HomeMy WebLinkAboutMEADOW RIDGE ESTATES BLK 2 LT 5Meadow Ridge
Estates
Block 2
Lot 5
#051-461-17
/ MUNICIPALITY OF ANCHORAGE
/® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
I ENVIRONMENTAL ENGINEERING
DIVISION
825 L Street - Anchorage, Alaska 99501
Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM
REPORT
NAME �e/q®�)
�PY/r J,q �lgms
PHONE
����"�I®I
NEW
UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATIIOjN%'
d' -C° ! Imo: R:
NO. OF BEDROOMS
Well�p / Absorption area
DISTANCE TO:
UY
Dwelling /
PERINr'O. r
J
F- z
Manufacturer
Material .9•"
No. of compartments
wF
to
Lict. c �cvy in gallons
/
IF HOMEMADE:
Inside length
Width mv.
Liquid depth —
DISTANCE TO:
Well
Dwelling
PERMIT NO.
Q
Manufacturer
Material
Liquid capacity in gallons
O
DISTANCE TO:
Well
(j�
Foundation /
Nearest lot lin /
PERg
as
w
_j a z
No. of lines
Length of c e I/na
Total length of lines
Trench width
Distance bet e lines
w z cc
L
4
0 inches
bTop
finish
Material beneath
Total
of tile to grade
tile
P"
effective absorption area
I dfiehes
c
Length
Width
Depth
PERMIT NO.
U]
Type of crib
Crib diameter
Crib depth
Total effective absorption
area
w
DISTANCE TO:
Well
Building foundation
Nearest lot line
Class
Depth --
Driller
__j
Distance to at line
PERMIT N0. —
�
!Go
W
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
37 � L" 0 N rel/4S
SOI L TEST RATING
rTy
/ �0
INSTALLER
N
REMARKS
INS&I,471-ow To
All
SDI
77
4,
p
-
APPR0 ED DATE LEGAL
5 6�y— 9�
72-013 (Rev. 3/78)
MUNICIPALITY OF ANCHORAft
t tp tnie<t.t of ne l.th and Savtronmentral PrOt ttiO
1, t tF tchoraga, AK, 99501
2654-4120
L till DVIii [TTEN PERMIT
WELL AililJt3fl (}g -SITE SEWCR PERMIT
i
Kenneth Ii. 11I -]Aa nzs Maijiliq Addres94 3444 seuklala Or.Lva
pbofte Number: 243--8101
R ai ft c 3,ptioY l,st5 Block 2.._maadou Ridge -- %t_ "Cti.ze.
' €�f Sloil Abzor tion System 16; _
ape � �
Tifef t b .' Xx _ t$ t:a iAi f icl-d Seepage Bad- _ fla I f in Tank F w
Maxa6IA Nuffi s of t3 t:�9. Steil Rati.�t ( . ft hr)
._.r .
°the Required Size of Lhe Soil Absorption SyStPn fs=
LENV
, I.AVEL OF -P Tl1 W I DTH
4"ntt l ng_h d. rinion Ig tnca knell-h(ist feet) of the brenrh ar clt;aitt�i�ici.
dpoth of a teench or pit: is the distance between the buv°fac O 0f thO k7r0l-ttF
thug bottom of the exoa vat ion (in Utet) , there in no set width for tyrenci e s
T'h€, geaveL depth is ene jfttnjmwj depth of gravel 'betwicwn the OutfalL Pipe •.t
the bottoms of the excavation (in feet) .
* * REQUiR8D :XPTICWLk ) TANK SIZE a /� � � GALLONS
permit applicant has th,u responsibi.lLty to iufarm this department dUt ie}� t;?tt•
l,tgstallati_on .ingpec°tions of any walls adjacent to this ProPartY And thy; tlt.;rk
of res iaenc ies that the well W L.11 serves. '
-nqo(2) INSPECTIONS ARE REQUIRED
�1ckfill1n--j Of anY system Without ti.naj i.ttspacticr and approval. by this de. i
Nfill sue j _`-t to pis+uteic�rt
t=4in.im distance between a wall and any on -s LIQ Sc-;cdisposal system i% ,fit .l
k)r a private well or 150 to Zoo fret from a public well depending upon UWk t
r1� public � ell, I sni � dtot- n`e from a private well to a Priva.l� soAklrtr l;
is 25 feet', and to a `Ojf4tuntj;y "war Lina is 75 feet, T4 11 loq5 are requa-ri ;
atgd must he returned to thl<s departtwente within 30 Mays of the well CcitttPl R j i
t_hcr. requirejm6nts may appll+. Spwi,ftcations and construction dtagr Ql ar"'
avaiLabLe %:a insure proper l
finsta++.lfation. j 9
RE$ Hamm 31,
I cartiEy thai -.
(1) i wa Eardiltar wtv-h the reAquireinants for onasita sewers and wells Zt
sett Earth by i;he Mun W i,pal ity of iwichorage .
(2) l will, install ti -10 .tysLe'sa to accoedance with code's.
(3) .l understand that-. the :gin -site sewer syztea may require eaIarg1i t,
t li v ref; s iciene€ i_s r ti id, z e.d to ins ljsde More that 3 tads tion .
iqn � ;, (.,itX-��--�i Issued try:APP � 76 3_i,'#_dB r_ +.�€� r
1
MUNICIPALITY OF ANCHORAGE
Department Health and Environmental
82.5 L Street, Anchorage, AIC.
264-4720
Permit #
Applicant: Kenneth W
Location:
'rotection 1
:,j501
3444 Seppala Drive 03
* * * HANDWRITTEN PERMIT * * *
WELL AND/OR ON-SITE SEWER PERMIT
Williams Mailing Address:
Legal Description: Lot 5 Block
Type of Soil Absorption System
trench: xx Drainfield:
Phone Number:
2 Meadow Ridge
Is.
243--8101
Lot Size:
Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: L Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
C� ��
DEPTH LENGTH _- GRAVEL DEPTH WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(I -ii*G) TANK SIZE v /U O n GALLONS # #
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED #
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 bedrooms.
Signed: — Issued by:
Applicant
Date:
SWP/024(1/81)
- SOILS LOG
MUNICIPALITY OF ANCHORAGE
❑ PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: Y-,( (-i ,", DATE PERFORMED: ✓ 1 ��� //Cl)�_
LEGAL DESCRIPTION:.�� 1- dw) c,
r.N ,tea, SLOPE SITE PLAN
E
2
3 0/0
4
�U5 ,
7 / G,
r
8 C)
,0 r"*/
9 0
C.
10-
11
0 11 •� ,
12 0
13
v•�
14
15
16
17
81920 18-
19-
20
COMMENTS
J
A, .
t,.'
f
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
1J� s
L
O
P
E
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
n
i
1J� s
L
O
P
E
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND
-
PERFORMED BY: -- - - - _CERTIFIED?,,/W DATE
yy,,
` c: t -win 'I8M
I X6'601-'wolw'"Rs li�.� K"i ring/r
72-008 (6/79) r V)I11 69,1,..PWO
C�Iv 5 tjcd $>
C_ i,,i
Municipality of Anchorage
• Development Services Department '<
Building Safety Division
On -Site Water and Wastewater Program t
5p E T Y
4700 SoutfiBragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR SINGLE FAMILY DWELLING
Parcel I.D. 0519 6 117 HAA# 114N61
1.
Expiration Date:
GENERAL`iNFORMATI,ON ,�c
Completelegaldescription; MEAb 0 P- 66, A_ E- i iLJ Bib
Location (site 'address ordirections) Z0930 Cot4eallzy urel) A2.
Current Property owners) kf--A) 4 PAT l,.ti �, sl 5 Day phone /^ 19 6 - 230
Mailing address $00! �uPj�i ill '$/� /ill/cFEt fl K 9 95�y
Lending agency Day phone
Mailing address
Real Estate Agent i lot oJb12 Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Z
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual On-site
Individual Water Storage ❑ Individual Holding tank ❑
Community Class A Well [ Community On-site ❑
Public Water System ❑ Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 Health Authority 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.
Eagle River Engineering Services Phone
Name of Firm
Address Eagle River AK 99577
Engineer's Printed Name GHRrstned E"2 12 W00b Date
5. DSD SIGNATURE
✓ Approved for bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: Original Certificate Date:
(Rev. 01102)
D. LIFT STATION
Date installed Size in gallons an ole/Access (Y/N)
--
"Pump on" level at in. p covel at�L in. High water alarm level at in.
p Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO
Septic tankX44-s4etien on lot On adjacent lots
Absorption field on lotO �djecen ots
Public sewer main Public sewer manhole/cleanout
Sew ' service litre Holding tank
SEPARATION DISTANCES FROM SEPTIC/! 9LB1P}6 TANK ON LOT TO
Building foundation { 3 �" Property line -l' 10 r Absorption field
Water main 4 rte r Water service line 11`0 r Surface water +100
Wells on adjacent lots t 100
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:,
,'u�.,�+x:�.rxaw�.a><..�
Property lined Building foundation 2`; Water main t /D
.. ._
Water Service line + tO Surface water 't-100 Driveway, parking/vehicle storage */0
Curtain drain •FSd` NONE Wells on adjacent lots fiW),
F. COMMENTS r'
i L5E r5;
WR��b0021 FSELb Tp LOT Ll/J6. •A
G. ENGIN ER'S CERTIFICATION 41P�..�• qS
„F
I certify that I have determined through field inspections H and
review of Municipal records that the above systems are in
..;.
conformance with MOA HAA guidelines in effect on this date. _
CHRISiOt+t1ER
Engineers Printed Name 04R STCPr{EA i7, t Joos `�3+. CE:10Z87
Date <1l5ft,2421
r� �o '•• _ `sem
JJIV
HAA Fee $ 3® Waiver Fee $
Date of Payment �Z�°`% Date of Payment
Receipt NumberT7� Receipt Number
(Rev. 12101)'
%$ P—y2-2oa4 12:44 Pro
ab 1mm*I
1O Box 773413
29*RiVW. AX 99577
(OM 694.6454,
wmq, Norm
Olw e^OWMnp
10081 VFW fag" lei
Oyb fto, Ak Nen
(w)w41N
-
mnt ,
"Man utw p0�
Ckvhk AK eeen
wwwt %"
a"" Oprdet Undn M
Sorvks Aor"matlt
*ARW; MAN
oNno111: 244404004
DoMOeOM: 014OOoaft u=sm
to"IMB towa'w *
400 bmgpm. ti00p
A.O.Numhv;
faeA NM 00
4101M Mob
reeearo
CNRp OIrM4: NOn�NNN IlOAe
.,.. .M COrMnOrt: t%pwtDlN 7mM►O�OM'•
i
as 190a 4i0Nt
Mp 4ad. It
'NameMODM Be 111000Aw. wri o0"'wee,"&a. few uw
Tog Onowt,
a _
rMf NMp 0000 M e MM �•pOw
1 x/00.00 No Ne
MMNMN:Road- co mM1M
bens "WIN ww omed OAAN
Rd' 00 Aid% dan WNt
r. nUy n"$ ,JM
pNiOm;
I
OlAnrlal .. ...A11W .
OAtat pNAnnAe� 1750
en r CurM700:
G I flOw/OyWAt:�w.r—
tkrt..►�.I,r W.
a.J 4 Ar
wmak. So. do
.swrww .tl Mae
rA1.00 mw+awY
tANmOre aNOrpwc H>te.N t0.w t0:ao h70;o0
Agar Ctiww r'tn
OIN000w V4 TWO OF CuOknkr ROprttNYlWw
wew, 1 � ci
AAAtpt10 M 14 AAmAO!e — AOOieltO
�y Ydur' w1AlAd aePnnys w AAAMtAnyA0r1 OPgOtr bke+wlNNiA Alld YArCAA /AMNMN OMM M pn-0.
AAtr N ww i.0� ww a dtuip.d MOr10' wry 0! A OhNeRr 4IIlQfFwbHIPCh0vksMIAbmg
PIA -10
MUNICIPALITY OF ANCHORAGE
DFPARTMENT OF HEALTH & HUMAN SERVICES E: `
wl
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # l/7 HAA #
1. GENERAL INFORMATION
Complete legal description Lot 5; Block 2; Meadow Ridge Estates
Location (site address or directions) NHN Country View Drive
Property owner Ken 6Alliams Day phone 229-3016
Mailing address _ 2-0_ Rox 671526 Chnai ak, AR 9()567
Lending agency
Mailing address
Agent
Address
Unlass otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 2
3. TYPE OF WATER SUPPLY:
Individual well
Community well XXX
Public water
Day phone
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my sea! affixed hereto and as cf 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.
S & S ENGINEERING
Name of Firm 17034 Eagle River Loop Road No 204 Phone i I 1 cl
Eagle [diver, Alaska 99577
Address -
Engineer's signature
6. DHHS SIGNATURE
rf
Approved for ��� bedrooms
Disapproved.
Conditional approval for
Additional Comments
e e
Date 5_��Z)l`7S
ff 3® � 1l� S •S/ i�
(� RCBERT C COWAN 1 ?
it l t:••., � `��
bedruoms, with the following st,pulations:
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph S above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and theirlending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA #21
RECEIVED
Municipality of Anchorage MAY 2 6 1998
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division MUNIC:IPALIIY OF ANCHOMAG
525 L Street, Room 502 • Anchorage, Alaska 99501 * �60' TWM�WES DIVISI
Health Authority Approval Checklist
XIM)OW RID4C
Legal Description: I -o 5' C3/'xe;V1 'Po_sr17 S Parcell.D,: lJ-r>- I
A. WELL DATA
C l F1�s A If A, B, or C, attach ADEC letter. ADEC water system number. X t / zl 3 /
Log present Y/N).
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well production
WAFER SAMPLE RESULTS:
Date completed
_ Cased to
FROM 1 L LOG
Coliform Nitrate
Date of sample:
Casing height (above ground)
Wires properly protected (Y/N)
Collected by:
AT INSPECTION
B. SEPTIC/HOLDING TANK DATA
Date installed Tank size JQLo cul Number of Compartments Cleanouts CN) 6 +`-,-
Foundation cleanoutWN) _ f 5 Depression (yl@ 00 High water alarm (Ye 00
Date of Pumping _ 4ZO
�--. Pumper. ,V IIAR'1�2f
C. ABSORPTION FIELD DATA
Date installed 5 z4' B3 _ Soil rating (g.p.d./ft2 or 2/bdr ) _1_:0_ System type Y-eNC-4
Length Width _30 Gravel thickness below pipe Jr / Total depth /
Effective absorption area D Monitoring Tube present 0" N) Depression over field (Y t� �o
Date of adequacy test— J z��� Result (Pas ail) �,�/> "S _ For 1o/o bedrooms
Fluid depth in absorption field before test (in.); h _ Immediately after Xlq gal. water added (in.): -) f �I _
Fluid depth 2-7 (ins) Minutes later: 87 Old' Absorption rate = _ 04- g.p,d.
Peroxide treatment (past 12 months) (Y/N) jlur)6 K owtJ If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at* _
Cycles tested
E. SEPARATION Dl3T4CEE
SEPARATION DISTANCES
Septic/holding tank on lot _
Absorption field on lot
Public sewer main
Sewer /septic service line
Size in gallons
_ "Pump " level at*
*Datum
ON LOT TO:
On adjacent lots
adjacent lots
Public sewer ma k
Lift station
"Pump off" level at*
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
f,/+ 1 +
Foundation t) Property line Ib Absorption field
Water main/service line Ig Surface water/drainage ioo + Wells on adjacent lots .?00 I+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
� � it
Property line � 4 Building foundation io Water main/service line
4 Driveway,parking/vehicle /vehicle stora e area to
Surface water 1()1) P g g
Curtain drain NONE Wells on adjacent lots 200,+
F. ENGINEER'S CERTIFICATION APfLIEO FoQ 1Jaw�iZ ( 51
re Wc�Tl
I certify that I have determined thru field inspections and review of Municipal records
in conformance with IAA gui lines in effect on this date. ;
'mac
Signature
Engineer's Name �i OJT k��i C• CO w/�r�
Date
a3/ I
HAA Fee $ 300-C)o
Date of Payment '_/26 /98 -
Receipt Number
72-026 (Rev. 3/96)*
Q37/6 CG 730'
Waiver Fee $
��+:}......_. erg •:ir•. Pee.
ROBERT C. COWAN
CE -8801 ,+
M's -Q0
Date of Payment 5 /�6 /� 8 -
Receipt Number 0 -3'7/6(07303
are
1 ici a ty ®f Anchorage
renP p
�1 t 1D'i yi, rii\�1��
Departrrlent of Health and Flumari Services �1hMI-C
825 °L" Street
Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650
Mayor
http://www.ci.anchorage.ak.us
907-343-4744
June 2, 1998
Robert C. Cowan, P.E.
S&S Engineering
17034 Eagle River Loop Road
Suite 204
Eagle River, AK 99577
Subject: Waiver Request for Meadow Ridge Estates Block 2, Lot 5
Waiver Request #WR980021, PID #051461 17 #HA980123
Dear Mr. Cowan:
Your request for a waiver of the required 10 foot horizontal separation from the
on-site wastewater disposal system to a property line has been approved. The approved
separation distance is 5.0 feet.
This waiver approval applies to the existing on-site wastewater disposal system to
property line separation only. Any future upgrade to the on-site wastewater disposal
system will require all separation distances be met or another approval from this
department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-4744.
Sincerely,
Donna C. Mears
Civil Engineer
On -Site Water Quality Program
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR# I iIOG}S�f r��1 PID#{}-Ut 1-1 LHA# Permit #
Date Received: May 26, 1998
Legal Description: Lot 5 Block 2 Meadow Ridge Estates
Engineer: Robert C. Cowan, P.E., S & S Engineering _
17034 Eagle River Loop Road, Suite 204, Eagle River, Alaska 99577 _
Applicant: Ken Williams --
Waiver Requested: Lot line waiver of 5 feet from the southwest property line.
Criteria: 1. Geology:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
Points:
Waiver is Granted: Waiver is NOT Granted:
List Conditions or Reasons for. above:
Date: '2 `�� By: /h
N me o
ewer
Rec #: 03716/0730__ Amount: $.115.00 Date Paid: May 26, 1998
s&S�
�1n��Rln�
May 21, 1998
ROBERT C. COWAN, P.E.
CIVIL ENGINEERS
(907)694-2979
FAX(907)694-1211
HEALTH AUTHORITY
APPROVALS
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
SEWER &WATER
Anchorage, AK 99519
MAIN EXTENSIONS
REFERENCE: Lot 5; Block 2; Meadow Ridge Estates
SEWER&WATER
INSPECTION
Request you issue a Health Authority Approval on the referenced property and
grant a waiver for the horizontal separation distance between the leachfield and the sv--H LV4 i r
property line at 5 feet. We do not anticipate any adverse effect on the adjacent
ENGINEERING STUDIES
properties. 5 'L 4 /1 7- y ,
AND REPORTS
The property is served by Dawn Water Co.
If require additional information, please contact us.
WELL INSPECTION
you
& FLOW TEST
Sincerely,
SITE PLANS
Robert C. Cowan, P.E.
RCC/gk
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
fA
4XI
+
WI -4
Y I
P-7
_46 ------ -
X
bt CP.4 bL
MO.
q,
AS -BUILT
--Thefeby certify that I have surveyed the following described
property: 69 rk
L
Anchorage Recording Precinct, Alaska, and that the improve-
ments situated thereon are within the property Pne.q and do
not overlap or encroach on the property lying adjacent there-
to, that no improvements on property lying ac[Jac(mt thereto
encroach on the premises in question and that there are no
roadways, transmission lines or other visible casements on
said property except its indicated hereon.
Dated at Engle River, Alaska
' "i
this.. _4��_"day of.__AI&.
SCALE:
ROBERT C. JOHNSON -;,r '
Registered Land Surveyor No
Box 466, Eagle River, Alaska
Phone (907) 694-2543
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date June 24 , 1986
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 5 Block 2 Meadow Ridge Pstates T15N R1W Sec 1
Location (address or directions)
(b) Applicant Name Ken Williams Telephone: Home Business
Applicant Address P.O.. Box 671526 Chugiak, Alaska 99567
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ® ; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution Alaska Pacific Mortgage Telephone 563-2100
Address P.O. Box .1 00420 Anchora_gP , al aska 99510
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. TYPE OF RESIDENCE
Single-Farnily ® Multi -Family ❑ Other
Number of Bedrooms 3-
3. WATER SUPPLY
Individual Well ❑ Community 10 Public ❑ Dawn Water System
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite ® Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (1 1,84)
5. ENGINEERING FIRM PROVIDINU INSPECTIONS, TESTS, FILE SEARCH, DA 1 A AND INFORMATION
6.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm EAGLE RIVER ENGINEERING SERVICES Telephone
EAGLE RIVER, AK 99577
Address nnnV-7-7A10Q
Date 2:Z 694 5195
DHEP APPROVAL
Approved for Obedrooms by _
Approved X Disapproved
Terms of Conditional Approval
,
• Pv<1Ohcfirieer's Seal
3
V C`5 Louis A. Rut P,res
OFESS0"�
Conditional
CAUTION
Date 7� eG
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
i U1 Vll_II nLl I , v, n, Xl l wRn
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA) J U IN ,1 Q 1986
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: �-�' fly,[
_5u, TSS— y,/ �'i Gx) -s c . I
A. WELL DATA
Well Classification ``s s "A If A. B, C, D.E.C. Approved (Y/N) y �4w" trJ4ic.� Syr
Well Log Present (Y/N) Date Completed — Yield _
Total Depth Cased to
Static Water Level
Casing Height Above Ground _
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line _
Cleanout/Manhole
Water Sample Collected by —
Water Sample "Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Depth of Grouting
Pump Set At —
Sanitary Seal on Casing (Y/N) —
Depression Around Wellhead (Y/N)
On Adjoining Lots
On Adjoining Lots —
_ To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Date
Date Installed 5 �� 3 Size 10'90 5-'* / No. of Compartments
Standpipes (Y/N) Air -tight Caps (Y/N) —y Foundation Cleanout (Y/N)
Depression over Tank (Y/N) All Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) �y�� ; for
Holding Tank High -Water Alarm (Y/N) x1_24 Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well cdd To Building Foundation
To Property Line To '� To Disposal Field E r
To Water Main/Service Line — ��� To Stream, Pond, Lake, or Major Drainage
Coursef�
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorptions Strata Z45 Type of System Design %e�✓�
Date Installed 1/ S' 3 Length of Field ys
Width of Field 3o Depth of Field l
Gravel Bed Thickness 5 /
Square Feet of Absorption Area �D 50 Standpipes Present (Y/N) l
Depression over Field (Y/N) All Date of Last Adequacy Test 6/a 6
Results of Last Adequacy Test f r Ki k -Z �� 3 le, Ile, Wre4
Separation Distance from Absorption Field: `
l
To Water -Supply Well UO To Property Line
i
To Building Foundation To Existing or Abandoned System on
Lot A114
• On Ad1 oinin Lots /
To Water Main/Service Line `16
To Stream/Pond/Lake/or Major Drainage Course _
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION I/�
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
9
To Cutbank (if present)
A//i/
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ��/� — Date
Company
G�/�—S MOA No. .� OF
IC -1 .
Receipt No. F&n 7� �, Eagle Rivar Engineering Services f1`
Date of Payment %-3���s(o P.O. Box 773294 Ei Y< ��.,Tt4§3 ••�
Eagle River, AK 99577 e'e e.'.••; •„ ,'
Amount: $ 6/94.5195 io
O•a,•••q•**.*••• •,auo:.ii
O� 4r,1
0 4'
e. Louis A. Bufera ; W iio
140
Page 2 of 2 t1,\�
72-028 (11/84)
BILL SHEFFIELD, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSEIi"TION Telephone: (907)
Address:
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
DATE: June 24, 1986
PWS I.D.# 211431
To Whom it May Concern:
274-2533
According to records on file in this office the DAWN WATER COMPANY
Water Regulations
Water System is in compliance with the State Drinking
Sincerely,
Michael P. Lewis
Environmental Engineer
Time
APPLIC MT FILLS OUT UPPED HAI ONLY
Property Owner ��.
/ Phone
, G ? �! I j /! {-- _ i ,__ - ! �• J /� - r."
Mailing Address
Zip Code -
Buyer
Date
Address
Zip Code
Lending Institution
'• y <__ (� ,�j/j I-, i- �- ,. /�
j 'l r i.
Phone
Address«�!%.
Zip Code
Realty Co. & Agent
Phone
Address
Zip Code
Legal Description
7- .j—� �> :.: j�l- --- % % (' �i :%cJ :^. -, j - ,�:... ..... �._ +`-_; �'%' j _ `. �.....( o A
;i
Street Location�.-.;.,:, `%/��
Iype of Residence
V Single Family
AIJU
❑ Multiple Family No. of Bedrooms_y�%---
L: ii Other
(L --- APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
Water Supply
( ) CONDITIONAL APPROVAL'
DATE J/
Cl Individual
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
Community
For wells drilled prior to that date, give well depth (attach log if available).
�j Public Utility
Area
Sewer Disposal
Septic Tank Size
N 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
Dale
Dale
Inspector
Inspector
Inspector
Inspector
UN ALTTY--0FAKICR0-RAG —
Field Notes:
DEPT. CSP HEALTH i,
ENVIRONMENTAL PROTECTION
AIJU
(L --- APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE J/
BY:
Soils Bating
Date Sewer Installed=V�efll,Absorption
Area
Well Log Received
Septic Tank Size
T
ank
72023 13102)
X,
r
' r _ -_ BILL SHEFFIELD, GOVERNOR
437 E Street
1 SECOND FLOOR
ANCHORAGE, ALASKA 99501
$"fl'e Q)}I�'.�'VI��/� �' (907) 274-2533
WWII.
P.O. BOX 515
SOUTHCENI•RAL REGIONAL OFFICE- ❑ KODIAK, ALASKA 99615
(907) 486-3350
P.O. BOX 1207
U SOLDOTNA, ALASKA 99669
(907) 262-5210
P O. BOX 1709
VALDEZ, ALASKA 99686
July 22, 1983 (907) 835-4698
P O. BOX 1064
❑ WASILLA, ALASKA 99687
t907) 376-5038
To Whom It May Concern:
According to records on file in this office the Meadow Ridge Water.
System is in compliance with the State Drinking Water Regulation.
JFH/msm
cc: Robbie Robinson
1 8-09 L H
Sincerely,
Ja s Hyden �t
Environmental Field Officer
Ni.,mid alit
MEMORANDUM
DATE: July 25, 1983
TO: Environmental Health Division -- Staff
FROM: Environmental Engineering Manager
SUBJECT: Meadow Ridge Estates Water System
As evidenced by the attached copy of a letter_ from the State
of Alaska, Department of Environmental Conservation, the community
water system serving the Meadow Ridge Estates Subdivision has now
been approved.
This memorandum will therefore remove the temporary hold issued
on on-site water and sewer permits and health authority approvals
for the Meadow Ridge Estates Subdivision, and will be effective
immediately.
Robert W. Robinson
Environmental Engineering Manager
RWR/ljw
91-010 (4/76)