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HomeMy WebLinkAboutMEADOW RIDGE ESTATES BLK 3 LT 3MEADOW RIDGE ESTATES BLOCK 3 LOT 3 051-461-24 NOT ELIGIBLE FOR COSA BECAUSE OF HEALTH ISSUES! 61`11/' I--. MUNICIPALITY OF ANCHORAGE l G/✓Gxrh�E3� �'\ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION II ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PFIONE W NAME /✓�47/ --- ----- 2 %7-04�e,C? ❑ UPGRADE MAILING ADDRESS / �J .LIQ - LEGAL DESCRIPTION LOCATION NO. OF BROOMS yy Absorptio4r6ea Dwelling / PERMIT NO. DISTANCE TO:-NQciG (,�%j7� U - I- Z Manufacturer Material No. of compartments v'r I_iq. capacity pacity, in gallons Inside length Width IP HOMEMADE: Liquid depth �apac' Well �� Dwelling PERMIT NO. 6101' DISTANCE TO: 02.1 Manufacturer Material Liquid capacity in gallons T h 0 W '(( Foundation Nearest lot lint PERMI DISTANCE TO: w y w w y -- 2 w No. of lines J Lengtheach line / AlY Li Total length of lines Trench Idth ' ,:? _ inches Distance between lines r- _ a a h JCl Top of rile to finish grade 6 / Material beneath the 04/ inches Total effective absorption area 0 Length Width Depth PERMIT NO. w — 0depth Q I- Type of crib Crib diameter Crib Total effective absorption area a w w w Well Building foundation Nearest lot line U) DISTANCE TO: __ — m Class Depth Driller Distance to lot line PERMIT NO. _I r w Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: - ® OTHER u ,N PIPE MATERRII " LS r �P�1Z©`i UC. F�""1 � ���On� •ro `%'�u�1t/4// � — — SOIL TEST RATING INSTALLER !1G(/ �jLLp/J J/K� REMARKS •"" r `—�/�dUnl t) "'1l�•Uc� rzy al OOri L:. — — _ UEl�ltlE'i �h z[�c� Gy ✓cs�— -' p — U� q ey —too oa eae a a • �� �— �o Russell L Oys1Er V�sfJ'.VO No. ° _ - `--- t r - -- ---_ - - - - _ ..o APPROVED z"u'Aeg LEGAL �- A 19MQ rRov Z/lRl �U OWN 1: UT� I 1 -711 .-���� PD 12 1 A Irym 1111-1 wa! 1", Q Bin DEPHRTMENT L |EHLTH HND ENVlRUNMENTHL Til CTION 825 /L' STREE{/ RNCHORRGE/ HK99501 0 264~4720 ���-'NE "Ir, �o -1 .1 F . � PERMIT Na /^ ~ RPPLICHNT PRUL HHNS0N 2110 E ]8TH RVE 277 0G60 LOCF!ITION COUNTRY VIEW DR LEGHL L] B] I'll EHDOWRIDGE EST LOT SIZE 49000 SQUHRE FEET TYPE OF SOlL O8SORBTlON SYSTEM IS� TRENCH MAXIMUM NUMGER OF BEDROOMRHTING (SQ FT/BR)� 150 TRE) SIZE OF THE S RPTION TEiI ����� / /� ZV YHE LENGTH DlMENSION IS THE LENGTH (}N FEET) OF NFlELD THE DEPTH OF H TRENCH OR PIT ITHE SURFHCE OF THE GROUND HND THE BOTTOM OF THE EXCHVHTIUN (IN FEET) THERE IS NO SET THE GRHVEL DEPTH IS THE MINI�UM DEPTH OF GR�VEL BETWEEN THE OUTFHLL PlPE HND THE BOTTUM OF THE EXCRVATION (lN F�ET) oot PRE IM U X 100 K 0 0 ��FIN - 9" mlc T to! psi K J, Hill HEH Q CA 10 0 1 CID w"N YR.; PERMIT HPPLICHNT HAS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURlNG THE INSTHLLRTION INSPECTlONS OF HNY 4F., L1 HDJHCENT TO THIS PROPERTY HND THE NUMBER OF RESIDENCES TI OT THE WELL HILL SERVE �HI'rfi P-A� 8HCKFILL1NG OF RNY SYSTEM NITHOUT FINHL INSPECTIONHND HPFROVHL BY THlS DEPHRTMENT WILL BE SUBJECT TO PREUTION. MINIMUM DISTANCE BETWEEN H WELL HND IINY ON~S}TE SEWHGF: �lSPOSHL SYSTEM IS 100 FEET FOR R PRIVHTE W�LL/CORELL D�pENDING UpON THEA OF PUBLIC WELL 150 TO 20� FEET FROM H PUUL1 NSpECIFICRTlUNS ND CONSTRUCTION DIHGRHMS HRE OTHER REQUIREMENTS MRY HPPLY� H RVRILRBLE TO INSURE PROPER INSTHLLRTION. ��������������� �����UK� ��, I CERTIFY THHT 1: I HM FHMILlHR WITH THE R�QUIREMENTS FOR ON~SITE SEWERS FORTH BY THE MUNICIPHLITY OF 2 I WI|L INSTRLL TH� SYSTEM IN HCCORDHNCE WITH TUE CODES� ]' I UND '~ERSTHND THRT THE ON~SlTE SEW[� SY�TEM MAY REQUIRE R SlDENCE` IS REMUDELED TO INCLUDE MORE TI ] BEDROOMS SIGNEDi_~��.�f����...'~�~��~��������.��~~~�^`~~^~~�-~~ H SON :3 . Q T,50- AND WELLS HS SET ENLHRGEMENT lF THE 4'as C1-0Un i Mater Fncountc,i d? 1 F Yr_•; 9 x,C %qha t Dera'ch? it°adinq Date Grnss Time het Time Depth to H,0 Net DrC)I r.c�lation Rate �nutE Prnrr,seallation: Secnaoe fit 11rain Field --- -F -- — Depth of Inset Depth To Bot torn 07 'it Or Trench FIII 5: 15d Sy Ft. IIrarmstl,o �roa r�,nuirr,S�_LLotu ofi11LIS_7-'_LO-16-'-.--------- ---- -- / J t i_ Lit e J _c icrfuir:rd B,____��Data Certified Ly: C'i't_ 6-30-78' I i'ii rl Cl .TI'C 1(0`<:1 \, Cl:f /� ..�(- I. li cI J'Jlr3 rtcrc;r_cS For PrIu1 11:ans„ra f) tc' Fcrfc;rr-.ed 6-30- a n d rl e s c r i n t i o n: I_ o f 3 B l o c f.:3 S u U rf i v 5 'i Ct n _i e d ow_t:t- is rorm Reports SoiIs -Lon Yes' Percolation lest— -----_-__ ent.h t oil Ch�ractrristi c - - — - ____._S ----- -- - ---- -- - Putt ,. BOUld21- I ► _�_ I , � 1 11_l _ I P - s i l.t.y Sandy Gra�'e1 ` 1 ff Pott o:a o;. I'cst Hol a 4'as C1-0Un i Mater Fncountc,i d? 1 F Yr_•; 9 x,C %qha t Dera'ch? it°adinq Date Grnss Time het Time Depth to H,0 Net DrC)I r.c�lation Rate �nutE Prnrr,seallation: Secnaoe fit 11rain Field --- -F -- — Depth of Inset Depth To Bot torn 07 'it Or Trench FIII 5: 15d Sy Ft. IIrarmstl,o �roa r�,nuirr,S�_LLotu ofi11LIS_7-'_LO-16-'-.--------- ---- -- / J t i_ Lit e J _c icrfuir:rd B,____��Data Certified Ly: C'i't_ 6-30-78' Ile � �i /Lt-bj l-�--1� J'Jlq.9�. k.uWIMAI1Tv nK ANCHnRAGC —�'—DEPT. 0, HENLIH & MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL r:-..CTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 Al ` O 6. TYPE OF RESIDENCE _ V 2q� I O ENVIRONMENTAL ENGINEERING DIVISION Telephone 264.4720 R E C E I �— X] SINGLE FAMILY ® Two ❑ Five REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. - --* 1. PROPERTY OWNER PHONE Paul H. Ranson IX COMMUNITY _ 688-3571 MAILING ADDRESS – P.O,Box 8-137. Anchorage,Ak. 99504 depth (attach log if available.) PRORERTY-RESIDENT (If different from above -, - - NHN.Country view Dr,Peters-.Creek Ak; 99567 --- n PHONE -- - 688-3571 2. BUYER -- - Paul H. Hanson PHONE MAILING ADDRESS — 3.NDING INSTITUTIONn, (p- h- - - - - - PHONE MAILING ADDREP /� LAAL-� It k a rir j�i� _i , ,1L 4. REALTOR/AGENT PHONE N/A MAILING ADDRESS 5. LEGAL DESCRIPTION Lot 3 Blk 3 �— Meadow Ridge Estates s/d STREET LOCATION - - NUN Country View Dr. Chugiak,Ak.99567 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ One ❑ Four ❑ Other_— X] SINGLE FAMILY ® Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three O Six 7. WATER SUPPLY ❑ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled IX COMMUNITY _ since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM --- n M INDIVIDUAL/ON-SITE** 1 **If individual/on-site, give installation date _/-%�. If system is over two (2) years old an adequacy test is required C-1 PUBLIQUTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. P1 THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE `D SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE `E7 THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL �E7 COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON -SITEDATE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER INSTALLED _ INSTALLER 'ElSeptic Tank or ❑Holding Tank Size: f CVO If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK .{� MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS &—APPROVED FOR `� BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION t -U i U Mev. o/ /01 Municipality of Anchorage -. Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: Steve Eno Legal description: Meadow Ridge Estates Block 3 Lot 3 The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on ❑ Calculation error in design. ❑ Additional soils information needed. ❑ Water monitoring results inadequate. _ ❑ Discrepancy in information submitted. ❑ Topographic information missing or Inadequate. _ ® Incomplete; missing Survey shows tank In drive. 1. Must be verified by tank manufactorer and engineer that tank can take extra load of being driven on ® Incomplete; missing Or oennanent steel or concrete barriers musle Installed around tank. ❑ Additional adequacy lest information needed. ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. _ ❑ Locations of all soils, percolation and water monitoring tests not shown. ❑ Proposed system too deep for soils information submitted. ❑ Well log required. ❑ Omission in narrative. ❑ Insufficient fill over tank or field._ ❑ Other. Name of reviewer: Jeff Date: 11/16/2005 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK "IWI Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci. anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1. GENERALINFO,RMATION Complete legal description Location (site address or directions) 2 Q Ss 'C_ary V°�cl d �lv� Curren( Property ownersDay phone g9c/—PZ- Mailing address' •: HAA # L5_ Expiration Date: 3 G3 Lending agency Mailing address Real Estate Agent Mailing Address Day phone Day phone K' W_ 9/LS Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ 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 engineers 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. Name of Firm 441t letys fro . Phone _K 76 .2A Address z7,3 7 A.0, Pa, .f Engineer's Printed Name STEVL gVA:j G Date 5. DSD SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory M tRvv 01.071 bedrooms. US OF 41. %1 r••..' fi+l PE V>� bedrooms, with the following stipulations: X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage *S. Development Services DepartmentBuilding Safety DivisionOn-Site Water &Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST' Legal Description:/Z6,4p04!e/ C6 edr JJA B6Y k 3 LO Parcel ID: (5 SI — T % /-;Z4/ A. WELL DATA /�UBLtC t�1Arr.�i� Well type _ If A, B, or C ovide PWSID # _ Well Log ( ) Date completed _ASULTS: l (Y/N) _ Wires properly otected (Y/N) Total depth ftft. Casing heig (above ground) in. AT INSP TION Date of test Static water levelft. ft. Well productiong.p.m. g.p.m. WATER SAMPLE Coliform colonies/100 mi. Nitrate mg.11. Other bacteria colonies/100 ml. Arsenic: _ mg./l. Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material r' Pf.= .3TC Date installed 7/%,P Tank size 06 gal. Number of Compartments Z Cleanouts (Y/N) Foundation cleanout (Y/NY/Ny Depression over lank (Y/N) High water alarm (YIN) /t Date of pumping.?ir Pumper R s C. ABSORPTION FIELD DATA Date installed Z12, Soil rating (gMIMII�or 0bdrm) ,J�E6 System type 7_944,5AG IF/ Length _?? ft. Width -4:;, ft. Gravel below pipe 7_ ft. Total depth ft. Eff. absorption area 53-fe t Monitoring lube 4 Depression over field _a_ Date of adequacy test 1910S Results (Pass/Fail) M For,.T —bedrooms Fluid depth in absorption field before test _0 in. Water addedi gal. ¢ New depth in. Elapsed Timet_ I V min. Final fluid depth Q in. Absorption rate >=�s2 P f- g p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) fjAJAG If yes, give date D. LIFT STATION Date installed "Pump on"level at in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off" level at Cycles tested Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit re irements? SEPARATION DISTANCES FROM WELL ON LOT TO: POSM42- C JO47, 2 Septic tank/lift station on Absorption field on lot Public sewer main Sewer /septic seryice line On adjacent On a2tank Publi Hold Vr is manhoWcleanout SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 rf Property lined Absorption field Water main 4n rf' Water service line �� '/ Surface water Wells on adjacent lots /00 r& SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1,0 rf" Building foundation `I Water main //S r Water Service line 16 rt Surface water _ /dQ vt Driveway. parking/vehicle storage Curtain drain t.KfPd- Wells on adjacent lots /dar F. COMMENTS G. ENGINEER'S CERTIFICATION "v^ f ...... . 11 .. r ...., !� 1 certify that I have determined through field inspections and r ► ;'. -.V i review of Municipal records that the above systems are in ✓ �'�'�-i''`�'' " conformance with MOA HAA guidelines in effect on this date. i 4.!7�r..... r. „ .... Engineer's Printed Name ic E+ Date ���L�.•�''••.., :;..'. Y r^ryi,t� r✓. HAA Fee $ L4 an � Date of Payment Receipt Number (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number y ivy"oz ;sv+w ism �9 ASBUILT SEWARD ASSOCIATES LAND SURVEYING 694 -OP 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: FOLLOWING DESCRIBED PROPERTY: OF At DATE] 2E�dl�/�'/�"Es'�f1J'Jr/�l�T��!%� �+P�� •• 9�,�� ` AND THAT NO ENCROACHMENTS�EXIST F7CCEPT AS of �� r . 'f' 1 INDICATED. IT IS THE RESPONS19ILITY OF THE i �: TM` GRID, iYui/9�z OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS op*:.... i �c WHICH DO NOT APPEAR ON THE RECORDED SUBDI- D.ene Mark S..•ud / VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' /oB_GY '• LS 6918 ANY DATA HEREON BE USED FOR CONSTRUCTION t '� '•.� - • �'t OF FENCE LINES, OR FOR ESTABLISHING BOUND- A VIP \^wny;r� DRAWN'�� ARY LINES.