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PTARMIGAN ROOST BLK 2 LT 11
Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211053 PID Number: 020-042-79 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name BRIAN &SEPTEMBER CASSIDY ABSORPTION FIELD ❑ Deep Trench ® Wide Trench ❑ Bed ❑ Mound Site Address 16250 SANDPIPER DRIVE, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 1.2 GPD/SF 5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2 Ft. Gravel depth beneath pipe 3 Ft. Subdivision Block Lot PTARMIGAN ROOST 1 11 Fill added above original grade *VARIES 5.16 - 6.83 +/- Ft. Gravel length 58 Ft. Township Range section Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 500 Ftz 1 Ft. Well 100'+ 100'+ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water 100'+ 100'+ Material HDPE Number of compartments 2 Lot Line 5'+ 10'+ NA Foundation 10'+ 101+ LIFT STATION Manufacturer Capacity Gal. Remarks Original system connected to with diverter. "Includes previously existing & added fill to OG. Alarm location Electrical installed by Installer NORTHERN EXCAVATION PIPE MATERIAL House to tank 3034 Tankto era nfleld 3034 Draintield 3034 CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection ection 1M 3/17/2021 2nd 3/18/2021 Location and description 3`d 3/19/21 4/h 3/22/21 DOOR SILL ON-SITE WATER AND WASTEWATER SECTION APPROVALAaw l� Conditional Approval: Date '•:t� TH J • • • • ...... • • • • r Curtis Huffman Septic System Approved - �� �F'•• CE 128991•_�� i Note: this approval does not include well �6,Date F�.��G�1 FOpROFEssIONP�. li>,� permit requirements. kr-,vv U.7/UL/ 1 O/ PID: 020-042-79 PERMIT: OSP211053 ASPHALT / I / DRIVE NEW CO INSTALLED 4' UP GRADIENT FROM EXISTING FIELD K ORIGINAL EXISTING FIELD MT I/ MT J s/0' ��So NEW 1250 -GAL HDPE SEPTIC TANK 5'+ TO DECK SUPPORTS DIV. DCO C G F F D l WELL RADII TH21-1 STAKED AT CONST. A—C=11,0' B—C=26.9' rDFCO H CO /_DCO DIV CO MT A—D=15,5 B—D=29,8' 97.07 87.9 A—E=20,4 89.25 B—E=33.8' A — F = 2 3.5' ass? 1.250"EW -GALLON 8so a. HOPE DPE TANK A—G=42,5' 77.75 B—G=54,0' A—H=50.9' SEPTIC SECTION SCALES NTS B—H-57,6 A—I=53.6' PTARMIGAN ROOST 132, L11 B—I=60.1 A—J=101.5' PREPARED FOR: B—J=99,3' BRIAN & SEPTEMBER CASSIDY A—K=68,1' 16250 SANDPIPER DRIVE B—K=80,5' ANCHORAGE, AK 99516 FIRST WATER CONSULTING 13030 Sues Way Anchorage, Alaska 99516 (907)350-9566 FirstWaterAK©gmail.com 4BR HOUSE 747�, MT C11.58 O FINAL GRADE ORIGINAL GRADE 5 FILTER FABRIC 82.75 7 5 80.75 SEWER ROCK 77.75 19' TH21-1 (EXIST.GRD) /-87.75 FILL-ORG/OI. ORG/OL-ML GM/9P-9P NO GRND.WTR DRY -3/18/21 SUPPORT®SERVICES: AZ F - &.IC- 5 91F DATE: 3/22/2021 tis Huffman. SURVEY: HOLT CE 128991 ' DRAWN: FWCS SCALE: 1" = 30' a 3/22/21- �w�' �pESS1D MUNICIPALITY OF A NC HORA E On-site Water & Wastewater Program POI Pax 198550 4700 Elmore i9oda +fin rage, AlaM995yMMO Phone: {907) 940x7944 Fax: (907) 343,7*7 h tp:IAWW mLgrd,oroneft On- i#la Wastewater Disposal System Permit Permit Number- Q$P211053 York Type= S19ptiC Upgrade Tax Code Dumber; 02004279001 Site Legal Add rens; PTARMIGAN ROOST BILE{ 2 LT 11 13-.5235 Slite MaiIIPig Address: 16250 SANDPIPER DR. Ar rage Owner: CA5SIRY R R I A N & SEPTEMBER K 0esilgn Engineer: FIRST WAT ER CONSULT I NG This permlt is for the construction of: Effective date; Expiration Date: Lot Size In Sq Ft: Total Bedrooms_ 3D31 34M22 45150 ❑ Disposal Feld (21 SepkiC Tank ❑ Holding Tank EJ Frivy ❑ Private Well 0 Water Storage All con struction sha l I be I h urdanCe With. 1. Tha 4ached approved dasign. 2. All requiromenls spenilied in Anr:horage Municlpak Dada Ohaplers 15.!55 and 15.65 and the State of Alaska WastewaWr U ispoGal Regulations (18AAC 72) and D ran king Watiet R oga lal ions ( 1 8AA030) 0. Tho wasiewaier code requires inspections during 1 he insialfalion, The engiO00t 1ah1311 nCdOy the IDav0l0prnen1 Seraicee Departmenl per AMC 15.65. Provide ncmication by railing (907) 343.7904 (249). 4. From OCIC 69r 15 to April 15, a subsudaw soil absorption voom under oonslmc:6Dn during freezing weather shall be edher: a. Opened and 010sed on Ira same day, or b, Oovemd, saalsd, aW heated to prevent freezing Placeived Ry: Issued By: VU"JU e" _YM021 Dat -a: Date: 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com March 1, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: PTARMIGAN ROOST BLOCK 2, LOT 11 The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. We propose to install one typical 5 -wide drain field and 1250-gallon tank to serve the existing 4-bedroom residence. The design is based on the recent test hole conducted on February 22, 2021 and in reference to MOA record docs performed in 1981. No groundwater was observed at the 2021 test hole excavation or monitoring. However the August 1981 testhole noted observations of groundwater at 12, from original grade, which would make these readings at 17, per the recently conducted testhole (5, of fill found above original grade). We have therefore conservatively designed to a maximum depth of 10, from existing grade and 5, from original grade. This also appears to correspond with the existing field which is 10,+ below grade. The slopes are moderate at 10-15% at the proposed upgrade location. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211053, Rebecca Carroll, 03/02/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211053, Rebecca Carroll, 03/02/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211053, Rebecca Carroll, 03/02/21 4661 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: PTARMIGAN ROOST B2, L11 PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 3/1/2021 DEPTH FEET OG SOILS 1 2 3 ORG/OL - FILL 4 5 ORIG. GRADE 6 ORG/OL-ML 7 8 GM/sp-gp 9 10 11 12 13 14 15 16 17 18 19 BOH 20 Reading Date Gross Time Net Time Depth to Water Net Drop 2/22/21 10 min 62 62 10 min 62 62 10 min 62 5 15/162 10 min 62 5 14/162 10 min 62 5 15/162 10 min 62 5 15/16 2 PERCOLATION RATE 1.7 (MIN / INCH) TEST RUN BEWTWEEN 6 & 7 FT PERC HOLE DIAMETER 62 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: 3/1/2021 TESTHOLE # 21-1 DATE PERFORMED: 2/22/21 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: BRIAN & SEPTEMBER CASSIDY 3/1/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211053, Rebecca Carroll, 03/02/21 ~~ ] MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTI~CTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE LEGAL DESCRIPTION DISTANCE TO: /~ 7 Absorption area, Dwelling , PERMIT~ ~<~Z~ Manufacturer ¢~~ MaWR~_ No~ compartments Liq. ca~ ~ons IF HOMEMADE: Inside length Width Liquid depth ~ ~ ....~ Well Dwelling PERMIT NO. ~z M~c~~~~~~ ~,eria,~~~~ , O Z ~ '~c'ty ~ Well , Foundation , Nearest ,ot~e/0 PERMIT NO. ~ 5 DISTANCE TO: ¢/OO ~ .. No. of lines Length of ea~i~ Total length of~e~ Trench width Distance be~Neen lines ~ ~ ~ Top of tile to finish grade ¢ Material beneath tile ~ ~ ~ .Sinches Total ef,ective g3p~n area Length Width Depth PERM IT NO. ~ TVpo~~ ~ OJame~~ Crib 0~5 Total ef~rption area " ~,STANCE TO: Wel~ % ~gfoundatio% ~lot ~n: ~ ~~ Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic t~ ¢ Absorption area(s) OTHER PIPE.~TERIALS REMARKS 1~ mom ILS009 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF -- 175 DRILLED AT THE RATE OF -922, 00 PER FOOT. PROPERTY OWNER 11th. lac%r..eJL C. & PGIz,&Clm 62. oavr,3 345-0307 Cc,Up4e Conz t. 718 P vz;?-Ow 99501 349-7162 fiZ,," ?gym Ro.04. LOCATION OF WELL SITE -U- 11 Elk. 2 SIL&. PtaAa aaa DRILLER __ %UUZI,e C.LatL4 o-4 .naa)2a U 3,&U,Lia(7, i%1o&k c. WELL LOG: 0----12' Si.Ltr� ClAaveL and bou,Ldez4. 12---23' Cann(-amevza te. fI &;wken werLUte,�ed lzacP. ( tre&lock 23 --175' Bed&o ck. i i .� e cLi�en tcvu� iia ck. Th tn. cyzea.6 o-� �tyzea �shacv�incc 4maU aaourt.6 aA watvz.. 166--172 Aee t 4hotoa,6 a Lra:ten bea&,Lag aa.,zou.4 a tea wW—L a P-&oductton. o.,' BcP G,,etv6 4euefzat houJr4 oA pdapiac.. Oatvz ie-cauvu, coae4 caWl a 50 fleet o� u�urace. 3/4 Ro�e Su lrraeJzstbie, Pup 4houtzl ire L" tat Led' 15 Peet Coad oA D1r i.L{.in,,: 922-00 [2e z. Paot X . 175 fleet: 33850.00 Cam t o,o �Ye U SeaL: 120.00 Dh� COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF r3870o 00 THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS DATE Seat 7th-, 1981 r DEF'FIRTMENT r "~'i HEF!LTH FINE:, =J"l ,, I RUI'qHEI'EI HL. .OTECT t ':Ii',! 825 "L STREET., Rt'iCHORRGE., RK. 264-4728 C~ ~'..,f --. 2:~; ]E -F E] :~.;; E _~..,..!I ~2. F~: F' E~ iF]." P~ .'E T' 8±0828 ) FIF'PL I C FINT LOCFI'I" i ON LEGRL JFIMES D. R Z 5'5 '-¢" ':' ST. , ! .... E;RRROH SRN[:,P I F'ER Lid B2 PTFIRMIGFIN F'ZCST S,-'[:, L lIT "-' '-" ' =, I ,'-E T'¢F'E OF SOIL RE:SE~RF"I"ION S'~'STEH IS: TRENCH MFIXIMUi"1 N_HEFZF.' OF E~E[:,F.'EZMS = ~ SOIL RRTING ,::Sgf FT,,"E:R)= THE RE'-]_ IF'E[, 'SIZE OF 'THE SOIL RE:SORF'TION~M IS: THE LENGTH DIMENSION IS THE LENGTH (IN FEET:.', OF THE TRENCH OR DRRINF!EL.D. THE DEPTH OF R TRENCH OR PIT IS THE DISTFINCE BETWEEN THE SURFRCE OF' THE GROUND FIN[.', 'THE SOT'TOM OF THE E',::,'CR'v'FITION (IN FEET). THERE IS NO SET WI[:,TH FOR TRENCHES. T!-IE GRFtVEL DEF'TH T'=' ' I=' =FM,,cL E,'ETWEEN THE OL~L F'IF'E __, Trl_ MINIMUM DEPTH OF .... -,,,F ..... FiND THE BOTTOM OF THE E::.:?:R',,,'RTtON ,'IN FEET). ...... ~,c'F" T '~ - F'FPHTT R,. L_I..:HNT HRS THE RE'EF'ZNSIEILIT'¢ TO tNFC;RH THiS DEF'RRTMENT DURING 'THE IN.~-];TRLLRTION TN'qF'FRTi]N'--] OF RNY WELLS R[:,.TRF:ENT TO THIS v,.:UF'EF..Tm RN[:, THE NUME:ER OF RESIDENCES THRT THE WELL WILL SERVE. BRCKFILLING OF RN'¢ .:,.:.,T,_-I'I IdiTHE_T FINRL INSPEC:TION RND RF'PRO',,,'RL 8'¢ TFIIS DEF'FiRTi"IENI' WILL BE SUBJECT TO F'F.'ZEEZ .TION. HINIMUM [:-'ISTRNC:E BETWEEN R WELL RND ANY ON-SITE SEWAGE DISPOSRL SYSTEM IS ±OR FEET FOR FI F'RIYRTE WELL OR ±50 TO 200 FEET FROM R PUBLIC WELL DEPEN[:,ING UPON THE TYPE OF PUBL. IC HELL H. INIMUM DISTRNCE FROM R PRIVRTE WELL TO R F'RIVRTE SEWER LINE IS 25 FEET RI'-,!D TO R COMMUNIT'T' SEWER L. INE IS 75 FEET. OTHER REI.Z~LIIRE.HENTS HR'T' FIF'PLU. SPECIFICFITIONS RND C:ONSTRLICTION DtFIGRRMS FIRE RVR!LRBLE TO INSURE PROPER INSTRL. LRTION. F'E:F:i-.1 ][ -F E::-::F' Z F-:EZ:::_; .E- E.L.,EZPI:.[: F. _~:::t.. I CERTIF'¢ THRT ±: I RM FRMIL!RR WITH THE REQUIREMENTS FOR ON-SITE SEP.IERS RN[." HELLS RS SET FORTH B'¢ THE MUNICIPRLIT'¢ OF RNCHORRGE. 2: I WILL INSTRLL. THE S'¢S]-EM IN RCCORDRNCE WITH THE CODES. ]:: I UNDERSTFIND THRT THE ON-SITE SEP.IER SYSTEM MR'¢ REQUIRE ENLFIRGEMENT IF THE RES II}ENCE IS REMOE:,ELED TO INCLLIDE MORE THRN SIGNED: ................................................... ~/~. RF'F'L I CFINT JRMES [:,. ROSS ~ ~ · ",,'4. 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST "ERFOR'v'ED FOR: 31~' OATE PERFORMED, lsl l LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 ~3 14 ~7 18 20 SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? YE~ IS O P E IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND MUNICIPALITY OF ANCHORAGE Development Services Department p P Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-042-79 Legal description PTARMIGAN ROOST BLK 2 LT 11 Site address 16250 SANDPIPER DR Expiration Date: 12/22/23 Current property owner(s) KATTENHORN SIMON ALLEN & GEORG X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Per the realtor, all standpipes were buried due to a land- scaping project. All but the 1981 standpipes were located and extended for this COSA. The Onsite Water and Wastewater section recommends the trench be located and standpipes repaired. By: Original Certificate Date: 9/22/23 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 M U NMPAUL TY O F A iki C H 0 F -JAG E A 05 Development Services Department Phone: 907-3_4 3-7904 On -Site krtrater & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 020-042-79 Complete legal description PTARMIGAM ROOST; BLOCK 2, LOT 11 Location (site address) 16250 Sandpiper Drive *Anchorage Current property owner(s) Simon Kattenhorn Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: A Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel I Plastic ❑ Concrete ❑ Fiberglass Age 2.5 - See advisory if steel older than 20 years �r 5k 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed Deep Trench ® Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ � Rpo Waiver Fee $ _ Date of Payment Date of Payment COSA # 05G 223 13 6 Waiver # COSA Application June 2022 91d COSA Checklist Legal Description: PTARMIGAM ROOST; BLOCK 2, LOT 11 Parcel ID: 020-042-79 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑■ Well log is filed with Onsite (or attached) Date drilled_ 9-81^ Total depth 175 ft Cased to *23-g ft ❑■ Sanitary seal is functioning correctly i Z 711 ❑■ Wires are properly protected 4 Casing height (above ground) 18+ in. Date of flow test for COSA 9/6/23 Static water level at begir Comments *ASSUMED= B. TANK DATA ning of test 26.9 ft Measured operating fluid level in septic tank 57" Date of pumping 9/11/23 ❑ Required maintenance completed, if AWWTS Comments: - D. ABSORPTION FIELD DATA Which system tested (date installed) 3/22/21 ❑■ ALL standpipes present per record drawing Total measured depth from grade 11.83 ft (max) Measured depth to pipe invert from grade 7.41 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 30"-32" ❑ Presoaked required if (Required if house vacant or field not us r more than 30 days prior to date of test Gallons introducedgallons date A=s, =enter reatment (past 12 months) ate Comments/Deficie COSA Checklist June 2022 Well production at time of test 6.6+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ■❑ Nc 0 Coliform bacteria is Negative Nitrate 4.96 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑■ Arsenic less than MRL (ND) Collected by GEG, Ltd. Date 9/6/23 C. LIFT STATION ❑ Required maintenance completed Age of lift station ye Lift station mated Adequacy test date 9/6/23 Results [E Pass Fluid depth prior to test 0 in Water added 671 gal New fluid depth 6 in Elapsed time 120 min Final fluid depth 0 in Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 36 Effective depth used 6 in Effective depth remaining 30 in in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' ❑■ Yes if No Community Sewer Manhole/Cleanout > 100' ** ❑■ Yes if No ft 0 Yes if No Neighboring Tank > 100' ❑■ Yes if No ft Private Sewer/Septic Line > 25' ❑■ Yes if No_ Absorption Field on Lot > 100' [j] Yes if No ft Holding Tank > 100' ❑■ Yes if No_ Neighboring Absorption Fields > 100' Water Service Line > 10' Yes Animal Containment > 50' QYes if No_ Mm Yes if No ft ** TO SUPPORT FOR LOW DECK Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑■ Yes if No ft Q Yes if No _ ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑■ Yes if No ft Surface Water > 100' Yes if No _ Tank to Property Line > 5' ❑o Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑■ Yes if No ft Private Wells > 100' Yes if No _ Water Main > 10' ❑■ Yes if No ft Community Wells > 200' ❑■ Yes if No _ Water Service Line > 10' Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *APPROXIMATELY 7.5' FROM MH1 TO SUPPORT FOR LOW DECK **PER AWWU RECORD DRAWING #30177 NO PIPES FOUND FOR 1981 TRENCH - CONDITION IS UNKNOWN ft ft ft ft ft ft ft ft G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Garness Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Garness Date 9 l 7-i 1 2 - 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 o6oOp0 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 o�OF A o Q exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety variables, including limited to) levels fluctuate of (but not soil conditions, groundwater (that may 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 01 ...... or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The this is for the benefit the that GEG J� f e A Garne s. QO content of report sole of person/party retained 9 E-79 to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. e� Q s c O �� P ' • • • • • • • • • COSA Checklist June 2022 _ LICENSEPro 5 #AECC 844�0�000��� 9%2//Z3 MUNICIPALITY OF ANCHORAGE Development Services Department t� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I. D. 020-042-79 1. GENERAL INFORMATION Expiration Date: A - 2(-)- 2-7 Complete legal description PTARMIGAN ROOST BLOCK 2, LOT 11 Location (site address) 16250 SANDPIPER DRIVE, ANCHORAGE, AK 99516 Current property owner(s) BRIAN & SEPTEMBER CASSIDY Day phone Mailing address Real estate agent 16250 SANDPIPER DRIVE, ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Z CU Waiver Fee $ Date of Payment t /Date of Payment Receipt Number (�' Receipt Number COSA # (� 2 11 060 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 31312021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the , system and maintenance. The operational life of all well and septic systems are subject to �4 OF A lk, `I these various and dynamic characteristics and are outside the control of the evaluator of the •�(� " mac. well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & NES .•_49 11 I '•* 6. DSD SIGNATURE • • • "' I �f . • Curtis Huffman System #1 Approved for 7 bedrooms �r��'Fcs•, CE 128991 � l TF�F� .1/3/21. - System #2 Approved for bedrooms 1� ROFESS0 Disapproved Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: J — Z3r Zd2 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 Nitrate Advisory max, Arsenic Advisory Other Legal Description: PTARMIGAN ROOST BLOCK 2 LOT 11 Parcel ID: 020-042-79 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 9/1981 Total depth 175 ft Cased to 23 ft (INTO BEDROCK) ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 12 in. Date of flow test for COSA 2/9/2021 Static water level at beginning of test 27 ft. Comments B. TANK DATA Age of tank(s) 0 years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank ® Standpipes/foundation cleanout per record drawing Date of pumping "NEW TANK D. ABSORPTION FIELD DATA Which system tested (date installed) NEW FIELD ® ALL standpipes present per record drawing Total measured depth from grade 11.8 ft (max) Measured depth to pipe invert from grade 8_8 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective Structure served by this system Well production at time of test 5.3 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® Nc ® Coliform bacteria is Negative Nitrate 5.00 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by NES Date of Sample 7/6/2022 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date NEW SYSTEM Results ❑ Pass For bedrooms Fluid depth prior to test _ in Water added gal New depth in Elapsed time min ® Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate and (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons FW'C5 Comments/Deficiencies::. 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 ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' ® Yes if No 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' Surface Water > 100' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ft ft ft ft ft ® 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. Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® 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 Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. kk Ale �. 4..TM ....�... d . Curtis Huffman ��� �<��, •, CE 128991 ,• �� �'���c�' • 7/26/22. • •�V�.® W ft Nitrate Advisory Certificate of On -Site Systems Approval # OSC 211086 Subdivision: Ptarmigan Roost B2 lot 11 A water sample revealed a nitrate concentration of 5.0 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. j Ma�Ung Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org 3. MUMMPAUTY F Development Services Department .camA t On -Site Water & Wastewater Section Parcel I.D. 020-042-79 I Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: 67 -.2-3 "2 6 `-1 IGAN ROOST BLOCK 2, LOT 11 Location (site address) 16250 SANDPIPER DRIVE, ANCHORAGE, AK 99516 Current property owner(s) BRIAN & SEPTEMBER CASSIDY Mailing address Real estate agent Day phone 16250 SANDPIPER DRIVE, ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment 3 �Ta02 1 Receipt Number COSA # G�GZ )10,3 6 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 3/3/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWCS L_ DSD SIGNATURE System #1 Approved for —1 bedrooms System #2 Approved for bedrooms Disapproved GJ -49 TH ....... Curtis Huffman (��'c�,,•, CE 128991 .,•��`��/ 1�\F�PROFESS1NAt, �.0 Conditional approval for bedrooms, with the followeA i16MMi�^� rX Ofd -SITE 0 WAST_' VATR Z J03 PROGRAM ))))))))1)v0't. B !O— U_ Original Certificate Date: 3-2-3-2— z 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 Legal Description: PTARMIGAN ROOST BLOCK 2, LOT If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 9/1981 Total depth 175 ft Cased to 23 ft (INTO BEDROCK) ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 12 in. Date of flow test for COSA 2/9/2021 Static water level at beginning of test 27 ft. Well production at time of test 5.3 gpm Comments B. TANK DATA Age of tank(s) 0 years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank ® Standpipes/foundation cleanout per record drawing Date of pumping *NEW TANK D. ABSORPTION FIELD DATA Which system tested (date installed) NEW FIELD ® ALL standpipes present per record drawing Total measured depth from grade 11.8 ft (max) Measured depth to pipe invert from grade 8_8 ft (min) ❑ NIA — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 020-042-79 Structure served by this system _ Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 3.53 mg/LF-1 Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Fw�cs Collected by Date of Sample 2/9/2021 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date NEW SYSTEM Results ❑ Pass For bedrooms Fluid depth prior to test _ in Water added gal New depth in Elapsed time min ® Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: FWCS 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 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' Surface Water > 100' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ft ft ft ft ft ® 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 _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® 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 Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION •i 1 certify that I have determined through field inspections and review �Aw,r��,:•' of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date.: • • i%) • • • .'; .... ....�..�..... • Curtis Huffman ¢� �'F�,/•, CE 128991 • •�ti�� $����:�p OFESS ON�'�'�-•�..� ft w ASPHALT ENCROACHES APPROX. 2.6' INTO LOT 12 J / AS BUILT SURVEY I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 11, BLOCK 2, PTARMIGAN ROOST SUB. ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL WITHIN THE PROPERTY LINES AND THAT NO VISIBLE STRUCTURES OR FENCELINES. ENCROACHMENTS EXIST OTHER THAN NOTED. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON. DATED AT ANCHORAGE, ALASKA THIS 22 NO NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES OR LOCATE STRUCTURES. DAY OF MARCH 2021 HOLT LAND SURVEYING 9555, FB 116-39, 212-5 ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS. TEL. 345-5513 MUNICIPALITY OF ANCHORAGE ~! DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 ./-~-.-~-~ Application Date GENERAL INFORMATION (a) Legal Description (inciude Io_LJ:dQ~k, subdivision, section, township, range) J Location (address or directions) (b) (c) Applicant Name ~-~-~ Applicant Address Telephone: Home ~¢.o '-- .~7.>'-/ Business Applicant is (check one): Lending Institution []; Owner/builder/~ Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the H~t~.the following address: 2. TYPE OF RESIDENCE Single~Family~ M ulti-Famiz_ly//E] Other Number of Bedrooms r/ WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite/~' Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDIN,~ INSPECTIONS, TESTS, FILE SEARCH, DA'fA AND INFORMATION As certified by my seal affixed hereto and as of the validation ~ate 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 insp~ection / Name of Firm .,-/--'~-;¢'~'¢-/ ~./ Telephone Address .,27,~ ,~ ~.~/~- /~J ./~o~ .-~'~,,~/,"d,4' -¢~ Engineer's Seal DHEP APPROV~ ~pprovod for ~)// Approvod ~ Disapprovod Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineerls work. Page 2 of 2 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description:'.~--~-~-C"~/~¢~R~-F~EJ~ MUNICIPALITY OF ANCHOP. AGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Well Log Prese~N) Date Completed -~--~ ~-~ ~-/¢'~¢.-/ Yield Total Depth /~L,-¢" Cased to / Static Water Level Casing Height Above Ground Electrical Wiring in Condu~N) Separation Distances from Well: / To Septic/Holding Tank on Lot Depth of Grouting Pump Set At Sanitary Seal onCasing (ad~( Depression Around Wellh (Yt~ / ; On Adjoining Lots /'~D --/--- / ~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line .-4"~ To Nearest Public Sewer Cleanout/Manhole -'¢'/~/ . To Nearest Sewer Service Line on Lot ' ~'/¢ /://~"~"¢/'4/I// ;Date ./ Water Sample Collected by Water Sample Test Results --~ ~-.' Comments .~.' ¢.~J~J'/l~ U~..~ ~¢J'¢~/ j ~-¢.~.~,.J).~yr~fZ.L¢(. B. SEPTIC/HOLDING TANK DATA Date Installed ~/--~ ---~/ Size /~¢~ No. of Compartments Standpipe/~) //~-% Air-tight Cap~N) Depression over Tank ('j~D Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /~¢ ~- To Property Line '-~"~ To Water Main/Service Line...-/ -- Course /¢/~?/~ Foundation Cleanout ('~ .-¢'~--~ Date Last Pumped / ~"-'-'~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field '-.~©~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84} C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata '¢~'~ ~,/~-.~e~,~ Type of System Design Date Installed ?" ~/~-~ --~/ Length of Field '-~-~--~ Width of Field ~-~¢ /-~-'~-.¢¢-% Depth of Field ~ ,dC Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Gravel Bed Thickness -;'-'-'-'-'-'-'-'-'~-,-~ Standpipes Presen~N) Date of Last Adequacy Test Separation Distance from Absorption Field: / To Water-Supply Well To Building Foundation Lot . .~,~'"~- To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments / To Property Line ,/Z) % To Existing or Abandoned System on ; On Adjoining Lots //~d-/ /%-~-~ To Cutbank (if present) ..¢/Z~.¢/~. ~:~?~..z~,_/_~- / D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~/~'~ ./'//~'~'~ Date /"<---~;¢ - ~ ~; Company/:~5~ ~ ~ ~-~2~ MOA No. Receipt No. ~ ~ ~'~ ~ Dateof Payment I'~ Amount: $ (~ ~ Page 2 of 2 72-026 (11/84) Location: BF_.S~E, EPPS & POTTS 2220 BAST 88 AVeNUe. A~OtC~An~-, AK 99507 (907') .?~$9-6451 WATER W~.L TES~ Lot: // Block: Client's Name: Address: Initial Reading c~l Meter: ~:~ ~./ c.~r.r~ c~r. rr~s -'~:-~--v Pr~tuction Rat~: ~ GPM 24-Hour Capacity, Gal]ohs / ~ D,~'T E RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECT~I~ MUNICIPALITY OF ANcHoRAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEP]'. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P;~OTECTION ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 [',~0V $ 0 1981 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER ~t~I~I~IF~/E DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed, Please allow ten (10) days for processing. 1. PROP~ERTYOWNER~,,t`' ' _ ~t ., ~' ' ~ - I PHONE MAI L1NG ADJ~R ESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LEN'~I NGtlNSTITUTION PHONE ,-. , MAI LING ADDRESS 4. REALTOR/AGEN"D I PHONE I MAILING ADDRESS 5. LEGAL DESCRIPTION~ STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,,BEDROOMS "' [] One [~ Four E~-~':$i'NG LE FAMILY [] Two ~'~' Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY E~]~ ' INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM ~" INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [~] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3, SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER [] OTHER []PUBLIC UTILITY Connection Verified []Septic~_~r. ~ [~Holding Tank Size: / If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line DATE INSTALLED INSTALLER SOILS RATING MANUFACTURER MATERIAL Septic/Holding Tank Absorption Area ISewer Line INearest Lot Line 5. COMMENTS DATE [3~'~PRov ED FOR ~/~L-- BEDROOMS ~]~CONDITIONAL APPROVAL (letter must ac~prn~any certificate)