HomeMy WebLinkAboutTALUS WEST #1 BLK 3 LT 24Talus West #1 Block 3 Lot 24 #015-202-07 Ju! 16 2� 05:09P Anchc,),age VVe-11&Pun q.,, e; 90724307401 P.1 SerAc e. s e P.C, Sox 19665n. Uark 'Ancilo"age, AK 99507 M--.yor (9 '71 313-7: 04 Pump Installation Log Well Drilling Permit Number. S\lt'---- late of Issue: Parcel ldentificatioiiNtjnjk,i:r: 015-ZOZ-()' Legal De-scription Prgerxy Owner Nante & Address. 6tto L Z-'-1 Pump In5tallation Daft: Pump Intake Depth Below Top of Well Casing: 1:cv..t Pump TrtanufarturWn Name: Pump Nlodel: Pump Site h, Pitless Adaptor Bearish Depth-- I Z --feet Pitless Adapter NEanufscturer's Name: Pitless Adapter Installer: z Well Disinfected Upou Completion? [qATe, F] No rylethod of Disinfecdon; 0 comwents.- F 4 Pump bisialler Name: At'-ptition- The putyip installer shad provic!,- 3 pump instalk6cn ingto ti). DSD within days of pur--.p installation, Municipality of Anchorage Development Services Department sjpx 'jy' Building Safety Division On -Site Water and Wastewater Program, 4700 S. Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.cl.endrorage.ak.us (907) 343.7904 ONSITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW020438 PID Number. 01520207 Nemr Ralph & Tam! Ertz Wastewater System: ❑ New 0 Upgrade A...: 4520 Snowcup Circle, Anchorage 99516 ABSORPTION FIELD Parr: 345-0175 Nu.W of a �: k c3 ow Tw hEl sNMn T..h0a d 13m—w 000W. Sod Rehq: TOW Doglt ern rtel"•l pede: LEGAL DESCRIPTION 0.8 GPDrF1' 7.5 Fl. Sara Loc SuEde11M.r1: Talus, W Addn#1 owa pL:e ta".Om ern rtiyW pale: Gavel dwh eon.etn pipe: 4.0 3 24 2.45-3.46 Fl. Ft. TOwuNp: Range: sem FA .Mm eewe Odpw PFM: 0.63.1.47 Gn Lergla: 2 x 38 = 76 Ft, Ft, We ❑ New ❑ Upgrade Grn rain: 5.0 ra "t RM.: 2 DSIraa lWwrrMq: 10 . Ft, F. DIe.Na.1aO (IMve4. A ToW D.pw: Gr.o b: T" eft"m ere.: 760 P" M.uOY: ASTM D3034 Fl. Fl. Ft D~ D.. ed: static Watr LM bMMlter: A Plus Home Services Dep lt,ate d: 11/5/02 FL �"° Purosr.L a.npw Graad: TANK GPM Fl. SEPARATION DISTANCES E) Septic ❑Holding ❑S.T.E.P. ❑Other. To From Septic Tank Absorption Field Lot Station Holding Tank ublklPdvste sewerune P;Ued Jet Aeration ' 1250 G.L M.Irlel: NuniOor of Da,ermrann: WON 102 108 112 NA concrete 3 sudeceweMr None None None NA LIFT STATION Lr Ler 15 25 20 NA 500 Gal. Anchorage Tank 7,erp en'4•N et: 'Poop arc'ywl.l: Wpl. wlr ewm r. Fa Wletw 10 40 25 NA 46 ti. 42 In. 51 in. Pump M.W a Abdel El.epaal IrapeaaM prle� W. C~Dien I None None None NA Om P100511 Ed's Electric 11.18-02 RpnM : Concrete septic tank was exposed and Inspected. BENCH MARK It is in good condition, with no leaks. Due to site LOumn w Ds.uiplan: Top of Manhole on Lift Station b .Z restrictions, the trenches were shortened to 38 It 95.90 FL and the effective depth increased to 4 ft. E m1P 4.t»...!-t.:q J, Cindy W. Ellis, P.E. n 11/4/02 Inspections by: Y Dates: 1 :.--- performed 11/5/02 2nd Development Services Department Approval `:• Cin VV. F11is'� E • 1ou5T� Reviewed and approved by: Date: ( F CE -10571, ••• • C tBoc. IM) ' ;i;'* a Permit No. SW020438 Page 2 of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 24 BLOCK 3 TALUS WEST ADDN #3 PID No.: 01520207 ISry0 1 WC P V I / \ •\ \\ C / R C �\\ • \ / i� III I // \\ \I II 1 1 WELL \� /\ EXISTING ELECTRILINE \\ \ 3 BDRM HOUSE / EXISTING �SEATIC TANK i / S MANHOLE B i i � i � EXISTING WELL MT2 ���' 100' RADIUS — DCOI MT1 TYPICAL DCO2 / \ DV / ---- 0O2 IMT3 •TH 1 1 \� MT4 30' TEST HOLE ORIGINAL SEPTIC SYSTEM I � � _ � � RADIUS - TYP SUMP 10' UTILITY EASEMENT i SEPTIC SEPTIC �� _SEPTIC ASBUILT SCALE: 1"=50' r ' 491"- '* *. 7 4, CE•1os77 ssld�'� MARK A 8 L 24.6 58.4 25.1 58.3 25.7 58.0 28.5 55.3 46.946.8 74.446.6 58.063.3 81.2 61.4 Permit No. SW020438 Page 3 of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 24 BLOCK 3 TALUS WEST ADDN #3 PID No.: 01520207 DCO1_\ `DCOL rLS MANHOLE, 95.90' 89.49' SOUTH TRENCH N.T.S. 38.0, W. Ellis 1os:�� 500 GALLON 1.250 GALLON 8 77' LIFT STATION I I I SEPTIC TANK I I I I � I I I SEPTIC SECTION I I I N.T.S. J I MT1 MT2 I I FINAL GRADE 97.42' - 98.18' I I 1.25'0 PIPE NOTE: I I ORIGINAL GRADE = I FILTER FABRIC 94.24' 96.64' - 97.55' I � I L- 4 I SEwER�ROCK I vuq I 90.05' I NORTH TRENCH 4. 9' 90.0 I N.T.S. I 3W I r------------------------------ M I T3 MT4------J FINAL GRADE 97.41' - 97.91' 1.25'0 PIPE NOTE: I ORIGINAL GRADE _ I FILTER FABRIC 64• q 5 - 96.90' L - ` 49 _' 89.49' SOUTH TRENCH N.T.S. 38.0, W. Ellis 1os:�� L0. -.19-2n02 07:34A FPOI1:A+ HU•E: SM!ICES. III 907-EtA-6770 RigtitFAX 11/17/2002 3:27 PAOE 1/1 T0: 3J91`934 j- I �L Ttj5htFAX Inspection Report Municipality of Anchorage, Building Safety Dloolon 4700 South 18ra98vv ...mar-rrnw• vo1Gfi 34943300 INYVECTION: FAX (907)249-7777 INFO: 343-11211 Nama Addrwra Legal SUUdlvlslon Comments or Dlrectione Inspection EA's electric 4520 SNOWCAAJP C19L OK3LT24 TALUS WEST 01 Call to meet on site Permit 02-9492 Phone 272-4591 P:jf1 Inspectlon Date 11/18/2002 AM Fina! Electrical Ralnapectlon N NO NONCOMPLIANCE OBSERVED ❑ CORRECTIONS ESSENTIAL AS EXPLAINED BELOW WILL RE-EXAMINE AT NEXT ❑ 00 NOT CONCEAL UNTIL REINSPECTION 0 INSPECTION COMMENTS! (tor Inspector use only) GLI.•t.ril�c.L` /pn jfj�/L Imo I i1 �• I X D�t r rJ1 18-2002 1.01 0_':MF11 ID:A+ HOPE: SEP)ICE_S• IIIc. PR;E:1 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 //-S'._oy 3: s :oa /; oa ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Oct 28, 2002 Expiration Date: Oct 28, 2003 Permit Number: SW020438 Parcel ID: 015-202-07 Legal Description: TALUS WEST #1 BLK 3 LT 24 Design Engineer: 0844 Watkins Engineering, Inc Site Address: 004520 SNOWCUP CIR Owner Name: Ralph & Tami Ertz Lot Size: 18849 SO. FT. Owner Address: 4520 SNOWCUP CIRCLE Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99516 - 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. `5. The following special provisions.' AT THE TIME OF CONSTRUCTION THE ENGINEER SHALL HAVE THE OUTLET END OF SEPTIC TANK EXPOSED AND THE INTEGRITY OF THE SEPTIC TANK CHECKED FOR LEAKS. Received By: Issued By: Date: Date: A91.2 07102 MUMUPAUTY OF AHC HOIR000 1 , Development Services Department _ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-202-07-000 Legal description TALUS WEST#1 BLK 3 LT 24 Expiration Date: 12/21/2023 Site address 4520 SNOWCUP CIR Anchorage AK 99516 Current property owner(s) POWERS SAVANNAH &WOLFE BRANDON X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: a Original Certificate Date: 9/21/2023 is Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory x Tank Age Advisory X Arsenic Advisory Other COSA ApprovMjune 2022 f 1, _ v Development Services Department A^ _ Phone 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-202-07 Complete legal description TALUS WEST #1 BLOCK 3, LOT 24 Location (site address) 4520 Wilderness Circle *Anchorage Current property owner(s) Ian Combs 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 907-590-4326 3. TYPE OF WATER SUPPLY: ❑® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: RK Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 24 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed 0 Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 0 Waiver Fee $ Date of Payment 17�2?� Date of Payment COSA # 0 S C- 13 X13 Waiver # COSA Applicaton June 2022 COSA Checklist Legal Description: TALUS WEST #1 BLOCK 3, LOT 24 Parcel ID: 015-202-07 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA 01 Well log is filed with Onsite (or attached) Date drilled 8/26/76 Total depth 151 ft Cased to 150.6 ft 0 Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 6/30/23 Static water level at beginning of test 74.1 ft. Comments Well production at time of test 4.7+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ® Nc ❑■ Coliform bacteria is Negative Nitrate 6.52 mg/L n Nitrate less than MRL (ND) Arsenic ug/L 0 Arsenic less than MRL (ND) Collected by GEG, Ltd. Date 6/30/23 5'5 ejw a .f, C. B. TANK DATA���, , C. LIFT STATION Measured operating fluid level in septic tank 55" ❑ Required maintenance completed Date of pumping 7/25/22 Age of lift station 21 years ❑ Required maintenance completed, if AWWTS Lift station material STEEL Comments: '11" 11 CONCRETE TANK IN SEPT 2002 PER MOA RECORDS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 11/5/02 W ALL standpipes present per record drawing Total measured depth from grade 8.08 ft (max) Measured depth to pipe invert from grade ft (min) n N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑■ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not us r more than 30 days prior to date of test Gallons introduced gallons date Any rejuvena ' reatment (past 12 months) enter date Adequacy test date 0/3u/c3 Results M Pass Fluid depth prior to test 17 in Water added 646 gal New fluid depth J1 in Elapsed time 140 min Final fluid depth 26 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 48 in Effective depth used 26 in Effective depth remaining 22 in Comments/Deficiencies: TESTED 2002 NORTH TRENCH ONLY. 1976 RESERVE TRENCH SUMP APPEARED TO BE DRY. THE 1976 TRENCH WAS NOT EVALUATED. 32" OF LIQUID IN SOUTH 2002 TRENCH AT THE BEGINNING AND END OF TESTING. COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ❑i Yes if No ft FNFI Yes if No ft Neighboring Tank > 100' n Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' E] Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft R Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑o Yes if No ft ❑■ Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5'+ ft Surface Water > 100' ❑E Yes if No ft Tank to Property Line > 5' ❑■ Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' [E Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10' ❑■ Yes if No ft Community Wells > 200' M Yes if No ft Water Service Line > 10' n Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS SEPTIC PIPE LABELED MT4 WAS NOT LOCATED DURING INSPECTION *MET CODE AT TIME OF INSTALL. L, IS z -t \1 J c>''emi, �a t., , m a u L L)PE. G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Gayness Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Gayness Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not 3uarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022 9*�p0 T ..... ... . . ........ ......D Qef Go nes 13 —79 J 0 LICENSE4�QaPr sslon o 31AECC884 ��OODOd� Sonja Blewett From: ARM Septic Services, LLC <armservicesak@outlook.com> Sent: Thursday, September 21, 2023 9:14 AM To: Vanessa Sayer Cc: Ian Combs; Sonja Blewett; Nicole Lee; jill; Erik Widger; Jeff Garness Subject: Re: 4520 snowcup circle Hello, The Foundation clean out has been properly repaired and sleeved with plastic to prevent future frost -jacking. Any debris in the cleanout was vacuumed out to prevent issues from rocks/soil causing blockages, etc. Let me know if you have any questions. Thanks! Nathaniel Swanberg Septic Technician ARM Septic Services, LLC Ph: (907) 688-9433 Cell: (907) 854-1684 Email: ARMServicesAK@outlook.com Pers: swanberg.n_armservices@outlook.com Website: www.ARMServicesAK.com Facebook: www.facebook.com/ARMServicesAK/ On Sep 20, 2023, at 11:12 AM, ARM Septic Services, LLC <armservicesak@outlook.com> wrote: Good Morning, I just wanted to pass along my field technician wanted me to pass along he is running a little bit behind and he won't be at the job until this afternoon. Just wanted to keep you all in the loop. Thanks, Mariah On Sep 19, 2023, at 10:15 AM, Vanessa Sayer <vanessa@unityhomegroup.com> wrote: Thank you for the update, I have let the buyer's licensee know to pass along to owners. Thanks! E transaction c.oU dir,2tC.0 1 BILL TO Ian Combs 4520 Snowcup cr Anchorage, AK 99516 ARM Septic Services, LLC Invoice 17933 Old Glenn Highway Chugiak, AK 99567 (907) 688-9433 ARMServicesAK@outlook.com www.ARMServicesAK.com INVOICE # DATE TOTAL DUE DUE DATE TERMS ENCLOSED 3535 08/07/2023 $825.00 08/07/2023 Due on receipt ACTIVITY 4TY' RATE AMOUNT Lift Station Service:Lift Station Service 1 500.00 500.00 liftstation maintenance Camera/Locate:Camera Services 1 325.00 325.00 camera to inspect concrete tank. liftstation looked good overall. could not observe tank with camera. middle baffle looked good. no baffles observed in tank. liquid level appeared normal. (operating at outlet pipe invert.) A 3.75% interest charge will apply to all invoice over 30 days late. BALANCE DUE ARM Septic Services, LLC Sonja Blewett From: ARM Septic Services, LLC <armservicesak@outlook.com> Sent:. Wednesday, August 16, 2023 8:44 AM To: Sonja Blewett Subject: Re: 4520 snowcup circle You can get a snake or camera down it, however I observed some sand sitting in the bottom of the FCO when I arrived onsite. Let me know if you have any questions. Thanks! Nathaniel Swanberg Septic Technician ARM Septic Services, LLC Ph: (907) 688-9433 Cell: (907) 854-1684 Email: ARMServicesAK@outlook.com Pers: swanberg.n_armservices@outlook.com Website: www.ARMServicesAK.com Facebook: www.facebook.com/ARMServicesAK/ On Aug 15, 2023, at 1:43 PM, Sonja Blewett <Sonja@garnessengineering.com> wrote: Is the FCO functional? Sonja From: ARM Septic Services LLC <armservicesak@outlook.com> Sent: Monday, August 14, 2023 11:09 AM To: Sonja Blewett <Sonja@garnessengineering.com> Subject: Re: 4520 snowcup circle Here's the updated checklist. Mariah will be in touch with the camera invoice. Let me know if you have any questions. Thanks! Nathaniel Swanberg Septic Technician ARM Septic Services, LLC Ph: (907) 688-9433 Cell: (907) 854-1684 Email: ARMServicesAK@outlook.com i | MUNICIPALITY OF ANCHORAGE | ~-- � | Development Services Department Phone907-343-/904 ! Oil -Site Water & Wastewater Section Fax 907-343-7997 Lift Station/Pump Vault Maintenance Log | / | OwreStreet Address i *Sludge level /nohao -Pumping: required -Pumping completed Lift station: i ,Punnpbonketcleaned -Effluent filterd es no ' ~-� / ,Control floats c}eaned^Pnoperfloat settings confirmed/ ! -Operation satisfactory rnoo Alarm System: and visual g`ex -Dedicated electrical | i ^ | -4|ann system operation not satisfacto-N Manhole Riser i ^Gnoundwaterintnusionatrimertobankonnnedinn ----=-- / -Ground water intrusion around pipe penetradona ^/Vaepho|efuncti �1., ! ^KAonho|eUd� Functional Insulated Properly Secured | Other no All manufacturer required inspections and maintenance completecJ62 / / Technician R=50.00 L=36.13 clv-.------- 1 112 Stmy Fram,r a`aHouse c„ rte' a<` 46.0 co dock 0 LOT 24 Tank4 o s { be vent ftyp) Chain Unk fence ,%N iAW AW � t �,..., ,w , s' 49th �• r or p ep �AW I a U.G. Power & Tale. Easement EASEMENTS ,F RD OTHER THAN THOSE .., RECORDED SHOWNPLAT ARE NOT M UHMPA UTY O HOHOO RAGE DEVELOPMENT SERVICES DEPARTMENT 0/1 On -Site Water and Wastewater Section www.muni.org/onsite Holding Tank Advisory Certificate of On -Site Systems Approval # OSC231303 Subdivision: Talus West #1 Block:3, Lot: 24 907-343-7904 Fax: 343-7997 The holding tank for this property is 24 years old. The average life for a steel tank is 20 years. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. N UMMPAUTY O ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC231303 Subdivision: Talus West #1, Block: 3, Lot: 24 907-343-7904 Fax: 343-7997 A water sample revealed a nitrate concentration of 6.52 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical' methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. \ Municipality of Anchorage -. Development Services Department Building Safety Division • a ^ ' On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-202-07 Permit Number SWO20419 Property owner(s) Ralph & Tami Ertz Day phone 345-0175 Mailing address (1) 4520 Snowcup Circle Mailing address (2) Anchorage, AK Zip Code 99516 Legal description (Lot, Block & Sub'd.) Talus West Addition #1, Lot 24, Block 3 Legal description (Section, Township & Range) Lot Size aPpx-4q79o9 Acres F . Number of Bedrooms 4 / g'Q'2 l THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade 0 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. aee (Signature of proerty owner or authorized agent) Permit Fees: 4" � Waiver Fees: Date of Payment: /0 — X3102 Date of Payment: Receipt Number. D oZ7,P-L-5 —7T Receipt Number: (Rev. 12100) Watkins Engineering, Inc. P.O Box 110443, Anchorage, AK 99511 (907)349-1851 cwellis@gci.net October 22, 2002 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 RE: Talus W#11, Lot 24, Block 3 Subsurface Disposal Field Upgrade To Whom It May Concern: Attached please find the application and supporting documentation for upgrading the subsurface disposal field for the referenced 4 bedroom house. The original drainfield, a deep trench with 12 ft of rock and 42 ft long, was installed in 1976 and is currently surcharged. The existing 1250 gallon Jet Aeration concrete septic tank was installed in 1976, but it is currently operating as a standard tank — with no aeration. The tank was holding 65 inches of fluid at the time of inspection, indicating that it is not leaking. We propose to utilize the old tank and to keep the existing leach field as a reserve system. The proposed design of the upgraded system is based upon a test hole dug on September 30, 2002. The TH was dug to a total depth of 17 ft, encountering one foot of fill, organics, silt, and sand. No water was encountered in the test hole or the ground water monitoring tube after one week. A percolation test was run on a silty sand layer at 6.5 ft, with a result of 7 minutes per inch. Based upon this rate, an application rate of 0.8 gpd/ft2 is used in the design. Proposed Soil Absorption System: 4 Bedrooms x 150 GPD/BR = 600 GPD 600 GPD / 0.8 GPD/ square ft = 750 sq. ft required System Type: Shallow trench (5 -wide) Maximum Depth: 7.5 ft Effective Depth: 3.0 ft Reduction Factor: 0.58 Length Required: 750 sq. ft / 5 ft x 0.58 = 87 ft Proposed Length: 90 ft (2 x 45 ft) Sewer Upgrade Permit Application for Talus W. #1, Lot 24, Blk 3 Watkins Engineering, Inc.; October 2Z 2002; page 2 am not aware of any adverse effect that this upgrade would have on any adjacent properties' water and wastewater treatment needs. Thank you for consideration of this permit application. If you have any questions or need further information, please call me at 349-1851 or 360-3389 (cell). Yours truly, l2kz' o&� Cindy Ellis, P.E. Attachments: Permit Application & Fee Site Plan, 100 scale Proposed Upgrade Plan, 30 -scale Soils Log and Perc Test for one Test hole MOUND OVER DESIGN CRITERIA: (TH) o GRADE 4 BDRM X 150 = 600 GPD HLL APPLICATION RATE: 0.8 GPD/SQ. FT. -2.5 pM N FILTER FABRIC 5.0 WIDE TRENCH SS 600/0.8 = 750 SO. FT. REQURIED SM 750/5 X 0.58 = 87' REQUIRED ML —9.5 5.0' DRAIN ROCK TRENCH: ML 7.5' DEEP 3.0' EFFECTIVE 5.0' WIDE -17.0 (2) X 45' LONG = 90' rEXISTING ADJACE WELL 100RADIUS — PICAL PI \) 1 \ 1 I I i \ V / EXISTING WELL 100' RADIUS EXISTING HOUSE 1 I I EXISTING SEPTIC PROPOSED SEPTIC i _ — — — O EXISTING ADJACENT oP SEPTIC — TYPICAL 2 5 lkl 5 q-a O Septic Design Prepared For RALPH AND TAMI ERTZ LOT 24, BLOCK 3 TALUS WEST, ADDITION NO. 1 Prepared By: Watkins Engineering, Inc. DATE: Cindy W. Ellis, P.E. SCALE: P.O. BOX 110443 DRAWN: ANCHORAGE, ALASKA 99511-0443 CHECKED: PHONE: (907) 349-1851; FAX: (907) 349-1934 10/21/02 1 "=100' DJR CWE 49TH* W. Ellis 10577 i Ar I 1— S N 0 W C U P it II � 1 I I I 1 1 I I 1 1 1 I 1 1 I 1 1 1 I 1 I 1 i 11 1 1 rl 1 1 , 1 r r I -'T---r-- � - r 1 / / EXISTING 1,250 GALLON DIET AERATION CONCRETE TANK TO BE RETAINED CIRCLE— EXISTING 4 BEDRM HOUSE WELL WELL FCO `�` PROPOSED 500 GALLON LIFT STATION STI1 PROPOSED DOUBLE CO __—___�` ' 1 — C PROPOSED DNERTER 1 MT Mt: r \ 1 Ir --------------' 1 CO 1 I `--- 1 1 MT TH81• MT j IL 24.0' i ----- —------- i / PROPOSED 1.25' FVC �.` W/ 0.25.0 HOLES AT 24' O.C. EXISTING TRENCH W/r24 12' EFFECTNE, 42' LONGw 30' TEST HOLE TO BE RETAINED RADIUS - TYP --------------------- LOT 25 10' UTILITY EASEMENT LOT 23 -------------- ADJACENT SEPTIC ------ ` Septic Design Prepared For RALPH AND TAMI ERTZ LOT 24, BLOCK 3 TALUS WEST, ADDITION NO. 1 ,� 4J9_LH 9 Prepared By: Watkins Engineering, Inc. DATE: 10/21/02 A'• W. Ellis SCALE: 1"=30 �`: Cin Cindy W. Ellis, P.E. DRAWN: DJR E.1om P.O. BOX 110443 ANCHORAGE, ALASKA 99511-0443 CHECKED: CWE�ay G PHONE: (907) 349-1851: FAX: (907) 349-1934 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 995196650 www.muni.org/onsite (907)343.7904 Soils Log - Percolation Test Performed For. Ralph & Tami Ertz Date Legal Description: Talus W. Addn 1t1. Lot 24, Blk 3 Township, Range, Section: 12 - 1 1 ML. F WAS GROUND WATER ENCOUNTERED? NO IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? None Date: 10/7/02 a L O P E AMU Reading Depth Gross Time Net Time (Feet) FILL 1 10/2 2:00 2- 6 5 M 2 3 5m/ 4- 1.75 M L 5- 102 2:30 6- 6 — 7_ 102 Wzy- 12 - 1 1 ML. F WAS GROUND WATER ENCOUNTERED? NO IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? None Date: 10/7/02 a L O P E AMU Reading Date Gross Time Net Time Depth to Water Net Drop 1 10/2 2:00 0 6 2 10/2 2:30 30 1.75 4.25 3 102 2:30 0 6 — 4 102 3:00 30 1.75 4.25 5 10/2 3:00 0 j 6 — 6 10/2 3:30 30 1.75 4.25 PERCOLATION RATE 7 (.kww k) PERC HULL UI MLI LK e TESTRUNBETWEEN a.s FT AND 7.0 FT COMMENTS Poe, hole was pre -waked PERFORMED BY: Cindy W. Ellis. P.E. I Cindy W. Ellis CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 10/7102 Irl . GREA ER r ANCHORAGE AREA BORA. JGH CII�Y/ Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME •"-+ 0^�f MAILING ADDRESS , -6 6� 1`r S ,/ 67 PHONE L -' i nrATInN ��� 2- • LEGAL DESCRIPTIONy �7 .3 -72,,_,� SEPTIC TANK: DISTANCE r FROM WELL 7 MANUFACTURER MATER IAL NUMBER OF COMPARTMENTS INSIDE LENGTH /o INS: WIDTH LIQUID DEPTH I IQUID CAPACITY_/ � GALLONS. SEEPAGE P�T:�_r p lv 3 I Z/ Z / NUMBER OF PITS DIAMETER OR WIDTH_. LENGTH_, DEPjH 7 LINING MATERIAL CRIB SIZE: DIAMETER —DEPTH _LL DISTANCE FROM: WELL 3/ TOTAL EFFECTIVE BUILDING FOUNDATION_, NEAREST LOT LINE. ABSORPTION AREA (WALL AREA)zL'h�. ADDITIONAL ABSORPTION WELL: 1 '4r��7dnJ / !) TYPE II�•^-`� C� CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL , OTHERSOURCES APPROVED DISAPPROVED DISTANCES: INSTALLED BY �) % PIPE MATERIAL: LOT SLOPE: REMARKS: Form No.EQ-0]1 a G•6 O DEPTH NEAREST SEPTIC , �7 SEWER LINE , TANKL.L_, RE DIAGRAM OF SYSTEM DISTANCE FROM: SEEPAGE SYSTEM Iv K 4-.p . DATE APPROVED G.A.A.B. ''�p 7S 1 -)M -W DRILLING, INC. 7D DRILLING LOG o Well Owner f 'cndcrgra.s Cort.', traction Use of Well Doig Location (address of: Township, Range, Section, if known; or distance main roar] 1-24, Blk 3, Talus Vest Size of casing Depth of Hole 151 feet Cased to 1 Sn • r' feet Static water level 20 ft. (above) (below) land surface. Finish of well (check one) open end ( N ); Screen ( ); Perforated ( ). Describe screen or perforation Pone Well pumping test at m gallons per (hour) (minute) for -'-t hours with In" ft. of drawdown from static level. . Date of completion �)(' """ 76 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness TO Cnsinc 5tickun TO 4 Fill. TO e' nrc,ar ler e, TO 10 -r. -.,.r., .-i t t�•�...,�,2.... 125 TO—L" TO do c,i 1 t'V CPi �1 ] C:r n,rot .rpt rl.O qci 4— TO -TO }'�t9'1 f%..•;rrd ('„ntrnctor cclt4jcatc No's. 814 & X3 2 —STATE rtn TO t •,c, c...�l t -r. -.,.r., .-i t t�•�...,�,2.... 125 TO—L" —2 Silty Sand 1., To 1F0 Water Gravel: andv TO TO -TO }'�t9'1 f%..•;rrd ('„ntrnctor cclt4jcatc No's. 814 & X3 2 —STATE t ilJtJ I G I F=' L I TY OF 1=�tJr`H�RFGE DEPARTMENT C HEALTH AND ENVIRONMENTAL Y�?TECTION �_� )10 2516 E. ' l ODOR RD., ANCHORAGE, AK. 95,07 d / ' 276-2221 t`JEL-L Or-J—S ITE E.EWEF4 PERM I T PERMIT NO. C 76469 ) 1el oK yQv HPPLICHNT HOSE PENDERGRASS /I�LQ.JCy" SRA BOX 1585A 349-4207 LOCATION SFJOWCUP CIRCLE LEGAL L24 B3 TALUS WEST LOT SIZE 18849 SQUARE "FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH' MAXIMUM NUMBER OF BEDROOMS = 4• SOIL RATING CSO FT/SP)= 275 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C•EF' 1'H= 1 r LEtJGTH= 4� iGRF N EL E>EPTH= IL2� THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DP.AINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN 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 CIN FEET). F't fCF�HGEPLF1tJT REG!lJ I REG• ; EITHER, A CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED. ; A CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF A'MAINTENANCE AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL ABSORPTION SYSTEM AND/OR YOU MAY BE SUBJECT TO PROSECUTION. IF A CLASS I SYSTEM IS USED THE LENGTH IS 33.0 FEET. IF A CLASS II SYSTEM IS USED THE LENGTH IS 42.0 FEET. E:ACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT -TO PROSECUTION. - MINIMUM DISTANCE BETWEEN A 6JELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. .SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER, INSTALLATION. - PEft:M I T 'IFIL I G FOR Ce"E YEf=lR FROty I _n3 LJE I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. I WILL INSTALL THE SYSTEM IW ACCORDANCE WITH THE CODES. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE I5 REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED I5SUEC 1 __ IY._i .�J,,,�: _. _li'1 )=": =!r,_ .. i .i_ -. ii-.`:: _ 1 ..!. 1'-'1 )t•1 QS Sow. A off 1 ITN 1 ✓ In ✓�.��lv-U!//.i..iE- S•S �/L ]1�•i. 1' ( 'IIJ[ t•� • : .:� , / � .�I. .� ._• t.lr IIID ,1 •..i 1 1 _ 1 c1a�u Iso 64. Go / bL &4 .2/la,1l 1� tIII 1: Iu J Ise %l�iC�h,l' -LJbct9L'Dllp/ �/rr� :_rr :, i l0 111 i ::i r•1?I.:. _, LI'.lijPAQ''aq JICc. _I•,I - � '_ J:...,,. :,,; *it__S eh�wl -!1 i_4.7-_! .-.hl•1 J_::•.�. _ 1 jjr lr r. 1f :i 1ZiaT _a ?r1 (Td -1=T ItII a:lr of "ni m .I'iia H' n4 t 3•il "434 �& TALI Tc IG'119 510 J!:1!__)' )i "it' H q,j -11 Co El Ill, I , �.J'1'If _ �'.1 t15�'•Ilcl� _ �^ iG r!I 1-.�J Pl.ni [.Itp. -il !T e1 i� 1_i ,l 1_. �'J ...!i CT:i'3=i I1f'i 4i Iifi'•:rl i".: :.+T iJ wrins !iv: -.J lly,4'i1 J!J `' Il•I;IJi C? n`1bOn Y TIATH I 1J _ owl1'""205 O 1 r J 1, �.: ; 1 •!'�•-1•-,� t R'i� ri if 4 '.Y 1 I) •r S "IiTUJ._-"lii'.i Ili 'f A.vq 1151 ONE E 21 HTAMTJ .y r U=!,A c i P!'?Ti'Y ' 1 :;:_:ft.1 J H I T'? ?-t h .SJ• I H W YA-1 3HT • "Eu 21 H.1" ii.'.':: o 'Lill' Y:' _!lt'd0A fi 1 U -IR b1JI r! J'G'NI 1=.t: , 11 ",117 i 1 '.'G '',,, , i•.li, i r .j, l.. 1 �^/ l 1ll'! .r1 .IUA 1 1. I ... r" i .d'J- 19 J ! :a is -1 13f•`'' ZF'i 1 SPOW1 JT 1201,) ri' 1 4in J 1 .! 'F�,'11 r.i'. ilr.l,;, t 1..1=1 Tei V., E,. IIIH11' rl,_ 111 •iri i:'! _1•il .I` i,',� 1ri _f .',i�,t !i� . T._ _ ,1 1- 1 J I 1 Ani _N 3.l_rlJ I rr:'F ti a-,I:I I q 11011 aUh [ N , w;. 11rr_ Jri i In _11 C1 "i �._1 .S 1' 1'•.- i ;.•1 -i -• i}.i=• ;il ._'.J.1-1!1 :..•!_-I'I in }1i I='-kiU NO i FOAM TIJ70q ?,I"i Hlili Wh" WON -!il l i l!n t:::JTl ll''1 _i•. i "•' . 1•:•:! 141 HTIN H3l'1 Lt:1.�jFj iii -:I "Ion' n' J.lrf.'l l'r 34 I_: JI r. 1!'I PI3 r.%'i= �i-1w i! � ? r 1: •''l l:_, _,r! i 1 rii-11 M')'I •. 1 7 HoYtl'ii. i 3• Wall BAON BUUJJ'I[ \ _�___..________�_il.-_,.'J ria• __-?.�-,3`ti. � \'}y1��\\�' = ri - • • - 89GE eo Municipality of Anchorage Q°,, °z • On-Site Water and Wastewater Program !:i ` (907) 343-7904 a . Certificate of On-Site Systems Approva /10 ti Parcel I.D. 015-202-07 Expiration Date: • '"'gam - 1. GENERAL INFORMATION: Complete legal description TALUS WEST#1; BLOCK 3, LOT 24 Location (site address) 4520 Snowcup Circle "Anchorage,AK 99516 Current Property owner(s) Marion Gramith Day phone 440-0259 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: 9 (0 D COSA to be released to the e • eer, un ess otherwise requested by the engineer. COSA Fee $ 5 21, Waiver Fee $ Date of Payment .21241 Date of Payment Receipt Number G tvW3L04 Receipt Number COSA# c i2-t 1385 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. • Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: 7/3 I IP? �00000pp. In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system OF 'l'4. ' "%' in accordance with the guidelines and regulations established by the Municipality of Anchorage and o .....i . -' 11 industry practices. The reported results describe the condition of the system/s on the date/s of the QDO P.•' T ""A"'" /A . A evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells /( ..._. * : 14 P .�*v and septic systems depend upon a variety of variables, including but not limited to, soil conditions, Qgroundwater levels (that may fluctuate during the year), quality of construction (materials and //V/ +I 0 workmanship), and the water usage of the family utilizing the system/s. These conditions can vary,and O.... V are outside the control of GEG. Satisfactory test results do not guarantee future performance of the Q of r y A.irness• system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of DO o /.. CE 7953 OO the well or septic system. GEG makes no representation whether an alternative well or septic system 0' i31 1 Q.•• •.cam can be installed on the property in the event either of the current systems fail to perform adequately in 0(1 ere •: cc,.,:=7 the future. The content of this report is for the sole benefit of the person/party that retained GEG to %44dpr�resslo'o.' perform the evaluation. Reliance upon the information provided in this report by any other person or �O0000�� party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for 3 bedrooms C �\`Y 01=,��VC System #2 Approved for bedrooms :J� �4 :, ON-SITE Disapproved WATER AND -o Conditional approval for bedrooms, with the fdt ow WWW�t�E. MEN:,-,rr, •:PROGRAM 0 A'' Q \I'('. -------- ----__4044) By: A t,,,_ (--- Original Certificate Date: F- (9 -i- The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: }� COSA Checklist / Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: TALUS WEST#1; BLOCK 3, LOT 24 Parcel ID: 015-202-07 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 8/26/76 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 151 ft. Cased to 150.6 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 8/26/76 7/10/18 Static water level 90 ft. 77 ft. Well production 9(7) g.p.m. 4.4+ g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 ml. Nitrate ND mg./L. Collected by: GEG, Ltd. Arsenic: <5.0 ug./L. Date of sample: 7/10/18 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/CONCRETE Date installed 8/15/76 Tank size 1250 gal. Number of Compartments 3 Cleanouts (Y/N) YES Foundation cleanout(Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES Date of pumping 7/6/18 Pumper ISSAC'S PUMPING SERVICE C. ABSORPTION FIELD DATA 'BELOW EXISTING GRADE AT MONITORING TUBE NORTH/SOUTH Date installed 11/5/02 Soil rating 0.p.d. 2or ftZ/bdrm) 0.8 System type DUAL TRENCH Length 2 X 38=76 ft. Width 5/5 ft. Gravel below pipe 4.0/4.0 ft. Total depth *7.9+ ft. Eff. absorption area 760 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 7/10/18 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 8 in. Water added 918 gal. New depth 30 in. Elapsed Time: 120 min. Final fluid depth 18 in. Absorption rate >= 45o+ g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) NO If yes, give date - TESTED SOUTH TRENCH ONLY • NORTH TRENCH HAD 8 INCHES OF LIQUID IN THE EAST MONITORING TUBE THAT EXTENDS APPROXIMATELY 44 INCHES INTO THE DRAINROCK 1976 TRENCH WAS NOT EVALUATED DIVERTER VALVE LOCATED BUT VIABILITY IS UNKNOWN *SEE MAINTENANCE LOG BY ARM SERVICES COMPLETED ON 7/23/18 **YES-PER 2002 MOA ELECTRICAL REPORT D. LIFT STATION VIABILITY OF WEEP HOLE UNABLE TO COMFIRM DUE TO PUMPING BEING DONE PREVIOUSLY Date installed 11/05/02 Size in gallons 500 Manhole/Access (Y/N) YES "Pump on" level at * in. "Pump off' level at * in. High water alarm level at * in. Datum * Cycles tested Meets alarm & circuit requirements? ** E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation `5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *MET CODE AT TIME OF INSTALLATION 4 OF / �• 4 G. ENGINEER'S CERTIFICATION =:�P•�•••" • ••••�..%. .•♦ I certify that 1 have determined through field inspections and : \RG\E 8475Z Ci \C -Ge: SNOB 1•) R=50.00cr / L=36.13 / Lo N X125.00 x=55•p0 — — / FZ o Well ;µ.ii:. ..`i _sly.: w`i-,ria :_y:.=' tAsphalt •-K= - ^:.-, 't4 ,�111111 ter_.t,�.. `�` i : Wood fen - r'`.4= ,,; y;� .— —: � 33 • .'••• ,;` 46.0 • ."1;s � . : 2.0 O -•�1` -` 4 1 112 Story Frame 4 o -a,z^2 -' House N Shed (C:, c0 ',.•.. hy a` ' °=^ci) .ir 46.0 `` co. — S LOT 23 deck E. = SCALE: 1"= 30' ° LOT 25 N co LOT 24 4 N 0 °° ° eptic Tank \ .u2. N 0 „,-Septic vent(typ) 1 �NN\A\ ° 1 �� O •F • •A4. 11 ° ,`P.• .•-- °). 49th �� ' -i ° i � • i� ••. •. • .• • /•c lizobeth L. Walatko..g so a Chain link fence(typ Ii s,�• •8036 - LS .•4" h I� ssiow,�•-'�� 10' U.G. Power&Tele. Easement Nvo - - x xX Y u.. x x x x — — i ^ -t6 1 S89°57'45"E 125.65 Revised 7-31-18,Corrected welt location AS-BUILT NO CORNERS SET THIS DATE LOT 4 I I hereby certify that I have performed a Mortgagee's inspection LOT 5 of the following described property: LOT 24, BLOCK 3, TALUS WEST SUBDIVISION ADDITION No. 1 Anchorage Recording Precinct,Alaska,and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto,that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways,transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage,Alaska EASEMENTS OF RECORD,OTHER THAN this 26th day of JULY 2018. THOSE SHOWN ON THE RECORDED FRED WALATKA&ASSOCIATES,L.L.C. PLAT ARE NOT SHOWN HEREON 18-7, pg 11 BE 907-248-1666 Engineers and Surveyors UNLESS OTHERWISE NOTED. E MUNICIPALITY OF ANCHORAGE • Phone. 907-343-7904 Development€ Services Department Fax 907 343-7997 On-Site Water 8, Wastewater Section Lift Station/Pump Vau!'. Maintenance Log C)wncrY,,t�lLt.�_t.�9'�:.a�it.�t4.+.i.��^---_—._.. Street Address 25 � f' Septic Tank: Y -Pumping completed rllS�es no -Sludge level /R.....lnches -Pumping required es n , Lift station: 'Pump basket cleaned :�j e n�� -Effluent filter cleaned yds _no •Control floats cleaned €y e_s _no •Proper float settings con.ktmed '`-y--, no -Operation satisfactory OM no T e Alarm System: —' -Dedicated electrical alarm circuit; no -Audible and visual alarm inside dwelling 'ye _.._tto •Alarm system operation/.4_63_ aryytot satisfactory Manhole Riser �-- "----- -Ground water intrusion at riser to tank connection yes f•//i4 -Ground water intrusion around pipe penetrations yes a Oc-Weep hole functional yg _ S. •Manhole lid Functional s, no Insulated no Properly Secured (y_e .09 Other -All manufacturer required inspections and maintenance completed yes no Comments: Qualified Maintenance Provider: ' U fl ! t , Date of maintenance, Technician _�-At..�, ,_ _ ,_.._..____ _, Company _AiSi .._.__._._.-_..,....�. Signature '?:r..,ak _...__.___.—.._.—_.v Datt_1jA?,/18 Mailing Address: P.0.Box 196650"Anchorage,Alaska 99519-6650*www•muni.ory 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.muni.org/onsite (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 015-202-07 1. GENERAL INFORMATION HAA 0- 030 Z k7— Expiration Date: / " / !j— 0 3 Complete legal description Talus West, Addn #1, Bik 3, Lot 24 Location (site address or directions) 4520 Snowcup circle, Anchorage. AK 99516 Current Property owners) Ralph & Tami Ertz Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 4520 Snowcup Cir., Anchorage, AK 99516 Day phone 345-0175 Vista Mortgage f David White Day phone 273-7326 4241 B Street, Anchorage, AK 99503 LaVonne Ertz Day phone 562-6464 Prudential Vista Real Estate 14241 B St., Anchorage, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site El 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 4 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-slte wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority App roval 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. (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, 1 verify that my Investigation, based on procedures outlined In the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. 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 Watkins Engineering, Inc. Phone 349-1851 Address P.O. Box 110443, Anchorage, AK 99511 Engineer's Printed Name Cindy W. Ellis Date b-11-03 5. DSD SIGNATURE Approved for L4• bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following WA I tK AN U -� • 00n/10ALI Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By 144 Original Certificate Date: co (RN. 01M) Municipality of Anchorage y • Development Services Department , Building Safety Division OnSlte Water 6 Wastewater Program • • ^ 4700 South Bregaw St. P.O. Box 196650 Anchorage, AK 995196650 www.muni.org/onstte (907) 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Talus W. Addn Al Bek 3. Lot 24 Parcel ID: 015-202-07 A. WELL DATA wen typePl+ Date completed 1978 Total depth 151 fL Date of test Static water level Wen production it A. B. or C provide PWSID # NA Wen Log (YIN) Y Sanitary seal (YIN) YL - Cased to 160.8 It. FROM WELL LOG 19713 go R. Unreadable g.p.m. WATER SAMPLE RESULTS: Wires property protected (YIN) Y Casing height (above ground) 28 in. AT INSPECTION 515-03 117 R. 4 2 g.p.m. Conform o colon1esI100 ml. Nitrate 0.1 U mgA. DOW bacteria 0 colonies/100 mi. Arserdc: NA mgJl. Data of sample: 5-25 —C 3 B. SEPTICIHOLDINO TANK DATA Tank TypeNaterlal concrete - verined 1115/02 Tank size- 150 gal. Number of Compartments 3 Fouralatkm de WUt (YAd)'��1 Depression over tank (YIN) N Datilof pumping 11/4/02_ pumper A+ Home Services C. ABSORPTION FIELD DATA Collected by: Cindy EMS Date installed 1978 Cleanouts (YIN) High water alarm (YIN) NA Date installed 11/5/02 Salt rating (g.p.d.Al9 or R'UM)0_8 System type shallow trench Length 7R, Width 5.0 R. Gravel below pipe 4.0 R. Total depth 7.5 1t. Eft. absorption area 760 ttr Monitoring tube Y Depression over Reld N Date of adequacy test NA - NEW Results (PasslFail) NEW For 4 bedrooms Fluid depth in absorption Reld before test NA in. Water added NA gal. New depth Nn in. Elapsed Time: WA min. Final fluid depth NA in. Absorption rate x NA g.p.d. _ Any rejuvenation treatment (past 12 mo.) (YIN 3 type) No If yes, give date D. LIFT STATION Date installed 11== Size in gallons 500 Manhole/Access (Y/N) Y 'Pump on' level at 45 in. 'Pump off' level at 42 in. High water alarm level at S1 M. Datum Bottom of tank Cycles tested NA - NEW Meeh alarm & dreu% requiremems9 YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank4lft station on lot 102 It On adjacent tots 100+ Absorption field on lot 108 ft On adjacent lots 10D + Public sewer main 100+ PubUc sewer manhole/cleanout 100+ Sewer /septic service One 50+ Holding tank NA SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 70 Property One 15 Absorption field 15 Water main 100* Water service One 50+ Surface water 100+ Wells on adjacent kits 10D+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 2D+ Building foundation 35 Water main 10D+ Water Service line 00« Surface water 10D+ 00mmay. mrWovemkie 6WnW 40+ Curtain drain None known Wells on adjacent lots 100+ F. COMMENTS Previous HAA was for 3 SR, but both old & new drainflelds are sufficient for 4 SR. -Permitted for 4 BR. 0. ENGINEER'S CERTIFICATION(�a•• ••t� 1 certify that I have determined through held Inspections and(L.". 9TH review of Municipal records that the above systems are in J conformance wlfh MOA HAA guidelines M effect on this date. Engineer's Printed Name Cindy W. Ellis I dy W EIIjE Date 11-03 CE.10sn HAA Fee E �� 2 Waiver Fee $ _ Date of Payment �� I i!D I�y� / ? Date of Payment Receipt Number '3 C?�S lD S Receipt Number, (Rev. 19/01) 06/04/03 RED 14:06 FAX 2738445 S',vc w c cep PRUDENTIAL VISTA R.E. It is the responsibility of�thk owner to'determine existence of any easements, covenants* or re- thestrlctions which do not -appear on the recorded sub- division:plat:_.Under no circumstances should any Nn oFREco data :hereon .be used "for constructign or for estab- wM OR T++E MECC lishinc boundary or fence lines. The surveyor takes11!owR �,eo►e. i responsibility for the initial transaction on1Y• FFFNo J -'- t'ANCHORAGEiRF-CORDING ,24- BLOCK 3 & SRASS CAP MONUMENT A/�/� O IRON A►E / I�/D. ( PLAT NO.ij+?D) 0 wO R TACKOR./RO DISTRICT W `JUNG &ASSOCIATES .1426 HYDE/t STREET ocvlelnM A"CNO�!!!GE ALASKA 99501 FIElDB00K: 311TE: • 6y: SCALE: �r0�/ wORKOROER:./RQ / 002 Z3, 0 OF A 11 SW 2 ?•3 fa. • MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES. O Division of Environmental Services On -Site Services Section. P.O. Box 196650 .Anchorage, Alaska _ 99519-6650 343-474.4 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D.# ��s HAA#HP29DQ-� 1. GENERAL INFORMATION l Complete legal description oaf 2 [3 /ac k3 Tafw wvf Location (site address ordirections) y5' 20 Snow cup Circle Property owner nested me ke- Scho o(er • • " • 1 • . •' • • - Day phone Mailing address yt2O -S^�"'cf'�' Cfrfle'' f}nchoragP /Qk 9951e Lending agency e" AV M10'1 4 > Day phone 263 -0-700 f2l Gti Ffrew�ee l,ane� AncA� Ak 99503 Mailing address Nuel T%omaw Furk.^e Pronerh<i Day phone -T"62-7653 Agent Address 2125' C " St. An ch or q<L.A� q9s o3 HAA will be held for pickup. Unless otherwise req 2. NUMBER OF BEDROOMS 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 ., ;.;., c ;,;..;•, . Holdingtank`�1 - Community on-site i Public sewer,;; NOTE:.. If community wastewater system,"provide written confirmation from State ADEC attesting to the legality and status of system , r t: .. Tid13 (RaANq Fran MOA 021 S. STATEMENT OF INSPECTION BY ENGINEER ' As certified by my seal affixed hereto and as of the validation date shownf 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 F/af/o/► TccA ni cuf ferv�cv Phone 3 yam- 124--1- Address ` /YS30 Ecl o Sf d Ar+ Aai a Ak 99s /� Engineer's signature Date_g=4 'Z /94y { ... alt OF A4 A -M -P i -' .THEODORE F. MOORE*� CE -3589 a• 6. \ DHHS .SIGNATURE —`a ..... �_ ._... Approved for bedrooms., Disapproved Conditional approval for bedrooms, with the following stipulations: aid' Additional Comments �., By Date Z 7 _ '' - .� . -tee . - - • i ...'dc , The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given inparagraph 5'i bove by an independent professional engineer registered in the State of Alaska. The DHHS does this asa courtesyto purchasers of homes and their lending institutions In orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct`Inspections cr analyze data before a certificate Is Issued The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer s work.... Municipality of Anchorage AL Department of Health and Human Services Aim HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 2l/ /3 'iat/uf uxes t Parcel I.D. A. Well Data Well type P✓t If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 6/ Z6 / 7 6 Driller M —w Total depth 1S1' Cased to 15,0- 4" Casing height 30" Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION Date of test 81 76 9 /I / 9 `/ ——MUNICIPALITY OF ANCHORAGE Static water level 9o' 721 ENVIRONMENTAL SERVICES DIVISION Well flow 9 g.p.m. 6.6 g.p.FrFP 0 8 1994 Pump levell IYZ' RECEIVED SEPARATION DISTANCES FROM WELL TO: RECEIVED l L V L Septicfholding tank on lot 1051 b c.c% _:On adjacent lots > roc,' Absorption field on lot 127, {o c. o. ; On adjacent lots > I ao Public sewer main nI. A. Public sewer manhole/cleanout N.A. ' Sewer service line > 2s' Petroleum tank Nurse seen WATER SAMPLE RESULTS: Coliform 0cc,//100 m.2 Nitrate 40.1V/..0— Otherbacteria ocAe =Or/ -e --C Date of sample: 9 /it 911 Collected by: F/a}fep 7ec6 Stec B. SEPTIC/HOLDING TANK DATA Date Installed 8/ rs / 76' Tank size1? V gV1 Compartments 3 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N. A Alarm tested (Y/N) N. A. Date of pumping 7 /Z1 / ?Y Pumper A * SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Weil(s) on lot 1 os'' J; -A- c. A On adjacent lots > Ivo' Foundation I Y' To property line 22' Absorption field 1,y I Water main/service line > to' Surface water/drainage > 100' n-026(3W)'Front CONTINUED ON BACK PAGE C. LIFT STATION N. A. Date installed Manufacturer Size in gallons Manhole/Access (YM) Vent (Y/N) 'Pump on" level at "Pump off" Level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 8/15/ 7A' Soil rating (GPD/Ftr) 27S 0'/CoAn System type _Trete c,4 Length H Z' Width 3' Gravel thickness r Z Total depth 1.70 Total absorption area 1008 Cleanout present (Y/N) Y Depression over field (Y/N) N Date of adequacy test 9 /1 / 9 Y Results (pass/fail) pe si for 3 Bedrooms Water level In absorption field before test 69 It After test 91 " Peroxide treatment (past 12 months) (YM) A/oAe kmt-, . of If yes, give date N. .4 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 12 y' 4y+ c. o. On adjacentlots > too' Property line To building foundation 36, To existing or abandoned system on lot N..4. On adjacent lots 3o' Cutbank N. A. Water main/service line > to, Surface water > too' Driveway, parkingivehicle storage area > So' Curtain drain NoA¢ seen E. ENGINEER'S CERTIFICATION I cen9y that 1 have checked, verified, or conformed to all MOA and HAA guidelines i�Al,hjQre of this inspection. V A:� i j, 9TH!6'V7 Signature �__ /'� �c %.............,.,...��.....:...�� Engineers Name T/i eoafo re F. Muor� . 1HEODORE ?.`)A �Y1RE "` ` CE -3539 ~ Date -CfgAtmber 7, /99Y Ar 1�tQy ••......•• . �ltr,F,ta'•�'4' HAA Fee $ "30o. "= Date of Payment 9- -9 Receipt Number 60140 72-026 (3(93)' Baal f'.6 y6 Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE ' DEPARTMENT OF HEALTH & HUMAN SERVICES tit 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 Parcell.D.# 01!—a6A-07-0a0 HAA #-V1_Rol \UIR9 1. GENERAL INFORMATION / '1 Complete legal description e-� Location (site address or directions) Property owner sk. v4 Day phone 3 �/,1 —63& i Mailing address'' - 20 S, taura�c Lending agency Mailing add Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone 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 (Ra. 1191) FrOM MOA 121 i 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 furtherverify 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 / n hh l"' Address 6-11-1 Engineer's signature 6. DH_ HSS -SIGNATURE Approved for � bedrooms. 0 Disapproved. Conditional approval for Additional Comments Phone IQ 1/'i - 5 0 � a Date ✓ ;ZV• q f bedrooms, with the following stipulations: 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. 72425 (Fbv. 1/91) Baca MOA 121 Municipality of Anchorage Department of Health & Human ServicesNNW HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LnT &q Bks Parcel I.D. 015 - A09— Q I -ao-0 'r'A L V & vti EST - A. WELL DATA Well type R If A. B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) �Z Date completed8�2&,%76 Driller Y-lyi Total depth I-sCasedto 191 Casing height Rog Sanitary seal (Y/N) Date of tdst Static water level Well flow Pump level " FROM WELL LOG /976 90 , SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot %1 Wires properly protected (Y/N) AT INSPECTION g.p.m. �2 g.p.m. 13 ; On adjacent lots 1 O6 + Absorption field on lot ISO t ; On adjacent lots lee + Public sewer main N/A Public sewer manhole/cleanout ►��/> Public sewer service line U&N Petroleum tank inti WATER SAMPLE RESULTS: Coliform Y Nitrate Other bacteria • 1 J Date of sample: Collected by: S• B. SEPTIC/HOLDING TANK DATA Date Installed 12 76 Tank size I a 5 c Compartments °-S Cleanouts (Y/N) -,Y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N/a Alarm tested (Y/N) 1`//A Date of pumping "/ZI- qo �Aaac s SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well s)onlot Ica t Onadjacentlots 100 F Foundation US To property line Absorption field 14 Water main/service line 5o t Surface water/drainage NIA 72o2e (9.n 3/91) Flog, MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION I`f/ A Date Installed Size In gallons _ Vent(Y/N) High water alarm level Manufacturer Manhole/Access (Y/N) —"Pump on" level at "Pump off" level at Meets MOA electrical codes (Y/N) . 1 ,. N SEPARATIODISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Cycles tested Surface water _ Date Installed 91 h Soil rating .2 System type ! QkIVGf! Length !V1 r Width 3 Gravel thickness 12 7 . Total depth /7 Total absorption area /oo P Cleanouts present (Y/N) Depression over field (Y/N) Date of adequacy test h • /5. 9 1 Results (pass/fail) for - �� bedrooms Peroxide treatment (past tz months) (Y/N) %✓ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /00+ On adjacent lots 1010 t Property line 2 0 To building foundation go To existing or abandoned system on lot On adjacent lots 00./. Cutbank y11 - Water main/service line > > o Surface water KLA Driveway, parking/vehicle storage area o Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines In effect on ttLe date of this Inspection. P .. Signaturey' yam' .14 Engineer's Name- I oLber. S'n .^ICI .. r••�r A "'•l' Date u+. l $ 14 Q �, •.•'. CE -2225 _ '.✓ ^<< HAA Fee $ - Waiver Fee: $ Date of Payment - �2 3` 9 Date of Payment Receipt Number Receipt Number 72-M (Rw. 3/91) B• k MOA 21 T _ SIPUF:t <LAND F^ _ E 6151 M. DIMOND BLVD. ANCHORAGE, ALASKA 99502-7904 1901) 248-5095 RESIDENTIAL WELL INSPECTION LEGAL: Lot 24, Block 3, Talus West LOCATION: 4520 Snowcup Circle OWNER: Steve Bowen TYPE OF WELL: Private, Single Family WELL LOG AVAILABLE: Yes INSTALLATION REQUIREMENTS MET:Yes WELL YIELD FROM WELL LOG: Gallons per Minute PUMP YIELD FROM TEST: DATE OF INSPECTION: 6 Gallons per Minute May 15, 1991 TEST PROCEDURE: Well was pumped at a constant rate while the drawdown was monitored with an acoustic probe. At the beginning of the test water level was found at 78 feet below top of casing. At a pumping rate of 6 gallons per minute the water level dropped to 137 feet after 60 minutes of pumping. The water level stabilized at this level. A total of 520 gallons were pumped in a period of 82 minutes. The recovery was monitored for 25 minutes. During this time the well recovered to 88 feet, a 83% recovery. TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested for E.Coli and total nitrogen on May 17, 1991 E.Coli 0. Total Nitrogen ND (Non Detected). Max. allowable Total Nitrogen 10 mg/1. TEST RESULTS: This well meets the requirements of the Municipality of Anchorage. THIS WELL WILL PRODUCE MORE THAN 3 GALLONS PER MINUTE FOR MORE THAN FOUR HOURS The Municipal requirement for well flow is 150 gallons of water per bedroom per day. This well exceed this requirement. The assessment of the condition of the well applies only to the conditions as of the day tested. The flow rate may change due to subsurface conditions that may not be observed from the surface, and changes in the land use and other factors that may impact the aquifer feeding the well. T _ S F--" U F2 k L— of 1i n F=' _ L 6751 W. DIMOND BLVD. ANCHORAGE, ALASKA 99502-3904 (907) 248-5095 SEPTIC SYSTEM ADEQUACY TEST LEGAL: Lot 24, Block 3, Talus West °�== "!n•••' LOCATION: 4520 Snowcup Circle OWNER: Steve Bowen '- RESIDENCE: Single Family, 2 Bedrooms ��,� ._-<•''•�%> WELL: Private, On Site SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: 4 Bedroom System TANK: Jet Aeration 1250 Gal. Three Comparts. ABSORPTION SYSTEM: Trench ABSORPTION AREA: 1008 Sq. Ft. SOIL RATING: 275 INSTALLATION DATE: 1976 DATE OF LAST PUMPING: 7/28/90 Isaacs DATE OF TEST: May 15, 1991 TEST PROCEDURE: System was inspected and measured. Tank was found with 4 feet of cover and with a liquid level of 55 inches. Trench clean out was 4 ft. deep and dry. Trench monitor tube was 14.5 ft. deep with 97 inches of water. 520 gallons of clean water was added to the trench while the water levels in the tank and the monitor tube were monitored. The first 100 gallons was entered in the foundation cleanout and caused the water level in the tank to rise 10 inches, indicating that the tank outlet was broken or plugged. The next 420 gallons were entered at the trench cleanout and caused the water level in the sump t.a-rise 8 inches. The water level in the tan(; dropped 5 inches during this interval. Within ten minutes after the water was shut off the level in the sump was back to original level. The outlet of the tank was excavated and it was found that the pipe was broken. It was replaced. TEST RESULT: This system meets the code requirements of the Health and Social Services Department of the Municipality of Anchorage. NOTE The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long this system will function satisfactory for current or future occupants. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 2644720 Application Date "'?.1 A40-2 Z2 ZeQa-10 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L. Z,4 S 3 Tal u s W� s -f- `���,d._l�ca�� In 5zz7LRc� Location (address odirections) G<� (b) Applicant Name BeQLU Telephone: Home Business i (c) (d) Applicant Address i0 SAO - CClr Address (e) Real Estate Company and Agent Address Telephone (I) Mail he HAA to the following address: 2. TYPE OF RESIDENCE Single-Family��r\Multi-Family0 Other Number of Bedrooms —1 3. WATER SUPPLY Individual We1I4 Community O Public O Note: 11 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[3 Community O Holding Tank O Note: If community well system• must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. r ' 72-025111/Bal Page 1 of 2 roN W 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 verily 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 regulations in effect on the da Name 0.11-0 Date 6. DHEP Approved for Approved — Terms of Cor bedrooms b�Yj-7 — Disapproved Conditiona _ E CAUTION F. £!zemore {! 1517 E . Date'�S H The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations 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 requirements. Employees of DHEP 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(11184) Mri w KtALTH & ENVIRONMENTAL PROTECTION n A) MUNICIPALITY OF ANCHORAGE (MOA) MAR 2410 HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1064 RECEIVED 264-4720 Le al Description: �� rJ✓ 72? ' S e�n �_ 91k& A. WELL DATA Well Classification [ �W a�e If A. B, C, D.E.C.�Appproved (Y/N) p Well Log Present Y ) —� Date Completed [ / %6 Yield Total Depth Case�f to !GjQ-6 Depth of Grouting Static Water Level R Pump Set At iS Casing Height Above Ground �� �� Sanitary Seal on Casing IY/ ) Electrical Wiring in Condui&) Depression Around Wellhead (� Separation Distances from Well: / `/� I / J To Septic/Holding Tank on Lot �0 : On Adjoining Lots 100 1�L To Nearest Edge of Absorption Field o Lot On Adjoining Lots ' To Nearest Public Sewer Line AfIATo Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line /o'n,Lot �}! Water Sample Collected by -y : Date I - ° Water Sample Test Results ✓d //O� 1 ���uz f Comments 'gad, -Iv '& na Se�T-/' T// B. SEPTIC/HOLDING TANK DATA 6 ) ( 4 Date Installed Aa9. 71� Size ! — �jo. cf Compartments Standpipesr)l) Air -tight Captp) Foundation Cleanoutr6N) T— Depression over Tank (19 Date Last Pumped _/v) �r Z ©� Pumping/Maintenance Contract on File ()G) ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) 4114 Separation Distances fraSeptic/Ho)ding Tank: / To Water -Supply Well To Building Foundation To Property Line g' To Disposal Field e_4: To Water Main/Service Line Course 6) n Commei Page 1 of 2 72.026(11184) To Stream, Pond, Lake, or Major Drainage C. ASSORPTION FIELD DATA n a Soils Rating in Absorption Strata a T m g ��� � Type of Sysle Design L�i2 Date Installed CJ- " Length of Field i - CJ / Width of Field 3 Depth of Field /7 Square Feet of Absorption Area Depression over Field (Y67— Results of Last Adequacy Test Gravel Bed Thickness Standpipes Present) Date of Last Adequacy Test Separation Distance fro bsorptionTield: To Water -Supply Well.I % � / To Property Line Z To Building Foundation & To Existing r Abandoned System on Lot apt On Adjoining Lots _1 To Water Main/Service Line AZZA To Cutbank if present) To Stream/Pond/Lake/or Major Drainage Course � D. LIFT STATION Date Installed 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 Ofl:jAve(at Check Permitted Bedroom Rating Against HAA Request " Icertifyth tlhavech k ,,verified,orconformedtoall Aa Signe Date Co t No. Receipt No.�%9 i Date of PaymentZ5(o Amount: $ J� Page 2 of 2 72026 (11,84) Pumping Cycles during Adequacy Test. Meets MOA in effect on the date of this inspection. -•,•,\,a �+oA vK €ngin$ear,� ✓ _ . �ir.7l F7 F��4 _ � 'lc James F. Size, # 1517 E r^ r mar Tro z 8 3 Ta f�s IME t4 Lo V0L 7Ibt1k)k M?fT 6r-KT'� 7B`3 gO . „MUtI,,C,',P,�'rl"CF ANCHCRgcEENHEALTH 6 . _ NMENTAL PROTEC710N MAR 2 41986 R CEIVED J Time Time .a Dar, Date Date ? —.2 0 Inspector Inspector Inspector Comments Conditional Approval --- — -- I E drooms �`; , o- :I APProv31 Date Sewer Installed � Permit No. Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY _ Property owner Richard Johnson Phone Melling Address S.R.A. Box 1685-8, Anchorage, Alaska 99507 345-5440 Buyer Steve Bowan 3210 Woodland Park Drive, Anchorage, Alaska Address Lending Institution Alaska Pacific Bank Phone Address P. 0. Box 420, Anchorage, Alaska 99510-9986 274-9661 Realty Co. a Agent New World Reaity4o. ; Chuck Haddy Phone P. 0. Box 10-13114, Anchorage, Alaska 99511 345-3854 Address Legal Description Lot 24, Block 3, Talus West Street Location 4520 Snow Cup Circle Typef Residence Single Family 2 ❑ Multiple Family No. of Bedrooms ❑ Other Wat Supply I Individual ATTACH WELL LOG. A well log Is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to that date, give well depth (attach log If ❑ Public Utility available. Sewage Disposal 197-7 R Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility* O Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. May 4, 1982 G Mr. Richard Johnso v S.R.A. Box 1635 -D c Anchorage, AK 995 •3 Subject: Lot 24 D.., ..2'11us West c-\ i Approval for the ir,,._vidual sewer and water facilities cannot be granted until the follmving items have been completed: ° The water analysis report needs to be submitted to this office from the Chem Lab, 5633 A Street, for our review. ' The septic tank pumped with a receipt submitted to this department. ' An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this office for our review. ' A maintenance contract for the Jet unit serving the sewer system needs to be obtained from Consteel Company, 37G-5919, and a copy submitted to this office for our review and our files. ' The lid to the jet unit is in need of repair. Please notify this department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Enclosure RP97/p/Eft Sincerely, Robert C. Pratt Associate Environmental Specialist may 4, 1902 tie,: World Realty Co. Chuck daddy P.O. Gox 10-1314 Anchorage, M, 99511 ^. Subject: Lot 24 Block 3 Talus West Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: • The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. • The septic tan), pumped with a receipt submitted to this department. • An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to Rational Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this office for our review. ' A maintenance contract for the Jet unit serving the sewer system needs to be obtained from Consteel Company, 376-5919, and a copy submitted to this office for our review and our files. ' The lid to the jet unit is in need of repair. Please notify this department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt Associate Environmental Specialist Enclosure RP98/p/Ell MUNICIPALITY OF ANCHORAGE-� 1 DGPARTML -i OF HEALTH AND ENVIRONMEN 1 PROTECTION 825 L Street, AnchoraaP. Alaska 99501 264-4720 Date Received: February 27, 1978 #1: Time #2: Time #3: Time Date 61h W6 Date Date Insp �nn �. Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Alaska Pacific Bank Mailing Address: Post Office Box 420 99510 Phone: 276-3110 2. Property Owner: Mose Pendergrass Phone: Mailing Address: 4520 Snowcup Circle 99502 3. Legal Description: Lot 24 Block 3 Talus West Subdivision 4: Single Family Residence: (x) Number of Bedrooms: Three Multiple Family Residence: ( ) 5. Well System: Individual Well (x) Permit # Construction Number of Bedrooms: Community/Public System ( ) Depth of Well 150' Well Log on File ( ) Bacterial Analysis 6. Sewage Disposal System: On-site System (x) Public Utility ( ) Permit # Septic Tank Size Absorption Area Installed 1977 Installer Manufacturer Soils Rate 7. Distances: Well to Septic Tank to Sewer Line to Nearest Lot Line Nearest Lot line Material to Absorption Area Absorption Area Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 24 Block 3 Talus West Subdivision Comments: Affadavit Attached: /(—)) Letter Attached: ( ) Approved Date: Disapproved: Date: Department Worksheet: !( - 10&� o�O V.a[•0d0• 11VP1 1WOUNH1N1 101 ION 1161 lady (ap!s Aayla aaS)—0301AO1d 39V13A03 33NVUSNI ON 008E W0.1 Sd 1 ane ••..•...•.•.......••.••.•••.•••• .............•.•.....• �iun aaeeaunnv nr ua�nari . rr1Va • V!uI'll SaM11aa aH►ua apY'YaV+q94"s L ,^^..^^ AYADDa 011uA11a0 VOM L331AY7= 1317071 _ NAIPO alta Sw IY•Aba at S.643 Y NYO17Y _....;V 573/ jV 011100V 101 1131ANIS 1VM011d0 4P 3007 317 ONy15 "0'd a) L0 'ON CNV 133SIS 011NU sn1d) 00E-11VW 0313112130 HOA 1d1303M MUNICIPALITY OF ANCHORAGE -'Department of health and Environmental Protection 825 L Street, Anchorage, Alaska 99501 + I 264-4720 Bequest for Approval of Individual Sewer and Water Facilities 1. Property Owner: Mose Pendergrass _ Mailing Address: 4520 Snowcup Circle Phone: 2. Name of Buyer: Dean Boice Mailing Address: Box 4-943, Anchorage 99509 Phone: 274-6896 3. Lending Institution: Alaska Pacific Bank Mailing Address: P.O. Box 420, Anchorage 99510 Phone: 276-3110 4. Realtor/Agent: none Mailing Address: Phone: 5. Legal Description: Lot 24, Block 3 Talus West Street Location: 4520 Snowcup Circle 6. Single Family Residence: (19 Number of Bedrooms: 3 Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply: *Individual Well (X) Public/Corrmunity System ( ) If Individual Well, well depth 150' If Community System, name of system 8. Sewage Disposal System: *°On-site System Public System ( ) If On-site System, date of installation: 1977 *NOTE: A well log is required on ALL wells drilled since 6/75. **If on-site sewer system is over two(2) years old, -an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. " 3/77 l De O.W0, GREATER ANCHORAGE AREA BOROUGH partment of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received FFPhruary 28. 1977 Time of Inspectiong,nn a.m. Date of Inspection 3-1-77 Tues. RCP REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. 1. Approval requested by: Alaska statebank Mailing Address: gin Fact Northern Lights Blvd Phone: 279-7637 2. Property Owner: Mose Pendergrass Phone: 349-4207 Mailing Address: Star Route A Box 1585-B 3. Legal Description: Lot 2e Block 3 Talus West 4. Location: Snowcur) Circle see directions ,5. Type of facility to be inspected Single Family No. of bedrooms 6. Well Data: A. Type individual B. Depth 150, C. Construction D. Bacterial Analysis 7. Sewage Disposal System: On—site system, Permit #76469 A. Installed 1976 B. Installer C. Septic Tank: 1. Size D. Seepage Pit: 1. Absorption Area E. Disposal Field: Total length of lines 8. Distances: 2. Manufacturer 2. Material A. Well to: Septic tank Absorption area Sewer Lines _, Nearest lot line Other contamination B. Foundation to septic tank Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages Page 21.of two pages=.Req�t for Approval' of Individual S. r b Water Facilities Legal Description Lot 24 Block 3 Talus West Comments Approved Disapproved Date 3 /V Approval,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM �I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date i JAN MUNICIPALITY OF ANCHORAGE MUN(CIPALITt OF ANOIOUIGE • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DEPT. OF t'ALTN L 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 ENVIRONMENTAL PkOTLCTIOR REQUEST FOR APPROVAL OF FE628 19774 + , INDIVIDUAL SEWER and WATER FACILITIES c R_ECEI 1. Type of Inspection: CMRO---,—VA FHA CONV_Z 2. Property Owner:/ / 10 -J Pi / r c /I e7 T Mailing Address: S/9q• LSO)& J?'5- J� Day Phone: 3. Name of Buyer: d S 0(ehd C/3 5 /Pl9 S S Mailing LL'� Address: f �1;` Day Phone: 4. Name of Lending Institutions: _/ 7_ _ S V4 n Mailing Address: 11444 rR�f Zjy 6''S• Phone: `L f 24 S7 5. Name of Realtor or Agent: Mailing Address: Phone:- 6. hone: 6. Legal Description: �D /'• �•C I.Z�� ��� /u s a^-� QS" Location: Type of Facility to be Inspected: t'v le // No. Bdrms. 8. Water Supply W Lo Type of Supply Public Utility Individual I.-- If i If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System 72003(3/76) Type of System: l�J 0.4 Public Utility Individual (on-site) L"' If Individual, date of installation Y lz 0 7D N C Y