HomeMy WebLinkAboutCONIFER HEIGHTS BLK 3 LT 7Onsite File Conifer Heights Block 3 Lot 7 #015-093-16 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: ________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. A A. Municipality of Anchorage OU On -Site Water and Wastewater Section • (907) 343-7904 Pam of 2 4' ON-SITE WASTEWATER INSPECTION REPORT *0k Permit Number: OSP201025 PID Number: 015-093-16�u. 44, Dwelling: 01 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: Q New ®❑ Upgrade Name Tim Bowman & Judy Engh ABSORPTION FIELD El Deep Trench El Wide Trench El Bed E:1 Mound Site Address 7754 Port Orford ❑ Other Phonember Nuof Bedrooms Soil Rating Total depth from original grade 3 -'NC- GPD/SF Fl. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Conifer Heights 3 7 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES Tol Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Fl. Well 100'+ 25'+ TANK ❑o Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1000 Gal. Surface water 100'+ Material Number of compartments Lot Line 5'+ NA HDPE 2 Foundation 10,+ LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034Tank to 3034 drainfield Installer A+ Home Services Drainfield CO/MT 3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 776.5 ry Inspectio ��, 5/4/20 5/4/20 Location and description 2nd 3`d 11/3/20 41h Bottom step of Deck ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date OF. co • �� y dStev , -F2. Fanrione 101••. c17 8149 Q Septic Syste &tj� Approved Date `° I,oFFss0l,,r Note: this approval does not include well permit requirements.�`����®�°� kRuV VJIVG/ 10) K: U) �l 0 -n () 0—_ 0 c) -'; -:a a: --i > -, 'o 0 Cc) I CE) K: -q -Tl 0 c) m -0 --j M 0 r- 0 0 r- X ;u ryl < _0 zoccg�Fnow 5 =� * z co 7 :j -D --4 > > ou)or Z O= r- -0 rn 0 0 Ln 0 c: :1z r- --A 0 0 CD M z m C) 0 z r- . z O T 0 m m > z C ::E r- --i r- M 0 (n x M C m > --q u 21 E c m Lf) "I NOTES: PANNONE ENG SVC, LLC (C.I. 1088)REVISIONS P.O. BOX 1807 PALMER, AK 99645 . ........ 51h11/24/2020 sl ....... even ne tt* * .... ' anno. *-. CE 8149 ftm DATE RECORD DRAWING M co O < N m 6 SCALE 1" = 50' P.I.D. NO 015-093-16 DRAWN ACP 0 PERMIT NO. OSP201025 0 SHEET 2 OF 2 mm cn 0 z 0 m Ln t0 J --,i C14 0 > > ;u m r'j cn> (7) Ln C/) ;:a 0 ---1 F+ M,, mm M-0 O CD -P' 0 ci -u m Ln CO 0 E-( cf) NOTES: PANNONE ENG SVC, LLC (C.I. 1088)REVISIONS P.O. BOX 1807 PALMER, AK 99645 . ........ 51h11/24/2020 sl ....... even ne tt* * .... ' anno. *-. CE 8149 ftm DATE RECORD DRAWING PHONE FAX (907) 745-8201 CONIFER HEIGHTS B3 L7 TIMOTHY BOWMAN & JUDY ENGH 7754 PORT ORFORD DRIVE ANCHORAGE, AK 99507 SCALE 1" = 50' P.I.D. NO 015-093-16 DRAWN ACP SITE PLAN PERMIT NO. 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ID 7 C N 0) � rn N m CL a0 NZ ,Z w m 0 0 j c 4D= q E o-0'= 0 nJom LO 0) N N o" a) C: O Y 0 Ql @ m a)� n N C N O N N N OO C O C (D N o E 2 �E��' ° N O V N C Z 0 '0 a N E a- x Q Q H r o E u m O E o c C),�� N W O 01 2] Nr cu E a C �ac=3 L Cil m 3 m y2Oac a NN O N G si d 7i m. a N2o�� y>„ a) m Q m a v) c c Fes- no a) a '� O .� .fl om _ au) -0 0 a o m c O00 C N> :C cu to m N N o d 3 a O N Ln to o N rn 20 9 N E L O G M E a)Ea�:FO c UO .� w.+ t tYi) @O Q m Uall) a y O` N to N N O ..1.. ru ¢ w �Es I >. � m U 'j.C Es -C i < Z.O > O` y- L C ci CY a O O a,� Q c E w o � Lo (D m �' Y" @j ymEs O �c � > Nvo-� -TEca �� V 1 Y > v'CO o °� E Er mec� v i v u no i- > Qtoa- o�w U m 0 m N a h m m Y �� v (n Y tD Y L 00 C N C •V _ Zom� = h N ? E s-1 47 Ln O O No a CO w io: NCUm0 4-J til a'6 O ,�p3 F v c 0) N Q ..1 = <L tDol POST IN A CONSPICUOUS PLACE ALL WORK MUST BE INSPECTED Field Inspection Request required 2 wort ft days in advance of stating work and 2 wori ft days in advance for Mat krspedton. Can (907) 343.82M (voice recorder) for scheduling. Permit is not valid WOW the call-in and also must include the one -call ticket (utility locate) number. MUNICIPALITY OF ANCHORAGE - RIGHT OF WAY DIVISION 4700 ELMORE ROAD TELEPHONE (907) 343.8240 FAX (907) 343-8250 cnt. o� s v. epartment RIGHT OF WAY PERMIT ,-.; R211074 Work See reverse for requirementstremarks. I have read and understand both sides of Ws permit I agree to the terms and conditions; and I certify that all work will comply with federal, state, and municipal codes and regulations and the provisions of this permit Signature: Q 9—el� L --Date: 2-13-2021 Dent MUNICIPALITY OF ANCHORAGE sir Development Services Department Right of Way Section r Department ENCROACHMENT PERMIT R211074 THIS AGREEMENT, made this 9th day of February, 2021, by and between TIMOTHY D. BOWMAN & JUDY R. ENGH and their heirs, administrators, and assigns, hereinafter called "PERMITTEE", and the Municipality of Anchorage, a municipal corporation organized and existing under its Charter and the laws of the State of Alaska, hereinafter called the "PERMITTER". WITNESSETH: WHEREAS, PERMITTEE is the owner of the following described real property: CONIFER HEIGHTS SUBDIVISION, BLOCK 3, LOT 7, according to the official records thereof, on file in the office of the District Recorder, Anchorage Recording District, Alaska, and; WHEREAS, PERMITTER owns and/or maintains the real property more particularly described as follows: The TEN FOOT UTILITY EASEMENT, immediately along the south boundary of PERMITTEES property as shown on Plat No. 71-190, on file in the office of the District Recorder, Anchorage Recording District, Alaska, and; WHEREAS, PERMITTEE has placed a septic system upon the referenced real property which encroaches 1.0 feet upon the PERMITTER'S 10.0 -foot Utility Easement. NOW, THEREFORE, it is mutually agreed between the parties hereto that: The PERMITTER, acting through the Director of Development Services Department, hereby grants to the PERMITTEE the privilege of allowing septic system to encroach 1.0 feet upon the PERMITTER'S 10.0 foot Utility Easement, as shown on "Attachment A," included herewith. The PERMITTEE agrees forever to indemnify, defend, save and hold harmless, the Municipality, its officers and employees, from any and all lawsuits, claims or actions brought to any person for or on account of damage to property or injury, disease, illness or death of persons, including all costs and expenses incident thereto, arising wholly or in part from or in connection with the existence of, alterations, maintenance, repair, renewal, reconstruction, operation, use or removal of the encroaching septic system, as placed upon the PERMITTER'S 10.0 -foot Utility Easement. The PERMITTEE shall not assign or transfer any of the rights granted herein to another individual or company without first notifying and securing the approval of the Director of Development Services Department. 4. This Agreement and Permit grants PERMITTEE no interest in PERMITTER'S real property whatsoever, except only the encroachment rights described herein. 5. The PERMITTER reserves the right to revoke this permit upon twenty (20) days written notice to the PERMITTEE. The PERMITTEE agrees upon such notice of revocation, to move said encroachment(s) from the 10.0 -foot Utility Easement in which it is placed. Should the PERMITTEE refuse or fail to comply with said written notice, the PERMITTER may, without further notice to the PERMITTEE, remove or cause to be removed the encroachment(s), and the PERMITTEE hereby agrees to reimburse the PERMITTER for all costs incidental to the removal thereof. In addition to the mutual promises heretofore made, the PERMITTEE has paid the PERMITTER a one-time permit application fee of $120.00. The PERMITTER hereby waives the annual fee of $315.00. IN WITNESS WHEREOF, the parties hereto have hereunto set their hands and seal the day and year first hereinabove written. GRANTEE: Timothy D. Bowman Owmer &I-14r, Judy R. Engh Owmer GRANTOR: MUNICIPALITY OF ANCHORAGE February 10, 2021 Jack L. Frost, Jr. Right of Way Supervisor DocuSigii Envelope ID: 6022D5CE-3A3B-4E1C-9FF0-ECB23594DD59 August 28, 2020 7754 Port Orford Dr Anchorage, AK 99507 To whom it may concern, ::1177_14 Subject to your agreement to indemnify the company as set forth below, GCI Communication Corp has no objection to the septic system encroaching into the utility easement of Lot 7, Block 3, Conifer Heights Subd. also known as 7754 Port Orford Drive, city grid 2440, GCI WO#20-000-28-01. This letter of non -objection in no way precludes GCI Communication Corp from full use and enjoyment of any rights it may have within any portion of the utility easement and or the right-of-way, including unlimited access for servicing its facilities. Also, any additional and extraordinary costs incurred during any future required construction, repair or reconstruction of GCl's facilities to accommodate any or all the encroachments shall be paid by the property owner. By signing below, you agree to indemnify and hold GCI Communication Corp harmless, now and forever, for any damage, costs, expense (including reasonable attorney's fees), liabilities and injury to any person or property occurring as a result of the encroachment. Please indicate your acceptance by signing and returning this letter to me at the address below. (� Sincerely, ed by: Signature CDOCUS' r FL _Z_ January 13, 2021 14EA42871F7741C... Date Markus Kofoid Manager Sr. Field Services Central Region GCI Communication Corp 5151 Fairbanks St. Anchorage, AK 99503 907-868-6168 Office 907-868-8580 Fax aLa ka COMMOINIC TIONS. aty, .lcarammunications.com January 12, 2021 Tim Bowman 7754 Port Orford Dr Anchorage, Alaska 99507 Alaska Communications has no objections to the existing septic system encroaching into the 10' Utility Easement located along the southern & western boundaries of block 3, lot 7, Conifer Heights Subdivision, otherwise known as 7754 Port Orford Dr, Anchorage, Alaska as depicted on the drawing provided by Pannone Engineering Services. Alaska Communications currently utilizes this easement and has no objections to the encroachment. Alaska Communications hereby issues this letter with stipulations to allow the encroachments of the above mentioned into the easement. Acceptance, (your signature below), and use of this letter of non -objection by yourself, your heirs, your assigns, or your successors, will constitute agreement to the following stipulations: 1. Alaska Communications will be held harmless, now and forever, for any damages or injury to any person or property as a result of this encroachment. 2. Any Alaska Communications facility damaged or destroyed as a result of this encroachment will be repaired at no cost to Alaska Communications. 3. Any costs incurred by Alaska Communications for special construction necessitated by this encroachment will be borne by the property owner. 4. All applicable safety code regulations will be observed and maintained. 5. This letter of non -objection will in no way preclude Alaska Communications from full use and enjoyment of its rights within any portion of this easement 6. Alaska Communications is under no obligation to restore any structure damaged as a result of Alaska Communications full use and enjoyment of its rights within any portion of easements or right-of-ways. Please sign both copies, retain one copy for your use and return the other to Alaska Communications Sincerely, Austin King, Network Engineer Il, Outside Plant Alaska Communications Outside Plant Engineering, MS#14 600 Telephone Ave. Anchorage, AK 99503 ACCEPTANCE SIGNATURE: DATE: January 12, 2021 Grid SW2440 OWC November 24, 2020 Timothy Bowman & Judy Engh 7754 Port Orford Dr. Anchorage, AK 99507 Subject: Letter of Non -Objection — Septic Lot 7, Block 3, Conifer Heights To whom it tnay concern: )ENSTAR Natural Gas Company A DIVISION OF SEMCO ENERGY Engineering Department, Right of Way Section 401 E. International Airport Road P. O. Box 190288 Anchorage, Alaska 99519-0288 (907) 277-5551 FAX (907) 334-7798 ENSTAR Natural Gas Company has no objection to the existing septic encroachment within the ten foot (10 FT) wide utility easement, adjacent to the West property line of Lot 7, Block 3, Conifer Heights, according to Plat No. 71-190, Records of the Anchorage Recording District, Third Judicial District, State of Alaska. Acceptance and use of this letter of non -objection by yourself,_ your heirs, your assigns, or your successors, will constitute agreement to the following stipulations: • Landowner/Contractor working near ENSTAR gas facilities shall contact the Alaska Digline, Inc., (907) 278-3 121 or 811 for line locating two (2) business days prior to any related excavation. This service is free of charge. • ENSTAR will be held harmless, now and forever for any damages or injury to any person or property as a result of this encroachment. • Any ENSTAR facility damaged or destroyed, as a result of this encroachment will be repaired at no cost to ENSTAR. • Any costs incurred by ENSTAR for special construction necessitated by this encroachment will be borne by the land owner. • All applicable safety code regulations will be observed and maintained. • This letter of non -objection will in no way preclude ENSTAR from fall use and enjoyment of its rights within any portion of its right-of-way. Sincerely, Andrew Traiser Right of Way & Permitting Supervisor ENSTAR Natural Gas Company CHUO-= POWERING ALASKA'S FUTURE October 14, 2020 Steven Pannone Pannone Engineering Services LLC P.O. Box 1807 Palmer, Alaska 99645 Subject: Encroachment Permit for proposed septic in easement Conifer Heights Sub, Block 3, Lot 7 EN20019, Grid 2440, MOA I.D. #015-093-16-000 Dear Mr. Pannone: Please find the attached copy of the CEA Encroachment Permit EN20019 document recorded October 14, 2020 at Serial No. 2020-048225-0 for your records. If you have any questions, please call me at 762-4754 Sincerely, Sean Bolender Right -of -Way Agent 11 Cliuqccli Electric Association, Inc. ,,)601 E ec -tfon Dwvo, PO. Box 1963CO, aye, Anch l 0 a Abska 995 1 9,5300 ® :907,1�63-7494 Fax 90,7) 562-0?027 a (800) 478-7494 202J-048225-0 A Recording Dist: 301 - Anchorage s 10/14/2020 12:03 PM Pages: 1 of 4 P!�IIAI�V��IIIIInI�II����V�Y��I��I�II��I�AI��II�ViPIII�IIRIIII 1203-13B Grid 2440 EN20019 015-093-16-000 This pen -nit is between Chugach Electric Association, Inc., an Alaska non-profit electric cooperative, (herein "Chugach"), whose address is P. O. Box 196300, Anchorage, Alaska 99519 and Timothy Bowman and Judy Engh (herein "Permittee"), whose address is 7754 Port Orford Dr., Anchorage, Alaska 99507. 1. Easement. Chugach is the grantee or user of an easement for the construction and maintenance of electrical facilities, as follows: Described in that certain written instrument recorded on the 7th day of May 1964, at Misc. Book 84, Page 234, on file in the office of the District Recorder, Anchorage Recording District, Third Judicial District, Seward Meridian, Alaska, Dedicated by the plat of the subdivision known as Conifer Heights Subdivision, according to Plat Number 71-190, recorded on the 181h day of August 1971, on file in the office of the District Recorder, Anchorage Recording District, Third Judicial District, Seward Meridian, Alaska, (herein "Casement") which pertains to the following described real property: The Southerly Ten Feet (S'ly 10') of Lot Seven (7), Block Three (3), Conifer Heights Subdivision, according to Plat Number 71-190, recorded on the 18`h day of August 1971, on file in the office of the District Recorder, Anchorage Recording District, Third Judicial District, Seward Meridian, Alaska. Permittee acknowledges the validity of the Easement. Permittee warrants and represents that Permittee is the owner of the fee simple interest in the land subject to the Easement and the following described real property to which the Easement is adjacent: Lot Seven (7), Block Three (3), Conifer Heights Subdivision, according to Plat Number 71-190, recorded on the 18" day of August 1971, on file in the office of the District Recorder, Anchorage Recording District, Third Judicial District, Seward Meridian, Alaska, Encroachment Permit - Page 1 of 4 eRecorded Document (herein "Parcel"), 2. Encroachment. Permittee has constructed or purchased the following improvements on or within the real property subject to said Easement: A septic System that encroaches approximately Two Fect (2') into the northerly side of said Easement along the southerly property line. (herein "Encroachment"). 3. Permit, Chugach hereby authorizes Permittee to continue the existence of the Encroachment in its existinCD g location subject to the covenants set forth in this permit. 4. Indemnification. Permittee shall indemnify and hold Chugach harmless from any claims for personal injury, property damage or other loss arising in any way from the continuation of the Encroachment. 5. No Expansion of- Increase. Permittee shall not in any way expand or increase the extent to which the Encroachment occupies any of the real property encumbered by the Easement without the prior written consent of Chugach. Chugach has no obligation to provide such consent. 6. No Interest in Real Estate Acquired. Permittee hereby acknowledges that the Encroachment and any additions thereto, even if in violation of this permit, has not and shall not in the future give rise to any interest or estate in the real property subject to the Easement or any other real property. Without in any way limiting the foregoing, Permittee acknowledges that the Encroachment is not adverse to any interest of Chugach and its continuation is entirely with the permission of Chugach for purposes of the common law doctrine of adverse possession. This permit creates no interest in the real property subject to the easement. 7. Modification of Utility Facilities. If the electric utility facilities located within the Easement are upgraded, added to, replaced or reconstructed, Permittee shall pay that portion of Chugach's total costs for such modification which is reasonably attributable to accommodating or preserving the Encroachment. If such payment is not made within thirty (30) days of written demand for same, Chugach may tenninate this permit in accordance with paragraph 9, below. 8. Covenants Running with the Land. The obligations of the Permittee arising from this permit shall be covenants running with the land which shall burden the Parcel and the Permittee's interest in the land subject to the Easement and shall benefit the Easement. 9. "Termination. Chugach may terminate this permit after the giving of thirty (30) days written notice of such termination if: a. The Encroachment is enlarged, increased or extended within the real property affected by the Easement Encroachment Permit - Page 2 of 4 2of4 eRecorded Document 2020-048225-0 b. The Encroachment is damaged by any means to an extent of more than thirty percent (30%) of its replacement cost at the time of destruction. C. Permittee fails to make the payment described in paragraph 7, above. 10. Term. This permit shall, if not sooner terminated by Chugach, expire forty (40) years from the date hereof. 11. Entire Agreement. This written permit constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all other prior or contemporaneous agreements, oral or written, between the parties. No modifications., amendments, deletions, additions or alterations of the pen -nit shall be effective unless in writing and signed by all of the parties hereto. Z:� CHUGA . H LFCTRIC ASSOCIATION, INC. Shelly Schmitt, Yenior Manager Date:— �—imothyBo an Date:- 1 C3 - -7 - Z -,o B � ruldy- Fng Date:— /0-, Encroachment Permit - Page 3 of 4 3 of 4 eRecorded Document 2020-048225-0 STATE OF ALASKA ) ss: THIRD RD JUDICIAL DISTRICT The foregoing instrument was acknowledged before me this *1 day of 2020, by Timothy Bowman, & Judy Engh NOWY Puble--------- NEIL PATRICK E. MANUEL Z' Shft of MY EVWft Do-- 13,2= Notary Public in and fortheof Alaska My commission expires: STATE OF ALASKA ) ss: THIRD JUDICIAL DISTRICT The foregoing instrument was acknowledged before me this L —day of (5 CJ 0 be V- , 2020, by :51Ne_11 )L- �_ Senior Manager, Distribution Engineering of Chugach Electric Association, Inc., an Alaska corporation, on behalf of the corporation. .4-0 .............. OTAi?#j� "'080c, V Expires AFTER RECORDING RETURN TO: Chugach Electric Association, Inc. P.O. Box 196300 Anchorage, Alaska 99519-6300 Notary Public in and for the State of Alaska My commission expires: In, r c J% 0 1 d.0.0 Encroachment Permit - Page 4 of 4 4 of 4 eRecorded Document 2020-048225-0 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program pOBox 18605O 47UDElmore Road Anchorage, Alaska gn519-6O50 Phone: 884 Fax: (gOT)343-7g8r Permit Number: OSP201025 Work Type: SepticTankUpgnade Tax Code Number: 01508318000 Site Legal Address: CONIFER HEIGHTS BLK 3 L 7 G:2440 Site Mailing Address: 7754PORT DRFORODR, Anchorage Owner: B{}VVK4AN TIMOTHY D & Design Engineer: PANN{}NEENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 2/19/2020 2/18/2021 31188 [] Disposal Field P Septic Tank 0 Holding Tank' [l Privy [] Private Well [] Water Storage All construction shall beinaccordance 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 VVasbsvvmtor Disposal Regulations (1 8AAC72) and Drinking Water Regulations (1 8AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 1S.G5.Provide notification bycalling (QO7)343-7904(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: e. Opened and Closed onthe same day, or b. Covered, sealed, and heated toprevent freezing I Provisions: A minimum 20" manway riser is required to the first compartment of the septic tank. Received B) 3 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-093-16 Property owner(s) TIMOTHY BOWMAN & JUDY ENGH Day phone Mailing address 7754 PORT ORFORD DR, ANCHORAGE AK 99507 Site address Same Legal description (Sub'd., Block & Lot) CONIFER HEIGHTS B3 L7 Legal description (Township, Range & Section) Lot Size 31,186 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade 0 Duplex (D) ❑ Holding Tank ElRenewal ❑ 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. (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: ��l��a��b Date of Payment: Receipt Number: Receipt Number: /�)�-�QJLi Permit No. U ��° ��U�� Waiver No. Permit App_-'- :._.,:c: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201025, Rebecca Carroll, 02/19/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201025, Rebecca Carroll, 02/19/20 GREA,,'R ANCHORAGE AREA BORouGH Department of Environmental Quslity 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL MANUFACTURER INSIDE WIDTH INSIDE LENGTH MATERIAL LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY /(J'~'""GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES I ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE FOUNDATION DISTANCE BETWEEN LINES NEAREST LOT LINE TOTAL LENGTH OF LINES TRENCH WIDTH t'~lN. TOTAL EFFECTIVE MATERIAL BENEATH TILE "~ ~ SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER .IN. ABOVE TILE ~/' IN. WELL: TYPE ~, BUILDING FOUNDATION__ CESSPOOL APPROVED CONSTRUCTION NEAREST NEAREST SEPTIC LOT LINE __ SEWER LINE TANK OTHER SOURCES DISAPPROVED REMARKS DEPTH SEEPAGE SYSTEM DISTANCE FROM: DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: ~ SEWER LINE DEPTH: ''~[ PIPE MATERIAL: LOT SLOPE: REMARKS: APPROVED I G.A.A.B. Form EQ-032 pERMIT NO. APPLICANT LOCATION LEGAL 2510 E. t[:,OR R[:,.., ANCHORFIGE'., AK. S' 97 ._~~. ~ · "-].'76- 222i ~~~,' PORT OXFORD DR. L7 Bi: CONIFER HTS SUB LOT ~IZE ]:5000 SQUFIRE FEET TgPE OF SOIL RBSORBTION SgSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ~ SOIL RATING )= THE REQUIRE[) SIZE OF THE SOIL ABSORPTION SVSTEM [:~EF'T'H= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRI.NF'IELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF "I'FIE GROUND FIND THE BOTTOM OF THE E,~4CA'v'FITION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. ]"HE GRFIVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OI..ITFALL PIF'E AND THE BOTTOM OF THE EXCFIVFITION (IN FEET). F-: bE ¢! L, I E." E [:, S; E F' T I ,2: T R !'*.! I<] '_----. I Z E =: 2L rZ~ Et 0 ,]~ Ft L_ L,_ CJl'-,,, BFIC:KFILLING OF FIN9 SYSTEM WITHOUT FINAL INSPECTI ON FIND APPROVAL 8V 'THIS DEPARTMENT WILL BE SUBJECT TO PROSECIJTION. MINIMUM DISTFINCE BETWEEN FI WELL AND ANY ON-SITE SEWAGE DISPOSAL. SYSTEM IS ±00 FEET FOR R PRIVATE WELL OR 200 FEET FOR R PUBLIC WELt_. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER :[NS'T'Rt._L_RTION. F'EEF-."r-1 I T %."RL I [:, F~]]R OI%IE '-r'ERF.' F-E'C,r-1 I S ~]L;EE I CERTIF'¢ THAT i: t RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FIN[) WELL. S 8S; SET FJRIH B~ FHE MUNIL. IEHLITb _F RN_.HOF.'.RGE. 2: I WILL INSTALL ~E S'¢STEM IN ACCOR[>RNCE WITH THE CO[:,ES. 7:: I LIN[:,EF.:STAND-~T THE ON-SITE SEWER SYSTEM MR'~" REL.]U I RE ENI_ARGE:MENT RESIDENCE I S',,~td;10~LED TO I NCLLI[:,E MORE THFIN 3 BE[:,ROOMS. RF'~ I¢RNT NELDR WRRKENT I N ISSUED B'¢ .... I F; 7'HE ,.':];rlh~ ~. ~ '. Pcrform(~d For ~/_.d~z.~/' Legal Uescrip'~6h-~-- lhis form reports: Del) th Feet 14- /6' Was ground water encountered? ?© If yes, at wi~at depth? Percolation rate Rcading -Proposed installation: oeepage Pit brain Field .............................. l)ep[h of Inlet ...................... . ~ep[h to bottom o[ pit or tree,ch ~;(~-040 WATER WELL LOG FOSS DRILLING 1336 Ingra Street Anchorage, Alaska 99501 SIZE OF CAhING~~ DEPTH OF HOL~~o STATIC WATER LE~EL~ 1 9 l~r. YIELD FEET OF DRAWDOWN. REMARKS DATE COMPLETED PUMP TO BE SET AT.~~~_~.~ to to, to , r-lLIt~ I C I PAL I TY OF RNCHOF:RI]E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 E. TUDOR RD. , ANCHORAGE, AK. 27~;-222't NELL PERM I 'T PERMIT NO. ( ?~210 ) APPLICANT ~RULDUNHA~ LOCATION PONDEROSA CR LEGAL L? B~ CONIFER HGTS 2208 EUREKA LOT SIZE E~ k-'-299i ~4000 SQUARE FEET MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELL OR 200 FEET FOR R PUBLIC WELL. WELL LOGS 8RE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS PRE AVAILABLE TO INSURE PROPER INSTALLATION. PERMIT %~ALID FOR ONE ~'EAR FROM I SSLIE I CERTIFY THAT i' I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND NELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL I~TALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~~Il-- APPLICANT PAUL DUNHAM ISSUED BY- __DATE--~-~-'~- -- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage. Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner r~D. Mailing' address ~1.~1 ~ . Lending agency ~,. Mailing address Day phone Day phone Agent Addre'~s Day phone m Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide Written confirmation from State ADEC attest- ing to the legality and status of system. 4.~ TYPE OF WASTEWATER DISPOSAL: Individual on-site COmmunity on-site public sewer NOTE: If community wastewater system, Provide written confirmation from State ADEC ~ attesting to the legality and status of system. ~ 5. STATEMENT OF INSPECTION BY ENGINEER. Name of Firm Address ~, Engine,s signature- ~~ As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Phone Date /~/Z/~f~ D7 SIGNATURE ·· ^ .roved Disapproved. Conditional approval .for bedrooms. bedrooms, with the following stipulations: Additional Comments By: Date The MunicipaliW of Anchorage Depa~ment of Halth and ~Human sewi~ (DHHS) i~u~ Halth ~uthodW Appr6val Ce~ifi~t~ b~ only upon the mpr~n~tions given in paragraph 5 a~ve bY an inde~ndent - ~ Pmf~ional engin~r ~iste~ in ~e S~te of Al~ka. Th~ DHHS d~ this ~ a cou~esYtO pumh~m'~f h°m~ .~ ~ and their lending in~itutions in order to ~ti~ ~in f~eml and ~te ~uimmen~. EmplOy~ of DHHS do not conduct ins~ions Or~anal~e data ~foma Ce~Ei~te;iS~t~u~.~The UuniciPali~ of ~Anch~Js not Municipality of Anchorage P~ E (~ E IV E D/~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division DEC :5 1998 825 L Street, Room 502 · Anchorage, Alaska 99501 · (9~}~_ Anch_orag. e Dept. Heaith& Human services Health Authority Approval Checklist Legal Description: ~_ ~z,-~ ~OAJ t'~'~ ~-r-~ Parcel I.D.: (~/~"* A. WELL DATA Well type ~:~::3t~ ~jA"-rT~ IfA, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) '~ Date completed ~/l"z / F ~ Total depth ~~M;,--~ Cased to ~¢)"(" Casing height (above ground) Sanitary seal (Y/N) ~ Wires' properly protected (Y/N). Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~ Date of sample: FROM WELL LOG ~lq. AT INSPECTION g.p.m. ~, ~Z_ g.p.m. Nitrate l'" ~'7 ,~ Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed /~//"~-~ Tanksize /t~c~ Numberof Compartments '~- Cleanouts (Y/N) High water alarm Foundation cleanout (Y/N) "C' Depression (Y/N) Date of Pumping i'~'H:~¢~ Pumper ~ ~ C. ABSORPTION 'FIELD DATA Date installed /¢>/'~ · ~ - iSoil rating (g.p.d./fF or fWbdrm) /O-"c> System type ~ T- Length- ~,~- Width 'q Gravel thickness below pipe ~ Total depth Effective absorption area ~-"~ Monitoring Tube present (Y/N) ~ Depression over field (Y/N) Date of adequacy test II/~[~ ~ Results (Pass/Fail~,S_~ For ..~ bedrooms Fluid depth in absorption field before test (in.); ,-~ Immediately after ~ gal. water added (in.): Fluid depth ;~ ~' ~ (ins) Minutes later: ~ Absorption rate = /-~,5"'~ g.p.d. Peroxide treatment (past 12 months) (Y/N) t~te,4)c~,,- If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) ~ High water alarm le?~l~ *Datum Size in gallons ~ "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot. Absorption field on lot Public sewer main On adjacent lots On adjacent lots /~ o.-~- Public sewer manhole/cleanout Sewer/septic service line ¢ ! c~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ' ~ o ¢ Property line '~.-~ Absorption field. Water main/service line .,b"'~'('' Surface water/drainage /oo~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /c)'+ Building foundation ~t Water main/service line ,~"~'"' Surface water ! c~ c)'f- Driveway, parking/vehicle storage area Curtain drain / c~ ''~ Wells on adjacent lots /~ o 't F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipa s are in conformance with MOA HAA guidelines in effect on this date. Signatur.e, ~~----?~ Engineer s Name .~;'r-'-c=~/~ ~-'~-~~ r ' ' --.----~,-.~,,~-~,~,~,'l- Date HAA Fee $ Waiver Fee $ Date of Payment Recei pt Number Date of Payment Receipt Number 72-026 (Rev. 3/96)* Steven R. Pannone, P.E. Consulting Engineer Legal: Owner: Residence: P.o. Box 102954 Anchorage, Alaska 99510 (907) 272-8218 WELL & SEPTIC SYSTEM ADEQUACY TEST Lot 7, Block 3 Conifer Heights S/D Mr. Crandon Randell 6131 West Tree Drive Anchorage, AK 99516 Septic System: (from MOA Records) Date of Pumping: Date of Test: Tank Size: 1000 gallons. Absorption System Type: Deep Trench Absorption System Size: 5x5x65 Absorption Area: 650 s.f. Installation Date: 10/76 Soil Rating: 150 sf/br 11/27/98 By: A+ Home Service 11/28/98 Test Procedure: The System was inspected and measured. Tank was found with 4 feet of cover. Liquid depth was measured to be 3 Inches. The drain field was found to have 5 Feet of cover and a total depth of 10 feet. There was 34 inches of liquid measured in the field's monitor tube. Water was added from the well at a constant rate of 4.2 gallons per minute (GPM). The water levels in the tank and drain-field monitor tube were monitored. A total of 450 gallons of water was added. During the test the level rose 0 inches in the field's monitor tube and 4 inches in the clean-out at the beginning of the field. No rise was noted in the tank. The infiltration rate was monitored for 30 Minutes. At the end of this period the water level in the field returned to the original level. During this period, a total of 450 gallons were absorbed. By extending the observed infiltration rate, a total absorption rate of 450+ gallons per day was arrived at. The field was steamed cleaned by Dayton Sewer and Drain. It was found that there was a clog in the drain field line between the beginning of the field and the monitor tube at the end of the riel& which explains why the liquid level did not rise in the monitor tube. An adequacy test to determine the wells production was conducted at the same time as the septic system adequacy test. The initial static level of the water was found to be 239 feet below the top of the casing, with a total depth reported to be 600 feet from MOA records. Water was pumped from the well at a constant rate of 4.2 gallons per minute (GPM) for 2 hours. A total of 450 gallons were pumped from the well with the static water level drawing down to 264 feet below the top of the well casing. The water quality was also tested for bacteria and nitrates. The test results are being determined at the time of this report. TESTS RESULTS: This system meets the code and operational requirements of the Municipality of Anchorage. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system. 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. We can therefore not give any estimate of how long the system will continue to meet the operational requirements of the Municipality and State. Oept. Health mCT&E Er~vtronme,~ll 8ewicea Sample Client I~# Printed Date/Trine 1~/03/98 22:39 Colloetei Dat~Tlme ~ 1/29/98 T~nl~l ~r: Steph~ C. Ede SCL KA~ CT&E Environm~?a! Servloss Inc. ,& LaborwtorY Oivllion 200 W, Pett.r Drive ~g Water A~lysis R~o~ for Total Colifo~ Bacteria ~,~: ~ INS~UCTIO~S ON ~ r Bg~ SAMPLE DATR: Mootb u Ro~l~ Re~t sample (for re.ne sample with lab re¢. ~. ~ - ) ~ SpKlai S~PLg L~A~ON r~ T~St~t Wats' c. Unt~ted water Amalysis shows this Water SAMPLE to be: t:l U~sfacto~ S~ over }0 hott~ olt, resulm may be Tim~ Received Andyti~tl MetbM: Coml'~er~ts: i~}N,M~mbnm¢ Filt~ t; MMO-~1JO D~2:_ , __Tim' ~ ~l~t notified or ~lll~tl~n~tory r#~ilts: BACTEKIoLOGICAL WATER ANALYSIS Itl,CORD MMO-MUG R~lt: T~tl coiHom __ ~ .----- Cot~/iM r~ Membrsne Filter: DIFectCouM ~ _ COLtHP-M~ Coitf. rln/l~ mi TIm~ ~ ltr~ Yertflcsflon: LTB~ fecal Coliform Conflrmillou ~.__~ Flail Membrtue Fitter ltts~tlt$ ~ ......... .^mvt anti. MtOI..#GA#. MtSSOtJm, NIVV j~PlSg'V. Ol~lO. WR6'T t0~glgg 'lViNB~NOa IANB Bm:)'~O~dd .~$:60 DEPARTMENT OF HEALTH & HUMAN SERVICES P.O. Box 196650 Anchoragei Alaska' ~. 99519-6650 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1, GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone ~,' Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. ".:~ 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA#21 · ~po~ sjeau!§ue leUO!SSeIoJd eq) u{ suo!sslmo Jo sJoJJe Jo) elq{SuodseJ )ou op gHHC] ~o sae,(oldm~3 'm,u~meJ!nbaJ e)e)s pue leJepe,t u!eLzeo/u,s!ies o) Jap Jo u! suolinilisu{ ~ulpuel J{eq) pue sa~oq )o sJeseqoJnd o) Xse~noo e se s{q) seop ~HHO ~qJ. 'mlSelV,to elelS chi u! peJaisl§eJ Jaau!§ue leuo!sse)oJd )u~puadapu! ue ~q aAoqe g qdeJ§eJed u! UaA!§ suo!ie)ueseJdeJ eq) uodn 41uo peseq saieou!~aO le^oJddv /qpoqin¥ q)leeH sanss! ($HHO) sao!~e~ uemnH pue qileaH ~o )uem~edaa e§eJoqou¥ )o 4)lled!o!un~ aq.L gl-l/g eO s),uewwoo leUOp,!ppv :suo!ielnd)ls BU!MOIIOJ eq~, q:l!M 'SLUOOJpgq leAoJdde leUO!l!puoo -- 'pg^oJddes!a Joj pg^oJdd¥ 'sgpoo e),e),S pue led)o!unlAl lie LI)!M eoUellduJoo u! s! uJe),s/~s lesods!p Jg),eMg),SeM Jo/puc ,(Iddns Jg),eM g)!S-UO eq), 'uop, ogdsu! pue UOp, e§p, SgAU! ~LU UJOJ,~ puc SglU e§eJoqouv jo/q!led!o!unlAl LUOJJ pgu!e),qo uop, euJJoiu! gq), uo pgseq ),eq),,(~tpg^ Jgq)Jn~ I 'u!gJgq pe),eo!pu! gJn),onJ),s,to gdX) pue suJooJpgq jo JgqLunu eq), Jo~ e)enbepe pue leUOp, oun,t 'e,tes s! LUe),S/~S lesods!p Jg),eMg),SeM Jo/pue Xlddns Jg),eM e),!s-uo gq), leU), SMOqS uop, eo!ldde leAoJdd¥ ,(),poq),n¥ q),legH s!q), ,to uop, e§p, seAu! XLU ),eq),/~!JgA I 'MOIgq UMOqS g),ep uop, eP!leA gq), jo se pue o),eJgq pexkue legs XuJ/~q pgu!lJeo s¥ '9 I::I::igNIDN:::I Ag NOI.LO::IdSNI :lO .LNglNg.LY/S 'g Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: Lo1~'7 r~'~ (--.Ol, t;,~. ~.c~ll4-~ ParcelI.D. A. WELL DATA Well type ~ Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level If A, B, or C, attach ADEC letter. %/ Date completed Cased to FROM WELL LOG ADEC water system number & /l ~-/ 7~ Driller ~ / ~'"' Casing height Wires properly protected (Y/N) g.p.m. AT INSPECTION /$ '.~ ~UN~oP^ur¥ oP ENVIRONMENTAL SERVICES DIVISION NOV 0 8 1991 RECEIVED g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/he4~tank on lot J Absorption field on lot I ~.~ Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Nitrate (P. '~ I Other bacteria, Collected by: Date of sample: N~ B. SEPTIC/HOLDING TANK DATA Date installed ~°/7/~, Cleanouts (Y/N) High water alarm (Y/N) 1 Date of pumpin~ ~ ,,, ~lOll Tank size J 0-o-¢2 Compartments Foundation cleanout (Y/N) ~ Depression (Y/N) 1~//.~ Alarm tested (Y/N) 'J~/~ [ f~a-~, g.1 5 Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot J 1 ~ On adjacent lots To Property line ~-O ~--- Absorption field Surface water/drainage Foundation Water main/service line 72-026 (Rev, 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) , ~ , "Pum'p on" level at High water alarm level Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed lO J3 Length ~- width Total absorption area Soil rating I~'0 System type T~I~N, Ct~- Gravel thickness ".'%'"' Total depth I ~ Cleanouts present (Y/N) ~/ Depression over field (Y/N) ' Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Date of adequacy test for ~"~O ~ bedrooms If yes, give date SEPARATION DISTANCE' FROM ABSORPTION FIELD TO: Well on lot J~.~' To building foundation ,.,~"'~, On adjacent lots _/~ Cutbank Surface water Curtain drain'' On adjacent lots '~/~--~ Property line To existing or abandoned syst.e.rn on lot /'~/'~-~- Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effeCt on the date of this inspection. HAA Fee $ ~;;:~¢::f ' 'f Date of Payment Receipt Number iff'fi*r[' Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 20T WEST 15YH. AUENUE SUITE 206 ANCHDRAGE, ALASKA (907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: Lot 7 Block 3 []on:i..Fer' Heights LOCAT I ON: 7754 F'ort Or.Ford OWNER: Crandon Randell RES I DENCE: S:Lngle Family~ 3 Bedrc)oms WELL: Private~ On Site SEPT IC SYSTEM: FROM MUNICIPAL. RECORDS: 3 Bedrc:.~c)m System TANK: Greer Steel 100C.) Ga,l.. Two Comparts. ABSORPTION SYSTEM: Trench ABSORPTION AREA: 650 Sq. Ft,, SOIl .... RATING: 150 I NST'ALL..AT I ON DATE: 10/07/76 DATE OF LAST PUMPING: Isaacs :L()/01/9.1. DATE OF TEST: 0/26/9 TEST PROCEDURE: System was inspected and measured. Tank was m~:(~[.m~J"~d with 1''3 '~eet O~ cover and with a liqu:i.d level o~ 46,,5 Trench sump was :lin(i) 'Ft,, d(.~:.)~p w:i. tln 36,,5 inches 0~ water,, 480 gallons o¥ clean ~ater was added to the trench while the water levels :i.n the t~."..~r)k,~ trench c:.lean oL.d"..~ af')d the SLlmp w:.'..'~re monitc)red, The v.,,ater level :i.n the t. ank did not change~ ,,~h.il.e the. level in the sump and c].ean o(..it rose ...) inc:hes in the sump and :J.n(:::hes :i.F') the (:.~le~.,'.~n (.".)u.t,, One hatir a~.ter the. wa. ret was shut a~ the water levels were back to pre test levels. On I1/06/921 {:he a snake ~as used to clean the l~ne between the clean out and the sump. An obstruction in the line ~,as-Found and a6t. er' some wor'k large amounts o~ sludge was discharged t.o the sump,~ which rapidly ~:i. lled up to level c)~ the cleanout. L:Lne was aga:i.n 'Lested by adding water to +'he clean out, The ~irst ,~z gallol']S C:aL.lSed the leve]m in tJ')e SLlflip arid c:leanoLlt to rise ~./4 :i. nch,, Add:i.'Lional 50 ga].].ons did not cause any ..Ftir"ther' r-]J. se ~ater levels, We c~on(]].L.~ded tlnat this p:Lpe was :Lnstalled with 'Lhe holes up and with an unper~ora'Led 6-inc:h sump,, TEST RE.~ULT: This system meets the ct)de requ~,rements the Health and Social Services Department of the Munic:ipality of An c h or a g e ,, NOTE The operational l:i.~e o~ ali. sep'l:.ic systems depends on the ]. oc::a], scJi 1 (::ond :i. t :i. ons ,~ groundwater 1 evel s that may '~: 1 uctuate during t. he year,~ and t. he water usage o.f t. he ~am:i. ly being served by the syst. em,, These c(:]nd:i.t, ions are out. side the control (:)~ the eva].uat(::)r o.~: this sep'l::.ic: system, We can there.fore not ~.ve any (.:,:~stii[~ate o.~ how ].ong this syst. em will .~unc:ticln satis~:actory .~or 207 W£ST 15TH. AYEHUE SUITE 206 ANCHORAGE~ ~LCC~I(A 99502-7904 RESIDENTIAL WELL INSPECTION LEGAL: LOCATION: OWNER: TYPE OF WELL: L.o'L". 7 Block 3 Con:L~er Heights 775/.1. Port Or.~ord Crandon Randeil Private, Single Family WELL LOG AVAILABLE: Yes INSTALLATION REQUIREMENTS MET:Yes WELL YIELD FROM WELL LOS: 6 Gallons per Minute PUMP YIELD FROM TEST: 5,, 5 Ga]. 1 ()ns per" Mi nt..tt.e DATE OF INSPECTION: Oc:tober 26 199.t. TEST PROCEDURE: We].]. was pumped at a constant rate wh:Lle the dr'awdc~wn was moni toted wi t.h an acoust i c: pr'obe. At. the I:)eginning of the test water level was found at 268 '~eet below top of casing,, At a pumping rate of 4 gallons per m:Lnut, e the water' level drol:)ped t.o 283 a~ter" 54 m:i. nutes o-F pump .... :Lng, and a deliwz,~r'y o.F 23C, gallons. The well was pumped at var ...... Nax draw down was t.o 285 ~:t,, The we~l ~ecovered 7 '~t,, in 10 minutes ~:,:::~r a well yield o-F 1 gal. per m~n. TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested .~(:)r E,,Col:L and total nitrogen on Oct,, 26,~ ,1.991 E,, Co].i 0,, ]"oral N~.'tr'c:)ger'~ 0.31 m(;;~/1. Max. allowable Total. Nitrogen :1.0 rog/t,, TEST RESULTS: "Fh:i. s we]. 1 meet. s t. he r"equi remen'L".s Mun i c :i. pal .i. ty (::)~c Anchorage. o ~ 'L" Iq e ]"he Mun:i.c:Lpal requ:imreme?nt, for well flow is 150 gallons of water" per bedroom per day,, This we. ll exceed t. his r'equirement,, The assessment o.F i:.he condi~.:.:Lon o-F tine wel I appl :i, es only to t. he condit.i.c)ns as c)~: the day tested. Tine .Flow rate may change due sLtDsLu''J:ac".E.? (::or')d:i.t:imOnS t. hat may not be observed -From the sur'~ace~ and changes :Ln the land usc-? and o~her ~Cact. ors that may impact, t. he a (::j L( :i..~: G: r- -F e e (::l i r') g '~: h (..'.:.) w ~.'.i, ]. 1 . CHEMICAL & GEOLOGICAL LABORATORY A'DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALYSIS REPORT g¥ SAMPLE £or WOgKo~&ert 39635 Date Report Printed: OCT 26 91 ~ 13:53 FAX: (907) 561-5301 Client Sample II):L7 B3 CONNIFER HTS 7754 PORT OXFORD Client Name PWStD :UA Client Acer Collected OCT 26 91 ~ 11:30 h~s. BPO ~ Received OCT 26 91 @ 11:50 h~s. Req # Preserved with :AS REQUIRED Ordered By :TOBBEN SPURKLAND, P.E. ;TOBBENB PO ~ NONE RECEIVED :TOBBEN SPURKLAND Analysis Completed :OCT 28 91 Send Reports to: Laboratory Supervisor ;STEPHEN C, EDE 1)TOBBEN SPURKLAND, P.E. Chemlab Ref ~: 915762 Lab Smpl ID: 1 Matrix: WATER Allowable Paramete~ Tested Result Units Method Llmit~ NITRATE-N 0.31 mt/1 EPA 353.2 Sample ROUTINE SAMPLE COLLECTED BY: STUART. Remarks: 1 Test~ Pezfozmed ' See Special Instructions Above UA-Unavailable ND- None Detected "See Sample Remarks Above NA- Not ~nalyzed LT-Less Than, GT-Greater Than Member of the SGS Group (Soci~t~ G~n~rale de Surveillance) CHEMICAL & GEOLOGICAL LABORATORY co. ~ TELEPHONE (907) 562-2343 ~ ~ 5633 B Street Anchorage, Alaska 995 t 8 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER Il I II II [] I~UBLIC WATER SYSTEM I.D. # ' [] PRIVATE WATER SYSTEM 3 Phone No. Ma~t~ng Address City 5~w.~ Z~p Coae SAMPLE DATE: c-~ ....~ i i Mo, Day' Year SAMPLE TYPE: ~t-~Routine Check Sample (for routine sample with lab ref. no. ) [] Treated Water Special Purpose [] Untreated Water SAMPLE Time Collected No. LOCATION t Collected ...._.By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: /~ Satisfacto~ [] Unsatisfactory [] Sample too long in transit; sample should no[ be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: Membrane Filter · No. of colonies/lO0 mi. Lab Ref. No. ,,' ,,,,, ,d,=_ ~J ResuJt' I ~ A.D.E.C. Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE Membrane Filter: Direct Count Verification: LSB Fecal Coliform Confirmation BGB Coliform/100 mi TNTC OB = COLLECTING SAMPLE Final Membrane F~sulls/// ~2 ' Reported By ""~-/' ~'~'~ /' Too Numerous To Count Other Bacteria Date Time: \ Coliform/100 mi 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 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~o~u~ [;)~n h,~*r~ Telephone: Home '3'¥~¢' -'~*/'v'C~ Busines Applicant Address 7 (c) Applicant is (check one): Lending Institution [] · Owner/builder ~; Buyer []; Other [] (e~ ,h..;in); (d) Lending Institution J-~K- Address , ,, ~Og~ (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 WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have wriiten confirmation from the ~ .~:e Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL ; Onsite [] Public [] Community [] H°ldih~] Tank [] Note: If community well system, must have written confirmation ' om the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 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 alt Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date Engineer's Seal Approved f o r (--'~r¢-'/'~--E-~', Approved ..... [.~"'"~' Disapproved Conditiona~'''''''-5 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 =ir~ 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) MUN~IPAUl~ Of ANCHO~GE DEM. OF HEALTH & ENVIRONMENTAL ~OTEC11ON R,ECEIVED MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: /,~,~' 7~ A. WELL DATA Well Classification ! Well Log Present (Y/N) Total Depth ~' ~ ? Cased to Static Water Level ' Casing-Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line N~. Clea nout/Manhole Water Sample Collected by If A, B, C, D.E.C. Approved (Y/N) Date Completed ~' / t?., / ?~' Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ~ ~ oo ' I '~ ; On Adjoining Lots ~, ~O~ ' To Nearest Public Sewer HoA. To Nearest Sewer Service Line on Lot 3' F~ ; Date ~/~'/'~"' Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed I~! ~/?~' Size lO~'~¢l No. of Compartments ~k- Standpipes (Y/N) Y' Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) N Depression over Tank (Y/N) N Date Last Pumped ~/'~ / ~'~"' Pumping/Maintenance Contract on File (Y/N) N~/~. ; for Holding Tank High-Water Alarm (Y/N) N0 Separation Distances from Septic/Holding Tank: To Water-Supply Well ~ ~ ° To Property Line ~' ~ To Water Main/Service Line N,,~. Course ~ I~ ~ Temporary Holding Tank Permit (Y/N) No~-. To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed rO / 7 / 7~' Width of Field ~,~" Square Feet of Absorption Area Depression over Field (Y/N) N Results of Last Adequacy Test A,~,,,~u~,/"~, Separation Distance from Absorption Field: TO Water-Supply Well ! ,~ ' To Building Foundation ~'o' Lot N,~I. To Water Main/Service Line N, To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~ ,~,'~ Type of System Design~. Length of Field ~'v~' ' Depth of Field I O Gravel Bed Thickness ~c ' Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line ~ le To Existing or Abandoned System on ; On Adjoining Lots ~ 3 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) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA- Comments ** Check Permitted 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. Signed _~'~~ ~, ~ Date Company ,~.~ Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 [11/84) Engineer's Seal · ' MUNICIPALITY OF ANCHORAGE MUN ClPALITY OF ANCHOJGE ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PRoTEcTION DEPT. OF i!~ALTH /~=~ '~'~ 825 L Street- Anchorage, Alaska 99501 ENVIRONIvIENTAL PF. OT£CTION ~ Telephone 264-4720 REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND sEwEI~¢,I~,ir~£ DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPE. RTYOWNER --~ . I PHONE. MAILING ADDRESS ~-~ ~ PROPERTY RESIOENT (If different from above) PHONE '2. BUYER~ ' ' ' PHONE MAILING ADDRESS . 3. LENDIN(~ INSTITUTION .~ l,~ PHONE 4. REALTOR/AGENT ~I HON5 GA D ES ' I MAILIN D R S 5. LEG.~L DESCRIPTION /3 6. TYPE OF RESIDENCE  S INGLE FAMILY [] MULTIPLE FAMILY 7. WATER S~IPPLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY 8, SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** I--3 One [] Four [] Other ~ Two [] Five [] Three [] Six *ATTACH WELL LOG. Awell log is required for all wells drilled since June t975. For wells drilled prior to that date, give well f t **depth (attach og i ava lab e.) (~ ~ If individual/on-site, give installation date /~'~ ? . [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOI NTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2, WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE I-]PUBLIC UTILITY Connection Verified []Sep~c~_Ta.n,,kor' [] Holding Tank Size: ~ If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line NUMBER OF BEDROOMS [-- ONE [] THREE [] FIVE [] TWO [] FOUR [] SlX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING MANUFACTURER/ ~__~OO ~) MATERIAL Septic/Holding Tank IAbsorption Area I JSewer Line [] OTHER INearest Lot Line 5. COMMENTS DATE ~ ...~ LEGAL DESCRIPTION ;PROVED BEDROOMS' [] CONDITIONAL APPROVAL (etter must cog~panv certificate) [~-' DISAPPROVED ~L / /~ BY (Tit ~ '~ 72-010 (Rev. 3/78)