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Home My WebLink AboutPTARMIGAN ROOST BLK 3 LT 8Ptarmigan Roos? Block Lot 8 #020-042-83 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP241256 PID Number: 020-042-83 Dwelling: # Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name ROGER HOLLAND A ORPTION FIELD ❑ D Trench El Wide Trench []Bed ound Site Address 16361 SANDPIPER DRIVE, ANCHORAGE, AK Other Phone Number of Bedrooms Soil Rating Total depth f original grade 907-351-8277 5 /sF Ft. LEGAL DESCRIPTION Depth to pipe invert from original de Gravel depth beneath pipe Ft. Subdivision Block Lot PTARMIGAN ROOST 3 8 Fill added above original gr Ft. G I length Ft. Township Range Section - - Gravel width Ft. Beds: Number of Lines Di s a between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total orption area Number of trenches Dist. between ches From Tank Field Tank Line Ftz - Well 100'+ EXIST. - - 25'+ TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer INFILTRATOR SYSTEMS Capacity IM -1530 Gal. Surface Water 100'+ EXIST. - - Material Number of compartments Lot Line rj'+ EXIST. - - NA PLASTIC 2 Foundation 10'+ EXIST. - _ ATION Manufacturer Capacity Remarks PER THE CONTRACTOR, OLD TANK WAS PUMP Gal. AND FILLED WILL CONCRETE SLURRY. Alarm location Elec r . talled by Installer PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 ARM SEPTIC SERVICES Drainfield EXIST. CO/MTD3034 Inspector GEG BENCH MARK (Assumed elevation) 96.75 It Inspection151 9/10/2024 Location and description dates: 2�e aro 4th TOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp �o Conditional Approval: Date . 4 TSI*�p0 e s., Septic Systerrt� Approved f ; ' " Date ich ., I L,Q0�4 Qe f ey Ga CE -7 e�P �Q` �c0000 e: this approval does not include well permit requirement �OpO°fessoQo� �OOoo #AECC884 (Kev uwu2/ltl)/ 12PARCEL ID NUMBER:OSP2456 RECORD DRAWING I 020-042-83 ---------------------------------------------------- -------------------- 20' UTIL. ESMT. -------------------------------------t---------------- -------------------- A I B I C DBL1 18.1 45., 7 DBL2 18.9 46.2 MH1 21.5 48.0 STI 27.5 42.4 DBL3 30.2 39.3 DBL4 30.3 38.3 C01 34.1 28.8 53.2 CO2 40.8 18.8 40.5 19.6 NEW STEEL MT \ AND CO NEW IM -1530 INFILTRATOR SEPTIC TANK DOUBLE CLEANOUTS (DBL3 & DBL4 5 J –DOUBLE CLEANOUTS -- (DBL1 & DBL2) O EXISTING 5 -BEDROOM HOUSE EXISTING SANppiPER OR ENGINEERING � SALES � CONSULTING 3701 E. TUDOR ROAD, SUITE 101 - ANCHORAGE, ALASKA' PHONE (907) 337-6179 `WEBSITE: www.gamessengineedng.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ROGER HOLLLANS C/O ARM SERVICES 907-688-9433 2 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: PTARMIGAN ROOST; BLOCK 3, LOT 8 J.L.M. TYPE OF WORK: DATE: RECORD DRAWING OF SEPTIC TANK UPGRADE 10/7/2024 W U Q Q. x 10� Jbffrey A.�afness ac J, , V CF -71953 r` 10 As LICENSE �,11A ES " S\ :oV��• #AECC884 r��' ,iid2trse-a10121 % 2r�, NOTE: PIPE LOCATIONS ARE SHOWN PER GEG SHOTS TAKEN WITH IEICA DISTO �,r. S910 LASER DISTANCE METER. SWING TIES TO HOUSE CORNERS WERE ENERATED IN AUTOCAD. APPROXIMATE LOCATION OF EXISTING DRAINFIELD— NEW STEEL MT \ AND CO NEW IM -1530 INFILTRATOR SEPTIC TANK DOUBLE CLEANOUTS (DBL3 & DBL4 5 J –DOUBLE CLEANOUTS -- (DBL1 & DBL2) O EXISTING 5 -BEDROOM HOUSE EXISTING SANppiPER OR ENGINEERING � SALES � CONSULTING 3701 E. TUDOR ROAD, SUITE 101 - ANCHORAGE, ALASKA' PHONE (907) 337-6179 `WEBSITE: www.gamessengineedng.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ROGER HOLLLANS C/O ARM SERVICES 907-688-9433 2 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: PTARMIGAN ROOST; BLOCK 3, LOT 8 J.L.M. TYPE OF WORK: DATE: RECORD DRAWING OF SEPTIC TANK UPGRADE 10/7/2024 W U Q Q. x 10� Jbffrey A.�afness ac J, , V CF -71953 r` 10 As LICENSE �,11A ES " S\ :oV��• #AECC884 r��' ,iid2trse-a10121 % 2r�, PERMIT NUMBER: OSP241256 RECORD D RAW I N G PARCEL ID NUMBER: I 020-042-83 TOP OF TANK @ INLET= 93.08 - I INLET INVERT OF PIPE @ INLET= 92A7 — OF MANHOLE J—FINAL GRADE= LID=96.75 / 96.16-9629 PER THE CONTRACTOR, THE TANK WAS INSULATED WITH 2" OF RIGID INSULATION 1530 2 -COMPARTMENT INFILTRATOR SEPTIC TANK \FFLE WALL OUTLET TOP OF TANK @ OUTLET = 93.08 (VERT OF PIPE @ OUTLET = 92.20 AV �:�'` ♦®♦ GARNESS 1 4 ................ ..... .................. ... ENGINEERING SALES CONSULTING e 3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, ALASKA -PHONE (907) 337-6179' WEBSITE: www.gamesserigineeririg.com ® •..••.... • +e+'+ �•••• •••R PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ® � = re y Pi,•G mess �a ROGER HOLLLANS C/O ARM SERV ES 907-688-9433 3 OF 3 ®$moi• : CE -7 53 ' _� PROJECT/LEGAL DESCRIPTION: DRAWN BY:AV �� (��`'•,, i� 2 � PTARMIGAN ROOST; BLOCK 3, LOT 8 J.L.M. 1 FO ` • �• •••,�A'�''�, �� TYPE OF WORK: DATE: LICENSE RECORD DRAWING OF SEPTIC TANK UPGRADE 10/3/2024 4AECCBsa MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241256 Work Type: SepticTank Upgrade Tax Code Number: 02004283000 Site Legal Address: PTARMIGAN ROOST BLK 3 LT 8 G:3238 Site Mailing Address: 16361 SANDPIPER DR, Anchorage Owner: HOLLAND ROGER D & LESLIE B Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: 8/15/2024 8/15/2025 39067 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: • For the COSA, the trench under the driveway will have to be addressed. Also, the sump at the end is to be found/repaired if necessary. -Received-By: _L -6,5, t A -fO (5�iE s' Date: Issued By: Gtr Date: _ (�� 5 ON-SITE SEPTICMELL PERMIT APPLICATION Parcel I.D. 020-041-83 Property owner(s) Roger Holland c/o ARM Services Mailing address 16361 Sandpiper *ANCHORAGE, AK Site address 16361 Sandpiper *ANCHORAGE, AK Phone: 907-343-7904 Fax: 907-343-7997 Day phone 907-688-9433 Legal description (Sub'd., Block & Lot) Ptarmigan Roost; Block 3, Lot 8 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field El Initial F-1 Single Family (SF) El (w/wo ADU) Septic Tank [-I Upgrade R Duplex (D) ❑ Holding Tank Renewal F] Multiple Dwellings El Privy ❑ (SF and/or D) Private Well El Water Storage n THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 4 -LL -2- 2 S Waiver Fees: Date of Payment: Date of Payment: Receipt Number: Receipt Number: Permit No. 0512 211 Waiver No. GMevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsWermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241256, Deb Wockenfuss, 08/15/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241256, Deb Wockenfuss, 08/15/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241256, Deb Wockenfuss, 08/15/24 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 LEGAL DESCRIPTION [] UPGRADE D,STANCETO: I We'b --f I A' s°rpt'o"?r ' ' D.,I,ng, Manufacturer ~/.~_~. Mate iai Inside length Wl~h iLIq. capa~/~a~)ons IF HOMEMADE: DISTANCE TO: I Well ~ No. of comp~..~ents Liquid depth -- Liquid capacity !n ~'HIonL ~ O,STANCE ?0: We~ ~ ?/'~'*- ~ S"' Length Wpdtn Depth PERMIT NO.(~//0 ODD,~ ~ PERMIT NO. Type of crib Cr,b diameter Crib depth Well foundation DISTANCE TO: Depth Driller Distance tO lot hne PERMIT NO. ~:~/O ~.~. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS INSTALLER REMAR[(S /9 72~13 { Re(./3/78) I~IELL AND PERMIT N0. < B1092~: > I'IL.'-I I C I Pi:iL I T'~' OF RI'-.ICH 0 P.. R lie DEPARTMENT f~HERLTH R~tD ENVIRONMENTAL /~'~OTECTION 825 "L STREET, ANCHORAGE, AK. 9~,.,,J1 APPLICANT CARIBOU INVESTMENT/ LOCATION RABBIT CREEK LEGAL L $ B 3 PTARMIGRr~ ROOST S?D LOT SIZE TYPE OF SOIL ABSORPTIOr-I SYSTEM IS: TRENCH MR×IMUM ~IUMBER OF BEDROOMS = 5 SOIL RATING (SQ FT/BR>=~ 150 THE REQUIRED SIZE OF THE SOIL RBSORPTIOr-I SYSTEM IS: DEPTH= S lEl'-.I g Th = I g R R'..-' E L DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRRINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETI,IEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET>. THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOm1 OF THE EXCAVATION <IN FEET>. REQU I RED SEPT I C TRNK S I ZE= 1500 GALLONS PERMIT APPLICAr~T HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY Ar-ID THE ~IUMBER OF RESIDENCES THAT THE I. IELL WILL SERVE. TI-lO e. 2 > I I'-~_'~PECT I 01'-.I $ ARE RE[~.U I RED BAC~.',FILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTIOt'I. MINIMUM DISTANCE BETWEEN A I.IELL Ar.iD ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 29~ FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTAt.~CE FROM A PRIVATE &.~ELL TO R PRIVATE SElqER LINE..I5 25 FEET R~1D TO R COMMUNITY 5EI.~ER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 3~ DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUC~IOt-I~[~IRGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. : ' ~'~.' PERMIT EXPIRES DECEMBER ~l~ "l~8i I CERTI~ THAT . .: , . l: I RM FAMILIAR i,IITH THE REQUIREMENTS FOR Or-d-SITE 5EI4E~S RHD~'WELLS RS SET FORTH ~ THE MUNICIPALITY OF 8~-4CHORRGE. 2: I ~4ILL INSTALL THE S~STEM IN ACCORDANCE ~IITH THE CODES..? ~. 3: I UNDERSTRF~D THAT THE ON-SITE SEWER S~STEM MR~ REQUIRE~ENL'RRGEMENT IF THE RESIDENCE I5 REblODELED TO INCLUDE MORE THAN 5 BEDROOMS. ~.. ~; APPLICANT CARIBOU INVESTMENT, INC. ~' ~ ~SSUED BY--- V4. 0 ,.~IUNICIPALITY OF ANCHORAGE ~ . Department f ' Health and Environmental .rotectzon · . 825 L Street, Anchorage, AK. 99501 ~ ~- 264-4720 * * * HANDWRITTEN PERMIT * * * WELL AND/OR ON-SITE SEWER PERMIT . ~/~/~-~ W~/~2~ Ma 11 lng Address: Location:/~'f~ ~/~-/~ Phone Number: '1-7~- ~ Legal Description:Z~ ~ ~/4;/~tf~ ~o ~!~7'--Lot Size: ~ Type of Soil Abso/~i. on. System Is: Trench: ~-'-. Dra~nfleld: -- Seepage Bed~ Holding Tank: Maximum Number of Bedrooms: Soil Rating (sq. ft/br) The Required Size of the Soil Absorption System Is:' The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /.~D D GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this departme~ will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fe~ for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 1 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-~ite sewer system may require enlargement if include more_that 3 bedrooms the residence is remodeled to · SigneR: Issued b~'~_~ Applicant Date: ~ ~ ~:~/ ' SWP/024(1/81) --.~,'~./, Of . ~ MUNICIPALITY OF ' -:-;.. - '.~ pepar~ment o~ ~ealth and E~vironmentai Protection ~'. ' ' '" 825 ~ s~ree~, ~cho~age, AK. ~950L .... : 26~ -4720 ~ ~ * ~ND~RITT6~ PERmiT * · * ~. Tre~h: ~/ Oca~/old: _ ~eopage ~: Ro~ding O~T~ LENGTH GRAVEL DEPTH . WlOT · ~.~a length dLme~cton L~ hhe length(Ln ~aek) o~ the trench or th~ bot~ o~ the excavation(in feoh). ~0ce Lc Do so~ ~idth ~o= ~e gravel ~epkh [s ~he ~[mt~ depth of grave[ behween the ou~fa~[ ~ ~he ~tto~ O~ ~h~ excavatiOn(in ~ee~). ' ~ REOUIRED SSPTIC(HO~[~) TANK SIZE" ~ GALLONS Purm[~ applicant ha~ the rus~nsibi[[ty ~0 in[om [his depa~nt during t~t installation ins~ion~.o~ any we%%s adjacent t0 thkc. ~ropa~ an4 the of reaidence~ tha~ ~ha welt ~[ll ~ecve, ~ ' · · ~ ~0(2) INSPECTIONS A~ R~QUIRED ~ 4 4 Backf/Iting O~ any ~ys~o~ ~ithouh final [nsp~tion and approval bY thL~ de~q~ %~i/[ b, subj~t tO prO~Ut[O~. HLn~ di~taBca between a we%% and any oa-~ite"sewagc disuse[ ~y~tem is for a private well o~ 150 to 200 ~eet ~C~ a pub~[c welt depending u~h is 25 ~eet an4 to a co.unity sewer line is 75 ~eeh. D/ell %~¢ ara and must ~ retu~ to thLc department vithia 30 days o:'the welt Other roqu~c~nts may app%y. 6p~LELcation~ and consent/on dLagr~ aca'~ ,Z certffy that~ ' (l)~ [ ~ f~LLLa= %;Lth the roqu[ro~nts for on-site oewec~ and wells . ~ set :orth by ~l~aLity of ~chorag?. (2)~ Z wLXX inst.% t~ s~tem Ln accordance .~th c~e~. . (3) [ %und~rstan~ that ~h~ ~n-sfte sewec ~y~teR ~a7 ceguLT~ t~ rbciaenc~ t~ re~aLud to include ~,hat ~ Sig -- [~ue4 ' S'W?/O 24 (L/eL)" MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 925 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6- 7- 8- 9- 10- 11- 127 13 14 15 16 17 18 19 20 COMMENTS DATE PERFORMED: ~.~ic~ 'PTA I &A N SLOPE I' SITE PLAN "49! 2225-E 25. 1971 WAS GROUND WATER ENCOUNTERED? ~ P E IF YES. AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN ' FT AND FT PERFORMED BY: CERTIFIED 72-008 (6/79) Box 1~69, ~;?AR Ro~"r~: A AN~ilORA(II~, A~AS~rA 9950~ 644-??14 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF DRILLED AT THE RATE OF .~)2.00 PER FOOT. PROPERTY OWNER ~ott .~r~b'e~.t~er~. ~. Z4z.~j. ~J~ LOCATION OF WELL SITF WELL LOG: 0 .... 28~ $~LO~ 25---42' Con. q~Loae,'t~¢, fl;h,',o£oz weaZhe~ed ~¢ 4~. ~o~ o~ w~te~ ~o~o~ i,~ore 225 ~e~. 250 f.¢e.~ of- ~.a,ter ,~,tazzd~q o~g ho.t,~.o,~. 1.6 ga~ p~'~ ~oo2c: 400 qoA~ ga 4~e, zu¢. Ov~ 2500 qoX,,~ Co.~.t o-~ g,t. Zdd~9: E6710.00 Coo,t. o/~ ged. d. Se,ad.: S20.00 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS DATF Se't:~' lO~ch~ 1~81 SERVICE CHARGEOF ~% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS. · .. ,,~ ....... .'Tis) 4'- MUNICIPALITY OF ANCHORAGE Development Services Department �q /� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-042-83-000 Expiration Date: 9/12/2025 Legal description PTARMIGAN ROOST BLK 3 LT 8 Site address 16361 SANDPIPER DR Anchorage AK 99516 Current property owner(s) HOLLAND ROGER D & LESLIE B X The On-site system(s) is/are approved for 5 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: 0 Original Certificate Date: 10/21/2024 is Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval June 2022 MUNICIPALITY -OF ANCHORAGE Development Services Department Phone: 907-34.3-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application I. GENERAL INFORMATION Parcel I.D. 020-042-83 Complete legal description PTARMIGAN ROOST; BLOCK 3, LOT 8 Location (site address) 16361 SANDPIPER DRIVE, ANCHORAGE, AK Current property owner(s) ROGER HOLLAND Day phone 907-351-8277 2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ■❑ Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed 0 Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment /0 A/ -Z- U Date of Payment COSA # 0 S C 2 V i V/ (0- Waiver # COSA Applicalion_June 2022 COSA Checklist Legal Description: PTARMIGAN ROOST; BLOCK 3, LOT 8 Parcel ID: 020-042-83 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 9/10/1981 Total depth 305 ft Cased to *BEDROCK ft Q Sanitary seal is functioning correctly Q Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 9/12/2024 Static water level at beginning of test 28.2 ft. Comments *ASSUMED B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 8/28/1981 AN ALL standpipes present per record drawing Total measured depth from grade 10.3 ft (max) Measured depth to pipe invert from grade 7.56 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 2.9 a4 •-7ta, ❑ Presoaked required if o®�`' (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced _gallons date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Well production at time of test 0.9 gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes 101 No FE Coliform bacteria is Negative Nitrate 2.76 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L 0 Arsenic less than MRL (ND) Collected by GEG, LTD. Date 9/12/2024 STATION ❑ Require Age of lift station Lift station nce com rs Adequacy test date 9/12/2024 Results Q Pass Fluid depth prior to test 0 in Water added *1418 gal New fluid depth *29.5 in °� V Elapsed time 132 min n� Final fluid depth *8.5rinAbsorption rate 750FIELD STATUS — POEffective depth (per rEffective depth usedEffective depth rema ents/Deficiencies: *1,000 GALLON WATER HAUL USED FOR SEPTIC TEST. 29.5" WAS MAX. RISE DURING **BASED UPON GEG ELEVATION SHOTS. t., 10 va A`gam 14 MT- I el4i ® O i„ 6 -t Ji.-- S r- t Cd Pr 7c)s' 6 w3 J w COSA Checklis _ une 2022 g �f✓� lol 2 0 p 7Ze E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ❑i Yes if No ft 0 Yes if No ft Neighboring Tank > 100' ❑i Yes if No ft Private Sewer/Septic Line > 25' RN Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' FE] Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft ❑i Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' QYes if No ft QYes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q■ Yes if No ft Surface Water > 100' M Yes if No Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' ■0 Yes if No ft no Yes if No ft Q Yes if No ft Mn Yes if No ft Wells on Adjacent Lots: Private Wells > 100' ME Yes if No Community Wells > 200' M Yes if No If tank or field is under driveway comment below F. ENGINEER'S COMMENTS ALL ASPHALT WAS REMOVED ON SOUTH END OF DRAINFIELD. THIS END OF DRAINFIED HAS 7.2' OF COVER. ft ft ft G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Garness Engineering Group, LTD. (GEG) Engineer's Printed Name Jeffrey A. Garness Phone 907-337-6179 Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. :..l ,!................... Irky .....Mess,: ,i CE -7953 c�GL ..�,��o ��1��ofessron�ao COSA Checklist June 2022 #AECC884 _-V4S6% 101'?-4� -� LOT B PLAT #72-121 �- LOT 13 BLOCK 2 ASPLS MORTGAGE LOCATION SURVEY NOTES: NO TITLE REPORT WAS PERFORMED FOR THIS SURVEY, EASEMENTS SHOWN PER THE RECORD PLAT. THERE MAY BE ADDITIONAL EASEMENTS NOT SHOWN HEREON. THIS MORTGAGE LOCATION SURVEY HAS BEEN PREPARED IN ACCORDANCE WITH ASPLS MORTGAGE LOCATION SURVEY STANDARDS. IT IS A REPRESENTATION OF THE CONDITIONS THAT WERE FOUND AT THE TIME OF THE SURVEY. THIS SURVEY DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY 'SURVEY MAY DISCLOSE. THE INFORMATION CONTAINED IN THIS DRAWING SHALL NOT BE USED TO ESTABLISH ANY FENCE, STRUCTURE, OR OTHER IMPROVEMENTS. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT. 29mm N=89"28'1 0") .,20.00')' .31.23") !D=N 44*47'30 E) 0=28.15') Lu W -� I , of 3 Of 60' SCALE- 1#1 = 30 FEET I I fix 1711) OF& A�4 Idaw AW 49TH 00 owes 0#604**006beet -Ryon G. Johnson& No. 192159 .9/20/2OZ4 AW a,"* 4,18 0 * slo%� a RECORD DATA PER PLAT #71-214 0 FOUND 5/8" REBAR, NO CAP PP — -GRAVEL DRIVEWAY EDGE OF ASPHALT E — E— OVERHEAD UTILITIES uj pp -0- POWER POLE w Lp LIGHT POLE PADMOUNTED TRANSFORMER UTILITY VAULT r) w UTILITY PEDE S T D @) Eu SP C PIPE 7 SEPTIC TANK LID WELL 30 30 IS T STORY DECK w 2ND STORY DECK BRICK PAVERS N=89"28'1 0") .,20.00')' .31.23") !D=N 44*47'30 E) 0=28.15') Lu W -� I , of 3 Of 60' SCALE- 1#1 = 30 FEET I I fix 1711) OF& A�4 Idaw AW 49TH 00 owes 0#604**006beet -Ryon G. Johnson& No. 192159 .9/20/2OZ4 AW a,"* 4,18 0 * slo%� a MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT !� 907-343-7904 On -Site Water and Wastewater Section I Fax: 343-7997 www.muni.org/onsite Well Water Advisory Certificate of On -Site Systems Approval # OSC241416 Subdivision: Ptarmigan Roost, Block: 3, Lot: 8 This well's productivity was determined to be .9 gallons per minute. The minimum well productivity required under (AMC 15.55) for a 5 -bedroom residence is .52 gallons per minute or 150 gallons per day per bedroom. Although the subject well currently exceeds this minimum requirement, the production capacity can fluctuate and may be insufficient to meet your needs. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-042-83 GENERAL INFORMATION Complete legal description FTARMIGAN ROOST BLOCK 3, LOT 8 Location (site address) 16361 SANDPIPER DRIVE, ANCHORAGE, AK 99516 Expiration Date: Current Property owner(s) GEOFFREY & CAROLYN HADDAD Mailing address Lending agency Mailing address Day phone 16361 SANDPIPER DRIVE, ANCHORAGE, AK 99516 Day phone Real Estate Agent Mailing Address Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBEROF ~EDROOMS: 3. ~TYPE OF WATER'~UPPLY: · ~ Individual Well :i;i.;' Individual :Wale'[ S!orage Community Class'__ Well Public Water System 5 TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [~ [] Individual Holding Tank E~ [] Community On-site [--] [] Public Sewer E~ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a pubiic water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this 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 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 07/13/2011 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. DSD SIGNATURE ~/Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X By: (Rev 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other ,,- inal Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: PTARMIGAN ROOST BLOCK 3, LOT 8 Parcel ID: 020-042-$3 A. WELL DATA Well type :PRIVATE IfA, B, or C provide PWSID # __ Well Log (Y/N) ¥ Date completed 9/10/1981 Sanitary seal (Y/N) Y__ Total depth 305 lt. Cased to BEDROCK ft. FROM WELL LOG Date of test 9/10/19gl Static water level $5 ff. Well production 3 g.p.m. WATER SAMPLE RESULTS: Coliform NEC; colonies/100mL Nitrate 2.51 mg/L Arsenic: ND .mg/! Date of sample: 7/1/201:1 Collected by: AzcTezxa B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 8/28/1981 Tank size 1500 gal. Number of Compartments _2 Cleanouts (Y/N) _Y Foundation cleanout (Y/N) ¥* Depression over tank (Y/N) N__ High water alarm (Y/N) N Date of pumping ?/1/11 Pumper IRs Wires properly protected (Y/N) Y Casing height (above ground) 24 in. AT INSPECTION 7/1/2Oll 32 ft. 1.1 g.p.m. Eft. absorption area 980 it2. Monitoring tube Y Date of adequacy test 7fl/2011 Fluid depth in absorption field before test 0 in. Depression over field N Results (Pass/Fail) Pass For 5 bedrooms Water added 1000 gal. New depth 14.4 in. Elapsed Time: 360 min. Final fluid depth 0 in. Absorption rate >= 750+. g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type)NIf yes, give date--__c- C. ABSORPTION FIELD DATA Date install~l,8[28[lggl Soil rating (g.p.d./ff2 or ff2/bdrm) 15o Length 98 ff.. Width ~ ff. Gravel below pipe 5___ff. System type TRENCH Total depth 8.___~8 lt. (Measured 7/1/11) LIFT STATION Date installed "Pump on" level at __ Datum in. E. SEPARATION DISTANCES Size in gallons "Pump offf level at__ Cycles tested in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main ?$'+ Sewer/septic service line Animal containment areas Manhole/Access (Y/N). High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 101Y+ Holding tank loo% Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5% Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Curtain drain 50'+ (None Known) Driveway, parking/vehicle storage 10'+ Wells on adjacent lots 100'+ F. COMMENTS *FC0 inside foundation. . G. ENGINEER'S CERTIFICATION ~~ I certify that I have determined through field inspections and 'i~~. ~..:.:.';'. ~..i', review of Municipal records that the above systems are in :~i...~..::""' ~.../.~:~"~'~"":~ .:.' '~ ::. ... conformance with MOA COSA guidelines in effect on this date. ':.~ Engineer's Printed Name KENNETH M. DUFFUS .:.~!~ Date 7/13/11 ' ~~:~;~ COSA Fee $490.00 Date of Payment Receipt Number (Rev. 1 i/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6850 www.muni, orgfonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ' ~'~ "~)~" ~'~ 1. GENERAL INFORMATION COSA. Expiration Date: Complete legal description Location (site address) Current Proper~ owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address PTARMIGAN ROOST; BLOCK 3, LOT 8 16361 SANDPIPER DRIVE 'ANCHORA(~Em AK JAMES &: WANDA BELISLE Day phone 345-2220 16361 SANDPIPER DRIVE *ANCHORAGE~ AK Day phone CHARLIE WHITLOCK W/COLDWELL BANKER Day phone 265-9165 3000 CENTRE STREET 101 *ANCHORAGE~ AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank [] Community On-site [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, I va#fy 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 (am) 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-si~e 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 CARNESS ENGINEERING CROUP, Ltd. Phone 357-6179 Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. CARNESS, P.E...._:. Date Engineer's Comments: In conducEng this evaluation, GEG, ltD. a~lempted to provide a thorough, conscient, iou.? engineedng analysis of the system in accor¢lance with ADE C and MOA ~'~ DSD Gutdelines& Regulations. The reported results described the pedonnonce of the ~,._'~.. ......... ;~'. '~' system under the conditions encountered at the time of the Jest, and separation ~'_~-~' I distanceemeasuredtoreadilyldontitiablefeetures. The eperational life of alt wells and A'T../3;*' ~ c~ T~.iII'~ I "..'.-.~.v~ septic systems depend on the Iocal soils condition, groundwater levels that may ~ ?' :~. . .~' ~'"~J/* ~.. .~. . . .I , . ~ ". .~. . v.~ fluctuate during the year, and the water usage of the farnily being served by the system. / ~ _ results do not guarantee future performance of the system, nor do they guarantee that '~. ~ '-._Je] fr ~' A."~,~_o rn ~ s s.. there are no I~idden defects or encroachments. GEG, LTD. can therefore not prevfde v~.~.. -../ CE_79~-'-.-~.-, .... ~._~ any warranty or fufure esb'mate of how long the system will conbhue to meet the ~ ~,'_/" the sole benefit of the owner listed above Any reliance upon or use of this report by any '~of~e, other pereon or party is not authorized, nor will it confer any legal #ght whatcoever. 5. DSD SIGNATURE ..... ~"~'"°' ~'~ .' WATER AND : Et[ Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: ~ : WASTEWATER ~ ~ :b,'~Oz~ .... ~...~'.~,~'v Attachments: COSA Checklist ~ Septic System Advisor,/ Well Flow Advisory ~/.,,,"~ "' Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other Odginal Certifica~:e Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.munLorg/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS .&,PPROVAL, CHECKLIST Legal Description: PTARMIGAN ROOST; BLOCK 3~ LOT 8 A. WELL DATA Well type pR~VAT£ If A, B, or C provide PWSlD# Date completed 9/10/1981 Sanitary seal (Y/N) YES Total depth 305 ft. Cased tOB£DROCKft. Welt Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ tn. FROM WELL LOG Date of test 9/10/1981 Static water level 55 ft. Well production 3 g.p.m. AT INSPECTION 8/ /2oos 32 0.67 g.p.m. WATER SAMPLE RESULTS: Coliform O coloniesll00 mi. Arsenic: .~_~. ug./L. B. SEPTIC/HOLDING TANK DATA .itrate~). ~ I mg./L. Date of sample: 8/4/08 'qNSIDE HOUSE Tank Type/Material Tanksize 1500 gal. Foundation cleanout (Y/N) *Y Date of pumping 8/1/08 ABSORPTION FIELD DATA Date installed 8/28/~98~ Length 98 ff. Total depth *8.8 SEPTIC/STEEL Number of Compartments 2 Depression over tank (Y/N) NO Other bacteda O Collected by: colonies/lO0 mi. Ltd. 8/28/1981 Date installed Cleanouts (Y/N) YES High water a~arm (Y/N) N/A Pumper MCDOiqALDS PUMPING ~B[I.OW [XISTJN~ (~RAID[ OSUMPI Soil rating (g.p.d./ftJo~ 150 System type TRENCH Width 3 ft. Gravel below pipe 5 ft. Eft. absorption area 980. ft~ Monitoring tube YES, Depression over field Date of adequacy test 8/1/08 Results (Pass/Fail) PASS Fluid depth In absorption field before test DRY In. Water added 986 gal. Elapsed Time: 35 min. Final fluid depth DRY in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN NO For 5 bedrooms New depth 2 In. 750+ g.p.d. If yes, give date - D. LIFT STATION Date installed .Size in gallons Manhole/Access (Y/N~ ~ "Pump on" level at in. Pump off" lev~ at In. Datum ~ .------- Cycles tested. Meets alarm & circuit requirements?. Eo SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanldl[ft station on lot Absorption field on lot. 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas 50'+ 100'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N,/A Manure/animal excrete storage areas 100'+ Buildin, g foundation Water main Wells on adjacent lots SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 5'+ Property line 5'+ N/A Water service line 10'+ 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation, 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacentlots 100'+ F, COMMENTS Absorption field 5'+ Surface water. 100'+ Water main N,,/A Driveway, parking/vehicle storage 10'+ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer*s Printed Name JEFFREY A. CARNESS Date Waiver Fee $ Date of Payment Receipt Number. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 ~wvw.ci.anchorage.ak.us (907) 343-7904 ,XVater 3,Veil Advisory Health Authority Approval # 080293 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 3, Lot 8 of Ptarmigan Roost subdivision, the well's productivity was determined to be 0.67 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 5-bedroom residence is 0.52 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. SGS Ref. K Client .Name Project Name/fl Client Sample ZD Matrix 1084200001 Garncs$ Engineering Group, Ltd. Ptarmigan Roost B3,L8 Ptarmigan Roost B3,L8 Drinking Water All Date~'I'lme$ are Alaska Standard Time Printed Date/Time 08/I 8/2008 8:46 Collected Dar e/Time 08/11/2008 10:01 Received Dar e/Time 08/11/2008 12:30 Technical Director Stephen C. Ede PWSID 0 ~ Sample Remarks: Allowable Prep Analysis Results PQL Units Method Contsmer ID Limits Date Date Init ~Lt crobiolo~ La.ora toz~ Colony Count 0 col/100mL SM209222B A (<200) 08/11/08 DLC TotalCollfonn 0 col/100mL SM209222B A (<1) 08III/08 DLC FccalColiform 0 col/100mL SM209222B A (<1) 08/11/08 DLC $GS Ref.# Client Name Project Name/# Clienl Sample ID ,Matrix 1084014001 Garness Engineering Group, Ltd. 16361 Sandpiper Ptarmigan Roost B3,L8 Drinking Water All Dare'Times are Alaska Standard Time Printed Date/Time 08/19/2008 14:27 Collected Date/Time 08/04/2008 8:05 Received Date/Time 08/04/2008 9:05 Technical Director Stephen C. Ede PWSID 0 Sample Remarks: Allov,~,ble Prep Analysis parameter Results PQL Units Method Conlai~r ID Limits Dale Date Init l~ta~s b~ ICP/M5 Ilardness as CaCO3 144 5.00 mg/L SM20 2340B D 08107/08 02115102 NRB Waters De,ar tment Tolal Nitmte/Nitrite-N 2.41 0.100 mg/L SM204500NO3-F B 02106/08 JDZ Private Individual Analysis Aluminum ND 20.0 ug/L EP200.8 D 08/07102 08/15/08 NRB Antimony ND 1.00 ug/L EP200.8 D (<6) 08/07/08 08/15/08 NRB Arsenic ND 5.00 ug/L EP200.8 D (<101 02/07/02 02115102 NRB Barium 32.4 3.00 ug/L EP200.2 D (<2000) 02/07/02 08/18/02 NRB Cadmium ND 0.500 ug/L EP200.2 D (<5) 07d07/08 08II5/02 NRB Calcium 47200 500 ug/L EP200.2 D 02/07/02 02/15/08 NRB Chromium ND 2.00 ug/L EP200.2 D (<1001 08/07/08 08/15/08 NRB Copper 62.5 1.00 ug/L EP200,2 D (<13001 08/07102 08115/02 NRB Iron ND 250 ug/L . EP200.g D (<3001 02/07/08 02/15/08 NRB Lead 0,214 0.200 ug/L EP200.g D (<151 08/07/08 08115/02 NRB Magnesium 6250 50.0 ug/L EP200.8 D 02/07/02 08/15/08 NRB Manganese 1.22 1.00 ug/L EP200.2 D (<50) 08/07/02 02/15/02 NRB Chloride 6.42 0.100 mg/L EPA 300.0 C (<250) 08/07/08 02/07/02 LCP Fluoride ND 0.100 mg/L EPA300.0 C (<2) 02/07/02 08/0?/02 LCP Selenium ND 5.00 ug/L EP200.2 D (<50) 08/07/08 08/15/08 NRB Sodium 7460 500 ug/L EP200.8 D (<250000) 08/07/02 08/15/08 NRB Silver ND 1.00 ug/L EP200.8 D (<1001 08/07/02 02/15/02 NRB Thallium ND 1.00 ug/L EP200.2 D (<2) 08/07/08 02/15/02 NRB Sulfate 20.5 0. I00 mg/L EPA 300.0 C (<250) 08107/02 08/07108 LCP Zinc 51.2 5.00 ug/L EP200.g D (<5000) 02/07/02 02115102 NRB SCS Ref.# Client Name Project Name/# Client Sample ID Metrlx 1084014001 Gm'ness Engineering Group, Ltd. 16361 Sandpiper Plarmlgan Roost B3,L8 Drinking Waler All Dates/Times are Alaska Standard Time Printed Datcfrime 08/19/2008 14:27 Collected DatefPime 08/04/2008 8:05 Received Date/Time 08/04/2008 9:05 Technical Director Stephen C. Ede PWSID 0 Allowable Prep Analysis parameter Results PQL Units Method Container ID Limits Date Date Init Private Individual Analysis Tolal Dissolved Solids 181 10.0 mg/L SM20 2540C E (<500) 08/04/08 EIIC Nickel ND 2.00 ug/L EP200.8 D (<100) 08/07/08 08/15/08 NRB IICO3 AIkalinily 119 10.0 mg/L SM20 2320B E 08/I 1/08 SYII CO3 AlkaUnlty ND I0.0 mg/L SM20 2320B E 08/11/08 SYll Oll Alkalinity ND 10.0 mgtL SM20 2320B E 08/11/08 SYII Conductivity 171 1.00 umhos/cm SM202510B E 08/04/08 SYII pll 6.70 0.100 pllunits SM204500-IIB E (6.5-8.5) 08/04/08 SYII Alkalinity Il9 10.0 mg/L SM20 2320B E 08/I 1/08 SYII Colony Count I col/100mL SM20 9222B A 08/04/08 DLC TotalColiform Positive col/100mL SM209222B A (<1) 08/04/08 DLC FccalColiform Negative col/100mL SM209222B A 08/04/08 DLC 5432 E. Northern Lights Blvd, Suite 11466 Anchorage, Alaska 99508 (907) 3384476 ~.voi~, # 5 0 6 7 Description Price i,~r ~i, Amount Septic tank pumped Sludge in tank Leach treatment Bio-mat in leach gloater level in leach Cap on Stand Pipes Other: Recommendations: rotat /~ ~ 1..5% interest will be charged monthly on unpaid bills untII paid. lEgAl PROPERTIES No, 7477 ?. 2 Municipality of Anchorage Development Se~ices Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak-s (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING o2o-o42-83 Parcel I.D. .I:,; ).,,~.. -. .... 1. GENERAL INFORMATION Expiration Date: Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SANDRA ANDERSON Dayphone 644-3457 16361 SANDPIPER DRIVE * ANCHORAGE, AK * 99516 Day phone MIKE MESSICK W/ REMAX Day phone 2600 CORDOVA DRIVE * ANCHORAGE, AK * 99503 257-0110 Unless othervvise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER BUPPLY: Individual Well ~ Individual Water Storage Community Class Well ~_~ Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ~F1 Individual Holding tank Community On-site B 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. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Invesb'gation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for tho number of bedrooms and type of structure indicated herein. I further verify that based on tho information obtained from the Municipality of Anchorage files and from my investigation and inspecb'on, the on-site wafer supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTE'WATER CONSULTANTS. INC. Phone Address 3701 E. TUDOR ROAD. SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. OARNESS, P.E. Date 357-6179 "Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provfde a thorough, ¢onscieetious engineering analysis of the system in accordance v~th ADEC and MOA DSD Guidelines & Regulations. The repcvled results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all welts and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being sen/ed by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee fufure performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, Inc. can therefore not pmvfde · any warranty or future esb'mate of how long the system Mil continue to meet the operational requiremeets 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 bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: ..... ON-S TE ~: WAIERAND : ~ ~. WASTEWATER = PROGRAM .' Attachments: NAA Checklist Septic System Advisory Well Flow Advisory Odginal Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 SoUth Blagaw St. P.O. Box 196650 Anctmmge, AK 99519-6650 www.ci.ancharage.ak,us (90Z) 34379O4 Legal OescfC~an: WELL DATA Well type F~IVATE If A, B, or C provide PWSID~ N/A Date completed 9/10/1981 Sanitmysaal(Y/N) YES Total depth 305 ft. HEALTH AUTHORITY APPROVAL CHECKLIST PTARMIGA~I ROOST SUBDMSIONi LOT B~ BLOCK 3 Parcel ID: Cased to BEmmCK It. FROM WELL LOG 9/lO/ 95 55 fl. .g.p.m. Nitrate ~_mgJL.. Date of sample: 8/20/2003 Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform (~ colanies/100 mi. Arsenic: N/A mg./L. B. 8EPTIC~IOLDING TANK DATA Water added 1042gal. 020-042-83 Well Log (Y/N) Wires property protected (Y/N). Casing height (above ground) AT INSPECTION 8/20/2003 33 .ft. 0.76 g.p.m. YES 12+ in. Other bacteria (~) colanies/lO0 mi. Collected by: AKWWC, INC. Tank Type/Material :~ ~ ~.t.L Tanksize 1500 gal. ..,,,.~Nu~L~erofCompallments2 Foundation cteanout (Y/N)~ Depression over tank (Y/N) NO Date of 'pumping 8/20/2003 Pumper C. ABSORPTION FIELD DATA Date ~ta~ed 5/95/1951 Soil raUng (;.p4~t'o,~) 150 Length 98 ft. Width 3.0 .ft. Total depth 8.9 ft. Eft. ab$o~on sma 980 ft~ Monito~ng tube YES, Date of,=dequacy test 5/20/2003 Results (Pass/Fall) PASS Fluid depth in ebso~)t]on field before test 0 in. Elapsed Time: 214. min. Final fluid depth Any rejuvenation treatment (pest 12 mo.) (Y/N & type) Date installed 8/28/1981 Cleanouts (Y/N) YES High water alarm (Y/N) N/A CHUGACH PUMPIN0 System type DEEP TRENCH Gravel below pipe 5.0 ft. Depmsalon over field NO For 5 bedrooms Now depth 2.5 in. 750+ g.p.d. If yes, give date - in. Absorption ram >= NONE KNOWN D. UFT STATION Date installed Size In gallons Ma~A~als;-~(~tT~__ _ "Pump on" level at in. "Pump off' n. High water alarm level at ~ ,in. Datum Cycles tested Meets alarm & circuit requirements?. E. SEPARA'nON DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO; Septic tank/lift station on lot100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ On adjacem lots 100'+ On adjacent lots 100'+ Public sewer manhota/deanout Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Absorpt;'on field, Surface water. Building foundation 5'+ Property line Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation, 1 Surface water 100'+ Wells on adJacent lots 100'+ Property line 10'+ Water service line 10'+ Curtain drain NONE KNOWN F. COMMENTS 100'+ Water main N/A Driveway, parking/vehicle storage 10'+ G. ENGINEER'S CERTIFICATION I certify that I'have determined through field inspecikms end .- .. ret4ew of Municipal roco~la that the above systems am/n conformance with MOA HAA guidelines in effect on this date. Engineer's Pdnt~d Nan~e JEFFREY A. GARNESS Date of Payment <~' 2.~ "O_.~ Receipt Number ~ (Rev. 12/011 Waiver Fee $ Date of Payment Receipt Number, Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 w-s~v.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Health Authority Approval # 030443 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 3, Lot 8 of Ptarmigan Roost subdivision, the well's productivity was determined to be 0.79 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 5-bedroom residence is 0.52 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. 25. 2003 I:I?P~ RE~^X PROPERTIES ' No. 7641 P. 2 Parcel I.D. # · MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services ' On-Site Servlces Section P.O. Box 196650 Anchorage;Alaska 99519-6650 343-4744 . CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HA^ # 1. GENERAL INFORMATION Complete legal description LO"~" ~'; '~, J~. '~ Location (site address or directions) Property owner I_'~¥~: ~.~ ~,~',.~ Day phone Mailing address II- '~t, I ~ ~.~ ~,%o.~r" . Lending agency Mailing address iz/~o ~" ~,~s (~ l~'.t~ l$J¢~ C~-~. 3o~. J.r~l',,c'.~ 'T'.z.~- 7~03t~ Agent /'~,~-~.r*. ~,r~.~.~/-,~" t~'~-iL'(a.~ · Dayphone Address '~.(~ o-~ ~_~, Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: .~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL.' Individual on-site Holding tank Community on-slte Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. STATEMEN'J',.OF INSPECTION BY ENGINEER ' ' ~ AS ¢b~!ffed by my seal affixed hereto and as of the validation date shown below, I verify that my Inv, estigatiOn o.f this Hea!th 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 strdc!um indicated herein. I further verify that based on theinformation obtained from th'e Municipality of Anchorage files and from my investigation and Inspection, the on-site water sul~ply a.n'~l~(~r Wastewater disposal system Is in compliance with all Municipal and State codes, ordinan~c&s, and regulations In effect on the date of this inspection. NameofFirm "~0/~.~/4' ~,l/v'k~{~ Po~- Phone ~-~//~ Address ~O ~ ~ /~'- ~ ~/ Z o ~ Engineer's signature "~'~-, ~--~v~~ Date 7/~,/,,/~, fo DHHS SIGNATURE )(' Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments -The Munlci~'ality of A~.c'h6rage Department of Health and Human Sen/Ices (DHHS) ssues Hea th Authority Approval C~irtificate's"based only upon the representations given In paragraph 5 above hy an Independent professlo, nal engine~l;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 professlonal engineers work. Legal A. ~ DATA Well type Log prcstm (Y/N) ~ ~ (Y~) Date of lesl S~c watc. r level WcJJ pm:loot/on Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ~, 825%" Street, Room 502 · Anchorage, Alaska 99501· (907) Health Authority Approval Checklist /.~TG f~V.'~ PT&I~MI6A~ Pau~lI.D.: 0,70- ' If A. B. or C, attach ADEC letter. ADEC wat~ system number ~/d~ Dat~ compict~d q/to I ~1 c~ ~o ~ c~8 ~it,~ (~bo,,~ ~u~) ~,~ wi~s properly pmtec~ (Y/N) y FROM WELL LOG AT INSPECYION g.p,m. WATER SAMPLE I~.,~UL~I~: ColiJorm Nlm Od~r bacmria Date of ~mplo: .~.~_~q ~ Collected by: T~ ~ iL SEPI-iCfltOLD1NG TANK DATA C. AI~ORI-tION ~-tt./Z~ DATA q£ / LIFT STATION Date installed $i~e in r,a~ons Manbole./Ae__--~__ (Y/N) '*Pump on*' level at* "Pump off" level at* High water aiann level al* *Datum Cycl~ tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding lank on lot JO~:~ ; On adjacent tots AbsorpUon field on lot Public sewer main I~//..~ Sewer/sCl~c sen, ice line : On adjacent lots Public sewer manhole/cleanout Lift sla~on ~'~/~ SEPARATION DISTANCES FROM SEPTIC/HOLDINO TANK ON LOT TO: Building foundation Waler mnln/service ftne SF-,PARATION DISTANCE FROM ABSOFo-tlON F11=I .1~ ON LOT TO: Water mnin/setvice ~ Building foundation / 7 / cm, t~. drain Dfive~ay., parking/vehicle storage area a=~ / Wefts on ad.ant lots | 1 ~/ Ptop~.. line '7 / 0 F. ENGI[NI~:R'S CERTIFICATION I ceftin, that I have determined tlant field inspections and ~ of Munict in ~nfo~ wi~ MOA H~ ~idelines in effect on ~ ~te. Si~m~ ~ Earner's N~ HAAFee $ c:~ · ~ Date of Payment Receipt Numtu~' lmm,. 8/95 OSS: haa, wk.doc Waiver Fee S Receipt N.mhea- CT&E Environmental Services Inc. Laboratory Division ~~-~-~,~,~-~-~-~-~e-~-~a-~-~:o-~-.~'~ 200 W. Potter Drive Anchorage, AK 99518-1605 Tel: (907) 562-2343 Fax: (907) 561-5301 CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID 963286001 Tobben Spurkland P.E. 8/3 Ptarmigan Roost 8/3 Ptarmigan Roost Drinking Water PW$1D 0 Client PO// Printed Date/rime Collected Date/rime Received Date/rime Technical Director 07/31/96 20:4 I 07/26/96 13:45 07/26/96 14:20 Released B.,LT..> -'~_ .: _ . Sample Remarks: Allowable Prep Analysis Parameter Results PGL Units Method Limits Date Date Init NitrJte-N 0.100U 0.100 rng/L EPA ]53.2 07127196 EH8 #itrate-# 0.190 0.100 ~J/L EPA 353.2 07/27/96 EHB Total Coliform 0 0 col/100mL S~18 9222B 07/2&/96 TAV ~~ Member of the SGS Group (Soci6t§ G6n~rale de Surveillance) ENVIRONMENTAL FAClUTIES IN ALASKA. CALIFORNIA, FLORIDA. ILUNOIS, MARYLAND. MICHIGAN. MISSOURI. NEON JERSEY, OHIO. 1NEST V1RGINIA CT&E Environmental Services Inc. Laboratory Division Drinking Water Analysis Report for Total Coli£omx Bacteria 2:o w..===,; o¢~,.. Anchorage. AK 99518-1 ~05 RE.-LO LVSTRUCTIO.VS O. V P~E~ERS~ $1DE BEFORE CO££ECTLVG SA VP£E Tel: ($07~ =~2-2343 Fax: (~07! 55! -5~0! II {~ $¢nd~,volce ,Month Day SAMPLE TYPE: Repeat Sample (for routine sample with lab ref. no. ) ~ Special Purpose SA.X[PLE LOCATION Year Treated Water b'ntreated VVa ter Time Collected Collected By TO BE COMPL[TED BY L.-L~ORATORY Ar. alysls shows tSis X%:tr $.~MPLE to be: ~' Sa:Sit'ZlOty Uns~dsfa:to~' Sample over 30 g~=rs old. r~sults may be enreliabl¢ Sample too long in :masS:: samp[~ should not be over 45 hour~ o[~ zt exam/nation new sample via spe:ia[ dtlive~ mail 712¢ Date Received Time Received Analysis Began Analytical :Method: ..~-/'MemSran¢ Filler .'~ MMO-MUG · Number oCco[onle$/100 ml. Lab Ret. No. Result' Analyst 96.3286 J ~ ~ S.:.{ to A.D.E.C. ¢~"~ Fbk.~ Jun Tim.-: Client notified of unsatlsfacto~' results: Da:=: [] BACTERIOLOGICAL WATER .-LN.-LLYSIS RECORD · M.xIO-.M~'C Result: Total Coliform .Membrane Filter: Direct Count Verification: LTB Feral Coliform ConfirmatiOn Final .Membrane Filter Resul;s ,¢.. Coil 0 P.*PT ON~ OF Colo nies~fit 0 0 mi Date 7.?--7' ct ~ Coliform/lO0 mi Time ! ~ hfs 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. # .O~.o .-.~)¥~_-~- HAA # ~'~'~OtL~ IC~"~L~:~ GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Agent ~-~J ~ ~ ~ ~-~ ~-~ ~--~'/ Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~) 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. ::: ,.. 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. 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 Address ~,.e ~ / Engineer's signature bedrooms. DHHS SIGNATURE ~/ Approved for ' Phone Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date ';'i:he Munici~ality of Adchorage 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A, Well Data Well type ~ Log present (Y/N) ~ Total depth ~ C)~ Sanitary seal (Y/N) Cased to Parcel I.D. ("3~O -Oq,,3.-- ~::~ If A, B, or C, attach ADEC letter. ADEC water system number Date completed q'/t o/~ ! Driller 'P~ ~- ~'~-~"-'~- ';~, c,f .r~'~. b'~ Casing height Wires properly protected (Y/N) Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: g,p.m. AT INSPECTION / - ~ g,p.rl~rl ~o ~ .< '7' Septic/holding tank on lot 11:),.% Absorption field on lot -J O '7 Public sewer main /'~,/,,~ Sewer service line ~' I D ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout .Petroleum tank WATER SAMPLE RESULTS: Coliform ' ~)' Nitrate ~).. ~.~'"~ Other bacteria Date of sample: t/~(~ Collected by: ~,, B. SEPTIC/HOLDING TANK DATA Date installed (~/,,~,c~/Az) ! Tank size ! ~ ~ Compartments Cleanouts (Y/N) / Foundation cleanout (y/N) ~i Depression (Y/N) High water alarm (Y/N) '}~/7~ Alarm tested (Y/N) ~'~ Date of pun~pin~ I II'~.~l ~,~ :- Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I ~ =.~ On adjacent lots .~' ~ ~ Foundation To property line _~> ~'~) Absorption field I ~ ,Water main/service line Sudace water/drainage ~11{~ CONTINUED ON BACK PAGE C. LIFT STATION ~//^ Date installed Manufacturer Size in gallons Vent (y/N) 'Pump on' level at High water alarm level Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) 'Pump off' Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water. D. ABSORPTION FIELD DATA Date installed ~/?~'~ / ~:~ I Length ~ ~ Total absorptiori area Date of adequacy' test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft~) ! ~:~ ~) System type "~,,<..z,~l Width ~ I Gravel thickness ~ t Total depth q ~ (-~ Cleanout present (y/N) V Depression over field (y/N) ~ ],"~ / ~ ~ Results (pass/fail) ~ for .~ Bedrooms ^.ertest If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots .'~ Surface water ~ Curtaln drain 7X~/[~ I 1 ..~ On adjacent lots ~ / ~ Property line To existing or abandoned system on lot Cutbank ]'~ ce)w.t.~_ Water main/service line Driveway, parking/vehicle storage ama E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect'Drzthe date of this inspection. Signature ~'~ ~ Engineers Name / '"~o It ~, ~__..~ Date HAA Fee $ Date of Payment Receipt Number 724326 (3~93)' ~ack Waiver Fee $ Date of Payment Receipt Number :.. APPL'?"NT FILLS OUT UPPER HAI~-~'NLY .~,oper,yOwne, .~, Jim/Pe~ny _Fo~ter ~ _ Phone Ma~in~ Addre~ / ,~ 134 Nuni~ak [Circl~ ~Eagl~ Riyer . z~. 0957~ ue.,mg ms.~uo. ~Post_ Office ~Box ~4v2090 Anchorage 99509' 265-3843> ~ 27~2 ,~[mbell~$2~6 ~Anchorage, ~99503~ 276-276~ Sandpiper. Dr~ve(162nd 'off Golden~iew)' ~ Multiple Family NO. of S~r~ Five ~ Other Water Supply ~ Public Utility ~ Holding Tank NOTE: THE INSPECTION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED. Time Time Time Time Dale Dale Dale ~..~3 Dale JUL ~ 8 I RECEIVED { ~APP~OV[D B[D~OO~ 'OONDI%ION~ O~ APP~OVAk { } DI~AP~OV[D ( ) CONDIT~NAL APPROVAL' August 1, 1983 Jim and Penny Foster Post Office Box 6769 Anchorage, AK 99502 Subject: Lot 8, Block 3, Ptarmigan Roost Subdivision Approval for the individual scl;er and water facilities cannot be granted until the following items have been completed: A four (4) inch cleanout needs to be installed to the leaching .area. . Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, RP20/p/E Robert C. Pratt Associate Environmental Specialist £&unicipa. lity,, Anchorage 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264 4111 November 18, 1981 Caribou Investments, Inc. 619 East 5th Avenue Anchorage, Alaska 99501 Subject: Lot 8 Block 3 Ptarmigan Roost Subdivision Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: i)!~(2) A well log needs to be submitted to this office for our files and reivew. The outside faucet was not turned on in order to obtain a water sample for analysis. Please call. this office for another appointment. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Alaska Pacific Bank Post Office Box 420 99510 ! DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION EJ~IRONMENTA[ PROTE~'JON NOV 9 1981 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES Caribou Investments Inc./Larry [~riqht[276-0000 619 E. 5th Ave. Anckora~eo A]a~a 99501 Lot 8 Blk 3 Ptarmiqan Boost .... 2. BUYER PHONE James and Penny Foster 345-4229 3. LENDING INSTITUTION I PHONE Alaska Pacific BankI 276-3110 101 W. Benson Anchoraget Alaska 99503 T.~rv Wr~h~ 337-3831 MAILING A~)DRES~ ~ 5301 R.. 30th Anchoracjer Alaska 99504 5. LEGAL DESCRIPTION Lot 8 Blk 3 Ptarmigan Roost STREET LOCATION Sand,9~per drive $. TYPE OF RESIDENCE NUMBER OF,BEDROOMS [~ SINGLE FAMILY I-1 One [] Four F-I Other [] Two [] Five i--~ MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY ~. INDIVIDUAL* ' ATTACH WELL LOG. A well log is required for all wells drilled f'-I COMMUNITY since June 1975. For wells drilled prior to that date, give well I'-I PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~] INDIVIDUAL/ON-SITE** 1981 .YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS I--I SINGLE FAMILY [] ONE [] THREE [] FIVE I--I OTHER 1-'1 MULTIPLE FAMILY [] TWO [] FOUR I--} SIX PERMIT NUMBER 2. WATER SUPPLY ~ [] INDIVIDUAL. )EPTH OF WELL [] COMMUNITY DATE DRILLED 1-'1 PUBLIC UTILITY Connection Verified , LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED mPU~UC UTI,,TY ~ - ~'[ Connection Verified _ INSTALLER [--ISepticTank or []HoldingTank . /~'~)~"~"lfTank shomemade SOILS RATING'~ ~ .... ,Size: , ~ . j :~ ...].;:~.J~.~/;~l ,,. ,~i ~.. give dimensions: TYPE OF TANK MANUFACTURER ~ .... .; ....... J~ .. ..[-; TOTAL ABSORPTION AREA MATERIAL Absorption Area to nearest Lot Line 5. COMMENTS [Z~ APPROVED FOR ,~'"~ BEDROOMS ~,. r-] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY ~ /..~_ "3 ,.,_.oc ,~ ~. 72-010 (Rev. 6/79)