Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
SOUTHFORK WEST BLK 4 LT 6
Southfo k VVes Block 4 Lot 6 #078-031 - 18 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201271 PID Number: 078-031-18 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name JEFFREY & VICKIE SWING ABSORPTION FIELD -EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 1355 WEST RIVER DRIVE, EAGLE RIVER ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Fill added above original grade Ft. Gravel length Ft. SOUTHFORK WEST 4 6 Township Range Section Gravel width Ft' Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'-1- -- 100'-1- 25'+ TANK ® Septic ® S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water 100'+ -- 100'+ Material HDPE Number of compartments 2 Lot Line 10'+ -- 10'+ NA Foundation 10'+ -- 10'+ LIFT STATION Manufacturer ORENCO / GREER Capacity 1250 Gal. Remarks 3BR HOUSE — w/ 2 SYSTEMS Alarm location GARAGE Electrical installed by CONNECTED TO EXISTING PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Installer JRS Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection1s` 8/12/20 8/13/20 Location and description Znd dates: 3`d 4`h BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL .� A ~� Conditional Approval: Date ' •:�,f.�i .. 4.... ....�:* rr . -.. / " " " " " "' Curtis Huffman k Septic System Approve v/�,• CE 128991 ��/ �ti t Z 1 Date � ��t lF�Fo� ��lzozNA��2,� 1, ROFESSIO -�- OFESS\ Note: this approval does not include well permit requirements. � �� (Rev ub/u2/18) PERMIT: OSP201271 PID: 078-031-18 NEW 1250—GAL HDPE STEP "J TANK \ C MT D MH F A—C=14.6' B—C=15,3' A—D=18,1' B—D=16.2' SCALES 1' = SEPTIC SECTION SOUTHFORK WEST BLOCK 4, LOT 6 PREPARED FOR: JEFFREY & VICKIE SWING 1355 WEST RIVER DRIVE EAGLE RIVER, AK 99577 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 firstwaterAK©gmail.com SCALE, NTS SUPPORT@ SERVICES: ' .�> OF AL,4F -w-, s� 9 Ti DATE: 8/17/2020 rtis Huffman SURVEY: JLS 2020 ;rj,. CE 128991 DRAWN: FWCS 8/17/2020.op SCALE: 1 ° = 30'tssto��' 7/31/2020 MUNICIPALITY OF Development Services Department T On -Site Water & Wastewater Section Parcel I.D. 078-031-18 ON-SITE SEPTIC/WELL PERMIT APPLICATION Phone: 907-343-7904 Fax: 907-343-7997 Property owner(s) JEFFREY & VICKIE SWING Day phone 9075381875 Mailing address 1355 WEST RIVER DRIVE, EAGLE RIVER, AK 99577 Site address 1355 WEST RIVER DRIVE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) SOUTH FORK WEST 134, L6 Legal description (Township, Range & Section) Lot Size 111930 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank 0 Upgrade 0 ❑ (D) Holding Tank F-1Renewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. F WEc--- (Signature of property owner or authorized agent) Permit/Rush Fees: Cc,20 Date of Payment: 5 a0 Receipt Number: Permit No. OSl�ZC�12%� Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350 -9566 / firstwaterAK@gmail.com July 23, 2020 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: SOUTHFORK WEST BLOCK 4, LOT 6 The owner has requested that we obtain a septic permit to upgrade the existing aged steel STEP tank on the above referenced lot. We propose to install a 1250-gallon HDPE STEP tank outside any deck supports to serve the existing 3-bedroom residence. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201271, Deb Wockenfuss, 07/31/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201271, Deb Wockenfuss, 07/31/20 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 9951943650 Page www. ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAl. SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: -~'~J'~'OO 2~ PID Number: ""~ C4~.~,a[f/~4/j Wastewatersystem: [-INew ~'Upg~'ade SEPARATION DISTANCES ~eptic DHolding DS,T.E.P. ~=w--fOg'~ tOO¢ tOO& -- ~ / . LIFT STATION / "'~' BENCH MARK Inspections pedormed by2~0+~,~ ~.Dates: 1' ~f~!Oc _~~, Development Se~ices Depa~ent Approval' ~...~Q~ DESIGN NOTES: 1. Total Depth of Trench is .3'. 2. Sewer Service Line minimum 2% slope. :3. Trench is Minimum 1' from Lot Line. 4. Lots Served by Private Water Wells. 5. Run New Sewer Service Line Inside To New Septic Tank w/ Found< Slope 5-10% ~H1 use ~eU Space Cleanout. C.O,"s Galton Septic Tank \ \ Disconnect STEP Tank Leave In Place Arrow Future Use ~eptl¢ ~yste~ Reconstruction Does Not Peectude Adjoining Lots lrro~ ~:~nlt~tlon [nprovenents. F.C.D. S,T. C.O.! S,T.C,O.2 D.C.D. MT/CD 33 10 I 34 11 % 39 6 89 46 l lOP, THP, IM gI',IGII'TEEP. ING ~__ SBUTHFDRK ~EST ~LBCK 4, LBT 6 REV[SE9 i AS-BUILT LBT PLAN U 0 O_ U Ir. C 0 b- hi "6 MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK ~)9519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Feb 21, 2006 Expiration Date: Feb 21, 2007 Permit Number:, SW060023 Legal Description: SOUTHFORK WEST BLK 4 LT 6 Design Engineer: 0838 North Rim Engineering Owner Name: MIKE BOWDEN Owner Address: PO BOX 770097 EAGLE RIVER, AK 99577- Parcel ID: 078-031-18 Site Address: 001355 WEST RIVER DR Lot Size: 111930 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of; [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage Ail construction must be in accordance with: : 1. The attached approved design, i 2. Ail 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. 5. The following special provisions. ~ -THE UPPER SIX INCHES OF THE MOUND SYSTEM MUST CONSIST OF TOP SOIL AND THE MOUND MUST BE VEGETATED SUFFICIENTLY TO PREVENT EROSION. Received By:. Issued ~ Date: Date: */;/Z,//~ ~, Ii I Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (9O7) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Permit Number SW Property owner(s) Mailing address tPO Site address/.~5~" ~ i~.,,.,~q'' ~"~rv~'~. /~ rZ"rv'/c~ Day phone ~"~D~'-, ~q~7~ ~.~<-Zip Code Zip Code Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) LotSize /11, C,/30 Acre ' THIS APPLICATION IS FOR: Sewer Only [] Sewer and Well ~ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub [] Swimming Pool [] Therapy Pool [] Number of Bedrooms Well Only [] Water Storage [] Jacuzzi [] Water Softening Unit [] 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 owne~r authorized agent) Permit/Rush Fees: LI/~c' Waiver Fees: Date of Payment: /~¢2 ~,.~ 1~' Date of Payment: Receipt Number: ,/q I~ a Receipt Number: (Rev. 09/~) ~MjE-I. IX TF:RIM I '~'~INEERING MEMO Steve Eng, PE, PH 17237 Bear Paw Circle, Eagle River AK 99577 (907) 694-7028 tel (907) 694-7026 fax NorthRirnEng@aol.com Date: 7/17/06 Number of Pages: 7 To: Joe Goodall MOA On-Site Services Subject: Construction Revision; Southfork West Block 4, Lot 6 Permit # SW060023 Joe, At your direction ~ve completed additional test holes at the site. Surprisingly we discovered superior sandy soil down-slope. The revision is included. Please issue approval immedlately due to the continued breakout of effluent below the existing trench-this is ~i contlnulng health hazard. Thanks-Steve Revision Southfork West, Block 4, LOt 6 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is an existing 3-bedroom, single family home. The existing leach trench has failed and will be replaced. New test holes were completed and sandy soil , discovered. The design revision is included. The existing S.T.E.P. tank will remain in place as a backup system; the old leach field should rejuvenate over time. This lot is large as are the neighboring lots; the absorption trench will be a minimum of I' from the lot line (waiver). No adverse impacts are expected from replacement. The existing water well has adequate separation as does the neighboring systems. Utility easements will not be encroached upon. The design is based on the previous design and utilizes a 5' wide trench with allowable reduction factor. An application rate of 1.2 GPD/FiTM with 0.64 reduction factor for utilizing a 5' wide trench. ~ Specification Requlrements: Ail components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and : Wastewater Regulations. : · Two compartment, 1000 gallon septic tank. · Watertight couplings on inlet & outlet. · 5' minimum between the tank and bed. 10' to property lines. · 3' ofcover or insulation is required for trench; an equivalent of I" 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' 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' 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 ofcast iron. · Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain-rock, i · Drain rock to be ½ inch to 2 ½ 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 }11 or equal) DESIGN NOTES: % Total Depth of Trench is 2. Sewer Service Line minimum 2% slope. 3. Trench is Minimum 1' from Lot Line. (~ 4. Lots Served by Privote Woter Wells. 5. Run New Sewer Service Line Spoce To New Septic Tonk w/ Found, Cleonout. Slope I~ 5-10X ~/eLI C.O.'s Gallon Sep~cl¢ Tc~nk \ \ Dls¢onnec* STEP Tank Leave In Ptoce ~ Arrow Future Use Septic System Reconstruction Does Not Preclude kdJolnlnO \ \ \ ( I IOP, THP, IM ~ ~1~1 GINEEP. IN G' Eagle SDUTHFDRK WEST BLOCK 4, LOT 6 REVISED REVISION LBT PLAN 'i' I' = 60; ........ t~at.~ ........ ~S~C~T: . k. 7/12/0fi_ _ II/q I*- U ('7 Z I*- 0 ,,H' -- 0 0 ~J 0 O. O. [21 - Uo r'l I.-- Oj z I-hO .1 C C § IX THRIM ~ E~GLNEERING SOILS LDG - PERCDLATIDN TEST Date PerForMed: 6/89/06 PerPorMed For~ Prudential Vista Legal Description, Block 4, Lot 6 4 - 5- 6- 7- 8- 9- 10- 11- 18- 13- 14 - 15- 16 - 17 - 1B- 19- 80- 21 - DEPTH (FEET) ~ Drganlc ' ;h~'%*" Sand SLope 8 5-10% Groundwater?.No Depth Water Depth AFter Honitorinq, None Date: 7/6/06 Date Gross TIMe Net TIMe Depth Net Drop 6/89 0 -- 5- __ 6/89 10 10 Mln, 11' 6' 6/89 18 -- 5, __ 6/29 88 10 nih, 11' 6' 6/89 83 -- 5- -- 6/29 33 10 MIn, 11' 6' ,Percotatlon Rate 8 Min./inch Perc Hote DiaM'eter G' Test Run Between 3' and 4' Comments: Prp--~n(~ked ; Per?arMed By--g, I ~ CERTIFY THAT THIS TEST WAS Per?ormed in Accordance with A~ State/Municipat GuideUnes ~in E??ec~ ON THIS DATE. DATE, 7/15/06 ~ ...... ~.. --. , - ' 'LDT 6 907--694-- 7028 GEDTECHNICAL T,H, 1 :~*-= ........ ~'~, ..... ............................................................ Z/_~_<9 ~_ _1 ~_.~_r_.¢_, THRIM [NEERIN® SOILS LDG - PERCDLATIDN TEST Date PerFormed, 7/10/06 PerFormed For: PrudentiaL Vista Legat iDescription: 3Lock 4, Lot 6 2- 3 - 4 - 5 - 6- 7 - 8 - 9- 10 - 11 - 14 - 16 - 17 - 19- 20- 21 - DEPTH (FEET) · ~ ;,-~ji:.'.'i · : .: ¢'~~', :5 %.' ..&. ?~'.. Organic SP SLope I~ 5-10%. Sand w/Low Sit't Groundwoter? No Depth ~oter Depth A?ter Monitorlnc Dote: 7/17/06: ]Dc~te Gross Time Ne't; Time Dep'th Net Drop 7/10 0 -- 6- -- 7/10 10 I0 min. 12' 7/10 12 -- 6, __ 7/10 22 lO min. 1P' 7/10 23 -- 6- __ 7/10 33 10 min. 12' Percototlon Rote 2 mln,/Inch Perc HoLe Dlometer G' Test Run Between 2' end 3' t Comments, Prp-~QQkPd Per?ormed By~:~zz~DJ~g, I ~ CERTIFY THAT THIS TEST WAS PerFormed in Accordance with AtL State/HunicipaL GuideLines ;in EFFect DN THIS DATE. DATD 7/15/06 N OR THRIM ~ ENGINEERING i 172J7 ~eo? Pow Circle ~ Eagle River. Alasko 99577 907--694-- 7028 ~..~.~ ............ i SFIUTHFKIRK WEST!]BLOCK 4 t~)):' '-g' '"" ' 'ILI]T B :: \"~ ........ ' '~ IGEOTECHNICAL T,H, 2 ~ ~- ....... : ........................................... ' 7/15/~6__.1 e__o.£_.a_] Municipality of Anchorage Page t of ~'' DEPARTMENT OF HEALTH 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 "~~ ~ ~1~ Wastewater System: ~ew D Upgrade Pho~. ~ ~ ~ [No. of ~ooms: ~ Deep Trench ~Shallow Trench ~ Bed ~ M~und D Other WELL: ~ew D Upgrade Gravel;;:;~: ~ F, ~ . [~ Ft ;,ass~hcahon (Prwate. A.B.C): TOtal Depth: Ft Cased TO: FI Total absorption area* -- ~/~ SO Ft ~ia~~ SEPARATION DISTANCES ~ Septic O Holding ~.~.E.P. Surface Water ~ [~+ [~+ ~ ~ LIFT STATION ; Line Assumed Elevatio S & S [NGINEEEING Eagle River, Alaska 995~ 2nd ~-t~ ~~ Department of Health and Human Se~ices approval '~"~ I ~'~ ;2-OI3 (Rev 9/91) MOA 25 Permit No.~/'-~'01 (::>1 Page '"2.- of Municipality of Anchorage DEPARTMENT OF HEALTH 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 PERFORMED FOR: LEGAL DESCRIPTION: L--~~f ~-~:). ~-~ Township, Range, Section: ~ SLOPE MURIC',."t, O' ARchor.ge DEPA~.T..MENT OF HEALTH & HUMAN SERVICES 825 L Street, Anchorage, Alaska 99502~650 1 4- 5- 6- 7 8 9 10 11 12 13 15- 16- 17- 18- 19- 20- COMMENTS WAS CROUND WATER ENCOUNTERED? SITE PLAN Reading Date Time Time Water Drop PERCOLATION RATE (minutes/tach) PERC HOLE DIAMETER '.. · ',~ , I - "-~ J TEST RUN BEI'WEEN ~ FT AND ~FT - - · -~ ! ~ PERFORMED BY: $ 8, $ ENGINEERING I CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River Loop Road No. ~ ACCORDANCE WlTHL~d~e~Tj~t~T~ ~j:~N~.~t~ GUIDELINES IN EFrEC~ ON ~HIS DA~E. DATE: 72~ (R~. ROBERT SHAFER, P.E. ROGER SHAFER, P.E. Oc~obe~ ~1~ 1991 CIVIL ENGINEERS (907) 694-2979 FAX 694-121 '1 SEWER &WATER MAIN EXTENSIONS SEWER & WATER INSPECTION STRUCTURAL& MECHANh~AL INSPECTIONS P.O. ~ox 196650 A~o~ge, ~ 99519-6650 REFERENCE: SEFTIC ZNSPECTZON REPORTS: NE ½,SW ½, SEC. 6, Tl414, Lot $, B~ P~ Lo~ 6, 8~OCE 4, SO~ FOrE ~ S~5~uZ~O~; LOt 16A, S[C. 15, Lot 6, ~OC~ ~, T~ End Sub~u~ion; Lot 5, BLocE I, G~ SZnce~V , ROGER 3. SHAFER, PJS/g~ cc: REFERENCED F~OPERTY OWNERS 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 #L# STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW920101 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:MCCULLOCH LEE ANN OWNER ADDRESS:Il631 DAWN ST. #4 EAGLERIVER, AK 99577 PARCEL ID:07803118 LEGAL DESCRIPTION: SOUTHFORK WEST BLK 4 LT LOT SIZE: 111930 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: EXPIRATION DATE: 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE: DATE: PAGE 1 OF 1 5/22/92 5/22/93 ISSUED BY: unicip lity of Anchor ¢ Department of Health and Human Services Tom Fink. 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 May 18, 1992 Lee Ann Mc Culloch 3501 Dorbrandt Anchorage, Alaska 99503 Subject: Lot 6 Block 4 South Fork ~e~Subdivision Permit %SW910104, PID %078-031-18 The subject permit, issued May 16, 1992 by this office single family well and/or on-site wastewater system, expired as of May 16, 1992. for a has A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $200.00 for an on-site wastewater permit; $75.00 for a well permit and $275.00 for a combined on-site wastewater and well permit. If you have any questions, Si~erely,~ / ~"'~'n'"' Smlth/~'P. "'J~ enc: Copy of Permit please call this office at 343-4744. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 #L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW910104 DESIGN ENGINEER:S & $ ENGINEERS OWNER NAME:MCCULLOCH LEE ANN OWNER ADDRESS:3501 DORBRANDT ANCHORAGE, ALASKA 99503 DATE ISSUED: 5/16/91 EXPIRATION DATE:f5/16/92 PARCEL ID:07803118 LEGAL DESCRIPTION: SOUTHFORK WEST BLK 4 LT 6 LOT SIZE: 111930 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: ~. _ _~¥~ _/~/~~.. ISSUED BY: DATE: October 21, 1991 ROBERT SHAFER. P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694.2979 FAX 694.1211 WELL INSPECTION & FLOW TEST ROAO DESIGN SOIL TEST PERCOLATION TEST Munic~pa~y of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Stree;t. P.O. Boz 196650 An~o~gz, A~ 99519-66~0 REFERENCE: SEPTIC INSPECTION REPORTS: RECEIVED OOT 2 19 1 F,veltn & Human Services NE ~,SW ~, SEC. 6, T14N, RIW, S.M. Lot $, Bea¢ Pare SabdZui6ion; Lot 6, BLoc~ 4, Sou. th For~ ~e~g Subdivision; Lot 16A, Sec. 15~ T12N, RSW, S.M. Lot 29, H~ide Pare Subd~ui6ion; Lot 6, B~oc~ J, Trai~ Erie Subdiui~ion; Lo~ $, BLoc~ I, Gat~wa~ To The Par~ SubdZu~ion; Ove. r .t./~.6 sep~c sY~ lo.ed on the ~bove ~ef~enc~ prop~. ~A~ o~ with ~ However, to {oun~o~ in6~d. Onc~ foun~o~ comp~d i~p¢~on ~ ho~. prop~ b~c~k. Th~fo¢~, compl~d ~p~c i~p~on r~po[~ for th~ prop~ ~r& forthcoming. If ~o~ Sinc~y, ROGER J. SHAFER, P.E. ~S/~ cc: REFERENCED PROPERTY OWNERS DESIO. 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 09577 ROBERTSHAFER, P.E. ROGERSHAFER ~ 7, 1991 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 SEWER & WATER INSPECTION WELL INSPECTION & FLOW TEST ROAD DESIGN P~RCOLATION TEST DEPARTMENT OF HEALTH ANO HUMAN SERVZCE$ 825 L P.O. Box 196650 A~o~9~, A~ 99~19-66~0 REFERENCE: LoG 6; B~ock 4; Sou. t.h Fo~ ~e6t Subd. Zui6Zon PERUZT REQUEST NARRATZVE - ~E~T A. SHAFER, P.E. · DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 PERFORMED FOR: LEGAL DESCRIPTION: L~ [~- ~lc=>. ~-----~'~,/-.- Township, Range, Section: W~-~' SLOPE SITE PLAN Municipali~ of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L" Street, Anchorage, Alaska 99~2~650 SOILS LOG -- PERCO~TION TEST WAS GROUND WATER ~.~__~ : ENCOUNTERED? Reading Date Cross Net Depth to Net Time Time Water Drop 1 2 3 4 5 6- 7- 8- 9- ~o_~ 18- 20- , ~ ! PERCOLATION RATE ~'~j.H~tes/,nch) PERC HOLE DIAMETER ~::~" TEST RUN BETW£EN ~--~/AND '~ FT COMMENTS ~ / ~, : , · · - · I/ / ~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN 72~ (Rev. 4/~) / ,, PERFORMED FOR: , Municipality ol Anchorage ~, ~ :, ~ ~"-..,..~...-~ DEPARTMENT OF HEALTH & HUMAN SERVICES SOILS LOG -- PERCO~TION TEST ~/. DATE PERFORMED:~ ~,~j ~1 SITE PLAN LEGAL DESCRIPTION: L ~ ~ ~ *~;:>, ~:~'z.~.7~.. Township, Range, Section: WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth ~ Water k~er ~ IdoniloriAg? / Bait 1 2 3 4 5 6 7 8 9. 10 11- 12- 13- 14- 15- 16- 17- 18- 19- Reading Date Gross inet Depth to Net Time Time Water Drop ~ ,~-q-~ o,.<:,_~ '~ [/~' .--7. 20- "? -"'/ I~, PERCOLATION RATE 4~/'~nutes~lnch) PERC HOLE DIAMETER TEST RUN BETWEEN ~.~--~T AND CCO ~ CE Wi~H {~,~i~IClPAL GUIDELINES I[~C~ ON ~HIS DA~E. it~'i-~=~ ' TEL: I Mag 12,9S 10:47 NoiOO2.P.04 ~.....~.].- ' *,.- .,/.! ' SULLIVAN ER WELLS P.O. BOX 170JY~ ~HUQIAK, A~ g0ie7 * T~LJPHONE ~J.~TSg j DEl'TH OF WELL ~ .~TATI¢' OF W.-~TER F r LEVEL DRAW DOWN FT. GALS, FER HR .KJNI) OF lAID OF FORMATION: r~, O :,t. I,,~~. Fl._O--~'~'/,d'¢ '~'71 ¢~'d/~ From FI. lo__FI From FI. to. Ft. From .FI. to FI. ,, From. FI, lo Fl. From FI. Io Irt. FIom Ft. to Ft.. From From, )m ', FL ~ FL I _ MAY 2 4 1995 MUn~c~palily of Anchorage Dept, Health & Human Services J_ __ J MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 078-031-18 1. GENERAL INFORMATION Expiration Date: I I 1 9^ Z 0 Zy Complete legal description SOUTHFORK WEST BLOCK 4, LOT 6 Location (site address) 1355 WEST RIVER DRIVE, EAGLE RIVER, AK 99577 Current property owner(s) JEFFREY & VICKIE SWING Day phone Mailing address 1355 WEST RIVER DRIVE, EAGLE RIVER, AK 99577 Real estate agent Day phone 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: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 9 12, 5D CO UID Waiver Fee $ Date of Payment $ 1 o2v Date of Payment Receipt Number 3 11135 Receipt Number COSA # 05CZQ )� 1 9 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 8/10/2020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. 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, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FI ES 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved *: 49TH .....•:*. ...�::: r� • '. Curtis Huffman ��f's�F,�• i428Ao �`•ii0/�*� ,`���PROFESSIONP Conditional approval for bedrooms, with the following stipulations: 1111(((((((( 6 Original Certificate Dater - 19-2020 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other I" In- 1< -1 Original Certificate Dater - 19-2020 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: SOUTHFORK WEST BLOCK 4 LOT 6 Parcel ID: 078-031-18 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 6/1992 Total depth 61 ft Cased to 61 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 7/7/2020 Static water level at beginning of test 20 ft. Well production at time of test 4.1 gpm Comments B. TANK DATA Age of tank(s) 14 & 0 years Tank type/material STEEL & HDPE Measured operating fluid level in septic tank 49" & NEW ® Standpipes/foundation cleanout per record drawing Date of pumping 6/4/2020 & NEW, D. ABSORPTION FIELD DATA Which system tested (date installed) 8/2006 & 8/1991 ® ALL standpipes present per record drawing Total measured depth from grade 5.6 & 4.5 ft (max) Measured depth to pipe invert from grade 3.2 & 3 ft ❑ N/A — pressurized field ® Monitor tubes o to bottom of effective If riot state Structure served by this system _ Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 0.347 mg/LNitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) FWE�,�,,.. Collected by ` Date of Sample C. LIFT STATION 7/7/2020— Z Required maintenance completed Age of lift station 0 years Lift station material HDPE Comments: TWO COMPLETE SEPTIC SYSTEMS Adequacy test date 7/7/2020 Results N Pass For 3 bedrooms Fluid depth prior to test 6 & 0 in Water added 450 & 450 gal New depth 15 & 7 in g I ' Elapsed time 1400 min depth into effective ® Code -required soil cover over field Final fluid depth 6 & 0 in ❑ System presoaked Absorption rate 450 & 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date FW`cs Comments/Deficiencies: BOTH SYSTEMS TESTED (2006 & 2019 — TESTED LOWER TRENCH) « L,_.:. E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No _ Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No —ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelinds in effect on this date. 1100,, '• �k �'•.�, d• TH •, .... .. ....... .. t .... ....... ... .. Curtis Huffman CE 128991 ����1i�p OFESS ON�\:'I..�,M- ft ft ft ft ft ft ft ft S28'43'34"E 214.04' \ ¢ LLC co 25' CREEK MAINTENANCE ESMT�I�� w w O 910 0) 10 0 \ S25°03'54"E \ 112.22' LOC1,12cll'i CJ CO2 °do .\FC^l�T�OUcl CSD Uu•' J' ??11HaS i .y o -O rn \ bOd, \ ;D W t"{y+ O O �� I— Y po yo a O J 88 \ H t ASW > 16 N104 \ O(� VVV O J 26.0' o Y� 5 OWN / ���� Q• abi� �w v`o o z ^ 'j C Ln 0 / COi .3 m N o v � <Y w Xz O A• O" i / _U V� `c fl uo 06 24.0' N O Q c Vl /� o � c � 9z 00 W / /� �E �� 389.63 �/'�' z a c 3 0 N o w C �, �" �� A E.•� 0. 0 >, � r- . u a a • tom• U ' / -/` 6' 22 //• •' 00 - .� 'JO' N v T m A ROR�E � w� X45 ZE aQ • -- / �- i 0®� ����°a 18 2 zoo > 4� O .% •�n K ai Er .� U •� O / �� i d dv�.a �n.•���� Uwb 3 N Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE FOR A OF ON-SITE SYSTEHS APPROVAL SINGLE FAHILY DWELLING Parcel I.D. 078-031-18 1. GENERAL INFORMATION COSA# Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SOUTHFORK WEST; BLOCK 4, LOT 6 1555 WEST RIVER DRIVE *EAGLE RIVER 99577 MIKE &: LUAN CALLAHAN Day phone 1355 WEST RIVER DRIVE *EAGLE RIVER 99577 696-5251 Day phone CINDY LINDBLOM W/ GREATLAND REALTY Day phone 11411 OLD GLENN HWY *EAGLE RIVER, AK 99577 694-9125 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well · Individual On-site · Individual Water Storage [] Individual Holding tank [] Community Class Well [] Community On-site [] Public Water System 'E~ 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 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 afl 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 JEFFREY A. GARNESS, P.E. Phone Date 357-6179 Engineer's Comments: In conducting this evaluation, GEG, LtD. alfempted to p~'ovide, a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of afl wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. DSD SIGNATURE bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 EImore Road 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; BLOCK 4, LOT 6 Parcel ID: 078-0,31-18 Ao WELL DATA Well type PRIVATE Date completed Total depth 61 6/92 IfA, B, or C provide PWSID# N/A Sanitary seal (Y/N) YES Cased to 60'-5" ft. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 1 2+ in. FROM WELL LOG Date of test 6/92 Static water level 28 ft. Well production 40 g.p.m. AT INSPECTION 9/28/11 56 4.85 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/lO0 mi. Nitrate ND mg./L. Arsenic: ND. ug./L. Date of sample: 9/29/1 1 Collected by: GEG, Ltd. SEPTIC/HOLDING TANK DATA SEPTIC/STEEL Tank Type/Material STEP/STEEL Date installed 1000 2 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Foundation cleanout (Y/N) Y/Y Depression over tank (Y/N) NO High water alarm (y/N) Date of pumping ~O..]& /~DIi Pumper ,_[/~,1.~ J~U~IiOi~J~- ABSORPTION FIELD DATA I'BELOW EXISTING GRADEI 7/20-8/7/06 1.2 Date installed 8/14-16/91 Soil rating (g.p.d./ft2or~ 0.6 50.5 Length 60 & 59--1 19ft. Width 5 ft. YES YES 2006/1991 TRENCH System type DUAL TRENCHES 2.5 Gravel below pipe 1.5 ft. *5.62 Total depth*4.79&*5.54ft. Eft. absorption area Date of adequacy test *,9/28/11 Results (Pass/Fail). PASS Fluid depth in absorption field before test 10.5/0.5 in. Water added 840/107o gal. · Elapsed Time: 120/894 min. Final fluid depth 12.5/2 in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date - · *TESTED 2006 SYSTEM & LOWER TRENCH OF 1991 SYSTEM: ***MONITORING TUBE OF UPPER 1991 TRENCH DOES NOT EXTEND TO BOTTOM. UPPER TRENCH HAS 1.5' (CALCULATED) OF LIQUID IN IT. 395 YES NO 762 ft2 Monitoring tube***YES Depression over field NO For 3 bedrooms New depth __in. 450+ 450+ g.p.d. D. LIFT STATION *NO Date installed 8/14-16/'91 "Pump on" level at 50" in. Datum BOTTOM OF TANK E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ELECTRICAL INSPECTION REPORT ON FILE AT MOA. Size in gallons 1250 Manhole/Access (Y/N) YES "Pump off" level at 41" in. High water alarm level at 45" in. Cycles tested 3 Meets alarm & cimuit requirements? *UNK 100'+ Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas 50'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field 5'+ Surface wate[ 100'+ '1'+ 10'+ KNOWN Building foundation. 10'+ Surface water 100'+ Wells on adjacent lots 100'+ Water main N/A Driveway, parking/vehicle storage 10'+ Property line Water service line Curtain drain NONE COMMENTS *PER APPROVED 2006 INSPECTION REPORT. 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 COSA Fee $ ~ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number AS-BUILT I hereby certify that I have s.urveyed the following described ~ oo.-~ ~,.~,~ ~-~. ~_~..~. ~ x~.~ ~ , , ., ~omge Recor~g ~ct, AI~, :~d'that ~e ~prove- m~ts si~ ~ ~ ~ ~e ~r0~ ~ and ~o not ~lap or en~oa~ on the ~p~ l~adj~cent thereto, that ~ ~provements on Pr0p~ 1~S adjacent ~ereto en~oa~ on ~e p~s ~ qu~on ~d that ~ ~e no roadways, ~am~sion '~es or o~ ~le e~emen~ on said prope~ ~cept ~ ~cated h~n.. Dated at E~e ~, ~a~a I" =~' ~x ~, ~e ~v~r, ~a 995~ ~one (90~ ,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. munl.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ' O '7~* 0 ~, I - 1; GENERAL INFORMATION Complete legal description COSA# C) 6; Expiration Date: .Location (site address) /~5'5' V,[~'E?" /E/v~'..~., D,~/v'~_ J C-r~ent ?,op? ow. er(s) ~0,~//.'/~ Day pho,~e ¥~,~-~'~7," Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Dayphone Un/ess otherwise requested, COSA will be held by DS• for pickup. NUMBER OF BEDROOMS: .~ Day phone 6'o~?-~'r-./' 7'~ TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well 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 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 titJe (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 Syste'ms Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and ma~, 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 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 /',/O,cJ["~,-' Address Engineer's Pdnted Name ..~'7"---~ Phone 5. DSD SIGNATURE J Approved for ,.~ Disapproved. Conditional approval for .__ bedrooms. bedrooms, with the following stipulations: Additional Comments Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Odginal Certificate Date: Municipality of Anchorage Development Services Department Building Safety Di~sk:m On-Site Water & Wastevmter ProGram 47OO Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6~50 www.muni.org/onsite (go7) 343-7~04 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST A. WELL DATA Well bjpe ~ If A, B, er C provide PWSID # __ Datecompletad~'/~-. Sanita~$eal (Y/N) 7/. Total depth ~'/ fl. Cased to ~/{ ft. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~ colonies/100 mL B. SEPTIC/HOLDING TANK DATA Perc~ ~D: 07~:..031 Well Lng (Y/N) y w~es propa~ p~otac~d (Y/N) Casing he,iht (above groped) AT INSPECTION Nitmte~. 3'.%"' mg/L Other bacteria ~__ colonic'es/100 mL Date of sample:~'/',~--?,/e ~' Collectod by:. Date installed ~ ~earx~s (Y/N) y High water alarm (Y/N) Tank Type/Mat~ ,~(~/.~ l~,/~-~'~' Tank size F~a~' ~W ~ ~mpi~ '~ ~[~' ~m~ C. ~SOR~ON FIE~ DATA Date im~l~ Total depth ~' fl. Date of adequacy test Fluid depth in absorption field before test in. Elapsed Time: __ min. Final fluid depth System type '~'_/J'~ H Grav~ below pipe ~'- ~ fl. ~ ~u~(Pa~afl) F~ ~ ~ms Wa~ ~d~ ~. N~ dep~ in. ~. ~ rate >= ~ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. UFT STATION Data installed ,/ Size in gallons 'Pump on' level at/ in. 'Pump off'k~ Datum / Cycles test,etd E. SEPARATION/DISTANCES in. SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/.aa~ess (y~/ High water alarm/I,l,l~l at Meets alalm & ~ mquimn'mms? in. Septic tank/lift station on lot ,/~/~ Ab~erption field on lot t/ Public sewer main ,A/'/ Sewer/septic sewice line /~ Animal containment areas /<J~/,,~- On adjacent lots On adjacent lots Public sewer menbele/deenuut Holding tank /~'/,,'~' Manure/animal excreta stm'age areas /v',/..~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation. Water main Wells on adjacent lots /4-?- Water sewice line //~ ¢1" Absorption field ~ / Surface water /O'o ~+- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: PropeHylins //./.. 'e' Bulldlngfoundation /~ ~' Watermaln Water Sendce line //~) Curtain drain F. COMMENTS s acewater. / O Wells on edjacem lots COSA Fee $. Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number MEMO Steve Eng, PE, PH 17237 Bear Paw Circle, Eagle River AK 99577 (907) 694-7028 tel (907) 694-7026 fax NorthRimEng@aol.com Date: 8/10/06 To: Jeff Poet MOA On-Site Services Subject: Southfork West Block 4, Lot 6 Number of Pages: I Jeff, The site ~vas regraded & branches removed. Photos below. Thanks-Steve Regraded Septic System Cover 8/10/06 End of System CO/MT 8/10/06 AS-BUILT I hereby certdy that I have surveyed the following described property: Lo't 6 .~ ~/~c.? ~--I! Anchorage Recoiling Pr~inet, ~la~k~, ~nd lhat the ~prove- merit* ~itu~ed Ihe~on ~ wilhin the p~y line~ and do not ~etlap or en~ach on the p~pe~y l~gg ad acent the~to, that ~ improvements ~ pm~,y ly~8 adjacent the~to en~ach on the p~m~s in question and lhal the~ a~ no roadways ~ansmissbn lines or other v~ible ea~men~s on said ~cept as ind~ated he,on. Dated at Eagle Riv~, Rhska · is ~ ~' dayot ~ ~' ~ 2~ G ' ' - ROBERT C. JOttNSON -~ ~ ~ALE: . ~giste~d ~nd Su~eyor No. ~LS ~one ~ 6~3 . Municipality of Anchorage Ma!for Mark Be~.fich 8/812006 Steve Eng North Rim Engineering 17237 Bear Paw Circle Subject: Waiver Request for SOUTHFORK WEST Block 4 Lot 6 ~ Waiver Request #WR060044 Parcel ID #078-03 I-18 HAA# 060073 Permit # 060023 Dear Engineer, Your request for a waiver of the required I0 feet horizontal separation from' the absorption field to the property line has been approved. The approved separation disfince is 1.0 feet. b fi Id . This waiver approval applies to the existing a sorption ~e to property hne separation only. Any future upgrade to the on-site wastewater disposal system will requir~ 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 Contmunity, Security, Prosperity Municipality of Anchorage Development Services Department Building Safcny Division On-Site Watcr and Wastcwatcr Program 4700 Brasaw Strcct P.O. Box 196650 Anchoragc, AK 99519-6650 www.ci.anchoragc.ak.us (907) 3430904 Waiver Review Worksheet WRY: 060044 PIDg: 078-031-18 HA#: 06007~I Permit~: 060023 Dale Received: 6/20106 Legal Description: SOUTHFQI~K WEST Block 4 I. gt~ Engineer:. Steve Ena North Rim EnQIneerinu 17237 Bear DaW (~trcl9 Applicant: Callahan Waiver Requested: 1 foot seoaration distance absorption field to Drooert¥ line Criteria: Geology Points: A. Waler Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Waiver is Granted: J Waiver is not Granted: List Conditions or Reasons for above: I~h"~evlewer Rec~: 6'20.06 Amount: $175.00 Dale Paid: 6-20-06 Parcel I.D. MUnicipality of Anchorage Development Services Department Building Safety Division On-Sita 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 1. GENERAL INFORMATION Complete legal description Location (site address) / .~.q'..5" 'V-,/,¢'"~ 7"" Current Property owner(s) t~/~',E Mailing address / ~.5'.5' Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: .-~ COSA# 3.' TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well Expiration Date: Day phone Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site ~ Individual Holding Tank . [] Community On-site [] Public Sewer The Municipality of Anchorage Development Services Depadment (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,Naska. Certificates of On-Site Systems Approval are required for the lransfer 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 System§ 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 Munidpality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER ordinances, and regulations In effect at the time of installation. Address / 7.~' 7 ~5~'~_,- Engineer's Pdnted Name .~"~ 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(ara) in compliance with all applicable Municipal and State codes, 5. DSD SIGNATURE Approved for Disapproved. bedrooms. Phone ~/'~'.4/- '~'d'~-~ XX Conditional approval for 3 bedrooms, with the following stipulations: Money to be escrowed in the amount of $30,000° to construct e new wastewater disposal system including engineering and surveying, pursuant to permit number 5WO60023. Money in escrow shall not be released until this office has given firml approval. Construction shall be completed no later than June iS, 2006. Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: "~ - //.?Z _ ~) ~, (Re~. 11,'05) Municipality of Anchorage Development Services Department Building Safety Dlvlaion On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196850 Anchorage, AK 99519-6650 www. muni.org/onslte (so?) 343-7~04 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Desc~ption: A. WELL DATA Well type P Date completed ~'/?Z Total depth ~"/ ft. ff A, B, ~ C ~e ~SID ~ __ Well L~ ~,~1 (Y~)~ W~ ~ ~t~ ~) ~b ~/ fl. ~si~(a~) I ~ in. FROM WELL L~ Date of test Static watm level ~' ~ ft. Well production /-~ g,p.m. AT INSPECTION ~.~0 ft. '~ ~' g.p.m. WATER SAMPLE RESULTS: Coliform ~ calonlas/100 mL O, B. SEFTIC/HOLDING TANK DATA Tank$ize /~'O gal. . Number of Compertments Foundation cleanout (Y/N) y Depression over tank (Y/N) Date of pumplng !,~f ~,10 5' Pumper Nitrate ~o -~5"mgA.. Date Of sample: Other bacteria ~ colonies/100 mL c ,, ed 4/° Date :~tallad ~/~'/~ / Cleanouta (Y/N) y High water alarm (Y/N) 7 C. A~$ORFTION RELDOATA-- ,F,~IC~_~ /~/J~°~'CT/~/- ,c'c~4//~J Date installed Soil rating (g.p.dJft~ m ~/bdrm) System type Length ft. Width ft. Gravel below pipe Total depth ft. Eft. absorption area ~ Monitoring tube Dep~___~_ion over ft* Date Of adequacy test Fluid depth in absorption field before test__ in, Elapsed Time: __ min. Final fluid depth Any rejuvenation treatment (pest 12 mo.) (Y/N & type) Results (Pass/Fail) .~'~. I/-, For ~ bedrooms Water added__ gal. New depth in. in. Absorption rata >= I g.p.d. If ~. ghte date i D. UFT STATION 'Pumpon'levalat _~(~ in. Datum ~ E. SEPARATION DISTANCES Size in gellens /~-$'O 'Pump off level at ~ / in. Cycles tested _~ Manhole/Access (Y/N) 7 High water alarm level at ~ ~' Jn. Meets alarm & circuit requirements? ~ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ./43 Absorption field on lot ./ Public sewer main Sewer/septic sewice line 2 Animal containment areas On adjacent lots /'~ On adjacent lots Public sew~ manhole/deanou! Holding tank /'~'/,~ Manure/enimal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ,,~ ',v- Water main /~"/,,~ Wells on adjacent lots /~ ~ /~- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ,-- ~"c/~Jd J' Property line Water Service lice Curtain drain ~./',.~ F. COMMENTS Pmpertyllce /~ Water sewice lice Building foundation / Surface watar /O o ~- Wells on adjacent lots ,/rig Date of Payment Receipt Number (Rev, I Surface watar Lp Water main ,'L//'~ , G. ENGINEER S CERTIFICATION I ~d~ t~t I ~ deM~ ~h ~ ~s a~ ~ ~ MOA CO~ gu~eli~s ~ eff~ ~ ~ daM. ,' E~n,s ~nt~ Name ~ ~ ~ ~~~-~ Da~ ~/l~/o ~ ~,~. .,,~ ".-., , ~ i ' ~u~ F~ $ /~ ~F~$ II~ ~ipt Numar