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FOREST RIDGE BLK 1 LT 2
Forest Ridge Block 1 Lot 2 #017 - 112 - 75 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ..~.J fl'/o'Z.~ PIP Number: OI'7 - I ~ ~., -'7~' "'~: ~--~.~,~h' E~u~.o~g ~ INc.. Wastewater System: 5i~'New n Upgrade Address: ~ J 'Z/,qo ~ ~L; ~c~,~. ~. ABSORPTION FIELD .bone: ~''~ IN°'°fB~'': ~.pTre.ch ~ShaliowT.~ch ~Bed ~Mou.d ~Othe~ Numar of li~: WEL~ ~ New ~ Upgrade G~.l wi~t~: I ~ F~ ~ SEPARATION DISTANCES = Septic O Holding ~S.T.~P. Water i~l+ IW% Io~+ -- ~ LI~ STATION Remarks: ~ ~t~ t~ A "~a,.,~,~; BENCH MARK r Depadment of Health and Human So.ices approval~' F~-~,~, ~ ~- ~ ......... PERMIT ti0. ~;W970254 Nunicip. out oF Anchor~oe DEPARTMENT OF HE~_THAND HUI~AN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 e Anchore'ge0 A[,',sko. 99519-6650 · Teteohone, 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LOT 2, BLOCK 1, FOREST RIDGE SUBDIVISION P.I.D. NO. LOT 1 017-112-75 2000 GALLON RECIRCULATING SEPTIC TANK WITH TRICKLE FILTER WEt/, WEt~ WE~.I. LOT 2 LOT 3 NEW 4 BORM HOUSE / I I I I SITES P~RI~IT ~o. SW970254 PAC~ ~ OF 3 Municip, o[it oF AnchoraQe DEPARTMENT OF HE~_THAND HUFTAN SERVICES ENVlRONHENTAL SERVICES DIVISION · P.D. Box 196650 e~Ancho~'~ge, ~J.t~sk~ 99519-665.0 · Te.l.e. phone,. 343-4744 ON-SITE WASTEWATER DISPOSAL ~SYSTEM AND/OR WELL INSPECTION REPORT LECAL LOT 2, BLOCK 1, FOREST RIDGE SUBDIVISION P.I.D. NO. 017--112-75 f UPFLOW FILTER ~.--93.6' FL,.-~.3-1998 18:21 COLONY BUILERS, INC. P.B1 i~CW~ OF ~O~GE - B~G SA~ D~SION 3~ ~ ~R RO~, ~O~G~ ~ Far: 00~ $45-~235 INFORMATION: 007) 343-8211 SUBDIVISION: FOREST RID~F~ WHEN CORRECTIONS ARE MADE, prF_ASE C.~LL FOR IN~P£CTION ~z,5 DO NOT REMOVE THIS NOIlCF,. TOTP~_ P.O1 RAYS SERVICES & SUPPLIES Spedalizing Iff on-site wastewater disposal systems Fcbruary 24, 1998 Product Sales and DisMbutior Managemen~ Sevices Evaluatlon~ Colony Builders Attn: Bill Taylor 2340 Loren Circle Anchorage, AK 99516 REFERENCE: Lot 2; Block 1; Forest Ridge Subdivision Dcar Mr. Taylor,' At your request, we visited thc referenced property for thc primary purpose of evaluating fl~e on-site wastewater disposal system (recirculati,~g trickling filter with upflow filter) for initial start up. The house was vacant at fl~e time of our visit and construction activities were still being performed, tlowever, it appears flint fl~e on-site waste~ater disposal system had been completed and file tank had been filled wifll water. The control panel for the recirculating pump and effluent discharge pump was located on fl~e outside office structure in line fl~e manholes on fl~e tank. The power was on at thc control panel and fl~c system appeared to be operational. Thc timer for the recirculating pump was set 1o recirculate fl~e tank effluent wifl~ an $ mioute on cycle every 20 minutes. Assumlng a reeirculafing rate of g gpm, 64 gallons of.eflluent would run through fl~e filter every 20 minutes. This is equivalent 1o approximately 10 ~'cles per day. These settings were in accordance wifl~ Anchorage Tank's installation manual, however, experience has shown that fl~e media may be oversaturated at this rate. After fl~e system bas been in operation for approximately 30 days, fl~e on time should be reduced. Experience wifll off,er systems would indicate that a rate of 3 minutes out of every 13 minutes would be more appropriate. These adjustments can be made wifl~ fl~e first sanlpling required by fl~e Municipality of Anchorage (MOA), Department of llealth and tluman Services (DtlIIS). Thc timer for the effluent discharge pump was set to run approximately 1 minute per bour. At tiffs rate al~proximately 480 gallons of x~ter will be discharged l'rom file system in a 24 hour period. Adjustments may also be required to tiffs time control after the home becomes occupied. Adjustments will be evident if' alarms are sounded frequeutly eifl~er £rom over loading fl~e system (high water alarm) or under use (Iow water alarm). Thc recirculating functions were tested through 4 complete cycles, thc effluent disclmrge portion of' this system was tested fl~rougb at least 3 cycles itl each of. the automatic and manual modes. The total system was let~ itl an operatioual mode at the completion of'our visit. P.O. Box 772804; Eagle River, Alaska 99577; 696-7297 Page Two Lot 2; Block I; Forest Ridge Subdivision February 24, 1998 It is my understanding that tile MOA, Dill-IS will require monthly sampling of this system. It is also recommended by file manufacturer of these components that they be maintained quarterly for the first year and at least semi-annually thereafter. Sampling and maintenance of this system is beyond tile scope of our agreement at this time. However, we will be more than happy to provide these services upon your request. If we may be of fuflher service, please contact us. Sincerely, ~lmfer RLS/gk ce S ,& S Engineering Specializing In on-site wastewaler disposal systems O EO i ER'$ SEP OC SYSTE OUOBE PERIdlT ISSUED TO: 1)~L~ ~,~.x-~-b PERMIT NUIdBER:SvJ. PEYlT ISSUED BY: ~ - A~o~ ~ DATE ISSUED: ADDRESS: ~ ~ ~, LEGAL DESCRIPTION: ~ ~ ~ ~ SYSTEId DESCRIPTION: TANK SIZE: SAND FILTER: n TRENCH x x L w ED · ~BED ~' x I~" x o,~'* k w £0 OUTLET FILTER: p UId PS <l~--~-c-'~ 0 DRAINFIELD x x L W TOTAL AREA: "~o c>~ £0 INSTALLING CONTRACTOR: ADDRESS: "z..'~ A TELEPHONE NUMBER: SEPTIC TANK PUMPER: ADDRESS: TELEPHONE NUMBER:. DATE DESCRIPTION DATE DESCRIPTION FEB-26-1~ CCLONY ~UIt.f~, INC. P.01 _± for Lo~ :2; Block I; F~xest R~dse Subdiv~siou On-~te Wastewatcr Disposal Sy~em Cost o~uu~:d~& exdud~ lab co, ts is $50.00 per rvcnt. Tois a&reeme~t may be terminated 10 days prior to any sa,~Ii~ event. Colony ~uild Ray's Services and Supply FAX TO: FROM: (~(I-'T-'~-.,lto," . FAX TO:~( t FROM: TOTI:L P.O! FEB-20-199~ 11:22 COLO~/Y ~UILE~. INC, P,03 Municipality. of Anchorage Depaflment of Health and Human Service~ 925 't.' P.O. f~oa 't9~6.50 Anchorage, Alaska I (w~) ccz~r that l (~) lure zctd thc above swtemcnts and am (a~e) iwtr~ of the risks outlined. 1 (w~) also ce~f~ ~ I (~) am (L'~) in d~e proem of pun:hasmJ ~-'~ legal des~ii~i~e): Notax~¢ PAGE 2 OF 2 STATE OF ALASKA SWOP~ BEFORE ME THIS 2/23/93 BY Thomas R Culhane DONNA L PETERS NOTARY PUBLIC FEB-20-1~ 11:21 CO_~IY I~JILE~, I~C, P.~ PROPERTY OWI~.'R AG~I~.MI~NT FOR ~ MAINTENANCE OF AN ON-,~I'E V~A.STEWATER DISPOSAL TAb qx~'~m~ b m3de for thc pu~'posc of ~ an on-si~ wu~ewam, d~Toul sys~m on the sub~:X ~. Sub~2~ to ~he Mm2~ciptihy of Anchor'qe. on an mmual ~,!,, an impc~ion and ol~t6on mmn~ fi~2 a rcSi.~r~ prof~uiomt ,-~f~%-r. This ~ net ($i~) (S~mre) (Pdf~ed lqmn~) (Pt, in~d N-,'~') ~o~afize Her~) PAGE 2 OF 2 STATE OF ALASKA SWORN BEFORE ME THIS 2/23/93 BY Thomas R Culhan¢ PRI~'~ t:D NAME NOTARY PUBLIC 'ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. Date.. ,;o ? CML ENGINEERS (901) 694-2979 FAX (907) 694-12 ! 1 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 RECEIVED OCT 6 1997 Municipality of Ancl~orage Dept. Health & Human Services The septic i~n~[e~,~ons for.~Ae_/~ference, d property, w.ere [~er%%r~_;~t~%~e~w~t'~er Dia;pdos~'/ ~;~t~em ~ndP;oir°,~e~ ~bs;e~cttt~gn Report we are waiting for the 5uA,&~o~ ;~W~T to be completed. If we may be of further service please contact us. Sincerely, 17034 NORTH EAGLE RIVER LOOP · SUITE 204" EAGLE RIVER. ALASKA 99577 PAGE 1 OF MUNICIPALITY OF i~CHORAGE DEPARTMENT OF HEALTH AND HUMJ%N SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970254 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:BALLARD DAVID OWNER ADDRESS:2340 LOREN CIRCLE ANCHORAGE, AK 99516 DATE ISSUED: 8/14/97 EXPIRATION DATE: 8/14/98 PARCEL ID:01711275 LEGAL DESCRIPTION: LOT SIZE: 43357 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM 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 (18AACS0). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY C~LING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THIS PERMIT IS ISSUED FOR;AN INNOVATIVE WASTEWATER SYSTEM AND THE ATTACHED PROPERTY OWNER/MAINTENANCE AGREEMENT SHALL RECEIVED BY: /&r-~,~ '-- . ISSUED BY: ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. CML ENGINEERS July. ,, 1997 (907) 694-2979 FAX (907) 694-1211 RON~ DESfGN SO~!. TEST MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 2, Block 1, Forest Ridge Subdivision Request you issue a permit to drill a well and install a septic system to serve the proposed four bedroom house on the referenced property. Also, we are requesting you issue a permit for the installation ora 2000 gallon recirculating septic tank with a trickle filter and a upflow filter for disposal of on-site domestic waste water on the referenced property. Test holes were excavated and percolation tests performed. The approximate location of the test holes are located on the attached site plan. At the time of excavatlon water was encountered at 13 feet in test hole #1, and 10 t~t in test hole #3; .'md no water was encountered in test hole #2. After ground water monitoring, water was found at 11 feet in test hole #1, and at 9 feet in test hole #2, and at 6 feet in test hole #3. An innovative system has been chosen for this site based upon the soil conditions, and groundwater levels. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patte~m by the iratallafion of the proposed septic system. Ifyou requke additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/mg id, uNICI?ALIIY 0~: ANCHORAGE r~HVtP. Ot-~ENTAL SERVICES AUG 0 1 RECEIVED Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 ,, EAGLE RIVER. ALASKA 99571 ~ I lOT ~ I D~WN ~~61tlEESI~¢4 BDRM = 600 GPO J~~ J APPLICATION RATE FOR POUSHEg EfflUENT = ~ 600/2 =. 500 SO.FT. REQ D. DISTRIBUTION BED. 2' DEEP (~EMOVE A~ O~GANICS) +2' SAND FILTER 0.5' EFFECTIVE 15' WIDE 20' LONG TRACT H LOT I PROP. WgI. L SITE OSED 2000 GAL RECIRCULATING SEPTIC TANK WITH TRICKLE FILTER ALT. S,TEJ UPFLOW FILTER BED BDRM ~ ,,-lo~ LOT 2 CIRCLE /-¢2 "~'~X-SECON DARY ALT. S~TE LOT 3 LOT 5 pARK CU£NT LOT 14 LOT 1 STRUCTURES, RASEkIENTS. OR ENCROACHMENTS SHOWN OH THIS SITE PLAN ARE AS SHOWN ON AN AS-RUILT SURVEY DRAWN BY: GASTALDI LAND SURVEYING IT I$ THE RESPONSIBIUTY OF THE CONTRACTOR TO VERllry EASEMENTS, REQUIRED SEPARATION DISTANCES. AND PROPERTY UNES PRIOR 10 CONSTRUCTION. ~ LEGAL I ~T ') J DRAWN J.L.M. INSULATED PLASTIC UD VENT CAP · ~ [J ORENCO TF'5060 TRtCKUNG ORENCO G2 ~ F.OAM INSULA~ON (TYP. ~ ~tANHOLE) 4' x 8' BLUE BOARD INSULATION (FROM HOUSE) TANK FABRICATED FROM 3/16' PLATE COATED WiTH TNEMEC 46-465 COAL TAR/ EMULSION ~ RIC)CK 1 FORF~T RIDGF g[JBDIVI_C;ION J CKD.' R,C.C. J DATE7--23--97 I SHT' 2 OF 4 RECIRCULATING SEPTIC TANK WITH TRICKLE FILTER FERNCO QC 106 ORENCO S85-PVC SPLICE BOX WITH S CORD ;LEAN- MEDIA OUT PiPE 6' ABS 1" SPA HOSE NSIDE 4' ABS I PUMP VAULT 24,' £ 7' HUB 6-~) HOLE & FERNCO 7x6 REMOTE ELECTRICAL CONTROL/ALARM BOX~ MH6OOSl MANHOLE (l'fP.2) HVIOOBAK HOSE & VALVE ASSEMBLY (TYP.2) OUTLET (TO UPFLOW FILTER) SVTO8672- 24EF.IR BIOTUBE SCREENED VAULT RETNNERS ORENCO PI IOS13HHF EFFLUENT PUMPS CUENT L~a^~' IhT '~ Jc,~D.' ~'n~'C~T torito- DRAWN J,L,~, R.C.C. I DATE7--23--97 I SHT. 3 OF 4 CUT TO FIT 7~ UPFLOW FILTER x4.1 NOTE: FABRICATE FROM 10 GA. PLATE COAT INSIDE & OUT WITH TNEMEC 46-465 COAL TAR PITCH 4' x 8' BLUE BOARD ANTI-SIPHON ASSEMBLY FROM LIFTING EYE 1-1/4' COUPLING (~P.2) -- IMPORTANT: J TERMINATE PIPE ABOVE ~ID 5x4 FERNCO 4' 5' SEPTIC HUB% ;2MM BLOCK PEA) CUBIC ;IDE VIEW ]CTION TOP VIEW JIM ABS CLEANOUT EXTEND TO SURFACE BED /--LINE OF /iNSIDE FRONT VIEW L t 4'MN,,.I (REMOVE ALL 6' IN. TO GROUNDWATER ORGANICS ANI~ TO BEDROCK J SM MATERIAL,) L ' PROFILE //PROPOSED 2..~,~ GAL ~--PROPOSED PROPOSED BE"' IROULATINO SEPTIC TANK /U(Ps~p~W~[I~T,~ER WITH TRICKLE FILTER / \ CROSS-SECTION Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 - SOILS LOG -- PERCOLATION TEST / LEGAL DESCRIPTION:~.-QT'2,~.-~/, F/Y~i~C'/' /~d~r~' ~ Township, Range, Section: · ~ ELOPE EITE PLAN 1 2 3 4 5 6 7 8 9- 10- 11 13- 14- 15- 16- 17- 18- 19- 20- WAS GROUND WATER ENCOUNTERED? S IF YES. AT WHAT I~' DEPTH? p DATE PERFORMED! ' E ge~h lo Waer After # ILlonitoting? Gross Net ' Depth to Net Reading Date Time Time Water Drop :~o ~o ~ ~/~" ~,' :~ ~o ~,/~,, ~//~,, ~ ~ ~o ~tV/, ~/4 " PERCOLATION RATE ~'~ (m,nutes/,nch) PERC HOLE DIAMETER ~:~ r, TEST RUN BETWEEN ~ FT AND ~'" FT COMMENTS '"."-,--.,.. PERFORMED BY; 17~ ~A~la Dl,.me [~ ~ ~ ~ _ . ACCORDANC~ Wi~L~rI~A~AL GMIOELINES IN EFFECT ON THIS DATE. 72-(X)8 (Rev. 4,8~) CERTIFY THAT THIS TEST WAS PERFORMED l" DATE: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCR,PT,O.:~r2-;Y-//:/ . ~"~/~? l SLOPE 2 4 G- DATE PERFORMED: Township, Range, Section: 10- WAS GROUND WATER ~.~ ENCOUNTERED? SITE PLAN 11- 12- 14 15 16 17 18 19. 20- IF YES, AT WHAT DEPTH? Depth 1,1 Waler After Gross Net Depth to Net Reading Date Time Time Water Drop :'-I( i PERCOLATION RATE /-'--.~L (minutes/tach) PERC HOLE DIAMETER TEST RUN BETWEEN ~' FT AND ~/ FT COMMENTS {,/--~ g~,,'P ~c?~, --/~ ~'~ ~'~',~ ~/~ ~ ~, PERFORMED B~70M ~le Rl~ L~ R~d Ne. ~ t ' C CERTIFY THAT~HIS T~ST WAS PERFORMED IN ACCORDANCE WlIH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ /~1 / ~ ~ 72-008 (Rev. 4/85) Municipality ol Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage, Alaska 99502-0650 SOILS LOG ~ PERCOLATION TEST ! LEGAL DESCRIPTION:~T'~,~/--J::[! /~,'~'C~? PIL.~E 5/4:)Township, Range, Section: -- SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9- 10- 11- 12- 13 14 15 16 17 18 19- 20. WAS GROUND WATER ENCOUNTERED? S IF YES. AT WHAT 6 I pOE DEPTH? ¢, /q Depth ~ Water A~er q~ ~ Il 7 Reading Date Time Time W;*,,,r Drop PERCOLATION RATE ~'1 tm,nules/inchJ PERC HOLE DIAMI~ TER / TEST RUN BETWEEN '~ FT AND 4 FT COMME.'S ~w m 'T; ff. ~- 12-008 {Rev. 4,85) SO~.TEST ROBERT C. COWAN, P.E. July 30, 1997 ClWL ENGINEERS (907) 694-2979 FAX (907) 694-1211 RECIRCULATING SEPTIC TANK WITH A TRICKI,E FILTER AND UPFLOW FILTER SPECIFICATIONS Lot 2, Block 1, Forest Ridge Subdivision GENERAL STATEMENT OF WORK The work covered by these specifications and the plans consist of furnishing all labor, materials, tools, transportation, and equipment necessary to complete an Recirculating Septic Tank with a Tdcldc F'dter and Upflow F'dter system as described herein and on thc attached drawings. All work under this project shall comply with the latest edition and addenda to all applicable codes, ordinances and standards including Municip.~.'ty of Anchorage-Dept. of Health and Human Services (MOA)-(DHHS) septic installation gmdelines and On-Site Waste Water Disposal Systems ~ermits. 4 Bedroom single family home = 600 GPD Soil acceptance rate = 0.7 GPD/SF (sand filter) Use 2.0 GPD/SF for polished effluent 300 S.F. required Us'rog a 15' wide bed with 0.5' effective depth 300/15 = 20 LF Construct bed as shown on attached site plan SITE INVESTIGATION The Contractor who proposes to complete this project must carefully examine the project documents, have full knowledge thereof, have investigated the site, and be satisfied with the conditions affecting the work. Conditions include, but are not limited to those bearing upon transportation, disposal, handling and storage of materials, availability of labor, water, electric power, roads, and uncertainties of weather, physical conditions at the site including all underground utilities, the conformation and condition of the ground, the character of equipment and facilities needed pre 'Im~ to and during prosecution of the work. The Contractor must be satisfied with the character, quality and quantity of. surface and subsurface materials or obstacles to be encountered insofar as this information is reasonably asc~.rtalnable from an inspection of the site, including all prior exploratory work, as well as from information presented by the plans and specifications made a pan ofthis project. Any failure by the Contractor to become acquainted with the available information will not tell.eve him/her from respons~ility for performing the work as stated in these specifications and drawings. 17034 NORTH EAGLE RIVER LOOP * SUffE 204 * EAGLE RIVER. ALASKA 99577 Page 2 Lot 2; Block 1; Forest Ridge Sub. July 31, 1997 Location of utilities shown on the plans are not exact. Above ground utilities have been field located. Below ground utilities are shown as depicted on "as-built" plans. The Owner and his Engineer shall not be held liable for damages to utilities incurred during construction due to deficiencies or omission on the plans. At least twenty-four (24) hours prior to commencing work, the Contractor shall contract all local utility companies to obtain underground utility locates. The Contractor shall exert due care to prevent damage to utilities. Should a utility be damaged, the Contractor shall notify the utility company and shall have repaired at his own expense any damage resulting fi.om failure of the Contractor to request an underground utility locate or to exert due care. If any utility company determines that a utility has to be temporarily raised, lowered, moved, guyed, shored, braced or otherwise protected during construction, it shall be done at the expense of the Contractor to the satisfaction of the utility company. INSPECTIONS Typically, there will be a minimum of.s~.ve~?)-inspections required during the installation of the waste water disposal system. These inspections will occur as follow: Inspection of work in progress may be made by the Engineer and MOA-DHHS at any time. The following schedule of required inspections is to be adhered to. Twenty-four (24) hours notice is required prior to each inspection. Inspections can only be arranged during weekdays and during normal working hours. The following inspection schedule is to be strictly adhered to: Recirculating septic tank/Ikq station is in place, but not backfilled. Sewer piping fi.om building to tank is complete- ' ' ' 2. Upflow filter tank is installed with infiltrator/piping in place (prior to placement of filter liner material). Engineer to be notified with Contractor's schedule during actual construction of the upflow filter to allow spot inspection during construction. Any deviation fi.om reported schedule is to be reported to the Engineer. 4. Finai inspection of the upflow falter with all pressure piping in place, but prior to placement of cover material. 5. Inspection of open trench excavation of leaching bed as per MOA Code. Page 3 Lot 2; Block 1; Forest Ridge Sub. July 31, 1997 6. Inspection of leaching bed prior to final backfill with all piping in place. 7. Inspection of final grading. The Owner shall contract with the Contractor to perform the work outlined in these specifications, plans and in accordance with the attached MOA permit. There will be no contractual arrangement existing between the Contractor and S&S Engineering. S&S Engineering shall be the Owner's representative and will inspect the work as stated above to document the Contractor's activities. Final acceptance of the Contractor's work rests with the Owner and the MOA. S&S Engineering shall have no liability to the Owner or to others for acts or omissions of the Contractor or any other persons performing work on this project or the failure of the Contractor to carry out the work in accordance with these construction documems. S&S Engineering's inspecting Engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. All landscaping fences, sidewalks, paving, driveways, utility markers and other improvements, removed to facilitate the Contractor's operations shall be fully restored to their original condition and location by the Contractor unless otherwise directed by the Engineer. Items damaged by the Contractor during removal, storage, or restoration, shall be repaired or replaced in kind by the Contractor. This work shall be considered inddentai to the project. MINIMUM MATERIAL SPECIFICATIONS 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM FS10 (ItDPE) Yes No ASTM D2662 (/kBS) Yes Yes ASTMD2241 Yes Yes ASTM D2239-74 Yes Yes Use ora type of pipe other than listed above must be approved by the inspecting Engineer. Page 4 Lot 2; Block 1; Forest Ridge Sub. July 31, 1997 3. Insulation shall be at least 2" thick extruded direct burial polystyrene {Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with water fight couplings (Caulder, Femco, or equal). 5. A permeable non-toxic s'dt barrier (Typar 3401, Mirafi 140XN, or equal) must be installed between the final leach field gravel layer and the native soil backfill. 6. All leach field gravel (sewer rock) shall be 0.5"-2.5' screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current MOA or DEC requirements. A. General RECIRCULATING SEPTIC TANK/LIIZr STATION The work under this section consists of the performance of all operations pertaining to furnishing and installing the septic ~ station and piping to the sand filter. B. Materials 1. Tank for Lift Systems ~ Septic tank shall be a 2000 gallon two compartment steel tank specifically for the use of Orenco Systems, Inc. patented ~ station assem- bly Orenco No. 4200. b. The tanks shall be designed for soil loading conditions as required by MOA and State regulations. The design or analysis shall be in accordance with accepted engineering practice and local regulatory agenfies. ¢. All welding shall be in accordance with applicable codes and standards. v. F'~t compartment shall have a separate 6" pump out riser. Page 5 Lot 2; Block 1; Forest Ridge Sub. July 31, 1997 b. An additional second compartment outlet riser shall be 12 gauge sheet steel and shall extend 12" (minimum), above surface grade, shall have a minimum nominal diameter of 24" and shall be capable of being equipped with the following: 1. A junction (Nema 4x) box or equal, bonded or attached to the riser. 2. UL listed electrical cord grips, installed in the ]'-box. e. A lid - shall be furnished with the riser. It shall be constructed of fiberglass or equivalent aggregate finish, meet H-10 loading requirements and have a latching mechanism. d. Riser installation - each riser shall be sealed or welded to the top or' the tank in such a manner as to prevent infiltration ofground water. e. Lid insulation - 4" rigid extruded polystyrene shall be placed in'the riser directly below and attached to the lid. f. Riser insulation - 2" sprayed shop applied urethane on circumference riser with 46465 Tnemee coating. Effluent Pumping Assembly iL Eftluent pumping assembly shall be Oreneo systems (TM) Model 20-OSI-05-HHF series consisting of the following: 1. 1/2 H.P. 110 volt or equal U.L. Listed ef[luent pump. 2. Screened pump vault (U.S. patent l~lo. 4439323) 59" deep, 3/16" thick high-density PVC cylinder houses the pump, level con- trois and screen and serves as a baffle to prevent the screen from clogging. Fdteen 1 1/2" diameter holes are drilled in the vault at a level that places them at about the midway point in the depth of'the septic. Flap cheek: Allows the vault to drain when removing the tank. Page 6 Lot 2; Block 1; Forest Ridge Sub. July 31, 1997 Screen: 15" diameter cylinder of high-density polyethylene 1/8" mesh. 3. All piping shall be PVC or other non-corroding material. b. Pump controls and alarm system shall be Orenco systems SICTETMRO 110 volt with the following options consisting of': 1. Event counter ' ' 2. Elapsed time meter 3. Program timer 4. 10 watt heater 5. Remote alann panel option with a minimum of 80 DB sound pressure at 24", operating temperature 30AC to 65AC, continuous sound to be located in the home. 6. Oil-tight visual alarm with push-to-silence feature. Automatic audio-alarm reset. 7. 15 amp motor rated toggle switch, double pole, double throw with three positions; mantml (man), automatic (auto) and center (o~ (H.O.A.). 8. Nema 4x-rated, fiberglass, or equal, enclosure with hinged cover. 9. All controls to be installed as per manufacturer's recommendations. 10. Control panel to be installed on outside wall of home within sight ofseptic tank/li~ station. c. Piping fi.om the septic tank to the uptlow filter is to be 1 1/4" PVC schedule 40 solvent weld piping properly bedded as described in Materials Specifications and sloped to drain back to the septic tank. Insulation board 2" thick and 2' wide centered over pipe is to be placed where soil cover is less than 4' depth over pipe. Page 7 Lot 2; Block 1; Forest Ridge Sub. July 31, 1997 CONSTRUCTION SEQUENCE In order to insure proper inspection procedure, the system is to be installed in the following order: 1. Sewer line fi.om house to tank 2. Recirculating septic tank/lift station 3. Upflow filter 4. Leach fidd 5. Yma~ grading CONSTRUCTION Pipe Grade and Alignment Variance ofindividual pipe sections fi.om established line and grade shall not be greater than 0.01 feet, providing that such variance does not result in a level or reverse sloping invert. During the progress of the work, the Contractor shall provide instruments such as transits, or levels, for transferring grades fi.om offset hubs or other construction guides fi.om the control points and bench marks provided to the Contractor by the Engineer. The Contractor shall provide qualified personnel to use such instruments and who shall have the duty and responsibility for placing and maintaining such construction guides. Pipe Laying All pipe shall be laid on undisturbed soil or compacted to 95%. Each section of pipe shall be properly supported to insure true alignment and an invert which is smooth and free fi.om roughness or irregularity. At all times, when work is not in progress, open ends of pipe and fittings shall be securely and satisfactorily dosed so that no undesirable substance will emer the end of the pipe or fittings. Page 8 Lot 2; Block 1; Forest Ridge Sub. July 31, 1997 Electrical Installation Electrical installation is to be to code by a licensed electrical contractor, with Municipality inspection where required. Electrical inspection report to be provided to the engineer as soon as a~i!ahle. If MOA inspection is not required, a licensed electrician is to provide a letter to the Engineer stating that the system meets or exceeds all applicable codes. Excavation Excavate to proper depth to allow gravity flow, install tank level, tolerance 0.05 foot, on undisturbed or compacted to 95% class'fled sand fill material. Line excavated recireulating septic tank and upflow filter pit walls with 2" +35 PSI burial foam full depth oftank. Back fill between tanks and foam with sand material and compact in a manner to prevent damage to the tanks surface coatings. Create a level sand surface over the tank and add 2" burial foam +35 PSI directly over tank. Mound unclass'fl~ed soil over the tank locations to a depth of 2' above finished grade to allow positive drainage away fi.om tank and counteract buoyancy. Connections All connections to be as per MOA-DHHS and LIPS requirements PVC 3034 piping with Caulder or equivalent couplings for inlet riser pipes. All tank connections are to be completely water tight. Page 9 Lot 2; Block 1; Forest Ridge Sub. July 31, 1997 UPFLOW FILTER Attacbeda~ drawings of both the Orenco "trickstep" tank (Recirculating septic tank) and the "Upflow" filter, prepared by Anchorage Tank. All materials and construction of the up,tow falter shall be installed as per drawings and specifications set by Anchorage Tank and MOA-DHHS o MOUNDED Lv~&CH FIELD BED General The work in this section pertains to furnishing all materials and installation of the septic leach field. Materials All materials shall be as approved by the MOA-DHHS for leach field construction. Leach field piping is to be fabricated to allow pressure dism"oution. All holes in the fabricated piping are to be deburred and fiushed dean. Construction Construction is to be as per MOA-DHHS Codes and Guidelines. Mound System Installation Any peat or organic matter must be removed fi-om the elevated mound site. b. The bottom of the basal bed area as well as the top of the sand filter is to be within two inches of level. c. The distn"oufion piping is to be ofPVC (ASTM D3034 or equal). All joints are to be solvent cemented. d. The side slopes of the top layer of the mound system must not be steeper than 33% 0:1). e. The top of the mound shall be covered with a minimum of 6 inches of topsoil and vegetated sufficiently to prevent erosion. f. The dism'bution pipes are to be embedded in sewer rock. Care should be taken to backfill in such a way as to prevent damage to the piping system. Page 10 Lot 2; Block 1; Forest Ridge Sub. Suly 31, 1997 Silt barrier material must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Backfill over the final gravel layer must not be less then twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. Municipality of Anchorage Depadment 0f Health and Human Services 825 'L" Street Rick Mystrom, P.O. BOX 196650 Anchorage, Alaska 99519-6650 Mayor http'J/',,,o,~v.ci.anchorage.ak.us Dear Homco~=er/Prospeetive Buyer: The on-site was~vater disposal system you am purchasing/installing is an "alternative" wastewater disposal system. This system, hnown as a "Recirculafing/Upflow Filter Septic System", is undergoing testing within the Municipality of Anchorage under the Alternative System section of the Waste~ater Disposal Regulations (AMC 15.65). There are certain risks involved with the oxv~ership of one of these systems: The technology used in this system has been shmvn to be effective in other areas. The system is currently undergoing a t~vo year testing period in Anchorage under the guidance of the Department of Health and Human Services (DHHS) and the State of Alaska Department of Environmental Conservation (ADEC) to determine its effectiveness in a subarctic environment. Thc system for this property may have received vertical separation distance waivers from both State of AJaska and Anchorage Municipal Codes to both ground water and bedrock. These ~aivers were granted due ~ the system's expected perforr~ce wit]~ the site conditions on this property. If the test results do not support these waivers, modification or replacement of this system may be required. If this system fails to meet the requirements set for it to become a standard, code approved waste~ater disposal system, it ma5' have to be removed and replaced by either a holding tank or (if possible) other ~vastewater disposal system that meets Municipality of Anchorage requirements. The cost of uny conversions required to meet code requirements will be the responsibility of the homeo~aaer at the time of conversion. I (we) certify that I (we) have read the above statements and am (are) a~are of the risks outlined. I (we) also certify that I (we) am (are) in the process of purehasing (property legal description): (purohr~scr Name) (Purch,~scr Signature) (Purchaser Name) (Purchaser Signature) NoU~ Here i STATE OF ,ALASKA · . ..~ DEPARTMENT OF NATURAL RESOURCES " ';" ' : .. DIVISION OF MINING & WATER MGMT "' WATER WELL RECORD LOCATION OF WELL . · BOROUGH 8UBOIVIG/O~N LOT BLOCK SECTION QT~S SECTION TOWNSHIP' RANGE MERJDIAN []N DE ~c' ' Os Ow LOCATION/SKETCH: BOREHOLE DATA: Material Type and Color DEPTHS MEASURED FROM:lTIcasing top I-lground surface Depth From To WELL OWNER: WELL DEPTH: Depth of hole: Depth of casing: /~.~ · DATE OF COMPLETION ft DEPTH TO STATIC WATER LEVEL: / t~'~ ft below~/-E~, top Of casing [] ground surface" METHOD OF DRILLING: I~ air rotary . [] cable ~ool: . [] other ~ ' ...... "' :- USE OI~ WELL: ~ domesti~ [] irrigation [] monitor. ' [] public supply [] other ' CASING STICK-UP: ' ,~-- ft.' Diam: ~ 'in. Casing type::~.~'~7~' ~(~'~. to /r"2/ ft WELL INTAKE OPENING TYPE: .;EJ open end [] screened r-I perforated r-I open hole Depths of openings: to ft SCREEN TYPE: Diam: in. Slot~Mesh Size: Length: ft GRAVEL PACK TYP~: ' ' :'- ...... Volume used: Depth to top: Depth: from ft to ft DEVELOPMENT METHOD:" C~/)t~.. Duration: '"? ~---/, ,.,,,..~ · PUMPIN_~ LEVEL AND YIELD: . ' ,,/,/~'C~ ft after ~'" ,. hrs Pumping ~-~ gpm I~UMP INTAKE DEPTH: ft Horsepower: __ WELL DISINFECTED UPON COMPLETION7 ~ YES I-1 NO CONTRACTOR INFORMATION: ,, .; ~. /~.,' '~ ' rtegisteced Business r~ame ' / b'gnature of AuthOr zed ttespresent~3tive Date REMARKS: PLEASE MAIL WHITE COPY OF LOG TO: DNRIDIVISION OF MINING & WATER MGMT 3601 C St, Suite 800 ANCHORAGE AK 99503-5935 ....... * .........._' ?.hone (907)762-2538, Fax (907~562-1384 CT&E Ref.# 980647002 Cllent Name S & S Enginecring Project Name/# N/A Client Sample ID Lot 2 Blk 1 Forest Matrix Drinking Water Ordered By PWSID Sample Remarks: Client PO# Printed Date/Time 02/17/98 12:58 Collected Date/Time 02/13/98 09:15 Received Date/Time 02/13/98 10:45 Technical Director: Stephen C. Ede Released B~j~.~ ~ Parameter Rest{ts Units Method Attowmbte Prep ~atysia Limits Date Date {nit #itrate-N Uaters Oepartment Armatyses ?oral Coliform 0.100 U 0 0.100 EPA 300.0 10 max 02/13/98 RMV coL/IOO~L St418 9222B 02/13/98 G $ Municipality of Anchorage On -Site Water and Wastewater Program 4 (907)343 7904 is5 A F E T r Certificate of On -Site Systems Approval Parcel I.D. 017-112-75 Expiration Date: 7 X23 ^2 0 1. GENERAL INFORMATION: Complete legal description FOREST RIDGE: BLOCK 1, LOT 2 Location (site address) 5331 Bishop's Castle Circle *Anchorage99516 Current Property owner(s) Paul & Selma Gabbert Day phone 351-4177 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class_Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ 1 WaiverNariance request for: i Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ ~ W2 'YD Waiver Fee $ Date of Payment �(� a �a0 Date of Payment Receipt Number Receipt Number COSA # a 5 20 /asp Waiver # COVID-l9 2570 DISCOUNT APPLIED k 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 (GEG) Phone: 907-337-6179 Address:3701 East Tudor Road Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: C Li b 12,6 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for 4_( bedrooms bedrooms \TYtor(r(r�(ii _ bedrooms, with the followir�i_ *ultipN-SITE �y zf WATFQ e A, � �? System #2 Approved for Disapproved Conditional approval for #AECC884 y ''))111)))1))) By. � Original Certificate Date: 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 Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other =__ /] c -Ah CCi4•:� SJ 0•:ice Legal Description: FOREST RIDGE; BLOCK 1, LOT 2 If more than 1 septic system on lot: COSA Checklist # 1 of A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 915/97 Total depth 104 ft Cased to 101 ft 0 Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 5/29/20 Static water level at beginning of test 21.5 ft. Comments B. TANK DATA Age of tank(s) 23 years Tank type/material STEPS El Measured operating fluid level in septic tank 5 0 Standpipes/foundation cle pout per record drawing Date of pumping �1 / '7(7 r D. ABSORPTION FIELD DATA BED Which system tested (date installed) 9/26/97 0 ALL standpipes present per record drawing Total measured depth from grade 3 ft (max) Measured depth to pipe invert from grade X2.9+ ft (min) ❑ N/A — pressurized field 0 Monitor tubes go to bottom of effective. If not, state depth into effective 0 Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: 'DRAINFIELD IS INSULATED COSA Checklist yellow sheet Parcel ID: 017-112-75 Structure served by this system 1 Well production at time of test 8+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes 0 No 2 Coliform bacteria is Negative Nitrate O mg/L ❑ Nitrate less than MRL (ND) Arsenic /V0 ug/L ❑ Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 5/29/20 G. LIFT STATION ❑ Required maintenance completed Age of lift station 23 years Lift station material STEEL Comments: Adequacy test date 5/29/20 Results ❑✓, Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 604 gal New depth 1 in Elapsed time 25 min Final fluid depth 0 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) NONE If yes, enter date NIA 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' El Yes Community Sewer Manhole/Cleanout > 100' QQ Yes if No ft Q Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' ✓0 Yes if No ft Water Main > 10' Animal Containment> 50' Yes if No ft 0 Yes if No ft Yes if No ft Water Service Line > 10' [✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' M Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' El Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' F,71 Yes if No ft Wells on Adjacent Lots: Yes Absorption Field > 5' R/1 Yes if No ft Private Wells > 100' ✓0 Yes if No ft Water Main > 10' R� Yes if No ft Community Wells > 200'✓Q Yes if No ft 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' F -I Yes if No *51+ ft If absorption field is under driveway comment below Property Line > 10' F71 Yes if No ft Wells on Adjacent Lots: Water Main > 10' P/1 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' 1771 Yes if No ft Community Wells > 200' 1771 Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALL. THE CONDITION OF THE 23 YEAR OLD STEEL SEPTIC (S.T.E.P.) TANK AND UPFLOW FILTER ARE UNKNOWN. SEE ATTACHED MOA ADVISORY NOTICE. a�Q0000. 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 I Q MOA COSH guidelines in effect on this date. .`.:... g .... .� QJe fre%'A nest. O E—'795 O COSA Checklist yellow sheet v�Qa pro fess °moo #AECC884 ��OOood� Qf� Septic 'Tank Advisory Certificate of On -Site Systems Approval #OSC 201250 Subdivision: Forest Ridge Block 1 Lot 2 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic/ step tank for this property is 23 years old. Typical replacement costs range from 15,000 to $20,000. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. Mailing dddress P O Box 196650'* Anchorage, Alaska 99519 6650' www muni org Invoice Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchoracye. Alaska 99516 Phone 727-8864 Fax 345-1391 June 22, 2020 PAUL GABBERT & SELMA RAMSDELL 5331 BISHOPS CASTLE CIRCLE ANCHORAGE, AK 99516 Re: Septic Repair Legal: FOREST RIDGE BLK 1 LT 2 Description of Excavation Services Provided: 1. Repair of the up -flow sand filter. Total due this invoice $ 2,800.00 F- 90 7, 14, 3-71 :Box , 9�1650 Anchni-Ige, AK 99519�fjo-s4y - Intermittent Dosing Sand Filter MaintUenance Log (>,vnerPh Qne ujd�Lkc:�,— Street Address.�57-�NL_a Li<�� C�� C`, I- 4 Lj� Legal Desc, PID— S2j�sti+c Ta�nk: n l� I 0--� �$ Vilwo I inches -t-umpjng:, required(��no -Pumping cornpieted 110 AtIorptiqrt Field- N,,,, �e. ;.o -Liquid level inches -Flushing valves per approved design yes no *All fiUShing valves opened. Lift stattion distibution lines flusile'd, and flushinavalves closed Y -!$—.n no *Plump basket cleaned 1-2,02 *Biotube effluent filter cleaned (veno -Timer float settinga I inches -High level float setting73 inches -Refference- poin GI -Pump on -pump off minutes 'Cumulative lifetime cycles -J2.9 1. -Cumulative run timodz�-7 o—,hours -Operation satisfactory Ce � no Ali_�ystem: *Air pump filter cleaned *Date of latest install or rebuild Alarm Stam: -Dedicated electrical circuit ( ae no *Float setting 7-3 inches ,Air pressure -Air system operation satisfactory not -Audible and visual alarm inside dwelling<�no -Alarm system operation(L-a-ti�—actoncit�satisfactor,,r Co L-nments: 14 ..... ...... ... . . .............. ................. ........... ....... ............ .................................. 1-11 ......... ............. 1-1 ........ ........ UlLintenanoe Provider Technician Company Signature IDSF Mz7ntenarce Lr -,,/,0313,dOC Date of maintenance Date �_6 - —Z0 MUNICIPALITY OF ANCHORAGE 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 J nof 20-QQ, by and between herein the "OWNER," and the Municipality of Anch rage, 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 0 VV t l 'in "lt fiaic,ti located at (lega 'd"e'sce.rtption) 6r.sCA /I 2. (Owner is required to read, understand and initial each section) G42/ Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service 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 to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality 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 AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 WAA— Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. jtLr— 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. VtAL Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. K9_ Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. 04A_ 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 every 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. (rev. 05/18/2018) Page 2 of 3 OWNER: By: (signature) Date: Y,;Z��...(print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this day of , 20_,� by Z& � _l LJ,�- (print name) Title: (rev. 05/18/2018) Page 3 of 3 FOR ALASNOTARYPUBLK My Commission expires: �-NO • .SUB aa. IV'JT�TiCIPALIT�'°� ALA���\ �� //1llfll V\ Date: 3 By: f/�� (signature) (print name) Title: (rev. 05/18/2018) Page 3 of 3 CastleCJr � t� Cl0 N � N O .� Q��• OF • AC' �S r� �•_ • • •� ,' 49th ... 0 00 .Fred Walatko 3255 — S AV SCALE: 1"= 50' S72o39� EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. JAG, FB 16-3, pg 24-26 BE 30 I~ N O .§ m 0 O 0 O!W 30 AS -BUILT NO CORNERS SET THIS DATE w w F- 0 z Ld w W 7 I hereby certify that 1 have performed a Mortgagee's inspection of the following described property: LOT 2, BLOCK 1, FOREST RIDGE SUBDIVISION Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 25th day of APRIL 2m FRED WALATKA &.ASSOCIATES (907-248-1666) Engineers and Surveyors c 1 6 9 70 SCD 6- 7/2 • I '--;j Municipality of Anchora 1 : '�~ ,' On-Site Water and Wastewater Program 0- MAY 1 a a 0 , J" �__% (907)343-7904 t6 cuiN c h Certificate of On-Site Systems Approv. °t 5 e L 95 erri-Parcel1.D. 017-112-75 Expiration Date: A3/7 1. GENERAL INFORMATION Complete legal description FOREST RIDGE; BLOCK 1, LOT 2 Location (site address) 5331 Bishop's Castle Circle *Anchorage 99516 Current Property owner(s) Thomas Culhane Day phone 240-8688 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well © Individual Ikl Individual Water Storage ❑ Holding Tank ❑ Community Class Well 0 Community 0 Public Water System 0 Public Sewer ❑ WaiverNariance request for:N/A Distance:N/A 44______, Received IL .e Date: y//Z£3/i6 COSA to be released to thitz;64... s oth� quested by the engineer. COSA Fee $ Si? —/ / Waiver Fee $ Date of Payment S l/col/fe Date of Payment Receipt Number 0co13(`(.1 Receipt Number COSA# 030 c l I (o 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. (GEG) Phone (907) 337-6179 Address 3701 E. Tudor Road, Suite 101, Anchorage AK, 99507-1259 Engineer's Printed Name Jeffrey A. Garness Date 5/6> r(, • In system in a cng thisevaluation, with the guidelines and regulations established by the Municipal ty of septicon of the well and/or �ss•,sssOF l*Ail_ 5 Anchorage and industry practices. The reported results describe the condition of the system/s on the �4 ...cc` (111 date/s of the evaluation. Separation distances were measured to readily identifiable features. •4�.''�.•" ... ) Hidden defects or encroachments may exist that were not identified during the evaluation. The /••• • 0.0 operational life of all wells and septic systems depend on a variety of variables including,but not ._ limited to, soil conditions,groundwater levels(that may fluctuate during the year), quality of a *;� 4 J. E* 0 s construction(materials and workmanship),and the water usage of the family utilizing the system/s. • h•'•' • f '•" ••• j These conditions can vary, and are outside the control of GEG. Satisfactory test results do not I • guarantee future performance of the system/s;therefore, GEG makes no warranty(express or ', • j implied)regarding the future performance of the well or septic system. GEG makes no 1 ';•I ,1" -y '. .^.mess o representation whether an alternative well or septic system can be installed on the property in the �0�i S, CE- 9 event either of the current systems fail. The content of this report is for the sole benefit of the % S7fb /L person/party who retained GEG.Reliance upon the information provided in this report by any other 0 4 �4 ' tib e person or party,including but not limited to subsequent property purchasers,is not authorized.In ••��•... ..... P • short, GEG disavows any legal duty to anyone other than the person/party who paid for this report. t11talit ESSt'ie alit''''' • 6. DSD SIGNATURE / / System #1 Approved for �( bedrooms System#2 Approved for bedrooms \-(N( OFAA . rc Disapproved �� yp dui Conditional approval for bedrooms, with the following sti ation N-SITE • WATER AND :0 I. 1 /±T_' Z: co PROGRAM �6: Uo ON 1%:74%,,,- ..rG.. /// - 'if_''{ot v... l By: •,. l -gOriginal Certificate Date: -------•-•,.-------•-•,. 1143/16 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only /✓Mt) 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 blue sheet e-1.12.doc • 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: FOREST RIDGE; BLOCK 1, LOT 2 Parcel ID: 017-112-75 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 9/5/97 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 104 ft. Cased to 101 ft. Casing height(above ground) 41 S in. Omu/ FROM WELL LOG AT INSPECTION (-6G Date of test 9/5/97 4/19/16 Static water level 16 ft. 13.1 ft. 5 Well production 20 g.p.m. 3.9+ g.p.m. e WATER SAMPLE RESULTS: Ul Coliform 0 colonies/100 ml. Nitrate pc)mg./L. Collected by: GEG. Ltd. E Arsenic: N Oug./L. Date of sample: 4/19/16 4 o CJB. SEPTIC/HOLDING TANK DATA b Tank TypelMaterial SEPTIC STEEL Date installed 9/26/97 .,, STEP u, 2 Tank size 2000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (Y/N) YES Date of pumping 10/20/15 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA BELOW EXISTING GRADE Date installed 9/26/97 Soil rating _.p.d./ft2. in 2.0 System type BED Length 20 ft. Width 15 ft. Gravel below pipe 0.5 ft. Total depth 2.9+ ft. Eff. absorption area 300 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 4/19/16 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 853 gal. New depth 0 in. ' Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) NONE KNOWN If yes, give date — *1/3 OF 2000 GALLONS STEP TANK **SEE MAINTENANCE LOG D. LIFT STATION Date installed 9/26/97 Size in gallons *660 Manhole/Access (Y/N) YES "Pump on" level at TIMER in. "Pump off level at TIMER in. High water alarm level at **73 in. Datum**TOP OF MANHOLE Cycles tested ** 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 1001+ Sewer:/septic service line 251+ Holding tank 75'+ Animal containment areas 501+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 'Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 1001+ Wells on adjacent lots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 5'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS _oob`JO G. ENGINEER'S CERTIFICATION o r OF. � ��4 o� .. .... I..:. 9S,4p0 * At ' Jfo,.# �o� I certify that I have determined through field inspections and Q c g review of Municipal records that the above systems are in '� conformance with MOA COSA guidelines in effect on this / f 0 ..... . 0 date. f '•.Je r- Garn-•s Engineer's Printed Name JEFFREY A. GARNESS - �Q 9, r 9 - • Date /L/� 4e� .•.ib/b'\�od fro f essio^c o (Rev.11/05) 8435Z 30 Lot 1 O "5NN' LU �Q4 Septic ven s n w LO E a+i7. v� ��) (V co �C3b / OM Septic tanks Z e LLJ Block Ret.Walls/ 25.0 0 W /GO. a en f/ o 3.5 N N— \ �/ A.Ist.. 33.0 0 E Ch LU X 20.0' a) O LU Asphalt 0 2 Story Frame COu, 0 AI _ c� �+ — 15 0 �. Z '�IJ,j r well �'tL5 - 400 d S S r i\> j0 33.0 W ri 05 Cie 0 \r o N LOT 2 E . . • • 0 \ / K• #� N • / F \ / o \ / r tom Si-20391j F 25-8 34 Lot 3 30 1 P�� o •f . •Ail�gsI� I ••49th �\ .6:,i_ •�� I, AS-BUILT NO CORNERS SET THIS DATE / *• •••�' I hereby certify that I have performed a Mortgagee's inspection 'J)� •• of the following described property: LOT 2, BLOCK 1, J *•We ,*.-a-__ / FOREST RIDGE SUBDIVISION /NN''�ll�i1 / C,•.Fred Walatka :2 o ,, `"s„•• 3255 — $ •••Se Po Anchorage Recording Precinct,Alaska,and that the cqF 9 improvements situated thereon are within the property lines � o • • • • • • do and do not overlap or encroach on the property lying II k .orEssioNo- `-- adjacent thereto,that no improvements on the property lying k Ii.'SVS" adjacent thereto encroach on the premises in question and that there are no roadways,transmission lines or other visible easements on said property except as indicated hereon. SCALE: 1"_— 50' Dated at Anchorage,Alaska this 25th day of APRIL ,2016 EASEMENTS OF RECORD,OTHER THAN THOSE SHOWN ON THE RECORDED FRED WALATKA&ASSOCIATES PLAT ARE NOT SHOWN HEREON. Engineers and Surveyors JAG, FB 16-3, pg 24-26 BE (907-248-1666) ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE AND%aJ( SA S Giabb)rt THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this 5 Day of oVeofig of 20[1.-„ by and between AA 4SlIviik GEac 'k herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Maintenance and Repair Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as A ,Cvwt�Vattvr �/ W`�I `J�` 1 IGh 1hG,0k5 a recIYculakthc }tank w akr1/4LK1t1b01/4 Ott() ()pFlow .(iI-tt and R6171171-Ion ,e - located at(legal description). @e v A-4'94976254 g —vi— Z- 7,5— 75 L2 D I Fore -l- Rtdie. 2. Definitions. Alteration. Any change to the design or function of an AWWTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Certificate of On-Site Systems Approval (COSA). An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with Anchorage Municipal Code (hereinafter, "AMC") 15.65. These approvals certify that the systems arc adequate for the homes that they support and meet the codes that were in place at the time of system construction. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. Permit. An On-Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AWWTS. 3. Term. The term of this Maintenance and Repair Agreement shall begin on the date of approval by the Municipality to operate the installed system or issuance of a COSA, and shall continue while the AWWTS is in use or is operational or until the property is sold or title is transferred by the owner and a new COSA is issued to the new owner or transferee of the property. 4. Alterations, Installation and Removal of Additional Equipment. Prior to performing any alterations to an AWWTS, the owner agrees to obtain an On-site Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65. 5. Maintenance and Repairs. A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall maintain their AWWTS in a satisfactory condition capable of producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. The owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the municipality and the manufacturer of the AWWTS for the entire term of the AWWTS.. In addition, it shall be the responsibility of the Owner during the term of this Maintenance and Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules and orders for the AWWTS. C. Upon request by the Municipality, the owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system. When a record of maintenance is documented and maintained by the system vendor, the owner agrees to allow the Municipality access to this information. D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60 for improper discharge. E. Owner agrees that only maintenance and repair personnel approved by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. F. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. G. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. H. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. 1. Owner agrees to provide and maintain a telephone connection to the AWWTS as required by the AWWTS approval. 6. Nonwaiver. The failure of either party at any time to enforce a provision of this Maintenance and Repair Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Maintenance and Repair Agreement or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 7. Amendment. A. This Maintenance and Repair Agreement shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality that this Maintenance and Repair Agreement was executed with, and such writing shall be attached to this Maintenance and Repair Agreement as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this agreement, the only authorized representatives of the parties are: ( a. Owner: ?as S �i1k'la ah\f.„f'6, b. Municipality: Director, Community Development or designated authority C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repair 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 Maintenance and Repair Agreement. 9. Severability. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Maintenance and Repair Agreement. OWNER: i By: 6"�f (signature) Date: 11754.10 , 1 dl I 4bbeift (print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT The foregoing instr1 meet was acknowledged before me this 16hday of N.)01-em , 20 Ito, by �F0.� (jet Ai NOTAR P BLIC FOR ALAS Sarldx3 uolssiwwop (yy � ZOIAROOIN VABVIN My Commission expires: /' 31Z �I 0; + f ..,,fix JI7fiRd AMOLON NOTARY PUBLIC MARVA NIDOINICZ PIM?) Y�. MUNICIPALITY: LMYCommissionExpires 1 Z BY: �/J W NKi (signature) Date: 11/216 rint name Title: /� (p ) li ParcelI.D.# 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 ~ $£RVICES DIVISION FEB- RECEIVED ., GENERAL INFORMATION Complete legal description Lot 2: Block 1: Forest Ridqe Location (site address or directions) · P~operty owner Mailing address '~.i'Lending agency · Mailing address -Agent -- · Colony Builders~ Inc. -2340 Loren Circle Address NHN Bishops Castle Circle Anchoraqet AK Day phone A~cho~age, AK 995]6 Day phone 244-6233 Day phone e e Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WA;I'ER SUPPLY: NOTE: Individual well xxx Community well Public water If community well system, provide written confirmation from State ADEC ~ttest- lng to the legality and status of system. ~ TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: xxx If community wastewater system, provide written confirmation fr. om State ADEC attesting to the legality and status of system. o STATEMENT OF INSPECTION BY ENGINEER As certified by my s.eal affixed hereto and as of the validation date shown be ow, 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 0f structure indicated herein. I further verify that based on the nformation 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 regulabons tn eff(~ct on the date of th s nspection. Name of Firm $ & $ ENGINEERING Phone (~1 ,J -~- ~l?~: ' 17034 Eagle River Loop Road No. 204 Address Ea~l[e River, Alaska 99577 Engineer's signature - Date ~ / / ? [ ~ ~d 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Sen/ices (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. r-'dVIIL~O~M~NTAL ,SERVICES OlVi$10l~, FEB 18 Municipality of Anchorage _ DEPARTMENT OF HEALTH & HUMAN SERVIC~ C E I V Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist LegalDescription: L,T 2,~>r~.v. t~ I:'~.e~' ~OG~ _('/.O ParcelI.D.: OI1--112--'/5' A. WELL DATA Well type Log pmssnt If A, B, or C, attach ADEC letter. ADEC water system number Date completed <~ Cased to I ON t Casing height (above ground) Wires properly protected ~/N) AT INSPECTION FROM WELL LOG ! g.p.m. Date of test Static water level Well production ~ g.p.m. WATER SAMPLE RESULTS: O Colllol~n Date of sample: A / I ~ Nitrate o. / Other bacteria B. SEPTi~TANK DATA Date installed q -Z(,-91 Tank size Collected by: Number of Compartments High water alarm (~tN) 17034 Eagle River bp Ro.d, No. 204 Eagle River, Al&sk. 99577 __ Claanoute ~/N), · Soil rating (g.p. dJfF or ftVbdrm). '2 · O Foundation cl_eanout (~/N). ~'~ Date of pumping,,,~'""t ,:. Pumper C. ABSOflItrTION FIELD DATA ' "' Date ~nstalled '~- S°~t'I '" e Date of adequacy test System type ~0 ~, /+~z' Gravel thickness below pipe O-~;; Total depth 4'*41 ~o MonttedngTube present ~IN) *tgE~ Depression over flald (Y/~ t Jr3 Results (Pass/Fall) ~ For /'~ .bedrooms Fluid depth in absorption field before test (in.); Immediately after ~ gal. water added (in.): Fluid depth '"--"' (ins) Minutes later:. Absorption rate = ~ g.p.d. Peroxide treatment (past 12 months) (Y/N) '"-'-' If yes, give date 72-O26(Rev. 3/96)* *l"~,tr.a.~ I~'I~.'T~L ~'~P Cfgt..eca Date installed ~/Z M nholalAcces High water alarm level at* I.~ Size in gallons 'Pump on" level et* t~l ~ *Datum Cycles tested 'Zooo "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots [ oo jooLI- Public sewer manholalcleanout ~,/~, Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDINGTANK ON LOTTO: I Foundation ~1 Property line ~'1~ I+_,. Absorption field. Watermalniservicellne I,1'4' Surfacewater/drenage leel'~ Walls on adjacent lnts SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Properly line Surtace water Curtain drain I / o Building foundation 2"/! Water malniservice line I Oo I 1' ' Driveway, parking/vehicle storage area ..~o I~1 e~tr, I/-~e~ ~ Wells on adjacent lots I oo I~. R ENGINEER'S CERTIFICATION I cerfify that I have determined thru field inspections and review of Municipal reco,~~~rns am in ceni'on'na~ce ~ Mm H/~p~/de///les in e~1~of ~ th/s date. ~ (9~'" .~'.:~ 724326 (Rev. 3/9e)* Waiver Fee $ Date of Payment Receipt Number