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FOREST VIEW HEIGHTS LT 17
Forest View Heights Lot 17 #014-141-24 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP 211250 PID Number: 014 141 24 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑t Upgrade Name KEVIN PETERS ABSORPTION FIELD X Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 7241 LEWIS PLACE El Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 0.8 GPD/SF 10.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3 Ft. Gravel depth beneath pipe 7.5 Ft. Subdivision Block Lot FOREST VIEW HEIGHTS LOT 17 Fill added above original grade 0.6 Ft. Gravel length 55 Ft. Township Range Section Gravel width 2 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 8255 Ft;? 1 -Ft. Well 100 +100 +100 - +25 TANK ❑ Septic 9 S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1500 Gal. Surface Water +100 +100 +100 — Material Number of compartments Lot Line +10 +10 +10 NA PLASTIC 2 Foundation +10 +10 +10 _ LIFT STATION Manufacturer Capacity Remarks FREE DRAINING SANDY MATERIAL NOT ENCOUNTERED O REN CO 1 500 Gal. WITHIN FOOTPRINT OF LEACHFIELD. SIEVE NOT PERFORMED Alarm location HOUSE Electrical installed by Installer PIPE MATERIAL House to tank 3034Tank to 2665 drainfield NORTHERN EXCAVATION Drainfield 2665 CO/MT 3034 Inspector C.BALZARINI / M.BALZARINI BENCH MARK (Assumed elevation) 100 ft Inspdection 15` 8/26 8/30 nd Location and description 2 3b 8/31 4th BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp tl OF A`:9sil�� Conditional Approval: Date law'�� ,.. ... .��..rr . Septic S em >— ZrHARLES G BALZARIKf % Approved Date ©�� 2� ���is •. CE -13854 •��`�r 9/27/21. , . ,� Note: this approval does not include well permit requirements. lilF�PROFE5S10NP44 kr-,(--V UU/UG/ 16) LEGEND Q CLEANOUT \ MONITOR TUBE \ �'� 7QO, DRIVEWAY Nil s A 8 ' 45.6 30 46.3 :30.91. 48.5 34.2 ....51.1 38.3.,:i 51.7 '52.8 67.S :52.3 54.3 30 +100.0' BTM SIDING 02.2 �-102.1 FILTER FABRIC x102.7 8.2' COVER ( j- I I ( I COVER 1500 GAL POLY TANK SCHEMATIC PROFILE VIEW SHOWS ELEVATIONS OF INSPECTED ELEMENTS BUT DOES NOT DEPICT SYSTEM IN ITS ENTIRETY. INSPECTION FOR GENERAL CONFORMANCE TO DESIGN AND MOA REQUIREMENTS ONLY. DISTRIBUTION PII T EFFECTIVE SEWER °F A/.kk ®: 49 THt . . .. .. Nr • • t;HARLES G BALZARINI ��00,;q ��F06, CE -13854 . •��`�� `Plcc�FO , 0a�21 X221,, -q .� ��,'_ PROFESSIONP .� LONG DEEP TRENCH 'EFFECTIVE WCK. SCALE: 1" = 20' TUBE rJNJ6Ht1) TESTHOLE 1 GRADE 102.1 102.1 ORIG. GRADE X99.1 INVERT •91.6 NO GWT (5/27/05) (ELLIS TESTHOLE) 80.6 NTS C&M ENGINEERING SERVICES 907-854-5558 LEGAL DESCRIPTION: FOREST VIEW HEIGHTS LOT 17 OWNER:PETERS DATE: 9/22/21 REV: 0 1 DRAWN: CB REF: SITE PLAN W U g CL w J 40 r Existing Welts CD S89058'30" E 133.58' �1 o C h J y � y o a oy� ooh ooCo 0 maw 03 eco 0 a> !z 2u "a `o 2u = m v a� w E 0 U 4 � m a Qt c � 0 3 w N y @ y yaws Q m hQ ti QQZ Ua� 20 m I -Z LU ti �Q W W TO W dCZ) °w maw �' Z p�LuW Z� OO= wzti CO Z O Q Ix LUti� O WWW oo LU f �g � U ul coLLJ Z�2 o C) c��V�O OLutiL� WZZ� U�cWi�vj U iV co i- W U W U a) CO M J U Q N WOO) WN- O � Z N O � 2 O N 10 h �+ro W3 aj co Q J oo� �3 !h 0 A N N t � V Z O LL Uj co 0 U iV co i- W U W U a) CO M J U Q N WOO) WN- O � Z 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: OSP211250 Work Type: Septic Upgrade Tax Code Number: 01414124000 Site Legal Address: FOREST VIEW HEIGHTS LT 17 G:2134 Site Mailing Address: 7241 LEWIS PL, Anchorage Owner: PETERS SARAH & KEVIN Design Engineer: C&M ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: cn1 I v. DeI)artniont 7/21/2021 7/21/2022 8349 Q 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 Special Provisions: A sieve analysis is required near the Northwest section of the proposed field. Submit results with the As -built Inspection Report. If the results require a design change, construction of the system will stop pending On -Site review and approval. Received By: Date: Issued By: Date: Z, l 2 n Municipality of Anchorage �� s \C�i/ Ur. �;rrmenc P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV211050 COSA#: Permit#:OSP211250 PID#: 014-141-24 Legal Description: FOREST VIEW HEIGHTS LT 17 Engineer: C&M Engineering Your request for a waiver of the required 15 feet horizontal separation from the absorption field to absorption field has been approved. The approved separation distance is 1 foot. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. is ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ e ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ e ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ 1 Waiver is Granted: X Waiver is not Granted: Date: ( Z ( Approved by: Name Z x M x . e� **** VARIAN C E/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE O • Development Services Department ` " T Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 014 141 24 Property owner(s) PETERS Mailing address Site address 7241 LEWIS Day phone Legal description (Sub'd., Block & Lot) FOREST VIEW HTS LT 17 Legal description (Township, Range & Section) Lot Size 8349 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) ❑ (w/wo ADU) Septic Tank 0 Upgrade ❑ ❑ (D) Holding Tank Renewal ❑ El Renewal Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: none Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. C&M ENGINEERING (Signature of property owner or authorized agent) Permit/Rush Feesl 95 f--#36 % Date of Payment: ?�/ I Receipt Number: 6-0 Permit No. 0510?,/ 2 50 Waiver Fees: 4 2. �J__ Date of Payment: Receipt Number: Waiver No. 05 GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System for FOREST VIEW HEIGHTS LOT 17 Dear Reviewer, The above referenced property is currently served by an older failing and undersized septic system. The owner wishes to install a new 4-bedroom septic system. Our review of available documentation and field investigation show that this project will not adversely impact any nearby Wells, Wastewater disposal systems, replacement disposal sites, or drainage flowing onto and off of the subject property. A testhole was excavated to verify soil conditions. The historic Ellis test hole is used to satisfy depth to impermeable and groundwater requirements. We encountered differing soil conditions than those identified in the Ellis testhole. If free draining sands are encountered we have the equipment to conduct a sieve analysis. If soils do not appear to be free draining, we will consult with the moa inspector and may perform an additional percolation test. If soils are found to be too free draining and not in compliance with MOA sand requirements, we will stop work and consult with the MOA on an appropriate solution. We are requesting a waiver between the existing pit and the new field. The extents of sewer rock placed for the pit are unknown. We are requesting the distance from the end wall of the trench to the pit be approved for 1-foot based on the below points. • If excavation of the trench reveals soil staining or effluent, we will stop work and consult with the MOA. We expect that some contaminated material will be removed and replaced with moa sand or other suitable material. • The exact dimensions of the pit system are unknown, however we did not encounter it when we excavated the testhole. The new septic will likely communicate effluent with the existing pit. Although the existing pit is not able to pass an adequacy test, it will still absorb a portion of effluent. We believe the volume of effluent potentially communicated to and disposed by the pit will be greater than the volume of effluent disposed of by the area of the field which may encroach on the pit. Additionally due to the depth of the pit, the trench system is able to disperse effluent through the sidewalls at an elevation above the pit inlet invert. The pit inlet pipe invert is at a depth of approximately 9.5’ below grade and the new trench is slightly uphill from the pit. • The pit was approved by the MOA in c.2005 with appropriate documentation. Based on the submitted soil log and documentation, there is no apparent impact by impermeable layers or groundwater related to effluent that may be communicated through the pit. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211250, Deb Wockenfuss, 07/21/21 Included with this letter is a permit application and design package, including plans, specifications, calculations. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini@gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE 7/9/21 Residence: number of bedrooms 4 br Water usage/bedroom 150 gpd/br Water Usage 600 gpd system type: CONVENTIONAL type: DEEP Application Rate 0.8 gpd/sqft required absorption area 750 sqft trench width (W) 3 ft gravel depth (D) 7.5 ft below distribution pipe Min Required Length: 50 ft Max ex depth 10.5 ft Calc By: CGB Date: 7/19/2021 C&M ENGINEERING SERVICES 907-854-5558 Septic Design Calculations FOREST VIEW LOT 17 RESIDENCE/LOT INFO DRAINFIELD **DIMENSIONS FOR REFERENCE ONLY. SEE PLANS FOR DIMENSTIONS TO BE USED IN CONSTRUCTION** Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211250, Deb Wockenfuss, 07/21/21 EXISTING WELL 4 BR HOME DRIVEWAY 10 0 ' W E L L R A D I U S DOUBLE CLEANOUTS DEMOLISH OLD TANK PER MOA REQUIREMENTS 5% FOREST VIEW HEIGHTS LOT 17 FOREST VIEW HEIGHTS LOT 16 FOREST VIEW HEIGHTS LOT 18 100' NEIGHBORING WELL RADIUS FOREST VIEW HEIGHTS LOT 4 (NO WELL OR SEPTIC) FOREST VIEW HEIGHTS LOT 3 (NO WELL OR SEPTIC) FOREST VIEW HEIGHTS LOT 5LEWIS PLACEFUTURE 4 BR RESERVE SITE REQUIRES USE OF AWWTS TESTHOLE (C&M) 1' CONTOUR DOWN-SLOPE FILL IN PIT WITH SEWER ROCK NEW 1500 GAL POLY TANK "MOA EFFLUENT LIFT" W/INSULATED RISERS SEPTIC AREA 25.4' 24.6'10' UTILITY EASEMENT55 FOOT LONG DEEP TRENCH WITH 7.5' EFFECTIVE SEWER ROCK. MAX EX DEPTH 10.5' FT 1.25" DIST PIPE W/ 1/8" HOLES AT 2' O.C. 1.25" PIPE 100' NEIGHBORING WELL RADIUS (LOT 5) 10' 10.0' 5.0' CONTRACTOR MUST SURVEY EXACT 100' WELL RADII 14.6' APPROX LOCATION OF ELLIS TESTHOE C&M ENGINEERING SERVICES 907-854-5558 SITE PLAN LEGAL DESCRIPTION: FOREST RIVER HTS LOT 17 OWNER:PETERS DATE: 6/10/21 REV: 0 DRAWN: CB REF: SCALE: 1" = 30' CHARLES G BALZARINI CE-13854R EGISTEREDPROFESSIONAL ENGINEERLEGEND CLEANOUT MONITOR TUBE NOTE: THE PROPOSED SEPTIC SYSTEM MUST BE INSTALLED GREATER THAN: 100' FROM ANY PRIVATE WELLS 200' FROM ANY PUBLIC WELLS 100' FROM ANY SURFACE WATER 5' TO ANY TEST HOLES 10' TO THE HOUSE FOUNDATION 7/9/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211250, Deb Wockenfuss, 07/21/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211250, Deb Wockenfuss, 07/21/21 Municipality of Anchorage ` Development Services Department Building Safety Division OnSfte Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.d.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWO50162 PID Number. 014-141-24 Nam. June Macon Wastewater System: ❑ New 0 Upgrade Aaarsat, 7241 Lewis PI., Anchorage ABSORPTION FIELD Phone Nu bet N Sedroon a ,3 O DrV Tena 0 ShNbwTr«ch ❑ Baa ❑Mm d pom.r LEGAL DESCRIPTION Sot, R." 1.2 Tetal Depth hom ongwW Feet, GpFr' a 15.45 Ft. Bbch _ Lal 17 aWm.cn. Forest View Heights ot,prn b pa» Dettom ham Onprl prat,• G,dean a henrM p.pe 9.3 Fr 6.1 Ft Tp nsnD Range Saaorc FII Wiled ahwe wg,.W greet, Gs" Lonp 0.3 FL NA FI. Well: []New❑U rade P9 ° 4' diameter Nulnher CO lra Dee ca hetreen am Ft NA NA Ft CIaud"hon (Pmate. A B. CI Tool Dept- Caaee b TNN anaa,ha, wee P" Paw Metarml Ft. FL 375' Fe D3034 Dnbr Data onsee StaowNet Lt,vN InstaIW; Denali (for tank) Dt,M lnNalbd soros Ft Y� Pump seta Cearo Neghl Am» Gr TANK GPM FL FL SEPARATION DISTANCES Aseptic ❑Holding ❑S.T.E.P. ❑Other. To Septic Adsorption LIR Holding ubrirlPdvate hra ap11Of won From Tank Field Station Tank sewer Line Anchorage Tank & Welding 1250' Gal Wer 101.3 106 NA NA 65 Ma�.l 10 ga. steel Nu 2 et carnp'enana � ft-w— 100+ 100+ NA NA LIFT STATION Let Lm 18 20 NA NA a NA na xlul.r. Gal Fauee.lcn 30 40 NA NA Yum, an' b al 'Film,, arr I at Nqn "a" alarm at N F ti curbin Dram NA NA NA NA Purr,, Make a AbeN Elaac lnaps pedar tad by Remade Old tank was abandoned in place. Pre-existing BENCH MARK seepage pit was exposed and documented. Test hole tMuon aril Deenlpllon concrete slab near gas meter dug to confirm soils (log attached). •1250 gal tank mea lcNon Ft 100.00 installed due to availability. Stamp _Engineers Inspections performed by: Cindy W. Ellis, P.E. Dates: 1'r 5/20/05 49TH 2nd 6/7/05— Development Services Department Approval . �_'�-�:: Reviewed and approved by: Date: 12 C dy W. Ellis ;1 (Rer Iwo) CE-10571 ; N 89'58'30" W 133.58' ` TH#1, 5-20-05 �t DC 1 SHE I I t T1 ST2 ST2 DCO2 Existing 1 �� 3BR House — ° SP v L WELL B I I Existing Septic Tank - abandoned ' In place. Forest View Heights, Lot 17 Record Drawing of Septic System June Macon Parcel ID: 014-141-24 Permit No. SWO50162 Cindy W. Ellis, P.E. June 10, 2005 Scale 1 Inch = 30 ft DCOs before & after tank. 1250 gal —DEEP BURIAL septic tank. Pre -Existing Seepage Pit AS -BUILT Watkins Engineering, Inc. P.O. Box 110443 Anchorage, Alaska 99511-0443 Phone: (907) 349-1851, Fax: (907) 349-1934 OF A TH ...................... 'Y W. ELLIS 10577 A B DC01 33.5 52.1 STI 34.6 51.7 ST2 38.0 48.6 DCO2 39.4 48.0 SP 52.0 49.3 AS -BUILT Watkins Engineering, Inc. P.O. Box 110443 Anchorage, Alaska 99511-0443 Phone: (907) 349-1851, Fax: (907) 349-1934 OF A TH ...................... 'Y W. ELLIS 10577 Forest View Heights, Lot 17 Record Drawing of Septic System June Macon Parcel ID: 014-141-24 Permit No. SWO50162 FINAL GRADE = 101.81 d� , �� OF.A t a�P'' "•...�P "' ° `asTH '. �ff l� (. '•• CI Y W. ELLIS gyp`:, •.• i% - 10577.' u > ........ ^= Cindy W. Ellis, P.E. P.O. Box 110443 June 10, 2005 Anchorage, Alaska 99511-0443 No Scale Phone: (907) 349-1851, Fax (907) 349-1934 94.00 1250 GALLON 93.43 DEEP BURIAL (10 ga.) SEPTIC TANK 93.18 N.T.S. FINAL GRADE = 102.63 Top of Seepage Pit 0 93.90 Original grade = 02.33 1 93.02 4 fl diameter Bottom of concrete Seepage Pit Test Hole seepage pit. 86.88 Relative Depth 80.83 No water. AS -BUILT Forest View Heights, Lot 17 Record Drawing of Septic System June Macon Parcel ID: 014-141-24 Permit No. SWO50162 Watkins Engineering, Inc d� , �� OF.A t a�P'' "•...�P "' ° `asTH '. �ff l� (. '•• CI Y W. ELLIS gyp`:, •.• i% - 10577.' u > ........ ^= Cindy W. Ellis, P.E. P.O. Box 110443 June 10, 2005 Anchorage, Alaska 99511-0443 No Scale Phone: (907) 349-1851, Fax (907) 349-1934 1 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Boz 196650 Anchorage, AK 99519-6650 www.munl.orWonsite (907) 3417904 Soils Log - Percolation Test Performed For. June Macon Date Performed: 5/20/2005 Legal Description: Forest View Heights, Lot 17 Township, Range, Section: Depth (Feet) of 0.5 _S'5 5P/ le CSW a�� 9�a✓� Qerc I'g.A 21.s PERCOLATION RATE 91 (minJe✓nee) PERC HOLE DIAMETER 6 �1 TEST RUN BETWEEN 13.0 FT AND 13.5 FT COMMENTS OF SOr1 `or19dUdrd- kd-tIT 54"d WAS GROUND WATER Date ENCOUNTERED? NO Depth to Water S IF YES, ATWHAT DEPTH? — L Depth to water after o Monitoring? None E Date: 5/27/05 `-9 Reading Date Gross Time Net Time Depth to Water Net Drop 1 67/05 1:20 1 6-0 6 2 1:21 1 6-0 6 3 1:22 1 6-0 6 4 1:23 1 6-0 6 5 1:24 1 6-0 6 6 1:25 1 6-0 6 PERFORMED BY: Cindy W. Ellis. P.E. I 24. W&& CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI S IN EFFECT ON THIS DATE. DATE: � Ari a - MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 6 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SWO50162 Legal Description: FOREST VIEW HEIGHTS LT 17 Design Engineer: 0844 Watkins Engineering, Inc Owner Name: JUNE MACON Owner Address: 7241 LEWIS PLACE ANCHORAGE. AK 99507 - Date Issued: Jun 03, 2005 Expiration Date: Jun 03, 2006 Parcel ID: 014-141-24 Site Address: 007241 LEWIS PL Lot Size: 8349 SO. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit Is for the construction of: Q✓ Disposal Field Z✓ Septic Tank Holding Tank [] Privy Private Well Water Storage 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 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 provisions. THE EXISTING SEEPAGE PIT NEEDS TO BE DOCUMENTED IN CONJUNCTION WITH THE TANK INSTALLATION. AN AS -BUILT INSPECTION REPORT NEEDS TO BE SUBMITTED FOR BOTH THE SEEPAGE PIT AND TANK. Received By: Date: Issued ByDate: (a 3 -cis 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.muni.org/onsite (907)343-7904 ON-SITE SEWERNVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 014-141-24 Permit Number SW Property owner(s) June Macon Day phone Mailing address (1) 7241 Lewis Place Mailing address (2) Anchorage, AK Zip Code Legal description (Lot, Block & Sub'd.) Forest view His, Lot 17 Legal description (Section, Township & Range) Lot Size 8349 Acre(ED THIS APPLICATION IS FOR: Number of Bedrooms 3 Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade El THIS PROPERTY CONTAINS: Hot Tub ® Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. '.E (Signature of property owneHor authorized agent) Permit Fees: `I(t0.0 Waiver Fees: Date of Payment: LO t ID5 Date of Payment: Receipt Number. Receipt Number. (Rev. 12=) Watkins Engineering, Inc P.0 Box 110443, Anchorage, AK 99511 (907)349-1851 cwellis@gctnet May 31, 2005 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 RE: Forest View Heights, Lot 17 Septic Tank Replacement To Whom It May Concern: Attached please find an application to install a new 1250 gallon deep burial steel septic tank at the referenced 3 bedroom house in Anchorage. A larger tank than needed is proposed due to availability and a minimal difference in cost. The septic system serving this house was installed in 1970 and was undocumented. During the recent inspection of the system, the existing concrete tank was found to have a hole in it at the water line. The existing seepage pit was inspected and found to be adequate. It will be documented with the tank installation, in conjunction with a request for a Health Authority Approval. The proposed septic tank will be installed more than 100 ft from any private well or surface water. 1 am not aware of any potential problems that this installation could cause for adjacent properties' water and wastewater needs. Thank you for consideration of this permit application. If you have any questions or need further information, please call me at 349-1851 or 360-3389 (cell). Yours truly, Cindy J Ellis, P.E. President ------ — - 1n—cTAve---------- 2a ' Buten Flei is I \ 2V Buten tits lots all served T v / by Anchorage Water 2 and Wastewater Utility for sewer and water. y — — 20/ 19 =8\ � I _�o� 1 Proposed Septic Upgrade -Site Plan y� ��' Well servip6 o Lot 20 � F TH CindyW. Ellis, P.E. P.O. Box 110443 c^=".:' "" U • • CIN W. ELLIS ; PU May 31, 2005 Anchorage, AK 99511-0443 : '• 10577 , �u Scale 10 - 100' No documented : ' ••. well or septic V •.. u.eN c5•i o /4 16511/ 5 UNDEVELO D X15 I I I� 6 Forest Yew Heights, Lot 17 Proposed Septic Upgrade -Site Plan Watkins En Engineering, Inc g g' ��' June Macon o ,�P• Parcel ID: 014-141-24 F TH CindyW. Ellis, P.E. P.O. Box 110443 c^=".:' "" U • • CIN W. ELLIS ; PU May 31, 2005 Anchorage, AK 99511-0443 : '• 10577 , �u Scale 10 - 100' Phone: (907) 349-1851 Fax (907) 349-1934 : ' ••. V •.. u.eN c5•i WELL Forest View Heights, Lot 17 Proposed Septic Tank Upgrade June Macon Parcel ID: 014-141-24 Cindy W. Ellis, RE May 31, 2005 Scale 1 Inch = 30 ft \ N 89'58'30" W 133.58' i rN i Septic Tank to be installed at / least 5 R from property line. Proposed 1250 gal DEEP BURIAL septic tank/ DCOs before & � i �aRer tank. #1. � 5-20-05 SHE I No wells within 100 ft of proposed septic system. 1 ISE Existing 3 B I N House / I I w Existing Septic Tank - Existing Seepage Pit to be abandoned ' to be retained. in place. North Lot line and 100 R well radii to be staked by Registered Land Surveyor. Watkins Engineering, Inc. P.O. Box 110443 Anchorage, Alaska 99511-0443 Phone: (907) 349-1851, Fax: (907) 349-1934 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. 014 141 24 1. GENERAL INFORMATION Expiration Date: I —C – 26 zZ Complete legal description FOREST VIEW HEIGHTS LOT 17 Location (site address) 7241 LEWIS Current property owner(s) KEVIN PETERS Day phone Mailing address Real estate agent Day phone 2. TYPE OF DWELLING: Fx] Single Family (w/ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: NONE Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ O Waiver Fee $ Date of Payment a N 2 021 Date of Payment Receipt Number 0 5OryD Receipt Number COSA # OS C 2 11 5'1 (O 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. Name of Firm C&M ENGINEERING Phone 8545558 Address 20182 TULWAR Engineer's Printed Name CHARLES BALZARINI Date 9/18/21 6. DSD SIGNATURE W System #1 Approved for bedrooms CHARLES G BALZARIKI System #2 Approved for bedroomsVIP,. . CE -13854 •.��� Disapproved �i1lF�PROFE5S1oN�?Aw Conditional approval for bedrooms, with the following stipulations: , _Q OF , tENT SESj By: Original Certificate Date: -dd 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 . 1. Legal Description: FOREST VIEW HEIGHTS LOT 17 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled UNK Total depth UNK ft Cased to UNK ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) +12 in. Date of flow test for COSA 5/17/21 Static water level at beginning of test 40 ft. Comments B. TANK DATA Age of tank(s) 0 years Tank type/material SEPTIC PLASTIC Measured operating fluid level in septic tank na ❑ Standpipes/foundation cleanout per record drawing Date of pumping na - new tank D. ABSORPTION FIELD DATA TRENCH Which system tested (date installed) 2021 ❑ ALL standpipes present per record drawing Total measured depth from grade 11.1 ft (max) Measured depth to pipe invert from grade na ft (min) FOR 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 na gallons Comments/Deficiencies: NEW SYSTEM, TESTING NOT REQUIRED COSA Checklist yellow sheet Parcel ID: 014 141 24 Structure served by this system 1 Well production at time of test 3.4 gpm Water storage tank volume na gallons Well disinfected for coliform test? ❑ Yes FOR No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic 1.239 ug/L ❑ Arsenic less than MRL (ND) Collected by C.Balzarini Date of Sample 5/17/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station 0 years Lift station material Comments: NEW LIFT STATION Adequacy test date na Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test na in Water added na gal New depth na in Elapsed time na min Final fluid depth na in Absorption rate na gpd Any rejuvenation treatment (past 12 months) NA If yes, enter date NA 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' ✓l Yes Community Sewer Manhole/Cleanout > 100' ft Q✓ Yes if No ft M Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' ❑✓ Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' 0✓ Yes if No ft Neighboring Absorption Fields > 100' Surface Water > 100'✓Q Animal Containment > 50' M Yes if No ft ft ED Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' MV Yes if No ft M✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q✓ Yes if No ft Surface Water > 100' Q✓ Yes if No ft Property Line > 5' ✓v Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ✓V Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Main > 10'✓Q Yes if No ft Community Wells > 200' 0✓ Yes if No ft Water Service Line > 10' 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' ✓l Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓Q Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10'[]✓ Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100'✓Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION / certify that / 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. 9/18/21 COSA Checklist yellow sheet Ano .499 TM �•• CHARLES G BALZARII F' 13854 CE-••`� c 1•)Aw ROFESSIO -. Parcel I.D. 014-141-24 RI Municipality of Anchora�gj SEP 16 On -Site Water and Wastewater Program \� (907)343-7904 s Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Forest View Heights Lot 17 Location (site address) 7241 Lewis Place Current Property owner(s)-_ Mailing address Real Estate Agent 2. TYPE OF DWELLING: © Single Family (wlwo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 ny 4. TYPE OF WATER SUPPLY: ❑ Individual Well X❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Expiration Date: /a - a /- /' Day phone -- - - Day phone TYPE OF WASTEWATER DISPOSAL: Individual ny Holding Tank ❑ Community ❑ Public Sewer ❑ WaiverNariance request for: N/A Distance: N/A Received by: Date: °I 30/ is COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ �J Date of Payment Receipt Number 036 Jam! G COSA# 05cl6lSz�f Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF'fECTION 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 Gayness Engineering Group, Ltd. (GEG) Phone (907) 337-6179 Address 3701 E. Tudor Road, Suite 101, Anchorage AK, 99507-1259 Engineer's Printed Name .Jeffrey A. Garness 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 systemis on the datels 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 on 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 systems. 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. The content of this report is for the sole benefit of the personlparty who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the personlparty who paid for this report. 6. DSD SIGNATURE Je�System #1 Approved for bedrooms go System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: �`�iittuurfrr((�, Sv \jY,q 6y OF,I,�� Qw do ON-SITE WATER AND WASTEWATER PROGRAM mss` �SERVO�� The M&fciptfroVr&o—rage 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA bale sheer e -1-12.d. If more than 1 septic system Is on the lot: COSA Checklist # _of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: FOREST VIEW HEIGHTS; L17 Parcel ID: 014-141-24 A. WELL DATA *PER GEG INSPECTION **89 FEET DEEP PER CINDY ELLIS, P.E. 6/10/05 Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) NO Date completed 1970(?) Sanitary seal (Y/N) YES Wires properly protected (YIN) YES Total depth *81+ ft. Cased to **89 ft. Casing height (above ground) 12+ in. FROM WELL LOG Date of test OG Static water level LL ft. Well production 9.p•m- WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: Iuoug./L. Nitrate /sO mg./L. Date of sample: 9 /3 /2015 AT INSPECTION 9/3/15 48 ft. 2.2+ — 9 -p.m - Collected by: GEG. %ttd, B. SEPTIC/HOLDING TANK DATA *DOUBLE C/O'S BEFORE TANK Tank Type/Material SEPTIC/STEEL Date installed 6/7/2005 Tank size 1250 gal Number of Compartments 2 Foundation cleanout (Y/N) *NO Depression over tank (Y/N) liP. Date of pumping L3 e, Pumper %�kC' f7ona C. ABSORPTION FIELID DATA BELOW EXISTING GRAD Cleanouts (Y/N) YES water alarm (Y/N) N/A **HAA APPROVED IN 2005 Date installedt97_ 0 Soil rating.p.d. orft'/bdrm)1.2 System type SEEPAGE PIT Length **UNK ft. ` 1 Width **UNK ft. Gravel below pipe 6.1 ft. Total depth*15.5ft. Eff.,absorption area**UNK fe Monitoring tube YES Depression over field NO Date of adequacy test ;9,/3/2d15 -Results (Pass/Fail) PASS For E bedrooms Fluid depth in absorption field before test 7 in. Water added 485 gal. New depth 7 in. Elapsed Time: 0 min. Final fluid depth 7 in. Absorption rate a= 450+ g.p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date – A zoJ0o _ Ga'tL'4, s pnr sa,s.tc. c.-�,.s ieXLF-P 6b0 ops qlz//�r D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at - in. "Pump ofP' leve High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manurstanimal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ - Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line * 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *ASSUMED— DIMENSIONS OF SEEPAGE PIT ARE UNKNOWN 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 of ed on this date. Engineer's PrintedNameJEFFREY A. GARNESS Date ql{ & / r+! (Rev. 11/05) PRWOM ROM) AMR nwr �A« I �s 30' 133.58' 589° 58'30"E W U GRAVEL DRIVE £ �[ LU zN •:E C:O. k w (D�L 39.8' . Ito I � I 133.58' S890 58'39'E 0 v 1 16 UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCIION OR FOR ESTABLISHING BOUNDARY OR PENCE LINES, TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY. ONLY FOR THE COST OF THE SURVEY. THE SURVEYOR LISTED DISTANCES PREVAIL OVER SCALING, REPRODUCTION MAY CAUSE ERRORS INSCALE. LOT VAWY SURVEY TYPE SYIAa LS ASPJiALT /OUtGiAT1ON AS -BUILT CI f WAL S R GT N2E AS -OXT + SET RESAR DRAGE 0 FOUND RE$Aft .g_g—g yKi00 FENCE CONCRETE PLOT PUN ... As-SUILT ... LOT 9 VEY ... TOPOGRAPHY t�..�•a' �.:I 000. ASSUMED ELEV.-I{--R4--IF METAL FENCE tLLiG! MOD DECK AS–BOLT', , . No MM WT rl RMMMCATM As-&UlLT .. NO WN813 SE PLOT PLANS & LOT SURVEYS NOTE: IT THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION. TO VERIFY PROPOSED BUILDING GRADE RELATIVE ONLY THOSE. IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE SHOMIN, FENCES, WELLS, SEPTIC CLEANO.3TS, SIDEWALKS, DRIVEWAYS, TO FiNWFD GRADE A14D UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS ETC„ ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. Prepared by SURVEY CER'nnCAilON `�*y,�;yx%%4 Robert E. Jahns, Jr. & Assoc. LOT LAN PLOT PLAN r�(+ Professional Land Surveyors a met I Twee oti>+N�Y> a+a w tat em.. ena erae.e Awgh .w met 3 •c a 1_r 1700 Brink Drive. law ravne a wrµwnse.a a r me lee mange $ , � ANCHORAGE, ALASKA 91504 - #ieM06} aw armee. N bow GVA M ba MQ 6YYW. �� BC9Ie: Ree. Lot S.F. Rao, Plot Fie No.AF MOMN , 49 ; 30' Dote sur pa: 09/02115 Drawn 0)'.REJ Gnecxed bSMK FOUNDATION AS–BUILTa : flinaaem m mp w Nwt a a. ,. a. ROB E. J JR 91"""anin° Hlanws� °` Pew r Grid: W:O. c JA Dote Drown: 09/03115 2134 15-353 e oa°AV 4�1 _� r�� DescrlptiOn: -p Lo1 FINAL STRUCTURE AS -BUILT_ m'`;. ,+ i=Legal +�#j�� aLIVJF a a s Ae �'rafOesiond 7 FOREST VIEW HEIGHTS .• 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.muni.orglonsite (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 014-141-24 1. GENERAL INFORMATION HAA # 0;:� q Expiration Date: 9_16 -09 - Complete f6-0S Complete legal description Forest View Heights, Lot 17 Location (site address or directions) 7241 Lewis Place, Anchorage, AK g95D-4- Current Property owner(s) June Macon Day phone Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 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. 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. (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 verity 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 Watkins Engineering, Inc. Phone 349-1851 Address P.O. Box 110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis Date 6,16-05- 6. -16-OS 5. DSD SIGNATURE 1 '-. Cir(fy W. EIAs Approved for bedrooms. 3N '•.. CE - rosn �..• Disapproved. ....... ss iir....... w � Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: C-16 — O 5� (Rw. 011M Municipality of Anchorage ' Development Services Department Building Safety Division On-Sne Water 6 Wastewater Program 4700 South Bragaw St. P.O. Box 196850 Anchorage, AK 99519-6850 www.muni.orgbnsits (907) 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Forest View Heights, Lot 17 Parcel ID: 014-141-24 A. WELL DATA wen type P Date completed tam Total depth 99+ ft. Date of test If A, B, or C provide PWSID S — Well Log (Y".N Sanitary seal (Y/N) Y Wires property protected (Y/N) Y Cased to 89+ ft. Casing height (above ground) 12 in. FROM WELL LOG NA Static water level NA n. Well production NA 9•p•m- WATER SAMPLFr RESULTS: �/ f l �q 11,5 AT INSPECTION 2/8105• 53 3.1 Coliform o colonles/100 ml. Nitrate <0.01 m9A. Arsenic: NA mg./I. Date of sample: ,, 05l5�'Q 6 B. SEPTIC/HOLDING TANK DATA Tank Type/Material steel UPW tank -10 gauge Tank size 1250 gal. Number of Compartments 2 ft. S-IQ-b� Other bacteria 0 oolonies/100 ml. Collected by: Gerrbss EngrJ WaWns Engr Date installed 8/7105 Cleanouts (Y/N) 4 Foundation deanout (YM) DCO Depression over tank (YM) N High water alarm (YM) NA Date of pumping NA - new Pumper NA C. ABSORPTION FIELD DATA Date Installed 1970 Son rating (g.p.dAf or fetbdrm) 1_2 System type seepage pit Length NA ft. Width 4' diameter ft. Gravel below pipe ht: 6.1 ft. Total depth 15.75 ft. Eft. absorption area 375' a Monftodng tuba Y Depression over field N Date of adequacy test 6110/05 Results (PasslFaiq PASS For 3 bedrooms Fluid depth In absorption eld before test 0 In. Water added /ros gal. New depth 28 in. ��1.7�� Elapsed Tkne: 80 min. Final fluid epth 24 in. Absorption rete >- 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (YM 6 type) No If yes, give date D. LIFT STATION Date Installed NA 'Pump on' level at _ In. Datum Size in gallons `Pump ofr level at _ In. Cycles tested Manhole/Access (YM) _ High water alar level at Meeh alarm & circuit requirements? in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/Qft station on lot 101.3 On adjacent lots 100+ Absorption field on lot 108 On adjacent lots 100• Public sewer main 100* Public sewer manhole/deanoul 100+ Sewer /septic service line 65 Holding tank NA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 30 Property line 18 Absorption field 20 Water main 100+ Water service line 60+ Surface water 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 20 Building foundation 40 Water main 100+ Water Service line 80+ Surface water 100+ Driveway, parkingHehide storage 50+ Curtain drain NA Wells on adjacent kits 100+ F. COMMENTS 'Well flow lest conducted by Jeff Gamess, P.E. Seepage ph exposed b documented on 5120/05. Test hole confirmed soils. G. ENGINEER'S CERTIFICATION I cer* that I have detemlined Mrough fled inspections and ` review of Municipal records that the above systems are in * 9 TH conformance veldt MOA HAA guidelines in effect on dus date. Engineer's Printed Name Cindy W. Ellis "ry (D-lD-oS Cin y W Ellis Date ., CE -los" HAA Fee Date of Payment Receipt Number. (Rev. 12/01) Waiver Fee $ _ Date of Payment Receipt Number. 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