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Home My WebLink AboutPTARMIGAN LT 4Onsite File 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 Permit Number: Sc'j 7C6(Jov,- PID Number: (-),so- 3c � - kWastewater Name: L /-1 L I System: NCNew ❑ Upgrade Address: -7-010 [- O C fl 7 ABSORPTION FIELD Phone: _ No. of Bedrooms: Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: p Oi Total Depth from original grade: I d GPD/Sq. Ft. /,q Lot: Block: —p Subdivision:` j Depth to pipe bottom from original grade: Gravel depth beneath pipe �9 /� /- x� b// �f�/Y oZ Ft. a Ft. Township: Range: Section: Fill added above original grade: Gravel length: Ft. 4/7 Ft. WELL: U I� New ❑ Upgrade Gravel width: -,3 Number of lines: Distance between lines: ^J%i Ft. Ft. Classification (Private, A,B,C): - Totaa Depth: Tota. Cased To: / Total absorption area: 710 Pipe material: 2014t,15714 PR I XAI e Ft. O Ft. SQ. Ft. Driller: / Date Drilled: Static Water Level: Installer: y / Date installed:�� Yield: Pump Set at: Casing Height Above Ground: TANK 6 GPM Ft. (/ Ft. SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding uhiic/Private Manufacturer.- -rA,A11< Capacity in gallons: / From Tank Field Station Tank Sewer Lines I%Ale_l/ -5Lgo Well- ��% / /DLI /t//A 1,11A 7o,9/ Material: S%EEL Number of Compartments: �i Surface � 1\//A LIFT STATION water /CC - Lotr / / / j Size in gallons: Manufacturer: Line 3S Foundation ? / 2 j NIA Pump on" level at: "Pu p oifrlevel at: High water alarm at: Curtain !,I% Pump l Electrical Inspections performed by: Drain /r Remarks: BENCH MARK Location and Description: jam/ /IySUL/'FT/O/V-Qf/LiJ2 w r., p�f fes.... c.r 17� of Re bn� /�/' ,1 0 /' g5I—D UE-1-10"s'c F"'isl, Assumed Elevation: 724L /,DO ENGINEERS SEAL �5 FIZFS �� '-, a= e0•soeboafus d7 Inspections performed by: Dates:ls FA•ev�§s• 2nd �� /DF ee %e Veao es evueeeeweoe• - $ t• : Louis A. Butero '• Department of He and Hu ices approval cl.t�ae Reviewed by: Date: aL '.�, and approved Y Permit No. SW 9& &OOS'li Page 2 of 2 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 Legal Description: PTARMIGAN LOT 4 PID No.: 0S S& Z 3 PTARMIGAN BLVILD\\ M e 241.1 SWING TIES A -C = 102.6 100, o B -C = 72.63 00, RgD,5s- L� 100' WELL B -D = 82.3 US y< .. WELL. RADIUS 1500 GAL \ PROP SEPTIC TANK 00 0C HSE ]O� I\ 0 3X47' TRENCH Vol- VACANT LOT RESERGV-� Q�O�, SVOQ VACANT LOT PQ A 82.5' - W -L❑T 4 0 ZO ZO 63,338.25SF bN 01 ® - TEST HOLE VACANT LOT (U o • - MONITOR TUBE 0 0 - SEWER CLEANOUT z - WELL — — - EASEMENT - LEACHFIELD 0 0 0 0 N SCALE 1'=60' O rT 8/9/96 15 9, 4 ENGINEER'S SEAL a00000p�o4 0 ELEVATIONS SOUTH VEST PROP CUR. (PT A) �- o �F'• �F'q� 9S�p (NOT TO SCALE) ASSURED ELEV = 9345 � O4:-,�P .•• j 00 ORIGINAL _ 49TH O GROUNU o �+D LEVEL AT. m Q....... .. ..........0 1' MOm FlLL 99A2.5 V ' 33PSI INSIAATI@I NO GVT 83A . LOUIS A. BUTERA : t�T D TANK 97.3 7.2 7.0 97.0 Q S % . CE -6736 BB.] 044�� pROF E.... ` LOCATION OF WELL STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING & WATER MGMT WATER WELL RECORD BOROUGH -SUBDIVISION -LOT BLOCK - SECTION QTRS - SECTION TOWNSHIP RANGE .- MERIDIAN - f ❑N ❑E i ❑S 0 LOCATION/SKETCH: WELL OWNER: DEPTHS MEASURED FROM:❑casing top ❑ground surface WELL DEP ' DATE OF COMPLETION Depth of hole:F1'� ft BOREHOLE DATA: Depth Depth of casing�ft % l t G / w Material Type and Color From To DEPTH TO STATIC WATER LEVEL: ft below lktop of casing ❑ ground surface Date: METHOD OF DRILLING: (fair rotary ❑ cable tool ❑ other USE OF WELL: domestic ❑ irrigation ❑ monitor El public supply ❑ other ` CASING STICK-UP: ft. Diam: in. to_21ft Casing type: in. to ft WELL INTAKE OPENING TYPE: Xopen end ❑ screened ❑ perforated ❑ open hole AV Depths of openings: to ft SCREEN TYPE: Diam: in. Slot/Mesh Size: - Length: ft GRAVEL PACK TYPE: Volume used: Depth to top: GROUT TYPE: Volume: Depth: from ft to ft DEVELOPMENT METHOD: Duration: v� PUMPMG LEVEL AND YIELD: ft after hrs pumping gpm PUMP INTAKE DEPTH: ft Horsepower: WELL DISINFECTED UPON COMPLETION? SZYES ❑ NO CONTRACTOR INFORMATION: REMARKS: RECEIVED E G I E D ` Y 2Registdusiness N?aamme AUG 12 1996 PLEASE MAIL WHITEY OFLOG T0: Signature of Authorized Resprese ative Date DNR/DIVISION OF MIN'S V NR#1dF7'cnorage 3601 C St, R r th &Human Services ANCHORAGE AK 99503-5935 Phone (907)269-8639, Fax (907)562-1384 P PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES �- P.O. BOX 196650, 825 "L" STREET, ROOM 502 L ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960086 DATE ISSUED: 5/23/96 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE: 5/23/97 OWNER NAME:KIEHL CYRIL & LOIS OWNER ADDRESS:2020 MULDOON #225 ANCHORAGE, ALASKA 99504 PARCEL ID:05036237 LEGAL DESCRIPTION: PTARMIGAN LT 4 LOT SIZE: 64033 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS.PERMIT IS FOR THE CONSTRUCTION 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED P ISSUED BY: DATE: .�--.27 76 DATE: -05 -o� 3 -?6 6 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 •'L' Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: (001-c `IY Bv/LpEA�S DATE PERFORMED: (O -Ir q LEGAL DESCRIPTION: ^f%)r42R1 b41k1 Township, Range, Section: T, -DOTH SLOPE SITE PLAN H 3 A EET� t /" To,03or l 6 7 a- 10 10 17 18 19 Ak -f7emJtr-%%/j' ifra HNN WAS GROUND WATER ENCOUNTERED? Nd IF YES, AT WHAT i DEPTH? I Depth to Water After Monitoring? ASA to 1N.J 0211: S—io_56 11 Reading Date to i. lc s/s/sc Gross Time Net Time Depth to Water Net Drop 57571Z 8:3� (ENGINEER'S SE�AIi �Yf" G' 4 f� 3 %k 3 6 3 Imo' 6f b�,i P N'l14 n!m Oy�4�yOry ob YI, t:'V:S A. 'ut rn G 8' 63 yo h: 7 toG G/G PERFORMED FOR: (001-c `IY Bv/LpEA�S DATE PERFORMED: (O -Ir q LEGAL DESCRIPTION: ^f%)r42R1 b41k1 Township, Range, Section: T, -DOTH SLOPE SITE PLAN H 3 A EET� t /" To,03or l 6 7 a- 10 10 17 18 19 Ak -f7emJtr-%%/j' ifra HNN WAS GROUND WATER ENCOUNTERED? Nd IF YES, AT WHAT i DEPTH? I Depth to Water After Monitoring? ASA to 1N.J 0211: S—io_56 11 Reading Date to i. lc s/s/sc Gross Time Net Time Depth to Water Net Drop 57571Z 8:3� 3 %k 3 6 3 Imo' ti YI, G 8' 63 yo h: 7 toG G/G a 14„ to a'• % , 5:00” (y /,�" 01 'A( 20 PERCOLATION RATE 2� 3 (minutesimch) PERC HOLE DIAMETER TEST RUN BETWEEN 5 FT AND i FT COMMENTS �Pcc L//-, /. ziti{ Sz.l d -G >-.-�5 %Sr Eagle River Engineering S ervices Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax May 10, 1996 Jim Cross, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Ptarmigan Lot 4 Narrative & Permit Application Dear Mr. Cross: The proposed well and septic system will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity. 4. Drainage will not be affected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \1996\96 -024A -NAR SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Ptarmigan Lot 4 05/10/96 A. GENERAL 1. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. 9. Any remaining open test hole excavations shall be filled. B. SEPTIC TANK/LIFT STATION 1. Septic tank and lift station shall be 1,500 gallon Orenco/Anchorage Tank model OSI 05-20-HHF. 2. Receipt from licensed electrician stating the lift station was wired to applicable codes to be supplied to Engineer. C. TRENCH 1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom. 2. The bottom of the trench shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed 10' at any point. 4. The effluent line within the trench shall be 1-1/4" PVC with 1/8" holes drilled 9-1/2" on center with orifice shields installed, holes facing up. One 1/8" hole on bottom of pipe at each end. 5. The trench gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 7. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH= 10' GRAVEL DEPTH = 8' under pipe, 2" over pipe TRENCH LENGTH = 47' TRENCH WIDTH = 3' SOIL RATING= 0.8 GPD/ft2 BEDROOM CAPACITY = 4 SEPTIC TANK = 1,500 gallon with lift Twenty-four (24) hours notice required for all inspections. \1996\96-024a-spc 0 VACANT LOT GAL 82.5' VACANT LOT NO SURFACE WATER NO KNOWN CURTAIN DRAINS PTARMIGAN BLVD 241.1 PROP. WELL n THl��oo, PROP HSE /per Li LOT 4 ip v p � c :0 63,338.25SF v 159.4 VACANT LOT T 0 c 0 ri m 0 — TEST HOLE • — MONITOR TUBE 0 — SEWER CLEANOUT 9 - WELL — - EASEMENT — PROPOSED LEACHFIELD WELL SEPTIC SITE PLAINOF 44 �.•��••�� LEGAL: 'TARIUIGAN LOT 4Q�•.•• 9Ss1� OWNER: COLONY BUILDERS AF CONTRACTOR: N/A * :49TH JOB# 016-02ADATE: 05/20/96 SCALE 1" 00' i 0 0 :,. ...� EAGLE RIVER ENGINEERING SERVICES �I .Lours A BUTERA P.O. Box 773294 �,-J}F CE -6736 �g_A, A EAGLE #, ' e6 � 907 8.94-nsK�a 95/ n7) R-9Q—g9g7 1��h::Ess��''� EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 96-024 Calculated By: LB Date: 5/10/96 Legal: PTARMIGAN LOT 4 Single Family 4 Bedroom Dwelling Deep Trench Subsurface Wastewater Disposal Field TEST HOLE 3 Water use at 150 gallons per bedroom = 600 gallons Percolation rate = 2.3 minutes per inch Wastewater application rate = 0.8 gallons per day per square foot Required absorption area = 750 square feet (adjusted up) Trench width (W) = 3 feet Gravel depth (D) = 8 feet Required length = Required absorption area / 2 / D Required length = 750 1 2 / 8 Required length = 47 feet Total Excavation Depth = 10.0 feet Pressure effluent lateral: Assume 5' head at orrice 25 GPM flow rate .42 GPM per orfice 25 /.42= 60 orfices Spacing = 47'/ 60 orfices = 78' or 9.4" o `� •• OF' g 49— C S�4 OD��P T p � ............. :. ".,... LOUIS A. BUTERA, 0 'n CE -6736 �G 0��4 ° PROFEss�oNP��o SINGLE FAMILY ON-SITE WORKSHEET ERES PROJECT NUMBER: 96-024 CALCULATED BY: LB LEGAL DESCRIPTION: PTARMIGAN LOT 4 NUMBER OF BEDROOMS: 4 WATER USE PER BEDROOM: 150 GALLONS PERCOLATION RATE: 2.3 MINUTES PER INCH DEPTH TO GROUNDWATER: 16 FEET DEPTH TO IMPERMEABLE LAYER: 16 FEET USABLE SOIL STRATA ANTICIPATED DEPTH OF COVER: 2 FEET TOTAL USABLE DEPTH: 10 MOUND OR BED SYSTEM USABLE SOIL STRATA DEPTH: 8 WASTEWATER APPLICATION RATE: 0.8 GAUSQ.FT ABSORPTION AREA REQUIREMENT: 750 SQ.FT MINIMUM BED LENGTH 12 FEET WIDE BED 63 FEET 15 FEET WIDE BED 50 FEET TRENCH SYSTEM WASTEWATER APPLICATION RATE: ABSORPTION AREA REQUIREMENT: SHALLOW TRENCH OPTIONS 5 FEET WIDE TRENCH EFFECTIVE REQUIRED TRENCH DEPTH (FT) ENGTH (FT) 1 131 2 105 2.5 95 3 88 3.5 81 4 75 DESIGN SPECIFICS FIELD SYSTEM: D GRAVEL DEPTH: 8 TRENCH OR BED WIDTH: 3 LENGTH: 47 TOTAL 83 EXCAVATION 75 DEPTH: 68 0.8 GAUSQ.FT 750 SQ.FT DEEP TRENCH OPTIONS 3 FEET WIDE TRENCH EFFECTIVE REQUIRED TRENCH DEPTH (FT) ENGTH (FT) 4 94 4.5 83 5 75 5.5 68 6 63 7 54 8 47 9 NA (B=BED, S=SHALLOW TRENCH & D=DEEP TRENCH) FEET FEET FEET 10.0 FEET 0 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 '`L" Street. Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST � vL;��5D 9^dy4 ICI v cg a,acn c7 V- A. Aviera C€•4F.ib �c {a PERFORMED FOR: C.o%ny 13y�LaerS DATE PERFORMED: 6 4� 3 - % S r2 Lary LEGAL DESCRIPTION: lgTaTownship, Range, Section: 7-y. '0 t✓ t__ 10 t ✓ 1` e j-7— t4 WAS GROUND WATER i30r=ow O' Ole ENCOUNTERED? 11 IF YES, AT WHAT 12 DEPTH? 13 41516 14- 15- 16 71819 17- is - 19 20 COMMENTS 7 4 SLOP LAN S L elf' P I s < < E Oepth to Water After / Manllaringll- Reading D P H F E r Te(a5O1 I , �(-9«HSG Mal 1 Net Drop v C>il 4-J �. D'j� 3 (57 a v J - 6 / �m.A.i ai S I Rt Fol �Vyt1� 4 . 7 8 If IV z / 10 t ✓ 1` e j-7— t4 WAS GROUND WATER i30r=ow O' Ole ENCOUNTERED? 11 IF YES, AT WHAT 12 DEPTH? 13 41516 14- 15- 16 71819 17- is - 19 20 COMMENTS 7 4 SLOP LAN S L elf' P I s < < E Oepth to Water After / Manllaringll- Reading Date Gross 'rime Net Depth to Time Water Net Drop n 10..� t Z 1 'v ,4 4 z S, If PERCOLATION RATE 00 Immutesnncht PERC HOLE DIAMETER G TESTRUNSETWEEN 3 5 FT AND 4•C FT PERFORMED 8Y: c('' cI' Uj,-r '—+ u: ✓rI- { •! ,._ � CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. p,a PERFORMED FOR: Co%Y 3v�Y�cls '1 GATE PERFORMED:: T4 , Lor Z/ LEGAL DESCRIPTION: /PT a -wri a „ Township, Range, Section: Tiy,,,- Q aEPyH SLOPE SITE PLAN F Se Tid10 PLOVIA " - 1 pf�a',•'_ rbtal . r Me el ��„S o^ 4,(, Y 3 ^ -r 4 6,2 to pa%T0In S o} $ Ci s• 14- co✓ -Iievr� 5mv,rlue 5 , 6"wo 6 �), 010"S4,, M4Y,y 1wrJe rack,, f rJ,(,' 12 13 14 1$ 16 17 18 19 20 L7 'f COMMENTS 41- — C f fj WAS GROUND WATER ENCOUNTERED? AJ,7 S I I I S`o IF YES. AT WHAT /v A_ L II DEPTH? P Ste. /tet E gepth to Wafer After Monitoring? dr; palt Reading Date Gross Time Net Time Depth to Water Net Drop Saa 'C ENGrriEE° y, Municipallty of Anchorage .�•`,+es = air. •xaevoaso�e.•- DEPARTMENT OF HEALTH &HUMAN SERVICES ``"""'""`'°'°"`""'1'a` 825 "L* Street= Anchorage, Alaska 99502-0650 �; R? , , < Li, SOILS LOG — PERCOLATION TEST 1 t� ' !� 4J4AOQ \e p,a PERFORMED FOR: Co%Y 3v�Y�cls '1 GATE PERFORMED:: T4 , Lor Z/ LEGAL DESCRIPTION: /PT a -wri a „ Township, Range, Section: Tiy,,,- Q aEPyH SLOPE SITE PLAN F Se Tid10 PLOVIA " - 1 pf�a',•'_ rbtal . r Me el ��„S o^ 4,(, Y 3 ^ -r 4 6,2 to pa%T0In S o} $ Ci s• 14- co✓ -Iievr� 5mv,rlue 5 , 6"wo 6 �), 010"S4,, M4Y,y 1wrJe rack,, f rJ,(,' 12 13 14 1$ 16 17 18 19 20 L7 'f COMMENTS 41- — C f fj WAS GROUND WATER ENCOUNTERED? AJ,7 S I I I S`o IF YES. AT WHAT /v A_ L II DEPTH? P Ste. /tet E gepth to Wafer After Monitoring? dr; palt Reading Date Gross Time Net Time Depth to Water Net Drop Saa 'C �'S•°i' 2: 33 y' Li, 4 Z 1 t� ' .- I Z- S u 1 t7 ,u' N u 6/ 9ir6 PERCOLATION RATE r�() (minutesrinch) PERC HOLE DIAMETER b TEST RUN BETWEEN FT AND 5 FT PERFORMED BY: C".iF Vof �r'a:�vpr. =� � • r I - - CERTIFY THAT THIS TEST WAS PERFORMED IN ACCCROANCE WITH ALL STATF Antn A.0 1d1r"tQA1 n1:In Cl 3XIec Int eeeenT nwi rU.e nnTC nnre ? . / 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.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. LonGJD X102_-3% 1. GENERAL INFORMATION HAA #_P A D! D 2 2 S Expiration Date: _ 3 — d Complete legal description L-crT 4 f �'-DAV Mlc- {Ltj Sib Location (site address or directions) ;W`5/ Current Property owner(s) AK'T 4 �c lyl 43F-- 0J1J Day phone 2- —4&& Mailing address Lending agency Mailing address 90,7-& el-Al?na(e:-,ta-*c +3vU) Day phone Real Estate Agent f\k'�E_ ��sr3o� Day phone Mailing Address Unless otherwise requested, NRA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 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) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. 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 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 Health Authority 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 -[:,;) V�tJ J'T Q• P. e_ -- Address Address x&7c j3l�pV_5('e5,QE p' Engineer's Printed Name ?5P2,Ct`T P. EiI � 5. DSD SIGNATURE Approved for 4 bedrooms. Disapproved. Phone 2Z9 - 377 Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: C(/, �a-[iI Original Certificate Date: S 2 3 - d i (Rev. 1? 00) Municipality of Anchorage • Development Services Department Building Safety Division ` On -Site Water & Wastewater Program a T' 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: �� `t f�Tf�2PA IG A�►1 Parcel ID: 050-2% A. WELL DATA Well type INP. If A, B, or C provide PWSID # _ Well Log (Y/N) es Date completed 7J��/%p Total depth jaL_ft. Date of test Static water level Well production Sanitary seal (Y/N) Cased to 3i—ft. FROM WELL LOG Z—& iq (p 6� WATER SAMPLE RESULTS: 9— p.m- Wires properly protected (Y/N) Casing height (above ground) �✓� in. AT INSPECTION 5(ooI 5g) ft. ea-T&P 5 9 - p.m - Coliform C colonies/100 ml. Nitrate 4 •r,Z mg./I. Other bacteria 6:�> colonies/100 ml. 1 Date of sample: % l 5 111 01 Collected by: pazol'r �4-1lJ B. SEPTIC/HOLDING TANK DATA Tank Type/Material 1x%00 e0t,iL Dateinstalled O(Oho Tank size 15� gal. Number of Compartments 2 Cleanouts (Y/N) Foundation cleanout (Y/N) 05 Depression over tank (Y/N) K10 High water alarm (Y/N) Date of pumping �J O Pumper --M's / G f d�tTiiGb D� _ C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ftz ortt4h ria) System type VgFT 1f2;67" Length 47 ft. Width 5 ft. Gravel below pipe `8 ft. Total depth �= ft. Eff. absorption area 5�0 ft' Monitoring tube Depression over Feld "o Date of adequacy test 54(p 1 Results (Pass/Fail)�S For 4 bedrooms Fluid depth in absorption field before test � in. Water addedW gal. New depth : in. Elapsed Time: if min. Final fluid depth 40 in. Absorption rate >= PW g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) 00 If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at _ in. ___EuwvVff level at _ in. Cycles tested E. SEPARATION DISTANCES (Y/N) High water alarm level at Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankilift station on lot 10% 1 On adjacent lots f � Absorption field on lot I P 4 On adjacent lots -I UO Public sewer main _ 1A Public sewer manhole/cleanout 1\1 / Sewer /septic service line + Holding tank SEPARATION DISTANCES FROM SEPTICµ49kDWGrTANK ON LOTTO: Building foundation (�J Property line 59 Absorption field 1 4 1. 1 Water main 'hl � Water service line ^' �� Surface water �� 1 Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Water main c�pr Driveway, parking/vehicle storage _ Property line i � Building foundation _�z Water Service line 'i D Surface water 4- 100 Curtain drain 11atitE AQp(Lt.iiWelis on adjacent lots + j Db F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 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�jP�� Date in. HAA Fee $ 3 v 0 a 0 Waiver Fee $ Date of Payment 5-- .11- Q/ Receipt Number 14 (0!6 7 (Rev. 12/D0) Date of Payment Receipt Number iBINNF$P �............. N Or �FljMP �� QROFESS7BC= 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 AUTHOR ITEE APPROVAL FOR A SINGLE FAMILY DWEA6 Parcel I. D. # 050-362-37 HAA # 1. GENERAL INFORMATION Complete legal description Ptarmigan Lot 4 Location (site address or directions) NHN Ptarmigan Blvd., Eagle River Property owner Colony Builders, Inc. Day phone 244-6233 Mailing address 2340 T,nrPn Ci -mlP. An -m age AK 99516 Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system: - 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site x 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 N21 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. Phone Name of Firm Eagle River Engineering Services 694-5195 Address P.O. Box 773294, Eagle River, AK 99577 Engineer's signature -� Date • 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments V M bedrooms. auTlc bedrooms, with the following stipulations: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based. only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA e21 Municipality of Anchorage a DEPARTMENT OF HEALTH & HUMAN SERVICES r'Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343 -f.44l 4 1996 Health Authority Approval Checklist Municipality of A,c,ctn� Elie Dept. Health & 4-iUM21-1 S� ry ces Legal Description: Z- Parcel I.D.: 050-13&Z-31;? A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Yta Date completed 6?AU Total depth -9/ Cased to ?/ Casing height (above ground) yes flz Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: 5�7 g.p.m. Wires properly protected (Y/N)yrS Coliform '49- Nitrate /-/, %/ m bi 1-4=- Other bacteria Date of sample: /0�1�go Collected by: B. SEPTICfHeMNG TANK DATA 9 - p.m - Date installed%t1D Tank size /5CV Number of Compartments /— Cleanouts (Y/N) l� Foundation cleanout (Y/N) Y" Depression (Y/N) /Ya High water alarm (Y/N) lyl,4 Date of Pumping AX -11d Pumper C. ABSORPTION FIELD DATA Date installed r%& 960 Soil rating (g.p.d./ft2 Vii) 01 ly D4�6p System type 7�4/11C-/l Length / Width Gravel thickness below pipe Total depth Effective absorption area �' 00 Monitoring Tube present (Y/N) � Depression over field (Y/N) /V4 Date of adequacy test Ivy Results (Pass/Fail) RII5 S For 4 bedrooms Fluid depth in absorption field before test (in.); /�/ 14 Immediately after= gal. water added (in.): Fluid depth NIA (ins) Minutes later: I Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) /IJ 1A If yes, give date 72-026 (Rev. 3/96)" D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* _ Cycles teste E. SEPARATION DISTANCES Size in "Puma el at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/fielding tank on lot M / "Pump off" level at` On adjacent lots f/00 / I J Absorption field on lot /01/ On adjacent lots �,,vv0 Public sewer main 141A Public sewer manhole/cleanout 1114 rr�� I r/septic service line � i,y Lift station N14 SEPARATION DISTANCES FROM SEPTIC/WG4=B NG TANK ON LOT TO: Foundation Property line SCJ / Absorption field 5 / Water main/service line Surface water/drainage f-/00 / Wells on adjacent lots /00 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: e / � Property line %/ Building foundation WatersaWn/service line f $� Surface water /-/00 Driveway, parking/vehicle storage area Curtain drain / ON6/ A?PA4W 7' Wells on adjacent lots F. ENGINEER'S CERTIFICATION /certify that/ have determined thru field inspections and review of Municipal records fl l.a ��k.44 re ° a�°:.� in conformance with MOA HAA guidelines in effect on this date. �� ,•'q@meq+. Signature P,4 0v¢�•A,.,,»«,3x.4@•�;,a Engineers Name41 Date � ef%t�f 4°4e�`.ee®sad@P•��j'fl HAA Fee Waiver Fee $ Date of Payment �1 �l —tel (� Date of Payment Receipt Number (DQ 3 U a \ Receipt Number 72-026 (Rev. 3/96)*