HomeMy WebLinkAboutTUSTAMENA TERRACE #1 LT 13Tustarnena
Terrace
Lot 13
#017-381-49
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Name: ~U pg rad e
'~M~ ~A~ Wastewater System: ~ New
Address:
IN°'°f~dr°°ms: ~eepTrench ~ Shallow Trench ~Bed ~Mound DOther
Soil Rating: Total Depth from original grade:
Lot: Block: Subdiv~ion: ~l' ~ Depth to pipe boEom from original grade: Gravel depth beneath pipe
Township: I Range: I Section: Fgl added above orlginal grade: Gravel length:
WELL: ~ New D Upgr~ ~rave]width: ~umberoUines: IDis~anceb~tween]in~:
Classification (Private, A,B,C): ~pt~ Cased To: Total absorption area: Pipe material:
r~/ Ft. Ft. ~W~ SQ. Ft. ~lo
~ GPM Ft., Ft.
TANK
Pump Set at: ~ Casing Height Above Ground:
SEPARATION DISTANCES ~pt~ u Holding ~ S.T.E.P.
To Septic Absorpgon Lift He,ding Public/Private Manufacturer: Capaci~in gallons:
From Tank Field Stagon Tank SewerLines ~' ~O~ ~ ~ ~
Material: Number of Compa~ments:
Sudace '~+ ~ LIFT STATION
Water ~ ~ ~
mat:
Remarks: BENCH MARK
Loc~tion and Description:
I Assume Elevatio '
ENGINEER'S SEAL
Department of Heal~ an~uman_Se~ices approval
Reviewed and approved by: Date://-2~-~ "~- ~ES~
72q)13 (Rev. 9/91) MOA 25
' PERMIT Nh,
UPGRADE SYSTEM
7' EFF, G3 LF
10' TOTAL ~EPTH,
SW970351
WASTEWATER ABS~RPTIrlN SYSTEM
LnT 13, TUSTAMENA TERRACE
TRENCH SYSTEM,
60 LF, 9 Tn II,B'
EXIST,
HOUSE
P,I,D, 017-381-49
WELL
EXIST, WELL
S~/ING-TIES
CO A B
TI 38,7 53,8
T8 46,3 61.5
DV 484, 63,6
lid 48,3 63,4
Ct 37,3 51,7
MT 46.3 59,8
C8 9%6 110,3
98,5' -~] ~L~
~ SEPTIC TANK
TANK ELEVATION
EXISTING TRENCH
SYSTEM IN FAILURE
TO BE REUSED,
Lot 14A
Deep Trench 60' Lon0, 3' Wide.
TRENCH PROFILE
tawing C;\~/or'k N13TUST.'nWG
MT CD
7
TRENCH SECTIDN
79.1' Bottom oF Test Pit
ND WATER FDUN~
PREPARED FDR~
Dennise H~rdy
5500 N~knek Drive
Anchorage, AK 99516
(907) 753-5730
PANNDNE ENG. SVC
P. 0. BOX 142025
ANCHORAGE, ALASKA 99514
227-3582, 272-8218 F~x
nATEi 10-86-97 IAS-BUILT
SCALE' 1'=60'
I
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW970351
DESIGN ENGINEER:STEVEN R. PANNONE
OWNER NAME:HARDY DENNIS L & BONITA J
OWNER ADDRESS:5500 NAKNEK LN
ANCHORAGE, AH 99516
DATE ISSUED:10/03/97
EXPIRATION DATE:10/03/98
PARCEL ID:01738149
LEGAL DESCRIPTION:
TUSTAMENA TERRACE Mi LT 13
LOT SIZE: 114955 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 { 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS
RECEIVED BY: . .~
DATE:
DATE'.
Steven R. Pannone, P.E.
Consulting Engineer
(907) 272-8218
P.O. Box 142025
Anchorage, Alaska, 99514
(907)272-8218 Fax
September 22, 1997
Municipality of Anchorage
Dept. of Health & Human Services
On-Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519
Subject:
Lot 13 Tustamena Terrace Subdivision
Septic Upgrade Permit
Gentlemen:
My firm was contacted to investigate the septic system serving this lot for an upcoming sale. The existing trench system
was tested to determine its adequacy for a four bedroom house. The system was found to be in failure. A single test hole
was excavated on September 15, 1997 for a system upgrade. The soils report and a percolation test result is attached.
Ground water was monitored for seven days. No groundwater or bedrock was encountered in the test hole.
The lot is approximately 0.9 acres in size. Lot 11 slopes to the northwest at a rate of approximately 1 to 3 percent. The
proposed installatiun will be locateA on the south western portion ofthe lnt. The exisfmg field will be reused. Adiverter
valve will be installed between the two fields. The septic tank wilt be verified during the installation It will be reused if
found competent and replaced if found leaking. Double clean.outs will be installed down stream from the tank. The
proposed location is greater than 100 feet away from the existing well serving this property and 25 feet from the water
service lines. The surrounding wells are located greater than 100 feet from the proposed installation. The proposed
installation will not affect the future development of the surrounding or exist'rog lots. See the attached design.
If you have any questions about the proposed installation, please contact me at 272-8218
Sincerely, ~:
~, P.E.
C:\WOR1GI3TUST.001
DESIGN
WASTEWATER ABSnRPTIF1N SYSTEM
LDT 12 TUSTAMENA TERRACE
P,I,D, 017-381-49
~XISTING TRENCH
~YSTEM.
TRENCH
7' EFF, 63 LF
10' DEPTH.
C.D. AT
ENDS PLACE M.T. AT
END.
~SYSTEM
7' EFF, 63 LF
10' TOTAL DEPTH.
/
EXIST, 4
HOUSE
,/
WELL
EXIST. WELL
Lot 18
IS LBCATED
THAN 200'
PROPOSED
AND
WITHIN 10'
EXISTING TRENCH
SYSTEM IN FAILURE
TO BE REUSED.
VALV
WELL IS LOCATED
GREATER THAN 800'
FROM PROPDSED
SYSTEM
EXISTING BED
SYSTEM
Drawing C,\Wo~-E\t3TUST,DWG
DESIGN:
Pert R:te : 12 Min/Imch
Soils= 188 s~/br
4 Bedroom House
750 SF Rqd
Deslg~m 7' E~O~ective .. 'i
10' Total Depth : .
3' ~ide, 63' Long
To~[ Absorption =,888 sC
PREPARED FDR,
Pc~mnone Eng.: Svc~
Dennis Hardy
5500 N:knek Drive
Anchorage, AK 99516
(907) 753-5730
P, D, BDX 142085
ANCHDRAGE, ALASKA 9.~514
878-8818, P~DNE & FAX
DATE, 9-16-97 '1 DESIGN
SCALE~
!
DESIGN DETAILS
~ASTE~/ATER ABSORPTIDN SYSTEM
LFIT 13 TUSTAMENA TERRACE
P.I,D. 017-381-49
z
w
I)miwlng C~\Work\13TUST,I)WG
PREPARED FOR,
Dennis Hardy
5500 Naknek Drive
Pannone EmS. Svc,
P. 0. BDX 142025
ANCHDRAGE, ALASKA
Anchorage, AK 99516
(gO7) 753-5730
99514
272-8218~ PHDNE & FAX
DATD9-21-97
DESIGN
:NPT TO gCALEI
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
625 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: ~- I~ --FI~,~T~N &,~,)A "/-'/=~(~- Township, Range, Section:
DEPTH
2
3
4
5-
6-
8-
9-
10 -
~2 -
~4 -
15 -
16 -
18 -
~9 -
20 -
SLOPE
WAS ROUNDWATER
ENCOUNTERED?
S
L
iF YES, AT WHAT O
DEPTH? ~
E
Oeplh to Water ~ei'
Monitoring? c¢~2 ~""""""""'~-D~le:""~ ~r~
SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE ~ ~' (minutes/inch) PERC HOLE DIAMETER .
TEST RUN BETWEEN "~ FT AND ~ FT
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE.
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE:
'~;--~! MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
~ * ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- AnchoraDe, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PL~ONE ~FNEW
LEGAL DESCRIPTION
LOCATION ~0. OF BEDROOMS
~z
~ Manu factur~ Mat~ No,compartments
Liq. ca acity 'n gallons Inside length Width ~ Liquid, th
~ DISTANCE TO: ~ ~
~ ~ l No, of lin~ Length of each line Total length of li.~,~ Trench widt~ ~inches Dista~en lines
~ Top of tile to finish grade ~ ~ Total effective absorption area
~ ~ / Material beneath tile ~ ~hes
~M Type ~'b~ ~ C~ ~ ~P¢%ve abs°rpti°n are~
~ ~ANCE TO: ~ - ~ ~uilding fo~ . Nearest I~~
~ ~ ~ I Depth Driller Distance to lot line PERMIT NO'.
OTHER
PIPEMAT~ ~ ~
INSTALLER /~ ~
72-013 {ev. 3/78)
PERMIT NO~
RPPLICBNT THOMRS SHOEMRKE
LOCRTION TUSTRMENR TERR-NRKNRK LN
LEGRL L±2 TUSTRMENR TERR RDD ±
TYPE OF SOIL RBSORPTION S~'STEM IS: TRENCH
MRXIMUM NUMBER OF BEDROOMS = 2 SOIL
THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS:
DEPRRTMENT Or HERLTH FIND EN',,,'IRBNM~)~.CF.r.:IL P,-..,.]TEC:TION ....
L=:25 '"L"' STREET, RNCH~?RGE., ~K. E~95E~i
264-472E~
B,
'- ' "
R HT I N = FT/BR ) =
LOT SIZE 4F~aC4:= _,b!UHRE FEET
THE LENGTH DIMENSIBN IS ,THE LE~jGTH (IN FEE~;k.OF THE TRENCH OR [:,RRINFIEL[:,.
THE DEPTH OF R TRENCF BR PIT IS THE DI.~E BETWEEN THE SURFRC:E CIF THE
uRuUND HN[ THE EL ITEM O~ THE bXLHV~TZO~4 ~.~N FEE~.).
THERE "-
Z=, NO SET P~Z[:,TH FIR TRENCHES.
THE GRRVEL DEPTH I~ THE MINIMUM DEPTH OF ~'¢EL BET~4EEN THE OUTFRLL PIF'E
RND THE BOTTOM OF THE EXCRYRTION (IN FEET~
F_RMIT RF'PLICRN'F HRS THE RE.=,PuN..,IE, ILI r,. Tu IL~(~c,~,~ C~EFHRTMENF [.URINb THE
IN=,TRLLHTION IN_,PEE. TI_N_, uF RN~ LELL=, R[.,.IRI_.Eb F ~O~T.P]~ ~ROFE~ F~ ~N[., THL
NUMDER OF RESIDENCES THRT THE NELL MILL SERYE.
BRCKFILLiNG OF RN'~ .......m==,.m.'~f* P.IITHOUT F'INRL INSF'ECT-~ RND [tPFRL- ' ']~",HL E,r"' THIS
[EFMRTMEN] k!ILL _,E =,UE,~_CT TO PRZSECJTION ,'
MZNZMUM DI~TRNCE BETI4EEN R WELL RNEJ ~-'SITE SE:P~RGE [:,ISPOSRL SYSTEM IS
iC~e FEET FOR R RRI',,,'RTE FIELL OR ZSe TO 2~¢~'T F'RoM~ F'UBLIC 14ELL [:,EFEN[:,ING
UFON'"' THE TYPE OF PUBLIC I.,~E:LL. '' ;.
MINIMUM [.I=,T~NCE FROM R PRIYRTE HEL_ TO R F'RIYRTE-=,~IqER LINE IS Z5 FEET RND
TO R COMMUNIT'¢ ¢c[
OTHER RE~UIREMENT$ MBY RPPLY~ $PEC:IFICBTIONS Bb?,~ L,~FRU..FIuN [:'IBGRRMS ~RE
I CERTIF"¢ THBT
~: I FtM FRMII_IRR WITH THE RE6IUIREMENTS FOR ON-SIsTE .=EHER~ RND HELL=, FIS SET
FORTH B'¢ THE M_NIZIPR_ITY OF' RNCHORRGE ~ , ...
2: I NILL INz, TRLL THE ~T_TEfl IN RCC:ORE:,FINCE MITH THE' C0[:,~$.
2: I I_INDE~"~TR[,R, THRT THE: uN-=,ITE SEWER _T=, :~1 MFI'¢ RE6ILIIRE ENL EMENT IF THE
RESIDENCE IS mEMnDELEB TO TNr':LItDE MORE ~. z, E, EDRuUM=,.
RPF'LICRNT THIJI 1H_, SHOEMF!KE ~' ~"
LOT S[Z~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH, AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anc~h'orage, Alaska 99502 276-222I
SOILS LOG -- PER(~OIcATION TEST
[] SOILS LOG
~ PERCOLATION
TEST
LEGAL DESCRIPTION;
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
DATE:
825 "£" S Fi~EET
A ~,i Ct IQ HA¢; :, A I_ASI(A ac,.;o,,:, '
(907} ;¥:4 d]] !
January 4, 1982
Tom Price
SRA Box 3750
Anchorage, AK
99507
Permit ~ 810621
Subject: L13 TUSTAMENA TERRACE S/D
A permit issued by this department for a well and/or sewer
system has expired as of December 31, 1981.
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 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 call this office
at 264-4720.
Sincerely,
pL~oSg~:mB~aChnha~leZr~'
Sewer and Water Program
Enclosure: Copy of Permit
DEF'RRTMENT 0', ,dERLTH RND ENVIRONMENTAL F JTECTION
825 '"L'" STREET,, FINCHORFtGE., BK. 99501
254-4?20
1.4ELL PERE'I ! T'
PERMIT NO. ( 8i0G2± )
8PPLICANT TOM PRICE
LOCATION NRKNEK
LEGRL
SRR BU,, ~75~ ...... ~
L 12 TU--,TRMENR TEF. RR_.E
LOT _ I~.E
345-1±79
490A0 S'Z~_FIRE FEET
MINIMUM DISTANCE BETWEEN R HELL. RND RNV ON-SITE SEWRGE D!SPOSRL SVSTEM IS
t00 FEET FOR R PRIVF:ITE WELL OR t50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON TNE TYPE OF PUBLIC WELL
MINIMUM DISTRNCE FROM R PRIVATE WELL TO FI PRIVRTE SEWER LINE IS 25 FEET AND
TO R COMMLINITV SEWER LINE IS 75 FEET.
WELL LOGS RRE REQUIRED RND HUST BE RETURNED TO THE DEPRRTMENT 1.4ITNIN E:O DAYS
OF THE WELL COMPLETION.
OTHER REt~UIREMENTS MRV RPPLV. SPECIFICRTIONS RND CONSTRUCTION DIRGRRNS RRE
RVRILRBLE TO INSURE PROPER IN;STALLRTION,
F"E F':E.1 I T E:=-::P I F-. E__ [:,E C:E ~-IE: EF-:: 7_<:1~.,
I C:ERTIFV THRT
±: I RM FRMILIRR WITH TWE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BV TNE MUNICIPRLITV OF RNCNORRGE.
~:: I WILL INSTALL THE SYSTEM IN RCCORDRNCE WITH TNE CODES.
_,IGNEC ...............................................
FIPPLICFtNT TOM FF. I.,E
IS'S_ED E'9_ ............................. DFtTE-~£~J_=~Z ....... V4. 0
.~" F'~-'NICIPALITY OF ANCHORAGE ?'~. ' ' n
Department o~ Health and Environmental - o~ec~lo
~ 825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT
WELL A'~~~ PERMIT
Location: ,~//~ /~_~ /~ Phone Number: ~ ~LS~'- /
/
Legal Description: ~ /'3 ~-~'~/~/~-/~/~ Lot Size: ~~~3
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage Bed: __ Holding Tank:
Maximum Number of Bedrooms: ~ Soil Rating (sq. ft/br)
The Required Size of the Soil Absorption System Is: '
DEPTH LENGTH GRAVEL DEPTH WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 1 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
~~residence :~ ~7~ '--"'
the ~i~eK~_~ to include more that/~/bedrooms.
igne Issued 'by
S
~ ~'~ -~Applicant . ~/'C/ /LC --~, ~
SWP/024(1/81)
v�6 '1 8 9 '0
r\d� 7
•
• Municipality of Anchorage a ,1\10 8 20/ - :�
On-Site Water and Wastewater Program $ • « �� i •
(907) 343-7904 " ' 4 -
4144Y-
6 t `
Certificate of On-Site Systems Approva\
017-381-49n• _ :
Parcel I.D. Expiration Date:
1. GENERAL INFORMATION
Complete legal description Tustamena Terrace #1 Lot 13
Location (site address) 5500 Naknek Lane
Current Property owner(s) Robert Bowler Day phone
Mailing address 5500 Naknek Lane Anchorage, AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING:
E] Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by. S 4 A. T Q U J Date: (41W/1-
COSA
Q 41 l /1-
COSA to be released to the engineer, unless of erwise requested y the engineer.
COSA Fee $ J�r-at Waiver Fee $
Date of Payment WV/ji 9 Date of Payment
Receipt Number 0a U d1Receipt Number
COSA# 6 5ciwza 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. w '
In conducting an adequacylest,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 618/2017
.—e..OF Ak4 kkk
I
*9P •••J� q*A
6. DSD SIGNATURE '
.m (---- 0
rA
System #1 Approved for 11 bedrooms •S1.even H•nnone . fie
System #2 Approved for bedrooms fvii¢•,. CE-81495
Disapproved ,�kviek.„c'.
Conditional approval for bedrooms, with the following stipulations:
,,y--v( OF AiVCyo
nOp,..
-N!ASTE\NAGE" o
.-c,� PRCGkAiv --
c��
.r
,*nt.T .-r.".,
E37.-- rt-. ----
y: im. Original Certificate Date: Cc:>---/ti—i7
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 __X__
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_c _
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description Tustamena Terrace #1 Lot 13 Parcel ID: 017-381-49
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (YIN) N*
Date completed UNK Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 123 ft. Cased to 121 ft. Casing height (above ground) 1 8+ in.
FROM WELL LOG AT INSPECTION
Date of test UNK 5/31/2017
Static water level UNK ft105. ft
Well production UNK g.p m. 3 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 9.05 mg/L
Arsenic ND ug/L Date of sample: 5/31/2017 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SeptICISteel Date installed 10/22/1997
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 - t-/-167 Pumper P\*
C. ABSORPTION FIELD DATA
Date installed 1012211997 Soil rating (g.p.d /ft2 or ft2/bdrm) 0.8 SF/BORN System type Deep Trench
Length 60 ft. Width 3 ft. Gravel below pipe 7 ft
Total depth 11 .9 ft Eff. absorption area 840 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 5/31/2017 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 41 in. Water added 600 gal. New depth 45 in.
Elapsed Time 1440 min Final fluid depth 41 in. Absorption rate >- 600+ g.p.d.
N
Any rejuvenation treatment (past 12 mo ) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+ On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 100+
Sewer/septic service line 25+ Holding tank 00+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
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+
ABSORPTION FIELD ON LOT TO:
Property line 1 0+ Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 1 00+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
*No well log. Well camera & inspection 8/12/2012.
St.M,0,9 ani.
G. ENGINEER'S CERTIFICATION -.��4G ,
I certify that I have determined through field inspections and ,.r�'���v 1
review of Municipal records that the above systems are in 0*.- 49TH 1\ •*y
conformance with MOA COSA guidelines in effect on this date. % •••• - f
r %_` t, '
Engineer's Printed Name Steven Pannone = '.S evenc:. llonnone .
[ I 6.9;-.. CE-8149• ii
rr
Date L.Y fl ' YOO '
COSA canary sheet_2-6-15.doc
• Municipality of Anchorage �'..II
k i_ Development Services Department
Building Safety Division , [IV
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 171234
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
13 of Tustamena Terrace #1 subdivision. This inspection revealed a nitrate
concentration of 9.05 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 Street
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.ancho rag e.a k.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 017-381-49
1. GENERAL INFORMATION
Complete legal description .
Expiration Date: /O - /~-- D.P-_
Lot 13 Tustamena Terrace #1
Location (site address or directions) 5500 Naknek Lane, Anchorage, AK 99516
Current Property owner(s) Dix Littlepa.qe Day phone 348-2592
Mailing address .5500 Naknek Lane, Anchora.qe, AK 99516
· Lending agency
Day phone
Mailing address
Real Estate Agent
Becky PowelFReMax
Day phone 244-5881
Mailing Address
Unless othenMse requesfed, HAA will be held by DHHS for pickup. HAA picked up by:.
2. ' NUMBER OF BEDROOMS:
4
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
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) on properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to home owners. 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 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.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal afro(ed hereto ar~l as of the validation date shown below, I vedfy that my Investigation
based on procedures outlined In the Health Authority Approval Guidelines for this Health Authority ^ppmval
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 further verity 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 applicable Municipal and
State codes, ordinances, and regulations in effect at the time of Installation.
Name of Firm Pannone En,q. Svc. Phone. 272-8218
Address P.O. Box 102954~ Anch, AK 995'10
Engineer's Printed Name Steven R. Pannone, P.E. Date "~//~ ~
Engineers Comments: In coaducting an ad~tuacy tcst, I attempt to provide a thomtm~, c~.scicntious ~'~"~"-'~' ' ~
caginccri~g analysis of[he systcra in accord~ce with MOA DSD Guidclinc~ & P,e~dons. The ~, ,'~ ...... ...~//~%
thc tc~t, and scpm'ation distancc~ measured to readily idc~thiabl¢ fcaturcs. The opcrational li£c o£ all ~ '-9,.,." ,._~ _~.
wells a~d scptic sy~er~ depend on thc local soil condifion, gmtmdwa~lcve~t~yfl~ ~'~."* --~T~ ~
..... · . 'q-~d __ /'~% · ·
during the )~mr. and the water -~e of the family being served by thc system. The~e condJQons are ,~...~ ...r~,~,.--. ........... .~....~
results do not gu.at, nice future lx:d'ormancc of ~e system, nor do they guar~mtec t~at t~erc arc no ~~;...':~. .......
hiddendefect~orcncmachm~mt$.PEScanthcrcforcnotpm,,q~y~m~m~for~o~ ~'~_ ..$teven R. Ponnone..~$
norgiveany~matcofhowlongmesystem~llcontianetomectt~eopentionalrcquircmeauofm¢ ~O,/r~'-.' No. CE 8149
ADEC or MOA DSD. T'a¢ contcat o£~s report i~ for ~e sole benefit ora¢ o~,~er listed above. A~y }e%~"'.C)'~cD¢~O ~ ...e~, ,~
6. DSO SIGNATURE
~ Approved for ~ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Attachments: HAA Checklist
Septic System Advisory
Well Flow Advisory
By:
Expiration Date:
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: 7 - / ~-'' ~'~'--
Reissue Date:
Total depth 123 ff
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw Street
' P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 13 Tustamena Terrace #1
A. WELL DATA
Well type _P If A, B, or C provide PWSID # Well Leg _N
Date completed ~gt~/v~L~3t''', Sanitary seal Y Wires properly protected Y
Cased to '1~1 ft Casing height (above ground) ,
FROM WELL LOG AT INSPECTION
Parcel I.D.: 017-381-49 ·
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform ~ colonies/100 mi
Date of sample: 71812002
B. SEPTIC/HOLDING TANK DATA
It It
. g.p.m ~,~4 g.p.m
Nitrate Z~, ~/'~ rng/I Other bacteria
Collected by: Laura Pannone
Tank Type/Material Anchoraoe Tank Steel
Date installed 10122/1997 Tank size 1250
Cleanouts Y Foundation cteanout Y
gal
in.
~ colonies/lO0 mi
Number of Compartments
Gravel below pipe 7 It
Monitoring tube Y D~pression over field IN
P For 4 bedrooms
New depth32 in.
Absorption rate >= 600 g.p.d.
If yes, give date
Length 60 fl Width 3 fl
TcY~al depth 1tt88 ft Effective absorption area ~ ft2
Date of adequacy test 718/2002 Results (Pass/Fail)
Fluid depth in absoq~tioo field before test 27 in Water added600 gal.
Elapsed Time: 60 rain Final fluid depth 27 in
Any rejuvenation treatment (past 12 mo.) 0(/N & type) I~
(Rev. 11/99)
Date of pumping 7/812002 Pumper A+ Home Services
C. ABSORPTION FIELD DATA ~)IC0,-~-- o. Lso ,_~p_. Col3qff~ .-.~-.'iL/'(~ C)~ ~./~._,~c~. o.~
Date installed 10122/1997 Soil rating (g.p.d./fl= or ff2/bdrm) .08 System type Trench
Depression over tank N
High water alarm NIA
D. UFT STATION
' Date installed
Size in gallons
'Pump on" level at in'Pump off' level at
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
· Septic tank/lift station on lot 140'
At~orption field on lot 164.S'
Public sewer main 1Q0+ '
Sewer/septic sewice line 190+
Jn
Manhole/Access
High water alarm level at in
Meets a~arm & circuit requirements?
On adjacent lots 100+ -*
On adjacent lots 100+
Public sewer manhole/cleanout
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Property line SO'
Water sewice line 25+
Wells on adjacent lots 100+
Building foundation 30'
Water main
Drainage 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation 35'
Surface water 100+
Wells on adjacent lots 100+
Property line 10'
Water Service line
Curtain drain 100+
F. COMMENTS
Water matn 100+
Driveway, parking/v~icle-s~age 30+
$
Date of Payment
Receipt Number
(Rev. 1
Engineer's Printed Name Steven R. Pannone. P.E.
Date '~-/~ [~7~
I certify/hat I have determined through fle/d/nspeotfons and
review of Municipal records that the above systems are in
conformance w/th MOA HAA guidelines in effect on this date.
100+
AbSOq~ti0n deld 15'
Surface water 100+
Two Trenches. Installed 1981 & 1997. Tested new system 1" Ilduld in old. Dh(,
ENGINEER'S CERTIFICATION
'Z
L = 170.74
X
X
X X
S B7°34'3rl"w 1
0
LEGENO:
X SEWER VENT
j!.'L-I~-OZ 04:ZlP~ FI~t~T&E F./~¥1I~M[~TAL SRV
CT&E Eevlrenmmlta!
lac.
07/0&'02 JDT
To~ Colit'~rm O
col/IOOn.L SMII p_~?']~t (":l) D'7/Q&'02 SSt[
Parcel I.D. #
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
HAA # ~,~c~-'~
1. GENERAL INFORMATION
Complete legal description /._c~'T- /'~ ', ,~&-~,~,A "'~--~-z~¢~ ¢6 ¢ I
Location (site address or directions)
Property owner~'3:~
Ma!ling address
Lending agency
Mailing address
Day phone
Day phone
Agent
Address
Dayphone '~'/~-
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
NOTE:
Individual well
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA#21
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 further verify that based on the information obtained from
the Municipality of Anchorage flies and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with ail Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm~-"~r~,*o~,'~--- ~-~c~. ~:.xz~ Phone '~c~'~-~l ~
Address ~:~.c~ ,~ './-. l q~_ ~-~- /q ,,,~ o ~ /3, I~,, c3 ~._~-I ~1
Engineer's signature~3~-'~
[:)ate
DHHS SIGNATURE
/'~ Approved for '¢
Dis'approved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
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 thia 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.
Municipality of Anchorage
DEPARTMENT OF ,EA'TH & HUMAN S RWC
Environmental Se~ices Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 4 41997
. . Municipali~ of Anchorage
Health Authority Approval CnecK ist Dept, Health & Human Se~ices
Legal Description: Z,
A, WELL DATA
~ell type~'~,J A,~-47-- If A, B. or C, attach ADEC letter. ADEC water system number
Log present (Y/N) '~ K
Total depth (~-3 ~E)
Sanitary seal (Y/N) ~
Date completed' U ~ E.~oc,J~J,
Cased to I~ [ ~ ~- E) Casing height (above ground',
Wires properly protected (Y/N)
FROM WELL LOG ·
AT INSPECTION
Date of test
Static water level
Well production
g.p.m.
WATER SAMPLE RESULTS:
Coliform '~ ~
Date of sample:
B, SEPTIC/HoLDING TANK DATA
Date installed ~/C~./~./'~ Tank size
Foundation clean0ut (Y/N)
Date of Pumping '
C, ABSORPTION FIELD DATA
Date instailed /c,/~ ~-
Length ~'E:) Width
Effective absorption area
Nitrate '-~. ~'"~
Collected by:
Other bacteria "'"'~'-"'
l~__~c-) Number of Compartments ~- Cleanouts (Y/N).__
Depression (Y/N) ~ High water alarm (Y/N) ~
Pumper A,''t- [J,-~,//~- ~ ~ (
Soil rating (g.p.d./fF or fF/bdrm) ~::', ~ System type ~
'~ Gravel thickness below pipe ';:~ Total depth
. ~ z~C~ Monitoring Tube present (Y/N) ~ Depression over field (Y/N)
Date of adequacy test
Results (Pass/Fail) '~A .-~-.,% For ~
bedrooms
Fluid depth in absorption field before test (in.);
Fluid depth
(ins) Minutes later:
Immediately after ~-gal. water added (in.):
Absorption rate = "--- g.p.d.
Peroxide treatment (past 12 months) (Y/N) ' If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed , Size in gallons
Manhole/Access (Y/N)
High water al~~j ~1~
~d
E. S~PARATION DISTAN~£~
"Pump off" level at*
SEPARATION DISTANCES FROM ,WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot /~, O, ,,~-
Public sewer main
Sewer/septic service line / :~ c:~ t
On adjacent lots
On adjacent lots / cpo
Public sewer manhole/cleanout
Lift station /
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ~-~ ~' Property line ,~-o ¢ Absorption field /4¢
Water main/service line .~'C.P ~ Surface water/drainage /-c~c~ ~ Wells on adjacent lots
SEPARATION DISTANCE FROMABSORPTION FIELD ON LOTTO:
Property line ! ¢ ~ Building foundation ~.~,-~' Water main/service line
Surface water / ¢:~:2''~' Driveway, parking/vehicle storage area
Curtain drain /c~c~ ~ Wells on adjacent lots /¢=c~ -(
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and revi~
in conformance with MOA HAA guidelines in effect on this date.
Signatur~~~'~-
Engineer's Name -...%-I'
Date /~/"~/~
are
HAA Fee $ .'~-~ ~
Date of Payment
Receipt Number {~ % ~_).~,L&,
Waiver Fee $
Date of Payment.
Receipt Number
72-026 (Rev. 3/96)*
2.00 W. Pot[er Drive, Anchorage, AK 95518-1601i --TEl: (907) 562-2343 Fax: (~7) 56i~5301
=~ ~ger noa=, ~l~n~, AK ~87~5471 --Tel: (~07) ~7~a666 Fax: (907) 474,9~
~T-38-1997' 18:89 CT[E ESI ANCHORAGE 98?5615381
CT&E Ref.#
Client Name
Prelect Name/#
Ctien~ ~uaple ID
Matrix
976611001
Pannonc I~ Sty.
LI3, ~cna,o~ag~ 5~
Dr~g W~er
10/29/97 13:07
10/2~/97 ~:~
~{trate-~ 3.52 0.100 mg/L EPA 3OB.0 ~0 m~x ~/~?/~? GCP
Total CeHform 0.00 cot/10OmE ~418 ~Z2B 10/27197 T~W
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SiTE SEWER AND WATER FACILITY
264-4720 ·
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 13 Tustemena Terrace Subdivision
Location (address or directions)
5500 Naknek Lane
(b) Applicant Name Dennis Hardy Telephone: Home 345-3642 Business 753-2810
ApplicaetAddress 5500 Naknek Lane, Anchorase, Alaska
(c) Applicant is (check one): Lending Institution [] i Owner/builder []; Buyer []; Other [] (explain);
(d) Lending Institution
Address
(e)
(f)
Telephone
Real Estate Company and Agent
Address
Telephone
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family J~x Multi-Family [] Other
Number of Bedrooms three (3)
WATER SUPPLY
Individual Well [~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite [kx Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (~1/84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto an¢ as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances! and regulations in effect on
the date of this inspection.
Name of Firm Telephone
Address
Date
This office has received written confirmation from the owner(Dennis L. Hardy,
P.E.) regarding the conditional approval dated March 12, 1986. As per
his written confirmation, the cleanout pipe after the septic tank has
been repaired.
Engineer's Seal
Approved for three(3') bedrooms by te March 18, 1986
Approved xxxxxx Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a cedificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
I_EGAI_: TUSTEME]"..IA HEIGHT':3 SUBD/LOT 13
5500 NaF:nek Lane
Anchorage~ Al,:,, 9951.6
:[6 Mar'ch,¢ 1986
MI.tnic:ipality 0~: Anchorage
Departmerrf: o~: Health and Er~virc)nmenttal
Division o'¢ Environmantal Health
DEN cert::i.~::i, cate .For on....-si','.':e sewer/water dated 10 Marc:h 1986
[In 16 Marc:h I inspect:ed the pipe. It is a 4" diameter F:'VC
pipe with [:~(~;,].ZI. and hub ~::i.t:t::i. ng. 'The 'Fitting is loc:ated near the
t'.hE:~ C:[3l][~ec:'!':ic)l'l. ]: r'l.z, mc)vE.d thE. s~oJ. 1 "[:r"c)[~ arc, und t:he '~:itt~l]g
re?connected t'.he pipe. ]"o preclude ~UtLU'*'e .jac:kir~g prc)blems,~ i
Dennis L,, Hardy,~ P,,E,,
0 v,~ n e r
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720'
Application Date ..~/O ~'~'
GENERAL iNFORMATION
(a} Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) CApplicant Name ~E'.~CJ~5 //~1~/ Telephone: Home ~¢~'''--~'~'r/~7' Business 7
' '~ Applicant Address ~ ~ ~ ~/ ~
(c) 'A~licant is (check one): Lending Institution ~; Owner/builde~; Buyer ~; Other ~ (explain);
(d) Lending institution
Address
Telephone
(e)
Real Estate Company and Agent
Address
Telephone
(f)
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family'~l~ Multi-Family []
Number of Bedrooms
Other
WATER SUPPLY
Individual Well~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status. ~'
4. SEWAGE DISPOSAL
... Onsite~, Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
'attesting to the legality and status.
Page 1 of 2 72-025 (11/84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown~ below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection. /~' ~'"¢¢/_ ~../'.
Name of Firm Telephone
Date
Approved Disapproved Conditional
Terms of Conditional Approval ,~/)',~Z../ /'7~_~,¢~/,,~ %¢
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements, Employees of DHEP do not conduct inspections or
an, alyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions iP th, e
professional engineer's work.
Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legar Description: ~z~'7"~
MUNICIPALITY OF ANCHoP, AG~
DEp~, OF HEA~.TH &
ENWRONMENTAL PRoTEcTION
MAR 1
RECEIVED
A. WELL DATA
Well Classification
Well Log Present (YO'
Total Depth~ /,~¢-~ ~
Static Water Level (~
Casing Height Above Ground
If A, B, C, D.E.O. Approved (Y/N)
Date Completed /A'/J'~"I)~/'~} Yield ~_~.")
Cased to~ /~-~/! 4//~/u//A
Depth of Grouting
Pump Set At
Sanitary Seal on Casing~N)
Depression A. round Wellhead (Ye
Electrical Wiring in Conduit Y~)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on L~t /~ 0 ·
To Nearest Public Sewer Line
Cleanout/Manhole ~/~
Water Sample Collected by /¢'~--~
Water Sample Teat Results
Comments~ /~/~-- ~ '7"~"~'2''~
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Near~st Sewer Service Line on Lot
; Da~e,
SEPTIC/HOLDING TANK DATA
To Water-Supply Well
To Property L~ine
To Water Main/Service Linb
Course
Comments
Date Installed
Standpipes~q)
Depression over Tank (Y~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y?N) ,~/,~
Separation Distances from Septic/Holding Tank:
Size /~'"'"'"~"O '~//'¢ No. of Compartments
Air-tight ~aps~) Foundation Cleanou~)
Date Last Pumped
,~J/~¢' ';for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72 026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field
Results of Last Adequacy Test
Type of System D;ig/n
Length of Field -.~
Depth of Field /~"'!
Gravel Bed Thickness ~' /
Standpipes Prese nt(~)'4)
Date of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ./~O"
To Building Foundation
Lot *"~/,~
To Water Main/Service Line
To Property Line ,,/~)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
; On Adjoining Lots
To Cutbank (if present)
To Existing or Abandoned System on
Comments
LIFT STATION ,~/,/~
D~ Dimensions
"Pump On' Level at ~mp Off Level at
High Water Alarm Level at
Tested for Pumping Cycles du~equacy Test, Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify t hat I h.~/~ e,~d,/v~er.~ed, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~¢ ¢.¢/-2,.-.~E. ~"cx ~..~ Date ~-/o '~ ~
~ MOA NO. ~O~ ~ ,~
Company
L~oy C. Reid, Jr.~
Receipt No. ~'~"'~
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
ALASKA II'lC.
DENNIS HARDY
5500 NARNEK LANE
ANCHORAGE ALAS KA
iqTAL COFITROL
~n§ineed~§ 8 ~nuiro~m~l~l ~lu~lies
SELLER-SAME
MARCH 10 1986
WILL PICK UP FROM OUR OFFICE
60101
LEGAL:TUSTEMENA HEIGHTS SUBD/LOT 13
ADEQUACY TEST FOR SEWER SYSTEM
ADEQUACY TEST DATE-MARCH 5 1986
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 576 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 1000 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR
THIS 3 BEDROOM HOUSE.
THE SEPTIC TANK/PACE. AGE PLANT WAS PUMPED ON MARCH 5 1986 .
THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER
SUPPLY OR WASTEWATER SYSTEM.
FLOW TEST ON WELL
WELL FLOW DATE-MARCH 5 1986
A FLOW TEST WAS PERFORMED ON THE WELL. 1000
PUMPED AT A RATE OF 1.3 GPM OVER A DURATION OF
THE DRAWDOWN WAS 6.3 ' WITH A RECOVERY TIME OF
AND THE STATIC WATER LEVEL WAS 103.4 FEET.
THE WELL IS ADE, UATE FOR THIS 3 BEDROOM HOME.
GALLONS OF WATER WAS
2.5 HOURS.
180 MINUTES
MUNICIPALiTy OF ANCHORAGE
DEPT. OF HEALt
ENVIRONM~ .... H &
~l~t,~L PROtECTIoN
ZAR i i 1986
RECEIVED
1200 LUesl 33nj Aucnu¢, Suite B. J~nchoro§¢, Alaska 99503 .(907) 561 50L!O
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
JoB ~-/~
SHEETNO OF
CHECKED BY. DATE
/.'Jo
SCALE
MUNIcIPALiTY
· i ~ ~o~c~,o~
I
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~]RONM[N~A[ pROTECTIO~
825 L Street Anchorage, Alaska 99501
( ENVIRONMENTAL SANITATION DIVISION b~0V 3 0 1981
Telephone 264-4720
DIRECTIONS: Complete ali parts on page 1. Incomplete requests will not be proce~ed, Please allow ten (10) days
PROPERTY RESIDENT (If different from above) ~ PHONE
PHONE
2. BUYER
MAILING ADDRESS
MAILING ADDRESS
TREET LOCATION ~
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] One [] Four [] Other
[~SING LE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [~ Three [] Six
7. WATER SUPPLY
I NDIVI DUAL* * 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 UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
¢ ,ND,V,DUAL,ON-S,TE" ./fY l YEAR ON-S,TE SYSTEM WAS ,NSTALLED.
[] PUBLIC UTI LITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
=ERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTI LITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] ~NDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified iNSTALLER
[] Septic Tank or [] Holding Tank
Size: _ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line
5, COMMENTS
~J~'m"~APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must ac~pany certificate)
//
[] DISAPPROVED