HomeMy WebLinkAboutSOUTHFORK BLK 2 LT 1outhfork
Block 2
Lot 1
#078-021-05
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
Municipality of Anchorage
Community Development Department Page 1 of 2
On-Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite• (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP151373 PID Number: 078-021-05 ❑ New ❑✓ Upgrade
Name:
Sharon Kelly ABSORPTION FIELD
Address ❑ Deep Trench ❑✓ Shallow Trench [' Bed ❑ Mound
1711 South Creek Road [' Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
3 1.2 GPD/SF 5.0 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 1.0 Ft._ 4.0 Ft.
Southfork 2 1 Fill added above original grade Gravel length
Township Range Section 2.5 Ft. 67.0 Ft.
Gravel width Beds: Number of Lines Distance between lines
SEPARATION DISTANCES 5.OFt. N/A N/A Ft.
To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Tank Line 670 Ft2 1 N/A Ft.
Well 114.4 129.7 N/A N/A 25+ TANK ❑Q Septic El S.T.E.P. El Holding El Other
Manufacturer Capacity
Surface Water 100+ 100+ N/A N/A Anchorage Tank 1000Gal.
Material Number of compartments
Lot Line 87.3 57.3 N/A N/A Steel 2
NA
Foundation 42.2 54.2 N/A N/A LIFT STATION
Manufacturer Capacity
Curtain Drain 50+ 50+ N/A N/A Gal.
Pump on level at Pump off level at High water alarm at
Remarks
in. in. in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank 3034 Tank to 3034
Installer drainfield
Dean Construction and Development Drainfield 3034 CO/MT 3034
Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 2015ft
Inspection5, Location and description
dates: 1 5/17 /16 2n° 5/17/16
3f° 8/9/16 4'h 3/13/18 SE Bottom Trim, Point C
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp
Conditional Approval: Date r 4'�OF AL'Q �li,
Ale fel*: 49 TM A.\ '•* I!
• .• •'
I bteven K 'annone
Ale
Oi liE 814
Approved ----,ii,� k---y -J Date L(1 01 1444=4pFE5S� ••
Inspection Report_1-1-12.doc
DESIGN PARAMETERSt t I 11 l
PRIMARY / RESERVE SEPTIC SYSTEM I I WELL \ \ a \ \ l '
NO. BEDROOM: 3 (450 gpd) I 1 • ) \ 1 3
TANK SIZE: 1000g I I / \ \ •
PERC RATE: 1-5 MPI I I I � c i 1 I
SOIL RATING: 1.2 GPD/SF I I 2 1 2020 I
AREA RQD: 375 SF
2025—
AREA �} zolI f /- 2030\ 1
SYS. TYPE: WIDE TRENCH 4.0'ED I ( I 51
MIN LENGTH: 37.5 LF o l 2005 zoio
/ E .
USED: A Or 2000 \ `� R
67 LF X 5.0' WIDE, 4.0' E.D., 5.0' TD 6 I •I II SR\ ` \ '\ \
TOTAL AREA: 670.0 SF 1 ` NOUS '1 1 1.4 \.
I v 1 \ SFD C _ G
� � \
I ( DC01 �`
1990 '1 \ w '4- \
FC
\ 11
\ DECOMMISSIONED 1000G r W-----
I 2�
\ SEPTIC TANK PER MOA CODE` `W \T1 l I \ \
A /
DC DV 11),--,\` INSTALLED NEW 1000G A \
I 1 /is_
I
\\\ \ TSEPTIC TANK C \
M2 ►‘ c1 I \ `\lsssr •0 \ 1 \ITH1 \ \ \ \\56.0 \ \ \ \
../\ •7 * \ \ 1
'-`, V
M1
I \ �" (Ai
\ INSTALLED NEW DRAIN FIELD
C D T2 •7- 1 C2 \\67LF x 5.0'W x 4.0'ED x 5.0'TD
Ti 52.20 46.60 7 �, PROVIDED FILL TO CREATE 3.0'
J \ ` OF COVER
T2 58.40 51.30 0 \ \ 1 INSTALLED MONITOR TUBE AND l
C2 122.30 73.50 • \ \ l CLEAN OUT AT EACH END \
M1 1 15 60 68 i00, / \ `` 4
CO N.
CO
J S '- H ~
Z 1- H < 0
0-� p p D o FILTER FABRIC Cr
az mz a ¢ mz w z 4"0 GRAIN PIPE z w
Dw o J J> DRAIN ROCK 6"ABOVE PIPE INV 0
O.0 OU U U coo
OG/FG 2007.0
I .
4.0
�-/� L_ F.G. 2002.7
2002.4 NEW 1,000g ` 0.0. 2000.0 TN-1
\....
SEPTIC TANK 2002 2 OR -0.5
PROFILE 1999.0 4'SEPTIC ROCK 1999.0
SCALE:NTS NO
GM/ GROUND
I -670 1 SM WATER
OBSERVED
1989.0 5/17/16
BOH
-11.0
NOTES: ,.����AN\, Dote
RECORD DRAWING PANNONE ENG SVC, LLC pF q�ql� 4/2/2018
P.O. BOX 100217 ANCHORAGE, AK 99510 's.•• ..'••.S lo
PHONE (907) 272-8218 FAX (907) 272-8211 eco.. �4i ty## Scale
DRAWN BY: ;17*.-4' 11-1 )� .*
0 1"=50*
ACP 4"" <10r••' ' ' • 0 P.I.D. NO
SOUTHFORK, BLOCK 2, LOT 1 - �� - 1-05
SHARON KELLY r, Steven R. Pannone PERMIT NO.
1711 SOUTH CREEK ROAD ������s. CE 8149...1,4e„ OSP151373
PLAN EAGLE RIVER, AK 99577 �k, �Fjgp-•1 ,\P= � Sheet
2
SGS
SGS Ref.# 1181086001
Client Name Pannone Eng. Srv. Printed Date/Time 03/22/2018 8:26
Project Name/# 1711 South Creek Rd Collected Date/Time 03/20/2018 13:30
Client Sample ID 1711 South Creek Rd Received Date/Time 03/20/2018 16:07
Matrix Drinking Water Technical Director Stephen C.Ede
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic 15.2 * 5.00 ug/L EP200.8 C (<10) 03/21/18 03/21/18 VDL
Waters Department
Total Nitrate/Nitrite-N 0.105 0.100 mg/L SM21 4500NO3-F 13 (<10) 03/21/18 AYC
Microbiology Laboratory
E.Coli Negative I 100mL SM21 922313 A 03/20/18 K.W
Total Coliform Negative I 100mL SM2I 92236 A 03/20/18 K.W
1
i
L--'Cy• r t 4_ ✓- ` • 61(
oS l+�
C-Ti4-6\-° d p°/�
Wt 7P C �l -
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1 ‘14 cc/0/ft_,
ill
F-vot, i ,� G g�fie. Crli . s, kr
C .
C9 vs eyetAk 06-1,1 Cvvie
3 ,,s..i- sC.--e-v4\-u its-cotAeitt-14 fri --..„_ c 6 0-1
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Permit Number:
Tax Code Number:
On -Site Wastewater Disposal System Permit
OSP151373
07802105000
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Work Type: Septic Upgrade
Permit Effective Dates: December 14, 2015 to December 13, 2016
Design Engineer:
Subdivision:
Site Legal Address:
Owner/Address:
Site Mailing Address:
PANNONE ENGINEERING SERVICE
SOUTHFORK
SOUTHFORK BLK 2 LT 1 G:1059
KELLY SHARON R REVOCABLE
LIVING TRUST KELLY SHARON R 1 TRUSTEE 4300 B STREET SUITE 505 ANCHORAGE AK 9
1711 SOUTH CREEK RD, Eagle River
This permit is for the construction of:
Lot Size in Sq Ft: 87311
Total Bedrooms: 3
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By.
MUNICIPALITY 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. 078-021-05
Property owner(s) Sharon Kelly
Mailing address 4300 B Street, Ste. 505, Anchorage, AK 99503
Day phone
Site address 1711 South Creek Road
Legal description (Sub'd., Block & Lot) Southfork, Block 2, Lot 1
Legal description (Township, Range & Section)
Lot Size 87,311 Sq. Ft. Number of Bedrooms
3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field ❑X Initial ❑
Single Family (SF) ❑X
(w/wo ADU)
Septic Tank ❑x Upgrade ❑X
Duplex (D) ❑
Holding Tank ❑ Renewal ❑
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
aoolicaMe-Municioal Codes.
of property owner or
Permit/Rush Fees: 61A . Waiver Fees:
Date of Payment: Date of Payment:
Receipt Number: 3
20)1101 Receipt Number:
Permit No. O5 f [6 1313 Waiver No.
Permit App_.; .:..,:c:
Pannone Engineering ServiceS uc
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steverapanengak.com
November 12, 2015
Subject: Southfork, Block 2, Lot 1
Septic System Upgrade Permit Request
Design Narrative
This is a design narrative for a permit to install an upgrade septic system to be issued for this property.
The proposed systems will serve an existing three bedroom (3) bedroom house. Currently the lot is
developed. This lot and the surrounding lots are served by private wells. The well on this lot is over 100'
from the proposed septic system and the surrounding wells are over 200' from the septic system.
1. Soils. One test hole was performed on this lot by PES in October of 2015, and groundwater was
monitored for at least seven days. Ground water was not observed to a depth of 11.0' below the
surface in the test hole monitor tube after the 7 day monitoring period. Bedrock was not encountered
in the test hole. Based on the results of the percolation tests and overall soils appearance; an
application rate of 0.8 gallons/day/square feet was used for a conventional wastewater system in the
area of the test hole.
2. Soil Absorption System Design.
a. See Sheet 1 of the design package.
3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field.
The proposed deain field upgrade will maintain at least 100 feet from all surface water and drainage
ditches.
4. Topography: The existing topography generally slopes from the northeast to the southwest in the
area surrounding the septic system at approximately 20%. There are no steep slopes within 50' of the
proposed drain field. The proposed drain field will maintain 50' separation all steep slopes.
5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that
the review is complete and that there are no further comments is received from MoA On -Site
Department, the note will be removed and "Issued for Construction' drawings will be issued.
The proposed installation will not affect the future development of this or the surrounding lots.
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
WELL (E)
w '
HOUSE HOUSE
w (E)
Ll
ti N
rII\ \ w
/ o DIVERTER VALVE (P)
x�oelo
/ 51.1=
PRIMARY / RESERVE SEPTIC SYSTEM
NO. BEDROOM: 3 (450 gpd)
TANK SIZE: 1000g
�PERC RATE: 1-5 MPI
SOIL RATING: 1.2 GPD/SF
AREA ROD: 375 SF
SYS. TYPE: WIDE TRENCH 4.0'ED
MIN LENGTH: 37.5 LF
0
o.
2.9
x�OSlo �iP
—\ �Z
W \
VERIFY INTEGRITY OF 1000g SEPTIC TANK (E)
IF FOUND TO BE LEAKING DECOMMISSION PER
CODE AND INSTALL 1000g SEPTIC TANK (P)
WITH DOUBLE CLEAN OUT
�\/�TH1
RESERVE DRAIN FIELD (P)
ry PREF x 5.0'W xEx 5.0'TD
C
PROVIDE FILL TO CREATE
TE 3.0'
OF COVER OVER FINAL GRAVEL
OR INSTALL RIGID INSULATION
INSTALL MONITOR TUBE AND
CLEAN OUT AT EACH END
USE:
60 LF X 5.0' WIDE, 4.0' E.D., 5.O TD -
TOTAL AREA: 600.0 SF 7�7�+ ��++77��77 LLC NOTES: Pt1L`Il`IONE L'1`1G- SVC, LLC
FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211 i
`SOF A y�4 Date
.... Cq� z/3/tots
l*: 49 TH
......
SOUTHFORK, BLOCK 2, LOT 1
SHARON KELLY •Steven R. Pannone
1711 SOUTH CREEK ROAD ��{•, CE. 8149
PLAN EAGLE RIVER, AK 99577
r'=so•
I.Q. NO
DERMIT NO.
OSP151373
Sheet
1 OF 2 li
1
2
3
4
5
6
7
8
9
10
12
13
14
15
16
17
,8
TEST HOLE 1.
OR ORGANICS
13BROWN SILTY
SM SAND AND
GRAVEL
BOH
DATE PERFORMED: 10/29/15
SOILS LOG - PERCOLATION TEST
SLOPE
w
71HOUSE
38R
g (E)
WAS GROUND WATER
ENCOUNTERED? N
IF YES, AT WHAT
DEPTH? DRY
DEPTH TO WATER AFTER
MONITORING? DRY
DATE: 11/11/15
SLOPE
TH
X
READING
CLOCK
DATE TIME
NET TIME
WATER
LEVEL
READING
NET DROP
1
10129/15 2:45
---
2.03
2
2:51:23
6.38 MIN
- 8.03
6.00
3
2:52
--
2.03
--
4
3:00:04
8.07 MIN
8.03
6.00
5
3:01
---
2.03
---
s
j 309:06
8.10 MINI
8.03
1 6.00
PEROLATION RATE 1.4 (minfinch) PERC HOLE DIAMETER 6 inches
TEST RUN BETWEEN 3 FT AND FT _
COMMENTS: Test hole excavated by JR'S SEPTIC. Prec hole was presoaked.
Test run for at least one hour. Last 3 readings reported.
PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
NOTES:
PAMNE
D ADA O1`IL'
P 0 80X 100217
L'1`IG �C�
EN
ANCHORAGE AK
LLC
LLC
99510
.���� \\\
" �F .. `l
"�� • ""' 'qS �
Date
12/3/2015
FOR CONSTRUCTION
PHONE (907) 272-8218 FAX (907) 272-8211 /%rij�p 7 0 Scale
/ *: 49 * /
NTS
.... ... ... .. ... P.I.D. NO
SOUTHFORK, BLOCK 2, LOT 1 -021-05
SHARON KELLY /' Steven'R"Pon'none' j PERMIT No.
S'. CE 8149 \��
1711 SOUTH CREEK ROAD c OSP151373_
SOILS LOG EAGLE RIVER, AK 99577oFESsioNP� Sheet
2 OF 2
72-013 (Rev. 3/78) 0
MUNICIPALITY OF ANCHORAGE
A
DEPARTMENT OF HEALTH & ENVIRONMENTAL_ PROTECTION
ENVIRONMENTAL_ ENGINEERING
DIVISION
825 L Street - Anchorage, Alaska 99501
Telephone 2.64-4729
ON-SITE
SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION
REPORT
...____.-_____..__._...__.__.�—_s.._.____._._.�.�._.
NAME
PHONE
[L}iGEW
,b F4PI
14 11&`C?.(/–
❑ UPGRADE
MAILING ADDRESS
a V?C341
LEGAL DESCRIPTION
LOCATION
N0. OF BEDROOMS
L) Y
DISTANCE TO:
Well �00/
Absorptionr`a
Dwelling ���
PERMIT NO. �zas 6
aQ
Manufacturer^
Material
No, of compartments
wN
C � �
C
y
Liq. capacity in gallons
Inside length
Width
Liquid depth
IF HOMEMADE:
�---:..
O L'
DISTANCE TO:
Well -
Dwelling
PERMIT NO.
J0Z
02<
Manufacturer
Material
Liquid capacity in gallons
Well
Foundatio
Nearest lot line
PERMIT NO.Z f
LU
DISTANCE TO:
�7
j��'' So
� LL Z
No. of lines
Length of each
Total leng h�ines
Trench width /
Distance between lines
F- Z w
aline
^ irre4ees
cc F-
Top of tile to finish grade
f
Material beneath tile
r-�
Total effective absorption area
p
u-• I(A
of ides
Length
Width
Depth
PERMIT NO.
w
Q F•
Type of crib
Crib diameter
Crib depth
Total effective absorption
area
as
LU
LU
Well
Building foundation
Nearest lot line
DISTANCE TO:
CI
Depth
Driller
Dis�t�ancepg lot line
PERMIT O.
wVl
/ [su KvIOLtM�
3
W
DISTANCE TO:
Building foundation
�p„vy�
Sewer line
.�..��Uf
Septic tank
iclG�J�
Absorption areas)
I
OTHER
-/
PIPE MATERIALS
v a3
N
E�
SOI L TEST RATING
17U�
INSTALLER
h
bfAn-
REMARKS
€
d
t7
✓t 6 U fS
S
s
r
I 5
fo
APPROVED
LEGAL
�JtDATTE
"��O .1
72-013 (Rev. 3/78) 0
1-1 U 01 1 KV 1 F" F--! L.- 11. M V U) F7 F��o T-14' IC F-1 Ci E
• O"ML-1 I -ili1X1OMMFITEIFillEEIT QHEIlVRAT&O0N
_'TREET,: 1H1f%K7HORFAGFE; In. :1
14 1"E Ni_...... Q F,"! 1 -A E,> 1Z) Pol :1 "T' EE EEA -1 FR!
(flay I
F'PL_1 C F"I k! T E)ELLICIA EB1.I1A C1ERS F`O 2,�`4 E. R. 9 9!.`5 7'iF
LOCAT 1 ON A
L. E? G A L L.I.B2 SOUTH FORK Se"I" LOT .1E.5iZIE 999999 Scluf-Irl F E E
TYPE! OF 05CII i.... F'1B.`._`MRK* 1 ON SLY,,,.,�;TEIM IS DRAJ,'tF_ I EH.J-D
I
MAXIMUM C)F RATIPIC'i t: a-) FT, --'BR)= 1.40
THEE RERQUIREM SIZE: !:IE..THEE SOI[ ABSORPTION SYSTE"I
E -"E: F:: -T' orq -31. L FE_-_ IT 1-1 mw= Ty NOR R71 Q Q 90 E 0 F"'
THER LEN CITh WMENSI&-1 IS THELEENQT'H I.*11'I FE. -KEIT) OF THE' TREENCH OR DR.',A:U-,tFIF.".LE),
THE DEP] H C)F A TRDICH OR Pfll* THE'.' DI*S'TANCE Br-.:1"i-,iED.-1 -!"HE OF 1'HEi:
GROUNEw ANE) THE BC-,7'TCire1 OF-— THE (.'11`4 FEEM.
THE ORMEA. I)EPTH 11-; THE VI INI11UM DEEPTH OF E`,'ETWEDI TFIIE. OU"TT"ALL PIPE
FINE) THE..". E"501T,01191 Or" !'HE EXCAkJATIC0f 0N FEEM.
WKWU X ! 1_, i ,, i;:"::" I = — - - 'E
F-',ER1111" APPLICANT HAS 'THE: FREES POWS' 1'B iTY TO INFORM ..y. FII:-: "I"HE
OF ANY 14ELLS FII '.1;-I T'O PROPERTY AP -M THE
NUMBEER CAT THE NEW. WILL SERVE.,
1 144 15 V EE7 C.: -T -a_ RD 104 Q 1=1 Fit 1EE W E"7 MG1 LJ
BACKFILLINQ OF Akhr' WITHOUT FINAL. INSPEECTION Airff) APPRO%*11- BY THIS
!_, PARTMEorr- WILL BE: _UBJE:I,".AF To
III -AIP-JOE" F',E`.:TWEE-KN,! A WEL.L. AND AW? ONKSITE S'.",EIWAGE I.E.:
1191i"11"A"! E111I -7
100 F"E.-FET F::*CIR (::I 1='RIVATE7 WELL OF: 050 TO 200 INERT FROM f."i 141ELL. ClEPEND ING
UPM. -I ]"HE 1*IT"'E ('-'IF* :1 C: W ELL_
MINIMUM C,ISTF`!NGE FROM A PRIVATE 1.4ELL TO A PRJEVF-ITE: ,'.3EJ4ER !.._INET IS 25 FEEEET FINED
TC) F COJII%IUN-JITNI ER t DIE',7-5 F:.'EET.
WELL F -1!;E RDQUIF='.E[) Fit -,V r1U1T BE RE'FLjR),JED TC) "['HE DEPAF,"-.`f'ME1'1T WITHII,l 1 N'lleS
OF" INEELL
OTHER FREE GILJ I FREE PIENTS MAY APPI.Y. F-INI) C:O%TRLK!TICV DIAG&,':F:IP1c& AREE
AVAIMENE: "N) PROPEER INSTALLATION,
. .. . .....
V KNIF"i X V. E F
1 MERTIFY THAI'
0
F. M FA1411__IFIF,". WITH 'THE: REEGUIREVIEN'r,; F -"OF-.., ON---S:r*TiT ANR) WELL.-'.; A"S SET
FORTH FBI? THE: 10F
2: 1 WILI. INSMI.L. THE SYSTEM 114 ACCCIRDF.'INCE 'NITH FHE C:O[)Fi:S.
3: 1 THAT .?.HE:. OW -SIVE t4L. CiEi: ME NT IF:' THE
REV IDETRIE: I&I NEIICDEI E:[) TO 11'r-IC:1 UEW MORE: THAN. "T PRIEM C)ROOMS.
5 f G 1,-_1 E 1� . .... ... __ .. . ....... .. .... ..... .
f MPPL I C",Ahl 1"
E .. . ......... ...
V111.
O & E ENL,NEERING & DEVELG.M�MENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280 '! % 'Y// -dj jU
Russell Oyster Earl Ellis
694-2774 SOIL LOG 688-2280
Performed for: Name: ��a Tel. No.
Mailing Address:
Legal Description: `'�
Depth (feet) Soil Characteristics
0 f
—7— e f aeGaA AI r e -
S
2
3
,4
5
6
7
6
9
10
11
12
13
14
15
16
P !t�' . 2r -el ""T4
Znn
O= 140, IT -
Ground Water Encountered: Yes No If yes, what depth
Proposed Installation: Seepage Pit Drain Field
X3$,5
PLOT PLAN
PERC.TEST
m
.49111
�,'ay�g'py aQm
11 9mL B •e "33.. e�
m F
} V j'm Russell L. Oyster w
cy�T R� No. 4236-E
Q'oFE
ZIT CJS L-Efi�r_ eJrt-yt ter= ,tom cc0'C"/eJ
✓6i 1 til r A4"M ` y f t.-
Performed by: Date:'
a
DOC Co. dDa
SULLIVAN
WATER
WL
EL S
P O OnV III 1-Ul0l A V
ALASKA ASKA 99567 TELEPHONE
688-2759
OWNER OF LAND A/ f 7-6) DEPTH OF WELL 60
ADDRESS STATIC LEVEL OF WATER FT.
s v 1ik -
LEGAL DESCRIPTI'ON__40_ 07 —l"2�" 1'/` 1) RAW DOWN FT.
DATE .'Startede-'-' /-E -2 Ended e, GALS. PER FIR -1 4
'70
MISCL. INFORMATION:
R'S NAM
DRILLr E
PERMIT NUMBER
KIND OF CASING
KIND OF FORMATIPN:
From (9 Ft. to___0_Ft.___0
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to --Ft-----
From-l-i-LI't. to 0 Y-cf Ft. /5"
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to --Ft-------
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From-
to
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to
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V
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to—Ft.--
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MISCL. INFORMATION:
R'S NAM
DRILLr E
` � NB9.59'49"E 329.99' N
► 57.7
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9B, 8,3Z S.F.
34.11' 2.27 Ac.
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
� Application Date
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, ction, township, range)
Location (address or dire ti ns)
sA / .0 >L6/�� Ot-G�c. of/IGC,ii4"7e� 4 sc�•fY S�� j�
(b) 'Applicant Name —tee L:e °` G Telephone: Home Business
Applicant Address ✓J_�o)•C�°�`�/7e �!'�S �'7
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ® ;Buyer ®; OtheXr (explain);
(d) Lending Institution ."
Address
(e) Real Estate Company and Agent
� Address .
Teleph ne V/z,9
(f) t e HAA to the following address:
2. TYPE OF RESIDENCE
Single -Family D51 Multi -Family ❑ Other
Number of Bedrooms- -3
3. WATER SUPPLY
Telephone
3P� ,
M
Im
O,
77
Individual Well v Community ❑ Public
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite Public ❑ Community ® Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
72-025 (11/84)
Pagel of 2
5. ENGINEERING FIRM PROVIDING .ASPECTIONS, TESTS, FILE SEARCH, DA. AND INFORMATION ' B
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
>" Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
r for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm Telephone
MOINEERINQ
j Address 13 1F6X
Date
!11
� ki ', 9 rts�Ka'Shafar v
'�' � lgg7•E : ��-
°{ . _ ♦ �n" �@ �� .• .tea �
i
6. DHEP APPROVAL
t
' Approved for G%E bedrooms by Date �---
Approved Disapprov Condit
`i Terms of Conditional Approval ---
f
I
I
i
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72.025 (11/84)
^) MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF MEALTH 8e
HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION
CHECKLIST - FEBRUARY 1984 19 e
264-4720
Legal Description:
A. WELL DATA
S Ij� If A, B, C, D.E.C.
Well Classification Approved (Y/N) 0
Well Log Present &N) Date Completed 13'7-- Yield • SCA P&-" A -
Total Depth IU-Oo Cased to �� �F Depth of Grouting
Static Water Level —✓c�" Pump Set At
Casing Height Above Ground 1!�� Sanitary Seal on CasinggWN)
Electrical Wiring in Conduit (QN)
Separation Distances from Well
Depression Around Wellhead (YkW
t
To Septic/H&kfilrg Tank on Lot l , * ; On Adjoining Lots tib,
To Nearest Edge of Absorption Field on Lot tom,« ; On Adjoining Lots
To Nearest Public Sewer Line To Nearest Public Sewer
Cleanout/Manhole �' To Nearest Sewer Service Line on Lot 25 --
Water Sample Collected by5 L c`iGt - Lt+ Jc. ; Date 9-1,7 - isg'
Water Sample Test Results
Comments n'
B. SEPTICTANK DATA
Date Installed 1-2-071 Size 1d15PEZ2 No. of Compartments
Stand pipes,,�VNl) Air -tight Caps4WN) Foundation Cleanout (YY4P
Depression over Tank (YJ Date Last Pumped
Pumping/Maintenance Contract on File (Y/N)
A ;for
r�
Holding Tank High -Water Alarm (Y/N) P Temporary Holding Tank Permit (Y/N) �
Separation Distances from Septic/Hakttng Tank:
To Water -Supply Well k � Ik To Building Foundation
To Property Line
To Water Main/Service Line
Course
Comments
Pagel of 2
72-026(11/84)
To Disposal Field 511
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata lei off'
Type of System Design
Date Installed 2 - 7 - 82_ Length of Field _
Width of Field (o4::� Depth of Field
N
Gravel Bed Thickness
Square Feet of Absorption Area AG -7 Standpipes Presento?N)
Depression over Field (Y/4 Date of Last Adequacy Test - t 3' 85
Results of Last Adequacy Test S 6rns�.6-ca��
Separation Distance from Absorption Field:
To Water -Supply Well I co �+ To Property Line
To Building Foundation
Lot
ki
To Water Main/Service Line t co' -I'
To Stream/Pond/Lake/or Major Drainage Course _
To Driveway, Parking Area, or Vehicle Storage Area
Comments —
D. LIFT STATION
Date Installed .
To Existing or Abandoned System on
On Adjoining Lots 1:11_ �4-
To Cutbank (if present)
( 'A -
Dimensions
Size in Gallons I Manhole/Access (Y/N)
"Pump On" Level at "Pump Off' Level at
High Water Alarm Level at Vent (Y/N)
Tested for
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
Pumping Cycles during Adequacy Test. Meets MOA
I certify that I have checked, verified, or conformed to all M9A and HAA guidelines in effect on the date of this inspection
Signed
Date
84
Company
SAB !"!Li nn o.
6P�A
PH, ft4*79
�Jri
Receipt No: �,,��
32
1j
Date of Payment
9 - 1 �- `ds
,..F 11
'°'°°'°°+$"y-���
�+
Amount: $
°,.•
Se '�
of
n.*c aw.lu f_.y
Page 2 of 2
A A.OShafer
�, No, 1457-1:
a`�\`�OPMOFEW��,r;
72-026 (11/84
Time
Time
Ae
Date
Date
bate
I
A1" �
_ C� /
Inspector
Inspector
Inspector
Comments
Conditional Approval
Date Sewer Installed
Permit No.
Septic Tank Size
/fo p Q
t`7,_ -X 2
7
/
S"d'S
Holding Tank Size
Soils Rating
Well To Absorption Area 1" /-
Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER_HALF_ONLY
Property Owner William E. Johnston
Phone
P.O.Box 334, Eagle River, AK 99577
694-9766
Mailing Address
Buyer Michael Harvey and Tammy Tomlinson
1106 Norman St., Anchorage, AK 99504
Address
Lending Institution First National Bank of Anchorage, Eagle River, AIC
Phone
P.O. Box 548, Eagle River, AK 99577
694-2103
Address
Realty Co. & Agent Commonwealth AREA, Inc. (Myrna Johnston)
Phone
P.O. Box 249, Eagle River:, AK 99577
694-9555
Address
Legal Description Southfork Subd. Block 2.. Lot I
Street Location Synth Creek Rd. (Mile 7.0 Hi.land Road)
Typepf Residence
Single Family 3
❑ Multiple Family No. of Bedrooms
❑ Other
Wateupply ,
Individual ATTACH WELL LOG. A well log is required for all wells drilled since June
•❑`Community 1975. For wells drilled prior" to that! date, give well depth (attach log If
❑ Public Utility available.
Sewa
yDisposal 1982
individual Year Individual Installed:
❑ Public Utility When Connected to Public Utility:
D Holding Tank
p�Ny EppG ppEp �EFpppEE pp pcE
4tjWQ E Wp1%TI( fijj6VRT AC� tt y.1jjH A18E�Sg W?IWtiRLlYe I C RAN BE INITIATED.
vID 618910 77
• r) 5� , <A
2 '" Municipality of Anchorage " r.;�a'� v.:-I.�' 3
On-Site Water and Wastewater Program i MA' •r,1.:�P '' a
(907) 343-7904 ( I)-- --
1, 'V
c� c.
Certificate of On-Site Systems Approval `` of sa L9c;\
Parcel I.D. 078-021-05 Expiration Date: 7-10-1 c�
1. GENERAL INFORMATION
Complete legal description Southfork Block 2 Lot 1
Location (site address) 1711 South Creek Road
Current Property owner(s) Sharon Kelly Revocable Trust Day phone
Mailing address 1862 Waverly St. Palo Alto, CA 94301
Real Estate Agent Day phone
2. TYPE OF DWELLING:
O 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 0
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
` p
Received b : Pli l! 'Liwi_ .>�I tatif A Date: 4/11//c3
COSA to be released to the engineer,unless otherwise request-0 e engineer.
COSA Fee $ L. 8 Waiver Fee $
Date of Payment )01-q ilk Date of Payment
Receipt Number ( R/ Gi Receipt Number
COSA# MC.r 8.1 l ) 1 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 infbrhfation 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.
In conducting an adequacy test,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 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.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 Date 3/28/2018
04:.*Z,/ •*
6. DSD SIGNATURE ' "' •••/�
System#1 Approved for 3 bedrooms ��f Sleven R. •annone•
Ofig. CE-8149, 4z /
System#2 Approved for bedrooms s
Disapproved 'k `- OFESSIONP 'r
Conditional approval for bedrooms, with the following stipulations:
acv sQ
z4 -PPV"
Fl nAAArl`rr
By: ��� Gt:�'�. _/ Original Certificate Date: `i 1 v -re
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 blue sheet r c
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: Southfork Block 2 Lot 1 Parcel ID: 078-021-05
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed 6/1982 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 260 ft. Cased to 260 ft. Casing height(above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 6/1982 9/8/2015
Static water level 30 ft. 32 ft.
Well production 8 g.p.m. O 8* g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 0.105 mg/L
Arsenic 15.2 ug/L Date of sample: 3/20/18 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 5/17/2016
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A
Date of pumping NEW Pumper N/A
C. ABSORPTION FIELD DATA
Date installed 5/17/2016 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SF System type Shallow Trench
Length 67 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 5 ft. Eff. absorption area 670 ft2 Monitoring tube Y Depression over field N
Date of adequacy test NEW Results (Pass/Fail) For 3 bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
N
Any rejuvenation treatment (past 12 mo.) (Y/N &type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
100+ On ad scent lots 100+
Septic tank/lift station on lot J
On adjacent lots 100+
Absorption field on lot 100+ 1
75+ +
Public sewer main Public sewer manhole/cleanout
25+ Holdingtank 100+
Sewer/septic service line
50+ +
Animal containment areas Manure/animal excrete storage areas 10
SEPTIC/HOLDING TANK ON LOT TO:
10+ 5+ Absorption field 5+
100+
Building foundation Property line p
Water main 10+ Water service line 10+ Surface water
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage
100+
Curtain drain 50+ Wells on adjacent lots
F. COMMENTS
*Approximately 500g Bladder underneath house.
G. ENGINEER'S CERTIFICATIONiip. ", .OF AL.`Ikt
44 1 certify that I have determined through field inspections and IV03.•� ''4 7e;-p
review of Municipal records that the above systems are in 0*: lli I' •.-141
conformance with MOA COSA guidelines in effect on this date. d .
Steven Pannone ':Sleveri nnone .
Engineer's Printed Name ill.- CE-8149
OFtE
iVS
3/28/2018 ����••.�er� rgy
Date * .r
COSA canary sheet_2-6-1 5.doc
Municipality of Anchorage R,
J
( Development Services Department ,,-Air, r .:
Building Safety Division 4 illit
S A T E !F
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Water Well Advisory
Certificate of On-Site Systems Approval (COSA) # OSC 181114
During a recent COSA on-site inspection and test of the potable water
supply well on Block 2, Lot 1 of Southfork subdivision, the well's
productivity was determined to be .8 gallons per minute. The minimum well
productivity required by this Department (AMC 15.55) for a 4-bedroom
residence is .42 gallons per minute. Although the subject well currently
exceeds this minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction of non-critical
water uses such as washing cars and watering lawns and gardens may be
required.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
VI \ �,
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SOS
ASBUILT SETWARD & ASSOCIATES LAN SURVEYING 694-0829
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE:
FOLLOWING DESCRIBED PROPERTY: •_ / �a �,�` (),A/
.....<9,1e,' 'sU�Low"/ 4W!7 . DATE �� . 's i�r
AND THAT NO ENCROACHM€NTS EXIST EXCEPT AS y� /d° c.,.. '• •,:1':: '•- -'i r
INDICATED. IT IS THE RESPONSIBILITY OF THE jr.Y 45 H l''V
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID= ..>""°
EASEMENTS, COVENANTS., OR RE.`iTRICTIONS sem//o.S`� _ ; 51
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- ----b `g ', •_ Duane µtri coward
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: q ':s. i.S-5 8
ANY DATA HEREON BE USED FOR CONSTRUCTION /�3-3Z r2-,,.A y� ;5�4'
AOF RY LNFlES.INES, OR FOR ESTABLISHING BOUND- DRAWN: '' ,� t '� A7-
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT ® 907-343-7904
On-Site Water and Wastewater Section ;` Fax: 343-7997
www.muni.org/onsite
Arsenic Advisory
Certificate of On-Site Systems Approval # 0SC181114
Subdivision: Southfork, Block: 2, Lot: 1
A water sample revealed an arsenic concentration of 15.2 micrograms per liter
(ug/L). The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. information on arsenic is available from the On-Site Water and
Wastewater Program website (www.muni.org/onsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address: P.0. Box 196650* Anchorage,Alaska 99519-6650 *www.muni.org