HomeMy WebLinkAboutMEADOW RIDGE ESTATES BLK 3 LT 6Meadow Ridge
Estates
Block 3
Lot 6
#051-461-27
MUNICIPALITY OF ANCHORAGE
�® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL. INSPECTION REPORT
PHONE
PHONE NEW
NAME
II
'=\(j�.l� _ .�r (. ��I .�(� F-1
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
NO. OF BEDR QMS
Well
Absorption area
Dwelling
PERMIT NO.,
Uy
DISTANCE TO:
(!,()f1'1
I- zManufacturer
��
_
Material (
No. of compartments
(n
Liu. capacity in-allans
4J �(��
IF HOMEMADE:
Inside length
1`��I
Width
Liquid depttl
-
J 0 2
DISTANCE T0:
Well
�r
Dwelling
PERMIT NO.
—
2 Z
Manufacturer
-
Material
Liquid capacity in gallons
F
O
WPI
Fo dation �. ���!
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Nearest lot I lief
,
PERMIT N0.
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wy
DISTANCE TO:
i�',ILJI'V)v1'
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w ii U
No. of lines
Length of each line t
Total length -of -lines
Trench wi)j l
('
Distance betwQen lipgs
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? w�
L! ��� l�
;) `Li
J lJ
_ J inches
i
ap
Top of tile to finish grade
Material beneath tile ., -1
j) -inches
Total effective sorption area
M
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Length
Width
Depth
PERMIT NO.
a
f�
Q
Type of crib
Crib diameter
Crib depth
Total effective absorption area
ad
W
w
N
Well
Building foundation
Nearest lot line
DISTANCE TO:
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
J
( _
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w
Building foundation
Sewer line
Septic tank
Absorption area(s)
DISTANCE TO:
OTHER
PIPE MATERIALS
) I ,dye, j) (�
S01 L TEST RATING
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-INSTALLER
REMARKS
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APPROVED DATE LEGAL
I , — 11
72-013 (
1 i .
i
U SOILS LOG
MUNICIPALITY OF ANCHORAGE }
❑ PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST
Pouch 6.650, Anchorage, Alaska 99502 276.2221.
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: C"y���'��� l 1 �/ DATE PERFORMED:
LEGAL DESCRIPTION: 7
SLOPE SITE PLAN
DEPTH t_
(FEET) �.� J G7 illL i��✓�J"'✓'{� i",t�'�i Y•
t -
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2 J - -
3 f
4 —
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6
7
s
C�zi�
9
10
11
12
13
14
15
16
17
18
.19
20
COMMENTS
n
LO
WAS GROUND WATERS
. i ---.. —
ENCOUNTERED? O
P
IF YES, AT WHAT -- -
DEPTH? -
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE
TEST RUN BETWEEN
e, M CL:11 0 ✓ ) Se , .'; j .{.
PERFORMED BY: 01.11
72-008 (7/76)
FT AND t
I tx, 6.S Ct'vd-, u
CERTIFIED BY:
r
(minutes/inch)
FT
DATE: ' S A
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iva
Municipality of Anchorage
•
On -Site Water &Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-461-27 Expiration Date:
1. GENERAL INFORMATION
Complete legal description MEADOW RIDGE ESTATES; BLOCK 3, LOT 6
Location (site address) 20939 COUNTRY VIEW DRIVE *CHUGIAK, AK 66567
Current Property owner(s) DONALD & LAURA BAILEY Day phone C/O AGENT
Mailing address 16135 KINGS WAY DRIVE *ANCHORAGE, AK 99516
Real Estate Agent KEIRA DREHER GROUP W/ KELLER WILLIAMS Day phone 227-3490
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class A Well
0
Community On-site
❑
Public Water System
❑
Public Sewer
❑
Received by:
COSA to be released to the engineer, unless othermse requested by the engineer.
COSA Fee $ L\on
I
Date of Payment I, al b l�C V
Receipt Number �o� �J a0 G\ O
COSA#
Dater I t I l k I l`z-
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, t verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. i further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 //
Engineer's Printed Name JEFFREY A. GARNESS, P.E. - Date 11 GAL
Engineer's Comments
in conducting this evaluation, GEG, LtD. attempted to provide a thorough,
aoo�oOp 4'
F
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
p • "' . . . q�4p�
system under the conditions encountered at the time of the test, and separation
•.
C
distances measured to readily identifiable features. The operational life of all wells and
O * 9 y*
septic systems depend on the local soils condition, groundwater levels that may
_
Q ....... .. ..... ..... '• ...
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 the system. Satisfactory test
... ... ....... ..........
results do not guarantee future performance of the system, nor do they guarantee that
Q J Go ness:
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the•!}I.(�
0 9. ' _ CE -7 d
operational requirements of the ADEC or MOA DSD. The content of this report is for
��"0 Pro
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
fessio�oa�
�Oni�
other person or party is not authorized, nor will it confer any legal right whatsoever
6. DSD SIGNATURE
System #1 Approved for bedrooms. ``��G��r -rCi
J ON-SITE
System #2 Approved for bedrooms. g WATER AND
Disapproved. WASTEWATER
PROGRAM c,
Conditional approval for bedrooms, with the following stipulation.
lnm
The Municipality or Anchorage Davalop,emt 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. ATTCHMENTS: /
COSA Checklist
Septic System Advisory
0
Nitrate Advisory
Arsenic Advisory
Z
Advisory Other
L 41;400 4&�:
(Rev. 11/05)
Original Certificate Date:
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: MEADOW RIDGE ESTATES; BLOCK 3, LOT 6
A. WELL DATA
Well type A If A, B, or C provide PWSID# 21 143
Date completed Sanitary seal (Y/N)—
Total depth ft. Cased to ft.
Date of test
Static water level
Well production
WATER SAMPLE
Coliform /
FROM WELL LOG
00 ml. Nitrate
ft.
Parcel ID: 051-461-27
PUBLIC WATER
Well Log (Y/N)-
Wires properly protected
Casing height (aboyfi-gr(
AT
.P.M. g. p. m.
mg./L. Collected by:
in.
Ar C: ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA *FLOOR DRAIN IN LAUNDRY ROOM NEAR TANK.
APPROVED ON 2007 COSA.
Tank Type/Material SEPTIC/STEEL Date installed 5/8/78
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) * Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 10/9/12 Pumper SANITARY PUMPERS
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE
Date installed 5/8/78 Soil rating (g.p.d./ftor '/bdrm 125 System type TRENCH
Length 50 ft. Width 3 ft. Gravel below pipe 6 ft.
Total depth *10.91 ft. Eff. absorption area 600 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 11/2/12 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth Din.
Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date –
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" level at in. "Pump off' level —' . High water alarm level at
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAtft station on lot
Absorption field on
Public sewer main
Sewer /septic service line
areas
On adjacent
On adjacent lots
manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
Water main
5'+
10'+
Wells on adjacent lots 200'+
Property line 5'+ Absorption field 5'+
Water service line 10'+ Surface water 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Properly line 10'+ 'Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage *0'
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
F. COMMENTS
TRENCH RUNS UNDER DRIVEWAY. APPROVED ON 2007 COSA.
G. ENGINEER'S CERTIFICATION
I certify that l have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSH guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date 11/5/12,
(Rev. 11/05)
OF
v ..
y A .. . .ess.:
CE- 7973
dl..� (�; �cod�O
� co_
.• Duro.-µat S.wud e:
a�� �skralL
ASBUILT SEIIARD h
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
SCALE;
FOLLOWING DESCRIBED PROPERTY:
�ron2rr.ivass�s�-aT'rre9l�Td'.s+°:!
DATE,
AND THAT NO ENCROACHMENTS'EXIS7 EXCEPT AS
INDICATED.. IT IS THE RESPONSIBILITY OF THE
GRID!
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS/dGL
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
FB:
VISION PLAT. UNDER NO CIRCUMSTANCES SHW D
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
DI?AWN',,,/
ARY LINES.
.• Duro.-µat S.wud e:
a�� �skralL
Amu
Municipality of Anchorage
.•gym � •,
Development Services Department '
Building Safety Division
On -Site Water and Wastewater Program , • ETV
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel l.D. DJrI � � iLO) 'o`( COSA # U030�"3
Expiration Date: 12--19 - 0--9-
I
1. GENERAL INFORMATION
Complete legal description MEA-Douti2lDCr-E 5 t.tp 6 3
Location (site address) X09 3'1 Ccx+r 1TVz_q 0f -7w, -D& .
Current Property owner(s) 514At2owl r-2Jf-rLE Day phone P-40- -7X001
Mailing address p o r�2x �� I a 1 C +tv l x1AiL , A-V 1195th -3 — D -t b
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: q
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑
Individual On-site
Individual Water Storage ❑
Individual Holding Tank
❑
Community Class Well 1:1
Community On-site
13Public
Water System Ltd_**�
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners., Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Eegie River Engineering Services Phone _(4 y— sig
u,te 201
Address Engle RivQ; AK 99577
Engineer's Printed Name Cggj2-;;rojoNT-lo— V_ D
5. DSD SIGNATURE
_Lz Approved for ---4--bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: w • Original Certificate Date:__9 — 15 — O 18
(Rev. 11105)
Municipality of Anchorage ; , .•�,
(•�/ Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: MEo1 )6LQ TzIDGS CS -r. A 3 LIe Parcel ID: QS 1' !Y & /-2 /
A. WELL DATA
Well type _
Date completed _
Total depth
Date of test
Static water level
Well production
WATER SAMPLE
Coliform
ug/L
If A. B, or C provide PWSID # _
Sanitary seal (YIN) _
Cased to ft. ,y
FROM WELL LOG
00 mL Nitrate mg/L
date of sample:
B. SEPTICIHOLDING TANK DATA
Well Log (YIN) _
Wires properly protected
Casing height
AT
oberVe-ground) in.
ON
ft.
g.p.m.
Other bacteria colonies/100 mL
Collected by:
Tank Type/Material . crO rl C-.4 e,TE_F_I- Date installed I gay
Tank size 1, a.50 gal. Number of Compartments --- Cleanouts ON) Y� 5
Foundation cleanout OI) IL�fDepression over tank (Yo LLQ High water alarm (YW rJ0
Date of pumping (o% S 4 0_1 - Pumper "(eZ 5
C. -ABSORPTION FIELD DATA
Date installed I q 1 f Soil rating (g.p.d.1112 or ft /bdrm I a 5 System type Tr?-c-nl C fi-
Length 50 ft. Width 3 ft. Gravel below pipe fn ft.
Total depth ft. Eff. absorption area L.eofe Monitoring tube YL_-�_ Depression over field _LLQ_
Date of adequacy test Results (Pas Fail) T A 55 For +_ bedrooms
Fluid depth in absorption field before test _Jj'Jr in. Water added_G_26 gal. New depths in.
Elapsed Time: 10 min. Final fluid depth _ in. Absorption rate >= &00 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) h;o0f: 441c>L,,_10 If yes, give date tJJIA=
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
'Pump on' level at _ in. 'Pump off levelt in. evel at
Datum ested Meets alarm & circuit requirements?
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankilift station on lot
Absorption field on lot _
Public sewer main
On adjacent lots
On adjacent lots
Sewer /septic service line Xr " Holding tank
in.
A ' ment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation S I Property line 41S I Absorption field V S
Water main 4-10, Water service line i -t O r Surface water f t 0o
Wells on adjacent lots +-100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line t 10 1 Building foundation t 10' Water main 4- 10 1
Water Service line t %0 Surface water + 100' Driveway, parking/vehicle storage O'i
1
Curtain drain +SOI Wells on adjacent lots -%- I o0
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name rtYiZ\S-rola iCIP �(�
Date '4.11Il 0a
COSA Fee $ ;v Waiver Fee $ _
Date of Payment R Date of Payment
Receipt NumberbSgJ L4 --TG Receipt Number
(Rev. 11/05)
I r J D GR0SS6 5
CHWSTOPHER R WOOD
CEiI)3L1
�yCt�°oL:sn"w i�•sos
ASBUILT
h ASSOCIATES
I HEREBY CERTIFY -THAT I HAVE SURVEYED THE SCALE:
FOLLOWING DESCRIBED PROPERTY„� OF At
r2r.�.�ia�fes nf9l�TX.�+^ J DATL•'= C .
AND THAT NO ENCROACHMENTS IEXIST VXCEPT AS 7/� �
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID
EASEMENTS COVENANTS OR RESTRICTIONS Hw/�6t r '!
EASEMENTS, r / ' , F�
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- - qq r Deena Mi k Sewerd : /
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: f •� ts- v y
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES. D1 AWN:
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES���
M1
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 1. D. # _•iia \ - \iu \ - 2-1 HAA # 0 n`l 2
1. GENERAL INFORMATION
Complete legal description L' � ',' 3
Location (site address or directions)
0151 l"A'.+iL . .4. -
Property owner SYL_u;�4 UMAT"VvV Day phone 698- 5400
Mailing address �1 , r � i0 i 3 C%lav iy67
Lending agency
Day phone
Mailing address
Agent ' C'c^�Nv 41 � �,v,.�. %��, Csr Day phone 696-b'600
73A/LY .tc,r /
Address►lgnf 13K��NcsS �� 1ft✓a i 456-77
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: L96 o2y>j�
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
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
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 021
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 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.
Name of Firm T >VU
Address '2-o z-( o
Engineer's signature
6. DHHS SIGNATURE
Approved for
Disapproved.
0
Q
c bedrooms.
Conditional approval for
Additional Comments
Phone 6'96 ",Q�1
>< q q S-?�
Date S�Z 3
bedrooms, with the following stipulations:
Date 91�C 2_ -
The
The Municipality of Anchorage Department 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 professional engineer's work.
72-025 (Rev. 1/91) Back MOA 921
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Lc�, P5r-L
Legal Description: Mu�oo.3 P_1fx"„ Parcel I.D.
A. WELL DATA
Well type 4 If A, B, or C, attach ADEC letter
Log present(Y/N)_
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level
Date completed
Cased to
FROM WELL LOG
ADEC water system number A// 3/
Driller
Casing height
Wires properly protected (Y/N)
17
g.p.m.
AT INSPECTION
SEPARATION DISTANCES FROM WELL T :
Septic/holding tank on lot ; On adjacent lots
Absorption field on lot ; On adjacent lots
Public sewer main
Sewer service line
Public sewer manhole/cleanout
Petroleum to
WATER SAMPLE RESULTS:
Coliform / V ZA Nitrate
Date of sample: Collected by:
Other bacteria
R. SEPTIC/I TANK DATA
Date installed �/76� Tank size Compartments
Cleanouts (Y/N) y Foundation cleanout (Y/N) // Depression (Y/N)
High water alarm (Y/N) Alarm tested (Y/N)
Date of pumping�� y' Pumper9iurr,,cypaju���_e
SEPARATION DISTANCES FROM SEPTIC/H@Lf TANK TO:
Well(s) on lot Zvoma On adjacent lots �o41, Foundation
To property line �� �`— �Cl �
Absorption field l Water main/service line
Surface water/drainage /dy `
8 r
Yel)
72-026 (Rev. 7/91) Front
CONTINUED ON BACK PAGE
+j
z
Co
n
i
M v
J1.
O
g.p.m.
ZZ
< z
i
crrn
0 0
�0
O "'
Z.
Cleanouts (Y/N) y Foundation cleanout (Y/N) // Depression (Y/N)
High water alarm (Y/N) Alarm tested (Y/N)
Date of pumping�� y' Pumper9iurr,,cypaju���_e
SEPARATION DISTANCES FROM SEPTIC/H@Lf TANK TO:
Well(s) on lot Zvoma On adjacent lots �o41, Foundation
To property line �� �`— �Cl �
Absorption field l Water main/service line
Surface water/drainage /dy `
8 r
Yel)
72-026 (Rev. 7/91) Front
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed N/'r Manufacturer
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
Manhole/Access (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots
"Pump off" level at
Cycles tested
Surface water
Date installed _ /78 Soil rating ZS g� System type
Length! Width
5
Gravel thickness
T t I ,-,r tion area 600 s, P, Cleanouts present (Y/N)
Total depth
V
oaap
Depression over field (Y/N) Al Date of adequacy test Zc�)
Results (pass/fail) 2 _/-)for for 4 - — bedrooms
Peroxide treatment (Past 12 months) (Y/N) /-/0 If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot N04: On adjacent lots 't�_4 Property line
To building foundation
On adjacent lots -4 15+ Cutban
Surface water o r
Curtain drain 41 L. *, �J LL, N
E. ENGINEER'S CERTIFICATION
To existing or abandoned system on lot
/5 /
lel,ti
k Water main/service line
Driveway, parking/vehicle storage area 6 c1,= y
e)ij AD
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name
Date06
HAA Fee $ '0
Date of Payment 9 •`Z/` g,(_'57Q)
Receipt Number 2-40P7 7
79 -WR IRav 3/411 Rack MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
D. R. DAYTDN, P,E., RLS.
WONUI 9 Chugiak, Alaska 99567 (907) NNW
20210 Donalar Street
696-2417
August 28, 1992
ADEQUACY TEST
Legal Description:
Lot 6,
Block 3, Meadow Ridge Estates
Date of Test: August 28,
1992
Septic Tank: 1250
Gallon,
2 compartment, steel tank
(DHHS
Records)
Absorbtion System:
50' x
6' effective depth trench
(DHHS
Records)
Soils Rating: 125
sq. ft.
per bedroom
(DHHS
Records)
Daily Design Flow:
4 bedroom - 600 gallons per day
Test:
605 gallons of water were injected into the absorbtion trench
in 2 hr. 15 min.
Results:
The absorbtion trench accepted the 605 gallons with no rise
in the monitor tube liquid level.
Conclusion:
The absorbtion system is currently functioning adwquately
for a 4 bedroom home.
,y
a n �onnouf+�dfy ee
r ` Cavil' !i. Dnyfnil
,DC7%:.�c as on en eoen K���� A9
�' <i n40:=c G��
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
September 3, 1992
David Dayton
20210 Donalar
Chugiak, AK
SUBJECT: Dawn Water System, Meadow Ridge
Class "A" Public Water System, PWSID #211431
Dear Mr. Dayton:
WALTER J. HICKEL, GOVERNOR
(907) 349-7755
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:
1. The last satisfactory Total Coliform Bacteria Sample results was submitted
to this Department on August 13, 1992. This does meet the provisions of
18 AAC 80.200(a) of the State Drinking Water Regulations.
2. The last inorganic Chemical Contaminants sample results were submitted
to this Department on October 9, 1990. This does meet the provisions of
18 AAC 80.200(a).
3. The last Radioactive Contaminants Sample results were submitted to the
Department on June 10, 1992. This does meet the provisions of 18 AAC
80.200(a), State Drinking Water Regulations.
4. The last Organic Chemical Contaminants/Volatile Organic Chemicals were
submitted to this Department on June 10, 1992. 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,
�l Keven K. Kleweno
District Engineer
KKK/cf
Time
APPLIC AT
PILLS
OUT UPPER HAL ONLY
Property Owner �.',r.:
-
Dale
Phone
Date
Date
Inspector
Zip Code
Mailing Address
Inspector
Field Notes:
Buyer
( APPROVED BEDROOMS `
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
Zip Code
Address
DATE
BY:
Soils Rating
Date Sewer Installed
Well To Absorption Area
Phone
Lending Institution
1 X
Well to Tank
.
Zip Code
._
Address
Phone
Realty Co. & Agent
_ _ !'•'�
Zip Code
Address
.t ,_, <.
.-
Legal Description
Street Location, i- 1\1C.
f
Type of Residence
q Single Family
_
❑ Multiple Family
No. of Bedrooms �
❑ Other
Water Supply
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
❑ Individual
For wells drilled prior to that date, give well depth (attach log if available).
❑ Community
❑ Public Utility
Sewer Disposal
Year Individual Installed:
Gl Individual
When Connected to Public Utility:
❑ Public Utility
❑ Holding Tank
MUST ACCOMPANY
EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
NOTE: THE INSPECTION FEE
Time
Time
Time
Time
Date
Dale
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes:
4r�,
( APPROVED BEDROOMS `
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE
BY:
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
Septic Tank Size 9SW
1 X
Well to Tank
72023 (3182)
/'�ytt�tlrp
i
k
A
Danny Swires
P.O. Box 1324
Chugiak, Alaska 99567
EXCAVATION
WORK�-
July 14, 1983
ROBERT A.SHAFER
CIVIL ENGINEER
694-2979
Dear Mr. Swires,
Reference: Lot 6; Block 3; Meadow Ridge Estates Subdivision
A sewer system adequacy test was performed on the system located
on the referenced property, as you requested. The septic tank was
pumped and verified to have a capacity of 1000 gallons. The
nch
ate sorption24rhourswwitheoutdabny adversecontinuous
effectflow
on thewsystem. a
p
It can be concld�dtwo bedroomtresidenceest tlocated he eonadisposalter
from this this property
system serving
is currently functioning adequately. However, the system cannot
be guaranteed against subsequent failure.
if we may be of further service,
Sinker
please do not hesitate to call.
R]�S/ss v
cc: Municipality of Anchorage
Department of Health and Environmental Protection
SRB 196X EAGLE RIVER, ALASKA
-
DA'I-E RECEIVED
INSPECTION APPOINTMENTS
TIME
TIME
TIME
NUMBER OF,BEDROOOMSS �.
❑ Other
ED One 11 Four
DATE
DAT
DATE
❑ Three Cl Six
7. WATER SUPPLY
❑ INDIVIDUAL*
* ATTACH WELL LOG. A well log is required for all wells drilled
INSPECTOR
INSPECTOR
INSPECTOR/�
DraA
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONDEPT. c:•' .. - — &
825 L Street - Anchorage, Alaska 99501 ENVIRC:':::.-:: L ._ :. cCTION
•
ENVIRONMENTAL SANITATION DIVISION „L}iw j 0 981
Telephone 264-4720
II,, ,, // LL
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEVRh 1LVTW
DI RECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTYOWNER
PHONE
MAILING,DD � .�
PROPERTY RESIDE N llf different from above) 1
PHONE
PHONE
2. BUYER
MAILING ADDRESS /
/
PHONE
3. LENDING INSTITUTION
a -(
AILING ADDRESS
L
PHONE
4. REALTOR/AGENT -
MAIL,NGAD KESS
5. LEGAL DESCRIPTION
J
STREET LOCATION
6. TYPE OF RESIDENCV
NUMBER OF,BEDROOOMSS �.
❑ Other
ED One 11 Four
ga''SINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
❑ Three Cl Six
7. WATER SUPPLY
❑ INDIVIDUAL*
* ATTACH WELL LOG. A well log is required for all wells drilled
'COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
B. SEWAGE DISPO AL SYSTEM
�.�. �'
ON-SITE SYSTEM WAS INSTALLED.
INDIVIDUAL/ON-SITE**
'�"/ 0 YEAR
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
f �?
/ ifi;�yff 1�
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER of BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
EJ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
INSTALLER
❑Septic Tank or ❑Holding Tank
Size: ( 0 _S�-o 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
L APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accq pany certificate)
❑ DISAPPROVED
DATE
BY
72-010 (Rev. 6/79)
rid•, �1�iwca ,�` �•,���1�,�
July a, 1.98.1
£325 "L" S7RL.rl
ANCHORAGE, ALASKA 99501
(907) 264-4111
GEORGE M. SULLIVAN,
MAYOR
Of PAR I MENT Of HEALThI AND EIVVIRONME NTAL PRM LCTION
Charles C. fIal.l.
Box 996
73agle River, Alaska
I,ot 6 Block 3 Meadow Ridge Estates Subdivision
995`17
11a1.L/Swires Property
Subject
Approval ;`or the individual sewer and water facilities
cannot be granted until the following has been completed,
(1) 'Phe septic tank pumped with a receipt submitted to
this: office.
TI there are any questions,
264-4720.
Si_ncerc..IY 1
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
please call this office at
cc: Alaska USA 1.,'ederal. Credit: Union
Pouch 6-613 99502
.�.`..,.e...�.�usre:w.ii�RFU!saViaWfT']iIM1�1E NGSkA!AN'fl#�E�