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HomeMy WebLinkAboutSOUTHFORK NORTH BLK 5 LT 4Southfork North Block 5 Lot 4 #078 - 021 - 15 Municipality of Anchorage a • , 11 �� 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 Page 1 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SW030090 PID Number 078-021-15 of 3 Name: JOHN THOMSON Wastewater System: ■ New 0 Upgrade 17343 SANTA MARIA DRIVE a EAGLE RIVER, AK 99577 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 240-2020 3 a Deep Trench ■ Shallow Trench D Bed CI Mound CIOther LEGAL DESCRIPTION �` Rabat 1.0 Gpond rr Total oath *em «ta 6.o AX R Block: Lot Subdivision: 5 4 SOUTHFORK NORTH Depth to Oft bottom hon stair° p.vdc SEE DWG. n. Grout depth beset pip; 2.0 r,_ Township:Range: Section; — — — I7• Mat ots originalgrads SEE DWG. n. Gravy' length: Gravy' 2 0 35 (70 TOTAL) re WELL: ■ New 0 Upgrade Goal width: 5.0 n. Number Yrs Dittos batman Ore al 2 15 n Cbwilkalbn (Pias. A&C): PRIVATE Tow broth: 100 n. Csed Ts 100 ,. Total ,b.apua, grab 500 so. n. Poe Motel: D 3034/ F-810 COW: SULNAN WATER WELLS Data DSWet 5/8/2003 Stott Mal., lank 0 n. Instant : SOUTH FORK CONST Dab Srtad: 6/23/2003 T°2 25 fiN Pump Set At UNKNOWN n. Oats Sight Mom Gard: 2 n. TANK SEPARATION DISTANCES ■Septic CIHolding 0S.T.EP. DOther To From Septic Tank Absorption Field Uft Station Holding Tank Pubdc/Prwpte Sewer Un.. 4aiufactu'e'' ANCHORAGE TANK Guam* fn gaIIn 1000 Well 100'+ 100'+ — — 25'+ galena' Number twee w eanpa tmrb. 2 Surface Water 100'+ 100'+ — — — LIFT STATION / Lot Line 5'+ a5'+ — — — suit s, ,bnufaebae: gallant Foundation 5'+ 10'+ — — — 'Pump an' level a a: WO NMI( airs at: Curtain Drain Rana uob. Erabkal ,rep.ato ,r• Potam»d NONE KNOWN Remarks: 'SEE ATTACHED LETTER. BENCH MARK laeaaen Dmalplbrc and BOTTOM OF TRIM 0 NORTHWEST CORNER A..wnw n.•atbra 100.00 n. •4l �Om i.d,f(r ��� "4p ENGINEERS lora;e�;;ot 044000 . , SEA 'x;40 • 00 .. "�� N. t • ss•. O 795 •,.• `ov v 0 Inspections performed by AKWWC, INC. Dates: 1st 6/23/2003 2nd 6/23/2003 3rd 6/23/2003 Development Servi es Department Approval /� Reiewed and approved by: 2 3v/' &• i Date:S .2S OS (R.r. 12/01) (/ i / PERMIT NUMBER: SW030090 AS -BUILT DRAWING PARCEL ID NUMBER 078-021-15 INSTALLED FLOW SPLITTER DBL2 DBL1 MIKE ANDERSON N APPROXIMATE LOCATION OF TOP OF SLOPE THAT IS GREATER THAN 25X NEW DRAINF1ELDS A 8 C ST1 22.1 10.2 ST2 25.5 15.2 DBL1 27.3 16.5 DBL2 28.0 16.0 FS 39.2 16.2 MNIE C01 48.6 29.6 Mil 49.7 29.9 CO2 Mit CO3 MT3 C04 MT4 1 G N • \ \ <^♦ \\ • J BNS ♦ \�1 N N N N EW 1000 GALLON JA> SEPTIC TANK x TERNATE SITE ♦�\� et4ar \ 1 ♦ \ N N N MIKE N ANDERSON TH/2 NEW WELL ALASKA WATER & WASTEWATER CONSULTANTS, INC 3701 F TUDOR ROAD. SUITF 101 • ANCNDRAGF. AR 09507 • MONF. (907)337-6179 • FAX (007)3111-3166 MIKE +ANDERSON THIS DATE: 8/12/2003 58.8 60.4 \ MIKE \ +ANDERSON 1Nj1 DRAWN BY: C.J.G. SCALE: 1"=40' PREPARED FOR: JOHN THOMSON PHONE NUMBER: (907) 240-2020 PAGE NUMBER: 2 OF 3 LEGAL DESCRIPTION: LOT 4, BLOCK 5, SOUTH FORK NORTH SUBDIVISION TYPE OF WORK: _ AS -BUILT DRAWING OF NEW WELL AND SEPTIC SYSTEM LOCATION oo 17.5 16.1 33.5 35.0 35.4 36.8 21.5 20.9 25.6 28.3 f ;(l A. Gar ess. r 7 • ♦Fp0 ..... ado 6°4� D PERMIT NUMBER: SW030090 AS -BUILT DRAWING PARCEL ID NUMBER: 078-021-15 TOP OF TANK A INLET - 93.57 irFINAL GRADE - 98.23-98.88 INERT OF BUNG AT INLET - 92.99 TOP OF TANK AT OUTLET - 93.47 INVERT OF BUNG AT OUTLET - 92.72 TH#1 FLL1ER FABRIC 164 FINAL GRADE - 92.53-93.03 ORIGINAL GRADE 92.13-93.13 BITER FABR)C & INSULATION INERT OF PIPE —5'--1 —O— RELATIVE ELEVATION OF BOTTOM OF TEST HOLE - 81.13 (TEST HOLE DRY) 89.13 (AVG.) BOTTOM OF TRENCH - 87.13 (AVG.) 10 ■ ALASKA WATER & WASTEWATER CONSULTANTS, INC. 3701 F TUDOR ROAD. SUITF 101 • ANCNORAGF. AK 00507 • PNONF (907)3374179 • FAX (0071339-374.6 PREPARED FOR: PHONE NUMBER: JOHN THOMSON (907) 240-2020 LEGAL DESCRIPTION: LOT 4, BLOCK 5; SOUTHFORK NORTH SUBDIVISION TYPE OF WORK: AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE INERT OF PIPE 92.00 (AVO.) BOTTOM OF TRENCH - 90.00 (AVG.) RELATIVE ELEVATION OF BOTTOM OF TEST HOLE - 84.00 (TEST HOLE DRY)—le-- DATE 7/8/2003 DRAWN BY: C.J.G. SCALE N.T.S. PAGE NUMBER: 3 OF 3 4k fl ess.' \FOO fess%°' c erttfieb rtEIing !Log by OOC CO dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2750 OWNER OF LAND: - /" J f`.ti"i+7 ' : •` ADDRESS' LEGAL DESCRIPTION: 3; a:7- hf t a'C!c /SLK S hey 4 DATE: Thin T1 PERMIT NUMBER: 0 S a n V Date of Issue `J -- TAX IDENTIFICATION NUMBER: i) 7: - • % J - / r Is well located at approved permit location? 4 s J No Method of Drilling: fr rotary J cable tool Depth of well- /D6 Casing Type r•::. Wall Thickness ? inches Diameter L inches, depth / 4 u • feet Liner Type: #U 4s.:•= Casing Stickup Above Ground. -'t' Static Water Level- G 4:: -I •a t% Recover Rate' 2 1 gpm Method of Testing. /g Well Intake Opening Type: -.I Screened: Start_ J Perforations Start Grout Type' Depth: from U 4.' i• v feel feel r3ropen end J open hole _feet Stopped feet Stopped Volume /C":4 411 ' feet feet feet to .;r C) feet Welt Disinfected Upon Completion? ad Yes J No Method Of Disinfection'i ilL&. _ a_. S J rjrc''""1 • Comments: BORE HOLE DATA DEPTH F.W, To , a" S' ,1 -'"411 - cis c '•i /0 1 3/ /C. 1( d/ h , et: Y 64..c-14.-4- 4 e 5 J-' L 44.1 r; / /71.4.r4 sr7.e '< /3 o v cit.c • Driller's Name /324 -(-- ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. •d ALASKA WATER & WASTEWATER August 12, 2003 CONSULTANTS, INC. Municipality of Anchorage Development Set -vice Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Lot Line Waiver for Lot 4, Block 5; Southfork North Subdivision. To whom it may concern: The lot line was flagged by the contractor during construction of the septic system. It was noted during our inspections that the dranfields were 10+ feet from this flagged lot line. An as -built survey has been completed by a registered land surveyor and the drainfields are less than the 10 feet setback requirement to a property line. We request that your department issue a 5 foot lot line waiver from the northwest property line to the new drainfield. I am unaware of any adverse impacts this w. 'ver would have on adjacent wells or septic systems. If you have any questions, please conta - at 337-6179. Thank you for your assistance. Presi P.E., M.S. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179 • Fax: (907) 338-3246 * Website: akwwc.com 8/25/2003 Municipality of Anchorage Mark Ilegich, Mayor Building Safety Division P.O. Ilox 19665() • 47(X) Ilragaw Street Anchorage, Alaska 0519-6650 • (907) 343.8301 • Fax (907) 343-820) hIIp://WWW.n um Larg Jeff Gamess Alaska Water & Wastewater Consultants, Inc. Subject: Waiver Request for Southfork North Block 5 Lot 4 Waiver Request #WR030075 Parcel ID #078-021-15 HA030432 Dear Engineer: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Jeffrey W. Poet Engineering Technician On -Site Water & Wastewater Program 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.ci.anchorage.ak.us (907) 343-7904 Waiver Review Worksheet WR#:030075 PID#: 078-021-1¢ HAM 030432 Permit#: 030090 Date Received: 8-22-03 Legal Description: Southfork North Block 5 Lot 4 Engineer. Asaska Water & Wastewater Consultants. Inc, 3701 E. Tudor Road. Suite 101 Anchorage. Ak. 99507 Applicant John Thomson Waiver Requested: 5 foot generation absorption field to property line Criteria: Geology A. Water Table B. Sal Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Points: Total: Waiver Is Granted: Waiver Is not Granted: List Conditions or Reasons for above: Date: Q, -2S-03 By 4e of Reviewer Rec#: 8-22-01 Amount: $jQ Date Paid: 8125/2003 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: SW030090 ILegal Description: Southfork North Block 5 Lot 4 Design Engineer. 0041 AK Water & Wastewater Consultan• Owner Name: John Thomson Owner Address: 17343 Santa Maria Eagle River , AK 99577 - Date Issued: Apr 21, 2003 Expiration Date: Apr 20, 2004 Parcel ID: 078-021-15 Site Address: 17343 Santa Maria Lot Size: 103272 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank fl 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: Li al y Iv Date' Ja/0.3 Issued By: Date: 4/Z4/03 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.d.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 073'-121 / C .o7.a—a+- —7 Property owner(s) JOHN THOMSON Mailing address (1) 17343 SANTA MARIA • EAGLE RIVER Permit NumberSL) 0300`(0 Day phone 240-2020 Mailing address (2) Zip Code 99577 Legal description (Lot, Block & Sub'd) LOT 4 BLOCK 5: SOUTH FORK NORTH SUBDIVISION Legal description (Section, Township & Range) N/A Lot Size / nA7c2 7 a Acres/Sq.Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only 0 Well Only 0 Sewer and Well I. Water Storage 0 Sewer Upgrade 0 THIS PROPERTY CONTAINS: Hot Tub 0 Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit 0 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. ALASKA WATER & WASTEWATER CONSULTANTS, INC. -(Signature-ofproperty-owneror-euthorized-egent)- Permit Fees. 41504-100= $ 550 Waiver Fees' Date of Payment: 117 f'r03 () Date of Payment: Receipt Number: 3? 9 110 t Receipt Number- / ALASKA WATER Er WASTEWATER • April 14,2003 CONSULTANTS, INC. Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Proposed Well and Septic System for Lot 4, Block 5; South Fork North Subdivision To whom it may concern: The proposed 3 bedroom house is to be served by a private water system and septic system. The proposed septic system will consist of a 1000 gallon septic tank and dual 5 -wide type drainfields. Two test holes were excavated on the property. The drainfield will be designed around the 30 foot radii of these test holes. The well shall be located as on the site plan. 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 the insitu sandy soils will act as a sand filter. 2. TRENCH DESIGN: a. Percolation Rate: <1 minutes/inch b. Proposed Application Rate: 1.0 gallons/day/f12 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 450 ft2 f. Total Depth: 6 feet (max.) g. Effective Depth: 2 h. Width: 5 feet 1 Reduction Factor: 0.70 j. Minimum Length: 2 @ 35 feet long each (70 feet total length) k Effective absorption area = 500 11 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 6901 Debarr Road, Suite 2B • Anchorage, AK 99504 Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: akwwc.com 4. TOPOGRAPHY AND WAIVER REQUEST: The average topography around the area of the proposed drainfields are 15-20 percent slopes running approximately southwest to northeast. There is a slope greater than 25 percent northeast of the proposed drainfield that will be approximately 35+ feet away. We request a 35 foot waiver from the proposed drainfield to the top of this slope. Given the porosity of the soil the effluent should move downward rather rapidly with minimal lateral migration. Based upon these factors it is reasonable to assume that there is little risk with the granting of this waiver. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. NOTE: A site plan drawing. a design drawing, a trench detail drawing, two soil logs, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 213 • Anchorage, AK 99504 Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: akwwc.com s. LOT B, BLOCK 5; SOUTHFORK NORTH 5/0 1 1 1 1 LOT 5, BLOCK 5; SOUTHFORK NORTH S/D l.-09E3) PROPOSED SEPTIC SYSTEM (SEE DESIGN PAGE 2 OF 3) . MIKE ANDERSON TH/4 ALTERNATE SITE 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 \ ♦ ▪ I`ll 1 1 1.0T 6,1 BLOCK 4; 1SOUTHFORK NORTH 5/0 1 11 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 \ 1 1 `\ \ \• MIKE ANDERSON TH/2 MIKE ANDERSON AirTH/3 MIKE ANDERSON 7H/1 •1 • LOT 7, BLOCK 4; SOUTHFORK NORTH i „ gE •.`�. =k SOUTH FORK EAGLE RIVER• i PROPOSED 3 BEDROOM HOUSE WNDEvt-LOPE� PROPOSED WEU. LOT 3. BLOCK 6; SOUTHFORK NORTH 5/0 cs'oc LOPE • • • • • • • 1 AGatigt ALASKA WATER & WASTEWATER CONSULTANTS, INC.' 60A1 (KRAPR ROOD SI IITF TR • ANCHOR40F AN 00504 • PHONF (0073}7.4170 • FAX (007133AJ21.A i i I I 1 1 1 ( 1 I 1 I I 1 1 1 I 1 1 LOT 2. BLOCK 5;1 SOUTHFORK NORTH 5/0 \\ DATE: 4/14/2003 DRAWN BY: Z.T.G. SCALE: 1"= 100' PREPARED FOR JOHN THOMSON PHONE NUMBER: 240-2020 PAGE NUMBER: 1 OF 3 LEGAL DESCRIPTION: SOUTH FORK NORTH SUBDIVISION; LOT 4, BLOCK 5 TYPE OF WORK: PROPOSED WELL AND SEPTIC SYSTEM LOCATION 1 1 1/1 /1 I 1 -SOF 4 NOTE: THE NORTH LOT LINE TO BE FLAGGED AND STAKED BY A REGISTERED LAND SURVEYOR PRIOR TO ANY CONSTRUCTION. ALL MIKE ANDERSON TEST HOLE LOCATIONS ARE APPROXIMATE. REQUEST A 35 FOOT WANER FROM PROPOSED DRAINFIELD TO 25x+ SLOPES INSTALL ROW SPUTTER ALTERNATE SITE MAY REOUIRE THE USE OF A UFT STATK) N N APPROXIMATE LOCATION OF TOP OF SLOPE THAT 15 GREATER THAN 25% PROPOSED DRAINFIELD. EXCAVATE TWO TRENCHES THAT ARE 6 FEET DEEP MAXIMUM BY 5 FEET WIDE BY 35 LONG (70 FEET TOTAL). ADD 2 FEET OF CLEAN. WASHED SEWER DRAINROCK. EXCAVATE TRENCHES PARALLEL TO SLOPE CONTOURS. 4, INSTALL DOUBLE CLEiANOUTS ROPOSED 1000 GALLON SEPTIC TANK MIKE DERSON TH/2 NSTALL FOUNDATION CLEANOUT ALASKA WATER & WASTEWATER PROPOSED WELL CONSULTANTS, INC. 6001 DFPARR ROAD $I IIrr 7R • ANfMORARF AR 04504 • PNfNF (001/33-.970 • FM (00713SR•3)46 MIKE +ANDERSON TH/3 DATE: 4/14/2003 DRAWN BY: Z.T.G. SCALE: 1"=40' 'REPARED FOR: JOHN THOMSON PHONE NUMBER: 240-2020 PAGE NUMBER: 2 OF 3 ,EGAL DESCRIPTION: SOUTH FORK NORTH SUBDIVISION; LOT 4, BLOCK 5 TYPE OF WORK: PROPOSED WELL AND SEPTIC SYSTEM LOCATION MIKE 11 -ANDERSON TH/I 5 FEET WIDE EET SEPERATION 35 FEET LONG MT MTO •I Cod 5 FEET WIDE CO L_ INSTALL ROW SPLITTER 35 FEET LONG — FROM SEPTIC TANK MTOj co FINN. GRADE 6 FEET DEEP MAXIMUM AT ANY POINT t.—S FEET WIDE ORIGINAL ow"( 10 FEET FILTER FABRIC INSULATKNI 2 FEET OF EFFECTIVE i•i i'••„„ • •••• M• • •••'•4••••• FINAL GRADE 1/- 6 FEET DEEP MAXIMUM AT ANY POINT ALASKA WATER & WASTEWATER CONSULTANTS, INC. - 600N OFRARR ROAD SIIITF 7R • ANrwnRAf.F AM 00504 • PNANF (0071337-4I7Q • FAX (00713}4-3746 PREPARED FOR: PHONE NUMBER: JOHN THOMSON 240-2020 /GAL DESCRIPTION: SOUTH FORK NORTH SUBDIVISION; LOT 4, BLOCK 5 OAIE: 4/11/2003 DRAWN BY: Z.T.G. SCALE: N.T.S. PAGE NUMBER: 3 OF 3 5 FEET WIDE TYPE OF WORK: DETAIL DRAWING OF PROPOSED DRAINFIELDS P OFesslOtt L04W.:=1S-. ALASKA WATER & WASTEWATER CONSULTANTS, INC. 0001 DEM10t ave, tart 20 • NK310W0C, M. 06604 • Flat (907)337-4170 • FM (007)330-3244 • WEBSntOfi.eaol SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION' SOUTHFORK NORTH SUBDIVISION; LOT 4, BLOCK 5 PERFORMED FOR: JOHN THOMSON DATE: 4/2/2003 (feet 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 T r • • r ORGANICS GM/SM ML w/ SOME GM (TEST HOLE #1 SOIL CLASSIFICATIONS 11:111x1 W0 RIMS RANO GW GP GM GC SW SP SM SC ORG ML CL OL MH CH OH DEPTH TO GROUNDWATER DATE DRY 4/2/2003 DRY 4/9/2003 4/3/2003 1 — — LOT 5. BLOCK 5; SOUTHrORK NORTH S/D DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 4/3/2003 1 — — 6' — 2 — <1 0' 6' 3 — — 6' — 4 — <1 0' 6' 5 — — 6' — 6 — <1 0' 6' PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 4.0 FT. AND 4.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES • NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: ZACHARIAH GALL COMMENTS' THE WSW SANDY SOILS WILL ACT AS A SAND FILTER PERFORMED BY AKWWC, INC. I. JEFFREY A. GARNESS, CERTIFY THAT THIS W ERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: A, 14 �03 �1m ALASKA WATER & WASTEWATER CONSULTANTS, INC. 6001 OEBNO ROAD, SUITE 29 • AMNOR•DC AK. 69784 • PHONE: 0107)337-4171 • FAX (007)336-3246 • WENOTE ab.a•em SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION. SOUTHFORK NORTH SUBDIVISION; LOT 4, BLOCK 5 PERFORMED FOR: JOHN THOMSON 11 12- 2- 13- 13- 14- 14- 15- 15- 16- 16- 17- 17- 18 18 19- 20 9- 20 SOILS LOGGED BY: TEST HOLE #2 SOIL CLASSIFICATIONS StORRO GW GP GM GC SW SP SM SC DATE: 4/2/2003 ORG ML CL OL MH CH OH DEPTH TO GROUNDWATER DATE DRY 4/2/2003 DRY 4/9/2003 4/3/2003 1 — — Q I \�\ \ \,. Je 1 At a I I; iy 111 nest:: E-7953 ,••�. 4 6°q4 fro fessloloc ' 40000 LOT 5, BLOCK 5: SOUTHFORK NORTH S/D C D 109 .) DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 4/3/2003 1 — — 6' — 2 — <1 0' 6' 3 — — 6' — 4 — <1 0' 6' 5 — — 6' — 6 — <1 0' 6' PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 4.0 FT. AND 4.5 FT. A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES a NO JODY MAUS PERCOLATION TEST PERFORMED BY: ZACHARIAH CALL COMMENTS' THE INSTTU SANDY SOILS WILL ACT AS A SAND FILTER PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS ER ORMED 1N ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: p.2 FROM : REGIONAL INVESTMENT CO FAX N0. : 030 0645217 Jul. 15 2002 05:56PM P5 • MEMO June 19, 2002 TO. Mike Anderson From: Alan Hanle RE: Lot 4 Blk 5 South Fork North Subd. 4 Soils Testholes were deg and logged on Mon ti/11/02: testhotes an absoheebuorth(ess-wet and -e$% 1.2 R M a 1 and E31 • 7 teShotec contain tenses of sql that un etr0010t0.3 filer d a 5 S l n. / ndi rate. Tanned. 2 has a GM tense of 25' k depth. Testhote 4 has his same GM tense to the avenge depth 014'. Problonc Terrain 1s moderate In the hnmetiate ern M testhate 4 , eW raging a to I% and tote roto 24% in the an immediately surrounding tesltw% 2 However, t'ns cownslopes width 30 -35 R. have grades >3S%. • Assuming that telt parable GM irnse is at toast 2' h depth consistal tel between lasthole 2 and 4. ii may be possible tg wnsLUC an absorption bed in the area, however due to the shallow depth to water seepage, an absorption bed will have to be elevated, further Mespeniing the oowrWopo Watt, therefore increasing the mass amount 01 fill needed to lessen downslope grades. It may be necessary or desirable to contest some of this gmundntu flew OM a curtain drain. A drain may toner% proposed bed elevation by '• lowering the goundwate , but there em no guarar*as, lois probeny is dowsiope from mound rwype terrain. A drain In atlation may be ors spendy, due to the depth of excavation and the cod of trucking drain rock ttS muss up Highland Rd.1! Welt IoealjoQ: Due to the septic area location on the upper elevations of the lot. the well totation sha0 have to be approx. 12510140' downhill Steepl Flow does one get o wee Sntling tlg way down there? And back up armlet Build a road. And that's mora mo. y. Also, keep k mind the cost et the water service int lengtrl The haw bcatioe k.planned to be uphil of the septic sour. Thereto re. the water service tine may be 150 R or more in length. And then keep in mind the cost of woe pump / piping maintenance in the future. Tha septic system likely most surfed to ft these conditions will 4a:y be an innovative type. The proposed buyer of this tot is Mather Phaotndd and she requested a flirty soenano es weal the development oeas might be here.** waste this Info to analyze w ho'll:rlhey want to go through. imitable purchase or to request a reduction in the asking Oct of the tet • A N.' u a tAjlr y02.4r S BG ;erns,/ p 4, Se T/ rNi / �,a .�i'•e ryj'k y ,fid-»' . SQ" Aceres iid75:1 .3Q 'L4"Or! FROM : REGIONAL. INVESTMENT C0 6::41r:.7:M1 • • FAX N0. : 830 8645217 S� 1 �ul. 1S 2002 05:5GPM P6 ... ..o- s /', ye Lot 4, Elk S South Fork North Subd. r,.iii,oy P.5 r .r • .. This drawing b only an approximation of the testhola locations. The tat configuration is .scaled from a copy of an EAGLE RIVER AREA Atlas nap. • t/t 'r ICOr.•rk • Ad!S:i net 'ti'10+ FROM : REGIONAL IM.ESTI'£NT CO • t 5 f. c FAX IID. : 830 6645217 Lot 4, P.3 u 1. 15 2002_05:512M P7 ;M . • Ib�•><. its. aiJ �is� f pa, .Y.tati`1. -f-:451.-Oai9. • 4,r.:$4,4$ • f i t3.ti • . la. • • .0 s.ii Sty •ebjr • ML c;t •a :corn ilo %V Z Vis. snap/Le gra rely i VC/ •tt'1G' • ei a t. \ DETAIL 1• l \M.. .t }w' 4/ M t 8.1 WMA•.• 0.9' 6.0.1 MOWN •LMOUND POO lin [a KM. Mine I/•5\6'1v 12.29• .S \ ,s_3 /2 •e � i N.9e•1\rw I 62.53 6i e: • TWO* Mott tilt N/I111I1q\ WU Int{ Y X01 9 . 619.16 1• S) p.4 N00'06.. qfy gl.eo ~rJ. I / _••� •�dJe. i ryyoi I s` r TR.D` ��i 5.41 o, _ 165,111 S.F. nNsau Ir,wi! ' 3.6026.. •W M•,4, wr..64 I / / Vt. \.1 I / an / / N77•fr23'•1 70.33• N3e•s% 47'W 40.60• j11•1' �' 1 i ,gip • • ••• Ir,Y,0641 W e1! • 103,272 S/. 2.371 Ac. • OM 41[ law tort 6 t 101030 S7. 2.3i96c V 2 205, 394 S.F. SI6aAe •1N -Rt ,IYM IY—t 106.721 S7. LOOFA. 236.295 SF. 1.4256.. �• leuwu,. 1 amwr MINIM • • i mug 1,t[ lsvfof 0 C �� A •-. ,„. nos. •../•Y• I.e 04 ••w[ 1Utw4 11.04m0 N 00.09 CMUG. C N 990.24 X15 TAT E :.1 PPS lir PARK \ \ 66.1-4 VIM 111. • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 078-021-15 1. GENERAL INFORMATION Complete legal description SOUTHFORK NORTH B5, L4 Expiration Date: / 2._ ^a2 hi " %5 Location (site address) 1945 WEST RIVER DRIVE, EAGLE RIVER, AK 99577 Current Property owner(s) MICHEA & PAULA WESTBROOK Day phone Mailing address 1945 WEST RIVER DRIVE, EAGLE RIVER, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: N Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 2 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received. by: 404: / �9A lp 9-9e775 Date: COSA to be released to the engineer, unles se requested by the engineer. COSA Fee $ 521. Waiver Fee $ Date of Payment 1J2I/(5 Date of Payment Receipt Number 00310 b Receipt Number COSA# 05c45153.. Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Phone 868-3791 Date 9/16/15 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. 6. DSD SIGNATURE System #1 Approved for a. bedrooms. System #2 Approved for bedrooms. OF AL \ k9Tlt �* KENNETH M. rU 16 -•F'Ess101u' Disapproved. Conditional approval for bedrooms, with the following stipulations: tll(l((l(q $� yC( OF4, ( ON SITE �i. WATER AND R`c -J' EJj( WASTEWATER z1 kigtl 6kcs �O� Fsy:_� i iii.'Originai Certificate Date: q -2 7 -A� The r' i r/.f • i1i rage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_10-10-12.dw 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 B5, L4 Parcel ID: 078421.15 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 5/8/2003 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 100 ft. Cased to 100 ft. Casing height (above ground) 24+ in. FROM WELL LOG AT INSPECTION Date of test 6/29/2004 8126/15 Static water level 30 ft. 0 ft. Well production 3 g.p.m. 4.5+ g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 0.264 mg/L Arsenic: ND ug/L Date of sample: 8/26/15 Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC / STEEL Date installed 6/23/2003 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 8125/15 Pumper SANITARY C. ABSORPTION FIELD DATA Date installed 6/23/2003 Soil rating (g.p.d./112 or ft2/bdrm) 1.0 System type SHALLOW TRENCH Length 2 X 35' = 70 ft. Width 5 ft. Gravel below pipe 2 ft. Total depth 5+ ft. (Measured 8126/15) Eff. absorption area 500 ft2 Monitoring tube Y Depression over field N Date of adequacy test 8/26/15 Results (Pass/Fail) PASS For 2 bedrooms Fluid depth in absorption field before test 0 in. (s. TRENCH) Water added 510 gal. New depth 6_5 in. Elapsed Time: 5 min. Final fluid depth 0 in. Absorption rate >= 300+ Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date g.p.d. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at _ in. "Pump off" level at _ in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: 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 1001+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 1001+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOTTO: Property line .)45±Lryai t/ liu ding foundation 104 Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 104 Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS South trench (closest to house) tested. North trench had 13" of fluid in MT. 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 KENNETH M. DUFFUS Date 9116115 COSA canary sheet_2-5-15.doc A 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/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 078-021-15 1. GENERAL INFORMATION Complete legal description Southfork North S/D Block 5, Lot 4 COSA # (7sC Expiration Date: cp — `6 -1/ Location (site address) 1945 West River Road Current Property owner(s) Daniel Raymer & Bridget Broderick Day phone Mailing address 1945 W River Road, Eagle River, AK ggc77 Lending agency Day phone Mailing address Real Estate Agent Nathan Bear / Keller Williams Day phone 727-1130 Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: Individual Weld:. Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding Tank ❑ Community On-site 0 Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 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 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 . Brooms and type of structure indicated herein. I further verify that base` n he information obtained from nicipality of Anchorage files and from my investigation and inspection y e site water supply twater disposal system is(are) in compliance with all applicable Municipal a it&cedes, ordink laild regulations in effect at the time of installation. Name of Firm Pannone Engineering Services, LLC Address P.O. Box 10023.7, Anchorage, AK g9510 Engineer's Printed Name Steven R. Pannone, P.E. Phone 272-8218 Date GL~ Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water 4411•7-471‘..F411,11114111111,41.O 4 levels that may fluctuate during the year, and the water usage of the family being served by the system. �.•,P•••••••'........•-:/6 .• These conditions are outside the control of the evaluator of this system. All systems eventually fail and r c9,.••• `9• satisfactory test results do not guarantee future performance of the system, nor do they guarantee that � :' 49TH " there are no hidden defects or encroachments. PES can therefore not provide any warranty for future ; + performance nor give any estimate of how long the system will continue to meet the operational 0 L�---i S. requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed : _ .__ R. Pannone: : &': above. Any reliance upon or use of this report by any other person or party is not authorized nor will it1% ' No. CE 8149 confer any legal right whatsoever. ��� ••• ••': 5. DSD SIGNATURE 414 :%Fs.tl\ L-' Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: .`;fur 04, e���p.••r p• ON-SITE. . '•. �' ; MATER AND YJASTEVOTEt .RAMz •, pROG • • • • • V t � 'C�9ENT S� ��1laj�,eF�l Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 3 " / t ~% Municipality of Anchorage 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 North S/D Block 5, Lot 4 A. WELL DATA Well type Private Date completed 5/8/2003 Total depth 100 ft. If A, B, or C provide PWSID # Sanitary seal (Y/N) Y_ Cased to 100 ft. FROM WELL LOG Date of test 5/8/2003 Static water level 0 ft. Well production 25 g.p.m. WATER SAMPLE RESULTS: Coliform eb- colonies/100 mL Nitrate ©.zu! mg/L Arsenic: 5-43°ug/I Date of sample:3/'i/2011 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel Tank size 2.000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping //9/2o11 Pumper JR's Septic Pumping Parcel ID: 078-021-15 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 24 in. AT INSPECTION 3/9/2011 o ft. 4.5+ g.p.m. Other bacteria 4)6- colonies/100 mL Collected by: ci Date installed 6/23/2003 C. ABSORPTION FIELD DATA Cleanouts (Y/N) Y High water alarm (Y/N) N Date installed 6/23/2003 Soil rating (g.p.d./ft2 or ft2/bdrm)1.o apd/sf System type Shallow Trench Length 2X = 70 ft. Total depth 6.as ft. Width s ft. Gravel below pipe 2 Eff. absorption area 500 ft2 Monitoring tube Y Depression over field N Date of adequacy test3/9/2011 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test o in. Water added40 gal. Elapsed Time: to min. Final fluid depth o in. Absorption rate >= 450+ ft. New depths in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date g.p.d. D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level at in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100+ Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent Tots Absorption field on lot 100+ On adjacent Tots Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 50+ 100+ in. 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 10+ Water main 10+ Water service line 25+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 5+ * Building foundation 10+ Water Service line 25+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS * Lot Line Waiver WR#o3oo75 Absorption field 5+ Surface water 100+ Water main 75+ Driveway, parking/vehicle storage 10+ G. ENGINEER'S CERTIFICATION I certify that 1 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 Steven R. Pannone. P.E. Date a 49rH I• NS 0 ;Steven R. Pannone: i %% N.o. CE 8149 i. i 'ESS\ COSA Fee $ 4400- D91qaiver Fee $ 1 Date of Payment 3 IS/ 11 Date of Payment Receipt Number Receipt Number (Rev. 11/05) SGS SGS Ref.# Client Name Project Name/# Client Sample ID Matrix PW SID 1110848001 Pannone Eng. Srv. SOUTHFORK NORTH B5L 4 SOUTHFORK NORTH B5L4 Drinking Water 0 Printed Date/Time Collected Date/Time Received Date/Time Technical Director 03/15/2011 13:44 03/09/2011 4:30 03/10/2011 8:10 Stephen C. Ede Sample Remarks: Parameter Results LOQ Units Method Allowable Prep Analysis Container ID Limits Date Date Init Metals by ICP/MS Arsenic Waters Department Total Nitrate/Nitrite-N Microbiology Laboratory E. Coli Total Coliform 5.00 U 5.00 ug/L EP200.8 C (<10) 03/10/11 03/14/11 NRB 0.229 0.100 mg/L SM20 4500NO3-F B (<10) 03/10/11 AYC Negative 1 100mL SM20 9223B A 03/10/11 DLC Negative 1 100mL SM20 9223B A 03/10/11 DLC 0 0-n 1AIV 9S:8 I IOZ/OI/£ (JPEG Image, 2048x1536 pixels) - Scaled (57%) http://mail.google.com/a/panengak.com/?ui=2&ik=03 e95b 17aa&view=att&th=12eaOddObbfl... Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 is) CERTIFICATE OF HEALTH AUTHORITY APPROVAL 1/4%, FOR A SINGLE FAMILY DWELLING �. HAA# �CJ(I,1 -2)Z Parcel I.D. 078-021-15 1. GENERAL INFORMATION Expiration Date: / / ' a. S — 0 9 Complete legal description SOUTH FORK NORTH SUBDMSION: LOT 4, BLOCK 5 Location (site address or directions) IOI IKWEST RIVER DRIVE or EAGLE RIVER, AK Current Property owner(s) JOHN THOMSON Day phone 240-2020 Mailing address 17343 SANTA MARIA • EAGLE RIVER, AK, 99577 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System • TYPE OF WASTEWATER DISPOSAL: Individual On-site 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 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, 1 verlfythat my investi 'on, based on procedures outlined in the Health Authority Approval Guidelines to} tl$$s application, shpw th e on-site water supply and/or wastewater disposal system is(are) safe, functional &id 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 aoti-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal ' and Stato codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Address 3701 E. TUDOR ROAD. SURE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. CARNESS, P.E. Engineer's Comments: In conducting this evaluation, AKWWC, Inc. 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 pefonnance 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 em no hidden defects or encoachments. AKWWC, Inc. 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 3 bedrooms. Disapproved. Conditional approval for Phone 337-6179 Date e/t J03 bedrooms, with the Mowing stipulations: 411 AP 00 y*0n. e f A. rorne••. —79 `ftp .......••. cp lOtProressioC o'er'' �OOpOo�� Attachments: HAA Checklist Septic System Advisory Well Flow Advisory BY:ItQ (Rev. 11/01) t/- az / ai Manitenance Agreements Supplemental Engineer's Reort Other c?� ti� • � � • WATER AND 1 WASTEWATER PRU'JRAM �m•£NTSC1IN� Original Certificate Date: S — a• Se -03 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.d.anchorage.ek.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Deaulptlon• SOUTHFORK NORTH SUBDIVISION: IAT 4, BLOCK 5 Parcel ID: 078-021-15 A. WELL OATA Well type . PRNATE H A,13, or C provide PWSID# N/A Well Log (YM) YES Date completed 5/8/2003 Sanitary seal (Y/N) YES Wires properly protected (WN) YES Total depth 100 ft. Cased to 100 ft Casing height (above ground) 24 in FROM WELL LOG AT INSPECTION Date of test 5/8/2003 Static water level 0 ft _tett ft• Weil production 25 g p m. g p.m. WATER SAMPLE RESULTS: Conform 0 colonies/100 mi. Nitrate 0.112 mg/L. Other bacteria 0 colonies/100 ml. Arsenic: N k mg /1 Date of sample: 8/18/2003 Collected by: AKWWC. INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 8/23/2003 Tank size 1000 gal Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (WN) YES Depression over tank (Y/N) NO Date of pumping NEW Pumper — High water alarm (Y/N) N/A C. ABSORPTION FIELD DMA Date installed 8/23/2003 Soil rating e 2035' Length 70' TOTAL ft. Width ft)/bdrm) 1_0 System type SHALLOW TRENCH 5 ft Gravel below pipe 2.0 ft Total depth 6.25 ft. Eff. absorption area 500 ft' Montoring tube YES Date of adequacy test *NEW SYSTEM Results (Pass/FaII) Fluid depth in absorption field before test _ in. Water Elapsed Time: _ min. ep atlon treatment (past 12 mo.) (Y/N & type) Depression over field NO For New depth _in Absorption rate >: g p d If yes, give date D. LIFT STATION Date installed Size in gallons Manhote/A "Pump on" level at in. Pump off n High water alarm level at in Datu i Cydes 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 1001+ Absorption field on lot 100'+ On adjacent lots 1001+ Public sewer main N/A Public sewer manhole/deanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line 5'+ Absorption field 51+ Water main N/A Water service line 10'+ Surface water 1001+ Wells on adjacent lots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line Curtain drain F. COMMENTS 101+ Surface water NONE KNOWN G. ENGINEER'S CERTIFICATION 1001+ Driveway, parking/vehicle storage Wells on adjacent lots 100'+ I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineers Printed/Nam Date ill 2. JEFFREY A. GARNESS 10'+ HAA Fee $ 525,— Rust.% Ili Date of Payment • 22.03 Receipt Number 40566 i' (Rev. 12/01) Waiver Fee E 150. - Date of Payment CJ . 22. b 0.3 Receipt Number 40 5 (0G 8-21-03; 4:25PM: SGS Ref.# Client Name Project Name/t/ Client Sample ID Matrix Sample Remarks: 1035301001 • AK Water & Wastewater Consultants Inc. L4, 81k5 Southfork Notth S/D Outside Faucet Drinking Water ;007 5815301 A 2/ 3 All Dates/Times are Alaska Standard Time • Printed Date/Time Collected Date/time Received Daterrime Technical Director Released 08/21/2003 11:20 08/18/2003 15:05 08/19/2003 12:00 Stephen C'Ede Parameter Waters Department Nitrate -N Microbiology Tabora Total Coliform Qualifiers Results PQL 0.178 0.100 tory 0 Units Method Allowable Prep Analysis Container ID Limits Date Date Intl mg/L EPA300.0 D (o-10) coV100mL SMI 922213 A (0.1) 08/20/03 AB 08/19/03 IS OMNI 1 1 8-21-03; 4:25PM: RUSH ;907 5815301 r 3/ 3 CT&E Environmental Services Inc. ,f ■ Laboratory Division • • 200 W. Potter Drive )rinking AnalysisReport Re ort for Total Coliform Bacteria Anchorage, AK 99518-1605 907) READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE . Tel: ( Fax: (907 56561.52-2343013 TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: MUST BE COMPLETED BY WATER SUPPLIER p PUBLIC WATERSYSTEM LD.B 75.% PRIVATE WATER SYSTEM • • . O Send Results 0 Send Invoice • • Wau "4"." ... ii^Y �aa ���. Comma .r ALASKA WATER & WASTEWATER r.. NY.M 3701 L Tudor Road, Suite 101 PiellehYMber 14404 Addis Anchorage, Alaska 99507 su. iy Cada O Send Resuffs Tweet ha Maass Address 1■ sCtea WawrO '/... Lr1srrWA rSItt 2Y. ;701 t Tudor Dnart *Ors 1 D Anchorage, Alaska 99507 s..1. . ie Cad. SAMPLE DATE: SAMPLE TYPE: $ Routine O Repeat Sample ((or routine sample with lab ref. no. ) O Special Purpose SAMPLE LOCATION • Lots Bt -IC trrt 'oa1C Ile" / Od?f tpr' F &c -e r ' Ole • Month 1111 Day Comments: y0� 10171 Year Treated Water Untreated Water Time Collected ' 1505 Collected • By Satisfactory O Unsatisfactory O Sample over 30 hours old, results may be unteliable O Simple too long in transit; sample should not be over3Ohours old at examination to indicate reliable result?. Please send new sample via special delivery mail. Date Reeelved . 14.03 Time Received • 17 00 Analysis Began Analytical Method:' Membrane Filter O MMO-MUO • Number of colonies/100 ml. Result 1035301 'IA i■ rr irnn,unmemin Frodi ?kw Prim . Analyst '!/TTS Fbks Jun ❑ Faxed . Date: Time: yrt3.6 1p Client notified ofuoeas results: •Phonedp/� Spoke with Date: !1(1103 Time: 1705 - • axed BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result: Total Coliform Membrane Filter: Direct Count D E. Coll Colonles/100 ml Verification: LTB BCH COLIF.IRM Fecal Coliform Confirmation Final Membrane F iter Results Reported By ite S Coliform/l00 ml • Time ("0 ' hrs TNTC. T.. Moment T. Gun. 00 - Ode lawn ff�lEMS Member of the SOS Group (Societe Ganarate de Surveillance) i r 1 •d AS BUILT I HEREBY CERTIFY. THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: rcrer cour uteri vs tfa'ar' • AND THAT NO ENCROACHMENTS EXIST 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 OF FENCE LINES, OR FOR ESTABLISHING �DOUHD_ ARY LINES. p. 1 SEWARD & ASSOCIATES LAND SURVEYING 696-0829 SCALE: eretIO- DATE; GRID: . swrrs` DRAWN: •c//y1 l0sO\-\\ fM* .'•%/- • E0¢ •. LS -6912 •