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Home My WebLink AboutTALUS WEST BLK 1 LT 4Talus West Block 1 Lot 4 #015-201-27 Oeve(apmen Service= Department wilding Safety Divi=ian 'A ctar C Was'erlai er Pcagrcr 4.00 3ragaw 51ree' P.C.Sc-- 196-M .Anchoraie, 9-,.- .wert.9eaicn _ � A.I:?971a aao0 iwayar www mum.arn."mmyre (?OT) 293-7904 Pump Installation Lag ;Il DriIIing Permit iftumher: Stip(_ -cel Identification Number:_ ral Description 8 1 np Lnstallution Date: WEST 1, - 1f /2— Date of issue: Property Owner Name & ?address: I)wl- SC41,4- np Intake Depth Below Top of WeLE Caging: 134, feet mp Manufacturer's Nam>d np Model: =-P Size 31 hp less Adapter Buil Depth: /0 feet less Adapter binnufacturer s Mame: /�/} inp astsIIe- j✓�, y Orme Ml\ O ten ao n The pump insralker shall provide a pump installation log to the ➢SD within 30 days of pump installation MUNICIPALITY OF ANCHORAGE �v DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION , ENVIRONMENTAL ENGINEERING DIVISION 825 L Street • Anchorage, Alaska 99501 Telephone 264-4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME d OILv PHONE ❑NEW UPGRADE MAILING ADDRESS LEGAL DESC IPTION LOCATION NO. OF BEDROOMS O DISTANCE TO: Well Absorption area DwellingPERMIT NO. EzY Manufacturer Ma erial No. of compartments Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth —10Z DISTANCE TO: Well Dwelling PERMIT NO. _ ? Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: Well Foundation Nearest Igil yy!� P MIT N w Z F-? 2 No. of lines Length of each yne Total length f I' Trench wi th inches Distance between lines w1— O Top of tile to finish gr ade / Material beneath rile inches Total elf ti sorption area w f7 Length Witlth Depth PERMIT NO. aF wQ. Type of crib Crib diameter Crib depth Total effective absorption area w DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lo[ line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATER LS SOIL TEST RATING � c INSTALLER `5 REMARKS Iver _ r U` f Yom{ APPROVED DATE LEGAL jwq ja 1%5 l 0+// 72-01i3 Inev. J/Ial MUNICIPALITY OF ANCHORAGE DepartmentiO4'4 Health and Environmentar ?rotection 825 Street, Anchorage, AK. .9501 264-4720 * * r w a * Permit( ._ HANDWRITTEN PERMIT Lt 900 / ON-SITE SEWER PERMIT— _ Applicant: d G Mailing Address: Location: Phone Numb Legal Description: 6 l� Lot Size: Type of Soil Absorption 6ystem Is:'/ Trench: Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms:_ Soil Rating(sq.ft/br) _a,2_S— The Required Size of the Soil Absorption System Is: DEPTH 4?�— LENGTH . GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). �) * * REQUIRED SEPTICCNOL-9 fIG) TANK SIZE GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * *.* TWO(2) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection.and approval by this departmen will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3 * * * I certify that: (1) I am familiar with the requirements for on-site set forth by the Municipality of Anchorage. (2) I will install the system in accordance with cc (3) I understand that the on-site sewer syst4th tresid c is remodeled to include moSigne3: h1< < Issued b plicant Date: SWP/024(1/81) sewers and wells as enlargement if oms. GRE R ANCHORAGE AREA BO, `"GH • ��✓, Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME-OA2v CANDLE MAILING ADDRESS6946-f1MOTI4-/ PHONE544-9149 LOCATION HUFFMAN'^WILDC-110C--SS LEGAL DESCRIPTION LOT Q, BU I.-TALOS LUES SEPTIC TANK: DISTANCEQ–� / Ll L A fPprove d NUMBER OF FROM WELL _V MANUFACTURER V UC(R- MATERIAL STEEL COMPARTMENTS INSIDE LENGTH INSIDE WIDTH — LIQUID DEPTH -- I IQUID CAPACITY 1000 GALLONS. SEEPAGE PIT: ' NUMBER OF PITS DIAMETER —' OR WIDTH 17 , LENGTHZI, DEPTH 9' , LININGG-MATERIAL3 (DOZ CRIB 512E: DIAMETER 4 DEPTH9 DISTANCE FROM: WELL. LtLETe 2(MC75. }-20 / TOTAL EFFECTIVE 735 BUILDING FOUNDATION 3 88 � NEAREST LOT LINE ABSORPTION AREA (WALL AREA)! SQ. FT. /ADDITIONAL ABSORPTION WELL: TYPE PIRIVAIE CONSTRUCTION BUILDING FOUNDATION DEPTH DISTANCE FROM: NEAREST / NEAREST SEPTIC/ SEEPAGE LOT LINE ID , SEWER LINE TANK I I SYSTEM I � CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED DISTANCES: INSTALLED BY: PIPE MATERIAL, - C(!.4 -C 41 LOT SLOPE: REMARKS: Form No. EO -031 REMARKS DIAGRAM OF SYSTEM H0052 � r NOU5�1 • 97, IiO WELL DATE APPROVED 5ECPAot PIT- H -> G.A.A.B. d L .COu[ LINE1 r� GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL OUALITY ?4OO -I1P011 ROAD VOUCH R.BSO ANCHORAGC. ALASKA 99902 279.841lA SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT ` /lice/ (-4tic(ee INSTALLATION LOCATION LEGAL DESCRIPTION L y 3 INSTALLATION OF SEPTIC TANK TYPE. AND SIZE OF FACILITY TO BE SERVED SOIL TEST RESULTS COMPLETION DATE ANTICIPATED MAILING ADDNF.SS PIT f . DRAIN FIELD PERMIT NO. PHONE344 07NOTE, THIS PERMIT IS NOT VALID WITHOUT COIL TEST s�•� /LtZ: 3 F PFR MiT VAI iD 0IF YFAR FINAL IN:PCCTIONI 24 HOUR NOTICE RCOUIRED. BACKFILLING OF ANY GYCTEM WITHOUT FINAL INSPECTION DY THE HSALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. ---- SEPTIC TANK SIZE - 900 TYPEStPP1 DT rnn CZEtESEEPAGE AREA MINIMUM DISTANCES.RCOUIREMENTS Fee.%)ATION TO SEPTIC TANK 5 ft. FOUNDATION TO SEEPAGE PIT 20 ft• DRAIN FIELD 10 ft. SEPTIC TANK TO SEEPAGE PIT WALL 15 ft. - SEPTIC TANK 5 ft, . SEEPAGE PIT 20 ft. DRAIN FIELD 10 ft. TO NEAREST LOT LINE. nn WELL TO SEPTIC TANK A/ � SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK 10 ft* SEEPAGE PST 1O ft. . ORAIN FIELD 10 ft. . SEPTIC TANK. 25 ft- SEEPAGE PIT 100 ft- DRAIN FIELD 50 ft. . TO RIVER. LAKE. STREAM. DIAGRAM OF CY.^,TEM 1 C• CRIT IRP" SIPHON • Sfe:IC IIPC FISH AIR110NT 0110 IA::I`fCeS �SAS1 IRO SAIDONIVISTrrelp SOII IE�1S• INII:IPI x1F.IVUx C C Neel Rd M:e•ever Ilea eros", ICAI HM.r Jrhrrq. VAST 1 CERTIFY THAT AM FAMILIAR WITH THE PEOUIREMENTS OF DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE N II -f. t•:!iR lN:•I, IN AM SI[PCQ hl $011 1!)1. 0AS[e ON f' Aepel WATER: illi � Casae i'.Nr :CJ' Rr UN' P •ren: Peine IP Pm. idly PATS SIM. ~dIqt NfN.1 Y. S. Mr Im An Ile sleNf IevAIM. IIAne d INCH [ASI IRp" SIPHON PIP[ �S[AAC[ PIT �.MI0 CRAYft eACAFIII MINI NUN ANCHORAGE AREA BORqtf'Gtj ORDINANCE NO. 28.68 AND THAT THE ABOVE �..iE-�L.� PILI•' -:II "fit "f S' CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING OAP OF -1,]i.. II':'I YInUd1. EXCAVATION S FEET INTO UNDISTURBED SOIL. I:.' 1:.'..::::P• IPI1pp' I.P S: fiA lP:l• le A INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT f,:rl-I•upl IC FITTED WITH AIRTIGHT REMOVABLE CAPS. ' In e11- VO• jjyl- 41 GCAVEL DACKFILL dH•. r.T• ^•IT IPx4 SIV;" 1 II:I CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. Nhl'11f 111 Poo- i...•..:r4• P•g. P••n S•urR GI•• AT HEALTH AUTHORITY OR LICENSED DESIGNER '• AC':IAI.PH 1 CERTIFY THAT AM FAMILIAR WITH THE PEOUIREMENTS OF DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE N II -f. t•:!iR lN:•I, IN AM SI[PCQ hl $011 1!)1. 0AS[e ON f' Aepel WATER: illi � Casae i'.Nr :CJ' Rr UN' P •ren: Peine IP Pm. idly PATS SIM. ~dIqt NfN.1 Y. S. Mr Im An Ile sleNf IevAIM. IIAne d INCH [ASI IRp" SIPHON PIP[ �S[AAC[ PIT �.MI0 CRAYft eACAFIII MINI NUN ANCHORAGE AREA BORqtf'Gtj ORDINANCE NO. 28.68 AND THAT THE ABOVE �..iE-�L.� /z 1--:i- s- 1 Civil Engineers JAMES W. ROONEY, P. E. MALCOLM A. MENZIES, P.E., L.S. JAMES H. WELLMAN, P.E. May 24, 1973 ENCAEERING & GEOLOGICr%L CONSULTANTS 229 EAST 51st. AVE. — P.O. BOX 6087 — ANCHORAGE, ALASKA 99503 TELEPHONE 907-279-0483 TELEX 090-35419 Rappe Excavation 8001 Arctic Blvd. Geologists R & M No. 36616 Re: Test FIole and Soil Log Report for Sanitary System Lot 4 B 1 Talus West Sub -Division Dear Mr. Rappe: Land Surveyors RALPH R. MIGLIACCIO Engineering Geologist We are submitting herewith the test boring results and our comments regarding soil condition encountered at the subject site. This investigation was performed in accordance with your request of May 23, 1973, and those procedures outlined in a letter dated September 13, 1971 by Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of Environmental Quality. A single test hole was put down within the Lot 4 area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor -mounted backhoe and the test hole was extended to a total depth of 12 feet below ground surface. The final log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, P, & M ENGINEEERRRIING & GEOLOGICAL CONSULTANTS y ' - I James W. Rooney Partner xc: GAAB JWR:sm ANCHORAGE FAIRBANKS JUNEAU r !o-----� GREATER ANCHORAGE AREA BOROUGH 3500 TUDOR ROAD ANCHORAGE. ALASKA 99507 December 4, 1972 Gary Candee 6943 Timothy Street Anchorage, Alaska 99502 DEPARTMENT OF ENVIRONMENTAL QUALITY 13nvnn lyt"W OVIAN3 J0,U;0 1M�'0" V38Y ID"OKWV a31v3aD Wd ZL618 - ,,,,, QaAI$pgg �N Subject: Permit to install sewer system Dear Sir: A permit was issued to you by this Department for the installation of an on-site sewer system and at this time we have no record of this system having been installed. Please complete this form and return it to this Department at your earliest convenience. yes no 01. The system has been installed. 2. The system will be installed later this year. 3. Void my permit; the system will not be installed. Q] 4. The system will be constructed during the next construction season. Your cooperation is requested as we have a great number of outstanding permits for 1972 and we would like to clear our permit files out as much as possible. hank you, elu� John R. Lee, R.S. Environmental Services Supervisor r !o-----� GREATER ANCHORAGE AREA BOROUGH 3500 TUDOR ROAD ANCHORAGE. ALASKA 99507 December 4, 1972 Gary Candee 6943 Timothy Street Anchorage, Alaska 99502 DEPARTMENT OF ENVIRONMENTAL QUALITY 13nvnn lyt"W OVIAN3 J0,U;0 1M�'0" V38Y ID"OKWV a31v3aD Wd ZL618 - ,,,,, QaAI$pgg �N Subject: Permit to install sewer system Dear Sir: A permit was issued to you by this Department for the installation of an on-site sewer system and at this time we have no record of this system having been installed. Please complete this form and return it to this Department at your earliest convenience. yes no 01. The system has been installed. 2. The system will be installed later this year. 3. Void my permit; the system will not be installed. Q] 4. The system will be constructed during the next construction season. Your cooperation is requested as we have a great number of outstanding permits for 1972 and we would like to clear our permit files out as much as possible. hank you, elu� John R. Lee, R.S. Environmental Services Supervisor GRATER ANCHORAGE AREA BOROUGIi Geoartnent of Environmental Quality 3500 Tudor Road, Anchorage. Alaska 99507 274-B686 Date Received Time of Insoscticn %Oct tct6 , Date of Insvection� REQUEST FOR APF ;OVAL OF O INDIVIDItL SEVER d WATER FACILITIES FOR s- 1. Approval Rcypacsted By: Address: Phone: 3+r�-9iK9 2. Prooerty Owner: Phones re 3. Legal Description: A" ' 4. Location: 5. Type of Facility to be Innsspeected:� Nunber of Bedrooms: 6. Well Data: A. Type dLjz'--1� B. Depth C. r/ n Constructionc,G D. Bacterial Analysis c -� 7. Sewage Dis-)osal System: A. Installed S - 2 S - 3 B. Installer , C. Septic Tank: 1. Size/ 2. b'anufacturerFE/2 D. /� Seepage Pit: 1. Size 17%2 `7 2, Material3 GrIlICA11h, E. Disposal Field: Total Length. of Lines �— / B. Distances: 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 /av` 6R 35 v7 liecpce;t for Approval of Individual Sewer dater Facilities Page Tyco �-/Approv / i+n �.'lCGfi�Elii'ap, roved Date y �% Approval ppr al lalid for One Year From Date SionPd Greater Anchorage Area Borough, Depart-ment of Environmental Quality DIAGRAM OF SYST01. . 2 -u6 P eirfAr- I certify that the information contained in this request for approval to be a true and accurate representation of the subiect sewer and water facilities located at: Dateu� /4 73 r�, I c6-1220 (a) STATE OF ALASKA DEP"VENT OF HEALTH AND SOCIAL Sr''9CES DIVISION OF PUBLIC HEALTH BACTERIOLOGICAL WATER ANALYSIS DATE P=IC ❑ SFsad91BUC ❑ B81 WAL O OTifBt RUKW RCSULTS TO NAME ADDREIS CRY OAtDRSOt�1SCt '�i / J� �. SAMPLE COLLECTED BY r DATE COLLECFID Sampl. CaRecwd From 0 CIA -Tap ❑ Oder aAw Lob. Ne. Records Is thio Wice bNosw this WATER SUPPLY to be ok ❑ Salbiac•Iory ❑ Wwbsa6Y ❑ UmWaaotr Son" Stow - Analysis shows this Wabq SMQ18 to br ❑ Saddomory ❑ Questionable ❑ UvorY6naory.. R m '{wesNdaororC or "OladoaaAii sista b Idlmhd clow Fou ehostd tdrs fasediob atlla as n000asod,d blow. 1. Haiti p eoo•Imeor waw b padluted. BoU or chemtan 'roar thwow o outlined w the snclo�d Isalbr 'Drink It Pure.' 1 Increase chlodwafta suffkiondy to meet recommended residual standard.. a® Determine source of oontaminaibn and take action necessary to assiaR n. Pm a saw waw supply of all taw. Bntwcam TOP • , ❑'Borcmeot Tay — 1 Check chlorination and other mechanical equipment Mab Certain N is fanafotlo9 Property. Wel ❑ Duq ❑ DMrea ❑ AB SOURCE: ❑ Bpdeq ❑ Cistern ❑ ah Dug Well or cavern Cooaruabm Watts. ❑ wood ❑ cc, w ❑ Hetet ToP • ❑ '.Vood ❑ Cmaw ❑ Mord LOCATION: ❑ to Ba.mest ❑ Basmew oftw ❑ INTesd ❑ Dur Sown DISFASCE TO: LOM g qa Pip. ever • field FeeL ph Po9'• Fete.. Pool — dh—ie Btl.TMIAL: Building Sewer. ❑ b� ❑ Wood ❑ TSe ❑tide - ❑ �t � B. Contact year stearal ❑ Local Health Department or � ❑ Alaska ❑ Plostb Moroi Mdrb! _Type orW®ce Public flodih, sanfwliaa olDas for buSeaw, oeard'mloe and OCNIEPAla Does Waw Becoar Noddy of Dbwkr*V ❑ Tes ❑ No SANITARUIN'S REMARKS wa.ar Diam.l.r of W.n Depth F.A. W.11 Caenq Dias d Mar.rbl Dep Dead °tP 1 FuL Drop Pp PIMP LOCATION: ❑ b Wes ❑ bamon"a �t ❑ Ins --- ot ❑yo 13 (St list ❑ Odwr PURPOSE OF EIIANINAYm Blo— RosprsledT - ❑ Ta ❑ Na pew seam of 41ypie ❑ Tse ❑Ire IwpaiwtesTdeaT ❑ To, ❑ No READ INSTRUCTIONS ON REVERSE SIDE BEFORE %1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Dm.wale.d - ' Ttme R.o.4vd - tete lie. AGAR COLLECTING SAMPLE sob` (hon..aoa. _Codiarm Dwwip —Ocher i abobielb. pr laoeal _Dwgo tT..1 . _MpaM ter - Dete w .. Tbts asdyst. bdim'r CcMoa Orgsofecu. to Dr Absent -. _.�� -/ n ..P..ael — C R after checkfaq equipment a disinfeelinq residual Is Dol obtained. plea wire this office for eaergancy assistance or advisory serviom A ❑ Bared S This Is a surface water source and subject to pollution by ma and ambab. a An approved water apply source should be developed. 13 To. ❑ sea oris con❑ — B. baprvee 7w[ ❑ spring - ❑ dnq well ❑ ddsaa well Open Top - ❑ drilled well ❑ cWero ❑ Udder House — 7. Relocate your wall to a sale location In miationship to Four sewage disposal system. ❑ sore suksm" puc TOT'k T+.L R. Salpb too bnq In tmaelN sample should pot los over, M boos old at .F.st. P i r F.eL eaadoatlon to indicate reliable results. piers send dew eompis. ❑ BOWS ffieba In btmriL please seed Bsw sample. . Btl.TMIAL: Building Sewer. ❑ b� ❑ Wood ❑ TSe ❑tide - ❑ �t � B. Contact year stearal ❑ Local Health Department or � ❑ Alaska ❑ Plostb Moroi Mdrb! _Type orW®ce Public flodih, sanfwliaa olDas for buSeaw, oeard'mloe and OCNIEPAla Does Waw Becoar Noddy of Dbwkr*V ❑ Tes ❑ No SANITARUIN'S REMARKS wa.ar Diam.l.r of W.n Depth F.A. W.11 Caenq Dias d Mar.rbl Dep Dead °tP 1 FuL Drop Pp PIMP LOCATION: ❑ b Wes ❑ bamon"a �t ❑ Ins --- ot ❑yo 13 (St list ❑ Odwr PURPOSE OF EIIANINAYm Blo— RosprsledT - ❑ Ta ❑ Na pew seam of 41ypie ❑ Tse ❑Ire IwpaiwtesTdeaT ❑ To, ❑ No READ INSTRUCTIONS ON REVERSE SIDE BEFORE %1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Dm.wale.d - ' Ttme R.o.4vd - tete lie. AGAR COLLECTING SAMPLE sob` (hon..aoa. _Codiarm Dwwip —Ocher i abobielb. pr laoeal _Dwgo tT..1 . _MpaM ter - Dete w .. Tbts asdyst. bdim'r CcMoa Orgsofecu. to Dr Absent -. _.�� -/ n ..P..ael WILLIAM A. fGAN, GOVERNOR I)EI'T. Ol' ENI'litON31E.N-T.►l, IU(-;L(Ile\SILJE-lltVAUT\I`\1OIN sou THC[NERAL REGIONAL OffLCF MACRAY 8LDG. 938 DENALI STREET Ma.TC.1l 15, 1973. ANCHORAGE 99501 ?fr. G^.ry Cam -lee 6943 Timotlrj Anchorage, Alaska 99502 SLWECP. Lot 4, Block 1, --Talus Hest Subdivision Dear Mr. Candee: We have reviewed your situation in light of the interpretation of the 40,000 Sq. Ft. -20,000 Sq. Ft. requirement contained in Section 18 AAC 72.030 of the Department of Environmental Conservation haste Water Regulations. It is our finding that since you had mmership of the lot on or before February 5, 1973, and that you intend to construct a private residence for your personal use, that this particu- lar Section of the Waste Water Regulations is not applicable in your case. We would however advise you that of course all existing Borough Regulations are in effect and are applicable in all cases except where State requirements are more stringent. cc: CAAB-DEQ -"' Yours truly, KVyl ry Regional vironnenta Engineer RECEIV$b HAH 1 61973 AM a"PT. OF ENVIANCMORONM!lA 146 EA 80Pq/f.11 OU4g1 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. nIEi- I -L4 COSA# Ln '�L)nb� Expiration Date: %—/ 0 - OR 1. GENERAL INFORMATION Complete legal description Lot 4; Block 1; Talus West Subdivision Location (site address) 4821 Talus Dr. Anchorage, AK 99516 Current Property owners) Pichard Moore Day phone 677-2163 Mailing address saR18 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well El Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Q Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ 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 On -Site 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 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 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 s a s Engineering Address 15861 S. Birchwood Loopc. r k, PJ( 9ss Engineer's Printed Name !. 5. DSD SIGNATURE _k�_ Approved for Disapproved. 3 bedrooms. Phone 694-2979 Date ` 17, o Conditional approval for bedrooms, with the following stipulations: it. $"W tan.1 Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: 0—Q6 (u« I1W) I Municipality of Anchorage •• • '1 Development Services Department 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 L'OF�ON-SITE SYSTEMS APPROVAL CHECcK�LIST Legal Description: "T � "L� � �wS ''T S/p Parcel ID:[1i✓� A 01_12 7 A. WELL DAta _ ` �)-IIV14-M If A, B, or C provide PWSID # Well Log (Y(N Well type 'cdA473Sanitasea ) Wires properly protecte De omp t it Total depth _Lq3 ft. Cased to ft. Casing height (above ground) 17- 4n. FROM WELL LOG AT INSPECTI N Date of test 3 2 Ooh Static water level2!5fg.p.m. t• ' ft'PWell roduction ter; g.p.m. . r WATER SAMPLE RESULTS: Coliform Q_colonies/100 mL Nitrate mglL Other bacteriay colonies/100 mL Arsenic: & ug/L date of sample:: ZWof, Collected by: g liyFl<P_1n JA-7C. � B. SEPTICIHOLDING TANK DATA Tank Type/Material Gmic , Tri_ Date installed42,�r Tank size /COOgal. Number of Compartments 22 CleanoutslJ) yE'S �� ,.�� t ' D Foundation cleanou�l) ' yL� Depression over tank (Y/®, /tea High water alarm (Y& —10-0 Date of pumping Pumper f f r lm i aeYlC L�� C. ABSORPTION FIELD DATA Datem$$�� +- Sta7ed r 3 3 'Soil rating (g.p.d.lft' ft�lbd aZ System type T"—IM Length b� r ft. Width 1r 2 ft. ��,Gravel below pipe 6 ft. Total depth L ft. Eff. absorption area 67 tt= Monitoring tube *-S Depression over field Date of adequacy test z Results Pas ail) � For 3 bedrooms 11 Fluid depth in absorption field before test 32 in. Water added/CCOgal. New depth 3 in. I Elapsed Time: Q min. Final fluid depth in. Absorption rate >_ 90+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y(9 type) 012 If yes, give date D. LIFT STATION jU/n Date installed Size in gallons 'Pump on' level at _ in. 'Pump off' at in. Datum _ Cycles tested E. SEPARATION DISTANCES High water alarm levet at Meets alarm d circuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: �/ I r.�STAULrO pR1C2 / Septic tank/lift station on lot ! vn lo/M73 On adjacent lots Absorption field on lot /CD On adjacent lots /co 14 Public sewer main /V�/4 Public sewer manhole/cleanout AJfN _ Sewer/septic service line oZs ta' Holding tank Animal containment areas SO t Manure/animal excrete storage areas /Q9 't- SEPARATION tSEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation $ Property line $ Absorption field $ "r Water main _ /l7 /a Water service line /O00 a Surface water � Wells on adjacent lots /ck!!;) q f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: J Property line it Building foundation /O Water main Water Service line D '1 r �_ Surface water /� Driveway, parking/vehicle storage D 'e` Curtain drain A%CVC,- K/tereIV Wells on adjacent lots _ 100 1 'PialVH7£ 155 It TC> «pss A�i�C F. COMMENTS / G. ENGIWEER'S CERTIFICATI I certify that I have determh review of Municipal records conformance with MOA COS) Engineer's Printed Name _! Date G COSA Fee $ Date of Payment Receipt Number cil (Rev. 11/05) field inspections in k'�u in Waiver Fee $ Date of Payment Receipt Number C /a SOS ReEX 1081142001 Client Name S & S Engineering 1'rolect Name/M IA DI Talus West Client Sample ID IA Il l Talus West (Matrix Drinking Water P%VSID Sampte Remarks: All Datesmates are Alaska Standard Time Printed Dalefrinne 04/09/2008 10:36 Collected Dateli'ine 0320/2008 13:50 Iteceived Datelrinne 03202008 15:10 Technical Director Stephen C. Ede Allowable Prep Analysis I'usneter Results POL Units Mcdwd Container II) Limits Date Date Unit Metals by ICP/NS Arsenic 7.46 5.00 ug/L EP200.8 C (<10) 0325/08 04/04/08 NRB Waters Department Total Nitratc/Nitritc•N 0.999 0.100 mg/l. SM20 450ONO3-F D (<10) 04102A)8 L Ir Microbiology Laboratory Colony Count Tonal Colifumr Fecal Coliform 0 0 0 col/100mL SM209222B col/100m, SM209222B eot/100nd, SK1209222B A A A (<200) (<I) (<I) 0320/08 0320/08 0320/08 MC bLC DLC Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 015-201-27 COSA# INDMeg Expiration Date: co=7 — O iNK 421 :7_1gI�1;[*1:IIT, L•YlEel 21 Complete legal description Lot 4; Block 1; Talus West Subdivision Location (site address) 4821 Talus Dr. Anchorage, AK 99516 Current Propertyowner(s) Lee Schooler Dayphone345-2962 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System Day phone Day phone TYPE OF WASTEWATER DISPOSAL: a Individual On-site 0 ❑ Individual Holding Tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ 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 On -Site 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 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, 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 S & S Engineering Address Engineer's Printed Name S. DSD SIGNATURE ✓ Approved for 3 Disapproved. Conditional approval for bedrooms. Phone 694-2979 iver, AK 99577 Date, —6-0&-' A. odd 4m4 bedrooms, with the following stipulations: Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By 4(61 / Original Certificate Date: 3 ` 7 — 0 �o (Rev. 11A5) Municipality of Anchorage • Development Services Department Building Safety Division ` On -Site Water 8 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 CHECKLIST Legal Description: LT 4j3( (cz k ' : J A-u)S it Dr3T nk Parcel ID: O 16 - A. WELL DATA Well typ RIVAl t� If A, //B, or C provide PWS�IDD�# Date completed — TO �I�Sanitary seal (&Y N),� Total depth J93:ft. Cased to fid+ ft. FROM WELL LOG Date of test Static water level Well production 9.p -m. WATER SAMPLE RESULTS: Coliform _colonies/100 mL Nitrate 0.7 3 mg/L Arsenic: _� mgA Date of sample: 2 1 lm' B. SEPTICIHOLDINO TANK DATA Well Log (Y& Q6 Wires properly protected(ON) N11eg Casing height (above ground) IZ t in. AT INSPECTION tol2r, Cr, it) I / ft. Ho g.p.m. Other bacteria D oolonies/100 mL Collected by: 54--45 Epcuf"r- vZlK76 Tank Type/Material SE i'T)L I S-irL-(_ Date Installed 5 /as 1 -4 --,- s1-4--,- Tank size IQM gal. Number of Compartments _•;_� (i1 Cleanouts&) 7� S Foundation cleanout Depression over tank (Y(P1�V�t High water alarm (Y& ► 0 Date of pumping 10111 S Pumper tb r/ / l ac C. ABSORPTION FIELD DATA Date installed 525 15 ItSoillrafing (g.p.d./ft=fiz/bdr 2S System type 6'el Tl`AX-t'( Length.'2q' I ft. Width 1 ft. Gravel below pipe '1 Total depth j3 ft. Eff. absorption area3P67Monitoring tube d�Q Depression over fiei Date of adequacy test itTatxxn)Resu Pas ail) For 3 bedrooms Fluid depth in absorption field before test ,52 n , in. Water adde&7�gal. New depth in. Elapsed Time: 10-9 min. Final fluid depth 62" in. Absorption rate >= f 'f g.p.d. Any rejuvenation treatment (past 12 mo.) (Y& type) K_V; If yes, give date D. LIFT STATION f 31A Date installed Size in gallons 'Pump on" level at _ in. 'Pum Datum Cycles tested. E. SEPARATION DISTANCES SEPARATION DISTANCS_EN ELL ON LOT TO: Septic tankllift station c n trot 1 Absorption field on lot /- f Public sewer main Nilt4 Sewer /septic service fine 25 1-1 Animal containment areas S014 in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 160 t+ On adjacent lots 10014 Public sewer manhole/cleanout KDA Holding tank ilk Manure/animal excrete storage areas I cct '4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: t Building foundation 5 4 Properly line s i–t Absorption field 1 5 "L' Water main 01A Water service line 25 41 Surface water /Lo 14 Wells on adjacent lots in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1 j Building foundation U) * Water main A-)1 A /0 I Water Service line aS 1 Surface water. 0 r -L Driveway, parking/vehicle storage /O Curtain drain t+!oWE KAZ tW#0 Wells on adjacent lotsI tX� 11 t�Ql ✓FtT�(I 581 + TO c ut's5 A F. COMMENTS 1I F16Lb tK35TPK- .- , G. ENGI EER'S CERTIFICATION t&> rtitEb t"-loQ- To ocZX 7 1 certify that 1 have determined through field inspections and review of Municipal records t e above systeryryss are bn conformance with MOA COSAocutdiffnes in effect on this dafbl Engineer's Printed Name r4T Date COSA Fee $ �f 3 Waiver Fee $ _ Date of Payment /i – C G Date of Payment Receipt Number 3 3 q 16 8 Receipt Number (Rev. 1IM) Wo &'jh sl► tlpa .4 An'i•w nol� 11•• •'-1 r V \IM YM! i1• I•f.Yli M+ pi�Al pYJIWWi Y\Yt- '_ PI 011114 YIWi Yu rrllW Yq•Il -• J•••_ J• l� M� Fav°s5•ru•;� /a•>=. JIJ • - ' ' /n• uric. �.;��>--._-___ .-�—•--- C. Or 1 x F. ♦1 IAI i; 711171,ees Ax. SURVEY LERTIFlCATIGtU I says+'+IIyPreparell by MUE P1.u1 - ,•'"�� :.!:�'.,f�°o, Robert E. Johns, Jr. & Assoc. u.ar .w AN lrr lbwwf a•»N �''Q�.••'•••• �".,S � T .i 4 1' a.wr.awlw.nw ra.rwrl eG�• ••• ,f'-9 ITOl..SSIQTI 111 L4r':• nlri-i P.yi4.`• . rr Y. .,1 +.r.. r w a. .! j • r1 IT- I IA VR. w a...• •. N = r 1•`x•1..1 w•�. A;1 �� .. 1} I/ 11/f,•Qx: A•:1A , AI A':A'.L 94741- _ Mr.N ti W •�-'. i • i• ....... l I 51. L O iNIC l 11 C J tll 11.•: .1 •�_ �— 1 21. I r r•b: I • 11. rrulrxlAnal A:. -IA +r a...• .. .�.=)..... ...,. YIN i....ra t_u•ai 1. wr u'r1J O �"... i /••r llob :rnw)sA: IL—II-I)J Cr prp Sg 1T :hwh•11 Sy __- • yr: w,u... r.� �.: •.. r..... � ' :M: ; itERI E. J•" -1Y •:,.� t... IN �- •. .. r.—� . .w' ..Aua • i of UAlrl .11'0.1.qhY A'U ...•...... A}ails �I•ll•-.CJ�: �• ��°rl LI"lt�-i7'i •. •I S'� j-1:13 LOT 4 WIR I .._... ..• u.r 1 w w. rw �wewaaa Q'ALtts 1ieEsL :iulJllivirUl:'.0 n to, L_P.i LI wiwwl AY -a 11 SURVEY TYPE-•---�_�EIABfJL:i ~.—._•.- :1:r AfRAIt l- - m I I mV )pp.41V1 AJ-) al r { ,� Mf N15li ' ==` •-� itil'IIH.I n r1.■<u nr11Ar S E1 Mui Mur ....i 111,1 .. LOIYagY... %i+fs..H• -J..Y-O mr,-L fill MICE l�._. _.� 1•W ItiR rru�l� P; 1'Yta�� .Mx' M• b• Ip rrfi)f 1 Q11U �� A9t)IllOf LY�� IfV. ...-. 44r'�NI'f PLOT PLAIIS k LOT SURVEY: H -01P Il IS WL r•L!d>(I:ISUIII IY Q' '111-- IIIJI[OQR NJ (M"ER• P -MOR TO ONLY 71109.1W, IIIPR7YCL10Nn AR1)Y1: .1\:)'.1111: .111'1 1411.,A.l wit r.l' P:III$fill A"1:1:11• lu A1111iY 117.111.11.1111 LIA,114411 (h AOL IMAIIVE CNcwj. ixN(.L3, wru.S. 8TY'TN: f.l i.A!'411 :, 1111-IA'AlM7. I••1d eV. i', Til II'/1;{IIPP (JiACC MW'IT(•T•f CE411PEouu1s At,[) 10 OSIERUYIE CIC., AP[ S11p11;11 YJ TI1f.IR .1.P✓AWJ-Ig11. 11 (:q f•!ui. lYp1'. !Ani.Y fIII'. fxl:ilflPti III All'( CAi14E141% I}Y•11i11AN1i11 W Pt.-MOCIICIM NAY PREV[IlT SCRIC IIA RJY{,NI.PITG Ilb'.A V:101 Lill "Jill UWAll... 11,:111.11 DO N111' APPEAN Ml T1 1^,T k4COf.000 E(IRV14i.IL14 PLAT. A1.. 019TAfICBTi ARF! ftf.f:-•If Lj Jill, • 1111 r.'h :'1•- 11�nLL• IY71:111 1x1 LY71 u1STi)'i7.3 5110116 M: AS-EJtl.1 RF USJ''U TOR CIMISIIUCR041 (ri Rift (;11•011U11N1 RVJP•.!Rf 1'dt •Lll1!: typt; Lk UNVAtA 1AALS PEWMJ-3111f FOR ME. YIIIIAL TIIMI".ACRg1 7111-Y N:U ASUME3 FOIA1NTAL 11-10.lTf fJP.f 1•/i lift Cl.l 111 dl! "IL'4r I I3 -SP C:P•1M40r.S PAiVAIL VVAA $CAI NO. REPROOIk01Yl MAY CAUSE' ERGfYIi H .^,CAII SCS ReLM Client Name Project Name/N Client Sample ID Matrix 1060735001 S & S Engineering L4131 Talus West SD 1-4 BI Talus West SD Drinking Water All Dates/rimes are Alaska Standard Time Printed Date/time 03/022006 11:15 Collected Date/time 02/132006 16:35 Received Date/time 02/132006 16:57 Technical Director Stephen C. Ede Sample Remarks: SM20 23208 - Alkalinity analyzed after hold time had expired. Allmsable Prep Analysis Parameter Results PQL Units Method Conuiner ID Limits Date Date Init Nitrite -N ND 0.100 mg/L EPA 353.2 D 02/13/06 1C Nitrate -N 0.730 0.100 mg/L EPA 353.2 D 02/13/06 JC Metals Department Ilardness as CaCO3 144 5.00 mg/l. SM20 23400 C 02/15/06 02/15/06 TK Private Individual Analysis Aluminum ND 20.0 ug/L EP200.6 C 02/15/06 02/15/06 TK Antimony ND 1.00 ug/L EP200.8 C (<-6) 02/15/06 02/15/06 TK Arsenic ND 5.00 ug/L EP200.8 C (<-10) 02/15/06 02/15/06 TK Barium 7.50 3.00 ug/L EP200.8 C (<-2000) 02/15/06 02/15/06 TK Cadmium ND 0.500 ug/L EP200.8 C (<-5) 02/15/06 022/15/06 TK Calcium 41100 500 ug/L EP200.8 C 02/15/06 02/15/06 TK Chromium 1.96 1.00 ug/L EP200.8 C (<-100) 02/15/06 02/15/06 TK Copper 25.2 1.00 ug(L EP200.8 C (<-1300) 02/15/06 02/15/06 TK Iron ND 250 ug/L EP200.8 C (<-300) 02/15/06 02/15/06 TK Lead 4.02 0.200 ug/L EP200.8 C (<-15) 02115/06 02/15/06 TK Magnesium 10100 50.0 ug/L EP200.8 C 02/15/06 02/15/06 TK Manganese 1.52 1.00 ug/L EP200.8 C (<-50) 02/15/06 02/15/06 TK Phosphorus ND 200 ug/L EP200.8 C 02/15/06 02/15/06 TK Fluoride ND 0.100 mg/l. EPA 300.0 C (<-2) 0228/06 JEhI Chloride 7.85 0.100 mg/L EPA 300.0 C (<-250) 0228106 JEM Potassium 888 500 ug/L EP200.8 C 02/15/06 02/15/06 TK Selenium ND 5.00 ug/L EP200.8 C (<-50) 02/15/06 02/15/06 TK Sodium 3290 500 ug/L EP200.8 C (<-250000) 02/15/06 02/15/06 TK Silicon 4930 200 ug/L EP200.8 C ON 15/06 02/15/06 TK Silver ND 100 ug/L EP200.8 C (<-100) 02/15/06 02/15/06 TK Sulfate 17.5 0.100 mg/L EPA 300.0 C (<-250) 0228/06 JEht Thallium ND 1.00 ug(L EP200.8 C (<-2) 02/15/06 02/15/06 TK �I J SCS ReEN 1060735001 Client Name S R S Engineering Project Name/4 L4 01 Talus West SD Client Sample ID L4 B Talus West SD Matrix Drinking Water All Dales/Tins" are Alaska Standard Time Printed Date?ime 03/02/2006 11:15 Collected Date rime 02/13/2006 16:35 Received Dale rime 02/13/2006 16:57 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results POL Units Method Container ID Limits Date Date ]nit Private Individual Analysis Total Dissolved Solids Zinc Nickel IIC03 Alkalinity CO3 Alkalinity 011 Alkalinity Conductivity PH Alkalinity Total Coliform 176 10.0 mg/L SM202540C D (<-500) 02/16/06 KP 274 5.00 ug/L EP200.8 C (<-5000) 02/15/06 02/15/06 TK ND 2.00 ug/L EP200.8 C (<-100) 02/15/06 02/15/06 TK 143 10.0 mg/L S%120 2320B D 03/01/06 PLW ND 10.0 mg/L SN12023200 D 03/01/06 PLW ND 10.0 mg/L SN12023200 D 03/01/06 PLW 340 1.00 umhos/cm SX12025100 D 02/15/06 PLW 8.00 0.100 pi units EPA 150.1 D (6.5.8.5) 02/13/06 PLW 143 10.0 mg/L Sh1202320B D 03/01/06 PLW 0 col/100mL SN1209222B A (<-I) 02/13/06 DPT 200 W. POTTER DRIVE ANCHORAGE. ALASKA 99513 SGS/CT&E ENVIRONMENTAL SERVICES Tek 907 -SM -2343 Fax 9OT-561-MOl Lab Ref No. Drinking'WaterAnalysis Report for Total Coliform Bacteria 1060735 READ W STRUCTM5 ON WARK BIOS BEFORE COLLECTING 6AMPLE MUST BE COMPLETED BY WATER SUPPLIER OPEN ❑ PUBLIC WATER. SYSTEM IN NATE WATER BYSTW 0 6"PA&ft 13 Send keoles SAMPLE COLLECTION: or..r�_t—Jw.Fj 'w: l E3 Bard Rws% , QSerd Inalos SAMPLE TYPE ❑ Routine, ❑ Treated Water Repeat Sample , ❑ Untreated Water (refer to tab no t 7 Speda( Purpose TmrpoAW to Lab BI^. jZ15gfn6 66 COIIWM OIAer: mw. TO BE COMPLETED BY LABORATORY Sample Receiving: . Daft: 2-15-6r, pSamp%ovar601nuso% ❑ RUSH SAMPLE I,—, Rewe eoy be vaeaab% . Tem Wskw DOeryMethod: For taaaar Fax t. Received By. calms c .............................................................................................................................................. Bacteriotooicat WNar Anatvale Record: Senl to Ail<Q: MMOLUO (PIA) REIRUS: FBK dal A""% BMW ToW CoahmK Malyst E Cot Sem to chat ' Maylkal Mallmd: MEMBRANE RTERRESULTS: Phoned 0 Faxed Q . oast!Cant CdavanOarL OrwM• . Membrane "bar vwlCKIM WW MMO-MUG (PIA) T«e+.r L au Reported / 11rtt.Tr Wrw rEwr Reported By �P D47 ateRlme: a� I �/ 0 (• ji 1 ca ea .o.. a..n. &vraas Form a FW 0063 12/1TM3 14me6hus01VWI.CmWDala"kADOCUMENTIFORMSeppmved CW Forth 121TO33b . 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 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: Bob Shafer Legal description: Talus West Block 1 Lot 4 The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on _ ❑ Calculation error in design. _ ❑ Additional soils information needed. _ ❑ Water monitoring results inadequate. _ ❑ Discrepancy in information submitted. ❑ Topographic information missing or inadequate. ® Incomplete; missing Are all septic pipes for both fields and tank on survey? ® Incomplete; missing Well scales less than 97 feet from c.o. on survey, ❑ Additional adequacy test information needed. ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. ❑ Locations of all soils, percolation and water monitoring tests not shown. _ ❑ Proposed system too deep for soils information submitted. _ ❑ Well log required. _ ❑ Omission in narrative. ❑ insufficient fill over tank or field._ ® Other. _ Name of reviewer: Poet Date: 3/6/06 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK O MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH 8 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. # C 1 S— — -)-c 1 — J i 1. GENERAL INFORMATION Complete legal description iGrALITY OF ANCHORAGE !MENTAL SERVICES DIVISION OCT 3 1 199G RECEIVED HAA # 1a (�`'llr ('.1 l `� Lot 4; Block 1; Talus West Subdivision Location (site address or directions) 4821 Talus Drive Anchorage, AK Property owner Hary & Diane Hood Day phone 345-1995 Mailing address 4821 Talus Drive Anchorage, AK 99516 Lending agency premier Mortgage Day phone 563-7736 Mailing address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 %, 3. TYPE OF WATER SUPPLY: Individual well XXX 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 xxx 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-M (Fk +.1A1) Front MOM21 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, l 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. S 8 S ENGINEERING n y_ �� 7 Name of Firm 17MA r,nls Rival i GOP ROad NO 104 Phone Address Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE X Approved for Disapproved. Conditional approval for Additional Comments 0 Date L/3c/9 L• PSG r ROBUT G COV/AN CE -8801 tI; .. bedrooms. bedrooms, with the following stipulations: Date 1/'8'`%E 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 courtesyto purchasers of homes and their tending 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. 72-025ln...w1l 6. MOA $21 s Municipality of Anchorage ! � DEPARTMENT OF HEALTH & HUMAN SERVIOR&1PAUTY Or AW-11ok A Environmental Services Division ENVIRDNA WALSERVICESDivi 825 L Street, Room 502 a Anchorage, Alaska 99501 • (907) A7AA 3 1996 Health Authority Approval Checklist RECEIVED !, Legal Description: L 0 T L+ B La k. K I 7 A L v s ivf s 7" Parcel I.D.: 0 1 S" — a o 1— 7 7 A. WELL DATA Weil type FRJ v N T f- If A, B, or C, attach ADEC letter. ADEC water system number Log present (YO N O Date completed pit' ° R TO -7/At/73 Total depth 1 H 3 Cased to 1! 0 4' Casing height (above ground) Sanitary seal IDN) Date of test Static water level Well production Y 6 J FROM WELL LOG v1K WATER SAMPLE RESULTS: Wires properly protected &N) YE S AT INSPECTION 10/30 /9L v rK g.p.m. S.3 Coliform O Nitrate 0, 5 34 Other bacteria o1 Date of sample: ! 0 a f; / 9 6 Collected by: S & S ENGINEERING • yr Loop Road No. 204 B. SEPTI OLDING TANK DATA Eagle Rivr, Alaska 99577 Date installed s`/ -15/7 3 Tank size 10 c 0 Number of Compartments I Cleanouts ON) Y Is Foundation cleanout O/N) t/ 1 3 Depression (Y,@ N 0 High water alarm (Y/Q r 0 Date of Pumping Pumper A i "d m t SE .e v, c t J C. ABSORPTION FIELD DATA Data installedS l; r/73 X 7/13 /S3 Soil rating (g.p.dJW or ;) �y 1 S System type C a , e 7 R 4 c'/ Length d y Ca 7 ` Width 17 / 3 f Gravel thickness below pipe 9' G Total depth )3 L Effective absorption area 3i ` 6 h "Monitoring Tube present (ON) Yf J Depression over field (Y/& tv 0 Data of adequacy test / 0 / S o /9 6 Results as /Fail) PA S 1 For 3 bedrooms Fluid depth in absorption field before test (in.); 9L 4 t Immediately atter 00 gal. water added (in.): Fluid depth 4 ''1 " (ins) Minutes later: -7 3 Absorption rate = N S'0 -4 a.p.d. Percodde treatment (past 12 months) (YM) N k N t K w v w A/ If yes, give date 72-028 (Rev. 3198)• D. LIFT STATION Date installed Manhole/Access (VM) High water alarm level at' E. SEPARATION DISTANCES "Pump on" 'Datum SEPARATION DISTANCES FROM WELL ON LOT TO: olding tank on lot 97 Absorption field on lot Public sewer main _ N / N Size in gallons On adjacent lots On adjacent lots "Pump off" level at' / u o '4 Public sewer manhole/cleanout /Do, -,L N/q Sewer /septic service line 1 S _- Litt station rJ / A SEPARATION DISTANCES FROM EPTI OLDING TANK ON LOTTO: Foundation S r Property line S Absorption field r / Water main/service line ^t S Surface wateddrainage / o C "r Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line l l Building foundation r 4- Water main/service line a S r Surface water ) o D �4- Driveway, parkingNehicie storage area a o '4 Cumin drain N O N E k N o w „i Wells on adjacent lots / o o a p'a �, r t / S Y t c&411 A -11- a. f.« %.A5 C�srt•C,t n 4 Caw is G a r r�.tiL F. ENGINEER'S CERTIFICATION C F n 8 SQA r Y'41- y K r,r c u r. s,,r «w r o,... S t C t 09 C LC> ,t•L or /o hpbj 0 , A 7'1'.4 LH EO. I ceruly that 1 have detemrined fhru field inspectlons and review o/Municipal records that pbobsia are in awdormance–�// }/�/q gul Ines in effect on iYris date. j�,MO F qt s , Signature /L-i'Lf� [ � Engineer's Name d w A.J ^` _ Gy/ i. (0, Date /0 /3o/ 9 G p R08ERT C. COWAN t�c�,•ti CE -8801 HAA Fee $;t!z ) • Date of Payment Z �/ 4 Receipt Number W-6 72-026 (Rev. 3/98)' Waiver Fee S Date of Payment Receipt Number MUNICIPALITY OF 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. # t~S HAA It 1. GENERAL INFORMATION Complete legal description Lot 4; Block I; Talus West Location (site address or directions) Property owner Mailing address Lending agency Mailing address 4821 T~us Drive Anchorag¢~ AK ~2920 Trent Circle Anchorage, Day phone ~K 99516 Day phone Agent Beth Simpson/ SIMPSON CO. Day phone Address 12350 Industry Way Anchora co~ AK 99515 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 3 '"-4 XXX If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPI-" OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025[Rev 1/91) Front MOA~2t 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verifythat based on the information obtained from the Municipality of Anchorage files and from my inves_ti_gation 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 Fir~n&~5_ENL.,iNEERiNG Address 17034 Eagle River Loop Eagle River, Alaska 93577/ Engineer's signature DHHS SIGNATURE X'_ Phone Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage Department of Health and Human Services HEALTH AU'rHOFIITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type Log present (Y/~ /k./4 If A, B, or C, attach ADEC letter, ADEC water system number_ /~]L0j Date completed I~EFo.~¢ .5~,/Z~/r).~ Driller tJY~ /'r Cased to ~,- //_ Casing height Wires properly protected:~4) Y¢].~ Total depth Sanitary sea~) ~'~'~ FROM WELL LOG AT INSPECTION Date of test Static water level ~ E ' Well flow g.p.m. ~,% + Pump level1 d [/~ SEPARATION DISTANCES FROM WELL TO: Septic/~ tank on lot _ ~?/~ ~ ;On adjacent lots /~ Absorption field on lot //~ ~ ~ _; On adjacent lots Public sewer main ¢0¢E ~(3E~ ~ Public sewer manhole/cleanout Sewer se~ice line ¢~ ~ Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: / B. SEPTIC/.bI~L4~INC~rI'ANK DATA Date installed High water alarm (Y~ _Nitrate_ _(~,~/"1 ~h Other bacteria (~//"oo./t~ Collected by: Compartments / _Depression (Y/~--~b Alarm tested (Y/N) .Pumper _~,g,!7-o SEPARATION DISTANCES FROM SEPTIC/bt~TANK'TO: Well(s) on lot <::~¢ ~' '>//< ~ On adjacent lots. /CY..3 To property line /(3/7~- Absorption field ~'~ Surface water/drainage ~,/(*~.3~ ~- 72-026 (3/93)' Front Water main/service line ~ ~7~ CONTINUED ON BACK PAGE C. LIFT STATION ~O~J~ ~~~. Manufacturer Size in gallons Manhole/Access (Y/N) (Y/N)_ "Pu~~~ ~ ~ Level at __ Vent ~. On adjacent lots Sudace water D. ABSORPTION FIELD DATA Date installed Length ~, r~ r'_¢~ Width Total absorption area Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) _~?-~ :~-'-~- System type ~'~-~ Grave/thickness ~'~-'~ Total depth Depression over field (Y/~ for After test If yes, give date ~///~- Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ///2 "~/~'- To building foundation On adjacent lots ~-O Surface water /~-'-'-'-'-'-'-'-'-~ ~'7 Curtain drain k)O C E. CERTIFICATION On adjacent lots __ /(~0 ~ Property line //' ~ To existing or~wa~m~-system on lot / '~ ~-~' ~ Cutbank ~ ~&c~ /~/~d~.~/,~Water main/service line Driveway, parking/vehicle storage area ~ ~/ I certify that I heve checked, verifi_/cCoor conformed to all MOA and HAA guidelines in effecto~;ihe HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES Drinking Water Analysis Report for Total Coli£onn Bacteria 263, B ST BET ANCHORAGE. AK 99518 READ INSTRUCTION, g ON REFE.RSE S JOE .BEFORE CO£LECTJIVG SAMPLE. TEL: (9071 562-2343 FAX: {907) 56t-5301 MUST BE COMI~LETED BY WATER SUPPLIER [] PUBLIC WATER SYSTEM I.D. # (~~ /~..?_]tlVATE WATER SYSTEM ~ SendResuRs ~] Sendlnvoice [] Send Re*ullx H Send lnvoice SAMPLE DATE: [~ Month SAMPLE TYPE: r~ Repeat Sample (for routine smnple with lab ref, no. ) ' [] Special Purpose SA1VEPLE LO CATION Day Year [] Treated Water [] Untreated Water Time Collected Collected By TO BE COiV~LETED DY LABORATORY Analysis shows tiffs Water SAMPLE to be: Satisfactory [] Unsatisfactory [] Sample over 30 hours old, results may be unreliable Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via special delivery,mai[. Time Received / Z.~:_(~ Analysis Began AnalyticalMethod: ~ Membrane Filter MMO-MUG * Number of colonies/100 mi. Lab Ref, No. Result* Date: 1~_9~'~'. Time: Client notified of unsatisfactory results: Phoned Spoke wSth Analyst Bate: Time; [] Faxed [] Foxed BACTERIOLOGICAL WATER ANALYSIS RECOtUD MIVIO-i'ffUG Result: Total Coliform Membrane Filter: Direct Count Verification: LTB BGB Fecal Coliform Confirmation Final Membrane Filter Result//~ Date E. Coli. ~_~ Colonies/100 ml COLYFIRM [~.~, O'Z 'C/rI Time ColiformJl00 ml [ ~7~"/0 hrs PANT ONE OF 'TWO: REMAINDER TO FOLLOW )DNA ENVIRONMENTAL LABORATORY SERVICES REPORT of ANALYSIS 5633 B STREET Chemlab Ref.i~ :93.6451-1 ANCHORAGE, AK 99518 Client Sample ID :LOT 4 BLK 1 TALUS WEST SD 'TEL: (907) 562-2343 Matt ix : WATER FAX: (907) 561-5301 Client Name Ordered By :RJS Project Name : Project~ : PWSID :UA :S & S ENGINEERING Sample Remarks: ROUTINE SAMPLE COLLECTED BY: SS. WORI< Order :73731 Report Completed :12/06/93 Collected :12/01/93 @ 13:11 hrs. Received :12/01/93 @ 14:30 hrs. Technical Director:S?E~i~Q. EDE Release(, By :.~ QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 0.41 mg/L EPA 353.2/300.0 10 12/03 CMR See Special Instructions Above UA = Unavailable See ,)ample Remarks Above NA = Not Analyzed Undetected, Reported value is the practical quantification limit. LT = Less Than Secondary dilution. GT = Greater Than ~SL~C~ Member OI the SGS Group (Soci(~t(~ G~n¢rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA ANCHORAGE WESTERN DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 ..- CERTIFIED MAIL RETURN RECEIPT REQUESTED October 15. 1990 Alpha Circle Homeowner Association c/o Robert Schoff 4851 Alpha Circle Anchorage, Alaska 99516 SUBJECT: Class Change for Borealis Alpha Public Water System (PWS) Borealis Alpha PWSID *211708 Dear Mr. Schoff: You were contacted by phone on August 24, 1990, to confirm the number of service connections and residential population usage of the Borealis Alpha PWS. At that time, you told ADEC personnel the following: Number of service connections - 1Q Number of residential population - 2,1 Number of non-residential population - Q Believing this was the full residential capacity of design, your water system was classified as a Class C. An ADEC and Municipality records check reflect, however, that the T= homes on the subject water system have THREE or FOUR bedrooms each. In view of the above information, and in accordance with Alaska State drinking water regulations, be hereby informed of the classification change of the PWS. A change from a Class C. non- residential user of < (less than) 25 = a Class A residential user of > (greater than) 25. Clarity of this system's Class A classification, was'made by this department in an August 16, 1990 letter to you (see attached). Please be advised the last"total coliform bacteriological sample on record was September 17, 1990. The department will require monthly sampling to commence as of this date. Mr, Robert Schoff October 15, 1990 Page 2 Routine lsampling and analysis requirements are set forth in Title 18 Alaska Administrative Code, Chapter 80, Section 60, Table B (18 AAC 80.060, Table B) also attached You may direct questions, if any, to me at the above numbers. ., ,q,. •. I. .. . Sincerely, L14ia VERA E. CRAIG Environmental dcialiat Attachments' cci Marie Pried,''ADSC/sCRo, Drinking Nater Program Mike Lewis,•ADEC/AWDO VEC/pf