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HomeMy WebLinkAboutTUSTAMENA TERRACE LT 14ATustamena Te Poce Lot 14A 017-381 -17 Municipality of Anchorage Page [ of ~-~ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ..~l.~l ~'~'~,~'/,.~ PID Number: ~/~//~ Name: ~ Upgrade ~/~ l~. ~/~ Wastewater System: ~ New A~ ~~ ~. ~4~/~ ABSORPTION FIELD LEGAL DESCRIPTION S°ilRating: ~GPD/Sq. Ft. T°talDepthfr°m°riginalgrade: Lot: /~ Block:~ ~ ~/~Subdivisio · ~ Depth~to pipe bottom ~fr°m original grade: Ft. Gravel depth beneath pipe~.~ f Ft. ~o~ns,,,: I,~n~.: r~e~,,on: Fill added above original grade: Gravel length: ~/ WELL: ~ New ~ Upgrade Gravel width: ~ ;t. Num~of lines: IDis/a~cebe~ee~,ines:Ft. Pipe material: ~/~ Classification~l~(Private.[ ~}A'B'C): . Total ~Depth: F{~ 3~s~d_T~h ~Ft. Total absorption area: ~/~SQ. Ft. ~ ~ Driller: ~- ~~- -D~ie Drilled: Static Water Level:Ft. ~zlnstaller' ~ ~,~ ~.,.,n~A Y~.~d: ~ .ump S.~.~: ~bTAN K SEPARATION DISTANCES ~s..~i~ ~ Ho~d~n~ U S.T.~.~. To Seplic Absorption Lift Holdin9 ~ublic/Private Manufacturer: Capacity in ~a~ From Tank Field Station Tank Sewer Li~es Well [~1~ i~l~ ~ ~ ~ Material: Number of Compart merits: Surface Water I~ I~ ~ ~ ~ LIFT STATI C~rt~n~,~~ ~[~ ~4~F ~/~o~e, ~,.ct,,~,,.~,.~,on~,o,me~: Remarks: ~ ~~ ~ BENCH MARK ~ ~Location and Description: Assumed Elevati0n: ".~ ENGINEER'S SEAL S & S ENGINEERING ~ ~ agle River, Alaska ~577 2nd ~~ .... Department of Health an~Human Services approval ~~~<;':~, - ,~ ~ ., ~:,~ Reviewed and approved by: Date: ¢- / ~~~;""" ...... '" 72-013 (Rev. 9/91) MOA 25 ' 'Permit No. swg_z0358 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description:TUSTAMENA TERRACE SUBDIVISION, LOT 14A PID No.:01738117 · 81.7' NO WATER FOUND .6. B Cbl 48.0 ~6.5 ! ~- co2 I 51.0 [ 31.0 I {I ~ COS 73.0 65.0 '~ ~ C04 91.0 84.5 ' ~ CO5 [ 94.0 I 94.0l ~ MT1 19°'5 I 98.01 DRIVE BED FCO IN CRAWL SPACE~ 24' /_EXIST. BED 1000 GAL SEPTIC TANK · ENGIN£ER'S SEAL 72-013 A (2/91) MOA 25 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930356 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:NICHOLS MICHAEL K & OWNER ADDRESS:5536 NAKNEK LN ANCHORAGE, AK 99516 DATE ISSUED: 9/10/93 EXPIRATION DATE: 9/10/94 PARCEL ID:01738117 LEGAL DESCRIPTION: TUSTAMENA TERRACE LT 14A LOT SIZE: 46686 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ISSUED BY: DATE: HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER &WATER INSPECT[ON ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SiTE PL~NS ROAD DESIGN . SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL tNSPECTIONS ROBERTSHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS August 18, 1993 (907) 694~2979 FAX 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND H~ SERVICES 825 L Street Anchorage, Alaska 99501 REFERENCE: Tustamena Terrace Subdivision, Lot 14A Request you issue a Dermit to uDgrade the seDtlc system serving the three bedroom house on the referenced DroDerty. The existing system failed an adequacy test. Since this system was upgraded in 1991, we excavated to provide a cross section of the soils adjacent to the seepage bed in order to determine the cause of failure. As a result the following conditions were found to exist: The upgraded system was designed as a mound system. However, it appears that the engineer allowed the system to be put in 4' below the original grade. The upgraded design was based on percolation results between 2 and 3 feet. However, we found a clay layer between 4 and 5 feet. It appears the existing upgraded system was installed directly on a clay layer. This condition requires the system to become saturated to the point where effluent can move horizontally through the layers above the system. The newly designed system will be installed adjacent to the existing system. The existing system will be used in conjunction with the new system to provide surge capacity during peek use. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic upgrade. A test hole was excavated and percolation test performed in the area of the proposed upgrade. Attached is the proposed upgrade design. ON SiTE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP . SUITE 204 . EAGLE RIVER, ALASKA 99577 Page Two Tustamena Terrace Subdivision, August 18, 1993 Lot 14A If you have any questions or require additional for your review, please contact us. ~,~ert A. Shafer, P.E. ,RAS/LSU/lsu information 1" = 40' UPGRADE lox -I ~ /I I I ~ ~ ~o I~ ,~~ ~ ~> o 0~0 z~ z~ ~ 0~ o~m ~zm ~Z~zm~ 0~ ON-SiTE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Tustamena Terrace Subdivision, Lot 14A GENERAL: 1. o The scope of this project includes the installation of an absorption bed to serve the three bedroom residence located on the referenced property. The existing leachfield is to remain in use. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. o The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Page Two Tustamena Terrace Subdivision, August 18, 1993 Lot 14A 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. LEACHFIELD BED INSTALLATION: Excavate the proposed Bed Area to the depth shown on the design. The bottom of the excavation shall be within 2 inches of level. If the bottom of the excavation becomes smeared, it must be raked or scratched (ruffed-up) before gravel or sand placement. If a sand layer is required, place sand over entire excavation to the required depth shown on the design. The top of the sand layer must be within 2 inches of level. o Sewer rock shall be placed uniformly throughout the entire bed. Perforated distribution pipe must be installed level with perforations down. Gravel depth below the perforated pipe shall be a minimum of six (6) inches. Gravel depth above the perforated pipe shall be a minimum of two (2) inches. The total gravel depth throughout the entire bed shall be a minimum of twelve (12) inches. The perforated distribution pipes must be no more than six feet apart. The distance between the outermost perforated distribution pipes and the sidewall of the absorption bed must be no more than three feet. Page Three Tustamena Terrace Subdivision, August 18, 1993 Lot 14A o Silt barrier material must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter and installed at the locations shown on the design. The portion of the monitor tube extending through the gravel depth shall be perforated six (6) inches below the bottom of the horizontal distribution lines. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finished grade over the bed must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank constructed by a manufacturer. proposed for installation must be Municipally approved septic tank o The following septic system Anchorage: pipe materials are approved for use in installations in the Municipality of Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. o Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Page Four Tustamena Terrace Subdivision, August 18, 1993 Lot 14A A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the %200 sieve. When sand is being used as a filter material, it's gradation specifications must conform to current M.O.A. or D.E.C. requirements. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction· If necessary, a pre- construction meeting will take place on-site. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: y/C/"~O~, ~ LEGAL BESORIPTION: Z /¢/~ 7-~'~'~¢~//J~'~¢2~-° 7~/'Townsh'p, Range, Section: 'fi. 1 2 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14 15 16 17 18 19 20 SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT O DEPTH? P SITE PLAN I -~} ~ ~ / E Monitoring? ,~,,A~ y . Gross Net Depth to Net Reading Date Time Time Water Drop ¢ 4~ ~ /~ ~" I" COMMENTS 72-008 (Rev, 4/85) THIS TEST WAS PERFORMED iN MUNICIPALITY OF ANCHORAGE DE.A.TMENT CE .EALT. AND .UMAN SE.V,CES O/-~ -- 3 ~ ~ - / 7 Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name ~ ~__& I~ DISTANCES { C~C~ ~ ~ SEPTIC ABSO"PT[O" WELL ~ddress TANK FIELD Phone(s) -- Permit NO Bedrooms WELL }Ow~llip' ~.L~eCt~ j.~/~ ) }~ ~ AS-BUILT DIAGRAM (Show location of well, septic sysiem, p~operty lines, founder Manulacturer Capacity in ga[Iods / Material NO ol Compadments TYPE OF SYSTEM ('~ ~TRENCH '~BED ~ W. DRAIN ~OTHER Depth to pipe bottom [torn Total depth from original grade original grade ~ Gravel depth beneath p~e Gravel width / ~oial absor,t,o::rea~: ~ ~0 FT Distance between ,ines~. / Number ol lines Soil rating Pipe material ' FT /~ l.s[aller ~ Gl Cl~ Date Installed P~ / ~ ~ 4~ ~PRIVATE : OTHER ,:dentifv) Instaltel Date ]nslalled: %~ ~ 3 /',~ *~ / : ~ ~ /~ REMARKS: ,nspec i ns PedormeO by: 'Slale 9 i ~/~ ~ s inspeclion was p~dormed according to all ~'~:%t~ ~'*%,R°be~N°' 4149- EE' KnieT~p.?~( ~ .~ Health Depaament Approval: 72-013 (3/85) Tom Fink, Mayor January 10, un c pali y Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 1991 Michael Nichols 5536 Naknek Anchorage, Alaska 99516 Subject: Lot 14A Tustemena Terrace Subdivision Permit #900182, PID #017-381-17 The subject permit, issued by this o'ffice for a sing!e,¢amily well and/or on-site wastewater system has expired as of December 31, 1990o A new permit must be obtained from this office for a well and/or on-site wastewater system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this office for documentation of the installation and to close the permit. If a private engineer inspected [he installation of the on-site wastewater system, the original as=built inspection report (three-part form) must be sent to this office for review, approval and documentation.' All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $90.00 for an on-site wastewater permit; $50.00 for a well permit; $140.00 a combined on-site wastewater and well permit. for If you have any questi?~s, Sinc~ ~ Joh Smith, p.E. ¥ Pro~r aSmmiMt ah~ager On-site Services please call this office at 343-4744. JW/ljm:200 enc: Copy of Permit "Kids Are Our Future" ~ ~ Septici. System Upgrade 1. Bed Design ~ 3 bedrooms ~ 200 sf x 1.5 = 900 sf Bed = 24 x 38' = 912 sf. EXisting tank good condition. 2. Ail mater:ials, methods and,inspections to follow MOA regulations. lC SYSTEM DESIGN June 26, 1990 Michael Nichols · ~ALE PREPARED BY: 1,, = so, Kniefel En~ineerin~ ~OA CE page 1/2 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCR,PT,ON: L ~.A'~.~ T~.$T/~-~A 1 7 9 11 12 13 14 15- 16- 17- 18- 19- 20- COMMENTS PERFORMED BY: DATE PERFORMEE Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After ~ Monitoring? ~_ Date: SITE PLAN P E Gross Net Depth to Net Reading Date Time Time Water Drop .~0 ;~ /o o,~7 ,~ o,~o /-5o /o 0,37 PERCOLATION RATE I'LV~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT CERTIFY THAT THIS TEST WAS PERFORMED IN =.-%__ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85)  ~ MUNIClPALITY OF ANCHORAGE ' (~10~¢ $~' · DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE /~ ~NEW MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS ~ DISTANCE TO:Iw"'' /oo-+ I~'°~>~'°n""~ ,Dwel]ing~l.~ PERMI~f/.~ No, of compa ents h Z Manufacturer ~ ~ Liq. capacitymflin allons Inside length Width Liquid depth O~ IF HOME'DE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O Z ~ Manufacturer Material Liquid capacity in gallons Q Well / ~ Foundation ~ O ~ ~ Nearest lot line/~ ~ ~~m~ z No. of lines ~ Lengthen)of each~.~line Total length of/~ll es Trench widt ~ inches Distance between~ lines ~ ~ Top of tile to finish ~rade ~ Material beneath tile Total effoctive absorplion area Length Width Depth PERMIT < ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ ~lass Depth Driller Distance to lot line PERMIT NO, ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS ~ /~ [ t~[ ~ SOl L TEST RAT[ N G I¢0 ~'/~d,-~ o ~-w~,ll iNSTALLER I /, ff~u~e I . 2 ~ ,~s.l~.~~ ~ s c S- 72-013 (Rev. 3/78) J~(t~e~ lin, ~.UNICIPALITY OF ANCHORAGE ~ Department ( ',.Health and Environmental; ?otection ~ _, 825 L ~Street, Anchorage, AK. 9~501 ,- 264-4720 * * * HANDWRITTEN PERMIT * * * Lgcation: ~/~ Phone Number: ~c~-- / Legal Description:: Z~--/~ ~-~,/~.~ Lot Size: Type of Soil Absorption System Is: Trench: /' Drainfield: Seepage Bed~ Holding Tank Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) /~ The Required Size of the Soil Absorption System Is:' DEPTH ( ( ! LENGTH /-7"//! GRAVEL DEPTH ~ __ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(~TANK SIZE = /~ GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31~ 1 9 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will i~stall the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include mor~ tha~3~ //~ bedrooms. Signe~: Issued b~'-~F~/ ~g~_~ ~,~-~ Applicant SWP/024 (1/81) MUNiCIPALiTY OF ANCHORAGE D~art~n~ of ~eal~h an~ ~vironmental ~rote~t~on 025 L Street. ~chorage. ~. 99501 ~at~on~ ~hona N~ber~ ~e ~$~ir~ ~ize of the So~A ~sorption Sy~te~ ~; ' -' ~ T depth o~ a trenoh o~ ~it ~ the ~a~aa bo~we~n the ~u~ga~e of ~he eh~ bottom of ~e e~cavahion(in f~et). ~ ~ no set width fo= ~a gravel depth l~ the m~ dop~h O~ grave~ betwe~ ~he ou~fa~l Pipe the ~kkom of the e~cavation (in fe~t). &B~ta%%ation insp~tions O~ any we~l~ a4~acen~ ko this pro~ertF and the ' ' ' TWO(2) INSPECTIONS ARE REQUIRED ' ' ' Backffi[L[~ o~ a~y sys~ wi~hou~ ~a[ inap~tion an~ app~oval by ~is F.--/~=a private w~I1 or 150 ~o 200 feet ~r~ a pub~i~ we%Z 4epend~ng u~n' of public we~L~ Min~ distance from a private wet% t0 a prLvate ~war an4 ~st be ~etu~R~ to thi~ depar~en~ within 30 days 9f the we~[ complet.~ Other require~nts may apply. Sp~i~ations an4 cons~rucaion diagr~s are. I c~ify ~hak: (~) t ~ f~ili~ wi~h ~hm r~quirem~nts for on-si~ sea, ers and s~t fore,by hh~ M~i~ipality of (2) I will ~ta~ ~he ~t~ ~ aocor4ano~ ~xth ~0~- ' /, , MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 4- 5 6 7 8 9 10 11 12 13 14 15 16 17, 18- 19- 20- SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop ~f ,~.~ i, 1.5' ..~ ~ ~ / COMMENTS PERFORMED BY: (~ .,,~"~:~'"~ ~~,~'~ CERTIFIED BY: PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN / ~L 0.~ FT AND / ~' '~T 72 008 (7/76) PERMIT NO. DEPBRTMENT Oi HEALTH ~ND ENVIRGNMENTFIL P ~TECTION 825 "L" STREET, BNCHORBGE., 264-4720 k~ELL F'ERid~T ( 8~02±0 ) RPPLICRNT LOCRTiON LEGRL THOMRS E PRICE SINGLE FBMILY DHELLING L±4A TUSTBMENA TERRBCE SRR 80X ~75 C ~D507 LOT SIZE ~45-±±79 999999 SQUSRE FEET MINIMUM [I=,TRNL. E BEIUEEN R HELL RN[:, ANY ON-SITE SEWRGE CI=FLc. RL SYSTEM IS ±00 FEET FOR R PRIVRTE WELL OR ±50 TO 200 FEET FROM R F'UBLIC WELL [:,EPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DiSTRNCE FRGM R F'RIYRTE WELL TO ~ PRIVRTE SEWER LINE IS ';'~ ~., FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS 8RE REQUIRED 8ND MUST BE RETURNED TO THE DEPBRTMENT WITHIN ~0 DSYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MSY BPPLY. SPECIFICBTIONS BND CONSTRUCTION DIBGR8MS BRE BVSIL8SLE TO INSURE PROPER INSTBLLBTION. I CERTIFY THRT '±: I RM FRMILIRR WITH THE REQUIREMENTS FQR GN-SITE '=' , -,EI~ER_, RN[:, WELLS R':; SET FORTH B"r' THE MUNICIPRLITY OF RNCNORRGE. 2: I WILL INSTRLL THE ':;YSTEM IN RCCORDRNCE WITH THE CODES. /RPPL I C:~NT THOMRS E .~E .. I .=.,=,UED BY ____DFITE .... V4. 0 = 9 10 • Municipality of Anchorage _ � r e -G On-Site Water and Wastewater Program � j 'r' • (907) 343-7904 s;;CT? • 7 ti Certificate of On-Site Systems Approval `yb Aw 017-381-170_ 1 ./3_1 ` 01 6 s L% Parcel I.D. Expiration Date: 1. GENERAL INFORMATION Complete legal description Tustamena Terrace Lot 14A Location (site address) 5536 Naknek Lane Current Property owner(s) James Bearden Day phone Mailing address 5536 Naknek Lane Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: r r Received b JDkms. �. aU' Date: LQ_ f COSA to be released to the engineer,unless otherwise requested y t engineer. COSA Fee $ 624, Waiver Fee $ Date of Payment 4/4 88 Date of Payment Receipt Number O . Receipt Number COSA# D5 01719.0 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe 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 soil condition,ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system.The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 5/31/2018 \vv OF ACgsl• A4 Ole ... :..Pd 6. DSD SIGNATURE � System #1 Approved for bedrooms :Steven R. Pannone• O % CE-8149 / System #2 Approved for bedrooms �� 9s,•. ••\A Disapproved ill \\`�t`�'r Conditional approval for bedrooms, with the following stipulations: Cf�QP4\�Y 0E44/,Lk. ON-SITE c WATER AND m 'PI WASTEWATER o PROGRAM " .)or Original Certificate Date: -13 --/ The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: ` ;1'� COSA Checklist X Nitrate Adviso. Septic System Advisory Arsenic Advisory''"' ''o Well Flow Advisory Other ' . .c COSA blue sheet f c If more than 1 septic system is on the lot: COSA Checklist# 1 of I Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Tustamena Terrace Lot 14A Parcel ID: 017-381-17 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 4/11/1983 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 1 21.7 ft. Cased to 121.7 ft Casing height (above ground) 24+ in. FROM WELL LOG AT INSPECTION Date of test 4/11/1983 5/21/2018 Static water level 17 ft. 104. ft Well production 0.7 g p m !.��r ` '� g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 8.29 mg/L Arsenic ND D ug/L Date of sample: 5/21/2018 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 5/24/1983 Tank size 1000 gal. Number of Compartments 2 Cleanouts(YIN) Y Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A Date of pumping 4/13/2018 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 9/24/1993 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.5 GPD/SF System type BED Length 38 ft. Width 24 ft. Gravel below pipe ft.S:::''LC _ - Total depth 1..5-4.O ft. Eff. absorption area 912 ft2 Monitoring tube Y Depression over field N Date of adequacy test 5/21/2018 Results (Pass/Fail) PASS For 3 bedrooms( Fluid depth in absorption field before test D� in. Water added 450 ( gal. New depth`el(din. Elapsed Timer min. Final fluid depth 0j(� in. Absorption rate >= 450+ P g.p.d. N Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES 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 75+ Public sewer manhole/cleanout 100+ Sewer/septic service fine 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway,parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Survey on file. 4' 300 At- to A1704- 5-7.-0,a A cc G. ENGINEER'S CERTIFICATION ''''' OF t\A . ,c� .:40\k 1 certify that / have determined through field inspections and ,0'<, I .'ff- ' review of Municipal records that the above systems are in 0*:•,9 TH %\ *'4 conformance with MOA COSA guidelines in effect on this date. /• • 1 Engineer's Printed Name Steven Pannone • n '..pori CE-8149 O Date 5/31/2018 69i6) .rte l�l�`ea����— COSA canary sheet_2-6-15.doc MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT i • t(1 907-343-7904 On-Site Water and Wastewater Section `� Fax: 343-7997 www.muni.org/onsite Well Water Advisory Certificate of On-Site Systems Approval # OSC181249 Subdivision: Tustamena Terrace, Lot: 14A This well's productivity was determined to be .61 gallons per minute. The minimum well productivity required under (AMC 15.55) for a 3-bedroom residence is .31 gallons per minute or 150 gallons per day per bedroom. Although the subject well currently exceeds this minimum requirement, the production capacity can fluctuate. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P.0. Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT + h t 907-343-7904 On Site Water and Wastewater Section 1\ �� Fax: 343-7997 www.muni.org/onsite -... Nitrate Advisory Certificate of On-Site Systems Approval # 0SC181249 Subdivision: Tustamena Terrace, Lot 14A A water sample revealed a nitrate concentration of 8.29 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P.O. Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids,and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org 1 Q.. . .- . ....... __ . . . . _ ... . .. . . 4 oo�000pp \ 0 • 0,rCr.,F..�F'"4�..lh nn oo \ • • 0 p..'. 49 TH %\ Ov ,bO \4\ 4 •Oy • VA .S 01, fides•o a�" :/, O.0 o '. SHANE A. HOLT: 0 - - -- - ,,mc AS.o0e'c LS-6914 ••.., i \ ; — ti4 0s yip \ (].KLA �' , --_ O° 440 A P?0 ' ' pP M I \\ \\ 6S \ V pp�FCS 71G I \ \ , K \ \ </ eqi / • \\/'/' 69. \ \ \ 5 97°33132°W 149.20' I \ \ 9y.< \ 0� \ ` 4.f.F \ 1* ,j, \ a ° 0 \ 9, \ ° -'��TAo/T AS-BUILT SURVEY e • IPS 6 90 NO CORNERS SET THIS DATE ° l'''.3' SCALE:-i'•c&Q� :(� t3- %g --- 66 J (HERESY CERTIFY THAT(HAVE VERFpiMEOA A` MORTGAGEES INSPECTION OF THE TOLLOWNG DESCRRED PROPERTY \ '� LOT IA&TUSTAMENA TERRACE SIA \ •\' /-i \ THE INFORMATION IEREON IS FOR THE USE OF LENDING INSTITUTIONS lIST TOALLY TO SNOW ANY CONFLICTSBETWEENANCHORAGE RECOROPIOOISTRICT,ALASKA AND THAT \ ,/ ET6TING SIROCTl11ESANO RATTED LOT LYES OR EASlNf.NI S ANO 15 H7 T BE UCH)FOR POST NOTTING AOORIONAL THE NWROVFMFNTS SITUATED THEREON ARE WITHIN THE . \ /i STRUCTURES OR FENCEUXES. PROPERTY LINES MO OTTER TWT NOTES HD VISIBLE ENCROACHMENTS EMI T ..... EASEMENTS OF RECORD.OTHER HUN THOSE MOWN ON IRE RECORDED RAT.ARE NOT SNOWS HEREON. DATEO AT ANCHORAGE.ALASKA THIS 21ST NOTE:ANY FENCEINNES SHOWN ARE IOCATEO APPROMMATELYN4D ARE NOT TO BE USED TO DETERMINE PROPERTY LimasO.AY OF SEPTEMBER 7008. - OR LOCATE STRUCTURES MIT LAID SURVEY NG l5SA.AT.1,13146 TEL 7155513 Municipality of Anchorage Development Services Department CERTIFICATE FOR A 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 OF ON-SITE SYSTEMS APPROVAL SINGLE FAMILY DWELLING Parcel I.D. 017-581-17 1. GENERAL INFORMATION COSA# 050 t"[ OIq Expiration Date: /--/' ~ ¢- / I Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address TUSTAMENA TERRACE S/D; LOT 14A 5556 NAKNEK LANE * ANCHORAGE, AK * 99516 CLIFTON TERWlLLIGER Day phone XXX 5556 NAKNEK LANE * ANCHORAGE, AK * 99516 Day phone RUTHANN BAKER W/ PRUDENTIAL Day phone 501-~882 3801 CENTERPOINT DRIVE * ANCHORAGE, AK * 99505 Unless Otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well · Individual On-site · Individual Water Storage [] Individual Holding tank [] Community Class Well [] Community On-site [] Public Water System [] 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 ~)f 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 Guidefines for this appfication, 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 afl appficable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone Date 337-6179 Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis Of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of afl wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Repot[ Other Original Certificate Date: /-- ~" 4;20'-/ / 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 Legal Description: WELL DATA *PER Well type PRIVATE SYSTEIVlS ,PPROVAL CHECKLIST TUSTEMENA TERRACE S/D; LOT 14A Parcel ID: 0 / 7 -' -~ ~> i - GEG LTD. INSPECTIONS. **BASED ON SURROUNDING WELL LOGS. SEE AR'ACHED If A, B, or C provide PWSID# N/A Well Log (Y/N) NO YES 12+ Date completed UNKNOWN Sanitary seal (Y/N) YES Total depth '120+ .ft. Cased to **40'+ ft. FROM WELL LOG Date of test '.~.7 Static water level ~,~.~.~ ft. Well production .,-- g.p.m, WATER SAMPLE RESULTS: Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 9/15/2009 105 ft. 0.6 g.p.m. Nitra~ ?:~'.'~- ~mmg./L Date of sample: I I'~ / t [ Coliform ~ colonies/lO0 mi. Arsenic:, I',,lO ug./L. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO Date of pumping ~ ~ Pumper. 1¢1/I ABSORPTION FIELD DATA I*E~ELOW EXISTING GRADE] Date installed 9/30/1993 Soil rating ~r ft2/bdrm) 0.5 Length 38 ft. Width 24 ft. Total depth *4.08 ft. Eft. absorption area 912 ft2 Monitoring tube YES Date of adequacy test 9/15/2009 Results (Pass/Fail) PASS Fluid depth in absorption field before test **0/7 in. Water added 715 gal. Elapsed Time: 10 min. .Final fluid depth **0/7 in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE *INSULATED PER INSPECTION REPORT. **SEE ATTACHED Other bacteria Collected by: *IN CRAWLSPACE Date installed in, 5/24/1985 Cleanouts (Y/N) YES High water alarm (Y/N) N/A MCDONALDS PUMPING System type BED Gravel below pipe 0.5 ft. Depression over field NO For 3 bedrooms NewdePth *'1/7 in. Absorption rate >= .450 g.p.d. KNOWN If yes, give date - LETTER CONCERNING ADEQUACY TEST. colonies/lO0 mi. GEG Ltd. D. LIFT STATION Date installed Size in gallons "Pump on" level at in. ~ J Cycles tested, E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access (Y/_~ J "Pump off" leve~gh water alarm level at 100'+ Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas 50'+ Meets alarm & circuit requirements~ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N//A 100'+ Building foundation Water main Wells on adjacent lots SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 5'+ Property line 5'+ N/A Water service line. 10'+ 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots. 100'+ Absorption field 5'+ Surface water. 100'+ Building foundation 10'+ Water main N/A Driveway, parking/vehicle storage 10'+ 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 Pdnted Name JEFFREY A. GARNESS Date [ I I q'l'7--D-i I COSA Fee $ Date of Payment Receipt Number (Rev; 11/05) Waiver Fee $ Date of Payment, Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Certificate of On-Site Systems Approval (COSA) # 111014 During a recent COSA on-site inspection and test of the potable water supply well on Block , Lot 14A of Tustamena Terrace subdivision, the well's productivity was determined to be 0.6 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3-bedroom residence is 0.3 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. Municipality of Anchorage Community Development Department Development Services Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # 111014 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 14A of Tustamena Terrace subdivision. This inspection revealed a nitrate concentration of 9.25 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. Aarow Pump & Well Service LLC (907)346-9355 Inspection Report 5536 Naknek Lane Well camera ran down to 60'. No perforations or leaks in casing found. Brian R. Wille Aarow Pump & Well Service GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS .... January 25,2011 Municipality of Anchorage Development Service Department Building Safety Division On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Adequacy Test Results for Tustamena Terrace, Lot 14Ao To Whom It May Concern: On 9/15/2009, we performed a site visit for the purpose of obtaining a C.O.SoA. Prior to the start of our adequacy test, liquid levels were checked in both monitoring tubes of the bed. The northeast monitoring tube was dry. However, the southwest monitoring tube contained a liquid level of 7 inches. This would indicate a surcharged system, since the effective depth of the drainfield is only 6 inches (per inspection report dated 9/30/1993). However, no liquid was witnessed in the distribution lines. Elevations were checked and the depths of the monitoring tubes were found to be congruent, and at the proper depth. The liquid levels in both monitoring tubes were monitored during the adequacy test. During the test, seven hundred fifteen (715) gallons were introduced into the drainfield over a period of one hundred and sixty-eight (168) minutes. This caused the level in the northeast monitoring tube to rise one inch, and dissipate over the following ten minutes. The liquid level in the southwest tube did not fluctuate at all during the course of the test. Based on this data, we have reason to believe the southwest monitoring tube is possibly bi.matted and non-functional. We consider the results from the southwest monitoring tube non-viable, and are using the information from the northea nst monitoring tube as our criteria to determine the adequacy of this system. If you have any questions, please contact us at 337-6179. Thank you for your assistance. ..... ~ffreJf ~. ~ah~.~)P.Eo, M.S. Presi/le~/t 3701 Eo Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com o o / ~0 o~ o ~ ~ om ~ m~ ~ o z o 0 zo c ~ ~0 ~ ~ ~o zO mo>> ~m~o om~m m>~O ~z~ z~z OCO ~ z> mm >. SGS Ref.# 1110004001 Client Name Garness Engineering Group, Ltd Printed Date/Time 01/11/2011 8:09 Project Name/# Tustumena Terrace Lot 14 A Collected Date/Time 01/03/2011 11:40 Client Sample ID Tustumena Terrace Lot 14 A Received Date/Time 01/04/2011 9:05 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 01/05/I1 01/07/11 NRB Waters Department TotalNitrate/Nitrite-N 9.25 0,I00 mg/L SM20 4500NO3-F B (<10) 01/05/11 AYC Microbiology Laboratory E. Coil Negative 1 100mL SM20 9223B A 01/04/11 DLC Total Coliform Negative 1 100mL SM20 9223B A 01/04/11 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 01738117 1. GENERAL INFORMATION Complete legal description Lot 14A, Tustamena Terrace Subdivision Location (site address or directions) 5536 Naknek Lane Property owner Mr. and Mrs. Roy Jordan 5536 Naknek Lane Mailing address Day phone 345-5121 Lending agency Mailing address Agent Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Three (3)x~ TYPE OF WATER SUPPLY: Individ6al well .- XXXXXX Community well Public water NOTE: ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: XXXXXX Individual on-site Holding tank Community on-site If community well system, provide written confirmation from State ADEC attest- 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 o STATEMENT OF INSPECTION BY ENGINEER As certified by my'seal affixed hereto'and~0f 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. NameofFirm Anderson Engineering Phone 563-7155 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's signature 7~.~t.J.¢ ~..~~ Date 10/14/96 6. DHHS SIGNATURE Approved for '~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Muriicipality of Anchorage Department of Health and Hb.:- Services (DHHS) issues Health Authority Approval Ce'rtificates based only upon the representations g~.., in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as s courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-O25 (Re~'. 1/91 ) Back MOA ~Y21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SEI~/~;C~E IV E P Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 OCT ,1 4 1996 Municipality of Anchorage bn st'-'"eckliO'ept' Health & Human Services Health Authority Approval LegalDescription: /~O~" /t4~ '-~-'qJ~r~.A4/=~/~ ParcelI.D.: 01'3~117 A. ~LL DATA ~A ~ Well t~e ~ J~ ff A, B, or C, at~ch ~EC letter. ~EC water system number Casing height (above ground) Wires properly protected (Y/N) Log present (Y/N) Y Date completed Total depth [~- / ~ Cased to ],~ I Z Sanitary ~eal (Y/N) y Date of test Static water level Well production FROM WELL LOG AT INSPECTION · ~"t/ g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate Date of sample: lO~Il/qb B. SEPTIC[HOLDING TANK DATA Date installed ~/~ ~ Tm~k size 6000 ~ Foundation cleanout (Y/N) '~ Depression (Y/N) Dateofmum,pi~ng '~/~/~/~ Pumper ~["~bq~ Collected by: Other bacteria Number of Compartments ~' Cleanouts (Y/N) Y /~J High water alarm (Y/N) ~ C. ABSORPTION FIELD DATA 9~ ~ Date installed ~/~t~/~' S0ilrating (g.p.d./ft2orfi2/bdrm) ' ~* SystemWpe . Length ..~,~ Width ~¢1 Gravel thickness below pipe . ~ t. Totaidepth Effective absorption area iT/I ~ ~ ~onitoring Tube present(Y/N) Y Depression over field (Y/N) Date ofadequacy test iP/I/q[,a Results(Pass*ail) PP,$~ For ~T'-~/~ bedrooms Fluid depth th absorption field before test (in.); ~ Immediately after q'~gal, water added (in.): 4 Fhfiddepth ~ (ins.) Minutes later: 4 ~ Absorption rate = ) /'~"~ .g.P.d. Peroxide treatment (past 12 months) (Y/N) /~ ff yes, give date TATION Date instafied~~ Size in gallons Manhole/Access (Y/N) ~ump' off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorptiou field on lot Public sewer umin d t Sewer/septic service line ~> ~.~ I ; On adjaceut lots ~'/OD t ; On adjacent lots Public sewer manhole/cleanout Lift station ),/0Ot SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: t' Building foundation >' /O Property line ~']O Absorption field Water mai~ffservice line ~'2~' ! Surface water/drainage )']g?~ ' Wells on adjacent lots > lOt SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~'/~9 Water main/service line ~ Z Surface water ~> / D O ! Driveway, parking/vehicle storage area Curtaiu drain d~'M/..~ Or,J ~r'Wells ou adjaceut lots ~' /t~D t Property line F. ENGINEER'S CERTIFICATION I certify that I have deternuned thru field mspecttons and review of Municipal record~t~q(.th~boge' systems are in confor t ance ~, th MOA H~M euidelines ia effect on th s date o, ~.':, ~;:.,~o~"7: & HAA Fee $ ~OO ~OO Waiver Fee $ Date of Payment [ O - ~ ~ ~ Date of Payment Receipt Number O,~,~ ~ ~~ Receipt Number Rev. 8/95 DSS: haa.wk.doc MUNiCIPALI.[:Y~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 Parcel I.D. # CERTIFICATE OF HEALTH AU'I'HORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 14A; Tustamena T~rrace Location (site address or directions) 5536 Naknek Lane Anchorage, AK 99516 Property owner Mailing address Lending agency Mailing address Mik~ n,d ~n~ Nicho£~ Day phone 5536 Naknek Lane Anchorage, AK 99516 Day phone Agent Bev Hopkins/DYNAMIC PROPERTIES Day phone 279-7611 Address 501W. Northern Lights Anchorage, AK 99503 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well ×XX Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: XXX Individual on-site Holding tank Community on-site Public sewer 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 sjuewwoo I~uo!~!PPV suo!il~lnd~,s bU]MOllOJ eqi qi!M 'suJooJpeq 'swooJpaq JO~ II~AoJddIB leUOp,!puoo 'peAoJdd~s!a ,Io~ peAoJddV X' :I~II3.I.VN~DIS SHHa '9 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~//Z-/x~/ T~.~'~,~7~,~-~/~¢ ~-,~/,~ ~-~.~"~" Parcel I.D. A. Well Data Well type /~?/~'~ ~ Log prese/n-t (y~) Total depth Sanitary sea (~) Date of test (.~o/'~, × If A, B, or C, attach ADEC letter. ADEC water system number Date completed //~' ~ -~ Driller /Zl Casedto //~-'] '~ ~) Casing height FROM WELL LOG Static water level //~ ! Well flow Pump level1 ~ ~ SEPARATION DISTANCES FROM WELL TO: Septic~.'-~,~,'-"--~ tank on lot Absorption field on lot ' Public sewer main Sewer service line Wires properly protectec~lN) AT INSPECTION .g.p.m. ~:). ~ g.p.m, t~l ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Date of sample: :/Z.W~/~7 B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts(~) High water alarm (Y/N) Date of pumping Nitrate / ~'-o"-~ /~.~/~_, Other bacteria (~) /- Collected by: ..~ ~ 5 E,,t~(,,.2~ ,,~,.~'~ Tank size /"~ 4:~ ~.~ Compartments /~,a~.~ cleanout (Y~ Depression (,~ Alarm tested (Y/N) /t.// SEPARATION DISTANCES FROM SEPTIC~I~IZ~t~3r~ANK TO: Well(s) on lot ~0 © ~ On adjacent lots //0~ -~ Foundation /0 To property line ~) / Absorption field ~ ~ ~te~-mafl'r/~ervice line SUrface water/drainage /"~'0~'J~ :/~ ~ 1 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets M~(Y/N) SEPARRATION DISTANCE FROM LIFT STATION TO: Well on Ici J On adjacent lots Manufacturer "p~t~'~ / /"~ "Pump off" Level at / ~ Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed f Length ~'~ Width Total absorption area Date of adequacy test -/~ Water level in absorption field before test Soil rating (GPD/FF) ~,' 2--rTZ- ( Gravel thickness Cleanout present (~",1) Results (pass/fail) ,/¢// Peroxide treatment (past 12 months) (Y/N) System type ~- Total depth Depression over field (Y~_.~). for ~ --~ Bedrooms After test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot //~ ~p r'¢- On adjacent lots ~/~ co r'.¢_ Property line To building foundation ./~ (¢- To existing or abandoned system on lot On adjacent lots 2: ~ tO_ Cutbank /,'c2 ~ /¢ ~ ~i~/service line Surface water //<:~ ¢ ¢- Driveway, parking/vehicle storage area Curtain drain ./~¢/~ ¢ ~ f.JO ~ .~J E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA Engineers Name .... HAA Fee $ '.~D~ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number From : RLPINE DRILL 90? 345 0202 0et. 24.1996 09:52 PM P01 Water Well - Test Pump Report Conducted by Alpine Drilling & Enterprises Owner: Ray and AlayneJordan Well Location: 15536 Naknek Lane, Anchorage, Alaska Well Information; Total Depth: 121' Depth of Casing: 121' Casing Size: 6" Screen Diameter: Screen From: .... Slot Size: - Pump Information: Intake Depth Static Water Level: Pump Size Pumpon: Time: 10:10a.m. Date: 10-10-96 Time Pump off: 2:10 p.m, 10-8-96 Pump was turned on and flow metered at above time and controlled by a low water device after reserve statle water was pumped from well. Static level of well was not taken but it is known that the levels are Iow for that area. The well was pumped for a period of four hours at maximura drawdown and a total of 143 gallons was pumped. This com~ out to a rate of .59 gpm which is over the recommended flow rate by MOA. Depth and slatie may be found on original log. The water system consisls of the normal pump etc. which pumps into a storage lank which appears to be 300 gallons. Alpine Drilling & Enterprises David L. Harper October 12, 1996 Municipality of Anchorage Department of Health and Human Services Onsite Services Section P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Lot 14A, Tustamena Terrace Subdivision Septic System Adequacy Test Dear On Site Services Engineer: The absorption bed currently serving the three bedroom home on Lot 14A, Tustamena Terrace Subdivision is a combination of a failed bed constructed in July of 1990 and a new 24' X38' bed constructed in September of 1993. According to the as-built for the 1993 .system the two beds are currently tied together. A survey of the new bed reveals the monitor tube in the northeast corner is nearly 1.0' below the flow line of the bed. Approximately 5" of standing water was noted in this monitor tube prior to the adequacy test. The monitor tube at the southwest corner of the bed was dry. The piping in the bed was found to be somewhat out of level. A total of 450 gallons of water was pumped in to the absorption bed from the post tank cleanout. The water level in the southwest monitor tube rose from 0" to 4". The water level in the northeast tube rose from 5" to 7". Less than 22 hours later the water level in both tubes had returned to their pre test elevations. This would indicate the bed is currently capable of absorbing more than the required 450 gallons per day. At the present time this bed is operating at a level which meets Municipal requirements. Because of the history of absorption beds on this property i t is impossible to gurantee any future operating capabilities of this system. Sincerely, Michael E. Anderson, P.E. ' ' : "' - ' ' J't' ' '" '%'' ~ '. ' '" · " ' -"' ' 'L' '-' . ' '" ~,. .- ' '" . · ..... ",'. ' ."·"W..,TER}W~'LL? tEST PLUMP, REP, O-RT'-.~', ~-i~ ~.~ .~ ~ Conduc~ by ~ ~~ . ~ ~~ ' , Well Information: Ttl. Depth ~:Depth of Casing /~/ ~reon F~m ~ To ~. _ _. . _ ~ Casing Size/_z~Z Screen Dlam ~ Screen Slot ~ _ ' ' - ~: Rema~s Pump In~o~atlon: Intake Depth Pump Size ' Air Line Depth Static Water Level AY. Discharge GPM, Max. Drawdown. · Pump o": ~ /~.'/~ ~ D~t~'?~ ~ump Off: T~=e~:'/~ D~t. /~'~ ~' WATER pIEZO- FLOW WATER PIEZO- FLOW TIME LEVEL 'TUBE GPM REMARKS TIME LEVEL TUBE GPM REMARKS ,w. ..~ t' ~._/', '!/ .. : ~'-' / / 0 /' / I 10×22~8 CT&E Ref.# Client ~ame l'rojed ~ame/# Client ~mple ID Ordere~'By PWSID~, ~ample ~temark,~: 17:01 CT&E ESI RNCHORRSE ~ 5635389 CT&E Environmental Services Inc. Laboratow Division ~ ~ Laboratory Analysis Report 96553400'2 Andczsoa Englneeri~ N/A Lot 14A Client PO# Printed Dat~Time 10/22/96 16:11 CollectedDate/Tlme 10/11/96 11:50 Rexelved DateJTlme 10/11/96 12:00 Tedmical Dire~or: b~ephen C, Ede Sample ~oll~ted by: Mike Anderson, Parameter Tote[ C~Jiferm Alienable Prep Analysis Results PQL Units Nethod [|~fte P6~e pate InJ~ ~,97 O.gOO mg/L $M18 ~SOO-RO]F 10 max 10/11/96 EMB 0 0 cot/1OOmL s~l~ 9222a 10112196 200 W. Potter Drive. Anchorage, AK 99518-1605 -- Tel; (907) 562-2343 Fax: (907} 561-5301 3180 Peger Road, Fairbanks, AK 99709-6671 -- 7el: (907) 474-8656 Fex: (907) 474~9685 ENVIRO~NMENTAL FACILITIES iN ALASKA, CALIFORNIA. FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA ~.o~o~ s~wc~sCOMMERCIAL TESTING & ENGINEERING CO. REPORT of ANALYSIS Chemlab Ref.~ :93.3643-1 Client Sample ID :L14A TUSTAMENA TERRACE S/D Matrix :WATER 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Client Name :S & S ENGINEIERING WORK Order :68741 Ordered By :R. SHAFER Report Completed :07/29/93 Project Name : Collected :07/26/93 @ 12:45 hrs. Project~ : Received :07/26/93 @ 15:00 hrs. PWSID :UA Technical Director:S'z'~HENg. EDE Released By /-- Sample Remarks: ROUTINE SAMPLE COLLECTED BY: SS. QC Allowable Ext. Anal Parameter Results Qual units Method Limits Date Date Init Nitrate-N 2.58 mg/L EPA 353.2/300.0 10 07/28 LLH * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution, GT = Greater Than ~S~S Member of the SGS Group (Soci~t~ G6n~rare de Su~eillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA .:, APPLI( HT FILLS OUT UPPER HAl, ONLY Pr°~RettY~Owner .... ,. i i ~ ': Mailing Add're,ss .... Zip Code '~¢~Sir~le Family ..... Sewer Disposal ~, ~ ~\ Time Time Date Date Date Date ~/~' "~/~, ~c~- Inspector Insp~tor [nsp~tor Insp~tor 'CONDITIONS OF APPROVAL ( ) APPROVED BEDROOMS ~ X [~ - ~ ~ _ 'i~ Soils Raling Date ~wor InstaUo~ ~ Well To A~n Area /~ f WollLogReceivod i ¢0 ~'- ~y--~ ~ Well to Tank /~ Septic T~k Size 72.023 (31~) January 27, 1984 Thomas R. Schoemake P. go Box 11-1438 Anchorage, AK 99511 Subject: Lot 14A, Tustamenia Terrace Approval for the individual sewer and water facilities cannot be granted until the ~ollowing items have been completed: o The depression over the sewer system will need to be filled so that surface water drains away from the sewer system. Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, JR23/ej/E1 cc: First National South Center Jim Roberts Associate Envlronm ~ntal %~ank of Alaska Specialist