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Home My WebLink AboutCONIFER HEIGHTS BLK 1 LT 23 Municipality of Anchorage Page I of ~--~ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~ ~'.~.o~1/4 PID Number: C~I,~' Name: ~~ ~u ~~ Wastewater System: D New ~ Upgrade ABSORPTION FIELD ~No. of BeSeems: ~DeepTrench ~ Shallow Trench ~ Bed ~ Mound ~ Other Phon~ ~ LEGAL DESCRIPTION sci, Rating: Total Depth fro~ original grade: O - ~l~ GPD/Sq. Ft. Lot: Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe ~, I ~ q~t~ ~ t-z~ Ft. ~ Ft. I ' ~ ~ Ft. ~ Ft. WELL: g New ~ Upgrade ~ Gravel width:~ ~ Ft. Number~ of lines:JJ Distance/~bJtween' lines:Et. Classification (Private, A,B,C): Total De~ ~ed To: Total absorption area: Pipe materi~h Drill,r: Dat~ ~rill,d: $taticWat, r k~vol: In,tall~r: Dato in~tallod: · ~ J PumpSetat: J casing Height Above Ground: ~.u Ft. .~. TANK SEPARATION DISTANCES ~eptic ~ Ho~ding a S.T.E.P. TO Septic Absorption Lift Holding Public/PrivateManufacturer: Capacity in gallons: From Tank Field Station Tank Sawer Lines ~ ~ Mmeriah Number of Oompa~ments: Water /~+ toe* LIFT STATION~~ Lot I ~ ~ Size in gallons: Manufacturera~~ J Line 3 ~ J I Foundation j ~ I /~ ~ "Pump on' level · " off" level at: High water alarm at: Remarks: ~t~t~u~A~o~CRc~ BENCH MARK Location and Description: Assumed Elevation: /~-~ ENGINEER'S SEAL Inspections pedormed by: ~c-~c~~ Dates: 1st ~/2eJq~ Department of Health and H~man Se~ices approval ~viowad and approvod ~y: Dato: ~ - ~- ~ 72-013 (Rev. 9/91) MOA 25 '" ' "; ", - - CO A FC 33,8 6,0 C1 46,3 9,4 TI 4%6 1E,4 TE 50,5 21,6 :DC 51,6 E4,8 DM 50,0 E7,5 FS 48,1 27,5 CE 41,5 16,5 ABSORPTION 3, BLOCK 1 CONIFER TS \, ',, \ , [lIST, ) ! NE~ 1500 g SEPTIC T~NK FLDV BUN M1 E8,9 EE,:~__ - C3 E1,3 ~,4- C4 46,7 36,E M~ 38,6 61,1 __ -~___ _~ / C5 40,1 67,8 E1 66,6 43,3 E~ 76,7 7i,5 ~. 9ESIGN~ / ~ Pert R~te = 40 MIn/In~ ~5 , , -,,- '.. - LI~ s 95,5 LF, Two Trenches ~' ..... 1~ 48LF, 1 ~ 47,5 LF " · =-- ~ ~ ..... ~ ......... ~ .............a,,,,,~ I PREPARE9 FDE, George & Ingrld Sue~er~ P, D, 9BX 14~0E5 (907) 354-87~3 ~ATE, 7-3~-97, AS-~U~LT' ~ALE~ 1'=50' AS-BUILT DETAILS WASTEWATER At~SDRPTIF1N SYSTEM LOT 83, ]BLOCK 1 CONIFER HTS Z W C~ :~rli ~D.I.INDW ~flO N~313 Drawing C,\Work\E3-1CONF,))WG PREPARED FOR, George & Ingrld SueFPer~ 7705 Por~ OrPord Drive Anchorage, AK 9951G (907) 354-8723 N[ZIiVQ'NnD3 P:nnone Eng, Svc, P, 0, BOX 142025 ANCHORAGE, ALASKA 99514 272~8218~ PHONE & FAX DAT£, 7-31-97 / AS-NOTED I AS-BUILT PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUlW~AN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970214 DESIGN ENGINEER:KND ENGINEERING OWNER NAME:SEUFFERT GEORGE W & OWNER ADDRESS:7705 PORT OXFORD DR ANCHORAGE, AK 99516 DATE ISSUED: 7/25/97 EXPIRATION DATE: 7/25/98 PARCEL ID:01509353 LEGAL DESCRIPTION: CONIFER HEIGHTS BLK 1 LT 23 LOT SIZE: 27776 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 (18A_ACS0). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE AS-BUILT OF THE PROPOSED SEPTIC SYSTEM WILL NEED TO INDICATE ALL CLEANOUTS AS DISCUSSED ON JULY 25, 1997. RECEIVED BY: ~w-.~-- ~~ ISSUED BY:____~~~~ DATE: I~ND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 July 10, 1996 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Conifer Heights S/D, B1, L23 - Septic Upgrade Permit Gentlemen: Following a request from the owner, on June 17th and 27th, 1997 we dug testholes for the proposed upgrade. The well passed but the septic system failed. The results of this percolation test are attached. The lot is served by an individual well. The proposed upgrade system will be placed east of the existing system. As indicated on the site plan there is sufficient grade to maintain a gravity system. The existing 1250 gallon tank will be abandoned in place and replaced with a 1500 gallon tank. The proposed upgrade will be for a five bedroom. There is a cut bank of approximately 4'-6' within the existing slope easement. As a precaution we are requesting a waiver to slope of up to 35' for this proposed design. As indicated by the site plan drainage arrows, natural drainage is away from this site and will be maintained after construction. There is no surface water within 100' of the proposed installation. There are no known curtain drains within 50' of the proposed installation. No wells exist within 100' of the proposed installation and the community well is over 200' away from the proposed site. This upgrade should have no adverse effect on development of adjacent lots. If you have any questions, please contact me at 696-6111/FAX 696-8111. ~UNtGI~ALITY OF ANGHORAG~ Respectfully submitted, ngineering · ~.NvIRONI~ENTAL SERVICES DIVtSlOht JUL 1 G 1997 RECEIVED attachments: On-Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test WASTEWATER CONIFER DISPOSAL HEIGHTS SYSTEM/SITE PLAN BLOCK 1, LOT 25 22 EXISTING .INSTALL SEP~C ~* SEPTIC TANK NO SEP~C SYSTEMS WffHIN 200' OF PROPOSED WELL, EXCEPT AS NOTED, NO PRNATE OR PUBLIC WELLS Wi~IN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED, 1. 5 BEDROOMS X 150 GAL./D~Ay/BEDROOM = 75.~:Y'GPD 2 · SOILS RATING: 40 MIN/I~OFi = APPL. RATE 0/1:5 GPD/SF 3. 750 GPD/0.45 ,GPDZS.F/= 1,6,6,7 SF ./ 4. 1,667 SF /(2 x ~ = 92.7L 5. MIN. DESIGN SIZE ~ 2 TRENCHS-~1~,Z5' LONG x 2' WIDE x ~ DEEP 6. DEPTH OF GRAVEL BELOW PIPE IS 7. TOTAL DEPTH OF SYSTEM IS 11.0' FROM ORIGINAL GRADE. NOTES: -' 1. TIE INTO TRENCH-'~T MIDPOINT. 2. CONTRA~ TO VERI~ INTEGRI~ OF EXISTING TANK. 5, INSTAL~ 1000 GALLON SEPTIC TANK IF REQUIRED. INSU~TE TANK IF <4' COVER. 4. INSU~'ENCH WITH 2" HD BURIAL FOAM IF <3' COVER. 5. CONTRACTOR WILL ENSURE MAXIMUM 2~ SLOPE INTO SEPTIC TANK. 6. CONTRACTOR TO ABANDON EXISTING TANK IN P~CE IF NEW TANK INSTALLED. PREPARED FOR: GEORGE & INGRID SEUFFERT 7705 PORT ORFORD ANCHORAGE, ALASKA KND ENGINEERING 20441 PTARMIGAN BLVD EAGLE RIVER, AK, 99577 (907)696-6111/Fox (907)696-8111 DATE: 7/3/g7 I DRAWING SCALE: 1" = 100'1 97053-Sl Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" SIreet, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCR IPTION:~Z~ I~ 6 7 8 9 10 '11 12 13 14 15 16 17 18 19 2O ~:)t 'Z'~T°wnship, Range, Section: SLOPE WASGROUND WATER ENCOUNTERED? . . S IF YES, AT WHAT ~A (~ DEPTH? P E SITE PLAN Monitoring7 Dale: 7 J AI Gross Net Depth to Net Reading Date Time Time Water Drop Z.. Z' 15' I b ~'t ~ ,~ ~-~ " t/fi" ~ .-~ z' I,-/-. - ~3 ';'.~" -- ~_ z '. ~q lO ~;~ ~ ~/~" V,/" ,X- Z.:;I~; - ,~',z '_: /_,. z : :~_~- / o~.,;,., ,~ ~/o ' '/q " PERCOLATION RATE _ d° - (m,nules/~nch) PERC HOLE DIAMETER ACCORDANCE WIIH ALL STATE ANDMUNICIP~A GUIDELINES IN EFFECT ON THIS DATE DATE 72-008 (Rev 4/85) PERFORMED FOR: Municipalily of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 5 7 9 10 '11 12 13 14 15 16 ~. 18 19 20 ] ~',~1~ eee· '.ceee I~,~'~ DATE PEBrO~MED: ~~ ~ ~7 Township, Range, Section. T~*/ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? L IF YES, AT WHAT /~A pO DEPTH? E Depth to Waler Alte.~r.,~ /9 Monit0ring7 Date: ~'/Z7 7 [ [AI Gross Net Depth to Net ReadingDate Time Time Water Drop b ~-1,~.¢7 5:o~ -- 7q/~'' - . l .¢: la /o,,,;,, 7 ~q" '/~" ~ ~ ~ I~ - 7 ~/~ ,, _ ~ ~ qo - 7 ~/~' ~ ~'~/ /~,~ -7~" W" _ PERCOLATION RATE ~, O {m,nutes~,nch) PERC HOLE DIAMETER 'TEST RUN BETWEEN ~,,o FT AND 7 ~to~' ~ -~'[-,' ACCORDANCE WITH ALL STATE D MUNICIPAL G'~IDELINES 72-008 (Rev IN EFFECT ON THIS DATE DATE IFY IHAT THIS TEST WAS PERFORMED IN GREA.,-R ANCHORAGE AREA BOR,..:,GH Department of Environmental Quality 3330 C Street Anchorage, Alaska gg§03 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION SEPTIC TANK: DISTANCE FROM WELL~ MANUFACTURER INSIDE LENGTH INSIDE WIDTH MATERIAL LIQUID DEPTH NUMBER OF ~ COMPARTMENTS LIQUID CAPACITY/'~''~:~ GALLONS. T.4~=_ DA~.i':-i FiE~D: '""~'~"/,,~ft~ DISTANCE FROM WELL''''o'/dO NUMBER OF LIN~ / ABSORPTION AREA ~3~ DEPTH: FOUNDATION DISTANCE BETWEEN LINES NEAREST LOT LINE TOTAL LENGTH OF LINE~ TRENCH WIDTH"'~(e IN. TOTAL EFFECTIVE TOP OF TILE TO FINISH GRADE SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER ~.~, ~ MATERIAL BENEATH TILE "1~1. ABOVE TI LE ~'~ IN. WELL: TYPE(~ ~'~:~ ?, BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE_ OTHER SOURCES DISAPPROVED NEAREST SEWER LINE__ DEPTH SEPTIC SEEPAGE , TANK SYSTEM REMARKS DISTANCE FROM: DISTANCES: INSTALLED By: ~3~ SEWER LINE DEPTH: PIPE MATE RIAL:~ gL"~ LOT SLOPE: REMARKS: DIAGRAM Of SYSTEM D AT E "7/'~/?(--~ G.A.A.B. Form EQ-032 PERMIT NO. M,_'N ~' ,:: Z :IL Z T"r' CIF Rr*l£:l~ F-:R,3E DEPRRTMENT .... HERLTH RND ENVIRONMENTRL , ,J2TECTTON 25t0 E. TUDOR F.'.D.., RNCHORRGE., RE.~'-~...,ril"'- = "' "''"~ 276-222i PJEL. L. AN[:, E~I'4--_-'_-. I TE ".=-%EL.~EF.." F'EF-."["I I T ( 76280 ) APPLICANT LOCATION LEGAL GEORGE SEUFFERT F'ANORRMA DR t.2_~ Bi CONIFER HGTS i~48 BENNINGTON DR LOT SIZE TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH 27776 SQUARE FEE]" MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT?BR>= ±00 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E:,EF'"TH= :1.4 LENGTH= __--4~4 GRR"~"EL [:,EPTH= ~!2; 'THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRAINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET>. 'THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET>. EEC, SEF"T I C TRNK; BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS [:,EPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS t00 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INS'TRLLATION F'EE:r.1 I T %.'RL I ~, FEmF.: Lqr4E %r'ERR F"R.".Orq I I CERTIFY THAT i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE, 2: I WILL INSTALL THE SYSTEM N ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-S TE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED ~A~'L I~.SNT GEORGE S :LUDE MORE THAN 4 BEDROOMS. JFFERT I SSLIE[:, B~ _~~2~ .... DATE ............... CONSULTANTS, INC. ANCHORAGE FAIRBANKS JUNEAU :'49 EAST 51ST AVENUE * P.O, BOX 6087 ANCHORAGE, ALASKA 99503 * TFL. EPHONE 907-279-0483 TELEX 090-3541g May 28, 1976 R & M NO. 656243 Mr. George Seuffert 1348 Bennington Dr. Anchorage, Alaska RE: Test Hole and Soil Log Report for Sanitary System Lot 23 Block 1 Conifer Heights Subdivision Dear Mr. Seuffert: We are submitting herewith the boring logs, percolation results and our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of May 19, 1976, and those procedures outlined in a letter dated July 15, 1976, by Mr. Rolf Strickland of the Municipality of Anchorage, Department of Environmental Quality. A single test hole was put down within the Lot 23 area for the purpose of defining general subsurface soil conditions and conducting percolation tests for the proposed sanitary system. Excavation was accomplished with an auger type drilling rig and the test hole was extended to a total depth of 17.5 feet below ground surface. The final log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R &. M CONSULTANTS, INC. James W. Rooney~u%~ Vice President .... JWR/PJ/pe xc: Municipality of Anchorage TH 1 5-27-76 0.0' ORGANICS (PT) 1.0' SANDY SILT W/TRACE .GRA~J~ _[~I~ ..... 2.0' SILTY SANDY GRAVEL (GM) 4.5' SAND (SP) 6.5' SILTY SAND W/SOME GRAVEL (s~) J ' SANDY SILTY GRAVEL .(GM) No Water Table 17.5' Log Represents Location of Test Hole Lot 23-Block 1 Conifer~ ~Heights :.Subdivis ion IDw~.~.~. I ,' v ~, ~-~ I I" Ic~' ' ' / /1:::~ A~ _ / ! Log of Test I ', ~-~-'~ i . I Anchorage, Alaska ' I ........ ' [~ALS-.1,=3', ' I .... ' m ~ ~ ~mu~v~T~, ~. I I Uw~. N~ A- 01 t"= PERCOLATION TEST GEORGE SEUFFERT R & M NO. 656243 ELAPSED DROP TIME TIME INCHES 3:30 0 0 3: 31 1 1/2 3: 32 1 3/4 3: 33 1 3/4 3:34 1 * 3/4 3: 35 1 1/2 3:40 5 2 1/2 3.'45 5 2 1/4 3:50 5 2 1/4 3:55 5 2 ,~-4~90 5 1 3/4 4:05 5 2 4:10 5 1 3/4 4:15 5 1 3/4 4:20 5 1 1/2 4:,25 5 1 1/2 4:30 5 1 1/2. 60 Minutes 23 3/4 Total Drop builder, prior to cons~.~c~i~ the O~er or , to verify the ~ proposed building grade relative to finished ~ ' grade and utility conn~tions and to deter. 71~ the existence of any easem~,nts, cov~ s, or restrictions wh'idh do not appear on the recorded subdivision plat. · [ ~ . .. ~./,, SCALE: ," .,--~' ~ ~ M CO~U~T~,~NC. CD)J/ WILSON WELL DRILLING 1305 W, 45TH STREET ANCHORAGE, ALASKA 99503 PHONE 272-93,43 DRILLING LOG Location (address of: Township, Range, ~.eetion, if known; or distance main road._ Size o£ casing {~"¢' Depth of Hole .... ]_?-}f ~' '' =~feet Cased to I ~ V l ~' feet Static water level ....... J ~_~___~[t. (above) ~-'b~el~v~ land surface. Finish of well (check one) Screen ( ); Perforated ( ). open end ( ); Describe screen or perforation Well pumping test at,~;5 L~_gallons per (hour) of drawdown from static level. Date of completion .... L~_~__~L. ,.._~__~.~~ WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness Well Owner WILSON WELL DRILLING' DRILLING LOG (addreSs of: Township, Range, Section, if known; or distance main road Stat~ yater )frei ?~'~ ft. (above)- ~ l~d surface. Finish of well (check one) o~n end ( )' ' '~tc .Screen ( )' Perforated ( } :~-~" Describe screen or peroration.. , ~.¢':/of drawdo~ from ~tatic level. g~nd surface Give details of fo~atio~ penetrated, size of material, ~l~[ ~~ " "To TO TO-~ .TO .TO FILE CU2TOMER-!D WATER WELL .INVENTORY CHAN~E ;E WALTER QQQQ SW QQQ NE QQ NW q NW $ t3 TWN Oi2N RNG OOZW M £ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of EnvirOnmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) prOperty owner Mailing address ' Len'ding agency Mailing address Day phone ~'~ (u ~ I c~c~_~/ Day phone Address 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: J Unless otherwise requested, HAA will be held for pickup. Individual well ~c Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to t..he legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm .E~'7"~'V~.,,-~ 1~.~:~,~,~/voW~.~ O_. E_~, Address ~:~. o .~=,o ~. / 41 ~ c~'~- ~ ~., o~- Engineer's signature,_~ ~ DHHS SIGNATURE '~' Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: , Date / ~' The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72..025(Rev. 1/91) Back MOA#21 Municipality of Anchorage D r' r' ~ DEPARTMENT OFHE~,LTH & HUMAN SERVICESI~ r' I~ E IV E Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 3~7441 1997 Municipality of Anchorage Health Authority Approval Checklist Dept. Health & Human Services Legal Description: L."/.3 t~, I O-¢,,~ I~'~'~- ~-'r',.¢ Parcel I.D.: G' I,~"¢~ff..$ .5-'3' A, WELL DATA Well type ~:)E(U~'T' x(Z" IfA, B, orC, attachADEC letter. ADECwatersystern number Log present (Y/N) ~" Date completed Total depth ~/-~'~" ~ Cased to ~ ~"-~,.~- Casing height (above ground) Sanitary seal (Y/N) ~ Wires properlY protected (Y/N) FROM WELL LOG AT INSPECTION Date of test :::~'./~¢~ I q~ .'~ Static water level Well production ,..~--... c~ g.p.m. WATER SAMPLE RESULTS: Coliform - Date of sample: Nitrate q~ ~ :~ Collected by: Other bacteria g,p,m, B. SEPTIC/HOLDING TANK DATA Date installed '~/~! ¢t'~ Tank size Number of Compartments ~__ Cleanouts (Y/N) *~7p Foundation cleanout (Y/N) ~'~ Depression (Y/N) V.J. High water alarm (Y/N) '-'- ~ate installed ~/{~ ~ Soil ratin. (..p.d./~.or ~/bdrm) ~' ~ Sy~t.m ~p~ ~ m Length ~ ~ ~- ~ ~dt~ ~ Grovel thickness below pipe ~ Total depth J 2 - I~ ~ ./ Effeotive absorption'area~ ~ Monitoring Tube present (Y/N) ~ Depression over field (WN) .~ Date of adequacy:'test ~ ~ Results (Pass/Fail) ~ ~5 For ~ bedrooms Fluid depth in absorption field before test (in.); ~ Immediately after ~gal. water added (in.): ~ Fluid depth ~ (ins) Minutes later: ~ Absorption rate = ~ g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) ~ High water alarm level at*~.,..-~''~'~ *Datum E. SEPARATION DISTANCES Size in gallons "Pump off" level at* F, SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ! ~-'~ ~ Absorption field on lot /C~, · ~ Public sewer main /c~,~- Sewer/septic service line On adjacent lots /O On adjacent lots Public sewer manhole/cleanout ~'~'~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ,~t i.~ ~ Property line ~ '~' t Absorption field ~ Water main/service line .~',~ Surface water/drainage /~(~..4- Wells on adjacent lots /'o/" SEPARATION DISTANCE FROM ABSORPTION FIE~D ON LOT TO: Property line 1/' Surface water / c'c~ Curtain drain Building foundation /--~"~' Water main/service line Driveway, parking/vehicle storage area ..-~"'~ Wells on adjacent lots / // ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal in conformance with MOA HAA guidelines in effect on this date. Signature~ ~ -- Engineer's Name -S'T-,~.V~.,O '~2 ,'~:tA,,o4)o,x~:~,~ c.j~ Date ~.//~ ,/'~ 'C~ HAA Fee $. Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Recei pt Number 22 \ 19 BLOCK ~ 1 GARAGE: '~ 2 STOI~Y ~,, '~, HOUSE It is the responsibility of t~e owner to determine the exi~t~ce of any eosements, covenents Or .,,~:a.;~ nlnn Under no circumstonces S~ould ::~"~'A%'"h,~;~ b~ ~se~ ~o~ new ~o~st~ct~on o~ '"~ .... i hin oundor ~ fence lines, dZt:IO Z6-I£-LnP, lO'd ~ .... X~ · DEPARTMEi , '~} · 8 2 5 #1: Time ~ '~ ~ MUNICIPALITY OF ANCHORAGE !F HEALTH AND. ENVIRONMENT, Street, Anchoraa~. Alaska 264-4720 Date Received: PROTECTION 99501 November 7, 1977 #2: Time #3: Date Insp Time Date Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Lomas and Nettleton Company Mailing Address: 4449 Business Park Boulevard Phone: 274-7661 e Property Owner: Mailing Address: George Walter Seuffert Star Route A Box 61-G 99507 Phone: 349-5630 4: Legal Description: Lot 23 Block i Conifer Heights Subdivision Single Family Residence: (x) Number of Bedrooms: ~~~ Multiple'Family Residence: ( ) Number of Bedrooms Well System: Individual Well (x) Community/Public System Permit # .7~. ~-?, Depth of Well ~'~ ~ / __ Well Log on Fi e~(~ Construction ~(t~ ~~jBacterial Analysis Septic Tank Size Absorption Area Sewage Disposal System: On-site System (x) Per.mit # 7& ~--~-~ Installed 14 ~ ~ ~~-~ Manufacturer C ~ ~ ~ ~-- ~ Soils Rate Material Distances: Well to Septic Tank ~ ~ to Absorption Area to Sewer Line Public Utility ( ) Installer ~ ~ Nearest Lot line Absorption Area to Nearest Lot Line IUNICI'P'ALITY OF ANCHORAGE Department of Hea].th and Environmental. Protection . 825 L Street, Anchorage, Alaska 99501 P_le~_~a.seRu~R~. 279-2511, ext. 224, 225 Phone Lomas and Nettleton with outcome as soon as possible. equest for Approval of Individual Sewer and Water Facilities Thanks '. Property Owner: George Walter Seuffert Mailing Address: SRA Box 61-G Anchorage, AK 99507 Phone: 349-5630 Name of Buyer: Refinance Mailing Address: Phone: o Lending Institution: The Lomas and Nettleton Company Mailing Address: 4449 Business Park Blvd. 99503 Phone: 274-7661 Realtor/Agent: Mailing Address: N/A Phone: Legal Description: Street Location: Lot 23 Block 1 Conifer Heights s/d NSA Port Oxford St. Single Family Residence: Multiple Family Residence: (x) Number of Bedrooms: ( ) Number of Bedrooms: Water Supply: *Individual Well ( ~ If Individual Well, well depth If Community System, name of system Public/Community System ( ) Sewage Disposal System: On-site System (x)' Public System If On-site System, date of installation: ( ) *NOTE: 3/77 A well log is required on ALL wells drilled si~l~7~)~ ANCHORAG2 DEPT. OF H~AITH & ENVIRONMENTAL PROTECTION NOV ? 1§77 RECEIVED De})a. rtment of Ilealth and .... ' "' ~ ~' Pro~.ec~.~_o~ for Approval off Individual Sewer and I4ate.~ Fac;i.l:ht. tes L e g a 1 D e s c r .~. p t; i on '; __}_o_~_.2_3~.._B l_Qg_~_~_l__~_on i f er He iqh~._~._s__~_b_O_~v!.~__~_o_n~ Department Work sheet: GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Nove~er 30, 1976 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 9:00 a.m. 12-2-76 Thursday 1. Approval requested by: Mailing Address.: 2. Property Owner: .George W. Seuffert Mailing Address: Star Route A Box 61-G e e Legal Description: Lot 23 Block 1 Conifer Heights Phone: Phone: 349-5630 Location: Port Orford Drive Type of facility to be inspected Single Family No. of bedrooms Well Data: L~ 0~ L~ ~, A. Type Individual B. Depth C. Construction ~ D. Bacterial Analysis Uu Sewage Disposal System: On-site system, Permit 976280 A. Installed 1976 197' C. Septic Tank: 1. Size ~ 2. Manufacturer D. Seepage Pit: 1. Absorption Area _~ZJ~2.J2~_~ 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area ~, Sewer Lines Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 - , L_ ! ..... '~: REQUEST F:OR APPROVAl. OF INDI¥1~UAL SE~ER a~d ~ATER FACILITIES 1. Type of Inspection: CMRO VA_ FHA CONV 2. Property Owner: Mailing Address: 5~, '-~::~¥ G £-C~- Day Phone: ~<~- ~----~'~o 3. Name of Buyer: Mailing Address: 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Agent: Mailing Address: 6. Legal Description: ~7'~'~ Location: ~o c¥ Day Phone: Phone: Phone: 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: No. Bdrms. ~ Public Utility Individual v' If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: If Individual, date of installation Public Utility Individual (on-site) 72-003(3/76) Page 2 of two pages - Ret .t for Approval of Individual I Ir & Water Facilities Legal Description Lot 23 Block 1 Conifer Heights Comments Approved~~_.._~ _~.~~ Disapproved. . Date ApproX.,Valid for one year from date signed Greater Anchorage'~'a-.Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily, SIGNED Date EQ-034 (1/74) -GREA.-.rc.,..ANCHORAGE AREA BOROUGH FROM: DEPARTMENT: ._~It~J.~t~II,. qlJI].l.t~ SUBJE~.~.~..~0..D.,.[~._.~~[ INITIATED BY: ~!.f...R,._..~t~!..ck!.~d.,..R.,.S.,,. Ass~., ~r,... DATE OF MEMO: DATE ANSWER TO: DEPARTMENT~ ..... ~]~I~I_J_,.~L, .[~t~..J~ J3It. R.~ ................................... REQUESTED: RECEIVER: ONLY ~ FOR.IMMEDIATE ACTION · ~jl EOR YOUR CONSIDERATION Ill .OTHER REQUESTED ACTION SCHEDULE PREPARE BACK-UP INFORMATION '~ CALL ME BEFORE YOU ANSWER NEED YOUR RECOMMENDATION ~' Tim. engineer mi ~hts part4adar case-iia~' 'p~Vtdad'-thts 'i)ep,tin~ vt~' ~iCi~'n'i~'~i'ls ! ~:...~: .... f~ ~A~..__~_ow.~~nd..appmwl. ns. s~mt t~d.. ..... .................................................................. , ' l~ ~~r ~ ~ts ~rtl~lar s~tvtst~ h. p~d ~ts ~It ~ su~-;~ 1974 Anchefege, Aluka 99601 Yeur letter ef October 11, 1974 his been this iMtvtslm riIard!~ se41 mndttlI 'and eater ,!villeMifty. l~Is !~iee fs Iii ti. ~tI Imk11c aid ts ..fMa~i by our dI~i~~ t~ prIIpeCttVI ~ fa rids a~i. The t~wII~ dI not ~ ~ 1~ In tki ~VtSfen and ~i net thi poltcy of tkts dIpartIK n~r Is ti IIOd pabllc pelt~y to rIoIiead pu~eh~ ~d' 1I~1 ~ttheIt the kI1edII t!~t this la~l Is i~l~!.i di~eligInt I~ler II the fine1 ele~tig betng Itgi~, lO~f S~lCk!md, R.S. $~ItII'I1y,' then. Ne find that _.thts a lot tl~y do.ne~ y~ eaa. GREATER ANCIIORAGE AREA BOROUGH 104 IVest Northern Lights Boulevard Anchorage, Alaska 99503 2265 Plat Status: Final Date: May 4, 1971 BOROUGH: Engineer ~_~th: Dep~U~e~lt, Public Works Department Sand Lake Fire Department School District Street Names Tax Assessor Alaska Department of Highways Alaska Railroad Anchorage Natural Gas Corp. Central Alaska Utilities Chulach Electric Association CITY OF ANCHORAGE: Fire ~arshal Hunicipal Light ~ Power Department Property Management Officer Public IVorks Department T~lephone Utility Traffic Engineer Water Utility GAB Telecommunications, Inc. Matanuska Electric Association Matanuska ?~lephone Association Assistant Superintendent orals Re: Subdivision / ~~t~/I~Cv~XXXXXXX Description of Property: Conifer Heights Okme r: Walley Martins, Et al. Gent lemen: Petition Jms been received by the Greater Anchorage Area Borough Planning and Zoning Conumission £or the proposed subaivi.~n , o£ subject property. Attacked is a copy of the proposed plat. Will you please submit your co.eats in ~riting, specifying any easements or other requirements that your depart- meat or agency may need. If we do not hear from you by May 4, 1971 , we will assume that you do not wish to submit any comments. If you have no further use for tho attac~ed print, please return it with Four co.eats. Enclosure Planning Department