HomeMy WebLinkAboutSOUTHFORK WEST BLK 4 LT 8outhfork
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Lot 8
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#078-031-20
Municipality of Anchorage
Development Services Department
f;
Building Safety Division
On -Site Water and Wastewater Program, 4700 S. Braga, SL
P.O. Box 196650 Anchorage. AK 99519-6650 Page / of 3
www ci.anchorage.ak.us (907) 34}7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. �vi 0 5'd /.0 PID Number:
Name
Wastewater System: ))New ❑ Upgrade
Adan
OX
ABSORPTION FIELD
��• �` / NuniWrq Batrooms
Tn o stun, Tn O eea o Mww 130~
LEGAL DESCRIPTION
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SEPARATION DISTANCES
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Inspections performed by: 14?1r Fn
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TN'. ISM
ERING
ILS LOG — PERCOLATION TEST
Date Performed: 6/3/05
Performed For: Mike Quinn
Legal Description: SOUTHFORK WEST Block 4, Lot 8
DEPTH
(FEET)
1
- _
Gross Time
Net ^Time
3
De'thV
Net Drool
1
6/9
5
--
6.25'
--
710
-
2
2 min
6.75'
0.5'
3
6/9
5
K
11
--
12
6/9
13 -
2 min
14 -
...
15 -
6/9
16 -
--
17 -
--
18 -
6/9
19 -
2 min
20 -
0.5'
Organic
Location Top of Ridge
Groundwater? No
Depth
GM Water Depth
Silty Gravel After Monitorino.11.5'
6/9/05 Monitor
/NO407-0,2 QR
OK 7/(2/05-Y z
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#
Date
Gross Time
Net ^Time
ENGINEERING
De'thV
Net Drool
1
6/9
0
--
6.25'
--
2
6/9
2
2 min
6.75'
0.5'
3
6/9
5
--
6.5'
--
4
6/9
7
2 min
7'
0.5'
5
6/9
9
--
6.5'
--
6
6/9
11
2 min
7'
0.5'
21 - Percolation Rate 4 min./inch Perc Hole Diameter 6'
Test Run Between 3' and 4'
Comments: Presoaked- Test Hole Near Hi h St e- S eclat Design Required
Performed By NorthRim Frg, I CERTIFY THAT THIS TEST WAS
Performed in Accordance with All State/Municipal Guidelines in Effect
ON THIS DATE. DATE: 6/13/05
TESTHOLE LOG
T. H, 3
GE❑TECHNICAL ;c..
-_.___-_- ----__-- 6/13/05
—_11 -of 2
NORTHRIM
ENGINEERING
17237 &&or Pow Circle
Eagle Rl" Alaska
'
, 99577
•, a-uaw
907694.7028
TESTHOLE LOG
T. H, 3
GE❑TECHNICAL ;c..
-_.___-_- ----__-- 6/13/05
—_11 -of 2
�2Th� IZI
ENGINEERING
S LOG - PERCOLATION TEST
Performed For: Mike Quinn
Date Performed: 6/3/05
Legal Description: S❑UTHFORK WEST Block 4, Lot 8
DEPTH
(FEET)
1 -
2 -
3 -
4
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12 -
13 -
14 -
15 -
16 -
17 -
18 -
19 -
20 -
21 -
• NCO..
Organic
Location See Drawing
Groundwater? No
Depth
GM Water Depth
Silty Gravel After Mnrni+nr,ly ^
,o01'10NifoR Q T�'
a,v -711zlos
#
Date
Gross Time
Net Time
De th
Net Dro
1
6/9
0
--
4'
2
3
4
6/9
6/9
6/9
2
4
6
2 min
--
2 min
4.5'
4.5'
5'
0.5'
--
0.5'
5
6/9
8
--
4'
--
6
6/9
10
2 min
4.5'
0.5'
Percolation Rate 4 min./inch Perc Hole
Test Run Between 3' and 4'
Diameter 6'
Comments:Presoaked
Performed By NorthRiM Fng• I 5 t CERTIFY THAT THIS TEST WAS
Performed in Accordance with All State/Municipal Guidelines in Effect
ON THIS DATE. DATE: 6/13/05
O AQ
NOR THRIM *yam.** TESTHOLE LOG j H. 4
ENGINEERING T
17237 Bear Pow Circle .•
Eagle River. Alosko 99377
907.694.7028 •••....... • -
---- --- _ -- _ OTECHNICALDotr 3�of 3
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MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water Q 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: SWO50188
Date Issued: Jun 21, 2005
Expiration Date: Jun 21, 2006
Parcel ID: 078-031-20
Legal Description: SOUTHFORK WEST SUBDIVISION BLOCK 4 LOT 8
Design Engineer: 0838 North Rim Engineering
Owner Name: MIKE QUINN
Owner Address: P.O. BOX 772641
EAGLE RIVER. AK 99577 -
Site Address: NHN WEST RIVER DRIVE
Lot Size: 95555 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
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.
5. The following special provisions.
-ENGINEER NEEDS TO DO AN ADDITIONAL GROUNDWATER MONITOR CHECK ON TESTHOLE #3 & 4
DURING CONSTRUCTION. PLEASE WRITE THE RESULTS ON NEW SOIL LOG OR WITH STAMP AND
SIGNATURE OR THE ORIGINAL TEST HOLES AND INITIAL AND DATE.
Received By.
Issued
Date: c 2!ICX
Date: tllzt
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
�2l� FOR A SINGLE FAMILY DWELLING
Parcel I.D. ow-, b -. A3/– a0 _ Permit Number SW
Property owner(s)�E Qy/K,t7 Day phone'
Mailing address InG. � 77XfKlj �Q4% R,-var Zip Code Q7-77?
Site address ANN WEsT T1 V612- 70. ,I Zip Code
Legal description (Lot, Block & Sub'd.) —S�3c-FfX�G ,!L WP Jf .err (--
Legal
Legal description (Section, Township & Range)
Lot Size 9�j 55E; Acre:
THIS APPLICATION IS FOR:
Number of Bedrooms
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 authokfed agent)
Permit/Rush Fees: 141 9) -V 1'lr--A Waiver Fees:
Date of Payment: I p L.I l Date of Payment:
Receipt Number: l o9C?RrQ "M Receipt Number:
(Rev. 09104)
Y
-21M
1<� IINEERING SOUTHFORK WEST S/D, Block 4, Lot 8
GROUNDWATER DISCUSSION
Recently the Municipality of Anchorage installed Storm Drain Lines in West River Drive.
This consists of deepened ditches with "French Drain" cobbles w/ aluminum culvert
manholes. The effect of these interception lines has been to lower the groundwater table in
the vicinity of the road. The photo below shows the Storm Drain Line.
This lowering of the groundwater table can be observed in the test holes of Southfork
West S/D, Block 4, Lot S. Test Holes I, 3, & 4 close to the road have low water tables,
while Test Hole 2 farther down-slope had a higher water table at 3 feet below the surface.
For this reason a conventional system was able to be designed for this lot.
""'L4
OF `1
..We...'.
*:ea TM �. k*
Sloven W. Eng
PE 6256
1N _INEERI� r NNG��
NorthRim Engineering
17237 Bear Paw Circle
Eagle River, AK 99577
907.694.7028
June 13, 2005
MOA On -Site Water & Wastewater Program
4700 Bragaw St
Anchorage, AK 99519
RE: Septic System Design & Well Location; Southfork West S/D, Block 4, Lot 8
A lot is being developed. Suitable soil was discovered in 3 of 4 test holes. This is a new
septic system and water well. Some of the neighboring lots are developed. This site should
not negatively impact any of the other area lots. The drainage slopes from front of lot
towards back of lot to the Southfork of Eagle River. Adequate separation to the stream
and surface water exists to the proposed site.
Please review the wastewater system design for the single family home. I have included
design plans & specs, design guidelines, & soil tests. If there is need for additional
information or clarification please give me a call.
Sin
Steve Eng, PE, PH
Design Enclosures
�2TI-21M
F�!qINEERING SOUTHFORK WEST S/D, Block 4, Lot 8
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: This is a future single family home projected at 4 bedrooms.
This requires a 1250 gallon septic tank. This lot is about 2 acres in size, as are neighboring
lots. Most of the neighborhood lots have been developed. No adverse impacts are
expected from developing this lot. The proposed water well is located on the drawing as
are the neighboring wastewater systems & water wells. The lot slopes from front to back,
toward the Southfork of Eagle River. No conflicts to any neighbor lots is anticipated. Four
soil tests were conducted and 3 of the 4 demonstrated similar soil; a sandy soil with an
excellent percolation rate. An application rate of 1.2 GPD/FP2 with 0.5 reduction factor
for utilizing a 5' wide trench was utilized.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
• Two compartment, 1250 gallon septic tank.
• Watertight couplings on inlet & outlet.
• 5 foot minimum beh,.wn the tank and bed. 10 foot to property lines.
• 3 feet of cover or insulation is required for trench; an equivalent of 1" insulation for each foot
soil cover.
• Tank & solid pipe must be set on well compacted, stable soil.
• 4 inch diameter cleanouts with airtight caps are required I to 4 fee[ from foundation wall, prior
to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing
cleanouts between the tank and the absorption field, not more than 10 feet from the tank
positioned to provide cleanout access towards the tank and towards the absorption field.
• All cleanouts must extend to at least ground level.
• In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
• Trench to be placed level, minimum of 4 feet to groundwater, 6 feet to bedrock from drain -
rock.
• Drain rock to be %= inch to 2 %: inch screened. Drain rock to be distributed uniformly
throughout the trench.
• Perforated pipe to be installed level with perforations down.
• Silt barrier (filter fabric) to be installed above the drain rock.
• Smeared trench sides must be raked or scarified before drain rock placement.
• Backfill over drain rock must not be less than 36".
• The finish grade must be mounded to promote drainage over the trench.
• Insulation must be placed over any pipe installed under driveways or parking areas.
• Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS
ASTM D2661,
• Sewer Service Line is minimum 2% slope.
• Septic Tank to be pumped every two years or when required.
• Insulation board to be extruded direct burial polystyrene (Dow Styrofoam III or equal)
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LOT PLAN
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SOILS LOG — PERCOLATI❑N TEST
Andy Baugh/Eva Loken
DEPTH
(FEET)
1 -
Date
Gross Time
2 -
Depth
0..Q
3
2/6
0
4
9'
--
5 -
2/6
5
6
7.75'
1.25'
7
2/6
36
--
8.5'
--
4
2/6
41
10 -
7.25'
1.25'
11
2/6
1 75
12 _
9'
--
13 -
2/6
80
14 -
7.75'
1.25'
15 -
16 -
17 -
18 -
19 -
20 -
21 -
Location: Mid -lot, 15 yds from road
Organic
SM
Silty Sand
w/ Gravel
Groundwater Observed: None
Depth To Water After Monitoring: None
Date of Monitor: 2/12/04
t#
Date
Gross Time
Net Time
Depth
Net Dro
1
2/6
0
--
9'
--
2
2/6
5
5 rain
7.75'
1.25'
3
2/6
36
--
8.5'
--
4
2/6
41
5 min
7.25'
1.25'
5
2/6
1 75
--
9'
--
6
2/6
80
5 rain
7.75'
1.25'
Percolation Ratei 4 min./Inch
Pre -Soaked Hole
Perc Hole Diameter = 6'
Test Run Between 3' and 4'
Performed in Accordance with All State/Municipal Guidelines in Effect
_tEV A°
NORTHRIM N
ENGINEERING
TESTH❑LE LOG
T. H. 1
17237 8*ar Pow C1rCN
EaVe Rlw, Alaska 99377 kph, `., ,:
SouthFork W L8B4
2/s/oa 1 E
Y/
SOILS LOG - PERCOLATION TEST
0THRIM Date Performed: 6/3/05
��9 NEERING
Performed Fors Mike Quinn
Legal Description SOUTHF❑RK WEST Block 4, Lot 8
I -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12 -
13 -
14 -
15 -
16 -
17 -
18 -
19 -
20 -
21 -
Comme
Perfo
Perfo
ON THIS DATE, DATES 5/26/05
DEPTH
(FEET)
tiE of Ac Ot
=��" -�:�
NORTHRIM
TESTHOLE LOG
T H 3
ENGINEERING
17237 &*or Pow ClrN•
Eopl• R1vw. Alaska 99377 ••'• a -•» ..'j
,
907.694.7028 4;r ....
GEOTECHNICAL
6/13/05 of 3
SOILS LOG - PERCOLATION TEST
2THRIM Date Performed: 6/3/05
W94NEERING
Performed For: Mike Quinn
Legal Description: SOUTHFORK WEST Block 4, Lot 8
1-
2 -
3 -
4 -
5 -
6 -
7 -
8-
9 -
10 -
11 -
12 -
13 -
14 -
15 -
16 -
17 -
18 -
19 -
20 -
21 -
DEPTH
Date
(FEET)
Net Time
Depth
Organic
1
6/9
0
--
4'
--
2
6/9
2
2 min
4.5'
0.5'
3
6/9
4
--
4.5'
GM
Q;.
Silty Gravel
6
2 min
5'
0.5'
5
6/9
8
--
Location: See Drawing
Groundwater? No
Depth
Water Depth
eF+or Mnni+nrinn NAnP nntPt (./9/05
# I
Date
Gross Time
Net Time
Depth
Net Drop
1
6/9
0
--
4'
--
2
6/9
2
2 min
4.5'
0.5'
3
6/9
4
--
4.5'
--
4
6/9
6
2 min
5'
0.5'
5
6/9
8
--
4'
--
6
6/9
10
2 min
4.5'
0.5'
Percolation Rate 4 min./Inch Perc Hole Diameter 6'
Test Run Between 3' and 4'
Comments:Presoaked
Performed By NnrthRim Eng. I c
Performed in Accordance with All
ON THIS DATE. DATEt 6/13/05
;0 CERTIFY THAT THIS TEST WAS
ate/Municipal Guidelines in Effect
NORTHRIM -y
`' n+ A'.
TESTH❑LE LOG
T. H. 4
ENGINEERING
17237 Boor Paw Circle y} •, p,,, t„•
Eoy,. R,... Noaka 99377 •;}�•..«-•..�=
907.694.7028 •�iD
GE❑TECHNICAL
PM
6/13/05 13 of 3
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: STEVE ENG
Legal description: SOUTHFORK WEST BLOCK 4 LOT 8
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 loo deep for soils information submitted.
❑ Well log required. _
❑ Omission in narrative.
❑ Insufficient fill over tank or field._
® Other. NEED TO DO AN ADDITIONAL GROUNDWATER MONITOR CHECK ON TESTHOLE #3 8 4. PLEASE
WRITE THE RESULTS ON THE ORIGINAL TEST HOLES AND INITIAL AND DATE. NEED TO DESIGN THE BOTTOM OF
jA10 S7A7B►^E4i ABO✓T Ropp 'Arg0✓fA[Ed7S Tyrrt J-ONb'uD fjT•v"d &v4rtfX [•rAk q,
Name of reviewer: JOE GOODALL Date: 6/20/2005
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
Municipality of Anchorage
• Development Services Department
/ Building Safety Division
Onsite Water 8 Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650 (�
www.munLorg/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 078-031-20 COSA# U C( OLI Li y
1. GENERAL INFORMATION Expiration Date:
Complete legal description SOUTHFORK WEST, LOT 8. BLOCK 4
Location (site address) 1501 WEST RIVER DRIVE * EAGLE RrVER, AK 99577
Current Property owner(s) NICHOLAS do AVERY MUNOZ Day phone
Mailing address
Lending agency
Mailing address
PO BOX 773528 • EAGLE RIVER, AK 99577
Day phone
696-2299
Real Estate Agent DAN BRENNEMAN w/EXIT REALTY Day phone 862-2297
Mailing address 19132 TRAIL BAY DRIVE " EAGLE RIVER, AK 99577
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
0
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 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 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 axed 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 riles 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 337-6179
Address 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date%Lt112—
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 Q 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 off 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 if confor any legal right whatsoever.
5. DSD SIGNATURE
_1/ Approved for _y__ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
L_
Arsenic Advisory
Maintenance Agreements
Supplemental Engineers Report
Other
ys��0
by�G rness:"
CE– 953 :i
1Z�1,� a9.�c9v�
VX OF A& bo
ON-SITE • 'G�-
WATER AND :1^=
WASTEWATER
PROGRAM
I r11 r
By; Original Certificate Date:
(Rev. 11A5)
a
- \ Municipality of Anchorage
l Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw 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: SOUTHFORK WEST, LOT 8, BLOCK 4 Parcel ID: 078-031-20
A. WELL DATA
Well type PRNATE If A, B, or C provide PWSID# N/A Well Log'(Y/N) YES
Date completed 7/11/05 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 92 ft. Cased to 91 ft.
FROM WELL LOG
Date of test 7/11/05
Static water level 2 ft.
Well production 8 g.p.m.
WATER SAMPLE RESULTS:
Casing height (above ground) 24 In.
AT INSPECTION
12/4/09'
24 ft.
2.69 g.p.m.
Coliform colonies/100 ml.
Nitratdo• 3i9 mgJL.
Other bacteria
colonies/100 mi.
Arsenic: NO ug./L.
Date of sample: 12/3/2009
Collected by:
GEG Ltd.
B. SEPTICIHOLDING TANK DATA
Tank Type/Matedal SEPTIC/STEEL Date installed 7/12/05
Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date or pumping 8/24/2009 Pumper SANITARY PUMPERS
C. ABSORPTION FIELD DATA BEEow EXISTING GRADE .
Date Installed 7/12/2005 Soil rating .p.dJ r ft'/bdrm) 1_2 System type TRENCH
Length 52 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 8,91 ft. Eff. absorption area 520 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 12/4/2009 Results (Pass/Fail) PASS For 4 bedrooms
Fluid dapth in absorption field before test 18 in. Water added 727 gal. New depth 26 in.
Elapsed Time: 120 min. Final fluid depth20 in. Absorption rate >= 600+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (YIN 8 type) NONE KNOWN If yes, give date —
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" level at In. "Pump off" leve 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
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 1009+
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 tine
P
10'+
Building foundation
10'+
Water main N/A
Water service line
10'+
Surface water
100'+
Driveway, parkingtvehicle 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 12-11, / 0 G
COSA Fee R �O Waiver Fee $
Date of Paymentf ` t Or _� Date of Payment
Receipt Number O g j fo Q S Receipt Number
(Rev. 11/05)
SGS RecN
1096444001
Client Name
Garress Engineering Group, Ltd
Project Namc/N
South Fork West Bh8
Client Sample ID
South Fork West BO L8
Matrix
Drinking Watcr H
Printed DateMme
12/10/2009 11:38
Collected Date/Time
12/03/2009 11:50
Received DateMme
12/03/2009 15:05
Technical Director
Stephen C. Ede
Samplc Remarks:
Allowable
Prep Analysis
Parametcr
Results
PpL
Units Method Cmlain ID
Limits
Date Date
Init
Metals by ICP/MS
Arsenic
ND
5.00
ug/L EP200.8
C
(<10)
12103/0912/08/09
NRB
Waters Department
Total Nitmic/Nitrito-N
0.329
0.100
mg/L SM20 4500NO3-F
B
(<10)
12/09/09
RJT
Microbiology Laboratory
Colony Count
0
coUl00mL SM20 9222B
A
(<200)
12/03/09
DLC
Total Coliform
0
col/100mL SM20922213
A
(<I)
12/03/09
DLC
Fecal Coliform
0
col/IOOmL S%1120 9222B
A
(<I)
12/03/09
DLC
From:UPS STORE EAGLE RIVER ALASKA To:3383246
A GOO 111 T
12/11/2009 11:53 #889 P.002/002
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE'
FOLLOWING DESCRIBED PROPERTY �'sa • �������
ro.coc/jrrrra' tbredf i� DATE' "�� OF AC,9
AND THAT NO ENCROACH vi'IENTS EXIST EXCEPT ASAP,. '
INDICATED. IT IS THE RESPONSIBILITY OF THE q T_H '
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID; ,', � `•
EASEMENTS, COVENANTS, OR RESTRICTIONS?-�
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- �� ' , o M..► s.. a
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' 1���•, LS-691Vjk
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES. DRAWN'
a�f
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
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. HAA# 050V0�
Expiration Date: S -/3-o6
1. GENERAL INFORMATION
Complete legal description /-OMe- V -16 -ST' 9400, c 4/ LOT" k
Location (site address or directions) SOI W15 LP 7- J�/cid RD
Current Property owner(s) Day phone* o5�94/- y 94r
Mailing address
Lending agency
Mailing address
_ Z' o Sax -7 72 "/
Day phone
Real Estate Agent t//W/(/ Day phone
Mailing Address %��/L1�)G OtC �(,tf= A>/Vf�
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
W -Y'
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Q Individual Holding tank
❑
❑ Community On-site
❑
❑ 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 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.
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 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
Phone j!! 94/-700c>~
Address 1 4W-5 / /`,xr' Ya,, Utre le
Engineer's Printed Name 61VC Date a z4LOS
.y
pf Atgvcptf
5. DSD SIGNATURE t`F0, sro•.n W.
Approved for bedrooms. �0'sr� FE 615
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X Maintenance Agreements
Supplemental Engineer's Report
Other
By: a, O_Z�t Original Certificate Date:
(Rw 01102)
Municipality of Anchorage
`• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: wl,EFJ 7— Bg L �' Parcel ID: D 78 -D -31
-2
A. WELL DATA
Well type _P_
Date completed
Total depth 9 Z ft.
Date of test
Static water level
Well production
If A. B, or C provide PWSID # _ Well Log (Y/N)
Sanitary seal (Y/N) Wires properly protected (Y/N) T
Cased to —!—,—ft. Casing height (above ground) in.
FROM WELL LOG
Zr
ft.
U,
WATER SAMPLE RESULTS:
am
AT INSPECTION
ft.
Coliform _colonies/100 ml. Nitrate -� F //mg./I. Other bacteria 4—colonies/100 ml.
Arsenic: mg./I. Date of sample: / 110S Collected by:
B. SEPTICIHOLDING TANK DATA
Tank Type/Material dN(WMAVIE TdFNtf s% P5- Date installed 7&a/as-
Tank
&a/ot
Tank size /Z SO gal. Number of Compartments _?, Cleanouts (Y/N) y
Foundation cleanout (Y/N) _Y_ Depression over tank (YIN) [54._ High water alarm (Y/N) N
Date of pumping /tib Pumper
C. ABSORPTION FIELD DATA
Date installed2 0 S Soil rating (g.p.d./ft2 or"d )/ Z System type 7_7z4E#t/C(71(
Length 5 Z ft. Width -s ft. Gravel below pipe L/ ft.
Total depth 75 It Eff. absorption areaEaO fe Monitoring tube T Depression over field _ .A(
Date of adequacy test 1 Results (Pass/Fail) For 1 bedrooms
Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in.
Elapsed Time: —min. Final fluid depth _ in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed ize in gallons M hole/Access (Y/N)
'Pump on' level at in. "Pump off" evel at _ in. High water alarm level in.
Datum Cycles tested Meets alar & circ ' requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot /40
Absorption field on lot /Oo �&
Public sewer main 16(14
Sewer /septic service line _N O f
On adjacent lots /QG .e -
On adjacent lots /O O '4 -
Public sewer manhole/cleanout AM,J
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation /O Property line Absorption field r`
r
Water main Water service line Surface water /OO r4 -
Wells on adjacent lots G f -
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
i r
Property line Building foundation /Q Water main /`/'Nt
Water Service line /a f Surface water Driveway, parking/vehicle storage 50 1,1` -
Curtain
Curtain drain — Wells on adjacent lots /0 d F
F. COMMENTS
V7
�1''r�..• p��.`�� `;,
G. ENGINEER'S CERTIFICATION
r
1 certify that I have determined through field inspections and
r. �'• t' a V�
review of Municipal records that the above systems are in
`
conformance with MOA HAA guidelines in effect on this date.
�. • ^ ••
�
STfJt� Y
Engineer's Printed Name F/ C
t( I",. Steven W. Ai
e �.� FE 62..6
Date /2�rF�os<t;.
;'✓
........ '; �.`•:v
e
HAA Fee $ "�� Waiver Fee $
Date of Payment /�/// 5� Date of Payment
Receipt Number Receipt Number
(Rev. 12/01)
SCS ReEt9
1057744001
Client Name
NorthRim Engineering
Project Name/a
South Fork West 134 L8
Client Sample ID
Southfork West 133 L8
Matrix
Drinking Water
PMPSID 0
Sample Remarks:
All Datcs/I'imes are Alaska Standard Time
Printed Date/time
12/012005 11:02
Collected Date/time
11212005 12:00
Received Date/rime
11212005 13:50
Technical Director
Stephen C. Ede
Microbiology Laboratory
Total Coliform
0
coVI00mL SM209222B A (<=I) 1121/05 TLF
Allowable
Prep
Analysis
Parameter Results PQL
Units hicthod
Container ID Limits
Date
Date ]nit
Nitmtc-N 2.11 0.100
mg/L EPA 353.2
D (<.10)
1121/05 1C
Microbiology Laboratory
Total Coliform
0
coVI00mL SM209222B A (<=I) 1121/05 TLF
v �rPalmer, A ska 99645Phone, 7454-3 Fax: 746-301
Drinking Water Analysis Report
Total Coliform Bacteria
1y0q5�]]�414p�
1�1YIAA111
Client:
r 5o4e.
Address:
3 c W PWSID#(if applicable):
Phone #:
9 - 70z Fax #: d 9 — G Z Paid:
This Section to be completed by Sampler
Legal Description of Property: 5:7oisf( 4—k— '�P s' & U L 'P
Sample Site Location: Delivered to Lab By:
(I.E.: Mchen sink bathroom sink, outside hose bib)
Time Sampled: 2 00 Date Sampled: .4 �4T s Sampled by: :K, Z: .
Sample Type: RoutinM Treated:[] Untreated:[] Repeat Sample M
This Section to Be Completed by Lab
` Analysis Results:
atisfactory
Unsatisfactory
FISample too long in transit (greater than 30 hrs.)
'Request resample.
Copy Sent to State: Yes o7
Chromogenic/Fluorogenic Method Results:
AIA Total Coliform Present (P)/Absent (A) Lab I.D. #: 1oS"77yv/ /ff .
Mol' E. Coli Present (P)/Absent (A) �femir we, gllee -,eesvi!�
Q;: est Lounf': co -{a"• is �c�n rr�
Date Received: N-2-11 Time Received: AK -6 Received by:
Date Test Begun: i//zi/of Time Test Begun: // oa Analyst: 7X'
Date Completed: ii/Z zks. Time Completed: /L• / tl— Analyst: 7f
/ Refer to Back Side for Instructions
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ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-0829
1 HEREBY CERTIFY THAT I HAVE'SURVEYED THE SCALEt N
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FOLLOWING DESCRIBED PROPERTY: "rte •1OF At \\�
DATE] , Q� .•• qS 0
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE rM''
OWNER TO DETERMINE THE EXISTENCE OF ANY GRIDS ' ""' ••• •• e• d
EASEMENTS, COVENANTS, OR RESTRICTIONS fw��csS i :lav• r'�
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- d Duma Mark Sward � /
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB, /•� •, is-e91s
ANY DATA HEREON BE USED FOR CONSTRUCTION-V-7-Y91I \�''' c-0�
OF FENCE LINES, OR FOR ESTABLISHING BOUND- �R�'► sk na«�w�.
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