Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
PTARMIGAN ROOST BLK 2 LT 5
Onsite File George P. Wuerch, Mayor Municipality of Anchorage Building Safety Division Onisite Water and Waste Water Program Memo: DATE: January 9, 2003 TO: Onsite Water and Waste Water Program File FROM: Joe Goodall Engineer II, On -Site Water Wastewater Program SUBJ: Ptarmigan Roost Block 2 Lot 5 Anchorage III _OA 9 All -America City ,I 11 2002 The legal description Ptarmigan Roost Block 2 Lot 5 has installed a new septic system permitted through D.E.C. that does not show in our documentation. The documentation in our file shows the old septic system installed on 3/11/92, for a three bedroom home. This information in our file is outdated due to the new installation of a septic system sized for a Bed and breakfast, the summer of 2002, permitted through D.E.C. All permit and as -built documentation for this new installation will be located with D.E.C. P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: (907) 343-8301 • Fax: (907) 343-8200 4700 South Bragaw Street • Anchorage, Alaska 99507 http://-tv,A,w.ci.anchorage.ak.us Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: q:7�PID Number: Name: L 4 ���� Wastewater System: ❑ New ❑ Upgrade Address: cl��lt ABSORPTION FIELD Phone: No. of Br ms: eep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: I �f ' Total Depth from original grade: _ L ^ GPD/Sq. Ft. Lot: Block: Subdivision: •f��J,"f,C7A4_—,' Depth to pipe bottom from original gra ei Gravel depth beneath pipe '� Ft. ,�Ft. Township: Range: Section: Fill added above original grade: Ft. Gravel length: Ft. WELL: ❑ New ❑ Upgrade Gravet.depth:k jjit Zs'� Number of lines: Distance/be een lines: " Ft. Ft. Class f' ion (Private, A,B,C): Total Depth: Cased To: Total absorption area:„// Piippee material: 'r 1p -PdeQ� 2 l Ft. Ft. %SQ. Ft. A'-- r Y—� '!> Driller: Date Drilled: Static Water Level: Installer: .,r Date installed: ✓�, /� Ft. Yield: Pump Set at: Casing Height Above Ground: TAN K GPM Ft. Ft. SEPARATION DISTANCES f)qleptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines 11 1004 Well 1O� f I /_b r l0 t Material: L Number of Compartments: Surface Water 100,+- I ()Q `-!- — -- LIFT ST ION Lot J �r '�✓ „ ` t f� -- Size in gallons: Manufacturer: Line Foundation / r 11-�Lf "Pump on” level at: Pu off' level at: 1".1:171 High water alarm at: Curtain Q Pump Make & Model Ele ical Inspections performed by: Drain !�� Remarks: BENCH MARK Location and Description:.jQu-rj- j g� evr y- e0'W" L O;p, L SC -1 bG1L- 'ADZ G 44 ` ynt r; ' Assumed Elevation: 6 ) ' o, ?r" EN Ef"AL opgv. po o�t�eb: tp O o� Sys�3 s� ®°i moi✓ e51 Inspections performed by: � G✓ -eI �t-4Dates: 1st 2nd�� Department of Health H a Servi approval 4&1 . ) I,p r� e QUI Reviewed and approved by: Date: tl6j ...:y .ft+.Y L -U 10 t 1/U l) MUA 20 AS -BUILT DkAWING TANK TOPOF em WENT 9O TOP OF � �UI I�w / BNNNCH�MARIL; BOTTOM OF SWM UMK7 OL7 � IJ�v INSTALLED RAN y sPUTIER / Wjrlj / el TEST ►HOLgEq�o�+o�m I . - - " ~ dt \ \ WELL EW TO BE USED ASA SITE. \ D� , f x°9'.54 \ / \\ 7 ALASKA WATER & WASTEWATER =E e.a.G. NTS_ INC. �' s 40' 601 DEBRRR now. is • ona Ht • r vm hliT9 • FM rom)LLN2�0 B ( VASE NUMBER, PREPARED 9 866-1591 1 OF X LEQk DEvmnxft PTARMIGAN ROOST SUBDIVISION; LOT 5, BLOCK 2. TYPE OF WORK: AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE 11 1 u Permit No. -Ski g2�D71� Page 0- of -z— Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Descriptio il" N IG a o�T �jj�� 2 LpT D No.: 4nZe 24-Z_:4;:5 rWb,L� 61Zkr2 �g &Leal L°3 x 2 —x� co r p' J _. �X(sr: 1cr�j I 4A'L_ S� L • ca TAMC. -` 4 b MAKER A J LA �Tl� 1 •�s. C,� / 72-013 A (2/91) MOA 25 PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES 0',0L) P.O. BOX 196650, 825 "L" STREET, ROOM 502 D� ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920024 DATE ISSUED: 3/05/92 DESIGN ENGINEER:S & S ENGINEERS EXPIRATION DATE: 3/05/93 OWNER NAME:MCCOY JOHN L & JANICE F OWNER ADDRESS:P.O.BOX 111965 ANCH. AK 99511-1965 PARCEL ID:02004273 LEGAL DESCRIPTION: PTARMIGAN ROOST BLK 2 LT 5 LOT SIZE: 56190 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED ISSUED BY: • /SZ, Mom 1 n�t�\ M February 25, 1992 HEALTH AUTHORITY Municipality of Anchorage APPROVALS DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 SEWER & WATER MAIN EXTENSIONS ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 6941211 REFERENCE: Ptarmigan Roost Subdivision, Block 2, Lot 5 SEWER & WATER INSPECTION Request you issue a permit to upgrade the septic system serving the referenced property. ENGINEERING STUDIES An adequacy test was performed on the existing system and the AND REPORTS absorption capacity of the existing seepage pit was found to be inadequate. A test hole was excavated and a percolation test performed in WELL INSPECTION &FLOW TEST the area of the proposed upgrade. Attached is an upgrade p p pg pg design which shows the location of the proposed trench. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic upgrade. SITE PLANS If you have any questions or require additional information for your review, please contact us. ROAD DESIGN Sincerely, �1 SOILTEST ROGER J. SPIAFER P.E. RJS/lsu PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 50' SCALE HOUSE rn �� R'9pv r UPGRADE m r p m 's9B N 9 � I,� O / y z n o ` c c s 0 00 rn BONY W co o m� mo C7), � ~ 2 o m A i O ro y ��1 0 O, O (31 �n a m � O O C y rr �D l O C) N n � N<I<ke, .4 C-11 O / y z Uo ` 0 00 rn BONY wn O ro y ��1 0 O, O (31 2 11 0 m � O O C y r 1m �D l O 1 �+ �D y .4 C-11 e ;E M Oyu to Fri 0 n 0 a r - Q) y 0 r- 33 D M D :Er r � n r n O o o j aA erz ��+) C"� 0 1> r o •40 ��`'CF16uso � O�Se•� Y � Uo 00 m BONY O ro y ��1 0 (31 2 11 0 m � r 1m N aA erz ��+) C"� 0 1> r o •40 ��`'CF16uso � O�Se•� Y � Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: ,1oH N • L,. 4-+f� iGe r ej DATE LEGAL DESCRIPTION:T�t2xr--� S �k. >©S-ff =5 nge, SeCti0n: DEPTH � SLOPE SITE PLAN 3�~~Ial� 4- 5 5 i 6 <0 c Q � 7 F t7 8 — Qe 9 r ' 10- 11 0 11 1 12 r 13 r 14 9 15 16 17 18 19 20 `�5H - 0- +4 ' WAS GROUND WATER ENCOUNTERED? A �� IF YES, AT WHAT DEPTH? Depth to Water Moniloring7Depth to=—=MM Water i� PERCOLATION RATE �� (minutes/inch) PERC HOLE DIAMETER lG /-;---� TEST RUN BETWEEN FT AND FT COMMENTSSG� t € 34 Ragle River Loop Roadkoj PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN Yi$cie River, AIRSka 9957Z, ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: `7 C.—• M-0010MI, ©Dun ■�ar�■r.���®I i� PERCOLATION RATE �� (minutes/inch) PERC HOLE DIAMETER lG /-;---� TEST RUN BETWEEN FT AND FT COMMENTSSG� t € 34 Ragle River Loop Roadkoj PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN Yi$cie River, AIRSka 9957Z, ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: `7 C.—• GRE. 'ER ANCHORAGE AREA BT_'` UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME Kfae_,,�A�- C ys{ MAILING ADDRESS SJ.' PHONE I.'d •'J LOCATION LEGAL DESCRIPTION leM(T �i Z -<1Z SEPTIC TANK: t//N�Hus� DISTANCE /� i _ NUMBER OF FROM WELL /�£� MANUFACTURER MATERIAL S/6 COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY lPalt� GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER --OR WIDTH—/"?- LENGTH -a/ DEPTHOfJ�10�/l/ / LINING MATERIAL/� CRIB SIZE: DIAMETER G_DEPTH DISTANCE FROM: WELL /BC �E6 !f TOTAL EFFECTIVE BUILDING FOUNDATION, NEAREST LOT LINE a _ . ABSORPTION AREA (WALL AREA) 3S6 SQ. FT. ADDITIONAL ABSORPTION WELL: <--/ TYPE f2G� / G- �� CONSTRUCTION 5 -rt //6" C( DEPTH BUILDING NEAREST NEAREST SEPTIC FOUNDATION—,LOT LINE—,SEWER LINE TANK_ CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DISTANCES:._ -S&_elA l �f INSTALLED BY: _A&W !tl�4147//`/%/ PIPE MATERIAL: :?,A LOT SLOPE: Zz,'&ST REMARKS: i 7 7 DISTANCE FROM: SEEPAGE SYSTEM_ REMARKS DATE DIAGRAM OF SYSTEM l Lam! 1 � I.'d •'J /�'j OGUe .C.c/�C 1-hAIZ ` G.A.A.B. Form No. EQ -031 GREATER ANCHORAGE AREA BOROUGH 0 DEPARTMENT OF ENVIRONMENTAL QUALITY O 3330 "C" STREET ANCHORAGE, ALASKA 99503 F TELEPHONE 274-4561 .o � •C OyO. xREO ,•KP•E SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT PERMIT NO. NAME OF APPLICANT - MAILING ADDRESS =IV Xk PHONFiCl'_&: r INSTALLATION LOCATI LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK SEEPAGE PIT �i DRAIN FIELD OTHER , TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH TO BE INSTALLED BY \ /J�� f a_ solL TEST RESULTS 1 NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. A. SEPTIC TANK SIZE F (Old TYPE SEEPAGE AREA SIZE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK r FOUNDATION TO SEEPAGE PIT. c 1 DRAIN FIELD 1 SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK r , SEEPAGE PIT �_., DRAIN FIELD TO NEAREST LOT LINE. G d r WELL TO SEPTIC TANK ` � SEEPAGE PIT / DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK CJ SEEPAGE PIT DRAIN FIELD (1' f SEPTIC TANK, �, SEEPAGE PIT G0 DRAIN FIELD , TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL SACKFILL CONFORM TO BOROUGH REGULATIONS RGARDIN INSTALLATION. OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED /SYSTEM IS,IN ACCORDANCE WITH SAID CODE. DATE ✓' 19_ APPLICANT'S SIGNATUR GREATER ANCHORA`:E AREA BOROUGH € HEALTH DEPARTMENT CASE 327 EAGLE: STREET EF.Cri -ED ANCHORAGE, ALASKA 99501 00�r nn (Sf t1P'Ti o+ 1 l C7 Date Performed Le al Description:. Lot Block :2 Subdivision � i � �r •i a +� ,j3. o o-'� opxFr,�Wsocrira a: Soils Log L ercolatio Test Depth,..... Feet Soil Char u teristics Location Sketch _. :. Organic tn(x F 'foPsei 2 �• ° • p n / �l a.: o.o C06GICs a.-tc) 6du 6.'� U j o i 1:2 Was Ground Water Encountered?� If Yes, At What Depth Reading, Date Gross Time Net Time Depth To H2O Net Drop erco a ion a e •,nn o -.- Proposed Installat—ion-Seepage Pit l� Drain field Depth'Of Inlet Depth )T�o Bottom Of Pit Or Tr�enc COMM : , i 'Slo t %l q o � t� (arcaFPO !/I YFLQ /'i C� r. .. .�. /1 �' _ _ ._I h Test Performed b Data Certified By._ Date: 1 N Municipality of Anchorage l On -Site Water and Wastewater Program 7. (907) 343-7904 s A E T Y Certificate of On -Site Systems Approval Parcel I. D. 020-042.73 1. GENERAL INFORMATION: Expiration Date: % - -?- I t2 ce- I Complete legal description PTARMIGAN ROOST; BLOCK 2, LOT 5 Location (site address) 16136 Sandpiper Drive *Anchorage 99516 Current Property owner(s) James Bowers Day phone 907-947-0347 Mailing address Real Estate Agent 2. TYPE OF DWELLING: ❑X Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual ❑X Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 4 _Zq12,50 COU10 Date of Payment Receipt Number 0 51 Fs 1 G COSA # 05C 201576 Waiver Fee $ Date of Payment Receipt Number Waiver # 10% 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness 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. 6. DSD SIGNATURE System #1 Approved for L/ bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the foil Date: )osl #AECC884 �O Y( OF4, i `gJ ON-SITE N,ztipAMER ASVD m n SNAST- ,TER z 0 t tcUGRAM `c/i/T By: ti,` Original Certificate Date: L Q -2-1 - 2 0 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 Nitrate Advisory 7� Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA. Checklist Legal Description: PTARMIGAN ROOST; BLOCK 2, LOT 5 Parcel ID: 020-042-75 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled t9" (') Total depth `175 ft Cased to UNKNOWN ft ❑M Sanitary seal is functioning correctly © Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 10020 Static water level at beginning of test 21.0 ft. Comments *PER GEG COSA TEST ON 1/6/16 B. TANK DATA Age of tank(s) 18 years Tank type/material Measured operating fluid level in septic tank 51" ® Standpipes/foundation cleanout per record drawing Date of pumping 6/2/20 D. ABSORPTION FIELD DATA TRENCH Well production at time of test 1.6+ 9 p Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes 51 Nc ED/61-01iform bacteria is Negative Nitrate �' )-v mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L M Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 10/2r20 C. LIFT STATION ❑ Required maintenance completed Age of lift station N/A years Lift station material NIA Comments: Which system tested (date installed) 7/16/02 Adequacy test date 10/3r20 0 ALL standpipes present per record drawing Results ❑✓ Pass For 4 bedrooms Total measured depth from grade 9.58 ft (max) Fluid depth prior to test 20 in Measured depth to pipe invert from grade 4+ ft (min) Water added 608 gal ❑ N/A — pressurized field New depth 27 in ® Monitor tubes go to bottom of effective. If not, state Elapsed time 120 min depth into effective © Code -required soil cover over field Final fluid depth 22 in ❑ System presoaked Absorption rate 600+ mod (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) N/A Gallons introduced gallons If yes, enter date NIA Comments/Def ciencleS: TESTED VVEST TRENCH ONLY. EAST TRENCH HAD 6" OF LIQUID IN IT ON THE DAY OF THE TEST COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private WelIon Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 1771 Yes if No Community Sewer Manhole/Cleanout > 100' Q✓ Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' F/ Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ✓Z Yes if No ft ❑✓ Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Q Yes if No ft F✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 1771 Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5'F71 Yes if No ft Wells on Adjacent Lots: Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' F/`I Yes if No ft Community Wells > 200' Yes if No ft 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' 121 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' 0 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' 7 Yes if No ft Community Wells > 200' 0 Yes if No ft Surface Water > 100' ✓M Yes if No ft F. ENGINEER'S COMMENTS *APPROXIMATELY 55' FROM DRAINFIELD TO MAN-MADE POND **APPROXIMATELY 68' FROM TANK TO MAN-MADE POND G. ENGINEER'S CERTIFICATION l certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet #AECC884 Nitrate Advisory Certificate of On -Site Systems Approval # OSC201576 Subdivision: Ptarmigan Roost, Block: 2, Lot: 5 A water sample revealed a nitrate concentration of 6.2 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. r Mailing Atldress P O Box 196650:*Anctiorage, Alaska 99519 6650 *www murn org From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Ma�hng Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org (d sscl�c� . � E ez4 Municipality of Anchorage p J Y On-Site Water (]and �jWastewater ProgramII (.707) 343-7.7Q4 s . E T Y Certificate of On-Site Systems Approval Parcel I.D. 020-042-73. Expiration Date: // / I 1. GENERAL INFORMATION: Complete legal description Ptarmigan Roost; Block 2,Lot 5 Location (site address) 16136 Sandpiper Drive Current Property owner(s) Tom Lucido Day phone 306-6886 Mailing address 16136 Sandpiper Drive Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: S-1 id1/40- COSA to be released to th.. -ngless otherwise requested by the engineer. COSA Fee $ 5 2_p Waiver Fee $ Date of Payment I "1//f Date of Payment Receipt Number Or{ ?2 a Receipt Number COSA# CSSC-I ( 1OId 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 _ l Engineer's Printed Name: Jeffrey A. Garness Date: .5 l k /i 4�oQop�O In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o OF A 1,"4,, in accordance with the guidelines and regulations established by the Municipality of Anchorage and 'KC-..•• ''' • py industry practices. The reported results describe the condition of the system/s on the date/s of the p Q-.• Qn evaluation. Separation distances were measured to readily identifiable features. Hidden defects or �� • J T •� ,1 encroachments may exist that were not identified during the evaluation. The operational life of all wells *j A /1 9 T �� •,��,QO and septic systems depend upon a variety of variables, including but not limited to, soil conditions, ci/ groundwater levels (that may fluctuate during the year), quality of construction (materials and Q 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 r,, If A. a ness,' vsystem/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of l/ 9 • E-795 •'• x`05the well or septic system. GEG makes no representation whether an alternative well or septic system V `ir . -)j / ••' .�� can be installed on the property in the event either of the current systems fail to perform adequately in Da P, , _.. ego the future. The content of this report is for the sole benefit of the person/party that retained GEG to %pea pr o f e s s1o�a�o perform the evaluation. Reliance upon the information provided in this report by any other person or ��OOP" % % • party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for LT bedrooms System #2 Approved for bedrooms QF Disapproved - U O C�_ Conditional approval for bedrooms, with tt? follllowigaitiRulaffb'ns: \NN, P-CFR o! S� v' Q�p�� PM G fr By: +,,. - ' / , ( Original Certificate Date: I -f '/Co 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 >" Nitrate Advisory — Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_1 o-15-12.doc • If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: PTARMIGAN ROOST; BLOCK 2, LOT 5 Parcel ID: 020-042-73 A. WELL DATA *ASSUMED, HOUSE AND SEPTIC CONSTRUCTED IN 1974 **PER GEG INSPECTION ***ASSUMED CASED TO BEDROCK PER SURROUNDING WELL LOGS Well type PRIVATE If A, B. or C provide PWSID# N/A Well Log (YIN) NO Date completed *1974 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES Total depth **175 ft. Cased to *** ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 1/6/2016 Static water level \-0 ft. 23.1 ft. Well production g_p.m_ 2.0+ g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrates. 3mg./L. Collected by: GEG. Ltd. Arsenic: ND ug./L. Date of sample: 5/14/2017 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 7/2002 Tank size 2000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 10/8/2015 Pumper ISAACS PUMPING SERVICE EAST C. ABSORPTION FIELD DATA WEST !"BELOW EXISTING GRADE] !TESTED WEST TRENCH] 3/10-11 1992 Date installed *7/16/2002 Soil rating I .p.d.If 'or ft`/bdrm) 1.2 System type TRENCH Length 55 & 55 ft. Width 5 & 5 ft. Gravel below pipe 3.5 & 3.5 ft. 509 Total depth**9.5+/8.7ft. Eff. absorption area 509 ft' Monitoring tube YES Depression over field NO Date of adequacy test 1/6/2016 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 19 in. Water added***729 gal. New depth 26 in. Elapsed Time: 1110 min. Final fluid depth 19 in. Absorption rate >= 600+ g.p_d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — ***TESTED 2002 TRENCH, WATER WAS INTRODUCED DIRECTLY INTO THE WEST TRENCH, 1992 TRENCH HAD APPROXIMATELY ONE FOOT OF WATER IN MONITORING TUBE. A D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off" level . _ . High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100 + On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75 + - Public sewer manhole/cleanout 100'+ Sewer /septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ 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'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS SOIL COVER OVER SEPTIC TANK (INSTALLED PERPENDICULAR TO SLOPE) VARIES FROM 2.95 FEET TO 4.87 FEET. _Qo600p04 G. ENGINEER'S CERTIFICATION OFA'�,�Sd� /certify that t have determined through field inspections and ,� * ; 7*d� review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on !his 17IP --- date. I A y A. Garness. Engineer's Printed Name JEFFREY A. GARNESS �Q m • CE-7 53 cp0 ,sp Date //7- Q04ap o\ fessio� �44000Qa #AECC844 (Rev. 11/05) • Municipality of Anchorage .r r.:!riifl ila ';li':•jii�?:� Development Services Department x!aF! ! I'`;' Building Safety Division g'4 l T On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # OSC 161010 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 5 of Ptarmigan Roost subdivision. This inspection revealed a nitrate concentration of 5.23 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in • water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. -'u Municipality of Anchorage On -Site Water &Wastewater Program (907)) 343-7904 1 r CERTIFICATE OF ON-SITE SYSTEMS Parcel I.D. 020-042-73 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Real Estate Agent Expiration Date: q-,2-1 - t 6:, PTARMIGAN ROOST; BLOCK 2, LOT 5 16136 SANDPIPER DRIVE *ANCHORAGE TOM LUCIDO & BOBBIE HOUGLAND Day phone 306-6886 16136 SANDPIPER DRIVE *ANCHORAGE KATHY FERNANDEZ Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site E ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer Distance:. _- WarserNariance request for: Received by: COSA to be released to the engineer, unless otherv+ise requested by the engineer. Date: COSA Fee $ I Waiver Fee $ Date of Payment �! Date of Payment Receipt Number Receipt Number COSA # i b) CJ 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. /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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 `ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In Conducting lhis evaluation, GEG provided an engineering evalualion of the vreN and/or septic system in accordance mith the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the systems on the datels of the evaluation. Separation distances were measured to readily idemifiable features. Hidden defects or encroachments may exist that were not idenfifred during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil condilians, groundwaferlevels (that may gucfuate during the year), quality of construction(materials and workmanship), and the water usage of the family utilizing the systenJs. These conditions can vary, and are outside the contact of GEG. Satisfactory fest results do not guarantee future perfamance of the systems, 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 properly in the event either ofthe current systems (ail. The content of this report is for the sole bansfil of the pereoNpady who retained GEG. Reliance upon the information provided in this report by any otherperson or party, including but not limited to subsequent property purchasers, is not authorized. In shon, GEG disavows any legal duty to anyone other than the persoMpady who paid for this mpon. 6. DSD SIGNATURE System #1 Approved for bedrooms. System 92 Approved for Disapproved. Conditional approval for 0 bedrooms. Phone 337-6179 Date I I,k !k> r� ........ ......................:.....I / i Jeffry A, arness :.'kii e 1� I` C —7,' 53 =o ®�e®®v� pROFE�S�ONP:��oC bedrooms, with the following stipulations::;; PROGRAMI Original Certificate Date: The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. A COSH heck COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev. 10172(12) If more than 1 septic system is on the lot: COSA Checklist # —of— Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: PTARMIGAN ROOST; BLOCK 2, LOT 5 Parcel ID: 020-042-73 *ASSUMED, HOUSE AND SEPTIC CONSTRUCTED IN 1974 A. WELL DATA **PER GEG INSPECTION ***ASSUMED CASED TO BEDROCK PER SURROUNDING WELL LOGS Well type PRIVATE If A, B, or C providePWSID# N A Well Log (YIN) NO Date completed *1974 Sanitary seal (Y/N) YES Total depth **175 ft. Cased to *** ft. FROM WELL LOG Date of test OG Static water level b ft. NO Well production -g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Arsenic: ND ug./L. B. SEPTIC/HOLDING TANK DATA Nitrate 4.16 mg./L. Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 1/6/2016 Date of sample: 1/6/2016 Tank Type/Material SEPTIC/STEEL Tank size 2000 gal. Number of Compartments E Collected by:. GEG. Ltd. Date installed 7/2002 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 10/8/2015 Pumper ISAACS PUMPING SERVICE *SEE ATTACHED ADEC DOCUMENTATION OF 200 - C. ABSORPTION FIELD DATA �2 INSTALL T *BELOW EXISTING GRAD TESTED WEST TRENCH 3/10-11/1992 _ Date installed *7/16/2002 Soil rating .p.d./ r ft2/bdrm) 1_2 System type TRENCH Length 55 & 55 ft. Width 5 & 5 ft. Gravel below pipe 3:5 & 3.5 ft. 509 Total depth** . + 8.7ft. Eff. absorption area 509 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 1/6/2016 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 19 in. Water added ***729 gal. New depth 26 in. Elapsed Time: 1110 min. Final fluid depth 19 in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date ***TESTED 2002 TRENCH. WATER WAS INTRODUCED DIRECTLY INTO THE WEST TRENCH. 1992 TRENCH HAD APPROXIMATELY ONE FOOT OF WATER IN MONITORING TUBE. D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off' level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM 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'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5' SEPTIC TANK (INSTALLED PERPENDICULAR TO SLOPE) VARIES FROM Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots too' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation _ 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway; parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS SOIL COVER OVER SEPTIC TANK (INSTALLED PERPENDICULAR TO SLOPE) VARIES FROM 2.95 FEET TO 4.87 FEET.. �-� SS=- A �" �" - . �" G �L �`y`' O lrf ✓Z ��64 QAoJfr No ItsLgu&-R- 60 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. GARNESS Date I ! 14' ) t (Rev. 11105) M I, Duane Mark Seward, hereby certify that I have performed an As -built survey of the .structure on this lot and that all the dimensions and information as shown hereon are true and that no encroachments exist unless shown otherwise. �9sBU/�T FJNAL Athtiilt Ela•t.?Nod. 71-213 SEWAJ 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE` FOLLOWING DESCRIBED PROPERTY: pf At 4� FTA�P�'!/6.�.i/,r'ORS"TSvlS.NLaTS•5; �' DATE �� AND THAT NO ENCROACHMENTS 151ST EXCEPT AS � 9�Yl97 �P•.•" INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID1 . "'".' • ...•• ••• * i . EASEMENTS, COVENANTS, OR RESTRICTIONS _?� WHICH Do NOT APPEAR ON THE RECORDED SUBDI- D.m. w ,k VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: 2 4i ••• ts- ,i i ANY DATA HEREON BE USED FOR CONSTRUCTION '`{' H °'�• �?`. OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWNI A14Ara��"� i ARY LINES.sa.sca< F.✓ January 14, 2016 To Whom It May Concern, In regard to our residential septic system we have never had a problem with freeze up or interruption of service since it was installed. Sincerely, Thomas V. Lucido 16136 Sandpiper Drive Anchorage, AK 99516 r STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE FOR DOMESTIC WASTEWATER DISPOSAL SYSTEMS A. APPROVAL TO CONSTRUCT Plans for the construction ormodification of Iocated in by domestic wastewater disposal system , Alaska, submitted in accordance with 19 AAC 72.210 have been reviewed and are approved. conditionally approved (see attached conditions). 5 e AM Kl& 414 BRirk�. la==rd a 7r7i.E DATE If construction hes not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before consoruction. 3. APPROVED CHANGE ORDERS Change (contract order number or descriptive reference) Approved by Date I APPROVAL TO OPERATE The "APPROVAL TO OPERATE" section must be completed and signed by the Department before this system is made available for ase. The construction of the A5 p_ domestic wastewater disposal system was completed on (date). The system is hereby granted interim approval to operate for 90 days following the completion date. 6Y TITLE DATE As-built/record drawings, submitted to the Department, or an inspection by the Department, has confirmed that the domestic wastewater disposal system was eonsmu ted um substantial conformance with the approved plans. The system is hereby granted Z approval to o te. Tma DistribWwt: - 1. Remain original for project ak I Make copies Por dimibution Rau Received STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION DOCUMENTATION OF CONSTRUCTION s Legal Description of the Location Submitted by: (Cheat arm) �Q a� f M 4 R oc�. �✓�0 ' n Certified installer ❑ Approved Homeowner Registered Engineer D Installer Name: Onsite Wastewater System Serves: yy CC Wr� t���i'tOfLt GXy+V w �'t „9 ❑ Single Family. Number of Bedrooms Mailing Address ❑ Duplex. Number of Bedrooms Bak77 `3�G1 ❑ Small Commercial Facility With Estimated e(� Desi Flow of less than 500 GPD. LN IS. WATER SUPPLY SYSTEM (SECTION R!S OPTIONAL) Source of Water and Containment (Check all that Apply) Type of Water Supply System Tmtrnem of Water (Check all that Apply) o Well (Drllledor Drfven) ❑ Surfau (Identify) ❑ hivate pone ❑ Chlorhntian ❑ Filtration © MineralRt moval Roof Catchment Q Holding Tank ❑ Other pdem{(y) ❑ Public aondtmanr ❑ Odter: Well Data Is the height of the well casing mote the 12' above the ground? ❑ Yes Is a sanitary seat or well tap installed on the well casing? ❑ Y ❑ No Is drainage diseased away from or around the "Sing Within radial Of 10 fast Of use wdl mng? Yes ❑ No Is well wire enclosed in owuir) ❑ Ya ❑ No Date Drilled Depth of Well (Fnd aide Water Level Wend) IS ( available) Pomp Ran (lfavailaw Separation Disnnce from *a Well to each of the if 14%vinz Sources of COmaminalwc Sg9WHolding Tank On Lot Sewr Lines on Lm AbseiptionAmon Lot F fm Fees Closest Se;MRoiding Tank on Adiwau Lot Chat on Cheat Up otan AWaptim Arden 1 Feat Feet AdWastUt Indicate separation Cisnn t from toxic matenals leer pnmts. alter On Lot Ft K On AgjBcm Lot F petroleum based materials, ' ' tieides, fun or herbieida to wex Water Sample Taken b : (Name) P y Sampler i � piuyer ❑ F+igirteer ❑ Banlar ❑0ovemmesl0frKiat Address Water Sample Results: 40, AnachCo Satish -Date ❑ Unsadsftceo -Date Comments/Recommendations• Sisnatae TyptedRrattedName ids > ABs: J. Thisxala+altanld br slg+xAbYa Cerr(J/rdlnrmlla.Prpfeuladiggtaan. Dle+q�orsAanarraatrarr I. Ailpvblic water aysnaau wart free?.eADECPIau approvalyrtoraammwiae Sse"AACdgSia'se"aaFa DrMfdnS Water Regulations foram& regylnrttrms. SECTION B -Con cdr's 3 ced?ifY tidal 1(or adt individual tender my direct supervision) have conducted an inspection of the project reierrnc:d i : Secdx. n A, cr pordors of the projecd which i had the responsibiitty for Onconstructeduutt&ad dw to rite best 0'my krcw!edge and information, the prgjec% or those +os, nt r* it s n accordance'WM the est piaars submitted to and approved by sSae A4zalca f3epart+ne Conservation, or in accordonee with tate attachedas-�DIn t draws of t;odatmctor .iydg�l��alolrx ae �pr.... see—� ar__ - — ie.T>3.is� .� X CS1ir�"t� e hi For multipic contractors, if applicable: Si dtat�ars of Contractor (please sign in ink) Date ^�urloxof3rd>adiraeior g SECTION C- Engineer's Sectio l cxrtify "oat 8 (or any individual under MY direct supervision) have conducted wt inspection of the above �fereado .d project, and diet to the best of my knowledge and anforddtatioa, She pdojecE was constructed in acror4!a,= with: {check one of the foliowine ,a^" A., rile .ate5t jJ3an� �t7i:7t� M on Engisse r State of Awa stract, spectaod professional Engineer in tjinkgegistration Number a �_ a'-r'.r:tr ' ��e of P•aafeRsiataR Engitaeer MUNICIPALITY OF ANCHORAGE • '" DEPARTMENT OF HEALTH & HUMAN SERVICES M Division of Environmental Services �Zt 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. # C12D—C)'-\ 'rA --)3 HAA # "Q 0LQn t I nl e 1. GENERAL INFORMATION Complete legal description Lot 5; Bloch. 2; Ptanm.Lgan Roo.6.t Subdi.v,ie.ion; Location (site address or directions) 16136 Sandpipeh Dkive Property owner John L. 9 Janice Mc Coy Day phone 345-1748 Mailing address P.O.Box 111965 Anchorage, Atazka 99511-1965 Lending agency Day phone Mailing address - Agent _ Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC . attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Phone Address 17034 Eagle River Loop Road No. 204 �!sg s River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE __X, Approved for bedrooms. Disapproved. Conditional approval for Additional Comments e Date •v� J bedrooms, with the following stipulations: Date Z The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services i HEALTH AUTHORITY APPROVAL CHECKLIST Legal Descriptio�31 t 4 :S I -T--:,> Parcel I.D. L,C CAL. Z t l-4�-r -c,- A. WELL DATA Well type EL If A, B, or C, attach ADEC letter. ADEC water system number Log present( 16 Date completed Driller u"Vf,26W �-I Total depth U OV -r )Cu) I� Cased to .401 4- Casing height I0 t r Sanitary sea (Y y ' Wires properly protectecON) Y r FROM WELL LOG AT INSPECTION 0 Date of test u rJ - ArJ Pct Lure �Cj 2 o ��" Z u 'X! 77 Static water level �•D Well flow g.p.m,g. a rn 6 v Pump level V ZO SEPARATION DISTANCES FROM WELL TO: z Septic/holding tank on lot _ U� r l ; On adjacent lots t �t Absorption field on lot On adjacent lotsd Public sewer main F -t C)»' -Lia- Public sewer manhole/cleanout L Sewer service line -2- Cj -4- Petroleum tank �-JC) a✓ ;:f- 10 tA( J WATER SAMPLE RESULTS: Coliform Nitrate 3� e- Other bacteria fro rte Date of sample: 4 �1Z Collected by: S1G t �>✓ 12 t a -'Gr B. SEPTIC/HOLDING TANK DATA Date installed -"4- / 7--1_'¢ Tank size 1 dC�e_�) Compartments Cleanout (Y N) T- Foundation cleano (Y N) Depression High water alarm (Y/N) Alarm tested (Y/N) �! Date of pumping Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot d r On adjacent lots l G r Foundation �OL✓ To property line ��✓ Absorption field) �Watermain/service line— Surface water/drainage 72-026 (Rev. 7/91) Front - CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/ SEPARATION DISTANCE .,�OM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water [led l(I � Soil rating L 2 fir -System type Date insta �� Width 5G{� Gravel thickness 5 Total depth �•r II Length � � Total absorption area V �+ . Cleanouts present (Y ) 7 /N Date of adequacy test Depression over field ( Results (pass/fail) Qt c for �� bedrooms Peroxide treatment (past 12 months) (Y N) tJ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: f Well on lot ( 49 Q / On adjacent lots L� a- Property line To building foundation f To existing or abandoned system on lot On adjacent lots �b -1 Cutbank , jo IJ Water main/service line Surface water i�D Driveway, parking/vehicle storage area Curtain drainE E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect ooQ,lthe�.date of this inspection. .a t J: 1t��`AJS ,Gad ilr - "55 S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Signature es; le River, Alaska YYZ11 �q a Engineer's Name' /��.q� ✓ -tit } J"i�). Date g t' HAA Fee $ r I V' Waiver Fee: $ — Date of Payment Date of Payment Receipt Number GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C". Street, Anchorage, Alaska 99503 274-4561 Date Received 1,111-2-6— Time ,/7/-2.5`Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: Phone: 2. Property Owner: Q�ri_y< a Phone: Mailing Address: 3. Legal Description: .5- A%1 z (/ c''/ 4. Location: U U 5. Type of facility to be inspected No. of bedrooms o2/ 6. Well Data:f_— l( A. Type �tiz��- B. Depth v}�S� C. Construction D. Bacterial Analysis�dot'? 7. Sewage Disposal System: A. Installed 7�� 1 V B. Installer C. Septic Tank: 1. Size COIF 2. Manufacturer D. Seepage Pit: 1. Absorption Area 3-3 ✓Z'�T 2 Material • ��� � ,ter E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank_, Absorption area , Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank �� Absorption area C. Absorption area to nearest lot line'/ /,-/— EQ -034 (1/74) Paae 1 of two aaaat Page 2 of two pages - RE .t for Approval of Individual Legal'Description Comments r & Water Facilities b)' C 5;f i Approv d4=LLZ isapproved Date �C Approval.,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ -034 (1/74) GREATER ANCHORAGE ARE!'; BOROUGH Department of Enviromnentai Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: C`,RO VA FHA CONV xxx 2. Property Owner: Anita Benson Mailing Address: #604 Arctic Blvd, Anch. Day Phone 279-0569 3. Name of Buyer: Self — Refinance Mailing Address: Same Day Phone 4 . Name of Lending Institution, NATIONAL BANK OF ALASKA, Mortgage Loan Dept. Mailing Address: Box 3-3859 99501 Pho;,e 279-2506 5. Name of Real for or ,Agent: None Mailing Address: Phone 6. Legal Description Lot 5, Block 2, Ptarmigan Roost Location: 4 i a E � o Type of Facility to be inspected: SFR No. Bdrms. 2 Water Supply Type of Supply: Public Utility Individual x If Individual, number of dwellings presently served , ---- If Individual, depth o/ well Sewage Disposal Syste;�l Type .o; System: Public Utility Individual (on-site) x If Individual, date of installation'