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HomeMy WebLinkAboutCONIFER HEIGHTS BLK 1 LT 12Conifer' Height lock I Lo1' 12 015-093 -48  Municipality of Anchorage Development Services Department Building Safety Division ~'~::::::---- On-Site Water & Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of ,,% On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: OSP111253 PID Number: 015--095--48 Nome: GLENN ARMSTRONG WastewaterSystem: [] New · Upgrade Address: 7755 PORT ORFORD DRIVE *ANCHORAGE, AK 99507 ABSORPTION FIELD No. of Bedrooms: tt~ Ph°ne:(907) C/O AGENT ~ /~' I-Igeep Trench r-lShallow Trench []Bed r-IMound []O LEGALDESCRIPTION so,, Rating: Tote, Depth from originol g/p~:~ GPD/Sq. Ft.~ Ft. Block: Lot: Subdivision: Depth to pipe bottom from original grade: Grovel dep,.~,,,~;~e~th pipe: 1 1 2 CONIFER HEIGHTS Ft.,,,-- Ft. Township: _ Range: _ Section: _ Fill added above original grade: \(~"3 ~ length: WELL: [] New [] Upgrade~~ Orovel width: ~..~-.~X("~ \.~''/~ Ft. Number °f I' .... Distance between Ii .... Ft. Classification (Private, A,B,C): Total Oept - Cased TO:(BEDROCK) Totcl absorption o~re .~ Pipe material: iiiii:r: Date Drilled: Static Water Level: Date instolled:(,j- WILCO i(~ J Ft. Pump Set At: Casing Height Above Ground: · Ft. TANK GPM SEPARATION DISTANCES = Septic ri Holding [] S.T.E.P. [] Other* T~o Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: Tank Field Station Tank Sewer Lines GREER 1250 Material: Number of comportments: Well 100'+ ~ - - 25'+ STEEL 2 Surface Water 100'+ - - - ~-- LIFT STATION Lot Line 5'+ __C/') _ _ _ size in gallons: J Monuf°ct ..... X "Pump on" level at: Foundation 5'+ L.JJ _ _ _ "Pump ~er alarm at: Curtain Drain - NONE KNOWN ~ Pump Moke~cal Inspections performed by: I I Remarks: OLD TANK WAS "DECOMISSIONED" BENCH MARK Location and Description: BOTTOM OF TRIM NEAR POWER METER (BACK OF HOUSE) Assumed Elevation: 100.00 Inspections performed by: G EG, Ltd. Dates: let 9/16/11 ,~E.~.~<~_<~.~F..~_,~, 2nd - _~,-- OF AL _,~ %%....// Approval 3rd - ~' 4Jg_T~/~"...-F. Development Services Department Conditional approval: Date: ~l.~¢..jjgfff, r~,.%~t~s... %%/:';'-h/ CEF7§53 .-" /~_'7~--_ ~h~ ~.. 91~' ,, ": '?~ Reviewed and approved by: /~///.~/'~/'~/. ate: ?-,2 I- 1 / PERMIT NUMBER: OSP11125,3 AS-BUILT DRAWING DRAINFIELD NEW 1250 GALLON SEPTIC FCO EXISTING 4 BEDROOM HOUSE PARCEL ID NUMBER: 01 5-093-48 ~, A B ST1 21.39 19.07 ST2 26.90 25.66 DBL1 28.95 27.94 DBL2 29.65 28.72 FCO 16.60 15.59 &O0' GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GiENERAL CONTRACTORS 3701 E. TUDOR ROAD, SURE 101 ' ANCHORAGE, AK 99507 * PHONE (907).337-6179 * FAX (907)538-3246 * WEBSRE: ww~.gclmesse~glneering.com PREPARED FOR: IPHONE NUMBER: PAGE NUMBER: GLENN ARMSTRONG I C/O AGENT 2 OF ,5 LEGAL DESCRIPTION: DRAWN BY: CONIFER HEIGHTS; BLOCK 1, LOT 12 PNB TYPE OF WORK: DATE: AS-BUILT DRAWING 9/21/11 1"=30' rn ess.- (Rev. 01/05) PERMIT NUMBER: AS--BUILT DRAWING PARCEL ID NUMBER: OSP111 253 01 5-093-48 FINAL GRADE = 97.77-98.29 ST1 / ST2 TOP OF TANK ~AT TOP OF TANK AT INLET = 9,3.71 ~ OUTLET = 95.72 INVERT OF BUNG EPTIC TANK ~ %-INVERT OF BUNG AT INLET = 93.27 i AT OUTLET = 92.95 GARNESS ENGI'NEE'RING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS 3701 E. ~R RO~, SUG 101 * ~CHO~GE, ~ 99~7 * PHONE (~7)537-6179 * F~ (907)3~-32~ * ~S~: www.games~ngineedng.com PREPARED FOR: I PHONE NUMBER: PAGE NUMBER: GLENN ARMSTRONG J C/O AGENT $ OF 3 LEGAL DESCRIPTION: DRAWN BY: CONIFER HEIGHTS; BLOCK 1, LOT 12 PNB ~PE OF WORK: DATE: PROFILE AS-BUILT DRAWING 9/21/11 (Rev. 01/05) erness., 14 13N 17811' S78° 09' 10 `N 10' DTII ESM W A �n N . \ CAR1' PORT EXISTING 4 HOUSE M � WELL IN ego SLOPE ESMT OQ ©O 99' ! 190 / r UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. LOT SURWY _,._.SURVEY TYPE MMEA,S-BULT SYMBOLS ❑ FmAL S7nocru tE AS -BUILT ° SET REBAR DRAINAGE ASPHALT o FOUND REBAR PLOT PiJW AS-8UK? ...LOT SU'RVFY ... TOPOGRAPHY 'e---9 9 WOOD FENCE •..: CONCRETE PLOT PLANS & LOT SURVEYS IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. fiiiRVFY r'.i+RTFirA'nt)N PLOT PLAN I h -by aw" wa i hdr " I+, ft Ofwy14 &W10t ' , and dmm 6w , I ww Ymt I No" hrM a wtdmym/ i d wo lot o mm arw01«9ny. rWo smbMrrd„,.my b.. mwwM rr. aro °°met FOUNDATION AS -BUILT i. Row L JOM x. Im fty domry ” I h°n. A.-elrt d ew en tnm lat w tMt�i lee a►T.edsm ad hAr�mYen er sheen hrem FINAL STRUCTURE AS-81.1111LT 6 R°bwt L mm x, hereby "my owt I have nwtanw .� h-ault r.ry d 1M we Inm wd no wwoeowmf2 *AK mor *m ettrrde6. 00 Q ASSUMED ELEV. *--*-X METAL FENCE ® WOOD DECK NOTE: ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. Prepared by Robert E. Johns, Jr. & Assoc. Professional Land Surveyors 1700 Brink Drive. ANCHORAGE, ALASKA 99504 Scale: 1" = 40' Rec. Lot S.F. Rat. Plat Fite No. Dote Surveyed: 9/20/11 Drown by. REJ �`a"d bIMK Date Drawn: Grid: W.O. 9/20/11 2440 11-328 Legal Description: LOT 12 BLOCK 1 CONIFER HEIGHTS Permit Number: Tax Code Number: Work Type: On-Site Wastewater Disposal System Permit OSPl11253 015O934800O Septic MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Upgrade Permit Effective Dates: September 16, 2011 to September 15, 2012 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: CONIFER HEIGHTS Site Legal Address: CONIFER HEIGHTS BLK 1 LT 12 G:2440 Owner/Address: ARMSTRONG GLENN & J 2201 OTTER ST ANCHORAGE AK 995040000 [) e l) a r t m e ~ t Site Mailing Address: 7755 PORT ORFORD DR, Anchorage Lot Size in Sq Ft: 32290 Total Bedrooms: 4 This permit is for the construction of: N Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Issued By: . //O" c.~~, ~ /~.~_-~z~.~_~ Date: MUNICIPALITY OF ANCHORAGE Community Development Department Development Services On-Site Water &,.Wastewater Program HI Mayor Dan Sullivan R U S i: On-Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 015-09,3-48 Property owner(s) GLENN ARMSTRONG Mailing address 7755 PORT ORFORD *ANCHORAGE, AK 99507 Phone: 907-343-7904 Fax: 907- 343-7997 .4¸ Day phone C/O AGENT Site address 7755 PORT ORFORD *ANCHORAGE, AK 99507 Legal description (Sub'd, Block& Lot)CONIFER HEIGHTS; BLOCK 1, LOT Legal description (Township, Section & Range) Lot Size Sq. Ft. Number of Bedrooms 12 THIS N/A THIS APPLICATION IS FOR: ( [] all that apply) Absorption Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage [] THIS APPLICATION IS AN: Initial [] Upgrade [] Renewal [] APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) ..... .'~ D~,'*'~.c~"'~-~'~ Waiver Fees: Permit/Rush Fees: Date of Payment: ,, '- '- ~ Date of Payment: Receipt Number: Gl; ', ~_~.---t'; ~--~ Receipt Number: Permit No. ' ~-' ~ ~ ~'-')'-L~ ~_3 Waiver No. (Rev. 01/11) GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS September 14, 2011 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Proposed Septic Tank Upgrade for Conifer Heights; Lot 12, Block 1, To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The septic tank (installed 1979) is badly corroded and needs to be replaced. We are proposing to pump and remove the existing septic tank and replace is with a new 1250 gallon septic tank in the same location. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any q/p/e~stions, please contact us at 337-6179. Thank you for your assistance. Sincerely, Pre~d~ff/f NOTE: ,4ttached is a site plan drawing and a design drawing, which are all part of the design package for this septic system. (Contact G.E.G. Ltd. for 7page construction specification letter.) 3701 E. Tudor Road, Suite I01 * Anchorage, AK 99507-1259 Ph: (907)337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com TANK UPGRADE WELL ON FAR NORTH END OF PROPERTY (NO CONC~Eg~) ~ DRAINFIELD INSTALL DOUBLE CLEANOUTS - SEPTIC TANK. EXISTING 1250 GALLON~ SEPTIC TANK TO BE PUMPED ~'- C 0 M PL-J~TELt--REMDVED AND REPLACED WITH A NE~ 1250 GALLON SEPTIC TANK. EXISTING 4 BEDROOM HOUSE ~ELL ON FAR EAST END OF PROPERTY (N~CONCERN) SCALE: 1"=50' GAR'NESS ENGINEERI'NG GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 * PHONE (907)537-6179 * FAX (907)538-3246 * WEI~SITE: www.gemessengineering.com PREPARED FOR: GLENN ARMSTRONG IPHONE NUMBER: C/O AGENT LEGAL DESCRIPTION: CONIFER HEIGHTS; BLOCK 1, LOT 12 PAGE NUMBER: 1 OF 1 DRAWN BY: DATE: P N B 9/~ 4/~ ~ TYPE OF WORK: SEPTIC TANK UPGRADE DESIGN (Rev. 01/05) A: 'GmPness ' i~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISI ON 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT I 3 ? q -/~(~("/ [] UPGRADE MAI LI N't3~ D DR ESS ""~ ~;~ 3('O ~ LEGAL DESCRIPTION U~ DISTANCE T lO ]~ , Dwelling ~Z Manufacturer Uateri~ ~ ~ ~ ~ G ¢< ~ ~ ~o. o, ~o~,,~t, Liq. capacity~n~altons I nsid~ngth Width Liquid de~ /~ ~O IF HOMEMADE: , Well Dwelling PERMIT NO. 9 ~ ~ ~,s~.c. ~o: ~ ~,n~,..tu,e~ ~ ~~~~~~t~o~ Q~ DISTANCE TO: Well ~ [O~ Foundation ~ ~0 Nearest lot line ~Q~ Top of tile to finish grade ~ j Material beneath tile ~inches~ Total effective ab~r~t~n area Length 'Width Depth PERMIT NO. ~ DI~NCE TO: -~ding fou~/ m Nearest lot line ~ ~ CJa~ Depth Driller Distance to 1o~ ~ne PERMIT NO.~ ~ DISTANCE TO: Building foundation~ ~ Sewer line ~ Septic tank (~ Absorptionarea(s)~[~ 0 OTHER PIPE MATERIALS SOIL TEST RATING / ~ U ~~ ' - INSTALLER ~ REMARKS ~-~ l~ ; ~' · V~t~, ,~r~F ~00 APPROVED DATE LEGAL 72-013 (Re~ 0 0 0 0 0 0 0 © 0 0 0 0 PERN ] 'T' NO. APPL. I CHN"F LOCRT I ON L. EGRL GLENN RRNSTRONG PORT OXFORD LT. 12BK. t CONIFER 4~ BOWLING #i LOT SIZE 272-i08Z 4~000 SQURRE FEET TYPE OF SOIL 8BSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RBTING (SQ F'T'/BR)= 225 THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: [::,E F' T'H= 21_ ;:.2~ LENGTH= 5'7 G R R',.,' F..~ L- I)E:F'TH= 8 ]"HE LENGTH DIMENSION IS THE LENGTH (IN FEET) ~TRENCH OR DRRINFIEL[:,. THE DEF'TH OF R TRENCH ':]R PIT I~ THE D[STRNCE _~ETWE~ THE SUR. FRCE C,F THE GROUND RND THE BOTTON OF ,THE EXC:RVRT[ON THERE IS NO SE'r W~BTH FOE. TRENCHES. THE GRRVEL DEPTH IS THE MINIMI_Ibl DEPTH OF GRR~ ~L 8ET~EN THE OLITFRLL PIPE RND THE BOTTOM OF THE EXC~¢RTION <IN FEE~. ......... F RC:K:~G~ P~RNT ~'~ Z CIf~ ....... R PRC:KRGE PLRNT blRV BE [NSTRL~ED ~ TH~ PER~ZTT~"S OFT]ON SUBJECT TO THE FOI_LONING CONDITZONS: / ~ ~ ~. EITHER R CLRSS~ ClR [[IN~F R~EIVED~:~RNT ~RY BE ]NSTRLLED. 2. R C:CNTINLIOUS M~NTENR~E RGREEMENT': Z5 REQU[REB. ZF R MRZNTENRNCE RGREEMENT IS N~ KEF'T ~:URRENT Y~f'MRY BE REQU]RED TO ENLRRGE THE SOIL RBSORPTZON S'¢S~M RND~R VOU.,~Y BE SUBJECT TO PROSECLIT[ON ........... ...... _ .............. BRC:KFIt_LING OF RNY SYSTEM N~IOLIT FZNRL INSPECTION RND RPPROVRL BY THZS DEF'RRTMENT NZLL BE SUBJECT TO PROSECUT[ON ,- ' '- - ~" '~-' .... I S MINIMIJM DI.C;TRNC:E BETWEEN 8 NELL RNB RN'~ ON-SITE SEWRGE DI~,PJ=,ML- :100 FEET FOR R PRIVRTE NELL OR 200 FEET. FOR R PUBLIC WEL. I .... WELL LOGS RRE REL4UIF..EI.. RN[:, MUST BE RETURNED TO THE BEPRRTMENT WITHIN 2:0 E:,RYC; OF THE NELL COhlPL. ETION. O]"HER REli~I.IIF..EIIEN[=,'"'""" ..... ~ MRY RPPLY. SPECIFICRTIONS RND CONSTRLICTION DIRGRRM'~.. _ ARE: RVRILRE:LE TO INSUR. E PROPER INSTRLLRTION. F" ET: F-:r-1 ][ 'T EXP I RES [:~ECEMBER ~i., -1_977 I CERTIFY THRT i' I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RN[:, WELLS RS _,ET FORTH B"r' THE MUNICIPRLI"I"Y OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. 2c: I UNDERSTRND "I"HF~T THE ON-SITE SEWER SMSTEM MR"r' REf~UIRE ENLRRGEMENT IfF THE RESIDENCE IS REMODEL. ED TO INCLUDE MORE THRN 4 BEDROOMS. '-' ",', · -:-" i?--- '~'-~--'--- '"- --- F~r.l F .~LE. V2:. 0 ~uly 8~ 1977 476274 ~r. Glenn Armstrong 433 DowlLng Road %1 Anohorage, Alaska 99502 SubJ~t 8 Permit ~xpiration Dear Mr. Armstrong= A permit issued by this department for well and/or on-site sewer installation on Lot 12 Blook I Conifer Heights Subdivision has expired sinoe the issue date exceeds one (1) year. In the event you still plan to install the well and/or em-site sewer system, a new permit is required. The original soil test may be used to obtain a ourrent permit. I~ the well has been drilled, a well log should be sent to this department to document the installation date. If you have any questions regarding the above matter, please do not hesitate to =ontaot this office immediately at 2?9- 2511~ extension 224 or 225. Sincerely, L~s N. Buchholz, LNB.lJh F'ERMIT NO. r,ll._l~q Il::[ F"RLZI-"~ ~:)F DEPRRTMENT OF HERLTH RND ENVIRONMENTRL PROTECTION 25t0 E. TUDOR RD.~ RNCHORRGE~ RK. 9950? 276-2221 L-JELL ANE:. ON--$; ~TE ~;EL~EP-. F"EF:r"'I Z T' ('?~274) APPLICANT GLENN RRMSTRONG 42;-4: DowLII",IG RD #.1 272-108:':.': LL]CFIT T ON F;~DRT CO<FORD DF.: '" LEGFIL Lt2 B':L r":ONTFER HGTg ,LOT ':;IZE 4~:0E~7~ '--,PLIFIRE FEET "I"'T'PE OF SOIL RBE;ORBT!ON SYSTEM IS. TRENCH hlR;:.:;lh'llJM NIJMBER I"',F BEDROOMS= 4 '_~IIJ\R~TI~G ..'.SI,, FT/BR)= 225 THE REQI..IIREE:, SIZE ,:IF THE SOIL FIBSO.B~TION-- -- --- ' 'S~TEM"~_~;: E:. E F'-IF H = 2L2 LENGTH= '~\57, I3~r-~" R %¢'~EE L DEPTH= -'E: THE I.~EI'..4, GTH D z MENS I O1'.,i ! S THE LENGT~ <~..EET) OF THE T~ENCH OR DRI.R INF I ELD. THF DEFTH OF R TRENCH OR PIT IS THE DIS'I~I'.,ICE BETWEEN THE SURFRCE OF THE GRF, UI'..ID RND THE BOTTOM OF' THE ECI=pCFfTION ,.'2~N FEET.'.,. THE GF..FIk, EL DEFTH I.~THE !.~:I'NIMU~ DEPT~xOF G~FI"¢EL BETWEEN THE AIITFI.RLL F:'IPE ..L.n==, I O1~.'~ II NSF RPPROVE;[:, PLRNT MFIY BE INSTRLLED. ~ r-:ONT:I:NUOUS MRINTEI'.,I~',tCE RGREEMENT IS REQUIRED. IF R MRINTENRNCE Rr~RFEMEI'.IT IS NOT I<EPT :CURRENT YOU I',11~¢ BE REQUIRED TO ENLFIRGE THE SOIL IRE~'::;ORPTION SYSTEM I=IND,,-OR?oU I',IFIY BE....~UB..'rECT TO PROSECUTION. IF." R CLFr'SS I SYSTEM z'-.'; LIsEE:', THE LEI'.,IG'~H IS 40:..0 FEET. IF Ft CLI.RSS l'i SYSTEM :I:S USED 'TH~TH !S 5z. O FEET. BFIE:KFILLIr.~G OF RNY SYSTEbl WITHOUT FINFIL INSPECTION FIND RPPROVRL BY THIS E:,EPRR'T'MENI" 14ILL BE SUB...TECT TO PROSECUTION. MINIMLIM DISTRNCE BETWEEN R WELL RND ANY ON-SITE SEWRGE DISPOSRL SYSTEM IS t00 FEET FOR R PRIVRTE WELL OR 200 FEET FOR 8 PUBLIC WELL, WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS OF'THE WELL COMPLETION. SPECIFICATIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. I CERTIF'Y THRT t: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLITY OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. ~: I UNDERS'¥RND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. S t G NE B,: GRE, ~r ANCHORAGE AREA BO~ Ugh DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONiE Z74-456 I SEWAGE DISPOSAL/SYSTEM -- APPLICATION AND PERMIT PERMIT NO. NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS SEEPAGE PIT COMPLETION DATE ANTICIPATED DRAIN FIELD OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUI ;TEM WITHOUT FINAL INSPECTION BY THE PROSECUTION. SEPTIC TANK SIZE }~ ~ TYPE MINIMUM DISTANCES, REQUIREMENTS / FOUNDATION TO SEEPAGE~PJ-T~ , DRAIN F SEPTIC TANK TO SEEPAGE Pit WALL SEPTIC TANK .~/ $ EEPAGE~ TO NEAREST LOT LINE. WELL TO SEPTIC TANK // ~ DRAIN FIELD // ~ ~ WATER MAIN TO SEPTIC TANK DRAIN FIELD/~ ~ SEPTIC TANK, /~/ ~ SEEPAGE~ TO RIVER, LAKE, STREAM. SEEPAGE ALSO CONSIDeR~R.EA WELLS. SEEPAGE , DRAIN FIELD 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. G ,A .A .B, OR LICENSED DESIGNER AREA SIZE /) ' / / T~(PE U ~' DIAGRAM OF SYSTEM~//~',=,,~/ I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE ~ ,, - S()II,S 1,()(i -- PEI{OI,ATION TEST Performed for k, o !;' .~ ', - ~ This form reports' Soils log_~. Percolation ..),~te Perform,,,d 2-/~s "')~ Lest Dep th Feet 3- 5- 6- 7 - GREATER ANCtlOI<t\GL AkLA UOR()UGtl Department of [nvironmeri~al ()uality 3330 "C" Street Anchorage, Alaska 99503 9 10- ll - 12 - 13- Was ground water encountered? /~'~ If yes, at wi~a~ depth? Reading Date Gross Time Net Time Depth to Water Net Urop Percolation ra~e minute. -Proposed installa~-T~'n" Seepage Pit Drain Fie)d Depth of Inlet .......... · Deptfi t-6'-b~-t~-~-*o~F-pit or trenci. ~o~.~.. ...... ~---i_-;-~i~;;~-~--ii--~.-'-' ....... _ ......................................... . ....... H\L Hidden Lake Area Reference Map-P12 12 160 ~67 176 161 ' MUNICIPALITY OF ANCHORAGE DEPT. Oh: ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOrr~VIR©NM~-NTAL p,,.©TECTION ~.; ~% 825 L Street- Anchorage, Alaska 99501 kk~ ! ~d// ENVIRONMENTAL ENGINEERING DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requ~ will not be processed. Please allow ten (10) days for processing. 1. PRDPERTYOWN~ ~ / . ~ ~ PHONE MAILING ADDRE~ ~ ~ r ~/ ~ ~// / P ROPERTYRESIDENT(Ifdifferentfromab°ve)~ ~ ~ ~ ~/~ ~(~ 2. BUYER ~ PHONE MAILING ADDRESS 3. LENDING INSTITUTION/ ~ [ / MAILING ADDRESS · ~ / / ' ' MAI LING ADDRESS B, LEGAL DESCRIPTION LaY-/z 6. TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY NUMBER OF BEDROOMS [] One [] Four [] [] Two [] Five  Three [] Six Other INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE**' [] PUBLIC UTILITY * ATTACH WE LL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) **If individual/on-site, give installation date ~ -//~4~''~ 2~. If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY TIME DATE INSPECTION APPOINTMENTS TIME DATE DATE RECEIVED TIME DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX [] OTHER 2. WATER SUPPLY [] INDIVIDUAL [] COM'MUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or i-]Holding Tank Size: /o~..~--b If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATEINSTALLED INSTALLER SOILS RATING MANUFACTURER MATERIAL 'Septic/H°ldingTank IAbs°r i Area?~;3 ~/t~ ISewerLine INearest Lot Line 5. COMMENTS DATE ILEGAL DESCRIPTION APPROVED FOR ~ BEDROOMS '-I CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED I BY (Title) ~~)~ 72-010 (Rev. 3/78) August 13, 1979 Glenn/Juliana Armstrong 7636 Arctic Boulevard ~4 Anchorage, Alaska 99502 SubJeot~ Lot 12 Block 1 Conifer Heights Subdivision Approval for your individual sewer and water facilities can not be spanted until the following items shave been completed: ~.~..AA well log submitted to this department. (2)/The sanitary seal on the well casing is tightened ~~/and re-inspected by this department. (3) The water analysts report be delivered to this office from ChemLab, 5633 B Street, for our review. Please notify this department for a re-inspection when the noted descrepancy has been corrected. If there are any further questions, please uontact this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/lJw First Federal Savings at%d Loan Association Post Office Box 4-2200 99509 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-093-48-000 Expiration Date: 9/8/2023 Legal description CONIFER HEIGHTS BLK 1 LT 12 Site address 7755 PORT ORFORD DR Anchorage AK 99507 Current property owner(s) SMITH MICHAEL L & MONICA M 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: 6/8/2023 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 Approval June 2022 MUMCWALITY OF ANCHORAGE Development Services Department'.1; P� Phone: 907-343-7904 On -Site Water & Wastewater'�ection Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-093-48 Complete legal description CONIFER HEIGHTS; BLOCK 1, LOT 12 Location (site address) 7755 PORT ORFORD DRIVE *ANCHORAGE, AK Current property owner(s) MICHAEL SMITH 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 907-947-2300 3. TYPE OF WATER SUPPLY: M 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: FE -1 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: N Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 12 - 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 $ �/ �/ Waiver Fee $ Date of Payment _ 6l �l Z�j Date of Payment COSA # U C_ Z (Sj L Waiver # COSAAppllnUon_June 2022 Legal Description: CONIFER HEIGHTS; BLOCK 1, LOT 12 Parcel ID: 015-093-48 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 6/13/79 Total depth 250 ft Cased to LINK ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in Date of flow test for COSA 5/26/23 Static water level at beginning of test 230 ft Comments B. TANK DATA Measured operating fluid level in septic tank 50.5 Date of pumping _, [ ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 1979 ❑ ALL standpipes present per record drawing Total measured depth from grade 11.25 ft (max) Measured depth to pipe invert from grade "3.31 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) NO If yes, enter date - Well production at time of test 3.1+ 9Pm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 6.39 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG Date 5/11/2023 C. LIFT STATION ❑ Required maintenance co Age of lift station years Lift statio erial Adequacy test date 5/26/2023 Results ❑ Pass Fluid depth prior to test 33.5 in Water added 773 gal New fluid depth 65.5 in Elapsed time 130 min Final fluid depth 60.5 in Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 96 in Effective depth used 60.5 in Effective depth remaining 35.5 in Comments/Deficiencies: 'SUMP - EXTENDS APPROXIMATLEY 8.3 FEET BELOW THE INVERT OF THE DISTRIBUTION LINE COSA Checklist June 2022 K1 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Yes if No Community Sewer Manhole/Cleanout > 100' Yes if No ft ❑■ Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' [O]Yes if No ft Absorption Field on Lot > 100' Pm� Yes if No ft Holding Tank > 100' W Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' g Yes if No ft 0 Yes if No ft ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' QYes if No ft F2] 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' Yes if No ft Surface Water > 100' Q Yes if No ft Tank to Property Line > 5' 0 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' no Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' M 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 Garness Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Garness Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry o060� 4 practices. The reported results describe the condition of the system/s on the date/s of the evaluation. y OF Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend o ` . • S��O upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing �:' L4 T �* the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not • ...: • • • • • • • • • • • • . • • • . • . . guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding i the future performance of the well or septic system. GEG makes no representation whether an alternative well .............. i or septic system can be installed on the property in the event either of the current systems fail to perform y A. Gorn s.- G adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG �Q' — 7953 to perform the evaluation. Reliance upon the information provided in this report by any other person or party N ;0�0 (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. �e^ed \ F o0 COSA Checklist June 2022 #AECC 8444����O��Q� 14 13P S78' 09' 0101 10' U(tLESMT� \ 1�CAR _ �' .-..•.•... a . PORT EXISTING HOUSE 3 N ti 6...•........ Z1� MWPNWW tie an.-WIftL4 JN.� Air Y 0 g �O / I � r QO UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING, REPRODUCTION MAY CAUSE ERRORS IN SCALE, LOT suR>EY _ �URVEY TYPE F6LN3A As_BunT 4:zYM80l S FINAL STRVCTuftC As-WLT PLOT PLAN . , . AS-WLT ... LOT 9AVEY , .. TOPOGRAPHY 11 to iHt. I"C"'UNSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. SURVEY CERTIFICA110N PLOT PLAN ti 6...•........ a on Mro,��ppFrapyn�7�eM to the bw of my haw Oemt MWPNWW tie an.-WIftL4 JN.� Air Y Aff FOUNDAMM AS-BWLT �. 1. Aabat E -Wm k im y drtTy Mit 1 - • .... WELL IN jog SLOPE ESMT '0 dev Innatfw ohn. "fte4lrnma mm odea FINAL STRUCTURE AS-BULLT 0 �O < 0 g �O / I � r QO UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING, REPRODUCTION MAY CAUSE ERRORS IN SCALE, LOT suR>EY _ �URVEY TYPE F6LN3A As_BunT 4:zYM80l S FINAL STRVCTuftC As-WLT PLOT PLAN . , . AS-WLT ... LOT 9AVEY , .. TOPOGRAPHY 11 to iHt. I"C"'UNSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. SURVEY CERTIFICA110N PLOT PLAN haw fewf o< SPI.W .f d yew bbtt oo rs t�owr a on Mro,��ppFrapyn�7�eM to the bw of my haw Oemt MWPNWW tie an.-WIftL4 JN.� Air Y Aff FOUNDAMM AS-BWLT �. 1. Aabat E -Wm k im y drtTy Mit 1 Naw Prk4mod an A+-Oilrx M tre ku dWmm on tris mood ontt me dhmukme and nbmwo m s dw tw.oe '0 dev Innatfw ohn. "fte4lrnma mm odea FINAL STRUCTURE AS-BULLT 0 �O < L Rabat C Joke Jr: hmrby orWy tht 1 hew Pararmee .n A. -$opt ywy of Mo 1 vkwctwv and. ttrA and that to fmi dha.rr,. and fitarm um .. Amm luso ars on are ea aw"MWASts amt w.a amw a 4121-/S 4.4 rlw°fesslonat �®���� a SET RE8AR DRAINAGE fD ASPHALT 0 FOUND REBAR -9 9 e 5Y0OD FENCE CONCRETE 00 Q ASSUMED ELEV, x- x x METAL FENCE ® WOOD DECK NOTE: ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE SHOWN, FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED, Prepared by Robert E. Johns, Jr. & Assoc. Professional Land Surveyors 1700 Brink Drive. ANCHORAGE, ALASKA 99504 Scale: tt M 40' Rec. Lot S.F. Rea. Plot nlle No. Dote Surveyed: 9/20/11 Drawn by. RE t Checked byn�K Date Drawn: 9/20/1 Grid: 2G�1 440 W.O. 11-3-3 28 Legal Description: LOT 12 BLOCK 1 CONIFER HEIGHTS www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OCS231182 Subdivision: Conifer Heights, Block: 1, Lot: 12 A water sample revealed a nitrate concentration of 6.39 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 P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org L v�. 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 � Box 196650 *Anchorage, Alaska 99519 6650 *www mum org CERTIFICATE Municipality of Anchorage Development Services Department · Building Safety Division ! On-Ske Water & Wastewater Program 4700 Elmore Road An c h ~a~eB, ~XK1999656~90~6650 www.mun oorg/ons ~e (907) 343-7904 OF ON SITE SYSTEIv1S APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-095-48 1. GENERA~L INFORMATION Expiration Date: 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; BLOCK 1, LOT 12 7755 PORT ORFORD DRIVE * ANCHORAGE, AK * 99507 GLENN ARMSTRONG Day phone C/O 7755 PORT ORFORD DRIVE * ANCHORAGE, AK * 99507 Day phone AGENT BARBARA MICHELSOHN W/ PRUDENTIAL Day phone 250-5577 3801 CENTERPOINT DRIVE, #200 * ANCHORAGE, AK * 99505 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. ~. STATEMENT OF ~NSPECTION BY ENG!NEER W~iu~.u. date shown be/ow, I verifyL,'"~',~, my' As ce~ified by my ~e~l ~.~xed hereto investigation, based On procedures ou~iined in the CeCil/cate of On-Site Systems Approval Guidelines ~or this appfication, shows tha~ ~h~ on-s~e water supply an~/or..~,~,~.'a'~-~'~*~r _,~;~nn.~! ...... .system is ~(are).~ .~afe,_ . functional and a~q,.~. for the number of bedrooms and type of structure indicated herein. I fu~,~er venfy . ~a. ba~ on ~he information~b.a,n~ ~ ~ ..... ~ ¢'~m t.he.M,.~,,n¢~ip*#ty,~, . ,. ~,~¢4-*~,*~¢..,,.~,,~, ~=~ .................. ¢u¢~ and ~.om my,,¢~,,¢ ~*~¢~",. ~..=-., ~,, ~,~d, in~p¢**i~% on-site water suppl7 and/or wastewater disposal system is(oro) in compfiance ~/tD afl applicable Munidpal ~ Stero co~es, or~i~onces~ ~ re~lo~ions [n effoct ~ ~o Nme o~ instoll~tion. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 557-6179 Address 5701 Eo 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 engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational.life of 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 t,ffe 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 fight whatsoever. DSD SIGNATURE ~"" Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: COSA Checklist Septic System Adviso,~.' Well Flow Advisory Nitrate Advisony (Rev. 1 ~/05) Arsenic Advisory. Maintenance Agreements Supplemental Engineer's Report ~mer Original Certificate Date:_ q Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Date completed 6/13/1979 Total depth 350 ft. Date of test Static water level Well production 3 WATER SAMPLE RESULTS: Coliform (~ colonies/100 mi. Arsenic: tJl~ ug./L. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size 1250 gal.. Sanitary seal (Y/N) YES Cased to *40+ ft. FROM WELL LOG 6/15/1979 250 ft. g.p.m. Nitrate ~-,i°~ mc.IL. Date of sample: SEPTIC/STEEL Number of Compartments Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 8/10/2011 2.39 ft. 3.68+ g.p.m. YES 12+ in. Collected by: GEG, Ltd. 2 Date installed 9/16/11 Cleanouts (Y/N) YES Foundation deanout (Y/N) YES Date of pumping NEW ABSORPTION FIELD DATA Date installed 6/15/1979 Length Depression over tank (Y/N) NO Pumper I. BELOW EXISTING GRADEI Soil rating (g.p.d./ft2or~ 225 High water alarm (Y/N) N/A 57 ft. Width 5 ft. Total depth '11.3 ft. Eft. absorption area 912 ft2 Monitoring tube YES Date of adequacy test 8/10/2011 Results (Pass/Fail) PASS Fluid depth in absorption field before test 0 in. Water added 605 gal. Elapsed Time: 130 min. Final fluid depth 16 Any rejuvenation treatment (past 12 mo.) (YIN & type) System type TRENCH Gravel below pipe 8 ft. Depression over field NO For 4 bedrooms New depth 24 in. in. Absorption rate >= 600+ g.p.d. NONE KNOWN If yes, give date - CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: CONIFER HEIGHTS S/D; BLOCK 1, LOT 12 Parcel ID: 015-095-48 WELL DATA *ASSUMED BASED UPON SURROUNDING WELL LOGS. SEE ATTACHED. Well type PRIVATE IfA, B, or C provide PWSID# N/A Well Log (Y/N) YES D. LIFT STATION Date installed Size in gallons ~ ~ "Pump on" level at in. =~~~~;1~~ High water_alarm level at ~ in, ~ Cycles tasted Meets alarm & circuit requirements? SEPARATION DISTANCES 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'+ On adjacent lots 100' + On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A 100'+ Building foundation Water main Wells on adjacent lots SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 5' + Property line 5' + Absorption field N/A Water service line 10' + Surface water. 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ 0 14' Water service line 1 0'+ Curtain drain NONE KNOWN .5'+ 100'+ Building foundation 10'+ Surface water 100'+ Wells on adjacent lots 100'+ Water main N/A Driveway, parking/vehicle storage 10'+ F. COMMENTS NOTE: HOUSE WAS VACANT AT TIME OF TEST, LESS THAN 60 DAYS. G. ENGINEER"S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date ~'/Z']I/ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number UND~ NO ~RCUMST~S ~ AN AS-BUILT BE U~D FOR c~smuc~ ~ F~ ESTABESHINa BOUND~Y ~ ~ MNES. ~E ~R~Y~ TAKES ~ONaaU~ F~ ~E INI~AL m~SAC~ON ~LY ~D ASSU~ES RNANC~AL UABlU~ ONLY FOR ~E COST OF ~E ~R~Y. ES~ DISTAN~S PREVNL O~R SC~NG. REPR~UC~ON MAY CAU~ ERR~S IN SCA~. O~ ~ S~Y ~E SYMBOLS ~ RN~ ~ A~LT ~ PLOT ~ . . . ~LT... ~T ~... ~y O F~ND R~AR ~ ~ ~ ~OD ~NCE ~ C~E~ ~ A~LT...NO~T~ ~A~ AS-~T...NO~S~T ~ A~ED ~V. % % % METAL ~NCE ~ ~ DECK PLOT PLANS · LOT SUR~YS NOTE: IT (S ~E RESPONSIBILI~ OF ~E BUILOER OR O~ER, PRIOR TO ONLY ~OSE IMPRO~MEN~ ABO~ GROUND AND ~SlBLE CONS~UC~, TO ~RIFY PROPOSED BUILDING GRADE RELA~ SHO~. FENCES, ~, SEP~C CLEANOUTS, SIDEWAYS. TO FINISHED GR~E AND U~LI~ CONNEC~ONS AND TO DE~RMINE ETC.. ARE SHO~ IN ~EIR APPROXIMA~ LOCA~ON, ONLY. SNOW ~E EXIS~NCE ~ ANY EASEMENt, CO~NANTS OR RES~IC~ONS MAY PRE~NT SOME IMPRO~MENTS FROM BEING SKIN AND LOCA~O. ~tCH DO NOT APPEAR ON ~E RECORDED SUBDI~SION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHER~SE NOTED. SuRlY CER~FICA~ON _~.~~ Prepored by ..... Robert E. Johns, Jr. & Assoc. '~,~'~"~~. ~ ~ ~. ~,~ ..... ' '~ee Professional Land Surveyors ~,~ ,s~ ' ...... ~-. ... 1" = 40' ~~~:- 9/20/11 REJ ~ ~ 9/20/11 2440 11-328 RN~ S~UC~ ~T~--~~ --A~ . ~-~-~'~ vo~~ ................ ~-~ ~ - -,- - - - - ,~ % ~ . LOT 12 BLOCK 1 ~ ~ ..~**- CON IFER HEIGHTS SGS Ref.# 1114366001 Client Name Garness Engineering Group, Ltd Printed Date/Time 09/15/2011 16:15 Project Name/# Conifer Hts L12 B1 Collected Date/Time 09/09/2011 14:15 Client Sample ID Conifer Hts L12 B1 Received Date/Time 09/09/2011 15:10 Matrix Drinking Water Technical Director Stel~hen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Hardness as CaCO3 128 5.00 mg/L SM20 2340B C 09/09/11 09/13/11 NRB Waters Department TotalNitrate/Nitrite-N 2.19 0.100 mg/L SM20 4500NO3-F B 09/12/11 AYC Microbiology Laboratory E. Coli Negative 1 100mL SM20 9223B A 09/09/11 CR Total Coliform Nelzative I 100mL SM20 9223B A 09/09/11 CR Private Individual Analysis Alkalinity 136 10.0 mg/L SM20 2320B D 09/09/1 Aluminum ND 20.0 ug/L EP200.8 C 09/09/11 09/13/1 Antimony 1.96 1.00 ug/L EP200.8 C (<6) 09/09/11 09/13/1 Barium 35.4 3.00 ugFb EP200.8 C (<2000) 09/09/11 09/13/1 Cadmium 1.03 0.500 ug/L EP200.8 C (<5) 09/09/11 09/13/1 Calcium 40000 500 ug/L EP200.8 C 09/09/11 09/13/1 Chloride 9.56 0.100 mg/L EPA 300.0 D (<250) 09/10/11 09/11/1 Chromium ND 2.00 ug/L EP200.8 C (<100) 09/09/11 09/13/1 CO3 Alkalinity ND 10.0 mg/L SM20 2320B D 09/09/1 Conductivity 369 1.00 umhos/cm SM20 2510B D 09/09/1 Copper 251 1.00 ug/L EP200.8 C (<1300) 09/09/11 09/13/1 Fluoride 0.148 0.100 mg/L EPA 300.0 D (<2) 09/10/11 09/I 1/1 HCO3 Alkalinity 136 10.0 mg/L SM20 2320B D 09/09/1 Iron ND 250 ug/L EP200.8 C (<300) 09/09/11 09/13/1 Lead 5.29 0.200 ug/L EP200.8 C (<15) 09/09/11 09/13/1 1 ACF NRB NRB NRB NRB NRB SDP NRB I ACF ACF 1 NRB SDP I ACF 1 NRB 1 NRB SGS Ref.# 1114366001 Client Name Garness Engineering Group, Ltd Printed Date/Time 09/15/2011 16:15 Project Name/# Conifer Hts L12 B1 Collected Date/Time 09/09/2011 14:15 Client Sample ID Conifer Hts LI2 B1 Received Date/Time 09/09/2011 15:10 Matrix Drinking Water Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Private Individual Analysis Magnesium 6700 50.0 ug/L EP200.8 C 09/09/11 09/13/11 NRB Manganese 2.84 1.00 ug/L EP200.8 C (<50) 09/09/11 09/13/11 NRB Nickel ND 2.00 ug/L EP200.8 C (<100) 09/09/11 09/13/11 NRB OH Alkalinity ND 10.0 mg/L SM20 2320B D 09/09/11 ACF pH 8.00 0.100 pH units SM20 4500-H B D (6.5-8.5) 09/09/11 ACF Selenium ND 5.00 ug/L EP200.8 C (<50) 09/09/11 09/13/11 NRB Silver ND 1.00 ug/L EP200.8 C (<100) 09/09/11 09/13/11 NRB Sodium 21800 500 ug/L EP200.8 C (<250000) 09/09/11 09/13/11 NRB Sulfate 30.6 0.100 mg/L EPA 300.0 D (<250) 09/10/11 09/11/11 SDP Total Dissolved Solids 221 10.0 mg/L SM20 2540C D (<500) 09/14/11 AYC Zinc 657 5.00 ug/L EP200.8 C (<5000) 09/09/11 09/13/11 NRB Arsenic ND 5.00 ug/L EP200.8 C (<10) 09/09/11 09/13/11 NRB Thallium ND 1.00 ug/L EP200.8 C (<2) 09/09/11 09/13/11 NRB