HomeMy WebLinkAboutTALUS WEST #2 BLK 4 LT 8ATalus West'
#2
Block 4
Lot 8A
#015-202-61
(,)
Municipality of Anchorage Page / of -Z
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
Permit Number: S W 0-3020(; PID Number: 19 1 S - 707 -6I
Name:
7o I ti s k r �' rn -12
Wastewater System: New ❑
Y Upgrade
Address:
IIIS L, r, AL A1)e-4 K 9s
ABSORPTION FIELD
Phone: 3 Lq - 7 /it
No. of Be4!ooms:
3
O Deep Trench ® Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade
GPD/Sq14 Ft
Lot. Block: _ Subdivision:
^ AZ
Depth to pipe Dollom from original rade:
Grovel depth beneath DlDe
1' I L.4 t M) S 1
�/ Ft.
FI.
Townshi I
Range: O � ' f
Il L'V
Section
SCnL2 ?
Fill added above original grade-
I
Gravel length:
3S
Ft.
Fl.
WELL: bNew ❑ Upgrade
Gravel width:
N m (lines
lwn
Distancebeeenlin
Ft.
`
�b FI.
Classification (Private. A.B.C):
P,-,,
Total Depth:
Cased To:
Total absorption area
Pipe material:
'%/'+/i
1 f P 1, --
'j/�O FI.
y Ft.
I S 50 Ft.
/I
D },0 r:
f/L
Date Drilled.
Stall Waler Level:
.1 Ft.CAt?
Installer:
T FFLS 4P -7r t:
Dale Installed:
7i
yield:
J
Pump Set at:
Casing Height Above Ground.
A
TANK
GPM
ll Ft.
FL
SEPARATION
DISTANCES
IId/Septic ❑Holding ❑S.T.E.P.
To
Septic
Absorption
Lia
Holding
ubliWrivate
Manufacturer:
Capacity In gallons:
From
Tank
Fate
s alion
Tank
Sewer Lloea
0 R et )C i7
r S i1
Well
/
2qo'
1
v�A
I
//�r
Material:
FT rpSurfac.LA=%
Number of Compartments:
2
Water e
a /00
2+0•
r,li0'
'
LIFT STATION
Lot/
Line
Line
60,
24•
,
62-
I
,
Size In gallons:
1 jb6
Manufacturer-
anufacturer
02C:l,JC_0
Foundation
20
1�
r
"Pump on" level at:
"Pump off" level at:
High water alarm at:
„
O
13 s"
.17-:7
Curtain
�—
,_
._1%=..._ _.
. _., .-
Pump Make 8 Model
Electrical Inspections performed by:
Drain
OS P,F
Remarks:
BENCH MARK
(RCSIQJ� TRENGN TNS
Location and Description:
7e'f le, =odr- r-,I;t •
i 5 sr n 17 T1 f', - <_ - rye ,t ; ..
'
Assumed Elevation:
/00
E L
A,:
Inspections performed by: Dates: ist ►o►' 2
2nd /01Z-2/07,CH1tIST0PIlERR
" D •'-
�'
Department of Health and Human Services approval
'`�:••.. CE103�1 :.
Reviewed and approved by: �(LA U O.Qu Q Date: 414
ss...
72-015 (Rau. 9191) MOA 25
Permit No. SW030205
Page 1 of 2
Municipality of Anchorage
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
Legal Description: LOT 8A, BLKA TALUS WEST#2 PID No.: 015-202-61
SWING TIES
C 30.5' 44.4'
D 1ez.r 2n.e• '
E 187.2. 220.2•
N90.00'00'E LOT 10 /494,83'
10' UTILITY EASEMENT SCALE_____-- SCALE.
)
O�ELD E �16' CHUGACH ELECTRIC ASSOCIATION EASEMENT
4 1.F nj
4.
®Ill
`qI PRESSURE D
Nmay+ 5D
# R ELA C
'1 LIFT BASIN FlLTER
S POD
p
glaud
p LOT 8A .
>o •a •• 3
n
3 N •GRAVEL �
N = 'DRAIE • h
r
v ° c
r
IIT11 N
O
Z
L=9.20'
R=230.00' 352.71'
S84.37'10'W [)RIVE
I; FIRNLINE —
11/18/03
ENGINEER'S SEAL
90004p�0
ELEVATIONS
n TOP Gr sarMCAsr Lor CORNER a OF q� 4p0
(NOT TO SCALE) Ass hEn ELEV - 102.00' v/oL^ ................s0il
103.5' STATION rT 2' INSULATION THOLE O•'l, \• .20
00
g..*..:.: 4.. .
D
Q
2 3' Q Q
1•,CHRISTOPHE R. WOOD, Q
TANK Q .� CE -10387 pv
IOTA'`IRI-l5.9'
100.8' \ TR2-9SS' TR2-95.5' GVT 29.4' �D�s•••. G"
\TR1-94.7' TRI -94.7• 04 FQ q•....... •ry•;,Op
TR2-94.8' T92-94.7' TR2-88.6' I\_ftFSQo`�'oo
Y
RightFax 3/19/2004 5:44 PACE 1/1 RightFax
Inspection Report
Municipality of Anehorager Building Safety Division
4700 South Bragaw
INSPECTION: VOICE 343-8300 INSPECTION: FAX (907)249-7777
Name
Address
Legal
Subdivision
Comments or Directions
ED'S ELECTRIC
11622 FIRNLINE DR
BK 4 LT BA
TAWS WEST#2
Zrl'�t"
INFO: 343-796Z
Permit 04-7436
Phone 272-4591
Inspection Date 3/19/2004 AM
AM'••CALL B4 FOR SITE MEET
Inspection Fli3l Electrical Reinspection N
NO NONCOMPLIANCE OBSERVED
❑ CORRECTIONS ESSENTIALAS EXPLAINED BELOW
❑ WILL RE-EXAMINE AT NEXT ❑ DO NOT CONCEAL UNTIL REINSPECTION
INSPECTION
COMMENTS: (for Inspeeccmr use only)
Inspector
a�
Date: .S" ! J- G'7
Mayor
Municipality of Anchorage
Department of Heal: is wad Hur-ran Sar✓ices
825'1' Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
http'/Av d.anchorage.ak.us
Permit Number: #SW 030205 Date of Issue: 6-19-03 Parcel Identification Number: 015-202-61
Date Started: 7-3-03 Date Completed: 7-3-03 Is well located at approved permit location? ® Yes ❑ No
Legal Description: tTatus West #2 Blk 4 Lt 8A
Property Owns Name & Address: John & Luanne Miller
11150 Our Road
Anchoraae. Alaska 99516
Borehole Data:
Depth (ft)
Method of Drilling ® air rotary . ❑cable tool
Soil Type, Thiclmess & Watcr Strata
From To
Casing type: steel
Seek -tip
0 2
Wall Thiekness:.250 inehes
silt
2 22
Diameter: 6 inches Depth: 46 feet
gravelly silt
22 40
Liner Type:
Diameter: inches Depth: feet
water sand & gravel
40 46
Casing stickup above ground: 2 feet
Static water level (from ground level): 20 feet
Pumping level: 46 feet after
2 hours pumping 30 gpm
Recovery Rate: 30 gpm
Method of Testing: Airlift
Well Intake Opening Type:
® Open End ❑ Open hole
❑ Screened Start feet Stopped feet
❑ Perforations Start feet Stopped feet
Grout Type: hentonire if 8 Volume: I
Depth: Start 0 feet Stopped ? feet
Pump: Intake Depth feet
Pump size hp Brand Name
G
Well Disinfected Upon Completion? ® Yes ❑ No
V
Method of Disinfection: chlorine tablets
Cj ��Qj
Comments:
Well Driller: Alpine Drilling & Enterprises
;\zs
AO Box 110496
o age Alaska 99511
G\Q���'S��ylG
Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property
Municipality Of
Mark Begich, Mayor % /
Building Safety Division
e
F.O. Box 19667jO • 4700 Bragaw Strect
Anchorage, Alaska 99519.6650 • (907) 343.8301 • F= (907) 343.8200
littp://mu-w.mitni.org
June 1, 2004
John & Luanne Miller
11150 Our Road
Anchorage, AK 99516
Subject: On -Site Water and/or Wastewater Permit.
Permit Number: SW030205
Legal Description:;'alu5--West712 Block- —Lot 8A:
Dear Mr.& Mrs. Miller:
An On -Site Water/Wastewater Permit, number SW030205, issued by this office for a single-family
system, will expire on June 18, 2004 This permit was valid for 365 calendar days.
If this was a well permit and the well has been drilled, a well log must be sent to this office for
documentation of the installation and to close the permit.
If this permit was for a wastewater disposal system, an original as -built inspection report must be sent to
this office for review, approval and documentation. This as -built inspection report must be signed by
the licensed Professional Engineer who inspected the installation of the system. As -built inspection
reports are required to be submitted within 30 days of the completion of the system.
If no system was installed under this permit, and you are still planning to install a well or wastewater
disposal system, a new permit must be obtained from this office. A new permit for a second year may
be issued for a fee of $115.00 if the renewal application is received on or before the expiration date of
the original permit.
When applying for a new permit, the fees are: $460.00 for a wastewater permit and $175.00 for a well
permit.
If you have any questions, please call this office at 343-7904.
Sincerely,
1�3
Daniel Roth
Program Manager
On -S ite Water and Wastewater Program
Enc: Copy of permit
I
' l MUNICIPALITY OF ANCHORAGE
Development Services Department --
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
/o- 22.03 @ 2.�0
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Date Issued: Jun 19, 2003
Expiration Date: Jun 18, 2004
Permit Number: SW030205 Parcel ID: 015-202-61
Legal Description:gfalus West #_2`B_4 L8A-"
Design Engineer:-0024-Eegt Iver Engineering Services Site Address: 11622 Firnline Drive
Owner Name: John & Luanne Miller Lot Size: 95733 SQ. FT.
Owner Address: 11150 Our Road Total Bedrooms: 3 Permit Bedrooms: 3
Anchorage . AK 99516 -
This permit is for the construction of:
p✓ 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: _2 O -03.
Date: / 1c;
J
Municipality of Anchorage
••.
Development Services Department ;• �.
Building Safety Division ;.
On -Site Water and Wastewater Program
4700 South Bragaw St ' • `� `
P.O. Box 1S6650 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. Permit Number SW
Prccer:: cr:ner(c)�bI1 YI a !/!fin YIP ikflI PYDay phcne �gg q$Od
Mailing address (1
Mailing address (2) NN1 Ogg— Zip Code �7�
Legal description (Lot, Block & Sub'd.)�-`�� r��i ''rn�(l (S l.� S -L F�
Legal description (Section, Township & Range)
LotSize_95JS2> Acres/0
THIS APPLICATION IS FOR:
Number of Bedrooms 3
Sever Only
Cl
Well Only
❑
Sewer and Well
Water Storage
❑
Sever Upgrade
❑
THIS PROPERTY CONTAINS:
Hot Tub
❑
Jacuzzi
Swimming Pool
❑
Water Softening Unit
❑
Therapy Pool
❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Duvell* g and is in accordance with applicable Municipal Codes.
proper j owner or authorized agent)
Permit Fees:yy "' 7�!5 V Waiver Fees:
Date of Payment: 3 Date of Payment:
Receipt Numter: o� cn Receipt Number
(P,ei. 121co)
Eagle River Engineering Services
Louis Butera, P.E.
P.O. Box 773294 (907) 694-5195 tel
Eagle Fiver, AK 99577-3294 (907) 694-3297 fax
June 9, 2003
Jim Cross, P.E.
Manager, On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Talus West Add No. 2, Lot 8A, Blk 4, ADVANTEX SYSTEM
Dear Mr. Cross:
On behalf of the owner of above referenced lot we are applying for a permit to construct a water well and
wastewater system. The present lot 8A is a 2002 replat of lots U9, block 4 in Talus West #2 subdivision.
The former lot 8 was considered unusable for septic systems by 3 test holes. Former lot 9 had 2 record test
holes showing fairly tight but usable soil. We explored the combined lot further and found no soil
conditions better than that logged in Test holes #1 and #2 by Alaska Water and Wastewater Consultants.
The subdivision covenants require an "aerobic wastewater treatment plant" be installed on each lot. We
have designed a leachfield utilizing the Advantex system and the record soil logs by Alaska Water and
Wastewater Consultants with recent monitoring.
The proposed revised septic system upgrade will have very limited impact on adjacent properties for the
following reasons:
The surrounding lots are large, allowing sufficient room for septic sites.
2. Immediate neighboring septic systems are all +30' distance.
3. This permit is for an Anchorage tank Advantex system, allowing reduction in leachfield
area.
4. Surface drainage will only be affected at the leachfield site and will not affect the
neighboring properties.
This work will not affect the reserve area on adjacent lots. If you have any questions please call our office
at 694-5195.
Louis Butera, P.E.
\2003\03-013 NAR.DOC
Eagle River Engineering ,Services
Louis Butera, P.E.
P.O. Box 773294 (907) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM — MOA CERTIFIED INSTALLER
LEGAL: Talus West Add No. 2, Lot 8A, Blk 4
REV June 9, 2003
A. GENERAL
1. The well and septic plan is for a 3 bedroom single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of
Environmental Conservation requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of
Anchorage, Department of Environmental Conservation requirements.
6. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval.
B. ADVENTEX SYSTEM AND SEPTIC TANK
1. Septic tank shall be a fiberglass 1500 -gallon tank capacity of MOA approved construction for use with Advantex
system. Install as per manufacturers recommendation.
2. Install one AX -20 filter pod over septic tank capable of treating 450 gallons per day of waste floc
3. Install Orenco 24" pump basin PB -2496 outside septic tank, with OSI pump model PEF 4ftnd controls to allow 23
gallon dosing of septic leachfield. Set pump float to 13.5" above pump, timer for 1 minute dose time. Controls to be
installed to MOA code by licensed electrician familiar with OST applications. Controls to include web based
monitoring system.
4. A municipal inspection report or receipt from a licensed electrician shall be provided to the engineer verifying lift
station wiring to all applicable codes.
C. DRAINFIELD TRENCH
1. The trench is to be located as shown on the site plan.
2. The total depth of the initial drainfteld excavation is to be 3' relative to existing ground elevation at ground water
monitor tube and end in scarified native GM soil material. The bottom of the trench shall be level, plus or minus
1.5" prior to placing sand. A 1' layer of coarse sand is to be placed over the native soil material to allow an effective
total depth of 2' below ground surface prior to placing leach gravel.
3. A one foot layer of gravel is to be placed over the sand material. The 1.25" effluent piping is to be buried within the
gravel layer with 2" of gravel cover over the piping.
4. The completed trench gravel and piping is to be covered with typar fabric material.
5. Soil or combination of soil and extruded board insulation to a depth of +3' or equivalent is to be placed over the
leachfield. The upper slope may be raked down over the leachfield to provide cover material.
RECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH = 2' (gravel portion). GRAVEL DEPTH = 0.8' under effluent pipe, 2" over pipe
DRAINFIELD LENGTH = 35' DRAINFIELD WIDT11= 5'
SOIL RATING = 4 GPD/ft' BEDROOM CAPACITY = 3
EFFLUENT PIPE = 11/4" from pump basin to leachfield then manifold to 1" PVC with 1/8" holes oriented down
spaced at 1.2' OC. 2 pipe runs in leachfield 2' between pipes 1.5' from sidewalls of trench.
Twenty-four (24) hours notice required for all inspections.
12003%03-013 adventcxTrench- spec.doc
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ALASKA WATER & ' WASTEWATER CONSULTANTS, INC.
I SOIL LOG — PERCOLATION TEST I
LEGAL DESCRIPTION: TALUS WEST S/D• LOT 9. BLOCK 4
PERFORMED FOR: JOHN AND VERONICA PRECZEWSKI
DATE PERFORMED: 6/23/99
DE1+ TEST HOLE #2
1 ORGANICS
2ML
1IIIIIII I SWITH SOME
ANDY POCKETS
SM/GM AND ML.
POCKETS OF
CLEAN MATERIAL
6
WEEPING O
7' – 9' BELOW - -
GRADE
8
10 j I I I I I III MU IMPERMEABU_
11-1 B.O.H.
12
DEPTH TO DATE
GROUNDWATER
10.25' 6/21/99
6.8' 6/28/99
II
TH/1 TH/2 II
II
II
TEST HOLE LOCATIONS
ARE GENERAL II
DATE READING CT
TIME (MINLIT S) I F`NET TIME W READING NEG ELI (E CHDERSO)PI
6/23/99 PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING
13
• -
S.
IIIIIIIII
2:42 —
3:12 30
31191
o
3/4
14
-A
~`
••
S !
I�xHu1�811m
1..
6.
4
►ty;
1
DEPTH TO DATE
GROUNDWATER
10.25' 6/21/99
6.8' 6/28/99
II
TH/1 TH/2 II
II
II
TEST HOLE LOCATIONS
ARE GENERAL II
DATE READING CT
TIME (MINLIT S) I F`NET TIME W READING NEG ELI (E CHDERSO)PI
6/23/99 PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING
13
Q...
S.
1
2
2:42 —
3:12 30
1
o
3/4
14
~`
3
3.12 —
6.
4
3:42 30
1
3/4'
15
5
3:42 —
6•
re Ar
er
iW 6
4:12
16
;Je
.:,
s.� ..N
-7953..
`
17
RfG PROF
SS10N*�
18
19
PERCOLATION RATE
7.1 (MIN./INCH)
PERC. HOLE DIA. _
TEST RUN BETWEEN
4.5 FT. AND 5
FT.
20
6 (INCHES)
COMMENTS:
PERFORMED BY ALASKA WATER do WASTEWATER. I, JEFFREY A. GARNESS, CERTIFY THAT THIS
WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON
ALASKA WATER & WASTEWATER CONSULTANTS, INC.
( F
6aG, DEBARK ypND 29 • ANCHORAGE. AK. 99504
PHONE (907) 3* 6179 ' iA% (D07) SS6-3246
SOIL LOG — PERCOLATION TESTI
Or
LEGAL
DESCRIPTION: TALUS WEST S/D• LOT 9 BLOCK 4
.. ... .. ...
PERFORMED FOR: JOHN AND VERONICA P RECZEWSKI
•• ""••'•"
f y A. Gom.+s;
DATE
PERFORMED: 6/23/99
Q q '• CE -7953 ' `
t.
°(.c
=__— TEST HOLE # 1
C ., '•........•••
•d Or f 0a001,d
_
ORGANIC/LOAM
2
-_ SOIL CLASSIFICATIONS
_
SM/ML ro'.GW ORG
3
.:.r+. GP ML
GM CL
+4SW
MH TH%1
TH/25
...SP CHSM
OH6
GM/SAM SC TEST HOLELOCATIARE
IDRtrL
GENERALWEEPING
O77FEET
ROUNDWATERDATE6
9• 6/23/99
6.67' 6/26/99G
9
—_
►�-
10
B.O.H.
CK TIME
WARE R LEVELNE
DEsi
11
DATE READING TIME (MINUTES)
NCH
6/21/99
12
13
F
Fr
MPS
�.
AQ'
14
15—as
i R
cher r 6•
J Mfr = 5
16
s E 7953; �SpPeQEtOC
17
PROFE551a
18
PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
19
TEST RUN BETWEEN 4.5 FT. AND 5.0
FT.
20
COMMENTS:
PERFORMED BY ALASKA WATER do WASTEWATER. I. JEFFREY A. GARNESS. CERTIFY THAT THIS
MUNICIPAL GUIDELINES IN EFFECT ON
WAS PERF M IN ACCORDANCE WITH ALL STATE AND
DATE: Z
OF
Municipality of Anchorage"'r•"••"'»:«•••••«• •�•••
DEPARTMENT OF HEALTH 8 HUMAN SERVICES °� •a• ........
825 "L" Street. Anchorage. Alaska 99502-0650 Louls A Butera ;Ar,
SOILS LOG = PERCOLATION TEST d��%,�+., CE• 736
PERFORMED FOR: DATE PERFORMED: S 'v29 —03
THl r4/•.l WtfT A.ed rJe, a
LEGAL DESCRIPTION: ).4t kA /3744* y Township. Range, Section: 7i..:1, R 3 �j Sec D -t- Srrl
DEPTH I SLOPE SITE PLAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS Tyll
EMEEMMMMEN
ENUMMORNE
.mw.
ME
iwWWIN
I11WIP �Effm
Maram=■HU.
I'M-M■_■■■ENEW.'
■
4 GROUNDWATER
'COUNTERED? Nr�
S i
YES. AT WHAT b f
PTH? p
A to water Met
laring? ^�1* Batc
Reading Date Gross Net Depth to Net
Time Time Water Drop
N/A TCS / Ni /. •w /' y
:RCOLATION RATE M1 ,�w tm,nutes.,acnl PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
6 �•
PERFORMED BY: 6LE Ri✓6it Fi.•bN•6L.Cr✓GI 'f7 CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE.
T2 -0081R" 4.851
_ Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
625 "L" Street. Anchorage, Alaska 99502-0650
SOILS LOG = PERCOLATION TEST
le'O�N�Si� If
.4
' Louis A.Butera v
CE -6736 i
PERFORMED FOR: 1:72fwe r DATE PERFORMED: S -02•'7 -03
IfH2 77o /..,r werr A.ed r.?o, -P-
LEGAL
LEGAL DESCRIPTION: -Lo>`• frA (,eek y Township, Range, Section: 7/1 ,j R 7 �j .re, D y rm
�car.. I SLOPE SITE PLAN
1 � %Gprr• / /firs.✓
2 /aRf ir••cc
/ fL••f
3
4
5 1124 -CH
6
7
eZE®■■■w■■
E®um■■m■■
.mm�mm
I■■■■■■■■■E
I
=Fim�®!'�„
I'0-2■■■■�■MSI.
11��RSZiX�WMIM
■
■■■■�■
■■■■■.m■
■■■■■■MEM.
10 WAS GROUND WATER
ENCOUNTERED? /✓.7
11 S
IF YES. AT WHAT LO D f'
12 DEPTH? P
E
Oep h to Water Atter
13 Monawmg7 6 6 Oatc C -6-o3
14-
15-
16-
17-
18-
20-
COMMENTS
41516171820COMMENTS T H 2
PERCOLATION RATE � Immu:es mcnl PERC HOLE DIAMETER
6'
TEST RUN BETWEEN FT AND —FT
PERFORMED BY: 6LE !P/rfie Fi-ba+•/L?x^'61 CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. 6— 3
72 -MB IR" 4,BSI
✓e ..r .M Wew. w.MHw«iue
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES ,
b.s :Louis A.Butera
825'L" Street. Anchorage. Alaska 99502-0650 % CE4138 g i
SOILS LOG = PERCOLATION TEST
.,,...:e:_1,, -
PERFORMED FOR: / I" DATE PERFORMED: S -,A 17 _Q 3
fhr3 To/«I werr Aaed No, Q -
LEGAL DESCRIPTION: Lof PA R/OLk // Township. Range. Section: 7/1 ^I aP 3 a+/ Sec Syn
pEPTH SLOPE SITE PLAN
1
2
3-
"
/
Net
Time
Depth to
Water
Net
Drop
5OAIf_
4-
4
5-
567
6-
7
LpNh `
6
Y
All 1Oi
9
3=S N/fir•
714'
;0 -I I CH -m4
12
13
14
15
16
17
18
19
20
COMMENTS T/''3
WAS GROUND WATER
ENCOUNTERED? N D
IF YES, AT WHAT _
DEPTH?
Depth to water Aller ,r '
Mondaring7 /O_ Batt A -6-e2
ear
Reading
Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
5OAIf_
ICA - iba
LpNh `
Y
All 1Oi
a -n..!
3=S N/fir•
714'
■
Y//r-
ear
Reading
Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
5OAIf_
ICA - iba
LpNh `
Y
All 1Oi
a -n..!
3=S N/fir•
714'
Y//r-
PERCOLATION RATE �/i (m.owesmcnl PERC HOLE DIAMETER 6
TEST RUN BETWEEN 3 FT AND y FT
PERFORMED BY: 54-4Z. -- R/✓lif I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE 6- S -,a:?
72-008 IRev. 4.851
••m
'r OAz
•� .• •% ac
e Municipality of Anchorage {' •'
y
DEPARTMENT OF HEALTH & HUMAN SERVICES ."
825 -L" Street. Anchorage. Alaska 99502-0650 a,: louts A Butera �
ti CE -6736 i
SOILS LOG = PERCOLATION TEST t„'sr�;•.,•••• ••,.•R•;
PERFORMED FOR:�{ DATE PERFORMED: S ,a5 —03
THy / 4/MJ werr Awd rUe• cP-
LEGAL DESCRIPTION: l.pf kA Q1411r'y Township, Range. Section: 7/,, rJ !e 7 ,�j Sec Q Z rete
oery�m SLOPE SITE PLAN
2-
3
3-
4-
4
5-
5
—_
c r o,, -Ile,), 47- ee
6-
7 7
8
9
10 WAS GROUND WATER
ENCOUNTERED? NO
11
IF YES, AT WHAT
12 DEPTH?
Depth to Water Alter
13 MamWrtng? ���' Bale
14
15
16
17
18
19
20
REEMEMERIME
'ENUM■■H■■
■■MUMMEIME■
PERCOLATION RATE (minu:es mcnl PERC HOLE DIAMETER
6
TEST RUN BETWEEN FT AND FT
COMMENTS rH G/ Nut pia w
PERFORMED 8Y: 6GE �P/rfif fi•6~LT..✓FI ` , moi» CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. •S— 9 G Y
77-008 tPev. 4.851 '
• '.s Ur A '� b
F' E186INE i15'S, '1; JZ
Municipality of Anchorage "'«.«•»«• •»•«••••�
DEPARTMENT OF HEALTH 8 HUMAN SERVICES: ....••N».�...
825 "L" Street, Anchorage, Alaska 99502-0650 ��� Loins A. Butera /
SOILS LOG = PERCOLATION TEST CE -6736 •• c� ,;
PERFORMED FOR: ��'^ DATE PERFORMED: S -o�S - O 3
7/•Ir 774/«f weir Aeed Ne•a
LEGAL DESCRIPTION: 1•et' PA B/eclr v Township, Range. Section: 7/1 ,j R Q y sin
o"Tw I SLOPE SITE PLAN
1
2
3-
4-
5-
6-
7 567
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS 77-e "—
ro'"' / - 0'ec-0 • C
%j mow..+✓ — ���
/l,eo/• �r ^•�G
WAS GROUND WATER
ENCOUNTERED? /✓D
IF YES, AT WHAT
DEPTH? P
E
Eeplh to Water After
Momta ing? d r7 cite: 6 • C— o ?
Reading
Data
EMEM■■M■■
Net
Time
Depth to
„t,z Water
Net
Drop
IwWv��l;
IM_■■■■ENEWN
soon
WAS GROUND WATER
ENCOUNTERED? /✓D
IF YES, AT WHAT
DEPTH? P
E
Eeplh to Water After
Momta ing? d r7 cite: 6 • C— o ?
Reading
Data
Gross
Time
Net
Time
Depth to
„t,z Water
Net
Drop
So
qv
30
S-
•'
.� : it
s�-
30
PERCOLATION RATE / 60 Im,nutes.mchl PERC HOLE DIAMETER 6 "
TEST RUN BETWEEN 3 FT AND ;'r FT
PERFORMED BY: F 6LE r✓41 -5 "" CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE 6— 5' —D 3'
72-008 %Af 4,851
EAGLE RIVER
ENGINEERING SERVICES
P. O. Box 773294
EAGLE RIVER, ALASKA 99577
Phone 694-5195
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SHEET NO. L- OF
CALCULATED BV L odw DATE
CHECKED BY DATE
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EAGLE RIVER
ENGINEERING SERVICES
P. O. Box 773294
EAGLE RIVER, ALASKA 99577
Phone 694-5195
JOB Tr, /, jr r- 4.ld IV4 a /- -;�4ZW
SHEET NO. OF
CALCULATED BY DATE
CHECKED BY — DATE
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EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 694-5195
ERES Project No.: 03-013
Calculated By: LB
Date: 06/09/2003
Legal: Talus West Add No. 2, Lot SA, Blk 4
Single Family 3 Bedroom Dwelling
TEST HOLE 1 & 2 from /LW.W.C.
Bed Subsurface Wastewater Disposal Field
Using Advantex treatment system
Safety factor (SF) =
Water use at 150 gallons per bedroom =
Percolation rate =
Wastewater application rate =
Required absorption area =
Bed width (W) =
Gravel depth (D) =
1.5
450 gallons
7.1 minutes per Inch
4 gallons per day per square foot
113 square feet
5 feet
1 feet
Required length = Required absorption area / Bed width
Required length = 113 / 5
Required length = 34 feet with SF
Total Excavation Depth = 3.0 feet with 1' filter sand
SPACE ORIFICE HOLES AT 1.2' ON CENTER,
Louis A Butera
CE4736
UFR rE•...�'iR�yv
03-013 Advant cal drainfield 3br.xls 5:54 PM06/09/2003
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Total Dynamic Head (TDH), feet
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rinput Parameters
Orifice Size 1/8 . inches
Residual Head at Last Orifice
5.0 .
feel
Ofifioe Spacing
4.0
feel
Number of Laterals per Cel
2
Lateral Length
35.0 -
feel
Lateral Pipe CkusfScheduk
40
Lateral Line Size
1.00 -
Inches
Distributing Valve Mode
None
Mangold Length
3.0
feet
Manifold Pipe ClasslSc edul
40
Manifold Line Size
1.25
inches
Lift to Mangold
5.0
feel
Transport Length
150.0
feet
Transport Pipe ClassfScheduk
40
Transport Line Size
1.25
inches
Discharge Assembly Size
1.25
Inches
. Flow Meter
None -
Inches
Add-on' Friction Loves
r 0.0
feet
Calculation
Minimum Flow Rate per F 0.43 gpm
Number of Orifices per Zone 18
Total Flow Rate per Zone F 7.8 gpm
Number of Laterals per Zone I 2,
% Flaw Differential i stand Last 1.0 %
rStatic He
LAW Manifold 5.0 feet
Residual Head at Last Orifice 5.0 feet
anal Head Losses —
Head Loss in Laterals 0.1
Head Loss through Distributing 0.0
Head Loss in Manifold r 0.0
Head Loss in Transport Pipe 1.4
Head Loss through Discharge Q3
Head Loss through Flow QO
'Add-on' Friction Losses r QO
feet
feet
feet
feet
feet
feet
feet
Size Pump For
Design Flow Rate 7.8 gpm
Total Dynamic Hea 1-1-91 feet
The nominal diameter of the pump
discharge assembly piping
D
Generate fit .
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 015-2 02-61
1. GENERAL INFORMATION
Expiration Date: Z-- 3 -2(!9Z7_ -
Complete legal description Talus West #2 Block 4 Lot 8A
Location (Site address) 11622 Firnline Dr, Anchorage, AK 99516
Current property owner(s) Miller, John H Day phone
Mailing address PO BOX 110505, Anchorage, AK 99511
Real estate agent Teresa Burnett
2. TYPE OF DWELLING:
❑■ Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone (907)242-9644
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
Private Septic
0
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 5 5 0 Waiver Fee $
Date of Payment I t 0 1 o� b Date of Payment
Receipt Number 0 7, Receipt Number
COSH # U S c a 11 ( q 7 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. I acknowledge that On -Site staff may visit the site to verify the information submitted..
Name of Firm Forge Engineering Phone (907) 522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller, P.E. (M.J.) Date 10/29/21
.0 •`uTH
q�ll
6. DSDSIGNATURE
/ System #1 Approved for 3 bedrooms "� �
\
% BenjadAr chiller /
System #2 Approved for bedrooms�F0%_ % ioi2siz92 . • �`�`�%/
Disapproved }�1111iFVAROFESSIONPAw
Conditional approval for bedrooms, with the following stipulations:
OF A4r//i�/i
WATER AND m
WAST'_ -v o
04
Y Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description:
•
Talus West #2 Block 4 Lot 8A
If more than 1 septic system on lot: COSA Checklist #
A. WELL DATA
0 Well log is filed with Onsite (or attached)
Date drilled 7/3/2003
Total depth 46 ft
Cased to 46 ft
*1 Sanitary seal is functioning correctly
W Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 10/20/21
Static water level at beginning of test 28 ft.
Comments
B. TANK DATA
Age of tank(s) 18 years
Tank type/material Advantex/Fiberglass
Measured operating fluid level in septic tank n/a
Fm_1 Standpipes/foundation cleanout per record drawing
Date of pumping See maintenance report
D. ABSORPTION FIELD DATA Shallow Trench
Parcel ID: 015-202-61
of Structure served by this system
Which system tested (date installed) 10/25/2003
W ALL standpipes present per record drawing
Total measured depth from grade 2.4 ft (max)
Measured depth to pipe invert from grade ft (min)
0 N/A — pressurized field
0 Monitor tubes go to bottom of effective. If not, state
depth into effective
❑® Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies: Insulation present and trench depth matches IR.
COSA Checklist yellow sheet
Well production at time of test 5.4 gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑ No
no Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Forge Engineering
Date of Sample
10/18/21
C. LIFT STATION
0 Required maintenance completed
Age of lift station 18 years
Lift station material Fiberglass
Comments:
Inspected 6/23/21 Anchorage Tank
Adequacy test date 10/20/21
Results Q Pass For 3 bedrooms
Fluid depth prior to test 0/0 in
Water added 564 gal
New depth 3/0 in
Elapsed time 1440 min
Final fluid depth 0/0 in
Absorption rate '450 gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
Yes
Community Sewer Manhole/Cleanout > 100'
ft
Q✓ Yes
if No
ft
M Yes
if No ft
Neighboring Tank > 100'
F/ Yes
if No
ft
Private Sewer/Septic Line > 25' ✓] Yes
if No ft
Absorption Field on Lot > 100'
[D Yes
if No
ft
Holding Tank > 100' 0 Yes
if No ft
Neighboring Absorption Fields
> 100'
Animal Containment > 50' 0 Yes
if No ft
Q✓ Yes
if No
ft
Manure/Animal Excreta Storage > 100'
—✓0
Community Sewer Main > 75'
0✓ Yes
if No
ft
Yes
if No ft
From Septic/Holding Tank on Lot to: (Please
enter
distances if less than required)
Building Foundations > 10'
F- Yes
if No
ft
Surface Water > 100' F✓ Yes
if No ft
Property Line > 5'
✓M Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
0✓ Yes
if No
ft
Private Wells > 100'✓Q Yes
if No ft
_ _.Water Main > 10'
Q✓ Yes
if No
ft
Community Wells > 200'✓Q Yes
if No ft
Water Service Line > 10'
0✓ Yes
if No
ft
If septic tank is under driveway comment
below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' ✓❑ Yes if No ft If absorption field is under driveway comment below
Property Line > 10'
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Yes
if No
ft
Private Wells > 100' Q✓ Yes if No ft
Water Service Line > 10'
Yes
if No
ft
Community Wells > 200' Q✓ Yes if No ft
Surface Water > 100'
✓❑
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
OF Al"
s •' 419
-.. Benja chiller
F� •. CE 12592
�� i�lF�• 10/29/21 , •��UAMP,�
PROFESSI0W
(V oa oao
o
e �
,he locatio;i of the structure(s)as
shown on this record drawinq
(as -built complies with itle 2 ; AMC
By:
I Date:
N
SCALE:��Sa�
m
w
DATE:
W
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
GRID:
EASEMENTS, COVENANTS, OR RESTRICTIONS
z�3
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
FB:
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES..
DRAWN.
e
4 e n
N
0
m�
r
N
SCALE:��Sa�
m
w
DATE:
W
ASBUILT SEMARD &
I HEREBY CERTIFY THAT 1 HAVE SURVEYED THE
SCALE:��Sa�
FOLLOWING DESCRIBED PROPERTY:
r���r yi�sT�ar1 moo, z Com A� 66r� y
DATE:
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
GRID:
EASEMENTS, COVENANTS, OR RESTRICTIONS
z�3
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
FB:
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES..
DRAWN.
Q4
r
0
b
OF 14
SS `�na•Merh Sewer3
+ LS -5918
9
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this ).nW Day of �i1P�GA(�- of 20 21, by and between
%d -g 1 , herein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as Advantex
located at (legal description)
Talus West #2 Block 4 Lot 8A
2. Maintenance, Renairs and Alterations.
(Owner is required to read, understand and initial each. section)
Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
ov It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
5� Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
�tl Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
Il Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWNVTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
OWBv:
Date: J l 0 07-1
At V( d0. 1 (print name)
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
The foregoing ' strument wa acknf wledged before me this, day of
20,;?/ by � �("
NOTARY P OR ALASKA f ��: 0TAR Y
- - My Commission expires: d�
;�TF
On E
MUNICIPALM'.
tJ.,(signature) Date: r 3 2d �-
(print name) Title:
rJOf /_ 41 ZrJL1 0 r . LJ 0000 f f U Hr LUJ rHl7C CJ;J
on Oma■IM me NNE a 394802 MEMO ON ■ <A 0
f✓�
not M IRS ®A ■ on ■ on No®®
>rrr� Q®■ ® e ME® MOREEK a 0Rlt1111r■ R a
FAdvanTe; t' Field Maintenance Report
Annual Insp,ctian
Property Ownor/hHrklnu N
John Miller
Slto Addtape
11622 Firrlline Drive i, Anchorage AK 99516
AX Ska ID h 001111ty ID 0 pod 8
AX -102355 SWO30205 1202009
Retrieve O&M Info
Baily flow -
Reclrc ratio_
Timor settings:
Perform Field Sampl Ing/Observations
NTU (15 f NTUs)
pt (6-9)
DO (2-6)
(Ff
Non -typical ❑ Sulfid !
❑ Cabbage ❑ Decay
Qdor of Sample
......... �/_xyyi
Typical ❑ Musty
fpffFarthy ❑ Maidy
Non -typical ❑ Sulfid !
❑ Cabbage ❑ Decay
Oily film in PVU [ Yes No
/
Foam In tank E Yen o
Check Control Panel
........... P-1
fleelrc A�m�p+s
Discharge Amps
p
.........
Audible and visual elan 'is
OOK
Dial tone (telemetry cel r)
ZYes ❑ No
Inspect/Clean Pump iiystem
Inspect
Riser/Lid ...........
......... �/_xyyi
Splice Box ..........
... . .... z
Float Coals . . .......
.........
Floats ..............
......... ilk
Pump ..............
........... P-1
BiatuW' Filter .......
..........
Biotube Pump VaLlk ..
.........
Recirculating Splitter V;
Iva...... .
Corrprrll�nts —�� '_
SlUnature-4
Clean
operator
Larry Betts
RTU 61UL t
RTU117493
measure siudge/Scum
Sludnm
AnchorageTank
907-272-3543
Contarf Phone
(907) 346-7111
Pate of Lads Inspoctlon
09/14/2020
Scum
1atCompartment
Currc
Previous
Current
Previous
2nd Compartment
urront
Previous
Current
Previcua
Inspect/Clean AdvanTex Filter
Odor.ormal ❑ Pungent
Biorn banal ❑ Ex V0
Bridging/Ponds None/Minor n Excessive
Inspect/Clean Discharge Pump System
Inspect
Rieer/Lid
Splice Box
Float cor{Ic
IrlspectlSOrvice Other System Carr,ponents
Inspect
Laterala/Orifice s
Clean
Pod Bottom
Intako Vent
Inspect
Clean
Floats
Pump
Inspact clean Inspect Clean
Milnicction Equipment Dispersal I,a#erals/Oriflces'o
Observations
Additional SeWioes Rendered
❑ Cleaned textile sheets? ❑ Replaced UV Items?
i� Replaced/Used other Items?
Parts Used: W � Warranty, B = Billable (✓ appropriate selection)
W 0 Item Number Dest:rlptlon
Final/Safety Inspection
RSV reinstalled
,(Manifold reconnected; flush valvos closed
Summary/Recommendatiomg
System performing; no further action needed
n - ..
1ilds bolted on
17-1,6
ontrol panel roactivated
[Tank needs pumping
❑ Other? .-
Pate r _Ic__ _ ._ /
Fax completed form) to 1-866.384-7404