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Home My WebLink AboutMEADOW BROOK Tract YM adow Brook T act Y #050-243-38 Development SerVices Department Building Safety Division On-Site Water and Wastewater Program. 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page www.cl.anchorage.ak, us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ""~: L~-,~E.O,d~ ~,~/5Xt'3'C.~Z-L/ WastewaterSys{em: DNew [-IUpgrade l'otal O ep{h fr ~11 o~{g~nal ~ld®: Well: 0 New 0 Upgrade SEPARATION DISTANCES ~semic ~ Holding ~ S.T.E.P. ~ Othen Septic Abso~tion L~ Holding Pub~le M~ Tank Field Station Tank S~r Une ~~ s~--w.,.,J~ ]~¢ ~ / LIFT STATION ",-,~,: BENCH MARK Inspections pedormed by:-. _~ Dates: t" Municip. oti~c oF .A,n,_~ h.o ,r 9 g.e' DEPARTMENT OF HEA~_THANU HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION p.rl. Box 196650 e Ancho~ge, Alasko 99519-6650·Tetephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT L£CAL TRACT Y, MEADOW BROOK S/D P.I.D. NO. O~"O- ~y,)-~,~ ', LOT 28A % ........................................................1-1 2 °-' '"' ["-~ ""~-~ 2-* ~ "~ '- .......................... 0 ', ~" ',., ~. ~ ",~_~/~ ~ ^ ,.~ ,~ ,.,,.~ ,.... ,...~~ ~,1 , \ . . \\- \ ",. £':'.'2'" ..A;~'.'~'~, \ ~~ ................................... ~(:~/,::r...:,...:r.~.c?'~ ~ ~ ......... w,~ov~-a~e,,.~ ........... ... -,-- Municip. ~i~ o? Anchor~oe DEPARTMENT OF HE~_THAND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION · P.O. ~]ox 198650 eAnchornge, A~osko 99519-6650eTelephone~ ;34;3-4744 ON-S~TE WASTEWATER DISPOSAl_ SYSTEM AND/OR WELL INSPECTION REPORT ~.ECA~ TRACT Y, MEADOW BROOK S/D EXISTING 6'x6' I EXISTING 1 6'xl 6' SEEPAGE PIT DRIVEWAY PER,~flT NO. PAaE .'~"~ OP 4 Municip. c~Ji't of" Anchor-'oc~e DEPARTMENT OF' HE~)(..THAND HUHAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 eAnchoroge, AtosRo 9951g-6650eTeLephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL iNSPECTION REPORT TRACT Y, MEADOW BROOK S/D P.I.D. NO. OrO -- ~'~3--.~ ~ EXISTING 6'x6' EXISTING 16'x16'/ / -~ SEEPAGE PIT / / $CAL~: 1" - 40' I~e,lom~ecl Legal bescrIpIIml: 6- 7- 8- tt-I t2. t~. N. t~- t~oMUEUts T~,r- Slope .~,~i~EE~E~L! ~..'Z'~- I ...... ROBERT ~ COWAN i,~= ~J ~, ~', ...'~'~ / '~ '~;~ ........ :~..:::~ ~%- / Slle Plan See Si[e Plan -- . he~tdhld bale o~'os. 'time Hel Time bepth lo Water N~t brop I~I:I~coLAIIc~IhAtI: ~ ~te..~J t'rncIIoLEblAJ~IEIER (~-~ ~' I t~fh~]hkh/vbUI. ~- J~t ANb ~ ~t ' ~ bEl~ror~UEO IH Abbot~13AUcE wtttl ALL STATE AND LIUJ, II~IHAL ~OlDELINEs IN EFFECT OH Tills DATE. DALE: ~, ,)' ~a/w5 I : · . Municipality of Anchorage Development Servtceg Department Building Sai'ety Division On-Si{e~ater and Waslewaler Program zlT00 South Bra(jaW St. p.O. Box '196650 ,Anchorage, Al( 995t9-6650 · . Www.cl.anchorage.ak.U~ , (907) 34:1-~9o4 ~ . · CERTIFICATE OF HEALTH AUTHORITY APPROVAL · FOR A SINGLE FAMILY DWELLING Parcel I.D.O.,~*~ '"~-'~3 -~ '1. GENERAL'INFORMATION HAA# Expiration Date:' ..Complet61~galde~cripiion Tract Y; Meadov Brook Subdivision '"' tocati0n(~ite'addre~0r~;'.directions)10739 Old Ea~le River 'Rd. ~.Curre6ti~roPedyown~r(~) Estate of .Mary Lou Brings Day phone '. ~.Mailing address Lending agency , , Day phone Mailing address e Real Estate'Agent' ' " MailingAddress Jake Crisafoli' 11940 Business Blvd~ ~s$oi'he~ise~quesle~HAAwill~heM~DSD~rp~k~. NUMBER OFBEDROOMS: 3 Day phone Eagle River, AK'99577 ' ' ' 3, TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank [] Community On-site [] [] Public Sewer ' [] :.;-i:.' . . The Municipality of Anchorage Developmenl Services Department (DSD) Issues Certificates of Healtl~ Authority Approval (HAA) based only upon lhe representations given In paragraph 5 by an. Independent professional civil engineer registered in the Slale title (except between spouses) for propedies served by a single family on-site wastewaler disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Cerlifiee~es ef Health Authority Approval are valid for 90 days from ihe date of issue [or propedies served by a private or Cl.a,~s C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissue~"for a pedod of up to one year with valid water samples.) Cedific~[es are valid l'oi' one year for properties serve~ by Class A or B wells or a public water system. The Municipality of Anchorage Is no~ responsible for errors., or omissions In the professional engineer's work. STATEMENT OF INSPECTION bY Ei~Gi~EER As Certified by my seal a[fix~d hereto and as ol the validation date shown below, I verity that my Investigation, based on procedures oullined In the Health Authority ,~oproval Guldellnes for this application, shows that the on-site water supply and/or wasteWater disposal ~y{;lerrt Is(are) sale[functional and adequate for Ihe number of bedrooms and type ot' structure Indicated hereln. I ~.ldhei' Verify tha! based ~n the info~'malion obtalned from the Municipality of Anchorage files and from my in;JeStigation and Inspeclion, the on-site water supply and/or wastewater disposal system Is(are) In compliance With all apprmable.Munlclpal and Slate codes, ordinances, and regulations in effect at the time of Installation. -, Name of Firm S & Address 17034 N. S EnKineerinK .':.-'-.. Phone.694-2979 Eagle River Loop Ste. 204 Eazle'River,.AK 99577 Engineer's Prinie~l N~r~e Rober't C. Cowan DSD SIGNATURE ..... ~ Approved [or. ~ bedrooms.. Disopproved. - ..... ... conditional approval for b~drooms; with the following stipulations: Additional Comments Attachmer~is: . HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreemenls Supplemenlal Engineer's Report Other Original Cedificate Date: ~A"'-/,,.~._ ~ ~ Municipality of Anchorage Development Services Department Building Safety DMsion On-Site Water & Wastewater Program 4700 South Bmgaw St P.O. Box lg8650 Anchorage, AK gg519-6650 www.ci.anchorage.ak, us (907) 343-79O4 A. WELL DATA HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~~.~:. Parcel ID: ~'~)'Z4~'- Weil type ~ Date completed ''~ [~' Total depth ~'"~'~' ff. If A, B, or C provide PWSID # Sanitary seal (Y/N) Cased to ~ro FROM WELL LOG Date of test '~?~ q ~' ~" Static water level Well production WATER SAMPLE RESULTS: Coliform <~) colonies/100 mi. Arsenic: ~ mg./L B. SEPTIC/HOLDING TANK DATA g,p.m. Date of sample: .~/t~'~ Tank Type/Material ~t ~__.,~.~___ Tank size/~ ~O~:) gal. Number of Compartments Foundation cl.ea~_out (Y/N) ~/ Depression over tank (Y/N) Date.pumping ?/~.~/~9"3 Pumper C. ABSORPTION FIELD DATA Well Log (Y/N) Wires properly protected Casing height (above ground) AT INSPECTION g.p.m. Other bacteria ~ colonies/100 mi. Date installed ~ Cleanouts (Y/N) High water alarm Date installed ~ Soil =ting (g.p, dJf~ or l~/bclrm)/' ~' Total depth ]0 fi, Eft. absorption area~i~d Monito~g tube ~ Date of adequacy test~_~_:~ Results (Pass/Foil) Fluid depth in absorption~ 'field before test~/in. Wa~er added "~ gal. Elapsed Time: _.~"min. Final fluid depth 44 in. Absorption rate >= Any rejuvenation ~reatment (past 12 mo.) (Y/N & type)//I/'O~/~- ~'_ ,/~/'~Z,o/~ If yes. give date System type ~~r- Gravel below pipe ~ ff. Depression over field ~ For ._~ bedrooms New depth.~_ in. 4~"~ g.p.d. D. LIFT STATION .D, ate installed ,~ Pump on" level at/ in. ! Datum E. SEPARATION DISTANCES Size in gallons 'Pump off" level at Cycles tested in. Manhole/Access (Y/N) High water aiarm level at Meets alarm & circuit requirements? in. Absorption field on lot Public sewer main Se~'efTseptic service line SEPARATION DISTANCES FROM WELL ON LOT TO' Septic tank/liff~n on lot On adjacent lots On adjacent lots. Public sewer manhole/cleanout Holding tank fJ / SEPARATION DISTANCES FROM SEPTIC/~ TANK ON LOT TO: Building foundation ~'~ Property line ~' ~(- Absorption field main /XJ--/,,q- Water service line ,~ ~ Surface water. Water Wails on adjacent lots-- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LoT TO: Curtain drain/J(/~J~ to'- Property line /~) ~ Building foundation /0 L Water main Water Service line ~ ~ Surface water ,/'~/~''' Driveway, parking/vehicle storage Wells on adjacent lots ~/~ ~ F. COMMENTS G. ENGINEER S CERTIFICATION ',r, ' certify that, have determined through field inspections and review of Munici'pal records that the above ay'stems are in conformance with MOA HAA guidelines in effect on this date. ENG, NEE~~ ,- . . ~.. Engineer's Pdnted Name ~08 '/c 7- (~. C~a/.~ / / · ~, "~,_~. ... ~..~'~,. Date F- / 't / a .3 HAA Fee $,~o Date of Payment Receipt Number (Rev, 12/01) Waiver Fee $ Date of Payment Receipt Number 05-0§-03 IO:40AM FROM-CT&E ENVIRONffENTAL SRV 9075H1§30l T-40H P.02/03 F-222 SGS Rtl.# Client Name Project Name~ Client Sample Matrix 1032331001 S & S Engineering Tract Y, Meadowbrook S/D Tract Y, Meadowbrook S/D Drinking Water Sample Remarks' Ali Dates/Times are Alaska Standard Time Printed Date/TIm~ 05/02/200:3 12:43 Collected Date/Time 04/29/2003 15:00 Received Date/Time 04/29/2003 17:47 Technical Director .~. Steph~n C~, £de Allowable Prep Analysis Parameter Results PQL UnRs Melhod Limits Dale Date Init ~a~-e~s Depot:truant; Nitrate-N 2. ! 7 0.100 mg/L EPA 300.0 (<-- 10) 04/30/03 N.i.c=obiol ogy Labor:aCorn' Total Coliform 0 col/100mL SMIR 9222B 04130103 KAP