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HomeMy WebLinkAboutCONIFER HEIGHTS BLK 3 LT 9Conifer 's Heights Block 3 Lot 9 #015-093-14 Development Services Department Building Safety Division On -Site Water & Wastewater Program fl 4700 Elmore Road P.O. Box 196650 a Mark Begich Anchorage, A K 99507 Mayor www.mLini.org/onsite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: 015-093-1 Legal Description CH� �� �� "' Property Owner Name & Address: �-�- -Fwc Jrm Aes W2/ --?o Pump Installation Date: Pump Intake Depth Below Top of Well Casing: 3Ql2feet Pump Manufacturer's Name:+ Pump Model:OTS15.21 l Pump Size r hp Pitless Adapter Burial Depth: 12— feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: Well Disinfected Upon Completion? Yes ❑ No Method of Disinfection: Comments: ANCHORAGE WELL & PUMP SERV. Pump Installer Name: 330 EAST 76TH AVENUE ANCHORAGE, AK 99518 PHONE: 907-243-0740 AW PS.COM Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Inspection Report_1-1-12,cWc Municipality of Anchorage .Community Development Department Page 1 of 3 On-Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.orglonsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: PID Number: 015-093-14 ❑ New ❑✓ Upgrade Name: Annemarie Rome ABSORPTION FIELD ❑ Deep Trench ❑✓ Shallow Trench ❑ Bed ❑ Mound Address 9421 Ponderosa Dr. Anchorage, AK 99507 ❑ Other Phone - Number of Bedrooms. Soil Rating Total depth from original grade 3 10o 5i 82 6Ft. LEGAL. DESCRIPTION - Depth to pipe invert from original grade 3 Ft Gravel depth beneath pipe 3Ft Subdivision Conifer Heights Block Lot_ 3 9 Fill added above original grade 0 Ft Gravel length - 38 Ft: Township Range Section Gravel width 2.5Ft. Beds: Number of Lines NIA Distance between lines N/A Ft. SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Total absorption area 228 Fe Number of trenches 1 Dist. between trenches N/A Ft. Well N/A 126.7 N/A N/A 90.0 TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water N/A N/A N/A N/A Gal: Material Number of compartments Lot Line N/A 10.5 N/A N/A NA Foundation N/A 43.7 N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain NIA N/A N/A N/A Gal. RemarksPES is only documenting addition to existing Pump on level at in. Pump off level at in. High water alarm at in: documented system. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank Tank to drainfield Unknown - Drainfleld CO/MT Inspector BENCHMARK (Assumed elevation) ft Inspdeates: Vction� Unknown 2"" Location and description _ 3a 4th COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp �'� Conditional Approval: PP Date mrAkV.� .. !Q�q'9��1i *' ...... a�even "f�annor�e I� 8149,..fr N Date„moi Inspection Report_1-1-12,cWc A B AA T1 17.70 60.90 M M - DEC / \ M 1 79.80 105.70 C1 81.40 107.10 C� \ SUMP 70.50 75.60 �\ � 1 1 II WELL (E) 1 � M � 9 0 1,000 GAL / O 3 BR g STEEL TANK (E) g O w - HOUSE g IN DECK INSTALDRAINFLED PER INSTALLED PER _ Q INSPECTION REPORT 0 M DRIVEWAY A Q) WELL (E) \�Gj SUMP/ 00.2 Cl T1 � 116\ / / DC 25. 6 / M1 \ SHALLOW TRENCH SEPTIC 38LFx2.5"Wx3'EAREA —` INSTALLED BY Cl 7y HOMEOWNER 10.5 �w�W'� I WELL (E) 3 SEPTIC l AREA 10 NOTES:PANNONE ENG SVC, LLC ���� OF A \� Dote — � � RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 _'�c ...•.• Cgsli) 0 19/ 2015- PHONE (907) 272-8218 FAX (907) 272-8211 �y'Scale DRAWN BY: •,* 1"=50" NJC % .... .... .. ..... P.I.D. NO CONIFER HEIGHTS, BLOCK 3, LOT 9 a15-093-14 ANNEMARIE ROME f PteveCER 8149 No� PERMIT NO. 9421 PONDEROSA DR. PLAN ANCHORAGE, AK 99507+'ll��9 OFFSs ' Sh2 eOF 3 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS AND ATTACHED SPECIAL PROVISIONS. 2. SCOPE OF WORK: DOCUMENT EXISTING DRAINFIELD ADDITION. PROFILE LEGEND FILTER FABRIC ABBREVIATIONS R.I. RIGID INSULATION W WATER LINE/ CU 4" 0 DRAIN PIPE DCO DOUBLE CLEAN OUT WELL RADIUS TEST HOLE DUCTILE IRON PIPE If DIVERTER VALVE TH TEST HOLE 10/12/977 FLOW SPLITTER — SS — NEW SEPTIC GRAIN ROCK 6ABOVE PIPE INV FOUNDATION CLEAN OUT BEG BELOW FINISH GRADE _ OR TANK CLEAN OUT N0.- OG ORIGINAL GRADE USED: C# CLEAN OUT NO. - FG FINISH GRADE 38 LFx2.n'Wx3' E.D., 6' TDM# MONITOR TUBE NO. TS&V TOPSOIL AND VEGETATE TOTAL AREA 228 SF cwjI NIC 3 0_ SECTION Sw I -i2.5�-- _8 SM 6.0 j -10 GPS o .1 0 SP S 0 of z -12 = wo a o w OV w V 6Q U PROFILE LEGEND ABBREVIATIONS R.I. RIGID INSULATION W WATER LINE/ CU COPPER DCO DOUBLE CLEAN OUT WELL RADIUS DIP DUCTILE IRON PIPE DV DIVERTER VALVE TH TEST HOLE FS FLOW SPLITTER — SS — NEW SEPTIC FC FOUNDATION CLEAN OUT BEG BELOW FINISH GRADE _ _ T# TANK CLEAN OUT N0.- OG ORIGINAL GRADE USED: C# CLEAN OUT NO. - FG FINISH GRADE 38 LFx2.n'Wx3' E.D., 6' TDM# MONITOR TUBE NO. TS&V TOPSOIL AND VEGETATE TOTAL AREA 228 SF NIC NOT IN CONTRACT NOTES: PANNONE ENG SVC, LLC RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 NJC CONIFER HEIGHTS, BLOCK 3, LOT 9 ANNEMARIE ROME 9421 PONDEROSA DR. DESIGN DETAILS ANCHORAGE, AK 99507 OF. AQkk, 110/19/201.51 even F281Pan none PERMIT N0. CE 8149 one .O_ ;6Po?OFES51` �'�" Sh3 e0F 3 \\vv% MUNICIPALITY OF ANCHORAGE Ilea h and Environmental ProLe on Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME Vot"At -" MAILING ADE-)KESPHONESPHONE___.-_----- LOCATION -._ __ _ --_-- LEGAL_ L)[_SCRIPI ION SEPTIC TANK: DISTANCE NUMBER OF FROM WELL---oT..��N_-_ P1ArJUFACIURER .- -�Q v"F-f,.1ATF f21AL _Q[pi1 7� '_ _ __C.OP,1PARTr1EN'TS---�--_--- INSIDE LENGTH_.._____ _._.___ INSIDL WIt)I II _ LI(TUID DEPTH _ ___ _-_._ L_1C1lJIU CAPACITY/ �!_ GALLONS, TILE DRAIN FIELD: DISTANCL f"ROM W'E:l_IQT� __FOUNL)ATION _./iO��N ���� NEAREST LCii � L_INC' ,o �_ TOTAL LENGTH -_,_OF I_INL # of Lines ___._ _._._.____ DI`,IANCE BLIWEL_N LINES __#1C___Tf0.NCH W1DTII_____ IN. TO FAL EFFECT IVF ARSORPTION AREA -_--- 22�,�r-� 3% ___ SQ. f T. LENGTH OF EACH LINE-- 3� DEPTH: TOP Of TIL(_ 1O f INISH GfRAL)E _.__7_.______ f)EPTH Of f ILTLR h1ATERIAL. E3[NCATH TILL.__, IN. AE30VE. TIL_F_ -------- 1^1. SEEPAGE PIT: DIr;METER ----- OR WIDTH -__LENGTH.___, DEPTH _Log Crib Rings Crib Size: DIAM[TER.. --_DEPTH_____ DISTANCE_ FROM: TOTAL EFFECTIVE BUILDING FOUNDATIOfJ ___._. . , NEAREST LOT t_ INE __—�_ . APSORPTION AREA (WALL AREA) Well { I Class Depth:Well Distance To: Lot Line Bldg: Sewer Line: I Pipe Materials: Cj # of Bedrooms y, Installer:ACZ Remarks. ! J, A"I-- - WELL SQ. F F. _I I I, If1 f I, i I � I � II I f� DATE _ - APPROVE[ _ _ _-_----_------ --_-----_.____-- /0//6/7� lwl k.A ��������� ��� ��������� ~� DEPARTMENT [ HEALTH AND ENVIRONMENTAL F ITECTION 825 'L STREET, ANCHORAGE, HK` 99L� ( 264-4720 �_' -��3/ PyIL ���� ��� ���_���� ����� ������ PERMIT NO. ( 77949 ')/ �^/�� APPLICANT DONNELL CONST 4312 ZODIHK L/ / �/n u^ �- ]44 217] LOCHTION PONDE ` LEGHL 1_9 B] CONIFER S/D LOT SIZE 40000 SQUARE FEET TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH ^ MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: III FE 1="-T- bi= � �I :: P4 c3 w si= �:: L ����uvm HE: I..._ ����*-T- 1 9= �5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. � THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. ` THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). ��#:: * -. - q k. - fi . I_' �I *..* _* 11 "-: -r*.' I F I - I (, 1 1 - f E I P 4 F < " 3 31 : z: E-_,= A. - 0 f 1 4 21 ����..... 11-A��� _________ L-":- ���P-A -T- K:) F=" -l- 1 C) P-4 __..... ___......... ...... ...... H PACKAGE PLANT MAY BE INSTALLED AT THE PERMITTEE'S OPTION SUBJECT TO THE FOLLOWING CONDITIONS: 1. EITHER H CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED. 2, H CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF H MAINTENANCE AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL ABSORPTION SYSTEM HND/OR YOU MAY BE SUBJECT TO PROSECUTION. .... ........ .......... ......... ...... .... ... ....... ..... _.... ____.... ________________________ 1 0.4 0_3 i Clr4"_=>' t=flF:RE: ___ BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE. AVAILABLE TO INSURE PROPER INSTALLATION. F=h EE FT! 1*91 1 4' F--:" :1 FT E= c3 III EE CD En P1 ED EE FR 'IdL" fl_ cO 71 7- I CERTIFY THAT 1: I HM FHMILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIGNED�__��°� APPLICANT DONNELL DONNELL CONST ~ ISSUED BY__~�-�'' _,�oc�DHTE. ...'__ V].0 CONSTRUCTING SENGINEERS CIVIL ENGINEERING AND LAND SURVEYING SRA BOX 60 g ANCHORAGE, ALASKA�,99507 -,344-0817 • 344-7060 r° /Z,177 Lai 9 !3/oc/c 3 Cn�v�F� S'01('s (-o 67 0- i o C2 C7 Jq N l C lo �Q- 12��� f oA)D&/Zos4 c l Z USF C30 vv) M -W DRILLING, INC. DRILLING LOG Frank 1'. Rowe, owner Well Owner ,sau McBriae . builder Use of Well otrl. Location (address of: Township, Range, Section, if known; or distance main road Lot, 9 B1k 3 Conifer heights, Anchorage Size of casing Depth of Hole 402 feet Cased to 214. 3 feet Static water level 2 0 ) ft. ?SNS) (below) land surface. Finish of well (check one) open end (XX ) ; Screen ( ); Perforated ( ). Describe screen or perforation N/A Well pumping test at --!!—gallons gallons per M (minute) for 1 hours with 1G ` �� ;tt of drawdown from static level. Date of completion Il/18/77 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 195 TO 210 210 TO 400 M Pte` Ca.sinA sticku Organics and fill Silty clay Silty gravel Loope gravel Sand Sandy gravel Loose Gandy gm -el Loose gravel Bedrock, water veensz in sporadic fractures thio _igh ou,_- TO TO _N'' ,IVA Certified Contratlor Curuileate No's. 814 & 973 .TO 2 — STATE TO TO 5 TO 2 �� TO 35 35 To 70 30 TO 79 79 TO 1.25 1.2 5 To 165 195 TO 210 210 TO 400 M Pte` Ca.sinA sticku Organics and fill Silty clay Silty gravel Loope gravel Sand Sandy gravel Loose Gandy gm -el Loose gravel Bedrock, water veensz in sporadic fractures thio _igh ou,_- TO TO _N'' ,IVA Certified Contratlor Curuileate No's. 814 & 973 .TO 2 — STATE ` f{ f PROPERTY RESIDENT (If different from above! P E f 2. 'BU ER„ -PH ONE MAILING ADDRESS 9. LEN6I G INSTITUTION PHO NE MAILING ADDRESS a, 'REACT R/AGENT THON i - MAI LI NG ,ADDRESS I AL- DESCRIPTION aij= - S7REET LOCATION t 6. TYPE-OF RESIDENCE NUMBER °F BEDRO DINGLE FAMILY © One ❑ Four ❑ Other ` ❑ Tw p Five CJ MULTIPLE FAMILY Three C7 Six 7. WATER SUPP INDIUIDIiAL* *ATTACH VIIELL tDG. A well tog is required for al(welis drilled- i ❑ COMMUNITY since June-1875, For wells drilled pr[or to that rate, give well PUBLIC UTILITY depth {attach lag if available.) 8. =SEWAGE DISPOSAL SYSTEM I?IVIDUAL/OIVSITE** **Ifindivtdua(/on•site,giueinstallatondat_ O • if system is over two {21 f ears old an adegUacy test is regutred E] PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BIE INITIAT�Q. 72-014(3/78! - TH'IS•SIDE FOR OFFICIAL USE ONNY INSPECTION APPOINTMENTS , ❑ COMMUNITY' ❑ PUBLIC UTILITY Connection Verified DATE RECEIVED TIME TIME TIME DATE DATE INSTALLER DATE INSPECTOR INSPECTOR TYPE OF TANK INSPECTOR DIRECTIONS: TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY Sewer Line NUMBER OF BEDROOMS ❑ ONE ❑ TWO En ' THREE -'--M- FI'VE ❑ OTHER ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL PERMIT NUMBER - DEPTH OF WELL ' ❑ COMMUNITY' ❑ PUBLIC UTILITY Connection Verified .DATE DRI-L.LED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified r PERMIT NUMBER L DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR _ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY (Title) LEGAL'DESCRI PTI ON 72-010 (Rev. 3/78) • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 015-093-14 Expiration Date: 1. GENERAL INFORMATION Complete legal description Conifer Heights 133 L9 Location (site address) 9421 Ponderosa Dr. Current Property owner(s) Peter JR & Antonia Bockman Day phone Mailing address 9421 Ponderosa Dr. Anchorage, AK 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well •❑ Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class _ Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNar once request Received by:... l% ` Date: COSA to be released to the engineer. unless olbemriae renuccr n� me �..ee. COSA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number 0(a5V% Receipt Number COSA# 05",18 1 )'f0 Waiver# STATEMENT OF INSPECTION BY ENGINEER Ascertifiedby 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 andfor wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of installation. In conducting an adequacy lest, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on Me local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventuality fail and satisfactory lest results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining 11% of Me system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Alf. 99510 Engineer's Printed Name Steven R Pannone Date 4/1012018 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for _ bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: By_v�L�' (3-2 Original Certificate Date: (0 _0 The Municipality of Anchorage Development Services Division (DSO) issues Cedificales of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the Slate of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory cosh au. mni • '. .. . Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # + of i Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Conifer Heights B3 L9 015-093-14 Parcel ID: A. WELLDATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Datecom t11�18L1977 P�ed Sanitary seal (Y/N) Y - Wires properly protected Y Total depth 402 ft. Cased to 214,3 ft. Casing height (above gr 2+ in. FROM WELL LOG AT INSPECTION Date of test 11/18/1977 9/25/2017 Static water level 200 ft. 224 ft Well production 1.5 g.p.m. 0.7 g.p.m. WATER SAMPLE RESULTS: W' "* COlrfofm tjEq� colonies/100 mL Nitrate V/[tr��'n'1lmgg/L Arsenic �-- L ug/L Date of sample: A /� 11(b Collected by: PES B. SEPTIC/HOLDING TANK DATA ' Tank Type/Material Septic/Concrete Date installed 10/16/1977 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alar (Y/N) N/A Date of pumping 10/5/17 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 10/16/1977 Soil rating (g.p.d./fti orflz 100SF/BDRM /bdrm) Sys,. pe Deep Trench Length 55/38 Total depths ft. Width 2.5 ft. Gravel below pipe 3 ft. tL Eff. absorption area 558 li Monitoring tube Y Depression over field N Date of adequacy test 9/25/2017 ResultsPass/Fail PASS 3 ( ) For bedrooms Fluid depth in absorption field before test 23 in. Water added 455 gal. New depth 26 in. Elapsed Time: 120 min. Final fluid depth 23 in. Absorption rate , 450+ d 9P. Any rejuvenation treatment (past 12 mo.) (YIN 8 type) N If yes, give date 5 D. LIFT STATION Dale installed Size in gallons ManholelAccess (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Masts alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tankllift station on lot 100+ On adjacent lots 10 Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ + + Animal containment areas 50 Manure/animal excrete storage areas 10 SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Waterman 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage Wells on Curtain drain 50+ adjacent lots 100+ F. COMMENTS Survey on file. G. ENGINEER'S CERTIFICATION 1 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. Engines a Printed Name Steven Pannone Date 4/10/2018 COSA canary sheet_2B15.doc MUNICIPALITY OF F ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT • �: On -Site Water and Wastewater Section www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC181140 Subdivision: Conifer Heights, Block: 3, Lot: 9 907-343-7904 Fax: 343-7997 A water sample revealed a nitrate concentration of 6.11 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address: P.O. Box 196650 -Anchorage, Alaska 99519-6650 `www.muni.org Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby' disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Mailing Address: P. O. Box 196650' Anchorage, Alaska 99519-6650 ° www.muni.org MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite * _e� Well Water Advisory Certificate of On -Site Systems Approval # OSC181140 Subdivision: Conifer Heights, Block: 3, Lot: 9 907-343-7904 Fax: 343-7997 This well's productivity was determined to be .7 gallons per minute. The minimum well productivity required under (AMC 15.55) for a 3 -bedroom residence is .31 gallons per minute or 150 gallons per day per bedroom. Although the subject well currently exceeds this minimum requirement, the production capacity can fluctuate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address: P. O. Box 196650' Anchorage, Alaska 99519-6650' www.muni.org • -� Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 015-093-14 1. GENERAL INFORMATION Expiration Date: Complete legal description Conifer Heights B3 L9 Location (site address) 9421 Ponderosa Dr. Current Property owner(s) Peter JR & Antonia Bockman Day phone Mailing address Real Estate Agent 9421 Ponderosa Dr. Anchorage, AK 99507 2. TYPE OF DWELLING: Fx7l Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY Individual Well ED Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ WaiverNariance request for: Received b �( COSA to be released to the engineer, unless otherwise Day phone TYPE OF WASTEWATER DISPOSAL Individual Holding Tank ❑ Community ❑ Public Sewer ❑ engineer. Date:ITVI � COSA Fee $ 5ab Waiver Fee $ Date of Payment 1 . /i' Date of Payment Receipt Number mq% Receipt Number COSA # 5uo?� Me? Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we Cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Phone (907)272-8218 Date 10/2/2017 Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: n` o'/ 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. FAIN COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet [ , o If more than 1 septic system is on the lot: COSA Checklist # I of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Conifer Heights B3 L9 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 11/18/1977 Sanitary seal (YIN) Y Total depth 402 ft. Cased to 214.3 ft. Parcel ID: 015-093-14 Well Log (YIN) Y Wires properly protected (YIN) Y Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 11/18/1977 9/25/2017 ft Static water level 200 . 2'2 �/` f ft. Well production 1.5 g. p. M. u '(1� g. p. m. WATER SAMPLE RESULTS Coliform NEG colonies/100 mL Nitrate 2.96 mg/L Arsenic ND ug/L Date of sample: 9/25/2017 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Concrete Tank size 1000 gal. Number of Compartments 2 Collected by: PES Date installed 10/16/1977 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) N/A Date of pumping Pumper A i l \y1 Yl -Y SLY Vl us Date installed 10/16/1977 Soil rating (g.p.d./ftz or ftz/bdrm) 100SFIBDRM System type Ueep I rencri Length 55/38 ft Width 2.5 ft. Gravel below pipe 3 ft. Total depth 6 ft. Eft absorption area 558 ftZ Monitoring tube Y Depression over field N Date of adequacy test 9/25/2017 Results (Pass/Fail) PASS For 3 bedrooms v Fluid depth in absorption field before test 23 in. Water added 455 gal. New depthiln Elapsed Time: ' 2D min. Final fluid depth 2'b in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at __ _ -in. "Pump off' level at Datum E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 50+ Manhole/Access (YIN) in. High water alarm level at Meets alarm 8 circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation11 0+ Water Service line 10+ Curtain drain 50+ Surface water. 100+ Wells on adjacent lots 100+ Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10+ F. COMMENTS Survey on file. K4ev-i0 ZeS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven Pannone Date COSA canary sheet_2-6-15.doc 10/2/2017 in. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # OSC 171468 During a recent COSA on-site inspection and test of the potable water supply well on Block 3, Lot 9 of Conifer Heights subdivision, the well's productivity was determined to be .7 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is .31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. �G 8G • Municipality of Anchorage On -Site Water and Wastewater Program* 1060 s (907) 343-7904 It V a It Certificate of On -Site Systems Approval Parcel I.D. 015-093-14 Expiration Date: 1. GENERAL INFORMATION Complete legal description Conifer Heights, Block 3, Lot 9 Location (site address) 9421 Ponderosa Dr. Current Property owner's) Annemarie Rome Day phone Mailing address 9421 Ponderosa Dr. Anchorage, AK 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: M Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 17 Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request Received by: J 4-2-/ 1_-—L / Date: /0/21 /.)o l COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5)_150 31 5 1D % 9141 6 b Waiver Fee $ Date of Payment /6/7y 145- Date of Payment Receipt Number 64 lLtl in Receipt Number COSA # 05Q5_151D Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of. this report is for the sole benefit of the owner listed above. - Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE ✓ System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Date 10/19/2015 Conditional approval for bedrooms, with the following stipulations: Original Certificate Date:0 I (, of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA bluesheet f ., If more than 1 septic system is on the lot: COSA Checklist # + of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Conifer Heights, Block 3, Lot 9 Parcel ID: 015-093-14 A. WELL DATA Well type private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 11/18/1977 Sanitary seal (YIN) Y Wires properly protected (YIN) Y Total depth 402 ft. Cased to 214.3 ft. Casing height (above ground) + in. FROM WELL LOG AT INSPECTION Date of test 11/18/1977 9/14/2015 Static water level 200 ft224 ft Well production 1.5 g.p.m. 0.7 g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL- Nitrate ND mg/L Arsenic ND ug/L Date of sample: 9/15/2015 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Concrete Date installed 10/16/1977 Tank size 1,000 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N • High water alarm (Y/N) N Date of'pumping 9/25/2015 Pumper Isaacs Pumping Sef-vice C. ABSORPTION FIELD DATA Date installed 1011611977 Soil rating (g.p.d./ft2 or ft2/bdrm) 100 SF/BR System type Deep Trench Length 55/38 ft. Width 2.5 ft. Gravel below pipe 3 ft. Total depth 6 ft. Eff. absorption area 55.8 ft2 Monitoring tube Y_ Depression over field N Date of adequacy test 9/14/2015 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 15 in. Water added 450 gal. New depth 25 in. Elapsed Time: 190 min. Final fluid depth 15 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons _ in. "Pump off' level at Cycles tested R11 Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+- Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certffy that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date: Engineer's Printed Name Steven R. Pannone Date 10/19/2015 COSA canary sheet -2-6-1 6.doc Lu . 0 co 0 0 v a\ a n 2 w i m • o}�� M v \ �h w O N a zI: 2L6 wm = LL o \ F � O \ J \ �0 wiz 0 oWR o(Y� W W V C) I! zo tL 0 s0 w z O- w J w CO W Q 2 W Q F U) �i5 ra 0 a G C C D lD -U _Oy OtN-J N 0 00 Wm •` • 0 • 0I To; am dx 00 U m cD _N yC .L H / O.d , co It . Ra 2EaEL W 40 LL <0 aac zowazl-1 2.2 m.c 1S o 3 a O N OTD - !-L.. D N D O C LL N yoa2 NNr.CLNN - G� c� 9 Wrn y (r¢ `�MEC««dna Sow LL >oa�a`m° �m O L_ U Q K y L Z D D. "O A N "' .D d JO \ ¢mwmw>tn2 N /`o N 01 0 v a\ a n 2 w i m • o}�� M v \ �h w O N a zI: 2L6 wm = LL o \ F � O \ J \ �0 wiz 0 oWR o(Y� W W V C) I! zo tL 0 s0 w z O- w J w CO W Q 2 W Q F U) �i5 ra Municipality of Anchorage ° s Development Services Department a a Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # OSC151580 During a recent COSA on-site inspection and test of the potable water supply well on Block 3, Lot 9 of Conifer Heights subdivision, the well's productivity was determined to be 0.7 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval.