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Home My WebLink AboutFOREST RIDGE BLK 2 LT 5 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: '~ {,,~ ~ ~-'~,,~ ~r'~ PID Number: ~~ ~~~ Waslewater System: ~ New ~ Upgrade ~ t ~ ~, b~~ ~ ~ ABSORPTION FIELD Phone: I,o. of~r..,: ~DeepTrench ~,~allowTrench ~B~Mound ~Other TO~I Depth from odginal grade: WELL: ~ew D Upgrade ~.ve; width: ~ SEPARATION DISTANCES ~ septic ~ Holding ~.T.E.P. Su~ace i ' Remarks: BENCH MARK S & S ENGINEERING Depa,ment of Health~d Hu ices approval Reviewed and approved b Date: ~/ Perml! No. $W930488 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: FOREST RIDGE SUBD., BLOCK 2. LOT 5 01711294 PID No.: · WATER FOUND 1.5' fiELOW LAKE OTIS GRAVEL ' A B COZlZl I1~1 UH 131 12Ol ~1122 1371 ~133 1491 ~4 82 85 [ * ' ' ' "" :.'.I~P~TIUN ~0~."'.' ' · ~..~"[ 3500 IlA~Et COLGIIY Tg-IONE l': 244-6233 ~f~RESg: 15111 SOUTH ~INSOf: 5/10'/199~ COH~EN~: ~LL A~ ~PTXC ONLY .r~ ~ .............. ;?- ....... ~-; ....... ~'fPE OF INSFECTION: ELECTrIC:AL FI/IfiL ~//~ //~.~ 0 0 f~ NO HONCOHPLZANC~ OI~SRR~C[' [ C ] ~ILL REEXAKXNE AT N~XT INSPEC~IOtt t' ] m,O NOT CONCh;AL UNTIL kEIN~'ECI'E[~ ¢OLOHY ~UZ L~)£R$ .'WEll SUI~ONI~ON LOCATION/SKETCH: ; MEASURED FflOM:r'lca~ino top [~l;rou~i surface B(~REHOLE DATA: Depth Matet~l Type ~nd Color From To CONTRACTOR iNFORMATION: Registered Business U / ~ig~r~OI ~uth0rized ~esprese~tatwe ate 90T ~4~ 69~4 STATE OP ALASKA DEPARTMENT OF NA't'URAL [RESOURCES DIVtSlOtJ OF WATER WATER WELL R[CORD · ~ . D~ ns WELL OWN[R: WELL · DATE OF COMPLETION Depth of hole:~£~;~_.~__~-.-ft DEPTH TO STATIC WATER LEVEL: ~) ftbelow C~qopolcas;ng I'1 ground surface MI21'HOD OF DRILLING: O~a;r rotary I'1 cable tool [] Other _ , USE OF WELL: [:~gomestic O irrigation [] monitor [] pubiic SupI:Iy ri othe~ CASING STICK-UP: ~lt. O~am: .._.~._In. tO.j~.~ ~A/[LL IHTA~E OPENING TYPE: ~en end ~ screened ~ perle,areal 0 open Deptk~ of ope~ngs' _ to SCREEN TYPE: Diem: GrcAVEL PACK TYPE: _ ____ Depth to top: GROUT TYPE: _ ~ Volume: Depth: from It DEVELOPMENT ~ETHOD; / PUMPING LEVEL AND YIELD: .__~. It alter / t,rs PUMP INTAKE DEPTH: . ft Horsepower; _ WELL DISINFECTED UPON COMPLETION? []~YES [] t~O REMARKS: PLEASE MAIL WHITE COPY OF LOG .TO: DNR/DIVISION OF I,'/A~ER .. PO BOX 772116 EAGLE RIVER AK 99577.2116 PAGE 1 OF 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 #L~ STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930488 DESIGN ENGINEER:S ~ S ENGINEERING OWNER NAME:NORCOL INVESTMENTS OWNER ADDRESS:15111 SOUTH WINDSOR CIR ANCHORAGE, AK 99516 DATE ISSUED:Il/19/93 EXPIRATION DATE:ill19/94 PARCEL ID:01711294 LEGAL DESCRIPTION: FOREST RIDGE BLK 2 LT 5 LOT SIZE: 51384 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION 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 (ISAACS0). 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: T~zREVIS~DiDE$I~'SURMITT~D'll/15/93::MUsT :BE~REVIS~D-AS FOLLOWS:iT~E-BASAL-BED.A~S.MUSTBB-EXCAVATEDoTO_3.5_FEET2. BE~OW.GROUNDD.LEVEL_ORTHROUGH.THE.GRAY.DENSE..CLAYLENS -. ~HICHEVER .IS THEDEEPEST. THE..BASA~ BED DIMENSION MUST BE~ PAGE 2 OF 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 #L# STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 B~SED;ONTHE 140-MiN/INCH pERc RATE FOR~THE GM AccEpTING SOIL~STRATUM;.~ ,, RECEIVED BY: .-~ ,~' ISSUED BY:~ .~/~~ ' ROBERT SHAFER, P.E. ROGER SHAFER, P.E. October 24, 1993 CIVILENGINEERS (907) 694-2979 FAX 694-1211 ,~.T,^u'r,o,rn, 4unicipality of Anchorage ~,,~s )EPARTMENT OF HEALTH AND HUHAN SERVICES 325 L Street ?.O. Box 196650 %nchorage, Alaska 99519-6650 ~EFERENCE: Forest Ridge Subd., Block 2, Lot 5 (equest you issue a permit to drill a well and install a :eptic system to serve the proposed four bedroom house on the ~eferenced property. £~EE,,~Sn~,ES ~O test holes were excavated and percolation tests performed. ~he approximate test hole locations are shown on the site ~lan. ~U.~S,EC,O, ~e do not anticipate any adverse effects on the neighboring &~o~s~ ~roperties by the installation of the proposed septic upgrade. If you have any questions, or require any additional [nforma' ;n for your review, please contact us. -~rt A. Shafer, P.E. 17034 NORTH EAGLE RIVER LOOP - SUITE 204 * EAGLE RIVER, ALASKA 99577 ILEOALF(,)RI'51 NIUGI- 5UBUIVISIUN~ BLOCK 2, L(JI b FROI! SYSTE~ 3' DIA. SOLID --PRESSURIZED SYSTEM: PUMP = 20 OSI 05HH STAGE (,-,$0 GPM) DISTRIBUTION DETAIL 50' '~-I 1/4" DIA. LATERAL 30' ENDS CAPPED LATERALS ,,., 44' LONG EA. G ' ~' 6' TOPSOrL & SEED _ PM/I_AT . O HOLES/LAT (58 O.C.) ~1' / t~' 50 HOLES TOTAL ~' 0.59 GPM/HOLE r{ / Ii //-~N.U, c~)~: '16" DIA. HOLES FACED DOWNWARD 2'm~noN.II / Il / 1/4" DIA. LATERALS __ ~JJ t H La.,_ ~ DIA. SOLID MANIFOLD mPm~M~))u~lg'X]Y~-~m~ ~.JJ~1'm~.~RIC--_ Il /- ,~,,.~ lll I'"-- , - .... ~ )),.(PER)4EABT~. B.A~RI~ 30' SE~R ROCK. ~ UNDER ~ ~ O~R DI~. PIPES PROFILE 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 5- 6- 7- 8- 9- ,~.IENGINEER'$ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES / ~,~wnship. Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? ~' pO E M~l~il~i'ino ? ~1~ Reading Date Gross Net DePth to Net Time Time Water Drop , ,. iju ~,~ 2. ~,, _ : L'~ Ir~ ~,,., ~ '1~ " :~s ~o ,. ~" ~lt" ~ '~ ,, fi,, ~/K" ,3 - E,o. H. 14- 15- 16- 17- 18- 20. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL OESCRIPTION:/~,~ ~.~.NG[NEEI~'S SEAL) DATE "~?../I. ~1~ g~nship, Range, Section: WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Oepth te Warn SLOPE SITE PLAN 14- 15- 16- 17- 18- 19- )/~0 Gross Net DePth to Net Reading Date Time Time Water Drop ~,,;~.~ p~ -- ~o, ._ '. ~ ~ ~/~" ~/~., ~(~ 5% ,/~,, 20. PERCOLATION RATE ,~) :L(m,nute~,nc.} PERC HOLE DIAMETER ~ ' ' -.. . TEST, RUNBE.TWEEN ..~,~------"'~AND i~o-~ FT PEaFOR~EO eY: ~'~" ~--'~ R:¥~r L- - ~ -. -~ ~~Y 1HR~ ~S'tEST W*S PE:4FOR~ED ~N PEREORMED OR: 'T rc LEGAL DES R'rT'O": 1 8 9 tO 13 I? '18 tg 20 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG ~ PERCOLATION TEST DATE PERF ~oZ~wnship. Range, Section: SLOPE SIC"/ ~v//.,- i T74,.g_. SITE PLAN COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Oel~h tO Water Nler ' ~i~i~? Reading Date Grou Net DePth to Net Time Time Water Drop :~ I0 - A~?'/ PERCOLATION RATE ~ (mmules,,,nch) PERC HOLE DIAMETER TEST RUN BETWEEN ~,_.~T AND ~-~ FI PERFORMED BY!TO_~ ~,~le RJv~ L~ Road No, ~ I ~ / CERTIFY THAT THIS TEST WAS PERFORMED IN / Munl~li~ of Anc~rage DEPARTMENT OF H~LTH & HUMAN SERVICES 825 'L Strut, Anchorage, Alaska ~502~50 - wnship, Range, Section: SLOPE SITE PLAN L .O.H .ASOROUND.ATER · ENCOUNTERED? 4 5 6 7 8 9 10 11 12 IF YES, AT WHAT DEPTH? 13 Del3~ I~ Wmr ~r lloni~'i~g? Iht,- Reading Date Gross Net Depth to Net Time Time Water Drop 14 15 16 17, 18- 19- 20- PERCOLATION RATE ~ Immures/tach) PERC HOLE DIAMETER ~ COMMENTS TEST RUN RETWEEN ~ AND ~ ' )*~FT ,,/ / PERFORM~ ~ ~;~ L~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDA~L~$~ ~UNICIPAL GUIDEL ON THIS DATE. DAT~ _ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG ~ ~ PERCOLATION TEST · EGA DESCR,PT,ON= 1 DATE PERF 4 m 10- 11 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS WAS GROUND WATER ENCOUNTERED;' IF YES, AT WHAT DEPTH? . E // Depth to W~ ~r ~'7 ~ Reading Date Gross Net Depth to Net Time Time Water Drop %:q~, .- i '/s ,. _ ~, :O.~ io., ~v~~ PERCOLATION RATE c~-*' (minutes, tach) PERC HOLE DIAMETER TEST RUN BETWEEN ~AND f~t"~' FI PERFORMED BY; T 7034 Eagle Rlv~ L~p R~d No. 2~ I ~~ ~CERTIFY THAT THIS TEST WAS PERFORMED IN E'91. River, Alaska 99577 //// ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN~CT ON THIS DATE. DAT~ 72~8 (R~, 4~) ~. (ENGINEER*S SEAL] o, A.cho,a0. DEPARTMENT OF HEALTH & HUMAN SERVICES 825 *L" Street. Anchorage, Alaska 99502~650 SO~LS LOG -- PERCO~T~ON TEST / / LEGAL DESCR.PTION: ~. ~,' ~%W ~ Township, Range, Section: 4- 5- 6- 7- 8- 9- 10- 11 SLOPE SITE PLAN 13- ~"~ :WAS GROUND WATER ENCOUNTERED? ~o.H IF YES, AT WHAT ~ [' DEPTH? pO E Oel~h to Wa/er Aller M~itering? ~*~'~/ Reading Date Gross Net Depth to Net Time Time Water Drop 14- 15- 16- 17- 18-' 19- 20- PERCOLATION RATE ~.7~'FT PERFORMEDByIT0~E~ R pR No 2~ I ; ' ~//~ CERTIFY THAT THIS TEST WAS PERFORMED IN Eagle River, Alaska ACCORDANCE WITH ALL STATE AND MUNIClPA~ GUIDELi~N~F ECT ON THiS DAT[ DATE: 72~ (Rev. 4,~J DRAWN L. S. ULSHER CKD. R.A.S. STRUCTURES, EASEMENTS, OR ENCROACHMENTS REVISED SHOWN ON THIS SITE PLAN ARE AS SHOWN ON 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 CO~ DATE10/23/93 SHT. 1 OF 2 11/17/93 SOUTH WINDSOR CIRCLE PROP. DRIVE PROP. 1500 GAL S.T.E.P. ~r~.T. P~DIUS PLATI'F~3 DESIGH CRITF IA: 4 BDRM = 600 CPD SOILS = 0.4 GPD/SQ. FT. 600/0.4 = 1500 SQ. FT. REQ'D BED CRITERIA:' REuOVE OROAN CS INSTALL 3' LAKE OTIS GRAVEL 6' SEWER ROCK OVER AND UNDER DIST. PIPES 24' X 65' CONTRACTOR IS REQUIRED TO OBTAIN UTILITY LOCATES PRIOR TO ANY EXCAVATION WORK. N HOVSE 10' T & E ESMT. % BED 100' PROP. BLOCK DRAWN L. S. ULSHER CKD. R.A.S. SliT. ~ STRUCTURES, EASEMENTS, OR ENCROACHMENTS REVISED 11/17~95 ~ SHOWN ON THIS SITE P~N ARE AS SHOWN ON AN AS-BUILT SURVEY DRAWN BY: .......... JEFFREY A. GASTALDI ~. ~.. ~...~ -.' IT IS THE RESPONSIBILTIY OF THE CONTRACTOR TO VERIFY EASEMENTS, REQUIRED SEPARATION " ............ ~..~ DISTANCES, AND PROPERTY LINES PRIOR TO '~.~ .... -~, CO~N. SOUTH ~ ~ ~ WINDSOR ~ ~ 'CIRCLE I ~ X _ '~. / ~ ~ ) ,o. SOILS = O.~PD/SQ. FT. ~ V/ ~ ~ /XI ~ O. rT. REO'D ' '"~ ' ' * ~' BED C ~NS~*LL ~' ~ ORS ~.AV~L [~ ~~~. 7 s' S[wE~ ~OC~ OVER AND UNDER ~ ~~ DIST. PIPES ~ ~ ~~ ~ ~o~. 2~'x ~. y ~ / CO,T,,C~O~ ~s ,~QU~,~D ~O N Y ~/ OBT~N~UTILITY LOCATES I .Y PRIOR TO ~Y EXCAVatION ~ .~' / ILEGA'I'ONESI }{IUGI' 5UBUIVISION, DRAWN L. S. UL,SHER I CKD. R.A.S. 63' BLOCK V~ LO I b REVISED 11/17/93 (~YP)] s' o.c. 2" DIA. SOLID M,MqIFOLD I 1/4' DIA. IATERAL O (Tr~) 24' DETAIL PRESSURIZED SYSTEM: DISTRIBUTION PUMP = 20 OSI 05HH 5 STAGE (~$0 GPM) 4 LATERALS ~ 57' LONG EA. 7.5 GPM/LAT /-~' TOPSOIL & SEED 12 HOLES/LAT (5' 0 C) ~ / ~ ..... ~. HOLES TOTAL ~ ~).~25 GPM/HOLE _ ~ / ~ ~ ~ ~ '16" DIA. HOLES FACED DOWNWARD ~~s~o..~ / II /'"' 1/4" DIA. ~TERALS ~ JJ t JJ La., ~ ~o~ o~.~,=~ i~ ~ o~ ..~v.~J~ / I ' 24' S~R ROCK, 6" UNDER & ~ O%~R DI~. PIPES PROFILE HOU-17-199~ OJ: 13 F~ ~4~6740 P.01 Wilitarn Rowe & A ssoclates ~,ca] £$1atc Apprals~r$ & Con~uh&m~ November 17, 1994 Municipality of Anchorage Zoning Enforcement PO Box 6650 Anchorage Ak. 99519 Attn Mr. Robble Rob~rmon Re: Lot 3B3 Blk 1 Fischer $/'D 'Tax # 015-292-23 Mr. Robinson; We recently inspected the property refrenced above for FHA financing of a new loan. The listing agent of the home hae indicated to ue that the recorde in your office are taxing the home as a duplex property. Actually the home Is a slngle family residence. The Improvement I~ ~plit entry construction with open parking. I here IS only one kitchen In the property an~ tl~e basement IS exited through the upper level. Furttler, Is our oplnlon that the home has never been a duplex. If we can be of any further service please feel free to contact us. TnTAI P.R1 ON-SITE NABTENATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCEs Lot 5, Blk 2, Forest Ridge S/D GENEP~L= 1. The scope of this project includes the installation of a 1250 gallon wast.water S.T.E.P. system (septic tank) and a pressurized absorption bed to serve the proposed four bedroom residence located on the referenced property· 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. The contractor shall be responsible for obtaining any necessary underground utility locates. 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. 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: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Page two 0 0 Septic tanks installed with less than 4 ft. of cover shall be insulated. 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. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. PRESSURIZED MOUND SYSTEM INSTALL]%TION= 1. Any peat or organic matter must be removed from the elevated mound site. me The bottom of the basal bed area as well as the top of the sand filter is to be within two inches of level. The distribution piping is to be of PVC (ASTM D3034 or equal). All joints are to be solvent cemented. The side slopes of the top layer of the mound system must not be steeper than 33% (3:1). The top of the mound shall be covered with a minimum of 6 inches of topsoil and vegetated sufficiently to prevent erosion· 0 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. 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. Page three 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. MINIMUM MATERIAL SPECIFICATIONS= Any septic tank constructed by a manufacturer. proposed for installation must be Municipally approved septic tank ® The following septic system Anchorage: pipe materials are approved for use in installations in the Municipality of 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. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 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. 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: 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. me 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. 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. 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 Parcel I.D. # _ 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Lot 5; Block 2; For~%'t Ridge Subdivision Location (site address or directions) Property owner Mailing address. Lending agency Mailin. g address 15111 South Windsor C~rcle Anchoraget AK Jack Perrin Dayp~one 345-9060 15111 South Windsor Circle Anchorage, AK 99516 Day phone Pe~v Gonzales/ Fortune Prooert~ Dayphone 265-911~ Agent Address 2. NUMBER OFBEDROOMS: 3. TYPE OFWATERSUPPLY: Unless otherwise requested, HAA will be held for pickup. 4,,, NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site XX Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe,*functional and adequate for the number of bedrooms and type of structure indicated herein. I further verifythat 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 ~s inspection. Name of Firm Address Engineer's signature the date of~ ,%1~.. sot3gj Phone ~"2 7- ~;/~'~' Alaska Water &. Wastewater Consulta,n, ts, o~' prior to, ¢1o$in§ for the Engineering S~P~ices Pmvi~ 6. DHHS SIGNATURE Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes · and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate Is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Munl¢l all of Anchora RECEIVE D pty ge. Enwronmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (90d~~ Legal Descri~on: A. WELL DATA wal~ type /~ r ~'v~ t ¢ Health Authority Approval Checklist ff A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth ~ / Date of test Stefic water level Well production FROM WELL LOG Date completed Cased to Fc// O/ Casing height (above ground), Wires prepedy protected (Y/N) AT INSPECTION WATER SAMPLE RESULTS: Coliform ~ Nitrate ~I~-~/~¢ - Dateof sample: ~1'~/ ~).~ : d,,b .../' B. 6EPTIC~OLDING TANK DATA Detein~t-,ed 12/H/~t5 Tankaize /'*'CC:~ Number of Compartmente Z Claanouts(Y/N) ~/'~" Foundation cleanout (Y/N) ~/e ~' Depression (Y/N) ///-~ High water alarm (Y/N) Oate of Pumping Lf-lS"~) Pumper A'~ c. AaSOR~nON eEI.O OATA Deteina-'lad /Z/~//~:; So, raU.g~or,'rmrm) O. 3 S~mty,. Le.~ '~:/' 2LI' ' '_ Wlclth (3ravel thickness below pipe (-'~' _C Total depth :~. Effective absorp~on area ~ (~ [~ '/~ ~ Monitoring Tube present (Y/N) Y~.~ Depression over field (Y/N) Date of adequacy tsst ~/~'/(7~ Results(Pass/Fall) pcr~/~ For /-/ .bedrooms Immediately after (~(::)Ogal. water added (in.): Abeomfion rate = If yea, give date Fluid depth in absorptlcm field before test (in.); ~)~ ~' Fluid depth (ir~) Minutes later:, '--" Perexk:le treatment (past 12 months) (Y/N) r~ (~7 72-026 (Rev. D. UFT STATION D,te n=,ed High water alawn level at* /'/'~ // Cycles tested ~ -/-;~a..~ '' Size in gallons /5'00 'Pump on" level at' ~.~" "Pump off level at* 'Datum ~<:~'~'~ ale ~'~- E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ~ O0 ' '~' Absorption field on lot , 1~0 / ')- Public sewer main Sewer/septic service line On adjacent lots I (~O / '~' On adjacent lots / ~) 0 / ~'' Public sewer manhols/cleanout /f////~ Lilt station I OO ' ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation I 5/ '/- Property line -~) / ~ Absorption field. / ~' ~ I0c3/ Water maln/sewice line JO / ~-- .Surface water/drainage / ~ / {- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Prope~/line I 0 / Building foundation 2 0 / ~ Water maln/se~ce line Surface water /(~' "~ Driveway, parldng/vehicle storage area g Curtain drain /q (P ~ ~'//~ t,~"~ Wells on adjacent lots /(:~ ~- 72-026 (Rev. 3/96)* Waiver Fee $. Date of Payment Receipt Number T-~87 P.O~03 F-~Sg CT&E Ret.# CIJeM ]game PWS[D A.K W~er ,&. 9v'as~ev,.~t C~ns~za~s I~c. Fetch Rlc~c Lot S l~k 2 Fo.s~ Ri~e lo: 5, bk2 Cilenz Printed Date/Time 03~J0!99 13:34 Collected Dme/T~me 03/26/99 15:15 Received ~e~e YOTIL CoLiform 12QB/1GCI#L~ ~0 L'O~I ~418 922Z! 03;2~199 KAP N~trl~e,N 0.S0O U 0.50~ ~41~ EPA $~3.0 1O~x 03/?.6/99 D3126199 S~L RECEIVED Analysis l~epor~ for To~ Co~fo~ Bac~d~ ~.~ Tel: n MMO*ML'O BACTZ~IOZ, OGICAL WATLq ARALYSLS RECOI43) MUNICIPALITY OFANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services · On-Site Services Section P.O. Box 196650 Anchorage,'Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot St' B~o~k ~ For~t ~d~ $-bdlulslon Location (site address or directions) ~ I ~\ ~L~4¥'N [ ~3 t_c~[r~ff'N ~'~c..~ Property owner Mailing address Lending agency Mailing address Agent Address CO[ONV BUI£DER8 2340 LO~¢~ Ci~c~¢ Day phone 544-4253 Anehoraq¢, AK 99516 Day phone Day phone e e Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well Y~ Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water supp y and/or wastewater disposal system Is in compliance .with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm s & $ ENGINEERING ' 1703~ Fnnle I?~e~ t~ Dn~ ~. ~ Address Engineer's signature DHHS SIGNATURE .~' Approved for ~7~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: "~"~ "~cC::',~.t~.~ ~~ Parcel I.D. A. Well Data Well type'~- ~/~F'. Log presen~.~ ) Total depth ~1 I Sanitary se~N)~-/ If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~['~ ~ / cI ~'"' Driller ~[.--'~ ~'~' Cased to ~)~'~ -I .Casing height I. FROM WELL LOG Dateo, test Static water level Well flow Pump level1 Wires properly protected~N) ~// AT INSPECTION ,~- i, AuNICIPAU1't OF ANCHOt<,~G TNVtI[o~NTAL $~P. VtCES DtVt$1ON ~'IAY 1 7 1994 g.p.m. '°'P ECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots I c~:) ' 'r- Public sewer manhole/cleanout I`-3 Cw._3'~- Petroleum tank I,~ I~--- WATER SAMPLE RESULTS: Coliform t~ Nitrate Date of sample: ~//I/~ z~ ~P. / ~ Other bacteria Collected by: ~- ~ ,~ ~'/,-)~ B. SEPTIC/HOLDING TANK DATA Date Instalmed / ~-/~r'/~/~ Date of pumping Pumper Tank size ,/~'"~--~ Compartments Foundation cleanou~'N)~ Depression (Y~) /"-J Alarm tested (Y~I'_.~,]). Foundation / '~ / .Water main/service line /O I /... SEPARATION DISTANCES FROM SEPTIC~ TANK TO: Well(s) on lot / ~'~' I On adjacent lots / C3'Z) ~ ~ To property line ~ / I~I Sudace water/drainage Absorption field 72-026 (3~33)' Fn:mt CONTINUED ON BACK PAGE C. UFT STATION Date installed Size in gallons 'Pump on' evel at Manufacturer .~.,d,.~:,-~_~ ~ ~- Manhole/AccesS) '~r~'~ ~ 'Pump off' Level at ~'~'~ '/ High water alarm level ~ ~1 Meets MOA electrical cede~) V SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot ~ ~.~..t. On adjacent lots Cycles tested '~. Surface water D. ABSORPTION FIELD DATA Length~'~ ~ Width Total absorption area ~1 ~ Soil rating (GPD/FF) ~. '~ System type .~.,~.1 Gravel thickness ~'~ I Total dep~ t preenS) T Depro~i°n ~er field ~ Date of adequ.acy t~st Water level in absorption field before test Peroxide treatment (past 12 months) ~'~ ~'- After test If ye~, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: On adjacent lots Surface water Curtain drain I',-.-[ E. ENGINEER'S CERTIFICATION Well on lot I '~"~" To building foundation On adjacent lots I ~:~4D ( 'n~-' Propertyline TO existing or abando.ned~system on lot Cutbank ~-~,p I_..+ Water main/service line Driveway, parkingNehicle storage area I cerb'fy that I have checked, verified, or confon'ned to all MOA and HAA guidelines in effect o~.~..,_clate~j~ this inspection. Date i' HAA Fee $ ,'Z~%.~i(.~O . Waiver Fee $ Date of Payment ~ -~-') ~ ~-~ Date of Payment Receipt Number ,~Sc~O~ ~.-k.~o'")'" Receipt Number. 72-026 (3/93)' Back · 05x1~94 / 17:24 CT&E EN~JIROHHENTAL LAB SERVICES N0.726 Commercial Testing & Engineering Co. Environmental L~borator¥ Services LABORATORY ANALYSIS REPORT C'I'&E Clle. t Sample ID Client N;~'nc OrderedBy t'roJect ~rarae t'roJect# PWSID 94.2213-1 LOT 5 BI~ 2 I'OR~qT RIDGE WATER S & S ENGIIqEEItL',,'O UA s.s. -- WORK O:.dcr ?8288 i'~{'tted Da:,: ¢,~/13/~4 ~) 17:00 hrs. Collected F~t c 05/11/94 ~ 09:35 ks. P, eceiveJ l'-~tc 0~11;94 ~'~ 11:30 hrs. *l~¢hntcal Director Relea~l B): STEP/-IEN C. IJD£ Pa.n~.¢ter l',esuI'~ Qmtl I~n,tl ]k{eO~od ]qiltai~N CLi0 U ~ng,q. EPA 3S3.2/300.0 Alh',wable EX'L Anal Lin:{t~ D;,te Date " $cc Special lasLu~.lions Ab ove · ' $~ Samplc lLcma/ks Ab ore ]'lA-, Not Au,'dyxed U- ~t~te~ ~o~ed valt~ J~ the p~'[ic~ ~lification li~t. LT= I~ss 6633 B $trset, Anchorige, AK 99518.1600 -- Tel: (907) 562-2343 Fax: (~7) 561-5301 ENVIRONMENTAL FAClLmES IN A~SKA. COLD.DO. FLORIDA, ILLINOIS, MARY~NO. NEW JERSEY, OHIO. UTAH. WEST ~RGINIA