HomeMy WebLinkAboutCONIFER HEIGHTS BLK 3 LT 8Conifer Heights Lot 8 Block 3 #015-093-15 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 NAMEPHONE 7J�J❑ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION I LOCATION b NO. OF BEDROOMS V Y DISTANCE TO: Welllei` Absorption area DwellinglQ ! PERMIT N a Q LU i.. Manufacturer M 1 No. of co rtments ti Liq. capacity in gallons : � IF HOMEMADE: Inside length Width Liquid depth Y Jaz DISTANCE TO: Well Dwelling PERMIT NO. O < Manufacturer Material Liquid capacity in gallons O W= DISTANCE TO: Well � Foundation! Nearestof I�e PERMIT NO. Q J LL Z H Z w No. of lines Le th f eac li CJ Total lengt f lines Trench widt inches Distance bet een li es FTop p of the to finish grade Material befeath tile (� inches Total effective absorpt' n area W a Length Width Depth PERMIT NO. Q I— as W Type of crib Crib diameter Crib depth Total effective absorption area LU y DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. LU DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MAT�IALS d SOIL TEST RATING Cvo INSTALLER At REMARKS yrs to f i APPRO D DATE LEGAL 72-013 (Rev. 3/78) / TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (5Q FT/BR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: �F_�:F�:" -r "= _IL:�L L_ FE " 13 -r "= '--n 0 0 R F71 V iE L_ 0a E: F��* -r "= -4 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IM 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 (%N FEET). �EFF �U I F;6.* F= C -a �e F=" -r I f_- -r f =1 N K "-=-. 127 e= _-L !2 '_5 10 �n L_ L_ Q�� 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 ___ -rWO < L2 > I "'SS F="a 0 -r I "_ ":E5 F-1 FR. e ��0 U I IR E: L"'-** ___ 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 R PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO fq PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. 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. �a FR M I -r �X F=" I FZ a:-=. 0w 0- a M 0 a F_" :9:::L^ :lL P-4 I CERTIFY THAT 1: I HM FAMILIAR 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. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE 4 BEDROOMS. SIGNED: -------- PL CH HARRY H. MHCKEY L� -- ISSUED BY�/�����-� ___DHTE�����_^����c�_��_ V4�0 ��'- �------------��-T- --v- --x- �� M U N 1 1::: 1 F=* F=l L_ I -r V Q F= �N r-- " C-1 I:;.:*- F=i C3 E: � DEPARTMENT [- HEALTH AND ENY%._.._-.._ r�OTECTION � 825 ~L STREET, ANCHORAGE, HK. 99^,1 264-4720 ' �{ ���� ��� 03 r-4 _�I -r E" ���e � ��FRM I � ' _ .. PERMIT NO. ( 800572 APPLICANT HARRY H MHCK�Y A. ST RT SOX#1�75 688=281]./// LOCATION LEGAL LOT SIZE 42000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (5Q FT/BR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: �F_�:F�:" -r "= _IL:�L L_ FE " 13 -r "= '--n 0 0 R F71 V iE L_ 0a E: F��* -r "= -4 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IM 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 (%N FEET). �EFF �U I F;6.* F= C -a �e F=" -r I f_- -r f =1 N K "-=-. 127 e= _-L !2 '_5 10 �n L_ L_ Q�� 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 ___ -rWO < L2 > I "'SS F="a 0 -r I "_ ":E5 F-1 FR. e ��0 U I IR E: L"'-** ___ 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 R PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO fq PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. 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. �a FR M I -r �X F=" I FZ a:-=. 0w 0- a M 0 a F_" :9:::L^ :lL P-4 I CERTIFY THAT 1: I HM FAMILIAR 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. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE 4 BEDROOMS. SIGNED: -------- PL CH HARRY H. MHCKEY L� -- ISSUED BY�/�����-� ___DHTE�����_^����c�_��_ V4�0 ��'- �------------��-T- --v- --x- �� t7, pm"'A.941M CTS. m 16 M CA ,z A�z 4e I A; j jpy JS I" tsvltta4l� it. IV l.Y_Arf_ A% Ct c Z? lo, failSfiteia r........ W:? I I I oc 0 1 i til f (< {n1at it Y; of "All- J SIO ir. 421.6t (AIVIll I. (mbo,o, III, lew) land 3urtar.m . 0 a 0 p f"Ir,jjli of well' (004211--;oo, Woon, p6riorated, opap-holII, other I I a P, a 16 : ".. __ __ - , ___ . -, _.__ — - _ __ k04 OV (pamp i (if r I/m w I o! 0rqidown crow. static ;uv#!, 90#4 Municipality of Anchorage On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-093-15 Expiration Date: 3 'Y 1. GENERAL INFORMATION Complete legal description CONIFER HEIGHTS S/D BLOCK 3, LOT 8 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 9401 PONDEROSA DRIVE, ANCHORAGE, AK, 99507 THOMAS & KATHLEEN ULRICH Day phone 9401 PONDEROSA DRIVE, ANCHORAGE, AK, 99507 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Day phone 336-9401 TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ l `u ^^ LL Waiver Fee $ Date of Payment l o l a-1(_li� (/x� Date of Payment Receipt Number �5b5 � Receipt Number COSA# O�C�3604 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Lh). attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered of the time of the test, and separation distances measured to readily identifiable Amfures. The operational life of all wells and septic systems depend on the local soils condition, groundwaferlevels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any otherperson or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for - bedrooms, with the following Phone 337-6179 Date 10 /2 if/;CE- rness: 1P. f'. J95,�, .r lOf(fANQ, it Q, ��/// Jam' ON-SITE �c WATER AND m m WASTEWATER o PROGRAM C Original Certificate Date: 10 -SJ -13 The Miff57ciriarlfy or An ge Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenaf ons 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. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 11105) L/ Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: A. WELL DATA CONIFER HEIGHTS S/D; BLOCK 3, LOT 8 Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 10/26/1980 Sanitary seal (Y/N) YES Total depth 253 ft. Cased to 234 ft. Date of test Static water level Well production FROM WELL LOG 10/26/1980 188 ft, 3-4 —9-p M. WATER SAMPLE RESULTS: Coliform D colonies/100 ml n� Arsenic: �=ug./L. B. SEPTIC/HOLDING TANK DATA NitrateNJ1 mg./L. Parcel ID: 015-093-15 Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 10/11/2013 Date of sample: 10/4/2013 211 ft. 2.55+ g,p,m, Collected by: GEG, Ltd. Tank Type/Material SEPTIC/STEEL Date installed 2/15/1980 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 10/4/2013 Pumper (Dena I; &)-�An22 n r. %u� K S C. ABSORPTION FIELD DATA -BELOW EXISTING GRADE Date installed 10/15/1980 Soil rating (g.p.d.lft`orlllbdrm 100 System type TRENCH Length 57 ft. Width 3 ft. Gravel below pipe 4 ft. Total depth *10.9 ft. Eff. absorption area 456 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 10/11/2013 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test DRY in. Water added 625 gal. New depth 6 in. Elapsed Time: 120 min. Final fluid depth DRY in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump off' level atwa er alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM 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 N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date 1o,(Z*/r3 (Rev. 11105) o q ti n N 0 ao H � Z o a co 0 I.LantFKi1N6JKM • PLANN! ACO WEST 8ENNN ANCHORAGE, ALASKA SM Sc L to' LIM. , H3rYYf A I Wuamm rote it % iN vwwe r-tsagw7wllt> w Ya edeas 41nr •.FRM1L oawa,� or ,u*Wwx was 0 s apan ae aF aRwdw aama" VNa. UAW nASMWaqw bemmwmft ortv NW*" IN Ma Ann VJr Wj"C,• CIERT1t I"PON1 I ear.as mwdly woo I a.ra L.MAl04iClNFTWNI r aa.wa+drveatih�e.n.�faraNra�h� Ned#M*A R£-C��r,—,Tre,lrSET FOlJNO.a. Mepa.ainans d+aawn tll n. ak6h d,. MaNb 6++.esd 8-L^ +w avaaaehmarru mbn O '" t"m n►Me. C N• ..+.w •n •sauavt�raws aFAW ha-Sv�cr oamt ►elided a a s Q Ea z72sr�1 nFr NkwON et �N�rrW IMP w �. r °f LQ7= �toGKl3x �n 562fiGl6HT5 SV Sa.. DATUM. .., nasu�IEe p 41j(j I 10 FST � %7+ ,rr^r •ter J • Qj !� �n f a �Seprt[, h g, a g d z aNr 4OWL Am µ� daava � flaysf Q .. U � o q ti n N 0 ao H � Z o a co 0 I.LantFKi1N6JKM • PLANN! ACO WEST 8ENNN ANCHORAGE, ALASKA SM Sc L to' LIM. , H3rYYf A I Wuamm rote it % iN vwwe r-tsagw7wllt> w Ya edeas 41nr •.FRM1L oawa,� or ,u*Wwx was 0 s apan ae aF aRwdw aama" VNa. UAW nASMWaqw bemmwmft ortv NW*" IN Ma Ann VJr Wj"C,• CIERT1t I"PON1 I ear.as mwdly woo I a.ra L.MAl04iClNFTWNI r aa.wa+drveatih�e.n.�faraNra�h� Ned#M*A R£-C��r,—,Tre,lrSET FOlJNO.a. Mepa.ainans d+aawn tll n. ak6h d,. MaNb 6++.esd 8-L^ +w avaaaehmarru mbn O '" t"m n►Me. C N• ..+.w •n •sauavt�raws aFAW ha-Sv�cr oamt ►elided a a s Q Ea z72sr�1 nFr NkwON et �N�rrW IMP w �. r °f LQ7= �toGKl3x �n 562fiGl6HT5 SV Sa.. DATUM. .., nasu�IEe p 41j(j MUNICIPALITY OF ANCHORAGE Cit i 9 a- Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 015-093-15 Certificate of On -Site Systems Approval ? Expiration Date: 7 S 2�0 2 I Legal description CONIFER HEIGHTS BLK 3 LT 8 Site address 9401 PONDEROSA DR Current property owner(s) PARKER DAVID & BOBOTAS MELISSA X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: LZA Original Certificate Date: 7 1 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval—June 2022 MUNICIPALITY OF 0, �. Development Services Department �- On -Site Water & Wastewater Section ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-093-15 Complete legal description Conifer Heights Block 3 Lot 8 Location (site address) 9101 Ponderose Drive, Anchorage, AK Current property owner(s) David Parker & Melissa Bobotas 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: © Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ® Concrete ❑ Fiberglass Age 43 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed V Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $_ SSD Date of PaymentV2 3/23 COSA # 05023 I I �? Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 Legal Description: Conifer Heights Block 3 Lot 8 Parcel ID: 015-093-15 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ✓❑ Well log is filed with Onsite (or attached) Date drilled 10/26/1980Total depth 253 ft Cased to 234 ft Sanitary seal is functioning correctly © Wires are properly protected Casing height (above ground) 14 in. Date of flow test for COSA 11/2/21 Static water level at beginning of test 206 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 49 Date of pumping 5/29/23 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 10/15/80 ❑✓ ALL standpipes present per record drawing Total measured depth from grade 10.9 ft (max) Measured depth to pipe invert from grade 6 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced _gallons gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 4.4 qpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes 91 No 9 Coliform bacteria is Negative - - Nitrate mg/L FZI Nitrate less than MRL (ND) Arsenic ug/L ✓❑ Arsenic less than MRL (ND) Collected by Arcterra Consulting Date 5/10/23 FT STATION ❑ Require tenance completed Age of lift station rs Lift station material Comments: Adequacy test date _ Results Q Pass Fluid depth prior to test 11/2/21 0 in Water added 600 gal New fluid depth 2 in Elapsed time 60 min Final fluid depth 0 in Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 48 in Effective depth used 2 in Effective depth remaining 46 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' _/1 Yes if No ft Community Sewer Manhole/Cleanout :. 100' ✓❑ Yes if No ft 0 Yes if No Neighboring Tank > 100' ✓❑ Yes if No ft Private Sewer/Septic Line > 25'✓❑ Yes if No Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' Q Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' Yes if No Rv Yes if No ft _ Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft © Yes if No ❑ N/A — Served by Community Well (not on lot) or Public Water ft ft ft ft ft From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ✓❑ Yes if No ft Surface Water > 100' ❑J Yes if No * ft Tank to Property Line > 5' _/1 Yes if No ft Field to Property Line > 10' ./❑ Yes if No ft Water Main > 10' ✓❑ Yes if No ft Water Service Line > 10' , 21 Yes if No ft F. ENGINEER'S COMMENTS Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' ✓❑ Yes if No ft © Yes if No ft If tank or field is under driveway comment below *:Man made, self contained, water feature within 15' of septic system. G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Areterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date 9//J? 'S Engineer's Comments: This investigation was completed in compliance with AD EC and MOA regulations. .'Wt The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The �t C flow and absorption rates may change due to subsurface conditions that may not be observed from the =&�1�'W­"`ti.,� . 1 surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year & c � .,(�� % and the water usage of the family being served by the system. The operational life of all well and septic rJIt¢s yjT systems are subject to these various and dynamic characteristics and are outside the control of the evaluator; 1 „],,,,,,,,, of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen ; ' encroachments, deficiencies or discrepancies exist ��,KEN`tETH M. OlJ F��4 CE;?It6/ CASA Checklist June 2022 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-093-15 1. GENERAL INFORMATION Expiration Date: 2-_q -2 (9?-?- Complete 9ZZ Complete legal description Conifer Heights Block 3 Lot 8 Location (site address) 9401 Ponderosa Drive,_ Anchorage, AK,_99507 Current Property owner(s) Dustin & Cecile Davis_ Day phone Mailing address 9401 Ponderosa_ Drive,_ Anchorage, AK, 99507 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: 4 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well 0 Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class _ Well ❑ Public Sewer ❑ Public Water System T _ Waiver/Variance request for: Received by: _ Date: _ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment - o/J "Z. Date of Payment Receipt Number (r'3 7L9 ____ Receipt Number COSA#-.,- o SO), I I (0 59 Waiver # istance: 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 ARCTERRA CONSULTING, INC. Phone 696-6111 Address _ 20441- PTARMIGAN BLVD., EAGLE RIVER, _AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 6 .-% Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. T assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen OF 1,11 \ encroachments, deficiencies or discrepancies exist. <V1��` 1 1 Cl TGt�r �1 6. DSD SIGNATURE X— System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: --PIIT p O/V o �Fn <-ter Rq/V D rn -- R0G444 R -- �/�!!►)i)111�11 Original Certificate Date:_ The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist _ X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory _ Other _ COSA blue sheet 10-10-12.doc Legal Description: Conifer Heights Block 3 Lot 8 Parcel ID: 015-093-15 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA It Well log is filed with Onsite (or attached) Date drilled 10/26/1980 Total depth 253 ft Cased to 234 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 14 in. Date of flow test for COSA 11/2/21 Static water level at beginning of test 206 ft. Comments B. TANK DATA Age of tank(s) 41 years Tank type/material Septic/Concrete Measured operating fluid level in septic tank 49" Standpipes/foundation cleanout per record drawing Date of pumping 9/9/21 D. ABSORPTION FIELD DATA Structure served by this system Well production at time of test 4.4 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes 0 No 11 Coliform bacteria is Negative Nitrate 8.47 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L N Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 10/18/21 STATION ❑ Requ maint( Age of lift station Lift station material Comments: completed years Which system tested (date installed) 10/15/80 Adequacy test date 11/2/21 ALL standpipes present per record drawing Results Vol Pass For 4 bedrooms Total measured depth from grade 10.9 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 6 ft (min) Water added 600 gal ❑ N/A — pressurized field New depth 2 in Monitor tubes go to bottom of effective. If not, state Elapsed time 60 min depth into effective Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced gallons if yes, enter date Comments/Deficiencies: 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 if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft 0 Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ft ® Yes if No ft ft If septic tank is under driveway comment below 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' ® Yes if No ft Surface Water > 100' ® Yes if No " ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes ifNo ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft Wells on Adjacent Lots: Water Main > 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' ® Yes if No * ft F. ENGINEER'S COMMENTS *: Man made, self contained, water feature within 15' of septic system G. ENGINEER'S CERTIFICATION / certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet o �RCTERR,y ^ t ~ffq'Y�'ySU.TING R' AK saSTT-� November 9, 2021 CONSULTING, INC 20441 Ptarmigan Bld, Eagle River, AK 99577 Office (907) 696-6111, Fax (907) 868-3793 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Septic Tank Comfirmation — Conifer Heights Blk 3 Lot 8 The Municipality of Anchorage On -Site record documents for this property show the septic tank was installed in 1980 and states it is a 1250 gallon Greer steel 2 compartment tank. During our November 2nd field inspection to verify tank integrity we found only one standpipe. We had the tank pumped and verified the capasity of 1250 gallons with the fluid level of 49 inches. We had a camera scope the tank to determine any failure and found that it is a single compartment concrete tank. Attached are pictures from within the tank verifying the concrete walls. I believe the tank has been in this location for several years due to the existing vegetation in the area. If you have any questions, please contact me at 696- 6111/FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. Kenneth M. D tffu , P.E. Attachments: Tank photos 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 From: Right of Way Requests MOAROWRequests@muni.org Subject: RE: 9401 Ponderosa ROW encroachment Date: Nove be�9, 2 11:03 AM To: D uffus-ueea@arc rra.n ig t of Way Re nests MOAROWRequests@muni.o Dea: MOA ROW has no permitting authority for Slope Easements. They are part of the dedication certification on most all plats to accommodate the up or down slopes projected onto private property to accommodate the road structure and drainage. Regards, Lynn McGee Senior Plan Reviewer Right of Way Section lynn.mcgee@anchorageak.gov Office: 343-8226 Fax: 249-7340 CS1 An online Tool for Anchorage From: Dea Duffus <dea@arcterra.net> Sent: Tuesday, November 9, 202110:41 AM To: Right of Way Requests <MOAROWRequests@muni.org> Subject: Re: 9401 Pondersosa ROW encroachment [EXTERNAL EMAIL] Here is the asbuilt in the on site files. The well is in the southwest corner. The roadway is only a couple feet below the well elevation. This COSA was approved 2 other times without this issue being addressed. Dea On Nov 9, 2021, at 7:53 AM, Right of Way Requests <MOAROWRequests@munj.org> wrote: Dea: Nitrate Advisory Certificate of On -Site Systems Approval # OSC211659 Subdivision: Conifer Heights Block 3 lot 8 A water sample revealed a nitrate concentration of 8.47 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. 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. 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. Ma�hng Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org MUNICIPALITY OF ANCHORAGE d DEPARTMENT OF HEALTH & HUMAN SERVICES V Division of Environmental Services=' On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel I.D.# 015-093-15 HAA# N 1. GENERAL INFORMATION Complete legal description CONIFER HEIGHTS S/D: 1 OT 8, BLOCK Location (site address or directions)_ 9401 PONDEROSA DRIVE ANCHORAGE AK 99516 Property owner CHUCK AND HOLLY COURT Day phone (907) 333-8802/346-3392 Mailing address 9401 PONDEROSA DRIVR ANCHOR;AK 16 Lending agency Mailing address. Day phone Agent. GREG BRODERICK Day phone (c)07) 973-79gq Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: if community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: - Individual on-site xxx - Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC ing to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 Computer Version 4b a S. 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 inspe tion, the on-site water supply and/or wastewater disposal system is in compliance with all Municiparqnd State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Engineer's ALASKA WATER & WASTEWATER CONSULTANTS, INC. SHALL BE PAID $1000.00 AT, OR PRIOR TO, CLOSING FOR THE ENGINEERING SERVICES PROVIDED. 6. DHHS SIGNATURE Approved for_- bedrooms Disapproved Phone (907)337-6179 Conditional approval for bedrooms, with the following stipulations: Additional Commer By: Date_2 - /Y -00 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent Professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Computer Version Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVtJCE*R 8 Environmental Services Division v�iP 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907)"34'14,#/k of Zoo® Health Authority Approval Checklist Legal Description:_ CONIFER HEIGHTS S/D: LOT 8 BLOCK 3 Parcell.D.: 015-093-15 A. WELL DATA Well Type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N/A Log present (Y/N) YES Date completed 10/26/80 Total depth 253 Cased to 234 Casing height (above ground) 15" Sanitary seal (Y/N) FROM WELL LOG Date of test 10/26/80 Static water level 188' Well production 3 to 4 g.p.m. WATER SAMPLE RESULTS: Wires properly protected (Y/N) YES AT INSPECTION 3/3/2000 Coliform 0 Nitrate 0.6 ma/L Other bacteria 0 Date of sample: _ 3/1/2000 Collected by: A.W.W.C., INC. B. SEPTIC/HOLDING TANK DATA Date installed 2/15/80 Tank size 1250 Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression (Y/N) NO High water alarm (Y/N) N/A Date of Pumping 3/3/2000 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed 10/15/80 Soil rating (g.p.d.M2 orft2/bdrm) 100 System type TRENCH Length 57' Width 3' Gravel thickness below pipe 4' Total depth 11' Effective absorption area 456 SQ FT Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO Date of adequacy test 3/3/2000 Results (Pass/Fail) PASS For Bedrooms Fluid depth in absorption field before test (in.); DRY Immediately after 1000 gal. water added (in.): 123 Fluid depth DRY (ins) Minutes later 30 Absorption rate = 600+ Peroxide treatment (past 12 months) (Y/N) NONE KNOWN If yes, give date ----- 72-026 (Rev. 3/96)' Computer Version D. LIFT STATION Date installed Manhole/Access High water alarm E. SEPARATION DISTANCES level at* - "Pumpbff" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer/septic service line 25'+ Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ a line Property rtY 5'+ Absorption field 5'+ Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main/service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage area 10'+ Curtain drain F. ENGINEER'S I certify that I of Municipal with MOA H Engineer's HAA Fee $ A)O Date of Payment Receipt Number 72-026 (Rev. X96r computer Version Wells on adjacent lots 100'+ 'd inspections and review stems are in conformance this date. Waiver Fee $ Date of Payment Receipt Number C ME Environmental Services Inc. iw po CT&E Ret" 1000873001 AK Water & Wastewater Consultants Inc. Client POO Printed Date/rime 03/07/2000 12.44 Client Name Project Name/a Conifer 14t5 Lot 8 Bk 3 Collected Date/Time 03/01/2000 13:20 Client Sample Ib Conifer l4ts tot 8 Bk 3 Received Date/Time 03/01/2000 15:40 Stephen C. Eden Matrix Drinking Water Technical Dlrectqr Ordered By Released �%[l ��r PWSID 0 Sample Remarks: Parameter VATERS DEPT N;tratc-N MILRO LAB Total Coliform Results POL units Method 0.607 0.500 mg/L EPA 300-0 0 eol/100ml. SH18 92220 Allowable Prep Analysis Limits bate bate Init 7<101 03/01/00 SCL 691-3 E0/20'd 298-1 1089199 1V1N3WN081AN3 310-HO81 03/01/00 ZZ:Zi 00-20-80 KAP MUNICIPALITY OF ANCHORAGE ' DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # O 1 S- 09 3 ►s �'! 1. GENERAL INFORMATION 2. 3. 4. HAA # �, l �l r, Complete legal description_ L-C,A a, 'Vock 3 y 6'v1F'.Ce'- 41y Location (site address or directions) 9 yG/ D,-, Property owner Pe �e,- H l fy is Day phone 3 Yd- /77/ Mailing address '910 I 0"- A, c6or-aZe +k, 99s // Lending agency Day phone Mailing address Agent I-cs 0*y Qe-Vo e- - E RA Re�lA,, Day phone '21-3 -Z-?to Address Unless otherwise requested, HAA will be held for pickup. NUII BER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water L-1 V 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 furtherverify 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 Fla F}&n T204» icu! Se.-(/tc51 Phone Address 1 f S 3 a �c /+� S/�. /41'6 0 r'u9'c . A -k 9 9s- I, - Engineer's signature 57 9y� Date 9 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments By: bedrooms. �v 4UTIC bedrooms, with the following stipulations: Date L 11 1 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Pump off' level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 1 1 2 + ; On adjacent lots > too( Absorption field -on lot t l U f ; On adjacent lots '�p ty0 ` Public sewermain(V a Public sewer manhole/cleanout IV A.. Sewer /septic service line 1> Z S ' Lift station Al. X SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 1r% Property line S"Y Absorption field 10' Water main/service line_> t0 Surface water/drainage > 10v I " Wells on adjacent lots "*> I tea SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 2 5 Property Line YS' Water main/service line > !G ' Surface water > too' Driveway, parking/vehicle storage area 6' ` Curtain drain - No nt Sea n Wells on adjacent lots 7 1610 ' F. ` ENGINEER'S CERTIFICATION R p. d Y & . I certify that I have determined thru field inspections and review ofMunicipal records ata above systems;4q, in conformanc�ee with MOA HAA guidelines in effect on this date. Signature. (� L71 �!R!! 4 •RR i!!R!!!l ts0.o t��� Engineer's Name Th ey 4-10 l�t�o• ngftie C Date o'U HAA Fee $ 3 �O � � Date of Payment 211 l ?& Receipt Number C ?-97 Rev. 8/95 OSS: haa.wk.doc Ivor 1,�K�, r /�Orvt7a�t@ Waiver Fee $ Date of Payment Receipt Number . .,ea (MT) d/, ichl?6 MT, HAS FED-) RRPftiR-F-0 PH– 7 O ModRE PHONE Co,Jvs. oi.j l011rh6 U) h: tv u� 09/18/96 16:48 CT&E ESI ANCHORAGE -+ 9073451355 NO.266 003 CT&E Ref.# Client Nitme Project Name/# Client Samplc ID Matrix Ordered By PWSJD Parameter Nitrate -N Totat Coliform ME Environmental Services Inc. Laboratory Division a—,y -- I — ------ 200 a 200 W. Potter Drive Anchorage, AK 99818.1605 Tel: (907) 682.2343 Fax: (907) 561-5301 964601001 Client PO# Flattop Teclulical Srv, Printed Date/Time 09/18/96 14:18 L8 $3, Cwuifer Hts Collected Date/Time 09/13196 12:30 L8 83 Conifer Hts Received Date/Time 09/13/96 13:45 Drinking Water Technical Director: Stephen C. Ede Released By C &..,— Allouabte Prep Analysis Resutta PRL units Method limits pate Date Init 0.100u 0.100 mg/L SM 450OF 0 0 c01/100ML SM18 92220 09/17/96 ESC 09/13/96 TAV _ Member of the SGS Group tSoc*6 G6n6rale de Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA FLATTOP TECHNICAL SERVICES 14530 Echo St., Anchorage, AK 99516 Ph. (907) 345-1355 ADEQUACY TEST DATA SHEET Legal Description:_ 1-8, G 3 , 60AJe'- 14 k H2O METER NET. GAL Street Address: 9410! ponder%tcc.. Client Name:_ Pe Pe- /4r4lvckjz , Test Date: 9 / 13 /9C Tested $y: % Jr. "c>a-c w is Initial Conditions: 2Z7 Float #1 in set " b.t.o. it pipe w. " fluid Float #2 in set " b.t.o. " pipe w.—" fluid Float #3.in set " b.t.o.. " pipe w. " fluid Float #4 in set b.t.o. " pipe w. " fluid Water added through: ACTION TAKEN TIME H2O METER NET. GAL WELL LEVEL rtckr S �f w is t -198 2Z7 r0:2o 8ZS 27 23& .' 2 Yo 17-0 P 10: If 2 8 76 -78. 2 ko ; l7ek� at alit �ccll cacd Ir : t� est � �-etuw Zyv' i tow w 11 : S8 Z: 08 239 236 de .26W f t2: tt3 12: 2v g 7e 7& t- 0 Z3 4/ 23 12: Z7 9/0 `may t5'7 2Y7 2Y7.r r 2: S2 2Y7 1 t2 2K7 1:22 2K3 Measured Well Yield d S7 �/ _ S 7 u/ ----— - -U•6 � n r�Adequate for Bdrms y� Unit Absorption Capacity Average Absorption Rate v Surge Capacity . Adequate for Bdrms 5. LEGAL. DESCRIPTION DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME 4 - Ac" Q DATE DATE DATE ❑ Two ❑ Five ❑ MULTIPLE FAMILY -�\ INSPECTOR INSPECTORI INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF H-AI.TH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOBNVIRONMENTAL 'r,"OTECTION 825 L Street - Anchorage, Alaska 89501 0* JAN 1 ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 REC � I Vf D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACE DIRECTIONS: Complete all, parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE Barry .A; and Madeline M. Mackey 688-2813 MAILING ADDRESS Star Route, Box # 1175, Chugiak, .Alaska 99567 PROPERTY RESIDENT (If different from above) PHONE New Construction , 2. BUYER P N MAILING ADDRESS 3. LENDING INSTITUTION PHONE Alaska Pacific Bank MAILING ADDRESS(Target Realty) (I will pick up or contact Richard Brown or Jack Blair 4. REALTOR/AGENT PHONE 277-0551 'argot Realty - Richard Brown or Jack Blair MAILING ADDRESS (Pick-up } 5. LEGAL. DESCRIPTION Logiffirliv. STREET LOCATION Pondorosa 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS 0 One 4-ij- Four ❑ Other Cy& SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY X7 Three ❑ Six 7. WATER SUPPLY F INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM Ill INDIVIDUAL/ON-SITE** 12€30 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC'UTILITY 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 NUMBER OF BEDROOMS L7 ONE ❑ ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER FOUR ❑ SIX 2. WATER SUPPLY INDIVIDUAL ❑ COMMUNITY PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH of WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tankor.0 Holding Tank Size: �— If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELLTO: 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 ac o a ❑ DISAPPROVED certificate) DATE BY