Press Alt + R to read the document text or Alt + P to download or print.

No preview available

The URL can be used to link to this page

Home My WebLink AboutFOREST RIDGE BLK 1 LT 5Forest Ridge Block 1 Lot 5 #017�112�78 - Municipality of Anchorage Page Jof 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: SwQJo/o/ PID Number: 0/7//278 Name: Wastewater System: XNew ❑ Upgrade woxeo4. /.Vvesrr ,ei Address: ABSORPTION FIELD /F+ft.v TrA� vb Phone: No. of Bedrooms: ❑ Deep Trench ❑ Shallow Trench ,R -Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating Total Depth from original grade: Z•• O. CGPD/S Ft Lot. Block: Subdivision: Depth to pipe bottom from originalg/rade. / Gravel depth beneath pipe 5" / o.Arrr Rfob X0.1 Ft 10. S' Ft. Township: Range: Section: Fill added above original grade: Gravel length: 2./A FI IYO FI Gravel width: Numbrf lines: Distance between lints: WELL: ❑ New ❑ Upgrade i 10 Ft Ft. Classification (Private. A.B.C): Total Depth: Cased To: ° Total absorption area: Pipe material: I AA /PATlr 23 a Ft. �3 FL /s0o So Ft .tsnv osat9 Driller: Dale Drilled: Static Water Level: installer- Q Date installed: b-113-193 t Ft. z,/ 2izia 7 �J!!/4L � Yield: Pump Set at. Casing Height AOpye Ground TANK / GPM V h- Ft. f111' Ft. SEPARATION DISTANCES 0Septic ❑Holding f3E.T.E.P. To Septic Absorption Lilt Holding ubliUPnvale Manufacturer: Capacity in gallons: From Tank Fwld Suwon Tank Sewer Linea YgA),,04o/AAi6 TV /S'oo Material: Number of Compartments: Well /00..0 /04)•I /00/% I .1Z Surface LIFT STATION Water /0a •t /00 as /Oo /s Lot/D rf /0 F><- /O I �� Size in gallons: Manufacturer: AAk_hoAA&ar %iA.c.l,� Line /s.0o "Pump on" level at: 'Pump off' level at: High water alarm at: Foundation / / za CurtainONE 0%(J/V Pump Make a Model Electrical Inspections performed by: 1 Drain OS/ OS'//// /)1.0-A BENCH MARK Remarks: Location and Description R E C E I V E D 7 -of LIP Loa✓EZ W/n700A/ SGIaL 11 2 :194 ev N. G. GOAA)--A NOV Assumed Elevation: 'C'0s /oa.oaFL De tman. Health & Hu ENGINEER'S SEAL H °• S R 5 ENGIN1191UNG�' �" Se F 17D34 Eagle Rlvef LOOP Road, No. "4 Inspections performed by: _>9 -91 -River Awka943� Dates: is zz a ii • ••••^ ~•'•"e"•"t"' 2nd S3 .. .............,A:j ucbod A. Ua•Fa Department of Health and Human Services approval +'.'• No.'u'E era Jolt C"113=i- Reviewed and approved by: Date: 72-013 (Rev. 9/91) MOA 25 Permit No• SYY93O 1 n 1 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 9 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report rnorCT Dinr_r o1 nr'V I I nT R 01711278 uescnplLon: - -- _ _ _ rlu rvU.. Col co 90.8' qt� RECEIVED Nov 121993 Municipality of A11001 age Dept. Health & Human Services NEW 1500 CAL NEW BED B 4 BDRM CO HOUSE FCO ,„ A w1 \40' \ \ WNDTOP EA LOWER SEAL \ MNOOW L t� 30' 2.013 A (2/91) MOA 25 A85.2' WATER FOUND 7-16-93 A B FCO 8 20 COI 12 17. MH 21.5 14. MTI 18.5 27. MT2 39 35 MT3 44 60. M 55.5 N S.T.E.P. TANK ENGINEER'S SEAL oF del f1Y :.• {i ..ice_ �n ......».»•y. w '• A A. Sn•fu SCALE r - 40' No. 14374 COLONY BUILDERS 907 345 69E4 P.01 T1SF}'t;TION F.F.Pii(:9' ttuNIC7PALT1'Y OF At•!�7Nl�kArE, EI!1I1.LtING FAF'STY 4TVI:ilUN 1Nf'CrGhA7TAN {h('"):''r„' tNSPCCT1Ott:; t°J0: ).,[„�•3Ah4 _, .. _..�v�:_.._._. �.•......>.,�. .. !!i: v.a-�aaRC L'4:—va1-:RY. _. anal �. aar^.. •3Cs 4.n y:J1 _.. __ r'eeti IT ii: 9•+ Cli'- WAME: Cnl.r!Nt' ItI.AF.k$ r'11�1Nr: 4' 244-L23: C,UDkI$S: :,239 MAHY TELL UAYF.: Il!Ia/l tti3 LOT, r ItLOCK; I SUIID: IOPF.4T COMMENT': I.Oct, ?M3x CO?. :1!I; wEST F.LFCY1C YOU t Uti .' F;F ;;6Lf: TC - !,. i 3,Y'r1 OF INS1'ECTION: ILIC7kIi.AL frtli:(. 0 0 ..----•. .. .. _-_ _...... -0-0 __„-.. _.-.. .. ... j. !: r. si 4•..i 111 rt F. C�5:01I41, f; ] N4 N{,t✓,rl!1PlIr'.NC'F, iIB=:Ck':CG lty;::l,.•.?nEC P`:L�lul j WILL k1;CXYtMItIG A'f f:I INSPECTIOO LC Nl.t'! Cl'tl fAL i!,:l';L Sf It+S�'t;CTE.It 1';O1fMF,NT�: C �eCT►z��1�� -�0 a RECEIVED NOV 12 1993 Mull C pat :y .r• .. ., . ..,e QopL Hoath & Huma•1 Su % cap ~� r,c c - •.I f'fIP Itt�l".:•.:'! ;ilr! L C1: '� - PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE prn DEPARTMENT OF HEALTH AND HUMAN SERVICES b_a,C)3 P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 1I.00 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT co -a a l 3 PERMIT NUMBER:SW930101 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:NORCOL INVESTMENT 50% & OWNER ADDRESS:5239 MANYTELL AVE ANCHORAGE, ALASKA 99516 PARCEL ID:01711278 LEGAL DESCRIPTION: FOREST RIDGE BLK LOT SIZE: 47789 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 1 LT THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 5/13/93 EXPIRATION DATE: 5/13/94 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 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. 11IDD `)-Iln-%2 SPECIAL PROVISIONS: RECEIVED BDATE: 6 /3 (v ISSUED BY: C�Ztt� 'Q /ice DATE: April 10, 1993 HEALTH AUTHORITY APPROVALS 4unicipality of Anchorage EPARTMENT OF HEALTH AND HUMAN SERVICES 25 L Street .0. Box 196650 SEWER WATER nchorage, Alaska 99519-6650 MAIN EXTENSIONS ROBERT SHAFER. P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694.1211 EFERENCE: Forest Ridge Subdivision, Block 1, Lot 5 SEWER 8 WATER NSPECTION equest you issue a permit to install a septic system and to rill a well to serve the proposed four bedroom house on the referenced property. ENGINEERING STUDIES AND REPORTS o test holes were excavated and percolation tests performed. he approximate test hole locations are shown on the site lan. WELL &FLOW TESTIION le do not anticipate any adverse effects on the neighboring roperties by the installation of the proposed septic upgrade. f you have any questions, or require any additional SITE PLANS nformation for your review, please contact us. i cerely, ROADDESIGN nw�nn U11 ` mes P /( i iams ivil nqi er SOILTEST PERCOLATION TEST STRUCTURAL& MECN CAL NSPECT:Z aS ONSITE WASTEWATER DISPOSAL SYSTEM DES GN A. Shafer, P.E. 17034 NORTH EAGLE RIVER LOOP - SUITE 204 - EAGLE RIVER, ALASKA 99577 LEGAL DRAWP FROM SYSlEI S' DIA. S( z 9 V - -. DETAIL fir TOPSOIL k SEED Y1 / Ire ntPEttyEAB �� FILTER �FABR 0 0 2' DEEP (REMOVE ORGANICS) J 12' 'SAND FB.TER PROFILE 30' ENDS CAPPED (TYP) GRADE 2—' MIN' IlPERMBLE BARRIER --ORIGINAL GRADE DIST. PIPES LAID VIIHIN SEWER ROCK. 8• UNDER k r OVER DIST. PIPES • •/4. N.�.N� b.A A. Sh f*- .7�( No. I477 -E , II LEGAL DRAWN L. S. ULSHER I CKD. R.A.S. DESIGN CRITERIA: 4 BDRM = 600 GPD SOILS = 0.5 GPD/SO. FT. 600/0.5 = 1200 SO. FT. REO'D ZSEPTIC BED DESIGN: AREA % 2' DEEP (REMOVE ORGANICS) / INSTALL 2' SAND FILTER 6' GRAVEL OVER AND UNDER DIST. PIPES 30' X 40' LOT 4 10` MIN. SHT. 1 OF 2 WITHIN 10' T Ac E $S6 OF PROP. BED 1\ 0_j PROP PRESSURISED DISTRIBUTION BED�� s�( VV 7� % ` VACANT/ LOT 3 bM A. 0.14t ."t, No. 0%T SITE OF PROP. 1500 GAI, \ 4RBDR61 S.T.E.P. SYSTEM \ TM ,21 HOUSE ✓ \ i, LOT 6 � V LOT 5 L VACANT 7 'D 40' C SETBACK PRESSURIZED DISTRIBUTION SYSTEM: PUMP = 20 OSI 05HH 5 STAGE (-30 GPM) 5 LATERALS - 34' LONG EA. 6 GPM/LAT N HOLES/LAT10 4 50 HOLES TOTAL5 ) 0.59GPM/HOLE 3/16" DIA. HOLES FACED DOWNWARD 1 1/4" DIA. LATERALS 3" DIA. SOLID MANIFOLD ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS . Forest Ridge Subdivision, Block 1, Lot 5 GENERAL: 1. The scope of this project includes the installation of a pressurized absorption bed equipped with a 1500 gallon wastewater S. T.E.P. system (septic tank effluent pump) to serve the proposed four bedroom residence located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be resposible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. Page two Forest Ridge Subdivision, Block 1, Lot 5 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 30 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. PRESSURIZED MOUND SYSTEM INSTALLATION: 1. Any peat or organic matter must be removed from the elevated mound site. 2. The bottom of the basal bed area as well as the top of the sand filter is to be within two inches of level. 3. The distribution piping is to be of PVC (ASTM D3034 or equal). All joints are to be solvent cemented. 4. The side slopes of the top layer of the mound system must not be steeper than 33% (3:1). 5. The top of the mound shall be covered with a minimum of 6 inches of topsoil and vegetated sufficiently to prevent erosion. 6. The distribution 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. 7. 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. S. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. Page three Forest Ridge Subdivision, Block 1, Lot 5 Construction Practices 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 F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 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 watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the 1200 sieve. 7. When sand is being used as a filter material, it's gradation specifications must conform to AMC 15.65.060D. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. Page four Forest Ridge Subdivision, Block 1, Lot 5 Construction Practices 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. • I v PERFORMED FOR: LEGAL DESCRIPTION im 2 SMAC _ Yn AZ o f1pL.E 3 1Trli 11AL/W Slti Wr7N SorwE 4 � 6- 7 7 10 11- 12- 13- 14- 15- 16- 17- 18 ,121314151617,6 19 20 COMMENTS WE C4Wsct JLUPt WAS GROUND WATER Yrs ENCOUNTERED? L.0. }' IF YES, AT WHAT DEPTH? Depth to Water Atter Monitoring? Date: JI it PLAN PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN�FT NO 3 FT PERFORMED BY: 1%034 Eaale Rlvar Le nn Read tUn� Eagle River, Alaska 995n�/ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINFr 72-M (Rev. k85) ON THIS DATE. DATE: THAT THIS TEST WAS PERFORMED IN � ,:F .� . �r r� :�s►�s PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN�FT NO 3 FT PERFORMED BY: 1%034 Eaale Rlvar Le nn Read tUn� Eagle River, Alaska 995n�/ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINFr 72-M (Rev. k85) ON THIS DATE. DATE: THAT THIS TEST WAS PERFORMED IN PERFORMED LEGAL COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG —PERCOLATION TEST GMI« * wriza. Lrivl s DATE PER Township, Range, Section: WAS GROUNDWATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Aller Monitoring? r I L 7l O P E Reading D. PERCOLATION RATE TEST RUN BETWEEN fI /inch) PERC HOLE DIAMETER W FT S 3 5 E14v INttKIr v PERFORMED BY7034-capla R``i''�--�{{,,e��_ogqnqq.SS+77R77oad No. 204 )rCTNTHISDATE. CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE iM1114)kL''SPRTt�A1VD? 7 CIPAL GUIDELINE$- EFDATE: 72-008(R". 4i85) �� PERCOLATION RATE TEST RUN BETWEEN fI /inch) PERC HOLE DIAMETER W FT S 3 5 E14v INttKIr v PERFORMED BY7034-capla R``i''�--�{{,,e��_ogqnqq.SS+77R77oad No. 204 )rCTNTHISDATE. CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE iM1114)kL''SPRTt�A1VD? 7 CIPAL GUIDELINE$- EFDATE: 72-008(R". 4i85) �� LOCATION OF WELL STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER WATER WELL RECORD BOROUGH .SUBDMSION LOT BLOCK SECTION OTRS SECTION TOWNSHIP RANGE MERIDIAN 1 z.� Jr I DN ❑E I I ❑S ❑w LOCATION/SKETCH: WELL OWNER. Ccloliy I-Ii1r1c rrs DEPTHS MEASURED FROM:❑casing top ❑ground surface WELL DEPTH: DATE OF COMPLETION Depth of hole: it Depth of casing: / 3 ft % / /8 19 BOREHOLE DATA: Depth Material Type and Color From To �'�/ ✓'` �'C ^ Z. DEPT"0 STATIC W/L,.TL�6R LEVEL: ttbelow IJi top of casing .O ground surface Date: C METHOD OF DRILLING: Q air rotary ❑ cable tool LJ v� ✓ tfi G n. .X /a o 1 * 3 ❑ other USE OF WELL: C'Cdomestic ❑ irrigation ❑ monitor ❑ public supply ❑ other CASING STICKd�IP• ��- It. Diam: (7 in. to /Xit Casing type: t Z _'— in. to it WELL INTAKE OPENING TYPE: G�open end ❑ screened ❑ perforated D open hole Depths of openings: to It SCREEN TYPE: N Diam: in. Slot/Mesh Size: Length: - it R E C E GRAVEL PACK TYPE: \ Volume used: Depth to top: JUL GROUT TYPE: Volume: 1 93 Depth: from It to ft 1) Unicipapty of A choraon DEVELOPMENT METHOD: Pt.HeaHti n ..- _ CONTRACTOR INFORMATION: IL)IYIC 1'1(�iriCl f, E11 1. 1� (4.) Regis ed usmess Na��-s ' bignatue of Authorizeda resentatn� ��—ati5 e LEVEL AND YIELD: It after 2- tus PUMP INTAKE DEPTH: it Horsepower. WELL DISINFECTED UPON COMPLETION? 13 YES ❑ NO REMARKS: PLEASE MAIL WHITE COPY OF LOG TO: DNRfDIVISION OF WATER PO BOX 772116 EAGLE RIVER AK 99577.2116 i M lig *-t= BL5 t • f+, Municipality of Anchorage r; On-Site Water and Wastewater Program (907)343-7904 _r Certificate of On-Site Systems Approval Parcel I.D. 017-112-78 Expiration Date: C �� 1. GENERAL INFORMATION Complete legal description Forest Ridge Block 1 Lot 5 Location (site address) 5239 Manytell Ave. Current Property owner(s) Kevin & Tara Sweeney Day phone Mailing address 5239 Manytell Ave. Anchorage, AK 99516 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 0 Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment /1/247/Ig Date of Payment Receipt Number Q97citi(7 Receipt Number COSA# Q 6C1 V 1(Qf to 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. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden detects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 745-8200 Address P.O. Box 1807, Palmer, AK 99645 Engineer's Printed Name Steven R Pannone Date 11/26/18 of - 6. DSD SIGNATURE * 49 TM' •*�� I System #1 Approved for , bedrooms 1 •Steven R. Pannone. System #2 Approved for bedrooms CE Disapprovedtt PPOFESS1IO4 Conditional approval for bedrooms, with the following stipulations: l Y OTERAD WA C) N1AST�WATFR n PROGR*A Gc r °1 SE0c� , / By Original Certificate Date: 1 ( 9' '� The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA)based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sneer t If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Forest Ridge Block 1 Lot 5 Parcel ID:017-112-78 A. WELL DATA Well type Private If A, B,or C provide PWSID# Well Log(Y/N) Y Date completed 6/18/1993 Sanitary seal (Y/N) Y Wires properly protected(Y/N) Y TotaF depth 123 ft. Cased to 123 ft. Casing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 6/18/1993 5/21/2018 Static water level 7 ft. 32.4 ft. Well production 15 gpm 5.0 g p m WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 0.104 mg/L Arsenic ND ug/L Date of sample: 11/14/18 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material S.T.E.P./Steel Date installed 7/16/1993 Tank size 1250 gal. Number of Compartments 2 Cleanouts(Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) Y Date of pumping 5/22/2018 Pumper A+ Home Services C. ABSORPTION FIELD DATA 7/16/1993 2 2 0.5 GPD/SF (g.p.d./ft or ft2/bdrm) System type BED Date installed Soil rating Length 40 ft. Width 30 ft. Gravel below pipe 0.5 ft. Total depth 3.5 ft. Eff. absorption area 1200 ft 2 Monitoring tube Y Depression over field N Date of adequacy test 5/21/2018 Results(Pass/Fail) PASS For 4 bedrooms in absorption field before test 0/0/0/0 in. Water added 600 0/0/0/0 Fluid depth pgal. New depth in. Elapsed Time: 120 min. Final fluid depth 0/0/0/0 in. Absorption rate >= 600+ g.p.d. N Any rejuvenation treatment(past 12 mo.)(Y/N&type) If yes, give date D. LIFT STATION Date installed 7/16/1993 Size in gallons 250 Manhole/Access(Y/N) Y "Pump on"level at 40 in. "Pump off'level at 36 in. High water alarm level at 45 in. Datum Bottom of tank Cycles tested Meets alarm&circuit requirements? Y E. SEPARATION DISTANCES 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 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 1 O+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway,parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Survey on file. G. ENGINEER'S CERTIFICATION �`PF g4.4k } I certify that I have determined through field inspections and �A�j'iP' `4-. .y�� review of Municipal records that the above systems are in 0*:49 TH 1' ...IA-TO conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven Pannone i••.Sleveri IR.'ISannarie:* e, 11/26/18 ti CE-8149 ..;ce• l Date �� •4. ��% (!i \��* ~ COSA canary sheel_2-6-15.doc J,ASfL,v Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING cl Parcel I.D. 017-112-78 COSA #_ _ t)l 661 a Expiration Date: 1. GENERAL INFORMATION Complete legal description Forest Ridge S/D, Block 1. Lot 5 Location (site address) 5239 Manvtell Avenue Current Property owner(s) Aaron Henry Day phone 349-1807 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 5239 Manvtell Ave. Anchorage. AK 99516 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: If 3. TYPE OF WATER SUPPLY: Individual Well 19 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as 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 Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box 102954, Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 4-13-07 Engineers Comments: In conducting an adequacy test, l attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water �.�� OF aay levels that may fluctuate during the year, and the water usage of the family being served b the system. :� �F' •"""'"•A: Y S Y S Y B Y Ys ..P,•••' i� Thesc conditions arc outside the control of the evaluator of this system. All systems eventually fail and�,' 9 satisfactory test results do not guarantee future perfomlarlce of the system, nor do they guarantee that t" •�j there arc no hidden defects or encroachments. PPS can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the b10A DSD. The content of this report is for the sole benefit of the owner listed �. Ci Steven R Ponnone+�S: above. Any reliance upon or use of this report by any other person or party is not authorized nor will ittiE Nv7$�E18149 �<v� confer any legal right whatsoever. �1af�eOQ'^•—'�••� �•I 5. DSD SIGNATURE �4osstQ: _Z Approved for __4l_1 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: AQP.. ......-:ya ON-SITE un ^TrIAIATLD Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date:IV-19-07 (Rev.11.05) Municipality of Anchorage t .� ' Development Services Department Budding Safety Division < On-Sfte Water & Wastewater Program 4700 Bragaw Street P.O. BOX 198850 Anchorage, AK 9951M650 www.muni.org/onsfte (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Forest Ridge SID. Block 1. Lot 5 Parcel 10: 017-112-78 A WELL DATA Well We Pdvate If A, B. or C provide PWSID #_ Date completed SMOM993 Sanitary seal (Y/N) XU Total depth 123 R. Cased to -Lft. FROM WELL LOG Date of test BM8/1993 Static water level 7 R. Well production 15 g.p.m. WATER SAMPLE RESULTS: Coliform-Q,_cotonies/100 mL Nitrate SID mg/L Well Log (Y/N) Yes Wires properly protected (Y/N) Yes Casing height (above ground) _Lin. AT INSPECTION 3/302007 30 ft. 6.9+ O.P.M. Other bacteria 0 colonies/100 mL Arsenic: VJ_D ugA Date of sample: 9y Of;7 Collected by: SRP B. SEPTICfHOLDING TANK DATA Tank Type/Material STEP/Steel Date installed 7M611993 Tank size 1250 gal. Number of Compartments $ Cleanouts (Y/N) Yes Foundation cleanout (Y/N) es Depression over tank (Y/N) )Yo High water alarm (Y/N) Yes Date of pumping 412/2007 Pumper A* Home Services C. ABSORPTION FIELD DATA Date installed TM GM 993 Soil rating (g.p.d,e or ft2/bdmm) Q. System We Bad Length 40 R. Width _30 ft. Gravel below pipe 0.5 ft. Total depth L5 ft. ER. absorption area 200 RZ Monitoring tube Depression over field V_ Date of adequacy test 3131172007 Results (Pass/Fall) Pass For 4 bedrooms Fluid depth in absorption field before test 2f in. Water added§00 gal. New depthDry in. Elapsed Time: Q min. Final fluid depth PSC in. Absorption rate >= 800+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date D. LIFT STATION Date installed 711611993 Size in gallons 250 Manhole/Access (YIN) Yes "Pump on" level at 40 in. "Pump air level at 336 in. High water alarm level at 45 in. Datum Bottom of Tank Cycles tested 15 Meets alarm & circuit requirements? Yes E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 160 Absorption field on lot 150+ Public sewer main NIA Sewer /septic service line 150 Animal containment areas 100+ On adjacent lots X00+ On adjacent lots 100+ Public sewer manhole/cleanout N/A Holding tank 75+ Manure/animal excrete storage areas 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 12 Property line _10+ Absorption field 10+ Water main We Water service line 50+ Surface water 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 14 Water main WO Water Service line 50+ Surface water 100+ Driveway, parking/vehicle storage 25+ Curtain drain 75+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 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 Steven R. Pannone, P.E. Date 4M 31200T COSA Fee $ f'/� Waiver Fee $ Date of Receipt Number 63-�2-' (Rev. I I M5) Date of Payment Receipt Number O. ��:....... � �+ • V, ,� � r .»» it 're�m�naP'� N., rF el4l _ SCS Ref.M 1071329001 All Dates rimes are Alaska Standard Time Client Name Pannone Eng. Srv. Printed Date rime 04/11/2007 12:52 Project Name/a L5 DI Forest Ridge Collected Date rime 03/30/2007 15:05 Client Sample ID L5 DI Forest Ridge Received Date/time 03/30/2007 15:24 Matrix Drinking Water Technical Director Stephen C. Ede PWSID 0 Sample Remarks: Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic Waters Department Total Nitratc/Nitrite-N Microbiolow Laboratory Total Colifonn fsJ 0 0 5.00 ug/L EP200.8 0.100 mg/l. EPA 353.2 C (<10) 04/02/07 04/05/07 TK D (<10) col/IOOmL SM2092220 A (<1) 04103107 JDS 03/30/07 DPT Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program ee 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage. ak. us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-112-78 �y�� HAA# U4:A/r Lq 1. GENERAL INFORMATION Expiration Date: / a — / -- p c4 Complete legal description Location (site address or directions) 5239 VANYTELL ANENUE • ANCHORAGE AK 99516 Current Property owners) WILLIAM GARRY & NICOLA MEEK Mailing address C/O neu wnj � u, ...----- Day phone (AGENT) 257-0114 Lending agency Mailing address Day phone Real Estate Agent DAN WOLF W/ REMAX Day phone____2557-0114 Mailing address 2600 CORDOVA STREET * ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ■ Individual Water Storage Individual On-site ■ Community Class Well Individual Holding tank 0 Public Water System El Community On-site 0 Public Sewer 11 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER seal affixed hereto and as of the validation date shown al Guidelines fobelow, I verify r this application, As certifiet My d by my rocedures outlined in the Health Authority App safe, functional and adequate investigation, based on p I and/or (,wastewater disposal system is(are) based on the shows that the on-site water supply e of structure indicated herein. I furtherrify ttand inspection, the for the number of bedrooms and ni Anchorage files and from my investigation licable Municipal information obtained from the Municipality of salsystem on-site water supply and/or wastewater disposal system is(are) a compliance with all app and State codes, ordinances, and regulations in effect at the time of installation. 337-6179 GARNESS ENGINEERING GROUP, Ltd. Name of Firm : ArecuORAGE. AK 99507 3701 Address JEFFREY A. GARNESS, P.E. Engineer's Printed Name Ti mnR ROAD. SUITE 101 Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering at of the system in accordance with ADEC and MOA system G under the condition's encountered tThe reportedhe time of thedescriresltsme sepa tion performance of the rhe sdistal eptiIces measured to readily c systems depend on able features. I the local)sos condition, groundwater nal levels that fe of may welIs and family teeny served by the system. fluctuate during the year, and the water usage of the rTese etsults do no't guarantee future performance of thelsystem, atr of tnor do they guarantee that t there are no hidden defects or encroachments. G stemtd can therefore continue to not provide r vide any warranty or future estimate of how long the system f the ADEC or MOA DSD. The content of this report is for operational requirements oupon theAny relianc otherope soneoit of the ownerrparty s of aluthorized,ve. nor will it confer any legal right this any 5. DSD SIGNATURE � I/ Approved for �4 — bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory �r By: AO (Rev. 19M7) Phone Date ( 0 bedrooms, with the filowing stipulations: v --ON SPE - G� WATER AND : m -WA&TEWffER PROGRANt �i�. • . ASO \\ 01ENTSE`� N ` Manitenance Agreements Supplemental Engineer's Reort Other cl- Original Certificate Date: _1—---`-- Municipality of Anchorage � T� Developrr'r�nt Services Department ""� e`' Building Safety Division = � �_ 4 On -Site Water &Wastewater Program S A e , �O.w ox 1�665�0 Anch�ora ea K 99519 6fi50" c .anchorage ak us =$F 4 ey.xdsa rmwsn +d tr.. t. i z 90`/"j3d3 751)"4 y EALTH-"AUTHORITY APPROVAL CHECKLIST al DescnQtron ��OFiS�"... D L K � 1 � ,_Parcel 1Di " 01`7-112`_78"'" '" A Sro:u~r=uv`'vi 6:.Lr4 b�`kLw K tYPe PR if AB or C P r.� _ dwde PWSID N/ -A' Well Log (_Y/N) YES completed 6 18 1993 "Sanitary seat (Y/N) YES "" � pa - , ��,,,„� Wi ©s properly protected (Y/N) YES i epth 't 3 :, Cased to ` 123 ft Casing height above grountl) 21+ in x eoftest"•��B%18%1993� � 8/1�2004 �• - �c water level 7 " ft 4 colonies/100 ml,I NitFata m /L x Q—Q 9 Otherbacteria —colonies/100 mi. x.,.k,. rc N A Date of sample: 8 10 2004 "Collected by:-GEG Ltd. y el atenai ..E STEEL „ r Date installed 716/1993 size 1 X00 gal Number of Compartments 2 anon cle$nout (Y/N YES p' "`"� „ � egression oviir tank (Y/N) NO _ Htgh Water alarm (Y/N) YES pumping /24/2004 umPer A stalls ' 7 6 199`3 �� z Soli raring .p.d / r ft /bdrm) 0 5 System type BED" - ft GC�vel below pipe __4..5 ft �pth� 6 0 ft.,gEff. absorption are51200 ft' Momtonn tube YES '""" " "` "'" � r ,9 Depression over field NO adequacy test 8/10/2004 --------_ fZesults (Pass/Fail) "PASS For 4 bedrooms -ao P t in a sorption fiditl before test in Water added 718" gal New depth 0 in. Tmie Final tTuid de th 0 ' min Absorption rate > 600+ venatiotreatment'(past 12 rimo) (Y1N &type) NONE KNOY�fJ . unweei �n � ..._a,,,...�a u......,.__.. if ves. dive data MOA r�ij .,� -1500 Manhole/Access (Y/N) YES w eve at' 0 m in " Higi�water alarm level at 43 m 3 Meets alarm & circuit requirements? YES Surface`N Wel'Is on that the abo 4 guidelines 0/o )N FTECD"ON LOT TO dafion 10'+' Water main N/A x s 100'+ Driveway, parking/vehicle storage 10'+ N... .. + acent lots tems are in ct on this date. . .a.. _., ._. Date Kece pt rrvunwc :..r . A... n...,.. ess., • 1 •� e�G p0a._ _d o 100+ lots e' Oh adjacinent `On lots 100'+ adjacent . •. N/A Public sewer manhole/cleanou4 t >,•=�.Ho�dingtankN/A a, St0tl0HOLbTf&TANKON LOT TO: FROM 5'+.• �. ,,-a a 5'+ Absorption field P ' + Proj" line _ _—___-- 100 + Waf'er`seNice line ' 10'+ Surface water Surface`N Wel'Is on that the abo 4 guidelines 0/o )N FTECD"ON LOT TO dafion 10'+' Water main N/A x s 100'+ Driveway, parking/vehicle storage 10'+ N... .. + acent lots tems are in ct on this date. . .a.. _., ._. Date Kece pt rrvunwc :..r . A... n...,.. ess., • 1 •� e�G p0a._ _d o ,- 1.111nx rroperties; Received: 8/29/04 4:28pM; 907-2584687; 90724ae392 .� Aug -26-04 4:43PM• tiemax rroperzy®�,� rmdu � Page 2/2 FROM : GASTALDI LAND SURVEI PHONE N0. 9072489362 Aug. 26 2004 02:27PM P2 1'I=40F a5-175 FOREST RIDGE SUBDIVISION LOT 5, BLOCK 1 47,709 S.F. \ ' 'QL psi qi �d BUILDING DETAIL SCULLS 1--2C --.. ..-.. , WT R I nac A0RKY6D 7NE PR0Fgt" Down Awn AND TINT No JEW JL Mo-'OAMrt uk ft 6SANA7O DM OW OMM A9 GMCAM. TIC A23PON911PW OF TIE: OWNER TO 4729 IwSF SM AYLWS OlfOFI W TNS CONDiX OF ANI' gMMMW s, ASG NAVA 99502 oOVONAM OR Rp nolon 9M R Do NOT DHOW 219-9,01 APPZYt ON TK RRCIOf♦OFy 9RIONIBION NAT, IOIOa NO TSTA" 4' OWL ANY WA 9Alo 9A,c NW=N K USED FOR CONSnWJ RON OR FOR 9137 �/p'/�p6a � ' 9mkoRY g1 ppm umm FA jQO N0. ANCNORAOE RWOMM DWRRO. AAWA o2..1A Fml N07E: NO CORNSAS NT TNIO DAIS. SGS Ret# 1044881001 Client Name Gamess Engineering Group, Ltd. Project Name/# Lot 5, Block 1, Forest Ridge Client Sample ID Lot 5, Block 1, Forest Ridge Matrix Drinking Water ,ample Remarks: All Dates/Times are Alaska Standard Time Printed bate/Time 08/17/2004 11:40 Collected Date/Time 08/10/2004 7:08 Received Date/time 08/10/2004 8:00 Technical Directory Stephen de Released H Parameter Results PQL Units Aftomble. Prep Analysis Method Container ID ]nit Limits Date Date Waters Departmtent Nitrate -N 0.100 U 0.100 mg/L EPA 300.0 B (<=10) 08/10/04 JJB Microbio3.o9Y Laboratory Total Coliform 0 col/100mL SM209222B A (<=1) 08/10/04 DKC LEi-d EO/ZO'd E01-1 IOE5195L06 UJIM3S AN3 SDS 'IS3 391 -W08d WdSY 10 b0-61-80 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES O Division of Environmental Services On -Site Services Section E C E I V E D P.O. Box 196650 Anchorage. Alaska 99519-6650 343-4744 NOV 12 1993 CERTIFICATE OF HEALTH AUTHORITY fv;u e ,.c N�l;)y of Anchors APPROVAL FOR A SINGLE FAMILY DWELLING Oept. HUalth 8 H S 6 Parcel I.D. # 1. GENERAL INFORMATION uman erv)ces HAA# V1f1cl")0'1ry'Z Complete legal description Lo.t 5• Btock 1; Fonee.t ki4e Subdi.v.i4ion Location (site address or directions) Property owner COLONY BUILDERS/ B.iU Tayton Day phone 244-6233 Mailing address 2340 Lonen CiAcfe Anchohane, AK 99516 Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: 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(Rw.1N1) frons MOAS21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and'as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Phone Address S & S ENGINEERING .. w - Engineer's signatur Eagle River, Alaska 99577 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments Date - bedrooms, with the following stipulations: By: _ Jot+(y (-T4. Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct Inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72d2SCA".1/91) 6, WAN21 Municipality of Anchorage s Department of Health and Human Services WEIVED HEALTH AUTHORITY APPROVAL CHECKLIST �� rE Su��✓ls�or-� NOV 12 1993 Legal Description: L4n,-�K- /i �-�TS Parcel I.D. Z,�t,-S I y el Aneherag* 'EJI Hoamih & Human Service A. Well Data Well type ✓iA,7 1� If A, B, or C, attach ADEC letter. ADEC water system number Log presentbN) _Date completed �8 �3 Driller Abri J& -77> N) L.1- Ir -IJ Total depth / 2- 3 Cased to X23 / Casing height /Zy Sanitary se&/N) 7 Wires properly protectecL19N) Y FROM WELL LOG Date of test i Static water level Well flow S 9•P•m• Pump levell L4 fL SEPARATION DISTANCES FROM WELL TO: AT INSPECTION oz m C <z r, � w C `3 Septic/holding tank on lot "/" ; On adjacent lots Absorption field on lot /� r f ; On adjacent lots Public sewer main /y0 1-15 Public sewer manhole/cleanout ,L/OrJC Sewer service line 2,5 r-/" Petroleum tank Nk:�- WATER SAMPLE RESULTS: Coliform Q Nitrate NLS Other bacteria 67 Date of sample: /I. Z Jq --�> Collected by: s i s E144 le B. SEPTIC/HOLDING TANK DATA Date Installed / Tank size / 63Z 4AL Compartments -Z.-' Cleanout % 1) `/ Foundation cteanou6/N) _Depresssiion (Y©� High water alarm (Y ) 7 Alarm tested�l) `Y Date of pumping umper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: V r 2/ Weil(s) on lot /� V- On adjacent lots /� 4- Foundation / r To property line /0 r � Absorption field S Water main/service line 104- Surface water/drainage re-028CM3)' FRx-d CONTINUED ON BACK PAGE C. LIFT STATION Date installed ��1 Manufacturer 1d,%-Gf` eA<t _T�,4IC Size in gallons Manhole/Access&<A) 7 N Ven&N) _'Pump on' level at -1'3 'Pump off' Level at S54 High water alarm level �'f If Cycles tested 3 Meets MOA electrical code&'N) Y SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot 16D r� On adjacent lots /63 ,• Surface water D. ABSORPTION FIELD DATA Date installed // &477 2> Soil rating (GPD/Ft=) 6 • S System type Length 401 Width 30 ( Gravel thickness /�• S r Total depth Total absorption area /260 � G M_1 resent�l (1� rp p ) Depression over MAl Date of adequacy test Ai IA' Results (pass/fall) /V E-40 5Y5S 25_25 7 Bedrooms Water level in absorption field before test /J/)& After test Peroxide treatment (past 12 months) (YAC f If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /iTD r� On adjacent lots /0D r Property line /0 r_�_ To building foundation / To existing or abandoned system on lot 1_3104' - On adjacent lots .30 ,4- Cutbank '56-14 Water maintservice line Surface water /� { Driveway, parking/vehicle storage area 50 { Curtain drain /J K__ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified• or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineers Name Date HAA Fee $ •�X I CIO , Alaska 99577 Date of Payment //-/ Z —13 Receipt Number 72-026 (M)' Back Waiver Fee $ Date of Payment Receipt Number ;robsrt A. S:•:kr No. WTE rsk COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES I. REPORT of ANALYSIS Chemlab Ref.# :93.5906-1 Client Sample ID :L5 BS FOREST RIDGE S/D Matrix :WATER 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562.2343 FAX: (907) 561-5301 Client Name :S & S ENGINEERING WORK Order :72807 Ordered By :R. SHAFER Report Completed :11/08/93 Project Name : Collected :11/02/93 @ 16:00 hrs. Project# s Received :11/02/93 @ 16:45 hrs. PWSID :UA Technical acedDirector:SjEPitE�7 CG iE Released By : ��i��'�"/� Sample Remarks: ROUTINE SAMPLE COLLECTED BY: S.S. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate -N 0.10 U mg/L ERA 353.2/300.0 10 11/03 CMR RECEIVFr.' Nov 12 IS1 Municipal'!, ul 1� "? a Dept Health & Human Sn " Ce+ =ec =_axe_ xx=�--xxe--xxxeeexxxeeeexx===xxxeeexxxx� xxxexeexxxxeeexxxee— =xxxeexxxxxecxxxxxexxx * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than If.eN st s Member of the SGS Group (Socidt9 Gdndrale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA. COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA