HomeMy WebLinkAboutCONIFER HEIGHTS BLK 3 LT 16Municipality of Anchorage
On -Site Water and Wastewater Program - (907) 343-7904 Page 1 of 3
ON -SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181024 PID Number 015-093-07
Dwelling: 9 Single Family (SF) nDuplex (D) El Multiple (SF and/or D) Project: F1 New F0_1 Upgrade
Name:
Doretta Kelley/Michael Hughes Revocable Trust
ABSORPTION FIELD
El Deep Trench no Shallow Trench [I Bed El Mound
Address
9300 Ponderosa Dr. Anchorage, AK 99507
El Other
Phone
Number of Bedrooms
Soil Rating
Totaldepth from original grade
T1002
(907) 929-5203
14
1.2 GPD/S F I
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
6.2 Ft.
Gravel depth beneath pipe
.0 Ft.
Subdivision Block Lot
Conifer Heights 3 16
Fill added above original grade
0.4 Ft.
Gravel length
50 Ft.
Township Range Section
Gravel width
5 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To Septic Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist between trenches
Tank
From Field
Tank
Line
500 Fe1
Ft.
Well >100'1 >100'
N/A
N/A
>251
TANK 9 Septic [:1 S.T.E.P. 0 Holding 0 Other
Manufacturer
Anchorage Tank
Capacity
I 1250 Gal.
Surface Water >100, >10o,
N/A
N/A
Material
Number of compartments
LOT Line >5' 3.5'*
N/A
N/A
Steel
2
NA
Foundation >10' >10'
N
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain None Noted
Gal.
Remarks *OSV181009
Pump on level at in.
Pump off level at
High water alarm at
Pump make and model
lElectrical Inspections performed by
Installer
PIPE MATERIAL House to tank D3034 Tankto
drainfield D3034
A+ Home Services
Drainfield D3034 COW j23Qa4
Inspector C. Johansen, J. Millette
BENCH MARK (Assumed elevation) 100 ft
Insdates: vI ction 3/07/18 20J 3/08/18
d
Location and description
3'a 41
Garage Slab
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
Conditional Approval:
Date
AW 12�
low V .
49 TH
..... ..........
• Be ruin Schiier o�
CE2592 1
Appr Date3
Approve N—J/
'0
nspection Kepon_v-1-11.aoc
CONIFER HEIGHTS B3 L16
PERMIT # OSP181024 PID # 015-093-07
/S:
/ NEW ABSORPTION TRENCH //N /
5OLF x 5 x 4'EFFECTIVE
\ > i
PORT ORFORD dRIVE /
10'SLOPE EASEMENT T —� /
PERK2 –Q ,
EXISTING TRENCH • • TH#1 Z I
® •
PERK 3 4 1 1
MT 1" `
PERK 1•_ •
• DV 001 - \ ',
1250-GAL STEEL TANK
SV
2CQ2 •. • O
2C0
7-'4' .7)
\ 2
\\ A B 0
2C0 51.9 37.0 4-BDRM HOME \
:-
SV1 54.0 39.3 \
SV2 61.5 47.0 I -
2CO2 64.5 50.0 LOT- 1 , - ._
DV 65.3 51.0 ,
CO1 83.2 79.0 PATIO 1 N>k
MT1 84.0 79.0 r /
CO2 127.0 117.01 1 /
MT2 126.3 116.01 E,10'UTILITY EASENTI\ '
ii/—
7
/ j\ EXIrpTING WELL LOT 15 1 / //
I ® 1/ / / /
/ \
�/ I/ // ///I/l
NOTE:
��"��xxu, NO SLOPES>25%WITHIN 50'OR SURFACE WATER WITHIN 100'OF THE LEGEND
OF AkArkk' PROPOSED SEPTIC SYSTEM• CO CLEANOUT
ire. '..1'1
'�y1l 2C0-DOUBLE CLEANOUT
j . 7H 1'1 .*�� ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS FCO FOUNDATION CLEANOUT
PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC DV FLOW DATLO ER VALVE
r.
.. SYSTEMS.
Benjat ,n Schuler MH MANHOLE
�1 PF'• CE 12592 •4 �� 0 50 100 MT-MONITORING TUBE
I:' WI 12.2018 PROFESSIONP•��Air: MI MI 11111 MI FEET SV SEPTIC VENT
`•�\"`� 1"=50' TH TEST HOLE
CONIFER HEIGHTS B3 L16
PERMIT # OSP181024 PID # 015-093-07
cv O
O U) (1) N
- - 98.3 — — —
— — r 93.8
.
7r1
C\\
93.2 1250 GAL 93.0
SEPTIC TANK
kt
''''''' — 88.9
7— 99.OFINISH GRADE
2 98.6 ORIGINAL GRADE Ov
if/
92.4 ORAINFIElO ROCK 92.4
88.4 88.4
50' H
NO GROUNDWATER 2/28/18
82.1
r-
4
I—
l
�i*�P .• TM ` \ .,f9*fie'
/i -. Benja Schiller :
PROFILE AS-BUILT 0iTh,c.•• Cf ,P2ps2 • \A.,
(NO SCALE) lV PROFESSIONA�'�
GE
ENGINEERING
PO BOX 240773
ANCHORAGE,AK 99524
522-7773 677-7766(FAX)
March 12,2018
Municipality of Anchorage
Development Services Dept-On-Site Water& Wastewater Program
4700 Elmore Rd
Anchorage,AK 99507
Subject: Conifer Heights, Block 3 Lot 16—9300 Ponderosa Drive
Septic system upgrade and trench re-classification
Dear On-Site Services Engineer:
The owner of the above lot decided to upgrade their septic system. The original design was for a
3-bedroom home,but at some point in the past a bedroom was added to the house. The upgrade to
the septic system included a new trench designed for 4 bedrooms.
During design and construction, we dug a new test hole and performed three perk tests. All three
benches perked at between 1-5 minutes/inch,including a test done right next to the existing trench.
This trench was designed for a perk rate of 5.7 min/in. We have included the new perk tests and
are asking for this trench to be accepted at the new perk rate of 1.2 min/in.
The existing trench is 40' long, 7' effective depth, for a total absorption area of 560SF. With the
new perk rate,the application rate of 1.2 GPD/SF makes the existing trench acceptably sized for a
4-bedroom home. With this adjustment, this trench will be able to be tested for the COSA as
needed in the future.
Sincerely, .. •" 4,
?*149TH i :* r
Benjamin Schiller, PE
Benja in Schiller :
'Vs. CE 12592 /
'ffF • '3 u fi�t$.•'a�,r
+,l�F�PROFESSIONP\c
ltd\\\S.L�4
MUNICIPALITY OF ANCHORAGE9FAqt;1k'
DEVELOPMENT SERVICES DEPARTMENT ''r
4
4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 it:STM \ *t�
SOILS LOG AND PERCOLATION TEST ..
Benj in Schiller
t't-P•• CE 12592 ` -
LEGAL DESCRIPTION: CONIFER HEIGHTS B3 L16 �1t1`\PROFESSIONP-�
PERFORMED FOR: NN:W.
DATE: 3/9/2018 PROJECT No.: Professional Engineers Stamp:
PARCEL ID#: 015-093-07 TECHNICIAN: C. JOHANSEN
DEPTH PERK #3
(feet)
1 SLOPE SITE PLAN
2
3
4
5 SEE SITE PLAN
6 1
7
8
9
10 WAS GROUND WATER ENCOUNTERED?
IF YES L WHAT DEPTH?
11 DEPTH OF WATER AFTER MONITORING:
DATE OF MONITORING:
12
GROSS TIME NET TIME DEPTH TO NET DROP
13 DATE READING (MINUTES) (MINUTES) WATER (INCHES)
(INCHES)
14 3/9 TEST HOLE PRESOAKED PRIOR TO TESTING:
15 1 1230/ 1236 6:05 0/6M 6.00
16 2 12:07/ 12:13 6:10 0/6.0 6.00
3 12:14/ 12:20 6:20 0/6.0 6.00
17
4 12:21 / 12:28 7:03 0/6.0 6.00
18 5 1229/ 1236 7:04 0/6M 6.00
19 6 12:37/ 12:44 7:04 0/6.0 6.00
20
PERCOLATION RATE: 1.2 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 4 FT. and 5 FT.
COMMENTS:
Municipality of Anchorage {
ICALION;
Mien
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
http:l/www.muni.orq/Onsite
Development Services Division
On-Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSV181009 COSA#: Permit#: OSP181024
PID#: 015-093-07
Legal Description: Conifer Heights B3 L16
Engineer: Forge engineering
Your request for a waiver of the required 10 feet horizontal separation from the absorption field to
the property line has been approved. The approved separation distance is 3.5 feet.
This waiver approval applies to the existing absorption field only. Any future upgrade to the on-
site wastewater disposal system will require all separation distances be met or another approval
from this department.
Waiver is Granted: X Waiver is not Granted:
Date: 3/�0 , Approved by: M00144
zc �8 _
Name of Rev' er
****
VARIANCE/WAIVER REVIEW ****
GE
INGINCERING
PO BOX 240773
ANCHORAGE,AK 99524
522-7773 677-7766(FAX)
March 19, 2018
Municipality of Anchorage
Development Services Dept- On-Site Water& Wastewater Program
4700 Elmore Rd
Anchorage,AK 99507
Subject: Conifer Heights,Block 3 Lot 16—9300 Ponderosa Drive
Lot Line Waiver
Dear On-Site Services Engineer:
The owner of the above lot has installed an upgrade for their septic system. Unfortunately, when
the final measurements were taken, it turns out that the end of it was put in closer than 10' to the
lot line.The lot line is adjacent to the Port Orford Drive ROW,and will not impact the neighboring
property at all. The trench also will not impact the property to the north across the ROW, and is
not affected by the existing well on that property. We request that a waiver be issued for a 3.5'
separation to the lot line.
Sincerely, 4.0``NNN
OF Aqq k
i�P•
Benjamin Schiller, PE OI
j* TM •�c '*"
Benja ' • chiller :1j
� CE
12592
fi e*•• 3/198,.•� _�
ikiFipRGfESS10Na�..
w
�civeurr
,�"" �.
�' MUNICIPALITY OF ANCHORAGE enc ,
On-Site Water&Wastewater Program �o'm Se
PO Box 196650 4700 Elmore Road c.. I.
P. , - Anchorage,Alaska 99519 6650 Phone:(907)343-7904 Fax:(907)343-7997 ,N ...r,� � "� jjj http//www.muni.org/onsite . -.: r'
SNC 1)(.'l lil P t Ol ell
On-Site Wastewater Disposal System Permit 3/g/10 j0/.#,Tai k
v- Ta,pp:p _
Permit Number: OSP181024 Effective Date: 3/2/2018
Work Type: Septic Upgrade Expiration Date: 3/2/2019
Tax Code Number: 01509307000
Site Legal Address: CONIFER HEIGHTS BLK 3 LT 16 G:2440
Site Mailing Address: 9300 PONDEROSA DR, Anchorage
Owner: KELLEY DORETTA L& Lot Size in Sq Ft: 34921
Design Engineer: FORGE ENGINEERING Total Bedrooms: 4
This permit is for the construction of:
0 Disposal Field Q Septic Tank ❑ Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: �/ Q/I /T11.(1. vUL ,f_ Date: 3 5
Issued By: `>°,{+,r,ti 6,n, Date: 3Arje
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
February 27, 2018
Municipality of Anchorage
Development Services Dept- On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Conifer Heights, Block 3 Lot 16 – 9300 Ponderosa Drive
Septic system design and permit application
Dear On-Site Services Engineer:
The owner of the above lot has decided to upgrade their septic system. The current design is for a
3 -bedroom home, but at some point in the past a bedroom was added. We are submitting this
permit to replace the septic tank and build a new field. The attached site plan identifies the location
of the home, well, septic tank, and existing field, as well as the proposed field. No conflicts exist
between this proposed system and any wells, whether on this lot or adjacent lots. Drainage arrows
are shown on the site plan showing the grade and direction of flow. The drainage pattern in general
will not be changed by the construction.
The test hole recently placed on the lot indicates silty sand with some gravel (SP-SM), but that is
under about 5.5 ’ of fill and organics. No bedrock was found down to 16.5 ’ and no groundwater.
The percolation rate of the soils under the fill was tested at 2.4 min/in, so an application rate of 1.2
gpd/sf was used in the design of the new absorption trench. We are proposing a 5-wide trench, 4’
effective depth, with a total length of 50’. The elevation of the distribution line will be 6’ below
the surface for a total depth of 10’. Soil will be mounded slightly above the trench to prevent water
from ponding above it.
The 1000-gallon septic tank will be removed and crushed. A new 1250-gallon tank will be placed
in the same spot. A minimum of 4’ of cover will be placed over the tank, or 2’ of cover and 2” of
insulation. A double cleanout will be placed after the tank along with a flow diverter valve. The
existing trench will remain connected to the system with the valve, allowing it to recover for future
use.
The ground surface on the lot slopes moderately toward the northwest, between 8-10%. There are
no steep slopes anywhere on the property. The new trench will be constructed parallel to the slope
as much as possible. It will be a minimum of 100’ from all wells and surface water, more than 5’
away from the septic tank, and more than 14’ from the existing trench.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181024, Rebecca Carroll, 03/02/18
If the system is constructed as designed, it will have no adverse impact:
• On the wells in the area or those to be constructed in the future.
• On existing septic systems in the area or those to be constructed in the future.
• On reserve space on any lots located in the area.
• On drainage patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Benjamin Schiller, PE
2/27/18
// // // x x // // // //2CO
10050 0
FEET
1"=50'
4-BDRM HOME
EXISTING WELL
NOTE:
NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE
PROPOSED SEPTIC SYSTEM
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS
PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC
SYSTEMS.
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
DV - FLOW DIVERTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
CO
TH#1
CONIFER HEIGHTS B3 L16
Feb 28, 2018 PONDEROSA DRIVEPORT ORFORD DRIVE
EXISTING TRENCH
40LF x 3' x 7' EFFECTIVE
ALTERNATE SITE W/ ADVANTEX SYSTEM
(8.6 LF x 3' x7' REQ'D)
10' UTILITY EASEMENT
PATIO
PERK 1
PERK 210' SLOPE EASEMENT
REMOVE AND DISPOSE OF EXISTING
SEPTIC TANK OR CRUSH AND BURY
IN-PLACE. REPLACE W/ NEW 1250-GAL
STEEL TANK
NEW ABSORPTION TRENCH
50lf x 5' x 4' EFFECTIVE
NEW DIVERTER VALVE
CO
MT
8-10%
8-10%
8-10%
2COPROVIDE DOUBLE CLEANOUT BEFORE
SEPTIC TANK
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181024, Rebecca Carroll, 03/02/18
CONIFER HEIGHTS, BLOCK 3 LOT 16
DESIGN FACTORS: SYSTEM REQUIREMENTS:
600 GPD PEAK FLOW
PERK RATE: 2.4 MIN/IN
APPLICATION RATE: 1.2 GPD/SF
5' WIDE DEEP TRENCH SYSTEM
1,250-GAL SEPTIC TANK
600 GPD / 1.2 GPD/SF / 5' WIDE * 0.5 REDUCTION FACTOR = 50 LF REQUIRED
NOTES:
GRADE AREA OVER TRENCH TO DRAIN AWAY
MIN 6' SEPARATION FROM BEDROCK
MIN 4' SEPARATION FROM GROUNDWATER
MIN 100' SEPARATION FROM NEARBY WELLS
MIN 100' SEPARATION FROM SURFACE WATER OR STREAMS
5-WIDE TRENCH SECTION
(NO SCALE)
THEREFORE: CONSTRUCT AN ABSORPTION TRENCH 50' LONG x 5' WIDE x 4' EFFECTIVE
DEPTH. FLOW LINE ELEVATION IN TRENCHES TO BE 6' BELOW ORIGINAL GROUND SURFACE.
TOTAL DEPTH TO BE 10' BELOW EXISTING GROUND. PROVIDE 3' COVER OVER TRENCHES
AND 4' COVER OVER SEPTIC TANK, OR INSULATION WITH 2' COVER.
5'
Feb 27, 2018
4" PERFORATED PVC (HOLES DOWN)
DRAINFIELD ROCK
6"
5.5'
4'
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181024, Rebecca Carroll, 03/02/18
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
TH#1 PERK#1
SLOPE
SLOPE
SITE PLAN
See Site Plan
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
TEST HOLE PRESOAKED PRIOR TO TESTING:
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
Conifer Heights B3 L16
2/21/2018
J. Millette
Development Services Department
4700 Elmore Road Anchorage, AK 99519-6650
Municipality of Anchorage
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH OF WATER AFTER MONITORING:
IF YES @ WHAT DEPTH?
NO
none
1:00/1:10
2/21
1
2.4 6
6 7
2
1' OB
015-093-07
3
4
5
6
6
Professional Engineers Stamp:
Feb 28, 2018
fill (SM w/ waste - stumps & branches)
Organics (pt)
silty sand
w/ some gravel (sp-sm)
more cobbles w/ depth
10 5 1 4 / 11 1 4
1:10/1:20 610 5 1 4 / 11 1 4
1:20/1:30 610 5 1 4 / 11 1 4
1:30/1:40 10 5 1 4 / 9 1 2 4 1 4
1:40/1:50 10 5 1 4 / 9 1 2 4 1 4
1:50/2:00 10 5 1 4 / 9 1 2 4 1 4
none
2/28/18
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181024, Rebecca Carroll, 03/02/18
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
PERK #2
SLOPE
SLOPE
SITE PLAN
See Site Plan
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
TEST HOLE PRESOAKED PRIOR TO TESTING:
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
Conifer Heights B3 L16
2/21/2018
J. Millette
Development Services Department
4700 Elmore Road Anchorage, AK 99519-6650
Municipality of Anchorage
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH OF WATER AFTER MONITORING:
IF YES @ WHAT DEPTH?
1:05/1:15
2/21
1
2.2 6
6 7
2
015-093-07
3
4
5
6
Professional Engineers Stamp:
Feb 27, 2018
10 5 1 4 / 10 3 4
1:15/1:25 10 5 1 4 / 10 1 2
1:25/1:35 10 5 1 4 / 10 7 16
1:35/1:45 10 5 1 4 / 9 1 2 4 1 4
1:45/1:55 10 5 1 4 / 9 1 2 4 1 2
1:55/2:05 10 5 1 4 / 9 1 2 4 1 2
5 3 16
5 1 4
5 1 2
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181024, Rebecca Carroll, 03/02/18
, ~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME~ [] UPGRADE
"' DISTANCE TO: IW''', /ZO' [ Abs~n area Dwelli~ ~1' PERMIT NO.
'<~ ~ Manufacturer ~~ Mat~~ ,o.~com~artm.nts
in gallons Inside length Width Liquid depth
~/ IF HOMEMADE:
~ ~ DISTANCE~O: Well Dwelling PERMIT NO.
=-~OZ~ Manufacturer ~ ~~ ~iquid ca~acitg in ,allons
~ DISTANCE TO: Length~h I~-~ Total~ I~'-- ~r~h Distance between lines
~Z~ N°. °f lines
~ inches To~ti~ption
~ Top~f.tile to fin~[h ~ade~l area
OTHE~
SOl L TEST RATING I~
INSTALLER
REMAR~s
/,- .
72-013 (Rev. 3/78)
PERMIT NO.
r'lLIF~ ICI ! ~LIT'~ I2F R~I~H ~:RGE
DEPRRTMENT OF-,~ERLTH 8ND ENVIRONMENTBL F'NOTECTION
825 ~L~ STREET, 8NCHORRGE~ RK. 99501
264-4720
P4ELL Rr~E:, Of-$--,~ITE '__~EPSER P ERF1 IT
( 78100i )
8PPLIC8NT
LOCRTION
LEGRL
SRM HILL
PONDEROS8
L16 B3 CONIFER HTS
SRR BOX ?2-H 99507
LOT SIZE
~49 4747
~8000 SQURRE FEET
TYPE OF SOIL RBSORBTION SYSTEM IS: TRENCH
MB~IMUM NUMBER OF BEDROOMS
SOIL RRTING
THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS:
[~.EPTH= ~L2 LENGTH= ~_'_B GRF~b'EL C. EPTH= ?
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRBINFIEL[).
THE DEPTH OF ~ TRENCH OR PIT IS THE DIST8NCE BETWEEN THE SURFBCE OF THE
GROUND 8ND THE BOTTOM OF THE EXCRV8TION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GR8VEL BETWEEN THE OUTF8LL. PIPE
RND THE BOTTOM OF THE E~C8¥RTION (IN FEET).
~:E[qLI I REC, SEPT I E:
PERMIT 8PPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPBRTMENT DURING THE
INSTRLLBTION INSPECTIONS OF 8NY WELLS 8DJBCENT TO THIS PROPERTY RND THE
NUMBER OF RESIDENCES THRT THE WELL WILL SERVE.
TP~£~ (2) I F~$PEC:TIO~$ R~:E RE~21_II ~:E[)
BRCKF'ILLING OF 8NY SYSTEM WITHOUT FINBL INSPECTION 8ND RPPROVBL BY THIS
DEPRRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTBNCE BETWEEN 8 WELL 8ND 8NY ON-SITE SEWBGE DISPOSBL. SYSTEM IS
100 FEET FOR 8 PRIYBTE WELL; OR
150 TO 200 FEET FROM 8 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBL. IC WELL.
WELL LOGS 8RE REQUIRED 8ND MUST BE RETURNED TO THE DEPBRTMENT WITHIN ~0 DBYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MBY 8PPLY. SPECIFICBTIONS 8ND CONSTRUCTION DIAGRBMS 8RE
8VBILBBLE TO INSURE PROPER INSTBLLBTION.
F'ERM I T E)<P I F~:E$ DECEMBER
I CERTIFY THBT
:1.: I 8M FRMILIBR WITH THE REQUIREMENTS FOR ON-SITE SEWERS 8ND WELLS RS SET
FORTH BY THE MUNICIPBLIT't~ OF 8NCHORBGE. .- '=.
2' I WILL INSTBLL THE SY-~;TEM IN 8CCORDBNCE WITH THE [.ODE_.
I
UNDERSTB~_~BT
, j~ ,
THE ~N-SITE SEWER S~STEM MB~ [E~iI[E ENLBRGEMENT
I F THE
/
/._
/~i'''°';, GREATER ANCHORAGE AREA BORO' 'GH
it1 Departmeni: of Environmental Quality
3330 "C" Street
Anchorage. Alaska 99503
, SOILS LOG -- PEROLAT'ON TEST
Performed for ~,~A .... ? ~C~ Date
Legal Description:L~/~, ~'~ 3, C~~j~~~~%, ~'(~
This form repo~s: Soils log T~-~ ~)-~ U~z~c~O Percolatio,-, ~est ~~
Was groundwater encountered? /lO¢ ~/.T, ~tkYZ)U~yes, atwha'tde3th? ~
Reading Date Gross Time Net Time Depth to Water Net Drop
..... ~ ,,
_
7 ..... ', / ...... ?~ ~ ~,%
Proposed installation: ~eepage ~¥1d %~~:~
Depth of Inlet . Depth to bottom of pit or trench '~
COMMENTS: _(~_..."~/~;~ ~-~v.-~_. F~c.t ~ ~0 l% ~~ ~f~~.~~'
P~UL O. HANS'~N, P.~.
SR~ BOX 395-V
ANCHORAGE, ~L~SKi 99507
April ~1, 1978
~,~r. Sara P. Hill
BRA Box 72H
Anchorage, Alaska 99507
Dear )~r. Hill
In accordance with your request~ have co~ed s~ils analyses for ¢
on-site sewage disposal on notF 3; Co ife eight
Subdivision, Anchorage. Drillt~ consist.~of three test holes, was
performed on k%rch 28, 1978 by Denali Drilling, Inc. of Anchorage em-
ploying a B-50 Mobile drill; logging and percolation testing were per-
formed by myself in accordance ,~ith the Unified Boil Classification System,
the Boil Triangle, and. the "SIanual of Septic-Tank Practice". All three
test holes were saturated at least 24 hours prior to the test. The
attached sheets detail the results.
As is typical with soils in the O'.~.'~lley-Hillside area, the encountered
soils consisted generally of glacial drift composed of a mixture of silt,
sand, and gravel. The silt component has a large influence on 'the per-
colation rate, measured to be 135, 155, and ~00 sq ft/bedroom.
test holes (TH 1&3) suffered some sloughing during percolation, so two
tests were repeated, vzJ. th water levels determined by means of a 1"
perforated plastic pipe installed immediately after drilling/
The three lots are amply covered'~ith large spruce and birch trees, in-
dicative of good drainage; however, the drainfield trench for Lot 5 '
should be located slightly southwest of TH t, and about 5 feet higher
in elevation in order to avoid potential seepage from a nearby low a~ea
that has no outlet. During breakup, water could collect in this low
area and be detrimental. In my opinion, the three lots appear satisfactory
for on-site sewage disposal, in terms of topography, drainage; and soil
percolation.
t Paul G. Hansen
MUNICIPALITY OF ANCHORAGE
o
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I. D. 015-093-07
Legal description CONIFER HEIGHTS BLK 3 LT 16
Site address 9300 PONDEROSA DR Anchorage AK
Current property owner(s) SELLERS
Expiration Date: 4/22/2025
X The On -site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Original Certificate Date: 5/31 /2024
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory X
Tank Age Advisory Arsenic Advisory
Other
COSA Approval June 2022
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax. 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I. D. 015 093 07
Complete legal description
CONIFER HEIGHTS BLK 3 LT 16
Location (site address) 9300 Ponderosa
Current property owner(s) Sellers
2. ON -SITE SYSTEMS SIZED FOR 4 BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: ■❑ Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: X Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑■ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 6 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑E Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On -site staff
to verify the accuracy of the information provided.
COSA Fee $ �SO Waiver Fee $
Date of Payment 5� f2 `l c� Date of Payment
COSA # C) Waiver #
COSA Application —June 2022
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC241140
Subdivision: CONIFER HEIGHTS, Block: 3, Lot: 16
A water sample revealed a nitrate concentration of 7.65 milligrams per liter (mg/Q.
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. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. 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.
:r` � Mailing Address P-O` Box�.96650 *:Anchorage; Alaska 99519 6650 �` www murn org
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Mailing Address P O Boxk1966S0 *Anchorage, Alaska 9951946650 *£www mum org z
COSA Checklist_June 2022
COSA Checklist
Legal Description: Parcel ID:
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
COSA Checklist_June 2022
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F.ENGINEER’S COMMENTS
G.CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Phone
Engineer’s Printed Name Date
C&M ENGINEERING
CHARLES BALZARINI, PE 5/12/24
Development Services Department �� 7 Phone: 907-343-7904
On -Site Water & Wastewater Section --- Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 015-093-07
1. GENERAL INFORMATION
Expiration Date: _/®^!J ^2® Z7--
Complete
Z
Complete legal description Conifer Heights Block 3 Lot 16
Location (site address) 9300 Ponderosa Drive
Current property owner(s) Neal & Erica Fossler
Mailing address
Real estate agent
9300 Ponderosa Drive
Teresa Bell
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone (907) 350-0151
Day phone (907) 240-2248
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
Q
Private Septic
❑■
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 550 Waiver Fee $
Date of Payment G' Q c2 9 C a Date of Payment
Receipt Number .3� Receipt Number
COSA # _ 05Laa 13 � � Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone (907) 522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller, P.E. Date 06/20/22
OF
q�p �
6. DSD SIGNATURE '
/ ...........
System #1 Approved for i bedrooms Benjarr�r t5chi11er .:
System #2 Approved for bedrooms <`c�s., CE 12592.06/20122,
2592 ��Aw
��. • 06/20/22 , • •�c� ,®.
Disapproved ����F�pROFESSIOHP� ��°
Conditional approval for bedrooms, with the following stipulations:
ON-
"'��1.�1)))))11117.
BY Original Certificate Date: —7–
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: Conifer Heights Block 3 Lot 16
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 05/16/78
Total depth 350 ft
Cased to U N K ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA 05/31/22
Static water level at beginning of test 230 ft.
Comments
B. TANK DATA
Age of tank(s) 4 years
Tank type/material SEPTIC/STEEL
Measured operating fluid level in septic tank 48
no Standpipes/foundation cleanout per record drawing
Date of pumping 6/27/22 A+ Home Services
D. ABSORPTION FIELD DATA
Which system tested (date installed) 03/08/18
❑ ALL standpipes present per record drawing
Total measured depth from grade 9.1 ft (max)
Measured depth to pipe invert from grade 5.0 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective 4.1
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced N/A gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 015-093-07
Structure served by this system
Well production at time of test 3.8 gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate -1 -82 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by Forge Engineering
Date of Sample
C. LIFT STATION
06/01/22
red maintenance completed
Age of lift stati lr-,_ years
Lift station material ____1
Comments:
Adequacy test date
05/31/22
Results Q✓ Pass
For 4 bedrooms
Fluid depth prior to test
6 in
Water added 671
gal
New depth 9 in
Elapsed time 1440
min
Final fluid depth 4
in
Absorption rate '600 gpd
Any rejuvenation treatment (past 12 months) N/A
If yes, enter date N/A
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
Community Sewer Manhole/Cleanout > 100'
❑✓ Yes
if No
ft
F1 Yes
if No ft
Neighboring Tank > 100' F71 Yes
if No
ft
Private Sewer/Septic Line > 25' ❑✓ Yes
if No ft
Absorption Field on Lot > 100' ❑✓ Yes
if No
ft
Holding Tank > 100' n✓ Yes
if No ft
Neighboring Absorption Fields > 100'
Animal Containment > 50' 0✓ Yes
if No ft
0 Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' Q Yes
if No
ft
0 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
✓M
Yes
if No
ft
Surface Water > 100'
Q Yes if No ft
Property Line > 5'
El
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Q
Yes
if No
ft
Private Wells > 100'
n Yes if No ft
Water Main > 10'
F/I
Yes
if No
ft
Community Wells > 200'
0 Yes if No ft
Water Service Line > 10'
[Z]
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
✓[] Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
C Yes
if No
3.5* ft
Wells on Adjacent Lots:
Water Main > 10'
❑✓ Yes
if No
ft
Private Wells > 100' []✓ Yes if No ft
Water Service Line > 10'
0 Yes
if No
ft
Community Wells > 200' []✓ Yes if No ft
Surface Water > 100'
✓Z] Yes
if No
ft
F. ENGINEER'S COMMENTS
OSV181009*
G. ENGINEER'S CERTIFICATION
l certify that l have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
• TH '.
•,�.-tom :--:-�.... f`��.,...�,, . �:. .
. Ben* nio&hiller
CE 12592
Y� �`r%F�• . 06l21t22, - **2
FESSO�—
CE" eV
•i f rMunicipality of Anchorage
--41N-
On-Site Water and Wastewater Program
(907) 343-7904
Certificate of On-Site Systems Approval
Parcel I.D.
015-093-07 Expiration Date: 2_1 -1 6
1. GENERAL INFORMATION
Complete legal description Conifer Heights Block 3 Lot 16
Location (site address) 9300 Ponderosa Dr.
Current Property owner(s)
Doretta Kelley&Michael Hughes Revocable Trust Day phone (907) 929-5203
Mailing address 9300 Ponderosa Dr. Anchorage, AK 99507
Real Estate Agent Day phone
2. TYPE OF DWELLING:
H Single Family (w/wo ADU)
❑ Duplex
L] Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well H Individual H
Individual Water Storage PI Holding Tank ❑
Community Class Well I I Community ❑
Public Water System i i Public Sewer C
WaiverNariance request for: Distance:
Received by: Date:
COSA to be released t the engineer,unless otherwise requested by the engineer.
COSA Fee $ aio3• Waiver Fee $
Date of Payment 31140 Date of Payment
Receipt Number 00 (gar) Receipt Number
COSA# O5(-I IOq`I Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Forge Engineering Phone (907) 522-7773
Address PO Box 240773, Anchorage, AK 99524
Engineer's Printed Name Benjamin Schiller, PE Date 3/12/18
*•' TH
6. DSD SIGNATURE / -•*
System #1 Approved for bedrooms "' ••••,
BerOml Schiller /
System#2 Approved for '
CP �2ss2 i
bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
\••Y 01-446'
0,0
ON-SITE
WATER AND `
m WASTEWATER g,-
T, PROGRAM
OJ
G
By' Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_t' c
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Conifer Heights Block 3 Lot 16 Parcel ID: 015-093-07
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed 5/16/78 Sanitary seal (Y/N) Y Wres properly protected (Y/N) Y
Total depth 350 ft. Cased to U n k ft. Casing height(above ground) 24 in.
FROM WELL LOG AT INSPECTION
Date of test 5/16/78 3/12/18
Static water level 226 ft. 232 ft.
Well production 3 g.p.m. 3.25 g.p.m.
WATER SAMPLE RESULTS:
Coliform Neg colonies/100 mL Nitrate 5.29 mg/L
Arsenic ND ug/L Date of sample: 2/28/18 Collected by: Forge Eng.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 3/08/18
Tank size 1250 gal. Number of Compartments 2 Cleanouts(Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping Pumper New Construction
C. ABSORPTION FIELD DATA
Date installed 3/08/18 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SF System type 5-Wide
Length 50 ft. Width 5.0 ft. Gravel below pipe 4.0 ft.
Total depth 10.6 ft. Eff. absorption area 500 ft2 Monitoring tube Y Depression over field N
Date of adequacy test New Const. Results (Pass/Fail) 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
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100 On adjacent lots 100
Absorption field on lot 100 On adjacent lots 100
Public sewer main >75' Public sewer manhole/cleanout 100
Sewer/septic service line >25' Holding tank >75'
Animal containment areas >50' Manure/animal excrete storage areas 100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation �' Property line >5' Absorption field >5'
Water main Water service line >10' Surface water >100'
Wells on adjacent lots >100
ABSORPTION FIELD ON LOT TO:
>10'Property line Building foundation 10 Water main �10
Water Service line 0 Surface water 100 Driveway, parking/vehicle storage 10
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION ���NtaNNA,
I certify that I have determined through field inspections and w4 ' .•• X9+1
review of Municipal records that the above systems are in 04:49 m •••*0l
conformance with MOA COSA guidelines in effect on this date. IA
Engineer's Printed Name Benjamin Schiller, PE / „ •.
3/12/18 B min Schiller
Date �� �w/• 1
.• C 1 592 �,�
COSA brown sheet 10-10-12.doc
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT i • �t�i 907-343-7904
On-Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite -�-
Nitrate Advisory
Certificate of On-Site Systems Approval # OSC181084
Subdivision: Conifer Heights, Block: 3, Lot: 16
A water sample revealed a nitrate concentration of 5.29 milligrams per liter (mg/L).
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address: P.0. Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen,which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids,and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Mailing Address: P.0.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org
PORT ORFORD DRIVE
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PLOT PLAN AS BUILT X SCALE 1" = 40' GRID SW 2440 Project No. 18-081/R1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates , inc .
(907) 522-6476 Phone
(907) 522-4625 Fax opo F C1,
Professional Land Surveyors kenOlangsurvey.com v ,9
jonathanOlangsurvey.com S nn
I hereby certify that I have surveyed the following described property: ,OIC/) 1\ �OV
LOT 16, BLOCK 3, CONIFER HEIGHTS (PLAT No. 71-190) *: 49TH �� � P�D
Anchorage Recording District, Alaska, and that the Improvements situated thereon areo
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed °O.43'?.. KENN LAN' • cr
premises and that there are no roadways, transmission lines or other visible ^ �,
easements on said property except as indicated hereon. QA ... )�,(,(1A% .•' oo°0
VO4 'PF '••.LS-5202.••' c.;),,,,,'--
Dated
,Jp
Dated this the �'`�� Day of I`i'',i.'L'-�', , , at Anchorage, Alaska 0 �, , • .1oo
4 OPESSIONAk.�.
It is the responsibility of the owner to determine the existence of any easements, �D�O�O' .
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
Municipality of AnChorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650 ' ?~ / ~//
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-093-07
1. GENERAL INFORMATION
cos^ 0.5C
Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
CONIFER HEIGHTS S/D; BLOCK 5, LOT 16
9300 PONDEROSA DRIVE * ANCHORAGE, AK * 99507
BART RUTTAN Day phone 346-1994
9500 PONDEROSA DRIVE * ANCHORAGE, AK * 99507
Day phone
dANET BORDEREAUX W/ DYNAMIC Day phone 244-5456
5111 C STREET * ANCHORAGE, AK * 99505
Unless otherwise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well · Individual On-site
Individual Water Storage [] Individual Holding tank
Community Class Well [] Community On-site
Public Water System [] Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On:Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipafity of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Date
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorOugh,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described 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 soils condition, groundwater 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 the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use Of this report by any
· other person or party is not authorized, nor will it confer any legal right whatsoever.
DSD SIGNATURE
l/Approved for
Disapproved.
Conditional approval for __
bedrooms.
bedrooms, with the following stipulations:
rness..' k ~
ess~q~( ( i(l'
~ ON-SITE
~ j WATERAND
~ : WASTEWATER
~ · PROG~B
~.'~. '.. ..'
Attachments: COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
(Rev. 11/05)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
G-<~/~ Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700. Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.rnuni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Legal DeScription:
CONIFER HEIGHTS
CHECKLIST
BLOCK 5, LOT 16 ParcellD:~)l_~-O~-07
SURROUNDING WELL LOGS. SEE ATTACHED.
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+
AT INSPECTION
9/1/2010
2,31 .ff.
2.83 g.p.m.
S/D;
UPON
Collected by:
*4" ABS CLEANOUT IN GARAGE.
INSPECTED VIA CAMERA BY MCDONALDS PUMPING.
A. WELL DATA *ASSUMED BASED
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 5/16/1978 Sanitary seal (Y/N). YES
Total depth 350 ft. Cased to *40+ .ft.
FROM WELL LOG
Date of test 5/1 6/1978
Static water level 226 ft.
Well production 3 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi. Nitrate~,,'~Smg./L.
Arsenic: J~ IF~ugJL. Date of sample: 9/1/2010
B, SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tanksize 1000 gal. Number of Compartments 2
Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO
Date of pumping 5/6/2010 Pumper
C, ABSORPTION FIELD DATA ~'BELOW EXISTING ~RADEI
Date installed 6/1/1978 Soil rating (g.p.d./ft2o~ 135
Length 40 .ff. Width 3 ff.
in.
System type TRENCH
Gravel below pipe 7 .ft.
Depression over field NO
For 3 bedrooms
New depth 61 in.
in. Absorption rate >= 450+ g.p.d.
NONE KNOWN If yes, give date -
Total depth ~~[t. Eft. absorption area 480 ft2 Monitoring tube YES
Date of adequacy test 9/'1/'2010 Results (Pass/Fail) PASS
Fluid depth in absorption field before test 52 in. Water added 740 gal.
Elapsed Time: 120 min. Final:fluid depth 57
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
NOTE: SUMP ONLY EXTENDS 76" BELOW DRAINPIPE. TOTAL DEPTH IS CALCULATED.
NOTE: SMALL PORTION AT NORTH END OF TRENCH APPEARS TO HAVE INADEQUATE SOIL COVER.
NO FREEZING ISSUES HAVE BEEN'REPORTED BY HOMEOWNER.
Date installed 6/'1/1978
Cleanouts (Y/N) YES
High water alarm (Y/N)
A+ HOME SERVICES
Other bacteria LJ colonies/lO0 mi.
GEG Ltd.
D. LIFT STATION
Date installed
"Pump on" level at in.
~ ~ Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Size in gallons Manhole/Access ~ ~
"Pump off" level_~----~ High water alarm level at
100'+
Septic tank/lift station ,on lot
Absorption field on lot, 100'+
Public sewer main N/A
Sewer/septic service line 25'+
Animal containment areas 50'+
in.
Meets alarm & circuit requirements?
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
N/A
100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+
Water main N/A Water service line, 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorption field 5'+
Surface water. 100'+
Property line
Water service line
Curtain drain NONE
F. COMMENTS
10'+
10'+
KNOWN
Building foundation 10'+
Surface water 100'+
Wells on adjacent lots. 100'+
Water main N/A
Driveway, parking/vehicle storage
10'+
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date oJ/~t~//~
COSA Fee $
a,eo,.a.men,
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 9951%6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On-Site Systems Approval # 101206
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 16 of
Conifer Heights subdivision. This inspection revealed a nitrate concentration
of 8.35 milligrams per liter (mg/L) was reported for the property's well
water sample. The Environmental Protection Agency (EPA) has established
a maximum contaminant level (MCL) of 10.0 mg/L for public drinking
water systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Please see the
attached "Nitrate Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
.$
MUNICIPALITY OF ANCHORAGE
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.# ~_.~' t ~'-
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
· ~-'~l ~ '--O "~"' HAA # '~ i
GENERAL INFORMATION
Complete legal description
Location (site address or directions) c~'~OO
Property owner
Mailing address
Day phone
Lending agency
Mailing address
Day phone
Day phone
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.
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
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation 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 Phone "~ > ~''' ~'/'7C~'
Address
bedrooms.
Date
Engineer's signature
DHHS SIGNATURE
v Approved for '~' ~'~ :-
!
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Note: The we]_], for th±s property meets existing State and Municipal Codes.
There are nitrates present. It is suggested that periodic testing be
performed to insure the wells continued suitability. Current nitrate
connentratffon i,~ 5.67 mg/]. EPA maximum concell~a~io~ i8 10,0 mg/1.
More information on nitrates is available from the On-site Services Program,
DHH~, 31~3-1~71~/~.
Additional Comments ~ ~ :"~' '~ : ' -~: : "~ ' ~ ' ': ~:~"~
~ ' ~ ~ ' ~ I "X , , '",.
The Municipality of Anchorage Department of Health and Human Sewices (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA
Alaska Water & Wastewater
7320 East Chester Heights Circle ~ Anchorage ~ Alaska 99504
(907) 33%6179 ~ Fax (907) 338-3246
Consulting Engineers
June 27, 1998
Municipality of Anchorage
Departmem of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
RECEIVED
dUN 2.9 1998
Municipality of Anchorage
Dept. Health & Human Services
Attn: Donna Mears
Ref: Release of Conditional Health Certificate for Confier Heights, Lot 16, Bk 3
Dear Ms. Mears:
The depression near the clean-out at the beginning of the trench has been filled in. At this time,
we are requesting that you issue a non-conditional HAA. If you have any questions, please
contact me at 337-6179,.or 244-9612. Thank you for your assistance.
Sincerely,
Jeffi'o '~ G~ness, PT'_'_'_E., U.S.
Princi ~al
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)
e
Property owner
Mailing address
Lending agency
Mailing address
Day phone ('_.._~0~)
Day phone
Agent
Address
Es?'. Co,
Day phone ~;~4~
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.
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
5. STATEMENT OF INSPECTION BY ENGINEER.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation 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
DHHS SIGNATURE
Approved fOr
bedrooms.
Phone
Date I 7~ /14'/C1'~
Disapproved.
bedrooms, with the following stipulations:
Money shall be put in escrow to correct the depression over the trench.
The above work. shall be completed by no later than June 15, 1998. Money
in escrow shall not be re%~ased until this office has given final approval.
Additional Comments The well for this property meets existing State arid Municipal
Codes. There are nitrates present. It is suggested that periodic testing be
performed to insure the wells continued suitability. Current nitrate
concentration is 5.67 mg/1. E~A maximum concentration is 10.0 mg/1.
More information on nitrates is available from the On-site Services Program.
By:
DHHS, 343-4744. ,t~~C. ~J2~ Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The 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#21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744
:.~ONMENTAL SERVICES DIVISI(~r
REC
Legal Description:
Health Authority Approval Checkliat
A. WELL DATA
Well type ?hi{/A-'[~- If A, B, or C, attach ADEC letter. ADEC water system number ~'//~
Log present (~N) ~/ES Date completed
Total depth ~-~0' Cased to /'~_p0tccr.- (~ ,,~
Casing height (above ground)
Sanitary seal (~N)
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
g.p.m.
Wires properly protected (~)
AT INSPECTION
+
g.p.m.
~/= T~-~ Hou,;;
Coliform (~ Nitrate ._~, ~'~C/n~-//._. Other bacteria O
Date of sample: t P-) 0~ / c[°c Collected by: '~',
B. SEPTIC/HOLDING TANK DATA
Date installed ~>/Ol [ ~ Tank size 10(.)O ~CNumber of Compartments o~ Cleanouts(~N)
Foundation cleanout (Y/I~ ~o Depression (Y/{~ ~o High water alarm (Y/~)) ~J/A
Date of Pumping ~ Pumper C~/,-0 /~': DOt,~I-C~
C. ABSORPTION FIELD DATA ~
Date installed (~/Oj/::~ Soil rating (g.p.d./fF or/~n)
System type ~EE~' '7'~¢H-
Length ~O/ ,~,.,,c~a.~ .. ~,.,,,
Width ?o41~ Gravel thickness below pipe ~v ~'Total depm
Effemive absorption area ~0 ~F C~, Monitoring Tube pre~ent ~N) ~, Depression over field (YIN)
Date of adequacy test I ~JO~ [~ Resul~ (Pass/Fail) ~%5 For T~ bedrooms
F~uid depth in absorption f~e~d before test (in.); ~" ~mmediate¥ a~er~o=~, w=ter added On.):
Fluid depth ~ ~ ~'' (ins) Minutes later: {~ ~. Absorption rate = ~0 ~ g.p.d.
Peroxide treatment (past 12 months)(Y/~ ~o~ ~ If yes, give date
72-026 (Rev. 3/96)*
Date i nstalle~e"d-~.
,..,~""'"'""--~ ~,, Size in gallon
Manhole/Access
(Y~)-'---.,.~~ "Pump off" level at* __
High water alarm level at*
E. SEPARATION DISTANCES ~
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
!
/~)O '/- On adjacent lots /OO --~
Absorption field on lot
/~O ~- On adjacent lots /00 ~
Public sewer main
Public sewer manhole/cleanout /tJ///~
Sewer/septic service line
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation,. ,.~,/~ ~.,~ ~"... i Property line /O '-/- Absorption field c:),
Water, main/service.line /O Surface water/drainage /~O '-/- Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
i
Property'line ID 4- Building foundation /O 1./- Water main/service line
Surface water /00 '+ Driveway, parking/vehicle storage area
Curtain drain ~'~Jo~ ~o~ Wells on adjacent lots
R
ENGINEER'S CERTIFICATION/A___
· · ~ :'
I
in conforma~'~' g~d'~es in'~ffect °n this *te. ' ~'~;' . " ~ ~',;~ ,, are
Engineer's Name d~A' ~~
HAAFee $ '~ ''~ ~ ,, ,
Date of Payment
Receipt Number
,Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev, 3/96)*
Alaska Water & Wastewater
?320 'East Chester Heights Circle -~ Anchorage ~ Alaska 99504
Phone (907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
December 14, 1997
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Subject: HAA for Private Well & Septic System. Lot 16, Bk 3, Conifer Heights S/D.
To whom it may concern:
The subject lot has a 3 bedroom house on it which is served by a private well and septic system.
The results of the field investigation and adequacy tests are summarized as follows:
A. WELL: The static water level on 12/4/97 was 233 feet below the top of the casing (BTC).
Water was pumped from the well at a rate of 4.26 gpm for 75 minutes (320 gallons), during
which time the level in the casing dropped 36 feet, to 269 feet BTC. At that time, it was noted
that the flow rate was dropping off. In the following 238 minutes the flow rate averaged 1.24
gpm (295 gallons), and the level in the casing rose 26 feet, to 243 feet BTC. It was assumed that
the reduction in the flow rate was due to the presence of a filter in the house which was clogging.
Regardless, it is clear that the well production exceeds 1.24 gpm. In summary, over a period of
313 minutes the well produced 615 gallons, with a drawdown of only 10 feet, which corresponds
to 1.96 gallons per minute. Based upon this data it was determined that the capacity of the well
exceeds the Municipal requirements for a 3 bedroom house (.31 gallons per minute).
B. SEPTIC TANK: The existing septic tank was installed on 6/1/78. According to the M.O.A
records, it is 1000 gallons, has two compartments and is made of steel. Most tanks of this type
have a structural life of approximately 20-25 years. No warrantee is made regarding the future
life of the tank.
C. SEPTIC SYSTEM ADEQUACY TEST: The trench is 40 feet long, 3 feet wide, and has an
effective depth of 7 feet. Prior to starting the test the liquid level was 14 inches below the invert
of the drainpipe. Six-hundred & fifteen (615) gallons of water was introduced into the sump
over a period of 313 minutes, which caused the liquid level to rise 3 inches (11 inches below
the invert). Twenty-four hours later the level had dropped 5.5 inches, indicating that greater than
615 gallons had been absorbed. Based upon this data, it was determined that the absorption rate
of the trench exceeds 450 gallons per day, as required for a 3 bedroom house.
NOTE: The adequacy of a septic system is influenced by numerous factors, including, but not
limited to, seasonal surface water infiltration, groundwater variations, septic system
maintenance (frequency of septic tank pumping, usage of biological additives), condition of
drain pipe and pipe joints (which can be damaged by seismic activity and deteriorate with age),
type of substances deposited in septic system (cigarette butts, sanitary napkins, misc. objects),
and the amount of water being introduced on a continual basis. Consequently, the results of this
adequacy test are only valid for the specific day of the test. Furthermore, because of the limited
nature of this investigation, it is possible that there are hidden defects which may not have been
detected. No warrantee is made regarding the future performance of this well or septic system
D. DEPRESSION OVER TRENCH NEEDS TO BE FILLED: There is a visible depression
near the clean-out at the beginning of the trench. This should be filled (spring 1998) prior to the
issuance of a non-conditional HAA.
E. CLOSING: If you have any questions, please contact me at 337-6179, or 244-9612. Thank
you for your assistance.
Je _~_y//A/~ess,'lLF-~, m. S.
Princ~all ~
/0°
't
~ MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOf~IVIRONMENTAL PROTECTION
~~ ENVIRONMENTAL ENGiNEERiNG DiVisiONOCT
,RECEIVED
~EQUEST FO~ APP~OVAL OF INDIVIDUAL WATE~'AND 8EWE~ FA01LITIE5
DIREOTION~: Oomple~e ~11 p~r~s o~ p~ge ~. Incomplete re~u~ ~ill no, be pro~es~e~. Ple~e ~ltow ~en H0) ~Vs ~o~ pro~e~ing.
MAILING ADD~ESS -
PROPERTY RESIDENT {If'diffe~ent from above) - ~ / PHONE
~, BUYER - '_ ' ' ' - PHONE
MA LNG ADDRESS
3, LENDING INSTITUTION
MA LING ADDRESS ' ' --' ..... ' ........
4, REALTOR/AGENT I PHONE'
MAI LING ADDRESS
I -- i F I Y [] One [] FOur [] Other I
1~- S NGLE AM L
[] Two [] Five .I
i--1. MULTIPLE FAMILY ~ Three I~ s,, I
'7. WATERSUPPLY ' ' ' - I
I ~ NDIV DUAL* *ATTACH WELLLOG Awel og srequredfora we sdr ed
[] COMMUN TY since June 1975. For wells dri led p/rior to that date, give well -
[] PUBLIC UT LITY depth (attach log if Brai,labia.) "
8. SEWAGE DISPOSAL SYSTEM - - ~ ~ -
~- INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
[] PUBLIC UTIL TY by this Department. - '
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 APPOINTMENTS
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
[] I NDIVI DUAL/ON -SITE
[] PUBLIC UTI LITY
Connection Verified
[]Septic Tank or [] Holding Tank
Size: If Tank is homemade
give dimensions:
NUMBER OFBEDROOMS
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SiX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
TYPE OF TANK MANUFACTURER
MATERIAL
TOTAL ABSORPTION AREA
4, DISTANCES
WELL TO:
Septic/Holding Tank
Absorption Area to nearest Lot Line
Absorption Area
JSewer Line
[] OTHER
INearest Lot Line
5. COMMENTS
DATE
LEGAL DESCRIPTION
~APPROV ED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
72-010 (Rev. 3/78)
October 16, 1978
Samuel P.
Star Rollte A Box 72-H
Anchorage, Alaska 99507
SubJectl Lot 16 Block 3 Conifer Heights Subdivision
This department has no records of a sewer system berg ins~alle~ on
~he sllbJeat property. A permit was not
Therefore, your request for approval can not be granted until the
following has been
(1) Have a percolation test performed on the existing sewer system
to determine its adequacy.
(2)
Supply this office with a receipt of the septic ~ank that was
installed and also a receipt of gravel purchased for backfill.
(3) Submit a ~ell log.
(4)
Obtain a permit from this office for ~he oons~t,aotion of a
sewer system and ~he drilling of a well.
(5)
:~xpose five(S) feet of pipe l~to the inlet ~d {Ave(5) feet of
pipe out of ~he outlet of the sel~cio tank. This is ~o verify
the pipe~aterial used.
there are ~y further questions, please ~ontact ma at 264-4720.
Asso~iate Specialist
Sta~e of Alaska
Veteran's A~tministration
907 West No, hem Lights Blvd. 99503