HomeMy WebLinkAboutSOUTHFORK NORTH BLK 6 LT 4outhfork
North
Block 6
Lot 4
#078-021-21
Municipality of Anchorage
Development Services Department
US-0
Building Safety •�M� �V��
Division
On -Site Water and Wastewater Program, 4700 S. Bragaw SI
.
P.O. Box 196650 Anchorage, AK 99519-6650 Page , ofzj
www.cl.anchorage.ak.us
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION
REPORT
Permit Number: W O 7.7 PID Number:
N.«..eki Illur
Wastewater System: New El Upgrade
7
1111LIVII
V.7ABSORPTION FIELD
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LEGAL DESCRIPTION SM R.nna • INN DePR hpnpynN pM•
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SEPARATION DISTANCES
Septic ❑Floldin g ❑ S.T.E.P. ❑Other:
To Septic Absorption Lill
From Tank Field Station
Holding WIIUPfWele
Tank Sewer Line
"'K^'•' .n.a1r
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17034 Eagle River Loo Road No. 204
Inspections performed by: g P
Dates: 1"
..: = ..i
2 n
Development Services Department Approval
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'tel ftoetRT C tawnri
Rev
Reviewed
ed and approved by: Date:
cc 8801 i• ,�
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PERMIT NO. SW040472
PACE 2 OF 4
Municipalit of Anchorage
DEPARTMENT OF HEATH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 •Anchorage, Alaska 99519-6650 • Telephone 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 4, BLOCK 6, SOUTHFORK NORTH S/D P.I.D. No. 078-021-21
LOT 5 \ `• '•� LOT 6
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L C- CE 8801
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PERMIT N0. SW040472
PACE 3 OF 4
Municipalityof Anchorage
DEPARTMENT OF HEATH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 4, BLOCK 6, SOUTHFORK NORTH S/D P.I.D. No. 078-021-21
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PERMIT NO. SW040472
PACE 4 OF 4
Municipalit of Anchora e
DEPARTMENT OF HEATH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 •Anchorage, Alaska 99519-6650 • Telephone 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 4, BLOCK 6, SOUTHFORK NORTH S/D P.I.D. NO. 078-021-21
1 ST2 � 99.7'
FINAL GRADE
95.5'_/11000NGALLON
POLYETHYLENE
SEPTIC TANK
2" INSULATION
95.2'
CO1
CO2 PMT1CO2
O1=58.9'
2 = 58.7'
FINAL GRADE
JIM INSULATION
.�
'H ••2 = ••
MT2 = 54.3'J "MT1 = 54.3'
NO WATER FOUND
46.3' B.O.H.
N. T. S.
A
B
FCO I
I S.0
7.5
ST1 1
33.0
37.5
ST2
36.0
41.0
TMT
37.5
43.0
DBL1
38.5
43.5
DBL2
39.0
44.0
C01
263.5
275.0
CO2 1
207.5
222.5
CO3
124.5
134.5
C04
215.0
228.0
MT1
260.5
271.5
MT2
206.0
221.0
N. T. S.
Certff feb orftling Rog
by
DOC CO. dba
SULLIVAN WATER WELLS
f P.O. BOX 670272, CHUGIAK, ALASKA 99567 *TELEPHONE 688-2759
s
t i
OWNER OF LAND: kI J/..J n/09 P1+Y BORE HOLE DATA
ADDRESS:
LEGAL DESCRIPTION: _SL/Trii
/3L [L /
DATE:
PERMIT NUMBER: O4 O U Date.of Issuel—) - JJ
.----•TAXIDENTIFICATION NUMBER:'&21--P- 17a/ -2L
Is well local ed at approved�errnit location? Q-Ye's O No
Method of Drilling:r rotary p cable tool
Depth of well:
Casing Type Tc - Wall Thickness inches
Diameter—6 inches, depth feet
Liner Type: l..w ,....1 c'
,.-Casing Stickup Above Ground: feet
Static Water Level: feet
Recover Rate: I C gpm
Method of Testing: /'il 11
Well Intake Opening Type: ty -on end 0 open hole
�e/
_0 Screened; Start feet Stopped�-
0 Perforations Start feet Stopped feet
Grout Type: Ar'� T' Volume S L S
Depth: from ✓✓ feet, to feet
Well Disinfected Upon Completion? 'Yes O No
Method of Disinfection: C H < ir.-,je 60
Comments:
1 I C'r1 S .,. r. J� r, r-,,- J A
Driller's Name 12, LA
ATTENTION: It Is the responsibility of the property / r
P ty p perty owner to submit a copy of the well rog E6ti`e pr p�f aut�o� trly°Municipality
of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSv Borough:
Department of Environmental Conservation. ' - I
MUNICIPALITY OF ANCHORAGE
Development Services Department
Onsite 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
Initial
Permit Number: SWO40472
Date Issued: Nov 04, 2004
Expiration Date: Nov 04, 2005
Parcel ID: 078-021-21
Legal Description: !SOUTHFORK NORTH SUBDIVISION BLOCK 6 LOT 4
Design Engineer: 0003 S & S Engineering Site Address: NHN WEST RIVER DRIVE
Owner Name: KEVIN MURPHY Lot Size: 241908 SO. FT.
Owner Address: NHN WEST RIVER DRIVE Total Bedrooms: 3 Permit Bedrooms: 3
EAGLE RIVER. AK 99577 -
This permit Is for the construction of:
0 Disposal Field [?] Septic Tank ❑ Holding Tank ❑ Privy Q 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
Date: lr l t lo7'
Date:
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.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 6 0'6'p%- P-/ Permit Number SW
Property
KeViri / /urPhilz Day phone a:93',-)yVq
Mailing address (1) dU.2
&ng address (2) .
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Lot Size AL1069 Acre Sq.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms 3
8957.7
Sewer Only ❑ Well Only ❑
Sewer and Well 09 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.
(Signature of property owner or authorized agent)
PermitFees:
/)r � N60."
Date of Payment: O / a-g/o y
Receipt Number: v (.0 1 6 3 !Jn
(Rev. 12/00)
S & S ENGINEERING
17034 Eagl* River Loop Road No. 204
Waiver Fees:
Date of Payment:
Receipt Number:
October 27, 2004
ROBERT C. COWAN, P.E.
CML ENGINEERS
(907)8942979
FAX(907)694-1211
,EAMA„T,OF1ITM
MUNICIPALITY OF ANCHORAGE
APPfl VALS
Development Services Department
P.O. Box 196650
Anchorage, AK. 99519
SEWERS WATER
"ANECTENSIONS
REFERENCE: Lot 4, Block 6, Southfork North S/D
SEWERSWATER
It is requested that you issue a permit to install a septic system to serve the proposed
INSPECTION
three bedroom dwelling on the referenced property.
A test hole was excavated and a percolation test was performed. The approximate location
ENGINEERNGSTUDIES
of the test hole is located on the attached site plan. At the time of excavation 4/03/00 water
ANDREPORTS
was not found. After seven days of monitoring the test hole was found to be dry.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
muINSPECTION
areas or drainage patterns by the installation of the proposed septic system. The
&FLOWTEST
construction of this system will not prevent any future development on any of the adjacent
properties.
SITE PANS
If you require additional information, please contact us.
Sincerely,
RCAD DESIGN
Robert C. Cowan, P.E.
SOCIEST
RCC/jhm
Enclosure
PERCOWION
'
TEST
STRUCTUOL S
LECHANC1L
NSPECTIom
ONSITE
WASTEWATER
DtSPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER ALASKA 99577
1 " = 40' DESIGN SITE -PLAN
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PERFORMED
Municipality of Anchorage
DEPARTMENT OF HEALTII 8 HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
LEGAL DESCRIPTION:_
DE PT I/
(FEE TI
1_
2
J/1
3-
4 ;
5
6-
� 'r
7 /
8-
9-
9 / D
u
10 aa/
11 Com/
IV
Q/1LI,+r
511.1"
13
14
15
16
17
18
19
a
rs
WAS GnOUND WATER
ENCOUNTERED?
S
IF YES. AT WIIAT L
O
DEPTIP �'
P
E
Depth to Water After DAY /o-,s'_o'y
Mottitatinp7 �M V,._ Dam: 4 "11 '00
Reading
Date
Gross
Time
Net Depth to Net
Time Water Drop
—P
t•
PERCOLATION RATE
Immutevmchl FERC NOLE DIAMETER
COMMENTS 5 1KN-f'LL
TEST RUN BETWEEN
0bw— oJ-Slrtr- - Pe�eecr c
FT AND al FT
t�ItDE.
$1
it
a ,
rs
WAS GnOUND WATER
ENCOUNTERED?
S
IF YES. AT WIIAT L
O
DEPTIP �'
P
E
Depth to Water After DAY /o-,s'_o'y
Mottitatinp7 �M V,._ Dam: 4 "11 '00
Reading
Date
Gross
Time
Net Depth to Net
Time Water Drop
—P
t•
PERCOLATION RATE
Immutevmchl FERC NOLE DIAMETER
COMMENTS 5 1KN-f'LL
TEST RUN BETWEEN
0bw— oJ-Slrtr- - Pe�eecr c
FT AND al FT
t�ItDE.
$1
it
a ,
20
t__]
PERCOLATION RATE
Immutevmchl FERC NOLE DIAMETER
COMMENTS 5 1KN-f'LL
TEST RUN BETWEEN
0bw— oJ-Slrtr- - Pe�eecr c
FT AND al FT
t�ItDE.
$1
PERFORMED BY. S A S ENGINEERING I CERTIFY THAT TyiIS TES WAS PEnronMED IN
17034 Eayle Rivper Loop Rud U4i / I
ACCORDANCE Wl �Jii �' AV&ii LnrIG1tAL G I S IN EFFECT ON THIS OATE. DATE: y q d V
72 008 (Rev. 41851 ri�/7
S&
ROBERT C. COWAN, P.E.
CML ENGINEERS
(907)694-2979
FAX(907)694.1211
ON-SITE WASTEWATER DISPOSAL SYSTEM
HEALTR91THO07Y
CONSTRUCTION PRACTICES .
APPROVALS
and
MATERIAL SPECIFICATIONS
SEWER ILWATER
MAW EXTET4gfS
.
REFERENCE: Lot 4, Block 6, Southfork North Subdivision
October 27, 2004
°R•W"TER
INSPECTION
GENERAL:
1. The scope of this project includes the installation of a 1000 gallon Premier
polyethylene septic tank and a new trench to serve the proposed three
„°mRE� 5T1D
bedroom residence located on the referenced property.
2. Construction shall be in accordance with the approved site plan and design
drawings, Municipal permit with any special provisions or conditions, and all
WELL TES;"10N
applicable State and Municipal Wastewater Disposal Regulations.
3. The contractor shall be responsible for obtaining any necessary underground
utility locates.
SITE PIANS
4. Unless specifically agreed otherwise, the property owner shall be responsible
for final grading areas subsequently depressed from soil settling.
ROAD DESIGN
5. Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department for system installations. Owners installing their
own systems must also receive prior approval from the Municipal Health
solLrEsr
Department.
SEPTIC TANK INSTALLATION:
PERCOLATION
TEST
1. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
STRUCTURALS
CKMACAL
INSPECTIONS
2. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
ON SITE
WASTEWATER
DSPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER ALASKA 99577
Page 2
Lot 4, Bik 6, Southfork North SID
October 27, 2004
All standpipes on the septic tank shall extend a minimum of 12 inches above final grade.
4. Septic tanks installed with less than 4 ft. of cover shall be insulated.
A foundation cleanout shall be installed one to four feet from the building foundation. In
the line between the tank and the leachfield there shall be two adjacent cleanouts (unless
an effluent pumping system exists within the septic tank). These cleanouts shall be
located on undisturbed soil not more than 10 fl. from the tank. The first cleanout, in line,
shall be to clean toward the leachfield. The second cleanout shall be to clean toward the
septic tank.
6. Final grading over the septic tank shall be such that a positive slope exists away from the
septic tank.
ABSORPTION TRENCIIIDRAINFIELD INSTALLATION:
1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the
excavation shall be within 2 inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock)
placement.
2. Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced downward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
3. A silt barrier must be installed between the final gravel layer and the native soil backfill.
Ensure the silt barrier covers the entire gravel surface before placing backfill.
4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations
shown on the design, and extend a minimum of 12 inches above final grade. The portion
of the monitoring tube extending through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is equivalent to the effective depth of
the gravel as noted on the design.
5. Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The
finish grade over the trench must be mounded to prevent the formation of a depression
after settling.
Page S
Lot 4, Blk 6, Southlork North SID
October 27, 2004
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Tyne of Pipe Perforated Solid
Cast Iron
Yes
Yes
ASTM D3034 (PVC)
Yes
Yes
ASTM F810 (HDPE)
Yes
No
ASTM D2662 (ABS)
Yes
Yes
Use of a type of pipe other than listed above must be approved by the inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or
equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
7. When sand is being used as a filter material, its gradation specifications must conform to
current M.O.A. or D.E.C. requirements, which ever requirement applies.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of the
wastewater disposal system. These inspections will occur as follows:
Page 4
Lot 4, Blk 6, South(ork North SID
October 27, 2004
1. The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
2. The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer
is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -
construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or
control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these specifications
and plans and in accordance with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be
the owner's representative and will inspect the work as stated above to document the contractors
activities. Final acceptance of the contractors work rests with the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor to
carry out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR/INSTALLER
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWERIWELL SUBMITTAL COMMENT SHEET
To' 60B COWAN
Legal description: SOUTHFORK NORTH BLOCK 6 LOT 4
The attached paperwork has been reviewed and is being returned for the following reasons:
❑ Original signature or stamp missing on
❑ Calculation error in design. _
❑ Additional soils information needed.
❑ Water monitoring results inadequate. _
❑ Discrepancy in information submitted.
❑ Topographic information missing or inadequate.
❑ Incomplete; missing _
❑ Incomplete; missing _
❑ Additional adequacy test information needed. _
❑ Water sample unacceptable. _
❑ Measured/proposed distances/dimensions missing. _
❑ Locations of all soils, percolation and water monitoring tests not shown.
❑ Proposed system too deep for soils information submitted. _
❑ Well log required.
❑ Omission in narrative.
❑ Insufficient fill over tank or field._
® Other. THE TANK TO LEACHFEILD LINE CLEANOUTS MAY NOT BE MORE THAN 100 FEET FROM EACH
OTHER..
Name of reviewer: JOE GOODALL
Date: 11/3/2004
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
Municipality of Anchord
On -Site Water & Wastewater Program
(907)343-7904
u
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 078-021-21
1. GENERAL INFORMATION
Expiration Date: Z 1
Complete legal description SOUTHFORK NORTH; BLOCK 6, LOT 4
Location (site address) 1982 West River Drive *Eagle River 99577
Current Property owner(s) Kevin & Ann Murphy Day phone 223-2489
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual Well
E
Individual On-site
E
Individual Water Storage
❑
Individual Holding tank
❑
Community Class_ Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
WaiverArarianw request for:
Received by:
COSA m ba released .n ise requested by the engineer.
COSA Fee $
Date of Payment /^�o�ZA//�1
Receipt Number 037 L40 Ca
COSA# �Sc�6/ y931
Date:
Waiver Fee $
Date of Payment
Receipt Number
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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK, 99507
Engineer's Printed Name
Engineers Comments:
JEFFREY A. GARNESS, P.E.
In conducting this evaluation, GEG provided an engineering evaluation of the well andeesepfic system in accordance whin Ne
guidelines antlregulations established by the tdunicipallyofAnch rag, and intlusVj practices. The repodedresulm desnibe Ne
condition of the systems on the deals of the evaluation. Separation distances were measured toreadilyidamfiabe features.
Hidden defects or encroachments may exist that were not identified during the evaluation. The operational lite of all wells and septic
systems Selection a variety of variables inclumbg, but not limited to, soil conditions, gmuadwatertevels (Nat may flunusts during
the year), quality or construction (materials and workmanship), and the water usage oflhe family beiang Ne systems. These
conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee PoNrepedormence of Ne
sys em/s; therefore, GEG makes no wananty (express or implied) regarding the future performance of the well or septic system.
GEG makes no representation whether an alternative wall or septic system can be installed on the propely in Ne event amerorNe
current systems rail The content of this report is for the sale benefit of the pereoNparly who retained GEG. Reliance upon the
information provided in this repel by any other person or party, including but not limited to subsequent property purchasers, is not
aumorisas In short. GEG osevorvs any legal duty to anyone other than the persvilpaly who paid kr Nis repot.
6. DSD SIGNATURE
System #1 Approved for bedrooms.
Phone 337-6179
Date /0 r41 b
♦ : J f y A. Gayness
..b CE -79%g3
♦ FQ � �
♦ p P
LICENSE♦♦♦ kxxx`**
CAECC884
System #2 Approved for bedrooms.
Disapproved. \P_\1 _\ C.yOAi�i
Conditional approval for bedrooms, with the following stipu gs: ON-SITE
V7
WATER AND
By:
Original Certificate Date: 4 0'Z �—(
The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations 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
Septic System Advisory
Well Flow Advisory
(Rev. I011v12)
�t_ Nitrate Advisory
Arsenic Advisory
Other
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, LOT 4 Parcel ID: 078-021-21
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 8/24/05 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 117 ft. Cased to 117 ft. Casing height (above ground) 18+ in.
FROM WELL LOG AT INSPECTION
Date of test 8/24/05 10/4/16
Static water level 20 ft, 50.2 ft.
Well production 15 —9 P.M. 3.6+ g.p.m.
WATER SAMPLE RESULTS:
Coliform _� colonies/100 ml. Nitrate 0129 +ng./L. Collected by: GEG, Ltd.
Arsenic: N0 ug./L. Date of sample: 10/5/16
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/HDPE Date installed 6/17/05
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 9/28/16 Pumper JR'S PUMPING SERVICE
C. ABSORPTION FIELD DATA TELoW EXISTING GRADE
Date installed 6/17/05 Soil rating .p.d./ft r ftlbdrm) 08 System type SHALLOW TRENCH
Length 83 ft. Width 5 ft. Gravel below pipe 2 ft.
Total depth 4.5+ ft. Eff. absorption area 592 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 10/4/16 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 549 gal. New depth 3 in.
Elapsed Time: 142 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date -
MT ON NORTH SIDE OF TRENCH ONLY EXTENDS 20" BELOW THE INVERT.
MT ON SOUTH SIDE OF TRENCH ONLY EXTENDS 21" BELOW THE INVERT.
D. LIFT STATION
Date installed _
"Pump on" level at in.
Size in gallons Manhole/Access (Y/N)
"Pump off"level at wa er 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'+
On adjacent lots 100'+
Absorption field on lot
100'+
On adjacent lots 100'+
Public sewer main
75'+
Public sewer manhole/cleanout 100'+
Sewer /septic service line
25'+
Holding tank 75'+
Animal containment areas
50'+
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM
SEPTIC/HOLDING
TANK ON LOT TO:
Building foundation 51+
Property line
5'+ Absorption field 5'+
Water main 10'+
Water service line
10'+ Surface water 100'+
Wells on adjacent lots 109+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
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 t 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 10 /j r, /110
LICENSE
WAECC884
(Rev. 10/12/12)
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NOTES:
1. DISTANCES ARE EXPRESSED IN U.S. FEET.
2. DISTANCES SHOWN ARE PER PUT 88-12.
ENGINEERING, INC.
2525 Gambol] Street, Suite 200, Anchorage, Alaska 99503
Tele: (907) 563-3835 Fax: (907) 563-3817
LOT 4, BLOCK 6
SOUTHFORK NORTH SUBDIVISION
PER PLAT 88-12, ANCHORAGE
RECORDING DISTRICT, AK.
'•.�6, DECK
• O•
'REPARED FOR Kevin S. Murphy
P.O. Box 772303
Lingle River. AK 99577-2303
UR VEY CERTIFICATION: EEI has conducted a physical survey of this
roperty as shown on this drawing and that the improvements simated thereon
'c within the property lines and no encroachments exist other than noted.
XCLUSION NOTES: It is the owners responsibility to determine the existence
F any easements, covenants, or restrictions which do not appear on the recorded
lbdivision plat. NOTE: Under no circumstances should any data hereon be
:ed for the construction or for the establishing of property lines.
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