HomeMy WebLinkAboutMEADOW RIDGE ESTATES BLK 3 LT 2Onsite File
Meadow Ridge
Estates
Block 3
Lot 2
#051-461-23
The absorption field is only sized for up
to 3 bedrooms, so only a 3-bedroom
COSA will be granted.
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211463 PID Number: 051-461-23
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ®Upgrade
Name
DAPHNE GURLEY ABSORPTION FIELD - EXISTING
Site Address ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
21119 COUNTRY VIEW 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 Gravel depth beneath pipe
Subdivision Block Lot Ft. Ft.
MEADOW RIDGE ESTATES 3 2 Fill added above original grade Gravel length
Township Range Section Ft. Ft.
Gravel width Beds: Number of Lines Distance between lines
SEPARATION DISTANCES Ft.
Ft.
To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches
Tank Field Lift Station
From Tank Line Ft' Ft.
Well 200'+ -- 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer Capacity
Surface Water 100'+ __ GREER 1500 Gal.
Material Number of compartments
Lot Line 10'+ __ NA HDPE 2
Foundation *8,5'+ __ LIFT STATION
Manufacturer Capacity
Remarks Tank insulated. *ST 10'+ to house foundation & Gal.
8.5'+ to garage, which FF is below bottom of tank. Alarm location Electrical installed by
PIPE MATERIAL House to tank 3034 Tank to 3034
Installer DIRTWORKS drainfield
Drainfield CO/MT 3034
Inspector F�/�/CS BENCH MARK (Assumed elevation) 100 ft
Inspection15' 11/10/21 Location and description
dates: 2nd 11/11/21
3'd 11/15/21 4'h TOP OF MH RISER
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Conditional Approval: Date •� "�►`""• •' ��
TH
Septic System • • Z.....
Approved - Curtis Huffman
Date 11 ��',�� �%•..�11% 68991• • •�w��',�
Note: this approval does not include well permit requirements. pROFESSIONP .�
(Rev 05/02/18)
PID: 051-461-23 PERMIT: OSP211463
IKEYBOX
Lo
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Q APPROX. WATERLINE
LOCATION
I
A—C=24.0'
B—C=15.2'
A—D=26.1'
B—D=19.5'
A—E=27.4'
B—E=23.9'
A—F=25.1'
B—F=27.5'
37.6'
WATERLINE
10'+ TO ST.
O�
GPS
zo
v')
q `3BR Nc o
e LOT 2
D C DFCO B LK 3
FE
� MH - BM TOP MH
DCO CO
EXISTING DECOMMISSIONED EXISTING
FIELD S.T. & INSTALLED NEW
1500 -GAL HDPE SEPTIC TANK
WITH NEW DFCO & DCO.
NOTE:
TANK IS 11'+ TO HOUSE FOUNDATION &
8.5' TO GARAGE FOUNDATION. BOTTOM OF SEPTIC SECTION
TANK IS ABOVE GARAGE FF ELEVATION.
OUTSIDE & ABOVE SOIL BEARING PRISM.
MEADOW RIDGE ESTATES BLOCK 3, LOT 2 SUPPORT, SERVICES: - F
' 5 AIIIIIIIIIII,
PREPARED FOR: AV �� AZ4 1
DAPHNE CURLEY '0 TH �� 1#
21119 COUNTRY VIEW DRIVEFC. �* 9
CHUGIAK, AK 99567
FIRST WATER CONSULTING DATE: 11/16/2021 0
SURVEY: JLS ` trtis Huffman
13030 SUES WAY DRAWN: FWCS 1 f� CE 128991w
SCALE: 1" = 30' 11/16/2021�+AW
ANCHORAGE, AK 99516 1
1'-wPAGE: 1 OF 1 \ h'OFESgI0�A1'
907-350-9566 FirstWaterAK®gmail.com \\__�
30�
0
ANCHORAGE RECORDING DISTRICT, ALASKA
AS -BUILT OF:
MEADOW RIDGE ESTATES SUBDIVISION
LOT 2 BLOCK 3 PLAT 72-261
SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property, lines and no
enchroachments exist other than noted. Under no circumstance should
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
WORK ORDER NUMBER: DATE: SCALE: E—MAIL:
NOV 15, 2421 1 "=40' schul(er0ok.net
21-161 DRAWN BY: CHECKED BY GRID NUMBER: BOOK AGE
JLS NW1362 210365
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1831 Talkeetna Street
Anchorage, Alaska 99508
(907) 227-1455 office
(907) 274--4992 fax
MUNICIPALITY QF ANCHORAGE
on-site Water & Wnstowaw Program
P4 Bax 1966W 0700 Elmom
Anchorage, Msska99579-5650 Phone: 1907) Fax: (907) 343-7991
On -Sitar Wastewater Disposal Sy5tem Permit
Permit Number. 0$P211463 Effective Data -
Work Type: SepiiGTank Upgrade Expiry Ij on Date;
lax -150ds Number_ ❑ i� 1 ;a�0
5itrb L ogal Arlrinag�r MEADOW RIDGE ESTATES BLIP 3 LT 2 O='I S62
Site MailingAddrr3ss; 21 110 COUNITRY VIEW DR, Chugiak
Owner; CURLEY C3RECORY S & DAPHNE L Lot Sire in Scl Ft;
ae$ign Engineer= FIRST WATER CONSULTING Total Bcdreom!5;
This parmit is for the construction of:
I V212D21
1 1#022
40574
❑ Disposal Field 0 Septic Tank Q Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All coinst~ructic>n shall be in ace-ardanoe! YAth;
f, The attached appfined design.
2. All requirements specified in Anchorage Muno6pal codas Chapters 15-55 and 15,65 and the Slate of Alaska
Wig stewater Disposal Regolatlons (18RAC72) and Ddnking Water Regulations (ISAAC80)
Zl_ Tho wm[cwoler 000c iuqufm2s inapect1pn5 during tris InstallaLiui i_ TJje eriUlaieer shall notify I1h6 Development
Services Department per AMC 15-65- Provide notification by calling (907) 343-7904 (.249)-
4- From October 15 to April 15, a subsurface soil absorption system under GpnskrUolior1 during freezing weal.her
shy II be ellh er_
a. Opened and CloSed len the same day, or
b. Cmmred, sealed, and heated io pfevrnt freezing
spial Proviaians;
f 1) The water service line shall be Iccared prior to plBCemant of the now tank to confirm rninimurin 10 F# separation
10 ELeptio system.
' 2) The 4 -bedroom pernnR applies to rh a tank only- The existing Rk)swp6on field is only sized for up t0 3
li bedrooms, so only a 3 -ked ruorn COSA can be granted utile= fieEd is upeized.
Receiucd By:
Issued By;
11/02/2021
Date:
Da: e:
4
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-461-23
Property owner(s) GREGORY & DAPHNE GURLEY Day phone
Mailing address 21119 COUNTRY VIEW DRIVE, CHUGIAK, AK 99567
Site address 21119 COUNTRY VIEW DRIVE, CHUGIAK, AK 99567
Legal description (Sub'd., Block & Lot) MEADOW RIDGE ESTATES B3, L2
Legal description (Township, Range & Section)
Lot Size 40,574 Sq. Ft. Number of BedroomsA y "
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Date of Payment:
Absorption Field ❑ Initial ❑
Single Family (SF) 0
Septic Tank 0 Upgrade X
(w/wo ADU)
(D) E]
Holding Tank ❑ Renewal ElDuplex
Multiple Dwellings ❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that
this is in accordance with
applicable Municipal Codes.
nature of property owner or authorized agent)
Permit/Rush Fees: 5
Waiver Fees:
Date of Payment: //a 0
Date of Payment:
Receipt Number:211673
Receipt Number:
Permit No. OSP.211 y6 _.�
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
October 29, 2021
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: MEADOW RIDGE ESTATES BLOCK 3, LOT 2
The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic
tank on the above referenced lot. We propose to install a 1500-gallon HDPE tank per the
attached design to serve the existing residence. The lot and area are served by a community well.
The design will not impact any of the neighboring properties. Please contact us if you have any
questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211463, Rebecca Carroll, 11/02/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211463, Rebecca Carroll, 11/02/21
NAME
MUNICIPALITY OF ANCHORAGE
DFPARTMENT 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
R-2, S\5 UPGRADB
LEGAL DESCRIPTION
LOCATION
IO' DISTANCE TO: Well Absorption area
~'Z ,Manufacturer '~_~
DISTANCE TO:
Manufacturer
We
DISTANCE TO: "-~
No. of,,nes
Top of tile to finish grade
Length
Type of crib
DISTANCE TO:
Class
DISTANCE TO:
Width
Crib d] a m e t e~,~_~ ~__
Well
Building
Dwelling
]Mate~i~
/WTd~
NO. OF SEDROOMS
PERMIT NO.
No. of compartments
Liquid depth
IDwelling PERMIT NO.
Liquid capacity in gallons
Foundation
Material
JNea,eat i.e
Material beneath tiie
Depth
Driller
PERMIT NO. "'] ~O gg(~
Total effective absorption area
PERMIT NO.
Total effe~i~ gbsorption area
Nearest Iot~ir~r~ ~-,~ ~, Ill,,,J ~,.~1
OTHER
PIPE MATERIALS
SOIL TEST RATING\ ~
INSTALLER
--' DATE
72-013 (Rev. 3/7~)
. .LEGAL
::tPI::'I.. I CFINT F'LFITZEK I.]:OI'.,I'J~;TI-;i:IJCT I
~.OC:Ffl ]" '[ C I'.,I C~4~~~
...EE!iI::IL L2' E:]: MEFIDO!-'.I I';.'.I[:'EiE S,."b
8()',=.,: 5;?.2:: CI...IIJG I FIK
I,...OT :~.!; i ZE
688 25::l..5
:5 (;!t..IFIRIE F:'IE IF_{ T
'f'"r'PE OF 2!;OIL. RE',SORE:TION 5'¢STEM I5: TREI"4CH
FIFI',:.:;II"'IUM I'.,IUI"IE:EI:?. OF E:E[:,ROOM'."~ .... 2-::
~{!;OIL. RFITING ,.'.".:~6! FT,.."DR)::"- ::LSE:.~
THE RE6!U IRE[:, '.:E]I ZE:. OF 'I"IaE SO I L.. RF~:SORF:'T :[ ON E;"r'STEM I S:
'FF.IE L[;.N(]iTH DIMENSION l'S THE LENGTH ,:::f.N F:EE'r) O1::' THE TREI':,ICt-I OR
"I"HE I:::,EPTH OF R TRENC:H OR F'IT Z'.;L:; THIS [:,ZSTRNCE BETHEIEN THE SIJF.:FF:iCE OF:' THE
GIROIJNE:, laN[:, THE BOT'TOM OF TIqE E',:,.iCFI',/FCFION ,::l'N FEET).
THERE I LE; lqO SET I.,.I ~ [)]1-1 FOR TREi'.4ClaE':':;.
....... '" .:~v. '-i ~-.~ E,E. II ILE..I'4 THE OUTFFIL..I. F:'TF'E
THE .:F..H,I::L E:,[CF'TH I:E; THE f'IINIMUM,E:,EF'TFI OF -F,,'-',,,,'-- ,' .... :':. ..
FINE:' THE E:O]"TOM OF'" 'THE E,s,',CIg,,,'FFF I C.$,t ( ]: N FEi'.:Fr).
I::'EF:.:M I T RI::'F'L I CFIN'[' HFIS THE RE'SPONf51 E: I L.. i 'T"r' TO I I",IFORM TH I S [:'EF'FIRTMEI'4]' DLIR :[ IqG THE:
I N':'~;TF~LL..laT I ON I NSPECT.T ON~r.i OF f:lN"r' HELLS RD,)'FfCENT TO TH I L:!; PF;.:OPE:RT't' RNI?' THE
NUMBER OF RES]:DEI",ICES THRT THE HELL. HI[J.L. ':'i;ER"/E.
E:FICI':::F ILL I NG Of::' F:li"J"r' S"r'.'STEM 14 I'['I'4OL.IT F :[ NFIL. ;[ I',ISPEC'[ I ON RNE:' RPPRO',,,'FIL. ['.:Y'r' "I"H };
[:'EF'fflRTf"IENT H:[t..L BE ::JUI.E:...TEC..'T TO PROSECLIT:[ON.
MI'N:[MLIM [:,ZSTFINCE 8ETHEEI'.,I R HELL
::LEvEl FEET FOF). FI F:'RI',,,'FITE HEL. L.~ OR
&SE~ TO 20C~ FEET F'RLqM 6t PI..IBL.):C HEI...L E:,EPEN[.',]:NG UPON THE T'fI:'E OF F'UBL.IC: I.,.IEL[ ....
Cd"HER RELqlJ ].' REI'"IENTS MF"t~r' FIPF:'I..."r'. SPEC :[ F"I CRT IONS F~I',I[:' CON'-=.;TRIJE:T I ON E:' ]: RGI:;?.I::IM:i~; t:::IRE
FI'v'FI]:LRDL. E TO :[i",I%URE PROPER II'42;TFIL. LF~TION.
:[ CERT];F"r' THFIT
::L: I F:IM F:RM:f. LIFIR 1.4ITH 1"HIE RE6:!LIIREMENTS FOR ON-2;ITE SEI,.IERS RN[:, HELl....'.:.!;
F;'ORTH E?¥' "I-HE MUN ;[ C ]; PRL I T'¥' OF I]I'.4CFIORFIGE.
;?.: ): WILL INSTFtLL THE S'¢.'F.,TEM ]:N RE:COR[:,FIi'.,ICE 14ITH THE CCIDE'.i::.
:ii:: ]: UNI:)ERSTI::IN[:, THFFI" THE ON.-...:}..iITE 2;EI4ER ':-S'¢'S'f'EM MFI'¢ RELqlJ]:iq:E EiqI..I-[. EI1EHt IF:' TIql[!:
RE'.'5iDEI',ICE I'.:!; REMODELED TO II',ICL. IJE)E MORE THFIN ii: BEDROOMS.
'.'51G lql'£[): ~..~~ .~-
T F:,L F~'~-f RIJ C T ]] I~.l~".l
QGRF
ER ANCHORAGE AREA BO JGH
Department of Environmental quality
3330 C Street
Anchorage, Alaska 99503
NAME ~
LOCATION
INSPECTION
LUe ~, r
REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
NUMBER OF
INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY GALLONS.
SEEPAGE PIT:
NUMBER OF PITS ~ DIAMETER
LINING MATERIAL
BUILDING FOUNDATION
ADDITIONAL ABSORPTION
OR WIDTH J'~', LENGTH I~~/, DEPTH
CRIB SIZE: DIAMETER ~* DEPTH t/ DISTANCE FROM: WELL
TOTAL EFFECTIVE
NEAREST LOT LINE ABSORPTION AREA (WALL AREA) ,~'~'
SQ. FT.
WFLL:
BUILDING
FOUNDATION
CESSPOOL
APPROVED
CONSTRUCTION
NEAREST
LOT LINE
., OTHER SOURCES
DISAPPROVED
NEAREST
SEWER LINE
REMARKS
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TANK __ SYSTEM
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form No. EO--031
DIAGRAM OF SYSTEM
Certificate of On -Site Systems Approval
Parcel I.D. 051-461-23 Expiration Date: V CJ c2 8 , a 0'? .3
1. GENERAL INFORMATION
Complete legal description MEADOW RIDGE ESTATES BLOCK 3 LOT 2
Location (site address) 21119 COUNTRY VIEW DRIVE, CHUGIAK, AK 99567
Current property owner(s) GREGORY & DAPHNE GURLEY Day phone
Mailing address 21119 COUNTRY VIEW DRIVE CHUGIAK AK 99567
Real estate agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
❑
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
®
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 550
Date of Payment 1 (Jr � D)- 1
Receipt Number 3 i, t 1 3
COSA # OSC g 11 L� q
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY ANCHORAGE AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 11/12/2021
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 ,�1��
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any estimate of how long a system will function satisfactory '��Q;•' • ••
for current or future occupants or guarantee that no unseen encroachments, deficiencies or g. ,�
discrepancies exist can be given by First Water Consulting &
/ Q9 _
Fwrs j .
6. DSD SIGNATURE
•. Curtis Huffman /
System #1 Approved for 3 bedrooms �j�P<`9 CE 128991
System #2 Approved for bedrooms ,1iF�PROFESSTO
Disapproved
Conditional approval for bedrooms, with the following stipulations:
��.�•� Ur -your,,,
(CN-S�TE,n
W A1ER,, -SER o
5
By: Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist
Legal Description: MEADOW RIDGE ESTATES BLOCK 3, LOT 2 Parcel ID: 051-461-23
If more than 1 septic system on lot: COSA Checklist #
of
Structure served by this system
A. WELL DATA – COMMUNITY 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 gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date of Sample
Comments __________________________________________________________________________________
B. TANK DATA
Age of tank(s) 0 – NEW TANK years
Tank type/material SEPTIC / HDPE
Measured operating fluid level in septic tank NEW
Standpipes/foundation cleanout per record drawing
Date of pumping NEW TANK
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 6/30/1978
ALL standpipes present per record drawing
Total measured depth from grade *11.1 ft (max)
Measured depth to pipe invert from grade 6.1 ft (min)
N/A – pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective 5’ OF THE 8’ ED
Code-required soil cover over field
System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Adequacy test date 10/28/2021
Results Pass For 3 bedrooms
Fluid depth prior to test 3 in
Water added 600 gal
New depth 14 in
Elapsed time 1400 min
Final fluid depth 1 in
Absorption rate 450+ gpd
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Comments/Deficiencies: *AT MT INSTALLED ON 6/11/1998
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
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
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No *8.5+ ft
Property Line > 5’ Yes if No
ft
Absorption Field > 5’ 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 septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10’ Yes if No **6 ft
Property Line > 10’ Yes if No **3 ft
Water Main > 10’ Yes if No
ft
Water Service Line > 10’ Yes if No
ft
Surface Water > 100’ Yes if No
ft
If absorption field is under driveway comment below
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No
F. ENGINEER’S COMMENTS
*TO GARAGE FOUNDATION – ST IS ABOVE GARAGE FOUNDATION. **EXISTING MOA WAIVERS / APPROVAL.
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.
11/16/21
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental ServiCes
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343~4744
Parcel I.D. #
1.
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description got 2f
Location (site address or directions)
, ...,~ ~ C,,..¢. ~
Block 3, Meadow Ridge Estates
21119 Country Drive, Chugiak, AK 99567
~ .,Prop. erty owner ',~-,*,~. Daohn~ ¢--;r.3.e~. Day phone
~(..,..Mai]i:ng address ...... 2i119 Country View Dr., Chugiak, AK 99567
~,."-Lending agency ' -ci, ty Mortgage Day phone
%Mail!ng address :
694-216].
263-0?00
/(gent
Add ress
J. D. Meecham
Day phone
121 W. Fireweed Ln. , Suite 120, Anchorage, AK 99503
263-0700
e
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: c,','] _
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
xxx
NOTE:
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
XXX
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91} Front MOA ~21
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
S & $ ENGINEERING
Name of Firm
17034 Eagle River Loop ~oad No. 204
Engineer's signature , _ _-
Phone
=
DHHS SIGNATURE
/~ Approved for ~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
The Municipality of AnChorage Department of Health and Human Services (D~:~$) issues Health Auti~ority
Approval Certificates based only upon tt~e representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DH H$ does this as a ¢ourtesy to purchasers of homes
and their lending institutions in order to satis~ certain federal and state requirements. Employees of DHH$ do not
conduct inspections or analyze data before a certificate is issued. The Municipality of An¢l~orage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA
RECEIVED
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICI~N ;~ 0 1998
Environmental serVices Division MUNICIPALITY OF ANCHORAGE
825 L Street, Room 502 o Anchorage, Alaska 99501~(9~::~:~14f,-c~[~4~s
Legal Description:
A. WELL DATA
Well type
Health Authority Approval Checklist
'l~z~.v_.~. ~,~ t~Ai~-',,J l~,~Parcel I.D.: O
If(~B, or C, attach ADEC letter. ADEC water system number
p t (Y/N) , Date completed
Total .-, Cased to Casing height (above ground)
Sanitary seal (Y/N) '"~ Wires properly protected (Y/N)
FROM WELL L~G.~.~ .~ AT INSPECTION
Date of test
Static water level
Well production g:p.m. ~'--~
Coliform ' qqT~a'te---~---_~. Other bacteria
Date of sample: Collected byl ~'~.~.~.~
B. SEPTIC/HOLDING'rANK DA'f~
g.p.m.
Date installed ~/)~-/~:~' Tanksize IC~),¢u~ Number of Compartments. 0 i Cleanouts(~J)o~, _
Foundation cleanout Yf~) ~ O Depression (Y/~ '~ (.) High water alarm (Y/(~) /~.t/~
Date of Pumping_~. ~ ~ Pumper ~,,j~
C. ABSORPTION FIELD DATA
Gravel thickness below pipe
Effective absorption area .;,,'iL_ ~'~' Monitoring Tube present CN)
Date of adequacy test (-~!'')~[(~' t Results a~ail).
Fluid depth in absorption field before test (in.); I'~ ~ . ImmediatelY after ~(o~gal. water added (in.):
Fluid depth I ¢- ~,', (ins) Minutes later: ,~5 m),~ Absorption rate = '"~'~0+ g.p.d.
Peroxide treatment (past 12 months) (WN) ~..4~r, ~j~t4~-~ If yes, give date ~~'-
bedrooms
72-026 (Rev. 3/96)*
Date installed ~ Size in gallons
Manhole/Access (Y/N) "Pum~
*Datum
High water alarm level at*
Cycles tested
E. SEPARATION ~
SEPARATION DISTANCES~/~OT TO:
Septic/holding tank on lot "~--.~_ On adjacent lots
Absorption field on lot -'"""'""~'~r~~ots
Public sewer main Public sewer manh~
Sewer/septic service line Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ¢ '-'r Property line ~ ~ A- Absorption field
Water main/service line i(; I ~- Surface water/drainage ioo' ¢ Wells on adjacent lots
"Pump off" level at*
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
6,1
Property line '~ (~'/'"~ iduildif~g foundation
Surface water
Curtain drain
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots *?...o o
ENGINEER'S CERTIFICATION "~ "~
I ceRify that I have determined thru field inspections and review of Municipal records that the above systems are
in conformance~~ ~with MO~ H~A~uidelines in effect on this date.
Signature ~~'~~
Engineer's Name ~¢~¢~ C, ~O~
72-026 (Rev, 3/96)*
GALL ON YOUR COMPANY ...... :.'.,AJJfi.:~:d~',l:~
·:..,:r ~ ~',~%.u-:
NON-OB~CTION TO EASEMENT ENCROACHMENT DOCUMENT
By this document Matanuska Telephone &~¢~ihlion. Inc. (MTA) decl~es that it has no objection to
encroac~ent of Leach F~eld w~thm time,tatted Utilily Easement upon said Lot 2, Block 3, Meadow Ridge
Please be advised that MTA through the issuance of this document does not forfeit any of its rights to the use
of the area cited. In the exercise of these rights MTA will, if needed, upgrade, maintain, repair, and/or replace
buried or aerial telecommunications facilities within the easement. Any repairs that may be required to the
encroachment as a result of utility construction will be borne by the property owner of record. This docmnent
does not authorize the placetnent of' any additional encroachments within thc easement area.
This document is, in no way, an agreement t9 v~cate auy portig.n of the utilitv easement an¢ shoql, d. nm be
interpreted as. ~ch.
Issued for Matanuska Telephone Association, Inc. this 29th day of June, 1998 by,
THIS IS 're CERTIFY, that on this 29th day of June, 1998 before me the undersigned, a Notary Public in and tbr
lhe State of Alaska, duly commissioned and sworn as such, personally appeared Becky Glenn known to me
and to me known to be the individual named in and who executed the foregoing instrument and acknowledged
to me that he signed and scaled the same as a volunf~ry act and deed for the uses and purposes therein
mentioned. , ,,,~?.'
· ~.' .. .-.,, ...... ... ~'~!~!.. '" .~¢,u'; .v~,--
IN'WITIxIES~.~I._Et~. O~, I have hereunto set my hand and official sea!j...th, e day and year first abc (~
,. 'x::r',:.. ;~.. . ..~. ~ .s~...,..,,~· -~. ..... ....~,.,ff. .... ..-. .... ; .... ,,~
: : ,,.~-~' ~.~: . .Notar7 Public in and for ,.~~ ~.;...:~
' ' .~ -. ,%. ,,~ikX-"' ~. ~. ~. , x...-. "'~;'~ .'.'.~ . . . .... ~ ~ffi~g~,~',,f,,t~,'.w....'. -
'.~."~*~'~'~i':'~.~' ~.~.%~/t '~ .....:';: "~;.~mmission ~n~~ _~.. '~lffi~ ?:......,,,, .....,:-.-
~d" "" "/','~.~.~. ~"" ~o¢.'JZ- ~,~ ..... ~.~i~i~¢.--:: ,-
~ .... .. -~, x',_v,,.-, .. · .......... , ~-....~,, ~,a~ . ~ ' · .
· ~w.,..~.~ ~ .......... -' · ~...~ . '"~.~..~.~~..'~'
GRAlxlTORS ADDRESS: ' '""?; ';': GRA~T, EE~C?C;DB'~F. SS:
· Please Return to: .: .--' ·. :,: ..... ~.~,
Matanuska Telephone Association, lnc~ i'.'. · Olifley;"Joe Allen & Betty
Ke~fl .ESlate and Properties Section ' 6911 Starkes Grade Road
..-P,Q.B0x. 3550 . .~.:.'~;' '.!:: .'. PolloekPincs, Calif. 95726
~.;r. ".,'t;,¥~t ~..~ ,~.~ '~
Mntsnuska -rolephona Association, Inc.
P.O. Box 3560 · Palmer, Alaska 99645-3550
1.800.746,gE, 10 .* 907.761,2510 · Fax 907.761,26a. 6
3une 29, 1998
Greg or Daphne Gurley
21119 Country View Drive
Chugiak, Alaska 99567
Dear Mr. or Mrs. Crurley,
Subject to your agreement to indemnify the company as set forth below, GCI Cable Inc.
of Alaska has no objection to the septic system encroaching into the utility easement, on
Lot 2, Block 3, Meadow Ridge Estates Subdivision, city grid NWl 362.
This letter of non-objection in no way precludes GCI Cable from full use and enjoyment
of' any rights it may have within any portion of the right-of-way, including unlimited
access for servicing its facilities.
By signing below, you agree to indemnify and hold GCI Cable harmless, now and
£orever, for any damage, costs, expense (including reasonable attorney's t'ees), liabilities
and injury to any person or property occurring as a result of the encroachment.
Please indicate your acceptance by signing and returning this letter,,~o myself at the
address below. C\
· '" Accept ce
System Designer Date [
,5151 Fairbanks Street · Anchorage, Alaska 99503 · 907/786-9260
Cable services provided bv GC.I Cable, Inc.
~KUM ~N~lSN-NaZurai-baS WU/ DDL UBOJ BO-LO-~D BL:31MM IU I~B/~LDJg~ ~3L/
June 26,1998
Gre~ Gurley
2119 Country view Drive
Chu~iak, Alaska 99S67
Dear Mr. Gurley:
ENSTAR Natural Gas Company has no objection to the sewer
septic system (leach field that encroaches into utility
easement on Lot 2 Block 3 of Meadow Ridge Estates
Subdivision. This easement is not needed by "ENSTAR".
If you have any questions please call me at 264-3743.
Right-of-Way Agent
Post-It~ Fax Note 7671 D.~. ' #,~1 I~
co.~oe~:t, ! co....~......-.~ ~.. ~_~,
Phone ~ Phnn~ Il
F~ ~ F~ ~
STATEMENT OF NON-OBJECTION FOR ENCROACHMENT
WITHIN UTILITY EASEMENT
Matanuska Electric Association, Inc. (MEA) has no objection with the location Of
a septic s~,stem within the utility easement
along the west boundary of the following property;
Lot 2, Block 3, MEADOW RIDGE ESTATES SUBDIVISION, according to Plat No.
72-261, Anchorage Recording District, Third Judicial District, State of
Alaska.
This non-objection is conditioned by the stipulation that MEA will be held
harmless from any and all damages to the encroachment that may result from the
existing and future use of said easement.
by:
Matanuska Electric Association, Inc.
Gdneral Manage, r"or his Representative
Date
MEA ACKNOWLEDGEMENT
STATE OF ALASKA
THIRD JUDICIAL DISTRICT
)
) SS.
)
The ioregoing agreement was acknowledged before me this
day of June , 1998 , by Robert Ylvisaker
26th
Notary Public for the State of Alaska
My commission expires: C/-2-(~)/
333.1/121~.1
Rick M/strom,
Mayor
Depar[rnent of Health and Numan Services
825 "L" Street
P.O. Box196650 Anchorage, Alaska 99519-6650
htt p:.r',rwW~v.ci.anch O rag e. a k. Lis
July 13, 1998
Robert C. Cowan, P.E.
S & S Engineering
17034 Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Subject: Waiver Request for Lot 2 Block 3 Meadow Ridge Estates S/D
Waiver Request #WR980029, PID #051-461-23, HA980i70
Dear Mr. Cowan:
Your request for a waiver of the required 10 foot separation
between an on-site wastewater disposal system and a lot line has
been approved. The waived distance is 3 feet from the leachfield to
the south property line.
This approval applies to the existing on-site wastewater disposal
system lot line separation only. Any future upgrade to the on-site
wastewater disposal system will require all separations be met or
another approval from this department.
If there any further questions or concerns regarding this waiver,
please cai]. our office at 343-4744.
Sincerely,
Civil Engineer
On-site Services
ljw //7
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
PID~ 051-461-23
WR~ WR980029
Date Received: June 30~ 1998
Legal Description: Lot 2 Block 3 Meadow Ridge Estates
Engineer:
Applicant:
Waiver Requested:
HA9 HA980170 Permit
Robert C. Cowan~ P.E.~ S & S Engineering
17034 Eagle River Loop Road, Suite 204, Eagle River. Alaska q9577 __
Greg & Daphne Gurley
Leachfield to south, property line of 3 feet
Criteria: 1. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
Waiver zs Granted: ~ Waiver is NOT Granted:
List Conditions or Reasons for above: ~E ~/~£~f ~U~£~
Date: 7~ 7-~ By: ~
Name of Reviewer
Rec ~: 03759/2463 Amount: $ 115.00 Date Paid: June 30. 1998
meemn
ROBERT C. COWAN, RE.
ROBERT A. SHAFER, RE.
June 29,1998
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
HEALTH AUTHORITY
APPROVALS
S EWER & WATER
MAIN E~TENSIONS
SEWER&WATER
INSPECTION
ENGINEERINGSTUDIES
AND REPORTS
WELL INSPECTION
& FLOW T EST
SiTE pLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
MUNICIPALITY OF ANCHORAGE
DepmtmentofHealthand Human Seiwices
P.O. Box 196650
Anchorage, AK 99519
REFERENCE: Lot 2; Block 3; Meadow Ridge Estates
RECEIVED
JUN L5 0 1998
Municipality of Anchorage
Dept. Flea]th & Human Services
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
property line at 3 feet, We do not anticipate any adverse effect on the adjacent
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/gk
17034 NORTH F~,GLE RIVER LOOP ° SUITE 204 ° EAGLE RIVER, ALASKA 99577
! 50.00
N ~°02'bO"~ 153.79
CHUGACH STATE PARK
' ~m -,<~..o~ ~. ~ . , .