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HomeMy WebLinkAboutCONIFER HEIGHTS BLK 1 LT 15Onsite File Conifer Heights Block 1 Lot 15 PID# 015-093-50 1978 field may be damaged. If in the future it is to if necessary. Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221227 PID Number: 015-093-50 Dwelling: © Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: © New [Z Upgrade Name Adam Lewis ABSORPTION FIELD ❑ Deep Trench ©Wide Trench El Bed El Mound Site Address 7735 Port Orford Dr. Anchorage, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 1.2 GPD/SF 5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.88 Ft. Gravel depth beneath pipe 2.12 Ft. Subdivision Block Lot Conifer Heights 1 15 Fill added above original grade 0.16-3.43 Ft. Gravel length 70 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field I Lift Station Tank Line 500 Ftz Ft. Well 100+ 100+ 25+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water 100+I 100+ I Material Plastic Number of compartments 2 Lot Line 5+ I 10+ I NA Foundation I 10+ 10+ I tlr-TATION Manufacturer Capacity Gal. Remarks Old field decommissioned per code, new system field verified 121+ separation from old system. Alarm location Electric ' alled by Installer PIPE MATERIAL House to tank Tank to D3034 drain5eld D3034 A+ Drainfield D3034 CO/MT D3034 Inspector Arcterra Consulting BENCH MARK (Assumed elevation) 100ft Inspection��, dates: 8/18/22 2nd 8/18/22 Location and description 3'd 8/19/22 41h 8/19/22 Garage slab ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp �, rrraa��r wtw ��•♦1 Conditional Approval: Date .•�,�P� *4921 * ♦i Septic System♦���,� Approved Date j KENNETH M. UFFUS i CE 16 ♦iF,p�o / / L.+ +��� Nhis approval does not include well permit requirem nts. ���♦ raarrr (Rev 05/02/18) AS—BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP221227 CONIFER HEIGHTS BLOCK 1, LOT 15 PID# 015-093-50 J SHED DECK EXISTING HOUSE �Op• PAVED \ D/W SHED \ I \ \ \ I \ \ I \ \ WELL fi m A—C=12,3' A—I=1100' 1 0.2 99,o 11 B—C=34.1' B—I=92.01 w A—D=16.0 A—J=110.0. 9o.zo = B—D=37,2, B—_J=91'5 y o FINAL GRADE m A -E=17.5' o B --E=38.3' 13 01 A—F=19.0' o m B—=39.6 a 1 50 GAL 84,0 A—G=48.4 N SEPTIC T m B—G=50.0 TANK SEWER ROCK m A—H=48,2' s1.90 B—H=481' 94.9 94k 70' Ld _mk Ln Ad OF 4Z l 1 m . N�*:49TH f=oo / G —71 . v mow. SSiol�' .. E ■���� PREPARED F❑R1 ADAM LEWIS 7735 PORT ❑RF❑RD DR. ANCHORAGE, AK FIELD BOOKS BOUNDARY: N/A sTAIONG: N A As"' HOLT DWG FILE. AOAD FlLF` FILE DDYPuTm. ow�wh K SD CHEIXFIY. KMD DAM 91V2222 omo.. SW244 '108 Nom'° 21083 SCALE: 1' = 30'1 SCALE: NTS MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.orglonsite On -Site Wastewater Disposal System Permit Permit Number: OSP221227 Work Type: Septic Upgrade Tax Code Number: 01509350000 Site Legal Address: CONIFER HEIGHTS BLK 1 LT 15 G:2440 Site Mailing Address: 7735 PORT ORFORD DR, Anchorage Owner: LEWIS ADAM & KRISTEN LVG TRUST Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: Lill .ti's fir, I� I Dei)artme:nt 7/6/2022 7/6/2023 30713 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: ,' Date: Issued By: (fU Date: 4 MUNICIPALITY OF ANCHORAGE 0 K. Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-093-50 Property owner(s) Adam Lewis Day phone Mailing address 200 W 34th Avenue #763 Anchorage, AK Site address 7735 Port Orford Dr. AnchoraLye. AK Legal description (Sub'd., Block & Lot) Conifer Heights Block 1 Lot 15 Legal description (Township, Range & Section) Lot Size 30,713 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Fieldx❑ Initial Single Family (SF) ❑x (w/wo AD U) Septic Tank Upgrade (D) El Holding Tank ❑ RenewalDuplex ❑ 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. Dea Duffus (Signature of property owner or authorized agent) Date of Payment: �/a 9/1-20192 Receipt Number: D X50 (� Permit No. 0 SPS a 1;� a 7 Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221227, Deb Wockenfuss, 07/06/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221227, Deb Wockenfuss, 07/06/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221227, Deb Wockenfuss, 07/06/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221227, Deb Wockenfuss, 07/06/22 1 0 PORT ORFORD DRIVE GOEMW ._., I ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: CONIFER HEIGHTS LOT 15 BLOCK 1 PLAT 71-190 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Linder no circumstance shout,* any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary Nixes. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE: E-MAIL,: .__... AUG 26, 2023 1"=30' schuilerOck.net 23-098 DRAWN BY: CHECKED BY GRID NUMBER: a00K A(> JLS SW2440 230302 * = FND 5/8" REBAR U AWF O F �1 N �� L A ;'VD i .• 49TH •, 7 , ?A - I ...... ........... ..... � z t•" RA RA 'r ; D `.JOHN L. SCHULLER: 0 % LS --104x8 qj ( _4 �9ir,.�. • •. x �,� ' • , , . • ` �� i 1831. Talkeetna Street �� • • .14, d ,� Anchorage, Alaska 99508 Ar � 4'�` ,,oe, O fo� L ,..�,. (907) 227-1455 office e ssion`�•... (907) 274-4992 fax t1� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME Roger Hamacher PHONE 349-2011 [~ NEW [] UPGRADE MAILING ADDRESS LEGAL DESCRIPTION SRA Box 196 L15 BI Conifer Heights LOCATION Port Orford Drive I DISTANCE TO' '~n _v ' I ,J..u o I-- Z J Manufacturer ~ J Greer u~ Liq. capacity in gallons J v Well = I D,STANCE TO: I N/A ~ --~ ~ Manufacturer c~ I I Well ~3: I DISTANCE TO: I 130t .~ u. ;Z No, of lines Length of each line ~¢ I- Top of ti e to f nish grade ~ 4' Length Width ~ I N/A ~ ~ ~ Type of crib Crib diameter Well ~ DISTANCE TO: ~ JClass Depth  ~ DISTANCE TO:' Building foundation AbsorPtion area 15' Inside length Dwelling Foundation 40 Total length of lines 53' Material beneath tile Depth Crib depth Building foundation Driller Sewer line OTHER PIPE MATERIALS Cast Iron/4" Perforated Plastic SOl L TEST RATING 145 Sq/BR INSTALLER H&M Excavating REMARKS Dwelling 14' Material Steel Width NO. OFBEDROOMS 4 PERMIT NO. 78O389 No. of compartments Liquid depth PERMIT NO. Material Liquid capacity in gallons Nearest lot line :25 Trench width 3 6 inches 72 inches PERMIT NO. 780389 Total effective absorption area 636 Sq. Ft. PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line PERMIT NO. Septic tank Absorption area(s) ,L g~4?,~t~7.~"'~\ ~EPRRTMENT r HEALTH AND ENVIRONMENTAL 3TECTION ~~.~.~%~~,,..,~... 825 'L STREET, ~NOHOR"AE, "K. 99,.,~ ~ 264-472~ %P:~ WELL AND ON--SITE ~EWER PEAr, IT PER, T N0. < >. APPLICANT LOCATION LEGAL ROGER HAMACHER PORT OXFORD DRIVE LiS Bi CONIFER HEIGHTS SRR BOX 9t6 LOT SIZE 34~-2011 307i3 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBEROF BEDROOMS SOIL RATING THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS' DEPTH= iB LENOTH= ~ GRAVEL DEPTH,= 6 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND liND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). REQUIRED SEPTIC TANK SIZE= :~-Ii~E~- GALLONS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. ------ TWO ( 2 ) INSPECT IONS ARE REQU I RED BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WI LL BE SUBJECT TO PROSECUT ION. MINIMUM DISTANCE BETWEEN R wELL AND RNY ON-SITE SEWAGE.DISPOSAL SYSTEM IS i00 FEET FOR R PRIVATE WELL~ OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST 8E RETURNED TO THE DEPARTMENT WITHIN 30 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T E~<P I RES DECEMBER ~i-- 19?B I CERTIFY THAT t: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH 8Y THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN RC~RDANCE WITH THE CODES. ~' I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MR¥ REQUIRE ENLARGEMENT If THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. ~~. Inc. · ~ toioff, box 8718 · onoho¢c~e, alaska · 9950~. ~e,~,,: May 18, 1978 '!'. ~). C. No. 78A-077 .. M,*. Roger Il:]reacher SPA Box 916 Anchorage, Alaskn 995()7 Lot 15, $1o,k l, Anchorage, Alaska We are submitting herewith the t,, st bct*in~; rt.sults and our comments regarding soil conditions on,'~,unlored at ti~t* s:ul,.i{,ct qite. This in- vestigation wa~: p,~rfol'nk.d ill ,lt'Ct'l'ti:lllCC with 197B and those procedur,.~: ,,t~t I ia ,d m.. tho 5hinic ipalit y of Anchorage, Department of [~nviFolllat,,q, Il flu:il il'v. A single test hole was drilled.,.,,it-},in tho s,bject sire area for tile purpose of defining 'gon~.r:ll :.~lb.qt,rlace soil. condiLic,:ls for thc pro- posed sanitary system, l),-illin>; ~,.'~;s .it', ot:q~l ;s:ht-d with :tn auger type drilling rig and the test I,o1,, wag t,×tt.:tdc,i l,~ ., t'ot:l: tlcpl.h of 19 feet below ground surf:lc.,. 'iht lit:.,l It,". ,~? th,. test. hole is closed. Groundwater wns m'~t e:~c~t~utcrt,t in tl~t. t~.st h~,i.. ~;l~ile drill]n;7. A percolation test :.;as performed *'rom a depth indicatcd and reflects average infil, trati~,n tr,m. t!,~lt d,,pth to the botr,~l:: t,f iht~ hole. We appreciate being given this o,'.pt,rtu:~i~- to be of .~ervice to you. Should you have any qucs~ it,ns wi'h :',:'.ard to thc ab,'ve, ple.tse do not hesitate to Very truly yours, TIlE DRILLING COMPANY, Paul L. Jack:~:m, Geologist / Duncan, pl,J :j t · anchorage · fairbanks .ate*'~° 78A-077 Lot 15, Block ! No Scale PORT ORFORD DRIVE Test hole location is approximate only and has not been established by survey methods. TH 1 5-17-78 Organic Material (PT) Silty Sand Gravel with some silt and a trace of sand (GM) Sandy Gravel with some silt (layers of sand) (GM) Gravelly Sand with some silt (SM) Sandy Gravel with some s~lt 0.0 1,0 3.0 5.5 10.0 12.0 No Water Table 19.0 TD Log represents location of Test Hole - I~t 15, Block 1, Conifer Heights Subdivision Anchorage, Alaska Roger Hamacher Log of Test Boring Lot 15, Block ! Conifer Heights Subdivi~ion Anchorage, Alaska TIME 1G:O0 10:01 10:07 10:03 10:04 10:05 10:10 10:15 10:20 ]0:25 10:30 10:35 10:40 10:45 10: 5:'~ 10:SS ] 1 ELAPS ED Tl bill ' :',, ' .,'l ~(::, "i'ST '['.D.C. ~1o. 78A-077 "lay 18, lq?8 nut es ) .-.. '....')' ................ ,,. i_,L_-_,.___ ,__ - ....................... ,N~..IL 3h!. t t,~', t. NChr~S 0 1 l 1 1 5 5 5 5 5 5 5 S 5 5 ',7 I./2 (4 l ~,,i I ? 70 7 ! TS , i i' i l t./" 1 1 i/2 t ~/2 I i/:, ~ .~ /4 ~14 i,'2 ~ ./4 ),, 4 '.', ; ~-0 3i4" Ii'oral -' · ~q Minut t-.q/iht a F~ O F~ 7~ O FC H O ~ O TOP OF FOUNDATION WALL ELEVATION · ¢'.]~¢'~, 0 PREPARED FOR ~ ............ ~.:__~m~ ....... IPLOT PLAN I=- ........ IF.": ..... L~.7' ,,~ _ '__~ TRYC ] NYMANI IT SMALL BE THE RESPONSIBILITY OF THE BL~ILDE~. · .= y · / .,_ .. LOl /~' , BLOCK Z y. A.<,:CII:)R DRI _:.LiN(, 2207 :Af 36-th AnchoragEl , . talc,. )a�;�� July 1978 r L0( a ares „r ?2 ft.; and, 8t, Rocks 'd f t . So.n.d. Gravel 5-9 ft. '� Gravel j?_ ft.: Brown- :;lay i6 ft. Clay Gravel 24 ft. -Iravel f 1 f t. Clay.. , '- 6 ft`. Clay Travel _& ft. ;:>and Y;. nx Gravel s );9 f't. a�Tel, Dater. , ,r ?•-%inuta � f y � } �Ji t ii4l {SIIi+L ?z� F f/ 11 i, j I � 1: MUNICIPALITY OF ANCHORAGE Development Services Department `Kr Phone: 907-343-7904 On -Site Water & Wastewater Section Fax. 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-093-50-000 Legal description CONIFER HEIGHTS BLK 1 LT 15 Expiration Date: 12/27/2023 Site address 7735 PORT ORFORD DR Anchorage AK 99507 Current property owner(s) LEWIS ADAM & KRISTEN LVG TRUST X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory X Tank Age Advisory Arsenic Advisory Other COSA ApprovaIjune 2022 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 Application 1. GENERAL INFORMATION Parcel I.D. 015-093-50 Complete legal description Conifer Heights Block 1 Lot 15 Location (site address) 7735 Port Orford Dr. Anchoraae, AK Current property owner(s) Adam Lewis Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: V Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age 1 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ✓❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $2 -SO Waiver Fee $ Date of Payment_ 9 �/ t-3 Date of Payment COSA # 0 2"j 13` i Waiver # COSA Application—June 2022 Legal Description: Conifer Heights Block 1 Lot 15 Parcel ID: 015-093-50 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑✓ Well log is filed with Onsite (or attached) Date drilled 7/1/78 Total depth 219 ft Cased to 219 ft 91 Sanitary seal is functioning correctly ✓❑ Wires are properly protected Casing height (above ground) 12 in. Date of flow test for COSA 4/13/22 Static water level at beginning of test 202 ft. Comments B. TANK DATA Measured operating fluid level in septic tank New Date of pumping New install 8/18/22 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 8/18/22 0 ALL standpipes present per record drawing Total measured depth from grade 8.43 ft (max) Measured depth to pipe invert from grade 3.02 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑✓ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 5.1+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes F/I N © Coliform bacteria is Negative Nitrate 8.73 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L © Arsenic less than MRL (ND) Collected by Areterra Consulting Date 8/23/23 FT STATION ❑ Require tenance completed Age of lift station rs Lift station material Comments: Adequacy test date New Results ❑ Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) Effective depth used in Effective depth remaining in in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) 0 Yes Septic Tank/Lift Station on Lot > 100' ft Surface Water > 100' Community Sewer Manhole/Cleanout > 100' 0 Yes if No ft Q Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' Community Wells > 200' Q Yes if No ft Animal Containment > 50'�/❑ Yes if No ft ✓❑ Yes if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft Q Yes if No ft ❑ N/A —Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' 0 Yes if No ft Tank to Property Line > 5' ✓❑ Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' 0 Yes if No ft Private Wells > 100'✓❑ Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' 7 Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Areterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date a' 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 a �7 and the water usage of the family being served by the system. The operational life of all well and septic Ar f ¢ m , systems are subject to these various and dynamic characteristics and are outside the control of the evaluator or of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will % function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen ` encroachments, deficiencies or discrepancies exist. �� KENNETH M� 15 or COSA Checklist -June 2022 NM111h I Nitrate Advisory Certificate of On -Site Systems Approval # OSC231348 Subdivision: Conifer Heights, Block: 1, Lot: 15 A water sample revealed a nitrate concentration of 8.73 milligrams per liter (mg/Q. 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. Since nitrates are known to slowly increase, we recommend you monitor the water quality. 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. Mailing Address � O Bax 196650 *gg Anchorage, Alaska 99519 6650 *www mum org 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 from 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. Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650'* www muni org N 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 0/~--- ~ --,.~0 NAA# ~ ~c~°~C~-~ ~ \ 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phoneo~ ~-~ Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer 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 date of this inspection. Name of Firm / c)~'-''-j) )P'¢ ~'1 ~ ~ ~J '~' ~' [~ J ~ I~ Phone ~ 7 ~- ~/~ ~ Address ~ '~, I_'_~/! 5"~ g'~ ~ ~///~' //' . ~/o~_? Engineer's signature "'~'~- ,=~, z~.~J~ ~--~-/ Date DHHS SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ...... Date ~,~,.~'.~,~ 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. 72-025(Rev. 1/91) Back MOA#21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type Log present (Y/N) y Total depth Sanitary seal (Y/N) Cased to FROM WELL LOG Date of test Static water level Well flow Pump level1 If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~/7' ~' Driller ~r~4g.~¢ o v' ~ c~ Casing height Wires properly protected (Y/N) AT IN.,SPECTION F-o / / ~' g.p.m. ~, ~" -~ g.p.m. 7 + SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I ~ Absorption field on lot Public sewer main Sewer service line ~' ~,~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~/~ / Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ~/'~/~ / 7 ~ Cleanouts (Y/N) ~'/ High water alarm (Y/N) Date of pumping Nitrate Collected by: Other bacteria Tank size /~L ~ (..2 Compartments ~ Foundation cleanout (Y/N) Depression (Y/N) ~//"-~ Alarm tested (Y/N) ~//~ I~/~/"/'t//~ ,~ -'~ Pumper /~ ~ ~ ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 10 To property line ~ ~0 Absorption field ! ~'"' Water main/service line Surface water/drainage 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~7/t~/7~ Length Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Width Soil rating (GPD/Ft2) I/~/5 System type Gravel thickness ~ Total depth J ~.~ Cleanout present (Y/N) y "--- Depression over field (Y/N) i'-! Results (pass/fail) ~1 for V Bedrooms I~,~ After test / '7 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot > / ~ On adjacent lots >/~ Property line To building foundation '~ ~ ~-- To existing or abandoned system on lot On adjacent lots .'~ ?0~..~ Cutbank ~'~ o t,4 ,E~ Water main/service line Surface water ~ [ O Driveway, parking/vehicle storage area ~' Curtain drain ~ l ~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on t_~~[his inspection. Signature Engineer's Name ' Date H~ Fee $ / Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number TIME )ATE INSPECTOR DIRECTIONS: THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS TIME DATE INSPECTOR DATE RECEIVED TIME DATE INSPECTOR 1. TYPE OF RESIDENCE [] .SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: ~,_~"O If Tank is homemade g~ve dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS NUMBER OF BEDROOMS [] ONE [] TWO [] THREE [] FIVE [] FOUR [] SlX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING MANUFA~i~[~RER MATERIAL 'Septic/Holding Tank IAbsorpfion Area Sewer Line [] OTHER Nearest Lot Line [Z~'~APPROVED FOR ~. BEDROOMS I--I CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE I BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78)