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HomeMy WebLinkAboutPTARMIGAN ROOST BLK 2 LT 1 ~GREATER ANCHORAGE AREA BORUUGH Department ;~3~n~ir~eme;ntal quality Anchorage, Alaska 99503 IN~gECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE NUMBER OF C~)~)~ ~L~'~-~COMPARTMENTS / INSIDE LENGTH ~ INSIDE WIDTH~ E'IQUID OEPTH¢~ LIQUID CAPACIT4/~i~LLONS. B.,LD,NG FOUNDA~.~ONfiT//~7 NeAReST LOT L,Ne~O~ tOTAL eF~ect,VE ~ · ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION 5(~J~ WELL: type . _~- J/(~b//~O~STRUCTiON BUILDING NEAREST NEAREST FOUNDATION LOT LINE SEWER LINE CESSPOOL OTHER SOURCES APPROVED . DISAPPROVED REMARKS DEPTH DISTANCE FROM: SEPT lC SEEPAGE TANK SYSTEM DISTANCES: INSTALLED BY: LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM NAME OF APPLICANT 4~ INSTALLATION LOCATION PHONE~ FINANCED THROUGH -- ~ TO BE INSTALLED ~y _ SOIL TEST RESULTS ~ ~ ~ /' ~¢~' ~'5~)~~/ HOT~: THIS PERMIT I~ NOT VALID WITHOUT 5OIL FINAL INSPECTION: 24 HOUR NOT'CE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION bY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUE~JECT TO PROSECUTION. MINIMUM DISTANCES, REQUII~EMENT$ FOUNDATION TO SEEPAGE Pit ~ . DRAIN FIELD SEPtiC TANK TO SEEPAGE Pit WALL ~'~/ SEPTIC TANK ~ SEEPAge Pit ~/J WATER MAIN TO SEPTIC TANK SEPTIC CONFORM TO I CERTIFY THAT I AM FAMILIAR V41TH THE REQUIREMENTS OF GREATER ANCHORAge A-~-A BOROUgh i DATE .. ~ APPLICANT'S SIGNATURE ' TH-1 8-26-75 0.0f ORGANICS w/SO_,%E SILT 1,0' GRAVELLY SAND T-~ACE SILT S~NDY GRAVEL, TRACE SILT NO WATER TABLE 7.5~ T.D. Log represents Lot 1, Block 2 Ptarmigan Roost Subdivision ~:!~[. ~. Consult~nfs Inc. NCHORAGE FAIRBANKS ALASKA JUNEAU RONA~D HOWES PROPERTY Log of test hole Anchorage, Alaska DArE 8--29--75 i$CALE 1 "=-~ ' J D',VN BY ..... I ......... I ........ ~ CONS[ILTANTS, INC. AN(:HORAGE FAIRBANKS JUNE.~,U 249 EAST 51ST AVENUE P,O, BOX 6087 TELEPHONE 907-279°0483 TELEX 090-3541g August 29, 1975 R & M No. 562106 Ronald Howes 3 Z/~~ ~3 ~ 0 Box 10367 Klatt Road Station Anchorage, Alaska RE: Test Hole and Soil Log Report for Sanitary System Lot 1, Block 2, Ptarmigan Roost subdiviszon Dear Mr. Howes: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject'.§ite. This inves- tigation was performed in accordance with your request of August 26, 1975, and those procedures outlined in a letter dated July 15, 1975, by Mr. Rolf-Strickland of the Greater Anchorage Area Borough Department of Environmental Quality. A single test hole was put down within the Lot 1 area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor-mounted backhoe and the test hole was extended to a total depth of 7.5 feet below ground sur- face. The final log prepared for the test hole"h~'s been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M CONSULTANTS, INC. Vice ~res±dent JWR/ja xc: GAAB MUNICIPALITY OF ANCHORAGE Development Services Department Phone- 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 020-042-69 Certificate of On -Site Systems Approval ec eqt N re 5 Expiration Date: 12/12/2023 Legal description PTARMIGAN ROOST BLK 2 LT 1 Site address 16335 LUNA ST Current property owner(s) COPLEY CHARLES M & KAREN R X The On-site system(s) is/are approved for 3 bedrooms — Conditional approval for Comments or advisories: bedrooms, with the following stipulations: Bv: L5AVfj�� /X Oriainal Certificate Date: 9/12/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approvaljune 2022 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 COSA Application 2024 REFRESH.doc Certificate of On-Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 020-042-69 Complete legal description PTARMIGAN ROOST BLOCK 2 LOT 1 Location (site address) 16335 LUNA STREET ANCHORAGE, AK 99516 Current property owner(s) CHARLES & KAREN COPLEY Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: Private Well Private Well serving 2 dwelling units Private Well serving 3+ dwelling units Community Well or Public Water Storage 4. TYPE OF WASTEWATER DISPOSAL: Private Septic Private Septic serving 2 dwelling units Holding Tank Community Septic or Public Sewer 5. SEPTIC TANK: Steel Plastic Concrete Fiberglass Age _48_ - See advisory if steel older than 20 years 6. ABSORPTION FIELD: AWWTS Bed Deep Trench Wide Trench Seepage Pit Waiver request for: Distance: Expedited review requested: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment Date of Payment COSA # Waiver # COSA Checklist.docx COSA Checklist Legal Description: PTARMIGAN ROOST BLOCK 2 LOT 1 Parcel ID: 020-042-69 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 1976 Total depth 196* ft Cased to Unknown* ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 6/6/23 Static water level at beginning of test 22 ft. Well production at time of test 5.3+ gpm Water storage tank volume NONE gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 0.919 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 8/7/2023 Comments *Unknown and assumed into bedrock per Alpine Drilling & Enterprises letter - see MOA file. B. TANK DATA Measured operating fluid level in septic tank 56” Date of pumping 6/19/2024 Required maintenance completed, if AWWTS Comments: Concrete septic tank C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 6/23/76 ALL standpipes present per record drawing Total measured depth from grade 6.1 ft (max) Measured depth to pipe invert from grade 3.2* ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective 3.1’ ED Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 6/6/23 Results Pass Fluid depth prior to test 5 in Water added 480 gal New fluid depth 10 in Elapsed time 1420 min Final fluid depth 5 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 60 in (MOA 5’ ED) Effective depth used 28 in (Missing ED + Final Fluid Depth) Effective depth (ED) remaining 32 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears approximately 1.9’ (23”) ED is missing per assumed *crib invert entrance from top of crib measured observations. 6” fluid depth in crib measured on 6/20/24. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No *88 ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *Per MOA previous waiver - 11/12/1986. G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 6/27/24 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 6/27/24 MUNICIPALITY OF ANCHORAGE 0� Development Services Departments Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-042-69 Legal description PTARMIGAN ROOST BLK 2 LT 1 Site address 16335 LUNA ST Expiration Date: Current property owner(s) COPLEY CHARLES M & KAREN R X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: 12/12/2023 bedrooms, with the following stipulations: By: Original Certificate Date: 9/12/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUHMPAUTY OF ANCHORAGE Development Services Department - Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 020-042-69 Complete legal description PTARMIGAN ROOST BLOCK 2 LOT 1 Location (site address) 16335 LUNA STREET ANCHORAGE, AK 99516 Current property owner(s) CHARLES & KAREN COPLEY Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ® Concrete ❑ Fiberglass Age 47 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ® Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Jam' 9� c� j Date of Payment COSA # �5G2 3 I O 7 Waiver Fee $ Date of Payment Waiver # COSA Applicalion.doc COSA Checklist.docx COSA Checklist Legal Description: PTARMIGAN ROOST BLOCK 2 LOT 1 Parcel ID: 020-042-69 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 1976 Total depth 196* ft Cased to Unknown* ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 6/6/23 Static water level at beginning of test 22 ft. Well production at time of test 5.3+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 0.919 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 8/7/2023 Comments *Unknown, but assumed into bedrock per Alpine Drilling & Enterprises letter - see MOA file. B. TANK DATA Measured operating fluid level in septic tank 56” Date of pumping 6/5/23 Required maintenance completed, if AWWTS Comments: Concrete septic tank C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 6/23/76 ALL standpipes present per record drawing Total measured depth from grade 6.1 ft (max) Measured depth to pipe invert from grade 3.2* ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective 3.1’ ED Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 6/6/23 Results Pass Fluid depth prior to test 5 in Water added 480 gal New fluid depth 10 in Elapsed time 1420 min Final fluid depth 5 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 60 in (MOA 5’ ED) Effective depth used 28 in (Missing ED + Final Fluid Depth) Effective depth (ED) remaining 32 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears approximately 1.9’ (28”) ED is missing per assumed *crib invert entrance from top of crib measured observations. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No *88 ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *Per MOA previous waiver - 11/12/1986. G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 8/23/23 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 8/23/23 ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: PTARMIGAN ROOST LOT 1 BLOCK 2 PLAT 71-214 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shoult any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines, EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE; E-MAIL; AUG 22, 2023 1 "i40' schullerO ak.net 23-095 DRAWN ICHECKED BY GRID NUMBER: BOOK AGE: JLS SW3238 230273 Z)a�1 J �J J U VV 2-Z �5 * = FND 5/8 " REBAR SUP AWW 0 F 4 4� �• 10 "S� / 49TH '• ? / a . . �... ...................:..`.� -JOHN L. SCHULLER.• o LS -10408 •' �® .. �°�. ' • 1831 'lalkeetna Street �a '� 'Z�•• ��' �� = An,ch.ora a Alaska 99508 Ar oK\ ' 6 1 f e asio=\ as (90'7) 227°-1455 office L s �,a�. 907 274--4992 f ax MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# (~-~LI~~ (~c 1. GENERAL INFORMATION Complete legal description Location (site address or directions) j~' 3' 3,¢- /.~,,~_ %7~. Property owner Mailing address Lending agency Mailing address Agent. Z'~-~_~ Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: -~ '-~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Fron[ 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 inves_ti_gation 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 FI,~,A/-~? F-,~¢,~ ,~'~ f ~e,"~,'~(~,- Phone Address 1¥.5-.~ 0 ~'04o _C/:~ ,,4-,~ c,4 ora~,~ ,,~r< Engineer's signature ~~ ~ ~ DHHS SIGNATURE Conditional approval for Date bedrooms, with the following stipulations: Additional Comments Date. // The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not cor~duct 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-O75 [Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /-o¢' (/ ~//c~. ?/'r4r/'r)~;;~,n ~oo~f Parcel I.D. A. Well Data Well type . Fc~ Log present (Y/N) Total depth lc)~ ' Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~ ~¢ 7o~ Driller Cased to ~roc~ ~e Casing height Wires prolSerly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~'y' Absorption field on lot '~ too' Public sewer main ~,A. Sewer service line g.p.m. ; On adjacent lots ~ ~oo, ; On adjacent lots ~> loo, Public sewer manhole/cleanout /~. ,,~. Petroleum tank WATER SAMPLE RESULTS: Coliform ~J co//too m~. Nitrate 0...~ ~,,~ {~' Date of sample: to / ~-~ (¢ _~ Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ¢/eX /7¢' Tank size //'¢~- ~¢~a/ Compartments Cleanouts (Y/N) ~" Foundation cleanout(~TN) /~,o~.r ~. Depression (Y/N) High water alarm (Y/N) N, A. Alarm tested (Y/N) Date of pumping I~ /¢ 19 3 Pumper A~,c4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot~ ~,8'~,~ c.c. On adjacent lots To property line ~ ~o ' Absorption field Surface water/drainage ~ too' 72-026 (3/93)* Front Foundation ¢- ~ ' .Water main/service line ..C ~/ c N CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (WN) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Soil rating (GPD/FF) II ~ Gravel thickness Cleanout present (Y/N) y Depression over field (Y/N) Results (pass/fail) po-o- for '~ 'f" After test '~ g" No If yes, give date Length ?~ Width Total absorption area o' Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: System type Total depth N Bedrooms Well on lot ~> t oo' On adjacent lots ~. t oo, Property line :~ to, To building foundation ,~$- ' :F~-oz,, c. c,[ To existing or abandoned system on lot /~. 4, On adjacent lots ~. 3' o' Cutbank /~. ,4.. Water main/service line ~ ~.5" Surface water Curtain drain I rS' :R-~,~ ro~'J ,~ Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines ii , of this inspection. Signature _'~T~ Engineer's Name ~'7~o~--~or~' ~;. Date tV o u, ~.~ HAA Fee $ ~.'o ~ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL,~1 ~-'c.o ~J~'- ~ 1 c:~/~ i OF ON-SITE SEWER AND WATER FACILITY I 264-4720 GENERAL INFORMATION (a) (b) (c) Application Date Legal De. scr. iption (include lot, block, subdivision, section, township, range) .L6cati0n (addres§ o~- 81irbctions) Applicant N~m~ ~ ~ ~7~ Telephone: Home ~ ~ J 7~ Business' Applicant is (ch~ck ~ne): Lending Institution ~; Owner/buitder~; Buyer ~; Other ~ (explain); (d) Lending Institution Telephone Address ~ (e) Real Estate Company and Agent ~ Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family[~ Multi-Family [] Number of Bedrooms -~ Other WATER SUPPLY Individual Well J~ Community[]' Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite.~' Public [] Community [] Holding Tank I-1 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDIr. G INSPECTIONS, TESTS, FILE SEARCH, D~ fA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functiona~ a;qd 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 /~'~ ~,'~' / ~*~'~ Telephone ~/'-~-~ ~ DHEP APPROVAL Approved for "/~/~'"~"-~ bedrooms by -~"'~- '~~ Approved · Disapproved Conditional Terms of Conditional Approval Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisly certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page .2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION NOV5 '191~! RECEIVED WELL DATA HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ,62 LI PF,4t~/FI/G~f/V' Roo,s 7~ Well Classification Pt~II/R 7'~- If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y~) ~ Date Completed f~'J~v//~r~/~//~' Yield Total Depth j c~ / Cased to ~ Static Water Level ~;~ / Casing Height Above Ground J~ ~ / Electrical Wiring in Conduit CN) Separation Distances from Welt: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot /L/0/''/- ; On Adjoining Lots To Nearest Public Sewer Line ,N//~ To Nearest Public Sewer Cleanout/Manhole ~//fi) To Nearest Sewer Service Line on Lot Water Sample Coll~cted by ~-~, /,~/¢/~"~.~UCK ;Date Water Sample Test Results ~i~ .~/~'/~ F/¢(~ ~0/~/~ Comments '~-~EE /'4 T'?BcdED I~1£L£ ~_5 Depth of Grouting Pump Set At Sanitary Seal on Casing ~N) Depression Around Wellhead (Y,~ ~~'v~ ; On Adjoining Lots / 00 /'~ IOO~¢ B. SEPTIC/HOLDING TANK DATA Date Installed ~h~/q~ Standpipes (~/N) Depression over Tank (Y~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) iV Sepa~ration Distances from Septic/Holding Tank: To Water-Supply Well ~¢ / ~ To Property Line ~.~O / -j* To Water Main/Service Line /Y/~ Course I (~0 / ~' Comments I~) (,U/2,[ TT¢~4/ ¢J~tI/~,~ Size Air-tight Caps C/N) /: 1~% ~;Z No. of Compartments J Foundation Cleanout (Y,~, Date Last Pumped J O/2-I / ~2~O /1///~- ;for ~/~ Temporary Holding Tank Permit (Y/N) /V//~' To Building Foundation 2rO TO Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Width of Field 2~ ' Iii Square Feet of Absorption Area Depression over Field (Y~) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well j t./ 0 i ~F- To Building Foundation Lot I~//~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field 2 °~ / Depth of Field ? / Gravel Bed Thickness '-~ / Standpipes Present (:~N) Date of Last Adequacy Test F/cc Y To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~.~0 TO Cutbank (if present) I00 ¢ Comments LIFT STATION Date Installed Dimensions _~.// Size in Gallons Manhole/Access~%ZN~- "Pump On" Level at ~ "Pum~u~,Off" Level at . ~, Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) / uvHcip&H :yo An chovage P.O. dOX 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES November 12, 1986 Jeff Kaitchuck Alaska Environmental Control Services 1200 West 33rd Avenue, Suite B Anchorage, Alaska 99503 Subject: Lot 1 Block 2 Ptarmigan Roost Subdivision Waiver Request WR86-t54 Dear Mr. Kaitchuck: Your request for a waiver of the 100 foot separation required between the septic tank and well on the subject lot has been granted. This distance has been waived to 85 feet. This waiver is valid for the existing three bedroom single family dwelling only. Sincerely, Stephen S. Morris Civil Engineer On-site Services ALASKA IUII OrlmE!F1TAL COF1TI OL S& dlC{ S, IRC. ~n§ineerinq 8 (~noironmeml Studies October 30, 1986 Department of Health & Human Services 825 L Street Anchorage, Alaska 99501 Re: Lot 1, Block 2, Ptarmigan Roost Subdivision On October 17, 1986 we performed a health authority inspection on the subject lot. After concluding the inspection it was determined that the separation distance from the well to the septic tank is in violoation of existing separation distance requirements. The separation distance waiver guidelines issued on a memorandum from Bruce Erickson, District Office Coordinator, State of Alaska, Department of Environmental Conservation, dated January 3, 1985, suggests that tile geological conditions be addressed separately. The water table is 10 feet below the septic tank. Soil Type: 8ravelly Sand Soil Sorbtion Permeability The water table gradient is a negative 17% slope. The horizontal separation distance from well to the septic tank is 85 feet. Point Value = 1.22 Point Value = 2.5 Point Value = 1.0 Point Value = 1.0 Point Value = 2.56 TOTAL POINT VALUE = 8.28 According to the guidelines, a total point value of 8.28 indicates contamination is unlikely from bacteria. Water samples taken on the subject lot are free of coliform bacteria and have a 0.37 mg/1 nitrate-N count. The well and septic tank are on the same contour which is perpendicular to the slope of the lot. Any contamination from the septic tank would have a tendency to flow away from the well. We feel that the reduced separation distance does not constitue a health hazard. Therefore we request a written waiver for the separation distance of 89 feet from the well to the septic tank be granted. If you have any questions please feel free to contact me at 561-5040. Sincerely, _.~:~'~ ~ ~ & Jeff Kaitchuck ~%~.o°~ '°,,~'~ Engineering Technician ~}'~ ~200 ~est 33r~ ~oe~u~. ~ui[e ~, ~nch0r0qe. ~[os~0 99503,(907) 56~-50~0 Alpine Drilling & Enterprises Domestic -- Commercial N©- Pump & Water Systems cP.O Box 110496 TO: ,4 ' INVOICE 2065 QUANTITY DESCRIPTION AMOUNT TOTAL ~BOR Thank You · SIGNATURE (I Hereby Acknowledge the Satisfactory Completion of the Above Described Work.) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. ALASKA ENVIRONM~ENTAL CONTROL SERVI( ~:, iNC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) '561-5040 SHEET NO. OF CHECKED BY DATE ' " APPLIC' '~IT FILLS OUT UPPER HAL' -"ONLY P,,lailing Address I~ ~3'5 C LP /'d A Zip Code 'f'i'(?5 Buyer Address Zip Code Lending Institution Phone Address Zip Code Realty Co. & Agent :~O[ [X..~ / {-[:'~{~.~ !:_ ~-~'~ Phone Address Zip Code Street LocatJ~ I[O ':3 % : L ~2~~ ~ Type of Resi~nce ~gle Family ~ 'Multiple Family No. of Bedrooms ~ Other Water Supply ~ndividual A~ACH WELL LOG. A well log is required for all wells drilled since June 1975. ~ ~ommunity For wells drillep prior to that date, give well dept~(attach I~g if available), Sewer Disposal dividua, Year Individual Instal,ed: I ~'~:~ ublic Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED, Time Time Time Time Date Date Date Date Insp~tor Insp~tor Insp~tor Insp~tor ~~ . '~-~,:,: -.: ~_- (~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) OONDITIONAL APPROVAL* DATE SOHS ~a~ing Date ~wer installed Well To Abso[ption Are~ Well Log ~eceived GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 j~//~ Date Received Augus_____~t _3, 197___~6 :/~O~k~J Time of Inspection 1:30 p.m. Date of Inspection 8-4-76 Wednesday ~'- REQUEST FOR APPROVAL OF B~chholz ~ INDIWDUA[ SEWER & WATER FACILITIES 1. Approval requested ~: Mailing Address: 2. Proper~ Owner: Ronald D. Howes Mailing Address: 3. Legal Description: 4. Location: See map 5. Type of facility to be inspected 6. Well Data:Ind~vidua~ A. Type~~ C. Construction ~"~)-~tx;~~ 7. Sewage Disposal System: A. Installed C. Septic Tank: 1. Size D. Seepage Pit: E. Disposal Field: Box 10-367 Anchorage Lot 1 Block 2 Ptmarigan Roost Phone: Phone: 349-4360 Single Family No. of bedrooms 3 On-site system B. Installer 2. Manufacturer 1. Absorption Area 2. Material Total length of lines B. Depth 205/feet D. Bacterial Analysis 8. Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank , Absorption area , Other contamination , Absorption area C. Absorption area to nearest lot line , Sewer Lines , EQ-034 (1/74) Paqe 1 of twn Page 2 of tw.o pages - Req ~t for Approval of Individual S" ;e§al Description Lot 1 Block 2 Ptmarigan Roost r & Water Facilities Comments Apiprove~ App~c~al Disapproved Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM 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)