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MEADOW RIDGE ESTATES NORTH ADD BLK 6 LT 3
Meadow Ridge Estates North Addition Block 6 Lot 3 #051-531-24 M UN IC I PALITY OF ANCHORAGE W'' nCF3t Orr -Sika Water & WastewaterProgram PO BOK '.56650 4700 Elrnure FkcAmhorage, NnsYm i}519-GG50 Phone: (907} 343-7964fax: (847) 343 7597" µ P,lrIIi enT On -Site Wastewater Disposal System Permit PL-rmit Number: OSP221081 Effeulive Date, 4==2 workTypo: SoloWTigrik Upgrade Expiration Date: 4f2OJ2= Tax Cede Number: 46153124004 Site Legal A,ddruss; MEADOW RIDGE ESTATES NORTH AOD BILK 6 LT 3 G.1462 Site Mailing Address; 24945 HOMESTEAD R.p, Chugiak Owner: LAWRENCE PAUL B Lot gIzi� in Sq Ft, 20292 Design Engineer; FI RST WATER CONSULTING Total l3idna4mw. 3 Thi s pe rm It is for the con s#uc#i cm of: ❑ Disposal Field Q septic 790 ❑ Holding Tank D Privy ❑ Prirate Well ❑ Wiater Storage All c:arrstruction $hall hD In necordarLcewftht 1- The attached aped design_ 2- Al I mquirarpv nts specified In Arr h rage Mlunir 1pia I ovde Chapters 15.55 and 15.65 and th E, Slate of Al as ka . WauteWater Disposal Regulstlons (19AAC72) and Drin!cing Water RaUulations {1 AAAC80} Z1. Tho woctnwator gado raqulror. Irrr.PC tlurl:3 duririg Lhra inatnlletion. The erxglncer phall rKti y the Developiiwi!L 5erv�ces Department per AMC 1:5.55. Provide natihcadon by calling (9V) �4n-7904 (24 7), 4. From 4et2tser 1510 April 15, a subsurface sail ahsorptioh system under constnxtian during imezing weather shall be either, a. Opened and Closed on th* same day, or b. Gcvered, sealed, orad heated to prevent freezing Special Proulslorrs= The meter service fine shall be Iacaled prior to inslollation cf the septic tank, to the emient required 10 conrirm minimum 14 ft separation 1n septic system, Received By: Issu��l �y_ 4/2012022 0811e; Dale; ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-531-24 Property owner(s) PAUL B LAWRENCE Day phone Mailing address 19727 WAR ADMIRAL ROAD, EAGLE RIVER, AK 99577 Site address 24945 HOMESTEAD ROAD, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) MEADOW RIDGE EST. N. ADD 136, L3 Legal description (Township, Range & Section) Lot Size 20,292 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank El Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN Initial Upgrade Renewal TYPE OF DWELLING: ❑ Single Family (SF) (w/wo ADU) x Duplex (D) ❑ Multiple Dwellings (SF and/or D) THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. nature of property owner or authorized agent) Permit/Rush Fees: � as 5 Waiver Fees: Date of Payment: y 13 d 0�2 2 Date of Payment: Receipt Number: 1 .3 41 _� H Receipt Number: Permit No. O S P a a 103 1 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc x❑ 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com April 15, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: MEADOW RIDGE ESTATES NORTH ADD, BLOCK 6, LOT 3 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. The lot and area are served by public water / Class A well. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221081, Rebecca Carroll, 04/20/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221081, Rebecca Carroll, 04/20/22 Municipality of Anchorage Page ( of Z DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report 5W g25( Number: Permit Number: PID Name Wastewater System: El New Upgrade Addre29�19� /,.��s� eD gg ABSORPTION FIELD Phone. No of Bedrooms Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: D'4GPD/Sch Ft. Total Depth from original grade:�� / Lot: Block. ry' �S bdivision: c Depth to pipe bottom from original grace: Gravel depth beneath pipe - / '"7 Ft. Ft. Township: Range: Section. Fill added above original grade: Gravel length: 1 Ft. Fl. WELL: ❑ New ❑ Upgrade Gravel width: Number of lines Distance between lines. Ft. V Ft. Clncs.fication (Private, A,B,C). Total Depth. Cased To: Total absorption area: Pipe material: d'81O Ft Ft 660SQ. Ft. i V Driller. Date Drilled: Static Water Level: Installer ^ c—U Date installed:/a q y H, lwlrt-1 / F-. Yield Pump Set at: I Casing Height Above Ground. TANK GPM Ft Ft. SEPARATION DISTANCES opticCE�/6)r Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer. Capacity in gallons: �J\ From Tank Field Station Tank Sewer Lines [� /60-Z) Well ,,��TT� 2.(/ti4'17 Material: G Number of Compartments: Surfac LIFT STATION Water Lot 1 Size in gallons: Manufacturer: Line t -✓ �� -- Foundation '41 'Pump on" level at: mp off" level at: High water alarm at: Curtain t . I I�1 Pump Make del Electrical Inspections performed by. Drain BENCH MARK Remarks: Location and Description: --rc? D -F e -e � r -t ou.1u a -I I" Assumed Elevation: K7� Ft ENGINEER'S SEAL OF e6 5 b S ENGINEERING Inspections performed by: 17034 Eagle River Loop Road, 8W4: 1st Eagle River, Alaska 94577 2nd ;r WL 11 d zH li Swl ;Y' IL Department of Health and Human Services approval Reviewed and approved by: Dater 72-013 (Rev. 9/91) MOA 25 Permit No. SW930251 Page 2 of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report MEADOW RIDGE ESTATES, NORTH ADDITION Legal Description: BLOCK 6. LOT 3 PID No.:051 531 24 C04 NEW TRENCH 1 CO3 MT1 n n C04 128.9' I I1 110.4' - FINAL GRADE SR 125.4' SR, 106.6' SPILL-OVE 4 116.4' �1 SCALE 1" = 10• 99.6' 93.6' NO WATER POUND MTz T" coz co ° os I ssz %EXIST. TRENCH ° Ti LOT 3 of 2 SCALE 1" = 40' A B CO1 22 60 CO2 67 80 MT1 78 65 C04 114 135 C05 111 112 CO3 69 81 EXISTING 1000 GAL. SEPTIC TANK A / 3 BDRM I HOUSE :K DECK I 0 I Q I B I LY I Q I I U DRIVE H LI I I W \ I 2 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE oJ`Q-) 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 /� DUiri ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930251 DATE ISSUED: 7/23/93 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 7/23/94 OWNER NAME:MCKAY CAROL L OWNER ADDRESS:24945 HOMESTEAD RD CHUGIAK, AK 99567 PARCEL ID:05153124 LEGAL DESCRIPTION: MEADOW RIDGE ESTATES NO ADDN B LK 6 LT 3 LOT SIZE: 20292 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: ( z b C DATE: Z�'l July 12, 1993 HEALTH AUTHORITY 4unicipality of Anchorage APPROVALS EPARTMENT OF HEALTH AND HUMAN SERVICES ttention: Robby Robinson 825 L Street nchorage, Alaska 99501 SEWER & WATER MAIN EXTENSIONS ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX 694-1211 E: Meadow Ridge Subdivision, Block 6, Lot 3 SEWER &WATER INSPECTION equest you issuance a permit to upgrade the septic system serving the three bedroom home on the referenced property. n adequacy test was performed on the existing system and the ENGINEERING STUDIES AND REPORTS absorption capacity of the system was found to be inadequate. conditional Health Authority Approval was issued on ecember 23, 1992. WELLINSPECTION k test hole was excavated and a percolation test performed in &PLOW TEST he area of the proposed upgrade. Attached is the proposed pgrade design. his property is served by a Community water system. There SITE PLANS re no protective well radii which encroach upon the proposed eptic system area. We do not anticipate any adverse effects n neighboring properties by the installation of the proposed eptic upgrade. ROAD DESIGN f you have any questions or require additional information or your review, please contact us. SOIL TEST incerel� PERCOLATION TEST A. Shafer, P.E. STRUCTURAL& MECHANICAL INSPECTIONS S/LSU/lsu ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP - SUITE 204 - EAGLE RIVER, ALASKA 99577 LEGAL {,\MEADOW �KD DRAWN L. S. ULSHER ' R.A.S. w DESIGN CRITERIAAA: A 3 BDRM HOUSE = 450 G SOILS = 0.6 GPD/SQ. T. 450/0.6 = 750 SQ. T. EQ'D L- EqC (E RIVER, AlpsdP DEEP TRE H: 11' DEEP 7' EFFECTIVE 54' LONG 7-5 (jj CONTRACTOR IS REQUIRED TO OBTAIN UTILITY LOCATES PRIOR TO ANY EXCAVATION WORK. ALL PORTIONS OF SYSTEM WITH LESS THAN 3.5' OF COVER REQUIRE INSULATION. i PROPERTY SERVED BY COMMUNITY WATER SYSTEM. NO WELLS WITHIN 200' OF SEPTIC SYSTEM. n T DATE 7/14/93 I11T. 1 OF 1 1` MT CC TRENCH MT 1 \ DETAIL SCALE 1' = 10' )[IST. 1000 GAL SEPTIC TANK 1 co / co Co Co !co ( /EXIST. TRENCH\BDRM / 3 l -{ ?j HOUSE ; LO ` DECK ; STRUCTURES, EASEMENTS, OR ENCROACHMENTS SHOWN ON THIS SITE PLAN ARE AS SHOWN ON AN AS—BUILT SURVEY DRAWN BY: `t < DUANE MARK SEWARD I h IT IS THE RESPONSIBILTIY OF THE CONTRACTOR TO VERIFY EASEMENTS, REQUIRED SEPARATION DISTANCES, AND PROPERTY LINES PRIOR TO CONSTRUCTION. DECK' i i j i DRIVE o Q w i wLJ 0 = i THE ENGINEER MAY VARY TFiE EXACT DIMENSIONS AND OES!CN PARAME"fERS IN THE FIELD, IF NECESSARY, TO MEET SiTF CONDITIONS. � 9 Municipality of Anchorage, i, I I ry S DEPARTMENT OF HEALTH & HUMAN SERVICES, 825 "L" Street, Anchorage, Alaska 99502-0650 zs SOILS LOG — PERCOLATION TEST 6 ; o6sr-t A. shafo No. 1457,F PERFORMED FOR: DATE PERFO ED:G LEGAL DESCRIPTION: L,,'r-27 5 V , L_p t`A�l1Do,� Township, Range, Section: E�PPTHO-tbua,� SLOPE SITE PLAN (FEEC) 1 � 2� 49 31- C/ 6M P I S Ivr 4 6 /d WAS GROUND WATER � ENCOUNTERED? IF YES, AT WHAT LO DEPTH? /4' P E Depth to Water er Monitoring? z Date: o' 16- 17 6 17 - C). 18 19 20 COMMENTS Reading Date Gross Net Time Time Depth to Water Net Drop P � U- 2 2S \ o t✓ n� 2N " 3 o' L.Ij� PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN --- LL---Fi-AND FT 17034 Eagle River Loop Road "ou _ I PERFORMED B&SIle River, Ales a 99577 / ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI / 72-008 (Rev. 4/85) X CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: - 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 NAM �- HONE / HON l NEW fL-t G�------...-UPGRADE -- --------------_._----------------c�c��� MAILING ADDRESS LEG DESCRIPTION r 67 LOCATION - NO. OF'!�ROOMS W II Abs rpioy)area DISTANCE TO: 1Q �)t Dwell ng PERMI' Material No. of compartments QManufacturp."� Lin. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth y DISTANCE TO: Well Dwelling PERMIT NO. JAZ 02< _Manufacturer -_._._. _ Material Liquid capacity in gallons 0 �= U- Z DISTANCE TO: No. of lines Wellt LengthP.7h line Found a ion Total I ngthP lines Nearest lot l�in�ey ( Trenchr idth PERMIT NO�%' Distance bet fines h z u.1 QCt - - -- ,o -_.. - - - -- -- ------ �t ' --- -effecti H 0 Top of the to finish grade Material beneath rile !21 Total rption area ._ Length Width Depth PERMIT NO. w ---- ---- -- Q F- ° a w Type of crib Crib diameter -- Crib depth --- Total effective absorption area - y DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER 0 U PIPE MATERIALS -�� r� C'78<S✓ S� � SOIL TEST RATING INSTALLER _ ------—_��-- REMARKS II L' � .i APPROV DATE LEGAL 4; �S' / l (� 72-013 (Hev. 3178) THE 14EQUl9ED SIZE OF THE SAM. HBSDRPTION SYSTEM IS� QTPM�Xbl 0 ����Kid ���� TMIN Q Fit pot M M U Q HIE Q " !- by W", THE LENGTH DlMENS ION IS THE LENGTH (IM FEET) 8F THE THE DEPTH GF 9 TRENCH OR PIT IS THE DISTHNCE 8ETWEEN GROUND HND THE BOTTOM OF THE EXCHYHTION (IN FEET) THERE IS NO SET HIDTH FOR TREMCHES THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETW HND THE BOTTOM OF THE EXCHVHTION (IN FEET). PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THlS DEPHRTMENT DURIMG INSTHLLHTIlot! INSPECTIONS OF HNY NELLS HDJHCENT TO THIS PROPERTY HMD THE NU�BER OF RESIDENCES THHT THE WELL. WILL SERVE. ��� �8. N WI Z TU H 10 1=4 EEC 10 0- 1: 03 SH HEiiI M Q 111 R -A Z F? TOE PIT, IE! HCKFILLING OF HNY SYSTEM HITHOUT FIN1L INSPECTION HND Fin PRCM; FR. BY THlS DEPHRTMENT HILL BE SUBJECT TD PROSECUTION �Q Q WWI 1: 1- son 1-1 TO, X TV! FRn SO Q NEI Q TIE 01 ITS? EYE to! 00 J., S. so 03 , :�:! I CEPTIFY THHT 1� I HM F41ILIH0 WITH THE PEQUIPEMENTS FOR OM~SITE SEWERS HND WELLS HS SET FORTH 8Y THE MUNICIPHLITY OF HNCHORHGE. 2� I NILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES. ]� I UNDERSTHND THHT THE ON-SITE SEWER MAY REQUIRE ENLHRGEMENT IF THE RESIDEMCE IS REMODELED TO INCLUDE MORE THHN n BEDRDOMI xSOILS LOG MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION \ TEST \\ 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 5e—le- e /e- 4=7! C,a ✓ - A o4 y / DATE PERFORMED: t/ �¢ 2 z / LEGAL DESCRIPTION: / (e' d"k t d� r P R SLOPE SITE PLAN IF ���c. COMMENTS PERFORMED BY: 72-008 (6/79) WAS GROUND WATER J� j� S ENCOUNTERED? —" t C F IF YES, AT WHAT E DEPTH? ` Reading Date Gross Time Net Time Depth to Water Net Drop 2 d O's -0 4 Z %/ S -L lU 0 vy 0'z � `IS' D o • S"' ay Ca / /7- 17- O(/ /�.: ©1 - 5 rzzz 0 7Y� •o S - PERCOLATION RATE C21— (minutes/inch) TEST RUN BETWEEN FT AND LFT • A � CERTIFIED BY: DATE: �p`b_ o Municipality of Anchorage •. `Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051- S31 -Z!- COSA#_ H/� 0�1 0332 Expiration Date: — 2 -' / O 1. GENERAL INFORMATION Complete legal description Lot 3; Block 6; Meadow Ridge Estates Subdivision North Addition Location (site address) 24945 Homestead Rd. Chugiak, AK 99567 Current Property owner(s) Brian Dixon Mailing address Lending agency Mailing address Real Estate Agent Mailing Address PO Box 3456 Kodiak, AK 99516 Peggy Kelly / Dynamic Unless otherwise requested, COSA will be held by DSO for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑� Day phone 907602.5105 Day phone Day phone 261-7625 TYPE OF WASTEWATER DISPOSAL: Individual On-site 2 Individual Holding Tank ❑ Community On-site ❑ 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 engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 S & S engineering Phone 694-2879 Address 15861 S. Birchwood Loop Chugiak, AK 99567 Engineer's Printed Name Robert A. Shafer Date a 5. DSD SI NATURE e>' INDIA ji a , ) Y V Approved for _bedrooms. .•tF 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: "k�— Original Certificate Date: (Rw IIM) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SY 11STEMS APPROVAL CHECKLIST �b��•r a1k�,yJc RICK nv q. Legal Description: , £A e FS� Parcel ID: 057-x'3 /- ZZ it A. WELL DATA Well type 1 C. Date completed _ Total depth ft. Date of test Static water level If A, B, or C provide PWSID # _ Well Log (Y/N) Sanitary seal (Y/N) _ Cased to ft. FROM WELL LOG ft. Wires properly protected Casing height (aboywc AT ft. in. Well production g.p.m. g.p.m. WATER SAMPLE REULTS: Coliform �oSnies/100 mL Nitrate mg/L Other bacteria colonies/100 mL Ar ugl date of sample: _ Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Se Date Installed 9 21 Tank size N66 gal. Number of Compartments Z Cleanouts (Y/N) V Foundation cleanout (Y/N) Depression over tank (YIN) j&/ . High water alarm (Y/N) Date of pumping f `J Pumper `) • 5 �J (Yl I l� C. ABSORPTION FI LD DATA Date installed 3 °13 Soil ratingg.p.d./ or ft2/bdrm) System type 'Tf er1 Length ft. Width 3 ' ft. Gravel below pipe '% ft. Total depth JL ft. Eft. abso ption area XGfe Monitoring tube �I Depression over field Date of adequacy test 7M Results (Pass/Fail)SS_j _ For 3 bedrooms Fluid depth in absorption field before test 'n in. Water a�dlded�LQ gal. New depth I in. Elapsed TimeiZ0 min. Final fluid depth v in. Absorption rate >= y1-0 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) A If yes, give date D. LIFT STATION Date installed Size in gallons 'Pumpovel at _ in. 'Pum a _ in. D Cycles tested E. SEPARATION DISTANCES (Y/N) High water alarm level at Meets alar & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: )U'w TL. Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line On adjacent lots On adjacent lots manhole/cleanout Holding tank Manure/animal excrete storage areas in. SEPARATION DISTANCES FROM SEPTICR4eb9+NG TANK ON LOT TO: Building foundation S ft Property line C /f Absorption field Water main/0 rf�f Water service line /O f Surface water Wells on adjacent lots /oo/f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: J* Property line /d f Building foundation Water main Water Service line 149 Surface water ��yf Driveway, parking/vehicle storage d rt Curtain drain mane kna`.rh Wells on adjacent lots !70 F. COMMENTS /Orf G. ENGINEER'S CERTIFICATION I certify that I have determinet� review of Municipal records .t . conformance with MOA Name gc Engineers P`qe Nam/ A) D 7 Date field inspections and )ove systems, ale in COSA Fee $!::fi 01 0 Date of Payment1��" O� Receipt Number0 1i�3 � (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number n A. •snob • � �. 113 •E Pp/ 1. • r UND" NO THE SAriiii TAKES niN Alli "Kei xii ... Ali ... PLO I PLAN LO IT IS TME FlEiiii SURVEY CERTIMATION mi FOLMATIN AS -OAT ron /V'PYI -5-s' Z:i % of) C11% t n VA w I AplT 7 :WONSwury Fat Tw Ww"MAL TR i CCINVIIIINCTION mu li ESTANUSHNG BOUNOARY OR CTIM Day i A� Fli UAAKM (*&y FOR 74C COST Cr rMe SU0i WX VOM IN LR 247 1 SCALE . . . . . . . . . . . . —TIt . . . . . . . . . . SYMBOLS 8CLS SET REBAR U" ii 0 rm :;F DRAli I I Z . I ASPi ... li NEW la%waam- A—kaill AS%hi ELEV, wom FUM EYE EENCMETE .0 A. Robert E. sic 4DAP4D li UNLESS OTMEii ared by Is, Jr. & Assoc. Land Surveyors II AYE 1"W1462 1"' 9220 .1 LOT 3, BLOCK 6. HEADOU RIDCE ESTATES NORTH Municipality of Anchorage /• Development Services Department o Building Safety Division ='t""'•�u On -Site Water and Wastewater Program : A I , T 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-531-24 HAA # ja Q 3 Q a 0Q Expiration Date:�- 1. GENERAL INFORMATION Complete legal description Lot 3, Bk 6, Meadow Ridge Estates, North Addition Location (site address or directions) 24945 Homestead Road Current Property owner(s) Amy Vaudreuil Day phone (907) 279-5528 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 24945 Homestead Road Chugiak, Alaska 99567 Day phone Terry Gose Day phone (907) 240-3667 RE/MAX Properties 2600 Cordova Street Anchorage, Alaska 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: _3 3. TYPE OF WATER SUPPLY:* TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site KI Individual Water Storage ❑ Individual Holding tank ❑ Community Class A Well ® Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pinard Engineering Phone (907) 357-3647 Address PO Box 871347 Wasilla, Alaska 99687 Engineer's Printed Name Paul E. Pirard Date�t 5,(_ 5. DSD SIGNATURE VApproved for 3 bedrooms. Disapproved. OF At �i 00 of e , 00 0 `'.. 00000 •. 90600.00;1 e, 9 ;d �,P,eel E. Plnard •o �,�; tA �J �E-4703 •:Ow 4•• .•e • ,a9 00...00 .� 1� PR FESS% ,�-�"• Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (Rev. 01102) Municipality of Anchorage o,.= •�,� • Development Services Department Building Safety Division " On -Site Water & Wastewater Program 54 lily 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ct.anchorage.ek.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 3, Bk 6, lbacbv Ridge Est, North Parcel ID: 051-531-24 A. WELL DATA Well type A If A. B, or C provide PWSID # 211431 Well Log (YM) N/A Date completed NIA Sanitary seal (YM) —21A Wires property protected (YM) N/A Total depth N A fL Cased to N A ft. Casing height (above ground) N/A in. FROM WELL LOG AT INSPECTION Date of test N/A N/A Static water level N/A ft. N/A ft. Well production N/Ag,p.rn, N/A g.p.m; WATER SAMPLE RESULTS: N/A Coliform cotonies/100 ml. Nitrate mgA. Other bacteria colonies/100 ml. Date of sample: Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Material Steel Date installed 7/14/82 Tank size 1000 gal. Number of Compartm 2 Cleanouts (YM) Y V Co ,N aby( spm•- TmLo2 Foundation cleanout (YIN) -.L Depression over tank (YM) HN_ High water alarm (YM) N/A Date of pumping 5/15/03 Pumper Chugach J Pumping C. ABSORPTION FIELD DATA i Date installed 9,[23/93 Soil rating (g.p.dA? or ff/bdrm) —Q,_6 System type Deep Trench Length 54 ft. Width 3 ft. Gravel below pipe 7 ft. J j Total depth 11 ft. Eff. absorption area 756 ft' Monitoring tube Y Depression over field N Date of adequacy test 5/12/03 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0_0In. Water added 55 0.0 p rp �gai. New depth_ in. Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= 500 g.p.d. Any � (past 12 mo.) (YJN & type) N An rejuvenation treatment If yes, give date D. LIFT STATION N/A Date installed "Pump on" level at _ in. Datum Size in gallons "Pump off" level at _ in. Cydes tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot Absorption field on lot Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuit requirements? N/A On adjacent lots On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line 10t+ Absorption field 51+ Water main 101+ Water service line 10' + Surface water 10011+ Wells on adjacent Iots200 1 + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 18I + Building foundation i n r + Water main 10 r + Water Service line 101+ Surface water 1001+_ Driveway, parking/vehicle storage 301+ Curtain drain N/A Wells on adjacent lots 2001+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Paul E. Pinard Date 5/15/03 HAA Fee $ 3 7SO" Waiver Fee $ Date of Payment 5". 2 O - D 3 Date of Payment Receipt Number 35P -70 1 Receipt Number (Rev. 12100) PINARD ENGINEERING P.O. Box 871347 Wasilla, AK 99687 (907) 357-ENGR (3647) ADEQUACY TEST LOCATION: Lot 3, Block 6, Meadow Ridge Estates, North Addition APPLICANT: Amy Vaudreull 24945 Homestead Drive Chuglak, Alaska 99567 SEPTIC TANK TYPESIZE: Steet/1000 gallons, per MOA Records ABSORPTION SYSTEM: Deep Trench, per MOA Records DAILY FLOW: 3 BEDROOMS x 150 GALBR = 450 gallons TEST DATA JOB NUMBER: 03-079 DATE OF TEST: 6/12103 FIELD STAFF: A. Wien NUMBER OF BEDROOMS: 3 SCUM: 0.5'+(Hard) SLUDGE: T NEEDS TO BE PUMPED: Yes XX No CURRENTLY IN USE: Yes XX No Time Flow Rate Volume Cumulative Volume Septic Tank Septic Tank Soil Absorption System Comments pM (GPM) (GALs) (GALs) Liquid Level A Level Monitor Tube 1• A SAS Levet Monitor Tube 2' a SAS Level 8;10 7.1 - - 4.1' - 0.0' - Start Test- Meter 44563 8:25 7.2 107 107 4.1' 0.0' 0.0' 0.0' 44670 8:40 7.4 108 215 4.1' 0.0' 0.0' 0.0' 44778 8:55 7.4 112 327 4.1' 0.0' 0.0' 0.0' 44890 9:10 7.4 111 438 4.1' 0.0' 0.0' 0.0' 45001 9:25 112 550 4.1' 0.0' 0.0' 0.0' Stop Test 45113 RFCAVFRY Date Time ST MT1 SAS MT2 6/19 6:20 PM 4.07-0.1' 1.67-0.6' 'ALL MEASUREMENTS IN FT. TEST: PASSED XXX FAILED COMMENTS: There was no measurable liquid in the newer SAS prior to or at any time during the test. The original SAS is still on line (in service) but the MT for this Trench was tilled In with soil to a level 5' BGL A liquid level was not found at any time during the test in this MT (original SAS). Reviewed by: Paul Pinard -re Date: 5114103 ,Cop • N 89' Zo ^ w 7JRr FRAME ! Tao woo o .a GC r, UMM wo CU1QAl1TANCCI DWA.D AN A34MT R LSD rOt VCNFW4X=C'NL g14Q =r"Ui M'RD.DDARY CR FDMM IXM TN[ SMAYCR TAX1S PCM=E1TY rot M 1=41. TRAM== ONLY IUD AMUM W140AL UAeutt ONLY IN TN[ COST CF 7NC SURVEY. MM ml 11 PFW4L OM SCAUft RD'lOa1OM tAAY;*%=. gtM M•10" Mawr Suomi Ira."" A.-.�.tRt SYMOW • ar sum 'yam n ' maw= = �".� 3 Aw"ALT IIf F"a ITMAM_wW A Fur ... Awr... MRN t ... ttatr.Ir I" O FIMM1 " .O -+-r MOOD so= �ammu�+ CQNCFM iA Asem stilt .,►-«-+F YCTAL FRfla ® C[CK MAT IT IS 7NE RCV"24= UTY or TNM NtAJM ON CM4011, PNOR 70 ONLV 7HOW SWOOMMIC S AROW DrtOUD AND %1nRtE Tai K ORCODN VORFY PROPm/YLMG atAtW FIMAT[ AND YTLITY 00041= 014111 AM 7O 0979PA X wgM. POMM MA" � 0MAHMM SMCXALKL DRVEWAY& ETO, ARE 11tOMN-IM 7NOR /M"MMAW LOOAMR. ONLY. SNOW THE C111"I iCE OF ANY 1Ai0O171.• GOV4/ANA a R>QTIDCTMIN MAY PWX%04? 310M MFROVdDRR I=" MDNO UM AND LOCAttO. WNICN DO NOT APPEAR ON THIO ACOORDED WINCrA ION MAt ALL V4Sr^MCft SMVEY �� ""`''�+ ed bJ .�E� Robert E. Johns, r. & Assoc. „ Professional Land 'Survoyors tw w �riirr..� rr.. WS 12tA ML r.r r rra r rr.r.� D A Jarf01 R••. LA SY. R«0. Nal FL $16. ITUDADON AS -VAT • 1 ■ =�' bow* ior.w...•.WNW soft wr �' D•1• 111 0 by at"" blt ~.r.r.r....rr.�1.r• cow CAN" O1`NW1462 Rn i 1-18-93 93-003 RrtAL �A1-aa� 121-S r r..+. LOT 3, BLOCK 6. HEADOV RIDGE ESTATr.S NORTH A Parcel I.D. # MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services 44 On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 051-531-24-000 HAA# HA920858 1. GENERAL INFORMATION Complete legal description Lot 3 Block 6 Meadow Ridge Estates North Location (site address or directions) 24945 Homestead Chugiak 99567 Property owner Carol L Mc Kay Day phone Mailing address PO Box 670324 Chugiak, Alaska 99567 Lending agency Day phone Mailina address__ Agent Nancy Doner % Polar Realty Dayphone 349-7681 Address 1101 East 76th Avenue, Anchorage, Alaska 99518 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: Three (3) 3. TYPE OF WATER SUPPLY: Individual well Community well xxxxx 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 xxxxx 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 #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 all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S Engineeri Phone 694-2979 Address 17034 Eagle River Loop Road, Suite 204 Eagle River 99577 Engineer's signature 6. DHHS SIGNATURE xxx Approved for Three (3) bedrooms. Disapproved. Conditional approval for Date i bedrooms, with the following stipulations: Additional Comments All work has been completed for the upgrade of Date October 20, 1993 at1TIC 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 421 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I.D. O �i IG�J17� A. Well Data Well type Got- Ih:1 If A, B, or C, attach ADEC letter Log present (Y6) r\ l Date completed _ Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump levell Cased to FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: ADEC water system number Casing height Wires properly protected (Y/N) AT INSPECTION RECEIVED OCT 12 1993 g.p.m. n wRlc Dept. Health Human Servi01 ces Services Septic/holding tank on lot /i�/�/ r ; On adjacent lots OJOS. Absorption field on lot On adjacent lots I f� Public sewer main Public sewer manhole/cleanout Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate Petroleum tank Collected by: Other bacteria Date installed q2 Tank size � Oob Gj 1�-%Eompartments Cleanout (Y N) Foundation cleanout (YtI Depression (Y& h High water alarm (Y ) D� Alarm tested (Y/N) Date of pumping 2 6 Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot IJ On adjacent lots Foundation 7iD /I 10=% To property line l� Absorption field � Water main/service line Surface water/drainage 72-026(3/93)'Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer (Y/N) "Pump off" Level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANC OM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD�Dff!A� Date installed l ' 2� ��� Soil rating (GPD/Ft2) System type Length Widt Gravel thickness Total depth l U� Total absorption area Lo Cleanout presen ( N) Depression over field (Y 1 �2IV -b-IZ+ 11�pl t L_ Date of adequacy test Results (pass/fail) W s4 for Bedrooms Water level in absorption field before test After testg�LLDD Peroxide treatment (past 12 months) (YCN) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot�P. On adjacent lots Property line �I I � To building foundation b To existing or abandoned system on lot On adjacent lotsCutbankI_l��- Water main/service line�� Surface water Driveway, parking/vehicle storage area Curtain drain�O-SA6���� E. ENGINEER'S CERTIFICATION l certify that I have checked, verified, or conformed to al�A and HAA guidelines in effect on the date of this inspection. ,.+- �o n •° 3, ~Y < 'G Signature Engineer's Nam 7034 Eagle River L P Ro d No. 204 Eagre-Ifiver, Alaska 995 Date /� 6l 3 �:•,•. HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number p 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D. # 'I:) \ - `L -L t - q4--� HAA# 11f:� 21'' , L�:aS l 1. GENERAL INFORMATION Complete legal description Lot 3; Block 6; Meadow Ridge Estates Subdivision North Addition Location (site address or directions) 24945 Homestead, Chugiak, Alaska Property owner narral I Bakk Day phone 746-6162 Mailing address HCR 04 Box 9301, Palmer, Alaska 99645 Lending agency Day phone Mailing address Agent Nancy Doner/POLAR REALTY Day phone 349-7681 Address 1101 East 76th Avenue, Anchorage, Alaska 99518 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 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 XXX 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. 1791) 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 all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm y ,, �rmGINEFRING Phone 17034 C:agie ,jiver Leop 16901 #140- WAR Address ai.•a,^ ;iaska 99577 Engineer's signature s 6. DHHS SIGNATURE 0 Approved for bedrooms. Disapproved. b1ew,l- Date `Z—I -,E�-riZ w R u A4J � I �MYap ��q�)ii•�e tn�gq V.1 Y4t 'a w�wnu��Ma6O N J. ,321.97 5 Conditional approval for 3 bedrooms, with the following stipulations: we, Z�A�Cs�'Gsrie/� / �j t�i�G L✓ f r /lcecssi7i X G �+G��:s 7�7,� Additional Comments U tTIr Date l?- '5 ',-;, TheMunicipality 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 orderto satisfy certain federal and state requirements. Employees of DHHSdo 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) Rack MOA 921 i. � j�f/vt'v`��7 t l��C,P-�� G.., Ia �o , o •� , �-, vin �Tv ✓ C� 1 WF-tc-'q n fJii ," L�J�5�1"v C.�IGh� 04. wG t-�F _22-52- pcL�v'i M� G��u 2��..r i ��� �.LO ��, a • f,.L, S ,� �, �jJ t2-�%o-r-� .� l� '1�'k'-u t�C� lE 1 N P%`� t., � per. � • 56 r 1* '� t yl ril x 1 w`1 �••~ rr'ir7 Anws...s�1w+uSeAry -..t: i' i• LtlVx+s.,A•.µi fitwetN �• .i FI M-471 d;or Ota O� � 44' �e�ii.e►°'�a� 7i '®41+ m NOS.' liiv N itruct �,� it �0 t30t � {truature� or TIM; PLA` -1. c r* �x6�'• V� � 'ihis date tha use of Manding i bmahy earthy tw r have partonced it Mortages's B, ationship of existing apa:tlon Ot the toUowing do rxtbed propertr: �.........�. ° 22tsarxsnl:e and at livas. � M 010 -meg $� 1• ilos'XLj,Ctfin& additiQtue i A.bthor�tR $eaordina i'ttiUalca• end 1Latthi. ltaD AteIIti a7tLILLtad ttia7enP are r6 wi svt the prOF jim and trot crsalap a eftmoaeb cat the pro in amt the to, that no ttTpw pn propav wing sd�Samt than ----.•�.•` �• anameb all ttxo rTtmisee X21 44i1tipri it1Q that there an �� ni.7► �.✓ r"dwayr, trgiim- Jon Hats or other tiil�lbta eaaemea4 acid proyerw escapt as iTidisattd ILOYWIn. G7 aarc tl, I .. dsr o March _ _ _ _...:. iP 89 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST 44 Legal Description: Parcel I.D. A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number 2' 1 +51 Log present(Y/N)_ Total depth Sanitary seal (Y/N) Date of test Date completed Cased to FROM WELL LOG Driller Casing height Wires properly protected (Y/N) AT INSPECTION Static water level Well flow g.p.m. g.p.m C.) o z Pump level e_01 D rn — SEPARATION DISTANCES FROM WELL TO: 00 m O T ` �� ` + � ^' Z y Septic/holding tank on lot ; On adjacent lots Absorption field on lot On adjacent lots a;O C3 Fn Z Public sewer main Public sewer manhole/cleanout Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate Date installed k0cb�L Tank size Cleanouts (-V/N) High water alarm (Y/N) Petroleum tank Other bacteria Collected by: oCx_> Compartments 2 Foundation cleanout 6P/N) `( Depression (Y44 Date of pumpingyz `I —92 Alarm tested (Y/N) - _ Pumper 0_0AW TACmf1vPI� SEPARATION DISTA�CES 4 M SEPTIC/HOLDING TANK TO: Well(s) on lot D On adjacent lots 2� i To property line l C�, "r Surface water/drainage Absorption field �dU IC>C�t a' Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer 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 Soil rating C> System type�a Length Width '''J Gravel thickness I � Total depth —13 Total absorption area p 72_c, Cleanouts present 6VN) Depression over field (Y 1�Vp t4 Date of adequacy test Results (pass V for �—' bedrooms Peroxide treatment (past 12 months) (YZf�T If yes, give date SEPARATION DISTANIfE FROM ABSORPTION FIELD TO: ( Well on lot t4 a On adjacent lots -Z C, Property line I c:;,'4 - To t" - To building foundation On adjacent lots To �Xisting or abandoned system on lot p \ t _Cutbank a 4, Water main/service line Surface water 1 A- Driveway, parking/vehicle storage area at Curtain drainf E. ENGINEER'S CERTIFICATION No�F✓r"��tP�Tt 5�-Pt �c �fE�w p �� E`� I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on /jgdl_te of this inspection. S& 5 ENGINEERING 17934 Eagle River Loop Road No. 204 Signature cagIn River, Alaska 99577 Engineer's Name Date 12-18 -19Z HAA Fee$ /7000 Date of Payment `Z—xe— Z Receipt Number3!L L ���✓�� 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number WALTER J. NICKEL, GOVERNOR L / DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 December 1, 1992 Mr. Ray Shafer S. & S. Engineering SUBJECT: Dawn Water Supply Class "A" Public Water System, PWSID 211431 Dear Mr. Shafer: (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: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on October 31, 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 8, 1990. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. 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. There last Organic Chemical Contaminants/Volatile Organic Chemical were submitted to this Department on September 23, 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, A//44� Michael Lu Environmental Eng. Asst. II ��rs printc3 u�ecycletl paper b Y C; Paper 7Fj +� � � w Wp�MJgj/p�p� /MeA - rH•,M AaY� ,rt /I• /..i// /VP..r' .. LMyenm•A*.t•Id,tftanuh' �� fi 8: usimns or REaoRnfi MEP Tlu v ,9053 BROWN CU THE MMU P%6`.1':, MS NOT SiiMN (9 • to informatim btroan is for the uSa Of Tanding .ttatitutions showing th.9 rela.t.lrnithiV Of oxif;ting it'ruoturev and, platted eamoSTlP.I tv and lot linev n ,% 16 not to be used for poulti.c.ning; xdW tioDAL itruoturee or lemeMivaa • ., W._...r�, vw/v.AMS 44p1 AFI Z 't+arehy c nu)r ftl I lead* trta torr w a Motkael'a in apa411oa of the joUo +writ dwKwibad property: $fit+=is. Huchoraae Recording 1s'aciaat, AWks, aatd that thi 4 isaDrovc mots sit"%" thumm are W101W the propamy lime and d: not nvsrlap or enaroad3 Co the prop�y 1" ndjsimt thart to, tlsat nd ozptavnmezita en vro�zfi� twin¢ ad9Yomt thamt, earroa,eb an tbA prs.KA-Usm is *uritis» and that there are n t' ewayu, trarl=jxtipn Um er other visible, aasnmtmU V as pray rst+ttr> as ieda$atad hwret�n Daoad st A.aahotta{a, Alm&$ i! 89 — 600-4565 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) Lot 3~ Block 6~ Meadow Rid,qe Subdivision ~,r~-1~,~ \~4{~-- Location (address or directions) (b) Property owner AHFC Telephone: (home) .. Mailing Address Business. (c) Lending Institution HOME SAVINGS AND LOAN Telephone 257-2323 Mailing Address A~chorage. Alaska ATTENTION; Margar¢.t (d) Real Estate Company and Agent _ RE/MAX OF EAGLE RIVER - L~,~¢_ Walk~,.r Address 16600 C&ntc~rfic~t.d Drive, 3~¢- 201, Eag~_~. Riu¢.r~ Alaska Telephone 694-4~00 (e) Mail the HAA to the following address: (0r check here~ if hold for pick up.) List contact person and day phone number below: S & -q FNGINEFEIN~/~q~-¢qTq 17034 Eagle Rive~ Loop Road, S~te 204 9957'7 Eagle River, Alaska 99577 TYPE OF RESIDENCE Single-Family ~ Number of bedrooms ~ / WATER SUPPLY Individual Well [] CommunityX~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site~ 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. 72~025 (Rev. 7/88) Page 1 of 2 ¢ 5. 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, funct ona .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 Ad dress Date Telephone S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 6. DHHS APPROVAL /' Approved /~'//" Disapproved Conditional Terms of Conditional Approvat The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7/88) Back Page 2 of 2 A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) ~ k,~(~_~ ~Q~_ ~LITY OF ANCHORAGE (MOA) ~0~,L~g~.~,C~.S D~l_'~lth_ Authority Approval (HAA) ~ .~// CHECKLIST - FEBRUARY 1984 ~O~_, ~ 343-4744 Date Completod ~opth of Groutin~ Legal Description: If A, B, C, D.E.C. Approved~N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot "Z.-,~o I.~. To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING ,TANK DATA Da '7/~ ~L/~'~ ~" te Installed ~,~;~")--~ Size ~. ,¢t.cx~ No. of Compartments -2--- Standpipes,:¢~4) "-/' Air-tight Caps~N) "/( Foundation Cleanou, t Depression over Tank (Y/~;~ /_.k ~D/a~e Last Pumped ''/~ [ °~'-~'7; for Pumping/Maintenance Contact on File (Y/N) / _,/ Holding Tank High-Water Alarm (Y/N) ~/~ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well '~o I.,u ..- To Property Line ~ ~' To Water Main/Service Line ~,c:> I j~ To Stream, Pond, Lake or Major Drainage Course Comments '~' .~c1~ ~ ~'~C::,~ ~--~ ~-~ 72-026 (Rev 7/88) Front To Building Foundation To Disposal Field Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ~ 'f~/q'~ Type of System Design Depth of Field \'"'~ ~-~' Gravel Bed Thickness ,~ I Square Feet of Absortion Area "~ ~ ~ ~ Statndpipes Presen~C:~N) '7' Depression over Field (Y/N) ~ Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ .L~ To Property Line [ ~l~ ,~.. To Building Foundation ~.~ t ~ / I To Existing or Abandoned System on Lot \ c=, ; On Adjoining Lots ..-~.~I ~ ...~. To Water Main/Service Line ~,,~ ~ To Cutback (if present) ~/J~ To Stream, Pond, Lake, or Major Drainage Course \ ~f-4- To Driveway, Parking Area, or Vehicle Storage Area \ c~ ~--~ D. LIFT STATION )~/~ D%lnstalled ___ Dimensions Size i'n~ons Manhole/Access (Y/N) "F~u.m.p.On" ~ "Pump Off" Level at High Water Alarm Leve"l"a~ Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) 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 ~;bjs inspection. Signed $& 2 Company}7034 Eagle River Loop Road No. 20~ Date Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 STEVE COWPER, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 316 ANCHORAGE, ALASKA 99503 563-6775 FOR: ROGER/ S & S Engineering DATE: March 24, 1989 PWSID: 211431 To Whom It May Concern: According to the records on file in this office, the DAWN WATER CO. water system is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, / VERA E. CRAIG Environmental Field officer 1 -197 - MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL / 3 OF ON-SITE SEWER AND WATER FACILITY d 5 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) LOT 3, BLOCK 6, MEADOW RIDGE ESTATES, SECTION 2, T15N, R1W Location (address or directions) HOMESTEAD ROAD, PETERS CREEK, ALASKA (b) Applicant Name LEE WALKER Telephone: Home N/A Business 694-4200 Applicant Address RFANLAX OF RAGT,F RIVER P.O. BOX 772849 EAGLE RIVER, AK 99577 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other ® (explain); REALTOR (d) Lending Institution NZA Telephone N/A' Address N/A (e) Real Estate Company and Agent RFAMAX OF RMF RT 1FR Address 'P 51-77A, `FACT F RT/FR AK Telephone 694-0nn f Mail the HAA to the following address:, T,FE WALKER % REMAX OF EAGLE RIVER e "� f 'P.O. BOX y 772849 FACT F RIVER, AK _99577' i 41 + } i y y , �2. TYPE OF RESIDENCE IF Single -Family ® . Multi -Family ❑ Other w, Number of Bedrooms s ; 3. WATER SUPPLY i Individual Well ❑ Community Public ❑ 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 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) 5. ENGINEERING FIRM PROVIDING .,SPECTIONS, TESTS, FILE SEARCH, DA71 , 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 EAGLE RIVER ENGINEERING SERVT S Telephone 907/694-5191i Address , P.O. BOX 773294 RAGT T =T R, AK 99577 Date ®meq •t •LqY� t, y.. 49mm k 96:6GOY6@6411 m............�+ 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) MUNICIPALITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL SERVICES DIVISION CHECKLIST -FEBRUARY 1984 264-4720 OCT 2 L 1987 Leal Description: li'le�clo cia - c1 �T A. wag) g V E D %� If A, B, C, D.E.C. A ( Well Classification Approved Y/N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Static Water Level 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 B. SEPTIC/HOLDING TANK DATA Depth of Grouting Pump Set At — Sanitary Seal on Casing (Y/N) - - Depression Around Wellhead (Y/N) ; On Adjoining Lots On Adjoining Lots — To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Date Installed �� Size �lip�gu / No. of Compartments Standpipes (Y/N) % Air -tight Caps (Y/N) X Foundation Cleanout (Y/N) Depression over Tank (Y/N) N Date Last Pumped �o/s 7 Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) Temporary. Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well To Building Foundation 3S� To Property Line ter/ To Disposal Field' S(Jef= To Water Main/Service Line yib To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(1 1/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �2 Type of System Design Date Installed Length of Field Width of -Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area 72`�' 0 Standpipes Present (Y/N) ke. c 4 Depression over Field (Y/N) f1/ Date of Last Adequacy Test V/V/sem Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well fou To Building Foundation Lot A// To Water Main/Service Line t Co I To Stream/Pond/Lake/or Major Drainage Course To Property Line Y/o To Existing or Abandoned System on On Adjoining Lots f 3� To Cutbank (if present) / 11e^ve To Driveway, Parking Area, or Vehicle Storage Area Comments �go%[. le_.cA ,.�5 //�� G 7�5'% S/ojat /✓o EUic� ec AF 14-oe SP r�o 7`0 "'e" r�✓, 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 ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have c e"d, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company ,�/ r' -r MOA No. Receipt No. 1061 06 Date of Payment Amount: $ / D d �� Page 2 of 2 72-026 (11/84) Eagle River Engineering Services P. 0. Box 773294 Eagle River, AK 99577 694-5195 r.�}�gine®t,ppl �oQp d Goose* Date I fW ,r'y �e000406........... •*a.. Louis A. Butera ea CE -6736 �s do ��� ®��PROFESSIO�A�ww�a'� or STEVE COWPER, GOVERNOR S E DEPT. OF ENVIRONMENTAL CONSERVATION/ ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775 3601 "C" STREET, SUITE 1334 ANCHORAGE. ALASKA 99503 DATE: PWSID #: __2114x1_-_-______ To Whom It May Concern: According to the records on file in this office, the Water System is in compliance with the State of Alaska Drinking Water Regulations. Since �. Ronald S. Klein Environmental Field Officer AAcrtn_ Time APPLI( NT FILL OUT UPPER HAL ONLY Prof,ar;y Owner , t - Phone Mailing Address C75/! j de Buyer Address Zip Code Lending Institution - C_ �� p�; ` �" - f - Phoneme/ Inspector / / 7 \ �/ ��ip ` ✓ v Address Lde/ / Realty Co. & Agent 1 /- /-.{ / // _. ,/ }-( 1711, x461 �� //c5% /j if"_./ Phone Address ! Zip Code Legal Description /' w - /)�j /;.�1.,�S �� �yo 1,2 Street Location ENVIR01A- , ,.U. ICTION Type of Residence 110V `; 1952 Single Family RECEIVED ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply 1/ ' Co ❑ Individual DATE ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Community BY: For wells drilled prior to that date, give well depth (attach log if available). Public Utility Date Sewer Installed Well To Absorption Area Well Log Received Sewer Disposal `-7— 61-1-- Well to Tank 119041 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. AAcrtn_ Time Time Time Time 41_ Date Date Date Data 0 Inspector Inspector Inspector Inspector P�« 0A Field Notes: MUNICIPALITY OF ANCHORAGE DFPT Or l'- ''.P! A ENVIR01A- , ,.U. ICTION 110V `; 1952 RECEIVED (3 ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITION(LAPPRRVA.E 1/ ' Co DATE BY: Solis Rating Date Sewer Installed Well To Absorption Area Well Log Received `-7— 61-1-- Well to Tank 119041 Septic Tank Size 72023 (31a2)