HomeMy WebLinkAboutPTARMIGAN ROOST BLK 3 LT 2Ptarmigan
Roost
Block
Lot 2
3
#020-042-87
-ID -K
Municipality of Anchorage Page 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 Inspection Report
Sy 430 L10 % 0.2o O Hf.Q7
Permit Number: PID Number:
Name: �l?J � C � N t=
Wastewater System: New ❑ Upgrade
Address: • &P 1130
ABSORPTION FIELD
Phone. 3 Y5__ q /(c tl
No. of Bedr oms:
Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating
/• 2
Total Depth from original grade:
GPO/SqFt
Lot. BlockII Subdivision:
Depth Depth to pipe bottom from original grade
'/-7
Gravel depth beneath pipe
TGArW / SKI I7. 'J
% FI
Ft
Township.
Range:
Section:
Fill added aboveo�np7 incl grade:
;=)
Gravel length:
62
F_ FI
Ff
WELL: New ❑Upgrade
Gravel width:
Number of lines:
!
Distance between lines:
Ff
Ft
Classification (Private. A.B.C):
VAT
Total Depth:
Cased To:
3.S
Total absorption area: rs ^
Pipe material;
Fen,JP7 3031/
T 121
Ft.
FL
%O SO Ft
DrillI
Date Drilled:
3.1/��j
Static Water Level
!A2
Instaner:,'�'�,
i7u
Date installed:
il(iacAVTs
Ft
WIVI .t V
YleI3 13
3 GPM
Pump Seta,
c, *- l FI
Casing Height Above Ground.
a_ FI.
TANK
SEPARATION
DISTANCES
.septic ❑Holding 0S.T.E.P.
To
Septic
Absorption
L.11
Holding
PubhUPY,vale
Ma/mtf'actc(w/ re r'
Capacity in atlons:----as
?
From
Tana
Field
Station
Tank
Sewer 4naa
` G,
L)
Well
11 L4
12.5
NIA
Material: S
Number of Com.0—Tants:
Water
K/A
N1161
LIFT STATION
Lot
.a
/ y
/per
Size in gallons:
Manufacturer:
Line
J
FoundationAA
"Pump on" level at:
`Pump off' level at:
High water alarm at:
Xo
Curtain
N
pump Make d Model
Electric at Inspections performed by:
Drain
rT
Remarks:
BENCH MARK
Location and Description:
II
et F�
Assumed Elevation:. „
OFt
E (411KiL'F,iFAL
OF q�at
all Op
J• T54
/ .....». e. a
s 9D
Inspections performed by: e Dates: 1s 7
2nd
� a. aa... ... .......
.;sr
Department of Health"Humanes appy al
b:an srti.>land
CE -2225
�1
I
0.,e......_,,Reviewed
��a�tZeOr��4�
and approved by:Date:
72-017 (R. 9/91) MOA 25
�I
well
I AC 71' E
( BC 42.5
AD 44.5 q
' BD 24.5 g /
AE 30 /
BE
1 AF 16 16 Q�
I BF 14
SQ
I /
-/Wel( /
j
25 0 25 575 00 125 150
SCALE: 1' = 50 FT.
C=, �,
Cir `I.. ...... ..
a1iLL'ROFE55��4
I TOBBEN SPURKLAND P.E. I I LOT 2 BLOCK 3 PTARd11GAN ROOST I I SEPTIC SYSTEM AS BUILT I
103 W 15TH. AVENUE GENE BRYNER 994
DATE. APRIL 8, 1
9aCHt ;0_90501 SHEEk2/3 GRID: 3238
LOT LINE
13
52
0 Monitor Clean Out
Clean Out
Double Clean Outs
1250 gal Septic tank
GREER TANK
0
Mira F; 140
5 Ft of Septic Rock
UNDER PIPE
Standard Trench:
4' Wide
52' Long
9' Deep
5' Sewer rock under pipe
4' Cover
NO SCALE u so
TESTHOLE EXTENDED TO 17 FEET.
NO BEDROCK OR HARDPAN
125a"tbo'k.Sep bc•;tS k a
f �
c.
ti
11uavtN JYUKALANU P.L. I I LOT 2 BLOCK 3 PTARMIGAN ROOST (I SEPTIC SYSTEM AS BUILT
203 N151hoce Ave GENE BRYNER DATE: APRIL 8, 1994
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PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE Pial
DEPARTMENT OF HEALTH AND HUMAN SERVICES Z -I -J4_ 9q
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650 n a M
'L1-5-` q
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW930406 DATE ISSUED:10/04/93
DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. EXPIRATION DATE:10/04/94
OWNER NAME:BRYNER GENE & FLORENCE K
OWNER ADDRESS:P.O. BOX 113023
ANCHORAGE, AK 99511
PARCEL ID:02004287
LEGAL DESCRIPTION: PTARMIGAN ROOST BLK 3 LT 2
LOT SIZE: 44568 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
1.
THE
THE
A TEST HOLE MUST BE
SEPARATION DISTANCE
SYSTEI
RECEIVED
ISSUED BY
DUG TO A DEPTH OF 15 FEET TO VERIFY
TO BEDROCK PRIOR TO CONSTRUCTION OF
DATE:
DATE:
T _ SF UFZt<ILAND F' _ E
203 W 15th. Avenue, Suite 206
ANCHORAGE, ALASKA 99501
(907) 279-3916
SEPTIC SYSTEM DESIGN
L O T 2 R LOC K 3 PTARMIGAN ROOST
GENE BRYNER
No Ground Water or Impervious Layer to 14 ft.
Use Standard Trench
Soil Rating. From test 8/20/93
< 1 min/in = Use filtersand
Existing sand qualifies as filter, see sieve
analysis
Required Area per Bedroom:
150 / 1.2 = 125 sq.ft.
Testhole Total Depth
Less 6 feet
Less Cover
Rock Depth
Number of Bedrooms
14
8
5
5
4
Length of Trench 125 x 4 / 10 = 50
SYSTEM CONFIGURATION
STANDARD TRENCH
TOTAL LENGTH
TOTAL WIDTH
TOTAL DEPTH
ROCK DEPTH
COVER
SEPTIC TANK
50 FT-
* FT-
* FT.
5 FT.
3 FT.
1250 GAL.
The installation of this well and septic system will not impact
adjacent lots. The well location conforms to the siting of the
existing wells in the area, and will not prevent the adjacent lot
owners from developing these lots or replacing the existing
septic systems.
There are no developed or natural surface / sub surface drainage
courses on this or the adjacent lots.
The proposed septic system will not change the general slope of
the area. Ponding and/or concentration of surface runoff will not
result from this installation.
Septic System Des.-Agn
t-oL 2 Mock :, Ptarmigan Ronst
LOT 3
I I ¢ Well
/ LOT 12
I '
1 I Qe O
I I LOT 2 / j /
SQ /
/ S PROPOS D
B L ffDP79SED/
LO
R
I p I LOT J
f
LO 1 /
50 0 50 100 150 200 250 300
SCALD = 100 FT.
TUBBEN SPURKLAND P.E. LOT P BLOCK 3 PTARMIGAN ROOST SEPTIC SYSTEM DESIGN
203 W 15TH, AVENUE GCNE BRYNER 11 DATE, SEPT. 24, 1993
ANCH_ AK. 99501 SHEET, 113 GRID 3238
i
1
1
1
1 t `
' PRIMARY TRENCH
1
1
I
TEST
-�- well /
REPLACEMENT SITE
PROP7SED /
25 0 25 50 75 100 125 150
CrAI Ci 1 • = 'Tn CT
UBBLN 4FUKKLAND r.L.LQT 2 BLOCK 3 PTARMIGAN ROOST SEPTIC SYSTEM DESIGN
203 W 1 AVENUE DATE- SEPT. 24, 1993
ANCH, AK..TH. 99501 GENE BRYNER
—.1 SHEET 2/3 GRID. 3238
Standard T
2' Wide
50' Long
9' Beep
5' Sewer
3' Cover
-- -- -- LOT LINE— --
25
Cleanouts
Monitor
4' Topsoil
3' Cover .
Mira fl 140
5 Ft of Septic Rock
UNBER PIPE NG SCALE
able Clean Outs
- Exist. Gro
4' Rin Cover
Fr Tank
1250 got septic tank
1 LIDDL1 ,)fURM1LHIVL r -.c. LOT 2 BLOCK 3 PTARMIGAN ROOST SEPTIC SYSTEM DESIGN
Anc :i,re5th Ave GENE ER DATE
Anch _ i � re Ak 99501 SEPT. 24, 1993
(vm) P79-i91a I I
_ SHEET 313 GRID, 3238
� _ v
PERFORMED FOR:
LEGAL DESCRIPTION
DEPTH
(FEET) 10
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
SM
SP
Municipality of Anchorage
DEPARTMENT OF HEALTH 8 HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
e Z
7L 2
Township,
6
WAS GROUNDWATER
ENCOUNTERED? /A
S
TWHAT A P
^/ G
P
rAtl—•T,C�S
Date:
IF VES, A
DEPTH?
Depth to Wale
Monitoring?
DATE
Section:
�j7r>rigar KTaS1 s/b
SITE
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
/
e17110
0"
—
2
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3J ac
3v trr
.,z
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A -5,
20 -T f C / le
COMMENTS /00 F
IL-1' PERCOLATION RATE �4(mmutevincnt PERC MOLE DIAMETER fo
TEST RUN BETWEEN I FT AND 5 FT
f'!'� (P„AnC ( J
PERFORMED BY:/'PW KCr�f�?�, I �f-�.''%i""� '� CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. 8/2393
72-008 (Rev. 485)
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• Municipality of Anchorage��
On -Site Water and Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL eE
Parcel I.D. 020-042-87 Expiration Date: S
1. GENERAL INFORMATION
Complete legal description Ptarmigan Roost BIk3 Lt2
Location (site address) 16261 Sandpiper Dr., Anchorage Ak. 99516
Current Property owner(s) James & Susan Thompson Day phone
Mailing address 16261 Sandpiper Dr., Anchorage Ak. 99516
Real Estate Agent
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
7
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Received by: g'Z (,LAAA �' I Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ Waiver Fee $
Date of Payment
Receipt Number
COSA# {Z' % q 0 2
Date of Payment
Receipt Number
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 Certif icate of On -Site System s 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 Pannone Engineering Services LLC Phone 272-8218
Address P.O. Box 100217, Anchorage AK 99510
Engineer's Printed Name Steven R. Pannone Date 17-072 l
6. DSD SIGNATURE
3 System #1 Approved for, bedrooms.
System #2 Approved for, bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
By: r Original Certificate Date: � - 2- .21
The r19runicipality 6 &16'Orage Development Sew ices Division (DSD) issues Certificates of On -Site Sy stems 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.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 9-1-12.tloc
If more than 1 septic system is on the lot:
COSA Checklist # of _
Structure served by this syst—
em
Certificate of On -Site Systems Approval Checklist
Legal Description: Ptarmigan Roost Bik3 U2 Parcel ID: 020-042-87
A. WELL DATA
Well type Pnva`e
&111188
Date completed
Total depth 250 ft.
Date of test
If A, B, or C provide PWSID #
Sanitary seal (Y/N) Y
Cased to 23 ft.
FROM WELL LOG
3/11/1994
Static water level 12
Well production 1.25
ft.
U,.
WATER SAMPLE RESULTS:
Coliform Absent colonies/100 mL Nitrate 2.6 mg/L
Arsenic: 0.201 ug/L date of sample: 4/28/13
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel
Tank size 1250 gal. Number of Compartments 2
Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N)
Date of pumping 7/23/2012 Pumper A+ Home Services
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 37 in.
AT INSPECTION
7/25/2012
29
4.3
ft.
g.p.m.
Other bacteria Absent colonies/100 mL
Collected by: PES
Date installed 4/5/1990
Cleanouts (YIN) Y
N/A
C. ABSORPTION FIELD DATA
Date installed 4/5/1990 Soil rating (g.p.d./ftZ orft2/bdrm) 1'2gpd/sf System type Deep Trench
Length 52 ft. Width 4 ft. Gravel below pipe 5 ft.
Total depth 13 ft. Eff. absorption area520 ftZ Monitoring tube Y Depression over field N
Date of adequacy test 7/25/2012 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in.
110 0
Water added 473 gal. New depth 0 in.
Elapsed Time: _ min. Final fluid depth _ in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N
Absorption rate , 450+ g.p.d.
If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at _ in.
Datum
E. SEPARATION DISTANCES
WELL ON LOT TO:
Size in gallons
"Pump off" level at —in.
Cycles tested
Manhole/Access (Y/N) _
High water alarm level at
Meets alarm & circuit requirements?
Septic tank/lift station on lot 100+ On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 100+
Sewer /septic service line 25+ Holding tank 100+
Animal containment areas 100+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+
Water main 10+ Water service line 10+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+
Water Service line 10+ Surface water 100+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone
Date
COSA brown sheet 9-1-12.doc
Absorption field 5+
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage 110+
in.
• Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 020-042-87
1. GENERAL INFORMATION
Expiration Date: I — -S 13
Complete legal description Ptarmigan Roost BIk3 Lt2
Location (site address) 16261 Sandpiper Dr., Anchorage Ak. 99516
Current Property owner(s) James 8t Susan Thompson Day phone
Mailing address 16261 Sandpiper Dr., Anchorage Ak. 99516
Real Estate Agent
2. TYPE OF DWELLING:
Q Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Q
Individual
Q
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
— - - - Public Water System
❑
Public Sewer
❑
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ !4 C/ 0
Date of Payment q - ( % —12—
Receipt
1Z
Receipt Number 0.2 1 2 0 f�
COSA#
Waiver Fee $
Date of Payment
Receipt Number
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 Certif icate of On -Site System s 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 Pannone Engineering Services LLC Phone 272-8218
Address _ P.O. Box 100217, Anchorage AK 99510
Engineer's Printed Name Steven R. Pannone Date
6. DSD SIGNATURE
System #1 Approved for. bedrooms.
System #2 Approved for. bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
By: Original Certificate Date: / 0 " ,�' 12 --
Th unP Ipalit oforage Development Sery ices Division (DSD) issues Certificates of On -Site Sy stems 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.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 9-1-12.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: Ptarmigan Roost Blk3 U2
A. WELL DATA
Well type Pnwd[e
Date completed „,
Total depth 250 ft.
Date of test
Static water level
Well production
If A. B, or C provide PWSID #
Sanitary seal (YIN) Y
Cased to 23 ft.
Parcel ID: 020-042-87
Well Log (Y/N) Y
Wires properly protected (YIN) Y
Casing height (above ground) 37 in.
FROM WELL LOG AT INSPECTION
3/11/1994 7/25/2012
12 ft. 29 ft.
1.25 4.3
g.p.m. g.p.m.
WATER SAMPLE RESULTS
Coliform Neg colonies/100 mL Nitrate 4.61 mg/L
Arsenic: ND ug/L date of sample: m 112
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel
Other bacteria Neg colonies/100 mL
Collected by: PES
Date installed 4/5/1990
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N/A
Date of pumping 7/23/2012 Pumper A+ Home Services
C. ABSORPTION FIELD DATA
Date installed 4/5/1990 Soil rating (g.p.d./ft2 or felbdrm) 1.21Pd1s1 System type Deep Trench
Length 52 ft. Width 4 ft. Gravel below pipe 5 ft.
Total depth 13 ft. Eff. absorption area 520 ftz Monitoring tube Y Depression over field N
Date of adequacy test 7/25/2012 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 473 gal. New depth 2 in.
Elapsed Time: 110 min. Final fluid depth 2 in. Absorption rate , 450+ g,p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at _ in.
Datum
E. SEPARATION DISTANCES
Size in gallons
"Pump off" level at_ in.
Cycles tested
WELL ON LOT TO:
Septic tank/lift station on lot 100+
Absorption field on lot 100+
Public sewer main 75+
Sewer /septic service line 25+
Animal containment areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Manhole/Access (Y/N) _
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank 100+
Manure/animal excrete storage areas 100+
Building foundation 5+ Property line 5+
Water main 10+ Water service line 10+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+
Water Service line 10+ Surface water 100+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone
Date 1 20t�
COSA brown sheet -9-1 -1 2.doc
Absorption Feld 5+
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage 10+
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PLOT PLAN AS BUILT X SCALE 1" = 40' GRID SW 3238 Project No. 12-198
Lang & Associates, inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049
(907) 522-6476 Phone o00
Registered Land Surveyors (907) 522-4625 Fax _o`o`OF q Op04
kenOlongsurvey.com / jonathanOlangsurvey.com �p�`�!• " ek
I hereby certify that I have surveyed the following described property: �O�Q '�O
LOT g2, BLOCK 39 PTARMIGAN ROOST (Plat No. 71-2114) 49L 0�
Anchorage Recordin District, Alaska, and that the Improvements situated thereon are Q „D
within the property lines and do not encroach onto the property adjacent thereto, that Q a Q
no improvements on the property lying adjacent thereto encroach on the surveyed Q }y .(,r Q
premises and that there are no roadways, transmission lines or other visible �io""= ""'1'::'�'Q
easements on said property except as indicated hereon. O '. KENNETH G.
Dated this the Day of fwco2 'n 2012 , at Anchorage, Alaska O�Q�� '�(�� Z ?• 'po0
It is the responsibility of the owner to determine the existence of any easements, �4pRaFfSSioNN tea€'
covenants, or restrictions which do not appear on the recorded subdivision plat. ODOO�o�a
MS
MUNICIPALITYANCHORAGE Ak
• DEPARTMENT OFFHEALTH
&8 HUMAN SERVICES
Division of Environmental Services go
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 l.D.M 020-042-87 HAA# +lfl
1. GENERAL INFORMATION
Complete legal description Lot 2; Bloch 3; Ptarmigan Roost
Location (site address or directions) 16261 Sandpiper Drive
Anchorage, AK
Property owner _Dnnnn T.au Day phone 348-7798
Mailing address - 16261 Sandoiner Drive Anchorage AX 99516
Lending agency
Mailing address
Day phone
Agent Tprri Pia;;/ Prw3pni•ial .Tank Whites Day phone 7r,7_2157
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well XX
Community well
f.
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XX
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.
72-0ri (Mv. 7NI) Front MOA N21
i
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I 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 Ais inspection.
Alaska Water 337-6/71
Name of Firm
Address
Engineer's signature
—_ Alaska Water,&
Wastewater Cg ngsu�tDatW Inc.
Shall be PAID
or prior to, closing for the
Engineering Services Provided.
6. DHHS SIGNATURE
X Approved for 3 bedrooms.
Phone
Date f L 19' S
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
MAE �Jrl r
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 courtesyto 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.
r&= Mw. wi) 8. MOAW
LI:i.
" 16 1999
Municipality of Anchorage N "CLOAU I OF ANLHU"Ok
DEPARTMENT OF HEALTH & HUMAN SBk3tdHEau savices orvlsic,
Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: PTARMIGAN ROOM LOT 2 BLOCK 3 Parcel I.D.: 020-04287
A. WELL DATA
Well type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N/A
Log present (Y/N) YES Date completed 3/17/94
Total depth 250' Cased to 23.5' Casing height (above ground) 2'
Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
FROM WELL LOO AT INSPECTION
Date of test 3/17/94 7/24/98
Static water level 12'
Well production
WATER SAMPLE RESULTS:
g.p.m.
Coliform Nitrate Other bacteria
Date of sample: I o't-7-19 Collected by:
B. SEPTIC/HOLDING TANK DATA
A.W.W.C., INC.
g.p.m.
Data installed 4 4/a4 Tank size 125n Number of Compartments _2 Cleanouts (Y/N) YES
Foundation cleanout (YIN) YES Depression (Y/N) NO High water alarm (Y/N) N/A
Date of Pumping 12a/gg Pumper _ NORTH 4Nn
C. ABSORPTION FIELD DATA
Date installed 4/^/94 Soil rating (g.p.d./W or tiz/bdrm) 1.2 System type TRENCH
Length 59' Width 4' Gravel thickness below pipe 5' Total depth 9'-11'
Effective absorption area 57n Monitoring Tube present (Y/N)YEq Depression over field (Y/N) NO
Date of adequacy test 12,63/29-- Results (Pass/Fail) PASS For a bedrooms
Fluid depth in absorption field before test (in.); DRY Immediately after 468 gal. water added (in.): 3'
Fluid depthX (ng4 (ins) Minutes later: 1 Absorption rate - 450+
a.p.d.
Peroxide treatment (past 12 months) (YM) NQNF KNOWN If yes, give date -
72-026 (Rev. 3/96)•
D. UFT STATION
Date installed
Manhole/Acoess(Y/N)
High water alarm level
'Datum
Size in
ar
"Pump off" level at'
• UNABLE TO FIELD VERIFY SEPARATION DISTANCE TO
CyC -SEPTIC SYSTEM ON LOT 1 BLOCK 3, PTARMIGAN ROOST
S/D; OWNER WOULD NOT PERMIT US ACCESS TO HIS
E. SEPARATION DISTANCES PROPERTY /tip'. r el!`,rr _Cf 44"A40 144A 4
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot 100'+ On adjacentkits
Absorption field on lot 100'+ On adjacent lots
Public sewer main N/A Public sewer manhole/cleanout
Sewer /septic service line 25'+ Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5'+ Property line 5'+ Absorption field 5'+
Water main/service line 10'+ Surface watendrainage 100'+ Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
100'+
Property line 10'+ Building foundation 10' Water main/service line 10'+
Surface water too'+ Driveway, parking/vehicle storage area 10'+
Curtain drain
F. ENGINEER'S
1 cer* that
in conform rn
Signatur _
Engineer's Ng
Date 12
Wells on adjacent lots
inspections and review of Municipal
is in effect on this date.
HAA Fee $ Z41-0 '
Date of Payment / oZ U g
Receipt Number Z%Iv 3 04 8a
72-026 (Rev. 3/96)'
Waiver Fee $
Date of Payment
Receipt Number
100'+
pcfq , s are
MUNICIPALANCHORAGE
• DEPARTMENT OF HEALTH
&HUMAN SERVICES
Division of Environmental Services
On -Site Services Section LLJLW
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. N i" ,2L _ ,... `, 2 - `D HAA #
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner 4.0—P1 %4 -e-e- Day phone
Mailing address
Lending agency
Day phone
Mailing address �p
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: �I
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: tf community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
nms (R«.1Ai) F., t Moi 921
S. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
Investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm o yk*—'^ S� ? t Phone 9 7q-2,g1k
Address O^ i ../. i 1-4,- M 9 n 3
Engineers signature
6. DHHS SIGNATURE
Approved for r bedrooms.
Disapproved.
Conditional approval for
Additional Comments
0
Date 1o1a�1
• V
1_ . .. ..
I.
1
bedrooms, with the following stipulations:
Date / —7 — m
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval.Certificates based only upon the representations given in paragrdph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasersof 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 engineers work.
2402$(P«A/91) 8K MOAM21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES R E C E I V
Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4f12 9 199
Municipality of Anchorage
Health Authority Approval Checklist Dept. Health & Human Services
i
Legal Description: f - m,µ44. Qooft4- Parcel I.D.:
A. WELL DATA
Well type z If A, B, or C, attach ADEC letter. ADEC water system number N/4 -
Log present (YM) Date completed 3' 17. 9 y
Total depth .2 5 D Cased to .23 Casing height (above ground) 39 it
Sanitary seal (Y/N) Wires properly protected (Y/N)
FROM WELL LOG
Data of test 3 - / 7• q q
Static water level l ,L
Well production ?✓ • .2- g:p.m.
AT INSPECTION
02.-5 g.p.m.
WATER SAMPLE RESULTS: K t'_ sa,, r j"'e 9(114's
Coliform Nitrate �. 3 7 b/L Other bacteria Nb
Data of sample: to -/7 - '? k Collected by:
B. SEPnemoLDING TANK DATA
Date installed yly/� y Tank size 19450 Number of Compartments .2. Cleanouts (Y/N)__y
Foundation cleanout (YM) Depression (YM) N High water alarm (YM) ti
Date of Pumping _ Pumper 1 AQQ Cf S
C. ABSORPTION FIELD DATA
Data installed Soil rating (g.p.dJtt' or iN/bdrm) % Z System type /.I�tyl
ri4
Length e2 Width _ Gravel thickness below pipe Total depth
Effective absorption area Monitoring Tube present (Y/N)� Depression over field (YM) Wil_
Date of adequacy test b� /� 9� Results/ (Pass/Fail) T For bedrooms
Fluid depth in absorption field before test (in.); Q r / �Immediately afters -legal. water added (in.): Gl Y Y
Fluid depth Alit -(ins) Minutes later: ✓ Absorption rate = > a.p.d.
Peroxide treatment (past 12 months) (Y/N) NO If yes, give date
72-026 (Rev. 3198)•
D. LIFT STATION
Tl/fir
Data installed
Manhole/Access(Y/N)
High water alarm level at* _
Cy s tested
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at'
'Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
"Pump ofr level at'
Septic/holding tank on lot i 108 On adjacent lots >12 D
Absorption field on lot 117 On adjacent lots 1 17, y
Public sewer main NIR Public sewer manholetcleanout N/06,
Sewer /septic service line > 1911,5- Lift station Y4&9
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 7 Property line ? 10 Absorption field /3
Water main/service line >AS Surface water/drainage N 0 Wells on adjacent lots 'IF loL3
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /.2 Building foundation &W Water maintservice line > A
Surface water t-4' 0 Driveway, parking/vehicle storage area l 4
Curtain drain N 1-0 Wells on adjacent lots 1 O tg
F. ENGINEER'S CERTIFICATION
I cerfify that I have detemdned thru field inspecfions and review of Municipal recgte(b $fat a a6yJB-s are
in conformance with MOA HAA guidelines in effect on this date. ,`-'J , `: ' • °
Signature
Engineer's Name t o b ¢H V kLatdr C S yo i <.-.n k:,:od
Date......... • .\moi
HAA Fee $ ? C co Waiver Fee $
Date of Payment Q -3 -ci % Date of Payment
Receipt Number C7 L 1-1 S f. °1nn Receipt Number
72-026 (Rev. `La.mn�c� L. -ac c q, -ears
�i2nn mbv\ PA 6` N AY\c—A c it, Qrr