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Home My WebLink AboutFOREST RIDGE BLK 2 LT 17 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: '"~1~ P'-'~31~j..-,~3 PID Number: ~1'~' II ~'(~)~--"- Name: L.L)~L*L,I~ ~. ~~ Wastewater System: ~ew D Upgrade Address: t~l ~l D~ ~ cl~'~ ABSORPTION FIELD Pho..: INo.~edmoms: OOeepT,ench O Shallow Trench OBed~ound OOther Tolal Depth from original grade' LEGAL DESCRIPTION so,,R~,,.~: ~. ~.o,sq ~, /. ~ Township: I Range: S~lion: Fill add~ above originat grade~ / Gravel length: WELL: D New D Upgrade Gravel widlh: ~/FI ~ ~r'tler'. D~ Dr'I~: '"h¢ Water LC'I: Installer: Date InstallS: SEPARATION DISTANCES ~ Septic . ~ Holding ~.T.E.P. .o .,,, Well I~ I~'~' I~ ~ -- ~ Uateri~ Num., ol C~ments: S...Cew.~er ~ ~ ~'~ ~ ~ LIFT STATION Foundation I~' I~j I~' ~ Remarks~~ ~ ~~ BENCH MARK A,,.~.~ E,..,io.: /~ ENGINEER'S ~EAL Inspections performed by: ]~34~i~a~: ls~~ ~ Department of Healt~Human~ ~ces approval ~ ~.~?,,~... Reviewed and approved ~~ ' Date: Permit No. ~ Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519°6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: FOREST RIDGE SUBDIVISION, BLOCK 2, LOT 17 PID No.: O1711282 co I Co ~'98.9' I FINAL UH / . 1250 CAL. , SYSTEM I N.T.S. NEW BDRM HOUSE PRESS. DIST. BED 1250 GM~ S.?.E.P. SYSTEU ~m I ]4.0 I 28.5 I }&TI I 30.0 40.2 I m'3 I 42.o I 50.0 I YT3 40.0 [ 33.5 I UT4 30.0 20.0 72-013 A (2/91) MOA 25 UNI~IPALIT¥ OF ANCHORAGE, BUILDING SAFETY DIVISION - * · ' 3500 EASTTUDOR ROAD · · · IN~,PECTIONS(g!],7)563-~54 '"; ~ ~, ~ INFORMATION(~7)7~211 FOUNDATION ~ r~ BONDBEAM ~ r'l FRAMING . [] INSULA'IION I~ SHEETROCK f~ STRUCT. FINAL . I'1 OTHER I-I ~NO NONCOMPLIANCE OS~ERVEO ] WILl. RFEXAMINE AT NEXT IN~PECTION COMMENTS. £LEC. ROUaH ~ r'-i GASTEMP. n ELEC. FINAL ~. E,~l ~ aAS [] OTHER · MECHANICAL r'l MECfL FINAL. [] FIREFINAL _ [] PLBG. FINAL . [] ZONING D OTHER .. [~ I'1 CORRECTIONS ESSENTIAl. AS EXPLAINED BELOW O DO NOT CONCEAL UNTIL REINSPECTED WHEN CORR~'/CTiON$ ARE MADE, PLEASI--' CALL FOR INSPECTION DO NOT REMOVE THIS NOTICE LOCATION OF WELL STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER WATER WELL RECORD LOCATION/SKETCH: WELL OWNER: I , ilclc MERIDIAN DEPTHS MEASURED FROM:Dcasing top I-Iground suHace BOREHOLE DATA: Material Type and Color Depth From . To WELL DEPTH: Depth ~f hole: /45 Depth of casing: I~ DATE OF COMPLETION ft REC ,JUL 1993 Anchora tt below r'~'top of casing [] ground surface METHOD OF DRILLING: ~/air rotary n cable tool I[-] other USE OF WELL: ~ domestic I-I irrigation r3 monitor I-I public supply I-I other. CASING STICK-UP: ~ ft. Diam: ~, in. to./~ft c slng type: d in'. to WELL INTAKE OPENING TYPE: lq'open end I-I screened D perforated I-I open hole Depths of openings: ~ .to ft SCREEN TYPE: ~,, Oiam: in. SIoUMesh Size: ~ Length: It GRAVEL PACK TYP~ Volume used: Depth to top: GROUT TYPE: Volume: Depth: from % It to It DEVELOPMENT METHOD: Duration: PUMPING LEVEL AND YIELD: ft after ,--- hfs pumping gpm PUMP INTAKE DEPTH: ft Horsepower:. __ WELL DISINFECTED UPON COMPLETION? I~ .YES .r-I NO CONTRACTOR INFORMATION: · ' ' I ~, ' Regis~.ered Business Name~l, ~ . ' ~nature of Authorized Re~pTesentatlve Date .- REMARKS: PLEASE MAIL WHITE COPY OF LOG TO: DNR/DIVlSION OF WATER PO BOX 772116 EAGLE RIVER AK 99577-2116 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:SW930128 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:TAYLOR WILLIAM F III & TAMI D OWNER ADDRESS:15131 OXFORD BLUFF CIR ANCHORAGE, ALASKA 99516 PARCEL ID:01711282 LEGAL DESCRIPTION: FOREST RIDGE BLK 2 LT 17 DATE ISSUED: 5/27/93 EXPIRATION DATE: 5/27/94 LOT SIZE: 44706 (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 343-4329 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 PROVI S~~/~/~ ROBERT SHAFER. P.E. ROGER SHAFER, P.E. ~ ~5,1995 CIVIL ENGINEERS (907) 694-2979 SEWER & WATER INSPECTION SITE PLANS ~UNZCZPALZT¥ OF ANCffORAGE P~a~ o{ H~th and Human $~vic~ ~: Jo~S~ P.O. Bo~ 196650 A~o~g~, AK 995~9 MkY 2 5 1993 Mumc~p=hty o~ A,mnorege Dept, Health & Human Services REFERENCE: Lot 17; B~ock 2; Fo~t Ridge S~bdiuislon addr~66~.fl to ~¢. Bill TuV~o¢/COLONV BU/LDERS d~.d UaV If, 1995. Howeu~, ~ ocde¢ ~ ~6~t ~ ~e deu~o~e~ o~ ~e ~t~e ~OIL TEST Po E. PERCOLATION TEST ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP · SUITE 204 ° EAGLE RIVER, ALASKA 99577 LEGAl. I DRAWN FOREST RIDGE SUBDIVISION BLOCK 2 LOT 17 t. S. ULSHER ICED. R.A.S. DATE 5/25/95 SHT. 1 OF 2 DESIGN CRITERIA: 3 BDRM = 450 GPD SOILS = 0.5 GPD/SO. FT. 450/0.5 = 1500 SQ. FT. REQ'D BED DESIGN: 1.5' DEEP INSTALL 6" SAND FILTER 6" GRAVEL OVER AND UNDER DIST PIPES 25' X 60' ' ~t~ PROP. PRESSURIZED ~0~ %~ ALTERNATE SITE DESIGN NOTE: ALTERNATE SiTE ~ BE FILLED TO ALLOW SOILS TO EXCAVATE ORGANICS INSTALL 4' PIT RUN TOP SOIL AND BED PROP. 3 BDRM HOUSE APPROX. LOC~TION I00' WELL RADIUS PROP, PRESSURIZED DISTRIBUTION ~UMP = 20 OSI 05HH ~ 5 STAGE (~SO GPM) LATERALS ~ 54' LONG EA. ~ 7.5 GPM/LAT HOL£S/LAT (4' O.C.) - 50 HOLES TOTAL ~ DIA. HOLES FACED DOWNWARD 1/4" DIA. LATERALS DIA. MANIFOLD /VACANT 7 .58 GPM/HOLE t,4o. 14.57.~ WELL Z SUBI)IVISION, BLOCK 2, LOT R.,~.S. J°^~J/~s/~ j~,~ OF ~ ° / / / o / / 17 PROFILE ON-SITE NASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERI~L SPECIFICATIONS REFERENCE= Lot 17, Blk 2, Forest Ridge Subdivision GENE~AL~ The scope of this project includes the installation of a 1250 gallon Septic Tank Effluent Pumping (S.T.E.P.) system and two drainfield trenches to serve the proposed 3 bedroom house on the referenced property. me Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. ® Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC T~NK INSTALL~TION~ A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. me The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. page 2 Construction practices Lot 17, Blk 2, Forest Ridge Subdivision 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION= Excavate the proposed trenches to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed- up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. e Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. page 3 Construction practices Lot 17, Blk 2, Forest Ridge Subdivision MINIMUM MATERI~L BPECIFICATIONS= Any septic tank constructed by a manufacturer. proposed for installation must be Municipally approved septic ta~k The following pipe materials septic system installations Anchorage: are approved for use in 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. Ail 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. INBPECTIONS= 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 4 Construction practices Lot 17, Blk 2, Forest Ridge Subdivision 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 olAnchorage ;; [ ~ -..~ / ~ (. '~ ~ ~ DEPARTMENT OF HEALTH & HUMAN SERVICES ~'~:.~; ROGER J, ~'qAF~R .~ ~ 825 'L" Street, Anchorage, Alaska 99502~650 ~ ~ No. 82~5 ~ ~ SOILS LOG -- PERCO~TION TEST ~;'J~ '.. ~ ~ LEGAL DESCR,PT,ON:bT I~ ~C~,.. ~T ~: ~:C) Township, Range, Section: SLOPE SITE PLAN A WAS GROUND WATER y~:~ ENCOUNTERED? IF YES, AT WHAT I I~ DEPTH? 1~ pO E Depth to Water After I ~ Monitoring?' ~ Date: Gross Net Depth to Net Reading Date Time Time Water Drop :lC~' tr~ ~", :~ I~ ~' ~e" 3 , 'a" PERCOLATION RATE ~:~'~' (m,nutes~mch) PERC HOLE DIAMETER 4~ 5 ? 8 g 10 It COMMENTS River L~ R~, ~. ~ ~ ~ /~ CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED 170~ ACCORDANCE WITH~ ~ ~ND MUNtCIPAL GUIDELINES IN EFFECT ON TH S DATE. DATE: 72-008 {Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PER FORM ED FOR: ~.-~/~ ~/~' ~:(J ~L DEP-£ '" "') "~ ~n LEGAL DESCRIPTION: ~T I~,~5 ~ ~Township, Range, Sect'o: SLOPE 6 7 8 9 10 12 13- 14- 15- 16- 17,- WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT . DEPTH? Depth to Waer A~ter ~ Moni~o~ri.o? 13'~' Oale: SITE PLAN S Gross Net Depth to Net Reading Date Time Time Water Drop 6'.o% ~c~ ~" ~,'~" · _ (mmute~'mch) PERC HOLE DIAMETER FTAND FI 19 PERCOLATION RATE ~"~'~ TEST RUN BETWEEN Z~ $ & $ £NGINEERIN~ ,.....--~,~ / PERFORMED BY: ~, 7?:4 E'--~!~ Dtvo,- I ,~e? Road No. 2~4__~'-~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WiTH ~.rJ Sl~A~ke ;~N~'~ai~UNiClPAL GUIDELINES IN EFFECT ON TH S DATE. DATE: 72-008 (Rev. 4/85) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTIoN:L.I'~' .~[~---e~-.~ ~---r~'~ ~*i:~.~."~DT°wnship' Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT I Mon~'ing? ~.O,tl. 2- 3 4 5 6 7 8 9- 10- 11- 12- 13- 14 15 16 17 18 19. 20- Gross Net Depth to Net Reading Date Time Time Water Drop :~ ~ ~y~" v~', :~ ~ ~" V~" : ~ ~ v~" ,/~,, PERCOLATION RATE [ C) (minutes/tach) PERC HOLE DIAMETER -- TEST RUN BETWEEN .--LL.~FTAND ~,"~' FT E '- ~ [~P R~d Ne Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 May 12, 1993 Bill Taylor Colony Builders 3811 Eastwood Loop Anchorage, Alaska 99504 Subject: On-site water and Wastewater Permit Request Lot 17 Block 2 Forest Ridge Subdivision, PID #017-112-82 Dear Mr. Taylor: An on-site water and wast.water permit for the subject lot can not be issued for the following reasons: The area proposed for the site of the r~placement absorption field does not have at least two foot of unsaturated accepting soil stratum. Recent groundwater monitoring in test holes #1 and #3 showed that the underlying groundwater is too shallow for the five foot deep wide drainfield installatlon proposed for the primary absorption field. During our site visit on May 4, 1993, it was noted that framing had been completed on this two story residence and siding was being installed. By a copy of this letter, the Building Safely Division of the Public Works Department is being advised that an on-site water and wast.water permit has not been issued for this lot. If there are any questions, please call our office 343-4744. 7-si~ ~ervices cc: Ron Watts, Chief Of Building Inspections Building Safety, DPW S & S Engineering SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDrES AND REPORTS SITE PLANS ROAD DESIGN SOIL TEST STRUCTURAL& MECHANICAL INSPECTIONS ROBERT SHAFER. P E RCGER SHAFER. P.E March 2, 1993 CIVIL ENGINEERS (907) 694-2979 FAX 694.1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 17, Block 2, Forest Ridge Subdivision Request you issue a permit to drill a well and install a septic system to serve the proposed 3 bedroom house on the referenced property. The platted location of the proposed well on this property is within the utility easement. We have proposed the well to be located outside the easement. A test hole was excavated and a percolation test performed. The approximate location of the test hole is shown on the site plan. The monitor tube was checked and was found to be dry. This property has enough room for a septic upgrade which can be seen on the attached site plan. Test holes have been excavated and percolation tests performed near the alternate site. The alternate site will require a sand filter to elevate the bottom of the absorption bed above the seasonally high groundwater level. We intend to monitor the existing test holes through spring to determine the seasonally high water level elevation. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. · If you require any additional please contact us. erely Roger J. Shafer, P.E. information for your review, ENVikC, NI~,%[~T/I ~ER', IC.:S DIVISION I.:AR 0 1993 RECEIVED 17034 EAGLE RIVER LOOP. SUITE 204. EAGLE RIVER. ALASKA 99577 Nm I SH?. I~Z' LEGAL ~ IT, i~r.-?_- , ~ · I CKD. I DRAWN ~,~. ~. IDATE .~ J,~.~ ISHT. No. 82. Loc~zm~ oF I1 I TO ~ I LEGA~-oT 17 BLOCK 2. FOREST RIDGE SUBDIVISION J,,~,, ,J.P.W. j c,~,~. I_ ;HAFER No. ~t5 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2 3- 4- 6- 7- 8- 9- 10- 11 13- 14- 15- 16- 17- 18- 19- 20- SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? p E r Oepth to Water ~er Idoni~ino? SiTE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop %:~S .~o 3~/,~ I~'' PERCOLATION RATE C~¢~* Im,nutes/,nch) PERC HOLE DIAMETER ~ re TEST RUN ~E?wEEN ~'~ FT AND ~ FT cOMMENTS PERFORMED lay: ~ ~- ~: ;'~*~1~;~,,,~' I ~ 170~4 f ..... ~ - ACCORDANCE WiTH ~L ~T~~L~~ EFFECT O~THIS ~agi. ~ver, Alal~a 995~ 72~ (R~. 4/~) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE. DATE: Municipality o! 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- WAS GROUND WATER ENCOUNTERED? DEPTH? pO E O4pth Io Water N1er Monitoring? OaI~ SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop (m:nutes/mch) PERC HOLE DIAMETER PERCOLATION RATE TEST RUN BETWEEN FT AND FT COMMENTS h~ D t-4,'~. ~ A -~'r->~9 - 0r~ ~o~-~-,,,~ ~ PERFORMED BY: 17034 Eag}e RiveP Looa ~=; H. ~~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS OATE. DATE: 72-008 (Rev. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater P;ogram 4700 South. Ersgaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchcrage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. OI'7- '1. GENERAL INFORMATION Complete legal description /.-o Lec~tlen (site address or directions) Expirahcn Date: Current Property owner(s) D,,~ ~' I r> ca "i-T 0_,~-, L Day pi~one ._.~ t{.~_,q z~ L Maiiing address Lending agency Day phone Mailing address Real Estate Agent Mailing Address "'~.~/z-,,-~Eav'a. 4.'_'n ~-e.'~[,",--'X .Dayph°ne . . Unit. ss othenMse requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: '~ 3. TYPE OF WATER SUPPLY: ' Individual Well Individual Water Storage Community Class ..... Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site L-~ Individual Holding tank [] Community On-site [] Public Sewer [] The Munlcipa!it'! of Anchorage Development Services Department (DSD) Issues Certificat6s of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approva~ a,'e required for the transfer of tit~e (except betwee~ spouses) for properties served by a single-family on-site wastewater disposal and/or w=ter supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 d~ys from the date of issue for prcpertJes se.wed by a private or Class C we!l and may be reissued wit~ new water sample re-.'u!ts. (Certificates may be reissued for a period of up to one year with wild water somples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors cr omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto an(~ as of the wtidation date shown belcw, I ved['i that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this ap~lica~on, shows that the on- site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the infcrmation obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with ail applicable Municipal and State codes, ordinances, and regulations in effect at the time of inst-~llation. Address ~'~'~ I)~' ~ ~ ~/ I¢) 7_. Engineer's Printed Name 5. DSD SIGNATURE ~ Approved for .-~ Disapproved. Conditional approval for Phone bedrooms. bedrooms, with the following stipulations: Additional Comments .,~.~.~-e,.. ON-SITE '-. ~ WATERAND · ,,,: :. WASTEWATE..' ; ~ .. t-'N(JGF. AM o. ~'- <'?-. ' ...... "~- Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ~ - c7 -~.-~-- (Rev 01A~2) Municipality of Anchorage DevelOpment Services Department Building Safety Olvtsion On-Site Water & Wastewater Program 4700 Sou~ Bragaw St. P.O. Bo~ lg6650 Anchorage, AK 99519-6650 www.cLanchomge.ak, us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: I, A. WELl. DATA ~.aT 1'7,~KP. FOO.~z~T ~-tb~ ParcellD: Welltype.~ IfA, e, orCprovtdePWSlO# I~I//A Oatec°mpleted &l~l~ Sanlta~/aeal (Y/N) y Total depth ~ ~_.~ It_ Cased to I~_~ ft. FROM WELL LOG 7~ It 7' g.p.m. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform /~. colonies/100 mi. Date of sample: B. SEP11C/HOLDING TANK DATA Tank Type/Material ~"rJ~ P/ :~T~ ~ g~ Tankeize I~o gal. NumbarofCombarlments Foundation deanout (Y/N) ..~ Depression over tenk (Y/N) Date of pumping /~ '1~ C. ABSORPTION FIELD OATA well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION Lengm /,, 0 Total depth ~ tt Date of adequacy test /~ 4/~.. - g.p.m. Other bacteria ~,it_~ colonies/100 mi. Date instelled ~/.,q-S'/~' '~, Cleanoute (y/N) High water alarm (Y/N) Date installed ~ Soil mfing (g.p.d./ff= oH~n) Oe Eft. abao~pfion area ~ Monitoring tuba Fluid de~ in a~on field ~m ~st ~- · in. ~r add~ ~ gal. ~ ~: ~ ~ Fi~I fluid de~-~n. ~o~n mm >= ~ mj~efl~on ~a~e~ (~st 12 ~.) ~ & ~m) System type ~'D Gravel below pipe <~. ~ f. Depm-$ion over field ~J For ..~ bedrooms New dep~o-- .~ in. ~O g.p.d. If yes, give date ~ D. UFT ~rATION 'Pump on' level at ~. in. 'Pump off' level at q ~ in. Datum '~, ~ T'o_~,~ k. Cycles tested E. SEPARATION DISTANCES anhole Aa High mr alarm level at ~ ~ in, Mm alarm & dmuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic lank/lift station on lot Absorl~on field on lot Publ~ sewer main Server/septic sendce line On adjacent lots On adjacent lots I.U~ Public sewer manhole/cleanout Holdlng lank SEPARATION DISTANCES FROM SEPTIC/HOlDING TANK ON LOT TO:. Building oundation Water main Wells on adjacent lots Pmberty line ~'0 Water seWice line SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT.TO: P Openy ,ne waterSe~aceli~e: ,~O'F Absorption field t ~ ~' Surface water I~t I C:) B~llding foundation I,O ~ .Water main F. cOMMENTS Surface water ~4 Wells on adjacent lots · Driveway, pa~ng/vehiCle ~toraga' e2 ~ ~' ENGINEER'S CERTIFICATION I cerffy that I have determined through field inspections and review of Municipal recorcls that the above systems are in conformance with MOA HAA guidelines in effect on this date. EngtneefsPdnt,dNam, -'~Jo~4 ~u~r~,c.t.e. uf,~ Waiver Fee $ Date of Payment Receipt Number CT&E Ref.# 1024474001 Client Name Tobben Spurkland P.E. Project Name/# 17/2 Forest Ridge Client Sample ID 17/2 Forest Ridge Matrix Drinking Water Ordered By PWSID 0 Sample Remarks: All Dates/Times are Alaska Standard Time Printed Date/Time 07/23/2002 14:48 Collected Date/Time 07/18/2002 18:00 Received Date/Time 07/19/2002 9:15 Technical ~~ Director Released By Parameler Results PQL Unitn Method Allowable Prep Analysis Limi~ Date Date Init Naters Department Ni~mt=-N 0.200 U 0.200 rag/L EPA 300.0 (<10) 07/19/02 JDT M~crob~olog~ Laboratory Total Coliform 0 col/100mL SMI8 9222B {<1} 07/19/02 KAP MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Divlslon 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 Day phone 2540 Lo~t¢r~ C,~_,~ Day phone Day phone ** e Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 5o STATEMENT OF INSPECTION BY ENGINEER Se 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 Ancho~'age 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 _~ ~ c ~.,.~;~,N~ ~ Phone Address 1..7.0.~4_E, agle R. [-~1'_,~ R.,.,~. 204 DHHS SIGNATURE ~ Approved for ~ Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulationS:· Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage ,~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: *'~,~'~'~T' ~--I~--' ~;::>. Parcel I.D. C~I'c~'-'II'~>~--- A. Well Data Well type '~; L/~ If A, B, or C, attach AOEC letter. ADEC water system number Log presen6~) Total depth Sanitary se a~{Y~N) FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septi~ tank on lot I&3''~/-~ Absorption field on lot Public sewer main Sewer service line ~ r j,.._ Date completed ~//C~ _~) Ddller ~/~;D/i.--3~" "~' ~S Cased to / Casing height J ~' ~res properly protecte~)~ AT INSPECTION .g.p.m. i.,AUNICIPALITY OI; ANCHORAGE ,~NVII~ONMENTAL SERVICI~S DIVISION g.p~.p 1 ;~ 199;5 RECEIVED ; On adjacent lots : On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~-~ Nitrate Date of sample: Collected by: Other bacteria B. SEPTIC/HOi;{)IflG TANK DATA Date installed ~ ~'/,~.,-'~'"/~" '~ Tank size ~ ~.~.~-Compartments "'~""' · Cleanouts Y~) "~ Foundation cie anou~'q) "'7'/' Depression (~ /(.-.-/ SEPARATION DISTANCES FROM SEPTIC~ TANK TO: Well(s) on lot /~ ~" On adjacent lots /~-~ "7/'''-- Foundation /<~jL.. ~ To property line /'~ /-'/-~ Absorption field '~ ~ Water main/service line /~)/''/'''' Surface water/drainage /ZT~ i_/_ CONTINUED ON BACK PAGE C. UFT STATION Date installed Vent~JN) / 'Pump on' level at High water alarm level ~ ~" Meets MOA electrical code~' ) / SEPARATION DISTANCE FROM LIFT STATION TO: Manufacturer Manhole/Access(~ "~ ~.-" 'Pump off' Level at Cyc es tested Well on lot / ~'~ ""~"-- On adjacent lots Surface water.' D. ABSORPTION FIELD DATA Length ~ ! Total absorption area Date of adequacy test Width Water level In absorption field before test Peroxide treatment (past 12 months) {Y~ Soil rating (GPD/FF) ~., 5 System type ,/~/~jT-,r',r',r',r',r',r-~ ~'~' / Grovel ~ic~ess ~, ~ / Total dep~ ~ ~ ~en~) ~ ' Depre~ionoverfield~ ~ Resul~ (pa~ail) ~ for ~ ~dr~ ~/~ After test ~ 2 If yes, g~e date ~/~ , SEPARATION DISTANCE FROM ABSORPTION FIELD T~: J Well on lot /~'~ '"~ To building foundation On adjacent lots Surface water Curtain drain ~-~/~---,. On adjacent lots /~'~ ~ Property line /,~/'j''' ! '~' / To existing or abandoned system on lot ~/~ ' Cutbank ~"'~) ~" Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, vefifi~d;'c~' conformed to all MOA and HAA guidelines in effect on the date of this inspection. HAA Fee $ .-.~ ~) ~ o Waiver Fee $ J' .... '~' ~ - Date of Payment ....O- Receipt Number -,~-/ Date of Payment Receipt Number. 72-~26 (3/93)' Back COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES · ..c. ,~ REPORT of ANALYSIS Chemlab Ref.~ :93.4526-1 Client Sample ID :B2 L17 FOREST RIDGE t~atrix 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Cltent Name :S & $ E~GIN~a~ING Ordered By JR. Project Name ProJect~ : ~SID :UA Sample Remarks: ROUTINE SAMPLE COrlJ~U-l'~u BY: J.K.B. WORK Order :70386 Report Completed :09/07/93 Collected :09/01/93 @ i2.'05 hrs. Received :09/01/93 @ 12:40 hrs. Technical Director.'$'l'~HE~ £. EDE Released BY : ~'~. ~v..-~ NO INFOR~tATION ON TAG/ Qc Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nltrate-N 0.10 U mg/L EPA 353.2/300.0 10 09/03 LLH * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = U~detected, Reported value is the practical quantification limit. LT = Less ~ D = Secondary dilution. GT = Greater Than ~ S~"~S Member of the SGS Group (Soci~t~ G~n~rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA. COLORADO. UTAH. ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY. SOUTH CAROLINA