HomeMy WebLinkAboutCONIFER HEIGHTS BLK 3 LT 4Conifer
Heights
Block 3
Lot 4
#015-093-19
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP241048 PID Number: 015-093-19
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
TRACEY A GOTTHARDT
ABSORPTION FIELD — ADVANTEX W1 FAP 2.0
❑ Deep Trench ® Wide Trench ❑ Bed ❑ Mound
Site Address
7840 PORT ORFORD DRIVE, ANCHORAGE
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
4 GPD/SF
5 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2.5 Ft.
Gravel depth beneath pipe
2.5 Ft.
Subdivision Block Lot
CONIFER HEIGHTS 3 4
Fill added above original grade
VARIES 0.1' CUT TO 0.1' COVER Ft.
Gravel length
20 Ft.
Township Range Section
Gravel width
5 Ft.
Beds: Number of Lines
NA
Distance between lines
NA Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
156 Fe
1
NA Ft.
Well
50'+
50'+
50'+
25'+
TANK ® Septic ❑ S.T.E.P. ❑ Holding ® Other ADVANTEX
Manufacturer
ORENCO / ANCH. TANK
Capacity
1500 Gal.
Surface Water
50'+
50'+
50'+
Material
COMPOSITE PLASTIC
Number of compartments
2
Lot Line
5'+
5'+
5'+
NA
Foundation
10'+
10'+
10'+
ILIFT
STATION — PUMP BASIN
Manufacturer
ORENCO
Capacity
75+ Gal.
Remarks DECOMMISSIONED OLD SEPTIC TANK & INSTALLED
NEW AX FAP2 W/ PUMP BASIN & INSULATED FIELD.
Alarm location
FIRST FLOOR
Electrical installed by
RISING SON
MOA ON-SITE STAFF ON SITE: BEN COGGER
Installer MIKE N ANDERSON, PE (MNA)
PIPE MATERIAL House to tank 3034 Tank to 3034
drainfield
Drainfield 3034 CO/MT 3034
Inspector MNA & FWC
BENCH MARK (Assumed elevation) 100 ft
Inspeection 15` 5/6/2024 2nd 5/7/24
Location and description
3rd 5/9/24 4h 5/10/24
TOP OF MAN HOLE MH
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
At
Conditional Approval: Date
,•wg�Q: • !fes �t
*: 49 TH
.....�:*
..........`...... r
/ • /
Septic System
Approved
,'
�j Curtis Huffman
- /
r �'••
� <`c CE 128991
(/(/ Date / 2'{
, ��lF •. 05/13/2024•'�C��,�
�l
�FOp•...••,..A
,l ROFESSOA��,`-�
Note: this apprval does not include well permit requirements.
kmuv uoiuu ia/
PID:015-093-19PERMIT:OSP241048
FIRST WATER CONSULTING
OF qj,9s���
CO49 TH*`-�
S ws Ilat'l—
U
s SHANE A. HOLT/
LS-6914
4^
a o
4�a n,l°fessions% Ls��
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
EASEMENTS OF RECORD, OTHER THAN TH05E APPEARING ON THE RECORD PLAT, ARE NOT SHOWN
HEREON (UNLE55INDICATED)
NOTE: FENCELINES THAT MAY APPEAR ON THI5 DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE.
I
AS -BUILT SURVEY I" =30'
NO CORNERS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 4, BLOCK 3, CONIFER HEIGHTS SUB.
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EXIST OTHER THAN NOTED.
DATED AT ANCHORAGE,ALASKA THIS _10 TH DAY OF
_MAY , 2024.
HOLT LAND SURVEYING
9309 &ROVER DRIVE
ANCHORAGE,AK 99507
13743, FB 184-78 236-61 345-5513
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
hftp://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP241048
Work Type: Septic Upgrade
Tax Code Number: 01509319000
Site Legal Address: CONIFER HEIGHTS BLK 3 LT 4 G:2440
Site Mailing Address: 7840 PORT ORFORD DR, Anchorage
Owner: GOTTHARDT TRACEY A
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
Effective Date
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
DeI)al'tnlenf
4/16/2024
4/16/2025
48799
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions:
• A test hole is required prior to construction of the absorption field, in the location shown on the site plan, to
onfirm minimum separation to impermeable soil and a percolation rate. If results require a design
0 change, construction shall stop pending approval of a change order. Please submit results with the
inspection report (or change order, if required).
i
4
y/4/- Gd G(ou►101WA I"ef �—ourLA Gcee r, ie�� �es�yn i 5 Ge�/%r.
/AqA)
Reeeived-By: Z 9 y EAt A f v
Issued By:
Date:
Date: Z
Munidality ®f Anchorage "� S
\__��/ Urpartment N
P.O. Box 196650 ® 4700 Elmore Road
Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV241013 COSA#: Permit#:OSP241048
PID#: 015-093-19
Legal Description: CONIFER HEIGHTS BILK 3 LT 4
Engineer: First Water Consulting
Your request for a waiver of the required 16 feet horizontal separation from the absorption field to
the 1980 field has been approved. The approved separation distance is 9.0 feet.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-
site wastewater disposal system will require all separation distances be met or another approval
from this department.
............................................... ■ ............................. ■ 1
Waiver is Granted: X Waiver is not Granted:
Date: 16 1 ALA Approved by: Dt,
Name of Revieyv
**** VARIAN C E/WAIVER REVIEW ****
nU�UHOC� D ALJ TY OF r\ HCH R A G
Development Services Department
�907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 015-093-19
Property owner(s) TRACEY A GOTTHARDT Day phone
Mailing address 7840 PORT ORFORD DRIVE, ANCHORAGE, AK 99516
Site address 7840 PORT ORFORD DRIVE, ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot) CONIFER HEIGHTS BLOCK 3, LOT 4
Legal description (Township, Range & Section)
Lot Size 48,799 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
E]
Initial ❑
Single Family (SF) El
Septic Tank
EUpgrade
(w/wo ADU)
Holding Tank
El
Renewal❑
(D) ElRenewal
Privy
❑
Multiple Dwellings ❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION
INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
Ignature of property owner or authorized agent)
Permit/Rush Fees: c) J S Waiver Fees: -q 'r
Date of Payment: ! 2 �% Date of Payment:
1
Receipt Number:
Permit No. n S() L% 10 9 1
Receipt Number:
Waiver No. OSV 2.cI 1 O 13
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
DEVELOPMENT SERVICES DEPARTMENT
On -Site Water and Wastewater Section
www.muni.org/onsite
CHANGE ORDER
PERMIT # OSP241048
PID 015-093-19
907-343-7904
Fax: 343-7997
SUBDCONIFER HEIGHTS TRACT BLOCKS LOT4
CONTACT PERSON CURTIS HUFFMAN / FIRST WATER PHONE 907-350-9566 FAX
PLEASE GIVE A DESCRIPTION OF THE CHANGE TH24-1 was conducted to verify soils, perc, & subsequently
groundwater was monitored. The other test holes that were used in this proposed design are at a lower
elevation along the road and appear to be more susceptible to shallower groundwater per our TH24-1.
We are therefore changing the design to 201 x 5'W x 2.5'ED - 5' from grade. We are still T above monitored
groundwater from TH24-1 during this high groundwater time of year and also combined with this Advantex
system. No other changes or modifications of this permitted design have been done & believe this slight
modification will not result in additional review time charges and will not effect the property or adjacent lots.
CUSTOMER SIGNATU
Date: 05/08/24
APPROVED (date)
TOTAL HOURS y5
HOURLY RATE $145
TOTAL TO BE PAID -W 7?-. �5
DATE PAID
RECEIPT #
On -Site
Reviewer:
Comments
Issued
(date)
Review
Time
(hours)
APPROVED (date)
TOTAL HOURS y5
HOURLY RATE $145
TOTAL TO BE PAID -W 7?-. �5
DATE PAID
RECEIPT #
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
!
!!
April 9, 2024
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC SYSTEM UPGRADE PERMIT
LEGAL: CONIFER HEIGHTS BLOCK 3, LOT 4
The existing IDSF septic system has been found failed and we request a septic permit to
upgrade the existing septic system on the above referenced lot. We propose to install a
shallow trench with an Advantex system and pump basin to serve the existing 4-bedroom
residence per the attached design. The design is based on MOA record documents of the
test holes conducted in the fall of 1999 that showed groundwater at 6.25’ on October 5,
1999, with a conventional percolation soils application rate of 1.2 GPD/SF or 2 GPD/SF with
the existing IDSF.
We propose to use a conservative soils application rate corresponding to the Advantex
System per the design. An additional test hole will be conducted to verify soils and conduct
a percolation test. This soils log with percolation test will be submitted with the Inspection
Report. With the increased effluent treatment of the Advantex, the potential effluent and
transference or interaction between the decommissioned 1980 field and proposed field will
be marginal or nonexistence. The property is best served by retaining the 2000 IDSF field
for future use due to the lot’s characteristics. The proposed field with the quality of the
monitored effluent and the vertical and horizontal separation will have no effect on the
functionality of the existing IDSF or decommissioned 1980 field.
The slopes are moderate at 5-10% at the proposed upgrade location. The lot and area are
served by private water with no known private wells within 50’ of the proposed septic
system. Based on visual observations and review of available information, the design will
not impact any of the neighboring properties. Please contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241048, Deb Wockenfuss, 04/16/24
DESIGN CALCS:
4BR X 150 GPD = 600 GPD
600 GPD/4 GPD/SF = 150 SF SAS
150 SF / 5'W X .64RF (2,.5ED) = 20 FT. TRENCH
USE 1 TRENCH - 20'(L) X 5'(W) X 2.5'(ED)
TOTAL MAX DEPTH FROM EXISTING GRADE: -5'
CONDUCTED TEST HOLE TH24-1 & DESIGN MODIFIED
USED REDUCED SOILS APPLICATION RATE.
PRESSURIZED DISTRIBUTION: 201F 1.25"PVC WITH
3/16TH HOLES & 0.7' SPACING (TYP).
NO WELLS WITHIN
PROPOSED O50'OF
FIELD
B3, L8
B3, L9
I�
b
WWI=
INSTALL 5' FROM GRADE & ADD 3'+ OF COVER OR
ADD 2" OF INSULATION AND 2'+ OF COVER WITH
EXTENT OF COVER OUTSIDE DRIVEWAY (ADJUSTED
AS NEEDED) & MAINTAIN 9'+ TO 1980 FIELD.
REMOVE ANY BIOMAT & ADD MOA SAND TO
MAINTAIN 9'+ SEPARATION.
NO SL
PR OSE
B3, L3 -. %/
RADIUS
-BR HOUSE WELL
a1A`�
CMDUC70 TH24-1 . o�
FIELD TOP OF
DECOIDDS9DN EXISTING STEP TANK I
d NSTALL NEN IWO-GAL ADVANTEX FM 2 WITH
PUMP BA541 (PB1 W/ Xy. E GROUNDWATER
IS FNCOUNIFRED ADD 4CY OF CEMENT
AROUND AX FM 20 FLANGE FOR BUOYANCY.
USE DIYFRTER TO CONNECT TD
NEW FIELD a TO DOMO ESF.
MAINTAIN as'+ FROM SLOPES >25
Q INSTALL PARALLEL TO SLOPE
DESIGNED BASED ON DOSTING TEST
HOLE DATA h PREVIOUSLY
NDA PERMITTED DESIGN IN MOA
FE1
RECORDS. CONSERVATIVE APPLICATION
RATE OF 4 CPD/SF USED
VS 8 GPD/SF PER RECORD SOLS
THI
yT
EXIMG IDSF
a CARNESS
TEST HOLES
STAKE 50 WELLS, 10' FOUNDATION
...SETBA KS AS REQUIRED OR NEEDED.
B3, L3
APPROXONAYE
1 OD 'WELL
RADIUS
THIN 35'(
EX 6ELD.
B2, L11
CONIFER HEIGHTS BLOCK 3, LOT 4 SUPPORT,SERVICES: ®®®®®
PREPARED FOR: ®��� OF
TRACEY A GOTTHARDT ®<� �`
7840 PORT ORFORD DRIVE ® 9 T1
ANCHORAGE, AK 99516
FIRST WATER CONSULTING
DATE: 5/7/2024 rtis Huffman ,W
13030 SUES WAY SURVEY: HOLT O CE 128991 �'41 Ao
DRAWN: FWCS 5/7/2024
ANCHORAGE, AK 99516
907-350-9566 FirstWaterAK@gmail.com SCALE: 1" = 5D'PAGE: 1 OF 2 ��a��
0. NEEDED.
FE1
�1
CRAOTE`TE
yT
TE
oo' WELL
RADIUS
EST TED 1980
9'+
° TO
MAINTAIN
MATION
TRENCH.
2
NO WELL
CONFLICTS
WITH PROPOSED
SEPTIC SYSTEM
b
B2, L12
APPROXIMATE
190' WELL
RADIUS
CONIFER HEIGHTS BLOCK 3, LOT 4 SUPPORT,SERVICES: ®®®®®
PREPARED FOR: ®��� OF
TRACEY A GOTTHARDT ®<� �`
7840 PORT ORFORD DRIVE ® 9 T1
ANCHORAGE, AK 99516
FIRST WATER CONSULTING
DATE: 5/7/2024 rtis Huffman ,W
13030 SUES WAY SURVEY: HOLT O CE 128991 �'41 Ao
DRAWN: FWCS 5/7/2024
ANCHORAGE, AK 99516
907-350-9566 FirstWaterAK@gmail.com SCALE: 1" = 5D'PAGE: 1 OF 2 ��a��
C 0,4e]
DESIGN DETAILS:
INSTALL NEW 1500—GAL ADVANTEX FAP 2.0 SYSTEM. MAINTAIN 10'+ FROM FOUNDATION,
50' TO WELLS, 5' TO FIELD & DECK SUPPORTS WITH 4' OF COVER OR INSULATION. INSTALL
ONE 20'L x 5'W x 2.5'ED TRENCH —5' FROM GRADE, w/ 3'+ OF COVER OR 2'+ OF COVER
& INSULATION MAINTAINING 50' TO WELLS / SURFACE WATER, 10' TO LOT LINE,.... INSTALL
PER AMC 15.65, 15.55, & MASS ... TANK BEDDING, SEPARATIONS, MATERIALS,
133, L3 I
APPROXIMATE//
100' I WELL
RADIUS.
BR HOUSE 50' WELL
RADIUS
i GRAIL
CONDUCTED TH24-1 DR%�
C FIELD TOP OF SLOPE
2'+ OF VER WITH
DECOMMISSION EXISTING STEP TANK INSULATION. ADJUST
& INSTALL NEW 1500 -GAL ADVANTEX FAP 2 WITHDRIVE & ADD B RIER A
PUMP BASIN (PB) W/ DIV. IF GROUNDWATER 100' WELL o NEEDED. EXTENT OF FI
AROUND AXIS UF PR2.0 ED AFLAN EDD YFOR BUOYANCY. OF CEMENT RADIUS. MT \
USE DIVERTER TO CONNECT TO
NEW FIELD & TO EXISTING IDSF.
MAINTAIN 35'+ FROM SLOPES >25
& INSTALL PARALLEL TO SLOPE.
%+
DESIGNED BASED ON EXISTING TEST
HOLE DATA & PREVIOUSLY
MOA PERMITTED DESIGN IN MOA
RECORDS. CONSERVATIVE APPLICATION
RATE OF 4 GPD/SF USED
VS 6 GPD/SF PER RECORD SOILS.
TH1
EXISTING IDSF °
& GARNESS
TEST HOLES
m
ESTIM TED 1980
IREN MAINTAIN
9'+ EPARATION
TO EW TRENCH.
00' WELL
RADIUS.
132, L*
j� NO WELL
CONFLICTS
W WITH PROPOSED
Q
0
SEPTIC SYSTEM
CONIFER HEIGHTS BLOCK 3, LOT 4 SUPPORT#SERVICES: ®®®®®
PREPARED FOR: OFA
TRACEY A GOTTHARDT Alf
7840 PORT ORFORD DRIVE F� l- ® (%) 9TH
ANCHORAGE, AK 99516 111111! 0
FIRST WATER CONSULTING
DATE: 5/7/2024 rtis Huffman
13030 SUES WAY SURVEY: HOLT rcP CE 128991 csof
DRAWN: FWCS 5/7/2024
ANCHORAGE, AK 99516 SCALE: 1" = 30'
907-350-9566 FirstWaterAK@gmail.com PAGE: 2 OF 2 ®®®®®
C
F-Ist W
CONSULTINGG
3030 Sues Way - Anchorage, Alaska 99516
Tel. 907-350-9566 firstwaterAK@gmail.com
SOILS LOG -PERCOLATION TEST
LEGAL: CONIFER HTS. B3, L4
DEPTH
Depth to
Water
FEET
OG SOILS
1
4 9/16"
"
ORG/OL
2
"
3
4 6/16"
4
6"
5
"
6"
GM/gp-sp
6
6"
7
8
9
10
11
12
BOH
13
14
15
16
17
18
19
20
1
*.49TH .---•�*��l
• Curtis Huffman :
CE 1289917 low,
,• �`��/
PROFESSIONS
PERFORMED FOR: TRACEY A GOTTHARDT
FESTHOLE # 24-1 DATE PERFORMED: 5/1/2024
GROUND WATER ENCOUNTERED: NO
IF YES, AT WHAT DEPTH: NA
DEPTH TO WATER AT MONITORING: 12'
DATE: 5/7/24
SEE SITE PLAN FOR SLOPE & LOCATION
COMMENTS:
GROUNDWATER MONITORING WILL BE REVERIFEID
ON 5/8/24 (7 DAYS) PRIOR TO CONSTRUCTION & NOTED
ON INSPECTION REPORT.
VERIFY GROUNDWATER MT
AT TIME OF CONSTRUCTION
Reading Date Gross Net
Time Time
Depth to
Water
Net
Drop
5/1/24 10 min
6"
4 9/16"
"
6"
4 7/16"
"
6"
4 6/16"
"
6"
4 5/16"
"
6"
4 6/16"
"
6"
4 5/16"
PERCOLATION RATE 2.3 (MIN / INCH)
TEST RUN BEWTWEEN 3 & 4 FT
PERC HOLE DIAMETER 6"
PRE-SOAKED PRIOR TO TEST & ALL READINGS TO
THE 1/16TH
PERFORMED BY: FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT
ON THIS DATE. DATE: 5/7/2024
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this .-/,�j Day of of 20X by and between
�— , herein the "OWNER," and the Municipality of
Ancil' ,herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as AN ADVANTEX SYSTEM
located at (legal description)
CONIFER HEIGHTS BLOCK 3, LOT 4
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
TC includes an annual maintenance fee (typically $400 to $600).
Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
C
Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Page 1 of 3
=f_ Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
_ assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
Owner agrees that an sale or transfer of title of the property g Y p p rty will not occur without a new
Certificate of On -Site Systems Approval.
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
OWNER: I
By: (signature)
(print name)
1
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before
202,y, by :: fr
NOTARY PUBLIC OR ALASKA` y
My Commission expires: %/i
MUNICIPALITY:
Date: Apo
j A�v
me this 15 day ofAoo r,,
By: Gf% (signature)
(print name)
(rev. 05/18/2018)
i STATE OI= ALASKA
@
NOTARY PUBLIC
Kendall Fuller
My Commission Expires: September 1, 2024
Date:
Title:
Page 3 of 3
Municipality of Anchorage Page 1 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Insp6ction Report
Permit Number: SW990423 PID Number: 015-093-19
Name:
LOUIS AND MARY BALEST
Wastewater System: ❑ New ■ Upgrade
Y p9
Address:
7840 PORT ORFORD DRIVE ANCH., AK 99516
ABSORPTION FIELD
Phone:
(907) 227-8323/346-1971
No. of Bedrooms:
4
ElDeep Trench ❑Shallow Trench IN Bed 11 Mound ■Other
LEGAL DESCRIPTION
Soil Radng:
2.0
Total Depth from original grade:
**0.52-2.22
GPD/Sq.
FG Ft.
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe:
4 3 CONIFER HEIGHTS
+ 0.5-2.2
Ft. 0.36 Ft.
Township:
Range:
Section:
Fil added above original grade:
Gravel length:
—
—
—
2.8-4.3
Ft. 20 Ft,
WELL: ❑ New ❑ Upgrade
Gravel width:
18
Number of liner
8
Dialance between lines:
2.5 +/—
FL
FL
Cl..M.Don (Private, A,e,C): Total De
Cased To:
Tata, abeorpDon area:
pipe material:
ft
rt.
360 se. Fl.
ASTMD-3034/F810/SCH 40 NC
Driller. Data Drilled:
Static water level:
Installer.
DENALI
Date InstalledR. :
5/9/00-5/10/00
Yeld:Pump
Set At:
Casing Height Above Ground:
TANK
GPM
FL
Ft
SEPARATION
DISTANCES
El Septic El Holding ■S.T.E.P.
TO
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer.
ANCHORAGE TANK
Capacity In gallons:
1500
From
Tank
Field
Station
Tank
Sewer Unes
Well
100'+
100'+
100'+
—
25'+
Material:
STEEL
Number of compartments:
2
Surface
Water
100'+
100'+
100'+
-
-
LIFT STATION
Line
5'+
10'+
5'+
—
—
Size in gallons:
1500
Manufacturer.
ANCHORAGE TANK/ ORENCO PRODUCTS
Foundation
5'+
10'+
5'+
-
-
Pump on level al•
*Pump off level at:
High water aI.. ab
46"
-TIMER
CTIVATED-
Curtain
Pump Make k Model:
Declrical Inspections performed by:
Drain
NO KNOWN
20 081 05 HHF
M.O.A.
Remarks: * THIS IS AN INNOVATIVE BOTTOMLESS
BENCH MARK
Location and Oeecriptlon:
INTERMITTENT SAND FILTER SYSTEM
THRESHOLD OF GARAGE MAN DOOR.
** 2.36 FEET OF M.O.A. APPROVED SAND FILTER
ADDED
Aeaumed Devagon: 100.00 Ft.
ENGINEER'S SEAL
oobOoppO
or' .. ........AL p�
Inspections performed by: AWWC INC. Dates: 1st s/s/oo
0**0
......... „
2nd 5/10/00
3rd 5/15/00
'. e re A. GarnesS:
Department of Health and Human Services approval
7953
Qi)'
Reviewed by: -3 -00
4�°
4�4Gar'rofessloa°oma
and approved Date:
400�0000�
72-013 Rev. 9/91) MOA 25
PERMrr NUMBER:
SW990423 AS -BUILT DRAWING
SW9
( I /
! I I
! ! I 100' WELL RADIUS
I (
1
I
I ( AIRINSTALLED
COMPRESSOR \ 4 BFB p�MO
t �1
( �I
I (
(
! (
ST1
29.6
1 39.6
ST2
34.8
40.3
MHL
36.5
40.7
MT1
79.0
69.4
MT2
65.2
53.5
MT3
87.0
73.7
MT4
76.5
59.6
NEW 1500 GAL
S.T.E.P. TANK
I /I
I jW
11�
1 l�
INSTALLED AIR UNE_
J
\\ MT9 //
PARCEL ID NUMBER:
015-093-19
1/ NEW BOTTOMLESS
INTERMITTENT SAND FILTER
5/18/200
DRAWN BY:
ALASKA WATER & WASTEWATER_ J.W.M.
h-: �°��< CONSULTANTS, INC.-- SCALE;
6901 DEBARR ROAD SUITE 28' ANCHORAGE AK 99504 • PHONE (907)337-6179 • FAX (907)338-3246 1 = 40
PREPARED FOR: PAGE NUMBER:
LOUIS AND MARY BALEST (907)227-8323/346-1971 2 OF 3
LEGAL DESCRIPTION:
CONIFER HEIGHTS SUBDIVISION; LOT 4, BLOCK 3
TWE OF WORK:
AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE (BOTTOMLESS ISF)
..... ..
. .. ... ........
F '•• r A. Gayness.
—7953
�c O
PERMIT NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER:
-
SW990423 015-093-19
MNMO LID - 95,26
FINAL GPAJ7E - 116-92118,
f0l' Of
A I rf 88.85 \ /
IM/ERfOF ANG -
AT INLEf - 65,27
0009 am
695,16 (NIGH)
fOP OF 5AN9 - 9530 —
1W LINE -
NSW 1500 6& ON
5,T,U. TANK
—f07 OF TANK
AT 01.a f - 68,87
-imu OF p"
Af OUILEf - 66,25
WATER AT 90.78 IN TH#1 ON 5/5/00
90.94 IN TH#2 ON 5/5/00
PINW-am- / `F fEKFA3RIL
97.75 + /
PLriV00D
ORIGINAL am
93,46 (LOND
60fTOM GF 5/ 4" 915VI(5(NION
LIQ s 95.66
OF 6ED - 92.94 (AVO)
5/18/2000
...,...'»,,..,......_.:.�.,.... .»......_.... _...:...,... DRAWN BY:
ALASKA WATER & WASTEWATER SCALE. :J'W'M'
* • 4 �{,�
CONSULTANTS, INC � �-•��- - ��^^-'^�'
6901 DEBARR ROAD, SUITE 20 •ANCHORAGE, AK 99504 •PHONE (907)337-6179 •FAX (907)338-3246
N.T.S. .......... ... .............
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
LOUIS AND MARY BALEST (907) 227-8323 3 OF 3 QQ r A; Gar ss:'
LEGAL DESCRIPTION:Q " -7953 o,
CONIFER HEIGHTS SUBDIVISION; LOT 4, BLOCK 3 4Far co�0�
TYPE OF WORK:4�PdTrofes"s(°�°\ 00
PROFILE AS -BUILT OF SEPTIC SYSTEM UPGRADE (BOTTOMLESS ISF) �OOoo��10
06/26/2000 15:01 FAX 907 343 8214 BUILDING SAFETY 0001
I Xv-door
f
Pop I of RaPECHOWREMRT
MUNICIPALITY OF ANCHORAGE - BUILDING SAFETY DIVISION
4700 SMITH MACAW SllMT ANCHORAGE, ALASKA
INSPECTIONS.• Veim (001)30.000 Fac (907) 34 "235 INFORMADON.• (W?) 3.1"2.11
"DREM ggpzlo ?og-r
,5,)ero,4eb b)A
L07%
COMMENTS
SURDIMM.•
PERAff TIVMVAM- &4-1
DAM 6-11er-1067
I
MB OF
PaPEC770N.-
;4
No no dmw& El 0 C.C).Vpon&
rl wmm-wrami AtuqdfttqmdmL C.C.0.qpvvcd(o=manftbdow).
COMMEIM.
Recl., V,
L/vAt ro
Demonloi 4?? ?000
at % Palit�,
Olth& OtAn"oro -
/*7QJ7,9QV
069
1AMPEMM,
zw7z. 15 — 16 —
COMEMONSMW MADE, MX" COZ FOR RMEMON
D0NffffM0VE7WN&HCZ'
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On -Site Services 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: Nov 30, 1999
Expiration Date: Nov 29, 2000
Permit Number: SW990423 Parcel ID: 015-093-19
Legal Description: CONIFER HEIGHTS BLK 3 LT 4
Design Engineer: 0041 AK Water & Wastewater Consulta Site Address: 007840 PORT ORFORD DR
Owner Name: Louis & Mary Balest Lot Size: 48799 SQ. FT.
Owner Address: 7840 Port Orford Total Bedrooms: 4 Permit Bedrooms: 4
Anchorage , AK 99516-1020
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 ( I SAAC80 ).
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.
5. The following special provisions.
THIS PERMIT ISSUED FOR THE CONSTRUCTION OF AN ALTERNATIVE INTERMITTENT DOSING SAND
FILTER (IDSF). THE ATTACHED PROPERTY OWNER MAINTENANCE AGREEMENT SHALL BECOME A PART
OF THIS PERMIT PACKAGE.
Received By:
Issued By:
Date: //—_3/.f " 9"f
Date: /x`30-71
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 213 — Anchorage — Alaska 99504
(907) 337-6179 — Fax (907) 338-3246
Consulting Engineers
November 11, 1999
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Septic Upgrade Design for Conifer Heights Subdivision; Lot 4, Block 3
To whom it may concern:
The existing 4 bedroom house is served by a private well and septic system. The existing septic
system consists of a 1250 gallon septic tank and a deep trench type drainfield. The existing
drainfield is surcharged and is believed to be encroaching on groundwater. Two test holes were
excavated south/southeast of the existing septic system. Comments regarding the proposed
design are summarized as follows:
1. SOILS: Attached are the soil logs with the soils classification, groundwater monitoring and
percolation test results. In TH#1, the soil below the organics is a SW material to a depth of 4 feet
and then transitions to a SP material to a depth of 6 feet. At 6 feet, the soils transitions to a GP
material to a depth of 8.5 feet (bottom of test hole). In TH#2, the soil below the organics is a SM
material to a depth of 5 feet and then transitions to a SM/GM material to a depth of 9.5 feet
(bottom of test hole). At the time of excavation, groundwater was encountered in both test holes
at 7 feet in TH#1 and at 9.5 feet in TH#2. After seven days the monitoring tubes were checked
and water was found to be at 6.25 feet in TH#1 and at 7.4 feet in TH#2. A percolation test was
performed in TH#1 between the depth of 2.5 feet to 3.0 feet and found the rate to be 3.7
minutes/inch. A percolation test was performed in TH#2 between the depth of 3.0 feet to 3.5
feet and found the rate to be 3.6 minutes/inch.
2. TRENCH DESIGN: Due to the shallow groundwater and limited space, we believe that a
bottomless intermittent dosing sand filter system is the best option for the septic system upgrade.
a. Percolation Rate: 3.7, 3.6 minutes/inch
b. Application Rate: 2 gallons/day/ft2
c. Number of Bedrooms: 4
d. Design Flow: 600 gallons per day
e. Minimum Absorption Area: 300 ft2
f. Total Depth to Bottom of sand: 3.5 feet
g. Effective Depth: 3 inches
h. Width: 20 feet
i. Length: 18 feet
j. Reduction Factor: N/A
k. Effective absorption area = 360 ft2
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
4. TOPOGRAPHY: The area where the proposed bed is to go is at the base of a small hill to
the south. Approximately 40 feet to the west of the proposed ISE bed is a slope that is greater
than 25%. We are requesting a 35 foot waiver be granted to this slope. Given the porosity of the
soil, effluent from the bed should move downward rather rapidly, with minimal lateral migration.
The sloped area is heavily vegetated and it is our opinion that there is minimal risk with the
granting of this waiver.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you
for your assistance.
NOTE: Attached is a site plan drawing, a design drawing, a detail drawing, two soil logs and a
4 page construction specification letter which are all part of the design package for this septic
system.
\ v
LOT 12, BLOCK 1 ) i
CONIFER HEIGHTS S/D /
/
i
/
LOT 6, BLOCK 3
CONIFER HEIGHTS S/D
/ 1 1
1 1
1 LOT 7, BLOCK 3 11 11
1 CONIFER HEIGHTS S/D
LOT 5, BLOCK 3
CONIFER HEIGHTS S/D /
I EXISTING'4 —
� , h 1 (BEDROOM HOUSE
LOT 8, BLOCK 3 1
\\\\
CONIFER HEIGHTS S/D I III \
1 1
PROPOSED SEPTIC
/ a1 SYSTEM (SEE DESIGN 1
PAGE 2 OF 3) 1
I I
/ I
1 1
I / TH#
/ LOT 9, BLOCK
CONIFER HEIGHTS
/
/ /EXISTING SE
3 SYSTEM
S/D//
L
/ /CONI
/ I .
/
OT 3, BLOCK 3
FER HEIGHTS S/D
/I
1{tu WE ReDIU� / I
1 I I
1 11
\\
\ I
/ \ /V
j
\
LOT 8, BLOCK t
i 11 CONIFER HEIGHTS S/D
I
l-----------
LOT
-----___—_LOT 7, BLOCK 1
CONIFER HEIGHTS S/D
\ : VACANT
COs 11
1
I
/I
/ F
/
LOT it, BLOCK 2
/ CONIFER HEIGHTS S/D
r
I LOT 12, BLOCK
_� CONIFER HEIGHTS
I \
I \
I
1 1WDIU6 \
I 100' WEU. I
L — I
—J
ALASKA WATER AND WASTEWATER CONSULTANTS, INC.
6901 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK. 99504
PHONE: (907) 337-6179/FAX: (907) 338-3246
\L DESCRIPTION:
CONIFER HEIGHTS SUBDIVISION; LOT 4, BLOCK 3
OF WORK:
SITE PLAN FOR SEPTIC SYSTEM UPGRADE
PREPAREDFOR:
DPHONE NUMBER:
AND MARY BALEST (907)227-8323/346-1971
11/11/99 1_ K.D.W./A.C.G. 1 1= 100' 1 1 OF 3
/ —7
CIf7953
pro f essio�t
t NOTES
THE CONTRACTOR SHALL FIELD VERIFY THAT ALL SEPARATION DISTANCES
CAN BE MET PRIOR TO INSTALLATION OF THE PROPOSED SEPTIC
SYSTEM.
THE AIR COMPRESSOR SHALL BE LOCATED WITHIN THE CRAWLsPACE OR
THE GARAGE. THE CONTRACTOR SHALL PROVIDE A 0-10 PSI
PRESSURE GAUGE AT A LOCATION WHICH IS READILY ACCESSIBLE FROM
WITHIN THE HOUSE. NOTE: A 30 PSI GAUGE WILL NOT WORK.
THE AIR COMPRESSOR SHALL BE A THOMAS INDUSTRIES MODEL 5070,
AS SUPPLIED BY ANCHORAGE TANK. THE AIR LINE SHALL BE 1/2 INCH
DIA. HDPE (1 PIECE), INSULATED WITH 1/2 INCH FOAM PIPE WRAP (R3
VALUE). INSIDE A 2 INCH SCH.40 PVC JACKET. THE LINE SHALL BE
BURIED TO A MINIMUM DEPTH OF 3 FEET.
THE CONTROL PANEL FOR THE STEP TANK SHALL BE INSTALLED WITH A
AUDIBLE/VISUAL INDICATOR WITHIN THE GFAVL� GARAGE.
I
I
' ZI
f
�I
I
1
I ' PROPOSED 1500
S.T.E.P. TA
/ NOTE: THE CONTRACTOR SHALL
HAVE THE EAST PROPERTY LINE
FLAGGED BY A REGISTERED LAND
SURVEYOR PRIOR TO CONSTRUCTION./
100' WELL RADIUS
r / /
I AIR(S EMPRESNOTE)/O/R7 J/ /
\ EXISTING 4
BEDROOM HOUSE
I INR LIN
INSULATED
' I (SEE NOTE)
' 1.25 INCH HDPE LINE SLOPED BACK T0--�
I LIFT STATION FOR DRAINAGE OF LINE. NO
I I
LOWTS(CH WILL ALLOW CONNECTIONS WATER O
SHALL BE
COLLECT.
ALL
STAINLESS STEEL WITH STAINLESS STEEL
I BANDS. NO HOSE CLAMPS.
AND, 1 -TOP OF SLOPE
/ (SEE DETAIL AND PROFILE, PAGE 3 OF 3)
ALASKA WATER AND WASTEWATER CONSULTANTS, INC.
6901 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK. 99504
PHONE: (907) 337-6179/FAX: (907) 338-3246
CONIFER HEIGHTS SUBDIVISION, LOT 4, BLOCK 3
TYPE OF WORK:
DESIGN OF SEPTIC SYSTEM UPGRADE
PREPARED FOR: PHONE NUMBER:
LOUIS AND MARY BALEST (907) 227/8323/346-1971
11/9/99 1 A.C.G. 1 1= 40' 1 2 OF 3
EXISTING SEPTIC SYSTEM TO
BE ABANDONED COMPLETELY
rH#2
O
c
/ O
O
O
� Q
4" 91A, MONITORING fLM AT EACH -
CORNFR, FERFOKATE9 [iEfMrN fOP
OF SAND ANP PI51R16UilON PIPE
INVERT. (WILL I/ 4 INCH DIA I M5)
I 1/ 4'' DIA. WFF -.-\
PIxHAU UNE FROM
5.fE.F. TANK AND MANIFOLD
18' x 20' 60170MLESS ISF��
NO UNER ON DOFTOM, PRE5%M
PIPING 9E5I6NED PY ORENCO AND
5LFFI.IE9 6Y ANCHORAGE TANK,
AIR UNE COIL 5WI2 Af -
APPROX, 2 FEET. OrNCO
"WA5ffWW" TYPE PROVIDEP
6YANCHOWA TANK.
ORIGINAL GRADE
6" LAYER OF 5/ 8" PEA GRAVEL
WfH a PVC LATERALS PLOW
MIDWAY IN fW 5 MTUM.�
(GRAVEL BELOW PIPE - 5")
2 FEET MIN, or FILTER
AIR LINE 18" DELow
fOP OF 5AN9
---- --- ---- 0,-1
°'J
PLAN VIEW
3/ 4" PVL LAVIZ&5 (ff.9)
MT r FINAL 6mPo m
2' MIN, OF COVER
PROFILE VIEW
5/ 4" DIA. 5CH, 40 PVC LATERALS
(HOLES, SWW5, AN9 FLU HING
VALVES PER MNCO 9E516N)
- 2" IN5LUA110N
- FILTER FADRIC
OVER PFA GRAVEL
ALASKA WATER & WASTEWATER CONSULTANTS, INC.
6901 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK 99504
PHONE: (907) 337-6179 / FAX: (907) 338-3246
LEGAL DESCRIPTION:
CONIFER HEIGHTS SUBDIVISION, LOT 4, BLOCK 3
TYPE OF WORK:
BOTTOMLESS SAND FILTER (ISF) DETAIL
PREPAREDFOR:
GPHONE NUMBER:
AND MARY BALEST (907)227-8323/346-1971
DATE: DRAWN BY: SCALE:---FPA-GE:
11/9/99 A.C.G. N.T.S. 3 OF 3
ORIGINAL GRA9E
-o
oob�Opp
...........
SAO
t 4 ...
p ••
e f Of ;••••
33
7953
Qsf0�caG
0
�On�P/'ofrssiono\ 00
4/
•
me
1IMOD
11�ll�
Wers
4/
ALASKA WATER & WASTEWATER CONSULTANTS, INC. _ 00000000
6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, Alt. 99504 �.0�•'• (��p
PHONE (907) 337-6179 * FAX (907) 338-3246
SOIL LOG - PERCOLATION TEST
LEGAL DESCRIPTION: CONIFER HEIGHTS SUBDIVISION; LOT 4, BLOCK 3 """"" "' "" ""...
PERFORMED FOR: LOUIS AND MARY BALEST �" f y ss: Q
DATE PERFORMED: 9/29/99 C 7953 mph
P
(feet; t TEST HOLE #1 pp�evpr
ORGANICS
a
SOjEoI._L.-'1._ CLASSIFIC]ATIONSp°
2 ooo°o J
°o`°p°o SITE PLAN
GWORGOO—-----
GP n
3 SW ML
000 o°°o� L I �_ GM _1 C(-
4 uw�OL
°°0°°°° `
Q.
°� °0 SW I� Iii l_ MH i l
uV° 0 0°n°opo°c
a o o oouo°o ov SP 7�
`J oveo0°o SF o_°n°v°o°c L CH
OH
uQ o �o SM i
6 SC 4,
so
7 DEPTH TO DATE
GROUNDWATER
8 v o GP 7.0' 9/29/99
9
B.O.H. 6.25' 10/5/99 1 11 TH#1l TH#2
I
10-
11
12
13
14
15
16
17
18
19
PERCOLATION RATE 3.7 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
20 2.5 FT. AND 3.0 FT.
TEST RUN BETWEEN
COMMENTS:
PERFORMED BY ALASKA WATER & WASTEWATER. I, JEFFREY A. GARNESS, CERTIFY THAT THIS
WAS PERFO ME IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON
DATE: �l t
DATE READING CLOCK NET TIME WATER LEVEL NET DROP
TIME (MINUTES) READING (INCHES)
9/29/99 PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING
1 3:30 — 6" —
2 � 3:40 10 2 3/4" 3 1/4"
L 3 J 3:41 I 6"
4 3:51 10 I 2 7/8" 13 1/8"
5 3:52 — I 6" I —
L_ 6 J 4:02 10 3 1/16" 2 15/16"
403 — 6' —
I � 8� 4:13 I 10 3 1/4"
9
101
I 4:14
4:25
10
6"
I 3 5s 16"
2 3/4"
2 11/1
I
12
I 4:35
10
3 5/16"
12 11/16"
ALASKA WATER & WASTEWATER CONSULTANTS, INC.
SOIL LOG — PERCOLATION TEST
LEGAL DESCRIPTION: CONIFER HEIGHTS SUBDIVISION; LOT 4, BLOCK 3
PERFORMED FOR: LOUIS AND MARY BALEST
DATE PERFORMED: 9/29/99
(fePTH et) =� a TEST HOLE #2
ORGANICS
2 rnv7 SOIL CLASSIFICATIONS
3
4
5
6-
7-
9-
10-
11-
12-
13-
14-
w,n+ �µ
SM/GM
7 L LLI_iJ� �—
B.O.H.
15
16
17
18
19
20
COMMENTS:
DEPTH TO
READING
GW
DATE
ORG
9/29/99
s..;
GP
I_l_I_I
ML
SMI
YIIM
�Z�/I
GM
GC
P%l�/)
(r
CL
OL
oc o oc
o°n c°o°i
SW
—
MH
—
qua �ooa,
SPP
CH
10
3 5/16"
SM
�' '
OH
s 4 GrrA
3:44
SC
6"
—
s F
4
3:54
10
w,n+ �µ
SM/GM
7 L LLI_iJ� �—
B.O.H.
15
16
17
18
19
20
COMMENTS:
DEPTH TO
READING
GROUNDWATER
DATE
9.5'
9/29/99
7.4'
10/5/99
SITE PLANr J
1" = 100' --------
I I \
I
I /
I I
I I /
/ r
II I TH#1+ r H# /
DATE
READING
CLOCK
NET TIME
I WATER LEVEL
NET DROP
3.0
FT. AND
TIME
(MINUTES)
READING
(INCHES)
9/29/99
PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING
1
3:32
—
6"
—
3:42
10
3 5/16"
2 11/16"
3
3:44
6"
—
4
3:54
10
3 1/4"
I 2 3/4"
3:55
—
I 6"
I —
I
6 I
4:05
10
I 3 1/4"
12 3/4"
7 I
4:06
—
6"
I 8
4:16
10
3 1/4"
2 3/4"
�9
4:17
—
6"
—
I
10
4:27
10
3 1/4"
2 3/4"-
11
4:28
—
6"
—
12
4:38
10
3 3/16"
2 13/16"
PERCOLATION RATE
3.6
(MIN./INCH)
PERC.
HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN
3.0
FT. AND
3.5
FT.
PERFORMED BY ALASKA WATER & WASTEWATER. I, JEFFREY A. GARNESS, CERTIFY THAT THIS
WAS PERF RM D IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON
DATE: 0117-155
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
NAME
PHONE
EW
❑ UPGRADE
MAI LING ADDRESS
.7 C T- 130K 1176-
LEGAL DESCRIPTION
L � f �3fiF G a�v< fifiC. els,
LOCATION
PPX % d X Fv 1:71'/
NO. OF BEDRO MS
,
UY
DISTANCE To
Wel
..L /vi01
Absorption area
Dwelling
PERMIT NO.
b'`(9Chs -7
wQ
Manufacturer n n �I
Materialr,�C `
No. of compartments ,
Liq. cayagit ' allons
IF HOMEMADE:
Inside length
Width
Liquid depth
Z
DISTANCE TO:
Well
Dwelling
PERMIT NO.
2 Z FQ-
Manufacturer
Material
Liquid capacity in gallons
D
LU =
DISTANCE TO:
Well
Foundation
Nearest lot line
PERMIT NO.
J LL Z
F, z w
No. of lines,
Length of eyhlinq
SS
Total length of Iin
Trench width
inches
Distance between lines �
I//
HTop
p
of tile to finish grade 3<
Material beneath the
� inches
Total effective absorption area
0
LU
Length
Width
Depth
PERMIT NO.
Qa F
LU
Type of crib
Crib diameter
Crib depth
Total effective absorption
area
LU
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
Class N�� i
Depth
Driller
Distance to lot line
PERMIT NO.
w
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
nC'4s /,C C ,
SOIL TEST RATING
INSTALLER
REMARKS
A
7tt
APPROVED DATE LEGAL
/O - / 7 - �U
72-013 (Rev. 3/78)
I 1::�- I F=* F4 L_ I -r V I= �" IZ�. " 10 F:;;?- F-1 (3 F=
DEPARTMENT O- HEALTH AND ENVIRONMENTAL P,qTECTION ' -- ---
,
825 ~L STREET, ANCHORAGE.. AK. 99.264-4720 h
L4 F= L_ t- e F;;.' �F=RM I -r_���
PERMIT NO. ( 800573 )
APPLICANT HARRY H. MRCKEY ST RT BOX#1175 688=2813
LOCATION PORT OXFORD DR
LEGAL , LOT SIZE 43000 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 100
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
�FEF=r"= A_2" L_eN0"rH= 0Rr-lVE:L_ E>E:F�`r"= :S
THE LENGTH DIMENSION ISTHE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (%N FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
��F='*-rlf-- -rF4NK :E;l=-E:- �--zl"3k2l
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.
< -_2 > I F=* I -E (-- -r I Cj N �-- F:4 F;R.'a F;;?- F= L:;� U I F;;? a I -D,
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN H WELL AND ANY 0N -SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND
TO H COMMUNITY SEWER LIME 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.
F=" 1E FZ M I -r a X F=' I��LD, a C FE M 0 I=- FZ =--IL" 0
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.
]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE LEDA INCLUDE MORE T 4 BEDROOMS.
5IGNED:',�_~~_'--.-_
_______^___~_=�-
�
------
APPLICANT HHR�
R.
MACKEY
ISSUED _
twl 1.1 hi 1 (z: 11 F!" 001 IL 1 0- by C73 107 10 04 1711-1 &3 14 FA C3 K `
DEPARTMENT 1 HEALTH HND ENYIRONMENTHi 'ROTECTION
2516 E. [UDOR RD�, HNCHORHGE, RK. - '507 o'
~�
276-2221
1"A K A.. 1L. low V45 17; dy" Tys :1: 5- FE7 TO K 14 K F? FA K FR P1 1 J
PERMIT NO. ( 77064 )
APPLICANT 277-6776
L0CHTION PQRT OXFORD DR
LESHL
1-.4 B] CONIFER HGTS SUB[:- LUT SIZE 48794 SQUARE FEET
H CONTINUOUS MHINTE HNCE HGREEME I IRED. IF H MHINTENHNCE
AGREEMENT IS NOT KE T CURRENT YOU HY EQUIRED TO ENLARGE THE SOIL
ABSORPTION SYSTEM H�D/OR YOU MHY �� SUBJECT TO PROSECUTION.
IF H CLASS I SYSTEMJIS USED THE LENPTH IS 470 FEET.
IF H CLASS II SYSTEM\ IS USED THE LENGTH IS 61.0 FEET.
-T- hT fit 'c 2? > 1: 04 Y5 K -7- 1: (71 Tyj 45 V1 FR EH F1 EE C1 tj X FQ ET�
BACKFILLING OF ANY SYSTEM ITHOUT FINAL NSPECTION HND APPROVAL BY THIS
DEPHRTMENT WILL BE SUBJECT\TO PROSECUTION,
CTL
�' :rid V v��
�'
In
TEST HOLE LOGS
Test Hole 1
Elevation- 87.0 (assumed)
Water Table 24 Hours After Drilling- 717"
Seasonal Frost- None
Date Drilled- February 19, 1977
Total Depth- 14 feet
Depth Description
0 to 1' Brown, F2, wet Silty Gravelly Sand, SM
1 to 5' Grey, F2, damp Gravelly Silty Sand, SM
5• to 7h' Grey, F2, damp to wet Grave y Si ty Sand, SM .
7h to 14' Brown, F2/F4, saturated Gravelly Sandy Silt/ Silty Sand,ML/SM
Test Hole 2 - .
Elevation- 91.4 (assumed)
Water Table 24 Hours After Drilling- None
Seasonal Frost- 12 inches
Date Drilled- February 21, 1977
Total Depth- 11 feet
Date Saturated- February 26, 1977
Date of Percolation Test- February 27, 1977
Depth Description
0 to
1'
Brown,
F4,
damp
Organic Sandy Silt,
OL, PL
1 to
3'
Brown,
F2,
damp
Silty Sand, SM
3 to
5'
Grey,
Fl,
damp
Sandy Silty Gravel,
GM, Max. Size- 1"
5 to
8'
Grey,
F1,
damp
Silty Sandy Gravel,
GM, Max. Size- 4"
8 to
11'
Grey,
F2,
damp
Silty Gravelly Sand,
SM
Drilling Refusal
@ 11' (Cobble)
��
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i
��
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6132914 _ 0 rYli�i✓/fir
79 9Q
i
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February 28, 1977
Paul G. Hansen, P.E.
SRA Box 395-V
Anchorage, Alaska 99507
Mr. Vinod Batra
4907 Buckingham Way
Anchorage, Alaska
SOILS EXPLORATION AND PERCOLATION TEST
LOT 4, BLOCK 3, CONIFER HEIGHTS SUBDIVISION
ANCHORAGE, ALASKA: PROPOSED FIVE -BEDROOM
RESIDENCE WITH BASEMENT
In accordance with your request, soils exploration and percolation
testing for on-site sewage disposal were performed on the subject
lot. Drilling was performed on February 19 and 21, 1977 by Denali
Drilling, Inc. of Anchorage employing a Minuteman drill mounted on a
Playcat tracked vehicle and consisted of one 14' and one 11' test
hole. Logging and percolation testing were performed by myself in
accordance with the Unified Soil Classification System, Soil Tri-
angle, and the "Manual of Septic -Tank Practice". Soils were des-
cribed and classified by means of numerous grab samples..
The property is noted for a bluff approximately 40 feet high on the
western side of the 1.1 acre lot as well as two E -W trending gullies.
Both gullies, however, show no evidence of even intermittent flow.
The one nearest the proposed residence location has a natural dam
near the top of bluff, so it.would be impossible for any streamflow
to occur. The site is amply covered with large spruce and birch trees,
Indicative of good drainage. No ponding of ice or water was noted.
TH 1 was drilled in the low point of the gully in order to better
verify the absence of a water table; however, the water table was
encountered, finally stabilizing at 717". Since the water table was
too shallow for meaningful percolation testing, TH 2 was drilled .-
25 feet west at a higher elevation at the top of bluff. Drilling
refusal was encountered at 11 feet; however, no water table was
found. Based on the TH 1 water table elevation, we would expect tp
encounter it at 12 feet in TH 2; based on the topography of the bluff,
it is more likely at 14 feet or so.
In general terms, the soils consist of silty sandy gravel (GM), silty
gravelly sand (SM), and sandy silt/silty sand (ML/SM). Coarse gravel
and cobbles are occasionally present. A.percolation test was per-
formed in TH 2. A perforated plastic pipe was installed, and the
test hole was saturated for 24 hours prior to the test. The test
indicates a percolation rate of 5 minutes/inch, or 125 sq ft/bedroom.
The test hole logs would suggest a value of about 160 sq ft/bedroom.
In this case, the topography is an especially important factor in the
placement of an on-site sewage system. We recommend that a septic
tank and absorption trench be employed at locations indicated on
Sheet 3. This will minimize removal of large trees and will avoid
extensive earthwork in leveling the disposal area. The proposed
septic tank location will have to be raised about four feet with ap-
proximately 100 cu yd of fill, but this can be obtained from excavated
basement soils. The trench could parallel the top of bluff, as shown.
At this location, the water table would be at least 12 feet deep.
In my opinion, the
in terms of surface
disposal.
a,
�.• • . . ee .s.i�e
t�'�.•• �..yes..•�s.�..
k �
.c PATJL G. i3ANSEN fqs
Attachments
lot appears satisfactory for the proposed residence,
drainage, foundation soils, and on-site sewage
a
Paul G. Hansen, P.E.
i
fig-
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1 (4304d f; is I )ego I desc! i -I! I');
:�Pf tit he,
"Insf, ' 'Oil t e
I Of3cccaac.#.�
R 1 LLER 'S HATER W.
V� 'i tps ion s r-.
ro M. r d f't: s I y, rcj,7f I'Z
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 015-093-19
Legal description CONIFER HEIGHTS BLK 3 LT 4
Site address 7840 PORT ORFORD DR
Current property owner(s) GOTTHARDT TRACEY A
Expiration Date: 3/18/2025
XThe On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
By: Original Certificate Date: 5/14/2024
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 ApprovM_June 2022
MUNICIPALITY OF ANCHORAGE
o
.51
z�
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 015-093-19
Complete legal description CONIFER HEIGHTS BLOCK 3, LOT 4
Location (site address) 7840 PORT ORFORD DRIVE, ANCHORAGE, AK 99516
Current property owner(s) TRACEY A GOTTHARDT Day phone
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
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 NEW AX FAP 2.0 PENDING -See advisory if steel older than 20 years ry�k'J
�'Dvylw
6. ABSORPTION FIELD: ®AWWTS [:]Bed ❑ 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 $ 570 Waiver Fee $
Date of Payment / /' g �2 y Date of Payment
COSA # 0._', C Z c( Waiver #
COSA Application 2022.doc
COSA Checklist 2022.docx
COSA Checklist
Legal Description: CONIFER HEIGHTS BLOCK 3, LOT 4 Parcel ID: 015-093-19
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 11/12/1980 Total depth *291 ft
Cased to 207 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA 4/5/2024
Static water level at beginning of test 207 ft.
Well production at time of test 1.7 gpm
Water storage tank volume NONE gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 7.36 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 3/18/2024
Comments *PER MOA DOCS, WELL DEEPENED TO 291’ ON 8/22/1984. SIMILAR NITRATE RESULTS & WELL PRODUCTION
OF 2017 COSA DATA.
B. TANK DATA
Measured operating fluid level in septic tank NA
Date of pumping NA – ADVANTEX
Required maintenance completed, if AWWTS
Comments: NEW AX FAP 2.0 INSTALLED
C. LIFT STATION
Required maintenance completed
Age of lift station NEW years
Lift station material PLASTIC
Comments: NEW PUMP BASIN INSTALLED
D. ABSORPTION FIELD DATA – NEW ADVANTEX
Which system tested (date installed) NA - NEW FIELD
ALL standpipes present per record drawing
Total measured depth from grade 5.1 ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective. (ED)
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 date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date NA – NEW
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY – NOT TESTED
Effective depth (per record drawings) 30 in (MOA 2.5’ ED)
Effective depth used 0 in
Effective depth remaining 30 in
Comments/Deficiencies: NEW ADVANTEX SEPTIC SYTEM TANK & ABSORPTION FIELD INSTALLED MAY, 2024.
COSA Checklist 2022.docx
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’
Yes if No *50+ ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No *50+ ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
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
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No *5+ ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No *50+ ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No *50+ ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
*MAY MEET CONVENTIONAL SEPARATIONS, BUT SYSTEM MEETS CATIII SEPARATION DISTANCE
REQUIREMENTS.
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 FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 5/13/2024
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The 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 in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. 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, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
05/13/24
1®litrate Advisory
Certificate of On -Site Systems Approval # OSC241111
Subdivision: Conifer Heights, Block: 3, Lot: 4
A water sample revealed a nitrate concentration of 7.36 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. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. 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.
INIUNICIPALITY OF ANCHORAGE
ADN AN -CED NV 4STENAVATER TREATMENT SYSTEM
� AINTENANCE AND REPAIR AGREEMENT
THIS -A7\D REPAIR AGgR_EETME T, herein the ` -4GREEAIE\T" made and
entered int -o -as of this ( Da -%r of 1Gt✓ � of 20al by and between
e\ herein the "ONVNER," and the Municipality of
Anchorage, herein the "MI1i\TICIPA.LITY '', im accordance «=ith Anchorage Municipal Code
(AMC) 15.65.36-5. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The %Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AW«'TS).
described as _ AN ADVANTEX SYSTEM
located at (legal description)
CONIFER HEIGHTS BLOCK 3, LOT 4
2. Maintenance, Ret)airs and Alterations.
� (owner is required to read, understand and initial each section)
Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
mnanufacturer's representative. The AWNAITS shall be maintained in a satisfactory
condition capable of perfornning as designed and producing treated septic effluent in
accordance Frith the equipn�elifs approval for operation in the Municipaliq.
S11"
it shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), inalrltenance, adjustment(s), replacement costs, and inspection costs. This
S17includes an animal maintenance fee (typically 5400 to S600).
Owner agrees that only maintenance and repair personnel approved by the Muncipalit
Y
or the manufacturer's representative will inspect and make any necessary maintenance.
+�'� repairs or permitted alterations to the system.
J_ Owner acknowledges that regular maintenance of an A\W7TS reduces the potential
— �
failure of the system, which could include sewage back-up and costly repairs or draintield
replacement.
(rev. 05/18/2018) Pagel of 3
Other acknowledges that the may request I'eCOI'd5 of IliallltellaIlCe and
repairs froni the manufacturer's representative or maintenance provider.
Jam} Owner ackdiowledges that the fine for failing to maintain and repair an AWN TS may be
assessed in accordance with -AAIC 14.60.030.
Owner agrees to grant the NIunicipality reasonable access to test and inspect the
AN WTS. The Municipality will give at least 24-hour notice.
Owner agrees that any, sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
Owner agrees that the ANVAN TS installation and maintenance requirements
aS provided
by the ANNINNVTS vendor/installer and approved by the Municipality are the governing
,/ guidelines for the construction, maintenance and repair of the Owner's AIA WTS.
5) `
Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The tern -1 of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonivaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Lary. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Audicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of
Oil" N ER:
By:
(` (sigulature--) Date:
(Print nanie)
STATE OF ALASKA
) ss.
THIRD JUDICIAL DISTRICT
4"
The foregoing lnstniment «'as acknowvledged before me this day of
2044byr ,jj
NOTARY PUBLIC FORALASKA,
My Commission expires: ..909b v ofca�Seal
STATE OFAIASKA
Nohry PubIk
Nkokllonaz
Gbnrsidan•?30�100TCaee� F�meSl&giRf7T
MUNICIPALITY:
By. —�� (signature) Date: /S 7- -I
(print name) Title:
(reg-. 05/18/2 01 S) Page 3 of 3
•
• (F e V
Municipality of Anchorage
On-Site Water and Wastewater Program 4 6V I
(907) 343-7904
Certificate of On-Site Systems Approval
Parcel I.D. 015-093-19 Expiration Date: 00 g:1 0.O 1S
1. GENERAL INFORMATION:
Complete legal description CONIFER HEIGHTS; BLOCK 3, LOT 4
Location (site address) 7840 Port Orford Dr. *Anchorage 99516
Current Property owner(s) Kelly Snodgrass Day phone 242-5061
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (wlwo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class _Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: Date: /V-1 7/,7
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 5-a& Waiver Fee $
Date of Payment Or(lit? Date of Payment
Receipt Number d35 lob Receipt Number
COSA# 45ca-1K33 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 (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: (I I4f 4
0000p�4
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system oQ OF A \�04
in accordance with the guidelines and regulations established by the Municipality of Anchorage and � .
industry practices. The reported results describe the condition of the system/s on the date/s of theQQ Q`.•' ( '•, Q
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or Q
encroachments may exist that were not identified during the evaluation. The operational life of all wells / * ; A 9, H IJ ••,7*vO
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, /' Q
groundwater levels (that may fluctuate during the year), quality of construction (materials and VA
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and A
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the O :f r: A. , -•.s:
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of Qn m CE/79
the well or septic system. GEG makes no representation whether an alternative well or septic system v09 • .eco
can be installed on the property in the event either of the current systems fail to perform adequately in • � ,<,°�
the future. The content of this report is for the sole benefit of the person/party that retained GEG to 0� Pr o f e ss+o�40
perform the evaluation. Reliance upon the information provided in this report by any other person or 4��0�00��
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved ` Q*. "
Conditional approval for bedrooms, with the following stipula`t 14t, '0,
t, pc
ON-SITE '
G�
WATER AND
WASTEWATER
PROGRAM
Sr-
-
SER\ftC
By: la-ethl6.x-A UTin EcL Ian d Original Certificate Date: 1 1/� 1[201-1
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist Nitrate Advisory 7�
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10-10-12.doc
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: CONIFER HEIGHTS: BLOCK 3. LOT 4 Parcel ID: 015-093-19
A. WELL DATA 'WELL DEPPEND IN 8/22/84
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 11/12/80 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth "291(?) ft. Cased to 207 ft. Casing height(above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 11/12/80 11/1117
Static water level 190 ft. 206.4 ft.
Well production 4 TO 5 g.p.m. 1.8 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 ml. Nitrate
7 52 mg./L. Collected by: GEG, Ltd.
Arsenic: <5.0 ug./L. Date of sample: 10/19/17
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material S.T.E.P./STEEL Date installed 5/9-10/2000
Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES
Date of pumping I1 1111-4- Pumper A, 14 E_ s-eilvtLes
C. ABSORPTION FIELD DATA -BELOW EXISTING GRADE AT Mu
Date installed 5/9-10/2000 Soil rating (qp.d./)or ftlbdrm) 2 0 System type IDSF BED
Length 20 ft. Width 18 ft. Gravel below pipe 0 36 ft.
Total depth *2.3+ ft. Eff. absorption area 360 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 11/1/17 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test DRY in. Water added 677 gal. New depth DRY in.
Elapsed Time: 0 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 -
-ELEVATION OF ALL FOUR (4)MONITORING TUBES WERE SHOT AND FOUND TO BE WITHIN 1 INCH OF EACH OTHER
'SECOND COMPARTMENT OF 1500 GALLON STEP TANK
"SEE A+HOME SERVICES IDSF INSPECTION REPORT
D. LIFT STATION ***PER 2000 MOA ELECTRICAL INSPECTION REPORT
Date installed 5/9-10/2000 Size in gallons *500 Manhole/Access (Y/N) YES
"Pump on" level at TIMERin. "Pump off'level at TIMERin. High water alarm level at •• in.
Datum "" Cycles tested Meets alarm& circuit requirements? —.YES
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 75'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 25•+ Holding tank 75'+
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 10'+ 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 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
EAST SIDE OF BED IS SHORT COVER BY APPROXIMATLEY 1-2 INCHES-SEE ATTACHED E-MAIL FROM OWNER REGARDING
NO FREEZING • I F 1-41'4.---r
Cc."LI) Nn: 26- G'CF�446IJ/fL4rAE- • c6S
I N t .brJ Y' Porvg ' f 'iv c p 7`- (gyp'_ chi c'l'
.ataal�:
.•'-'(\E OF ��te
G. ENGINEER'S CERTIFICATION :- '• •t,
I certify that I have determined through field inspections and , *.: '9 • r •
review of Municipal records that the above systems are in • fi•
conformance with MOA COSA guidelines in effect on this • •
• •• •••:• •
da No
te. I.cm : Je-r �•. Gornes. j i
Engineers Printed Name JEFFREY A. GARNESS +�J'J�•., •• 79 .4").4.V�:
Date ll /7-//1-• rough fPRoFa•••
*AECCBB4
(Rev.10/12/12)
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p co 49 TH ,..-8.- 9000
s-Aeof,A, // �o AS-BUILT SURVEY 1" =30'
0 O NO CORNERS SET THIS DATE
On: SHANE A.HOLT QO
VOf
Q 4'•a � 91•� o GI (I—HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
44�0/��:iG�>1140o OF THE FOLLOWING DESCRIBED PROPERTY
04000° LOT 4, BLOCK 3, CONIFER HEIGHTS SUB.
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THEINFORMATiONHEREONISFORTI-IEUSEOfLENDINGINSTITUTIONSSPECIFICALLYTOSHOWANY \ THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS.AND IS EXIST OTHER THAN NOTED.
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES.IMPROVEMENTS,OR FENCELINES.
EASEMENTS OF RECORD,OTHER THAN THOSE APPEARING ON THE RECORD PLAT,ARE NOT SHOWN DATED AT ANCHORAGE,ALASKA THIS _19TH DAY OF
HEREON(UNLESS INDICATED) OCTOBER , 2017.
NOTE FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. HOLT LAND SVRVEYIN6
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. `
\ 9309 GROVER DRIVE
\\` \ ANCHORAGE,AK 99507
13743. =B 1!14-78 345-5513
Municipality of Anchorage Y
•; r' Development Services Department
Building Safety Division ` �' Y
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 # OSC 171533
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 3, Lot 4 of
Conifer Heights subdivision. This inspection revealed a nitrate concentration
of 7.52 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.
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ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
BETWEEN MUNICIPALITY OF ANCHORAGE/
AND N(t1 CIOl1haat-
THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this
\ j � 1V(Ace'L, CiO I
y Day of / " Juf�r1,h c?- of 20 I -t;by and between �t(0
J
herein the"OWNER,"and the Municipality of Anchorage,herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein,the
parties to this Maintenance and Repair Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. Municipality grants permission to
Owner to utilize and operate an Advanced Wastewater Treatment System
(AWWTS),described as F:
located at(legal description). ,� u
( fc r 1-11-s ► c; L- /
2. Definitions.
Alteration. Any change to the design or function of an AWWTS that
includes the installation or removal of any parts,components or pieces not
included in the original construction permit and design.
Certificate of On-Site Systems Approval (COSA). An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with Anchorage
Municipal Code(hereinafter,"AMC") 15.65.These approvals certify that
rV.
the systems are adequate for the homes that they support and meet the
codes that were in place at the time of system construction.
Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AWWTS that were included
in the original design which would allow the AWWTS to continue to
perform as designed.
Permit. An On-Site Wastewater Disposal Permit as required by AMC
15.65 to construct and operate an AWWTS.
3. Term. The term of this Maintenance and Repair Agreement shall begin on the
date of approval by the Municipality to operate the installed system or issuance of a
COSA, and shall continue while the AWWTS is in use or is operational or until the
property is sold or title is transferred by the owner and a new COSA is issued to the
new owner or transferee of the property.
4. Alterations.Installation and Removal of Additional I quiprocrit. Prior to
performing any alterations to an AWWTS,the owner agrees to obtain an On-site
Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65.
5. Maintenance and Repairs.
A. Throughout the term of this Maintenance and Repair Agreement,the Owner shall
maintain their AWWTS in a satisfactory condition capable of producing treated
septic effluent in accordance with the equipment's approval for operation in the
Municipality. The owner shall enter into a service agreement with an AWWTS
Vr.
service and maintenance provider approved by the municipality and the
manufacturer of the AWWTS for the entire term of the AWWTS. In addition, it
shall be the responsibility of the Owner during the term of this Maintenance and
Repair Agreement, and any renewals thereof,at the owner's sole expense,to pay
for any and all: (1) repair(s), (2) maintenance,(3)adjustment(s), (4)replacement
costs,and (5) inspection costs.
B. Owner agrees to comply with all applicable ordinance, laws, regulations,rules
and orders for the AWWTS.
C. Upon request by the Municipality, the owner agrees to provide the Municipality a
written schedule of routine maintenance and repairs which have been performed
on the system. When a record of maintenance is documented and maintained by
the system vendor,the owner agrees to allow the Municipality access to this
information.
D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS
may be assessed in accordance with AMC 14.60 for improper discharge.
E. Owner agrees that only maintenance and repair personnel approved by the
Municipality will inspect and make any necessary maintenance, repairs or
permitted alterations to the system.
F. Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS upon 24 hours written notice.
G. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On-Site Systems Approval.
11111111r
iwneragrees that the AWWTS installation and maintenance requirements as
provided by the AWWTS vendor/installer and approved by the Municipality are
the governing guidelines for the construction,maintenance and repair of the
Owner's AWWTS.
6. Nonwaiver. The failure of either party at any time to enforce a provision of this
Maintenance and Repair Agreement shall in no way constitute a waiver of the
provisions, nor in any way affect the validity of the Maintenance and Repair
Agreement or any part hereof, or the right of such party thereafter to enforce each and
every provision hereof.
7. Amendment.
A. This Maintenance and Repair Agreement shall only be amended, modified or
changed by a writing, executed by authorized representatives of the parties,with
the same formality that this Maintenance and Repair Agreement was executed
with,and such writing shall be attached to this Maintenance and Repair
Agreement as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this agreement,the only authorized representatives of the parties
are: /I 1��
a. Owner: V(%�( Ci0�" r ..
b. Municipality: Director,Community Development or designated authority
C. Any attempt to amend,modify,or change this contract by either an unauthorized
representative or unauthorized means shall be void.
1111111F:. risdiction: Choice of Law. Any civil action arising from this Maintenance
and Repair Agreement shall be brought in the Superior Court for the Third Judicial
District of the State of Alaska at Anchorage. The laws of the State of Alaska shall
govern the rights and obligations of the parties under this Maintenance and Repair
Agreement.
9. Severability. Any provisions of this Maintenance and Repair Agreement decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining
provisions of the Maintenance and Repair Agreement
OWNER:
By: 0,44o7V t'�(C L '(signature) Date: //// 7/4 7
V j I Y 1a vLtT ;. N. 75
1 (print name) �� UTd,
s•-ff.: NO1ARY '' -
�• * PUBLIC • =
!
ill STATE OF ALASKA (pt!i ) _ * =
to' tetictial&diskigi j? ) ss. No. 91-762 ;:
f1) The foregoing instrument was acknowledged before me this 17 iff day of kiNl, it ,P t.'
"W° 201'( , by /OWN bjENh 14-
Doc.Date: it 1114W I/ #Pages
ZI. ee ,). ..... 1 Notary Name:Valeria N.Tsutsuml First Circuit
Doc. Description "AIL' L ak4.4,-
NOTARY PUBLIC ORq�,ASKA . .. 1r�finent At-42b.) �/ e/its " "r''°'"-
My Commission expires: September 1p,20 ? Z •�' ill 11 1I
` c N. T>0Ts,Notary Signature Date
j.:: NOTARY
- • PUBLIC
_ * = -
No. 91-762
MUNICIPALITY: ,sl"q4OFHP
P
By: laAAtfU: (sig ,,. , '
ure)
Date: 111 L'7 20 ! 1
Re/becco. Car ro It (print name) Title:
Parcel I.D.
Municipality of Anchorage
Development Services Department
Building Safety Division
OnSile Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-0650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
015-093-19
1. GENERAL INFORMATION
&T
Expiration Date: K-2,&- 07
Complete legal description Conifer Heights Blk 3 Lot 4
Location (site address) 7840 Port Orford Drive, Anchorage, AK 99507
Current Property owner(s) Sean R. & Sandra L Pannell Day phone
Mailing address 7840 Port Orford Drive, Anchorage, AK 99507
Lending agency Day phone
Mailing address
Real Estate Agent Beth Simpson/Keller tNllliams Alaska Group Day phone 907-727-2384
Mailing Address 101 W. Benson, Blvd, Suite 200, Anchorage, AK 99503 ANCHORAGE, AK 99503
Unless otherwise requested, COSA will be held by DSD forpickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
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 Onsite 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 Onsite Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single4amily on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of Onsite 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 sample results. (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 Onsite 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 Watkins Engineering, Inc. Phone 907-349-1851
Address P.O. Box 110443, Anchorage, AK 99511.0443
Engineer's Printed Name Cindy W. Ellis, P.E. Date 2121/2007
6. DSD SIGNATURE
l� Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
WATERAND - in: -
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: l� Original Certificate Date:
(Rw 11,m)
Municipality of Anchorage
• Development Services Department
Building Safety Division
Onsite Water & Wastewater Program
4700 Bragaw Street
P.O. Box 198650
Anchorage, AK 99519850
www.muni.orglonske
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Conifer Heights Blk 3 Lot 4 Parcel ID: 015-093.19
A. WELL DATA
Wen type Pry 11 A, S. or C provide PWSID 0
Date completed N/1211980 Sanitary seal (YIN)Yes
Total depth 212 ft. Cased to 207 ft.
FROM WELL LOG
Date of teat 11/12/1980
Static water level 190 ft.
Well production 4 th 5 g.p.m.
WATER SAMPLE RESULTS:
Conform 2-colonies/100 mL Nitrate 6.86 mg1L
Arsenic: X0_005 mgry Date of temple: 1/292007
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material S.T.E.P/ Steel
Tank sae 1500 gat. Number of Compartments 2
Well Log (YM) Yes
Wires property Protected (YIN) Yes
Casing height (above ground) 24+ in.
AT INSPECTION
1292007
204 ft.
1.6 9 -
p.m -
Other bacteria 0 colonies/100 mL
Collected by: Rocky Trainor
Date installed 5!92000
Cteanouts (YM) Yes
Foundation cleanout (Y" Yes Depression over tank (YIN) NO High water alarm (YM) Yes
Date of pumping 7242008 per Isaacs Pumping Services
C. ABSORPTION FIELD DATA
Date installed 5192000 Soil rating (g•p•d.lfte or fte/bdrm) 2.0 System type Bed
Length 20 ft. Width 18 ft. Gravel below pipe 0.38 ft.
Total depth 2•B 1t. EB. absorption area 38� f e Monitoring tube Yea Depression over field no
Date of adequacy test 1292007 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0.75 in. Water added 03 gal. New depth 2.5 y,•
Elapsed Time: 20 min. Final fluid depth 0.75 in. Absorption rate >= 600 g.p•d.
Any rejuvenation treatment (peat 12 mo.) (YIN & type) No If yes, give date
D. LIFT STATION
Date instaned &WOW Size in gallons AM STEP Manhoie/Acceas /NY
'Pump on' level at timer in. 'Pump ofr level at timer in. High water alar NMI at 48 in.
Datum bottom of tank Cycles tested 10+ Mests alarm & arcuit requimmerns9 Yea
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanklUR station on lot 109 On adjacent Iota 100+
Absorption field on lot 123
Public sewer main 100+
Sewer /septic service line 80+
On adjacent iota 100+
Public sewer manhole/cleanout _1.00+
Holding tank 100+
Animal Containment areas 100+ Manure/animal excrete storage areas 100+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 28+ Property line 80
Water main 100+
Wells on adjacent lots 100+
Water service line 81
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorption field 33
Surface water 100+
Property line 10 + Building foundation 40+ Water main 100 +
Water Service line 80+ Surface water 100 +
Driveway. parki Vahide storage 35+
Curtain drain NA Wella on adjacent lots 100 +
F. COMMENTS: IDSF. Compressor operating satisfactorily. Maintenance agreement signed by buyer is attached
G. ENGINEER'S CERTIFICATION
I certily that I have determined through flea inspection and
review of Muninpal records that the above systems are in
conlormaroe with MOA COSH guidelines in effect on this date.
Engineer's Printed Name Cindy W. Ellis, P.E.
Date 2/21/2007
COSA Fee S !
Date of Payment .2IUrI
Receipt Number
(Rev. tips)
Waiver Fee $
Date of Payment
Receipt Number
49TH
IaY W. Ellis
CE -loan
LOT 6
,5o
LOT -5
S 86'30'00" E 150.00'
6$ h� 10' UTILITY EASEMI NT
5 5 Op --- ---------- ---
30,
S 7g 56
LOT 4 °
IS
EWER
MANHOLE
OF TSTARCN
/
LOT 3
ohaa.co •v,
KATHI JOHNSON
JACK WHITE COMPANY
LAND h CONSTRUCTION SURVEYORS -
440 WEST BENSON BLVD. # 103
ANCHORAGE. ALASKA 99503
2001 -L -289A KLDev v,co f 024401
KLO
E
180.00
,
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LS -8202 +ei
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30' 4��O00000��Q�
EXCLUSION NOTES: It is the a.ners' responsbXity to delermine
the exislante at any easements. CoVenanlf, a restrictions
rhith do not appear art the f4COrded suad-.%iW, plot. NOTE;
Under no ClreulnstaACAS should any data hereon be used for
Construction ar for e3toClishin9 properly Unes.
SURVEY CERTIFICATION: LANILCN has ConduCted a
physical survey of this property ds sheen On this
drawing and that the improvements situated there•
W We .ilhin the properly I:neS and no enaooCh-
ments exist other than noted.
AS—BUILT OF; LEGAL OESCRtPnON
5/4'119 w/CAPQQ 5/8' 1*8 O
3.25* AL.MM. OMaNWEnT
Nue R TALK 0
EERCC-—
OVElblMG-
WOOD OEOIS- r
STMOPPES-
107) 562-5291 LOT 4, . BLOCK 3,
(Tax) 361-6626
eoo.a: CONIFER HEIGHTS
n•
REF 941.444
Municipality of Anchorage ,..
• '� Development Services Department
Building Safety Division '
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 070032
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 3, Lot 4 of
Conifer Heights subdivision. This inspection revealed a nitrate concentration
of 6.86 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
attathed"Nitmt FaetSheet"-for-important-information-regarding-nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
Municipality of Anchorage -0
Development Services Department .^ ��` E'.
• i - Building Safety Division
On -Site Water 8 Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-093-19 HAA# H A (! r t7 -5'- / 6
1. GENERAL INFORMATION Expiration Date: / — O
Complete legal description CONIFER HEIGHTS SUBDIVISION; LOT 4, BLOCK 3,
Location (site address or directions) 7840 PORT ORFORD DRIVE • ANCHORAGE, AK 99516
Current Property owner(s) AMY & WILLIAM McFARLAND Day phone 344-7543
Mailing address 7840 PORT ORFORD DRIVE ' ANCHORAGE, AK 99516
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing address
Unless otherwise requested, HAA will be held by DSO for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
E
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 Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered In the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority
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 engineers
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 Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(aro) 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 riles 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone
Address 6901 DEBARR ROAD, SUITE 2B " ANCHORAGE. AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, AWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines 8 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 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. AWWC, Inc. 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 parry is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Date
337-6179
/O/J /j—
oo6o`JO
o 4� TH
C--toe7953
orn
�Otli• . eoQoa
Conditional approval for 4 bedrooms, with the fllowing stipulations:
NOTE: THE WELL ON THIS PROPERTY MEETS EXISTING STATE AND MUNICIPAL CODES. THERE ARE NITRATES
PRESENT. IT IS SUGGESTED THAT PERIODIC TESTING BE PERFORMED TO INSURE THE WELLS CONTINUED SUITABILITY.
CURRENT NITRATE CONCENTRATION IS 5.34 mgt. EPA MAXIMUM CONCENTRATION IS 10.0 mg1L. MORE INFORMATION
ON NITRATES IS AVAILABLE FROM THE ON-SITE SERVICES PROGRAM, A T 343.7904.
At the time of title transfer the new property owner shall sign the attached
mainrpnnnrr neroPmonr vhirh chill ha rotnrnort to 'thio nffioo b<foro n"
unconditional approval will be2issued.
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
(Rn. 12101)
✓ Manitenance Agreements
Supplemental Engineer's Reort
Other
Original Certificate Date:
Municipality of Anchorage 0
��.
• Development Services Department
Building Safety Divbbn
.. ':.
On-Sra Water & Wastewater Program
470D South Bragaw St.
P.O. Box 196650 Anchorage, AK 995194650
www.dandarage.ak.us
(907)343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: CONIFER HEIGHTS S/D; LOT 4, BLOCK 3, Paroel ID: 015-093-19
A. WELL DATA
Well" SATE If A, B, or C provide PWSID# N/A Well Log (YM) YES
Date completed 11 /12/80 Sanitary seal (Y/N) YES Wires property protected (YM) YES
Total depth 212 ft. Cased to 207 ft. Casing height (above ground) 18+ in.
FROM WELL LOG AT INSPECTION
Date of test 11/12/80 9/30/2002
Static water level 190 ft, 204 ft.
Well production 4 g.p.m. 1.41 g,p,rn,
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate .5AamgR. Other bacteria 0 oolonies/100 ml.
Arsenic: MIA. mg./L. Date of sample: 9/30/2002 Collected by: AKWWC, INC.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL/S.T.E.P.
Tank size 1500 gal. Number of Compartments 2
Foundation deanout (YM) YES Depression over tank (Y/N) NO
Date of pumping 10/3/2002 Pumper
Date installed 5/15/2000
Cleanouts (YM) YES
High water alarm (YM) YES
A+ HOME SERVICES
C. ABSORPTION FIELD DATA "ELOW FINAL GRADE To Tor OF SAND.]
Data Installed 5/15/2000 Soil rating .p.d ftt/bdnn) 2_0 System type I.S.F.
Length 20 ft. Wklth 18 ft. Gravel below pipe 0.36 ft.
Total depth 2.55 ft. Eff. absorption area 360 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 9/30/2002 Results (Pass/Fall) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 In. Water added 603 gal. New depth 0 in.
Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate x 600+ g,p.d,
Any rejuvenation treatment (past 12 mo.) (Y/N b type) NONE KNOWN If yes, give date —
D. LIFT STATION
Date installed 5/15/00 Size In gallons 1500 S.T.E.P. Manhole/Access (YM) YES
"Pump on" level at TIMER in. 'Pump otP level atTIMERIn. High water alar level at 46 in.
Datum BOTTOM OF TANK Cycles tested *N/A Meets alar 6 circuit requirements?—YU_
E. SEPARATION DISTANCES I *QUM1ERLY INPEC ION PERFORMED BY
A+- HOME SERVICES 10/2002
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAlft station on lot 100'+ On adjacent kits 100'+
Absorption field on kit 100'+ On adjacent kits 100'+
Public sewer main N/A Public sewer manhole/deanout N/A
ii Sewer /septic service line 25'+ Holding tank N/A
I SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
i
' Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
i Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line t O'+ Building foundation t0'+ Water main N/A
Water service line t0'+ Surface water t 00'+ Driveway, parkinghrehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and
review of Munidpal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineers Print71X
Date /0
HAA Fee $ cJ / 5
Date of Payment 10/07102-
Receipt
0/71ozReceipt Number �3
(Rev. wool
Waiver Fee $
Date of Payment
Receipt Number
10/03/02 TRU 11:59 FAX 907 562 5485 PRUDENTIAL VISTA REAL E Z002
LOT 5 30,
LOT 6. „
@l S 86'30'00" E 150.00'
/
3p
68 41
10' UTILITY EASEMENT
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30'
HEW" -BCK{[ie-9Wk[MCIC EXCLUSION NOTES: R is the owners respansasity to determine LEGEND: SET FND
O+oEwsa r,h
K A TH 1 .JOHNSON
Me existence of any eosemenls. covenants. or restrictions 3/8'Re W/W@ 5/e' RS 0
Which do not appear on the recorded subdivision plot. NOTE: S,2Y ALYON. Q1 MONUMENT
JACK WHITE COMPANY
Under no elrcumstoncas should any data hereon be used fa Ntdl • TAO(p
cen"clion a fa establishing property lines. rE"OC-
+iAl'fLiA`K K K1iiK K K FFK K K
SURVEY CERrirlCATION: LANTECH hos conducted o OVERNANG-
physicol survey of this property as shorn W this WOOD OECxS-
r
Waring and that the improVWmenls s;tualed Mere- CONCRETE-
®
en ore within the properly lines and no encroach- AWNALT- 0
Ment, exist other than noted. GRAVEL-
AS—BUILT OF: LEGAL DESCRtPTION: SEPTIC STANpowES-
LAND k CONSTRUCTION SURVEYORS -PLANNERS -ENGINEERS WA" WELL -
WEST BENSON BL.
ANCHORAGE, aLaSKA 99503
ANC ALAS
(907) 562-5291 LOT 4, BLOCK 3, IrP
HORN ORDER NUNOCR:
MAY 22
cid.) 56,-6626"
CONIFER HEIGHTS'
2001—L -289A
ir
KpeD
e
z 4D
RE L 44
Municipality of Anchorage
j Development Services Department
Building Safety Division
Onsite Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage,'AK 99519-6650
www.d.onchorage.skus
(907) 343.7904
A<
♦ , pY,
CERTIFICATE OF HEALTH AUTHORITY. APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-093-19 HAA#
1. GENERAL INFORMATION Expiration Date: �i ' ✓�' d /
Complete legal description CONIFER HEIGHTS SUBDNISION; LOT 4, BLOCK 3
Location (site address or directions) 7840 PORT ORFORD DRIVE
Current Property owner(s) MARY BALEST/LEWIS Day phone 346-7840
Mailing address
Lending agency. -
Mailing address
Real Estate Agent
Mailing address
7840 PORT ORFORD DRNE, ANCHORAGE, AK 99516
Day phone _
KATHI JOHNSON: PRUDENTIAL J. W. IDay phone 762-3123
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Weil
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority
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 sample results less than 30 days old. (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 seat affixed hereto and as of the validation date shown below, I verify that my
Investigation, based on procedures outlined in the Health AuthorityApproval 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 Mun/cipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Finn ALASKA WATER & WASTEWATER CONSULTANTS, INC.
Address 6901 DEBARR ROAD, SUITE 28 ' ANCHORAGE, AK 99504
Engineers Printed Name JEFFREY A GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, AWWi?, Inc. attempted to provide a thorough,
conscientious engineering analysls of the system In accordance with ADEC and MOA
DSD Guidelines & Regulations. The repertod 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 No of all wells and
septic systems depend on the local solls condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of 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. AWWC, Ina 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 solo benefit of the owner listed above. Any reliance upon or use of this report by any
other person or parry Is not authodzed, nor will It confer any legal tight whatsoever,
5. DSD SIGNATURE
Approved for 174 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the fllowing
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Phone 337-6179
Date 3 (
Manitenance Agreements
Supplemental Engineer's Reort
Other
0Ff'lcy��i,
• ON-SITE: • �r
WATERAND.
WASTEWATER
PROGRAM ;
ca
By-_ (2`Original Certificate Date: S'
(RW. 12=) //
Municipality of Anchorage
u"a Ya,
• Development Services Department
Building Safety Division
On.Slts Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 198850 Anchorage, AK 99519-8650
www.d.anchomge.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: CONIFER HEIGHTS SUBDIVISION; LOT 4, BLOCK 3 Parcel ID: 015-093-19
A. WELL DATA
Well typo PRIVATE If A. B. or C provide PWSID# N A
Well Log (Y/N) YES
Date completed 11/12/80 Sanitary seal (YM) YES
Wires property protected (Y/N) YES
Total depth 212 ft. Cased to 207 ft.
Casing height (above ground) 18+ In.
FROM WELL LOG
AT INSPECTION
Date of test 11/12/80
5/21 /01
Static water level 190 ft,
204 ft,
Well production 4 g.p•m•
1.6 9 -P.M.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate 4.92 mg./L.
Other bacteria 0 colonies/100 ml.
5/21 /01 Collects •
Date of sample: by:
AWWC, INC.
B. SEPTICIHOLDING TANK DATA
Tank Type/Material STEEL
Data Installed 5/15/00
Tank size 1500 gal. Number of Compartments E
Cleanouts (YM) YES
Foundation deanout (YM) YES Depression over tank (YM) NO
High water alarm (YM) YES
Date of pumping 5/30/01 Pumper
DENALI SEWER & DRAIN
C. ABSORPTION FIELD DATA •TO TOP OF SAND
Date Installed 5/15/00 Soil rating .p.d. r fe/bdrm) 2-0
System type LS.F.
Len 20 ft. Width 18 ft. Gravel below pipe 0.36 ft.
g�
Total depth 02.45 ft. Eff. absorption area 360 W Monitoring tube YES Depression over field NO
Date of adequacy test N/A Results (Pass/Fail)
PASS For 4 bedrooms
Fluid depth in absorption field before test _.QL in. Water added _ gal. _in.
W
Elapsed Time: _ min. Final fluid N YSTEM.Absorption
rete >= g.p.d.
atment (past 12 mo.) (YM & type)
If yes, give data
D. LIFT STATION
Date installed 5/15/00 Size in gallons 1500 S.T.E.P. Manhole/Access (Y/N) YES
"Pump on' level WINER In. "Pump off" level atTIMERIn. High water alarm level at 46" in.
Datum BOTTOM OF TANK Cycles tested "N/A Meets alarm & circuit requirements? YES
E. SEPARATION DISTANCES 'OUARTERLY INPECTION PERFORMED BY
A+ HOME SERVICES 5/2001
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
On adjacent lots 100'+
On adjacent lots 100•+
Public sewer manhole/cleanout N/A
Sewer /septic service line 25•+ Holding tank N/A
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 1 have determined through held inspections and e ? hi
review of Municipal records that the above systems are in ......
• . . • • • • •. • •"'
conformance with MOA HAA guidelines /n effect on this date.
J f A. GornessEngineersPrin me JEFFREY A. GARNESS + •, E-7953
Dace 31 0/ p'., •..........•
u�l�wP�o
HAA Fee $ 500 • c
Date of Payment to �O 1
Receipt Number _.5175
(Rev. 12=)
Waiver Fee $
Date of Payment
Receipt Number
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 1.D.# n1�—�>- 1�1 HAA#
1. GENERAL INFORMATION
Complete legal description Conifer Heights, Block 1, T.nt- a
Location (site address or directions) 7840 Port Orford Drive, Anch, AK 99516
Property owner Loyd & Darlene Miller Day phone 346-1917
Mailing address 7840 Port Orford Drive, Anch. AK 99516
Lending agency Day phone
Mailing address
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4 -
3. TYPE OF WATER SUPPLY:
Individual well X
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:
X
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 MOAN21
5. STATEMEt4f OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm Environmental Management, Inc.
Phone 907 272-9336
Address 206 E. Fireweed ln., # 201, Anchorage, AK 99503
Engineer's signature
6. DHHS SIGNATURE
_4e:f�_Approved for bedrooms.
By:
Disapproved.
Conditional approval for
Additional Comments
Date
bedrooms, with the following stipulations:
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-M (Rev. 1/91) BeCk MOA 821
Municipality of Anchorage IaL
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Conifer Heights, Block 3, Lot 4
Legal Description: Parcel f. D.
A. Well Data
Well type Private If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Yes Date completed 1 1-1 2-80 Driller Mitch Mitchell
Total depth 21 2 f t. Cased to 207 f t. Casing height 9411
Sanitary seal (Y/N) Yes Wires properly protected (Y/N) Y,- �q
Date of test
FROM WELL LOG AT INSPECTION
11-12-80 7-11-94
Static water level 1 9 0 ft.
Well flow 4 to 5 g,p,m,
Pump levell
192 ft.
5
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 1 0 5 f t . ; On adjacent lots
Absorption field on lot 1 1 0 f t . ; On adjacent lots _
;0 r
rn <__
n r -
r i
/ �r
co
rrn
C7
150 ft.+
150 ft.+
m
56 z
a
7�. r
o
M T
C
rrn
N
v
Orn
Z
Public sewer main
N/A
Public sewer manhole/cleanout
N/A
Sewer service line
N/A
Petroleum tank
N/A
WATER SAMPLE RESULTS:
Coliformy c.IarA- $ /loon.(. Nitrate y. 3 m2: Other bacteria O
Date of sample: 7-1 1-94 Collected by: Chad Helgeson
B. SEPTIC/HOLDING TANK DATA
Date installed 10-17-80 Tank size 1250 Compartments 2
Cleanouts (Y/N) Ypa_ Foundation cleanout (Y/N) Yes Depression (Y/N) No
High water alarm (Y/N) No Alarm tested (Y/N)
Date of pumping 11-3-93 Pumper Isaacs Pumping Service
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 1 0 5 f t . On adjacent lots 1 f f + Foundation I9--€ t: -
To property line 2 0 f t. + Absorption field 11 ft- Water main/service line N/A
Surface water/drainage 1 4 6 ft.
72-026 (3/93)• Front CONTINUED ON BACK PAGE
C. LIFT STATION N/A
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
_Cycles tested
Surface water
Date installed 10/1711 0 Soil rating (GPD/Ft2) 100 sq. f t/bdrm System type Trench
Length 35 ft. Width 3 ft. Gravel thickness 8 ft. Total depth 10 ft.
Total absorption area 560 sq. ft. ,Cleanout present (Y/N) YeS Depression over field (Y/N) No
Date of adequacy test 7/11/94 Results (pass/fail) Pass for 4 Bedrooms
Water level in absorption field before test 32 inches After test 49 inches
Peroxide treatment (past 12 months) (Y/N) No If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 110 ft.
To building foundation 29 ft.
On adjacent lots 150 ft. -f-
Surface
rSurface water None Observed
Curtain drain None Observed
E. ENGINEER'S CERTIFICATION
On adjacent lots 150 ft. -t- _Propertyline 30 ft. -t-
Cutbank
To existing or abandoned system on lot 11 ft:
None Observed Water main/service line 44 ft.
Driveway, parking/vehicle storage area 25 ft.
1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in
Signature
Engineer's Name
Date
HAA Fee $ 21YQ cdb
Date of Payment 2 ;�- a/-9 "-
Receipt Number � JA, (, ?,.5-32
72-026 (3/93)` Back
ate of this inspection.
oF Aa4r�
X, John Earl Simpson
CE -8061
Waiver Fee $ _
Date of Payment
Receipt Number.
,7
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date February 13, 1986
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 4 Block 3 Conifer Heig is
Location (address or directions)
7840 Port Oxford Drive off Hil.'
e Drive
IL
(b) Applicant Name Payne Henderson Telephone: Home Business 561-5107
Applicant Address 440 W. Benson Anchorage, Alaska 99503
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other ® (explain); Engineer
(d) Lending Institution Telephone
Ar1rirPCC
(e) Real Estate Company and Agent Heritage Homes and Investments
Address 207 E. Northern Lights Blvd. Anchorage, Alaska 99503
TPIPnhnnP. 276-1333
(f) Mail the HAA to the following address: R
Mail to: Peninsula Engineering 440 W., Benson Anchorage, Ak. 99503
2. TYPE OF RESIDENCE '
Single -Family ® Multi -Family ❑ Other
Number of Bedrooms 4
3. WATER SUPPLY
Individual Well ® Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite ® Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11/84)
r"
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm Peninsula Engineering Telephone -
Address 440 W. Benson Anchorage, Alaska 99503
Date February 13, 1986
,*,�T%ul A
f oe �f
• B. W NE .N so I o
®' CE -4488
®�cT •ytl000.000.•°OmfessloraA
561-5107
6. DHEP APPROVALS
Approved for 4 bedrooms by Date
Approved J46W l/_ Disapproved Conditional
Terms of Conditional Approval
CAUTION
Engineer's Seal
FEbruary 18, 1986
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGI
DEPT.OF HEALTH '&
MUNICIPALITY OF ANCHORAGE'(MOA,, ENVIRONMENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA) ' � E B 14"
CHECKLIST`- FEBRUARY 1884
264.4720
C E i V E D
Legal Description: ��l a
A. WELL DATA
Well Classification-ZIDIVID it& -L If A B,, C, D.E.C. Approved (Y/N) V'
Well Log Present (Y/ l)— Date Completed A/%/Z%
Total Depth UZZ Cased to 2-0 7 � Depth of Grouting � -
Static Water Level `1611 Pump Set At
Casing Height Above Ground Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot 1o5 ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot _ ; On Adjoining Lots noo,-*-
To Nearest Public Sewer Line 0A To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by Date- 1A
Water Sample Test Results 14
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed IROJO ZO Size %210 No. of Compartments
Standpipes (Y/N) Air -tight Caps (Y/N) ` _ Foundation Cleanout (Y/N)
Depression over Tank (Y/N) / Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) f ; for
Holding Tank High -Nater Alarm (Y/N) Temporary Holding Tank Permit (Y/N)
Separation Oistances from Septic/Holding Tank:
I � J
To Water -Supply Well —To Building Foundation
To Property Line —� m To Disposal Field
I'
To Water Main/Service Lined To Stream, Pond, Lake, or Major Drainage
Course
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata •- Type of System Design
Date Installed o%7/g&w Length of Field rte !
Width of Field c"' Depth of Field
Gravel Bed Thickness
Square Feet of Absorption Area 360 47 Standpipes Present (Y/N)
Depression over Field(Y/N) IN Date of Last Adequacy Test �
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well l i o E To Property Line —401+
To Building Foundation r 2.0/ To Existing or Abandoned System on
,t
Lot �/"'`q`�4°�°—'- ; On Adjoining Lots
To Water Main/Service Line To Cutbank (if present) 250
To Stream/Pond/Lake/or Major Drainage Course YV#we
ToDriveway, Parking Area, or Vehicle Storage Area 701
Comments
D. LIFT STATION
Date Installed A10Af,
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
** Check Permitted Bedroom Rating Against HAA Request *•
Vent(Y/N)
Cycles during Adequacy Test. Meets MOA
I certify that I h ve checke fied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signe _ Date p_
Company MOA No. -- D 17
Receipt No.
Date of Payment
Amount:$
Page 2 of 2
72-028 (11/84)
�F A4q ®�®
•�` •••
►�; 49
� Engineer's Seal
TH
......* 000000 •0. 00 i
.. . •• •
o e, yryE N RSON m
'•• CE -4488 •: ��
AV
else �r
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ 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
to 0 _
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size: _ j� If Tapk is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL T0:
Septic/Holding Tank Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
APPROVED FOR BEDROOMS
El CONDITIONAL APPROVAL (lett must accompany certificate)
❑ DISAPPROVED
C
DATE /' —
BY
v
72-010 (Rev. 6/79)