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Home My WebLink AboutSOUTHFORK NORTH BLK 6 LT 2��h �2 �1�h Municipality of Anchorage Page 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 Permit Number: e PID Number: C>-FiR Name: Wastewater System: Ig New ❑ Upgrade Address: 1 01 ( ABSORPTION FIELD Phone: -Z 41 q a 3 a.S-, No. of B ooms: ❑Deep Trench Shallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: O• Total Depth from original grade: 7Z; 99— GPD/S . Ft. Lot: Block: Subdivision:(�6 1� Depth to pipe bottom from original grade: Gravel depth beneath pipe Z SC�-'t v Z�E! Ft. 1C2 Ft. Township: Range: Section: Fill added above original grade: 6 Gravel length: Z Ft. -�_S_0%3[ SV -'S Ft. WELL: U. New ❑ Upgrade Gravel width: Number of Distance betwfenlines: /-5 _S' Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: F9/0 /30 Zl Ft. I Ft. -Sig SQ. Ft. 3 Driller: SVLIvd+(,j Date Drilled: Static Water Level: Ft. Installer: a)W/Vt_�2_ Date installed: 8//S`/92; Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: n j� `C-(a(li Capacity in gallons: / ®D O From Tank Field Station Tank Sewer Lines /V Cid well i�z 5 /(9I 6 130 6 Material: STS r_ Number of Compartments: Z WateSurface r r&0 loot LIFT STATION Lot/ �Cvpt t Size in gallons: Manufacturer: Line tpC� Foundation 40, SO ` .'Pump on" level at: p at: High water alarm at: Curtain l nCp* �� Pump Me ode[ Electrical spections performed by: Drain Remarks:A-r�--cD tZf3C0CA 6� 5 �'s�v BENCH MARK Location and Description: _ "DV t� Z� T(Urt/ CSO r L"T?!ti_ L L _�_fOJ.l7 /So( ICC, �c.-r`-r �Ack Assumed Elevation: �/.Sem -. :.,,•::.• EAL ' OP t, 46th Inspections performed by: Dates: 1st 2nd Department of Hea and H man Services approval Reviewed and approved by: Date: 72-013 (Rev. 9/91) MOA 25 PERMIT NO, SW980095 THE PARK IS UNDEVELOPE THERE ARE NO WELLS OR SEPTICS WITHIN 200' OF THE PROPOSED SYSTEM AS -BUILT WASTEWATER ABS❑RPTI❑N S' LOT 2, BLOCK 6 S❑UTHF❑RK CO A B C ; TI 48.9 595 T2 54.8 65,7 C1 80,8 84.0 LOT BLOCK 6 C2 109.0 t TP._ Ci\Work\1-6SOUTH,DWG •' 49TH ren R. Pannone. Mr. Ray Nabinger No. CE 8149 °9 . P.O. Box X45- / [c711'L ,.gg?jD,-*�' w Anchorage, AK 995aaI<j • � (907) 249-3259 !1 �� (907) 249-3249 FAX t T 2, BLOCK 6 A DC1 �s S DESIGN, Perc Rate, 8 Min/Inch Soil Ratings 0.8 gpd/sf 3 B.R. 536 SF Required Deep Trench 5' Effective, 2-3' Wide, B' Total Depth, 60' Long 600 SF Total P,LD. NO. 078-02-119 SHEET 2/S LOT 3 IS UNDEVELOPED THERE ARE NO WELLS OR SEPTICS WITHIN 200' OF THE PROPOSED SYSTEM NEW TWO ;J[71kVL1 TRENCHES SHT 3 OF4 PANN❑NE ENG, SVC P. ❑. BOX 142025 ANCHORAGE, ALASKA 99514 272-8218 AS -BUILT PERMIT NO, SW980095 AS—BUILT DETAILS PID. NO. 078-02-119 TE TI WASTEWATER ABS❑RPTI❑N. SYSTEM SHEET 3/-4-- loci LOT 2, BLOCK 6 SOUTHF❑RK S/D 1 - M M 3 FLOW i� �� 1nONV313 SPLITTERrL DC 2 0. g I 4 L Q w Qi 1 DETAIL A "6 t ZLd fy �� u r 4 Z�w K -' QN3 HOV3 3 q.-+ ~ 0� 3Hn1 1901INOW 7 m y:!: inC�a_ WQj 3 a d 'p I inONV3l3 m m Ld U H Ld m m Z t- 6 a% ID a<;;< F H y `t V7 U W W 3 w 2' > w J w W ¢ N inONV3l3 3 mCu CV) 1nONV313 . .w m InONV3l3 a .-i 17 ,V.. al IA CO y ! 1n[INV313 w W Z-0 �,•• NOI1VQNn03 49 —TH .............................. ` 3� C!\Work\1-65❑UTH,DWG wk:......................:....; PREPARED F❑R+ j` ;Steven R. Pannone; PANN❑NE ENG, SVC, ♦ % No. CE 8149 i Mr. Ray Nabinger P, ❑, BOX 142025 P.O. Box a6y) s l Ct CDilZ ANCHORAGE, ALASKA 99514 �� Anchorage, AK 995ap I <( (907) 249-3259 DATE4 _ 103 oS98272-8218 FAX (907) 249-3249 FAX N❑T TO SCALE AS—BUILT y� Municipality of Anchorage w DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: AJA� ima 6L'2 DATE I LEGAL DESCRIPTION: L -?_n ISOV'-CFi�C2Y� Township, Range, Section: DEPTH --T -3 3 SLOPE SITE PLAN (FEET) 1 �s 2 3 4- 5 5 6 7 ML - 8 GM 9- to - Z04 10Z04 12 13 14 15 16 17 18 19 WAS GROUND WATER ENCOUNTERED? A) a S IF YES, AT WHAT L O DEPTH? P E Depth to Water After 8/�S1 � 5 Monitoring? gate: Reading Date Gross Time Net Time Depth t� Water Net Drop / 6l /5/ 7 Z-'30 F 1193 -S:cc:;, -a0 3 3/ 3 3/ _ V 4 3 0 —a 0 Y 11z 3/4 D —s- 30 I — i -7/115 20 1__] 6k PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER �r (� TEST RUN BETWEEN_ FT AND y FT COMMENTS ` w,� s �� unoA K GTZ, PERFORMED BY: IZI' q AAA rPV L -S- 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: �L 9, F5 72-008 (Rev. 4/85) 11/11/93, 12:22 FAX 9072499249 Y°SUtsd rrm ;; by .� SULLIVANWATER WELLS P.C. tl x /10V& CHUWAK ALAWA 09/07 • TlU"H0W 000.7'130 BORE OWNSR OF LAND "`a ��04lolhl'r=& ADDRESS LEGAL DESCRIPTIONjQU0 + Ail _ to $ r A. PF-RMIT NULABER Date of Issue- �P' TAX INDENTIFICAT ION NUMBER D 73P •041.I[ Is well located at apprmr d permit IWAtidrr4. C$A'd7 a No Methad of Drilling; `eitrotary Q cable tool Depth of well: Ca o Casing THAs S tffA&..VM nh*f m 61Di1ea Dtartastar L�_inchea, de loaf unerTw.: N9 aojer - Casing Sfzkup Above Ground: 3 static Water Level (f m ground level): • ZI " test Pumping level:,, feet after.,._._._hte. Iwmp _-9Drn. Recover Rate: --LrAm Method of lasting: AIA, VVSA Intake Opanini Type: towind ❑ OwHole Q soreened: Start teat Stopped �W ❑ Perforations start feet stopped G3routType. 4fEt!r4'g+T'f volume cagii A A' Depth: from /) feel, to feel Pump Intake Depth: het Em ®M H . cue i,;.t� •sr; s��P Q JSSLAJ r..J tiiu•. Pump Size hp grand Namme,. Y*ll Disinfected Upon COmpietion? Qorr a ANO Method of Disinfection: ^ iLd ^ ••JC 40ra P&I comments: 0n rc 40e �� o `7/ Sri• Driller's Name ATTENTION: it is the respansibillty of the property owner to submit a copy of the well log to the proper authority. Municipailtyr of Anchorage: Departrnent of 1-140b & Human Som"s and/or Department of Environmental Conservation, Matsu Somugh: Department of Envircrin lW Conservation, RECEIVED NOV 13 1998 Municipality of P.rEt noifit @ 0 --Pt. I?vaitta & 3 �ttTi2tfid#� 11/19/98 19:12 FAX 9072493249 FEDE% FRI ANC AA IM 01 November 19, 1998 Jim Cross Department of Health and Social Services PO Box 196650 Anchorage, Alaska 99519 Dear Jim I am an owner builder on Lot 2 Block 6 Southfork North Eagle River subdivision. I installed the sewer system at this location as an owner builder. The entire system was engineered and inspected as you can see from the record. The engineering was followed explicitly during construction. I am employed as a facility maintenance specialist and have a working knowledge of building systems, If you have further questions or need additional information feel free to contact me at PO Box 190112 Anchorage, Alaska 99519. Sincerel Al y Nabingcr 1 ' �fc�fFh/'sc�� I9'`«' 62 11720�z 1 °01 �A�S° 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 AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW980095 DESIGN ENGINEER:STEVEN R. PANNONE OWNER NAME:RAY NABINGER OWNER ADDRESS: PARCEL ID:07802119 LEGAL DESCRIPTION: SOUTHFORK NORTH BLOCK 6 LOT 2 LOT SIZE: 255394 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 5/06/98 EXPIRATION DATE: 5/06/99 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: �� o� q { RECEIVED BY: - &�-`Yuclw' 1 DATE: �H^ ISSUED BY: l e/t Z DATE: `� 6, /CJ Steven R. Pannone, P.E. P.O. Box 142025 Consulting Engineer Anchorage, Alaska, 99514 (907) 272-8218 (907)272-8218 Fax April 15, 1998 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 2 Block 6 Southfork Subdivision Well and Septic Permit Gentlemen: My firm was contacted to investigate the possibility of installing of a new system at the above referenced property. Currently the lot is undeveloped. Two test holes were excavated on March 22, 1998. The soil report and percolation test results are on file with your department. A copy of the soils logs are attached. Ground water was monitored for fourteen days. No ground water was encountered or monitored. No bedrock was encountered in the test hole. The lot is approximately 10 acres in size. Lot 2 slopes to the northeast at a rate of approximately 10 to 15 percent The proposed installation will be located on the eastern portion of the lot. The proposed location will be greater than 100 feet away from the proposed well serving this property and 25 feet from the water service lines. The surrounding systems are located greater than 200 feet from the proposed installation, the lots to the north, south and east are undeveloped. The proposed installation shall not impact the future development of the surrounding or existing lots. See attached design. The new system will maintain over six feet vertical separation to the bedrock and over four feet vertically to the ground water. If you have any questions about the proposed installation, please contact me at 272-8218 Sincerely, Steven R. Pannone, P.E. Attachments: C: \ W ORR\ 1-6 soff 001. v+pd S 0, ••, 49¢l+ ji1- Steven� R��../ Pannone fir'! �0a pr70€[S'slvfih„ CHUGACH STATE LOT 1, BLOCK 6 SOUTH FORK WEST Cl,\Work\i-GSOUTH.DWG Mr, Ray Nabinger (907) 249-3259 (907) 249-3249 FAX Mr. Larry Severson (907) 562-6418 DESIGNi Perc Ratet 8 Mln/Inch Sall Rating, 0,8 gpd/sf 3 B.R. 536 SF Required Deep Trench 5' Effective, 2-3' Wide, 8' Total, Depth, 60' Lang 600 SF Total PANN❑NE ENG, SVC P. ❑, BOX 142025 ANCHORAGE, ALASKA 99514 272-8218 DESIGN DESIGN P.I.D. NO, PERMIT NO. WASTEWATER ABS❑RPTI❑N SYSTEM LOT 1 & 2, BLOCK 6 S❑UTHF❑RK S/D SHEET 1/3 3 r Y Q a w r a F- ti u SEE DETAIL SHEET 2/3 PROPOSED PRIVATE WELL 'ED4 { i 100' WELL { RADIUS PROP RADI SELL PROPOS �H HOUSE -.. ElZ'TP 2 �/,sem._y!! ----- -,.TP,A PROPOSED PRIVATE WELL \LOT 2, BLOCK 6\, CHUGACH STATE LOT 1, BLOCK 6 SOUTH FORK WEST Cl,\Work\i-GSOUTH.DWG Mr, Ray Nabinger (907) 249-3259 (907) 249-3249 FAX Mr. Larry Severson (907) 562-6418 DESIGNi Perc Ratet 8 Mln/Inch Sall Rating, 0,8 gpd/sf 3 B.R. 536 SF Required Deep Trench 5' Effective, 2-3' Wide, 8' Total, Depth, 60' Lang 600 SF Total PANN❑NE ENG, SVC P. ❑, BOX 142025 ANCHORAGE, ALASKA 99514 272-8218 DESIGN PERMIT NO, THE PARK IS UNDEVELOPE THERE ARE NO WELLS OR SEPTICS WITHIN 200' OF THE PROPOSED SYSTEM i0al WE RADIUS PROPOSED - PRIVATE WELL k % I 1'"t 1� C %work'%!-GSOUTH�wu DESIGN WASTEWATER ABSORPTION S' LOT 2, BLOCK 6 SOUTHFORK LOT- 1, BLOCK 6 ll_�_ ICA -4- ----- 4 ..... w PREPARED FOR! RPannone aA I Mr. Rav Nalolnoer io 10075 N9-312fg olZ i f wvix -:544-3-244 FAX i m1 PROPOSED 1 If HOUSE� ;TP 2 P.I.D, NO. SHEET 2/3 LOT 3 IS UNDEVELOPED THERE ARE NO WELLS OR SEPTICS WITHIN 200' OF THE PROPOSED SYSTEM I nT P, Ri-nr-w r PROPOSED PRIVATE WELL DESIGN Perc Rate, 8 Min/inch Soil Rating 0Z gpd/sf �4 Bliz, SF Nequirled 51 Effective, 2-3, Wide, 8' Total; Depth, 60' Long 600 SF TotaL M A lklMklr rXlr a v 1� P ANNEIRE Emu, S. v C r-5 ❑ m nox i _' A UA 1 2 'j U`5 'AAIrUUMDA=- AICAVVA oar -,Ie DESIGN PERMIT No. DESIGN DETAILS P.I.D. NO. 015-073-33 WASTEWATER ABS❑RPTI❑N SYSTEM LOT 1 & 2, BLOCK (i SallTHF❑RK S -/I- SHEET 3/3 o � N 49Tt+ """" 'e Ci\Work\1-6SOUTH,DWG ��•••.•• �•� PREPARED FOR: R. Pannone mr ,E 8149 i Mr. Ray Nnbinger AW (907) 249-3259 �••'�� (907) 249-3249 FAX Mr, Larry Severson (907) 562-6418 inc 3Hn1 2101INOW Ina 1nONV3l3 1nONV3'13 1nONV3l3 1nONV3l3 1nONm313 NOI1tlONnOd s u> 01 c> 01 LU i (� F- m acs. iU W N R � C o 0-8 -i 3 I. %o c� W J H L.L Q ry PANN❑NE ENG. SVC, P. ❑. BOX 142025 ANCHORAGE, ALASKA 99514 DESIGN L ye••F Municipality of Anchorage t, DEPARTMENT OF HEALTH &HUMAN SERVICES +»....�. 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TESTsfe.an tt. Pannone PERFORMED FOR: �A l /tf A-9 iN C�' &yL DATE PERFORM % LEGAL DESCRIPTION: LZ, T 6 Sov-4F�raK Township, Range, Section: DEPTH SLOPE SITE PLAN 1 — — 2- 3- G0A 4 5 6 7 8 9 t'A L - 10 am 11 12- 13- 14- 15- 16- 17 21314151617 18 19 d tZGt A A) I GS X4 S A 3 " S t t_-rL 1-0 �2Ave��Y SrL� I a �zL M'S4 WAS GROUND WATER A/ ENCOUNTERED? J - S IF YES, AT WHAT L O DEPTH? P E Depth to Water After 4:f— Monitoring? 1 Date: / MAE Reading Date Gross Time Net Time Depth3se=IP Water Net Drop 3lz24p; /0: rl tv : S a z (, �rY 3/s !p ; S 2 2 (o `IAZ- 'jK 10:1S Y 7- 6'tV 'IY t6rS 8 It � S 16.54 t -?-'/Y `S !Erre 11:0l 20 —I I Ap- 415 ae Ifull PERCOLATION RATE 4012 (minutes/inch) PERC HOLE DIAMETER 1rTEST RUN BETWEEN FT AND VFT COMMENTS i �S-T ♦�o L !� Cu n S Fn2 to SoA k- &b 69�e CA V A'r--L9Q TA -r- ILS PERFORMED BY: 5'�ti%aV` NL3` I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: `3 /22-/4 72-008 (Rev. 4/85) Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 5 A F E T T CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 078-021-19 Expiration Date: 4e /z 22. __. 1. GENERAL INFORMATION Complete legal description Southfork North Block 6 Lot 2 Location (site address) 1792 West River Dr. Eagle River, AK Current Property owner(s) Mailing address Real Estate Agent & Clarence Stevens Day phone 1792 West River Dr. Eagle Riv_er,, AK __,_ 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class _ Well ❑ Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ JWaiver Fee $ _ Date of Payment %�6�2 Z Date of Payment Receipt Number D 7'�3 ► G Receipt Number COSA # 0 S C, � 1 3 31 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. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 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 r OV\ encroachments, deficiencies or discrepancies exist. / �`) I 1 6. DSD SIGNATURE X System #1 Approved for 3 bedrooms. System #2 Approved for bedrooms. Disapproved. X19 'r -H /\ KENIETH... I / .5 -� 1 .. 7116 err; to`r' 1 Conditional approval for bedrooms, with the following stipulations: A/q,R AND 0 ~NGGT 11E& Z O11P /Jl)J, Original By: Original Certificate Date: 7 / Z z The Municipality of Ancho ge 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other �qh _ 14d V f kLr COSA blue sheet 10-10-12.doc Legal Description: Southfork North Block 6 Lot 2 Parcel ID: 078-021-19 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 7/14/98 Total depth 61 ft Cased to 61 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 42 in. Date of flow test for COSA 6/20/22 Static water level at beginning of test 26 ft. Comments B. TANK DATA Age of tank(s) 24 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 49" 11 Standpipes/foundation cleanout per record drawing Date of pumping 6/3122 D. ABSORPTION FIELD DATA Which system tested (date installed) 8/15/98 11 ALL standpipes present per record drawing Total measured depth from grade 4/3.4 ft (max) Measured depth to pipe invert from grade 3/2.4 ft (min) ❑ N/A — pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 4.8 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes N No Coliform bacteria is Negative Nitrate mg/L M Nitrate less than MRL (ND) Arsenic ug/L ll Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 6/15/22 STATION ❑ Requ maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 6/20/22 Results Q Pass For 3 bedrooms Fluid depth prior to test 10/12* in Water added 450 gal New depth 11/12 in Elapsed time 1400 min Final fluid depth 10/12*in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date *Lower trench saturated upon arrival, water added to far end of higher trench. ** System appears to be above 90% capacity and should be replaced soon. 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 ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25'21 Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Surface Water > 100' ® Yes Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No ft 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 ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft 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 ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 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. COSA Checklist yellow sheet www.muni.org/onsite Septic System Absorption Field Advisory Certificate of On -Site Systems Approval # OSC221331 Subdivision: Southfork North, Block: 6, Lot: 2 During the absorption field adequacy test, 10 and 12 inches of standing water was observed in the absorption field. This indicates approximately 97.8% of the absorption area is inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Ma�lmg Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Septic 'Tank Advisory Certificate of On -Site Systems Approval #OSC221331 Subdivision: Southfork North Blk 6 Lt 2 907-343-7904 Fax: 343-7997 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this COSA / property is 24 years old. A leaking septic tank may be a source of contamination to the aquifer. Typical replacement costs range from $10,000 to $15,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of a 16 -year-old septic tank. Ma�lmg Address P4 O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org L Parcel I.D. 078-021-19 Zl3 alb ff, Municipality of Anchors On -Site Water and Wastewater Prograi (907) 343-7904 Certificate of On -Site Systems 1. GENERAL INFORMATION Expiration Date: / r fq—( I Complete legal description Southfork North, Block 6, Lot 2 Location (site address) 1792 West River Dr. Current Property owner(s) Raymond & Valerie Nabinger Day phone Mailing address 1792 West River Dr. Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: El 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: Individual Well 0 Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ v ` - WaiverNadance request for:, COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ J� Date of Payment Receipt Number6-721OGi COSA# De,CII4 I`-%�Pb Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal, , ed, hereto; and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Cenificate of Or _its Systems Approval Guidelines for this applicaflon, 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and 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 Ipcal soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for -� bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Phone (907) 272-8218 Date 9/29/2016 bedrooms, with the following stipulations: ((t z Jc ON-SITE Original Certificate Date: (9 cl` _ a 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 COSAbluesheelf :., c B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 8/15/1998 Tank size 1,000 gal Number of Compartments 2 Cleanouts (Y/N5 Y ®, Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 9/23/2016 Pumper JR's Pumping C. ABSORPTION FIELD DATA 8/15/1998z 0.8 GPD/SF Shallow Trench Date installed Soil rating (g.p.d./ft orftz/bdrm) System type Length 50.8/50.5 ft. Width 5/5 ft. Gravel below pipe 1 /1 ft. Total depth 4h3' ft. Eff. absorption area 582 ftz' tu Monitoring be Y Depression over field N Date ofadegoaby test 9/2$/2016 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0/12 1 in. Water 456 added gal. Newdepth6/12 in. 270 0/12 450+ s p. Elapsed Time: min. .Final fluid depth in. Absorption rate >= d. N Any rejuvenation treatment (past 12 mo.) (Y/N & type) o If yes, give date _ If more than 1 septic system is on the lot: COSA Checklist # +_of I Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Southfork North, Block 6, Lot 2 Parcel ID: 078-021-19 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 7/14/1998 Sanitary seal (Y/N) Y Wires properly protected tY/N) Y_ Total depth 62 ft. Cased to 61 ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 7/14/1998 9/28/2016 Static water level 30 ft. 29 ft. Well production 15 g,p.m. 5.3+ 9 P m WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate 0 33y_mg/L Arsenic �U � ug/L Date of sample: 9/28/2016 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 8/15/1998 Tank size 1,000 gal Number of Compartments 2 Cleanouts (Y/N5 Y ®, Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 9/23/2016 Pumper JR's Pumping C. ABSORPTION FIELD DATA 8/15/1998z 0.8 GPD/SF Shallow Trench Date installed Soil rating (g.p.d./ft orftz/bdrm) System type Length 50.8/50.5 ft. Width 5/5 ft. Gravel below pipe 1 /1 ft. Total depth 4h3' ft. Eff. absorption area 582 ftz' tu Monitoring be Y Depression over field N Date ofadegoaby test 9/2$/2016 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0/12 1 in. Water 456 added gal. Newdepth6/12 in. 270 0/12 450+ s p. Elapsed Time: min. .Final fluid depth in. Absorption rate >= d. N Any rejuvenation treatment (past 12 mo.) (Y/N & type) o If yes, give date _ 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 & circuitrequirements? E.SEPARATION'DISTANCE 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 100+ 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 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 1.0+ Curtain drain 50+ Wells on adjacent lots'. 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that <I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven Pannone Date 9/29/201.6 COSA canary sheet 2-G-15.doc - mi Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steveftpanen¢ak.com 30 September 2016 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road P. 0. Box 196650 Anchorage, Alaska 99519 Subject: Southfork North, Block 6, Lot 2 To whom it may Concern; There are two fields that comprise the soil absorption system for the 1998 system, which we tested. The lower field was saturated when we arrived on property. The upper field was dry. Water was added to the double clean out to determine how the field operated under normal use. Water was observed entering both fields. Water was then added to the field clean-out on the upper trench, to determine how the upper field operated. The water -levels in the lower field did not rise with the induction of 456 gallons, while the upper field rose 6 inches. The test was run continuously at 1.5 gallons per minute (GPM) with the water being introduced directly into the upper field end clean- out. After the 456 gallons were introduced into the upper field, the water level in the upper trench returned to dry in 60 minutes. The conclusion is that the lower field is completely saturated, while the upper field is working adequately for a three-bedroom house. The effluentappears to be splitting evenly between the two fields. The entire system is approximately 50% used. It is my opinion that this system is operating adequate for a three-bedroom system. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 e1 Lot 3 Frontier Surveys, LLl Project No: 16-101 10. /-' ,10' Telecommunications & Electrical Easement LOT 3 7.0, tiNti 7g&- Q Q O titi' i ,l Date: October 12, 2016 Detail A - House Dimension Scale: 1" = 20' Lot 2 Block 6 255,394 sq. ft. 1792 W. River DriveCL Two Story Wood Framed House w/ Attached 2 Car Garage I d W Ou Cu 'fD In 00 Z Legend: a Electric Meter/Outside'Power \ 218.63' NOW 09' 27-W Gas Meter ® Deck o Tel. Utilities ® Water Well CHUGACH STATE PARK Q Septic General Notes: 1. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. 2. Dimensions to property lines are plus/minus 0.1ft. 0 66 110 220 3. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Law.' Feet L• This document based on Plat No, 88-12 Palmer Recording District. yM► OFe This survey complies with ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary e� survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the ",..• �� existence of any easements, covenants or restrictions which do not appear on the recorded plat. Under no circumstances should this document be used for construction or for establishing a boundary or fence line, ek: 4YM . . As—Sullt Survey of Ordered B Jon Rodriguez Lot 2, Block 6 of South fork North Subdivision . PIF. .ro GI ....... LS -9812 1 I, Pierre M. Stragier, hereby certify that I have performed a Mortgage Inspection Survey on the '• o1Cr-to_� ��. �`�Y'. .rr subject property as' described above on October S,2016 q��i�J"'mar me•• � r Frontier Surveys, LL at: 88-12 Grid:N A 650 W, 58th Ave. Suite E �o>r5r= Anchorage, Alaska 99518 info0frontiersurveys.com — t: 907.460.1686 FE3 15-003 (18A) MUNICIPALITY OF ANCHORAGE w • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # O 7 OZ I HAA # 1. GENERAL INFORMATION Complete legal description LOT z1'1ioclL61 TZ ->0K vo2r}� Location (site address or directions) Property owner .LR • l-� A" A_J Ali sJ zeyt- Day phone 4 -3X59 Mailing addresses D�R nK / r o rl2 AIV CN Lending agency Day phone Mailing address Agent Day phone Address. Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well U Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site K Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOAB21 I 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm _",00M2- LlatL�• SQL Phone Address d d ! d 2 �� ( A A (t_ 9'0j,r/a Engineer's signatu--Date. /// CZ 6. DHHS SIGNATURE Approved for�� L— bedrooms. Disapproved. Conditional approval for Additional ComrYients 0 41ITIr', Steven R. Pannone i lz- CE, $149 a� FROF[SS�OY�p bedrooms, with the following stipulations: Date " 27 9 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not. conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-M(Rev..1/91) Back MOA #21 V LIJ gg Municipality of Anchorage �bf�dRTMENT O HEA TH &HUMAN SE�Ifi�Wfhctfi am Environmental Services Division dejjWiPtW1W"AVV e een 1 1999 issued to a vehicle whi h may not Ions ' L Street, Room 502 • Anchorage, Alaska 99501 sia(QQ. �ip-f � ge time waiver and the MUNICIPALITY Ur ANc.HURAGE vehicle may require repair before subsequent ENVIRONMENTALSERVJCE-SwaRftith Authority Approval Checkli' rificates are issued. Legal Description: L Z; b e, Sw- Yr-ezK N00 -T4- Parcel I.D.: SFR— OZ -(!_y-, . ., .. A. WELL DATA Well typeZ�uA [a If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Total depth &_2 Sanitary seal (Y/N) Date of test Static water level Well production ELAN 1 1999 Date completed 7-(J/Y1 q 0 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Cased to &Z' Casing height (above ground) 31 FROM WELL LOG 41igj � 30 Wires properly protected (Y/N) AT INSPECTION -7l/vl Q;6 30, 9 -P.M. /r g. p. m. WATER SAMPLE RESULTS: Coliform �[1i NitrateC r�� %L� .+�� Other bacteria Date of sample: t 1,7 l IF Q Collected by: G S Grp B. SEPTIC/HOLDING TANK DATA Date installed 0/1,5-1 f 8� Tank size I C� o 0 Number of Compartments Z Cleanouts (Y/N) Y Foundation cleanout (Y/N) ? Depression (Y/N) >,/ High water alarm (Y/N) Date of Pumping C. ABSORPTION FIELD DATA Pumper //sl & Date installed. al t l q P, Soil rating (g.p.d./W or ft2/bdrm) 0-0 System type IA a Length /01-3 Width -S o Gravel thickness below pipe Total depth T Effective absorption area 552 Monitoring Tube present (Y/N) v Depression over field (Y/N) .4✓ Date of adequacy test PEP" 9;//.�/?L Results (Pass/Fail) 'Qk S S For __3 bedrooms Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.): `— Fluid depth (ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)" D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm E. SEPARATION DISTANCES Size in g evel at` 'Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot �?• S Absorption field on lot Public sewer main Sewer /septic service, line / oo On adjacent lots On adjacent lots "Pump off" level at` / UD { C c� o t Public sewer manhole/cleanout 1Jl`iQ Lift station /ao SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation `l 8 Property line Absorption field Water main/service line _:?- b , _Surface water/drainage `Goy Wells on adjacent lots �8 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Building foundation Sb• S Water main/service line Surface water do + Driveway, parking/vehicle: storage area Curtain drain _ / &0 Wells on adjacent lots _ C 06 F. ENGINEER'S CERTIFICATION I certify that l have determined thru field inspections and review of Municipal in conformance with MOA HAA guidelines in effect on this date. Signature -- Engineer's Name Date l ! (4 lgr `� c HAA Fee $ .LC!L CL) Date of Payment Receipt Number 72-026 (Rev. 3/96)" Waiver Fee $ Date of Payment Receipt Number ;ordsp Lhad stems,, i - pyp4Nlf lsf.`—,� ..Wf.11 /lllf iNef,!�fM< Steven R. 7aTmone i{i t,, C 8149 r y. Raymen Nabinger P.O. Box 190112 Anchorage, NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 • FAX 456-3125 8005 SCHOON STREET ANCHORAGE, ALASKA 99518 (907) 349-1000 • FAX 349-1016 POUCH 340043 PRUDHOE BAY, ALASKA 99734 (907) 659-2145 • FAX 659-2146 DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA Date Received: 1/22/99 Date Analyzed: 1/22/99 Date Reported: 1/23/99 AK 99519 Next Sample Due: Phone Number: ( )249-3259 Fax Number: ( )249-3249 Collected by: SCOTT CROWTHER Sample Type: Private water Systems Method of Analysis: Membrane Filtration (SM 9222 B) Comments Time Received: 08:10 Time Analyzed: 13:00 Time Reported: 11:24 S = Satisfactory U = Unsatisfactory POS = Positive Test Result ND = None Detected TNTC = Too Numerous To Count (>200 Colonies) CG = Confluent Growth HSM = Heavy Sediment Masking, Results May Not Be Reliable SA = Sample Age >30 Hours But <48 Hours, Results May Not Be Reliable Old = Sample Age >48 Hours, Too Old For Analysis Comments: R = Resample Required NT = No Test * # Colonies/100 ml # Colonies/ml Sample Sample Total` Fecal Other* HPC"* Date Time Coliform Coliform Bacteria Result Lab# Location Comments 1/21/99 17:00 0 ND 0 NT AC11311 South Fork North L2 86, Satisfactory WATER OUTLET L C/,) Sherri L. Trask Environmental Analyst 1/23/99 Northern Testing Laboratories, Inc Anchorage, AK MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 078-031 -1 1 HAA # A 2 SCY)4- 1. GENERAL INFORMATION Complete legal description Southfork West S/D, Lot 2, Elk 6 Location (site address or directions) Southfork Eagle River - Next to Park entrance, (West River drive) Property owner Pendergr-ast; Day phone 696-0020 Mailing address contact Agent Lending agency Mailing Day phone Agent Eva T,okt rn Day phone 689-6476 Address 11625 Ger}ter€j_eld Dr Eagle River, Ak 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Please Call Jeff Garness Individual well XX for Pick -Up -Thanks Community well Public water NOTE: if community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX _ Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA e21 M 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature Alaska Water & Alaska Water & WastewAervshall be paid at closing for the engineering services The invoice was submitted to Prudential Real Estate, Eva Loken. 6. DHHS SIGNATURE X Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments M Phone 317-6179 Date $1050.00 provided. Vista M/,O• • s• /I /1\1 •a VJI,°° ' CV793J i v\ 2 C °•0 ° �\ r bedrooms, with the following stipulations: Date --17-98 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 724M (Rev. 1/91) Back MOA #21 Municipality of Anchorage OU* DEPARTMENT OF HEALTH & HUMAN SERVICES R EC E I ` E _ '1 Environmental Services Division 1� Lo 4 5f 825 L Street, Room 502 *Anchorage, Alaska 99501 a (907) 344�744 �6 199 Health Authority Approval Checklist Municipality of Anchorage ', / / Dept. Health & Human Services Legal Description: SdUTNIPbRiL WEEL7 �� Lo7 2� x 6 Parcel I.D.: 0'+8- 031 —(I A. WELL DATA i Well type tZWft--7E If A, B, or C, attach ADEC letter. ADEC water system number /J/A Log present O'N) YES ES Date completed /6&9`/ tYt� P1/6/_L_ Lo& Total depth Cased to 66.5' Casing height (above ground) 1�+ Sanitary seal &N) yE& Wires properly protected ON) FROM WELL LOG Date of test Idk4 Static water level a0' Well production g g.p.m. WATER SAMPLE RESULTS: AT INSPECTION Coliform_ Nitrate 0, 2�! L Other bacteria Date of sample: 0,r)_- X+— (8 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed johl - t i 9 Tank size 0S6 &7EF Number of Compartments -�_ Cleanouts &)—AEL Foundation cleanout (DN) yCS Depression (Y& High water alarm &jY N) Xff Date of Pumping Pumper S RIM 1911 U& C. ABSORPTION FIELD DATA fI&EO - Pc'.f. Tn15p' _ n.7 Date installed 1631— ///I Soil ratingg.p.d./ orft2/bdrm) System type S' W+OF- DZ%IN, e51" No27H oN0 Length 85 Width ,5 Gravel thickness below pipe .5 t Total depth 36" sou -IN t -7"D Effective absorption area 4�& SF Monitoring Tube present Depression over field (YO No Date of adequacy test ��1 a� las Results (Pass/Fail) PftSS For 3 bedrooms V, NaaM 500 611 No0.ro F,,j9 Fluid depth in absorption field before test (in.); #." 6rrs Immediately afterU9 gal. water added (in.): YY2" Sown cNn H1/}1k Norm EVo Fluid depth a S�u?6 "ins) Minutes later: 68 Absorption rate = �{� + g.p.d. Peroxide treatment (past 12 months) (Y/& NSC Ll & jiu X If yes, give date tj 72-026 (Rev. 3/96)* D. LIFT STATION Date installed 16/3( — ii/i /q Manhole/Access Y&) _ y6S n High water alarm level at* yy Cycles tested 5 4- E. SEPARATION DISTANCES Size in gallons 12 -so ST&y (/4>-C , "Pump on" level at* ya t _ `Pump off' level at* *Datum I3TTom oF� rR• Z SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot. IUy "k On adjacent lots Absorption field on lot _ 100 r _ On adjacent lots Public sewer main t Sewer /septic service line _ a5 + Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 00 t4- Foundation /0 t* Property line 10 Absorption field /0 t4 Water main/service line _(Or -F Surface water/drainage (00 Wells on adjacent lots loo SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: (�'�' �'ot Y (AV -oscn - a`o NOT�135Ct to'+ POL SNS Q6%PLT Utz ANY UgVrUwS St4 5 OF SuRf'�rF S Sf=e Az"ACM p Wf17F01 /0 Property line as c�, t�z suave Building foundation f Water main/service line /0 r r Surface water 00 ,�- Driveway, parking/vehicle storage area /0 '_ n Curtain drain I bNis _ rvOwr j Wells on adjacent lots _ /00 i' F. ENGINEER'S CERTIFICATION I certify that/ ve deterrni d thru field inspections and review of Municipal records thatt vve systems are in conforma with MO AA ui elis m effect on this date. �?' d OF Al q%%t � as Signature G�h10/t TH 0� Engineer ame _ J.AwtcS lLL/A�r�f Date C).) --I o�c�' I`1c� �P M eY„JAMES P. WILLIAMS � �w N0.9608 c^�� HAA Fee Date of PE Receipt N 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number C&E Environmental Services Inc. Ack CT$zE ]Ref,# 980900001 Client Name AK Water & Wastewater Services Project Name/# Lot 2 Blk 6 Southfork'West 5D Client Sample D) Lot 2 Blk 6 Southfork West SD Matrix Drinking Water Ordered By PWSID 0 Client PO# Printed Date/Time 03/04/98 12:03 Collected Date/Time 02/27/98 14:50 Received Date/Time 02/27/98 16:30 Technical Director: Stephen C. Ede Released BA, ,1� Allowable Prep analysis Parameter Results PUL units Method Limits Date Date tnit Nitrate -N 0.217 0.100 ma/L EPA 300.0 10 man 02/26/46 RM4 Waters Department Analyses Total coliform 0 cal/100ml. SM1s 92226 02/27/x$ TMW 2020'd T0£ST95L06 39hN0H3Nti IS3 3513 �b:ST 866T—b0-dUW Awake WOW o waatawMar 7320 East Chester Heights Circle — Anchorage — Alaska 99504 Phone (907) 337-6179 — Fax (907) 338-3246 Consulting Engineers February 28, 1998 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Subject: HAA for Private Well & Septic System. Lot 2, Bk 6, Southfork West S/D. To whom it may concern: The subject lot has a 3 bedroom house on it which is served by a private well and septic system. The results of the field investigation and adequacy tests are summarized as follows: A. WELL: The static water level on 2/27/98 was measured at 24' below top of casing (BTC). Water was pumped from the well at an average rate of 6.25 gpm for a total of 178 minutes (1113 gallons). The level in the casing dropped 15 feet during the first 19 minutes of pumping, to 39 feet BTC. Throughout the rest of the pumping period the level fluctuated between 39 feet and 42 feet BTC, indicating that the well was recovering as fast as the water was being pumped out. Based upon this data, it can be concluded that the capacity of the well exceeds the Municipal requirements for a 3 bedroom house (.31 gallons per minute), and will produce greater than 3.0 gallons per minute as required for FHA financing. B. SEPTIC SYSTEM ADEQUACY TEST: The drainfield was installed in the fall of 1994. It is 85 feet long, 5 feet wide and has an effective depth of 6 inches. The total absorption area is 425 square feet. Water was introduced into the lift station at an average rate of 6.25 gpm for 149 minutes (929 gallons), which caused the liquid level to rise 3 inches, to a total depth of 6 inches (see attached HAA check list). The last 813 gallons introduced only caused a rise of 1.5 inches in the drainfield. The liquid level then dropped 1.5 inches in 88 minutes. Based upon this data, it was determined that the absorption rate of the trench exceeds 450 gallons per day, as required for a 3 bedroom dwelling. C: SEPARATION DISTANCE TO LOT LINE: The separation distance between the leachfield and property line (per the septic inspection report) is shown be greater than 10 feet. The attached asbuilt survey by Seward & Associates shows the separation distance to the south property line to be less than 10 feet. The accuracy of the asbuilt survey is uncertain. Short of having a more detailed survey performed it must be assumed that the original inspection report is correct. NOTE: The adequacy of a septic system is influenced by numerous factors, including, but not limited to, seasonal surface water infiltration, groundwater variations, septic system maintenance (frequency of septic tank pumping, usage of biological additives), condition of drain pipe and pipe joints (which can be damaged by seismic activity and deteriorate with age), type of substances deposited in septic system (cigarette butts, sanitary napkins, misc. objects), and the amount of water being introduced on a continual basis. Consequently, the results of this adequacy test are only valid for the specific day of the test. Furthermore, because of the limited nature of this investigation, it is possible that there are hidden defects which may not have been detected. No warrantee is made regarding the future performance of this well or septic system If you have any questions, please contact me at 337-6179. Thank you for your assistance. Sincerely, q,�A�A P11tv Uy'►W` James P. Williams, P.E. Civil Engineer c.c. Prudential Vista