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Home My WebLink AboutPTARMIGAN VIEW ESTATES LT 4Ptarmigan View Estates Lot 4 #015-271-48 Jun 13 22 08:27p Anchorage Well & Pump Ser 9072430742 p.1 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section & Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: Parcel Identification Number: 015 _ 271 48 Date of Issue: Legal Description PTARMIGAN VIEW ESTATES Block Lot 4 Property Owner Name & Address: CROCKETT ROBERT P & MARSHA K 3031 CHRIS CIRCLE ANCHORAGE, AK 99516 Pump Installation Date: 06 06 _ 2022 Pump Intake Depth Below Top of Well Casing: 70 feet BERKLEY Pump Manufacturer's Name: B5P4SP07221-02 Pump Model: Pump Size: '75 hp Pitless Adapter Burial Depth: 10 feet unknown -no visible name Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: Well Disinfected Upon Completion? KYes ❑ No Method of Disinfection: PELLETS Comments: Pump Installer Name: _ ANCHORAGE WELL & PUMP SERVICE 7640 KING STREET Company: ANCHORAGE, AK 99518 907-243-0740 Mailing Address: City: State: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage 1jePartment P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 w (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On-Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV221031 COSA#: Permit#: PID#: 015-271-49 and 015-271-48 Legal Description: PTARMIGAN VIEW ESTATES LT 3 and PTARMIGAN VIEW ESTATES LT 4 Engineer: Grant Mathews, PE Due to the public sewer main extension for the proposed Sky Ridge Subdivision, a sewer manhole will be within 100 feet of two of the neighboring lots. The approved separation distances are 82 feet to the well on Ptarmigan View Estates Lot 3 and 98 feet to the well on Lot 4. See the engineers waiver request located in the subdivision file. Waiver is Granted: X Waiver is not Granted: Date: v %/01-?— Approved by: Lell- Name of Reviewer f **** VARIAN C E/WAIVER REVIEW **** Municipality of Anchorage Page I 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: ~ ~/.~J~l ~¢~ PID Number: ~ ~ ,~7/- Name: ~ ~ ~ ~fb F Wastewater System: ~ New ~Upgrade *~'~'~: ~'5~ ~H~/5 ~/~ ABSORPTION FIELD Phone: ~ NO. of B~ooms: ~ Deep Trench D Shallow Trench B Bed D Mound D Other LEGAL DESCRIPTION so. Rating: Total Depth from original grade: Lot: Block: Subdiv~ion: Depth to pipe bosom from original grade; Gravel depth beneath pipe Township: I Range: Section: Fill added above original grade: Gravel length: Number of lines: lDistence baleen lines: WELL: B New ~ Upgrade Gravelwidth: ~ Ft. II Ft. Clarification (Private, A,B,C): Total Depth: Cased TO: Total absorption area: Pipe material: Date Drilled: ;tatic Water Level: Installer: Date installed: ~/~/~ Yield: . ~ I Pump Set at: Casing Height Above Ground: TAN K SEPARATION DISTANCES ~ s~pti~ ~ Ho~Ui~ ~ S.T.E.P. TO Septic Abso~tion L~ff Holding ~ublic/Prlvate Manufacturer: ~0~t~t apsci~ingallons: From Tank Field Station Tank Sewer Lines e~ 1 Material' .t ~ ~J~ ~ ~ ' Number of Compa~ments: Sudace Water 'N ~ / ¢¢/~¢¢~> LIFT STATION LOt Sizein gallons: ~ Manufacturer: I Remarks: BENCH MARK Location and Description: Inspections pedormed by: % * Dates: 1st ¢~¢¢ ; Depadment of Health and Human Se~ices approval "~:' ": : 72-013 (Rev. 9/91) MOA25 CHRIS STANDA£D T£ENCH / 12 FT DEEP ~ J~ £T LONe FEET EFFECTIVE ~CK~ AC 60 FT BC 58.5 AD ~4.5 J c'5 0 £5 50 75 100 j I S£AL£; 1~ = 50 FL P A£MIGAN VI£ : £STA £ £01- 4 5051 CHRIS CIRCLE BENCH )#ARK: WINDOW SILL ASSUMED ELEK 100.00 F[ IlSEPTIC SYSTEM AS BUILT DA TE: JUL Y 6, 2000 SHEET: 2/5 GRID: 2654 TOBBEN SPURI(ZAND P.E. Il 205 W 15TH. AVENUE II ANCH. AK. 99501 (907) 279-5916 PERMIT ii Sb/OO1g9 PID # 015 £71 48 PVEOOO4£,BF/6 *tand~rd ?rench~ £' W/de BM' L on9 ~£' ~eep ~,8' Se~xer rock 6' Covet' NO ££ALE /V/onltom C{eonouts Cover $4 t 82,8 5,0 £t oF Septic Rock EffecHve Nil SCALE ot_ 1000 90/ Septic tank EX/STING ~"'"': ................................. ',b" :'""~ ~,.:~ TD~EN SPURKLAN]) ~.'.~ 'o No, CE ~e~5 ~ ,~ lO00 gal, septic l, onk ESPINOSA CONCRETE TDBBEN SPURKLAND P.E. BO3 W15th Ave Anchopcge Ak 99501 PTARMIGAN VIE~g ESTATE LOT 4 JOJl CHRIS CIRCLE SEPTIC SYSTEM SCHEMATIC ])ATE, JUL)' 6, 2000 SHEET~ GRID, 2~o~4 PERMIT ff S~/000189 PARCEZ ID if/ 015 271-48 PI/EOOO45. DWG MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jun 23, 2000 Expiration Date: Jun 23, 2001 Permit Number: SW000i89 Legal Description: PTARMIGAN VIEW ESTATES LT 4 Design Engineer: 0007 Tobben Spurkland, PE Owner Name: Carol & Rich Schmidt Owner Address: 3031 Chris Cir. Anchorage, AK 99516-1443 Parcel ID: 015o271-48 Site Address: 003031 CHRIS CIR Lot Size: 21816 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ~ 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 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 Feast 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 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. Received By: Issued By: Rick Mystrom. Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P,O. Box 196650 Anchorage, Alaska 99519-6650 http://www.ci.anchorage.ak.us June 23, 2000 Tobben Spurkland 203 W. 15th Ave., Suite 203 Anchorage, AK 99501 Subject: Waiver Request for Ptarmigan View Estates, Lot 4 Waiver Request #WR38 Parcel ID #015-271-48 SW000189 Dear Mr. Spurkland: Your request for a waiver of the required 10 feet horizontal separation from the on-site wastewater disposal system to property line has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the existing on-sitewastewater disposal system to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On-Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health & Human Services On-Site Services Waiver Review Worksheet WR#: WR000038 PID#: 015-271-48 HA#: Date Received: June t4, 2000 Legal Description: Ptarmigan View Estates, Lot4 Engineer: Tobben Spurkland, PE 203 W. 15th Ave., Suite 203, Anchorage, AK 99501 Applicant: Carol & Rich Smith Waiver Requested: 5 foot lot-line waiver Permit~: Criteria: 1. Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation 2. Special Conditions: 3. Other: Total: Waiver is Granted: X ********** List Conditions or Reasons for above: ~-~ J:~ Waiver is not Granted: Bate: g - 2 3' 0o Rec#: 0650'1 Amount: $'115.00 Name of Reviewer Date Paid: 6-'14-00 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 4 PTARMIGAN VIEW ESTATE RICK & CAROL SCHMIDT Municipality of Anchorage Department of Health and Social Services 825 L Street Anchorage, Alaska 99501 June 13, 2000 We are submitting au application for the upgrade of the septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following: No Ground Water or Impervious Layer to 18 ft. Use Standard Trench Soil Rating. From Testhole 06/01/00 5 mid/in = 1.2 gal per sq.ft/day No. of Bedrooms 3 Required Area per Bedroom: 150/1.2 - 125 sq.ft. Total area required: 125 x 3 = 375 sqft Testhole depth 18 feet Bottom Rock At 12 feet Top Rock At 6 feet Rock Depth 6 feet Total Trench Length 375 / 12 - 31.25 ft. USE 35 LF SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 35 FT TOTAL WIDTH 2 FT TOTAL DEPTH 12 FT ROCK DEPTH 6 FT COVER 6 FT SEPTIC TANK EXISTING CHECK BAFFLES The installation of this septic system will not prevent development of adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. CHRIS £I1~ ' -- ._.} LDT51 ~' 'l Il ~--"1 '~,~'LZT? 4 ; LDf L~ ~ I I I I I~1 ~0 lO0 150 S£/~LD 1~ = I00 FL 1i~ ?t~. AVE, 380 TOBBEN SPU£KLAND P.E. 205 W 15TH. AVENUE ARCH. AK. 99501 (907) 279-5916 PTA£MIOAN VIEt~ ESTATE LOT ¥ 5051 CHRIS CIRCLE SEPtiC SYSTEM DESIGN DATE: JUNE 15, 2000 SHEET: I/5 GRID: 2654 PEf~MIT if SVOOOXX PID fl 015 27~ 48 PVEOOO41,D~/5 CHRIS CIR ~r~ Well STANDARD TRENCH 12 FT DEEP $5 FT LONG 6 FEET EFFECTIVE LOT LINE BULL RUN DIVEBSIOi~ VA"L~,~ ESPINOSA CONCRETE TANK ~ ~ CHECK BAFFLES 85 0 $0 7S lflO I~S I S£ALE~ 1' 50 FL 205 W 15TH. AVENUE ANCH. AK. 99501 (907) 279-5916 PTARMIGAN VIEtf ESTATE LOT 4 5051 CHRIS CIRCLE SEPTIC SYSTEI/ DESIGN DATE: JUNE 15, 2000 SHEET: 2/5 GRID: 2654 PERMIT # S~/O00XX PIP tt 015-271-48 PVEOOO42, DI(6 Stondord ?rench: L°' k/ide 35' L on9 12' Deep 6,0' Sewer rock 6' Cover ND SCALE ~ 6' Cover lOOO 9al Sept:lc ~,onk EXISTINO --0 6,0 Pt o£ Septic Rock Effec#ve ND SCALE lOOO 9al, septic fzonk TBBBEN SPURKLAND P.E, 203 W15%h Ave Anchorage Ak 99501 PTARMIGAN VIEW ESTATE I0~ ~ JOJl CH,~IS CI£CLE SEPTIC SYSTEM SCHEMATIC DATE: JUNE 1~ 2000 SHEET, GRID, LO634 PERMIT ~ SWOOOOXX PARCEZ ID // 015-271-48 PVEOOO4$.DW$ Munl-~lF'allty of Anchorage DEPARTMENT O~' '~EALTH & HUMAN SERVICES 825 "L" Street, ARchorage, Alaska 99502-0650 SOILS LOG- PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION: ~L~'~- ~-~ (3 Y2_ 4~ 7 10 12 20- Township, Range. Section: WAS GROUND WATER ENCOUNTERED? s E SiTE PLAN --. °_~::, n..i Time Time Water Drop PERCOLATION RATE ,"~ (m~nules/,nch) PERC HOLE DIAMETER -- TEST RUN BETWEEN 7 FT AND ~ FT DZSCLAINFR~ grnundwRteF cAnditions indicated are for the dates Past and future presence ~nd/or depth of 9ro~ndwater can not be trom these observations. shown only. predicted PERFORMED BY: 'j~'~ _.4 I ~r ~'~ - CERTIFY THAT THIS TEST WAS PERFORMED IN · ACCOROANCE WITH ALL STATE AND MUNICIPALGUI~ELiNESiN EFFECT ON THIS DATE. DATE: .. 72-008 trey, 4/85) ~~ ,VIUNICIPALITY OF ANCHORAGE ,//I1 ~'~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENI'AL ENGINEERING DIVISION (' 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME , "nZ!Cy-. MAILING ADDRESS o o7, ~LEGAL DESCRIPTION t PERMIT NO. · DISTANCE TO: ]Well t O.% ' Dwelling ~ ~Z Manufacture~~ ~terial~~-- No. ofco~rtments ~ ~"'7~""°n~ ,. HOME.DE: Insidelength W~dth Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~ ~ ~ Manufacturer Mate, iai Liquid capacity in gallons ~= DISTANCE TO: Well //b ' Foundatio~' Nearest lot line ~ / PERMIT~Aoz77NO. ~ ~~ No. of lines / Length of ~i~e Total le~f lines Trench~ 'width'/ inches Distance between lines ~ ~.~ ~ Top of tile to finish grade ~ / Material beneath tile -- ~ roches Tota~effective~7~ absorption~.~area Length Width Depth PERMIT NO. < ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS ~~. ~ . ~,,, ., ~- ,~ DATE LEGAL 72-013 (Rev. 3/78) 0 -W DRILLING, INC. v DRILLING LOG Well Owner P :t'^iclr Sch=idt Location (address of: Township, Range, Section, If known; or distance main road �__*;ot Ytarri,^.aa Vice "states, AnahoraAe of Well Doc:. Size of casing f' nepth of Hole 232 feet Cased to L:30 •'_ feet Static water level ft. (above) below) land surface. Finish of well (check one) open end a, Screen ( ); Perforated Describe screen or perforation 1'+.11/A' F Well pumping test at 12 gallons 'per j)l�fl;) of drawdown from static level u 1 t Date of completion 5 / o / e' (minute) for 1 hours with_ 1'11' ft. WELL LOG Depth in feet from P ; ;t� ground surface Give details of.formations penetrated, size of material, color and hardness "'• TO ' TO 7 _ATO 14 � "• TO 1 !: 3 1 / 'TO An 42 TO 71 71 rn %9 iGTO 52.5 ;12. ,to 117 117 TO 147 10 TO 1 _ 153 TO 101 1�1`3—TO ",' TO --2-1 _- R'S I k'Silt+� sand pravcllY,r�` '!� lSi1"t„v ;Yi'ave1. cla�ev:"=hJue' Wet i _AVP.1 SLY tv Gravelly hnd,# ran Silty sand and :,ravel: �lt'tti'A Ccrtifir:d Co:aractor a• �t...l 1 . t. ..�.. �-'i • t.nYtt ilCat� \n'r S' � kf E/id I , { lt;' .:tc: [1i:c'. , .tr.:_c• ,, 2—STATE Well Owner. Location DRILLING, DRILLING LOG Dom. .Use of WeB (addre~ o£: Township, Range, Section, if known; or distance main road Lct ¢ ?Carrel,zen Vie. w Estates, Anchorage - feet Cased to · feet Size of casing :: Depth of Hole 2 ~ 230 A Static water level Screen ( ); Perforated ( ). Describe screen or perforation i~/A Well pumping test at 7'.2 gallons per of drawdown from static level. ft. (above) ::[b'~ID'~) land surface. Finish of well (check one) open end ( x:.: ); (minute) for ~ hours with ~ r~r~o,' ft. Date of .completion ¢ / ''~ '~./'7 :: WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness ": .TO ' C,~.qin.t~ -~tick~,.~ ') TO. " TO_ '"f ! .') nnl-hl e Si ~rv Srmvo! Silty sand 71 Silty sand: gravelly 79 Silty gravel: clayey, blue 32.5 Wet ~ravel: silty 117 Gravel!v ha~d nan 117 TO 147 Silty sand and gravel: seepage R E T U R N T 0 their money to tlMm at tho address a~ tbs ~. RETURN TO I:l~:laLY SIGNED Redif~prm® 4S 471 SIGNED SEND PARTS I AND 3 WITH CARBON INTACT. PART 3 WILL BE RETURNED WITH REPLY. DATE January 4, 1978 Patrick Schmidt 3a20 East 64th Avenue Anchorage, Alaska 99502 Subject: Lot 4 Ptarmigan View Subdivision Permit #77515 A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If there are any further questions, please contact this office at 264-4720. Sincerely, Health and Environmental Protection Sewer and Water Section Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1. GENERAL INFORMATION Oomplete legal description HAA# /¢~/',,z_~,~_~ Expiration Date: Location (site address or directions) Current Property owner(s) Mailing address Lending agency Mailing address Day phone Real Estate Agent Mailing Address Day phone Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer The Municipality of Anchorage Department of Health and Human Services (DHHS) 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. DHHS 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 tharh 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 engineer's work. 72 025 IRe,/ 01,00)' 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 To C)'~,~.-/,J Address :.&¢ :% Engineer's Printed Name DHHS SIGNATURE Approved for Disapproved· Conditional approval for __ bedrooms. Phone Date bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: Original Certificate Date: Reissue Date: 75 025 trey OI 00~' L'-~Municipality of AnchorageL-'J Department of Health and Human Services Divisfon of Environmental Services On-Site Services Sect[on 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-4744 'CEIVED JUL 06 E000 MuNJCIPALfT¥ OF ANCHORAGE , .,~k~MENTAL SERVICES DIVF'I - Legal Description: J_ O ~'- HEALTH AUTHORITY APPROVAL CHECKLIST ~ ~7','~l~/~,l\L V[~--~./ ESTATE Ol.~' Parcel I.D.: ~"7~- _CB A. WELL DATA Well type Date completed Total depth ~'~o ft FROM WELL LOG Date of test IfA, B, or C provide PWSID # __ Sanitary seal Cased to ¢~ ~ ft Static water level ft Well production WATER SAMPLE RESULTS: Coliform ~ colonies/100 mi Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Date installed g.p.m Well Log ~/ Wires properly protected y Casing height (above ground) J ~ o in. AT INSPECTION /~z~ ft g.p.m Nitrate /,4 lj~ mg/I Other bacteria z~ colonies/100 mi Collected by: -//~ -% Tank size Cleanouts "/ Foundation cleanout ~/ Date of pumping ~//~¢/~ ~ gal Number of Compartments. ,~-, Depression over tank 1--[ High water alarm Pumper C. ABSORPTION FIELD DATA Date installed ~'A,¢'/~-'~ Soil rating (g.p.d./ft2 or ft2/bdrm) i. ,2. System type . Depression over field For ~/' bedrooms Length. ;~J~ ff Width .-,'2_. ft Gravel below pipe Total depth ¢-/2- ft Effective absorption area ~/2,~ fF Monitoring tube Date of adequacy test iq/A- Results (-~-ass/Fail) L~ Fluid depth in absorption field before test __~ in Water added Elapsed Time: v/ min Final fluid depth P// in Any rejuvenation treatment (past 12 mo.) (Y/N & type) u/' gal. New depth_ ~-~// in. Absorption rate >=__k""' g.p.d. .If yes, give date ~ 72-026 (Rev. 01/00)* LIFT STATION Date installed "Pump on" level at __ Datum Size in gallons ~ in "Pump~at__ in Cymes tested E. SEPARATION DISTANCES Manhole/Access High water alarm level at __ in Meets alarm & circuit requirements SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot - On adjacent lots Absorption field on lot I ~,o -I- On adjacent lots Public sewer main Sewer/septic service line .> Public sewer manhole/cleanout Holding tank ' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property line ~ / z~ Water service line '~ Wells on adjacent lots Building foundation Water main t4/A Drainage Absorption field Surface water Surface water ~.l I ~ Wells on adjacent lots __ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ,-.~ Building foundation -'~ ~-/ Water Service line Curtain drain NI Water main bi ~/.~ Driveway, parking/vehicle storage F. COMMENTS G. ENGINEER'S CERTIFICATION Date HAA Fee 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 ~'o ~/0 ~ ~,/ ~('"~,~ d v k [~ ~ '~ Waiver Fee $ Date of Payment Receipt Number Date of Payment Receipt Number 72-026 (Rev, OI/00)' 07=0~=00 08:24 FROM-CTE ENVIRON)rENTAL Zt~.~ CT&~ ~.vir~menl~l ~rvices In(~. T-O09 P.03/05 F-$22 CT&E Ref.# 1 (103340002 Client Name Tobben Spurkland P.E. Project Name/# N/A Client Sample HJ Claris CLr¢le ~ · ~ ~ Matri,~ Drh-d<i~lg Water Ordered B~' PW$IB Sample Remarks Client PO# Pre-Paid Colis/NO3 Printed DaieFl'ime 07/04/2000 18:44 Collected Date/Time 06127/2000 t3:30 Received Date/Time 06/27/2000 14:00 Technical Director Stephen C. Ede 0.500 U 0,~00 mS/L EPA 300.O 10 mmx 06/27/00 Total Cotiform ¢o~/IOOmk $m18 9222B MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 4 ~tarmigan View Subdivision Location (address or directions) (b) Applicant Name Patrick Schmidt Telephone: Home 344-9872 Business Applicant Address P.O. Box 10607 Anchorage, 99511 (c) Applicant is (check one): Lending Institution [] · Owner/builder [] ' Buyer [] · Other [] (explain); (d) Lending Institution City Mortga~;e Corp Address P.O. Box 42810, Anchorage, Alaska (e) Real Estate Company and Agent Address Telephone 99510 Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family']~ Multi-Family [] Number of Bedrooms three (3) Other WATER SUPPLY Individual Well I~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ~x Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 ~2-025 (~,.84) ENGI2,iEERING FIRM PROVIDIN~ JSPECTIONS, TESTS, FILE SEARCH, DA~ AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional 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. Name of Firm D-High Engineering Telephone Address Date Engineer's Seal This department has received written confirmation from the engineer regarding the Conditional Approval of April 24, 1986. The corrections have been accomplished and an inspection has been completed by the engineer. The subject property meets with Municipci standards and is now approved. DHEP APPROVAL Approved forthree(3) bedrooms by ,,'~~ Approved xxxxxxxx Disapproved Terms of Conditional Approval Conditional Date June 30. 1986 CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date /f / </~ / ~'(~' GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) GAS/-' 9 Applicant Name'-'~T~l¢l~..<~.14nq,~7 T' T.elep..ho, n..e: Home ~/--~' ? <Y?Z., Business Applicant is (check one): Lending Institution []'; Ov~r~/l:u~r" ~J~; Buyer ~' Other Q (d) Lending Institution Address iO'O' /~ "*~ (e) Real Estate Company and Agent Address Telephone Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family,l~ Multi-Family [] Other Number of BeOrooms~'-~)T/¢/"~e~' WATER SUPPLY Individual Well ~]' Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite I~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 I ' 72-025 111/84) ENGINEERING FIRM PROVID INSPECTIONS, TESTS, FILE SEARCH, £ -~ AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Healt'h Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codesl ordinances, and regulations in effect on the date of this inspection. NameofFirm o,t-Ii(.,H ~A/GiAJEEEIfl;~ Telephone ~'~('~ '~' Izj'' Date '~/(~ / ~'(~ Engineer's Seal (..T-c:,~'C> itt c~44' ,G/--- DHEP APPROVAL Approved for 1/'~"~"~/~'-~)bedrooms by ~-~ '~' '~~ Ap~/oO Disap~'ed Conditional Terms of Conditional Approval Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a c.ertificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MO,-,/ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: /..0'1' MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION APR 1 6 A. WELL DATA Well Classification '~'~s/~"3~/I,~' ~/~'/~." ~1/'~ ) If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ~ Date Completed ~{2X.,, j 7~ Yield IZ ~/~m (, Depth of Grouting /~on~ ,~./o~P Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Y Total Depth Z_~_ Cased to Static Water Level I 3.~; Casing Height Above Ground ! Electrical Wiring in Conduit (Y/N) Y Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot IO7 To Nearest Public Sewer Line Cleanout/Manhole /V//J. Water Sample Collected by "~EE Water Sample Test Results ~4r/~; Comments ~rno~z~ J~ ~ ~/~ZL · On Adjoining Lots ' On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot · Date 4/q[~'& B. SEPTIC/HOLDING TANK DATA -'~j "~ Size lO00 ?.at., No. of Compartments Air-tight Caps (Y/N) 'tx Foundation Cleanout (Y/N) Date Last Pumped 4 //~/~'~- /~J 'for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Date Installed Standpipes (Y/N) Y Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) I~/A Separation Distances from Septic/Holding Tank: To Water-Supply Well ~'. To Property Line ~1" To Water Main/Service Line Page 1 of 2 .......... - 72-026(11t84) ABSORPTION FIELD DATA ~ 2..~p~/~,~:~,..**...' o,,s ^b orpt,on Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ,¢'o '7 / / To Building Foundation -.~ Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field 4 '/~ (/'~'~¢) Depth of Field (. ~l Gravel Bed Thickness '~" Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on · On Adjoining Lots ~//~ To Cutbank (if present) /V'//~ D. LIFT STATION Page 2 of 2 Date Installed ~. Dimensions Size in Gallons ~ Manhole/Access (Y/N) "Pump On" Level at ~ "Pump Off" Level at High Water Alarm Level at XX~ Vent (Y/N) . Tested for ~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments "Check Perm_i·tted Bedroom R. ati:g Agai?s, HA)k~equest '* I certify that)"~ave~Checked, v~rffied, or conformed to ~1 MOA and HAA guidelines in effect on the date of this inspection. / ~ . Signed ~/'.--,~-~ ~ Date Company O' H[~?( ~'¢,,iMo.~izl~, MOA No.- e ~ :,.. Receipt NO. ~ '~. ~ "7 ? Date of Payment ~-I 1o' c~ ~ ~,,ff'~ Amount' $ ~ O "~' '.,' -' ineer's Seal 72-026 (11/84) unicipality of Anchorage P.O. Bo~ 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES April 24, 1986 Dee High, P.E. D-High Engineering 3605 Arctic Boulevard, Suite 993 Anchorage, Alaska 99503 Subject: Lot 4 Ptarmigan View Subdivision Waiver Request, WR86-048 Dear Mr. High: Your request for a waiver of the minimum required separation distance between the well and septic tank on the subject lot has been approved. The required 100 foot separation has been waived to 95 feet in this case. This waiver is valid for the existing three bedroom single family dwelling only. Sincerely, Stephen S. Morris Civil Engineer On-site Services SSM/ljw D-HIGH ENGINEERING Civil Design Proiect Management & Inspection Municipality of Anchorage Department of Health & Enviromental Protection 825 L Street Anchorage, Alaska 99501 April 16, 1986 A~R ~ ~ w.o. D86133 mttn: Susan Oswald RECEIVED RE: Lot 4 Ptarmigain View Subdivision/ Septic/ Well Seperation Waiver 3806 ^.CT,C, SU,TE ~ ^.cHo.^GE, ^L^SK^ 99503 (9 o 7 ~u~-^~r~ ~ ~.CHORA~ DE~. OF HEALTH & ~VI~ONME~T~ PROTECTION Dear Susan, While performing a Heath Approval inspection for lot 4, Ptarmigain View Subdivision, I noted that the septic tank set within the 100 foot protective well radius. Existing records indicate that the the septic system was installed in May 1978. At that time, the system was inspected and approved based on the tank having a clearence of 103 feet. We would like to request a waiver to the 100 foot protective radius for the following reasons: Only about 1/2 of the tank is with in the 100 foot radius. The remaining portion of the tank is outside the protective radius. The well log indicates that the surface soils consist of silty sands or silt gravels with a hard pan down to 117 feet. The total depth of the well is 232 feet with water being found between elevations 210 and 232. These soils are highly impervious to the flow of water making the chances for well contaminatin from the septic tank highly improbable, ur.../! ~_ There contour of the ground slopes away from the well at about 90 degrees. There is little to no chance that surface water would drain from the area of the tank to the well. ~-~o In discussions with the owner, there has been no apparent problems with the existing septic system in terms of blockage, leakage or ~-z~-~ odor. Our adequacy test resulted in an absorption rate of 879 gallons per day. It was tested for a three bedroom home. II Enclosed is a copy of the record drawing and well log for your review. Based on the above, we would recommend approval of the waiver. Ver~__Tr ul y Yours Dee High, P.E.(,./ Owner ~1 / ~ MUNICIPALITY OF ANCHORAGJ. / DEPT. OF HEALTH & 'I " ENVIRO~MENTAL PROTECTiON '"'"'"- ' ~ RECEIVED ~.':' · ~F~- :' ': · ~ '~: ~ ~ ~- -.. . ~- · ~ '~' " ~'-" '" ~:,";w~ I June 18, 1986 CITY M O RTGA ,.. Department of Health and Enviromental Protection Division of Environmental Health 825 L Street Anchorage, AK ATTN: Stephen Morris RE: Lot 4 PTARMIGAN VIEW S/D Mr. Morris: Per our telephone conversation this afternoon, I am returning the original "Blue Form" which indicates a "Conditional Approval. Along with the Blue Form I am attaching a photocopy of the Encroachment Permit issued by Public Works. At this time we would like to request a new Blue Form showing an "Approved" system. If you could call me at: 276 8125 Ext 275 I will be most happy to pick up the form. If I can be of further assistance, please do not hesitate to call. Sincerely, /\ Sher± Dean Loan Officer 405 West 36th Ave., Suite 100 · Anchorage, Alaska 99503 · (907) 563-0700 ENCROACHMENT PERMi THIS AGREEMENT, made this 6TH day of June , 19 86 , between MUNICIPALITY OF ANCHORAGE, Grantor, and Carol Schmidt , Grantee, WITNESSET}{: The Grantor does hereby grant an Encroachment Permit in the following described Public Right-of-Way or Easement Area to Wi t: Ptar.~'mi gan View Estates: Lot 4 located within the NW]/4;.q~i~n 21;T]2N;R3W; S.M. Alaska Grid# 2634 ( 3031 Chris Circle ) The encroachment hereby authorized is described as a~ld limited tc the following: That portion of a leach field and stand pipe that encroaGh~s intQ the street riqht-of-way approximately 20' (feet) as shown a~tachment "A". In consideration for this permit, the Grantee agrees that he will indemnify and hold harmless the Grantor against any a~d all claims which may arise or be caused by the construction, alteration or maintenance and existence of the above described encroachment or for any damages whatsoever arising out o[ the granting of this permit. The Grantor reserves the right to revoke this permit upon twenty (20) days written notice to the Grantee. The Grantee, agrees upon said notice of revocation, to immediately remove said encroachment from the easement, street or public right-of-way.i Should the Grantee refuse or fail to comply with said writt~ notice, the Grantor, may without further notice to the Grantee,i remove or cause to be removed the encroachment, and the Gra~]tee hereby agrees to reimburse the Grantor for all cost incidental to the removal thereof. The Grantee hereby agrees to pay an annual fee of $ 10.00 · IN %~ITNESS WHEREOF, the parties hereto have hereunto set their hands and seals the day and year first above written. Grantee: ~[~.c~,~6L[- Grantor: ANCHORAGE