HomeMy WebLinkAboutSOUTHFORK NORTH BLK 6 LT 3•
#078 - 021 - 20
Municipality of Anchorage
• +� Development Services Department
Building Safety Division:
OnSlte Water 8 Wastewater Program, 4700 South Bragaw St.
a
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3
Onsite Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW040238 PID Number: 078-021-20
Name:
JOHN THOMSON
Wastewater System: ■ New ❑ Upgrade
Address:
17343 SANTA MARIA • EAGLE RIVER, AK. 99577
ABSORPTION FIELD
Phone: No. of Bedrooms:
(907) 240-2020 3
O Deep Trench ■ Shallow Trench a Bed O Mound a Other
LEGAL DESCRIPTION
SON Rating:
1.0
Total Depth fmm anginal gmde
CPO/Sq.
rt 6.0 MAX n.
Block: Lot: Subdivision:.
6 3 SOUTHFORK NORTH
Depth to pipe bottom Invn aright prods:
SEE DWG.
growl depth beneath pipe
4.46
a rt
Township: — Range: — Section:
rill added some angles/ bode:
'grovel length:
—
SEE DWG.
n 52 rc
WELL: ■ New ❑ Upgrade
gravel clam
5
Number of U.
1
Dblance betweea Ines
—
Ft.
re
claveifkation Prkvt% AA.C%
Tatal i) h:
Cased TO:
Total Obowpeon area,
Pipe material:
PRIVATE
154 rt
154 rt.
520+ sp. rt
D 3034/ F-810
Dr IW:
SULLIVAN WATER WELLS
Date MW&-
7/16/04
Slol(c er tsvel:
38Nat
awtalNr.
GEG, Ltd.
.le olelaNa
Dow
8/tl:2-3/2004
n
YNM:Pomp
Set Ah
ht
Cnhg 1Mlght Above ground:
IWM
UNKNOWN n
2 rz
TANK
SEPARATION
DISTANCES
■Septic C) Holding 0S.T.E.P. OOther
To
From
Septic
Tank
Absorption
held
LHt
Station
Holding
Tank
Mie/Prhab
sewer uvea
YOnufaetunr:
ANCHORAGE TANK
DePachy In ".Nils:
1000
Well
100'+
100'+
—
—
25'+
Millets/:
STEEL
Number of eanpartmeate:
2
Surface water
100'+
too•+
-
-
-
LIFT STATION
Lot Line
5'+
10'+
—
—
—
She In gallons:
_
ManulocWrx:
Foundation
5'+
10'+
—
_
_
'Pmp onw level ab
="-
Nigh water alarm at:
Curtain Drain
NONE KNOWN
°ectrica Inspections Prff ned by:
Remarks:
BENCH MARK
_.
location and Onodption:
TOP OF CMU AT POINT "Aa
-
Asoumed Elewtlam
100.00
Ft.
ENGINEERS
0
o F,.... .... •gs4p
•.'0
GEG, Lt.
performed by: Dates: 1st /2004
4TInspections
.. y'.0
2nd 8/3/2004
. . ...........:��
0
3rd —
OQ '• ff y . Go ess..
Development Services Departm t Approval004
a
Reviewed and approved by: Date: .1 ^ as
�P
rofessiol,00
(Rev. 12/01)
4
040000`0
13
INSULATED
UNDER DRNEWAY
W/ 4- X 4•YADE
RIGID INSULATION
Eam
17:?TJ7Q��7
\\ LOT 5, BLOCK 5,
\\ SOUTHFORK NORTH S/D
\
AN
/ le, O,
.'J
LOT 4, BLOCK 5,
SOUTHFORK NORTH S/D
SEE DETAIL AS—BUILT iNtV
ON PAG 3 F 4
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS& GENERAL CONTRACTORS
A761 G mnno Gnen Kill TP 101 • nufunoncP AK ooen7 • P nuc ron,u,Ai7o * VAV fOA71X{A_v1.
JOHN THOMSON
PHONE NUMBER:
240-2020
SOUTHFORK NORTH SUBDIVISION; LOT 3, BLOCK 6,
OF WORK:
AS—BUILT FOR NEW WELL AND SEPTIC SYSTEM
70/5/2004
WN BY:
R.A.L.
LLE:
I" = 100,
;E NUMBER:
2OF4
OF
...gyp
Profeaf
\1
PERMIT NUMBER: AS—BUILT DRAWING PARCEL ID NUMBER:
ALTERNATE SITE
d v
d
Q. V
�1
INSULATED \\ \\ \\
UNDER DRIVEWAY
w/ 4' X 4'WIDE
RIGID INSULATION d \
ZODOGk.LLON K/fDBLI
/ Ll
J
3. o \
/ V 4 \
/ v
da. P
V .
O a Q
v
� a c
a
0
NEW WELL
1
a v
GRAINFIELD
\I
'
'
/
A
8
C
FCO 3.90 9.00
–
ST1 8.80 7.80
–
ST2 14.50 9.40
–
DBL1 16.30 10.60
–
DBL2 17.60 11.30
–
001 128.09 –
125.
CO2 148.88
152.
CO3 147.44 –
149.
MT1 167.20 –
159.
MT2 168.42 –
1160.
GATE: p0��
m m
10/5/2004 o OF• 00
DRAWN BY: Op F,•.......... gsp0
GARNESS ENGINEERING GROUP Ltd. R.A.L.
CONSULTANTS t GENERAL CONTRACTORS SCALE: 40. {�, ; ... ... T ..... :...? �O
3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE. AK 99507 • PHONE (907)337-6179 • FAX (907)338-3266 — D
PREPARED FOR: -PHONE NUMBER: PAGE NUMBER: 0
JOHN THOMSON (907) 240-2020 3 OF 4 Q ••J f r A. orn S.
LEGAL DESCRIPTION: �. –7953 e�QQ
SOUTHFORK NORTH SUBDIVISION; LOT 3, BLOCK 6. °r
TYPE OF WORK:�Qedp('oo
�otensio�
AS—BUILT DRAWING OF NEW WELL AND SEPTIC SYSTEM ��40p slo
PERMIT NUMBER: AS -BUILT DRAWING P078 ID NUMBER:
SWO4O238078-021-20
/�--FINAL GRADE
/ = GA95-9998
OF RIGID INSULATION
TOP OF TANK AT
INLET = 96.45-
n
L4
NEW 1000 GALLON
INVERT OF BUNG SEPTIC TANK
AT INLET = 96.33 '
ORIGINAL GRADE
61.95-62.95 -�
RELATIVE ELEVATION
OF GROUNDWATER • 50.95
-RELATIVE ELEVATION OF
BOTTOM OF TEST HOLE • 48.45
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE. AK 99507 - PHONE (907)337.6179 • FAX (907)338-3246
PREPARED FOR: PHONE NUMBER:
JOHN THOMSON (907) 240-2020
LEGAL DESCRIPTION:
SOUTHFORK NORTH SUBDIVISION; LOT 3, BLOCK 6,
TYPE OF WORK:
AS -BUILT DRAWING OF NEW WELL AND SEPTIC SYSTEM
FINAL GRADE _
83.77-63.95
INSULATION
r FILTER FABRIC
-INVERT OF PIPE
61.41
BOTTOM OF
TRENCH = 56.95
1O/5/2OC
4WN BY:
R.A.L.
uF:
N.T.S.
;E NUMBER:
4 O 4
TANK AT
96.31
INVERT OF BUNG AT
OUTLET = 95.91
NUN
.,.T
prof
40i
certitteb 3Britti g tog
by
Doc oo. eea
SULLIVAN WATER WELLS
P.C. SOX r=2, ct1UGIAK. ALASKA SO= '
ooF�awn y.t Nv Sa►a ._w'
As's •13.
r ra•
r _
i
a
rc 1�+ . r.o- ♦.
3 Stxaamt • 'Star fqa fed
2
Fsr-..rj4.s r4s
_ 1,1 '
ifTgrnoN. it is the fwpcmu ity of the property owner to subMI a copy of the Wag b9 to the MOM vAhMitY. MunicipaBl
7f fie: pepatrnent of Health d. Human Services and/or l)ep utment of Erwironmme tal Cwanallon. Matsu BorouO
)q*ttrtent of Envirmnentai Cansenration.
TO/10 39vd NdAI'1 M 6SZZ889 10:00 6661/10/10
S)3 ll :Yj
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 995196650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Date Issued: Jul 01, 2004
Expiration Date: Jul 01, 2005
Permit Number: SWO40238 Parcel ID: 078-021-20
Legal Description: 15OUTHFORK NORTH.SUBDIVISION BLOCK a LOT 3
Design Engineer: 0855 Gamess Engineering Group, LTD Site Address: NHN WEST RIVER DRIVE
Owner Name: JOHN THOMSON Lot Size: 23e296 SQ. FT.
Owner Address: NHN WEST RIVER DRIVE Total Bedrooms: 3 Permit Bedrooms: 3
EAGLE RIVER, AK 99577 -
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specked 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.
Received By:
Issued By:
E
s52?� Date: -0y
Date: -7-1-04
Municipality of Anchorage
• ''` Development Services Department
to i 3 'ii
Building Safety Division `
On -Site Water & Wastewater Program s
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
r�6F,/O\R A SINGLE FAMILY DWELLING
�
Parcel I.D. "I D'DI — �V Permit Number 0 V_
Property owner(s) JOHN THOMSON
Day phone 240-2020
Mailing address (1) 17343 SANTA MARIA ► EAGLE
RIVER. A K.
`'
iVl4Wng address (2) l iW Wv5r 'Rv eyL
TxtV& Zip Code 99577
Legal description (Lot, Block & Sub'd.) SOUTHFORK
NORTH SUBDIVISION: LOT 3. BLOCK
B.
Legal description (Section, Township & Range)
Lot Size a 3%i '"14 —Acreq.F
Number of Bedrooms 3
THIS APPLICATION IS FOR:
Sewer Only ❑
Well Only
❑
Sewer and Well ®
Water Storage
❑
Sewer Upgrade ❑
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.
GARNESS ENGINEERING GROUP Ltd.
/� � °`
Permit Fees: i(on 1 %5 Waiver Fees
Date of Payment: 1e 01 Date of Payment,
Receipt Number: 0 q Rei I �T Receipt Number:
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS k
June 24, 2004
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907)343-7904
Ref: Proposed Septic System for Southfork North Subdivision; Lot 3, Block 6,
To whom it may concern:
The proposed 3 bedroom house will be served by a private well and septic system. We are
proposing to install a 1000 gallon septic tank and 5 -wide dual trench type drainfield. Two test --_
holes where excavated on the property one by Steve Pannone, P.E., and one by our firm. The
drainfield will be designed around the 30 foot radius of our test hole. Comments regarding the
design are summarized as follows:
1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring,
and the percolation test results.
2. TRENCH DESIGN
a. Percolation Rate: 1.3 minutes/inch
b. Proposed Application Rate: 1.0 gallons/day/ft2
c. Number of Bedrooms: 3
d. Design Flow: 450 gallons per day
e. Minimum Absorption Area: 450 ft2
f. Total Depth: 6.0 feet (maximum)
g. Effective Depth: 4.0 feet (minimum)
h. Width: 5 feet
i. Reduction Factor: 0.5
j. Minimum Length: 50 feet long
k. Effective absorption area = 500 ft2
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: gamessengineering.com
4. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic
system.
5. TOPOGRAPHY: The area around the proposed drainfields has a 15 to 20 percent slope
running approximately southwest to northeast. In short, there are no slope concerns.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
.E., M.S.
NOTE: A site plan drawing, a design drawing, one soil log, and a 7 page construction
specification letter which are all part of the design package for this septic system.
3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507
Ph: (907) 337-6179' Fax: (907) 338-3246 • Website: gamessengineering.com
PROPOSED
WELL
LOCATION
LOT 4, BLOCK 6.
SOUTHFORK NORTH S/D
(UNDEVELOPED)
PROPOSED
SEPTIC SYSTEM
(SEE DESIGN
PACE 2 OF 2?%
3 BEDROOM
HOUSE
LOT 5, BLOCK 6,
SOIRHFORK NORTH S/D LOT 4, BLOCK S,
SOUTHFORK NORTH S/D
♦ x ♦
♦
♦
I ♦ .
sTtvE PANNONE'S
TEST HOLE
i ♦
/ 1
1
I I
I
1 1
\ APPROXIMA /
\ LOCATION /
/ LOT 2. BLOCK 8,
\\ j SOUTHFORK NORTH S/D
i
V
DATE:_:
6/24/2004 «' of
DRAWN BY: r .......
R.A.L.
GARNESS ENGINEERING GROUP, Ltd. Sreli. `�: _ y'
CONSULTANTS i GENERAL CONTRACTORSi — 1 OO,*
5]01 E. TUDOR ROAD. SUITE IOI •ANCHORAGE, AK 99507 • PNONE 90])337-6179 • FA% 11111111-1111
IREPARED FOR PHONE NUMBER: PACE NUMBER:
JOHN THOMSON 240-2020 1 OF 2 ¢ .J ffr6 Ga ass:
EGAL DESCRIPDON: i 79 eG
SOUTHFORK NORTH SUBDIVISION; LOT 3, BLOCK 6, °f ♦`A�`�
YPE OF WORK: `i4'a �dP Car
SITE PLAN FOR PROPOSED WELL AND SEPTIC SYSTEM o ofesteloo
PROPOSED
WELL
LOCATION
J
DOUBLE
CLEANOUT
1000 GALLON
SEPTIC TANK
'ROPOSED GRAINFIELD. EXCAVATE
ONE TRENCH THAT IS 6 FEET
DEEP MAXIMUM AT ANY POINT BY
5 FEET WIDE BY 50 FLEE LANG
TOTAL, ADD 4 FEET OF CLEAN
\WASHED SEWER DAINROCK.
�
i
ALTERNATE
SITE
\\
� INSULATE
LINE UNDER DRIVEWAY
WITH 4 INCHES OF BLUE
INSULATION 4 FEET WIDE 'NOTE: THE CONTRACTOR
SHALL HAVE THE SOUTH
LOT LINE FLAGGED BY A
REGISTERED SURVEYOR
PRIOR TO CONSTRUCTION
-O
F DRAWN BY:
GARNESS ENGINEERING GROUP, Ltd. R.A.L.
CONSULTANTS i GENERAL CONTRACTORS SCALE:
907)338-3246 = 50' '
3701 E. TUDOR ROAD, SUITE 101 •ANCHORAGE. AK 99507 •PHONE (90])33]-6119 • FA%
IREPARED FOR: PHONE NUMBER: PAGE NUMBER:
JOHN THOMSON (907) 240-2020 2 OF 2
.EGAL DESCRIPTION:
SOUTHFORK NORTH SUBDIVISION; LOT 3, BLOCK 6,
TYPE OF WORK:
DESIGN FOR PROPOSED WELL AND SEPTIC SYSTEM
. ............
.� ... ....
Ga ........
e e Ga ess.
��n «ob
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS i GENERAL CONTRACTORS
roi a 7LODR ROAD. SM 101 • ANCHOWPL AL 90507 • MML -■rn • RA%: • WOMM
SOIL LOG - PERCOLATION TEST G
LEGAL DESCRIPTION: SOUTHFORK NORTH SUBDMSION; LOT 3, BLOCK 6,
PERFORMED FOR: JOHN THOMSON DATE: 6/14/2004
DEPT _ _
(1°et� _ -; ORGANICS TEST HOLE #1
1
7
8
9
10
11
12
13
14
15
16
17
18
DEPTH TO DATE
GROUNDWATER
11.5' 6/14/04
12.0' 62204
0
ff. . A•..G.. ne s.:... _.
7953 R:
ti
.e ..... • ee4�s�
DATE READING
CLOCK NET TIME
TIME (MINUTES)
WATER LEVEL
READING
1SOIL
CLASSIFICATIONS
— —
6.
—
2
GW zzzz:M - •.
0.
6.
3
— —
Z*.Vk GP11111111 ML
4
— 8
0.
II:III"11GM %// CL
5
— —
6"
—
Gc NN i •
— 8
0.
6.
SWMH
IIIIIIIII
_
CH
;! •
■
Sc
C.
7
8
9
10
11
12
13
14
15
16
17
18
DEPTH TO DATE
GROUNDWATER
11.5' 6/14/04
12.0' 62204
0
ff. . A•..G.. ne s.:... _.
7953 R:
ti
.e ..... • ee4�s�
DATE READING
CLOCK NET TIME
TIME (MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
6/17/2004 1
— —
6.
—
2
— 8
0.
6.
3
— —
6-
4
— 8
0.
6.
5
— —
6"
—
6
— 8
0.
6.
19� PERCOLATION RATE 1.3 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 4.0 FT. AND 4.5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: E YES ❑ NO
SOILS LOGGED BY: CALEB GALL PERCOLATION TEST PERFORMED BY: ROB CAMPBELL
COMMENTS:
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WASERFO'tMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 2
Dec 16 03 02:30p
FROM : PSE ENG SVC
COLIN ROTH
PHDg No. : 272 821B
SOILS LOG • FMOOLATION TEST
PANNONE.ENGINEERING SERVICES
P.O. BOX 104054
ANCHORAGE, AR 99310
(9073 392-8218
VU"/ zed el -if p.e
, c. 03 2003 04:25AM P7
PERFORMED POA: Mod DATE PERFORNMO: 11/22/03
LEGAL DESCM=N: Let 3. VlMk 6 EOuthtork NoRh BID
TENTROL53
t !bowie:
2
9
WAS ORCgMD WATER
zNCoUxTrj zDP No
iF PBS. A7 WHAT
DE7RIw, NIA-
. DEPRI TO WATER AF F�.R
M �N[TOR1 c -0RT-
SiCf I 1
977T eti
11C�pMa ORla sam
loa
orraamq
TMC
=RTA
low
b"
90
303!
31/4
W5
__
a .
_,
M0
70
9 i/1
3
ton
—_
s_t
�_
313
21
33/4
1t. PEROLATION RATE Spain/inehl FERC NO11Y D71i3r9'rs'R 6 Inches
TEST RUN AT ♦ PT TO S T.
COMMEMB: Telt hate oceavnted by Dan Seek Mnav tkw Test Hole wren beeeer ked bekae xte Me
t.
y•d
Municipality of Anchor
On -Site Water and Wastewater Program M
ILC_
(907) 343-7904 A F E T j_,0K
CERTIFICATE OF ON-SITE SYSTEMS Apfjz'
Parcel I.D. 078-021-20 Expiration Date
1. GENERAL INFORMATION
Complete legal description Sounthfork North Block 6 Lot 3
Location (site address) 1900 West River Dr.
,VAL
Current Property owner(s) Jonathan Kling / Jaguelyn Spies Day phone
Mailing address
Real Estate Agent
1900 West River Dr. Eagle River, Ak 99577
2. TYPE OF DWELLING:
M Single Family (w/wo ADU)
F-1 Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
3
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY:
Individual
0
Individual Well
Holding Tank
D
Individual Water Storage
E]
Community
El
Community Class _ Well
El
Public Sewer
❑
Public Water System
n
WaiverNariance request for:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee Waiver Fee $
Date of Payment Date of Payment
Receipt Number CILO 4340 Receipt Number
COSA # 0-5clqlwo Waiver #
Distance:
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 ARCTERRA CONSULTING, INC. Phone 696-6111
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date
12/20/2019
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition
of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface
conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen i OF ALS \
encroachments, deficiencies or discrepancies exist.
6. DSD SIGNATURE r
...
r KENNETH Ni. D vpf
System #1 Approved for bedrooms. �, 7116 ��/
System #2 Approved for bedrooms. ' �\rFoZ�Z`r`c��'
OFcjsio .I
Disapproved.
Conditional approval for bedrooms, with the follow``\Q�N*i if
`
0%_SITE r
oTEF, o
r ^
FROG
1JJJJ1))))111��
Original Certificate Date:_(2�2� r
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 AdAdrys
Well Flow Advisory
COSA blue sheet 10-10-12.doc
Other
COSA Checklist
Legal Description: Southfork North Block 6 Lot 3 Parcel ID: 078-021-20
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system 1
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 7/10/04
Total depth 154 ft
Cased to 154 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 30 in.
Date of flow test for COSA 12/11/19
Static water level at beginning of test ft.
Comments * Artician plug near the top of casing
B. TANK DATA
Age of tank(s) 15 years
Tank type/material Septic/Steel
Measured operating fluid level in septic tank 49
Standpipes/foundation cleanout per record drawing
Date of pumping 12/11/19
D. ABSORPTION FIELD DATA
Which system tested (date installed) 8/2/04
ALL standpipes present per record drawing
Total measured depth from grade 7.3 ft (max)
Measured depth to pipe invert,from grade 3 ft (min)
❑ N/A — pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective
Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Well production at time of test 3.7 gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes 0 Nc
Coliform bacteria is Negative
Nitrate 0.218 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L X Arsenic less than MRL (ND)
Collected by Arcterra Consulting
Date of Sample 12/5/19
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 12/11/19
Results Q Pass For 3 bedrooms
Fluid depth prior to test 0 in
Water added 450 gal
New depth 0 in
Elapsed time 1 min
Final fluid depth 0 in
Absorption rate 450+gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
® Yes
if No
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
[O Yes
if No
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' VI Yes
if No
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No
Neighboring Absorption Fields > 100'
Animal Containment > 50' ® Yes
if No
® Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
0 Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ® Yes if No ft Surface Water > 100'
ft
ft
ft
ft
li,
® Yes if No ft
Property Line > 5' ® Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' ® Yes if No ft Private Wells > 100' Yes if No _
Water Main > 10' ® Yes if No ft Community Wells > 200' Yes if No_
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' R] Yes if No ft If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
ft Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft Private Wells > 100' ® Yes if No
Water Service Line > 10'
® Yes
if No
ft Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
ft
in
Iii
ft
6 `,,
u� �
• Municipality of Ancho a (NOV 17 2015
On -Site Water and Wastewater Prog _
(907) 343-7904 �6 0" s A ET Y
CERTIFICATE OF ON-SITE SYSTEMS A C
Parcel'I.D. 078-021-20 Expiration Date: `3 11 (P
1. GENERAL INFORMATION
Complete legal description SOUTHFORK NORTH BLOCK 6, LOT 3
Location (site address) 1900 WEST RIVER DRIVE, EAGLE RIVER, AK 99577
Current Property owner(s) WAYNE & LOUISE COBBJOINT REV. TRUST Day phone
Mailing address PO BOX 9029,'KODIAK, AK 99615
Real Estate Agent ` Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ M If I D II' S' I F N Al D I
u IV,
a we Ings ( Ing a ami y an or
up ex)
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual
IndividualWater Storage
❑
Holding Tank
El
Community Class.— Well
❑
Community
Public Water System-
❑
Public Sewer
❑
Waiver/Variance request for:
Distance:
COSA Fee $ !d -to . Waiver Fee $`
Date of Payment [11 A I5 Date of Payment
Receipt Number Receipt Number
COSA# 05615Ito33 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 ARCTERRA CONSULTING, INC.' Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 11/17/2015
Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition
of the well and septic. applies only to the conditions as.of the day tested. The flow and absorption rates may change due-tosubsurface
conditions that may not observed from the surface, changes inland_ use, localsoil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the: family being servedby.. the. system. The operational life of all well and septic systems are
- subject to these various and dynamic characteristics and are outside the control: of the
evaluator of the well and septic system. Therefore, - -
AmTerra can not give anyestimate of how long a - -
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen g OF Az \
encroachments, deficiencies or discrepancies exist. / !SY AS.
Ar
6. DSD SIGNATURE F
System #1 Approved for KENNETH M. uF s �
Y pp bedrooms. i� ue ` l$�
Af
System #2 Approved for bedrooms. °�a •W
r es loNP' i
Disapproved.`\`��
Conditional approval for bedrooms, with the following stipulations:
OFANCh r,
_ nN-SITE
WATER AND z-
I ^
PROGRAM
%p 14 :
BY: Original Certificate DateMPP�9111 �s
The Municipality of Anchorage Development Services Division(DSD) issues Certificates of On-Site.Systems:Approval (COSA) based :only
upon the representationsgiven in paragraph 5 by, independent professional civil engineer registered 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 Arsenio Advisory
Well Flow Advisory Other
_ COSA tilde sheet 10-16-12Aec. - _
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: SOUTHFORK NORTH BLOCK 6. LOTS — _ — Parcel ID: 078.021.20
A. WELL DATA
Well type PRVT If A, B, or C provide PWSID #
Date completed 711012004
P.M-
Sanitary seal (Y/N) Y
Total depth 154 ft.
Cased to 154 ft.
FROM WELL LOG
Date of test
7/10/2004
Static water level
38 ft.
Well production
8 9—
WATER SAMPLE RESULTS:
Coliform 4E& colonies/100 mL Nitrate 0+1 Z9 mg/L
Arsenic: hA9 ug/L Date of sample: 11-5-20150
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC 1 STEEL
Tank size 1000 gal. Number of Compartments 2
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
Date of pumping *.4 ZD- d Pumper���
C. ABSORPTION FIELD DATA
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 24+ in.
AT INSPECTION
11.15.2015
ft
Collected by: ARCTERRA
Date installed 8/2/2004
Cleanouts (Y/N)
High water alarm (YIN) N
Date installed 8/2/2004 Soil rating (g.p.d./ftz or ft2/bdrm)150 System type SHALLOW TRENCH
Length 52 ft. Width 5 ft. Gravel below pipe 4.46 ft.
Total depth 7.3 ft. (Measured 1115/15) Eff. absorption area 520 ft? Monitoring tube Y Depression over field N
Date of adequacy test 11.5.2015 Results (Pass/Fail) PASS For 3bedrooms
Fluid depth in absorption field before test 0 in. Water added 460 gal. New depth 0 in.
Elapsed Time: 11 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes; give date
D. LIFT STATION
Date installed
"Pump on" level at — in.
Datum
E. SEPARATION DISTANCES
WELL ON LOT TO:
Size in gallons
"Pump off' level at _ in.
Cycles tested
Septic tank/lift station on lot 1001+
Absorption field on tot 1001+
Publicsewermain 75'+
Sewer /septic service line 251+
Manhole/Access (Y/N)
High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout 100'+
Holding tank
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 54 Property line 51+ Absorption field 5'+
Water main 104 Water service line 104 Surface water 1001+
Wells on adjacent lots 100'+ j
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 104 Water main 104
Water Service line 101+ Surface water. 100'+ Driveway, parking/vehicle storage 104
Curtain drain 504(NONE KNOWN) Wells on adjacent lots 1001+
F. COMMENTS
*Well Plug installed below wellsea]. Steep icy switchback driveway,= septic tank to be pumped next summer.
G. ENGINEER'S CERTIFICATION
I certify that l 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. OF
lowALS
Engineer's Printed Name KENNETH M. DUFFUS / r
Date 1147.2105. 0* TJj
9H;*
COSA canary sheet_2-e-15.doc
KEN - - N. OF
tte1*14
J0
-� Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program=
4700 Elmore Street
U P.O. Box 196650
R N i Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
,y FOR A SINGLE FAMILY DWELLING
_
Parcel I.D. -'19 /' '--L6 nRo?�1R
COSA #_
/ Z Q
1. GENERAL INFORMATION Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s) I is n;, ,. eer
. Day phone 694- leso
Mailing address PO box 'T-41092 C I Ak
Lending agency
Day phone
Mailing address
Real Estate Agent Eva ok .,
— Day phone 684 -6y -fro
Mailing Address
Unless otherwise requested, COSA will be
held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual Water Storage
❑
Individual On-site
Community Class Well
❑
Individual Holding Tank
❑
Public Water System
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
I 'L7.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation.
based that
procedures outlined in theand/or Iwa t wastewater disposcate of On -Site altems systempisr (arae) safe,nes functional and or this application,
shows that the on-site waterand
tsupply
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from thV Cicipality of Anchorage( file; and from my investigation applicable Municipal and Stale codesh,lhe* on-site ,
supply Ory ^ater disposal system is are in compliance with all app
ordinac �1 _ regulations in effect at the time of installation.
• .3`1110
Name of Firm -SP tA A1f%A neeri„5 Phone Z�9_^
Address 2° S W, 1511
Engineer's Printed Name
5. DSD SIGNATURE
Approved for bedrooms.
Date 9 9�
��.pF qtgs�1t'
% :49TH
' p .•i
� LAAs e. SPUFKLA`:D:�, �
1(�1j500 V
H4oFES5ttl�P�'�'�
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
i
?: ON-SITE ••
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Supplemental Engineer's Report
Well Flow Advisory
Nitrate Advisory Other
Original Certificate Date: 011
By:
(Ra. HN5)
Municipality of Anchorage
Development Services Department
Building Safety Division 7
On -Site Water & Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Sc.,is &rk Nor4,N Dlo4L 6 AoV 3 Parcel ID:Di 8 -02.1-20
r
A. WELL DATA
Well type P wAt If A. B, or C provide PWSID # = Well Log (Y/N) y
Date completed 1-oY Sanitary seal (Y/N) Wires properly protected (YIN)
Total depthI
- Stif ft. Cased to 15y ft Casing height (above ground) t-18 in.
FROM WELL LOG
Date of test to u
Static water level 3 ft.
Well production 18 9 p m
WATER SAMPLE RESULTS:
.Coliform 0 colonies/100 mL Nitrate 0. IZ mg/L
Arsenic: ND ug/L date of sample: 1- "2oj6
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material k�IDMAe TIA
Tank size 1000 gal. Number of Compartments Z
AT INSPECTION
9 IR I 0
unknown ft.
5.6 g.p.m.
Other bacteria _0 colonies/100 mL
Collected by: _ nz1,
Date installed _ 8'L�2.00� y
Cleanouts (Y/N) y
Foundation cleanout (Y/N) _% Depression over tank (Y/N) /V High water alarm (Y/N) A/
Date of pumping 9 11 0 Pumper
C. ABSORPTION FIELD DATA
Date installed 44-7001, Soil rating (g.p.d./ft2or /bdr ) 150 System type_S4a�low I�ercl>
Length ft. Width 5
„ ,: ft. Gravel below pipe- 9,9fo ft,
Total depth 1.1 ft. Eff. absorption area 5-10_ft2 Monitoring tube i/ Depression over field N
Dale of adequacy test _21$ o Results (Pass/Fail)P- 1151, For 3 bedrooms
Fluid depth in absorption field before test _)0' in. Water added 640 gal. New depth in.
Elapsed Time: ,_ min. Final fluid depth in. Absorption rate >= `l50
g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) None ke%.... . If yes, give date
D. LIFT STATION
Date installed
-Pump on' lev _in•
Datum
E. SEPARATION DISTANCES
Size In gallons Manhole/Access (Y/N)
'Pump off" level _in. High water alarm level a
in.
Cycles to d Meets alarm t: it requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
I
Septic tank/lift station on lot I00 +
r
Absorption field on lot 100+
Public sewer main 14
Sewer /septic service line ZS r t
Animal containment areas 50r1-
On adjacent lots too r+
On adjacent lots jpp r+
Public sewer manhole/cleanout n��A
Holding tank N�A —
t
Manure/animal excrete storage areas I o0+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 1
5 t+_ Property line 5 1+ Absorption field 5 t
Building foundation p �' i
In + Water service line lot
( Surface water
Water main I oo+
Wells on adjacent lots -00r+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: i o 1+
t1U
Property line Io + Building foundation r+ Water main
1lock
Water Service line is rA- Surface water 100 + Driveway, parkingNehicle storage
Curtain drain
/\J, 0. WO, Wells on adjacent lots 2cot+
F. COMMENTS
e\L b L o%- ale11 sca� • ��
�o,F.A. q 11
G. ENGINEER'S CERTIFICATION - ' s�i
1 certify that 1 have determined through field inspections and 91
H , t
review of Municipal records that the above systems are in /
conformance with MOA COSA guidelines in effect on this date. S o
/ LgFS E..S _Vry
LAQS Spur�IA� �� �'. 1 00 :VI
Engineer's Printed Name r' jSO�P.��-
Date
C f W "
COSA Fee $, Waiver Fee $_ p j
Date of Payment
9 �� Lqd Date of Payment
Receipt Number �J3U Receipt Number
(Rev. 11/05)
ME Ref. #. 1084537
Client Name: Tobben Spurkland P.E.
Project Name: South Fork North 131, L1
Client Sample ID: South Fork North 81, L1
Matrix: Drinking Water
PWSID n/a
SGS Environmental Services
200 W. Potter Drive
Anchorage, AK 99518
Tel: (907) 562-2343
Fax: (907) 561-5301
Client PO#:
Printed Date/Time:
Collected Date/Time:
Received Date/rime:
Technical Director.
n1a
09/11/08 11:50
08/26/08 15:55
08/26/08 16:53
Stephen Ede
Released By:
Deanna crump
Sample Remarks:
Arsenic. Nitrate, Total Coliform data
Parameter
Results POL Units
Allowable Prep
Analysis
Method
Limits Date
Date
Init
Arsenic (As)
ND
Nitrate/Nitrite
0.12 ug/L
EPA200.8
10
09/11/08
SCL
Colonies
0.00 mgt
EPA 353
10.0
09/11/08
Total Coliform
col/100ml
SM209222B
o.o
Fecal Colitonn
0
08/26/08
DLC
0
0826/08
DLC
0826/08
DLC
f.1
n
No4e; To St.,,tn
on F; It.
ASSUILT
Copy
EN
1 HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
tr�� met' 6
AND THAT NO ENCROACHt TENTS EXIST EXCEPT AS
OWNER TO INDICATED, T IS THE RESPONSIBILITY OF THE
MINE THE EASEMENTS, COVENANTS, OR RESTRICTISTENCE OF ONS
Y
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY I)ATA OFFENCE LINA E USED FOR CONSTRUCTION
ARY LINES. OR FOR ES
TABLISHJ,NG BOUND-
I•d
s1SiARD 6 ASSOSCALEt CIATES LANA SURVEYING 69
DATE: OF..At
GRID:TM
FB- / •D'— Ms.k 3---,d*
/os- - 3 ��4 '• LS -8918
DRAWN �1,�f�� •.....• ' �S*�i
ASR v,w T'�
Municipality of Anchorage
• Development Services Department
Building Safety Division
Onsite Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.d.anchorage.ek.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 07802120 HAA#
1. GENERAL INFORMATION Expiration Date: 3 ` a 0 s
Complete legal description SOUTHFORK NORTH SUBDIVISION: LOT 3. BLOCK 6.
Location (site address or directions) NHN WEST RIVER DRIVE • EAGLE RIVER, AK. 99577
Current Property owner(s) JOHN THOMSON Day phone 240-2020
Mailing address 17343 SANTA MARIA DRIVE + EAGLE RIVER, AK. 99577
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:
TYPE OF WASTEWATER DISPOSAL:
Individual Weil
■
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
CommunityvClass Well
❑
Community On-site
❑
Public Water System
❑
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 samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or 8 wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the onsite 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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SURE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines 6 Regulations. The reported results described 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 soils condition, groundwater 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 the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will it confer any legal night whatsoever.
5. DSDSIGNATURE
Approved for 3 bedrooms.
Disapproved.
Conditional approval for
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Phone
337-6179
Date ft 12,7 o
bedrooms, with the flowing stipulations:
Manitenance Agreements
Supplemental Engineer's Reort
Other
WgFR AND
WASTEWATER
By: Original Certificate Date: -.2 — O
(Rw. 12/01)
Municipality of Anchorage
Development Services Department
Building Safety Division m g
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Boz 196650 Anchorage, AK 99519-6650 b
www.ci.anchorage.ak.us
(907)343-7904
,
HEALTH AUTHORITY APPROVAL CHECKLIST
E
Legal Description: SOUTHFORK NORTH SUBDIVISION, LOT 3. BLOCK 6, Parcel ID: 07802120
A. WELL. DATA
Well type PRIVATE If A, B, or C provide PWSID# NIA Well Log (Y/N) YES
i
Date completed 7/16/2004 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES f
x
Total depth 154 ft. Cased to 154 ft. Casing height (above ground) 24+ in.
l
FROM WELL LOG AT
INSPECTION
Date of test 7/16/2004
—
Static water level 35 ft,
ft.
P
Well production 8 g.p.m.
— at 0.
f
WATER SAMPLE RESULTS:
Coliform'.._ colonies/100 mi. Nitrate&•MC mg./L. _Other
bacteria _$�_colonies/100 ml.
Arsenic: N/A mg./L. Date of sample:
Collected by: GEG, LtD.
i
B. SEPTICIHOLOING TANK DATA
I
Tank Type/Material STEEL
Date installed 8/3/2004
Tank size 1000 gal. Number of Compartments 2
Cleanouts (Y/N) YES
r
Foundation cleanout (YIN) YES Depression over tank (Y/N) NO
High water alarm (Y/N) N/A
r
d
Date of pumping NEW Pumper
C. ABSORPTION FIELD DATA ®
I
Date installed 8/3/2004 Soil rating .p.d. r ft2/bdrm) 1_0
System type SHALLOW TRENCH
Length 52 ft. Width 5 ft.
Gravel below pipe 4.46 ft,
r
Total depth !.8-7.Oft. Eff. absorption area 520+ ft' Monitoring tube YES : Depression over field NO
l
Date of adequacy test NEW Results (Pass/Fail)
— For ms
M
Fluid depth in absorption field before test= In. Water
_gal. New depth =in.
F
Elapsed Time: = min. FNai epth = In.
Absorption rate >= — g.p.d.
�r ytaj ion treatment (past 12 mo.) (Y/N & type) —
If yes, give date —
I
Y
S
Date installed
"Pump on" level at _in.
E. SEPARATION DISTANCES
Size in gallons
High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
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 too'+ Driveway, parking/vehicle storage 5'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and f'.'
review of Municipal records that the above systems are in """""' ' "" """..
conformance with MOA HAA guidelines in effect on this date.
Gam ss; ...
Engineer's Printed Name JEFFREY A. GARNESS 79`
Date 11(2 9 �0 y �•pro..,.wad EC
w
HAA Fee $ 5 7
Date of Payment j I I ag IoN
Receipt Number
(Rev. 17J01)
Waiver Fee $
Date of Payment
Receipt Number