HomeMy WebLinkAboutT12N R3W SEC 23 S2NE4 100 X 180Onsite File
#015-331-28
-FORGE
e E N G I N E E R I N G
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
February 10, 2020
MOA Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: T12N R3W Section 23 S2 NE4 100 x 180 —11221 Ridgecrest Drive
Septic System Design
Dear On -Site Services Engineer:
The owner of the lot described above has requested his new septic system be classified as suitable
to serve a four-bedroom home. The system is adequately sized for four bedrooms, but an alternate
septic site must be located. The Site Plan shows the location and design of the alternate site. If
this design is followed, no adverse impacts will occur to adjacent properties.
Sincerely,
Michael E. Anderson, PE
�rrru'
2�/%Z'0
�®o:�oIL®®'041
OF 44
'''•49th . ..e.��
v( ..` �4
.e
E 7 ANDERSON••' •
0. � 717 i
NO.2/10/20
CE -4381
t` c
T12N R3W SEC. 23 S2 NE4 100x 180
PERMIT # OSP191472 PID #
i I
---
-JJ/
Tl
-I EXISTING WELL
U,
015-331-28
LAKE O THE HILLS .@3 L1
\
LTERNATE SITE: 12' LONG x 5' WIDE x 4'
EFF. DEPTH ABSORPTION TRENCH
y / - - �I (EXCAVATE CONTAMINATED MATERIAL IN
PARCEL 126F \� / EXIST G TRENCH U ER & ON 12' EITHER
50' RADIUS _
/ _ SIDE OF ALTERNATE TRENCH LOCATION
\ �/` �1�� I - \ BEFORE INSTALLATION, &REBUILD WITH
NEW,12' LONG x 5' WIDE /MOA APPROVED�SAr4D4
E�TIC
\ I 10' GAS ESMT x 4' EFFECTIVE DEPTH 1`-
-
541 PG 803) \ ABSORPTIGN TR NCH. / _ 1
N�W 1500 GALLON
\ I INSPECTION PIPE FOR \ A VANTEX NVQ
30' PUBLIC USE ESMT \ I MOA INSPECTIONON /AX20 POD.
(BK 412 PG 343) 1 I ELECTRI C_Q!�?IJIT. MT1 02 \
M THA M
MH1 H
T
LUND LOT 3
POW_R POLE & OH
POVVER LINES
EXISTING WELL
/
C GRIAVEL ROAlk
\ I
1 1
I
II I
/ 1
\ I
GE
ENGINEERING I
J,EXIS IIN ORPTION,
-I EXISTING WELL CO3 �O TRENCHABANDONt1Cl
C \ PLACE. CTG IENTATYON
CO
UNKNOWN. 12' SEPARATION TO\
B NEW TRENCH WAS VERIFIED
WHEN IT WAS EXPOSED
DURING TRENCH INSPECTION.
SEC 23 S2NE4 sy _
20' ELEC ESMT
PK 541 PG 725)
EXISTING SEPTIC TAW
DECOMMISSIONED IN
PLACE PER MOA CODE.
PARCEL 26D
�J 1 LAK *THE HILL$"_B3-LA7 —
EXISTI WELL � \ \ /
\\ \�/�\ \ I \ I A\ B C
II
/ \I
PARCEL 26C ® y
I /
11
EXISTING WELL /
PLAN AS -BUILT
0 50 100
FEET
111=50'
FCO
10.9
5.3
MH1
40.9
\20.7
\
_\
Mid2 827.5
C01 \27.0 37.
MT1 26. 38.8
CO2 37.7 & 6
MT2 37.6 35.0
CO3 I 49.6 25.
LEGEND
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191472 PID Number: 015-331-28
Dwelling: ❑N Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New 9 Upgrade
Name:
Victoria A. Lampi
ABSORPTION FIELD
❑ Deep Trench W Shallow Trench El Bed El Mound
Address
11221 Ridgecrest Drive Anchorage, AK 99516
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
244-4830
3
6.0 GPD/SF
8.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
4.0 Ft
Gravel depth beneath pipe
4.0 Ft.
Subdivision Block Lot
S2 NE4 100 x 180
Fill added above original grade
2.2 Ft.
Gravel length
12 Ft.
Township Range Section
12N 3W 23
Gravel width
5.0 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
120 Ft',
1
1 Ft.
Well
>50'
>50'
N/A
N/A
>25'
TANK ❑ Septic ❑ S.T.E.P. ❑ Holding X Other
Manufacturer
Advantex F.A.P.
Capacity
1,500 Gal.
Surface Water
>100'
>100'
N/A
N/A
Material
Number of compartments
Lot Line
>5'
>10'
N/A
N/A
Fiberglass
2
NA
Foundation
>10'
>10'
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
None
Noted
Gal.
Remarks Septic system is sized for
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
4 bedrooms.
Pump make and model
Electrical Inspections performed by
PIPE MATERIAL House to tank D3034 Tank to
drainfield D3034
Installer
A+ Home Services
Drainfield D3034 CO/MT
Inspector J. Williams
BENCH MARK (Assumed elevation) 100 ft
Inspection151 11 /12/19 11 /13/19
Location and description
2nd
aro 4th
Threshold of back door.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
®♦��� OF
Conditional Approval: Date
AV
m'� 49th
x....16
..................
C:i
®mumu..unu.......uu.I.nn....uuu. p
MICHAEL E. ANDERSONff
�s
���/S�•`. No. CE-4381e AV
F�•<. 11 /14/19 0
.� •F.
Approved �ii�iZ Date i 1 18 I�
®� �kill,
®Sa\
inspection Keport_y-1-12.doc
T12N R3W SEC. 23 S2 NE4 100x 180
PERMIT # OSP191472 PID # 015-331-28
i I
I I \ I %
\
EXISTING WELL
50' RADIUS
PARCEL 126F
\ X LAKE 0 -THE HB3 U
NEW,12' LONG x 5' WIDE v/
\ I 10' GAS ESMT x 4' EFFECTIVE DEPTH
V/ (BK 541 PG 803)\ ABSORPTION TRENCH. 7-45- I \—
V I - N�W 1500 GALLON
\\ II INSPECTION PIPE FOR \ A VANTEX NVQ —
30' PUBLIC USE ESMT I I MOA INSPECTION ON /AX20 POD.
(BK 412 PG 343) I I ECECTRI CQ!�?uIT. MTT1 02 \
THA M MH
MH1 T
LUND LOT 3
POW_R POLE & OH
POWER LINES
EXISTING WELL
/
C GRIAVEL ROA
\ I
1 I
I
I
/ I
GE
ENGINEERING I
Lr J,EXIS INGAB ORPTION,
II I EXISTING WELL CO3 , O TRENCH ABANDONbE'lCl
C CO `
\ \ PLACE. CT ORIENTATYON
UNKNOWN. 12' SEPARATION T&
B NEW TRENCH WAS VERIFIED
WHEN IT WAS EXPOSED
/ \ �/ DURING TRENCH INSPECTION.
SEC 23 S2NE4 sy _
20' ELEC ESMT
PK 541 PG 725) 7N
EXISTING SEPTIC TANX\
DECOMMISSIONED IN
PLACE PER MOA CODE. _ )
PARCEL 26D
\ I LAK�*'THE HILLOaTLA7 -
I EXISTI WELL � \ \ /
I \\ _j i I A\ B C
II
/ \I
PARCEL 26C ® y�
•I / I
EXISTING WELL /
PLAN AS -BUILT
0 50 100
FEET
111=50'
FCO
10.9
5.3
MH1
40.9
\20.7
\
Mid2 827.5
C01 \27.0 37.
MT1 26. 38.8
CO2 37.7 & 6
MT2 37.6 35.0
CO3 49.6 25.
LEGEND
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
Tl 2N R3W SEC. 23 S2 NE4 100x 180
PERMIT # OSP191472
:• Us
P I D # 015-331-28
o�-
U2 95.2 FINISH GRADE
DRAINFIELD ROCK
�-o
93.0 ORIGINAL GRADE �E U
85.0 85.0 —
12'
NO GROUNDWATER 10/15/19
81.0
PROFILE AS -BUILT
(NO SCALE)
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: OSP191472
Work Type: Septic Upgrade
Tax Code Number: 01533128000
Site Legal Address: T12N R3W SEC 23 S2NE4 100 X 180 G:2639
Site Mailing Address: 11221 RIDGECREST DR, Anchorage
Owner: LAMP[ VICTORIA A
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date
Expiration Date:
Lot Size in Sq Ft
Total Bedrooms:
110-Z419 T&_�
C���1�1It s
v.
Departineut
10/21/2019
10/20/2020
18800
❑ 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
12.
vW rw
0 U
Received By: Date:
J � q
Issued By: \ P l`�i�,(' Q S� Date:
MUNICIPALITY OF ANCHORAGE
C,.
Community Development Department t 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. 015-331-28
Property owner(s) Victoria A. Lampi
Mailing address 11221 Ridgecrest Drive Anchorage, AK 99516
Site address Same
Day phone 244-4830
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section) T1 2N R3W SEC 23 S2 NE4 100 x 180
Lot Size 18,800 Sq. Ft. Number of Bedrooms Three (3)
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑X
Initial ❑
Single Family (SF)
❑X
(w/wo ADU)
Septic Tank
MUpgrade
0
Duplex (D)
ElHolding
Tank
ElRenewal
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: � 5Jcw Do Waiver Fees:
Date of Payment: l Dl`I Lol I q Date of Payment:
Receipt Number: 003-1i) Receipt Number:
Permit No. OS P1 11412 Waiver No.
Permit App_::- : .....:c
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
October 16, 2019
MOA Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: T12N R3W Section 23 S2 NE4 100 x 180 – 11221 Ridgecrest Drive
Septic System Design
Dear On-Site Services Engineer:
The owner of the above lot intends to replace the existing failed septic system on the property with
an advanced treatment septic system. We are submitting this design and permit application for the
construction of a new septic system. The attached site plan identifies the location of existing wells
in the area, the existing septic system and the proposed septic location. No conflicts exist between
the proposed system and any other well or septic system on this or adjacent lots.
The ground surface on the lot slopes to the northeast at grades greater than 25%. The absorption
trench has been designed to meet the steep slope requirements of the Mumicipal Code. Contours
are shown on the site plan showing the grade and direction of flow. Stormwater drainage will not
impact this septic system. The new trench will be constructed parallel to the slope as much as
possible.
Wells on this and adjacent lots are shown. The new system will be a minimum of 50’ from all
wells and surface water, and more than 5’ away from the septic tank.
Please refer to the attached test hole log and plan and profile sheet for the septic design. If this
design is followed no adverse impacts will occur to adjacent properties.
Sincerely,
Michael E. Anderson, PE
10/16/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191472, Rebecca Carroll, 10/21/19
755
750
745
760
MH
10050 0
FEET
1"=50'
20' LONG x 5' WIDE x 4'
EFFECTIVE DEPTH
ABSORPTION TRENCH.
NOTE:
SLOPES >25% ARE WITHIN 35' OF THE PROPOSED SEPTIC SYSTEM.
THE SYSTEM IS DESIGNED TO MEET CRITERIA FOR STEEP SLOPE
CONSTRUCTION. NO SURFACE WATER WITHIN 50' OF THE PROPOSED
SEPTIC SYSTEM
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS
PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC
SYSTEMS.
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
TH-A
T12N R3W SEC. 23 S2 NE4 100x 180
RIDGECREST DR10/16/19 3-BDRM H
O
M
E
10' GAS ESMT
(BK 541 PG 803)
30' PUBLIC USE ESMT
(BK 412 PG 343)
O.H.POWER LINE
20' ELEC ESMT
(BK 541 PG 725)
GRAVEL ROAD
SHED
DECOMMISSION
EXISTING SEPTIC TANK
PER MOA CODE.
EXISTING WELL
EXISTING WELL
EXISTING WELL
EXISTING WELL
EXISTING WELL
50' RADIUS
EXISTING ABSORPTION
TRENCH. EXACT LOCATION
UNKNOWN. MAINTAIN 12'
SEPARATION TO NEW TRENCH.
1500 GALLON
ADVANTEX TANK
w/AX20 POD.
2CO
MH
CO
MTCO
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191472, Rebecca Carroll, 10/21/19
T12N R3W SECTION 23 NE4 100' x 180'
DESIGN FACTORS: SYSTEM REQUIREMENTS:
450 GPD PEAK FLOW
PERK RATE: 2.2 MIN/IN
APPLICATION RATE: 6 GPD/SF
5' WIDE TRENCH SYSTEM
1,500 GALLON ADVANTEX FAP TREATMENT
TANK w/AX20 FILTER POD
TYPICAL TRENCH SECTION
(NO SCALE)
4" PERFORATED PVC (HOLES DOWN)
DRAINFIELD ROCK
5'
6"
6"
3.5'
4'
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
BOTTOM OF TRENCH: 8' BELOW GRADE
FLOW LINE ELEVATION: 4' BELOW GRADE
TOP OF TRENCH: 0.5' ABOVE GRADE
450 GPD / 6 GPD/SF /5' WIDE / 4' DEEP * .5 (RED. FACTOR) = 7.5 LF TRENCH REQ. (20 LF SPECIFIED)
10/16/19
GEOTEXTILE FABRIC
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191472, Rebecca Carroll, 10/21/19
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
TEST HOLE A
SLOPE
SLOPE
SITE PLAN
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
TEST HOLE PRESOAKED PRIOR TO TESTING:
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
T12N R3W SEC23 S2NE4 100x180
9/26/19
J. Millette
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH OF WATER AFTER MONITORING:
IF YES @ WHAT DEPTH? -
2.2 6
4 5
015-331-28
Victoria Lampi
4:01 / 4:11
---
1
2
3
4
5
6
4 0
16 / 9 1
16
OB
Professional Engineers Stamp:
10/19/19
10
NO
NONE
10/15/19
BOH
FILL
SILTY SANDY GRAVEL
5 1
16
4:12 / 4:22 4 0
16 / 8 15
1610 4 15
16
4:24 / 4:34 4 0
16 / 8 10
1610 4 10
16
4:35 / 4:45 4 0
16 / 8 9
1610 4 9
16
4:46 / 4:56 4 0
16 / 8 10
1610 4 10
16
4:57 / 5:07 4 0
16 / 8 9
1610 4 9
16
GM
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191472, Rebecca Carroll, 10/21/19
�.` 49 TH
QO
�O `Os SHANE A. HOLT gypLS-6914 ..
��\'- fessioW foo
Vfin. NO CORNERS SET THIS DATE
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS
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•
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
SEE TITLERELIORT(STEWART TITLE ORDER 524393)
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 8TH DAY OF
OCTOBER 2019
14399, FS 199-62
HOLT LAND SURVEYING
9309 GROVER DRIVE
ANCHORAGE,AK 99507
907-345-5513
iN11'NIC'IP 1LITY OF ANC'HC3I�:WE
:: M."ANC.'ED Vt AS*I'I NN'A'I'EI2 'I'IZEAT�-IEN'I' SA'STEM
'MAINTENANCEAND REPAIR AGREEMENT
THIS MAIN'T'ENANCE AND REPAIR AGRL•'L-;:i-IliNT. herein the "AGREL•'VIEN"I madc and
entered Mto as of this l `l Dav of OC —cW- of 20i. by and betv,.-cen
1 C_7oRfl l' _ herein the "OWN'l.R.'' and the w1unicipality of
Anchoranc. herein the 1%It•NICIP/11 .IT S" . In accordance with Anchorage Municipal Code
(ANIC:) 15.6_5.365. In consideration of the rnutll It coVenanits contained herein. the parties to this
Agreement a<,rce as follows:
1. AdN•anceclyN'aste'.,%7ater Ti,eattncnt Svstems. The Vhunicipality grants permission to the
(_ha ner to utilize and operate an Advanced \Vastew-atcr Treatment Systctn
described as Advantex Waste Water Treatment System
located at (legal. description)
T1 2N R3W SECTION 23 S2NE4 100 x 180
?. t'Iuinteriactce. Repairs <tnd Alterations.
((Jwmer is required to read, Understand and initial each :Section)
'hhrotlghout the term ofthis Agreement. the Owner shell enter into a .service ageemcnt.
witli in ANN11WTS service and maintenance provider approved by the 1\•• Unicipality or the
martUfac[ureCS The A\%`W•lS shall he maintained in a satisfactory
condition capable of• perlormin�, as designed and producin�a treated septic effluent in
accorclancc a.-ith the egLli])Ment's appl-ON-al for operation in the .Municipality -
1t shall be the responsibility of the Owner during, the term of this Ao rcernent to pay for all
rcpair(s), maintenance, adjuStment(s), replacement costs. and inspection costs. This
includes an annual maintenance -Ce-_ Mpicali ` 400 WSW)),
Yl- Owncr agrees that only maintenance and repair personnel approved by the %Municipality
or the mmnufacturer s representative Nvill inspect and make any necessary )Maintenance.
repairs or permitted.alterations to the system.
V7 nlvncr acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system. which could include seN.vao e backup and costly repairs or drainJeld
replacement.
Owner ac1< titsledges that the N LMICipalit-V may request records of'raiintenance and
repairs from the rnanulactiirer's rcprc:crttative or maintenance provider.
2- Owner acknowledges that the line for failing to inaintain and repair an ,lWW'TS may he
assessed in accordance with AMC 1=1.60.030.
Owner agrees to grant the N-tunicipality reasonable access to test and inspect the
A%V\N7S. The Municipality twill give at least .14 -hour notice.
�t Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems approval.
Owner agrees that the AW%VTS instaI'lation and maintenance requirements as provided
by the A%VN,'TS vendor; installer and approved by the Municipality are the governing
<gt}idelines for the construction, maintenance and repair of the Owner's AWWTS.
Owner agrees to maintain remote monitoring of the _1NVWTS as required by the
AtiVWTS approval.
Terni. The term of this ,agreement shall Lein on the elate of approval by the
Municipality to operate the installed system, or upon transfer of title, and sha11 continue
while the AViVITS is operational or until title is transferred.
4. Nonwaivcr. The failure of the \ImUcipality at any time to enforce a provision of this
Aareement shall in no Avay constitute a waiver of the provisions, nor in any way affect
the validity of the Aareement or an-,, part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
i. Amendment. This agreement shall only- be amended by authorized representatives of
the Owner and ;\-lunicipalitY. any attempt to amend this agreement by either an
unauthorized representative or unauthorized nicans shall be void.
6. Jurisdiction: Choice or Law. Anv civil fiction arising from this Aueement shall be
brought in the Superior Court for the'rhird Judicial District of the State of Alaska at
Anchora<ae. TIte laws of the State of Alaska shall govern the rights and obligations ofthe
parties under this .Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
juritiglictlon shall not invalidate the remaining, provisions of the Ueement.
OWNER::
�(Signature)Date.—l o LIGL
ic. roaw LAm P!--i.hrint nan]c)
S'FATE 017 ALASKA
TII1RD R."DICIAL. DISTRICT )
kh
rlie fore`��in�� instrument «as acknowle-d�,ed before me this � day of _ UC10%2t'
U[w7,Wm
ry Public
\n -V PUBLIC FOR AI..• K:A CAYOON
v coil 1111S51C11] C'\j�l]'CS:�All�ske
-T SGPL 14, 2022
1tii1V'TCIPALTTY: � a
By: _V (Sl�rlliitllfe)
(print mime)
Date: 10 I/
Title: - —
'"' MUNICIPALITY OF ANCHORAGE
(~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
I ~.'~l~ ~ll~ 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE ~'~ NEW
D & B GENERAL, I~C.
MA~UNGA~.~SBox 10-~9, ~CHORAG~, ALASKA 99~11
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
RI~ECREST DRIVE 3
Well I Absorption area Dwelling i PERMIT NO.
DISTANCE TO: 102' 10' 12' 810883
a < G~ER T~ STL. 2
Liq. cap~b] gallons IF HOME.DE: Inside length Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O z ~ Manufacturer Material Liquid capacity in gallons
-- ~. DISTANCE TO: Well ~9' Foundation ~, Nearest lot line ~' P~.
-- No. of lines Length Total length of lines
~ ~ ~ Top of tile to finish grade ~ Material beneath tile ~2 Total effective absorption area
~ inches 900
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ ~]ass Depth DriJler Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
PVC/CAST
SOIL TEST RATING
250 Sq.ft./bdrm.
INSTALLER ,
D & B GENERa, INC.
R EMAR KS
~.O1.. OCT. 24, 1970 ,t~
APPROVED DATE LEGAL
72-013 {Rev. 3/78}
-5: .-; ~ .-, ,.~.
~his well is producing "~' gallo~ns~gf water per hour.
/'
SR BOX 668, BOGARD RD. /\ / )/" ~/ ')/'//'~
PALMER, ALASKA 99645
r ~'"/ v"'// .... ,J]~, -- j'//
/.,..~-~,],, :.:. ~- 3 .."L/~"Z/'::~:~ n~ '.'
TELEPHONE 745-4071
~ BIk. Sub : / ~ ~ <: i:' ;;'~: '~ELL LOG
84 ~ --Z84-- _--284--'
PLEASE PAY FROM THIS INVOICE ~ ~(.22 ~""* '/~.-~'~' ':5;~ r~. £)''''?,- pe~ toot AMOUNT'¢Z
PERMIT NO.
[:,EF'RRTMENT ( HERLTH RND ENVIRONMENTRL JZITECTIGN
825 'L' STREET, RNCHORRGE, RK. 9950i
264-4720
)
RPPLICRN]' 1.4RRREN L. SRNDERS
LOCRTION RIDGE CREST DRIVE
LEGBL ~T!2N R3W SEC 23
TYPE OF SOIL. RBSORPTION S~STEM IS:
:L ," ._,b z,L. EN I L.
,2~' .'~
LOT _,I~E
TF. EN _.FI
i800Et E;QUFtRE FEET
MH,.,IM. il N_MEE¢ AF E, EE. RuUtl-, = 3
_,(ILL RFITING (SQ FT,.."E:R)=
,'" '~- '-- RBSORPTION ~?'=,,TFM lb';:
THE REg!UIRE[:, .=,t,~E OF THE _,OIL
E:~ EF'-FH == ± ~.2-:~ L_E f-4C:JTH= 75 I]F:R%-"EL [:,E{F'TH= e;
THE LENGTH DIMENSION IS THE LENGTH (IN FEET:> OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE [:,ISTRNCE BETklEEN THE SURFRCE OF THE
GROUND, RN[:, THE BOTTOM OF THE ENCRVRTION (IN FEET).
THERE IS NO SET H IDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OLITFBLL PIPE
FIND THE BOTTOM OF THE EXCRVRTION (IN FEET).
-~., -. -,- , ,-,- ,-- , " Cl~4 THI.-- ....
F'ERMIT Hr F[ I_.RNT HI-lc, THE RE.:,FLN_,.[EILIT~ TO INF_F.f '- D, EF'RRTMENT DIIRTNG ]'HE
.- FRUPEF. TY AND ]'HE
INz, ThlLt_HTION IN.:,FELTIuf,L OF RN'¢ WELL--, R[:,JACENT TO THIS ""' '"
HI_IHEER OF RE..,ID. ENuE_ THRT THE WELL WILL _ER E.
E,H_.kFILLINtJ OF RN"? '--??'STEM WITHOUT FINRL INL=;PECTION FIND, FtPFR_ HI. E,? THI_,
[EPHR"fMENF WILL BE SUBJECT TO PROSECIJTION.
MINIMUM DISTRNCE E:ETWEEN R NELL RND RN? ON-SITE SEWRGE DISPOSRL S'¢STEM IS
±80 FEET FOR R PRIVRTE WELL OR ±50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TVPE OF PUBLIC WELL
MINIMUM DISTRNCE FROM R PRIVRTE NELL TO R PRIVRTE SEWER LINE IS 25 FEET RND
TO R COMMUNITV SEWER LINE IS 75 FEET.
NELL LOGS RRE REg!UIRED RND MUS]' BE RETURNED TO THE DEPRRTMENT WITHIN ]:0
OF THE NELL COMPLETION.
OTHER REg!UIREMENTS MR"r' RPPL."r'. SPECIFICRTIONS RND CONSTRUCTION [>IFIGRRMS RRE
R'¢RILRBI..E TO INSURE PROPER INSTRLLRTION.
.. . :.. . --- '. --' -- .... __~:: :"L.,, - "::~."::: Z1
F EFL[¢I :E -r E:=-~F" Z F-: E.=. [. EL-EI'IE. EF.
I CERTIF'¢ THRT
±: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH B'¢ THE MUNICIPRLIT~' OF RNCHOR~GE.
2: I WILL INSTRLL THE S~'STEM IN RCCORDRNCE WITN THE E:ODE%.
]:: I LINDERBTFIND THRT THE ON-SITE SEWER S~'STEM MR'¢ REQUIRE ENLRRGEMENT IF THE
RES[[:,ENCE ~S REMOD, ELED TO [NCLLIDE MORE THAN ~: BEDROOMS.
s G N E D: _ _ _ ._ ...........
NRF. REN L. _'~RNE:ERS
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION .
TEST
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
PERFORMED BY! ¢/- J'/~', (~
~iTE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
/ -e-
Z- /.y,¢_','- / o ~.,',,.£0 ,¢. o~
PERCOLATION RATE
TEST RUN BETWEEN
(minutes/inch)
~/'~'--. FT AND '~'~' '~- , ET
CERTIFIED BY: DATE:
72-008 (6/79)
Aacho rage
825 "L" STREET
ANCHORAGE, ALASKA 99501
(907) 264-4111
GEORGIZ M, SULLIVAN,
MA YOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
December 31', 1980
Bert Queer
1300 Post Road
Anchorage, Alaska
99501
Permit # 800393
Subject: T12N R3W Section 23
A permit issued by this department for well and/or sewer
system has expired as of this date.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log should be sent
to this department to document the installation date.
If an engineer inspected the installation of the on-site
sewer system, please have them send us the as-builts for
our files.
If there are any further questions, Please call this
office at 264-4720.
Sincerely, / / /~
Les N. Buchholz, R.S.///.
Senior Environmental ~p~cialist
LNB/ljw
enc: Copy of Permit
SWP/057
PERMIT
~]PPL l CANT
LOCAT I ON
LEGAL
BERT QUEER
RIDGEVIEW DR.
T12N R~W SECTION
i300 POST RD.
LOT SI~E
g44-9~47 '
18000 SQUARE FEET
T'¥'PE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMI_IM NUME'ER OF BE[:,R00MS = ~: SOIL RFITING (S(;~ FT/BR)= 22.0
THE REQUIRED SI~E OF THE SOIL ABSORPTION SYSTEM IS:
C~EPTH= l~- LEbiGTH= 42 GRR%,'EL
DEPTH= 8
THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF 8 TRENCH OR PIT IS THE DISTANCE BETHEEN THE SURFACE OF THE
GROUNC~ AND THE BOTTOM OF THE EXCBVATtON (IN FEET>.
THERE IS NO SET WIDTH FOR TRENCHES. ~
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE
AND THE BOTTOM OF THE E~CRVRTION <IN FEET>.
F:E~!IJ I RE[~ SEPT I C TRNk~ ~ I ZE=" 1000 GRLLOr-4S
PERMIT APPLICANT HRS THE RESPONSIBILiTV TO INFORM TRIS DEPARTMENT DURING THE
INSTRLLRTION INSPECTIONS OF ANY HELLS ADJACENT TO THIS. PROPERTY AMD THE
NUMBER OF RESIDENCES THBT THE HELL WILL SERVE.
TIWO ( 2 ) I [~SPECT I OIlS ARE REQU I RED
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
C,EPRRTMEHT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN R WELL AND RNY ON-SITE SEWBGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM 8 PUBLIC WELL DEPENDING
UPON THE T~PE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE HELL TO B PRIVATE SEWER LINE IS 25 FEET 8ND
TO 8 COMMUNIT~ SEWER LINE IS 75 FEET,
HELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMEi~T WITHIN ~0 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F'ERM I T EXP I RES DECEMBER ~:1... ~1.980
I CERTIFY THAT
l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND HELLS RS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I HILL INSTALL THE SYSTEM IN BCCORDRNCE WITH THE CODES.
_?.: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
DOUGLAS A, STARK and ASSOCIATES. CONSULTANTS
957 Westbury Drive o Anchorage, Alaska 99503 · Phone: 277-4300
August: 8:~ 1980
Soil Test
Paroei~ Parcel4 of Deeds BOok $?~ Page 0875 (1¢. 150' of E. 26'10'
of S, I00': of N., i680'~ Section 23,: T12N, R3W~ S.M.
Ridgeview Drive
Testl loca~fon: Nort~ line of property 30' E. of W.-Iine.
'Tes~ methodr A ?t cu~; had been-made to secure road material. In,
addition~,,.~.,,9.~ ~ep backhoe hole was dug.. No groundwater was
encountered, A two-£oo~ deep post hole was dug next to the
backhoe hole and a soil sample taken~and percolatio~ test
made at this Iocatio~ 8" below original ground'.. The hole
was dug'and' wetted on~8~-~i, It rained until the morning 0f'
8-8:~, af whiC~ time th~erc, o'iation~fest was made per USPSS
recommendations~ specifically 5¢:.. Ali holes were ief~ open~
Tes~: results: the per¢olatio~ rate the firsf lS' minutes was 15
minutes' per' inc~; the, rate the last 15 minutes was ~0 minutes
per' inch.
Attachments: l~dm~p~ soii gradati0~.
Performed for c
bREATER ANCHORAGE AREA BOROUUH
Department of Environmental Quality
3330 "C" Street
Anchorage, AlasEa 99503
SO.LS LOG - PE,.OVAT,ON
TEST
Legal Description: ~f~.c~.- ~r ~;t¢l)~, /~afL ~'7~ PAr~-~ 03~) ~
This form reports: Soils log c'~ Percolation test
Date Performed
Depth
Feet
m
10- ~
12-
14-
16 ~-~--
18-
20-
Was groundwater encountered? /~/~ If yes, at what depth?
Reading Date Gross Time Net Time Depth to Water Net Drop
Percolation rate minute.
Pr, oposed installation: Seepage Pit Drain Field
D~pth of Inlet . Depth to bottom of pit or trench
COMMENTS:
Performed By: ~ Certified By: ~ Date:
W
MUNICIPALITY OF ° HC HOAGIE
Development Services Department s Phone: 907-343-7904
On -Site Water & Wastewater Section - Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 015-331-28
1. GENERAL INFORMATION
Expiration Date: ,
Complete legal description T1 2N R3W SEC 23 S2NE4 100 x 180
Location (site address) 11221 Ridgecrest Drive Anchorage, AK
Current property owner(s) Victoria Lampi Day phone 224-4830
Mailing address 11221 Ridgecrest Drive, Anchorage, AK 99516
Real estate agent
Careen Hewitt
2. TYPE OF DWELLING:
Q Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Private Well
Water Storage
Community Well
Public Water System
Waiver request for:
3
Day phone 727-2289
�� gM81
IVti V 12019
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ Waiver Fee $
Date of Payment�:I Z
LJ Date of Payment
Receipt Number Q 2%7r:) /03'591'D Receipt Number
COSA # 0'-5r 1 Q 1EE0! Waiver #
Distance:
TYPE OF WASTEWATER DISPOSAL:
El
Private Septic
0
❑
Holding Tank
❑
❑
Community
❑
❑
Public Sewer
❑
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ Waiver Fee $
Date of Payment�:I Z
LJ Date of Payment
Receipt Number Q 2%7r:) /03'591'D Receipt Number
COSA # 0'-5r 1 Q 1EE0! Waiver #
Distance:
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone 907-522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503
Engineer's Printed Name Michael E. Anderson, P.E. Date 11/14/19
6. DSD SIGNATURE
System #1 Approved for 13 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
WASTEWATER z
Jcn
PROGRAM cj
�� �n 3�
�JJ
By: JK NiVA Original Certificate Date: _9 0 I c1
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations 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. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
COSA Checklist yellow sheet
COSA Checklist
Legal Description: Parcel ID:
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test?Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date of Sample
Comments __________________________________________________________________________________
B. TANK DATA
Age of tank(s) years
Tank type/material
Measured operating fluid level in septic tank
Standpipes/foundation cleanout per record drawing
Date of pumping
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA ______________________
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective
Code-required soil cover over field
System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Adequacy test date
Results Pass For bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
Comments/Deficiencies:
T12N R3W SEC23 S2NE4 100 X 180 015-331-28
5.8
5/18/81 NA
233
230
>12 FORGE ENGINEERING
11/14/19
155
10/10/19
<1
F.A.P. / Fiberglass
N/A
New Construction - 11/12/19
5' Wide Trench
11/13/19 New Construction
10.2
6.2
NA
Trench is sized for 4 bedrooms.
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to:(Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’Yes if No ft
Absorption Field on Lot > 100’Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’Yes if No ft
Holding Tank > 100’Yes if No ft
Animal Containment > 50’Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
From Septic/Holding Tank on Lot to:(Please enter distances if less than required)
Building Foundations > 10’Yes if No ft
Property Line > 5’Yes if No ft
Absorption Field > 5’Yes if No ft
Water Main > 10’Yes if No ft
Water Service Line > 10’Yes if No ft
Surface Water > 100’Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’Yes if No ft
Community Wells > 200’Yes if No ft
If septic tank is under driveway comment below
From Absorption Field on Lot to:(Please enter distances if less than required)
Building Foundation > 10’Yes if No ft
Property Line > 10’Yes if No ft
Water Main > 10’Yes if No ft
Water Service Line > 10’Yes if No ft
Surface Water > 100’Yes if No ft
If absorption field is under driveway comment below
Wells on Adjacent Lots:
Private Wells > 100’Yes if No ft
Community Wells > 200’Yes if No ft
F. ENGINEER’S 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 COSA guidelines in effect on this date.
11/14/19
✔✔
✔
✔
✔
>50 ✔
✔
✔✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
Septic system is sufficiently sized to accommodate a four bedroom home.
✔
Received Date/Time 10/10/2019 17:22
10/10/2019 15:40Collected Date/Time
1196101001
Matrix
SGS Ref.#
Client Sample ID T12N R3W SEC23 S2NE4 100x180
Client Name
Project Name/#
Printed Date/Time 11/07/2019 17:02Forge Engineering Inc.
Technical Director Stephen C. Ede
T12N R3W SEC23 S2NE4 100x180
Drinking Water
Sample Remarks:
Parameter Results LOQ Units Method
Allowable
Limits
Prep
Date
Analysis
Date InitContainer ID
EWW10/11/19SM21 2540Cmg/LTotal Dissolved Solids 212 10.0 (<500) A
Metals by ICP/MS
BMZ10/30/19SM21 2340Bmg/LHardness as CaCO3 10/15/191885.00 B
Waters Department
EWW10/14/19SM21 4500NO3-Fmg/LTotal Nitrate/Nitrite-N ND 0.200 (<10)D
Microbiology Laboratory
A.L10/10/19SM21 9223B100mLE. Coli Negative 1 C
A.L10/10/19SM21 9223B100mLTotal Coliform Negative 1 C
Private Individual Analysis
DMM10/15/19EPA 300.0mg/LChloride 10/14/198.79 0.200 (<250) A
EWW10/15/19SM21 2510Bumhos/cmConductivity3761.00 A
DMM10/15/19EPA 300.0mg/LFluoride 10/14/19ND0.200 (<2)A
DMM10/15/19EPA 300.0mg/LSulfate 10/14/1912.9 0.200 (<250) A
EWW10/15/19SM21 2320Bmg/LAlkalinity17310.0 A
BMZ10/30/19EP200.8ug/LAluminum 10/15/19ND20.0 B
BMZ10/30/19EP200.8ug/LAntimony 10/15/19ND1.00 (<6)B
BMZ10/30/19EP200.8ug/LArsenic 10/15/19ND5.00 (<10)B
BMZ10/30/19EP200.8ug/LBarium 10/15/1939.0 3.00 (<2000) B
BMZ10/30/19EP200.8ug/LCadmium 10/15/19ND0.500 (<5)B
BMZ10/30/19EP200.8ug/LCalcium 10/15/1950100500B
BMZ10/30/19EP200.8ug/LChromium 10/15/19ND2.00 (<100)B
EWW10/15/19SM21 2320Bmg/LCO3 Alkalinity ND 10.0 A
2
Received Date/Time 10/10/2019 17:22
10/10/2019 15:40Collected Date/Time
1196101001
Matrix
SGS Ref.#
Client Sample ID T12N R3W SEC23 S2NE4 100x180
Client Name
Project Name/#
Printed Date/Time 11/07/2019 17:02Forge Engineering Inc.
Technical Director Stephen C. Ede
T12N R3W SEC23 S2NE4 100x180
Drinking Water
Parameter Results LOQ Units Method
Allowable
Limits
Prep
Date
Analysis
Date InitContainer ID
Private Individual Analysis
BMZ10/30/19EP200.8ug/LCopper 10/15/19ND1.00 (<1000)B
EWW10/15/19SM21 2320Bmg/LHCO3 Alkalinity 173 10.0 A
BMZ10/30/19EP200.8ug/LIron 10/15/19ND250(<300)B
BMZ10/30/19EP200.8ug/LLead 10/15/19ND0.200 (<15)B
BMZ10/30/19EP200.8ug/LMagnesium 10/15/191520050.0 B
BMZ10/30/19EP200.8ug/LManganese 10/15/191201.00 (<50)*B
BMZ10/30/19EP200.8ug/LNickel 10/15/19ND2.00 (<100)B
EWW10/15/19SM21 2320Bmg/LOH Alkalinity ND 10.0 A
EWW10/15/19SM21 4500-H BpH unitspH8.2 0.100 (6.5-8.5) A
BMZ10/30/19EP200.8ug/LPotassium 10/15/191100500B
BMZ10/30/19EP200.8ug/LSelenium 10/15/19ND5.00 (<50)B
BMZ10/30/19EP200.8ug/LSilver 10/15/19ND1.00 (<100)B
BMZ11/05/19EP200.8ug/LSodium 11/04/194360500B
BMZ10/30/19EP200.8ug/LThallium 10/15/19ND1.00 (<2)B
BMZ10/30/19EP200.8ug/LZinc 10/15/1933.6 10.0 (<5000) B
3
1VIUNICIPALITY OF ANCH=ORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this Day of 4641140" of 20 / f , by and between
i
���a-r ,herein the "OWNER," and the Municipality of
Anchorage. herein the "MUNICIPALITY". in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein; the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as Advantex Waste Water Treatment System
located at (legal description)
T1 2N R3W SECTION 23 S2NE4 100 x 180
2. Maintenance. Repairs and Alterations.
(Oti&,ner is required to read, understand and initial each section)
10 Throughout the term of this Agreement. the Owner shall enter into a service agreement
with an AWWTS seii4ce and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
It shall be the responsibility of the Owner during the term of this Agreement topay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
�includes an annual maintenance fee (typically $400 to $600).
5` Owner agrees that only maintenance and repair personnel approved by the Municipality
p h'
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
Owner acknowledges that regular maintenance of an AWNN7TS reduces thep otential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rpv 05/1R/'?01R)
Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and 'inspect the
AWWTS. The Municipality will give at least 24-hour notice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval,
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AVIWTS vendoriinstaller- and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
While the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce ever} provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void..
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
OWNER:
By: (signature) Date:ji J t
` ! &V 6-e-'" (print name)
STATE OF ALASKA
ss.
THIRD .T" DICIAL DISTRICT 1
The foregoinginstrument was acknowledged before
20At by 'e '
NOTARY PUBLIC RR ALA ' A
My Commission expires: j
MUNICIPALITY:
B� (signature)
Iro (print name
(rev n5 /,)oi Q,
me this Ill, of Q V�
DEBBIE HARROP
Notary Public
State of Alaska
my Commission Expires Jan 31, 2023
Date:(5 1
Title:
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 I.D. # /( ;\~- ~,\ -~¢::A~
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner '1 (,~Jq~,,//~ ~. ~/1~/~ /~U,~C/3. Day phone
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA ~21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
DHHS SIGNATURE
Approved for
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
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.
Legal Description' T)
A. WELL DATA
Well type 'P//~i(~ ~lf A, B, or C, attach ADEC letter.
Log present (Y/N) V
Total depth
Sanitary seal (Y/N) '~/
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Date of test
Static water level
Parcel I.D. ~r/''~ v~/- ~-/¢¢
ADEC water system number
Date completed ,,,~ ~/ ~_<~;~t[ Driller
Cased to ~-- --~/ Casing height
FROM WELL LOG
Well flow g.p.m.
Pump level
SEPARATION DISTANCES FROM WELL TO:
/
Septic/holding tank on lot
Absorption field on lot
Public sewer main
/
Sewer service line ff
Wires properly protected (Y/N)
AT INSPECTION ~
/o--rw
g.p.m.t~l
; On adjacent lots
;On adjacent lots
Public sewer manhole/cleanout
Petroleum tank /"~/~/~
oO
WATER SAMPLE RESULTS:
Coliform ~ Nitrate<(~)'/ / '~/z¢/¢¢ Other bacteria
Date otsamp,e: /¢2 Co,,eeted by:
B. SEPTIC/HOLDING TANK DATA
Date installed {'/~/~,)~'"-/?
Cleanouts (Y/N) '7/'
High water alarm (Y/N)
Date of pumping /~
Tanksize I ~)O~) ~ / Compartments
Foundation cleanout (Y/N) ~/ Depression (Y/N)
Alarm tested (Y/N)
SEPARATION DISTANCESf FROM SEPTIC/HOLDING TANK TO:
Well(s)on lot [ t (¢~ Onadjacentlots ~ J k-'PO I Foundation
~"¢ ~, ! '~ Water main/service line
To propertyline /I"~.~/ Absorption field
Surface water/drainage ~'J On ~-~ ~' O ~
72-026 (Rev. 7/91) Front
CONTINUED ON BACK PAGE
C. LIFT STATION ~ ....
Date installed Man_~u~fa ud~rer
Size in gallo~'--'"'~'-~ ~e/Access (Y/N)
Vent (Y/N) _"Pum.~r~f~at "Pump off" level at
High water alarm level~' ~. Cycles tested
Meets M~es (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed /O/ '/~/
'75-/ ~_~¢Z¢ Gravel thickness
Length Width ~:~ '*(~ '~"
Total absorption area ~' ~ ~ ~. ~¢ Cleanouts present (Y/N)
Depression over field (Y/N) Date of adequacy test
Results (pass/fail) ~
Peroxide treatment (past 12 months) (Y/N)
Soil rating ~__~0 ¢~" ~?/4'~?e'm type
Total depth ,/O. (~ ' -'
for ,-~ bedrooms
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellonlot [ '~ ~-¢'{ _Onadjacentlots ~ /~') / Propertyline
To building foundation /' ,]
__ To existing or abandoned system on lot
On adjacent lots ~ O r~ ~o _ Cutbank /~O/~ ~. Water main/service line
Surface water /w O~ ~. Driveway, parking/vehicle storage area
Curtain drain 'f~ (;'~ ~ ~--
/
/0
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in
S i g n at u r e _.~"~~ /~' ~'~'~/~'~
Engineer's~/N~me J -'~/~////~,.~ F'-
of this inspection.
HAA Fee $ /
Date of Payment
Receipt Number
72-026(Rev 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
Sizemore & Associates
6410 Switzerland Drive
Anchorage AK 99516
NOFtTHERN
3330 INDUSTRIAL AVENUE
2505 FAIRBANKS STREET
Attn: James Sizemore
TESTING LABORATORIES, NC.
FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125
ANCHORAGE, ALASKA 99503 (907) 277 8378 · FAX 274 9645
Report Date: 12/15/92
Date Arrived: 12/10/92
Date Sampled: 12/10/92
Time Sampled: 1005
Collected By: JS
Our Lab #: A121707
Location/Project:
Your Sample ID: 11221 Ridgecrest
Sample Matrix: water
comments:
Lab
Number Method Parameter
* Definitions *
B = Below Regulatory Min.
H = Above Regulatory Max.
E = Estimated Value
M = Matrix Interference
D = Lost to Dilution
MDL = Method Detection Limit
Date Date
Units Result * MDL Prepared Analyzed
A121707 EPA 353.3 Nitrate-N mg/1 <MDL 0.1 12/10/92
Microbiology Supervisor
MUNICIPALITY OF [~[Iil !0RAGE
. ' I~ ~i[Ai. HEALTH
DIVISION O~ ENVIRO[';M
DEPARTMENT OF HEALTH AND ENVlii0[I~IENTAL PROT~G'fAO~
APPLICATION FOR HEALTH AUTHOR iT~ APPROVAL CERTIFICATE
1o General Information Application Date O___U~]V 30,..]985
(a) Legal Deseription (include lot, block, tj!lb~lIvision, section, to~mship, range)
S_E]/2 of NE]/4O00 ] ' Se 3
(b)
Location (address or directions)
]]22] RJdqecres% Drive
Applicants Name Paul & Debra Mitchell 'J.~l!l~h°ne - H°me346-]96~usiness
Applicants Address 1122] Rid~ecrest
(c) Applicant is (check one) Lending Instil:~
Buyer ~ ; Other~-~ (explain);
(d) Lending Institution
~.. ; Owner/builder~ ;
Telephone
Address
(e) Real Estate Coo & Agent
Address
Telephone
(f) Mail the HAA to the following address~
2o ~ype of Residence
Single-Family~
Multi-Family~
(describe)
Number of Bedrooms lhree
Water Su~ty~
Individual Well ~ Community ~--~ t',ib! ~z' ~
Note: If community well system~ must have w~l~i A+~ confirmation from the State
Department of Environmental Conservation aLl,~ ;ng to the legality and status.
°
Sewag~al
.ilolding Tank~
Onsite 51/ ublic 511 Community 21 l
Note: If community well system~ must have w;l~.~ confirmation from the State
Department of Environmental Conservation a(~''~ f~g to the legality and status.
[Page 1 of 2]
Engineering Firm Providing Inspections, Tests, File Search~ Data and info~ation
As certified by my seal affixed hereto and as of the validation date sho~ below: I
verify that my investigation of this Health Authority Approval shows that the on-site
water supply and/or wastewater disposal system is safe, functional amd 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 fro~ ~!
investigation and inspection, the on-site water supply and/or w~stewatar disposal
system is in compliance with all Municipal and State cedes, ordinances, ami regula-
tions in effect on the date of this inspection°
Name of Firm___J~
Telephone
Address 8010 King Street, Anchorage, Alaska 99518
Date July 30, 1985
DHEP Approval
Approved for ~3~Fd ~ bedrooms By
Approved / Disapproved CCn~ t io~
Tems o~ CondSe~onal Approval
CAUTION
THE ~COlqICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND EI'WiROi£.~ITfb-L
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON ~
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIO~,~L ENGiI~EER REGIS'I'E~
IN THE STATE OF ALASKA° THE DHEP DOES THIS AS A COURTESY TO PL~CHASERS DF E~E$ AI~D
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL A~%q) STATE RMQU_II~_~-
MENTSo EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DA~_A BEFOtLE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE POR %TRROR$
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK°
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
J%4UN, ICIPALi'i¥ OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
REC, EIVED
A. ~ELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description: SE]/2 of NE1/4 100 x 180'
Sec 23, Lot 26E Township 12N Ranqe 3W
Well Classification si nql e fami 1 y
Well Log P~esent (Y/N) Yes
Total Depth ~ O ! Cased to
Static Water Level
Casing Height Above Ground ]6 inches
Electrical Wiring in Conduit (Y/N) Yes
Separation Distances f~om Well.:
To Septic/Holding Tank on Lot 702 feet
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewe~ Line N/^
Cleanout/Manhole N/A
wate~ Sample Collected By
Wate~ Sample Test R~sults
If A, B, c~ C, D.E.C. Approved(Y/N) N/J~
Date Completed
Pump Set At
7-30-85 Yield 375gal/hr.-
Depth of Routing
Sanitary Seal on Casing (Y/N)Yes
Dap~ession A~ound Wellhead (Y/N) No
; On Adjoining Lots lO0+ feet
119 feetV'; On Adjoining Lotsl00+ feet
To Nearest Public Sewer
To Nearest Sewe~ Service Line on Lot N/A
Cherie McCrack~n ; Date 7-30-85
Satisfactory~ results attached
B. SEPTIC/HOLDING TANK DATA
Date Installed 10-15-81 Size 10O0 qal No. Of Cc~pa~nts 2
Standpiges (Y/N) Yes Air-tight Caps (Y/N) Yes . Foundation Cleanout (Y/N) YeS
Depression ove~ Tank (Y/N) No Date Last Pumped August 7, 1985 receipt attached~-~''
Pumping/Maintenance Contract on File (Y/N) ; for
Holding Tank High-Water Ala~ (Y/N) No Temporary Holding Tank Permit (Y/N) N,0
Separation Distances f~o~ Septic/Holding Tank:
To Water-Supply Well ]02 feet To Building Foundation ]2 feet
To Property Line 20+ feet To Disposal Field ]0 feet
To Water Main/Service Line N/A TO Stream, Pond, Lake, c~ Major Drainage
Course 10O+ feet
Con~nts 600 aallons of water introduced, water levels remained within 1 inch
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
De
Soils Rating in Absorption Strata
Date Installed 10-15-81
Width of Field
Square Feet of Absorption Area
Depression over Field (__Y/N) No
Results of Last Adequacy Test
250 sq ft/hdrm Type of System Design Tile Drained
Length of Field 75 fee%'! Tr-~nch'
Depth of Field 1
Gravel Bed 1'nickness 6 feet
900 / Stan~i~s ~esent (Y~)Yes
~te of ~st A~a~ ~st N/A
I
Separation Distance from Absorption Field:
To ~ter-Supply Well ]'19 feet - To P~opert!; Line 15 feet
TO Building Foundation_ 22 feet To Existing or Abandoned System on
Lot N/A ; On Adjoining Lots 30+ feet
To Water Main/Service Line N/A To Cutbark(if present) N/A
To Stream/Pond/Lake/c~ Major D~ainage Course ]00+ feet
To D~iveway, Parking Area, o~ Vehicle Storage Area 50+
Coi~,~nts odor of sewa§e present at the end of absorption field~ no sewage oreseht
nn ,~urfac~ Hand duQ test pit to 4 feet ah north end of leach line, was dry and soil
..free_ Qf_ o~dor._.~ ......... '
LI~'~ STATION N/A
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested fo~
Electrical Codes(Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
Meets MOA
Cor~ents
** Check Permitted Bedroom Rating Against HAA Request
I certify that I have checked, verified, or conformed to all MOA
on tl~ date of this inspection.
Signed Allan W, Murfitt
Co. any A, W, M.rfltt Company
KB1/d5/s
[Page of BAq.°°
Date 7/30/85
MOA No. SIR6-~16
in effect
2-15-84
.~., ~ ~ ~_ ~ HA[~~,
APPLIC ;~IT FILLS OUT UPPER ~ONLY
Property Owner Wal'~ and Eva Sanders
344-5871
Buyer Paul and Deborah Clark
Address Zip Code
Phone
Lending Institution NatiortaA Bank of Alaska Attn.- Maryann Fishk
Z6~-2881
Address Nor{-_h6~3~'~ Lights & C St. zip Code
Phone
Realty Co. & Agent Totem Realty~ ~.D_c. Attn: l:~hodi [{arelAa
Address 724 E. 15th Ave. , Anchorage, Ak zip Code 99501 ~72-0571
Legal Description T12NR3W. Sec. 23, S1/2,.NE1/4, 1001 X 180l
Street Locatic~ Ridgecrest Dr. Approx .Mi. 2"O'Malley Rd. turn right
Type of Residence
Time Time Time Time
Date Date Date Date
/-/7
Inspector Inspector Inspector Inspector
Field Notes:
(~) APPROVED BEDROOMS ~-~ *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
DATE ~' ~'~- ~-(~/~/~
BY: ~"/r~.~~ ~_ '~_ ~v/'~''~ ~
Soils Rating Date Sewer Installed Well To Absorption Area // ¢~.~ / Well Log Received ,~__~.
/ <~ '<:
~.~.~ /~) ~ ~,..~[ WelltoTank /lb ~--~ Septic Tank Size /~a 0