HomeMy WebLinkAboutPTARMIGAN ROOST BLK 2 LT 12
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
hftp://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP241362
Work Type: Septic Upgrade
Tax Code Number: 02004280000
Site Legal Address: PTARMIGAN ROOST BLK 2 LT 12 G:3238
Site Mailing Address: 16300 SANDPIPER DR, Anchorage
Owner: AREND JAMES C & MARGARET S
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
2 Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date:
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
OVA.:
Dcimrtincttt
11 /5/2024
11 /5/2025
37659
❑ Private Well ❑ 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
Received By: '' Date: .� i s 2n
Issued By: Date: 2
4
Community Development Department 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. 020-042-80
Property owner(s) James and Margaret Arend Day phone (907) 440-0663
Mailing address 16300 Sandpiper Dr, Anchorage, AK, 99516
Site address
�� 16300 Sandpiper Dr, Anchorage, AK, 99516
Legal description (Sub'd., Block & Lot) Ptarmigan Roost, Block 2 Lot 12
Legal description (Township, Range & Section)
Lot Size - 37,659 _Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(ED all that apply)
Absorption Field
0
Initial R
Single Family (SF) RX,
(w/wo ADU)
Septic Tank
EK
Upgrade RX
Duplex (D) ❑
Holding Tank
R
Renewal 1-1
Multiple Dwellings El
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
EJ
THIS APPLICATION INCLUDES A VARIANCE / 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 of property owner or authorized agent)
Permit/Rush Fees:
Waiver Fees:
'7'-/ Date of Payment:
Date of Payment:
Receipt Number: Receipt Number:
Permit No. Waiver No.
Permit App_'-'- '. :-'., c ,
October 16, 2024
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Ptarmigan Roost, Block 2 Lot 12 – 16300 Sandpiper Drive
Septic system design
Dear On-Site Services Engineer:
The owner of the above lot has an existing 4-bedroom home on the property, so we are submitting
this permit application for the construction of a new septic system. The attached site plan identifies
the location of the home as well as the existing well and new septic location. No conflicts exist
between this proposed system and any other well or septic system, whether on this lot or adjacent
lots.
The ground surface on the lot slopes steeply on the east and west sides of the lot. However, near
the middle of the lot the slopes are much milder. Contours are shown on the site plan showing the
grade and direction of flow. Downslope of the septic installation area there is a short section of
slope that drops off toward the road at more than 46%. However, the section is very short with a
drop of less than 10’, and the area is much flatter below that. The attached slopes profile shows
that the dropoff will not cause any daylighting of septic effluent. Stormwater drainage will not
impact this septic system. The new trench will be constructed parallel to the slope as much as
possible.
Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all
wells and surface water, and more than 5’ away from the septic tank. Please refer to the attached
test hole log, plan and profile pages for the septic design. If this design is followed, there will be
no adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241362, Curtis Townsend, 11/05/24
x
x
x
x
x
x
x
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
1"=30'
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
PTARMIGAN ROOST, BLOCK 2 LOT 12
FEET
0 30 60
SEPTIC PLAN
10/15/24
940
950
930
920
910
NEW 1250-GAL SEPTIC TANK
LOCATE FCO AT INSTALLATION
EXISTING 26' WIDE x 37' LONG, 6" EFF
DEPTH BED TO REMAIN IN SERVICE
FIND AND REPAIR ANY MISSING PIPES
EXISTING TANK TO BE
DECOMMISSIONED PER UPC
(2) 50' LONG x 5' WIDE, 6" EFFECTIVE
DEPTH ABSORPTION TRENCHES
MIN 6' SEPARATION
DV
FS MT
MT
MT
MT
2CO
CO
CO
CO
CO
TH#1
10
'
U
T
I
L
I
T
Y
E
A
S
E
M
E
N
T
10'
U
T
I
LITY
EA
S
EM
E
N
T
SA
N
D
P
I
P
E
R
D
R
I
VE
20' UTILITY
EASEMENT
4-BDRM HOME
WELL w/ 100' RADIUSNEIGHBORING
WELL RADIUS
NEIGHBORING WELL
OUT OF VIEWPORT
>5'
>10'
PTARMIGAN ROOST
B3 L3 WELL RADIUS
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241362, Curtis Townsend, 11/05/24
PTARMIGAN ROOST, BLOCK 2 LOT 12
TYPICAL TRENCH SECTION
(NO SCALE)
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
DESIGN FACTORS:SYSTEM REQUIREMENTS:
600 GPD PEAK FLOW
PERK RATE: 3.0 MIN/IN
APPLICATION RATE: 1.2 GPD/SF
5' WIDE TRENCH SYSTEM
1250-GAL SEPTIC TANK
BOTTOM OF TRENCH: 4' BELOW GRADE
FLOW LINE ELEVATION: 3' 6" BELOW GRADE
600 GPD / 1.2 GPD/SF / 5' WIDE * 1.00 RED FACTOR [6" DEEP] = 100 LF TRENCH REQUIRED
(100 LF SPECIFIED)
10/16/24
5'
4" PERFORATED PVC (HOLES DOWN)
DRAINFIELD ROCK
6"
3'
6"
GEOTEXTILE FABRIC
6"
PROVIDE ADDITIONAL FILL TO
ACCOUNT FOR SETTLEMENT
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241362, Curtis Townsend, 11/05/24
0+00.00 0+50.00 1+00.00
1"=10'
SLOPE CROSS SECTION
SEPTIC TRENCH (TYP)
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
46%
AN
G
LE
OF EF
FLUE
NT INF
LUE
N
CE
3:1 MAX SLOPES
PTARMIGAN ROOST, BLOCK 2 LOT 12
6.0
FEET
0 10 20
8/22/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241362, Curtis Townsend, 11/05/24
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE: PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
DEPTH
(feet)
TEST HOLE 1
DATE READING START TIME NET TIME
(minutes)
DEPTH to
WATER NET DROP
PERCOLATION RATE: (MIN/INCH)
(inches)(inches)
DATE OF MONITORING
WAS WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING
IF YES @ WHAT DEPTH?
3.0
9/27 1
2
3
4
5
6
GP (POORLY GRADED GRAVEL)
Professional Engineers Stamp:
YES
PTARMIGAN ROOST, BLOCK 2 LOT 12
9/27/2024 020-042-80
A+ HOME SERVIES
11:53 1 0
16
1' OB
30
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
PERC TEST LOCATION
TECHNICIAN: J. OPHEIM
7 0
16
11'
10'
10/4/24
COMMENTS:
SITE PLAN
6 0
16
USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED
10/1/24
12:09 1 0
1610 6 0
16 5 0
16
12:20 1 0
1610 5 12
16 4 12
16
12:31 1 0
1610 5 0
16 4 0
16
12:44 1 0
1610 4 8
16 3 8
16
12:55 1 0
1610 4 5
16 3 5
16
7 1:07 1 0
1610 4 5
16 3 5
16
FILL
OG OB
GM (SILTY GRAVEL)
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241362, Curtis Townsend, 11/05/24
PLOT PLAN AS BUILT —2L SCALE 1" = 40' GRID SW 3238 Project No J24-192 Al
P.O. Box 210005 OG-MF.�
L o n g & Associates, i n C. Anchorage, Alaska 99521-0005 202q—
(907) 522-6476 oQo004p�O
Professional Land Surveyors jonothanOlangsurvey.com o 0 F A
kenOlongsurvey.com
I hereby certify that I have surveyed the following described property:
LOT 12, PTARMIGAN ROOST (Plat No. 71-214)
Anchorage Recording District, Alaska, and that the improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on said property except as indicated hereon.
Dated this the `— Day of TO at Anchorage, Alaska
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
*....!......l..Ar-).
.
... . ... .. o
NAT G
CIO, —9944. •AR •. ..• aQo
4�n �FfSSIONA� ��
State of Alaska AECC963
Municipality of Anchorage Page / of~
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Nam~/,¢2~_~¢ ~. ~~ Wastewater System: ~New ~ Upgrade
~/ C~/D o¢~ ~. ~ ABSORPTION FIELD
Phone: Nc. of ~rooms: ~ Deep Trench ~ ShaHowTrench ~Bed B Mound ~ Other
Total DeRth from orig~al~rade:
LEGAL DESCRIPTION SoilRating: ~ GPD/Sq. Ft.
Lot: / ~ Block: ~ ~ubdivision: / Depth to pipe bottom fiom ordinal gra~e: Gravel depth beneath~e~ /
Township: Range:~ ~~ Fill added above~,original~ ~grade:~,~ ~t.~ Gravel length: ~ ~ / Ft.
Number of lines: I Distan6e betw~n Pines:
WELL: ~New ~ Upgrade Gravel width: ~/ Ft. ~/ ~--~Ft.
Clas~c~tion (Private, A,B,C): ~ Total Depth: Cased To: Total absorption area:~ Pipe mat~ria ~/~h
Driller: / Date Drilled: Static Water Level: In~r~__~ ' ,Date installed:
Yield: Pump Set at: Casing Height Above Ground:
GPM Ft. Ft. TAN K
SEPARATION DISTANCES CSept~c U Ho~din~ U S.T.~...
TO Septic Absorption Lift Ho~ding Public/Private M~n~facturer: Capacity in gallons:
Surface
Lot /~ /~ ~ ~ Size in gallons: Manufacturer:~
Line
CurtainDrain ~ ~ ~ /~, ~ ~ ~ump Mabel Electrical inspections performed by:
Remarks: BENCH MARK
Location and Description:
ENGINEER'S SEAL
Reviewed and approved b ~Date: ' ¢:' "::" "'"
72-013 (Rev. 9/91) MOA 25
Permit No.
$W920040 2 2
Page of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
PTARMIGAN ROOST, BLOCK 2, LOT 12 02004280
Legal Description: PID No.:
CO1 C02
· ' FINAL GRADE
NEW ~70.4
1250 GAL
MT2 MTI C04
~74'
ISR ' ,,
~-- 69.7'
~x,_ 70.2,
· 66.1' WATER FOUND
NEW 1250 GAL
SCALE f' = 40'
4 BDRM HOUSE I
FOUNDATION
SEPTIC TANK~ ,4.5'
NEY/' BED
FCO
CO1
C02
CO
CO
C03
MT1
MT2
C04
20.0 53.6
28.5 63.6
29.3 64.2
130.3 I 65.2
142'3 I73'0
/4°-? / 58.8
/64.2 I85.0
[66.4 [77.8
72-013 A (Rev. 9/91 ) MOA 25
LOCATION OF WELL
I
,STATE OF ALASKA
DEPARI'MI~NT OF NATURAL RESOURCES
DIVISION OF WATER
WATER WELL RECORD
LOCATiON/SI(ETCH:
I
DEPTH~ IVIF~SURED FROM:E]cas;n~ top ~ground surface
~OREHOI,E DATA."
Material Type ~nd Color
Depth
From To
WELL DEPTH; DATE OF COMPLETION
Depth of hole: /6 ~' fL
.......... i._ /
ground surface
ME'THOD OF D.R~LL!I~G; '~air rotary [] cable tool
~1 ¢:her
US~- v.." WELL: ,b,~;dornestic ~ iq;gatiOn [.3 monitor
C.r,,m::'Q S110K..U~ ~ ft. Diem: ~,% In. tO //~.tt
WELL INTAKE OPENING TYPE; [-] open end ~ screened
~ pert, orated ~ open hole
SOr;~ff:;~ TYPE: ................. Diem:
$1ot'Mesh Size: ............ Length:
G~VEL PACK TYPE:
Vofum$ used: Depth tO top:
GROUT TYPE: Volume:
Depth: from ............... ft to.
ft
Duretlon:
PUMPING LEVEL AND YIELD;
_ / G ~ f~ ~fter _ flr~ pumping ~ opm
PUMP INTAKE DEPTH: _ ft Horsep~oyver:
WELL DISINFECTED UP'ON COMPLETION?
REMARKS:
PLEASE MAIL WHITE COPY OF L0'~
TO:
DNR/DIVI$10N OF WATER
PO BOX 772116
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES /;-
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW920040 DATE ISSUED: 3/25/92
DESIGN ENGINEER:S & S ENGINEERS EXPIRATION DATE: 3/25/93
OWNER NAME:AREND JAMES C &
OWNER ADDRESS:5401 CORDOVA NO 204
ANCHORAGE, AK 99518
PARCEL ID:02004280
LEGAL DESCRIPTION: PTARMIGAN ROOST BLK 2 LT 12
LOT SIZE: 37659 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH
INSPECTION.
RECEIVED BY:
ISSUED
DATE:
HEALTH AUTHORITY
APPROVALS
SEWER &WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
31, 1992
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
Multiparty of Anchorag~
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P. 0., Box 196650
A~chorage, Alaska 99519-6650
REFERENCE:
Septic Inspection Reports:
Lot 13; Block I; Timb~rlan~ Park #1
Lot 12; Block 2; Ptarmigan Roost
RECEIVED
JAN 4
iD Municipality ot Anchorage
ept. Health & Human Services
Over last summer w~ performed inspections on the insta~tion of
septic systems located on the abov~ referenced properties. AU of
th~se systems were installed in a satisfactory manner and in
accordanc~ with th~ permits issued by your offic~.~
However, to date, th~se r~main virtually undeveloped properties
without foundations installed. Once foundations are installled w~
wi~ complete inspection reports with swing-ti~s tied into th~
corners of th~ house. The appropriate ~levation data can then §~
tied i~o a proper benchmark. Therefore, completed septic
inspection reports for th~s~ properties are forthcoming.~
If you have any questions or comments pleas~ contact us.
Sincerely,
ROGER J.. SHAFER, P.E.
RJS/tv
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
February 25, 1992
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
Anchorage, AK 99519-6650
REFERENCE: Ptarmigan Roost Subdivision, Block 2, Lot 12
We request you issue a permit to drill a well and install a
septic system to serve the proposed 4 bedroom house on the
referenced property.
Two test holes were excavated and percolation tests performed
on the property on May 20, 1992. The approximate location of
the test holes are located on the attached site plan. The
monitoring tubes within the holes have been checked and found
to be dry on February 20, 1992. On May 27, 1991 there was
water found at 7.5' and 9'
This property has enough area for a septic upgrade which can
be seen on the attached site plan. We do not anticipate any
adverse effects on neighboring properties by the installation
of the proposed septic system.
If you have any questions, or require additional information
for your review, please contact us.
Sincerely,
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
RJS/lsu
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
/" ~-- 6'0'
SCALE
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG m PERCOLATION TEST
LEGAL DESCRIPTION: L~'~ ~- ~ ~ ~ t~Ar.~ Township, Range, Section:
SLOPE SITE PLAN
WASGROUND WATER
ENCOUNTERED?
!
s
IF YES. AT WHAT L
O
DEPTH? p
E
Depth to Water After ~ I/ I
Moniloring? -/ ~"~' Dale:
1
2
3
4
5
6
7
8
9,
10
11
12
13
14
15.
16-
17
18
19
20
Reading Date Gross Net Depth to Net
Time Time Water Drop
~_ '?.-'-c:~ ,, (5'~/"4" .,t~
PERCOLATION RATE ~ '-'~1 (minutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEEN~ FT AND FT
COMMENTS $ & ~ ~.. [~l 1,~ i [,,~ ~.,~. ~ ~ ~[,~.~ /~/ / '
· · 0. ///
17d3~. Ea,~]e River Loop Road No 2 / ~
PERFORMED B~® River, AlasEa g~S7~ ' ~~
: ' ~/-~ ~ CERTIFY THAT ~E~T WAS PERFORMED IN
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL OESCRIPTION: ["1~" 1~ 'Z-- '"~"-/~ >jl~/~Township, Range, Section:
7
1
2
3-
4
5
6
7
8
9
10.
11
12
13
14
15
16
17,
18-
19-
2O
.~...~ SLOPE
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water A~r
Monitoring7 ~-~"~-~{ Date:
SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
~r G:~---~-~ ~' ~.,-.'/DJ" ~"
PERCOLATION RATE ~'- (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN "~ -- FT AND ~ FT
COMMENTS ~ .
S &SENGI,~EEEING .~ /~ /
17034 Eag,e River Loop Road" ///~ // ~
PERSORM~O ~ag~ ~:v=~, Al==k= 3~=7F*~o. 204 ~/ /~ CERT~SY THa~ffHI~EST~AS. PERFOaMEO ~N
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 02004280
1. GENERAL INFORMATION
Complete legal description
HAA # ~ f~,°l '~r'1.4~7t"~
Ptarmigan Roost'Subdivision,. Block 2, Lot 12
Location (site address or directions) 16300 Sandpiper Drive
Property owner James C. Arend Day phone
Mailing address5401 Cordova No. #204, Anchoraqe, Alaska 99518
Lending agency City Mortgage / Brenda Reynolds Day phone
Mailing address
277-0809
Agent Day phone
Address
Un/ess otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPLY:
Individual well xx
NOTE:
Community well
Public water '"
If community well system, .~rovide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site '
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
$ & $ ENGINEERING
Name of Firm _ .
ii0;~4 Eagle River L~op~d l~¢, 204
Address, Eagle River, Alaska~..//.~/~9~/~7
Engineers signature
Phone
DHHS SIGNATURE ~¢,_~z~.L~
~" Approved for _
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authorit~
Approval Certificates based only upon the representations given in paragraph 5 above by an independent~
professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes ~
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is i,ssued. The Municipality of Anchorage is not
i~7 ~ifi~il fBTcrk el rc~ r#1~Or OmissiOns in the prOfessiOnal engineer s wOrk' .
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: -'"~z.~-~ ~_/ L~-'/- /'~- Parcel I.D.
A. Well Data
Well type
Log present)
Total depth
Sanitary seal'N)
/~ k/'-fd, 7':~ If A, B, or C, attach ADEC letter. ADEC water system number
Date of test
Static water level
Well flow
Pump level1
Date completed '~¢' J~'~l ~1'~
Cased to
FROM WELL LOG
Wires properly protecte(~N)
AT INSPECTION
/
g.p.m. /
Driller ¢r L-~
Casing height
JCuNICIPALtTY OF ANCHORAGE
ENViRoNMENTAl' SERVICES DIVISION
AUG ~ 0 i993
O' ECEIVED
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot J
Absorption field on lot [
Public sewer main
Sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank f'--[ [~--
WATER SAMPLE RESULTS:
Coliform ¢ Nitrate
Date of sample: ~/,.~/~'~
B. SEPTIC/HOLDING TANK DATA
Date installed
Date of pumping
Collected by:
Other bacteria
"~r' [ ¢"~ l~'~-- Tank size I'~'~ /'~-~U-~ompartments
Foundation cleanou~)~ Depression (Y~
tested (WN) ~ :
Alar~ ~
Pumper ~ ~1~ ~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot j/~/ On adjacent lots
To property line l (2'--~ Absorption field ~ '4--
Foundation
Surface water/drainage
Water main/service line
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date install~ Manufacturer /
Size in gallons ~ Manh~
Vent (Y/N) ~'~~On'' level at _ .--'"'"'"/ "Pu'mp ;fi" Level at
MHi:ehtsWaMteorAal~recmt;:Velca, codes (Y. JJ4~~ Cycles tested
SEPAR~T~OM LIFT STATION
Well °_~tOt~ On adjacent lots ~ Surface water
Total absorption area
Date of adequacy test
D. ABSORPTION FIELD DATA
Date installed '~-'-"-~ [
Length ~ ~-- / Width
Water level in absorption field before test
Soil rating (GPD/Ft2) ,~,,,~
~ / Gravel thickness ~'~,
Cleanout present (~N)
Results (pass/fail) .
Peroxide
treatment
(past 12 months)/(~2
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~ Z~F~ I
To building foundation ~'~'~/
On adjacent lots
Surface water
Curtain drain
System type ~ ,~-~'~
Total depth .~A /
Depression over field (Y/~ P
for '~ Bedrooms
After test ~//~L.
If yes, give date ,~.///~- -
On adjacent lots I ~ ' --f- Property line
To existing or abandoned system on lot
Cutbank I,.1,~-1- ¢ Water main/service line
Driveway, parking/vehicle storage area
'+
E. ENGINEER'S CERTIFICATION
Signature ..
Engineer's Name
Date
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect
S & S ENGINEERING //~~~
17034 Eagle River roop//~g{~O. 204
Eagle River, Alaska 9~/,{i~/," ' -'
HAA Fee $ i.~)~ -~)~)
Date of Payment
Receipt Number
72-026 (3/93)* Back
/
Waiver Fee $
Date of Payment
Receipt Number
1g~ -' :~; 1
'CHRIS AR~ND PHOTOGRAPHt'
S+S Engineering
Attn: Lynda
~e: ~t 12', Block 2 Ptarmigan
F~: 694-1211
CHRIS
Roost
P H 0 t 0 .... p-~. ::IICI ,j.
To ~vhom it pay concern:
The septic on the abov,e referenced properly was installed' in the zt~'mmer of 1992.
The.houSe is being built now and the septic system has not beeh'in use. ,
Sincerely, ..
~rames C. Arcnd
Hom,'ebuyer