HomeMy WebLinkAboutRANSOM RIDGE LT 3ARansom Ridge
Lot 3A
#020-092-92
Municipality of Anchorage
Community Development Department Pagel of 3
On -Site Water & Wastewater Program
4700 Elmore St. -P.O. Box 196650 Anchorage, AK 99519-6650-http://www.muni.org/onsite (907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number. OSP161320 PID Num 020 092-92
Name:
JEFFREY QUINN
Address:
16861 RANSOM RIDGE ROAD *ANCHORAGE, AK 99516
Phone: No. of Bedrooms:
925-949-9577 2
LEGAL DESCRIPTION L
Subdivision: Block: Lot:
RANSOM RIDGE 3A
owns Ip: anger ion:
SEPARATION DISTANCES
To Septic Absorption Lift
From Tank Field Station
well 100'+
Surface water �2D 100'+
Lot Line �'} 101+ `�} - N/A
Foundation 10'+ A Curtain Drain NONE KNOWN
bar. - ❑ New E Upgrade
ABSORPTION FIELD
❑ Deep Trench ■ Shallow Trench ❑ Bed ❑ Mound
❑ Other
Soil RaUry: Total Depth from original grade. _
0.45 GPDrse. Ft. 10 & 10 (MAX.) FL
Deptb to pipe Invert from original gmtle: Gmvel depN beneath pipe:
SEE DWG. Ft 4&4 Ft
Fill added above originalgrate: Gmallelp,
SEE DWG. Ft 35 & 35 (70 TOTAL) F1
Gm ill aldth Sao. Number of IIS: Distance beram, Imes:
Ft FL
5&5
Total absomon am:
Holding PublclPtivato 700
Tank Sewer Lines
25'+ 1 TANK ❑ Sentit
Installer
BOTTOM OF NORTH AND SOUTH TRENCH INSPECTED BY MOA
ONSITE EMPLOYEE TIM ECKLUND ON 12/15/2016
WILCO EXCAVATION
Manuta=w.
SG. Ft 1 2 10+ FL
Elolding S.T.E.P. ❑Hther
Gel. I
I LIFT STATION
Manolaaarer
Gel, I
Pump Make 6 Mod% EleMcel IMpectl(ns pedm,rd 6V
PIPE MATERIAL
House to tank EXISTING Tankto EXISTING/D3034
dralnfield
Drainfield D3034 CO/MT D3034
Inspector GEG, Ltd. BENCH MARK (Assumed elevation)
Inspection 9727 Ft
Dates: 1st 2nd L0C0tlO°°'"oB°`d0"°"
1�nsnnlF 12nsnnle
3rd 12/16/2016 4th TOP OF BULL RUN VALVE ASSEMBLY
ENGIN R'S SEAL
Community Development Department Approval �.••` "��44
.•
Conditional approval:
Date:
Ir
♦ ffrey A'.a-iii
CE795
•. F .., tZlzz1i6:
Approved: Vt^� -C Date: 2� -) LICE 040 4,�OFESS\C1��:
#AECCaa4 11�•Isk
Inapectlan Report 1-1-12doc
PERMI
NUMBER
PAR
EL
OSP161320: RECORD DRAWING 020C-092-92 BER:
OSP161320
A I B
C01
168.9
180.3
CO2
196.8
210.3
CO3
157.9
171.4
C04
187.2
2010
MT1
169.9
181.7
MT2
193.6
207.2
MT3
158.7
172.0
MT4
185.6
200.2
FD
129.9
178.3
FS
130.7
137.1
C05
130.7
137.1
T.H.R1 WAS DRV ON
12/15/2016
1
SITE CONDITIONS AND BOTTOM OF
NORTH AND SOUTH TRENCH
INSPECTED BY MOA ONSITE EMPLOYEE
TIM ECKLUND ON 12/15/2016
ALLOWING THE EXISTING CONNECTION TO
REMAIN AT THE BEGINNING OF THE 1969
TRENCH APPROVED BY MOA EMPLOYEE
REBECCA CARROL ON 12/19/2016
RANSOM RIDGE; LOT 4
CREEK
R
RANSOM RIDGE; LOT
HOME
100' FROM CLOSEST EDGE
OF CREEK EASEMENT ON
RANSOM RIDGE; LOT 4
8 ELEC. EASMT.
; LOT 16
EXISTING STEP TANK
GARNESS ENGINEERING
GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS
3701 E.IUOOR R .SURE 101 . ANCHORAGE, M( 8850) • R E (Wn OM) -0119 • FN((W]) 3363218 • WE9517E: ww.p�vpLwYpmn
PREPARED FOR:
PHONE NUMBER:
PAGE NUMBER:
JEFFREY QUINN
925-949-9577
2 OF 3
PROJECT/LEGAL DESCRIPTION:
DRAWN BY:
RANSOM RIDGE; LOT 3A
D.J.G.
TYPE OF WORK:
DATE:
RECORD DRAWING
12/22/2016
RANSOM RIDGE; LOT 3B
ED ROUTE OF
PRESSURE LINE
RUN
J y A. Gamess
♦� J j CE -795
♦♦♦♦i �FESS�� :'
LICENSE
#AECc684
PERMIT NUMBER: PARCEL ID NUMBER:
OSP 161320 RECORD DRAWING 020-092-9z
T.H.# 1
NORTH
FINAL GRADE = 94.25-94.33
!-ORIGINAL GRADE O HIGHEST
FABRIC
INVERT OF PIPE 4
88
.43
BOTTOM OF
SOUTH
5 FEET
-� 5 FEET
10+ FEET
RELATIVE ELEVATION OF
BOTTOM OF T.H.=78.43
(T.H. DRY ON 12/15/16)
BOTTOM OF NORTH AND SOUTH
TRENCH INSPECTED BY MOA
ONSITE EMPLOYEE TIM ECKLUND
ON 12/15/2016
GRADE = 97.75-98.75
T.H.f1
)RIGINAL GRADE O HIGHEST
POINT = 98.59
FABRIC
-INVERT OF PIPE
= 92.59
r BOTTOM OF
TRENCH = 88.59
GARNESS ENGINEERING GROUP, Ltd
-1 CIVIL & ENVIRONMENTAL ENGINEERS
=1 E IIIOOIt IIO.O, $uir: 101 •,wolrnws, M w 7 • Fllor¢ SAMA • FAC SM-wo •'�F)BIE �
IREPARED FOR: PHONE NUMBER: PAGE NUMBER:
JEFFREY QUINN (907)786-9551 3 OF 3
_EGAL DESCRIPTION: DRAWN BY:
RANSOM RIDGE; LOT 3A D.J.G.
YPE OF WORK: DATE:
RECORD DRAWING 12/22/2016
RELATIVE
ELEVATION
OF BOTTOM
OF T.H.=
82.59 (T.H.
DRY ON
12/15/16)
f� V A. Guiness r 4me
ICE -79 3
p1�.,,I2Z... �F :
' 11uFESS\t�;:o'
On -Site Wastewater Disposal System Permit
Permit Number: OSP161320
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Tax Code Number: 02009292000 I Z,
Work Type: Septic Upgrade r
Permit Effective Dates: December 05, 2016 to December 05, 2017 'e'V4 eag
Design Engineer: GARNESS ENGINEERING GROUP LTD
Subdivision: RANSOM RIDGE
Site Legal Address: RANSOM RIDGE LT 3A G:3337
Owner/Address: (QUINN JEFFREY E & KERRY ANN
16861 RANSOM RIDGE ROAD ANCHORAGE AK 995165337
Site Mailing Address: 16861 RANSOM RIDGE RD, Anchorage Lot Size in Sq Ft: 53040
Total Bedrooms: 2
This permit is for the construction of:
Y Disposal Field N Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
CO # 1 Reco'ec-i -)n eYis� i e�c4 @ vw tll ea'Ad, now S�l(+ier 40
(oven el e �i move not-e covh
.e c-1 o v\ Pol '\�@ . CO nor+1 \ end
e xls �� erc� 4-O 1 11_D+0- 1-J, T- MT a� 5"'tV1 ev.d
w Aiil\ �ood V o NMT �a'M �e aa" o_�Vw0 _"\ ernj
Date: �/ C
Date: 1 Z 05 o
Municipality ®f Anchorage
Development Services Division
On -Site Water and Wastewater Program
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: SV161125 COSA#: Permit#:OSP161320
PID#: 020-092-92
Legal Description: Ransom Ridge Lot 3A
Engineer: Garness Engineering Group
Applicant: Jeffrey Quinn
Your request for a waiver of the required 50 feet horizontal separation from the absorption field
to the excessive slope has been approved. The approved separation distance is 0.0 feet. .In
addition, your request for a waiver of the required 5 feet horizontal separation from the
absorption field to the test hole has been approved. The approved separation distance is 0.0 feet.
See engineer's letter for waiver requests.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver. ,
❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
® Adjacent properties are not affected by this waiver.
...............................................................................
Waiver is Granted: X Waiver is not Granted:
Date: 12 D5 .2O1(o Approved by: )CdJ(c% l Ari�
Name of Reviewer
...............................................................................
l
**** VARIANCE/WAIVER REVIEW ****
MUNICIPALITY OF
e
Community Development Department
Development Services
On -Site Water & Wastewater Program
Parcel I.D. 020-092-92
ANCHORAGE
Mayor Dan Sullivan
On -Site Sewer/Well Permit Application
For A Single Family Dwelling
Property owner(s) JEFFREY QUINN
Mailing address 16861 RIDGE ROAD *ANCHORAGE, AK 99516
Site address 16861 RIDGE ROAD 'ANCHORAGE, AK 99516
Legal description (Sub'd, Block & Lot ) RANSOM RIDGE; LOT 3A
Legal description (Township, Section & Range)
Lot Size
APPLICATION IS FOR:
(® all that apply)
❑
Absorption Field
Septic Tank
❑
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Sq. Ft.
Phone: 907-343-7904
Fax: 907- 343-7997
Day phone 766-9551
Number of Bedrooms
7 ,�C
APPLICATION IS AN:
Initial
❑
Upgrade
Renewal
❑
THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR:
DRAINFIELD TO SLOPES >25% /-1, A ,At \-p c,r u
TYPE OF DEWELLING:
Single Family (SF)
(w/wo ADU)
Duplex (D) ❑
Multiple Dwellings ❑
(SF and/or D)
Distance: 0 FEET 0 v -T
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 711.M -VV Waiver Fees: L47,UU
Date of Payment: Q //V Date of Payment: (01(PG
Receipt Number: OI rU Receipt Number: OV2nyG ✓0
Permit No. f IS � 1(01 /X Waiver No. O SV 1 U11yJ
(Rev. 01111)
Qua_nc
GARNESS ENGINEERING GROUP, Ltd A° °7 7's'
CIVIL & ENVIRONMENTAL ENGINEERS
December 2. 2016
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Proposed Septic System Upgrade for Ransom Ridge; Lot 3A,
To whom it may concern:
The existing 2 bedroom house is served by a private well and septic system. Per the
homeowner's request, we are proposing to install a new 2 bedroom septic system. We
are proposing to re -utilize the existing 1250 gallon STEP tank and install a new 2 bedroom
sized dual 5 -wide trench type drainfield. One testhole was excavated on the property and
the proposed drainfields and its reserved site is designed around the 30 foot radius of this
testhole. Comments regarding the design are summarized as follows:
1. SOILS: See the attached soil log which shows the soil classifications, groundwater
monitoring, and the percolation test results.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
3. SURFACE WATERS: There is a creek located to the north and west of the proposed
drainfield but is located well over 100 feet away.
4. TOPOGRAPHY: As can be seen on the attached topography drawing, the average
topography around the proposed drainfield is 25-30% running southeast to northwest.
5. WAIVER: We are requesting a zero (0) foot waiver to slopes greater than 25%. The
existing slopes are a maximum of 30% and the drainfield will be installed on these slopes.
We are also requesting that your department issue a waiver from the required separation
distance of drainfield to testhole from 5 feet down to zero feet. Justifications for granting
these waivers are as follows:
• Mounded drainfields are allowed to have 3:1 (33%) slopes, which in this case is
met.
• The existing drainfield was installed on the same topography.
• Per the attached waiver drawing daylighting would occur approximately 37 feet
from the drainfield which would give ample time for vertical migration of the
3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com
Page 2 of 2
wastewater.
Any sluffing from the testhole that falls into the proposed trench will be excavated
out, possibly resulting in an increased trench width in the localized area. The
testhole was backfilled with native material.
We are unaware of any adverse impacts this installation or waivers would have on
adjacent wells or septic systems. If you have any questions, please contact us at 337-
6179. Thank you for your assistance.
Sincerely,
Ir
P. E., M. S.
3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www. garnessengineering.com
I
i
NOTE- THE CONTRACTOR SHALL HAVE
GEG, Ltd, HAS A 8 PAGE SPECIFICATION LETTER
DESIGN CRITERIA:
GALLONS PER DAY (GPD), 450
THAT PERTAINS TO THIS DESIGN. TO OBTAIN A
NUMBER OF BEDROOMS, 2.0
THE WEST &
SOUTH LOT LINES, AND
COPY OF THE LETTER CONTACT GEG. BY
GALLONS PER DAY (GPD)- 300
ALL WELL
RADII FLAGGED BY A
PROCEEDING FORWARD WITH THIS INSTALLATION,
PERCOLATION RATE/S, 60 MIN/INCH
REGISTERED
LAND SURVEYOR PRIOR
THE ENGINEER, WELL DRILLER, CONTRACTOR AND
PROPOSED.APPLICATIDN RATE, 0.45
TO
CONSTRUCTION.
PROPERTY OWNER AGREE THAT THEY HAVE READ
MINIMUM DRAINFIELD SQ.FT.-667 FY'
CONNECT NEW 1.25' PVC
THESE SPECIFICATIONS AND AGREE TO ACCEPT
PRESSURE LINE TO EXISTING
LENGTH, 30 FEET
THE TERMS AND CONDITIONS OUTLINED.
DRAINFIELD DESIGN:
EFFECTIVE, 4 FEET
TO BE CONVERTED TO D3034 4'
MAXIMUM DEPTH, 10 FEET
WIDTH, 5 FEET
PVC A MINIMUM OF 10 FEET
ACTUAL SOFT., 300 FEET?
LENGTH, 2 2 35 FEET = 70 FEET
BEFORE THE FLOW SPLITTER
ASSUMED LOCATION OF EXISITNG
M.O.A. APPROVED SAND FILTER, N/A
EXISTING 1250
PRESSURE LINEI EXACT LOCATION
EFFECTIVE, 4 FEET
GALLON STEP TANK
IS UNKNOWN,
REDUCTION FACTOR, 0.50
LOCATED PRIOR TO THE INSTALLATI01
-THERE IS A CREEK TO THE!NORTH &'
ACTUAL SQ.FT., 700 FT'
OF THE PROPOSED TRENCH. CLEANOUT
WEST OF THE PROPOSED ➢RAINFIELDI
AND MT TO BE INSTALLED AT NORTH
HOWEVER, IT IS 100'+ FROM THE
""A
END OF EXISTING TRENCH, OLD
RESERVE SITE DESIGN CRITERIA:
NUMBER OF BEDROOMS, 3
GALLONS PER DAY (GPD), 450
PERCOLATION RATE/S, 60 MIN/INCH
PROPOSED APPLICATION RATE, •2
MINIMUM DRAINFIELD SQ.FT., 225
APPROXIMA E LOCATION
-CAT III ADVANCED TREATMENT
OF SLD ES >507
RESERVE SITE DRAINFIELD DESIGN:
MAXIMUM DEPTH, 10 FEET
CONNECT NEW 1.25' PVC
WIDTH, 5 FEET
PRESSURE LINE TO EXISTING
LENGTH, 30 FEET
PRESSURE LINE, PRESSURE LINE
EFFECTIVE, 4 FEET
TO BE CONVERTED TO D3034 4'
REDUCTION FACTOR, 0.50
PVC A MINIMUM OF 10 FEET
ACTUAL SOFT., 300 FEET?
BEFORE THE FLOW SPLITTER
No
APPROXIMATE LOCATION OF EXISTING
TRENCH TO BE PROFESSIONALLY
LOCATED PRIOR TO THE INSTALLATI01
-THERE IS A CREEK TO THE!NORTH &'
OF THE PROPOSED TRENCH. CLEANOUT
WEST OF THE PROPOSED ➢RAINFIELDI
AND MT TO BE INSTALLED AT NORTH
HOWEVER, IT IS 100'+ FROM THE
END OF EXISTING TRENCH, OLD
PROPOSED DRAINFIELD
CONNECTION POINT MUST HE CAPPED.
❑
\o.
\o.
oT
CLEANOUT TO BE '
INSTALLED I
F I
� I
LWM
❑
sD
MT
I
U 3 FEET
C
F
NEW CONNECTION
J
M
POINT 1
LLI
❑
PROPOSED DRAINFIELD
❑ T
\\
J APPROXIMATE
BOTH FS ARE TO REMAIN N
MT
LOCATION OF T.H. #1
ABOVE GRADE
CO
O
SAE,
RESERVED
SITE TO BE
ADVANCED
TREATMENT
I'
— — — —
— — — — — — — — —
— — — — — — ------------------
-----------------10'
10' TELE. & ELEC.
EASM'T.
GARNESS ENGINEERING GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
JEFFREY QUINN 1 2 OF 2
LEGAL DESCRIPTION: DRAWN BY:
RANSOM RIDGE; LOT 3A D.J.G.
TYPE OF WORK: DATE:
SEPTIC SYSTEM DESIGN UPGRADE 12/5/2016
y A,`Jness.. ty
CE -79 3
��YOFESS\Sf.*♦♦
GARNESS ENGINEERING GROUP, Ltd
CIVIL& ENVIRONMENTAL ENGINEERS
•ta 3701 E.7UOOR ROAD. SHITE 191' ANCHORAGE, AN 9950] -PHONE (907)337L1]9'FAX (907)33&32dB' WEBSITE', wrvgameeamgmeeng com
SOIL LOG - PERCOLATION TEST
LEGAL DESCRIPTION' RANSOM RIDGE; LOT 3A
PERFORMED FOR: JEFFREY QUINN
DEPTH
(feet) TEST HOLE #1
1 =__� ORG
SOIL CLASSIFICATIONS
•
rr
DRY
1
DRY
10/12/2016
�II�
10/18/2016
r
-
VZZZA
240
Umpi
r
BBN
3
•
ffilbly1
M
111111111
4
3:10
E
M
vzzzxo
5
3:10
-
r
"
EIlI1111!
340
1!'.��
r
r
0.5"
r
M
r
r
r
r
r
r
r
r
r
is
SOIL CLASSIFICATIONS
•
rr
DRY
•
DRY
10/12/2016
�II�
10/18/2016
IGI11!11
-
VZZZA
240
Umpi
5.5'
BBN
3
•
ffilbly1
6"
111111111
4
3:10
E
5.5"
vzzzxo
5
3:10
-
6"
"
EIlI1111!
340
1!'.��
•
0.5"
DEPTH TO
GROUNDWATER
DATE
DRY
10/11/2016
DRY
10/12/2016
DRY
10/18/2016
6"
-
10/1112016
DATE READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
10/16/2016 1
2:10
-
6"
-
2
240
30
5.5'
0.5"
3
2:40
-
6"
4
3:10
30
5.5"
0.5"
5
3:10
-
6"
"
6
340
30
5.5"
0.5"
19 PERCOLATION RATE 60 (MIN./INCH) PERC. HOLE DIA.
TEST RUN BETWEEN 5.5 FT. AND 6.5 FT.
6 (INCHES)
20 A FOUR HOUR PRESOAK WAS PERFORMED: E3 YES ❑ NO
SOILS LOGGED BY: DAVID GARNESS PERCOLATION TEST PERFORMED BY: LANDON BRUCE
CnMMFNTS: PERCOLATION READINGS ARE WITHIN 1/16 OF INCH.
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFORM IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 1 "L
Municipality of Anchorage
Community Development Department Page 1 of 3
On -Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP121257 PID Number: 020-092-92 ❑ New ❑✓ Upgrade
Name:
ABSORPTION FIELD
Richard Chamberlain
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
16861 Ransom Ridge Road Anchorage, AK 99516
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
229-9792
2
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Ransom Ridge 3A
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Lift Station
Tank
Line
Fe
Ft.
Well
>100'
>100'
>100'
NIA
>25'
TANK ❑ Septic El S,T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
1,250Gal,
Surface Water
>100'
>100,
>100'
N/A
Material
Steel
Number of compartments
Two
Lot Line
>5'
>10'
>10'
N/A
NA
Foundation
>6'
>10'
>10'
NIA
LIFT STATION
Manufacturer
Anchorage Tank/Orenco
Capacity
250Ga1.
Curtain Drain
None
Noted
Pump on level at
Pump off level at
High water alarm at
RemarksTank Only Rep laced Under This Permit:
42 in.
42in.
44 in.
Existing Tank Decommissioned in Accordance With
Municipal Code.
Pump make and model
OSI P2005-11
Electrical Inspections performed by
Municipality of Anchorage
PIPE MATERIAL Housetotank D3034 'fankto
drainfeld D3034
Installer
A Plus Home Services
Drainfield HDPE CO/MT D3034
Inspector MEA
BENCH MARK (Assumed elevation) 100.Oft
Inspection,
1° 9/10/12 9/10/12
Location and description
2ntl
dates:
Bottom Step from Upper Deck West Side of House.
3" a'"
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
:'`> 1i��9���1
OF A4 1
A<qll�
Conditional Approval: Date
`Q;: • mS,f I�
}
9 0
49TH :*
A^ NICHAEL R. ANDERSON
40 j CE -4381 � ®
/+i1��
Approved Date
PRO�ESS10�a�'�
Inspection Repo1r 1-16f2#bd/
LEGEND
S1 — Septic Vent
CO — Clean Out
MT — Monitor Tube
MH — Man Hole
FCO — Foundation Clean Out
❑ — Existing
❑ — Proposed
f 49th
MICHAEL E. ANDERSON
No. CE -4381 ,
RANSOM RIDGE
.51
I o� SUBDIVISION
-01 LOT 3A
.- 53,040 S.F.
I NOTE:
I As Built Not Completed
From Surveyor As Built.
Locations are not Exact..
I Existing 67' Long x
4' Wide x 5' Effective
Depth Absorption
Trench.
I1m
L--------------------------
10' T & E Easement
N89'54'51"W 311.50
PLAN AS BUILT
SCALE 1" = 40'
Municipality of Anchorage
Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore
Road Anchorage, AK. 99519-6655 — 343-7904
PID No. 020-092-92
Permit Number:
OSP121257
On—Site
Wastewater Disposal System or Well Inspection
Report
:X
W
O0
Z _
1
1
I
IExwe�ll9
1
I
A I B
I ®
S1 1 10.7'12&V
_
S2 15.2' 25.5'
Two
Bedroom
1 Home
0
I
o
a
I
I
N
Z
I
/S2 1,250 Gallon
:u'
a
/ STEP Tank
v
S1 MH
v
I
�
i
b
o
i
i
Existing Tank
Decommissioned
oo
s/ 3 �g
In Accordance With
z
I
a o
Municipal Code.
c
v 'S a.
�
m
I
�
mI
I
w I
m6
LEGEND
S1 — Septic Vent
CO — Clean Out
MT — Monitor Tube
MH — Man Hole
FCO — Foundation Clean Out
❑ — Existing
❑ — Proposed
f 49th
MICHAEL E. ANDERSON
No. CE -4381 ,
RANSOM RIDGE
.51
I o� SUBDIVISION
-01 LOT 3A
.- 53,040 S.F.
I NOTE:
I As Built Not Completed
From Surveyor As Built.
Locations are not Exact..
I Existing 67' Long x
4' Wide x 5' Effective
Depth Absorption
Trench.
I1m
L--------------------------
10' T & E Easement
N89'54'51"W 311.50
PLAN AS BUILT
SCALE 1" = 40'
Permit Number: OSP121257
Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
PID No. 020-092-92
3.6
HFW.h�
1,250 Gallon
STEP Tank
Tank Only Replaced Under This Permit. Existing Tank Decommissioned
in Accordance with Municipal Code.
PROFILE AS -BUILT
No Scale
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP121257
Tax Code Number: 02009292000
Work Type: Septic Upgrade
Permit Effective Dates: August 21, 2012 to August 21, 2013
Design Engineer: ANDERSON ENGINEERING
Subdivision: RANSOM RIDGE
Site Legal Address: RANSOM RIDGE LT 3A G:3337
Owner/Address: CHAMBERLAIN RICHARD A &
KENNEDY JEAN M 16861 RANSOM RIDGE ROAD ANCHORAGE AK 995165337
Site Mailing Address: 16861 RANSOM RIDGE RD, Anchorage Lot Size in Sq Ft: 53040
Total Bedrooms: 2
This permit is for the construction of:
N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By
MUNICIPALITY OF
ov Community Development Department
Development Services Division
On -Site Water & Wastewater Program
Mayor ®an Sullivan
ON-SITE SEWERANELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.: 020-092-92
Property owner(s): Richard Chamberlain
Phone: 907-343-7904
Fax: 907-343-7997
Day phone: 229-9792
Mailing address: 16861 Ransom Ridge Road Anchorage, AK 99516
Site address:
Same
Legal description (Sub'd., Block & Lot): Ransom Ridge, Lot 3A
Legal description (Township, Range & Section)
Lot Size: 53,040 Sq. Ft. Number of Bedrooms: Two (2)
THIS APPLICATION IS FOR:
THIS APPLICATION IS AN:
(® all that apply)
Absorption Field
F-1Initial
El
Septic Tank
X
Upgrade X
Holding Tank
❑
Renewal ❑
Privy
❑
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
I certify that the above information is correct. I further certify that this application is being made
for a Single Family Dwelling and is in accordance with applicable Municipal Codes.
property owner or authorized agent)
Permit/Rush Fees: d Waiver Fees:
Date of Payment: 8 l4 id Date of Payment:
Receipt Number: 6-I'l/a 6- Receipt Number:
Permit No. _ DSPI d 1,1SIL Waiver No.
C:\Users\AndEng\Desktop\Mike\Ransom RidgeTermit Application Lot 3A.docC:\UsersWndEng\DesktoplMike\Ransom Ridge\Permit
Application Lot 3A.doc -
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
August 11, 2012
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 3A, Ransom Ridge Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The STEP tank on Lot 3A, Ransom Ridge Subdivision is near failure and must be
replaced. We are proposing to replace the tank with a new 1,250 -gallon steel STEP
tank to serve the two-bedroom home on the lot. We are therefore requesting a permit
be issued for the construction of a new STEP tank to serve the home. The attached
Site Plan and backup documentation identify the location and configuration of the
existing septic system and the location of the new tank. Also identified on the plans is
the existing well on the lot. The existing tank on the lot will be properly disposed in
accordance with Municipal Code. The drainage patterns on the property will be
maintained after construction.
The ground surface on the lot slopes to the south at a shallow grade in the area of the
new tank. The tank will be placed in the same location as the existing tank at nearly the
same elevation. It will then be tied in to the existing service line. The tank will be
constructed parallel with the contours of the land as much as possible in conformance
with Municipal requirements.
If the tank is constructed in accordance with our design the following statements apply:
The tank, if constructed as designed, will have no adverse impact on the wells in
the area or those to be constructed in the future.
2. The tank, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
Lot 3A, Ransom Ridge
August 11, 2012
Page 2 of 2
3. The tank, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The tank, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerer
Michael E. Anderson, P.E.
Attachments
RANSOM RIDGE SUBDIVISION
C) w LOT 3A
(/) 0 53,040 S.F.
Z
I �
Existing
well
I �
Two
Bedroom
Home
0
I
I w
O I
O
.! . SV 1,250 Gallon
MH STEP Tank z
/
o I _ Dispose of Existing Tank
o I — — I In Accordance With
Municipal Code.
I
E
Place New 1,250 Gallon STEP of I a
Tank and Place Foundation w I U?
Cleanout if Required. w
�I
of
fl
I
I
I
LEGEND
SV — Septic Vent
CO — Clean Out
Monitor Tube I Existing 67' Long x
MT — 4' Wide x 5' Effective
MH _ Man
Hal
FCO — Fou dation Clean Out I Depth Absorption
Trench. I
❑ — Existing I I I
❑ — Proposed I j
I
.��PE............. --- -----------------
,.••• 10' T & E Easement
.•
X . 49th • •/ N89'54'51"W 311.50
`: //
i
/................................................ •
�'; MICHAEL E.. ANDERSON •: �: SITE PLA N
No. cE—assn
'�f 1 FES;; ��.� SCALE 1" = 40'
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
46r"Awr � I f�,clS
Address TO SEPTIC ABSORPTION WELL
FROM TANK FIELD
Phone( Permit No. No. of Bedrooms WELL
3 (0 Z' 6, 69, 8'7031 >/moo
y r
LEGAL DESCRIPTION LOT LINE ®
LotBlockASubtlivisi_ ,on
'� wFOUNDATION �
Township, Range, Section
..�/AI g&J AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation,
7 driveway .afar Md... etc 1
TRENCH
TANKS
SEPTICu,::� M, ❑ HOLDING
Manufactures
Capacity in gallons
Material
No. of Compartments
TYPE OF SYSTEM
TRENCH
❑ BED
❑ W. DRAIN ❑ OTHER
Depth to pipe bottom from
Total depth from original grade
original grade
FT
(0-7
FT
Fill added above original grade
Gravel depth beneath pipe
y 't
FT
�r
FT
Gravel length
Gravel width
C�
FT
FT
Total absorption area
Distance between lines
070
SQ FT
FT
Number of lines
Soil rating
.301
SQ FT
Pipe material
)WS -/d
WELLS
PRIVATE ❑ OTHER (identity)
Classification (A,B,C) I Total Depth I Cased to
Installer
I REMARKS: ( Y VR — F1�.j" 1
k
ENGINEER'S SEAL
^a
Date:
I " —� /V&_ — c�e
rtrtify that this inspection was performed according to all
Municipal and State guidelines in elle71Sate: !g �"/
r
DaterHealth Department Approval, -
a
A
° 'CS ALASKA BUIR0WI]TAL WOOL
a Engineerinq & Enuironmental Studies
SORUICOs, Inc.
MUNICIPALITY OF ANDgORAGE
DEPT. OF I-tEAtrff &
ENVIRONMEN'(AL PROTECTION
MAY 181988
May ,, 1988 RECEIVED
Municipality of Anchorage
825 L Street
Anchorage, AK. 99501
Attn: Dan Roth
Re: Lot 3A, Ransom Ridge
Dear. Dan:
This is in response to your letter dated 4/27/88 regarding the asbuilt for the
subject lot.
For item #1. -- The original percolation test utilized a safety factor
multiplyer of 2. Current percolation test calculations do not consider this
safety factor. Therefore, using current procedure, the percolation rate is 28
min/inch which equals 242 square feet per bedroom of area required adjusted to
275. The system was redesigned by the inspecting engineer using the original
unadjusted rating of 313 square feet per bedroom. The system is actually
oversized by 120 square feet of area.
For item #2 - We were informed that Susan Oswalt of the MOA was aware the
' excavator, White Fox Trading Co., was not licensed and would take care of 140 -
;approving them as the installer. ig;ym•- "
For item #3 - Swing ties off of the house to the standpipes would be nearly,'
impossible due to the terrain. Lot corner stakes were not located. The bench
that the system is on is easily identifiable.
If you have any questions, please call.
Sincerely,
Alan C. Wien
Engineering Technician
Approved by:
c-
f/ I
Leroy Reid , r. , PhD, PR
President
conn II I..t iz�J A..° , ° %,;t. R _ A.,.6,.,.,,,,,. AI—L.. nncno - (nn7) ccs conn
INSPECTION REPORT
MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION
3500 EAST TUDOR ROAD
INSPECTIONS (907) 563-3464
INFORMATION (907) 786-8211
NAME PERMIT NO...�'/�i''
STREET ADDRESS _1:d,A�d'�y✓ �G`�'�
/PHONE,
�,,.,..
p$
' LOT /BLOCK / _ `j_-� SUBDIV.�% ,+� /DATE `"
FOOTING ❑ ELEC. TEMP. ❑ PLBG. UNDGR. ❑
FOUNDATION ❑ ELEC. SERVICE ❑ PLBG. ROUGH ❑
BOND BEAM ❑ ELEC. R66GH11GAS TEMP. ❑
FRAMING ❑ ELEC. FINAY ��'r GAS ❑ .
INSULATION ❑ OTHER_ O MECHANICAL
SHEETROCK ❑ MECH. FINAL ❑
i
STRUCT. FINAL ❑ FIRE FINAL, ❑ PLBG. FINAL ❑
OTHER ❑ ZONING _ ❑ OTHER ❑
=WILL
MPLIANCE OBSERVEDCORRECTIONS ESSENTIAL AS
5'. EXPLAINED BELOW '
MINE AT NEXT INSPECTION : ❑ DO NOT CONCEAL UNTIL REINSPECTED
COMMES -
n A
cbf
INSPECTOR t ATE
WHEN CORRECTIONS ARE MADE, PLEASE CALL FOR INSPECTION
DO NOT REMOVE THIS NOTICE �.
84-W2 (Rev. 11/87) .t
Municipality of Anchorage
Department of Health and Human Services dht'L5
Tom Fink, 825 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
April 27, 1988
Leroy C. Reid, PhD., P.E.
Alaska Environmental Control Services, Inc.
1200 West 33rd Avenue, Suite B
Anchorage, Alaska 99503
Subject: As -Built For Lot 3A Ransom Ridge
Dear Mr. Reid:
The enclosed as -built has been returned for the following
reasons:
1. According to our calculations the absorption trench
is undersized by approximately 192 square feet of
absorption area.
2. The excavator, White Fox Trading Co., was not
licensed to excavate septic systems in 1987.
3. The standpipe at the end of the trench, if at all
possible, should have two(2) swing -ties for purposes
of future location.
I ask that you contact me at your earliest convenience to
discuss the above matters concerning this as -built.
Sincerely, )_ '
Daniel J. Roth
Civil Engineer
On -Site Services
cc: Gus Andress, P.E., Manager
On -Site Services/Water Quality Programs
Municipality
of
Anchorage
January 12, 1988
P.O. BOX 6650
ANCHORAGE, ALASKA 99519-6650
(907)343-4200
xwAxxxR Tom Fink,
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
George Clemens
16704 Ransom Ridge
Anchorage, Alaska 99516
Subject: Lot 3A Ransom Ridge Subdivision
Permit #870311, Tax #020-092-92
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1987.
Permits are issued on a calendar year basis by authority of
Municipal Ordinance. A new permit must be obtained from this
Department for any well and/or on-site sewer system not
installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this Department for documentation of the installation and to
close the permit.
If a private engineer inspected the installation of the on-site
sewer system, the original as -built inspection report (three-part
form) must be sent to this office for review and approval, and
for documentation.
Effective January 1, 1988, a new fee schedule is in effect.
When re -applying for a new permit, the new fees are; $90.00 for
an on-site sewer permit; $50.00 for a well permit; $140.00 for
a combined sewer and well permit.
If there are any further questions, please call this office at
343-4744.
Sinc ely,
;�
Robert W. Robinson
Program Manager
On-site Services
RWR/ljw
enc: Copy of Permit
e1
/2--
��
~ MUNICIPALITY
OF AN�»"�HGE
Department
o� Health & Human Services
G25 L Street,
Anchorage; Alaska 95011 4720
ON~SITE
SEWER � SEPTIC TANK & WELL PERMIT
Permit
Number: 1370311
Date
Issued: 11/�0/87
Owner Name: GEORGE CLEMENS
Day Phone:
Owner
Address: 16704 RANSOM
RIDGE
345~6288
ANCHORAGE; AK
99516
Papcel Id: 020-09 2
Lot Legal: /A
Lot Size 1.25A Pup ft.
or .1cres)
Max
8ed1%o0ms: This Permit:
2 Total Capacity: 2
SEWER
SYSTEMS: Listed below
are the options available to you in designing your
sewer
system. Choose the option
that best Fits your sitc--
Depth to Pips BcALom
(ft.>: ` 4.()
Gravel Depth
Total Dep�h
(ft): 6.O ^� �
Gravel Width
(1t): 5.0
Gravel Length
<ft>: 121.0 ** 171Z4.
Gravel Vo1un!e (cubic
yds): 56.1 � //������^~���~�
Soil Rating Used Kul �t/brm):
"~ �
431
**
Gravel length > 50 �eet
requires mulLiple soils tests.
**
Gravel lenqth > 75 fGet
requires multiple runs (not exceeding 75 L each>.
LIFT
STATION: Ifa li[t sLation
is installed� a high waLer alarm must be
connected
to Lhe residence.
AFF
LK, TANK: Minimum total septic
Lank capacity: 1,000 gal1onsEach septic
tank
must have at least 2
top cit septic tank<s) < 4.0
ieet
requipes insulation over
tank(s).
WELL:
Log must be submitted
to Municii::�ality o'i h
and
Human Services within 30
days of well CAMEO lOlt. ioo,
NOTIFY
DHHS PRIOR TO INSPECTION,
PHONE 343�4681 AFTER HOURS.
e1
/2--
��
�
' �UNICIPALITY OF ANCHORAGE
Department o� Health & Human Services
825 L Street, Anchorager Alaska 99501 343~4720
ON~SITE 6EWER & SEPTIC TANK & WELL PERMIT
Permit Number: 87O3I1 Page 2
r
(ENG ` SEAL)
,!Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
_ 825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: Bernrie V!4 9 e eS DATE PERFORMED:
LEGAL DESCRIPTION: 94n40n - IQ dSl e_ fet Township, Range, Section: g r q tJ R 366
E /V0 w „ 4 ®i 3A SLOPE SITE PLAN
PC4LIF
1
2GM }�n 5.1% Sttlt�y.J�
3
4 to jr'
rM5
6411 11
7 1� 8
9
t0 WAS GROUND WATER
ENCOUNTERED?
11 S
IF YES, AT WHAT L
12 DEPTH? P
E
Depth to Wrier Aper
13 W° �' `P Monitoring? ---moi
14-
15- i OF A4 4
P�.
1649rH� '•;9v00
170�• s••0 *000
••• •••••• :•.•®
18 + OY C. REID, JR. : /
0 '•• CE - 2251 •. �w� r
Ar
III Pmfess!00
Y
MMENNEEMPRA
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
-s Al)
—
aro
1
- 231
►0
.307
03
231
3
-JO
��h
7'i)
FT AND
9104,
03
I
-,
3,10 O
+r CYC r Acre f,4e IS
xrl
to
3.04
p3
2-S-1
3.10
..
,301
10
301!
.03
S 301-340
10
310 — Bo a
•o
6 J10-321
1+0
311 - 3.013'
-035
20
G� d�
5-4 �
L
PERCOLATION RATE
(minuteumch) PERC HOLE DIAMETER
3
3 r2
��h
TEST RUN BETWEEN
FT AND
FT
COMMENTS
% f► 12 �, .,�-k e(
Y13 f7 i �.
..n.uL��4-�.L
+r CYC r Acre f,4e IS
Hrn ul4f „. .
a>r r2,c�
�'� ��.- err
r
/, c d ,
PERFORMED BY: A EC -C /nc
Sr $S C%2A
ERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE
DATE: 6 - is S
1
q,
f — p A4%%Ar
S I `r deo eo.. o.s na•a• a,
C. REID, JR. o $
CE 251 •:`
�' ! � ®err° e•�...•... •��� .�
41 � / � t �proPessioRd� �•v
i s 4'r�,.
%<tc� se- $Soo ❑
i I Srr� Lepf 3- 317Y cze itbac -3'/c
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3
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ti
,,}rF
j i � / /�r.r•�'ryeG' w
4 I , IN furca n.
Nog"5�f 5 "G✓ 22G.So'
Lot Survey Certification �����aggq �L //Prepared by
Ihereby certifyttwtlhavesury�![ OF Al q1�Alii /✓Oi'THr✓�sfrH
eyed the property shown and � iltl • ••••'••••o0 ®� Professional Land Surve or.
described hereon,ard that the I y •. >, ti� ��
SCa18' / it _ 6 p ' pate Drawn:
improvements situated thereon
are within the property lines and ;49 :!t
do not overlap or encroach on pate Drawn:
adjacent property and that no
improvements onodpcentprop- �• • •e. •• ® Field Book: B%'- 2 Reference:
erty overlap or encroach on the ; Jerry t. Shpr6aha
premises in question and that J' •• 1#D. 4468 -S : ,fi, i
thereorienoroodwa utilit 6 q ••e ,.� Q� Lego! Descrjption:Go 3 , /SAN say, /�'iw✓4 t
lin said siblxcepta encs �ei; fEastot+at +„o Prepared for: `
an said rt except as
indicated hereon. seal
MUNICIPALITY OF ANCHORAGE
Development Services Department C� Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 020-092-92
1. GENERAL INFORMATION
Complete legal description
16861 RANSOM RIDGE ROAD
Location (site address)
Expiration Date: -3 - 1�_
RANSOM RIDGE LT 3A
Current property owner(s)
Mailing address
Real estate agent
JAKOB GEORGE
SAME
2. TYPE OF DWELLING:
I] 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
COSA to be released to the engineer, unless otherwise
3
Day phone
Day phone
the engineer.
Date:
COSA Fee $ 1350-00 Waiver Fee $ _
Date of Payment (n'' ----.3V1 II 2DI01 Date of Payment
Receipt Number cwcxmiog�a Receipt Number
COSA# 6SCI1 IM Waiver #_
TYPE OF WASTEWATER DISPOSAL:
M
Private Septic
El
❑
Holding Tank
❑
❑
Community
❑
❑
Public Sewer
❑
the engineer.
Date:
COSA Fee $ 1350-00 Waiver Fee $ _
Date of Payment (n'' ----.3V1 II 2DI01 Date of Payment
Receipt Number cwcxmiog�a Receipt Number
COSA# 6SCI1 IM Waiver #_
S. 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 MIKE N ANDERSON, P.E. Phone 727-6864
Address 4661 NATRONA AVE. ANCH AK 99516
Engineer's Printed Name MIKE N ANDERSON, P.E. Date 3-11-19
OF Al'XI
it
y Q
i fir: 49TH s*
6. DSDIGNATURE ........
System#1 Approved forbedrooms %"°°°" """'••••'•
a �•• MICHAEL. N. ANDERSON! '%
Q i•. .�-.
System #2 Approved for _bedrooms CE -9q69
dI�;X. ��41fI
Disapproved & FO''
k "Ro"Ii®�
Conditional approval for bedrooms, with the following stipulations:
0
Original Certificate Date: -3-1
The Municipality of Anchorage Development Services Division (DSD) issues Cenificates 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 Alaske. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's vrork.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COM Cnerkfn Nue Sheet
COSA Checklist
Legal Description: RANSOM RIDGE LT 3A
Parcel ID: 020-092-92
If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system
A. WELL DATA
N Well log is filed with Onsite (or attached)
Date drilled 1...f
Total depth 260 ft
Cased to 30' ft
X Sanitary seal is functioning correctly
INE Wires are properly protected
Casing height (above ground) 24"+ in.
Date of flow test for COSA v2&1s
Static water level at beginning of test 30 ft.
Comments
B. TANK DATA
Age of tanks) so"'6 years
Tank type/material STEEL
Measured operating fluid level in septic tank 40
❑Q Standpipes/foundation cleanout per record drawing
Date of pumping
D. ABSORPTION FIELD DATA
Well production at time of test 1.2 gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? H Yes ❑ Nc
® Coliform bacteria is Negative
Nitrate 0.821 mg/L ❑ Nitrate less than MRL (ND)
Arsenic _ ug/L N Arsenic less than MRL (NO)
Collected by MNA
Date of Sample 2-2s1e
C. LIFT STATION
M Required maintenance completed
Age of lift station 7 years
Lift station material STEEL
Comments: CLEANED BY ARM SERVICES
ivt&18
Which system tested (date installed) _
2-11-19
Adequacy test date _
® ALL standpipes present per record drawing
Results ❑✓ Pass For 3 bedrooms
Total measured depth from grade 10 ft (max)
Fluid depth prior to test 12/8 in
Measured depth to pipe invert from grade -L—ft (min)
Water added 500+ gal
❑N/A—pressurized field
New depth 24/16 in
❑� Monitor tubes go to bottom of effective. If not, state
Elapsed time 1440 min
depth into effective
_
❑� Code -required soil cover over field
10/S
Final fluid depth _ in
❑ System presoaked
Absorption rate 500+ gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) UN
date of test)
Gallons introduced _gallons
If yes, enter date
Comments/Deficiencies:
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lotto: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
Q
Yes
Community Sewer Manhole/Cleanout > 100'
❑Q Yes
if No _
ft
0 Yes
if No _ ft
Neighboring Tank > 100' ❑Q Yes
if No _
ft
Private Sewer/Septic Line > 25'Q❑ Yes
if No _ It
Absorption Field on Lot> 100' El Yes
if No _
ft
Holding Tank > 100' ❑Q Yes
if No _ ft
Neighboring Absorption Fields > 100'
❑Q Yes if No _ ft
Water Main > 10'
Animal Containment> 50' ❑Q Yes
if No ft
Yes
if No
ft
❑Q Yes if No _ It
_
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway comment below
Community Sewer Main > 75' Yes
if No
_ ft
] Yes
if No _ it
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
Q
Yes
if No _
ft
Surface Water> 100'
❑Q Yes if No _ ft
Property Line > 5'
[71
Yes
if No _
It
Wells on Adjacent Lots:
Absorption Field > 5'
Yes
if No
_ ft
Private Wells > 100'
❑Q Yes if No _ ft
Water Main > 10'
Yes
if No
_ ft
Community Wells > 200'
❑Q Yes if No _ It
Water Service Line > 10'
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'
Q
Yes
if No
_ ft
If absorption field is under driveway comment below
Property Line > 10'
El
Yes
if No
_ ft
Wells on Adjacent Lots:
Water Main > 10'
ED
Yes
if No
_ ft
Private Wells 2: 100'
❑Q Yes if No _ ft
Water Service Line > 10'
❑Q
Yes
if No
_ ft
Community Wells > 200'
❑v Yes if No _ ft
Surface Water> 100'
Yes
if No
_ ft
=:0CJ I:14 4 t4a*101 i4I i41 MIZ Y i9
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.
COSA Checklist yellow sheet
OF
*.'49TH
A • USON• D<
CE
�69
0
Municipality of Anchorage
On -Site Water & Wastewater Program
(907) 343-7904
err
pA� 11 g1. li k�(a
r,
' rr.
Certificate of On -Site Systems Approval
Parcell.D. 020-092-92 Expiration Date: I',"
1. GENERAL INFORMATION
Complete legal description RANSOM RIDGE: LOT 3A
Location (site address) 16861 Ransom Ridge Road 'Anchorage 99516
Current Property owner(s) Jeffrey Quinn Day phone 510-225-8385
Mailing address
Real Estate Agent Carne Schliesing Day phone 907-250-6199
2. TYPE OF DWELLING:
E Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 2
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for N/A Distance:
Received by. Date:
COSH to be releas to Vie gine ss omenvise requested by Ne engineer.
COSA Fee $ 12° - Or1 Waiver Fee $
Date of Payment I �- plena" Date of Payment
Receipt Number l ✓ Receipt Number
COSA# 0.SGILOR010 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) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK, 99507
Engineers Printed Name JEFFREY A. GARNESS, P.E.
Engineers Comments:
In conducting Thiseveluelied GEG provided an engineering evelmlmnof the well aneVoor septic system in accnkenw with Ne
guidelines and regulations established by Ne Municipality of Anrbmege and sidusbypmdees. ihempodedretic desnme, the
condition of the systeMs on The coitus al' Me evaluation. Separation distonces wire measured to rmdey Nmgfieblefeelures.
Midden defects or encroechmmis may exist that were not identified during The eaddematihe operetionel file Wall wells and septic
systems depend an a widely of variables including, but not lmuled 1p, sal armed.. gmuMwetev Amich; (that mayfmolmle dudrg
the year), quality ofconsvuclim(materials and wortmanshlpJ, and the waferusege o/0e/ iryuWirirg the systeMs these
conditions can very, and are outside The control of GEG. Satisfactory lest results do riotgutrentee hdure pedamencoofihe
sysleml, therelare, GEG makes no wimarty (express .,implied) regeNing Ihz futureperfience aldre well wsrytic system.
GEG melees no represenlalum whether en altemalive well orseptic system can be inslelleeon IAe proceed in The elmnl eiderallhe
current systems fail. The content of this report is for the sole benefit oftmalu rsoNpedywhorelemei GEG. Reliance upon 0e
inlamalion provided in this report by any Whet person or party, including but trot limdtl to subso,oMpropedypurdiaseri, is rid
eulhodsed In shod, GEG disavows any legal duty to anyone olAerlhen the pesoYPerly who PeitllwWs report
6. DSD SIGNATURE
System #1 Approved for bedrooms.
System #2 Approved for bedrooms.
Disapproved.
Phone
337-6179
Date i2/ZZr'b
Conditional approval for bedrooms, with the following stipulations:
\P tOFt r rt Cfrr4
=J= ON-SITE
=� WATER AND
WASTEWATER oz=
PROGRAM
By: f"4 IlCVLSV Lmy'vA ECkLflJ Original Certificate Dale: 0-27/201 1
The Municipality or Anchorage Develoleemt 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 engineers work.
7. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
(Rev. 10/11/1])
Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # _of_
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description:
A. WELL DATA
RANSOM RIDGE, LOT 3A
`CASED TO BEDROCK
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 12/18/87 Sanitary seal (Y/N) YES
Total depth 260 ft. Cased to '30 ft.
FROM WELL LOG
Date of test 12/18/87
Static water level 20 ft.
Well production 1 —9 P.M.
WATER SAMPLE RESULTS:
Parcel ID: *020-092-92
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
AT INSPECTION
8/10/16
29.9 ft.
1.3+ g.p.m.
Coliform 0' colonies/100 ml. Nitrate 1.15 mg./L. Collected by: GEG, Ltd. &'AAROW PUMP AND WELL SERVICES
Arsenic: NO ug./L. Date of sample: 12/2/2016 & •12/13/2016
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material S.T.E.P/STEEL Date installed 9/10/12 -
Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES
Date of pumping 5/20/16 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA BELOW FINAL GRADE
Date installed 12/15-16/16 Soil rating (.p.d./ft r ft'/bdrm) 0.45 System type SHALLOW TRENCH
Length' 35 & 35 (70 TOTAL) ft. Width 5&5 ft. Gravel below pipe 4&4 ft.
Total depth '9.8+ ft. Eff: absorption area 700 ft' Monitoring tube YES Depression over field NO
s
Date of adequacy test 8/10/16 Results (Pass/Fail) PASS For 2 bedrooms
Fluid -depth in absorption field before test NEW in. Water added =gal. New depth =in.
4
Elapsed Time: "= min. Final fluid depth = in. Absorption rate >= 300+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date -
INFORMATION REGARDING 1987 TRENCH IS IN MOA RECORDS
'PER 2013 INSPECTION REPORT
D. LIFT STATION "SECOND COMPARTMENT OF 1250 GALLON STEP TANK
Date installed 9/10/2012 Size in gallons "415 Manhole/Access (Y/N)
"Pump on" level at '42 in. "Pump off' level at '42 in. High water alarm level at '44 in.
Datum BOTTOM OF TANK Cycles tested 3 Meets alarm & circuit requirements? 'YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer /septic service line 25'+ Holding tank 75'+
Animal containment areas f 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 51+ Property line 51+ Absorption field 5'+
Water main - 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 101+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWNWells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date
rRev. 10/12/121
RANSOM
N 89 54' 51" W 226.50
.: 49 !HW 7,
SHANE A. HOLT
LS -6914
\s.°Ies sln nsl 1'�0
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EA SEMEN TS: 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 1" =30'
NO CORNERS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 3 A, RANSOM RIDGE SUB. ( PLAT 85-283)
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 19th DAY OF
-DECEMBER , 2016.
HOLT LAND SURVEYING
9309 DROVER DRIVE
ANCHORAGE,AK 99501
345-5513
• Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval > 1 )
Parcel I.D. 020-092-92 Expiration Date:
1. GENERAL INFORMATION
Complete legal description Ransom Ridge, Lot 3A
Location (site address) 16861 Ransom Ridge Road Anchorage, AK 99516
Current Property owner(s) Richard Chamberlain Day phone 229-9792
Mailing address 16861 Ransom Ridge Road Anchorage, AK 99516
Real Estate Agent
2. TYPE OF DWELLING:
0 Single Family (wlwo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: TWO
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver/Variance request for: -
Distance:
Received by:
�� _
Data:
COSA to be released to the engineer, unless otherwise requested
by the engineer.
COSA Fee $ Y `70'
Waiver Fee $
Date of Payment GL2&16
Date of Payment
Receipt Number 0559
Receipt Number
COSA# 656/3/00
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) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
6. DSD SIGNATURE
V System 41 Approved for _a bedrooms
Phone
522-7773
Date 9/26/2013
System #2 Approved for _ bedrooms
Disapproved
Conditional approval for bedrooms, with the following:
°A4
°
Ar
0
49 lb
�'m�ar�lt,�'o.�rsasaevo �
s �E CE = 4381
By: Original Certificate Date: I — P_'" r
The nicip yichorage 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 forerrors or omissions in the professional engineers work.
7. ATTACHMENTS:
COSA Checklist X ` Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA bluesheelf L c
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: Ransom Ridge, Lot 3A Parcel ID: 020-092-92
A. WELL DATA
Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y
Date completed 12/18/87 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 260 ft. Cased to 30 ft. Casing height (above ground) >18 in.
FROM WELL LOG AT INSPECTION
Date of test 12/18/87 8/8/13
Static water level 20 ft. 31.9 ft.
Well production 1 g.p.m. 3.5 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate 1.42 mg/L
Arsenic N/D ug/L Date of sample: 8/5/13 Collected by: Anderson Engrg.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEP/Steel Date installed 9/10/12
Tank size 1,250 gal. Number of Compartments 3 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) _
Date of pumping New Const. Pumper
C. ABSORPTION FIELD DATA
IN
Date installed 12/29/87 Soil ratingz 313 sF/BDRM Deep Trench
(g.p.d./ftz or ft /bdrm) System type
Length 67 ft. Width 4 ft. Gravel below pipe 5 ft.
Total depth .1 1 ft. Eff. absorption area 670 ftZ Monitoring tube Y Depression over field N
Date of adequacy test 8/8/13 Results (Pass/Fail) Pass For 2 bedrooms
Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 0 in.
Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 300 g p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed 9/10/12
"Pump on" level at 4L in.
Datum Bottom of Tank
Size in gallons 250 Manhole/Access (Y/N) Y
"Pump off' level at 42 in. High water alarm level at 44
Cycles tested New Const. Meets alarm & circuit requirements? Y
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot >1 00On adjacent lots >1 00'
Absorption field on lot >1 00' On adjacent lots >1 00'
Public sewer main N/A Public sewer manhole/cleanout N/A
Sewer /septic service line >25 Holding tank N/A
Animal containment areas >50 Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5 Property line >5r
r
Water main > 0 Water service line >10'
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line >10, Building foundation >10'
Water Service line >10 Surface water >100'
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that t have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 9/26/2013
COSA brown sheet 10-10-12.doc
Absorption field >5
Surface water >100'
Water main N/A
Driveway, parking/vehicle storage >10'
®F A
-ri
m�
in.
m^ aANCHAB E. ANDERSON
CE _ 4361 s
p®®Pew. 17- 24,17 -
It
y MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES i
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. #t�. (�-_dpi - HAA # V �S \ L San
1. GENERAL INFORMATION
Complete legal description Lot 3A; Ransom Ridge Subdivision
Location (site address or directions)
Property owner ^Forge Clemens Day phone
Mailing address 11185 Tuxford, Sun valley, California 91352
Lending agency Day phone
Mailing address
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 2
3. TYPE OF WATER SUPPLY:
Individual well XXX
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:
Individual on-site XXX
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 #21
5.
6.
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm S & S ENGMEERING Phone
Address 17034 Eagle River Loop Road NO:'2"
Eagle Kiver, ,
Engineer's signature
DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments —
By: _. ct-rt �; KA (TN
1uTIC
Date
�-31-moi l
bedrooms, with the following stipulations:
Date a ` 9,1
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a 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 421
Municipality of Anchorage
i . Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L -of 3A Parcel I.D.
A. WELL DATA II
Well type�`L� If A, B, or C, attach ADEC letter. ADEC water system number A
Log present (qN) y Date completed -12, (g �7 Driller —
t U
Total depth 2�n Cased to 3� (`Ic Casing height �2
Sanitary sea IQYDN) T Wires properly protected(V%)
4F *pA_L1W OF ANCHORAGE
FROM WELL LOG AT INSPECTI94IgDNMIgWAt SERVICES DIVISION
Date of test `2 �� g Z "1' " "••-1991
Static water level r CC
Well flow 1 g.p.m. 2 '7 R.P9 E' V`/ G D
� n
Pump level l�i/i . 2 j % I(D� L L.) 6LL la it
Sin
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot l �� ; On adjacent lots t�
Absorption field on lot �� pt ; On adjacent lots
Public sewer main o kk, Public sewer manhole/cleanout
Public sewer service line Petroleum tank
WATER SAMPLE RESUL S:
Coliform I Nitrate Other bacteria
\
Date of sample: �"� '� 1 Collected by:-
B.
y:
B. SEPTIC/G TANK DATA
Date installed 6-1 Tank size L25i42' Compartments -2--
Cleanouts d'N)
Foundation cleanoutd'VN) y Depression (Y/fij) +-J
High water alarn>(('�Zi ) Alarm tested�IN)
Date of pumping , " I exi
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot On adjacent lots ( 01Z� I4_ Foundation 2
I I
To property Iine Absorption field �'�L Water main/service line 1(,o 4 -
Surface water/drainage )
72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer�L�. �drJiC�
Size in gallons �2rt� %� �i Manhole/AccessaVN) y
Vent&VN) — "Pump on" level at "Pump off' level at
q r
High water alarm level J Cycles tested 7—
Meets
Meets MOA electrical codesWN) _ e
SEPARATION DISTANCE FROM LIFT STATION TO:
l
Well on lot On adjacent lots
D. ABSORPTION FIELD DATA
C)ot A- Surface water �2
klvAW 114
Date installed «- 2_1 - Soil rating '2i ( 3 System type � 11`��*-�
Length _ 0 Width Gravel thickness S Total depth
Totall absorption area wo Cleanouts presenttl/N)
Depression over field (Ye Date of adequacy test
Results (pass/fail) for I Z
Peroxide treatment (past 12 months) (Y/N) ILA16 nIAN If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
�
Well on lot I C5-�D _�_On adjacent lots l ra�) �- Property line I'o
l
To building foundation YZ6 To existing or abandoned system on lot
On adiacentlots 1721-> Cutbank �ork Water main/aprvicplinp 1�1
Surface water < k Driveway, parking/vehicle storage area mol k
Curtain drain
E. ENGINEER'S CERTIFICATION
bedrooms
I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
� u• L., 3j oy' 1
Signature S R S ENGINEERING
00
®
17034 Eagle River Loop Raad N.Os w • • +
Engineer's Name Eagle River, Aleake�193"
/q n/ ®•.saes • ae•60°a a•
Date '/ —� ®p %f�•® MiQ.a ,F d. !3.Hf T. ,P.Ei. a w !�
y •s
Vill
a 4'�"W
AW
�7 U
HAA Fee:1 / if Waiver Fee: $
Date of Payment �" Date of Payment
Receipt Number ��"l 3w Receipt Number
91 1itII P.04
WELL
Date Drilled: 12-18-R7 Lot 'l 51k.3A
Ransom Ridge Subd.
Static Water Level 2a feet Gallons Per Minute
Draw Down NZA feet Total Feet of Wing�3Q'
Type Material Drilled:
0 feet t0 30 clav and gravP�
30 feet to 260 bedrock - -
t0
to
�o
to
to
CO
HEFTY DRILLING
3540 AKULA DRIVE
ANCHORAGE, AK 98618
(901) 945-0593
RECEIVED
AUG 1 1991
Municipality of Anchorage
Dept. Health & Human Services
JUL-31-91 WED 19:26 992
Date: July 31,1991
3457332 P.01
Wilco Contractors
16701 Ransom Ridge
Anchorage, Alaska 99516
345-6288
To whom it may concern:
The house on Lot 3A Ransom Ridge has never been occupied
since the construction of the house was completed. The
new owners have moved in on July 31,1991 and they are the
first people to occupy this home.
Sincerely,
Bill Wilkinson
(guardian of the property)
9
AUG- 4-91 SUN 21:03 992 3457332 P.01
Y
FROM fPECLINE NEVADA 8. 6.1991 6146 P. 1
,
TO whom it may concern:
July 31, 1991
The house on Lot 3A Ransom 04go has not bean occupied
Once the house was completed, The recent Owners have
moved in On July 31,1991,
Sincerely,
Gaorfle Clemens
441
U