HomeMy WebLinkAboutPTARMIGAN ROOST BLK 3 LT 5Ptarmigan Roost
Lot 5
Block 3
#020-042-90
---� -
--MUNICIPALI
MUNICIPALITY OF ANCHORAGE
DET�MENT OF HEALTH AND HUMAN
DEPT, OF HEALTH 6 -
ENV, Df
PROTECTION
SERVES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
;r,r
vk 2 2 ENV
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTIO
Name
Gene P. 5ry01e-
DISTANCES;"
Admess r
FflOM TO
SEPTIC
ABSORPTION
Aktt�
TANK
FIELD
WELL
`5
pnwon—I"`5.%�—'57^+'
Permit No
ND°er
WL
p
/03
/ Q
�Tr'.tt/
8 do 36-3
LEGAL OESCRianOM
LOT LINE
tiOIL f
s -p
—20
Lot
Blocs
SUINJ,Vt$iD0
' �"' ��°Jt
Townnbh,p. Range. Section
FOUNDATION
Sr
Z O
Gf
T///V R3 ce-
AS -BUILT DIAGRAM (Show IWabon of
wen. sept¢ system, progeny lines. louncation
TANKS
driveway.
water Oodles. etc)
,
IP SEPTIC ❑ HOLDING
r,
tib
we
I
Manufacturer
Capacity m gallons
An<401- C
/2Y0
Material
S tee 1
No. of COmpanmenla
TYPE OF SYSTEM
-
[X TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER
^7
[hpth 10 pl�Whom Irom
wq.nat graadede
Total depth nom ony,nal gyne
00
FT
Et'•D,,
F,a auded aWve Ongmayladu
FT
Gravel depth bene"I PipeFT
rd r' FT
w
Graver mny:n
Gravel width
5-D FT
3 - 5-
FT
101-1 absorption area
I Distance bsiwem bites
b�O SOFT
FT
co
r
Numtxr tit -nes
Sud raring
Pipe material
SOFT
c/ 303y FS/0
Insla,ler
4'>".9 (a
Date mstalied
_
A -y 26, 27 /y86
p
WELLS
des
❑PRIVATE ❑ OTHER (Identify)
de»Lcalun 1A.a.L1
total Depth
Cawd l0
J2
FT
FT
REMARKS:
/ 10 WPA'
Inspections Performed by. ENGINEERS SEAL
_A 1'
t Cei�`��"— •�'Yl�� CMify Ilial Nis inspection was performed according To ell
Municipal end Slal guidelines In fled on Nis date: Z7 4" kJ 70l i�ti•Y )� i �` '� fT /'
Health Department Approval: Dale
72-019 (9,85)
Sent By: ;
9073467767;
May -26.00 15:04;
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Page 212
F:
MU" I C I Too_ I TY 0f= ANCI-1J 1= -AGE
•.� DEPARTMENT C HEALTH AND ENVIRONMENTAL . .OTECTION
.�• 825 L STREET, ANCHORAGE, AY 99501
264-4720
ON—S I TE SEWE=F=; F 'I=QO0M
PERMIT NO: 088030%86 Z%L /En9i.at�r dirrPeaTbn
DATE ISSUED: ^^ 1 /
APPLICANT: GENE P. HRYNER /����� of o.�, q,•.�0.�
ADDRESS: 8200 KID RD.
ANCHORAGE, AK 99507
CONTACT PHONE: 344-5807
LEGAL DESCRIP: SUBDIVISION: PTARMIGAN ROOST LOT: 5
BLOCK: 3
SECTION: 2 TOWNSHIP: 11N RANGE: 3W
LOT SIZE: ,E!Q.6 (SQ.FT. OR ACRES)
MAX BEDROOMS: 4 3
Listed below are the options available to you in designing your septic
system_ - ---
Choose the option that best fits Your site.
- - -
' H'tEhlC1 1 -� laEDW _ DFZA I h1- - -
DEPTH TO PIPE BOTTOM (FT.) 14:0' 4.0 4.0
GRAVEL DEPTH (FT.) tv.O: •' 0.5
TOTAL DEPTH (FT.) 3.5
GRAVEL WIDTH (FT.) X2."5 4.5 7,5
� 5.0
,�.2 '
GRAVEL LENGTH (FT.) 22.0
.0:"O"1 41.o 65. 0
GRAVEL VOLUME (CU.YDS.) 30.1 33.5 48.22
TANK; SIZE (GALS) 1,250.0 1,250.0 ** 1,250.0 **
SOIL RATING (SQ.FT./BR) 150 150 150
a* TANK: MUST HAVE AT LEAST TWO COMPARTMENTS
- - - - - - - - - - - - - - - - - - - - - - - - - - -
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MDA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 4 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST HE OBTAINED; (2)
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND
ELECTRICAL WORE; MUST HE DONE BY A LICENSED ELECTRICIAN.
SIGNED
APPLICANT:
ISSUED BY
CODES,
AS-BUILTS
(3) THE
DATE: 2�
DATE:-8���--
hIuIV I C 7"•AIL I TY OF= AN CI 7FiAtsE
DEPARTMENT uF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK 99501
264-4720
ON—SITE BEWEFi a WELL- 'PEF--�M1_r �2
PERMIT N0: 860189 0
DATE ISSUEll: 06/23/86 Q o�
APPLICANT: GENE P. BRYNER
ADDRESS: 8200 KIP
ANCHORAGE, A: 99507
COP41ACT PHONE: 344-5804
LEGAL DESCRIP: SUBDIVISION: PTARMIGAN ROOST LOT: 5 BLOCK: 2
SECTION: 2 TOWNSHIP: 11N RANGE: 3W
LOT SIZE: 36978 (SQ.FT. OR ACRES)
MAX BEDROOMS: 4
Listed below are the options available to you in designing your septic
System. Choose the option that best fits your site.
+� GRAVEL LENGTH ? 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH)
* TANS: MUST HAVE AT LEAST TWO COMPARTMENTS
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
I certify that:
I. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set back:
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 4 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORT: MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED
AF'F'L I CAt
DATE: (0- f
ISSUED BY A• -F/ DATE:
TF2ENC1-1
33EIE)
W _ 13FRA I N
DEPTH TO PIPE BOTTOM (FT.)
4.5
5.0
4.5
GRAVEL DEPTH (FT.)
7.5
0.5
3,5
TOTAL DEPTH (FT.)
12.0
5.5
8,0
GRAVEL WIDTH (FT.)
2.5
24.0
5.0
GRAVEL LENGTH (FT.)
51.0
47.0
81.0 +ter
GRAVEL VOLUME (CU.YDS.)
37.8
41.8
60.0
TANK SIZE (GALS)
1,250.0 *+r
1,250.0
1,250.0 +t
SOIL RATING (SQ.FT./BR)
188
188
188
+� GRAVEL LENGTH ? 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH)
* TANS: MUST HAVE AT LEAST TWO COMPARTMENTS
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
I certify that:
I. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set back:
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 4 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORT: MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED
AF'F'L I CAt
DATE: (0- f
ISSUED BY A• -F/ DATE:
ALASKA ENVIRONMENTAL
CONTROL SERVIC INC.
12d0 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561.5040
JOB- T �•r/.R�ar( %'T C.S
BHEET NO. r 1 OF
CALCULATED BY DATE ..f --'y
CHECKED BY .....
c am, JR
-2251
.._-----'.D.a..l.'R:iTWI<[Bi� 1986
1`FF Tut
i b<�..s J•:Ord .
._..__._. � _.—_.___.__.. i.__.:.___ Al/K• _. � k
•oo
36J V76 .37
rF if
Gu. /„ 66: wa-k
ALASKA ENVIRONI)4ENTAL
CONTROL SERVIC � INC.
.1200 West 33rd Avenue Suite B
ANCHORAGE, ALASKA 99503
Phone 561.5040
.IDB f�r<t.m .'�Yf1.—Loo,{f Gt S 8/or t
BHEET NO. OF
CALCULATED BY_p� DATE.A.A /3 /4e6
CHECKED BY / DATE
SCALE •'+ YOYO
i A
Septa E. t3; i
I
,
ry
1 I _
Cabs
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w
s /oP /c? 3 - Y P/o i pp i° S,
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
r
PERFORMED FOR:__. 6"C Bryne— DATE
LEGAL DESCRIPTION:. tvA. m' 3 Ls Township, Range, Section:
14 ML f, 14-
is-
16-
17-
18-
19.
4 -
1516171819
20
z 7//
SITE P'.
w■■■■■■■mamummummm
�■.
■am.■■.I■■m
10
WASGROUND WATER AO
■0\10m0.1
In-
F.
!,
1f•
ENCOUNTERED?
■ommmmmimm■
11
mo_■•-■m■om■
S
■■■.■.■■■■
IF YES, AT WHAT
L
0
12
■■m■■■..■■
DEPTH?
P
So I•^� and
ll�
E
13
.!
rry kt
Depth to Water Atter • 1 ! • ' y
A -I F6
Monitoring? batt
14 ML f, 14-
is-
16-
17-
18-
19.
4 -
1516171819
20
z 7//
SITE P'.
w■■■■■■■mamummummm
�■.
■am.■■.I■■m
■0\10m0.1
In-
F.
!,
mommmmommm
■ommmmmimm■
mo_■•-■m■om■
■■■.■.■■■■
■■m■■■..■■
PERCOLATION RATE (mmute5nnch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
COMMENTS -$'o� / 4-" .2 '/o /O t7 V%!Vo /fv f, -d ,�- /}'-p n
PERFORMED BY: A -C- CC �6 02� I t� f�yC
�L'E1ifIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT O THIS DATE. DATE: -/ Z �"
72-M (Rev. 4,115) J
r
.
��•�,UNICIPALITY OF ANCHORAGE n
DEPARTMEN. OF HEALTH AND ENVIRONMENTAL PRO. _.;TION !e\ PERCOLATION
• • TEST
4 625 L. 61,w* An home.. Alaska 99501 2644720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR1r/j\I yPy�I C�1W�/I� /�/�•�•� c' `I'yvC_' DATE PERFORMED: •+
LEGAL DESCRIPTION: 1 1 •. Ys11 Ir,(% 1 Rryy- 1 �`-'�-lI�I V10h /1Ci ---Is Lo
1
2
37
4,
5-
6-
7 6-7
e•
• s:
10-
11
12 .
13
14
15
16
17
16
19
20
COMM
OL V
aM &,M brown10tal SraVel
! gravel
n , dry
es
So ncLLk %�}y gavel
• ew e5
cbrk,grey dry
Cobbles
Common
WAS GROUNDWATER A
( ENCOUNTERED?
IF YES. AT WHAT
DEPTH??/
Reading
DateGross
Time
Net
Time
Depth to
Water
Net
Drop
630 43
9 3YN
/o min
1.72
e21
fNz
V'�I Bj
VY7
m/
2: VIP2(0
a
/3D 3
/0:07
iu: oY
1.(.(.
.20
/0:/y
Om t/
I: QQ
.12
_0
/40 lvo
1.71
.Ili
PERCOLATION RATE
G *VOW ••� .... . ........... M���
PERFORMED BY: TIF? -••w �I!Rr. .DATE:5411 _
• C. REID,
[n/afei• .n o.•-. sfoK+� •• CE • 225) : Ar
G�6�Sb lw l� t+' l ( a• jr
r
i '• .....••' 4
aQr fFs .�• D• [iwewS /t1 pIDIEiSICI� �,�•�
Municipaidyg
of
Anchorage
POU -_4 6-650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
TONY KNO WLES.
MAYOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Permit #: 840357
January 31, 1985
TO: Permit Applicant
SUBJECT: Lot 5 Block 3 Ptarmigan Roost Subdivision
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1984.
Permits are issued on a calendar year basis by authority
of Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system not
installed by the expiration date.
If you have drilled the well, a well log needs to be sent
to this Department for documentation of the installation
and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, the original as -built inspection report
and the yellow copy must be sent to this office for review
and approval, and for documentation.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
Keith E. Bandt, SuP a visor
Environmental Engineering Program
KEB/ljw
enc: Copy of Permit
SWP/057
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK 99501
264-4720
O" --'c I TE 1EWEFR *, LJEL-L F}EFZt-1 I -r-
PERMIT
PERMIT NO: 840357
DATE ISSUED: 05!18/84
APPLICANT: DONALD G. WOODRUFF
ADDRESS: P 0 11-1665
ANCHORAGE, AK 99511
CONTACT PHONE: 345-6076
LEGAL DESCRIP: SUBDIVISION: PTARMIGAN ROOST LOT: 5
SECTION: 2 TOWNSHIP: 11N RANGE: 3W
LOT SIZE: 36978 (SQ.FT. OR ACRES)
LOT LOCATION: WINDSONG DR
MAX BEDROOMS: 3
LISTED BELOW ARE THE OPTIONS AVAILABLE TO
YOU IN DESIGNING
SYSTEM. CHOOSE THE OPTION
- - - - - - - - - - - - -
THAT BEST FITS
- - - - - - - -
YOUR SITE.
TFSEhFCH
- - - - - - - -
F3E0
;DEPTH TO PIPE BOTTOM (FT.)
4.0
.
4.5
GRAVEL DEPTH (FT.)
9.5
0.5
TOTAL DEPTH (FT.)
13.5
5.0
r GRAVEL WIDTH (FT.)
2.5
21.0
GRAVEL LENGTH (FT.)
30.0
41.0
GRAVEL VOLUME (CU. YDS. )
27.7
31.8
TANK SIZE (GALS)
10000.0 **
1,000.0
SOIL RATING (SO. FT. /BR)
188
188
BLOCK: 3
YOUR SEPTIC
- -
W. E>FZR I IV
4.0
3.5
7.5
5.0
61.0
45.1
1, 000. 0 **
188
*W TANK MUST HAVE AT LEAST TWO COMPARTMENTS
- - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - -
I CERTIFY THAT:
I. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA.
2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOR CODES AND REGULATIONS,
AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT.
3. I WILL ADHERE -TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK
DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC
SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT.
4. I UNDERSTAND THAT THIS PERMIT IS VALID FOR A MAXIMUM OF 3 BEDROOMS AND
.ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK. MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED 5 � �8 • � fL
--�^ DATE: -------------------------------
APPLICANT: DONALD G.�WOODRUFF
ISSUED BY ---- DATE: �� g
---- C�-� ------------ --'- ---------
MUNICIPALITY OF ANCHORAGE
�f \I DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED
LEGAL DESC
LI
OL. v
GM dArk Sra el
GM
Sa to s41h j gravel
brmn dr
Cobbles y
GM
Sand1 C ->M1 yaVe1
-dew co b\ es
dork,grey dry
So
WAS GROUND WATER /` /^ L
ENCOUNTERED? O
Cobbles P
comm,r��y� IF YES, AT WHAT E
y) 1 DEPTH?
Xv SOILS LOG
0 t),3 -r7
PERCOLATION
TEST
DATE PERFORMED:
n1 V
SITE
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop,
t14,0
613093
9 3
1-9 3
9•y'l
/o inin
1.'72
.2-1
yz0
�'3of�3
g: y7
2.Ou
q: 67
/ iwIn
I.8m
2l0
/U m
Lmb
20
N a
61(30�s3.
/0:6v
2. 0!7
I.I
li2
29
%Orrin
"PZ0
/0.'30
Z. S
&
iolX193
7O :'70
/D i
1.91
. I y
PERCOLATION RATE
TEST RUN BETWEEN
❑' bcyl►-r�nm 1nP�„\APS,
PERFORMED BY:. COI OW I &ate—s CERTIFIED
72-008 (6/79)
FT
FT
DA
1045
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH t£ HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
(907) 3434744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
Parcel l.D.# 020-042-90
1. GENERAL INFORMATION
Complete legal description PTARMIGAN ROOST SA), LOT 5. BLOCK 3
Location (site address or•directions) 16001 WINDSONG DRIVE, ANCHORAGE AK. 99516
Property owner IFN AND ROSE MARIE HALE Day phone -345-6820
Mailing address 16001 WINDSONG DRIVE. ANCHORAGE AK. 99516
Lending agency Day phone
Mailing address
Agent DONNA ORR w/ PRUDENTIAL JACK WHITE Day phone (907) 240-7493
Address 4241 B STREET. ANCHORAGE AK. 99503
Unless otherwise requested, NAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well xxx
Community well
- Public water
NOTE: IIf community well system, provide written confirmation from State ADEC attest.
Ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL: ,
Individual on-site xxx -
Holding Tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
Ing to the legality and status of system.
72-025 (Rev.1191) Front MOA a21 Computer Vemlon
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $2090.00 at,
or prior to, closing for the engineering services provided.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, l 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 ori -site water supply and/or wastewater
disposal system is in compliance with all Municipal d State codes, ordinances, and regulations in effect
on the date of this Inspection.
Name of Finn
Engineer's
Phone (907) 337-6179
In conducting this evaluation, AWWC, Inc. tt rode a thorough, conscientious engineering a6ysls of the
system In accordance w8h ADE C and M A H Guidelines & Regulations. The reported results described the
performance of the system under the conditions encountered at the time of the test and separation distances
measured to readily identifiable features. The operational lite of all wells and septic systems depend
on the local soils condition, ground water levels that may fluctuate during the year, and the
usage of the famly being served by the system. These conditions are outside the control c
the evaluator of the system. Satisfactory test results do not guarantee future performance
of the system, nordo theyguarantee that there are no hidden defects or encroachments.
AWWC, Inc. can therefore not provide any warranty for future estimate of how long the
system will continue to meet the operational requirements of the ADEC or MOA DHHS.
The content of this report Is for the sole benefit of the owner listed above. Any
reliance upon or use of this report by any other person or party is not authorized,
nor will it confer any legal right whatsoever. a
6. DHHS SIGNATURE
Approved forbedrooms
Disapproved
Conditional approval for
Additional Comments
By:,
bedrooms, with the following stipulations:
Date ti-- 1'00
The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an Independent
professional engineer registered In the State of Alaska. The DHHS does this as a courtesy to purchasers of
homes and their lending Institutions in order to satisfy certain federal and state requirements. Employees of
DHHS do not conduct Inspections or analyze data before a certificate is Issued. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
72-025 (Rev.1191) Back MOA R21 Computer Version
Municipality of Anchorage
DEPARTMENT OF HEALTH S HUMAN SERVICES
Environmental Services Division
80 V Street, Rm 602 Anchorage, Alaska 99501 (907) 34311744
Health Authority Approval Checklist
Legal Descrlptlon: PTARMIGAN ROOST S/D: LOT 5. BLOCK 3 Parcel I.D.: 020-042-90
A. WELL DATA
• PER DHHS RECORDS REVIEW ON 5/3/00
•• PER 1993 FAA
M
Well Type PRIVATE B A. S. or C. attach ADEC letter. ADEC water system number N/A
Log present (YQ4) YES Date completad 7/31/86
Total depth 60' Cased to 45' Casing height (above ground) 16'
Sanitary seal (YIN) YES Wires properly protected (Y/N) YES
FROM WELL LOG
Date of test 7/31/86
Static water level 32'
Weti production 3 a.p.m.
WATER SAMPLE RESULTS:
AT INSPECTION
4/14/2000
Courorm 0•0 Nitrate 04.07ma/L Other bacteria '•0
Date of sample: 4/18/00 k 4/25/00 Collected by: A.W.W.C., INC.
S. SEPTiCIHOLDINO TANK DATA
Date installed 8/26/86 Tank size 1250 Number of Compartments 2 Cleanouts (YIN) YES
Foundation cleanout (YIN) YES Depression (YIN) NO High water alar (YIN) N/A
Data of Pumping 4/14/2000 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA 10 MT DOES NOT EXTEND TO BOTTOM OF TRENCH
Date installed - • 27/86 Soil rating (g.p.dJR2 or »ffn 150 System type TRENCH
Length 52' Width 3' Caravel thldmess below pipe 6' Total depth 12'+/- AT WT
Effective absorption area, 600 $O FT Monitoring Tube present (Y/N)-UL Depresslon over field (YIN) NO
Date of adequacy test 4/14/2000 Results (Pass/Fag) PASS For 3 Bedrooms
Fluid depth in absorption field before test Ona; 07 Immediately atter 626 gal. water added (In.$ 10
Fluid depth 6.5 (aro) Minutes later. 250 Absorption rete . 450+
Perodde treatment (past 12 months) (Y/N) NONE KNOWN B yes, give date -----
72.ONSm. 3WCwp rVerdan
0. LIFT STATION
Date installed Stze
Manhole/Access
High water alarm
E. SEPARATION DISTANCES
level aC "Pump or level at'
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
SEE WAIVERREQUEST
Septicfiotding tank on lot '98' On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent kits 100'+
Public sewer main NSA Public sewer manhole/deanout N/A
Sewer/septic service One 25'+ Lift station N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5'+ Property line 5'+ Absorption field 5'+
Water maln/servlce line 100+ Surface water/drainage 100'+ Web on adjacent lots 100'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property One 10'+ Building foundation 10'+ Water maiNservice line 10'+
Surface water 100'+ Driveway, parldngNehide storage area 10'+
Curtain drain NONE KNOWN Welts on s
F. ENGINEER'S
I Coro that / i
Engineer's
HAA Fee S
Date of Payment
Receipt Number
r2 -M Pw• 7WeT CWwmr VGnbn
lnspecM= and review
ems are In Contbrmance
Welver Fee
Date of Payment
Receipt Number
LTA CT&E Environmental Services Inc.
Laboratory Division 59
200 W. Potter Drive
Drinking Nater Analysis Report for Total Colifonn Bacteria Anchorage. AK 99518-1605
Tel: (907) 562.2343
READ INSTRL'CTIO.VSONREVERSESIDEBEFORE COLLECTI.YGSAMPLE Fax- (907)561.5301
MUST BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY
13 PUBLIC WATER SYSTEM I.D. N LTJ
DO PRIVATE WATER SYSTEM
Send Results X/ Send Invoice
.�., rYm .�., ..m•�r ..+
_01"ISUN1111ft MIR-
\{. Y
Ya. Ym r
goal r1aparr Road 54
Anchorage. AK 99604
YY. w
Yr
a Send Results o Send Invoke
oa.. m.
Y,Wn,
u A
Yr
SAMPLE DOTE: off] FEF5
Month Day Year
SAMPLE TYPE:
Analysis shows this Water SAMPLE to be:
`i Sactory
D Unsatisfactory
D Sample over 30 hours old, results may
be unreliable
D Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received
Time Received
Analysis Began 151A5
Analytical Method: '-Membrane Filter
o MMO-MUG
Result* Analyst
1001?50
VRoutine D Treated Water
o Repeat Sample (for routine sampleUntreated Water
with lab ref. no.
D Specha Purpose Time Collected
SAMPLE LOCATION Collected By
2&�Mt �Lot & &&02_aw G�fs
Comments:
benllo A.U.&C.
®
S1 L--
Anch Fbks
Jun ❑
Faxed
Date: Time:
Client notified of unsatisfactory results:
Phoned
Date:
BACTERIOLOGICAL WATER ANALYSIS RECORD
N1M0-MUG Resah Total Coliform
E. Coll
Spoke with
Time:
Membrane Filter. Direct Count 0 Colonies/100 ml
Verification: LTB
BGB COLIFIRM
Fecal Collform Confirmation
Final Membrane Fllte esults _ Col/lfo�rfml/100 ml
Reported By ate Time v v hrs
r�M_a Member of the SGS Group (Sr
ENVIRONMENTAL FACILITIES IN ALASKA. CALIFORNIA, FLORICA. ILLINOI12 ...'
'-4 r6ndrals de Surveillance)
Faxed
TVTC-TM Neme 'To C"M
oa -othv seeene
"gOURI. NEW JERSEY. OHIO. WEST VIRGIUV
04-24-00 11:41 FROWaE ENVIRONIENTAL
aG- CTLE Environmental Services Inc.
CT&ERctw
1001646001
Clent Name
AK Wats & Wastewater Consultants Inc
Project Name/#
ptarmigan Roost Lot 5 Bk 3
Client Sample ID
Ptarmigan Roost Lot 5 Bk 3
Matrix
Drmking Water
Ordered By
PWSiD
0
5615301 T-480 P.02/03 F -T65
Client POn
Printed Date/time
Collected Date/time
Received Date/time
Technical DirteWr
0424/2000 15:35
04/192000 16:00
04/192000 11:40
Stephen C. Ede
ie� .4-�
Alloratae Prop Analysis
Parameter Results PDL Units Metnou Limits Dau Date Init
UATERS DEPT
mitrate•N
MICRO LAB
Total Coliform
4.07 0.500 ro/L EPA 300.0
30 OB. No Colt % cal/1001AL SM18 92228
.A�, `D w
/ - 1.4,E
CD
iry
(410) 04/19/00 SCL
04/19/00 KAP
Municipality ofAnehorage
Department of Health and Human Services di -1h5
- 825 "L" Street
Rick M1tystrom. P.O. Box 196650 Anchorage. Alaska 99519.6650
h avor
hltp:'www a anchorage ak us
June 2, 2000
Jeffrey Gayness
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2-13
Anchorage, AK 99504
Subject: Waiver Request for Ptarmigan Roost, Lot 5, Block 3
Waiver Request #WR000023
Parcel ID #020-042-90
HA000176
Dear Mr. Gamess:
Your request for a waiver of the required 100 feet horizontal separation from the
septic tank to private well has been approved. The approved separation distance is 98.6
feet.
This waiver approval applies to the existing septic tank to private well separation only.
Any future upgrade to the on-site wastewater disposal system will require all separation
distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-4744.
Sincerely,
Ate-4uV
Daniel J. Roth
Civil Engineer
On -Site Water Quality Program
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
On.Slte Services
Waiver Review Worksheet
WR#: WR000023 PID#: 020-042-90 HAM HA000176 Permit#:
Date Received: May 4, 2000
Legal Description: Ptarmigan Roost, Lot 5, Block 3
Engineer. Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2-B, Anchorage, AK 99504
Applicant: Steven & Rose Marie Hale
..........
Waiver Requested: 98.65 foot waiver from the well to the septic tank
Criteria: 1. Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
2. Special Conditions:
3. Other.
Waiver is Granted: X •••••••••• Waiver is not Granted:
List Conditions or Reasons for above: �s E F_ R 27-A r UbV
Date: 5--2¢ -00 By: jAAZ
..........
Name of Reviewer
Rec#: 06711 Amount: $625.00 Date Paid: May 4, 2000
4 , t I
WAIVER RV4MXSr FOR Lor r Bloc,
IIwAIVER REQu,ESr VUMVEIP WR000023
k
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5 F- P7/ L r.#VAe -
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ALASKA WATER E7, WAST'EWA rJt:�ii
CONSULTANTS, INC.
May 3, 2000
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Attention: Mr. Dan Roth
Ref: Waiver Request for Well Separation to Septic Tank for HAA
Ptarmigan Roost SID, Lot 5, Block 3
WELL AND SEPTIC TESTING: The existing referenced 3 bedroom house is served by a
private well and septic system. On April 14, 2000, we performed a well flow test and a septic
adequacy test at the subject property. As per MOA records, the septic system consists of a
1250 gal tank and a 50 ft long deep trench -type drainfield, both installed in August 1986. A total
of 626 gallons of water were introduced into the cleanout in the drainfield, which was completely
absorbed within 250 minutes. During the well flow test, the well produced an average of 5.4
gallons over 115 minutes. These results are sufficient for a 3 bedroom house.
WAIVER REQUEST: The well on the subject property is located 98.65 ft from the septic tank
on the property, when measured edge to edge. This distance was measured with a Topcon
GPT -1003 surveying instrument. Measurements on previous HAAs indicated a distance of 101
ft and 103 ft, but were probably in error due to the fact that there are several trees between the
septic tank and the well and the terrain is not flat, making it difficult to measure with a tape.
Measurements could also have been made from center to center, rather than edge to edge.
Attached are a site plan, a detail drawing, and a topography site plan showing the
encroachment. As can be seen on the detail drawing, the septic tank encroaches upon the
well's 100 ft protective radius. We request that your department issue a 96 foot separation
distance waiver from the well to the septic tank. Justification for the waiver is as follows:
The location of the septic system is in a very visible area (uphill from the driveway) so that if
any effluent were to surface, it would be noticed and the problem corrected.
Recent well water samples indicated that no bacteria was found, and the nitrate levels were
4.0 mgA, which is less than the maximum allowable of 10 mgA (see attached results).
The well on the subject property is 60 feet deep. There was no well log in the MOA hard
files. Therefore, we are proposing to base our evaluation on surrounding well logs.
6901 Debarr Road, Suite 213— Anchorage, AK 99504 — Ph: (907)337-6179 — Fax: (907)338-3246
Attached are the well logs for the following lots in Ptarmigan Roost S/D: Lot 7, Bk 3; Lot 2,
Bk 1; Lot 11, Bk 2; Lot 10, Bk 2: Bedrock was encountered in these wells between 9 feet
and 33 feet. Silty gravel appeared to be the predominant soil over the bedrock. Based upon
the recent water sample results, it appears that the aquifer has been moderately impacted
by nitrates; however, it is reasonable to assume that there is minimal additional risk to the
aquifer associated with granting the subject waiver (2% reduction in separation distance).
With the granting of this waiver, we also request that you issue a Health Authority Approval. If
you have any questions, please contact meat 337-6179. Thank you for your assistance.
M.S.
6901 Debarr Road, Suite 213 — Anchorage, AK 99504 — Ph: (907)337-6179 — Fax: (907)338-3246
i
I LOT 8A.
I GOLDENVIEW HEIGHTS S/D
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I
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--------------
MID S2. S 1/2, S 1/2. N 1/2. ICD
---------------
NW I 4, SECTION 2, T11N, R3W ZO
---------------------
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LOT ec.
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j GOLDENVIEW HEIGHTS S/D
I3
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I
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--------
I — -------------------
LOT 1, BLOCK 1;
PTARMIGAN ROOST S/DLOT
EXISTING j
PTARMIGANBBLOCK ROOST 5/D
SEPTIC
EXISTING
3 BEDROOM
'!1
/
/ HOUSELOT
4. BLOCK 3; / /
I
Qom• PTARMIGAN ROOST S/D
�G
/•
���•/• I /
3: �•
LOT 6, BLOCK
1 / PTARMIGAN ROOST S/D
OfLLI
Qe�
LOT 4, BLOCK 2: ��
EL
Q LOT 4, BLOCK 3:
PTARMIGAN ROOST S/D
PTARMIGAN ROOST S,
LOT 3. BLOCK 3:
NI PTARMIGAN ROOST S/D
DATE.4/21/2000
DRAWN BY:
M.
ALASKA «TATER & WASTEWATER
CONSULTANTS. INC.
SCALE:J•L
— 100
"""'• • /. .•...
6901 DEBARK ROAD, ELITE Ire • ANCHORAGE. AK 9950. • "M9071337-0179' FAX (9072338-]266
PAGE NUMBER:
PREPARED FOR PHONE NUMBER:
MARIE HALE 345-6820
1 OF 2
„„ .. „.,,,
�, f re Gamess;
STEVEN & ROSE
yl�, ai •, C 7953
LEGAL DESCRIPTION:
PTARMIGAN ROOST S/D; LOT 5, BLOCK 3,
F,
��� o e' ••.,,,...• ' �o��>
v'y7y�v
TYPE OF WORK:
SITE PLAN FOR WAIVER REQUEST
hfossxo(,
i
W �
z
100' WELL RA IUS
_Z
CALAS KA RATER & WASTEWATER
CONSULTANTS. INC.
5901 OFSARR RDAD SUTF 29 • ANCHORAGe AK 9950. • FHONe (901)331-0119' F" (901)535-526
REPARED FOR: PHONE NUMBER.
STEVEN & ROSE MARIE HALE 345-6820
EGAL DESCRIPTION:
PTARMIGAN ROOST S/D; LOT 5. BLOCK 3.
YPE OF WORK:
WAIVER REQUEST DRAWING
-\\L__-__
II
SEPTIC TANK
TRENCH TYPI
PASSED ADE
ON APRIL
4/21/200
AWN BY:
J.L.M.
ALE:
1"=30'
GE NUMBER:
2 OF 2
EM. /
ALLON
EEP /
ELD.
ST /
�r...:
A.� Gamess;
7953 F
..... ' •co4o
e
W �
z
100' WELL RA IUS
_Z
CALAS KA RATER & WASTEWATER
CONSULTANTS. INC.
5901 OFSARR RDAD SUTF 29 • ANCHORAGe AK 9950. • FHONe (901)331-0119' F" (901)535-526
REPARED FOR: PHONE NUMBER.
STEVEN & ROSE MARIE HALE 345-6820
EGAL DESCRIPTION:
PTARMIGAN ROOST S/D; LOT 5. BLOCK 3.
YPE OF WORK:
WAIVER REQUEST DRAWING
-\\L__-__
II
SEPTIC TANK
TRENCH TYPI
PASSED ADE
ON APRIL
4/21/200
AWN BY:
J.L.M.
ALE:
1"=30'
GE NUMBER:
2 OF 2
EM. /
ALLON
EEP /
ELD.
ST /
�r...:
A.� Gamess;
7953 F
..... ' •co4o
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MUNICIPALITY OF ANCHORAGE
!T/ DEPARTMENT OF HEALTH & HUMAN SERVICES
O 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
1. GENERAL INFORMATION �� t g
Complete legal description
HAA # VAQC
3
Location (site address or directions) 16001 WindfQr,q T%r.
Property owner Di17r]� Day phone 3 41s_1116 8
Mailing address
{�• 0. f3o)c 113023 , &AC rayt- 9R5/l
Lending agency' Day phone
Mailing
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
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 x
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.
72-02S (A.. 1191) Pont MOA 021
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 this inspection.
Name of Firm/ PoArcdnSu0T Phone Z5$- Z'/ZO
Address 1503 'W, 33,' ,e -
Engineers signature ��t "y1. Date 815,
r
�: p9Ttj r A
NI.•°•�)�00000000
/J .fn A // J
iN.i.1YN....N..•
Wilt V. ALWAM
CE -13N _,
6. DHHS SIGNATURE
_)C_ Approved for �_ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
By: J04$4 L IT=i- Date L9A7/Tj
111TIC
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.
72M(RW7/91) B.k MOAN21
Municipality of Anchorage a ARL
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
Lf 5, Blk. 3, P�Armhla4, )ZwdParcelI.D. D'Z'O �DVy-90
A. WELL DATA
Well type 1 V4+V' If A. B, or C, attach ADEC letter. ADEC water system number N
Date completed 9113119 ✓�% W/�/QmS
Log present (Y/N) � Driller Q u
O
Total depth 61D Cased to 60 Casing height /
Sanitary seat (Y/N) N Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION MUNICIPALITY OF ANCHORAGE
/,j /9 3 ENVIRONMENTAL SERVICES DIVISION
Date of test /O v 1993
... 32' Zo. Y`' AUG '1%1
Static water level 3 �� F
Well flow 3 g.p.m. RK E I V`I E D
Pump level
Unkncwa (/nkn.wn
1-7
SEPARATION DISTANCES FROM WELL TO: /00r
i
Septic/holding tank on lot /01 ; On adjacent lots
Absorption field on lot l03 ; On adjacent lots /
00
Public sewer main NZA ^ ' btic sewer manhole/cleanout
Public sewer service line
/1��/ t Petroleum tank Al
WATER SAMPLE RESULTS:
Coliform )JAYIP Nitrate
3.8 Other bacteria
Date of sample: 6X3 4 3 Collected by: /gA&V )
B. SEPTIC/HOLDING pTANK DATA Z
Date installed oZ2 A.1 Tank size 1250 9u�� Compartments
Cleanouts (Y/N) �- Foundation cleanout (Y/N) Y Depression (Y/N) N
High water alarm (Y/N) / N/%} Alarm tested (Y/N) N/�
Date of pumping , _ 92 ��
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: s
Well on lot /0% ' On adjacent lots /00 Foundation
To property line t Absorption I ield 5 Water main/service line
41
�v�A
Surface water/drainage NIA
CONTINUED ON BACK PAGE
72-M IRW. 2191) Front MOA 21
I-
C. LIFT STATION ,t' /�
Date Installed IV1 Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent (Y/N) "Pump on" level at "Pump off' level at =
High water alarm level Cycles tested _
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots — Surface water _
D. ABSORPTION FIELD DATA
8/z/8G z
Date installed Soil rating 150 System ren
r t Y type
Length 52 Width • 3' ` Gravel thicknessy ' Total depth /0 r
Total absorption area 0 ,5t. t r Cleanouts present (Y/N) Y
Depression over field (Y/N) _N Date of adequacy test 813113
Results (pass/fail) 0-5S �/ mC
for bedrooms
Nv w�fd+ t� a{{er (tS .
Peroxide treatment T
(past 12 months) (Y/N) N If yes, give date _
SEPARATION DISTANCE.FROM ABSORPTION FIELD TO:
1 r '
Well on lot 10 3
n —On adjacent lots Propertyline Sof
To building foundation / To existing or abandoned system on lot iV�v4
Onadjacentlots—��� Cutbank N/`Watermain/service line—/VIA
Surface waterDr
Curtain drain /
� `NSA iveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
/certify that/ have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
SignatureC�. • J/�t2tn� j�Q,� • ;stt'
Engineer's Name EaK% TTi1rrnetvt «:...:99AUSMAN
Date4AVeCE 13
HAA Fee $ —11 O , 00 Waiver Fee: $
Date of Payment B-11-96
Date of Payment
Receipt Number 02. 6 Receipt Number
72-M (ROY. 3/91) Seek MOA 21
