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TALUS WEST #1 BLK 7 LT 1
Talus West #1 Block 7 Lot i #015-202-45 . -- Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW9LOZ38 PIDNumber: 0t5'Z07_y6' Name: G.W. C Wastewater System: ❑ New ❑ Upgrade Address: '/ZOO Fro ABSORPTION FIELD f vnone: No. of oma: O Deep Trench ❑ ShaVow Trench O Bed ❑ Mound Other LEGAL DESCRIPTION Soil Rating: Total Depth from origin grade: GPD/S Ft Lot: Block: Subdivision: I 7 Depth W Pipe bottom ho ngmal grade: Gravel depth bene at pipe // s T µ Ft Ft Township: Range: Section: Fill added above o genal grade: Gravel length: Ft Ft WELL:* ❑ ew ❑ Up ade Gravel width: Number of li a: Distance between Nnes: Ft Ft Classification (Private. A7C): Total Dep Cased To: Total ab so tion area: Pipe mat ial: FL FL so ft Driller. Dat riled: Static Water Level: Installe. Dat el stalled: Ft. Yield: Pump Set at: CaRng Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES 0Septic Holding ❑S.T.E.P. To sopbc Absorption Lm HoWinp PubliciPmato Manufacturer.Cap acity in gallons - From From Tank F.M Station Tank Sever unas 2 DOD WeIF Material: Number of Compartments:Surfac Waters /oo'-► — LIFT STATION Lot Line -'• r /D f Size In gallons: Manu cturer. Foundation ,,.�. �— / O 17L "Pump on" level at: 1 "Pump oH" level at: I High water arm at: Curtain lid I Pump Make BM Electrical inspections rformed by: Drain Remarks: BENCH MARK Location and Description: Go vc F E g5Zfg a ae loo+ �w aee_,�- Assumed Elevation: /4D Ft ENGINEER'S SEAL (E OF 44 11 ,Rr Inspections performed by: Dates: 1s� r 49L i 2nd i Department of Heal and Services approval :.Kenneth �E�µgD 44-� I Reviewed and approved by: Date: Q Al? FESS' 72-013 lRev. 2/91) MOA 25 AS -BUILT SITE PLAN WASTEWATER DISP❑SAL SYSTEM LOT 1, BLOCK 7, TALUS WEST 81 2ONTIER DFVE ` 1000 WELL WELL DRzS 7 RN SrD RQ N DING 7n SEVER AREA O OF AZ4Sf i 4 .. * /KENNETH 6 CE -77 118 Atf Ib' FESSIVO Aw 93.14 TO HOUSE 2000 GALLON HOLDING TANK 88.89' NOTES: 1. OLD TANK AND FIELD HAS BEEN ABANDONED IN PLACE. 2. 9 VOLT ALARM SYSTEM INSTALLED AND TESTED. PARED FOR: KND ENGINEERING 20441 PTARMIGAN BLVD G. W. KEHL EAGLE RIVER, AK, 99577 4200 FRONTIER DRIVE (907)696-6111/Fox (907)696-8111 ANCHORAGE, AK 99516 DATE, 8i29/% DRAWING R SCALE, V - IN' 96041 -SI MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960238 DESIGN ENGINEER:KND ENGINEERING OWNER NAME:KEYL GERHARD W JR OWNER ADDRESS:4200 FRONTIER LN ANCHORAGE, AK. 99516 PARCEL ID:01520245 LEGAL DESCRIPTION: TALUS WEST #1 BLK 7 LT 1 LOT SIZE: 18534 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: HOLDING TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: tlG',ouPm DATE ISSUED: 8/07/96 EXPIRATION DATE: 8/07/97 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED ] ISSUED BY DATE: Z &_1 DATE • Ogl o / C TK D ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696.8111 July 9,1996 Municipality of Anchorage Dept. of Health & Human Services, On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Upgrade permit, Lot 1, Block 7, Talus West #1 Gentlemen: Recently my firm conducted an adequacy test on the above property. We determined that this system was in failure, probably due to encroachment of ground water. A single testhole was placed in the southwest corner of the lawn. A copy of the soil log is attached. This lot was previously filled in order to allow the development of a lawn. The fill material was placed over fabric, as shown on the log. During the excavation of the testhole, water was entering at 3' and at 5'. No monitoring tube was placed, and the excavation was ended at 6'. There is a swampy area near the southwest corner of the property which has remained wet during all of our visits to the site. There are areas of standing water in the depressions created by the installation of major utilities along Elmore Road. As a result we are observing a 100' setback to these surface water sources. With this setback in mind, we are unable to identify adequate room for a replacement trench. In addition, the existing septic tank is approximately 80' from the well, not 110' as shown on the inspection report and a subsequent Health Authority worksheet. We are requesting the issuance of a permit for a 2,000 gallon holding tank for this property. The tank will be located 100' from the nearest surface water source and over 75' from the adjacent wells. If you can any questions about this application, please contact me at 696-6111 or FAX at 696-8111. to.N/�P�� Respectfully submitted, IESi/d�Engineering .904 C Kenneth M.vs,. At illFD attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test WASTEWATER DISP❑SAL SYSTEM LOT I, BLOCK 7, TALUS WEST kl "CLEMi lax O " o u VILL I I ,I o , - � I 5 �pzu. OI DING TANK Tv I + SEVER AREA O LasTw s•srzx J •fH _ _ _ _ LJ I 12000 TR Riyn. [alnxi SIACE WATER SEVER AREA LOI ) SEVCR ARCA LOT 8 DESIGN DETAILS L INSTALL 2,000 GALLON HOLDING TANK, 2. HIGH WATER ALARM WILL BE WIRED TO POSITION INSIDE GARAGE. 3. CONTRACTOR TO INSURE 2% GRADE FROM DWELLING TO HOLDING TANK, 4. CONTRACTOR TO PROVIDE LICENSED ELECTRICIAN TO INSTALL HIGH WATER ALARM. 5. OLD TANK AND FIELD WILL BE ABANDONED IN PLACE. -AKLU 1 -UK: KND ENGINEERING 20441 PTARMIGAN BLVD G. W. KEHL EAGLE RIVER, AK, 99577 4200 FRONTIER DRIVE (907)696-6111/Fu. (907)696-8111 ANCHORAGE, AK 99516 DATE_ 7/6196 DRAWING R SCALE 1- 100' 96 -SI PERFC LEGAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 //TEST RUN BETWEEN FT AND FT COMMENTS A(i0 PERFORMED BY: , 1 CERTIFY THAT TH!P �TTEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNI%'1 AL GUIDELINES IN EFFECT ON THIS DATE. DATE:flA 72-M (Rev. 4/85) MUNICIPALITY OF ANCHORAGL'�' Her ch and Environmental Prote: pion Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 fJp PLpT'-mRP. ;.. INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME MAILING ADDRESSp`X-1�6_�'.. S,Q,,B.,_ PHONE 341-:3494 LocnTloN-Y�-eNnfR__/erF_�Qi�oc+Nc�s_ LEGAL DCSCRIPTION �.-^1 S��oc�'�y �L.0 S�l��gi SEPTIC TANK: DISTANCE FT aeT-�D TFNUMBER OF FROM WELL-AAO—MANUFACTURER AA—LIQUID (CPGZSC�.MATERIAL \OUCR.E, COMPARTMENTS�-A INSIUC LENGTH 01A INSIDE WIDTH N IA _ LIQUID DEPTH Nj — LIQUID CAPACITY I'�$O GALLONS. TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELL – FOUNDATION _NEAREST LOT LINE_ OF LINE Ir' Of Lines (1.J Coe_ DISTANCE BETWEEN LINES AA TRENCH WIDTH1(*- IN. TOTAL EFFECTIVE Aii°_OVPTION AREA 1)0C)-_. SQ. FT. LENGTH OF EACH LINE �'rj0 FT RT' UFPI11: TOP OI' TILL TO 1INISII GRADE MATERIAL L BENEATH TILE ��' IN. ABOVE TILE –6_IN. SEEPAGL PIT: DIAMETER _OR WIDTH_, LENGTH_, DEPTH Log Crib _Rings_ Crib Size: DIAMETER —DEPTH— DISTANCE FROM: WELL , Fr FT TOTAL EFFECTIVE L'UILUING 10UNDATION35-, NCARCST LOT LINE . APSORPTION AREA (WALL AREA) 2)00 SQ. FT. !11 $,ass:`M. Depth: 311 Distance To: Lot Line IAF -dg: 3e. F -i' Sewer Line: ape Materials: CpsT I�n1 of Bedrooms: Istaller:� �Ir !marks: DATEAJ-\B_11_ APPROVED �1._ - -PI cK-E .a_1- - Leo' � - � •` -p— Ai C dt DATEAJ-\B_11_ APPROVED TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 'SOIL RATING (50 FT/BF:)= 200 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM I5: �% L7EF'TH= 12 LENGTH= J V IG�'Hkr'EL E>EP-TH= y+" THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINAFIELD. 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). PAS, J40/4 "'T - --------- F=-FFCF<F=iGE F_L_F=ir_IT FT&P"--t"S'uN--------- A PACKAGE PLANT MAY BE INSTALLED AT THE PERMITTEE'S OPTION SUBJECT TO THE FOLLOWING CONDITIONS: 1. EITHER A CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED. 2. 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. — — — — — — — - — — — — — — — — — — — — — — ----------------- --- ---------------- --- TL4(D C Z-7- 7 I t.JSF-E1=T 101 r4 S> F:tFZ: FzEG�!U I F;ZEO --- 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 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F='EF�:M I T E?{F� I F1ES• ECrEC_-EME3EF7_ .:1., 1577 I CERTIFY THAT 1: I AM FAMILIAR, WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED:- ---• ;C5lNTWSU,�' ------------------ AFPLICANT HT ISSUED BY V3. 0 r'tUr-J I C I n�L I TY OF Hr -41= F=1CiE - DEPARTMENT t -HEALTH FIND ENVIRONMENTAL _7TECTION �• ' 825 'L' STREET, ANCHORAGE, AK. 99501 An1- WELL F=ir 279-2511 -l0 IDr-J— 5I TE S•EWEF;.:: F1EFRF`y T PERMIT NO. C 77736 ) I Cl 101'DIS �1 APPLICANT BUCK. HIGHT BX 1586-C SRA 349 3 94 a Q LOCATION FRONTIER LEGAL LT.1BK.7 TALUS WEST LOT SIZE 11000 SQUARE F TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 'SOIL RATING (50 FT/BF:)= 200 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM I5: �% L7EF'TH= 12 LENGTH= J V IG�'Hkr'EL E>EP-TH= y+" THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINAFIELD. 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). PAS, J40/4 "'T - --------- F=-FFCF<F=iGE F_L_F=ir_IT FT&P"--t"S'uN--------- A PACKAGE PLANT MAY BE INSTALLED AT THE PERMITTEE'S OPTION SUBJECT TO THE FOLLOWING CONDITIONS: 1. EITHER A CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED. 2. 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. — — — — — — — - — — — — — — — — — — — — — — ----------------- --- ---------------- --- TL4(D C Z-7- 7 I t.JSF-E1=T 101 r4 S> F:tFZ: FzEG�!U I F;ZEO --- 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 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F='EF�:M I T E?{F� I F1ES• ECrEC_-EME3EF7_ .:1., 1577 I CERTIFY THAT 1: I AM FAMILIAR, WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED:- ---• ;C5lNTWSU,�' ------------------ AFPLICANT HT ISSUED BY V3. 0 N V'�-l- 5G-2n� 10-Zt0'0 2' O 1v J IC G I C YAU �tJ VP O � C I � o I I N V'�-l- 5G-2n� 10-Zt0'0 2' I 1v IC I C YAU �tJ VP y I I •w� V• I 9 0 V I � I V E: Vn AS -BUILT SURVV. LEGEND: I2 i'r V� Sca13 16, = 3 © Bross Gap Monument O Iron Pipe • Steel Pin C Survey Hub 8 Tock I hereby certify that a survey of Lot 1 ,Block , Subdivision was made on S C 1�'f and ......, that the improvements situated thereon are within the property lines p.�'��;.• A and do not overlap or encroach on the property lying adjacent thereto,:' that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission,i•��C7'�/ lines or other visible easements on said property except as indicated ,yA•``• • •evYY•••J hereon.j NO.30=2S Dated at Anchorage, Alaska, this ZL day of G r 0. 19 •• i CONSTRUCTING ENGINEERS SRA Box 60, Anchorage, Alaska 99507 344.0817 344.7960 HELL CONSTRUCTION LOG Drilling Co. A •'J A >, /J USGS no. •q Driller v /' r Type of rig -,l—' j /�i�- A r/ ata well completed ry �`y � 7 7 LL1 �-- ■ell owner__ F'[�f /. 1 / rS��;7O: Nearest community rm a/&s T 5y� Well location: (address g legal description) / 7jer V location sketch or remark& i / iv Depth of well ft. Casing: depth it. dlam. d In. Static water level, 3 J ft. (above, below) land surface. Date 39 - /,9- 7 Finish of well: ( en -e screen, perforated, open -hole, other) Describe Intervals and size: Volt yield tested by (pumping. boiling, 0at / gel/min, for hours with_1 ft, of drawdown from static level. DRILLER'S MATERIAL LOG Depth below surface In land feet Give description of strata penetrated (size of material, color, hardness of drilling, and water content) to u 12 Sr, i T _S to S i,, fl �to 17 F to 3-0 LG G>,V&/ A Stir to �/,:— r/ d .S'/% Sd.err I o to "U lot -A C_ r A V e. 7Oto lr/,r low Si "el to to to to to to to to t to to to ` to to to to ___ 0 Municipality of Anchorage On -Site Water and Wastewater Program < " (907) 343-7904 s A r[ T r Certificate of On -Site Systems Approval Parcel I.D. 015-202-45 1. GENERAL INFORMATION: Expiration Date: Y' e� 1 `1 I m A Complete legal description TALUS WEST #1; BLOCK 7 LOT 1 Location (site address) 4200 Frontier Lane *Anchorage Current Property owner(s) Rick Erickson Day phone 227-3728 Mailing address Real Estate Agent 2. TYPE OF DWELLING: © Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 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: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSH # 05 C ;Z 1 171 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 Engineerinq 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: 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 guarantee 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. 6. DSD SIGNATURE fSystem #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, .sfN r'y !ornes 9. J, CE— 79`53 Q0 el � o #AECC884 ON-SITE WATER AND with the following stilIlio11�AST'_V'ATER o J� PROGFAM ,o By: V" ZOriginal Certificate Date: 1 a 1-I1)02 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 Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other 1" 0-y. O Wa So r � Y` 0A Legal Description: TALUS WEST #1; BLOCK 7, LOT 1 If more than iseptic system onlot: COSAChecklist #�of A. WELL DATA ILI]VVaUlog iofiled with Onsite (or attached) Date drilled Total depth 73 ft Cased to 73 ft 'Li -C, Sanitary seal is functioning correctly XVViresare properly protected Casing height (above ground) 12+ in Date of flow teat for C{)5A 11m0o1 Static water level at beginning of test 28.5 Comments XNEMNEMPIRM Ageoftenk(s) 25 years Tanktype/mateho| SE~~1d Measured operating fluid level inseptic tank _____ [01Stand pip*s/foundaUoncleanout per record drawing Date ofpumpingSEE ATTACHED HISTORY D.ABSORPTION FIELD DATA Which system tested (date installed) ___ 0ALL standpipes present per record drawing Total measured depth from grade _ft (max) Measured depth topipe invert from grade (min) 0N/A - pressurized field F�Monitor tubes Qotobottom ofeffective. If not, state depth into effective 17 Code-reauired soil cover over field L�] System presoaked (Required if vacant f eater than 30 days prior to date of test) _gallons ments/uemc/enoes: COSA Checklist yellow sheet Parcel ID: 015-202-45 Structure served by this system Well production ettime oftest 81+ ~pm Water storage tank volume N/A gallons Well disinfected for coliform hest? EJ Yes 1-0� No L!yCo|ihorm bacteria is Negative Nitrate 3 mA/L M Nitrate less than KARL (ND) � Ansenin_____ug/L ��/A'-raenioless than MRL (ND) Collected by GEG, LTD Date of Sample 11/30/21 C. LIFT STATION FlRequired maintenance completed Age oflift station years Lift station material Comments: Adequacy test date Results, EJ Pass For edrooms Fluid depth prior to in Water a �S,vdepth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12months) If yes, enter date _____ E. SEPARATION DISTANCES From Private Well mnLot to: (Please enter distances if less than required orhcommunUyWell) Septic Tank/Lift Station onLot >107 MYes ifNoft CommunhxSewer K4anhn�XC|eanout>10U' — Yes if No �»�ft E]Yes ifNoft Neighboring Tank >10I 17,7�Yas ifNoft Community Wells >2OO' ��Yen ifNoft Private Sewer/Septic Line >25'[,7]Yes ifNnft Absorption Field onLot >1OO' F�Yes if No N/A ft Holding Tank >1DO' El Yes ifNo��� ft Neighboring Absorption Fields >� 100' Animal Containment > 50' FV1 Yeo if No ft F/� Yee if � -- Manure/Animal ExcretaStnraDe>1UO. Community Sewer Main >�75' P71 Yes ifNoft [qYes ifNoft From Septic/Holding Tank onLot to: (Please enter distances if less than required) Building Foundations > 10' F71 Yes if No ft Surface Water > 1001 QV Yes if No ft Property Line >5' MYes ifNoft Wells onAdjacent Lots: Absorption Field >5' 1771 N/AYmn if Private Wells >188' F-1 Yes if No ~/5'+ ft Water Main >1O' 0Yea ifNoft Community Wells >2OO' ��Yen ifNoft 'Water Service Line >10' ��Yes ifNoft |fseptic tank isunder driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' if No ft If absorption field is under driveway comme Property Line > 10' Yes if No ft Wells on Adjacen Water Main > 10' Yes if No WellsYes Private >1OO' F1 Yes ifNmft Water Service Line �i 10, es I ifNoft Community Wells >2O0' []Yes ifNoft F.ENGINEER'S COMMENTS STEEL HOLDING TANK IS LIKELY APPROACHING THE END [lFIT'S USEFUL LIFE. / certify that / have determined through field inspections and review ofMunicipal records that the above systems are /nconformance with MOA COSAguidelines in effect cwthis date. COSA Checklist yellow sheet �3 fffVy' rn'*' k. 211 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Septic Tank Advisory Certificate of On‐Site Systems Approval # OSC211713 Subdivision: Talus West #1 Block:7, Lot: 1 The holding tank for this property is 25 years old. The averag e life for a steel septic tank is 20 years. Typical replacement costs range from $10,000 to $15,000. 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. (4,e Municipality of Aneje 1On-Site Water and Wastewateram(907)343-7904s,re, n 404.Certificate of On -Site Systems Parcel I.D. 015-2;1'�-45 Expiration Date: 1. GENERAL INFORMATION Complete legal description Talus West #1, Block 7, Lot 1 Location (Site address) 4200 Frontier Lane Anchorage, AK 99516 Current Property owner(s) Richard C. Erickson Day phone 952-8862 Mailing address 4200 Frontier Lane Anchorage, AK 99516 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: Three 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual ❑ Individual Water Storage ❑ Holding Tank E Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Receivedby: /_ hit/ ( �� Date: COSA to be relea d to h engineer, nless otherwise requested by the engineer. COSA Fee $ 60-vp �Waiver Fee $ Date of Payment -711-7115 Date of Payment Receipt Number 0T4(Pol�Sl Receipt Number COSA # © �J �7� 1 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 Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 6. DSD SIGNATURE 00 �;F�........ " �...... f(y System #1 Approved for �° • ELi�SERSON - bedrooms �� :, TMai System #2 Approved for bedrooms �I .-7-1 b....... Disapproved 4d4A!®aa®� vo�� Conditional approval for bedrooms, with the following stipulations: ��iiuutullr t, �—QN-SIVE =:g kn1ATER ANU By: /'" ` G /0,-e Original Certificate Date: Th unlcipa ity hwage Development Services Division (DSD) Issues certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet t:.:a c 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 7, Lot 1 A. WELL DATA Well type Private If A, B, or C provide PWSID # _ Date completed 9/18/77 Sanitary seal (YIN) Y Total depth 73 ft. Cased to 73 ft. FROM WELL LOG Date of test 9/19/1977 Static water level 33 ft. Well production 12 g.p.m. WATER SAMPLE RESULTS: Coliform 0 --L--c mL Nitrate 6.75 mglL Arsenic ND ug/L Dateofsample: 7/1/15 B. SEPTICIHOLDING TANK DATA Parcel ID: 015-202-45 Well Log (YIN) Y Wires properly protected (Y/N) Y Casing height (above ground) >18 in. AT INSPECTION 7/15/2015 18 ft. 10.5 g.p.m. Collected by: And. Engineering Tank Type/Material Holding/Steel Date installed 8/14/1996 Tank size 2,000 gal. Number of Compartments Cieanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping 6/23/15 Pumper A Plus Home Services C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d.tft2 or ft2/bdrm) System type Length ft. Width ft. Gravel below,pipe ft. Total depth ft. Eff. absorption area ft2 Monitoring tube _ Depression over field _ Date of adequacy. test Results (Pass/Fail) 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.) (YIN & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons Manhole/Access(YIN) in. "Pump off' level at in. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot NA On adjacent lots >1 00' Absorption field on lot NA On adjacent lots >100, Public sewer main > Public sewer manhole/cleanout >100 Sewer /septic service line >25 Holding tank >75 ' Animal containment areas > Manure/animal excrete storage areas >100 SEPTIC/HOLDING TANK ON LOT TO: Building foundation >51 Property line >51 Water main >10 Water service line >10 Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line Building foundation Water Service line Surface water Curtain drain Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P. E. Date 7/16/2015 COSA brown sheet 10-10-12.doc Absorption field >5, Surface water >100, Water main Driveway, parking/vehicle storage W E. ANDERSON CE -4381 '9-f 110 -t jv i,F Municipality of Anchorage Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www,muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 151364 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 7, Lot 1 of Talus West #1 subdivision. This inspection revealed a nitrate concentration of 6.75 milligrams per liter (mg/L) was reported for the property's well water sample. 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. 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. Municipality of Anchorage Development Services Department E= j Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. Dili_;0_45 COSA1f n(QO�iSU 1. GENERAL INFORMATION Expiration Date: 1 1— 0 - 0_C__ Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address TALUS WEST SUBDMSION A1: LOT 1. BLOCK 7 4200 FRONTIER LANE • ANCHORAGE. AK 99516 JERE WEATHERWAX Day phone 345-5552 4200 FRONTIER LANE • ANCHORAGE. AK 99516 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer 0 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Onsite Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 samples. (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 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. Phone Address 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines B Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local sols condition, 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 the system. Satisfactory lost results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore no provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole bonefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory 337-6179 Date % 1 ZZ /ob bedrooms, with the allowing stipulations: Arsenic Advisory Maintenance Agreements Supplemental Engineers Reort Other -.x-10. AAS 1�i ATE •• :TER AN WASTE R PROGRAM By: Original Certificate Date: 9-8—'06 Municipality of Anchorage otall ' Development Services Department Building Safety Division ` On -Site Water 6 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519.66M www.muni.orglartsite (907)343.7904 CERTIFICATE OF ON—SITE SYSTEMS APPROVAL CHECKLIST' Legal Description: TALUS WEST SUBDIVISION N1: LOT 1. BLOCK 7 Parcel ID: D 1 Jr -12 43 A. WELL DATA Weil type MYATE If A, B, or C provide PWSIDA N/A Date completed 9/18/1977 Sanitaryseal (Y/N) YES Total depth 73 ft. Cased to 73 ft. FROM WELL LOG Data of test 9/19/1977 Static water level 33 ft, Well Log (Y/N) YES Wires property protected (YM) YES Casing height (above ground) 18+ in, AT INSPECTION 6/22/2006 22 ft. Well production 12 g.p.m. 6.8 9 -P.M. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate SOP mgA. Other bacteria �colonies/100 m1. Arsenic: gJL. Date of sample: 6/22/2006 Collected by: GEG, Ltd. B. SEPTICINOLDING TANK DATA Tank Type/Material HOLDING TANK/STEEL Date installed 8/14/1996 Tank size 2000 gal. Number of Compartments 1 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (YM) NO High water alarm (YM) YES Date of purnpumg 5/30/2006 . Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.dJftb1r ft%dnn)— Length ft. Width ft. Total depth ft. F1f. absorption area_ ft' Monitoring tube System type Gravel below pipe ft. E of adequacy test Resulb (Pa Forbedrooms depth in absorption net _ in. Water added —gal. New depth —in. — min. Final fluid depth _ In. Absorption rate » g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 3 type) If yes, give date D. LIFT STATION Date Installed Size in gallons Manhde/Axess 'Pump on' level at _in. 'Pump off High water alarm level at Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tenM station on lot N/A On adjacent lots 100'+ Absorption field an lot N/A Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ Public sewer manhde/deenout N/A 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 fine 50+ Absorption field N/A Water main N/A Water service line 101+ Surface water 100'+ Wells on adjacent lots 751+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water service line Surface Driveway, parking/vehicle storage Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that / have determ/nad through field kopedADns and review of Municipal records Chet the above systems are in conformance with MOA COSH guldeUnes in efied on this date. Engineefs Printed Name JEFFREY A GARNESS Date -711Z/a' COSA Fee S 4130. Uo Waiver Fee E _ Date of Payment 3 J,0 G Date of Payment Receipt Number 3 j Receipt Number, (Rev. 1Imm . SGS Reta 1063350001 Client Name Gamess Engineering Group, Ltd. Project Name/a Talus West HI Lot Blk 7 Client Sample ID Talus West #I Lot DIk7 Matrix Drinking Nater All Dates/I7mes are Alaska Standard Time Printed Dale/time 07/07/2006 15:25 Collected Date/time 06/22/2006 10:20 Received Dale/Time 06/22/2006 14:05 Technical Director Stephen G Ede Sample Remarks: Parameter Results PQL Units Method Container ID Allowable Limits Prep Analysis Date Date Init Metals by ICP/14S Arsenic ND 5.00 ug/L EP200.8 C (<10) 06/28/06 06/10/06 Mil Waters Department Nitrate -N 2.83 0.100 mg/L EPA 353.2 D (<10) 06/23/06 ALR Microbiology Laboratory Total Coliform 0 col/100mL SN1209222B A (<I) 06/22/06 TLF FRONTIER LANE 1 a'L S 89°56'20"W 100.00' E OF. A t °144 ............................... o SHANE A. HOLT: !, LB -6914 ��G ..............O* - S 139"56'06"E 120.00' THEINFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PUTTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCELMES. ASBUILT SURVEY, NO CORNERS SET THIS DATE ) V-30' 1 HEREBY CERTIFY THAT 1 HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 1, BLOCK T. TALUS WEST NO. 1 ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THE VISIBLE IA VEMENTS SITUATED THEREON ME WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED PUT. ARE NOT SHOWN HEREON (UNLESS INDICATED) I DATED AT ANCHORAGE, ALASKA THIS 26TH_ DAY OF JUNE 1006_. NOTE ANY FENCELINES SHOWN ME LOCATED APPROXIMATELY AND ME HOT TO BE USED TO DETERMINE PROPERTY LINES HOLT LAND SURVEYING 6264. FB 64-74. 124-70 OR LOCATE STRUCTURES. TEL. N5 5512 ANY PAYING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS. E I I I I I E 1 I I I o I I I I3 I I ,0 I Im oI_ 1 l0 1 C. S I I I T 0 O o f I I 1p I I I I I { I I � I I I I I I I I I I I + +—-I----------- I 1 �.Y YIOrPOWCRATLLI II E OF. A t °144 ............................... o SHANE A. HOLT: !, LB -6914 ��G ..............O* - S 139"56'06"E 120.00' THEINFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PUTTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCELMES. ASBUILT SURVEY, NO CORNERS SET THIS DATE ) V-30' 1 HEREBY CERTIFY THAT 1 HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 1, BLOCK T. TALUS WEST NO. 1 ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THE VISIBLE IA VEMENTS SITUATED THEREON ME WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED PUT. ARE NOT SHOWN HEREON (UNLESS INDICATED) I DATED AT ANCHORAGE, ALASKA THIS 26TH_ DAY OF JUNE 1006_. NOTE ANY FENCELINES SHOWN ME LOCATED APPROXIMATELY AND ME HOT TO BE USED TO DETERMINE PROPERTY LINES HOLT LAND SURVEYING 6264. FB 64-74. 124-70 OR LOCATE STRUCTURES. TEL. N5 5512 ANY PAYING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS. MUNICIPALITY ANCHORAGE • `� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 0/S2G2 �/� HAA # \1!'1cVc r' SSL, 1. GENERAL INFORMATION Complete legal description '7AL1/6-R16r67--t&/ - r314 7 Zell Location (site address or directions) --/zoo Fro.7�i�/Lh. Property owner l Day phone Mailing address yZGO Frc��ie✓ La he AM-/�'Gs� 9i Lending agency Day phone Mailing address Agent �,"iic %sa � c /c iJh Fc Day phone o Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: S 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank _ Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-=(RW.1/01) Front M04121 S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm KNT) Fnginggring Phone —691- - Address - - 2 41 Ptarmigan Blvd. � •,� .. — __-- _ _ -- Engineers signature 6. DHHS SIGNATURE Approved for 2ZEE3) bedrooms. Disapproved. Conditional approval for Additional Comments Date OF 10 Kenneth hL 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. - 72-M (F%v. 1/91) Beck MOA m MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DiVIMCN e Municipality of Anchorage AUG 291996 !� DEPARTMENT OF HEALTH & HUMAN SERVICEfi Environmental Services Division IR E C E I V E D 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 / Health Authority Approval Checklist Legal Description: l�ua West `ll B 7 L / Parcel I.D.:_ D/$,Z O 4 yS A. WELL DATA Well type i It A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 9 9 7 Total depth 7.50 Cased to 7 3 Casing height (above ground) 2 3 Sanitary seal (YM) Date of test Static water level Well production FROM WELL LOG gL/8/77 33' /z g.p.m. Wires properly protected (YM) AT INSPECTION /75 2. '-f 9— p.m- WATER SAMPLE RESULTS: Cg Coliform ( Nitrate 3.9w ether bacteria Data of sample: 9116-191, Collected by: �iV12 T� B. SEPTIC/HOLDING TANK DATA Date installed J�� / Tank size 2 U DD Number of Compartments —AL Cieanouts (Y/N)_�L Foundation cleanout (Y/N) I Depression (Y/N) A/ High water alarm (Y/N) Y Data of Pumping NBPu Pumper .VA C. ABSORPTION FIELD DATA Data installed Soil ratin (g.p.d./fl' or tt'/bdrm) System type Length Width Gravel thickness bel pipe Total d pth Effective absorpti area onitoring Tube presen (YM)_ Depression field ll Date of adeq test Results (Pass/Fail For bedroon Fluid depth i absorption field befo test (il I mediately after_ gal. ter added (in.): Fluid dee (ins) Min later: Absorption rate = p.d. Pill treatment (past 12 ths) (YM) If yes, give da 72-026 (Rev. 3/96), D. LIFT STATION Date installed Manhole/Access (YM) High water alarm level at' Cycles tested E. SEPARATION DISTANCES Size in gallons 'Pump on" level at* 'Datum SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off" level at' Septic/holding tank on lot 75 + On adjacent lots 10 0, t Absorption field on lot N A On adjacent lots /06'-+' Public sewer main /0 '4- Public sewer manhola/deanout iy '+ Sewer /septic service line /V ' Lift station A1,4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation /b �a Property line / D Absorption field n/,4 Water main/service line /Ort Surface water/drainage /oD '4 Wells on adjacent lots 75- SEPARATION 5 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Building foundation Water main/service line Surface water rnreway, parking/vehicle storage area Curtain drain —7Wells on adjacent kits F. ENGINEER'S CERTIFICATION I cerNly that I have determined thru field inspections and review of Munidpaf records . V Atl eF!l�a, in conformance with MOA HAA guidelines in effect on dus date. ori.- �•-.••,f 1 Signature 0* 9.7li Engineer's Namele"AW Ad t KeMeM M. Du w �j Ce lie Date ; �/2 g �L f . `j /1 SW fit: 9�_'•Wl�L`•, HAA Fee $_,3 aD - dD Date of Payment fb? b, Receipt Number ;Z.2,6 72-028 (Rev. 3196)• Waiver Fee $ Date of Payment Receipt Number AUG 28 196 04:29PM NTL AN040RAGE P.414 NORTHERN TESTING LABORATORIES, INC. r• 33301NOUSTRIAL AVENUE FAIRBANKS. ALASKA 99701 (907) 456-3116 . FAX 4563125 ( 8005 SCHOON STREET ANCHORAGE. ALASKA 99518 (907) 349.1000 • FAX 349.1016 I RA'D Engineering Report Date: 08/26/96 70441 Ptarmigan Blvd. Eagle River AK 99577 Date Arrived: 08/16/96 Date Sampled: 08/15/96 Attn: - Time Sampled: 3.720 Collected By: mm MDL . Method Detection Limit Our Lab #: F164917 t Flag Definitions Location/Projeet= Kitchen Faucet B Below Regulatory Min. Your Sample IDs Talus West #1 L1/87 R . Above Regulatory Max. Sample Matrixl Water Comments: Lab# Method ParameterDate Date ----------Unite Results + MDL Prepared Analyzed £PA 300.0 Nitrate -N Reported By: Patricia A. 7 Senior Chemist mg/L 3.46 0.15 08/17/96 HUG 2B '96 04:2BPN NTL HNCNORPa P.3i4 NORTHERN TESTING LABORATORIES, INC. �' • 3330 INDUSTRIAL AVENUE FAIRBANKS. ALASKA 99701 800.5 SCI 100N STREET (007) 458-31I9 • FAX 4.%.3175 I APICHURAGE, ALASKA 90318 (907)349-10(X) • FAX 34511016 DRINKING NATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA NN Engineering 20441 Ptarmigan Blvd. Eagle River, AK 99577.3736 Phone No. Purchase Order No. Collected by: KNO Sample Type: Routine Untreated Method of Analysis: Membrane Filtration Comments: Public Nater System I.D.# Date Received: 96 Time ived: 18-oo Date Analyzed: 8/16/96 Time Analyzed: 1515 Date Reported: 08/19/96 Time Reported: 1054 Next Sample Due: Comments: S - Satisfactory U - Unsatisfactory POS - Positive Test Result ND - None Detected TNTC - Too Numerous To Count WOO Colonies) CG - Confluent Growth HSM - Heavy Sediment Masking, Results May Not Be Reliable SA - Sample Age >30 Hours But <48 Hours, 01d - Resultliabe SamplesAge >48tHoursBe elTool Old For Analysis R - Resample Required NT - No Test * # Colonies/100 ml ** # Colonies/ml Sample Sample Total* Fecal* Other* HpC** Date Time Coliform Coliform Bacteria Result Lab# Location --- - ------^------_ Comments 1 08/15/96 17:20 0 NO -------- ----------------------------------- 0 NT AC2282 Talus Nest #1 L1/B7 Satisfactory Kitchen Faucet Ju enchaefer E owtal Analyst n n 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 264-4720 Application Date B�r/86 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 607' /^ R[nct[ 7 -PAL u1 L -EST a/ Location (address or directions) ,/zoo Fne�.7rEre- LAroE Ar�CN•r Art. 99Srb (b) Applicant Name G EK Y Ano KEYc Telephone: Home ?4S- -f 63'1 Business S'64 -066C, Applicant Address -9200 Pf7o1.71fK LAMA AH1N. Art. 159516 (c) Applicant is (check one): Lending Institution O ; Owner/builder(; Buyer 13; Other O (explain); (d) Lending Institution 1tr MqT. iArrK of .41+,CN• Telephone 2615^ 3012 A~N• Al(. Address GJo LYH7HIA LAn704 - DIwl.r O Fi1?A"eA1 , PO. flax 11246'0�0 99511-2407 (e) Real Estate Company and Agent Address 1v/A Telephone NIA (f) Mail the HAA to the following address: C�`.w. Kf-v_L wd2k SG4-o�OgC-, 2. TYPE OF RESIDENCE Single -Family M Multi-Family[3 Other Number of Bedrooms 3. WATER SUPPLY Individual Well Community[3 PublicE3 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. \t I'tt; . 4. SEWAGE DISPOSAL Onsite Public[3 Community[3 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. Page 1 of 2 72-025 (11,84) ' n n 5. ENGINEERING FIRM PROVIDIN. INSPECTIONS, TESTS, FILE SEARCH, Dw1A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Lra�-rl�po�r FrrG�NF6Y2irrL NameofFirmH'9"ACf-WfrrT Telephone 390)--715'/ Address --7100 olb Sf&a, Ar2 rJ f/a.Y. LINiT ci Date ell sVeG 6. DHEP APPROV J Approved for bedrooms by to 5 Approved l� Disapprove Conditional Terms of Conditional Approval ,CAUTION Engineer's Seal .:,f, .P,f, OF Al 11p� Alb•rt L. Swank Jr. CE -4910 •. g/ir/e6:.. S` ROFES„-� C7/ \` 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 engineers work. Page 2 of 2 72-02511181) n G"T. C I- ; .rl a MUNICIPALITY OF ANCHORAGE (MOA) C vJi.'.C��'.=rT%� PdOi-CTION HEALTH AUTHORITY APPROVAL (HAA) �',Uh 1 .` CHECKLIST - FEBRUARY 1984 284-4720 + ..EC .I''�V E�ILJ Legal Description: LoT /— /3tecoe 7 a TatvS t�EST A. WELL DATA Well Classification PRtVA7E If A, B, C. D.E.C. Approved (Y/N) F/1.A Well Log Present (Y/N) 'yES Date Completed 9'/7- 77 Yield /Z 6r" . Total Depth 73 Fr Cased to 73 Ft Depth of Grouting NIA Static Water Level 33 FT Pump Set At NA Casing Height Above Ground T. Ft Sanitary Seal on Casing (Y/N) Yf5 Electrical Wiring in Conduit (Y/N) yEs Depression Around Wellhead (Y/N) No Separation Distances from Well: To Septic/Holding Tank on Lot //o F1- ; On Adjoining Lots H14 To Nearest Edge of Absorption Field on Lot 1Z5 Fr ; On Adjoining Lots Nip To Nearest Public Sewer Line /'/ ZA To Nearest Public Sewer Cleanout/Manhole /+r 1.4 To Nearest Sewer Service Line on Lot Water Sample Collected by 6E9NAR 0 k'EYL ; Date Water Sample Test Results 5A7/TFwf7a1+•1 Comments B. SEPTIC/HOLDING TANK DATA Date Installed 2-15"'79 Size *r /Z So (--%L No. of Compartments 2 Standpipes (Y/N) YES Air -tight Caps (YIN) yES Foundation Cleanout (Y/N) YES Depression over Tank (Y/N) ho Date Last Pumped APING /V6 Pumping/Maintenance Contract on File (Y/N) /YO ; for Holding Tank High -Water Alarm (Y/N) tic Temporary Holding Tank Permit (Y/N) NO Separation Distances from Septic/Holding Tank To Water -Supply Well //o F7- To Building Foundation /OFT To Property Line 3 o F T To Disposal Field / SFT To Water Main/Service Line A, �A To Stream, Pond, Lake, or Major Drainage h Course _, A Comments 72-026(11 ,84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata NIA Type of System Design LE,ecH Fr fc7 Date Installed 2_/5'_78 Length of Field So F f Width of Field 3 F'r Depth of Field /2 Fr Gravel Bed Thickness 8 f t Square Feet of Absorption Area 800 Standpipes Present (Y/N) WS Depression over Field (Y/N) /40 Date of Last Adequacy Test '7-/6 8 6 Results of Last Adequacy Test 2 5 9 2 G Ac. 10A y Separation Distance from Absorption Field To Water -Supply Well /2S FT To Property Line 2n F7 To Building Foundation 3 Sf r To Existing or Abandoned System on Lot /411 ; On Adjoining Lots /Y /A To Water Main/Service Line S') Fr To Cutbank (if present) N/A To Stream/Pond/Lake/or Major Drainage Course N/A To Driveway, Parking Area, or Vehicle Storage Area S-9 f r Comments D. LIFT STATION 1q14 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 Off" Level at Check Permitted Bedroom Rating Against HAA Request " Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA Icertifythatlh/a/c eckyed.veee ied,or onformed to all MOA and HAA guidelines in effect on the date of this inspection Signed /( 1Y JJCf.es DateS/E�e Company tnr.:o.ri 6*16/I/fin1.m OANO. If o4a.-Y+cfP.fnT, Receipt No. j o o % 13 0 0 0 - Date Date of Payment f 8 �� b ti�F, Amount: $ 1e 5'-'40 Page 2 of 2 72-026 111,841 Engineer's Seal • � n i ; \ hi l(f�( 'I I Ik, -111 Consu'tsnt Engineers Civ,!. Mechanra' July 25, 19£6 i Manufacw•inE Gerhard ti:. Keyl, Jr. Engmee,mF 4 Z ov FRo�v9!F% t r9r Froto:ypekescarcn Anchorage, Alaska 9958? 995i(, b Developmcnt REF: WELL AND SEPTIC SYSTEM ADEQUACY TESTS JOB: J398 Dear Mr. Keyl: V4Q On•B-= — July 16, 1986, Albert L. Swank Jr., P.E. (Alaska registered CE #4910) performed a well flow rate test and septic system adequacy test at your residence and found the following information. For the well flow rate test, flow rate, in gallons per minute (gpm), had to be determined. The time required to fill a 5 gallon container was found to be 53 seconds (.883 minutes). Flow rate gallons/time = 5 aal/.533 min. = 5.7 gpr.: = £208 gal/day. For the adequacy test, the existino septic system's absorbtion rate had to be determined by alternately filling the tank with water then letting it stand and calculating the absorbtion rate. During the test, the following data was recorded: Time of Day Minutes Activit• Gallons 7 :'1 F_0-6-0 � b u 114, i 8:05 to 8:35 30 REST --- 8:35 to 9:25 50 FILL 2S3 9:25 to 9:55 30 REST --- 9:55 to 10:45 50 FILL 283 10:45 to 11:15 30 REST --- Total ime= inu es, Uotal a ons= 9 Gallons Absorbtion - Gallons/Time =(849 gal/ 240 r.in)/2 = 1.£ gpm = 2592 gal/day. In order for the septic syster, to be approved, the Municipality of Anchorage requires that both the well and septic system have flow rates that exceed the requirements of the house, which are 150 gal/bedroom/day x 3 bedrooms = 450 gal/day. 4031 WspenCircle In summary, actual well flow rate = 8208 gal/day Anchorage. AK 99503 actual septic absorbtion rate 2592 gal/day (907)2485029 required septic absorbtion rate 450 gal/day According to our calculations, the septic system at your residence satisfies the requirements set forth by the Municipality of Anchorage. Con;uanp. Enpneers If you have any questions please do not hesitate to give re a call at 349-7151. Sincerely, Gv.!. Nccharnca' E Naloanu•ng Engmeennp Froto,.ype Research & Development 4031 Wspen Grcic Anchorage. AK 99503 (907)246 5029 Albert L. Swank Jr., F.E. ALS : }:fh i Nytol Swank h. W •., CE A910 v2i 9 �•`............ kk DFESS'�—' MUNICIPALITY OF ANCHORAGE N aO oulY -DEPARTM OF HEALTH AND ENVIRONME(""',t PROTECTION 825- L Street, Anchoraap. Alaska 99501 264-4720 #1: Time 10:30 a.m. Date 1-30-78 Insp Pratt Date Received: January 30, 1978 12: Time #3: Time Date Insp Date Insp ft REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Mailing Address: Phone: 2. Property Owner: Buck Hight Phone: 349-3494 Mailing Address: Star Route A Box 1586C 99507 3. Legal Description: Lot 1 Block 7 Talus West Subdivision 4: Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: Two Number of Bedrooms: 5. Well System: Individual Well (x) Permit # Depth of Well Construction Community/Public System ( ) 73' Well Log on File (xl9 Bacterial Analysis 6. Sewage Disposal System: On-site System (x) Public Utility ( ) Permit # Installed 197.7 Installer Septic Tank Size Manufacturer Absorption Area Soils Rate Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line I . 2. 3. 4. 5. � n MUNICIPALITY OF ANCHORAGE ;r Department of Health and Environmental Protection 825 L Street, Anchorage, Alaska .99501' " 264-4720 .. st for Approval of Individual Sewer and Water Facilities Property Owner: Mailing Address Name of Buyer: Mailing Address: Lending Institution: Mailing Address: Realtor/Agent: Mailing Address: Legal Description: Street Location: 6. Single Family Residence: Multiple Family Residence: Phone: Phone: Phone: Number of Bedrooms: ( ) Number of Bedrooms: 7. Water Supply: *Individual Well rr Public/Community System ( ) If Individual Well, well depth 95 If Community System, name of system 8. Sewage Disposal System: *bn-site System (.L)� Public System ( ) If On-site System, date of installation: / *NOTE: A well log is required on ALL wells drilled since 6/75. **If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77 Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 1 Block 7 Talus West Subdivision Comments: Affadavit Attached: j9 Letter Attached: ( ) Approved: � Date: Disapproved: Date: Department Worksheet: