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Home My WebLink AboutSOUTHFORK NORTH BLK 2 LT 5b 25 13 02:49p Sullivan Water Wells 1-907-688-2259 p.1 193 SULLIVANWATERWELLS j _. Daersne-C-M-1ael-Geothermal Phane 907-688.2759 � wwwsu9Mevrshrwells.eon Well Log Permit Number. OSP 121049 Date of Issue 411a/2oiz Parcel Identification Number: 07814115000 Date Started: 4/1112012 Date Completed: 41IM012 Is well located at approved permit location? X—!Yes FNo Property Description SOUTHFORK NORTH Lot 5 Block 2 Section: Tom: Range: Property Owner Name & Address: DEREK RADER. Borehole Data: Soil Type, Thickness & Water Strata Casing Stickup Overburden Hardpan W/Cobbles Sand & Gravel Wet/Nolst Hardpan WICobbles Sand $ Gravel Water Sample Results: Arsenic: Nitrates Total Coliform Bacteria Other bacteria: From To a 2 2 4 4 33 33 37 37 64 — 54 64 --&D . ng/1 ..65 mgr u`Q coloniesit00ml, �------eoU100ml- Method of Drilling C' air rotary [7i cable tool Casing type: Wallthickness o_25 inches Diameter 6 inches Total: 64 feet Liner type: Diameter inches Depth: feet Casing stick-up above ground: 2 feet Static Water Level (from top of casing) 19 feet Pumping Level- feet after _9 hours pumping gpm Recovery Rate 20 gpm Method of Testing: Air Well Intake Opening Type x l Open End I Open Hole Screened Start feet Stopped feet Perforations Start feet Stopped feet Grout Type: Bentoniledrygranular Volume: 50 Pounds Depth n-4 Start 0 feet Stopped 44 feet Pump Intake Depth: feet Pump size: i ->P brand name Well disinfected upon Completion? IX Yes No Method of disinfection CHLORINE 5a PPN Comments: Well Driller: Sullivan Water Wells P.O. Bax 670272 Chugiak, AK 99567 (907)688-2759 Attention: The property owner shall provide this log to DSD (onsite) and DNR within 30 days of completion- ARCTIC PUMP & WELL INC. Jiro Sullivan ({y�� PO Box 770197 Eagle River, AK 99577 wa ua�c , (907) 688-2510 (907)258-2510 (907)745-2510 aow1@,eci.net Pump Installation Log Well Drilling Permit Number: osp121049 Parcel Identification Number: 07814115000 Date Of Issue: 4/10/2012 Legal Description SFN B2 L5 Property Owner Name Address: s o a -I'A- y /V MC3 Contracting Lot: 5 300 Hiland Rd Block: 2 Eagle River AK 99577 Pump Installaion Date: 4/14/2012 Pump Intake Depth Below Top of Well Casing: 55 Pump Manufacturer's Name Franklin Pump Model: 10JS05S4-2W230 Pump Size: 1/2 Pitless Adapter Burial Depth: 13 Feet Pitless Adapter Manufacturer's Name B-10 Pitless Adapter Installer: U/K Well Disinfected Upon Completion? Yes Method of Disinfection: Chlorine Comments: PumpinstallerName: Arctic Pump & Well, Inc. Thursday, February 21, 2013 On -Site Water System Permit 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 Permit Number: OSP121049 Tax Code Number: 07814115000 Work Type: Well Initial Permit Effective Dates: April 10, 2012 to April 10, 2013 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: SOUTHFORK NORTH Site Legal Address: SOUTHFORK NORTH BILK 2 LT 5 G:0959 Owner/Address: RADER DEREK D 3750 MCMAHON AVE ANCHORAGE AK 995162820 Site Mailing Address: Lot Size in Sq Ft: 61999 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field N Septic Tank N Holding Tank N Privy Y 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. Receive Issued MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program � � 1 ' Mayor Dan Sullivan RU ON-SITE SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 078 -1 y J- 15 y v(to Property owners) I- k)-,cQ Day phone - ('907 )3 51 - 3 77�2. Mailing address 37SO Mc / 1adoAl� — Nnk'AcL , qq� jC Site address AJHnj 50 fk kir—c— O rl ue- Legal description (Sub'd., Block & Lot) I�hIA lary- bre LLT- S; 3loci± Legal description (Township, Range & Section) Lot Size 6�9q 9 Sq. Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (19 all that apply) - Initial Absorption Field ❑ Septic Tank[] Upgrade El Holding Tank ❑ Renewal ❑ Privy ❑ Private Well Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: 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: Permit/Rush Fees: JCD + ) )Push Waiver Fees: Date of Payment:. q113 I I d. Date of Payment: Receipt Number: nom( -5)5 PermitNo._ OSPIdIO`I� Receipt Number: Waiver No. GABuilding\On SiteTormsUient FormsTermh App_010411.doc (Rev. 1/11) Ix \ S FORKIA= + S/DLOT. SOUMFORK MOM S/D LOT 2.8LOCK 4 r r SONiHFORK NORM S/D LOT 3.9LOCK 2 \ a D.B. CRAY HOMESTEAD 012 N S/D 7 —11/19/200 i�Yf T - --. .. .. x DRAWN BY. ALASKA «'ATER & �V-'ASTEyATER A.J.G. CONSULTANTS. INC.SCALE = 100 I>DF T{R-IIM IMn� Suf]f IUB • 1rKwpM1fe M1R p0511] • ►N(1NF TW]A5 AM • rAT V550.5746 'REPARED FOR PHONE NUTABER: PAGE NUMBER: KEN PINNED (9D7) 830-770D 1 OF 2 ECAC DESCRIPTION: SOUTH FORK NORTH SU@DWISION; LOT 5, BLOCK 2 WE OF WORK: SITE PLAN FOR PROPOSED WELL AND SEPTIC SYSTEM LOCATION 1 5 1 1 w070104` AS -BUILT DRAWING PARCEL 1141--15 1 I CSEREA 11 No �� S�1iHFORK 110M LM 4, BLOCK 2 TEST HOLE LOCATION ON OESICN WERE APPROXIMATE. ACCURATE LOCATIONS ARE AS SHOWN Sit 131.61 157.2i ST2 128.34 155.14 DBLI 125.20 153.18 DBL2 124.23 152.55 FS 94.64 135.85 COI 101.23 112.68 LQt 102.61 113.89 CO2 80.90 156.32 W12 79.24 153.85 CO3 85.42 106.56 6TT3 85,67 109.01 C04 62.30 153.89 MT4 60.30 153.11 ►,TTS f 125.79 151.94 SOUIHFDRK NORXN. SGLE rLOT 0., BLOCK 21-'� ' 100' WELL RNDUS _. GARNESS ENGYINTEERTNG GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS - - '•• Ml L TOOL RNA lute %. 14100LAAL M "M diol[ (1Rj vl m • ?aNOXyJh1Ty - PREPARED FOR: E NLMBER: PACE NUMBER: KENNETH PINNED 830-7700 2 OF 3 ^nIS LEM OESCRIFnON: DRAWN BY: PA SOUTHFORK NORTH, LOT . BLOCK 2 K.D.M. Y iTPE OF WORK: DeTE: AS—BUILT DRAWING 8/26/2008 Municipality of Anchorage Development Services Department``• 1\' Building Safety Division, On -Site Water 8 Wastewater Program, 4700 Bragaw St. 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. SW070104 PID Number. 078-141-15 Name: KENNETH PINNED Wastewater System: ■ New ❑ Upgrade Address: 3705 ARCTIC BLVD. #2724 a ANCHORAGE, AK ABSORPTION FIELD Phone: No. of Bedrooms: (907) 830-7700 3 Cl Deep Trench ■ Shallow Trench O Bed 0Mound 0Other LEGAL DESCRIPTION Sail Rating: 0.8 Total Do" ham original grade: 3 MAX n. GPD/Sq. n. Block: LDL: Subdivision: 5 SOUTHFORK NORTH Depth to pipebanam hem algNal grade: 1.98/1.48 Garel depth bencU ppa: 0.99/1.19 2 n rt Township: Range: Section: - - - rill added abere anginal grade: Grwel tewbth: 100 ® 50) SEE DWG. In. (2 n WELL: ■ New ❑ Upgrade Grwal width: 5 Number Of Enw: 2 O+rance between Epee: 15 R FL CbeeA'ication (Prhate. A.B.0 : IWeb To: Total obcrption yep: P'pe motorial: D 3034/ F-810 FL In. 575 so. in. bwtalw TWEED EXCAVATION We "Ow. 9/13-14/2007 Date Draped: staid Mal« Laval: OR\\- rL rwb: N0� Pump s.t At:GaeMq he"M Above Gra": TANK gle11 n In. SEPARATION DISTANCES ■Septic 0Holding 0S.T.E.P. 0Other To septic Absorption Lift Holding ublic/PMoN uO1F1lOL{1A1 PREMIER PLASTIC DapoNtY b galbrr: 1000 From Tank Field Station Tank sewer unee Well - - - - 25'+ yal«�. PLASTIC ""'ab« a a Portr.wnW 2 Surface Water 100'+ 100'+ — — — LIFT STATION Lot Line 5'+ 10'+ — — — Sae b galwr. � Foundation 5'+ 10'+ — — — an /dualet wrnP at ol: High water abrin el: Pump Nako Ebctr" Mpctbu p donned or Curtain Drain NONE KNOWN Remarks: HOUSE NOT BUILT AND WELL NOT DRILLED BENCH MARK Location and Description: BOTTOM OF TANK Mwmed Elwatbn: 99.04 rt GEG Ltd Inspections performed by: . Dates: 1st 9/13/2007 ENGINEER3 sBAI Qo� �04p 2nd 9/14/2007,9 - ,.. .s OQ t v 3rd Development Services Department Approval'? P . `�>*Op� approval: - Date: -2-� •• •••••• .. .........Conditional `ey Zle, eJ O ,p y ess: C6179,y t3 ' .lov 00, ��0400esslo" ov Revieawed and approved by: Date: r iNUMBER: AS—BUILT DRAWING PARCEL INUMBER: SW0 - SW070I04 078-11 41-15 �R EA SOUTHFORK NORTH, LOT 4, BLOCK 2 TEST HOLE LOCATION ON DESIGN WERE APPROXIMATE ACCURATE LOCATIONS ARE AS SHOWN 1 1 I 11 11 TH/1,{J 1 \ 1 TERNATE SITE ��------ r/ k :02 11 11 I I I I TH/z j1 11 11 II BL 1 1 I 1 NEW 1000 GALLON PREMIER PLASTIC SEPTC TANK A I B STI 131.65 157.24 ST2 128.34 155.14 DBL1 125.20 153.18 DBL2 124.23 152.55 FS 94.84 135.85 C01 101.23 112.68 MT1 102.61 113.89 CO2 80.90 156.32 MT2 79.24 153.85 CO3 85.42 105.58 MT3 85.67 109.01 C04 62.30 153.89 MT4 60.30 153.11 MTS 125.79151.94 QAP/ 03 COl�t NEW DRAINFIELDS 1 / 1 / / 1 / 1 / I / I / SI SOUTHFORK NORTH, B I LOT 8, BLOCK 2 r— 1• I I I 100' WELL RAIDUS ` L THOSE SHOWN DN THE RECORDriDo PLAT ARE NOT SHOWN HERE (( o Vr �v� GARNESS ENGII�TEERING GROUP, Ltd. p �.,. 4 ` CONSULTANTS S GENERAL CONTRACTORS -- �'••••• . i=I L RIOOR I A M0 tot • MIb101WL IIT "W ("Non. !PREPARED FOR: PHONE NUMBER: =O • �1lL w..y.,wwgwvgawn PACE NUMBER: 0 • ••••• ••... A. Gar KENNETH PINNEO 830-7700 2 OF 3 e ss; LEGAL DESCRIPTION: SOUTHFORK NORTH. LOT 5, BLOCK 2 DRAWN BY: K.D.M. OD•, Op a E-7953�_'• % 10 GR 4�0o •• �.. TYPE OF WORK: AS—BUILT DRAWING (R.. 01/05) PERMIT NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: — SW060163 078-141-15 GE INADEQUATE COVER OVER 0538-105.46 SEPTIC TANK AND LOWER TOP OF TANK AT INLET _ 104.37 INVERT OF BUNG INLET _ 103.61. WEST TRENCH FILTER FABR. MUATKN NEW 1000 GALLON 'PREMIER PLASTICS' SEPTIC TANK /NAL GRADE _ 99.46-99.23 rGR:� 1 `BOTTOM OF TRENCH 94.98 -- —10, TANK AT - 104.29 INVERT OF BUNG OUTLET - 103.23 EAST TRENCH I I F9V1 cORADE RrA 101.40+ M FILTER FABRIO-L /raKa11 —REIATNE ELEVATION OF BOTTOM OF TEST HOLE _ 09.99 (H2O B 89.98) GARNESS ENGINEERING GROUP, Ltd. �....�........ CONSULTANTS 3 GENERAL CONTRACTORS 3"1 E T1AOR RGA0. R 101 • "CHDRACL AR W301 . ROK (007IW 91T9 • FM ($OrA " • 9m59[t w�.9s.rnywwpae_ PREPARED FOR: PHONE NUMBER: PAGE NUMBER: KENNETH PINNED 830-7700 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: SOUTHFORK NORTH. BLOCK 2. LOT 5 K.D.M. TYPE OF WORK: DATE: PROFILE DRAWING 8/26/20, m.01105) RT OF RPE _ 9911 w OF TRDXH _ 97.32 RETATNE ELEVATION OF BOTTOM OF LEST HOLE _ 89.32 (H2O O 91.32) �z n^a ' w � •.'a P ••, F GO ESS' CE— e� I��p . �•'&I3� • oc �401�d PFO i D ? VX r� 3 i� of NSB /G s N •s ; � �P• 1�� n ON.j i • r F 0 �F W w z ccU O z J . t 11� Q 1 J lob \ 00 4i�Y 2(0, H5' ,Z%mN\5g3 fl•. p0. /3 �= RiY�R vE i,► `o 0o SDyTN� e � z �o W 0 0 ow¢ O Q W cc W 2 V I- crO= LLo Z V N = z z�LL M W a (n U) o W F 6 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 1D 1AP� j KU �1 4� ci ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Renewal Permit Number: SW070104 Date Issued: Jun 13, 2007 Expiration Date: Jun 12, 2008 Parcel ID: 078-141-15 Legal Description: Southfork North Block 2 Lot 5 Design Engineer: 0855 GARNESS ENGINEERING GROUF Site dotes: Unknow : 61999 SO. FT. Owner Name: KENNETH PINNED permit Bedrooms: 3 Owner Address: 3705 ARCTIC BLVD #2724 Total Bedrooms: 3 ANCHORAGE. AK 99503 - This permit is for the construction of: / Private Well ❑ Water Storage Q Disposal Field Q Septic Tank ❑ Holding Tank ❑Privy ❑ All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Z Received By: Issued By: i Date: Date: \ Municipality of Anchorage r. Development Services Department j Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEPTIC/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcell.D. c77k— / /?Ae'.61'L• o Day phone{9e70 k3 — 770 d Property owner(s)�/ NN�`TN Mailing address 3 7�S �,Ac;7.2 V- • Zip Code '9' Site address m N IJ So W h�1 \ \I >°x � �� rE Zip Code Legal description (Sub'd, Block & Lot) Legal description (Township, Section & Range) Lot Size ti ZL 999 Sq. Ft. THIS APPLICATION IS FOR (®all that apply): Absorption Field e� Septic Tank Holding Tank ❑ Privy Private Well Water Storage ❑ O eAr .? Number of Bedrooms 3 THIS APPLICATION IS AN: Initial ❑ Upgrade ❑ Renewal J3 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. (S gnature of propertyowner or authorized agent) Permit/Rush Fees: �t �� 7 Waiver Fees: Date of Payment: 7 Date of Payment: Receipt Number: q5 ARW Receipt Number: (Rev. 11105) MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 6 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Renewal Permit Number: SWO60163 Date Issued: Jun 16, 2006 Expiration Date: Jun 16, 2007 Parcel ID: 078-141-15 Legal Description: Southfork North Block 2 Lot 5 Design Engineer: 0855 Garness Engineering Group, LTD Site Address: Unknow Owner Name: KENNETH PINNED Lot Size: 61999 SO. FT. Owner Address: 3705 ARCTIC BLVD #2724 Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE. AK 99503 - This permit is for the construction of: 0 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 specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By. Issued By. Date: Date: iL /6 0-6 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsile (907)343-7904 ON-SITE SEPTIC/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 6 7 IS Propertyowner(s) • ��,r/NC�Ty %�jNNEd \\ Day phone (pe E ° '7700 Mailing address �17e S. �,r'c.�� +��✓a = 7z¢ Zip Code 9 *9%5'0 -7 Site address _ �_ Zip Code Legal description (Sub'd, Block & Lot) '561t4hFDCtr /1012TH T 2- L5 Legal description (Township, Section & Range) Lot Size 9/� 9�� Sq. Ft. THIS APPLICATION IS FOR (®all that apply): Absorption Field a Septic Tank Holding Tank ❑ Privy ❑ Private Well Water Storage ❑ Number of Bedrooms THIS APPLICATION IS AN: Initial Upgrade ❑ Renewal ❑ certify that the above information is correct. 1 further certify that this application is being made for a Single Family Dwelling and is in .Accordance with applicable Municipal Codes. `� (Signature of property owner or authorized agent) Permit1RushFees:L/&0•0 Date of Payment: Receipt Number. (Rev. 11/05) Waiver Fees: Date of Payment: Receipt Number: MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SWO40405 Legal Description: ,Southfork North Block 2 Lot 5 Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: Ken Pinneo Owner Address: 3705 ARctic Blvd Anchorage , AK 99503 - Date Issued: Dec 02, 2004 Expiration Date: Dec 02, 2005 Parcel ID: 078-141-15 Site Address: Unknow Lot Size: 61999 SO. FT. Total Bedrooms: 3 Permit Bedrooms: 3 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 specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By. Issued By. f 11— Date: r Date: 7 • Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 03-8- /L/1-(5- Permit Number SW Properlyowner(s) (<-£W -P(NNEO Day phone A3o^?-700 Mailing address (1) 377 C' 49T -IL gr_yp 2'*"4 /1 tVch Ah Mailing address (2) Zip Code 011 5 3 Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size 614i9 _Acr<� THIS APPLICATION IS FOR: Q Number of Bedrooms 3 Z -T Sewer Only ❑ Well Only ❑ Sewer and Well Water Storage ❑ Sewer Upgrade /❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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. (Signature of property owner or authorized agent) rKENe Peres t Fees: /( S �F_NE ry Waiver Fees: Date of Payment: 1210 Lo y Date of Payment: Receipt Number: 3 19 S70 &I Receipt Number: (Rev. 12100) MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM 1 WATER SUPPLY PERMIT Initial Permit Number: SW030496 Date Issued: Dec 03, 2003 Expiration Date: Dec 02, 2004 Parcel ID: 078-141-15 Legal Description: LSouthfork North Block 2 Lot 5' Design Engineer: 0041 AK Water & Wastewater Consultan+ Site Address: Unknow Owner Name: Ken Pinneo Lot Size: 61999 SQ. FT. Owner Address: 3705 ARctic Blvd Total Bedrooms: 3 Permit Bedrooms: 3 Anchorage . AK 99503 - 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. l: Received By. Issued By. Date: Municipality of Anchorage ,•. • Development Services Department •rllit 1' i; Building Safety Division „ �- - On -Site Water 3 Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING 1' � Parcel I.D. `n�uI —I Permit Number 5L~030049G Property owners) KEN PINNEO Day phone 830-7700 Mailing address (1) 3705 ARCTIC BLVD. ' ANCHORAGE, AK Mailing address (2) Zip Code 99503 Legal description (Lot, Block & Sub'd.) SOUTH'�ORK NORTH SUBDIVISION; LOT 5, BLOCK 2 Legal description (Section, Township & Range) N/A Lot Sized Q Q"^1 Acres q.Ft. 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. ALASKA WATER dr WASTEWATER CONSULTANTS, INC. Permit Fees: Date of Payment: Receipt Number. O —1 Waiver Date of Payment: Receipt Number: ALASKA WATER & WASTEWATER CONSULTANTS. INC. November 19, 2003 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Proposed Septic System for Lot 5, Block 2; South Fork Subdivision 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 a dual 5 -wide trench type drainfield. Two test holes were excavated on the property. The drainfields will be designed around the 30 foot radius of test hole #2. The proposed well is to be drilled in the area shown on the attached site plan and design drawings. 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. It is our opinion that an application rate of 0.8 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: 6.7 & 7.1 minutes/inch b. Proposed Application Rate: 0.8 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 563 112 f. Total Depth: 3.0 feet (max.) g. Effective Depth: 1.0 h. Width: 5 feet i. Reduction Factor: 0.87 j. Minimum Length: 100 feet long (2 @ 50) k Effective absorption area = 575 ft2 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: akwwc.com 4. TOPOGRAPHY: The area around the proposed drainfields is approximately 10-15% slope running east to west. 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�tny questions, please contact us at 337-6179. Thank you for your assistance. �� P.E., M.S. NOTE: A site plan drawing, a design dren ging, two soils logs, 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: akwwc.com / / I \ 1 \ SOUTHFORK NORTH :S/D/ \ LOT 3,BLOCK 2 \ \ \ \ SOUTHFORK NORTH S/D \ , LOT 1,BLOCK 4 \\ 1 1 1 1 1 I 1 1 1 I 7 SOUTHFORK NORTH S/D LOT I,BLOCK 2 , C _C� \ �DGflPOfCR fC S r4 1 t 1' A4TERNA7_ SffF` SOUTHFORK NORTH S/D 'y,^ — — LOT 2.BLOCK 4 11 1 1 \ -\` ---------- 1 i 1 Fi ♦ 1 /( ' 1 3 ♦♦�-----�' �-/ 1 X11 U D.B. GRAY HOMESTEAD \ \ n \ 1 \ ,1 \\ 1 PT1C SYSTEM / \ \GE 2 OF 2)' \ i ROPOSED 3, BEDROOM HOUSE \ SOUTHFORK NORTH S/D \ LOT 3, BLOCK 1 O \ Q \ \ POSED \�• \\I \\ \ \ 1 , 1 1 \ I 1 I 1 , 1 1 I \ P W � p/,D1Us 1 r `• 1 I I / 1 / ♦ ♦\ SOUTHNORTH S/D --- — LOTT6. B,BLOCK 2 / \ \ 1 100' WELL RADIUS I ALASKA «TATER & WASTE «TATER CONSULTANTS, INC. 11/19/2003 A.J.G. 1" = 100, PREPARED FOR PHONE NUMBER: PAGE NUMBER: KEN PINNED (907) 830-7700 1 OF 2 LEGAL DESCRIPTION: SOUTH FORK NORTH SUBDIVISION; LOT S. BLOCK 2 TYPE OF WORK: SITE PLAN FOR PROPOSED WELL AND SEPTIC SYSTEM LOCATION T � e ff 79531; �� ' '�� ♦,per:' ,I,w._•' ......''•c off'__+ pgtW01� ALASKA NVATER & «'ASTENVATER CONSULTANTS. INC. SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: SOUTHFORK NORTH SUBDIVISION; LOT 5, BLOCK 2 PERFORMED FOR: KEN PINNED DATE: 10/20/2003 DEPTH[�_'_'_'_'� (feet) f—=--� ORGANICS TEST HOLE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 GM/GM GM/SM SOIL CLASSIFICATIONS *+ ' GP GM GC .0 0- o • o SW '• �'• SP iNlfli SM � - 0 Sc DRY ML CL OL MH CH OH 7' 10/22/200 11111111 10/29/200 3:01 — 6' BEDROCK DEPTH TO GROUNDWATER DATE DRY 10/20/200 7' 10/22/200 8' 10/29/200 3:01 — DATE PERCOLATION READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) t 1 3:01 — 6' — 1 2 2:31 1 1 1/4- 4'3 4 3/4- to r" 1 NpN,G' 3 2:31 — TH/t — S TH#2 4 4:01 30 1 1/2- 4 1 2' 5 4:01 — 6' — i 1 / 4:31 1 / 4 1/2 - 2' � t 14 1 I 6" l SITE PLAN 1 1 1'-100' DATE PERCOLATION READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 10/20/2003 1 3:01 — 6' — 2 2:31 30 1 1/4- 4'3 4 3/4- 3 2:31 — 6' — 4 4:01 30 1 1/2- 4 1 2' 5 4:01 — 6' — 6 4:31 30 1 1/2- 4 1/2 - 2' PERCOLATION RATE 6.7 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 3.5 FT. AND 4.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: 0 YES ❑ NO SOILS LOGGED BY: KELLY HEITSTUMAN PERCOLATION TEST PERFORMED BY: CALEB CALL COMMENTS: PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WA PE FORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: O OF. 00 ALASKA �VATLR 8 �VASTENVATKR CONSULTANTS, INC. �' 4 '74 WNE - - ........ .. . ............ SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: SOUTHFORK NORTH SUBDMSION; LOT 5, BLOCK 2 1 7,Q ess.: PERFORMED FOR: KEN PINNEO DATE: 10/20/2003 �QQa. C 795 ' ti8`1 4 ... ' (feet) ORGANICS ��%p°p°'ofesslooa� �--r.� TEST HOLE 2 00000 1 M 2 3 4 5 6 7 8 9 10 GM/GM CLASS IFICATIONSCLASSIFICATIONS SOIL GW ---= ORG GP I I ML GM CL GC OL w o 0 •,> >.,• SW MH '• �'• SP CH 4t1SM �'"OH GM/SM o' SC — wOZO ' • 12 13 14 15 16 17 18 DEPTH TO GROUNDWATER DATE DRY 10/20/200 9' 10/23/200 9.5' 10/29/200 6• — % \ NET TIME (MINUTES) , 11 NET DROP (INCHES) 10/20/2003 1 1 � 6• — 2 2:31 1 1 5/8- 4 318- 8•3 3 2:31 — 6• — 4 , TH/2 30 1 1/4- , 5 4:01 — 6• — 6 4:31 30 1 3/4- 4 1/4- 1 i 1 � I G 1_ 1 SITE PLAN \ i".100, DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 10/20/2003 1 3:01 - 6• — 2 2:31 30 1 5/8- 4 318- 8•3 3 2:31 — 6• — 4 4:01 30 1 1/4- 4 1/4- 4•5 5 4:01 — 6• — 6 4:31 30 1 3/4- 4 1/4- 19 PERCOLATION RATE 7.1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 3.5 FT. AND 4.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO SOILS LOGGED BY: KELLY HERSTUMAN PERCOLATION TEST PERFORMED BY: CALEB GALL COMMENTS: PERFORMED BY AKWWC, INC. 1, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PrRFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: / Municipality of Anchorage On -Site Water & Wastewater Program (907) 343-7904 4 jz� \j CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcell.D. 078-141-15 Expiration Date: 1. GENERAL INFORMATION Complete legal description SOUTHFORK NORTH; BLOCK 2, LOT 5 Location (site address) 1991 SOUTH RIVER *EAGLE RIVER AK 99577 Current Property owner(s) DEREK RADAR Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: 3750 MCMAHON AVENUE *ANCHORAGE, AK 99516 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 351-3772 3. NUMBER OF BEDROOMS: 3 Date of Payment Receipt 0 imber CW1 Del 4. TYPE OF WATER SUPPLY: COSH # _. o5C ! 3 (GS 1 TYPE OF WASTEWATER DISPOSAL: ndividual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received by: ✓d Date: COSA tot? eleased to the engineer, unless otherwise requested by the engineer. COSA Poe $ �os' IUBW ZNSt� �0 � Waiver Fee $ Date of Fay ment r3 f c%1�� 3 Date of Payment Receipt 0 imber CW1 Del Receipt Number COSH # _. o5C ! 3 (GS 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 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. Phone Address 3701 E. TUDOR ROAD, SUITE 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 & 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 right whatsoever. 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved. 337-6179 Date 2/;)7 /13 it0 .�CI�rr��i bedrooms. = ON StTR G� bedrooms. Wo ATER o \N co ^ ®CERA a approval for te PR �� Conditional a pp � bedrooms, with the following sons: .r•�G�_! Zltot""JG _4m%y h%C tD Ale h"4 SG , -3 )The. `Jurl.e✓ iG 'ID k, LedG<k1<C) iD SMY/ 6I(5)`an///7 G<i�%/ /oKIH f l�Q�{C 1'Fi 'Fo be The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based oily rPa'reo( 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. ATTCHMENTS: COSA Checklist iC Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other By: (Rev. 11105) Original Certificate Date: 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 2, LOT 5 Parcel ID: 078-141-15 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 4/11/12 Sanitary seal (YIN) YES Wires properly protected (YIN) I YES Total depth 64 ft. Cased to 64 ft. Casing height (above ground) 24+ in. Date of test Static water level FROM WELL LOG 4/11/12 111061 Well production 20 WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. AT INSPECTION NEW WELL ft. M. g. p. m. Nitrate 0.653 mg./L. Collected by: GFG. Ltd. Arsenic: ND ug./L. Date of sample: 2/5/13 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/PLASTIC Date installed 9/13-14/07 Tank size 1000 gal. Number of Compartments E Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping ** Pumper — C. ABSORPTION FIELD DATA *BELOW FINAL GRADE Date installed 9/13-14/07 Soil rating (g.p.d./ftor /bdrm 0_8 System type SHALLOW TRENCH Length 2®50=100 ft. Width 5/5 ft. Gravel below pipe 0.99/1.19 ft. Total depth*4.08+/*4 50+ ft Eff. absorption area 575 3 ft Monitoring tube YES Depression over field NO Date of adequacy test ** Results (Pass/Fail) PASS For E bedrooms Fluid depth in absorption field before test — in. Water added =gal. New depth =in. Elapsed Time: — min. Final fluid depth = in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date **HOUSE WAS COMPLETED RECENTLY. SEPTIC SYSTEM HAS NOT BEENJNUSE. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump oft level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES 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 iGIsms On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS 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. Engineer's Printed Name JEFFREY A. GARNESS Date (Rev. 11/05) 01JUIUM ey A. Garness, C —79$3 ILA J•3' Eo° e " iolD/ ASBUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: ,fol/Tjy��P.F'�YO,f1/1SG.6,' `ors,�2 AND THAT NO ENCROACHikNTS €)IST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SCALE. GRID= Sw 9.s 9 FB- DRAWN. lliJ1 a -O+®14%40 t pF• A�gRm A SIcX'.ai �-��.rsx'x Njunicipality of Anchorage (d -- Development Services Department J Building Safety Division �_. On-Site Water 8 Wastewater Program 4700 Bragaw Street � P196650 Anchorage,age, AA K 99519519 -6650 www.muni.orgionsite (907) 343-7904 r ALI CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. D -79 - /414- / COSA# 0 + O / ✓� 3 1. GENERAL INFORMATION Expiration Date: Complete legal description SOUTHFORK NORTH S/D• BLOCK 2 LOT 5 Location (site address) NHN SOUTH RIVER DRIVE • EAGLE RIVER AK ' 99577 Current Property owner(s) KENNETH PINED Day phone 830-7700 Mailing address 3705 ARCTIC BLVD #2724 • ANCHORAGE AK * 99503 Lending agency Day phone Mailing address Real Estate Agent Day phone 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 On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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$ystems 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 B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I venfy 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. /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 Finn GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date [ 2R o Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 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 Me 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 right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: so % CnVele 0veY �"drt k d-�fe /�/ a - /t OtJS� 1)C_ -fbN.G tin C et, ef *17-1 crtA.l eL�'� Yo VAJ e / _,56 u eJ Attachments: COSA Checklist (/ Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other / By:4%%�� Original Certificate Date:�— (Rw i1N$( Municipality of Anchorage Development Services Department Building Safety Division \_- On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SOUTHFORK NORTH S/D• BLOCK 2. LOT 5 Parcel ID: O 7(q A. WELL 'DATA WELL NOT DRILLED. Well type If A. B, or C provide PWSID# _ Well Log (Y/N)- Date completed Sanitary seat (YIN)_ Wires properly protected (YIN Total depth ft. Date of test Static water level Well production WATER SAMPLE Colifoim'� Cased to ft. Casing height (ab round) in. FROM WELL LOG ATI CTION g.p.m. J- - colonies/100 ml. Nitrate mg./L. Other bacteria colonies/100 ml. entc: ' ug./L. Date of sample: Voueciea Dy: B. SEPTIC/HOLDING TANK DATA 'HOUSE NOT CONSTRUCTED YET. **SEPTIC HAS NOT BEEN USED. Tank i ype/Material SEPTIC/PLASTIC Date installed 9/13-14/2007 1000 YES Tank size gal. Number of Compartments ? Cleanouts (YIN) Foundation cleanout (Y/N) 'NO Depression over tank (Y/N) NO High water alarm (YIN) N/A Date of pumping "NEW Pumper C. ABSORPTION FIELD DATA EL w rwnL cRAo Date! finstalled 9/13-14/2227 Soil rating q.p.d. or ft'/bdrrn) 0_8 System type DUAL 5 WIDE TRENCH Length _jgLJ:L ®50) ft. Width 5 ft. Gravel below pipe 0.99/1-19 ft. .4.25/ Total depth _10—ft. Eft. absorption area 575 ft' Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fail) For Fluid depth in absorption field before test a ed _gal. New depth _in. _min. Final fluid depth _ in. Absorption rate >_ 9;PA Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date NOTE: `THIS IS A CONDITIONAL C.O.S.A. SOIL COVER OVER TANK AND LOWER DRAINFIELD MUST BE RESOLVED BEFORE A FULL C.O.SA CAN BE ISSUED. D. LIFT STATION Date installed Size in gallons Manhole/Access 'Pump on" level at in. 'Pump off" E. SEPARATION DISTANCES water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service areas WELL NOT DRILLED On adjacent On adjacent lots manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation • Property line 5'+ Absorption field 5'+ Water main N/A Water service line ' Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation • Water main N/A Water service line ' Surface water 100'+ Driveway, parking/vehicle storage 5'+ Curtain drain NONE Wells on adjacent lots 100'+ F. 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. 0...... Q fr y A. Co es -s Engineer's Printed Name JEFFREY A. GARNESS CE— %953%:� Date — ��25 f o4 •p.,S[.ZYr'��Qd��, WQ%pro f we s1on0� o COSA Fee S_ l S M0-94 02 G o • `� Date of Payment_ J 9 Receipt Number a�3.34 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number .Del o5 3 , "oa 1 23/ 6 J m N Q b '4, d) N mD C O 09 N `• W U m C N y� I-_ e=�L� �� N O� a96 N m b N `a Z,rn� W Yy c m am�•�vm g F- a•�•cc os Q m m L Ucc Oon- OL y,LLW d p m m v W y m rnLEE m m C C� m p� p C Q 'V d O-. N m� m•y p— L N O b C = ^C d O b ° m m °1 is x C mQ < NR W N O O m N n ¢E$Lm°$05 o/.H5, 0 0 0 < 53cl" A RI VE �o .o SoUTN, � s