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Home My WebLink AboutMEADOW RIDGE ESTATES BLK 2 LT 2Meadow Ridge Estates Block 2 Lot 2 #051-461-20 krxuv uuiucu to) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221465 PID Number: 051-461-20 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name Kim Sperman A RPTION FIELD ED] De Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 21113 Meadow Lake Drive Other Phone (907)230-7097 Number of Bedrooms Three(3) Soil Rating Total depth from original grade /SF Ft. LEGAL DESCRIPTION Depth to pipe invert from originalg e Gravel depth beneath pipe F . Ft. Subdivision Meadow Ridge Estates Block Lot 2 2 Fill added above original grade Gr I length Ft. Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dista a between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between t ches From Tank Field Tank Line Ft2 Well >100' >100' N/A N/A >25 TANK ❑9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1,000 Gal. Surface Water >1 00' >100' N/A N/A Material Plastic Number of compartments Two (2) Lot Line >5' >10' N/A N/A NA Foundation >10' >10' N/A N/A STATION Manufactur Capacity Remarks Gal. Alarm location Elec r ailed by Installer PIPE MATERIAL House to tank D3034 drainfield Tank to D3034 A+ Home Services Drainfield D3034 CO/MTD3034 Inspector B Schiller BENCH MARK (Assumed elevation) 100 ft Inspect1-1 6/26/23 Location and description 31d 2ion n Bottom of siding @ SW corner 4th ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp IF Conditional Approval: Date .' .� AwlAI i* .49 TH ....... Septic System Benjarri�n-Schiller Fc Approved Date Z CE 12592 �� r �s 4 9 rF • 7/10/23 , • "�0 .r �� PROFESS10 Note: this approv does not include well permit requirements. \®®®®v�4�- krxuv uuiucu to) MEADOW RIDGE ESTATES, BLOCK 2 LOT 2 PERMIT # OSP221465 BLOCK 1 LOT 1 -7 BLOCK BLOCK 1 LOT 2 / Q- / O / Q BLOCK 1 LOT 3 / BEN MARK: / / BOTT SIDING / / B ZNoME FCO / SU • MH 2Co A / ENGINEERING .D / / BLOCK 2 LOT 1 / / / 10' UTILITY EASEMENT APPROX WATER LINE LOCATION LOT 2 NEW 1,000 -GAL SEPTIC TANK EXISTING TRENCH. CONFIRMED CONNECTION TO LATERAL IS > 15' FROM TANK AND TRENCH IS NOT 1A/1-1KI G /1 P' TAI - IAl AAl%/ --- BLOCK 2 LOT 3 PLAN AS -BUILT 0 50 100 FEET 111=50' NOTE: THIS PROPERTY AND SURROUNDING LOTS ARE ON A COMMUNITY WATER SYSTEM V / / / / / A # 051-461-20 i / / 1 I L / � r r r / r / r r / L/ II� l l W r ( r( o / U / BLOCK 3 LOT 3 j BLOCK 3 LOT 4 / FCO 9.4 19.5 MH 12.6 19.8 SV •. Benja i Schiller CE 2521 2 92 • �.� AW t F•• „ •� PROFESSIONP�� 21.5 2CO .D / / BLOCK 2 LOT 1 / / / 10' UTILITY EASEMENT APPROX WATER LINE LOCATION LOT 2 NEW 1,000 -GAL SEPTIC TANK EXISTING TRENCH. CONFIRMED CONNECTION TO LATERAL IS > 15' FROM TANK AND TRENCH IS NOT 1A/1-1KI G /1 P' TAI - IAl AAl%/ --- BLOCK 2 LOT 3 PLAN AS -BUILT 0 50 100 FEET 111=50' NOTE: THIS PROPERTY AND SURROUNDING LOTS ARE ON A COMMUNITY WATER SYSTEM V / / / / / A # 051-461-20 i / / 1 I L / � r r r / r / r r / L/ II� l l W r ( r( o / U / BLOCK 3 LOT 3 j BLOCK 3 LOT 4 / FCO 9.4 19.5 MH 12.6 19.8 SV 16.2 21.5 2CO 18.7 22.5 LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE MEADOW RIDGE ESTATES, BLOCK 2 LOT 2 PERMIT # OSP221465 ENGINEERING PID # 051-461-20 • j 0 (NO SCALE) -� 1 7 H .......... • • • . BenjaSchiller ' I��F�,•. CE 12592 •��i ��di�pROFESSiONp�'.d � ! �. � � <. ZII MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221465 Work Type: SepticTank Upgrade Tax Code Number: 05146120000 Site Legal Address: MEADOW RIDGE ESTATES BLK 2 LT 2 G:1362 Site Mailing Address: 21113 MEADOW LAKE DR, Chugiak Owner: SPERMAN TRAVIS & KIM Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft: Total Bedrooms: -,l»ent :f De partrnent 11/30/2022 11/30/2022 11/30/2023 24097 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing 3 Special Provisions: • Confirm orientation of the existing septic field at time of new septic tank install to confirm that the 5' separation from field to tank can be maintained. Show the correct field orientation on the inspection report drawing. Received By: S S %gyp Issued By: &A�,� Date: Date: I 3J 20 Z2- MUHMP s DTI Y OF AHC HOO RAGE Community Development Department ,- Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-461-20 Property owner(s) Kim Sperman Day phone 907-230-7097 Mailinq address 21113 Meadow Lake Drive, Chugiak, AK 99567 Site address 21113 Meadow Lake Drive Legal description (Sub'd., Block & Lot) Meadow Ridge Estates Block 2 Lot 2 Legal description (Township, Range & Section) Lot Size 24,097 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank 1ZUpgrade ❑X Duplex ❑ (D) Holding Tank ❑ Renewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: �aS Date of Payment: 101J -1,2 - Receipt (a 2vReceipt Number: 0, Permit No. 05Ba-2- Permit App_::- : :'_. c Waiver Fees: Date of Payment: Receipt Number: Waiver No. November 8, 2022 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Meadow Ridge Estates Block 2 Lot 2 - 21113 Meadow Lake Dr Septic system design Dear On-Site Services Engineer: The owner of the above lot has a septic tank that has reached its end of useful life, so we are submitting this permit application for its replacement. The attached site plan identifies the location of the 2-bedroom home as well as the wells and septic location. No conflicts exist between this proposed system and any other wells or septic system, whether on this lot or adjacent lots. We are replacing the septic tank with the same size. The new septic tank will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the absorption field. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221465, Curtis Townsend, 11/30/22 Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND 2CO MEADOW RIDGE ESTATES, BLOCK 2 LOT 2 FEET 0 50 100 FCO NOTE: THIS PROPERTY AND SURROUNDING LOTS ARE ON A COMMUNITY WATER SYSTEMMEADOW LAKE DRIVE2-BDR M HOME 11/8/22 COUNTRY VIEW DRIVE10' UTILITY EASEMENT SEPTIC PLAN EXISTING ABSORPTION TRENCH (EXACT ORIENTATION UNKNOWN) DECOMMISSION EXISTING SEPTIC TANK NEW 1,000-GAL SEPTIC TANK W/ NEW FCO AND 2CO AFTER MIN 10' FROM FOUNDATION APPROX WATER LINE LOCATION Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221465, Curtis Townsend, 11/30/22 OFGo 49 TH*y, SHANE A. HOLT.. 2,1 i �40 LS -6914 yo'2,1 44��°Jes sione� �'ocao THE INFORMATION HEREON I5 FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND I5 NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON (UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. AS -BUILT SURVEY V = 40' NO CORNERS SET THIS DATE OF THE FOLLOWING DESCRIBED PROPERTY LOT 2, BLOCK 2, MEADOW RIDGE ESTATES 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 _30TH_ DAY OF SEPTEMBER , 2013. 6081, F8 161-19 HOLT LAND SURVEYING 600 HIGHVVEW DRIVE ANCHORAGE AK 99515 345-5513 MUNICIPALITY OF ANCHORAGE�� ® DEPARTMENT OF HEALTH & ENVIRONIVIENTAI. PI;U 1 17 I IUN l ENVIRONMENTAL ENGINEERING DIVISION \ 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WLLL INSPECTION REPORT NAME �NFW TPH5K_E__ 7JV5/ --- - --- -- 9- 3 37 ❑UPGRADE MAILING ADDRESS LEGAL DESCRIPTION -- LOCATION NO. OF BEDROOMS Well Absorption area j Dwelling / PERMIT NO. U DISTANCE TO: jN/� _ S r 0 RV y i Q Manufacturer Material No. of compartments �1 y Liq. rcpUty in gallons IF HOMEMADE: Inside length Width Liquid depth o C7 z Well Dwelling DISTANCE TO: PERMIT NO. O Z Q -/" - - - ------ - - Manufacturer / r ( Material -- Liquid capacity in gallons S Well Foundation / Nearest lot line PERMIT NO. W y DISTANCE TO: ,5 � a z No. of lines l Length of each line / Total length of line> Trench widt v Distance between lines z W ~ _ _ _ Inches y1A a Tof tile to finish grade / Top Material beneath tile t /�1 Total effecti e absorptiory area cc O �1), inches Length ._ Width _ Depth PERMIT NO. w Q H Type of crib Crib diameter Crib depth Total effective: absorption area it.Ld a w rn Well Building foundation Nearest lot line DISTANCE TO: CI $s Depth Driller Distance to lot line PERMIT NO. _j J U _— w Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER — PIPE MATERIALS SOIL TEST RATING INSTALLER �CiJ/�.zn r old s �orvsr - REMARKS — too-,�a u ti c No. 1457•' s�R,j 1111% OF i AT DATE LEGAL 11 n I I IN_.. 11101 DE��THE�T '�� HE9LTH HND ENYlR0HMEHTHL cRO7ECTlON S23 STREET9MCHORHGE 264~4720 1 T,8�� PERMlT NO ( 820445 ) ^��7 HPPLICHNT SCHMIDT BROSSRB i96 -X E�R� 688-]O7.7 LOCHTION HEHDO!� LHKE RD LEG9L LOT 2 �LK 2 �EHDOW RIDGE SUB LOT SIZE 40080 SQURRE FEET TYPE OF SOIL HBSURPT�ON SYSTEM IS� T|�ENCH MHXIMUM NUMBER OF BEDROOMS � ] SOIL RHTlNG (SQ FT/BR)= 150 THE REQUlRED SIZE OF THE SOIL HBSURPTIDN 5YSTEM IS� THE LENGTH DIMENSION IS THE LENGTH (IM FEET) OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TRENCH 0R PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE GROUHD HND THE BOTTOM 8F THE EXCHVHTION (IN FEET) THERE lS NU SET NIDTH FOR TRENCHES THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHYEL BETWEEN THE OUTFHLL P[PE HND THE 8OTTOM UF THE EXCHVHTION (IN FEET) �� PERMIT HPPLlCHMT HHS THE RESPONSIBlLITY TO lMFORM THIS DEPRRTMENT DURING THE INSTHLLHTION INSPECTIONS OF RNY WELLS HDJ9CENT TO THIS �ROPERTY 8ND THE NUMBER 0F RESCES THRT THE WELL WILL SERVE It W D1 �� , it BHCKFILLING OF HNY SYSTEM WITHOUT FINHL lNSPECTlON HND HPPROVHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION ��if� -' SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: � (Q -//V rC)l/ P.J�DS l ,[.7ft/SJ� DATE PERFORMED: `JVt1vi3 i I`1ar7. LEGAL DESCRIPTION: / ,>r 2— // 1 A �2 McAye)Gj Rrp&&-� ;)zj&o 14 -- 15- 16 5 16 17 z:. .j�A?t _ k �J. 18 •aan � � g 9 Robert A. Si f::r 1 g f/a fl�FSF�e`•ee. c"�.AO ua 20 1�4%4",�:.\�'�® PERCOLATION RATE TEST RUN BETWEEN SLOPE TER V� L O P E ITE PLAN t Reading Date O rc�c�n i Cs Net Time Depth to Water Net Drop 2 CT 3 , 7 v�j 4 / .0 5 lf�irC-Co-)IC- �ANp IFy 6 u • •r) es - 15b 8 g 0 /'�J 10 11 WAS GROUND WA ENCOUNTERED? 12 4' 1 IF YES, AT WHAT 13–/ fj DEPTH? (A 14 -- 15- 16 5 16 17 z:. .j�A?t _ k �J. 18 •aan � � g 9 Robert A. Si f::r 1 g f/a fl�FSF�e`•ee. c"�.AO ua 20 1�4%4",�:.\�'�® PERCOLATION RATE TEST RUN BETWEEN SLOPE TER V� L O P E ITE PLAN t Reading Date Gross Time Net Time Depth to Water Net Drop COMMENTS PERFORMED BY 72-008 (6/79) CERTIFIED —(minutes/inch) FT AND - FT DATE — Municipality of Anchorage On -Site Water & Wastewater Program (907) 343-7904 ' J E CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I. D. 051-461-20 Expiration Date: r I 1. GENERAL INFORMATION Complete legal description MEADOW RIDGE ESTATES; BLOCK 2, LOT 2 Location (site address) 21 1 13 MEADOW LAKES DRIVE *CHUGIAK, AK 99567 Current Property owner(s) DOUGLAS & TARA OMAN Day phone 223-3905 Mailing address 21113 MEADOW LAKES DRIVE *CHUGIAK, AK 99567 Real Estate Agent ERVIN & BRANDY MALCUIT Day phone 841-2380 2. TYPE OF DWELLING: E Single Family (w/wo ADU) s/R*� ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site N Individual Water Storage ❑ Individual Holding tank ❑ Community Class A Well N Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received by =, Date:. COSA to be released to the engineer, unless othemise requested by the engineer. COSA Fee $ Fy Date of Payment lo //V1 Receipt Number (lam COSA# a5CP3/5q0 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation; based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) incompliance 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, UD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 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 otherperson or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE _)L_1/ System #1 Approved for 3 bedrooms System #2 Approved for Disapproved. Conditional approval for bedrooms bedrooms, Phone 337-6179 Date L- CE -795 to.�tb.�� < 1 E L ,rofessioOG a� OF A& `JZ ON-SITE g WATER AND with the following stipulations: WASTEWATER OZ_ . PROGRAM Original Certificate Date: Z rU — / :�Z —/ 3 The Milhicipality oYAO'elforage 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 Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist __L/ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other fp.n 111W 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 RIDGE ESTATES; BLOCK 2 LOT 2 Parcel ID: 051-461-20 A. WELL DATA COMMUNITY WATER Well type A If A, B, or C provide PWSID# 210401 Well Log (Y/N) Date completed Sanitary seal (Y/N)_ Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height (aboye round) in. FROM WELL LOG AT IN CTION Date of test Static water level Well production 9-p M. 9-p M. WATER SAMPLE RESUL Coliformcolonies/100 ml. Nitrate mg./L. Collected by: A Ic: ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA X INSi oi; (y_ -S7 06;x�(E Tank Type/Material SEPTIC/STEEL Date installed 10/82 Tank size 1000 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 pumpingU fI_ Pumpers )C ' 5 C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 10/82 Soil rating (g.p.d./ft`or /bdrm 150 System type TRENCH Length 40 ft. Width 2.5 ft. Gravel below pipe 6 ft. Total depth *7.79 ft. Eff. absorption area 480 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 9/31/13 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 700 gal. New depth 3_5 in. Elapsed Time: 830 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN "Pump on" level at in. "Pump ofr level High water alarm level at in. Cydes tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanklfift station on lot Absorption field on lot Public sewer main Sewer/septic service line areas On adjacent 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 101' Surface water 100'+ Wells on adjacent lots 200'+ PUBLIC/100'+ PRIVATE SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation 10'+ Water 10'+ Water service line In, 1+ Surfacewater 100'+ Driveway, paridng/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots200'+ PUBLIC/100'+ PRIVATE F. COMMENTS *WR#920075 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 Na a JEFFREY A. GARNESS Date l 0 l t b /3 (Rev. 11/05) W� Fu Lo loo AID�O C -l -a p-/ 5is 4, lOr22rOZ AVTE- r vc,zr M y e£ Ammut ahrP �vrs nor RMZEE ace ro '�'es. u2r Sno+c AiB.I PRUIRYY ar ArAtt AS - BUILT SLPVEY .S'C'I SCALE I' . 40 •...1� �N.w�..�� ! FEREBY CERTIFY THAT i NAVE FERFCTL`fED A •••'..w •" •Cfii.e MMTGAMTS MSFECTION OF TFE FCLLOWING Shane A. DESCRIBED PRO" ERTY lS 6911 .0 LOT 2. BLOCK 2. WAOOW ROM ESTATES SLE Tw jpkD HATXIN FET+EON 75 k174 T:E LnE CF EAsErENrs & tiLCM MER LvmW INSTITUtA�PtSF�SN'ECFMLY TO 9W II M TV#.La'E OKW ON IfE � PPLLA�fi OTLOI LIES � Eil��T�S AW JS 4 L AAE NOT WT'�7 TIErLnefflPFErCFLNE3r" ACarXYKL. Ft? 451-47 ANCpWAGE RECcMMO DISTRICT, ALASKA AFI THAT ne JILMOVDIENTS SITUATED TMMEON ARE MTMN TIE FRTX'ERTY LINES AND M EWROACPFIENTS'EXIST OTFER TILANNOTED. DATED AT ANCf CZAGE, ALASKA TMS 4TH _- DAY Or MICH �_Y..�_ I9_ 95 HOLT LAID SLp2VEYING TEL. 345-5513 JOB Cm Municipality of Anchorage O • Development Services Department Building Safely Division On -Site Water and Wastewater Program 4700 South Bragaw St. �.,... P.O. Box 196650 Anchorage, AK 99519-6650 www.cf.anchorage.ek.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 051-461-20 HAA# 8A 51 Expiration Date: / C - - C 3 1. GENERAL INFORMATION Complete legal description Lot 2: Block 2: Meadow Ridge Estates Subdivision Location (site address or directions) 21113 Meadow Lake Drive Chtipi nk .,Current Property owner(s) Arnie McKinnon Day phone 688-9366 Mailing address 21113 Meadow Lake Dr. Chugiak, AK 99567 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. �F ily �it/ c/o -7- 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class A Well QC 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 seal affixed hereto and as or the validation date shown below. I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type or structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S Enp•ineerin¢ Phone 964-2979 Address 17034 N. Eagle River Loop Ste. 204 EagleRiver, AK 99577 Engineer's Printed Name Robert C. Cowan Date /o /7.3 A Z LM 7' A; ROBERT C. COWAN 5. DSD SIGNATURE If c CE -8801 /�•; V Approved for - bedrooms. ... C, - Disapproved. tl ��:av��`~ Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory fp". ISMO) Yf OFq��,��'� 4,0 � • ON -SI I t : �' WATERAND • m: WASTEWATER p°OCRAM X Maintenance Agreements Supplemental Engineer's Report JC Other �� ✓ Original Certificate Date: I C - 2 - Municipality of Anchorage • Development Services Department Building Safety Division On -Sb Water 6 Wastewater Program 47W South Bragaw SL P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907) 343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L -0'r Z 1 t!Lt?G IL- `L� DVA -3 Parcel ID: X1 A. WELL DATA �-L Si 4 � fzo&& ieSi s'ID Well Z!04 I type _ If A, B, or C provide ID t Date completed _ Sanitary seal (Y/N) Total depth ft Cased to ft FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RULTS: Coliform lonies/100 mi. Nitrate mg.A. Arsenic: rl A. Date of sample: Well Log (YM) Wres properly protected (YIN) Casing height (above ground) in. AT INSPECTION ft. g.p.m. Other cteria colonies/100 ml. Coll by: B. SEPTIC-41OLDING TANK DATA `— Tank TypelMaterial I L� 7(E�i Date installed Tank size /CCO gal. ((((((Number of Compartments Cleanouts (Y/N) b /10 /gZ Foundation cleanouttt (YIN) y @epression over tank (YM) `� High water alarm (YM) /* Date 4f pumping !�7i Pumper / r7+A-'Y C. ABSORPTION FIELD DATA TT Date installed /t9 $%i Soil'rating (g.p.d./ft=o Axirm)zD Systemtype T4,c-vC H Length `70 ft. Width ' • 9;;� IL Gravel below pipe ft. Total depth0 ft. Eft. absorption area4&ft? Monitoring tube Depression over field Date of adequacy test /O/lv/OZ- Results (Pass/Fail) S 5 For 2 bedrooms Fluid depth in absorption field before test d in. Water added SSvgal. New deptt>�n. Elapsed Time: ,V min. Final fluid depth J2_ in. Absorption rate >= J� g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) Iq If yes, give date D. LIFT STATION Date installed N R 'Pump on' level at in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump ofP level at _ in. Cycles tested Manhole/Access (YIN) High water alarm level at Meets alarm 3 ciraril requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: N14 11 1' Septic tanknift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cl out Sewer /septic service line Holding tank SEPARATION DISTANCES FROM SEPIIIC/1.10 196 TANK ON LOT TO: i Building foundation f Property line rt Absorption field / r Water main /� r + Water service line / 0 fi Surface water 4�� Wells on adjacent lots � r-1- d AwaN / SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: / Property line / Xf Building foundation 74- IV Water main 7— in. Water Service line / /O/f Surface water iOD /-F Nveway, parkingNeNde storage 5 r^� Curtain drain � 14VE /C/A'ells on adjacent lots � 904- F. F. COMMENTS zv, i l ✓lam JP1- Am, 9ZGY»� G. ENGINEER'S 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems am in conformance with MOA HAA guidelines in etfeet on this date. Engineer's Printed Name R 0 /3 E ,iT C. CJ64.4e,' Date / O /} 3/0 Z HAA Fee $ 37J-- Waiver Fee $ Date of Payment I ° > �� Z Date of Payment Receipt Number 3 4' 7r Receipt Number (Rev. Ivor) 7 U 4 October 14, 2002 HEALTHAUTHOFM APPROVALS MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 SEWERSWATERAnchorage AK 99519 MHN E7(TENSIOENSIONS , REFERENCE: Lot 2; Block 2; Meadow Ridge Subdivision ROBERT C. COWAN. P.E. ROBERTA. SHAFER, P.E. CMLENGINEERS (907) 6942979 FAX (907) 6941211 SEWEAaWATER We performed a septic adequacy test on the onsite septic system serving the above INSKcNDN referenced property on October 6, 2002. The drain field had one monitoring tube present at a depth of 93 inches, with the invert of the drain tile 52 inches from the top of the ground. This indicates that the monitoring tube only extends approximately 4 feet into ENGINEERINGSTUDIES the gravel. ANDREPORTS The following observations were made during the inspection. Water was introduced to the monitoring tube at approximately 6.5 gallons per minute. Less than 0.5 inches of fluid was measured at any point during the test. A total of 550 gallons of water was WELL PaTintroduced into the system. 4PLawTEST TEST y These observations confirm the findings of Mr. Douglas T. Kenley, P.E., who last tested the system in 1996. We believe our test confirms the system functions adequately for a 2 SITE PLANS bedroom residence. If you require additional information, please contact us. ROADOESIGN Sincerely, SOILTEST Robert C. Cowan, P.E. RCC/tS/moa/meadowAm PERCOLATION TEST STRUCttMALA MECHANICAL INSPECTIONS ONSITE WASTEWATER DSPOSALSISTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER ALASKA 99577 5vor1c- pipe, / (,VCGAT Io•J Amo p-1 5jC jf�,cG14EL_-12-iIjC. IOlZZ/OZ Avir. rttaEAAYeEALevrrmi. szmv 4ENrs Avr vrslaE ace ro aEEP S%W. A' FAVfR YADaRSET IT iLL "'RT7Y LT)vAERS Shone A. 11n11 s *.01 LS 6914 ,1�b�4pFCg51, ltT TFE fFD,WTION IL - w IS kap TIE 115E Cr LEFDPDWITUT"SSt'EC CALLYTOSFW ANY CO"PLCTS BE WEN EXISIM STRLCTWES AFD PLATTED LOT GES OR EASEF£NTS AW 19 WT TO BE LGED POT POSITIONR.O AMOONAL, STRLCTtFES OR FEFULPES 4� 4,6', mcg, 9s EAS£FE)qTS & IT room OTPER CW ON 11MI PUT,. ARE NOTE RE SICK) fcwo\t FS 61-47 L" AS - BUILT SURVEY SCALE 1' • 40' I HEREBY CERTIFY THAT I HAVE FERFCRNED A IIMTGAGEES INSPECTION OF TW FOLLOWING DESCRIBED PROPERTY LOT 2. BLOCK Z. WADOW RIDGE ESTATES SLR ANChCXVAGE RECORDING DISTRICT. ALASKA AND THAT ME IF1'RDVEAENTS SITUATED TIEREON ARE WIMN TIE FROFfRTY LINES AAO NO ENCROACTPENTS'EXIST OTTER MAN NOTED. DATED AT ANCHORAGE. ALASKA THIS 41H DAY OF -KV?04__—___-__- HOLT LAND SURVEYING TEL. 345-5513 ioD CBBI MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section �,,,'. P.U. Box 196650 Anchorage, Alaska 99519-6650 343-4744`" It 6` /OM1 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # IL ,1 - X %, t\ - "-I-) 1. GENERAL INFORMATION �C• HAA# �`��llc;� '( .:.d Complete legal description Lot " Block ', Mea6o,,v ! idge ilstatQs Sub Location (site address or directions) '7 71-) Meadow Lake 9r. , Chum a':, Alasim 9OJS67 Property owner Michas l.'and F)ebra Stanl;a Day phone Mailing address Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well X Public water Day phone Day phone 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: Y Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 921 h 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I 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 Address Douglas T. Kenley 1-IC01 Box 5034 Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. Pal:rer, Alaska 99545 '' bedrooms. Conditional approval for Additional Comments Phone (907) 745-7.073 Date 2/15/95 y TH, 0':/',t3 (. ICE I'LEY.A. , CE 0176 .. bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA N21 Municipality of Anchorage DEPARTMENT OF HE=ALTH & HUMAN SERVICES Environmental Services Division 825"I-" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 tj) �!, Ute, Health Authority Approval Checklist `��'� �,,��^^ �g ns yo Legal Description: G�> 2 �`'�'� yeoiaprr�u� ,P�o�� Parcel I.D.;k 6151 �- UE(Pt- A. WELL DATA aZ Well type I A)B, o>oattach ADEC letter. ADEC water system number Log present (Y/N) Total depth Sanitary seal (YM) Date of test Static water level Well production WATER SAMPLE Coliform Date of sample: Date completed Cased to Casing height (,above Wires properly 10 [feted (YIN) FROM WELL LOG / AT INSPECTION B. SEPTIC/HOLDING TANK DATA 9 -P.M. Nitrate Collected by Other bacteria Date installed Ocr i�6'Z Tank size /ate,0a,�Number of Compartments Cleanouts (Y/N)� Foundation cleanout (Y/N) _ Al) Depression (YIN) A-1 High water alarm (YIN) Date of Pumping 2 Vo -9 (Pumper C. ABSORPTION FIELD DATA Date installed ,` 19,9—" Soil rating (g.p.d./I12 or ft2/bdrm /rd System type �•e� �f/ Length SOF/ Width Gravel thickness below pipe Total depth �Of Effective absorption area 4 Monitoring Tube present(Y/N) Y Depression over field (Y/N) X/ Date of adequacy test %'� 196 Results (Pass/Fail) oAs For bedrooms Fluid depth in absorption field before test (in.); 0_ Immediatelv after�� gal. water added (in.):y Fluid depth D (ins.) Minutes later: Absorption rate = -> 45-v g.p.d. Peroxide treatment (past 12 months) (Y/N) A/ If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* P o f' level at* High water alarm level at* *Datum Cycles-tesiect E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 1/.4 On adjacent lots /� Absorption field on lot On adjacent lots Public sewer main ��ia Public sewer manhole/cleanout �� Sewer /septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation %ff Property line -"« Absorption field Water main/service line !D'�/Surface water/drainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation lO F / Water main/service line /O '`F/Z Surface water Als9 Driveway, parking/vehicle storage area Curtain drain N//� Wells on adjacent lots 4114 F. ENGINEER'S CERTIFICATION Property line .� EE Aii, /G�fiSa I certify that I have determined thru field inspections and review ofNlunicipal records Xhat tfie ahoye:Ostems are in conformance with IOA H,A4A guidelines in effect on this date. Signature�''� Engineer's Nante 6U a -S v I t' i etil c 2 Date C49 HAA Fee $ Date of Pay. Receipt Nui Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number Douglas T. Kenley, P.E.HCO1 Box 6034 Palmer Alaska 99645 (907) 746-1073 February 15, 1996 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Adequacy Test at Lot 2, Block 2, Meadow Ridge Subdivision, located at 21113 Meadow Lake Drive, Peters Creek, Alaska Gentlemen: An adequacy test was performed by Fred Kenley on February 13, 1996, on the septic system only. The property is on a community well. The septic system was installed in October, 1982, by Schmidt Bros. Construction. The system consisted of a 1,000 gallon capacity steel tank that entered into the middle of a 40' long, tile, drain -field trench. Material beneath the drain tile, according to the inspection report, was listed to be 7211, 30" in width, with 4' of cover above the tile. The tank had two clean - outs present with the water in the tank at 46 1/2" at the inlet side, 49" at the outlet side, indicating that the tank was out of level. The drain field had one clean-out present at the end to a total depth of 93" with the invert of the drain tile being 52" from the top of,the ground, which would indicate roughly that the clean-out only went down V into the gravel. No water was present at the bottom of the clean-out before the test started. Water was introduced into the clean-out of the tank on the outlet side to determine if the line was clear to the drain field. Approximately 55 gallons were pumped through the line, at which time there was still no water detected at the clean-out at the end of the drain field. The water level on the inlet side of the tank rose approximately 111, indicating the water had gone through the drain field. Water was then introduced into the clean-out at the end of the drain field at a rate that averaged out at approximately 6 1/2 gallons per minute, with measurements taken every 10 minutes to determine the water level in the clean-out. Less than 1/2" of water was detected during the final 30 minutes of testing. A total of 455 gallons of water was introduced into the system in the 1 hour and 15 minute time frame. it is felt that, although the total 6' of gravel could not be monitored, the system is adequate with 67% of the drain field still available for use. sincerely, Douglas T. Kenle P.E. X Douglas T. Kenley Civil Engineer State of Alaska C.E. 8176 HUSTON.XLS SEPTIC SYSTEM ADEQUACY TEST Legal Description Applicant Date of Test SYSTEM DATA Tank Volume Number of Bedrooms Absorption system Number of Bedrooms Absorption required (1.5 daily flow) / ✓JODii BOG TIME FLOW (gpm) VOL. (gals) TEST DATA TANK LEVEL TUBE LEVEL i<lG�r o..Yr COMMENTS X,0 In v .. e9 .. Q i ,J-ejF System Passed _✓ Sysylem Failed.- i,rJ G.O. ,rr �stJO OF 17 �.✓i.V Fi�G.,O. � r 5 ,30 _ y9 Page 1 9 M ieipali-ty ®f Aieh®rage Department of Health and Humar. Services 825 "L" Street Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor January 17, 1995 I-ALn AC) Deborah D. Stanka 21113 Meadow Lake Drive Chugiak AK 99567-6234 Dear Ms. Stanka: During the fall of 1994, the On -Site Services Section of the Department of Health and Human Services conducted a review of on-site septic systems involved in the legal proceedings concerning Chuck Landers. Your property, Lot 2, Block 2, Meadow Ridge Estates Subdivision was involved in this review process. Following site visits and submittal of additional required information by the engineer on this project, Mr. Henry Wilson, P.E., your system was determined to be in compliance with applicable municipal codes. One of the additional submittals required for your system was a Certificate of Health Authority Approval for a Single Family Dwelling. I have included the original of this certificate and an additional copy for your files. The original blue copy of the certificate should be delivered to the lending institution which processes the mortgage on this property, for the existing original in their possession includes an invalid signature. All remaining paperwork (permit designs and/or as -built inspection reports) concerning your on-site septic system has been updated and is on file at the Department of Health and Human Services. Should you desire, you may obtain a copy of this paperwork for your files. If you have any further questions regarding this matter, please contact me at 343-4744 Sincerely, J mes Cross, P.E. Program Manager On -Site Water Quality cc: Robert 0. Baker, Ph.D., Acting Manager, Environmental Services Division HENRY WILSON 9601 BUDDY WERNER DR.: ANCHORAGE, AK 99516 (907) 346-2000 3 July �, 1994 Constructing Engineers Engineers, Surveyors Muncipality of Anchorage DHHS, On -Site Services Po Box 196650 Anchorage, AK, 99519 re: Lot 2 Block 2 Meadow Ridge Estates Health authority approval checklist and certificate Gentlemen: CHARLES A. LANDERS HC83 BOX 192-A, MYRTLE DR. EAGLE RIVER, AK 99577 (907) 694-9098 Please substitute the attached original signed reports for the reports originally submitted and processed, and remove the file copies and send to me at the above address. 04 W41.11� Henry H. Wilson, P.E. MUNICIPALITY OF ANCHORAGE ° DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# OSI- HAA# NA 9zo�6io 1. GENERAL INFORMATION Complete legal description 1_Z57_ N�eaduul ?)�1' C t Location (site address or directions) Z( 1 13 Meadow Lie D" ) Cog, �k Property owner Mailing address Lending agency Mailing address. Day phone Day phone Agent 5h nr c k�e Day phone 6SaA933 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well x Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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 MOA e21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm QrS-�r°"Phone 3qG-L0Q0 Address _ 9�:O` w�i e i by A NchOr2r� , K 9 9Si � Engineer's signature 44 ��"" a Date // - 3 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for By; . CAUTION The Municipality of /krichorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of 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. ON •IiE�ki..AGrFi.Yi6ff11C.a�ti' .� r •� ".*a tq*qvaev.v ... @* ago Ho *o .. -1)% NO. 1732-E � G�� `., Jun. 2.9, 1949 .: 7,,—o e\ %-JUNAL ��•av 2�sr�LJM/(fE/ SR4.ItE bedrooms, with the following stipulations: Additional Comments L"t LNti WtN\VEa QZR-C'Z� WR 97_0,3'::1S 72-M(Rw.1/91) Back MOAN21 ® Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LZ q�z- me,2d0, �j5e. Parcel I.D. A. Well Data OSI- A61-2.� Well type 1 / If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Driller -- Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) _-Z FROM WELL LOG Date of test Static water level Well flow Pump levels SEPARATION DISTANCES FROM WELL TO: N Septic/holding tank on lot Absorption field on lot ocl X, Public sewer main Sewer service line WATER SAMPLE RES Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate AT g•p• On adjacent lots On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: ti• Other bacteria Date installed 8-L Tank size 1000 Compartments Z Cleanouts (Y/N) Y Foundation cleanout (Y/N) (Ili Depression (Y/N) f J High water alarm (Y/N) _ N A Alarm tested (Y/N) Date of pumping 1 I- to -92 Pumper :3-Fz'5 PQv-\P,g SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot N A On adjacent lots + To property line 30Absorption field Surface water/drainage --' C�o S' _Foundation s' Water main/service line 2-0 72•026(aW)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCsF FR M LIFT STATION TO: Well D. ABSORPTION FIELD DATA On adjacent lots tested off" Level at Surface water Date installed lO f `b2 Soil rating (GPD/Ft') ) 5v s�/��Y System type - 1�,E� Length 40' Width Z 1,Gravel thickness �' Total depth jo Total absorption area 48o s4 Cleanout present (Y/N) Y Depression over field (Y/N) N Date of adequacy test - 9Z Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) rJ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ^/ A On adjacent lots PASS for R C70 Bedrooms test _ yes, give date Property line To building foundation S' To existing or abandoned system on lot rJ(" On adjacent lots -}56 Cutbank 4too Water main/service line— Su rface ine_Surface water �-` C)d Driveway, parking/vehicle storage area 2-1D Curtain drain --Hoo' E. ENGINEER'S CERTIFICATION l certify that I have checked, verified, or conformed to all MOA and HAA guidelines in .>ii�4: rt Y }Q' F5e'V.(%;v':i X),fA f,.)i:�'it�.,L•A,i:ti Nf::.Y Signature X06 Engineer's Name Date HAA Fee $ ISO Date of Payment Receipt Number 72-026 (3/93)' Back I1-Cz-f)z. Z -.r, Z34 Waiver Fee $ a inspection. Date of Payment '3p 06 I I -)z -9z Receipt Number -L4 Z 3 4 (4J83) -3-9 MUNICIPALITY OF ANCHORAGE •I DEPARTMENT OF HEALTH & HUMAN SERVICES h i� Division of Environmental Services M}� On -Site Services Sectionr P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D. it i(- � - HAA it ti Ll ED L.tel 1. GENERAL INFORMATION Complete legal description LZ -g /Y1eadou') Location (site address or directions) ZI113 M Q 2a un J >,�ke�✓ Property ownerDay phone Mailing address Lending agency Day phone Mailing address Agent S1�a'�� k� Day phone 6884939 Address �,i��va ?1\09q4s5 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well x Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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( Fronl MOA 021 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application -shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Con s rv^5 S, nezCS Phone' -909 Address �vt Ku�1y��r� I4��6ec Igz M�� Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. V_ _� e__ -7 bedrooms. Conditional approval for Additional Comments ' u / By: - bedrooms, with the following stipulations: Z11TIC 7 L IJ i Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 12-025 (Rev ti91) Back MOA 921 Municipality of Anchorage , Department of Health & Human Services t HEALTH AUTHORITY APPROVAL CHECKLIST h5 Legal Description: 1 2_ M� z�O ��` Parcel I.D. b5 I- zn A. WELL DATA Well type AP('^^u' tY t If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) N Date completed Drill Total depth Cased to Cas' eight Sanitary seal (Y/N) Wires proper) rotected (Y/N) Date of test Static water level Well flow / Pump le�4� SEPARATION DISTANCE Septic/holding tank on lot Absorption field on lot — Public sewer main Sewer service line WATER SAMPLE RESUULL Coliform Date of sample: FROM WELL LOG AT INSPECTION t`t`l 9•p•,. g.p.m.; ` U S FROM WELL T B. SEPTIC/HOLDING TANK DATA Nitrate On ad' ent lots —>n adjacent lots is sewer manhole/cleanout Petroleum tank Collected by: Other bacteria Date installed �" /� Tank size boo Compartments 2 Cleanouts (Y/N) Foundation cleanout (Y/N) t\j Depression (Y/N) High water alarm (Y/N) _N A Alarm tested (Y/N) J Date of pumping tt' )ae9Z Pumper-ar.%_� �g SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO Well(s) on lot N On adjacent lots To property line 30 _Absorption field 5 Surface water/drainage ) °y Foundation 51 Water main/service line ZOI 72-026 (Rev. gist) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Manufacturer Manhole/Access (Y. Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DIST FROM LIFT STATION TO: Well on I On adjacent lots ABSORPTION FIELD DATA Date installed I0 /87- Soil rating Length '40 Width �• "Pump off" level at Cycles tested Surface water r 5o 5s (wrm System type Gravel thickness II Total absorption area Cleanouts present (Y/N) Depression over field (Y/N) Results (pass/fail) PA55 N Date of adequacy test -1neNc Total depth I0 / Y for C3) bedrooms Peroxide treatment (Past 12 months) (Y/N) N If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot tV On adjacent lots —Property line S' To building foundation To existing or abandoned system on lot On adjacent lots Surface water Curtain drain — +50, Cutbank t. loe 'H\ 00` rtc3o E. ENGINEER'S CERTIFICATION Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the; datO,of,,this inspection. c!f SignatureEli6. ,a Engineer's Name Ay,\ 11or-aSe h2y� 99St(P C i i y Date I I� II-}zs f, -..., ' HAA Fee $ / 70 (f) Waiver Fee: $ Date of Payment Date of Payment Receipt Number 474 Z c3 6447 X Receipt Number °�� C� (:44 7�� 72-026 (Rev. 3/91) Back MOA 21 icipality of Anchorage -> Department of Health and Human Services 825 "t_" Street Tom Fink, Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 November 13, 1992 Hank Wilson, P. E. Constructing Engineers 9601 Buddy Werner Drive Anchorage, Alaska 99577 Subject: Waiver Request for Lot 2 Block 2 Meadow Ridge Estates Waiver Request #WR920075, PID #051-461-20, HA920766 Dear Mr. Wilson: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 1 foot. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, Robert W. Robinson Civil Engineer On-site Services ljm .. MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR920075 PID# 051-461-20 HA# HA920766 Permit # Date Received: November 12, 1992 Legal Description: Lot 2 Block 2 Meadow Ridge Estates Subdivision Engineer: Hank Wilson, P E.. -Constructing Engineers 9601 Buddy Werner Drive Anchorage Alaska 99516 Applicant: Thomas L. Enlow Waiver Requested: Lot line - 1 foot Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Points: «*•+.* Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Date: //, Rec #: 24234/4783 By: Mame o Amount: $70.00 Date Paid: 11-12-92 o� -' I i - I t— I i � N L { 00 M N Z.• M i iI ue(v O ZI i Fi;An' o IiauSti i A�- E: i a Z7 i ,- O N z9 -08-ZS E ISO -00 {v 0-2 L�� VYJa I hereby certify that a survey of LOT 2 BLOCK 2 MEADOW RIDGE ESTATES SUBDIVISION was made on NOVEMBER 11, 1992 and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on property Lying adjacent thereto encroach on the premises i question and that there are no roadways, transmission Lines or other visible easements n said property except as shown hereon. It is the responsibility of the owner t determine the existence of any easements, covenants or restrictions which do not appear n the recorded subdivision plat. Under no circumstances should any data hereon be used for construction or for establishing boundary or fence lines. Dated in Anchorage, AK, NOVEMBER 11, 1992. CONSTRUCTING ENGINEERS AS—BUILT SURVEY 9601 Buddy Werner Dr Anchorage, AK, 99516 346-2000 694-9098 SCALE 1" = 30' SURVEYOR'S SEAL HENRY WILSON 9601 BUDDY WERNER DR.: ANCHORAGE, AK 99516 (907) 346-2000 November 12, 1992 MOA On -Site Services 825 L Street Anchorage, AK, 99501 Constructing Engineers Engineers, Surveyors — Attn: John Smith, Manager re: Lot Line Waiver request L2B2 Meadow Ridge Est Dear Joh4,5� CHARLES A. LANDERS HC83 BOX 192-A, MYRTLE DR. EAGLE RIVER, AK 99577 (907) 694-9098 RECEIVED NOV 1 31992 munlo+pamy of Anchorage Dept. Health & Human Services We are submitting a request for a MOA Health Authority approval with a lot line waiver for the subject lot. As part of the submittal we are enclosing a copy of the Survey As - Built we performed showing the location of the absorption field. As you can see from the survey, the septic field is on;y 11 from the lot line. The documentation on file for this system indicated 20, to the lot line, which was not what we found it to be. Thank you for considering this waiver request. Respectfully, Chuck Landers Constructing Engineers DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 September 3, 1992 David Dayton 20210 Donalar Chugiak, AK SUBJECT: Dawn Water System, Meadow Ridge Class "A" Public Water System, PWSID #211431 Dear Mr. Dayton: WALTER J. NICKEL, GOVERNOR (907) 349-7755 I have completed a review of this office's files concerning the monitoring status of the above -referenced Class "A" Public Water System and found the following: 1. The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on August 13, 1992. This does meet the provisions of 18 AAC 80.200(a) of the State Drinking Water Regulations. 2. The last inorganic Chemical Contaminants sample results were submitted to this Department on October 9, 1990. This does meet the provisions of 18 AAC 80.200(a). 3. The last Radioactive Contaminants Sample results were submitted to the Department on June 10, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. 4. The last Organic Chemical Contaminants/Volatile Organic Chemicals were submitted to this Department on June 10, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above -referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Keven K. Kleweno District Engineer KKK/cf Time APPLIC NT FILLS OUT UPPER HA( ONLY Property Own C �� ; , - �� Phone Mailing Address 1 Zi Code t i A .. `'-.(-_ P " Buyer- C _ r', 1 Address�; �'�% i � (- U r'i -� 1 Z f� i- .r. (_` -L._ Zip Code l - (9 - ;,i I Lending Institution""`� - ( - Phone Address �) / / v{..�-� Zip Code `✓'� `I t �. ".tel/.7 V ( Realty Co. & Agent -'� '� �"" Phone Address -4Zip Code ( ..) Legal Description r+' �i Street Location BY: Type of Residence Soils Rating Single Family Well To Absorption Area Well to Tank fl"Multiple Family No. of Bedrooms- ❑ Other Water Supply- ❑ Individual fi�eCommunity ""`'" .f ATTACH WELL L:44c9�`A well log is required for all wells drilled since June 1975. For wells drilled t.:: that date, give well depth (attach log if available). 'Ll -Public - _ ,, r D '' Utility 1� Sewer Disposal -L9,&dividual -Public Utility Year Individual Installed: When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: ( APPROVED BEDROOMS j 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: Soils Rating Date Sewer Installed 1�( Q Well To Absorption Area Well to Tank Well Log Received Septic Tank Size 72023 (3182)