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FOREST VIEW HEIGHTS LT 16
Onsite File Forest View Heights Lot 16 #014-141-23 (Kev u5iuz/i b) Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201309 PID Number: 014-141-23 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name John Matthews ABSORPTION FIELD El Deep Trench ❑Wide Trench El Bed ❑Mound Site Address NHN Lewis Place Anchorage, AK ❑ Other Phonef Bedrooms Soil Rating Total depth from original grade (907)224-5271 77� 3 1.2 GPD/SF 9 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 5 Ft. Gravel depth beneath pipe 4 Ft. Subdivision Block Lot Forest View Heights 16 Fill added above original grade 1.6 Ft. Gravel length 38 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 380 Ft2 1 Ft. Well >100' >100' N/A N/A >25 TANK ❑® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity Gal. Surface Water >1 00' >100' N/A N/A Material Number000 f compartments Lot Line >5' >10' N/A N/A NA Plastic 1 Foundation >10' >10' N/A N/A LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 drainfield Tank to D3034 Installer Northern Excavation Drainfield D3034 Co/MT D3034 Inspector Luke Tidwell BENCH MARK (Assumed elevation) 100 ft Inspection 15` 8/14/20 10/27/20 Location and description 2�a Top of foundation. aro 4'h ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp °°••�S,�®0, Conditional Approval: Date ���P,.°••"°°°'°" f° 49th io ......,.....esonu°s....vuan..................... . E. ANDERSON Septic System °MICHAEL ��.- % No. CE-4381 Approved Date 1� a k ,2021 ®FFD ,x12/30/20 Note: this approval does not include well permit requirements. �������®®� �� (Kev u5iuz/i b) 1"=50' 38' LONG x 5' WIDE x 4' EFFECTIVE DEPTH ABSORPTION TRENCH 3-BDRM HOME CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND MH MT1 PERMIT # OSP201309 PID # 014-141-23 FOREST VIEW HEIGHTS, LOT 16 A B FCO 26.9 MH 32.4 SV 34.7 A B 2CO 37.0 CO1 51.2 MT1 52.2 MT2 35.1 1.1 13.1 18.0 22.1 38.2 40.2 47.3LEWIS PLACE12/16/20 FEET 0 50 100 10' UTILITY EASEMENT220215220220 CO1 FCO CO2MT2 2CO SV TH EXISTING WELL WELL 1,000 GALLON SEPTIC TANK w/20" MANWAY.PROPOSED WELL EXISTING WELL PLAN AS-BUILT CO2 37.448.9 ALTERNATE SITE - CATEGORY III SYSTEM w/15' LONG x 5' WIDE x 4' EFFECTIVE DEPTH ABSORPTION TRENCH. APP. RATE - 5 GPD/SF. PROFILE AS-BUILT (NO SCALE) 92.1 87.8 92.7 97.1FCOMH SVPERMIT # OSP201309 PID # 014-141-23 FOREST VIEW HEIGHTS, LOT 16 12/16/20 1000 GAL SEPTIC TANK 98.3 FINISH GRADE 38' DRAINFIELD ROCKMT TH#1NO GROUNDWATER 8/11/20 87.7 91.7 COCO80.7 87.7 91.7 96.7 ORIGINAL GRADE MT2CO91.9 ® DOC CO dba BILL Sc COLE ULLIVAN WATER WELLS P.O. Box 670269, Chugiak, AK 99567 688-2759 OWNER OF LAND: John Matthews ADDRESS: LEGAL DESCRIPTION Forest View Heights Lot 16 DATE: 9-28-20 PERMIT NUMBER: OSP201309 DATE OF ISSUE: 8-12-20 TAX IDENTIFICATION NUMBER 01414123000 Is well located at approved permit location: ®Yes ❑No Method of Drilling: ®air rotary ❑cable tool Depth of Well: 104' Casing Type: Steel Wall thickness .250 inches Diameter: 6 inches, depth 104 feet Liner type Static Water Level: 41 feet Recovery Rate 20 ® gpm F] gph Method of Testing Air Well Intake Opening Type: ® open end ❑open hole ❑ Screened Start feet Stopped ❑ Perforations Start feet Stopped Grout Type: Bentonite Volume: 50 lbs Depth: from 2 feet, to 42 feet Well Disinfected Upon Completion: ®yes ❑ no Method of Disinfection: Chlorine 50 PPM Comments: Ib b Zl Bore Hole Data Casing Stickup Overburden Silty Sand & Gravel Silty Sand & Gravel w/Clay & Cobbles Silty Sand & Gravel 3 GPM Sand & Gravel Drillers Name: Cole Sullivan ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. Matsu Borough: Department of Environmental Conservation. DOC CO dba BILL 8c CGLE U n 0 0 R LLIVAN WATER WELLS P.O. Box 670269, Chugiak, AK 99567 688-2759 www.sullivanwaterwells.com Pump Installati®n L®g Well Drilling Permit Number: SW OSP201309 Date of Issue 8-12-20 Parcel Identification Number: 01414123000 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Received Date/Time 10/06/2021 13:37 10/06/2021 13:30Collected Date/Time 1216645001 Matrix SGS Ref.# Client Sample ID Forest View Heights L16 Client Name Project Name/# Printed Date/Time 10/20/2021 15:19Forge Engineering Inc. Technical Director Stephen C. Ede Forest View Heights L16 Drinking Water Sample Remarks: Parameter Results LOQ Units Method Allowable Limits Prep Date Analysis Date InitContainer ID Metals by ICP/MS DSD10/18/21EP200.8ug/LArsenic 10/16/21ND5.00 (<10)B Waters Department EBH10/14/21SM21 4500NO3-Fmg/LTotal Nitrate/Nitrite-N ND 0.200 (<10)C Microbiology Laboratory M.A10/06/21SM21 9223B100mLE. Coli Negative 1 A M.A10/06/21SM21 9223B100mLTotal Coliform Negative 1 A Page 2 of 5 8/12/20 PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) August 12, 2020 M.O.A. Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Subject: Forest View Heights, Lot 16 – NHN Lewis Place Septic System Design Dear On-Site Services Engineer: The owner of the above lot intends to build a 3 -bedroom home on the property. We are submitting this permit application for the construction of a new well and septic system. The attached site plan identifies the location of the home and the proposed well, septic location and alternate site. No conflicts exist between this proposed system and any other well or septic system on this lot or adj acent lots. A test hole was placed on the lot on August 11, 2020 in close proximity to the test hole placed by First Water Consulting on May 21, 2019. Soils encountered in our test hole varied significantly from First Water Consulting in than silty gravel was found to 16’ below the surface. The percolation rate of this material was determined to be 3.3 minutes per inch. No sand was found the full depth of the test hole. Our design is based on the subsurface soils found in our test hole. The ground surface on the lot slopes to the northwest at grades approximating 15%. There are no slopes greater than 25% within 50 feet downslope of either the primary or alternate site. Ground contours are shown on the site plan indicating the grade and direction of flow. Stormwater drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. Wells on this and adj acent lots are shown. The new system will be a minimum of 100’ from all wells and surface water and more than 5’ from the septic tank. Please refer to the attached test hole log and plan and profile sheets for the septic design. If this design is followed, there will be no adverse impacts to adj acent properties. Sincerely, Michael E. Anderson, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201309, Rebecca Carroll, 08/12/20 1"=50' 38' LONG x 5' WIDE x 4' EFFECTIVE DEPTH ABSORPTION TRENCH 3-BDRM HOME NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND MH FOREST VIEW HEIGHTS, LOT 16 LEWIS PLACE8/11/20 FEET 0 50 100 10' UTILITY EASEMENT220215220220 COFCO CO MT 2CO SV TH ALTERNATE SITE - CATEGORY III SYSTEM w/15' LONG x 5' WIDE x 4' EFFECTIVE DEPTH ABSORPTION TRENCH. APP. RATE - 5 GPD/SF. EXISTING WELL PROPOSED WELL 1,000 GALLON SEPTIC TANK w/20" MANWAY.PROPOSED WELL EXISTING WELL Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201309, Rebecca Carroll, 08/12/20 FOREST VIEW HEIGHTS, LOT 16 DESIGN FACTORS: SYSTEM REQUIREMENTS: 450 GPD PEAK FLOW PERK RATE: 3.3 MIN/IN APPLICATION RATE: 1.2 GPD/SF 5' WIDE TRENCH SYSTEM 1,000 -GALLON SEPTIC TANK TYPICAL TRENCH SECTION (NO SCALE) 4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK 5' 6" 6" 4' 4' NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY BOTTOM OF TRENCH: 8.5' BELOW GRADE FLOW LINE ELEVATION: 4.5' BELOW GRADE TOP OF TRENCH: 0.5' ABOVE GRADE 450 GPD / 1.2 GPD/SF /5' WIDE * .5 (RED. FACTOR) = 37.5 LF TRENCH REQUIRED (38 LF SPECIFIED) 8/10/20 GEOTEXTILE FABRIC Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201309, Rebecca Carroll, 08/12/20 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST TECHNICIAN: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH (feet) PROJECT No.: TEST HOLE 1 SLOPE SLOPE SITE PLAN DATE READING GROSS TIME (minutes) NET TIME (minutes) DEPTH to WATER NET DROP PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH) TEST RUN BETWEEN: FT. and FT. COMMENTS: (inches)(inches) Forest View Heights, Lot 16 8/11/20 J. Millette DATE OF MONITORING: WAS GROUND WATER ENCOUNTERED? DEPTH TO WATER AFTER MONITORING: IF YES @ WHAT DEPTH? - 3.3 6 3 4 014-141-23 John Mathews 4:10/4:20 8/11 1 2 3 4 5 6 6/10 1' OG Professional Engineers Stamp: 8/12/20 10 NO None** 8/11/20 Silty Gravel - GM 4 4:25/4:35 6/9 2 1610 3 2 16 4:36/4:46 6/9 2 1610 3 2 16 4:47/4:57 6/910 3 4:58/5:08 6/910 3 5:10/5:20 6/910 3 ALL MEASUREMENTS TO 1/16". **WATER MONITORING FROM TUBE PLACED BY FIRST WATER CONSULTING ON 5/21/19. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201309, Rebecca Carroll, 08/12/20 4661 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350 -9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: FOREST VIEW HTS. L16 PERFORMED BY: FWCS - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 8/1/2020 DEPTH FEET OG SOILS 1 2 ORG/OL 3 4 5 6 7 8 SW/sp 9 10 11 12 13 14 15 16 17 18 BOH 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 5/21/19 < 2 min 64 64 5 64 64 5 64 64 5 64 64 5 64 64 5 64 64 PERCOLATION RATE <1 (MIN / INCH) TEST RUN BEWTWEEN 4 & 5 FT PERC HOLE DIAMETER 64 PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 5/30/19 TESTHOLE # 19-1 DATE PERFORMED: 5/21/2019 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: Sandy soils readily absorbed water during perc test. Insitu material suitable for filtration VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: JOHN MATHEWS 8/1/2020 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201309, Rebecca Carroll, 08/12/20 dpi UHMPP-kLF u Y OF nL\ NU ORALE 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. 014-141-23 Expiration Date: C C��J X02 a 1. GENERAL INFORMATION Complete legal description Forest View Heights, Lot 16 Location (site address) 7275 Lewis Place Current property owner(s) Mailing address Real estate agent Mark Haberman Day phone 632-2877 11560 Hideaway Trail, Anchorage, AK 99507 2. TYPE OF DWELLING: ❑® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑® Private Septic ®❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community- ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment l 01 D 1 Date of Payment Receipt Number --A-1-`' 1-- 1 Receipt -Number COSA # 0 S C c2 I 1 (o 5 6 Waiver # 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 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 11/5/21 Aw low *: 49TH 6. DSD SIGNATURE System #1 Approved for 3 bedroomseenjarrrnchiiler System #2 Approved for bedrooms �����srF�. , iE 5 292 Disapproved �kkF,pROFESSI©O.,��- Conditional approval for bedrooms, with the following stipulations: OF r `� �►-SITE �'�% Nu MATER ER z O c� PROGRAM �. BY Original Certificate Date: T 0 a The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume 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 of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: Forest View Heights, Lot 16 014-141-23 ■20 9/28/20 N/A 104 ■ 104 ■ ■ ■ ■ ■ 24 Forge Engineering 9/28/20 41 10/6/21 <1 Septic/Plastic New ■ Installed on 8/14/20 (Vacant since installation) 5-WIDE TRENCH 10/27/20 New System ■ 10.6 6.6 ■ ■ N/A COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to:(Please enter distances if less than required or if community well) 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 From Septic/Holding Tank on Lot to:(Please enter distances if less than required) Building Foundations > 10’Yes if No ft Property Line > 5’Yes if No ft Absorption Field > 5’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 septic tank is under driveway comment below From Absorption Field on Lot to:(Please enter distances if less than required) Building Foundation > 10’Yes if No ft 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 If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft F. ENGINEER’S COMMENTS G. ENGINEER’S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 11/5/21 ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔