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HomeMy WebLinkAboutFOREST RIDGE BLK 1 LT 9Forest Rid Block I Lot 9 #017-113-08 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 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231378 Work Type: SepticTank Upgrade Tax Code Number: 01711308000 Site Legal Address: FOREST RIDGE BLK 1 LT 9 G:3137 Site Mailing Address: 5107 MANYTELL AVE, Anchorage Owner: RUHL RUSTIN G & KART A Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: Is, u DeI)arrment 11 /14/2023 11 /13/2024 43537 ❑ Disposal Field Q 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: S 5L)r-J) -rv> or,-4 (' Date: i ! 20 2_ 3 Issued By: C L Date: 1 2 7-3 r' 4 F1.11UNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON -SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 017-113-08 Property owner(s) Rusty Ruhl Mailing address 5107 Manytell Ave, Anchorage, AK 99516 Site address 5107 Manytell Ave, Anchorage, AK 99516 Day phone (907) 748-4444 Legal description (Sub'd., Block & Lot) Forest Ridge, Block 1 Lot 9 Legal description (Township, Range & Section) Lot Size 43,537 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X Septic Tank ❑X Upgrade RX (w/wo ADU) Holding Tank ❑ Renewal ElDuplex (D) El Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. j �_ (Signature of property owner or authorized agent) Permit/Rush Fees: �— Date of Payment: f Z ?n 2 3 Receipt Number: Permit No. o P 2. 3 / 3 Waiver Fees: Date of Payment: Receipt Number: Waiver No. Permit App_'- : - November 1, 2023 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Forest Ridge, Block 1 Lot 9 - Manytell Ave Septic Tank Replacement Dear On-Site Services Engineer: The owner of the above lot has a septic tank that has reached its end of useful life, so we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the wells and septic location. No conflicts exist between this proposed system and any other wells or septic system, whether on this lot or adjacent lots. We are replacing the septic tank with the same size STEP tank designed for 4 bedrooms. Due to the high groundwater the tank will need to be epoxy-coated steel. The new septic tank will be a minimum of 100’ from all wells and surface water. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231378, Curtis Townsend, 11/14/23 / / // DECOMMISSION EXISTING 1500 STEP SEPTIC TANK Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 1"=30' EXISTING 48' LONG x 18' WIDE PRESSURE DISTRIBUTION BED NEW 1500-GAL STEEL STEP TANK CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND FOREST RIDGE, BLOCK 1 LOT 9 FEET 0 30 60 MANYTELL AVE 4-BDRM HOME SEPTIC PLAN 11/1/23 10' T&E EASEMENT 10' T&E EASEMENT 100' SEPTIC SETBACK EXISTING WELL Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231378, Curtis Townsend, 11/14/23 Municipality of Anchorage Page / of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~t~/ '~5~l~3-- PIDNumber: 01'7113~&' .am,: ~/~ ~/7~¢~ Wastewater System: ~New D Upgrade ~~ ~ ABSORPTION FIELD Total Depth from ori inal grade:. WELL: ~ New ~ Upgrade ~r.~e~width: /~ /Ft Num~r~oflines: '~ GPMI O/'~ Fl.I (1~ Ft. TANK SEPARATION DISTANCES o Septic O Holding ~S.T.E.P. Re~arks: '" BENCH MARK Inspections pedor~.r. ~,,k. ~s~ Dates: 1st ?-z~ -~ .. Reviewed and approved by . . Date: /-2~ ~ P~,rmlt No. SW950182 Page 2 of 2 Municipality of Anchorago DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 91 BLOCK 1, FOREST RIDGE SUBD. PIDNo.: 01711508 sTI ST2 }.IT3 I, IT4 2' AKE OTISI CRJ VI~L q~ d,' J · 9¢ 9' ~AT£E FOUN ~) 4-17-93 A B --yNE~ BED FCC' 45' 1  ST1 42' MT1 65' MT2 55' 4[ , MT4 75' 31 , ^iEW 1500 O~~ ;.T.E.P. SYST . TOTAL P.02 LOCATION OF WELL STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING & WATER MGMT WATER WELL RECORD BOROUGH LOCATION/SKETCH: DEPTHS MEASURED FROM:l-lcasing top r'lground surface BOREHOLE DATA: Material Type and Color From Depth To-** SECTION QTR$ SECTION TOWNSHIP Ds RANGEDw[] E I MERIDIAN WELL OWNER: WELL DEPTH:/~ Depth of hole: Depth of casing: ,/./// DATE OF COMPLETION It DEPTH TO STATIC WATER LEVEL: ft be,ow/ ,op o, casing r')ground surface METHOD OF DRILLING: ~air rotary n cable tool r'lother USE OF WELL: ~, domestic r'l irrigation [] monitor [] public supply [] other. CASING STICK-UP; ~.~ ft. Diam: ~ in. Casing type: .c)~l~.~y/~- ~ in. to./(/./ ft WELL INTAKE OPENING TYPE:/~] open end [] screened li perforated [] open hole Depths of openings: to ft AUG 1 A 1995 MuniCipality De? Health & SCREEN TYPE: Diam: in. Slot/Mesh Size: Length: ft GRAVEL PACK TYPE: Volume used: . Depth to top: GROUT TYPE: Volume: Depth: from It to DEVELOPMENT M~,~ Duration: . PUMPING LEVEL AND YIELD: ft after ft hfs pumping / '~_ gpm PUMP INTAKE DEPTH: ft Horsepower: __ WELL DISINFECTED UPON COMPLETION? ~ YES r-i NO CONTRACTOR INFORMATION: .,~ REMARKS: ~egist~d Business Name/ ~ u · ~//_ ~ ~ - PLEASE MAIL WHITE COPY OF LOG TO: ~~ /~~ ~ ~ DNR~ISION OF MINING & WATER MGMT ~ign~tu[e of Authorized Res~entatiqe e - ~601 C ~ 8u[~ 800 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE I OF 1 ! 7/; ? ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW950182 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:NORCOL INVESTMENTS OWNER ADDRESS:2340 LOREN CIRCLE ANCHORAGE, AK 99516 DATE ISSUED: 7/28/95 EXPIRATION DATE: 7/28/96 PARCEL ID:01711308 LEGAL DESCRIPTION: FOREST RIDGE BLK i LT 9 LOT SIZE: 43537 (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 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 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: THE BED SYSTEM LATERALS A~//HAVE 3/16" HOLES SPACED 2.5 FT DATE: DATE: ROBERT SHAFER, P.E. ROGER SHAFER, P.E. 1994 CIVIL ENGINEERS (9O7) 694-2979 FAX 694-1211 SEWER & WATER INSPECTION PERCO~ATICN TEST ~EPARTI,{ENT OF HEALTH AN~ HUUAN SERVICES 8£$ 'L' S:tcee,t P.O. 8ox. 196650 Ancho.c~g¢, A.t,a.~ 99519-6650 REFERENCE= FOREST RIDGE SUSPIVISZON: T~.ae.~ A; 8.t. oc/z 1 £eq,~.t Vou Zaaue a pecm,i..t ,to ,i..s~,ta.~ ,', ,sept, Lc aVz, tem ,to a~ue .the p~.opoa~ ~o~ 6eScoaa im,,xe on .~e ne~e~e~*~'a Th~ ,~pp¢ox. Zma. te Zoccu~.o~ o1~ ,the .t.~at ho~.e.6 a.¢~. 6ho~ on :the a.t.~ched ~Lte pla.,. M~: :the ,t,/.~e o{ e~c~ua,,t. Zon, ~a. te¢ ~ e,cocuc,teceE a,t 6 {,t. cued a.{te~, g¢ou.~d ~:~.,t~J~. mor~to~g :th~ou. gh Spt, beg 1993, ma:te.¢ ~ {ou.~cL a~ S {t. in t~6:t ho~ #I a.nd 4 {t. in t~6:t hole #£. Th,l,a p.copec;ty tu~, enou. gh a,~.~ ~o¢ a. {u. tu.¢¢ ~,ep:tZc upg,'uzd¢ which c~n be. z, een on :the a.,t,~ ~,L.:te :the propo,sed .~eptJ. c z.:F~.tern. :1'{ Fo,, /,~v¢ ~n~ ~,,~t/on~, o¢ requ.~.e a.dditio~ in{orma~on {o~ ce; SITE WASTE WATER D~SPOSAL SYSTEM DESIGN 17034 NORTH E.~GLE RIVER LOOP · SUITE 204 "' EAGLE RIVER, ALASKA 99577 LEGAL I DRAWN ALL PORTIONS OF SYSTEM WITH LESS THAN 3.5' OF COVER REQUIRE INSULATION. DESIGN 4 BDRM = 600 GPD SOILS = 0.7 GPD/SQ. FT. (SAND FILTER) 600/0.7 = 857.5 SO. PT. REQ'D DRAINFIELD: 18' X 48' 2' DEEP INSTALL 2' LAKE OTIS GRAVEL .5' EFFECTIVE PRESSURE DIST. SYSTEM: PUMP = 20 OSI ~SHH - 5 STAGE (~50 GPM) 5 LATERALS ~ 42 LONG EA. = 10 GPU/LAT. 16 HOLES/.LAT. (2.5' O.C.) - 48 HOLES TOTAL =0.6 GPM/HOLE 5/16' OIA. HOLES FACED OOWNWARD I 1/4' DIA. LATERALS 1/2' DIA. SOMD MANIFOLD CONTRACTOR IS REOUIRED TO OBTAIN UTIliTy LOCATES PRIOR TO ANY EXCAVATION 'WORK. ~...~ ~o ,.~ ~ CLIENT FOREST RIDGE SUBDIVISION, J. ANDERSON J CEO. R.A.S. I STRUCTURES, EASEMENTS, OR ENCROACHMENTS SHOWN ON THIS SITE PLAN AR[' AS SHOW~ ON AN AS-BUILT SURVEY DRAWN BY: 'JEFFERY A. GASTALDI IT IS THE RESPONSIBILTIY OF THE CONTRACTOR TO VERIFY EASEMENTS, REQUIRED DISTANCES, AND PROPERTY LINES PRlOt: CONSTRUCTION. I BLOCK 1, LOT 9 I DATE3--25--94 I SHT. 1 Rt. visr. b 6-z$-9~, OF2 AVl:'. UTIL ESMT LOT 9 I I I PROPOSED 1500 GAL~.~i S.T.E.P. SYSTEM 100' SEPTIC-~ SETBACK 40'SEPTIC SETBACK PROPOSED 4 BDRM HOUSE · TH A. Shef~ PRESSURE DISTRIBUTION BED -10' UTIL ESMT MANYTELL AVE.  LEGALFoREST RIDGE I DRAWNj. ANDERSON FRO~ I 1/~' SOUl) MA~'IFOLD SUBDIVISIONt J CKS. R.A.S. BLOCK 1, LOT 9 I DATE --25--94 IS% OF 2 REVISED 6-25-94 48' O~.t. O lit DETAIL 18' £h']:)S CAPP£D ~'%'3/16' DJ.A. HOttUS ' Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage. Alaska 99502-0650 · SOILS LOG -- PERCC}LATION TEST LEGAL DESCRIPTION: F-E)~.~'~' 4- 5- 6 7- 8- 9- 13. 14 15 16 17 18 19 20 DATE PERFORMED: Township, Range. Section: WAS GROUND WATER ENCOUNTERED? COMMENTS U~ ~) SLOPE SITE PLAN IF YES, AT WHAT ' DEPTH? Oelah Ia Water ~Jler ~'~'--" Mo nilofin § ? Reading A .%0 Gross Net Time Time DePth to Net Water Drop PERCOLATION RATE ~"~ (m*nuteszmch} PERC HOLE DIAMETER , . T~STRUNSETWEEN ~ FTAND ~ FT PERFORMED BY: S 8, S £NGINEERING ~ ~ ' CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eaglo Rlvm' Loop Road No. 204 ACCORDANCE WIT~ ~I~ ~9~ GUSDEUN~S ~N E~FECT ON TH~S DATE. DATE:, 72~ (R~.  D E PA R T M E NM; n(~c/ffl; 'AYL°TIHA;CI~ °JaMgAeN SERVICES' · 825"L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DE$CmPTION: ~O~-'~' k:.t~C~E~' ~/'~ Township. Range, Section: SLOP~ S~TE P,^N I o~o~,~c$ 4 8 10 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 13 - ~ ~ Oepth ~ ~ Moni~ring? Gross Net Depth to Net Reading Data Time Time Water Drop "~-'~o-?! /t- S/X ~c~ P~t¢ /~ ~,-~ . 14- 16- 17- 18- 19- 20 - PERCOLATION RATE ~" ( Immures/tach) PERC HOLE DIAMETER TEST RUN BETWEEN ~'~ FTAND ~;:~-'~ FT COMMENTS ~ $ & $ £NOINEERINO ~ ~ PERFORMED BY; 1 ZU34 Eagle Kiver L~op Koad ~o. ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCOROANCE WI~E~ =~ ~J~'L GUIDELINES IN EFFEC' ON ~IS OA'E. DATE: ~ -- ~ ~ -~ % ROBERT SHAFER, P.E ROGER SHAFER, P.E. ON-SITE ~IASTF.~IATE~ PZSPOSAL SYSrFJl CONSTR~CTIOI,I P~C'TIC. ES ~fATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 SEWER & WATER INSPECTION SITE PLAN~ REFERENCE: FOREST RIPG£ SUBDIVZSZON= Tract A; l~oc~ (I) ga.,~on 6ep,t./.c ,t.~mk ¢{{,b.~.es~t puJ, pZ~ ~V6tem (S.T.E.P) ~ucE a pr~..a6u.,,~.zed ab6orp/c~.on bed to 6erue ,the propo6ed ~ou~. bezLcoom The con,t,,u*,ctor 6tuz~ be re~po~aibLe {or obZa~L~g a~V ~ece~6a.~V {rom ~o~ ~et. tZ~g. O~ propec~J 0~¢ ~ha.~ be re~por~Zb~e urgeta.~on ~omth ou~ ,the Con. t, cac. tor6 ,b. ta;ta.&~tu:d ~a.6;te.ux~e¢ dJ.6po6a~ ~.~'6tem6 mu.6t be. re. ce. Lye pcZo~ approua, t. {rom .the Mu~cip~ ~z~th Pepac,tmrs.~t. SEFTIC TANK ZNSTALLATION= A 6ep.t, Zc ,t~nk Z6 ,to be. co~.:t, cucted by a. cect:Z{Z, ed 6ep,t. Zc .tank ma~u~{.a~e¢. Cor~Zc-c~on ~ha~ ~Jcc~uZe ~uo 4" c~e~ou~ {or pu.~p.cng acc~6. 5. K~ 4~ndpipe~ on ,the ~.ep.t. Lc ,'t~nk ~ha~Z ex.te~d a mZ.c~u~n o{ I~' 4. Srp;C~c t~n~6 Z~a~z~erl with ~6 than 4' o{ couer z, ha.~ be 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Two T~ct A; BLock 1 ~ Fo¢~6,~ R,[.Eg~. Subd, i.u,[.6.1.o~ £9, 1994 FZn~ g~d~g ouer ~he ~¢ptZc tank ~ha~ be ~ch that ~ po~,i.t,l, ue ~Lop¢ PJgF_[eJ.~XZED ll~XIt~ SYSI'F_~ Z~LSTALLATZON: 1. AnF p~ o~ o~g~n~c matter mu~t b~ removed ~om th~ e~eu~t[E mound The d,~,t.~bu, t,l. on pip.i.n~ ~ to be o{ PFC joZn,t.~ are ,to be ~oLue~ The top o{ the mound ,~ha,~ be cou~ed ~u. Lt.h ,, minimum o~ 6 .i. nche~ o{ top,soit. ~nd vegetated ~-{{Zc~e~ to p~eue~ e~o~ion. e The di6t,'ul, bu. tion pipe4, ~e to be embedded Zn 6ew~ rock. Ca..,te 6hound be t~k~ tO backf~ ZR 6u~J~ ~t u~z~ ~6 ~0 preue~ d~mage to the pip.i..ng g~v~ ~{~ce bc{o~.¢ placing b,',ck{it~. Page Thaee Tract A; Block I; Forest Ridge S, bdiui6ion March 29, 1994 1. ~ATE~IAL SPECIFICATIONS= tank propo6ed {or in6~on mu~ be conatxacted bg a The {o~owing pipe mat~ a~e approved ~or u~e in 6eptZc 6~6tem i~tZo~ ~¢ the M,,~c~pa~g of Ancho~ge: e So~.Zd Ca6t I~on ~STY ~3054 (PFC) ASTY FMO (HPPE) Ye~ No ASTId D2662 {ABS) Ye6 in~pec~ing engineer. In6u~n 6ha~ be at lea~t £" thick extruded direct buaia~ polyatyrene (Dow Chemlcai Company Styrofoam HI or equai). Sep~c tank lnlet~ (Cau~de¢, Feanco, or equ~). A~ le~;ieZ~ g~vM (~ewer ¢oc~} 6ha~ be 0.5"-2.5" acreened g~ve~ m/th Ze~ ~an s~ ~.~in~ ~he #~oo ~Zeue. ~hen ~and i~ being u~ed a~ a fi~ter mat~, lt~ g~dation 6peci{i~o~ maat con{orm to current M.O.A. or P.E.C. requirement. Page Fou~ Tract A; B~ock 1; Fore6;~ RZdBe SubdJ. ui6~.on Ma~ch ~9, 1994 X~PE~XO~: The ~6t Ja~pec~ton m~t be conducted a~ter the exo-uation o~ dlt~he~, pit~, trench., o~ bcd~ and ~o~ the i~ta~on o~ any g~auet. ~ep~c tank ma~ be 6e,t, in p~ce, bu~ ~ay ~ot be back~itZed before ba.¢.,tZe.,t, gca. ue.t, dd~t.~d, bu;td, on ~.,tne.6 , 6tandpZpe.6 , e. Zeanou.~6 , and Zn6~ta,td. on, but he,oeo .the placement o~ "n~t oth~ b~ctz~Z~t.. $. The ~i~a~ in6p~,ction ~6 ,to o~cur upon ~J. na~ g~ad~ng o~ the prop~g. ~a~ ~d S ; S EnB~e~B. S ~ S Eng~B ~ be ~e o~'6 ~e own~ and ~e M.O.A. S Z S Engineering 6ha~_ have no LtabLCOty to the owner o~ to o~6 ~o¢ a~ o~ o~6io~ ~ ~ co~o~ o¢ any o~ p~6o~ p~{o~ ~o~k .on ~ p¢oje~ or ~e ~ o~ ~e ~a~o¢ to ~ o~ ~e work Zn ac~r~nc~ ~ co~u~on do~e~. S ~ S E~ine~'6 ~pe~ e~e~ ~ not be proce~ or the ~a{~ prec~,~o~ ~de~ to t~ p~oje~. CONTRACTOR/ZNSTALLER Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. o~7-~:~-o8 COSA # ~%-)(~ i i~ ',~© '% Expiration Date: / /- / g,~-- // GENERAL INFORMATION Complete legal description Forest Ridge Block ~ Lot 9 Location (site address) 5zo7 Manytell Avenue, Anchorage, AK c~95z6 Current Property owner(s) Kimberly 8, David Thompson Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 2. NUMBER OF BEDROOMS: 3. , TYPE OFWAT. ER SUPPLY: Individua/Well ~ IndMdual Water Storage Community Class Public Water System 5~.o7 Manytell Avenue, Anchorage, AK qg,;z6 Day phone Layne Gunter/Keller Williams unless othen~ise (equested, COSA will be held by DSD for pickup. Day phone 865-6599 TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding Tank E~ Well [] Community On-site [] Public Sewer r-'-I The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems 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. (Certificates may be reissued for a period of up to one year with valid water samples.) 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. 4. 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 for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the 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 of installation. Name of Firm Pannone Enqineering Services, LLC Phone 272-8228 Address P.O. Box zoo2z7, Anchorage, AK q95~o Engineer's Printed Name Steven R. Pannone, P.E. Date 8131~-~- Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed above. Amy reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ~J Approved for ¢ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: 0N-SITE WATER AND WASTEWATER PROGPAM ...... Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ,r...~ '-' /'--~ ~ ? / ft. g.p~L Manhote/A~ (Y/N)Y High water, alarm,~ at ~ Meets'alam-t & circuit reqaimmen~s? ¥ On adjacent lots On adjace~ lots *'co+ Public sewer"~e/d~ NA Holding~tank Manure/animai,~ex~sterage areas ~. Pm~ line ~,o+ W~er service line ~,~+ AbS~field SurfaCewa~er ~'RON'DiST~ :F:R, OI~I~'/~BS~ON FIELD O.N LOT': TO: Building- ~oundation *'o+' ~ water ~oo+ W~ts on.adjaCent lots *,60+ Water main ~ DriveWay,~p~t~cte ~e xe+ Pre~.line Water~ ~ '2~+. ] F. "rs E~:P~'Name COSA, Fee ~ Date ~ P~nt Receipt. ~mber (Rev. 1~/0~) Waiver Fee $ Date of Payment Receipt Number R. Ponnom · C.E 8149  MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services · .' 'On-Site Services Section --- · "-,;-: , .'~ "' P.O. Box196650 ~;Anchoraae.:Alaska'~99519-6650 ' ' "-;- ,"~- ' ~;-.. ~ ,'-"-' "' - ~7~ ": ' .......... APPROVAL FOR A SINGLE FAMIL.Y DWELLING Parcel I.D.# C)I '/~ ~1 ~ .- (9 ., ........ L . ..., :., # .1. ± GENERAL INFORMATION "' · ...... ..... · '...- . . .......... .. ,,:' . ~ ~ . ...:,..} ':' .. . :~.'-:'L:.'.. ~0~ati~ [sit o~di ectio~) ~ ' " ' * ......... :::' eaddress r ~ z~ u e -. ..... ..... .. .... :,.;:,.;,: ',v~'~----- '. ' ':.._.';~ ...'.' ~ ;: .. ',.,;.','.: ....... ;.-~;'.c;.'.~-.;,'. ~.':'.';.;.'~" "' .~. *.. '~ '. '.-~ ~n~o~9~.. AK ' - "' "~" .... ' · :';..2Z ... · '~'Ma nnaddress*.. ~40 to~en ~Me -Annotater AK 995}6 .... ' ' '"':""'*' ~r~a.~.._u.~agency "* "' ' ....... ' ......... "' ' ' ...... ....... :-'"' .........:,._., ........ . .................. . ...... Day phone i" ~"~*':"; 7~,".;,' '~ Unle~ othe~ise r~uested, ~ w~ll .......... ,, ,~., . ;; .......... i .'~* Corem :' ~ ':' :- ' ...... ..... __~ ,,... ;:.. ~ .....Public Water ..-.=.-.; ..... ... :. .... NOTE: - If communi~ well s~te~, p~ovide wri~en confi~ation from :.. ' tng to the legali~ and sMtus of system.. a~esttng to th~ ~le ah~ a~d St~t~s of system. ' '~ ; '~ '*-, .... .'" ,'. '. E. 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 H~alth Authority Approvai application show~ that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms . and tyl~ of structure indimted herein, I further verify that t~ed on the information obtained from the Municipality of Anchorage files and from my nvestigation and insp~'tion, the on-site water supply and/or wastewater disposal system is in c~)mpl'ian~'~ith'~'~l Municipal and State cedes, -'- ...... 0.r..d! .n,a?..c .e~. ,.,and regul.a~!o~s in effect on the date of th~s inspection..:_ .:2 ...... Name of Firm .' S & s ENGINEERING · ... .... 17034 Eagle River Loep Read N~. 2{3~ [' ; . . · * "/o ~' (---~:--~'~Engtneer'ss~gnature_ · ..~ ...... ~ ............. : ....: ....................... ,~,~' . ,. ~. 'f ........... ..... ...,~ ........... . ... . . · ~.~',--~...~,,,,...,~~ .. ·. . ,../~.Droveo bedrooms ..................... .' :, '.+x;~d¢.'::*~'.' ~Er' "-'-~ %:'Conditional ~approval for 5 ":"'~' :~' bedrooms,.'.~ith:the'follo~n~'sti~01ations:,'*''''~'~r~''' · '. ~ ,~x~' "-" .'~('-'.; ~ " ' ' ' ' ....... . ...... ,.,-.-.. ..... ;. ... . ...o .:-: - .... "- :'~ .~tB~,_..Z-'~~-. ~ · -'"'1. '~. _ ~ - .'. ~ ...... ~-~'*~,"~-~Dat~'-/,,--,~ ~,7~ ~_ '. ~ t- ~ -:~ .~ ~h, ~....~,~ ~; .~ .5 . ........... ..... ...., .... ~.~_;.~:~: ~ ~'~ ................................. · ~ 5T~ ~un~li~,~ ~ge ~ent of H~I~ and Hu~n ~wI~'(DHHS) I~ H~I~'A~o~ .=~Rm~l ~6~~ on~ u~n ~ ~nations g~n n ~mgmph 5 ~ by an inde~dent ... p~a~gm~r ~i~.? ~ Sate of Al~ka.~e DHHS d~ th~ ~ a ~ua~ to pum~m of ho~ '.. ~.~ ~ing tn~q~~ ~in ~e~ a~ ~e ~u~ ~plo~ o~ D~HS do not · condu~ Ins~ions or anal~e'daa ~fom a ce~ifi~te Is I~.~The Munici~li~'bf AEcho~ge b 'not ':..~ible for e~m or omi~io~ in ~'p~f~io~al engi~fs wo~.- -:- ~: :* :,: .... :-.-.: . . .. · . Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L' Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Well I)~pe. P~ Lo8 presem Sauila~. seal Health Authority Approval Checklist Fo.4t~ = r /~,Dd-~ 5-/~arceI I.D.: IfA, B, or C. a,ach ADEC le~r. ADEC water system number Dale complcted Case(ilo I ~ / y~$ FROM WELL LOG Casing height (alxwc ground) I -4- Wires properly protected (~)'N) ¥ ~ .~ Date of I~Sl Static water I~v¢l Well production g.p.m. AT INSPECTION WATER SAMPLE RESULTS: Coliform Da~e of sample: B~OLDING TANK DATA [ ami., .led Nib'ate Tank size / 3'" 0 0 0.. / Other bacleria 0 Collec~l ~': 17034 Eagle Rker Loop Road N~ :204 Eagle River, dUaslm ~9577 Number of Compmlments Foundation cleanout ([~fN) yE 3' Depression (Y~) ,c' 0 Da~ofPamping ~'/A ~"~¢~ Pumper -- AI~ORI~'ION FIEI.D DATA Dam ii aled / s' / High water alarm Soil rating ~r It"/txlrm) / ~' Gravel Ihic~mess below pipe O. ? Syst~mtype 8~o Effective abeorption area ~' 6 q Moniloring Tube present[~./N) )~ 5 Dept, ession over field (Y~) Damte ofadequac~ test ~/4 - ~v~ ~ Results (~ail) For Fluid depth in al:~erption field before tesl (in.); ~,,~1 (in.): Fluid depth ~~ Absou~tion ram = g.p.d. Peroxide treatm¢ 2 months) (Y/N) If yes. give date. __ De LIFT STATION Date iizstalled ~' / ! / v/ 5" Manhole/A~ ~) y i .~- High water alarm level at* q ~' Size in gallons "Pump on" level al* ~ ~ *Datum T.S.~< fi',,~' 15"~o "Pump of' level al* 3 5 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~hoiding tank on lot /0 c~ Absorption field on lot Public sewer main : On adjacem Ires ; On adjacent lots Public sewer mathol~/cleanom Lilt station Sewer/septic sc~/ce line °t ~ / 0 SEPARATION DISTANCES FROM(~=.~/HOLDING TANK ON LOT TO: Building foundation / '/ Prol~' lin~ ~ '/ Absorption field Water main/service line ¥ 6 ~ Surfacewater/drninnge ]00 '¥' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION Fll~l.r~ ON LOT TO: Building foundation ~- / Water mnln/service line Smface water ] 0 6 ~ C~qa/~druin t~'~ /e~O~' Dr/veway, pa~king~ehicle storage area Wells on adjacem lots IOO -t Pro~.' line .~o F. ENGINEER'S CERTIFICATION I eerie.fy that I have determined thrufleM inspections and review of Municipal records that in c°nf°rmance w~/.2?~gu~:s in effect on this date. Signature ~ c-, -I ~ Engincer's Name /~d~ ~ r ~'. HAA Fee $ Date of Payment Receipt Number Waiv~ Fee $ Date of Payment Receipt Number Rex,. 8/95 OSS: haa.wk.doc Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Parcel I.D. 1. 017-115-08 GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date: .~- Completelegaldescription FOREST RIDGE SUBDIVISION; LOT 9, BLOCK 1 Location (site address or directions) 5107 MANYTELL AVENUE * ANCHORAGE, AK Current [~roperty owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SCOl-r NORDSTRAND Dayphone 348-0298 5107 MANYTELL AVENUE * ANCHORAGE, AK I Day phone F.S.B.O. Day phone Unlesso~e~iserequested, HAAw#lbeheld~ DSD ~rpickup. 2. NUMBEROFBEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage Community Class Well Public Water System r-] 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 4 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. Cedificates 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) 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. Note:Alaska Water and Wastewater Consultants, Inc. shall be paid $ E.~='-- at, or prior I to closing for the engineering services provided. I 4. 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 application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the 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 of installation. Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEB~RR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 357-6179 Engineer's Comments: .~='~'~'?')'~'~/~I~~''~ In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, (~l~l ,~. con scientiousengineeringanalysisofthesysteminaccordancewithADECandMOA DSD Guidelines & Regulations. The reported results described the performance of the · system under the conditions encountered at the time of the test, and separation '....7'-~/1 distancesmeasuredtoreadilyidentifiablefeatures. Theoperationallifeofallwellsand fluctuate during the year, and the water usage of the family being served by tho system. These conditions are outside the control of the evaluator of the system. Satisfactory test v[,.~.~.,~..~,l.j/~.. results do not guarantee future performance of the system, nor do they guarantee that -- '. ness.: any warranty or future estimate of how long the system will continue to meet the · operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE V""" Approved for /"/" bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other ~"-/,9) H ,L~ ) ) ~ ~'' (Rev. 12/01) Original Certificate Date: MuniciPality of Anchorage Developmel t $ e ices Department 47~B~gawSL ' :P~O; Box:~g66~mge,~ 0951~ HEALTH AUTHORtTY APPROVAL CHECKLIST LegaJDesCrlPt[on: , I=OREST _RIDGE ,SfD; tOT 9f BLOCK t Pa~l ID; ,, ,017~113--0B A. WELL DATA Well;type.,~_~VA.~, I! A, a~ or'~r0~ldCPWSi!~ Date completed~ :8/~3/lg95~. S~Mltat~eaHY/N];-~ Total:dep~ ,:: !41: ,It, Case~:t~: ,, t41 , . 813/1995. , Date of test StatJowater I_eve!.. Well: prc~gctlor~. Well Log,(Y/N),, . YES: Wlms,pmPerlypmtectea~(Y/N)~ ,-:~ Caslnghelght (above ground) 12+, in. AT INSPECTION ,, 2/11/200;3 , .:102 , ft. . 6.5?, ~ L g;p~m. WATERSAUPLE RE_ SUI,TS: Cctlform ~: .; ~lon~e~0Q~[. ~te: 0-~ .-mg~. ~enl= ,N/AL ,, mg~. Date,0f:sample: .2/11/2003 B,$ EPTI'C~O~I~G~T~KOATA ~ank $~,< ~50~ ~.~aL Num~er=f~mPa~en~ ,, 2 Founda~on aeano~t.~ ~ Oepre~lon~verank.~).. No oateofpumplng~:,,,,,:2/~/2~03 , Pum'per~ .. c, ABSORP~ON~FIEEDDAT~ ': ' ' oate.~lle~ .... e/~/lg'~s ~o!lm~ng:~rfl~),o.7 Len~, : ~ .... · ~,.,,~:::,~ 18 ,. ,~. Qther bacteria :~ ~ ~-colonles/10o mi. Collected by:. AKWWOt,INC. , Dateln~!lea: . .8,/:1/1995 ..... Cleanouts (Y/N), YES , , High water alarm (Y/N), YES , CHUGAOH PUMPING,, TOtal depth:: '2.9: .fL Eft. ab.$.o)q3fl{3~re~8: 86~-~t" Monitoring tul3e, YES Date~e~e. quacytest. 2/1!1/~'003i: ~RGsults(Pass/Fail) PASS Flulddepthinabsorptlontiel(tb. efo. re~te:St ::O in. Wateradded ,925 gal. Elapsed Time: o re!n, FinalflPlct~pth ,O: in. Absorption rate >= , 600+ AnyreJuvenatlontreato!ertt(past12~o.,)(Y/N:~tyPe) ,, ,-NONE KNOWN .... Ifyes, glvedate,, System type , EIED. Gravel bel0wplpe .0.5 , fL Depression:over field~ N° For 4 bedrooms Newdepth O..~...in. g.p.d. D. LIFT STATION Oate installed 8/1/1995 'Pump on' level at 4.3' in. Datum BOITOM OF TANK E. SEPARATION DISTANCES Size in gallOns 1500 "Pump o~ level at 53' in. Cycles tested 5 SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line 100'+ 100'+ ,, N/A 25'+ Manhole/Access (Y/N) YES High water alarm level at 45' in. Meets alarm & circuit requirements? YES On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank . N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line ,10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 10'+ Curtain drain NONE KNOWN F. COMMENTS Building foundation . 10'+ Surface water '100'+ Wells on adjacent lots 100'+ Absorption field Surface water 5'+ 100'+ Water main N/A, Driveway, parldng/vehicie storage 10'+ *85' TO RUNNING WATER IN ROAD DITCH ON WOODHAVEN AVE. SNOW MELT G. ENGINEER'S CERTIFICATION I certify that ! have determined through field inspections and review of Munidpal records that the above systems are in conformance with MOA l-MA guidelines in effect on this date. Engineers Printe~ Nar~e Data JEFFREY A, GARNESS Waiver Fee $. Date of Payment. Receipt Number P95-50 FOREST RIDGE SUBDIVISION LOT g, BLOCK 1 43,537 s.f. WOODHAVEN AVENUE N 89a48'11"E 193.00' · 10' T. & E. ESMT. LOT 9 SEPTIC VENTS  ,~' '"'" EXISTING .-' '~' FOUNDATION Z 107.6' =30' "FOUNDATION AS-BUILT" AS ' BU IL T , her.bycertify that I huve surveyed the property depicted above and that no GASTALDI LAND SURVEYING encroachments exist except as Indicated, deft A. Gastaldl~ R.L.S. I1 Is the responsibility of the owner to 4726 West 88th Ave. determine the existence of any easements, Anchorage, Alaska 99502 covenants or restrictions which do not PHONE 248-5454 appear on the recorded subdivision plat. Under no circumstances should any data hereon be used for construction or for GRID . DATE establishing boundary or fence lines. 3137 8/25/95 ANCHORAGE RECORDING DISTRICT, ALASKA F.B. JO~ NO. NOTE: NO CORNERS SET THIS DATE. 95 -08 FR91