Loading...
HomeMy WebLinkAboutCONIFER HEIGHTS BLK 2 LT 11 • Municipality of Anchorage Community Development Department Page 1 of 2 On-Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage,AK 99519-6650• http://www.muni.org/onsite• (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181208 PID Number: 015-093-26 ❑ New ✓❑ Upgrade Name: MARTI MOREHOUSE ABSORPTION FIELD Address ❑ Deep Trench ❑✓ Shallow Trench ❑ Bed ❑ Mound 7841 PORT ORFORD DRIVE E Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 1.2 GPD/SF 3.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 2.0 Ft. 1.0 Ft. CONIFER HEIGHTS 2 11^T Fill added above original grade Gravel length Township Range Section 2.0 Ft. 30/60 Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES 5.0 Ft. Ft. To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Lift Station Tank Line .57( -4'SirFtz 2 10.1 Ft. Well 103.5 143.4 110.7 N/A 70.8 TANK fSeptic S.T.E.P. 0 Holding 0 Other Manufacturer Capacity Surface Water 100+ 100+ 100+ N/A ANCHORAGE 1500Ga1. Material Number of compartments Lot Line 70.7 17.4 72.8 N/A STEEL 2 NA Foundation 12.8 38.3 21.4 N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ 50+ 50+ N/A ORENCO 250 Gal. Pump on level at Pump off level at High water alarm at Remarks 40 in. 36 in. 45 in. Pump make and model Electrical Inspections performed by P2005 MOA BUILDING SAETY PIPE MATERIAL House to tank 3034 Tank to Installer drainfield 3034 DEANS CONSTRUCTION Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 814ft Inspection 5, Location and description dates: 1 7/25/18 2n0 7/25/18 p 3" 7/25/18 4th 7/30/2018 AT HOUSE POINT B COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp .4,,�\\\\ Conditional Approval: Date ��. A(,4Sjl! tol*:.. a " v Vt.e'veri R. 'Pon � CE 8149 A ' I� 9 mss.. ,..:" Approve `�-- l DateS2-6-1 p }i 4,`D ,. , l Aoit�t j�ei\\1�` Inspection Report_1-1-12.doc b / kl/k-8 TEa . , WELL E Ri v -_- r� Q) 110° 4 'o's�o ► ABANDONED DRAINFIELD PERr ***:)may 4 Slope MOA CODE /•-i r ** - I, ri ..... 44\ ` l- L ~fir 1 28.1 DRIVEWAY11r Wier .-'!°..!°>"\ O �� .>1' 04-1•:. ,� ;, TRU NOR: 'ALE : 1"= 50' OMPSON / Pf 103.5 ♦ *(-----Tfr: ( `�e C4 17.4 B' M4 FD n T� T2 LS�� 1 411111111111 Ct 11 / WELL Q 8t6 ,,�y ,�,• �' (E)\ ( DCO '� k ,��M1i820 \ INSTALLED'ABSORPTION FIELD Cl j,4 :, 3OLF/6OLFx5.0'Wx1.0'E.D.,3.0'T.O. ABANDONED TANK(E) PER MOA CODE C3 1 'l , W/ COs & MTs AT ENDS & 2" R.I., ADD 2.0' COVER / INSTALLED 15000 STEP TANK W / DCO BEFORE AND FS AFTER TO AT TIM CONSTRUCTION A B IMIT OF FILL SOIL J / VERIFIED PROFILE 10 DCO 9.0 41.4 / 3' RETAINING WALL/ 1---- T1 1 6.6 32.2 PRIMARY DESIGN PARAMETERS _824 T2 23.4 30.3 LS 25.6 29.9 NO. BEDROOM: 4(600gpd) if Cl 44.0 44.2 ' TANK SIZE: 15008gSTEP M 1 43.9 43.1 PERC RATE: 3.0 MPI SOIL RATING: 1.2 GPO/SF C2 63.2 42.5 AREA ROD: 500 SF li REDUCTION FACTOR: 0.88 - M2 62.3 41.5 ADJUSTED ABSORPTION AREA: 437.5 SF C3 63.2 64.6 SYS.TYPE: WIDE TRENCH 1.0'EO MIN LENGTH:88 LF M3 65.1 65.6 USED: C4 89.3 63.9 30.0LF/60.OLFx5.0'Wx1.0'E.D., 3.0'TD - M4 90.2 65.3 'TOTA i SF y ,�vl AREA: �( I 0 5 oQ 0 0 o Q • DRAIN ROCK 6" m mz z z 0 o ABOVE PIPE INV ,5 Q 6 < O K p ov Bti J -' �-` 8 Z 4" 0 DRAIN PIPE o z -- u MFG. v -1 . 0 EXISITNC FILTER FABRIC - 814.0 -• - - FILL -- 818 2" R.I OG.FG. 4.0 `\ ' / 813.0 n1-Ks o / 1500 g STEP 1/ 609.4 TANK W:8 .0/E 810PROFILE E:809.0 `.. M o SCALE:NTS W:810.0 17AL19 :00.0 10.0 0 • N.uue ROURY 12.0 sum NOTES: PANNONE ENG SVC, LLCDote RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 99510 7/30/2018 PHONE (907) 272-8218 FAX (907) 272-8211 Scale 1'=50' CONIFER HEIGHTS B2 L11 ____ ,,.. 31p •1, ••• P.I.D. NO 015-093-26 DRAWN ACP MARTI MOREHOUSE PERMIT NO. 7841 PORT ORFORD DRIVE • OSP181208 ANCHORAGE,AK99507 Sheet 2 OF 2 „ornc,„. MUNICIPALITY OF ANCHORAGE ,IlleOn-Site Water&Wastewater Program �� f ,5�� PO Box 196650 4700 Elmore Road _ 'A ' Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 r. http://www.muni.org/onsite Di.partmen t 4hCMp R;,C,E On-Site Wastewater Disposal System Permit Permit Number: OSP181208 Effective Date: 7/20/2018 Work Type: Septic Upgrade Expiration Date: 7/20/2019 Tax Code Number: 01509326000 Site Legal Address: CONIFER HEIGHTS BLK 2 LT 11 G:2440 Site Mailing Address: 7841 PORT ORFORD DR, Anchorage Owner: MCVEY SCOTT A & Lot Size in Sq Ft: 33395 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 4 This permit is for the construction of: 0 Disposal Field El Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: in.... 1. Maximum excavation depth shall not exceed 3 feet for entire length of drainfields. 2. The entire proposed drainfield is not within the 30 ft radius of a percolation test. Additional percolation test(s) shall be provided prior to construction. Submit signed and stamped soils log with inspection report. Received By: 4. 4S0A00 „do. Date: Issued By: ' Ca4AA911 Date: 7 2 t ete•AUS MUNICIPALITY OF ANCHORAGES a ,..., „).„, Community Development Department t_ Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water& Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Sill Parcel I.D. 015-093-26 Property owner(s) MARTI MOREHOUSE Day phone Mailing address 7841 PORT ORFORD DRIVE, ANCHORAGE, AK Site address 7841 PORT ORFORD DRIVE, ANCHORAGE, AK 99507 Legal description (Sub'd., Block & Lot) CONIFER HTS B2 L11 Legal description (Township, Range & Section) Lot Size 33,395 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑x Initial ❑ Single Family (SF) n (w/wo ADU) Septic Tank ❑X Upgrade 0 Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. l ` .41 IQ��" (Signatu f property owner or authorized agent) Permit/Rush Fees: Et '"l to •tiC Waiver Fees: Date of Payment: ' 112/1?t? Date of Payment: Receipt Number: 0344LC3 Receipt Number: Permit No. (N P i<F(Abg Waiver No. Permit App_:-:• :�..:c; Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181208, Rebecca Carroll, 07/20/18 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181208, Rebecca Carroll, 07/20/18 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 L DESCRIPTION .~HONE 9- 7 7 I jEW PGRADE DISTANCE TO: DISTANCE TO: Manufacturer DISTANCE TO: is le to fi Length IF HOMEMADE: Well We,, 10 5 ' ~grade Width Inside length Width Dwelling ~ath tile Material N ea res~l o~)n e Trenct~6 :DROOMS No. ~nts Liquid depth PERMIT NO. Liquid capacity in gallons Distance between lines inches ~ PERMIT NO. 3tion area Type of crib DISTANCE TO: Class Crib diameter Crib depth TotaJ effective absorption area Well Building foundation Nearest lot line DISTANCE TO: OTHER ~'OI~_'T~'ST RA~'~N-'~ - ' . ' ' ' 7/ REMARI~S 3t ~l'ne / Absorption area(s) APPROVED DATE LEGAL 72-013 (Rev. 3/78) I © © PERMIT NO. rllJr-d IC:IPRLIT'¢ OF Rr-dC:H[mRF~,]E DEPARTMENT pc HEALTH AND ENVIRONMENTAL PROTECTION 825 '~ STREET~ ANCHORAGE AK. 95 264-4720 [qELL Rr4[:, Or-d--SITE L~EL4ER F"EE:r'IIT 888662 > APPLICANT DESIGNS IN WOOD, LTD. SAR BOX 2072-H 99507 LOCATION WHITE DRIVE LEGAL ;b~'~'~'~'~"~r~~'~J~?~ LOT SIZE TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [)EF'TH= LEN6TH= ~]RR%~EL [)EPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRRINFIELD. 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>. Z.':4.q.-4747 ~6000 SQUARE FEET ~:EC-!Lm I RED SEPT I m3 TRNI< S I ZE= 1250 6RLLOhlS 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. TL.Jm~ 42) I r~SPECTICmr~S RRE REC!LIIRE[:, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. NELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE NELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I l' E.'-<P I RES [:,ECEr,IBER --'--~-1.. ~98E1 I CERTIFY THAT 1: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS 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 IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED: APPLICANT DESIGNS IN WOOD, LTD. DEPARTMENT Orr HEALTH AND'ENVIRONMENTAL °ROTECTION / ~..~.//~ ~25 'L STF'.EET, RI'4CHORAGE, AK. 3.S .,1 p~ ~/ ..,,.,....--~ 264-472~'3 ' I. IELL Hr-.ID, C~1'-4--'---"~ I TE -KEI..-IER PERI~I I T PERMIT NO. ( , ';, ~PF'LICnNT ~¢5/~~'/s ~,U COO0 ~ C 7'~' ~"~eC.- LOCATION U-,'A,'-/-~' "Pr". LE.~ALF~ ~, ... .................. . .......... ......... ' LOT '~'.-IZE o~- ko/O~0 _~,21_IRRE FEET TYPE . - ...... MAXIMUM NUMBER OF BEDROOMS =t-~ SOIL RATING ,.'SQ FT,/BR)= I'~~ THE REQUIRED SIZE OF THE SOIL J=IBSORPTION SYSTEM IS: ,_ ,= ,-, -,- ,-, = ,:... ,=. -,- ,_, = o,:' ,:,.'.,..,='us'ro T. S ,:'.o.,:...'r.,. T.,:' NUMBER OF' RESIDENCES THAT THE HELL WILL SERVE. TL-~O <2> I~4~PECTIO~$ ARE .REteLl IRED BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION, MINIMUM DISTANCE BETWEEN A HELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS i00 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM R PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. HELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PEEP1 I T E×P I RES DEi_-:Er-IBER _-~..-1., ::L'_:~.80 I CERTIFY THAT 1: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWE~.S AND HELLS RS 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 IS REMODELED TO INCLUDE MORE THAN i~ BEDROOMS. APPL I CANT ~ ~O~M~N~, INC, 5024 E;Of~DOVA · BOX 60ii7 · ANCHO~AGE ALAGKA 99502 · PH 90? 279 0483 · TLX 090 25280 October 28, 1980 R&M No. 051001-86 Design & Woods Construction SRA Box 2072-H Anchorage, Alaska 99507 Subject: Subsurface Soil Investigation for Sanitary Sewer System, Lot 11, Block 2, Conifer Heights Subdivision, Anchorage, Alaska Dear Mr. Hill: At your request of October 20~ 1980, R&M Consultants, Inc. conducted the subsurface soil investigation at the proposed location of the sanitary sewer system on the subject lot. The investigation complied with the procedures required by the Municipality of Anchorage DHEP. The topography at the excavation site is uneven. At the time of the investigation, the site had original vegetation consisting of scattered pine and birch and native shrubs. The investigation which was accomplished on October 22, 1980, consisted of a test hole excavated to a depth of 11 feet below the existing ground surface using a backhoe. The test hole was sited by you and its location is shown on the attached soil log. The test hole was logged by Dan Cooper, a technician from' our office. Grab samples were taken to the laboratory for classification. The soils encountered in the exavation are shown on the attached test hole log. This log displays specific conditions encountered at the test location on the date of the investigation. Subsurface conditions may vary in other parts of the lot without any apparent superficial evidence of the change. Ground- water level may fluctuate both seasonally and from year to year. No ground- water v~as encountered, however,, slight seepage water was encountered in the test hole at a depth of 10 feet. Where groundwater is encountered the bottom of the absorption system must be at least four feet above the wat~'r table. Bedrock was not encountered. At the time the hole was excavated seasonal frost was not present and permafrost was not encountered. A percolation test was initiated, however, because of the sandy nature of the material, useful measurements were not obtained. Based on the visual classification of the material, the recommended absorption area for the soil condition found is 135 to 150 square feet per bedroom. October 28, 1980 Design & Woods Construction Page 2 We have appreciated this opportu, nity to be service to you. Please contact us if you have any questions' concerning this letter or if we can be of additional service. Very truly yours, R&M CONSULTANTS~ INC. William Thompson, P.E. Senior Engineer WT/kym/ssic /z / / / ~ / / L..,.O ,'T- I0 GRID. ~...L.~, Z..~ ~.~ PROd. NO. /% \ ~'"~ DWG. NO. ~,0~: ~ . [] SOILS LOG PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264~,720 SOILS LOG - PERCOLATION TEST Designs G Woods Construction DATE PERFORMED: [] PERCOLATION TEST 10-22-80 LEGAL DESCRIPTION:LOt Perc Test Hole 10 ~2 13 Block 2.~Conifer Heights SLOPE OVERBURDEN 1 ' Reddish Brown Silt 2.5' SAND W/COBBLES Slight Water S~epage 10' B.O.H. ~,, 11' NO Bedrock No-~° Groundwater SITE PLAN WAS GROUND WATER S ENCOUNTERED? NO . L O P E IF YES, AT WHAT DEPTH? 1 80. 00 o ~ & ,'+ pexCo] ac:iOn ~ ~_~,~T~st Ho~.e N Rhlte DrJ ve 14 15 16 17 18 19 20 COMMEN"~ S PERFORMED BY: 72-008 (6/79) Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN~ - FT AND Estimated Seepage Area Required 135 ~l~-~q. Fto Per Bedroom. 6� g91° 77 •` � Municipality of Anchorage On-Site Water and Wastewater Program a'� �f� (907) 343-7904 a- E T Y A +b � Y Certificate of On-Site Systems Approval `` OL 6 a Parcel I.D. 015-093-26 Expiration Date: )1-6-1g 1. GENERAL INFORMATION Complete legal description Conifer Heights Block 2 Lot 11 Location (site address) 7841 Port Orford Drive Current Property owner(s) Marti Morehouse Day phone Mailing address 7841 Port Orford Dr. Anchorage, AK 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received b•: , , ��.LA,- - jl� r , , !.vi Date: R COSA to be released to the engineer,unless otherwise requested by e eng eer. !J� COSA Fee $ 42(pWaiver Fee $ Date of Payment 3-1-IS Date of Payment Receipt Number C77(01 Li G Receipt Number COSA# 0SC\g 138b Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection,,the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at the time of installation. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R Pannone Date 7/31/2018 OF Aqkkk0 6. DSD SIGNATURE r " System#1 Approved for LI bedrooms •Seven R. Pannone: System#2 Approved for bedrooms CE-8149 �� �i Disapproved OFESS��P Conditional approval for bedrooms, with the following stipulations: ` ems CUVIAevd.I 044 i L 1 � r� - � I , r wrr� y��)� p ql.c� bov;stike � G ur n�'� e-vv, ,v to OA.0 Pt _QC G., t� w '-,1b\- r t` s� ON-SITE c. WATER AND n WASTEWATER --y) PROGRAM 4/T n^rn lil^C .. ,J/ By: ` �, C � JJJ Original Certificate Date: F' - 1-Y The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet i . If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Conifer Heights Block 2 Lot 11 Parcel ID:015-093-26 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 11/7/1980 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 250 ft. Cased to 250 ft. Casing height(above ground) 18 in. FROM WELL LOG AT INSPECTION Date of test 11/7/1980 6/20/2018 Static water level 200 ft. 228.4 ft. Well production 3+ gpm 5.6 g p m WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 7 39 mg/L Arsenic ND ug/L Date of sample: 6/20/2018 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 7/25/2018 Tank size 1500 gal. Number of Compartments 2 Cleanouts(Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) Y NEW Pumper N/A Date of pumping C. ABSORPTION FIELD DATA Date installed 7/25/2018 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SF System type Shallow Trench Length 30/60 ft. Width 5J ft. Gravel below pipe 1 .0 ft. 3.0 • Y N Total depth ft. Eff. absorptio ,. •- ft2 Monitoring tube Depression over field Date of adequacy test NEW --sults(Pass/Fail) For 4 bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= 600+ g.p.d. N Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed 7/25/2018 Size in gallons 250 Manhole/Access (Y/N) Y "Pump on" level at 40 in. "Pump off' level at 36 in. High water alarm level at 45 in. Datum Cycles tested M e-W Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 10+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION OF Ai:1kt / certify that I have determined through field inspections and j Cij- TM �)` y�l�� review of Municipal records that the above systems are in p"*: I\ ••* f conformance with MOA COSA guidelines in effect on this date. d•••11,•• i•••••�4 ••• 0 Engineer's Printed Name Steven Pannone ••:Sleveri it•Pannone . / Date 7/31/2018 61;.. CE-8149 . r/ IkiuO\ ` a\ COSA canary sheet_2-6-15.doc COVERED ENTRY WON 2.4'x 107'CAH! CANT ABOVE 11 n 24.3 29.I 8.0'DECK �' N v 2 STORY ` r RESIDENCE n -..1 2.e CANT N. 53.4' 2.4'x 21.8'CANT 2.4'x 10.6'CLIP IllllII lhII 4.2'BALCONY HOUSE DETAIL SCALE: 1'. = 30' f.—........,..7 , / \ \ / / / —�_` ~ ...-- -\\ 411/7£ / / y�1•0o 1 T kallfr CONC.RETAIN � Ra 6?O. s /00 PRO eCTJVa weft RAD/ WALL \ (T AVOAL) Oi V / WELL - \ 1 �• I ' ASPHALT. ~� 0 J .��PAVEMENT; /, �" 2/ CONC. BLOCK \ RETAINING WALL \ O SEE HOUSE tea. ' �ip�/// DETAIL / / SEPTIC MANHOLE \/ Z Lai ! WOODEN N. O FENCE 0 r0 ' 7 8.4' x 16.3' SHED p m _ 4i0o O I o Lot 10 a ' Lot 11 •r 0 30•00' / 33,395 s.f. co // I ' SEPTIC PIPES 10' UTILITY rl / N ?6•30'0p"w i80 00 /`- / EASEMENTS '.......-----10' SLOPE EASEMENT / // Lot 12 i 1 1 I I ' Lot 9 PLOT PLAN _ AS BUILT 1 SCALE 1 40' GRID _ SW 2440_ Project No. 18-294/R1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 0000DOQO (907) 522-4625 Fax �a Professional Land Surveyors kenOlangsurvey.com o! �F A( ©p y jonathanOlangsurvey.com ,,,,cc".... �`••. .'• Qs111 I hereby certify that I have surveyed the following described property: �a�� DO Lot 11, Block 2, Conifer Heights (Plat No. 71-190) ,./01(/)... 49TH 1 Anchorage Recording District, Alaska, and that the Improvements situated thereon ore 0 !' VA within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed Q ••••� Q r KENNETH G. G premises and that there are no roadways, transmission lines or other visible °O �, �� easements on said property except as Indicated hereon. Q' i( ii. p .,,,,,, p �'•. —5'208.••• Y;S Dated this the Day of , 'i�' , at Anchorage, Alaska 0 a ••• • Oo ppOR SSlOtuu•Al-o It Is the responsibility of the owner to determine the existence of any easements, �000ooa' covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT • !","i2 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On-Site Systems Approval # 0SC181380 Subdivision: Conifer Heights, Block: 2, Lot: 11 A water sample revealed a nitrate concentration of 7.39 milligrams per liter (mg/L). 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. Mailing Address: P.0.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids,and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. • TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Mailing Address:P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org Parcel .I.D. Municipality of Anchorage ! Development Services Department Building Safety Division on-Site Water and Wastewater Program. ' 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK' 99519-6650 www. ci.anch°rage.ak, us . . (907) 343-7904 ~ g -<'-- o q CERTiFI~X~E' 01~ H'-~L~H ,~UTHORITY APPROVAL .. ;' FOR A ,., Lr-, ~ ~,VV~' ,C~ING~'I~^MILYr~'"i~Li"NG "~' """ "'" , ExPiration Date:. /.~ -,5-'- ~)/¢ GENERAL INFORMATION Complete legal descriptio'n /,,o~L I1., Location (site address'or directions) Current Pr, ope~y., bwner(s) ~. .. · .~ .,.'.. .~' - , Mailing'address ' Lending agency · Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: . ~ TYPE OF WATER SUPPLY: ' Individual Well Individual Water,Storage Community Class ~ Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual' On-site Individual "Holding tank Community On-site Public Sewer E] [] The Municipality of Anchorage Development serVices 'Department (DSD) Issues Certificates of Health Authority Approval (HA,&) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and maybe reissued with new water sample results. (Certificates may be reissued for a pedod of up to one year with valid.water samples.) Certificates are valid for-one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. STATEMENT OF 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 Health Authority 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, andregulationsineffectatthetimeofinstallation. R~¢u.,a! o~,ly- ~N,~J /..J~.o ~'~.~ul~ Name of Firm F'/c,)-/o,,~ 7'~cA~',¢ ,~/ -C~';,c(/ Address l¥~3'~ ,E. c6~ .S'~/..~ An¢/-~'~q~ /~' Engineer's Printed Name "7"J~ ~_o,~'o/'~, ,~. ~-~,o o ~ DSD SIGNATURE : ~ . ApProved for /"{" bedrooms. Disapproved. ~ · Conditional approval for Phone Date./17),.,// z ~'_, "Eooy bedrooms, with the following stipulations: Additional Comments : ......................... Note: The' well for this'property meets existing State and Municipal Codes. There are nitrates present. It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concentration is 5.55 mg/l. EPA maximum concentration is 10.0 mg/l. More · 'information on nitrates is available from the On-Site Services program, at 343-7904. Attachments: HAA Checklist S'eptic System Advisory Well FIoWAdvisory X Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (Rev. 01/02) ,... Munic of Anchorage DeVelopment'Services DePartment ~ '., Building iSafety Division -.~ ~. ~ ~i .OnLSite ware? & Wastewater Program ! 14700 'S°uthBragawSt. : . - ' · 'P.'O."BCX 196650iAnChomge, AK 9951'9-6650 ';, ! . www.e.i.anchorane.a~.us . , , ~, (907) .,'~.~-/uu~, ,: ii' ~ *! ~ · ', , , , 'r ' ! I: ,~ , ' '~ ' ' A. WELEDATA .... ,. , ....., ~ : ¢ . , , . : ,.... , ,! ~ :!'.:i: Wellbjpe. t,,~F ; ,' IfA, B;;orCprovide'PWSlD#i "" .: :.'. ¢,Wel: i' ~: :: , : -. · , ..... . ~, - .¢.,, · .., · ),, Date. cgmpleted II {7'/~.,0/. ~Sanitary seal;~!N) :' y'; :... ; ~ :Wires propeily (Y/N) Total d, epth ~_...,,¢_~_ ff.... . ,Cased to ~.__ff..: ' .I "': : Casing height te ground).,. ~,/ in. , ,~ :',' :':.', FROM WELL LOG ~: i, ...~--, ::. AT INSPECTION ,. . . Dateoftest ..,. ...... Ii/'r / ~¢ ,,., ,, ....... /Z. /¢. ' '; ' WATER SAMPLE RESUL,TS: '.i ,~ '!;, i:!.-.. :; ,!", i ' ; ', !1:., :.. ,. · . ; } ~ - .' ~ , : , ;. ; ;,~ ,,,r. "' : ;"'~. !'"''' ....... , ~ '" ' ,' ; , I , ' .... ', Colform; .(::2 : coloniesll00ml ?:; ¢:Nitrate~-:$.Z. mgll: -: ';~ ?: Otherbacte'riat ' '~:::~ ,., : .... ~l '-'-"7-'7- ' l::,: .... ;: L :..:~ *'1. · . ":-: .... ,:_l ,!:.':] .::- .., .. ; ~7: ....' ........ , '~ ~' semc.i .. ' mg./I..-, -, : .~ r ; Date of sample: , I/2.~/oy Collected by:: ,:.~l~'l~,Z/=:,.t,. 7"¢¢4 ~'~,,~. :B. SEP.TICIHOEDING TANK DATA i ,, ., . .... ,~ : ..~, -. , . ~: ,~ . ' I' ., ~ ~' - ', , I]' ',--r :::; ': ':? ': ' : '. , ', , ;'', ~'~ " '. ' ;t I ~ ; , f .' ' iL ,' ,: !Tank .s, ize :t'~g'O_.gal.',,?;/ ' ,Numbe.r, bfCompartments[ ~.:!;:';'~! ..... ClS'ano'uts ~/.N)!;! i' : :' Foundabon clea, nout (Y/N)' ~: 'Depress on over tank (Y/N) ,: ~i ~ H g'h wateralarm (Y/N) ' ~ ~ , I t ,. ',- :, . .: t · -! . ...~ . . ,.. ., .... . !:~ ! '. Date of pump ng I / 3'O/0~:: ,Pumoer,~. ~,j~,' [.',~.~ I I ' -' 't , -' ' ~ '. ' ' .,., '-. Date mstalled..,~l J,t~/~...~Sod rabng (g.p.dJft ,orft/bdrm) ",~_.~..~,..Syste . pe ' ., .; .:.:Length ' '7_{'.:':.. ft.::!..:..~?,:~ Width : i:,l,~,.~...';i ~ ;i:',ft." 7.¢.Gra~)el~eloW'oiue . fi/,,,~ ft : .,: . , Total depth ?,J; "ft. ':; Eft. absi3rption"ai'eao~C~, f¢ ¢:Monitoriri(~t~bs'+' ~,-,'I dS~rss$idr{'o{/~:-field' ; .:, . ,~ . . . . . ~ . ~ ;.., ,. . ,. ..... . : !: · . . Date ¢ adequacy test ',5'a,¢ /O._~ . Resu ts (Pa ss/Fad) , ,~{~x"_rr ,. : , ~, For. 5/ bedrooms . ,~ .. ., r ',. .¢. , , !,, : . ' ~., / ' .;' ' .!.. :, ... Fired depth m absorpt on field before test ~ m:: ' ..... Water added~,,~O cal.: , ~ ~ ,~ · . · New deoth'~ln ' . '! ?,.ElapsedTime':'9'~/ rain;, :: 'Finalfluiddepth.~_.~, ir} . '!~ i AbsorPtion rate >2- .~O,~ : . ~: :i . '.- ,~. ; ' ..' .I '. . .., . ',~ : : .- o'r' ' : :; ',: Anyreluvenabontreatment(pastl2mo.)(y/N&tTpe)_~d~ ¢ .~t~no~--~., .If~,s,'~Oivedate , ~ , , ,- . . ~ I I . · , ~! , ~, , . , · i ':i ,',; ' , : ', ' '; : .... '. : ' , ' ' l' ; ~', ,~ ~ '¢' ',f i' '. , SGS Ref.# Client Name Project Name/# Client Sample ID lx~atrix 1040501002 F~attopTechnica~$rv, N/A LII, B2, Coni~rH~. S/D DdnkJng Water PWSID 0 All Dates/Times are Alaska Standard Time Printed Date/Time 02/02/2004 13:3{; Collected Date/Time 01/28/2004 12:15 Received Date/Time 01/28/2004 12:50 TechnicaIDirector _ Stephen. C. Ede Released~~,-,.~'/~/~-- Snmple Rem,ctrks: AIIownble Prep · Anal~is Parameter R~sult~ P(~L Units Method Container ID Limits Date Date Init Waters Department Nitrat~.N 5.52 0.100 mg/L EPA 300.0 B (<-10) 01/28/04 JJB Microbiology Laboratory Coliform col/lOOmL SMI8 9222B A (<=1) 01/28104 DKC Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak, us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Ot ~' - o? :~ -, 'Z~ GENERAL INFORMATION Complete legal description /..o/- 1/., Location (site address or directions) Current Property owner(s) Mailing address Expiration Date:. Lending agency Mailing address Real Estate Agent Mailing Address Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. [' ( ¢~z e NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System f,= r' TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding tank [] Well [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority/ Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 pedod 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 Health Authority ,Approval Guidelines for this application, shows that the on- site water supply and/or vcastewater 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 tiles 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 Address Engineer's Printed Name Phone 7~/~ Date _ j'r,, e DSD SIGNATURE L-"' Approved for , :Note: Disapproved. Conditional approval for There are nitrates present. .~. bedrooms. -, ',, · , ~-' bedrooms, with the following sbpulations~,~ ~he ~e[[ ~o~ th~s p~ope~Cy.,~eets exts~ State a~d Hu~c~pa[ Codes, insure the wells continued suitability. Current nitrate concentration is 5.5 mg/1. EPA maximum concentration is 10.0 mg/1. More information on nitrates is available from the On-Site Services Program, at 343-7904. Additional Comments ~ ~.-' ... ~,~'~ ~. ,~ · ON-SITE . ~. ?.: WAZERA" :mi ~ : .w. ASTEWATER: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X ~ :. PROGRAM ..' Maintenance Agreements ~.,~.'... _..' _~..~,~'~ Supplemental Engineer's Report ~'~'"~.~f.'~t,/T Other (R~.01K)2) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P,O, Box lg6650 Anchorage, AK g9519-6650 www.ci, anchorage, ak.us (907) ~4~-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:, A, WELL DATA Well type p.v~' Date completed Parcel ID: Total depth ~6'_~ ff. Date of test Static water level Well production If,4, B, or C provide PWSID # Well Log (Y/N).. /',Po Sanitary seal (Y/N) T Wires property protected (Y/N) Cased to '2 5'0 It. Casing height (above ground) FROM WELL LOG AT )NSPECTION ~o~ ft. ta -~ fL ~'~' g.p.m. . . ~..Q g.p.m. Nitrate ~=-. mg./I. Date of sample: WATER SAMPLE RESULTS: Coliform ~) colonies/100 mi. Arsenic: -- mg,/l. SEPTIC/HOLDING TANK DATA TankType/Material .g'e?f~¢ / Tank size . f '~ ~-~ gal. Number of Compartments Foundation cleanout (Y/N) Y' Depression over tank (Y/N) Date of pumping ~/' ! .Y/Zc~, P_ Pumper irt. Other bacteria _ _0 colonies/100 mi. Collected by: Date installed. II / I~ / ~',-~ Cleanouts (Y/N). Y C'(} High water alarm (Y/N) h~. 4~ ABSORPTION FIELD DATA Date installed ;~ //9/&~, Soil rating (g.p.d./t~ or ~/bdrm) I :~ Length '7~ lt. 'Width ~ ff. Total depth ,~ , fL Eft. absorption area ~4>~ Monitoring tube Date of adequacy test ~ Results (Pass/Fail) Fluid depth in absorption field before test ~ in. Water added ~,~Ogal. Elapsed Time: ~ ¥ min. Final fluid depth qCC,~ I in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) _ System type . 7'-,~,~¢~ Gravel below pipe ~f, ~ It. Depression over field For ~'f bedrooms N,ew depth ~so~fion rate >= ~O~ g.p.d. If yes, g~e date N. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) 'Pump on" level at in. 'Pump off' level at in. High water alarm level at __ in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ! 4~ t' On adjacent lots '~ I o=,, Absorption field on lot ! o ~ ' On adjacent lots ~. t o~, Public sewer main . ~,./. ,4, Public sewer manhole/cleanout Sewer/septic s.ervice line ~> Z~-' Holding tank N. ,4-, . SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation I '~' ~c~. c o. Property line .. ~ ~$-' Absorption field Water main /~. ,~. Water service line ",> t o" Surface water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line q¢~' ~C,-¢,~, c.~,. Building foundation. ~',~' Water main ~. 4-. Water Service line '~ ~ c~ ' Surface water ~, ~ oo, Driveway, parking/vehicle storage Curtain drain /~ ~*¢",~ Wells on adjacent lots. lq' ~'~'~' ht.~. Fe COMMENTS ~ e f, ~'c .~ y.~ /"¢,',, ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date· Engineer's Pdnted Name Date. ~'~_ ~., Waiver Fee $ Date of Payment Receipt Number HAP, Fee $ Date of Payment Receipt Number (Rev. 12/01) CIYIL & ENVIRONMENTAL ENGLNEER/NG" ENERGY CONSERVATION & ANALYSIS TIlEODORE F. MOORE, P.E. 14530 ECHO ST. Pti: (907) 345-1355 ANCHORAGE, AIASKA 99516 July 2, 2003 JeffPoet M.O.A.D.S.D. P.O. Box 196650 Anchorage, AK 99519 Dear Mr. Poet: Apropos ofour discussion this aflemoon regarding the septic system adequacy test I conducted on May 29, 2003 for the 4-bedroom residence on Lot 11, Block 2, Conifer Heights S/D, located at 7841 Port Orford Drive in Anchorage, I am pleased to provide the following supplementary information. During the course of the test that day I added a total of 530 gallons of water into the septic system. After the first 280 gallons ofwater was added the fluid depth in the monitor tube had risen from 42 inches to 49.5 inches. I continued to add another 100 gallons ofxvater which brought the fluid level up to 51.875 inches. I then waited 202 minutes during which period the fluid depth receded to 45.5 inches, and then added another 150 gallons of water which brought the fluid level back up to 48.875 inches. After that, the fluid level receded 0.625 inches back down to 48.25 inches within the next 14 minutes. Considering only the final 150 gallons of water which brought the fluid back up to approximately the same level that it had been at 199 minutes previously, i.e. never above the top of the horizontal distribution pipe, it can be extrapolated that the average absorption rate during that period was 0.75 gpm. In my opinion, this performance indicates that the system is still capable of absorbing the required 600 gpd for issuance ora 4-bedroom HAA certificate. Also, as noted on the checklist, I did arrange to have additional fill placed over the system where necessary to ensure a minimum of 2 feet of soil cover. Sincerely, Ted Moore, P.E. cc: Ron Dailey Municipality of Anchorage Development Services Department Building Sa£ety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 wxwv.ci.anchorage.ak.us (907) 343-7904 ,Septic System Advisory Health Authority Approval # 030308 During a recent adequacy test on the septic system for Block 2, Lot 11 of Conifer Heights subdivision, 42 inches of standing water was observed in the absorption field. This indicates that approximately 93% of the absorption area is inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Health Authority Approval. SGS Ref.# Client Name Project Name/# Client Sample ID Matrix Sample Remarks: 1033029001 Flattop Technical Srv. Lot I I. Blk2. Conifer ills. Lot I I, BIk 2, Conifer l-Its. Drinking Water All Dates/Times are Alaska Standard Time Printed Date/Time 06/03/2003 16:12 Collected Date/Time 05/29/2003 I 1:00 Received Date/Time 05/29/2003 12:45 Technical Director ~/.~.....~ Stephen~C.~Ede R 'cas d ~""'"'"~' Allowable Prep Analysis I'aramclcr Results PQL Units Method Limits Date Dale Init Waters Department Nitmte-N Microbiology Laboratory Total Coliform 5.55 0.100 mg/L EPA 300.0 (<=I0) 05/29/03 JS 0 col/100mL SMI8 9222B (<=1) 05/29/03 KAP MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4?44 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) z. II, ITS Location (address or directions) 78'4/ PO~>-F Ol~FoRb (b) Property owner Mailing Address 7~z4/ ]~oI~T O~Fol~b Telephone · (home) Business (c) Lending Institution N, ~.. Telephone Mailing Address (d) Real Estate Company and Agent FO~'TuNE 'PRoP£RTI£~ , Address ~000 "t~" ST , i~ld¢l~o~i~G£ c/cl,5'0~ Telephone ,..CG 2 -7(o5'3 (e) Mail the HAA to the following address: (or check here r~, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family'l~ Number of bedrooms 3. WATER SUPPLY Individual Well ~' Community [] Public [] Note: If community well system, must have .written confirmation from the State Department of Environmental 'Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~ 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. 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 F'L ~TTOP -J'ECE, Address Date ~-~ Telephone ..~$- 1 3.5'5' Engineer's Seal 6. DHHS APPROVAL Approved for ~ Approved ~- Terms of Conditional Approval bedrooms by -~o~,~. ~ cr¥~ Date ~///c~O Disapproved Conditional 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  MUNICIPALITY OF ANCHORAGE (MOA) ~,~v*, .~.- Legal Description: ," \%0~~ a. WELL DATA Well Classific~%C Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 L II, B2 CoNiF~ 8TS If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) 'YE $ Total Depth 25'0 Cased to 2~O' Static Water Level 1~)2,' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on LOt' 10'7 ~o To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ~'/oO' To Nearest Sewer Service Line on Lot Date Completed I//7/~o Depth of Grouting Pump Set At UNK. Yield~.?G?~ ~EA~ ~/23,/9o Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) C,o, ; On_,~djoining Lots '7/00 ll~ 1'o ST/l~b P~P£ ; On Adjoining Lots '7 ~/oo ~ To Nearest Public Sewer Cleanout/Manhole '7[oo Water Sample Collected by F/./i'rToe TEcl~ $¢C$ ;Date WaterSampleTestResults .~ ~.c~.? - ~:~ CO(¢~or~ /loo.w.~i Comments g'rE/tb,/ Pu~P~G eP' ~OI ~/~L~.ONS ~T '~¢ ~/~XllVt[/~ B. SEPTIC/HOLDING TANK DATA Date Installed 11/3o Size Standpipes (Y/N) Depression over Tank (Y/N) l 2 ~O No. of Compartments Air-tight Caps (Y/N) Foundation Cleanout (Y/N) Date Last Pumped cl/25/~ Pumping/Maintenance Contact on File (Y/N) t4.~. ; for Holding Tank High-Water Alarm (Y/N) ~. i~, Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FI~OM SEPTIC/HOLDING TANK' To Water-SupplyWell [0~ FRo~ C.~. To Building Foundation To Property Line 8~' ~o~ C.O, To Disposal Field I~' <P~ To Water Main/Service Line ~ ~0' To Stream, Pond, Lake or Major Drainage Course 7 [o o Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absor/ption Strata Date Installed Width of Field Type of System Design Length of Field 7~ / Depth of Field (~ ' T~NC~ Square Feet of Absortion Area / Goo ~ No Depression over Field (Y/N) Results of Last Adequacy Test FIDE'~. ~/ITE SEPARATION DISTANCE FI~OM ABSORPTION FIELD: To Water-Supply Well ti8 F~'o,~ S~ pipe To Building Foundation ~3~ F'~o~ s~.~ Lot lq,/~, ; On Adjoining Lots To Water Main/Service Line ~75" ECfo~t ¢?/tNb P~P¢ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Gravel Bed Thickness z¢, Sta,fndpipes Present (Y/N) Date of Last Adequacy Test Fo~ Ur ¥£5 To Property Line ufo F¢ot~ STt~D PIPE To Existing or Abandoned System on Comments 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 .l~c~li~J~r~e,s in effect on the date of this inspection. Signed ~'¢'~~~ - A Date ~ ~ ~ /~ ~...~., ........ ....~.~ .... ~ Engineer's Seal No .... Receipt NO Heceipt No. ' ~~ o, .a .nt Amount: $ /2~ ~C) Date of Payment 72-028 (Rev. 7/88) Back Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE fo~ Work Orde~ $ 25590 Date Repo~; P~nted: JUL 23 gO ~ 12:50 Client Sample ID:Lll B3 CONIFER HTS GARAGE LAUNDRY SITE PWSID :UA Collected 3UL t9 90 ~ 13:30 gecelved JUL 19 90 ~ 16:00 Presexved with :AS REQUIRED Client Name ~ FLATTOP TECHNICAL SRV Client Acct: FLATTOT P.O,# NONE RECEIVED Req # Ordered By : TED MOOHE Analysis Completed :JUL 20 90 Send Repoxts to: Laboratory Supezviso; .L~TE?HEN C. EDE 1)FLATTOP TECHNICAL Special Instruct: Chemlab Re£ #: 902536 Lab 3mpl ID: I Matrix: WATEh Allowable ?azamete~ Tested Result Unlts Method Limits NITRATE-N 4.0 mE/1 EPA 353.2 lO Sample ~OUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY T. MOORE. ! Tests Perfoxmed ' See Special Instructions Above 9A-Unavailable ND~ None Detected ** See Sample Remazks Above NA~ Not Analyzed LT-Less Than, GT-Gzeate~ Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-472O GENERAL INFORMATION (a) Application Date Legal Description (include lot, block, subdivision, section, township, range) ~-or II ~ B~.? ,.2 (~..~o~,J / F---~/~ Location (address or directions) (b) Applicant Name ~-, ~-, .-~I~:P--,[D Telephone: Home ,.~z~...)_ )z}~'~ Business Applicant Address f:~C~''¥,,' ~ (c) Applicant is (check one): Lending Institution []; Owner/builder ~; Buyer []; Other [] (explain); (d) Lending Institution /V//~ Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~[~ Multi-Family [] Number of Bedrooms ~ Other o WATER SUPPLY Individual Well J~ 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 J~ 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. 72-025 (11/84) Page 1 of 2 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 DHEP APPROVAL(~-7~'~ Approved for Approved Engineer's Seal ., ~ t,.'., , , . ...... bedrooms b :--~ ~"~C ~- ate Disapproved Conditional" Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION · MUNICIPALITY OF ANCHORAGE (MO~,; HEALTH AUTHORITY APPROVAL (HAA) ['J[~'( 0 ;~i 1~ CHECKLIST- FEBRUARY 1984 264-4720 RECEIVED Legal Description: Z.crc /! ~c/~, ~ WELL DATA Well Classification '~e,u~'r~- If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ~ Date Completed ll/'~/gr'~ Yield Total Depth ~-~'O Cased to ~...~"o Depth of Grouting Static Water Level I'~C~. 57 Casing Height Above Ground . I E5" Electrical Wiring in Conduit (Y/N) ~ Separation Distances from Well: Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot IC~'1- ; On Adjoining Lots ICL~'F To Nearest Edge of Absorption Field on Lot 1~3''f ; On Adjoining Lots l To Nearest Public Sewer Line . .~J/.~l To Nearest Public Sewer Cleanout/Manhole /,J,//~ To Nearest Sewer Service Line on Lot Water Sample Collected by ,/Y),~c~ ~.1~7:'~-iE:/,~__...,~ ~, ,ml~, ~rrS; Date ~Jr / Z~/~ Water Sample Test Results ~'~'T-is~-/4CTo~_~-- v Comments B, SEPTIC/HOLDING TANK DATA Date Installed JC~O Size /Z.-_~--C) No. of Compartments Standpipes(Y/N) J Air-tight Caps (Y/N) J Foundation Cleanout (Y/N) Depression over Tank (Y/N) ~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ,'~'/,~ ; for Holding Tank High-Water Alarm (Y/N) ,V/~ Temporary Holding Tank Permit (Y/N) ,~'/~ Separation Distances from Septic/Holding Tank: To Water-Supply Well /cz:)+ To Property Line To Water Main/Service Line Course .2.--~'0~' To Building Foundation To Disposal Field lO To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /<;~-/- To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments TYpe of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) ,~,///~ D. LIFT STATION Date Installed'" 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'~.e~'~"~at ./"/VVent (Y/N) ~ Pumping Cycles during Adequacy Test. Meets MOA ** Check Permittec~ Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Date MOA No. Signed Company Receipt No. ,~_~ ~"~.'O Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) L~::a tion= 2220 FAST 88 AV'~CJE A~QiORAGg, AK 99507 (907) 349-6451 WATER l,a~,l', TEST Date: ~/~/~ Sutx~ivision: Block: Client's Name: Address: GPM 24-Hour Capacity.~ C~lloas APPLI¢ - NT FILLS OUT UPPER HAl ~ ONLY Pro,arty Owner Mr. & Mrs;' Phillip~Hudson ', Phone UallingAdd~'ess SiI::~A BOX 2111 B Anchoracre Z~pCode 99507 349--1141 Buyer Coldwell Banker Relocation C/O Jack Wh~-~e Co. Address 3201 C St.. Anchoraae z~p Code 99503 Lending instttUtlO~,nkno~ Phone Address Zip Code Realty ¢o. & Agent Coldwell Banker Jack White Co. (Jack Vanden Berg) Phone Address 3201 C St., Anchoraqe z~pCode 99503 277--1553 Lega~ Description Lot 1i, Block 2, Conifer Heights Sub. Street L0caUo~ NHN Corner of Port Orford & White Dr. Type of Residence ~ Single Family  ~4ultiple Family No. of Bedrooms 4 Other Water Supply ~ Individual ~f~ll Log attached. ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. [] Community\ For wells drilled prior to that date. give well depth (attach Icg if available). [] Public Utility ~ Sewer Disposal '<~;~ 1980/81 3[] IndJvJdua;I,~, Year Individual Installed: [] Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time I Time Time Date Date Date D~,--~S- Inspector Inspector Inspector Inspector Field Notes: ,~,l-t'2,-"~ MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH a ~7~/~/~ ENVIRONMENTAL PROTECTION JUL 2 7 _RECEI_V_ED ( ~-+APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ' ) DISAPPROVED ( I COND,T,ONALAPPROVAL' Soils Rating / ,~,.~" Date Sewer Installed Well To Absorption Area /'~ ~ ! Well Log Received ~ //'--! ,,~'~¢~ Well to Tank /~:; / ! Septic Tank Size t 72-023 (3182) &u ci ality Anchorage POUCH 6-~50 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES. MA YOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION August 1, 1983 Mr. and Mrs. Phillip Hudson SRA Box 2111 B Anchorage, AK 99507 Subject: Lot 11, Block 2, Conifer Heights Sub. Approval for the individual sewer and water facilities cannot be granted u~til the following items have been completed: o The septic tank pumped with a receipt submitted to this department. Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, .J~ Roberts ~A~sociate Environmental Specialist JR69/p/E w,, ~ DATE RECEIVED INSPECTION APPOINTMEI~ TS DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHOI~GE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONDEPT. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P2,OTECTION ENVlRONMENTALSANITATION DIVISION APR 1 6 1981 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEV~"'" ~JL~ DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER I PHONE I MAII~tNG ADI~RES~ ' '~ PROPERTY RESIDENT (If d'f er ntr ab ) PHONE 2. BUYER PHONE MAILING ADDRESS~' 3. LJ~NDING INSTITUTION ] PHONE MAI Ll~ ADDRESS 4. REALTOR/AGENT I PHONE I MAI LING ADDRESS 5. 'LEGAL DESCRIPTION STREET LOCATION NUMBER OF~BEDR~ [] One L~' Four [] Other 6o TYPE OF RE.>fitDENCE ~//SINGLE FAM LY [] MULTIPLE FAMILY [] Two [] Five [] Three [] Six 7. WATE~ R S_~aI~[Y ~ INDIVIDUAL~ [] COMMUNITY [] PUBLIC UTI LITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE~SPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY 1~"~ YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [~SI NG LE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [~INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified GE DISPOSAL SYSTEM L~INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified [E~e~tic T~_ank or [] Holding Tank Size:/~-~:~ ~ If Tank is homemade give dimensions: [] ONE I--I TH~REE [] FIVE [] TWO L2~ FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER [] OTHER DATE INSTALLED INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: ~ Absorption Area to nearest Lot Line Septic/Holding Tank IAbsOrption Area Sewer Line INearest Lot Line 5. COMMENTS DATE IJ~]'//"APP ROVE D FOR ~r BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79) )0 !URVEYgR'~ CEFITIFICATION. ~- ~'' ~ROPERTY O[IGRIIEO ON THII pLAT AND THE MPROVEMENTI tlTUATED THEREON ARE ~OGATED ~$ ~HO~N ON THI~ PLAT, /,SO. LEGEND 0 LOT CORNERS ~:~)~'T'~OL , - rOUNOATION &,/, ~D~ Lo~ El L/ NOTES' mU,LO,.O L.OOAT,O..HOW. MEETS A~ .umo,vm.,o. COV~.A.~' ORDINANCES, E, IT I~ THE RE~PON~I~I~ITY OF THE BUILDER TO VERIFY AL~ ELEVATION~ WITH RESPECT TO AL~ UTILITIES,80RAINAOE. ~. THIB PLAT REPRE~ENT~ THE PARCEL OF PROPERTY DESCRIBED BELO~ TAKEN FROM THE RECORDED p~AT DESCRIBING THAT pARCEL. INSTRUMENT~ PRIO~ TO OR &FT~R THE FI~ING OF THE R~CORD~D D~AT ~R~ NOT gHO~H ON THI~ PLAT. 4, THE INFORMATION ONTH1~ PL.AT I~ FOR THE U~E OF ~ENOIN~ IN~TITUTIONt ~p~CtFICA~LY TO ~HOW ANY CONF~iCT~ BETWEEN*EXI~TING ~TRUCTURE~ AND PLATTEO ~OT ~INE~ OR EA~M~NT~ ~ THE PLAT I~ NOT TO BE U~ED FOR pOSITIONING &DDITIONA~ ~TRUCTURE~ OR FENCE~. ~49- 645 1 A 5 BU~L"F L. OT t l~ ISLOCF-, 2... CO~,l I FE R, HK4 GH'T'5 BESSE. EPPS 8~ POTTS ?.2?-0 E. 88'th. AVE. ANCHORAGE, ALASKA 99507 FLD. BK.' ~u~Cipality ~ i~,~; Anchorage . ~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4i 11 : GEOI~.~GB M. SULLIVAN, ~' " MA YOR ' April 21, 1981 Designs In Wood, Ltd. Star Route A Box 2072H ~ Anchorage, Alaska 99507-- SUbject: Lot 11. B1Oc~-:2:Co~i~fe;j.~eights SU~di~isio~.- ~ ' ' ~- · !%::"~'~-7 Approval for the ~nd~v~duaI~.sewer~'and water f~e~l~t~es cannot be granted u~til the following item has,~been completed: .. (1) A well log submitted '~ reivew. !f there are any further questions, pleased'Call this office at 264-4720. Sincerely, Les N. Buchholz, R.S. Senior Environmental Spe~'atist LNB/lj w CC: First National Bank of Anchorage % Wes Chubb Post Office Box 4-20-90 99509 · .- !; :' ,./.,