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Home My WebLink AboutCONIFER HEIGHTS BLK 1 LT 19Conifer Heights Lot 19 Block 1 #015-093-52 Apr 26 22 11:07p Anchorage Well & Pump Ser 9072430742 p.1 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section \_ _-� Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: Parcel Identification Number: 015 - 093 - 52 Date of Issue: - - Legal Description Block Lot Property Owner Name & Address: CLERC, DREW & REBECCA CONIFER HEIGHTS 1 19 7715 PORT ORFORD DRIVE ANCHORAGE, AK 99507 Pump Installation Date: oa - 25 - 2022 Pump Intake Depth Below Top of Well Casing: 210 Pump Manufacturer's Name: RED .JACKET Pump Model: 8S 1 6 Pump Size: .75 hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Manufacturer's Name: MARTINSON Pitless Adapter Installer: Well Disinfected Upon Completion? X Yes ❑ No Method of Disinfection: PELLETS Comments: feet Pump Installer Name: ANCHORAGE WELL & PUMP SERVICE Company: 7640 KING STREET ANCHORAGE, AK 99518 Mailing Address: 907-243-0740 City: State Zip: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-SJle Servicee Section 825"L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 Page / of w~w.ci.anchorage.ak.us (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: ~ - ~( ~(~ PID Number: ..m,,: ,~.¢¢.~.~_... ~..~[~r~or'3 WastewaterSystem: E~]New ~'Opgrade ^~r~,: ABSORPTION FIELD ~"'~'~ ~ ~ Num~rof~r~s: ~p Trench ~ Sha~Trench LEGAL DESCRIPTION ~'"*~"*:~ ~ o~o~e ~~ ~. Well: ~t 5~ New ~ Upgrade O"'" ~: SEPARATION DISTANCES ~eptic ~ Holding B S.T.E.P. B Other: Tank Field Station Tank S~r Line¢, ~e~V~I~ ~0 ¢ O Gal. wa~ Engineer's Stamp Depa~ment of Health and Human Se~ices approval ~ ,~ , ~ ~.',:-~ Reviewed and approved by: n.~ ~2. ~Date: /O' ~'~* 2 2 Permit No. 99-0186 Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: ,345-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 19, BLOCK 1, CONIFER HEIGHTS SUB. PID No.: 015-093-52 \ I C01 10 47 98.1 95,6 '" VALVE 54 52 96 2 93 0 ~ 10' U1'LIIY EAS£MENT C04 ~ MT 85 644 9655I \ ~ L ~--~--~ / ~f~ ~ C05 70.6 12.4 99.5 [92.67 ~ ~ I ~ I~ ~ ~JACE~ WELL ~ ~ . NEW ~,000 GXLLON ', X''' / ~ ~' 2~ ..... ~ ASBUILT / / -~ SCALE: 1"=60' / -~o, ~.~ OF A~.~ s~mmc S~OT,O. MARK A B CRND. PIPE ELEV. ELEV. CO1 10 47 98.1 95,6 7CO1 16 48,4 97,8 TCO2 28,7 49 96,6 CO2 52 51 96.2 93.0 CO5 55.4 51,6 96.2 95.0 VALVE 54 52 96.2 95.0 MT 85 64.4 96,55 CO4 91 75 95.8 92.6 CO5 70.6 12.4 99.5 92.67 0ct-04-00 10:22 CT&E Anchorage/Micro 907 561-5301 P.01 CT&E Environmental Services Inc. Laboratory Division ~ 200 W. Potter Drive Drinking Water Analysis Repprt, for Total Coliform. Bacteria r,,:An°h°mge'12071 $62-2a43AK SeSle.leos READ INSTRUCTIONS ON REI/ER~E SIDE BEFORE COLLECTING SAMPLE Fax: (907~ 561-5301 ', MUST BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY Analysis shows this WaMr SAMPLE to bef 0 pUBI.ICWATERS¥$TEMI.D.# ~ ~ } , , I.I 0 Safisfaclor~ ~ o pRIVATE WATER SYSIEM ri ~uld Month SAMPLE TYPE: ~ Routine o Repent Sample (for routine snmpb wRb lab ref, no. , ,) o 'Sp~lal PuqMse SAMPLE LOCATION Da~ n Untrmtttd Water Time Co,eof ed Colhel~ on WATER ANALYSIS R~CORD MI~O. MU~iisou~ Te~iColltofln ~ C~ Mmubruo ~ lYd~t Count _'~ ~ Colonies/100 mi ~t.V.~ /~rtflcsdom LTB BGB COLIFmM i ol,~ _~r,( Fiq.~e~jl Coliform Cooflrmado.-- { ~'~ Final Membraae Filter i;Msults Coliform/IN mi Reported By Dat~ Time hr~ CommeRts: Fazed [] Faxed d~~ MembM of tho S~S Oroup (Socid~ Gda~'nlo do Suflmillanc~). ENVIRONMENTAJ,. FACILffIES IN ALASI(A, CAUFO~N~ FLORIDA, IL.UNOIS, MARYLAND. MICHIGAN, MISSOURI, NEW JERSEY. OHIO WEST VIRGINIA I MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Sewices Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 09, 1999 Expiration Date: Jul 08, 2000 Permit Number: SW990'186 Legal Description: CONIFER HEIGHTS BLK 1 LT 19 Design Engineer: 0088 Anderson Construction & Eng'g Owner Name: Steven Johnson Owner Address: 7715 Port Orford Drive Anchorage, AK 99516-1019 Parcel ID: 015-093-52 Site Address: 007715 PORT ORFORD DR Lot Size: 36073 SQ. FT. Total Bedrooms: 7 Permit Bedrooms: 7 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Date: ,ssueds,: Date: Michael N. Anderson, P.E. 14250 Goldenview Dr Anchorage, Alaska 99516 Ph 345-3377/Fax 345-1391 June 10, 1999 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Lot 19, Block 1, Conifer Heights Subd. To Whom it may concern: This is a request for a new septic system upgrade for the above lot. On May 12, 1999, a test hole was dug on the property, the two previous on-site septic systems had failed and the owner has requested another upgrade. The new test hole appeared to be consistent with the soil rating of the previous systems, with a perc of 12 minutes per inch. No water was observed at the time of the excavation or after the 7 day waiting period. The soil was sandy gravel with layers of silty sand in spots, all the material was very loose. A two foot steel bar was driven into the bottom of the test hole to determine if bedrock was a concern, thus allowing the system to be placed within 4 feet of the bottom of the hole. This was done to allow the deepest system possible due to the small area available for the upgrade. A slower perc rate was used in the design of the new system due to the previously failed systems for an added safety factor. The 1983 system will be connected into the new system with a diverter valve for future use to increase the life of the systems. The separation distance (20') between the first system and the new system will not be possible therefore it will be remain abandoned. The two tanks (I000 & 500 gal) will be inspected at the time of the leach field installation to determine the integrity of the units. The upgrade of this septic system does not appear to have any adverse impact on either neighboring lot which also have on-site septic. If you have any questions about this request, kindly contact me at 345-3377. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage, Alaska 99502-0650 SOILS LOG ~ PERCOLATION TEST PERFORMED FOR: L~AL OE$ORiP~',ON: ~-- I q B ( 5 6 7 8 9 10 11- 12- 13- 14- 15= 16- 19- 19- 20- Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? OeplJl to Wat~i' After SiTE PLAN Gross Net Del~th to Net Reading Date Time Time ~P~/~1 Water Drop PERCO~T,ON RATE / Z~ TEST RUN BETWEEN ~'~ ~' (minutes/tach) PERC HOLE DIAMETER __ FTAND ('~ ET % \ \ \ \ \ ADJACENT LOT I I ,,' x\', ,, ,,.~,),\., / ......... ~, '~ ~ ~ ~ /~/ ~.~ ~', ,, ~ADJACENT WELL RADIUS ~ ~ '~ ' [ /// . /~~ ~ / [ ~MOUND OVER DESIGN CRITERIA:~ '~ w/ INSU~TION 7 BDRM = 1050 GPD SOILS = 0,7 GPD/SQ. FT. . 1050/0.7 = 1500 SQ. FT. REQ'D TRENCH: sP 12.0' DEEP~ ~R 1 O' EFFECTIVE 2.0' WIDE . AIN ROCK 75' LONG ~7'~ SEPTIC DESIGN PREPARED FOR STEVE dOHNSON LOT 19, BLOCK 1 CONIFER HEIGHTS SUBDIVISION PREPARED BY 14250 N. GOLDENVIEW DRIVE '~ ......... ,.'~ (907) 345 3577 / FAX (907) 545-1591 SCALE: 1"=60' JUNE 4, 1999 -~ \ ~ADJACENT WELL RADIUS \ ~-- __.~ ........ .__~.m~_~,. 'k X X, ", ~PLITTER VAL~~~~X',' ,X'~5' PROPERTY LINE X ~ X ~500 GALLON ~< XC.O. ?~' ~IH'IA X ~ /SEPTIC TANK SEPTIC DESIGN PREPARED FOR STEVE JOHNSON ~, LOT 19, BLOCK 1 CONIFER HEIGHTS SUBDIVISION PREPARED BY /, MICHAEL N. ANDERSON, P.E. /~250 N. GOLDENVIEW DRIVE (907) 5~5-5577 / FAX (907) 5~5 1591 SCALE: 1"=50' JUNE 4, 1999 \ \ \ \ \ ADJACENT LOT I ..-' _ ~~ENT WELL RA / / ~ 1 ~MOUND OVER / ~~ ~GRADE / -1' OR , ~J ~ Z~FILTER FABRIC DESIGN CRITERIA: ~I%' ~ W/ INSULATION 7 BDRM = 1050 GPD SOILS = 0.7 GPD/SQ. ~. 1050/0.7 = 1500 SQ. ~. REQ'D TRENCH: sP 12.0' DEEP 1~ ~R 10' EFFECTIVE ' AIN ROCK 2.0' WIDE 75' LONG ~7'I SEPTIC DESIGN PREPARED FOR ~%~.,O~azR~t~ STEVE JOHNSON ~' - .,~-'~, CONIFER HEIGHTS SUBDIVISION ~,~.,~ ~;/,,. ~,... 14250 N. GOLDENVIEW DRIVE (907) 545 5377 / FAX (907) 545-1391 · SCALE: 1"=60' JUNE 4, I ggg ____. \ ~ADJACENT WELL RADIUS ~ ~ ~ gPLHTER VALVE ~ / , ~ A ~EW~O GALLON / ~1/I,'' vIE SEPTIC DESIGN PREPARED FOR ~ 0~ STEVE JOHNSON ~ LOT 19, BLOCK 1 ~.. CONIFER HEIGHTS SUBDIVISION ~Z:'49]~ 14250 N. GOLDENVIEW DRIVE j~. SCALE: 1"=50' JUNE 4, 1999 I unicipality of AnchoraGe Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.or9/onsite (907) 343-7904 0ERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-09,5-52 1. GENERAL INFORMATION COSA# O Expiration Date: Complete legal description CONIFER HEIGHTS S/D; BLOCK 1, LOT 19 Location (site address) 7715 PORT ORFORD DRIVE * ANCHORAGE, AK * 99507 Current Property owner(s) MIKE KEECH Day phone 952-0001 Mailing address 7715 PORT ORFORD DRIVE * ANCHORAGE, AK * 99507 Lending agency Day phone Mailing address Real EstatbAgent KATHLEEN POULIN W/ KELLER WILLIAMS Day phone 865-6561 Mailing address 101 W. BENSON BLVD, #503 * ANCHORAGE, AK * 99503 Unless otherwis~: requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 7 TYPE OF WASTEWATER DISPOSAL: · Individual On-site · [] Individual Holding tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4-, qt~t=M~=it~t ¢)~ INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the vafidation date shown below, I verify bSat my invest~ation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows t,ffat the on-site water su~pl:v and/or wastewater di~c, osal 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 fi/es and from my investigation and inspection, t,~e on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of afl wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family be/ng 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 dhow long the system will continue to meet the operational requirements of the ADEC or MOA DSDo The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. DSD SIGNATURE ~ Approved for '? Disapproved. bedrooms~ Conditional approval for ""-' ^ ,_,heck.~ ~'U S~'-~ ~' ":~'~ Septic System Advisory Well Flow Adviso~ (Rev. Arsenic Advisopy Maintenance Agreements Supplemental Engineer's Report Other ~~ Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: CONIFER HEIGHTS S/D; BLOCK 1, LOT 19 Parcel ID: 015-093-52 WELL DATA *ASSUMED BASED UPON SURROUNDING WELL LOGS. SEE ATTACHED. Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) Date completed 5/3/1978 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES 12+ in. Total depth 209 ft. Cased to *40+ .ft. Casing height (above ground) FROM WELL LOG AT INSPECTION ; of test 5/3/1978 4/29/2011 S't~tic water level 185 ,ff. 191 ff. Well production 15+ g.p.m. 4.6+ g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/lO0 mi. Nitrate 7.96 rog.IL. Collected by: GEG, Ltd. Arsenic: nd ug./L. Date of sample: 4/29/2011 B. SEPTIC/HOLDING TANK DATA *MISSING ON AS BUILT SURVEY Tank TyPe/Material SEPTIC/STEEL Tank size 2000 gal. Number of Compartments 2 Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO Date of pumping 5/5/2011 Pumper. C. ABSORPTION FIELD DATA I'BELOW EXISTING GRADE] Date installed' ,'7,/[19/1999 Cleanouts (Y/N) High water alarm (Y/N) ISAACS PUMPING Soil rating ~2or ft2/bdrm) 0.7 System type DEEP Length 72 ft. Width 2 .ft. Gravel below' pipe 10.5 ft. Total depth * 1 6.1 ft. Eft. absorption area 1512 ft~ Monitoring tube YES Depression over field NO Date of adequacy test *'4/29/2011 Results (Pass/Fail) PASS For 7 bedrooms Fluid depth in absorption field before test 6 in. Elapsed Time: 120 min. Final fluid depth 74 Any rejuvenation treatment (past 12 mo.) (YIN & type) Water added 1155gal. New depth 81 in. in. Absorption rate >= 1050+ g.p.d. NONE KNOWN If yes, give date - **PREVIOUSLY DOCUMENTED 198.3 TRENCH CONNECTED AS RESERVE SITE. 198.3 TRENCH WAS SURCHARGED UPON INSPECTION. 1999 TRENCH WAS IN USE AT TIME OF INSPECTION AND TESTED. '~:i!~I~. ~T~.~.:'!!~EANO~ :~:FO~.~'', ~ii~H' ~(S~.ON 2~, INSPECT~DN BE:PORT) COULD NOT BE LOCATED. BUT LOCATED Date installed AND CONFIRMED BY GEG. 7/19/1999 YES N/A TRENCH YES D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons "Pump off" level_~. Cycles tested. 100'+ Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas 50'+ Manhole/Access ~ ~ High water alarm level at Meets alarm & circuit requirements~ in. On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: '5'+ 10'+ KNOWN Building foundation. 10'+ Surface water 100'+ Wells on adjacent lots 100'+ Property line Water service line Curtain drain NONE COMMENTS *SEE ATTACHED WAIVER LETTER, Absorption field Surface water 5'+ 100'+ Water main N/A Driveway, parking/vehicle storage 10'+ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date ~'/'7.,b//I COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Community Development Department Development Services Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # 111167 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 19 of Conifer Heights subdivision. This inspection revealed a nitrate concentration of 7.96 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. Robert E. Johns, Jr. A Assoc. ~ ~e ~4 ~ ~ [ ~ Scole: Rec. Lot S.F. Rec, Plot File No, Drewn b~ Checked b~ U RN~ ~C~ ~-B~LT · SET REBAR ~ ~ DRAINAGE ~ ASPHALT ~ ~T P~ . . . AS-BUILT . . . LOT SURLY . . . T~O~APHY ~ FOUND REBAR ~ ~ ~ WOOD FENCE ~ CONORE~ ~ ~-BUILT. , . NO ~RN~S ~ ~ ~~ ~I[T... ~O ~ ~T~ ASSUMED ELEV. ~ X X ME~AL F~OE ~ WOOD P~T ~S a LOT ~R~ NO~: IT IS THE RESPONSIBILITY OF THE BUILDER OR O~ER, PRIOR TO ONLY ~OSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONS~UCTION, TO ~RIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES. ~LLS, SEPTIC CLEANOUTS, SIDEWALKS, DEI~WAYS, TO FINISHED GRADE AND UTILI~ CONNEC~ONS AND TO DE~RMINE ETC., ARE SHO~ IN ~EIE APPROXIMA~ LOCA~ON. ONLY. SNOW THE [XIS~NCE OF ANY EASEMENt, CO~NANTS OR RES~ICTIONS MAY PEE~NT SOME IMPEO~MENTS FROM BEING SEEN AND LOCATED. ,,~IOH D0 NOT APPEAR ON ~E RECOR,DED SUBDIVISION PLAT., ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED., ..... UNDER NO OIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOE CONS~UCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. ~E SUR~YOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSAC~ON ONLY AND ASSUMES FINANCIAL UABILI~ ONLY FOR THE COST OF THE SURLY_ m USeD DISTANCES PREVAIL O~R SC~NG. REPRODUC~ON MAY CAUSE ERRORS IN SCALE., , GARNESS ENGINEERING GiROUP, CONSULTANTS & GENERAL CONTRACTORS Ltd. May 2,201 1 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Conifer Heights Subdivision; Block 1, Lot 19; Lot Line Waiver Request; To whom it may concern: The primary drainfield on the property was installed on 7/19/1999. According to the as-built survey performed by Robert E. Johns Jr. & Associates (5/9/2009), the 1999 trench is less than 10' from the north lot line, and inside a utility easement. Attached are letters of non-objection from the relevant utility companies. We request that you waive the distance from the lot line to the drainfield to 5'+. We are unaware of any adverse impacts this waiver would have on any adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. ~ '.~e ,P.E.,M.S. Thank you for your assistance. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com SGS ReL# 1111616001 Client Name Garness Engineering Group, Ltd Printed Date/Time 05/11/2011 9:28 Pro.iect Name/# Conifer Hts BI, L19 Collected Date/Time 04/29/2011 12:15 Client Sample ID Conifer Hts BI, L19 Received Date/Time 04/29/2011 14:45 Matrix Drinking Water Technical Director Stephen C. Ede PWSID 0 Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<I0) 05/02/11 05/09/I1 NRB Waters Department Total Nitrate/Nitrite-N 7.96 0.100 mg/L SM20 4500NO3-F B (<10) 05/03/11 AYC Microbiology Laboratory E. Coli Nep. ative 1 100mL SM20 9223B A 04/29/11 DLC Total Coliform Nep. ative I 100mL SM20 9223B A 04/29/11 DLC : i 0 ~+ ~+ 0 iO Owner , WILSON ELL DRILLING' 1305 W. 45TH STREET ANCHORAGE, ALASKA 99503 PHONE 272-9343 DRILLING LOG Location (addr~s of: Township, Range, Section, if ~own; or distance main road ~:~ ~-:(' ..'~.:~ - .. ".~-:' r~ ~~X feet ~ ~ater level ?,~'~ ft. (above). ~ land sur[ace. ~inish of well (check one) open end ( Screen ( ); Perforated ( ). Describe screen or perforation pumping test at~-] _gallons per Of drawdown from static level. of completion' ' (hour), WELL LOG ~for hours with ' in feet from -, surface Give details of formations penetrated. size of material, color and hardness ft. ,, TolO0 .-_-_TO. [ ,..~ ,'J/ I' '~ TOI(,~ J/% . TO TO ' TO ,,, TO FILE QQQQ SW LAT N?2 BRILLER WIL£ON QQQ NE QQ LON WATER WELL .INVENTORY CHANGE ;E WALTER NW Q NW S ~, 'rwN ~2N RNG O03W W69 W ALT PtETH BATE 07 ~a 'ig?& FIN DEPTH COHP by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2769 LEGAL DESCRIPTION ~BL~ORE HOLE DATA DEPTH PERMLTNUMBER~ Date of Issue d -_L__~-- TA:Z"/RDENTIPICA:rlONqqUMBER ~.--~ ~' IswelHocated at approved permit location? ~ [] No Method of Drilling: ~'~otary I~ cable tool Depth of well: CaSing Type ~Wall Thickness Diameter ~ ~' inches, depth Liner Type: Casing Stickup Above Ground: Static Water Level (from ground level): Pumping level:.~ Recover Rate: Method of Testing: inches ~ 4/(,. feet feet ! oC;oc' feet feet after hrs. pumping gpm /3" gpm [] Open End [~ Open Hole feet feet feet feet Well Intake Opening Type: [] Screened; Start feet Stopped ~;I-'15"erforations Start I c..f~) feet Stopped Grout Type: t~ ~,,T-0,~ f~'~ ¢ ~/d~olume ~ ~r(') Depth: from ~ feet, t.o Pump Intake Depth: Pump Size .hp Brand Name Well Disinfected Upon Completion? ~s [] No Method of Disinfection: C.~,,~,~' ~0 ~°/0~1 . Comments: v:,~,;c~v,,l,ry ol ,~ncnorage pt. Health & Human Services Driller's Name ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality~ of Anchorage: Department Of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 RO. Box 196650 Anchorage, AK 99519-6650 www. oi.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ¢'%' Expiration Date: GENERAL INFORMATION Complete legal description ~.¢ Location (site address or directions) Current Property owner(s) Mailing address '*"~-~ Lending agency ~o~ ,¢~, o ,~ Day phone '~% Lc - Day phone Mailing address Real Estate Agent Mailing Address Day phone Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates cf Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independen: professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served b'> a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality, of Anchorage is not responsible for errors or omissions in the professional engineer's work. 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Address ~t.~ ,40 Engineer's Printed Name DHHS SIGNATURE /--"" Approved for ~ bedrooms. Disapproved. Conditional approval for /'~ ~ ~'r,', ¢ ~ Phone O ~% bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: / - ,/¢ -,.""~., / Original Certificate Date: Reissue Date: RECEIVED k'-~Municipality of Anchorage k_3 ~ Department of Health and Human Services OCT 0 4 2000 Division of Environmental Services On-Site Services Section 825 "L" Street Room 50~UNiciR (907) 343-4744 Legal Description: HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D.: A. WELL DATA Well type Date completed ~/'/'2 Total depth ~-c~l ft FROM WELL LOG Date of test Static water level / Well production /~' WATER SAMPLE RESULTS: Coliform (¢ colonies/100 mi Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material IfA, B, or C provide PWSID # Sanitary seal ~ Cased to "zo~t, ft ff g.p.m Nitrate I,~'% mg/I Collected by: Well Log Wires properly protected Y Casing height (above ground) /~) in. AT INSPECTION Ipso ft other bacteria~colonies/100 mi Date installed ?/~9/'~?' Tanksize '2-000 gal Number of Compartments Cleanouts '~' Foundation cleanout ~' Depression over tank Date of pumping I~ .~ ~4..~ Pumper C. ABSORPTION FIELD DATA Date installed ~ Soil rating (g.p.d./ft2 or ft2/bdrm) ~2, ~ System type Length '?'7-- ft Width ¢~- ft Gravel below pipe {O,~' ft Total depth (~ ft Effective absorption area/~'F~ft2 Monitoring tube Date of adequacy test N(.'~,o Results (Pass/Fail) /~ r~ Fluid depth in absorption field before test in Water added Elapsed Time: k//~ min Final fluid depth t,f~ Any rejuvenation treatment (past 12 mo.) (Y/N & type) · Depression over field For ~ bedrooms gal. New depth ~¢~ in. in Absorption rate >= ,~///~ g.p.d. If yes, give date __ 72-026 (Rev. 01/00)* LIFT STATION Date installed ~ Siz~ "Pump on" level at ,,~-.-ffr? "Pump off" level at n Datu~l~~ Cycles tested E. SEPARATION DISTANCES Manhole/Access High water alarm level at __ in Meets alarm & circuit requirements SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/~-e.tat4ort on lot /~c~ Absorption field on lot /oo Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank ~///¢ SEPARATION DISTANCES FROM SEPTIC/IC6i~EB44~ TANK ON LOT TO: Building foundation Water main /c~o Drainage Property line rS' O I .¢. Water service line ! ¢o Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 5' Water Service line Curtain drain PC Absorption field Surface water · Building foundation /~,/¢- Water main F. COMMENTS Surface water /uo I.f- Driveway. parking/vehicle storage Wells on adjacent lots /o o /¢ 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 HAA guidelines in effect on this date. Engineer's Printed Name ~.'1~.[~,~[ ~ /~,t ~t e~4. o~ Date /O ['~,'/o ~ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 01/00)~ Waiver Fee $ Date of Payment Receipt Number /-~ CT&E Environmental ServiCes InC. Laborator~ Division ~~mrm,,m,~'~m'~p'J~m'~m'~m'~m'~m',~'~p,~m,,mfm 200 w. Potter Drive Drinking Water Analysis Report. for Total Colifonfx Bacteria re :Anch°rag'°(907) 562-2343AK 99518-15011 READ INSTRUCTIONS ON REVERSE SIDE BEFORE C~LLECTING SAMPLE Fax: (907~ 561-5301 MUST BE COMPL~'rbD BY WATER SUPPLIER TO BE COMPLETED BY LABOKATORY. PUBLIC WATER SYSTEM I.D. # K PRIVATE WATER SYSTEM Send Results [~ . Sendlnvoice Send Re$¥ln QI S~nd In,;olc~ I SAMPLE DATE: Month SAMPLE TYPE: ~1~ Routine {2 Repeat Sample (for routine sample with lab ref. no. ) cl Special Purpose Day Year SAMPLE LOCATION Treated Water Untreated Water Time Collected Coll.'ted By lysis shows this Water SAMPLE to be: Satisfactory D Unsatisfactory ~ Sample over 30 hours old, results may be unreliable Sample too long in transit; sample should not be'over~g}hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received /~" Time Received Analysis Began 00 mi. Result* Analyst oc,,t LO P,.O.E.C. Anch Fbks Jun Date: Time: Client notified of unsatisfactory results: Phoned ~ Spoke with BACTERIOLOGICAL WATER, ANALYSIS RECORD E. Coil Colonies/100 mi COLIFIRM. MMO-MUG R~sult: Total Coliform Membrane Filter: Direct Count Verification: LTB BGB __ Fecal Coliform Confirmation Final Membrane Filler R~sults Reported By 4~-~-Lc-'~''~ Date Coliform/100 mi Time ['~ ~ hrs Faxed Faxed Comments: ~ ~ ~l~l~ Member of the S{}S Group (Soci~t~ G~n~rale do So~'oilla"ce) ENVIRONMENTAL FACIUT1ES IN ALASKA, CALIFORNIA, FLORIDA, ILUNOfS, MARYLAND. MICHIGAN, MISSOURI, NE-~V JERSEY, OHIO, WEST VIRGINIA ~1~. CT&E Environmental Services Inc. CT&E Ref.# Client Name Project Name J# Client Sample ID Matrix Ordered By PWSID Client POg Printed Datefrime 10/06/2000 13:26 Collected Date/Time 10/02/2000 7:30 Received Date/Time 10/02/2000 10:55 Technical Director Stephen C. Ede 0 Released ~ Sample Remarks: / v Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init 1005965001 Mike N. Anderson, P.E. Steve Johnson Steve Johnson Drinking Water Waters Department Nitxate-N 1.81 0.500 mg/L EPA 300.0 10 max 10/02/00 SCL Microbiology Laboratory Total Coliform TNTC OB col/10OmL SM18 9222B 10/02/00 KAP Anderson Construction & Eng'g ATTN: Michael N. Anderson 14250 Goldenview Drive Anchorage, AK 99516- October 06, 2000 Subject: Waiver Request for CONIFER HEIGHTS BLK 1 LT 19 Waiver # WR000084 Lot Line Request for Parcel D 015-093-52 Dear Engineer: Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater disposal system to the lot line has been approved. The approved separation distance is 5 feet. This waiver approval applies to the current on-site wastewater disposal system and lot line separation only. Any future upgrade to the on-site wastewater disposal system and lot line will require all separation distances to be met or another waiver approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, JeffP°~~ ~o~ Engineering Technician II][ On-Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health & Human Services On-Site Services Waiver Review Worksheet WR#: WR000084 Date Received: October 6, 2000 Legal Description: Conifer Heights, Lot 19, Block I PID#: 015-093-52 HA#: HA000496 Engineer: Anderson Construction & Engineering 4640 Shoshoni, Anchorage, AK Applicant: Steve Johnson Waiver Requested: Lot-line waiver. ,~ ~50//~,~"~! Permit~: Criteria: 1. Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation 2. Special Conditions: 3. Other: Points: Total: Waiver is Granted: List Conditions or Reasons for above: Waiver is not Granted: Date: /"O "~,'"~) O Rec#: 06178 Amount: $115.00 c:~¢~mde"~e"~ Reviewer Date Paid: 10/4/00 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 MAI LING. AD[ZR ESS LEGAL DESCRIP'I:ION ~, DISTA Liq. cap~itg in ~allons ln~}do~ ~idth Liquid d~pth ~O~ IF HOMEMADE: -- , ~ ~ ~ DISTA~ Well Dwelling PERMIT NO. ~ ~11 ~ ~oundati~ ~ ~oaro~t lot lino r ~MIT ~0. ~Z~ · No, of ~es Length of each line ~ Total length o Trench Dista n lines To of tile to finish rede Material beneath til~ Total ef~ctive pbsorption area Length Width Depth PERMIT NO, m ~ ~D~ST~C~ ~11 ~~ 8uildin~ foundati~ ' ~ear~t lot lino ~ (~l~ss~. ,.~ ~...~ Depth Driller Distance to lot line PERMITNO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PiPE MATERIALS .EUARKS , t - 72-013 , ;v. 3/78) PERMIT NO. r'lUt-~I!;] 'ALIT"T" CwF ANC~ ]RAGE DEPARTMENT .... ; HEALTH AND ENVtRONMENTAL.-,ROTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 Ot~--'_-~ITE SEbIER PERMIT ( 8~0842 ) APPLICANT LOCATION LEGRL STEVEN F JOHNSON L19 Bi CONIFER HEIGHTS SRBOX 207~..~15 PORTORFORD LOT SIZE TYPE OF SOIL ABSORPTION SYSTEM IS' TRENCH / MAXIMUM NUMBER OF BEDROOMS = 7 2..:44-~42;8 ~-' . : SOIL RATING :,I~E OF THE SOIL ABSORPTION '-,~=,TEM THE REQUIRED c ~ '="~ IS: E)EF TH= 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>. THERE IS NO SET HIE)TH FOR TRENCHES. THE GRAVEL-DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE.BOTTOM OF THE EXCAVATION (IN FEET>. ~L:L. 5 LEt-~GTH= ~:9 G RA%-"EL DEPTH= RE[;!.I_I IRE[:.. SEPT I C: TANK _'!:; I ZE= 2000 C~iRLLONS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT E.,URING THE INSTALLATION I.NSPEC.TIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESI~,ENC'ES THAT THE WELL WILL SERVE. ------ TI...ICI ,:.' 2 ) I I'-.ISF'ECT I ON--'~ ARE REI_-qLI IRE[:. BACKFILLING OF ANY S.YSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT ~JILL BE :UB..TE[.T TO'PROSECUTION., MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS i00 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDtN~ -'UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM R PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET 8ND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE -AVAILABLE TO INSURE PROPER INSTALLATION. F"ER~q IT E~;PIRE5 E~ECEPIBER ---~l~ :L983 I UERTIFY THAT a RE~UIREMENT=, FOR ON-SITE ~EWER~ AND WELLS AS SET FORTH E,~ THE MUNICIPALITY OF ANCHORAGE. ~. I WILL INSTALL THE SYSTEM IN 8CC:ORE~GNCE WITH THE CODES. : ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT tF THE RESIDENCE IS, REMODELED ~0 INCLUDE MORE THAN 7 BEDROOMS. RPPLIC:RN~ 5TEVEN F .TOHNSON ISSUED BY. _ _DATE___ t~' MUNICIPALITY OF ANCHORAGE i DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON:SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME IPHONE MAI LING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS ; Manufacturer Material No. of compartments Liq~in gallons IF HOME.DE: Inside length Width Liquid depth ~ DISTANCE TO; Well ~./~ Dwelling PERMIT NO. 0 ~ ~ Manufacturer ~ ~ ~ Material Liquid capacity in gallons '/ Foundation~ ~ DISTANCE TO: Well /~ ~/ Nearest lot line PERMIT NO. ~ ~ ~ No:of lines Len~f each line Total length of lines Distance between lines ~ O~ ~ Top~niSh grade ~, Material~~beneath ~ ~ ~ inches Total effectiv~absorption area Length Width Depth PERMIT NO. ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well BUilding foundatiOn Nearest lot line ~ DISTANCE TO: ~ Class DePth Driller Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER SOl L TEST RATING INSTALLER REMARKS . .~ ~ . ~ ...... APPR~__~:~ ~ ~t~ DATE LEGAL 72-013 (Rev. 3/78) APPLICANT STEYEN JOHNSON LOC:RTtON POF.'.T ORFORD L. EGI'aL L:l. 9 B.1. CONIFER HTS T"r'PE OF SOIl_ FtE:SORBTION SYSTEM IS: TR. ENCH [:'EPFtRTMENT OF' HERLTH RND ENVIRONMENTF:IL PRO]"ECTION 825 '"L"' STREET., RNCHORRGE, RK. 995e~1 264-472C~ ( 7'803:C~4 ) 8:.t. 8C~ SPRLICE RD LEI"[' SIZE ]~:44 542-':8 :..].':C~EIC~C~ SQURRE FEET MNXIMUM NUMBER OF: BEDROOMS = 5 SOIL RFlTING "..'SQ FT..'"BR)= THE R. EQUIRED SIZE OF' THE SOIL RBSORPTION SYSTEM IS: [:, E: F' T' [-~ == it. :iL. r_=.'; LEE 1'-4 ,_-~ 'T' H = .~2; 4 ,3 [~-: F~ %.' E: L. E":, E F" -r ~-.-t = 7". THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF' THE TRENCH OR [:,RFIINF'IEL. D. THE DEPTH OF 8 TR. ENCH OR PIT IS THE D ISTFINCE BETt.4EEN THE SURFFICE OF THE GROUND FIND ]"HE BOTTOM OF THE E;:.::CRVRTION (IN FEET). THERE IS NO SET WIDTH FOR. TRENCHES. THE O'iRFIVEL [:,EPTH IS THE MINIMUM DEPTH OF' GRRVEL BETWEEN THE OLITF'FIL. L PIPE FIND THE BOTTOM OF "rile E',,..':CFIVFI]"ION (IN FEET). PERMIT RPF:'LICRNT HRS THE RESPONSIBILITY TO INFORbl ]'HIS DEPBR]"MENT [:,URING THE: INS]"RLLFITION INSPECTIONS OF I=IN¥ WELLS RDJFICENT TO THIS PROF'ERT"r' FIN[:, THE NUMBER OF RESI[:'ENCES THR"F THE WELL WILL. SERVE. ..................... 'T [,..I () ":] 2 ::.' I t'-~t ::-~; F' E: ~T:: 'T' ]] C! IP4t S n:t F-: E [~.: E C-:! [..J :J: FF-": E: BI=ICKFILLING OF F1N"r' S'¢STEM [4tTHOUT FINFIL INSPECTION FIN[:, FtPPROVRL 8"r' "['['lis DEPRRTMENT t.4ILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANC:E BETI. qEEN R I...tELL RND RN'.r' ON-SITE SEWAGE [:,ISPOL=;F~L SYSTEM IS :1.8E'~ FE:ET FOR 8 PR IVRTE [,.IEI~L.~ OR .1..56.~ TO 28A FEET FROM R PUBLIC WELL DEPENDING UPON THE T'¢PE OF PLIBI..IC klELL.. 1.4ELL LOGS taF.'.E REE.!LIIRED laND MUST BE RETURNED 'T'O THE DEPARTMENT I.,.IITHIN ]:C~ Dt:'¥r'S OF THE WELL COMPLETION. OTHER REf.'..'t.IIREMENTS MR'¢ FIF'PL'¢. SF'ECIFICR'rION$ AND CONS'T'RUC:'T'ION [:,IRGRI=IMS FIRE RVF:IILRBLE TO INSURE PROPER INSTRLLFtTION. I CERTIF'¢ THFIT t: I RM F:RMILIRR 14ITH THE REQUIREMENTS FOR ON-SITE SEWERS RND 1.4ELLS RS SET FORTH B"r' THE ML.INIC:IPRt. IT'~" OF RNCHORRGE. 2: I WILL. INSTFILL THE SYSTEM IN RCCORDRNCE 1.4I~H THE CODES. ]:: I UNDERSTF4ND THRT THE ON-SITE SEWER SYSTEM MFI¥ REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 5 BEDROOMS. S I GNE[:, · :~'L.. I ,]::,~ ~ ~: ~' ~ ~ ...... ISS ,FD E:'.,.' ...... .... ~ ~ ................... DaTE_~[O *_.__._._.=_.~ ,,,,,., ,~ .... ': " , GRL..,ER AHCIlORAGE AREA 8'OROUG,, · ,. : 'DEPARTI,iENT OF ENV~ROtlHFqTAL QUALITY 3330 "C" Street · ' .ANCIlORAGE, ALASKA 99503' Performed For. ~;r-~ d~___ ~0~ m ~ ~ t' Case Dated Performed Legal Description: Lot I~]. Block.. I.. _Subdivision.~ow~'tne~ F~,~f~ This Form Re.ports Soils Log_ ~.. : ~, Percolation' TeSt_._~ - Soil Tes~ l. lust Be Logged To 4' Below.Proposed Seepa'~e System Depth Soil Characteristics Feet ~.(.- Wa: Ground Water Encountered? I'f Yes, At What Depth? :, '14 Reading Date Gross Time Net Time Deptl~t,~j.~ll, i Proposed [ns~'~'T]-~'~io'~[: Seepage Pit Drain Field Depth of Inlet ~ Depth t--6~-6-~-Om o'f-Pit or Trench ' .~., .......... ~:~.~~:, , ua~o Certified BY:~~ ...... "- 'N ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PR~EC~ICIP~L~ ~ANCHORAGE ~_~ ~ 825 L Street-Anchorage, Alaska 99501 DEPT. 6F HEALTH & OCT 1978 REQUEST FOR APPROVAL OF INDIVIDUAL WATER_ AND sEw~~~I" D DIRECTIONS: Complete all parts on page 1. Incomplete r~u~ wilt not be proce~ed. Please allow ten (10) days for processing. MAI L~G ADDRESS ....... PROPE~Y REStDERT'(Tf d~ffbr~frIm ab~veY - ' - .... -- P~ONE 2 BUYER ' " V ~ ~ ' ~HONE . MAILING ADDRESS . 3. LENDING I~TITUTION - - ~ I PHONE MAILING AD~ES~ 4. REALTOR/AGENT ~ PHONE' I MAILINGADDRESS , 6. LEGAL DESCRIPTION* . " i, 1 STR E ET~L-'~C~ATI~ N - ~ ' /~ ' ~ ~ ~ .... ' t 6. TYPE~OF RESIDENCE - ' NUMBER OF BEDROOM~ ' ~NGLE FAM LY [] One [] Four [] Other E~ Two .-~~ -- I I--1 M U LTl PLE FAM I LY [] Three [] Six 7, WATER SUPPLY ' ~'~NDIVIDUAL* *ATTACH WELL LOG. A wel log is required for all wells drilled [] COMMUNITY since June 1975. For we Is dri led prior to that date, give well , [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~DIVIDUAL/ON SITE"* W~lf nd vdual/on-s te, g ye nsta at on date ~-~7~/ . ' If system is over two (2) years old an adequacy test is required [] PUBLIC UTI LITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME ~ATE INSPECTOR TIME DATE INSPECTOR 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 [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified I--]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 --1 ONE [] TWO [] THREE [] FIVE [] FOUR [] SiX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING MANUFACTURER ~ MATER AL Septic/Holding Tank IAbsorption Area I Sewer Line [] OTHER Nearest Lot Line 5, COMMENTS ~APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE I BY (Title) LEGAL DESCRIPTION L 72-010 (Rev. 3/78)