The URL can be used to link to this page

Home My WebLink AboutFOREST RIDGE BLK 1 LT 10Forest Rid Block I Lot 10 #017-113 -09 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 5(.0 (~ ~ 0'~ ~ ~ PI D Number: Name: ~;[ / ~/D~ Wastewater System: ~New ~ Upgrade *~':~ ~o~,~/~ ~.~)~ ABSORPTION FIELD Ph°ne:~--~/ IN°'ofB"r~m':~ ~D.pTrench =ShallowTrench ~Bed =Mou.d ~Other' Total Depth from original erode: LEGAL DESCRIPTION ~i,R.,i.~: ~.~ Remarks: ~l~T~-,rr~ ~,~C BENCH MARK I/y" I ~um~ Elevation: Depadment of Heal!b and~uman Sew~ s approval Reviewed and approved by: Date: 7- 72-013 (Rev. 9/~1 ) MOA 2~ P£R~IT NO, SW980326 PAGE 2 OF 3 Municioo. tit;v o'F' .A. nsh.o,r'gg.e' DEPARTMENT OF 'HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION · P.D. Box 196650 ~....Anchoro. ge, Ale. sko. 995i9-6650,~ Teleohone. 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 10, BLOCK 1, FOREST RIDGE S/D P.I.D. NO. 017-11,.3-09 WOODHAVEN 10' TELE. &: ELEC. EASEMENT .--I FLUSH VALVES ~ ~ (FV~-FV4) FLUSH VALVE (rV~) MANHOLE (MH) &TH#2 \ 4 BEDROOM HOUSE CE;8801 P£RMIT bio. SW980326 Municip. o, ti-'c o? .A,n c: h.o..r' 9 9.e' DEPARTMENT OF HEA~TH AND HUMAN SERVICES ENVlRONHENTAL SERVICES DIVISION · P.O. Box 196650 ~_Anchor~ge, Al~sk(z 99519-66500TeteDhone, 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LgCAL LOT 10, BLOCK 1, FOREST RIDGE S/D P.tD. NO. 017-11,:3-09 ST1 94.0' ST2 NEW 1500 GALLON SEPTIC TANK FINAL GRADE A B FCO ,31.0' 20.0' ST1 49.0' 40.0' ST2 55.5' 45.0' MT1 115.0' 92,0' MT2 1,31.0' 19.0' SIDE VIEW 33' (~4)X 10' BOTTOMLESS SAND FILTER · JU~-~8-1999 14:213 CIll3NY BUILERS, INC. P.O1 ' ~' .. .;.'': ........ ~-' ..:.::'.': .-rATE OF ALASKA · " '":~ "* "~ ...~. ..... · ".:..' ' DE~ARTMF~ OF NATURAL RESOURCES : "~.;~ ' ~-':';'~-": ' : ' ; · "' . :, ' ' DIVISONOFM "-:,~';IO~0f'v,~i,,~',~-',,~'~,~.'~2.'." .....':.,' . ~.,.... : :. '..:;.. , ...... ~?&WATER~MT V~'~LL OWNER; . ~ JEP~HS MF-~SURED FROM:'~casing tol~ []grOUnd su. rfacle- ' ~0~HOLE DATA: -- ' Depth ~ .4:~erial Type a~d .Color F~om TO & Human. WELL D[~T~: DATE OF COMPLETION Depth of hr, le:.~.~..'~ / fl DEPTH T0 STATIC WATER L~EL: ft below ~ top of casing ~ gro~ su~ace M~HOD OF DRILL~G: ~a~r rota~ ~ ca~e tool USE OF WELL: ~'domestic [] irrigation [] morutor I-I public Supply [] outer : CASING STICK-UP: "~--' Pedorated ~ Open Depths of openings: ~ to ~ SCR/~ ~PE: _ Plato: ~n. G~VEL PACK TYPE; ~ Voi~e used: GROUT TYPE: Depth; from ft lO ft D~O~ M~HOD; Duration: ~ PUMPING LWEL AND YI~D: after ~ pumping PUMP' INTAKE DEPTH: ~ ft Hoesepower; DISINFECTED UPON COMPLETION? ~ YE~'~-NO ' ".CTo~ II'.~FORMATiON:: -'--~_~'~. _~ "<' .'/_~ /.O- ~ F ~'~dPL~F'~S~MI~IL WHITE COPY OF LOG TO: ,, c o~ Aut.~onze~ ,'Respre'sen~at~ve . ~)ete -- ON OF MINING & WATER MGMT 3601 C St, Suite ~00 ·" ' ANCHORAOE AK Phone (90~1259-8639 TOTAL P.01 825 "L" Street R,ck Mystrom. Mayor P.O. Box 196650 Anchorage. Alaska 99519-6650 http:l/www.ci.anchorage.ak.us J'uly 1, 1999 Robert C Cowan, PE S 8: S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot I0 Block 1 Forest Ridge Subdivision Waiver Request #WR990034 Parcel ID #017-113-09 HA990274, SW980325 DearMrCowan: Your request for a waiver of the required I0 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is 5.0 feet. This waiver is fi.om the east property line to the absorption field on lot. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Civil Engineer On-Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section W~iver Review Worksheet PID~ 017-113-09 HA# HA990274 June 14, 1999 WR# W~990034 Date Received: Legal Description: Lot 10 Block ! Forest Ridge Subdivision Engineer: Robert C Cowan, PE, S & S En~ineerinK 17034 Ea~le River Loop Road~ Suite 204~ EaKle River, Alaska Applicant: Bill Taylor % Colony Builders Permit % SW98052~ 99577 Waiver Requested: Lot line waiver of 5 feet from the east proper~y line to the leachfleld. Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: ~ Waiver is NOT Granted: List Conditions or Reasons for above: Date: 7- I° g · ~a~e of Reviewer Rec %: 04929/5423 Amount: $ 115.00 Date Paid: June 14~ ]999 ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. June 10, 1999 MUNICIPALITY OF ANCtlORAGE Department of Heahh and tluman Services P,O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 10, Block I, Forest Ridge CML ENGINEERS (9o7) s94-2979 · F, AX (907) 694-1211 RECEIVED JUN 14 1999 Municipality of Anchorage Oept. Health & Human Services Request you issue a Health Authority Approval on the referenced property and grant a waiver for the separation distance between the east property line and the leachfleld at 5 feet. We do not anticipate any adverse effect on the adjacent properties. lfyou require additional information, please contact us. Sincerely, RCC/skh 17034 NORTH EAGLE RIVER LOOP · SUFFE 204 · EAGLE RNER. N.ASKA 99577 ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. CML ENGINEERS (907) 694-2979 FAX (907) 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 RECEIVED OCT 29 3998 The septic inFpectigns for/t~e ~eferenced0/~ property were performed on ;0/~) -/~D~ and /~F . Prior to submitting the On-site Wastewater Disposal System and/or Well Inspection Report we are waiting for the ~,,~ $~¢.~ to be completed. If we may be of further service please contact us. Sincerely, Robert C. Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Aug 27, 1998 Expiration Date: Aug 27, 1999 Permit Number:. SW980326 Legal Description: FOREST RIDGE BLK 1 LT 10 Design Engineer:. 0003 S & S Engineering Owner Name: BILL TAYLOR Owner Address: 2340 LOREN CIRCLE ANCHORAGE, AK 99516-0000 Parcel ID: 017-113-09 Site Address: Lot Size: 78386 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage Ail 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 Ddnking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours pdor to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to Apdl 15, a subsurface soil absorption system under construction during freezing weather must be either;. A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special previsions. THIS PERMIT FOR THE CONSTRUCTION OF AN ALTERNATIVE WASTEWATER DISPOSAL SYSTEM. THE ATTACHED PROPERTY OWNER MAINTENANCE AGREEMENT SHALL BECOME A PART OF THIS PERMIT PACKAGE. Received By: P.~d ~P-~ Issued By: ~ ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. July 30, 1998 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 SOIL'rEST MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 10, Block 1, Forest Ridge Subdivision Request you issue a permit to install an innovative system to serve the proposed four bedroom house on the referenced property. Two test holes were excavated and percolation tests performed. The approximate location ofthe test holes are located on the attached site plan. At thc time of excavation 1/20/95, no water was encountered. After ground water monitoring the seasonal high was determined to be at 5 feet. An innovative system has been chosen for this site based upon the high seasonal ground water and limited area. To provide adequate area for both a primary and an alternate absorption field it is necessary to achieve a polished effluent entering the absorption area which will provide sufficient room to meet this objective. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. Ifyou require additional information, please contact us. Sincerely, RCC/mg Enclosure 17034 NORTH EAGLE RIVER LOOP · SU~'E 204 · EAGLE RIVER. ALASKA 99577 · . FOREST RIDGE S/D -" r-- I- I R.O.P. R.C.C. 07-30-98 1 OF 4 ~ri,,~ DESIGN CRITERIA: s,nUCTU,~S. ~.c,~s. o. 4 BDEM = 600 GPD AN AS-SUILT SUEVEY O~WN 600/2.0 = 300 SO.~. REQ'D. It IS THE RESPONSIBILTY OF THE CONT~CTOE TO V[RIU [~[,[NTS. R[OUIR[O SEPA~TION .,-, ~ .~ ~ ~ ~E~ CRITeRiA: msTx,c~s. AND PROP[R~ UN[S PRIOR TO ~ I~. ~ HS;7 CONSTRUCTION. P~.[~ (,o7).~-,,,, 1 ' DEEP ~ 20' WIDE , I I PRiO~ TO ~ ~YA~N ,, ,I , 29 I / 30 I 51 ~ t/l ~ 52 ,, ' ~ ~' ~ ~I ' Z I ~1 ] ~~1 I _0 ~ ~ ~' - ----------- ~ ---- .......... ~ ............... ~ ............. J ..................... ~ .............. ~, ~ ' AVE. ~ %LOT 1~' *~,~,~1~~ L~ '/ '~1 '- , ~ ~ /~ /~,,,'----~ X i ~ TIMBERLUX I LOT 9 ,~ ~ ~ ADD. NO. 3l I ~ ~' ~ '--.. i ~ ~ X x/ T"'----~- _.~ ..... ~ '"-~'"'-~i I i ' Il A~ POR~ONS OF SYSTEM '~~~/ v --.._ / ~ LOT 10, BLOCK 1, FOREST RIDGE S/D DESIGN CRITERIA: ~usE '1 rrin~ 4 BDRM = 600 GPO i // '~ I " _ · 600/2.0 = 500 SQ.~. REQ O.I / ~ i ~..ff I , 18' LONG · ~ i ~ ~ /~TNN UT~ L~TE$ I I ~__ ~_~ ...... ~ I , ~ ......... x_ ~ oL[ A Lpg2: .................................................... [ ~, X, ~ m ~ ~ PROPOSED , / I ',LOT 1 0,' ~T.~f. ,,~ , . ~, S~D FILTER I ~ ~ · /o~g ~ / / SUCH ~ G~GE OR C~ SPACE II z ~ ~ ~. ~.~,os ~ / / / 0NC[U~ ~sT~ ..... o ~ ~ ~/ ~m.~cs~ / / / I , ~v · / I HOUSE . ~ ~ ~ -- ~ , ~ / , ~. ~~ ~~-~: .... ,, ] / / .-co~, ~,~ ,,,~. oT , f ~ -~ / / vring ~- (~~q~FICE SPACED ET' O.C, Is bonded ~ 30 mil C~00 PVC MIN. TO D~SER ~NE ~ 3/4'-2' JACOB ~SUL ~ ~ t I ~ I L Z 2" INSU~ON / TOP VIEW around or r~r 180 x 20' BO~OMLESS SAND FILTER CTIC OB/FICE SH~ILD 80' {Typ,~~'~i~lqcE SPACED 27' O.C. .... ~ ~ ~MON'ITOR TUBE : : .~X COHNRCTOR-~ ~VC HOSE ~ t/4' D~ PVC : PVC ~IN. N ~M mSER IER ~NE (~E ~'"LOT 10, BLOCK 1, FOREST RIDGE S/D .~O[~....~ -"~.~.~. r-'-~.= i~ o~_~o_, r~o~ ~,~; ~ , ~: _ = ~ ~ L~,,~ 11~1---~"- r~ II_~~ z~ ~ ~ ~ ~,., ~.f.. ;,~,~,~.~,~,./ , ~. SIDE VIE~ ~ lg' X ~ BOTTOMLESS SAND FILTER ROBERT C. COWAN, RE. ROBERfA. SHA~ER. RE. CML ENGINEEI~ FAX (907) 694-121 Township, Range, Section: ~ LaT 10) SLO.E 1 2 3 4 5 6 7 8 9 10 11 13- 14- 15. 10. 18- 19- 20- T~g7 ~ .I ENCOUNTERED? SITE PLAN IF YES, AT WHAT ~-~-~=-~el~ t~ Water ~er Gross f~et Depth to Net Reading Date Time Time Water Drop ,,. PERCDLAT,O. RATE (/,~ ,.n..~e.~,.C.~PERCHO~ED,^~,ETER d ' PERFORMED BY: · ~ ~., . CERTIFY T~T THIS TEST WAS P~FORMED IN ~gl= .~'r~r, Alaska 995~ . ROBERT C. COWAJJ, RE. ROBERT A. SHAFER CML ENGINEERS (907) 694-2979 FAX (907) 694-121 1 2 3 4 6- 7- 8 10. 11 13- 14 15 16' 17- 18' 1g- 20- Gross /Jet Depth to Net Reading Date Time Time Water Drop ~:o? (o ~ ~" ~" PERCOLATION RATE I~ (mmutes.,mch) PERC HOLE DIAMETER TEST.U. EETWEE. .'U; ETA.D PT PERFORMED BY . ~1 '~'~' ~ 11034 Eagle River L~ Ro~ No.~ ACCORDANCE ~ ALL STATE AND MUNt~ ~~T ON 1H~S ~ATE' DATE: ~2~ (R~. ~'~) RECEIVED ROBERT C. COWAN, P.E. AUG 5 ]998 ROeERT^.SHA~ER.P.E. _... MUlltCipdl,iy ~1 v',.~t'lO a~-~VILENGINEERS August 4, ] 998uept. Health & Human Se~ 694.2979 FAX-(907) 694-1211 INTER3IITTENT SAND FILTER SPECIFICATIONS Lot I0, Block 1, Forest Ridge Subdivision GENERAL STATEMENT OF WORK The work covered by these specifications and the plans consist of furnishing all labor, materials, tools, transportation, and equipment necessary to complete an intermittent sand filter system as described herein and on the attached drawings. All work under this project shall comply with the latest edition and addenda to all applicable codes, ordinances and standards including Municipality of Anchorage-Dept. of Health and Haman Services (MOA)-(DHHS) septic installation guidelines and On-Site Waste Water Disposal Systems permits. 4 Bedroom single family home = 600 GPD Use 2.0 GPD/SF for polished effluent 300 S.F. required 18' X 20' sand filter and absorption area Sand filter to be constructed on accepting soil SITE INVESTIGATION The Contractor who proposes to complete this project must carefully examine the project documents, have full knowledge thereof, have investigated the site, and be satisfied with the conditions affecting the work. Conditions include, but are not limited to those bearing upon transportation, disposal, handling and storage of materials, availability of labor, water, electric power, roads, and uncertainties of weather, physical conditions at the site including all underground utilities, the conformation and condition of the ground, the character of equipment and facilities needed preliminary to and during prosecution of the work. The Contractor must be satisfied with the character, quality and quantity of surface and subsurface materials or obstacles to be encountered insofar as this information is reasonably ascertainable from an inspection of the site, including all prior exploratory work, as well as from information presented by the plans and specifications made a part of this project. Any failure by the Contractor to become acquainted with the available information will not relieve him/her from responsibility for performing the work as stated in these specifications and drawings. 17034 NOFffH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER. ALASKA 99577 · JUN-07-~.999 1:3:38 CO_~HY E~JILEt:~:5, IN(:. P,01 t I ' ~ MU~ICIPA~'Y OF ANCHOraGE, BUILDING ~APETY DIVISION Page 2 Lot 10; Block 1; Forest Ridge Sub. Aug 4, 1998 Location of utilities will be the contractor's responsibility. At least forty-eight (48) hours prior to commencing work, the Contractor shall contract all local utility companies to obtain underground utility locates· The Contractor shall exert due care to prevent damage to utilities. Should a utility be damaged, The Contractor shall notify the utility company shall have repaired at his own expense any damage resulting from failure of the Contractor to request an underground utility locate or to exert due care. If any utility company determines that a utility has to be temporarily raised, lowered, moved, guyed, shored, braced or otherwise protected during construction, it shall be done at the expense of the Contractor to the satisfaction of the utility company. INSPECTIONS Typically, there will be a minimum of four (4) inspections required during the installation of the waste water disposal system. These inspections will occur as follow: Inspection ofwork in progress may be made by the Engineer and MOA-DHHS at any time· The following schedule of required inspections is to be adhered to. Twenty-four (24) hours notice is required prior to each inspection. Inspections can only be arranged during weekdays and during normal working hours. The following inspection schedule is to be strictly adhered to: Septic tank/lift station is in place, but not backfilled. Sewer piping from building to tank is complete and properly bedded· Sand filter location is excavated and prepared for filter construction. Engineer to be notified with Contractor's schedule during actual construction of the sand filter to allow spot inspection during construction. Any deviation from reported schedule is to be reported to the Engineer. Final inspection of the sand filter with all pressure piping in place, but prior to placement of cover material. Test pressure piping to ensure adequate flow and pressure, (requires completion of lift station wiring and piping prior to this inspection). 4. Inspection of final grading and adequate cover. The Owner shall contract with the Contractor to perform the work outlined in these specifications, plans and in accordance with the attached MOA permit. There will be no contractual arrangement existing between the Contractor and S&S Engineering. S&S Engineering shall be the Owner's representative and Page 3 Lot 10; Block l; Forest Ridge Sub. Aug4, 1998 will inspect the work as stated above to document the Contractor's activities. Final acceptance of the Contractor's work rests with the Owner and the MOA. S&S Engineering shall have no liability to the Owner or to others for acts or omissions of the Contractor or any other persons peffon-ning work on this project or the failure of the Contractor to carry out the work in accordance with these construction documents. S&S Engineering's inspecting Engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. All landscaping, fences, sidewalks, paving, driveways, utility markers and other improvements, removed to facilitate the Contractor's operations shall be fully restored to their original condition and location by the Contractor unless otherwise directed by the Engineer. Items damaged by the Contractor during removal, storage, or restoration, shall be repaired or replaced in kind by the Contractor. This work shall be considered incidental to the project. 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: T.vpe of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes ASTM D2241 Yes Yes ASTM D2239-74 Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting Engineer. Page 4 Lot 10; Block 1; Forest Ridge Sub. Aug4, 1998 3. 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 water tight couplings (Caulder, Femco, or equal). A. General SEPTIC TANK/LIFT STATION The work under this section consists of the performance of all operations pertaining to furnishing and installing the septic tank/lift station and piping to the sand filter. B. Materials 1. Tank for Lift Systems a. Septic tank shall be a 1500 gallon two compartment steel tank specifically for the use of Orenco Systems, Inc. patented lift station assembly Orenco No. 4200. b. The tanks shall be designed for soil loading conditions as required by MOA and State regulations. The design or analysis shall be in accor- dance with accepted engineering practice and local regulatory agencies. c. All welding shall be in accordance with applicable codes and standards. 2. Risers a. First compartment shall have a separate 4" pump out riser. The second compartment shall have a separate 4" pump out riser. Page 5 Lot 10; Block 1; Forest Ridge Sub. Aug4, 1998 b. An additional second compartment outlet riser shall be 12 gauge sheet steel and shall extend 12" (minimum), above surface grade, shall have a minimum nominal diameter of 24" and shall be capable of being equipped with the following: I. A junction (Nama 4x) box or equal, bonded or attached to the riser. 2. UL listed electrical cord grips, installed in the .I-box. c. A lid - shall be furnished with the riser. It shall be constructed of fiberglass or equivalent aggregate finish, meet H-10 loading requirements and have a latching mechanism. d. Riser installation - each riser shall be sealed or welded to the top of the tank in such a manner as to prevent infiltration ofground water. e. Lid insulation - 4" rigid extruded polystyrene shall be placed in the riser directly below and attached to the lid. f. Riser insulation - 2" sprayed shop applied urethane on circumference of riser with 46465 Tnemec coating. 3. Effluent Pumping Assembly a. Effluent pumping assembly shall be Orenco systems (TM) Model 20- OSI-05-HHF series consisting ofthe following: 1. I/2 H.P. 110 volt or equal U.L. Listed effluent pump. 2. Screened pump vault (U.S. patent No. 4439323) 59" deep, 3/16" thick high-density PVC cylinder houses the pump, level controls and screen and serves as a baffle to prevent the screen from clogging. Page6 Lot 10; Block 1; ForestRidge Sub. Aug4,1998 3. Fifteen I 1/2" diameter holes are drilled in the vault at a level that places them at about the midway point in the depth of the septic tank. 4. Flap check: Allows the vault to drain when removing the tank. Screen: 15" diameter cylinder of high-density polyethylene 1/8" mesh. 5. All piping shall be PVC or other non-corroding material. b. Pump controls and alarm system shall be Orenco systems SICTETMRO 110 volt with the following options consisting of: 1. Event counter 2. Elapsed time meter 3. Program timer 4. 10 watt heater 5. Remote alarm panel option with a minimum of 80 DB sound pressure at 24", operating temperature 30°C to 65°C, continuous sound to be located in the home. 6. Oil-tight visual alarm with push-to-silence feature. Automatic audio-alarm reset. 7. 15 amp motor rated toggle switch, double pole, double throw with three positions; manual (man), automatic (auto) and center (off) (H.O.A.). 8. Nema 4x-rated, fiberglass, or equal, enclosure with hinged cover. 9. All controls to be installed as per manufacturer's recommendations. Page7 Lotl0; Block 1; ForestRidge Sub. Aug4,1998 10. Control panel to be installed on outside wall of home within sight of septic tank/lilt station. c. Piping from the septic tank to the sand filter is to be I 1/4" PVC schedule 40 solvent weld piping properly bedded as described in Materials Specifications and sloped to drain back to the septic tank. Insulation board 2" thick and 2' wide centered over pipe is to be placed where soil cover is less than 4' depth over pipe. CONSTRUCTION SEQUENCE In order to insure proper inspection procedure, the system is to be installed in the following order: 1. Sewer line from house to tank 2. Septic tank/lift station 3. Sand filter 4. Leach field CONSTRUCTION SEQUENCE In order to ensure proper installation, the system is to be installed in the following order: 1. Sewer line from house to tank 2. Septic tank/lift station 3. Sand filter 4. Final grading 1. Pipe Grade and Alignment Page 8 Lot 10; Block 1; Forest Ridge Sub. Aug 4, 1998 Variance of individual pipe sections from established line and grade shall not be greater than 0.02 feet, providing that such variance does not result in a level or reverse sloping invert. During the progress of the work, the Contractor shall provide instruments such as mits, or levels, for transferring grades from offset hubs or other construction guides from the control points and bench marks provided to the Contractor by the Engineer. The Contractor shall provide qualified personnel to use such instruments and who shall have the duty and responsibility for placing and maintaining such construction guides. Pipe Laying All pipe shall be laid with Class C bedding, free oflarge stones and organic matter. Each section of pipe shall be handled carefully and placed accurately, the spigot end shall be fully inserted pointing in the direction of flow and glued in place to make a water tight seal. Each section of pipe shall be properly supported to insure tree alignment and an invert which is smooth and free from roughness or irregularity. At all times, when work is not in progress, open ends of pipe and fittings shall be securely and satisfactorily closed so that no undesirable substance will enter the end of the pipe or fittings. Bedding of Pipe for Sewer Lines The pipe should be bedded with Class C bedding materials, compacted to 95%. Native materials may be used as back fill material above the pipe, provided it is free of large stones and organic matter to a point one (I) foot above the top of the pipe. All pumping services shall be installed in accordance with the manufacturer's recommendations and standards, electrical installation is to be to code by a licensed electrical contractor, with Municipality inspection where required. If MOA inspection is not required, a licensed electrician is to provide a letter to the Engineer stating that the system meets or exceeds all applicable codes. Page 9 Lot 10; Block 1; Forest Ridge Sub. Aug 4, 1998 Tank Installation Excavate to proper depth to allow gravity flow, install tank level, tolerance 0.01 foot, on undisturbed or compacted to 95% classified sand fill material. Line excavated tank pit walls with 2" +35 PSI burial foam full depth of tank. Back fill between tank and foam with sand material and compact in a manner to prevent damage to tank surface coating. Create a level sand surface over the tank and add 2" burial foam +35 PSI directly over tank. Mound unclassified soil over tank location to a depth of 2' above finished grade to allow positive drainage away from tank and counteract buoyancy. 5. Connections All connections to be as per MOA-DHHS and UPS requirements PVC 3034 piping with Caulder or equivalent couplings for inlet riser pipes. All tank connections are to be completely water tight. SAND FILTER The work under this section consists of materials and construction/installation of the sand filter. A. Materials 1. The Contractor shall provide a washed sand to meet ASTM C-33 Concrete Sand Specifications with the additional requirement that all but 1% of the materials passing the #100 sieve be removed. A sample may be taken from the sandbed during construction for purposes of quality control. Ifthe sample does not meet specifications, all sand will be removed and replaced. 2. The Contractor shall be responsible for providing pea gravel that shall be washed material containing no fines (0% passing the #100 sieve) and a maximum size of 1/4" diameter. Page 10 Lot 10; Block 1; Forest Ridge Sub. Aug4, 1998 3. The Contractor shall provide round rock that shall be washed gravel with rounded edges, well graded with maximum diameter of 1/2". 4. The Contractor shall provide the manifold assembly. The manifold assembly shall be the Orenco Model SFM 1036 or equivalent with orifice shields and flushing assembly. All drilled holes to be cleaned of burrs and pipes flushed, prior to assembly. Flushing valve to include riser to +12" above finish grade with extension handle provided to operate globe valve from the ground surface. 5. Side walls and top of the filter box to be insulated with 2" direct burial polystyrene insulation and be inside the plywood box. 6. The Contractor shall provide the filter fabric. 7. The linear air diffuser line and compressor is available from Orenco, no model number available. The feed line from the house to the filter is HDPE arctic insulated pipe 3/4"-2" SDR-I 1 MaskelI-Robbins or equivalent. The compressor will have a gauge (0-10 psi) and be installed in a heated area, crawl space, or garage. Construction of Sand Filter The sand filter construction is to follow procedures as outlined in the Orenco Installation Manual as applicable to this design. Rock, pea gravel and filter sand are to be hand leveled to proper depth (tolerance within 0.01 feet) in filter, taking care not to allow mud or fine soil material into the filter or rock layers. This would include any soil material picked up by excavation machinery buckets while loading specified material. The Contractor should estimate filter material volumes such that allowance is made for wastage of material in contact with the ground at site· Work on the sand filter may be suspended at the Engineer's discretion due to inclement weather conditions, such as rainfall. The sand filter and material stockpiles will be completely covered by a tarp over night during construction until finished. Filter intemal construction should be accomplished in one (I) day's time· Page 11 Lot 10; Block 1; Forest Ridge Sub. Aug4, 1998 The area over the sand filter to be finish graded with a minimum of 2 feet of cover and to prevent ponding of surface water run off. Side slopes shall not exceed 3:1. Six inches of top soil and seed are required over the entire sand filter when the side slopes approach 3:1, or at the discretion ofthe M.O.A. Thc Engineer will reject any sand, round rock or pea gravel that docs not meet specifications or is contaminated in transit or while handling. If such material is placed in the filter, all soil material may be required to be removed and replaced with new material. CONTRACTOR/INSTALLER MUNICIPALITY OF ANCHORAGE Development Services Department' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems, Approval Parcel I.D. 017-113-09-000 Expiration Date: Legal description FOREST RIDGE BLK 1 LT 10 Site address 5031 MANYTELL AVE Anchorage AK 99516 12/11/2023 Current property owner(s) BECKMAN ALASKA FAMILY TRUSTBECKMAN T J & G M/TRUSTEES X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 9/11/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 Development Services Department � �/ Phone. 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 017-113-09 Complete legal description FOREST RIDGE; BLOCK 1, LOT 10 Location (site address) 5031 Manytell Ave. Current property owner(s) Tom Beckman *Anchorage, AK 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 223-7152 3. TYPE OF WATER SUPPLY: ❑® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: 0 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS [IM Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee Waiver Fee $ Date of Payment Z7 Date of Payment COSA # ODC- Waiver # COSA Applicatlon_June 2022 COSA Checklist Legal Description: FOREST RIDGE; BLOCK 1, LOT 10 Parcel ID: 017-113-09 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA F0 Well log is filed with Onsite (or attached) Date drilled 10/29/98 Total depth 121 ft Cased to 121 ft OR Sanitary seal is functioning correctly OR Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 7/11/23 Static water level at beginning of test 87.0 ft. Comments B. TANK DATA Measured operating fluid level in septic tank Date of pumping NOT REQUIRED On Required maintenance completed, if AWWTS Comments: *SEE ATTACHED MAINTENANCE LOG D. ABSORPTION FIELD DATA Which system tested (date installed) 7/13/12 FX ALL standpipes present per record drawing Total measured depth from grade *2.08 ft (max) Measured depth to pipe invert from grade ft (min) 0 N/A — pressurized field. 01 Per record drawings, field is insulated. 0011 Monitor tubes go to bottom of effective. If not, state depth into effective ** ❑ Presoaked required if Enintaroduced vacant or fiels�.uet-as2s�or more est) gallons date Any rejuvenation treatment (past 12 months) YES If yes, enter date 5/21-29/23 Well production at time of test 4.2+ gpm Water storage tank volume N/A gallons Wsinfected for coliform test? ❑ Yes X No Coliform bacteria is Negative Nitrate mg/L (Nitrate less than MRL (ND) Arsenic ug/L ( rsenic less than MRL (ND) Collected by GEG, Ltd. Date o C. LIFT STATION ❑ Required maintenance completed Age of lift station 19 years Lift station material STEEL Comments: Adequacy test date 7/11/23 Results Q Pass Fluid depth prior to test 0 in Water added 780 gal New fluid depth 4 in Elapsed time 95 min Final fluid depth 0 in Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 3 in Effective depth used 0 in Effective depth remaining 3 in Comments/Deficiencies: TESTED IDSF BY ENTERING WATER THROUGH LIFT STATION *SEE EMAIL FROM OWNER REGARDING NO FREEZING **ASSUMED - MTS ARE SET TO SAME ELEVATION COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Q Yes if No Community Sewer Manhole/Cleanout > 100' fi Yes if No ft [j] Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' E Yes if No ft Holding Tank > 100' DYes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Q Yes if No ft 0■ Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ME Yes if No It [0] Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q Yes if No ft Surface Water > 100' ❑■ Yes if No _ Tank to Property Line > 5' Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No *51+ ft Private Wells > 100' Q Yes if No _ Water Main > 10' ❑■ Yes if No ft Community Wells > 200' 0 Yes if No _ Water Service Line > 10' Z Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *WR#990034 - PER AS -BUILT SURVEY, IT APPEARS TO BE SLIGHTLY CLOSER THAN F TO EAST LOT LINE ft ft I 0 G. CERTIFICATION & 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Garness Engineering Group, LTD. (GEG) Engineer's Printed Name Jeffrey A. Garness Phone 907-337-6179 Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022 �.OFC�u, . .�t•4 )4gITi�i ...:....................... Q J Gi_,uwss: E-795-1 LICENSE44dP,ofesS'10(' � #AECC884 �DDOpOOo Jeff Garness From: Jeff Garness Sent: Friday, September 8, 2023 10:31 AM To: Cogger, Benjamin M. Cc: Sonja Blewett Subject: Forest Ridge, B1, L10 - IDSF Soil Cover Issue Ben, The following are mitigating factors regarding the soil cover issue: 1. Per the 2012 inspection report, the IDSF is insulated, so only 2 feet of soil cover is required. 2. The existing soil cover is approximately 1.75 feet. 3. A linear compressor continuously feeds "warm" air into the bottom IDSF. 4. The system has been in operation over 10 years and the owner reported no freezing issues. Jeffrey A. Garness, P.E., M.S. President Garness Engineering Group, Ltd. 3701 E. Tudor Road, Suite 101 Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 Mobile: (907) 244- 9612 Website: www.garnessengineering.com ,. c Intermiftent Dosing Sand Filter Maintenance Provider, I Technician Al 4S' v �A x Comparly k4 - . Iivuvlor ie�e IDSF Maintenance Date of maintenance Signature iA Date M%WIIWMI,� A k V) Street Address Owner Se tic Tank: *Sludge level inches *Pumping- required ypA_Ao) *Pumping completed yps no es,/ no *Effluent filter cleaned *Proper float seftings confirmed OgLno k4oil Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box lg6650 Anchorage, AK ~9519-6650 www.ci.anchorage.ak, us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D., 017-113-09 1. GENERAL INFORMATION Complete legal description Expiration Date: Lot t0~ Block 1, Forest Ridfle S/D Location (site address or directions) 5031 Manytell Ave., Anchorage, AK 99516 Current Property owner(s), Mr. Michael Cortez Dayphone,Unknown Mailing address 20710 Teal Point Dr.~ Katy~ TX 77450 Lending agency Day phone Mailing address Real Estate Agent U. S. Inspect Day phone,703-293-1499 Mailing Address 3650 Concorde Pkwy~ Ste. 100, Chantilly~ VA 20151-1129 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class .~ Public Water System We~l [] [] [] [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request lo home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued with new water sample results less than 30 days old. 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 or omissions in the professional engineer's work. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for 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 redly Ihat 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 applicable Municipal and State codes, ordinances, and regulations in effect at Ihe time of installation. Name of Firm Pannone En,q.'Svc. Phone 272-8218 Address .P.O. Box 102954, Anch, AK 99510 Engineer's Printed Name 'Steven R. Pannone, P.E. Date Engineers Comments: in conducting an a&-'quacy ~cst, ] attempt {o provide a thoro~h, con~icmtio~ ~ eagincering analysis of the s3~stem i~ accordance with MOA DSD Ou~delhes &. Regulations. The I'~pOl'iCd I'~U]~ d~Cli~ thc ~'t'orlilaylc~ of thc s'j'stcm UlldCl' the condlhOl~ ~llCOUllt ~ at Ibc time of ~"~'~,~.; ..... the I,.~t, and separation distances measured to readily idc'ntifiable fcat~cs. The op..~ational Ii f¢ of all ~' ;'"),~,"' wells and scpfic systems &'pe~d on thc local S°il condition, grouad ~atcr levels that may fluctuale ' a, ~ · · . · ' · dunn l~e .aadthcsaterusa cofthefamil bcin se~edb the .The~ec, ondmonsa~ . · g y~ g . y g v ..s.s.s.s.s.s.s.s.s~,. . ,, ........ ,..~...~ outs'adc ~¢ conlxol of the cvaluator of this sys~cm: All systems eventually fail ~d sat~sfacto~ff t~t ; results do not guarantee future performance of the s~lem, nor do they guarantee lhat there are no ~ .'~...~.; hiddc-a defects or eacroachmeats. PES can thcn:fore not provide any ~arranty for future performance ~ e'~$t ~e n nor g~v¢ any estmmt¢ of how long the s"ffstem wffi conlmue to mc'ct the or, craUonal rcquax'ments of the ~.)~'". ADE¢ or MOA DSD. 'l~e cont,.mt of this report is fo~: thc S°l¢ b~efit of the o~aer listal a~ve. Any reliaace nP°n °r use °f this rep°rt bY any °the' pcrs°n °r lx~tY is n°t auth°&ed n°r sqll it c°nfcr any 6. DSD SIGNATURE X Approved for 4 bedrooms. Disapproved. Conditional approval for .__ bedrooms, with the following stipulations: Additional Comments : · Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory p,rat on Date: II/z?/o ,s~:-'''?'.' '- '"0 o -srr ', .. ^ *','.0)]))))1~9u Original Certificate Date: ~/2 7/0/ Reissue Date:///2 ~ / O/ Maintenance Agreements Supplemental Engineer's Report Other Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 10. Block 1. Forest Ridae S/D WELL DATA Well type P If A, B, or C provide PWStD iV ~ Date completed 1012911998 Sanitary seal Y Tolaldepth 1~1 fl Cesed to 121 ff FROM WELL LOG Date of test Static water level 94 Well production S WATER SAMPLE RESULTS: Coliform ~ colonies/100 mi Dateofsempie: ~[ Ld~ B. SEPTIC/HOLDING TANK DATA ft g.p.m Parcel I.D.: 017-113-09 Well Log Y Wires properly protected Y Casing height (above ground) ~2 in. AT INSPECTION 8119/2001 01 fi. 4+ gp.m Cleanouts Y Foundation cleanout Y Date of pumping t500 gal Number of Compmlments .~ Depression over tank N High water alarm Y__ Pumper A+ Home Sewice$ C. ABSORPTION FIELD DATA Date installed 10126/1990 Soil rating (g.p.d./ff~ or fi.=/bdrm) 2 aod/sf System type Bottomless ISF Length ~1~1 fi. WKtth lID /t Gravel below pipe 0.25 h To*al depth 1.5 ff Effective absorption area ~ ft~ Monitoring tube Y_. Depression over field .~L Date of adequacy test 81t912001 Results (Pass/Fail) P For 4, bedrooms Fluid depth in absoq3tion field before test IDW in Water added600 gal. New depthDfv in. Elapsed Time: 0 min Final fluid depth Dnt In Absoq31ion rate >= 601~+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NP If yes, give da~e (Rev. 11/9G) Tank Type/Matedal Steel S,T,I~,p. Date in,'ttalied 10126/t998 Tank size Nitrate o mg/! . Other bacteria ~ colonies/100 mi Collected by: Laura R. Pannone D. UFT STATION Date installed 10126/1998 Size in gallons t500 'Pump on' level at 43 in'Pump off' level at 33 in Datum Bottom Cycles tested ~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 10o'+ On adjacent lots' 100'+ Manhole/Acces~ Y High water alaml level at 45 in Meets atmm& circuit requirements? Yes Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Pul~ic sewer manhole/clea~i)ut Sewer/septic sewice line 100'+ Holding tank 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 34' Property line 40' Absoq~tion field 45' Water main 10'+ Water service line lQ'+ Smfacewater 100'+ Drainage 100'+ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line S' * Water Sewice line 10'+ Curtain drain 1Qo'+ Building foundation Suri;ace water 100'+ Wells on adjacent lots lO1' Water main 10'+' Driveway, perking/vehicle storage 10' to St. F. COMMENTS Waiver on File. Pressure aaae madina i,~ 3 [~i --- O. ENGINEER'S CERTIFICATION mview of Municipal records that the above systema are in conformance with MOA HAA guidelines in effecf on this date. Engineer's Printed Name St~ven R. Pannone, P.E. Data .. HAA Fee $ Waiver Fee $ Date of Payment Receipt Number, (Rev. 11/g9) Date of Payment Receipt Number ~t~ CT&E EnvironmentaIServiceslnc. CT&E Ref.# 101'/553001 Client Name Punnone Eng. Sty. Project NameZ# L 10/B 1 Forrest Ridge Client Sample ID Bath Sink Main Floor Matrix Drinking Water Ordered By PW$1D 0 Sample Remarks: Sample meets ADEC criteria for Public Water Systems for metals reported below. Parameter Rcsul~ PQL Units Method Phosphorus ~00 U ~00 ug/L EPA 200.8 Client PO# Printed DateM*lme 11/08/'2001 14:14 Collected Date/Time 10/28/2001 13:45 Received Date/Time 10/29/2001 11:55 Technical Director Stephan C. Ede Released B~ Allowable Prep Analysis Limits Date Date I 1/07/01 Init KGF Aluminum 20.0 U ' 20.0 ug/L EPA 200.8 Antimony 1.00 U 1.00 ug/L EPA 200.8 Arsenic 1.50 U 1.50 ug/L EPA 200.8 Barium 3.00 U :3.00 ug/L EPA 200.8 Beryllium 0,400 U 0.400 ug/L EPA 200.8 Cadmium 0.100 U 0,100 ug/L EPA 200.8 Calcium 500 U 500 ug/L EPA 200.8 Chmmlum 3.00 U 3.00 ug/L EPA 200.8 Cobalt 4.00 U 4.00 ug/L EPA 200.8 Copper 59.6 0.800 ug/L EPA 200.8 Iron 250 U 250 ug/L EPA 200.8 Lead 5.37 0.400 ug/L EPA 200.8 Magnesium 500 U 500 ug/L EPA 200.8 Manganes~ 3.37 3.00 ug/L EPA 200.8 Molybdenum 10.0 U I 0.0 ug/L EPA 200.8 Nickel 2.00 U 9.00 ug/L EPA 200.8 Potassium 500 U 500 ug/L EPA 200.8 Selenium 2.00 U :2.00 ug/L EPA 200.8 Sodium 62100 500 ug/L EPA 200.8 Zinc I l0 2.00 ug/L EPA 200.8 Silver 1.00 U 1.00 ug/L EPA 200.8 Thallium 0.300 U 0.300 ug/L EPA 200.8 Vanadium 5.00 U 5.00 ug/L EPA 200.8 11/07/01 KGF 11/07/01 KGF 11/07/01 KGF 11/07/01 KGF 11/07/01 KGF 11/07/01 KGF 11/07/01 KGF 11/07/01 KGF 11/07/01 KGF I 1/07/01 KGF 11/07/01 KGF 11/07101 KGF 11/07/01 KGF 11/07101 KGF 11/07/01 KGF 11/07/01 KGF 11/07/01 KGF I 1/07/01 KGF 11/07/01 KGF 11/07/01 KGF 11/07/01 KGF 11/07/01 KGF 11/07/01 KGF Microbioloc~,_ Toial Coliform col/10OmL $M18 9222B (<1) 10/29/01 SBII CT&E Envlronmmtal Services Inc. 9075515~01 T-~OT P.OI/01 F-18T CT&E Ref*.# 1017969001 ~t Seraph ~ ~ui~ Ho~ B'.b ~D O Sample NI~a~-N Client PO~ l'rin~d Dste~l'lme I 1/21/2001 18:(]1 C. oll~--ted D~Tim~ 11/19/2001 O:O0 R~ceh, od Dilr~l'lme 11/19/2001 13;23 Technical Directer Stephe~ C. IEee Allo~ble Ptvp Analysis 0.S00 U 0.~00 ~ EPA 300.0 (<10) 11/19;Ol SCL Municipality o. fAnchorage Development Serv,ces Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.a ncho rage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-113-09 1. GENERAL INFORMATION Expiration Date: Complete legal description ;, Lot 10, Block 1~ Forest Rid.qe S/D Location (site address or directions) 5031 Manytell Ave., Ancho~.qe~ AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Mr. Michael Cortez Day ph0ne Unknown 20710 Teal Point Dr. Katy~ TX 77450 Day phone' U. S. Inspect Day phone 703-293-1499 3650 Concorde Pk~n/i Ste. 100~ Chanfilly~ VA 20151-1129 Unless otherwise requested, HAA wfll be held by DHHS for pickup. HAA picked up by:. 2. NUMBEROF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site ~ Individual Holding tank Community On-site ~ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DSD also .issues HAAs upon request lo home owners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. 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 or omissions In the professional engineer's work. 5. STATEMEI~T OF INSPECTION BY ENGINEER As ceRified by my seal affixed hereto ~nd as of the validation date shown below, I vedfy that my investigation based on procedures outlined In the Health Authority Approval Guidelines for 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 redly that based on the infom3ation 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of Installation. Name of Firm Pannone Eng. Svc. Address P.O. Box 102954, Anch, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Phone. 272-8218 Engineers Comments: Et conduct~g a~ adcquaoj test, I a~pt ~ ~ · ~ ~fio~ ~ ~ of ~ ~ h ~ ~ ~ MOA DSD G~ & R~fi~. ~e ~ ~ d~ ~c ~ of~c ~ ~ ~c ~ndi~ ~t~ at ~c ~ of · e ~ ~d ~fi~ ~ m~ ~ ~ly ~able f~. ~ ~fi~ ~e of~l ~lh ~d ~fic ~ ~d ~ ~ 1~ mil ~ ~ ~ leve~ ~t ~y fl~ outddc thc comml of the evaluator of th/s sy~m. All ~ ~y ~ ~ ~fisfa~ ~ ~ ~f~ ~ ~ P~ ~ ~ef~ not ~ ~y ~ for ~ ~o~ ~EC ~ MOA ~D. ~c ~n~t of ~s ~ h for ~e ~Ic ~efit of ~e ~ ~ a~ve. ~y 6. DSD S[GNA~ ~ ~ppm~ ~or ~ ~edmoms. ~isappmmd. .'.Con~i~onal. appromi'for - bedrooms,'with the folloWing stipulations: ~: WATERAND : m:: Additional Comments Attachments: HAA Checklist , septic System AdvisOry Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: Odginal Certificate Date: <~' '- ~ "7- Reissue Date: Municipality of Anchorage Dovelopment Services Department Building Safety Division omsite Water and Wastewater Program 4700 South Bragaw Street P.O. Box 1966,50 Anchorage. AK 99519-6650 www. ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Descriplion: A. WELL DATA Well type P Date completed t012911998 Total depth 121 ft Lot 10. Block 1. Forest Ridae 8/D If A, B, or C provide PWSID # Sanitary seal Y Cased to 1;H fl FROM WELL LOG t012911099 Date of test Static water level 94 Well production 6 WATER SAMPLE RESULTS: Coliform ~ colonies/100 mi Date of sample: ~11~1~l)01 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel S.T.E.P. Date installed 10126/1998 Tank size Cleanouts Y Foundation cleanout Y ft g.p.m Parcel I.D.: 017-tt34)9 Well Leg Y Wires property protected Y Casing height (above ground) 22 in. AT INSPECTION U~9/2001 4+ g.p.m Nitrate · ~ mg/I Other bacteria colonies/100 mi Collected by: Laura R. Pannone lr~00 gal Depression over tank N Number of Compartments 2 High water alarm Y_._ Date of pumping 1~117/;11)01 Pumper A+ Home Senfjces : C. ABSORPTION FIELD DATA Date installed 1012611999 ' Sail rating (g.p.d./fl2 orfl=/bclrm) 2 aod/sf Length 33 fl Width t0 ft Gravel helowplpe 0.25 fl '' System type Bottomless ISF Total depth t.5 ff Effective absorption area 330 fi2 Monitoring tube Y Depressicm over field N Date of adequacy test 611912001 Results (Pass/Fail) P For ~, bedrooms Fluid deplh in ab~oq~,ion field before test IDry In Water added600 gal. New depthDry in. Elapsed Time: _0 rain · Final fluid depth IDrY in Abserption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NP If yes, give date (Rev. 11,~)) D. UFT STATION Date installed 10126/1998 Size in gallons 1~00 'Pump on' level at 43 in'Pump oft' level at Datum Bottom Cycles tested ~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tAnkJtift station on lot 100'+ Absorption field on lot 100+ Public se~er main NIA Manhole/Access Y__ 33 in, High water alarm level at 45 in Meels ala~n & circuit requirements? .Yes On adjacent lots 100'+ On adjacent lots tQ0'+ Public sewer manhole/cleanoot NIA Sewer/sepUc service line 100'+ Holding tank t00'+ SEPARATION DISTANCES FROM SEPTIC/HoLDING TANK ON LOT TO: Building foundation Water main 15'+ Drainage 100'+ Pmpen'y line 40' Water service line 10'+ Wells on adjacent lots 100'+ Absorption field 45' 'Surface water 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line 5' * Water Service line' 1'0'+ Curtain drain lOO'+ F. COMMENTS Building foundation 8~' Surface water 100'+ Wells on adjacent lots ,. 101' Water main 10'+ ' Driveway, parking/vehicle storage 10' tO ~t~ * Waiver on File. Pressure aaoe readino is 3 G. ENGINEER'S CERTIFICATION · I certify that I have deten~,ned through tleld inspections and revfew of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone. P.E. Date O[C~{ ~ ~.- NO C[ 8149 Wa~er F~ $ D~e of Payme~ R~i~ Numar ~NVmCS: ~. :1.9824 ~ .HOME SERVICES, 7501 F.. 140th Avenue Anchorage, Alaska ~9516 345- ~890 I~i~ C~z FY/ Block ,.. Lot Ga;Ions Septic Leach Area Holding Tank [] PROBLEM AREA-- CALL FOR MORE INFORMATION [] NEED8 TO BE DONE AGAIN IN 6 MOflTH8 ~ Good 8ha~3e [] sludge buildup on bottom [] Jim' ca.p ml~lng or [] Cut standpipe to 1' above ground needs replacing S~anaplpes T~me [] Floater =n top r'-I Needs Sept~dne : -'A+ Home Services, inc. Inspeotions Tank Type: - Name: Address: Phone Humber. Insp~tlon # Air Flow Elapsed Time /, ~5, q, 0 Event Counter '~"~/~-. Dat~ & Time / 7 3131 0 \ Problem: · ~tK CT&E Environmental Services Inc. CT&E Ref.# Client Name Project Name~# Client Sample ID Matrix Ordered By PWSID Sample Rem~ks: 1015463001 Pnnnone Eng. Lot 10 Blk I Forest Ridge Outside Hose bib Drinking Water 0 Client PO~ Printed Date/Time 08/23/2001 13:13 Collected Date/Time 08/19/2001 16:00 Received Date/Time 08/20/2001 7:50 Technical Director Stephen C. Ede Results PQL Units Me,od Allowable Prep Analysis Limits Datc Date Init Niu'nte-N 0.$00 U ' 0.500 mg~L EPA 300.0 (<10) 08/21/01 SCL Mierobiolo~ L~oraeorv Total Coliform 4 OB, No Coli col/100mL SM18 9222B (<1) 08/20/01 ICAP MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING -C ~ HAA# 1. GENERAL INFORMATION Completelegaldescription / ~ ~ lc B,.cc~c I Fo,14s r" R lO C.~ -~[~ Location (site address or directions) G'~F"~,'I,-c -~- ,~- ~,,~,,,y r~ Property owner Mailing address Lending agency Mailing address Agent Address '13,~. T~¥~,t ~c~..~,~, o,,~.~.~)Dayphone Day phone · Day phone 3'/5"-¢3 '/ I 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. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I ver!fy 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 Address S & S ENGINEERING ;~'~,~ E. agie K~ver Loop Road No. 204 Eagle River, Alaska 99577 Engineer's signature Phone Date J DHHS 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 Sen~ices (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 DH HS does this as a courtesy to pumhasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Em ployeas of DH HS 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 JUN 1 4 i99~ DEPARTMENT OF HEALTH & HUMAN SEP, V~iT, E~un' Environmental Services Division:~'~::~J'n.~ saw~:Es 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744 Health Authority Approval Checklist LegalDascdption: LOT )o t]cocK I Fo,'{~$~- ~Ja/,~ '-r~ Parcel i.D.: 017 -I1:~ -c~9 A. WELL DATA Well lype Log present (~/N) ¥~,~ Total depth ~ ~ I s~n~ary se~ ~) ,¥ 4. $ Date of list Static water level Well production WATER SAMPLE RESULTS: If A, B, or C, attach ADEC letter. ADEC water syslim number Dali completed Cased to ) ~' I Casing height (above ground) Wires properly protected (~)N) Y ~ ..,/ FROM WELL LOG AT INSPECTION ~ g.p.m. g.p.m. Date of sample: (* / ff / q fl a. SEPTIC/HOLDING TANK DATA Data installed /e/~. (~/q ~' Tank size Foundation cleanout ~1) ¥ ~. $ Date of pUmping/v/4 - ~ · ~J C. ABSORPTION FIELD DATA Nitrate ~). ~" Other bacteria Colleclid by: S & S ENGINEERING 17034 Eagle River Loop Road No. 2G4 Eagle River, Alaska 99577 ),5'o 0 Depression (Y/~ /~ O High water alarm{~N) Pumper '-' Number of Compartments ~- Cleanouts{~l) ¥~;J' Dam'installed /0 ~/qg ' ~llmUng~or~)~S~em~e ~a ~,~r,~ ~n~ 33' (~c.~ ~__)o ' ' ' Gmvel~i~bel~pi~ O.~V T~de~ I '~> (~--,~ *~ ~) Eff~so~ ~]0 rr~M~R~ngTubepmse~) y~ ~p~on~rfleld~ ~o Da~ ~ adeq~ ~t H/~ - ~ ~ ~ Resu~ (P~I) . ~For ~ bed~ Ruid dep~ in ~o~ field ~fom ~a~ ~ate~ a~r g~. ~r added (in.): Fluid de~ ~ec ~on rote = g.p.d. P~~nt ~t 12 mmV) ~) If yes, gNe date 72-026 (Rev. 3/96)' UFT STATION Date installed ! O Manhole/Access (~/N) High water alarm level Cycles tested Size in gallons 'Pump on" level at' ~/3 *Datum ~"~'~ ~ "Pump off' level at* 3 3 SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot / O0 + On adjacent lots Absorption field on lot JO0 ~ On adjacent lots Public sewer main Sewer/septic service line ]00 Publi~ sewer manhole/deanout SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundafion 3 ~ / Property line ~ o Absorption field Watermain/servicellne ,/Q/~- Surfacewatarldrainage /o0 ~- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: / · ,, r e,~n~g Water main/service line Property line E' (~m,v~.,,~ R~ *~uildl foundation ~' '/ / Surface water / 0 0/'f- Driveway, pad~ng/vehide storage area /o'+ Curtain drain ~ ,v ~. ~: ~,~ ~ ,~ Wells on adjacent lots /oO F. ENGINEER'S CERTIFICATION HAA Fee $. Date of Payment I certify that I have determined thru field inspec~ons and rm4ew of Municipal records~l~'~_.....~..Wle~ff~.rns are 2'_ . , %~-.._\ .%,. c. co,.,. /~ ~...~Z:~. ~ WaiverFeo$ ///0'-'~-"- ~'~ Date of Payment ~'//~'f~ /~/~ ,- ,