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MEADOW BROOK BLK 2 LT 4
Meadow Brook Lot 4 Block 2 #050-191-43 Municipality of Anchorage Page 1 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Y Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report 44 ' Permit Number: SW0001 23 PID Number: 050-191-43 Name- Wastewater System: ❑ New ❑ Upgrade Gregory and Mary Adams Address: ABSORPTION FIELD 18237 Sanctuary Dr., Eagle River, A Phone: No- sf BTeems(3 ) 1'h O Deep Trench ❑Shallow Trench ❑Bed ❑Mound ❑Other LEGAL.DESCRIPTION Soil Rating: Total Depth from original grade: GPD/So. Ft. Lot: Block: Subdiv ion: Brook Depth to pipe bottom from original grade: Gravel depth beneath pipe 4 2 Meadow FL Ft. Township: Range: Section: _ Fill added above original grade: Gravel length: - _ Ft. - Ft. WELL: New ❑Upgrade Gravel width: Number of lines: Distance between lines: Ft. Ft. Classification. (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Municipal Water Ft. Ft. - - - SO - Ft. Driller: - Date Drilled: Static water Level: Installer: - - Barr Excavating5/30/00 Date installed: - Ft. Yield: Pump Set at: Casing Height Above Ground: - - TANK - GPM FL FL SEPARATION DISTANCES X7 Septic ❑Holding ❑S.T_EP. To Septic Absorption -.Lift Holding - Public/Private Manufacturer - Capacity in gallons:: From Tank Field- Station Tank Sewertines Anchorage Tank - N/A N/A N/A N/A N/A Material: Number of Compartments: welt Steel Two (2 ) - Surface - N/A N/A N/A N/A LIFT STATION - N/A Water >100, Lot - >5r N/A. N/A N/A Size in gallons: Manufacturer. - Line .N/A. - "Pump on" level at: "Pump off' level at: High water alarm at: Foundation >5' N/A N/A N/A N/A Curtain None oted n Lo - Pump Make &Model Electrical Inspections performed by:. Drain BENCHMARK Remarks: Septic Tank Only Placed - - - Location and Description: - Under This Permit. Sidewalk in Front of House - - - Assumed Elevation: 100.0 Ff ENPINeFR'SS�EAL- - .. ✓ by y Ast % y, i .t' ,i xN rW - tr>sCk' k'il� e Inspections performed by: MEA Dates: l st ele �v�e - 2nd 5/30/00 +b� Ci4y i•H is t ,.4 Department of Health and Human Services_ approval 51 e ppffii o-"'� g " Reviewed approved by: Date: t and -72-013(Re, 9/91) MOA 25 Municipality of Anchorage Page 2 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744 On -Site Wastewater Disposal System or Well Inspection Report Permit Number SW000123 PID No. 050-191-43 I D z 0 -I C: Three Bedroom -( House v m ( TBM Ashalt Driveway; B S1 ° S2 C2 I. C3 t0(14 10' Ut lity-E sement KANTISHNA DRIVE PLAN AS -BUILT SCALE 1" = 30' L OTE: Only the Septic ank Placed Under his Permit. Existing bsorption Pit Remains n Service. A B S1 6.0' 24.0' S2 12.6' 25.7' C4 30.5' 39.5' D z 0 -I C: Three Bedroom -( House v m ( TBM Ashalt Driveway; B S1 ° S2 C2 I. C3 t0(14 10' Ut lity-E sement KANTISHNA DRIVE PLAN AS -BUILT SCALE 1" = 30' L OTE: Only the Septic ank Placed Under his Permit. Existing bsorption Pit Remains n Service. Municipality of Anchorage Page 3 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744 On -Site Wastewater Disposal System or Well Inspection Report Permit Number SW000123 PID No. 050-191-43 .. N NCn - - 2111 Insula on - T Exi ting ,000 Gal. Agsorp ion Crib ep. Tank 94.6 94.4. Note: Only the Tank and Post Tank Cleanouts Were.Placed Under This Permit- Existing Absorption.Crib Remains.in Service. PROFILE AS BUILT. SCALE 1" 10, rr� Hx Jaa f3J1 `jai �`�"vp �e V P^ 3 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 5�-- ��31 DoG� _{:3©pr" ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 24, 2000 Expiration Date: May 24, 2001 Permit Number: SW000123 Parcel ID: 050-191-43 Legal Description: MEADOW BROOK BLK 2 LT 4 Design Engineer: 0014 Anderson Engineering Site Address: 018237 SANCTUARY DR Owner Name: Charles Barr Lot Size: 10714 SQ. FT. Owner Address: 11609 Hebron Dr. Total Bedrooms: 3 Permit Bedrooms: 3 Eagle River , AK 99577 - This permit is for the construction of: Disposal Field M Septic Tank Holding Tank ❑ Privy Private Well Water Storage 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 (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: 15;_"" _A0 Date: May 22, 2000 Municipality of Anchorage Department of Health and Human Services 825 "U Street Anchorage, AK 99502-0650 _ Subject: Lot 4, Block 2, Meadow Brook Subdivision Septic System Design, and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing'septic tank on Lot 4, Block 2, Meadow Brook Subdivision has failed and must be replaced immediately to prevent damage to private property and to alleviate an unsafe condition. We are therefore applyingfor a permit to place anew 1,000 gallon septic tank to serve the house. The Site Plan shows the location of the tank along with the location of the existing absorption crib. The subdivision is currently served by.the City water system and no conflicts exist between the existing system and the water services or mains in the area. The new tank will be constructed a minimum of 10' from the existing water service line. The ground surface on the lot slopes very gradually from east to west at a shallow grade in the area of the new septic tank. The new tank will be constructed a minimum of 5' from the house foundation and 5' from the existing absorption crib. Surface grading and relandscaping will be accomplished to assure drainage is away from the finished surface. The subdivision is currently served by the Municipal water system and all setbacks are easily met from the water service. In addition, the new tank will not conflict with existing systems or those to be constructed in the future. If the system is constructed in accordance with our design the following statements ' apply 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those.to be constructed in the future. The subdivision is currently, served by the Municipal water system. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserved i Three --` Bedroom Home 1 Asphalt (Driveway Garage I. + O Septi60Tanallonl- I Post Tank CleanoukS I4 — Existing. L Absorption 10' U ility asement a SCOPE OF WORK: 3 p�ANTISHNAQRNE 1 Remove and Dispose Existing Collapsed Septic Tank. s 10, ry, 2. Verify Foundation Cleanout. Place New Cleanout if Necessary'r 1-11 In -3. Place New 1,000 Gallon Septic Tank. 4. Place Two New Post Tank Cleanouts. }.= u SITE PLAN SCALE 1" = 30'�r >u` NOTE: Lot Is Served By A Community Water System. `No Conflicts Between New Septic Tank and Water Services or Mains in the Area. ati', ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 4, BLOCK 2, MEADOW BROOK SUBDIVISION GENERAL: The scope of this project includes the removal and disposal of an existing failed 1,000 gallon septic tank. It also includes the procurement and placement of a new 1,000 gallon septic tank. The foundation cleanout must be located and verified and replaced if necessary. In addition, two post tank cleanouts must be placed at the location shown on the Site Plan. The disturbed area must then be regarded to preconstruction condition. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION The new 1,000 gallon septic tank must be procured from an approved source and installed at the location shown on the plans. 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. Lot 4, Block 2, Meadow Brook May 22, 2000 Page 2 of 3 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: ( NOT IN THIS CONSTRUCTION) 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Lot 4, Block 2, Meadow Brook May 22, 2000 Page 3 of 3 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. GRE ER ANCHORAGE AREA BO"JGH 1 f Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME AssociaiP Builders _ MAILING ADDRESS P-0- RDX 11Q1, E._B.._, AK __ PHONEfi94-979 _ tishna LOCATION Corner of Sanctuary Drive & KaTEGAL DESCRIPTION Lot 4, Block 2, Meadow Brook Subdiv. SEPTIC TANK: DISTA NCE16 NUMBER OF FROM WELL ZL'_' — M/�NUFACTURER/J/l > MATERIA Ol z,/ '� Z-2—COMPARTMENTS INSIDE LENGTH — INSIDE WIDTH— _LIQUID DEPTH LIQUID CAPACITY /, Ol>eJ GALLONS. SEEPAGE PIT: NUMBER OF PITS L_. DIAMETER OR WIDTH/2—', LENGTH�y DEPTH - ����,,cc,, LINING MATERIAL �� _ CRIB SIZE: DIAMETERrDEPTHG� -DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION � NEAREST LOT LINE /i/i ABSORPTION AREA (WALL AREA) )/ % SQ. FT. ADDITIONAL ABSORPTION WELL.: DEPTH DISTANCE FROM: NEAREST SEPTIC / SEEPAGE SEWER LINE_ _ TANK. SYSTEM _. KrVAM CONSTRUCTION BUILDING NEAREST FOUNDATION_ _. LOT LINE CESSPOOL / OTHER SOURCES APPROVED _DISAPPROVED REMA DISTANCES: �L' /9 C rc 6= two INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: Form No. EQ -031 DIAGRAM OF SYSTEM DATE iz�l f 112Z2 APPROVED Coe // 4k, 2� a ULit 4111 I' A OA AAS /444 454 GREATER ANCHORAGE AREA BOROUGH n DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330 "C" STREET ANCHORAGE, ALASKA 99503 TEL-EPHONE 274-4561 SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT 1h Sm-�uc,�.e !c�c�iM— �®-- - �/�J/�,/ 0 / (r, NAME OF APPLICANT MAILING ADDRESS tc PHONE INSTALLATION LOCATION LOCATION LEGAL DESCRIPTION -- '" ��`GLl-GG �' "" /QV"'"✓[, ��-�/, INSTALLATION OF: SEPTIC TANK _ SEEPAGE PIT DRAIN FIELD OTHER TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH ZIA TO BE INSTA L��77LED BY SOIL TEST RESULTS COMPLETION DATE ANTICIPATED NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE /OV() TYPE_ MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK SEEPAGE AREA SIZE / FOUNDATION TO SEEPAGE PIT DRAIN FIELD - SEPTIC TANK TO SEEPAGE PIT WALL__ / . �D l SEPTIC TANK - l SEEPAGE PIT DRAIN FIELD _ TO NEAREST LOT LINE. / WELL TO SEPTIC TANK .-__�Y " SEEPAGE PIT DRAIN FIELD __.-- ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, SEEPAGE PIT TO RIVER, LAKE, STREAM. SEEPAGE PIT DRAIN FIELD ST IRON INTO ANO OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. A INCH DIAME.TrS._C._45T�BON_�^IPH ON PIPES ON SEPTIC TANK AND SEEPAGE PIT - _-_-_- FITTED WITH AIRTIGHT REMOVABLE CAPS. ------------- ---- - -- GRAVEL F3ACFC%IGI� CONFORM TO BO OUCH E LATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER CW ORAGE DESCRIB-D SYSTEM IS IN ACCORDANCE WITH SAID CODE. ^� DATE _ APPLICANT'S SIGNATU FORM NO. EO -016 'TYPE DIAGRAM OF SYSTEM GH Ofj,DINANCE NO. 28-68 AND THAT THE ABOVE U4/20/99 '1'Ul' 13:15 FAX 0890499 VISTA REAL ESTATE' LH t[li. 00Y C f'r� i„ A_ W pltilll„�¢ RI J b r / t et vly}/ ..... .. T..�... i 1 r. fir.. '7” ..� :• 37C1,..w.".n,,V, •Sa71M."'i:.. 60.001 a AS -BUILT 60' s -r. ( KAN`CtSNNA pctivF—) I hereby certify that I have surveyed the following described property: 40Y 4 }Q� 2 -} — l1EAbnw BROOK SU$,.Q.� Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property linea and do not overlap or enctoach on the property lying adjacent thereto, that no improvements on prop- erty lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska this___-L.—day of— SCALE: f_ SCALE: I �=Z01 ver, No. 880 -LS Municipality of Anchorage On -Site Water & Wastewater Program (907) 343-7904 x` AP(? 1 $ 2MA gin= CERTIFICATE OF ON-SITE SYSTEMS APPROV4gto:r,, St it, l. Parcel I. D. 050-191-43 Expiration Date: (P 1. GENERAL INFORMATION Complete legal description MEADOW BROOK; BLOCK 2 LOT 4 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: 18237 SANCTUARY DRIVE *EAGLE RIVER AK 99577 JOSEPH SARGEANT Day phone 334-590-4889 18237 SANCTUARY DRIVE *EAGLE RIVER AK 99577 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Day phone TYPE OF WASTEWATER DISPOf AL: Individual Well ❑ Individual On-site 0 I.n.dividual Water Stora_oe ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site LJ Public Water System Public Sewer ❑ WaiverNariance request for. �r Received b % Date: COSA to be released to -ho engineer, unless otherwise requested by the engineer. COSA Fee $_ . 6GSD Date of Paymert _ cl /1B /it/ Receipt Number . Gtr 0q���7 COSA # __ 68LI u 11 ck Waiver Fee $ Date of Payment Receipt Number Waiver # Dig ince: — 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. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD, attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described 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 soils condition, groundwater 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE 0 System #1 Approved for 3 bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following Ia�T•M 337-6179 Date f y 1 OF ey, A. 'e ess,� C 7 53 ad /'ro fession000 �e40oo�a ,,4lOF AAtr' J ON-SITE WATER AND d WASTEWATER PROGRAM Original Certificate Date:. 4/ . - 9 3 The tWnici;ff1itAr Adiorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of At iska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (PP ivnsi Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # _of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: MEADOW BROOK; BLOCK 2 LOT 4 Parcel ID: 050-191 —43 A. WELL DATA Well type Date completed Total depth ft. Date of test Static water level Well production WATER SAMPLE PUBLIC WATER If A, B, or C provide PWSID# Sanitary seal (YIN)_ Cased to ft. FROM WELL LOG ft. Well Log (YIN)_ Wires properly protected Casing height (abqw1gir AT Coliform ___ __, Colonies/100 ml. Nitrate mg./L. Collected by: ft. M. in. A Ic: ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 5/30/00 Tank size 1000 gal. Number of Compartments 3 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping— Pumper �� Y� t S C. ABSORPTION FIELD DATA -BELOW EXISTING GRADE Date installed 5/t/73 Soil rating (g.p.d./ft2or /bdrm LINK System type CRIB Length 14 ft, Width 12 ft. Gravel below pipe 6 ft. Total depth *8.33 ft. Eff. absorption area33 1 22 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 4/2/14 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 29 in. Water added 759 gal. New depth 52 in. Elapsed Time: 995 min. Final fluid depth 26 in. Absorption rate >= 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off' level at High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line areas On adjacent On adjacent Iota manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main **10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *0' Building foundation 10'+ Water **10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *PER 1973 INSPECTION REPORT **BASED UPON AWWU DRAWINGS. 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 COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date t f �l,44 (Rev. 11!0.5) Municipality of Anchorage � e • Development Services Department F R Building Safety Division 5 On -Site Water & Wastewater Program 4700 Braaaw Street P.O. Box 196650 Anchorage, AK 99519-6650 A ,r- www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 055 l0f-2—Q..3 Parcel I.D. 050-191-43 COSA# 1. GENERAL INFORMATION Expiration Date: Complete legal description MEADOW BROOK BLOCK 2 LOT 4 Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address 18237 SANCTUARY DRIVE * EAGLE RIVER. AK 99 MARY & GREG ADAM Day phone 18237 SANCTUARY DRIVE * EAGLE RIVER, AK 99577 Day phone Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 694-3622 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site ❑ Individual Holding tank ❑ ❑ Community On-site ❑ 0 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As cer'cified by my seal aiffized hereto and as of the validation date shown baiv^w, i verify that try 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. 1 further verify that based on the irforrnation obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 ,, Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date l(- la Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described 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 soils condition, groundwater 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE _4Z Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: / (Rev. 11/05) J . ON-SITE WATER AND WASTEWATER _ - PROGRAM J By: Original Certificate Date: / (Rev. 11/05) Municipality of Anchorage • Development Services Department'== - ° Building Safety Division - 3 A E T T On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MEADOW BROOK BLOCK 2, LOT 4 Parcel ID: 14 3 A. WELL DATA PUBLIC WATER Well type If A, B, or C provide PWSID# .Date completed Sanitary seal (Y/N) Total depth ft. Cased to ft. FROM WELL LOG Date of test Static water level ft. Well production WATER SAMPLE RES Coliform _ *"- colonies/100 mi. Nitrate mg./L. Well Log (Y/N) Wires properly protected (Y/N Casing height (ab o round) in. AT INSPECTION ft. Other bacteria colonies/100 ml. ug./L. Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 5/30/2000 Tank size 1000 gala Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping Pumper ONE STOP SERVICES C. ABSORPTION FIELD DATA BELOW EXISTING GRADE Date installed 5/1/1973 Soil rating (g.p.d./* 2/bdr UNK System type CRIB Length 14 ft. Width 12 ft. Gravel below pipe 6 ft. Total depth *8.33 ft. Eff. absorption area 312 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 9/10/2010 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 25 in. Water added 692 gal. New depth 48 in. Elapsed Time: 360 min. Final fluid depth 9 in. Absorption rate >= 450+ g.p.d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) TERRALIFTED If yes, give date$ 10 2010 D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off' level High water alarm level, at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line — Anim ment areas PUBLIC WATER On adjacent lots On adjacent lots manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main **10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *0'+ Building foundation 10'+ Water main **10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *PER 1973 INSPECTION REPORT **BASED UPON AWWU DWGS. G. ENGINEER'S CERTIFICATION I certify that / have determined through field inspections and p9*� review of Municipal records that the above systems are in 0.... .. ' ' .... " " " " " ' conformance with MOA COSA guidelines in effect on this date. f y Ga ness.- Engineer's Printed Name JEFFREY A. GARNESS �04�9j CE— Date6� Op'`@,. •'' •g . T Q�npr f essio�°��-� COSA Fee $ v Waiver Fee $ Date of Payment 02 to Date of Payment Receipt Number 0' q7q Receipt Number (Rev. 11/05) Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 s (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Program Gent f~a Pig C+ Department N **** VARIANCEIWAIVER REVIEW **** WR#: 101223 HAM 101222 Permit#: PID#: 050-191-43 Legal Description: Meadow Brook Block 2 Lot 4 Engineer: Garness Engineerinq Group Applicant: Mary & Greg Adam Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 0.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: 9/29/2010 Approved by: { ame iewer .............................................. ONES■ ■ ...................... . Rec#: Amount: 0.00 Date Paid: **** VARIAN C E/WAIVER REVIEW **** GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS September 28, 2010 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Lot Line Waiver for Meadow Brook S/D; Lot 4, Block 2, To whom it may concern: According to the 1973 inspection report, the drainfield is 0 feet from the south property line. We request that your department formalize the implied 0 -foot lot line waiver from the south property line to the seepage pit. I am unaware of any adverse impacts this waiver would have on adjacent wells or septic s stems. If you have any questions, please contact us at 337-6179. Thank you for your assist4icV. S1 P.E., M.S. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com r r r r r \ 1 1 r r r \ r \ r r r \ \ a�>0 r \ x \ � r r \ r \Lp \ G \ o�0000pp� \ � of A .' 4 9 . IH 0...............................� Qn p SHANE A. HOLT, �O \ Va SA LS -691 4 4ppoA ..... 20 0� P O R�FES S�oNA�-�O \ 0��pO0o� 0. H. DECK rr P5 PJ��P� O t r r r O 00 V"3 - - �- - Solo* G roe 5-0 02 5-6 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON.(UNLESS INDICATED) NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES OR LOCATE STRUCTURES. ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS. 0 KS -BUILT SURVEY ( NO CORNERS SET THIS DATE) / 1"=20• I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 4, BLOCK 2, MEADOW BROOK SUB. ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS _17TH_ DAY OF SEPTEMBER 2010. HOLT LAND SURVEYING 11400, FB 143-8 TEL. 345-5513 i \� \ `;.. rr P5 PJ��P� O t r r r O 00 V"3 - - �- - Solo* G roe 5-0 02 5-6 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON.(UNLESS INDICATED) NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES OR LOCATE STRUCTURES. ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS. 0 KS -BUILT SURVEY ( NO CORNERS SET THIS DATE) / 1"=20• I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 4, BLOCK 2, MEADOW BROOK SUB. ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS _17TH_ DAY OF SEPTEMBER 2010. HOLT LAND SURVEYING 11400, FB 143-8 TEL. 345-5513 One Stop Services, INC Quantity 7654 Old Harbor Ave Rate Anchorage, AK 99504-1930 Off 907-338-5563 Job Site. 18237 Sanctuary Dr Fax 907-338-5564 Alaska Terra Lift 1 4212 Harca St 175.00 Eagle River, Alaska 99577 Invoice Date Invoice # 8/9/2010 1851 P.O. No_ Terms Due on receipt Item Quantity Description Rate Amount Job Site. 18237 Sanctuary Dr pump truck 1 pump out septic crib 175.00 175.00 Vi i Thank you for your business. Total $175.00 �-d e7,0:L0 06 94 d' ■ zggg(((ttt� CD irn' �lsg �to U op t$a m ADmA yD � O °im O$m0 m°cs m �fo°yoS n9€al 0� - - I - z Z m Cn �' 12D1 �F • 8414 ..8415 tzDl i Fv, •Fj '.8414 S2. -__� E�i 12 •Op \ 24DI60 i }0 a m ', Z \ 10333 c 0 m o c i -LI Y T P 6DI rOm •s •w 1r o !, 1 801 �s 8510 o 0 s zt .off o m a r -f .0 ' 11111 , 6DI Il `� cr O ;s °mr p` 1665 �/� c) CIO l� - z n SDI V %M M " °' 2 (n GI y ri • p r G) r- ' v ' lVmm mm IzI p .0> A n A � ♦ O m ._ F sm AIi B H - r O ps, fli rc c n < 8o I 2 J Z m In A A r 2 J -SIC C9 1'9 5ro o •`gyp < 2B F r Si v 11295 22 e : sp 16DI �F 8507 12CI 12DI 2� i'. zzl�mo< z mn r-- czg -ooco CCCdddrrr �a Z =3 vz��<��ln�zzvgv��onoo�nnn _c CD a8=s=�°�°�g0,0 S _ D cr N m m CD n C, m m ii N S O N m (D V Ol TONS/NA � tir'OU.2T ar /o l doss s rvV 503.0 n V. V,3 y I 0 Q N � o 2-50 30 ✓ 5oa o (52/.0) x / 6 S 0 ro �I j "NII v 05 /mac Uct 1:. SNV. 496.0 w 0 n------ r rbU l _ m n f11. 30° Tial 2•'>9 N e ' 3 504. C:> (5/6.0) ° r- -------------- �---tP 3+30 CROSS l I / 1 ab o o A l i� i ;v 4i, il Rl ro UI N 0 i �. r Il p \1 n r - I O, -H0 G OC- ?'=BENO ® INV5//. ©-/O C2oss 2NK 5/25 coLv/LGE ST j 2EM0✓E PLUy A7-,3.6.,5 T�'E IjXJ( 11, 4 �Y N (yi sSoec� � 9i: �d 9iloNr'=d •�C,. /`.tea :�-.�. I ot.o ceossp►1 rives � s��.s � � > . �JN/1S/N,a I � Od 30 G✓ 1B Ij u i j I IJP -Ir' �I ,� ZZ J �m j2o°IIS 309 g c/-CZ.c i, 3r34.85 CPoss�r .rvv 578.0 �:�-ril� G�'V,5 zo I < 4x50 �zaoE_ rniv 57&O(��;� (59/./7) p / ANyc r , n I � 5rao Piaci zNv s�zo � � � � U °------- p roc— -- -�- -r- a Or/O c,,e05 S/VV 598.0 --- - - - ` — CZoss Oy-30 a 1. x y I N r 01 2-80 �GUC7 SiVV. -- 60/O 6/3.91 I J , - c,, 0 0 �I j "NII v 10 j7 r 11, 4 �Y N (yi sSoec� � 9i: �d 9iloNr'=d •�C,. /`.tea :�-.�. I ot.o ceossp►1 rives � s��.s � � > . �JN/1S/N,a I � Od 30 G✓ 1B Ij u i j I IJP -Ir' �I ,� ZZ J �m j2o°IIS 309 g c/-CZ.c i, 3r34.85 CPoss�r .rvv 578.0 �:�-ril� G�'V,5 zo I < 4x50 �zaoE_ rniv 57&O(��;� (59/./7) p / ANyc r , n I � 5rao Piaci zNv s�zo � � � � U °------- p roc— -- -�- -r- a Or/O c,,e05 S/VV 598.0 --- - - - ` — CZoss Oy-30 a 1. x y I N r 01 2-80 �GUC7 SiVV. -- 60/O 6/3.91 I J , - c,, 0 0 Municipality of Anchorageo � t ti • Development Services Department Building Safety Division 5 On -Site Water & Wastewater Program 47.0.0 Braaaw_Street P.O. Box 196650 ' Anchorage, AK 99519-6650 www.muni.org/onsite f (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-043-18 COSA# 1. GENERAL INFORMATION Expiration Date: % O Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address KNIK VIEW ESTATES S/D; BLOCK 3, LOT 16 22507 JUDD DRIVE * CHUGIAK. AK * 99567 VID & JOY MORTON Day phone 22507 JUDD DRIVE * CHUGIAK, AK * 99567 Day phone SALLY CARMAN W/ CENTURY 21Day phone 227-0506 400 W. TUDOR ROAD. #A-440 * ANCHORAGE. AK * 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System N 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER 5. AS certified by rfty Seal aiffixev ereiG and as of time vafivauvn dart shown li2r01v, i 'v8rhy u,ur r"y investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. i further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date f� Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described 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 soils condition, groundwater 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any v�k00wo.OF4/6/i other person or party is not authorized, nor will it confer any legal right whatsoever. �w ♦ �' DSD SIGNATURE � .Z ; r I TE WAATERAND Approved for _ bedrooms. VYASTEWATER ; Disapproved. PROGRAM -- Conditional approval for bedrooms, with the following stipulations: ���J ••. • • . , . •'� �`� JJs��'01 Attachments: COSA Checklist tr ` Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report v1Lrate AdVIsviy Other By: -t/ (Rev. 11105) Original Certificate Date: / -- / - / Municipality -of Anchorage •" Development Services Department Building Safety Division a On -Site Water & Wastewater Program g 4 E r. 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: KNIK VIEW ESTATES S/D; BLOCK 3, LOT 16 Parcel ID: Otr 3 / S A. WELL DATA PUBLIC WATER Well type If A, B, or C provide PWSID# Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly protected (Y/N Total depth ft. Cased to ft. Casing height (ab o round) in. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RES Coliform colonies/100 ml. Nitrate mg./L. ft. g.p.m. Other bacteria colonies/100 ml. Ayge'nic: ug./L. Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 8/27-28/2003 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 9/25/2010 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 8/27`28/2003 Soil rating .p.d_/ or ft2/bdrm) 0.8 System type DEEP TRENCH Length 47 ft. Width 3 ft. Gravel below pipe 8 ft. Total depth *15.3 ft. Eff. absorption area 752 ft2 Monitoring tube YES Depression over field NO Date of adequacy test **9/21/2010 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 765 gal New depth 0 in. Elapsed Time: — min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — **HOUSE WAS VACANT AT TIME OF TEST. 2000 GALLON PRE—SOAK PERFORMED IMMEDIATELY PRIOR TO TEST. DRAINFIELD REMAINED DRY THROUGHOUT PRE—SOAK. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump ofP' level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service PUBLIC WATER On adjacent lots On adjacent lots manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *4' Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 1'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS *PPR IAICPC' G. ENGINEER'S CERTIFICATION a ' .%I P 1 certify that I have determined through field inspections and * T Q review of Municipal records that the above systems are in • ' ' • ' ' ' ' ' ' ' ' ' • ' ' ' ' ' ' ' ' ' ' ' ' • '� conformance with MOA COSA guidelines in effect on this date. QO ' .J f A. Garn ss;' Engineer's Printed Name JEFFREY A. GARNESS Q CE m`p Date ` eafrofessio0\ ��040�ovr`� ,* COSA Fee S `7 0 Date of Payment -/ f Receipt Number 02 4, O O (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number 09/24/2010 08:10 FAX 907 278 5800 CENTURY 21 North Homes n rn Af N , J 19002/002 OF V A�p;� ®t i pe it �� �iMou��O.em.aede,y�.e a eo • ��� Ao6Nri C. Johnson A �,{�1.'y "1�5' �• sty AS -BUILT 1 hereby certify that I have surveyed the following described pt oppny. L o T' / 6 g o C. 3 Kms, J( ill-¢. u. 1;�,,-+ /,o n 14, 7 / 5- K I W .5 M, Anchorage Recording Precinct, Alaska, and that the improve• ments situated thereon are within the property lines and do not ovgrlap or encroach on the Property lying adjacent thereto, that no improvements on property lying ad' cent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska this `-� day of� 4' h/ M 2O0 La ROBERT C. JOHNSON SCALE: Registered Land Surveyor No. 880 -LS Box 77-0456, Eagle River, Alaska 99577 Phone (907) 694-2543 Municipality of Anchorage P.O. Box 196650 0 4700 Elmore Road Anchorage. Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Program menr e ° `SPr t Cr N Department **** VARIANCEIWAIVER REVIEW **** WRM 070034 HAM 010494 Permit#: PID#: 051-043-18 Legal Description: Knik View Estates Block 3 Lot 16 Engineer: Anderson Engineering Applicant: MMBM Contracting Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 4.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: 10/1/2010 Approved by: ' P ame viewer ■■■■■■■■■■■■.■■.■.■■■■■.■■■■■■■■■■■■■■.■.■...■j,1'■■■ ■ ■■■■■■■■■■■■■■■■■■■■.■■. Rec#: 52624 Amount: $175.00 Date Paid: 5-24-04 **** VARIANCEIWAIVER REVIEW **** 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 J CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 5 _ I q) •- _ HAA # 1. GENERAL INFORMATION Complete legal description x-07_ 4 /5 LOC -L Z S Location (site address or directions) �c 2 jA-Al ��/ Property owner G—/� y �� 5 Day phone �'3 7- - 31 - Mailing address 3 7 Lending agency Mailing ad Agent Address _ 13 //t6A4A C.2tTf1iti41,. ' Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: -3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water X Day phone Day phone --:) y )� - fid a 7 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 X 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 MOA4121 5. 21 WA 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 furtherverify 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 ENGINEERING Phone G `I 17034 Eagle River Loup ';rad A!�+. 2f'.1 Address Eagle River, Alaska 99577 Engineer's signature Date DHHS SIGNATURE 1Z Approved for %l_ bedrooms. Disapproved. Conditional approval for Additional Comments ROBERT C. =,VAN f�Q n i`�'��'•� CE -8801 bedrooms, with the following stipulations: Date 6� / (o - 2-1- The 1 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 courtesyto purchasers of homes and their lending institutions in orderto 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-M (Rev. 1/91) Back MOA 1121 IV�� .IuwIGINALTrY c, XPARTMENT OF HEALT ��l� A J S;: C*D. Municipality of Anchorag�lVVIHONMENTALI�L� lI 1 1Vi4MY 2 6 1999 DEPARTMENT OF HEALTH & HUMAN S9RVMIS �,ylyl61yjN AX OF ANCHORA vi�iVNulY OF nN�hukAGE Environmental Services DlvislOn IVVIRONMENTAISAVY&.9DI vvfKUNMEI��5SRvl�om 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: Loi 1. D.: 0 S'0 '1"11 ^q— L� _ A. WELL DATA Well type(I til I Lt If A, 8, or C, attach ADEC letter. Aater system number Log present (Y/N) Total depth Sanitary seal (Y/ Date of test Static water level Well production to FROM WELL LOG WATER SAMPLE RESULTS: Coliform / Nitrate Date of Casing height (above ground) Wires properly protected (Y/N) 9 - p.m - Collected by: AT INSPECTION Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed >'3 _ Tank size r)Number of Compartments Cleanouts (Y/N) t. 5 Foundation cleanout (Y/N) ir- AM Depression (Y/N) //ti High water alarm (Y/N) Date of Pumping S- aG! �i �1 Pumper =t VZ .S '`x SlwE(Z FW,& MA,, IN C. ABSORPTION FIELD DATA / Date installed —_ Soil rating (g.p.d./ft2 or ft2/bdrm) till( _ System type Lengthf—Width 1�2� Gravel thickness below pipe _ &- Total depth _ Effective absorption area 2 I' Monitoring Tube present OY N)Vt14 Depression over field (Y N) �.� Date of adequacy test CJ ResultsPass Fail) S S For _ bedrooms Y';-2 ri Fluid depth in absorption field before test (in.); -� Immediately after_ gal. water added (in.): 7 Fluid depth (ins) Minutes later: Absorption rate = —4 g.p.d. Peroxide treatment (past 12 months) (Y/N) /V() If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size Manhole/Access (Y/N) High water alarm level Cycles E. SEPARATION DISTANCES ° p on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot � i Ir�/LlN /7'1 6AZ_iL On adjacent Absorption field on lot Public sewer main Sewer /septic se adjacent lots "Pump off" level at* Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: i Foundation Property line . Absorption field_ Water main/service line /00 Surface water/drainage Wells on adjacent lots Uo AL SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line e)A1Z D/'C_1A16- Building foundation a Water main/service line IO 4 - Surface water. /00 / �L Driveway, parking/vehicle storage area 30 ,/ Curtain drain IV6/ 11VC— /<�-,/V 0 N N Wells on adjacent lots F. ENGINEER'S CERTIFICATION l certify that l have determined thru field inspections and review of Municipal in conformance with MOA HAA uideliinees in effect on this date. Signature Engineer's Name �Q'� �� _ Cir Date �- G / �[ j HAA Fee $ ` 4 Date of Payment!ate+ _xz Y Receipt Number o/T/ e�� OWW o ) 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number ;0G 't iytlh2'atio'v' •s are ;a ROBERT C. COWA 1 r V V01 IJf 1JJJ 1 L . YV JVlUJY1L11 � 1.11 1 ••.vim -- Sent By: AMC ENGINEER&; 907 272 5593; Jun -14.99 8:29; Page 1/2 DATE: S j .5:W JOB NAME, TO: b AMC JOB M: FIRM;j f r_051V C. SUBJECT: FROM: V -0,9-411/f2 Nuittber of Pages Including Cover Sheet: _ L MESSAGE OR ADDITIONAL INFORMATION: VAX MENORAl1Dum hater and Componv. Inc. FAX (907) 272-5593 e-rneil: amcQamc-engineers.com 00.1 Ops! _ __COd/L%9� _�i7�� I/�i'L "� ✓�..19� jr'�rf„L..�/..i'iT'ly�W-��y loved Ct-o T5 NAFORMSTAXTRAN.00C Operator Initials: "Value-added 677giracringScrvices" G0/ 1"Jf 1777 1L. 40 Sent By: AMC ENGINEERS; JUN. -1Q' 991140N) 08,09 JU,0�41 L11 J I"IIYL J LI1V 111LL1\YI IM � �tiL vv 907 272 5593; Jun -14.99 8:29; Page 2/2 AW • ENGINEERIN TEL:562.0824 P. 001 ANCHOUGra iMltk`X'E$ Wh Q'rCTMA"a 1�$ UTTi.ITX EJ1gI31tening Division 3MO Amit Boulevard AnthomVe, A14ska 995O3,3M Fu Number MM 362-M4 IW* 70 1999 $etfy L. Boggs 6223 Gewimo Orck, AncSrage, Alaska 99S64.1659 Re: Mteadow ®roast, SIM* 2, Let 4.{Grid NW153) Dear Ms, bosgs: hfil" li►WArOwW RECEIVED JUN 14 1999 Adett 040awy 3833 ,9u1et11O `^�NnW. Alake $9603 The Anchorage Water 6 Wfaatewater 0"ity received a written relQuest frM David L. Boggs on your bWWf, on Jute 44 1999, For a lett u of nonobjection for the MAIC seepage pit that is 1pcated within the 4alllry. wnr eertr located on the south tO' of the nr*encW lot. The *built drawing, d"KI AprII.26, 1973, submitted with the request idantI% the locmian of the emmwt and septic taepage pli, AWWU water meinfinn we located within the Sanctuary Dove VW Kantishna Drhre righhs-e way. Ban," sealer SONIC* Id not available to the referenced IoL AWWU issues this letter of non ob*tl M. for tho anaptic seepage pit with ftipylations, and by using it the property WAMor is agreeing to the Following; t. AWWU will be Iteld'harmlas, now and forever, for any darnaM peras a mmk of the mmoschrnent; or injury to arty 2. All applic444e codes W replations will be observed and rnaintairted within the oasemant; 3. This letter of non•tribj'Oalon will in no way preclude AW1, u from full use and enjoyment of its rights withln any portion of the easereow+t; and, 4. The pivperry owner ill pey 41hy additional and 9)aeawdinary costa inwrneti during any future required ttepair or MW struction of the AWWU fatiiltlas to atccommodne. the encroachment. Should you have any questions, pleefce call Hallie Stewart at 564-2721. Sincerely, �01" X Roberta Piper, P.E. Planning ongfrreer hr,ray,t�,� Fromi o: 5&5 Engineering MTA OSP ENG Fax 907-761-2646 Jun 8 '99 7:41 P.01 M61� CALL ON YOUN COMDAP" xaN•OBJXCTION TO EASEMENT ENCROACNIVLC,IiM AC10E}WNT By this document Matanuska Telepb.one Association, Ipc. ,(1vi As).:'d�al'ares that it has no objection to the encroachment of it %optic Seepage pit withitl the p19ttf!4,1 D1' -deity Eeisement upon Lot 4, Block 2, Meadow Brook Subdivision, Township 14 Noah, Range. 2-W6t, Section 12, S,M. N*#RM##i+bwrMA�rF#KK4KNKKFR*K*K•AKA*�b+hKKAilekrkfib KM4+hiYbkRTM'M#kF+b�##P+ib¢KKKk#+�'f f##4Ablc#bs##b Please be advised that MTA through the issuar " of this document does not.fbrfeit any of its rights to the use of the area cited. In the exercise of these rights MTA will, if needed, upgrade, maintain, repair, aucVor replace buried or aerial telecommunications facilities within the easement. Any repairs that may be required to the encroachment as a result of utility construction will be borne by the property owner of record. This document does not authorize the plaeernent of any add'it'ional encroachments within the easernent area_ TWis dpcumCnt ts, In 170 wean a±CtPJQffiCrlt tp V0.4�t R11�1 Q, thC_tlilli C3�er[lCnt lend �1�Otlld IlOi b� interpreted as such: Issued for Matanuska Telephone Association, Inc. this 4th day of Juno, 1999 by, Real Estate & Properties Supervisor THis is To cRnwY, that on this 4th day of Itme, 1999, before me the undwsig iad, a Notary Public in and for the State of Alaska, duty cotnmissioited and sworn, as such, personally appeared Bonnie Bailey known To me and to me known to be the individual named in and who executed the foregoing instrument and acknowledged to me that he signed and sealed the same as a voluntary act and deed for the uses and purposes therein, mentioned. 1N WI'T'NESS %r�JB tEO , I have hweurlto set my hand and official seal the day and year first above written. '-4:ll�lJ mon, Nosy PuWto State at Ala+k- Notary Public ii�and =8102 � �' My commission expires: i `fY1_ GRANTORS ADDRESS; GRANTEES ADDRESS, rlcase Return to:`''` Matanuska Telephone Association, laic. Betty L. Boggs Real Estate and Properties Section 6223' p. IV 0. Bowe 355.0 Aiiq 9504-1659 r :Palmer, Alaska 9964'5 ' ati.}1� MatanuskaTbiaphoneAssociation. inc. ry4bIN a 1740 South Chugach Street • Palmar, Alaska 9064!5 %S�rf ,,.•{'.. ,, , _. _ ,1Y4 � Eagle Rivmr 907.894..3211 • Primer 807.746.3211 • Wasilla 907.376.3711 uu/ lul1333 10.L3 JClluJY1 G11 From: To: 5&S EnQlneering Sent By: AMC ENGINEERS; Juke 4, 1999 Belly L. 8090 11237 5m%b wY 1 River, AK Dear Mrs. DOW: J HIYU J GYIY lIYGGf�11Yq rHIYG CJL 907 272 5593; Jun -5.9® 19:29; Pege 4/5 -W,sQs"K �„IW1I'r.GK11MY Yl1l�. b1/G'L BIgTAfl W11M'« � A qjy& ON OF MAOULL tKMY WA ORAY10N 3000 9 WWW rko p 0 Ow WOOS kr,%Wo0a AMM 9951 } Marr; 7r►.sui Eli ult Nil on moo' bw ap objv d= w Ow Pb 1"ed is ebs 10' utility eaeerMO dog dw &oub dk of lot 4 No* 2 Meadow Brook Subaivisitm. if yOu bare my Q11giWnl Oup =U zw l 204.3712, Very Truly Yours, $NSTAR Nall Cita Citi POY 1(e. pi Ka► Crlbwe $rt&W ca- mils From: fo. 5&S EnpineSting dent By; AMC ENGINEERS; 907 272 5593; Jun- 4-yj aAj 7•j[ rX uLi LADLE .Inrte 4,1999 Bdty L. BMI 6223 GeroAIMO 0¢1e AaahftgM, AJ"ku 9950444W Dear Ms. "po v I'f'y Jun' 5.99 10:30; Page 515 VJ ray nu, yurftlny��� r. Sub*A 10 Y�r'� 14� to ittdeaso* the Cam I es set foNt below, 00Cpblc Inc, eotiwt 9n dw stWc keah field eaaoeo "MO O"Mm of Aillsitn has rw � isiotl, 'Km�vvtt .s an tbo sulah ptgp M UM of Lot . SI 3. Mdadow 13tooic Subdue 18237 SsactttWy 1Dtive in city Bd iu no WW pmIuudes GO cable "use old W*Yfusnt Tris y rI& of 1 UM of the W Wry em omm rad os for si& of un,Y rlSifts it �4' eve �lhlA errdl' Porti°n way, Wdu&4 nnlitnited $:940166 fair "Mcing its %cilities. AW IM rddiIWOM rxtreordituey cos$ lmcwrtrd &rift MY AIMM tecir,W oarai K"k � ettconsWAdort of Ocl, a stc udo to WWWWdm m' or a of the dents be Veld by tbt+ pt'DpeM ate' BY Wvi% btlov, ).MI �► to k�t�Y Mad h� is � ba aleas, fWw 444 forevtrx, boar &"6014p, easm, tarp (iWudWS fie: altotweY's fets), lisblutiea U4 injury to toy paw of pvpmoocturin� as a result oitLo operos Pkstm iadiWe yaw 1Qo* by tri AM rewur;ai* this tOW to OWN)f ru the addtoss bolow. SirmwNely, Rabecco Colt" Date 08p D6Sip EqOmr 6161 �adrat '. �' AMOS 08509 • 007lytS OM - ++ -- 1 JV 11 111 G.1 rrom io: stns hnglneenng JUN 07 '99 09:29PM MATANUSKA ELECTRIC (D 1&taaasitu Elecuk Association, Inc. p.0 - 1U ?.479 Palm, Ala ka 9%45am I'A"t ow (907) 745 r Fax. (907) 745-M HIWJ D CIYL.'llIVtCKlIVU Wd LC. 01 IUIVV 11111C. 1,11.41 rin 7111tcopm COVER LETrIm sEdV'I' BY: rHUt �1 P. 1/2 DATE. _o"'- r- 9 i TI11EEs TRANSMT TOi b411;01 Fax fh SMM. Bob Y1vis.aWr Frs+e; (907) 745-9329 MATEWAL TO BE KEA Fhdne Mj ( 907) 761-9278 10A-7 - 0 1 lG/, /S . ?r , e.,e 6oW AP06uot_ OF I NUM81tR OF PAGEL$: (EXCLUDING COVER 9 i111 vw u r JU I UJ41 1 J HIYL J C.IYl711YG[LfC 11VV I'HUC CIJ Fmm: To: W EngineennD -• �..•.. ....._..._. .__ .... SUV 07 '99 03:29PM rATfYVIJWA ELECTRIC STATEMENT OF NON -OBJECTION FOR ENCROACHMENT WITHIN UTILITY EASEMENT Matanuska Electric Association, Inc. (MEA) has no objedflon with the location of a �eDtic �g®oaa_e oit within the utility easement along the gQN1herly boundary of the following property; Lot 4, Block 2, MEADOW BROOK SUBDIVISION, according to Plat. No. 72.51, Anchorage Recording District, Third Judicial District, State of Alaska. P.2/2 Situated in Section 12, TowMhlp 14 North, Range 2 West, $toward Meridian. This non-obiectl0n Is Conditioned by the stipulation that MEA will be held harmless from any and all damages to the encroeohment that may result from the existing and future use of bald assement. Matanuska Electric Association, Inc. BY a G - General Manager c his Reprosentaeive June 7, 1989 Dabs — MEA ACKNOWLEDGMENT STATE OF ALASKA ) ) SS. THIRD JUDICIAL DIMICT ) The foregoing. agreement wee acknowledged before me this 7)h day of Jung, 1 g,i�by S0Nn Yivieeker, 0. Notary Public for the State of Alq§k My commission expires: 1_y_ — nuaM+aoxlmwaen,�Dt NOTARY PUBLIC PATAICIA A. MC40BERTS STATE OF ALAWA