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Home My WebLink AboutFOREST RIDGE BLK 2 LT 8Forest I id Block 2 Lot 8 #017-112-91 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241276 Work Type: SepticTank Upgrade Tax Code Number: 01711291000 Site Legal Address: FOREST RIDGE BLK 2 LT 8 G:3137 Site Mailing Address: 14901 SOUTH WINDSOR CIR, Anchorage Owner: BEVERIDGE WILLIAM THOMAS & CHR Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 9/9/2024 9/9/2025 55883 ❑ Disposal Field R1 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date: Date: -� �Zu 4 ON -SITE SEPTICMELL PERMIT APPLICATION Parcel I.D. 017-112-91 Property owner(s) WILLIAM BEVERIDGE Day phone 281-908-4236 Mailing address 14901 SOUTH WINDSOR CIRCLE *ANCHORAGE, AK Site address 14901 SOUTH WINDSOR CIRCLE *ANCHORAGE, AK Legal description (Sub'd., Block & Lot) FOREST RIDGE; BLOCK 2, LOT 8 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 4 &— peZ owjejL 5 ZEA-7_00-% r, V1L f4ii A. -Ca % V_ GoQDf APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) F] Septic Tank R Upgrade rX (w/wo ADU) Holding Tank EJ Renewal Duplex (D) ❑ Privy EJ Multiple Dwellings El (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: 65'EACH I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: Date of Payment: Receipt Number: Receipt Number: Permit No. Waiver No. GADevelopment Services\Building Safety\On Site Water and WastewaterTormsUient Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241276, Curtis Townsend, 09/09/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241276, Curtis Townsend, 09/09/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241276, Curtis Townsend, 09/09/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241276, Curtis Townsend, 09/09/24 Municipality of Anchorage Page i of 2. DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,O, Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~.~d ~h 00(~z PID Number: Name: Wastewater System: ~ New D Upgrade I~qO/ ~nor~ W/~o~ C/~ ABSORPTION FIELD '~';5~.O~g.I ~ Deep Trench OShallo~Trench UB;d OMound UOther LEGAL DESCRIPTION so, Rating: 0t ~GPo~q Ft Total Dept" ffomo.glnalg~de:7 ~ ~ ~r ~,~ ~ /F,. ~F,. I /Z GPMI ¢~ Ft. Z Ft. TANK SEPARATION DISTANCES u Septic = Holding ~.T.E.P. WelY /~2~ ~O~~ I~Z* z~i~ Matedal~ Numar of ~mpa~ments: su~. ,+ '+ LI~ STATION Water /dO Idd I00 ~ - Remarks: ~LW~ 6~ O,~ BENCH MARK . . ENGINEER'S ~EAL.. / Depadment of Health~uma~ices approval Reviewed and approved by: ~~~ Date:... / Permit No. SW940002 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 DescriptionFOREST RIDGE SUBD., BLOCK 2, LOT 8 PID No.: 01711291 i \ COl CO2 \ 105.3' MH NEW 1500 GAL S.T.E.P. SYSTEM i [ NEW \ 4 BDRM HOUSE \ B `CO �NEN`1500 GAL. CO2 MH � E LOT 8 `\ ANEW DRAINFIELD i 1112 I SCALE 17 017 A (IM)' GRADE ENGINEER'S SEAL ' res as Z't or t ; op J C .. Na. Ill?-! •� •F 4\.0"G75'1' eat W' 50 a CO2 1 45 0 46.0 m \\ i M.11 40.5 49.5 -, MTl 99.0 116.5 1112 I SCALE 17 017 A (IM)' GRADE ENGINEER'S SEAL ' res as Z't or t ; op J C .. Na. Ill?-! •� •F 4\.0"G75'1' eat ~.OCATION OF WELL ¢OLOHY ~UILD~R$ 90? ~45 69~4 $ 'E OF ALASKA DEPARTMEN'i Or NATURAL RESOURCES DIVI$10N OF WATER LOCATIONI~K~CII: I~ WC~L O~I[R~ .. , / DEPTHS M~SURED FROM:~cas;ng top ~ground ~urface ~ WElL D[PIH: DATE OF COMPL~ION ~mOL~ O~T~L O~p~ II o.~ o, ~:_ / ~, / ~ / ~// Mater~l Ty~,e ana co:or [rom To II ....... ' [~_._t~ ~elow ~ top cf caring ~ O~oun~ surface I-i cable too! U~E OF WELt: ~] domestic (~ hE;ger.,on C~ monitor ,~ Cub:~u supply ~ othe~ C~SIHG STICK.UP; ti. D~m' ~ in. to/~lt WELL I;~ TA~[ TYI G~VEL PACK TYPE: ~ Vciurr,~ bS~: ~_ De,th tc top: GROUT TYPE: V~tume: Depth: f~om . f[ to It Duration: PU,'vlplt~lG LEVEL AND Y_I~LD: /_~ ~ -~ it after __~'~- hfs pun',~irt:) /_.~..~gpm ~UMP IN~AK( DEPTH: ~t tlorsepower: ,__ W~ DIS~NFECZED UPON COMPL~ION7 ~ YES ~ NO CONTRACTOR INFORMATION: RaQ,§l~etf..e B.us'ness_ N_~me . ~ignature of Authorized Respr~ta:ive Date REMARKS: PLEASE f~,AIL WHITE COPY OF LOG TO: Or,;fl/OIVISION 0;: WATER PO E:OX 7721 ll; EAGLE RIVI~R AK 99577-2116 .~P£~T IOU~ .~ A t'l'-T ¥ D IV'~S lOtl I tt['Ol; M hl' I Ot'~ COI.ONY BLDERF, PEI,','ll~f ~: 93"t17I 14901 ,.qOUTH U!UZOF: BLOCK.' 2 SIJl:[*: FOkE¢.;T Rl[~fil: I~/~TI~; 6/21/1994 COl, [lOX MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PERMIT NUMBER:SW940002 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:NORCOL INVESTMENTS OWNER ADDRESS:14901 SOUTH WINDSOR CIR ANCHORAGE, AK 99508 PAGE 1 OF 2 DATE ISSUED: 1/04/94 EXPIRATION DATE: 1/04/95 PARCEL ID:01711291 LEGAL DESCRIPTION: FOREST RIDGE BLK 2 LT 8 LOT SIZE: 55883 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ~THETTRENCHiMUSTZ~MAINTAIN/NOTiLESS'~HANiSOFEET-SEPARATION FROM ANY ~SLOPE-OF.~5%'OR~REATER~ ~THE ALTERNATE'SITE-MUST HAVE ALL ~GANIcSiREMOVEDiAND A MINIMUM~OFZ4iFEET.-OF-CLASSIFIED'FILL-'INSTALLED~'~COMPACTED, PAGE 2 OF 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 6ND ~GRADED 'iBY 'NOT ~LATER -.THAN "JULY ~15';Y:l 994. FINAL'~PPROVAL.OF-TME A$-~UILT.AND_HEALTH AUTHORITY-WILL NOT E:.GRANTEDUNTIL,THEABOVE~COND~TIONSj}IA~E.2~EEN...S~IEDv-A ND-.THE :ALTERNATE. SITE ~A~PRON~D 'BY ~DHHS. ~ DATE ISSUED BY: ROBERT SHAFER. P.E. ROGER SHAFER. P.E. December 1, 1993 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 ROAD DESIGH SOIL TEST ON SrTE WASTE WATER D~SPOSAJL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEAL TH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Forest Ridge Subdivision, Block 2, Lot 8 Request you Issue a permit to drill a well and Install a septic system to serve the proposed four bedroom house on the referenced property. Two test holes were excavated and percolation tests performed on the referenced property. The approximate locations of the test holes are located on the attached site plan. The monitoring tubes within the test holes have been checked and found to be dry. This property has enough area for a septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. An alternate site will be developed as shown on sheet 2 of 2 of the site plan. It is planned to have the alternate site fully developed prior to final approval of the preliminary site construction and issuance of a final Health Authority Approval. If you have any questions, or require additional information for your review, please contact us. RLOOP * SUITE 204 * EAGLE RIVER, ALASKA 99577 LE6^L FOREST RIDGE SUBDIVISION, BLOCK 2, LOT 8 DRAWN L. S. ULSHER IcKD. R.A.S. IDATE12/1/95 ISHT' 1 OF 2 \ PTIC SET BACK \ DESIGN CRITERIA: ~ 4 BDRM = 600 GPD o SOILS = 0.6 GPD/SO. FT. ~ 600/0.6 = 1000 SO. FT. REO'D ~. DEEP TRENCH: o~ 7' DEEP ~ 6' EFFECTUVE ~: 85.5' LONG MIN. 2' COVER AND 2~ INSULATION REQUIRED PRESSURIZED DISTRIBUTION SYSTEM: PUMP = 20 OSI 05HH - 5 STAGE (~$0 GPM 1 LATERAL ~ 77,5' LONG = 50 GPM/LAT 50 HOLES/.LAT (2.5' O.C.) - 50 HOLES = ~1 GPM/HOLE 1/4" DIA. HOLES FACED DOWNWARD 1 1/2" DIA. LATERAL STRUCTURES, EASEMENTS, OR ENCROACHMENTS SHOWN ON THIS SITE PLAN ARE AS SHOWN ON AN AS-BUILT SURVEY DRAWN BY: GASTALDI LAND SURVEYING IT IS THE RESPONSIBILTIY OF THE CONTRACTOR TO VERIFY EASEMENTS, REQUIRED SEPARATION DISTANCES, AND PROPERTY LINES PRIOR TO CONSTRUCTION. CONTRACTOR IS REQUIRED TO OBTAIN UTILITY LOCATES PRIOR TO ANY EXCAVATION WORK. T & E ESMT. \ \ \ \ \ \ \ \ PROP. 1500 GA[. S.T.E~. \ \ LOT 8 LOT 9 \ \ \ \ \ \ \ \ \ \ SITE FELL TO BE HAULED IN TO RAISE AREA FOR ALT. SITE (FILL S/B HAULED IN ~f/IN Ist YEAR TO ALLOW FOR CONSOLIDATION FOR FUTURE CONSTRUCTION MINIMUM 4' DEPTH SEE SH. NO. 2 OF 2 lOT R J DAT~ 2/21/93 I SH~. OF 2 CUT BANK ~J(INDSOR ROADWAY CIR. NOTE: REMOVE ALL ORGANIC MATERIAL PRIOR TO PLACING FILL. FILL WILL BE PLACED AND ALLOWED TO CONSOLIDATE. ALL FILL MUST BE IN PLACE PRIOR TO FINAL APPROVAL OF PRIMARY SITE CONSTRUCTION CROSS-SECTION VIEW OF ALT, SITE DEVELOPEMENT N.T.S. Municipality pi Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: ,~-C~'"~ Township, Range, Section: 2 5 7 8 10- 11- 12- 13 15 16. 18- 19- 20- SLOPE SITE PLAN WASGROUNOWATER ENCOUNTERED? IF YES, AT WHAT DEPTH? PERCOLATION RATE ;~(~ Immules~mchl PERC HOLE DIAMETER TEST RUN BETWEEN ~,~_,~,~AND ~ ' FT ,,/ / 170~4 £mge River Loop Road No. 20'4 //~n / £egle River, AliSa ~577 ~ , , pERFORMED B~% i ~7~_~'~ CERTIF ~ TH..T THIS TEST WAS PERFORMED IN :;C27~4~ITHALLSTATEANDMUN:CIPALGUIDELINE~~~A~ OATF- --~ ~ Munlcipalily of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 3 4 6 7 8 9- to - u,/D~-~. 11 12 14 15- 16- 18- 19 2O S l S EBINEERI~ ./ti WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? P E Mo~ilm'ing? _t.,.,-~,a--; Oat~: .,./.-., DATE PERF Township, ~an§e. Section: SLOPE SITE PLAN ? Gross Net Deoth to Net Reading Date Time Time Water Drop 3:~op,~ ,-- .,~ '/~." '-- : ~d 16 '- 5~'' ~" TEST RUN BETWEEN PERCOLATION RATE I'~ (m,nute~,nctU PERC HOLE DIAMETER ~ Ir ~ C[RT;FY ~HAT THIS TEST WAS PERFORMED IN 17034 Jlgle River Loop Road Ne. 204 PERFORMED ~. ;,,~,. ~.,..,, ,,,.ii,,, ...,,, ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINB~IN EF! '~T DN THIS DATE. DATE. MUNICIPALITY OF ANCHORAGE __ �4 Development Services Department r Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval �.s-1 . O_C)a5 Parcel I.D. 017-112-91-000 Expiration Date: -81-2V-02& A Legal description FOREST RIDGE BLK 2 LT 8 Site address 14901 SOUTH WINDSOR CIR Anchorage AK 99516 Current property owner(s) KAPLAN ALASKA COMMUNITYPROPERTY TRUST 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`�JG77-`J�_O ?� 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 X Arsenic Advisory Other COSA Approva"une 2022 MUNICIPALITY OF { _aq Development Services Department {� On -Site Water & Wastewater Section ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 017-112-91 Complete legal description FOREST RIDGE BLOCK 2, LOT 8 Location (site address) 14901 SOUTH WINDSOR CIRCLE, ANCHORAGE, AK 99516 Current property owner(s) KAPLAN AK COMMUNITY TRUST... Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 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: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 29 - See advisory if steel older than 20 years 29 -YEAR OLD STEP TANK TOWARDS END OF LIFE 6. ABSORPTION FIELD: ❑ AWWTS ❑ 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 $ 0 Waiver Fee $ Date of Payment Date of Payment COSA # O- OG 5 ( I :S I Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: FOREST RIDGE BLOCK 2, LOT 8 Parcel ID: 017-112-91 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 1/15/1994 Total depth 135 ft Cased to 135 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 5/5/2023 Static water level at beginning of test 92 ft. Well production at time of test 4.5+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 5/1/2023 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank NA Date of pumping 5/3/2023 Required maintenance completed, if AWWTS Comments: NA – STEP TANK FLOAT LEVELS – SEE REPORT C. LIFT STATION Required maintenance completed Age of lift station 29 years Lift station material STEEL Comments: SEE MOA ADVISORY – THIS OLD STEP TANK WILL NEED TO BE REPLACED W/ NEXT COSA D. ABSORPTION FIELD DATA Which system tested (date installed) 1/19/1994 ALL standpipes present per record drawing Total measured depth from grade 9.1 ft (max) Measured depth to pipe invert from grade 7.9 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective 4.9’ of 6’ ED Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000 gallons 5/4/23 date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 5/5/2023 Results Pass Fluid depth prior to test 15 in Water added 750 gal New fluid depth 36 in Elapsed time 1440 min Final fluid depth 13 in Absorption rate 750 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 72 in (MOA 6’ ED) Effective depth used 26 in (Missing ED + Final Fluid Depth) Effective depth (ED) remaining 46 in Comments/Deficiencies: Total measured depths from existing grade. ED per elevation measured shots & appears approximately 1.1’ ED is missing. 72 hours later absorption field had 4” of fluid. COSA Checklist.docx 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’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ 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’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS 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 FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 5/19/2023 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 5/19/23 MUNICIPALITY OF ANCHORAGE f � Development Services Department T Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Lift Station/Pump Vault Maintenance Log Owner Street Address I Lno 16ocf1�► »�� r Septic Tank: -Sludge level 2"inches -Pumping: required yes no -Pumping completed es no Lift station: -Pump basket cleaned a no -Effluent filter cleanedes no -Control floats cleaned r no -Proper float settings confirmed :�sno -Operation satisfactory es no Alarm System: -Dedicated electrical alarm circuit es no -Audible and visual alarm inside dwelling�S_o -Alarm system operation satisfacto not satisfactory Manhole Riser -Ground water intrusion at riser to tank connection es no -Ground water intrusion aro�esneo penetrations es no -Weep hole function I es no -Manhole lid: Functional Insulated es no Properly SecuredCesno Other `` -All manufacturer required inspections and maintenance completed es no Comments: Qualified Maintenance Provider: Technician-0.`r'Cy - n Company h -k ---S Date of maintenance � Signature Date 11( MUNMPAUTY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT cc,,, On-Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC231131' Subdivision: Forest Ridge Block:2, Lot: 8 907-343-7904 Fax: 343-7997 The septic tank for this property is 29 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more, not including engineering, surveying or MOA permitting fees. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. 0 c z z 0 0 0 0 0 P . 49 TH K SHANE A. HOLT1. .' BOO LS -6914 0` O Q"ao Aro lessiona� �Qo ��DD000�� THE SURVEYDATA AND MEASUREMENTS HEREONAREPREPARED FOR THE OWNER OF RECORD AS OF THE DATE OF THIS SURVEY. ANY USEOF THIS DRAWING BY THIRD PARTIES IS PROHIBITED UNLESS WRITTENPERMISSION IS PROVIDED. SURVEY ORDERED BY: matt dimmlck keller williams THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD OR OTHER RIGHTS OF WAY, OR ANY ENTITY NOT ON THE RECORD PLAT ARE NOT SHOWN HEREON, UNLESS NOTED. NOTE. FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAYBE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. ONLY VISIBLE IMPROVEMENTS ARE SHOWN HEREON AS-BUILTSURVEY I" =301 NO CORNERS SET THIS DATE I HEREBY CERTIFY THA TI HA VE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT8 BLOCK2 FORESTRIDGESUB ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUA TED THEREON ARE WITHIN THEPROPERTYLINESANDNO VISIBLEENCROACHMENTS EXIST OTHER THAN NOTED. DATED ATANCHORAGE,ALASKA THIS 15 TH DAYOF MA Y 2023 HOL 7LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK\11-99507 15786 231-53 PP3-s5z5 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1. GENERAL INFORMATION Complete legal description tDT /~. "~ icl ~. Location (site address or directions) I I~ c},0 { Current Properly owner(s) "~o..~ L ¢ ~ Expiration Date: .'~ - Day phone Mailing address 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. Day phone Well TYPE OF WASTEWATER DISPOSAL: '~ Individual On-site [~ [] Individual Holding tank [--I [] 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) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of HeaRh Authority Approval are valid for 90 days [rom 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 may be reissued for a period of up to one year with valid water samples.) Certificates are valid for cne year fcr properties served by Class A or B wells or a public water system. The Municipality of Anchorage is ncr responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As ce~fied by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastawatar 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 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(are} in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time o[ installation. NameofFirm '"-~:Jo~,~. ~,ur-V,_~.~ '-~..~- Address ~ ~ IE~ ~ Engineers Pdnted Name ~ ~[~-~ 5. DSD SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for Phone Date bedrooms. .... · ' '" '".' ENGINEER'S '~'~'.~: .... '' ~.~ STAMP bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Sragew St. P.O. Box lg6650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: WELL DATA Well type :~ Date completed///~/'~/ Total depth I ~j.~, ft. Date of test Static water level Well production ParcelIO: C) I"1- ti;L-flY Well Log (Y/N) "~ Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION c//~ ft. WATER SAMPLE RESULTS: Coliform ..~.~colonies/100 mi. Date of sample: SEPTIC/HOLDING TANK DATA Tank Type/Material Nitrate ~-~ rngJI. Otherbacteria~colonies/100ml. ~T~'eL- Dateinsteiled II Iq[qq Tanksize /~:)OO gal. Number of Compartments ,~- Cleanouta(Y/N) "~ Foundation cteanout (Y/N) ~ Depression over tank (Y/N) !~ High water alarm (Y/N) ~/ Date of pumping 17" I Jl~ O/~ Pumper .A. ut g,~ ~.,~ :~ J::)# / / / , C. ABSORFrI'ION FIELD DATA Date instailo. ~/lq/~y so, ~,.o (g.p.d~ or.~rm) o.& TO~I dop~ q Y~ E. Eft. abso~fl~ ar./Oe~ ~ Mon~.ng ~be ~ Date of ,dequaw t.t ' ~OI ~ul~ (P~F~I) ~ Fluiddep~ in a~o~fion field before t~t~ ~. Water add~ Tempi. Etaps~ T~e: ~m~. F~ fluid d~ / ~ in. ~s~n rate >= ~y rejuvenation ~a~ent (past 12 ~.) ~ & ~e) ~ System typo- ) ~.~ ~lq Gravel below pipe ~ ft. Depression over field For q bedrooms ~,. · ~ew depth~rj~.in. bc''-c~ g.p.d. If yes, give date v/ D. UFT STATION Date Installed I Itq ~q~ 'Pump on" level at '/~ in. Datum ~ E. SEPARATION DISTANCES s ze · galons I 'Pump off' level at' ~ in. Cy estested. !O 't Manhole/A_ _cce~_ _s (Y/N) High water alarm level at in. Meets alarm & cimutt requirements? ~ Septic tankJllft station on lot Absorption field on lot Public sewer main SEPARATION DISTANCES FROM WELL ON LOT TO: Sewer/septic service line I ~ Jd On adjacent lots On adjacent lots Pubflc sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation i ~ Propen'~ line I 0 '~ Absorption field Water main t¥//'A Water service line ~-5 4/, Sun'ace water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water Sea, ice line cumin drain Building foundation Surface water ~__ Wells on adjacent lots Water main t~//~f Driveway. parking/vehicle storage ~'O ~ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspecEons and review of Municipal recoils that the above systems are in conformance with MOA HAA guidelines in effecf on this date. Engineer's Printed Name "-~,1 .--~v rK_~L..~ Data t.'-lo k, t HAA Fee $ '5¢.-~ ~ Date of Payment Rleceipt Number (Rev. 12/00) ~:'<3 ,' .-- .,-~' % *~ '). ' WaNer F~ $ Da~ of P~ent R~ipt Nu~er 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 01711291 HAA# GENERAL INFORMATION Complete legal description Forest Ridge Subdi~ision~ Block 2~ Lot 8 Location (site address or directions) 14901 South Windsor Circle Anchoraget Alaska 99508 Property owner (~nl nn_v Rn t ld~r.~ Day phone Mailing address Lending agency Mailing address Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Xx Individual well Community well Public water NOTE: · lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site If community well system, provide written confirmation from State ADEC attest- 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 verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein, I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance .with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection· Name of Firm ~ ~ Phone Address ; 17034 Eagle R!v.e,~l~OOPRo. qd'No. 204 , · Eagle River, ~ 9~','~ Engineer's szgnature ///// ~,,7.~-~ _ DHHS SIGNATURE Approved for Disapproved, Conditional approval for bedrooms. bedrooms, With the following stipulations: Additional Comments By:, ~~ Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent profession al engineer registered in the State of Alaska. The D H HSd oes this as a courtesy to pu mhasers 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 LegalDescription: '~:,~r_--~-- "Z-; ~ ~' ParcelI.D. A. Well Data Well ty~'-~ Log prese Cr~)~/.~ / Total depth Sanitary sea~.y,~N) If A, B, or C, attach ADEC letter. ADEC water system number ~/'~ Date completed I/1~"'/~ Driller .,~/.~ ~JE. Cased to. / ~,~/ ,C/~? height, Wires properly protected~/N) / AT INSPECTION Date of test Static water level Well Ilow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot / '~ / Absorption field on lot '~ Public sewer main Sewer service line FROM WELL LOG /'~- g.p.m. O'p'n~ =,- : On adjacent lots / ~::~) ; On adjacent lots / Public sewer manhole/cleanout /'J ,::~,"--)~ .Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: :::~/I/~z~ .Nitrate ~./~ m~/z-.--Otherbacterla ~ Collected by: ~.~ ,~ ~ B. SEPTIC/HOLDING TANK DATA Date Installed ,//~/~':~" Tank size /~ Compartments ~'~ Cleanou'~t/~) V Foundation cleanou~)y Depression (Y(N~ High water ala"'" n~/ 7 Nar' m testec~l) .L//' ~ Da,eo, mp, d/x. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot J '~ ~' / On adjacent lots To properly line ~:' / Absorption lield ~ t Water main/service line Sudace water/drainage CONTINUED ON BACK PAGE C. UFT STATION Date installed Size in gallons High water alarm level 'Pump on' level at .Manufacturer, Manhole/Access~ ' *y "~"~ ~' .'Pump oft' Level at Cycles tested ,~ Meets MOA electrical code~) '%'// / SEPARATION DISTANCE FROM LIFT STATION TO: Well On lot / ~,1 - On adjacent lots /~"-~/4-- Surface water, /o-'~ L.y--- D. ABSORPTION fiELD DATA Date installed '-'~ . /'~ Lengt. ~::~ ~'~F ' T~ abs~Ptior~ area D'a{e'of adequacy test Soil rating (GPD/FF) g~.~-/' System type '7-'~ Width ~' .~---~ ~ Gravel thidmess ' ~ / Total depth ~. ~, i IO0~ Glemae~" resent ~N) V Depression over field (Y~/~ A JL)//G Results(pasMai]) /'J~f~r-z~-'/~ for "~ Bedrooms W~;r level in a~rP(ion field before test /,-~//~' Peroxide treat .rn.e. n{ (Past 12 months) (Y~') SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ ~' On adjacent lots To building foundation On adjacent lots Ntertest' /,.D//~ If yes. give date ,[-)/.~, Property line' C) (,~l TO existing or abandoned system on lot Cutbank ~-.-~:) I Water main/service line 1 43 ~ '"J-"' Surface water Curtain drain Driveway. parking/vehicle storage area F.. ENGINEER'S CERTIFICATION I cer~fy that I have checked~MOA and HAA guidelines in'effect on the date of this inspect~n. --inee's Name' -'~-7 "~"' 7-'::"'" '~' '~~ ~ Nam~~ ' .... i~... .. ;. .AA Fee $ ..~), Date of Payment Waiver Fee $ Date of Payment Receip~ Number