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HomeMy WebLinkAboutSOUTHFORK NORTH BLK 6 LT 1outhfork North Block 6 Lot 1 #078 - 021 - 18 Municipality of Anchorage Page , of Lt DEPARTMENT OF HEALTH AND HUMAN SERVICES FOn-Site ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 Wastewater Disposal System and/or Well Inspection Report Permit Number: S( -W T66g>4 4 PID Number: t3 38 _ 02 —//1? Name: M.T2. Wastewater System: W New ❑ Upgrade Address: ABSORPTION FIELD Phone: N (o o. of Bedrooms: S 6Z— [j / v ❑Deep Trench Shallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: C) • 0- GPD/S. Ft. 3 a Lot: Block: Subdivision: - Depth to pipe bottom from original grade: Gravel depth beneath pipe 6 Ftlre z o Ft. / ! Ft. Township: Range: Section: Fill added above original grade: Gravel length: Ft. /00 Ft. WELL: `P New ❑ Upgrade Gravel width: Number of lines: Distance between lines: S Ft. L Ft. Classification (Private, A,B,C): �[2 -r-E, Total Depth:. (0 To: 61 Total absorption area: Pipe material: / ( O 2 Ft. Ft. .S �S SQ. Ft. P&I0 30 Driller: &Y LL I Date Or 11d: -/C(!j$g Static Water Level: 2 t Installer: Date instaed: L)AA-) Ft. Olt ,;� Yield: I Pump Set at: Casing Height Above Ground: TANK GPM Ft. ,3 Ft. SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines lC)Cio Well Material: Number of Compartments: Surfac Watee /�� Int LIFT STATION Lot /O Size in gallons: Manufacturer: Line�?� Foundation + "Pump on" level at: "PumAe t: High water alarm at: Curtain ,(. Pump Mak odel Electrical Inspections performed by: Drain Remarks: I- �� BENCH MARK Location and Description: :,s_9 — 9 D l ZIA-10 m Mo R F- S LA - Assumed Elevation: //2-:2: ENGINEER'S SEAL r ��.sl' S � i" � 4 • ���i ( y� • \ �i•Aas� 0 44gh �!� fie' Inspections performed by: o -U9:1 _Dates: lst W/61 2d �M�� wrb..IYNMNMOTwq. , 2nd 5f/S_1 �i?S �..,,,..,..,.... Steven R. Pannone Department of Health and Human Services approval ' CE - 8149 Reviewed and approved by: /G '/��L�- C Date: PE 1713 .L'V W (rtev. wwq MVH Co V PERMIT,NO, SW980094 THE PARK IS UNDEVELOPE THERE ARE NO WELLS OR SEPTICS WITHIN 200' OF THE PROPOSED SYSTEM AS -BUILT WASTEWATER ABS❑RPTI❑N S LOT 1, BLOCK 6 S❑UTHF❑RK C❑ A B T1 26.7 36.2 .5 T2 31.8 39.7 DC 34,8 42,0 FS 45.0 50.8 Cl 77.8 91,8 Ml 76.8 91.0 C2 53,4 39.3 M2 51.2 37.2 NEW 10008 �R SEPTIC TANK v V - G r.7 i 10 S 1 i TIS :,.::_1 I C,\Work\1-6SOUTH,DWG -: 49TH WELL TP SEPTIC SY". OOLFxl'EFF LOT 1, FLOCK 6 ten N. rannone,s Mr, Larry Severson No. CE 8149 ��,= P.O. Box 771935 ,(tP_3010 .•° Eagle River, AK 99577-1935 z• ........... „�. �� (907) 562-6418 3 HR 3 P.I,D, NO, 478-02-118 SHEET 2/* LOT 3 IS UNDEVELOPED THERE ARE NO WELLS OR SEPTICS WITHIN 200' OF THE PROPOSED SYSTEM DESIGNi Perc Ratei 8 Min/Inch Sall Ratingi 0.8 gpd/sf 3 B,R, 536 SF Required Deep Trench V Effective, 5' WIde,RF=,87 3' Total Depth, 100' Long 575 SF Total PANN❑NE ENG. SVC P. ❑, BOX 142025 ANCHORAGE, ALASKA 99514 272-8218 aTE, 10-10-98 AS -BUILT PERMIT NO, SW980094 AS -BUILT DETAILS P.I.D. NO. 078-02-118 WASTEWATER ABS❑RPTI❑N SYSTEM SHEET 3/4 LOT 1, BLOCK 6 S❑UTHF❑RK S/D 1nONV313 0 0 !3J C) J LQ E:l m z ED fy LLI LdW J w W 0 4 Lr5 m lnC3NV313 3 05f OD 1n[INV313 m Na i> p L�7 J 1nONV313 z O F m e oD• u cU N I 1nONV313 W o W ff z�v, Ln ���`, ■',,,�� m Nona°°ay o- 0 49h3� ........................... ......r....../ Cl\Work\1-6SOUTH•DWG i PREPARED F❑R1 PANN❑NE ENG. SVC. :Steven R. Pannone; i No. CE 8149 ' \ i Mr, Larry Severson P. ❑. BOX 142025 1 .,,`Zelotc).•.* P.D. Box 771935 ANCHORAGE, ALASKA 99514 I�♦ ............ • .��� Eagle River, AK 99577-1935 274-0308, 272-8218 FAX ,& -.6� (907) 562-6418 DATE 10-10-98 • CF' e������� N❑T TO SCALE AS—BUILT 1nONV313 0 0 m o a a �3 !i fft lj -C U j U N !# LJ IIN3 H3V3 6 ., +— 3Hnl N01INOW - p)•-' C 9 f J� o3 o aL y u` d 11 tl s U i spy a 1nONV313 0 0 !3J C) J LQ E:l m z ED fy LLI LdW J w W 0 4 Lr5 m lnC3NV313 3 05f OD 1n[INV313 m Na i> p L�7 J 1nONV313 z O F m e oD• u cU N I 1nONV313 W o W ff z�v, Ln ���`, ■',,,�� m Nona°°ay o- 0 49h3� ........................... ......r....../ Cl\Work\1-6SOUTH•DWG i PREPARED F❑R1 PANN❑NE ENG. SVC. :Steven R. Pannone; i No. CE 8149 ' \ i Mr, Larry Severson P. ❑. BOX 142025 1 .,,`Zelotc).•.* P.D. Box 771935 ANCHORAGE, ALASKA 99514 I�♦ ............ • .��� Eagle River, AK 99577-1935 274-0308, 272-8218 FAX ,& -.6� (907) 562-6418 DATE 10-10-98 • CF' e������� N❑T TO SCALE AS—BUILT NOV-17-1998 11!32 SEVERSON COUNSELING 907 563 8287 P.01 November 17, 1998 Jim Cross Municipality of Anchorage Department of Health and Human Services As an owner -builder on lot 1 Block b Southfork North, I have installed my septic system. I hired an engineer (Steve Pannone) to design the system and oversee the the project. He was on site during the course of installation of the system and verified that it was installed according to design. I have had experience in building in the past. I have built seven spec houses plus this is my third owner -builder house. This is the fifth house that has had a septic system installed. Larry J. Severson TOTAL P.01 %t.L.rxtifirb Priffing jL#g by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-21 OWNER OF LAND ADDRESS /'� A`_) /,r} o X 77035' /= LEGAL DESCRIPTION 13 q 7/4 AJU4rtY EyIS' r".u11 :cc. PERMIT NUMBER Date of Issue_ TAX INDENTIFICATION NUMBER Is well located at approved permit location? Q Yes Q No Method of Drilling: ❑ air rotary C1 cable tool Depth of well: F Casing Type S7Fg it Wall Thickness ' inches Diameter 6 / inches, depth feet Liner Type: "') ('ti1 Casing Stickup Above Ground: CA feet Static Water Level (from ground level): feet Pumping level: feet after hrs. pumping gpm Recover Rate: gpm -.30 14112 - Method of Testing: Well Intake Opening Type: n End C] Open Hole Q Screened; Start feet Stopped feet C] Perforations Start feet Stopped feet Grout Type: Volume Depth: from feet, to Pump Intake Depth: Pump Size hp Brand Name Well Disinfected Upon Completion? 4TY�es 0 No Method of Disinfection: OVA0 'l1" , M jO/n Comments: BORE HOLE DATA DEPTH From To 0 (0! 1 00104A APR 14 1999 MuniCipaiity of Anonor uman ®4v ; Driller's Name 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. OCT -26-1998 10:2? SEVERSON COUNSELING 907 563 8287 P.01 Qwrt r fikb P r i rxr by DOC 00. dba SULLI VAN 'NATER WELLS I!O. Bolt 670272, CWUGIAK, ALASKA 59507 • TELEPHONa age -2759 OWNER OF LAND „}- PERMIT NUMBER 4 &a4Xj_Date of TAX INDENTIFICATION NUMBER1�a /r Is well located at approved permit locati0 [J No Method of Drilling, Depth of well: Z' I Casing Type ,S rLzjEi _Wall Thickness r v1 ncnes Diameter _inches, depth_ / feel Liner Type. /0 a ^l f= Casing Stickup Above Ground: feet Static Water Level (from ground level): _ 1 feet Pumping level: feet after _hrs, pumping _gpm Recover Rate: __,?_�gpm Start feet 46 c.J TO,.I i = VOlume I t, 4)1 d 9' Depth: fram_��-feet, Brand Name. 4]LLe D No 0'k � Dee pt, i-leaftPi & t-luman Servioes l�.. IDriilei's Name 011tj AT° cNTION. It is the responsibility of the property owner to submit a copy Of the well 109 to the proper authority, Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation, TOTAL P.01 k�y a� cop, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW980094 DESIGN ENGINEER:STEVEN R. PANNONE OWNER NAME:LARRY & KAREN SEVERSON OWNER ADDRESS:6841 VIBURNUM ANCHORAGE, AK 99507 PARCEL ID:07802118 LEGAL DESCRIPTION: SOUTHFORK NORTH BLOCK 6 LOT 1 LOT SIZE: 106721 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 5/06/98 EXPIRATION DATE: 5/06/99 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: RECEIVED BY: ` ` � y & " DATE: ISSUED BY: 1 ;�� c / DATE: Steven R. Pannone, P.E. P.O. Box 142025 Consulting Engineer Anchorage, Alaska, 99514 (907)272-8218 (907)272-8218 Fax April 15, 1998 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 1 Block 6 Southfork Subdivision Well and Septic Permit Gentlemen: My firm was contacted to investigate the possibility of installing of a new system at the above referenced property. Currently the lot is undeveloped. Two test holes were excavated on March 22, 1998. The soil report and percolation test results are on file with your department. A copy of the soils logs are attached. Ground water was monitored for fourteen days. No ground water was encountered or monitored. No bedrock was encountered in the test hole. The lot is approximately 10 acres in size. Lot I slopes to the northeast at a rate of approximately 10 to 15 percent The proposed installation will be located on the eastern portion of the lot. The proposed location will be greater than 100 feet away from the proposed well serving this property and 25 feet from the water service lines. The surrounding systems are located greater than 200 feet from the proposed installation, the lots to the north, south and east are undeveloped. The proposed installation shall not impact the future development of the surrounding or existing lots. See attached design. The new system will maintain over six feet vertical separation to the bedrock and over four feet vertically to the ground water. If you have any questions about the proposed installation, please contact me at 272-8218 Sincerely, Steven R. Pannone, P.E. Attachments: Q\WORKU-6sothf.001.wpd 3 �> ,r_ ^re 4M. Steven R. Pannone 4 CE -81t_ 'Z PERMIT NO. DESIGN P,LD, NO, WASTEWATER ABS❑RPTI❑N SYSTEM LOT 1 & 2, BLOCK 6 S❑UTHF❑RK S/D SHEET 1/3 Y H a w r r y 2 SEE DETAIL g Lu SHEET 2/3 100' WELL ' ` PROP E RADIUS�/I,PROPOSH HOUSE ...... £� TP 2 i -'TP'A PROPOSED - PRIVATE WELL I Ci\Work\1-6SOUTH.DWG r. 49TH CHUGACH STATE LOT 1, BLOCK 6 SOUTH FORK WEST 0 2, BLOCK 6 PROPOSED PRIVATE 100' WELL RADIUS b•••• • v PREPARED FOR; R. Pannone. Mr. Ray Nabinger 'E 8149 °� � (907) 249-3259 � (907) 249-3249 FAX Mr. Larry Severson (907) 562-6418 DESIGN, Perc Ratei 8 Mln/Inch Soli Rating, 0.8 gpd/sf 3 B.R, 536 SF Required Deep Trench 5' Effective, 2-3' Wide, 8' Total Depth, 60' Long 600 SF Total PANN❑NE ENG, SVC P. ❑. BOX 142025 ANCHORAGE, ALASKA 99514 272-8218 aTEi 3-25-98 DESIGN �ALE� 1 Q0' PERMIT NO. DESIGN WASTEWATER ABS❑RPTI❑N SY LOT 1, BLOCK 6 S❑UTHF❑RK THE PARK IS UNDEVELOPE THERE ARE NO WELLS OR SEPTICS WITHIN 200' OF THE PROPOSED SYSTEM 100' WE RADIUS PROPOSED PRIVATE WELL C,\Work\1-6SOUTH.DWG I PROPOSED HOUSE ............. TP 1 'J c ,.SZJ s LOT 1, BLOCK 6 PREPARED FOR, Mr. Larry Severson (907) 562-6418 PROPOSED HOUSE TP 2 5x— OL ¢� P.I.D. NO, SHEET 2/3 LOT 3 IS UNDEVELOPED THERE ARE NO WELLS OR SEPTICS WITHIN 200' OF THE PROPOSED SYSTEM _ PROPOSED PRIVATE WELL 100' WELL RADIUS x LOT 2, BLOCK 6 ` DESIGN, Perc Rate, 8 Min/Inch Soil Rating, 0.8 gpd/sf 3 B,R. 536 SF Required Deep Trench 5' Effective, 2-3' Wide, 8' Total Depth, 60' Long 600 SF Total PANN❑NE ENG. SVC P, ❑. BOX 142025 ANCHORAGE, ALASKA 99514 272-8218 NTE, 3-25-96 DESIGN ' PERMIT NO. DESIGN DETAILS P.LD, NO. 015-073-33 WASTEWATER ABS❑RPTI❑N SYSTEM LOT 1 & 2, BLOCK 6 S❑UTHE❑RK S/D SHEET 3/3 C3 (U In I 1 I CI\Work\1-6SOUTH.DWG Mr, Ray Nabinger (907) 249-3259 (907) 249-3249 FAX Mr. Larry Severson (907) 562-6418 lni 3Hnl WENON inOi inUNW313 inmum inONV3l0 1nONY3l7 inONW3l3 NouvaNn03 u to w J N L 0 PANN❑NE ENG. SVC. P. ❑. BOX 142025 ANCHORAGE, ALASKA 99514 a7A-nlnQ a7a-Q?)10 I"AV DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: LARRY 5 !>wnV,e;y2SOti/ DATE PERF LEGAL DESCRIPTION: G l sev-nA77Ol/LK Township, Range, Section: DEPTH SLOPE SITE PLAN (FEET) I I I 1—i '1o2 2 3 GTZrAV&C_ `—/ 4 -3o c"D&�nS G -8 "a I'HSA I/q`r PF3A4AAV(9C 5 6 7 SIL TS 8 pVI L- ��o cD cyLS. 9j15�M 10 11 12 13 14 15 16 17 18 19 WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? P E T Depth to Water AltRj Monitoring? NtrZ/4 Dater r Reading Date Gross Time Net Time Depth toCOP Water Net Drop 3/zz y q: 4 0 :7' Z- R:�12 2` tai° 3$ 3/4 315 Q:44 2.. G�� 31 Y 4 5. 4: 11 ?/4 [ a' S 4: S 3 4:S 5 fv`v $ Ws*, Z/41 '3% 20 C2 k ,per IL_ JI PERCOLATION RATE V (minutes/inch) PERC HOLE DIAMETER � � {� S TEST RUN BETWEEN _ FTAND LE FT �l COMMENTS Ct UUAIP✓2l3 sc /-At<(:6 6�,4CkgA f -c=0 S Y—T�>AnJ Tz,�4--AtLS PERFORMED BY:(�; -� NNdN 13 I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ,wrtifteb Prilling I.og by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 OWNER OF LAND 44<g y ^rL` US if ,�J� BORE HOLE DATA ADDRESS LEGAL DESCRIPTION S� ATM F6/Z< /y0kT/3� 6 1- 10 /U? J PERMIT NUMBER oo 71 Date of Issue - TAX INDENTIFICATION NUMBER�a �l Is well located at approved permit locatio es ❑ No Method of Drilling: it rotary C3 cable tool Depth of well: Casing Type iFFL- Wall Thickness o?. inches Diameter inches, depth % feet Liner Type: /0 3r -i L Casing Stickup Above Ground: feet Static Water Level (from ground level): oZ i' feet Pumping level: feet after hrs. pumping gpm Recover Rate: _ . g p m Method of Testing: Q Well Intake Opening Type: I OZ-p_e*�nEncl ❑ Open Hole Q Screened; Start feet Stopped feet Perforations Start feet Stopped feet Grout Type: Volume .1p 4) [ Q S Depth: from r7 feet, to 'J feet Pump Intake Depth: Pump Size hp Brand Name Well Disinfected Upon Completion? tjYe ❑ No Method of Disinfection: C/J%oMm- Comments: b c_ RECEIVED S EP 2 3 1998 r'unic!pal,,,of Anchorage Dent. Health R timan tiaryiees Drillers Name 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. FEB -04-99 17:07 FROVrCTE ENVIRONMENTAL tR 5615301 T-666 P.03/08 F-833 CT&E Environmental Services Inc, Laboratory Division ,, ,trs®��r y �e�rs�vo�r��vrri .ou��.erw.►,vv�rw�+ 200 W. Potter Drive Drinking Water Analysis Report for Total Coliform Bacteria net RZAD LIVSTRUCTIONS ONMVERSE SIDE BL°FORE COLLECTING SRMPLE` ` Fox ❑ PUBLIC WATER SYSTEM I.A. N PRIVATE WATER SYSTEM Q SrnQReaxlrx C1 5e alnavrra :Itt�a�r. urs a. om r GiW . u N AI T rN �- Send K-yrrbs SOM4Invoice ^3 _._.. . Ars /.1^afG 9-sVr A; SAMPLE DATE' Ru t month Daly' Year -a SAMPLE TYPE: o Routine G Reppeat Sample (for routine !w4ple with lab ref. no. ) 0 Special Purpose SAMPLE LOCATION CV a %6a t.t Comtnrnts. Q Treated water Q Untreated Water Time Collated Coilectod By t_ -Cy Pinna mot 8-1606 rA Analysts shows this Water SAMPLE to ba, Satisfactory Unsansfactoty q Sample over 30 hours old, results may be unreliable cl Sumnle too long, to trusts; sample Should not lie over 48 hours old at examittanon to mdioate reliable results. Please send new sample via special elcry matt. Date Received Time Received p Analysis Inas Analytical Method: Membrane Filter q MMD -MUG • Number of colonle.000 ml. Result's Analy,t 990444 E7 � Fhks Sun ❑ iSlrlf Dare. Time. Client notified a' unsatisfactory results: ® Q Phonra Spoke with Faxstt uat� Timc BACTEP1TDLOGICAL WATER ANALYSIS REC®RID MMO-MUG Result: Total Colisarm _ E C°Ii ---- Membrant Filiert Direct Coons Coloniewl0o ml Verification; 1.T5 7.tiTC-Tavnrr .ffl.s ru Count os-a&'BaCrol. Fecal Coliform Confirmation Finai Niembraae Filter Results Coliform/100 ml Reported By - K4=:� Data Z `j ciTime 1 O L) brt; 0 Mw Member of the mato GroupiSosiatt C-Anaeate as SurvoillAnIzO ENVIRONMENTAL FACILITIES IN ALASKA. CALIFORNIA. FLORIDA. ILLINOIS, MARYLAND. MIChtGAN• MISSOURI. NEW aERSEY, OHIO, WEST VIRGINIA FEB -04-99 17:07 FROM -CTE ENVIRONNiATAL I CUE Ref.# Client Name Project Name/# Client sample 11) MairN Ordered By PWSID Cr&E Environmental Services Inc 990444001 Pannone Eug. Srv, Li 136 South Fork N Ouisi4e Fuse Drinlciug water Parameter RcBuLTS Tatar Coliform 0 nitrate -x 0.373 $616301 T-666 P-02/03 F-633 Client PO# Printed DatelTime 02/04/99 1409 Collected Date/Time 02!01199 13:00 Received Date/jIme 02/02/99 10:20 Technical Director: Stephen C. Ede Released By ALlowaMe Prep Analysis POG units 140000 Limits Pave Date Iniv col1100mL SR98 92228 02102/99 KAP 0.100 Mon EPA 300.0 10 man 02/02/99 02102/44 LCL OCT -26-1998 10:27 SEUERSON COUNSELING (;�,� " C�Ertifieh 'xPriMxrg Aing by Doc Ce. aba SULLIVAN WATER WELLS F.O. BOX 67027$, CHUGIAK, ALASKA 99567.71ELEPHONE 608-2759 OWNER OF LAND /jjjfgY C—d g e Ear l ADDRESS LEGAL DESCRIPTION PERMIT NUMBER Date of issue-� TAX INDENTIFICATION NUMBER_QAa Lr� Is well located at approved permit locatlo 0 No Method of Drllllrg: r fotery rj cable tool Depth of well: _ " Casing Type , j iPF�w Wall Thickness #di -t.4 incnes Diameter Inches, depth / feet Liner Type: /LJ J.11 r Casing Stickup Above Ground: -----jest Static Water Level (from ground levet); 1 feet Pumping level. feet after _hrs, pumping gpm Recover Rate: �2�gpm Method of Testing; Well Intake Opening Type: per, End 0 Open Hole Screened; Start feet Stopped feet Perforations Start feet Stopped feet Grout Type: jj gFe.3 "r r1" Volume I IN 1) J_ 6' Depth: from 1:) feet, to "!"..� feet Pump Intake Depth: Pump Size hp Brand Name Well Disinfected Upon Complotlon? ❑ No Method of Disinfection: A ,,j w: ArLI APM Comments: 0,4-rE 4 A ,e- � ��� 9/7 e - -virh�I Ur,�n`nO eyjce� Drillers Name 4.0-2s AT"'dNTION: It is the responsibility of the property owner to submit a copy of the wall log to the proper authority. Municipslity :l Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation, TOTAL F.B1 MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 rR1�j CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLINGI Parcel I.D. # e>_2� —Z% HAA # J I� 1�1 I( 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner GAR-P—`e S ¢VdD0ca A% Day phoneG�' l Mailing address L� OX_ - Lending agency Day phone Mailing address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS, 3 3. TYPE OF WATER SUPPLY: Individual well —- Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 • Municipality of Anchorage _a y On -Site Water and Wastewater Program 10e,41" (907)343-7904 Parcel I.D. 078-021-18 Certificate of On -Site Systems Expiration OCT 0�2,015 1. GENERAL INFORMATION Complete legal description Southfork North, Block 6, Lot 1 Location (site address) 1736 West River Dr. Current Property owner(s) Larry He Karen Severson Day phone Mailing address PO Box 771935 Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual Fx� Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request Received by: d Q�ld' Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ ` 521a Waiver Fee $ Date of Payment to16:A5 Date of Payment Receipt Number ©o 62?:G Receipt Number COSA # S C1575 44 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 - - m is(are) in compliance with all applicable Municipal and State Codes, ordinances, and regulations in effect at the time of installati0 -*�? In conducting an ode aoy est, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and 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'oi the�'bvaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, n4,r do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The Content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE __%Z System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Date 9/29/2015 Steven 1C06ririor e.: -P,•, CE -8149 .�'A Conditional approval for - bedrooms, with the following stipulations: v- Original Certificate Date: /n ti 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 blue sheet 7 , c If more than 1 septic system is on the lot: COSA Checklist # I of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Southfork North, Block 6, Lot 1 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 7/14/1998 Sanitary seal (Y/N) Y Total depth 81 ft. Cased to 81 ft. Parcel ID: 078-021-18 Well Log (Y/N) Y Wires properly protected (YIN) Y Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 3/29/1999 9/24/2015 Static water level 55 ft 0 ft Well production 30 g.p.m. 6.2+ 9 - p.m - WATER SAMPLE RESULTS: Coliform Nitrate �• g mg/L colonies/100 mL Arsenic A) D ug/L Date of sample: 9/24/2015 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Collected by: PES Date installed 8/15/1998 Tank size 1,000 -gal.. Number of Compartments 2— Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YM) N High water alarm (YIN) N Date of pumping 9/17/2015 Pumper JR's Pumping C. ABSORPTION FIELD DATA Date installed 8/15/1998 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 GPD/SF System type Shallow Trench Length 100 ft. Width 5 ft. Gravel below pipe 1 ft. Total depth 4.4 ft. Eff. absorption area 575 ft2 Monitoring tube Y Depression over field N Date of adequacy test 9/24/2015 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 474 gal. New depth 0 in. Elapsed Time: 80 mina" Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Nowt a- Vlyo 7rJ If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level at Datum E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 50+ Manhole/Access (Y/N) in. High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent -lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas .100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON`LOT TO: Property line 10+ Building foundation 10+ Water Service line1 0++ Curtain drain 50+ Surface water 100+ Wells on adjacent lots 100+ F. COMMENTS *Well deepened On 3/29/1999 *Well is artesian and is plugged. G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and reviewof ,Municipal records that the above ,systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 9/29/2015 COSA canary sheet 2-6-15, doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parkingtvehicle storage 10+ to{too r 11m vY 0 X w' � oW C5 �z 1V C7 ffia CJi m A a —i z M tm cSAn m — r o O 0r�r D m m n N n m m �o a< �n aflgKt bpi* Qo �O m m r Q� YM 3yCr rr rrri � C m 51 x O C m G7 It m Or- r am va��"'DptlO N FL 1 rop-raamr'�' rti w. m rn 1..,a m a m a ♦�4aNslh 4� i Gi a o gfb d a s c u r+,.�•',.• lI.,SJ.a 1 2 7 oc"' — dN Q 3r�sNv M�� ��. •F� Yp/�'!1 t" mmm v� U9 cn il a w n y S ?. , '° m a o 00 -- mo m Oa 0 - O::' 3 Pmoroa0ya''a ° '`. YY r 8 m o � nW aromN®mn '4 a w N zi. U Jf