Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
TUSTAMENA TERRACE LT 2A
Tustarnena Terrace Lot 2A #017-381-07 MUNICIPALITY OF ANCHORAGE DEI 1TMENT OF HEALTH AND HUMAN SERI -S ' Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES TO FROM SEPTIC TANK ABSORPTION FIELD WELL Address 13 ILIO A%rcA Xva<L /?<Id�ye /i.0 aff yAr WELL ( n ^' /l 2 6,4 / a Phone(s) Sys -6Y66 Permit No. �Gdog6f No. of Redrooms LOT LINE (: rA z 6 as..6g,7i, C�^, 2.S 6- y) 60 (a� Hyl LEGAL DESCRIPTION Lot A Block Subdimsnm �uy han�n4 'ja a�4, FOUNDATION /5 3 0 $S 66 Township, Range, Section S' -e, 2 7 7-f 2 Al Q.7 IJ AS -BUILT DIAGRAM (Show location of well. septic system. properly lines. foundation. driveway, water bodies, etc.) TANKS I rzo 0 � C '& ElSEPTIC El � '&TNG Manufacturer 5 Capacll gallons 5h / Material fi No. of Compartments [ ' y o Lo TYPE OF SYSTEM TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from original grade N rJ FT Total depth from original grade 9 FT %o t✓e// - -• ` o / '),Q Rr. - "t N '� - -- t IS `„ tc P �^- Q fu FIJI added above original grade Y� FT Gravel depth beneath pipe, T FT — r Gravel length '�o FT _ Gravel width ..3 -7b /i FT _ Total absorption area 6-60 SO FTI Distance between lines - /DFT Number of lines Soil rating /zs Sp FTLDIlnstailecl (pipe material 910 �3o3Y K Installer %jo .4r/IJ <J w[ 15 anb 16 WELLS ❑ PRIVATE ❑ OTHER (Identify) Classification (A.B.C) pth FT Cased to FT Installer L[mmiled. JE K REMARKS: Excel/� h J'q i$ ryriff Ihr. 2r'M/q en w a e I r S rz a / .� acv rwae WLr •'c� Ise ut ave'- T/7e S JIF+ al t/Nk'/i 7�e^e 'S /e'ti Scale: /t r= YO' AV Inspections Performeo 6y: ENGINEER'S SEAL <7'z Date: 3L,1`z id L'IKG inspection was performed according to all I certify that This Municipal and Stale guidelines in effect on this date: Health Department Approval: Date. 72-013 (3/85) % .j PERMIT NO: DATE ISSUED: �����C:", .1 F, e,:,!h L- I - 11 , "N", 0 IF7 ��������E- DEPARTMFNT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET/ ANCHORAGE, AK 99501 264-4720 860084 UPGRADE ����"u^n ^~� k�r +,=' ,.�^, 04/03/86 APPLICANT: DAVID D. ZTMMERMAN ADDRESS: 13140 BIRCH ROAD ANCHORAGE, AK 99516 ' CONTACT PHONE: 345-6466 LEGAL DI --.'SCRIP. SUBDIVISION: TUSTAMENA 'TERRACE LOT: 2A BLOCK: NA SECTION: 27 TOWNSHIP: 12N RANG[: 3W LOT SIZE: 26957 (SQ"FT. OR ACRES) I certify that: 1. T am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of' Anchorage (MOA) and the State of Alaska. 2. I will instal] the system in accordance with all MOA codes and regulations, and in com7liance with the design criteria of' this permit, 3, I will adhere to al] MOA and State o� Alaska requirements [or the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot" IF A LIFT STATInM IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTG WILL mOT BE APPROVED 1,4I1HDUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST 8E DONE BY A LICENSED ELECTRI�IAN" SIGNED --t-^-~� DATE: APF- 7MAN LAT~ --`-`-- --- --��-�--��----- ISSL|Eo BY4, �� /7�����-- --!�----------~----'--------'-^----- ^ DATE. .... -~... ...... -------- qc» &-/ i/ Gc-- � c-��w���� Ta-- e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: &VtrC1 27i wft4e/ oag DATE PER FORMED: >- ` %ev�tn� cam' C� LEGAL DESCRIPTION: r�/�, TGL�UC(ilB(i(Gf Township, Range, Section: (ati� jGp� JpC"7 1 A SLOPE SITE PLAN I, 4 F E 7 a 9 10 11 12 13 14 15 16 17 18 19 20 �RGa16U(G 7447- 5I4Tt 54DOY 6&WOZ e4a C'2S SlG% I I i I t j WAS GROUND WATER c2a5y ENCOUNTERED? 00 11 r IF YES, AT WHAT DEPTH? Depth to Water After Manitorino7 UIrIGIC- Date: MUNICIPALITY C DEPT. OF ENVIRONMENT/ MAR Z RECE F I I PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER 7 \TEST RUN /BETWEEN FT AND FT COMMENTS '\CT �( � �Pyo'l r] � PERFORMED BY: 112— - 4,—CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT OTHIS DATE. DATE: 72-008 (Rev. 4/85) GRE! 7R ANCHORAGE AREA BOR' IGH Department of Environmental Quality " 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME I 4 /(��2�r11rl�ii-MAILING ADDRESS ^SRA 36x /77 LOCATION �9ZhL '(�*�'�^""�""" LEGAL DESCRIPTION SEPTIC TANK: DISTANCE NUMBER OF FROM WELL 161 MANUFACTURER MATERIAL COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY A�•S0GALLONS. TILE DRAIN FIELD: i _ I TOTAL LENGTH DISTANCE FROM WELL FOUNDATION 3S NEAREST LOT LINE �'� OF LINES NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH- IN. TOTAL EFFECTIVE ABSORPTION AREA �'-' SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE _ MATERIAL BENEATH TILE- IN. ABOVE TILE IN. WELL TYPE_"1U -CONSTRUCTION !' K DEPTH DISTANCE FROM: BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL NEAREST SEPTIC SEWER LINE . TANK_ APPROVED DISAPPROVED REMARKS SEEPAGE SYSTEM_ DISTANCES: DIAGRAM OF SYSTEM RAJ INSTALLED BY: V! VV � 9a� SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS: �� . DATE APPROVED_- G.A.A.B. Form EQ -032 I 1136 GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 !11 Q TELEPHONE 274-4561 :K SEWAGE DISPOSAL SYSTEM - APPLICATION AND PE MIT NAME OF APPLICANT •"��GI""�•�✓<IJ MAILING ADDRESS V"' ^�� uNC��PHONE / INSTALLATION LOCATION -7/t/ 12 LEGAL DESCRIPTION �T �JT /✓G`� `�� /C�%�F �f����� /l�K'���'/�/ fir / y INSTALLATION OF: SEPTIC TANK SEEPAGE PIT , DRAIN FIELD OTHER I .< TYPE AND SIZE OF FACILITY TO BE SERVED T GYAlAb=G7/-z J//'J(�L/ 7.0 �`/< ac ,v ir,i•/ice �p�pA6! A�L� �Y .' ru -Z ///moi FINANCED THROUGH TO BE INSTALLED BY ..�;✓ U SOIL TEST RESULTS. NOTE: NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE �''� TYPE J /_S -/h 4-LLG/.l SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF SYSTEM l � FOUNDATION TO SEPTIC TANK, J /. I-FOUNDATION TO SEEPAGE-Pii �-r +�/ ,DRAIN FIELD � l< SEPTIC TANK TO SEEPAGE PH' WALL�L�/ SEPTIC TANKy SEEPAGE PI-R:_Z�. DRAIN FIELD �— TO NEAREST LOT LINE. WELL TO SEPTIC TANK �L�� SEEPAGE -PF DRAIN FIELD "l/ ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK ��� SEEPAGE PIT DRAIN FIELDJl) SEPTIC TANK, (©'-UJ • SEEPAGE PIT / «<�/ DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER AANFHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ./ / ' /f � / DATE �t.[�i� /di// / 75APPLICANT'S SIGNATURE I ■■■■� o NEE MEE ■ ��■ ■■ ■IEN ■■■ �, ■ ■■■■ MEN __ ►��,�■■ mom ME 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER AANFHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ./ / ' /f � / DATE �t.[�i� /di// / 75APPLICANT'S SIGNATURE I Performed for Legal Description: This form reports: GREATER ANCHORAGL AREA BURUui' 'Department of Environmental, Quaii"ty 3330 "C" Street Anchorage, Alaska 99503 SOILS LOG - PEROLATION TEST M. Sgt. Richard Winegar ,� Depth Feet 1 - Topsoil —_------- -- 2 Gravelly Silty Sand (SP -SM) 3 4 Silty Gravelly Sands (SM) 5 Occasional cobbles to.1.5 ft. 6 - 7 19% Gravel Size 8 - 44% Sand Size y 37% Silt Size - as� 10 _ 12 - 13 - g S/opP on to Performed 6/11/75 14 _ 15 BOTTOM OF TEST HOLE Was ground water encountered? No--_` If yes, at what depth? Reading Date Gross Time Net Time Depth to Water Net Drop Percolation rateminutie. —>-- ---- Drain Field Proposed instal lation— : Seepage Pit _ _ Japth of Inlet — Uth to lottom of pit or trend COP4l1E11TS:No -bedrock_ or-.ground_ep ter _encountered_throug)1�Ltt_ d�pi1l-Qf--te _pit_,__2-�0 _sq.� xe _ e_et_dxainage._aroma-r_e-uire=L--p�r_�earu�u-- -- -- ----- Certified DY C413STBLLCTSQN_.TF.&T-Uate:.6/1175 Performed GY:__ _✓ldy ._w�------- .n-ncr James D. Mack, Lab Manager LAB S/opP on to Performed 6/11/75 14 _ 15 BOTTOM OF TEST HOLE Was ground water encountered? No--_` If yes, at what depth? Reading Date Gross Time Net Time Depth to Water Net Drop Percolation rateminutie. —>-- ---- Drain Field Proposed instal lation— : Seepage Pit _ _ Japth of Inlet — Uth to lottom of pit or trend COP4l1E11TS:No -bedrock_ or-.ground_ep ter _encountered_throug)1�Ltt_ d�pi1l-Qf--te _pit_,__2-�0 _sq.� xe _ e_et_dxainage._aroma-r_e-uire=L--p�r_�earu�u-- -- -- ----- Certified DY C413STBLLCTSQN_.TF.&T-Uate:.6/1175 Performed GY:__ _✓ldy ._w�------- .n-ncr James D. Mack, Lab Manager LAB 0 ,l�60.r o w �I p v v-• O L• ^ A'OV I 1N895s0. 9oor -X902 \ !Os UL/JI''y E4Se>ne,?Z 1 "77 — — -� : �,\ II�n� ,I XO I- 1 0�1e. ly 37 IIp .a 3a UV O 1 5FPTr,� S/rE ?4AV i dArA A86& -d 6K Anchorage Recording Precinct, Alaska, and that the P(uH s40 (V iLI /w15 GV l��9 4rn�j $P/%�•C$ Gi(�i(i / 9 .LI / 04 z SUf, 't IyFO",� 5 89`59 sc W 60• 30=• NAKNEK M S'W'/ Cleo& Our Z.00 Plo t"tom•• 140.34114 J + tri •' Stole ! �_ 40 i.8. 77-J L I 40,ic/Pq , FNkjR�FPp(iry of ! O^'46OTgZ Eq�� cH0 2 t ,PRo Fc N�B (� Woi( Asbu;�t I hereby certify that I have surveyed the following r described property: L -OT 2A TllSTA MENA TERRACE ! i Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the prop- ♦♦♦ erty lines and do not overlap or encroach on the z property lying adjacent thereto, that no improve- i •' '�yQ� ments on property lying adjacent thereto encroach on the premises in question and that there are no - roadways, transmission lines or other visible easeAr ments on said property except as indicated hereon. + Dated at Anchorage, Alaska this 6 day of A. 19 8 _ ^PRICE SURVEYS ! i �vMo LOCATION OF WELL FNk/RQA1, r A h�q`T cy 9C PR// B AGF MqR 21` "ec, 0,V r�WATER WELL RECORD STATE OF ALASKA DEPARTMENTOF NATURAL RESOURES Division of Geological 8 Geophysical Surveys 1 RFc� ,V^r Drilling Permit No. (Pieces complete either to, Ib of to.) ♦D A.D.L. No. la. Borough Subdivision Lot Block Ib./4gin. Section No. TownshipN❑ Range E Meridian —of—of—of— S❑ W❑ Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: - Address: Street Address and Area of Well Location 2. WELL LOG Feet Below Surface 4. WEI,I,.,,O,E PTH: (final) JJZZIIUU 5. 6PTE OF CA,M PL ETI N / 1'9 g4 Material Type Top Bottom ft Tan Silt sand ra'v'el. v-,/ bldrs. 0 30 y-}[ 6. LJCable tool ❑Rotary ❑Driven C] Dug 1 ❑ Auger C3 Jetted [3 Bored ❑ Other: Tan silt 30 45 - 45 74 7. USE: ]0 Domestic ❑ Public Supply ❑ Industry ❑ Irrigation ❑ Recharge ❑ Commerical ❑ Test Wall ❑ other: TErt brn, silt 74 111 Brn. gravelly till 111 126 Tnn silt / streaks cf silt 126 142 B. CASING: ❑ Threaded %❑ Welded did.. 6 1.. to 380 It. Depth Weight 17 lbs./ft. diam. in. to ft. Depth Stickup it. Tan dry Silt 142 171 Grey till 171 190 'c,rnx,P11v till, 190 212 S. FINISH OF WELL: Type; Open bott Orn Diameter: Ten till w gravel 212 233 c 4 Slot/Mesh Size: Length: Set between ft. and ft. Backfilling Gravel pock Dry brn, silt` 244 246 Tan sand & gravel 246 251 Gravelly 1' wet 251 261 IO. STATIC WATER LEVEL: 120 o.b.ft. 7 19 84 Date E) Above or ❑Below land surface Brn. silt 261 303 Brn. silt w/ gravelly till 303 , 1 Equipment used: dart valvts. bei lar Grey r1ay 318 334 Gre • till weak dirt' ' Water 334 338 11 . PUMPING LEVEL below land surface and YIELD ft. after 2 hrs. pumping 5 g.p.m. — ft. offer hre. pumping_g.p.m. Grey Silt w gravel 338 1'' .nd & (%ravel 348 354 Gravelly hard lya'1 354 355 12.GROUTING Well Grouted: E] Yes RjNo Material: C] Neat Cement C-] Other: R `.^nri n _ 3-"; S6 BL'c, s& w/ bldrs, 356 370 l3. PUMP: (if available) HP Blk, San( & 2rElVei. 37O j]] Length of Drop Pipe ft. capacity 9 P.M 377 380 ❑ Subm. ❑ Jet ❑ Centrifical ❑ Other wpntllarpd roci, 14.REMARKS: 16. WATER WELL CONTRACTORS CERTIFICATION: 13. Water Temperature ❑ F ❑ C - _° - This well Was drilled under my)urisdlction and this report is true to the best of my knowledge and bellefi Dotten Dri.11iva t,). AA051Y. Registered Business Nome Contract License Number 851 ' ;-iart;�eall ?:oad� Anrh., Aka 99507 Addrese: 11 tt jj Signed: ,1:. "_II II f/.'I/j..,..,_ - 0 C :. Dote: :S-_.,:--.{.. IAufhcrized Representative Form 02-WWR (II/BI) Copy Distribution: WHITE - State OGGS, PINK -Driller, CANARY- Customer Dotten Drilling Co. -- BOX 10056 JOHN'S ROAD ANCHORAGE, ALASKA 945o2 PHONE 344.-1952 - JELL L( G For: R -chard Winegar. Date cow; fete is August, 1975. :size: 6". Lot 2A Tustemena -orres Location: Depth: 338'. 3U tic level: 1201 off bottom. PrO..coon: 6 QPM. Tari silt, sand;gravel & boulders j- 30 Tar si t_ 3U A5 3i.l ty band & gravel 45 74 Brown ::ilt, dry 74 111 Brown 4ravelly till ill 126 Tan silt 126 1 V_ Grey t:.11 1.72 193 Wet, gravelly till %193 i12 Tan tial 212 123 Pan till w/gravel, wet 223 133 e`raaer sand & gravel,, ; wea.k,. dirty 233 T34 Dry brawn silt' 234 ;46 brown silty sa d & gravel P46 :5i Gravelly till, wet X51 <61 Brown silt w/Feet ,ravel streaks 261 30 Gravelly till, wet 3Q3' 31e Gray clay 318 234 Gray till 334 330 ,`rater 3and & ara:vel A 336 339 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/onsit6 (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLPFAMILY DWELLING Parcell.D. 017-381-07 COSA# 0si✓10/0,go 1. GENERAL INFORMATION Expiration Date: t3-,Z7—/O Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address TUSTAMENA TERRACE: LOT 2A 13140 BIRCH ROAD + ANCHORAGE, AK 99516 BRIAN WOLF Day phone 13140 BIRCH ROAD • ANCHORAGE. AK 99516 Day phone LAURA KLAYUM W/ PRUDENTIAL VISTA Day phone 632-1243 16600 CENTERFIELD DRIVE • EAGLE RIVER. AK • 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 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 seat 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 337-6179 Address 3701 E. TUDOR ROAD, SURE 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 8 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 fisted above. Any reliance upon or use of this report by any otherperson or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for —4-1 bedrooms. Disapproved. Date _511 Cl itD Conditional approval for bedrooms, with the tllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other `��i��jtY OFgty''••. -' • ONSITE WATERAND ; 1n= WASTEWATER PROGRAM ' By: Original Certificate Date: %—/ O (Ra. 11.05) - 7 I•• . P '••J Go r ess.r 'c,• ' E-7 a i Conditional approval for bedrooms, with the tllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other `��i��jtY OFgty''••. -' • ONSITE WATERAND ; 1n= WASTEWATER PROGRAM ' By: Original Certificate Date: %—/ O (Ra. 11.05) - 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 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: TUSTAMENA TERRACE; LOT 2A Parcel ID: 017-381-07 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 7/19/84 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 380 ft. Cased to 380 ft. Casing height (above ground) 12+ in. FROM WELL LOG Date of test 7/19/84 Static water level 260 ft. Well production 6 — 9 -p.m -WATER SAMPLE RESULTS: Coliform, 0 colonies/100 ml. Nitrate®•8�5mg./L. AT INSPECTION 5/13/2010 235 ft. 4.16 n Other bacteriacolonies/100 ml. Arsenic: &LD ug./L. Date of sample: 5/13/2010 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 9/16/1975 Tank size 1250 gal. Number of Compartments UKN Cleanouts (YIN) YES Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 11 /10/2009 Pumper MCDONALDS 'PUMPING C. ABSORPTION FIELD DATA BE ow EXISTING GRADE 9/16/1975 •"'203 TRENCH Date installed 7/16/1966 Soil rating (g.p.d./ft2o !bd 125 System type TRENCH 58 7 Length 70 ft. Width 3-4 ft. Gravel below pipe 4 ft. .1 1 812 Total depth •88 ft. Eff. absorption area 560 ft' Monitoring tube YES Depression over field NO Date of adequacy test "5/13/2010 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test30 in. Water added 600 gal. New depth 48 in. Elapsed Time: 120 min. Final fluid depth44 in. Absorption rate >= 600+ g.p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date – **TESTED 1986 TRENCH. -**PER MOA RECORDS APPROVED 5/3/1998 D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump�..L� iin. High water 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'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ 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'+ Driveway, parking/vehicle storage 2' Curtain drain NONE KNOWN 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 COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date d jC) I J O COSA Fee S 7 %y Date of Payment S o �i Receipt Number D G ! —7 2 :�Z (Rev. 1 f 105) Waiver Fee $ Date of Receipt Number _SGS SGS ReLN 1102121001 Client Name Garness Engineering Group, Ltd Project Name/N Tustumcna Terrace Lot 2 A Client Sample ID Tustumcna Terrace Lot 2 A Matrix Drinking Water Printed Date/Time 05/18/2010 14:59 Collected Date/time 05/13/2010 12:02 Received Date/rime 05/13/2010 12:20 Technical Director Stephen C. Ede Sample Remarks: _. Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Daic Date [nit Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 05/13/10 05/17/10 SCL Waters Department Total Nitrate/Nitritc-N 0.865 0.100 mg/L SM20450ONO3-F D (<10) 05/13/10 AYC Microbiology Laboratory E. Coli Negative I 100mL SN1209223B A 05/13/10 DLC Total Coliform Negative 1 100mL SN1209223D A 05/13/10 DLC Municipality of Anchorage •. • j 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 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-381-07 COSA# 1. GENERAL INFORMATION Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address TUSTAMENA TERRACE: LOT 2A 13140 BIRCH ROAD • ANCHORAGE. AK 99516 VALARIE WOODS Day phone 13140 BIRCH ROAD • ANCHORAGE. AK 99516 Day phone FSBO Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 223-7642 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 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 tiles 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. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS: P.E. Engineers Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines b 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 readilyidon6Yable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may nuctuate 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 benerit 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 V� Approved for __Lt_ bedrooms. Disapproved. Phone 337-6179 Date 11 2 Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory J Arsenic Advisory Maintenance Agreements Supplemental Engineers Report Other By: IN Original Certificate Date: Z/ 6) i (Rev 11105) Municipality of Anchorage Development Services Department Building Safety Division On -S's Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: TUSTAMENA TERRACE: LOT 2A Parcel ID: 017-381-07 A. WELL DATA Well type PRNATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 7/19/84 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 380 ft. Cased to 380 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 7/19/84 6/24/08 Static water level 260 ft, 233 ft, Well production .m. 5.45 g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Arsenic: J_ug./L. B. SEPTIC/HOLDING TANK DATA Nitrate G'mg./L. Other bacteria colonies/100 ml. Date of sample: 11/11/09 Collected by: GEG Ltd. Tank Type/Material SEPTIC/STEEL Date installed 9/16/1975 Tank size 1250 gal. Number of Compartments UKN Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 11/10/2009 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA BELOW EXISTING GRADE 9/16/1975( 203 A'G TRENCH Date installed 7/16/1986 Soil rating (g.p.d./ft'o t /bd 125 System type TRENCH 58 7 Length 70 ft. Width 3-4 ft. Gravel below pipe 4 ft. *12.1 812 Total depth •8.58 ft. Eff, absorption area 560 ft' Monitoring tube YES Depression over field NO Date of adequacy test •'6/24/08 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 28 in. Water added 900 gal. New depth 35 in. Elapsed Time: 120 min. Final fluid depth 32 in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — ••ESTED 1986 TRENCH r� (f/7�1k D. LIFT STATION Date installed Size in gallons 'Pump on" level at in. 'Pump off" E. SEPARATION DISTANCES Manhole/Access water alarm level Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO Septic tank/lift 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'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ 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 Zine 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 100+ Surface water 100'+ Driveway, parking/vehicle storage 2' Curtain drain NONE KNOWN 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 COSA guidelines in effect on this date. Engineers Printed Name JEFFREY A. GARNESS Date 11) -2 D Ci COSA Fee S_ Digo. 00 Date of Payment yam/ 9 Receipt Number. ofly.31 9 (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number SGS RtL0 1096177001 Client Name Garness Engineering Group, Ltd Project lame/p Tustamena Terrace Lot 2A Client Sample ID Tustamcna Tcrrace Lot 2A Matrix Drinking Water Printed Date/rime Collected Date/rime Retched Date/rime Technical Director 11/20/2009 15:29 1111112009 12:40 11/1112009 16:40 Stephen C. Ede Sample Remarks: EP200.8 Arsenic ND 5.00 Parameter Allowable Results PQL Units Medw Conwincr ID Limits Prep Date Analysis Date Init Metals by ICP/MS EP200.8 Arsenic ND 5.00 Waters Department NRB Total Nitrate/Nitritc-N 0.809 0.100 Microbiology Laboratory (<10) Colony Count 0 Total Coliform 0 Fccal Coliform 0 ug/L EP200.8 C (<10) 11/16/09 11/19/09 NRB m8/L- SM204500NO3-F B (<10) 11/20/09 LCE col/l00mL SM209222B A (<200) col/100mL SM209222B A (<I) wV100mL SM209222B A (<I) II/11/09 DLC II/11/09 DLC II/11/09 DLC m�mm--Ww%mm ---------- --- ----- •SS'SL 3„LZ,9O„O S ,00'091 3„01,00°0 5 W C3 N N 0 0� m EI iA �W 0 �N :1 Q o •. W '0 N . 0): 1��44d�S4 _= " J o °`moo ---------- --- ----- •SS'SL 3„LZ,9O„O S ,00'091 3„01,00°0 5 W C3 N N 0 0� m EI iA �W 0 �N :1 Municipality of Anchorage -�1 Development Services Department 6 Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street - P.O. Box 196650 Anchorage. AK 99519-6650 www.munl.org/onsit/onsite /j ..X(' `�"' ✓"/ (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. COSA# D g b3A5 1. GENERAL INFORMATION Expiration Date: O 19 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address TUSTAMENA TERRACE: LOT 2A 13140 BIRCH ROAD "ANCHORAGE. AK 99516 VALARIE WOODS Day phone 223-7642 13140 BIRCH ROAD "ANCHORAGE. AK 99516 Day phone FSBO Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well 0 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 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 riles 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 337-6179 Address . 3701 E. TUDOR ROAD, SUITE 101 r, ANCHORAGE. AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 0 8 Engineers Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 6 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 tight whatsoever. 5. DSD SIGNATURE 1'1� Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the Illowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory t/ Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other lll(fnturl,r, `�1kk V\SY OFgN`r%,. J • ON-SITE ••:�� = � � WATER AND ; rK WASTEWATER ; PROGRAM �O. ���..lM.'•...••.c N By:G%;G%� Original Certificate Date: (R.. 11105) 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 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: TUSTAMENA TERRACE: LOT 2A Parcel ID: 0I ?-35? 1 — P % A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 7/19/84 Sanitary seal (YIN) YES Total depth 3BO ft. Cased to 380 ft. FROM WELL LOG Date of test 7/19/84 Static water level 260 ft. Well production 6 g.p.m. WATER SAMPLE RESULTS: Coliform _0 colonies/100 ml. Nitrate 0.816 mg./L. Well Log (YIN) YES Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 6/24/08 233 g, 5.45 g.p.m. Other bacteria 0 colonies/100 ml. Arsenic: _0 ug./L. Date of sample: 6/24/08 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 9/16/1975 Tank size 1250 gal. Number of Compartments UKN Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 6/24/08 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA BELow EXISTING GRADE 9/16/1975 203 TRENCH Date installed 7/16/1986 Soil rating (g.p.dJft'o/bd 125 System type TRENCH 5 8Length 70 ft. Width 33 4 ft. Gravel below pipe 4 ft. *12.1 812 Total depth +8.58 ft. Eff. absorption area 560 ft' Monitoring tube YES Depression over field NO Date of adequacy test 6/24/08 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 28 in. Water added 920 gal. New depth 35 in. Elapsed Time: 120 min. Final fluid depth32 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — TESTED 1986 TRENCH D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off leve High water 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'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 50+ 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'+ Driveway, parking/vehicle storage 2' Curtain drain NONE KNOWN 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 COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date -711.5-L COSA Fee 5 L/ "2i (_ (N(A Date of Payment 71 oAR Receipt Number �Oq� (Rev. 11105) Waiver Fee $ Date of Receipt Number SGS ReE# 1082967001 Client %tame Garncss Enginccring Group, Ltd. Project Name/# Tustamena Terrace Lot 2A Client Sample ID Tustamcna Tcrracc Lot 2A Matrix Drinking Watcr PN'SID 0 Sample Rcmarks: All Dates rimes are Alaska Standard Time Printed Date/time 07/032008 9:03 Collected Date rime 06242008 14:00 Received Dateltime 06242008 15:35 Technical Director Stephen C. Ede Parameter Results PQL Units Allowable Method Container ID Limits Prep Analysis Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.6 C (<10) 0627/08 07/02/08 NRB Waters Department Total Nitratc/Nitritc-N 0.816 0.100 mg/L SM20 4300NO3-F B (<10) 0627/08 JDZ Microbiology Laboratory Colony Count 0 Total Coliform 0 Fecal Coliform 0 coV100mL SM20922211 coV100mL SM209222B COVI00mL SM209222B 0624/08 DLC 0624/08 DLC 06/24/08 DLC MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# 017-381-07 HAA# - 1. GENERAL INFORMATION Complete legal description Lot A; Tustamena Terrace Location (site address or directions) corner of Naknek Lane & Birch Rd. Anchorage, AK Property owner Larry Griffen Day phone Mailing address C/O Totem Realty 724 E 15th Avenue Anchorage, AK 99501 Lending agency Day phone Mailing address Agent Bob Baer/ Totem Realty Day phone 244-6025 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well xx Community well Public water 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 xx Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOA#21 - . 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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)�spection. Name of Firm Phonez� �- 6 • � • - -:� �LUId•1:1 r1.^..•7�7•\�1<`+irY�w7u wffimft�_ Date Alaska Water & Wastewater Consultants, Inc. is to be paid $ 2oo.00 at closing for engineering services performed. .Z" OFA ®� DV�-JZ cl0 CI ='"l S .D Z x•o:a .. • o e. i 6. DHHS SIGNATURE 1e re A. Games* •'W .0 �n • E-7953 ,• r��'A. Approved for __YO U1Z bedrooms. . Fo......... ��® wwe ww xbM Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments M Date 1.19-99. 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-M(Pe.1/91) Beck MOAM21 SRN -17-1999 19:06 CT8E ESI PNCH13RRGE CT&E Environmental Services Inc, Laboratory Division 200 W. Potter Drive Anchorage, AK 99518 Tel: (907) 562-2343 Fax;(907)561-5301 Cheml-ab Ref. #: 99.0262 Client Name: AK Water & Wastewater Cons, Project Name: Na Client sample 10: L2A Tustamena Terrace Matrix: Drinking Water PWSID n/a 9075615301 P. 01. 02 Client PO#: NO Printed DateJrlme: 1117199 19:00 Collected Date/Time: 1/14/99 13;55 Received Date/time: 1/14/99 1610 Technical Director: Stephen Ede Released By: r JAN 19 1999 Municipality of Anchorage Dept. Health & Human Services Allowable Prep Analysis Parameter Results POL Units Method Limits pate Date Init Total Coliform (MF) 0 061/100 ml SM9222B 1/14/99 KAP Nitrate 0.197 0.1 mg/L EPA 300 10.0 1/14/99 SCL r JAN 19 1999 Municipality of Anchorage Dept. Health & Human Services MUNICIPALITY OF ANCHORAGE ° DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # HAA # W1F L:1 i�;� 1. GENERAL INFORMATION _ Complete legal description O a�1/ i �fS7HMc/vff �cizaacr S/O Location (site address or directions) ( 0fzNe.2 of 14<1\ji=/�_ Property owner P Y L+&Lv �RiFFi-7 N 6Sy- X2!`4 Day phone 3y S - 680 2 Mailingaddress R)2ct-i- 2j Lending agency Mailing address_ Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: I Y 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 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 (Rm t/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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 Address Engineer's signature Alaska Water 6. DHHS SIGNATURE Approved for �262 Vbedrooms. Disapproved. Conditional approval for Additional Comments By:� MITir Phone 3 -6 (7c -I Date S/ 2 e ts3 f cx7 Vs �` 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. 7M-0 (Rev. 1/91) Back MOA X21 RECEIVED Municipality of Anchorage MAY 0 4 1998 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MUNICIPAMOFANCHORAGE 825 L Street, Room 502 • Anchorage, Alaska 99501 �rY gjj�Lftj$Es DIVISIQ 0 Health Authority Approval Checklist Legal Description: I I(A.S-f/NMErj (Ef? RWU'— /0 Parcel I.D.: obi -38/- pr? A. WELL DATA Well type ?-t tW 9 F If A, B, or C, attach ADEC letter. ADEC water.system number N/4 Log present WN) L6S Date completed -H 1-8`I Total depth �S'Ur (Cased to 3190 Casing height (above ground) Sanitary seal 6/N)y�S I� ✓��(J� Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test 7H,- SLI +(3-c/cs Static water level a60' e q t-CwL,+7Eo Well production 6 g.p.m. 3,� AtiIN. g.p.m. WATER SAMPLE RESULTS: Coliform 19 Nitrate 01,40,U3 rnd� A- Other bacteria Date of sample: 9 �9 Collected by: 5• P. vi. STEEL PEA -P- P. B. SEPTIC/HOLDING TANK DATA Coil Off i---Wr2-- TN-lv- pE�- A+ H.S, la5o Date installed 9110"+S 4S Tank size GA<Cu Number of Compartments UIVK Cleanouts ('N) Foundation cleanout (Y/N) YE5 Depression (Y/ IQ Nu High water alarm (Y.& NA Date of Pumping 9 `98 Pumper /V,C%4cf:�S PVMOJroG C. ABSORPTION F ELD D4kTA SVS7E�^ uPGRAocn ��I6I�S OLD) (,UPomc—.) _ 0 p Date installe 9 l6 �S �-/6 Sb Soil rating (g.p.d./W or /b rm) Ca.0 �o2S System type I�71a I�Ea ac-:AcJi� 46 as y 13' SwiN END Length 58' � 40 LF Width UNk. 3-4 Gravel thickness below pips alt. X-jr. Total depth I?' Iooflm END 9 on . 81zsi SEo S"r"S N vcs u4�. Effective absorption area Monitoring Tube present Y ) Depression over field (Y/Ib A)6,N6 � '� Date of adequacy test IY8 58 Results (Pass/Fail) pftsS For FWa bedrooms ZNI f� P S{HTH Np1)(J jw7N E "' Fluid depth in absorption field before test (in.); 19'h" %lmmediately after gal. water added (in.): Imo" 61.s" �""�' j uX Wlh UT14 IC: T11@n Fluid depth, yLIV1 3S1' (ins) Minutes later: IX -M MJN• Absorption rate = goo + g,p,d, (1s r u Peroxide treatment (past 12 months) (YAI@ No's K�uwN If yes, give date NIA luw` 72-026 (Rev. 3/96)* TESTO THF_ IRIS TRcNU+ SYsTa',L- 0-1-Y. ($EE AT-0gQ4&' CE77c2) iNa 1986 71ZENcrt SYS7�ycn WhS,,. �uu0 SURCHARG60 (FAIL) D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm E. SEPARATION DISTANCES e in gallons imp on" leve *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot /00 loo "Pump off" level at* On adjacent lots loo,4 On adjacent lots / Public +sewer main Public sewer manhole/cleanout ��fE Sewer /septic service line ads F Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation S +- Property line S14- Absorption field 5 'f' Water main/service line 10 k Surface water/drainage Wells on adjacent lots /0o 14 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: t Property line /a Building foundation to I+- Water main/service line 10 14 Surface water loo , -I- Driveway, parking/vehicle storage area I U Curtain drain �UNi_ KhtOwN. Wells on adjacent lots 166 t Ru o F. ENGINEER'S CERTIFICATION 1186 SF -PVC SYVEI-A" I" s-TA-7Fi OF FWUIRE fj Qom ^ 04"16 ltdts gFF1, a-S74W-.0r PIE ?W9 s:4r6> �¢T�a�a F--oe4 t9 ysys7� wgs' I certify that have deter @ ed thru field inspections and review of Municipa records tl�IItems are in conforms ce with MO H iqe ines in effect on this date.�(�R�'pC& qg�r. • • • '9 l � i A ( en�Sll198 °A •• `;-r -V 4 Engineer' Name �AaAES IUTAAAS t; s• r��x,•.: ";tfifdE$i'�YjLElAMS l Date M� y � y� $ cs'• N0.9fi118 C.E. .•°�� HAA Fee $� � Date of Payment "i—A/ /!Gj Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number Alaska Water & Wastewater 7320 East Chester Heights Circle — Anchorage — Alaska 99504 Phone (907) 337-6179 — Fax (907) 338-3246 Consulting Engineers May 1, 1998 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 N[� 19-1S faSP. R�.�an-r s-,�a-'ej aa �-/e� z So;L'S• KIZ F AfJ)f'Dvr-0 Subject: HAA for Private Well & Septic System serving Lot 2A, Tustamena Terrace S/D . To whom it may concern: The subject lot has a 4 bedroom house on it which is served by a private well and septic system. The results of the field investigation and adequacy tests are summarized as follows: A. WELL: On April 8, 1998 the static water level (SWL) was measured at 238 ft. below top of casing (BTC). A flow meter was connected to the water system and the flow turned on full. After pumping for 244 minutes a total volume of 952.5 gallons was pumped from the well and the SWL, had dropped to 282 ft. BTC. Based upon our test results, it was determined that the well produces approximately 3.85 gallons per minute, which exceeds the Municipal requirements for a four bedroom dwelling (0.42 gallons per minute). This flow rate cannot be guaranteed, subsequent variations can occur. B. SEPTIC SYSTEM ADEQUACY TEST: Upon our arrival to the subject property April 7, 1998 we measured the liquid levels in septic standpipes and determined that the 1986 septic system was surcharged. The liquid levels were then checked in the 1975 septic system and were measured to be approximately only 20 inches. The 1975 leachfield is a 58 foot long trench with an effective depth of 7 feet (per the 1975 inspection report). Based on these low liquid levels we tested the 1975 septic system only. A total volume of 952 gallons were added to the south end of the trench causing the liquid level within the trench to rise to the invert of the distribution line (100% full). After 1221 minutes the liquid levels in both sumps at each end of the trench had dropped approximately to the 25 inch level (see attached HAA checklist). Based upon this data, it was determined that the absorption rate of the 1975 leachfield meets the absorption requirements for a four bedroom system (600 gallons per day). On April 15, 1998 A+ Home Services installed a bullrun valve downstream of the septic tank in order to isolated the 1986 system from the 1975 system. Currently the 1975 septic system is in operation and the 1986 septic system is now out of service. It appears that the sewer line between the septic tank and the 1975 septic trench has a low spot in it, or is at a slight reverse grade resulting in a 2 inch static liquid level at the double cleanouts. It is our recommendation that the new occupants alternate leachfields at least once each year. NOTE: The adequacy of a septic system is influenced by numerous factors, including, but not limited to, seasonal surface water infiltration, groundwater variations, septic system maintenance (frequency of septic tank pumping, usage of biological additives), condition of drainpipe and pipe joints (which can be damaged by seismic activity and deteriorate with age), type of substances deposited in septic system (cigarette butts, sanitary napkins, misc. objects), and the amount of water being introduced on a continual basis. Consequently, the results of this adequacy test are only valid for the specific day of the test. Furthermore, because of the limited nature of this investigation, it is possible that there are hidden defects which may not have been detected. No warrantee is made regarding the future performance of this well or septic system If you have any questions, please contact me at 337-6179. Sincerely, James P.Williams, P.E. Civil Engineer •••�•oo® io •f�"'(5. .. •• •e N... H��jo JAMES P. WiLUAMS® 'iJ • • N0.0608 •� �<° CEO ESS10N��®®� APR -14-199G 13:29 ME ESI RNCHORAGE L,i CME Environmental Services Inc. CT&E Ref.€1 981590001 Client Name AIC Water & Wastewater Services (Project Name/# N/A Client Sample ID Lot 2A, Tustamena Terrace Matrix Drinking Water Ordered By PWSID 0 Parameter Results 9075015301 P'.02i05 Client POA Printed Date/Time 04/14/98 08:28 Collected Date/Time 04109!98 15:10 Received Date/Tinto 041'10/98 09:00 Technical Director: Stephen C. Ede Released By AL lowauLa Prep POL Units Method Limits Date nnatvsis Date lnit TataL eolilorm 0 tai1100ML smis 92228 04/10/98 rMW Nitrate -N 0.426 0.100 me/L EPR 300.0 10 max 04/11/98 RMV • MUNICIPALITY OF ANCHORAGE, DEPARTMENT OF HEALTH & HUMAN SERVICES M0j Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# C M_91 (�-1 HAA# l�nq 1l�all� 1. GENERAL INFORMATION Complete legal description Lof z A To_�a nna Terrrca 2. 3. a Location (site address or directions) / 3 )Ho G "roll 961, Property owner Da o:d D. Z n c mar Day phone 3,/5- G vG 6 Mailing address r 3 iHo 6 irct, PJ, Arch ,f Ak !2 Lending agency Day phone Mailing address (� 34r — c .Ls/ . Agent D Ie M«rel( — Melly ;, Imo; Qpr✓ Day phone 279 SSG/ Address " e SBS'e.A�cl,rr� y� �I� gg51G Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site _ y Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOA#21 20 vow eD-B rill's -U) SMeL -NioM s,aaau!6ue leuo!ssaload aql u, suo!ss!wo ao sjoaaa aol olq!suodsai lou si a6eaogouy to (i!led!o!unw aql 'ponss, s, aleo!lpeo a aaolaq elep az leue ao suo!loadsu! lonpuoo ;ou op SHHo;o saa (oldw3'sluawaipbai a;els pue leaapal u!eljeo lys!les o;aapio u! suo!lnipsu! 6u!puel alagl pue sawog;o siesegoand o; (selinoo a se s!l; saoP SHHa all'e�su,V to alelS aq; u, peials!6aa jaau!6ua leuo!ssa;oad luepuadopu! ue Aq anoge 9 ldvifted ul u9n16 suo!leluasaadaa all uodn Aluo paseq salso!i!laao lenoiddy l!aoglnv g;leaH senss! (SHHo1 sao!naeS uewnH pue glleaH 10;uaLup3dap aoejogouv to l!led!o!unw all , 6ale(] �� :suo!;elnd!is bu!Mollol aql l;!M 'swooapaq ..... d t1 ila��ayy •U alr,c w sluawwoo leuo!}!ppy ao1 Ienoidde 1eu0!l!PuoC) . •panoaddes!Q •swooapaq ao1 panoaddv 7— 3Hn1tlMJIS SHH❑ '9 -*88 ainleu8!s 8,aaau!Bu3 ssaappy !Sf �—'✓�� auogd ��i .�- N��/�s4� ��y�� wa!310 aweN •uo!loodsui s!ql to alep aql uo loelle ui suo!;elnbaa pue 'saoueu!pao 'sapoo ale;S pue led!o!unn Ile ql!m aoue!Idwoo ui si waleAs lesods!p Aelemolsum io/pue (lddns aaleM ails-uo eql 'uo!loodsui pue u011e8118anu! (w woal pue sal!l aBeaolouy 10 j!led!o!unW aq; woal pau!elgo uo!lewaolui aql uo paseq ley; (1!aanaallanl I •u weq paleo!pu! aanlonais 10 ad j pue swooapaq to Aagwnu all Aol elenbepe pus Ieuo!lounl'ales s! wels (s Iesods!p as;umejsenn ao/pue Alddns Aelem al!s-uo all ;eq; smogs uo!leo!Idde Ienoaddy l!aoglny glleaH s!q; to u01;e8!lsanu! !w leq; f%l!aan I 'molaq unnogs alep uo!lep!Ien aql to se pue olaaaq pax!lle leas Aw (q pelpl.lao sv H33NION3 A8 NO11O3dSNl dO 1N3W3.LV.LS '9 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo✓ ?A 7-L/51-41WCNA %E/LPr4CCParcel I.D. A. WELL DATA Well type n/ ✓aAG If A, B, or C, attach ADEC letter. ADEC water system number Log present &N) Date completed Driller .�91�c17 Total depth 390 7Z74 Cased to /Pa "�4 Casing height / 857 Sanitary seal/ON) Date of test Static water level Well flow Pump level FROM WELL LOG Wires properly protected &N) AT INSPECTION /Zo / ZSZ. � SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot //s, Absorption field on lot //t / g.p.m. s: ; On adjacent lots ; On adjacent lots Z 0 y j LLL w � g.p.m.: a CV LLJ Z z LU W /So 1 ` Public sewer main N Q. Public sewer manhole/cleanout _ Public sewer service line /V, /q, Petroleum tank N WATER SAMPLE RESULTS: Coliform 5o. ; a `Ar In n,. Nitrate 0 • `J Other bacteria Date of sample: 6//IAf Collectedby: l4 o he-kn'mre B. SEPTIC/HOLDING TANK DATA Date installed 9- /G - 75 Tank size /Z 5o Cleanouts &N) Foundation cleanout ON) High water alarm (Y/Oi Date of pumping 4-16,71 Compartments Depression (YAO Alarm tested (Yo SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s)onlot IIS -1.1 On adjacent lots /-130/' Foundation /7 ' To property line ZZt Absorption flaid it Water main/service line SO/ Surface water/drainage 72-02e (Rev. 3191) Front MOA 21 - CONTINUED ON BACK PAGE C. LIFT STATION fol- tarp/rc�.h/� Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access(Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Date installed ZL, -1c, /r, G Soil rating "Pump off" level at Cycles tested Surface water _ Length I o Width 3 a- a I Gravel thickness W System type 1 rc„cI) Total absorption area 56, o s(, . { I . Cleanouts present (S)N) Depression over field'(Y/QI Results (pass/fail) Peroxide treatment (past 12 months) (YAJ Total depth'i 7 Date of adequacy test ro - / `/ - 9 for If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /0? ' On adjacent lots 50 Property line To building foundation 2 /' To existing or abandoned system on lot On adjacent lots So' Cutbank M -A1 Water main/service line 56 Surface water N o U r Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION bedrooms 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature x Engineer's Name , o Date F/ HAA Fee $ "?a v Date of Payment 69 12 ri of l Receipt Number f,2 K/ 3� �( N //0 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number 2,52-3 260.6 77¢ z?6 z79 �y9 Z�y 7-1y DALE R. MERRELL, P.E. 11766 Wilderness Drive ANCHORAGE, ALASKA 99516 '.a 907 349-6451 or 907 345-1387 ' �<<•:`ale. !i, i:4erre11-. WATER WELL TEST Date: Subdivision: 57-,+tit"fCd Lot: Z � Block: Client's Name: Z/�1 rce t Address: TESTER- w/E2../L�z(� ffceFzae.9J Initial Reading on Meter: b,e� DRAW DOWN TIME GPM GALLONS VOLUME GALLONS TOTAL FIELD MONITOR LEVEL METER READING z:35,4/y fl a o zsz, o 2.-So ------ o' /S .S; i zY G z a z z : S S. JL -3 726 37-8 24.7 y[•�o S ,� y z 9. a S / s S/ s o s z -7 e2-1GZ s3 Gs a 6 8 fLG ,Pi `3 2 a� 2t- 5' 7-& ZS81 4•' z s o Zsz i NOTES: Production Rate: -:�7-14 GPM 24 -Hour Capacity `7776 Gallons NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE 1437 FAIRBANKS, ALASKA 99701 907-456-3116 2505 FAIRBANKS ST. ANCHORAGE, ALASKA 99503 907-277-8378 Dale Merrell 2220 E. 88th Ave Anchorage AK 99507 Attn: - Our Lab #: A111351 Location/Project: - Your Sample ID: 13140 Birch Road Sample Matrix: Water Comments: Method Parameter ---------------------- 418 C Nitrate -N Reported By: William E. Buchan Anchorage Operations Manager Report Date: 06/20/91 Date Arrived: 06/17/91 Date Sampled: 06/17/91 Time Sampled: 1437 Collected By: KA Flag Definitions U = Below Detection Limit DL Stated in Result B = Below Regulatory Min. H = Above Regulatory Max. E = Below Detection Limit Estimated Value Date Units Result Flag Analyzed ------------------------------------------ mg/l 0.4 06/19/91 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 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2A Tustamena Terrace Subdivision Location (address or directions) (b) Applicant Name David Zimmerman Applicant Address Telephone: Home 345-6466 Business 279-9233 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder EV, Buyer ❑ ; Other ❑ (explain); (d) Lending Institution National Bank of Alaska Address (e) Real Estate Company and Agent (f) Address Telephone Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-Familya Multi -Family❑ Other Number of Bedrooms - four (4) Telephone 3. WATER SUPPLY Individual Well MKX 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 Rk Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025(11184) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA'1 A AND INFORMATION Q 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 Address Date Telephone Engineer's Seal This department has received written confirmation from the engineer regarding the Conditional Approval of March 24, 1986. The corrections have been accomplished and an inspection has been completed by the engineer. The subject property meets with Municipal standards and is now approved. DHEP APPROVAL Approved for four(4) bedroomsby ate Approved XXXXXXXXXXX Disapprov Conditional Terms of Conditional Approval CAUTION HE 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 - - i Application Date 3) �� g6 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) �e lus�aweva %NUoce la� 33 27 Location (address or directions) (b) Applicant Name 64 Z;eraay —Telephone: Home 3`/S 6`x(06 Business Applicant Address i3 / E� Z%rC4 'aUle4!"`41&9F516 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder R"; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent lf) Address Telephone Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-Familya Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well P, Community ❑_ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Pane 1 of 2 72-025(11/84) 5. FNGINER11ING FIMNI PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 Address Date 3- 2(L �c aol '3o b�I� er�JAi calAL f>ti��✓�Yc 6. DHEP APPROVAk' Approved for /206192 bedrooms Approved Telephone ` r�lO j9e $dal Reid, Jr. �v 0. PROFESS1aNe;� I sf t alb 9 '96 X131 Terms of Conditional Approval r✓ 1- `'r enc' G • —■ 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. - MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) MAR 2 i 19* CHECKLIST - FEBRUARY 1984 284-4720 _ 4, RJ C �l V E D Legal Description: 49 /U5pr 1a eedace 0/0' 7 A. WELL DATA Well Classification &I oc, �L If A, B, C, D.E.C. Approved (Y/N) r '7-l9�1i'/A Well Log Present ©N) Date Completed Yield �P - Total Depth D Cased to 3$0 rr Depth of Grouting N� Static Water Level t��1 �(°O. Pump Set At r Casing Height Above Ground 1 Sanitary Seal on Casing&q) Electrical Wiring in Conduit6Y J) Depression Around Wellhead (Y/( Separation Distances from Well: %r /f To Septic/Holding Tank on Lot On Adjoining Lots To Nearest Edge of Absorption Field on Lot /"� �S ; On Adjoining Lots (00 f To Nearest Public Sewer Line /U� To Nearest Public Sewer 5 4 Cleanout/Manhole /Uqk pp AC -C-5 Nearest Sewer Service Line on Lot � Water L Sample Collected by 4O e � 37'r ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed`� 456- %5 Size 42 SO No. of Compartments 'Aoesti Say Standpipes(Y N) Air -tight Cap (Y ) Foundation Cleanout 0l) Depression over Tank (Y 19 Date Last Pumped 3- 6` 86 Pumping/Maintenance Contract on File (Y/N) 7)A ; for 104 /A Holding Tank High -Water Alarm (Y/N) N� Temporary Holding Tank Permit (Y/N) 41 Separation Distances from Septic/Holding Tank: To Water -Supply Well f/3 f SG° To Building Foundation S To Property Line �� r f , To Disposal Field S To Water Main/Service Line �- Course Comments Page 1 of 2 72-026(11/84) To Stream, Pond, Lake, or Major Drainage LOA( Tu5 KPka 7evv-ace C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata -25"0 Type of System Design Date Installed -7S L Length of Field S � Width of Field Depth of Field d�a"o Gravel Bed Thickness C,6P 1 r 6 5a y Square Feet of Absorption Area 60 Standpipes Presen&N) Depression over Field (Y/C%f Date of Last Adequacy Test Results of Last Adequacy Test r7�2 Punar/�(� / e e Gta� Wei" p"2�N F 0 Separation Distance from Absorption Field: / To Water -Supply Well —u!5- 1 4 -5! To Property Line - - /D Y To Building Foundation a To Existing or Abandoned System on ..n -- Lot lo Water Main/Service Line 5-O !/ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle SJgrage Area Comments (/> GUCVV D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at Fligh Water Alarm Level at Tested for Electrical Codes (Y/N) Comments On Adjoining Lots To Cutbank (if present) O 'F Dimen/s. < !e7Access (Y/N) Pump Off' Level at Vent(Y/N) ** Check Permitted Bedroom Rating Against HAA Request ** Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. he Signed _ !�o_e Date f2_ar5l - e6 Company MC 1'cc_ MOA No. &571_00-V •�;�nF A���n Receipt No. 2L r 6 U Date of Payment y'a/ -V4=' apo Amount: $ �,' y�PC�urSr 90 day C'oNd•"��a•�c.! `�f'/O ro va� 'tciaT �o/al�c�/�r•e�� 5e y-e��aea� ��, SPr,tiJJ� see Page 2 of 2 G� fa�vted c rear a� oh /eev 72-026 (11/84) o. 2251•E ,nROFac•s(Ot: ., Dotten Drilling Co. BOX .10056 JOHN'S ROAD ANCHORAGE, ALASKA 88502 PHONE 344-1952 AELL L(G For: Q-ebard 'L";inerr,ar. Date come le L( 9: Auvust, 1975. :)ize: 6". Lot 2A Tustemena tarry s , . .. Loca.tion: — ---- — -- - --_ Depth: 3;b Stc. tic level: 1[U' off bottom. PI'0- AUL10n: : GYN;. Tar: si.`.t, 9arld, F_.r--..' 'N' r bi._t Gil ty :>and & gra-ve Brcwn :'il.t.f dry Brown rravelly t11�.. MIDNIGHT \, Part si-t PUMPING CO. (ir.y t_-1.1 328 Bonlface #2666 Vie"t , 12;.f avelly till Anchorage, Alaska 88504 Tan till / G %�P✓H� 9 'TaSi t1.L1 w/gravel, NAME "J 1 ria.ter Ee nd & Prrave ADDRESS' �G .Dry brown silt 2 3 Brown e.ilty sand & PHONE DATE GT'avel..y till, wet CASH QHE9K CHARGE DATE TIME Brown -ilt W/'"Vet ,, X Gravel l:y till, wet DESCRIPTION CAPACITY AMOUNT Gray clay ' Gray till - SEPTIC TANK iIater ,amnd & :FravG CESSPOOL - HOURLY RATE 4h 74 1 1. 17 112 <<'3 as 40 5L X61 U.3 �1. 34 _30 3� TOTALS I I MUNI -• OF ANCHORAGE PPINTMOPE CORP. ANCHORAGE. ALASKA 3303983 pEpT. OF HEALTH & ENVIRONMENTAL PROTECTION MAR 2 1 RECEIVED ALASKA MUIRMETAL COnTROL SCR US, InC. 6ngineerinq & enuironmental Studies March 20, 1986 WNICIPALITY CF ANCHaRACE Department of Health & Human Services 825 "L" Street/4th Floor Anchorage, Alaska 99502-0650 Attention: Mr. Steve Ivbrris Subject: 90 Day Conditional Health Approval for Lot 2A, Tustamena Terrace. Dear Steve: An adequacy test of the existing leachfield on the subject lot was performed March 11, 1986. The test indicated that the system is absorbing only 100 gallons per day, inadequate for this 4 bedroom house. We request a 90 day conditional Health Authority Approval, that a 4 bedroom upgrade be completed this spring, enabling the owners to take advantage of the present interest rates to refinance their home. Please review the attached site plan and soil test which identify suitable soil and area to upgrade. We calculate they will need 65 feet of additional trench. We feel a 90 day conditional approval will not create a health risk, because there was no evidence of surface discharge of sewage, and the owners report no back-up problems. The owners are planning an extensive remodeling of the house and are moving out March 24 to allow the Contractor to work. They have rented another home for 90 days. Present system capacity should cover the toilet flow for workers. A water sample taken from well March 11, 1986 was free of coliform bacteria contamination. If you have questions, please call. Sincerely NjC/pq Dennis Roec�Me�FyFgN FMj OFpT<rry Field Engineer R Nrq� pq�r/Y yo�q Approved By: M�R2 rFcro��� L roy .Reid ., PhD, P.E. President 1200 West 33rd Auenue. Suite B • Anchorage. Alaska 99503-(9071 561-5040 60111 ALASKA CnUIROWnTAL COnTROL ONUS, InC. engineering & Enuironmentol Studies MARCH 21 1986 DAVID ZIMAR WN SELLER—SArvE, WILL PICK UP FROM CUR OFFICE 13140 BIRCH ROAD ANCJ-ia AGE- ALASKA 99516 LEGAL:TUSTA'VENA TERRACE/BLOCK 1/LOT 2A ADEQUPCY TEST FCR SEWER SYSTEM ADEQUACY TEST DATE—MARCH 11 1986 THE TYPE CF ABSCRPTION SYSTEM IS A TRENCH WITH AN AREA OF 812 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTI% 100 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 58 GALLONS. THE SYSTEM IS UNACCEPTABLE BECAUSE THE SURGE. CAPACITY IS LESS THAN 75 GALLONS. THE SYSTEM IS NDT CAPABLE OF ACCEPTING 600 GALLONS CF WATER PER DAY. SEPTIC TAw ADEQUACY THE EXISTING SEPTIC TANK VOLLNE CF 1250 IS ADEQUATE FOR THIS 4 BEDROOVi HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON MARCH 6 1986 . THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FCR TrE WATER SUPPLY OR WASTEWATER SYSTEM. F" 2.,,..... .. MUND�P Lljy OF A y C. Rxid. Jr. �',`, ENVIRON,ytEN7 HtA4Tf, 8ORAOE No. 2251E . ��yt>`, ' q� '` l�AR ( PRO 'TECTION p!I^vFcS3t� -y'' i 1986 RECEI VE p 1200 West 33rd Auenue, Suite B • Anchorage, Alaska 99503-(907) 561-5040 Loa 1-i6-iq MUNICIPALITY OF ANCHORAGE DEPT. Of' HEA TR &ANCHORAGE �V SIRONMENTAL P,07cC7I0N DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT, 825 L Street - Anchorage, Alaska 99501 • JAN 51979 ENVIRONMENTAL ENGINEERING DIVISION i A)A /U:r Telephone 264.4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROP; OWNERPHONE ❑ Two ❑ Five 3yy-c�xzs- MAILING AD//DRESS MAsI�LIN��/ 7. WATER SqPnY �� LJ INDIVIDUAL* PROPERTY RESIDENT (If different from bo e) a ❑ COMMUNITY PHONE 2. BUYER depth (attach log if available.) PHONE s� I��INDIVIDUAL/ON-SITE** 29'7-O z MAILING ADDRESS by this Department. � 2 /.� c /,l /✓ 3. LENDING INSTITUTION - PHONE L✓rr ry e % rLs J o MAILING ADDRESS 12 , n2 4. REALTOR/AGENT PHONE /t/eie c.. MAI LING ADDRESS 5. LEGAL DESCRIPTION & TJ S1 BEET LOCATION 12- DeC7 -o o1L i A)A /U:r 6. TYPE O_.F, R/ESIDENCE NUMBER OF BEDROOMS LX SINGLE FAMILY ED One ��Four E] Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SqPnY LJ INDIVIDUAL* *ATTACH WELL LOG. Awell log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) _DISPOSAL SYSTEM 8. SEWAGE /� **If individual/on-site, give installation date negnort I��INDIVIDUAL/ON-SITE** If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) V THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE O OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY --INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified PERMITNUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ELIM5IVIDUAL/01\1-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ❑Septi Tank or ❑ Holding Tank Size: / ci+SLn If Tank is homemade give dimensions: SOILS RATING ',-:), TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL } 4. DISTANCES WELL T0: Septic/Holding Tank - Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS l APPROVED FOR _- BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATEBY I.- /.> _) 1 q (Title) ?_C. PO/4- LEGAL DESCRIPTION 72-010 (Rev- 3/78)