Loading...
HomeMy WebLinkAboutCONIFER HEIGHTS BLK 3 LT 13C. onr 015-0c -10 Heal '~UNICIPALITY OF ANCHORAGE , and Environmental Protec Fourth Floor WeSt 825 L Street Anchorage, Alaska 99501 264-4720 .3n INSPECTION LOCATION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE /~/., ~. ~ NUMBER OF FROM WELL/I[.U g'/~_ MANUFACTURER MATERIAL ~ COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY ~-~ALLONS. TILE DRAIN FIELD: DISTANCE [:ROM WELL/~_~FOUNDATION W~I~ NEAREST LOT LINE /~ ~OF TOTAL LINELENGT~-/ # of Lines / DISTANCE BETWEEN LINES ~//~ TRENCH WIOTH~__~IN. TOTAL EFFECTIVE ABSORPTION AREA ~/~ ____ SQ. FT. LENGTH OF EACH LINE ! DEPT. o~ F,,TER _2/ DEPTIt: TOP OF TILE TO F:INIS[i GRADE ¢ MATERIAL BENEATH TILE ~/ABOVE TILE IN, SEEPAGE PIT: DIAMETER __ OR WIDTH , Log Crib Rings Crib Size:! DIAMETER___ BUILDING FOUNDATION__ NEAREST LOT LINE____ LENGTH .... DEPTH DEPTH DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. Well Class: Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: ~¢~ % of Bedrooms: ~ Installer: ~;~.~., Remarks: ~ I i FE. Rllll NO. [:,EF'RR'T'MEN"f' 0~ iERLTH FIN[) EN',,,'IRf"INMENTRL F', I"EC]"ION RPF'L 'f I"';RN'I" LI]CRI" I ON LEGAL R II"':HARE) '¢ NEL~:;ON 2)'18 W 2ND FINF:H F JNL.,ERI_i_,H DR I VE El31- 13: BL 3: CEINIFER HEIGHTS SU LI3T SIZE 4(~¢}FtCJ SQUFiRE FEEl" - '"" .... '" · TRENuH "F'¢F'E OF' '=;OIL HB=,uRBFION S','S'I"EP1 IS "" -' t , "" ' SO I L RRI" I NG "'=- - FT/"BR ;, = ~5 ~_O.~J MRxIr,ILIM N JrlBEF.. OF BEDROOMS = 4 ~.- "I"HE REQUIRED SIZE OF THE ~U~L HB~LRFI~ON SYSTEM .... I"HE L_ENGTH DIMENSION IS THE LENGTH (IN FEET) OF' THE "FRENCH OR DRAINF:'IELD. I"HE DEPTH OF R 'FRENCH OR PIT IS T'HE DIST'FINCE BETWEEN THE SURFACE OF' THE GROUND AND THE BOTTOM OF' THE E×CRVRTION (IN FEET). I'HERE IS NO SET' WIDTH FOR TRENCHE% THE GR. FIVEL [)EPT'H IS THE MINIMUM DEPTH OF GRFIVEL BETWEEN THE OUTFFILL PIPE FIND "['HE BO"FTOM OF 1"HE EXCFtVFITION (IN FEET). =.EF i Z F: TANK ~ T ZE= :1_'-:"= .= ;z, I:-£1 i'.]i R I._ L_ I]]1 ~-.~ "' F~: E IT;! El I FA..' E [:, " ........ :" F" R 17_: F,:: R L3 E F' L R r-.I l'" 13 F' ""r I i---i [-,I R PFICKFIGE PLANT MR'~ BE INSI"RLLED RT' THE PERMITTEE"S OPTION SUBJECT "FO T'HE FOLLOWING CONDITIONS: '1. EITHER R CERSS I OR II NSF APPROVED PLFINT MAY BE IN~:;TRLLED. 2. R CONT'INUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF R MAINTENANCE FIGREEMENT IS NOT KEPT CURRENT YOU MAY BE: REQUIRED TO ENL. RRGE T'HE '=;OIL FIBSORF'TION S~r"=;TEM AND?OR '¢OU MRM BE SUBJECT TO PROSECUTION. "1"" L~ u2n ,:".,:..<':-;- -:, 1" r-.I $ F' E C 'T ! 0 N $ Fi F~.' E ~.' E I~! IJ ][ F; E E-', BFIF:KF~L.L. ING OF' FIN'¢ SYSTEM WITHOUT F'INRL INSPECTION AND FIPPROVRL E:¥ THIS DEF'RRTMEN'I" NILE 8E _-,UE,..E_.r Ti3 PROSEf":LITION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL S¥S"f'EM IS i~00 FEET' FOR R PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS FIRE REQUIRED AND MUST' BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS OF THE WELL. COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIF-ICRTIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY I"HFIT 1: I RM F'RMILIRR NITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS FIS SET FORTH B'¢ ]"HE MUNICIF'RLII"'¢ OF .ANCHORAGE. 2: I WiLE INC;TRLL THE S'¢S]"Er'I IN RC:CORDRNCE NITH T'HE CODES. ]:: I UNDERSTAND THAT' ]"HE ON-SITE SEWER ':;'eSTEr,1 MR'¢ REQUIRE ENLFIRGEMENT IF' THE RE':iIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. ~2'", '", ........... " '"' ] ' "-'"1 IF ('L I L..HNI F.. I L. HRF..[.. ~ NEL_-,L N I S'"~;IJED El'.' j= _DATE. ',,,' 3:. El GARY PLAYE R VIZNTUR S CONSULTING GEOLOGIST BOX 476-M, STAR ROUTE A · ANCHORAGE, ALASKA 99507 · PHONE 344-707! SOILS LOG Perfo~ed for ¢~O~ ~l~ ~ocation ~ ~ ~ ¢1 k ~) i ~ ' ~~ Date Soil Type Water Level Remarks = .tO ,ri ~ 12 16 18 20 Total Depth of Excavation Material at Total Depth Ck~/~ (~/~0) Groundwater ~ot.Reached Depth, if Reached__ Bedrock ~Not Reached Depth, if Reached Classification Method ~'~Visual ( ) Sieve Analysis () Gary F. Player, Consulting Geologist GARY PLAYER V NTUR S CONSUL. TING GEOLOGIST BOX 476-M, STAF~ I~OUTI~ A · ANCHORAGES, ALASKA 99§0? SOILS LOG Performed for ~,~~ 'V ~/~O%A 0 2 4 6 16 18 2O Soil Type Water Level Remarks Total Depth of Excavation___L_~II~'- Groundwater ~ot.Reached Depth, if Reached__ Classification Method tJ~'~sual ( ) Sieve Analysis () Material at Total Depth Bedrock t.~J~ot Reached Depth, if Reached Gary F. Player, Consulting Geologist . ©~// / ~tt is the rel~ .isibiltty of the owner or 2 ; /~ ~/~_./ .' b~lder, prior to construction, to ,verify ~ ~. /" / ~ ~ ' proposed building grade relative to fin- / / / ~sh~ grade and u~dity connectlon~ and . ~ ' ~ de~ermine the existence of any ea~e- / ~ / - manta, covenant, or re~trtatlo~ which ~ ~ / ~ do not appear ~ ~ r~ ~bdlvl- Io /o'J ' LOT /3 Lot i~, Block ~ Area Sq. Ft. Plat File No. Zoning District Anchorage Recording District, Alaska , REVISIONS ,, DATE j[ BY ® Iron Pipe · Steel Pin I~ Survey Hub & Tack .~_'t~' . ..'O-,o2-"~ ~'~ l SURV£Y C£RTIFiCATIO~ ~s$£~. ..... i~ Brass Cap Monument F � ti9ec,10 • Municipality of Anchorage ti77 ,- .1:). On-Site Water and Wastewater Program Lai li't i . (907) 343-7904 aqii i lit4! ] Y6 I4 �� Certificate of On-Site Systems Approval c- 0/ 6BZ9 Parcel I.D. 015-093-10 Expiration DaterO\J c9 01. 1. GENERAL INFORMATION Complete legal description Conifer Heights B3 L13 Location (site address) 9500 Ponderosa Dr. Current Property owner(s) Randall & Audra Finkenbinder Day phone Mailing address PO Box 154 Aleknagik, AK 99555 Real Estate Agent Day phone 2. TYPE OF DWELLING: O 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 El Individual Q Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by 01`�A./ s / l Date: E G260 COSA to be released to the engineer,unless otherwise requeste. b the engineer. COSA Fee $ Waiver Fee $ Date of Payment g P-3-117( -jt Date of Payment Receipt Number OUa5O6 Receipt Number COSA# 6503% 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. 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 local 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 Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 8/18/2017 OF AC `.41110- AMOK sI kk *ff �i\ . .•7 6. DSD SIGNATURE -\/ System #1 Approved for ' bedrooms t -Steven R. 'annone • Oi CE—8149 .'&1•6o System #2 Approved for bedrooms J' ,1 Disapproved k FROFESSI Conditional approval for bedrooms, with the following stipulations: (' N-Silt \NATER AND \IUHSIt=�•,\,� PROGR' t By: -P,Pi fiU,i (3i Original Certificate Date: g/l 9/2 01 —/ 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 COSA blue sheet_S - If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Conifer Heights Block 3 Lot 13 Parcel ID 015-093-10 A. WELL DATA Well type Private If A, B. or C provide PWSID # Well Log (Y/N) N Date completed 1977 Sanitary seal (Y/N) Y Wires properly protected (YIN) Y Total depth 370+/ ft. Cased to 40 ft. Casing height (above ground) 30 in. FROM WELL LOG AT INSPECTION Date of test UNK 8/10/2017 Static water level UNK ft. 2.50 ft. Well production UNK g p m •11 g.p.m. WATER SAMPLE RESULTS: Coliform NEC' colonies/100 mL Nitrate ND mg1L Arsenic ND ug/L Date of sample. 8/10/2017 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material ConcreteDate installed 10/1977 Tank size 1250 gal Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A Date of pumping 8/4/2017 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 10/1977 Soil rating (g.p.d./ft2 or ft2/bdrm) 85 sf/bdrm System type Trench Length 55 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth 11 ft. Eff. absorption area 600 ft2 Monitoring tube Y Depression over field N Date of adequacy test 8/10/2017 Results (Pass/Fail) PASS For 1- bedrooms Fluid depth in absorption field before test 48 in. Water added 455 gal. New depth 60 in. Elapsed Time 1440 min. Final fluid depth 48 in Absorption rate >= 450+ g p.d. N Any rejuvenation treatment (past 12 mo.) (Y/N & type) 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&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 1 00+ 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 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Survey on file. Drainfield was presoaked per engineer bulliten before test. 4UCSF �'�r eoras I . -c SF rad cL 4 k f-co -IS LDCGLke cL Xl O Lkxs ctiL , IN 9{ C Y (Lri Ve-uvN, G. ENGINEER'S CERTIFICATION s I certify that I have determined through field inspections and Co.•17/4: �)i %y+TA review of Municipal records that the above systems are in l*.• 49 TH /\ ••1t conformance with MOA COSA guidelines in effect on this date. p ••• lit •• •• Engineer's Printed Name Steven Pannone -11-:-Wo n'RI•Nririorie : • e 8/18/2017 ��}lyj,• CE-8149 Date ,r' •.4t/ COSA canary sheet_2-6-15.doc MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, toWnship, range) Location (address or directions) App ,cant Name ~''J Applicant Address Applicant is (check one): Lending Institution ~ ~ Owner/builder~ Buyer ~ ~ Other D (expl~Jn)~ Business '"' (d) Lending Institution ~'~/'~/I/ Address ~/'~. C o ~/,-,/~ Telephone (e) Real Estate Company and Agent Address Telephone (f) ~' the HAA to ~[f~jl~lj~il~: 17034 Eagle River Lo~, Rand Eagle River, Alaska 99577 TYPE OF RESIDENCE Single-Family~l~Multi-Family~ Number of Bedrooms Other WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite,[~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDIh, ,NSPECTIONS, TESTS, FILE SEARCH, D; . AND INFORMATION % As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Heal!t~ Authority Approval 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 .=~o .~' Cld~lldl~l=l~ IId~'_ ............ Telephone '~ ~:~¢'"'. ~' ~7 ~' Address 17034 Eagle River Leap Road No. 204 Eagle River, Alaska ~¥57Z Date ~-- Z,~-- ~ ~' DHEP APPROVAL Approved for _~~.~ Approved bedrooms by Disapproved Conditional Terms of Conditional Approval Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL (HAA) I~UNIC1PAUTY OF ANCHORN3~HECKLiST . FEBRUARY 1984 DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION WELL DATA RECEIVED 264-4720 LegalDescription: ~-oT /.~ Casing Height Above ~Ground Electrical Wiring in Conduiti~N) Separation Distances from Well: Well Classification ~ · ~, _ If A, B, C, D.E.C, Approved (Y/N) Well Log Present (Y,~I~ Date Completed /~.~'~e.o~. ! ~'~'~/~M Yield Total Depth ~' .~ o ~ + Cased to ~P ~'/' Depth of Grouting Static Water Level _ ~-'~'~ Pump Set At ~ ]'( P~" Sanitary Seal on Casing.i~N) Depression Around Wellhead (YZ~,-,~ To Septic/Holding Tank on Lot J / $ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line .k//~ To Nearest Public'Sewer Cleanout/Manhole ~o'//~ To-Nearest Sewer Service Line on Lot Water Sample Collected by ~ ~'~ ~-..O~i~'J&.,~D~ ' Date Water Sample Test Results ~ ~ ~/'= ; On Adjoining Lots ; On Adjoining Lots Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~ Size Standpipes ~)N) Air-tight Caps (~/~N) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N), Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: No. of Compartments Foundation Cleanout (~N) Date Last Pumped ~"/[ , for "~'/,b , , Temporary Holding Tank Permit (Y/N) To Water-Supply Welt // To Property Line To Water Main/Service Line / Course ~/"'/~ ! To Building Foundation ~. ~ To Dispo_spl Field.. ~'7' ~ -.. To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field 3~'~ Square Feet of Absorption Area Depression over Field (Y~_.~ Results of Last Adequacy Test ~'J/~ Separation Distance from Absorption Field: To Water-Supply Well lC-/ To Building Foundation Lot To Water Main/Service Line ! 5~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field // Gravel Bed Thickness Standpipes Present ~N) Date of Last Adequacy Test To Property Line ! To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) h..//~ Comments D. LIFT STATION Date Installed ~)~ Size in Gallons "Pump On" Level at High Water Alarm Level at / Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumpi__ng Cycles during Adequacy Test, Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. SignedS & S ENGINEF. AIN~ Date ~ -- ~' ~ '- ~ '~ 17034E~lle Rtv~'~ R~ Ne. ~ ComPile ~:v;;, A~:~= ~ MOA No. Receipt No. D Date of Payment ~ -- ~ ~ ~ ~ ~ ,moun : Page 2 of 2 72-026 (11/84) MUNICIPALITY OF ANCHORAGE '-"' ~DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date NO V /~1-,, 1 ~i::~-:~ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section township, range) Location (address or directions) , Telephone: Home ~; V& -. ~& 9 re. Business (c) Applicant is (check one): Lending Institution [] ;'Owner/t~h~r [~'; Buyer []; Other [] (explain); (d) Lending Institution Telephone Address '" (e) (f) Address Telephone · ;~.: - Mail the HAA to the following address: ~, · 2. TYPE OF~RESIDENCE Single-Familyx Multi-Family[] Other Number of,BedroOms 3, WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4, SEWAGE DISPOSAL O.nsite¢.~ Public [] Community [] Holding Tank [] ~'~.~ ,~ .. .. Note~ If community well system, must have written confirmation from the State Department of Environmental Conservation · · attesti, ng to the legality and status. :Page 1 off2:I~):'';I~'I : "' 72-02~ (11184) 5. ENGINEERING FIRM PROVIDIN ASPECTIONS, TESTS, FILE SEARCH, DA ~,ND INFORMATION ' 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 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.. ~ ' ~ "~'"~ '~ ~--7~" 3 ~ ~ NameofFirm ~~~~ ..Telephone Address ~ ~ / ~ ~ ".fl,,} ~,, .~..~"~' '" '}' V'' ?~ Engineer's Seal ~ ~'~'. JUN[ 2u, 1.971 ' '? Approved for~--~ u~-"("~l-) bedrooms by Approved / Disapproved Terms of Conditional Approval _ Conditional Date CAUTION "~ Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional 'engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending, ~'~ institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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 )rofessional engineer's work. Page 2 of 2 72-025 (11/84) -- - MUNICIPALITY OF ANCHORAGE(MOA) HEALTH' AUTHOFItTY-APPROVAL (!dA-A) . CHECKLiST-.FEBRUARY' 1984 -~-~ · LegatDescrlption: L{~Tt ~-- A. WELL DATA '_ ~i~ ' ~"~ ~ Well Classification' ~ ~_ /~/ If'A, ~N) Well Log Present (Y/N) _ ~_-,"~D~e C~om~lete'd _ -,! ~ '7'7/?-~ Yield Total Depth ,~.-~'TD C/ased to ~ '3 '7 ¢:~ .Depth-of Grputing _ t~J.o J- Static Water Level . ,O~,/~ Pump Set At - Casing Height Above Ground '~ O Sanitary Sea[ on Casing (.Y/N) Electrical Wiring in Conduit (Y/N) 3/ Depression Around Wellhead (Y/N) Separation D stances from Well: To Septic/Holding Tank on Lot I [ ~) ' On Adjoining Lots To Nearest Edge of AbsorptionF[eld on Lot . ( ~// ;'on AdjOining Lots - TO Nearest Public Sewer Line k/{2 iq P_~ To Nearest Public Sewer ~;-.~":' ~:':' ' Cleanout/Manhole -Water Sample Collected by Water Sample Test Results Comments~ To Nearest Sewer Service Line on Lot ~, ~ O - . : B. SEPTIC/HOLDING TANKDATA Date Installed ~;)~ '~7") Size No. of Compartments ~"/'g'' C) i-'-- i' - - Standpipes (Y/N) O ~.~' , Air-tight Caps (Y/N) Depression over Tank(y/N) - ~ ~ , i, r~ Date Last Pumped /'/~£/~'-.~ '- ' : Pumping/Maintenance Contract on File (Y/N) 1,//~ ; for t,,///~ ' Holding Tank High-Water Alarm (Y/N) ~(//A-.. Temporary Holding Tank Permit (Y/N) ' 1~//~.. ,..- Separation Distances from Septic/Holding Tank: To Water-Supply Well I ~_~ TOr Property Line '7 '~ c~. To Water Main/Service Line ~ / O Course To Build ng Foundation To Disposal Field To Stmaml Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date'~h~talled (~C--¢ / ~ 7 '7 Width of Field ~:)f~ '! / Square Feet of Absorption Area 77 Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation z/ Lot To Water Main/Service Line ~ ! C) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design '7-,~ Length of Field ~ --~ Depth of Field ! / Gravel Bed Thickness Standpipes Present (Y/N) Date o] Last Adequacy Test ///5"//,~-'~ To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) /V~.~/',/ Comments D. LIFT STATION /'N,/O ~,~ ~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manh~ole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, veri,f~ed, or co nformed to all M, OAsnd HAA guidelines in effect on the date of this inspection. Page 2 of 2 t~ ~'. JUNE 25. t97~ ,'~L;= ~ 72-026 (11/84) ~.~, ~ ~/ ~ ~ CONSULTING ENGINEER 203 W. 15th AVE °'C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 RESIDENTIAL WELL INSPECTION LEGAL = LOT 13, BLOCK 3, CONIFER HEIGHTS LOCATION .- 9500 PODEROSA OWNER: TYPE OF WELL: WELL LOG AVAILABLE= RICHARD NELSON SINGLE FAMILY NO INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: NOT AVAILABLE MUNICIPALITY OF ANCHORAGe: DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION RE( EIVED RATE OF RECHARGE: 3.75 GPM AT 130 FEET DRAWDOWN PUMP YIELD: 6 GALLONS PER MINUTE DATE OF INSPECTION= NOVEMBER 8, 1985 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 6 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. THE WELL WAS PUMPED FOR 60 MINUTES. RECHARGE WAS MONITORED FOR 40 MINUTES. STATIC WATER LEVEL WAS FOUNF AT 249 FEET BELOW TOP OF CASING. TOTAL DRAWDOWN AFTER 60 MINUTES OF PUMPING WAS 130 FEET. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON NOVEMBER 12, 1985. TEST WAS NEGATIVE. TEST RESULT.' .... w"t THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. CONSULTING ENGINEER 203 W. 15th AVE 'C'° SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOCATION: OWNER: RESIDENCE: MUNICIPALITY OF ANCHoRAG~ LOT 13, BLOCK 3, CONIFER HEIGHTSDEPT. OF HE/~TH & ENVIRONMENTAL PROTECTION 9500 PONDEROSA RICHARD NELSON SINGLE FAMILY, FOUR BEDROOMS NOV 2 ]9 15 RECEIYED WATER SYSTEM: ON SITE WELL SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: ESPINOZA CONCRETE TWO COMP. 1250 GAL. ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 770 SQ.FT. SOIL P~ATING: 150 INSTALLATION DATE: OCTOBER 1977 DATE OF PUMPING: NOVEMBER 12, 1985. ANCHORAGE CESSPOOL PUMPING DATE OF TEST: NOVEMBER 8, 1985 350 GALLONS OF WATER WAS ADDED TO THE TRENCH AT A STEADY RATE OF 6 GALLONS PER MINUTE. THE RATE OF INCREASE IN THE WATER LEVEL WAS MONITORED. 350 GALLONS CAUSED A TOTAL INCREASE OF 16 INCHES. AFTER ADDING THE WATER THE RATE OF ABSORPTION WAS MONITORED BY MEASURING THE WATER LEVEL EVERY 10 MINUTES FOR ONE HOUR. EXTENDING THE RATE OF ABSORPTION TO 24 HOURS SHOWED AN ABSORPTION RATE OF 720 GALLONS PER DAY. THIS SYSTEM HAS A SURGE CAPACITY IN EXCESS OF 350 GALLONS. THE ABSORPTION RATE IS 720 GALLONS PER 24 HOURS. THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, 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 this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State.