HomeMy WebLinkAboutCONIFER HEIGHTS BLK 2 LT 14Conifer
Heights
Block
Lot 14
#015-093-23
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: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
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 & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
8:25 L Street- Anchorage. Alaska 99501 Telephone 264-4'/20
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
· [] UPGRADE
MAILING ADDRESS
~ DISTANCE TO: [0~~
~ M~ufacturer~ Mete~ No. ofcompartme.t, ~
/~O IF HOME.DE:
Length W,dt~ ~pth PERMIT
~ DISTANCE TO:
~ DISTANCE TO: Building foundation Se~r li~e Septic tank Absorption erea(s}
OTHER ~'~
PIPE MATERIALS
t
REMA S
72~13 {Rev. 3178) )
I-'lLIr--I T C 1' Fr'~L 1' T'T' C'F RI",II__-~HC '~:F-IL~E ~[~'~9
'~ DEPRRTHENT OF HERLTH FIHD ENVIRONHE~'!TFIL PRUTEC:TIOH "~-~-"~
· . 825 'L' STREET., RHCHORF~GE., AK. 9~501 -- ~----/
I..IELL F41'4D ,_"~1'-4--S I TE SEI-IEF: PERt-1 1' 1~----~.-.'~x/~ j_']9
F'ERMIT fiE1 < 79025E: ) 0,0/'-, "'~'-/'~¢-
LOC:AT I ON CONIFER HTS
LEGAL L14 E:2 CONIFER FITS LOT SIZE ~SQURRE FEET
T'¢F'E OF SOIL FIBSORBTIOrl SVSTEH IS: TRENCH
HRMIf'IUM NUMBER OF BEDROOMS : 4
SOIL RRTING
7HE RE6!LIIRED SIZE OF THE SOIL RBSORPTIOfI SYSTEM IS:
[:. [E P T !-t = :1.£~ L E 1'-4 I.S T H = 51¢ G F;: R'...' E i_ P_-, E F' T !-I =~ 5.
THE LENGTH DIf'IENSION IS THE LEHGTH (IN FEET) OF THE TREfICH OR DRRINFIELD.
THE DEPTH OF Ft TRENCH OR PIT IS THE DISTFifICE BETHEEfl THE SURFFiCE OF THE
GROLIHD RN[:, THE BOTTOM OF THE EXCFIVFITION (Ill FEET).
THERE IS riO SET HIDTH FOR TRENCHES.
THE GRFIVEL DEPTH IS THE HINIHUM DEPTH OF GRI-3VEL E:ETNEEfl THE OUTFRLL PIPE
FiNE', THE BOTTOH OF THE EXCRVRTION (IH FEET).
f~:bZm2m_l I F;EC, SEPT I C TR I'-.i t=.-:. S I ZE= -1 2:-~_-~£~ GRLLLnI'-.I'L----_.
F'EF:MIT RPPLICFiHT HRS THE RESPOHSIBILIT'¢ TO IHFORM THIS DEF'RRTMENT [:,URIHG THE
IHSTFiLLRTIOfl INSPECTIOfIS OF RfI'¢ HELLS Fi[>..TRCEHT TO THIS PROPERTY AND THE
HUMBER OF RESIE:,EHCES THAT THE WELL I,IILL SERVE.
Tl4ra < 2 ) I I'--ISPEOT I 01'-,15 RF-:E F-:E _r--ibm I F-.'E 13,
E:RC:t(FILLING OF FiNY SYSTEH HITHOUT FINRL IHSPECTION RHD FiF'PF:OVFIL BY THIS
DEF'Fi~TMENT MILL E:E SUB..lrECT TO PROSECUTIOH.
I'IlIIIMUM DISTRfICE BETI,IEEN R PlELL FifID RHY OH-SITE SEHRGE DISF'OSRL SYSTEH IS
lO0 FEET FOR R PRIVFITE ~IELL.; OR
150 TO 200 FEET FROr'I R PUE:LIC NELL DEPEf~DING UPON THE TYPE OF PUBLIC HELL
HELL LOGS RRE REQUIRED RfID MUST BE RETURHE[:, TO THE [:,EF'RF'TI.1EfIT I,IITHIN 30 DRVS
OF THE HELL COMPLETION.
OTFIER REQUIREHENTS MFI'T' RPPLV. SPECIFICFiTIONS RfID COHSTRLIC:TIOfl DIRGRFiMS FiRE
R'.,,'RILFiE:LE TO IHSURE PROPER INSTFiLLFiTIOH.
F'EF-:f-1 I T E×P I RES I2-.ECEY'IBER 3'i.. l_'S-" 79
I
t:
FORTH BY THE HUHICIPFiLITM OF RNCHCiRRGE.
2: I P~ILL IfISTFILL THE SYSTEM IN FICCOF:DRfICE HITH THE CODES. .
2: I UNE:,ERSTRND THAT THE OH-SITE SEHER SVSTEM I'IAV REQUIRE EHLRRGEMEHT/IF THE
PESIDErlC:E IS REMCiE:,ELED TO IHC:LU[:,E HORE THRH 4 BEDROOMS. ~¢/~/~----
RPPL I~NT FiOE:ERT MILE, ' I
CERTIFY THAT
I RM FFIHILIFIR HITH THE REOUIREMEHTS FOR OH-SITE SEHERS FIflD HELLS FiS SET
HUN I C~'~ F::'I-3L 't T¥ OF' ~:~ ~4/"~-! 0 R i:t L] ,
DEPARTMEN~ OF HEALTH AND ENVIRONMENTAL PROTECTION,
, ' 825' 'L' STREET, ANCHORAGE, AK. 9.9501
264-4?20
WELL AND Or~--SITE SEI--JER: PERP1
PERMIT riO.
LOCATION
TYPE OF SOIL ABSORBTION SYSTEM IS:
LOT SIZE~dO 6 SQUARE FEE~
MR;<IMUM NUMBER OF BEDROOMS = ~ SOIL RATING
THE REQUIRED SIZE OF THE. SOIL RBSORPTIOI'I SYSTEI"I IS:
DEF'TH= /0 EEt-4GTH= ~"'0 ~RR%-'EL DEPTH=
THE LENGTH DIHENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIEED.
THE DEPTH OF A TRENCH. OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
OROUHD AND THE BOTTOM, OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH. FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE
AND THE BOTTOM OF THE EXCAVATION (IH FEET).
REQLI I RED SEPT T I; TANK '-='~ I----"E= /~0 GRLLt_'-IN$
PERMIT APPLICANT HAS THE. RESPONSIBILITY TO INFORM THIS DEPFIRTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
------ TNm3 ( 2 ) '1' t~l_C;,PECT I C~t~i$ ARE REQLI I F;ED
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WIL[i BE SUBJECT TO PROSECUTION,
MINIMUM DISTANCE BETWEEN'A WELL AND R~IY ON-SITE SEWAGE DISPOSAL SYSTEM IS
· 00 FEET FOR A PRIVATE WELL; OR
150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
WELL LOGS RRE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS ArID CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F'ERf'I I T EXP I RES DECEr'IBEF.' ~-1-: .- '1 §7--~.~.
I CERTIFY THAT
1: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS 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 IS REMODELED TO INCLUDE MORE THAN 8 BEDRO0~IS.
Applicant / -
4040 "B" STREET
ANCHORAGE, ALASKA 99503
(907) 278-1551
April 16, 1979
W.O.# A18820
Grid: 2440
~. Neal Burleson
3318 Illiamna
Anchorage, AK .99503
Subject: Percolation Test - Lot 14, Block 2,
Conifer Heights Subdivision
Dear Mr. Burleson:
At your request we have completed a percolation test on Lot
14 Block 2 of Conifer Heiqhts Subdivision in the hillside
area of Anchorage. The boring location is shown on Figure 1.
It was drilled using a continuous flight solid stem auger
drill rig mounted on a Nodwell carrier. The rig is owned
and is operated by Denali Drilling Inc. Drilling was supervised,
the test hole logged and percolation test performed by Mr.
O.M. Hatch, Alaska Testlab geologist.
The log of the test hole is included as Table A'of this
report. In interpreting the log, it would be helpful to
utilize the explanatory information contained on Sheets 1-3
of the report.
~'~en driling was completed a 3/4" slotted PVC pipe was
inserted in the hole to aid in determining the free water
level. For the percolation test the test hole was filled
with water and left overnight to saturate. On returning the
next day, the hole was refilled with water and the water
level carefully monitored for the next 60 minutes.
This procedure is not a standardized percolation test,
however, we understand the Municipality of Anchorage, Dept.
of ]]ealth & Environmental Protection prefers performed in
this manner to evaluate the site for proposed on-site sewerage
systcm.
~. Nea~ Burleson
April 16, 1979
Page 2
Using the above test ~he observed minimum percolation was
5 minutes per inch. We suggest that the system the on~
wastewater system be designed for an absorptio~ area ~l~u
square feet per bedroom. This recommendation is based~on
criteria in the "Manual of Septic Tank Practice" U.S. Dept.
of llealth Education & Welfare, Public }lealth Service.
We recommend the absorption trenches be inspected prior to
installing the system as the above recommendations are based
on the result of the six-inch test hole. The seepage trench
will provide a much clearer picture of the subsurface
conditions than the test hole. If the soil conditions turn
out to be more favorable than predicted, it may be possible
to economize the system by reducing'the length of the trench.
Conversely, if the soil appears tighter than anticipated,
then it may be necessary to enlarge the system or to use an
alternate location on the lot. The chief value of the drill
hole is in establishing the feasibility of on-site systems,
while examination of the trench is expected to provide
better specific information. The following items are attached
and complete this report:
Table A
Sheets 1-3
Site Plan
Test Boring Log
Standard Explanatory Information
We trust this report meets your present needs. If we can be
of further service please feel free to contact us.
Sincerely,
ALASKA T E S TLAB
James R. Finley, Jr.
Geotechnical Engineer
Approved:
Melvin R. Nichols, PP.
Laboratory Manager
· JRF :mfm
Attachments
Test llole ~1
Table A
NO ~A18820
Date: 4r9-79
Logged by: O.M.Hatch
Depth in Feet
From To
0.0 1.0
1.0 2.5
2.5 16.0
Soil Description
Brown Peat, damp, soft, Pt
Brown Gravelly very Sandy Silt, damp, stiff,
non-plastic, ML
F-l, brown slightly Silty Sandy Gravel with
trace of cobbles, damp, medium dens----6; maximum
particle size ~pprox..6", GM
Bottom of Test }lole:
Frost Line:
Free Water Level:
16.0 ft.
2.0 ft.
None observed
Sa.
NO. Depth
1 5.0
2 10.0
3 15.0
Type of
Sample Unified
G GM
G GM
G GM
· Remarks: 1.
3.
4.
5.
6.
Type of Sample, G=Grab, SP = Standard Penetration,
U = Undisturbed.
Dry Strength, N=None, L=L6w, M=Medium, It=lligh.
Group refers to similar material, this s~udy only.
General Information, see Sheet 1.
Frost and Textural Classification, see Sheet 2.
Unified Classification, see Sheet 3.
M-W DRILLING, Inc.
P.O. Box,l-1224 · 1310C International Airport Road
(907) 274-46l I
ANCHORAGE, ALASKA 99509
DRILLING LOG
Well Owner Robert Mtlby UseofWell Domestic
Location (address of: Township, Range, Section, if known; or distance main road
Lot 14 Block 2 Conifer Heights, Anchorage
Size of casing. 6" Depth of Hole
Static water level 200 ft. ~a'~
Screen ( ); Perforated (
Describe screen or perforation N/A
Well pumping test at 1/2 gallons per ~Y~i~)'~ (minute) for 1
of drawdown from static level.
Da're of completion 7/20/79
500 feet Cased to 182 feet
(below) land surtace. Finish of well (check one) open end ( XX );
).
hours with 100% ~.
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
0 .TO 2 Casing stickup
2 .TO Organics
__.TO
__.TO
__.TO.
__.TO__
TO__
__.TO
.TO.
.TO.
.TO.
· .TO.
__.TO.
.TO
.TO
4
11 26
26 36
36 65
._6.~ 157
157 182
182 500
11 Silty gravel
Loose gravel
Sand
__Loos~_gr~vel
_~an~_gr~a~el.-lmose
Hard pan
Bedrock: water see_~ps in sporadic
I--CUSTOMER
825 L St~t - Anchor~, Alaska 99501
D:WS:O. AUG 1 0 1979
Telephone 2~720 RECEIVED
~ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTION$: Complete all parts on page 1. Incomplete request~ will not be processed. Pleas~ allow ten (10) days for processing.
PROPER,T E
MAILING ~[DORESS
MAILING ~DDRESS
4. REALTOR/AGENT
MAILING A~D~ESS
STREET LOCATI~'N
6. TYPEOF RESIDENCE
SINGLE FAMILY
MULTIPLE FAMILY
7. WATER SUPPLY
::'~ INDIVIDUAL*
COMMUNITY
I-'1 PUBLIC UTI LITY
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
PUBLIC UTILITY
PRONE
PHONE
IPRONE
NUMBER OF BEDROOMS
r--I One r--I Four r-I' Other
r-i ;Two I'-I Five
~ ~ ,Thr~e ~ Six
· ATTACH WELL LOG. A well log is required for all wells drilled
since :June 1975. For wells drilled prior to that date, give well
de~th' (~ttach log if ~vailable.)
'·If ind!vidual/on-site, give installation date ,~...~
If ~yste~ is over two (2) years old an adequacy test~required
- by this Department.
' I
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
;.
72~)10{3/781
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TiME
DATE DATE DATE
iNSPECTOR .~ _ , iNSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
r-I SINGLE FAMILY [] ONE [] THR~E' i [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT
NUMBER
2. WATER suPPLY
[] . INDIVIDUAL . · DEPTH OF WELL .
[] COMMUNITY
, . DATE DRILLED ' .
[] PUBLIC UTILITY
, Connection Verified LOG RECEIVED ,
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE iNSTALLED
I'-IPUBLIC UTILITY : ' [
Connection Verified INSTALLER
[]Septic Tar~k~or [:]Holding Tank
Size: /~L,~J, IfTankishomemade SOILSRATING '-
give dimensions:' ' ' ].~)
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELI~TO: ,/00
E. COMMENTS
[I~...~APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY (Titte)
LEGAL DESCRIPTION
72-010 (Rev. 3/'/8)
CERTIFICATE
FOR A
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
OF ON-SITE SYSTEHS APPROVAL
SINGLE FAHILY DWELLING
Parcel I.D. 015-093-23
1. GENERAL INFORMATION
Expiration Date: / - //-//'
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
CONIFER HEIGHTS S,/D; BLOCK 2, LOT 14
7951 PORT ORFORD DRIVE * ANCHORAGE, AK * 99516
WARREN dACKSON Day phone ,546-5118
7931 PORT ORFORD DRIVE * ANCHORAGE, AK * 99516
Day phone
CHARLES BLALOCK W/ PRUDENTIAL Day phone 563-5500
3801 CENTERPOINT DR, #200 * ANCHORAGE, AK * 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well [] Individual On-site []
Individual Water Storage [] Individual Holding tank []
Community Class Well [] Community On-site []
Public Water System [] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this appfication,
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.
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 all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being sen/ed by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
DSD SIGNATURE
Approved for ~
Disapproved.
Conditional approval for
bedrooms.
-~
bedrooms, With the following stipulations'
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
(Rev. 11/05)
Arsenic Advisory
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
Legal Description:
CHECKLIST
CONIFER HEIGHTS S/D; BLOCK 2, LOT 14
WE LL DATA
Well type F;RIVATE If A, B, or C provide PWSID# .
Date completed 7/20/1979 Sanitary seal (Y/N) YES
Total depth 500 ft. Cased to 182 ft.
Parcel ID: O /,~"-' O q 3 -,,~, ~
Date of test
N/A
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
YES
YES
12+ in.
FROM WELL LOG
7/20/1979
Static water level 200
Well production 0.5
WATER SAMPLE RESULTS:
Coliform ~colonies/100 mi.
.IL.
B. SEPTIC/HOLDING TANK DATA
AT INSPECTION
8/11/2010
330 ft.
g.p.m.
0.41 g.p.m.
g./L.
Date of sample: 8/20/2010
Other bacteri~[al~mm~v, olonies/100 mi.
Collected by: GEG Ltd.
Tank Type/Material
Tank size 1250 gal.
Foundation cleanout (Y/N) YES
Date of pumping
ABSORPTION FIELD DATA
Date installed 8/7/1979
Length 50 ft.
SEPTIC/STEEL
Number of Compartments 2
Depression over tank (Y/N) NO
per.
~*BELOW EXISTING GRADEI
Soil rating (g.p.d./ft2o~ 150
Width 5-8 ft.
Date installed 8/7/1979
Cleanouts (Y/N) YES
High water, alarm (Y/N) N/A
ISAACS PUMPING
System type TRENCH
Gravel below pipe 6
Total depth * 13.9 ft. Eft. absorption area 600 ft2 Monitoring tube YES
Date of adequacy test 8/1'1/2010 Results (Pass/Fail) PASS
Fluid depth in absorption field before test 0 in. Water added 450 gal.
Elapsed Time: - min. Final fluid depth 0 in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN
Depression over field NO
For 3 bedrooms
New depth 0 in.
450+ g.p.d.
If yes, give date -
D. LIFT STATION
Date installed
"Pump on" level at.__.in.
~ ~ Cycles tested
E. SEPARATION DISTA~NCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Size in gallons Manhole/Access (Y__~N_) _-----
''Pump off" leve. L~~ High water alarm level at
100'+
Septic tank/lift station on lot
Absorption field on lot 100'+
Public sewer main N/A
Sewer/septic service line 25'+
Animal containment areas 50%
in.
Meets alarm & circuit requirements~
On ~djacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
N/A
100'+
Building foundation
Water main
Wells on adjacent lots
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
5'+ Property line 5'+
N/A Water service line, 10'+
100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorption field 5'+
Surface water. 100'+
Property line 10'+ Building foundation, 10'+
Water service line 10'+ Surface water 100'4-
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
cOMMENTS
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 ~/3,"//~
COSAFee$ 1~ ~
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Water Well Advisory
Certificate of On-Site Systems Approval (COSA) # 101239
During a recent COSA on-site inspection and test of the potable water
supply well on Block 2, Lot 14 of Conifer Hts. subdivision, the well's
productivity was determined to be 0.41 gallons per minute. The minimum
well productivity required by this Department (AMC 15.55) for a 3-bedroom
residence is 0.31 gallons per minute. Although the subject well currently
exceeds this minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction of non-critical
water uses such as washing cars and watering lawns and gardens may be
required.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
SGS ReL# 1104318001
Client Name Garness Engineering Group, Ltd Printed Date/Time 08/26/2010 13:52
Project Name/# 7931 Port Orford dr Collected Date/Time 08/20/2010 13:20
Client Sample ID 7931 Port Orford dr Received Date/Time 08/20/2010 13:40
Matrix Drinking Water Technical Director Stei~hen C. Ede
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 (<10) 08/23/10 08/24/10 NRB
Waters Department
Total Nitrate/Nitrite-N ND 0.100 mg/L SM20 4500NO3-F B (<10) 08/23/10 AYC
Microbiology Laboratory
Eo Coli Negative 1 100mL SM20 9223B A 08/20/10 SDP
Total Coliform Negative I 100mL SM20 9223B A 08/20/10 SDP
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m
Z
z
0
0
z
m
03
m
m
0
~9.2
/
N
N19o
N
o N
N
N