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Home My WebLink AboutFOREST RIDGE BLK 2 LT 15 ' Municipality of Anc~horage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650.e .Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: q3'O3~Jf~ PIDNumber: or'/IIZ. 5~r Name CO/..~/,) ~' /~C(f/.~[;:.~ i./~C Wastewater System: ~ New D Upgrade Address Z ~ ~ g~ ~ W~/~ ABSORPTION FIELD Pho.e ~' ~Z~ J~e~oom.. ~ Deep Trench ~Sh.llow,renc, ~Bed ~ou,d ~Other TOliI Depth from Or' i~al grade: LEGAL DESCRIPTION S°'I Ralingo ' WELL: ~ New D Upgrade mavel width: ~ O I.~ o~ I~ ~, Z.~ ~, TANK SEPARATION DISTANOES ~ s~p,~ ~ Ho~ng ~ S.t.~.~. TO ~pI,C Aba,piton L,ft Holdang r'ubh~P,tvale M~ Capacily in gallons: w~. IZ~/ /57~ IZg~ ~/4 ~ Meleria~ su,.c~w..~,IIo ~ 107' Ioy~ [ LIFT STATION Remarks: ~ ~0~ ~ ~ BENCH MARK I00. ENGINEER'S SEAL Inspections performed by: F4_ · Dates: ls~q~/~_ ~..~" ~4~,,., ..;.= ..~'[~, ... ~. Department of Healt~Huma~vices apprqval Reviewed and approved Dar ' k~~ . , '~'2' 0 '~"20 ~ SaOl.,Ue8 uetunH ~ qlleeH.ldaCI eSeJoqouv jo ~qlledlOlUny~l t,~6! 1 2 ~ Do"lg ~]01~1AlOg nS · Perml~ No.c~-~ -0~ P-ge ~ o! ~' 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 Wastewaler Disposal System and/or Well Inspection Report Legal Description: ~r/~, ~ ~ ~ ~E PID No.: 0 J ~ I I ~ e ~ RECEIVED 'APR 7 1994 ~,~ Municipalily of Anchorage Dept. Health & Human Sen/ices RECEIVED APR ? 19 4 Cu,~uk4t~ ~ fl~l~lq b~,RI ~e uept. Health & Human Murlltt Venus Way · Anc:l~oge, Alas~a 99515 l elel~,~ (901)345-2737 · rax(907)345-3264 SIEVE ANALYSIS co^ns~ S~EVr 1ARE '~, lilt' 4° r I ii1' i· Iil' IOIAL OI t tINE 51EVE :' IOlAt WI. OURNtO e TA~[ '1' MOIS I UR E CON 1 EN I' IARE NC). I V,'~I t IARE IA) DRY ~ IARE (BI T,~E Icl . % MOISIURE ,~ $1'ECIl'lC GRAVII Y -- I. ECI IAI EUER WT. OF SAMPLE IA) INIIIAL I~LANK REAOING SPECIFIC GRAVII¥ COARSE OVEN DRY WI. IAI Wt. IN I lINE ~SK ~. J" I ~L ~ WEI SOIL DRYWL rENAL gtANK READING CORR(CIIC~I B-C RI CORRECI tO fLASK Rb~OING DIE BIlL SP. GR. *¥~ (ri CI IECK AITROI'IUAI E SA~I'LE PRtI'ARAIION SIEVE ORC,,A~IIC IIYORO. O.tXl! I IYORO. W/~l I PIRMEAIIILII¥ ORGN'tlC PAN WASll MOISIURE ~. GR. tIlllA1 rUER SP, C~R. COARSE SP. GR. fiNE. All, ~ALINI 11' R[/Ub~RKS: PAGE 1 OF 1 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:SW930396 DESIGN ENGINEER:A.W. MURFITT COMPANY, OWNER NAME:NORCOL INVESTMENTS OWNER ADDRESS:15150 OXFORD BLUFF CIR ANCHORAGE, ALASKA 99516 DATE ISSUED: 9/27/93 INC. EXPIRATION DATE: 9/27/94 PARCEL ID:01711284 LEGAL DESCRIPTION: FOREST RIDGE BLK 2 LT 15 LOT SIZE: 48097 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 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 343-4744 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. ~PECIAL PROVISIONS:' ~HE SAND'USED'IN THE FILTER LAYER MUST BE A CLEAN COURSE" SAND WITH 4% OR LESS PASSING THE #100 SIEVE AND 2%.OR LESS ':PASSING THE #200 SIEVE. A SIEVE ANALYSIS MUST BE PROVIDED 'ON THE'SAND USED~~- ~ · '~ ~ '~ - A.W. Murfitt Company_ CONSULTING E~qGINEERS & TESTING 13810 Venus Way · Anchorage, Akska 99515 * Telephone (907) 345-2737 * FAX (907) 345-3264 Munidpality of Anchorage Depadment of Health and Human Se~ces 825 L Street P.O. Box 196650 July 21, 1993 A'rrENTION: Mr. John Smith, P.E. Well and Septic System Permit Request Lot 15, Block 2 Forest PJdge Anchorage, ,Naska Colony Builders, Inc. Our Job 93-213.08 Dear Mr. Smith: Attached is the design documentation submittal for well and septic system approval for the referenced residential lot. The proposed design is for a three bedroom, single family dwelling for Colony Builders, Inc. of Anchorage. Note that Mr. John Hagmeier of John Hagmeier Co., Inc. notified us of the proposed relocation of the well on Lot 14, BIock 2. This relocation will not affect our proposed design. We are concerned, however, that previous percolation testing excavations at this padicular site may have adversely disturbed the soils. In this regard, we have attempted to locate the new systems in areas which may have not have been disturbed. This can only be confirmed when the actual site construction inspections are performed and accordingly, the bed area may have to be increased to accommodate previous site disturbance. We look forward to a favorable review. Please call, however, if you have any questions.. Yours truly, AW. Murfitt Company AJlan W. Murfltt, P.E. A'FrACHMENTS: Soils Test and Percolation Test results. Soil C-rainsize Analyses. Site Plan and Section. SOILS LOG -- ~ , ...... ~v~ ~ ..,~ ~/~Z DATE PERFORMED:_ LEGAL DESCmPTION:~L J~; ~2 ~g~.~ownshlp, ~nge, Section: ! 2, 4 5 6 7 8 9~ II 13. 14 15 16 11, 18- 19- 20.-- WAS GROUND WATER ENCOUNTERED? -- IF YES, AT WHAT DEPTH? Deplh lo Waler After Monilorlng? Reading Date Dro$1 Net Depth to Nil! ~ " q:~ '0 /,,~ 3,2, ~,) " 9:.~h Io Iq, ~ 2f ~, I~ ~/ . ?:?0 0 ?.0 0 .PERCOLATION RATE ~Z (minutes/inch) PERC HOLE DIAMETER PERFORMED FOR: LEGAL DESCRIPTION: ! 2 3 4 5 6 7- 8- 9- 12 13 14 15, 18- 19. 20- Munl¢lpallly of Anchorage DEPARTMENT OF HEAL TH&HUMAN SERVICES 82.5 "L" St,eet, Anchorage, Alaska 99502-0650 soILs LOG -- PERCOLATION TEST ~., Eoz-c~/y ,B'q i/DcRs~ ~E~, DATE PERFORMED: I<, i?,~? FO~E~T~'IL)~'- Township. Range. Section: WAS GROUND WATER ENCOUNTERED? · 7E.~ Reading Dete Gross Net Depth to Net // /0/I~ /~ /~o ~ /o~ I~ I I~ ~.~ PERCOLATION RATE (minute~'inch) PERC HOLE DIAMETER . TEST RUN BETWEEN . 4%, ~ FTAND ],'3 FT COMME.NTS l}fOIJf/P C'~/~.T~I~ /f£~LttAfl~f~ ~T~ ~,~/~2 g~'~O~S : ~ ~,~, . ( ~o~ ~ ~,s ' DE FT~] ~URFI~ COMPANY / ' ~ ~ -- ~ ~; CERTIFy THAT THIS ~EST ~AS PERFORMED : 12-~8 ~fl~. 4/85) GRAIN SIZE DISTRIBUTION TEST REPORT ~ ~ c .... ~ - .~ _ 100 ° ~ ~ ~ ~ o 5 60 ~ 40 30 20 1o 200 100 10.O 1.0 0.1 0.01 j'O.O0! GRAIN SIZE - mm % +3" % GRAVEL % SAND ~ SILT ~ C~Y · 0,0 35,5 50,1 16,4 · 0.0 34,2 50.5 15,3 LL PI 085 D60 050 D30 D15 D10 Cc[ Cu · 25.66 2.39 0,95 0,278 · 23.17 2.24 1.01 0.285 MATERIAL DESCRIPTION USCS ~SHTO · SILTY SAND with GRAVELLo MOISTURE= 20.8% SM A-l-b · SILTY SAND with GRAVEKM, MOISTURE: 21.8% SM A-I-~ Project No.= 95-215.O8 Remcrks= Project= Forest Ridge Subdivision Colony Bldrs. Second set of perc tests · Locotion: Lot 15, Perc Test I - 2 · Locotlon: Lot 15, Perc Test 2 - 2 performed for Lot 15. Dote= June 28, 1993 Figure No. Permit No. Page 'Z~ oI, ~/~ 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 Wastewaler Disposal System and/or Well Inspection Report Legal Description: LC, T lC, ~ 2 Fb~,,Esl- R I ~" PID No.: LOT 1 ~ LoT lb · A ! ..... ! "" /I ~.E ~ '~ v ~e ~ / I LATC~AL~ v~IrT ITAT~~ /~ , // ~ ~TC, T~l] ~O IHd4 ~T PeR,CD ' ~ AND S036' R~PCCTIVELY NO SEPTIC 4100' ~ - TEST HOLE e - ~ONITO~ TU~ · - S~W[~ CL~OUT NO KNOWN CURTAIN DRAINS ~- .......... ~ ~. ~S[M[Nr . WELL_ ~ SEPTIC . SITE PLAN .~..~xx~. m LEGAL: LOT 14, BLK.2 FOREST RIDOE ~,~ ./* . · .. ' ..... ~ONT~C~R: JQH~ HAGMEIER GO... INC. , ~'~9~ '.~. ~o~ ~ ~-oo~1 ~,~: os/~o/~l sCULl !': = ~ i'..'~~~ 1~ P.O. ~o= ~a~94 ~F~' cc-,,, .'~r~ LOCATION OF WELL BOROUGHIJF SUBDIVISION tOT BLOCK ATE OF ALASKA DEPARTME~ I* OF NATURAL RESOURCES DIVISION OF WATER WATER WELL RECORD · SECTION QTRS DN OS RANGE DE Dw MEPJDIAN LOCATION/SKETCH: WELL OWNER: DEPTHS MEASURED FROM:Clcasing top I-Iground surface BOREHOLE DATA: Material Type and Color Depth From To Municil WELL DEPT. H~: Depth of hole: ..//,_~ Depth of casing:/// DATE OF COMPLETION ft ft // I ~ I ~",,~ DEPTH TO STATIC WATER LEVEL: d ~ ft below ~] tOp of casing Date: // I"1 ground surface METHOD OF DRILLING: /~ air rotary I-1 cable tool I-I other USE OF WELL: ~ domestic [] irrigation O monitor [] public supply [] othe{ CASING STICK-UP: ~ i ft. Diam: ~._~in. Casing type:, in. to WELL INTAKE OPENING TYPE: ~ open end I"1 screened I'-I perforated [-I open hole Depths of openings: to ft SCREEN TYPE: Diam: in. SIoUMesh Size: Length: ft GRAVEL PACK TYPE: Volume used: Depth tc top: GROUT TYPE: Volume: Depth: from ft to ft DEVELOPMENT METHOD: Duration: ~ .. ~--~C~ PUMPING LEVEL AND YIELD: ft after ~.- hfs pumping /,~ gpm PUMP INTAKE DEPTH: ft Horsepower: WELL DISINFECTED UPON COMPLETION? ~ YES CONTRACTOR INFORMATION: Registe~,~ Business Name Signature of Authorized Respr~mative Date REMARKS: PLEASE MAIL WHITE COPY OF LOG TO: DNR/DIVISION OF WATER PO BOX 772116 EAGLE RIVER AK 99577-2116 ./~----~. MUNICIPALITY OF ANCHOF{AGE D£PARTMENT OF HEALTH & HUMAN SERVICES Division~of Envlr0nrnental 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 Completelegaldescriptio.n,; Lot 15, Block 2, Forest Ridge S/D e Location (site address or directions) 15150 Oxford Bluff Circle ,./.° , Anchorage, AK " ~ ~' '": ....... ' 'ggY Dayphone 345-3519 P. r~3pert~, owner P Zemek ;M-~ilingaddress" i510 Oxford Bluff Circle, Anchorage, AK 99516 .Lending agency Mailing address Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 :, 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, proyide 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 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, ordina, rices, and regulations in effect on the date of this inspection. Name of Firm s & s ENGINEERING Phone Fo q ,-/ -- ~. ~ '7 ~/ ]7034 Eagle River L~op Road No. 204 Address Ea~le River. Alaska 995'[~' Engineer's signature /'~,/~..,t ~/'~ ~ Date 'q / '~' ? / '"l ~ DHHS SIGNATURE ['"/Approved for .'T'/--//~ ~ F_.. 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 purchasem 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 JUL DEPARTMENT OF HEALTH & HUMAN SERVl Enwmnmental Services Diwslon 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist LegatDescflpfion:~.oT 15- JS~-oc~ ::) Pd/14sr RID6.~ ParcelI.D..'. O/ ?-II'~.- $ ~ A. WELL DATA Well type PR,~tt 7',L. Log present ~N) ~/~- J Total dep~ I t ~' ' Sanifary seal ~) Data of test Statio water level Well production If A, B, or C, attach ADEC letter. ADEC water system number Cased to I! I Casing height (above ground) ~ .4- 'Y4[- $ Wires property protected ~/N) ¥ ~ $ FROM WELL LOG AT INSPECTION WATER SAMPLE RESULTS: Coliform O Nifrate ~O. S- D.,ta of.,q,le: B. SEPTIC/HOLDING TANK DATA Datelnstalled I~/~a/q~ Tanksize Found-tion cleanout ~/N) ¥¢ ~' - '~:~ Depression (Y~). Date ofJ~mping /~ ~ q Pumper .4 + ~/, ~ · C. ABSORPTION RELD DAT~",. Date iostallecl /0 Length 3 G / W~h EffeCtive abso~tlon ama. Data ,ast / Fluid depth in absorption field before test (in.): ~ ~'Y Fluid depth I)~,¥ (ins) Minutes later.'. Other bacteria o 17034 £~gle River Lgmp Rold N~. 204 Eagle River, Aladm 995'77 Number of Compartments ~- Cleanouts(~/N) High water alarm~N) ~{ 3- Soil rating }[g.p.dJfi~)r fiM3drm) System type Gravel thickness below pipe O. ~' Total depth Monitoring Tube present (~/N) Yt J' Depression over field (Y4~ Resu~ail) /08' SJ' For ~ bedrooms Irnmedlately alter ~/2D gal. water added (in.): Absorption rate - ~ ~O -~- g.p.cL pem0cide treatment (past 12 monthe) (y/N) ]~ 4,/¢ ~',~ s ,,,,~ if yes, give date 72-026 (Rev. 3/96)' D. UFT STATION Da e alied / o / Uanhole/Access High water alarm level Size In gallons 'Pump on' level al* G ~ "Pump off' level ar ~o'- Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: SeptlcJholding tank on lot /o0 /+ Absorption field on lot /o e + Public sewer main ~ /,4 Sewer/septic service llne ~ S' %/` On ao']acent lots On adjacent lots Public sewer manhole/clear, om UII slaUon SEPARATION DISTANCES FROM SEPTIC/HOLDINGTANK ON LOTTO: Feunda~on 'a :3 Properly line ~ (' A~sorptlon field 3 0 ¥- Wate['maln/serviceline /~ '~' .Surfacewater/dralnage /00 '~ Wellsonao'jacentiots /0o -f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line I '~ Building foundation G ¥ ' Water maln/servlceline IO Surface water _7oo '-~-- Driveway, parking~ehlclestomgearea ~ o "~- F. ENGINEER S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records ~erns are cE. o ~ Fea $~ Waiver Fee $ m ,Date of Payment ~ ~' Date of Payment Recelpl Number ~c~.. ~ 40 L~'7//~-~ ~ _) Receipt Number 72-026 (Rev. 3/96)' ~ ; ~ .: MUNICIPALITY.~ OF ANCHORAGE ':..;,'~ .: ~ '. ,. ...... ; .' '- -' DEPARTMENT OF HEALTH & HUMAN SERVICES .' '- · . . ~ ,. . Division? Environmental Services ~ : - * , On Site Services Section" ' ~;' ( '-=':" ' ....... ,., ........ ~ "P.O. Box 1~50 Anchorage, Alesk 5 848-4744 ..... APPROVAL FOR A SINGLE FAMILY DWELLING ~,, 1.'~ GENERAL INFORMATION ........ -.,~ ~ I ... - ;" '-' ..... .-~. co. mp!ete'legal description, LDT' I~' Location (site address or directions) 4'¢ Property owner.-k"~n~ "~,,,¢_ ~ n~ e 0o : Day phone .. ,~. Mai'l'in ~'a-d'd~;e~s' :- "- Lending agency, '" Day phone ' ' - -: ~-, -Mailing addro,~ ' -.-.'~' -~ .................. - ---~'-_-. NOTE: -- If community well system, provtde written confirmation '-~.. i~,~,.~:~.'~...:,c'ingtothelegalityandstatusofsystem, · ' .' 4. TYPE OF WASTE'WATER DISPOSAL= ..... .- · . , %.~'1~'/- ,.~\'~¥~..' ............... : '~'Commumty o,,osJte ' ' ' ;': :"~":~ "'" .: " :.: TM . ' NOTE: If community wastewater system, provide written confirmation from State ADEC a~lesting to the Mgality and status of system. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as ~f 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 Invest. gqation and inspection, the on-site water supply and/or wastewater _disposal system is tn compliance with all Municipal and State cedes, ordinances, and regulations In effect on the date of this inspection. .... · * Engineer's s~gnatUre Date ~ ' ... tth'""' ' · bedrooms, ;wi e following stipulations: The Municipality of Anchorage Department of Health and Human Servlces (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 es 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: L ~ f ~ A. WELL DATA Municipality of Anchorage DEPARTMENT OF HEALTH& HUMAN SE~V~C~ Environmental Services Division IVED 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 NOV 2 8 19 5 Municipality 6f Anchorage Health Authority Approval ChecklOam. Health & Human Services LO.: 0171! 7 ef Well type ~ IfA, B, or C. attach ADEC Icttcr, ADEC water system number Log present (Y/lq) y~-.. Date complctcd Total depth ~t/~' / Cased to (it/' · Sanitary seal (Y/N) y~ Casing height (above ground) ~_. Wires properly protected (Y/N) FROM WELL LOG Date of test I I f 2h ~ Static water level /'1l'7 Well production ~. ~ WATER SAMPLE RESULTS: AT INSPECTION g.p.m, gp.m. Coliform B. SEPTIC/IIOLDING TANK DATA Date installed {0/~/';3 Foundation cleanout (Y/N) Date of Pumping ~/t~ C. ABSORPTION FIELD DATA Date installed [ Length ~ O Width Nitrate (7. / Other bacteria Collected by: ~/~/qL~ ~ ~:~ Tank size [2...~"0 Number of Compatlments ~.. Cleanouts (Y/N) . y Depression(Y/N) Wt9 High water alarm (y/N) y Pumper Y Soil rating (g.p.d./fi: or fl-'/bdrm) O. ~ System type ~0 ~ O Gravel thickness below pipe O, ~ Total depth Effective absorption area' ~0 0 Monitoring Tube present(Y/N) ¢ Depression over field (Y/N) Date ofadeq~acy test ~ d'/~'-'7~ Results (Pass/Fail> ~ For ~'"~ ' bedrooms Fluid dcpth in absorption field beforc test (in.);'""-,.,. Immediatclya/lcr~',,gal. wateradded (in.): Fluid depth ~ Minutes later: %'x,. (in.) Abso~tion rate = %,-,. ' g.p.d. Peroxide. treatment (past 12 months) (Y/N) /~' If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons 'Pump on" level at* '~fi ~- O'O'*Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septidholding lank on lot / ~.~' Absorption field on lot ( ~'~ 7 Public sewer main /~}/t'/t~ "Pump off" level at* 4 ~.tt : On adjacent lots : On adjacent lots Public sewer manholedcleanout ~0'¢~0~ dO M. ITCdlDINrl!N Sev,,cr/septic service line A~C.,/~- Lift station ~,_~ O S£PARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation '~' 2g. Property line ~ ~ Absorption field t ~...~ Water main/ser~Sce line A/t/~ Surface water/drainage // O Wells on adjacent lots ~ / ~' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~' ~ Surface water t/0 '7 Curtain drain Water main/service line d / Drivmvay. parking/vehicle storage area Wells on adjacent lots / 9 ~ Date of Payment Receipt Number lcertCythatlh~edeterminedth~fieldinspection d gu~c~y~~ste~are in conformance wi~ ~ tL,~ gui~es in eff~t on thi~ ~ 'AF ~ . ~ ~. --' ~ · t~nOFES~?~ ~AF~ $ .~ ~0 ~ WaiverF~S 0 _.A_.~W. Murfitt Company.. NOV ~ 0 1995 ~ept. Health & Human Serv cee DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Envi~'onm6ntal 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 OJ'/ll~-~ HAA# qqoJ~)O GENERAL INFORMATION Complete legal description ~OT I S ~ ~t..,l~ ~. , ~'{:~-'T 'l~lO(~- Location (site address or directions) I~ I~0 O~F0~ ~LUE~ SQI~. Property owner Mailing address ~.,.~0 Lending agency Mailing address Agent C_,ot_o~W LOl~.E~ Day phone. Day phone Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: 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. 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. 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 supply and/or wastewater disposal system is in comPliance with all Municipal and State codes, ordinances, and regularly)ns in effect on the date of this inspection. Phone Name of Firm '~J. ~ ITT c.olv~o~¢3~{ Address I~[O ~5. ~A~ ~~ , ~ Engineefs:signature~ '~~ .~ SIGNATURE Approved for, _~--~ Disapproved. Conditional approval for -.~5~"...""..o W bedrooms. ', ~ bedrooms, with the following stipulations: Ad(dit~l 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. 1; ' GENERAL INFORMATION. - ...... - ....... ' :' ' , .&.~.Completelega'ldescription. ~ ~-~-'- , ~'F__..~,, . . '_ DEPAI~TMENT OF HEALTH& HUMAN SERVICES' "= ' Division of Environmental Services -" .On-Site Services Section "' - ' · ~. P.O;'Box196650 Anchorage, Alaska 99519-6650 APR1994 · · ', ~'~ 5; "~ :"~,',:, '..;'.: '-'.~ 343-4744 "~ ":: . . '- ' '--'-'~ - · ,.,. · ~,,.. · ~ ' , ..... ~:MunicipalityofAnchorage -. --. CERTIFICATE OEHEALTH AUTHORITY . , Dept. Health& Human Services · """ "" 'AP~ROVAL~FOR'A SINGLE FAMILY DWELLING Location (site address or direction~) I ~ 1 5 O"' OX F~ ~ L'endin~ agency drag address - Agent ...., "'"~ " ': '" '~'" ; '"]~ C' .' Address: - ' Day phone : otherWise requested, HAA will b~ h'eld for..p'i~J(up " 3.': TYPE OF WATER S'UPI~LY: ' ' ,~7 ' - "lndividd~lwell Public water ...... ;..: .... ~ .... .-,.~_, .... · ..... · * - NOTE: - .If community welt system, provid~i writtO~ 'cOnfirmation from ~t~te ADE¢ attest- ~=': :';'. ._lng t.o..th_e..leg~(ty.a, nd. st_a.t~s' .o,f ~ys?m. . ..... 4.:,.,TYPE OFWASTEWATER DISPOSAL: ..... : ; .. , . .......... : · ...... .._ ...q ............. .... ...... ' ..... · Ind~wdual on-rote ......: .~..'"' ............. .. Ho}diqg tank":': ........................................ . ,.__ Community on-site, · . '.' Public sewer ~ ' ..... If community wastev~ate[' ~ySt&m; :provide' writte'n- bonfiri~atioh from State ADEC ~ttestihg to the legahty a,nd sta!us of system· .' . ...... "NOTE: iNS~)ECTiON - . · '5. STATEMENT 'OF ...... 'BY. ENGINEER ~.: . *. ..... AS cer(ifi~d b~/m~/seal affixe~ hereto and as of the validation date show~ below, I verify that my .. ,.investigation of this Health Authority Approval application shows that the on-site water suppl~; 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 lity .h g.e~file .?yl e, ti~ !io, n~ ~a ~ :' ;: *';:'~'"' the Munic~pa of'Anc ora s an~l from nv s a nd inspection, the on-sitewat r. . . wat~ aip ~ai'~{{~n~' ii i~ c~'mp ah6~ witl~ ~,ii 'Uunl lp &od~'s,* supply and/or waste s o · . Ii c aland State ordinances, and regulations in effect on the date of this inspection. ' :'-' NameofFirm ~.~.I~U~.F['IT' (O~pi~t~ "Phone~45-Z737 "' :,-, .:., . .... ":' > Address e' ;'""'" D~t;~ "' ~, .. - ... Engineer'ssignatur : .6. DHHS SIGNATURE ..,' . Approved for. ..bedrooms Disapproved .'~ ......... Conditional approval for 5~':;~' ':' b'~ro'6*n~s, with ~the-following stipulations: ' .. .~.~/-.:,~ , . , ~ .... ~ / ~ddiiional Comments - ' The Municipality of Anchorage Department of Health and Humah Services (DHHS) Issues Health Authority :~.: ' .Al~proval Certificates based only upon the representations given In paragraph' 5 above Dy an Independent ·" ~.' ' ~,'' professiona eng neerreg stered n'theStateofAlaska TheDHHSdoesth sasacourt~sytopurchasersofhomes an~d.th..eir, i~nding institutio .n.s in order to sat!sfy?ertaln federal and ~tate requirements. Employees of DHHS do not ..conduct inspections or analyze data before a certificate Is issued. The Municipality of,Anchorage is not .... :: ' :...:... r(~sponsible for errors or omissions in the p?ofe~sl0nal'~ngineer's work.' ' . A. WELL DATA Well type 2::~f~'/~2e",~=: If A, B, or C, attach ADHc iette;'. Log present (Y/N) I~-,_~ Date completed Total depth /! ~' ! Sanitary seal (Y/N) Municipality of Anchorage R~,[I I V E D Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST ? 1994 Municjp~ily of Anchorage ADEC water system number Cased to ' //f ! Casing height - 2. ~" ~ Wires properly protected (Y/N) _~---"--~ Date of test Static water level Well flow Pump level FROM WELL LOG AT INSPECTION g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ ~' ~' ; On adjacent lots Absorption field on lot / ~' 7 /' ; On adjacent lots Public sewer main /~V/~V'~ ~ * ' Public sewer manhole/cleanout Sewer s~'rvice line ~ /I/'/[]~f Petroleum tank O. 10 WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: ~/~'//~ Y ,~0: lS'~q. Other bacteria ~ Co,ected by: /1. SEPTIC/HOLDING TANK DATA Date installed ~ Tank size ~ Compartments Cleanout$ (Y/Hi High water alarm (Y/N) Date of pumping Foundation cleanout (Y/N) ~ DePression'(Y/N) Alarm tested (Y/N) {~=~ Pumper ~1~/~ , SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) o~iot ': / ~-. ~' ~"'~: On adjacentlots ,~/~' TO propertyline ~:~F~-.- * ~ ~'~. Surface water/drainage Foundation ~'~'/~'~;~ Water main/ser~ice lir~e ' '~;~ Absorption field //o 72-026 (Rev. 7/9t) Front CONTINUED ON BACK PAGE -.. -~ ~,. -- C. LIFT STATION ~ . Date installed ' ':' ' ' "' Mal~u cturer: ' Size In gallons Manhole/Access (Y/N')' ~"//E~'. ' v;nt (Y/N)~,,l~ump on" level at ' High water alarm level '~t~u ' Cycles tested .Meets MOA electrical codes (Y/N) ~~7' :~..~C~'~.) .:. ,, !' .'. ',. SEPARATION DISTANCE FROM LIFI STATION TO: ' ' - Wellon lei" /2~ ,~ On adjacent I~t~" Z/~' ~--.' Surface water D. ABSORPTION FIELD DATA Date installed t~/1~1 Length .~0 FL Width~-. Total absorption area Depression over field (Y/N) '/~(~. Results (pass/fail) /~//~ .' Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FRoM ABSORPTION FIELD TO: ', . On adjacent lots // C~ ~'-/~"'~. '..' . · r pertyline TO building foundation 6'~ ~.' To existing or abandone.d system on lot On adjacent lots /~_..5' ~ Cutbank /(,/~I.~ Watermain/serviceline Surface water //(~ 7 ~"~' Driveway, parking/vehicle storage ar~a ' ?~' ENGINEER'S CERTIFICATION ..... · .Gravelthickness'~ (~.~' ~'~ Totaldepth Cleanouts present (Y/N) Date* (~f adequacy test /(~.,/ for bedrooms Waiver Fee: $ . . Date of Payment Receipt Number HAA Fee $ ~C~L.~, (:30 Date of Payment t-\ - ~'C~L~ Receipt Number ~5-"~ C~ ~ J ~ (R~. ~1) ~k MOA 21 I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect o~r~h~t~3/this in'specti*on.' · . · ~. ':.. _ . - · ~,-~.,..- OF ,4/ '~, '. . , ///i,¢ / /' / / · ~'"": /// ~,'? ." ~ '~ *'.7"f' e,, .. En,inee. Name Date . April 21th, 1994 Faxed to: 343-6740 John Smith Dept. of Mealth and Mu~an Services On-Site Septic Box 196650 A~chorage, AK 99519 Re= Drainage-Lot 15 Block 2 Forest Ridge Sub. Dear Mr. Smith: This letter is to follow-up My =onversation today with Robby Robinson concerning the drainage on the above described lot. Colony Builders intends to route the current run-off that is flowing near the septic tank to the east in the platted drainage easement. The septic system was installed in the late fall and it was impossible to eitablieh proper drainage at that time and the conditions now are unsuitable for heavy equipment (the MOA certificate of occupancy is conditioned on final grade). We expect to have the final grade and drainage pattern established no later than the end of June ~94. Ideally, if elevations provide the opportunity, we propose to abandon the platted drainage easement on the east lot line and capture the run-off flowing from the south prior to reaching the Goutherly lot line of 15 block 2 and route the drainage in an westerly direction along the easements. My hunch is this can be accomplished without any complication, but in t~.e ~orst =a~.we will utilize the platted drainage easements to~azntazn separatzon tO the septic tank. If you have any questions or further concerns, please call ~ at 244-6233. cC Robby Robinson 1""'30' OXFORD BLUFF C..I I~CLE FOREST P, IOC, E SuBD~v,S~ON LOT i5', BLOCK ?- RECEIVED APR T 1~4 FOREST RIDGE SUBDIVISION LOT 15', BLOCK ~' OXFORD e~urr RECEIVED CIRCLE APR Tlg~l m AS BUILT Residential Construction & land Development April 21th, 1994 RECEIVED Faxed to: 343-6740 John Smith Dept. of Health and Human Services On-Site Septic Box 196650 Anchorage, AK 99519 APR 2 5 1994 ~.iu, c.pal:B,, of Anchorage ~.;ot. Hea~lh & Human Services Re: Drainage-Lot 15 Block 2 Forest Ridge Sub. Dear Mr. Smith: This letter is to follow-up my conversation today with Robby Robinson concerning the drainage on the above described lot. Colony Builders intends to route the current run-off that is flowing near the septic tank to the east in the platted drainage easement. The septic system was installed in the late fall and it was impossible to establish proper drainage at that time and the conditions now are unsuitable for heavy equipment (the MOA certificate of occupancy is conditioned on final grade). We expect to have the final grade and drainage pattern established no later than the end of June '94. Ideally, if elevations provide the opportunity, we propose to abandon the platted drainage easement on the east lot line and capture the run-off flowing from the south prior to reaching the southerly lot line of 15 block 2 and route the drainage in an westerly direction along the easements. My hunch is this can be accomplished without any complication, but in the worst case we will utilize the platted drainage easements to maintain separation to the septic tank. If you have any questions or further concerns, please call me at 244-6233. cc Robby Robinson