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HomeMy WebLinkAboutMEADOW RIDGE ESTATES NORTH ADD BLK 6 LT 2Onsite File #051-531-25 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191475 PID Number: 051-531-25 Dwelling: Q Single Family(SF) ❑with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name LISI & BOBBY HENSON ABSORPTION FIELD Site Address ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound 24931 HOMESTEAD RD, CHUGIAK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. MEADOW RIDGE EST NORTH ADD 6 2 Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Total absorption area Number of trenches Dist.between trenches Septic Absorption Sewer Holding From Tank Field Lift Station Tank Line Ft2 Ft. Well 200'+* TANK 0 Septic 0 S.T.E.P. 0 Holding 0 Other Manufacturer Capacity ,+ GREER 1000 Gal. Surface Water 100 Material Number of compartments Lot Line 5'+ NA POLY 2 Foundation 1 O'-}- LIFT STATION Manufacturer Capacity Remarks * also meets minimum 100'+ to any Gal. private well Alarm location Electrical installed by PIPE MATERIAL House to tank 3034Tank to 3034 Installer drainfietd Jr's Septic Services Drainfield CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation)535 ft Inspection 15' 11/6/19 2"' 11/7/19 Location and description 3id 4'h NW Bottom house trim ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp �oa�\'0'� Conditional Approval: Date ,��P,��OF A �S�'t ------------- , Po • AlSeptic System 6 :,;._n r,r,o E . -` :, .,;e Approved /�{��/c.� Date Wz_19 ��.`',;.A�ICLD , a. Note: this approv oes not include well permit requirements. �N®��`t.--- (Rev 05/02/18) DESIGN PARAMETERS ' ' / el PRIMARY SEPTIC SYSTEM ' / / / i - o o N NO. BEDROOM: 3(450 gpd) s` , 'a; / // / / / / A B n i� irn o TANK SIZE: 10008 ir'' / // / / / • / o-- c.- mNo W *** / . / / / / MH 15.7 27.2 i, ** - i / j / / / // \ / T2 17.6 31.6 C N 0 a N G- / / / / /• DC 18.4 33.2 0, -- / t ,./ . , • / / / / / / / / / // // // MT 15.1 31.9 z TRUE NORTH _L SCALE 1'= 50' / j / z / / / / / ,-- / / / v� c�ES_ N �I / / / / / / / / / / ' / r J 5401 W r / / / / / / / n / /\/ _ / / / / / / W / / / / / /? / ' / SUBDIVISION IS SERVED BY '__ `_ I Fes] / / / / COMMUNITY WELL - NO _ .‘ku /Jagoj / / ' / // // // / WELLS W/I 200' / ' At7' ' '° h++ a9si `/ // / / /'/ / , / / / • / / �Q• a ,25,x/ i ]�\ / / /O' \ w / ISI / / / / / / \ / /�• :c o ABSORPTION FI E ' / //// / y� �• �'Ivi..•. ! .Fri SEEPAGE PIT(UNKNOWN DIME ONS \ / / • / �1��S4,.• '"'a�.;; (APPROVED 10/78)./ / / / e ` /,/ % / 1����` �� / / / 110.0 DRIVEWAY �• / s+s \/ / H 3BR /' Ev INSTALLED 10000 SEPTIC TANK N,� / / T SFD j -J W/DCO AFTER PLACE IN SAME ►( i f ./7/. O , HOLE AS ORIGINAL TANK) ®� /'• �" �� CO (13 0 15301 MT �� / m _ WATER LINE/ / jUI O Z O W W WELL RADIUS 24.2 /• 7 j C/ -�g'r Q O CC (1) (0 —55 —55 - NEW SEPTIC / / 1535 • �• O� / :^ 2 Z D U") /•. • /• >..rn E- jJ < co ABBREVIATIONS REMOVED SEPTIC TANK(E)— \ _ - -/1�• ` Cnc2>c O I ~ rn TH TEST HOLE PER MOA CODE . / / Z-= Z 00 Lu N Y (P) PROPOSED �• `-": .• W a N I-. m M Q (E) EXISTING �� �• / 1M,,',,,•`? U) O O Y CO CLEAN OUT NO. � �• Z°OQ W CO = Q FC FOUNDATION CLEANOUT �• •\ Zx� W () FS FLOW SPLITTER �'�� / Zm� (' 0) MT MONITOR TUBE NO. 1 �.�• \ Q9-- 0 N �V = TYP TYPICAL �• d. z — J N 0 0 0 a 0 _ . a Q 0 0 w `` W t M W g4 U U OU _ ELI 5350 4.0 J z . Z _I 4 4 000 g SEPTI• 53. a CL TANK(N) z 0 — W o I- 0' Z PROFILE o SCALE 1-.10' (X 0 I / / NOTES: Lot 3 1) LOT IS SERVED BY A COMMUNITY ' .'' ...: N- '\ WATER SYSTEM. 2) DUE TO SNOW & ICE COVER, THE O GRAVEL DRIVEWAY IS APPROXIMATE. �O `�• .et co �O U, a- Lot 3 a, Lot 2 0 20,728 S.F. Lot 4 svx. / / 8.2'x12.2' SHED WI / CONCRETE PORCH / 8.3'x16.3' SHED 4 // w/ RAMP /4. / 2 / / HOUSE DETAIL m 10 / �t3`. MANHOLE (v / �p Scale: 1" = 20' tr a� �w Q / p, Nal SEPTIC ..„ a,p .. •OO �. / �n' 24,3• PIPES G•/O ib. •N p 62' Lot 1 6' w Ii' .tg ti� / 1 STORY2.6 9A "W R' %9. Q 8.4• 2.4' RESIDENCE ��Zg 2a oP ) r h hob/ / S ~ ' 24 48. / ' O I� .SCP 26.3• i ` °`' 11% �o`ij1 1.3'x4.1' CANT PLOT PLAN ___ AS BUILT _X_ SCALE _1_= 40' _ GRID NW 1462 Project No. ____ 19=671 Al 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates , inc . (907) 522-6476 Phone ,pQopPpOO (907) 522-4625 Fax 5" OF A r‘Op Professional Land Surveyors kenOlangsurvey.com v ,9 0 jonathanOlangsurvey.com QoP ' ..:416A S Qp I hereby certify that I have surveyed the following described property: Q - LOT 2, BLOCK 6, MEADOW RIDGE ESTATES SUBD. — NORTH ADDN. (PLAT No. 74-133) v * 49TH /� '• *SOD Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and d9 not encroach onto the property adjacent thereto, that a no improvements on the property lying adjacent thereto encroach on the surveyed o� KENNETH G. premises and that there are no roadways, transmission lines or other visible ^ .'Lrj�, easements on said property except as indicated hereon. Q s '�,- ( Dated this the Z Day of _� , , at Anchorage, Alaska p Al.,,,,, '' aoo p04FfSS10NA4 — 4 It is the responsibility of the owner to determine the existence of any easements, OOOvoQ4 '' covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 NOTES: 1) LOT IS SERVED BY A COMMUNITY WATER SYSTEM. 2) DUE TO SNOW & ICE COVER, THE GRAVEL DRIVEWAY IS APPROXIMATE. Lot 4 HOUSE DETAIL Scale: 1" = 20' S��PO NpM� PLOT PLAN _ AS BUILT _X_ SCALE _ 1= __ 40__ GRID _ NW 1462__ Project No. ____19=671LA1____ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone Professional Land Surveyors (907) 522-4625 Fax kenOlongsurvey.com oo�pO�OO p OF A•. .`tet Q 04 jonathonOlangsurvey.com �dP ..• S I hereby certify that I have surveyed the following described property: LOT 2, BLOCK 6, MEADOW RIDGE ESTATES SUBD. — NORTH ADDN. (PLAT No. 74-133) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the Day of _11cVsyw�o�sti ?11Lq_, at Anchorage, Alaska ,* ;.'49TH ` y*f 1 pc t• K GLA .o �4p�PFo l ��'(101 S -X5202. S��oG FESSIONAL 00 It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 MUNICIPALITY C]FANCHORAGE On -Site Water & Wastewater Program pOBox ,96650 4700 Elmore Road Anchorage, Alaska gy519'605O 904 Fax: (S0/)o43'7gg7 PnrmitNumbec DSP191475 Work Type: 8epUcTonkUpgrade Effective Date: Expiration Date Tax Code Number: 05153125000 Site Legal Address: MEADOW RIDGE ESTATES NORTH ADD BLK 6 L 2 G:1452 Site Mailing Address: 24Q31HOMESTEAD RD, Chugiak Owner: HENSONL|3|J&BOBBY E Design Engineer: PANNDNEENGINEERING SERVICES This permit infor the construction of: 0 Disposal Field 0 Septic Tank El Holding Tank 171 Privy 10/21/2019 10/2O/202O Lot Size in Sq Ft: 20728 Total Bedrooms: 3 []Private Well [] Water Storage All construction shall bainaccordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65.Provide notification bycalling (BU7)343-7QO4(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: a. Opened and Closed onthe same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: MUNICIPALITY TY ®F ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-531-25 Property owner(s) BOBBY & LISI HENSON Day phone Mailing address 24931 HOMESTEAD RD, CHUGIAK, AK 99567 Site address 24931 HOMESTEAD RD Legal description (Sub'd., Block & Lot) MEADOW RIDGE EST NORTH ADD B6 L2 Legal description (Township, Range & Section) Lot Size 20,728 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Q Septic Tank ❑x Upgrade (w/wo ADU) pg � Duplex (D) ❑ Holding Tank ❑ Renewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) as Permit/Rush Fees: S O-0 Waiver Fees: Date of Payment: 1011-11 TO Date of Payment: / Receipt Number: OU 45 Receipt Number: Permit No. _ OS R fl 1 9D 5 Waiver No. Permit App_:• :• L " 0 j Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191475, Rebecca Carroll, 10/21/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191475, Rebecca Carroll, 10/21/19  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 NAME PHONE [] NEW MAILING ADDRESS [~ . ~) .~:), ~'~ LOCATION X~,~ ¢O**. ~,,,~ NO. OFBEDROOMS ; ~ell ~ 1 Absorption area Dwelling PERMIT NO. DISTANCE TO: ~.~ Z Manufacturer ~ Material No, of compartments ~ Liq,~capacity in gallons IF HOMEMADE: Inside length 0 [~ Width ~ ~ Liquid depth ~I.~ ~ ~ ~ DISTANCE TO: We~ Dwelling PERMIT NO. 0 ~ ~ Manufacturer Material I ~iquid ca~acitg in ~allons ~ Woll Foundation ~earost lot line ~[~MIT ~0. ~ DISTANCE~ ~_ No. oflinesV ., ,Length°feachllne~" Total lengthoflinos Trenchwidth inches Distancebetweenlines ~ Top of tile to fini~ Cad~ ~ ~ ~ Material beneath tile Total effective absorption area Q inches Length Width Depth PERMIT NO. ~ [ Type of crib Crib diameter Crib depth Total effective absorption area m ~e~ ~ Building foundation Nearest lot line ¢ DISTANCE TO: ~ ~ass~x v~ Depth Driller Distance to lot line PERMIT NO, ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER S~L TEST ~A~INq ~'l ~O~ ~ INSTALLER REMARKS ~13 (F ;v. 3/78) C, I'-I-- S I PERMIT NO. ( 78096Z< ) APPLICANT LOCATION LEGAL I'IIJN I C I != ,1L I T'T' I_-].m F FIIslCHml_,l;-:l::lI_~E DEPARTMENT OF HEALTH AND ENVIRONMENTAL. PROTECTION 825 "L" STREET.. ANCHORAGE.. AK. .99501 264-4?20 SEI~IER WILLIAM PLATZEK IJPGRRDE F'ERr,1 I T ~0 BOX 522 CHUGIRK 688 2515 L2 B6 MEADOW RIDGE LOT SIZE 2~000 SQUARE FEET TYPE OF' SOIL ABSORBTION SYSTEM IS: DRAINFIELD MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT?BR)= 0 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [~EF"I'H= 0 L 1~- t-~ G T ::: ~|-~ 0 m3 R :-I'...' I~ L C:,EPTH= ~_i~ 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). 'T~4E TRE~-4E:H W I[)TH IS ~. OEtpZl F-EEl~ THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE E×CAVATION (IN FEET). ~."Em':)LI I ~'.ED SEPT I C TRNK 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) I ~-~SPECTI CmNS ARE ~:E~I_mIRED BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL 8Y THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET' FOR R PRIVATE WELL; OR 150 TO 200 FEET' FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC HELL. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS 8ND CONSTRUCTION DIRGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'ERM I T E;~P I RES [)EC:Er'IBER I CERTIFY THAT 1: I 8M FAMILIAR WITH THE RE~.UIREMENTS FOR ON-SITE SEWERS AND WELLS AS SEI' FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. APPLICANT WI~RM''''"P~ZEK ' ~"'-I ............. DFITE .... ~ V3:. 2 I~ED 8Y ~ - - - MUNICIPALITY OF AHORAOE Development Services Department Phone: 907-343-7904 On -Site Water &Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-531-25 1. GENERAL INFORMATION Expiration Date: 2- 2 ZC-) Complete legal description MEADOW RIDGE ESTATES NORTH ADD B6 L2 Location (site address) 24931 HOMESTEAD RD, Chugiak, AK Current property owner(s) LISI & BOBBY HENSON Day phone Mailing address Real estate agent 24931 HOMESTEAD RD, CHUGIAK, AK 99567 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well [ Community ❑ Public Water System Public Sewer ❑ Pup 6ct�'kK ZZIepeho I, Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ S.J�' (� Waiver Fee $ Date of Payment 1.0 Q AIR Date of Payment Receipt Number 031 H-10 Receipt Number. COSA # 05C, tq 1 5 Sq 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 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE !/ System #1 Approved for 5 bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 745-8200 Date / lFG00 Z, OF Aq �m 1� CE iIT,? Conditional approval for bedrooms, with the following stipulations: BYL Original Certificate Date:�� The Municipality of Ancho ge 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 Legal Description: MEADOW RIDGE ESTATES NORTH ADD B6 L2 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Parcel ID: 051-531-25 Structure served by this system 1 Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative' Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample Static water level at beginning of test ft. Comments Served By GE Q c�yA-r-�`� �i•�s-t-- zz-f e ey j B. TANK DATA Age of tank(s) NEW years Tank type/material s"c/Poly Measured operating fluid level in septic tank n/a ❑® Standpipes/foundation cleanout per record drawing Date of pumping n/a D. ABSORPTION FIELD DATA Seepage Pit Which system tested (date installed) 1963 Fil ALL standpipes present per record drawing Total measured depth from grade 6.5 ft (max) Measured depth to pipe invert from grade —3.7 ft (min) ❑ N/A — pressurized field MR Monitor tubes go to bottom of effective. If not, state depth into effective C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 20191115 Results IDPass For 3 Fluid depth prior to test 7.5 Water added 450 gal New depth 13 in Elapsed time 225 min F' Ifl 'dd 75 bedrooms 01 Code -required soil cover over field Ina ul epth In Absorption rate >450 god r-1Systempresoaked N/A (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: ABSORPTION FIELD ORIGINAL A CESSPOOL AT TIME OF CONSTRUCTION (1963). TRANSITIONED TO SEEPAGE PIT IN 1978 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' ED Yes Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft Q Yes if No ft Water Service Line > 10' F/� Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' ❑ Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10'✓� ED Yes if No ft Surface Water > 100' ®✓ Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: 0 Absorption Field > 5' if No Yes if No ft Private Wells > 100'✓Q Yes if No ft Water Main > 10' P-1 Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' F/� 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' ED 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' P✓ Yes if No ft Water Service Line > 10' F,71 Yes if No ft Community Wells > 200' P11 Yes if No ft Surface Water > 100'✓0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that l have determined through field inspection's and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet 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 INFORMATIO" zl~/~N/~/r Application Date GENERAL (a) Legal Description (include lot, block, subdivision, section, township, range) £n~ ~ B£_o~/z ~-M~adow Ridg~ E~at~s Location (address or directions) Augus~ ~8; 1986 (b) Applicant Name Q/e. ndy K~.~a~,& Telephone: Home 688-$77~ Business Applicant Address P.~0. Bn~ 6707~?;; ~./~f~g./.a/~.~ A,C~S~za 99567 (c) Applicant is (check one): Lending Institution []; Owner/builder I'~; Buyer []; Other [] (explain); 561-1161 (d) Lending Institution ~,~a~{~a Paolflo [4n#~gag~ Telephone Address 101 hlo_x_Y'_ R_o_~x_O.._; p:(~. Rn~ ld~1~9~1; A~hn~ng~; (e) Real Estate Company and Agent ~0t~o_ Address OO~lfl Telephone (f) ~k~he HAAtothefollowingaddress: S ~ S Engineering SRB 196X Eaglz River, Alaska 99577 TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well1'3 Community[] Publicl~ Dawn Wat6r S~st~m 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 ~ Public [] Community [] Holding Tank [] Note: tf 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 PROVIDIh~ INSPECTIONS, TESTS, FILE SEARCH, Dh fA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this H~alth 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 ~ ,~ ( I~,fdt~-II~,l~'Dl~,l~''~ Address Date ~GLE RIVER: AK 9gS77 Telephone Approved ,,)(' Disapproved Conditional Terms of Conditional Approval 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 (MOLl HEALTH AUTHORITY APPROVAL (HAA) MUN,C,P^L' Y Or FE.RU^RY DEPT. OF HEALTH & 264-4720 ENVIRONMENTAL PROTE~ION SEP t 0 ~86 Legal Description: ~ ~. Well Classification ~ If A, B, C, D.E.C. Approved ~N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water 8ample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed lC2/0/f~"~ Size /f~ ~kL~ No, of Compartments Standpipes {~N) Air-tight Caps t~)/N) Foundation Cleanout (Y/N) Depression over Tank (Y~ Date Last Pumped ~,/~c~/'~?(~ Pumping/Maintenance Contract on File (Y/N) /~//,/~ ; for -- ' Holding Tank High-Water Alarm (Y/N) I'--///~ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course To Building Foundation f / To DispOsal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ~' .~--- Square Feet of Absorption Area Depression over Field (YN,~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ?~t'5~:~ -/d To Building Foundation ~.---Y ! Lot T© Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ' Type of System Design Length of Field (-.-~, I~'-, De p,t~_of Field Gravel Bed Thickness Standpipes Present (~) 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) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and. HAA guidelines in effect on the date of this inspection. S & S ENGINEERING Date /,~'/~/_,,J~ Signed 5J~ B 196X ' - . MOA No. C°mpanyE.A-Gi~ RIVER, AK Receipt No /--/~:)~) / Date of PaYment ~//~/O Amount:$ Page 2 of 2 72-026 (11/84) DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 I~ILL SI4EFFIELD, GOVERNOR Telephol:~e,: (907) Address: 274-2533 DATE: PWS I.D.# August 21, 1986 211431 To Whom it May Concern: According to records on file in this office the DAWN WATER COMPANY Water System is in compliance with the State Drinking Water Regulations Sincerely, ~ ~S~teven ;l.~.~, PE Distrio~ngineer 609976 TRIP F ~:~i 13TF::F~M]. 4S 472 PARTS ! AND 3 WITH CARBON 11'4TAr ' PAd'i" 3 WILL BE I~ETURNED WITH R~?!~r. '~UNICIPALITY OF ANCHORAG' ~_Oz=l~ DEPARTME... dF HEALTH AND ENVIRONMENi.~ PROTECTION 825 L Street, Anchoraa~. Alaska 99501 264-4720 Date Received: April 10, 1978 ~1: Time 1~.~ #2: Time #3: Time Date Date Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Mailing Address: Post Office Box 1068 99577 2. Property Owner: Betty L/Joe A Gurley Mailing Address: Post Office Box 887 99577 Alaska Mutual Savings Bank Phone: 694-95~1 Phone: 688-2576/h 694-2161/her work 3. Legal Description: Lot 2 Block 6 Meadow Ridge Estates Subdivision 4: Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: Three Number of Bedrooms: Se Well System: Permit # Construction Individual Well ( ) Community/Public System (x~ Depth of Well Well Log on File ( ) Bacterial Analysis Sewage Disposal System: Permit # Septic Tank Size Absorption Area On-site System (x) Public Utility ( ) Installed Installer Manufacturer Soils Rate Material Distances: Well to Septic Tank to Sewer Line Nearest Lot line to Nearest Lot Line to Absorption Area Absorption Area Page-Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 2 Block 6 Meadow Ridge Estates Subdivision Comments: Affadavit Attached: ( ) Approved: Disapproved: Departmen't Worksheet: Letter Attached: ( ) Date~: Date: ............................. (peJ!nbe,m ee~, o.qX~ ) AH3AI33(] qVl03~$ 'ON (]NV 13~HIS (a~m, sod snld) ,)OI~--'II¥1AI 031.-II/a33 ~10.-I .I. d1333a ].. o JNICIPALITY OF ANCHORAGE .~nt of Health and Environmental Protection 825 L Street, Anchorage, Alaska 995(}1 264-4720 7uest for Approval of Individual Sewer and Water Facilities Property Owner: Mailing Address: Name of Buyer: Mailing Address: Betty L. and Joe A. Gurle~ P. O. Box 887, Eagle River, Alaska Jimmy M. Gatos 995~one: 688-2576 Home (Betty~6~4-1]%~6~-~ Box 26~z.~gle River~ Alaska 99577 Phone: ~l~8-20~9__Home 274-5793 Work Lending Institution: Alaska Mutual Savings Bank Mailing Address: P. O. Box 1068, Eagle River, Ak 99577 Phone: 694-9571 Realtor/Agent: n/a Mailing Address: Phone: Legal Description: Lot 2, Block 6, Meadowridge Estates Street Location: NHN Homestead Road, Chu~iak, Alaska 99567 Single Family Residence: Mnltiple Family Residence: Number of Bedrooms: Number of Bedrooms: Water Supply: *Individual Well ( ) If Individual Well, well depth If Con~nunity System, name of system Public/Community System LX) Dawn Water Sewage Disposal System: *~Dn-site System >~XX) Public Syst=m ( ) If On-site System, date of installation: ???? *NOTE: A well log is re uired on ALL weils drilled si~ 'test is required by this de~artment A fee of $20.00 must accompany each request before procc~ng can be initialed. 3/77 2 October 1978 Mr. Joe Ourley P. O. Box 887 Eagle River, AK 99577 Dear Mr. Gurley: On 1 Oct 1978, your cesspool was pumped and then charged with 1,000 gallons of water in order to determine whether the cesspool would adequately serve as a seepage pit for your three bedroom residence located at Lot~Block-~c, Meadow Ridge Estates. Percolation through the seepage pit provided for an absorption of 499.8 gallons or 166.6 gallons per bedroom over a 24 hour period between 1-2 Oct 1978. Since there is no septic tank in existence as a part of this system, a septic tank, minimum 1,000 gallons, will be required to complete the system. The existing cesspool should be thoroughly cleaned and all solids removed at the time the septic tank is installed and prior to its application as a seepage pit. k~ten a septic tank has been properly installed, the existing cess- pool will adequately serve as a seepage pit to complete this system. CF: Dept of Health and~ Environmental Protection Sinc~ly, Z'