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Home My WebLink AboutFOREST RIDGE BLK 2 LT 13 Municipality of Anchorage Page .~.--~ o! 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: .,~t. JCJ3OlO0 PID Number: ..m~: ~Z~ ~__~ p~ Wastewater System: ~ New ~ ~graoe ~ ~e~ ~ ~,~F,~s~/~ ABSORPTION FIELD Phone: ~--~3~ ~No. of~m,: ~D.pTrench ~ShaflowTrench ~Bed ~Mound ~Other Total Depth Irom original grade: LEGAL DESCRIPTION so....,: ~.~.~ WELL: ~~ew D Upgrade ~/ SEPARATION DISTANCES a $epfic Q Holding ~S.T.E.P. su,,.w~te, ~O '~ /oe ~ /oo'~ ~ X LIFT STATION Line Remarks: O~,~,r~ '~ * ~ ' ST4 c ~e~ BENCH MARK Inspectionspedormedby:s[~,.:~,~m:~o Dates:lst 7'/-~7 Department of Health ~nd Hum~n~e~ices appro~l/ PER),{IT NO SW9301 O0 PACE 2 OF 2 Municipatffcy oF Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL. SERVICES DIVISION p,n, Box 196650® Anchorage, Alaska 99519-6650 · Telephone; 34:3-4744 0N-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~CAL LOT 13, BLOCK 2, FOREST RIDGE S//D P.I.D. NO. 017-112-86 DRIVE 1500 CAL. S.T.F,.P. TANK I R£LOCAT~D BED MT4 SCALE I' - 40' 1~O8~Rr G ~OWAN CE -8801 Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 'L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 June 13, 1996 Robert C. Cowan, P.E. S&S Engineering 17034 North Eagle River Loop, Suite 204 Eagle River, AK 99577 Dear Mr. Cowan: This office has reviewed the proposed redesign of the bed system serving the existing four bedroom home located on Lot 13, Block 2, Forest Ridge Subdivision. The removal of 17' of the west side of the bed and construction of the same area to the east, which will insure a minimum separation of 25' from the system to the slope in excess of 25% to the west, is an acceptable resolution for this system. If you have any further comments or questions on this matter, please contact me at 343-4360. Sincerely, Jalnes Cross, P~. ' Program Manager On-Site Water Quality cc: Bill Taylor, Colony Builders ROBERT C, COWAN, RE. ROBERTA. SHAFER, RE. ClWLENGINEERS May 29, 1996 (907)694-2979 FAX(907)694-1211 ROADO~SIGN SO~LTEST MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Hox 196650 Anchorage, AK. 99519 REFERENCE: Lot 13, Block 2, Forest Ridge S/D Attached is a proposed redesign of the constructed bed which is serving the existing four bedroom house on the referenced property. We are proposing to remove 17' of the west side of bed and install the same portion to the east side of bed. The purpose for this reconstruction is to meet the requirements for the 25' minimum setback distance from the 25% slope on the west side of the bed. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, Robert C. Cowan, RCC/gk P.E. Enclosure 17034 NORTH EAGLE RIVER LOOP · surrE 204 · EAGLE RNER. ALASKA 99577 CKD. DESIGN CRITERIA: 4 BDRM = 600 GPD SOILS = 0.4 GPD/FI'. SQ. 1500 SQ. FT. REQ'D BED DESIGN: 2' D[£P (REIdOVE: ORGANICS) INSTALL 2' SANl) FILTER 6" GRAVEL OV£R AND UNDER DIST. PIPES $0' X 50' BED DATEs/lO/95 SHT. PRESSURIZED DISTRIBUTION SYSTEM: PUMP = 20 OSl 05HH S STAGE (~30 GPM) $ LAT£RALS ~ 44' LONG EA. 6 GPM/I.AT 10 HOLES/LAT (58' O.C.) 50 HOLES TOTAL ~ 0.59 GPM/HOLE 3/16' DIA. HOLES FACED DOWNWARD I 1/4' DIA. LATERALS 3' DIA. SOUl) MANIFOLD 0 PROP. lO0' WELL RADIUS WELL .'.//T.' Municipality of Anchorage Page I ' of 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: P4:) PID Number: 4/'~' / "ame~J~.~TZ~.. /~~~ Wastewater System: ~New ~ Upgrade Phone: INo. o~rooms: ~DeepTrench DShallowTrench ~Bed ~ound DOther ~0 F~ Gravel width: Numar O~: D,sta~ ~ WEL~:,, ~New ~Upgrade ~ ~ Ft SEPARATION DISTANCES a s~ ~ Hoyden. ~.~.~.". Water Foundation ~ j ~1 ~1 ~ ~ "Pump~,lon" evel a: ~ ~,'Pump olr' level at: ~ ~iHigh water atarm ~ump Make & M~el Electrical Ins tions edotmed by: Remarks: ~ ~~ ~~ BENCH MARK Assum~ Elevation: ,' , [ ENGINEEr'S SEAl. Reviewed and approved by: Date: Permit No. ~ Page 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 15 PID No01711286 cot co2 · 87.2 WATER FOUND 4-18-93 NOTE: YEAR ROUND. A 25' HORIZONTAL SEPARATION DISTANCE IS TO BE ~{AINTAINED BETWEEN Tile NEW BED AND ANY SLOPE OF 2:5~ OR GREATER. A ),{INI},IU{,{ OF A 3:1 SLOPE IS REQUIRED ON ALL SIDES OF THE NEW BED (AS SHOWN IN DETAIL ABOVE). FILL IS TO BE ADDED AROUND THE BED SUCH THAT THE ABOVE CONDITIONS OUR MAINTAINED $CAl~ t' '" 40' I A B CO2 22 19 :.:,';,,,','i:~.'~q] :."F: ,.'?.:~::., e:,!:;..~,'., ...' ', ,'. INBP~CT ION ,~,£?OR~ ' ' · .'" r.:', :'?:'-'-.',','.'.. '..,.'~ '"'~:i'.::~'J';'"'~l '..'!;"':HO~I~I?ALIIY O~."gNCHOXA(~£, gUILD'ING SAFE'TY"D'IOf~ION". "',', '.'..I,G,.'Zt .~'" "'. · "".;: ." ' ' · ' .'~dd I~A.~,? .711~11) 1~flA~ .. ' .'. :. . '.'., ,. '" . ADDR~B~ 151~0 .OXfOrD BLUME ~ PHON~ t:.~44-6232~'~"~", t. OTC 13 BLOCK: 2 ~UBP: ~O~ST ~lP~ ~__ D~TE: ....... ~q ..... rq---~ ......................................................... ~'~ TYPE O~ INSPEC~IONC ELECTRICAL FINAL ' ' ' '"~ .00 . .'. :~"--, ' - " ' .. ~-i-., - 0 0 · . · - ........................................................................... ~_~.~.. NO NONCOHP~ZANCE OBSERVED ~ 3 CO~CZZON~ C~ENTIAL A~ " ... ~XPLAZN~D C ] gILL ~C~XAHINE AT N~Xff IN~PC~ZON C ~ [10 t(OT CONCEAL UNTIL COHHENTS: STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER WATER WELL RECORD LOCATION OF WELL BOROUGH 6UBDIVlSION LOT BLOCIC MERIDIAN LOCATIONISKETCH: WELL OWNER: ,,3ti DEPTHS MEASURED FROM:l-lcasing top I'lground surface BOREHOLE DATA: Material Type and Color Depth From To WELL DEPTH: 'Depth bf hole: //-// Depth of casing: DATE OF 'COMPLETION ft 0 DEP]*H TO STATIC WATER LEVEL: · "~'~/~- ft below ~] top of casing [-) ground surface Date: METHOD OF DRILLING: I;~ air rotary I-I cable tool [] other USE OF WELL: :1~ domestic I-1 irrigation I-) monitor [] public supply I'-I other CASING STICK-UP: .~=~ ft. Diam:,.-~/ in. to/~//f{ Casing type: ..~T..~.~ ~. in. to /d / ft WELL INTAKE OPENING TYPE: [] open end [] screened F1 perforated D open hole ¢ Depths of openings:, 9.-~' to /O C:~ ft SCREEN TYPE: . ~ Diam: in. Slot/Mesh Size: "' Length: ft GRAVEL PACK TYPE: '~ Volume used: ~ Depth to top: GROUT TYPE: ~'~ Volume: Depth: from It to Duration: ft PUMPING LEVEL AND YIELD: /o*~ ft after, ~ hfs pumping /~"" PUMP INTAKE DEPTH: ft Horsepower: WELL DISINFECTED UPON COMPLETION? ~] YES CONTRACTOR INFORMATION: REMARKS: Regis~tered Business Name ...~/ ~ :Signature o! Authorized Respr~s'entative Date gpm 0 NO PLEASE MAIL WHITE COPY OF LOG TO: DNR/DIVlSION OF WATER PO BOX 772116 EAGLE RIVER AK 99577-2116 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 PAGE 1 OF 1 L-/ PERMIT NUMBER:SW930100 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:NORCOL INVESTMENTS 50% & OWNER ADDRESS:15120 OXFORD BLUFF CIR ANCHORAGE, ALASKA 99516 DATE ISSUED: 5/13/93 EXPIRATION DATE: 5/13/94 PARCEL ID:01711286 LEGAL DESCRIPTION: FOREST RIDGE BLK 2 LT 13 LOT SIZE: 46631 (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 (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ~,-% DATE: pality April iO, i993 of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 ROBERT SHAFER. P.E. ROGER SHAFER. P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 REFERENCE: Forest Ridge Subdivision, Block 2, Lot 13 Request you issue a permit to install a septic system and to drill a well to serve the proposed four bedroom house on the referenced property. Two test holes were excavated and percolation tests performed. The approximate test hole locations are shown on the site plan. We do not anticipate any adverse effects on the neighboring properties by the installation of the proposed septic upgrade. . . . . If you have any quest. Ions, 'or require any additional information for your review, please contact us. .neet A. Shafer, P.E. PERCOLATION TEST ON SiTE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 LEOAL FOREST RIDGE DRAWN L So UI.~HER CKD. DESIGN CRITERIA: 4 BDRM = 600 CPD SOILS -- 0.4 GPD/FT. SO. 1500 $0, Fl', REQ'D BED DESIGN: 2' DEEP (REMOVE ORDANICS) INSTALL 2' SAND FILTER 6" GRAVEL OVER AND UNDER DIST. PIPES 30' X 50' SUBD., BLOCK 2, LOT 13 ,.,.s.I°ATE s/ o/9 ]s.T. PRESSURIZED DISTRIBUTION SYSTEM: PUMP = 2D OSI OSHH 5 STAGE (.,.$0 CPM) 5 LATERALS ,,-, 44' LONG 6 GPM/LAT 10 HOLES/LAT (58' O.D.) 50 HOLES TOTAL~ 0.59 GPM 5/16" DIA. HOLES FACED 1 1/4" DiA. 3"' DIA. SOLID UANI \ %.' PROP. 4 BDIO~ HOUSE DRA~ 1 OF2 I'Ee^LFOREST RIDGE SUBD., BLOCK 2, LOT 1.5 ~YS'I'EM ~.~O.C. . .E.P. --6' (wp) 0 ~ (~)] I 1/4' DIA. LATERAL 50' ENDS CAPPED (T/P) DETAIL PROFILE DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORM[" LEGAL DESCR'P?'O": F/'~?~:7 ~C~ ~ ~ ~'l ~.0T/~ TownshiP;LR~ge' Section: S,TE ,LAN"''''2'~'~"~" 4 WAS GROUND WATER ~}0 ENCOUNTERED? /v IF YES. AT WHAT ~ - DEPTH? pO E 5 6 7 8 9 10 11 12 13' 14. 15- 16- 17- 18- 19- 20- 2 u,- (m~nutes,'mch) PERC HOLE DIAMETER ~ TEST RUN BETWEEN /~ FT AND COM~E.TS (J£__~ ~ ~P F~c7~ To EcE~T~ ou~ ~~ 4~ .......... 0,~ so,cs ~u~ ~' ~, ' ' '~ / ~ E~ River, Ala~a ACCORDANCE W~ ALL ~E AND MUNICIPAL GUIDEL~ES IN EFFECT ON THIS DATE. 72~ (R~. 4/~) ~ a4onitoring7 ____ Oatt Gross Net O~th tO Net Reading Date Ti~ Time Water Drop Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L" Street. Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 2 3- 4- 5 6 7 8 9 10 11 14- 15- 16 17 18 19 20. Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SITE PLAN Oelr, h to Water Met Monit~i~? Oa~ __ Gross Net D~th to Net Reading Date Ti~ ~me Water Drop :H5 i~ 2 ~ ~/~ ~ ~ TEST RUN BETWEEN ,...,~'*-~T AND ~ FT PERFORMEDBY' 17~e~l_r~ . _ j /~/ ~ ~ CERTIFYTHATTHISTESTWASPERFORMEDIN ON-SITE NASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Forest Ridge Subdivision, Block 2, Lot 13 GENER]%L: The scope of this project includes the installation of a pressurized absorption bed equipped with a 1500 gallon wastewater S.T.E.P. system (septic tank effluent pump) to serve the proposed four bedroom residence located on the referenced property. 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. e Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be resposible for ensuring a satisfactory vegetation growth over the mounded area. 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. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. Page two Forest Ridge Subdivision, Block 2, Lot 13 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 INSTALLATION: 1. Any peat or organic matter must be removed from the elevated mound site. 2e 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. 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. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. Page three Forest Ridge Subdivision, Construction Practices Block 2, Lot 13 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. 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). Se 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. 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. Page four Forest Ridge Subdivision, Construction Practices Block 2, Lot 13 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 On-Site Services Transmittal Sheet The attached paperwork has been reviewed and is being returned for the following reason(s): __ Discrep~nc~ in legal description and/or owner name. __Discrepancy in number of bedrooms. __ Signature and/or stamp missing on -*-' . __ Show measured distances to sewers/wells, curtain drains and streams within 200 feet of proposed system. __Replacement disposal site not shown and/or tested. __Calculation error in design. __ Show locations of all soils, percolation or w~ter table tests. ~ Proposed system too deep for soil test submitted. __Topographic information missing or inadequate. __Narrative missing or inadequate. __Additional soil/pete test needed. __Sand filter requirements not satisfied. __Water monitoring results missing or inadequate because __ Incomplete; missing. __Well log required. __Water sample unacceptable because Please supply the necessary information and re-submit your request. ¥~ cooperations appreciated. Reviewer ~/~,~ ~~ LEA VE THIS FORM ATTACHED TO PAPERWORK /203-rev. 4/93 ROBERT C, COWAN, RE. ROBERTA. SHAFER. RE SO~. TES? $u~¢ 5, 1995 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 RECEIVED ~U~ZCZPALZT¥ OF ANCHOTCAGE P.O. 8o~ 196650 A~o~g~, AK 995~9 JUN 7 1995 ~'~,u., ;: ~.,.,¥ o{ Anchorage Oept. Health & Human Services ~EFERENCE: Lo~ 15; B~oc~ ~; Fo~ RJ. Eg~ Su~cf,~u,~Zo~ Ple~6e. Z66~e ~ fu~ H~ AcL:~ho~i/~V Approua~ cu~ ,thJ.6 Robe*ct C. Cocc~u% P.E. RCC/gk 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER. ALASKA 99577 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environme~3tal 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 - , HAA# Lot 13; Block Forest Ridge Subdivision Location (site address or directions) .Pr6pe~ty owfie[' · Mai'ling address' .... Lending agency 'Mailing address '. Agent Add~ess NHN Oxford Bluff Circle Anchoraqe~ AK Colony Builders Dayphone ' 2340 Loren Circle Anchoraqe, AK Day phone 244-6233 99516 Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well xxx 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: XXX 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 sho~n 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 compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm $ & $ ENGINEERING 11034 Eagle River Loop Ro~d No. Address Eagle River, Alask~9~577. Engineer's signature ~/~/ ~.~ Phone Date 7' REQUEST YOU ISSUE A FULL HEALTH AUTHORITY APPROVAL AT THIS TIME. ALL WORK REQUESTED ON THE CONDITIONAL HEALTH!AUTHORITY ~PROVAL DATED 11/4/93 HAS BEEN SATISFACTORILY COMPLETED. 6. D~H/~SIGNATURE __ Approved for + Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 h r/., r- · i~ DEPARTMENT OF HEALTH & HU.M, AN SERVICES E ~ I~ I V E D Environmental Services Dwision 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) Health Authority Approval Check!isVem. He Se ¥'cee Legal A. WELL DATA Well type ~ If A, B, or C, attach ADEC letter. ADEC water system number Log pmsent~l)F~'~ Date completed ~,,~ Total depth / Z~/~ Cased to //'// ' Casing height (above ground) ~ ) Sanitary seal ~N) ' Y ~'''~ Wires property protected ~1) ,~"~ Date of test Static water level Well production FROM WELL LOG /./d/ WATER SAMPLE RESULTS: Coliform 0 Date of sample: I 0 / (. / ~1 ~ B. SEPTIC/HOLDINGTANK DATA "Foundation cleanoutt~N) Y~=.S g.p.m. AT INSPECTION Nitrate Collected by: 0 Other bacteria S & S ENGINEERING 17~J4 Eagle River Loop Road No. 204 Eagle Rivet', Alask. 99577 g.p.m. .bedrooms /,.~O.~T"/ Number of Compart~ente ~ Cleanouts(~) Deprassion(Y~. ,/~/o ,ighwateralarmt[~"~A~l) Date of P :' "~, ~' Pumper ABSORPTION REED DATA'":. :.. · Date i~:~stalled 7- / : Soil rating (g.p.d.flF or fC/bdrm)System type Length, ' Width , · .,~0 ' Gravel thicimess below pipe ~ .~ ' Total depth ~ Date of adequacy test Rasuits (Pass/Fail) /or' Fluid depth in absorption field before tas~ '~edlateiy after gal. water added (in.): fluid depth .../df~')'Tdlnutas later: Absorption rate = g.p.d. Pe~past 12 momhs) (Y~) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION ' Manho Access High water alarm level at* Cycles tested S~ in gallons 'Pump on" level et' Z'{~// 'Datum 6' ~ rr ~,.~ . 'Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot JO ~ ~ / Absorption field on lot' /OC~ /~- Public cewer main /0~ /4 Sewer/septic service line ¢~ ~' //' ' On adjacem lots )00// On adjacem lots . /Od// Public sewer manhole/cleanout /~¢:) /~ Uft station /0~ 't SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ '~ Property line ~ ''~ Absorption field Water main/senace line /0 //r Sudace wa~er/dreinage ~00 ~-/- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Prepertyltne /4)//- ' ' "B~ildlngfoundatlon /O *~' .Watermain/sen~iceline /0 /~' Surface water /~ 0 /~ Driveway. parking/vehicle storage area ~'~ '~' Curtain drain ~o~., /~u,,./,,,.J Wells on adjacent lots /~0 ·/c ENGINEER'S CERTIFICATION .... I certify that I have determined thru field inspec~or~ and ret4ew of Municipal reco~tems am HAA Fee $ Waiver Fee $ Date of Payment DateofPaymem Receipt Number Receipt Number 72-026 (Rev. 3/96)* ROBERT C. COW, Md, RE. ROBERTA. SHAFER, RE. August 11, 1997 CML ENGINEERS (907) 694-2979 FAX (907) 694-1211 ~L'TEST RECEIVED MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519 AUG 1 2 1997 Municipality of Anchorage Dept. Health & Human Services REFERENCE: Lot 13; Block 2; Forest Ridge Subdivision A Conditional Health Authority Approval (HAA) was issued on 11/4/93 for the referenced property. All work required for the Conditional HAA has been completed. Please issue a full Health Authority Approval at this time. If you require additional information, please contact us. Sincerely, Robert C. Cowan, RCC/gk 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 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. # ~"~-~-~-~Ir~-L3,,~ . .HAA# ~-~ 1. GENERAL INFORMATION Complete legal description Lot 13~ ~odz ~; Forest Rldqe Su§diu~lon Location (site address or directions) Property owner Mailing address Lending agency Mailing address COLONY BUILDERS / 8J-~T~v~or Day phone Anchorage. AK 99516 Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup, NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 4 XXX 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. ~ ~-0.~ r. agio kiver L~oOFRo~ NO. 20,4 Address Eagle River, Engineer's signatu~~_ 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 inves.tgqation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & s ENGINEERING Phone ~'.z/'. DHHS SIGNATURE Approved for bedrooms. Disapproved. J'/'""Conditional approval for '~ bedrooms, with the following stipulations: Fill is to be added around the bed such that a minimum of a 3:1 slope be maintained on all sides of the bed, and such ~t a 25 foot horizontal separation distance be maintained between the ex~tin~ bed an~ any slope of'2~ nr ~renrer£ 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 forerrors or omissions in lhe professional engineer's Work. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:. I~Lb~.K 2., A. Well Data Well type ~/g/~/~ I, A, B, or C, attach ADEC letter. ADEC water system number /t''//J/~ Log pres~ent ~j)N) J.~ Date completed ,~/2. 0//'~".~ Drills r H z./~ / ~../~' ~)/2'/Z ~/~ . / / // Total depth . '~/z~ / / Ca'ed to /, z/Z / Casing height /2 .~ Sanitaq/sea'N) ~" Wires properly protecte~'N) ~ / / FROM WELL LOG AT INSPECTION · Date of test 6/2.,O/~ .~ J Static water level ,/_-/O -- J Well flow v/"3'"' ~' J g.p.m, g.p.m. Pump level1 ~' ~:: / SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot //~) ~ -/- Absorption field on Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform ~ ('"') " ' Nitrate 'DateOfsampie:' lb/~ / c)._~ ,~ .-, B. SEPTIC/HOLDING TANK DATA Cleanouts~) y ; On adjacent lots / ('~ ("'~ / ~ ; On adjacent lots /(~ ~) / '/- Public sewer manhole/cleanout ~ t/~/~ ~' Petroleum tank ~/'~ 0. II~ ~Q'/C (Y O) Other bacteria ~ · C~llected by: .~ 4 .~ E/~ ~ Tank size /SO0 ~L. Compartments Foundation cleanout ~N) y Depression (Y(~) High water alarm(~N) ~/' Alarm tested (~) Date of pumping ~/~! Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /~(/) ' ~ On adjacent lots / ~)~) ' "/" .Foundation -.~ / Topropertyline ! ~)' + Absorption field /~' '/- Water main/service line /(~) ' '/- Surface water/drainage / ~) ~ ' + r~-o2s r~s3)' F.x.~ CONTINUED ON BACK PAGE Date installed Size in gallons Vent (~) C. LIFT STATION y 'Pump on' level at High water alarm level "'/J~ Meets MOA electrical codes~N) 7 SEPARATION DISTANCE FROM LIFT STATION TO: Manhole/Access (~l). L/$" 'pump o.',e/ve at .Cycles tested Well on lot / ' + On adjacent lots /(~(~) ' 'f' Suffacewater ' J('~ ~ D. ABSORPTION FIELD DATA Length ~) ' Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y,~ SEPARATION DISTAt~CE FROM ABSORPTION FIELD TO: To building foundation ~. o~ * On adjacent lots ,_"'~ 0 ' ~ Suffacewater ! ~(~ ~ E. ENGINEER'S CERTIFIcATIoN M On adjacent lots I D(~) ~ 4-, Property line / (~) c + T° existing °r aband°ned system °n·l°t · Cutbank r-~ *,.~' '~ Water main/son/ice line Driveway, parking/vehicle storage area ~.~0 f ~ _ .~ ~lU_.,/}bbED 'Fo bJ~_$'r g~b o F' /3£/~ ~J I cerEfy that I have checked, vetitTed, or confcrmed to all MOA and HAA guidelines in effect on the date of lhis inspection. Waiver Fee $ Date of Payment Receipt Number HAA Fee $ Date of Payment Receipt Number 72~26 (3~93)' Back 16:40 CT~E ENVIRO~IENTPL LRB SERVICES COMMERCIAL. TESTING ENGINEERING CO. ENVIRONMENTAL LABOHATORY ~;ERVICES RE~T of ANALYSIS STREET Chemlab Re£.t :93.5323-1 Client S~,ple ID :L13 B2 ~OREST RIDGE S/D l~atrix tWATER San',ple Remarks~ ROUTINE SAI~PL'~ COr3Y-cl:[O BYI S.S. ~OP-~ Order Report Completed Collected ~71835 ~10/12/93 t10/06/93 @ 17~23 Received ~10/06/93 @ 17~45 hrs. TechntcalOtrecto:,~Ep~~_~, Released By t Allowable Ext. Anal Parameter Result~ Qual Units ~ethod Limits Date Date Init ...................................................................................... Nitrate-N O.lO u ~g/L EPA 353.2/300.0 See Special Instr~cttons Above HA = Not ~nalyzed See Sample Remarks Above Undetected, Reported value is the practical quantification limit. LT - Less Than Secondary dilution. GT · Greater Than I ~ ~AI SFRVICE~ COLORA~. WEST %'t~INIA NEW JERSEY. SOUTH CAROLINA