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HomeMy WebLinkAboutFOREST RIDGE BLK 2 LT 2Forest Ridge Block 2 Lot 2 #017-112-97 Municipality of Anchorage Page of 2- DEPARTMENT DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 a Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: PID Number: C t'a't 12� Name. t�i0{2op �- \ rJ��� En1TS Wastewater System: New ❑ Upgrade CIC �I(v ABSORPTION FIELD Phone: No. ofBe rooms: ❑ Deep Trench Shallow Trench D Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: GS GPD/Sc. Ft. Total Depth from original grad � Lot: Block: � division: Depth to pipe bottom from original grade: Gravel depth beneath pipe 2 se \Z% G Ft. ✓ Ft. Township: Range: Section: Fill atldetl above original grade: t S Ft. Gravel length: �/ I Ft. WELL:�QNew Upgrade Gravel width: Number of lines: Distant4 bt een lines, P Ft. t1 ' Ft. Clgssifoca/tion (Priva e, A,B,C): Total Depth: Cased To: Total absorption areas:: Pipe material: Q 1V TIG Ft. Ft. -1 So. Ft. Pr* I { �-Vc Driller: Date Drilled: Static Water Level: Installer: COL,01.4-/ Date installed: 11122gq5 Ft. tbLAt L-T* Yield: Pump Set at Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding )!i T. E. P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ' \ -�nr�npyQ (moi T1(y \�j OD Well .--- 2! Materia Number of Compartments: Watere t�'.d-- — LIFT STATION Lott Line 10 i 10'4- t0'r "' Size in gallons: lS'OU Manufacturer: ��GI ID\Z. P�� Tp�r—,K-- Foundation . 1' 1 IDI 11 ! l __ __ "Pump on lev at: "Pump off" level at: High water alarm at: l 4 N46 Curtain , A `� t / _ \ l�— ` N Pump Make & Mode 4 Electrical Inspections performed by: Drain i�+�� 051 OSf�H�' Remarks: pS BENCH MARK Location and Description: OJ.Y,. GU��E2 ghr— E Assumed Elevation: ENGINEER'S SEAL e. S & S ENGINEERING Loop Inspections S 71334 Eagle River L Road, 1 i Iii `3 by: 9 3 ' m �"° " performed tfesst Eagle Rivett' 2nd t� Department of Health and Human Services approval a<n en e+ x Reviewed and approved by: Date: 72-013 (Rev, 9/91) MOA 25 Permit No. SW930478 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 9 Anchorage, Alaska 99519-6650 * Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: FOREST RIDGE BLOCK 2, LOT 2 PID No.: 01711297 M 13 A (1/93)' MT Col CO2 M H 492.8' ...................... ...... ...... - ..... - ... ....... .............. ........ ��87.2' 1710 �L 87.5' SR ............................................ 9 1. 4 N.T.S. A 82.9' . .......... ..................... .......................... ......... .............. ...... WATER FOUND 10/12/93 ........... .... .......... ........................................ ............... CO1 21.0 16.5 ........... ------- ........... ......... ... ............... . . ...... . ........ .............. .. . .. ........ .. ......... .......... ....... . ..... .............................. .............. ------- .............. ...... ................. .. ........................... ................. EW PRESSURIZED ............ .................. .............................. ........... . DlSTRIPUTJON TRENCH! C jj NEW 4 BDRM HOUSE Fco ............... — .......... ......... ...... ...... ........... L A co co am MH W SCALE 1" 40" Aid 'k vzew M 13 A (1/93)' COLONY BUILDERS 907 345 6934 P.01 r IN'',PEC T TON REPORT t1'UNICIPALITY OF AW'HORWIE, BUIIDINe SAl:ETY DIVISION ;3500 EAST TUDOR FOAL. INSPECT IONS (907) 563-3464 INFORMA:C iON 1,907)786-8211 -•sUs:�a:ce r_�•+s:nw:::ec:cc//ca=jy.[m:�_om-sm_-^zs==ue=_:_r.na'�r�: NAME: �t�� 0-1 1� ✓5 o.nac•s r"_v.=-:ae: a: nc :>oe= = :�:: sc e�-zeuc:. c::.:s c: �cx x:s-_: __... PERMIT a:: � � /v� 7 ADDRESS: 15 WO . f tvl+l PHONE o' QOMM£NTI TYPE OF INSPECTION', y, ,i�F/'C L•t�Y' J'740 Vt&-*I 'il C�.11 110 NONCOMPLTANC.' OBSERVED L 7 i'UFfi.S'C'.TiOvS rSSrfF"f 1',iaL n5 FXF'I,.AI,NEQ -PE1.OW G I WILL REEXAMINE ,T NEXT INSPECTION C 7 rt(] !FO'.0 [:t1tFf;Etal, lJN'Tl'1. [,t:IN;3F' C':CRCt COMMENTS: r Post -it- brand fax transmittal memo 7J711 n of pages . INSPECTOR XJC,TC: G J ARE MAD'k PLEASE CALL. FOP TNSPEC li'l ION fit) NOT RT'MO',lE THUS NOTICE. CATION OF WELL �apR-6UGH 6UBDW1bi0t > vv.lw�a LOCATIONISKETCH: DEPTHS MEASURED FROM:L BOREHOLE DATA: Material Type and Color ,ry t -t. a AJ .. �_...�.t:. call �Ut K:c; �.J .. .._..-. w.r__-• �i .�.. rt� � 1'ui. STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER WATER WELt. REGARD iDY BLOCK I SECTION QTR$ WELL OWNER: SECTION TOvrvaHjP j RANGE MtMtOtAN CIN CE ps 1 Ow — I around surface I WELL DEPTH/ DATE OF COMPLETION Death of hola: !d / _ tt Depth kk Depth of From To DEPTHr �TO STATIC WATER LM EL: below K up of casing 0 ground surface —} I Date: METHOD OF DRILLU4z DU air rotary ❑ cabta tool :,other USE OF WE! LS+J?4 Domestic 0 , rigation 13 m0111110r (� public Supply Q Other__ — CASING STICKUP: '�7 _.. ft. Diam: in. toj!e/ it Casing WOE: r' _ _ Jn, to tt WELL INTAKE OPENING TYPE: i, open end []screened ❑ perforated n OpeB hole Depths of openings: _� to SCREEN TYPE: , in. ___ DiBm;ft SlotFGRAVEL 4:�T PACK TYPE: Volume used:_ — -GROUT Depth to�— . TYPE; Depth: from \ fY to tt `'DEVELOPMENT ME THOO:�-- MAR 2 5199 Municipality of Anol Int. Health & Human CONTRACTOR INFORMATICS v a .1 Par iaa" Business ame �f ,s �ti.•cy ��.s ' .. rS,onaWre ot AolnonZeoespletbrtetuva PUMPING LEVEL AND YIELD: it aftor .T„e ____ hes ptimping 9Pn! PUMP INTAKE DEPTH: 1t Horsepower. WELL DISINFECTED UPON COMPLETION? M:ygS O NO REMARKS: PLEASE &TAIL VJHI'CE COPY OF LOG TO: ONROI 90OON Ott WA TIER EAGLE RIVER AK 99577,2110 7671 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE E Jv DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502�j ANCHORAGE, ALASKA 99519-6650 1117-� ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930478 DATE ISSUED:11/15/93 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE:11/15/94 OWNER NAME:NORCOL INVESTMENTS OWNER ADDRESS:2340 LOREN CIRCLE ANCHORAGE, AK 99516 PARCEL ID:01711297 e'l LEGAL DESCRIPTION: FOREST RIDGE BLK 2 LT 2 C. �e LOT SIZE: 38646 (SQ. FT.)� NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: lo, 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 (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 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. SPECIAL PROVISIONS: 1. A SECOND TEST HOLE SHALL BE DUG AT THE TIME OF INSTALLA- TION TO VERIFY SOILS TYPE AT THE NORTH END OF THE DRAIN FLD. 2. THE 50 FT. SEPARATION DISTANCE IS TO ANY CHANGE IN SLOPE "TO" A SLOPE GREATER THAN 25%. RECEIVED BY: ISSUED BY: DATE: S DATE: ll�(h '6� 16 October 24, 1993 HEALTHAUTHORITY unicipality of Anchorage APPROVALS EPARTMENT OF HEALTH AND HUMAN SERVICES 25 L Street .O. Box 196650 inchorage, Alaska 99519-6650 SEWER & WATER MAIN EXTENSIONS Forest Ridge Subd., Block 2, Lot 2 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX 694-1211 SEWER & WATER INSPECTION equest you issue a permit to drill a well and install a eptic system to serve the proposed four bedroom house on the referenced property. ENGINEERING STUDIES wo test holes were excavated and percolation tests performed. AND REPORTS he approximate test hole locations are shown on the site lan. WELLINSPECTION a do not anticipate any adverse effects on the neighboring &FLOW TEST properties by the installation of the proposed septic upgrade. f you have any questions, or require any additional 'nformatio r your review, please contact us. SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN A. Shafer, P.E. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 A Z Q CL W N b I I LEGAL FOREST DRAWN L. S. ULSHER ESIGN CRITERIA: 4 BDRM = 600 GPD SOILS = 0.8 GPD/SQ. FT. 600/0 8 .= 750 SQ. FT. REQ'D DRAINFIELD: 5' DEEP 5' WIDE 3' EFFECTIVE 81' LONG Fmk 2. LOT SHT. 1 OF 2_� REVISED 11/12/93 STRUCTURES, EASEMENTS, OR ENCROACHMENTS SHOWN ON THIS SITE PLAN ARE AS SHOWN 01 AN AS -BUILT SURVEY DRAWN BY: JEFFERY A. GASTALDI IT IS THE RESPONSIBILTIY OF THE CONTRACTOR TO VERIFY EASEMENTS, REQUIRED SEPARATION DISTANCES, AND PROPERTY LINES PRIOR TO CONSTRUCTION. CONTRACTOR IS REQUIRED TO OBTAIN UTILITY LOCATES PRIOR TO ANY EXCAVATION WORK. ALL PORTIONS OF SYSTEM BUFFALO STREET WITH LESS THAN 3.5' OF COVER REQUIRE INSULATION. 10' T & E ESMT. —_---------- inn• -- --------- ----- Pk -015- RADIUS MIN. 50' EPERATION------- SOUTH WINDSOR CIRCLE THE ENGINEER MAY VARY THE EXACT DIMENSIONS AND DESIGN PARAMETERS -•N THE FIETD, IF NECESSARY, TO MEET SITE CONDITIONS. DISTANCE FROM ANY \ CHANGE N SLOPE GREATE THAN 259 �N \ PROP. DRAINFIE `ED3 10' C.E.A. ESMT. rH 02 A 0 \\ F CO CO 4R Mr \ PROP. ° DBL HOUSE co sx ®co JP A, rH ALT. SITE y PGP b� \ Y` \ \ DRIVE SOUTH WINDSOR CIRCLE THE ENGINEER MAY VARY THE EXACT DIMENSIONS AND DESIGN PARAMETERS -•N THE FIETD, IF NECESSARY, TO MEET SITE CONDITIONS. Municipality of Anchorage 0*7 DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "U' Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:'.� pp��,c' DATE LEGAL DESCRIPTION: (�i L tl lw � I2l�es/� Township Range Section: CITF PI AN WAS GROUND WATER VES ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water AtterLJ r Ponnitnrinn? �L Date:o �' 93 PERCOLATION RATE V (minutesimch) PERC HOLE DIAMETER 4-, r __ S & S ENGINEERING CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED rverpoao. rFECT e ACCORDAN�gk ftkW ratll RINICIPAL GUIDELISDATE. DATE: 72-008 (Rev. 4/85) Municipality of Anchorage m " DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L:' Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: ` ILL- (/�I'�GO6- DATE PE LEGAL DESCRIPTION: �2 Z �� S/,)Township, Range, Section: / SLOPE ©Itir- at'AVS/\& - bWt**f— SICZ7 CO".. Sw7w S�y Cmwen W (Fsw SAaD 25-w WAS GROUND WATER j•� IO ENCOUNTERED? /V S ` - s� L M IF VES, AT WHAT O NO 6,7 , DEPTH? P E Depth to Water Aft Z 42 i3 Monitoring? �(� Date: ltl Gross Reading Date Time Net Time Depth to Water Net Drop U 93 :0Aq-I _ i y4 /` — 112 10 let, " (u r h 2 fU 4 71 JO PERCOLATION RATE 13.3 (minutes/inch) PERC HOLE DIAMETER COMMENTS PERFORMED Bt7034 Eadle i2iver LOOP ROed NO.204 I Ea,gIe r*eir, Alaska 99577 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE 72-008 (Rev. 4/85) L--� CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Forest Ridge S/D, BLOCK 2, LOT 2 GENERAL: 1. The scope of this project includes the installation of a 1250 gallon septic tank and a leachfield trench to serve the proposed four bedroom residence 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 responsible 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 S/D, Block 2, Lot 2 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 10 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. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed - up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier 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. 4. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. 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. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page Three Forest Ridge S/D, Block 2, Lot 2 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 #200 sieve. 7. When sand .is being used as a filter material, it's gradation specifications must conform to AMC 15.65.060D. Page four 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. 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. » C 0 L Qu:? F•_U I LDER 357 34b G9Z4 FOREST RIDGE' SUBDIVISION c- sr. -ra) LOT 1, BLOCK z sa, z 7 s s. F. N7 aVERHEA'3 UTjL,r,eu fY,IST' 4.N `FAIN cl>T. p. a•ze.a�• 49 AA, r, Q:20 g9 4i N_ kEI..ATt'JE EL -RV- FROM ASiYM4Q DATUM �TYPr C F i W a Few F)!. V Ak l loi! o ORWf I v ) ler St t n aY! F. KANT. 1 40.0'A E� � vI 1 0 t t OT h FOUND S/8" R68AR CtYP•i y roo O { p ! ,, E PLOT PLAN I here%,y, certify that 2 neve surveyed Municipality of Anchorage Development Services Department Building Safety Division On-Site Water 8 Wastewater Program CI 10K 4700 Bragaw Street 3l P.O. Box 196650 _ Anchorage, AK 99519-6650 / www.muni.org/onsite �/� 4 (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. big - COSA# 01-0ml da 1. GENERAL INFORMATION Expiration Date: — .1/P/7( Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address FOREST RIDGE SUBDIVISION: LOT 2. BLOCK 2. 15000 SOUTH WINDSOR CIRCLE • ANCHORAGE. AK 99516 WARREN & BRENDA SCHIMMEYER Dayphone 223-7349 15000 SOUTH WINDSOR DRIVE ' ANCHORAGE. AK 99516 Day phone PEGGY YOUNG w/ DYNAMIC PROPERTIES Day phone 261-7618 3111 "C' STREET • ANCHORAGE, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 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 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 engineers 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 GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD. SUITE 101 " ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS. P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described 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 soils condition, groundwater 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sofa benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for t' bedrooms. Disapproved. 337-6179 Date 0 q O(o Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA ChecWist Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Reort Nitrate Advisory Other Lt`tJuiiitirr/r/ OF ANC,,0�. ' ON.S1iE 0 •,'iris . w�PS1 WNP'1 ' Ytc`i .,•� A _ . •'.ate 1� By Original Certificate Date: ? d o IA., i.xl Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water 3 Wastewater Program 47W Bragaw Street P.O. Bout 196650 l Anchorage, AK 99519 -WW www.muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: FOREST RIDGE SUBDIVISION: LOT 2, BLOCK 2, Parcel 10: A. WELL DATA 'PACKER IN WELL HEAD. STATIC H2O COULD NOT BE OBSERVED. Well" PRIVATE If A, 8, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 3/6/1994 Sanitary seal (YIN) YES Wires properly protected (YM) YES Total depth 101 ft. Cased to 101 ft. Casing height (above ground) 18+ in, FROM WELL LOG AT INSPECTION Date of test 3/6/1994 2/20/2006 Static water level 0 ft. '0 ft. Well production 10 g.p.m. 4.4 g.p.m. WATER SAMPLE RESULTS: Coliform _ 0 colonies/100 ml. Nitrate _Q_ mg./L. Other bacteria _rZcolonies/100 ml. Arsenic: _Q_ug./L. Date of sample: 2/20/2006 Collected by: GEG, Ltd. B. SEPTIC/HOLDING TANK DATA TankType/Material STEEL/S.T.E.P. Date installed 11/19-22/1994 Tank sae 1500 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation clesnout (Y/N) YES Depression over tank (YM) NO High water alarm (Y/N) YES Date of pumping 10/1/2005 Pumper DENALI PUMPING C. ABSORPTION FIELD DATA Deft installed 11/19-22/1994 Sod rating .p.d. ft%drrl) 0_8 System type TRENCH Length 81 ft. Width 5 ft. Gravel below pipe 3.5 ft. Total depth •s•5 ft. Eft. absorption area 750 ft' Monitoring tube YES Depression over field NO Date of adequacy test 2/20/2006 Results (Pass/Fad) PASS For 4 bedrooms 24.5/ 30.5/ Fluid depth in absorption field before test27 in. Water added 761 gal. New depth 33 in. 26/ Elapsed Time: 1185 min. Final fluid depth 2 in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed 11 / 19-22/94 Size in gallons 1500 Manhole/Access (YIN) YES "Pump on" level at 43 in. "Pump ofP level at 33 in. High water alarm level at 45 in. Datum BOTTOM OF TANK Cycles tested 3 Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAtft station on lot 100'+ Absorption field on lot 100'+ Public sewer main 100'+ Sewer /septic service line 25'+ Animal containment areas 50'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/deanout 100'+ Holding tank N/A 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 N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle, storage 10'+ Curtain drain 25'+ Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATIONCL `c 1 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. y A. Gorn s.' Engineers Printed Name JEFFREY A. GARNESS �►s CE _ �1 Date /OZ + e�Prore�� U30.10 COSA Fee Date of Payment `3 Receipt Number �t7�gq I (Rev. 1 M5) Waiver Fee $ Date of Payment Receipt Number SGS ReEN 1060813001 Client Name Garness Engineering Group, Ltd. Project Name/p Forest Ridge SD Lot 2 Block 2 Client Sample ID Forest Ridge SD Lot 2 Block 2 hlatri: t Drinking Water P1\'SID 0 Sample Remarks: All Dates/Times are Alaska Standard Time Printed Date/Time 03/01/2006 12:20 Collected Date/Time 0220/2006 15:05 Received Date rime 02202006 15:30 Technical Director Stephen C. Ede Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 Microbiology Laboratory Total Coliform 0 coVI00mL SM209222B C (<=10) 0221/06 0222/06 SCL A («I) 0220/06 DPT Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Nitrate -N ND 0.100 m8/L EPA 353.2 B (<=10) 0221106 3C Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 Microbiology Laboratory Total Coliform 0 coVI00mL SM209222B C (<=10) 0221/06 0222/06 SCL A («I) 0220/06 DPT A,qa : p0d-� 2 6 L � / z / o 041 A S bo c ti 2 I I� `�'�. •errs � 1°� 30� 1 i 1 Cominundy;on site' Public sewer attcaau ly: av, utcngywuay q.lu v, 1/91)• Front-: MOA 021 x 'A I ertif icates, based only upon the representations 'professional engi/enrrogistenedi^the 8b�eof DHHS does this $aacourtesy tnpurchasers 0fhonoes and their lending institutions in/ e,hoeadah/nnrtanfegendand state requirements. Employees nfDHHSdnnct 'conduct inspections oranalyze data before acertificate is issued. The Municipality ofAnchorage is not responsible for � wuAon--__---_--_______________�_� ' Municipality of Anchorage AIRL Department of Health -and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: —cP` 113 aZ I j oIES'f IcypryE. S/D Parcel I.D. A. Well Data � Well type ( 1 Z1LtAf-fr If A, B, or C, attach ADEC letter. ADEC water system number IL11A� Log present (Y/N) \ S Date completed 3-6—�Y Driller 14Lf 1/UE �+t�tts rr t Total depth ��� t Cased to I ca Casing height 11// %a Sanitary seal VJN) YES Wires properly protected (SAN) /� Date of test Static water level Well flow Pump levell FROM WELL LOG AT INSPECTION I D g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/heWOM tank on lot /00 ; On adjacent lots Absorption field on lot ad ; On adjacent lots _ Public sewer main N 1A Public sewer manhole/cleanout ` Sewer service line 6 14 -Petroleum tank WA Tom g.p.m. Tr► U d ' f- t w "f- WATER SAMPLE RESULTS: Coliform t LA —I p �/U ETFi�7� Other bacteria � Date of sample: ��a �� 1 Collected by: Sk S EN&I^JCcdUNC B. SEPTIC/HOLDING TANK DATA Date installed �( 193 Tank size /SX2Q 6A<- Compartments Z Cleanouts(L AC V) '/F5 1 Foundation cleanout(ON) �S Depression �(Yd1 High water alarm Y ) 2E2ss Alarm tested (Y/@ Date of pumping fO//4 ` 1 BUJ T/ -N<_ Pumper N SEPARATION DISTANCES FROM SEPTIC/MOMN d6 TANK TO: Weil(s) on lot I DU -' On adjacent lots i 06 '( Foundation (� To property line _�6 (� Absorption field 14- Water main/service line a5 Surface water/drainage t06 � 72-026(M3)•FMnt CONTINUED ON BACK PAGE C. LIFT STATION Date installed j ('� Manufacturer /`f\) kfo� Size in gallons Manhole/Access ON) ,"r soz) Lf Vent (Y/N) YFS "Pump on" level at 93,. "Pump off" Level at ( High water alarm level I � Cycles tested t,)IA Meets MOA electrical codes &) J` s SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot l DV jF On adjacent lots w Surface water. % 4G (-Z D. ABSORPTION FIELD DATA Date installed a2L 3 Soil rating (GPD/Ft2) ,System type S4g4 -ow Tzev- ft, Length 8 l Width S Gravel thickness '� Total depth S, S Total absorption area 7C -,o St- Cleanout present {S .) y�S • Depression over field (Y/(C JA /J 1A - ( 411 Results ` - Bedrooms Date of adequacy test (pass/fail) for Water level in absorption field before test PJ �A _f�4w After test /J/A f")Ew Peroxide treatment (past 12 months) (Y/lye No If yes, give date — SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot IM la' On adjacent lots 10614. Property line To building foundation 16, ' To existing or abandoned system on lot On adjacent lots Sy 14- Cutbank SU Water main/service lined r� Surface water 106 J- Driveway, parking/vehicle storage area P -S Curtain drain /66 -fi- E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or Signature Engineer's Name Date MOA and HAA guidelines in effea'"tte of this inspection. Alaska 99577 :?_ Z HAA Fee $ e da Date of Payment Receipt Number 72-026(3/93)* Back >vL T� Waiver Fee $ _ bate of Payment Receipt Number. 147.3 Alaska 99577 :?_ Z HAA Fee $ e da Date of Payment Receipt Number 72-026(3/93)* Back >vL T� Waiver Fee $ _ bate of Payment Receipt Number. 147.3 03/24/94 CT&ERcf,4 C1ienk Sample ID Matrix Client Name Ordered By Prnjcct Nkune Prgj4ctk PWSID 16:21 CTEE ENVIRONMENTAL LRB SERVICES N0. 104 902 Commercial Testing & Engineering Co. Environmental Laboratory Services ®rust®�+maria/+*r�►war"s�'�'''�s®d'����riiri. LABORATORY ANALYSIS REPORT 94.1206-1 1,2112 1'01tFST RIDGE ST) WATER S Na S FNGINEERLNG R. SHAFER UA WORK Order 76-796 Primed Pate 03!24!94 %i; 11":2x hr;. ckiJleotedT)ate ()3,'21/94 ()"1635 Receivedl)ate 03;22!9.4 6/;.12:3(: 1'eclutic:�i D.tectnr STEPHEN C. EDL ' Relea..ad Tiy. ------------ -------------- S:tnplcRcxnt¢ks: ROU'I''LNLSAlv1l'LECt)1,1.,L'.E'TT.bRY.JW- QC R:,::lts ';•:rvd �tethnd Parameter - ._----._.__ tl,Td n g:1, EPA 353.2,3vO,G Nitrate-lv Allowable Fxt, Asr,l. Limi:s D+.ate Date (nil :1-33'33- 33'33---r,9i`zl94 -C\ftt U.4 = Untav tailahle See Special Instnrumis Ab ov e NA = No t Analyzed See SzunplcRemiu.'ksAbove LT=T,essTAan U = Undetected Rep. wlcd valt'Ie is the practical q�nlif9cstion limit. LT= ,esqCkcThan 11tan D m Secondary liltdiott. 5633 B Street, Anchorage, AK 9951 E-1600 — Tel: (907) 562-2343 Fax (907) 561-5341 . _ _ _ --AAAA —AAAA -- - ---,. er 1 ITIfS IN ALASKA COLORADO FLORIDA, ILLINOIS, MARYLAND, NEVJ JERSEY, OHIO, UTAH, WEST VIRGINIA