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Home My WebLink AboutFOREST RIDGE BLK 2 LT 12 Municipality of Anchorage Page I of..2 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION" P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Teleph(~ne: 343,4744 On-Site Wastewater Disposal System and/or Well Inspection Report. Permit Number: ~wq3ozo~ PID Number: Name: /l,/~F-co~- .Z',u~, ~,~,,~-~- Wastewater System: ~New ~ Upgrade ~ Z~ ~,~. .ABSORPTION FIELD ~No. of B ~D~pTrench ~ShallowTrench ~B~ ~ound ~Other ~-~ GPD~q Ft. Township: ~ Range: j ~tion: Fill add~ a~ original grade: Gm~l length: WELL: ~ New ~ Upgrade G~vel width: Numar of lines: D~li~: Classifl~tion (Private. A.B.C): Total Depth: ~ TO: Toal ab~tion ama: Pi~ material: SEPARATION DISTANCES ~ s~p,c ~ Ho~di,a AS.T.E.P. Sudace Remarks: ~/~ , ~7~ ~=(g~7 ~ BENCH MARK ' ENGIN~'SSEAL 72-013 (A~. 9/91) MOA 25 Permit No. $W930209 Page 2,of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: 2 FOREST RIDGE SUBD., BLOCK 2, LOT 12 PIDNo.: 01711287 COl ~02 fill N.T.$. A B FC0 lt.0 18.5 ZOl 19.5 24.0 Z02 2'Z.0...27.5. V~It 29.0 29.0 ~,{TI36.0 45.0 VIT2 40.0 29.0 ~T3 86.0 76.5 ~{T4 85.0 84,0 ~ 100' WELL R~DIU$ PORTION ~ BED ~ NE~ 1500 GAL. t S.T E.P. SCAI~ 1' 40' NEW 4 BDRM HOUSE · STATE OF ALASKA . . DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER LOCATION OF WELL WATER WELL RECORD soRouoh LOCATION/SKETCH: WELL OWNER: . . DEPTHS MEASURED FROM:l-lcasing top I-1oround surface Depth From To BOREHOLE DATA: Material Type and Color Depth of hole: ~:~/ ft Depth of ~.ing: <~ / ft --_~L__//3 /--?-~- DEP~TO ~ATIC WATER L~EE ~ ft below ~ top of ~sing ~ g?~ ~udace Date: 7 //~ / ?~ METHOD OF DRILLING: ~' air rotary [ri cable tool I'1 other USE OF WELL: J~ domestic I-I irrigation [] monitor [] public supply [] other CASING STICK-UP: Diam: ~z~ in. to~'/ f casing ~: to WELL INTAKE OPENING TYPE: ~ open end [] screened [] Perforated [] open hole RECEIVED AUG 3 0 1993 Dept, Health & Human Depths of open{ngs: ~ to ~ ft SCREEN TYPE: Diam: Slot/Mesh Size: GRAVEL PACK TYPE: Volume used: GROUT TYPE:. Volume: Depth: from ft to itl. ft DEVELOPMENT METHOD: ..~_Z~.=_'r'~-~"~'~ Duration: LEVEL AND YIELD: ft after ~ hrs pumping~_.~..____gpm PUMP INTAKE DEPTH: ft Horsepower:. WELL DISINFECTED UPON COMPLETION;' ~ YES I-I N"-~-'~ CONTRACTOR INFORMATION: REMARKS: ~~~ ..~_~. ~ ~:~-/~ ~7_~ PLEASE MAIL WHITE COPY OF LO .~ro. ~ignature of Authorized Res rese~'tativ DNR/DIVlSION OF WATER ~*~ ' P ~... e Dante PO BOX 772116 EAGLE RIVER AK 99577-2116 SEWER & WATER INSPECTION SITE P!.~hlS SOIL TEST PE RCOf. AT~I TEST oel SrrE WASTE WATER DISFOSAL SYSTEM OESIGN ROBERT SHAFER, P,E. ROGER SHAFER, P,E. Febru~tv £1, 1994 CIVIL ENGINEERS (9O7) 694-2979 FAX 694-1211 MUNICIPALITY OF ANCHORAGE A~: Jo~ S~ P.O. Bo~ 196650 An~o~g~, AK 995~9 RECEIVED FEB 2 2 1994 MunJc;palit¥ ol Anchorage Dept. Health & Human Services REFERENCE= Lot 12; Block 2; Forest I~dge Subd~uZ6Zon A6buJ~C~ I~6pec~Zon Repo~ P~mZ~$W950209 H.A.A. HA#940034 Smith, The mod~fic~on to thc rx~6~g co~,,~ed ~b6orp~Zon ~ b~i~V co~ of r~ovi~ ~ppro~V ~0' o~ ~e ~ng ~b6orp~o~ b~ on ~e ~d ~t to ~e ~nge of ~ope, re~~ng the ~0' ~ b~e~ the ~ S.T.E.P. ~F~t~ ~ ~e ab~orp~on b~. T~ ~ req~e compL~e re~~on of ~e ~a~fo~ ~d ~. The ~0' ~r~ ~ ~ ~e topog~phv ~e m~ b~ ~z~ ~ ~ ~ 5 to 1 ~pe ~ ~ me~ ~e ~ng g~ound 6~f~ce ~pp¢o~ 15' back of ~e 6Lope ~nge. ~ or~n~ ~ ~ b~t ~b~ ~b~h~ ~ ~ ~o~ ~cc~V ~ ~ ~6~. ~eq~e ~ ~ ~e. Vo~ ~e ~b6orp~on ~ ~eu~n ~ the deu~op from ~ ~b6orp~on m~ b~ck o{ the ~pogcap~c ~LopC ~e. S~ce 6~a~g Of e~ on ~e g¢o~d ~n ~ ~e ~ be evid~ ~ ~ doubt~ a~o cou~ed bv te~t ho~ #I ~hich ~a~ orZgin~C~V excavated for p~marv ~ite. A n~u permit app~ca~n lu~ been prepared and 6ubmi~ted to coue~ thc proposed modifZc:~ion6. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 * EAGLE RIVER, ALASKA 99577 1994 ~ p~op~, ~e{o~e ~e ~g ~ ~ ou~Zz~ bc~ v~ 6Zn~ ~ 6V6t~ ~ ~u~ how~u~ ~e~ ~d ~e ~n ~ob~b~ ~pe~ ~e home ~o~ing. RCq,~t ~o~ co~ide~ the {o~wing ~cena~io reZa~iue to ~ ~ Co~o~ H~ A~o~y Approv~ ~ ~ ~e. Sinc~ the probL~ ~6o~ ~ ~ ~t~ ~ beg~ option m~ ~e propo~ mo~i~o~ ~ be ~ ~ ~n ~ne I, 1994. SZnce ~e ~g 6~6t~ ~ 25% ov~6lz~ for H~h A~ho~ Approu~. A~p~ ~ ~e ~e e~g 1500 cc Co~on~ AS SHOWN CO 1 C02 N.T.S. UTi ,~SU~T,O~ ~ /--99.8' ~8 9~.--~. ~'~.*::~'~': -',".. x~ IA B COl 22.0 19.5 C02 27.,5 27.0 Yl*] 29.0 29.0 UTI 53.0 59.0 MT2 60.0 56.5 MT3 104.,' 104 MT4 lO;} I06 Z0' OF SYSTEM AS NE%f PRESSURIZED DIST. 13ED NEW PORTION OF · NEW 1500 CAL. S.T.E.P. col 6o2 NEW 4 BDR~i HOUSE ~~ALT. SITE Tom Fink, 825 "L" Street Mayor P.O. BOX 196650 Anchorage, Alaska 99519-6650 February 17, 1994 Robert A. Shafer, P.E. S & S Engineering 17034 N. Eagle River Loop Rd., Suite 204 Eagle River, AK 99577 Re: Lot 12, Block 2, Forest Ridge Subdivision As-built Inspection Report-Permit No. SW930209 Health Authority Approval HA940034 Dear Mr. Shafer: Based on our review, the subject as-built inspection report and Health Authority Approval request cannot be approved. The subject permit was issued on July 12, 1993 based on a design prepared and submitted by S & S Engineering on June 20, 1993. The permitted design indicated that the drain field portion of the wastewater system would be located approximately 110 ft. from the west property llne and that the maximum slope along the western portion of the lot was 20%. During our site inspection we measured this slope to be approximately 55% and found that the drain field portion of the system had been constructed approximately 50 ft. from the west property line and approximately 5 ft. from the edge of the 55% slope. The system, as constructed, is in violation of AMC 15.65.060, which requires that a wastewater system drain field be locat~ at least 50 ft. from any topographic slope change of 25% or more. A conditional Health Authority Approval can be issued with' the following conditions: The existing 1,250 STEP tank must be blind flanged at the outlet and converted to a temporary holding tank with a high water alarm activated. A pumping contract with an approved pumping company must be in place to ensure that the tank is pumped on a regular and as needed basis. A new permit application and design must be prepared and submitted. The new design must be reviewed and approved by this office and must satisfy all code requirements including AMC 15.65.060. S & S Engineering February 17, 1994 Page 2 3.An escrow account must be established to cover all costs associated with conversion of the STEP tank to a holding tank, all pumping costs and all design and construction costs related to building a new drain field. The escrow account must specify that funds will not be released until the as- built inspection report for the new system is approved by this office and an unconditional Health Authority Approval has been issued. Sincerely, / P~ogram Manager, On-site Services cc: Colony Builders Municipality of Anchorage Page / of_2-- 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: __.~_~q~OZ~q PID Number: Name: ~,~,,c~,,-. .z',.,v~.~~r,.~,~r= Wastewater System: ,~ New [] Upgrade Address: /~,~c./V<~,4~-~' t ~/V.. ~"/~ r-IDeepTrench i-I Shallow Trench DBed [KMound i-IOther LEGAL DESCRIPTION Soil Rating: Total Depth from o,iginal grade: O.~' GPD/Sq Ft Lot: Block: Subdivision: Depth I0 pipe boflom from original grade: Gravel depth beneath pipe Township: I Range: I Section: Fill added abOve original grade: ' Graver lengt.: WELL: KNew [] Upgrade Gravelwidth: Number of lines: 10,$tancebelwee~lines: Classdrcahon (Private, A.B.C): Total Depth: Cased TO: Total absorption area: Pipe material: Yield:GPM I Pump Set at: Ft I Cas,rig He,ght A~ove G,oun(~Ftl TANK SEPARATION DISTANCES i-I Septic E] Holding ~[ S.T.E.P. Surface / / ~ L~n and Description: ENGINE~ SEAL ' Department of Health and Human Seduces approval Reviewed and approved bT: Date: Permit No; SW950209 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 995156650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report FOREST RIDGE SUBDIVISION, Legal Description: BLOCK 2, LOT 12 PIDNo.: 01711287 N.T.S. MH I~ITI INSULATION i A B .~Oi 22.0- -19.5 302 27.5 27.0 ~ltl 29.0 ~ITI 53.0 59.0 ~l'r260.0 56.5 ~iT3 104.5 104 ~IT4 lOl 106 1500 GAL. S.T.E.P.i COt 4 BDRM }lOUSE SLOPE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930209 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:NORCOL INVESTMENTS OWNER ADDRESS:2340 LOREN CIRCLE ANCHORAGE, ALASKA 99516 DATE ISSUED: 7/12/93 EXPIRATION DATE: 7/12/94 PARCEL ID:01711287 LEGAL DESCRIPTION: FOREST RIDGE BLK 2 LT 12 LOT SIZE: 49121 (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 ~ST 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. SPECIAL PROVISIONS: RECEIVED BY: DATE: DATE: -/2 -93 ENGINEERING STUDIES AND REPORTS SITE PLANS ROBERT SHAFER. P.E, ROGER SHAFER, P.E. June 20, 1993 CIVIL ENGINEERS (907) 694-2979 FAX 694-121t ~unicipality of Anchorage EPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Forest Ridge Subdivision, Block 2, Lot 12 Request you issue a permit to drill a well and install a septic system to serve the proposed four bedroom house on the ceferenced proper~y. ~wo test holes were excavated and percolation tests ~erformed. The approximate locations of the test holes are located on the attached site plan. The monitoring tubes ~ithin the holes have been checked and found to be dry. ~his property has enough area for a septic upgrade which can ~e seen on the attached site plan. We do not anticipate any ~dverse effects on neighboring properties by the installation )f the proposed septic system. If you have any questions, or require additional information [or your review, please contact us. rt A. Shafer, P.E. ,S/LSU/lsu 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 IDRAWN FOREST RIDGE SUBDIVISION. BLOCK 2. LOT I~ ,.. s. u,.s,E, Ic'`". R.A.S. I°A'" 6/22/9`3 Is"'.. , OF 2 DESIGN CRITERIA: 4 PlDRM = 600 GPD SOILS = 0.5 GPD/SQ. FT. 600/0..3 = 2000 SQ. FT. REQ'D BED DESIGN: 2' DEEP (REMOVE ORGANICS) INSTALL 2' SAND FILTER 6" GRAVEL OVER AND UNDER DIST. PIPES 36' X 56' PROP. ALT. $1T£ _-'-~-.- ~ ~ ~ DIST. PRESSURIZED DISTRIBUTION SYSTEM: PUMP = 20 OSl OSHH 5 STAOE (~$0 GPM) 6 LATERALS ~ 50' LONG FA. 5 GPM/LAT 10 HOLE/LAT (5' O.C.) 60 HOLE TOTAL ~, 0.5 GPM/HOLE 3/16' D~A. HOLES rACED 1 1/4" DIA. 3' DIA. SOLID GAL S.T.E.P. SYSTEM 4 BDRM HOUSE RIDGE SUBDIVISION BLOCK 2 LOT 12 fir o.c. ~3" DI~. SOLID t4ANITOLD DETAIL UH 1500 CO GAL S.E.T.P. SYSTEI{ f 6' TOPSOIL & SEED g' IN~.~TIOl'f II / II / SEWER ROCK, 6" UNDER & 2" OVER DIST. PIPES PROFILE ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE= FOREST RIDGE SUBDIVISION, BLOCK 2, LOT 12 GENERAL: 1. o The scope of this project includes the installation of a 1500 gallon wast,water S.T.E.P. system (septic tank) and a pressurized absorption bed to serve the three 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 leachfleld mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wast.water 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 INST~?~.~TION= 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. All standpipes on the septic tank shall extend a mlnimum of 12 inches above final grade. Page two Forest Ridge Subdivision, June 23, 1993 Block 2, Lot 12 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 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. e Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. PRESSURIZED MOUND SYSTEM INSTAT3.%TION: 1. Any peat or organic matter must be removed from the elevated mound site. 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. e 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. o 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 Forest Ridge Subdivision, June 23, 1993 Block 2, Lot 12 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. When sand is being used as a filter material, it's gradation specifications must conform toAMC 15.65.060D. Page Four Forest Ridge Subdivision, June 23, 1993 Block 2, Lot 12 INSPECTIONS~ Typically there will be a minimum of three (3) inspections required during the installation of the wast,water 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. 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 825 'L" Street. Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST SLOPE SITE PLAN I 3; 4 : 5 6 7 8 10 WAS GROUND WATER ENCOUNTERED? II 11 IF YES, AT WHAT DEPTH? 12 Reading Date Dross Net Depth to Net Time Time Water Drop : to 14. 15- 16. 17 18 19- 20' PERCOLATION . . -- TEST RUiN B,B.ETWEEN ~T AND ,.--..~L~ FT 17~ E~le RI~ L- R ' ' E~Ie I;Iv~, Alaska ~5~ ACCORDANCE WIT~ALL STATE AND MUNICIPAL GUlDELi~EF~CT ON THIS DATE. DATE: 72-~ (Rev. 4/~) LEGAL DESCRIPTION: ~T g~ %, m~: ~r t~ Township, Range, So.ion: L~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2- 3- 4- 5- 6- 7- 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS I/[SF- ~F-D WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? p E cl-6-'1,5 tm, r Oepllt to Waer Nt~r L~ A Reading Date Gross Net Depth to Net Time Time Water Drop ;fig ~o t~ v~" I0 ~ os I° I~ '/~ ~, " PERFORMED BY: 1_70_34 Eagle RIv~' Loop R~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN~$~FFECT ON THIS DATE. 72-008 (Rev. 4/85) PERCOLATION RATE~"".~a~>~mmutes/mch) PERC HOLE DIAMETER TEST RUN BETWEEN .~ FT?ND * FT CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: 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. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 017-112'-87 HA, A, ',~'\C'C~°~ q F~ M ~"~ ~ 1. GENERAL INFORMATION Complete*legal description Lot 12; Block 2; Forest Ridge Subdivision Location (site address or directions) Property owner William Grames Mailing address c/o C. lobe Spec Lending agency ,Mailin. g address, Address 218 W. ~,,'illow Ave. Wheaton. Day phone 5308 Manytell Avenue Anchoraqe~ AK Dayp9one 800-231-1301 Ill. ~Q187 NOTE: Individual well Community well Public water xx TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: Dayphone,,277-2663 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. xX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 5. STATEMENT OF INSPECTION BY ENGINEER As ~:ertified 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 supply and/or wastewater disposal system is in corn ordinances, and regulations in effect on ~he_j;late. o Name of Firm 'a~laa~:~~t~-.~ Address 31lance with all Municipal and State codes, I ~i.s ,nspection. Phone Date ALASKA WATER & WASTEWATER CONSDLTA~TS, INC IS TO BE PAID $1100.00 AT CLOSING FOR ENGINEERING SERVICES PERFORMED. 6. DHHS SIGNATURE ~ A.p. proved for z~ bedrooms. 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 pumhasers 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. legal Description: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES '""~ Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 * (907) 343-4744 Health Authority Approval Checklist WELl. DATA Well type ff A, B, or C, attach ADEC letter. ADEC water system number Log present I~N) 7~-~' Date completed Total depth 8 J' Cased to sanrm~/seal I:~N) FROM WELL LOG Date o~ ~ ~ ' I ~) - ~ ~ Static water level c~ '~ t Well production q g.p.m. WATER SAMPLE RESULTS: Coliform ~ Nitrate Casing height (above ground) wi~e prepe~/p.~c~ed (_~) YF---d AT INSPECTION g.p.m. B. SEPTIC/HOLD~A e~_~. Date installed Tank siz tuber of Compartments U~oe~. ~ ~..~ ~. . -" Foundation cleanout ~) ~E:(.t(- Depression (Y/~) I'~(~ High water alarm (Y/N) C. ABSORPTION REIn DATA I Date' 'nstell~ed~ Sol: reflng ~ or fWbdrm)0.5 System type Lan~ ~ ~,~-,. wJ~ ~.~v.~ ~i~,~ ~,~o~,i~, 6" Total depth present(~N) / ~ Depression over field (Y~.)') Date of adequacy test JOtl~l~J~ Results(Pass/Fall) ~:::)/~.~ For '~(~I~' bedrooms Fluid depth in absorption .eld before test (in.); ~)~L7 ' ~&e~all __ after I'~.~._~al. water added (in.): nuiddepth '~)~..-V (ins)Minutes later:. Peraxide treatment (past 12 months) (y~), 72-02e(nev. a/~e)' ~ ~)"m'L t~,ct~ ~o UFT ~TATION Date installed -:~/*~ - '~/'~'~ High w~ter ~darm level at* Size in gallons "Pump on" level at*~' /~' E. SEPARATION DISTANCES *Pump off' level 'Datum Septic/holding tank on lot Absorpfion field on lot Public sewer main SEPARATION DISTANCES FROM WELL ON LOT TO: On adjacent lots On adjacent lots /00 Public sewer manhole/cleanout Sewer/septic sendce line ~ S ~' Lift station /00 SEPARATION DISTANCES FROM SEPTI~ TANK ON LOTTO: Foundation ~ t 4- Property line ./O~ ~- Absorption field ~' Water main/senace line ifO ,.~ If. adjacent lots Sudace water/drainage ~ Wells on SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /0 ~4- Building foundation /O ~ Water main/service line Curtain drain ~ Wells on adjacent lots /'O~ I cerUfy that l h~ ,el~/rl~m fi~ld ,r~pecUone and review of Munldpa~ in conformance w t M/C/A/H~ gulcle~ines in effect on #lis date. f ~,'/.-~ Dam /~/// ~ '~k;~,'~,~;~': I..IAAFee $ ~ff'~ Date of Payment I///'~/'~~' 72-026 (Rev. 3/96)' Waiver Fee $ Date of Payment Receipt Number TOTI~I_ P.~ MUNZCZPA£ZT¥ OF ~NCHORAGE Dcpar,t~ent o~ H~.th~nd Human S~rvlc~ P.O. Box 196650 An~orage, AK 99519 REFERENCE: ROBERT SHAFER. P.E. ROGER SHAFER. P.E. CIVIL ENGINEERS Su~f/ £0, 1994 (907)694-2979 FAX 694-1211 RECEIVED JUL ~ ~ 199~ Municipality of Anchorage Dept. Health & Human Services Lot 12; ]~ock 2; Foceat P~dg~ S~bdiuZaion ENGINEERING STUOIES I AtdP:hO ~:~ A. SHAFER, P.E. Ik ROAD 50~LTEST 17034 NORTH EAGLE RIVER LOOP · SUITE 204 - EAGLE RIVER, ALASKA99577 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. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address ~540 Lor~n C~c~ Day phone ~44-6~55 A~cho~qet AK 99516 Day phone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 4 NOTE: Individual well Community well 15ublic water ' ' - · If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: NOTE: Individual on-site 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 fo~ 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 w,~stewater disposal system is in compliance .with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. · Phone - Enginee ~ ~ i.:~ ,.:: DHHS SIGNATURE ,X/'/_ Approved for _ J /~v Disapproved. Conditional approval for bedrooms. · bedrooms, with the following stipulations: Addit~o~ The Municipality o! 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 o! Alaska.'The DHHS does this as a courtesy to purchasers of homes and {heir lending institutions in order to satisfy certain federal and state requirements. Employees o! 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: ~'~.z-~--/- ~,z~.c S'~3D., z. or /z Parcel I.D. Well Data Well type Log present (~N) Total depth ~/" Sanitary seal (~N) If A, B, or C, attach ADE~ letter. ADEC water system number Date completed ~ -:~ -~-~ Driller Cased to ~°/° Casing height Wires pmperiy protected (~N) Date of test Static water level Well flow Pump level1 FROM WELL LOG AT INSPECTION 9 g.p.m. 75' ~.Zo.C. ~ /~ ' ~ ; On adjacent bts /~o ' ~ ; On adjacent bts SEPARATION DISTANCES FROM WELL TO: Septic/'~4~ tank on lot Absorption field on lot Public sewer main Sewer service line .Public sewer manholelcleanout /~ ~ +- 2~' ~ '~ .Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: ~ / i'~ /c~ Nitrate d./o ,,~ a/,~ Other bacteria Collected by: B. SEPTI~ TANK DATA ~.'3'. ~:. Date installed ? - ~ - 93 Cleanouts {~N) V¢$ ye:; High water alarm (~N) yec " Alarm tested (~YN) Date of pumping X.I ~'~ T,,~xpr-- Pumper. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Tank size Foundation cleanout Compartments ~ Depression (Y/~ ~ ('~-,.) Well(s) on lot /.~'o To property line .c~ Sudace water/drainage On adjacent lots /~0 ' ~ Foundation I.~ ~ Absorption field ~-' Water main/service line /o '+ CONTINUED ON BACK PAGE C. UFT STATION Date installed Size in gallons Vent (Y~ /uo High water alarm level [CO o ~FF'I-OE'AJ~ ~41~t~/~J(t- ~YST Manufacturer /~Z,~ .~ c H,-~.~- ,,~ ~' '7'~,<.~. Man~/~e~ ~ "Pu~ on" level at ~ ~ * "Pu~ o~ Level at ~ ' ~" C~l~ te~ Meets MOA electrical codes ~;N) ¥63' , SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot" /,_c'O ' 4- On adjacent lots ' water /~ '~- D. ABSORPTION FIELD DATA Date Installed ', '7- t ~' - g 9 Length .C6' W'~h -?(-, ' Tot~nl a~:)sorption area 2, dl~, j:;d' Cleanout present(~N) Date of adequacy test ,4)~ ~'yx'r~'m Results(pass/fail) Wa~er level in abso~lon field before test Peroxide treatment (past 12 months) (Y~) Soil rating (GPD/Ft2) Q. ,7 System type ,,,-~u~,z~3, Gravel thickness D.~- ' ,Total depth Z.' V~"~ Depression over field Aj/~ for ,,~/,~ Bedrooms After test SEPARATION DISTANCE FROM ABSORPTION FIELD TO: If yes, give date Well on lot {~-~3 ' '+- To building foundation On adjacent lots -~,' + Suflace water 1~ ' +' 2. q~ On adjacent lots /<A~ '+ Properly line .~' .To existing or abandoned system on lot ~U/4 .Cutbank ~'o ' + Water main/sewice line /~ ' + ,Driveway. parking/vehicle storage area ~ ' ',- Cudain drain ,~0~)¢ F~Jo~/M E. ENGINEER'S CERTIFICATION ..... .m'.~;?.~ :'~ I cergly If]at I have checked, vedfied, or co~fon'n~;klallMOA and HAA guidelines.., ..~n effeclu~,~._,, ~'f~cta~,,~ , ,of this inspec~on. '" .~,~¢ O?-~.~, ,.-~,.~ _.~_ / ..4,... ~ .. /' - -- k'~..~,,-.d, "',,~'? ' ~' ~,.2/_,.e m/_ ,'.,', ~. ,.,. ¢ ~'e/.,',-~..~.../.,'..~ '-" ' Engineees Name 17034 Eagle I~jv~ I~o~d No.~M ...... :,~,, HM Fee $ Date of Payment Receipt Number Waiver Fee's Date of Paymeni Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P,O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY 'APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ('~t'-T - I ~ ~. 0~--~ GENERAL INFORMATION Complete legal description Lot I~; Block ~: ,Fore~+.Ridge_ guhdx'ui~io~ Location (site address or directions) Property owner Mailing address COLONY ~JILDE~S 2540 Lor~ Day phone AK 99516 Lending agency Day phone Mailing address, "'" "' Agent Day phone" '" ..... '" Address : ~-~ ;' ~".~,L~ .... ", ': ..,. Unless otherwise requested, HAA will be held for Pick~up. "-' ~ · ,', ~ -2,I -. . ''~. -'.- 2. NUMBER OF BEDROOMS: 4 · .. · 3: TYPE OF WATER SUPPLY: '" '"~ :' Individual well *, Y~ .... ity ' '· ' -'- :. Commun well - .... , . . Public water .. NOTE: If com~n, un!t.y.well system, provide written confirmation from State ADEC attest- " t : -- lng to the legality and stat~ -O'f'~*~j~ ........... · t 4. "T~I~E' O'F WASTEWATER DISPOSAL: ....... Individual on-site .... ' Holding tan, k ~', " ........ ' .... -- ~ . .,Communlty on-site. . .. :,, . ..- . · ':';"" ?'"' ' "Public sewer ' "' NOTE: If community ~vastewater system, provide i~ritten confirmation from State ADEC attesting to the legality'and st~t~s'of ~yst~m. '" ' "· ' -' 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 App[oval 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 inves.ti, gation and inspection, the on-site water' supply and/or wastewater disposal .syst~_m.'is !n ' ' *' ' ' c.omphance W~th all Municipal and State codes, ~ ' ordinances, and regulations in eff.~'the date of this inspection. *-ngneerssgnature /, / ' " ' uate ~1 F/I/' -- ~ ' ~ , ~,~ :. ' ;~ Conditional approval for .... bedrooms.'w~th the following stipulat ns: ' , : Additional Comments By: ...~3 H'Z4 ~ r,~P(-- 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 purchasem of homes and their lending institutions In order to satisfy ce~ain 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 engi~eer'~ work. Health Authority Approval 9430034 is being approved under the following conditions: The existing on-site wastewater disposal system is located too close to a topographic slope change greater than 25%. The west 20 ft. of the existing bed system must be abandoned and repalced in accordance with the attached design. An additional test hole may be required to confirm soil suitability for both the original and replacement drain field sites. 2.An escrow account, sufficient to cover all costs associated with abandonment and construction of the drain.· .. field ~egme'nt and an additional test.hole,' must be 3 .~.establlsh'ed. The escrow account must specify that funds will not be released until DHHS has issued final approval' of the wastewater system. 3. Ail work, including preparation and submission of a revised as built insDection report, must be completed. prior to June 30, 1994. · "" '. '2:.'"' .-..':,:: .: Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: ~/~-~z:~ ,.~q,~E::::,. Parnell. D. A. Well Data Welltype ~/Llu'~{T~_" IfA, B, orC, attach ADEC letter. ADEC water system number Log present/N) ~i~'~ Total depth ~:~/t Sanitary seal~N) Y~ Date completed ~/,.~/~5 Driller t~L~lldg Cased to ~>/r Casing height //'f' .Wires properly protected~N) "/'~'~ Date of test Static water level Well flow Pump level1 FROM WELL LOG .g.p.m. ro.c. SEPARATION DISTANCES FROM WELL TO: Septi~tank on lot Absorption field on lot i~-~) t Jr' Public sewer main ~ ~',~" Sewer service line AT INSPECTION MUNICIPALITY OF ANCHOr, AGE ENVIROIq~ENTAL SERVICES DIVISION '"'"'"~_g&~r~N 2 1 1994 IVED zs '+ ; On adjacent lots /(~ ~ ; On adjacent lots /O0 ~"- Public sewer manhole/cleanout /'(~ ~ ~-' Petroleum tank /~Jo ~JE WATER SAMPLE RESULTS: c0,,o 0/ Date of sample: I I I r~ / ~ Nitrate O. tO/V~.,]//~ Other bacteria Co,e~ed by:. ~'~ B. SEPTIC~G TANK DATA Date,nsta,,ed Cleanouts~__~) High water alam'~'~N) Date of pumping '~I/~ SEPARATION DISTANCES FROM SEPTIC~TANK TO: Well(s) on lot /-~'~ ~' - On adjacent lots /~ ~- To property line ~'~" ~ Abso~tion field ~" ~" Surface water/drainage ~/(~ ~''~ '" Tank size /_~(~X~ gAL ~'7"~'/c' Compartments ~-- Foundation cleanou~N) ~ Depression ~ ~ Ala~ tested ~) ~5t/ Foundation /--~ ,Water main/service line 72,~26 (3/93)* Fro~t CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Yg tL)O "Pump on' level at High water alarm level Meets MOA electrical codes~N) V~'.~ 'rZT-E t .. Manufacturer ,,~ C H d.) I~ A'~ E' Manhole/Access(~) Y~.~ 'Pump off" Level at .--~ Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Wellonlot /~'"'0'"~ On adjacent lots /~) ¢"/'" Surface water. I0<~:)/'/'' D. ABSORPTION FIELD DATA Date Installed Length ~'~ ~' Width Total absorption area 2(~/'/_~ ~ Cleanout present~) Date Of ac~equacy test ,,'(~'/,,J 5/~'~;7'~-x'~'~ Results (pass/fail) Water level in absorption field before test /-~//~ Peroxide treatment (past 12 months) (Y~) Soil rating (GPD/FF) ~---~, 3 · .~ / Grovel thickness ~).~'" ~' .System type .Total depth ~- ~.~ Depression over field (Y.~ ~/~ for ~/~ ~dr~ After test If yes, g~e date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot //~"(~ ~""~ TO building foundation 4~- ! On adjacent lots <-.~// ~ Suflace water ~ /~ On adjacent lots /0~***) *''~''- Property line ,~// TO existing or abandoned system on lot ,/C///~ Cutbank -~'(~/'/~ Watermain/sen/ice line Driveway, parking/vehicle storage area --~ ~ Curtain draJn ,)L)c~/-.'P'~-~ K'~-J~F-~)~J HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back E. ENGINEER'S CERTIFICATION I certify that I have checked, ve#~g~onfom3ed to a/I MOA and HAA gu,'deli~e~'/n ~'~ec~ i~.ga'te .o[~lb. is inspection. / ; .., .... . . / 't ,. ,~ ~ o_~,~ Waiver Fee $ /--.~/---~ ~ Dat~ of Payment oO.. g--~'.._~ .5'" Receipt Number. Client Sample ID :L12 B2 [~REST RIDGE; Matrix :WAit~ R~RT of ~2~ ~3 R ~Ireet Fax. (907) 561-5301 Client Name :fi & fi 1r~I~IN~:.RIN~ Ordered By :R. SHAFT_JR Pro~ect Name : Pro~ect! : PWSID :UA Sample Rem~:'ks: ROUTINE SAM~L~E C0~LECTED BY= S.S. ~O~t; or~=: :75055 Report C:mpleted :0:/20/94 Collecte~ :U!/ll/~4 ~ lb:qU ~r~.' R~:eived :01/[7/94 @ 17:00 hrs.' Technical Dh*ector:S~T~H~N¢. ~"OE Releas.a By : /7/ ../L_-~/ff . //· OC Allowable Ext. Anal Parameter Results Oual Unitu tl~tlJud Llmlts Date Date Init - Nltrate-N 0.10 U ma/L EPA 353.2/30~.0 iG 01/19 LLH * See Spectal Xnstructions Above '' bee ~p~e ~m~rks ~*[.Jve D - ~econdar¥ dilution.