS)
Ve's
vez
use o4 a type o4 pipe othex than tilted above must be, approved by the
i"perting engineer.
3. luulation shatt be at least 2" .thick ex.tAude.d direct burial potystynune
(Dow Chem.ica2 Company Sty)to4oam Hl or equal).
4. Septic tank inlets and owlets shalt be bitted with wateAtfi.ght couplings
(Caulden, Fe)Lnco, or equal).
5. A permeable, nontoxic sitt barrie.r (Typar 3401, Mlra4.i 140/N, or equal)
must be instalte.d between ,the. 6 inaP leach4ield gravel layer and the
native. so,it back6 lt.
G. Alt leach4.ield gravel (seweh rock) shall be 0.5"-2.5" sciLeene.d gravel
with le.s than 3% passing the. 0200 sieve.
7. when sand is being used as a 4.%lte.r materia2, ,its gradation
speci6icati.om must con4ow .to current M.O.A. or D.E.C. xe.qu,inements.
INSPECTIONS:
Typically there wilt be. a minimum o4 three (3) .inspections required dutring .the
.ins.tatlation o4 the. wastematen disposat system. These inspections w.iIt occur as
40 Mows :
1. The 4.Lrst .i"pect-i.on must be, conducted a4teh the excavation o4 d.iteha,
pits, tbcenches, or beds and be4ore the .instaltat%on o4 any gravel. A
septic tank may be sett .in place, but may not be back4iUed be4one.this
.int pectio n.
2. The second inspection mush be, conducted a4ter .the placement o4 .the s tt
barnteh, gravel, dis-tAibuti.on .Pine%, standp.ipa, cteanouts, and
.insu.eati.on, but be.4ore..the. placement o4 any other bacfz4iU.
Page Four,
Lot G; Mock 1; Meadow Ridge Estate.
3. The. 4inat inspection is to occu.,% upon bina2 grading oU the. pnopenty.
O{ten there w.iU be move. ,than .these 3 i"peetions ne.qu,ixed, e�spe.ciauy with the
.insxattation oU mutti.pke ta.enehe.s, hand b,(Uens, pnessukized d.ist)tibuti.on
systems, etc. Thus, the inspecting engineeA is to be, contacted at least 24
hours prion to .the start ob constnuetion. IU neeessajty, a pre-co"tnucti.on
meeting witk take ptace. on-site. The inspecting engineeA w.i P.2 not coondLnate,
din.e.et on contn.o2 .in any way the contnacton's activities.
The owner shaU contract with the contnaeto)t to penUonm the. worth outlined .in
these, spec,i4icat-i.ons and plans and .in accordance with the attached M.U.A.
petunit. There wiU be no contnaetuat arrangement existing between the,
contnacton. and S & S Eng.ine.er..ing. S & S Eng.ineehi.ng shatt be the owner's
nepnese.ntative and w.itt inspect the wokk as stated above to document the
contnacion',s aetivitiez. F.inat acceptance o4 the contractor's worth, rests with
the owneA and the M.U.A.
S & S Engineening shat have no tiab,i 2 i ty to the ownek ok to otheas 4o2 acts ot
omissions o4 the contnaatok on any other peAsons per.Uorming wonfz on this pnojeet
on the {aitune o4 the contnacton to canny out the, worth .in accordance with these
constaucti.on documents. S & S Engineen-ing's inspecting engineeA witt not be.
nesponsibte. {ion .the construction means, methods, techniques, sequence,
procedures or the sabe.ty pnecauti.orus incident to thi.5 project.
CONTRACTOR/INSTALLER
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
NAME ®
PHONE
XNEW
-% CA r 6 0 5 / 'y' r^ Lc:-I_b
G J�S"✓ `f ,�
❑ UPGRADE
MAILING ADDRESS
00 AK c/ q.5- 7?
LEGAL DESCRIPTION
jf
F '
LOCATION
'to-
NO. NO. OF BEDROOMS
/1e,61 dv Q e;✓_ rs 6 reek
DISTANCE TO:
Well
Absorption area
Dwellin�C
/0 • /
PERMIT NO.
U�
7V
c, ,
`14 ,,
1= Z
Manufacturer qq
Material
No. of compartments
.
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
7 1
DISTANCE TO:
Well
Dwelling
PERMIT NO.
JOE
O Q
Manufacturer
Material
Liquid capacity in gallons
DISTANCE TO:
Well
Found tion •
Nearest lot line t
%
PER fIT NO.
w
�.
L�L% f,.,, .
u z
No. of lines
Length of each line
Total length of lines
width ,
Distance between lines _
'
h Z
—�
_ 42,
� b iaekes
3
Q h
Top of tile to finish grade f
��
Material beneath the
�GJ
Total effective absorption area
"'�•�'
p
I`r
inches
6- �?
Length
Width
Depth
PERMIT N0.
w
C7
Q H
Type of crib
Crib diameter
Crib depth
Total effective absorption area
a�
W
N
DISTANCE TO:
Well
Building foundation
Nearest lot line
Class
Depth
Driller
Distance to lot line
PERMIT NO.
W
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
tl
&V
4a
k
L -i
e__
/ ��v
SOIL TEST RATING
INSTALLERR�
1
�t e.6 G V C� v G1 I t cl
REMARKS
1
1'
t>
✓h
li '9 ei. ACL G'C'm e, PeriYi
1
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ow
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,FR pROFES510)aP/�
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
������������
.... q-�
D[-POR1T[3TT
Of-
||[RLT|| MD MN4IWON1-E%TAL MID TMIOV
825 /L'
STRE[T/ fl, NCHORH8E/ O|( 99501
264-4720
1NI'D HORR]:."i� 69421�i � [R�LE �IYE�
CUM—
Ss 1: 7077
ST KI: 9- � F�*E, 11 its Imi m L.. n F, in m i wi x ... ir,
PERMIT NO. O��056
8P�LIC8��T�
C[OL8R CONSTR
PHOPAE�
HDDRESS� BOX
1]02
EHGLE
RIVER, RK
99567
LEG8L DESCRIPTION
~ SU8DIV�SlON�
MEHD�W RIDGE �ST BLOCK� � LOTIS.
LOT
TOWN,7:HIP� � RRNGESECTION� ~
MHXIMUM NUM8ER OF
BEDROOMS �
] SOIL ROTI�G � 188 188 1O8 (SQFT/�R)
LISTED ICT-LOWFIRETHE
OPTIONS
OVRILR8LE TO YOU IN DESIGNING YOUR SEPTIC
SYST[MC||ODS[
-F 11 WTION THRT
BEST FITS YOUR SITE.
WIDTH
�
T.
420 FT
LENGTH
TOTRL D[PTH �
50 FT.
GRHVEL DEPTH
��HVEL VOLUME �
]2O CUYDS
T17,111K
ONS (TWO COMIRTMENT T8NK)
!i.-I! 1: Il"Z:: I;'
���
C:::- �Q rr .1
WIDTH
FT.
LENMTH
FT.
! 1'.1OTE ! - }75 FTR�QUIRES T�O TRENCH��
TOTHL DEPTH
GRHVEL DEPTH �
�0 FT
GR3VEL VOLUME �
TRNK SIZE �
275 CUYDS
1/0Q0.0 �..:iRLLONS
(TWO COMPRRTMENT TRN|()
. ..... .... .. ��
I CERTI�Y T||OT�
iI RM 1171
FO WITH THE REQUIREMENT�
FOR O��'SITE SEWERS HND WELLS HS SET
THE MUNI[IPOLIT//'
O!':'
HND THE STHTE CIF-
FL
L.THE
114 OCCDRD8KICE WITH THE CCDES RND ||OVE RECEIVED.
O COPY OF THE
FOY HND
DIRCRRM HTTRCHMENTS WHICH IS PHRT OF THIS
PERMIT,
�I UNDERSTRND
THAT THE ON-SITE
SEWER MR/UIFO[ El, LR; :OCEI - 1ENT IF THE
RESIDENCE IS R[! -
[D T:.-.: INCLUD[
MOR[ THHN ] BEDROOMS
PERMIT RPPLICRNT
HHS TH�
�[SPONSI8ILITY TO INFORM PERSO��EL DURING
THE ITRLLOTIDN
INSPECTIONS
OF RNY WELLS BDJHCENT TO THIS PROPERT//' O�.1D
THE NUMBER
THDT
THE WELL 1, 1I1. L SERVE
IF R LIrT STFTI014
MUST
8E fS-8UILTS
CHNNOT
BE OPPRM[D AITITUT ON ELECT�ICRL INSPECTION
REPORT� T||E ELECTRICRL
��ORK
MUST 8E DONE 8Y D LICE��S[D EL[CTRICIHN.
SIGNED
ISSUED DY12/09
E
DHT�
�
=�
.MUNICIPALIT`( Of ANCHORAGE
Department Health and Environmental 'rotection
825 Street, Anchorage, AK. 'J501
264-4720
Permit # HANDWRITTEN PERMIT #
WELL AND/OR ON-SITE SEWER PERMIT
Applicant • Mailing Address: 9)C4_16 -Z d`11/e(
Location: Phone Number:
Legal Description: �' Cp` j /�[ ot Size: <�
Type of Soil Absorption System Is:
Trench: Drainfield: _ Seepage Bed; Holding Tank:
Maximum Number of Bedrooms: Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
DEPTH � LENGTH GRAVEL 6t PTH � .l!% WIDTH _
The length dimension is the length(in feet) of le6 trfA h `6r 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 SEPT IC(Hj0JLDI-PIG) 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 under and that the on-site sewer system may require en4ent if
the s'dence is r eled to include more tha 3 bedroom
l l
Signed: .��Issued by: -
App cant
Date: _`G,
/ p
SWP/024(1/81)
❑ SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
� 825 L. Street, Anchorage, Alaska 99501 264-4720
=5 SOILS LOG — PERCOLATION TEST
PERFORMED FOR: k4ii-Intl ( &IaCL-J DATE PERFORMED:
LEGAL DESCRIPTION: LIpT �C, C.� i� / 1GA Q0lt� ,C/ J�CE-S rATc:S
SLOPE SITE PLAN
1
I,-
fj
9
w
M�
<6oHC FrAAE
17
IN
19
C'�got'4 6AIJ4 -SiCT-
�,PAt/EC
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Reading
Date
Gross
Time
Net Depth to Net
TimeDrop
TEST RUN BETWEEN Y ----FT
AND _esS«._� FT
�
////
COMMENTS .�CJ6�5/C/',2/ .Qorre)ly 4PCA
,0%
V1 04C -1111
e ea •.°°•
/90 '5( E
••e
PERFORMED BY:(�f=l�<-rt9,C�
°i
-R
,� .(.�. L,n (!,E! t/G DATE:
7
e•au• _
s
e°• a a r • ••e,°e S
S1`9y-oe,7
awr.nee C. kye
o J' °ems e• �. �
N
�Id® OFESS101
G6
w
a
7/16'
651
1/E
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Reading
Date
Gross
Time
Net Depth to Net
TimeDrop
TEST RUN BETWEEN Y ----FT
AND _esS«._� FT
�
////
COMMENTS .�CJ6�5/C/',2/ .Qorre)ly 4PCA
,0%
V1 04C -1111
e ea •.°°•
/90 '5( E
••e
PERFORMED BY:(�f=l�<-rt9,C�
°i
-R
,� .(.�. L,n (!,E! t/G DATE:
7
e•au• _
s
e°• a a r • ••e,°e S
S1`9y-oe,7
awr.nee C. kye
o J' °ems e• �. �
�Id® OFESS101
20
PERCOLATION RATE_/ly (minutes/inch)
TEST RUN BETWEEN Y ----FT
AND _esS«._� FT
////
COMMENTS .�CJ6�5/C/',2/ .Qorre)ly 4PCA
,0%
i
/90 '5( E
/�foeoc,M , /�26(//�FL LIAl. OF s'Col/6-2-
PERFORMED BY:(�f=l�<-rt9,C�
C'_o,dST,e'eJe_ 'i /Z�.eT CERTI FI ED BY:
,� .(.�. L,n (!,E! t/G DATE:
7
f kSS-c�<�I
S1`9y-oe,7
72-008 (6/79)
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. 051-461-08-000
Expiration Date:
Legal description MEADOW RIDGE ESTATES BLK 1 LT 6
Site address 20948 MEADOW LAKE DR Chugiak AK 99567
8/15/2023
Current property owner(s) BUSH BRANDON NICHOLAS &HAYLEA BROOKE
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Original Certificate Date: 5/15/2023
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X
Absorption Field Advisory
Tank Age Advisory
Other
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
COSA Approvaijune 2022
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 051-461-08
Complete legal description MEADOW RIDGE ESTATES BLOCK 1 LOT 6
Location (site address) 20948 MEADOW LAKE DRIVE, CHUGIAK, AK 99567
Current property owner(s) BRANDON & HAYLEA BUSH Day phone
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ® Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 5 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ® Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ J�S�
Date of Payment
COSA # aSc 23 l3 y
Waiver Fee $
Date of Payment
Waiver #
COSA Application.doc
COSA Checklist.docx
COSA Checklist
Legal Description: MEADOW RIDGE ESTATES BLOCK 1, LOT 6 Parcel ID: 050-461-08
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA - PUBLIC &/OR CLASS “A” WATER
Well log is filed with Onsite (or attached)
Date drilled Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume NA 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
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank 50”
Date of pumping 5/5/2023
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 5/8/1995
ALL standpipes present per record drawing
Total measured depth from grade 8.4 ft (max)
Measured depth to pipe invert from grade 4.5 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date 5/5/22023
Results Pass
Fluid depth prior to test 0 in
Water added 450 gal
New fluid depth 0 in
Elapsed time <5 min
Final fluid depth 0 in
Absorption rate 450 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 43 in (3.6’ ED)
Effective depth used 0 in
Effective depth remaining 43 in
Comments/Deficiencies: Elevation shots show approximately 3.6’ of ED, which is the same as the MOA record
drawings or inspection report (IR) of 3.6’ED.
COSA Checklist.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) - NA
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No *5+ ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
*Per IR septic tank was installed per previous MOA code & regulations.
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 5/10/2023
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
5/10/2023
LOT 5
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ANCIIORAGE RECORDING DISTRICT, ALASKA
AS -BUILT OF:
MEADOW RIDGE ESTATES
LOT6 BLOCK PLAT'672-261 waoi,su)?
SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a AIW OF 4 1 L A Ai
AW
physical survey of this property as shown on this drawing and that the
A W_ 6, 1P
improvements situated hereon are -within the property lines and no
enchroachments exist other than noted. Under no circumstance should AV 4 9TH
any inl=brmation on this drawing be used for construction of fences, ••••-Z
structures, improvements, or for establishing boundary Ifties.coo
WA
EXCLUSION NOTES: It is the owners responsibility to determine � .................:. .�
c
the existence of any casements, covenants, or restrictions which '.JOHN L. SCHULLER.-
do not appear on the recorded subdivision plat. LS -10408 ,-► ,*.%b_%-
1831 Talkeetna Street
WORK ORDER NUMBER: DATE- SCAU. E-MAIL 2,
MAY 9, 2023 1 40 schuller0ok.net Anchorage, Alaska 99508
. - - \'O�' 'Aw (907) 227-1455 office
2%3-037 DRAWN BY, CHECKED BY: GRID NUMBER: BCOKPAGE: 0 ession&
JLS NW1 362 230144 kv, "I'll": (907) 274-4992 fax
•
•
• ,uL a,
•j.c. •— Municipality of Anchorage °"�
On-Site Water and Wastewater Program . . IIIIIIIIH
(907) 343-7904
Certificate of On-Site Systems Approval
Parcel I.D. 051 461 08 1 G.-Expiration Date: L Z"10
1. GENERAL INFORMATION
Complete legal description MEADOW RIDGE ESTATES BLOCK 1 LOT 6
Location (site address) 20948 MEADOW LAKE ROAD
Current Property owner(s) JAMES WILLIAMS Day phone
Mailing address
Real Estate Agent MICHAEL KING Day phon- 8•. .•543
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU) C 30 D
�- �i li'J �•,i L �
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex) a. ��'
3. NUMBER OF BEDROOMS:
3 �� of s g t, 9 C�
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual 0
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System 0 Public Sewer ❑
WaiverNariance request for: NONE
Distance:
Received b Date: %//)11C‘
Y /
COSA to be rel sed :ei engineer,unless otherwise requested by the engineer.
COSA Fee $ 521c. Waiver Fee $
Date of Payment S(3U r1 • Date of Payment
Receipt Number GO Ob Receipt Number
COSA# O56-1W 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 C&M ENGINEERING Phone 854-5558
Address 20182 TULWAR
Engineer's Printed Name CHARLES BALZARINI Date 8/30/18
--OF '
6. DSD SIGNATURE ? "*• •'" 1",y, .
'"; ;'T� • . . •
System #1 Approved for .J bedrooms , , , PI
System #2 Approved for bedrooms '6 AR ES G BALZARINI
•Disapproved
�. CE-1859=49� ,•�
FFDpRo sn o\-`�--.
Conditional approval for bedrooms, with the following stt ; 7.:-� "
LS LI -(—�c *4 iS 3S1/�rc7 .�
See {�-�-� i , a 7
0461, ot _c:ce2Q c Pi)t i C 4-evvt(1. 1 2-CD 1 ea-r 0-Q
.„
US1
ifi.
a ON-SITE
�/ATER ANp
INAST
` PROGRArER `__.
.
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rr
By: 1\ %A, (- Original Certificate Date: 91—( 2�` P
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other _1 c
COSA blue sheet_f - ..
If more than 1 septic system is on the lot:
COSA Checklist# 1 of1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: MEADOW RIDGE EST BLOCK 1 LOT 6 Parcel ID:050 461 08
A. WELL DATA
Well type PUBLIC If A, B, or C provide PWSID# 211431 Well Log (YIN) -
Date completed - Sanitary seal (Y/N) - Wires properly protected (YIN)-
Total depth - ft. Cased to - ft. Casing height(above ground) - in.
FROM WELL LOG AT INSPECTION
Date of test - -
Static water level - ft. - ft.
Well production - g.p.m. - g.p.m.
WATER SAMPLE RESULTS:
Coliform - colonies/100 mL Nitrate - mg/L
Arsenic - ug/L Date of sample: - Collected by: -
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 5/21/1983*
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES pression over tank (Y/N) NO High water alarm (Y/N) NO
�l /l Pumper Jj 's
Date of pumping � l
C. ABSORPTION FIELD DATA
Date installed 5/8/95 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 System typeTRENCH
Length 61 ft. Width 5 ft. Gravel below pipe 3.6 ft.
Total depth 9 ft. Eff. absorption area 565 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 8/23/18 Results (Pass/Fail)PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 4 in.
Elapsed Time: <144 min. Final fluid depth 0 in. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N &type) NONE If yes, give date N/A
D. LIFT STATION
Date installed NA Size in gallons -- Manhole/Access (Y/N) --
"Pump on" level at-- in. "Pump off' level at -- in. High water alarm level at -- in.
Datum -- Cycles tested -- Meets alarm&circuit requirements?--
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot +100 On adjacent lots +100
Absorption field on lot +100 On adjacent lots +100
Public sewer main +100 Public sewer manhole/cleanout +100
Sewer/septic service line +25 Holding tank +100
Animal containment areas +100 Manure/animal excrete storage areas +100
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation +5 Property line +10 Absorption field +10
Water main +10 Water service line +10 Surface water +100
Wells on adjacent lots+100
ABSORPTION FIELD ON LOT TO:
Property line +10 Building foundation +10 Water main +10
Water Service line+10 Surface water +100 Driveway, parking/vehicle storage +5
Curtain drain +50 Wells on adjacent lots +100
F. COMMENTS
* DOCUMENTATION INDICATES TANK WAS INSTALLED IN 1983. TANK IS OVER
30 YEARS OLD AND FUNCTIONAL BUT SHOULD BE REPLACED. TANK LEVELS OK.
G. ENGINEER'S CERTIFICATION ~c3F lAk
�•• • • tomk,,
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. * T y 1,;-_ F '' *
Engineer's Printed Name CHARLES BALZARINI soi ' ' » ' " " " • ' g " " ' » ' '
Date 8/30/18
CHARLES G BALZARINI
CE-13854 00 e- vweeogi
k‘At6;PR6F-iis'o0'44.6-
COSA canary sheet_2-6-15.doc - "' "�► w►.
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT • hr.24e� 907-343-7904
On-Site Water and Wastewater Section \ ` � Fax: 343-7997
www.muni.org/onsite
Septic Tank Advisory
Certificate of On-Site Systems Approval # 0SC181448
Subdivision: Meadow Ridge EST Block:1, Lot: 6
The septic tank for this property is 7-4 5' years old. The average life for a steel
septic tank is 20 years. Typical replacement costs range from $6,000 to $9,000.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
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Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org
Municipality of Anchorage
Development Services Department °H
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-461-08 COSA # tt6C 1a ly
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Lot 6, Block 1, Meadow Ridge Estates subdivision
Location (site address) 20948 Meadow Lake Road Chugiak, AK 99567
Current Property owner(s) Federal National Mortgage Association Day phone
Mailing address P.O. Box 650043 Dallas, TX 75265
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Three (3)
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual On-site
❑✓
Individual Water Storage ❑ Individual Holding Tank
❑
Community Class Well ❑ Community On-site
❑
Public Water System ❑✓ Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. 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
Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Phone 522-7773
Engineer's Printed Name Michael E. Anderson, P.E. Date
d AucHAM E AWeii50N: W ;
5. DSD SIGNATURE ®®��f •• Cl !t 4m?� ���•®
_Z Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date:—d
(Rev. 11105)
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 6, Block 1, Meadow Ridge Estates Subdivision Parcel ID: 051-461-08
A. WELL DATA
Well type class A If A, B, or C provide PWSID # 211431
Date completed _ Sanitary seal (Y/N) _
Total depth ft. Cased to ft.
FROM WELL LOG
Date of test
Static water level
ft.
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
ft.
Well production g.p.m. 9.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L Other bacteria colonies/100 mL
Arsenic: _ mg/I Date of sample: _ Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 5/21/83
Tank size 1,000 gal. Number of Compartments Two Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 9/11/2012 Pumper sanitary Pumpers
C. ABSORPTION FIELD DATA
Date installed 5/8/95 Soil rating (g.p.d.lft2 or ft2/bdrm).8 GPDISF System type Deep Trench
Length 61 ft. Width 5 ft. Gravel below pipe 3.6 ft.
Total depth 8-9 ft. Eff. absorption area 565 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 8122712 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 0 in.
Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at_ in. "Pump off" level at _ in. High water alarm level at
Datum Cycles tested Meets alar & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankilift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer /septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5 Absorption field >5'
Water main N/A Water service line >10 Surface water >100'
Wells on adjacent lots >200'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation >10' Water main >10'
Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >25'
Curtain drain None Noted Wells on adjacent lots >200'
F. COMMENTS: Lot is Served by Class A Water System.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 9/10/2012
COSA Fee $ '—t-10—
Date of Payment C, I I 1 I is
Receipt Number O 54 G
(Rev. 11105)
0
Waiver Fee $ _
Date of Payment
Receipt Number,
4918 .
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UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USFD FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
R;E SURVEYOR TAKES RESPONSIBILITY FOR THE INITIA, TRANSACTION ONLY
AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY.
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY (:AJSE ERRORS IN SCALE_
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AS-BUILT ... NO COI SET Lj RECERT ITCAL AS BUILT ... NO WRNERS SET
00Il ASSUJMED ELEV METAL FENCE ® WOOD DECK
PLOT PLANS & LOT SURVEYS
NOTE:
:T IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE !
SHOWN, FENCES, WELLS
W FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
SEPTIC CLEANOU TS, SIDEWALKS, DRIVEWAYS,
ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW
THE EXISTENCE OF ANY EASEMENTS. COVENANTS OR RESTRICTIONS
MAY PREVENT SCME IMPROVEMENTS FROM BEING SEEN AND LOCATED,
WHICH JO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT,
AL_ DISTANCES ARE RECORD UNLESS OTHERWISE NOTED.
SURVEY CERTIFICATION
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MEADOW RIDGE ESTATES i
72-025 (Rev. 1/91) Front MOA #21
_, ;. Additional Comments
r
72-025(R". 1/91) Beck MOA #21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Est.
Legal Description: LOT (O "` k I M�"rjO ''R' evE Parcel I.D. a
A. Well Data
Well type C (-4ss If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed Driller
Total depth Cased to Casing height
Sanitary seal (Y/N) Wires properly protected (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump levell
SEPARATION DISTANCES FROM WELL
Septic/holding tank on lot
Absorption field on lot
Public sewer in
service line
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Nitrate
AT INSPECTION
g.p.m.
_; On adjacent lots
; On adjacent lots _
Public sewer manhole/cleanout
Petroleum tank
Collected by:
Date installed 11403 Tank size /voo
Cleanouts 65N) ZS Foundation cleanout J&/N)
High water alarm (Yg N c) A
Date of pumping S - 2J -
g.p.m.
Other bacteria
Compartments a
Y Cs Depression (Y/& j
alarm tested (Y/@ 00 NA
umper 7. k--' .'s 22uM�iN�
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ave _r _On adjacent lots a°o 4 Foundation
To property line ? _Absorption field Water main/service line
Surface water/drainage /0/
N
72-026 (3/93)' Front CONTINUED ON BACK PAGE
- O Z
6
-< r
z
O
rn ,�
D
nz
t
c
L
� C
Compartments a
Y Cs Depression (Y/& j
alarm tested (Y/@ 00 NA
umper 7. k--' .'s 22uM�iN�
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ave _r _On adjacent lots a°o 4 Foundation
To property line ? _Absorption field Water main/service line
Surface water/drainage /0/
N
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 DIST
N
D. ABSORPTION FIELD DATA
STATION TO:
On adjacent lots
Manufacturer
Manhole/Access (Y/N) _
"Pump off"
_Cycles te�
Date installed 5 - o - `l S Soil rating (GPD/Ft2) o .?3
Length fO 1 Width 15 Gravel thickness 3 •S
Total absorption area S-6 S" FT 2
Surface water
System type5'//4"`'-�
_Total depth I
Cleanout present (�N) Depression over field (YLM NO
Date of adequacy test NA,- Ngw s`/STEM Results (pass/fail)
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y&N
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot t'dA-
To building foundation
On adjacent lots r oo f
Surface water
Curtain drain
ia�I
adjacent lots
Igo
Cutbank
E. ENGINEER'S CERTIFICATION
for Bedrooms
After test
_If yes, give date
} Property line 30
To existing or abandoned system on lot
Water main/service line
Driveway, parking/vehicle storage area 23
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect grJ4td�of this inspection.
%
Signature
Engineers Name t✓/�� ;, eoaeer c,, ccU/nN r ,
CE -8801 ..;
Date
HAA Fee $ �L)d ' Waiver Fee $
Date of Payment 7S^ Date of Payment
Receipt Number �1� r2�p3o Receipt Number.
72-026 (3/93)' Back
Time
APPLIC.�94i FILLS OUT UPPER HAL 3NLY
Property Owner _ �-• :, „ ,.,� .• i
Phone
Mailing Address �!�
; / �,I / r, (% /r; ` Zip Code r%'�_(. j --
('�/ V/ r/> ,
Buyer
Date
Address
Zip Code
Inspector
Lending Institution-.�
r_. 1 -�`i ��
Phone
Address41
Zip Code
Realty Co. & Agent
`�,.. y7 -/�%.,
f
Phone
Address i) /..,
�., r,// �� ir_"; /,'!/- Zip Code
Legal Description
"Dept, of ll; th
—
( APPROVED BEDROOMS
*CONDITIONS
Street Location 9_f
( ) DISAPPROVED
Type of Residence
( ) CONDITIONAL APPPI1ROV
AI Single Family
�LL''�
DATE _ O'
❑ Multiple Family
No. of Bedrooms=.
BY:
❑ Other
Soils Rating
�S�y
Wafer Supply
Well To Absorption Area
Well to Tank
❑ Individual
Septic Tank Size /000
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975.
P Community
For wells drilled prior to that date, give well depth (attach log
if available).
❑ Public Utility
Sewer Disposal
v
X Individual
Year Individual Installed:
❑ Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes:
[, An
r
AUG 2 g 1983
Vtloicipaflty of
"Dept, of ll; th
—
( APPROVED BEDROOMS
*CONDITIONS
- [arui+�alu�;al-€'r<,fidetisn-'
OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPPI1ROV
�LL''�
DATE _ O'
BY:
Soils Rating
�S�y
Date Sewe Installed
Well To Absorption Area
Well to Tank
Well Log Received
Septic Tank Size /000
72029 171821
Time
Time
APPLIC NIT FILLS
OUT UPPER HAI ONLY
Property Owner i?� (..; 1 �.�:`.r•_)) i
171/1Z
e
Mailing Address C7 1 -:>--.;_ ;
) ;"-- !`.... Zip Code
Buyer
Date
Address ._. <, ". -�'I� i--: ._ i ,-
C. ::'i, ;•�,, Zip Code
Lending Institution , .,_„ -;� ,J.1 I - "- .•.
-
Phone
Inspector
F=ield Notes:
Address
Zip Code
'CONDITIONS
Realty Co. & Agent , .^.;: 7 :' �:=
_ I'i97 , -.. --
Phone ...
( ) CONDITIONAL APPROVAL
,, {., ,:
Address 1 : J -i ; - . .. _
: �1,.;-. Zip Code
-
Legal Description
-
Street Location
Type of Residence
.-Single Family `J
Soils RatingDate
Multiple Family No. of Bedrooms._
❑ Other
Water Supply
❑ Individual
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
1�1{Community
For wells drilled prior to that date, give well depth (attach log if available).
❑ Public Utility
Sewer Disposal
_[x Individual
Year Individual Installed:--
❑ Public Utility
When Connected to Public Utility:
Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
F=ield Notes:
( APPROVED BEDROOMS -?�'
'CONDITIONS
OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL
-3
DATE v ---
BY:
Soils RatingDate
Sewer Installed
Well To Absorption Area
Well Log Received �Z`_
Well to Tank
Septic Tank Size Ai[;1`1
7202] 101M1