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Home My WebLink AboutTUSTAMENA TERRACE #1 LT 11Tustomena T rrace Lot 11 #017-381-48 Municipality of Anchorage Development Services Department Building Safety Division On-Bite Water and Wastewater Program, 4700 S. Bragaw BL P.O, Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.u$ (907) 343-7904 Page of ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PID Number. OI7-- %~1- ~(::~ Wastewater System: I--3~New r-I Upgrade LEGAL DESCRIPTION ABSORPTION FIELD Well: [] New [] Upgrade I I- SEPARATION DISTANCES ~-.~D T"~. To Septic Absorption Lift Holding Tank Field Station Tank ~.' I~-o ~ ;7.'1 I~-o FI. °'" ~"'""' b'/~-- ~/~,4 z. TANK r-i Septic D Holding I"J S.T.E.P, ,~Othec BENCH MARK Inspections performed by: '~, .,~' Dates: 1" Development~Services Department Approval Reviewed and approved by: ~ Date: ·, Engineers Stamp ~.;:,. TOBB£NSPURKLANDP.£ 203 W 1517"1. AV~NU£ ANCH. AK. g950I (gO7) TUSTAMINAscon.~u~ei~TERRACE~osAs~Suat: $/D LOT PID # OIT-3BI-4B SEPTIC S)'STEW AS BUILT DATE: ~,E 22, 2002 SHEET: 2/3 GRID: 2837 pERlqlf # SIVOpoI59 TUTOOIIp.~IV6 ~ .I-INGM INSULATION elOCrC ooo LEGEND: 5 X 40.0 ORAIMr'7EI. D 2 FT TOTAL DEPTH .5 FI' Er'TECIIV£ ROCK 2 FI' COVER, 2' INSULATION I~.-., :'-:; ~ u ,., k 0 0 0 ~ ) 0 0 0 0 0 ~ ~ *--4'* )000 O~O~O~O~O~OL NO SCALE 1. PRII, IARY TRE4111ENT, SEP17C TANK 2. ~RAI'ION TANK 3. GI.4RIFICA170N TANK DISCHAt~£ TANK 5. SOIL ABSORPTION TOBEEN SPURKLAND P.£. 205 W15~ Ave TUSTA~flNA I~RRA¢ff LO? 11 J B/OCYCLE WASTE' WATER SYSTE~I I BADGER lANE DAIE: ~C 22, 2002 ~E~: S/J GRID: 2~7 PERMIT # SilO20159 Piti # 017-381-48 TUTOOIISflVG Right~ 10/21/2002 5:38 PAGE 1/1 Rtsh%FAX Inspection Report Municipality of Anchorage, Building Safety Division 4700 South Bragaw INSPE~-IiON: VOICE 343-~00 INSPECTION: FAX (907)249-7777 N;Ima Address Legal Subdivision CommentJ or Direction. SCOTt ]OHANNES 13011. BADGER LANE LTl.1 TUSTAN ENA TERR ADD INFO: 343-8211 Permit 02-8097 Phone 345-2115 Inspection Date 10/21/2002 Inspactian Final Electrical :-'l _ Retro Electrical ~ NO NONCOHPLIANCE OBSERVED [] CORRECTIONS ESSENT',.AL AS EXPLAINED BELOW W/LL RE-EXAHINE AT NEXT [] [] INSPECTION COMMENTS: (~or inspector use only) I~inq~ctlon N DO NOT CONCEAL UNTIL REINSPECTTON Znspector ; // lt~07/02 11:35 FAX 2?64429 P & 1/ J.~R.qTY ~01 FH~I : ~t-PI'~E D~ILLIt'I[.i F~X NO. : c.~7 3a$ ~ Nc~. O5 ~ 1~l-':'lP~ Municipality of Anchor. age Deparmaent of Health and Human Servmes ~25 'L' S~'eet P.O. Box 1~50 Atw. hacage. A.~a. sl,;a 99519-~$0 Permit Number:. #SW l)at~ oll,~ne: /'att'el td~n ~ . ~1 ~g~ T~eme~ T~a~ fs Ed ~k 0 L~ f ~ Pm~ ~ N~e & Add~ S~ J~nnOs Bor, hole D~'- Depth (fl] Soil 'J*yp~ 'F'r~Ze'~ ~ W~ 5~ ~ To ~k I~ 267 [] cabh: taol Arttntlom Tho wcU. drill~ s]u~l). F'ovlde a'.~ll log ~ th= v,,:v~'Y owner w~ 30 da~s cf ~mFleti~ and tl~ pr~rty TUSTAMENA 77-79 TERRACE, LOT 11 4.5,22,3 S.F. FIRST ADDITION N 89°59'00"E 10' UTIL. ESMT. 174.53' ,~7.0' Ld 50' o. EXISTING BUILDING ~*--- SEPTIC VAULT GRAVEL DRtVE 1"=30' ~'d'~ N 89°59'00"E 36.95' FINAL STRUOi'qRE AS~BrJILT A S- B O I L T , pROpE~ DEPIC~ ~0~ ~D ~T NO ~1 ~D SU~NG' ENCROACHM~ ~IST ~CE~ ~ INDIteD. JEFF A. ~1, R.~S. ff IS ~E R~PONSIBI~ OF THE 0~ TO 4726 W~ ~ AVENUE D~RMINE ~CHO~GE, ~ 99502 CO~ OR R~IC~ONS WH~H DO NOT PHONE 2~-5454 APP~ ON ~E RECORDED SUBDMSION P~T. UNDER NO CI~UM~C~ SHOU~ ~ DATA GRID DATE HEREON ~E US~ FOR CON~U~ON OR FOR 28,37 10/10/2002 ~MSHING ~UND~ OR ~NCE MNES. ~CHO~E RE~RDING DI~ICT. F.B. JOB NO. 02-14 W~ NOTE: NO CORNERS SET THIS DATE. MUNICIPALITY OF ANCHORAGE Development Sewice$ Department On-Site Water & Wastewater Program 4700 Sou~h Bragaw Street P.O. Box 196650, Anchorage, At( 9951~-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Jun 17, 2002 Expiration Date: Jun 17, 2003 Permit Number: SW020159 Legal Description: TUSTAMENA TERRACE #1 LT 11 Design Engineer: 0007 Tobben Spurkland, PE Owner Name: Scott Johannes Owner Address: 13050 Badger Lane Anchorage, AK 99516- Parcel ID: 017-381..48 Site Address: Lot Size: 43223 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify 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: Issued By: Date: 'T_ Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchorage.ak.us (907) 343-7904 ON-SITE SEWEPJ~VELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I,O. O 1'7- ~L~ I" ~ Permit Number Property owner(s) Mailing address (1) Mailing address (2) Legal description (Lot, Block & Sub'&) Legal description (Section, Township & Range) Lot Size ~-z~ ;~/'3~'~ Acres/~-"~ THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROP~=RTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Day phone Zip Code Number of Bedrooms ~[ Well Only ['] [] Water Storage [] [] Jacuzzi [] [] Water Softening Unit [] 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. (Signature of property owner or aulhorized ~gent) Permit Fees: -.~ ///~O ~ Date of Payment: ~/~/~ Z,..- Receipt Number: ~) ~'~0 ~.~, (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: T.S?U LAI D P.E. 203 W 15~h. Avenue, Suite 203 ANCItORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 11 TUSTAMINA TERRACE BADGER LANE Municipality of Anchorage Development Services Department Building Safety Division On Site Water and waste Water Program 4700 South Bragrw Street Anchorage, Alaska 99519-650 June 3, 2002 We are submitting an application for the installation of a septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic ofthe septic system, (sheet 3/3). Soil logs and percolation tests of applicable test holes are also enclosed. The septic system design is based on the following: Groundwater (~ 6 feet. Us~ Standard 5-Wide Trench with BioCycle Soil Rating. From Test hole 05/03/02. I> mln/in = 4 gal per sq.0dday No. of Bedrooms 4 Required Area per Bedroom: 150/4 ~ 37.50 sq. lL Total area required: 37.5 x 4 w 150 sqR Minimum Trench Length: 150/5~30 ft USE 40 SYSTEM CONFIGURATION BIOCYCLE STANDARD 5-WIDE TRENCI! TOTAL LENGTIt 40 FT TOTAL WIDTH 5 FT TOTAL DEPTli 2 FT ROCK DEPTIt 0.5 FT COVER 3 FT The installation of this septic system will not prevent wells from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoffwill not result from this installation. SCALE, 1' = 100 FT. [OBBEN SPURKLAND P.E. 203 ~i 15~1. AVENUE ANCH. AK. g950f :TUSTAMINA TERRACE $/D LOT 11[ SCOIT JOI~4NNE$ BAGGER LANE PID # 017-3£1-4~ SEPT/C $YSTE~( DESIGN DATE: June I, 2002 SHEET: I/3 ~RID: 2837 PE£NII' # SP/O~OXXX I'UI'OOIII.9~/G ror~ ~ I'OBSEN SPU£KLAND P.E. 205 ~Y 15TH. AVENUE ANCN. AK. TUSTAMINAscon.8~o6~TERRACE~o. NNEs,~NE S/D ~.o~ 11J RIB # 017-381-48 SEPITC SYSTEM Of'~16N DAIE: Jun~ & 2002 SHEET: 2/3 GRID: 2857 PERMIT # $~/820XXX TUTO8II~..~I~ 4-1NCN INSULATION 5 X ,10.0 DRAINFIEI. D - __ __- 2 FT TOTAL BEPTIi M~ .5 Fi' EFFECTIVE ROCK ~ . $ FT COVER !. PRMARY TREA17WENT, SEPTIC lANK AERATION TANK $. CLARIFICATION TANK 4. DISCHARGE TANK 5. SOIL ABSORPTION TOBBEN SPURKLANfl P.E. I 205 W~$t~ A~ I TUSTAIWIN4 TERRJC~ LOT Il BIOCYCLE WASTE WATER SYSTEI4 BADGER LANE W4Sl'E~41~T Srat~ St. gEWA~lC BATE: JUNE I, 2002 SHEET: $/3 GRID: 2857 PERMIT # SWO2OOXX PIll # 017-$81-48 TUTflOII3.BVG Performed For: Legal Descfipbon: Municipality of Anchorage Developmenl Services Department Building Safe~y Division On. Site Waler and Waslewater Program 4700 South Bragaw SL P.O. Box 196650 A~chorage, AK 99519-6650 Soils Log - Percolation Test Slope SUe Pran ~:l ~"~"o ~ O ~ WAS GROUND WATER ~)- ENCOUNTERED? 1 0- IF YES, AT ~AT DEPTH? Deplh to Wale~ A~et 1 1- Monitoring? ~3- 14. Reading Dale Gross Time Net Time Depth to Water Nel Drca 15- 16- 19- 20- COMMENTS PERCOLATION RATE ~ J (~le~h) PERC HOLE DIAMETER TEST RUN BETWEEN t FT AND ~- FT PERFORMED BY. ~ ,,~ I '~ -~ CERTIFY THAT THIS TEST WAS PERFCR.MED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Municipality of Anchorage Development Services Department Building S~¢ty Division On-Site Water and Waztcwatcr Program 4700 Bragaw Slr~ct P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 PROPERTY OWNER AGREEMENT FOR THE MAINTENANCE OF AN ON-SITE WASTEWATER DISPOSAL SYSTEM This agreement, dated Ol://'-Ilo z- , is made between the Municipality of Anchorage Development Services Department (DSD) and the property owner(s) of: This agreement is made for the purpose of maintaining an on-site wastewater disposal system on the subject property. The property owners agree to the following: Submit to the Municipality of Anchorage, on an annual basis, an inspection and operation statement from a registered professional engineer. This inspection and operation statement shall verify that the engineer has inspected all effluent and air pumps, timers, and alarms, and that any deficiencies have been repaired and that the system is functioning as designed. (Signature) (Printed Name) (Printed Name) The Foregoing lostrumen~was acknowledged be,fore me by ~'=~o ~4 '~-c~[?~. "J~a. vt~le%on this / ~[ dayof ' na~) ~*" ' ~o~'s printed nme) ~' }'- / ./ '2 My Co~ission Expires ~ [/~ [~ 825 "L" SYREET ANCHORAGE, ALASKA 99501 (907) 264-4111 December 31, 1979 Tom Price Box 81 Anchorage, Alaska 99501 Permit ~ 790087 Subject: Lot 11 ?ustamena Terrace Subdivision A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer has inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please contact this office at 264-4720. Sincerely, LNB/ljw enc: Copy of Permit F'EI:;:M I T NEL DE:PIr:II~:'['f,'I[~:NT Of HEF~L.-rH FIN[:, E.:iq',,,'lF:(:)lq?i~F~i'.,ITFIt... ~.,,.~ E~: E__ E F" EEl ~:." F-'I] ~ 'T' I::IPPL. ICF:INT "rHOHFI':S PRICE JR. BM. 8J. t:INCH ~a~5~ZI:L L(:)C:f::fI' ].' ON I~.EI/JFIL L,T. :!.,:L. "FIJ?'FFiP1ENFi Tf£f~:RRC:E S,.'-'[.':, LOT SIZF-' PIIi'-,IIHLIH DI~,TFINCE BETI.,.IEEI'.,I F:I t.,.IELL FIND FIN'.? ON-.Si;ITE SEI.,.IFIGE :L~iiC:~ [:'E:ET FOI-?, F1 F'RI',,,'RT[C !.,.IELI...; J.[5!;) TO :~.]C~t F'EJET FF.:Oi',I FI PI..IE,'I..!O [,.IEEE F..)EP[JI'.,I[.':,INC.~ UPON TH[E '[".r'fla: OF F'I.,IBL. IC I.q[-:[...[ .... [,.IEl._[... LOGS'; FIRE REtT!UIR[ED FII'.,ID I'dlJST BE F:ETI...IRNED TO THE DEF'f:IRTHE:F,!T P.IITHIN '£)F TFIE I.qELL COi',IPL[~:-I"II.')N. OTF.IEEf~: RE[~!I_JIR. I:JJi'dENTS P'IF:Ik' FtPPL."r'. '.T:,PECIFICFITIONE5 FIi",ID CON'.'E;"['F~:UCTION D:[FIGRI::IHS F"I',,,'FCr. L.FIBt_.E TO ZI",ISURE PF~'.OPER ZN'-:.;TFILLFIT]:ON. Z CER'I"]:F"r' "I"HFIT :[.: I FIM FF:IM I L ]:RR !.,.I I TH THE RE~..'.[LII R[.~t"IEF,ITS F'OF: ON-S;~ TE SEIqER:S F~N[::' NELL5 F:~:S :SET F'C~R]-H E?'r' THE: HIJNZCZF'K~L. ZT'~' 0[: laNCHOR. FIGE. ~:: I I.qZLL. INSTFILL. 'THIS :S'~':STEfq IN F!CCOR[>FINCE I.qlTH THE CI3DE:5, c?~7/ ~NVIRONMENi, ........ RECEIVL-; Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 L CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Oi~'- 3~5~ '- GENERAL INFQRMATION:. CompJetelegal description' Loca~ion-(siteaddress)' t"50~[' ~.~t,~. ~-,~n~1 Current ProPerty ~wner(Si" '..,~_~v~. ~r;,~c~- . Mailihgaddress : ,: 5Amc_- Lending agency '-:' "'~'~ /' Expiration Date: Day phone 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: ~ TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class ~ Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [~ Individual Holding Tank [] Community On-site . I--] Public seWer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional .civil engineer registered in the State of Alaska. Certificates of On-Site System's Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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 theprofessional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER .5. ordinances, and regulations in effect at the time of installation. Name ofFirm .~up~'~\c,~, ~n~;,n~..ri~..~ ' Phone Address ;~Q3 ~0, ~,5~'t' A¢~-, 7-o3-.. i j A~.. c~5oj Engineer's Printed Name L'~(~,$ ~[2u¢-~c~ Date 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, DSD SIGNATURE ~ Approved for Disapproved.. Conditional approval for .., bedrooms. bedrooms, with the followin9 stipulations: Attachments: COSA Checklist Septic System Advisory Well .Flow Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Nitrate Advisory ..~ Other Original certificate Date: / / [ , (Rev, 11105) Municipality of Anchorage DeVelopment Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 Legal Description: A. WELL DATA we, type ~ Date completed I~11107-- Total depth ~.~o~ ft. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Lot- II ParcellD:Ol"{--~;~l- Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform IfA, B, or C provide PWSID # ~ Sanitary seal (Y/N)....~. Cased to .I .{~.,.~ ft. FROM WELL LOG ft. g.p.m. Well Log (Y/N) '7 Wires properly protected (Y/N) casing height (above ground) AT INSPECTION ,oI i~I '2.o,0 I?-t ft. (,_.,% g.p.m. '~ in. J~e;~ coloniesll00 mL Nitrate ~-.~.a mg/L 'Arsenic: /~D ug/L 'date of sample:, to/IqlZo~o B, SEPTIC/HOLDING TANK DATA Tank Type/Material. ~o ~-~c\e. / [i~o0~,~ ~.~$ t Tank size Ii,DO gal. Number of Compartments Foundation cleanout (WN).~ Depression over tank (Y/N) . /V' P~ 'Date of pumping ..~'t" ~q.~,~J~e,~,nc~. Pumper C. ABSORPTION FIELD DATA Other bacteria. *colonies/100 mL Collected by: '~.~r~ o~'p,~,h~ Cleanouts (Y/N) High water alarm (Y/N) Date installed . '~)')-~~-Ob'L'' Soilrating (g.p.d./ft~orft~/bdrm) q Systemtype Length ~0 ft. Width ~ ft. Gravel below pipe (~, ~ ft. Total depth ~, [ ft. Eft, absorption area '7-oOft~ Monitoring tube ~ Depression over field /V/ Date of adequacy test [O I1~1 'Zo\O Results (Pass/Fail) ~5 For ~J bedrooms Fluid depth in absorption field before test ~ in. Water added 5-~O gal. New depth ~;~ in. Elapsed Time: ~ min. Final fluid depth. ~ in. Absorption rate >= (o00 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) /V'o if yes, give date '--' D. I'IFT .STATION Date installed 9/25] 2oo'/.. Size in gallons "Pump on" level at 7-5 in. "Pump off' level at Datum ~r' Cycles tested %-i.- Manhole/Access (Y/N) High water alarm level at '27_ Meets alarm & circuit requirements? in, E. SEPARATION DISTANCES · SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot [ '~,0 t Absorption field on lot ~ ~ ~ ~ 'Public sewer main /V'/A Sewer/septic service line ~ ?.5 Animal containment areas ~50 ! On adjacent lots On adjacent lots Public sewer manhole/cleanout ./V'/,~, Holding tank Alia Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property line t'[St Absorption field lOt Water service line '7 l l~ I Surface water ~ IOO I Building foundation ~ I Water main /V/A, 'Wells on adjacent lots > Em SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 'Z.D ~ ,/V'[A. Building foundation I ~ t Water main · Water Service line ~ ~.~1 Surface water '7/00 Curtain drain 7 50' - - {~,0,~ Wells on adjacent lots COMMENTS ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal recordsL 3~that the__~aboveyL\ systems_ are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name --~)~v~ o.w~ Date ItIH13.0,0 COSA Fee $ ~ C~' 4~ Waiver Fee $ Date of Payment / /- ~ ~' / o Date of Payment Receipt Number {~) ~-' ~ .,2. ~ ~ Receipt Number (Rev. 11/05) 77-79 TUSTAMENA TERRACE, LOT 1 1 4-3,22~ S.F. FIRST ADDITION 30' N 89~'59'00"E 174.33' 10' UTIL. ESMT. WELL GRAVEL DRIVE $7,0' EXISTING BUILDING N 89°59'00% 36.95' ~ FINAL STRUCTURE AS-BUILT ~, S-B U I L T I' HER~'~ c~-~,~.'.-..T, ~.vE s,.,RV~D TH~- ~PROPERTY DEPICTED ABOVE AND THAT NO ~STALDI LAND SURVEYING IENCROACHMENTS EXIST EXCEPT AS INDICATED. .......... SGS .... SGS ReL# 1105567001 Client Name Spurkland Engineering Printed Date/Time 10/22/2010 14:37 Project Name/# Tustamena #1 LI 1 Collected Date/Time 10/14/2010 10:30 Client Sample 1D Tustamena #1 LI 1 Received Date/Time 10/14/2010 17:00 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Hardness as CaCO3 124 5.00 mg/L SM20 2340B C 10/15/10 10/18/10 KDC Waters Department Total Nitrate/Nitrite-N 2.22 0.100 mg/L SM20 4500NO3-F B 10/15/10 AYC Microbiology Laboratory E. Coli Negative 1 100mL SM20 9223B A 10/14/10 DLC Total Coliform Negative 1 100mL SM20 9223B A 10/14/10 DLC Private Individual Analysis Alkalinity 102 10.0 mg/L SM20 2320B D 10/15/10 LP Aluminum ND 20.0 ug/L EP200.8 C 10/15/10 10/18/10 KDC Antimony ND 1.00 ug/L EP200.8 C (<6) 10/15/10 10/18/10 KDC Arsenic ND 5.00 ug/L EP200.8 C (<10) 10/15/10 10/18/10 KDC Barium 19.3 3.00 ug/L EP200.8 C (<2000) 10/15/10 10/18/10 KDC Cadmium ND 0.500 ug/L EP200.8 C (<5) 10/15/10 10/18/10 KDC Calcium 35000 500 ug/L EP200.8 C 10/15/10 10/18/10 KDC Chloride 6.94 0.100 mg/L EPA 300.0 D (<250) 10/14/10 10/15/10 SDP Chromium ND 2.00 ug/L E7200.8 C (<100) 10/15/10 10/18/10 KDC CO3 Alkalinity ND 10.0 mg/L SM20 2320B D 10/15/10 LP Conductivity 260 1.00 umhos/cm SM20 2510B D 10/15/10 LP Copper 27.3 1.00 ug/L EP200.8 C (<1300) 10/15/10 10/18/10 KDC Fluoride 0.140 0.100 mg/L EPA 300.0 D (<2) 10/14/10 10/15/10 SDP HCO3 Alkalinity 102 10.0 mg/L SM20 2320B D 10/15/10 LP Iron ND 250 ug/L EP200.8 C (<300) 10/15/10 10/18/10 KDC x,~:..i ,x' iiil~' i.. x",,n; !:tried i',, ms nc'.-Jlu, t u nc',,, certificate ul ()n-Si',c al';lU'~:~ u[ i:; h.,,ucd t;~ / MliNI(iIP,,'d I'!'~: iBioCycle Alaska 4971 Thompson Drive Homer, AK 99603 226-2476 office 399-0331 cell Emait: biocyclealaska~gci net Customer steve and Kathy Ginnett 13011 Badger Ln. Anchorage, At< 99516 344-5826 1st Qtr Maintenance 2010 ~ib~ycle LocatTon Huff man Install Date: NoWmber-02 Tank #: 137 MAINTENANCE DESCRIPTION PRIMARY CHAMBER SCUM LEVEL ~OK) HIGH AERATION CHAMBER & AERATION SYSTEM .... BLO'WERI'n: SIZE , ~ O (~) 120 L/M]N OEB~RALCON'DITiON ' ~ ~ POOR SYSTEM: AIR LEAKS ~ ~ [,EAKS ~R DIFFUSE~ SUPPLY ~ ~ POOR ~XED LIQUOR CON~ITI:ON ODO:R CLARIFICATION CH'A'MBER SLUDGE ACCUM IN ITtDPPF;R CLARITY OF EFFt.,UEN'I' DISCHARGE CHAMBER I)ISCHARGE PUMP OPERATING NO ALARMS CHECKED AND 0 ERATINGF,-,-~"~ H't. GH WATER ~/ - NO COMMENTS 1. st Qtr 2010 Maintenance was pertk>rmed today BY: LARRY BETTS DATE: BioCycle Alaska 4971 Thompson iDrive Homer, AK 99603 226-2476 ot2ice 399-0331 cell Email: biocyclealaska~gci.net Customer §'teve and Kathy ~'innett 13011 Badger Ln, Anchorage, AK 99516 344-5826 2nd Qtr Maintenance 2010 '~BioCycle Location Huffman Install Date: November-02 Tank #: 137 MAINTENANCE DESCRIPTION .... RIMAR~ CHAMBER SCU'M LEVEI, AERATION CHAMBER & AERATION SYSTEM BLOWER SIZE AE~'I1ON PRESSb~E NOISE LEk~L GE~RAL CO~)ITION SYSTEM: AIR LEAKS ~R DE:FUSEI~AIR SUPPLY M~ED LIQUOR CONDITION ()DOR HIGH HJGH LF~KS POOR CLARIFICATION CHAMBER SLUDGE ACCLrM IN HOPPER ,A.RI 15 Ol EFFLM:,N I LOW, DISCHARGE CH)dMBER DISCItAROE PUMP OPEIOV17ING HIGH FAiIR CLOUDY NO ALARMS CHECKED AND OPERATINCr:"?'~% COMMENTS 2nd Qtr 2010 'Maintenance was performed today BY: LARRY BETTS DATE: BioCycle Alaska 4971 Thompson Drive Homer, AK 99603 226-2476 office 399-0331 cell Email: biocyclealaska~gci,net Customer Steve and Kathy Ginn~t 13011BadgerLn. Anchorage, AK 99516 344-5826 ~a~i Qtr Maintenance 2010 BioCycle Location Huffman Install Date: November-02 Tank #: t37 MAINTENANCE DESCRIPTION PRIMAaR. Y CHAMBER scum HIGH AERATION CHAMBER a AERATION SYSTEM BLOV~R S~ZE ~, ~?,:'~ 120 L, MIN AERATION PRESSURE (~ HIGH LOW NOISE LEaL ~ HIGH GE~t~ CONDrHON ': Q~ POOR P~ING SYS~I]~;M: AIR I.iEAKS OK, LEAKS AIR DIFFUSEtUAIR SUPPI,Y O~:: POOR MIXED LIQUOR CONDrI'ION ODOR 7, N~J %S CLARIFICATION CHAMBER SLUDGE ACCUM IN HOPI?ER CI,ARITY OF EFFLUENT CLEAR ~ FAIR CLOUI)Y DISCHARGE CHAMBER DISC}LARGE PU'IvlP OPERAThNG ALARMS CHECKED AND OPERATING ~' AItUPOWER / YES HIGH WATER ~. YES NO NO NO ~1~ Qtr 2010 Maintenance was performed today BY: LARRY' BETTS DATE: COMMENTS ,4 B!oCyc e Alaska 4971 Thompson Drive Homer, AK 99603 226-2476 office 399-0331 cell Email: bi.ocyclealaska(~gci.net Custon{~ ~teve and Kathy'Ginne~ 13011BadgerLn. Anchorage, AK99516 344-5826 4th Qtr Maintenance .2010 B!oCycle Location ...... Huffman Tank #: November-02 137 MAINTENANCE DESCRIPTION PRIMARY CHAMBER SCtJM .LEVEL HIGH AERATIO~ CHAMBER & AERATION $'Y'STE~:('~'j BLOW ER SIZE ~60 ~8~0~ 120 L/MIN AE~*.TION P~SSURE ~3 HIGH LOW NOISE LEVEL ~ ~5 H,IGH G ENEP~&L CONDITION SYSTEM: MR LE~ ~ ~ LEAKS AIR DIFFUSEWAIR SUP:PLY ?~ POOR MIXED LtQUOR CONDITION ~R CLA~FICATION CHAMBER. SLUDGE ACCUM tN HOPPER CLARITY OF EFFLUENT CLOUDY DISCHARGE CHAMBER DISCHARGE PUMP OPERATING ALAP&~IS CHECKED AND OPERATING AIR;TOWER HIGH WATER 4th Qtr 2010 Maintenance was performed today BY: LARRY BETTS DATE: COMMENTS vv, ,e 4 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 9951~&-6650 www. ci. anchorage.ak, us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. D I-/-~l-~b 1. GENERAL INFORMATION Complete legal description Lo Location (site address or directions) Current Property owner(s) Mailing address Lending agency Expiration Date: .~' c..c'~ '~-~ ~C,. ~vt-, ~. Day phone Day phone Mailing address Real Estate Agent Mailing Address 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 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 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 sen/ed by a single4amily on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Hea~th Authority Approval are valid for 90 days from the date of issue for properties sen/ed by a private cr Class C we!l and may be reissued with new water sample results. (Certificates may tie reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for proposes served by Class A or B we!Is or a public water system. The Municipality of Anchorage is not responsible for errors cr 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 oufiined in the Health Authodfy Approval Guidelines for this application, shows that the on- site water supply and/or wastewater dispcsal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further vedfy 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 ail applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Address ~..0 '5 t~' / Engineer's Printed Name t-"-'~ DSD SIGNATURE /,~ Approved for /-~ Disapproved. Conditional approval for Phone bedrooms. bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other (Rev Original Certificate Date: / / - ! ¢'/- 0.2__ Munidpality of Anchorage o Development Services Department Building Safety Division On-~ite Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 :.* www.cLanchorage.ak.us (907) 343-7 .9~! ~ ., .' Legal Description: A, WELL DATA Wall type. ~ 'If A. B, or C provide PWSID # 1~6, Date compl,ted D,~I~I~J~ ',{/./,/~cSanitary seal (Y/N) y Total depth ~=~_ff. Cased to IJ, O ft. HEALTH AUTHORITY APPROVAL CHECKLIST LO'T"II, I o~,~-~l-(~t,/A, 'T'I~.E.czAC~_ ParcellD: FROM WELL LOG Date of test Static water level I ~ I ft. Well production e~, g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mi. Arsenic: mg./I. B. SEPTIC/HOLDING TANK DATA Tank Type/Material ~ ;~ ~ 4'/~ Tank size ~ gal. Number of Compa~nents . Foundation cteanout (Y/N) ~ Date of pumping ..,. I~ 7'~r' ' Depression over tank (Y/N) ..~ .u. r C. ABSORPTION FIELD DATA VVell Log (Y/N) ~/ Wires pm~dy protected (Y/N) Caang height (above ground) AT INSPECTION in. Otherbecteria NJ~' colonies/100 mi. Collected by: /~...'.'.'.~u. E.I,,~ ~ Date installed Cleanouts (Y/N) High water alarm (Y/N) Length Zt/O ' fL Wmdth &~ ft. Gravel below pil~ Os ~-~ ft. Total depfn ..~ ft. Eft. absorption area ~ ft2 Monitoring tube ~ Depression over field Date of adequacy test N/~, . Resjlts (Pass/Fall) / For ~ bedrooms Fluid depth in absorption field before test v'/ in. Water added '//gal. New depth t.,// in. Elapsed Time: ~//min. Final fluid depth. -/ in. Absorption rate >= ~ g.p.d. Any rejuvenation treatment (past 12 mOm) (YIN & type) ~/ If yes. give date D. LIFT STATION Date inete;led '~/~r',/~ ~ on" level at ,q.:~ in. 'Pump Datum ~.~.~t~ E. SEPARATION DISTANCES Size in gallons I 'Pump off' level at Cy es , Manhole/Access (Y/N) ',./ High water alarm level at ,~ ~ Meets alarm & circuit requirements? y SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field q..n lot Public sewer mair~ Sewe~/septic service line On adjacent lots Public sewer mannole/cleanout ' Holdin. g tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~.~ ' Property line /'/,~ ' - 'Absorption field Water main /¥/~ '""' ~ ...... ' Water service line ~ ~. Wells on adjacent lots ~'/0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~.-O '" ' "- Building foundation ~' I~1,., Water main Water Service line '~. ~, Surface water · /4 I0.. : · Curtain drain Iq I; Wells on adjacent lots ~' F, COMMENTS I certify that I have detemtined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Date . [~ 0 v/ J I{ ,,~.--¢~¢~.-. HAA Fee $ ~)7~'~ Wa1~er Fee $ " Date of Payment II's/e z. Date of Payment Receipt Number Z,~'O ~'5"' .Receipt Number (Rev. 12/01) On adjacent lots 200 W. Potmr Drive Drinking Water Analysis Report fdr Total Colifoim Bacteria A.c.o..... A~ SSS,,4S0S Yet: {907) 562.2343 READ INSTRUCTIONS ON ~V~IL~ SIDE B£FO~E COt t rCTING $/L~IPLE Fax:. (907) 661.5301 CT&E En.vir. onmental ~1~ '~r~ ~ MUST BE COMPLETED lilY WAI~K SLTPLIF. X PRIVATE WATER SY$IEM Month . Day Year 5AMPLEDATE: SA,MOLE TYI~: -' ,~ Routine lq Trtatcd Water O Repeat Sample (for rouU~e sample o Untreated Water wltlt lab rcf. no. ) r~ Special }'urpose Time* 'Collected SA..MI'LE LOCAT! ON Collected By .% i-lo al,Il _ TO BE COMPLETED BY LABORATORY Analysis shows llti; Water SAMPLE to b~: Saris f~ctor~, lq Unsntisfacto~ Sample cvcr 30 hours old results be ucreT ti> c Sar~le mo long in tra~sH; sample shouM .o~ be o','er~ ~hours old'at examiaation t~ ~ndi:nte reUable re~ult.q. }'lease scad new sara~le ma ~pecial d~tivery mai]. Date Recdved /~ Time]Received Analytical l~Iethod: 1~' Membrane Filter iq MMO-MUG '100ml. Result* Analyst Anch Fbks J~n C11e~t noti]ed of unsatlsfactor~ results: Da~e: Time: BACTERIOLOGICAL WATER ANALYSIS RECORD IqMO-MUG Result: To(al C6Ufeem ~*lembrane FUt.: Dlre~t Cooer VeriflcoUon~ LTB Feral Coliform Confirmation Final Membrane Filter Results Reported By · (~ Colonic/t00 ml BGB COLIFIRM CotKorm/lO0 mi i ~... 11~~ Uernb~rofmeSOSOrouplSoc~t6Oan~ratedlSUtve0ienCel ...................... - ..... -:.- ,-~..2=..':_ 4 '---- ;I-1~-0~ l§:Ot FROU-CT~ E,'I~ I ~,'l'~il. ~TK CT&E Envir~montal$*rvlce~lnc. 9C~SE15~OI CT&E Cltant Name Me(rix 1027739001 Tobben ~mld.u~l P.E. 13011 Lowflo Well 13011 ~o Well 0 SL~. gle Ra-aark~. £P 300.0 - San~le run pasl bald 4S hours. R~sults maybe bias~l high. Units 0.797 0.600 nWL EPA 300.0 AH Dalfl/Tlmes art Ala~l gt~odard Time ?rlnfed DatrJTIme I I/1~r2002 16:1~ Collected ~t~lme l I/0~2 16:40 R~dvad Dat~ ~ 1~2 16:40 TItcbnlc~ DIrKler Rel.aL-d BY ~~ ('~=lO) ]1/12:02 ~ ~,t.~ rob ioloi, y l, abo:ntot¥ Tolsl Coh form 0 col/lOOmL ~:MIS g222n