HomeMy WebLinkAboutPTARMIGAN ROOST BLK 2 LT 6Ptarmigan
I oost
lock 2
Lot 6
020-042
-74
Municipality of Anchorage SUBMITTA'
On-Site Water and Wastewater Program • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT SEP 26 2017
Permit Number: OSP171255 PID Number: 020-042-74
Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade
Name:
WILSON JERRY STOUT ABSORPTION FIELD - EXISTING
Address ❑ Deep Trench ❑ Shallow Trench ® Bed ❑ Mound
16150 SANDPIPER DR., ANCH., AK 99516 ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
3 GPD/SF Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot Ft. Ft.
PTARMIGAN ROOST 2 6 Fill added above original grade Gravel length
Township Range Section Ft. Ft.
Gravel width Beds: Number of Lines Distance between lines
SEPARATION DISTANCES Ft. -- -- Ft.
To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches
From Tank Field Tank Line Ft2 -- -- Ft.
Well 100+ 100'+ NA NA 25'+ TANK El Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer Capacity
Surface Water 100'+ 100'+ NA NA Anchorage Tank 1000 Gal.
Material Number of compartments
Lot Line 5'+ 10'+ NA NA Steel 2
NA LIFT STATION
Foundation 5'+ 10'+ NA NA
Manufacturer Capacity
Gal.
Curtain Drain NA *501+ NA NA
Pump on level at Pump off level at High water alarm at
*None None known. Existing1000-gal S.T.
decommissioned and new 1000-gal septic in. in. in.
tank installed per code & insulated. Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank 3034 Tank to 3034
Installer A+ drainfield
Drainfield CO/MT 3034
Inspector ARCTERRA BENCH MARK (Assumed elevation) 100 ft
Inspection
ates: 1s'9/12/17 2"d 9/13/17 Location and description
3rd 4'h Bottom of Siding
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engin
..40 - I
.. ; UF' AL
Conditional Approval: Date j�Y��' `\y,
# --411101 •
KEN ! /
Approved ltni. Date C.27-� , �F° �� ,,1,51!, \,
eer's Stamp
Inspection Report_9-1-12.doc
AS—BUILT SYSTEM DETAILS/SITE PLAN Permit 05P171255
PTARMIGAN ROOST BLOCK 2, LOT 6 PID# 020-042-74
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�^ ® I,:"-;••o GAL. S. I...:, •. • ..�,E�PN,..
1 o :.,:::...;._: .---1-11, 40.8
1 I l .. J WELL I
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67.0 .. ,/n_
\ I 9 ,I 1001 WE1-tR?
. nr,, I ITII ITV CACCR A CMT I •� ---
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CO"
`I SCALE: 1' = 30'
J
m X99,29 98.7•
A-C=36,0'
B-C=21,5' o 11 P ,t
N
�A-D=38.0' _ - - --
0 B-D=25.5' D 1
VARIES
11
A OI
ATI
J N —Jl000 GAL ---•-- T
SEPTIC
, ,_ TANK EXISTING FIELD
E 95.21 95,04
i
U
_. `� T� I I SCALE: NTS
�� OFL'L•<Q PREPARED FOR! CTE
L Ar. . '_ . 1 WILS❑N JERRY STOUT ti �R Rii 1'6,
a '* 19TH 1, * i 16150 SANDPIPER DRIVE " ��
ANCHORAGE, AK 99516 ���
\ D S
_ a 7 0
/ HELD BOOKS COMPUTED: i
t I ' KENNE'T'H M. 1•)i 7 - c3 alx
o CE-7118_ ,�`z Ai BouNDARY:BOUNDARY DRAWN: BMW Z 4,0,%:,/
t STAKING: CHECKED: co • .-
1 �' • "Air
STAKING KMD _ a ` -. ^di •'lin
t �-/o�� / ASBui�r: FWW DATE 9/25/2017 `''~1�9-. ``+' ��
FESS: DWG. FILE: GRID: 3238 6, C•% \.N4 eon,
j \`_ ACAD FILE: aae No.: /fFRSLIT]NG , s
FILE 17203 AK. 99577'
c(-17.--11
MUNICIPALITY OF ANCHORAGE
On-Site Water&Wastewater Program
PO Box 196650 4700 Elmore Road V
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
http://www.muni.org/onsite
cpartmcut
�'YCHpP AC+E
On-Site Wastewater Disposal System Permit
Permit Number: OSP171255 Effective Date: 9/7/2017
Work Type: SepticTank Upgrade Expiration Date: 9/7/2018
Tax Code Number: 02004274000
Site Legal Address: PTARMIGAN ROOST BLK 2 LT 6 G:3238
Site Mailing Address: 16150 SANDPIPER DR, Anchorage
Owner: STOUT WILSON JERRY JR & Lot Size in Sq Ft: 38966
Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall be in accordance with: •
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: Continuance of waiver OSV111310 approved. 90.0 foot waiver applies to proposed septic
tank and existing 1979 well only. Any future upgrades to the on-site septic system on this lot will require all
separation distances be met or another approval from this department.
Received By: Date: 9 6 /7
Issued By: /� . et-era, Date: '.47:20/
MUNICIPALITY OF ANCHORAGE
Community Development Department y Phone: 907-343-7904
Development Services Division -- Fax: 907-343-7997
On-Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D.
020-042-74
WILSON STOUT & VALERIE YAWIT 240-2248
Property owner(s) Day phone
16150 SANDPIPER DRIVE. ANCHORAGE, AK 99516
Mailing address
Site address 16150 SANDPIPER DRIVE, ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot)
PTARMIGAN ROOST BLOCK 2. LOT 6
Legal description (Township. Range & Section)
Lot Size 38966 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(EJ all that apply)
Absorption Field n Initial I Single Family (SF)
(w/wo ADU)
Septic Tank > Upgrade Duplex (D)
Holding Tank Renewal I I
Multiple Dwellings
Privy (SF and/or D)
Private Well 7
Water Storage j
THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature o., •perty owner or authorized agent)
Permit/Rush Fees: 15 Waiver Fees:
Date of Payment: 2/36//e Date of Payment:
Receipt Number: Q313A Receipt Number:
Permit No. OSP/9-/A5-5 Waiver No.
Permit App_9-1-12.doc
Q+RcTe/i),xi
ARCT ERRA
• CONSULTING, INC
1 ,t „,-
..,....,, ,,%,
212 E. 51st Ave,Anchorage,AK.99503
,.. Office(907)868-3791,Fax(907)868-3793
`fq 'SGCnNG• 9L
4k.999'7'
August 29, 2017
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Septic Tank Upgrade Permit—Ptarmigan Roost B2, L6
The owner has requested we proceed forward to obtain a septic permit to
upgrade the existing septic tank. An existing well is within 90' of the existing
septic tank and we request continuance of waiver OSP111310 to maintain
elevations and separation to and from the absorption field. If it is possible to
move the new tank away from the well while maintaining proper elevations and
separation, it will be done.
We propose to decommission the existing 1000-gallon septic tank per code and
install a new 1000-gallon tank in the same location to serve the existing 3-
bedroom house.
The adjacent lots are served by private water. There is no surface water within
100' of the proposed tank. We do not expect there to be any adverse effect on
adjacent lots by the development of this tank. If you have any questions, please
contact me at 868-3791 / FAX 868-3793.
Respectfully submitted,
ArcTerra Consulting,Inc.
Br:; M. Western
0! ner's Representative
Attachments: On-Site Sewer Application
20441 PTARMIGAN BLVD • EAGLE RIVER,AK 99577-8736 • PH(907)868-3791 • FAX(907)868-3793
SE-5'9'59'30"W9'30"W 239.20' Lot 5
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99.
-�- 1".'. ') Grovel Drive ' e (4)24.0' , a v /
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re
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Lot 2 e •
New Well
e) 30'
N89'59'30"E 192 !
Ac., - ,,� Lot 7 i
* 491.y /;+ Vid) \ 1,
+a ;
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t ho, fs ire r- i
¢ '�� L.S-762: 4Sb 2017 SEPTIC TANK UPGRADE:
1111,°, ,6onal .y Decommission existing septic tank per
4 �;; `" code & install new 1000-gallon septic
S4 Ordered by tank and two post-tank cleanouts per
Bethany Mehr�er-Wesser
code, maintaining 5'+ from foundation &
Legal Description:
Asbuilt existing field,and 10' + from water line.
Lot 6, Block 2, ' MO CC.O
Group Ptarmigan Roost
Land Surve Certification: TO VERIFY SEPARATION
1�nc Survey Certification: 1 hereby certify that a t
Land Development Consultants Inspection was performed on the described 9 TO WELLS, PROPERTY LINE, ETC...
Subdivision Specialists Notes: It is the owner's responsibility to del
Construction Surveying existence of any easements, covenants, or
which are not on the recorded subdivision PRIOR TO CONSTRUCTION.
Tom H Greyer,P.LS_ osbuilt shall not be used for constructs
124 E 7th Avenue establishing property tines.
Anchorage,Alaska 99501 1 -- - --
[907]306-8104 Checked by. THD Drown by CB Scale 1" _ 20' G•-id 3738
--
Tom@S4AK.com Job 201 73 i Field Book. 108 l Plot 71-214 I Dote: 10/13/2011
•
MUNICIPALITY OF ANCHORAGE
e 7 t DEPARTMENT OF HEALTH& ENVIRONMENTAL PROTECTION
C1 ENVIRONMENTAL ENGINEERING DIVISION
825 L Street-Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE
i,NEW
Bob A. Dortch 349-3676 _ ❑UPGRADE
MAILING ADDRESS
SRA 474-N, Anchorage, Alaska 99502
LEGAL DESCRIPTION
Lot 6, Block 2, Ptarmigan Roost Subdivision _
LOCATION NO.OF BEDROOMS
Sandpiper Drive (Rabbit Creek Area 3
Well Absorption area Dwelling PERMIT NO.
vY DISTANCE TO: 100.5 3.7 9.5 790149
a2 Manufacturer Material No.of compartments
yF
Greer Tank Steel 2
Liq.capacity in gallons Inside length Width Liquid depth
1 ,000 IF HOMEMADE:
2 DISTANCE TO: Well Dwelling PERMIT NO.
J0Z
_�FQ- Manufacturer Material Liquid capacity in gallons
0 Well Foundation Nearest lot line PERMIT NO.. T—
w= DISTANCE TO: 1 1 1 21 .2 15.7 790143
J LL Z No.of lines Length?Lew])line Total length of lines Trench width Distance between lines
Ew 1 45.5 45.5 36 inches N,q
¢F Top of tile to finish grad Material beneath tile Total effective absorption area
o 4.5 Washed drain rock 60 inches 455 Sq. Ft.
Length Width Depth PERMIT NO.
tu
LI
•traQ f_- Type of crib Crib diameter Crib depth Total effective absorption area
wl:t.
y Well Building foundation Nearest lot line
DISTANCE TO:
J Class Depth Driller Distan to lot line PERMIT NO.
w Domestic . 320 M&W i0 79A143
Lj nISTANCE TO. Building fro#ndation Sewer line Septic tank Absorption area(s)
f� N.A. 100.5 111
2017 SEPTIC TANK UPGRADE: 0.4 10, A4
Decommission existing septic tank 0.4 ItIft
94 .11t.sip.o0
per code & install new 1000-gallo .
immiummummummom P. 0
tank maintaining 5'+ from b ; 4 i. �l� YwE� P>
�_ -6'z -,�
foundation /existing field & °."'-,,- `�
100' + from private water wells. - 4/3 ' \O
NI
NOTES
--__ (ti
1. No wells on adjoining lots are 9
within 100' of proposed tank •
placement. 4;,' •:-•
t
2. No surface water noted within 1 r,Y
100' of proposed tank placement. 151 I
L,bT L,Li.tE-
LEGAL
Lot 6, Block 2, Ptarmigan Roost Subdivision
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 PHONE J~ NEW
Bob A. Dortch 349-3676 []UPGRADE
MAILING ADDRESS
SRA 474-N, Anchorage, Alaska 99502
LEGAL DESCRIPTION
Lot 6, Block 2, Ptarmigan Roost Subdivi'sion
LOCATION NO. OF BEDROOMS
Sandpiper Drive (Rabbit Creek Area
Well Absorption area Dwelling PERMIT NO.
_Or DISTANCE TO: 100.5 3.7 9.5 790149
t- 2 Manufacturer Material No. of compartments
~ Greet Tank Steel 2
Liq. capacity in gallons Inside length Width Liquid depth
1 ~000 IF HOMEMADE:
6 v DISTANCE TO: Well Dwelling PERMIT NO.
O z ,~ Manufacturer Material Liquid capacity in gallons
D Well Foundation Nearest lot line PERMIT NO..
;~ DISTANCE TO: II1 21.2 15.7 79014q
No. of lines 1 Length ~ea~l· line Total length ~lin~s. Trench width Distance between lines
I-~ Top of tile to finish grad~ Material beneath tile 36 inches N.A.
Total effective absorption area
~ .5 Washed drain rock 60 inches 455 Sq. Ft.
Length Width Depth PERMIT NO.
< ~- Type of crib Crib diameter Crib depth Total effective absorption area
DJ Well Building foundation Nearest lot line
'~ DISTANCE TO:
.~ Class Depth Driller Distan~6o ]et line PERMIT NO.
~ Domes t i c 320 M&W 790149
~ DISTANCE TO: Building ~o~ndation Sewer line N.A. Septic tank lO0.~ Absorption area(s) 1]]
OTHER __4~ OF I,,~
P,PEcastMATER,ALS, ron .~.~"~"~"~1~ ';~] ~'~, .Oo
SOIL TEST RATING 9m
i00 Sq. Ft./B.R. ~'.....,~,......,
Bob Dortch (Owner) ,. '. ,, ........ ?'
REMARKS ........ . .
_."... CE-.469 5 ,". ~:~
House to tank, cast iron. -~_.m~.O.o..~ .,
Tank to drain field, cast iron. ~,~,~ ~
Drain Field, perforated plastic, '
Risers at tank. begJnnJna oF drain ft~_ld.
and end of drain field is P.V.C.
ASTM D 3034 with caps.
APPROVED DATE LEGAL
LOT
L~E
,~ ,¢'~Z~ Lot 6, Block Roost Subdivision
Ptarmigan
M-W DRILLING, INC.
.qlCIPALIT¥ OF ANCHORAGE
DEPT. OF /iZ)LTI-{ &
ENVIRONMENtAL P~OTECTION
AUG 7 1979
Well Owner Robert Dortch Use of Well
Location (address of: Township, Range, Section, if known; or distance main road
Lot 6 Block 2 Ptarmigan Roost Subdivision, Anchorage
Dom.
Size of casing Depth of Hole 320
20.4
feet Cased to feet
Static water level 10 ft. (a?~) (below) land surface. Finish of well (check one) open end ( xx );
Screen ( ); Perforated ( ).
Describe screen or perforation Iq/A
Well pumping test at ~, gallons per (h~gly~
of drawdown from static level.
(minute) for 1 hours with 100%
Date of completion 5/14/79
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
0 TO_ 2 Casing s tickup
2 TO. 4 Organics
4 TO 15 Silty boulders
15 TO 17 Damp gravel
17 TO 320 Bedrock: water seaps in sporadic fractures throughout
_TO
TO
.TO
TO.
TO
TO
TO
/
TO N~VA ~cr~fi~d
TO 'Ce:'hficate ~: '
ires, 814 & ~/3
TO
; RE(;.!U Z REL":, :~i; :[ ;;!:'.[!: Eft:: ]"HE %0 1 L. ?!E:'.:~;OF.:I:::'T ')' F N :~;'¢:STI:EH .1( S:
THE LENGTH I]:, :i: t"!ENE; I' Ot",! :t: E; THE: LEI'.4GTH ( .'t.' N FEET ::, OF THE 'FRENCH OR [)I:~:F[ ]: NFI ELI::,.
'!"H[.Z i}EF'TH OF !::1 TREI'.,!CH OR F'IT Z f!i; THE [)]r.:~:];"i"61I'.,IC:E 13E'!"HEEI'.,! THE '.:ii;i..ll::i:F:l:::lC[ii O1::: THE
i][F;:OI..Jf.,!D I:ii'.,![:, THE E~O]"TOH OF ]'HE E;:.:;C:F:P/Fi"['IOIq ,:: ZN FEIET).
TI".IiERE I::.i; F,IO ~.;ET Ni[:,TH FOI:~: TREi'.,ICHE:::~;.
THE (:~;F.':F:I',,,%L. [)I:EPTH I'.~; THE i',IZf.,!IHUi',I [:,EF:'TH O1::' [:'~RFI',/'EL 8ETklEE:]q "f'HE OLI'T'F'F:IL.L. I:::'ZF:'E
FIN[:, T!.IE. BOT"f'Cd"I OF THE E::.;',CF'I',,,'I::ITZ Olq ,:; ! N FEE'"!" ).
i:::'IEFi:M l T I::IF:'F'L I CF:Ii'.,IT HI-:I'.'E; THE P.':E':'~;F'ON:ii!;
i I'.,I'.:!;TI:;:it...LFFF ! ON I N:SPIECT Z Oi'.,!:::; OF 6tN'T' HEL. L.:E; F:I[:,J'I::iCEI",Ff' TO TH Z :;5 F:'I:;:OI::'ERT"r' FIt",![:' THE
i",IIJMli~;ER OF REE; i [:,ENr::E'E; THI:::F[' THE I.,.iI::::L.L
i"'i :[ hi I i"'ILIM [:, ;!: '.:i!;'I"FINCE !¢:!=E"FHEEN F:I t.,tEI....I.... F:! i'.,l l]) Flh!"r' Oh!""'~i; I "FE :E;[i::l.qF!(]iE D I ~;POSI::IL '.?'r'~i;'t"!EP1 I
::t..EII?.~ I::'EET FOR la I::'Ri',,,'F:Fi*[F. P.tF:::l...[...~ O.',:;;:
:LS(::'i TO ;2. EHi!:.I f::'EET F'i:;;:OI"! F:IPLI[~L. ZC I.,.![:i]_L. I')EF'Ei",I[)!NG UPCIN THE T?F'E OF: I:::'UE!~L. IC: HEL.L..
i,.IELI... LOGS !::IRE REt]:!U!RE[:, f:lN[:' MLI'.~i;T 8E RETI..I.f,i:NE[:, TO THE: [)EF:'i::IRTHENT H.'[THII",I
O!:::' THE HELl_ COHPLETZON.
OTHER RE:.,'.';!U ): REI"IEi",cF:!:!; Ml:l"r' I::IF'[::'L¥. '.:~;[":'[!:;C Z I:::'Z CI::ITI CtJ",!:i:~; R.i",IE." COf',E!i;Tt:;;:UCT]~ Oi",I [:' ]: i::IGRF:IMS F:IRE
~::1¥1:::t I L.FIE~!...E TO Z !'.,!~!;I...1[;;:[~ PROPER I' N::?FFI!...LFFI"I ON.
): CERT!F'"r' THt::IT
:L: ! F'I!'"! i::'F!i"!:[L. ZI:::IF.'. H!TH THE I':;:E(;R..III;~:EMEi'qT:~i; FOR ON'""E;!TI}.' :i~.';EHEF?.:~; Fllq[) !-,.II:ELL:E; F'l:~i; ~i:;Er'
::'ORTH E:'./ THE HUNZC
:2: I !.,.! Z LL Z N:i:';TI::iLL THE :~;"r'::ii;TEJ"t Z l",! I::ICCOR[)f::I?',!CE I.,.! ;[ TH 'TI"'IE; CO[:'E:~;.
3:: I UI',~I:)ER:'.:.;'f'F::Ii",I[:, THRT THE; C~::5.'!.:TE :E;EHER :R~'¢:5"f'fEM PtF:I"r' R[.'](i:d.J!RE ENLFIFd]iEP'II!ENT IF THE
;~:E:i!!; I [)E¢',!CE I :ii; REMCd:-:'EL~) TO/:[ i",!,C!..U[)[~: MOP::E "['HFIN ]: E~EDROO!"l:!ii;.
5 ]: G f',! 19.'!::'
BORING NUMBER TP-1 Date Completed: 5-3-79
SOIL DESCRIPTION
ORGANIC MATERIAL, OL
1'
SANDY GRAVEL W/SOME SILT, GM
GP~VEL, GW
8I
9.5'
SAND, SP
14'T.D.
LOCATION SKETCH No Scale
NOTE; DISTANCES SHOWN ARE APPROXIMATE AND HAVE
NOT BEEN MEASURED BY SURVEYING METHODS.
EXPLANATION
GROUND
ORGANIC MATERIAL
Little Visible Ice 0:10' Vx
~ A.B. ~/CE DESCRIPTION
(/,)Ss 72 57.1°/o 85.9pcf
! ~--DRY DENSITY
II-wArER co~rr£Nr
L ~- 8LOWS/FOOT
~D. WA?ER TABL~
~ROZ STRATA CHANGE ~
BEDEOCK
[--FROZEN GROUND W.D.-WHILEDRI£LING
TYPICAL SOILS LOG J, A.~.-AFTERBORING
Ss 14 "SPLIT SPOON WITH 140LB HAMMER
Sz 1.4" SPLIT SPOON W/TH 340 LB. HAMMER
Sh Zb" SPLIT SPOON WITH 340 LB. HAIdMER
§p 2.§" SPLIT SPOON, PUSHED
A AUGER SAMPLE
Ts SHELBY TUBE
Tm MODIFIED SHELBY TUBE
Bs BULK SAMPLE
SAMPLER TYPE SYMBOLS J
SOIL
ORGANIC ~
MATERIAL GRAVEL
~ ~ COBBLES&
CLAY BOULDERS
~ SILT ~ BEDROCK
~ SAND I lC.E, MASSIVE
SYMBOLS
I DWN. E.R.R.
CKD.
0ATE. 5-3-79
N SULTANTS~ INC./1
Lot 6, Block 2 ] fF'B'
Ptarmigan Roost S%lbdivisi°nl/
Anchorage, Alaska ~ J PROJ. N0.
4 E TB
Municipality. of Anchorage 1.0
. r Vii" `ja _;�-u 2
On -Site Water and Wastewater Program < r
(907) 343-7904 5
CERTIFICATE OF ON-S.ITE SYSTEMS APPROVAL
Parcel I.D. 020-042-74 Expiration Date: 3
1. GENERAL INFORMATION
Complete legal description Ptarmigan Roost.Block 2 Lot 6
Location (site address) 16150 Sandpiper Dr. Anchorage, AK.
Current Property owner(s) Kelle Stinson Day phone
Mailing address 16150 Sandpiper Dr. Anchorage, AK
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:
3
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY:
Individual
Individual Well
®
Holding Tank
❑
Individual Water Storage
❑
Community
❑
Community Class _ Well
❑
Public Sewer
❑
Public Water System
❑
WaiverNariance request for:
Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 9 I2 .,rd CC) V D Waiver Fee $
Date of Payment �� Z O Date of Payment
Receipt Number Receipt Number
COSA # OS G Z() 166 Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified. by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ARCTERRA CONSULTING, INC. Phone 696-6111
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date
Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition
of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface
conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. The operational lifeofall well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future +�. �• \ \
occupants or can ArcTerra guarantee that no unseen OF .,4z
encroachments, deficiencies or discrepancies exist. -q y
1 it n TT4
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms.
System #2 Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
�1) O
.. _ N -SI
"--(D "" Q:R A1vD m
J
JJJ
GAA/L4 moo;
By: inn Original Certificate Date:) Z -'1 "-Z Q
The Municipality of Anchorage Development Services Division (DSD). issues Certificates of On -Site. Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
COSA blue sheet 10.10-12.doc
Nitrate Advisory
Arsenic Advisory
Other
Legal Description: Ptarmigan Roost Block 2 Lot 6 Parcel ID: 020-042-74
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
Well log is filed with Onsite (or attached)
Well production at time of test 2.1 gpm
Date drilled. 11/4/88
Water storage tank volume gallons,
Total depth 290 ft
Well disinfected for coliform test? ❑ Yes M No
Cased to 17 ft
Coliform bacteria is Negative
IN Sanitary seal is functioning correctly
Nitrate 2.19 mg/L ❑ Nitrate less than MRL (ND)
Wires are properly protected
Arsenic ug/L Ki Arsenic less than MRL (ND)
Casing height (above ground) 30 in.
- Collected by Arcterra Consulting
Date of flow test for COSA 11/4/20
Date of Sample 11/17/20
Static water level at beginning of test 30 ft.
Comments South well tested.
B. TANK DATA
Age of tank(s) 3 years
Tank type/material Septic/Steel
Measured operating fluid level in septic tank 49"
Standpipes/foundation cleanout per record drawing
Date of pumping 11/5/20
D. ABSORPTION FIELD DATA
Which system tested (date installed) 8/7/79
ALL standpipes present per record drawing
Total measured depth from grade 8 ft (max)
Measured depth to pipe invert from grade 3 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective=
Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Com ments/Deficiencies: ._.
COSA Checklist yellow sheet
STATION
❑
Req ul aint(
Age of lift station
Lift station material
Comments:
completed
Adequacy test date 11/4/20
Results ❑✓ Pass For 3 bedrooms
Fluid depth prior to test 0 in
Water added 450 gal
New depth 0 in
Elapsed time 10 min
Final fluid depth 0 in
Absorption rate 450+ gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
® Yes
if No
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
x ft
® Yes
if No
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment >_ 50' ® Yes
if No
® Yes
if No
ft:
ft
If septic tank is under driveway comment below
i
From Absorption Field on Lot to: (Please enter distances
if
less than required)
Manure/Animal Excreta Storage > 100'
Building Foundation > 10'
Community Sewer Main > 75' ® Yes
if No
ft
0 Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
ft
ft
ft.
ft
ft
Building Foundations > 10'
® Yes
if No
ft
Surface Water > 100'
® Yes if No ft
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Yes
if No
ft
Private Wells > 100'
® Yes if No ft
Water Main > 10'
® Yes
if No
ft
Community Wells > 200'
® Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
If septic tank is under driveway comment below
i
From Absorption Field on Lot to: (Please enter distances
if
less than required)
Building Foundation > 10'
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
ft
Wells. on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100'
® Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200'
® Yes if No ft
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
x1979 well decommissioned according to last COSA.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
•
• �E &
• Municipality of Anchorage •
On-Site Water and Wastewater Program a w
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 020-042-74 Expiration Date: [-2_---;0-1 7
1. GENERAL INFORMATION
Complete legal description PTARMIGAN ROOST BLOCK 2, LOT 6
Location (site address) 16150 SANDPIPER DRIVE,ANCHORAGE,AK 99516
Current Property owner(s) WILSON STOUT&VALERIE YAWIT Day phone
Mailing address 16150 SANDPIPER DRIVE,ANCHORAGE, AK 99516
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: 3
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY: Individual
Individual Well ® Holding Tank ❑
Individual Water Storage ❑ Community ❑
Community Class Well ❑ Public Sewer ❑
Public Water System ❑
WaiverNariance request for: . Distance:
Received by: Date: . �f/7
COSA to be released ngineer, unless otherwise requested by the engineer.
COSA Fee $ 5744, Waiver Fee $
Date of Payment I l,g6ll Date of Payment
Receipt Number 644p536 Receipt Number
COSA# 05C-f"?-1 Lig-0 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 9/22/2017
THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED
WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with
ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested.
The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use,
local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the
system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function
satisfactory for current or future occupants or can ArcTerra guarantee that no unseen ��•4
encroachments,deficiencies or discrepancies exist. SLR
s y
/ '14* Ti_i
6. DSD SIGNATURE -MOW
;mow/
System#1 Approved for :3 bedrooms. + mfr
r� KEAnEfH h1. D 4f■ta�rri �
/
System #2 Approved for bedrooms. + ' 711G"5, w/
Disapproved. i NhEssiO*
Conditional approval for bedrooms, with the following sti
71;P. ON-S1TE m
WATER AND
WASTEWATER o;
PROGRAM Jam'.
1.
47
€NT SER'J'9
By: r L.*�— ( G ,� Original Certificate Date: -/7
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet10.10-12.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 6 Parcel ID: 020-042-74
A. WELL DATA
Well type PRVT If A, B, or C provide PWSID # Well Log (Y/N) Y
Date completed 11)411988 Sanitary seal (YIN)Y Wires properly protected (Y/N) Y
Total depth 290 ft. Cased to 17 ft. (INTO BEDROCK) Casing height (above ground) 24 in.
FROM WELL LOG AT INSPECTION
Date of test 1114/1988 _ 8/16)2017
Static water level 11 ft. 11 ft.
Well production 3 g.p.m. 1.57 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 2 - 7 `mg/L
Arsenic: ND ug/L Date of sample: 9/14/2017 Collected by: ARCTERRA
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC 1 STEEL Date installed 9112/2017
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping NA-NEW TANK Pumper
C. ABSORPTION FIELD DATA —MT EXTENDS 3.1' BELOW INVERT
Date installed 817/1979 Soil rating (g.p.d./ft2 or ft2/bdrm) 100 System type DEEP TRENCH
Length 45.5 ft. Width _3 _ ft. Gravel below pipe 5 ft.
Total depth 8 ft. (Measured 8/16/17) Eff. absorption area 455 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 8116/17 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 1 in. (OR 36"BELOW INV.)
Elapsed Time: 5 min. Final fluid depth _0 in. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N &type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum _ _ Cycles tested _ Meets alarm &circuit requirements?
E. SEPARATION DISTANCES
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 100'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
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'+
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 50'+(NONE KNOWN) Wells on adjacent lots 100'+
F. COMMENTS
1979 WELL DECOMMISSIONED
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date. ) OF A 1 ` ,
Engineer's Printed Name KENNETH M.DUFFUS /A„�" 1-
Date 9122/2017 _ .•
COSA canary sheet_2-6-15.doc
` � KEtil ETH M. DI; Air
7116
Legal Address:
•
SubdivisionZ ./3,97/0,s". Block Lot -41
T R Section Lot
On-site Water&Wastewater Program certified contractor performing the well decommissioning:
Name: ,y4 e 147•'
-�" 7 r S-g
nature: '
Company:
•
Well decommissioning date Method of decommissioning: AMC 15.55.060L1 a. n b. ❑ C.
Location:Use the space below to provide a drawing of the property showing the following items;
• North arrow 111
• Decommissioned well,
• Other water wells on the property,
• Two separate swing-tie distances for each well shown on the drawing,
Note:The swing-tie distances shall be measured from either permanent structures or the property corners. /1
•
G\Community Development\Development ServiceslBuilding Safety\On Site Water and Wastewater\Forms1Client Forms\Well Decommisioning form.doc
Frontier Surveys, LLC Project No: 17-262 Date: September 15th, 2017
NORTH
Scale 1"=40' Ordered By: Morgan Michelsohn PIat:71-214 Grid:N/A
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i•,I Electric Meter/Outside Power --0- Fence •
Gas Meter E2 Deck 020 40 80
S Septic , Water Well ��� Feet
General Notes:
1.This document is created for the purpose of a single property transaction and is subject to Federal Copyright Law.
2.Excepting for gross negligence,the liability for this survey shall not exceed the cost of preparing this survey.
3.All measurements/setbacks are to the visual/apparent building footprint.
4.Dimensions to property lines are plus/minus 0.lft.
'Ilk
11101 *tiThis survey complies with ASPLS Mortgage Location Standards.The survey represents visible improvements and
AQ conditions at the time of the survey.This document does not constitute a boundary survey and is subject to any
,( ••....... ;4 inaccuracies that a subsequent boundary survey may reveal.It is the responsibility of the Owner to determine
r iAP `•,N••• •.V ♦ the existence of any easements,covenants,or restrictions which do not appear on the record plat.Under no
0., . •. • circumstances should this document be used for construction or for establishing a boundary or fence line.
n
4 7T H f' •
•• • As-Built Survey of:
�r .-7 0 Lot 6 Block 2, Ptarmigan Roost
t :•FREDERIC . AGNER•: / I,Frederic Wagner,hereby certify that this Mortgage Inspection Survey was performed by me,or
• LS 46 •• under my direct supervision on September 15th,2017.
i0A ,••.`)!L 117•.• •
�)4�, 0. 4 Frontier Surveys, LLC FRONTIER
>t*� t,��IP 650 W. 58th Ave.Suite E Anchorage,Alaska 99518 IL Surv- _ .
907.460.1686-info@frontiersurveys.com "ii: • .
PROFESSIONAL SEAL www.frontiersurveys.com
Municipality of AnChorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Etmore Road
P,O, Box .196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020-042-74
1. GENERAL INFORMATION
COSA#
Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
PTARMIGAN ROOST; BLOCK 2, LOT 6
16150 SAND PIPER DRIVE *ANCHORAGE, AK 99516
GEORGE (HANK) WILLIAMS Day phone .345-6551
16150 SAND PIPER BRIVE *ANCHORAGE, AK 99516
Day phone
BONNIE MEHNER W/ PRUDENTIAL
Day phone
.3801 CENTERPOINT DRIVE *ANCHORAGE, AK 9950.3
223-0005
Unless other~Vise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well · Individual On-site ·
Individual Water Storage [] Individual Holding tank []
Community Class Well [] Community On-site []
Public Water System [] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
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 appfication,
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 ~rom ,,my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with afl applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 357-6179
AddreSs 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Date
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal fight whatsoever.
DSD SIGNATURE
~"'"" Approved for 3
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
~. ON-SffE .
~: WATER AND
'-'"' ~, WASTEWATER '
'~ '. PROGRAM .'.
...'
Attachments:
COSA Checklist
Septic System Advisow
Well Flow Advisory
Nitrate Advisory
(Rev. 11/05)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
u[ner
Original Certificate Date: ,,/0 - ,.~ ~:7"//
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: PTARMIGAN ROOST; BLOCK 2, LOT 6 Parcel ID: 020-042-74
A. WELL DATA 11/4/88 WELL CURRENTLY SERVES THE HOME.
Well type PRIVATE-PRIVATE
5/14/79/ &
Date completed
Total depth 320/290ft.
IfA, B, orC provide PWSID# N/A
11/ /8..8
~am[ary seal (Y/N)YES/YES
Cased to20.4/17 ft.
BOTH WELLS CASED TO BEDROCK
FROM WELL LOG
5/14/79 & 11/4/88
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0
Arsenic:0.15 & 0.171 ug./L.
10& 11 ft.
3 & .3 g.p.m.
19 7~'1988
__ colonies/100 mi.
Nitrate 0.1/4.7 mg./L.
Date of sample: 10/6/11
Well Log (Y/N) YES/YES
Wires properly protected (Y/N) YES/YES
Casing height (above ground) 1 ,2+/12+in.
AT INSPECTION
*'10/6/11 "] TESTED
SOUTH
*'17 ft' WELL
**4.8 g.p.m.
**TESTED BY AAROW PUMP & WELL
Collected by: AAROW PUMP & WELL
& lO/6/11
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 1000 gal. Number of Compartments 2
Foundation cleanout (Y/N) YES Depression over tank (Y/N) __
Date of pumping 9/16/11 Pumper DENALI
Date installed 8/7/79
Cleanouts (Y/N) YES
NO High water alarm (Y/N) N/A
PUMPING
ABSORPTION FIELD DATA
Date installed 8/7/79
Length 45.5 ft.
Total depth *9.0 .ff.
I'BELOW EXISTING GRADEI
Soil rating (g.p.d./ft2or~ 100
Width 5 ft.
System type TRENCH
Gravel below pipe 5 ft.
Eft. absorption area 455 ft2 Monitoring tube**YES Depression over field NO
9/21/1 1 PASS For 5 bedrooms
Date of adequacy test
Results (Pass/Fail) __
Fluid depth in absorption field before test 0 in. Water added 450 gal, Newdepth 4 in.
Elapsed Time: 12,3.5 min. Final fluid depth 0 in. Absorption rate >-- 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date -
**SUMP EXTENDS ONLY ,3,25' BELOW INVERT.
D. LIFT STATION
Date installed
"Pump on" level at
in.
Size in gallons
Manhole/Access ~ ---------------
"Pump off" leveljt.-~. High water alarm level at
Cycles tested Meets alarm & cimuit requirements?
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
N,/A
100'+
*'90'
Septic tank/lift station on lot
Absorption field on lot 100'+
Public sewer main N/A
Sewer/septic service line 25'+
Animal containment areas 50'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Absorption field
Surface water
Building foundation 5' + Property line 5'+
Water main N/A Water service line. '10'+
Wells on adjacent lots 100'+
5'+
100'+
Water main N/A
Driveway, parking/vehicle storage 10'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10%
Water service line * 10'+
Curtain drain NONE KNOWN
COMMENTS
Building foundation 10'+
Surface water 100'+
Wells on adjacent lots 100'+
*ASSUMED **SEE ATTACHED WAIVER REQUEST
in.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Pdnted Name JEFFREY A. GARNESS
Date
COSA Fee $ ~
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
P.O. Box 196650 ® 4700 Elmore Road
Anchora.qe, Alaska 99519-6650 · (907) 343-7904 · Fax (907) 343-7997
.http:llwww. muni.omlOnsite
Development Services Department
On-Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
WR#: OSPl11310 HA#: OSCl11417 Permit:
PID#: 020-042-74
Legal Description: Ptarmi.qan Roost, Block 2, Lot 6
Engineer: GEG
Applicant: ,George Williams
yOur request for a waiver of the required 100 feet horizontal separation from the septic tank to
the private well has been approved. The approved separation distance is 90.0 feet.
This waiver approval applies to the existing septic tank to private well separation only. Any
future upgrade to the on-site wastewater disposal system will require all separation distances be
met or another approval from this department.
Waiver is Granted: X Waiver is not Grar)~ed:
Date: 10/~2_6/_1.1 ApProved b~.
/~j~ Name of Reviewer
Rec/¢: 05141G Amount: $1,050.00 Date Paid: 10124111
**** VARIANCE/WAIVER REVIEW ****
Lot
L~
CD
Lo~ 2
31.2'-
24.0'
S89'59'50"W
259.20'
Lot 5
N89'59'30"E
Lot 6
Old Well ~'t
~.®
Y New Well
192 77'/~(
Lot
7
30'
Ordered b~.
Bethany Mehner-Wesser
Description:
Asbui]t
Lot 6, Block 2,
Ptarmigan Roost
Survey Certification: I hereby certify that o Mortgegee's
Inspection was performed on the described property~
Notes: It is the owner's responsibility to determine the
existence of any easements, covenants, or restriction
which are not on the recorded subdivision plot. This
esbuilt shell not be used for construction or for
establishing property lines.
Found Rebor
Monument
Well
Septic
Pavement
Overhang
Wood Deck
Concrete
Fence
Checked by: THD Drawn b~. CB
Scale 1" = ~'~'0 Grid
3238
Job 2011-7,3 Field Book: 108 Plat 71-214 Dote: 10/1.3/2011
GARNESS ENGINEERING GROUE Ltd.
CONSULTANTS & GENERAL CONTRACTORS
October 20, 2011
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Waiver Request for Well on Ptarmigan Roost; Block 2, Lot 6 to septic tank on the property
The existing 3 bedroom house is served by two (2) private wells and a septic system. We request
you grant a 90 foot separation distance waiver from the well (drilled in 1979) on the referenced
property to its septic tank. The following items are justification for the waiver:
· The septic tank is downhill from the well and if the septic system was to overflow, effluent will not
travel toward the well head.
· The location of the septic system is in a very visible area so that if any effluent was to surface, it
would be noticed and the problem corrected.
· Recent water sample results indicated non detectable nitrate levels, and no coliform bacteria. Based
upon this water quality data, it appears the encroachment, which has existed for over 32 years, has
had no significant adverse impact on the groundwater quality.
Based upon the aforementioned facts, it appears that there is minimal risk associated with granting the
requested 90 foot separation distance waiver.
If. you.__ ,.have~nyqtdesti°ns'..~ ~ please contact us at 337-6179. Thank you for your assistance.
~'~incerely,/ W'
.J. effreyA, qarness. P.E.. M.S.
President
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: garnessengineering.com
t
22 11 10:36a Dad 3388078
Aarow Pump & Well Service, LLc
P.o. BOx 110496
Anchorage, AK 99511
office: (907) 346-9355 · F~x (907) 333-8976
Eagle River: (907)622-9335
6U~TOMER ~OB SITE
QUANTITY DESCRIPTION PRICE AMOUNT
LABOR HOURS RATE AMOUNT TOTAL MATERIAL
TOTAL LABOR
WORK ORDERED BY DATE COMP TOTAL
LABOR
PAY THIS AMOUNT
Thank You
SIGNATURE
(I Hereby' Acknowledge the Satisfactory Completion oJ the Above Described Work and agree that if above work is not paid for in 9.3 days I agree to arlow Aarow
Pump & Well Service, L.L.C. the right to remove unpaid for equipment and charge for labor aJrea, dy performed & labor to remove unpaid for equipment}
TERMS: ACCOUNTS PAYABLE AT lOTH OF MONTH FOLLOWING PURCHASE.
SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILl. BE CHARGED ON OVERDUE ACCOUNTS.
~M-W DRILLING,
INC.
.qICIPALITt' OF ANCHORAGE
DEPT. OF ]L~ALTI-~ &
[NVIRONMENI AL PROTECTION
AUg '7 ~979
,:,,,,.,.,.o R [ C [1 V [ D
Well Owner Robert Dortch
.Use of Well Dom.
Location (address of: Township, Range, Section, if known; or d/stance main road
Lot 6 Block 2 Ptarmigan Roost Subdivision, Anchorage
ft
Size of casing Depth of Hole 3 2 0
Static water level_l~__
Screen ( );
Describe screen or perforation -N/A
Well pumping test at ~--gallons per of drawdown from static level.
20.4
feet Cased ~o_ _feet
--ft. (a:~) (below) land surface. Finish of well (cheek one)
Perforated ( ).
open end ( xx
(minute) for t hours witk 100%
Date of completior~ 5/14/79
);
Depth in feet from
WELL LOG
ground surface
Give details of formations penetrated, size of material, color and hardness
0 2
-__TO
2 _TO. 4
4 TO_ 15
15 TO_.. 17
.... 13 .... TO. - 320
___.TO_
___TO
-- .TO
..TO
_TO..,
_TO_
___TO_
.TO
-___TO
- TO
Casing stickup
Organics
Silty boulders
Damp gravel
Bedrock: water seaps in sporadic fractures througho~t
ANAIXTICA
GROUP
_~arow Pump & Well Service I ,
Attn: John Netherton
PO Box 110496
Anchorage, AK 99511
907-230-1868
Fax: 907-333-8976
Client Sample ID: fi6150 Sandpiper Dr.
Sampling Locatio~ North Side Well
Client Project: k 16150 Sandpiper Drive.
Sample Matrix: ~'xDrinking Water
COC #: ~'~
PWS#:
Residual Chlorine:
Comments:
Lab#: Al 110169-01A
Analytica Anchorage
4307 Arctic Boulevard
Anchorage, AK 99503
Phone: 907-258-2155
Fax: 907-258-6634
Report Date: 10/20/2011
Receipt Date: 10/6/2011
Sample Date: 10/6/2011
Sample Time: 12:20:00PM
Collected By: Unknown
Flag Definitions:
MRL = Method Reporting Limit
MCL = Maximum Contaminant Limit
B = Present also in Method Blank
H = Exceeds Regulatory Limit
M = Matrix Interference
J = Estimated Value
D = Lost to Dilution
** = RL higher than MCL; target not detected
TNC = Too Numerous to Count - result rejected
CF = Confluent Growth - result rejected
TCNG = Turbid Culture No Growth - rejected
Analysis Method
Parameter Result Units
Flags MRL
Prep Prep Analysis
MCL Method Date Date Analyst
200.8/200.8 (Aqueous) - Family Well Water I
Arsenic <MRL ug/L
Lab#: Al 110169-01B
0.15
Test was conducted by: Analytica - Thornton
10 200.8 10/18/201110/18/2011RM
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
4500-NO3E (Aqueous) - Nitrate+Nitrite pres Test was conducted by: Analytica - Anchorage
Nitrate-Nitrite as Nitrogen <MRL mg/l~ 0.10 10 10/17/201110/17/2011MC
Lab#: A1110169-01C
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
9223B-PA (Aqueous) - Coliforms in DW
15;. Coli Pass
Total Coliform Pass
Test was conducted by: Analytica - Anchorage
PASS/FAIL 1.0 1 10/6/2011 10/6/2011 KM
PASS/FAIL 1.0 I 10/6/2011 10/6/2011 KM
Page 3 of 4
M-W DRILLING, Inc.
P.O. Box 110378 · 10330 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
88-167
DRILLING LOG
WeLt Owner ~ob Do.cch Use of We]]
Location (address of: Township, Range, Section, if known; or distance main road Lot 6, Block 2 Ptarmigan
Domestic
Size of casing, 6"
Static water level
Screen (
_Depth of Hole 290' feet Cased to 17' feet
11 ft. ~) ibelow) land surface. Finish of well (check one)
); Perforated ( ).
open end ( X );
Describe screen or perforation ~
Well pumping test a~gall0ns per of drawdown from static level.
Date of completion November ~, 1955.
(minute) for hours with
ft~
Depth in feet from
ground surface
0 _TO. 2
2 .TO. 4.5
4.5TO' 17
17 TO 290
WELL LOG
Give details of formations penetrated, size of material, color and hardness
Casing s tickup
.Organics
Gravel ~¥' till
BedrOck
GO¥ -
TO
TO.
TO.
.TO.
.TO
.TO __
TO .
__.TO
.TO
I - CUSTOMER
ANALYTICA
GROt. P
~arow Pump & Well Service ] Attn: John Netherton
PO Box 110496
Anchorage, AK 99511
907-230-1868
Fax: 907-333-8976
Client Sample ID: ,lt'~ 50 Sandpiper Dr.
Sampling Locatio0: South Side Well kwJ~-
Client Project: ~16150 Sandpiper Drive.
Sample Matrix: '~qT)rinking Water
COC # --~,.-
PWS#: .... ~ ........
Residual Chlorine:
Comments:
Analytica Anchorage
4307 Arctic Boulevard
Anchorage, AK 99503
Phone: 907-258-2155
Fax: 907-258-6634
Report Date: 10/20/2011
Receipt Date: 10/6/2011
Sample Date: 10/6/2011
Sample Time: 12:15:00PM
Collected By: Unknown
Flag Definitions:
MRL = Method Reporting Limit
MCL = Maximum Contaminant Limit
B = Present also in Method Blank
H = Exceeds Regulatory Limit
M = Matrix Interference
J = Estimated Value
D = Lost to Dilution
** = RL higher than MCL; target not detected
TNC = Too Numerous to Count - result rejected
CF = Confluent Growth - result rejected
TCNG = Turbid Culture No Growth - rejected
Lab#: Al 110169-02A
Analysis Method
Parameter Result Units Flags
MRL
Prep Prep Analysis
MCL Method Date Date Analyst
200.8/200.8 (Aqueous) - Family Well Water I
Arsenic 0.171 ug/L
Lab#: A1110169-02B
0.15
Test was conducted by: Analytica - Thornton
10 200.8 10/18/201110/18/2011RM
Analysis Method
Parameter Result Units
Flags
MRL
Prep Prep Analysis
MCL Method Date Date Analyst
4500-NO3E (Aqueous) -Nitrate+Nitrite pres
Nitrate-Nitrite as Nitrogen 4.70 mg/L
Lab#: Al 110169-02C
2.5
Test was conducted by: Analytica - Anchorage
10 10/17/2011 I0/17/2011MC
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
9223B-PA (Aqueous) - Coliforms in DW
E. Coli Pass
Total Coliform Pass
Test was conducted by: Analytica - Anchorage
PASS/FAIL 1.0 I 10/6/2011 10/6/2011 KM
PASS/FAIL 1.0 I 10/6/2011 10/6/2011 KM
Page 4 of 4
Permit
#790149
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Lot 6, Block 2, Ptarmigan Roost Subdivision, located in NW¼, Sec. 2, TllN, R3W, S.M.
Location (address or directions) -..."
16150 Sandpiper, Anchorage, Alaska 995.:16
(b) Property owner Bob & Marian D0rtch Telephone.: (home)
Mailing Address 16150 Sandpiper.~ 'Anchorage, Alaska ' 99516
(c) Lending Institution Commonwealth Mbr. t~a~e ' Telephone
· ,. ;'.';.,~i~i ,~ .', ~"
Mailing Address 3333 Denali, Suite 1]~0'i't'~-~:~-~6ra8e, Alaska 99503
(d) Real Estate Company and Agent Co[dwe[[ Bad,er-Area-Martell ?eppers
Address 4105 Tudor Centre Driv% Anchorade~ Alaska 99508
345-1863 Business
278-5229
Telephone 561-2488
(e) Mail the HAA to the following address: (or check here:~, if hold for pick up.) '
List contact person and day phone number below:
Raymond Alexander
2. TYPE OF RESIDENCE
Single-Family~)~ Number of bedrooms 3
3. WATER SUPPLY
Individual Well []
Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th?gality and status. ..'
4. SEWAGE DISPOSAL
On-site [] Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the lega,iilty and status.
72-025 (Rev. 7/88) Page I of 2
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.end 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 R&M CONSULTANTS, INC.
Telephone (907) 561-1733
Address P.O. Box 190087, Anchorage, Alaska 99519-0087
Date 9-14-88
Engineer's Seal
6. DHHS APPROVAL
Approved for ,~' bedrooms by
Approved ~-/~k,._ Disapproved
Terms of Conditional Approval
Conditional
Date ~ .
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representatiQ ..n.s giv~r~ 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 home§ and their lending
institutions in order to satisfy certai~n 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. 7/88) Back Page 2 of 2
~ ~.\.~ .C~'O~.k[~YI'PALITY OF ANCHORAGE (MOA)
[ e~ ' .,~O~ Health Authority Approval (HAA)
~g~ CHECKLIST- FEBRUARY 1984
~ O~~ ~ 343-4744
~g~%~ .~ Legal Description: _Lot
6,
~Zoc~
2
Woll Classification Private ~arer Source If A, B, G,
Woll k0~ ~resont (Y/~) Y Dato Completed 5-1~-79 Yiold 3 ~pm
Total Dopth320 ft~Gasod to 20.~ ftDepth of Groutin~ ~one ~ndScated
Static Water Level 15 ft.
Casing Height Above Ground 24 ln.
Electrical Wiring in Conduit (Y/N) Yes
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot 100,5 ft,
To Nearest Edge of Absorption Field on Lot 111 £t,
Pump Set At 309'-9"
Sanitary Seal on Casing (Y/N) Yes
Depression Around Wellhead (Y/N)
No
; On Adjoining Lots 160Jt/215'~
;On Adjoining LotsI80~145~
To Nearest Public Sewer Line ) 2 mlles To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot 8_5'
Water Sample Collected by gay Ale×ander ; Date 9-09-88
Water Sample Test Results Coliform 0 per 100 mls; Nitrates 0.31 mg/1
miles
Comments Well yield tested on 9-09-88 and produced 1 ~_pm or greater for 4 hours/
Bedrock encountered at 17 feet. Cased to 20.4'
B. SEPTIC/HOLDING TANK DATA
Date Installed ~Size 1000 gal. No. of Compartments
Standpipes (Y/N) Yes Air-tight Caps (Y/N)
Depression over Tank (Y/N) No
Pumping/Maintenance CQntact op ~=ile (Y/N) N/A
Holding Tank High~/ater:Alar~ (Y/N) ,. N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well. 10'0;5 ~-'~,::" ' -', To Building Foundation
To Property Line 55 ft. . To Disposal Field
To Water Main/Service Line 40 ft..*: ..';
To Stream, Pond, ta~e'0r'.Major Drai¢i?;.'~ Course None within 100 ft.
Comments
2
see
Yes Foundation Cleanout (Y/N) Yes-comment
Date Last Pumped 9-09-88
; for N/A
Temporary Holding Tank Permit (Y/N) N/A
9.5 ft.
3.7 ft.
Founda~tb~:clea~oQt located on interior of garage wall.
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed August 1979
Width of Field 3 ft.
100 sf/br
Square Feet of Absortion Area 455 ft.
Depression over Field (Y/N) No
Results of Last Adequacy Test
Adequate;
Type of System Design Trench
Length of Field 45.5 ft.
Depth of Field 9.5 ft.
Gravel Bed Thickness 5 feet
Sta~,~7~dpipes Present (Y/N)
Yes
Date of Last Adequacy Test 9-09-88
Field absorbed 1,200 gallon within 10 min.
of
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well 111 ft.
To Building Foundation 21.2 ft.
Lot None
To Water Main/Service Line 52 ft ·
completion of filling operation.
TO Property Line 15.7 ft.
To Existing or Abandoned System on
;On Adjoining Lots Lot7 = 62 £t. & Lot 5 = 230
To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course ~0.7' Miles to Little Rabbit Creek
To Driveway, Parking Area, or Vehicle Storage Area 28 feet
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I ha~e.~hecked, verified, or conformed to all MOA and
inspection.
Company R&H C~3NSULTA~_TS, ZNC.=
Date 9-14-88
the date of this
Engineer's Seal
MOA No.
Receipt No.
Date of Payment
Amount: $
/20 od
HA_ _~I1~ _~ffect on
Receipt No.
Waiver Fee: $
Date of Payment
72-026 (Rev. 7/88)Back Page 2 of 2