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PTARMIGAN ROOST BLK 2 LT 4
Ptarmigan Roost Block 2 Lot 4 #020-042-72 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191386 PID Number: 020-042-72 Dwelling: ® Single Family (SF) ® with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ®Upgrade Name MICHAEL & CHRISTIE LOUGHTON ABSORPTION FIELD ® Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound ❑ Other Site Address 16101 WIND SONG DRIVE, ANCHORAGE Phone 7-7 of Bedrooms 5 Soil Rating GPD/SF Total depth from original grade 9 Ft. LEGAL DESCRIPTION -1.2 Depth to pipe invert from original grade 9—per F:ZCS Ft Gravel depth beneath pipe 5 Ft. Subdivision Block Lot PTARMIGAN ROOST 2 4 Fill added above original grade VARIES 1.43 — 1.45 +/- Ft. Gravel length 15 Ft. Township Range Section Gravel width 3 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line- Total absorption area 150 Ft' Number of trenches 1 Dist. between trenches Ft. Well 100'+ 100'+ 25'+ TANK IZ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100'+ 100'+ GREER 1500 Gal. Material Number of compartments Lot Line 10'+ 10'+ NA HDPE 2 Foundation 10'+ 10'+ LIFT STATION Manufacturer Capacity Remarks 1-BR AUGMENTATION FOR ADU. 5'+ TO Gal. DECK SUPPORTS. Alarm location Electrical installed by Installer A+ PIPE MATERIAL House to tank Tank to 3034 drainfield 3034 Drainfield 3034 CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspdection 1" 10/22/2019 2nd 10/23/2019 Location and description 3`d 10/23/2019 41h DOOR SILL ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date �g—In TH • • • • • • • • • •.... .. Curtis Huffman ��• CE 128991 ��l ' 1/12/2021. • • G�. �����PROFESSIONA�'�.,®,� Septic System Approved - Date ad2% Note: this approval does not include well permit requirements. rRP\nsmgli Ai LEGEND \ SURVEYED PROPERTY BOUNDARY UNSURVEYED PROPERTY BOUNDARY EASEMENT -----W— WATER SERVICE LINE L=40.520, R=20.0 d=116. -----S— SEWER SERVICE LINE X x FENCE I ----101---- EXISTING MINOR CONTOUR ----100---- EXISTING MAJOR CONTOUR — — — ROOF OVERHANG PROPERTY SETBACKS DRAINAGEARROW \\ \\ \1 2`% GRADEARROW / I II // //' \� '/ J y9,600 ® WELL / 0 GRAVEL DRIVE / / / / I I BUILDING OVERHANG DECK 0 ASPHALT I A A\ 11 I AV / \\ / / / �\ ® SEPTIC CLEANOUT I I I 11 \\—/' / 1 // 1\ \ \ /� / EXISTING BARN _ /<) / / / 1 '� C -)CPI / /// / / I / / ( 4O EXISTING WELL LOT 4 \ N \ LUV/ EXISTING I \ \ 1 / I I Z I IS GRAVEL �XI�ING r� l /DRIVEWAY I 1 1 1 ( \ I i I I rACCEISSbRY / -\ OWE�6NP UNIT '60 A\ EXISTING / HOUSE 5.09 ( //26.9'/ 5 Co 20'UTILITY oo / \ / / / ( 10,0• / EASEMENT ,c aCo —74 00 08 I I I l I \ / 30 / I \ 8.4' 35.7' X \ 8.4' \ / — 31.4' LLI I > / RETAIN%NG WALL - _ — III \11 0 �/I 1 1 1 C;. FINAL AS -BUILT / I \ I I I \I F, 30.3' 1 46.2' 'ISd \ I I I I 1 � 1 1 I 1 I I I I 1\\ \I I I 11 26.7' / EDGE OF PAVED ROA 6.0'D y/ 9 59.8' F-- I y I EXISTING HOUSE PARKING ®\ (DOUBLE CAR GARAGE) / , / r / 2SSIDEVARD ,SETBACK \ / I / I / S89 59 30 W 293.37 TREE HOUSE \ \ I I li 24.3. I I 4% ® I I 46.5' CULVERT / — \ eo I I 1 / 1 III III I ASPHALT PAVEMENT ADU PARKING I IY II I II I GRAVEL PATH I I I II I I —856 1 I I I v 1 1 I W E / 30 GRAPHIC SCALE 20 0 10 20 40 1"-20' (FULL SIZE, IN FEET) (22 x 34 SHEET SIZE) (1"=40' on 11 x 17 SHEET SIZE) 30" x 21" BORDER SURVEY NOTES 1. THIS DRAWING SHALL NOT BE MODIFIED WITHOUT THE EXPRESSED WRITTEN CONSENT OF LCG LANTECH. UNAUTHORIZED USE OF THIS DRAWING IS PROHIBITED. 2. FIELD SURVEY WAS PERFORMED IN DECEMBER, 2020, BY LCG LANTECH AND REPRESENT THE EXISTING CONDITIONS AT THAT TIME. 3. EXCLUSIONARY NOTE: IT IS THE OWNER'S RESPONSIBILITY TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, RESTRICTIONS, OR RIGHT-OF-WAY TAKINGS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION, FOR ESTABLISHING PROPERTY LINES, OR FOR PLOT PLAN PURPOSES. 4. THIS PARCEL MAY BE SUBJECTTO PROTECTIVE COVENANTS FOR PTARMIGAN ROOST SUBDIVISION, BOOK 204, PAGE 521, MISCELLANEOUS INDEX, ANCHORAGE RECORDING DISTRICT. S. THIS PARCEL IS SUBJECT TOA DIMENSIONAL VARIANCE REQUEST, SEE MOA PLANNING AND ZONING CASE NO: 2020-135. SURVEY CERTIFICATE LCG LANTECH, INC HAS CONDUCTED A PHYSICAL SURVEY OF THE PROPERTYAS SHOWN ON THIS DRAWING AND CERTIFIES THATTHE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO ENCROACHMENTS BEYOND THE PROPERTY LINES SHOWN ON THIS DRAWING EXIST, OTHER THAN NOTED OR SHOWN ON THIS DRAWING. DATE STEVEN CALLAGHAN, LBS -12034 REGISTERED LAND SURVEYOR SITE INFORMATION OWNER NAME: MICHAEL & CHRISTIE LOUGHTON LEGAL DESCRIPTION: PTARMIGAN ROOST SUBDIVISION BLOCK 2, LOT PARCEL ID NO: 020-042-72-000 ADDRESS OF MAIN HOUSE: 16101 WIND SONG DRIVE ADDRESS OF ACCESSORY DWELLING UNIT (ADU): 16122 SANDPIPER DRIVE ZONING: R-6 MOAGRID NUMBER: SW3238 PARCEL AREA: 57087 SQUARE FEET, 1.31 ACRES TYPICAL SETBACKS FOR R-6 ZONING FROM TABLE 21.06-1: FRONT: 50 FEET SIDE: 25 FEET REAR: 50 FEET THIS LOT MEETS THE CRITERIA FORA DOUBLE FRONTAGE LOT WITH A FRONT YARD SETBACK OF 50 FEET, A SECONDARY FRONT YARD SETBACK OF 25 FEET, ASIDE YARD SETBACK OF 25 FEET AND NO REAR YARD SETBACK. SANDPIPER DRIVE AND WIND SONG DRIVE ARE MOA LOCAL ROADS. MAIN HOUSE:4 BEDROOMS ACCESSORY DWELLING UNIT: 1 BEDROOMS TOTAL: 5 BEDROOMS REQUIRED PARKING:3 SPACES PROVIDED PARKING: 4 SPACES 0 BEFORE YOU DIG CALL FOR FREE UNDERGROUND LOCATION Locate Call Center ofAlaska "Alaska oig Line' Statewide......... 1(800)478-3121 who will notify subscribed utilities only, other utilities need to be cont ¢ed Individually U�VO 49 TH v STEVEN 1" ONE INCH z 0 s m O z N W 19 p y N TS—! a LL 3 o Z C> t u H 2 0 Lu oa Lu p V'1 2 N N � . z O 3 m a LL! W U' J Z Z Lu O a mw A. N d Q 0 0 Q Q Z J } 3N LL° N Lu Lu N u N -II0 Q r � N N SHEET SIZE: 22 X 34 mu DESIGNED BY: CS/SC z Z w DRAWN BY: CS/SC O CHECKED BY: SC DATE: 1/4/2021 FILE NO. 1250.34 SHEET NUMBER V1 of 1 LLI I > / RETAIN%NG WALL - _ — III \11 0 �/I 1 1 1 C;. FINAL AS -BUILT / I \ I I I \I F, 30.3' 1 46.2' 'ISd \ I I I I 1 � 1 1 I 1 I I I I 1\\ \I I I 11 26.7' / EDGE OF PAVED ROA 6.0'D y/ 9 59.8' F-- I y I EXISTING HOUSE PARKING ®\ (DOUBLE CAR GARAGE) / , / r / 2SSIDEVARD ,SETBACK \ / I / I / S89 59 30 W 293.37 TREE HOUSE \ \ I I li 24.3. I I 4% ® I I 46.5' CULVERT / — \ eo I I 1 / 1 III III I ASPHALT PAVEMENT ADU PARKING I IY II I II I GRAVEL PATH I I I II I I —856 1 I I I v 1 1 I W E / 30 GRAPHIC SCALE 20 0 10 20 40 1"-20' (FULL SIZE, IN FEET) (22 x 34 SHEET SIZE) (1"=40' on 11 x 17 SHEET SIZE) 30" x 21" BORDER SURVEY NOTES 1. THIS DRAWING SHALL NOT BE MODIFIED WITHOUT THE EXPRESSED WRITTEN CONSENT OF LCG LANTECH. UNAUTHORIZED USE OF THIS DRAWING IS PROHIBITED. 2. FIELD SURVEY WAS PERFORMED IN DECEMBER, 2020, BY LCG LANTECH AND REPRESENT THE EXISTING CONDITIONS AT THAT TIME. 3. EXCLUSIONARY NOTE: IT IS THE OWNER'S RESPONSIBILITY TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, RESTRICTIONS, OR RIGHT-OF-WAY TAKINGS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION, FOR ESTABLISHING PROPERTY LINES, OR FOR PLOT PLAN PURPOSES. 4. THIS PARCEL MAY BE SUBJECTTO PROTECTIVE COVENANTS FOR PTARMIGAN ROOST SUBDIVISION, BOOK 204, PAGE 521, MISCELLANEOUS INDEX, ANCHORAGE RECORDING DISTRICT. S. THIS PARCEL IS SUBJECT TOA DIMENSIONAL VARIANCE REQUEST, SEE MOA PLANNING AND ZONING CASE NO: 2020-135. SURVEY CERTIFICATE LCG LANTECH, INC HAS CONDUCTED A PHYSICAL SURVEY OF THE PROPERTYAS SHOWN ON THIS DRAWING AND CERTIFIES THATTHE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO ENCROACHMENTS BEYOND THE PROPERTY LINES SHOWN ON THIS DRAWING EXIST, OTHER THAN NOTED OR SHOWN ON THIS DRAWING. DATE STEVEN CALLAGHAN, LBS -12034 REGISTERED LAND SURVEYOR SITE INFORMATION OWNER NAME: MICHAEL & CHRISTIE LOUGHTON LEGAL DESCRIPTION: PTARMIGAN ROOST SUBDIVISION BLOCK 2, LOT PARCEL ID NO: 020-042-72-000 ADDRESS OF MAIN HOUSE: 16101 WIND SONG DRIVE ADDRESS OF ACCESSORY DWELLING UNIT (ADU): 16122 SANDPIPER DRIVE ZONING: R-6 MOAGRID NUMBER: SW3238 PARCEL AREA: 57087 SQUARE FEET, 1.31 ACRES TYPICAL SETBACKS FOR R-6 ZONING FROM TABLE 21.06-1: FRONT: 50 FEET SIDE: 25 FEET REAR: 50 FEET THIS LOT MEETS THE CRITERIA FORA DOUBLE FRONTAGE LOT WITH A FRONT YARD SETBACK OF 50 FEET, A SECONDARY FRONT YARD SETBACK OF 25 FEET, ASIDE YARD SETBACK OF 25 FEET AND NO REAR YARD SETBACK. SANDPIPER DRIVE AND WIND SONG DRIVE ARE MOA LOCAL ROADS. MAIN HOUSE:4 BEDROOMS ACCESSORY DWELLING UNIT: 1 BEDROOMS TOTAL: 5 BEDROOMS REQUIRED PARKING:3 SPACES PROVIDED PARKING: 4 SPACES 0 BEFORE YOU DIG CALL FOR FREE UNDERGROUND LOCATION Locate Call Center ofAlaska "Alaska oig Line' Statewide......... 1(800)478-3121 who will notify subscribed utilities only, other utilities need to be cont ¢ed Individually U�VO 49 TH v STEVEN 1" ONE INCH z 0 s m O z N W 19 p y N TS—! a LL 3 o Z C> t u H 2 0 Lu oa Lu p V'1 2 N N � . z O 3 m a LL! W U' J Z Z Lu O a mw A. N d Q 0 0 Q Q Z J } 3N LL° N Lu Lu N u N -II0 Q r � N N SHEET SIZE: 22 X 34 mu DESIGNED BY: CS/SC z Z w DRAWN BY: CS/SC O CHECKED BY: SC DATE: 1/4/2021 FILE NO. 1250.34 SHEET NUMBER V1 of 1 MUNICIPALITY OF ANCHORAGE On -Sits Watar & Wastawatar Program F4 BOX 186650 4700 Bmore Road An4hatage, Pdatka99s519-6660 1151Dme! (W?x 5 -79CM Fax! (907) 343.7'997 On -Site Wastewater Disposal System Permit Permit Number: OSP 191385 Work Ty p m: Septic LJpg ra de Tax Cade Number: 0200 1272N0 S ito Legal Add reps . PTARMLGAN ROOS T SLK 2 LT 4 G:3 238 Si:Ee hailing Address: 16101 WIND SONG OR, Anchorage Owner: LO UG HTON MICHAEL D & Design Engineer: ANDERSON CONSTRtjrTION & ENOINEERIN0 This parrnl t is for the construction of: Effective Date: Expiration Date: t <. LR-1partment Lot Size in Sq Ft: Total Bedrooms; W412019 Q02020 57087 0 Dispoual FiEf Septic Tank ❑ Holding Tank ❑ Prluy ❑ Frivarr.'Ne'll ❑ Yater Storage All construction shall be In accordance with, 1- The attached apprGved design. 2- All requirements specified in Anchorage Municipal code Chapters 16.56 and 16,05 and the %ft of Alaska Wastewater Disposal Regulalions (1BAA072) and 0rinWng Vater Regulations j10uAC80� 3- Thp war-wwakor qQ-d4 rcquircri in:5pcQt1(Din7R rlurin!g #hC Inr#cllotion- Thr nglnci�-r :Dhatl notify khc Dcvcloprn=L Service s a epartrltent per AMC 15.65. Provid a notification by ca II ing (907) 343-7954 (24 7 �. 4- rrorn October 15 to April 1S. a subsurface sail absorption system under can*truction during freezing weather shall be either a 05>ened and Closed on the carne day, or b. Covered, sealed, and heated lo prevent freezing Special Provisions: Record drawings sh.sll show 5 -bedroom alternate drainfield- ` 9}4fl Received By: Oats - Issued By: Daw. 5 FPLP-NS MUNICIPALITY OF ANCHORAGE Development Services Department: Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 020-042-72 Property owner(s) MICHAEL & CHRISTINE LOUGHTON Day phone 530-417-1588 Mailing address 16101 WIND SONG DRIVE, ANCHORAGE, AK 99516 Site address 16101 WIND SONG DRIVE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) PTARMIGAN ROOST BLOCK 2, LOT 4 Legal description (Township, Range & Section) Lot Size 57087 Sq. Ft. Number of Bedrooms 1 - LA Sizeg 0.v\ e )d s-Hn3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ® Initial ❑ Single Family (SF) (w/wo AD U) Septic Tank ® Upgrade ® Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ ' (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. FWCS - Brent Western (Signature of property owner or authorized agent) Permit/Rush Fees: 595' Date of Payment: $ lao f iR Receipt Number: ()a4D Permit No. 05Pt91510 Waiver Fees: Date of Payment: _ Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\FormsUient FormsTermit Application.doc u 5 b� M Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345 -3377 / Fax 345 -1391 Support Services Brent M. Western 907-440-4601 August 30, 2019 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: ADU - SEPTIC SYSTEM UPGRADE PERMIT LEGAL: PTARMIGAN ROOST BLOCK 2, LOT 4 Weve been requested to obtain a new septic permit on the above referenced lot. We propose to install a new tank and augment the existing trench to for a proposed 1-bedroom ADU per the attached design. The design is based on the recent test hole that was conducted on August 22, 2019. The slopes are flat at the proposed septic location. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact Brent M. Western or me if you have any questions. Sincerely, Michael N. Anderson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191386, Rebecca Carroll, 09/04/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191386, Rebecca Carroll, 09/04/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191386, Rebecca Carroll, 09/04/19 Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345 -3377 Fax 345 -1391 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: PTARMIGAN ROOST B2, L4 PERFORMED BY: FWCS / MNA - I MIKE N. ANDERSON CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 8/29/19 DEPTH FEET OG SOILS 1 ORG/OL 2 3 4 5 6 7 8 GM/gp-sp fines / sand inc. w/ depth 9 10 11 12 13 14 15 16 BOH 17 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 8/22/19 10 min 1 2/16 4 14/16 10 min 1 4/16 4 12/16 10 min 1 3/16 4 13/16 10 min 1 4/16 4 12/16 10 min 1 3/16 4 13/16 10 min 1 3/16 4 13/16 PERCOLATION RATE 2 (MIN / INCH) TEST RUN BEWTWEEN 4 & 5 FT PERC HOLE DIAMETER 6 PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 8/29/19 TESTHOLE # 19-1 DATE PERFORMED: 8/22/2019 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: MICHAEL LOUGHTON 8/29/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191386, Rebecca Carroll, 09/04/19 3p, 0000wv�O LOT 5 OF 4 :49TH -�*D A............................0� ...................... 7...... STEVEN CALLAGHAN. ; L 12034 c 141�ea 7. l�p��jl�ago v��� °fessiono� 00 R=20.00' L=40.52' 30' Ix NOTE: THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LCG LANTECH. ORDERED BY: SARAH GEE PARCEL M 020-042-72-000 SURVEY CERTIFICATION: LCG LANTECH, INC HAS CONDUCTED A PHYSICAL SURVEY OF THE PROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO LEGAL DESCRIPTION: ADDRESS: 16101 WIND SONG DR. AS -BUILT ENCROACHMENTS EXIST OTHER THAN NOTED. LOT 4, BLOCK 2, EXCLUSIONARY NOTE: IT IS THE OWNERS' RESPONSIBILITY TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, RESTRICTIONS OR RIGHT-OF-WAY TAKINGS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO PTARMIGAN ROOST SUBDIVISION CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION, FOR ESTABLISHING PROPERTY LINES, OR FOR PLOT -PLAN PURPOSES. LEGEND: 250 H Street Anchorage, Alaska 99501 SEPTIC STANDPIPE S - _ Overhang 1 WATER WELL . Wood Deck a''YConcrete ,. FENCE —X—X— Department ff. DRAWN DATE: 7/16/2018 WORK ORDER: 18087 Phone 562-5291 DRAWN BY: AP PLAT: 71-214 J MEF m Itt. WE=Survey :Inc Mainline Phone 243-8985 CHECKED BY: SC GRID: SW3238 AECC 668 SCALE: 1" = 50' FB/PG:809/54 REF: 011_482 7 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME - f PHONE XNEW _J` 'r C'h E �—• �' n 9�,2 ✓�4 _r _Z(7;g 1:1 UPGRADE MAILING ADDRESS 8 0/y 17 LEGAL D SCRIPTION n ,f; �c Z L r -9t � 0 f LOCATION' NO. OF BEDROOMS W I a Absorpti area / `9 Dwelling PERMIT NO..7 Uy DISTANCE TO: � C N � / 5 wZa Manufacturer j/tel/ Materia � No. of compartments r/ ~ 1 r rn Liq. c pacitygallons zcr � IF HOMEMADE: Inside length Width Liquid depth z DISTANCE TO: Well Dwelling PERMIT NO. =_< Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: e I t PlfaCf F ndasion r_ja1_ Nearest lot line `� / PERMIT NO. 2. JE z No. of lines Length of each liney 1 Total len9. h of lines I Trench width Distance between lines z w I V �� )inches --CL ¢ F Top of tile to finish grade i Material beneath tile Total eff trve abso area () inches Length Width Depth PERMIT NO. w C7 Q F• Type of crib Crib diameter Crib depth Total effective absorption area w °• Lu y Well Building foundation Nearest lot line DISTANCE TO: Class. Depth Driller Distance to lot line PERMIT NO. J W 3� Building foundation Sewer line Septic tank Absorption area(s) 1 DISTANCE TO: OTHER PIPE MATERIALS 10 VC SOIL TEST RATING INSTALLER , r _ -t,-,G-� REMARKS r r ` -- 63 3 .1 C APPROVED DATE LEGAL 9_ y_ A. ,- 1 - --1 l - e L 4 Ll- 0��jphi 1 PV 17-45'"s �� �' � ` / ^` DEPHRTMENT HEM.-Tit-411 HWD ENVIR0NMENTHL ��OTECTION � 825 /L' STfTEET/ HNCHORHGE/ RK 99501 . 264�4720 1� �Iq K 2 1:1 P-A ---NET 1 "T 81 E T F ��F�-_, T-2. !I. T' U ( PERMIT N! ( 820751 ) / HPPLICHNT SUN CONSTRUCT1ON INC SFIH BOX 474E 99507 ]45-2089 LOCHTION LEGHL L4B2 PTHRMIGHN ROOST LOT �IZ� 999999 SQUHRE FEET TYPE OF SOIL HBSORPTION SYSTEM IS� TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RHTING (SQ FT/BR)= 150 ' THE REQUIRED SIZE OF THE SOIL HBSORPTION S�ST�M Q E7 F0, W &A t.. EHI TW9 oil 0- W! K 17, 12116". PEE.: F_ � THE LENGTH DIMENSIM 115 THE LENGTH (I14 FEET) OF THE TRENCH 8R DRHINFIELD � THE DEPTH OF Al TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE GROUND �ND THE BOTTOM OF THE EXCHYHTION (IN FEET). THERE IS NQ SET WIDTH FOR TRENCHES. THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN T'HE OUTFALL PIPE � HND THE BOTTOM OF THE EXCHVHTION (IN FEET) IF I: MA AT A-E, i 0E_: �FIR I.. L.. K-3�� ' PERMIT HPPLICHNT HAS THE RESPONSIBILITY THIS DEFAHRTMENT DURING THE INSTHLLHTION INSPECTION5 OF MY WELLS THIS PROPERTY HND THE � NUMBER OF RESIDENCES THHT THE WELL WILL SERVE � _�� ��� ��� ����������� ��� ������1-I:_� BHCKFILLING OF AIVSYSTEM WITHOUT FINHL INSPECTION HND HPPROVHL BY THIS � DEPHRTMENT 14I1-L BE SUBJECT TO PROSECUTIO�{ � MINIMUM DISTANCE BETA".-:EH H WELL HND HNY ON-SITE SEW8GE DISPOSHL SYSTEM IS 100 FEET FOR H PRIVHTE WELL OR 150 TO 208 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF �UBLIC WELL MINIMUM DISTHNCE FROM H PRIVHTE WELL TO H PRIYHTE SEWER LINE I� 25 FEET HND TO H COMMONITY SEWER LINE IS 75 FEET. WELL LOGS HIRE REQUIRED MUST BE RETUMED TO THE DEPRRTMENT WITHIN ]0 DHYS OF THE WELL COMPLETION � OTHER CONSTRUCTION DIHGRHMS HRE HVHILHBLE TO INSURE PROPER INSTHLLHTION K Eli 1 1Q_'[r;1 1: 7" ���FI:� 1 FIT M FIT IET� I CERTIFY THHT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR 004—SITESEWE�S HND WELLS HS SET FGRTH BY THE MUNICIPHLITY OF HNCHORHGE it: I WILL INSTALL THE SYSTEM IN HCCORDFNCE WITH THE CODES. W I UNDERSTHND THAI THE ON—SITE SEWER SYSTEM MRO.,' REQUIRE THE RESIS FREP1011.".)EEL.ED IO1C::1AjDE MORE THHN 4 BEDR8OMS SIGNED ~~--�—�—�~ PLICH14T/ TRUCTION INC 4. UED ........ ....... ' �° `M 1 ' \ SOILS LOG MUNICIPALITY OF ANCHORAGE m ye DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION O PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR:t 1 1'� -L NUJ ] 7 DATEPERFORMED: B •5' ''Isz LEGAL DESCRIPTION:-Nry ► y t oC Li 1 Tt-r F f CL- ov-CI,c 51 SLOPE �i 1 lilt 2 do 0� Ut Sl.�z') r �1�� -4-o 7 1, �e-6rc ry 0 8 , —g -41e 10 e 1 e 11 s' WAS GROUND WATER S No L Net Time o � ENCOUNTERED? O 12 e P e IF YES, AT WHAT E DEPTH? 13- 14- 15- 16- 17- 18- 19- 141516171819 SITE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop 20 PERCOLATION RATE TEST RUN BETWEEN COMMENTS PERFORMED BY: b ma -1 CERTIFIED BY: FT FT AND (minutes/inch) FT DATE: -- 1w. a' 0 and cc J tra W w M 7 r! IH ID rl CJ . 4�i� Oi N � : F bG: bk: <r; 1-4 3 • w z z � a rn 0 O O O O O O O O O O O O v w w w w w rn k � ep U` � l) �9 V; 'LS 'C V ; C �; fes, : a� � h F f•r (-- h F h h a F F F N: N: OG: O'J Cq: ; ' NO 1 N �: Lc): CO N O rJi U] o (M: 6)i C- O F O O O O O O } FO FO- •. Ul a W Z a H A 0 r S 0 0 i i i i V O O O U O O O O O O O O n CD I, Q W¢¢ z a a a a a a a s a s a O ¢ Q w w W w W W W W w 6 8 9 10 7, Municipality of Anchorage no410, On-Site Water and Wastewater Program ` L 1A)1 �; 6'� (907) 343-7904 3k.,1,. ' $ lE T Y CO Certificate of On-Site Systems Approva / � 0 { 8 _ Parcel I.D. 020-042-72 Expiration Date: f 1. GENERAL INFORMATION: Complete legal description PTARMIGAN ROOST; BLOCK 2, LOT 4 Location (site address) 16101 Wind Song Dr. 99516 Current Property owner(s) Hugh Hobson Day phone 242-8197 Mailing address 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: /1 Date: Vig COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 5 2-00`00 Waiver Fee $ Date of Payment 11•N20iDate of Payment Receipt Number 60913(.. Receipt Number COSA# 036(11-13 (a' 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 Engineer's Printed Name: Jeffrey A. Garness Date: 4. b/�D 0000000 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system `='47'. OF 4 4%d in accordance with the guidelines and regulations established by the Municipality of Anchorage and • • S O industry practices. The reported results describe the condition of the system/s on the date/s of the 0,(: ---.•• 1)n evaluation. Separation distances were measured to readily identifiable features. Hidden defects or �, ' 1'tt ��;� .J V encroachments may exist that were not identified during the evaluation. The operational life of all wells - * ; 4 9 r I '' ` .�*v and septic systems depend upon a variety of variables, including but not limited to, soil conditions, � 4 groundwater levels (that may fluctuate during the year), quality of construction (materials and � i workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and O ... . Q are outside the control of GEG. Satisfactory test results do not guarantee future performance of the Q • ' f : • Corn-ss: 0 system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of vn 9• . 79 . ��� the well or septic system. GEG makes no representation whether an alternative well or septic system O . V 7� (,,.••• -�ce4 can be installed on the property in the event either of the current systems fail to perform adequately in -11 �' S.!. �•V cAo the future. The content of this report is for the sole benefit of the person/party that retained GEG to %QPa�'ro{ess 0000„, perform the evaluation. Reliance upon the information provided in this report by any other person or ��40P4' � party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. " OF [ G•Rx-- *AEC�C 1 6. DSD SIGNATURE j ON-SITE '7G� System #1 Approved for Lf bedrooms WATER AND System #2 Approved for bedrooms WAS ? TEWATER <<) ROGRAN► Disapproved �% c� ,c . Conditional approval for bedrooms, with the following stipulations:" "�n�l�n� f Lv v-e-ti i , Q ..c'ceel S e {-Lc - I i s S 2.. © ,c./ax v's dL = �,.. CCL47 _ Original Certificate Date: 1 S ( 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 /C Nitrate Advisory _ _ Septic System Advisory I Ars FIs ( _ Well Flow Advisory Other 4 ,tr._ COSA blue sheet 10-10-12.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 4 Parcel ID: 020-042-72 A. WELL DATA *ASSUMED CASED TO BEDROCK AT ROUGHLY 28 FEET Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 9/29/1982 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 140 ft. Cased to *UNK ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 9/28/1982 5/10/18 Static water level 26 ft. 20.4 ft, Well production 2.5 g.p.m. 3+ g.p.m. WATER SAMPLE RESULTS: Coliform N (.3.- colonies/100 ml. Nitrate Wmg./L. Collected by: GEG. Ltd. Arsenic: A-)in ug./L. Date of sample: 6/15/2018 B. SEPTIC/HOLDING TANK DATA 36 YEAR OLD STEEL SEPTIC TANK IS APPROACHING THE END OF IT'S USEFUL LIFE Tank Type/Material SEPTIC/STEEL Date installed 9/24/1982 Tank size 1250 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 9/20/2017 Pumper A+ Home Services C. ABSORPTION FIELD DATA hilELOW EXISTING GRADE AT MONITORING TUBE Date installed 8/24/1982 Soil rating Tp.d./ft)or ft2/bdrm) 1.0 System type DEEP TRENCH Length 63 ft. Width 2.16 ft. Gravel below pipe 5 ft. Total depth *8.3+ ft. Eff. absorption area 630 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 5/10/18 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 754 gal. New depth 6 in. Elapsed Time: 105 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — SUMP EXTENDS 60 INCHES BELOW INVERT 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 *MET CODE AT TIME OF CONSTRUCTION. G. ENGINEER'S CERTIFICATION o •,`� �F...' ���p�0 QQ .S�O 0 I certify that I have determined through field inspections and * A � I Ilik '•-*OA review of Municipal records that the above systems are in V Y conformance with MOA COSA guidelines in effect on this Q /' 0 date. to .. ,f r:� •. Ga ess. Engineer's Printed Name JEFFREY A. GARNESS Q E-7913 op 49 ° �-s ". .,moo � Q '••ie 3.o E' �A� Date i_- -;.i.'/i 1; �O�aP o �� r0fessio�o� DOOOOo�� (Rev. 11/05) MUNICIPALITY OF ANCHORAGE -.--- L DEVELOPMENT SERVICES DEPARTMENT ' • f '� 907-343-7904 DEVE O On-Site Water and Wastewater Section ` �1 Fax: 343-7997 www.muni.org/onsite \ - Septic Tank Advisory Certificate of On-Site Systems Approval # 0SC181312 Subdivision: Ptarmigan Roost Block:2, Lot: 4 The septic tank for this property is 36 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. s a '41 9 Y. ( .. ' t•• ,, '> Or tr,. 4 1 m r.,,, .— '�yN ,. • fi• x:• T '� : ,,,..701,V.•,..-.Pi' '1' ,T" ; - .. ''. * t ,� • ;q,. L'.,,...,, ---.4, . `� •ff. .. ••rl,,M�.j1 �fr yam{ l� ('.'23./+.R h Yf d y y�y t. ... �; L5 L' Mailing Address:P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org 41..11\...11 1 ' - �.p q�o,000 ti .• -1-p�, ; . 49 . +tp ' i ii V 4.12e• V • enneth L. Dreyer: ,0 ' pQ+ ••-. LS-8202 •t' �1�' •''•.•.........••• flex 1 Q,0.o a� � �OJesssond 1 D O OCG R¢zo ; • • 700 . 5 0°` ,40 '90 - .• I , : i e9°� : ', 13, 30.0. ; ! . }...(:. .t. ., ,e) , 1 :. • / 0 t les twc I 31.7 • BARN , • 15.2 i 1. • � >.t .. � 1�1 ' 31.4 ••••••••-• ii u j ,,°; ..::::4'.;;•,..4:;i4. Qhs• war WOOD t> ! / h9Y6: at ru+c WALL a, •Q`G� • a• ,,, • ./ to w o CL' cr / \ ; LOT 4 j fl.• • ,�0 -oro ' .0 20o' ' UTlunr ' o ;, 1 EASEIuENT JO / • • Z Q • •0 :rya. ` 300 ' • - S 89'59'30" W 293.37' • LOT 5 w 1:4 14'4 4 ':'A d.4'4.4 4'4 4'4'4'4 4 9 4.4'4'1'4' ExauAON NOTES: It is the ewneri twponsbally to determine LEcu 0. SE f N0 ' onotasse en • the existence et any west Home, ceeenonls, or restrictionso/etitts w/CAPO • 1/1• Re 0 .,LINDA M c f N TIRE whkh envierAri'dr. e net envier en the recorded Aslc1 prat. NM!" -lt!•;,tmcet O punMles (4) ! - Under np circumstances should ens dote hereon be used ler. NUC! l+ ?Apt U I1 ns eo *uctien or ter .11.bfshing property lines. rttra- x si ... • SURVEY CLRTIIICATION: (AN TECH bee Conducted e Ovf]atArra- ' phyeicol survey el lois property es shown en this 1000 PECX1- -''l drawing end toot the improvements situated there-CO►teetTt- L • • on a• within the property toes end no encroach- Asr14i,1T- menle exist ether Ikon noted. telAstl- arWiiiiiii A S-..g U I LT OF: LEGAL DESaernaN: uPnc Stlll+oFr'. tio LAND do CONSTRUCTION SURVEYORS-PLANNERS-ENGINEERS 440 WESTwAttR saEtt— •ANC1tORACEENSON ALASKALw 99503 (907) 562-5291 LOT 4, BLOCK 2, MORK COUR WWII; wt. 'xxtt HAr IMAM AUG. 7. ' -50 71-214 PTAR M:1GAN ROOST 2001-1482Aa.w.e.: a wtno in �T►,xsoo,paot, TAC 1 KEN 3238 516,70&71 .IIIMMIWINIMMENNINII11110.. 1 RUSH! • Municipality ® �a4e On -Site Water and tewater r g X (907)3 904 e�.t CU Certificate of On -Site Sy roval / �y Parcel I.D. 020-042-72 Expiration Date: 1 I 1 L!5� 1. GENERAL INFORMATION Complete legal description Ptarmigan Roost; Block 2, Lot 4 Location (site address) 16101 Windsong Dr. "Anchorage 99516 -- Current Property owner(s) Alanna Small Day phone 225-405-4518 Mailing address Real Estate Agent 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: Individual Well ❑X Individual Water Storage ❑ Community Class _ Well ❑ Public Water System ❑ WaiverNariance request for: N/A Day phone TYPE OF WASTEWATER DISPOSAL: Individual ❑ Holding Tank ❑ Community ❑ Public Sewer IR Received by: '� t'Date: 5 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ $f P00 Date of Payment 8llq 115 Receipt Number 57a 64 COSA# 03C15l L/q Waiver Fee $ Date of Payment Receipt Number Waiver # N/A 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 E. Tudor Road, Suite 101 Anchorage AK 99507-1259 Engineer's Printed Name Jeffrey A. Gayness 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 alt wells and septic systems depend on 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 The content of this report is for the sole benefit of the person/party who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not authorized.. In short, GEG disavows any legal duty to anyone other than the personfoarty who paid for this report. 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for 0 bedrooms Date bedrooms, with the following ``a.lt r.atr QP�1TY OF q It ON-SITE Pv�, WATER AND r" WASTEWATER o c PROGRAM e�` 9)7)) SERV\��S��, Original Certificate Date: The Mtfnicipalityok"orage 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 Septic System Advisory Well Flow Advisory COSA blue sheet 9-1-12A.c Nitrate Advisory Arsenic Advisory Other 0 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 4 Parcel ID: 020-042-72 A. WELL DATA *ASSUMED CASED TO BEDROCK AT ROUGHLY 28 FEET Well type PRIVATE if A, B, or C provide PWSID# N A Date completed 9/29/1982 Sanitary seal (Y/N) YES Total depth 140 ft. Cased to *UNK ft, FROM WELL LOG Date of test 9/28/1982 Static water level 26 ft. Well production 2.5 — g -p.m - WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: NO ug./L. B. SEPTIC/HOLDING TANK DATA Nitrate 3.72 mg./L. Date of sample: 8 /6 /2015 TankType/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments 2 Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 8/5/2015 36.1 ft. 2.3 g.p.m. Collected by: GEG. Ltd. Date installed 9/24/1982 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 8/6/15 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed 8/24/1982 Soil rating.p.d. rfe/bdnn)1•0 System type DEEP TRENCH Length 63 ft. Width 2.16 ft. Gravel below pipe 5 ft. Total depth *8.4+ ft. Eff. absorption area 630 fe Monitoring tube YES Depression over field NO Date of adequacy test 8/5/2015 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 643 gal. New depth 2_5 in. Elapsed Time: 5 min. Final fluid depth a in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' E. SEPARATION DISTANCES Manhole/Access water alarm level Cycles tested Meets alarm & circuit requirements? 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 Sewer /septic service line 25'+ Animal containment areas 50'+ Public sewer manholetcleanout N/A Holding tank 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 N/A 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 N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineers Printed Name JEFFREY A. GARNESS Date � 4L —' (Rev. 11/05) L. 5` Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program s AF T Y. 4700 Elmore Street 1. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.. 020- OU-I;t COSA# vS(_.1 011 j Expiration Date: 1. GENERAL INFORMATION Complete legal, description Ujcx_b 2 Lt 4 Location (site address), Idol W i nA song, 06yer Anc6 c -g Ak Rq si 6 Current Property owner(s) Day phone Mailing .°address Lending agency Mailing address SAM Day phone Real Estate Agent 6,5� StAfl �0 n, Day phone �qo ZS60 Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: _9 3. TYPE OF WATER SUPPLY: Individual Well X Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site LQ Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 _S�c4A1gy► %n fyj Address 2u Wr 15}� Ave, 5i -c, aOa . Anck► aNy r AK 91 1 Engineer's Printed Name bus 5. DSD SIGNATURE __�Z Approved for bedrooms. Disapproved. Phone 171-31IG Date - T yoio c_,, 00, /! �n%LAIRS E!SPi1RKLA,'�,J." ZOO*" Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory v . IAlACTCIAJATCD - w � SG PROGRAM Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: r Original Certificate Date: J6-10 (Rev. 11105) Municipality of Anchorage • "'� Development Services Department z4 Building Safety Division " On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: PfAem,%G-ArN cZ o5l &,c,h ), LJ 4 Parcel ID: ©2-6 ` 4Z �,_k A. WELL DATA Well type -L-1 If A, B, or C provide PWSID # — Well Log (Y/N) Date completed H Z` 4�Z Sanitary seal (Y/N) �y Total depth L`it7 ft. Date of test Static water level Well production Cased to 30' ft. �Rcc,�Z FROM WELL LOG i„k `t 7.ti 1�1 2"5 WATER SAMPLE RESULTS: IY Wires properly protected (Y/N) Y Casing height (above ground) } in. AT INSPECTION _(� Zg Zv►c� oc t ft. g.p.m. 3,0 g.p.m. Coliform AJ mL Nitrate 4,`1mg/L Arsenic: ug/L date of sample: h ulZ(G U B. SEPTIC/HOLDING TANK DATA Tank Type/Material 3t.! Tank size iJ50 gal. Number of Compartments Other bacteria Ye colonies/100 mL Collected by: LAPN Jj2„,, � Date installed `.bg /1% 1 Cleanouts (Y/N) Foundation cleanout (Y/N) _Y Depression over tank (Y/N) _I High water alarm (Y/N) 1, Date of pumping ; : `I 2Cw Pumper _ !�+ 0"Me SY,v Un C. ABSORPTION FIELD DATA Date installed 9 Lti iygSoil ratingg.p.d./ft2 r ft2/bdrm) LID System typeDec,,, Tr ,_k Length 63 ft. Width Q ft. Gravel below pipe 5 ft. Total depth S5 ft. Eff. absorption area C�3iJ ft2 Monitoring tube Y Depression over field N Date of adequacy test1S wt0 Results (Pass/Fail) Ya5s For 1 bedrooms Fluid depth in absorption field before test 0 in. Water added GCO gal. New depth 5 in. Elapsed Time: S min. Final fluid depth 0 in. Absorption rate >= 0000 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) /1i'c) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off" level at in. High water alarmlevel at in. Datum Cycles teste Meets alarm & circ ' equirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot (00 + On adjacent lots (00%+ Absorption field on lot IODI+ On adjacent lots )c.>' + Public sewer mainT/A Public sewer manhole/cleanout IV JA Sewer /septic service line ZS I + Holding tank N%A Animal containment areas 501t Manure/animal excrete storage areas 140 t SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51 Of+ c,5, Property line IDS+ Absorption field Water main NLA Water service line 101+ Surface water 100 14 -Wells on adjacent lots 101D 14 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 1 d4 Water main IVIA Water Service line A0 t+ Surface water IW `4 Driveway, parking/vehicle storage )0 i + Curtain drain F. COMMENTS W t Wells on adjacent lots i OD��F G. ENGINEER'S CERTIFICATION 1 certify that l have determined through field inspections and review of Municipal records that the above systems are in ; q g THS f� conformance with MOA COSA guidelines in (Ieffect on this date. Engineer's Printed Name L 4 S lvla / URKLANQ, c� 1 50 ,v DateI� 7At0 I t �F� ?cel COSA Fee $ G Date of Payment Receipt Number :z 0 a (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Parcel I.D. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 020-042-72 1. GENERAL INFORMATION COSA #y1� 7 Expiration Date: ? — 1%n-7 Complete legal description Lot 4; Block 2; Ptarmigan Roost Subdivision Location (site address) 16101 Wind Song Dr. Anchorage. AK 99516 Current Property owner(s) Unda McEntire Mailing address Lending agency Mailing address Real Estate Agent Mailing Address same Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well (] Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone 345-6207 Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site (] Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 S d S Engineering Phone 694-2978 Address 15861 S. Birchwood Loop Rd. Chugiak, AK 99567 Engineer's Printed Name Robert A. sharer Date '1/310 / 5. DSD SIGNATURE rt 4 _(CI Approved for _ bedrooms. Disapproved.Srl"h�` Conditional approval for bedrooms, with the following stipulations: COSA Checklist X Arsenic Advisory Septic System Advisory Well Flow Advisory Nitrate Advisory By: (Rw }L05) Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date:t1 — 1-7-07 Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw, Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907) 343-7904 CERTIF11ICAT�E/ OF ON-SITE SYSTEMS A OVAL CHECKLIST Legal Description: L 'T "7 .2., /�Q� Parcel ID: 099 -Oq 2- A. A. WELLD I_ Well typed VK- I6 If A, B. or C provide PWSID # = Well Log©/ !) `TES Date completed 2oo9k `A Sanitary seal(BW) NE, Wires properly protectectON) _ ES Total depth LE ft. Cased to 30 ft. Casing height (above ground) /Z n+ in. FROM ELL LOG Date of test Static water level 026 ft. Well production 0?. -S g.p,m, WATER SAMPLE RESULTS: Col'rform cobnies/100 mL Nitrate 3 4 b mg/L Arsenic: _Q mgll Date of sample: 23 AT IN ECTION it B ft. 3.9 g.p.m. Other bacteria _Q colonies/100 mL Collected by: S9 -S 6W4/AtaSroVKXv B. SEPTICIHOLDING TANK DATA Tank Type/Material ��isil L6 L Date installed 2 z Tank size gal. Number of Compartments a Cleanouts�l) �M Foundation cleanou&) , E� Depression over tank ()(15h water alarm (Y q /yo i Date of pumping I t Pumper 5/if S v.2zp/lyg' C. ABSORPTION FI LD PATA Date installed �a Soil rating (g.p.d./ft= o 11/bd /50 System type iL --XXn Length (03 , ft. Width 0 6 tAXkWe,*- Gravel below pipe i Total depth ! ft. Eff. absorption area j 3D ft' Mon"F t g Depression over field Date of adequacy test Resu (Pas ail) For -� - bedrooms Fluid de in a u depth ' absorption field before test Q (n. Water added gal. New depth in. Elapsed Time: -0— min. Final fluid depth Q in. q Absorption rate >= �+ g.p.d. O Any rejuvenation treatment (past 12 mo.) (Y(9 type) n If yes, give date D. LIFT STATION Date Installed 'Pump on' level at _ in. Datum E. SEPARATION DISTANCES Size in gallons '.P a all at _ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: r Septic tankllift station on lot 100 � r Absorption field on lot /00 4 - Public sewer main A-) IN Sewer /septic service line c`2 -G f Animal containment areas '+ Manho181A-c—oess (Y/N) High water alarm level at in. Meets alarm d circuit requirements? On adjacent lots r On adjacent lots Public sewer manhole/cleanout Holding tank A.)1A Manure/animal excrete storage areas AZ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: I t I Building foundation 94- Property line S f Absorption field is f - r r Water main 4)k Water service line /D � Surface water 1406� I Wells on adjacent lots IM -r- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line �� t Building foundation Water main A-0 Water Service line 104- Surface water Driveway. parkingivehicle storage r Curtain drain It,' WE Wells on adjacent lots 16*0/ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined review of Municipal records the conformance with MOA COSY91 Engineer's Printe�,/ am Date 3 COSA Fee $ 4,20 Date of Payment Li l� �� Receipt Number '3 8 (Rev. 11105) h field inspections and above wsilems,-are in Waiver Fee $ Date of Payment Receipt Number I •, 9 4 t ' r i r� /ice 1Gil� ;tN�M1� GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS _= May 18, 2007 Gary Gagnon c/o Bob Stanton Prudential Vista 3801 Centerpoint Drive Anchorage, Ak 99503 Subject: Adequacy Test for Private Well & Septic System C Ptarmigan Roost Subdivsion Lot 4, Block 2, To whom it may concern: The subject lot has a 4 bedroom house on it which is served by a private well and septic system. As requested we performed adequacy tests on the well and septic system. The results of our field investigation and adequacy tests are summarized as follows: A. WELL: On the day of our test (5/18/2007) the static water level was 26 feet below the top of the casing (BTC). A total of six -hundred and fifty-nine (659) gallons were pumped from the well in 173 minutes, which caused the level in the casing to drop to 92 feet BTC (A total drop of 66 feet). Based upon this data it can be concluded that the well will continuously produce at least 3.24 gallons per minute and exceeds the Municipal requirements for a 4 bedroom house (0.42 gallons per minute). B. SEPTIC SYSTEM ADEQUACY TEST: The septic system consists of a 1250 gallon septic tank and a deep trench type drainfield that is a 2.5 feet wide, 64 feet long, and has an effective depth of 5 feet. It was installed on 9/24/1982. Prior to starting the adequacy test, the drainfield was dry. A total of 661 gallons of water was added to the drainfield, which caused a rise of 4 inches in the monitoring tube. The drainfield was checked approximately 13 minutes later and the drainfield was dry. Based upon this data, it was determined that the absorption rate of the trench exceeds 600 gallons per day, as required for a 4 bedroom house. If you have any questions, please contact us at 337-6179. P.E., M.S. 3701 E. Tudor Road, Suite 101 ' Anchorage, Alaska 99507-1259 Ph: (907) 337-6179' Fax: (907) 338-3246' Website: wwtiv. gamessengineering.com \ Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street ' ` T' P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.010 — OY'�- —7X COSA# Expiration Date: R oZ S- co 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owners) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Lot 4; Block 2; Ptarmigan Roost Subdivision 16101 Wind Song, Dr. Anchorage, AK 99516 Linda McEntire Day phone Day phone Day phone 345-6207 Unless otherwise requested, COSA will be held by DSD for pickup. 24W I, 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Individual On-site Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given In paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, I 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. NameofFirm S X S Engineering Phone _694-297a Address _17034 N. Eagle River Loon Ste. 204 Earle River, AK 99577 / Engineer's Printed Name f � 08 A 7- C. Co wg,✓ Date -/I;t 2/o C r ;c 1 ROBERT C. COWAN F� 5. DSD SIGNATURE X411 J%� CE.8G 1 r1. Approved for _q__ bedrooms. ltt _:C') ....... ......... I ,. Disapproved. Conditional approval for bedrooms, with the following stipulations: , Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: —lam( Original Certificate Date: �' D (Rev. 11105) Municipality of Anchorage .. • Development Services Department _ Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsde (907)343-7904 CERTIFICATE OF ON-SITE-S�Y"STEMS APPROVAL LLLDCHECKLIST Legal Description: Lcrrui PjLc> -Z; t-�+I t�Rti� r;oo�T ParcellD:d_-XQ-eC1-i2 A. WELL DATA Well typel Vfl iM If A, B, or C provide PWSID # = Weil Logg�Y J) � Date completed 5/f3Z Sanitary seal &)J 155 Wires properly protected) t viceaacrc Total depth r yo 1t. Cased to 3O' ft. Casing height (above ground) IZ F In, FROM WELL LOG AT INSPECTION Date of test 2 l 1041 Cr/ Static water level d26� Well production acs g.p.m. 3��1 g.p.m. WATER SAMPLE RESULTS: Coliform —!2—colonies/100 mL Nitrate 3e70mg/L Other bacteria 0 colonies/100 mL Arsenic: O mgrs Date of sample: 4900 Collected by: 4Sq_S 1�K7�1�71� (nr6 B. SEPTICIHOLDING TANCK' DATA Tank Type/Material �FFsil c- / STF� L Date installed Z Tank size ( 2c_�Ogal. Number of Compartments 2 Cleanoutsd5MH) S Foundation cleanout &N S Depression over tank (Y(M _LLO High water alarm (Yi j) fJ� Date of pumping 5 04 Pumper -'_T1Z 3 7:L>3 C. ABSORPTION FIELD DATA Date installed 1 Zri e2- Soil rating (g.p.d.W or /bdrm I System type bt6f' 77`O -r- 1f Length - 6 S_ ft. Width 2L11 iKtwA - Gravel below pipe 61 ft. 1 Total depth 1:? ft. EH. absorption area 6W f 2 Monitoring tube YA4 Depression over field -L29 Date of adequacy test II g 0 Results as ail) For �L bedrooms Fluid depth in absorption I I p ption field before test in. Water added 7� gal. New depth in. Elapsed Time: W min. Final fluid depth in. Absorption rate >= 6CO t g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N'8otype) k9 C> If yes, give date = D. LIFT STATION Date installed 'Pump on' level at _ in. E. SEPARATION DISTANCES Size in gallons anholelAccess (YIN) at _ in. High water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /CIO ri-- T Absorption field on lot Public sewer main A-) Sewer /septic service line 2S 1� Animal containment areas S0� On adjacent lots 1,90 �- On adjacent lots I oo /-k Public sewer manhole/cleanout Holding tank ANI 11) A Manure/animal excrete storage areas 100 1 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 / t Property line 9-!j- Absorption field 514 - Water main A) Water service line 10 -ft- Surface water Wells on adjacent lots IC SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main /J Water Service line I0 I� Surface water ICO /} Driveway, parking/vehicie storage /O I Curtain drain Ns'Vr� i *A) Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. 4 i aREeM► a =ccwAN 12 y� ♦ 4 Engineer's Printed Name I�.j s'E' , C. Giw9�✓ 6 lF•_. (t1i Date•7i.3',,:-` COSA Fee a `130. 00 Waiver Fee $ Date of Payment S 4 7 /0 6 Date of Payment Receipt Number o2l259 Receipt Number (Rev. 11/05) in. 9Q 0 _ 1 0 '4tgIN su 49 IH �� ....... U 0 7eWn'eiZh yer? ,DO'i LS -8202 +' I Ja Dp�p%' •......� ..•• ' „h�o I �OraelondI O , �G IR -2o; -2 o ; So i N �Q 9°� 0 °o ,�o •� ' N 30.0• 9 00, X95 7 / O BAIIRSNaIC 35.7 31.4 W / yrs. tl+Xu(4:•: 0.63. WE w000 ,r, t > ::...... ••••: 1lETApO wKI to IQ •:....:.: o; • b iQ • N ( .•�••• p InLtJ O I n 529 rOOY�^ I P� 2 a FL O^ ElnsTrTli . ••• ' SE v LOT 4 A'O0 20' UTILITY EASEMENT C) 0 i i ryp � i 30.0 I S 89'59.30" W 293.37' ' r LOT 5 t I EXCLUSION Il h the eenerl Twpone�Ally to dalermine LEC•ENO: SEI ENO ' onosnse en the eshlMce of eny eatemenla, covenants, or reatrklions S/elih w/CAene • 54* 118 Q A-1 N D A M c I N TI R E WhlcA do not oppear an the recorded Th"Mikm Plot. NOTE!' 123' At.YOm rtrnMNl iD ! Under no etramslonees should any data herein be used for. HLM a TACK U i I eons6vellon or Ex felobaro shinq property On". rEma_ K x _ 440 WEST BENSON BLVD. / 103 ANCHORACE, ALASKA 99503 "K ORDER NWRER: Mn• srxe. AUC. 7, 2001 1'.50• 2001—L482A'eAeezn °wwa^ Ow ' TAE KEN 3238 SURVEY CERTITICATION: LANTECN Not eendualed ° a�,riNO111111111111111113 - tpt phyeing nwve�r• el IAN property °a shown on het CDN�00PECKS- drawlnp and I' I the knprovemsnla situated IAae Cl»,t:KETE- an are within the yroperty. lines and no Merooch-]WATERIt- ITT) ASrNAtI- :.''�+�•• •• menta e.bt alhcr than noted. 1FAVEL- AS—E3UILT OF: tECALOESCIaPUON: s<p"csTAlrorrE.s- S-ENGINEERS 561-6628 7) 562-5291 LOT 4p BLOCK 2p 7)• .I KIAIaCR, 516/70&71 PTARMIGAN ROOST MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES i 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 l.D. # HAA# �Qc'1Ar"("9 � 1. GENERAL INFORMATION { Complete legal description �o'� `� �3K o2 !�7-o�P rkedJa h S Location (site address or directions) iso 64"s Property owner k*,ia a 9C EVIi K'9, Day phone 3W\- 6v20 7 Mailing address Lending agency Day phone Mailing add Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: V _�f 3. TYPE OF WATER SUPPLY: Individual well 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 t/ 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 921 5. ;.3 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 I O 138E _N1 -S('Q eV -L ,4rN D P eE Phone c172-39 I kh Address Engineer's signature DHHS SIGNATURE Approved for-u� bedrooms. Disapproved. Conditional approval for Additional Comments Date 10i1D��1Z bedrooms, with the following stipulations: By: f -�, Date 16--1& " � �— 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 421 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST It Legal Description: Parcel I.D. P.00S A. WELL DATA <D ,2-e 042.z — 7.L� Well type Z— If A, B, or C, attach ADEC letter. ADEC water system number NfiA Log present (Y/N) Date completed a�2ff1 �z Driller S �'/ R lR M Total depth 1 Cased to (3 a.) Casing height 00-0 Sanitary seal (Y/N) y Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION / Date of test 4/ % Zen` 9 Z � IPALITY OF ANCHORAGE Static water level o� 1n) C2 /p ENVIRONMENTAL SERVICES DIVISION Well flow o2 • S g.p.m. CQ, 39 Pa �. 1)9? Pump level`RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 110 ; On adjacent lots ! 5 D Absorption field on lot 3 g ; On adjacent lots 1� D Public sewer main Nlae Public sewer manhole/cleanout Sewer service line >/ Petroleum tank D WATER SAMPLE RESULTS: Coliform ��" / Nitrate Other bacteria Date of sample: r O 0 I qZ Collected by: _Q� I G V_1A B. SEPTIC/HOLDING TANK �D,,ATTAA g Date installed Q/aye —Tank size a Compartments Cleanouts (Y/N) Foundation cleanout (Y/N)_ Depression (Y/N) High water alarm (Y/N) �,/� Alarm tested (Y/N) Iq/ Date of pumping ) 1 l o� Pumper S�Uc C S SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 110 On adjacent lots > 1 15-0 Foundation Topropertyline 7c�-)Q Abbsorptionfield _2:5 Water main/service line Surface water/drainage N/ D ID W N1 72-026 (Rev. 7/91)Front CONTINUED ON BACK PAGE C. LIFT STATION 1\1 Date installed Size in gallons Vent(Y/N) High water alarm level — "Pump on" level at Meets MOA electrical codes (Y/N) —Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Surface water Date installed Soil rating 5D System type j ar=w4 Length 43 Width c; Gravel thickness Total depth 8 Total absorption area e0 30 Cleanouts present (Y/N) J% p Depression over field (Y/N) N Date of adequacy test T D` c8 ! Z Results (pass/fail) for V bedrooms Peroxide treatment (past 12 months) (Y/N) 1x 0 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot j b On adjacent lots 7 Property line To building foundation ad To existing or abandoned system on lot On adjacent lots > Cutbank �5© Water main/service line �.�2S Surface water N10 Driveway, parking/vehicle storage area So Curtain drain N Ib E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines iri effect on the date of this inspection. HAA Fee $ /70 Waiver Fee: $ Date of Payment ��-y 9� Date of Payment Receipt Number a ���� �� Receipt Number 7,;o L abed caeca 'AO8) azo -ZZ •snlels pue Aille6al ayI oI 6u!Is91le UOII13AJGSUOO leluawua!nu3 to Iuawliedaa alelS ayI woal uollewalluoo uall!ann aney Isnw 'walsAs Ilam Al!unwwoo ll :aloN Cl Nuel 6u!ploH ❑ Al!unwwoO ❑ o!ignd ial!s-u0 IVSOdSIa 3JVM3S 'ti •snlels pue Al!le6al yl oI 6u!Isalle uo!lenaasuo0 lelu8wuoJ!nu3 to Iuawliedaa alelS ayI wojl uollewalluoo ualllaM aney Isnw 'welsAs Mann Al!unwwoo ll :aloN ❑ ollgnd ❑ Al!unwwoO A IleM IEnp!n!puI AlddflS d31VM T swooapaq to aagwnN 4 Allwed-916ulS 30N3alS3d d0 3dA1 'Z U v :Mol q aagwnu ouoyd Aep pue uos.iad loeluoo ls!l (•dn Nold aol ploy l! away Noago ao) :ssajppe 6u!Mollol agl of VVH ayl H13N (a) auogdalal jw "' s 0 1 re lz ssaappv lua6V pue AuedwoO alels3 IeoH (p) ssaappV 6ull1eN auogdalal, uo!lnlllsul 6u!pual (o) 010,6 7 sel s A raNa �++ a OOP j 1 ssaappy 6ullleW IhC/ —ti 9�4£ — Z —Q ssau!sng �9O _ cfi (awoy) : auogdalaliV aauMo llaadoad (q) oSc]NI�+ �1 (suo!loaalp Jo ssaappe) uo!leool (abuea 'dlgsuMol 'uolloas 'uolslnlpgns 'Noolq 'lol apnloul) uolldlaosa4 1e691 (e) (lell!wgns of aoud palaldwoo aq IsnW) NOI1VWl30dNl lVa3N3J 'L -- #VVH�� — J #'4'IlaoJed JNIll3M4 AIINVd EMONIS HOd AllllOdd 831VM (INV 83M3S 311S -NO JO IVAOUddV A1IIJOH-LnV HllVEIH UO=l NOIlO3dSNl d0 31VOIJIIH30 bbL4-et?c S sa3imaS uewnH )g y1leaHNo Iuew O da(i . Yqpf' 3JVHOHONV d0 ).11lVdlOINnvi 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and' inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm / e56eti Jpur�GiatiGY �� i. Telephone o'1 ��l'3 9l6 Address go 3 LV /.S Date lWoer_ ,4,-7 � !`i ffz 6. DHHS APPROVAL Approved for y- bedrooms by Approved Disapproved Terms of Conditional Approval Engineer's Seal ��. o / . Date — Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 notconduct 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. 7/88) Back Page 2 of 2 GNG RII'RIPALITY OF ANCHORAGE (MOA) • Spw\st�ealth Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 M &FNM 343-4744 CNV' o spa I_o y i3kZ yv A. WELL DATA Legal Description: T Well Classification ES If A, B, C, D.E.C. Approved (Y/N) Wel=Depth—/ N) Date Completed �IZg�B 2 Yield 2 g TotCased to 30 Depth of Grouting Nome Static Water Level TD — Pump Set At Be, ^1 Casing Height Above Ground 30" Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) %� Depression Around Wellhead (Y/N) N SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot f>D To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line N/4%16 To Nearest Sewer Service Line on Lot Water Sample Collected by r. S Water Sample Test Results Comments B. SEPTIC/H6 TANK DATA 1 1D i On Adjoining Lots V *.e.a.k 4 On Adjoining Lots V6LC_aK4- To Nearest Public Sewer Cleanout/Manhole N/A 9"a Date 3IA71&1 Date Installed MU Size 1260 No. of Compartments l WO Standpipes (Y/N) it Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Depression over Tank (Y/N) N Date Last Pumped Pumping/Maintenance Contact on File (Y/N) NrA ; for Holding Tank High -Water Alarm (Y/N) M/A, Temporary Holding Tank Permit (Y/N) NSA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well 1OG f To Building Foundation 1 A To Property Line pt To Disposal Field To Water Main/Service Line iyw� .410 To Stream, Pond, Lake or Major Drainage Course 'q/A Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ISO Type of System Design =12 i NC. H Date Installed 1982, Length of Field & 3 Width of Field 30 Depth of Field % _ Gravel Bed Thickness Square Feet of Absortion Area 1630Statndpipes Present (Y/N) O NE _ Depression over Field (Y/N) IN Date of Last Adequacy Test 32718 9 _ Results of Last Adequacy Test 9S 7 ov 4/ �ed roovvt _ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well I to + To Property Line �D To Building Foundation go t To Existing or Abandoned System on Lot NSA ; On Adjoining Lots V1kC9X 1A 4 _ To Water Main/Service Line > A c To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course tyl4l To Driveway, Parking Area, or Vehicle Storage Area 6;p Comments D. LIFT STATION Date Installed . Size in Gallons N 0 ME - "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.. Signed 1C'" Company I el0 eK caA �,.lt �a C p Date 3LA? 8'9 d <';. Engineer's Seal MOA / .;a a .. iJo 7_225-E 1UNE 2S, 1971 Receipt No. Receipt No. Date of PaymentWaiver Fee: $ Amount: $ _ lDate of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 Time Time Time Time APPLI( -NT FILLS OUT UPPER HA, 1.3NLY Property -Owner , , r Phone Mailing Address /--'Y ;€fS/Jj:; Lt/(rF ;::��,-,.;;'lr�f� /..j., Zip Code`f�`-�rJ Date �;> Inspector Inspector Buyer Address �� Zip Code .. � JL Lending Institution fel a %%'f�,>%...f�7 _}rte%� ,51 -7 ;.Z.:C�k Phone /,� e.015011 Zip Code Field Notes '_ Address > c'1 + Realty Co. & Agent Phone f - - q) APPROVED BEDROOMS Address ( ) DISAPPROVED Zip Code ( ) CONDITIONAL APPROL' Legal Description , / /tel '' `-� ! �' r�F1U..3� ,✓ Street Location BY Type of Residence Date Sewer Installed Well To Absorption Area ��! Well Log Received /Y�`t'e-.�_-F K Single Family .i Well to Tank , ---`.� t Septic Tank Size. ❑ Multiple Family No. of Bedrooms f' ❑ Other Water Supply V5 Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal Individual _ - z. Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time �I Date Date Date Date Inspector Inspector Inspector Inspector �� .. � JL I c r� i N.7✓I Field Notes '_ 1 q) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROL' �- 5 DATE V BY Soils Rating Date Sewer Installed Well To Absorption Area ��! Well Log Received /Y�`t'e-.�_-F Well to Tank , ---`.� t Septic Tank Size.