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PTARMIGAN ROOST BLK 1 LT 3
Ptarmigan RO Block I Lot 3 #020-042-67 i°£ Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Waste'water Disposal System and/or Well Inspection Report Permit Number: S~//cJ¢~'~)~J W'l PIDNumber: Name; ~ ~ ~ ~ ~W H ~ ¢ Wastewater System: ~New C Upgrade Address: ~ ~ ~,~~ ABSORPTION, FIELD Phone: lNo of Bed~ms: D Deep Trench ~hallowTrench ~Bed ~Mound ~Other Total Depth from original grade: LEGAL DESCRIPTION s°'"~""~: ~,~ G~/s~.~ Township: ~ Range:lS~ Fill added above original grade: Gr~vel length: I ~ ~ ~t. ~ ~. Number of lines: ~Distance~enlines: WELL: ~New ~ Upgrade Gravel width: ~ Ft. t Ft. Classification ?rivate, A,B,C): Total Depth: Cased TO: Total absorption area; Pipe material: Yield: ~ I Pump Set at: ~ Casing Height Above Ground: - ~I TANK SEPARATION DISTANCES ~ Septic D Holding ~ S.T.E.P. Fro~ Tank Field Station Tank Sewer Lines ~ t 0 Cy C ~ ~ SudaCewater ~'/~ H/¢ ~/o ~ LIFT STATION "Pump on" level et ~ "Pump otf" level t: I High water alarm at: C¢;t,~. '~]~ ~[O ,~ -- Pump. ,e & Model E~V~¢ I Electrical inspections performed by; Remarks: BENCH MARK Location and Description: ~ I Assumed Elevat~ ~E~'S SEA~ Inspections performed by: · Dates: 1st Department of Health and Human Services approval Reviewed and approved by: Date: ~-~-~ ..'" ' "' ;~; ' 72-019 (Rev. 9/91) MOA 25 5O 75 ~£ALDU = 50 F~ SWING TIES: S-WIDE TRENCH 50 FT LONG AC 20 ?T 2,,~ ?T TOTAL DEPTH DC 22 6 INCHES OF R AD 69 REPLACEMENT SITE ' (~ BIOCYCLE 6000 A I D \. BENCH MARK SEPtiC SYSTEM Z~S BUILT DATE: NOV. 5,. 1998 SHEET: 2/5 OR/D: 5258 P ?ROl O32,DL,/6 TOBBEN SPURKLAND P.~ 205 W 15TH. AVENUE ANCH. AA 99501 (907) 279-5916 I IPTAR I N ROOST, BE ~ENE BRYNER 16100 WINDSONG DRIVE LOT 3' PERNIT # S~/98004i PI9 # 020?04£ 57 4-INCH /NSULATION ~ 6" WIN -- SAND BACKFILL -- 5~-2'' ~tlN ~'-0" MAX ~+ + 1-1/4 PVC WITH ~/B' HOLES AT .TO" 5 X 50 DRAINFIELD 2 FT TOTAL DEPTH 0.5 FT EFFECTIVE ROCK $ FT COVER ND SCALE DROUNDWA TER ~S 4FT LEGEND: 1. PR/WARY TREATWENT, SEPTIC TANK 2. AERATION TANK 5. CLAR/FICATION TANK 4. DISCHARGE TANK 5. SOIL ABSORPTION BENCH MARI~ BOTTON SIDING ASSUMEB ELEV, TDBBEN SPURKLAN3 P.E, JJ 203 WlSth Ave Anchopcge Ak 99501 PTARMIGAN ROOST BK 1 LOT 3 GENE BRYNER SEPTIC SCHEMAHC :DATE: NOV $, 1998 SHEET, .~r/..~ GR~D~ P TR?]?33,?V5 PERMIT # SI,/98004I PID ii 0£0-04£-87 . APR24 199 . 1201 ~smon? St. 99515 A~CHO~G~-, ~ASK~ Municipality of Anchorage Dept. Health & Human Services SIX INCH WATER WELL DRILLED ......... .-OUT TO THE DEPTH OF DRILLED AT THE RATE OF PROPERTY OWNER ~ro LOCATION OF WELL SITE 305 feet. 25,oo PER~OOT. Steel c~sing seated out to 38 ft. Mrs. (Gene & Florence) Briner. !.t. 3 Blk. 1 ~t~rmigan Boost Sub. DRILLER Bernie C!~us of ~m~,~t mri3]~m~ ~orks. WELL LOG: © 16' Silty fine gr~ve! ~ith 35% cl~y binder. 16- 38' H~rdpen. ~ cemented gravel going into ~ conglomerate of bedreck st ~} feet. ~ broken ~vesthered m~terisl. (Eerly bedrock. No water in this area except for s slightly ~et materiel. A little seepege overnight only.) 38 - 305' Bedrock. ~ sedimentary bedrock. Thin fissures in the rock at 110 feet ~id sho~7 some ~eep,~geo No actue! yie!~ hosteler. By 155 feet, ~ .... _ ~ o ~ ~n ~ tnls :/eli. by that point pro- ~uce~ "little less thnn 1/2 gpm yie].d~ By 250 feet, weter production up to possibly 3/4- {pm~ The '?tar, however, was coming out of crscks ~nd fissures of only grsnu!~r bedrock. By 279 feet~ our ~ter production was up to one and one h~!f gpm. ~ steady flow~ but rather slo~. It took ten minutes for the ~ster to recover ten feet off botton. From 279 to 305 feet, the pro- duction improved to a full two g~.!ons per minute. There v~as some good porous bedrock from 225 to 294 feet. The lTell et that point did improve~ but not like we'd hoped. The Yell set overnight~ end ~e pumped the w~ter crystal c!esr at 120 gs]_!ons per hour. Then ~ we thought we hsd e tragedy! The wster turned to mud! It took another hour ~o pump the water clean, but by that time, this l¥ell was making 3 1/2 gpm. 210 gallons per hour. COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLE'TION~OF ~AID DRILLING. ~ter recovery is back to 30 feet of surface. Inst~l! norse pump 280 feet, ft. x ~5 i'er ~t.~ less ~600.O0 ,~ovm i'~.ymen~. THANK YOU VERY MUCH. '~ ~ Muni Well Cap~ no charge. DAT~ April 3, 1998. ~O BERNIE CLAUS OF RAMPART DRILLING WORK~. ~,.50.00 pitiless adapter: No, ,ye amortized that over the ¥~ell footage. Municipality of Anchorage Page 1 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anch _),,age, Alaska 99519-6650 0 Telephone: 343/Rort On-Site Wastewater Disposal System and/or Well Inspection Permit Number: S1A/ q,g oo `i I PID Number: 0;2-0 – a L Name: Wastewater System: MIN ❑ Upgrade Address: LO 4 V -D sa N h ABSORPTI FIELD Phone: No. of 8e rooms: � / C�3'Deep Trench ❑ Shallow Tr ' ch ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: 1, 2 Total Depth from original grade: GP . Ft. y...J"' Lot: Block: Subdivision: -i>TA�? Depth to pipe bottom from origi 'grade: Gravel depth beneath pipe 6ANl P oos ! I FL 6 Ft. Township: Range: Section: Fill added above or grade: Gravel length: Ft. 5 D Ft. WELL: PfNew ❑ Upgrade Gravel width: 3 Number oflines: l Distance b' etweenlines: _ Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total abso ion area: Pipe material: {V!� 50 E5 Ft. 3 & Ft. 670-0 SC. Ft. 1" e 1 o E 3a Driller: P,A Date Drilled: 41314 Static Water Level: Instal : Date installed: t tPA P_T a 30 Ft. Dm NffL1,4 Yield: Pump Set at: Casing Height Above Ground: TANK GPM c�'�.. C) Ft. F SEPARATION DISTANCES t%Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding P c/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank ewer Lines A { V ( W A h\ t 1 /;Z � Well-I� �' ��� l _ Material: _ _ �ffL Number of Compartments: 7—LFl0 Watee LIFT STATION :Ot f' l f Size in gallons: Manufacturer: Line Foundation I "Pump on" level at. "Pump off" level at: High water alarm at: Curtain t✓ l Pump Make & Model Electrical Inspections performed by: Drain .1111111 Remarks: BENCH MARK Location and Desc,iption: r Q e; u 4, Assumed Elevation: FL ENGINEER'S SEAL i Inspections performed by: Dates: 1st_�3�� i 2nd Department of Health and Human Services approval Reviewed and approved by: ._ Date: — 72-013 (Rev. 9/91) MOA 25 I I -- — — — — —— ®®+OF — — — — — — —— N®® ® ® v -- — — — — — — — — — Aff I I � �.:f 49th ® ........................ LAJ o.....;t..:..... ................... •.....• TOB EN SPURKLAND e No. CE -2225 \�_®® e I I ®®0®�F�j p • ..........•P4" � I I i I e e 25 0 i5 50 75 100 125 150 . CALE. 1' = 50 FT, I I STANDARD SEPTIC SYSTEM TOTAL LENGTH 50 FT TOTAL DEPTH 12 FT e 0 I I TRENCH WIDTH 2 FT SEPTIC TANK 1250 GAL i SWING TIES. REPLACEMENT TRENCH �F� ` E e 0 AC 11 FT e BC 20.5 TH ,g2 I AD 3 AFD 32.5 �F B 21 oTH#1 EE 60 C D e BE 48.4 A B /— BENCH MARK e TOBBEN SPURKLAND P.E. PTARMIGAN ROOST, BK 1, LOT 3 SEPTIC SYSTEM AS BUILT 203 W 15TH. AVENUE ANCH. AK. 99501 GENE BRYNER DATE: APRIL 23, ' 1998 (907) 279-3916 16100 WINDSONG DRIVE SHEET. 2/3 GRID: 3238 PERMIT # EW980041 PID # 020-042-67 PTR01032DWG TREi Standard Trench. 2' Wide 50' L ong 12' Deep 6' Sewer rock 6' Co ver Monitor Clean Out o-� o� �'S NM SCALE O GEOTEX11LE 83.0 6 f't of Septic Rock Clean Out G`ean �00y e 0 O 1250 ga`eptic tank T 140et, O AW ;• , . ®• 49th ..................: i .� ® . .. :. .................. .� �'� TOB N SPURKLAND •' ®OCA •• NO, CE -2225 �e AV ''f ♦ IP, •• ...... • F _ ®® ®♦rRsw®Si10 ®®®®®® 89.0 Cleanout Monitor 4' Min Cover over Tank :III— IE 89.0 83.0 1250 gal. septic tank N17 SCALE BENCH MARK, ASSUMED ELEV, 100,00 T❑BBEN SPURKLAND P.E. PTARMIGAN ROOST BK 1 LOT 3 SEPTIC SYSTEM AS BUILT 203 Ave GENE BRYNER DATE: APRIL 2.3, 1998 Anchoraoragege Ak 99501 SEPTIC SCHEMATIC SHEET: 3 3 GRID: 3238 PERMIT # SW980041 PID # 020-042-67 PTR01033,DWG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW980041 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:BRYNER GENE P & FLORENCE K OWNER ADDRESS:16100 WIND SONG DR PO BOX 113023 ANCH. AK 99511-3023 DATE ISSUED: 3/25/98 EXPIRATION DATE: 3/25/99 PARCEL ID:02004267 LEGAL DESCRIPTION: PTARMIGAN ROOST BLK 1 LT 3 LOT SIZE: 81751 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18A3~C72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: ~ ISSUED BY: ~-~~~ ~/~' DATE: T SP AND 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN PTARMIGAN ROOST BLOCK 1 LOT 3 SW980041 Municipality of Anchorage Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 June 13, 1998 The septic system installed on this lot on 3/30/98 has been abandoned due to elevated groundwatwer conditions. Groundwater was measured at 7 feet below groundlevel during April and May. On June 10, 1998 a third testhole was excavated as shown on the attached Soil Log. The Owner wished to install a BioCycle because of the expected reoccurrence of the groundwater conditions. This revised design reflects this. Groundwater at 7 ff Use Standard 5-Wide Trench with BioCycle Soil Rating. 2 rain/in = 2.4 gal per sq.ft/day No. of Bedrooms 4 Required Area par Bedroom: 150/2.4 =62.5sq.ff. Total area required: 62.5 x4 =250 sq R Total Length: 250 / 5 = 50.0 Ft Bottom Rock At 2 feet SYSTEM CONFIGURATION STANDARD 5-WIDE TRENCH TOTAL LENGTH 50 FT TOTAL WIDTH 5 FT TOTAL DEPTH 2 FT ROCK DEPTH 6 INCHES COVER 3 FT BIOCYCLE 6000 PRE TREATMENT UNIT The installation of this septic system will not prevent wells from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding m~d/or concentration of surface mnoffwill not result from this installation. U/V~E VEL LTPEP lB II S = / / T ,?CAI ~ Z~ = loft FT, _ 4 TOBBEN SPURKLAND P.E. 205 W 15TN. AVENUE ANCH. AK. 9950! (907) 279-$916 PTARMIGAN ROOST, BK 1, LOT 3 GENE BRYNER 16100 WINDSONG DRIVE SEPtiC SYSTEM DESIGN DATE: MARCH 15, 1998 SHEET; 1/$ ORID: 5258 PERMIT # SW98XXX PiP # XX PTROiOS1, DW6 F '~5 ' 50 75 100 125 r ~CALE: /' -- 50 FL 5-WIDE TRENCH 50 FT LONG 2.5 F[ TOTAL DEPTH D INCHES OF ROCK TOBBEN SPURKLAND P.E. 205 W l$1'M. AVENUE ANCN. AK. 99501 PERMIT # SW980041 BIOCYCLE 6000 75 FT oTfl ~I BENCH MARK .. GENE BRYNER ~ JUNE 1~ 1998 16100 WINDSONG DR/~ SNEEL' 2/5 G~D: 020-048-67 P TROi O3£,DWG 4-INCH INSULATION ~~_ AIRCOWPRESSOR i-II4 PVO WITN 1/8" HOLES Al- SO" 5 X 50 DRAINFIELD 2 FT TOTAL DEPTH 0.5 FT EFFECTIVE ROCK 3 F? COVER SAND BACKFILL 5'-2" WIN S'-O" WA~ BIOCYCLE 6000 ND SCALE SILT BARRIER GROUNDWATER 4 FT LEGEND: i. PR/MARY TREATWEN~ SEPTIC TANK 2. AERATION TANK & CLARIFICATION TANK 4. DISCHARGE TANK 5. SOIL ABSORPTION BENCH MARK. ASSUMED ELE~ JO0, O0 ITOBBEN SPURKLAND P,E, I 203 ~/15th Ave Anchopoge Ak 99501 PERMIT // S~/98004] PTARMIGAN ROOST BK i LOT 3 GENE BRXNER SEPTIC SCHEMATIC SEPTIC SYSTEM DESIGN DATE: JUNE 1~ I998 SHEET, ~//~ GRID:3238 PID # 020-042-57 PTI~OZO33. Bk/6 Municipality of Anchorage DEPARTMENT OF NEALTH & HUMAN SERVICES S25 "U' Street, ^nchorage, Alaska gg502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL O~SCRIPTION: :~T/X,V-14,1~/4~.t ~oosT HH DA TEPERFORMED'" Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER N/ ENCOUNTERED? IF YES. AT WHAT 17 ' } DEPTH? -- -- E PERCOLATION RATE ~ (m:~,,des/inch) PERCHOLE DIAMETER TESTRUNBETWEEN (~ FTAND ~Y~,, FT DISCLAIMFR: Rro,~nd:water conditimn~ indicatRd arm for the dates ~hown only. Past and future presence and/or depth of groundwater can not be predicted '~rom these oos.~.v,~tlons. ~ 5 CERTIFY THAf THIS ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE'. DATE; . "~.~/¢~. 72-008 {Re~. 4/85) FIECEIt/FO Tel Municil:elily of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 625 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: . (ENGIN~ER}~SE.~L).~ '~, - Township, Range, Section: 1 2 3- 4- 5- 6- 7 8 10- 11 13- 14- 15-- 16--- 17- 18- 19- 20- COMMENTS WAS GROUND WATER ~ ENCOUNTERED? I~l~ O If YES, AT WHAT ~' DEPTH? pO E Depth o Water Alter M0niloing? Date: SLOPE SITE PLAN ~ia td i ~.,~ Date Gross Net Depth to Net Time Time Water Drop ~_ ~ ~ 5 ~ ;. ~ ~/~ ?/~ PERCOLATION RATE ~'- ~. (m~nutes/inchJ PERC HOLE DIAMETER __ TESIRUNBE}WEEN ~ FTAND ~ Y[-- FT PERFORMEDBY: % ~:'-~ ' ~-' ~ CERTIFYTHATTHISTESTWASPEREORMEOIN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. DATE: 72-008 (Rev. 4/85) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF r~EALTH & HUMAN SERVICES 825 "L" Street, A'~chorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 2 4 ~? 6 ~ 7 ~ $.'l+ HL_ 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS Township, Range, Section: WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth te Waler Altera//r Monitoring? ~ f ~'~ Date: SLOPE SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop l,, d,,, PERCOLATION RATE __ TEST RUN BETWEEN (minutes/inch) PERC HOLE DIAMETER __ FT AND FT CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCEWITHALLSTATEANDMUNIClPALGUiDELiNESiNEFFECTONTHiSDATE. DATE'. ~' //~ .]~ ' 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE Development Services Department '' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-042-67 1. GENERAL INFORMATION Expiration Date: ,5-^ l Ll - Z- O zZ Complete legal description PTARMIGAN ROOST BLK 1 LT 3 Location (site address) 16100 Wind Song Dr Current property owner(s) KABLE JOHN Mailing address Real estate agent Cher 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 830-2211 Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Q Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distan Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5� O Date of Payment Receipt Number COSA# Qsc22_I0yt-) Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 2/10/22 6. DSD SIGNATURE 1( System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: 0I MqL VJ PEER F ER o �o WPS�OF;PM �; J �,O B z-� �- zozz Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSH Credklist blue sheet Nitrate Advisory Arsenic Advisory Other • Legal Description: PTARMIGAN ROOST BLK 1 LT 3 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 4/3/98 Total depth 305 ft Cased to 38* ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 45 in. Date of flow test for COSA 1/28/22 Static water level at beginning of test 31 ft. Comments * Into Bedrock B. TANK DATA Age of tank(s) 23 years Tank type/material PIStC Measured operating fluid level in septic tank na ❑ Standpipes/foundation cleanout per record drawing Date of pumping na D. ABSORPTION FIELD DATA 9/4/98 Which system tested (date installed) same ❑ ALL standpipes present per record drawing Total measured depth from grade 4.5 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 020-042-67 of Structure served by this system Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes IN N ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by NRimEng Date of Sample 1/28/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station 23 years Lift station material PIStC Comments: Blocycle Adequacy test date 1128122 Results Q✓ Pass For 4 bedrooms Fluid depth prior to test 3 in Water added 600 gal New depth 6 in Elapsed time 30 min Final fluid depth 3 in Absorption rate 600 gpd Any rejuvenation treatment (past 12 months) no If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' LtJ Yes Community Sewer Manhole/Cleanout > 100* ] Yes if No ft ED Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' El Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' F-11 Yes if No ft 21 Yes if No ft if less than required) Building Foundation > 10' Yes Manure/Animal Excreta Storage > 100' ft Community Sewer Main > 75' El Yes if No ft E) Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water> 100' Q Yes if No ft Property Line > 5 LtJ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' Yes if No- ft Community Wells > ' Yes f ft 200 i I No Water Service Line > 10' Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption, field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Q Yes if No ft Water Service Line 2! 10* Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet �QOF A �E. V, Ir r* 49 Ili* Q: Steve Eng Aq CE -62515 X-' 'N&k �-/ 1.0-/* 2 MOF -UNICIPALITY ANCHORAGE �Q &11019 D10,11016 I Of 1; 0A I OWTV THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this Z^J Day of n of 20, by and between ��J0, 1� e_t �- , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), - described as BIOCYCL F located at (legal description) PTARMIGAN ROOST B1, L3 2. Maintenance, Renairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). 5 Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 5 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. "7of Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. 2ZA' Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. 1_�2_. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. 7 Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction, Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: By (signature) Date: Z-- Z—ZZ I (print name) STATE OF ALASKA THIRD JUDICIAL DISTRICT The foregoing instrument. ast ZO�by �. �-��Uw,r.r •� . i AOTAR �. Y PUBLIC.I+D My Commission expires: ss. edged before me thisr--� day of Aja,— j;? �. C /! State of Alaska 3KA NOTARY" PUBLIC 5. Miriam Beckford My Commiss1on B p1ms Qec 1G, 2G'b_ I _- MUNICIPALITY: By: "�= (signature) nt name) (rev. 05/18/2018) Date: Z _ 1 '1 -1Z. Title: Page 3 of 3 10-11 E'"Alaska 4th Quarter Inspection Report 2021 - 1—.1 _ I -- Anchorage AK 99503 Email: crbioak@gmail.COM (907) 274-0314 Homeowner Info Customer Name: Ward and Meghan Kable Tank#: 45 Install Date: Sept. 2002 Address: 16100 Windsong Area: Rabbit View-Goldenview Initial Inspection: Alarms Tested: Air 0 High Water [71 Battery Tested: YesE] No [_1 N/A (Please make sure alarm is on "normal", not "mute") Does system have a septic tank ? No 0 Yes R (Recommend pumping tank every 2 years) Is System Lid Locked? Lid hardware in working order? Is there any noticeable odor? Yes Repaired ❑ Yes FV1 Repaired E] Strong E] Mild NoneE] System Inspection U Inlet plumbing in working order? Solids pillow normal? Yes Replaced El Yes Requires Pumping ❑ Are all aerators functioning? Any buildup of solids? Yes ❑ Replaced Yes ❑ No F,4 Clarification return system operating? Any buildup of solids? Yes 0 Adjusted F—] Yes [:] No pH Reading: Dissolved Oxygen PPM Turbidity of discharge (in FTU) (pH of 6-8 is ideal) (2-5 is ideal) (Under 35 FTU is considered compliant.) 7.0 3.5 6.29 I's Pump float operating? Alarm float functioning? Any buildup of solids? Yes 0 Replaced 1-1 Yes Z Replaced ❑ Yes R No F,4 Filter cleaned? Dischargelinecondition: Yes [VI N/A ❑ Good j Replaced Comments: Inspected By: Chris Date: 12/29/2021 - Has emailing or mailing of form been requested? (contact office to request...) Yes 1:1 No z] Municipality of Anchorage On-Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parce, ,.D. 020-042-67 expiration Date: 1. GENERAL INFORMATION Complete legaJ.description Ptarmigan Roost Block 1 Lot 3 ,67~;cation (site ~do,r.e.ss) 16100 Wind Son~ Drive, Anchorage, AK .<L Cyr.r.e. nt Property 0wrr~[r(s) Smith Michael Day phone 252-6183 ': ::': 'Mailing address 5,:7-. Real Estate Agent, 2. TYPE OF DWELLING:, same Dwell Realty Day phone 252-6183 [] Single Family (w/wo ADU) [] Duplex [] Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 JUN 1 ~ z015 4. TYPE OFWATER SUPPLY: Individual Well : Individual Water Storage Community Class C Well Public Water System [] [] TYPE OF WASTEWATER DISPOSAL: Individual [] Holding Tank [] Community [] Public Sewer [] Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ ,~,~ Date of Payment Reoe pt Number COSA # Date: Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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(aro) in compliance with all applicable Municipal and State codes, ordinances1 and regulations in effect at the time of installation. Name of Firm NorthRim Engineering Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng 6. DSD SIGNATURE Phone 694-7028 System #1 Approved for L~ System #2 Approved for Disapproved. Conditional approval for Date bedrooms. ~d~ ~,,~ w. E,o .i.~ bedrooms. ~0 ~",- bedrooms, with the follow~np st~pulabons7 ,~-~_~ r, ..~S~ By: g: :~/~/~~ Original Ce~ificate Date: The Municipality of Anc~e Devlopment Se~ices Division (DSD) Issues Ce~ificates of On-Site Systems Approval (COSA) based only 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory COSA blue sheeLg-1-12.doc X Nitrate Advisory Arsenic AdVisory Other If more than I septic system is on the lot: COSA Checklist # of Structure served by this system __ Certificate of On-Site Systems Approval Checklist LegalDescription: .~?""~.,,~"~',,4,'t/(~,4-&¢ ,~OO("7~ A. WELL DATA Well type. . P IfA, B, or C provide PWSID # Total depth ~'05 fit. Cased to -~,~ ff. FROM WELL LOG Date of test z.~/X/*y Static water level 3 <~ ft. Wall production ~'. ~' g.p.~ WATER SAMPLE RESULTS: Z~'! ~-~ Parcel ID: O~O Well Log (Y/N) y Wires properly protected (Y/N) ~ Casing height (above ground) /-t/~,-~ in. AT INSPECTION ft. g.p.m. Coliform O colonies/100 mL Nitrate ,/V'~ mg/L Arsenic ,A,/'J~ ~ug/L Date of sample: .~/~/[$ Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Matarial /~ I0 C.. ~'~ j.. ~'" · Date installed ?~/~z;.//~o Tank size -/~'0<~ gal. Number of Compartments ~ Cleanouts (Y/N) y Foundation cleanout (Y/N) y Depression over tank (Y/N) ,~ High water alarm (Y/N) C. ABSORPTION FIELD DATA.. [ I ~ · ¢i'/~.t ~ - · Date installed.=~L/~ I/Sdil rating (g,p.d./E or ~/bdrm) ~,~ System type Len~t~ ,-, :: ~0 ~ ~d~ ~ ff. Grovel below p~pe .~':. ,,".. :, ~ . ~taldept~~ ff. ~ absorption area ~E~e Monitoringtube~ Depression over field ~Data of adequacy [e~t:, ~ Results (Pass/Fail) ~ For ~ bedrooms ~[~J~ de~t~in absorptio~tfi~be~re test ~ in. Water edd~ ~0 gal. New ~epth ~ in. ' "~ ~ 3~? .... ' Elapsed Tl~ .... ~. Final fluid depth ~ n. Absorption rate >= ~0 0 g.p.d. Any rejuvenation tr_e,'.~mbnt (past 12 mo.) (YIN & ty,pe) ~ If yes, give date E= LIFT STATION "Pump on" level at .~ ~' in. Datum ¢,,'tJ/F-l//~ SEPARATION DISTANCES WELL ON LOT TO: Size in gallons "Pump off" level at Cycles tested Manhole/Access (Y/N) y in. High water alarm level at ~-~Z - S in. Meets alarm & circuit requirements? y Sep;dc tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line,. Animal containment areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~ ~'~' Water main Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line Water'$e, rvice,.,ll'ne, / ~' ~'/' Curtain drain On adjacent lots ~,~ ~ On adjacent lots '~1-~ '¢ '(- Publ'ic sewer manhole/cleanout Holding tank ./~43 Manure/animal excrete storage areas _/~ ~ t'~' Property line /~) t./c A~orption field Water service line /~ ~' Surface water Building foundation ,,/~ 5/.. Water main Surface water /4:~ O *'¥ ... Driveway, parking,Nehicle storage We s on adj{~qent lots //J','q ~"f' F. COMMENTS G. ENGINEER'S CERTIFICATION certify that I have determined through field inspections and review of Municipal records that the above systems'.ar~.in conformance with MOA COSA guidelines in effect on this date. Engineer's· Printed Name COSA yellow sheet_2-6-15.doc S89° 59' 30"W 1S0.00' 20' UTIL ESMT UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE UNES, THE SURVEYOR TAKES RESPONSIBILITY FOR THE INiTiAL ~ANSACT~ON ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY, LISTED D)STANCES PREVAIL OVER SCALING. REPRODUC~0N MAY CAUSE ERRORS tN SCALE. ~ LOT ,':"IIRVE¥ SURVEY TYPE PLOT PLANS & LOT SURVEYS SYMBOLS SET REBAR ~ ~ DRAINA~ ~ ASPHALT o FOUND RESAR 0 0 0 WOOD FENCE ~ CONCRETE (~ ASSUMED ELJ~V. X % '4 METAL ~NcE F/7771 woop 0Ec~. i NOTE: SURVEY CERTIF[CATION Prepored by Robert E. Johns, Jr. & Assoc. Profe~sionol Lond Surveyors 3238 I~'G' ~5-17~ oo~. s,r..~,~: 06/03/15 Legol Description: 06/04115 Lot 3 BLOCK 1 PTARMIGAN ROOST ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this }/vt3x Dayof '~c~.n,,- of 20/5' , by and between ~--~c~ ]x.9~ .~-~-~, herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Maintenance and Repair Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as located at (legal description). 2. Definitions. Alteration. Any change to the design or function of an AWWTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Certificate of On-Site Systems Approval (COSA). An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with Anchorage Municipal Code (hereinafter, "AMC") 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. Permit. An On-Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AWWTS. 3. Term. The term of this Maintenance and Repair Agreement shall begin on the date of approval by the Municipality to operate the installed system or issuance of a COSA, and shall continue while the AWWTS is in use or is operational or until the property is sold or title is transferred by the owner and a new COSA is issued to the new owner or transferee of the property. 4. Alterations~ Installation and Removal of Additional Equipment. Prior to performing any alterations to an AWWTS, the owner agrees to obtain an On-site Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65. 5. Maintenance and Repairs. A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall maintain their AWWTS in a satisfactory condition capable o£producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. The owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the municipality and the manufacturer ofthe AWWTS for the entire term ofthe AWWTS. In addition, it shall be the responsibility of the Owner during the term of this Maintenance and Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules and orders for the AWWTS. C. Upon request by the Municipality, the owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system. When a record of maintenance is documented and maintained by the system vendor, the owner agrees to allow the Municipality access to this information. D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60 for improper discharge. E. Owner agrees that only maintenance and repair personnel approved hy the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. F. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. G. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. H. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. I. Owner agrees to provide and maintain a telephone connection to the AWWTS as required by the AWWTS approval. 6. Nonwaiver. The failure of either party at any time to enforce a provision of this Maintenance and Repair Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Maintenance and Repair Agreement or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 7. Amendment. A. This Maintenance and Repair Agreement shall only be amended, modified or changed by a writing, executed by au[horized representatives of the parties, with the same formality that this Maintenance and Repair Agreement was executed with, and such writing shall be attached to this Maintenance and Repair Agreement as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this agreement, the only authorized representatives of the parties are: a. Owner: b. Municipality: Director, Community Development or designated authority C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repair Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Maintenance and Repair Agreement. 9. Severability. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Maintenance and Repair Agreement. STATE OF ALASKA THIRD JUDICIAL DISTRICT (signature) (print name) Date: By: (signature) (print name) MUNICIPALITY: The foregoing instrument was acknowledged before me this 1~ day of ,J-/.X.,r,_;~ , 201'- b ' 3, y ,D-0~v,, L,~30,.~ ~. ~TARY PUBIC FOR ALAs~ Municipality of Anchorage On-Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 020~042-67 1. GENERAL INFORMATION Complete legal description Location (site address) Expiration Date: PTARMIGAN ROOST BLK 1 LOT 3 16100Wind Song Dr, Anchorage Current Property owner(s) Mailing address Real Estate Agent DOUGLAS & SANDRA STONER Day phone 16100 WIND SONG DR, ANCHORAGE 99516 Day phone TYPE OF DWELLING: [] Single Family (w/we ADU) [] Duplex [] Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual [] Holding Tank [] Community [] Public Sewer [] WaiverNariance request for: COSA lo be released to the engineer, unless ~,~e requested by the engineer. Distance: Date: COSA Fe~ Date of Payment Receipt Number COSA# O~, Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 6/28/2013 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 waler usage of the family being served by the system. The operational life of all well and septic systems ara 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 ~ System #1 Approved fore-/bedrooms. System #2 Approved for. bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: ~ ~MhTFR AND The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered ia the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. WAST F__W_A.T.E, R OriginalCertificate Date: /l//~/~ 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory X Nitrate Advisory 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 B1, L3 A. WELL DATA Well type PRVT Date completed 4/3/1998 Total depth 305 ff. Date of test Static water level Well production Parcel ID: 020-042-67 IfA, B, or C provide PWSID #__ Sanitary seal (Y/N)_Y Cased to 38 ft. FROM WELL LOG 413/1998 30 ft. 3.5 g.p,m. Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 24+ AT INSPECTION 611412013 29 ft. 4.4 g.p.m, in. WATER SAMPLE RESULTS: Coliform NEG colonies/lO0mL Nitrate 0.797 mg/L Arsenic: N..~D ug/L Date of sample: 611412013 Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material BIOCYCLE Tank size 1600 gal. Number of Compartments 4__ Foundation cleanout (Y/N) _Y Depression over tank (Y/N) _N Date of pumping 4/15/13.Serviced Pumper Date installed 914/1998 Cleanouts (WN) Y High water alarm (Y/N) Y BioCycle Alaska C. ABSORPTION FIELD DATA Date installed 811911994 Length 50 Total depth 4+ fi, Soil rating (g.p.d./ft2 or ff2/bdrm) 2,4 System type SHALLOW TRENCH ff. Width 5 ff. Gravel below pipe 0.5 Eft. absorption area 250 ft2 Monitoring tube Y Depression over field _N Date of adequacy test 8113113 Fluid depth in absorption field before test 2.75. in. Elapsed Time: 1300 min. Final fluid depth ~3 ~n. Any rejuvenation treatment (past 12 mo.) (YIN & type) N Results(Pass/Fail) PASS For 4 bedrooms Water added 720 gal. New depth 8,25 in. Absorption rate >= 600+ g.p.d, If yes, give date LIFT STATION Date installed Size in gallons "Pump on" level at __ in. "Pump off' level at __ in. Datum Cycles tested Manhole/Access (Y/N) High water alarm level at Meets alarm & cimuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer/septic service line 25'+ Animal containment areas 50'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main 10'+ Water service line 10'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water Service line 10'+ Surface water 100'+ Curtain drain 50'+(NONEKNOWN} Wells on adjacent lots 100'+ On adjacent lots 100'+ On adjacentlots 100'+ Public sewer manhole/cleanout 100'+ Holding tank 100'+ Manure/animal excrete storage areas 100'+ Absorption field 5'+ Surface water 100'+ Water main 10'+ Driveway, parking/vehicle storage 10'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of determined through field inspections and review of Municipal records that inspections and review of Municipal records that the above systems are in Municipal records that the above systems are in conformance with MOA above systems are in conformance with MOA COSA guidelines in effect on conformance with MOA COSA guidelines in effect on this date. COSA guidelines in effect on this date. on this date. Engineer's Pdnted Name KENNETH M. DUFFUS Date 8115113 COSA brown sheeL10-10-12.doc Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O, Box 196650 Anchorage, AK 995'~9-6650 www,cL an chorage.ak.us (907) 343-7904 Parcel I.D. 1. GENERAL INFORMATION Complete legal description Location (site address or directions) CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date: Current Property owner(s) Mailing address Lending agency Day phone Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well' Individual Water Storage Community Class__ Public Water System Well 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of AIaska. Certificates of Health Authority Approval are required for the transfer of titIe (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with vaIid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 the number of bedrooms and type of structure indicated herein. I further vedfy 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, Phone and regulations in effect at the time of installation. Name or Firm 'Z~ bbc ~,_ ~FV" ¢'V~ ~-~. Address ¢~-~D '~' t0 ~f ~ Engineer's Printed Name I~ b~ ~ bedrooms. 5. DSD SIGNATURE Y Approved for ~ Disapproved. Conditional approval for 1/.. L~. ~,~ Date ~'/¢/o / bedrooms, with the following stipulations: ,~.~,~.~'~ '. · '- ' '., ~' WATER ANn "- ~ ; WASTEWAI LR ." -% '. PROGRAM Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ~ - ~ /- O { (Rev./2/00) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Legal Description: A. WELL DATA Well type ~ Date completed ~/~/,¢/,¢' Total depth ~.,.~ ft. HEALTH AUTHORITY APPROVAL CHECKLIST LeJf'~ ~J~[ '~-&~-~C-~,tt~4 ~-O0~f- IfA, B, or C provide PWSID # 1'4/,~ Sanitary seal (Y/N) "/ Cased to ,.~/~ ft. Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground} in, Date of test Static water level Well production FROM WELL LOG ft. g.p.m. AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform ~ coloniesll00 mi. Date of sample: '7/~0/¢ I Nitrate O_.j~ ! 7 rog.ti. Collected by: Other bacteria ~,"4 L~ colonies/100 mi. .'_5 B. SEPTIC/HOLDING TANK DATA Tank Type/Material '~ I O(~.'~J (_., L E' Tank size Ibo'~:) gal. Number of Compartments q Feundation ¢leanout (Y/N) ~ Depression over tank (Y/N) J~l Date af pumping '7'/~1~1 Pumper A Jr" C. ABSORPTION FIELD DATA Date installed ~/~ ~'~' Soil rating (g.p.d./ft2 o~- ft',%d, ,, ,) r.,~. /"/j Length ~ ~) ft. Width 5 ft. Total dePth ~ ft. Eft. absorption area,~-~ ft2 Monitoring tube y Date of adequacy test %0/¢ J Results (Pass/Fail). '~ Fluid depth in absorption field before test O in. Water added~C~gal. Elapsed Time: /~¢~}'min. Final fluid depth //Z. in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) jx,[ Date installed Cleanouts (Y/N) High water alarm (Y/N) \/ System type Gravel belowpipe ~)t ~ ft. Depression over field I For /'7j bedrooms New depth ¢ in. ~ ~ g.p.d. If yes, give date D. LIFT STATION Date installed "Pump on" level at~.,,~ in. Datum E. SEPARATION DISTANCES Size in gallons "Pump offf level at ..~/~.~in. Cycles tested -.~ Manhole/Access (Y/N) ~'/ High water alarm level at _2 ~ Meets alarm & circuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift Station on lot t ~.-O Absorption field on lot ~/ltO Public sewer main 1'4/A Sewer/septic service line ~ ~ On adjacent lots __ '~/~-'~ On adjacent lots ___ ~' t ~ Public sewer manhole/cleanout _ Holding tank __. 1"l//5~--- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~-- (.-~ Property line Water main 1'.4/,~ Water service line Wells on adjacent lots .,~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~O Building foundation Water Service line [~C~ ~ Surface water ~ I Curtain drain J'~ I O Wells on adjacent lots Absorption field Surface water Water main Driveway, parking/vehicle storage F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name %~'~ ~<:~f~'--I Date lGo / HAA Fee $ Date of Payment Receipt Number (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number