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HomeMy WebLinkAboutCONIFER HEIGHTS BLK 1 LT 13A�k4'r WELL GRATER WELL LOG 1 1 FOSS DRILLING 1336 InSra Street Anchorages Alaska 99501 USE OF WELL DJ'YJP� SIZE OF CASING 6 " DEPTH OF HOLE�To CASED TO cZ&2 FT. STATIC WATER LEVEL AJ 0 FT. YIELD GAL o PER. MIN. WITH FEET OF DRAWDOWN. REMARKS DATE COMPLETED - /� - `',� PUMP TO BE SET AT� :Y--tozL 6 u�O d 6raj Pi I 2 ne- _RD t o r� .� �, Jc �n anr�Vg' /tav /d (7 t�Qv 0i CSV , 5_a. rJ �pDto ��b 4t o:;293 0- 0- 0- 0- 0- 0- 0 o Conifer Height lock I Lo1- 13A 015-093 -60 3 USANITTAL ncr a n �nf� Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page / of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: O'�>p 121 ZOO PID Number: U/S — Ogt 3 - 36o Dwelling: Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑ Upgrade Name: � k ABSORPTION FIELD V, c a .Deep Trench El Shallow Trench ❑Bed El Mound Address ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade r� �t Z GPD/SF Yr S Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Zr FL Gravel depth beneath pipe 610 Ft. SubdivisionII Block Lot C L) V1 N '�� ren ( t Fill added above original grade l O Ft Gravel length � Z Ft. Township Range Section Gravel width 'z-. 0 Ft. Beds: Number of Lines 1 Distance between lines — Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line & 2 j Ftp I--- Ft. Well `vQ' 1 /�ar� A W45 Jr,. TANK Septic ElS.T.E.P. El Holding [:1 Other T �h urer Manurezoe-(A �vh h Capacity /SUD Gal. Surface Water /�J � /Udt '�Nu Material r7 JL -re mber of compartments r, Lot Line 7-0 1� 7. 0 t4 NA Foundation ZvI�L Z�'� t LIFT STATION Manufacturer Capacity Gal. Curtain Drain�,� A Remarks ( {� O � �rTY�� \Jeivw. MrfStonz Pump on level at Pump off at in. High water alarm at in. Pump make a odel Electrical Inspections performed by Installer t I PIPE MATERIAL Housetotank _7103 f Tankto 3� drainfield ?iy //�� ` /��r ,�/�j ff--,, J'1frAR�/tJArI lYrb DN frt r Drainfleld 703 CO/MT 3!l °ref Inspector 1�1 ` j_ &r r lel Jet fAriAl ✓, Dr �^ BENCH MARK (Assumed elevation) /B P ft Inspection u dates: 7 /7—/`r 2' 7 /7 �!�/2_ Location and description 3" C70 a44- slob, COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Enginep�s� Stamp • �'' h Conditional Approval: Date ,� ��',��' a qA P ®^3�i. :MICHAEL N• ANDUSCN :tea t CE - Approved (i// Date1 / mspeuvn mepori a- i-iL.uW v 10 Permit No. OSP121200 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: CONIFER HEIGHTS BLK 1, LOT 13A PID No.: 015-093-36 BE CH, GARAGE 21 a8 - I I I I 51 MARK A 8 CO2 I C 60 FCO 10 45 C04 42 66 CO2 78 87 MT 60 EXISTING ANKS PUMPED AN CRUSHED \ \ \\\\ \ \ Co G 10 EXISTING WELL RADIUS A CO2 C01, 08 TC01 i� \ TCO2 �� B C04 �\ r � ` I r'--------- MT / \ / i C05 SBU T SCALE: 1"=30' FCD CDIrTC01 TCA3 C06 .P*7 OF . 1. IIII gD CO2 CO3 MT 5 C�� ♦ ♦. i1 \ i♦♦ ♦ ..��♦ •..♦ �jL-ice♦ i M I. 2' MULA ON p flLifR FPBNC F ♦ 49 IF ....• . ....... .um.........uu d.. i$ JG 01 95 1.500 GALLON STEEL TANK aw` va 9. ...................................•.� ������}}}}}}------ ��°.MICHAEL N. ANDERSON: �1� 9 t.. •♦♦��•_...... SEP11C SECTION SEPTIC `�• �• ♦ N.T.S. 21 a8 TC01 23 51 TCO2 28 58 CO2 32 60 CO3 33 61 C04 42 66 C05 78 87 MT 60 71 Permit Number: OSP121200 Tax Code Number: 01509360000 Work Type: Septic Permit Effective Dates: July 17, 2012 On-Site Wastewater Disposal System Permit 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 to July 17, 2013 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Subdivision: CONIFER HEIGHTS Site LegalAddress: CONIFER HEIGHTS BLK 1 LT 13A G:2440 Owner/Address: GRENDAHL D A LODGEPOLE COURT RESI TRUST 50% & GRENDAHL M J LODGEPOLE 7720 LODGE POLE CT ANCHORAGE AK 995076045 Site Mailing Address: 7720 LODGE POLE CT, Anchorage Lot Size in Sq Ft: 51263 Total Bedrooms: 5 This permit is for the construction of: Y Disposal Field Y Septic Tank 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. Received By: ~ ~ . Issued By: , _/~'~ MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On-Site Water & Wastewater Program Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Property owner(s) _[~ ~- ~¢¢'¢ ~ Mailing address ":~"~ ~-O Site address Legal description (Sub'd., Block & Lot) Cfc f~, ~,, Legal description (Township, Range & Section) Lot Size ~' I 7- fo ~ Sq. Ft. Number of Bedrooms t~'~C[ ~' ~ I Dayphone Phone: 907-343-7904 Fax: 907-343-7997 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 [] THIS 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. Permit/Rush Fees: Date of Payment: Receipt Number: Permit No. (Signature of property owner or authorized agent) ~,,0 ~'¢ I~ ~'W~ai~v'der' Fe es: ~/ I ~"/I ~ Date of Payment: / ~'~ _f-/~ (~/z2 Receipt Number: 0~,~ Pl,~/c~./~O Waiver No. G:\Building\On Site~Forms\Client Forms\Permit App_010411 .doc (Rev. 1/11 ) Michael N. Anderson, P.E. Civil/Structural Engineering & Construction 4661 Natrona Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 July 17, 2012 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Conifer Heights Blk 1 Lot 13A To Whom it may concern: This is an application for a new septic system upgrade on the above referenced lot. The current system is backing up into the house and needs replacement asap. The soils consist of sandy gravels with no water observed during or after the test hole excavation. The perc rate is 2 minutes per inch. The owners asked for a 5 bedroom system so a secondary trench has been shown on the site plan. There are no public or private wells within 200 feet of the proposed system location. There is neither surface water within 100 feet nor any known curtain drains within 50 feet of the proposed system. None of this development will have any adverse effect on the adjacent lots. If you have any question please call me at 727-8864. Sincerely Mich~/~d~son, p.E. Attachinents: Wastewater absorption system design and details DESIGN CRITERIA: , /~MOUND OVER 5 BDRM X 150 = 750 GPD ORO SOILS = 750/1.2 = 625 GPD -1.O_ t~_~ ~.-----~.L~TE~ FABRIC 625 GA/12 = 52' -3:o5: ~ ~4 ¢ PiPE ~S[WER ROCK (1) TRENCH sP/cP 9.0' DEEP 6.0' EFFECTIVE -s.o- -- 2.0' WIDE 12.0'1 52' LONG -18.o_ SEPTIC FIELD SECTION ~ VACANT /-- EXISTING WELL PARK /100' RADIUS, ~ LAND · ~ SEPTIC ! CONIFER HEIGHTS SUBDIVISION, BLOCK 1, LOT 13A Anchorage, Alaska ~'~MICHAEL N. ANDERSON/,~ Michael N. Anderson, P.E. DATE: 7/16/2012 ANCHORAGE, ALASKA 99516 .345-5577 / FAX: 345-1591 SCALE: 1"=100' / /-- EXISTING WELL T,~S g~ OWNEO ,/ ~ ~, ~5~ ~ ~NER OF ,' I / ~, ~N TA~ '' 2-~ xx~[ ~ 5 B[DROOM ~ W/ -. ....... SECONDARY ~ENCH 5-10~ DEBBY GRENDAHL CONIFER HEIGHTS SUBDIVISION, BLOCK ~, LOT 13A Anchorage, Alaska -,.,.,~, ............ ~, ...... e.....v..~.~f..J.;~ ................... :....~ ~UICHAEL N, ANDERSON]~-- Michoel N. Anderson, P.~. 9AT~: 7/~/20~2 4661NATRONA AVE. DRAWN: DJR ANCHORAGE, ALASKA 99516 545-5577 / FAX: 345-1391 SCALE: 1"=30' Pedormed For: Legal Description; 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 19- 20-i__ '...' w'~.v, ci.anchoraqe.ak.u_s ~; MICHAEL N. ANDERSON (907) 343-7904 ~,l ,~,' ·. CF - 9469 Soils Log - Percolation Test ~It?,~"- ...... '"~? ,'F, ~, I Date Performed: COMMENTS Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Slope t ! Township, Range, Section: Site Plan WAS GROUND WATER ~.( ENCOUNTERED? ~ S IF YES, AT WHAT DEPTH? L O Depth to Water After ~ Ep Monitoring? D~: ~/17 // ~-' Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER ~1~ TEST RUN BETWEEN ~,~ FT AND ~' FT PERFORMED BY: ~t~l ~ ~t~14. '~'/'~ rf [ CERTIFY THAT THIS TEST~WAS / PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES !N EFFECT ON THIS DATE. DATE: ~//'~,,/I '~__ GREI ER ANCHORAGE AREA BOR Department of Environmental Qualitv 3330 C Street Anchorage, Alaska gg§03 JGH INSPECTION NAME · -- _ LOCATION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL/~r¢ INSIDE LENGTH MANUFACTURER INSIDE WlD]-H /~ j~_ ,-~.. NUMBER OF ~.. MATERIAL I~, ,- ['~COMPART.~ME~NTS ,,~ LIQUID DEPTH I- LIQUID'CAPACIT~GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL /0£~)'"~' FOUNDATION /0/'~- ,, TOTAL LENGTH NEAREST LOT LINE /~ ~ OF LINES ~ ' NUMBER OF LINES ~ DISTANCE BETWEEN LINES ~/~ TRENCH WIDTH ~IN. TOTAL EFFECTIVE ABSORPTION AREA .~ ~ SQ. FT. LENGTH OF EACH LINE ~ ' DEPTH: TOP OF TILE TO FINISH GRADE ~ MATERIAL BENEATH TILE .~. ABOVE TILE IN. BU I LDI NG NEAR EST N EAR EST SEPT lC SEEPAGE FOUNDATION__ LOT LINE__, SEWER LINE TANK__ SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCE FROM: DISTANCES: INSTALLED BY:.~'~' SEWER LINE DEPTH: REMARKS: !.~'5'~ Form LQ-032 WATEH WELL LOG SIZE OF CA~ING ~ 3' DEPTH OF HOLE~. CA~ED TO J~ STATIC WATER LEVEL--FT. YIELDJ_~]/.&~zGAL.PER.MIN. WITH FEET OF DRAWDOWN. FOSS DRILLING 1336 Ingra Street Anchorage, Alaska 99501 USE OF WELL FT · REMARKS DATE COMPLETED , to to ,,to to GREA :r ANCHORAGe ARea BOF JGh DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C'° STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-456 ! SEWAGE DISPOSAL SYSTEM/i= APPLICATION AND PERMIT PERMIT NO. ,NSTALLATION LOCAT,ON /:::~'Z /~/E / INSTALLATION OF: SEPTIC TANK ~' SEEPAGE PIT DRAIN FIELD TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS PHONE OTHER NOTE= THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. AREA SIZE ~m ~ TYPEr ~. --~ . - U DIAGRAM OF SYSTEM MINIMUM DISTANCES, REQUIREMENTS / FOUNDATION TO SEPTIC TANK ~ FOUNDATION TO SEEPA~ ~* SEPTIC TANK TO SEEPAGE PIT WALE SEPTIC TANK ~ TO NEAREST LOT LINE. WELL TO SEPTIC TANK '~'~ '~ DRAIN FIELD ~ ~ WATER MAIN TO SEPTIC TANK DRAIN FIELD ,,KL/~ '/ / SEPTIC TANK, /~f'l~ / , SEEPAGE TO RIVER. LAKE, STREAM. , DRAIN FIELD , SEEPAGE-~PP ~ ~ DRAIN FIELD · SEEPAGE ~ : ALSO CONSIDER AREA WELLS. __/__/J / SEEPAGE PIT v/~ /1 DRAIN FIELD //'J'~ /, CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO U/NDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVE~ BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G ,A .A OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2S-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE FORM NO. EQ-01 6 Department of Environmental Quality . 3330 "C" Street ~.. Anchorage, Alaska 99b03 _ , S()II~S I,()(; - PEROI,ATION TEST Performed for z/_~_<~_.-~c~; O C.~5',?'~,r:_cL_ _ ~ __ This form reports' Soils log L)ate Perforn~ed j/-~:T~ Percolation test Depth Feet 3- 4- 5- 8- 9- 10- ll - !,2 - 13- 14 - Lv Was g~ound water encountered? If yes, at what depth? Reading Date Gross Time Net Time Percol at i on 'r-J~'e- ............... in~n-~-t-e-.- ...... .-Proposed instal lat~-~-n-:.- Seepa'ge Pit Drain Field Depth of Inlet Dept)-i--t-6'~b-o-~-t~-m-6'f-'l)it or trenci, COMMENTS: Date: E(~-' 040 (6/74) MUNICIPALITY-OFANCHORAGE 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. 015-093-60 1. GENERAL INFORMATION 2. Expiration Date: _ / — 15- - 2-02-0 Complete legal description CONIFER HEIGHTS BLK 1 LT 13A Location (site address) 7720 LODGE POLE CT, ANCH AK Current property owner(s) Mailing address Real estate agent DEBBIE GRENDAHL SAME TYPE OF DWELLING: F� Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and) 3. NUMBER OF BEDROOMS: 5 Day phone 346-2277 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic E Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date:/b -5Z? COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ SSD 33oQ-� Waiver Fee $ Date of Payment o' -l15^1 ckrIoloy Date of Payment Receipt Number 2q%j1( Receipt Number COSA # OJGot 1401 k'o 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 10-20-19 ° p e 6. DSD SIGNATURE°"°'° •°• °°°°°OOaOam J f� F Y e s o e e o 0 o e e a e e System #1 Approved for 4 bedrooms .......... oeooe o 0 �� :e MICHAEL N. AN..... a System #2 Approved for bedrooms ��%� CE -94 9 j A DisapprovedV,_� Conditional approval for bedrooms, with the following stipulations: OF `AIATER AND o VVAST,F_WATER o ^ S SERv�G\\'���\ i Original Certificate Date: t lD ` S T 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 Checklist blue sheet COSA Checklist Legal Description: CONIFER HEIGHTS BLK 1 LT 13A If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled *1975 Total depth *345 ft Cased to UN ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 21+ in. Date of flow test for COSA 9/19/19 Static water level at beginning of test 215 ft. Comments * WELL DATA FROM MOA FILE B. TANK DATA Age of tank(s) 2012 years Tank type/material STEEL Measured operating fluid level in septic tank 48 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 9/19/19 D. ABSORPTION FIELD DATA Which system tested (date installed) 7/17/12 A-1 ALL standpipes present per record drawing Total measured depth from grade 8.5 ft (max) Measured depth to pipe invert from grade 2.5 ft (min) ❑ N/A — pressurized field R Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 015-093-60 Structure served by this system Well production at time of test 2.2+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ N OR Coliform bacteria is Negative Nitrate 6.27 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 9/19/19 ,. C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 9-19-19 Results ❑✓ Pass For 5 bedrooms Fluid depth prior to test 3 in Water added 750+ gal New depth 6 in Elapsed time 1440 min Final fluid depth 3 in Absorption rate 750+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date UN E. `SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 0 Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft / Yes if No Neighboring Tank > 100' F71 Yes if No ft Private Sewer/Septic Line > 25' Fv-� Yes if No Absorption Field on Lot > 100' F,71 Yes if No ft Holding Tank > 100' 0 Yes if No Neighboring Absorption Fields > 100' Fv� Yes if No Water Main > 10' Animal Containment > 50' R Yes if No [Z] Yes if No ft 0 Yes if No Water Service Line > 10' 0 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' �✓ Yes if No ft 0 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' Yes if No Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' Fv� Yes if No Water Main > 10' F71 Yes if No ft Community Wells > 200' 0 Yes if No Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 2✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' F✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No Surface Water > 100'✓0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION / certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet ft ft ft ft ft ft ft ft ft ft 1'Slitrate Advisory Certificate of On -Site Systems Approval # OSC191496 Subdivision: Conifer Heights, Block: 1, Lot: 13A A water sample revealed a nitrate concentration of 6.27 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. 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. kt Maw i , e s�Ucrc 41, 19� nc+, Alask,�5 �6 a �wHri[�IaVg IM 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. 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O V Z Z os 00 �w < .. da z w ZZ. m O O O w <Ex NG3 /a Gam', H63.LNN7 J.77 ` 3 Z m C o o 0 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date .~/O~/~--- (a) Legal Description (include 1~, block, subdivision, section, township, rar~e) Loca=ion (address (b) Applicants Name [~g ho~a~ GaFfed ~ Telephone - Home Business Applicants ~dress (c) ~ppZ~canc ~s (c~ec~) ne~ng ~nsc~cuc~on ~; ~er/builder ~; Buyer ~; 0cher~ ~ (~plain); ' (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address (f) Telephone Mail the HAA to the following address: 2. Type of Residence Single-Family~ Number of Bedrooms Multi-Family~-~ Other (describe) 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 amd status. 4. Sewage Disposal 0nsi~e ~ Public ~-~ Community ~--~ Holding Tank ~-~ Note: If community well system, must have written confirmation from ~he State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] Engineerin~ Firm Providin~ Inspections~ Tests~ File Search~ Data and Information As certified by my seal a~fixed 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 :.hat, 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 ~unicipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm.,:/.~ ~7~L'/JOW;~]~.~d~.'~~~/~& TelephoneO'-~£-J~ Addres 6. D~P Anorov~ Appzoved for ,~w~' (~jJ bedrooms By ~ : ~",~--~-~ Da~~~ ~ - ~ Approved ~ Disapproved ~ Co~i~iom~ ~ Terms of Conditional Approval CADTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ~l~ALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES m~.ALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE D~EP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. 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. (DHEP SEAL) RR4/eJ/D18 [Page 2 of 2] 7-19-84 DATE: TO: FROM: SUBJECT: Municipality of Anchorage MEMORANDUM February 7, 1985 Laura Crow Environmental Health Division Request for Refund - Account # 2460 Please make the necessary arrangements for the following: Lot 13ABlock 1 Conifer Heights Subdivision - health authority approval, the applicant was mistakenly charged twice for the application fee. Previously pa~.d on 2-1-85, receipt ~322713. Marvin Grendahl 7720 Lodge Pole Cou~t Anchorage, Alaska 99516 Receipt ~ 322736 Amount .:$45.00 Account ~ 2460 Lot 3 Block 1 Spring Hills Subdivision #1 - On-site sewer and well permit, the applicant had a private engineer perform the necessary inspections in lieu of this office. Premiere Construction 4155 Tudor Road 9206 Anchorage, Alaska 99507 Receipt ~ 297608 Amount $145.00 Account # 2460 Thank you. Laura J. Ward Office Associate cc: files 91-010 (4/76) ALASKA E IiUIROIqmE I'ITAL CONTROL SeRu CES, Il'lC. (~nclinee~'incI f~ ~nuit'onmcnlal Studies February 5, 1985 Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99501 Subject: Lot 13~Block 1 Conifer Heights AECS re-inspected the subject property on 2/4/85 for elimination of the conditional health authority. The well was examined, the conduit encased the wiring and extended below ground surface. The conduit was secured at the sanitary seal; when grasped, the conduit remained intact and secure. This office feels that the conditional should be eliminated at this time; therefore, a blue (application) form has been completed with the conditional removed. If this office can be of further assistance, please contact us at 561-5040. Approved By: Sincerely, L. D. Montgome~y 1200 LUest 33rd Aucnue, Suile B · Anchorocle, /~lasl~a 99503 ,{907) 561-5040 '~. ' MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONME~ P~OTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE General Information Application Date (a) Lesal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name 06 ~O~A9 ~.~ ~SAt Telephone - Home Business ~Gl-1917 Applicants Address 7'7 2~O (.4DQ&~ ~OC~ C..OuI,~T (c) Applicant tis (check one_) Lending Institution ~ ; Owne~ Buyer ~-~ ; Other~ (explain); ' ' (d) Lendin~ Institution (~A ? ~ ~ ~.~ /_ ~¢C~/~,~ X Te.lephone Address Telephone (f) Mail the HAA to the following addre%s: 2. ~,7,,pe of ~esidence Single-Family ~ Multi-Family ~--~ Number of Bedrooms 3. Water Supp17 Individual Well ~. Community ~--~ Other (describe) 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 Disppsal 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] En~ineerin$ Firm Providing Inspecttons~ Tests~ File Search~ Data and Information As certified by my seal affixed hereto and as of the validation date sho~n below, I verify that my investigation of. this Health Authority Approval shows that the water supply ama/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 Manicipality of Anchorage files and from my investigation and inspection, the om-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Fire,. A Telephone CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO Pb/{CHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQULRE- MENTS. 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. (DHEP SEAL) P,a.4/eJ/D 18 [Pase 2 of 2] 7-19-84 · . MUNICIPALITY OF ANCHORAGe: DEPT. OF HEALTH ~ M~C~3A~.,T']'~ OF ANC[']ORAG~ (MOA) ENVIRONMENTAL PROLECfiON Casing ~tght To ~ptic~oldi~ Ta~ Date Installed J.. 1~--73- Si~ ( ¥oo · No. cf C~p~t~nts Standpipes ~) Air-tight Caps ~YN) Foundation Cleanout DeD=ession o~r Tank (y~ Date Last Pun%~d Pumping/Maintenance Cont:act on File (Y/N) ~,47 ,;' Holding Tank High-Water Alarm (Y/N) ~J~ Tem~a~ Holdin~ Tank Permit Sepa=ation Dxstan~es ~rcm Septic/Holding Tank: To Water-Supply Wall ~O~ To Building Foundation Field ~ ' To Dis~osaI To Water ~ain/Se=vics Line ~- · . To st=earn, Pond, Lake, (x Major D=ainage Date P.aid: Amour: [Pa~e 1 of 2] 2-15-84 C'.. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date .Installed · Ii - '~ - 7 ~- Width of Field ~ ~,1 Squa=e Feet of Absc~ption A~ea Depnession over Field (Y_~ Results of Last ~equacy Test Separation Distance frcm A~sc=ption Field: To Water-Supply Well ~- I%~' To P=ope=ty Line ~ ~/O To Building Foundation ~'~' To Existing or' Abandoned System cn Lot A~%, . ,,; On Adjoining Lots , C-l ~' ,,. To Water Main/Service Line ~D~ . To Cutbank(if present) To Stream/Pond/Lake/c= Major Drainage Course To Driveway, Parking A=ea, c= Vehicle Stc=ags A=ea ~ I Z~' ~z[/~m--Type of System Design Length of Field ~ -~?_ ~ .... Degth of Field ~ +ZO' Gravel Bed Thickness *'(~ ' ~-~o~ ~ ~ Standpipes Present ~/N) Date of Last Adequacy Test IS O~ ~C- Size in Gallons ~ , "Pump On" Level at ~ High Water Alarm Level at Tested for Electrical Codes(Y/N) Cc~ents Di~ensions Manhole/a=cess Off" Level at vent !7/N), Test. M~ets ~*DA ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, cr eonfcrmed to all MOA FAA Guidelines in effect on the date of this inspection. ~ , r* '.-9. J~*~. Leggy C. Reid, Jr. ~.o$ [Page 2 of 2]~~'' .... ° .... '~%~'~ 2-15-84 February 1, t985 ~klaska Environmental Control Service, InC. 1,ZOO West 33rd Avenue Anchorage, AE 99503 Re: Grendahl Lot 1.~, Block 1. Conifer Heights Dear Lee:: In regards to the property in question, our determin- ation is as follows. By means of visual and .audio testing, it has been ascertained that no water'comes from above the 40' level, which meets the standards of the Municipality. The actual casing level is indeterminate but bedrock is normally-encountered .at shallow levels in this particular area. If I can be of any more help, please call. S i~lc~erelF ,yours, AI~.INE' DRILLING AND ENTERPRISES David L. H,ar~er ALASKA [1UIROFlm TAL CONTROL SeRUICeS, IRC. o~ ~nqineerinq 6 t~nuironmental Studies 1200 LUest 33rd Aucnue. ,Suite B · Anchoraqe. Alaska 99503 *(907) 561-5040 TO Keith Bandt Department of Environmental Protection 825 L. Street Ah'~hora~6, A'k'~ g~501 DATE1./.3.!./85 SUBJECT Conife~ Hts/B!OC..k! / 'LO~ i'~ We did not find a copy of a'well log for the subject property. A Health Authority, issued by your office on JUne 29, 1977, approved the well and septic systems. It shows the well to be 345 feet deep~d ~b~a ~el..! I~as 6h f'i'ie~ ~hei~ i~ ~hep~6~eSs of refinancing the home, does not hav~ a cop~ iikeig~na~ ~ ~eJi345 ~ee~deep 'i's'no~ cased to at least 40 feet. Further at the static water 1eye1, rust and other material found on the upon the above, we recommend that the well be apBroved without a we1! 10g~ Approved by; Leroy Reid PND, PE ALASKA [1UIgO[lmE[1TAL COnTrOL I[1C. 1/28/85 GRENDHAL P.O. BOX 307 GIRDWOOD AK 99587 SELLER - GRENDHAL BUYER - SUBDIVISION - CONIFER HEIGHTS BLOCK - 1 LOT - 13~ ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 504 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 579 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON 5/3/84 . A FLOW TEST WAS PREFORMED ON THE WELL. 579 GALLONS OF WATER WAS PUMPED AT A RATE OF 3.22 GPM OVER A DURATION OF 3. HOURS. THE DRAWDOWN WAS 23' WITH A RECOVERY TIME OF 60 MINUTES AND THE STATIC WATER LEVEL WAS 215.7 FEET. THE WELL IS ADEQUATE FOR THIS 4 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1500 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE. 1200 LUcst 33r(I Aucnue, Suii'~ B. Ancl~oro§¢, Alaska 99503 ,(907) 561-50/40 ~.~ _~~~~! ~ MUN I C I PAL ITY OF ANCHORAGE , ii-~ DEPARTMEr OF HEALTH AND ENVIRONMENI' PROTECTION L Street, Anchorage, Alaska 99501 27~-2511, ext. 224 or 225 ~/~ II Date Received: June 29, 1977 #1. !i!i ~i #~' e #3: Time ~D~'e Date Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: First National Bank of Anchorage Mailing Address: Post Office Box 720 99510 Phone: 276-6300 2. Property Owner: Frank R. Schrage Phone: Mailing Address: Star Route A Box 6t-S 99507 344-6405 3. Legal Description: Lot 13~Block 1 Conifer Heights Subdivision 4: Single Family Residence: (x~ Multiple Family Residence: ( ) Number of Bedrooms: four Number of Bedrooms: Well System: Individual Well kx) Cormmunity/Public System ( ) Permit # Depth of Well Construction J~t.~.~~' 6. Sewage Disposal System: On-site System (x) Permit # Installed 1975 Septic Tank Size /~~ Manufacturer Absorption Area .~/~ ~_ Soils Rate 7. Distances: 345' Well Log on File (~) Bacterial Analysis 0~"~L Public Utility Installer_ Material Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line ,4UN I C I PAL I TY OF ANCHORAGE ?~.UN~C!PAI. IT¥ /F I~Ii~[/4'"~1/ 825 L Street, Anchorage, Alaska ~.. ~ 279-2511, ext. 224, 225 J~ ..... ~equest for Approval of Individual Sewer and Water Facilities 1. Property Owner: '/-~ ~ . ~ _ Mailing Address: ~~ ~~ ~ ~ Phone: ~~- Name of Buyer: ~U~ Mailing Address: ~ Lending Institution: Mailing Address: ~ Realtor/Agent: Mailing Address: Legal Description: Street Location: Single Family Residence: Multiple Family Residence: Number of Bedrooms: ( ) Number of Bedrooms: Water Supply: *Individual Well ( ~/Public/Community System If Individual Well, well depth ~V! ( ) If Community System, name of system Sewage Disposal System: On-site System ( ~/Public System If On-site System, date of insta].lation: ~. ~ 7~ ( ) *NOTE: A well log is required on ALL wells drilled since 6/75. 3/77 Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot. 13~Block 1 Conifer Heights Subdivision Comments: Affadavit Attached: ( ) Letter Attached: ( ) Approved:~_~_.~ ~ Date:/ Disapproved: ~ Date: Department Worksheet: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION Environmental Health Division CASE REVIEW WORKSHEET CASE NUMBER: S-8111 DATE RECEIVED: April 11, 1985 COMMENTS DUE BY: May 3, 1985 SUBDIVISION OR PROJECT TITLE: Lot 13A Block 1 Conifer Heights Subdivision //- 7- 7.~- ..5'~ ,.~ ( ) PUBLIC WA~i~.ER AVAILABLE ( ) PUBLIC SEWER AVAILABLE ( ) COMMUNITY' WATER AVAILABLE COMMENTS: 71-014 (Rev. 5/83) FT 1 ........... ~04 84 '- T  MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION Environmental Health Division CASE REVIEW WORKSHEET CASE NUMBER: DATE RECEIVED: COMMENTS DUE BY: S-7682 May 29, 1984 June 22, 1984 SUBDIVISION OR PROJECT TITLE: l 13A Block 1 Conifer Heights Subdiv~/~On with Vacation ( ) PUBLIC WATER AVAILABLE ( / ) PUBLIC SEWER AVAILABLE ( ) COMMUNITY WATER AVAILABLE · / COMMENTS: ~ / 71-014 (Rev. 5/83) I _ ~L'~ / / / ~L /o_ Lr'r/cz_T~-' ~..~.,;~/..-f~...,l'T'-,,., 3,.~ ' PA TF~ T [SURVEY CERTIFICATION: I hereby certify that I have ! aurveyed the property shown and described hereon and that the IImprovements situated thereon are within the property lines and no encroachments exist other than noted. 272-g231 rPLEASE NOTE: It Jsthecontractbr's responsibilit~to chec----~ RR'~R')OI¶ [ top of foundation In relation toifinish grade end building ~-'~-~' J setbacks In relation to lot lines end easements. / LEGAL DESCRIPTION: bO7- 13 ~,-~L,<- I Of= CO/d/F~/~ ?~/'~ /-ff'7',, ~ ~'~D, LEGEND: SET FOUND 5/8" REBAR · 0 HUB & TACK I-1 MONUMENT ~ AL-CAP ~ PK NAIL X IRON PIPE [--------I = E LEVS. - DATUM ASSUMED WO. e: BOOK/PG: 3 <I.-L- Z4Z DRAWN ElY: SCALE: GRID DATE x 0'0~ Y ? '~Z g X · ~'GGZ 0 o © Mark Begich Mayor Deve]opme~'~? Services Department Bui!di~g 5~fety Division On-Site Wcz?er & W~stewc~ter Program 4700 ~gow Street P.O. Sox L96650 Anchor*age, AK 995~9-6650 (907) 343-7904 Well Drilling Pe~-mit Number: SW Parcel Identification Number: Pump Installation Log Date of Issue: ~_~zF//! Legal Description G-t L- Pump Installation Date: ~/~Z/~¢// Pump Intake Depth Below ~op of Well Casing:~eet il Property Owner Name~ & Sddress: Pump Manufacturer's Name: Pump Model: Pump Size / hp Pitless Adapter Burial Depth: /.~.~- feet Pitless Adapter Manufacturer's Name: ~/~ Pitless Adapter Installer: Well Disinfected Upon Completion~Yes [] No Method of Disinfection: Comments: Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.