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HomeMy WebLinkAboutCONIFER HEIGHTS BLK 3 LT 17Onsite File Conifer Heights Block 3 Lot 17 #015-093-06 See waiver OSV211024 for 5-bedroom drainfield approval and conditions. Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211108 PID Number: 015-093-06 Dwelling: Al Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Q Upgrade Name ELMER BROWN ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ound Site Address 7738 PORT ORFORD DRIVE *ANCHORAGE, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth original grade 907-748-6684 5 GPD/SFJ Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot CONIFER HEIGHTS; BLOCK 3, LOT 17 Fill added above original gr Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total orption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 100'+ TANK 9 Septic ❑■ S.T.E.P. ❑ Holding ❑ Other Manufacturer TANK Capacity 1500/1000 Gal. Surface water 100'+GREER Material Number of compartments 1/0000 Lot Line 51+ NA HDPE 2/2 Foundation 101+z LIFT STATION Manufacturer Capacity I I Remarks OLD TANK DECOMMISSIONED PER UPC GREER TANK 1000 Gal. PER CONTRACTOR. CONTRACTOR UTILIZED EXISTING CONTROL PANEL FOR PUMP Alarm location .. GARAGE Electrical installed by ' LARRY KUNDER o EXISTa PIPE MATERIAL House to tank D3034 dTank trainfield Installer WILCO EXCAVATION Drainfield D3034/EXISTING Co/MTD3034 Inspector GEG AND TIM ECKLUND BENCH MARK (Assumed elevation) 100.04 ft Inspection 15' 6/21/21 - Location and description TOP OF MANHOLE #1 3°' _ 4,h_ ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp oQ�oo o� CT �a4 Conditional Approval: Date 44°oo .... .... ..... .....� Septic System y A. ess•, I-CE-7P53 p Ops ��oo — Approve -�--- Date r� 0 Note: this approval does not include well permit requirements.#Aeccar \\� °p000 `7 tnev u5/utri6) Ife PERMIT NUMBER: PARCEL NUMBER: OSP211108 REVVRD DRAWING 015-093-06 A I B k MH1 17.7 18.8 ST1 19.4 22.9 DBL1 21.3 24.2 DBL2 22.1 23.6 ST2 26.3 21.5 MH2 24.8 16.8 ALL ADJACENT LOT WELL RADII ARE APPROXIMATE / / / NEW 1500 GALLON HDPE GREER TANK FOLLOWED BY A 1000 GALLON HDPE GRE TANK (BOTH TWO COMPARTMENTS) CONIFER HEIGi TS; BLOCK 3, LOT8 EXISTING 5 BEDROOM HOUSE DBL MONITORING WELL PER TOBEN SPURKLAND, PE �. 4 A �H2 / ST2 EXISTING BED / / 100' 1 ,MT MT i i [SEPTIC AR!�D CONIFER HEIGHTS; BLOCK 3, LOT 16 RADIUS 100' WELL RADIUS CONIFER HEIGHTS; \ BLOCK 3, LOT 15 \ AoCkW' i0qS61 W. 'Wks C 753 AV o Ap ,�• LICENSE,4B®®�®4 ®® O #AECC884 vul = wmwm-- ENGINEERING o SALES �. CONSULTING 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 • PHONE (907) 337-6179 • FAX (907) 114246 • WEBSITE: w,vw.gamessenpaearinp,wm PREPARED FOR: P HONE NUMBER: PAGE NUMBER: ELMER BROWN 907-748-6684 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: CONIFER HEIGHTS; BLOCK 3, LOT 17 D.J.G. TYPE OF WORK: DATE: I,_ SEPTIC TANK RECORD DRAWINGS 7/29/2021 AoCkW' i0qS61 W. 'Wks C 753 AV o Ap ,�• LICENSE,4B®®�®4 ®® O #AECC884 vul PERMIT NUMBER: PARCEL NUMBER: OSP21 1108 RECORD DRAWING 015-093-06 TOP OF MANHOLE = 100.04 __l 7- FINAL GRADE = 99.62-99.65 TOP OF TANK AT INTLET = 95.37 -N in Im I I r- TOP OF TANK AT OUTLET = 95.36 INVERT OF BUNG AT INLET = 94.67 -/ / 1-` JL I I \ "-- INVERT OF BUNG AT OUTLET = 94.47 NEW 1500 GALLON H.D.P.E. SEPTIC TANK SIMTECH EFFLUENT FILTER MH2 TOP OF TANK AT INTLET = 94.82 -\ INVERT OF BUNG AT INLET = 94.09 TOP OF MANHOLE = 100.05 /-- FINAL GRADE = 99.56.99.62 OF TANK AT OUTLET = 94.85 PER CONVERSATIONS WITH WILCO EXCAVATION ON 712021 THE HIGH WATERALARM WAS SETAT 34 INCHES NEW 1000 GALLON H.D.P.E. SEPTIC TANK WITH PUMP AND ABOVE THE TOP OF PUMP AND THE ONIOFF FLOAT WAS EFFLUENT FILTER SET 20 INCHES ABOVE THE BOTTOM OF PUMP PER WILCO EXCAVATION A CINDER BLOCK WAS PLACED UNDER PUMP AND A LIBERTY 51 PUMP WAS USED d—tV Tp .....:.. ENGINEERING e, SALES - CONSULTING >' � 0701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507 • PHONE (907) 337-6179 • FAX (907) 33"246 •WEBSITE: w+rw.pamesungineeMp.com PREPARED FOR: PHONE NUMBER:PAGE NUMBER: o ELMER BROWN 907-748-6684 3 OF 3 . LEGAL DESCRIPTION: DRAWN BY: •• CONIFER HEIGHTS; BLOCK 3, LOT 17 D.J.G. ®® TYPE OF WORK: DATE: LICENSE SEPTIC TANK PROFILES 7/15/2021 #AECC884 0 ............................ 0 0 m.uuu...... ..uoo.•• 0 Game s� E-7 53 Ar .1... ® f%FEVO M g ��yoy��y�yzi CTymo(TCjT H ClriFo y a SOS yZ�C���o� is 't <is'ty�Giy?7 Ogoc=Ig pm foo ay�i =i C; m d y I'ii o o� � zomg m oa � AAF o cmim�i"< rn `I�Oy y < a X 2 y 2 n Q y � 2 iaao�� 'Im roC) T8 N�zmm� N m O n y ��o m a 2mo < .2-- S: �I vo�s�nn� � aS,ToOo o : 'TI y ••'O 004 I �. '/'��� o tig cym°p =mOe it �ZR �°Ooa s atb it a m oa • • e Yoh i NORTH 198.11 5'55 gt N oZ•59Z M u0 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 � o700Elmore Road Anchorage, Alaska 89519-665O Phone: Fax: <SV7>343-7997 Permit Number: OSp211100 Work Type: SmptcTankUpgrada Tax Code Number: 01609306080 Site Legal Address: CONIFER HEIGHTS 8LK 3 L 17 G:2440 Site Mailing Address: 7738PORT ORFQRDDR, Anchorage Owner: BROWN ELK8ERO&TERRIE8 Design Engineer: GARNESSENGINEERING GROUP LTD This permit isfor the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 4/2G/2821 4/2G/2022 0 Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0Private 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 1555 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) -. The wastewater code requires inspections during the ^installation. The engineer shall "notify Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 16h»April 15.a subsurface soil absorption system under construction during freezing weather shall beeither: a. Opened and Closed unthe same day, or b. Covered, seated, and heated to prevent freezing ISpecial Provisions: |ofinalize the 5'Uodnzomabsorption bed approval, analarm shall beprovided onthe air system to indicate air pump failure and it shall be confirmed that the air system is fully operational. Received ell lkl�" Municipality of Anchorage 4 Y j �%� r Ikl�u•hncnt ._J P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section XXXT VARIANCT/ xxKx Waiver#: OSV211024 COSA#: Permit#:OSP211108 PID#: 015-093-06 Legal Description: Conifer Heights Block 3 Lot 17 Engineer: Garness Engineering Group Applicant: Elmer Brown Your request that the existing absorption field be approved as a 5 -bedroom absorption bed has been approved. The approval is largely based on the presence and continued operation of the air grid, which provides additional treatment than a conventional absorption field. See engineer's waiver request for justifications. This waiver approval applies to the existing absorption field only. If at any time in the fixture the air system is disabled, this waiver is null and the approved drainfield size will default back to 4 - bedroom. Any future upgrade to the on-site wastewater disposal system will require all code requirements be met or another approval from this department. 2saa0aaaa0aaasa0Kaaaaaaa0acaaaavaaaaaaaaaaaaa00aaaaavavaa2aaaa00a0aaaaaamam0aaI Waiver is Granted: X Waiver is not Granted: Date: 3 b002 Approved by:��'( Name of Reviewer acaaaaaaaaaaaaaamaaasaaaaaaaaammaaaamaaaaaeaaaaaa■■ a a a IS e a a a a a v a m a a a a m IS a e a a aIII III M 0 Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 015-093-06 Property owner(s) ELMER BROWN Day phone 907-748-6684 Mailing address 7738 PORT ORFORD *ANCHORAGE, AK 99507 Site address 7738 PORT ORFORD *ANCHORAGE, AK 99507 Legal description (Sub'd., Block & Lot) CONIFER HEIGHTS; BLOCK 3, LOT 17 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 5"oEOAoa"""' APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Q Septic Tank 0 Upgrade 0 (w/wo AD U) ❑ Holding Tank ElRenewal ❑ Duplex (D) Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: BED 1Ki ze A +0 5 Wy-rv) Distance: N/A I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 22. 5� Waiver Fees: � ol0_5 Date of Payment: Zl Zj Date of Payment: _ 2io 2.0�z 1 Receipt Number: Receipt Number: 0 � 1 37G Permit No. Orj /9 21 I[ (D8 Waiver No. _ Qsy�llo ra� GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211108, Rebecca Carroll, 04/26/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211108, Rebecca Carroll, 04/26/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211108, Rebecca Carroll, 04/26/21 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Date: February 1, 1996 To: File From: ~]~s Cross, P.E., Program Manager, On-Site/Water Quality 1- Subject: Lot 17, Block 3, Conifer Heights Subdivision. The mound system for this property, which was originally designed and constructed under the supervision of Ted Moore, P.E., is undersized. During 1995, Tobben Spurkland, P.E. designed and supervised the reconstruction of the same mound system. Although the system remains undersized, in both cases the system received approval from the Municipality of Anchorage, Department of Health and Human Services (DHHS). The bottom of the imported sand filter layer of the mound does meet the required square footage for a four bedroom system. However, this layer tapers to a smaller area of sewer rock above the sand layer, and the area of sewer rock does not meet the area required by Anchorage Municipal Code. The approval for this system will not be revoked due to the size of the mound, and as long as the system continues to perform adequately, it will be eligible to receive Certificates of Health Authority Approval from DHHS. Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: S~,/q...~O~q PIDNumber:Ol~- O~'"~-- Name:Wastewater System: [] New Upgrade Address: ABSORPTION FIELD Phone: No. of Bedrooms: ~ Q Deep Trench ~ Shallow Trench Q Bed ~Mound ~ Other LEGAL DESCRIPTION Sol, Rating:~ ~ O GPD/Sq. Ft. Total Depth --fr°m~ginal~. ~grade: Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath Ripe Township: [ Range: Section: Fill added above ori~rade: Gravel length: Ft. ~ Ft, I Number of lines: [ Distance between linea: WELL:NewUpgrade Gravel width: ~. Ft.I Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: Siatic Water Level:Ft. Installe~ ~ ~ ~ ~. Date in~alled:.~ Yield: IPump Set at: ICasing Height Ab°ye GrOund: TANK GPM Ft. Ft. SEPARATION DISTANCES ~ Septic a Holding a S.T.~,P. TO Septic Absorption Lift Holding 3ublic/Private Manufacturer: Capacity in gallons: From Tank Fisld Station Tank Sewer Lines Material: Number of Compartments: Surface Water ~ ~/~ ~/~ LIFT STATION Lot Size in gallons: ~ Manufacturer: I Foundation /~ ~ ~ "Pump °n" level at: I"Pump °fr' level at: I High water alarm at: Curtain % Drain ~ W/~ Pump Make & Model Electrical Inspections performed by: I Remarks: BENCH MARK Location and Description: " Assumed Elevation: 72-013 (Rev. 9/91) MOA 25 203 W 15TH. AVENUE BATE: ~LT ANCH. AK. 99501 7758 PORT ORFORD DR. (9~7~ 279-3916 BRUCE BOULEY SHEET: 2/5 GRID: 2440 ~ 60 ~ '/////////// ///////////// ////////// / 25 ~ 46 ~ 22 ~ J5 ~ ~ 0 ¢ ~ ,4 I -I/4 PVC with 1/$" holes et .fO" ~ A if" o ,¢ O0000000000cEd( of Rocks ooooooooooooo / / / / / / / / / / / / / -- ~TRIBLITION G ?VC I/YlTH AT 5.5 UNDER LAKE 0175/ ID HOLES A l' 50 INSULATION /w/raft 1-1/4" O/sHbufion Pipe l" AIR DISTRIBUTION GRID 4" Topsoil SECTION 6" Halfp/pe 6" LONG I-~/4 PVC Holes Po/nEng Up J. 5 FEET EX/STING ~: · 49th {N SPURKLAND No, CE-2225 500 gal STEP tank BENCH /dARK: DOOR SILL ASSUt~ED ELEVATION fOO, OOFT TOBBEN SPURKLAND P.E. 20J V7 ~STH. AVENUE AK. 9950! LOT 17, HEIGHTS 77J8 PORT ORFORD DRIVE BRUCE BOULEY /WOUND REPAIR AS BUILT DATE: JULY JD, ~995 SHEET; J/$ OR/D: 2440 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950159 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:BOULEY BRUCE J & ALICE J OWNER ADDRESS:7738 PORT ORFORD DR ANCHORAGE, AK 99516 DATE ISSUED: 7/13/95 EXPIRATION DATE: 7/13/96 PARCEL ID:01509306 LEGAL DESCRIPTION: CONIFER HEIGHTS BLK 3 LT 17 LOT SIZE: 32554 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM 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 (18AACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: A DHHS REPRESENTATIVE MUST BE PRESENT DURING DEMOLITION OF ~ DUE TO THE PRE~F:,N~I:,.:?yI~'L SAND. RECEIVED SY:~ IS SUED BY'~~'~q>'~'"f~'/,~( T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: Failing Mound Lot 17, Block 3 Conifer Heights July 2, 1995 Gentlemen; A mound was installed on this lot in 1990. It failed within two years by effluent day lighting on one of the side slopes. A field inspections showed that there was more than 20 inches of liquid in the bed. Probing one foot under the rock showed the sand to be unsaturated. This is another instance where the mound has become anaerobic and formed a restrictive layer immediately under the rock. The solution to this problem seems to be to be able to maintain an aerobic condition in the bed. My suggestion to repair this system is to remove the rock and approximately one foot of the underlaying sand. Install an air distribution grid on top of the remaining sand, import one foot of Lake Otis Gravel, 6 inches of rock, replace the effluent pressure lines, insulation and the cover. The wasted sand and rock can be deposited along the slope of the mound, covered with 6 inches of topsoil. Please review and issue a permit to repair. Yours Tobben Spurkland P.E. 50 0 LOT ]8 /7 50 100 150 £00 850 300 ££ALE; 1" = ]00 FL L~TT i4 \ .Of?/VE~ (>____~ ? / TOBBEN SPURKLAND P.E. 203 W 15TH. AVENUE ANCH. AK. 99501 (9o7~ 279-5916 LOT 17, BLOCK 3 CONIFER HEIGHTS 7758 PORT ORFORD DR. BRUCE BOULEY SEPTIC SYSTEM DESIGN DATE: JUNE 15, 1995 SHEET: I/5 GRID: 2440 ~ 6O ~ ////////////////////////////////// / / 25 J5 C A I -I/4 PVC with I/$" holes at $0" 22 ~ A ~ I c oooooooooocEdf of Rock~ooooooooooooo 500 GAL STEP INSULA I'ION btirofi 140 1-1/4" D/sfibufion Pipe 1" Alt? DIST£1BUTION Geld 4" Topsoil PVC WITH AT 5.5 UNDER LAKE OTIS/.~ / / / / /1 6" Halfpipo HOLES A T 50 INCH, 6" LONG I-1/4 PVC Holes Pointing Up SECT/ON A-A $.5FEETEXISflNG ~ND 49¢h EN SPURKLAND CE-2225 500 gal STEP tank BENCH WAt?KL: SOUTH WEST CORNER OF HOUSE BOTTOM SIDING ASSUMED ELEVATION IO0. OOFT TOBBEN SPURKLAND P.E. 203 14/ 15TH. AVENUE AK. 99501 LOT 17, HEIGHTS 7738 PORT ORFORD DR/YE BRUCE BOULEY I J MOUND REPAIR DATE: JUNE 30, 1995 SHEET: 5/$ GRID: 2440 T. S PURKLAND P.E. 203 WEST 15TH. AVENUE SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM REPAIR LOT 17 BLOCK 3 CONIFER HEIGHTS This system was installed in 1990 and failed with a very short time. At present the effluent is day lighting on one slope. The original design drawings are enclosed with a proposed repair. Please give an estimate of the cost to repair as outlined. The estimate needs to include the following: Pumping of bed and septic tanks: Excavate sump in bed and pump. Remove and stockpile cover. Save insulation and piping- if possible and practical. Remove rock and 12 inches of underlaying sand. Place air grid 1-inch PVC, Schedule 40, with 3/32 inch holes at 30 inches. 4 lines 5.5 feet spacing. Install owner furnished compressor in garage, electrical code installation. Run supply line from garage to mound. Place 12 inches of Lake Otis Gravel and 6 inches of sewer rock. 30 yds of sand, 20 yds of rock Replace effluent lines. Cover orifices with 6-inch covers. Replace insulation and cover. Loose contaminated rocks and sand on side slope of mound. Cover with 4-inches of top soil. 50 yards MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES 14 J I vi PUL L I A M ABSORPTION Address ~ SEPTIC WELL TANK FIELD -/7 38 PORT..~o,RFO P,O bR , , Phone(s) er [No. of rooms 3~(0 - 3c~ O'1 Jqo00 ~7 ~" WELL IlO I~o ~o~ ~sc.,..,o. LOT LINE / O' 7 ' 3~ ' l ,oc i , 17 3 iFER ~TS FOUNDATION I0' Township, Range, Section SEC 13 ~ T i 2 N ~ R 3 ~ ..,~.w.~,~S'SU~wa,er"~O"~"~o"'~, ~ SEPTIC ~ HOLDING Manufacturer Capacity in gallons / ANCHORAGE TANK 1=5os~ + 5oo~.~. Material .o. Of Compa.ment. ( TYPE OF SYSTEM X ~ ~ TRENCH ~ BeD ~ W' DRA'N ~ OTHER X ~ H~'u~;E / Depth ,o pipe bottom from Total depth from original grade X~ ~ ~r~g~na~ grade -- ~ FT -- ~* ~ FT [ Fill added above original grade Gravel depth beneath pipe ~ ~ / Gravel length Gravel width Total absorption area Distance between lines ~ installer Date Instslled PRIVATE Classification (A,B,C) Total Depth ~ Cased to Installer Date Installed~ 7~ / "LNG NEE~'~$EAL" / [ ~ ~ale: I '/=~0 ~~ ~ ~.~. /~[[~ ~ ~~ Inspections Pedormed by: I ~~ ~ ~ ce~ilythatthislnspe.10nwaspea0rmedacc0rdtngt0all Municipal and State guidelines in efleM 0n this ~ Gf/~/eO~ Health Depa.ment Approv Date: ~ 72-013 (3/85) ? ~ ' INSPECTION REPORT MUNIClPALITyr OF ANCHORAGE, BUILDING SAFETY DIVISION 3500 EAST TUDOR ROAD INSPECTIONS (907) 563-3464 '"- INFORMATION (90G) 786-8211 BOND BEAM ~ ~ ELEC. ROU~ GAS TEMP, FRAMING ~ ELEC. FINA~ ~' ~ GAS INSULATION ~ OTHER ~ MECHANICAL SHEETROCK ~ MECH. FINAL ~ STRUCT, FINAL ~ FIRE FINAL ~ PLBG. FINAL OTHER ~ ZONING ~ OTHER ~o NONCOMPLIANCE OBSERVED [] WILL REEXAMINE AT NEXT INS PECTION [] CORRECTIONS ESSENTIAL AS EXPLAINED BELOW [] DO NOT CONCEAL UNTIL REINSPECTED COMMENTS DATE JN'SPECTOR WHEN CORRECTIO'I~IS ARE MADE, PLEASE CALL FOR INSPECTION 84-002 [Rev. 11/87) DO NOT REMOVE THIS NOTICE M I....I Iq L) e l::) ,.';~.'. [" 'l'_.ment (:) ~' l...lea ]. 't'..h E< Human S(.'::.:r. v :i. (:::es 82.5 I .... Str. eet, AnchoPage, A].a!i.=,l.,:a 995()1 0 I'-,I .... S i 'T [iil !iil IF. W Ii!i: R I:::' E R M I T' Date issu(.:.:.)d: 05/11/9() EnDine.er' Des:i. gned I:)(,',.mier'. l',.tame~', I.;:::[M I:::'ULt_IAM t]~,~ne!:.:~" Addr. e. ss~ 77'$8 I:::'OF;;,'T C)RI:::'OI::;:D DR ANCH :, AK "?'~-~',"!!; 16 Day I:::' h c:) rt (~:.:, ~, 346- :3907 t....c)'l:. !...eg a :t. ~: Sub (::1 .i. v .i. ~s :i. (::~r'~ ~ CC)t',I I I:::'li!i:R HG"I'S Lot ..", Sect :i. on: :I.:::.!', "fcm,~nsh :i.p: .'I. 2. N Range~ L.,:::}'t:.. S i z e 3 ;2554 ( ~.!i~ q ,, ~' T.. ,, (::) ~" a (::: ~" e s ) Max B~:~u::! t" c)on',s :', "Ih i s I:::'e r" m :i. t: 4 'T'c,'I'.. a 1 Cal::)ac :i. t y: 4 SEi:I:::"I' ]: C "l'Al'ql<: M:i.n :i. mum to'l:.a ]. sep'L :i.(::: tank capac J.'Ly: :i., 250 ga]. ],c)ns, I!i!:ach sep'L :i.,:::: {...':..'d"~k taus't:, have at i' .r:..~,..:.:~ t ~" (.:.::, q L.t i ['" ,'.-:~..~ s :i. i"i s ~..~ I a t:. i (::~i-'l (::) v ~.~:.:, ~', t a r'l k ( !iii ) ,, Dli!i:V ]: A'T .t. 01'-..I I:::!::i'E)M ENG ]: IqEEI::;: ' S )])ES I C.)lq t::i:lli~:(]:!U I RES DHHS AF:'PROVAt .... PR I OR TO iON :i;']"l::;:[ i!:]:'l'. :'.hi,, t'qC)'l ]:F:'Y DHHS BE!:::'C)I~Iii!: ALt .... ].t,l,:d- I:t.., I i "')N.~::i .t.F-t;:.~] AI....~_A i tON I::)!::: A I.. :i: F: '1 ~i~ FAT :1: C)F.t t::dEQIJ I Rliii:S :::::::::::::::::::::::::::::: I AT'E I:]i]...['ii:l:::'T'l::;'. I CAI .... I NSPEC;T ]: (::)lq ,, T',-,,'T ..... S t:::'1::: ::',"1 t i' 'I. !!i~ F:OI::i'. ¢.:~ 4 BliEDI::;:C) ]M S I t",lGl....l!!i: F:'AM :1: LY RE!ii.~ I :t:)l!!~],,IC;li!i: t. t,d .. ~' , AND !ii!: XF:' .i: Fi'.IES C)N :1.;2/3 !/9() ,, l:'or'.'l:.l"~ by the Mun.tc:i.l:::,a:t.:i. ty (:)~:' Ancl"~opar...'le (MOA) and 'l:..he State ¢:::,{' A].asl.::a, i;~:~,, .I: ~,.,,~i ]. ]. :i.r"~s.d'..all 'Lhe !!!system :i.n ac(:::oi"dar'lc:e ~,,.~:i. tl"~ att MOA cc)d(.~..',s and pegula'L:i.c.~ns, and :~]-'~ comp :::.!;,, I w:i.].], a(::ther'e '!:.el all MOA and S'I,:.aT..o (]~;' Ala!.:.;I.::a Pequ:i. Pements {',:::)P the set back d :i.s-t'...::.'.-'d"ic:(;.?'..i~i ~: r'.om al"t':.,.,' ex ist .~.rl,[..':I ~,,.~e]. :t, ,~, v,.~a~.~'i:.ewa'.l:..eP d ispc)sa], system .'.::)~" I:)ub 1 :i.c se~,,~er"a,:.:.:je system o1'"~ th :i.s .'::1.,, I (.~,F~d,'..:..'.!p~i.:.'l:..a:..~.r'~cl 'l'..h~?..t'L th.'i.'..[i, pe~"m:i.t is va],id ['c)p a f'r~a;.,'irllu, f'['~ o'[' 4 b(.:.=,.dPc:,ol~'is,, .'[ a:lsc) unde)Pstar"~d that the c:apac:i, ty of 'Lhe 'Lcrl:..al sys'Lem :i.s 4 t:.:ledr'oc)ms and any er'~]..~'..',~.l".gemert'L w:i.],], r'equ:i.r.e ar'l .~'..'~dd:i.'.l:...'i,c)l'"~a]. i:.')er'r¢;~:i.'l'..,, ;[ (Owl'",(.:.:.)r'.) I'-:: :1:t"1 I:::'I.~AM .I. ~' !"~:. e d )2':".~ / .... D A'T'E PORT ORFORD L L 17 ~/ELL 115o 6AC. $.T, E~ t ST HOUSE EPTIc SEPTIc. $¥5TE1',1 DRIVE Lib t~ELL ~.l..att6~5 Technlc~! Services " ...... 14530 Echo Street Anchorage, Alaska 995]R LIT, B3, CONIFER FIEI~IqTS SEPTIC SYSTEM REPLACEMENT SITE PLAN SCALE' DATE · 5/':1o ,DwN BY: NOTE: TI-liS I$ NoT A SuRVE'IED PLAT ALL LocATIoNS ARE APPRoX IMATF. FILL 54N D 2"D~R Sc~b.~o pvc i '~ ' ' ' ~ ....... ~o' j PlattoP Technica! Services 14530 Echo Street Anchorage, Alaska 99516 "ORENCo " LIFT L i7, 6 3, CONIFER HEIGHT S 5OIL. 'AB$ORPTION ~OUN D PLAN I -- /0 DATE: .-,c'/C~O DwN BY: ~ ~ .... ~'~"~ / 3," · . ' "'.:" ' . . .. · ,. ~.~ .~ · ~ "1 _~ , '" "~ '/- ~o.~ ~.: .~...:~.. ~o,,~,~ ~o ~,~ :..~:,.': ...: ~ .... ,., ~.....,: 7'7,~ UNDISTURBED NAT lvg Flattop Technical Services 14530 Echo Street Anchorage, Alaska 9951g L 17, I33, CON~FEP, H£16~TS :S/p SECTION SCALE: 1" =~' DATE: s/qo Dwt, t B'/: ~ Lot 17, Block 3, Conifer Heights S/D 7738 Port Orford Drive WASTEWATER DISPOSAL SYSTEM UPGRADE SPECIFICATIONS I. The scope of the proiect is the construction of a new wastewater disposal system sized for 4 bedrooms, including a new 1500 gallon septic tank incorporating a lift station, and a soil absorption mound. Due to the presence of a shallow water table which seasonally rises to within 0.5 feet of the natural ground level, the sand forming the mound will extend from 1.0 feet below to 3.5 feet above natural ground level. The base area of the sand is sized on a percolation rate of 250 square feet/bedroom as rated by DHEP in 1979, which is slightly more conservative than the perc rate of 224 sq. ft./bdrm. measured by Tobben Spurkland in 1987. The required area is 250 x 4 x 1,5 = 1500 sq. ft. which is accomplished by a 33' x 46, rectangle. The top area of the sand (which is also the area of the sewer gravel) is based on a soil rating of 125 sq. ft./bdrm., which is accomplished by a 22' x 35' rectangle. 2. The system is to be constructed as shown on the site plan and design drawings, except that minor modifications may be allowed or required by the engineer conducting the inspections. Additional cover material may be contracted for separately by the owner to provide more smooth contours il~ certain areas. 3. All construction practices and material specifications shall be in conformance with Municipal and State requirements. 4. The upper portion of the existing septic tank is to be uncovered to allow visual inspection of it's condition by the engineer, and installation of a second cleanout pipe., (If the tank is found to not be in satisfactory condition, then it shall be crushed and buried on site after pumping, and a ~ew 1500 gallon tank installed with an integral lift station.) 5. Assuming the existing septic tank is in satisfactory c¢)ndition, a new 500 gallon steel tank with "Orenco" lift station package (or equal) shall be installed downstream of the septic tank. An insulated, waterproof manhole riser shall be installed on the tank extending above ground surface giving access for lift station servicing. Floats shall be installed in the lift station per the supplier's instructions to provide a 123 gallon dose and to trigger an audible and visable alarm mounted inside the building in the event the pump fails to operate. The installer shall arrange for the necessary electrical permit and inspection. 6. The discharge line from the lift station to the soil absorption mound shall be 1.25" dia. schedule 40 PVC. The distribution manifold shah be 2" dia schedule 40 PVC. The distribution laterals shall be 1.25" dia schedule 40 PVC, capped at the ends and with 3/16" d~a holes drilled in the bottom every 30". All PVC pipe connections shall be glued. The hole distribution pipe hole size and spacing is based on the lift station output of 34 gpm a~ 20 feet of head. Since each 3/16" hole will pass 0.6 gpm at. 2 feet of residual head, 56 holes spaced 30" on center as shown will achieve even low pressure distribution. 7. The soil absorption mound shall be constructed by removing the peat and surficial soils to an approximate depth of 12" to expose the underlying silty sand layer in a 33' x 46' rectangular area. A total o[' 4.5 I'eet of medium sand shall then be placed, completely filling the base excavation and then sloping upwards to a 22' x' 35' rectangular level top area. The bottom 2 feet of this sand shall be compacted with a vibratory compactor in 8 inch lifts to achieve 95% of maximum density. A total of 9" of approved sewer gravel shall be placed on top of the sand mound, with the manifold and distribution pipes buried in the gravel with the inverts no less than 6" higher than the bottom of the gravel. Filter ~'abric and 2" of rigid, burial type insulation shall be placed over the top of the sewer gravel prior to placement of two feet of soil cover. The top 4 inches of the soil cover shall be organic topsoil to facilitate revegetation. The side slopes of the mound shall be no steeper than 2:1, and shall be seeded by the owner to promote rapid revegetation. Monitor tubes shall be installed in the locations shown. 8. The contractor or the owner shall be responsible to obtain any necessary utility locates. 9. A total of 6 inspections will be required during the course of the construction: (l) initial stakeout, (2) after tl~e topsoil is removed, but prior to placement of the sand, (3) during sand placement to observe compaction, (4) after the sand mound is complete, but prior 'to placement of gravel, (5) after the gravel is in place, the pipes are laid and connected up to the completed lift station, but before insulation and placement of final soil cover, and (6) after final backfill and grading is complete. NE~A 4× J~c~o~ ~o× --~ 24' Re'trleva[ rope 3" dlcl colic.r ~p check 5 500 GALLON LIFT pv~ union 24' x 4' 6' Cutver't Moidore 1' Fl, exlble Pres,_~t~e Hcis~ ~ 1' P V C P~oe Typ 8' Ur~eCho. ne ?-O~M (.shop o. ppU ~;h ToeMec +.op co~¢ Ad, Jus-to. bte I:'loCt Smt~_h ~ RAM-NE-l< or Equ~ 1/8' ~Legh poLyethy[eoe sT_re,, ~ dl~ x 39~ hI9h 1/'2h~ U,L, Ll_c-bed Submer~-lbb E?flueot Putq,o Rei;oJntno o. rqg I e_s STATION d 1,70 160 ~0 9O 7O GAL. o~bc~v e A~o.r-M Co~cxl cd'c,/ Be-t-ween DDSE ~o~ Le~i Ce~ ~ove V~u[~ A[~ But' tom ~D~ L_TFT S'TATU]N DATA n ~ ~ 1% ~0 25 3) 35 Golion~ pe~' r~nute TYe~C~J_ PU~ PERFO~ CURVE Flattop Techn~ca! Services 14530 Echo Street A. nchoraqe, Alaska 9951R Municipalily of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST i PERFORMED FOR: J"~"l~t P~II ¢~',,~ LEGAL DESCRIPTION: /.,. / ~. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Township, Range, SLOPE ~ * THEODORE , I %~ '.. .' .' .~ SITE PLAN WAS GROUND WATER ENCOUNTERED7 s IF YES, AT WHAT L O DEPTH? p~ Ei Depth to Water AIter Monitoring? 7" I~.~,L, Dale' ~/~,5'{~0 J I~'" B~, ' Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FTAND FT PERFORMED BY: ~'~¢~, ~,(~,'(~' ~,,¢1,,i ~~~ CE;TIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~/ ~/~O 72'008 (Rev. 4/85) CIVIL & ENVIRONMENTAL ENGINEERING * ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, ~'.E. April 30. 1990 14530 ECHO ST. PH: (907) 345-1355 ANCHORAGE, ALASKA 99516 Klm Pulliam 7738 Port Offord Drive Anchorage, AK 99516 Dear Ms. Pulliam: Per your request, on April 23 I conducted soil tests to determine the feasibility of enlarging the wastewater disposal system serving your residence on Lot 17, Block 3, Conifer Heights S/D, from the present 3 bedroom to the desired 4 bedroom size. The test involved digging a single test hole near the south end of the present soil absorption trench, at the locatiOn shown on the enclosed soil log. Totally saturated silty sand material was encountered immediately below the root mass in the test hole, and all the underlying material had a soupy consistency, as it was excavated. Water could be observed flowing into the excavation from all sides. A monitor tube placed in the test hole excavation indicated the groundwater table to be only 7 inches below ground surface elevation on April 25. Measurements of the fluid levels in the existing septic system showed it to be totally saturated with groundwater to within approximately a foot of ground surface. For example, we measured a fluid depth of 83 inches in the septic tank cleanout pipe, whereas the normal working depth should be approximately 48 inches. The bottom line is that your existing soil absorption trench cannot legally be extended because it is constructed below the seasonal high groundwater table, which is not allowed by the Municipal wastewater ordinance. In fact, with the groundwater table where it is, there is no conventional type of soil absorption system which would be automatically approved by the Municipality, and the normal recourse would be the installation of a holding tank. There are, however, a few alternative/innovative systems which might be worth exploring. Perhaps the simplest would be to request permission to construct a conventional soil absorption mound, but under the unusual situation where the bottom of it discharges directly into seasonally saturated soils, instead of the normally required 2 feet of unsaturated soil. I know of no engineering reason why this should not function just as well as any other mound system, although it would require a 7 foot high structure taking up a lot of the back yard. The Municipal wastewater ordinance does allow the installation of innovative systems to solve unusual problems. Two such systems which are currently being discussed and experimented with in Anchorage are the use of peat mounds which can provide a higher level of trea~.mer~t than sand mot~nds, and the t~se of a recirculating sand filter, such as one supplied by Anchorage Tank which has been used in the "lower 48". Both of these options are worth looking in to, but they may involve considerable expe. nse and entail ongoing effluent quality monitoring programs and provision for replacement if they fail to perform as designed.' Please feel free to give me a call if you have any questions on this report, or if you wish me to proceed with further work on your wastewater disposal problem. Sincerely, Ted Moore, P.E. MUNICIPALITY OF ANCHORAGE MEMORANDUM DATE: TO: THRU: THRU: May 31, 1989 Assemblyman James Barnett Larry D. Crawford, Municipal Manager H. Glen Glenzer, Executive Manager General Government Operations FROM: Robert A. (Bert) Hall, Director Department of Health and Human Services SUBJECT: Questions Pertaining to Upgrading an Existing On-site Wastewater Disposal System The Environmental Services Division of DHHS has reviewed specific questions pertaining to upgrading existing on-site wastewater disposal systems. These questions were raised by Mr. Andrew Pulliam, 7738 Port Orford, Anchorage, Alaska. Mr. Pulliam's existing on-site wastewa%er disposal system was first installed in 1979. This system, was, designed to meet the wastewater disposal requirements of a three bedroom house. In 1988 Mr. Pulliam applied for a permit to upgrade his existing system to four bedroom capacity. This upgrade requirement was triggered by the fact that Mr. Pulliam had constructed a new addition onto his 'existing house which .,included a fourth bedroom. Based on our understanding'of Mr. Pulliam's questions, the following answers are provided: 1. What impact will the proposed new On-site Wastewater Disposal ordinance have with respect to Mr. Pulliam's ability to upgrade his existing system? The On-Site Wastewater ordinance Task Force is still in process of finalizing their proposed revised ordinance. The current ordinance requires that when an existing three bedroom system is upgraded to a four bedroom system that a replacement wastewater disposal area be designated as part of the permit application. Kids Are Our Future Assemblyman James Barnett May 31, 1989 Page Two It is our understanding that the design criteria contained in the proposed ordinance will reduce the actual square footage requirements for the replacement area. In Mr. Pulliam's case, this reduction will probably make it easier for him to obtain a permit to upgrade his system. 2. Why is Mr. Pulliam not allowed to upgrade his existing on-site system? Mr. Pulliam may very well be allowed to upgrade his existing system providing that his planned upgrade conforms with current wastewater disposal regulations. On June 8, 1988 Mr. Pulliam applied for a permit to upgrade his on-site wastewater disposal system. After careful review, the permit application was denied based on design deficiencies in the proposed upgrade. A copy of the June 13,.1988 denial letter is attached. To date, DHHS has not received any further correspondence or a--revised permit application from Mr. Pulliam. installation of a new system, without first obtaining a permit from DHHS, is in violation of AMC 15.65.120 On-Site Wastewater Disposal Permits. 3. What appeal rights does Mr. Pulliam..have with respect to the denial of his permit application? Mr. Pulliam may appeal the denial of his permit application in accordance with AMC 3.60 Administrative Adjudication. In the interest of satisfying Mr. Pulliam's concerns, we have contacted him directly and have discussed the procedures he should follow in obtaining a permit to '6pgrade his system. We also recommended that he and his engineer submit a revised permit application which adequately addresses the design deficiencies specified in the June 13, 1988 letter. Please be assured that DHHS will provide whatever information and reasonable assistance Mr. Pulliam may require in his efforts to upgrade his septic system. We suggest that he contact our On-site Services Section at 343-4744. cc: Lee Browning, P.E., Manager, Environmental Services Kids Are Our Future unicipality of Anchorage Department of Health and Human Services Torn Fink, 625 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 June 13, 1988 Kimberly H. Pulliam 7738 Port Orford Drive Anchorage, Alaska 99516 Subject: Permit Denial For Lot 17 Block 3 Conifer Heights Subd. Dear Ms. Pulliam: The enclosed permit application has been returned for the following reasons: A portion of the proposed bed type absorption field is shown on the construction plans to be installed over the existing trench. Our files indicate that the original house and septic installation is for a 3 bedroom home. It is not in compliance with the Anchorage Municipal Code, Wastewater Disposal Regulations, Chapter 15.65.060, Section A (4), to install any part of an absorption field on top of an abandoned absorption field. Also, if a 4 bedroom upgrade is applied for to replace the existing 3 bedroom system, then reserve area must be shown on the lot pursuant to 15.65.040, Section G (4,5,6). If you have any questions of the above please do not hesitate to contact me at 343-4744. Sincerely, Daniel J. Roth civil Engineer On-Site Services cc: Tobben Spurkland, P.E. Exls~c, house Exls't, 1250 9o, t Tcink LE]T 18 °BRT ORFBRD DRIVE · Well LOT 17 LDT 16 New Addl'tlon Pro'~osed 30x4'~ Bed WeLL , , / Well ' LOT 15 20 0 20 40 60 80 100 120 Graphic Scale, l' = 40' GRID 2440 I1 TOBBEN SPURKLAND P,E, I/ 203 W, I5TH, AVENUE ANCHORAGE, ALASKA (907) 279-3916 LOT 17, BLOCK 3 CONIFER HEIGHTS SEC, 13, T18N, R3W SEPTIC SYSTEM DESIGN AUGUST 4, 1987 SHEET 1/2 30' FrOM Exist, Tank 4' C,O, Cap ALL Ends~ 4' Pete. Pipe, 9 Runs F-810 J 4' Monitor Tube Cap Bo~h Ends J 4' Sotld Header`, ASTM 3034 J 45' INFILTRATIrlN BED PLAN VIEr/ Monitor ~ube - ~--Final grade, slope ~co drain I ~ ~1,4 $o e~[ .................................................. =- ~ -- 5~ Cover' ~ Sit%barrier, Typ~r or equ~t INFILTRATION BED ~ le' sc¢~n~ ¢o~k SECTION TBBBEN SPURKLAND P.E. 203 W, iSTH, AVENUE ANCHORAGE, ALASKA (907> 879-3916 LOT 17, BLOCK 3 CONIFER HEIGHTS SEC, 13, T18N, R3~ SEPTIC SYSTEM DESIGN INFILTRATION BED AUGUST 85, 1987 SHEET 8/2 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 3 I-,I L. 5 6 7 10 12 13 GILT 14 15 16 17 COMMENTS Township, Range, Section: SLOPE ./ WAS GROUND WATER ENCOUNTERED? SITE PLAN s IF YES, AT WHAT DEPTH? !/ /D p E Depth to Water Afle Monitoring? r/. ~) Dale:' "~ Reading Date Gross Net Depth to Net Time Time Water Drop / o /C~ I i" ~o /o !o~ J~//~ PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~' FTAND 5 Y~' FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, 72-008 (Rev. 4/85) CERTIFY T~T THIS~ TEST WAS PERFORMED IN DATE: oI,P?  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 ~ ,,~ ~..._.~ ~ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION / NO. OF BEDROOMS [ Well , Absorption are Dwelling PERMIT NO. ~ ~ DISTANCE TO:I ~[00 ~ I /0 ~ ~ Z Manufacturer ~ ~ ~ ~, Mate, No. of compartment~ ~ ~ ~Liq. capacity in gallons Inside length Width Liquid depth /~ IF HOME~DE:  ~ DISTANCE TO: Well Dwelling PERMIT NO. ~ ~ ~ Manufacturer / Material Liquid capacity in gallons ~ DISTANCE TO: Well Foundational ~ Nearest lot line/~ / PERMIT NO. ~ ~ ~ ~ No. of lines Length of each line Total length ~es Trench width Distance between lines -- ~' ~/ ~ ~ inches .... ~ ~ ~ Top of tile to finish grade / Material beneath tile Total effective absorption area ~ ~ ~ / in~ ~O Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s} OTHER PIPE MATERIALS /~' ~ SOIk TfiST ~TI~G ,/ 72-013 (Rev. 3/78) o~ 0 : : : O! : o~ 0 0 0 0 0 0 0 0 © 0 0 © PERMIT NO, APPLICANT SAMUEL HILL LOCATION PORT ORFORD LEGAL Ll? B~ CONIFER HTS FIIJNIC1 'ALITY OF ANC~ ]RAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE.. AK. 264-4720 ELL ON-- ZTE 790~89 ) LOT SIZE ~0000 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEMiIS- DRAINFIELD THE REQUIREDSIZE OF THE SOIL ABSO T. O_Nt :M IS' E-"EP]-H= LENGTH GRA%"EL DEPTH= ~ THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF,.A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THE TRENCH WIDTH IS 5.000 FEET THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE~g~ALL PIPE AN[) THE BOTTOM OF THE EXCAVATION (IN FEET). lO~~f,~ ~ REQUIRE~ SEPTIC TANK SIZE= ~ GALLONS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. TWO ( 2 ) INSPECT IONS ARE REQU I RED BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELb OR t50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION, OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PEAr4 I T EXP I RES DECE~IBER ~l.. 4 :BT~ I CERTIFY THAT WITH TH~ 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. S I GNED' ~. V1 2 MUNICIPAL Pouch 6-650, Anchorage, AIMka 9960'2 276-222~ SOILS LOG--PERCOLATION TEST PERCOLATJON TEST 19 2O SLOPE SITE · Gross Net :Dap~th to Reediflg :! Date: ' Time . Time Water ' ... ;:,.:,:.-; ,:~ ~/3~'::.~.:.to~ ~':,: ~f ~, PER~OLATION RATE TE FT F:'liii:F;iff"lI'l" NO. ,:; 7'gE)2:l..q. i:, FI F:' F' L.. :[ C I:::1N T L El C FI T ]: 0 N LECiFII .... :ii!;F:IHUE:L... H :[ L.L F:'OI:;: T OF~tF O1:;:[:, L.::LT' EC.-_-': COI'.,I:[FE[F~: THE:. FilIE(;:!L1:1: F:Ei;[:, ~L.: I L.:i:Ei: OF: 'T'HE :E;O I L... FIEi::iii;CIF::F:'T.'[ CII'.,I '..'ii;'.,.'E;TEH :[ :!.::.;: Tl..iEi: I....E:t'-,ll::ii"l"H [:, I I"'IE:I",I:.:.'!; I O1",1 ]: :!ii; THE: LEi:I'.,IG"FH ,:: ]: I'.,I F'tEE:'T' ::, OF' "f'l..'l[ii: 'I"I:;i:IEI'-,II:::H CIR DF;;:F:1:1: t'.,tl::: :[ ['E !.... E:, . 't" I".1E E:, E': F:' 'T' H CI.I:::' t::! T I:~:t:i..':.l'.,t C t'-I O 1:',i: I:::' :1: T I :i":; T I-..I E [:, .'[ :~!; T la 1'.4 C E E', Iii!: T 1.,.t E [ii: I',1 T H Ei; :.:.!; I_1 I:;i: F: I:::t t~:: [!!: O I::: T ~-"1 [.'ii] 1:31:~:OUI'.,I[:, t::11'.,1[:, TI'.i[:Z E',OTTOH O!::: THE [i:.:X(~;:I:::I'v'I:::I"F :[ CIt'.,I ,:: :1: I'.,t i::'E:E;T ::,. 't"HE:F;i:[E :[:.::i; NO :.::i;E:T I.,.t:[DTH FOR 'T'HE 1:3F4'.t:::I'v'E!:I .... [:,EI::'TH :l::!ii; TH[.Z I"1:[i'.,1It"11...tP1 [)EF"I"H O1=' I]iFitF:t'v'EL li?,E:Tt.,.IEE!:t'.,I THE: OU'T'i:::I:::IL..L I:::' ]: t:::' E!: F:II'.,t[:, THE: E!$CF!"TI::)H O1::: 'T'Hliii: E::.:;I::::Fi',,,'t:=tT I O1'.,I ,:: I I'.,I FEET ::,. It:;;;i.". IE: n::;::~ ll.._J! ::fi:: It::',;:: lEE E::::, .".~;; E.:.!.E F:"-'IF ]E C:: ""IF" FIt lb..Il II..'.C ::E'!i; ::[ ;.:..!iZ I[.~:= ..... ::::11.... ;;;ii;.:.::: [~!!:.~ ~i!!:.tl II}iii f::::~ I! ........ L. lC)! II".JI ::.:.'!ii!;; ............................. T' ~..,,..n O :: ;~.:.-:: ::: :]:: ~...,~5.=..; F" E ,:~'F :]': O 1"4 ::~.::.': F~, fl::;;¢ [::::: fl::;:;;' E::" ,'.,=.., ~ ...... ~l "F IF;? F II"':: ................................ E, i::~ ,::: I-::: I:::' :1: LL.. :[ 1'.4G OF FIN .,. :5 .,. :.::.:TEr,'I I.,.I.T. "FHF, I rF F"'~''].'~FIL ]: N'::':F'F,-:T 1: ,'",t',i Fd'''t'1:':,"'''" RI:::'F'Ff'::,'' "-"":",'"'FI I* " [:'."r"'" -t:',.1"]:' "'" '"'::::' [::,EF'F:IF?.THL=.i'.,IT H :1: L.L .r.-!!~[.:.': :!i!;I...I[.:.L!E:C'T' TO F'F::O:~i;ECLIT .l: L')I",I. H ].' I",1 .'1.' i"II..,IH E:, .'[ ?ll'!:::ll",t(:::E [.:::E:TI.,.IE.~:E':N Fl I.,.IEL..L.. F:Ii"~[::, FII'.,t'.,.' ON-'".':'!!; :[ 'TE '.:i!;E!:I.,.tF:I(:~iE!: E:, 1%F:'EE:".';F:IL. :.:.i;"r':iii;'T'EH :t: ::l..Ei~.i:.~ f:::'E!:ET t:::OF.: I:::1 F'F?.:[',,,'FITE I.,.II.:.i:L.L..; Ot:~: ::L~SEt 'T'O 2:~;i!liii!l I='I:='i;ET F:F.:CiI"I FI F'UEi:L..'!:(.':: I.,.IELL I'..':,EF'[.:.'N[:'.'[I",tG I...11::'O1",1 THE: 'T"r'F:'E[ OF: I='I...tE~L..IC I.,.!E':I....! ..... I.,.IE.:.LI .... LOG'ii!; f:::!1:;i:['~: F.:EC:!U.II:;i:E':D I:::II'-,IE:, i'"ILIZT [3[=".: I";~:ETI...IFitI"4E[:, TO THE DEi:I::'F:tI:',i:-I"HENT I.,.I]:'TH.T.I',! }:::~;!:.~ [:'l:::l'T':!!i; O!::: TI"tlE I.'.I[.:.':L.L Cf;)[r'tI::'LE:':T :[ O1",1. OTHEi:t:;~: F. tE:(;:!LI :[ I;i:[.:.':l"t[ii:l",l"l":i!i; Hl::l"r' I:::II='I='L.'T'. :i!i;t::"E(:: :[ F: ]: CFI"F .'[ Ol",l'.iii; I=11",1[:' 1:::131",l:!i!;'l"l:;i:l...ICT I I.'37',1 E:' ~ f::lGl:;i:F!h'!~!!; F:II:N:IE l::l'v'l::l ].' I....FIE!~L. Ei: 'T'O :[ N%L.IF.':E I::'I':.:C~PE=.t:[: ]: f',I~!;TFtLLFIT I Ot',1. June 6, 1977 John Estabrook Post Offioe Box 883 Anohorage, Alaska 99510 SubJectl Permit l~xpir&tion Dear ~Ir. Estabrook= A permit issued by this department for well and/or on-site sewer installation On Subdivision has expired s~nce the issue date exceec~s one .~ In the event you still plan to install thew ell and/or on-site sewer system, a new permit is recruited. The original soil test maybe used ~o obtain a cur=ent permit. If the well ]las been drilled, aw ell log should be sent to this department to document the installation date. If you~have Lny questions regarding the above matter, please dO not' hesitate to contact this office immediately at 279-2511, ~xte~lsi0n 224 or 225. Sincerely, Les' N. Buohholz~ S~ltarian L~B.lJh PERMIT NO~ 1"ti_1,1"4 .L l,._..L I--'ML~ .L a 'T ~ I,_11~ Ml-~ll..,.-Ml.~r':.rll--!& DEPARTMENT OF HEALTH AND ENYIRONMENTAL PROTECTION 2510 E. ~OR RD. ~ ANCHORAGE~ AK. ~ELL RN~ ON--~ I TE ~E~ER PER~ I T APPLICANT LOCATION LEGAL ~OHN ESTRBROOK. PORT OXFORD Li? B~ CONIFER HGTS SUBD P 0 BOX 883 LOT SIZE 38000 SQUARE FEET TYPE OF SOIL RBSORBTION SYSTEM IS' TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT?BR>= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= 9. 5 LENGTH= 41 GRAVEL DEPTH= 5 \ \ THE LENGTH DIMENSION IS THE LENGTH (I~F~ETi OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE D I~TAI~C~E BETWEEN THE SURFACE OF THE GROUND ~ND THE BOTTOM OF THE EXCAVRTION~(~!N FEET), THERE I.~ NO SET WIDTH FOR TRENCHES~-~- ---, ~' THE GRAVEL DEPTH IS THE MINIMUM DEPTH ~ GRAVEL BETWEEN THE OUTFALL PIPE 8ND THE BOTTOM OF THE EXC8V~TION (I~T). MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELL OR 200 FEET FOR R PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T VRL I D FOR ONE YEAR FRO~I I$$UE I CERTIFY THAT 1: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF A~HORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS, · PORT ORFORD T.H.1 4-29-76 ORGANICS (Peat) GRAVELLY SAND W/TRACE SILT (SM SP) (200) SANDY GRAVEL - GRAVELLY SAND W/TRACE SILT (SP-GM) (190) .7.5' GRAVELLY SAND (SP) SILTY SAND W/TRACE G P~AVE L (SM) .11.5' SA/~DY SILT W/ LAYERS OF SILTY SAND (SM ~) (260) SANDY GRAVEL W/TRACE SILT (GW-GM) (160) No Water Table t5.0' ]7.0' T.D. Log represents Location of Test Hole Lot 17 Block 3 Conifer Heights Subdivision DWN: CKD: DATE: SCALE: John Esterbrook Log of Test Hole Anchorage, Alaska PRO& NO. DWG. NO. ' A-01 CONSULTANTS, INC. FAIHI~ANKS JUNEAU EAST 55ST AVENUE * P.O. BOX 6087 ' ANCHORAGE, ALASKA 99~03 · TELEPHONE 907-279-0,,~83 - TELEX 090-3541~ May 3, 1976 R & M No. 656224 ~lr. John Esterbrook P.O. Box 883 Anchorage, Alaska 99510 RE: Test Hole and Soil Log Report for Sanitary System Lot 17 Block 3 Conifer Hieghts Subdivision Dear Mr. Esterbrook: We are submitting herewith t~e boring logs, percolation results and our ¢ommentsregarding soil conditions encountered at the subject Site. This investigation was performed in accordance with your request of April 24, 1976, and those procedures outlined in a letter dated July 15, 1976 by Mr. Roll Strickland of the Municipality of Anchorage, Department of Environmental Quality. A single test hole was put down within the Lot 17 area for the purpose of defining general subsurface soil conditions and conducting percolation tests for the proposed sanitary system. Excavation was accomplished with a tractor mounted auger type drilling rig and the test hole was extended to a total depth of 17 feet below ground surface. The final log prepared for the test hole has been included in Drawing A-O1. Ground water was not encountered in the test hole. We appreciate being given this opportunity of be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M CONSULTANTS, INC. James W. Rooney Vice President JWR/PJ/pe xc: Municipality of Anchorage PERCOLATION TEST JOHN ESTERBROOK R & M NO. 656224 Time 9:45 9:46 9:47 9:48 9:49 9:50 9:55 10: 00 10:05 10:10 10:15 10: 20 10:25 10: 30 10: 35 10: 40 10:45 Elapsed Time 0 1 1 1 1 5 5 5 5 5 5 5 5 5 5 5- 60 Minutes Drop Inches 0 2 1 1/2 1/2 1 1 4 3 2 1/2 2 1/2 2 2 1 1/2 1 i 1/2 1 1 28 Inches Total Drop Parcel I. D.015-093-06 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION: Expiration Date: ___a 1 [,2 0 Z/ Complete legal description CONIFER HEIGHTS: BLOCK 3, LOT 17 Location (site address) 7738 PORT ORFORD DRIVE *ANCHORAGE AK Current Property owner(s) Mailing address Day phone Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 Zq D 4. TYPE OF WATER SUPPLY: Date of Payment TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for:, Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ ' . O Zq D Waiver Fee $ Date of Payment �- �" 2 D Z� Date of Payment Receipt Number !✓ 6 %2P(7 Receipt Number COSA # &SC 2 11 Z11 Waiver # C�' 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and Q000� industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or o ��-. `•�sv�� encroachments may exist that were not identified during the evaluation. The operational life of all wells 1 and septic systems depend upon a variety of variables, including but not limited to, soil conditions, !� groundwater levels (that may fluctuate during the year), quality of construction (materials and L • i workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and """ "' ... ............. are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of • . • • . • • • • • • . • . the well or septic system. GEG makes no representation whether an alternative well or septic system U �, y A. ar ,ess: can be installed on the property in the event either of the current systems fail to perform adequately in (}n 9. �E— the future. The content of this report is for the sole benefit of the person/party that retained GEG to il perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right rofsss�� o whatsoever. #AECC884 6. DSS SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for _ r bedrooms, with the following stipulations: By: Original Certificate Date: 7— S-2 Z The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Sit eW�k"(9IGp, I (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer regis�v,�b 1`,i Xsere r, a. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. `\\``\��QP` �'�D`C��// 7. ATTACHMENTS: ON-SITE COSA Checklist Nitrate Adv gy WATER AND m WAST'V TER z Septic System Advisory Arsenic Ady —O Well Flow Advisory Other PROS5 J ,o �- J�q lv;'-SERV\\• �-i Legal Description: CONIFER HEIGHTS; BLOCK 3, LOT 17 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 7/9/79 Total depth 348 ft Cased to LINK ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 4/2/21 Static water level at beginning of test 225.3 ft. Comments B. TANK DATA Age of tank(S) NEW years Tank type/material 5 EPnCH0PE Measured operating fluid level in septic tank NEW ❑ Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA Which system tested (date installed) 1990 ❑ ALL standpipes present per record drawing Total measured depth from grade 3.4 ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑M b Parcel ID: 015-093-06 Structure served by this system Well production at time of test 1.7+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? El Yes ❑ No F01 Coliform bacteria is Negative Nitrate mg/L MN Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG Date of Sample 4/2/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station NEW years Lift station material HDPE Comments: Adequacy test date 4/2/21 Results ❑✓ Pass For 5 bedrooms Fluid depth prior to test 0 in Water added 754 gal New depth 2 in onitor to es go to bottom of effective. H not, state Elapsed time 10 min depth into effective OR Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 750+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NO date of test) N/A Gallons introduced N/A gallons if yes, enter date Comments/Deficiencies: THE ELEVATION AT THE BOTTOM OF BOTH M rS ARE WITHIN 0.5 INCHES OF EACH OTHER - ASSUMED TO BE FUNCTIONAL COSA Checklist yellow sheet 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' ❑ Yes Yes Community Sewer Manhole/Cleanout > 100' rv7 Yes if No ft M Yes if No ft Neighboring Tank > 100' F71 Yes if No ft Private Sewer/Septic Line > 25'F, -(l Yes if No ft Absorption Field on Lot > 100' [✓ Yes if No ft Holding Tank > 100' M Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' p Yes if No ft ❑✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft [�✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' C]✓ Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5'✓[] ❑ Yes Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100'✓Q Yes if No Water Main > 10' 0 Yes if No ft Community Wells > 200'['✓ Yes if No. Water Service Line > 10' M 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' M Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No *71 ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' Yes if No ft F. ENGINEER'S COMMENTS *PER 1995 INSPECTION REPORT 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. COSA Checklist yellow sheet _J fEe Garn s.' 9C —7 53 ` ` Q`9's c�G 44��^e0, .l.!' pro f ess1000o #AECC8844OODO�Odc6 ft ft If, ft G U • Municipality of Anchorage ° On -Site Water and Wastewater Program <° (907) 343-7904 s F Y Certificate of On -Site Systems Approval Parcel I.D.015-093-06 Expiration Date: 1 1�1 1. GENERAL INFORMATION: Complete legal description CONIFER HEIGHTS; BLOCK 3, LOT 17 Location (site address) 7738 PORT ORFORD *ANCHORAGE AK 99507 Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® -Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 55 D t *) ( D (DNNb I TI 0)v N Date of Payment 5 20.2 i Receipt Number 0 6 % 2 b'G COSA # O SC a I f '21 `1 r Fee $ Date of Payment Receipt Number Waiver # 4 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: 50 I Z In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or �i�� •.. y encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, �� l groundwater levels that may fluctuate during the ear g ( y g year), quality of construction (materials an �/. � -- •.�� workmanship),and the water usage of the family utilizing the s stem/s. These conditions can vary, an P' •' • "' ' • ..• . • .."' .. 9 Y 9 Y rY, are outside the control of GEG. Satisfactory test results do not guarantee future performance of th system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of ;! the well or septic system. GEG makes no representation whether an alternative well or septic system )t f A. Gcrn - V C•= can be installed on the property in the event either of the current systems fail to perform adequately in {It1"o ` + CE— 7,953 \cZG the future. The content of this report is for the sole benefit of the person/party that retained GEG to v /I t . • o perform the evaluation. Reliance upon the information provided in this report by any other person or `U`�q�,p tt c\� v party (including subsequent property purchasers) is not authorized, nor will it confer any legal rightroress:o^ whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved 17 Conditional approval for 5 bedrooms, with the following stipulations: 11 �T 1t.d,yo),t By: Original Certificate Date: 5 11 aC) 1 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: ��`tt�.(�OF A4i4 COSA Checklist Nitrate Advisorye� �'Q�,% Septic System Advisory Arsenic Advisory .� `' OPS -SITE +l Well Flow AdvisoryOther WATER AND WAST v',`ATER o1 PROGE AICA iJJJ`O,p�8M' �ERv���,,,� COSA Checklist Legal Description: CONIFER HEIGHTS; BLOCK 3, LOT 17 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA Al Well log is filed with Onsite (or attached) Date drilled 7/9/79 Total depth 348 ft Cased to LINK ft ❑■ Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 4/2/21 Static water level at beginning of test 225.3 ft Comments B. TANK DATA Parcel ID: 015-093-06 of Structure served by this system CN/gallons iicWell production at time of tgpWater storage tank volume Well disinfected for coliform test? ❑ Yes 0 No R Coliform bacteria is Negative Nitrate mg/L❑ Nitrate less than MRL (ND) Arsenic ug/L O Arsenic less than MRL (ND) Collected by GEG Date of Sample 4/2/2021 THIS IS A CONDITIONAL COSA - THE SEPTIC TANK AND LIFT STATION ARE BEING REPLACED Age of tank(s) 41 years Tank type/material SEPTIGSTEE Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping *SEPTIC TANK BEING REPLACED D. ABSORPTION FIELD DATA Which system tested (date installed) 1990 Al ALL standpipes present per record drawing Total measured depth from grade 3.4 ft (max) Measured depth to pipe invert from grade ft (min) N N/A — pressurized field X Monitor tubes go to bottom of effective. If not, state depth into effective C. LIFT STATION ❑ Required maintenance completed Age of lift station 31 years Lift station material STEEL Comments: BEING REPLACED - CONDITIONAL COSA Adequacy test date 4/2/21 Results M Pass For 5 bedrooms Fluid depth prior to test 0 in Water added 754 gal New depth 2 in Elapsed time 10 min F0 Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 750+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NO date of test) If yes, enter date N/A Gallons introduced gallons Comments/Deficiencies: THE ELEVATION AT THE BOTTOM OF BOTH MT'S ARE WITHIN 0.5 INCHES OF EACH OTHER -ASSUMED TO BE FUNCTIONAL COSA Checklist yellow sheet 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' Q Yes Yes Community Sewer Manhole/Cleanout > 100' r, Yes if No ft M Yes if No ft Neighboring Tank > 100' M✓ Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' p✓ Yes if No ft ❑✓ Yes if No ft *PER 1995 INSPECTION REPORT Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' [✓ Yes if No ft M Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' Q Yes Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' if No *7 Yes if No ft Private Wells > 100' 0✓ Yes if No ft Water Main > 10'✓❑ ft Yes if No ft Community Wells > 200' [✓ Yes if No ft Water Service Line > 10' Community Wells > 200' Yes if No ft 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' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No *7 ft Wells on Adjacent Lots.- ots:Water WaterMain > 10' Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS *PER 1995 INSPECTION REPORT G. ENGINEER'S CERTIFICATION _o o O 1 certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with p y MOA COSA guidelines in effect on this date. ...... VO -P f. . Gar ss, CE -7953 COSA Checklist yellow sheet �Q�a pr o f e s sl0' °oQ MECC884 ��O,00—� L, GARNESS ENGINEERING Ltd 0. µ _.. ENGINEERING, SALES, CONSULTING urr. ..4 _ ..,z ,_a GROUP, May 11'h, 2021 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Request for Conditional COSA - Conifer Heights; Block 3, Lot 17 To whom it may concern: The subject lot is serviced by a private well and septic system. Per the agent, they are trying to close on the property ASAP. An adequacy test was performed on 4/2/21 and the drainfield passed for a 5 -bedroom system. It should be noted the existing approval is for 4 bedrooms, however, the design requested a variance to allow the system to be approved for 5 bedrooms. The design for a new septic tank/s was approved on 4/26/2021 (with 5 -bedroom approval). In addition, money is being escrowed by the lender at 1.5x the highest bid (attached). Given that the system passed an adequacy test, the septic tank design is approved, and money is escrowed, we are requesting that your department allow for a conditional COSA to be issued. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. 11 Jeffreyy G ss.P/E., M.S. President 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com ANTRf First American Municipality of Anchorage Attn Re Property: 7738 Port Orford Dr, Anchorage, AK 99507-6018 Buyer: Mark D. Carlson and Cori Carlson Seller: Terrie L. Stans-Brown and Elmer David Brown First American Title Insurance Company 3035 C Street Anchorage, AK 99503 Phn -(907)561-1844(800)770-0510 Fax -(907)561-1948 May 11, 2021 File No: 0201-3704799 (RD) At time of closing, First American Title will hold funds in escrow in the amount of 1.5 times the highest bid for the new septic in the amount of $34,434.00. All funds will be held in escrow until final MOA approval is received. First American Title Insurance Company Clarifel Walton, Assistant Rebecca Doyle, Escrow Officer Page 1 of 1 ADDRESS Elmer Brown 7738 Port Orford Anchorage, AK 99516 ARM Septic Services, LLC 17933 Old Glenn Highway Chugiak, AK 99567 (907) 688-9433 ARMServicesAK@outlook.com www.ARMServicesAK.com PROPOSAL # 1769 DATE 04/26/2021 ACTIVITY QTY RATE AMOUNT Excavation 1 23,356.00 23,356.00 Installation of two lifetime poly septic tanks and a lift station package. Estimate includes importation of engineered bedding material for the septic tanks and components, along with all electrical and electrical permitting. This estimate includes the following benchmark standards exclusive to an ARM installation: -Industry leading 5 -year warranty of the system's workmanship -Compaction (mechanical and hand) underneath/around ALL components to avoid future settlement damages (ask for more information). -Compaction and workmanship to allow client to maintain factory warranty for their components (tank etc.) -Careful bedding of all components in suitable or engineered soils to meet specifications. -Clean, friends, and professional work crew at all times. -Master craftsmanship of your system by passionate individuals. Please read and sign the "Residential Addendum A" provided as it applies to this contract. 60% down required, Remaining balance due upon completion of work. Credit:Credit 1 -400.00 -400.00 Senior Discount By signing below, the client agrees to the proposed work, terms, TOTAL 22 and price. The client has also read and signed the "Residential Addendum A" and agrees to the terms. The client acknowledges that ARM Services, LLC has the right to lien this property. Accepted By Accepted Date ARM Services, LLC $ ,956.00 Wilco Excavation LLC 8041 Marino Dr., Anchorage, AK 99516 Ryanwi lco. excavate(llq m a i 1. com 907-242-9863 BILL TO Elmer Brown 7738 Port Orfand 907-748-6686 jabrown,'@ I gci ,.net SHIP TO Estimate No: #APR21-007 Date: 04/27/2021 Valid For: 30 days ECSTIMATE DESCRIPTION QTY UNIT PRICE TOTAL Installation of 2 new septic tanks 0.00 1-1 500gal 2 compartment tank and 1-1000 gal 0.00 lift station tank with orenco components. 1 22314.00 22314.00 0.00 ESTIMATE INCLUDES: Both tanks, materials, 0.00 equipment, labor, electrical, and abandonment of 0.00 existing tanks. 0.00 0.00 0.00 DOES NOT INCLUDE: Landscaping 0.00 0.00 SUBTOTAL 22314.00 DISCOUNT 0.00 SUBTOTAL LESS DISCOUNT 22314.00 Tank you for your business! TAX RATE 0.00% TOTAL TAX 0.00 SHIPPINGMANDLING 0.00 Quote Total $ 22,314.00 Notes & Terms Due in FULL upon completion -W=:::::* l r 1� t. C4 00 fl Lij C) • `✓) �7 CL L i CIO LUco "Ji Lu p j KLLCC —LLL--- L r 1� t. Parcel I.D. # MUNICIPALITY OF ANCHORAGE ~ DEPARTMENT OF HEALTH & HUMAN SERVICES MU~'LOF ANCHOk~,~I~ Division of Environmental Services ENVIR SERVICES DIVISION On-Site Services Section P.O. Box196650 Anchorage, Alaska 99519-6650 {"/IA, J~ 2_? 1996 343-4744 CEFITIFICATE OF HEALTH AUTHORITY RECEIVED APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner ~-lo~,~.~.u Mailing address Day phone f Lending agency Mailing address Day phone Address 3~01 ~d~' ~~ 1=~ ~ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ./7/ 'w TYPE OF WATER SUPPLY: Individual well ~ Community well Public water Day phone 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 I'-'-o [~ [o~ ,.~ q~ ~u ,"~ L~ ~ ~ ~ ~ Phone Address ~0~ ~Y/ ~-~ ~ ~_ ~'. ~ Engineer's signature ~ ~' ~'~~' Date DHHS SIGNATURE 7 Approved for ¢ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Sen/ices (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) Eiack MOA ~21  Municipality of-Anchorage DEPARTMENT OFHEAkTH &,HUM~,N SERVICB~c~PAUW o~ ^NCHO~ Envir°nmentalrServices Division ENVIRONMENTAL SERVICES 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 '- Health Authority, Approval. Checklist R E C E, IV ED LegalDescription: L.~I~, BK~ ,. ~,'~ ~lk~s ParcelI.D.: Ol~- ~ -- A. ~LL DATA Well ~e ~ If A, B, or C, attach ~EC letter. ~EC wate[ ~stem number Log present (Y~) ~/ Date complet~ ~/~! ~ ~ Total depth ~ Casedto ~ ~ D Casing height (above ground) : Sanitary seal (Y/N) ' 7 Date of test Static water level Wires properlyprotected (Y/N) FROM WELL LOG AT INSPECTION Well production g.p.m WATER SAMPLE RESULTS: Coliform (~ Nitrate ~[ 1) Other bacteria Date of sample: ~- ~/! ~'/ct ~, Collected by: '~ --~ B. SEPTIC/HOLDING TANK DATA Peroxide treatment (past 12 months) (Y/N) N g.p.m. Date installed I q"] q Tanksize ~5~) Number of Compartments ~ Cleanouts(¥/N) x/ Foundation cleanout (Y/N) X/ Depression (Y/N) ~[ High water alarm (Y/N) ~ 1 '/ Date of Pumping [1/, ! qS' Pumper ] ,~ L a,t.,. ~ C. ABSORPTION FIELD DATA 0,7 q~,oC Date installed ~/O/qS- Soilrating (g.p.d./flZorft2/bdrm)~Systemtype ~oa,[~ I I Length ~ Width ~. Gravel thickness below pipe I~, ~1 Total depth Effective absorption area I~1~ se; ! Monitoring Tub© present(Y/N)~ Depression over field (Y/N) Date of adequacy test ,,/5'/q ~, Results (Pass/Fail) '~ For V bedrooms Fluid depth in absorption field before test (in.); aJ~.~./ Immediately after.~'~ gal~Water added (in.): Fluid depth C//~ (ins.) Minutes later: 1 ~ Absorpti°amte = -) ~ g.p.d. If yes, give date LIFT STATION Date installed '~/S! Manhole/Access (Y/N) High water alarm level at* Cycles tested Size in gallons "Pump on" level at* ~-~ "Pump off' level at* *Datum "~ o-[-[ o,-v~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot I I Absorption field on lot ! Public sewer main Sewer/septic service 'line ; On adjacent lots .; On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation I O ~ Property line ! ~ Absorption field .3 0 t Water main/service line ~ t ~t Surface water/drainage N10 Wells on adjacent lots )"> /OO / SEPARATION DISTANCE FROM ABSORFFION FIELD ON LOT TO: Building foundation Water main/service line Surface water N [ t~ Driveway, parking/vehicle storage area ~ ~0 ~ Curtain drain ~ ] ~ Wells on adjacent lots ~ tooI Property line "7 F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal are in conformance with MOA HAA guidelines in effect on this date. Signature /. ~A Fee $ ~. ~ W~ver Fee $ Date of Payment ~ Date of Payment ~eceipt Number ~ Receipt Number Rev. 8/95 OSS: haa. wk.doc Parcel I.D. 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 haa# GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner ';~-v~_,- '~oO J"~-.'-/ - Mailing address "7 '7 ~ ,~ --i'Ve ~1_ Lending agency Mailing address Day phone Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDRooMs:. TYPE OF WATER SUPPLY: Individual well NOTE: 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site ';'Holding tank '"':'~"'"~'?' Commufiity on-site .. Public sewer '-~ '~ ~':';: ........ ,.,- ...... Public water If community well system, provide written confirmation from State ADEC,atte~,~,t'-', lng to the legality'and status of system.,, If community wastewater system, provide wri~en confirmation from State ADEC a~esting to the legali~ and status of system. 72..025(Rev. 1/91) Front MOA#21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal a~fixed hereto and as of the validation date shown below, ! 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 .. "~'-C~J,~l (:~[~u~-~c..~l.~ "~" Phone Address ~1-0~ ~ /f:T'~,~l /'"'~-o~ Engineer's signature "T~. ~ Date 7/~,/~,~..- i 6. D HS SIGNATURE Appmv~ for bedrooms. ~--:--=-:-~-'- Di~PrOved: .... Con i.ona a rova >,.,, ...... : . . . Additional Comments "' ;'~" ' "L,',, t /'~%~ '~ Date ; ,,. The ~ici~ali~ of Anchorage Depa~ment of Health and Human Sewic~ (DHHS) i~ues Health Authori~ "'~ ,~? ".Appm~i~Ce~ifi~tes bas~ only upon the representations given in am m h 5 a ' .. ,,,, ~, . <,,.~ .... . . . P g p bove by an independent ' ..." J Lp~f~mnal engln~r r~lstemd in the S~te of Alaska. The DHHS does this as a cou~yto pumhasem of homes "and t~'lending in~itutions in order to ~tis~ ceAain f~eml and state requirement. Employ~ of DHHS do not conduct inspe~ions or anal~e, data before a ce~ificate is i~ued. The Municipali~ of Anchorage is not r~ponsible for e~om or oral,ions in the pmf~ional engin~fs work. 72-025(Rev. 1/91) Back MOA#21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type -~, Log present (Y/N) Total depth Sanitary seal (Y/N) Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Y '~ L/Z~ Cased to Date completed ~/-/'~2 Casing height Wires properly protected (Y/N) FROM WELL LOG lq7f Date of test Static water level Well flow I" ~ g.p.m. Pump level1 Be 3L~'e ~/ SEPARATION DISTANCES FROM WELL TO: Driller AT INSPECTION MuNiCiPALiTY OF ANCHORAGE ENVIRONMENTAL SERVICES DiViSiON ':,I l? 1995 g.p.m.,.: ~ ,_ RECEIVED Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line 1 5o ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~/7/~ Date of sample: Nitrate ~ Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed / rl 7 ~ Tank size Cleanouts (Y/N) 7 High water alarm (Y/N) Date of pumping Compartments Foundation cleanout (Y/N) y Depression (Y/N) 1~/~'~3,- Alarm tested (Y/N) T/~/.~ j/~- Pumper IX/ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot t / O On adjacent lots To property line / ~' Absorption field Surface water/drainage /"///~ Foundation Water main/service line 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) ~/ High water alarm level "Pump on" level at MOA electrical codes (Y/N) 7 Meets SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot ! ~ O On adjacent lots Manufacturer //,~ 'c~t' "7-~ ~ Manhole/Access (Y/N) ~ "Pump off" Level at Cycles tested ~.~ ~)"~ I ~ Sudace water D. ABSORPTION FIELD DATA Length ~ .~ Total absorption area Date of adequacy test Water level in absorption field before test t'q//~_~, Peroxide treatment (past 12 months) (Y/N) I'~ Soil rating (GPD/FF) Width ~Z. 'Z._ Gravel thickness ! ..~/~ . Cleanout present (Y/N) ~//,~..~'N-u,u~J Results (pass/fail) System type Total depth Depression over field (Y/N) for Z7/ After test Bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /~0 On adjacent lots ~ /c~5:) Property line To building foundation ;~ ~ To existing or abandoned system on lot On adjacent lots ~ ,~'~ Cutbank 1'~ ~ ~4 ~-. Water main/service line Surface water ~k~ I f~ Driveway, parking/vehicle storage area ~ / Curtain drain ~ I ~:~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effec~ ~q, tt)~,~'~a" ' "~eof,'~i~ inspection. Engineer's Name HAA Fee $ .,~._~0,00 Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) Location (address or directions) (b) Property owner Mailing Address (c) Lending Institution Mailing Address 773'$ N,~. ~ (~,mJ~r? ~(h~.~ Telephone'(home) ~¥~'-~°?Business Telephone (d) Real Estate Company and Agent hl,/~-, Address Telephone (e) Mail the HAA to the following address: (or check here I~, if hold for pick up.) List contact person and day phone number below: I'"c,,,', P,~II~ 5q~ -~?o 7 2. TYPE OF RESIDENCE Single-Family [] Number of bedrooms 3. WATER SUPPLY Individual Well [] Community [] Public [] Note: If community.well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site 1~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation'of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in cOmpliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm ~[~./-¢c,/¢ 7-~cJtit; c~[ 5er'~,~'¢.~j' Telephone Address Date 3' '/5- - / Approved for ~ bedrooms by/ Approved ~ Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~025 (Rev. 7/88) Back Page 2 of 2 A, WELL DATA Welt Classification P[~tVA"FE MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: l/TS If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ~ Date Completed '7/7 c~ Yield TotalDepth 3u~~ Casedto ~Z¢O' Depth of Grouting I~J. Static Water Level 2 3/+ Casing Height Above Ground ,3 ~ ' Electrical Wiring.in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot J J To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ~/OO To Nearest Sewer Service Line on Lot Water Sample Collected by FLATTOP Water Sample Test Results TEC..~/, Comments I Pump Set At ~ 'Sanitary Seal on Casing (Y/N) YE'~ Depression Around Wellhead (Y/N) ; On Adjoining Lots '~ /OO J~O ~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole IOO II ~VC <~ ;Date © Co~.~'o1~1,4 ,//oo N.A. B. SEPTIC/HOLDING TANK DATA / Date Installed ~/7~ Size Standpipes (Y/N) YE~ Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~.A. ~ ~.~o No. of Compartments Air-tight Caps (Y/N) Y~5 Foundation Cleanout (Y/N) Y--cE ~ O Date Last Pumped ~//¥/~ O N.A. ;for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well I To Property Line I~ To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course To Building Foundation To Disposal Field Comments 72-025 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption. Strata Date Installed Width of Field 250 u'/~DWM Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test t,I ,~, SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well [ ~-0 ' To Property Line To Building Foundation 3(o ' Lot ~_BO[~ PORTION o¢ /~BANbO~E'b'T~E~8~n Adjoining Lots ~/3/0' To Water Main/Service Line -~ ~0' To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course ~ I00 To Driveway, Parking Area, or Vehicle Storage Area ~0 ' Type of System Design Length of Field z~(o / Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) 'I/ES ~ 2 ~.T, Date of Last Adequacy Test N-c-iv` S'/.~, To Existing or Abandoned System on Comments D. LIFT STATION Date Instal led Size in Gallons d;'oo Gft/- ''Pump On" Level at High Water Alarm Level at Color) Tested for ~,~r. Meets MOA Electrical Codes (Y/N) Dimensions SOO $~L Manhole/Access (Y/N) yE s 31.& " " "Pump Off" Level at CORD @ ~/.~' (~ 3cJ" Vent (Y/N) YE <~ Pum. ping Cycles during Adequacy Test. Comments Receipt No. Date of Payment ~///'~-/,~ Amount: $ / 72-026 (Rev. 7/88) Back **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. _~,a,~_~ ~ Signed -~"~~- ~. ~ '~ -'~ Company F~o~ T~C~. SVCS , ~'~ .. ~,~ ,:-~ ~. Date ~/lg/~q ~;~' 4E[~ ~:~ ~'~ Engineer's Seal MOA NO. ~ - ~'~ ; .~.~ . T} ~ODORE F ~OORE .. ~ ~, ,~':, ~ ~- 3o8) -~ Receipt No.~- Pr~m~A~, ~* ~ / ~ ~ ~ Waiver Fee: $ Date of Payment Page 2 of 2 unicipality of Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. BOX 196650 Anchorage, Alaska 99519-6650 343-4744 June 19, 1990 Ted Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Waiver Request for Lot 17 Block 3 Conifer Heights S/D Waiver Request ~WR900020, PID #01.5-093-06, HAA#900230 Permit ~ SW90097 Dear Mr. Moore: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. waived distance is 7 feet from the west lot line. The This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sinc.~ly, //~ Robert W. Robinson Civil Engineer On-site Services ~hn Smith, P.E. Erogram Manager On-site Services ljw~7 MUNICIPALITY OF ANCHORAGE * - DEPARTMENT OF HEALTH & HUMAN SERVICES ~) / ~ -- DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~,1(~)'")- ~)c~"~ 7 OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date NOV. 23, 1987 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 17, Block 3, Conifer Heights Location (address or directions) 7738 Port Orford Drive (b) Property Owner Andy &Kim PulTiam Telephone: Mome Mailing Address (c) Lending Institution Telephone 346-3907 7738 Port Orford Drive, Anchorage, Alaska Business 99516 Mailing Address (d) Real Estate Company and Agent Address (e) Telephone Mail the HAA to the followino address: or: Check here ,[~"hold for pick up. List contact person and day phone number below. Andy &Kim Pulliam CONTACT PERSON 7738 Port Orford DriVe BRUCE D. PATTERSON E,E.' AnchOrage, Alaska 99516 563-3142 ", TYPE OF RESIDENCE Single-Family [~[X Numbe~: of Bedrooms 4 WATER SUPPLY Individual Well ~"Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, SEWAGE DISPOSAL Onsite~( Public [] comm~ni'ty [] Holding Tank [] Note: If commUnity well system, must have written Confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/86~ Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION AS certified by my seal affixed he..r, et0 a~nd as of the ~/alidation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm Datum Enqineerinq & Surveying Telephone 563-3142 Address 4011 Arctic Blvd. Suite 206~ Anchoraqe Alaska 99503 Date Nov. 232 1987 Engineer's Seal DHHS APPROVAL Approved for ~ bedrooms by Date CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-075 trey 8/86) Back MUNICIPALITY OF ANCHORAGE (MOA) MUN~CmAuT'¢ OF AN~ HEALTH AUTHORtTYA*PPROVAL (HAA) OF..PT. OF ~EALI'H & CHECKLIST - FEBRUARY 1984 ENVIRONMENI'AL PROfECfl(~q 264-4744 NOV 2 4 1987 ^. w , o,,-,RECEIVED Legal Description: Lot 17, Block 3 Conifer Heights Well Classification Pri rate Well Log Present (Y/N) Yes Total Depth 34B Cased to Static Water Level 215 If A, B, C, D.E.C. Approved (Y/N) Date Completed 1979 Yield Appr0x 24O Casing Height Above Ground 3 feet Electrical Wiring in Conduit (Y/N) Yes Separation Distances from Well: To Septic/Holding Tank on Lot Over' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line n/a Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments Depth of Grouting U.n_know~ Pump Set At 345 Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N} 100 feet ; On Adjoining Lots 100 feet+; On Adjoining Lots To Nearest Public Sewer 2gpm Yes No 100 feet + 100 feet + n/a To NearestSewerService Line on Lot over' 75 B. D. Patterson ;Date Nov. 12, 1987 0 coliform, Nitrate not detected f feet B. SEPTIC/HOLDING TANK DATA Date Installed 1979 Size 1250 No. of Compartments 2 Standpipes (Y/N) .yes Air-tight Caps (Y/N) yes Foundation Cleanout (Y/N) Depression over Tank (Y/N) nn Date Last Pumped gept 1 qR7 Pumping/Maintenance Contract on File (Y/N) no ; for . Holding Tank High-Water Alarm (Y/N) n/a Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well over !00 feet To Property Line over' 25 feet To Water Main/Service Line Course None visible within Comments approx. 25 feet yPs n/a To Building Foundation 10 feet To Disposal Field 5 feet To Stream, Pond, Lake, or Major Drainage f~et Page 1 of 2 72-026 (Rev 8/861 Front C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed [ 979 Width of Field 3 feet 25O Square Feet of Absorption Area 900 V' Depression over Field (Y/N) no Results of Last Adequacy Test Ni ne Hour test Separation Distance from Absorption Field: To Water-Supply Well Over 100 feet To Building Foundation Apprn× 23 feet Lot To Water Main/Service Line nv~r ,30 feet. To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field 90 feet,,' Depth of Field 9 feet Gravel Bed Thickness 5 feet Standpipes Present (Y/N) Date of Last Adequacy Test Dai 1.v capacitS Trench yes 11/19/87 .,685 gallons To Property Line 10 feet + To Existing or Abandoned System on ; On Adjoining Lots tn east. nv~r 5(3 feet To Cutbank (if present) n/a NOp~ within _2(l(1 feet Over 30 feet Comments wnfmw l~u~l in Ct~n~pin,,~ nnf in~irfium nt= lo~ol in tw~nrh Over 400 gallons put in with no rise in float level, Next 200 gallons resulted in a rise of- over z inches, D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) none Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** FILE HAS SIZE OF HOUSE AS THREE BEDROOM, PRESENT CONFIGURATION HAS ~ FOUR ROOMS THAT COULD BE CONSIDERED BEDROOMS. ** Check Permitted B~room Rating Against HAA Request ** I certify tl~ I have~or- / ~ conformed to all MOA and HAA guidelines in effect on the date of this inspection. ' 1 Signed L/]~....~../t'~ Date 1/23/87 Company DATUM ENG. & SURVEY MOA No, CE87-294 Receipt No. [_o~..~[_~ Date of Payment Amount: $ ~ ~'"~(]~. ~%['~ Engineer's Seal Page 2 of 2 72-026 (Rev 8/86/ Back MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) / ? zf l/.r 3, . ... Location (address or directions) ' (b) Applicants Name..L.G]en M. Poling Telephone - nome Applicants Address 7738 Port 0rford Drive, Anchora§e, AK 995]6 (c) Applicant is (check_one) Lending Institution ~-~ ; Owner/builder ~ ; Buyer ~-~ ; Other ~--~. (explain); '~ ' (d) Lending Institution National Bank of Alaska (Main) Telephone 276-]]32 Processor: Ms. Ruth LeBar Phone: 265-2883 Address Pouch 7-025, Anchorage, AK 99510 (e) Real Estate Co. & A§ent Coldwell Banker Jack White Co. /Agent: Elliot [aw~nn) Address 3201C St, #100 .... Anchoraqe~ AK 99503 Telephone 563-5500 (f) Mail the HAA to the following address: Elliot C, Lawson~ % Cnldw~ll Ranker .]ack ~!hite Co. ~nl C St. #1On: Anchorage, AK 99503 2. Type of Residence Single-Family,.~. Number of Bedrooms 3. Water Supply- Individual Well.~-~. Mul ti-Family ~-~ Other (describe) Community~-~ Public~-~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewa~,e Di..s. posal Onsite ~ Public ~ Community ~ Holding Tank ~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] ' 5. En~ineerin$ Firm Providin$ Inspections~ Tests~ File Search~ Data and Information DHEP Approval Approved for~u~bedrooms Approved~ As certif'ied by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of ~mchorage 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 regula- tions in effect on the date of this inspection. ~f~ ~/f/~ ~ o~ /~,~ Telephone ~/ Name of Firm Date ~/~ '-/ /A-f' .,,.. ~X.,, ..... ,-'2,~.' ,t '~. JUNE 20, 1971 ,... / I. ,-, tif ....... . Di sappr oved Cond i tio n~ul Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH ~ND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/eJ/DI~ [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHOPAGE (MOA) HEALTH AUTHORITY APPROVAL (FAA) CHECKLIST - FEBRUARY 1984 · Le gal -De s cr iption: MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION OCT RECEIVED Well Classification ~ ~ ~ ~ Well ~ ~e~nt (Y/N) ,/ ~ Total Depth ~ ~ W ! Cased to If A, B, c~ C, D.E.C.. Approved(Y/N) Dept~ of G~outing Static Water Level ¢,~/3-; 1~ Set At Casing Height Above Ground ~ / .... Elect=ical Wi=ing in Conduit (Y/N) SeDa=ation Distances f~cm Well: Sanitary Seal on Casing (Y/N)/ Demession A~ound Wellhead (.Y/N)'~.' To Septic/Holding Tank c~ Lot.. /~ ~- ; On Adjoining Lots /~ ~' To Nearest Edge of Absc=ption Field on Lot ~? ; On Adjoining Lots, ,/~'/- ,, TO Nearest Public Se~s= Line .,~g,,~w,.~,_. . ...... To Nearest Public Se~sr Cleanout/Manhole ,9/~_ To Nearest Se~s= Se=vice Line on Lot 7_5-- ~' Ware= Sample Collected Wate~ Sample Test B~sults SEPTIC/HOLDING TANK ,DATA pete ~nstal~ed F/~ ? Size ~ ~// No. of C~a=tm~nts ~t,, Standpipes (Y/N) .y Ai':~-tight Caps (y/N)y~l~ Foundation Cleanout (Y/N) .'~ Dep=ession ove~ Tank (Y/N) /t/ Date Last Pumped /9~Z/ . Pumping/Maintenance Contmact on File (y/N) ;g/~ ; fo= .olding Tank .igh-wate= Uam (~/N) /~ Te~=a~ ~ldi~ Tank Sepa=ation Distances f=cm Septic/Holding Tank.- To Wate=-Supply Well To PTope~ty Lins /W ~ To Water Main/Se=vice Line Cou=se .. Com~snts To Building Foundation ~-- / TO Disposal Field ~'"/ ..... TO St=earn, Pond, Lake, o= Major D=ainage [PaGe 1 of 2] 2-15-84 ABSORPTION FIELD DATA SoilS Rating in Absorption Strata ~ ~ ~ Type of System Design T Date Installed /~7~ Length of Field ~ ~ Width of Field ~ ~' Depth of Field ~ / Gravel Bed Thickness . Square Feet of Absorption A=ea ~D ~ Standpipes Present (Y/N) Depression ove= Field (Y/N) /f~ Date of Last Adsquacy Test?//F$¥ Results of Last Adequacy Test S~,%~.7 Separation Distance frcm Absorption Field: To Wate=-Supply Wsll /~ ~- To Prope=ty Line /~ To Building Foundation _~m 7~ To Existing or Abandoned System au Lot /b~ ; On Adjoining Lots ~ ~- To Wate= Main/Se=vice Line g~+ To---.~utbank(if ~esent) /t~_ To Stream/Pond/Lake/or Majo= Drainage Course To Driveway, Parking A=ea, c= Vehicle Storage A~ea ~ ~ Date Installed /~J%~/~ , Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Ievel at "Pump Off" Level at . High Wate= Alarm Level at Vent (y/N) Tested fo~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Conm~nts ** Check Permitted Bed~oau Rating Against HAA Request I ce=tify that I have checked, verified, c= confc~msd to all MOA HAA Guidelines in effect on the date of this inspection. Cc~pany /~ Z ~ ~ c ~/~//?~. MOA No. ~/-- ~/! KB1/d5/s [Page 2 of 2] 2-15-84 :1~ DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE ,NSPECTOR ,NSPECTOR ,NSPEOTOL MUNICIPALITY OF MUNICIPALITY OF ANCHORAGE DEPT. OF I:.-',! JH &  ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOI~NVIRONMEN1AL ; ~.OTECTION 825 L Street - Anchorage, Alaske 99501 ENVIRONMENTAL SANITATION DIVISION ,lAN 2 6 ~981 Telephone 264-4720R E C E 1 V E D 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) days for processing. 1. PROPERTY OWNER PHONE Bryant C. & Diana Russell 349-8689 MAILING ADDRESS SRA Box 2280, Anchorage, Al< 99507 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER P.ONE Unknown at this time MAI I-~ NG ADDR ESS 3. LENDING INSTITUTION PHONE Unknown at this time. MAI LING ADDRESS 4. REALTOR/AGENT PHONE Elliot C. Lawson, Jack White Compan.v 277-1553 MAI LING ADDRESS 3201 "C" St.~ Suite 100~ Anchorage~ AK 99503 NOTE: Send all reports and correspondence to Elliot Lawson at Jack White Co. 5. LEGAL DESCRIPTION Lot 17, Block 3, Conifer Heights STREET LOCATION NHN Port Orford 6o TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four IX-I SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [~ Three [] Six [] Other 7. WATER SUPPLY IX-I INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON'SITE** [] PUBLIC UTILITY Oct. 1979 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 UTI LITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE [~ PUBLIC UTILITY Connection Verified []Septic,Tank or [] Holding Tank Size: ! ~_~"O If Tank is homemade give dimensions: TYPE OF TANK NUMBER OF BEDROOMS [] ONE [] THREE [] TWO [] FOUR PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER [] FIVE [] SIX DATE INSTALLED INSTALLER SOILS RATING MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line Septic/Holding Tank IAbsorption Area Sewer Line [] OTHER INearest Lot Line 5. COMMENTS [] CONDITIONAL APPROVAL (letter m~'~npany certificate) 72-010 (Rev. 6/79) ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~J:N ' J //_~' ~ .~'~ 825 L Street-Anchorage, Alesk~ 99501 SEP 1 8 19F9 ~ Telephone 264-4720 REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACi~S DIRECTIONS: Complete ail parts on page ~. Incomplete reques~ will not be proc~sed. Please allow mn (10) days for processing. 1. PROPERTY OW~ p , [ ' r ~ PHONE MAIL~ ADDRESS PROPERTY RESIDENT (If different [rom above) / PHONE 2, BUYER PHONE MAI LING ADDR ESS ' MAILING ADDRESS ' ~ ' . I I - 4 R~O~A~T n~ ~~ V ", I PHONE MAI LING ADDR ESS 5. LEGAL DESCRIPTION STR E El' LOC'ATI ON 6. TYPE OF RESIDENCE '~ SINGLE FAMILY MULTIPLE FAMILY 7. WAT?R.~.IPPLY ~ INDIVIDUAL* /FI COMMUNITY FI PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM  IN DIVI DUAL/ON-SITE** FI PUBLIC UTILITY NUMBER OF BEDROOMS [] One FI Four ' r-I Two FI Five  Three [] Six [] Other * ATTACH WELL LOG. A well Icg is required for alt wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) **If individual/on-site, give installation date Iq"~O~ If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) TIME DATE INSPECTOR THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS TIME DATE INSPECTOR DATE RECEIVED TIME DATE INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] IN DI VI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified [--]Septic Tank or [] Holding Tank Size: !~,-~ If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line NUMBER OF BEDROOMS [] ONE [] TWO [] THREE [] FIVE [] FOUR [] SlX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED i,___.'3(_~~'~'I- PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING [] OTHER Nearest Lot Line MATERIAL ~T-~~ 5. COMMENTS ~AAPPROVED FOR ~ BEDROOMS CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE LEGAL DESCRIPTION BY (Tit~-~ C ~ 72-010 (Rev. 3/78)