HomeMy WebLinkAboutTALUS WEST #1 BLK 7 LT 6Talus West #1
Lot 6
Block 7
#015-202-50
(Kev u5/u2/16)
Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191515
PID Number: 015-202-50
Dwelling: ® Single Family (SF)
❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
WISTER & VALERIE WILLIAMS
ABSORPTION FIELD - EXISTING
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
4400 TRAVERSE WAY, ANCHORAGE
❑ Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
5
GPD/SF
JTotal
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision
Block Lot
Fill added above original grade
Ft.
Gravel length
Ft.
TALUS WEST #1
7 6
Township Range
Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area z
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft
Ft.
Well
100'+
--
25'+
TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
GREER
Capacity
1500 Gal.
Surface Water
100'+
--
Material
HDPE
Number of compartments
2
Lot Line
10'+
--
NA
Foundation
10'+
__
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks
Alarm location
Electrical installed by
Tank to
PIPE MATERIAL House to tank 3034 3034
Installer A+
drainfield
Drainfield CO/MT 3034
Inspector FWCS
BENCH MARK (Assumed elevation) 100 ft
Inspection V 12/10/2019
1/20/2020
Location and description
2nd
3`d
4'"
IDOOR SILL
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Conditional Approval:
Date
�!�Q ' •:tS;,fl�
........�r
1 . .... ....
• Curtis Huffman
Septic System
Approved -
Date 31 a���
�� �F'• CE 128991 •'��i
��1�lF�• � w
•t/30/202p.
PROFESSIONA�4
Note: this approval
does not include well requirements.
permit
(Kev u5/u2/16)
TALUS WEST #1 BLOCK 7, LOT 6
Z
NI
N
CD
DoI
CID
m
X—X—X—•—X
A—C=14.6'
B—C=17,7'
A—D=16.4'
B—D=15.1'
A—E=17.4'
B—E=11.4'
v
FCO
PID: 015-202-50
VEI
VX/X
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A CpRpO
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SCALES 1' = 30
it
CO B
DIV
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PERMIT:
rG
OSP191515
SEPTIC SECTION
SCALE, NTS
TALUS WEST #1 BLOCK 7, LOT 6
PREPARED FOR:
WISTER & VALERIE WILLIAMS
4400 TRAVERSE WAY
ANCHORAGE, AK 99516
FIRST WATER CONSULTING
13030 SUES WAY
ANCHORAGE, AK 99516
907.350.9566 firstwaterAK@gmoil.com
soma*
amww
WOZ?\�Azss
0,'e'almh'
X —X x
ANCHORAGE RECORDING DISTRICT, ALASKA
ASBUILT OF:
TALUS WEST SUBD, ADDITION No.l
LOT 6 BLOCK 7 FLAT 75-24
SURVEY CERTIFICATE: I. John L. Schuller. Have conducted a # OF �� �' �
AW. , ..... , ,� NL LANA
physical survey of this property as shown on this drawing and that the / �.. • • � �� 4S,
improvements situated hereon are within the property lines and no o ' • . '� ``�
of + Yk
enchroachments exist other than noted. Under no circumstance should / C? . 4 9TH •.'
any information on this drawing be used for construction of fences, R .1, 1
structures, improvements, or for establishing boundary lines. • a • .. I ...... • • •
EXCLUSION NOTES: It is the owners responsibility to determine ...... .................... ..:..L .�
• JOIN L. SCHULLER.-o i '-
the existence of any easements, covenants, or restrictions which � ,P.
do not appear on the recorded subdivision plat. �%LS-10408 L. �� ' •• •„�,,,�. ,,,�,�
,, • . , , . • ' �� �' 1831 Talkeetna Street
WORK ORDER NUMBER: DAA: SCALE: s E—MAIL gyp,. , , . �� Anchorage, Alaska 99508
JAN 20, 2020 1 =30 a� e,
DRAWN BY: CHECKED BY GRID NUMB R: BON/PAGE: �� O fe a\ �- ar (907) 227--1455 office
2�-�-- ��4 � ss�on ...
JAS SV1� 2735 200104 ��,�e,•��'®' (907) 274--4992 fax
11/27/19
MUNICIPALITY OF
0 Awe
p�Y �
Development Services Department
On -Site Water & Wastewater Section
Parcel I.D. 015-202-50
ON-SITE SEPTIC/WELL PERMIT APPLICATION
rf,- A[KiNS
Phone: 907-343-7904
Fax: 907-343-7997
Property owner(s) WISTER & VALERIE WILLIAMS Day phone 9073012251
Mailina address 4400 TRAVERSE WAY, ANCHORAGE, AK 99516
Site address 4400 TRAVERSE WAY, ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot) TALUS WEST #1 B7, L6
Legal description (Township, Range & Section)
Lot Size 25,097 Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial F-1
Single Family (SF) El
(w/wo ADU)
Septic Tank
El
Upgrade Fx�
Duplex (D) ❑
Holding Tank
❑
Renewal ❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES
A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
aic-
Date of Payment: 1I Iab119
Receipt Number: C L15:31
Permit No. d3eigisI5
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
Michael N. Anderson, P.E.
Civil/Structural Engineering and Construction
4661 Natrona Ave. Anchorage, Alaska 99516
Phone 345 -3377 / Fax 345 -1391
Support Services
Brent M. Western
907-440-4601
November 21, 2019
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: TALUS WEST #1 BLOCK 7, LOT 6
The owner has requested we proceed forward to obtain a septic permit to upgrade the
aged septic tanks on the subject lot. The proposed upgrade will serve the existing 5-
bedroom house.
The lot and area are served by private water. The proposed design will not impact any of
the neighboring properties due to the lot layout. Please contact Brent M. Western or me if
you have any questions.
Sincerely,
Michael N. Anderson, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191515, Rebecca Carroll, 11/27/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191515, Rebecca Carroll, 11/27/19
· Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater DiSposal System and/or Well Inspection Report
Permit Number: ~/qq 0 IO..~ PIDNumber: Ol~--;2O~--
Name: ~.~ ~ 1~ Wastewater System: D New ~Upgrade
Address:
~0 i~,~v~ ~ ABSORPTION FIELD
Phone: JNo. ofa~oom~:~ ~ Deep Trench BShalJowTrench gBed gMound BOther
LEGAL DESCRI PTI ON sog Rating: O, ~ GPD/~. Total Depth fromlorlglnaID grade:
Lot: Block: Subdiv~ion: ~ Depth to pipe b0~om from original grade: Gravel depth beneath pipe
Township: ~ Ranger [ Section: Fill added above original grade: Gravel length:
I
WELL: D New D Upgrade Grave~width: ~ Ft. JI '-- Ft.
Clarification (Private, A,B,C): ~otal Depth: Cased To: Total absorption area: Pipe materiah
SEPARATION DISTANCES ~ Septic ~ Holding / ~ S.T.E.P.
To Septic Abso~tlon Lift Holding ~ublic/Private Manufacturer: / Capacityin gallons:
From Tank Field Station Tank Sewer Lines
Material: / Number of Compa~ments:
Sudace
Water ~ LIFT STATION
Lot Size in gallons: ~ Manufacturer:
Line I ~
Foundation ~ ~
Cu~ainDrain ~ ~umpMake&Mode~ ]~ica, lns~ctionspe~ormedby:
Remarks: BENCH MARK
Location and Description:
A~um~ Elevation:
2nd
Depa~ment of Health and Human Se~ices approval
Reviewed and approved by: ~ ~ ~ Date: ?'2Z'qq
72-013 (Rev. 9/91 ) MOA 25
Well
STANDARD TRENCH;
TOTAL LENGTH
EFFECTIVE ROCK
COVER
DIVERTER VALVE
SWING TIES:
AC 58.8 FT
£C 85
AD 41
-- BL~ ~61--
~/IL
I D
? FT
$ FT
/
TREHCt
C
MARK
\
\
Well
SCALE: 1' $0 FT.
75 100 1~.5 150
Well
i~/ 49th
BENCH MARK: BOTTOM BIDING
ASSUMED ELEVATION 100.00 FT
ITOBBEN SPURKLAND P.E.
205 W 15TH. AVENUE
ANCM. AK. 99501
(907) 279-5916
PERMIT # S~/990105
II ?
ALUS VEST Y?LLYCK 7 L~TT 6
4400 TRAVERSE WAY
SEPTIC SYSTEM AS BUILT
DATE: JULY 10, 1999
SHEET; 2/5 GRID: 2758
TA ~0 7062, D ~/6
PID # 015-~02-50
?~' Lan9
i0' ~eep
7' £ewer rock
500 gal Septic tank
NO SCALE
IV/on/tom
Cleonouts --
3' £over
95+
SH t Bo
85.0
7.0 Pt o£ Septic Rock
EffecHve
ND ££ALE
85.0
SOO gal, septic tank
203 Wl5th Ave
Anchorage Ak 99501
LOT 6 BLOCK 7 TALUS ~YEST
GARY HERR
4400 [RAVENS ~/AY
BATE, JULY 10, 1999
SHEET, 5/,~ OR[B:
TAWO7065. DWC
SEPTIC SYSTEM AS BUILT
PERIdIT // SW990105 PARCEL ID // 015-202-50
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: May 24, 1999
Expiration Date: May 23, 2000
Permit Number: SW990105
Legal Description: TALUS WEST #1 BLK 7 LT 6
Design Engineer: 0007 Tobben Spurkland, PE
Owner Name: Gary Herr
Owner Address: 4400 Traverse Way
Anchorage, AK 99516-2225
Parcel ID: 015-202-50
Site Address: 004400 FRONTIER LN
Lot Size: 25097 SQ. FT.
Total Bedrooms: 5 Permit Bedrooms: 5
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsudace 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.
203 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
LOT 6 BLOCK 7 TALUS WEST
GARY HERR
Municipality of Anchorage
Department of Health and Social Services
820 1 Street
Anchorage, Alaska 99501
May 19, 1999
We are submitting an application for the upgrade of the septic system for this lot. The submittal
consists of three (3) drawings showing the present improvements on the lot and the adjoining
properties, (sheet t/3), the proposed improvements of the lot, of which only the septic system is
subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3).
Soil logs and percolation tests of applicable testholes are also enclosed. The septic system
design is based on the following:
No Ground Water or impervious soil to 16 ft.
Use Standard Trench
Soil Rating. From Testhole 05/14/99 15 min/in - 0.8 gal per sq.fl/day
No. of Bedrooms 5
Required Area per Bedroom: 150/0.8 - 187.5 sq.ff.
Total area required: 187.5 x 5 = 937.5 sqfi
Bottom Rock At 10 feet
Top Rock At 3 feet
Rock Depth 7 feet
Total Trench Length 937.5 / I4 - 67 ft.
SYSTEM CONFIGURATION
STANDARD TRENCH
TOTAL LENGTH 70 FT
TOTAL WIDTH 2 FT
TOTAL DEPTH 10 FT
ROCK DEPTH 7 FT
COVER 3 FT
DIVERTER VALVE
The installation of this septic system will not prevent wells from being installed on the adjacent lots.
There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots.
The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface
runoff will not result from this installation.
The existing trench has a total absorption area ofT00 sqft. 50 feet long and 7 feet of rock.
It has been in use since 1977.
I
/
6
N
50 100 150 ~00
SCALE; 1" = i00
Well
£50 ,900
TOBBEH SPURI(LAND P.E.
205 W 15TH. AVENUE
ANCH. AK. 9950!
(907) 279-5916
TALUS
~/ES? ~LDCK 7 LOT 6
4400 T/GAI/E/GSE b/AY
SEPTIC SYSTEM DES/ON
DATE: DEC. 28, 1998
SHEET: 1/5 GRID: 2758
PE/GMIT # S1~990077 PIP # ~5 2~2 5~ TAI¥O706LDF/6
STANDARD TRENCH:
TOTAL LENGTH
EFFECTIVE ROCK 7 FT
COVER $ FT
DIVERTER VALVE
0 RS SO 75 100 125 150
SCALE: 1~ : 50 FL
\
\
Well
(907) 279-$916
PE£MZT fl- S~/~OOXX
TOBBEN SPURKLAND P.E.
205 W 15TH. AVENUE
ANCH. AK. 99501
4400 TRAVERSE ~/AY
DATE: JAN. 26, 1999
P/D # 0~5 202 50
NEW T~ENCH (~999)
L~' k//cle
?O' Long
I0' Beep
7' *ewer rock
3' Cover
500 9al £epf,/c tank
NO *CALE
/V/on/top
Cleonouts
3' Cover ---~
£/! t
Z,O Pt o£ Septic ~ocl~
Effect/ye
NB SCALE
SOO 9al, septic tank
TBBBEN SPURKLAND P.E.
~03 WlSth Ave
Anchorage Ak 99501
LOT 6 BLOCK ? TALUS WEST
GARY HERR
4400 T£AVERS P/AY
SEPTIC SYSTEM DESIGN
DATE, JAN. 2~ 1999
SHEET, 3/3 GRID: 2738
PERMIT ,/,/ SW9900XX PARCEL ID // 015-202-50 TAWO7065. DWG
Mun(:.il:ality of Anchorage
DEPARTMENT OF -,EALTH & HUMAN SERVICES
825 "L" Street, Al..:horage, Alaska 99502-0650
SOILS LOG- PERCOLATION TEST
(ENGINEER'S SEAL) '
DATE PE"'EORMED: ,,Cmiq--~? ?
LEGAl. DESCRIPTION:
1
3
tO
12
14-
16 - ~ ~
18-
19-
20-
DISCLAIMFR~
Past and future presence
'trom these o<~rvatlons.
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
SITE PLAN
Time Time Water Drop
PERCOLATION RATE /~)~ (minules/mch) PERC HOLE DIAMETER ~
TI:ST RUN BETWEEN 5 FT AND /-~ FT
C, rnundwater c,~nditions indicated are for the dates shown only.
&nd/or depth of groundwater can not be predicted
PERFORMED BY: I . __ CERTIFY THAT THIS TEST WAS PEREORMED IN
'ACCORD^NCEWTH^L~STATEANDMUN,C,~A~G~,,~EU~ES,NEFFECTON~H,SOATE DATE: . P/~ /7~ i ?¢7
72-008 (Rev. 4/85)
Munl.'l[c,allty of Anchorage
DEPARTMENT O~: ~EALTH & HUMAN SERVICES
825 "L" Street, Am:borage, Alaska 99502-0650
SOILS LOG- PERCOLATION TEST
· (ENGI?EER'S SEAL)
PERFORMED FOR:
LEOA'. DEse.,PT,O.: L..L~,. t3lZ "/,
1
2
3
4
5
6
7
9-
10-
11
~.,,~T~...wnship, Range, Section:
SLOPE SITE PLAN
1'4, L
13-
14-
17
18
19
WAS oRouuo WAT.R
E~COUNZEa~D? ]Xl 0
IF YES. AT WHAT
DEPTH?
20
DISCLAIHFR: Groundwater
Past and future presence
'trom these ODS~.~.V~I;IOnS.
Gross Net Depth to Net
_.._FJLI,.~ to I~q ~ Time Time 1~ Il~ Water Drop
77q l~:s~ --
PERCOLATION RATE ID {m,nules/mch) PERC HOLE DIAMETER
TL:ST RUN BETWEEN ~ FT AND ~_,~Z~_ FT
c~nditions indicated are for the dates shown only.
aRd/or depth of groundwater can not be predicted
to. 7~
PERFORMED BY: [ ~ CERTIFY THAT~HISTE T WAS PERFORMED iN
'/
ACCORDANCEWITHALLSTATEANDMUNICIPALGLa;.ELiNESiNEFFECTONTHiSDATE DATE: ~"~,~
72-008 (Rev.
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ,¢ L~ q ~" O ~1'~ PID Number:
Name: FO~. ,~,"'/"FI~ F~- ~_ ~_..\ ¢___ wastewater System: [] New [] Upgrade'
Address; ~,~ g~) ~"~-.-O~'.1"~-~:~- L~ ABSORPTION FIELD
phone: I No. of Bedrooms:
I
j.~ [] Deep Trench [] Shallow Trench [] Bed [] Mound [] Other
LEGAL DESCRIPTION so, Rating: Total Depth from origi,al grade:
GPD/Sq. Ft.
Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe
L~'T~ rK '7 T'ALu ~ '1~'~ T'- Ft. Fb
Township: I Range: I Section: Fill added above original grade: Gravel length:
I
I
Ft. Ft.
WELL: [] New [] Upgrade Gravelwidth: Numberoflines: IDistancebetweenlines:
Ft.I Ft.
Classification (Private. A.B.C): Total Depth: Cased TO: Total absorption area: Pipe material:
Ft. Ft. SQ. Ft.
Driller: Date Drilled: ,,aticWate, Level;Ft. Installer;, .:~.¢~.~.i/1 Date installed:
Yield:GPMI[ Pump Set at: Ft,,I C,,~,g Re~g,t *bo,. G,o,.d:Ft. TANK
SEPARATION DISTANCES ~septie [3 Holding [] S.T.E.P.
To Sepllc Absorplion Lilt Holding ~ublic/Privste Manufacturer: , Capacityin gallons:
From Tank Field Station Tank Sewer Lines ~-~.
Well ~ ~) Material: ~
Surface
Wafer '~, I~ ~ LIFT STATION
LineL°t c.~L~ Size in gallons:Il Manufacturer:
Foundation , ~2. "Pump °n" level at: I "Pump °fl" level at: I High water alarm at:
CurtainDrain ~.. PumpMake&M°del I~lectricallnspectionsperformedby:
Remarks: BENCH MARK
ENGINEER'S SEAL
Inspections pedor[ned by: Dates: 1st
2nd.
Department of Hca Hum s approval
Reviewed and approved by ate: ~,~.'.',~, ,.: , ,¢ '. '
72-013 (Rev, 9/95 ) MOA 25
BC
500 GAL SEPTIC TANK
TOBBEN SPURKLAND P.E.
205 W 15TH. AVENUE
ANCH. AK. 99501
LO~ 6~ ~OC~ 7~ ~AL~/S ~ES~ I I SEPTIC SYSTE~ AS BUILT
ERIC FORSYTHE DATE: JUNE 25, 1995
4400 TRAVERSE WAY SHEET: fl! GRID: 2758
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE)
PERMIT
PERMIT ~ER:SW950117
DESIGN ENGINEER:TOBBEN SPURKLAND, P.E.
OWNER NAME:FORSYTHE ERIC M & CATHY M
OWNER ADDRESS:4400 FRONTIER LN
ANCHORAGE, AK
DATE ISSUED: 6/15/95
EXPIP~ATION DATE: 6/15/96
PARCEL ID:01520250
LEGAL DESCRIPTION:
TALUS WEST #1 BLK
7 LT 6
LOT SIZE: 25097 (SQ. FT.)
NUMBER OF BEDROOMS: 5 THIS PERMIT: 5
THIS PERMIT IS FOR THE CONTRUCTION OF:
SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ENGINEER SF~ALL VERIFY ADEQUATE SEPARATION DISTANCES FROM THE
SEPTIC TANK INSTALLED UNDER THIS PERMIT AND THE EXISTING
WELLS ON ADJOINING PROPERTIES. THIS INFORMATION SHALL BE
INCLUDED ON THE -B~ INSPECTION REPORT.
BY:
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T.SPURKLAND P.E.
203 WEST 15TH. AVENUE SUITE 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
Jim Cross
Municipality of Anchorage
Department of Health and Human Services
On-Site Service Section
820 L Street
Anchorage, Alaska 99501
June 15, 1995
Subject:
Replacement of leaking septic tank
Lot 7, Block 6 Talus West
Gentlemen:
During an HAA inspection of this property it was discovered that the 500 gal. septic tank installed in 1984 was severely
corroded with several penetrations of the metal. The outlet pipe was completely plugged. No effluent have gone to
the lrench for a long period of time.
This tank must be replaced, and we ask for a swift issuance of a permit.
Yours
Tobben~
O
S~LE; l" = 50 FT,
JET AEI?A TI[7AI ?ANK
'EPLAC£ SOO GAL £?EELI ~ANK
?£ENCH Ci-EAN OUT
TOBBEN SPURKLAND P.E.
205 W 15TH. AVENUE
ANCH. AK. 99501
LOT 6, BLOCK T, TALUS WEST
ERIC FORSYTNE
4400 TRAVERSE WAY
SEPTIC SYSTEM DESIGN
DATE: JUNE 15, 1995
SHEET: I/1 GRID: 2758
· '0'~ ~i~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 26¢4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE [] NEW
MAILING ADDRESS
LEGAL dESCRIPTION '
LOCATION . NO. OF BEDROO~
IWe]l I Absorpti5 area/ Dwe,lin~,____ / PERMIT NO.
DISTANCE TO:
Manufacturer ~ ~O~¢ M ate~i;M N°' °f c°Tartments
~ Liq. capacity in gallons Inside length Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O ~ ~ Manufacturer Material Liquid capacity in gallons
~ Well Foundation Nearest lot llne PERMIT NO.
~ m DISTANCE TO:
~ No. of lines Length of each line Total length of lines Trench width Distance between lines
inches
~D Top of tile to finish grade Material beneath tile Tota~ effective absorption area
O inches
Length Width Depth PERMIT NO.
( ~ Type of crib Crib diameter Crib depth Total effective absorption area
m We~l Building foundation Nearest lot line
m DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: 8ui[din9 foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER ~
REMARKS
'~
)EPT OF ~EAI TH
%[,k, Ei / M
DATE LEGAL
72-013 (Rev. 3/78)
DEPARTMENT OF,. ~EALTH ANEI., EN',/IRL]NMENTRL P FEF:TION
8 ....L ~TREET., RWCHORFIGE., AK '99.'.5_,E~7
.":,.- _ To
~J::,4 4, ,.8
ON--S ][ TE SEI-4ER PERI'"I I T
PERMIT: NO: ,=,41..]_<, _. LIFt~RHDE
FI, RTE ISSUED: ~._,..~5 '"-' · ,¢.. 4 ,."°,_,4
APPLICANT:
CONTACT PHONE:
THOMAS PERRYMAN
CZO DYNAMIC REALTY
ANCHORAGE, BK 9950~
279-76tl
LEGAL DESCRIF':
LOT SIZE:
_.UE, DI,,, I_,ION: TALUS WEST LOT:
SECTION,: '~'-" FI, '- '- - F?
,-~ T_~N~HIF . -12N RHN~E. ~W
c,,,~ 1~ .... - '>
~.~._,. ('--,ITJ ET. OR AL. RE~.
BLOCK: 7
I CERTIFY THAT:
I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS '--]ET
FORTH BY THE HUNICIPALITY OF RNCHORFtGE (MOA) AN[." THE STATE OF ALASKA.
2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOB CODES AND REGLILRTIONS.,
AND IN COMPLIANCE WITH 'THE DESIGN CRITERIA OF THIS PERMIT.
~. I WiLL ADHERE TO ALL MOB AND STATE OF RLR%K8 REQUIREMENTS FOR THE SET BACK
DISTANCES FROM ANY EXISTING WELL., WRSTEWRTER DISPOSAL SYSTEM OR PUBLIC
SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT.
IF R ~IFT STATION IS INSTRLLEEI~I~ R~ COVERED B'¢ MOA BUILDING CI~IDES.,
THEN ',l) RN ELECTRICAL F'ERMIT/~:,~NS~C~ION MLIST BE OBTAINED., (2) RS-BUILTS
WIL~ NOT BE RF'PROVED WITHOI_IT/~ ~EC~ INSPECTION REPORT.~ AND (~ THE '
ELEuTRIC:RL WORK MLIST~ [:,CIN~ BY ~L~C:~ED ELECTRIC:IRN. -'
.
ALASKA ' TiUIRO me TAL COFITROL Se lCe$,
~n§in~erin§ ~- ~nlrironmenlal $1udies
IFIC.
F~¥ 18 t984
Pete Jarr~tt
207 E NORTHERN LIGHTS
ANCHORAGE AK 99503
SELLER - Tom Perryman BUYER - Pete Jarrett
SUBDIVISION - TALUS WEST #1 BLOCK - 7 LOT - 6
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTt~ IS A TRENCH WITH AN AREA OF 113~ SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 870 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 1356 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
5 BEDROOM HOME.
THE SEPTIC TANK WAS P~iPED O~1/2/8~.
SEPTIC TANK ADEQUACY
HOUSE HAS A PACKAGE PLANT IN LIEU OF A SEPTIC TANK.
ADDITIONAL COMMENTS :
A MAIFNTENANCE AGREEMENT MUST BE SUBMITTED TO THE DEPAR~]~ENT OF
HEALTH AND ENVIRONMENTAL PROTECTION TO SHOW THAT THERE WAS UP
ICEEP ON THE SYSTEM IF NOT THEN THE PUMP MUST BE PULLED AND AN
ADDITIONAL 500 GALLON TANK MUST BE ADDED.
1200 [U8st 33rd r~u¢~ue. 5uil~ ~ o ~mchero§e. Alosko 99503 e[907) 561-50/10
oGRE¥~,-dR ANCHORAGE AREA BOk-,~JGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME //~////~ / 4/]/~
LOCATION
FROM WELL_ MANUFACTURER MATERIAL COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH
LIQUID DEPTH
LIQUID CAPACITY GALLONS.
DISTANCE FROM WELL FOUNDATION /-"//------~
NUMBER OF LINES / DISTANCE BETWEEN LINES
ABSORPTION AREA ,/// SQ. FT. LENGTH OF EACH LINE ,
DEPTH: TOP OF TILE TO FINISH GRADE. MATERIAL BENEATH TILE IN. ABOVE TILE
TOTA, LEN TH f/
NEAREST LOT LINE .~"/~) OF LINES
TRENCH WIDTN~IN. TOTAL EFFECTIVE
TYPE _ CONSTRUCTION DEPTH
DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION_ LOT LINE SEWER LINE __ TANK , SYSTEM
CESSPOOL
OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES:
INSTALLED BY: ~
SEWER LINE DEPTH: F(~
PIPE MATERIAL:
.OT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
THE L..EIq(:ii'TH [::, 3: I','IEEP.,I'.':_:; ]: Oh,I ]: ~; 't"HE L..Ei",IG'TH ,:: Z f',! FEET ::, OF I"HE: "i-F~:IENE:Ft OF.'. DRF:t
TI.lIE DiEF'TI.~! OF' t:-~ TI::~'.E:F,IE:H OF'. F:'ZT ]::5 THE D:[:STF:INE:E: E]E-II.,.IL::E['.,! 'I'HIE :~;I..IF'.F::'f::ICE: OF' '['FIE:
E[I~:OI..IN[;:, F:I?.,I[::, THE E~EFI'TEIH OF THE: EXE:FI',,,'FIT.[ON ,::Z['.,I
THE GF?.FY,,,'EL I)EF:'Ti.~ :[:~; THE: I'"l]:lq:[f'iUH DEf-:"i-H OF:' GF;~'.FI',,,'EL. !~!;E:'i"I4E:Ei"4 THE: OU"FFFII..!... F:']:F'IE
FIN[:) TFIIE BOTTEff"i Eft:' 'THIE IE,':-:',CFIVF:FT :[ ON ,:: :IN F'Eli~::"t").
Et['I'H[EE'. F:I CI...I::I:i~;:E; :[ OR ]:I I',tSF' RPPRO',,,'EB, PLI::Itq'T' t"1F:t'¢ E~E: II"4f~]TRL.LED.
R CON-I']:i",fUEdJ:E; I"IF:I:I:N'TEI",IF:tNCiE FIGF?.[Eli.:.:HENT I'?:~; I;?.E:6!UZi:~'.ED. :. ]:F:' R P1F:I:!:!q~I'ENFIi',ICE
RGREE:HIZI".I'T' :[':'5 NOT I',::Ei::"T CUI:4'.F,'.EI",I'f' "r'OLI r'll:¢.r' BE F?.E6]!I_JZI:;;'.ED ~['O I:Et'.,IL.FIRGE THE .<'_:;(_-~:i:i
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i'"1 :!: i",] :[ HUH [) I '.:.i;Tl:::li'qE:[.:_ BETI.,.!E[EN I:::1 I.,.IELI.. I::IN[:, I:~?.,l'.r' O~'q'.--S :[ 'FIE SEI.,.!I:::tGIE [:) I SPO'.E;Ftl.. :E;'¢fS"I"Ei'"I :[ S
:[.~i)~;!'.i F'E]IET FOR FI F'I:;~:i',,,'RTtE I.,.ItELL OF?. :='i'.E~C~ F:'E:ET F'OF~: FI PI..II!~L.):C I.,.fE:L..L..
I.,.IE:L.I._. LOt:%5 I::IF,::E i::::tE(;:iU];F?.ED FIN[:) h'lL.i:i~;-I' BE F:IETIJI::~'.NE[:) 'FO THE{ t)E:F:'I::IF~'.THE:HT I.,~ ): TH ]: i",I ]~:E~
OF' THE P.IIEI.J... E:OHPI...E'T':i:EII",I.
:E;F'IEC::I:F:[C:F:IT:[OI",I:E; F:ll'.,ll::, COI",!L"'5'f'I:;~:IJC~I']:Cdq E) ]: F:IEiF~:Fff"I'.E; I:::It:;:E: I::I',,,'F':I:ELFIE,'L.[E 'TO 71:?.,I:SUF;:E: F:'!:~'.OF:'ER
]: i'.4'.5 T£aL L.FIT :1:
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F'OF~:TH B'¢ TF'IE h'IUN:[E:ZF'F:IL.]:'I""¢ OF:
2?: :i: P.I Z LJ._ :[ I",tS;'TF:ILL. -I"I'~E: 'L:;'.r"_:~;TIEH ]: I",] RCE:Cd;?.I)F:IHC:E I.,.i :t: q"H -i"HIE CODE:S;.
Z'~:: ;1: UI",ID[EI:~::5']'FIN[::, 'I"HI::I'I' "rl...ltE Ob,I.-'.:.~;:[-f'lE '_:_:;E:!.,.IEI:::: :E;'.r':E;-['EH f"ll::l"r' [4'.i:~:6!L.I:t:F?.t~; E:NL_F:II:;?.GiEHEF,FI' ];i::' "t'1-..t1.:i:
F?.IES;:[[)iENCIE ]:'.i~; I:~:IEHEIDELE:D TO ]:i",IE:L. UDIE i"iOF.:E 'THI::41'-,! ~:.i E',EE:,I::::OEd'"i'-:!i;.
F:IF'F'I.... ]: C FIIq"t" 1.4 Z LI....
Z ::;;:5;LI [~ [::, t:.~ ". ......... E' I:: "['1:~ ...................................................
M -W DRILLING, INC.
DRILLING LOG
Well Owner 14illiam Siemens Use ofWellyoT
Location (address of: Township, Range, Section, if known; or distance main
Lot 6 Block 7 Talus blest
Size of casing 6 nepth of Hole 95 feet Cased to-9-5---7---feet
Static water level 65 ft. (iFM) (below) land surface. Finish of well (check one) open end ( ;{:C );
Screen ( ); Perforated ( ).
Describe screen or perforation 1,/A
Well pumping test at 12 gallons per (hour) (minute) for—l---hours with 1QUi #t
of drawdown from static level.
Date of completion 6/16/77
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
0TO 2 Casing sti
2 T„ 4 Organics
�' TO 15
15 m„ 25
Z5
TO
'i5
45
TO
60
60
TO
70
70
TOL'5
F5
TO
95
TO
TO
TO
TO
Silty gravel
Sand
Silty sand and gravel
Sandy gravel
Silty hsavel hardpan
Sandy gavel
Sandv water gravel
Certificate NVS. SLl be 4r13
2 —STATE
Municipality of Anchorage
• Development Services Department •`
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 995196650
www.ci.anchorage.sk.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 016-202-50 HAA
Expiration Date: f D — ' 0_67-
1. GENERAL INFORMATION
Complete legal description Lot 6 Block 7 Talus West #1
Location (site address or directions) 4400 Traverse Way, Anchorane AK 99516
Current Property owner(s) _Mike & Kelly Poston - Day phone 345-5368
Mailing address 4400 Traverse Way, Anchorage AK 99516
Lending agency Day phone
Mailing address
Real Estate Agent Ainslee Philios/Prudential Vista Day phone �y —q55
Mailing Address Centeroointe
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up b
2. NUMBER OF BEDROOMS: 5 vK +0c, } I IAsle 1 O(('
Kall�� f oslbniI2CCtlt��
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL
Individual Well ® Individual On-site 19
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 representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to home owners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A
or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
(Rev 1199)
5. 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 Health Authority Approval
application shows that the on-site water supply and/or wastewater disposal system is safe, functional and
adequate for the number of bedrooms and type of structure indicated herein. 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 in compliance with all applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Eno. Svc. Phone 272-8218
Address _P.O. Box 102954, Anch, AK 99510
Engineer's Printed Name _Steven R. Pannone, P.E. Date Ea�yIOS
Engineers Comments: In conducting an adequacy test, / attempt to provide a thorough, conscientious '6�� •jjj,,'
engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The ��
�` ...........
reported results describe the performance of the system under the conditions encountered at the time of ���P .••"'
the test, and separation distances measured to readily identifiable features. The operational life of all i C --D
wells and septic systems depend on the local soil condition, ground water levels that may fluctuate {z Tx
are
during the year, and the water usage of the family being served by the system. These conditions a 49— ••••••:
outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results •
do not guarantee future perromtance of the system, nor do they guarantee that there are no hidden defects ; ..... . .... ... ...................
or encroachments. PES can therefore not provide any warranty for future performance nor give any ; Steven R. Pannone:
estimate of how long the system will continue to meet the operational requirements of the ADEC or � '.
MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon �1 No. CE 8149
or use of this report by any other person or party is not authorized nor will it confer any legal right
whatsoever.
6. DSD SIGNATURE
Approved for IJP bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
.IDN-S� •' c's
WATER AND 0:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X Maintenance Agreements
Supplemental Engineer's Report
Other
By:
opp-O
Expiration Date:
(R• 11)99(
Original Certificate Date: % - 12, " O 5
Reissue Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 995198650
www.ci-anchorage.ak.us
(907) 3437904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 6 Block 7 Talus West #1 Parcel I.D.:_015 2020
A. WELL DATA
well type E If A, B, or C provide PWSID #
Date completed SM 61977 Sanitary seal Y
Total depth _$;_ft Cased to 95.7 ft
FROM WELL LOG
Date of test SM6M977
Static waterlevel 65 It
Well production 12 g.p,m
WATER SAMPLE RESULTS:
Coliform _R_oolonies/100 mi Nitrate 0.921 mgil
Well Log i
Wires property Protected y
Casing height (above ground) 12"+ in.
AT INSPECTION
6123/2005
47 ft
3.2 9 -p.m
Other bacteria --L colonies/100 ml
Date of sample: _612312005 Collected by: Laura Pannone Arsenic N/A mg/I
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel
Date installed I17/1&nk size 1000/500
gal Number of Compartments;ia
Cleanouts y Foundation cleanout Y Depression over tank hl High water alarm diq_
Date of pumping 9/16/2004 Pumper A+ Home Services
C. ABSORPTION FIELD DATAAq�
Date installed I ! I it rating (g.p.d./fe or fe/bdrm) 225M.8 System type Trenchrrrench
Length 81170 It Width 312 ft Gravel below pipe 717 ft
Total depth 1+.8110.9 R EtTectiva abacxptlon eras 113 Ant? Monitoring tube Depression over field Mly_
Date of adeq t Results (Pass/Fail) For ¢ bedrooms
Fluid Ic
de to absorption field before test ;I In* Water addedZ§88 gal. New depth43 in.
Elapsed Time: 1440 min Final fluid depth ,;2 in Absorption rate >= 750+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) No If yes, give date
(Rev. 1119x)
D. UFT STATION
Data installed
'Pump on" level at _ in"Pump off le
Datum Cycles t
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WL
Septic tanktff t station on lot 100+
Absorption field on lot 100+
Public sewer main N/A
ManholelAccess
in High water alar level at in
Meets alar 6 circuit requirements?
ON LOT TO:
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout N/A
Sewer /septic service line 60+ Holding tank 100+
SEPARATION DISTANCES FROM SEPTICIHOLOING TANK ON LOT TO:
Building foundation 6 Property line 10+ Absorption field_L.
Water main 100+ Water service line 25+ Surfacewater _ 100+
Drainage 100+ Wells on adjacent lots 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 6' Building foundation 25+ Water main 100+
Water Service line 25+ Surface water 100+ DdvftW, paddnWveNde storage 10+
Curtain drain None Observed Wells on adjacent kits 100+
F. COMMENTS
�3
---------------- .. ..��? r .....
1 car* that I have determined Enough field inspections and
review of Municipal mcords that the above systems are in �
conformance will; MOA HAA guidelines in effect on this date.
^.
Engineer's Printed Name Steven R. Pannone. P.E.
F
Date
HAA Fee 6 ' % / AS w USr l Waiver Fee S 7
Date of Payment % /[Date of payment /If
Receipt Number 7%7� Receipt Number -76
(Rev. 11419)
814
s
Municipality of Anchorage
11 P.U. Ikic l!MMiill • Anchorage. \huka!M.Ai 1!14i6ia • � • � �
ti-,. T.Icphune(Mq)714:4�KM)I I'as LM)71 :54:4$,IMI
47(M)11ragaw tilrcet • .\nchurngc, Alaska lM6i07
'rw1r.muni.urg
Mayor Mark Begich
Iluilding Safctv Di -vision
12 July 05
Pannone Engineering Service
P.O. Box 102954
Anchorage, AK 99510
Subject: Waiver Request for Talus West #1 Block 7 Lot 6
Waiver Request #WR050046
Parcel ID #015-202-50
Dear Mr. Pannone:
•
s
�s•i r, r.,/
Your request for a waiver of the required 10 feet from the Absorption Field to the
Property Line is approved. The approved separation distance is 5 feet.
This waiver approval applies to the existing Absorption Field to Property Line
separations only. Any future upgrade to the on-site wastewater disposal system will
require all separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
Jeff Poet
Engineering Tech
On -Site Water & Wastewater Program
Community, Security, Prosperity
Municipality of Anchorage
Development Services Department
+� Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519.6650
www.ci.anchorage.ak.us
(907)343.7904
Waiver Review Worksheet
WR#: 060046 PID#:016-202-60 HA#:060317 Permit#:
Date Received: 07/11/06
Legal Description: Talus West #1 Block 7 Lot 6
Engineer. Pannone Engineering Service
P.O. Box 102964 Anchorane, AK 99610
Applicant: Mike & Kelly Poston
Waiver Requested: Separation distance 6 Feet Absootion Field to Property Line
Criteria:
Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Points:
........................................................................mess...
Waiver is Granted: (_111
List Conditions or Reasons for above:
Waiver is not Granted:
Date: % / 2 - O By:
ffame'of Reviewer
so. .m...............................ee.m..................... a.................
Rec#: 70737 Amount: $176.00 Date Paid:/7 12/2006
ASSUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
SCALE,
r'OLLOWING DESCRIBED PROPERTY:
i.�ll/l/v�3!-fv�.�pd. pyo,/laTl�7
AND THAT NO ENCROACHMENTS EXIST EX6PT AS
DATE,
INDICATED. IT IS THE RESPONSIBILITY OF THE
OW14ER TO DETERMINE THE EXISTENCE OF ANY
GRID,
EASEMENTS, COVENANTS, OR RESTRICTIONS
z»)
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
FB:
Z
ANY DATA HEREON BE USED FOR CONSTRUCTION
g!5s6-e
OF c'ENCE LINES. OR FOR ESTABLISHING BOUND-
ARY LINES.
DRAWN+
PJL-08-2005 FRI 03:06 Ph FAX N0. P. 02
JUS 09-2005 FRI GINS F!i Mr -M, it F0; 192 (952 P•002
ENCROACHMENT PERNUT
1203-22C
C-2736
EN05053
CIS -202-50
This permit Is between Chugach Electric Asstxiadot:, lno, an Alaska nongttrofit electric
cooperative, (berein "Chug3ch"), whose addM3 is P. O: Bcx 196300, Anchorage. Alaska 99519 and
Michael R. and Ke,ly E. Poston, (herein °Pettniues"I whose -address Is 4400 Travene Way,
Anchoraga;AK 99516.
I • E166=1c7:1 Chugaa't Is the grantee or user of an easement for the eoratraction and
=ainreaance of electrical ficlildes, as follows:
DDadicatedbytheplat of the subdivisionknown"Talm Great SubdivisionAdditionNo.1,
to Plat Number 8040, recorded on the 231d day of April 1980, on file in the
otiiee of the District Recorder, Aaci:orage Recording District, Seward Meridian. Alaska,
Described in that Camara writt= instrument rccordcd on the 28th day of October 1981, in
Book 660, Page 303, on ffio In the office of the District Recerde., Anchorage Recording
District, Seward Meridhal, Alaska,
(hemin "Easement") W3 U, pe tains to the foLowing described real property ..
The South Tea Feet (S 10') Of Lot Six (6), Block Saver (7), Talus Rest Subdivision
AddificnNo.1, according to Plat N•amber 80-40,reeorded on the 23rd day of April1980,
on file in the office of tizz District Recorder. Anahorage Recording Distrix-, Seward
Moridian, Alaska.
Permittee ackno'i ledier the validity of the EasetnenL Pemiree aanaats cad represents that
Permittoa is the owner of the fee simple interest In the land subject to the Easement and the
fotiowia8 described real proper -1 to which ti.e Easement is adjsceru:
_ ._. Lot Six (6), $lock Seven (7), Talus West Subdivision Addition No. I, according to Plat
Nuibbfi8�40,—recoi�ea'on'dre''I3nIdey�t:f2(piill9Bb,
District Recorder, Anchorage Recording Distc.et, Seward Tvfvddier, Alasks,
(herein "Parcel").
Page 1 of
JUL-08-2005 Fl? i 03:07 PH FAX N0, P. 03
JU!-68'2(05 FRI 01:45 FM IDIND IT) 21 997, 762 4852 P. 063
1.. F^e..,...m . Pe-mittee has const acted or purchased the following improvements
on or within the real proper' subject to said Basement:
A septic system cleanout pipe that encroaches approximately litee ]Feet (3') Icto said
Easement for a diatance of approximately Ona Foot (10),
(herein "Encroachment").
3. Z=- Chugach hereby authorizes permittee to continue the existence of the
Hocroachmeat in is location sub] ect to the covenants set forth in this permit.
4. Inde>n1L4glion. Petmlttee sha.7 indemnify and bold Chugach harmless from any
cWuns forPersonal Wury, property damage or other loss Arisingia anywayfrcm the contizru4onof
the e=oachmettt.
S. ;<jQ.j agsion or increase Pamittc: shall not in any way expand or increase the
extent to which the Encroachment occupies any of the real property encumbered by the Lawmen:
without the prior written consent of Chugach. Chugach has no obligation to provide such consent,
6. No *hit in B"LEA111c Acmgr4 permittee hereby aelmowledgos that the
$noroachment and any additiom thereto, even if in violation of this pemtit,las not and shallnot in
the future give rix to any inteiest or estate In the real property subject to the Easem mt or any other
real property. Withotn in any way litniting the 'foregoing, Permittee nolmowledges that the
Encroachment is not advase to any interest of Chugach and its contimmation is entirely with the
permission ofCnngachforpurposes oft',tecommonlawdoctrineOfadversepossession. This permit
ereeEcs no interest in the real property subject to the easement.
7. motion of Utitily Fac!mrj. If the electric utility fxllities located within the
Easement are upgraded, added to, replaced or rcconstucted, Permittee shall pay that portion of
Ch'Wch's total costs for such zcodificadon'Meir is reasonably attributable to accommodating or
Preserving the Encroachment. if suchpayment is not made within thirty (3 0) days ofwrltten demacd
for some, Chugach may k=dnate this permit in accordance with paragraph 9, below,
8. CnytnaatsRuarninewlhtheiatu°. The obligations of the Permitt"aiaixgfromws
Permit shall be covenants running with the land which shall burden the Parcel and the Tormittee's
interest in the land subject to the Easemazzt and shall benefit the Euemeat.
9. ' ''o , Chugach may terminate this permit after ft giving of tbirty (30)
days written notice of such termination if:
a. Tito I'ancroechinoufTa .aiiged' incrri4eit oz eircaryce3 �vrhiri'the leaf props ry
affected by the Easacrent ;
Pncroachmentpermit. Page 2 of4
JUL-08-2005 FRI 03:07 PM FAX N0, P. 04
JUL-U-24105 FRI 01:48 PO OU'0Sii tl 507 152 4852 P.004
b. TheEnv:oschmentiadamagedbyanymeanstoanextcutofmorethaatf3rtypemnt
(309/6) of is replacetnent cost at the time of destmetion.
o Permittee fails to make the payment described in paragraph 7, above,
10. Tom, Phis parol shell, if trot aoenerterrninatod by Chugach, ctplre forry(40) years
from the data bereot
D. $ Spl. This written permit eonstit4tnthe entireagreement betwecntile
parties with respect to the subject matter herrof imd supersedes alt other prior or contempoaetreous
agrsemeets, oral orwrittan,betweenthe parties. Nomocificaticm.arn=Ai mts,deletions,additions
or alteratioas of the permit shall be cgxtive unless In writing and sigced by all of the parties hereto.
CITU GAMIELECTRIC
ASSOCIATION. NC.
By: �" �-✓
Edward M. JeroiO, Y.E., Director,
Engineering Services Diviiioa
Date:
'®t
Y.
Michael R, Yoron
Das: J _ P 05
� �IIi11_Jw
.
Date: %'0 %%
EacroachmeatPermit -Page 3 of4
Y
YJL-08-2005 FP.I 0308 PM FAN N0. P, 05
JUN8.2005 FRI 01:46 FM CuU'OR!M fi 501 l62 4352 P•C05
STATE,OF ALASKA )
) ea:
THIRD JLIDICIAL DISTRICT )
o foregoing in:tnert was aelrnowledgv before m thio day of
V un2005, by -G , e,
6 D
PRINT PERMIT s(s))) NAiA/lam/m(5)
�UHIIIIII-C •y��"'/ C
Notary public in and for the St of ka 4 �iv mod
My eomnr:asion expIIta' 6 �-
mi,nuua``N .
STATE OF ALASKA )
• ) ee:
THIRDJUDICIALDISTRICT )
.rr '
1 " The foregoing lash Al .- t was VictioMedged before me this da of
�Al Dizector 2005, by I d WAR lJ Gn I h
Alaskaeo rpotat[onDB�cesDivision
ofofChug�achElaotricAsseciation ,roan
, on behalf of the oorporaflon.
,,UINII; pill",% NotaryPablic in and for the Sts ofg�aak�,
my comteias(on W,*Vs•
AMR RECORDING RETURN TO:
Chugach Electric Association, Inc.
P.O. Bos 196300
1 Encroaclunent Permit - Page 4 of 4
ACS M
AW M Cmnmuniut'ont Syrtaru
July b, 2003
Mcheel 8 Kelly Poston
4400 Traverse Way
Anchorage, A6WW 99518
ACS hes no objection to the encroachment of the septb system deanouts into a platted easement
located on lot 6, back 7, Talus We -at SubdlNslon No. 1, as daplcted on the as -built drawing
submfrad.
A0009tanoe and use of this letter of nM -objection by yourself, your heirs. your assigns, Or your
Successors, VIII CanStituta agreement to the following atiputadons:
�. AGS will; be held harrdess, now and forever, for any damages or Injury to any
person or property as a result of tNs encaoacrtntent,
2. Any ACS faclllty damaged or destroyed as a result of Us encroachment will be
MPafred at no cost to AGS.
3. Any costs Incurred by ACE fcr special construction necessitated by this
encrAchment will be borne by the property owner.
4. All applicable safety code regulations wil be OO9srved and maintained.
6. This letter of non.objecbon wl l to nO Way Produce ACS from full ure and
enJoyment of its right$ within any Porten of Its right-of-way. .
Sincere
mForeman
Outs de Plant Enpinoerin
ACCECE: � DATE:
%�
7-5 -05
Grid #2738
CYJp nwv ltGL�MP.bVyMa.���PpC '
6C0 TeIephere Averuc Anchwaga. Alalia 99503.6091 ul 907.504.1000 ".w, aa!atka.nnm
Ed ttrz:60 SMF so In: 92aTW L36: 'ON xud BdbO Soo: WMJ
Jdl 07 05 03r14p
l'uly 7, 2005
Miciae , and Kelly Poston
Horne Owners
4400 Traverse Way
Anchorage, Alaska 99516
Dear Michael, and Kelly Poston,
p.1
Subject to your agreement to indemnify the company as set forth be'.ow, GCI Cable Ina
of Alaska has no objection to the septic System cleanouts encroaching into the10' utility
easement on the South property line of Lot 6, and Block 7, Talus West 4 1 Subdivision.
Known as (4400 Traverse Way Anchorage, Alaska 99516), in city grid # 2736.
This letter of non -objection in noway precludes GCI Cable from full use and enjoyment
of any rights it may have within any portion of the utility easement and or the right -of.
way, includi g u .united access for servicing its facilities. Also any additional and
extraordinary costs incurred during any future required construction, repair or
reconstruction of GCI's facilities to accommodate any or all of the encroachments shall
be paid by the property owner.
By sig ting below, you agree to Indemnify and hold GCI Cable harmless, now and
forever, for any damage, costs, expense (including reasonable attorney's fees), L'abi'sties
and injury to any person cr property occurring as ■ result of the encroachment.
Please indicate yoar acceptance by signing and returning this letterto myse'f aA the
address below, n
SinccWlly,
Rob Hansen -r
OSP Design date
5151 Falrbanks Street 9 Anchorage, Alaska 99503 • 9071806-5600
0
Vs
MUNICIPALITY ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # ' 15 -G — S° HAA # D D D G S
GENERAL INFORMATION
Complete legal description Lc i G ' (3'': -7 _I A Lus cGE� i
Location (site address or directions) `��"y irn. �'�,c �t'✓�� 7
Property owner a r alp Day phone
Mailing address 4 H <<' v- ✓��• •�/zy
Lending agency
Day phone
Mailing address
Agent Tz; e' L% 1AY?vi 5 i ce P -max Day phone 276--;1161
Address '77 L• [ (, c . rL r• ,! L
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: o
3. TYPE OF WATER SUPPLY:
Individual well ✓
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest -
Ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 iA«. 1911 From MOA 411
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 of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm I vhha�n S4 lnma�' ��_ Phone
Address
Engineer's signature ��c� Date
• y n , ,; ] i
'aau a J
6. DHHS SIGNATURE
Approved for bedrooms.
M
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
•
Date 9 -;Z G -00
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-0ss (n«. 1A1) Beau W0A ni
I'
'Municipality of Anchorage
• Department of Health and Human Service E C E I V E
Division of Environmental Services
On-Sfte Services Section 825 V Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650 SEP 2 12000
www.ci.anchorage.ak.us
(907)343-4744
QQ ISTMUNICIPMMOFANCHORAOE
OAWSQUI
HEALTH AUTHORITY APPROVAL CHECKL�SOMSION
Legal Description: Lo I io t31- 'j A Lv S L11144 Parcel I.D.: 4115-2e,t— o
A. WELL DATA
Well type K It A, B, or C provide PWSID # N/R Well Log Y
Date completed 11101177 Sanitary seal Wires properly protected y
Total depth 9-5 It Cased to 9.5 It Casing height (above ground) .2 Z in.
FROM WELL LOG AT INSPECTION
Date of test "A./7 7 4 /it l o�
Static water level b It y 9 It
Well production Lt +2 9 -p.m tionies/1
g.p.m
WATER SAMPI� RE$�TS:eilQ,Y� ctyColiform_colo es/100 mi Nitrate 0 i mg/I Other ba enaL 00 ml
Date of sample: 9/A(/0U Collected by: --I� S 9
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material tone, + 5410 3 ee.(
Date installed 7ti - Ynfgr Tank size 1~ +swo gal Number of Compartments it +!
Cleanouts _Foundation cleanout Depression over tank �► _ High water alarm I�
Date of pumping 8124100 Pumper Al
C. ABSORPTION FIELD DATA
Date installed TW 9 OtSoil rating (g.p.d.AM or ft2/bdrm) 0. b System type 1
Length '7 y ft Width __2- ft Gravel below pipe --2—ft
Total depth 117 It Effective absorption area_f fO ft2 Monitoring tube I` Depression over field _
Date of adequacy test �v Results (Pass/Fall) i7 For bedrooms
Fluid depth in absorption field before test2c� 9/ in Water added lQg0 gal. New depth 3y in.
Elapsed Time: „ ."rs min Final fluid depth 24?_ in Absorption rate >= 750g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) 1.4 If yes, give date ✓
72.026 (Rev. 01100)-
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in "Pump o vet at in
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Manhole/Access
High water alarm level at in
Meets alarm & circuit requirements.
Septic tank/lift station on lot jDo On adjacent lots > 10-0
Absorption field on lot 130 On adjacent lots > /oo
Public sewer main N%4 Public sewer manhole/cleanout N�A
Sewer /septic service line N/.4 Holding tank 14/4,
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation .5 Property line '50 Absorption field .2 5
Water main N/A Water service line > 2S Surface water N IL)
Drainage N 1 o Wells on adjacent lots > I vs7
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundationoq Q Water main N/A
Water Service line >2 5 Surface water N 1 0 Driveway, parkingivehicle storage > 3a
Curtain drain N 10 Wells on adjacent lots >/#,T-7
F. COMMENTS
'� .: ate`.:'• r
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in •• .• r
conformance with MOA HAA guidelines in effect on this date. STAMP2123
Engineer's Printed Name + b b a K 5P u r VC ja is K �d c..:'•.•„ ;
Date
HAA Fee $ — I7f ,mil Waiver Fee $ _
Date of Payment Date of Payment
Receipt Number Receipt Number.
72.028 (Rev. 01/00)•
09-18-00• 11:22 FROM -CTE ENVIROMENTAL
Lt`. CT&E Environmental Services Inc.
rr�rrrrrrrrrrrrrr
CUE ReLN
1005467001
Client Name
Tobben Spurkland P.E.
Project Name/N
Tall's West Lot 6 Rik 7
Client Sample ID
Tall's West Lot 6 Blk 7
Matrix
Drinking Water
Ordered By
pwslD
0
A-I6itIt11
T-284 P.02/03 F-751
Client PON Pre -Paid Colis/NO3
Printed Date/rime 09/15/2000 11:46
Collected Datc/rime 09/11/2000 14:15
Received Daterrlme 09/11/2000 16:45{J/� y/J�
Technical Directa phen G ErJ�7 Y
Released By
Sample Remarks
Allowable Peep Analysis
Paianieter Results PQI. Units Ma lual Limits Dom Date Init
Waters Department
Nitmtc-N
0.975 0.500 mg/l. EPA 300.0
10 max 09/11/00 SCL
Microbiology Laboratory
TotalColifonn 128 OB. No Cali col/100mL SN1189222B 09/11/00 KAP
09-18-00 11:23 FROM -CTE ENVIRONIENTAL -5615301
T-284 P.03/03 F-751
JAWV ME Environmental Services Inc.
ILaboratory Division/�riiri/oi'�oiriisioiiri��riisi�s�iirir�iisririri
Drinking Water Analysis Report for Total Coliform Bacteria
READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE 200 W. Porter Drive
MUST BE COMPLETED BY 4
PUBLIC WATER SYSTEM 10#
V PRIVATE WATER SYSTEM
Send RCSI.I:S n� �r
.vam•>vsln-t nsreCxce�y Mine
A' nd invoice
1V .._ `alre
r lam .IL PLy�
�-N'at I Ae fe
rs. IsrKH
AJ�'lla A.Le»
toutlne
Ip C,je
__Repeat Sample
Untreated Water
(refer to lab nq..
Send Rests
Send Involve
l:yT,;.,r y 11'1
�-N'at I Ae fe
IAnnn� AJc'e»
toutlne
Ip C,je
SAMPLE DATE G%
O _ -
Monro -
,-�_.
V.��
bq Y.31
SAMPLE TYPE:
toutlne
Treated Water
__Repeat Sample
Untreated Water
(refer to lab nq..
F ise send anew sample
Special Purpose
Date Received:
*r»
Time Collected
Location Collectoil from:
Collected. bYjjy al):
Anchorage, AK 99518-1605
ToL1907)562.2343
Fax: (907)561-5301
9Y LABORATORY
Analysis :'-nws this Water
MPLE to be:
� Eats!. 'ry
Jsat¢ ..tory
._: Sample over 30 hours old
Resutts may be umel axle.
_•. Sample too IC I in transit.
Sample snould nor Ce rivet
48 ^rs old fcr analysis t0 indicate reliable results.
F ise send anew sample
via somal C� , •Orry mail.
Date Received:
*r»
Time Received:
Analysis Began: �� -�A)
Analytical Method: '1L hrembrane Filter
/ �M11P,10-AtUG
Lab Ret No
n:• Ana:yst
1005467
oe ZZ:1,
• Numael of <oiom rnCuml
Sent toADEC: ANC FSK JUN
Date Tune. _ �_-
Client notified of unsatisfactory results:
RKa
Date
Syr.., «Ir.
Time
r a,
F..
MMO•MUG Result: Total Coliform E Coli
Mombrane Filter Direct Count A U j Colonies1100ml TNTC a Too Nunm�eus m Coam
'l
verification: LTB �e- OGB A) t COLIFORM _ os .rnn.r eutva
Fecal Coliform Conhrmabon: Y A-)ec G
Final Membrane Filter Results: �� C- coldormltoomt
Reported By: � � . Date: 1 L4 (X) Time: 73 �Q_hrs
Comments:
eittillb
LTA ME Environmental Services Inc.
Laboratory Division►iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii
Drinking Water Analysis Report for Total Coliform Bacteria
READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE 200W. Potter Drive
Anchorage, AK 99518.1605
Tel: (907) 562-2343
Fax: (907) 561-5301
PUBLIC WATER SYSTEM IDN
/ ' PRIVATE WATER SYSTEM
Send Results
S %J
Send Invoice
W«« syaiam Nam«Grroa�y Name
�'� Na'^•
pnane hump«
Fa. N�
Alaunq A *Ss
JUN
GW
suit, Z.p C• e
Send Results Send Invoice
C�y Name \.p�lad Nam•
F4mq AOOfeOa
Gly 5410 Z p Cwe
SAMPLE DATE: O
-. �iomh 0aY Tea,
SAMPLE TYPE:
(Routine _' Treated Water
/ .Repeat Sample Untreated Water
(refer to lab na 1
Special Purpose
Time Collected
LocatiColleet from: Collected: by (Initlet):
I ALVi
shows this Water SAMPLE to be:
7 Unsatisfactory
Sample over 30 hours old. Results may be unreliable.
.� Sample too long in transit. Sample should not be over
48 firs old for analysis to indicate reliable results.
Please send a new sample via special delivery mail.
Date Received: Y-2 /- eo
Time Received: I & 6-49
Analysis Began:
Analytical Method:
Lab Ref No.
1005697
Sent to ADEC:
Date:
LZ1E
'V Membrane Filter
MMO-MUG
Result*
Analyst
• N1lmeer or
colonlewitioml
FBK
JUN
Time:
Fa.
Client notified of unsatisfactory results:
r.
P.an• $pWe wN Fa.
Date: rime:
MMO-MUG Result: Total Coliform E. Coll
Membrane Filter: Direct Count (% Colonles1100ml TNTC• Too Num«opa m Co•M
Verification: LTB BGS COLIFORM oe •ote«sadoda
Fecal Coliform Confirmation:
Final Membrane HIS los I Collform/t00m1z
Reported By:
/
Da ts: ya�W Time: y w� hn
Comments:
ra� BGS Member of the SGS Group (ScciAtA G9nArale de Surveillance)
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D.#
1. GENERAL INFORMATION
Complete legal-description -~?~P--~ :~;
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Location (site address or directions)
Property owner
Mailing, address.
Lending agency
Day phone ~l.~- .~<:~_.~
Day phone
Mailing address
Address
Unless otherwise requested, HAA will be held for pickup. * ·
NUM'ERu OF BEDROOMS: ~ "~ .... :' .... "- ;'"
2.
3. TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
Public water
If community well system, provide written confirmation from State ~ADEC a'Ilest-~i
'i: ~" ~ "
lng to the legality and status of system.
4. ~ TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
community On.site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
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 of this Health Authority Approval application shows that the on-site water s[JPply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
NameofFirm -'~otv/ ~t~'i~,-~.~-~t..~ '~-t~. Phone
Engineer's signature Date ~'/?..'t./q.~-
6. DHHS SIGNATURE
-?:~ Approved for
· Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the follo~/ing stipulations:
\~ 'i,I kdditional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze, data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the p.rofessional engineer's work. ,
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
A, Well Data
Well type
Log present (Y/N) ~//
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level1
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~>///~/7 ~ Driller
Cased to ~ .~ Casing height
Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
1~ g.p.m. ~ ~
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
; On adjacent lots Jt ~(~'"~c' ,,
; On adjacent lots ~,~ ''j'' '
Public sewer manhole/cleanout I"~//.~
Petroleum tank ~ o ,~ E._
WATER SAMPLE RESULTS:
Coliform /~
Date of sample: (~/! ?/~-
B. SEPTIC/HOLDING TANK DATA
Date installed Z~ ,,~, 7~/~
Nitrate ~), ~ (x~ Other bacteria
Collected by:
Tank size ,/~¢' -/ 9'~-.) Compartments
Cleanouts (Y/N) "/ Foundation cleanout (Y/N) y Depression (Y/N)
High water alarm (Y/N) ~ Alarm tested (Y/N) J~
Date of pumping ~/,//~ l~,.,5~ Pumper .~ ,/~ ~..A- ~-.~
,,,./
Well(s) on lot ~'
To property line
Surface water/drainage
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
On adjacent lots ~Foundation
Absorption field --~ Water main/service line
CONTINUED ON BACK PAGE
72-026 (3/93)* Front
C. LIFT STATION
//-v
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N)
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
Date installed
Length ~".¢ / Width
Total absorption area //~ ¢
Date of adequacy test ~/i//~,
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Results (pass/fail)
On adjacent lots
Surface water
Soil rating (GPD/Ft
Gravel thickness
Cleanout present (Y/N) ~./
System type '/~/~..~/
Total depth /
Depression over field (Y/N)
for ~ Bedrooms
Aftertest A-~.I.,~.- ,~-.~¢~'r~
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot l
To building foundation
On adjacent lots
Surface water
On adjacent lots ~' / ¢ Property line ~ / /.~
To existing or abandoned system on lot ["~ ~' ~' '~-
Cutbank ['~- o ~4 ¢_ Water main/service line ~, ,~- O
Curtain drain
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certi~/that I have checked, verified, or conformed to afl MOA and HAA guidelines in effec¢ on the date of this inspection·
HAA Fee $ ~¢
Date of Payment ("~ -
Receipt Number ~/',¢:)
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
l, C~neral Information
Application Date
(a) Legal Description (include lot, block~ subdivision, section, township, range)
(b)
(d)
L~ion (address or dSrections)
Applicants Name ~7-~' ~V'B~ Telephone - Home
Applicants Address ~
Applicant is (check one) Lending Institution
Lending Institution
Address
(e) Real Estate Co. & Agent
Address 5~/
Telephone
Business ~'"'/~'- 7&//
(f)
Telephone ?-Tq" ?~'//
the HAA to the following address:
2. Type of Residence
Single-Family~
Number of Bedrooms
3. Water Supply
Individual Well~
Multi-FamilYF--~
Other (describe)
Community~ Public~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewage Disposal
Onsite~ Public I---~ Community ~-~ Holding Tank ~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
5. En$ineerin8 Firm Providin$ Inspectiohs, Tests, Pile Search~ Data and Information
As certified by my seal affixed hereto and as of the validation date shown below, I
verify that my investigation of this Health Authority Approval shows that the on-site
water supply and/or wastewater disposal system is safe, functional and adequate for
the number of bedrooms and type of structure indicated herein. I further verify that,
based on the information obtained from the Municipality of Anchorage files and from my
investigation and inspection, the on-site water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm~f~ ~V/~,,~>/~
(ENGINEER SEAL)
6. DHEP Approval
Approved for /~1 ~/~_-., bedrooms
Approved -- Disapproved
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE ML~ICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
RR4/eJ/D18
[Page 2 of 2]
WELL DATA
MUNICIPALITY OF .ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTIOI~
264-4720
Legal Description:
JUN i m
. zR CE!\/E D
'~/~//¢~-~' If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~ -/~' "? '] YieLd
Cased to ~, 7 / Depth of Grouting
Pump Set At
Sanitary Seal on CasingS)
Depression Around Wellhead (YN~
Well Classification
Well Log Present(~)
Total Depth
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit(~fN)
Separation Distances from Well:
To Sept c/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot //~
To Nearest Public Sewer Line
Cleanout/Manhole 4/~ To
Water Sample Collected by /¢~:
Water Sample Test Results '~xC'C~$'~'/f¢~7'~/2 }/'
Comments
; On Adjoining Lots
; On Adjoining Lots /¢/
To Nearest Public Sewer
Nearest Sewer Service Line on Lot
; Date ~
Stendpipes~N).
Depression over Tank(~N)
Pumping/Maintenance Contract on File (Y~)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well /CZ:)
SEPTIC/HOLDING TANK DATA /L~/
/
Sze'~E'~ /~Z~//~P ND. of Compartments /4///~
Cleanout (~'~)
Air-tight Caps~.}N) Foundation
Date Last Pumped
Temporary Holding Tank Permit (Y/N) /,//~
To Building Foundation //!
To Disposal Field ~ ?
To Stream, Pond, Lake, or Major Drainage
To Property Line
To Water Main/Service Line
Course
Comments
Page 1 of 2
T2-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~--/5~
Width of Field ~//
Square Feet of Absorption Area
Depression over Field (YN~.
Results of Last Adequacy Test
Separation Distance from Absorption Field:
_ I1¢,r
To Water-Supply Well
To Building Foundation
Lot
Main/Service Line
To
Water
t
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments ~Ef~ ~/~J~J 7~
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Presen (Y(~q)
Date of Last Adequacy Test _
!
Property Line /'/_.O .-~
To Existing or Abandoned System on
; On Adjoining Lots 3o ~
To Cutbank (if present) /J//¢
LIFT STATION
~~ Dimensions
S, ize in Gallons _ % Manhole/Access (Y/N)
'PumpOn"Levelat ~.~ / I "PumpOff"Levelat _
High Water Alarm Level at ~ f~--~Vont(Y/N)
~t~r~cfa~rcodes (Y/N) ~ ~"/ / 7A'"/~'""'~Pump( ' , ~....~ng Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request ** ~
I certify that I¢,// /~ ~__have/~he°ked' v~rified, or conformed to all MOA~ Cand HAA g uideli nes in effect on the~date of this inspec~
~'~--'-r/"' '"~ ~/-- --"~~- ~ Date /~ ~////* "~'"~" .... '- ........ ~'
Signed
Company "~' MOA No. ~/~' ~'~'
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72 026 (11/84)
ALASKA e CIiROnmeFITAL COFITROL SeR[TFCe$, Inc.
~l~§ineerin§ ~- ~nuiro~menl~l $ludies
19 June 1985
Pete Jarrett
207 E. Northern Lights
Anchorage, Alaska 99503
RE: Talus West #1 Block 7 Lot 6
A flow test was performed on the well at the above property on May 7,
1984. The flow rate was 4.5 gpm for 3 hours. During this test the well
produced,810 gallons. ~his is adequate for this 5 bedroom house.
Sincerely,
G~n Turner
I~ipironmental Scientist
1200 [Uesl 33rd Auenue, SuJl¢ [~,/~nchoroq¢, Alaska 99503,[907) 561-5040
~L~o~ =l~v,~uf~' ~l~-
· CONTROL SERVICE¥_~,INC,
1200 West 33rd Avenue Suite B
ANCHORAGE ALASKA 99503
(9071 561-5040
SHEET NO.
CALCULATED BY
CHECKED BY
SCALE
DATE
DATE
AGAL
501 W. NORTHERN LIGHTS BLVD./ANCHORAGE, ALASKA 99503/(907)279-7611
July 10, 1985
Ms. Cindy L. Lewis
Alaska Environmental Control Services, Inc.
1200 W. 33rd Avenue, Suite B
Anchorage, AK 99503
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTIO/'~
0UL 1 J. lg85
RECEIVED'.
Re: Lot 6 Block 7 Talus West Subdivision
4400 Traverse Way
Dear Cindy:
Please be advised the house located on the captioned property has been
vacant since July 1, 1984. It was on that date that we put all utilities
in Dynamic Realty's name and we have bills to substantiate the low usage
of electricity and gas.
I believe the attached billings, however, better substantiate that there
is no need to pump the septic. They are from Arctic Chain, Inc. showing
that the house was winterized (all water drained from pipes) on October 16,
1984 and it was not dewinterized until June 10, 1985.
In addition, I have checked the house at least once every week since
July 1, 1984 and can verify it was empty and still is empty as of this
date.
7~ruly yours,
Alisa "Petie" Stra~g
Associate Broker
Att.
"We do more for you in less time"
· WORK ORDERF~b BY ~
STA RT!.N G DATE
IN OUT
STARTING TIME
ORDER TAKEN BY ~ -
INVOICE
UNIT ~_~
600 WEST 41ST AVENUE ~5~~ CHARGE
ANCHORAGE, ALASKA
(907) 562-2060 COD
RADIO D~SPATCHED
~ JOB ADDRESS
NAME
C,TY P.O.E C,TY _P.ONE 7'--
PURCHASE ORDER NO.
NEAREST INTERSECTION
WORKTO BE DONE
I understand that payment for all services r;ndered al~ue~and payable upon completion.
I understand that any and all pending insurance reimbursements due on work perfo~ed are my responsibility to collect and not
that of Arc_tic Chain Plumbing and Heating. Labor is to be done at the rate of ~5--~ for the 1st hour (minimum charge)
and ~ per hour therea~er with ~ hour minimums. Required permits, pa~s, materials and equipment used are charged separately.
Exclusive of mrculatlng pump ~uplers, a~RA~[le~: ~s~ areA~r[~oted~or 90 days; all workmanshrp, exclusive of the
removal of air in heating loops, ~rry a 3~]~'gar~h~ ~67~a[ra~on Id~{;;~{i~eze in heat system. No warranW on drain line
I have read and understand the term~f~n{~a~nd authorize allied,done ta~ing responsibility for payment in full
of all services according to above termS.woRK AUTHORIZED BY(X)
WORK PERFORMED .~.~~/~2~//~ ~ 77~/~ ' ~ .
PARTS AND MATERIALS LABOR RECORD
QUANTITY · ,, ,~ DESCRIP, TION PRICE IN OUT DA~'E RT OT DT
EQUIPMENT MATERIAL
RATE DESCRIPTION PRICE LABOR
PERMITS
I HEREBY ACKNOWLEDGE THE SATISFACTORY COMPLETION OF THE ABOVE WORK AND BILLING AND AGREE TO J
PAY ANY FEES OCCURED TO COLLECT PAYMENT IN FULL
SIGNATURE
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. C~ne~al Inforn~tion Application Date ~) ~2--
(a) Leg~a,_~l D~/sc~iptior~ (include lot, bloc,k, subdivision ~ section, township, range)
Location (add~ess o~ ~.i~ections)
(b) Applicants Nam~ ~'e ~y/'2/-/~7~ Telephone
Applicants Add~ess
(c) Appliqant js (check one) Lending Institution
Buyer~; Othe~ (explain);
(d) Lending Institution
~; Owrmr/builder~;
%% lephone
Address
(e) ~al Estate Co. & Agent
Address
Telephone
2. T_j~ of B~sidence
Single-Family~
Numbe~ of Bedrc~
3. Water Supj!~y_
Individual ~11~.
Multi-Family ~ Other (describe)
Cc~nunity ~ Public ~
Note: If o~nity well system, must have w~itten c~nfirmation from the State
Depa~nnent of Environmental Conservation attesting to the legality and status.
Is the ~,~11 adequate for the number of bedrcc~s specified in this HAA
Sewage Disposal
Onsite~ Public ~ Community ~ Holding Ta~J~ ~-~
Is the %~stewate~ disposal system adequate fc~ the rnmbsr of bedrcx~ns ~N)
[Page 1 of 2]
2-15-84
5. Engineering Fi~m P~Oviding Inspections, Tests, D~ta and Information
I certify that I have checked, verified, o~ conforn~d to all MOA HAA Guidelines in
effect on the date of this inspection.
Signed Date ~---- ~-~¢
Signed by
Date ~*-/~:~/~ ~/
6. DHEP Approval
Approved for
Approved ~
bedrooms
Disapproved
Te~ms of Conditional Approval
Conditional E~
The Municipality of Anchorage Department of Health and Environmental P~otection dces
not guarantee the continued satisfactory performance of the water supply and/or the
wastewate~ disposal system. This approval indicates that, as of the validation date
shown above, based on the data and information furnished by an er~ineer registered in
the State of Alaska, the water supply and wastewater disposal system is safe and func-
tional for the numbe~ of bedrcc~s and type of structure indicated.
( D~EP SEAL)
7. Mail the HAA to the following address:
KB2/d5/s
[Page 2 of 2]
2-15-84
Well Classification
Well Log P~esent ~/N) y~j
Total D~pth ~O~. ~ ' Cased to
Static Water Level ~- /
MUNICIPALITY OF ANCHO D~PT. O~ HEALTH
C~I~ - F~RU~Y 1984 ,JU~ '~ ~% ~9
Legal Descripg~on:[~[ ~
If A, B, ~ C, D.E.C. ~p~o~d(Y~)
~te ~le~d ~-/~-~
~ ~ ~pth/of ~outing
~ ~t At ~/~
Casing Height Above Ground
Electrical Wiring in Conduit ~/N)
Separation Distances f~om Well:
To Septio/Holding Tank on Lot
sanitary S~al an Casing ~/N)
Depression A~ound Wellhead (Y~
; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot/~ / ; On Adjoining Lots ~/~
To Nearest Public Sewer Line ~//~ To Nearest Public Sewer
Cleanout/Manhole /{///9 To Nea~e. st Sewer Service Line on LOt
Water Sample Colleated By J, 'T~E/9~-~ ~/Date ,~/-~/
Water Sample Test Results ~/~/,'~/,~/ v
C~ents
SEPTIC/HOLDING TANK DATA
Date Installed ~/~
Standpipes ~/N) Air-tight Caps ~/N)
No. of Co,pavements 4~//~
Foundation Cteanout .~ )
Depression ove~ Tank (Y~ Date Last Pumped /-~F
Pumping/Maintenance Contract on Fil~ (Y~ ; for /~f~g
· ',
Holding Tank High-Watch AlaLnu (Y/N) Temporary H~
Separation Distances ~rcm Septic/Holding Tank:
TO Water-Supply Well /~ /
To P~operty Line ~/D ~
To Water Main/Service Line ~'/~ /
Course '/'- / '
TO Building Foundation
To Disposal Pield
To S~eam, Pond, Lake, c~ Major D~ainage
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~ -/f-~ ~ ~
Width of Field ~ ~ ~
Square Feet of Absorption A~ea
Depression ove~ Field (Y~
Results of Last Adequacy Test
Type of System Design
Length of Field ~/ ~ ~
Depth of Field // ~ ~A
standpipes lhzesent ~N)
Date of Last Adequacy Test
Separation Distance from Absorption Field:
To ~hter-Supply W~ll
To Building Foundation
Lot A/~ ; On Adjoining Lots ..;'/~ /
To Wate~ Main/Service Line ~/~3 ' To Cutbank(if present)
To St~eam/P. ond/Lake/o~ Majo~ D~aina~e Course
To D~iveway, Parking A~ea, or Vehicle Sto~age A~ea //~
Comments
LIFT STATION '~//~/>
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested
Electrical Codes (Y_~N)
Comments
Dinmnsions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
Meets MOA
** Check Permitted Bed~ocxa Ratin~ Against HAA Request
I ce~,tify that I have checked, verified, o~ confc~med to all MOA HAA Guidelines in effect
on the date of this inspection.
Signed
KB1/d5/s
[Page 2 of 2]
Date
Canole's Concrete Products
of Wasilla, Inc.
HON~E & COMMERCIAL SEWAGE TREATMENT PLANTS
BOX 149 - WASILLA, AK. 99687 - PHONE 376-5919
This Agreement entitles=
JET Home Plant Service Policy
Street
Address
City ~" ';~ :',' Phone
to the following service for __ year(s) from the date of acceptance.
Upon receipt of this signed agreement and $ ' ., CanoJe's Concrete Products agrees to perform the
following services during the term of the agreement:
Cenole's. Concrete Products will inspect the JET plant at the above address twice e yeer. These inspections
will include:
PLANT SERVICE
· Removal of aeration unit, inspection, adjustment, cleaning of aerafor's shaft, field service of aeration
unit, if needed, and re-installation.
· inspection, cleaning, and adjustment, if necessary of surface skimmer and/or tube setter.
· Examination of final effluent for color and odor, if there is access at time of inspection.
· Check of discharge point and wet weather overflow for blockage (if applicable).
· Inspection and adjustment of control panel setting and overload protection, if there is access at time
of inspection.
· Inspectio,n f~r, sludg¢ accumulation with errangements for removal when build-up warrants removal.
Cenole's Concrete Products further agrees to the following:
EMERGENCY SERVICE
· There will be no charge for emergency service calls.
· There will be no service or labor charges for removal or re-installation of aerator, if required.
· If improper operation cannot be corrected at time of service, homeowner will be notified immediately
and given estimated date of correction.
· If improper operation cannot be corrected at time of service, the Department of Environmental Quality,
GAAB, will also be notified.
· If necessary, the entire mechanical unit or any parts will be replaced according to the manufaclurer's
warranty program.
Freight charges to the factory or to an unauthorized repair station and aerator repair charges are not
covered under this agreement.
Owner's Signa?ure Date
Accepted for Canole's Concrete Products Date
IN OUT
.4G TIME
TAKEN BY.
~-~ INC. ~--
$00 WEST 41ST AVENUE UNIT C
ANCHORAGE, ALASKA ~503
(907) 562-2060
43240
DA~E/~ '-/~"~'q'
CHARGE ~
COD []
CAS. I OHEOK I V lMc ,
BILL TO
NAME
JOB ADDRESS
PURCHASE ORDER NO.
IWORKTOBEDONE ~'/~/T1£'~"~£ //~,~-~Z ~ '
CITY //'~'/ C/ /--
NEAREST INTERSECTION
PHON~
] understand that payment for ell services rendered are due and payable upon compTetlon.
I understand that any and all pending insurance reimbursements due on v,~rk performed are my responsibility to collect and not
that of Arctic Chain Plumbing and H~atlng. Labor is to be done at the rate °f ~-,~/~c='-,-~- ,~ -' . for the 1st hour {mlnlmum charge)
and per hour thereafter ,;'i,~ % hour mlmmurns. ReaqnUclr~atPeerrla~'st~,rePa~aS;ramnatteec~'~ra
Exclusive of circulating pump couc,e~s, all installed parts
removal of air in heating loops, c~riy a 30 day warranty. No warranty on loss of anti-freeze in heat system. No warranty on dfc. la !ine
stoppage, and understam- ,,,~ ~c;ms of this contract and authorize all work to be done ta~ing responsibility for'payment in full
I have read ~
of all ' ' ' ....
WORK AUTHORIZED BY(X)
PARTS AND MATERIALS
DESCRIPTION
RATE
EQUIPMENT
-.',, r. ~ ~. · ', ,- DESCRIPTI0,~\,.
, .,,.i: · :;~ ,"C.;~
-- ?-Yi-ilS iNVOICE
F LABOR RECORD
P.iCE DATE I .T lOT
~-,oo j,.]° I,~~/o,'~, 4-
I I I I'
PRICE
MATERIAL
LABOR
EOUIPMENT
PERMITS
TOTAL AhlOUNT
DT
I H[RLBY ACKNOWL£DG£ THE SATISFAC1OR¥ COMPLETION OF THE ABOVE WORK AND BILLING ANO AGREE TO
~ cATE RECEIVED
~ ~'$ iNSPECTiON APPOINTMENTS ( ~-~
DATE DAT DATE
MUNICIPALITY OF ANCHORAGE MUNICIPALI~ OF ANCHO~AG~
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~EPT. OF HSAL}H &
825 L Street - AnchoraBe, Alaska 99501 ENVIRONMENfAL PROTECTION
ENVIRONMENTAL SANITATION DIVISION NOV 5 1980
Telephone 264-4720
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be proce~ed, Please allow ten {10) days for processing.
MAILING ADDRESS
PROPERTY RESIDENT (If different from above) PHON~
- ~ ' PHONE
MAI LING AD DR ESS
4. RE~OR/AGENT PHONE
MAILING ADDRESS
:: , 'Y, %/
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
~ One ~ Four
~ SINGLE FAMILY ~ Two ~ Five
~ MULTIPLE FAMILY ~ Three ~ Six
[] Other
7. WATER SUPPLY
.~ INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTI LITY
* 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.)
sE ,A E o,sPosA, S"STEM
~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev, 6/79)_~ ,~.A ~ /I ~.[
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SIX
[] OTHER
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTI LITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[~]INDIVlDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septi~.~c Tank or E~]Holding Tank
Size: -~ ~t-' If Tank is homemade
give dimensions:
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
Septic/Holding Tank
Absorption Area Sewer Line
Nearest Lot Line
DATE
~PPROVED FOR .~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompanv certificate)
[] DISAPPROVED ~
72-010 (Rev. 6/79)
- ~ · . .CHEMICAL & GI~-~LOGICAL LABORATORIES ~r~£ ALASKA, INC.
,~ TELEPHONE {907)-279-4014 ANCHORAGE INDUSTRIAL CENTER
/_.~ ........ -,~ Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Water System Name
· Mailing Address
Citv
I,D. NO,
Phone No.
State
Day Year
SAMPLE DATE: ~
MO.
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sam ;)le
with lab ref. no.
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO.
2
3
5
Time Collecte(~
Collected By
TO BE COMPLETED BY LABORATORY
Ana ys s snows this Water SAMPLE to be:
[] Satisfactory
r- Unsatisfactory
[] sam 3Ia too ~ong m transit; sample should
not De over 48 hours old at exa'nination
[o ndmate reliable results. Please send
r~ew sample
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
[] Membrane Filter
Lab Ref, No, Result* Analyst
I r-~
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Collected Source
Lab. NO.
· resumptive 1Omi lOml 1Omi /Omi /Omi 1.0m1 O.Zml ,
24 Hours
48 HOURS
;onflrmatory
24 Hours
Multiple Tube Report:
Membrane Filter: Direct Count
verification: L.TB
BGB
Date