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HomeMy WebLinkAboutTALUS WEST #1 BLK 5 LT 17alus West'. I #015-202-37 J Municipality of Anchorage Page t of 3 Development Services Department On-Ske Water end Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Andwrage, AK 99519.6650 wiaw.ciAndrorage.ek.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWO40452 PID Number. 015.202-37 Norm Richard Tesch Wastewater system: Upgrade Address: 4331 Sunstone Circle Anchors a AK 99516 ABSORPTION FIELD phWow 345-W6 i6tlBsO'°"'" ` Four 4 Deep Trench LEGAL DESCRIPTION Soo flew 12 Total Depth tram awai wades Gpme 10 Ft. Bbda tak StaWWeion: Depth W We bt l a hum aptiW Wada: Gravel depth bensYh pipe: 5 17 Talus West No.1 4 Ft 6 Ft Towrwhip: Rape: Sectim Fa added above ai/tirN grade: Gravel U 0th: 0 tD 2 Ft. Ft. Well: Existing Gmed Mdh: 3 Number of Wbe: 1 I DWare between lines: Ft. Ft CWrficatim(Rivate. A B. C): Tow OwdyCaved to sal � area p . F,. Ft 528 Fe ASTM 3034 PVC odlar. Dar Drilled : sbtia 1" Levet FL A Pius Home Services I 10128.2912004 rWd"e pa"a< c•Wp wew.Gaaxt TANK CPM Ft. FL SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Lift Holding From Tank Field Station Tank Sewer une Anchorage Tank 1,250 ww >100, >100, WA WA >25' Steel Two (2) suraaewwa >100' >100' WA WA LIFT STATION - NONE ON LOT t me >6 >10' WA WA Ga. Faardetian >5' >10' WA NIA i, _ hl Howateralanat . c�.tan aab, None I Noted FIWM Make slae.l EbWw.lawpeatwrupahamsdW R"""te BENCH MARK Emung Septican m rtesned, 13"Illed and Elunean Northwest Lot Comer Cap. 100.0 Ft Engineer's Stamp p••�„OF assetit .• PSE '"q�,q eta s Inspections performed by: MEA Dates: 1" 10128104 O.49th 2nd 10128/04 Department of Health and Human Services approval • :� c1 MICHAEL E ANDERSON � � NO. CE Reviewed and approved by Date: g' 0 -6381 �� ��v ._ ✓' •••MY") a4ir4'ftF ESS J 21 Municipality of Anchorage Page 2 of 3 _ DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519.6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: SWO40452 PID No. 015-202-37 OUI IJLVI IG Circle 22 CF .•��(E,.... ,�'O • 49th . #` i...... "'� o' N ... PLAN AS -BUILT No. + SCALE I"= 4(r ESSI LOT 17, BLOCK 5, TALUS WEST SUBDIVISION Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519.6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number. SWO40452 PID No. 015-202-37 PROFILE AS -BUILT Scale: 1' - 10' MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 SOUTH BRAGAW STREET, ANCHORAGE, AK99519-6650' SOILS LOG - PERCOLATION TEST PROJECT #: PERFORMED FOR: Richard Tesch DATE PERFORMED: 10/28/04 LEGAL DESCRIPTION: Lot 17. Block S. Talus West Subdivision TEST HOLE # 1 SLOPE SITE PLAN Organic Material (� OL I ' 2 3 4 d 0 16 17 V', -ti • f•r• •'i 7G�.tr Lt..J•i C: BOH -16 Silty Gravel With Sand - GM Well to Poorly Graded Sand - SP/SW With Cobbles WAS GROUNDWATER ENCOUNTERED? No IF YES, WHAT DEPTH? DEPTH OF WATER None AFTER MONITORING: DATE: 11/4/04 WEIME ANoasa No. a•an SEE SITE PLAN S L 0 P E READING DATE GROSS TIME NET TIME NET DROP Start 10/28 10:03 1 10:13 t0 kD 8"Rechar a 10:14 2 10:24 /0 8" Recharge 10:25 3 10:35 FERC RATE: 1.3 MIN./INCH PERC. HOLE DIAMETER: 6" TEST RUN BETWEEN 4 FT. AND T. COMMENTS: Test Hole Pre Soaked Prior to Percolation Test TEST PERFORMED BY: MEA I, MICHAEL E- ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 3/18/2004 MUNICIPALITY OF ANCHORAGE Development Services Department On-S1te Water B Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT -ReneweF— Tnl'rrk.- dry Date Issued: Oct 22, 2004 Expiration Date: Oct 22, 2005 Permit Number: SWO40452 Parcel ID: 015-202-37 Legal Description: TALUS WEST #1 BLK 5 LT 17 ° Design Engineer: 0014 Anderson Engineering Site Address: 004331 SUNSTONE CIR Owner Name: RICHARD TESCH Lot Size: 25757 SQ. FT. Owner Address: 4331 SUNSTONE CIR Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE, AK 99518-2221 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 15.85 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. 5. The following special provisions. A SOIL, PERCOLATION AND GROUND WATER TEST HOLE NEEDS TO BE PERFROMED DURING CONSTRUCTION TO VERFIY THE DESIGNED ABSORBTION AREA. Received By: Issued Date: /V '2 T- 0 X Date: /v z Municipality of Anchorage • Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015.202.37 Permit Number SW Property owner(s) Richard Tesch Day phone 345.5576 Mailing address (1) 4331 Sunstone Circle Mailing address (2) 4331 Sunstone Circle, Anchorage, AK Zip Code 99516 Legal description (Lot, Block & Sub'd.) Lot 17, Block 5. Talus West Subdivslon & I Legal description (Section, Township & Range) Lot Size A545Acres/Sq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms Four (4) Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 1 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 authorized agent) Permit Fees: 0 Waiver Fees: Date of Payment Date of Payment Receipt Number. G17V4 ,nm Receipt Number: (Rev. 12/00) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 FAX October 18, 2004 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 17, Block 5, Talus West Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer. The existing septic system on the subject lot has failed and must be upgraded prior to obtaining a Certificate of Health Authority Approval on the lot. We are therefore requesting a permit be issued for the upgrade of the septic system to accommodate the four-bedroom home on the lot. The attached Site Plan and backup documentation identify the location and configuration of the existing and proposed septic systems. Also identified on the plans are the locations of the existing well. No conflicts exist between the proposed septic system and existing well and those on adjacent lots. Drainage arrows are shown indicating the current drainage patterns. The drainage patterns will be maintained after construction. The existing septic tank will be pumped, crushed, backfilled and abandoned in place. The existing absorption trench will be abandoned in place. Due to the lateness of the year we are requesting the existing soils test be used to design the new system. A new soils log and percolation test verifying the design parameters will be furnished with the as -built for the new system. The existing test hole was placed for the original system in mid May of 1979 and indicated gravel with varying amounts of silt and sand. The percolation rate is estimated at less than 5 minutes per inch and will be verified. We are proposing to place a new 1,250 -gallon septic tank and a 50' long by 5' wide by 4' effective depth absorption trench to treat and dispose the effluent generated in the house. The elevation of the distribution line in the absorption trench will be 11' below the surface and the total depth will be 15'. The test hole log indicates clean sandy gravel at the 11' depth. We propose to elevate the system as much as possible depending on actual conditions found in the field.: A full redesign will be submitted for approval prior to completion of construction. Lot 17, Block 5, Talus West Subdivision October 18, 2004 Page Two The ground surface on the lot slopes at shallow grades from east to west and north to south. The new trench will be constructed parallel with the slope as much as possible in conformance with Municipal requirements. The new septic system will be constructed a minimum of 100' from the existing well and any surface water in the area. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, W"J, 'F, Michael E. Anderson, P.E. Attachments ���.•••w•a•a �� OF F • �q�IM010 yr9�ai MICHAEL E. ANDERSON S No. CE -4381 4f 143.85 0.20 208.88 1s FIRNLINE 17781 445. 108.73 0 22 21 17 J pSz0, 1 V6�, 13,16 00 2 18 Sunstone Circle � 16 8 C G\Q1' Sl3 873• 8Wa a � RdF � N 3•f0,1q 15 8 5 14 a �, f 3•,e,�. 8 13 A O n n 451N11193 6809 J � ^N BS70 �Pky a 7 $ 0 1 WJ 2 P� N _ ate.. .... I ............... AREA PLAN '`` MICHAEL E. /J+pER50n No. CEJ i SCALE 1"= 100' ��•.., 20 ' yg s 8$ z P°nary 90.00 JQODD SUNSTONE 138.70 53.30 N 12 P 8 �•ig 11 w 17 J pSz0, 1 V6�, 13,16 00 2 18 Sunstone Circle � 16 8 C G\Q1' Sl3 873• 8Wa a � RdF � N 3•f0,1q 15 8 5 14 a �, f 3•,e,�. 8 13 A O n n 451N11193 6809 J � ^N BS70 �Pky a 7 $ 0 1 WJ 2 P� N _ ate.. .... I ............... AREA PLAN '`` MICHAEL E. /J+pER50n No. CEJ i SCALE 1"= 100' ��•.., r 22 21 West 215.00 10' Utility Easement 50'Longx5'Wide ------ ' Effegg Dept x 4h -- 63/ Absorption Trench � T 0 17 S%- 1,250 Gallon Septic Tank AbandonEI ��J Trench In Pla 43' Four Bedroom / Home Existing Well Pump Cru h and - ackfill Exi ting Tan 18 2r'y, c`Po'x`ti 16 / Sunstone Circle �?j,/•. MICI EL E. MlDERWN !�•••• No, CE�181 ,; ,r. SITE PLAN 77 i •��1��1, `S" �� SCALE 1',=40' LOT 17, BLOCK 5, -TALUS WEST SUBDIVISION LOT 17, BLOCK 5, TALUS WEST SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom House 5' Wide Trench System Perc. Rate: LT 5 Min./Inch 1,250 Gallon Septic Tank Application Rate: 1.2 GPD/SF 4' Drainfiekf Rock 4 Bedrooms X 150 GPD/1.2 GPD/SF (Application Rate) = 500 SF Absorption Area 500 SF/5 SF' .5 (Red. Factor) = 50 LF Trench Length THEREFORE: Construct a 50' Long x 5' Wide x 4' Effective Depth Absorption Trench. Flow Line Elevation in Trench to be 11' Below Original Ground Surface. Total Depth to be 15' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption Trench. 1 6" Natural Backfill 5' Geotextile Fabric 4" Perforated PVC (Holes Down) Drainfield Rock TYPICAL 5' WIDE TRENCH SECTION OF (NO SCALE) NOTE: Grade Area Over Trench to Drain Away.a9tn a Minimum 6' Separation From Bedrock _,. Minimum 4' Separation From Groundwater. Minimum 100' Separation From Wells in the Area. £ �w a woEnsor Minimum 100' Separation From Surface Water or Streams.`�m_ No. cE+x,h� ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 17, BLOCK 5, TALUS WEST SUBDIVISION GENERAL: The scope of this project includes the pumping, crushing and backfilling of the existing septic tank and the abandonment of the existing absorption trench. It also includes the procurement and placement of a new 1,250 - gallon septic tank at the location shown on the Site Plan. Work also includes the construction of a new 50' long X 5' wide X 4' effective depth absorption trench at the location also shown on the Site Plan. The distribution line in the trench will be placed at 11' below the existing ground surface. Total depth of the trench will be 15' below the existing ground surface. A separation distance of 100' from any well and 100' between the septic tank and absorption trench and any surface water must also be maintained. A minimum of 3' of fill is required over the absorption trenches and 4' over the septic tank. In lieu of the required fill 2' of insulation and 2' of fill may be placed. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. The Contractor must also verify the location of wells in the area and assure that the separation distances are met. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION A new 1,250 -gallon septic tank must be procured from an approved source and installed at the location shown. 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. Lot 17, Block 5, Talus West October 18, 2004 Page 2 of 3 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A sift barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. Y • Lot 17, Block 5, Talus West October 18, 2004 Page 3 of 3 MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. 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H INIP1LIP1 D I'.'?,TFII",ICE BE'I"I4EE:I",I FI [,.IE:[..I.. FIN[:, Rl",!"r' ON"-SITIE :J.EIE[ FEET FOR FI F'F~::[',,,'FITtE: I.,.I[:':LL..; CIE?. :tSC~ TO ;2111)C~ FLEET F'I:E:CI~'I I:::I PIjE:LZC: [,.I[E[..[. [)[£PFi:NE:-':(f-,IG LIPON '!'HE!: TY'F'E OF' F'I..IE',L ]:C E.IEZ.I NELL LOGS RRE FtEg!LI]:F?.E:D FIND P'IUST [3E [REZTIJRNED TO T'HE DE:F:'F~RTP1E:NT 1.4Z-I"HZN Z~._::l [:'Ft"r"."~; Cit-- THEE [qE:L.L C:Of,IF:'L.E:-r:[cII'-,I. EITI.-I[F:F;: [~'.Eg!I_.I:[2.EEI~IE:::I'.,IT'.':3 P'IFI¥ RF'F'L'~-'. .'._'.:,PEZCIFZCF:ITZCINS; laND C:ONSTF'.LJC:T_I.'ON D_T. FIEiF~fF:II',IS I::~F?.E Ft',,,'FtZL.FIBLE: 'FiD :[NSUfRIE: F'IE'.OF'E2. )i C:FZRT]:F"r' "rl-ln'r t.: [ i::1i¥1 FFli"I:(t._]iFIR 14]:T'H TH[_:i REig!LIZF?.Ei"IENT:B FOIl: OI'.,I-S:[-rE 'E, EiI4EF?.'-2; F:!IqP klIEL. I...S Fl::ii; :~:;ET FOI~'.TH B'~' THE i',ll..IN iii E: ): F'FIL :[ TY Cfi: FINC:HCIF..'FIGFZ. 2: ]: kllL. L. ):IqSTFILL THE S'-/STI~!:P1 :IN FIC:C:OF~:DRi'.~,C:E !4:I:TH THE C:OF.:,E:S. 2: :[ LIN[:,ER~-~TFff.,!D TI4F:IT THE Cff.,F--~:;]iTE S[.:iI.,.IER '.!~;"r'STEH f~lFl'~" [REg!I.I:[!:RE Ei',ILF:II:;~:(~iEI"IEN'I' IfF: THE ...................................... RPF'I., ~ C:FINT FROBEF?.T "" .... ' .......... "x'. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-2224 SOILS LOG -- PERCOLATION TEST [] SOILS LOG [] PERCOLATION TEST Bob Forman PERFORMED FOR;. Lot 17, Block 5, Talus Sub~. Add. #1 LEGAL DESCRIPTION: DATE PERFORMED: 5-10=79 1 2 3 4 5 6 7 8 9 10 11 13- 14- 15- 16- 17- 18 19 2O Organic overburden USCS GM Brown silty gravel 1 in. minus USCS GM Gray silty gravel with traces of clay USCS GM SLOPE SITE PLAN NFS Sandy grave] USCS GW WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATJON RATE {minutes/inch) TEST RUN BETWEEN FT AND , FT Lot is covered with large trees and has good natural drainage. Recomend COMMENTS David J./~,a~an P. E. L~ 97 S. F. / BeSroom . PERFORMED BY: 72-00B (7/76) WELL OWNER LOCATION WATER WELL LOG FOSS DRILLING 1336 Ingra Street ~chorage, ~aska 99501 SIZE OF CA~ING&~ DEPTH OF HOLE/]~T. CASED TO / I~ STATIC WATEH LEVEL~z~FT. yIELD ID GA~.PER.MZN. WIT~ FEET OF DRAWDOWN. REMA~S DATE COMPLETED ~'~-~-'~ PUMP TO BE SET AT ..p tc,~,¢ .A L V ~to~%~ A L V.M q/~to ~-m .A b V/rd ?~to/~ lO,rolO"/ A to__ .___tO to __t o to__ t O-- to I TIME TIME TIME DATE DATE DATE ~UNICIPALI~ OF ANC~Q~F DEPT. OF HFALTH & ~U~IClPALITY OF ANOHORAGE ENVIRONMENTAL PROTECTION  DEPAflT~ENT OF HEALTH E ENVI~OBMENTAL P~OTEOTION 825 L Street - Anchorage, Alaska 99501 DE0 6 Ig7g E~VIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DI,ECTIONS: Complete all parts o~ page 1. Incomplete requests will not ~e processed. Please allow ten (10) days for processing. PROPERTY OWNER ~AJLI~G ~-DD~SS ~RO~RTY R~IDE~T (If differen~ f~om above)' / '" PHONE 2. BUYER PHONE MAILING ADDRESS 3'. LENDING INSTITUTION MAi ~1 ~G AD ~R ~SS 4. REALTOR/AGENT 5. LEGAL DESCRIPTION STR E E'T LOCA'TI ON - ~ 6. TYPE OF RESIDENCE ~' SINGLE FAMILY ~ MULTIPLE FAMILY NUMBER OFxBEDROOMs [] One ~' Four [] Two [] Five [] Three ~] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 1~' INDIVIDUAL/ON-SITE** ./'/'~/ YEAR ON-SITE SYSTEM WAS INSTALLED. [] 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 PERMIT NUMBER 3. SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON -SITE }ATE INSTALLED ~PUBLIC UTILITY Connection Verified iNSTALLER E~3Septic 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 IAbsorption Area ISewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS [~A~PROVED FOR z~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED C~ & ¢IEOLOGiC, AL, LABORATOI~.8 OF INC,, p.o. Box4-1276 ANCHORAGE, ALASKA 99509 484gBU~iNEs~PARKBLvD' Drinkin§ Water/Analysis Report for Total Colifo~m Bacteria TO BE COMPLETED BY WATER SUPPLIER Public W r System Name ~ Mailing Address State City . Mo. Day Year Zip Code SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose SAMPLE NO. l LOCATION 06-1220 (b} Rev. 1978 [] :Treated Water [] Untreated Water Time Collected Collected By TELEPHONE {907) 279-4014 CITY D;te Received Ti~e Received A.q~lytical Method: [] Fermentation Tube ~i! t[~'Membrane Filter BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Form No. 18-310 (3-78) Lab. No TO: BE COMPLETED BY LABORATORY £ LABORATORY: 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-41 t 1 December 10, 1979 Robert A. Foreman Post Office Box 10-2177 Anchorage, Alaska 99511 Subject: Lot 17 Block 5 Talus West Subdivision Your request for health approval was filled out as Lot 17 Block 5 Talus West Subdivision. The legal description on the well lo9 is Lot 17 Block 5 Talus West Subdivision. The legal description for the on-site sewer permit is Lot 1 Block 6 or 2 and the inspection of the sewer system by the engineer shows the legal description to be Lot 7 Block 8. Therefore~ before we may send approval to the lending agency these inconsistencies will need to be clarified. If there are any further questions, please contact this office at 264'-~720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Alaska Mutual Savings Post Office Box 1120 Bank 99510 TO ~ ~ ~ AT DATE SIGNED Redi~orm ® SEND PARTS I AND 3 WITH CARBON INTACT. 4S 469 PART 3 WILL BE RETURNED WITH REPLY. S _ Municipality of Anchorage t-jj It�i.Q Development Services Department s Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL ..FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-202-37 HAA # Expiration Date:; 1. GENERAL INFORMATION Complete legal description Lot 17 Block 6 Talus West Subdivision No. i Location (site address or directions) 4331 Sunstone Circle Current Property owner(s) Richard Tesch Day phone 345-5576 Mailing address 4331 Sunstone Circle Anchorage AK 99516 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise iequestad, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Four 4 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 lepresentations given In paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served. by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and maybe reissued with new water sample results less than 30 days old. (Certificates maybe 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 engineers work . 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 119=04 x p• 4 i 49th z-- fir_ MCH�EL r l ftsw y g i' 5. DSD SIGNATURE ��� No ME - Approved fo r -Approvedfor bedrooms. �4sst.•••• Disapproved. Conditional approval for bedrooms, with the following stipulations: «rrrr Additional Comments ��,—QN 01= • m 119: WATER AND PROGRAM Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By; Gam, Original Certificate Date: $�O 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.ci.anchorage.ek.us (907)343-7904 r HE=ALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 17, Block 5. Talus West Subdivision No. t Parcel ID: 015-202-37 A. WELL DATA b Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 5!29!1979 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth ,118 ft. Cased to _119—ft. Casing height (above ground) >24 in. FROM WELL LOG AT INSPECTION Date of test 5/29/1979 11/212004 Static water level 66 ft. 61 ft. Well production 10 g.p.m. 8.5 g:p.m. j a WATER SAMPLE RESULTS: Collform colonies/100 mi. Nitrate 3.28 mg./l. Other bacteria 0 colonies/100 mi. Date of sample: 10/29/2004 Collected by: MEA B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 10/2912004 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping Pumper New Construction C. ABSORPTION FIELD DATA Date installed in 17st Ina Soil rating (g.p.d./fe orfe/bdnm)1.2 GPD/SF System type Dees) Trench Length 44 ft. Width 3 fL Gravel below pipe 6 ft. Total depth 10 fL Eff. absorption area 528 fe Monitoring tube Y Depression over field N Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in. Water addedgal. ! New depth in. Elapsed Time: min. Final fluid depth _ in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date 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 _ 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 N/A Public sewer manhole/cleanout N/A Sewer /septic service line >25' Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Building foundation >5' Properly 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 >16 Surface water >100' Driveway, parking/vehicle storage >6 Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION �•�~V♦♦1♦ J, CN., ♦1 1 certify that 1 -have determined through field inspections and 4 th•♦♦ review of Municipal records that the above systems are in ••••••. •••.. conformance with MOA HAA guidelines in effect on this date. NICHAM E. ANDERSON : t Engineer's Printed Name Michael E. Anderson. P.E. s No CE-4381ti� Date 11/4/2004 ♦1So ,A==O���� HAA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number (Rev. 12/00) LOT 02 COT 2/ �n c „r /O 4 U.S. 2/5.ar 75L. f &EC. ESMW — — �Z r� satr ie c 25, 75 7 S.F, ytr SUN STONE C/RCLE 'amu Lor /6 -BUILT Lot / 7 , Block 5 'i1j9Fo ;'•••.».»••'�o� -Talus West Sub: ! Add. No. Anchorage Recording District, Alaska (75-20) xoesmems at record after than "a" shown on . fte plat of record we not shown horson enless� etbsrwleo noted. LOT SURVEY CERTIFICATION LEGEND i hreby ertlty that I hew surveyed the property shown and described 6 Bross or Aluminum capped monument recovered hereon, and that esu hnproranents situated thereon we within the prov- arty ease and do not overlap or onordooh on adloasut property and that 0 Iron pipe and/or rebar recovered. O 2 x 2 hub 6 tock reoovered no bw"ements an adjacent property werlop or suroaah on the premises • We x 30" rebar set this survey In question end teat then we as roadway, oticty uses, or ether risible easements an said property oseapt M Indicated banes. Scale „o , aRopidtdreOLand Date © 11-03-04 Prepared by: R. L. BUTTON Surveyor (907)279-6200 6/9W. £iphM Ave. AxhMope Alosto9950/ Ref.F. B. No Property of: R0C�O/-„/ T�hVn- 27