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HomeMy WebLinkAboutPTARMIGAN ROOST BLK 3 LT 7Ptarmigan Roost Block Lot 7 #020-042-84 Municipality of Anchorage On -Site Water and Wastewater Section . (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221067 PID Number: 02004284000 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name John Blees A ORPTION FIELD ❑ D Trench El Wide Trench El Bed El Mound Site Address 16341 Sandpiper Drive, Anch, AK 99516 Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-360-6046 4 /sF Ft. LEGAL DESCRIPTION Depth to pipe invert from original g de F Gravel depth beneath pipe . Ft. Subdivision Block Lot Ptarmigan Roost Subd. BLK3 LT7 Fill added above original grade Ft. Gr I length Ft. Township Range Section 11N R3W Sec 2 Gravel width Ft. Beds: Number of Lines Dista a between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between tr hes From Tank Field Tank Line Ft2 t. Well 1001+ 25'+ TANK ❑® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1,500 Gal. Surface water 100'+ Material Epoxy Coated Steel Number of compartments 2 Lot Line 51+ NA Foundation 10'+ L ATION Manufacturer Capacity Gal. Remarks Septic tank replacement including PVC house to tank piping and tank to existing drainfield piping. Double cleanout added. Alarm location Electric ailed by Orenco Biotube effluent filter installed in 2nd compartment. PIPE MATERIAL House to tank0900 Tank to 3034 drainfield Installer Beek's Contracting, Inc. Drainfield PVC Exist. CO/MT3034 Inspector John Blees, P.E. CE -10263 BENCH MARK (Assumed elevation) 50 ft InspectionI5' 05/18/2022 05/19/2022 Location and description nd RIE Corner of concrete stoop slab. 3`" 4th ON-SITE WATER AND WASTEWATER SECTION APPROVAL�" ' � Date Conditional Approval: �,• y�J Via. ......gyp ..�1 c•ae, JOHN G. BLEES ,' � 0 CE - 10263 ,•'���© (Z Septic Syst Approved % Date (i' �4�pROFESS����4® /Note this(approvaI does not include well permit requirement . (Rev 7 ) 03/31/2022 Digitally signed by John Blees Date: 2022.03.31 11:22:41 -08'00' Digitally signed by John Blees Date: 2022.03.31 11:22:27 -08'00' SWING TIE TABLE POINT A DIST. POINT B DIST. 1 13.5 1 19.4 2 17.8 2 31.3 3 23.9 3 38.2 4 28.5 4 42.9 EXISTING PILE FOUNDED DECK i / 0 MON. POINT A APPROXIMATE EXISTING DRAINFlELD LOCATION PER 1984 RECORD DRAWING TO REMAIN. APPROXIMATE DATE 03/13/23 LOCATION OF NA ABANDONED TANK ASSUMED EL = 50.0' NE CORNER OF SLAB EXISTING HOUSE FF=54.4'± PROPERTY LINE CONNECT TO EXISTING DRAINFIELD PIPING. 2 (EA) 90' LONG \ SWEEP ELLS. INSTALL DOUBLE CLEANOUT. SEE DETAIL 2. POINT 4 C. 0. NEW 1,500 GAL EPDXY COATED STEEL TANK WITH DOUBLE MH RISER AND EFFLUENT FILTER. POINT 3 POINT 2 22.5' ELL SHED 45' ELL POINT 1 \ qo 100' WELL RADIUS \ � POINT B 1 PROPOSED SEPTIC REPLACEMENT PLAN SCALE: 1 "=10' DOUBLE CLEANOUT 2 DOUBLE CLEANOUT SCALE: NTS AS -BUILT o� QF q ��opp oP . 49 TH*( 0 r ... ' JOHN G. BLEES Q �J,� •, N0. CE -10263 ��� 0 5 10..... 'CSO F �ROFESS\�NPo� SCALE IN FEET FIGURE 1 BLEES RESIDENCE SEPTIC TANK REPLACEMENT 16341 SANDPIPER DRIVE SEPTIC TANK REPLACEMENT SITE PLAN - ASBUILT DATUM: DATE 03/13/23 SHEET NA DWN. DES 11 PROJECTION: NA SCALE SHOWN of PROJECT No. APPRVD. JGB NA 2 w N 0 o` 56 56 54 54 52 52 50 50 48 48 46 46 44 44 42 42 40 40 10+00 10+10 10+20 10+30 10+40 10+50 1 SEPTIC TANK REPLACEMENT PROFILE SCALE: H:1"=10', V.1"=2' 00000pO OF A oP . 49 TH ��.. 4� D ............. d. D JOHN G. BLEES 0 Q �J, •• No. CE -10263 --r�?r ��oo F EPROF 4���DOpoo�NP�� m X E a FIGURE 2 BLEES RESIDENCE SEPTIC TANK REPLACEMENT 16341 SANDPIPER DRIVE o SEPTIC TANK REPLACEMENT SITE PROFILE - ASBUILT N DATUM: DATE 03/13/23 SHEET a NA a OWN. DES 2 PROJECTION: w o NA SCALE SHOWN of AS BUILT PROJECT No. APPRVD. JGB NA 2 X, ;' 2" RIGID BOARD INSULATION CONC SLAB STOOP. I I FF=54.36 ASSUME EL=50.0 TOP RISER =50.52 TOP OF TANK =46.15 FINISHED GRADE EXISTING GROUND I I � INV EL=45.40 ' VEL=45.32 Sqf J LONG SWEEP 90' ELL. 49,•f 5' INV EL=46.45 2 5' CONNECT TO EXISTING INV EL= 45.52 DRAINAGE PIPING NEW 1,500 GAL EPDXY COATED (INSTALLED STEEL TANK ON OS -18-2022) LONG SWEEP 90' ELL. BIOTUBE EFFLUENT FILTER EL=41.3 SECTION 40.08 TYPICAL DROP CONNECTION Page 24 Division 40 — Standard Details & System Design Ti_R 41 MEN 'SE_\OTE 1 SCHEDULE 40 3BS Jll COMBO, Tim. SCHEDULE 40 ABS LONG SWEEP 40. n't GE\EFLAL, \TOTES: 1. O --,\,H ;1j DiCH NSuLA TIO\ \L- y BE SUBSiTiUTED PER FOOT OF SOIL UP TO i ,VO {2} FEET !LUNTM Uri MINNMlU_1S SOTL COVER SH_•iLT.. SOT BE REDUCED TO LESS TH--L- 75,10 r_;, FEET. - SECTION- =: 40.08 DETAIL `: 05-01 -- DROP CLEANOUT SC-,�LLE: N, I's REVISED: 04114 Page 24 Division 40 — Standard Details & System Design A-1 cn 0 0 U 0 --] -Z m < (-D Oo 0 < W LU U. LLJ Carroll, Rebecca M. From: Carroll, Rebecca M. Sent: Tuesday, April 12, 2022 10:21 AM To: Blees, John Subject: RE: Ptarmigan Roost 133 L7 - tank permit Hello John, Thank you for letting me know. I can just make a note on the permit, so no drawing/narrative revisions are needed. Currently, the smallest steel tank that is approved is a 1500 gallon, so you will need to upsize a bit. Greer is working on getting a 1000 gallon and 1250 gallon steel tank approved, but our review comments are back in their court so I'm not sure when to expect a resubmittal. Becca Carroll Onsite Water and Wastewater Municipality of Anchorage 343-7908 From: Blees, John <jblees@bristol-companies.com> Sent: Tuesday, April 12, 2022 9:59 AM To: Carroll, Rebecca M.<rebecca.carroll@anchorageak.gov> Subject: RE: Ptarmigan Roost 133 L7 - tank permit [EXTERNAL EMAIL] Good morning Becca, After discussing the replacement poly tanks with several installers and an engineer who does several designs withing the municipality, I have decided to go with a steel tank with epoxy coating in and out as provided by Anchorage Tank/Greer. I was planning to address this revision in the inspection report and on record drawings, but please let me know if the Muni will require anything further ahead of time. Thank you, John John Blees, P.E. LEED AP Senior Engineer Bristol Engineering Services Company, LLC 111 W. 16th Avenue, Third Floor Anchorage, AK 99501-5109 Phone : (907) 743-9356 Cell: (907) 360-6046 FAX : (907) 563-6713 jblees(a)bristol-companies.com httr)://www.bristol-companies.com/ From: Blees, John Sent: Thursday, March 31, 2022 11:24 AM 1 John Blees, P.E. (CE 10263) 16341 Sandpiper Drive Anchorage, AK 99516 907-360-6046 June 21, 2022 (Re -submitted 03/15/2023) Municipality of Anchorage Development Services Department On -Site Water & Wastewater Section Attn: Deborah Wockenfuss & Curtis Townsend RE: Lot 7, Block 3 Ptarmigan Roost - Aging Tank Replacement — Engineer's Inspection Report and Request for Approval to Operate — Permit #: OSP221067 Dear Ms. Wockenfuss, This inspection report documents the replacement if the aging, 1,250 -gallon steel septic tank at my 4 -BR residence located at 16341 Sandpiper Drive. The tank was replaced with a Municipality -approved 1,500 - gallon epoxy coated steel tank obtained from Anchorage Tank and installed on May 18 and 19, 2022. The installation was performed by Dan and Amy Beek of Beek's Contracting, Inc. I was present for the duration of the installation. The morning of May 18, 2022, 1 placed a call to Development Services requesting a bottom of hole inspection at 2pm that day. Dan followed up a call with the Municipal inspector letting them know we were a little behind schedule. He informed the inspector that the Owner/Engineer was on site. I originally planned to install a polyethylene tank, but after discussions with several installers, I decided to install a new steel tank. This was documented with the Department in an April 12, 2022 email to Becca Carroll (attached). The new tank was installed with two manhole risers, allowing the installation of an effluent filter (Orenco Biotube) in the second chamber of the septic tank, providing an extra measure of protection to the drainfield. A double cleanout was installed at the outlet side of the tank prior to connection to the existing drainfield piping. This property and adjacent properties have been developed for many years, and therefore no adverse impacts are anticipated for any of the surrounding parcels. The old septic tank on my property was crushed/flattened with an excavator mounted compactor and buried onsite. I observed his operation and am comfortable that minimal voids exist and risk of subsidence over the buried structure are minimal. The new tank was installed in the footprint of the original tank resulting in little or no change to existing conditions (i.e. separation distances to adjacent wells, wastewater systems, structures, property lines, etc.). Please find the attached site plan which identifies the approximate location of the existing septic system based on the 1984 record drawings, an as -built site plan, and an as -built profile between the building foundation and the existing drainfield piping. The original drainfield was not altered therefore no additional soils information is provided with this report. Groundwater was not present during the replacement of the tank. During my inspection I verified the tank was properly bedded and installed level. The tank was bedded to springline with self -leveling, self -compacting pea gravel to ensure complete support under the tank haunches. Elevations of the pipe inverts, tank inlet and outlet inverts, connection point to the existing drainfield piping, and top of riser were recorded compared to a fixed point adjacent the system (NE Corner of concrete stoop). 2 inches of 40 psi rigid board insulation (Insulfoam) was installed over the top of the influent piping, tank, and effluent piping to the point of connection the existing drainfield piping. Elevations and insulation are shown on the attached profile drawing. Upon final backfill, swing -tie measurements were collected for all new surface features and are documented on the as -built site plan in a swing -tie table. A final as -built survey is attached. Attached to this report, please find a copy of the permit, email documentation of the change from a poly tank to a steel tank, as -built drawings of the replaced tank, and photo documentation of the installation. Please don't hesitate to call or email if you have any questions or comments as you review this request for approval to operate. Sincerely, John Blees, P.E. Phone : (907) 743-9356 Cell: (907) 360-6046 jblees(@bristol-companies.com S 89'59'30" W 80.00' -i 30' 20' UTILITY EASEMENT \ g LOT 5 07 // APPROXIMATE DRAINFIELD 'o. LOCATION PER 1984 \ RECORD DRAWING p / LOT 8 / 04� EXISTING 1,250 GAL o co. STEEL TANK. \ate' ° LOT 7 0 0, \f OD�O�Q� OF A C0004 o* : 4gTH*0 ......... ..........�D D QO JOHN G. BLEES 0 Q �J,'• No. CE -10263 03/26/2022. PROF ES L i ,,bib EXISTING HOUSE �� \ 100' WELL RADIUS 20� GOQ�� S� PAVED DRIVE 411 V / a0 �P 3o, 0 a 0 a N 0 MON. APPROXIMATE EXISTING DRAINFIELD LOCATION PER 1984 RECORD DRAWING TO REMAIN. 0 5 10 SCALE IN FEET EXISTING PILE FOUNDED DECK R WHERE SINGLE RISER IS SHOWN. SII 12" SPOOL II/� DOUBLE CLEANOUT C.O. EXISTING HOUSE PROPERTY LINE CONNECT TO EXISTING PIPING INSTALL DOUBLE CLEANOUT. SEE DETAIL 2. C.O. NEW 1,250 GAL POLY TANK WITH DOUBLE MH C.O. RISER AND EFFLUENT FILTER (SEE ATTACHED). PROPOSED SEPTIC REPLACEMENT PLAN SCALE: 1"=10' _nom z DOUBLE CLEANOUT SCALE: NTS SHED 100' WELL RADIUS sl 49 TH �* ............................. ....�.... .. JOHN G'BLEES No. CE -10263 03/26/2022 . • PROFESS1�NPo�� FIGURE 2 BLEES RESIDENCE SEPTIC TANK REPLACEMENT 16341 SANDPIPER DRIVE PROPOSED SEPTIC TANK REPLACEMENT SITE PLAN DATUM: DATE 03/14/22 SHEET NA PROJECTION: DWN. DES Q NA SCALE SHOWN of PROJECT No. APPRVD. JGB NA 2 John Blees, P.E. (CE 10263) 16341 Sandpiper Drive Anchorage, AK 99516 907-360-6046 March 26, 2022 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Section Attn: Deborah Wockenfuss RE: Lot 7, Block 3 Ptarmigan Roost - Aging Tank Replacement — Engineer's Report and Permit Application Dear Ms. Wockenfuss, It is my intent to replace the existing aging, 1,250 -gallon steel septic tank at my 4 -BR residence located at 16341 Sandpiper Drive. The original tank was installed in May 1984. During inspection of the tank when it was pumped in August, 2021 it was determined that the tank's baffle was beginning to fail. I plan to contract with a certified operator/installer to perform the installation of a new 1,250 -gallon poly tank meeting the current MOA requirements. The tank will have two manhole risers, allowing the installation of an effluent filter (Orenco Biotube) in the second chamber of the septic tank, providing an extra measure of protection to the drainfield. A double cleanout at the outlet side of the tank will be installed prior to the drainfield piping as one was not provided in the original design or installation. This property and adjacent properties have been developed for many years, and therefore no adverse impacts are anticipated for any of the surrounding parcels. The old septic tank on my property will be pumped and removed. The new tank will be replaced in the footprint of the original tank resulting in little or no change to existing conditions (i.e. separation distances to adjacent wells, wastewater systems, structures, property lines, etc.). The COSA prepared in December 2012 indicates that all separation distances have been met or exceeded. I verified this by reviewing the records of the two nearest properties on Lots 6 and 8, of Block 3, Ptarmigan Roost Subdivision. Please find the attached site plan which identifies the approximate location of the existing septic system based on the 1984 record drawings. The existing surface features of the septic system were located from the 2009 property as -built survey conducted after the previous owner's remodel/addition. Copies of the records from the MOA onsite database are attached for your quick reference regarding the original system design (soils, percolation testing, lack of encountered groundwater, etc.). The original drainfield will not be altered other than the addition of a double cleanout between the new tank and existing drainfield piping, therefore no additional soils information is provided with this report. Inspections: I will perform a minimum of two inspections during the tank installation as required. One will take place after the new tank has been set and piping has been reconnected prior to backfill. I will verify proper tank bedding, and level installation. Elevations of the inlet and outlet inverts will be recorded compared to a fixed point adjacent the system (stoop concrete slab, etc.). Once the existing tank is uncovered and inverts of existing piping are verified, I will determine the depth of cover over the crown of the new tank and determine if rigid board insulation will be required. Based on the drainfield records, it is anticipated that the tank and drainfield have about 3.5 feet of soil cover, therefore 2 inches of rigid board insulation will likely be installed over the top of the tank. This will be detailed in the record drawings and the inspection report. A second inspection will be performed upon completion of backfill to verify final grading and locations of surface features. Attached to this report, please find the on-site septic/well permit application form, on-site fee worksheet, site plan and proposed tank and piping details, an aerial image showing adjacent properties, and onsite records including the original design of the system and past COSAs. Please don't hesitate to call or email if you have any questions or comments as you review this permit application. Sincerely, John Blees, P.E. Phone: (907) 743-9356 Cell: (907) 360-6046 iblees@bristol-companies.com S 89'59'30" W 80.00' --i 30' 20' UTILITY EASEMENT \ LOT 5 APPROXIMATE DRAINFIELD / LOCATION PER 1984 \ RECORD DRAWING o / LOT 8 EXISTING 1,250 GAL o¢o. STEEL TANK. \ate' ° LOT 7 ° i \�. 0 0. \ 5N � o , Or •8 EXISTING HOUSE \ p �R 100' WELL RADIUS s0. �O 00' F 66• 63 O� G% S� PAVED LOT 6 `'�� DRIVE �q �O 5P OF A ... -9s o0 -;0 JOHN G. BLEES J, •• No. CE -10263 0 �F 03/26/2022. V\ PROFESS01o�� 30. FIGURE 1 BLEES RESIDENCE SEPTIC TANK REPLACEMENT 16341 SANDPIPER DRIVE EXISTING CONDITIONS PLAN DATUM: DATE 03/14/22 SHEET NA 0 20 40 PROJECTION: DWN. DES j NA SCALE SHOWN of SCALE IN FEET PROJECT No. APPRVD. JGS NA 2 O MON. APPROXIMATE EXISTING DRAINFIELD LOCATION PER 1984 RECORD DRAWING TO REMAIN. 0 5 10 SCALE IN FEET EXISTING PILE FOUNDED DECK WHERE SINGLE � RISER IS SHOWN. DOUBLE CLEANOUT C.O. EXISTING HOUSE PROPERTY LINE CONNECT TO EXISTING PIPING INSTALL DOUBLE CLEANOUT. SEE DETAIL 2. C.O. NEW 1,250 GAL POLY TANK WITH DOUBLE MH C.O. RISER AND EFFLUENT FILTER (SEE ATTACHED). 1 PROPOSED SEPTIC REPLACEMENT PLAN SCALE: 1"=10' 3�I 2 DOUBLE CLEANOUT nI — SCALE: NTS �j;ll SHED 100' WELL RADIUS o� OF q oP 49 TH*( o-------- JOHN G. BLEES OQ J,'•, No. CE -10263 4 03/26/2022. �C�O 4�pp%'OROFESS\O'P_ �4000�a FIGURE 2 BLEES RESIDENCE SEPTIC TANK REPLACEMENT 16341 SANDPIPER DRIVE PROPOSED SEPTIC TANK REPLACEMENT SITE PLAN DATUM: DATE 03/14/22 SHEET NA PROJECTION: OWN. DES 2 NA SCALE SHOWN of PROJECT No. APPRVD. JGB 2 NA MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: Date of Issue: - - Parcel Identification Number: 020-042-84_000 Legal Description Ptarmigan Roost Block 3 Lot 7 Property Owner Name & Address: John Blees 16341 Sandpiper Drive, 99516 Pump Installation Date: 12 - 29 - 2022 Pump Intake Depth Below Top of Well Casing: 315 feet Pump Manufacturer's Name: Myers Pump Model: 2 N F L 102-8-P4-01 Pump Size: 1 hp 11 Pitless Adapter Burial Depth: feet Reused Existing Pitless Adapter Manufacturer's Name: Unknown Pitless Adapter Installer: Well Disinfected Upon Completion? N Yes ❑ No Method of Disinfection: Chlorine Tabs Comments: Pump replacement in existing well. Pump Installer Name: Robert and Dylan Company: Hefty Drilling Mailing Address: PO Box 112130 City: Anch state: AK Zip: 99511 Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. �r • ?r, i %" ', r it's $' , 1 cif P• +�� ~ �. •�€� n✓ J+ tv LL Ol low '?�'Sw or w aFt W r75 y. /�Y •T X . � •ai _ ,,1• ''1�... •� . Y��r P � ' _ � .` Der` i oat 0. w . �. lip, Jif �, * it + _ 1'M .�� �rti •.f ' r sf �' Y k. YAP .`� cam• x +r w��i'F �X• �� �.. �r :;. +}� _ f 711►' ` { is fb MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAILING ADDRESS <�44 f8e4X LEGAL DESCRIPTION m LOCATION NO. OF BEDROOMS 'A 3OVED #'' (-'Y-e— 72-013 (Rev. DATE LEGAL i I- L�e�L_At V DISTANCE TO: Well Absorption area Dwelling PERMIT NO. `1 z Manufacturer We,,, J64 6 C- 7,4,V < Material No, of co artments 0 Lic. gallons -5 IF HOMEMADE: Inside le Width Width W' A, ' Liquid depth Liquid depth L' u p DISTANCE TO: Well Dwelling IT 0 PERMIT NO. _j 0 z '7 0 t < Manufacturer Material Material Liquid_' - Liquid capacity in gallons w 3: Well DISTANCE TO: i 2_' _J� Foundation I _21 ,JLI i e PERt$IT No. I w _,5 P Z LU o� of lines Iinches Lengt each l4ie/ Total len ghAl lipes Tren Distance bet een lines I.. Top of the to finish grade, Materi 51 beneath tile ea % Length Width Depth < I- Type of crib Crib diar 1:r/a Crib depth LU __ Lm DISTANCE TO: Well Building fou 0 _j Class Depth Driller Distance to lot line k winiam CHa Building 50:;kifti n DISTANCE TO: Sewer line Sep tic tank 0 n affi (0 ' 266 OTHER PIPE MATERIALS SOI L TEST RATING a INSTALLER V v 1� GA -16 E- OX C Ck f REMARKS V y I C -,,IV&, 24C -A) VKQL;G1o&J, rt_L=8140jj� f -Ai Z-7) 7-0, 90 V3tFN_10 IA; 6- 3OVED #'' (-'Y-e— 72-013 (Rev. DATE LEGAL ' MUM I C I PRL I TY OF FiNCHQRRCiE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 TEELJFEE R WELL PERM I T PERMIT NO: 840149 DATE ISSUED: 04/09/84 APPLICANT: MIKE HINKES ADDRESS: SRA BOX 1699M GRAVEL DEPTH CFT. > ANCHORAGE, AK 99507 CONTACT PHONE: 345-5430 LEGAL DESCRIP: SUBDIVISION: PTARMIGAN! ROOST LOT SIZE: SECTION: 2 T014NSHIP: 11N 39000 (SQ.FT. OR ACRES) MAX BEDROOMS: 4 LOT: 7 BLOCK: 3 RANGE: 3W 'LISTED BELOW ARE THE OPTIONS RVAILABLE TO YOU IN DESIGNING CHOOSE THE OPTION SYSTEM_ - THAT BEST FITS YOUR SITE. DEPTH TO PIPE BOTTOM (FT.> TRE H - - g g p GRAVEL DEPTH CFT. > .0 5. 0 4. 0 :TOTAL DEPTH (FT.) 9.0 0. 5 GF.AVEL WIDTH (FT.) 2 5 4. 5 22.0 ;GRAVEL LENGTH (FT.) 60.0 41.0 GRAVEL VOLUME (CU. YDS. ) 30.5 33.4 TANK SIZE (GALS) 1,250.0 ** 1, 250.0 ** SOIL RATING (SQ. FT. /BR) 150 150 YOUR SEPTIC W E>FR Fl I N - - 4.0 3. 5 7. 5 5. 0 65. 0 48. 1 1,250. 0 ** 150 ** TANK MUST HAVE ATLEASTTWOCOMPARTMENTS - -- - - - - - - - - - - - - - - - - - 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.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 FIND ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT. IF A LIFT STATION 15 INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; 42> AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORE: MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED DATE: ------------------------------------- --------------- AFPLICANlT: MIY.E HINY,ES ISSUED BY ------------- DATE: ------------------------ tlUt 4I C I F'HL I TY OF Hrgf--"oRFiGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 C,tJ— ITE S=ELJEFe 1== WELL F EF:L7I T PERMIT NO: 540149 DATE ISSUED: 04/09/84 APPLICANT: MIKE HINKES ADDRESS: SRA BOX 1699M ANCHORAGE, AK 99507 CONTACT PHONE: 3345-5430 LEGAL DESCRIP: SUBDIVISION: PTARMIGAN ROOST LOT: 7 BLOCK: 3 SECTION: 2 TOWNSHIP: 1114 RANGE: 314 LOT SIZE: 29000 (Sia: FT. OR ACRES) MAX BEDROOriS: 4 LISTED BELOW ARE THE OPTIONS SYSTEM_ CHOOSE AVAILABLE TO YOU IN DESIGNING -YOUR SEPTIC THE OPTION THAT - - BEST FITS YOUR SITE. DEPTH TO PIPE BOTTOM (FT.) TF--_EtJCH - - 4.0 - E E[?- - - W- pF?Fi I r-4 - - GRAVEL DEPTH (FT.) 5. 0 4. 0 4. 0 TOTAL DEPTH (FT.) 9. 0 0.5 3.5 GPAVEL WIDTH (FT.) 4. 5 7. 5 GRAVEL LENGTH (FT.) `' 34.0 0 16.0 5. 0 GRAVEL VOLUME CCU. YD'' . > 17. 3 32. 0 18. 9 36. 0 TANK SIZE (GALS) SOIL RATING (SO.FT. /BR) 1,250.0 wa: 1, 250. 0 »:4 26 6 1, 250. 0 ** 83 83 83 »° TANK MUST HAVE AT LEAST TWO COr1PARTMENTS 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 14ILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOR CODES AND REGULATIONS, AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOP, 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 BE OBTAINED: (2) WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED APPLIC ISSUED CODES, AS-SUILTS (3) THE L/ il_��LCL2C42?1_1�_ _ DATE: /gY--�-- aF4T: Pit IF41:E5-�Y�i���p -- JJJ--- c. T------------- DATE: S _n & ENGINE®NC. S 7125 OLD SEWARD HIGHWAY ANCHORAGE, ALASKA 99502 (907) 349.6561 SOIL LOG PERCOLATION TEST SOIL LOG PERCOLATION TEST _BEDROOMS J�*,6PRIL-,84- LEGAL DESCRIPTION:r . a . • 222 . C.SLOPE SITE PLAN L ... ► LP .r Now 0 ■��P3. 0 - 2 ✓��� O_S- 3.5 2r"b WON J'� ' /!gyp $CY•lE RPAVEL3 TAACC $IS _- 3 SCAITC9-t) Co68L.E$. Sur pcup5 a•:.o IN LOCAL 144EG 'AnsS3 46•• ? 3Q .01 sAAI p w rn I S P 5 �'.';' x11E CRAVED SfATp¢+� c 8 ;.. LOOet eS 12 ERuAc2S 9 , SuGg7ty M01D7r1 PM2u� 7 GEQDEp 8 •.o,...;i 9 or O 11 :O. r ' • % , • WAS GROUND WATER S ENCOUNTERED? ►.1 D L 12 • O P • • IF YES. AT WHAT E 13 DEPTH? 14 13.O Reading Data Gross Time 15 __ ./'mac OFA�:4. _ - _ 17 ��- �;- ••-* 18 19 c •:IONM E 3NANSON ��le'yf• ••• 1834E •••�•• �) Net Depth to Time I Water DEPTH PERCOLATION RATE V �SUAL (FEET(minutes/inch) qp�._r� ,,,, L TEST RUN BETWEEN �� FT AND �_ FT COMMENTS�G!_TlM�D is(2 �/Rp 70pYr� , PERFORMED BY:/1-ZAAYtSM( CERTIFIED BY: rtap aui DATE: Net Drop R LOCATION OF WELL (Flea 6• e m yb stlMr W. ID or le.) le. Borou On BYDdiYtelOn LOf S C lo. I /epre. _,f�ef�ef re. OrSTANCE AND DIRECTION FRO O INTERSECTIONS Street Address and Area of Well Location n WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological 8 Geophysical Survey, Drilling Permit No. A.D.L. No. See lion r, To.nohip ND Range E[] Merldlon B❑ W" S. OWNER OF WELL: Address: 2. WELL LOG feuBele. Sur foe* M ot•rlol Type Teo A- WELL DEPTH: (final) S. DATE OF COMPLETION ft• BO/IOm Y 3 s. ❑eabl. to QRolofy Driven 00gg r� r ❑ Auger ll E3Ja•d 0 Bored ❑OIMrt S ?.USE: El Domestic CO] Public Supply ❑ Industry Irrigation O R•aherge O Cemmerleal ❑ Teel woO 0 Other: S. CASING: O Threaded r Welded dlam. In. to '2,1 -_ ft. Depth weignl,..L7 les./ alum• In. to ft. Depth Stickup ft. 9. FINISH OF WELL: Type— •r . DlaTabr•_! Blot/Moan Bla: Length: Sol bet.eoe ft. and fl. saeknning Orerel $,ask 10. STATIC WATER LEVEL: /O ft D Aeore or O 6610. land surf... '-Data Equipment used: 11. PUMPING LEVEL belew land surface and YIELD ft, after�hre. pumpiag Hol nosd l`iip , N t• II. aII6I 1,16. pumping .Iv �7 !I1Vd171":.1' 12.aRUUTING Well G:eulsd: O Yee O No Materiel: 11 N•at Ceawn/ 0 Other: IS. PUMP:—� (if available) NP Length or Drop Pipe 11. capacity o P.M. ❑ Subm. O ,161 o Contrulcal O other Id.REMARKS: is. WATER WELL CONTRACTOR'S CERTIFICATION: This all .e. drul.d IS. Water Temperatufe —e 0 p O C ease, my lufl.d rctian / and this r. art It fru• to the besr i ° Of my kno.teage end gene.; ''R r• ItBest INe6 Name Add,,,,: -„— Contract License Number Signed: 't. ' AulnCrtt•d Ppqualellre Dab: ✓ �J Iorm 02•WWR (11/911 COPY Distribution: WHITE. St°te OGGS, PINK"Drilter, CANARY-Customor /' �• WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological 8 GOOPBysical Surreys Orllling Permit No. LOCATION OF WELL (Please cyTzlets either lar 1► of Ic.) A_D. L_ N.. -LailBorough Subdivision Lol '' Bill LLbjl I/salve. Pe Section NO. TOOnaMP NO EQ Ranee Eo WO 010,1414" H-31 DISTANCE AND DIRECTION FROh O INT E117ECTIONE Street Address and Area of Wan Location S. OWNER OF WELL: Address: 2. WELL LOG feelface Eur leve• Material Typo Toe Better 4. WELL DEPTH: (final) �% Z7 eft• S. DATE Of COMPLETION _ice L `U eq 1-7 e f• ocabb tool QRelerl C30riven C]Dug 0 Adger ❑,Otte• ❑ Bored 0 others ' • d 7.1139: Q Dem.ub Q Public Supply ❑ IndYa.y 0 Irrigation 0 Recharge 0 Commensal 0 Teat well 0 Other: S. CASING: 0 Threaded 0 Welded diem. In. to '24 capon weight / ^ Ib../ft. diem, In, IO /1. Osplh SIIe1Y0it. B. FINISH Of WELL: Type:-Il/-+oi'• Diameter: SIot/Meeh 3120: Length; Set beleeo ft. and ft. Booafllling gravel such 10. STATIC WATER LEVEL? a j�ft. 0 Abeue or O Dole. land surface Da a Eautpmest used: 11. PUMPING LEVEL belo0 lana aurfaee and YIELD rt, atter--Z—bra, pumping�ks— O.P.M. It. offer hrs. pumpbg_g.P.m. NC( 31011. 111 a :Y. .r... tulv,� 12.GROUTING Well Grouted: 0 Yee ONO Material: 0 Neat Cement 0 Other• 1E. PUMP: (if aeallable) NP Length of Drop Pipe ft. capacity g.p.m. 0 subm. 0 ds# 0 Canlrlflcal 0 Other I4.111EMARKS: 16. WATER WELL CONTRACTOR'S CERTIFICATION: IS. Water Tempuelure _O 0 F 0 C This eUl was drilled and., my )ulledlcnon and thio report Is true to Ina best of my 11ea00dge and sella#; Register00 BYOines. Name CCn1140 Lice -so Number Address:... �. — i .�/. 7:/'.•i.,;/.. / ; j• signed:_: ).:/�•-!,fl.•I oats: j- .•.! i Aelherlied Ampreaeaallve J `-,, Farm 02-wwR (11/61) Coo, Distribution: WHITE-SI4t.000S. PINK -O, l.r. CANARY-C..ru..r KEN JOHNSON DRILLING CO. WATER WELL DRILLING PUMP SALES AND SERVICE 38 Years Alaska Drilling (907) 243.2282 KEN JOHNSON FAX- (907) 243.4852 3163 LINDEN DRIVE AN ORAG ALASKA 99502 DATE �Qt7 NAME PH0NE35�S- rl8p9 ADDR ZIP LOCATIO LEGAL: LOT D. PUMP DATA: HP DOLT, o PHLAMPS G MODEL// Ase Fox CONTROLS C PE-STIE ib --tee 0 PUMP INTAKE DEPIH TANK SIZE 8 TYPE a2t-o �/.t/.�o� s FILTERS 9 TYPE yoyP WELL DATA: CASING SIZEI:2I� DEPTH _ g8 -/ WATER LEVE GPM DD PITLESS:TYPE —DEPTA WELL TIME: ON SITE OFF SITE REMARKS: KEN JOHNSON CWD/PI NAVA CERTIFIED Municipality of Anchorage a"f e i__ On -Site Water and Wastewater Program`; (907)343-7904 se Err CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcell.D. 020-042-84 1. GENERAL INFORMATION Expiration Date: Complete legal description PTARMIGAN ROOST BLOCK 3 LOT 7 Location (site address) 16341 SANDPIPER DRIVE, ANCHORAGE, AK 99516 Current Property owner(s) DAVID & KATHRYN REIMER Day phone Mailing address 16341 SANDPIPER DRIVE ANCHORAGE AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo 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 ❑ Received by: �� ' - � ,� z- Date: COSA to be released to the engineer, unless othenyie/Fe uested by the engineer. COSA Fee $ L[- I b ` Waiver Fee $ Date of Payment I //0 113 Date of Payment Receipt Number ois (ao`F' Receipt Number COSA #_®SC- I 0- 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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 12/04/2012 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a , system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. El 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for, bedrooms. z Disapproved. Conditional approval for bedrooms, with the following stipulations: By: �•- j ���_ r Original Certificate Date: The t bipaltKof"A rage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the rep resen wns 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: ,.C" COSA Checklist Septic System Advisory Well Flow Advisory X Nitrate Advisory j,,,_ '=-a, •- Arsenic Advisory Other 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 BLOCK 3, LOT 7 Parcel ID: 020.042.84 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # Date completed 512311984 Sanitary seal (Y/N) Y Total depth 387 ft. Cased to 26 ft. (into bedrock) FROM WELL LOG Date of test 512311984 Static water level 310 ft. Well production 5 9 - p.m - WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate ND mg/L Arsenic: ND ug/L Date of sample: 11/21/12 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC / STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (YIN) Y Depression over tank (YIN) N Date of pumping 11120112 Pumper A+ C. ABSORPTION FIELD DATA Well Log (YIN) Y Wires properly protected (YIN) Y Casing height (above ground) 24+ in. AT INSPECTION 11121/2012 ft. Collected by: ARCTERRA Date installed 512411984 Cleanouts (YIN) Y High water alarm (YIN) N Date installed 5/2411984 Soil rating (g.p.d./ft2 or ft2/bdrm) 150 System type TRENCH Length 68 ft. Width 3.5 ft. Gravel below pipe 5 ft. Total depth 6_6 ft. (Measured 11/21112) Eff. absorption area 680 ft2 Monitoring tube `Y Depression over field N Date of adequacy test 1112112012 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 21.6 in. Water added 600 gal. New depth 27.6 in. Elapsed Time: 170 min. Final fluid depth 21.6 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at —in. Datum Size in gallons "Pump off"level at _ in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 1001+ Public sewer main 75'+ Sewer /septic service line 25'+ Animal containment areas 50'+ SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 1001+ On adjacent lots 100'+ Public sewer manhole/cleanout 1001+ Holding tank 100'+ Manure/animal excrete storage areas 1001+ Building foundation 51+ Property line 5'+ Absorption field 54 Water main 104 Water service line 104 Surface water 1001+ Wells on adjacent lots 1004 ABSORPTION FIELD ON LOT TO: Property line 10' Building foundation 101+ Water main 104 Water Service line 101+ Surface water 1004 Driveway, parking/vehicle storage 104 Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 1001+ F. COMMENTS 'Appears MT extends 4.2' into effective depth of 5' 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 KENNETH M. DUFFUS Date 1210412012 COSA brown sheet 9-1-12.doc OF Al r45 .4 Municlpality of Anchorage Development Services Department Building Safety Division OnSile Water b Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519650 www.cl.anchorage.ak.us 0. arncSS (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 020-042-84 HAA# 0502_18 1. GENERAL INFORMATION Expiration Date: Complete legal description PTARMIGAN ROOST SUBDIVISION: LOT 7. BLOCK 3. Location (site address or directions) ' 16341 SAND PIPER DRIVE • ANCHORAGE. AK. 99516 Current Property owner(s) TOM AND ROBIN BURRELL Day phone _(907) 345-2250 Mailing address Lending agency Mailing address Real Estate Agent Mailing address PTARMIGAN ROOST SUBDMSION: LOT 7. BLOCK 3. Day phone DONNA ORR w/ REMAX PROPERTIES Day phone 727-4488 110 W. 38TH, SUITE 100 • ANCHORAGE, AK. 99503 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 0 Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well 11 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 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 verity that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the onsite 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 tiles and from my investigation and Inspection, the onsite 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 Finn GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines d Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lest, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the tical 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. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE Approved for q bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Phone 337-6179 Date C-12 V,4,5- bedrooms. ,b,5- bedrooms, with the following stipulations: Maintenance Agreements Supplemental Engineer's Report Other WATER AND By:��y _fc{� O — Original Certificate Date: " .9, —7 — 0.57 e+a. 1vo,r Municipality of Anchorage • Development Services Department Building Safety Division OnSke Water & Wastewater Program 4700 South Bregaw St. P.O. Box 190650 Anchorage. AK 9951&6850 www.d.anctwrage.sk.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: PTARMIGAN ROOST SUBDIVISION: LOT 7. BLOCK 3. Parcel ID: 020-042-84 A. WELL DATA *CASED TO BEDROCK Well type SATE If A, B, or C provide PWSID# N/A Date completed 5/23/1984 Sanitary seal (YIN) YES Total depth3S7 ft. Cased to 026 ft. FROM WELL LOO Date of test 5/23/1984 Static water level 310 ft. Well production 5 g.p.m. WATER SAMPLE RESULTS: Conform 0_ colonies/100 ml. Nitrate D,.,_mgJL. Well Log (YM) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 3/14/2005 41 ft. 1.4+ g.p.m. Other bacteria _L_colonies/100 ml. Arsenic: N/A mgJL. Date of sample: 3/14/2005 Coned by: GEG. UD. B. SEPTIC/HOLDING TANK DATA Tank 7yp&Wterial STEEL Date Installed 5/24/1984 Tank st7e 1250 gal. Number of Compartments 2 Foundation deanout (YIN) YES Depression over tank (YIN) NO Cleanouts (YM) YES High water alarm (YIN) N/A Date of pumping 9/3/2004 pumper ISAACS PUMPING C. ABSORPTION FIELD DATA Date installed 5/74/1984 Son rating (g.p.dJflllr® 150 System type TRENCH Length B8 ft. Width 3.5 ft. Gravel below pipe 0•5 ft. Total depth 'es A Eff. absorption area 680 fe Monitoring tube "YES Depression over field NO Date of adequacy test 3/14/2005 Results (Pass/Fan) PASS For 4 bedrooms Fluid depth in absorption field before test 2 in. Water added 644 gal. New depth 7 in. Elapsed Time: 224 min. Final fluid depth 0 in. Absorption rate >= 600+ g.pA. Any re)uvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — 04MONTTORING TUBE ONLY EXTENDS 4.Y INTO SEWER ROCK. D. UFT STATION Date installed -Pump on- level at _in. E. SEPARATION DISTANCES Size in gallons High water alar level at in. Cycles tested Meets alar & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAtft station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lob 100'+ On adjacent lots 1001+ Public sewer manhole/deenout N/A 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 1008+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line * 101+ Building foundation 10'+ Water main N/A Water service line 100+ Surface water 100'+ Driveway, parkinglvehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS aft 040 W6444 -ro ( a i IV / 6GT64c-o- Fn A4 0. ENGINEER'S CERTIFICATION 1 car* that I have determined through field inspections and* 9 %� '..71review of Mimidpat records that the above systems are in .. ""' .. ' """ ... conformance with MOA HAA guidelines in effect on this date. Ca . �:.. Engineer's Printed Name JEFFREY A. GARNESS —7953 Date 5� 2y�05 HAA Fee E 14M.10 Date of Payment 45X2410.5 - Receipt Number 6?W& 11 a— M". 17J01) Walver Fee S Date of Payment Receipt Number " 8 co ,- M �z�D o 0_ O n O Z A =O O M R* m jCvx(i vm C G" cn w "'mmz A D Z ocsm >> sm(i y v f U) �7 -+>>' .%fi r,., DOC Cn Z C7O rn cnrnm Nrnm r .� xC C zu D �fjX DCA z °° rO < Z m m N C - o z �0 O �< m hod CTJ D> O O -< <A< N 7Mo � (n C� Gd O W O �D tj Z W c 11 0 fTi 0 C_ < -1 — z co ,- M o 0_ ti m jCvx(i vm Z �Ng rn�z Nn� N 9 ocsm >> sm(i O m r' �' I ( z Nan smr rn cnrnm Nrnm .� xC D �fjX 0o om0 Z = .a lT in O n > > Cn D 30osC � -.p nZ 000 �0 C7 hod 3-5- D> <A< N 7Mo � (n a CD.t D � I'< rt Z 0 00 ID C_ < -1 g N N 5—:r,< — m� aoco 3 O N 3m =f y .v 0 ac9p n O :73 (D s0 0v z vo o m o� as m -I .N .< -{ o 0 v+� r O e z maam O v a3mrtr�* K f N N N� S 7 S a N 7 N < Lo. �rnNo 0 M opo >>�_ p > aw N. m o o t�"PT7'ti mvrn°voa a o�s a C—:CD 00 Oo 0 55Dm oma N 3 os z 'D CD m C g cn am;a.�no y 0*0 o o < -C w cn r- m iv m �nm>m �I M UJ o n R D m Z mZ imc? n C D O ? a 0 v_ -u D m O M i x . O \ Cn m O m D x Z z 00 Clj O M 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 I.D.# O2O O%tz B¢ HAA If u10IQQ25 GENERAL INFORMATION Complete legal description L f7' 7 /5GlJGk 3 Location (site address or directions) -� 27&—�3r5 Property ownerGy-os,RpmDay phone zds1—zs951 Mailing address /G31/ O/L . A4/c.yo/t.46 C A.E.. Lending agency_ Seoft/� �1ov �4g� a Day phone Mailing add Agent Day phone 3YS-7-'99 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: -5=1 3. TYPE OF WATER SUPPLY: Individual welly Community well Public water 6d29- sr6� 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: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72m5 (R«. 1/91) Flom MOA 921 5. 6. M 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 'f1'L��Gihico� ��r�ic e r Phone 45"- C -S-6 9 Address Engineers signature DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments • Date -6/421q/ bedrooms, with the following stipulations: Date 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.. non (R«.1191) Back MOA 021 1 y Municipality of Anchorage Department of Health & Human Services AIELQ HEALTH AUTHORITY APPROVAL CHECKLIST UMS Legal Description: A 7 3 -3ZMi"Hl/94r! /�G+,lfParcel I.D. 47Z,57 B '�f A. WELL DATA Well type PryvT If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed Driller 3vd Zs�y Total depth 38'7 Cased toZTv r 6oltcoyce Casing height Z•O Sanitary seal (Y/N) V Wires properly protected (Y/N) �✓� ENVIR,,NNdN;AL S.kr;..LI, .AVL,QN FROM WELL LOG AT INSPECTION Date of test B-2 3-ff5� 6 _/¢_q� 'JUN 14 1991 Static water level 3�� g Z' 6 RECEIVED Well flow S 9.p -m. 10.9 6-0414, g.p.m. 3.3. Pph76,114�) Pump level AsJya+sv 7rCfT p/tAc✓oow.v /B .�• 3SM..v, wcec rr7rl'���ep Oo2 .Ss 64 /Lr SEPARA IONDI ELLTOy .v, 2An Gee!/�/o.vtCftrryctffe SEPARATIONDI FROM WELL TO: ,yoq �itoOr.>:T/a2V•LCQ�ttnc�vrJ i�ir 40'A -o3'. � Fo.0 ,t � ?QmitOaM Owcres�G Septic/holding tank on lot 6P/ ; On adjacent lots 4r L/3 2/D Absorption field on lot <O ; On adjacent lots Z_ 5'//-3= 1-6� 3°,StL L /3 220± Public sewer main Public sewer manhole/cleanout /d1A Public sewer service line /VZA Petroleum tank - NlA .K - All TC• 41ZAcvoewAlV k6COUC%Y CAGB S /A/GOA/CWfort T 01/," 1'0 CASCAl7iA/fi l�i4►CC F/toAh 'e0C1` F0AA1Anp,r/ fNs�.rr0 WC1-c.. GAS WATER SAMPLE RESULTS: �[ Coliform Nitrate -'*1 OG/� � Other bacteria Date of sample: 4g1111-71Collected by: yAi"'�I /3o<?s # WC�-L r4LDOtiCC'l /NrTANTCn�/S OG"MAKO GOAO.r rot . 90 .ti/y f Low SEPTIC/HOLDING (/G T NK D rysTrA4, o 6.rf T � PVM/EG Q fzac"(r . ICA 7-45 „ B. SEPTIC/HOLDING TANK DATA Date installed s12VA(952� Tank size <2S0 Compartments Z Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) ///�A IAlarm tested (Y/N)'_ N�A "- Date of pumping 6 `/3�Y� /9 -A lAes Aome' .Sei^7//Gee_- . SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: crs>/m Well(s) on lot <0l On adjacent lots Foundation /-T-' i To property line SS— Absorptionfield S 'r Water main/service line &VA Surface water/drainage IV!A 72-M(Rw. W) Fm l MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date Installed . Size in gallons Vent(Y/N) _ High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer. Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Surface water Date Installed 5/Z�/� Soil rating �S� ��0 System type T/C�NG/q Length 6B ' Width '5'Z a Gravel thickness S Total depth Total absorption area Cleanouts present (Y/N) Y Depression over field (Y/N) , Al Date of adequacy test Results (pass/tail) Oa ss for - bedrooms Peroxide treatment (past 12 months) (Y/N) N' If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TOG /3>.'/O Wellonlot. —On adjacent lots LS- 3e0fL6157–'•propertyline /Z To building foundation /✓? To existing or abandoned system on lot /V`A Onadjacent l(its*1-0getCutbank NIA Waterman/service line'Q Surface water /VIA Driveway, parking/vehicle storage area y rO t Curtain drain N�i4 E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guideli qt hard Signature _L, Engineers Name tjSeVV6�qtL�_T Date HAA Fee $ 117 0 t� Date of Payment L4' 1 Receipt Number 2; +90 ' / n n l l 72-M(Rw. 311(Buk MOA 21 Waiver Fee: $ — Date of Payment Receipt Number Aw 0 19 f j(this inspection. . h % f �I 4Gn_ MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information (a) tion (include lot I�Li� G iL Location (address or directions) (b) Applicants Applicants Addres Application Date J y tjw a subdivision, section, township, range) (c) Applicant is (check one) Lending Institution Buyer Q ; Other Q (explain); ; Owner/builder Lel ; (d) Lending Institution Telephone Address (e) Real Estate Co. S Agent Address Telephone (f) Mail the HAA to the following address: 3ti5- SH3 0 2. Tvne of Residence Single -Family Multi -Family Other (describe) Number of Bedrooms 3. Water Supply' Individual Well E0 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 21 r'1 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 regula- tions in effect on the date of this inspection. Name of Firm (- et �Lfl {-� Telephone •fie/ ej YCK�Z Address I ] E %%AVio' AA3c m&AF e Air 1,9 7sz t az E¢� Date Z Nov 84 � •0�e 'E n,, � e• •• Vim. ri n:� Ya7�� •••` V y0 is (ENGINEERp°$ oe � veooe ere• .� ft••eeje/THOM evavn �qa w:•w. I y 6. DHEP Approval :i ;t TMOMAeR.6 1 n 'r T,..,.`•. .2248-E ��- V +C•. y.••• p..!, Approved for/t�ir' F/ bedrooms By �.t.�-r l+ _•' Y•u.l s��9?'`•^� Date �� /•� Approved V Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON .THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DUEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 A. WELL DATA hW 41VPAL;7Y CF AKCHCRACJ' DEPT. CF HBA:T:1 Z L`:VI:C\.`dUaAL P:.LTLCT:CN MUNICIPALITY OF ANCHORAGE (Mon) NOV 15 1994 HEALTH AUIHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 RECEIVED Legal Description: SLS) (3iac 3 Well Classification 1miyiW64. If A, B, or C, D.E.C. Ap'proved(Y/N) -Ai1A Well Log Present (YM) Date Ccupleted n l�V�/Yield1 _I Total Depth 3 55 ' Cased to 3 � Depth of GrcutirgjlA 5 M Static Water Level 201 Pump Set At Casing Height Above Ground S" Sanitary Seal on Casing Electrical Wiring in Conduit (YM) YC -5 Depression Around Wallhead (YM AAO Separation Distances from Wall: To Septic/Holding Tank on Lot 10 ( On Adjoining Lots / DO To Nearest Edge of Absorption Field on Lot 1 C7Z On Adjoining Lots '>130 To Nearest Public Sewer Line IJ la To Nearest Public Sewer 1 Cleancut/Manhole NIS= To Nearest Sewer Service Line on Lot N/4 Water Sample Collected..By /ri (58 Da I Z AM14 844 Water Sample Test Results -':3,4 >7 t F AcT �y Caments B. SEPTIC/HOLDING TANK DATA Date Installed r Size No. of Caipartmarts Z Standpipes (YM) Nr& Air -tight Caps (Y/N) Sitz S. Foundation Cleanout (Y ) Depression over Tank (Y/N) ,) Date Last Pumped b,&- Pumping/Maintenance Contract on File (Y ) for I�A Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (X/N) Separation Distances from Septic/Holding Tank: To Water -Supply Wall D 1 To Building Foundation To Property Line To Disposal Field �1 JC�� To Water Maie/Service Line NJA- To Stream, Pond, Lake, or Major Drainage Course '} /ts Com:ents 3a� 030 iE ! :.. 00 [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design-MOOC-4 Date Installed f Ztj �$y Iength of Field Width of Field G�Z �� Depth of Field Fj, 51 Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present (YM) V Va Depression over Field (Y/N) /V O &te of last Adequacy Test JJ�� Results of Last Adequacy Test hJ O") S�iSTt)✓l Separation Distance from Absorption Field: To Water -Supply Well I b 2 To Property Lire JS To Building Foundation 13 To Existing or Abandoned System a: Lot N /A ; On Adjoining Lots -5D / To Water Main/Service Line _AJ /A- To Cutbank(if resent) AIA To Stream/Pond/Lake% Major Drainage Course NIA - To Driveway, Parking Area, or Vehicle Storage Area 7 Zp Comonts D. LIFT STATION %J OT Date Installed APPu4415t-e Dimensions Size in Gallons Manhole/Access (YM) "Rump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (YM) Tested for Pumping Cycles during Adequacy Test. Meets MDA Electrical Codes(Y/N) Ccmaents ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. j Signed Date 17AW,9e Ccapany MOA No. 4-0 KB1/d5/s (Page 2 of 21 2-15-84