HomeMy WebLinkAboutPTARMIGAN VIEW ESTATES LT 5Ptarmigan View
Estates
Lot 5
#015-271-47
Municipality of Anchorage; "
Department of Health and Human Services
Building Safety Division
On-Site Water and Wastewater Program, 4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519.6650 Page 1 of 3
www.d.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number SWSW030488 PID Number: 015-271-47
"K e
b
Wastewater System: ❑ New ® Upgrade
M11 Chris Circle _99516
ABSORPTION FIELD
Plwrw: NueDer Of Bedrooms:
04
®o..p Tr.rla, O Snalbw Tmal p Bad D Mouq O Olrwr
LEGAL DESCRIPTION
sot Ra"
Taal Depthm
a or" grade:
Blow Loi &Jb"Sbn
Ptarmician View Fstatialt
Depth b p. bottom from w gn Weft
4 F,
Gr" depth Wreath pips.
6.0 FL
TO..alp'. R-ge. secT
Fa added above "hal grade
Ger.l tw9th.
Well [I New El Upgrade
G al"dh
Hun O. a nn. DiMarwa bet~lata
Classftatwn (Privala. A e. C)
Total Depth F1
Casal to: F1
Taal absapbm ar.s
420
Pp. Mat"
3034 PVC
Dnller
Data Dnned.
Slalw Waler Levo-
bataw.
Dal. Ntated.
A
A+ Home Servjees
1211912003
Y.ald. Pup Sa at Ging H..gN Abov. G-jW
TANK
GpM FI. Ft
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
7o
Septic
Absorption
Uft
Holding
ublWPrlvate
Lfaraxaraaac
c'p'°p"
From
Tank
Field
Station
Tank
sewertine
Anchors eTank
1000"
we"
100.9
100.4
50
Met"
Steel
of
"^b«2Gapw m.Ns
Sefaca wale,
100+
100+
LIFT STATION
La LM
5.1
10.2
8a.:
Maexa w
Gal
�•
67.6
70.01
.Free W W.V M'.
•Pump off l.Ml al'.
Hqh water alarm N'
Fandrwn
H
N
N
C~D.
1 100+
100+
PWV Mafia& Mow
ElKbkal lrwp.aions pwfom"d by
16 F of 2" Rigid Insulation over north end of field.
BENCH MARK
/'
J0/ 46) c -to +ctn
L""and Dssovq
West Entry Stair landing
d't% %I
As EN W,on
et.5 U
100.0 FL
^I ^
`
/ U U Q'rV
!
OICI Doiltib ed " C N.51wd
Engineer's Stamp
U 6
r t :Geld
'.*�www�\a��
`
n Dkicc-
Inspections performed by: Pannone Eng. Svc Dates: 12/18/2003
49L" �• ':r}♦
......0 .......:
2"°12/19/2003
Department of Health and Human Services approval
0
0 :,Steven R. Pannone;
•i
Reviewed and approved by: Date: -(9
S''•. N^ CE 81 a9
•, ' l?...... •°�':
(Rev. ,,Aig)
PERMIT NO:SW030488 RECORD DRAWING
WASTEWATER DISPOSAL SYSTEM
LOT 5 PTARMIGAN VIEW ESTATE SUBDIVISION
EXISTING 1r= I
SEPTIC !
I
I
I
I
I— 1
LLI
L,J
CHRIS CIr
(� I PRIMARY FIELD
I 1 6' ED, 33 LF, 9' TD -
zI EXISTING
Q SEPTIC
= I I SYSTEM--�,
NOTES:
1) All work shall be performed
in accordance with, and all
materials shall conform to.
DEC regulations.
5 2) Soils will be verified in
area of new trench at time of
installation. surrounding soils
indicate 1.2 gpdsf soils.
3) Install new trench as
indicated.
e 4) Install monitor tubes at
each end of field.
3 5) Abandon existing tank
in place.
"l 49M YK `_*
R. Pannoi
CE 8149
1
A
_/ 5.
1000 GAL
SEPTIC TANK
EXISTING
SEPTIC
0%
P.I.D. NO: 015-271-47
RESERVE FILED EQ
ON ADVANTEX T I�
6' ED, ,� I
I I
I I
I I
I
WELL RAPT SI 100
I I
I
AY i i
Derek Conklin
3021 Chris Circle
Anchorage, AK 99516
FL RADIUS 1
(STING
WELL-\
I
I I DOUBLE
I I CLEAN -0
I
--t-AE E}
TANK IN CE
I I
�\ 1
PEC TE: 1 M
AP LI ATIOIN RAT 1.2 GPD/SF
18 OUSE
E 'DI A: 375S
3 113' WIDE x 6' D
9f SF TOTAL
1iD gI SEPTIC TAN
PANNONE ENG. SVC, LLC
P. 0. BOX 102954
ANCHORAGE, ALASKA 99510
227-3522 P. 272-8218 Fax
UE: 12-21-03 AS—BUILT
'ALE, 1"-60' _._.
I CO
A
B
1
I DC1
49.2
34.9
1
I T1
79.7
68.4
1
I T2
77.3
67.6
DC
76.2
67.3
C2
75.4
67.7
1
I MT
72.1
71.1
1
1
I
1 C1
70.0
72.7
�\ 1
PEC TE: 1 M
AP LI ATIOIN RAT 1.2 GPD/SF
18 OUSE
E 'DI A: 375S
3 113' WIDE x 6' D
9f SF TOTAL
1iD gI SEPTIC TAN
PANNONE ENG. SVC, LLC
P. 0. BOX 102954
ANCHORAGE, ALASKA 99510
227-3522 P. 272-8218 Fax
UE: 12-21-03 AS—BUILT
'ALE, 1"-60' _._.
PERMIT NO:SWO30488 RECORD DRAWING DETAILS
WASTEWATER ABSORPTION SYSTEM
LOT 5 PTARMIGAN VIEW ESTATE SUBDIVISION
NOTES:
1) ALL WORK SHALL BE PERFORMED
IN ACCORDANCE WITH, AND ALL MATERIALS
SHALL CONFORM TO, AMC15.65.
2) MAINTAIN 30' SEPARATION FROM ALL
SLOPES GREATER THAN 25%. unnv3b c
n
0
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8
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39m NOLNm
ua wm C
uw Nvm
3MA00
P.I.D. NO: 015-271-47
g It
ino Nim
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• rntrAMLIJ rUM: Pannone Eng. Svc., LLC
R. Pannone 3 = Derek Conklin 9
8149 `� P. 0. BOX 102954
(ZZL�� 3021 Chris Circle ANCHORAGE, ALASKA 99510
z• • Anchorage, AK 99516
�; ••• 272-8218 PHONE & FAX
DATE: 12-21-03
NOT TO S A AS—BUILT
SOILS LOG - PERCOLATION TEST �.��P. ................
PANNONE ENGINEERING SERVICES
P.O. BOX 102954 49TH
ANCHORAGE, AK 99510 i
..........................
j�. .
(907)272-8218 Steven R. Pannone i
�1 ° No CE 8149
�CL7Ei.••ii
PERFORMED FOR: Derek Conklin DATE PERFORMED: 12-18-03
LEGAL DESCRIPTION: Lot 5 Ptarmigan View Estate SID
TEST HOLE 2 SLOPE
1 Q� 6
OR/ Brown Silt Q
2 FILL FpStiNo
3-
4—
Q�
7 5
5 WELL 5La
Itq'
6 w
CHRIS CIr
r tN
7—
w to
S Z cx
SEPnC
SM/SP Gray siltysand
9 to poorly T/
graded sand
�I
10 TEST
11 HOLE BSEP
i TN
12 i
13
E WAS GROUND WATER SLOPE
d 14 ENCOUNTERED? NO
v.
is IF YES, AT WHAT
16 DEPTH? -N/A- TEST HOLE
BOII DEPTH TO WATER AFTER 1F
w 17 MONITORING? DRY
CL 18 DATE: 12/26/03
J 19
READING DATE GROSS NET DEPTH OF NET
20
U
of
0
In
J
O
3
PEROLATION RATE 2.5 (min/inch) PERC HOLE DIAMETER 6 inches
o TEST RUN BEWTEEN 7 FT and 8 FT
u
2
n COMMENTS: Test hole excavated by A+ Home Services. Test Hole was presoaked before pert test.
.`
PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
o WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
TIME
TME
WATER
DROP
12/10/03
19:a0
a'
----
19:50
10
2'
a'
19:50
10
a 1 9'
----
20:00
10
21 e'
a'
20:00
____
61 a'
----
20:10
t o
2 t a'
{'
MUNICIPALITY OF ANCHORAGE
Development Services Department
Onsite Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
03
(Z�tal63
Date Issued: Nov 21, 2003
Expiration Date: Nov 20, 2004
Permit Number: SW030488 Parcel ID: 015-271-47
Legal DescriptionrPtarmipan :View Esta'tea Cot 51
Design Engineer: 0062 Pannone Engineering Services Site Address: 3021 Chris Circle
Owner Name: Darek Conklin Lot Size: 21801 SO. FT.
Owner Address: 3021 Chris Circle Total Bedrooms: 3 Permit Bedrooms: 3
Anchorage , AK 99516 -
This permit is for the construction of:
Q Disposal Field ❑/ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specked 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
�Z//8/03 SSC FuGIAvFEjP"S R6v04L,0 r5s/GN 4.iTK Ti{` t:oRRsc%p
v c/4 rl o,v Acv D TK[ ,v 15 W C a C* T'i a N o� TNT PA� $/GLV
OK SrP)_1L SYSrLeM
Received Sr.
Issued By:
Date: Z " ✓
Z?Z_9= Date: Z 03
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.enchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcell.D. Ots— 2'7E,fg7- Permit Number SW 030988
Property owner(s) Darek Conklin Day phone
Mailing address (1) 3021 Chris Circle
Mailing address (2) Anchorage, AK
Legal description (Lot, Block & Sub'd.) Lot 5 P
Legal description (Section, Township & Range)
Lot SizeO 'Z? 110 rpt Acres/Sq.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms
Code 99516
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ED
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: Waiver Fees:
Date of Payment: / 0-3 Date of Payment:
Receipt Number: Uv? 1 D 5 9eceipt Number:
(Rev. 12/00)
Pannone Engineering Services, LLC P.O. Box 102954
Consulting Engineers Anchorage, Alaska, 99510
November 5, 2003
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 S. Bragaw Street
P. O. Box 196650
Anchorage, Alaska 99519
view
Subject: Lot 5 Ptarmigan`�states
Septic Upgrade Permit
FAILED SYSTEM
Gentlemen:
My firm was contacted to conduct a Health Authority Investigation of the septic system
serving this lot for a pending house sale. There is an undocumented system on this lot.
I have discussed this lot with you over the past year. The existing undocumented system
is located approximately 65 feet from the well. I am proposing abandoning the existing
system and installing a new system completely outside the 100 foot well radius. A single
test hole was excavated on October 24th. The soils report and a percolation test result
is attached. Ground water was monitored for seven days. No groundwater or bedrock
was encountered in the test hole.
The lot is approximately 0.45 acres in size. Lot 5 slopes to the west at approximately 3
to 10 percent. The proposed installation will be located in the southeast corner of the lot
on a relatively flat spot (1-2%). The existing fields will be abandoned and removed. A
new 1,250 -gallon steel S.T.E.P. tank will be installed outside the 100' well radius.
Double clean -outs will be installed down stream from the tank. The proposed location is
greater than 100 feet away from the existing well serving this property and 25 feet from
the water service lines. The surrounding wells are located greater than 200 feet from the
proposed installation. The proposed installation will not affect the future development of
the surrounding or existing lots. See the attached design.
If you have any questions or concerns, please contact me at 227-3522 or 272-8218.
Sinc5rrjL
Steven R. Pannone, P.E.
Attachments:
PERMIT NO:SW030488 DESIGN DRAWING
WASTEWATER DISPOSAL SYSTEM
LOT 5 PTARMIGAN VIEW ESTATE SUBDIVISION
/\ EXISTING
SEPTIC
1-4 SYSTEMSYSTEM
1 7 E
� I
LIJ
LIJ
c ; CHRIS CIr
I PRIMARY FIELD
10,
1 1 6 ED, 33 LF, 9'T
zEXISTING
1
Q I I SEPTIC
�\
= I SYSTEM
NOTES:
10'8
1) All work shall be performed
1000 GAL
in accordance with, and all
SEPTIC TANK
materials shall conform to,
DEC regulations.
EXISTING
2) Soils will be verified in
SEPTIC /
SYSTEM-
: area of new trench at time of
installation. surrounding soils
indicate 1.2 gpdsf soils.
3) Install new trench as
indicated.
EXISTIN
4) Install monitor tubes at
SEPTI
t each end of field.
SYSTE
3 5) Abandon existing tank
5 in place.
ON
6-
0%
I
FILED 0
P.I.D. NO: 015-271-47
I I
I
WELL RA It Si 100'
I I
I 1
I I
I I
� I
I
CLEAN
ABANDON
129-
0.0 I TANK IN
I I
� 1
1
�-1 I
I E�L RADIUS 100'
I
-4
STING
a
OF Ott
I WELL
� Lj'• �� 2 I I
1
3 i 49TM
I
I
I
I
1
1
1.2 GPD/SF
1E 'DjAREA* 375 S
3 F13 WIDE x 6' D
94 SF TOTAL
110 11 SEPTIC TAN
�*2 3••••••••••••••:• •a F'HLF'AKLU FUK: PANNONE ENG. SVC, LLC
,en R. Pannone P. 0. BOX 102954
m Derek Conklin
No. CE 8149 3021 Chris Circle ANCHORAGE, ALASKA 99510
7512(5,,.••'�'4l Anchorage. AK 99516
�• 227-3522 P, 272-8218 Fay
1,:'• DATE: 11-5-2003 DESIGN
PERMIT No: DESIGN DETAILS
WASTEWATER ABSORPTION SYSTEM
LOT 5 PTARMIGAN VIEW ESTATE SUBDIVISION
NOTES:
1) ALL WORK SHALL BE PERFORMED
IN ACCORDANCE WITH. AND ALL MATERIALS
SHALL CONFORM TO, AMC15.65.
2) MAINTAIN 30' SEPARATION FROM ALL
SLOPES GREATER THAN 25%.
Lm NY=
3eru xouran
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F—
U
L1 1
LJ
CJ
I
0
ri
mo WTO
n n
� I NONTJ
' 49TM /� Y
................ ...............
......:
Steven R. Pannone r
� ,
Derek Conklin
3021 Chris Circle
Anchorage, AK 99516
W
J_
li.
O
m
IL
Pannone Eng. Svc., LLC
P. 0. BOX 102954
ANCHORAGE, ALASKA 99510
272-8218. PHONE & FAX
DESIGN
PERMIT NO: DESIGN DRAWING
WASTEWATER DISPOSAL SYSTEM
LOT 5 PTARMIGAN VIEW ESTATE SUBDIVISION
Q,
7
EXISTING
SEPTIC
'Swl u"TA t(,
W EXISTING
W SEPTIC
r)l SYSTEM
V) CHRIS CIr
z [� EXISTING
Q SEPTIC
= SYSTEM p�
10' MIP
NOTES:
1) AM work shall be performed 1250 GAL
in accordance with, and all S.T.E.P. TANK
materials shall conform to,
DEC regulations.
2) Remove existing drain rock
c and in—situ soil contaminated
with organic matt (assume 1.0'
below bottom of bed). Import
la filter material (sand) to bring
excavation to proper elevation.
Dispose of contaminated soils.
f
i 3) Install new trench as
i indicated.
3 4) Install monitor tubes in
n opposite corner from
cleon—outs.
i
J
5) Verify integrity of the
existing tank. Replace if holes
E are found.
Y
4t? 49TH
ten R. Pannone
No.CE 8149
PRIMARY FIELD
5' ED, 38 LF, 8' TO
2
P.I.D. NO:
WELL RADIUS 100'
DRKWAY
10 .7
51.3 1 0.0
to
10' MIN.
EXISTING
SEPTIC
Derek Conklin
3021 Chris Circle
Anchorage, AK 99516
TH Y
1A 10' MIN:
L RADIUS 100'
STING
WELL
RESERVE FILED
5' ED, 38LF, 8' TD
0' MIN.
1
PEI -
RATE: 1 M
AP LICATION RAT 1.2 CPD/SF
3 B HOUSE
RE 'D AREA: 375S
38 F 2' WIDE x 5' D
1
PANNONE ENG. SVC, LLC
P. 0. BOX 102954
ANCHORAGE, ALASKA 99510
227-3522 P, 272-8218 Fax
tTE: 11-5-2003 DESIGN
'ALE: 1"-60'
PERMIT NO: DESIGN DETAILS
WASTEWATER ABSORPTION SYSTEM
LOT 5 PTARMIGAN VIEW ESTATE SUBDIVISION
NOTES:
1) ALL WORK SHALL BE PERFORMED
IN ACCORDANCE WITH, AND ALL MATERIALS
SHALL CONFORM T0, AMC15.65.
2) MAINTAIN 30' SEPARATION FROM ALL
SLOPES GREATER THAN 25%. 301UV'
w
1
sa a Z
O
I-
U
1.> iw Ld
39n1 aeuNM
P.I.D. NO:
0
• F'KtrAKtu rUK: Ponnone En Svc., LLC
P nnone a 9•
a Derek Conklin P. 0. BOX 102954
14 �i 3021 Chris Circle
(� ;. aU• ANCHORAGE, ALASKA 99510
♦ Anchorage, AK 99516 070_001 o DLIr1AIC a, cev
SOILS LOG - PERCOLATION TEST
PANNONE ENGINEERING SERVICES
P.O. BOX 102954
ANCHORAGE, AK 99510
(907) 272-8218
PERFORMED FOR: Derek Conklin DATE PERFORMED: 10-24-03
LEGAL DESCRIPTION:_ Lot 5 Ptarmigan View. Estate S/D
TEST HOLE I
F--0—R--j ORGANICS
I
2
3-
4-
45678SM/SP
ML
Brown Silt
NET
DROP
5-
6•
6-
4:00
10
7-
074 sumo
4:00
8—
a•
7
4:10
SM/SP
Grey siltysand
9
4:10
to poorly
~
W
Mct1 b0i
graded sand
10
W
DamK
yy�
11
0'
12
13
CHRIS CIr
14
W
15
Z
16
17
stPnc
BOH
=
Srsttr� _�
18
19
ammc
20
sLoPE
TEST
HOLE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WT [AT
DEPTH? -N/A-
DEPTH TO WATER AFTER
MONITORING? DRY
DATE: 11/2/03
SLOPE
TEST HOLE
READING DATE GROSS
TIME
NET
TIME
SITE PIAN
NET
DROP
6
6•
�� mmmC
4:00
10
Dry
074 sumo
4:00
-----
a•
7
4:10
10
D7
G
4:10
-----
~
W
Mct1 b0i
s too'
10
W
DamK
yy�
0'
SrSfE
H
CHRIS CIr
W
Z
1%KTNG
stPnc
=
Srsttr� _�
ammc
iH
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WT [AT
DEPTH? -N/A-
DEPTH TO WATER AFTER
MONITORING? DRY
DATE: 11/2/03
SLOPE
TEST HOLE
READING DATE GROSS
TIME
NET
TIME
DEPT OF
WATER
NET
DROP
10/24/03 ]:SO
6•
—__-
4:00
10
Dry
E
4:00
-----
a•
-----
4:10
10
D7
6
4:10
-----
6'
-----
4:20
10
Dry
8
PEROLATION RATE I (min/inch) PERC HOLE DIAMETER 6 inches
TEST RUN BEWTEEN 5 FT and 6 FT
COMMENTS: Test hole excavated by A+ Home Services Test Hole was presoaked before perc test
PERFORMED BY: Steven R. Pannnne_ P F T rtatrrtry ruAm �rte
A: -
Municipality of Anchorage
Development Services Department
• ++ Building Safety Division
Onsite Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6850
www.ci.anchorage.ak.us
(907)343.7904
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: PANNONE ENG.
Legal description: PTARMIGAN VIEW ESTATES LOT 5
The attached paperwork has been reviewed and Is being returned for the following reasons:
❑ Original signature or stamp missing on _
❑ calculation error in design. _
❑ Additional soils information needed.
❑ Water monitoring results Inadequate.
❑ Discrepancy in information submitted. _
❑ Topographic information missing or inadequate. _
® Incomplete; missing FOUNDATION CLEANOUT?
❑ Incomplete; missing
❑ Additional adequacy test information needed. _
❑ Water sample unacceptable. _
❑ Meesured/proposed distances/dimensions missing. _
❑ Locations of all soils, percolation and water monitoring tests not shown. _
❑ Proposed system too deep for soils information submitted.
❑ Well log required. _
❑ Omission in narrative. _
❑ Insufficient fill over tank or field. -
0 Other. ARE THERE CLEANOUTS ON A 1.5 INCH PERFORATED DL
UNDER PRESSURE? 14) 0 � � _T `S � L> l� CH 'l? (JV
Name of reviewer: DAN Date: 11/17/03
amt it
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
•
• OPJE . 8t,
Municipality of Anchorage
On-Site Water and Wastewater Program
(907) 343-7904 s F E T Y
Certificate of On-Site Systems Approval
v
Parcel I.D. 015-271-47 Expiration Date: /
1. GENERAL INFORMATION:
Complete legal description PTARMIGAN VIEW ESTATES; LOT 5
Location (site address) 3021 Chris Circle*Anchorage,AK 99516
Current Property owner(s) Chris&Meghan Jewell Day phone 865-6406
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer , ❑
WaiverNariance request for: Distance:
Received by: �f Date: / '� / L
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ SAC Waiver Fee $
Date of Payment io fa5//t Date of Payment
Receipt Number (?�l 7 Receipt Number
COSA# 05c ii/5(/ Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101-Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: (o J 2i-4f 0
,000000p�
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o• OF •.,4 . %Q�4
in accordance with the guidelines and regulations established by the Municipality of Anchorage and < hn
industry practices. The reported results describe the condition of the system/s on the date/s of the '� •�•• •7 U
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or QQ -.....A.-- ••
encroachments may exist that were not identified during the evaluation. The operational life of all wells / * ,•• 4 . V
a
OD
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, /••••••• ••••
ir
groundwater levels (that may fluctuate during the year), quality of construction (materials and // p Q
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary,and Q. .. .. Q
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the (//� •• - , e •. Corness, Q
system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of °a m CE •79 3 • `Q�
the well or septic system. GEG makes no representation whether an alternative well or septic system Q 9' ) •' p
can be installed on the property in the event either of the current systems fail to perform adequately in 11fe, t"J!Ztf• !•�' c,co
the future. The content of this report is for the sole benefit of the person/party that retained GEG to 4�PaProfesso�°oo
perform the evaluation. Reliance upon the information provided in this report by any other person or �� oOOoo�
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE
System #1 Approved for -� bedrooms
System #2 Approved for bedrooms �\ \`t vl- tirvcy
Disapproved `v� C1
Conditional approval ON-SITE �m,
for bedrooms, with the following•atipt I. AND
WASTEWATER 0,7-
PROGRAM •?.-
cs
�
4'iVSER AC,-
______e.,K____---—-r- --.-—-02.-_-:By: t^" --�� ` Original Certificate Date: l a-9‘ _l e
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 Nitrate Advisory •
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10-10-12.doc
•
If more than 1 septic system is on the lot:
COSA Checklist# of_
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: PTARMIGAN VIEW ESTATES; LOT 5 Parcel ID: 015-271-47
A. WELL DATA *PER ARROW WELL&PUMP 2012 INSPECTION-SEE MOA RECORDS
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) NO
Date completed 1970(?) Sanitary seal (Y/N) Wires properly protected (Y/N) YES
Total depth *230 ft. Cased to *40+ ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 10/10/18
•
Static water level ft. 144.4 ft,
••
Well production g.p.m. 5.2+ g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 ml. Nitrate ND mg./L. Collected by: GEG, Ltd.
Arsenic: <5.0 ug./L. Date of sample: 10/10/18
B. SEPTIC/HOLDING TANK DATA **DOUBLE CLEANOUTS BEFORE TANK
Tank Type/Material SEPTIC STEEL Date installed 12/18-19/03
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) *NO Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 6/28/18 Pumper NORTHLAND PUMPING
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE AT MONITORING TUBE
Date installed 12/18-19/03 Soil rating ..p.d./ft •r ft2/bdrm) 1.2 System type DEEP TRENCH
Length 35 ft. Width 3 ft. Gravel below pipe 6.0 ft.
Total depth *8+ ft. Eff. absorption area 420 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 10/10/18 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 10 in. Water added 702 gal. New depth 28 in.
Elapsed Time: 1425 min. Final fluid depth **10 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N &type) NO If yes, give date -
**DRAINFIELD MADE FULL RECOVERY
-MONITORING TUBE EXTENDS 5.7 FEET BELOW INVERT
-DRAINFIELD MAY BE SHY ON SOIL COVER.SEE ATTACHED EMAIL FROM CLIENT INDICATING NO FREEZING ISSUES
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at _in. "Pump off' level at .• *• wa er alarm level at in.
•- -•- Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots *100'+ (WITH CAVEAT)
Absorption field on lot 100'+ On adjacent lots "100'+ (WITH CAVEAT)
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'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10'+ Property line 5'+ Absorption field 5'+ (ASSUMED)
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line _ 10'+ Surface water 100'+ Driveway, parking/vehicle storage 6'
Curtain drain 10'+ Wells on adjacent lots 100'+
F. COMMENTS
`UNABLE TO PROPERLY VERIFY DISTANCE TO DRAINFIELD ON PTARMIGAN VIEW ESTATES: LOT 6 BECAUSE SUMP
IN DRAINFIEI D COULD NOT BE FOUND. 100'+TO DRAINFIELD MONITORINGIUBF ON HOMAN ACRFS:LOT 2.
MOA RECORDS FOR HOMAN ACRES: LOT 2 ARE VERY POOR SO 100'SEPERATIONDISTANCE IS NOT CERTAIN.
G. ENGINEER'S CERTIFICATION ,`P• •.••• •.S`L♦♦♦
I certify that I have determined through field inspections and , • 49'�; �� �•
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this ••• • ',
date. 10.;:%:.
or. swEngineer's Printed Name JEFFREY A.GARNESS
' CE-7953 a• :�
Date / Q/�),`6- ♦♦co „• .......
ESSI �P��••
LICENSE �III%„`s***
#AECC884
(Rev. 10/12/12)
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QO'� • • oQ AS—BUILT SURVEY 1 " = 20 '
�, NO CORNERS SET THIS DATE
OQON SHANE A. HOLT • ..�0
4(0 LS-6914 co ,e: ' I HEREBY CERTIFY THAT I HAVE PERFORMED A SL
4�4'°r SURVEYOROEREOBY OF THE FOLLOWING DESCRIBED PROPERTY
4 °fessiona'oo LOT 5, PTARMIGAN VIEW ESTATES ( PLAT 71-165)
ft§ .f0 DAR WALDEN a
KELLER WILLIAMS
ANCHORAGE RECORDING DISTRICT, ALASKA, AND T
VISIBLE IMPROVEMENTS SITUATED THEREON ARE IL
THE PROPERTY LINES AND NO VISIBLE ENCROACHr
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY EXIST OTHER THAN NOTED.
CONFLICTS
OTED-
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. DATED OCTOBER N C O R A G E,ALASKA THIS 8 T H DA
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN , 2018
HEREON ( UNLESS INDICATED)
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. HOLT LAND
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. 9309 GROV
ANCHORAGE
14061, FB 192-60 345-5513
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
i
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
/� n
Parcell.D. __.�� COSA# Q�CLZQ42
1. GENERAL INFORMATION Expiration Date: —1 — 2 l
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
PTARMIGAN VIEW ESTATES S/D• LOT 5
3021 CHRIS CIRCLE * ANCHORAGE, AK * 99516
SUSAN KREISER Day phone C/O AGENT
3021 CHRIS CIRCLE * ANCHORAGE, AK * 99516
Day phone
NATE BAER W/ KELLER WILLIAMS Day phone 727-1130
101 W BENSON BLVD #503 * ANCHORAGE AK *99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
0
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water 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.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. i further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone
Address
3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
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 right whatsoever.
5. DSD SIGNATURE
_,G Approved for -3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
337-6179
Date Z(o (Z
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
ON-SITE
WATER AND
WASTEWATER
PROGRAM
By: Original Certificate Date: ( 1
(Rev. 11/05)
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.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: PTARMIGAN VIEW ESTATES S/D; LOT 5 Parcel ID: OL_– :ZL4 %
A. WELL DATA *PER AAROW PUMP AND WELL INSPECTION. SEE ATTACHED.
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Lag (Y/N)
Date completed –1970 Sanitary seal (Y/N) YES
Total depth *230+ ft. Cased to *40+ ft.
FROM WELL LOG
Date of test
Static water level-vN�N��N ft.
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml.
Arsenic: /=_ ug./L.
Nitrate /N0 mg./L.
NO
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
AT INSPECTION
6/1/2012
Date of sample: 6/l/2012
7.46+ —
9 -p.m -
Collected by: GEG, Ltd.
B. SEPTIC/HOLDING TANK DATA *DOUBLE CLEANOUTS BEFORE TANK.
Tank Type/Material SEPTIC/STEEL Date installed 12/18-19/2003
Tank size 1000 gal. Number of Compartments E Cleanouts (Y/N)
YES
Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO High water alarm (YIN) N/A
Date of pumping Pumper M f 0On 4. J CJC,
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE
Date installed 12/18-19/03 Soil rating ( .p.d.1 r ft2/bdrm) 1.2 System type TRENCH
Length 35 ft. Width 3 ft. Gravel below pipe 6 ft.
Total depth *8 ft. Eff. absorption area 420 fC Monitoring tube YES Depression over field NO
Date of adequacy test **6/l/2012 Results (Pass/Fail) PASS For E bedrooms
Fluid depth in absorption field before test 23 in. Water added 680 gal. New depth 23 in.
Elapsed Time: min. Final fluid depth 23 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
**HOUSE WAS VACANT AT TIME OF TEST. DRAINFIELD WAS PRE—SOAKED WITH 2535 GALLONS IMMEDIATELY
BEFORE TEST. DRAINFIELD WAS DRY AT BEGINNING OF PRE—SOAK AND WAS DRY AGAIN WHEN CHECKED
THE FOLLOWING MORNING. DRAINFIELD ABSORBED 3215 GALLONS IN LESS THAN 24 HOURS. NOTE: NORTH
16' OF DRAINFIELD INSULATED PER INSPECTION REPORT. 24" SOIL COVER SATISFIED.
D. LIFT STATION
Date installed Size in gallons Manhole/Access
"Pump on" level at in. "Pump off" level Hiah water alarm level at
Cycles tested Meets alarm & circuit requirements9
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankflift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main N/A
Sewer /septic service line 25'+
Animal containment areas 50'+
Public sewer manhole/deanout N/A
Holding tank
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
10'+
Building foundation
10'+
Water main N/A
Water service line
10'+
Surface water
100'+
parking/vehicle Driveway, arkin g
y p store L 5`+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certdy 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 Printed Name JEFFREY A. GARNESS
Date 61 � a
COSA Fee S �qU
Date of Payment %a/a�`La�
Receipt Number Q qdT—
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
Community Development Department Right of Way Section
Development Services Division Phone: 907-343-8240
Mayor Dan Sullivan
June 27, 2012
Susan Kreiser
3021 Chris Circle
Anchorage, AK 99516
Fax: 907-343-8250
RE: Encroachment: Septic Tank and Pipe in the 10' Drainage Easement, Ptarmigan View Estates Subdivision,
Lot 5, Grid SW2634, 3021 Chris Circle
The Right of Way Division has reviewed a request for a letter of non -objection to an existing septic tank and pipe, which
encroaches 5.1' into the 10' Drainage Easement. On the as -built survey dated December 12, 2003, submitted with the
request, the petitioner has shown the septic tank and pipe.
This letter of non -objection is issued with stipulations, and by using it the petitioner is agreeing to the following:
Municipality of Anchorage (MOA) will be held harmless, now and forever, for any damages or injury to any
person as a result of the encroachments.
2. All applicable codes and regulations will be observed and maintained within the easement.
3. This letter of non -objection will in no way preclude MOA from full use and enjoyment of its rights within any
portion of the easement.
4. Additional and extraordinary costs incurred during any future required construction, repair or reconstruction of
MOA improvements to accommodate any or all of the encroachments shall be paid by the property owner.
5. Maintain letters of non -objection from the following utilities:
❑ Anchorage Water & Wastewater Utility ❑ Alaska Communications Systems
❑
Chugach Electric Association, Inc.
❑
Matanuska Telephone Association
❑
Matanuska Electric Association, Inc.
❑
ENSTAR Natural Gas Company
❑
Municipal Light & Power
❑
GCI Cable of Alaska
❑
Eyecom (Girdwood Cable TV)
®
No letters required
All letters of non -objection should be retained in your permanent files. If you have any questions, please call me at
343-8240.
Sincerely, y�
AUack . Frost, Jr.
Right of Way Supervisor
Concur
Property Owner(s)
AAROW PUMP & WER SERVicE, LLC
P.O. Box 110495
Anchorage, AK 99511
/1 �� Office: (Eagl River:
° Fax 2 -93 333-8976
�(�✓ Eagle Rivec (907) 622-9335
F
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P -MIP DEP:^
Old I'3TY
DESCR}PTI
PRICE AMOUNT
A
.
1. ,,.,... rLIP
w
LABOR
HOURS RATE
AMOUNT TOTAL MATERIAL
TOTAL.. LABOR
i
i
WORK ORDERED BY RATE COv1P TOTAL.
LABOR
PAY THIS AMOUNT
SIGNATURE
Q Hereby Acknowl e the Satisfaaary Completion or the Above Described Work and agree that if above work is not paid for in go days I agree to al:vm Aarow
Pump e, Wall Service, LLCequipment and charge for labor already perrformed & labor to remove unpaid for equipment.)
TERMS: ACCOUNTS PAYABLE AT 76TH OF MONTH FOLLOWING PURCHASE,
SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS.
%'1
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FASEMENTS OF RECORD, OTHER THAN Fri, 022, 03-6 p58
HOSE SHOWN ON THE RECORDED #�
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HOUSE M. I
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AS -BUILT NO CORNERS SET THIS DATE VC9.6s co
I hereby certify that I have performed a Mortgagee's Inspection
of the following described prope Lor 5,
PrArzoiGAM VfEW CZ;rArE5
Anchorage Recording Precinct, Alaska, and that the
Improvements situated thereon are within the property fines and
do not overlap or encroach on the property lying adjacent
thereto, that no Improvements on property lying adjacent thereto
encroach on the premises In question and that there are no
roadways, transmission lines or other visible easements on said
property except as indicated hereon.
Dated at Anchorage, Alaska
this 17 'A day of TUNE 20 oz
FRED WALATKA & ASSOCIATES
(907) 248.1666 Engineers and Surveyors
Parcel I.D.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 995195650
www.muni.org/onsfte
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
015-271-47
1. GENERAL INFORMATION
COSA # Lgpo q5
Expiration Date: % — l & — 07
Complete legal description Ptarmigan View Estates Lot 5
Location (site address) 3021 Chris Circle, Anchorage, AK 99516
Current Property owner(s) Heather & Mark Stratton Day phone
Mailing address 3021 Chris Circle, Anchorage, AK 99516
Lending agency Day phone
Mailing address
Real Estate Agent Katherine DeHoop / Coldwell Banker Day phone 230-8522
Mailing Address 3000 C Street, Suite 9101, Anchorage, AK 99503
Unless otherwise requested, COSA will be held by DSD /or pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
0
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site 0
Individual Holding Tank ❑
Community On-site ❑
Public Sewer ❑
L; T
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of 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 Onsite Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my Investigation,
based on procedures outlined in the Certificate of OnSHe 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 Watkins Engineering, Inc. Phone (907) 349-1851
Address P.O. Box 110443 Anchorage, Alaska. 89516
Engineer's Printed Name Cindy W. Ellis Date
rd
6. DSD SIGNATURE
✓ Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the
442-0
W
tdy W. Ellis
CE -lose .?
/ LLQ11111011 W. ""
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: /6-0-7
(11" 11M)
Municipality of Anchorage
• Development Services Department
Building Safety Division
OnSbe Water & Wastewater Program
4700 SM98w Street
P.O. Box 190650
Anchorage, AK 99519.0050
www.muni.orglonsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Ptarmigan View Estates Lot 5 Parcel ID: 015-271-47
A. WELL DATA
Web type Pit if A B, or C provide PWSID S _ Wed Log (YIN) No
Date completed 1970+1- Sanitary seal (YIN) Yea Wlrea property protected (YIN) Yea
Total depth I Eft. Cased to r{o k R. Casing height (above ground) 24 in.
FROM WELL LOO AT INSPECTION
Date of teat March 30.2006
Static water level fi. 145
Web production 9.p -m. LLt-- g.p.m.
WAIE&SAMPLE RESULTS: Ilbr07
RAW0 codomu11 0 mL Nitrate <g•1 mg1L Other bacteria' 0 cobnies/100 mL
Ate : < 0.005 m9A Date of sample: 3IP W7 Collected by: Rocky Trainor
B. SEP ICIHOLDING TANK DATA
Tank Type/Materiel Steel Septic Tank Date installed December 19, 2003
Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) Yes
Foundation cteanord (YIN) DCO Depression over tank (YIN) No High water alarm (YIN) WA
Data of pumping 414/!007 Pumper Northland Pumping Service Inc
C. ABSORPTION FIELD DATA
Data installed 12119a Soil rating (9.p.d.fie or felbdnn)1.2 System type Deep Trench
Length 35 R. Width 3 R. Gravel below pipe 6 R.
Total depth 9 R. Eff. absorption area 420 flu mor dtorirg tube Yes Depression over field No
Data of adequacy test 3130/2000 Results (PaaslFaiq Pass For 3 bedroom$
Fluid depth in absorption field before test 21.5 in. Water added489.2 gal. New depth 27.6 in.
Elapsed Tine: 154 min. Final fluid depth 22.6 in. Absorption rate >= 460 g.p.d.
Any rejuvenation Vestment (past 12 mo.) (VM & type) No if yea, give date
D. LIFT STATION
Data insta0ed NA Size in gallons Manhole/Access (y/N)
'Pump on' level at _ in. 'Pump (C level at _ in. High water alarm level at in.
Datum Cycles tested Mesa alarm b circuit requi wnents9
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAitt station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+
Public sewer main 100'+
Sewer /septic service line 45'
On adjacent lots 100'+
Public sewer manhole/cleanout 100'+
Holding tank WA
Animal containment areas 100'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 63' Property line5' Absorption field 5'
Water main 100'+ Water service fine 9T+ Surface water 100+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property fine 10' Building foundation 67' Water main 100'+
Water Service fine 100'+ Surface water 1001+ Driveway. PaWng/vehide storage g'
Curtain drain N/A Wells on adjacent lots 100'+
F. COMMENTS: Weil rate resrtieted to avoid running out of water, Water level during test @ 158' from TOC
March 28, 2007 water test had 2 OB with colhorm. No fecal. Well chodnated and retested 46.2007.
Distance from well to seotic aystem was chm* d Wer, rnml .im , -
0. ENGINEER'S CERTIFICATION 1% .... WX.....
I Gentry Mat I have determbred Nuougn field kwpectiom and ,�' 491tt
review of Municipal records Mat Me above systems ars in :y
cwdbr arx:a WAb MOA COSA guW11fies in effect on this date.
Engineer's Printed Name Cindy W EMs ; C) d
Y W. Ellis
Date 4 -/Z -o7 CE.1oen
COSA Fee E `r Waiver Fee $ -
Date of Payment y Date of Payment
Receipt Number Receipt Number
M". 111051
Parcel I.D. 015-271-47
1. GENERAL INFORMATION
HAA # o-�>o b4
Expiration Date:_q - p
Complete legal description Lot 5 Ptarmigan l/i r c 3 S
Location (site address or directions) 3021 Chris Circle, Anchorage AK 99516
Current Property owner(s) _Patience Hight *e Day phone 727-1191
Mailing address
Lending agency Day phone
Mailing address
Real Estate Agent Colin Roth/ReMax Day phone 727-1191
Mailing Address
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
2.= NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
3
TYPE OF WASTEWATER DISPOSAL:
®
Individual On-site
Municipality of Anchorage
❑
Development Services Department
:•'�°'
Building Safety Division
On -Site Water and Wastewater Program
+• •••
4700 South Bragaw Street
P.O. Box 196650 Anchorage. AK 99519-6650
❑
www.ci.anchorage.sk.us
(907)343-7904
❑
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
y
Parcel I.D. 015-271-47
1. GENERAL INFORMATION
HAA # o-�>o b4
Expiration Date:_q - p
Complete legal description Lot 5 Ptarmigan l/i r c 3 S
Location (site address or directions) 3021 Chris Circle, Anchorage AK 99516
Current Property owner(s) _Patience Hight *e Day phone 727-1191
Mailing address
Lending agency Day phone
Mailing address
Real Estate Agent Colin Roth/ReMax Day phone 727-1191
Mailing Address
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
2.= NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
3
TYPE OF WASTEWATER DISPOSAL:
®
Individual On-site
❑
Individual Holding tank
❑
❑
Community On-site
❑
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also Issues HAAs upon request to home owners. Certificates of Health Authority Approval are
valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. 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 engineers work.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat affixed hereto and as of the validation date shown below, I verify that my Investigation
based on procedures outlined in the Health Authority Approval Guidelines for 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 applicable Municipal and State
codes, ordinances, and regulations in effect at the time of Installation.
Name of Firm Pannone Eng. Svc. Phone 272-8218
Address P.O. Box 102954 Anch AK 99510
ON-SITE
Engineer's Printed Name Steven R. Pannone P.E. Date i?�-ZgtoZ
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious
engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The
reported results describe
♦♦��
the performance of system under the conditions encountered at the time of
the test, and separation distances measured to readily identifiable features.
♦�P ....
♦ •.
�J,.•'•�•
The operational life of all .
wells and septic systems depend on the local soil condition, ground water levels that may fluctuate
i
i {z
during the year, and the water usage of the family being served b the
S Y 8 Y system 7heu conditions are
,•
49 t" °
outside the control of the evaluator of this system All systems eventually fail and satisfactory test results
do not guarantee future performance of the system, nor do they guarantee that there are no hidden defecte.
...•i.
�
or encroachments. PES can therefore not provide any warranty for future performmnce nor give any
estimate of how long the system will continue to meet the operational requirements of the ADEC or
MOA
- � s. Steven R. Ponnone;
0 0%
DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon
or usethis report by any other person or party is not authorized nor will it confer legal
No. CE 8149♦J�, 011
�1�Cd (2ZtE C
any right
whatsoever.
6.
.•' �'
�OE�t�♦
DSD SIGNATURE
Maintenance Agreements
Approved for 3 bedrooms.
Disapproved.
Supplemental Engineer's Report
Conditional approval for bedrooms, with the following
stipulations:
EX
Additional Comments.
ON-SITE
•' t
WASTEWATER•: PROGRAM
Attachments:
HAA Checklist X
Maintenance Agreements
Septic System Advisory
Supplemental Engineer's Report
Well Flow Advisory
Other
By: ��� ^� Original Certificate Date: O 3
Expiration Date: Reissue Date:
(Rev. tmAs)
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 3 Ptarmigan VfEtd Es'T/Fi6S Parcel I.D.: 015.271-47
A. WELL DATA
Well type I' If A, B, or C provide PWSID # _
Date completed -Qir is 19 7 c6 Sanitary seal Y
Total depth ft Cased to _49—+ -ft
FROM WELL LOG
Date of test
Static water level ft
Well production g.p.m
WATER SAMPLE RESULTS:
Well Log N
Wires properly protected Y
Casing height (above ground) 12"+ in.
AT INSPECTION
61812002
145 ft
4.27 9 -p.m
Coliform __Q__colonies/100 ml Nitrate 0.1 mgA Other bacteria _0 colonies/100 mt
Date of sample: 12/2112003 Collected by: Laura Pannone
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel
Date Installed 12/1812003 Tank size 1000 gal Number of Compartments Z
Cleanouts Y Foundation cleanout Y
Date of pumping �W Pumper
C. ABSORPTION FIELD DATA
Depression over tank N
High water alarm NIA
Date installed 1211812003 Soil rating (g.p.dJft2 or ft2/bdrm) jJ System type Deep Trench
Length.;J_ft Width.;_ft Gravel below pipe 6.0 ft .
Total depth 19 It Effective absorption area 4aft2 Monitoring tube.Y Depression over field N_
Date of adequacy test .,L)Gw Results (Pass/Fail) 211�S For 1 bedrooms
Fluid depth in absorption field before test _ in Water added_ gal. New depth_ in.
Elapsed Time:.Q min Final fluid depth _ in Absorption rate >= _ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type)
(Rev. 11199)
If yes, give dale
D. LIFT STATION
Date installed Siz p.ga' -
"Pump on" level at in"Pump ofP le I at
Datum /
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100.9
Absorption field on lot 100.4
Public sewer main 100+
Sewer /septic service line SO
Manhole/Access
In High water alarm level at in
Meets alarm & circuit requirements?
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation _47.8 Property line1
—�.. Absorption field
Water main 100+ Water service line _S0+
Surface water 100+
Drainage 10 Wells on adjacent lots 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10.2 Building foundation 7Q� Water main _ 100+
Water Service line _S0+ Surface water 100+Driv 1
veway, parking/vehicle storage ---L__
Curtain drain NIA Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are In
conformance with MOA HAA guidelines In effect on this date.
Engineer's Printed Name Steven R. Pannnnn o r
Date t2
HAA Fee $ 3 % S ` -f - ' SQ
Date Of Payment 1 Z 2 N63
Receipt Number C) 0 5
(Rev. 1 im)
Wailer Fee $
Date of Payment
Receipt Number
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AS -BUILT NO CORNERS SET THIS DATE Ne9,ss.00"E
1 hereby certify that I have performed a Mortgagee's Inspection
f,.QFv�� 01 the following described prope L101'5.
PTARMIGAN VIEW �3TATE5
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OTHEREASEMENTS OF RECORD,
THOSE SHOWN ON THERECORDEDHANF6 02'2, 03-6 PSB
PLAT ARE NOT SHOWN HEREON. YY`yC fo
Anchorage Recording Precinct, Alaska, and that the
Improvements situated thereon are within the property lines and
do not overlap or encroach on the property lying adjacent
thereto, that no Improvements on property lying adjacent thereto
encroach on the premises In question and that there are no
roadways, transmission lines or other visible easements on said
property except as Indicated hereon.
Dated at Anchorage, Alaska
this y9{A day of TUNE 20 OZ
FRED WALATKA & ASSOCIATES
(907) 248-1666 Engineers and Surveyors