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HomeMy WebLinkAboutALPINE TERRACE BLK 3 LT 2Alpine Terrace #015-243-09 / MUNICIPALITY OF ANCHORAGE / • 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 NAME +- PHONE NEW ❑ UPGRADE MAILING ADDRESS ,l V LEGAL DESCRIPTION Rfimt T CCK 3 L�� Z LOCATION NO. OF BEDROOMS V Y DISTANCE TO: Well 1 Absorption�.area Dwelling! / i n PERMIT Zg15 g a2 W F. Manufactur Materiel / No, of compartmes C y Liq. capacity . - allons IF HOMEMADE: Inside length Width Liquid depth jaz DISTANCE TO: Well Dwelling PERMIT NO. = Z FQ- Manufacturer Material Liquid capacity in gallons O w= DISTANCE TO: Well do (}'� Foundati n �� �n Nearest to i t PERMIT y� 2`%S `) H Z w No. of lines ' Length of ea h line Total length of line Trench width ®inches Distance between,li_es . HTop p of tile to finish grade Material beneath tile inches Total effective a so tion are W a Length Width Depth PERMIT NO. Q F- o. a LU Type of crib Crib diameter Crib depth Total effective absorption area LU DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS IIO VC, SOIL TEST RATING INSTALLER U'AYMAAn REMARKS c� O APPROVED 8.1)61.8� DATE LEGAL arc �i LC'�-� 72-013 (Rev. 3/78) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys Drilling Permit No. LOCATION OF WELL (Please complete either to, Ib or to.) A.D.L. No. la. Borough Subdivision Lot Block Ib. 1/agtrs. Section No. Township N❑ Ronge E❑ Meridian k tfi' ,� ��a`a _of_ of_of _ S❑ W❑ Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL .,_L�fFl f/ 0A Of" j_ 0yp,' .. Address: V f Fa 'ar°c ° Ivr Street Address and Area of Well Location +wIt A T.." —56` 2. WELL LOG Feet Below Surface 4. WELL DEPTH: (final) 5. DATE OF COMPLETION ft. _ r; Material Type Top Bottom j € -; it.t p , ri� ? 6. ❑ Cable tool ['Rotary [:]Driven C] Dug 4 •. 4 i F ' ❑I, Auger C] Jetted C3 Bored ❑ Other teF-,R J.WIA �' y' Ilk ;,a,U?- t+ 7. USE: ❑ Domestic ❑ Public Supply ❑ Industry ❑ Irrigation ❑ Recharge ❑ Commerical ❑ Test Well ❑ Other: ,iANx ty/(''�� )Flt�t ?� 7 S. CASING: ❑ Threaded ❑ Welded dlam. In. to ft. Depth Weight Ibs./ft. tt � �t;; diem. I in. to ft. Depth Stickup ' 'tea ft. 9. FINISH OF WELL: Type: Diameter: Slot/Mesh Size: Length: Set between ft. and ft. Backfilling Gravel pack 10. STATIC WATER LEVEL: .G ft. ❑ Above or ®,Below land surface Date E)rRT- 01i F Equipment used: ENVIRONMcNTAL P ZOTECTION II . PUMPING LEVEL below land surface and YIELD E}� ft. after hrs. pumping ,6g.p,m. ft. after hrs. pumping g. p. m. APR 41 " LOS)? 12.GROUTING Well Grouted: ❑ Yes Q No Material: ❑ Neat Cement ❑ Other: 13, PUMP: (if available) HP Length of Drop Pipe ft. capacity g.p.m. ❑ Subm. ❑ Jet ❑ Centrifical ❑ Other 14. REMARKS: 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature ° ❑ F ❑ C This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief; tAL 61, SAI Ee i L Registered Business Name Contract License Number Address: e P. �y'Vt, 12 61 6,l P6 t (� ( a3 .r �� h r • ;'( z, rt 3t Signed ei ! ''d� t`Z Date: Authorized Representative Form 02-WWR (11/81) Copy Distribution: WHITE-Stote DGGS, PINK -Driller, CANARY -Customer C: N v, r 0 2 0 �3., 1.: " 10 H.. I K 'w" C3 FO FA FA C3 f" -1 FR FA CB E_.'._*K: ^ DEPARTMENT HEALTH HND ENVIRONMENTAL AOTECTION ` 825 'L' STREET, ANCHORAGE, HK 99501 264-4720 1-, 9 E: L_ L_ 9=0 P-4 K> 1.) PYA --- IE; I -T- llEn ����E_; � F",: F" E:... F ?. P: I I T" PERMIT NO. ( 820669 ) APPLICANT NORTHWEST BLDG CONSULTH 1]17 & NORTHERN LIGHTS 99503 278-3171 Lit! HTION LEGAL. L2B3 ALPINE TERRACE LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRHINFIELD MHXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ��F:�`T- E3 ����� I= !f; C3 K FA NA Em L. ����VA= j'� THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). 25 FEET AND -THREEFACT44 I EfflCa F=EEEF-r' THE GRFIVE L DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). DEPARTMENT WITHIN 30 I F�'!!EEE::'A ���-f"* 1 �1��= PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTHLLHTION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. -T-hK__y ::-n ���l "l 10P,,9' �=HFREE FRE=(;fR.Al:F;!KK> BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION HND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTHNCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS HRE AVAILABLE TO INSURE PROPER INSTALLATION. KIREF;Tfol 1: "7- EF061" 1 FRE"Is E> E= CT EE t! E ��� I CERTIFY THH 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMc SIGNED:________________________________________ APPLICANT NORTHWEST BLDG CONSULTANTS ~( 1 ? .•- sr �',.-1i f. ; , : i, iiy .t•#1i' � �":t t.'�; •�-.1�1 ! fi� ;'its s t �; �' 1 3 tJ�1 � %� ri =. ih�=.}' �. 'a-t'�_c:� t�:i�` x� +fit' �_�e•:�� r tr r r . ��}`y� r tit is? 1-1-�!•li?'� 1 '�_f3l� '":f�ttd`iti .�- 7 �_ t d ;-d 7 s� t•}135 3`!Yr��r� � i' i�'+-�, r".; ,'� � .° ' '*•` . '� -� i'h-M +itit ` i or i �"�� •?� SO 1L # '•' r } 31.3 I # 3� f 1� i q' s_v>vtils+t_r! #€• _ R 3 I ¢_' 1' Rg-Q } I RED ', I ?€ CIF i`it= `. 3� IL RP [ it- _; ti._ i� 4'� 13 f"j4z� i - ,-A 4 s r� - NTE E CCo 1-+4 t'!c q T.o''AJ+"i-ea PC r s rt . �:if�t'ff_f�#fy i�?•b' i'f-i% l�-i+_i1 it.tj'tr t.:+;- 1 ._ :=rt_,.i-f'a:ft �fl?� r (�,j e+r:�-�� .._. 4 1- s.i••c".t7'z•'sJi. s �= � f �•! f •� f's.� %+1 � t� t t H i't 4 rte: ;j t.,i f r:- Y •`,tea .tc ckc.: r ;`#f �! e� � R t` f f ie�j '.�� I'�'- �'`{I�s:�4�,`� :` s i i►a ((5,} s- t,: � q - .. i' 1 E f_%s3"t' *-: t' j f -•s. f-xt r t j,s•: i t NF :=•�: ti;,�x•: t r ti_ t, a r!i t L e t �� _ _ t.•#, i'�)•1 ;-!-�f t'`is„t-i`i.s??";.��r3f !'�„1.'�•riga �-siyt +a1i-1[_t_1rf'3#} �r �r+_.i frJi- t 1•i'�+!k�'_'_.. '�r'1f • • i L. j y iZ - Sial t.1 TL3_ I Wi ! Aimr rr�� iY= ii'� fs '1tls til ri_.f Iii;! r i'#it tom:=r'i3`;-- pi tN SMUM Of 1 1 7jr_;E +`-II ll'!7�'# 1' ! � r1 r44 ::i�1 :�r L ;sem s F+ trr'f• Mr a. s FeC F132. 3`.' p `-`r, f:�R i'E ' K. 1 `t y� r:7 ::a� : i r i ;s� W # !✓ H f f~ t j<:.fa 1Ce•G htt� 1 _ _ : >I.i i i. 130 fl -.s ! "s•r r tJ i # i.� _f _ _ ,i'!i'MUTJO 01 ;r.- y. irora ti3 P!o,r•.upF: .t zf_s- p -r <% oz rt r! _;ti•a3 ���5. t •:�, t �e,r ,"r TQ !i i._Os1'y Ake : Pl;:- 'J f r; _C- iW rfrs:. MICZ)�, _ r-ice."_fE r I elf 73'"1-�+�_� +rte ;�i s �•�.y�t�tr._ �1 r� '�.� r�'.'-, � -rc•� - _ _ - Ar'1'AI� #� ?= 1!� Li�i��}};'� h'P;�i•=rtt �f�fe saE i f1e ti€tf�1� I+_lira .i:6� _• i•d: i��_i.:,' fr.�:� �yt g�.�1,�,� i{•�: �_ >._._ . � . _ _ �'_ � .. 1� � _ .w �. . _ s i � fir= - '+_ . _� sem°' ._ �"•� r5rr ( F',F TH 'A l ±f € f is 1.1 i n t i "w .'. r i f.• _ r f x •y .: s �� +liJ t r.,z- - �fff, T:-'_ �' t .�' .� •�t,�-fit- f.�': �"�� • � �+� f 1�1, i �� x'�#ef j'i'i`' :. i • u .a � Pti i -t+ :� . ;r,;;°f t:=il•1#•r taI t 7'l �'e it: t"i �+ I i Alt R i't4w, rp,,i T r tl .fir aIC�' I'=• �'-t=t•1i,�r+ r ' _t:t� _P#.il�iRtr f -it lk i :�31 fTf z •r�rc•tlisf;�, 4H 1 1'•1G}2's?i3 29, {n r� I SOILS LOGS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: Nuc�) Lonsif u ' , DATE PERFORMED: rl' 1 ' VL LEGAL DESCRIPTION: N6,f)Q-, Jerf- au6It16 k �3 1 �—p I 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS ©rgIt A) a- sdncdy , s i I+y 19ramA C�P��-9rA�2�,sa►�c� m�X P)! 11ravQl ,-11II nn�X C SLOPE WAS GROUND WATER S ENCOUNTERED? V L X15 R air IF YES, AT WHAT ' ry 1 E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY: (n6c D-jrIanp, CERTIFIED BY: 72-008 (6/79) DATFy" l !tc_ C Municipality of Anchorage Q . 11 - i i ° On-Site Water and Wastewater Program (907) 343-7904 SAFETY Certificate of On-Site Systems Approval Parcel I.D. 015-243-09 Expiration Date: (0- 12-) 7 1. GENERAL INFORMATION: Complete legal description ALPINE TERRACE; BLOCK 3, LOT 2 Location (site address) 7500 Soldotna Drive*Anchorage 99516 Current Property owner(s) Phil&Jennifer Lincoln Day phone 244-4755 Mailing address 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 ® Individual IZ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: -7/13/49- COSA to be relea d to the engineer,unless otherwise requested by the engineer. COSA Fee $ 571.0 r Waiver Fee $ Date of Payment `) 3`7 111 Date of Payment Receipt Number O1 014a'G, Receipt Number COSA# OSeAl P-61 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 /6/0 Engineer's Printed Name: Jeffrey A. Garness Date: ''2 a4Qo�p�\ In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o: QF ' %%0 in accordance with the guidelines and regulations established by the Municipality of Anchorage and ��-. ••-• _ 1 industry practices. The reported results describe the condition of the system/s on the date/s of the O Q~ I Onn evaluation. Separation distances were measured to readily identifiable features. Hidden defects or 5"� ��' Vi) encroachments may exist that were not identified during the evaluation. The operational life of all wells * : LI•9 T *v and septic systems depend upon a variety of variables, including but not limited to, soil conditions, /••••••• •••'• ..•••• •••• •••• groundwater levels (that may fluctuate during the year), quality of construction (materials and j VA workmanship),and the water usage of the family utilizing the system/s. These conditions can vary, and ',�,.-.. .. . Q are outside the control of GEG. Satisfactory test results do not guarantee future performance of the f •••J f • ' Gar. -ss.: 0 system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of V0 30 CE 79 3 • e`'., � the well or septic system. GEG makes no representation whether an alternative well or septic system s ..---14. 6.1.1:9'",,,d can be installed on the property in the event either of the current systems fail to perform adequately in V4�e, the future. The content of this report is for the sole benefit of the person/party that retained GEG to \Q�c'ppofess o„o � perform the evaluation. Reliance upon the information provided in this report by any other person or �kOpQpQa party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE ''' System #1 Approved for 3 bedrooms vV Sid • WATER AND c' System #2 Approved for bedrooms -n VVASTEVVATER Disapproved `t' PROGRAM C' Conditional approval for bedrooms, with the following stipulations_.-,;:,.-, { vvN-0.4 (9v,rvor danww��c c.e ie hd is cn1/ LI " R,19cd '�vt.s „)..,,L0-,1%. _ efk--e-L._ 6K,„\ic IQ, z, ri./ etArs d-Qd i Avakir -121..e 26 1,001 By: v-\..r (._ Original Certificate Date: 7-( Z -1 7 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 Nitrate Advisory Septic System Advisory _ Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-1O.12.doc 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: ALPINE TERRACE; BLOCK 3, LOT 2 Parcel ID: 015-243-09 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 9/15/82 Sanitary seal (YIN) YES Wires properly protected (Y/N) YES Total depth 56 ft. Cased to 56 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 9/15/82 6/22/17 Static water level 23 ft 27 ft. Well production 10+ g p.m. 7.3+ g.p.m. WATER SAMPLE RESULTS: Coliform ND colonies/100 ml. Nitrate 6 03 mg./L. Collected by: GEG, Ltd. Arsenic: ND ug./L. Date of sample: 6/16/17 35 YEAR OLD STEEL SEPTIC TANK IS APPROACHING B. SEPTIC/HOLDING TANK DATA THE END OF ITS USEFUL LIFE Tank Type/Material SEPTIC/STEEL Date installed 8/24/82 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 6114117 Pumper A+HOME SERVICES C. ABSORPTION FIELD DATA Date installed 8:24:82 Soil rating (g.p.d lft-or ft'/bd)) 125 System type WIDE TRENCH Length 51 ft. Width 5 ft. Gravel below pipe 3 ft. Total depth 5 ft. Eff. absorption area 440 ft• Monitoring tube YES Depression over field NO Date of adequacy test 6/22/17 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 676 gal. New depth 22 in. Elapsed Time: 135 min. Final fluid depth 11 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN 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 wa er alarm level at in. •- . •• Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout '100'+ Sewer/septic service line 254 Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line •10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line `10'+ Surface water 100'+ Driveway, parking/vehicle storage 0' Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS 'ASSUMED PORTION OF DRAINFIELD IS UNDER PARKING/DRIVEWAY AREA-MET CODE AT TIME OF INSTALLATION SEE ATTACHED STATEMENT FROM OWNER REGARDING NO FREEZING ISSUES. ••\ G. ENGINEER'S CERTIFICATION .x\P,.••• ". �.4p I certify that I have determined through field inspections and '9 .' l���� .*1: review of Municipal records that the above systems are in r I ii •r conformance with MOA COSH guidelines in effect on this M '••' r ' - .... • date. ,•-n-. J J. / A. • - -ss ' Engineer's Printed Name JEFFREY A.GARNESS 1•t-P, l j�7 53 � 4)17 Date //7/ IP h bF SS 0" ••• LICENSE �II%%sass** *AECC884 (Rev. 10112112) • Municipality of Anchorage •• ::� ii i Development Services Department ` Building Safety Division ' 4t 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 # OSC 1712$1 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 2 of Alpine Terrace subdivision. This inspection revealed a nitrate concentration of 6.03 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. 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. Municipality of Anchorage -� Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. 9' P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us Aot (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0IS-243 - 09 HAA # D40l0-43 Expiration Date: 3 - %- O J✓ 1. GENERAL INFORMATION Complete legal description Alpine, TLPrace, Suba, L 2 6 3 Location (site address or directions) _V 000 SjAcNna Vr_ qR56')t Current Propertyowner(s) 16wil Nennia Day phone Mailing address Lending agency li w„t / Day phone 7 (c 2 *71';L33. Mailing address mol C�H�✓pmi b 1 11.4146 a Real Estate Agent 6r an W6.11 6.11 e it" Day phone 2SO - B9 99 Mailing Address. Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm P�2�and �nainea�+r,a ?hone 29-391(0 Address 203 w_i)iS4 Ade %4i%#,03 �nA� AK ` So1 —r C....4C4�na Date � 10-2004 Engineer's Printed Name �r�.,ne� r T .RAS" 4F�i IY1 Wfl 5. DSD SIGNATURE $, JG Approved for bedrooms. g0it Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Q�.�%C �/ (f�, ,��y C Original Certificate Date: (Rev. 01/02) R i Municipality of Anchorage ' Development Services Department`° Building Safety Division ^ On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description Laine T2t'faC2 S� L 2 R -A Parcel ID: 0I5 -Z4.3 -1___J1 � A. WELL DATA Well type $ &• Fuw,:\r If A, B, or C provide PWSID # _ Well Log (YIN) Y Date completed -F" F 82 Sanitary seal (Y/N) Wires properly protected (Y/N) Y_ Total depth .7r ft. Cased to -N-0—ft. Casing height (above ground) 16 in. FROM WELL LOG AT INSPECTION. Date of test 15 PZ 1211-f 2mK Static water level 23 Well production 10+ g.p.m. 5, rj }- g.p.m. WATER SAMPLE RESULTS: Coliform _colonies/100 ml. Nitrate &/8 mg./I. Other bacteria .N D colonies/100 mll Arsenic: ✓ mg./1. Date of sample: 12/ �oy Collected by: %•SI?V 01.1x, k E B. SEPTIC/HOLDING TANK DATA Tank Type/Material ,S+ee / Greer Date installed 0 2y 8Z I Tank size .loon gal. Number of Compartments 2 Cleanouts (Y/N) y Foundation cleanout (Y/N) --I- Depression over tank(Y/N) N High water alarm (Y/N) N Date of pumping 612ij 1oc,4 Pumper A+ C. ABSORPTION FIELD DATA r Date installed B� Z Soil rating (g.p.d./ft2 or ft'/bdrm) Z5 System type W/je 1 rency% Length 51 ft. Width 5 ft. Gravel below pipe 3 ft. k Total depth (p ft. Eff. absorption area 90 ft2 Monitoring tube Depression over field Date ofade adequacy test IZ �y`g�te%r t9For '�P bed i q y o Results (Pass/Fail) P4SS .For `'� bedrooms Fluid depth in absorption field before test 1 in. Water added 50 gal. New depthfl in. � Elapsed Time: 11GO min. Final fluid depth in. Absorption rate >= 450 g.p.d. f Any rejuvenation treatment (past 12 mo.) (Y/N & type) A10c kn%wn If yes, give date — Date installed Size in gallons 14 Manhole/Access (Y/N) "Pump on level _ in. "Pump off' level at in. High water alarm le t in. Datum Cycles test Meets alar circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO Septic tank/lift station on lot 101 On adjacent lots 100` +- Absorption field on lot Ilor On adjacent lots 100r 4 - Public sewer main n/IA Public sewer manhole/cleanout N Sewer /septic service line 7 50 Holding tank NSA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 30'+ Absorption field 5 r+ Water main -1a';P�7 NIA Water service line 10 r �- Surface water NN�Q Wells on adjacent lots 100 + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1or+- Building foundation (0+ Water main 10,+ Water Service line + Surface water /v O Driveway, parking/vehicle storage C) Curtain drain N%O Wells on adjacent lots r F. COMMENTS '2 0 -1 rs vtd r.v- r iVGLZeLj C. ' V� rD 1,P,.f�vt�Q 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 HAA guidelines in effect on this date. 1Oh�CN n Engineer's Printed Name k 1 vtdC t - HAA .� Date 19- - A-7—oN , z Fee $ Oo llt- rK-60 Date of Payment IZ/Z�/DL/ Receipt Number 102ND �i„ t'p!l I r} (Rev. 12/01) Waiver Fee $ Date of Payment_ Receipt Number_ SGS SGS Ref.# Client Name Project Name/# Client Sample ID Matrix Sample Remarks: 1048052001 Tobben Spurkland P.E. Alpine Terrace Lt 2 B 3 Alpine Terrace Lt 2 B 3 Drinking Water All Dates/Times are Alaska Standard Time Printed Date/Time 12/22/2004 10:29 Collected Date/Time 12/14/2004 18:00 Received Date/time 12/15/2004 11:43 Technical DirectorStep C. Ede �p/ Released t: / A j Parameter Results PQL Units Method Container ID Allowable Prep Analysis Limits Date Date Imt Waters Department Nitrate -N 6.18 0.100 Microbiology Laboratory Total Coliform 0 mg/l, EPA 300.0 B (<=10) 12/16/04 BJA coU100mL SM209222B A (<=1) 12/15/04 DKC .ST 4, a Oos MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1 - �L �-- [�� l _ HAA # b► f�� 1 L7 t �Sc� 1. GENERAL INFORMATION Complete legal description Lot 2; Block 3; Alpine Terrace Subdivision Location (site address or directions) 9600 soidotna Drive, Anchorage, Alaska_ Property owner F igene F1 ei shAuer Day phone d45-6907 Mailing address C/O Betsy LaLoy, 6821 Teresa Circle, Anchorage, Alaska 99516 Lending agency Mailing address Day phone Agent Sue Dvorak/FORTUNE PROPERTIES Day phone 562-7653 Address 3000 A Street, Anchorage, Alaska 99530 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature 6. DHHS SIGNATURE _ Approved for Disapproved. S & S F_NCsi�iiyR1NG Eagle River, Alaska 99577 gntt/2 ) bedrooms. Conditional approval for Additional Comments By: No. 204 Phone, IY-�� Date • x,r S p!� of ))1�Ns1•gi•Y•sA9 %PdY 1TrNif � y� `'•s+ it •a ai+f••,.+,rp+a+s. � itic a �, Idg. 3�7.y •n% bedrooms, with the following stipulations: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in 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. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 4ot Z, ��3� ATrn�eT�'�Ac�S�Parcel I.D./S�GIQ� A. WELL DATA Well type MM1114 If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed - Z I - F3 Z Driller JA). Al. 1��1tt� �(�I�1�5 Total depth S :t Cased to !SIP Casing height 1Z t Sanitary seal (Y/N) Wires properly protected (Y/N) v FROM WELL LOG AT INSPECTION -`Do z �. Date of test �' 2 Z `� " 3 "- rn Static water level Z3 2 -2-S 1Z r r Well flow (09.p.m.•t g.li rr� � � m Pump level l� (� U �0 1 � SEPARATION DISTANCES FROM WELL TO: _.co m (D r 9 Septic/holding tank on lot CX2 -lL ; On adjacent lots �� t r � fi Absorption field on lot On adjacent lots ( too Public sewer main ti/A A Public sewer manhole/cleanout t J A Public sewer service line N%'8 Petroleum tank WoNe t< ns ©1N IJ WATER SAMPLE RESULTS: ,S 1�5/ Coliform ii6f4c_�Ditg Nitrate 5��15fAc-tor Other bacteria z-ty`0 Date of sample: S - l O - �I Collected by:C �q't tj P -e - B. SEPTIC/HOLDING TANK DATA Date installed _ 2 Z Tank size �� Compartments 2-- Cleanouts (Y/N) 1+ Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) L [IA Alarm tested (Y/N) N'W Date of pumping S__ 1`t _fl ( A fLo F km& ��✓fctG5 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ( alb r t On adjacent lots 100 't Foundation S 'fi r i To property line 33' Absorption field S Water main/service line fl t Surface water/drainage /L -2O r t 72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level Meets MOA electrical codes MN) on" level at SEPARATION DISTANCE FROM LIFT STATI Well on lot On adjacent Manufacturer — Manhole/Access (Y/N) "Pump off" level at Cycles tested TO: to Surface water _ D. ABSORPTION FIELD DATA �h, w.' Date installed 49 - 2!q _ a Z Soil rating - System type Length i Width Gravel thickness 366 Total depth 1Q , Total absorption area -4!q O Cleanouts present (Y/N) t-+ Depression over field (Y/N) .& Date of adequacy test S - / 3 - C Results (pass/fail) jQ A S to ( for bedrooms Peroxide treatment (past 12 months) (Y/N) w11 fA If yes, give date U /A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot j -('Oro "f' On adjacent lots / DD Property line To building_ foundation (O l�" To existing or abandoned system on lot ,-J / kq On adjacent lots O t Cutbank A.2 —Water main/service line ( o I Surface water 'f Driveway, parking/vehicle storage area / D Curtain drain A) E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature S & S ENGINEERING 17034 Eagle River Loop Road No; 204 Engineer's Na iRgle River. Alaska 99577 Date ZUc.......a..a,.� �k No. 145Y-9 HAA Fee $n�r� Waiver Fee: $ Date of Payment vy Date of Payment Receipt Number Receipt Number 72-026 (Rev. 3/91) Back MOA 21 LABORATORY CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS REPORT BY SAMPLE for WORTorder# 34136 Date Report Printed: MAY 14 91 6 08:59 Client Sample ID:L2 B3. ALPINE TERRACE. PWSID :UA Collected MAY 10 91 ! 12:30 hrs. Received MAY 10 91 8 14:00 hrs. Preserved With :AS REQUIRED Client Name :S & S ENGINEERING Client Acct :SNSENGP BPO B PO # NONE RECEIVED Req # Ordered By :R. SHAFER Analysis Completed :NAY 13 91 Send Reports to: Laboratory SupW7� EDE 1)S & S ENGINEERING Released By : U--- 2) ..................................................................................................... .............. Chemlab Ref IR: 911949 Lab Smpl ID: 1 Matrix: WATER Parameter Tested Result Units ------------------------------------------------------------------------- NITRATE-N 3.5 mg/l Sample ROUTINE SAMPLE COLLECTED BY: R.D.J. Remarks: Allowable Method Limits ------------------------------------ EPA 353.2 10 .............................................................................................................. 1 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than Time APPLI( NT FILLS OUT UPPER HA; ONLY Prr-.)erty OwnerPhone _fx/� C_•- Time f Date Mailing Address f� —. �/ Zip Code Buyer17 f Address Zip Code Lending Institution Inspector �-> y Phone Address Zip Code Realty Co. & Agent " •: i , ,•, Phone l�Q aC/�J�'i, �* + MUNICIPALITY OF ANCHORAGE U-C"� ��sL v� DEPT. OF H`:ALTH Ft Address / Zip Code APR 4 198",z Legal Description RECEIVED (1) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL Street Location ( ) CONDITION A�<,�PPiftOVAL' Type of Residence DATE d Single Family Soils Rating Multiple Family No. of Bedrooms_ Well Log Received ❑ Other R.4 V -6 I -Well to Tank Water Supply Individual �) 1J� �,///p� aI�LU(0R — t, (� Q �QC GL�LY. ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal 21' Individual V Year Individual Installed:�--- ❑ Public Utility p When Connected to Public Utility:' ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time f Date Date Date Date t Inspector Inspector Inspector Inspector Field Notes: 1(� ® l�Q aC/�J�'i, �* + MUNICIPALITY OF ANCHORAGE U-C"� ��sL v� DEPT. OF H`:ALTH Ft ENVIRONMENTAL PROTECTION APR 4 198",z RECEIVED (1) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITION A�<,�PPiftOVAL' DATE d BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received R.4 V -6 I -Well to Tank Septic Tank Size ©Oct 72.023 (3/82)