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HomeMy WebLinkAboutTUSTAMENA TERRACE #1 LT 9Tustarnena Terrace #1 Lot 9 #017-381-46 Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Mark Begieh Anchorage, AK 99507 Mayor www.muni.org/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: aj Legal Description Property Owner Name & Address: 55`zs AZAA,"k, � AA_ olqc Pump Installation Date: 1p /l `< /V Pump Intake Depth Below Top of Well Casing: //0 feet Pump Manufacturer's Name: /,l Y Pump Model: 23 b ,11�6 V3 Lia Pump Size AZ lip Pitless Adapter Burial Depth: / 0 feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: All_�q Well Disinfected Upon Completion? <ves0 No Method of Disinfection: Comments: V4 ,emc—/ZS -"'"+o; ANCHORAGE WELL & PUMP SERV. Pump Installer Name: �5 330 EAST 76 -AVENUE •,4p,r ANCHORAGE, AK 99518 PHONE: 907-243-0740 AWPS.COM Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Municipality of Anchorage Page 1 or 3 Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.d.anchorage.ak.us (907) 349.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWO50385 PID Number. 017.381.46 Nerhe Wastewater System: Upgrade Duane Vaa en & Paula Clark 5525 Naknek Lane Anch., AK 99516 ABSORPTION FIELD phone e07 5' Wide Trench Tree 3 S•1 N•krV T" Dopa tmm 0n0^"1 grWe. LEGAL DESCRIPTION .45 WON? 7 Ft. BbtA L" 6LOdiwe"h Depth b ppe aplan tram mpaW grade Ga." Mph hansath We 9 Tustamena Terrace No.1 3 Ft. 4 FL TVMWW R -P sectm FA •mea •mgr• arq+W grade 1.3 Gaal Lrgni 100 Ft. Ft. Gaal walk n Nwh'. an "h*` D. W rM—.Inn Well: Existing 5 Ft. 2 >10 FL Clawr eion (Piw.e. A B. Q Toul Depth CeeW u' a" tl��1,000 FP ASTM 3034 PVC FI. FL Dnlw D.a Dnllw Slam W.ar LaeN A Plus Home Services 10125-2712005 FL ."l° Pan°s"" D.nw Htit,,le AtwnG TANK GFU Ft. FI SEPARATION DISTANCES Existing 1,250 Gallon Septic Tank To Septic Absorption Lift Holding ItibiriPrivate From Tank Field Station Tank Sewer Line well >100, >100, >100, NIA >25' >100' >100' >100' NIA LIFT STATION — NONE ON LOT swilloeweler Lel la" >5' >10, >5' NIA Dr >5' 610' >5' NIA lih,eiFavle"m �p w h in h None Noted Pump Auk• & Mmol Iwraul k"p•ahar" partam"0 by c~D,.n BENCH MARK Bottom Floor Slab. 100.0 FL Engineer's Stamp ptInspections r49th *�� performed by: A. Harala Dates: 1" 1012512005 2ne 1012612005 y ^\"o'; "W (�� liC.f ^ 0 . ._...._......_ ..._.. . 00� MICIUCL E. ANOCNSON J W Department of Health and Human Services approval 0 s No a -,}s, Reviewed and approved by: 17 p liz,/ Date: ID -2-Q-0 \�0 �j �`o io•pp-1e-,�1 114 #4Zo ,a,`- Municipality of Anchorage Page 2 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On-Site Wastewater Disposal System or Well Inspection Report Permit Number: SW050385 PID No. 017-381-46 LOT 9, TUSTAMENA TERRACE SUBDIVISION NO. 1 28a,aa' " 69159'p4"E � 1np1�' �noR CB A B S/ 51 9.1 373 S2 52 15.2 44.8 AR. C4 S! 27.8 44.5 SU Yl 33.5 28.7 ® Y2 A Y2 44.7 42.1 C4 27.8 42.4 ^ C7 Y1 CS 58.4 27.0 CS 42.5 58.9 N Ile} C7 59.8 J9.1 �Qip e 4 i� ,ey b. CS ,Op ED P^' 5 LUT BA AK/v W1E DRIVEWAY nIdWCM L" VaSS14411k r a 49th •� �i_.... _.._..... ....• S'c,� gCINEL L MI)CRSCYI t PLAN AS-BUILT '••"�'+ No cE-Amt SCALE V - 50' •89,8,Rarmi Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number. SW050385 PID No. 017-38146 U s m r r —d 101.5 rn e s> HW cum U61 9 95.3 0 L) SOUTH LEG L) 98.0 Cu U 50' (Trench Length) NORTH LEG E1 PR❑FILE AS -BUILT ?sMIL7MELLANDERSIt1 �0, it No. CE- 391 f No Scale 1. •• .._ •••••••••'_.e1. , - - - GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERALCONTRACTowe—.._-._ _.—_ SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: TUSTAMENA TERRACE SUBDMSION; LOT 9, PERFORMED FOR: PAULA CLARK DA DEPTH qS.S"" (feet) FILL/oRGANIcs TEST HOLE 1 •• .......... ye arness.. CE -7953 ; N s B 151. S 9 vSe 10 G III 11 I[-=- ��T�'2 s3.r 14 15-IIHIIIIII IM /ML 17 18 19� wu nu" RAIL 6D (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 5.5 FT. AND 6.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ® YES Cl NO SOILS LOGGED BY: SUSAN OSWALT PERCOLATION TEST PERFORMED BY: KENNY MAUS COMMENTS: PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PE ORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: iD 0 - f P.O. BOX 190708.2921 INTERNATIONAL AIRPORT ROAD • ANCHORAGE. ALASKA 995ium I TELEPHONE 2432455 i I Custonmes i Order No. / Date V 19 R Name u•..r l/ . �'�. Address S S S �✓. ( �t%r L. �J_ L _ 'A 59rl c ALL Claims and mtumed goods MUST be accomprved by Ws bill PAST DUE ACCOUNTS SUBJECTTO 1.5% SERVICE CHARGE PER MOW -90 A 127097 Reed by J I i ALL Claims and mtumed goods MUST be accomprved by Ws bill PAST DUE ACCOUNTS SUBJECTTO 1.5% SERVICE CHARGE PER MOW -90 A 127097 Reed by J I r MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SWO50385 Date Issued: Oct 05, 2005 Expiration Date: Oct 05, 2006 Parcel ID: 017-381-46 Legal Description: TUSTAMENA TERRACE #1 LT 9 Design Engineer: 0855 Gayness Engineering Group, LTD Site Address: 005525 NAKNEK LN Owner Name: PAULA CLARK & DUANE VAAGEN Lot Size: 50607 SO. FT. Owner Address: 5525 NAKNEK LANE Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE. AK 99516-3027 This permit is for the construction of: ❑V Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Date: 16 /G,125— Issued By: Date: .4 Municipality of Anchorage ;. • Development Services Department ,y- Building Safety Division On -Site Water & Wastewater Program ' 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.sk.us (907) 343-7904 ;• �i r1ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. DI9-3FI-q& Permit Number Property owner(s) PAULA CLARK & DUANE VAAGEN Day phone 345-9521 Mailing address (1) 5525 NAKNEK LANE *. ANCHQRA E. AK Mailing address (2) Zip Code 99516 Legal description (Lot, Block & Sub'd.) LOT 9: TUSTAMENA TERRACE SUBDIVISION 0-1 Legal description (Section, Township & Range) N/A Lot Size 5D% q Acr ISq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms 3 Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. Permit Fees: Y60 4 M 9t4 Date of Payment: Iii" S -fes Receipt Number. 11VK Waiver Fees: Date of Payment: Receipt Number. GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS October 4, 2005 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Proposed Septic Upgrade for Tustamena Terrace Subdivision; Lot 9, To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The septic system consists of a 1250 gallon septic tank that was installed on 5/1999 without inspection. The septic tank was was excavated and was verified to be of good integrity on 9/9/2005. The house is also served by a trench type drainfield sized for two bedrooms that is undersized and was found to be encroaching on groundwater. We are proposing to upgrade the septic system with a 5 -wide trench type drainfield sized for 3 bedrooms. One test hole was excavated on the property. The dminfield will be designed around the 30 foot radius of this test hole. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPHY: As can be seen on the attached topography site plan the average topography below the dminfteld is a 10-15 percent slope running approximately southeast to north west. In short there are no slopge concerns. We are unaware of any adverse impacts this installation would have on adjacent wells or septic 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179 • Fax: (907) 338-3246 • Websitc: gamessengineering.com systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Sincerely, P.E., M.S. NOTE. Attached is a site plan drawing, a design drawing, one soil log, which are all part of the design package for this septic system. (Contact G.E.G. Ltd. for 7 page construction specification letter.) 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: garnessengineering.com \ CSiPnc AR E�D LOT 2 BLOCK 2; ROSEBEUD HILLS S/D — — — — y — — — — — — — — — — — — I / / I / I 100' WF1I RAni1C / 1 1 \ LOT 3. BLOCK 2;; ROSEBEUD HILLS S/D — — — — — — — — — — — — — — — — — — — — — — — PROPOSED SEPTIC UPGRADE (SEE DESIGN _PAGE _2 OF 2) eno CSEPC E1 \ / LOT 10. / TUSTAMENA TERRACE S/D / 1 / li I LOT 13; / TUSTAMENA TERRACE S/D 4% I 1 CAERpEAO I A \ ^ 1 1 I I / LOT 4. BLOCK 2: / ROSEBEUO HILLS S/D (VACA'1T) — — — — — — — — — — — — — EXISTING BEDROOM HOUSE I 1 I 1 I I I I I / I / I / I / I / I LOT aA; I TUSTAMENA TERRACE S/0 T I (VACANI I \ / N 1 \ VAPPRO%IMATE / LOCATION / LOT 14A; TUSTAMENA TERRACE S/D l\ tido \ ' 6•,-.�•� SIO \ �T. 1.��eRWif GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS d GENERAL CONTRACTORS fAI C 11AM 111D. RA( 101 MCIMIIY, M K]0) . A4K (WV3)-11A . I" (W3)3 32" . PREPARED FOR: NE NUMBER: PACE NUMBER: PHO PAULA CLARK (907) 345-9521 1 OF 2 LEGAL DESCRIPTION: DRAWN BY: TUSTAMENA TERRACE SUBDIVISION; LOT 9. Z.T.G TYPE OF WORK: SITE PLAN FOR SEPTIC SYSTEM U 10/4/2005 tawl'jm% Fn OF BEDROOMS: 3 INSTALL FLOW PER DAY (CPD): 450 EXISTING DRAINFIELD TO BE SPUTTER nON RATE/S: 60 MIN./INCH COMPLETELY ABANDONED. 0 APPLICATION RATE:,45 DRAINFlELD SO.FT.:1000 I I �I� MAXIMUM DEPTH:7 FEET WIDTH: 5 FEET LENCTH:2 O 50 FEET M.OA APPROVED SAND FlLTER: N/A EFFECIIVE:4 FEET REDUCTION FACTOR: N/A ACTUAL SO.FT.: 1000 LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT GEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND / PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND rnumm�ue mmmrn PROPOSED DRAINFlELDS 1 ALTERNATE SITE CF I WILL REQUIRE THE USE OF A SCAT I BIOFlITER SYSTEM '•'}�Y. � I / lY N H I �p4 6iO,�O�JS�i. 7 � � / EAST LOT UNE FLAGGED BY A / LAND SURVEYOR PRIOR TO CO _ _ _ \SNF •:. 500 GALLON UFT STATION ON SEPTIC TANK. INTEGRITY OF SEPTIC TANK WAS VERIFIED TO BE GOOD ON 9/9/2005. `0... GARNESS ENGINEERING GROUP, Ltd.p;'�:' 4 H 9, CONSULTANTS 6 GENERAL CONTRACTORS �......••• •• •••••• ........... 3MI C TUDOR DON; !1111[ 101 • MOCbLC M[ 00001. R (901)y} IM 0 W (W)J,L M- • M[BLR: w�gstirwpirpea� PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ••• ••••••• ......•••• PAULA CLARK (907) 345-9521 2 OF 2 a f e A. G ness.: O LEGAL DESCRIPTION: DRAWN BY: TUSTAMENA TERRACE SUBDIVISION; LOT 9, Z.T.G.ON 4p a •10. 4 �SFcQc TYPE OF WORK: DATE: Professloll QO4Op�000ao DESIGN DRAWING FOR PROPOSED SEPTIC UPGRADE 10/4/2005 (KRV. UlMl GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS 6 GENERAL CONTRACTORS ro� c neon noa, swrt 101roM. • w,°nncL . "W7 • n°nr, (Wr-61ro • rwc 07-sza • .cevrt: ,vn.rwy:...b SOIL LOG — PERCOLATION TEST LEGAL PERFORMED DEPTH DESCRIPTION: FOR: TUSTAMENA TERRACE SUBDIVISION; LOT 9, PAULA CLARK DA 9/9/2005 13.5' (feet) 11.75' TEST HOLE # 1 12.45' 10/1/2005 FILL/ORGANICS 2:32 = SOI CLASSIFICATIONS 2 2:32 — 6• ---- 3 3:02 :`air i+t GP ML 5 1/2- 1/2' GM CL a — GC OL — 6 SW MH 5 5 1/2- '� �'• SP CH SM OH 6 SC 7 SM 8 9 10 11 12- 13- 14— GM/ML 21314GM/ML 15- 16- 17J 516 17 18 DEPTH TO GROUNDWATER DATE DRY 9/9/2005 13.5' 9/21/2005 11.75' 9/29/2005 12.45' 10/1/2005 H j ` .�. P •, f e mess CE -7953 .G / 3 BEORD --,HOUSE DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 9/20/2005 1 2:02 — 6• — 2 2:32 30 5 1/2" 1/2' 3 2:32 — 6• — 4 3:02 30 5 1/2- 1/2' 5 3:02 — 6• — 6 3:32 30 5 1/2- 1/2- 19 PERCOLATION RATE 60 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 5.5 FT. AND 6.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: 0 YES ONO SOILS LOGGED BY: SUSAN OSWALT PERCOLATION TEST PERFORMED BY: BENNY MAUS COMMENTS: PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PE ORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: /D IY40r v vdlE INIVE MEMI-01 N g� v t N LL W V(Ll � Inci INIVE MEMI-01 I ml 11411 'DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L STREET, ANCHORAGE, AP:. 99501 99�!�. 264-4720�+- t4 pp -L_ F'�F-'..*ria I T PERMIT NO. ! 800083 ) APPLICANT THOMA`_=, E. PRICE JR SRA BOA; 375-C 349-1302 LOCATION NAKNEK LANE LEGAL LOT 9 TUSTAMENIA TERRACE LOT SIZE 50000 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM I 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 15 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 34 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F='Ea==_ava I I- EEXF= I FZ .. C- 1= e= I—EME�F—EF' -A . -9 eo I CERTIFY THAT 1: I AM FAMILIAR WITH THE RF_QUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. t: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. SIGNED:- -------------------------- ------ 'APPLIC:ANT THOMAS E. PRICE JR ISSUED BY-���2----------------DATE__����./ __ V4. N 72-013 (f?ev.3P1R'1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ' J ENVIRONMENTAL ENGINEERING DIVISION - 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE EW '��k3U ❑UPGRADE MAILING ADDRESS Y)© at 1= O LEGAL DESCRIPTION al 1--01 4\v ST me E2Pa9C 'D LOCATION i�r NO. OF BEDROOMS or -:r-1 4v( E)r' A— Y DISTANCE TO: ell Absorption area b Dwelling ntepOSO j PERMIT NO. —` ?5C) (2l l _Z Manufacturer Material No. of compartments �— �' Liq. capacity in gallons IIF HOMEMADE: Inside length III Width Liquid depth I JL SC) I] Y DISTANCE TO: Well Dwelling PERMIT NO. JU'Z Oz F Manufacturer Material Liquid capacity in gallons O DISTANCE TO:ta II undation 3 Nearest lot line PERMIT NO. w= �P� .,_ © w z No. of lines Length of each line Total length of lines Trench width Distance between lines ' 1 - P Z w inches IV Top finish Material Total ¢ F of rile to rade g 1 i/ beneath the t0 effective absorption area ® ?)p (p inches (p Length Width Depth PERMIT NO. w Q F- Type of cri Crib diameter Crib depth Total effective absorption area a wLu rn ell Building foundation Nearest lot line DISTANCE TO: J ss Depth Driller Distance to lot line PERMIT NO. J w � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER tl kqC O PIPE ATERIALS SOI L TEST RATING INSTALLER REMARKS u0 CMY[l �� r YW Q �/ yL y e i c, o w A RO - D TEh:- -- LEGAL d- 72-013 (f?ev.3P1R'1 DEP9RTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 25 �L' STREET.- ANCHORAGE, AK. 99501 254-4720 KD r4-_=5 I TE :E:E!.•-tEFZ F EFtM I T PERMIT NO. { 780915 ) APPLICANT TOM PRICE LOCATION OFF NAKNEK LEGAL L9A TUSTAMENA TERR. Sr D TYPE OF SOIL ABSORPTION SYSTEM IS MAXIMUM NUMBER OF BEDROOMS = 4 BOX 81 ANCH 99510 LOT SIZE TRENCH ��y/•fib Ana ),q aq 8 dQUm 349 1302 50000 SQUARE FEET SOIL RATING (SQ FTIBR)= 250 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM C>EF•TI-1= moi- � l._EC-a�iTH=-�'��"r�F�Fltir+El� CyEF'TI--1= �..5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. 3 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 CIN FEET). FREe_=1U I Fs'EC> �EF•-IF I e^ TFir4K :S T 2�E= :lLvc1Cy 13nI_LGt-455 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. --- TWID r } f=IF?E F F=C-2l -e I F_E_r> ---- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPRRTMENT.WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100+ FEET FOR R PRIVATE WELL: OR 150 TO 200 FEET FROM A PUBLIC: WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F•EF;�M I T F=.'v-'.F' I F='E:S C>EC~E=ME�EF;Z =�:1_ I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR. ON-SITE SEWERS FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODE_,. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. S I GNEI I SSUEI ::L" -=;l r CS AND WELLS AS SET ENLARGEMENT IF THE V3. 2 I �IA� 1 li IA Zvi\���vv SO' '.-`2�0CE 66Odi RFC. R iA Ek S(73-235) - `0011 tNnC�.�r'. LANE,- c. 2°3 09 GO 12 ,ov'\ u iiC Fr 0 , o R,-- cn N Vol) rl 61 I �014 X 4- -r 'OLE CIRCLE I : I MUNICIPALITY OF ANCHORAGE DEPARTMENTOF HEALTH AND ENVIRONMENTAL PROTECTION 0. �Y Pouch 6600• Anchorage, Alaska 99502 2762221 SOILS LOG — PERCOLATION TEST PERFORMED FOR LEGAL DESCHIPTI (DEPTH (FE ETI 2 4 5 G , 7 a s 10 11 12 13 -I 14 15 16 17 81920 18- 19- 20 COMM NTS PERFOR::EO BY 72009 (7/76) 1,4 1) Cj SOILS Lo(3 PERCO' ATI'):,; TEST DATE PERFORMED.. I � ('f �.. T:/: .. , f :•s'ti. `, S -y` �/ it /'v'/iV� `.r.. i SLOPE _ _ SITE PLAN�:— r. �y �J.,J a^.( c_,%' /.rte/_• �;., .a WAS GROUND WATER / S ENCOUNTERED? / L Smoot\ IF YES, AT WHAT DEPTH? O P E N. w. O � r Reading Date Gross Time Net Depth to Time Water Net Droa 11 � 1 I/t. PERCOLATION RATE 9-7 lminuses'mchl c• 5 1 TEST RUN BETWEEN f A FT ANDFl /n x,,11 L �• '.I.{ ,` f iL;4 � 7_ 1 i/ l� �r' r CERTIFIED BY: _DATE' "_�" •I'i' 561891077 ti Municipality of Anch ' -1 gyiL 2 201 On-Site Water and Wastewater Proor- < • (907) 343-7904 I- SA "Y CV t �h it 01 . 8 i,g Certificate of On-Site Systems Approv. .D. 017-381-46 Parcel IExpiration Date: O CSC 30) .2otR 1. GENERAL INFORMATION Complete legal description Tustamena Terrace #1 , Lot 9 Location (site address) 5525 Naknek Lane Current Property owner(s) Sean T. Glasheen Day phone 907-545-0544 Mailing address 5525 Naknek Lane #1 Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 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 0 Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class WeII ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Distance: WaiverNariance request for: Received by: /,/,i44. ./ AV/ Date:7/cW//r� COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 5249 Waiver Fee $ Date of Payment X0.1-(i!2 Date of Payment Receipt Number C5V21.1) Receipt Number COSA# 85('.Ig130 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Forge Engineering Phone (907) 522-7773 Address PO Box 240773 Anchorage, AK 99524 Engineer's Printed Name Benjamin Schiller, PE Date 7/24/18 .4.7,....-_..‘. ...OF Cpq k 6. DSD/SIGNATURE •,Y• '�- — ; ". ... ,l I System#1 Approved for 3 bedrooms •' . r • BenjarnO5chiller ' i System#2 Approved for bedrooms �e ��` ''., CE 12592 '��� fol 43;•. 7124/18 .•��G�,� Disapproved �k‘F°pROFESSIONA AEI 4 Conditional approval for bedrooms, with the following stipulations: Q�$kir ��'W c1 .vim ON-S1TE Com... =g WATFR AND o WASTEWATER o 'm PROGRAM c c n4Prh,-,•-o\l��� By: - kee Original Certificate Date: J 0 93 Z 01$ / The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory n Other COSA blue sheet r c If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Tustamena Terrace #1 L9 Parcel ID: 017-381-46 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (YIN) Y Date completed 4/25/80 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 140 ft. Cased to 140 ft. Casing height(above ground) 12 in. FROM WELL LOG AT INSPECTION Date of test 4/25/1980 7/19/18 Static water level 17 ft 115 ft. 0.52 m. Well production 0'8 g.p.m . WATER SAMPLE RESULTS: Ne 8.43 /L Coliform g colonies/100 mL Nitrate m9 Arsenic ND ug/L Date of sample: 7/24/1 8 Collected by: Forge Engineering B. SEPTIC/HOLDING TANK DATA Septic/Steel Date installed 5/01/99 Tank Type/Material p Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N Date of pumping 7/09/18 Pumper A+ Home Services C. ABSORPTION FIELD DATA 10/27/05 0.45 GPD/SF S stem t e 5 - Wide Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) Y Yp Length 2 x 50 ft Width 5.0 ft. Gravel below pipe 4.0 ft. 1000 Total depth 8/9-1ft. Eff. absorption area ft2 Monitoring tube Y Depression over field 7/19/18 Fail Pass Results Pass/ Date of adequacy test ( ) For 3 bedrooms Fluid depth in absorption field before test 0/18 in. Water added 597 gal. New depth 2/22.5 in. 14400/19 Elapsed Time: min. Final fluid depth in. Absorption rate >= 450 g.p.d. None date Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give 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 >100On adjacent lots >100' Absorption field on lot >100' On adjacent lots >100' Public sewer main >75' Public sewer manhole/cleanout >100' Sewer/septic service line >25Holding tank >75' Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: 6' >5' >5'Building foundation Property line Absorption field Water main >10' >10' >100' Water service line Surface water Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10Building foundation >10� Water main >10' 10'Water Service line > Surface water >100 Driveway, parking/vehicle storage >10' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION ��~����\�\ OF A� t>i I certify that / have determined through field inspections and /,yy'y'�. `� '��+� review of Municipal records that the above systems are in '*: 491Yl )\ . *t♦, conformance with MOA COSA guidelines in effect on this date. / Engineer's Printed Name Benjamin Schiller, PE . . � •.. • t h• , „ 5 7/30/18 / .. Benja chiller : Ili Date F CE 12592 •,4 / �fi,4 ' 7/30/18 ' ill � PROFESS100 ‘\\\ - COSA brown sheet_10-10-12.doc MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT ' • F "i° 907-343-7904 On-Site Water and Wastewater Section / Fax: 343-7997 www.muni.ordonsite — Well Water Advisory Certificate of On-Site Systems Approval # 0SC181368 Subdivision: Tustamena Terrace #1, Lot: 9 This well's productivity was determined to be 0.52 gallons per minute. The minimum well productivity required under (AMC 15.55) for a 3-bedroom residence is 0.31 gallons per minute or 150 gallons per day per bedroom. Although the subject well currently exceeds this minimum requirement, the production capacity can fluctuate and may be insufficient to meet your needs. 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 , • i f ! 907-343-7904 On-Site Water and Wastewater Section �s Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On-Site Systems Approval # OSC181368 Subdivision: Tustamena Terrace #1, Lot: 9 A water sample revealed a nitrate concentration of 8.43 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. Since nitrates are known to slowly increase, we recommend you monitor the water quality. 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. 0. 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 a' Zpa.a --- p"E N gg 5 --- -4- 1d if"'"' -•-'1"--"41. f41'TY[+a--N— .+'^^r J—— a B ea a a a a /04 � 04- • 4 I p s 4o O j°s) . / t0 // / (. L1 / / (17 7..9 • OO••`` .PpO"� / // c / / •3 P / / / 0 I / / DWELL CO / / / 011 / / •.. +I / Z I PL► / C i,�.o' / 0 Pip / II Op�.7L` V / I r Er./ LEA~T• / . / \\ 04000p0 4 . of A&o �� o 'Mc \ \ Qo�P� j .. qs 0 6. .� nn ° \ \\ ff*9/ 4 TH1. 7 \\\ \\ ...,�'� ez4c,A•1J-� vA l�• )g \\�L\ 0. S I! // � .•0 \��0\ OO S SHANE A. HOLT; 0 \ $ \ LOT CA !, LS•6914 d /��E K .mow\ (i�d'� 4>G' •4\ 4a Oc \ %AgO�[��ro HAL%"do •^^ \ / NOTE I ORIVCWAY CN CR OAC MMC NT �4pp00000 v0 AS-BUILT SURVEY \ �� SCALE: 1'A40' N. \ \ . \ •Q.‘ N. I HEREBY CERTIFY THAT I HAVE PERFORMED A N MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 9,TUSTAMENA TERRACE FIRST ADDITION THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADOITIONAL ANCHORAGE RECORDING DISTRICT,ALASKA AND THAT STRUCTURES OR FENCELINES THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WIEASEMENTS OF RECORD,OTHER THAN THOSE SHOWN ON THE RECORDED PLAT.ARE NOT SHOWN HEREON. ENCROACHMENTSCRIN THE PROPERTYLINES AND THAT VISIBLE EXIST OTHER THAN NOTED. NOTE ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES OR LOCATE STRUCTURES DATED AT ANCHORAGE,ALASKA THIS 27T11 ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS DAY OF OCTOBER 2005 HOLT LAND SURVEYING 9864,FB 1 19.71,120.83 TEL.345.5513 1C`Aug u� - • '� Municipality of Anchorage 9 On -Site Water and Wastewater Program (907)343-7904 4A r„ y Certificate of On -Site Systems Approval Parcel I.D. 017-381-46 Expiration Date: 1. GENERAL INFORMATION Complete legal description Tustamena Terrace #1, Lot 9 _ Location (site address) 5525 Naknek Lane Anchorage, AK 99516 Current Property owner(s) April Leuzinger Day phone — Mailing address Real Estate Agent 5525 Naknek Lane Anchorage, AK 99516 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individualx❑. Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request unless otherwise requested by the engineer. COSA Fee $ L4" 6o Date of Payment 16 — t Receipt Number o23� 3G COSA # (7 CX;` 15"1 \ Date: IL e Waiver Fee $ Date of Payment _ Receipt Number 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 S(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE " __z System #1 Approved for bedrooms System #2 Approved for Disapproved - Conditional approval for bedrooms, Phone 522-7773 Date 10/28/2013 ° �9-T.8 , ��6• e•`o CE 4381 OFESSO nip bedrooms, with the following By: Original Certificate Date:—L/ / Thenic' akt of nchwage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory l� Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet f I- 1r c If more than 1 septic system is on the tot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Tustamena Terrace #1, Lot 9 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 4/25/80 Sanitary seal (Y/N) Y Total depth 140 ft. Cased to 140 ft FROM WELL LOG Date of test 4/25/80 Static water level 123 Well production J ft.. a• Parcel to: 017-381-46 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) >18 in. AT INSPECTION 10/17/13 121 ft .7 ' g. p. m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate w'� mg/L Arsenic 0 ug/L Date of sample: 10/16/13 Collected by: Anderson Engrg. B. SEPTICIHOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 5/1/99 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 10/29/13 Pumper A Plus Home Services C. ABSORPTION FIELD DATA 10/27/05 2 z .45 GPD/SF 5' Wide Trench Date installed Soil rating (g.p.d./ft or ft /bdrm) System type Length 100 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 8-10 ft. Eff. absorption area 1,000 ft2 Monitoring tube Y Depression over field _N Date of adequacy test 10/17/13 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption Feld before test 0/30.5 in. Water added 450 1135.5 i p p gal. New depth n. Elapsed Time: 1,440 min. Final fluid depth 0/30.5 in. Absorption rate >= 450 g p d 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 Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES W4tsi7►1S6,121[ I Septic tank/lift station on lot Absorption field on lot _ Public sewer main N/A >100' >100' On adjacent lots >100' On adjacent lots > 100' Public sewer manhole/cleanout N/A Sewer /septic service line >25' Holding tank N/A Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >51 Property line >5 Water mai>n 10 Water service line > 10' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10, Building foundation >10, Water Service line >10' Surface water > 100 Curtain drain None Noted 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 Michael E. Anderson, P.E. Date 10/28/2013 COSA brown sheet 10-10-12.doc Absorption field >5r Surface water >100'. Water main N/A Driveway, parking/vehicle storage >10' in. SGS Ref.# 1135180001 Client Name Anderson Engineering Project Name/# 5525 Naknek Lane Client Sample ID 5525 Naknek Lane Matrix Drinking Water Printed Date/Time 10/31/2013 15:32 Collected Date/Time 10/16/2013 12:34 ReceivedDate/Time 10/16/2013 13:00 Technical Director Stephen C. Ede Sample Remarks: 450ONO3-F - Total Nitrate/Nitrite - MS recovery is outside of QC criteria (biased low). Refer to the LCS for accuracy. Parameter Results LOQ Metals by ICP/MS 10/22/13 10/29/13 HKS Arsenic ND 5.00 Waters Department 10/18/13 AYC Total Nitrate/Nitrite-N 10.2 * 0.100 Microbiology Laboratory E. Coli Negative 1 Total Coliform Negative 1 Allowable Prep Analysis Units Method Container ID Limits Date Date Init ug/L EP200.8 C (<10) 10/22/13 10/29/13 HKS mg/L SM21450ONO3-F. B (QO) 10/18/13 AYC 100mL SM219223B A 100mL SM219223B A 10/16/13 SDP 10/16/13 SDP 204 Engineer: .egal Description: 'ermit: Report Type: Municipality of Anchorage P.O Box 196550 4700 Elmore Road Anchorage, Alaska 99519-6650 (907) 343-7904 Fax (907) 343-7997 http://www.muni.orcilonsite Planning and Development Services Department On -Site Water and Wastewater Program On -Site Sewer/Well Submittal Comment Sheet ANDERSON TUSTAMENA TERRACE #1 Lt 9 OSC131571 WellSeptic COSA Completed By: -he attached paperwork has been reviewed and is being returned for the following reasons: Need an evaluation of the annular seal around casing. 11/6/2013 J.Poet The ground surface is sloped away.from the well head. In addition the space between the casing and the earth is tight. No surface water can penetrate the annular space between the earth and the casing. -4'L t E L AAROW PUMP & WER SEiRViCE, LLC P.O. Box 110496 Anchorage, AK 99511 Office: (907) 346-8355 • Fax (907) 345-0202 Eagle River: (907) 622-9335 CUSTOMER No. 9991 I— JOB SITE�e, �. _J L 0 INVOICE DATE v WELL DEPTH Y SwL CHLOflN1ATED WIMP DEPTH SALESPERSON QUANTITY DESCRIPTION PRICE AMOUNT s LABOR HOURS RATE AMOUNT TOTAL MATERIAL TOTAL LABOR WORK ORDEREDT DATE COMP. TOTAL LABOR PAY THIS AMOUNT T'® SIGNATURE (I Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that if above work is not paid for in 90 days I agree to allow Aarow Pump & Wall Service, L.L.G. the right to remove unpaid for equipment and charge for labor already performed & labor to remove unpaid for equipment.) TERMS: ACCOUNTS PAYABLE AT LOTH OF MONTH FOLLOWING PURCHASE, SERVICE CHARGE AT RATE OF 1.5°! PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. Municipality of Anchorages opP Development Services Department Building Safety Division SA E.. c On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ei.anchorage.ak.us (907) 343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # 131571 During a recent COSA on-site inspection and test of the potable water supply well on Block , Lot 9 of Tustamena Terrace#1 subdivision, the well's productivity was determined to be 0.7 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 S .. E..' 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 # 131571 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 9 of Tustamena Terrace #1 subdivision. This inspection revealed a nitrate concentration of 10.2 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. Ex Municipality of Anchorage ,..., -• Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-36146 COSA* �7 n Expiration Date: _ d/ 1. GENERAL INFORMATION Complete legal description Lot 9,TustarrmenaTerrace subdMsionAddition No. 1 Location (site address) 5525 Naknek Lane Anchorage, AK 99516 Current Property owner(s) Joseph Guyette and Loma Nordby Day phone 441-1707 Mailing address 5525 Naknek Lane Anchorage, AK 99516 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Three (3) 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 Onsite Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of Onsite Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal afrmed 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 Anderson Engineering Phone 522-7773 P.O. Box 240773 Anchorage, AK 99524 . Engineer's Printed Name Michael E. Anderson, P.E. Date 5/11/2009 . � a �P��' • OF 44 :ra .... ............... .r ....:....., .W 9° MICHAEL E ANMSON 5. DSD SIGNATURE �• :• CE - 4381 �. Approved for 3_ bedrooms.+0 �9Fo••••••�•�••••t��� Disapproved: Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other ch�A�i'ce�^ nn B ' Z Original Certificate Date: S (RN. 11A5) Municipality of Anchorage •., ' Development Services Department ; Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot S. Tustamena Terrace Subdivision, Addition No.1 Parcel ID: 017-38146 A. WELL DATA Well type Private If A. B, or C provide PWSID # _ Well Log (Y/N) Y (Owners Report) Date completed 4/1980 Sanitary seat (Y/N) Wires property protected (YM) Y Total depth 140 ft. Cased to 140 ft. Casing height (above ground) i18 in. FROM WELL LOG Date of test 4125/80 Static water level 123 ft. Well production 6 g.p.m. WATER SAMPLE RESULTS: Coliform 0 6olonies/100 mL Nitrate 7.06 mg/L Arsenic:Nro ug/I Date of sample: 4121rog B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size !-=!�"• gal. Number of Compartments 2 AT INSPECTION 5/05/09 114.5 $. 1.2 g.p.m. Other bacteria 0 colonies/100 mL Collected by: A. Harala Date installed 5101mg Cleanouts (YM) Y Foundation cleanout (Y/N) Y Depression over tank (YM) N High water alarm (YIN) Date of pumping 6/15/09 Pumper A Plus Home Services N C. ABSORPTION FIELD DATA Date installed 10mro5 Soil rating (g.p.d./ft2 orf /bdnn) As sF/BDRM System type 5 Wide Trench Length : 100 fl Width 5 Total depth 6-10 fL Efr. absorption area 1•oro ft2 ft. Gravel below pipe 4 ft. Monitoring tube Y Depression over field N Date of adequacy test 5/05mg . Results (Pass/Fail) Pass For 3 bedrooms Fluid depth In absorption field before test 33/1.5 In. Water added 454 gal. = New depth 33.6/2.6 in. Elapsed Time: 1.152 min. Final fluid depth 31/1.5 In. Any rejuvenation treatment (past 12 mo.) (Y/N & type) i. Absorption rate >= 450 g.p.d. If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access(YIN) 'Pump on' level at _ In. 'Pump off" level at_ In. High water alarm level at in. Datum Cycles tested Meets alar 8 circut 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 NIA Public sewer manhole/cleanout N/A Sewer/septic service line >2V Holding tank N/A Animal containment areas None Manure/animal excrete storage areas None 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 >70' Surface water >100, Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main NIA Water Service line >10• Surface water >100' Driveway, parking/vehicle storage >5' Curtain drain None Noted Welts on adjacent lots >100' F. COMMENTS: G. ENGINEER'S CERTIFICATION `i ��:••""' 6 / certify that I have determined through field inspections and ! r qg-� ' review of Municipal records that the above systems are in i• ' ... .... .. ...: conformance with MOA COSA guidelines in effect on this date. ; Engineer's E. Anderson, P.E. s Printed Name 4 4- .�• CE -4381 Date 5111/2009 COSA Fee $ `fq 0 Date of Payment _ ��?✓ O c% ReceiptNumber S/SZ (Rev. 11105) Waiver Fee $ _ Date of Payment Receipt Number, yQA.AA _ tA d9w59'��aE — [AMa ,d LRTAT --__ r— r — r 4� A O O s� A� ♦ / � b to . Ll / / rj M ar ~at clllowa // // P ' 41I 1 ! \ \ ✓Y /�' O, 9 ♦ c�,` O, \\fa\\ OQe 7SMANC A. HOIT•: yI/p N \ �A\ LOT 8A O^ ' '•, L.13-6914 : • f� VKI w e o I� \ ooAORf MMOHN' l�rG • \ � WE T ORrvbwAr [w[wOACHH[HT �QO AS-BULT SURVEY \ �+� SCALE: : 1' R AD' \�O�\�\ TNCREIY CERTEY 7wT11NVl IERfoRMEOA \ IORTGAGII'S F4I[CTON OF THE IOLLOWNG DESCAMEo MOnRTY. LOT S. TVSTAMEHA TERRACE FUST ADO,TION MORMATRDN HEREON4 FORM USE OFLACI404TTTUTONS SIECFC LY TOLOWA COMUCTSIETMEEN &.$%GI1wlICMCSAM ILATTEOLOT VNESOR EASEY[NTSAb4EOT TOM MEDFOR FO5`TIDNNGADDIIONAL AN090RACE IECORDR4 OTSTRCT. ALASKA AND THAT iTRLCTURES011f[NCELME3 THE MI t MAfROVEMENTS SITUATED THEREON ARE URTHEY THE IROII RTY LW ES AND THAT ND "ME WEMEMTS OI KCMO.OTHER"" NO&K MORN CNTE RECORDED FLAT.ME NOT IND" HEREON EHOIOACMMENTS IXW OTHER THAN NOTED. NOTE ANv FENC[LMIESS,O&W ARE LOCATED AFIROFIYAIELY AND ARE ROT TO It USED TO DETIMME M,OIERTY LMS DATEDATANCNOMOL ALASKA" t77N_ OR LOCATE STRUCTURES M ANY IAV3RONH WAV t[ AOIRDMAtt 011[ TO SNOW' COMMONS DAY M OCTOE[R E003 HOLT LAND SORvfYw .M, fET1471,170E7 T0.. SAS ISIS ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 May 20, 2009 Joseph Guyette and Lorna Nordby 5525 Naknek Lane Anchorage, AK 99516 Subject: Lot 9, Tustamena Terrace Subdivision, Addition No. 1 Certificate of On Site System Approval (COSA) Water Sample Results Dear Joe and Lorna: The laboratory results from the water sample taken from your well indicate a nitrate content of 7.06 milligrams per liter. This amount is safe but is approaching the allowable limit of 10 milligrams per liter. Our investigation indicates a horse corral was previously located close to the well head. Manure and other animal excrement left from that time may be slowly degrading and encroaching into the underlying aquifer causing elevated nitrate content. The Municipality of Anchorage requires that any manure or animal excrement storage areas be placed a minimum of 100' from the well head. An animal containment area, such as a corral must be more than 50' from the well head. We recommend water quality testing on a periodic basis to insure the nitrate content in the water does not exceed the allowable limit of 10 milligrams per liter. No coliform, bacteria or arsenic was found in the water indicating it is safe for human consumption. Sincerely, CEQ4 . ,oma Michael E. Anderson, P.E. Attachments qq FIX31- SCS ROLM 1091545001 Client Name Anderson Engineering Project Name/N Tustamena Tern. Lot 9 Client Sample 1D Private Well Utility Rm Sink Matrix Drinking Water Sample Remarks: Printed Date/Time 05/042009 16:53 Collected Date/rime 04212009 11:32 Received Date/time 0422/2009 9:40 Technical Director Stephen C. Ede Penn Results POL Units Mcdtod Container ID Allowable Limits Prep Analysts Date Date Init Metals by ZCP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 0428109 05/01/09 NRB Waters Department Total Nitrate/Nitritc-N 7.06 0.100 mg/L S%1204500NO3-F B (<10) 0423/09 JDZ Microbiology Laboratory Colony Count 0 coVl00mL 5.20 92228 A (200) 0422/09 DLC Total Colifonn 0 cot/l00mL SM20 92228 A (<I) 0422/09 DLC Fecal Coliform 0 coVl00mL SM20 92228 A (<I) 0422/09 DLC Iyalc 11cmakide z Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519-6650 www.ct.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING '.iAklla Parcel I.D. 017.381.46 HAA # Expiration Date: — 2 $ — O. (o 1. GENERAL INFORMATION Complete legal description Lot 9 Tustamena Terrace Subdivision No.1 Location (site address or directions) 5225 Naknek Lane Current Property owner(s) Duane Vaagen and Paula Clark Day phone 240.1107 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 5225 Naknek Lane Anchorage AK 99516 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System Three 3 Day phone Day phone TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or wastewater disposal system Is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn _Anderson Ennineedna Phone 522.7773 Address P,O. Box 240773 Anchoraae. AK 99524 Engineer's Printed Name _Michael E. Anderson, P.E. Date 1012812005 6. DSD SIGNATURE Approved for —3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Note: The well for this property meets existing state an u present. It Is suggested a periodic testing Current nitrate concen r infor Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By CX -e -t Original Certificate Date: ca« rmo7 Municipality of Anchorage Development Services Department Building Safety Division On.Ske Water S Wastewater Program 4700 South Bragaw SL P.O. Bou 190850 Anchorage, AK 9951943650 www.ci.anchorage.sk.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: -lag, jUmqngr M"Su Parcel ID:- 91MBi A. WELL DATA wen type E&& It a B, or C provide PWSID S _ Well Log (Y/N) r• Sanitary seal (Yea) I Total depth _14LfL Cased to _L4Ln FROM WELL LOG Wires property Protected (Y/N) r_ Casing height (above ground),j_in. AT INSPECTION Date of test 4/25/1980 Br30r1005 Static water level 123 It. — 1 n Well production — 08 g.p.m. — Al 9 -p.m - WATER SAMPLE RESULTS: Coliform -L-colonles/100 ml. Nitrate JAL mg.A. Other bacteria _L coloniesl100 ml. Date of sample: IMORL. Collected by: Gamess Enaln"d w omup B. SEPTIC/HOLDING TANK DATA Tank Type/Material BeNdmeel Date installed 3nting Tank sae 1.250 gal. Number of Compartments j Clean" (YM) If Foundation cleanout (Y/N) Y Depression over tank (Y/N) H High water alarm (YIN) N Date of pumping AQ[• ZM Pumper, C. ABSORPTION FIELD DATA Data installed 14=2-7-- 0 ! Son rating (g.p.dJfe or fe/bdnn) AS aF System type S Y kTrench Length moi' 0 it Width J. n Gravel below pipe -4 n Total depth 02 it Eff. absorption area 1.000 fly Monnodng tube X Depression over field U Date of adequacy test Results (Pass/Faiq For,_, bedrooms Fluid depth In absorption field before test _ in. Water added_ gal. New depth_ kr. Elapsed Time: _ min. Final fluid depth ,_ in. Absorption rate g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 3 type) _N if yes, give date D. LIFT STATION Date installed •Pump on' level at _ in. Datum Sim in gallons 'Pump ofr level at _ in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septi tank/ ift station on lot >1W Absorption field on lot MW Public sewer main NIA Manhole/Access (YIN) High water alarm level at Meets alarm 6 dradt requirements? On adjacentkris XW On adjacent lots MW Public sewer manholetcleanout NIA Sewer /septic service line 4S Holding tank NIA SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation >S Property line4 Absorption field >S Water main NIA Water service line >10' Surface water MW Wens on adjacent lots MW SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation Mir Water main >10' Water Service line >10' Surface water MW Driveway, perkkgfvehide storage >4S Curtain drain None Noted Wells on adjacent lots MW F. COMMENTS G. ENGINEER'S CERTIFICATION I car* that I have determined through field inspections and review of Municipal records that the above systems are in conformence with MOA HAA guidelines in effect on this date. Engineer's Printed Name Michael E Anderson. RE HAA Fee $ 430 r ,r tl /7V r_ "sit Date of Payment /D 2 b - C ' Receipt Number %(o O!7 (Rev.12KM e Walver Fee S Date of Payment Receipt Number L in. -� Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Health Authority Approval # 050570 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block , Lot 9 of Tustamena No. 1 subdivision, the well's productivity was determined to be 0.81 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 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 Health Authority Approval. 09-09,05;13:32 ; ;907 561 5301 # 2/ 4 SGS Ref.0 1053582001 Client Name Garness Engineering Group. Ltd. Project Namem Lt9TustantenaTcrraec ClienrSampleID Lt9TustamcnaTerrace Dlatrix Drinking Water Sample Remarks: All Dates/Times are Alaska Standard Time Printed Date/time 09/08/2005 16:34 Collected Dateltime 08/30/2005 7:59 Received Date/Time 08/30/2001 11:02 Technical Director Stephen C. Ede Allowable Prep Analysis Pommel" Results POL Univ Method Container ID Limits Dam Dam Init Mimic -N 8.19 0.100 m8/L EPA3S3.2 D (<.10) 08/30/05 ATS Microhielogy Laboratory Total Coliform 0 coVI00mL S%1220 9222B A (o-1) 08/30/05 Tv 09-09-05;13:32 ; SGS/CT&E ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total -Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIO! EEPORE COLLECnNO SAMPLE MUST BE COMPLETED BY WATER SUPPLIER E3 Pusuc WATER SYSTEM IDS "§(PRrvATE WATER sYSTEM SaM Raeuft sendtmoloa ..I H .s. �a7 ('17�j ti• 32µG 9e / DY u. t ap Cs.. Total Oorlohn: SAMPLE COLLLEECTTIIIOOONI�+:� _ h H.. natal b Yr 13 send Raydta ;907 661 5301 # 3/ 4 200 W. POTTER DRIVE ANCHORAGE. ALASKA 09518 Tel: 907-662.2343' Fax 907-661-5301 Lab R&f tjm . t asaMlnvoke t SAMPLE TYPE. +� RouUna Tranfportad , to I.ah By.- Erteme, as collector ' Other. • . —Tact TO SE COMPLETED BY LABORATORY Samole RecelvIna- Date: Tlmo• (,[6 Tamp: Delivery Method: O. Rooelved By: f`mW h. Commonla: .................................................. Bacterloloolcal Water Analyats Record: An.Na48oean: �j�j6��—�3_O Analyst: A1lalyucal Method: 4fembrana Fitter MMO•MUG (P/A) 0 Treated Wator t Repeat Samplo , Untreated Water (refer to lab no.13 L Specht Purposo. ❑ S2,10kow3o houn Olt RUSH SAMPLE Rasulu MY be unroalbk' . 0 4e Hour Wales Phone fi 7) Por Ranots Lacvoons Fax P. ......................................................................... ......... D C MMPMUO IP/A)RESULT& DY u. t ap Cs.. SAMPLE TYPE. +� RouUna Tranfportad , to I.ah By.- Erteme, as collector ' Other. • . —Tact TO SE COMPLETED BY LABORATORY Samole RecelvIna- Date: Tlmo• (,[6 Tamp: Delivery Method: O. Rooelved By: f`mW h. Commonla: .................................................. Bacterloloolcal Water Analyats Record: An.Na48oean: �j�j6��—�3_O Analyst: A1lalyucal Method: 4fembrana Fitter MMO•MUG (P/A) 0 Treated Wator t Repeat Samplo , Untreated Water (refer to lab no.13 L Specht Purposo. ❑ S2,10kow3o houn Olt RUSH SAMPLE Rasulu MY be unroalbk' . 0 4e Hour Wales Phone fi 7) Por Ranots Lacvoons Fax P. ......................................................................... ......... D C MMPMUO IP/A)RESULT& PSK JUN r27 Total Oorlohn: E Cock s.nt m CVent MEM9R.WEFILTMPESULLT..S; Okw Count ColunLaVloonlL Phoned : Pared[] Oawnnt.• —CL eo f�'Satlsfactory ( Unsatisfactory Tan.T...w.u..wc� , Reported By: DabrTfma:_ f� �.�0 /� e�1 a .0. 0a n.e Nuaaskn oOl"K G Form a FW -0053 12/17/03 roup0ablPubCc1DOCUMENiIFDRMSIapproved�Coa FOnn 121703.rk / y9a•Qa ---- 9 591�pE . --�--- N6 _ --- ,d U" ITY H t 4♦ l n e D4 PrY Ir 41 O O 7D JP4 Y / FO f0 W ID 5♦.P a♦�w PPPDP / // D / DWELL DIV PF' P PPP / H~tO 47 P / LE♦N,T 1 / \� 00004pp0 t `^ o OF A o L�4p ........... 9 SHANE A. HOLT: OO F y \oiA\ LOT BA Q ?, LS•e91 a i •.\ p0o DG \ � HDT[ S DRIVEWAY [NCROACNMCNT Oppp0000 W AS-BUI \ LT SURVEY SCALE � \�\ SCALE: 1'•40' \ B•\ \ I HEREBY CERTIFY THAT I HAVE PERFORMED A \ MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 9. TUSTAMENA TERRACE FIRST ADDITION THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PUTTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT STRUCTURES OR FENCELINES. THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PUT, ARE NOT SHOWN HEREON. WITHIN THE PROPERTY LINES AND THAT NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. NOTE ANY FENCELINES SHOWN ARE LOCATED APPROXIIMTELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES OR LOCATE STRUCTURES DATED AT ANCHORAGE, THIS 37TH _ ANY PAVING SHOWN MAY BE APPROXI"TE DUE TO SNOW CONDITIONS. DAY OF OCTOBER 3005 HOLT LAND SURVEYING 9886, FB 119.71.12083 TEL. 345.5513 MUNICIPALANCHORAGE • �' DEPARTMENT OF HEALTH &HUMAN SERVICES y� i 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 1. D. # C 1 T 5 1- V C HAA # P A `l S_C-G 2—E 1. GENERAL INFORMATION Complete legal description Lot 9; Ti✓twe-na Tennace Subdiv.i,5ion Location (site address or directions) 5525 Naknek Lane Property owner Jim Simpson Day phone (615) 792-9243 Mailing address Box 93, Chapmans Bokough, Tennessee 37035 Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: Individual well XXX 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 XXX 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(RW.1/91) Front MOA921 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 furtherverifythat 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 5 & S ENCINE=RINc Phone 17034 Eagle River Loop Road No. 2Ck4 Address Eaal_ Ftivar AJaslea 944 f7 F Engineer's signature 6. DHHS SIGNATURE x Approved for bedrooms. Disapproved. Conditional approval for Additional Comments M l 07 tt - c; 7"1 Date u A I rcBERT C. C—AAN =` CE , bedrooms, with the following stipulations: Date / 3�- 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. 72-0M(RW.1191) Back MOAN21 S & S\ ROBERT C. COWAN, P.E. 4�ine�RInG ROBERTA. SHAFER, P.E. �1n� / June 22, 1995 CIVILENGINEERS %nEu 1 FAX(( 94-29 79 FAX(907)694-4- 1211 HEALTHAUTHORITY 1- {- I D RECEIVED APPROVALS Municipality of Anchorage Department of Health and Human Services Attention: Jim Cross JUN 231995 P.O.Box 196650 SEWERTWATER MAIN EXTENSIONS Municipality ofAnchora Anchorage, Alaska 99519-6650 p Y Anchorage Dept. Health &Human Services REFERENCE: Lot 9 Tustamena Terrace S\D SEWER&WATER Dear Mr. Cross, INSPECTION The work required on the conditional Health Authority Approval dated 3-16-95 has been completed. Attached is a recertified surveyor's asbuilt showing the new location of ENGINEERING STUDIES ANDREPORTS the monitoring tube at the end of the existing trench. Upon excavating through the trench at 10' from the property line, the following was noted: 1) the bottom of sewer rock WELL INSPECTION was found at 8 1/2' below grade, 2) the distribution pipe &FLOWTEST invert or top of effective was found at 4 1/2' below grade. This indicates an effective depth of 4' rather than 8 1/2' as indicated on the approved inspection report of 6-12-79. In the absence of excavation and inspection of the other end SITE PLANS of the trench, it would appear prudent to assume the entire length of the trench has an effective of 41. The new length of the trench was measured at 661. This makes the absorption area 528 FT2 and using the original soil test rating of 250 ROAD DESIGN FT2/bedroom, this system would be sized for a maximum of 2 bedrooms. The current house has only two bedrooms presently while your records indicate it is one bedroom. In any case a two bedroom approval appears appropriate. SOILTEST Please issue a final Health Authority Approval for 2 bedrooms rather than 4 bedrooms as originally submitted and retain this letter as a public record of the status of this PERCOLATION system as of this date. TEST Sincerely, STRUCTURAL&a%�" ez� MECHANICAL „�'_ INSPECTIONS v` + Robert C. Cowan, P.E. ONSITE WASTEWATER DISPOSALSVSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 IGLE FAMILY DWELLw s �_ ...,st,HAA #, 5.twnena Teuace Su6divIA i525 Na nek Lane NOTE If community well system,' provide wntten confirmation from State ADEC attest ing to the legality and status of system 6- 4 a� x 1�JI� 4 TYPE OF ,WASTEWATER DISPOSAL I Individual on site XXX �!P &§`5i&: Holding tank{ 1 \llAA f } Community t Public sewer NOTE !f community wastewater system, provide, written confirmatiomfrom State ADEC attesting fo the le'gafityand status of system. 72-025(Rw.1/81) Flynt MOAN21 -- - he MLnicjjaality of An he brage Department of Health and Human SeMces (DHHS) issues,';Health Authority �provaLG1ert)fioatj-Nbased only upon the representations given in .paragraph 5,above by'an Independent rotoyionalen (�j§ rKegisteredinthe State ofAlaska. TheDHHSdoes this asacourtesytopurchasersof,homes rtidtH6irif�hdin institutions in order to satisfy certain federal and staterequveme—., !EmployeesofDHHSdonot onduot;)hspections or analyze data before a certifwate'is_ )ssued T_he Municipality of Anchorage ,is not , asponsiple for errors or omiss_ ions in the professional engineer s work ! „51 A,{ 72-025(Rr.1/81) 6mk'MOA 021 - ® Municipality of Anchorage AL Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST -7�` I.D. .Legal Description: ,,T4,F,0�% `00cs A. Well Data Well type If A, B, or C, attach ADEC letter. ADEC w ter system number / /iJ1q Log present Y7) IES Date completed � KE q Z Driller UNK. Total depth j�{U Cased to ��� Casing height ,,JJ Sanitary seal �N) VFS Wires properly protected &N)rn FROM WELL AT INSPECTION C V Z r C:) Date of test < < a Static water level 1a3� IoZI v ti o Well flow ' 0.8 g.p.m. g.p.m� y Pump levetl r 38 Z z� ' ' T A/u ACTt7AL ELC. LWi 2A7NE2 i} vvELL SEPARATION DISTANCES FROM WELL TO: iT Ffi vk (3 (mNaf- 6WNER Septic/holding tank on lot /0 U ; On adjacent lots /W'/ Absorption field on lot /66 // ; On adjacent lots /00 Public sewer main /J�A Public sewer ;1�Vt manhole/cleanout J/ Sewer service line /Q Petroleum tank ANL ow/,J WATER SAMPLE RESULTS: Coliform Nitrate 6 s m��G Other bacteria Date of sample: 2�I I I iS Collected by: S S �IyCrlN�cc21 /UG B. SEPTIC/HOLDING TANK DATA Date installed (3 4', I Tank size 19—r—O C..L, Compartments o2 Cleanoutsk N) i -F Foundation cleanout (Y/® ZNSrDE &a. Depression (Y/ V)) /b High water alarm (Y,_I N�, Alarm tested (Y/ 1D. I I /J/0Date of pumping A )1� " f �s Pumper A+ E� SEPARATION DISTANCES FROM SEPTIC/HfPtG TANK TO: Well(s) on lot IW `fi On adjacent lots (06 '+- Foundation I6 d To property line 10 t- Absorption field to"/ Water main/service line 10 Surface water/drainage (Ob 1'- 72-026 (3M)* Front '­ 7z-ozs(3M)•Front CONTINUED ON BACK PAGE L FI T STATION Date installed" Size in gallons Vent (Y/N) "Pump High water alarm level Meets MOA electrical codes (Y/Ny SEPARATION DISTANCE FROM LIFT STATION TO: on lot _ On adjacent lots D. ABSORPTION FIELD DATA Manufacturer "Pump off" Level at tested Surface water Date installed 9 1 �1� ( 79 Soil rating (GPD/Ft') o� SF�6it System type PErQ4 Length reo Width ;22•5 Gravel thickness 6 Total depth // ^6 Total absorption area 1360 S(- Cleanout present ON) �S Depression over field (Y& )o Date of adequacy test Results (pass/fail) fss for Bedrooms Water level in absorption field before test D1ZY After test 3 Peroxide treatment (past 12 months) (Y(N) )I)07 KNcy" tJ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 106-1- On adjacent lots DD / f Property (jne To building foundation %0 f To existing or abandoned system on lot On adjacent lots fi Cutbank 1J�� Water main/service line (6 Surface water n / /0®� 1;0 Driveway, parking/vehicle storage area Curtain drain NOAJ tNOtl I N SUC µ TNA -7 7i -/&I T'et/'lC11 E. ENGINEER'S CERTIFICATION To A Nu/J, D)sT. Of to` WE -se P'L. 1 certify that 1 have checked, verified, or conf, d to all OA and HAA guidelines in Oect on the a e of this inspection. � �S�— A7 G+I r� SrTF= 61, Signature ? G Engineer's Name 17034 Eaplu iv .f. op act N6.204 f' i g EaghrRiverAtact Date HAA Fee$ �U, /0 /p Date of Payment �3 1 ! / 9 Receipt Number my (/y.� 72-026 (3193)' Back Waiver Fee $ Date of Payment Receipt Number RECOV.5/8" 3 I 4 G 822 R DEL vB�STREET fp"G ANCHORAGE, ALASKA 99502 PHONE 243-4990 3" ALUM. NUMENT RECERTIFICATION 33-42 L6//95 /95 ADD STAND—PIPE 32-59 /95 AS BUILT 32-56 DATEo 4041" OF Ateh FLD. BK. 4 ' ' f 49T�+ •••:: y*�j - ARMkm 0. MWW4 LS - 5773 'S NOTES: Easements not appearing on record subdivision plat are not shown unless description of easement is provided by client. It is the responsibility of the owner or builder, prior to construction, to verify proposed building grade relative to finish grade and utilities connections, and to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Elevations based on assumed datum unless otherwise indicated, and bearings and distances are record data. CLIENT: PAULA CLARK LEGAL DESCRIPTION LOT 9 TUSTAMENA TERRACE SUBDIVISION FIRST ADDITION PLAT NO. SCALE GRID 72-79 1"=50 2837 Fa/ H WO Q iwp /$ O X ���'^o Y•F ry JW Z m MR. •tl i�=' KJZ L sh OFQ w ILI W 5 rO Z OOF U�r �o �a J O' E 0 U. N"Z _ ood3 wN �wo N= wia �N z Q Z(�NWF F+ Q�o¢vwi in F 0 a I Fcn SIJ r �o610Z N I ozW —� co In Z K I / Ham' �0 oZFa,w Zco o a Z N �3 aor arI oaa O w oN VOw0 I ^� ,4El r Eo Q U Q d 0 0 Q W M CnO V1 �°'(r�Z I S v OZ3C'JU OJ �fP6, co aQZ wF ww>->MFo wLi U wvri>-Nwa 11 6E Oj 3 N Z� ou Q U wfnNNOOW0 wl E. �-' U = Ulnazz oa - Wd' wrJZ�41QQ OI tiN a rZlnJrw Z� I U)W 7- WC�7 m N 1 P ~ N z0 0 I + w o �o I � z \ Q � <a U z o= o zw j C4a N a i�� O� OWdUgyj 0wzi-ww _> rc ®�rtWif¢O W mQ 3ltlOS Nb3d 3115 05 = „L 02/21/95 09:19 COMMERCIAL TESTING - 9076941211 NO.778 904 ME Environmental Services Inc. CTLE Ref.# 95.0687-3 Client Sample ID 1,9 TUSTAMENA TERRACE Matrix WATER Client Name S & 3 ENGINEERING WORK Order 12783 Ordered By R. SHAFER Printed Date 02/21/95 @ 10:22 hre, Project Name Collected Date 02/17/95 m 15:95 bra. Project# Received Date 02/17/95 W 17:00 hrs. PPTSID UA Technical Director STEPHEN C. EDE Released Sample Remarks: ROUTINE SAMPLE COLLECTED BY: J.W -------------- .---__`___........ ..................--------_=======...e=.........___,.. See Special Instructions Above QC --------- = Unavailable P. Allowable Ext. Anal �U . Parameter -------------------------------; Results -----------.-..-----------------_...---------------........__----------------------- Qual Unite Method Limits Date DAts Init Nitrate-N 3.55 D mg/L EPA 353.2 30.. 02/20/95 CMR -------------- .---__`___........ ..................--------_=======...e=.........___,.. See Special Instructions Above UA --------- = Unavailable P. See Sample Remarks Above NA - Not Analyzed �U . Undetected, Reported value is the practical quantification limit. LT - Lees Than D - Secondary dilution. G7 - OYeater Than - 02/20/95 07:58 COMMERCIAL TESTING - 9076941211 NO.765 P03 CT&E Environmental Services Inc. Laboratory Division rdrrirririririirrrirrriiwwrrosPwrrrrriwrwwwwrr� Drinking 'Water Analysis Report for Total Coliform Bacteria 200 W, Poser Drive X&LiD IhS7RGt jjO.ASO:VREYERSESLDEBEFOREC0L1EC7-1-'1GSAh1PLE Anchorage, AK 99579-1605 ,Tel: (907)562.2353 - - - •-. Fax: (907)557.5301 IW -ST BE COWLETED 5Y WATER 51UPPLIER TO BE COMPLETED BY LABOR.iTORY O PLBLIc'VV-kTzR SYSTESI LD- 0=1 I 45rxlysis shows this VVatz: S.-k%PLE to be: _PRri->TE tVATER SYSTEM Sxtisfraary $erd Rerc a Serd /.' ow, �Tonth Dov Year S-AINKPL'c TYPE: X+ Rourine "s7 �• 0 RepeatSample (for rout.ine"mple ❑ Untreated Water ...— O Cnsztisfac:ory 0 Simple over '0 hours old, rtitIn ms• be unrelieb:e S�,.ple!oo Icrg i . T: .si:; sa7,1, soeic not be ovu -' S hoL!r< old zt CXEM i- V-;cn to irdiczte .eiEzbie results. Please send new sample via soedzl delivery mail. Date Received Z' r / Time ReceiNed /2C.X> -Attar'sis Began .4nalrical method: ,B�Membrzne;ii:e: -NVMO-NfUG ` Nur':ber ofcoknies/l00 m1. Lab Ref \o- Result" >, r. K.7t 95.0687 )L Scnf io AX E.C- -- _,non Fpl;r jun LI Pesed Dz:c,Qpl�-a Tim Clier.r notified of unsatiFfacton• results: ❑ L! Phones $Pb::e wi:h F4XC6 Da.: - -F: r: 13aCTERIOLOGICA-L WVATER A NALYSIS RECORD ?DIO-NfUG Result_ Total Com-orm _ /+t. Coli _ \len, brs.^,e Filter: Dner, Ceun* (� COlanieS(: QO ml Veri.-Intion: LTH BGg COLIFiRNf FBC31 Collform Confirm+:ion Final 3fcr..bmne id:e, Fc Ul6 _ Repored11v �-% `�%l �R-�i Date 2• 1r�'`7� "vi C- seer LToo., ro co.-, Coliform/700 ml 'rime t w OF TW AA ow ret s tJ=reel O: -Se SCS Cr,--- C-ene-e)e de S.r,reiil.9cc1 �Tonth Dov Year S-AINKPL'c TYPE: X+ Rourine 0 Treated Nater 0 RepeatSample (for rout.ine"mple ❑ Untreated Water .. Witb lab ref. no. ) 0 srecfal Puroose Time Collecicd S.AV7PLc LOCATION Collected B �7 LOT- � /LI�TfFiy]bUf! (El `3rr� rr l/y1 'G✓ O Cnsztisfac:ory 0 Simple over '0 hours old, rtitIn ms• be unrelieb:e S�,.ple!oo Icrg i . T: .si:; sa7,1, soeic not be ovu -' S hoL!r< old zt CXEM i- V-;cn to irdiczte .eiEzbie results. Please send new sample via soedzl delivery mail. Date Received Z' r / Time ReceiNed /2C.X> -Attar'sis Began .4nalrical method: ,B�Membrzne;ii:e: -NVMO-NfUG ` Nur':ber ofcoknies/l00 m1. Lab Ref \o- Result" >, r. K.7t 95.0687 )L Scnf io AX E.C- -- _,non Fpl;r jun LI Pesed Dz:c,Qpl�-a Tim Clier.r notified of unsatiFfacton• results: ❑ L! Phones $Pb::e wi:h F4XC6 Da.: - -F: r: 13aCTERIOLOGICA-L WVATER A NALYSIS RECORD ?DIO-NfUG Result_ Total Com-orm _ /+t. Coli _ \len, brs.^,e Filter: Dner, Ceun* (� COlanieS(: QO ml Veri.-Intion: LTH BGg COLIFiRNf FBC31 Collform Confirm+:ion Final 3fcr..bmne id:e, Fc Ul6 _ Repored11v �-% `�%l �R-�i Date 2• 1r�'`7� "vi C- seer LToo., ro co.-, Coliform/700 ml 'rime t w OF TW AA ow ret s tJ=reel O: -Se SCS Cr,--- C-ene-e)e de S.r,reiil.9cc1 MUNICIPALITY OF ANCHORAGE M E M O R A N D U M WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL N0. /ISDO 9O During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Lot q Block of rUSPAnEMA 7-CRI!}LE Subdivision, the well's productivity was determined to be .g gallons per minute. The minimum well productivity required by this Department (AMC 15.551 for a 2 bedroom residence is .2.0 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 Health Authority Approval. CHEMICAL & GL ,OGICAL LABORATORIES ; ALASKA, INC. TELEPHONE (907)-2794074 ANCHORAGE INDUSTRIAL CENTER 274-3364 5633 8 Street e �60 °°^^mP1e9 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY WATER SYSTEM: _ Analysis shows this Water SAMPLE to be: j I.D. NO. - .Satisfactory ❑ Unsatisfactory water System Name Phone No. - ❑ Sample too long in transit; sample should 1 r {, r. not be over 48 hours old at examination Mailing Address to indicate reliable results. Please send ii new sample. City State Zip Code SAMPLE DATE: m `r .3 p MO. Day - Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample ❑Treated Water with lab ref. 7 ❑ Untreated Water ❑ Special Purposee SAMPLE Time Collected. NO. LOCATION Collected By READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) Rev. 1978 Date Colied Date Received Time Received Analytical Method: ❑ Fermentation Tube ❑Membrane Fitter Lab Ref. No. Result' Analyst I m I I m I m *NG. of colonies/ 100 ml. or No. of Positive portions. BACTERIOLOGICAL WATER ANALYSIS RECORD a.m. Multiple Tube Report:_ Membrane Filter: Direct Verification: LTB_ Final Membrane Filter R Reported By Broth 24 hours: Broth 48 hours: 10m) Tubes Posltive/Total lOml Portions Date Time: a.m. p.m. CHEMICAL & (__)CICAL LAR®RAT®RIEk (_�4LASKA, INC. TELEPHONE (9071.279.4074. ANCHORAGE INDUSTRIAL CENTER - - 274-3364 - 5637 B Street r I ^roP1tle Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ) TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: WATER SYSTEM: J 9 - -� I.D. NO. _ - - ❑ -Satisfactory -.. .. arn— - -— 1� Unsatisfactory - ❑ .Sample too,long in transit;. sample should Water System Name ` Phone No -��., „-� 1J d„� D jot be over 48 hours old at examination to indicate reliable results Please send Mooing Add - - vl..r.� t-, l new sample. - ... e ' City- - Slate > ,Zip Code Date Received - r tY'=a o •v_i.2 Y 3 ?-ice_. SAMPLE DATE:11� l _1 rs i5�•-1 -Time Mo, Day Year Rec elVed _ Rev. 1978 SAMPLE TYPE: Analytical Method: Data Collected ❑ Routinevl t ❑Fermentation Tube ❑ Check Sample (for routine sample with lab ref. no. ❑ Treated Water ..-_j Membrane -Filter ❑ Special Purpose ❑; Untreated Water`°` ` ` SAMPLE Time Collected Lab Ref. No. Result' Analyst NO. - LOCATION ' .-: . -, Collected -• ' -By - ` -' • - 1 3 4 5 I I L J 9 No,of colonies/1.00:rl or N. of Pas wa v M.r.. - r tY'=a o •v_i.2 Y 3 ?-ice_. "oa.122or(b7 s _ -. 3.• BACT£RiOLOGICAL wAT£R ANALYSIS RECORD '- - _ Rev. 1978 Data Collected - 'source READ INSTRUCTIONS am Lab. N BEFORE : COLLECTING SAMPLE EMB Broth 24 hours: Broth 48 hours: Multiple Tube Report: 10ml Tubes PoOtlw/Total 10ml Pmtl"% Membrane Fllter: 01ract Count Collform/10"I Verillcatlon: LTB /O O �� _T, face ' 7 Final Membrane Fill _RK, V�(' Ilf rm/100ml Reported By �� /�1"— " — Data X.M. P.M. - -' DATE RECEIVED r' INSPECTION APPOINTMENTS TIME TIME (YlQG r TIME NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other DATE DATE DATE ❑ Three ❑ Six n �1 *ATTACH WELL LOG. A well log is required for all wells drilled INSPECTOR INSPECTOR 1 INSPECTO iL m0L Y<cxi 4 • J1CA Ak MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT, OF I'-":\L7i 1 & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTLWIRONIJ�EJT �- " ECTION 825 L Street - Anchorage, Alaska 99501 • APR 2 5 1980 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 EE cc �FF� REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWEFT'FX 9kyl@�' DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MAI LING ADDRESS ,;7 —5— PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE/ MAILING ADDRESS PHONE FREAR/AGENT DDRESS - 5. LEGAL DESCRIPTION. // - STREET LOCATION ` 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other SINGLE FAMILY cflTwo ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY /-t5-,1NDIVIDUAL- *ATTACH WELL LOG. A well 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.) B. SEWAGE DISPOSAL SYSTEM (INDIVIDUAL/ON-SITE** /-7 8 �l SYSTEM WAS INSTALLED. YEAR ON-SITE ❑ PUBLICUTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) 4 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY - 1. TYPE OF RESIDENCE ❑ SINGLEFAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING a St] TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL Q 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS V APPROVED FOR _ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE x BY 72-010 (Rev. 6/79)