The URL can be used to link to this page

Home My WebLink AboutMEADOW RIDGE ESTATES NORTH ADD BLK 4 LT 4 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 MAILING ADDR ESS¢-~ LEGAL DESCRIPTION ~]UPGRADE Manufacturer /~ DISTANCE TO: Length Top of tile to'finish grade o.~ ~ Width Type of crib Crib diameter ~/~1 Crib depth Total effective absorption area Well /~'~¢ Building foundation Nearest lot line DISTANCE TO: D~J)~.~/ .~'~-~7'~ Distance to lot line uilding foundation S'~wer I~ne Septic tank DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATIN~J I I~TALLER R EMAR KS PERMIT NO. Absorpt on area(s) LOCATION NO. OF ~BEDROOMS (J DISTANCE TO: ~ I~/~'L~ ~ ~ ~T~Well Absorption j~rea~ ~.~. Dwelling ~ f.~ PERMIT NO. ~ ~ Mater' I ~ Manufacturer ~~. ~ ~. No. ofcompartments~ ~ ~ L q. I Liquid depth .. IF HOMEMADE: Inside~ Width ~ PERMIT NO, DISTANCE TO: Well ~/~ I Dwelling Material Liquid capacity in gallons ~,"~V~'~ Foundati~ 1~ Nearestlo,,~ '~ PERMITNO. No. of lines I Length of each line, TotaLJe~th of lines)I Trench w~nohes Distance betwee~/¢ SZ-,S¢ ' inches Total e ffec~a~io~rea / ~-~' ~ -' Material beneath tileDepth ~8 iPERMITNO' MUNICIPALITY OF ANCHORAGE Department Health and Environmenta~ rotection 825 ~ Street, Anchorage, AK. ~9501 Permit ~ ( ' W[-L-L--AN4~/~R ON-SITE SEWER PERMIT Applicant: f~3~ . '_~~/./q"~, Mailing Address: /t'~. /~ff Location: Phone Number: 6 Legal Description: ~r q~/~ ~ ~~~~Lot Size: Type of Soil Absorption System Is: Trench: ~ Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: ~_ Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH / LENGTH ,-~_~'5 . GRAVEL DEPTH q / WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(WB~) TANK SIZE = /~ GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 B I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. sewer system may require enlargement if (3) I understand that the on-site include more that ~bedroomsy / the residence is remodeled to ~pplictnt ~ Date: ~ '-~<' Y (~5 SWP/024(1/81) SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST SLOPE SITE PLAN 2 3 4 5 6 7 8 9 10- 11 12 13 14 15 16- 17- 18 19 20 WAS GROUND WATER Russell L Oy~te~ bl~. 428~-I~ COMMENTS P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Weter Drop PERFORMED BY:__ PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND __ FT CERTIFIED BY: /~,/C~ ~ MUNICIPALITY 0f ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ~:~\ - 1. GENERAL INFORMATION Complete legal description Lot 4; Block 4;' M~adow Ridge'E~tat~ ~ Location (site address or directions) Property owner Mailing address Lending agency David Smith 21212 M~adow Lake Drive Chadian, AK 21212 Meadow La~e Drive Day phone Chu~iak, AK 99567 Day phone 688-6756 Mailing address Agent Address Day phOne Unless otherwise, requested, HAA will be held for pickup. '.*.~ ............ 2. -NUMBER OF BEDROOMS: - 5 ~ · 3. · ,,TYPE OF WATER SUPPLY: · ' Individual well Community well XXX NOTE: Public water If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: individual on-site Holding tank ' · ' ::' communit~ on-site xXX NOTE: Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-O25 (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. 5 & S ENGINEERING Name of Firm 17n-'~ Eagle River, ~a 99577 Address Enginee¢s signatu~~ Phone w DHHS SIGNATURE Approved for ~ bedrooms, Disapproved. .~,~,,.'~'~'.'u,: "-' ?~,', ~ Conditional approval for bedrooms, with the (ollowing .stipulations: Additional Comments By: 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 satis~ certain federa 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) ~k MOA~21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502e A.chorage, Alaska 99501. (907) 343-4~tzE NOV 6 1995 Legal Dcscriptiou: A. WELL DATA Log preseut (Y/N) "-,,, Health Authority Approval Checklist If A, B, or C, attach ADEC letter, ADEC water system number Date completed Total depth Sanitary seal (Y/N) Date of test Static water level Well production Date of~: Municipal~[¥ ol Anchorage Dept. Health & Human Services ~ Cased to Casing height (above ground) _ FROM WELL~SPECTION~ ~ i ,////~ g.p.m. %~ g,p.m. Collected by: ~ria Nitrate B. SEPTIC/HOLDING TANK DATA Date installed oO-cJ-o°~ Ta,hksize /DD~ Number of Compartments o~ Cleanouts~2q) Foundation cleanout d~) ¢,'¢,~,~ Depression (Y~ ~ High water alarm (Y~) Date of Pumping 7/Iq/q¢ Pumper C, ABSORPTION FIELD DATA Date installed ~o. ~.--oo.~ Soil rating (g,p,d./ftz or ft2/bdrm) /z/t9 System type "f~Et9 ~-~f7 Length 5~, ..~ Width..-~t9 Gravel thickness below pipe Total depth tf t Date of adequacy test /¥&l/q$- Results~l) f~:~ For 3 bedrooms Fluid depth in absorption field before test (in.);/o°, ~' Immediately after 77t9 gal. water added (in.): 2,5/ Fluid depth oCl~ (ins.) Minutes later: /~tO Absorption rate = ~o9-d) g.p.d. Peroxide treatment (past 12 months) (Y/N) L/~P;,t/DbOr/ If yes, give date Do ED LIFT STATION Date installed Manhole/Access (Y/N) Size in gallons "Pump on.q~l.e..vetmI*~ "Pump off' level at* High water alarm level at* ~'Datum Cycles tested~ SEPARATION DISTANCES SE PAR A TI O N D ISTA N C ESFR O IV[ WELL O NED T TO: F~,(~~- Septic/holding tank on lot .~'~, On adjacent lots Absorption field on lot ~ ; On adjacent lots sewe~ Public sewer manhole/cleanout Public Seo~eptic service line Lift station SEPARATION DISTANCES FROM SEPTIC~ TANK ON LOT TO: / ~ Building foundatiou ~'~ ~ Property line /~ d-- Absorption field /'/-- Surface water/drainage ~ '7{~t Wells on adjace~nt lots /0 Water main/service line ~ ~a-a~d~r' //~ o ~ /a.~ ' SEPARATION DISTANCE FROM ABSORPTION FIELD ONLOTTO: tY]a~'$h e~reea. Building foundation c-~ (~ '~ Water main/service line / ~ ~ Surface water /~ Driveway, parking/vehicle storage area ,.~ Curtain drain/[/tor~e_. /~r~ocOQ Wells on adjacent lots A Property. line in conforman~lm ~ui~elines in effect on this date. ?'~?: :-~?;~ ~gnat~e / / /~ ~ . i~:. ~': / ' ~' "5TM ~;': Englu d ~~~.~ ............................................................................ .................... ....... HAA Fee $ 3~x ~ Waiver Fee $ ~ ~,~ Date of Payment Receipt Number Rev. 8/95 DSS: haa.wk.doc Date of Payment Receipt Number / Rick Mystrom, Mayor M micipality of Anchorage Department of Health and Human Services 825 %" Street P.O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 November 16, 1995 Robert Shafer, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 4 Block 4 Meadow Ridge Estates North Waiver Request ~WR950062, PID ~051-531-06, HA950501 Dear Mr. Shafer: Your request for a waiver(s) of the required 100 foot horizontal separation of a septic system to the surface water has been approved. The approved separation distance(s) are 76 feet from the septic tank to surface water and 78 feet from the absorption field to surface water. This waiver approval applies to the existing septic system to surface water separation only. Any future upgrade to the septic system will require all separation distances be met or another approval from this department. Should the operation of the subject wastewater disposal system cause any contamination or degradation of the subject surface water, this waiver will become void. Sincerely, Civil Engineer On-site Services DJR/ljm ~5 ~UNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR~ WR950062 PIDa 051-531-06 HA~ HA950501 Permit Date Received: November 6, 1995 Legal Description: Lot 4 BLock 4 Meadow Ridge Estates North Engineer: Robert Shafer, P.E., S & S Engineering 17034 Eagle River Loop Road Suite 204, Eagle River, 99577 Applicant: David Smith Waiver Requested: Septic system to surface water of 76 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 is Granted: ~_ Waiver is NOT Granted: List Conditions or Reasons for above: ~ /~/~¢/-f~ Date: Rec a: 0].449/3940 By: Name of Reviewer Amount: $ 920.00 Date Paid:November 6, 1995 h-"/ .V OTI o~ ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. November 3, 1995 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services Attn: Dan Roth P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 4; Block 4; Meadow Ridge EstateS Dear Mr. Roth, This letter provideS additional information to supplement the requeSt for warv~r dated October 31, 1995. The following specifics need to also be taken into consideration in evaluating this request. I. A recent adequacy test performed on the existing septic system indicated that the system is functioning above standard. A failure of the septic system will result in the sewage backing up through the plumbing fixtur~ in the house before it could .y surface on the 9round. If req.~u~re~additional information please contact us. Sincerely, SOILTEST A. Shafer, P.E. PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. October 31, 1995 HEALTH AUTHORITY A~PROVALS MUNICIPALITY OF ANCHORAGE Department of Health and Hw~an S~rvices Attn: Dan Roth P.O. Box 196650 Anchorage, AK 99519 RECE CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 IVED NOV 6 1995 Municipality ol Ar~chorage Dept. Health & Human Services SEWER & WATER MAIN EXTENSIONS SEWER &WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE pLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN REFERENCE: Lot 4; Block 4; Meadow Ridge Estates Dear Mr. Roth, Request you issue the attached H~z~th Authority Approval and grant a waiver to the horizontal separation distances between the, surface water source and the on-site wast~wat~r disposal system as shown on the attached sketch. The following conditions should be used to justify the waiver. A home between water. constructed on a p~rmanent foundation system is located the on-site wast~wat~r disposal system and the surface The slopes towards the surface water are covered with vegetation that would slow down or prevent the migration of efflue~ and would make any surfacing effluent evident in sufficient time to prevent a complete migration. The soils in this area would probably prevent any subsurface migration to the surface water. It is anticipated that the sandy soils would also provide a cleansing of the effluent sufficient to meet peram~ters established for surface discharge. The meander line of the "lake" or marshy areas around the lake has varied over the years. It appears however that the lake is at its maximum capacity at thi~ time and the separation distances shown on the sketch are the minimum distances anticipated. If you require additional information please contact us. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 NY-id ]11S 1" =40' SCALE SITE PLAN ,/ 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. # ~;)~ \ - S?~\ -C)UE) 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # ~ ~'~c~ ~,C~ \ Lot 4; Bloc~ 4; M~dow Ridg¢'Sub~vision; Location (site address or directions) 21212 Meadow Lake Drive Property owner Mailing address Lending agency Mailing address WJ~£J. am Boyles 21212 Meadow Lake Drive NORWEST Day phone Chugiak, Ak. Day phone 688-0779 Agent Rae Ha~Z GREATLAND REALTY 11411 01d Glen Highway Address ~-'~ Ri;'~% z~,~,~ 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: $ ~' TYPE OF WATER SUPPLY: Individual well Community well X× Public water NOTE: Day phone 694-9125 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 Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. NOTE: 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 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 ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature 17034 Eagle River Loop Road No. 204 ~,agie ~iver, Alaska 9957i Phone DHHS SIGNATURE Approved for ~,~ Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ~ Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 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) Elack MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: [~o~' ~ ~l,-V- '¢¢ l'~,po~.[ A. WELL DATA Well type ~ If A, B, or C, attach ADEC letter. Parcel I.D. ADEC water system number Log present (Y/N) Total depth Sanitary seal (Y/N) Cased to FROM WELL LOG Date completed Driller Casing height Wires properly protected (Y/N) AT INSPECTION Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~:, ~c~ _ ~5'5 Cleanouts (~N) ~ High water alarm (Y~) Date of pumping Tank size \c~c~ C~_. Compartments Foundation cleanout ~YN)~ ~/ Depression (Y~ Alarm tested (Y/N) Pumper ~¢-- , ~. f'~ o ~.- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot '?--¢- c~ ~ ~'' On adjacent lots ~//~ To property line ~,.-o ~ ''~ Absorption field Lc' Surface water/drainage \~ C> ~ '~ 72-026 (Rev. 7/91) Front Foundation Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Manufacturer "Pump on" level at Meets MOA electrical codes (Y/N)..._~ SEPAR~E FROM LIFT STATION TO: W-eh~Fn lot · On adjacent lots Manhole/Access (Y/N) Surface water D. ABSORPTION FIELD DATA Date installed ~ Length ~¢'. ~' Width Total absorption area Depression over field (Y/(:~) Results4~_~ail) Peroxide treatment (past 12 months) Soil rating I'¢~'D ~/~¢-" System type Gravel thickness ~ ~ Total depth -7 Cleanouts present ~/N) Date of adequacy test ~ for ~ t~O~ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot '~"=' To building foundation On adjacent lots Surface water Curtain drain On adjacent lots ~'[/~ Property line To existing or abandoned system on lot Cutbank ~ 1 ~ 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 effe~t~e~d,,ate of this inspection. S & S ENGINEERING Signature 17034 Ea~le River Loop Road No, 2~ Engineer's Name ' NAA Fee $ Z)~ ~ . Waiver Fee: Date of Payment ~--~ ~ ~ ~ ~ Date of Payment Receipt Number ~ ~ ~ /~ ~/) Receipt Number WALTER J. HICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99503 (907) 349-7755 March 19, 1992 FOR: S & S Engineering PWSID Cf 211431 My review of the records on file in this office reveals that the Dawn Water Company, Class "A" Public Water System, is in compliance with the routine coliform bacteria sampling requirements listed in Table C, and with the inorganic sampling requirements listed in Table B of 18 AAC 80.200. Sincerely, Byron Roys Environmental Engineering Assistant BR/cf MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include Icl, block, subdivision, section, township, range) Lot 4 Block 4 Meadow Ridge Estates Subdivision H87-0188 Location (address or directions) (b) Property Owner A'lask& Mutual Telephone: Home Business Mailing Address (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address Telephone (e) MailtheHAAtothefollowinaaddress:or:Checkhere[], ifholdforpickup. Listcontactpersonanddayphonenumberbelow. S & S Engineering 17034 Eaqle River Loop Road #204 Eaqle River, Alaska 99577 TYPE OF RESIDENCE Single-Family 5~x Number of Bedrooms three (3) WATER SUPPLY Individual Well[] Community []X Public[] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [~x Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRev 8/861 Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone Address Date Engineer's Seal This department has received written confirmation from the engineer regarding the Conditional Approval of April 7, 1987. The corrections have been accomplished and an inspection has been completed by the engineer. The subject property meets with Municipal standards and is now approved. Approved for three (3)bedrooms by _ Approved xxxxxxxxx Disapproved Conditional June 5, 1987 Terms of Conditional Approval CAUTION 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 DH HS 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. Page 2 of 2 72-025 IRev 8/861 Back ROBERTA. SHAFER CIVIL ENGINEER 694-2g79 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSALSYSTEM DESIGN June 4, 1987 MUNICIPALITY OF A~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION JLII 5 t987 Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 RECEIVED REFERENCE: Lot 4; Block 4; Meadow Ridge Estates On April 7, 1987 you issued a conditional Health Authority Approval for a three bedroom residence located on the referenced property. The condition of this approval required a monitoring tube to be replaced in the existing absorption trench. A monitoring tube was installed on June 4, 1987 and verified by us. Request you issue a final HAA at this time. S~. ~S/ss SRB 196X EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) (b) (c) Legal D0scription (include lot, block, subdivision, section, township, range~---.~ Locati~ (address or direc-t,o~s~ - Applicant Name c/~'~.~'_-~-~-~'~'~'~'~'~.~elephone: Home Business Applicant Address Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution ~'~ /"--~-" ./~.,~-~-~'~'~Telephone Address ,~~~ (e) Real Estate Company and Agent ~-1~/.~¢7 ~ ~ (f) ~ the HAA to the following address: River, Alaska 995~ TYPE OF RESIDENCE Single-Family,j~ Multi-Family [] Number of Bedrooms -~ Other WATER SUPPLY Individual Well [] Community [] Public,J~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite,J~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11~84) ENGINEERING FIRM PROVIDll ,NSPECTIONS, TESTS, FILE SEARCH, D, , AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on Telephone the date of this insp,~c~o~PENGINEERING Address Eagle River, Alaska 99577 Date Approved for -.~ bedrooms by Date ¢ - 7- ~' 7 Approved Disapproved Conditional Terms of Conditional Approval /'=,)(('/~V/C~'E ~"~v/D oF' .,4~5o/f/CT/¢,4/ F/.E/,~) ~'O ~OlUlTOR T~E o~ 72,~Y~'t~L£ tt Iv~'~/ T~I?E ~-0 I~?LI~(E THE O~?l~//v~l_ T H /u ,T Lf E /, CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Well Classification Well Log Present (Y/N) Total Depth Static Water Level Cased to Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments 7 ~ ~ t ~:) "~ Legal Description: ~-.cr~ if/ ~ /'-/ If A. B. C, D.E.C. Approved~,/N) Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ~La:,c>" ..p ; On Adjoining Lots ~_c:~:¢'W ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ,~'~-,~ Standpipes ~'~N) Air-tight Caps'/N) Depression over Tank (Y(~ Pumping/Maintenance Contract on File (Y/N~)//. , Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~--c'nO/~ Size /C,~,~c:) No. of Compartments ~--- Foundation Cleanout (Y~[D. Date Last Pumped ~ ----~ '"Y,+ ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Property Line To Water Main/Service Line Course / To Disposal Field ('~' To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ ' ~ - Width of Field Square Feet of Absorption Area Depression over Field (Y~) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~..c~ To Building Foundation Lot To Wate~ Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design /,,g~_-/,,/C../--/ Length of Field ~'~., ~ ! Depth of Field Gravel Bed Thickness "/' Standpipes Present (Y/~ ,-~ Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~---~ To Cutbank (if present) "~'//,,~ D. LIFT STATION Date Installed Size in Gallons ]~"-,/ //._~ "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all M,/~, A~d HAA guidelines in effect on the date of this inspection. Signe(S &$ _~MC, INEERING Date Com_,.11~'~.34 Eagle River' Loop Road NO. 2iVaCA No/ '~ .~7,__ ¢_..,~__~ .. Vi~a{~le River, Alaska Receipt No. /O Date of Payment '~/~/~"~ Amount: $ Page 2 of 2 72-026 (11/84) DEPT. OF ENVIRONMENTAL CONSERVATION / ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA ~9501 STEVE COWPER, GOVERNOR Telephone: (907) Address: 274-2533 DATE: Ap Fi 1.__1, 1987 PWS I.D.~ 211431 To Whom it May Concern: According to records on file in this office the Water Regulations DAWN WATER COMPANY Water System is in compliance with the State Drinking Sincerely, ~.~_~/Regional Sanitarian Supervisor APPLIC NT FILLS OUT UPPER HAl ONLY Property Owner AK Painting ~ Drywall Phone MaillngAddress 941 E Dowling R~,, Anchorage ZipCode 99502 694-9711 Buyer / Unknown ii/ng Address Zip Code Lending Institution .J~'~S Phone Address Parkgate Bu , Eagle River ZipCode 694-9571 Phone Realty Co, & Agent Commomwe~lth, Area, Inc. (Helga Larson) Address P.O.Box Z49," Eagle River ZipCode 99577 694-9555 Legal Description Lot 4, Block 4 Meadow Ridge ]~states Street Locati(~MeadOw Lake Drive Type of Residence Single Family Multiple Family No. of Bedrooms 3 [~ Other Water Supply ~ individual Community ~ ~" ~ ~'~"'~ ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. ] For wells drilled prior to that date, give well depth (attach Icg if available). Public Utility Sewer Disposal 8 ~ Individual Year Individual installed:_ Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date '/ (~')--- ~ '--~ .;;~ Inspector Inspector Inspector Inspector Field Notes: O~' ~ .~. (~) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* [ - Soils Rating Date ~wer installed Well To Absorption Area Well Log Received DEPT. OF ENVIRONMENTAL CONSERVATION SO UTHCEN?RAL REGIONAL OFFICE July 22, 1983 TO Whom It May Concern: BILL SHEFFIELD, GOVERNOR 437 E. Street SECOND FLOOR ANCHORAGE, ALASKA 99501 (9O7) 274-2533 P,O, BOX 515 KODIAK, ALASKA 99615 (907) 486-3350 P,O. BOX 1207 SOLDOTNA, ALASKA 99669 (907) 262-5210 P.O. BOX 1709 VALDEZ, ALASKA 99686 (907) 835-4698 P.O. BOX 1064 WASILLA, ALASKA 99687 (907) 376-5038 According to records on file in this office the Meadow Ridge Water System is in compliance with the State Drinking Water Regulation. Sincerely, Ja s F Hayden -- Envzronmental Field Officer JFH/msm cc: Robbie Robinson 18-09LH / .n' cipality oi MEMORANDUM DATE: TO: July 25, 1983 Environmental Health Division - Staff FROM: Environmental Engineering Manager SUBJECT: Meadow Ridge Estates Water System As evidenced b~ the attached copy of a lette~ from the State of Alaska, Department of Environmental Conservation, the community water system serving the Meadow. Ridge Estates Subdivision has now been approved. This memorandum will therefore remove the temporary hold issued on on-site water and sewer permits and health authority approvals for the Meadow Ridge Estates Subdivision, and will be effective immediately. Robert W. Robinson Environmental Engineer. ing Manager RWR/1 j w 91010 (4/76)