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HomeMy WebLinkAboutMEADOW RIDGE ESTATES BLK 3 LT 4 GREA,,'R ANCHORAGE AREA BORL,, GH ,~¢ .,.,~ Department of Environmental Quality ~ 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-51TE SEWAGE DISPOSAL SYSTEM LOCATION SEPTIC TANK: DISTANCE ~A~- FROM WELL MANUFACTURER. INSIDE LENGTH INSIDE WIDTH MATERIAL LIQUID DEPTH NUMBER OF COMPARTMENTS /~;~:) LIQUID CAPACITY__ GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL FOUNDATION NUMBER OF LINES / __ DISTANCE BETWEEN LINES ABSORPTION AREA SQ. FT. DEPTi I: .NEAREST LOT LINE TOTAL LENGTH OF LINES ¢.=~. TOP OF TILE TO FINISH GRADE TRENCH WIDTH IN. TOTAL EFFECTIVE LENGTH OF EACH LINE DEPTH OF FILTER f _ MATERIAL BENEATH TILE~O- IN. ABOVE TILE '"'/ IN, WELL: TYPE BUILDING FOUNDATION__ CESSPOOL APPROVED CONSTRUCTION NEAREST NEAREST LOT LINE SEWER LINE , O-FHER SOURCES DISAPPROVED DEPTH SEPTIC SEEPAGE 1-ANK __, SYSTEM REMARKS __ DISTANCE FROM: DISTANCES: ._ __ DIAGRAM OF SYSTEM INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS: Form EQ-032 FI F':' F:' L ii: C (::1N '/" L J]]:J Jif:: j:zj -j-' 11] (:)N L E G FI I... I)EI:::'FIR'T'HEI'.,t'T' OF= HE'I::II...TH FII'.,tE:, ENV;[I:;.:OI'qI'"IEI'.,I'TF:II.... F'I;.:OTEC"FION :~5::1.6 E. "l"l. JIi:,Oi::~'. l::~:lZ]).., I::If.,tC.:HORI:::IGfE, Fhk:]. 2 7 E;--,. 2 2 2 ::Eg E] II..,,..tt E'E IF;~'.: IF" II:!EE IF;E:: Il'--il % ""IF · r 3E CH.,.IE.:I'.,I::5 COI'.,ITP."r~ ' 'I EH [:'R i....4. ..L,. :J :L I'.,11. t'.,IFIk:f::l I...OT '.E: :[ / / ,CSL_H £) /'Y L ~: ;(1.3E:JE:J ':: :' . F:I[;~:E F:'EE71" T"¢I='IE OF' :5.3:1: L. FtF3':= OF.'E',]" I O1",1 .= ~ .:: I El I :[ E; ' "I"F;:Et",!E:H I"IF:I::':: 1 I"'11...11"1 I',IIJHEJER OF E',EB, RE~OH:E; = 3 'E';O Z L.. 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IDNICIPALITY OF ANCHORAGE Deparhment of Health and Environmenkal Prohection PERCOL~IT iON TEST Performed for Joe Legal Description 10 12 14 16 18 Date Performed :','! [..~, [ ~q 20' '~?.3-' ~o-.~r- ~ ,n-.-s. ~..,/~;o, ,~ ~.n~,~" ~,-.~ {; .: ce s4 ]P~e~.,~.i ~' rate: 85 f%~%dr/ C, 'ii' ep !,O~'tO ~NC©tlp{',.eFO,a Date Net Time Percolation Rate Depth minute C", Net Drop F'I~.ELIM INAI~,Y I hcreb~/ cerLify that f have surveyed the following ~"z . '~ ...... :-, -/ --~~ Anchora:e Recording PrechmL AMs]m, and that the pro- posed improvements, as planned thereon by the builder, will be within the property lines and will not overlap o: encroach on the property lyfn~ adjacent thereto, that no improvemezts on property lvin~ adjncett thereto encronch on ~ho premiEos ~n question ~nd thn~ ~he~e are no roodways, tFansm{saicn lines o:' other visible ease- ments on said property except ns l~dicnted hereon. Dnted at E%gle lliv~r, A}nska I~OBERT SCALE: Re?.istered I,and gurveyor 1" :-. z/-,(, Box 45[k Ea~de River, Alaska Phone 694-2543 MUNICIPALITY OF ANCHORAGE Development Services Department m: Phone: 907-343-7904 On-Site Water & Wastewater Section �— Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 051-461-25 Expiration Date: 3 _S -ZCIz 0 1. GENERAL INFORMATION Complete legal description MEADOW RIDGE ESTATES B3 L4 Location (site address) 21035 Country View Drive Chugiak, AK Current property owner(s) Paul Chanek & Karen Lester Day phone Mailing address 23084 Butterfield Trail Bend, OR 97702 Real estate agent Day phone 2. TYPE OF DWELLING: H Single Family (w/wo ADU) ❑ Duplex n 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 U Water Storage ❑ Holding Tank _ Community Well ❑ Community Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 550 n Waiver Fee $ Date of Payment .3 l'7 Date of Payment Receipt Number O t-M Receipt Number /� COSA# 5c fa 04 Li 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year, and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system.All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system.The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. Date /q 830- OFA•gS9t 6. DSD SIGNATUREf • • •• System #1 Approved for 3 bedrooms ' :•t�v n R. =annon r CE 814;! • act System #2 Approved for bedrooms �� ' Disapproved 1\w �10"-"`^' Conditional approval for bedrooms, with the following stipulations: tet" t'4 d ,rte111 WPI Ewk`c o ?•<> PRpGIV° Q .�c) -IrivT S cam, By: Original Certificate Date: 3 S 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 blue sheet COSA Checklist Legal Description: MEADOW RIDGE ESTATES B3 L4 Parcel ID: 051-461-25 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system 1 A. WELL DATA El Well log is filed with Onsite (or attached) Well production at time of test gpm Date drilled Water storage tank volume gallons Total depth ft Well disinfected for coliform test? ❑Yes El No Cased to ft ❑ Coliform bacteria is Negative El Sanitary seal is functioning correctly Nitrate mg/L ❑ Nitrate less than MRL(ND) El Wires are properly protected Arsenic ug/L ❑Arsenic less than MRL (ND) Casing height(above ground) in. Collected by Date of flow test for COSA Date of Sample Static water level at beginning of test ft. Comments PUBLIC WATER B. TANK DATA C. LIFT STATION Age of tank(s) 43 years El Required maintenance completed Tank type/material SEPTIC Age of lift station N/A years Measured operating fluid level in septic tank * Lift station material N/A 1:1Standpipes/foundation cleanout per record drawing Comments: *CONCRETE TANK PUMPED BEFORE Date of pumping 3/5/19 TEST D. ABSORPTION FIELD DATA TRENCH Which system tested (date installed) 1976 Adequacy test date 3/5/19 ❑ ALL standpipes present per record drawing Results ❑✓ Pass For 3 bedrooms Total measured depth from grade 13 ft(max) Fluid depth prior to test 30 in Measured depth to pipe invert from grade 4 ft(min) Water added 450 gal ❑ N/A—pressurized field New depth 42 in I1 Monitor tubes go to bottom of effective. If not, state Elapsed time 160 min depth into effective 0 Code-required soil cover over field Final fluid depth 30 in Absorption rate >450 gpd 0 System presoaked N/A (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) date of test) If yes, enter date Gallons introduced * gallons Comments/Deficiencies:'+1.1500 GALLONS DRAIN°FIELD FLOODED COSA Checklist yellow sheet 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' Community Sewer Manhole/Cleanout> 100' 0 Yes if No ft 0 Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' 10 Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank> 100' 11 Yes if No ft Neighboring Absorption Fields > 100' Animal Containment> 50' 0 Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft �Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water> 100' 0 Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells >200' 0 Yes if No ft Water Service Line > 10' ❑✓ 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' 0 Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells >200' 0 Yes if No ft Surface Water> 100' 0 Yes if No ft F. ENGINEER'S COMMENTS (� fev [ tkee 1W S-kai�.d p t' s vv' ;cid 'c *ain `( f`rs i'' --1-tp 3-t i 9' G. ENGINEER'S CERTIFICATION ,SOF I certify that I have determined through field inspections and review g 1 ••• of Municipal records that the above systems are in conformance with *149M. i" %.* MOA COSA guidelines in effect on this date. 06041•40 t Q "tleven -. -annope vim.. CE 8149 .: . iiii3 COSA Checklist yellow sheet � { NN ' \ A N CO NN e!/�A z N N, <a r �� 0. •'� w OR I yEm o� ?6F4.2• Vim z 2 ��.>• 14100 @'O --r- _ 0r c r, A 1 O O_ Y + C _ - ia in o u m. • K N 0 O N T m 0 J 0 0 m r' _ x v T9 2 D -aa a) o o N W� K zO' , ti _ Cc„ Y .m 0 D. a i � O Or NA a !v CM N I nt m co or- 0 al-4. .00'OtZ 3.0G,Z0.00 S Mdt.'d 31d1S HWVOf?Ho PLOT PLAN — AS BUILT X SCALE 1" = 50' GRID NW 1362 Project No. 19-050/R1 Lang & Associates, inc. (150007) l Avenue, Anchorage, Alaska 69Q9QSO154-3-3049 (907) 522-6476 Phone Professional Land Surveyors (907)kenOlangsurvey.com522-4625Fax ..f.6:'� OF ..,4 1 JonathanOlangsurvey.com GoP 'r I hereby certify that I have surveyed the following described property: OOH' ''.44/0A LOT 4, BLOCK 3, MEADOW RIDGE ESTATES SUBDIVISION (PLAT No. 72-261) 0 49TH /� *V� Anchorage Recording District, Alaska, and that the Improvements situated thereon ore r,, !r VA within the property lines and do not encroach onto the property adjacent thereto, that Q • no Improvements on the roe lying adjacent thereto encroach on the surveyed r....-4-:..•• pP property rtt Y 9 J Y O" '. remises and that there are no roadways, 4 A KENNETH G. LANG •. easements on said property except as idicated hereon,lines or other visible (/S sii, {V0 ". QO VV14q�••.t.S-5202.•'y)1d Dated this the ` ' Day of :">` , ••• , at Anchorage, Alaska Q •••••••' p ,qO •o 400ga�SS10NAL o0 It Is the responsibility of the owner to determine the existence of any easements, Opppoa4 covenants, or restrictions which do not appear on the recorded subdivision plot. AECC963 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 CERTIFICATF OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 4; Block 3; Location (site address or directions) Property owner Mailing address 21035 Cou'nt]~tl Vie~ Drive p~ers Cr~E, AK Joe. Ow2.t~s P.O. Bo~ 772633 EAGLE RIVER, Day phone AK 99577 (w) 552-3194 (h) 694-1602 Lending agency Mailing address__ Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: XXX -~ Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 'TYPE OF WASTEWATER DISPOSAL,: Individual on-site Holdin9 tank Community on-site NOTE: XXX Public sewer 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 seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Flealth Authority Approval application shows that the on-site water supply and/orwastewaterdisposal 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 Phone DHHS SIGNATURE /~ Approved for ,/ Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Departmant of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to 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 prof~.ssional engineer's work. 72~)25 (Rev 119 ) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:~*¢' /Jr 6~.-¢- % t'~,¢.4,4~, ¢-~p~,¢ Parcel I.D. A. WELL DATA Well type_ If A, B, or C, attach ADEC letter. Date completed Log present(Y/N) Total depth Sanitary seal (Y/N) ADEC water system number Driller Cased to Casing heig ht_~ ~'--'~'-'~'-"----' Wires properly~ FROM W AT INSPECTION Date of test Static water level Well fl~ P u,p.J::P4~ evel g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot ; On adjacent lots ; On adjacent lots Public sewer main Sewer service line WATER SAMPLE RESULTS~.~ Coliform ~ Nitrate Public sewer ma~ .~ank Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~ ~ ~1 L~ Clea nout~..~/N) ',¢ High water alarm (Y~) Date of pumping \ D ~ Tank size \ Lb ~5 ~ Compartments Foundation cleanout ~/N) k{ Depression (Y/~ I~ ~ Alarm iested (Y/N) · ,~/¢~ Well(s) on lot ~60~ To property line_ ~o Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK 'FO: On adjacent lots ~l,L'~ .Absorption field \o ~ ~ Foundation Water main/service line 72~026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) Manufacturer Manhole/Access (Y/N) "Pump on" level at ....~--'~'~ump off" level at ~cles tested High water alarm level Meets MOA electrica~ SE~ANCE FROM LIFT STATION TO: .v~'eql on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~,c~qL~ Soil rating \'~ b~ I ~¢- System type -~"~12.-¢_.. ~ ~¢4 Length ~ ~ ~ ~ Width ~ Gravel thickness ~ O Total depth ~ ~ ~ Total absorption area ~O ~ Cleanouts present ~N) ~ Depression over field (Y~ ~ Date of adequacy test ~ ' ~ C - ~ ~ Results~ail) ¢~% for ~~ ~%~ ~ bedrooms Peroxide treatment (past 12 months)(~ ~O ~ ~~ If yes, give date ~ ~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot "~-c~ c:~~''k~ On adjacent lots ~\ -~ To building foundation kO On adjacent lots '~ ~ Surface water \ ~o Curtain drain ¢'\ ~ Property line To, ~xisting or abandoned system on lot &\ Cutbank -~ ,be ,Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Signature S & S ENGINEERING 17034 Eagle River Loop Road NO. 204 Engineer's Name Date Eagle River, Alaska 99577 HAA Fee $ / Date of Payment Receipt Number 72-026 (Rev, 3/91) Back MOA 21 Waiver Fee: $ ,. --~ Date of Payment ~.__7~ ~ / Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION WALTER J. HIOKEL, GOVERNOR ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3~470 ANCHORAGE, ALASKA 99515 (907) 349-7755 March 26, 1993 Mr. Ray Shafer S & S Engineering SUBJECT: [)awn Water Co. Class "A" Public Water System, PWSID 211431 Dear Mr. Shafer: I have completed a review of this office's files concerning the monitoring status of the above-referenced Class "A" Public Water System and found the following: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on March 8, 1993. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last inorganic Chemical Contaminants Sample results were submitted to this Department on October 8, 1990. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last Radioactive Contaminants Sample results were submitted to the Department on October 30, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC) were submitted to this Department on October 31, 1992. Based on analysis of the previous VOC samples results have been satisfactory. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above-referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Michael Lu Environmental Eng. Asst. II