Loading...
HomeMy WebLinkAboutCONIFER HEIGHTS BLK 3 LT 3Conifer Heights Biock 3 Lot 3 #015-093-20 Municipality of Anchorage Page 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: ~'~--~?~'~-~/-/" PID Number: /~/~"- ~ ~-¢ Name: ~.~ ~ ~_~ Wastewater System: ~ New ~Upgrade Address: ~,, ~~ ~ ~/...,~~% ~', ABSORPTION FIELD Phone: ~*' "~/ I No. of Bedrooms:~ ~eep Trench ~ Shallow Trench ~ Bed D Mound ~ Other LEGAL DESCRIPTI ON Sol, Rating: Total Depth from original grade: ~' ~ G PD/Sq. Ft. Lot: Block: Subdiv~ion: Depth to pipe bosom from original grade: Gravel depth beneath pipe Township: ~ Range: ~ Section: Fill added above original grade: Gravel length: I I WELL: ~'~ ¢' ~' ~ew~ Upgr~a~ Gravel width: ~ Ft. Number/of lines: Distance~between lines:Ft. Classification (Private, A,B,C): Total ~ Cased To: Total absorption area: Pipe material:~ ~ SQ. Ft. Driller: ~ Date Drilled: Static Water Level: Installer: Date installed: GPM Ft. Ft. TAN K SEPARATION DISTANCES ~e,tic ~ Ho~,n, : S.~.E.,. To Septic Absorption Lift Holding Public/Privat( Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines /~ ~~ '~ Waif' /~, /~ ,. ~ ~ ~ Material: ~~ Number of Compa~ments: Surface Water /~ '¢ /'¢ '~ -- -- ~¢~<~ LIFT STATION Lot ~ _ Size in gallons: Manufacturer: Foundation ~ ~x .... "~umpon"l~v,lat:~"~{elat: I High water alarm at: Remarks: BENCH MARK Location and Description: Assumed Elevation: ' ~ Ft, - ~... ...4.~ Inspections pedormed by: ~ -o,~ ~-~ Dates: 1st ~~ ~...}~.~ ........ 2nd 9 ~t. OOU~S T. KE~E~ Depadment of Hea~ and Human Se~ices approval '~.'*~'. Reviewed and approved by: Date: ~ -~-~ 72-013 (Rev. 9/91) MOA 25 Permit No. SW950254 Page 2 of 5 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone 54-5-474-4- On-Site Wastewater Disposal System and/or Well Inspection Report Leg,~,!,,De,sc,,~iption,:, Lot, 5, Block 3, Conifer Heights Subdivision No.: 015-095-20 Il ~ .© 72-015 A (2/91) MOA 25 Permit No. SW950234 P(~ge 3 of 5 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650, A~chorage, Alaska 99519-6650. Telephone 545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Lega! D,escription,: Lot 3, Block 5, Conifer Heights Subdivision PID No.: 015-093-20 _./z II - ~. ~ - ENGINEER'S SEAL 72-015 A (2/'91) MOA 25 Municipality of Anchorage •� ` DEPARTMENT OF HEALTH &HUMAN SERVICES `�. 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 4EoA--.ae��'¢�'�Z DATE PERFOP nk,. L _-� "-f G�o,.1���:.� - K Township, Range, Section: SLOPE DEPTH (FEJJT� 2 0 • • r 3- 4- 5 45 Deo 6 tl 7 8 J 9 10 �" WAS GROUND WATER Ja ENCOUNTERED? /y 16- 17 81920 18- 19- 20 COMMENTS Barr-oiy D X' /-/oc.do S L IF YES, AT WHAT O DEPTH? P E Depth to Water1 Attefa�E g Monitoring? �s/ Dale: SITE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop ysJ / •• _�� / y7 ym / O AIIAI2� r PERCOLATION RATE 8 (minutes/inch) PPERC HOLE DIAMETER 6 TEST RUN BETWEEN _ 'Z FT AND 7 �2 FT PERFORMED BY:I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ANCHORAGE RTMENT, OF HEALTH & HUMAN IS( .~na~ [istanc( ew~ prop( ?"curta PrO rap: mon ,to ,ev :! LEA VE THiS ated. PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950234 DESIGN ENGINEER:DOUGLAS T. KENLEY, P.E. OWNER NAME:TREFRY GEORGE D & DENISE L OWNER ADDRESS:7900 PORT ORFORD DR ANCHORAGE, ALASKA 99516 PARCEL ID:01509320 LEGAL DESCRIPTION: CONIFER HEIGHTS BLK 3 LT 3 LOT SIZE: 44275 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 8/22/95 EXPIRATION DATE: 8/22/96 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: RECEIVED l ISSUED BY DATE • ��� z --t DATE • l�s Douglas T. Kenley, PE HC01 Box 6034, Palmer, Alaska 99645 (907) 746-1073 July 31, 1995 Municipality of Anchorage Health & Human Services On-site Services Re: Percolation Test Results and General Site Investigation Report of Lot 3, Block 3, Conifer Heights Subdivision, Addition #5. Owner: Mr. George Treefry On July 28, 1995 the above referenced 1.03 acre parcel was inspected for the suitability of installation of a replacement on-site wastewater disposal system. The site is located in Southeast Anchorage off Huffman Road on Shelburne Road. A replacement system is being designed to meet the requirements of an existing four bedroom home. The planned system will include the installation of a new 1,250 gallon steel septic tank. An existing deep trench absorption system will also be replaced. The proposed absorption system is comprised of a single, 63 ft long, 6 ft. deep trench designed in accordance with municipal standards. The developed parcel slopes from east to west with grade ranging from 0-20%. The immediate area that has been selected for the waste water disposal system has an average slope of 2% towards the west. The site is sparsely treed with birch, spruce, and alders. It appears that there are no obstructions that would prevent surface water runoff. On-site observation and field measurements show that there are no neighboring water wells within a 100' radius of the proposed system. The proposed trench replacement will not impede replacement of neighboring systems in the future. No surface water was observed at the time of the inspection and it appears that there is no potential for contamination of future water wells. One single percolation test was performed at the site in determining an adequate location for the replacement waste water disposal system. An initial test pit for soil classification was dug to a depth of 15 -feet. The substrata consisted of 1.5 -feet of organic overburden overlying sandy gravel with trace silt to the bottom of the test pit. Neither bedrock nor ground water were observed. The percolation rate for the test pit was found to be 8 minutes per inch at approximately 4 -feet below grade. If there should be any questions concerning the percolation rates or characteristics of the site please call Doug Kenley at 746-1073 Sincerel , Douglas T. Kenley, PE CE #8176 MUNICIPALITY OF ANCHOkAUE ENVIRONMENTAL SERVICES DIVISION Uu 1 1995 RECEIVED 44, '6✓'E. wy� ° f�k; arum 1 v tLoc c MR. GEORGE TR EFRY ®®Uvfl ��� ������� m#� LOT 3, BLOCK 3..«. ............ .*»�. o $ CONIFER HEIGHTS SUBDIVISION r Z ANCHORAGE. ALASKA i0 F, m rm �C a uAr J �U g cog 0 0 Z m gg f �c z � 8 n x pp m A § O � ➢ Qmr mn CJ y IQ� v Ag 44, '6✓'E. wy� ° f�k; arum 1 v tLoc c MR. GEORGE TR EFRY ®®Uvfl ��� ������� m#� LOT 3, BLOCK 3..«. ............ .*»�. o $ CONIFER HEIGHTS SUBDIVISION r Z ANCHORAGE. ALASKA i0 coqoq M� N GGGGtH aazz� O� � D � N A r D D �J J z A z n 2 m z c•7 TbTNL- Del" { $.S' 1 S-0" MINIMUM pK 2'-0" MIN. W/ SUL. D 7�6= o r Amo " Al— �0 I H.. d a FH 6=9 n0 0 ~ N T a• _pp a TbTNL- Del" { $.S' 1 S-0" MINIMUM pK 2'-0" MIN. W/ SUL. D 7�6= o r Amo " Al— �0 I DOUGLAS T. KENLEY, P.E. •* ••a, m LARRY AND RENEE GRAHAM OWN [nytio•r 0 LOT 4 BLOCK d HEIGHTS SUBDIVISION $ � 0 Z & ANCHORAGE, ALASKA ���� • " _ d a FH DOUGLAS T. KENLEY, P.E. •* ••a, m LARRY AND RENEE GRAHAM OWN [nytio•r 0 LOT 4 BLOCK d HEIGHTS SUBDIVISION $ � 0 Z & ANCHORAGE, ALASKA ���� • " GREA i CR ANCHORAGE AREA BORA. 1.GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAMEA8AA � MAILING ADDRESS �t` ©� PHONE LOCATION LEGAL DESCRIPTION �- 3 ��'�" -Vp SEPTIC TANK: DISTANCE NUMBER OF FROM WELL 70 MANUFACTURER MATERIAL COMPARTMENTS Z INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY GALLONS. TILE DRAIN FIELD: ���,,� TOTAL LENGTH DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE_ OF LINES NUMBER OF LINE! DISTANCE BETWEEN LINES TRENCH WIDTH— IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER cf DEPTH: TOP OF TILE TO FINISH GRADE 13-- MATERIAL BENEATH TILE - .Fr IN. ABOVE TILE Y IN. WELL: TYPE- Q CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION—,LOT LINE , SEWER LINE , TANK , SYSTEM CESSPOOL , OTHER SOURCES APPROVED _ DISAPPROVED REMARKS - DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS: Form EQ -032 DIAGRAM OF SYSTEM V' Gk) KJ Vk 1771) ti Tq DATE (� APPROVED G.A.A.B. Nf N OU1-D <0 1A I F �T TSA) ie - f O� VMkC�j / l _ /�d�" t/ ✓vim'` R ANCHORAGE Oi DT NPARTMENT OF ENVIRONMENTAL QUALITY 0 "C" STREETTELEPHONE 274-4561 ALASKA 9950 , SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERM'` �-. `7 q "` ter ref\ ! v r < MAILING ADDRESS���� CyX / 26 yl;p PHONE7 - -t- NAME OF APPLICANT / INSTALLATION LOCATION ( f LEGAL DESCRIPTION "" INSTALLATION OF: SEPTIC TANK SEEPAGE PIT DRAIN FIELD OTHER' , TYPE AND SIZE OF FACILITY TO BE SERVED i FINANCED THROUGH TO BE INSTALLED BY ,� NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST SOIL TEST RESULTS COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE J TYPE - MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK -I " I SEEPAGE AREA SIZE TYPE FOUNDATION TO SEEPAGE PIT J,�`'' DRAIN FIELD T,p SEPTIC TANK TO SEEPAGE PIT WALL �y! X "" -=! r r J` ` A✓G r 01 1 SEPTIC TANK "� 'y SEEPAGE PIT ` ` DRAIN FIELD TO NEAREST LOT LINE. / f WELL TO SEPTIC TANK -, SEEPAGE PIT f DRAIN FIELDS ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD j 4 i 7 SEPTIC TANK, SEEPAGE PIT LG�DRAIN FIELD-, TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. n ^ G.A.A.S. OR LICENSED DESIGNER i1_... DiIAGr OA P' STg C4 Y M `6 I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO, 28.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE FORM NO. EQ -01 6 MA i I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO, 28.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE FORM NO. EQ -01 6 MA GREATER ANCHORAGE AREA BOQOU' Departnent of Environmental Ou�,..tv -' 3330 xC'/ Street Anchorage, Alaska 90503 SOILS LOG - PEROLAT1ONTDST Performed for61 Legal D8scriptiton: This form reports: Soils lo ' Percolation test Depth Feet 2- 3- 8- � 5 6 ~~ �/ ^- - -2� /~-/ / n "- y- ]0- S/ -r ll - 12 - 13 - 14 .Was ground water encountered? If yes' at what depth? Reading Date Gross Time Net Time Depth to Water Net Drop Fc�r_colation rate minute. Proposed instal lafi`6`n_._ Pit Drain Field Depth of Inlet Depth C0HM[QTS: _Certified Dv�----'---_D'�te:____-_--- ' --�l----------------- ' EQ -040 (8/74) ]BOX 1e36% STAR HoL'TE A ANCHOnAGEq ALASKA 00502 344-7'714 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 325 feet 47 DRILLED AT THE RATE OF '400 PER FOOT. PROPERTY OWNER Yxa' Jerry Shriner 344-0043 LOCATION OF WELL SITE Lt. MR Sub• DRILLER Bernie Claus of Rampart Drilling Works WELL LOG: ArcticDrillings Well deepened from 200 feet to 325 feeta Bedrock. Water bearing granular .rock at 321 feet, The only area yielding a usable amount of water: Slow flow per minute, however yielding an accumulative volume of 1440 gallons per 24 hour time frame, 120 feet of water head in casing with a four, hour full recovery on full draw dotim. Rampart Drilling Works will deepen this well at a later date, if Nxo Shriner feels more water is needed. No set up cost will be charged* C COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF $2125.00 THANK YOU VERY MUCH: BE CLAUS OF RAMPART DRILLING WORKS DATE July 2nd 1975 SED O ST DUE ACCOUNTS, SERVICE CHARGE OF I Va% PER MONTH WILL BE ASSES CERTIFICATE FOR A Municipality of Anchorage D eve I ° P m eB~a nSges~iyC~e'~s oDnepartment'i "i On-Site Water & Wastewater Program 4700 Braaaw Street P.O. Box 196650 Anchorage, AK 99519-6650 ' www.muni.org/onsite ~; / - |" (907) 343-7904 OF ON-SITE SYSTEMS APPROVAL SINGLE FAHILY DWELLING Parcel I.D. 015-093-20 1. GENERAL INFORMATION COSA# O~'~(7--, It Ioo Expiration Date: L.i//;/i] Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address CONIFER HEIGHTS S,/D; 7900 PORT ORFORD DRIVE BLOCK 3, LOT 3 * ANCHORAGE, AK * 99507 JOHN COX Day phone C/O AGENT 7900 PORT ORFORD DRIVE * ANCHORAGE, AK * 99507 Day phone REED MOORE W/ KELLER WILLIAMS Day phone 227-3575 101 W. BENSON BLVD, #505 * ANCHORAGE, AK * 9950,3 Unless otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: 4 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 [] 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 amxed hereLu and no · o, ,~e val, u~,,to,, date shown below, I veri~' +~* ~" As ce~ified by my seal ........... ~ ' - '~-" - investigation, based on procedures outlined in the Cedificate 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 in¢cated herein. I fuRher veri~ 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 appficable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Nameof-Firm GARNESS ENGINEERING GROUP, Ltd. Phone 3.37-6179 Address 5701 E. TUDOR .ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engit~eering 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 all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test 'results do not guarantee future performance of the system, nor do they guarantee that there 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 '1 Septic System Advisory Well Flow Advisory ,Nitr, a~ Adv:so,"y /, (Rev, 11/05) 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 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON.SITE SYSTEMS APPROVAL Legal Description: A. WELL DATA Well type PRIVATE CHECKLIST CONIFER HEIGHTS S/D; BLOCK 5, LOT .3 Parcel ID: *DEEPENED AND DOCUMENTED ON 7/2/1975. **ASSUMED BASED UPON SURROUNDING WELL LOGS. SEE ATTACHED. If A, B, or C provide PWSlD# N/A Well Log (Y/N) *YES Date completed *UNKNOWN Total depth ,325 ft. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 colonies/lO0 mi. Sanitary seal (Y/N) YES Cased to**40'+/BEDRQCK Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. FROM WELL LOG 7/2/1975 215 AT INSPECTION 12/27/2010 2O3 1 g.p.m. 0.68 Nitrate 7.41 mg./L. Other bacteria __ Date of sample: 12/7/2010 Collected by: 2 .ft. g.p.m. Arsenic: ND ug./L. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments Depression over tank (Y/N) NO Pumper 0 colonies/100 mi. GEG Ltd. Depression .over field. NO For 4 bedrooms New depth 25 in. 600+ g.p.d. If yes, give date - Total depth '10.5 .ft. Eft. absorption area 756 ft2 Monitoring tube YES Date of adequacy test 12/28/2010 Results (Pass/Fail) PASS Fluid depth in absorption field before test 0 in. Water added 600 gal. Elapsed Time: 120 min. Final fluid depth 18 in. ;Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN NOTE: DRAINFIELD WAS PRE-SOAKED ON 12/27/2010 WITH 1210 GALLONS OF WATER. 1000+ GALLON PRE-SOAK APPROVED PER JEFF POET. System type TRENCH Gravel below pipe 6 Foundation cleanout (Y/N) YES Date of pumping 9/2/2010 ABSORPTION FIELD DATA Date installed 9/2/1995 Length 63 ft. L'BELOW EXISTING GRADEJ Soil rating ~r ft2/bdrm). 0.8 Width 2 ft. High water alarm (Y/N) N/A ISAACS PUMPING Date installed 9/2/1995 Cleanouts (Y/N) YES LIFT STATION Date installed "Pump on" level at Size in gallons Manhole/Access (Y/N) ~ in. "Pump off" level--el at in. E. SEPARATION DISTANCES Cycles tested. SEPARATION DISTANCES FROM WELL ON LOT TO: 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'+ 100'+ Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas 100'+ Building foundation Water main Wells on adjacent lots SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 5'+ Property line 5'+ N/A Water service line 10'+ 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field Surface water. 5'+ 100'+ Property line 10'+ Building foundation. 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ COMMENTS Water main N/A Driveway, parking/vehicle storage 10'+ 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 COSA Fee $ ('{ CJI~ '"' Date of Payment, I" I O"' II Receipt Number O~'~'~'~:.:~ (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On-Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 Mayor Dan Sullivan Water Well Advisory Certificate of On-Site Systems Approval (COSA) # OSC 111008 During a recent COSA on-site inspection and test of the potable water supply well on Block 3, Lot 3 of Conifer Heights subdivision, the well's productivity was determined to be 0.68 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4- bedroom residence is 0.42 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On-Site Water & Wastewater Program ~~~*'"~--"~~" Phone: 907-343-7904 Fax: 907-343-7997 Mayor Dan Sullivan Nitrate Advisory Certificate of On-Site Systems Approval # OSC 111008 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 3 of Conifer Heights subdivision. This inspection revealed a nitrate concentration of 7.41 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis fi'om the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. SGS Ref.# 1106449001 Client Name Flattop Technical Srv~ Printed Date/Time 12/16/2010 17:03 Project Name/# L3 B3 Conifer Hts S/D Collected Date/Time 12/07/2010 11:00 Client Sample ID L3 B3 Conifer Hts S/D Received Date/Time 12/07/2010 11:30 Matrix Drinking Water Technical Director Stel~hen C. Erie PWSID 0 Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Hardness as CaCO3 183 5.00 mg/L SM20 2340B C Waters Department 12/08/10 12/16/10 KDC Microbiology Laboratory Colony Count 0 col/100mL SM20 9222B A (<200) 12/07/I0 DLC Fecal Coliform 0 col/100mL SM20 9222B A (<1) 12/07/10 DLC Total Coliform 0 col/100mL SM20 9222B A (<1) 12/07/10 DLC Private Individual Analysis Alkalinity 131 10,0 mg/L SM20 2320B D 12/10/10 SDP Aluminum ND 20.0 ug/L EP200.8 C 12/08/10 12/16/10 KDC Antimony ND 1.00 ug/L EP200.8 C (<6) 12/08/10 12/16/10 KDC Arsenic ND 5.00 ug/L EP200.8 C (<10) 12/08/10 12/16/10 KDC Barium 34.3 3.00 ug/L EP200.8 C (<2000) 12/08/10 12/16/10 KDC Cadmium ND 0.500 ugfL EP200.8 C (<5) 12/08/10 12/16/10 KDC Calcium 56000 500 ug/L EP200.8 C 12/08/10 12/16/10 KDC Chloride 7.25 0.100 mg/L EPA300.0 D (<250) 12/10/10 12/11/10 SDP Chromium 3~04 2.00 ug/L EP200.8 C (<100) 12/08/10 12/16/10 KDC CO3 Alkalinity ND 10.0 mg/L SM20 2320B D 12/10/10 SDP Conductivity 360 1.00 umhos/cm SM20 2510B D 12/10/10 SDP Copper 107 1~00 ug/L EP200.8 C (<1300) 12/08/10 12/16/10 KDC Fluoride ND 0.100 mg/L EPA300.0 D (<2) 12/10/10 12/11/10 SDP HCO3 Alkalinity 131 10.0 mg/L SM20 2320B D 12/10/10 SDP TotalNitrate/Nitrite-N 7.41 0o100 mg/L SM20 4500NO3-F B 12/08/10 AYC SGS Ref.# 1106449001 Client Name Flattop Technical Srv. Printed Date/Time 12/16/2010 17:03 Project Name/# L3 B3 Conifer Hts S/D Collected Date/Time 12/07/2010 11:00 Client Sample 1D L3 B3 Conifer Hts S/D Received Date/Time 12/07/2010 11:30 Matrix Drinking Water Technical Director Stephen C. Ede PWSID 0 Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Private Individual Analysis Iron ND 250 ugFL EP200.8 C (<300) 12/08/10 12/16/10 KDC ~ Lead 15.4 * 0.200 ugfiu EP200.8 C (<15) 12/08/10 12/16/10 KDC Magnesium 10500 50.0 ug/L EP200.8 C 12/08/10 12/16/10 KDC Manganese 18.7 1.00 ug/L EP200.8 C (<50) 12/08/10 12/16/10 KDC Nickel 2.13 2.00 ug/L EP200.8 C (<100) 12/08/10 12/16/10 KDC OH Alkalinity ND 10.0 mg/L SM20 2320B D 12/10/10 SDP pH SA0 0.100 pH units SM20 4500-HB D (6.5-8.5) 12/10/10 SDP Selenium ND 5.00 ug/L EP200.8 C (<50) 12/08/10 12/16/10 KDC Silver ND 1.00 ug/L EP200.8 C (<I00) 12/08/10 12/16/10 KDC Sodium 4130 500 ug/L EP200.8 C (<250000) 12/08/10 12/16/10 KDC Sulfate 18.5 0.100 mg/L EPA 300~0 D (<250) 12/10/10 12/11/10 SDP Thallium ND 1.00 u~L EP200.8 C (<2) 12/08/10 12/16/10 KDC Total Dissolved Solids 196 10.0 mg/L SM20 2540C D (<500) 12/09/I 0 J JR Zinc 745 5.00 ug/L EP200.8 C (<5000) 12/08/10 12/16/10 KDC / t I I · LOT Lot ,~ ,Block ~ Anchorage Recording Districft AIc~ska, LOT SURVEY' CERTIFICATION ;LOT (7/-/,.t)) hereby ~ectify fhet I have ~srYeyed the property Shown and described hereon~ end t~t ~ I~rovements ~ituoted thereon ate within the ~p- Im~ove~tt on odjocenf ~art~ ov~lap or e~Qh ~ lbs pmmite~ qu~tlon end thai there ate aa madwaya, ut[lily li~ ~ oth~ ~lelble Ret. 2440 Date © O/-O6-/t EB. No. 2-/5 S.F. /! / I ....., the plat Of tabard are n6t lhown hereon LEGEND ~ ~ass or Aluminum ca.ed monument r 0 Iron pipe and/or rebar renovate& Q 2 x 2 hub &~tack renovated · 5/8" x ~" rebar set this survey ~' Fence Li~e (Approx. L~olion) Prepored by: Pegiste~d L~nd (~07]2Y9.~ 519 ~ Hight~ Ave. Anoh~a~ At~a ~Ol Propert~ of: L_~/Oh/~_~ COX 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. # tl-1 s-OQ3-20 HAA # 1. GENERAL INFORMATION s Complete legal description Lot_ 3; Block 3; Conifer Heights = Location (site address or directions) 7900 Port Orford Drive Anchorage, AK Property owner George & Denise Trefry Day phone 227-8323 Mailing address 7900 Port Orford Drive Anchorage, AK Lending agency Day phone Mailing address Agent John Buchanan/Prudential Jack White Day phone 762-5866 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: XX Individual well 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 #21 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 dale of this inspection. Name of Firm Address Engineer's signature ALASKA WATER & Alaska Water & Wastewater C$ nsultant% kites Shall be PAID 8_7C� A or prior to, closing for the lnpinepdi-i�i arvicq% Provkle& 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments By: _ G Phone 337-611 2B Date OF q ` `• ,f it OF �• Msa ,.. w• « J y A. Gar nou �i` cc y CE -795 ar fi� °° .•°• �� d 1 0FESStb� bedrooms, with the following stipulations: Date , 2_ . 99 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 courtesy to 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 821 D. LIFT STATION Date installed Manhole/Access (Y/N High water rm level at* tested i "Pump on" Size in gal "Pump offer' E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot �� f On adjacent lots 0 Absorption field. on lot �� On adjacent lots Public sewer main A14 Public sewer manhole/cleanout N� Sewer /septic service line 5 t Lift station A)A SEPARATIONDISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation Property line V Absorption field Water main/service line o?5 Surface water/drainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD. ON LOT TO: Property line Building foundation © Water main/service line Surface water aQ Driveway, parking/vehicle storage area Curtain drain Hone )ehow,-) Wells on adjacent lots ®D F. ENGINEER'S CERTIFICATION I certify that I ve rmi a hrLefines spections and review of Municipal re a Stems are in conforma a wi O guin effect on this date. ., , .'Q 11 �JPA Signature u 5a •ter• ........jam Engineers Nare(' .lG=�y C' Date `�"� x!9 ��9'+►... ` �`���5 ��rtiF�Std� HAA Fee $' rJ ` Waiver Fee $ Date of Payment �*� L s/ Date of Payment Receipt Number / 70 Receipt Number 72-026 (Rev. 3/96)* INSPECTION APPOINTMENTS DATA RECEIVED TIME L. TIME TIRFE DATE n O DATE BATE INSPECTO INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH &ENVIRONMENTAL PROTECTIOWEPT. OF i :'ALTI l 8, 825 L Street - Anchorage, Alaska 99501 ENVIRONME `T; ,' -_ i ECTION • ENVIRONMENTAL SANITATION DIVISION FEB 2 9 1980 Telephone 264.4720 Uri II 11 E REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND>SE`FA�C� DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PPWERTY OWNER PHONE 344-a2 (4 MAIL NG ADDRESS PROPERTY RESIDENT (If dii rent from above) dJ PHONE 27Rl�„1VF�R PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE AILING ADDRESS� 4. RE LT /AGENT 'Co Q �� ,�s PHONE 33.3- 5losl MAI LIINGADD ESS & 5. LE/G//AL DESCRIPTION f/�� STREET LOCATION FC47— 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS j SINGLE FAMILY ❑ One ❑ Four ❑ Other r ❑ Two ❑ Five ❑ MULTIPLE FAMILY 81 Three ❑ Six 7. WATER SUPPLY M INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INI INDIVIDUAL/ON-SITE** /��6 � YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72.010 (Rev. 6/79) < P 72-010 ( Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED �l 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING 1 �� TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL f 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS 6—APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY 72-010 ( Rev. 6/79) Municipality of March 3, 1980 825 "l_" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Krogseng Real Estate 6025 Winding Way Anchorage, Alaska 99504 Subject: Lot 3 onifer Heights Subdivision Ger d Shriner/D'ane Webb Approval for the individual sewer and water facilities can not be granted until the following items have been completed: (1) A well log submitted to this department. ', (,2� (L -The water analysis report be delivered to this office `�%J` from Chem Lab, 5633 B Street, for our review. (3) The septic tank pumped with a receipt submitted to this office. If there are any further questions, please contact this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: National Bank of Alaska Mortgage Loan Department Pouch 7-025 99510