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HomeMy WebLinkAboutTALUS WEST #1 BLK 6 LT 7Talus West #1 Block 6 Lot 07 #015-202-43 Municipality of Anchorage Page t of 3 Building Safety Division Onsite water and wastewater Program 4700 South BraI Street P.O. Box 196650 M chaage. A1C 995796650 www.d.anchoragsakus (907)343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. 5WO30?61 PID Number. _{2152--202-43 146"0 Wastewater System: Tank & Holding Tan Only David Childers ABSORPTION FIELD 11706 Wilderness Drive Anchors a AK 99516 Pa, w tww .no s Existing Bed 345-0941 Three 1 Sit R.rp TaW D.ph hrn r9nr p.a.. LEGAL DESCRIPTION cPaFP F1. 11110,* Lac Slee : D.Nh t Pc. Eagan berm ry1W Orb a.i a.Fgh erral vw. 6 7 Talue Weet No. 1 fl• FL Towrrr.pRugs S.c.on: a.moa.Eow onp.�l Y1•a• ..N Lrglh. Fr. Fr. ww wan Er r... rria. rw. Well: Existing Fr. FL CEa.aralmn (Purrs. A B. C) Tar Degh', Cana b rw it' w - it. FI D~ Dr. D~ S1.Ee Wr.r Le.i Owner . 8/8/2003 Fr Y1w Punosww. Dara Alw•r•� TANK CAW n. FI SEPARATION DISTANCES N Septic 12 Holding 0 S.T.E.P. 0 Other. To Septic I Absorption Lin Holding uuwjPnvate Anchorage Tank g 1,000/2,000 From Tank Field Station Tank Sewer lJne wan >100'I >100' N/A N/A >25' r Steel Two (2) >109 AAO` N/A II LIFT STATION — NONE ON LOT Sms.w.w Lal L.» >9 AU N/A N/A unp un w Fa.Witm >9 >19 N/A N/A A in k ti Cun.+l D. None Noted I I anp e R.mrb' BENCH MARK 1,000 Gallon Septic Tank and 2.000 Gallon Holding Tank Only Placed Under This Permit. Existing Absorption Bed Lower 5tep From Deck. Southwest Corner. Aa.an.a Etiwg n Constructed in 1982 Remains In Tact. Diverter Valve Placed 100.0 n for Possible Future Use. Existing Tank Pumped, Crushed and Engincers StarQ Backfilled On-Site. B •••• 49th ! ` Inspections performed by: MFA Dates: 1" 8�12�0 L LiL Cf<4ICHAEL E. ANDERSON y�= • i No CE-43816 Department of Health and Human Services approval ••;'� �'� —_Date: r.�.. row Reviewed and approved by: $ - / - 03 • a•O�FESSt:•w a.....• Municipality of Anchorage Page 2 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number. SW030261 PID No. 015-202-43 VACANT 3 N89 56'20-E 195. G► 2,000 Gallon Holding Tank o E i H3 D m C ra �• \� Q� c W I S s1 Three G L. o Existing . I Bedroom Well O a Home E I �s LU I Existing Absorption Bed Constructed 1982 (Exact Location Unknown) S89 56'20"W 251.39 DV - Flow Diverter Valve H - Holding Tank Vent S - Septic Tank Vent n ® 4 ® S2, 13.5 39.7 80 888 H1 31.0 53.8 H2 36.8 57.6 H3 40.4 60.5 ••����■■■�••• ••� �E •• ....«.....A t ••0 PLAN AS -BUILT ' 49th SCALE 1' = 50' t MICINELLANDMON }t om k. No. Ce l LOT 7, BLOCK 6, TALUS WEST NO.1 •••• h 4 ss�a' .///•��• Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 995195655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number. SW030261 Valve n >n Bed 6.2 N 17 = 2 S Level 92.85 - I 2.000 Gallon Holding Tank PROFILE AS -BUILT Scale: i' . 10' g Tank PID No.: 015-202-43 49th NEL E. ANDERSON MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water B Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW030261 Legal Description. - ,TALUS WEST #1 BLK - 6 LT' 7 Design Engineer: 0014 Anderson Engineering Owner Name: David Childers Owner Address: 11706 WILDERNESS DRIVE ANCHORAGE, AK 99516-2229 Date Issued: Jul 21, 2003 Expiration Date: Jul 20, 2004 Parcel ID: 015-202-43 Site Address: 011706 WILDERNESS DR Lot Size: 22009 SO. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: Disposal Field ❑✓ Septic Tank ❑ Holding Tank E] Privy E] Private Well E] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by catling (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. 8/S/03 Ep6, fv/9/V7'3' TO Pur rifNk IA" rNF Alrw SEPT/c 7Wvk Tp ALLow FOR TIE 1_yls7-jA,4 D,Ep j -O Kc �pG ST"FO r"7' RDOM ODES No 7' F_xi rT OA' T*C LUT 7-6 Pu r 6A/ 4 P6_Rj4D5 ` U SOXJ9770iv FI SL b /4/. Received By: Issued By: Date: '%'Z Z- 03 1��Z 2 Date: 7L,21103 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._015:202475 Permit Number _=7Q 0 26L Property owner(s)-David.Lhildcr5 Day phone -345=0941 Mailing address (1).117D5WiIderne55-Drive. Anchoragc.AK,99516 Mailing address (2) Code Legal description (Lot, Block & Sub'd.) -Lots_Block-6jalu5-Wc5t-5ubdivi5ion-No.1 Legal description (Section, Township & Range) Lot Size ZZ (.Q(B___Acres/Sq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms Jhree_(3). Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade 10 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. C.., (Signature of property owner or authorized agent) Permit Fees: f q n Waiver Fees: Date of Payment: —11111[as Date of Payment: Receipt Number: 3 Receipt Number: (Rev. 12/00) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) July 16, 2003 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 7, Block 6, Talus West Subdivision No. 1 Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing septic tank on Lot 7, Block 6, Talus West Subdivision No. 1 has failed and must be replaced. We are therefore requesting a permit be issued for the construction of a new septic tank to serve the three-bedroom home. The attached Site Plan and backup documentation identify the location and configuration of the existing septic system, the new septic tank location and the parameters used in the design. Also identified on the plans are the location of the well on the lot and surrounding wells in the area. Drainage arrows are shown indicating the current drainage patterns. The drainage patterns will be maintained after construction. The ground surface on the lot slopes at varying shallow grades from east to west. The new tank will be placed in the same location as the existing tank and all work will be accomplished in conformance with Municipal requirements. The new septic tank will be constructed a minimum of 100' from the existing well on this lot and 100' from wells on surrounding lots. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. Lof 7, Block 6, Talus West No. 1 July 16, 2003 Page Two 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, 7'Y44a� Michael E. Anderson, P.E. Attachments 7�fr✓ , L9 i ! 49th ! MICHAEL E. ANDERSON Ist No. CE -438! % VACANT 3 N89 56'20"E !►� wo 195.43cu Win_ 0 Remove and place S/ Existing 1,000 allon Septic Tank O E 28' O N I '� • /�1 m Three w� Bedroom Existing O _ 5% Home Well �s E W I Existing Absorption Bed S89 56'20 251.39 8 SITE PLAN ♦` SCALE 1" = 50' i t, M •e"MMRSor, -No. cs4ui ' LOT 7, BLOCK 6, TALUS WEST NO. 1 ♦♦♦♦♦i ��s;;a��••••• ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 7, BLOCK 6, TALUS WEST SUBDIVISION NO.1 GENERAL: 1. The scope of this project includes the removal and proper disposal of the existing septic tank on the lot. It also includes the procurement and placement of a new 1,000 -gallon septic tank at the location shown on the site plan. Two post tank cleanouts must be placed between the new septic tank and the existing absorption bed. No other work will be performed under this permit. The new septic tank must be constructed a minimum of 100' from any surface water and 100' from the existing wells on this and adjacent lots. A minimum of 4' of cover is required over the septic tank. In lieu of cover 2" of direct bury insulation and 2' of cover may be placed. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION 1. A new 1,000 -gallon septic tank must be procured from a certified septic tank manufacturer if the existing tank is found to be defective. 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 'Lot 7, Block 6, July 16, 2003 Page 2 of 3 Talus West No.1 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: - NOT REQUIRED 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). Lot 7, Block 6, Talus West No. July 16, 2003 Page 3 of 3 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextilefabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. ) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE / EJ.N EW MAILING ADDRESS LEGAL DESCRIPTION ~ ~ DISTANCE TO:'1w"ll'1Absorpti°n Dwelling PERMIT NO,  Manufacturer Material No, of compartments ~ DISTANCE TO: ~ ~ ¢ Manufacturer Material i Liquid capacity in gallons ~ DISTANCE TO: ~ No. of lines 4-- Length of each line Total length of lines ~ Trench width. ~ DISTANCE TO: OTHER SOl L TEST flATI N~(~ INSTALLER I APPROVED DATE LEGAL 72-013 (Rev. 3/78) Department( ~ Health and Environmenta? ~rotection 825 ~ Street, Anchorage, AK. ~501 264-4720 Permit ~ ~e~(.~ * * * HANDWRITTEN PERMIT * * * Applicant: Location: Legal Description: /~ ~~ TYpe of Soil Absorption System Is: / Trench: Drainfield: Seepage Bed:~/ Holding Tank Maximum Number of Bedrooms: ~ ,~ Soil Rating (sq. fL/Dr) ~ ON-SITE SEWER PERMIT ~ ~~ Mailing Address: ~ ~0~-~/0'-~ Phone Number: ~ Lot Size: DEPTH The Required Size of the Soil Absorption System Is:~ .LENGTH ~&~ ~ GRAVEL DEPTH ~:F~'°~TH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). ~__~~ * * REQUIRED SEPTIC(HOLDING) TANK SIZE : ~ ALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31~ I 9 ~ ~ * * * I certify that: (1) I am familiar with the requ'irements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bedrooms. ___> =s sued by: t/-' t Date: 7F/~ 2~/~ ~_-~ . PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3- 4- 5 6 7 8 9 10 11 13- 14- 15 16 17 18 19 20- COMMENTS PERFORMED BY: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST DATE PERFORMED: SOILS LOG PERCOLATION TEST SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? ~AJ'"o [~ O P IF YES, AT WHAT E DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop / /o~ /~.'// .~ /.¢~ 7_ /~.' z/ /~ /¢0 ~,o~ PERCOLATION RATE (minutes/inch) L CERTIFIED BY: FT AND -- FT ALASKA I IIUIROlllIII I1TAL COF1TROL SI RUICES, IllC. SPECIFICATIONS FOR SEEPAGE BED ALTERNATIVE WASTEWATER TREATMENT SYSTEM- LOT 6, BLOCK 7, TALUS WEST SUBDIVISION 1.0 GENERAL 1.1 THE DRAWINGS SHALL BE A PART OF THIS SPECIFICATION. 1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE REQUIREMENTS OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERMIT. 2.0 LIFT STATION (NOT USED). 3.0 SEEPAGE BED 3.1 THE GRAVEL FOR THE BED SHALL BE SIZED BETWEEN 0.5 TO 1.5 INCH AND RELATIVELY FREE FROM SILT OR SAND. 3.2 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN COMPACTED DURING EXCAVATION. THE BOTTOM ELEVATION SHALL BE PLUS OR MINUS 2". 3.3 THE DISTRIBUTION PIPE SHALL BE 4 INCH RIGID PVC OR POLYETHYLENE. THE PIPES SHALL BE LAID LEVEL. 3.4 AN OBSERVATION PIPE SHALL BE PLACED AS SHOWN IN THE DRAWINGS. IT SHALL BE RIGID PVC, ASTM 3033 D-3034. THE SECTION SHOWN WITH HOLES MAY BE EITHER DRILLED 0.5" HOLES @ 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE OR A REGULAR SECTION OF REGULAR PERFORATED DISTRIBUTION PIPE MAY BE CLAMPED TO THE SOLID SECTION WITH A NO HUB COUPLING OR SOLVENT JOINT. A RUBBER RAIN- CAP (JIMCAP OR EQUAL) SHALL BE PLACED ON THE TOP THE PIPE. 3.5 THE GRAVEL SHALL BE COVERED WITH A LAYER OF UNTREATED BUILDING PAPER OR A NONWOVEN FABRIC SUCH AS MIRAFAR FIBRETEX 200 GRADE, OR POLY-FILTER X OR EQUAL. 3.6 IF INSULATION IS REQUIRED THE INSULATION SHALL BE DOW EXTRUDED BLUE STYROFOAM BOARD OR ARCO GEOFOAM EMBANKMENT INSULATION BOARD OF THE THICKNESS SHOWN ON THE DRAWINGS. 3.7 THE TOP OF THE BED SHOULD BE PLANTED WITH A WHITE CLOVER AND RED FESCUE MIX. 1220 West 251}~ Aucnu¢ · A,chora§¢, ~l~sk~ 99503 · {907) 276-1361 'ALASKA ENVIRONI~rAL · CONTROL SERVICES, INC. 1220 West 25th Avenue ANCHORAGE, ALASKA 99503 Phone 276-1361 : ' Z ~ ~;~ JOB / SHEET NO. CALCULATED BY CHECKED BY oF / DATE l, ) · u DEPARTI~ENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONIVIENTAL ENGINEERING DIVISION 825 L Street- Anchorage, A~aska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL DESCRIPTION LOCATION Absorption area / DISTANCE TO: I rropo~~ ' /0 No. ofco~rtments ~ Mate 'at ~ Manufacture~ ~ /~ ~ Inside ,el,9~ Width Liquid dep~ / 0 O0 Well __ i Dwelling ~ PERMIT NO~ ~ Z ; Material Liquid ~aclty in gallons O Z ~ Manufacturer -- Well O DISTANCE TO: ~ ~ ~'~ of,~?~ Trench width Distance between l/n~/~ ~ ' No. offs ~inches Total effective ab~,~ea ~ ~ ~ Top o~ tile to finish grade ~ Material b~neath ti]e ? ~'~nches ~ PERMIT NO. ~ Type of c~ Crib diameter Crib depth ~ Total effective absorption area ~ = Well ~ Building foundation Nearest lot Hne ~ Absorption area(s) ~ Building foundation wer line Septic tank OTHER PIPE MATERIALS DATE LEGAL 72-013 (Rev, '78) PERMIT NO. .... , BRFID¥ RPF'LICRNT EE.,WRR[. LOI]:RT I ON THLU-, WEST Be, TRL.US WEST %'"[:' LEGRL L? -' - - TYPE OF SOIL RBsORBTION S'¢S"FEM IS: MRt.~IMI-IM NUMBER OF BEDROOMS = ~' 0 SQLIRRE FEET TREN ..t I · ~"'l ' 2:PCI =,oiL RRTIHI]J K_-,L,. FT/'BR;'= '- F' RBSORPTION SYSTEM IS: ]'HE F:.EI]:!LIIRED .~I~'_E OF THE =,C IL THE LENGTH DIf'IEHSION IS THE LENGTH <IN FEET> OF THE TRENCH OR ['RRTNFIELD- THE DEPTH OF R TRENCH OR PIT ~5 THE DISTRHCE EtETWEEH THE 5URFRCE OF THE GROUND RND THE BOTTOM OF THE EXcRVFITION <IN FEET). _,El WIDTH FOR FREHL. HE .... DETblEEN THE oUTFRLL- PIPE THERE IS NO '="' THE GRRVEL DEPTH I~ THE MINIMUbl DEPTH OF GRRVEL RND THE BOTTOM OF THE EXCRVRTION (IN FEET;'- HM-, THE REqPF~NS~E:IL-IT'¢ TO INFORM THIS DEPRRTMENT DUR. ING THE PERMIT RPPL ICRNT "":: ..... INSTRLLRTION INSPECTIOHS OF RN~ ~ELLS RDJRC:ENT TO THIS pR]PERI"'¢ RN[:' THE NUMBER OF RESIDEHCES THRT THE WELL WILL ...... RND RPPROVRL E:'¢ THIS E:RCKFILLING OF RN'¢ >~:,TEfl WITHOUT F'If',IRL. INSPECT/ON DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISI"RNCE BETWEEN R WELL RND RN'¢ ON-SITE SENRGE DISPOSflL ~¢_lEI1 :108 FEEl' FOR R PRIVRTE WELL> OR ' R UPOH THE T"¢PE OF pIIBLIC P.IELL.. 1NO Tel 288 FEET FROM R PUBLIC NELL DEPEHDINm ' - - " , ~ RETURNED TO THE BEPRR"MENT PlITHIN WELL LLG~ RRE REQUIRED RND MU=,T BE OF THE wELL COMPLETION. -p.",q FIRE OTHER REQUIREMENTS MR'¢ RPF'L.5'. SPECIFIC. RTIONS Rt',ID CONSTRUCTION DIPIo~RM- RVRILRBL-E TO INSURE PROPER INSTRLLRTION. I CERTIF'¢ THRT UN-z, ITE SENER. S RI'lb NELL.S Hb _,El l: I RI"I FflMIL. IRR NITH THE REQuIREMEH'FS FOR - ~ ' FORTH 8'¢ THE MUNICIPFtL. IT'¢ OF RNCHORRGE. .... ct,,,= '-, -~ RCCORDANCE N ITH THE C:O[:,ES. . ...... -.' · · ~ q ~f'4D THFt/' I~l~ ,Jf'r=*-,- : .... Z -. ~-. , - .s: I UN[~ER-~ .... ,..-.~.,¢, ,=r., 'FO IHCLIIDE MORE THPI~4 .s E, EDROUM-. ;IGNED: -.~~g~-~gT4D,¢ ~ - ~NT ~,.IR R k:' I: ~.n~.. 15SLIED EW-. - - - ............ 'GARY LAYE CONSULTING GEOLOGIST -~ ~-,- r, SOILS LOG Soil Type Water Level Remarks 16 18 2O Total Depth of Excavation Groundwat er ~ Not Reached Depth, if Reached Classification Method Visual Sieve Analysis Material at Total Depth Bedrock ~ Not Reached Depth, if Reached Gary F. Player, Consulting Geologist WELL CONSTRUCTION LOG Well lec~tion: (~,dress & legal ,escription) ~'~ fi, G~E ~ Static water level ~'~ ft. (~ below)land surface. Date Finish of well: ~ screen, perforated, open-hole, other) gescfibe intervals and size: Wel& yield tested by (pum in,,(~air)at 1~ ,al/min. for ~ hours with ~ ft. of drawdown from static level. U~GG no. Date well completed Nea reet corn,un., Location sketch or r?marks DRILLER'S MATERIAL LOG Depth below land Give description of strata penetrated surface in feet (size of material, color, hardness of drilling, and water content) Municipality of Anchorage N s • 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.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015.202.43 HAA #_ n5039 Expiration Date: / I — I�� 1. GENERAL INFORMATION Complete legal description Lot 7. Block 6. Talus West Subdivision No.1 Location (site address or directions) 11706 Wtidemess Drive Current Property owner(s) Tamara Selmer Day phone 2226275 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 11706 Wtldemess Ddve Anchoraae AK 99516 Unless otherwise requested. HAA wr7l be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System Three 3 Day phone Day phone TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ❑ ❑ Individual Holding tank ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of We (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 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 Health Authority Approval Guidelines for this apprication, 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 522.7773 Address P.O. Box 240773 Anchorage AK 99524 Engineer's Printed Name Michael E Anderson. P.E. Date 8/128005 5. DSD SIGNATURE ✓ Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Aaamonal tiommerIIH = PROGRAM : Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report_ Other By: OZ:::�14� / 1,6/. /�r,� Original Certificate Date: g' (nw. IZW) Municipality of Anchorage .• • Development Services Department Building Safety Division On -Sibs Water R Wastewater Program • " • * r 4700 South Bragaw, St P.O. Banc 196650 Anchorage. AK 99519-8650 www.ci.anchorage.ak.us (907) 343-79W HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Wen type gbmilt If A, B, or C provide PWSID 8 Data completed amytfm Sanitary seal (YIN) Y Total depth eft. Cased to jLfL FROM WELL LOG Data of test 911711978 Static water level 44 R Well production 15 g.p.m. WATER SAMPLE RESULTS: Conform —t—oolcnles/100 ml. Nitrate 2.65rng.A. S. SEPTICIHOLDING TANK DATA Wen Log (Y/N) Y Wires properly protected (YM) Y Casing height (above ground) >24 in. AT INSPECTION ZIA ft S.1 g.p.m. Other bacteria _, colonies/100 ml. Tank size 1.000 gal. Number of Compartments Y Cleenouts (YM) Y Boldinq Tank — 2 000 Gallon Foundation deanout (Y/Nj Y Depression over tank (Y/N) fl High water alarm (Y/N) Y Dateofpumping 8/3/05 Pumper A Plus Home Berv±ces C. ABSORPTION FIELD DATA Length 90 R Width 28 ft Gravel below pipe .S it. Total depth ZA ft F.ff. absorption area J&&?e Monitoring tube X Depression over field IN Date of adequacy test MM Results (Pass/F" Pm For I bedrooms Fluid depth In absorption field before test ¢ in. Water addeda gal. New depd* in. Elapsed Time: JM min. Final fluid depth 2 in. Absorption rate >Q ISO g.p.d. Any rejuvenation treatment (past 12 (no.) (YIN R type) If yes, give date D. LIFT STATION Date installed Size in gallons 'Pump on, level at _ in. 'Pump air level at _ In. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankllift station on lot >1(V Absorption field on lot >1W Public sewer main WA Sewer /septle service line >25' Manholalkocess (YIN) High water alarm level at Meets alarm b dreuh requirements? On adjacent lots AW On adjacent lots >1W Public sewer manholeldearMt WA Holding tank >TS SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation W Property One >. Absorption field W Water main WA Water service One Mir Surface water x100' Wells on adjacent lots MW SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO. Property line >10' Building foundation >JW Water main WA Water Service line >2S Surface water AW Driveway. perkkglvehide stwegs >2S Curtain drain None Noted Wells on adjacent lots>100' F. COMMENTS G. ENGINEER'S CERTIFICATION / I certify that I have determined through field inspections and 9th review of Municipal records that the above systems are in c onformence w!M MOA HAA guidelines to effect on this date. arallo. t Nmorsw Engineer's Printed Name Michael E. Anderson. P.E. CE-4= � Data aR200 HAA Fee i Waiver Fee S Date of Payment Date of Payment Receipt Number Receipt Number (Rev. 1710 in. ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (F May 31, 2005 Tamara 11706 Wildemess Drive Anchorage, AK 99516 Subject: Lot 7, Block 6, Talus West Subdivision No. 1 Septic System Inspection and Testing Dear Tamara: The original septic system serving Lot 7, Block 6, Talus West Subdivision No. 1 was constructed in July of 1978 and was composed of a 1,000 gallon septic tank and an absorption trench. The absorption trench was replaced in September of 1982 with a 28' wide by 50' long absorption bed. The bed remained in use until August of 2003 when the septic tank was replaced with a new 1,000 -gallon septic tank and a new 2,000 - gallon holding tank was installed on the lot. A flow diverter valve was placed with the intent that the bed could be used in the future for disposal of septic effluent. At the time of construction in August of 2003 the absorption bed was flooded and could not be certified as meeting Municipal requirements for a Certificate of Health Authority Approval. All septic flow was directed to the holding tank and continues to be contained there at the present time. A recent probing of the monitor tube in the absorption bed indicated 5 inches of standing water. The bed is no longer flooded, but has not been totally regenerated as evidenced by the standing water. We then pumped 450 gallons of water into the bed from the exterior hose bib. The water level in the bed did not rise and remained at 5 inches. A probing of the bed today indicated the water.depth had receded to 2 inches. It is apparent that the bed is currently capable of absorbing a minimum of 450 gallons of water in a 24-hour period, which is the Municipal requirement for certification of a septic system. There is no guarantee, however, based on the past history of the bed how long it will continue to absorb water at this rate. Our recommendation is to operate the absorption bed and holding tank on a rotational basis. This can be accomplished by moving the diverter valve to direct flow from the septic tank. The bed can remain operational for six months at a time and then allowed to rest while effluent is contained in the holding tank for three months. The bed should be monitored to insure that effluent is being absorbed into the underlying soil strata. Lot 7, Block 6, Talus West May 31, 2005 Page 2 of 2 Most absorption systems continue to function and absorb water at a pace less than 150 gallons per day per bedroom, which is the benchmark for certification. This bed will probably continue to absorb water, but may not pass an adequacy test if subjected to continued use for a long period of time. As with any absorption system conservation of water within the house will extend the useful life the system. Sincerely, mlE4.C. Michael E. Anderson, P.E. Attachments N1 q �1 35' e ee Septic Vents S89'—,=;rs' 20 /95.43' /Z` N� 53 p )- WELLO ,5'89'x' 20" W �J D ;; DATE 02-/2 Lot 7 , Block `O *7a— / Au,s Mesf t u66-' Ac2 ' d No.1 Anchorage Recording Precinct, Aloeka LOT SURVEY CERTIFICATION -LEGEND GENO N*.td-tan 'Pj Iherebyxn.ty 111011 nave verve/ed Mwyoperly Shown and described And mall Me improvements siluctod thereon ere within the 4Z s Brass capped monument recovere �s6. LS -1192 taf Bred fl 4. *my Mas.7n nW rot 01 and t2 21ub a tack �iO ogOffS51C� adjacerooUlant s recovered � 0 •r^ " aesrap oeer��t pe�no Mad r5A"x Xf•rebor set this Survey ,�\�\\j�'� m y.ehCn V4 ire are not roadways, YY;!itJ Imes or other visible ee+.P.MS en laid trop*?/ *.Copt w indicated hereon r, Scale �/_ /"r4:;70" � Oats [� — C6 -77 Prepared by: R. L. BUTTON Rep;, Lo?o Sw v�.� -It Av /907J279-6PA0 Jig w Cg, -It Avs. Anc•Aaoys, re/*std 993Gr 9op Ref. %T� F.B. No./0 -5c5 Property of: ( . . 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.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-202-43 1. GENERAL INFORMATION HAA # Q 1 3 Expiration Date: Complete legal description Lot 7. Block 6. Talus West Subdivision No.1 Location (site address or directions) 11706 Wildemess Drive Current Property owner(s) David Childers Day phone 242-6691 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 11706 Widemess Drive Anchorage, AK 99516 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: E�■t (7 W4111111111111111 Individual Well Individual Water Storage Community Class Well Public Water System Three 3 Day phone Day phone TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ❑ ❑ Individual Holding tank ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 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 Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. 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 Finn Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 8115/2003 •���E.OF 04 eee `" ••epi . pt i' 49th •�: 5. DSD SIGNATURE !-f� Approved for 3 Disapproved. Conditional approval for Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory (Rw. 12M AEL E. IIRDERS0R No. CE -4381 bedrooms. bedrooms, with the following stipulations: Maintenance Agreements Supplemental Engineer's Report Other /,(/. Original Certificate Date: 9-19-03 ••'�c -�-6N SITE WATER AND �• PROGRAM = 1 / SENT SE�11>>" Maintenance Agreements Supplemental Engineer's Report Other /,(/. Original Certificate Date: 9-19-03 Municipality of Anchorage Development Services Department - Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 995194650 www.d.anchorage.sk.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well type Edft If A. B, or C provide PWSID # _ Date completed 11!17/1978 Sanitary seal (Y/N)1 Total depth _ Lft. Cased to A?� ft. FROM WELL LOG Date of test Static water level Well production g.p.m. WATER SAMPLE RESULTS: 82 ft. Well Log (Y/1) Y Wires properly protected (YM) Y Casing height (above ground) ),24 in. AT INSPECTION 22 ft. 12 9 -13 -m - Coliform 0 colonies/100 mi. Nitrate „ ZZL mg./I. Other bacteria _L oolonies/100 ml. Date of sample: 713012003 Collected by: D. Childers B. SEPTICIHOLDING TANK DATA Tank Type/Material See0clSteei Bolding/Steel Date installed 8V= Tank size 1.000 gal. Number of Compartments j Cleanouts (Y/N) Y goldi�q Tank ? 00 DeAl Igll Foundatloft cleanout (YINj'� Non over tank (YM) jj High water alarm (YRS N Date of pumping Pumper New Construction C. ABSORPTION FIELD DATA Date Installed 912/1982 Soil rating (g.p.d.e or ft2/bdrrn) 295 SFISDRM System type Shallow Bed Length 50 ft. Width 28 ft. Gravel below pipe .5 ft. Total depth L5 ft. Eff. absorption area 1A0g ftz Monitoring tube y Depression over field N Date of adequacy test Results (Pass/Faiq • For _ bedrooms Fluid depth In absorption field before test _ in. Water added_ gal. New depth_ in. Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) N If yes, give date D. LIFT STATION Date Installed Size In gallons 'Pump on' level at _ in. `Pump off" level at _ In. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Manhoje/Access (Y/N) _ High water alarm level at Meets alarm 8 circuit requirements? Septic tankAift station on lot a100' On adjacent lots 3,107 Absorption field on lot 3,107 On adjacent lots 3,100' Public sewer main WA Public sewer manhole/deanout WA Sewer /septic service line 3,25 Holding tank NIA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 3,S Property line 4 Absorption field 4 Water main 3,17 Water service line 3,17 Surface water 3,,IIW Wells on adjacent lots 3,107 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 3,17 Building foundation 3,17 Water main 3,17 Water Service line 3,10' Surface water 3,107 Driveway, parkingNshicle storage 3,25 Curtain drain None Noted Wells on adjacent lots 3,107 F. COMMENTS G. ENGINEER'S CERTIFICATION I car* that I have determined through field inspections and review of Municipal records that the above systems are in conformance wflh MOA MAA guidelines in effect on this date. _ a . ensnu. e. �NQERSOr Engineer's Printed Name Michael E. Anderson. P.E. • No. CE_43M Date OI1S/T003 eeAa.�::c�tttW_� HAA Fee Date of Payment S Receipt Number (Rev. 12M) 12X) 45' , Waiver Fee $ Date of Payment Receipt Number, in. August 15, 2003 Municipality of Anchorage Building Safety Division On -Site Water and Wastewater Program 4700 S. Bragaw Street Anchorage, AK 99507 Attention: Jeff Poet Subject: Lot 7, Block 6, Talus West Subdivision No. 1 Certificate of Health Authority Approval Dear Jeff: We are hereby applying for a Certificate of Health Authority Approval for Lot 7, Block 6, Talus West Subdivision No. 1. Our initial inspection of the absorption bed serving the three-bedroom home found it to be surcharged and in a state of failure. In addition, the existing septic tank was near collapse. We therefore applied for a permit to construct a new septic tank and attempted to locate an area on the lot for a suitable replacement absorption area. The lot to the south of this property is currently on a holding tank. The lot to the north is vacant, but after substantial effort we have determined the soil is unsuitable for a septic system as the percolation rate in areas tested to date are more than 120 minutes per inch. The soils on Lot 7 are identical to those tested on this lot. Very little area remains on the lot for an upgrade site due to the location of the existing bed, the location of the well and the presence of the utility easement to the west. We have therefore concluded that a suitable upgrade site is unavailable on Lot 7 and have placed a 2,000 -gallon holding tank to contain the sewage generated in the house. The existing absorption bed on Lot 7 was constructed in 1982. The engineer at the time determined the soils in the area of the bed percolated at a rate of 45 minutes per inch. We are unable to verify this rate. A flow diverter valve has been placed in line between the new septic tank and the new holding tank and the line to the existing bed has been tied in for future use if the bed regenerates itself. Documentation of the work completed on the lot along with the application for the Certificate of Health Authority Approval is included for your review. Please let me know if you have any questions. Sincerely, ���% /►� L (f _.,,,'tel Michael E. Anderson, P.E. Attachments .-�O x.95.43' . .. . yz= Septic • • 5_ Vents ?5/..--G' tk S89•11�6' L D�. : Ll rATE Lot 7 , Block 6 /us Nesf Anchorage Recording Precinct, Alaska W 0 WELL /02 t LOT SURVEY CERTIFICATION LEGEND e I heneoycOn.ty tr4t l nave survejedthe Xopertysnown and described q x Bross copped morunent recover "eO.Ond tqt the impMvemenrs sit•.reted ttareon ora within tW prop- a e iron pipe ond/brrebor recovered eny Imes Y.d de not orerlop or *mooch on adjacent property and thur no a : 2x2 hub Block recovered ,mprcrem.G• s cn adjocenr property, oierlop or encrocchon the penises • x ""x 3rrebar set this survey m -jmL^n v4 tree mare ore no rcodways, uroiry Wes oraper visible edserwnis on said property e,cept as indicotdd hereon 0 3D s J F-1 r �epFFSSi v ���+ Scale i DatePrepared by: R. L. BUTTON / — 9 _ /� •7/% Regi7rere0 Lend Swveyoe C6 (907J?79•E?00 S19WE/grr'Ave. Anch4rage,.410009930r Ref. ���� F. B. No./'., Property of: MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) k o c a t ib."n:~ &'ff~r r~ ~ r dire*(~ti'o~ .~). (b) Prop~?{~ ~,e3:?'/,'~/.EY/~',':''~''~/''~r~ Telephone.: (home) Business Mailing Address //7~ , ~/L ~5~ (c) Lending Ins~itution ' - Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here'J~ if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENC..E Single-FamilyXj~. ~ Number of bedrooms 3. WATER SUPPLY Individual Well"j~. /'Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISP~.$AL On-site~L Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72*o25 (Re,. Z/SS) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that b~sed 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 ,~5 Telephone ~?q-5'5~3 Address /q//Z-- b~ .~ ';~ /¢~J~/ /~ ~' Y~"-~ -~ Date Approved for ~ bedrooms by Date Approved ~ Disapproved Conditional -Farms of Conditional .Approval ~ The Mu nicipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 DH HS 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. 72-025 (Rev 7/88)Back Page 2 of 2 ,c~.© 5~ MUNICIPALITY OF ANCHORAGE (MOA) ~ ,~-~ [;"~'~ ~ Health Authority Approval (HAA) /~'~. i n: ~ ~/ A. WELL DATA Well Classification Well Log Present~xl) Total Depth ~z- / '~Cased to Static Water Level Date Completed ,¢~ Depth of Grouting Casing Height Above Ground Electrical Wiring in Conduit~__(~N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot /,¢o ~'../- To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /3//4- To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments /-v/~'z/-- ~ If A, B, C, D.E.C. Approved (Y/N) ,"J'/~ ~-/?~?~*'~ ~-~ Yield ~'~'// ~,,/a/.,/ ~,. Pump Set At ~J/~ Sanitary Seal on Casing(~lN) Depression Around Wellhead ; On Adjoining Lots /~ /'~; On Adjoining Lots To'Tq~arest Public Sewer Cleanout/Manhole /¢. ,~J/~-x/ ~ ; Date Date Installed 7-/E'-7¢Si~' ~' /c~rc' . f Compartments Standpipes~N) Air-tight CapstaN) Foundation Cleanout (Y~) Depression over Tank (YN~ Date Last Pumped Pumping/Maintenance Contact on File (YIN) ~/A ; for ' HoMing ~gh~ter Alerm (Y/N) Temporew Holding Tenk Permit (Y~N) SEPAB~TI~N~_GEe FROM SEPTIC/HOLDING TANK: TO Water-Sup~.~Jb'; ¢:~" ~. /~ ¢ To Budding Foundatmn ~ Prbpe~ty, bine,.~..~.~,..,. /o ¢ To Disposal Field /o :' : ...... 'fl" '" To Water' Ma/~/S~rw~ e ' /~ /~ To Stream Pond ba~ erMajor Drainage Course Comments 72 026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over I:ield (Y(~) Results of Last Adequacy Test '41))~-~f¢I'7"4¢ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well /¢r-~ /¢-- ~-~-~-- To Building Foundation ~z.-~' / ~ ~ Type of System Design Z~f~;'-~ ~ Length of Field ~"-,o / ~J Depth of Field -~ Gravel Bed Thickness ~'-s~ '~ ~--~- Statndpipes PresentON) / Date of Last Adequacy Test 7¢Z''7-¢¢'? ~' Lot To Property Line To Existing or Abandoned System on /~ ; On Adjoining Lots /'0 To Water Main/Service Line /dj ~ To Cutback (if present) /J/~ To Stream, Pond, Lake, or Major Drainage Course /ctz~ /¢- ~ To Driveway, Parking Area, or Vehicle Storage Area /'¢ / 'P Comments D. LIFT STATION Date installed '~. Dimensions Size in Gallons ~ Manhole/Access (Y/N) "Pump On" Level at ~ "Pump Off" Level at Water Alarm Level at ~ ' Vent High (Y/N) Tested for ~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) ~ Comments ~ **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of 'this inspection, f__~. ~v///.._~__- Company ~2 Date ~-~¢ MOA NO. Receipt No. Receipt No. ¢"~/~."~ '/~/'('~ .X,7')¢':~.2 Date of Payment OET' /~ "--d;~ Amount: $ ,~ ~-' ~(~ ' 72~026 (Rev. 7/88) Back Waiver Fee: $ Date of Payment Page 2 of 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 1. GENERAL INFORMATION IMUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Loc at:~ ~¢ (a~d~es~' (b) ~[~g~.a4¢e~,~e~z~ ~>/ Telephone: Home (c) ~n~lnstjtu~on~ ~¢ 7 Telephone (d) Rea Est~te,~9:~,~y ~nd Agent Address ~/ ~ Telephone ~¢~- ~¢ / Business (e) Mail the HAA to the followina address: or: Check here r-I, if hold for pick up. List contaot person and day phone number below. TYPE OF RESIDENCE Single-Family'S. ' Number of Bedrooms WATER SUPPLY Individual Well.~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~[. Publicl-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 72-025 fRev 8/86~ Fronl 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ,~'"'~'-"~ Telephone ~'~' / ~-~¢----~ Address /~"~ ~ ]] ~ ~ ~ ~ ~- ~ ~¢~J Date ~ -~--~ DHHS APPROVAL Approved for ~'~'"'~r-'~-~.~bedrooms by ~ '~' '~...~ Approved ~ Disapproved Conditional Terms of Conditional Approval Date CAUTION 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. Page 2 of 2 72 025 (Rev 8/86) Back WELL DATA Well Classification Well Log PresenL~.~) - Date Completed Total Depth _ ~:~2~/ Cased~,o~_ Static Water Level _~ MUNICIPALITY OF ANCHORAGE (M0~)~ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 MUNICIPALITY OF ANCHORAGE ' ~NVIP, ONMENTALSERVIC~SDJVJSJ~'gal Description: _/~.-~7 ~/~ ~'/~ 1'~ ~/ JUN 9 t987 ~/~C [ iV [ ~ I' A, B, G, D.E.C. Approved (Y/N) ~ Casing Height Above Ground Electrical Wiring in Conduit (~N) Separation Distances from Well: To Septic/Holding Tank on Lot /d~/"/~ To Nearest Edge of Absorption Field on Lot _ To Nearest Public Sewer Line "~,L/¢ To Nearest Public Sewer Cleanout/Manhole - ~//~ Water Sample Collected by /¢~"~ Water Sample Test Results . Depth of Grouting /J/~ ' /d Pump Set At y'+¢ Sanitary Seal on CasingS) Depression Around Wellhead (Y~) ; On Adjoining Lots /'~ ; On Adjoining Lots To Newest Sewer Service Line on Lot ; Date ~ -/~°¢"~ Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size Standpipes(?~) - _ Air-tight Caps.) Depression over Tank (Y~J-h Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: / To Water-Supply Well [H To Property Line /O r, To Water Main/~(~rvice Line _ /.(~omn~ents' ~ ' ' ' No. of Compartments Foundation Cleanout Date Last Pumped ¢)~¢-' -~''/~ _ Temporary Holding Tank Permit (Y/N) _ To Building Foundation To Disposal Field _ To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot ,./~) To Water Main/Service Line /,¢ '~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness O.- ~" Standpipes PresenterS}q) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) ..c'///~ D. LIFT STATION Size in Gallons _~_ "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ~ ~ycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I hav. e;ch ¢c k, ed,~,..erified, or conformed to all MOA and HAA guidelines in effect on the (late of this inspection Signed ~"~'~-~-- -~"'/' ~'- ~'~ Date ~' -.'rJ~'--4¢' ~ ' Company ../¢'~?~5 MOA No, Receipt No. Amount: $ Page 2 of 2 72-026 (11/84) ACHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ~ PRIVATE WATER SYSTEM Name Phone No. City State Zip Code Mo. Day Year SAMPLE TYPE: '~ Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose .) [] Treated Water ~ Untreated Water TO BE COMPLETED BY LABORATORY Date Received Time Received Analytical Method: Analysis shows this Water SAMPLE to be: '~ Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Membrane Filter * No. of colonies/100 mi. SAMPLE Time Collected L~ab Ref. No. NO. LOCATION Collected By , Result* Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter: Direct Count Verification: LTB __BGB Final Membrane Fil~r'~e~ults //~ Reported Sy ~~ ~'Date TNTC = Too Numberous To Count Coilform/100ml Coilform/100ml OB = Other Bacteria & GEOLOGICAL LABORATORIES OF ~ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE(907) 562-2343 FEDERAL TAX ID # 92-0040440 \~ ]:';,~$ ~0[,',!' .,fy/ .::;[piT.. ALASKA t UIRORm [1TAL CORTROL S -dlC S, IllC. JEAN HOHNSTEIN 2804 WEST NORTHERN LIGHTS ANCHORAGE ALASKA 99504 SELLER-KODELL PARKER 9/2/86 JEAN HOHNSTEIN 2804 WEST NORTHERN LIGHTS ANCHORAGE ALASKA 99504 60467 LEGAL:TALUS WEST #] SUBDIVISION BLOCK 6 LOT 7 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-08/28/86 THE TYPE OF ABsoRPTION SYSTEM IS A BED WITH AN AREA OF 1400 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 500 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 8 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 8 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 09/02/86 THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER SUPPLY OR WASTEWATER SYSTEM. FLOW TEST ON WELL WELL FLOW DATE-08/28/86 A FLOW TEST WAS PERFORMED ON THE WELL. PUMPED AT A RATE OF 7.05 GPM OVER A DURATION OF THE DRAWDOWN WAS 11.5 ' WITH A RECOVERY TIME OF AND THE STATIC WATER LEVEL WAS 21.4 FEET. THE WELL IS ADEQUATE FOR THIS $ BEDROOM HOME, 917 GALLONS OF WATER WAS 2.35 HOURS, 10 MINUTES JAN 2 6 1979 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW 4 (J I IVI MUNICIPALITY OF ANCHORAGE MUNICIPALITY O! Ai~CHOP, AGT: DEPARTMENT Of HEALTH & ENVIRONMENTAL PROTECTI_~[~ DEPT. OF hEALTH 825 L Street- Anchorage, Alaska 99501 ENVIRONMENTAL ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE Edward M./Vivian J. Brady 344-6748 MAILING ADDRESS Post Office Box 10-396 99502 PROPERTY RESIDENT (If different from above) PHONE 2, BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION Lot 7 Block 6 Talus West Subdivision STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One ~ Four ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY -[~ Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WE LL LOG. A well log is requ'ired for all wells drilled since June 1975. For wells drilled prior to that date, give well/3 depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM :~ INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date Ic~-~7. . If system is over two (2) years old an adequacy test is required [] PUBLIC UTI LITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS 'IME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS; NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE E~] PUB LIC UTILITY Connection Verified ~ [~Septic Tank or [] Holding Tank Size: J 0~ If Tank is homemade give dimensions: TYPE OF TANK [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SiX PERMITNUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING MANUFACTURER [] OTHER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESWELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS PPROVEDFOR .% .EDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE LEGAL DESCRIPTION BY (Title) 72-010 (Rev. 3/78) C ___[1~_ _le~. I_ 8~ QEOLOGIOAL LABORATORIE~ OF ALAa~ INC. 4649 BUSINESS PARK BLVD. P.O. 6OX 4-1276 ANCHORAGE, ALASKA 99509 Drinking Water Analysis Report for Total Coliform Bacteria TELEPHONE (907) 279-4014 TO BE COMPLETED BY WATER SUPPLIER PUBLIC WATER SYSTEM: Pubflc Water System Name Mslllng Address city I.D. NO. State Zip Code Mo. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. ) [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. 1 2 LOCATION I/, Time Collected Collected By I 06-1220 (b) Rev. 1978 TO BE COMPLETED BY LABORATORY LABORATORY: NAME CITY gate Received ~d7 ~-/r/~- Time Received /~ -~ -~ Analytical Method: [] Fermentation Tube ~/E~em brane Filter Lab Ref. No. Result* Analyst /~.~ I ~ BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Form No. 18-310 (3-78) MUNICIPAL1IY OF ANCH11 P DEPARTMENT OF HTELEPHONE IRON21NT:A-PROTECTION NOTICE OFVIOLATION 1790 Please take notice that the undersigned authorized representa- tive of jlh Dire for has reas� to beefeneahthe foto • O wbi is se rate violation of 4 of the Anchorage Code of Ordinan- such condition exists. ces each and ever day A COPY OFT: IS NOTICE HAS 6EEN SERVED UPON: A+ A, 1670 ° � •,�, - IN THE FOLLOWING MANNER: Y personal service y, by certified mailt the location described. 3. by posting this notice on oynbou not be found after diligent herein when such Pe effort to do SO. _ 19�eqal Proceed - If the violation or viol ions eferred to herein have not een Proceed - corrected by Z ded by law - 19 may be initiated P 19 Dated this 7eday of ME ITLE /J'//• 70.004 (Rev. 51781 �.