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Home My WebLink AboutTALUS WEST #1 BLK 3 LT 19Talus West #1 Block 3 Lot 19 #015-202-12 Municipality of Anchorage Department of Health and Human Services Building Safety Division Onsite Water and Wastewater Program, 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 3 www.ci.anchorage.ok.us (907) 349-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number SWSW040466 PID Number. 015-202-12 "eVr 'an UVffillette Wastewater System: ❑ New ® Upgrade 7z Rox 33 Auh,lrn WA 98071 ABSORPTION FIELD Phone. " `w BSOo ® Dep Tw xh D Shen" Tr.rxn O Bad o Ma xl a Omer LEGAL DESCRIPTION arpns TOM 9.12 r. BbrA Lal S.LGNebre Depth to PPS bonen ham"nel Wad@ Gant depth batreth PNe: Townhq: pence: 8edbn: Fa added aDaw odpnat Wade: 1-2 F1 Gn! Lwpth 114 Ft Well ❑New ❑Upgrade Grant o*xh: 3 F1 Number am.. potence beh~fir e 2 FL ct&"&ation (a*. A 9, Ck rovate Total Daph:Cath Ft to: Ft TOW ebeorpew move, 1368 Ppe MNerw.. 3034 PVC Domer Date DrAlod Static Wow L«at', Inataner 1 Date awned: F1 A+ Ho e Services 1111112004 Y.W Pump sat at: ca«ra Nepht Ab" Grand: TANK GPM Ft. Ft SEPARATION DISTANCES ❑ septic ❑ Holding ® S.T.E.P. ❑ Other. To Septic Absorption LIR Holding ub[bPr"ate M"" ted1 cevvaY From Tank Field Station Tank Sewer Lbe Anch Tank 1250Ga well 114 113.3 125 100+ Mat"'at Steel Nmfaerofcmn.tmente: 2 8..1 uwot. 100+ 100+ 100+ LIFT STATION La liw 45 11.1 45 Sao 250 Gat Marwlwd Orenco 6.0 14 15 pu"w oro Wel M: -Pomp oir t«at at: Hpn water at.nrr at: Fond~ 44 b 42 ti 46 b cwb D .n 100+ 100+ 100+ Prop Make a Medat Orenco P20 Electr" enim pede pwk-ad by. MOA RS Curt Raucie BENCH MARK Location w Dernpam: Lower Back Deck Aewnrd Ewatan: 100.0 FL Engineer's Stamp ♦ Inspections performed by: Pannone Eno. Svc Dates: 1"11/11/2004 2n01111112004 �.....:........ ... ::.....� i Department of Health d Human Services approval """""""""' "" """"""""'0 j � Steven R. Ponnone: 0 ��'� No. CE 8149 ' Reviewed and approved by: Date: areal 1r'., ''•�S'� (N«. 'CO ... ....... ��e,,t:Qya♦♦♦ PERMIT NO:SWO40466 RECORD DRAWING WASTEWATER DISPOSAL SYSTEM Lot 19 Block 3 Talus West, Add'n No. 1 EXIST'G AREA 1 NEW UPGRADE DEEP TRENCHESWED SAS 1(@ 49LF,1 @ 65LF _ 114 LF TOTAL / / CAUTIONI / NUMEROUSUNDER / GROUND UTILITIES G / IN AREA. CALLL FOR i/ / LOCATESI— -j 1.'0 NOTES: 1) All work shall be performed in accordance with AMC15.65. 2) Materials used shall be in accordance with those specified In AMC15.65, Wastewater Disposal. 3) Conned post tank line to mid point of drain field, typical. line Is 1 1/4'. 4) Maintain 10'separation to all lot lines and proposed water lines. 5) Lots served by a private well. No wells within 100' of proposed system. ,11111131 / EXIST / 4 R I Sr( / HO SE I 1 / I / 1 I ZZ4 l I / I— / / EXISTG AREA P.I.D. NO: 015.202.12 I I I --- JI / -- S SA)ANDONED :E / EXISTG SEPTIC / AREA APPROXIMATE LOC74 OF J END BASED ON'AS- BUILT' INFORMATION. FIELD VERI ' C �1250aL O a \ ETTANK -CRUSHED �[/ IN PIXC€ /-\ NE 1500g \\ \ S..E.P. TANK 19 \\ '\\ 1 1 I I J•••••••••••••••• PREPARED FOR: en R. Pannone Mr. Jan Witlette No. CE 8149 ' \ P.O. Boz 33 0910 4 •' �� Auburn. WA 98071 (253) 632-8683 CO B FC 8.9 5.2 TI 9.9 9.0 T2 23.9 16.8 4.9 18.6 \ M1 31. 44.9 \ M2 37.9 3 1 CO C D 1 M3 31.3 55.0 I M4 56.1 79.9 I M5 14.4 34.4 DESIGW PER YRATE:304 MPI I\P LICATION RA E: 333 SF/BR 10.40 GPD/SF 4 SR HOUSE REDID AREA 1333 F 6'EFFTDEPTH,11 LFX10'T.D. 1333 SF TOTAL 1500 GAL. S.T.E.P T K PANNONE ENG. SVC, LLC P. O. BOX 102954 ANCHORAGE, ALASKA 99510 227-3522 P. 272.8218 Fax DATE_ 11-18-04 RECORD PERMIT NO:SWO40466 RECORD DRAWING DETAILS WASTEWATER ABSORPTION SYSTEM Lot 19 Block 3 Talus West, Add'n No. 1 NOTES: 1, 1) ALL WORK SHALL BE PERFORMED IN ACCORDANCE WITH, AND ALL MATERIALS SHALL CONFORM TO, AMC15.65. 39n1 bOlINOW LL. K w a a 0 a w LL IL n. ^ 39n1 bOlINOW m CS •L n N O m� I4 e� l O z P.I.D. NO: 015-202-12 m N m O a iG O^1 1nowmo W lF uG 1nOP1V3To 4�q noNy�TO N I,VON(lO3 r 5 V"^• Pannone Eng. Svc., LLC Mr. Jan Willette P. O. BOX 102954 P.O. Box 33 Auburn. WA 98071 ANCHORAGE, ALASKA 99510 12531632-6683 272-8218 PHONE & FAX ..� ' T^1 -X9^04„ RECORD F -E8-21-2005 11139A FROM:A+ HOME SEfV:CESI IN 907-868-6770 KA Munlelpa Lty of INSPEDT1ON:voiCE7as-92oo INS] Nerve EDB ELECTR Mdr..a 4311 6NOWCUM Lapel SK A 1.7 tv •wb4tvlalsn TAWS WEST R' Comments or Dlreotlens AM CALL 61 FC \ Irmpeotlan Retro Etaatr'cal NONCOMPLIANCE089FAVEU (] CORRECTIONS ESSENTIAL AS EXCLAINEO I [] WILL RE-EXAMINE AT NEXT INSPECTION 1 OOMMENTB: (for Inepeolor use orAy) I Inspector _ 70:2728218 P:1/1 27:36 Report muueing salary otvislon en9ew FAX (907)2da-TM INFO: 343-7962 Penult 04-9606 Phone 27z-4nvI Inspeatlen Date 1 VtD200M1 MTC )binepeatlen N E] DO NOT CONCEAL UNTIL REINSPECTION FEB -21 -EUS MON 1 L;a3AM ID:A+ H"- SEPJ'l T5. INC. FAtiL• e 1 • MUNICIPALITY OFANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Nov 01, 2004 Expiration Date: Nov 01, 2005 Permit Number: SWO40466 Parcel ID: 015-202-12 Legal Description: TALUS WEST #1 BLK 3 LT 19 Design Engineer: 0062 Pannone Engineering Services Site Address: 004511 SNOWCUP CIR Owner Name: JAN WILLETTE Lot Size: 17500 SO. FT. Owner Address: 4511 SNOWCUP CIRCLE Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99516-2222 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 specked 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 Bu<- ��/� Date: O`l //O f Issued Byr—M- \ Date: // Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-202.12 Permit Number SW SA a I I Property owner(s) Mr. Jan Willette Day phone _(253.632.8663 Mailing address (1) P.O. Box 33 Auhim, WA q$U�t1 Mailing address (2)`Q 5 11 •Sn0111011 0 1 n�.1r Lt Nh' ggSX, Zip Code Legal description (Lot, Block & Sub'd.) Lot 19, Block 3 Talus West, Add'n No.1 Legal description (Section, Township & Range) 4511 Snow Cup Circle Lot Size 17,500 1-0,W Acre /Sq.Ft THIS APPLICATION IS FOR: Number of Bedrooms 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 ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: / Waiver Fees: _ Date of Payment: h9 oZ Date of Payment: Receipt Number: 65o0qqReceipt Number: (Rev. 17100) Z 94 Pannone Engineering Services, LLC Consulting Engineers (907) 272-8218 October 11, 2004 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 19 Block 3 Talus West S/D, Add'n No. 1 Septic System Replacement Permit Request Ladies and Gentlemen: P.O. Box 102954 ge, Alaska, 99510 )071272-8218 Fax I am writing to request a permit to construct an upgraded septic system be issued for this property. The proposed systems will serve an existing four-bedroom house. The lot is developed at this time. Two test holes were excavated on this lot on October 11, 2004. I am attaching a copy of the soils test results for the area we are planning to install the system in. Ground water was monitored through the seasonal high period of 2004. I monitored the water depth on October 17, 2004 and found there was no water in the monitor tubes. Bedrock was not encountered in either test holes. The lot is 17,500 square feet (0.40 acres) in size. 1. Soils. See the attached soils log. The proposed septic system will be constructed around the latest test hole. It is my opinion that the overall soils appearance of the soils, an application rate of 0.4 gallons/day/square feet should be used. 2. Trench Design. a. Percolation Rate: 20-40 Min Per Inch b. Application Rate: 0.40 gpdpsf (333 sf/br) c. Number of Bedrooms: 4 d. Design Flow: 600 gallons per day e. Min. Absorption Area: 1333 sf L Total depth: 10 feet g. Effective Depth: 6 feet h. Width: 2-3 feet i. Reduction Factor: N/A j. Minimum Length: 111 feet k. Design Length: 111 feet 1. Effective Absorption Area: 1333 sf m. Septic Tank Size: 1,500 gallon S.T.E.P. C:\Work\Letters\19-3 Talus West Nol.001.doc 3. Surface Water: There are no surface waters within 200 feet of the proposed septic system. 4. Topography: The average topography in the area of the proposed septic system is flat. The lot has an average topography of 1 to 2 percent. The proposed installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 227-3522 or 272-8218. Sincerely, Steven R. Pannone, P.E. 4Q'" /� '• ►.....r .. ..........:t... Civil Engineer 'j(�A?Steven R. Conn, Attachments: #i0 `:, No. CE 8149 C:\WORK\LETTERS\19-3 TALUS WEST N01.001MOC PERMIT NO:SW04 DESIGN DRAWING P.I.D. NO: 015-202-12 WASTEWATER DISPOSAL SYSTEM Lot 19 Block 3 Talus West, Add'n No. 1 \ / I i EXIST'G SEP I i� AREA ---J EXISTGS T�� / r------ 4L' H1 \ PROPOSED UPGRADE \ Sea, 37LFx6 ED SAS \ 111 LF TOTAL 18�� \ CAUTIONI' NUMERO�S.UNDE— GR9UND UTILITES ,N?�REA- CALL FOR / LOCATESI EXISTG / 4 SR HPOSE NOTES: 1) All work shall be performed in accordance with AMC15.65. 2) Materials used shall be In accordance with those specified in AMC15.65. Wastewater Disposal. 3) Connect post tank One to start of drain field, typical. One to be Arctic Pipe. 4) Maintain IV separation to all lot lines and proposed water Anes. 5) Lots served by a private well. No wells within 100' of proposed system. 4x ' 49 M an R. Pannone No. CE 8149 r 41 O / 1,-.. 0 1 SAV / 1 O% CUp 1 � � C'RQF EPARED FOR: JOB R S EXISTG SEPTIC J AREA 1 / I \ I I APPROXIMATE LOC'N OF �w I END BASED ON'AS-BUILT' \ J INFORMATION. FIELD VERII LOCATION. 10.0 THf22 `tY O 12509 ` U TANK - ABANDON PER�TE:30.4 MPI \ PR POSED 1WQ' APPLICATION RA E: 333 SF/BR \ S..E.P. TANK -D.40 GPD/SF 4 BR HOUSE — — REQ*) AREA 1333 F 6' EFFT DEPTH, 11 LF X 10' T.D. 1333 SF TOTAL 1500 GAL. S.T.E.P T K EPARED FOR: PANNONE ENG. SVC, LLC 1 \ I \ I I 1 �w I I C�rG DESIGW PER�TE:30.4 MPI APPLICATION RA E: 333 SF/BR -D.40 GPD/SF 4 BR HOUSE — — REQ*) AREA 1333 F 6' EFFT DEPTH, 11 LF X 10' T.D. 1333 SF TOTAL 1500 GAL. S.T.E.P T K EPARED FOR: PANNONE ENG. SVC, LLC Mr. Jan Witlette P. O. BOX 102954 P.O. Box 33 Auburn, WA 98071 (253)632-8683 ANCHORAGE, ALASKA 99510 227-3522 P, 272.8218 Fax DATE: 10.16.04 DESIGN MC W w w w w U g w w PERMIT NO:SW04 DESIGN DRAWING DETAILS WASTEWATER ABSORPTION SYSTEM Lot 19 Block 3 Talus West, Add'n No. 1 NOTES: 1) ALL WORK SHALL BE PERFORMED IN ACCORDANCE WITH, AND ALL MATERIALS SHALL CONFORM TO. AMC15.65. 1noNvaio.m t 39111 NOlINOW 000000000 w 000000000 W 00000000/0 p, 00000000 00000000 00000000 00000000,0000000 0 O 00000000 < W o_ Z 0 z o x(I O LU LL O ,0 N V! 3w a ZI p � 9TH ' Steven R. Pannone i �• CE 8149 '�� 3Sn1 UOIINOW Ino Nv3lo.m t 1nowmo 1nowmo 1noNv io NOLLVON OJ P.I.D. NO: 015.202-12 w 0 ► gid W f aqui a 0 LL J G LU i0 S U z LU w w w 0 IzVAKtu t -UK: Pannone Eng. Svc., LLC Mr. Jan Wlitette P. O. BOX 102954 P.O. Box 33 ANCHORAGE, ALASKA 99510 Auburn. WA 98071 (253) 632.8683 272-8218 , PHONE & FAX DATE: 10-16-04 ^ DESIGN SOILS LOG - PERCOLATION TEST PANNONE ENGINEERING SERVICES P.O. BOX 102954 ANCHORAGE, AK 99510 (907) 272-8218 PERFORMED FOR: Mr.Jan Willette DATE PERFORMED: 10/ 11 /04 LEGAL DESCRIPTION: Lot 19 Block 3 Talus West S/D, No. 1 TEST HOLE I TEST 4t 49 en R. Pannone No. CE 8149 M WAS GROUND WATER ENCOUNTERED? No IF YES, AT WHAT DEPTI1? -0- DEPTH 0 -DEPTH TO WATER AFTER MONITORING? pa w-1 DATE: 10-17-2004 awry. TEST HOLE PEROLATION RATE 20 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 7 FT AND 8 FT COMMENTS: Test hole excavated by A+ Home Services. Test Hole was presoaked before pert test. PERFORMED RY: Steven R. Pannone. P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACi OR Organics 1 ML Brown silt 2- 3- 345 4- 5— GM Poorly graded Silty GRAVEL 6- 78910 7- 8- 9- 10 11 12 ML gray Silts 13 14 15 SP/SM Poorly graded SAND to silty 16 SAND 17 BOH 18 19 20 TEST 4t 49 en R. Pannone No. CE 8149 M WAS GROUND WATER ENCOUNTERED? No IF YES, AT WHAT DEPTI1? -0- DEPTH 0 -DEPTH TO WATER AFTER MONITORING? pa w-1 DATE: 10-17-2004 awry. TEST HOLE PEROLATION RATE 20 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 7 FT AND 8 FT COMMENTS: Test hole excavated by A+ Home Services. Test Hole was presoaked before pert test. PERFORMED RY: Steven R. Pannone. P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACi SOILS LOG - PERCOLATION TEST PANNONE ENGINEERING SERVICES P.O. BOX 102954 ANCHORAGE, AK 99510 (907) 272-8218 PERFORMED FOR: Mr.Jan Willette DATE PERFORMED: 10/11/04 LEGAL DESCRIPTION: Lot 19 Block 3 Talus West S/D No. 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Is it 11 IE I5 21 TEST HOLE 2 Organics Brown sut Poorly graded Silty GRAVEL Poorly graded Silty GRAVEL gray Silts SLOPE TEST HOLE OC 4:: 49 TH ( V en R. Pannone No. CE 8149 Q 1l 10 Z WAS GROUND WATER ENCOUNTERED? No IF YES. AT WHAT DEPTH? -0- DEPTH TO WATER AFTER MONITORING? Dry DATE: 10.17-2004 bwM TEST HOLE PEROLATION RATE 40 (min/inch) FERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 9 FT AND 10 FT COMMENTS: Test hole excavated by A+ Home Services. Test Hole was presoaked before perc test. P9PRORMRT) RV- Steven R. Pannone. P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACI GRE~.-,,ER ANCHORAGE AREA BOk..UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM DISTANCE FROM WELL MANUFACTURER MATERIAL NUMBER OF COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY GALLONS. ^BSORPT,ON^REA [00 Fl SQ. FT. LENGTNOFEACNL,NE / ~ = ~' ' TYPE ___ CONSTRUCTION .DEPTH BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION__ LOT LINE , SEWER LINE__., TANK SYSTEM CESSPOOL OTHER SOURCES APPROVED __ DISAPPROVED REMARKS DISTANCE FROM: DISTANCES: SEWER LINE DEPTH: PIPE MATERIAL: DIAGRAM OF SYSTEM " G.A.A.B.// ,:; '?'?'CE:::]. ) ~ F' i:::: [. ]; C:I::Ii",I L. 0 E:l:::!'i- iii I]i]1 L [ii]E!il:::IL_ 'I'HE L. EMG-f',~.I [) :[ I"!E:N:i~; ]] Obi ]1 E; '1"HIE I_.ENG"i"I;-I ( :!: h! F'EE"f' ) QF '!HE "I'I:~:EN(;;H Ed:;;: DI:~:F:I :[ h!F' ;i; !ELD. 'i'~-IE DE:F:*Tt..~f OF' i::i 'Tt:;~:FZi'.,ICH OR I::'.~q' Z% ':f"ldE] I]:,Z:5'f'i:;~i'-4E:E ,?_::iE'I'HFE;E]'-,i ~f'HE :SLII:,]:F::'FIE:E OF 'FHE: GROLIMD F::il'-,tD "i'H!E E:Ei'l"'T'EIf"i CIl::: THE E',:'::CI::i',/FI'T ]: (:]M ,:]]:M F:EE'i'::,. -I"HEF;?.E ]::E; t",!0 E;E:'T' H];E)'i'H I-;01:;?. 'TREhfE:HiE:i~;. 'I'I4E: Gt;;:i::I',,,'E:L DIEF'~I'H ~t]% 'I'H!E t"I]]H;I;b'iUH IJ)iEi::"YH Ed:~ G,t:~iFtVEL. tEdE"I't.qEE:i'.,! '!"HE: L-d.Ff'I::'F'IL.L. F'];F::'E ?INE:, 'THE B0:[5'I;)I'"t 01::' ']'HIE E::.:;(]:I::I',,/I::I"[Z · _r F' "?H!F; DRILLING, INC, Well Owner DRILLING LOG : ) Use of Well Location (address of: Township, Range, Section, if known; or distance mare road Size of casing Depth of Hole Static water leveL_ _ft. (above) Screen ( ); Perforated ( feet Cased to feet (below) ]and surface. Finish of well (check one) open end ). Describe screen or per£oration Well pumping test at__.gallons per (hour) of drawdown from static level. Date of completion ); (minute) for hours with ft. WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness TO. .TO .TO_ .TO_ TO. _TO TO_ TO_ ____TO .TO. TO _TO_ ___TO 3--CONTRACTOR Municipality of Anchorage Development Services Department Division Onsite Water Building d Wastewater Program Y ` - 4700BragawStreet P.O. Box 196650 Anchorage. AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 015.202-12 COSA# Otoo(Is I. GENERAL INFORMATION Expiration Date: Complete legal description tot 19. Block 3. Talus West Sulklmsion No.1 Location (site address) 4511 Snowcap coda ancnora 98, Al<99516 Current Property owner(s) Jan Wplette Mailing address P.O. Box 33 Aubum, wA 09071 Day phone 253-632.86M Lending agency Mailing address Day phone Real Estate Agent Mailing Address Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Four (4) 3. TYPE OF WATER SUPPLY: Individual Well TYPE OF WASTEWATER DISPOSAL: Individual Water StorageIndividual ❑ On-site O Community Class Well ❑Community Individual Holding Tank ❑ Public Water System El CommunityOn-site ❑ Sewer ❑ eThe Municipality of Anchoragupon e Development Services Department (DSD) Issues Certificates of On Site Systems ngineer registered In In tthe State of Alaska.PCertifitcates o90en Ine Systems P ragreph 4 by an independent professional civil title (except between spouses) for properties served b Approval are required for the transfer of supply system. DSD also Issues COSAs upon request to homeowners Certificates of Onsite Systems y a single family on-site wastewater disposal and/or water 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. (Certifxxtes may Approval samples.) Certificates are valid for one year forPropertiesbe reissued for a period of up to one year with valid water The Municipality of Anchorage Is not responsible or rrors or Omisssiions In thea Proe sional engineer's water rk system. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my Investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of installation. Name of Firm Anderson Engineering Phone 522-7n3 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E.Mdenron, P.E. Date 414r2W6 b. DSD SIGNATURE V✓ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: 'T ' of I — O 62 CRr. ttrsi Municipality of Anchorage Development Services Department Building Safety Dhlalon OnSRe Water d Wastewater Program 4700 Bragaw Street P.O. Box 198850 Anchorage, AK 98519-8850 www.munLorg/onshe (907) 943-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Deauxiption: Lot 19, Brock a, Tru. Wed Sk b&Wak No.1 Paroel ID: 01S202-12 A. WELL DATA Well type my Date completed ten Total depth 14s rt. Data of teat Static water level Weft production If A, B, or C provide PWSID # _ Wan Log (YIN) Y Sanitary seal (YM) Y Wires properly protected (YIN) Y Cased to >4o fl. FROM WELL LOO J aM 9 -P.M. WATER SAMPLE RESULTS: Coliform o eolonleaH00 mL Arsenic: ND m9n B. SEPTICIHOLDING TANK DATA Tank TypeNaterlal sepsclsred Tank size 'Mo gal, Nitrate ND nrg& Date of sample: RIM Casing height (above ground) >,s in. AT INSPECTION 3n,l2ooe � rt. s.ta g.p.m. Other bacteria 4 colonlesm 00 mL Collected by: L. Harmrkdu Dete installed 1,numo4 Number of Compartments Toro Cleanouts (YM) Y Foundation deaeout (Y" Y Depression over tank (YM) N High water alarm (YM) Y Date of pumping New Cmdnream Pumper dam Nae Never Been In aerobe C. ABSORPTION FIELD DATA Dateinstalled iittvw Sop rating (g.p.dJr?orfe/bdnn).4OPOISF SYslemtype oaeprrarkdr Length ,u R Width 9 R. Gravel below pipe a rt. Total depth e•12 1L E f. absorption eros Isse fe MO MMM tube Y Depression over field N Date of adequacy teat 303IM4 Results (PasslFen) Pan For N bedrooms Fuld depth in absorption field before test a In. Water added f.?35 gal. New depth o lo. Elapsed Tyne: a min. Final fluid depth _L_in. Absorption rate » 800 p.p.d. Any reluvenaton Imatmerd (past 12 mo.) (YM d type) If yec give date D. LIFT STATION Date installed 12224 Size in gallons 250 Manhole/Acosss (YIN) Y 'Pump on' level at 44 in. 'Pump olr level at 42 in. High water alarm level at 4e In. Dahrrn Bosom d Tw* Cycles tested Faro Meets alarm b circus requiements? Y E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanIM station on lot >1W Absorption fteld on lot >100' Public sewer main wA On adjacent lots >1W On adjacent lots >10V Public sewer menhole/deanout NrA Sewer /septic service line a25 Hddk g tank WA Animal containment areas NIA Manure/animal excrete storage areas WA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation W Property line>5 Absorption field i9 Water main NIA Water service line >10' Surface water >1(V Wells on adjacent lots >1ar SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property tine >101 Building foundation >1W Water main WA Water Service line >101 Surface water )-1W Ddv&M. parldryvefrEte stiorage >2V Curtain drain Nom Ned Wells on adjacent lots >10V F. COMMENTS: SOPW System Has Nor Seen in service nm n was lnuww in November d 2004. 0. ENGINEER'S CERTIFICATION 1 car* that I have determined Utrough fi left inspections and review of Munk*W records that the above systems are in conformance with MOA COSH guidelines in effed on this data Engineer's Printed Name Mldrsei E. Anderson. P.E. Date 414r 006 COSA Fee $-43 00 Date of Payment USRooe Receipt Number 19,30 (star. 11M5) Waiver Fee S Date of Payment Receipt Number O \ aE~ENF p. p p, BncD DECK O ' nD.H. DECK C / �V Ei1N GLE ey / F7AME Na jAMSEY ev O a' \ tv -�A �N 2 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN ExISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCELINES. O O n C C � o E F'q�q �Q.C � qs 00 !� 497-H ........................... 5�.4f, /ice V SHANE A. HOLT.- LB-6914 OLT.LS•6914 L 4p��oq•'•...........••� mom AS -BUILT SURVEY (NO CORNERS SET THIS DATE) 1••20 1 HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 19. BLOCK I. TALUS WEST NO. 1 ANCHORAGE RECORDING DISTRICT. ALASKA AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE M10PERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED, EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED FLAT. ARE NOT SHOWN HEREON RUNLESS INDICATED) I DATED AT ANCHORAGE. ALASKA THIS 17TH_ DAY OF MARCH200E NOTE. ANY FENCELRIES SHOWN ME LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES HOLT LANDSURVEYING 10059.FB12Y1E OR LOCATE STRUCTURES. TEL. 2455517 ANY PAVING SHOWN MAY BE APPROXIMATE WE TO SNOW CONDITIONS. '*IU~IUI~LI I ¥ U~ ~I~U~U~ DEPARTMENq~,6F HEALTH AND ENVIRONMENTA~.xPROTECTION 825 L Street, Anchorage. Alaska 99501 264-4720 Date Received: October 17, 1977 #1: Time 11:30 a.m. #2: Time #3: Time Date 10-19-77 Wednesday Date Insp .~a.~. Insp Date Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Mailing Address: Phone: Property Owner: Mose Pendergrass Phone: 349-4207 Mailing Address: Star Route A Box 1585-B 99507 Legal Description: Lot 19 Block 3 Talus West Subdivision Snowcup Circle Single Family Residence: (x) Number of Bedrooms: Four Multiple'Family Residence: ( ) Number of Bedrooms: Well System: Permit # Construction Individual well (~ Community/Public System ( Depth of Well 146' Well Log on File Bacterial Analysis Sewage Disposal System: Permit # Septic Tank Size Absorption Area On-site System (x) Public Installed 1977 Installer Manufacturer Utility ( ) Soils Rate Material Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Rage Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 19 Block 3 Talus West Subdivision Comments: Affadavit Attached: Approved: ~ q Disapproved: Letter Attached: ( ) Date: Date: / f---p-2---o -x Department worksheet: Rev. 1977 DATE ALAS~. ? DEPARTMENT OF HEALTH AND SOCIAL SE.. DIVISION OF PUBLIC HEALTH Lab No. INDIVIDUAL AND SEMI-PUBLIC BACTERIOLOGICAL WATER ANALYSIS oFficE INDIVIDUAL []' NAME SEMI-PUBLIC [] CHLORINE RESIDUAL PPM REPORT RESULTS TO ADDRESS CITY ZIP CODE ADDRESS OF SOURCE Analysis shows this Water SAMPLE to be: ~ Sallsfactory [] UnsaHsfactary [] Questionable [] Sample too long in transit; sample should not be over 48 hours old at examlnatlon to ~ndkate reliable resuhs. Please send new sample. [] Bottle broken in transit, please send new sample. SANITARIAN'S REMARKS COMPLETE THIS SECTION ONLY IF WATER IS AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY DATE COLLECTED TIME COLLECTED Diameter of Well Depth Peet. Well Casing Mater/al Diameter Depth Length of Water Depth Drop Pipe From Rotlom Feet. Offset in In Utility PURPOSE OF EXAMINATION: Illness Suspected? New Source of Supply? [] Yes [] No READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING ,SAMPLE 06-1g20~ev. ]9~3(bl BACTERIOLOGICAL WATER ANALYSIS RECORD ..-; J~-' ' ~/" ~ ~:~r..Lab. No. Dote Received t ! ' !( '- Time Received Lactose Broth ?Occ 1Otc 1Oct 1Otc 10c¢ 1.0cc 1.0c¢ 24 Hours 48 Hours ' Brilliant Green 24 Hours ; 48 Hours EMB AGAR This analysis indicates CoJUorm Organisms to be: DEPARTMENk }F HEALYI~I AND ENVIRONMEN¥~ ,PROT[CTtON ~ ' 99501 825 ~ Street~ Anchorage, A!ask~ 279-2511, ext. 224 or 225 Date Received: Au~_u_$t___3~ 1977 ~1: Time #2: Time #3: Time Date Insp Date Date Insp ................ Insp · ' ACIL.~. PIES kEQ[JEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER ~' .... ' ~ Lending InstJ. hution Request: Alaska Statebank Mailing Address: __3_l_9_E._a_s_t- Nor__ t~h_e~r_n~.._.L.i_gh__%~s .~!~v_~_t.. Phone: 2. Property Owner: Mose Pendergrass Phone: 349-4207 M~iling Address: Star Route A Box 1585-D 99507 Legal Description: Lot 19 Block 3 Talus WEst Subdivision 4: Single Family Residence: ~ Number of Bedrooms: Four Multiple Family Resido. nce: ( ) Number of Bedrooms: 5. Well System: Individual Well ( ~x Con-anunlty/Public System ( ) Permit 9 .............. Depth o:f Well .......... 145' Well Log on File ( ) Construction Bacterial Analysis Sewage Disposal System: Permit ~ Septic Tank Size Absorption Area On-si. re System (~x Public gkility Installed Installer Manufacturer Solls Rate Material ( ) Distances: Well to Septic Tank to Sewe_ Line Nearest I, ot line to Nearest Lot Line to Absorption Area Absorption Area Wa.ge -Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 19 Block 3 Talus West Subdivision Comments: Affadavit Attached: ) Letter Attached: Approved: Date: Disapproved: Date: Department Worksheet: · ~. ~ <-~MUNICIPALITY OF ANCHORAGE<.j "~' ~'~'~,', ~ /~ Department of Health and EnvironmentalProtOcol0? //0~ 825 L Street, ~chorage, Alaska 99501 264-4720 ; ..... ~equest for Approval of Individual Sewer and Water Eacilities 1. Property Owner: Mailing 2adress: Name of Buyer: Mailing Address: Lending Institution: Mailing Address: Phone: /9 _~z~ ~_. Phone: o Realtor/Agent: Mailing Address: 5. Legal Description: ~ ~ /? ~/~, ~_, '/~/~g~ L~~. Stre~t Location: .%~OC~C.L~D. C~%nC~. ~ Single Family Residence: Multiple Family Residence: Phone: (~-~- Number of Bedrooms: ( ) Number of Bedrooms: 7. Water Supply: * Individual Well (~) Public/Community System ( ) If Individual Well, well depth ./~/~. If Community System, name of system o Sewage Disposal System: On-site System (~ Public System ( ) If On-site System, date of installation: /~ *NOTE: A well log is required on ALL wells drilled since 6/75. If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Alaska 99501 279-2511, ext. 224, 225 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES VA FHA 1. Type of Inspection: 2. Property Mailing Address: CONV_~.__ Day Phone: 3 ~ ,~ ~/~-¢ 7 3. Name of Buyer: Mailing Address: 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Agent: Mailing Address: 6. Legal Description: Location: Day Phone: /< Phone: Phone: 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: No. Bdrms._ ~ Public Utility. Individual If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility ___Individual (on-site) If Individual, date of installation //~ ~ b(~ /-~--~ '7 72-003(3/76)