HomeMy WebLinkAboutMEADOW RIDGE ESTATES NORTH ADD BLK 5 LT 5Meadow Ridge
Estates North
Addition
Block 5
Lot 5
#051-531-13
Municipality of Anchorage Page 1 of 3
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.cLanchorage.ak.m (907) 343.7904
ONSITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SWO40377 PID Number. 051.531-13
Wastewater System: New
MMBM Contracting,Inc.
P.O. Box 670495 Chu lak AK 99567
ABSORPTION FIELD
phona N oio1BiOowni
5'WideTrench
688.1236 Four 4
So+ rtaMV.
Tar Dept tnxn or9nei vde.
LEGAL DESCRIPTION
1.2 GPWFe
7 Ft.
11 ac L'AC
Depth b We Comm canon" P•os.
fres depdt .uatn
,,peB�aNnvr
5 5 Meadow Rid a Estates No. 5
3 Ft.
4 FL
TO.WV Range
1.2
Grewt L•ngn
50
Ft.
Ft.
evN aWet
NF r Ines
O�rrtp Oata�an Im•e.
Well: Municipal Water System
5 Ft.
1
FL
Cteenda vt (Pante. A B. CI
Twat Depth:Cw.d b:
eW Wmrptm res
500 Fe
w e nai
ASTM 3034 PVC
Ft. Ft.
firer
Doe united State Wr« t.aM.
MMBM Contracting, Inc.
9/9104
Ft.
r.m.
P.mp sr r.
"°°"' Gane
TAN K
GPLI
R.
Ft
SEPARATION DISTANCES
® septic ❑ Holding O S.T.E.P. 17 Other.
To
From
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
lublkvm to
sewer Line
Anchorage Tank
1,250
wM
>200'
>200'
N/A
N/A
>25'
«
Steel
Two (2)
whoa Wrr
>100'
>100'
NIA
WA
LIFT STATION — NONE ON LOT
Latina
>5'
>10,
WA
WA
Dr
Fandron>5'
>70'
WA
WA
WV
b
bA'ann
TV «
k
None
Not
MtltGa inepaa.orr Pa, a by
c~c.n
Rem-w
BENCH MARK
Garage Slab.
100.0 Ft-
LEngineer's
Engineer'sStamp
••••••.�y�s
oFf
Inspections performed by: T.L. Kimbroullh Dates: 1" 9/9104
0 49th
2nd 919104
0 •••• --
Department of Health and Human Services approval
�;, M-CHAEL'E ANDERSrN+
0�� by NO CC-UPI f �':
$
- f '�%�o�"
F •
Reviewed and approved by: Date:oe-
- -�'
iR
Municipality of Anchorage Page 2 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number: SWO40377
PID No. 051-531-13
MEADOW RIDGE SUBDIVISION
LOT 5, BLOCK 5
4�.....Y..... AS -BUILT PLAN
MICHNEL E. PNpER90N < 1 SCALE 40'
NO. CE4381 ,•'��
Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number: SWO40377
GARAGE
PID No. 051-531-13
PROFILE AS -BUILT
Scale: i" = 10'
MUNICIPALITY OF ANCHORAGE cll `7n�/"
Development Services Department"�O�
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Sep 08, 2004
Expiration Date: Sep 08, 2005
Permit Number: SW040377 Parcel ID: 051-531-13
Legal Description: EADOW RIDGE ESTATES #5 SUBDIVISION BLOCK 5 LOT 05
Design Engineer: 0014 Anderson Engineering
Owner Name: MMBM CONTRACTING
Owner Address: NHN HOMESTEAD ROAD
EAGLE RIVER. AK 99577 -
Site Address: NHN HOMESTEAD ROAD
Lot Size: 24392 SO. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
❑; Disposal Field E 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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 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.
Received By:
Issued By:
B. Covered, sealed, and heated to prevent freezing.
Date: 9 — U `Ci y
Date: `6 o
Municipality of Anchorage
Development Services Department
Building Safety Division
i
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.0 ri�_i*-�(- I-_-� Permit Number SW
Property owner(s) MM&M Contracting Day phone 6M1236
Mailing address (1) P.O. Box 670495 Chuglia�k, AK 99567
- 9 address (2)� eliA'ROCS
Legal description (Lot, Block & Sub'd.) Lot 5, Block 5. Meadow Ridge Estates Subdivision North Addition
Legal description (Section, Township & nge)
Lot Size 1�i,3%' Acre q.Ft
THIS APPLICATION IS FOR:
Number of Bedrooms Four (4)
Sewer Only ® Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: q-1, 0 N Waiver Fees:
Date of Payment q__1_ -0y Date of Payment:
ReceiptNumber. 7fo1� _ t}�M _ Receipt Number.
(Rev. 12100)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 FAX
September 1, 2004
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 5, Block 5, Meadow Ridge Subdivision North Addition
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 5, Block 5, Meadow Ridge Subdivision North Addition intends to
construct a new four-bedroom home on the lot. We are therefore requesting a permit be
issued for the construction of a new septic system to serve the new home. The
subdivision is served by a community water system and no conflicts exist with adjacent
septic systems or wells. The attached Site Plan and backup documentation identify the
location and configuration of the proposed septic system and alternate site. The water
service line is also shown. The current drainage pattern along with spot elevations is
identified on the Site Plan. The drainage pattern will be maintained after development
of this lot is complete.
A test hole recently placed on the lot indicated poorly graded sand and gravel with
cobbles in the area of the absorption trench. The accepting soils were tested and found
to have a percolation rate of 4.4 minutes per inch. No groundwater was found in the
test holes during placement and none was noted during the monitoring period. Our
design includes the placement of a new 1,250 -gallon septic tank along with a 50' long
by 5' wide by 4' effective depth absorption trench to collect and treat the sewage
generated in the house. The bottom of the trench will be 7' below the surface. The
distribution pipe will be 3' below the surface. A minimum of 3' of cover will be placed
atop the trenches and a minimum of 4' of cover will be placed atop the new septic tank.
The ground surface on the lot slopes at shallow grades from south to north as shown
on the Site Plan. The absorption trench will be constructed parallel with the slope of the
ground surface as much as possible in conformance with Municipal requirements. The
new septic system will be constructed a minimum of 10' from the water service
Lot 5, Block 5, Meadow Ridge
September 1, 2004
Page Two
proposed for the lot and on adjacent lots. It will also be constructed a minimum of 100'
from any surface water in the area.
If the system is constructed in accordance with our design the following statements
apply:
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.
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 reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
�� c Qt'-J�
Michael E. Anderson, P.E.
Attachments
FA
MICHAEL E ANDERSON
;t No. CE -438I I
24
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NORT ADDITION
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El' w�cwvi B. �Noe89oN r -
' t` AREA MAP
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•°��-i�Dtigt�Eys ���••r SCALE 1' =100'
MEADOW
RIDGE SUBDIVISION
LOT
5, BLOCK 5
eetieaa
�o��oaa
o
o
tie TFtt
etas
92
6 Four
roorn
BKOM
1.250 Gallon
Z Y
Septic Tank
G Long Wide
(.1 x a' Effective Depth
gpeolplion Trench 'of
N
�o
i
-
5
/ 10' Utility Easement
218.58
•••�aw•y4
O E� y
1 ,
SITE PLAN
•• �, •, No. c "i
••iit i �.••
SCALE 1" = 40'
LOT 5, BLOCK 5, MEADOW RIDGE SUBDIVISION
NORTH ADDITION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom House 5' Wide Trench System
Perc. Rate: 4.4 Min./Inch 1,250 Gallon Septic Tank
Application Rate: 1.2 GPD/SF 4' Drainfield Rock
4 Bedrooms X 150 GPD/1.2 GPD/SF (Application Rate) = 500 SF Absorption Area
500 SF/5 SF • .5 (Red. Factor) = 50 LF Trench Length
THEREFORE: Construct a 50' Long x 5' Wide x 4' Effective Depth Absorption Trench.
Flow Line Elevation in Trench to be 3' Below Original Ground Surface. Total Depth to be
T Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over
Absorption Trench.
2'6"
6"
4'0"
Natural
Backfill
5'
Geotextile
Fabric
4" Perforated
PVC (Holes Down)
Drainfield Rock
TYPICAL 5' WIDE TRENCH SECTION •••..�
•'�'�°F
(NO SCALE) ��.,�p'�,..•- • ••••• , c
NOTE: Grade Area Over Trench to Drain Away. Ja=i 4
Minimum 6' Separation From Bedrock.
Minimum 4' Separation From Groundwater. .�..,�
Minimum 10' Separation From Water Services in the Area. %,% Ylduel E.IwoER
Minimum 100' Separation From Surface Water or Streams.- 0# � , No. CE. i
MUNICIPALITY OF ANCHORAGE•������41kame4
DEVELOPMENT SERVICES DEPARTMENT .•���•••"•.. ���
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG .._., .._. _._ ....r., ....,..».�
.q MRG
1 t^ sMIL7uEl 6 M1aERSOH
LEGAL DESCRIPTION- LOT 5, BLOCK 5, MEADOW RIDGE EST.
PERFORMED FOR' PAUL MYERS
DATE 8/2/2004 PROJECT No • M0478 ���h�::`••
PARCEL ID,#' TECHNICIAN: T. L. KIMBROUGH Pro/esslanal En lme Stam
DEPTII TEST HOLE # 1
(fen)
1 OB/OG SLOPE SITE PAN
2 10%
3
4
5 SEE SITE PLAN
6
7
8 POORLY GRADED SANDS
WITH COBBLES TO 10'
AND BOULDERS > 10%
9 SP SFF FUTURE ASRUILT
10
11 < 10% > 259'0
12
DATE READING
13 (MINUTES) (MINUTES
14
15
16 BOH
17
l8 5 11:30 9.5"
19
20
PERCOLATION RATE• 4_3 (MMflNCII) PERC. HOLE DIA`(INCHES)
TEST RUN BETWEEN: 4 FT. and —5FT.
WAS GROUND WATER ENCOUNTERED? NO IF YES a) WHAT DEPTHS
DEPTH OF WATER AFTER MONITORING: NONE DATE OF MONITORING: 8/31/2004
COMMENTS: NO IMPERMEABLE LAYERS ENCOUNTERED. TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY VETECH ENGINEERING TECHNICAL SERVICE. 1, MICHAEL E. ANDERSON CERTIFY TIIAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 9/112004
E DEPWATH of INFT
GROSS TIME
NET TIM)TERNCHES)
(INCHES)
DROP
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
10:30
9.375"
2
11:00
30
2"
7.375"
3
11:00
9.125"
4
11:30
30
2.125"
7"
6
12:00
30
2.5"
7"
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG
LEGAL DESCRIPTION: LOT 5, BLOCK 5, MEADOW RIDGE EST.
PERFORMED FOR- PAUL MYERS
DATE: 8/2/2004 PROJECT No • M0478
PARCEL IDS{- TECHNICIAN: T. L. KIMBROUGH
DErnl TEST HOLE # 2
6rvi)
1
2
READING
OB/OG
NET TIME
(MINUTES)
3
NET DROP
(INCHES)
4
5
12:15
6
7
2
12:45
30
1.5"
POORLY GRADED SANDS
8
WITH COBBLES TO 10'
12:46
AND BOULDERS
9
SP
10-
0111213
1:16
30
11-
6.875'
12-
5
1:17
13-1
8.75'
16
17
18
19
mi
51TE PAN
SEE SITE PLAN
I< 10% > 25%
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DyEyATER P
(INCHES)
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
12:15
8.75"
2
12:45
30
1.5"
7.25'
3
12:46
9"
4
1:16
30
2.125'
6.875'
5
1:17
8.75'
6
1:47
30
2"
6.75"
PERCOLATION RATEL4.4 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 4 FT. and 5 FF.
WAS GROUND WATER ENCOUNTERED? NO 1F YES @ WHAT DEPTH?
DEPTH OF WATER AFTER MONITORING: NONE DATE OF MONITORING: 8/31/2004
COMMENTS: NO IMPERMEABLE LAYERS ENCOUNTERED. TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY VETECH ENGINEERING TECHNICAL SERVICE. 1. MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 9/1/2004
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 5, BLOCK 5, MEADOW RIDGE SUBDIVISION
GENERAL:
The scope of this project includes the procurement and placement of a new
1,250 -gallon septic tank at the location shown on the Site Plan. Work also
includes the construction of a new 50' long X 5' wide X 4' effective depth
absorption trench at the location also shown on the Site Plan. The
distribution line in the trench will be placed at 3' below the existing ground
surface. Total depth of the trench will be 7' below the existing ground
surface. A separation distance of 10' from any water service and 100'
between the septic tank and absorption trench and any surface water must
also be maintained. A minimum of 3' of fill is required over the absorption
trenches and 4' over the septic tank. In lieu of the required fill 2" of insulation
and 2' of fill may be placed.
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. The Contractor must also verify the location of wells in the
area and assure that the separation distances are met.
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
1. A new 1,250 -gallon septic tank must be procured from an approved source
and installed at the location shown.
2. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
Lot 5, Block 5, Meadow Ridge
September 1, 2004
Page 2 of 3
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.
6. A foundation cleanout shall be installed one to four feet from the building
foundation. Two cleanouts are required between the tank and the drainfield.
7. Final grading over the tank shall be such that a positive slope exists away
from the septic tank.
DRAINFIELD 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 trench 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.
Lot 5, Block 5, Meadow Ridge
September 1, 2004
Page 3 of 3
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, Femco, or equal).
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.
Parcell.D.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and 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
FOR A SINGLE FAMILY DWELLING
051531.13
1. GENERAL INFORMATION
Complete legal description
0
ZD
COSA # QC10 3 61
Expiration Date: / 0— / 9 " /0
LM 5, Block 5, Meadow Ridge Estates SubdMslon North Addibon
Location (site address) 25200 Homestead Road Chugiak, AK 99567
Current Property owner(s) Steven Kogutkiewicz
Day phone 392.6669
Mailing address 25200 Homestead Road Chugiak, AK 99567
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Four (4)
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well R1
Individual On-site
Q
Individual Water Storage ❑
Individual Holding Tank
❑
Community Class Well ❑
Community On-site
❑
Public Water System ❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite 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 Onsite Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat affixed hereto and as of the validation date shown below, I verify that my Investigation,
based on procedures outlined in the Certificate of Onsite 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 Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 1017/2009
-"''OF At
+►.c �.
r^--------- ;v°------
5. DSD SIGNATURE >II i uEt E µoccsC+•'�,:
/J .• CE .4381 ��r.•
J�Approvedforbedrooms. 4
•0
�; �;;.�•••���
Disapproved. +1jwftr sst� lee
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
By: Q
(Ra 11A5)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:Q
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsRe
_ (907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
_ - Legal Description: Lot 5, Block 5, Meadow Ridge Estates Subdivision North Addition Parcel ID: 051531-13•
A. WELL DATA
Ll
Ll�
Well type Class A If A. B, or C provide PWSID ter t Well Log (YM)
Date completed _ Sanitary seal (Y/N)_ Wires properly protected (YIN)
Total depth ft. Cased to ft. Casing height (above ground)
in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft
Well production g.p.m. 9 -
p.m -WATER SAMPLE RESULTS:
Coliform colonies/l00 mL Nitrate mg/L Other bacteria colonies/100
mL
Arsenic: , _ mgA Date of sample: _ Collected by'.
B. SEPTICAiOLDiNG TANK DATA
Tank Type/Material Septic/Steel Date installed 919/2004
Tank size' 1.250 ' gat. Number of CompartmentsTWe Cleanouts (YM) Y
Foundation cleanout (YM) Y Depression over tank (YM) N High water alarm (YM) N
Date of pumping 10/712009 Pumper SanBary Pumpers
C. ABSORPTION FIELD DATA
Date installed 91912004 Soil rating (g.p.d./ft= or f?/bdmt) L2 GPD/SF System type 5' wide Trend,
Length 50 ft. Width 5' ft. Gravel below pipe 4
ft.
Total depth _2_ft. - - Eff. absorption area1�ftp . Monitoring tube Y Depression over field
N
Date of adequacy test 10/6/2009 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 4 In.. Water added 622 ' gal. New depth 6
in.
Elapsed Time: 10 min. Final fluid depth 4 in. Absorption rate >= 600
g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date
D. LIFT STATION
Date Installed Size in gallons
'Pump ons level at_ in. •Pump off" level at _ in.
Datum Cycles tested
Manhole/Access (YIN)
High water alar level at
Meets alar & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
On adjacent lots
Absorption field on lot
On adjacent lots
Public sewer main
Public sewer manhole/cleanout
Sewer/septic service line
Holding tank
Animal containment areas
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation >s Property line >S
Absorption field >5'
Water main NIA Water service line
>10' Surface water >100'
Wells on adjacent lots >200'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation >10' Water main >10'
Water Service line >10' Surface water >100'
Driveway, parking/vehicle storage >25'
Curtain drain None Noted Wells on adjacent lots
>200'
F. COMMENTS' Lot Is Served by Class A Water System.
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 Michael E. Anderson, P.E.
Date 10n12009
COSA Fee $ q 10
Date of Payment i0 /0 %
Receipt Number 0 V 13 & C1
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
11
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ROM COUNTRY REALTY
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PHONE NO. : 9076981233
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AS -BUILT..
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Anchorage Rkording Pro4nct, AlAski, �w
ments'Fituated thereon are within Lh
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no Improvern".0n property I d 4
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traftsmissioh:hnes or other visibWeasernie
except its Wicated hereon. - -
Dated it f4li*11W. "Alaska
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Municipality of Anchorage
-1 Development Services Department
Building Safety Division
Onsite Water and Wastewater Program
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.enchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051.531.13 HAA # r) io
Expiration Date: S
1. GENERAL INFORMATION
Complete legal description Lot 5, Block 5 Meadow Ridge Estates Subdivision No. 5
Location (site address or directions) NHN Homestead Road
Current Property owner(s) MM&M Contracting
Day phone 688-1236
Mailing address P.O. Box 670495 Chugiak. AK 99567
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, NAA will
be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
Four 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
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 5 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 less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's
work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat affixed hereto and as of the validation datg 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 hbrein. 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 Finn Anderson Engineering Phone 522.7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 1217/2004
L
S. DSD SIGNATURE
NM c AN=SCN
No. a-4381 �
Approved for _ bedrooms. t.•
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
(Rw. 12M
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Pat;( Original Certificate Date: &-0 �4
41
Municipality of Anchorage
• Development Services Department
Building Safety Division '
— On -Site Water & Wastewater Program
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.enchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 5. Block 5. Meadow Ridae Estates No. 5 Parcel ID: 051-531.13
A. WELL DATA
Well type _
Date completed _
Total depth fL
Date of test
Static water level
Well production
If A, B, or C provide PWSID # _
Sanitary seal (YIN)_
Cased to ft.
FROM WELL LOG
WATER SAMPLE RESULTS:
Coliform colonies/100 ml.
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SeoticlSWI
Tank size 1.250 gal.
Foundation cleanout (YIN) Y
Date of pumping
C. ABSORPTION FIELD DATA
fL
9 -p.m -
Nitrate mg.A.
Collected by:
Number of Compartments 2
Well Log (YIN)
Wires property protected (YIN)
Casing height (above ground) in.
AT INSPECTION
0
Other bacteria colonies/100 ml.
Date installed 9198004
Cleanouts (YIN) Y
Depression over tank (YIN) N High water alarm (YIN) N
Pumper New Construction
Date installed 9198004 Soil rating (g.p.d./ftp or flbdrm)1.2 GPDISF System type T Wide Trench
Length 50 ft Width 5 ft Gravel below pipe 4 ft
Total depth 9 ft. EH. absorption area 500 fl? Monitoring tube Y Depression over field N
Date of adequacy test Results (PasslFail) For bedrooms
Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in.
Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) N If yes, give date
D. LIFT STATION
Date Installed
'Pump on' level at_ in.
Datum
Size in gallons Manhole/Access (Y/N)
'Pump off level at _ in. High water alarm level at in.
Cycles tested Meets alarm 6 circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot 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 >5' Property line >5' Absorption field >5'
Water main >10' Water service line >10' Surfacewater >100'
Wells on adjacent lots >200'
i
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation >10' Water main >10'
i
Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >5'
Curtain drain None Noted Wells on adjacent lots >200'
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- Michael E. Anderson, RE,
Date 12172004
HAA Fee $ 61, j5+
Date of Payment 121 "
Receipt Number _(r I SIy SAM
(ReJ. 1200)
Waiver Fee $ _
Date of Payment
Receipt Number,
`.rY•�
cif 49th * st*
7 *%K104AM L ANDERSM /2'
No ct�M
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j
CDITM REALTY PHONE NO. : 90768131238 Dec. 07 2004 10:37AM PI
'T
1p,� Wr
vp
,>s,
:_ 181 5*8
OAFS
iii Yrls .� \
AS -BUILT'
I herey certUy that I hove %;trrveyrd.tl%v tulluwblg:d - tsit nl;;a-
propel,
-o-
'Anchorage Recordinprecinct,ording rnct. Alacks, and that -the improve.,
41M, ments lituabed thereon are within the tropertylinei; and do nonot.;i.-
lying a Ah
overtap or encroach an the property clikehirthemtoj at
.1w Improvements property lyin adjaCent-then-to eugoach
.W provimrnt3ph* pro
", r-) 4 .,. .4— "V on the, A
'k�;- , . premises in question and t at. there'Pre no: r6adw-ays.
re Y, bmismi'ssiciAlihes or other visfbleeasemertts; cin'iiW
except as indicated hereon. -
Dated at Eagle River, Alaska
4k &I" u t this dAy of
RO=T C.40KNSOR ?:X.
SCALE:. Registered LAnd,Sirryeyor No, 54M,-
-0456,fagle Ri! 'er, Ain" 99577
box 77
'694
.0 Phone -250