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HomeMy WebLinkAboutCONIFER HEIGHTS BLK 3 LT 12He lock Lot 12 · 015-003 -11 O  Municipality of Anchorage Development Services Department ~'~: Building Safety Division ~ ~ On-Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: o$pIilO'~.6, PIDNumber: OI5- O~$- 1[ Name: ~ ~0 [[ Wastewater System: ~ New ~Upgrade ~5Zt Po-g~os~ Pr~¢~] A~c ABSORPTION FIELD Phone: B : ~ ~Deep Tren~ ~ Shallow Trench ~ Bed ~ Mound ~ Other: Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION I. 2 ~[~ [o.5 Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: Township: Range: Section: Fill added above original grade: Gravel LenCh: O - l [t. ~O ~j~, Number of lines: [ Distan~ be.oen lines: ~:2t ~ New ~ Upgrade Gravelwidth: 2.~ Ft. [ -- Ft. C ' ' ' ( ' , ~, B. C): Total Depth: Cased to: Totalabsorption area: Pipe Matedak Driller: Date Drilled: Static Water Level: Installer: Date Installed: Yield:GPMI Pump Set at: Ft. Casing Height ~ove Ground:Ft. TANK I SEPARATION DISTANCES ~ Septic D Holding D S.T.E.P. D Other: T~ Septic Absorption Li~ Holding ~ubliCPrivate Manufa~urer: ~ Capacity: Tank Field Statio. Tank Sewer Line MS~rt~O¢&~ ~k Numberof Compadments:GaL .ou.d~t~onSU"aO"w~'~r [0~+~ !o0'10 +4 ~~ _~ ~~ LIFT STATION Size: ManCa~urer: Lot Line [01+ I0 I + ~ Gal. " 'P~ __ ~ . t. "Pump on" level at: High water ala~ at: in, in. ~ ~ Pump Make & Mod~ Electri~l Insp~tions performed by: Remarks: gx/~+i~ ~k a~.~o~,~ ~ ~DA eo}~ BENCHMARK Lo~tion and Description: ~ Assumed Elevation: L~:~~ ~ ~ En, ioee. r:s ~,amp Inspections pe~ormed by: Dates: 1st ¢ ' Zolt ~7;~ 0~. Development Se~ices Depa~ment Approve ." Z"4C;T~.', ?:~ ? ;./;.. .... Cond,.iona, *..rova, ate: ; Reviewed and approved by: /X.,/' _~,' ~/, ./'" Date: .~p- El-// .i I I IT~NK ~E~ U~C ~E~U/~EUE~Sl _ LOCATIONS TAKEN FRO~ ON-sirE WATER AND WASTE ~r~ l ~ ~ ~ ~ ~: ~ ~. SPURK~m ENGINEERING CONIFER HEIGHTS BLK 3 LOT 12 SEPTIC SYSTEU AS~UILT 20~ · 15TH. AVENUE KENNETH ~OLL DATE: JUNE 6, 20~ ANCH. AK. 9950f PE~NIF ~ O3P]]]076 PID ~ 015-093-]] CONIFE~HEZGHT3~3L]2N.D~5 / A 8 C E 20.5' 22.5' F 22.0' 24.0' G 46.0' 31.0' H 19.0' 52.0' I 30.0' 38.5' ~ 0 1250 5al, Septic Tank 0 Installed Bauble Clean Outs ~ ~ To Ex/sting Field S~andard french~ 50' Long ze' s~ ~o~ ~: .... 4' Cover ' ~ / ~'k~ , ** ~;: ..... ~i/,~z~.....' ND SChLE / Monitor Silt Barrier~ / / 4' Cover I ELEV.=8& 1~ : ~ 7,~ ~ o~ Septic Rock 1~50 5al. Sep ~ic Tank L ELEK = 79.6' NO SCALE BENCH MARK BOTTOM SIDING SW CORNOR HOUSE ASSUMED ELEVA NON ~ 00' SPURKLAN5 ENGINEERING CONIFER HEIGHTS B~ 3 LO~ 12 S~PTm S~STE, ~ESmN 203 M15th Ave Anchorc~e Ak 99501 KENNETH MOLL DATE: MAY 23, PERMIT ~ OSPXXXX PARCEL I9 ~ OSi-093-H CONIFENHEI6HTSB3LI2~D~5 On-Site Wastewater Disposal System Permit OSPl11076 01509311000 Septic MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: Tax Code Number: Work Type: Upgrade Permit Effective Dates: May 31,2011 to Design Engineer: SPURKLAND ENGINEERING Subdivision: CONIFER HEIGHTS May 30,2012 Site LegalAddress: CONIFER HEIGHTS BLK 3 LT 12 G:2440 Owner/Address: MOLL KENNETH ROBERT 9521 PONDEROSA DR ANCHORAGE AK 995076075 Site Mailing Address: 9521 PONDEROSA DR, Anchorage Lot Size in Sq Ft: 45368 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: ~ Issued By: . v - Date: UNICIPALITY Community Development Department Development Services Division On-Site Water & Wastewater Program Mayor Dan Sullivan OF ANCHORAGE Phone:907-343-7904 Fax:907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Ot5-O~i5,- [I Property owner(s) F~e.n,~6{k no/i Mailing address ~5~ ~o,~c~ 0¢, Site address - .¢4~'~- Legal description (Sub'd., Block & Lot) 0o~',~, ~ci~&{5 ~iK Legal description (Township, Range & Section) Lot Size~ ~ ~ Sq. Ft. Number of Bedrooms Day phone THIS APPLICATION IS FOR: ([] all that apply) Absorption Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage [] THIS APPLICATION IS AN: Initial [] Upgrade J~ Renewal [] THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signatu/e of property owner or authorized agent) "'Permit/Rush Fees: ':" .'~.:' ' Waiver Fees: .... Date of Payment: ~-.-..:-' ,., Date of Payment: Receipt Number: '...: ~':''-~-~ ..., Receipt Number: .... - .......... ;: Waiver No. G:\Building\On Site\Forms\Client Forms\Permit App_010411 .doc (Rev. 1/11) Environmental Consulfing and Design SEPTIC SYSTEM DESIGN CONIFER HEIGHTS BLOCK 3 LOT 12 Municipality of Anchorage Development Services Department On Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, Alaska 99519 May l8,2011 Subject: Septic System Installation Permit 9521 Ponderosa Drive Ladies and Gentlemen: I am writing to request a permit to upgrade the septic system for the above referenced property. The proposed system will serve a 4-bedroom single-family residence. The existing system was installed in 1983 and did not meet COSA operational requirements. A soils log, design calculations, a site plan, design drawings and construction specifications are enclosed for your review. Design Calcs: No Groundwater observed to a depth of 17 feet below ground surface (may 12, 2011) Soil Rating. From Testhole (5/5/2011) 2.1 min/in = 1.2 gal per sq.ft/day No. of Bedrooms 4 Required Area per Bedroom: 150/1.2 =125 sq.ft. Total area required: 125 x 4 = 500 sqft System: The proposed system consists of a 1250 gallon septic tank and a deep trench absorption field. The absorption field will be 50 feet long and 2 feet wide and contain 7 feet (700 sq.ft, effective) of sewer rock. Soils: A test hole was excavated on May 12, 2011. See the attached soil logs. Ground water was monitored for through May 20, 2011. Ground water was not observed. Surface Water: No surface waters were observed within one hundred feet of the proposed septic system upgrade. Topography: The lot slopes to the west at approximately 5-10%. 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland~gci.net Environmental Consulting and Design I Waivers: None The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or concerns, please contact me at 279-3916. Lars Sl~urkland, P.E. Spurkland Engineering 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland~gci.net FEE / TS ~ / SPURKLAND ENGINEERING 205 1¢ 15T1-1. AVENUE ANCI-I. AK. (~OZ) CONIFER HEIGHTS BI.I( 3 LOT 12 KENNETH MOLL 9521 PONDEROSA DR., ANCHORAGE, AK 99516 SEPTIC SYSTEM DESIGN DATE: MAY 17, 2011 SHEET: 1/$ GRID: 2440 PERMIT ii DSPXXX PID ii 015-093-1I CDNIFERHEIGHTS33Ll~DI. DIVG INSTALL 4 BEDROOM SEPTIC SYSTEM 1250 GALLON SEPTIC TANK ' .. LENGTH 50 FEET ~ WIDTH 2 FEET :°2c~ ¢#~ h~ "'~ \ ~, L..~.".:::'. I "~"~' 5~~ """" '"2 / / ~ i,~,,,, ,~,, ~,~ ,,~,,,~m~,,,~l - - ' - ~./ 2 - - -7 - , · NOTE: THIS IS NOT A SURVEYED P~ WELL ~ SEPTIC j ,~ LOCATIONS TAKEN FRO~ ON-SITE WATER AND WASTE WATER ~ ~ DEPARTMENT DOCUMENTATION. A~ LOCATIONS SHOWN ARE ~w~o~. .....'.~. ........ SPURKMND ENGINEERING CONIFER HEIGHTS BLK 3 LOT 12 SEPnC SYSTEU DESIGN 20~ · 15TH. AVENUE KENNETH ~OLL DATE: ~AY ~7, 20~ ANCH. AK. 9950f ~907) 279-~9~6 952~ PONDEROSA DR., ANCHORAG~ AK 995~6 SHEEn ~/~ CR/D: 2440 PERMIT ~ OSPXXX PID ~ 015-093-11 CDNIFERHEIGHTSB3L12f11,fl~G Install Foundation Clean out 1250 Oal, Septic Tank Install Bouble Clean Install ~ull Run Bivemter Standard Trench; 2' ~/ide 50' Long 11' 1)eep 7' Sewer rock 4' Cover NO SCALE To Ex/sting Field 7,0 EffeclNe Cleanouts4, Cover ~°mi~c°r Silt ' ~ Borrle Fi oF Septic Rock ND SCALE 1250 Oal, Septic Tonk SPURKLAND ENGINEERING [ [ 203 ~15th Ave Anchorcge Ak 99501 ~79-~916 CONIFER HEIGHTS BI, K 3 LOT 12 KENNEfH MOLL 9521 PONDEROSA DR., ANCHORAGE, AK 99516 SEPTIC SYSTEM DESIGN DATE: MAY 83, 8011 SHEET: 3/3 GRID: 2440 PERMIT # OSPXXXX PARCEL ID # 051-093-11 CONIFEPHEIGHTS33L12D3.D~/G Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.ci,anchoraqe.ak.us (907) 343-7904 Soils Log - Percolation Test Performed For: I~Lr;l~ k.!~k ~i~ Date Performed: S/i2./Z. ci~ Legal Description: (J~9; f~,~ ~C-iq~i',~ ~iK .3 Lo¥ i'~- Township, Range, Section: ! Slope Site Plan 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 15- 16- 17- 19- 20- COMMENTS WAS GROUNDWATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? ~ L O Depth to Water After p Monitoring? j~dy E Date:5/i~/20'l Reading Date Gross Time Net Time Depth to Water Net Drop . ~/'Z/~Jl 'O~Oq~ ~ y,l;,x ~C; ~/~./'' PERCOLATION RATE '~, ~ ! (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND '7 FT PERFORMED BY: ~ " .~.) ' ~ ~1 I , - CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL~LI~ES IN EFFECT ON THIS DATE. DATE:  ~ 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 PHONE J ~[~EW LEGAL DESCRIPTION LOCATION NO. OF B~OMS ~ [ O ~ ~ IAbs°~°n area Dwelli.~~ PERMIT NOq ~Z Manufacturer ~ I~id~ ~ Widt~ Liquid depth . ~ ~ ~ DISTANCE TO'. Well r~ . In ~ Dwet~in, PERMIT NO. ~ -- ~ Manufacturer ~ ~ ~-~ Material Liquid capacity in gallons Foundation Nearest lot line , PERMIT ~ DISTANCE TO: Well I~'~ ~~. ~ Distance between li~es - ~--~ ~ No. of line~ Length~ of.~ea~ line~, Tot~ le~g~f I~ Trench~ ~ inches Total effective au~ur-~/~ption ~ ~ ~ Top of tile to finish grade / ' ~ Material b~eath tile area Q ~ inches ~ Length Wid~ / Depth PERMIT NO. ~ Type of crib Cr,~ ~e~ '~rib depth Total effective absorption area ~ Well [ Building foundation Nearest lot line ~ DISTANCE TO: ~ ~ Cl~ Depth Driller Distance to~ I~n~ PERMIT NO. ~ ~ DISTANCE TO: Building f°und~ Sewer line Septic tank(. ~ Abs°rpti°n area(s) OTHER PIPE MATERIALS ~ ) ~, SOIL TEST RATING ' INSTALLER REMARKS , APPRO~~ F~~' LEGAL 72-013 (Rev. 3~ I=:E:F.J'"t ii; '1" FtI='P L. ]: C:I=tI",IT L. 0 C:I:::I T ]: 0 Iq L. E:C:if:IL. J,.';::' J.. :!:.:: L. 0 G Ftt'.,I THE: I:r::E::QIJ :[ I:z.': E!: E:, :~; :[ 2!:E: '.'IF: T'H[.:.~. :E;O :[ L. F:IE:'.:ii;O[~tF'T .T. ON .='='; %T[:-:t I ]: E!; - 'T'HI.:.:: L...EI",iCYI"H [::, :1: t'IEI'.J"E; :[ O1"4 :[ .'E; T'HE.:. L._EI'.,tG"rH ,:: :[ I'.,I F'E::E:T ) OF' THE: "I"I:~:I.:ii:NC:H OF;: [::,f~:l:::t ]: I'.4F::' :[ E:L..E:,. 'THE L":,E:F'TH C~F::' FI TF:'.'F. ZI'.4CH OR P].'T ].'E; 'THE: E:, :[ E'.: "t" Ft t",I C: E: E',[£TI.,.IE:E:I",I THE': E;L.IF::F::'F:IC::[.:.: O1:::' "Ff..II:':: EiiI:~'.L")UI'.41:) I:::II'.,IE:, 'T'HE!: E~OTTOH OF' THE: E::'-.:',C::Ft',/'F:IT:[OI"4 ,::~.f',l F:' E: E: T ::, . 'T'HE:::RE; ]~ :E; NO E;E:T t.,.t.1: [::,'1"1...t F:'OF.'. 'T F;?. E: I'.,I C: H E :E; . THE: GF::f:I'v'E:L.. E:,EF:'TH :[:E; 'T'HE i"I].'i'.,IZHI.Jf't E:,I:ZF"T'H OF' (~il:~::l:::l',,,'['~:L. DE'T'I.,.IEi:E:.:I",t THE!: CIU'T'F:'I:::II....L.. F::' .I: F::' E.Z 1:::11'.,1[) THE E:OTTOhl C:IF' "l"Hli=:: [E::-,:CF:!.'v'I::IT :[ O1'.4 ,:: :[ tq FE:E~T ::,. 1:'1!'"..:1~i:i"1 :[. 'T' FIF'F'L. :1: C:f:tI",IT I'..IFI'.:~; 'THE: F.:E:2E F'Cd'.~:!.:.'; ]: E: :[ I._ :[ "1" r' '1"O T t'.,IF'Or~H q"l...I :t: :E; E:,[.:.:F::'Fff~.:TME:I'.,I'T' I:::,1...I1~i: ]' .'.lCii THE!: ]: I'.,l'.E;"l"f:lL.L.l::l"r' ]: ON .1: I'.,IE;F'F'C:T .1: ONE; OF:' I=ll",l"r' I-,.IE:L..LE~ F~E:,.:rI:::IC:IE:NT "1"O TH :[ ':'!..; F:!:~::OF:'E!:F.".T"r' I=tt'.,tl.~:, 'THE: I'.,IUHEi:E:I:;i: OF' I':::E:.=J; :[ t.~:'E'NC:EE; THFIT THE NELl .... kl 1' L.I .... '.:!!;E:I:~.:'v'E".. I CE:fY1" ]: l:::'"r' I"HFtT J.: I I:::11'"1 FI:::!F'I:[L.:[I=IF?. 14ZTH THE: F?.EQUIFi:Et'"IE:NT:E; I::CIF.': OI"~-""E.':ITE I:=OFi:TH E?'r' THE: I"IUI",I .'[ C: I 1='t:::11._ ][ T"r' CIF' tztI",IC:HOF::I::I~]i[~:. 2: :[ I.'.1 t LL. ]: NE;TFII...L. THE E;"r'E~"FEI"I ]: I",1 FIC:COF.'.E)F~iqC:E:' I.q :[ 'TH THE COE:'E]::Ei;. '2:: :[ UI",I[:,E:F.:E;TF:II"~D 'T'HFI'T' 'I"H[:Z Oi",I-".:.'.':]:TE ':'S[~.I.,.IEE: S'~'E;"I"E]I'"t i"IF:t"/ ?.E:QI. J II:;?.E: E:t",IL_F:IE'.C~iliii:HE!Et",I'T' ]:F' "I"HE~: I;',i: [ii: :).'.'; I E:'E:I",IC:Ei: :[ :!!i; R[.'T. HC~DE:L'I...E:D TO I NC:LLIE:'E: I"IOF.:E THFII",I 4 E:EEE:,I~:CHgHEi:. ::.~: :1: ,:~..lli~:E:,'../.. ___~.._~,.:...: F:I I::' i'~:::1 t",I qr~l" H CI l"tf:t'.:ii: E', 1...I K O I.,.I E: I-::: .......... :... ;:::: ............. ...... ...... ..SOl LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Peuoh 6.650, Anchor~e, Alaska 99602 276-222~ SOILS LOG - PERCOLATION TEST .ERFORMED FO.: ~ F%,' kO~ k'-, 6 7 8 9 10 PERCOLATION TEST WAS GROUND WATER ENCOUNTERED? SLOPE SITE PLAN  Gross Net Depth to Nat iq Date Time Time Water Drop 99503 Mr. Tom Burkowsky 903 West 29th Avenue Anchorage, AK 99503 4040 "B" STREET, ANCHORAGE, ALASKA PHONE: 907-279-2581 February 11, W.O. 17595 Grid 2440 Subject: Subsurface Investigation - Lot 12, Blk 3 Conifer Heights Dear Mr. Burkowsky: Transmitted herein in accordance with your instructions are the results of the above referenced investigation as performed by us on February 9 and 10, 1976. The Scope of. this project is investigation for Suitability of an on-site sewerage system. Included in this transmittal are: Vicinity Map Test Hole Location Sketch Test Hole Log Explanatory Information .Figure 1 Figure 2 Table A Sheets 1-3 The exploration was conducted using a track mounted Mobile Drill model B-50 drill rig with a continuous flight solid stem auger. The rig is owned and operated by Denali Drilling Inc. Drilling was supervised and the test holes logged by Mr. O.M. Hatcht geologist with Alaska Testlab. The percolation test was run by Mr. Wallace Oliver, staff technician with Alaska Testlab. The test hole was placed at the approximate location shown on the Figure 2. The log of this test hole is included as Table A of this report. In interpretting the log it would be helpful to utilize the explanatory information contained in sheets 1 to 3 of this report. When drilling was completed a 3/4" slotted PVC pipe was inserted in the hole to aid in determining the free water level. For the percolation test, the test hole was filled with water and left overnight to saturate. On returning the next day the hole was refilled with water and the drop in the water level carefully monitored over the next 90 minutes. Mr. Tom Burkowsky .February 11, 1976 Page Two This procedure is not a standardized percolation test, however, we understand that the Anchorage Dept. of Environ- mental Quality prefers tests performed in this manner to evaluate a site for a proposed on-site sewerage system. using .the above test, the observed minimum percolation rate was 10 min./inch. No water table was observed during drilling, but it should be noted that the free water level normally fluctuates seasonally and with precipitation. We hope this report meets your present needs. If we can 'be of further service, please do not hesitate to contact us. Approved: ~4elv~'n ~ Nichols, CE 1 Laboratory Supervisor Yours very truly, ALA S KA 'TE S T LAB R. Mark Hansen -~ RMH: mm Attachments Test Hole No. 1 TABLE A W0#17595 2/9/76 OMH Depth in Feet From· To SOIL DESCRIPTION 0 1.0 Peat, Pt, brown, damp, soft. 1.0 2.0 2.0 8.0 F-4, Sandy Silt, ML, bro~n, damp, stiff, NP. F.-4 Gravelly very Sandy Silt SM, brown, damp to dry, stiff, NP, rounded & subrounded particles to 3". 8.0 13.0 13.0 20.0 F-2, Silty Gravelly Sand, SM, brown, medium to fine, damp, medium density, rounded & subrounded particles to 2"; estimated silt content 20-25% at 10.0 ft., 15%± at '12.~ ft. F-4, slightly Gravelly Sandv Silt, ML, brown, damp, stiff, subrounded particles to 1" Enough sand and gravel to be SM at 17.0-20.0 ft. Bottom of Test Hole: Frost Line: Free Water Level: 20.0 ft. 2.5 ft. None Observed SA. NO. Depth Blows/6" M% Type of Sample Dry Strength ~roup 1 5.0 G 2 7.5 G 3 10.0 G 4 12.5 G 5 15.0 6 20.0 ...... G Remarks: 1) 2) 3) Type of Sample, G=Grab, SP=Standard Penetration Dry Strength: N=None, L=I, ow, [,~=~edium, I{=High Group refers to similar material this study on].y. 4.1 PERMIT NO. DEP~RTMENT OF HERLTH ~ND EN',/IRONMENTBL PROTECTION 825 '" L." s"rREET., RNCHOF.'.~GE., ~1<. D:~.50± 264-4720 I.-.IELL F' E F-." i"11 I 'T' ( 7:=:00E:R ) RPF'L I CRNT LOCRT I ON LEGFtL TOM 8UKOHSKI PONDEROSR DR Li2 8~ CONIFER HTS i7i8 LOGRN LOT SIZE 27'4-28D7 45 SL.]LIRRE FEE:"[ " ...... i .... _'-., T ~: ] E[ I IS MINIMI..IM DIz, IHN~.E BETHEEN R HELL RN[:' RN"r' ON-SITE SEWRGE [:,I~]F'OSRL '-'"-" ' 2L00 FEET FOR R PRIVRTE WELL OR 2~'-~0 FEET FOR R PUBLIC HELL HELL LOGS RRE F.'E]:.!_ IRE[:' RND MUST BE RETURNED TO ]"HE [:,EPRF.:TMENT WITHIN ~:0 [:,FI"r'S OF THE HELL COMPLETION. ].-: ,- f .... FiTHEF.'. RE.:.'UIREMENTS MFI"r' FIPF'L'T'. SF'ECIFIC:FITInI'-,IS FINB, i I'.,I.::TRU_.I IOI'.,I B, IFIGF.:F:tM:E; RRE R'v'F:ITLFIBLE TO INSURE PROPER TNSTFiLLFtTION. F" E-:: F;: r'l ][ ]"" L=.-2 ::-:: F" ][ F-': E 2; [:, E C: E I".1 E: E F-: :~: :.1__ .. ::L %:-~- -,7 I CERTIFY "Fl.-IRT -1.' I AM FRMILIi=IR HITH THE RE.-3UIREMENTS FOR ON-SITE SEWERS RNE:, I.,IELL. S F-'IS SE'l" FORTH B'.r' THE MUNICIPRLIT'¢ OF RNC:HORRGE. 2: I HILL INSTALL THE SYSTEM IN FtCCORE:,RNCE HITH THE: CODES. FIF'PL I f'.':FINTTOM 81_IKOHSK I Vi:. 0 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 www. munLorg/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Ct5 r-.Off3- It 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address COSA # Expiration Date: Day phone ~/8-5-5 ~ Lending agency Mailing address 'Real Estate Agent /414r~ ~ailing'Ad~lress ' >: UniX'sS otheK/viSe,i'equ~ested; COSA will be held by DSD for pickup. ,; 'i;,., ~'","';' ~,, 'i '/ NUMBER OF,.BE,DROOMS: LJ TYPE OF WATER SUPPLY: IndivMual Well [] Individual Water Storage [] Community Class. Well [] Public Water System [] Day phone Day phone -¢'"/3 - SS 7~ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer [] [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site System's Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my.investigation, based on procedures outlin6d.,in the Certificate of On-Site Systems Approval Guidelines .f.p£ this application, shows that the on-site water sUPply and/or wastewater disposal system is (are) safe, funct!ohal an.d ,adequate for the number of bedf~o~S'"and type of structure indicated herein. I further verify that based on.the information obtained from the. Mud~'Pality of Anchorage files and from my investigation and inspection, the $~-site w~ter supply and/or w~teWater disposal system is(are) in compliance with all applicable Municipal and State coSes, ordinances, and regulations in effect at the time of installation. Name of Firm 5pu~ ~,,~ <~.~;,.¢.,-; .,~., Address 7..o,~ ~/, 15~'k Ac...,, 5~r~, Zoz/ cJ~t~ej AK Engineer's Printed Name L~,~:,~ 5-~c~1 r~,~ DSD SIGNATURE "/ Approved for Disapproved. bedrooms. Phone Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (Rev. 11/05) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343'7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL DATA. Well type ]>¢i¥,~¥t~ Date completed 3/z/78 Total depth ~ ft. IfA, B, or C provide PWSID #__ Sanitary seal (Y/N) x/ Casedto 7~) ft. FROM WELL LOG I00 ff. ]-2. g.p.m. Date of test Static water level Well production Parcel ID: ets- Oq~ - II Well Log (Y/N) "/ Wires properly protected (Y/N) Casing height (abo~/e ground) AT INSPECTION G/3/Zo ,i 'Z.~O ft. J, ok g.p.m. in. WATER SAMPLE RESULTS: Coliform /~,~ colonies/100mL Nitrate ~,~[(~ mg/L Arsenic: ND ug/L date of sample: ~_~! B, SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size [2 50 gal. Number of Compartments Foundation deanout (Y/N) Date of pumping Depression over tank (Y/N) Pumper ~ Collected by: Cleanouts (Y/N) High water alarm (Y/N) C. ABSORPTION FIELD DATA Date installed (,/3/ZOll Soil rating ~orft2/bdrm) l, ~- Length _Re ft. Width 'Z,.,5 ft. Total depth ![ ft. Eft. absorption area -~Z0ft2 Monitoring tube Date of adequacy test JV'¢w Results (Pass/Fail) ' System type Deep Gravel below pipe -],-, ~ ft. '¥ Depression over field For-- bedrooms Fluid depth in absorption field before test -' in. Water added -- gal. New depth -- in, Elapsed Time: --"min. Final fluid depth -- in. Absorption rate >= ---- g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date -- D. LIFT STATION :E. Date installed ~- Size in gallons ..,AVlanhole/Access (Y/N) / e~ va[ at~,~''''~. ' evel at .~'''~ "Pump on" I "Pump off" le High water alarm ! in. Datu.,~~'' Cycles ~ Meets alarm &ci..~rr.,affrequirements? SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: septic tank/lift station on lot lC)C)~ 4, Absorption field on lot I OO'+ Public sewer main ,/V'/,A Sewer/septic service line Z. 5 -/- Animal containment areas 50 '4. On adjacent lots I On adjacent lots Public sewer manhole/cleanout Holding tank /V/~, Manure/animal excrete storage areas j~) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 ~ Property line ! Water main lc) + Water service line JO Wells on adjacent lots Absorption field. Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line J°e+ Building foundation lot+ Water Service line '~0 L/. , Surface water A/.O. (~ IOO'4.) Curtain drain A/'. O. ( 5o ~+) Wells on adjacent lots J00 ~. COMMENTS Water main Driveway, parking/vehicle storage I ceRi~ that lhave de te~ined through field ins~ctions and review of Municipal re,ds that the above systems are in Engineers Printed Name ~A~ __Date ~/&/Z°ll Date of Payment G, ~ - ~ I. Date of Payment Re~ipt Number O~ ~ ~ ~ Receipt Number (Rev. 4/10) Municipality of Anchorage Community Development Department Development Services Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # 111192 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 12 of Conifer Heights subdivision. This inspection revealed a nitrate concentration of 5.46 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. SGS ReL# 1112210001 Client Name Spurkland Engineering Printed Date/Time 06/06/2011 16:45 Project Name/// Conifer Heights B3 L12 Collected Date/Time 06/01/2011 15:00 Client Sample ID Conifer Heights B3 LI 2 Received Date/Time 06/01/2011 15:55 Matrix Drinking Water Technical Director Stel~hen C. Ede PWSID 0 Sam¢le Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Knit Metals by ICP/MS Hardness as CaCO3 172 5.00 mg/L SM20 2340B C 06/01/11 06/06/11 NRB Waters Department Total Nitrate/Nitrite-N 5.46 0.100 mg/L SM20 4500NO3-F B 06/03/11 AYC Microbiology Laboratory E. Coli Total Coliform Negative ! 100mL SM20 9223B A 06/01/11 DLC Negative 1 100mL SM20 9223B A 06/01/11 DLC Private Individual Analysis Alkalinity 139 10.0 mg/L SM20 2320B D 06/02/11 ATJ Aluminum ND 20.0 ug/L EP200.8 C 06/01/11 06/06/11 NRB Antimony ND 1.00 ug/L EP200.8 C (<6) 06/01/11 06/06/11 NRB Arsenic ND 5.00 ug/L EP200.8 C (<10) 06/01/ll 06/06/11 NRB Barium 17.2 3.00 ugFL EP200.8 C (<2000) 06/01/11 06/06/11 NRB Cadmium ND 0.500 ug/L EP200.8 C ('<5) 06/01/11 06/06/11 NRB Calcium 53500 500 ug/L EP200.8 C 06/01/11 06/06/1 I NRB Chloride 9.87 0.100 mg/L EPA 300.0 D (<250) 06/03/11 06/03/11 SDP Chromium , 2.22 2.00 ug/L EP200.8 C (<100) 06/01/11 06/06/11 NRB CO3 Alkalinity ND 10.0 mg/L SM20 2320B D 06/02/11 ATJ Conductivity 379 1.00 umhos/cm SM20 2510B D 06/02/11 ATJ Copper 96.8 1.00 ug/L EP200.8 C (<1300) 06/01/11 06/06/11 NRB Fluoride ND 0_100 mg/L EPA 300.0 D (<2) 06/03/11 06/03/11 SDP HCO3 Alkalinity 139 I0.0 mg/L SM20 2320B D 06/02/11 ATJ Iron ND 250 ug/L EP200.8 C (<300) 06/01/11 06/06/11 NRB © ~.."'49 T.~" (/h ~,. '. SHANE, L HOLT .' SURVEY ORDERED BY: MARY STEPHENS @ PRUDENTIAL REAL ESTATE 92 1 PONDEROSA DRIVE I 0' UTILITY EASEMENT N 89 50' 40" E 200.00 THE ~NFORN~ATION HEREON 'rS FOR THE USE OF LEND'rN~ .rNSTITUTZON5 SPECiFiCALLY TO SHOW ANY CONFLICT5 BETWEEN EX[5'~N~ STRUCTURE5 AND PLATTED LOT ITNE5 AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSIT~Ot~LN~ ADD.r~-LONAL STRUCTURES, IMPROVEMENTS, OR FENCEL.T. NES. EASEMENT5 OF RECORD, OTHER THAN THOSE APPEARIN~ ON THE RECO~D PL~T , ARE NOT SHOWN HEREON ( UNLE55 INDICATED) NOTE: FENCEL~NE5 THAT MAY APPEAR ON TFE5 DRAW[N~ ARE NOT TO ~.E USED TO DETERMNE PROPERTY L~NE5 OR POSIT.rON ADDT."~ONAL IMPROVEMENTS. ANY PAV~N~ SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR[CE. C~ ~ DECI~ 24.2 I8.1 0 AS-BUILT SURVEY 1" = 30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOW.rN6 DESCRIBED PROPERTY LOT 12~ BLOCK 3~ CONIFER HEIGHTS ANCHORAGE RECORD'rNG DISTRICT, ALASKA~ AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN EXIST OTHER THAN NOTED. DATED AT ANCHORAGE~ALASKA THIS 6TH DAY OF __3UNE , 2011. HOLT LAND SURVEYING 600 FEGHV~EW bRIVE ANCHORAGE,AK 99D15 345-55~3 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# O1 5"-- O~i5 - il -,~ 1. GENERAL INFORMATION Complete legal description Lot 12; Block 3; Conifer Heigh~;s Locatio ,n.(site address or directions) ,~.Property owner Mailing address ;~ ' iLending agency Mailing address Agent Larry Christine Burkows~ ~ P..O.~ Box 30095 Grand 9521 Ponderosa Drive Anchoraqe, AK Day phone Junction~ C~l~r~ g!503 Day phone Clark/ Remax Properties Address 2600 Cordova St. Anchorage, AK Day phone 99503 257-0130 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 '" 3. TYPE OF.WATER SUPPLY: Individual well Community well Public water NOTE: xxx If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature S & $ ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99~77 Phone Date -7/'~ /q ? DHHS SIGNATURE ~' Approved for Z~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engirleer 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. 1/91) Back MOA~I ,~NICIPALI]'¥ Ct~ ~CHORAGE of Anchorage ~UL 0~ ~S~ ~unicipali~ DEPARTMENT OF HEALTH & HUMAN SERVICES ~ U Environmental Services Division E E 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-474~ Health Authority Approval Checklist Legal Description: t_r~. I'Z '~LOCI4, ~, Parcel I.D.: {D i ~ ~ 04 ~ - t ! CON~ ~,~A- iq~t~.~rs 3/0 A. WELL DATA Well type ~Ybtw~OgRL If A, B, or C, attach ADEC letter. ADEC water system number Log present ~N) / Total depth ~'.~0 Sanitary seal ~) l~,c._~. Date of test Static water level Well production Date completed Cased to ~ 0 ~ Casing height (above ground) Wires properly protected(~N) FROM WELL LOG g.p.m. AT INSPECTION g.p.m, WATER SAMPLE RESULTS: / Coliform {~) '//301ol. Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA , -4'-~ m~j/j?, Other bacteria ~ S & $ ENGINEERING Collected by: ;7G34 ~.agie ~iver'Loop Road No. 204 Eagle River, Alaska 99577 Tank size ~ Number of Compartments . Date installed Foundation cleano~t (Y{~ t~ Depression (Y/~) ~0 High Water alarm (Y/N) Date of P~r:ig~'~ Pumper 4' /~r~?~- ~'~.v'/C~ Date~s~",l~'8'" ..... ~/~*~' ?'-, Soil rating (g.p.d./ff' or ff'/bdrm) / ~/=:..,ystem ~pe Lengt~~' ~' '"~_ _ ~ Width.;_~ ~// Gravel thickness below pipe ': " ~ ~' ~-~ ~ Mohitoring Tube present N) Effectiv~bso?ption ama . ~ / /'' Fluid depth in absorption field before test (in.); ~ # Immediately after ~ 13 gal. water added (in.): Fluid depth O (ins) Minutes later: ~ S Absorption rate = G Co ~ g.p.d. Peroxide treatment (past 12 months) (WN) ~]oM ~ ~~ If yes, give date. - " I Cleanouts (~'N) ~ / bedrooms I 72-026 (Rev. 3/96)* D. LI~ Date installed ~ Size in gallons. __ ~at* "Pump off" level at* Manhole/Access (Y/N) High water alarm level at* *Datum ~ Cycles tested ~ E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot iO,3~ 'F On adjacentlots 1(3o¢ + Absorption field on lot Ioo/+ On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation tO' -I- Property line ltv't' Absorption field iO 'Water main/service line Z.r~/'P .Surface water/drainage IoO~+ Wells on adjacent lots i00j 4- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water {DO/r ~r Curtain drain i~ i .~ I Building foundation F. ENGINEER'S CERTIFICATION Water main/service line ~/~' Driveway, parking/vehicle storage area Wells on adjacent lots ~OC) ~ ,.I- I certify that I have determined thru field inspections and in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name Date review of Municipal re~~~ are HAA Fee $ ~(J-~ Date of Payment Receipt Number ~Z-~'~ ~- 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 4~ CT&E Environmental Services Inc. CT&E Ref.# Client Name Project Name/// Client Sample ID Matrix Ordered By PWSID 973340001 S & S Engineering Lot 12 Blk 3 Conifer Hgts Lot 12 Blk 3 Conifer Hgts Drinking Water 0 Sample Remarks: Client PO~ Printed Date/Time 07/02/97 13:45 Collected Date/Time 06/25/97 12:30 Received Date/Time 06/25/97 13:00 Technical Director: Stephen C. Ede Parameter Nitrate-N Total Coliform Results 0.482 0 PQL 0.100 Units A[louabLe Prep Analysis Hethod Limits Date Date ]nit mg/L SM18 4500-NO3F 10 max 06/26/97 JBL coL/lOOmL SM18 92228 06/25/97 TM~ DATE RECEIVED INSPECTION APPOINTMENTS !TIME TIME TIME ~ A ~ 4..,~ d,,~, ,~ DATE DATE DATE I NSPECTAOR 1 NSPECTOR INSPECTOR +_/¥,:).- ?/. . ........................... MUNICIPALITY OF ANCHORAGE - DEPT. OF H:ALTH &  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~I~/I~ONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 'DEC 1 ''~ 1979 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed. Please allow ten (10) davs for processing. 1. PROPERTY OWNER i PHONE I MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION ~ PHONE MAILING ADDRESS 4. REALTOR/AGENT I PHONE I MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 5, TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One J~ Four [] Two E~' Five [] Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL~ [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A welt Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY /?? ~/ YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE r--IPUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: / -~L-5-'~ 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 [] TWO [] THREE [] FIVE [] FOUR [] SlX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING Septic/Holding Tank IAbsorption Area Sewer Line [] OTHER Nearest Lot Line 5. COMMENTS DATE APPROVED FOR ~ BEDROOMS CONDITIONAL APPROVAL (letter must accompany certificate) DISAPPROVED 72-010 (Rev. 6/79)