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HomeMy WebLinkAboutCONIFER HEIGHTS BLK 2 LT 3Conifer Heights Block 2 Lot 3 #015-093-32 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES to e_ S TO SEPTIC ABSORPTION WELL Address FROM TANK FIELD 3 i5 W N 1TE IN'T. Phone(s) Permit No. No. of Bedrooms WELL /+�j f LOT LINE , LEGAL DESCRIPTION 0 V Lot Block Subdivision J7 &— S FOUNDATION ,A f Township, Range, Section ` ` AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, .J driveway, water bodies, etc. TANKS ISI SEPTIC ❑ HOLDING ManufacturerCapacity in gallons ereC I of Sic Material No. of Compartments TYPE OF SYSTEM Pi -0E O (]-.TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER RIVE: Depth to pipe bottom from Total depth from original grade r original grade 5"'FT FT Fill added above original grade Gravel depth byneath pipe (0 FT U FT 4 uc Gravel length Gravel width t t FT 36 FT N �s Total absorption area " Distance between lines Distance Six 4" FT Q PA FT 15 f Number of lines Soil rating Pipe material • p� SOFT 4 sT'M D 303W PPC. Installer 1 Date Installed 01 ---89Ic c ,�Ako C. ,oN o , WELLS ` 36 F41,o OT fel PRIVATE ❑ OTHER (Identifv) o Classification (A,B,C) Total Depth Cased to2 FTJ FT .G C O 4 S Installer Date Installed: !�11 7to REMARKS: 4 _t U ( ,a1 t t Seale: 5. ENGINEER'S SEAL U� t tJML e2k 0Inspec ormed by: Date: /0-14f —8 1 Gi T� !~ • -. gyp. r•••• r• rM!• • ••.r 0 S & S ENGINEERING I certify that this i pection s performed according to all Ifo...... r 4No. L„ 17034Es�l�r�a aglRiver o• 304 1 10L Show ,2 Municipal ago -J,'. 1407.g�'"� Z o �1111 Health Department Approval: Date: ; OFE13$0 .per 72-013 (3/85) � � ^ MUNICIPALITY OF ANCHORAGE Department of Health & Human Services 825 L Street, Anchorage, Alaska 99501 343 WY ON-GITE SEWER Permit Number: 890097 Upgrade Date Issued: 06/21/89 Engineer Designed Owner Name: BILL JONES Owner Address: 8135 WHITE DR. ANCHORAGE, AK 99516 PERMIT 1WgqnL9 —1 Day Phone: 279-3094 Parcel Id: 015-093-32 Lot Legal: Subdivision: CONIFER HTS" Lot: 3 Block: 2 Sections 13 Township: 12N Range: 3W Lot Size 43560 (sq.{t. or acres) Max Bedrooms: This Permit: 2 Total Capacity: 4 SEPTIC TANK: Minimum total septic tank capacity: 1,250 gallons. Each septic tank must have at least 2 compartments. Depth to top of septic tank(s) < 4.0 feet requires insulation over tank(s). INSTALL PER ENGINEERS ATTACHED DESIGN" THIS PERMIT IS ISSUED FOR THE EXISTING FOUR BEDROOM SINGLE FAMILY DWELLING ONLY AND EXPIRES ON 12/31/89. NOTIFY DHHS PRIOR TO EACH INSPECTION BY THE ENGINEER. I CERTIFY THAT: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 2 bedrooms. I also understand that the capacity of the total system is 4 bedrooms and any enlargement will require an additional permit. Signed: DATE: i9 E&I --�---��~---�--�~�~---0�'-------------- ------�-----..... -- <Owner> BILL JONES » ~ Issued By: DATE: Oe SCALE v �yI i� �1t1l +�vW 111 z-1o� Q D CJ Z r X O 4 0 f n ra ns � i ^ •mak , y D CJ Z r X O 4 0 f n L D CJ Z r X O 4 0 e Municipality of Anchorage / • .� DEPARTMENT OF HEALTH & HUMAN SERVICES «• ....��.« 825 "L" Street, Anchorage, Alaska 99502-0650 4 too SOILS LOG — PERCOLATION TEST + Rekwt A. 6h*#w a :✓ �, •• No. 14,974•r ���" PERFORMED FOR: DATE PERFOR�� p LEGAL DESCRIPTION:N I X Ffe ` aTownship, Range, Section: SLOPE SITE PLAN QF,Er,✓ TTI ✓ 7 WAS GROUND WAT ENCOUNTERED? S IF YES, AT WHAT / y // DEPTH? Depth to water Afte Monitoring? .09 //01 0; ho/. COMMENTS PERCOLATION RATE PERFORMED@'& g 6NGINEERtNG I 72-008 (Rev. i v S L O P E PERC HOLE DIAMETER — FT i k�— CERTIFY THAT T ON THIS DATE. DATE: PERFORMED IN MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME C - ZW--❑ PHONE 211NEW UPGRADE MAILING AD ESS 70 LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS Well Absorption area l � Dwelling PERMIT NO. ` DISTANCE TO: b d 2 U Y a22 Manufacturer Matert-V No. of compart ents W 1.. ti Liq. capacity in g Ell IF HOMEMADE: Inside length Widt Liquid depth J DISTANCE TO: Well Dwelling PERMIT NO. QZ 2 z < Manufacturer Material Liquid capacity in gallons D DISTANCE TO: Well Foundation Nearest lot line PERMIT N ©�s w= /001 J LL Z No. of lines/ Length of each line Total length of lines Trench width Distance between lines F• ? W - _ Inches Top tile to finish Material beneath tile Total bsorption CcH of grade /f effective area p `Q ineHee 400 Length Width Depth PERMIT NO. W C7 a 1-- Type of crib Crib diameter Crib depth Total effective absorption area wa W N Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. J W $ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS may, ` t SOIL TEST RATING/so INSTALLER 710 REMARK AAL 1 / % APPROVE DATE LEGAL�- 72-013 (P%v. M8) l.J December 29,-1978 #780259 Leel He Cann 4701 Business park Boulevard Anchoragar Alaska 99503 Subject: Lot 3 Block 2 Conifer Heights ;Subdivision A permit issued by thin -department for well and/or sewer system has expired, Permits are issued on a calendar year basis;as stated on the permit, by, authority of Municipal ordinance` if you have drilled the well, a well log should be sent to this department to document the installation dates if therein aro any further questions, pie a contact this office at 264-4720. Sincerely, ' Les N, Buchholz, R*S. Senior Environmental. Specialist LNB/ljw enc t copy of permit { -a�&cf. � THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E:*-*,���F:---""'T"0--,--H= 1.1.0 f=5uA_ �������+= � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRFINFIELD. THE DEPTH OF H 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 OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). ��IG:.'! LJ :1 E> ����1 1:0 ���� 1 = TO TS 0 ���L. C3 54� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. ___ -1— 14 C3 .1 12 la ��A"*-_---_­-'lF=-:" E=1 (0 K :1 (3 04 E3 F1 F1 EE: #--1 1" FR K E> BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL/ OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAY,.`-'' OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS HRE AVAILABLE TO INSURE PROPER INSTALLATION. �E.---�0 - U : E - T- ��F: *," I F ;. _'�" a A���� I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON—SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE 15 REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. ' zii 5IGNED:_ ==wvw ---------- APPLICANT ________HPPLICHNT LEE MCCHNN ` ISSUED BY_ ----------- DATE ---------------- YI2 �1��P�I��������_ DEPARTMENT / -0: -T. ������ ������� �EHLTH HND 8NMENTHL �TECTION ' ��=—' ��cy 7� // ' n�— 825 'L STREET, HNCHO 9( E, HK. 995u1 '~^^ 264-472(9 ' ���� ��� PIP Pal ����� ������ PERMIT NO. ( 780259 APPLICANT LEE MCCANN 4701 BUSINESS PARK - 274—]50 _ / LOCATION CONIFER HTS / LEGAL L] B2 CONIFER HTS S/D LOT SIZE 42869 SQUARE FEET TYPE OF SOIL HBSORBTION SYSTEM - IS: TRENCH � MHXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 150 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E:*-*,���F:---""'T"0--,--H= 1.1.0 f=5uA_ �������+= � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRFINFIELD. THE DEPTH OF H 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 OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). ��IG:.'! LJ :1 E> ����1 1:0 ���� 1 = TO TS 0 ���L. C3 54� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. ___ -1— 14 C3 .1 12 la ��A"*-_---_­-'lF=-:" E=1 (0 K :1 (3 04 E3 F1 F1 EE: #--1 1" FR K E> BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL/ OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAY,.`-'' OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS HRE AVAILABLE TO INSURE PROPER INSTALLATION. �E.---�0 - U : E - T- ��F: *," I F ;. _'�" a A���� I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON—SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE 15 REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. ' zii 5IGNED:_ ==wvw ---------- APPLICANT ________HPPLICHNT LEE MCCHNN ` ISSUED BY_ ----------- DATE ---------------- YI2 • GRErt ER AN01OR"I AREA BOROUGH DEPARTMENT OF ENVTRONMF►ITAL QUALITY • 3330 "C" Street ANCHORAGE, ALASKA 99503' ,¢, Case # Performed For �FE Me-C4NN Dated Performed y l AM Legal Description: Lot____Block 2 Subdi vi s ioneCiA ,7c€ Sur; This Form Reports Soils Log_ t/` Percolation Test - Soil Test Must Be Logged To 4' Below Proposed Seepage System Depth Feet Soil Characteristics t IQed -av% KL sr. p Iravcl1 Sam , :'� � /- `g Arty -1 d?w.� Grdvc� let.$esp 5LvWe very 9,,* a — SP 9drw . 13- 14 3 --CA .a �,,, ' 5a,.,oly f rays I , CLea� ' �' N% � � ��3dv►,, t S•� C., b s Ground Water Encountered? No If Yes, At What Depth? MOMMMM I am-©MM"M MMMMMUM'1 Reading Date ■i©MNTMM Net Time Depth to H 0 Net Drop OF ACS'411 aMFMM-*Mam EMINNIMEMM MMIMMMMMI ■N'M.."IN MINE EMIMEMMUM lice, MMIMMMMIMM NNIMMENIM NO. 3 30 E ♦ ;'i .7 .' ■�M■ ■� m MI MOMMMM I am-©MM"M MMMMMUM'1 Reading Date Gross Time Net Time Depth to H 0 Net Drop OF ACS'411 NO. 3 30 E ♦ ;'i .7 .' Percolation Rate Minute •4"'.ve.;;"141"`".r:X'�' Proposed Installation: Seepage Pit Dr�.dti�• Depth of Inlet.__ .4 _ Depth to Bottom of Pit or 12' COMMENTS: Test Perforated-Ar.�,�.....r-�" Date Certified BY: - tvr .• aray. A,Q10 TApVA rirriF . ^ni/t7n7 Date: Qbba4-� .3 L,.e,.0 V% T Cr"4111jjebCl) /++-� _f Lit 0-.-, pcYA CDQYV` -y J i s-. 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Anchorage, Alaska, 960xi~-, �zca�.auNF,�c�aaCcz NEIN PHONE NUMBER t k SOI�,�ABSORPTION SXSTEM TEST` �kERF4�D FOR: -r DATE-..OF.-T'ESTIr vS 1irYaa *f ~.?.BEDROOMS:.RECORDS ON FILE: DRAINFIELDOTHER BEST P"MFORMED IN ACCORDANCE WITH JML STANDARD PROCEDURE ACEPT' 1 q Mt?NIC PALxTX OF ANCHORAGE DEPT. OF ENVIRONMENTAL QUALITY, ON 1 �J�1TH THE FOLLOWING MODIFICATIONS:`' 24012 4 S`QRGE gAPAC1TX : o1z' �f r SOIL ABSORPTTOI`i SXSTI ( SAS) W�;, " SEPTIC TM, PLUS SAS } 5 ` AB;$.OR?TION vn RATE bre s �g ti im .` VR ; AV AGE 24 hrs ' 4-,g? c's�� ,....r,.. STEADY S'�A'� t; OBSERVA IONS t NOTES:, F t x T BY: ' R"r RT BY: NU h �FERFOR�%D SIMV1l,7.ED BY: °mom TEST A ATT ED :DA, sy ti r 6�14- ^!00 rTp S 4:4 �f♦ 4 t° m �"i yF3 � r rn?!fir• 3 �, ; r' ,'. � � _><, r y, > rpt�.•�4e, P.E. 4703'NVfYfI 17MpStestI'Ei� NfI�Rs,000 ;,:7,`w� ,s• g[i d -+ h Tko , G5 �M PERFORMED BY: r' � � tx-,GAL,FaCRIPTION : ' x 5 r, ''3ELUW METER .READING GALLONS P�M1ED T E G S: #� yl t i M E f 8301's a► 10 #Kf 111M r� Fg "� A nt Vii M �' + 4 rp. a ie `'e. 4C *t } 1 c 4; k'�� S y i a . ;3 5 �A i`t`f i r r P C Municipality of Anchorage APSE: BG ® Development Services Department G Building Safety Division _ On -Site Water and Wastewater Program s 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. DiS -093 —32 COSA# osc�a�'sa Expiration Date: �y 1. GENERAL INFORMATION Complete legal description L-ef 3 13/®c b; Wr -� /_/ ❑ Individual Holding Tank ❑ Community Class Well Location (site address) _ 8 17 fko/1 f>,^ i . e Current Property owner(s) DGt r1 n./ Pccr-eCIl k Day phone 3 di y - at3 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 813 d /,&A,l-e D,-iwa 1, A-c6ol,52• gA4-, 99x16, Day phone Do -,e 11ts,noCsc3r )10-ttax Dayphone 727-3200 Unless otherwise requested, COSA will be held by DSD for pickup. P lege — »ct, 1 o,- 6e fl/ 13 tG 13U,, u t>7 L 0_c A u tie Gf y {v P, c L -e erg 2. NUMBER OF BEDROOMS: �J u�rneCScp.-�J�e1 eel k o. n.tf 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 sample results. (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. 4. 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. Name of Firm r to EL04 'fit < � "I cox I S e +~ (e <, Phone 3 Y_. —;,2 Address t`lS3G l�tAc Can�a� liact®% ?3nch,� /�9Sl� Engineer's Printed Name Date —7 4.APleed avmm ampmmwpB09g?:Ts 5. DSD SIGNATURE d } °auoRE r. rckk, cc - 93°�S Approved for �p _bedrooms. ait3l� aemoaA` F Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory _ Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: az Original Certificate Date: �2— (Rev. 1ros) Municipality of Anchorage Development Services Department fi = 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 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: L -O S, 1'� 2 (a h , J!�fr "tX SID Parcel ID: CIS--090--32- A. rS-093"3Z A. WELL DATA Well type Pw f If A, B, or C provide PWSID # N • A , Well Log (Y/N) `f Date completed 3 /S / -79 Sanitaryseal (YIN) 'r Wires properly protected (Y/N) `r Total depth U ft. Date of test Static water level Well production Cased to IS ft. FROM WELL LOG 5/S/ it -79 WATER SAMPLE RESULTS: 173 7 ft. 12 -M Coliform colonies/100 mL Nitrate 7.2Y mg/L Arsenic: 4JC ug/L date of sample: 7/3)/Wit B. SEPTIC/HOLDING TANK DATA Tank Type/Material See7';c Tank size 1 ?SO gal. Number of Compartments 2 Casing height (above ground) 1'2in. AT INSPECTION 6/2S/z0�2 7'1P ft. g.p.m. Collected by: Fl,*&e Tech Suc Date installed S/�9 / /9 -79 Cleanouts (Y/N) Y Foundation cleanout (Y/N) v Depression over tank (Y/N) N High water alarm (YM) N Dateofpumping rO //9/2011 Pumper AIOr/-7 lefPat C. ABSORPTION FIELD DATA Ib /Z7/ B i5U Tr[nc4 Date installed 5"/'z9 / 7? Soil rating (g.p.d./fe or ft2/bdrm) I System type Tne r+e L, 2s- 3 Length 51 ft. Width *3 ft. Gravel below pipe ft. 300 Total depthI �-/ ft. Eff. absorption area 6 12. ft2 Monitoring tube Y Depression over field N Date of adequacy test 6 / 2-9 / 201 2 Results (Pass/Fail) Pyr For _�' bedrooms Fluid depth in absorption field before test 35-6 in. Water added 7Z9 gal. New depth 6f in. Elapsed Time: I',!3 min. Final fluid depth -T6 in. Absorption rate >= G o6' g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) ISG he n mei, n If yes, give date N, A D. LIFT STATION %) P A. Date installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off' level at —in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot go, Absorption field on lot > t ao Public sewer main W R. Sewer /septic service line > '-S'' Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. On adjacent lots > 10 G ` On adjacent lots > 106 r (10%, b Public sewer manhole/cleanout M, .4 Holding tank N. A. Animal containment areas Nave e = > tGo � Manure/animal excrete storage areas Mone : > t do r SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ^ 15' Property line ^ 60' Absorption field Water main N • A, Water service line > is ' Surface water �i t GG ' Wells on adjacent lots > 166 ` SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 125, Building foundation > to ' Water main > 10 r Water Service line �> 101 Surfacewater ::? 10 6" Driveway, parking/vehicle storage '> To' Curtain drain None Seen Wells on adjacent lots > rcy ' F. COMMENTS * W6t rdee' re v t4,e t r, G. ENGINEER'S CERTIFICATION .'r' �'•<.^f �n ae 1 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 GCCD✓� l=• P7G G> "m Ti'r i;,)6rLR F. MOORE Date 6I Z3 / 2.012 ` ce.3,av �81,�31 COSA Fee $ !-f go Date of Payment g] s--) I la. Receipt Number ®35�Ti C (Rev. 4110) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage • _`o Community Development Department Development Services Division a E. On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 121382 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 3 of Conifer Heights subdivision. This inspection revealed a nitrate concentration of 7.24 milligrams per liter (mg/L) was reported for the property's well water sample. 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. Municipality of Anchorage P.O. Box 196650 0 4700 Elmore Road Anchone Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program Ment at,,, Deparent **** VARIANCE/WAIVER REVIEW **** Waiver#: OSP121286 COSA#:OSC121382 Permit#: PID#: 015-093-32 Legal Description: Conifer Heights Block 2 Lot 3 Engineer: Flattop Technical Services Applicant: Danny Purceila Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 96.0 feet. This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. •.............................................................................. Waiver is Granted: X Waiver is not Granted: Date: Approved by: /t7p� rz Name of Reviews ...........................................................• ...................• Rec#: Amount: $0.00 Date Paid: **** VARIANCE/WAIVER REVIEW **** Conifer Heights Subdivision, Block 2, Lot 3 Parcel ID: 015-093-32 Waiver for 96 feet from well to tank 9/5/2012 General 1. Surfacing effluent from the tank will flow away from the well. 2. The well was inspected with a camera and there was no breaks, cracks or perferations. The pitless is sealed. 4. If the well met the 100' separation, the total points would be 15.2, within the same range established by the ADEC. ADEC Criteria Points Water Table Depth of water bearing zone in well 146 feet Assumed bottom of tank 9 feet 137 feet 7.2 Soil Sorption Soil descriptions Permeability Soil descriptions DEC PTS Depth From Depth To Thickness Calc. Pts Sand, gravel, silt 1 9 20 11 0.08 Sand, gravel 0.8 20 42 22 0.13 fine sand, gravel 1 42 110 68 0.50 sand gravel 0.8 110 146 36 0.21 110 146 36 0.26 0 0.00 0 0 0.00 137 0.92 0.9 Permeability Soil descriptions As per ADEC waiver guidelines, with a minimum point value of 15.0, no bacterial polution possible but chemical pollution possible but unlikely from household chemicals. DEC PTS Depth From Depth To Thickness Calc. Pts Sand, gravel, silt 1.3 9 20 11 0.10 Sand, gravel 1 20 42 22 0.16 fine sand, gravel 1.2 42 110 68 0.60 sand gravel 1 110 146 36 0.26 0 0.00 0 0.00 137 1.12 1.1 Water Table Gradient - Assume -0% slope 2.9 Horizontal Separation 96 feet between septic field and well 2.84 Total Points 15.0 As per ADEC waiver guidelines, with a minimum point value of 15.0, no bacterial polution possible but chemical pollution possible but unlikely from household chemicals. OnSite Wed Sep 05,16:20:15,2012 Map: OnSite Scale 1:600 Legend: PARCELS ELEV ANICH-C( Txt ELEV ANCH TE SEWERPIPE STREAMS Txt STREET NAME WATER—PIPE CityVieWTM Municipal Software Corporation it 0 IV 001 m I FLATTOP TECHNICAL SERVICES CIVIL & ENVIRONMENTAL ENGINEERING " ENERGY CONSERVATION 8 ANALYSIS TED MOORE, P.E. 14530 ECHO CANYON ROAD PH./FAX: (907)345-1355 ANCHORAGE, AK 99516 E -Mail: tgmoore@gci.net August 23, 2012 MOA On -Site Wastewater Program P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: By means of this letter we are requesting issuance of a waiver allowing the existing septic tank serving the 4 -bedroom residence on Lot 3, Block 2, Conifer Heights to be approved for COSA issuance at a distance of 96 feet from the private water well on the same lot. A site plan, a well camera report and copies of relevant documents from your files are enclosed, along with the COSA application. According to the driller's log, the well was drilled in May of 1979 and has a reported total depth of 156 feet and a reported yield of 12 gpm. On the date of my test the static water level stood at 140 feet below the top of the casing. Steady pumping of 729 gallons of water from the well at an average rate of 5.3 gpm caused the water level inside the casing to be drawn down to 141 feet, but no further. Based on this performance I determined that the sustainable yield of the well is in excess of 5.3 gpm. According to records on file with the Municipality, the original wastewater disposal system was installed in February of 1979 and consisted of a 1250 -gallon steel septic tank that discharged effluent into a 51 -foot long soil absorption trench with 6 feet of gravel beneath the horizontal distribution pipe. The system was upgraded in October of 1989 by the addition of another 25 lineal feet of soil absorption trench. On June 28, 2012 I conducted an adequacy test of the septic system while the house was occupied. The initial fluid depth in the trench monitor tube was 56 inches, and the addition of another 729 gallons of water to the system caused the fluid depth in the trench monitor tube to rise another 12 inches. After the flow of water was stopped the fluid level receded 10 inches in a little less than 2 '/2 hours, which corresponds to an absorption rate of more than 600 gallons per day. The Municipal inspector's report pertaining to the installation of the septic tank in 1979 reports the separation distance between it and the well to be 100 feet, and subsequent documents in the file also report that distance. However, my measurements made at the time of the recent adequacy test, as well as the surveyor's measurements made in the course of preparing the enclosed as -built survey, indicate that the closest septic standpipe is only 99.4 feet from the well. Thus, allowing for the maximum projections of the tank and the well casing, we are requesting a waiver allowing the septic tank to be approved for COSA purposes at a distance of 96 feet from the well. It is recognized that the present tank is quite old and will undoubtedly need to be replaced in the not - very -distant future; however there is no sign of settlement over the tank at this time and the latest pumper's receipt does not indicate any problem with the tank. At the time when the tank is replaced it should be feasible to achieve the required 100 -foot separation between the well and the new tank. Water samples collected from the well on July 31, 2012 show no coliform bacteria, less than 5 micrograms per liter of arsenic and 7.24 milligrams per liter of nitrate nitrogen. The nitrate level is up significantly from the 0.12 mg/1 which was measured in October of 1989, but most nitrate levels in this area have been increasing in recent years and the present level is consistent with nitrate levels recently observed on adjacent and nearby properties. Thus, there is no basis to conclude that the observed nitrate level is somehow attributable to the proximity of this septic tank. According to the driller's log the well was drilled and cased to a depth of 156 feet, and has a static water level at 137 feet. This deeper -than -normal static water level should provide added protection from locally originating contaminants. Per your request I arranged with Aarow Pump and Well Service to run a camera down the well casing; their attached report confirms that there are no observable breaks or perforations in the casing or leakage around the pitless adapter. I trust that the foregoing analysis will enable you to grant the requested waiver and issue the requested COSA certificate. Please give me a call if you have any questions. Sincerely, Ted Moore, P.E. cc: Dave Windsor windsor�c�alaska.net -----......... i I I I 1 I 1 I i WHITE DRIVE _.--------------'________________________ I I I 1 1 I -----10' st3ifE SMT.,- WELL i jpl I ;k=100' i I' ! WELL DRIVE W w - I SEPTIC U LOT 7A AREA BDRM BLOCK3 HOUS HOUSE z PROSPECT HTS. #1 i 1250 -GALLON --. ---------- ... SEPTIC TANK LOT4 BLOCK 2 SOIL ABS. TRENCH I W LOT 3, BLOCK 3 NO WELL?' CONIFER HTS. WITHIN 100'OF SEPTIC I IL i r, i 1 �.Q ..... LOT 2 . , LOT 3, BLOCK 2, CONIFER HEIGHTS �'�.+ BLOCK 2 SEPTIC TANK WAIVER "49�" * t0, SITE PLAN .C.f....................... % -- — /.f ,.,.. ; ........... / FLATTOP TECHNICAL SERVICES 1 INCH = 50 FEET ♦♦p� :: THEODORE F. MOORE• 14530 ECHO CANYON ROAD I DRAWN BY TFM ♦'� •� CE - 3589 . ,O� ANCHORAGE, ALASKA 99516 AUGUST, 2012 Ar +,1` gofessl =♦- NOTE: THIS IS NOT A SURVEYED PLAT, ALL LOCATIONS SHOWN ARE APPROXIMATE. ,AAROW PUMP & WER SERVICE, LLC = UVI-1 �70! Z P.O. Box 110496 Anchorage, AK 99511 ;.,. L.` ` N®, 9517 Office: (907) 346-9355 • Fax (907) 345-0202 Eagle River: (907) 622-9335 S ' / I CUSTOMER JOB SITE _ I, -f F -1 INVOI('E OA.E WELL DEPTH SWI CHLORINATECPUUP DEPyH SALESPERSON 'QUANTITY DESCRIPTION PRICE AMOUNT <3 � r ( I s [ n LABOR HOURS RATE AMOUNT TOTAL MATERIAL I TOTAL LABOR i/ ZZ ' i i WORK ORDERED BY DATE COMP. TOTAL LABOR PAY THIS AMOUNT Thank You SIGNATURE (I Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that if above work is not paid for in 90 days I agree to allow Aarow, Pump & Well Service, L.L.C. the right to remove unpaid for equipment and charge for labor already performed & labor to remove unpaid for equipmeni.) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. N 89 54' 00" E 152.20 • " U 'SHANE A. HOLT LS -6914.' . AS -BUILT SURVEY 1" = 30' NO CORNERS SET THIS DATE v 0 0 Z: I HEREBY CERTIFY THAT I HAVE PERFORMED A Sl OF THE FOLLOWING DESCRIBED PROPERTY LOT 3, BLOCK 2, CONIFER HEIGHTS ANCHORAGE RECORDING DISTRICT. ALASKA. AND " MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # nk �z - 7�CII - 22 HAA # �6) \C�go\(C) �- 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) LUT 3; BLOCK 2; CONIFER HEIGHTS SUBDIVISION Location (address or'directions) 8135 WHITE DRIVE, ANCHORAGE. (b) Property owner BILL JUNES, Telephone: (home) Business 279-3094 Mailing Address 8135 WHITE DRIVE ANCHORAGE ALASKA (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent JACK WHITE COMPANY ATTN; BARBARA PARKER Address 3201 C STREET SUITE 100 ANCHORAGE, ALASKA 99503 Telephone 563-5500 (e) Mail the HAA to the following address: (or check here [XXf hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17014 liagle River 1 00P Road No -204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family [XX 3. WATER SUPPLY Number of bedrooms _ 4 Individual Well EX Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site IXX Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional :and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date Telephone S & S ENGINEERING Road No. 204 1;034;:a gle River Loop Eagle River, Alaska 9957.1 /o ~ftFF 5 Slv��v 4r 6. DHHS APPROVAL Approved for bedrooms b w Date ,d/7 /e Approved Disapproved Conditional Terms of Conditional Approval "115— CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 A. WELL DATA ICI PALITY OF ANCHORAGE (MOA) ,lealth Authority Approval (HAA) CHECKLIST FEBRUARY 1984 3d3-d7dd Q'1_ " OC Legal Description: /-- 3 6 2 �.us,7e� !dam t o�it �S S r�• Well Classification 54 rJG (e t' vm t !U If A, B, C, D.E.C. Approved (Y/N)— Well Log Present (Y/N) _ Date Completed ` 5 9 Yield 3. a- rm 5 - Total Depth��� Cased to T�, Depth of Grouting a2 q Static Water Level /4 ;Z Pump Set At Casing Height Above Ground �a 't Sanitary Seal on Casing (Y/N)— Electrical Wiring in Conduit (Y/N) tw Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot / e)0 t ; On Adjoining Lots / 00 + To Nearest Edge of Absorption Field on Lot I On t ; On Adjoining Lots ( 00 �'t To Nearest Public Sewer Line N To Nearest Public Sewer Cleanout/Manhole ti A To Nearest Sewer Service Line on Lot Q ;5� t Water Sample Collected by��d �N5'�P�� ; Date Water Sample Test Results (o't Comments B. SEPTIC/HOLDING TANK DATA Date Installed 221&12 Size 1,2 1S - a No. of Compartments Standpipes (Y/N) — —Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) n1 Dade Last Pumped as 01144 51 Pumping/Maintenance Contact on File (Y/N) Q /A ; for N L4 Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/ TANK: To Water -Supply Well / no t To Building Foundation r o -r- To rTo Property Line /o + To Disposal Field T00 / f" To Water Main/Service Line To Stream, Pond, La -knee or Major Drainage Course t DD -L Comments &�I « 1")lX'1 rev yo'Ln� Ly A r Anm-�e S(fy'01Lc 72-028 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption ftrata `� ���� Type of System Design I�NcIn Date Installed 25(A� A 1 Length of Field ! 1 teas pvr�c,��1 6 tfai Width of Field 3 b �) Depth of Field I Gravel Bed Thickness Square Feet of Absortion Area 6QO oo U01 f = 500 0 Statndpipes Present (Y/N) I Depression over Field (Y/N) _ Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well 100 ,11- To Property Line To Building Foundation —6 To Existing or Abandoned System on Lot N �rA ; On Adjoining Lots f" To Water Main/Service Line f C) t To Cutback (if present) r To Stream, Pond, Lake, or Major Drainage Course 00 f r To Driveway, Parking Area, or Vehicle Storage Area Comments6,? u04 ( 0, Z/ - Q, D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect o inspection. 10 Signed S & S ENGINEERING 17034 Eagle Kiver 11;=p Road No. 204 Company ska 995T! Date Z MOA No. Receipt No. Date of Payment v a Amount: $ Receipt No. Waiver Fee: $ Date of Payment 72-028 (Rev. 7/88) Beck Page 2 of 2 i • •AL N % Na 144 \ CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 \ FEDERAL TAX ID # 92-0040440 Client Sample ID:L3 B2 CONIFER HTS. PWSID :UA Collected OCT 20 89 @ 13:00 hrs. Received OCT 20 89 @ 13:00 hrs. Preserved with :AS REQUIRED ANALYSIS REPORT BY SAMPLE for Work Order # 17682 Date Report Printed: OCT 24 89 @ 09:55 Client Name S & S ENGR Client Acct SNSENGP P.O.# NONE RECEIVED Req # Ordered By : R.P. Analysis Completed :OCT 20 89 Send Reports to: Laboratory Super i or :STEPHEN C. EDE 1)S & S ENGR Released By �_ 2) ..................................................................................................................................=. Special Instruct: Chemlab Ref #: 8155 Lab Smpl ID: 1 Matrix: WATER Parameter Tested Result/Units ----------------------------------------------------------------------------- NITRATE-N 0.12 mq/l Sample ROUTINE SAMPLE. Remarks: COLLECTED BY R.P. Allowable Method Limits -------------------------------- EPA 353.2 10 V. 1 Tests Performed See Special Instructions Above UA -Unavailable ND= None Detected "` See Sample Remarks Above NA= Not Analyzed LT -Less Than, GT -Greater Than CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. &I - TELEPHONE (907) 562-2343 5633 B Street .� Anchorage, Alaska 99518 pa v �°�•• Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY ❑ PUBLIC WATER SYSTEM I.D.# I I____ tb . P< PRIVATE WATER SYSTEM Name Phone No. S & S ENGINEERING Mailing Ad w Eagle e' Loop o8 o. Eagle River, Alaska 99577 City rnState Zip Code SAMPLE DATE: 1z 166 ' Mo. Day Year SAMPLE TYPE: 4—Routine El Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected By 3 1 4 S 1 1 G� READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Anai SIS shows this Water SAMPLE to e. atisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received to Time Received /360 Analytical Method: Membrane Filter * No. of colonies/100 ml. Lab Ref. No. Result* Analyst 8155 m ED FT -1 L� 1 m BACTERIOLOGICAL WATER ANALYSIS RECORD��� I Membrane Filter. Direct Count Verification: LTB BGB Collform/100ml Final Membrane Filter Result's 0 QColiform/100mi Reported B��`�.� Date iSZTt� , Time: a.m. p.m. TNTC = Too Numberous To Count PART ONE OF TWO OB = Other Bacteria REMINDER TO. FOLLOW MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL�� OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date Mm 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) COKIEGr- 141%W15 . L 7 3 . &LOCK- 2 - Location (address or directions) S1 S5' WH IM PIZWE ANWORAGC , AY (b) Property Owner ANDM\N POTYS Telephone: Home Business 34-X1-(45,' Mailing Address '5kng A5 A00V6 (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: or: Check here if hold for pick up. List contact person and day phone number below. :34-9-64-51 - AWDCI�E.1 ?&TT S 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms I�(3UR 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite l?� Public 11 Community ❑ Holding Tank 13Note: If/community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRev 8/86) Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA i H AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. r� Name of Firm M �R y�►J6E�,1►JG, Telephone 349— 2-1 E37 Address 7601 VIP—DA LEE CL Date MAY 67 6. DHHS APPROVAL Approved for bedrooms by Date Approved x Disapproved Conditional Terms of Conditional Approval F iL CAUTION NE0, The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 faev 8/86) Back MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL SERVICES DIVIS►ONEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MAY 41987 264-4744 Legal Description: Cow wyZ 4'6iNT5 RECEIVED LOT 3,,1aLDCK2 A. WELL DATA Well Classification PRI QATE If A, B, C, D.E.C. Approved (Y/N) , PW- qL LOGr l2 60A Well Log Present (Y/N) Date Com leted 5 APR -7q Yield ThI65-r�l" _ 5.0 ciPm *40' Vis �hla-Y Total Depth ���� Cased toDepth of Grouting Static Water Level l3-7' Pump Set At UNKNOWN u Casing Height Above Ground Sanitary Seal on Casing (Y/N) yEs Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) NO Separation Distances from Well:. To Septic/Holding Tank on Lot 4- 100 f ; On Adjoining Lots +" 1�0� To Nearest Edge of Absorption Field on Lot } (00 ; On Adjoining Lots .+ im t To Nearest Public Sewer Line 4-751 To Nearest Public Sewer Cleanout/Manhole + too To Nearest Sewer Service Line on Lot +25' Water Sample Collected by ; Date 30 AeIZIL $52 Water Sample Test Results �P�'►SF�gbPy Comments 6E�e MTp&en (p(a WEU. TEST PMO WkTf'z- ".-.00.5 OJESULTS B. SEPTIC/HOLDING TANK_DATA Date Installed P1 mT Size 1250 yA'' No. of Compartments Standpipes (Y/N) ES Air -tight Caps (Y/N) �ES Foundation Cleanout (Y/N) Depression over Tank (Y/N) N0 Date Last Pumped 41 - 2- -Seo Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) ;for Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well 4(od To Building Foundation r To Property Line To Disposal Field To Water Main/Service Line # 15 To Stream, Pond, Lake, or Major Drainage Course-Ir150, Comments A�TJ�GNE(} ( f1AP) W0121 Wo A1mPtNl �1C� 2of 51 Page 1 of 2 72-026 (Rev 8/861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 150 SI=/ B.DQ(n Type of System Design � N� Date Installed Zq "P- 1q Length of Field Width of Field 36 Depth of Field j 21 Gravel Bed Thickness Square Feet of Absorption Area + X000 Standpipes Present (Y/N) \4E6 (1) Depression over Field (Y/N) NO Date of Last Adequacy Test M g% Results of Last Adequacy Test.��� aD Separation Distance from Absorption Field: To Water -Supply Well 1001 To Property Line 42I To Building Foundation %O To Existing or Abandoned System on Lot -4,101 ; On Adjoining Lots _I' 10 To Water Main/Service Line "t" 25 To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course + 150 To Driveway, Parking Area, or Vehicle Storage Area (Of Comments 5e� AMWW 10SA1_ZTWIJ oR'T D. LIFT STATION Date Installed I Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) +50 Pumping Cycles during Adequacy Test. Meets MOA I certify that I ave chked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company MOA No. Receipt No. ®F 44 Date of PaymentOF CO Amount: $ tih 6 ®� �igi� ralj®� Page 2 of 2 72-026 (Rev 8/86) Back 0 � • . ••ecus•• •osse••eeee�,. �os••eoe e®e •..••.• e• ... •s� Ca S. Me r �® e• #6353 F. s Ab - OF AGto �f.�e�es v 9 v •e•m • • u •• •. � I Care . M•y m. 353 d� �9•. „•' �vrr %%%YOFESSI�NP� r. .6-e"Co PANK- LEVC► 88` Location: Date: / MAY 87 Subdivision: CAJIFE2 446Ur5 Lot: 3 Block: 2 Client's Name: m 01251N 701r.5 Address: 8 135 W k rm DR ANGIO P46 ., pIC Tester: CS Ai!f.L Initial Reading on Meter: (o 16'1® NOTES: Production Rate:j�GPM' 24 -Hour CapacitY_LG3 loos WPM NOTES: Production Rate:j�GPM' 24 -Hour CapacitY_LG3 loos w J m Q O� ¢ IL rn z O w CC I0 0 LL..` LL 0 w w F - z a m aw WWF_ a z w W Z 0 U m Q Z O O 73 0 3 o 0 u ):1 i 0 � U Q F- O F- < � 0 u i ¢ ¢ ¢ cc ¢ m ¢ J �'v w J —� U wv C� 0 z U ¢ = Z y > wF- LU U cc 0 w w = ¢ Z Q Q J > WIx Ao O4¢ O a w CO LL 'a i U ¢= g 0 Z 1 O a w ¢ 0 W o. F- cc w D ¢ Q v LL r <1 CLI w J m Q O� ¢ IL rn z O w CC I0 0 LL..` LL 0 w w F - z a m aw WWF_ a z w W Z 0 U m Q Z O O 73 0 3 -0 0 W, lo� 51ope EsR1t. WHITE DRIVE _o 0 East )OZ. 20' m 1 � 1 1 '16 ,eea 38.0' r a� 2.01 o� 4-1 I 6 o J (Dec Z �E,o Multi Leve.) Horne, C6 410 , n . deck h"' SePf.'e N 990 54'00''E )52.Ze) OF 4C 1 AW � �7k :..•• '�sfi.� I Or• o e•.4•e r, �l�i'" `•• •••l•• • 90 06. it Lowell Pilser t a- �0 •rt ,�p,�0•••q•••N`a�SaQr FFsslertn��A ,R,."' SURVEYORS CERTIFICATION I HEREBY CERTIFY THAT 1 HAVE SURVEYED THE PROPERTY DESCRIBED ON THIS PLAT AND THE IMPROVEMENTS SITUATED THEREON ARE LOCATED AS SHOWN ON THIS PLAT. DATED THIS �-.� DAY OF , 198 z 30.06' LEGEND --- Canf ►lever or Overhang NOTES: I. IT SHALL BE THE RESPONSIBILITY OF THE BUILDER ORO WNER TO VERIFY THAT BUILDING LOCATION SHOWN MEETS ALL SUBDIVISION COVENANTS AND ZONING ORDINANCES. 2. IT 18 THE RESPONSIBILITY OF THE BUILDER 1'0 VERIFY ALL ELEVATIONS WITH RESPECT TO ALL UTILITIES. 3. THIS PLAT REPRESENTS THE PARCEL OF PROPERTY DESCRIBED BELOW TAKEN FROM THE RECORDED PLAT DESCRIBING THAT PARCEL. INSTRUMENTS RECORDED PRIOR TO OR AFTER THE FILING OF THE RECORDED PLAT ARE NOT SHOWNON THIS PLAT. AS BUILT LOT 3, BLOCK 2 CONIFER HEIGHTS BESSE, EPPS 5 POTTS 2220 E. 88th AVE. ANCHOR AGE, A K 99507 DRAWN BY: K p.1 L_ I S CAL E : I " " 5 b _ , .+.-r.c! o i CHK BY: DATE: '7 • z 2. -Pi FLD BK DWO NO. 1. cl F E: 14, JE1RR SE fil: 1ziI.LC'I0 TYPE OF SYSTEM 'Y p} s ❑ PUNi.: } iNDIVi0UA1 0 RESUBMIT SAMPLE 16 IBLtC '$itST i) tltCl E GLASS Sample rejected because: CHECK ONE aR MORE A B C esdential ❑ Sample too long in transit. $1` M TELEPHONE NUMUE Sample should not be over 30 hours. Q Sample received too late in week ❑ Not in proper con,�iner SiEM1. RESS ❑ Leaked out CITY STATE ZIP CODE Insufficient infor-�ation pro v [3 Insufficient Please read instr__tions on form. ktAT ON M R SAMPLE S L CTi:D l ) ❑ Other (Specify) eOL1 £D Y:(S A i RECEIVED FROM ' EF:;IPLE RECF I VE D BY CHECK-ftY ONE THIS COLUMN) DATE 4 TIME C F 0?'6RINKING WATER ❑ CHLORINATED ANALYTICAL METHOD: ✓CHECK TREAINT ❑ FILTERED ❑ UNTREATEn d ^THEP MEMBRANE FILTER Q RAW SOURCE WATER ❑ FERMENTATION TUBE ❑ NEW CONSTRUCTION OR REPAIRS ❑ OTHER(Specify) ' � _ Date R Time Started +4:! � *-3o Date & Time Completed -6 2v Erns X51 IS THIS SAMPLE A CHECK SAMPLE TO A PREVIOUS NON-CONFORMIN SAMPLE? YES &46 PREVIOUS COLLECTION DATE ANALYSIS REQUESTED (IF OTHER THAN TOTAL COLIFORM) LABORATORY RESULTS Analyst y -Sm %�havLS CJ Other Bacteria SEND REPORT TO:(PRINT FULL N✓AIIE,ADDRESS ANAk ZIP CODE Test unsuitahte -_causa: � NAME[ 7 —'—'— ❑ Confluent Growt� ADDRESS 2;2 0 r .. ❑ TNTC CITY STATEZIP �'9.SL' SATISFACTORY IMISATISFACTORY ❑ F BACTERIOLOGICAL WATER ANALYSIS RECORD FOR LAB USE ONLY TOTAL COLIFORMS Memb ane Filte,: Direct Count Coliform/100ml Veri ication: LTB BGB FECAL COLIFORMS Fina Membrane Filter Results Coliform/100ml " OTHER Repo`. d By Date Time,......._._ A..M. Xq hH. h MUCTION INS IONS ON 89K OF FORK • f t W'WL0'0.0 4 4, t OLA-�'� .-N.. OnAS- arm h0 AA 06 V., 5. LEGAL DESCRIPTION 4/ Jam' DATE RECEIVED INSPECTION APPOINTMENTS TIM.`TIME DATE TIME DATE DAT ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six INSPECTOR INSPECTD L-41 INSPECTOR ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well I CC depth (attach log if available.) MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTdWf. OF i-: ,,11 825 L Street - Anchorage, Alaska 99501 ENVIRONNIEN I AL . • i : CTION • ENVIRONMENTAL SANITATION DIVISION E 980 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND f 1EI 1�ES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. P7RPERTY OWNER �7 PHONE MAILING 6PDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTI UTION PHONE MAILING ADDRESS R, f 4. R AOR/AGENT _ PHONE MA ING ADDRE 0 e).s d e"W way y 5. LEGAL DESCRIPTION 4/ Jam' STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY ❑ One -)2< Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY ��✓j y�i G INDIVIDUAL- ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM 5Z INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE `tel SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO Z'"] FOUR ❑ SIX 2. WATER SUPPLY �'K] INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER , DEPTH OF WELL DATE DRILLED �— LJ LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER _ DATE INSTALLED � C 2 INSTALLER � a T i1 (-"x Guy,,^ Septic Tank or ❑ Holding Tank Size: 1 aS_d If Tank is homemade give dimensions: SOILS RATING 1 d TYPE OF TANK S Wkj MANUFACTURER G tLsz e Y . TOTAL ABSORPTION AREA Co V MATERIAL, ��SL tJ 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS M APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter mus ccompany certificate) ❑ DISAPPROVED DATE LL4— r r - BY , 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED. TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY El MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified -PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank` Size: - - If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS L+J` APPROVED FOR _ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) DISAPPROVED DATE J �( BY (T' LEGAL DESCRIPTION 72-U1U (Rev. 3/78) `� 9 01 -V,,, ALASKA 99501 1 T' 'N May 18, 1979 '�5 -a's--) 9 Lee Mc Cann 6700 Arctic Spur Road Anchorage, Alaska 99502 Subject: Lot 3 Block 2 Conifer Heights Subdivision Approval for your individual sewer and water facilities will not be granted until the following items have been completed: (1) A weZlog is submitted to this office. (2) The top of the well casing is sealed with a sanitary seal or tightened so that it is water tight. (3) The wa er analysis report be deliverd to this office from Chem ab, 5633 B Street, for our review. (4) Your permit for installation of an on-site sewer system has expired as of December 31, 1978. We have not received the as-builts of the installation in this office. If an engineer inspected the system, please have him send us the report for our review and files. Notify this department for a re -inspection when descrepancies have been corrected. If there are any further questions, please contact this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Alaska Statebank Darrell Smith 310 East Northern Lights Boulevard 99503 Iq