HomeMy WebLinkAboutTALUS WEST #1 BLK 3 LT 16Talus West #1
Block 3
Lot 16
#015-202-15
NAME
LOCATION
MUNICIPALITY OF ANCHORAGE
HeJ^:h and Environmental Proteaion
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
279-2511, x 224, 225
ECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ADDRESS
LEGAL DESCRIPTIONl1_7i16—&
PHONE
DISTANCE, �c '' _-..�I - - , , _ NUMBER OF
FROM WELL MANUFACTUIZERI+�KI� f_ IATERIAL./ COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH___ LIQUID DEPTH LIQUID CAPACITV�OGALLONS.
TILE DRAIN FIELD:
. TOTAL LENGTH
./
DISTANCE FROM WELL�I-IN—FOUNDATION�Q�NEARESST LOT LINEpW ( OF LINE
DISTANCE BETWEEN LINES-/%//4_TRENCH WIDTH.- IN. TOTAL EFFECTIVE
ABSORPTION AREA �� SO. FT. LENGTH OF EACH LINE
J I
DEPTH OF FILTER /
DEPTH: TOP OF TILE TO FINISH GRADE='{—AIATERIAL BENEATH TILE -//-&W ABOVE TILE 1�J.
SEEPAGE PIT:
DIAMETER OR WIDTH- LENGTH, DEPTH
Log Crib Rings/.:RIB SIZE: DIAMETER —DEPTH— DISTANCE FROM: WELL .
TOTAL EFFECTIVE
BUILDING FOUNDATION_, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT.
Well
Class L-tff Depth:
Well Distance To: Lot Line _
Bldg: Sewer Line:
Pipe Mater als:
$ of Bedrooms:
Installer:
Remarks:
DATEO�S� APPROV F044 --�
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DATEO�S� APPROV F044 --�
1.1�_�r-a or I� X F=• + •,-• lr
DEPARTMENT OF HEALTH ANG ENVIRONPIEPJTAL FyFOTECT IOr4
825 'Le-%'•STF.EET, ANCHORAGE_, AK. 5'=�' `+hi .
•
279-2511
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This Agreement entitles:
Te e-
HOME & COMMERCIAL SEWAGE TREATMENT PLANTS
BOX 1490- WASILLA, AK. 99687 - PHONE 376-5919
JET Home Plant Service Policy
P ( -4-
Owner 'Zfl
Street / / p/ , _/2
//�� J�DQ, '
Address H d F ,y ic�Cf cai �
CityZLuT�L • / 9�� Phone��`5— _1
to the following service for year(s) from the date of acceptsire.
con ss Gii
Upon receipt of this signed agreement ander_ agrees to perform the
following services during the term of the agreement:
Gfunslcca [!d I
s will Inspect the JET plant at the above address twice a year. These inspections
will Include:
PLANT SERVICE
• Removal of aeration unit, inspection, adjustment, cleaning of aerators shaft, field service of laeration
unit, if needed, and re -installation.
• Inspection, cleaning, and adjustment, if necessary of surface skimmer and/or tube setter.
• Examination of final effluent for color and odor, if there is access at time of inspection.
• Check of discharge point and wet weather overflow for blockage (if applicable).
• Inspection and adjustment of control panel setting and overload protection, if there is accessat time
of inspection.
• InsDect1n foj s udge accumulation with arrangements for removal when build-up warrants removal.
CC!,C K4,r e e
16 further agrees to the following:
EMERGENCY SERVICE
• There will be no charge for emergency service calls.
• There will be no service or labor charges for removal or re -installation of aerator, if required. i
• If improper operation cannot be corrected at time of service, homeowner will be notified immediately
and given estimated date of correction.
• If improper operation cannot be corrected at time of service, the Department of Environmental Quality,
GAAB, will also be notified.
• If necessary, the entire mechanical unit or any parts will be replaced according to the manufacturer's
warranty program. I
Freight charges to the factory or to an unauthorized repair station and aerator repair charges are not
covered under this agreement.
.gym
,yp�0
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for
Cow s7'`P! C{i
I �O�
91-g
I Date
9 Ky
Date
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
$Ff IT}
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. 015-202-15 COSA# QSC1ala��o
Expiration Date: / 0 r -
1. GENERAL INFORMATION
Complete legal description TALUS WEST #1 BLOCK 3 LOT 16
Location (site address) 11826 WILDERNESS DR., ANCHORAGE, AK 99516
Current Property owner(s) KYLE JAMES
Mailing address SAME
Day phone 720-7283
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:
2
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
R1
Individual On-site
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of 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 Spurkland Enginneering
Address 203 W. 15th Ave., Ste 202, Anchorage, AK 99501
Engineer's Printed Name Lars Spurkland
5. DSD SIGNATURE
_jZ Approved for k;2, bedrooms.
Disapproved.
Phone 279-3916
Date JULY 16, 2012
�E.O F A.<q 11,
iA,- S�1
y49T 1/r
50RKLAN
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: ( Original Certificate Date: :Z 2 -
(Rev. 11105)
Municipality of Anchorage
• "� Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: TALUS WEtiST I BIh 3 Lor l(r Parcel ID: 015-2oZ- 15
A. WELL DATA
Well type P'NT
Date completed 96 i7
Total depth 83 ft.
If A, B, or C provide PWSID # _—
Sanitary
Sanitary seal (Y/N) y
Cased to 83 ft.
Well Log (Y/N) '�E5
Wires properly protected (YM) i
Casing height (above ground) 117- . in.
FROM WELL LOG AT INSPECTION
Date of test 91q 71 17-
i
Static water level ft. 0 ft.
Well production 12 g.p.m. 5:0 g.p.m.
WATER SAMPLE RESULTS:
Coliform #rev, colonies/100 mL Nitrate l 5 i mg/L Collected by: GAQne55 EMinEEiziq& roup
Arsenic: ND ug/L date of sample:615 12
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material CofxecTE Date installed g ��
Tank size 1000 gal Number of Compartments 3 Cleanouts (Y/N) y
Foundation cleanout (Y/N) i Depression over tank (Y/N) N High water alarm (Y/N) !✓
Date of pumping 2117_ Pumper XeOun D ftie ��o Puwlpi n y
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.VW or Podrm 250 System type TREucN
Length 3D ft. Width 3 ft. Gravel below pipe I l ft.
Total depth 16.3 ft. Eff. absorption area}%ft2 Monitoring tube y Depression over field
Date of adequacy test 7121 l Z Results (Pass/Fail) PA55 For 2 bedrooms
— Flaid deptHn-absorption- ield-befereTest JLin—Nater-added5W-gaI.�� ^ fepth- lAn.
Elapsed Time: 1005 min. Final fluid depth % in. Absorption rate >= qDD g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) Arose Itnow.l If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YM)
"Pump on" level _ in. "Pump off level atin. High water alarm level at in.
Datum Cycles tes Meets alarm &i requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot (001+ On adjacent lots too r+
s r
Absorption field on lot 100 On adjacent lots 100 +
Public sewer main NA Public sewer manhole/deanout A/A
r
Sewer /septic service line 25 + Holding tank A/A
Animal containment areas 50 r f Manure/animal excrete storage areas . IOU 4 N,0>
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
t
Building foundation 5 + Property line 5 I+ Absorption field 5 +
Water main NA Water service line 10 14- Surface water 100 + (N. 0)
Wells on adjacent lots 100 f
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 101+' Building foundation I O r+ Water main NA
Water Service line 10 �{- Surface water IOD,+ (ALD) Driveway, parking/vehicle storage 5 r
Curtain drain 50+ 41V,0 Wells on adjacent lots IOD%}
F COMMENTS
JV,U, =. rvoT W05VLVf-�I
G. ENGINEER'S CERTIFICATION
I certify that t 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 —W5 uekLAND
• Date
COSA Fee $ (4Q o Waiver Fee $
Date of Payment -4((toll a Date of Payment
receipt Number---e�O��--Receipt tlumbe� (Rev. 4/10) -
QF ALq.ca
ll
A.
49T
URK N
Municipality of Anchorage
• -� Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
s• ,r.
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. 015-202-15 COSA#_ UP MIR&
Expiration Date: /
14
1. GENERAL INFORMATION f
Complete legal description TALUS WEST #1 BLK 3 LOT 16
Location (site address) 11626 WILDERNESS DRIVE, ANCHORAGE, AK 99516
Current Property owners) [AN C. & SHARON L. PURDUE Day phone
Mailing address 11626 WILDERNESS DRIVE, ANCHORAGE, AK 99516
Lending agency Day phone
Mailing address
Real Estate Agent KAREN CISMOSKI/PRUDENTIAL Day phone 907-242-1761
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well 0 Individual On-site
❑✓
Individual Water Storage ❑ Individual Holding Tank
❑
Community Class Well ❑ Community On-site
❑
Public Water System ❑ Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite 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 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 engineers 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 onsite 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-slte water
supply and/or wastewater disposal system Is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Finn WATKINS ENGINEERING, INC.
Address P.O. BOX 110443. ANCHORGE. AK 99511-0443
Engineer's Printed Name CINDY W. ELLIS. P.E.
5. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
Conditional approval for
Phone 907-349-1851
Date 10/0312006
bedrooms, with the following
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: 4 al,
(R". l M)
Municipality of Anchorage �,..
• Development Services Department
Building Satety Division
On -She Water 6 Wastewater Program • " ' • • °
4700 Bragew Street
P.O. Baas 195850
Anchorage, AK 99519.8850
www.munl.orglonaft
(907)343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: TALUS WEST 51 BLK 3 LOT 16 Parcel ID: 015.202-15
A. WELL DATA
Well type PRI If A, B, or C provide PWSID S _
Date completed 9/BR7 Sanitary seat (YIN) YES
Total depth 63 R. Cased to 63 fL
FROM WELL LOO
Date of test 9/5/77
Static water level 27 R
Web production 12 9 -p.m -
WATER SAMPLE RESULTS:
Cabform 0 colonles/100 mL Nitrate 1.79 M91LL
Arsenic: 40_,005 mall Date of sample: !I &w
B. SEPTICIHOLDINO TANK DATA
Tank Type/Matedal CONCRETE
Tank size 1000 gal. Number of Compartments 3
Was Log (Y/N) YES
Wres property protected (YIN) YES
Casing height (above ground) 18+ jn.
AT INSPECTION
9!20/2008
45 It,
7.1 9.p.m.
Other bacteria 0 colonies/100 ml-
Collected
L
Collected by: Berllans / Watkins Error
Date installed SIW7
Cleanouts (YIN)
Foundation desnout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) NO
Qate of pumping 9/2012008 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA
Date installed 6/5/77 Soil rating (g pAJbe or fftdrm) 250 System type TRENCH
Length 36 E. Wldlh 3 fL Gravel below pipe 11 fL
Total depth 15.6 R Eff. absorption area L6_02? Monitoring tube YES Depression over geld NO
Date of adequacy teat 9/20/2006 Results (Pass/Fall) PASS For 3 bedrooms
Fluid depth in absorption geld before test 6 ti. Water adde 2d 521• gal. New depth 91-261n.
Elapsed Time: 1206 min. Final guld depth 62.60 M. Absorption rate :.- 450 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NO If yea, give date
D. UFT STATION
Date installed NA
Size in gallons
'Pump on' level at _ in. 'Pump ofr level at _ in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic temidUlt station on lot 102'
Absorption field on lot 117'
Public sewer main 100+
Sinner /septic service line 90+
Animal containment areas 100+
ManholelAceess (YIN)
High water alarm level at in.
Mesta alarm a circuit retluirsmenor?
On adjacent lets 100+
On adjacent lots 100+
Public sewer manholeldennout 100+
Holding tank 100+
Manure/animal excrete storage areas 100+
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 11' Property line29 Absorption field 10'
Water main 100+ Water service One 40+ Surface water 100+
Wells on adjacent Iota 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 25+ Building foundation 25+ Water main 100+
Water Service One 50+ Surface water 100+ UMmay, parldnglvehicie storage 50+
Curtain drain NA Wells on adjacent lots 100+
F. COMMENTS: 'Nouse has been vacant since June 2005.
0. ENGINEER'S
I cer* that 1 have determined through gold inspections and
review of Municipal records that the above systems are in t Cjn Wjjjs
oonfcrmance with MOA COSA guidelines in effect on this date. -
Engineers Pdnted Name CINDY W. ELLIS, P.E. .•..
Date 10/03/2006
COSA Fee S q i) ` Waiver Fee $
Data of Payment �O e1 Date of Payment
Receipt Number 7 Receipt Number
(Rev. 1 i/M
SGS ReLq
1065539001
Client Name
Watkins Engineering
Project Namem
Talus West #I Blk3 Lot 16
Client Sample ID
Talus West Al Blk 3 Lot 16
Malls
Drinking Water
Sample Remarks:
All Dateslfimes arc Alaska Standard Time
Printed Date rime
09292006 11:05
Collected Date?ime
09/152006 15:35
Received Date/Ilme
09/152006 17:08
Technical Director
Stephen C. Ede
Allowable Prep Analysis
Parameter Results PQL Units Method Container m Limits Date Date Ink
Nitrato-N 1.73 0.100 mg/L EPA 3332 B 09/13/06 AIR
Nitritc-N ND 0.100 mg/L EPA3332 B 09/15/06 AIR
Metals Department
I lardness ss CaCO3 166
Private Individual Analvsis
Aluminum
ND
Antinion
ND
Arsenic
ND
Barium
11.7
Cadmium
ND
Calcium
47800
Chromium
ND
Copper
38.9.
Trust
ND
Lead
1.83
Magnesium
12200
Manganese
143
Phosphorus
ND
Chloride
10.6
Fluoride
ND
Potassium
1090
Selenium
ND
Sodium
4310
Silicon
5280
Silver
ND
Thallium
ND
Sulfate
18A
5.00 mg/L SM202340B C 09/18/06 0927/06 Mil
20.0
ug/L
EP200.8
C
09/18/06 09/23/06
Mil
1.00
ug/L
EP200.8
C
(<6)
09/18/06 0923/06
Mll
5.00
ug/L
EP200.8
C
(<10)
09/18/06 0923/06
Mil
3.00
ug/L
EP200.8
C
(0000)
09/18/06 0923/06
Mil
0.500
ug/L
EP200.8
C
(<5)
09/18/06 0923/06
Mil
500
ug/L
EP200.8
C
09/18/06 09/23/06
Mil
1.00
ug/L
EP200.8
C
(<I00)
09/18/06 09/27/06
Mil
1.00
ugfL
EP200.8
C
(<1300)
09/18/06 0923/06
M11
250
ug/L
EP200.8
C
(400)
09/18/06 0923/06
MI1
0.200
ug/L
EP200.8
C
(<15)
09/18/06 0923/06
M11
50.0
ug/L
EP200.8
C
09/18/06 0923/06
hill
• 1.00
ug/L
EP200.8
C
(60)
09/18/06 0923/06
M11
200
ug/L
EP200.8
C
09/18/06 0923/06
Mil
0.100
mg/L
EPA 300.0
B
(Q50)
0921/06 0922/06
DSII
0.100
mg/L
EPA 300.0
B
(Q)
0921/06 0922/06
DSII
500
ug/L
EP200.8
C
09/18/06 0923/06
Mil
5.00
ug/L
EP200.8
C
(d0)
09/18/06 0923/06
Mil
500
ug/L
EP200.8
C
(-250000)
09/18/06 0923/06
Mil
200
ug(L
EP200.8
C
09/18/06 0923/06
MII
1.00
ug/L
EP200.8
C
(<I00)
09/18/06 0923/06
Mil
1.00
ug(L
EP200.8
C
(Q)
09/18/06 0923/06
M11
0.100
mg/L
EPA 300.0
B
(Q50)
0921/06 0922/06
DSII
SCS Ref.#
1065539001
All Dates/rimes arc Alasiu Standard Time
Client Name
Watkins Engineering
Printed Date/rimt
09/29/2006 11:05
Project NameHt
Talus West #I Blk3 Lot 16
Collected Date/Time
09/15/2006 15:35
Client Sample ID
Talus West #1 Blk 3 Lot 16
Received Date/rime
09/15/2006 17:08
hlatrix
Drinking Water
Technical Director
Stephen C. Ede
Allowable Prep Analysis
Parameter Result, POL Vnits Method Container ID Limits Date Date Inp
Private Individual Analysis
Total Dissolved Solids
210
10.0
mg/L
SM20 2340C
D
(<500)
09/19/06
KP
Zinc
155
5.00
ug/L
EP200.8
C
(<5000)
09/18/06 0923/06
MI
Nickel
ND
2.00
ug/l.
EP200.8
C
(<I00)
09/18/06 0923/06
hill
NC03Alkalinity
148
20.0
mg/L
SM202320B
D
092M
PLW
CO3AIkalinity
ND
20.0
mg/l.
SM202320B
D
0921/06
PLW
OIIAlkalinity
ND
20.0
mg/l,
SM202320B
D
0921/06
PLW
Conductivity
335
1.00
umhos/cm
SM202510B
D
09/15/06
CRY
pit
7.66
0.100
pllunits
EPA 150.1
D
(6.5-8.5)
09/15/06
CRY
Alkalinity
148
20.0
mp/L
SM202320B
D
0921/06
PLW
otalColiform
0
coVI00mL
SM209222D
A
(<I)
09/15/06
TLF
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r
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9-19-06
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•., ,.•
•� �� ••..,..,.•.•,•.,...• CA 41V
Legal 09"tim:
_.. `
err
Lot 16 .Block 3
����aa����
Talus West#1
.�.•••••••••••••—
.
Lar "Z SURVEY TYPE
❑FaOIDAIIN AHlii
❑ II•AL BRIICTIIIIE AFIIILT
{,fir
• SET REBAR ..........
W DRAINAGE I •• � ASPHALT
❑ OT RAN ... AS-RiT ... LCAT INnEY ... TRGLMARIY
/L
O FOUND REBAR
00
,�
��.....
W000 FENCE '..::r::... CONCRETE
® l� titw Af-BIiT ... NG DGYef IR
(L.+1, r� ASSUMED ELEV.
.;:-�--� ecru e�,rr ITT771
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER. PRIOR TO I ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
CONSTRUCTION. TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FCNCfS. WELLS. SEPTIC CLEANOUTS, SIDEWALK$ ORIVEwAYS,
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
ETC
ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW
THE EXISTENCE Of ANY EASEMENT$, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED.
WHICH DO NOT APPEAR ON THE RECORDED SU DIVISION PLAT.
UNDER NO CIRCUMSTANCES SHOULD AN AS-BUI.T BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY.
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS N SCALE.
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH i£ HUMAN SERVICES j
® Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY i
APPROVAL FOR A SINGLE FAMILY.DWELLING
Parcel I.D. # • 015,202 15 000 HAA
1. GENERAL'INFORMATION i
Complete legal- description Lot 16; Block 3; Talus fnlest &1 1
1
Location (site address or directions) 11826 Wilderness' Drive
Anchorage, AK
Trent Carbaugh
Prbperty owner Day phone
Clvlailirig address`• . 1182b wxloerness
y i
Lending 'agency
Mailing address~
.Agent J lCharlottL- Schlosstein/ Re
Address 2600'C6rdova Suite 100
Day phone
es Day phone 257-0106
ge, AK 99503
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 tfie legality and status of system
r
.4'
4. . TYPE OF WASTEWATER DISPOSAL:
Individual on-site �
1
Holding tank .
Community on site`
Public sewer
NOTE-* If comm-6hity.wastewater,system; provide written confirmation from StateIADEC
attesting to the legality,and status of system. .
72-MIR«:1/2+l .Fran MOAnr`: .... - .. ..
5.1 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 furtherverifythat based on the information obtained from
the Municipality of Anchorage files and from Imy investigation and inspection, the on site water .
supply and/or wastewater disposal system is In with .all Municipal and State codes,
ordinances, and regulations In effect on the date of this Inspection.
S 8 S ENGINEERING
Name of Firm �ea4 Eegl Rivas t eop Rn a Wd 104 Phone
Address
Eagle River, Alaska 99577
�
Engineer's signature Date 3 /1 z ` 7
OF
., ► A'„ ` ROBERT C COWAN . /.Or f
CE -8801
6. DHHS SIGNATURE
Approved for -3 bedrooms:-
Disapproved._
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
By- � ..� Date
�~
n� 1-
The Municipality of Anorage Department of Health and Human Services (DHHS) Issues Health Authority"
'A roval Certificates based "onl upon the �re resentations' '
p y, p given'ln ra ra h 5 above b an Inde
,. P .... _ .. . ._ _. � , g P . _.... y .. , .Pendent . ,
protessionat engin6er registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes
andtheirleridinginstitutionsinordertosatisfycertainfederaland state requirements. Employees ofDHHSdonot -
conduct Inspections or analyze (data before a certificate Is Issued.The Municipality of 'Anchorage is not
responsible for errorsor omissions in the professional engineers work
. --- _-_..-.�.., .' .-. _-.._ »-._.._.. �_. ...--"-oM�MrIwI i Vr ANij'WAGE I ..
0MR044WAL SFAVIaS DIMION
NAR 12 1997
Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN S�n i'EIW V E D
Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: L n T /4 BL,( 3 )-.4L&$ Lai t r#/ Parcel I.D.: 01 S- 3 0 1-� S-
A. WELL DATA
Well type Fit -v,0176- If A. B, or C, attach ADEC letter. ADEC water system number
Log present QM) �l E S Date completed
`i/4 X77
Total depth
Sanitary seal O1 N)
Date of test
Static water level
Well production
g3'
YE
Cased to 't 0 -r- Casing height (above ground) I 1 -I-
FROM WELL LOG
A/G /77
WATER SAMPLE RESULTS:
Coliform
N
i
Wires property protected (�N) y" I
AT INSPECTION
310 Ig 7
y7
g.p.m. S, 7 t I g.p.m.
,Y ret rr.?,c red 'eV 7.7 IF I /,/-.-.v1,,, 4
Nitrate 0. 9 9 Other bacteria
Date of sample: 311 /47 Collected by: S & $ ENGINEERING
170M "Ole v p No.
B. SEPT OLDINCi TANK DATA ?E r ACR 4 r e Ih s Eagle River, Alaska 99577
il4N Rimf'it 0 )
Date installed s' S- 7 7 Tank size /o d O Number of Compartments 3 Cleanouts (ON) �'"" ~ • •E 46
Foundation, cleanout &N) Y E 3 Depression (Y/* High water alarm (Ya N
Data of Pumping 3% It i 19 7 Pumper it -r Ho m i f I a v, c e S
i�W4 vP,ti+A,+N..E , ADO /J i..er(,t To CXTS,e-OiL A..,O cN(<a 4o to,2 L44k S 3/1, /9 7,
C. ABSORPTION FIELD DATA • r�
Date installed S 11- / 7 7... Soil rating (g.p.dJftt or /bdrm S a System type T h f C14
r � I
Length 3 Width 3 Gravel thickness below pipe I I Total depth / &
Effective absorption area ' i 5'0 F Monitoring Tube present GIN)'1 jj Depression over field (Yl l
Date of adequacy test 3 // a /17 Results ail) PR -SS For 3 I bedrooms
Fluid depth in absorption field before test (in.); S 1 Immediately after Sar- gel. water added (i I.): li
Fluid depth Ce VZ 1. (ins) Minutes later: / 70 Absorption rate = 7 S a p.d.
Perodde treatment (past 12 months) (YM) If yes, give date `
I
72-023 (Rev. 3196)'
D. UFT STATION
Date installed
Manhole/Aocess(Y/N)
High water alarm level at'
Ct* t Y Sre_d�
E. SEPARATION DISTANCES
"Pump on"
'Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
e t olding tank on lot It/
Absorption field on lot I C o -I-
Public sewer main N /A
Sewer /septic service line 570 I /
Size in gallons
"Pump off" level at'
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FRO SEPTI OLDING TANK ON LOT TO:
Foundation S Property line Absorption field S t
Water mainfservice line 3 ° '4- Surface water/drainage ! o e r Wells on adjacent lots o o
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
` �
Property line I C t Building foundation /C Water main/service tine 3 o 4
Surface water
Curtain drain �- o E
cv +
K r✓v t✓ )./
F. ENGINEER'S CERTIFICATION
Driveway, parkingNshicle storage area 3c)
_ Wells on adjacent tots /C a " i
F
I c&Hffy that I have determined thru field inspections and review of Municipal
in conformance with M del s in effect on this date.
Signature /
E �egEcr � � A✓
are
a nee, n Name I
9
a w � ;� � NoeFRT C. COWAN i r j
3 // } /If -7
i
�' ws
Date
;•.
I
L�
HAA Fee
Waiver Fee $
%
Date of Payment`
/7
Date of Payment
Receipt Number
72-026 (Rev. 3/98)'
Receipt Number
W/12/W 11:02 CTBE ESI AKHORAGE + 9076941211
LCTBE Environmental Services Inc.
CT&E Rer.M
Client Name
Project Nante/M
Client Sample 1D
Matrix
Ordered By
MS1D
991051001
S & S Engineering
L16 B3 TaluA West MI
Drinking Water
Drinking Water
RIe M ala
Client POM
Printed Daterime 03/12/9710:14
Collected Datc/Tlme 03/03/97 10:00
Received Date/Time 03/03/9710:50
Technical Director: Stephen C. Ede
Released By
Sample Reuirks:
Allowable Prep
Analysis
Parameter
Results ►OL Units
Method Limit* Date
Date Init
Mitreta•M
0.986 0.100 ng/L
SM1a 4500•NO3r 10 INA
03/04/97 EMO
Total coli{ore
0 col/laout
Seta 92229
03/03/97 aAM
1\0 LIC. rn-r' P -,N
Time
APPLIC`W FILLS
OUT UPPER HACONLY
Time
Time i
Date
Date
Property Owner
r7w`� L-Et-F--,T-r-
I�2i1s—
•J'7
Melling Address
Zip Code
L
Inspector
Inspector
I'
Buyer • 'R
�-'/dlA "a'; I,-?
-
Address
Zip Code
Lending Institution
�:T NaTibfuAL.'3A1uk a %�nJQ IIQKA�t
ENVIi;itf.:ll;A.!:OE.�r=.J
I271932
AUG
2.7G. _
Address
L' LU Z N
Zip Code
L�,30
Realty Co. 6 Agent
() APPROVED BEDROOMS
'CONDITIONS OF APPROVAL i
Phone
Address
'
Zip Code
Legal Description
l o -r I& � � 3
'A L u S
Street Location
Type of Residence
Soils Rating
Date Sewer installed
Single Family
❑ Multiple Family
No. of Bedroom
Septic Tank Size o
❑ Other
Z -S --% %
1 Well to Tank lz o rt-
Water Supply
V Individual
`u"' e `- - C
ATTACH WELL LOG. A well lop Is required for all wells drilled since June 1975.
❑ Community
For wells trilled prior to that date, give well depth (attach lop If available).
❑ Public Utility
'
Sewer Disposal
K Individual
Year Individual Installed: C(1O I,v D q 7 7
❑ Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. I -
1\0 LIC. rn-r' P -,N
Time
Time '
Time
Time i
Date
Date
Date
Date
1
Inspector
Inspector
Inspector
Inspector
I'
Field Notes:"/^ Lm"r-� �'
J� G�O.J.�
MOu^'��"�f"'�
'
h1UNICIPALITY OF ANCHORAGE
' ✓CX lex=s.. Cnv�-L'-"
C"T Cr
✓Nv�a¢��.asW o"v Ra"+
ENVIi;itf.:ll;A.!:OE.�r=.J
I271932
AUG
RECEIVED
() APPROVED BEDROOMS
'CONDITIONS OF APPROVAL i
( ) DISAPPROVED
'
( ) CONDITIONAL APPROVAL'
DATE
BY:
Soils Rating
Date Sewer installed
Well To Absorption Area f W J"'
Well Lop Received
Septic Tank Size o
Z6'0
Z -S --% %
1 Well to Tank lz o rt-
no» GA%n
1�
August 31, 19B2
Rzymond L. Britt
SRA 16BG K
Anchorage, AK 99507
Subject: Lot 16 Block 3 Talus West #1
Approval for the individual sewer and water facilities cannot ;
be granted until the following items have been completed:
I
The water analysis report needs to be submitted to this
office from the Chem Lab, 5633 B Street, for our review.
1he septic tank punped with a receipt submitted to this
department.
0 A maintenance contract for the Jet unit serving the sewer�
system needs to be obtained from Consteel Company,
376-5919, and a copy submitted to this office for our
review and our files.
Please notify this Department for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 2G4-4720.
Sincerely,
Cory Willis, R.S.
CI-725/p/EH
1
Insp
Insp
Injp
REQUEST FOR APPROVAL OF INDIVIDUAL SEI.ER. AND WATER FACILITIES
T 11 11 T Re(ucst: First National Bank of
on ng ns,
Mailing Address: Post Office Box 4-2090
2. Property Owner:
Candee Construction
mailing Address: Post office Box 8482 99508
% Una M. Bennett
I
Phone: 274-1521/39
— Phonc: - I
% Mark Ko;�Ing�,274-�4505
3. Legal Description: Lot 16 Block 3 Talus West Subdivis:
4: Single Family Residence: OcX Number of Bedrooms: -
multiple Family Residence: ( ) Number of Dedroomr:
5. well System: individual 1IL11 ( k Community/Public System (
I
Permit # Depth of Well Well Log on File
Construction Bacterial Analysis
6. Sewage Disposal System: On-site System (X) Public Utilit
Permit # Installed V�r-�rl Installer
Septic Tank Size
Absorption Area
Manufacturer
Soils Rate ZS'D Material
7. Distances: well to Septic Tank
to Sewer Line
to Nearest Lot Line
Nearest Lot line
to Absorption Are
Absorp�ion Area
(jt I
��IUNICIPALTTY OF AtICHORAGE
D EPARTI*10,
NME11
.'OF HEALTH AtID ENVIRO T
ROTECTION
C25
L Strcet, Anchoracin. Alaska
90501
2 G 4 -4 7 2 0
0�,
Date Roccived:
December
Time
S!,�r)
#2: Time
3 Tinic
Date
Date
Date
1
Insp
Insp
Injp
REQUEST FOR APPROVAL OF INDIVIDUAL SEI.ER. AND WATER FACILITIES
T 11 11 T Re(ucst: First National Bank of
on ng ns,
Mailing Address: Post Office Box 4-2090
2. Property Owner:
Candee Construction
mailing Address: Post office Box 8482 99508
% Una M. Bennett
I
Phone: 274-1521/39
— Phonc: - I
% Mark Ko;�Ing�,274-�4505
3. Legal Description: Lot 16 Block 3 Talus West Subdivis:
4: Single Family Residence: OcX Number of Bedrooms: -
multiple Family Residence: ( ) Number of Dedroomr:
5. well System: individual 1IL11 ( k Community/Public System (
I
Permit # Depth of Well Well Log on File
Construction Bacterial Analysis
6. Sewage Disposal System: On-site System (X) Public Utilit
Permit # Installed V�r-�rl Installer
Septic Tank Size
Absorption Area
Manufacturer
Soils Rate ZS'D Material
7. Distances: well to Septic Tank
to Sewer Line
to Nearest Lot Line
Nearest Lot line
to Absorption Are
Absorp�ion Area
(jt I
Ragc Two Department of Ilealth and Environmental Protection
Request for Approval of Individual Sewc�r and I-17ater Facilities
Legal Description: Lot 16 Block 3 Talus West Subdivision
Cc;,mc,ntr,:
L
Affadavit Attached: Letter Attached:
Approv?ed: Date.
Disapproved: Date:
Department Workshect:
4 ew-�. Municipality of Anchorage e_�
DEPARTS.-INIT OF HEALTH 8, ENVIRONMENTAL PIRG.tECTION
POUCH 6-650 ANCHORAGE, ALASKA 99502
279-2511
� I �. A060MIA! n F
WATFR FArII
I
AlLrNICIPALITy
!DE OF ANio
ENVIROjZZOF HEALr�j �"AC,
Nt& pgOIZA
1. TYPE OF LOAN
- - - - - - - - - - - - -
7
RCEL
ASSESSORS PA NU#f CEI
0 VA 0 F.H.A. (31 CONV
3. LENDING INSTITUTION
4. REALTOR OR AGENT
i.11 r Mark Korting I
. �6?1,latj2nal Bank of Anchorage
2090
A,� n -, 7,23, Real Estate Corner of Alaska.
Box
555 W. Northern Lights Bouilevard
Anchorage, Alaska 99509
Anchorage, Alaska. 99503
A: ':� Una 14. Bennett 274
1521-9S-/
AIT% p �j o %, � Office 274 450.
5. SELLER
6. BUYER tHome 344 b447r—
% "I � [ WALTERS, Craig M.
Candee Construction
i
PO.Box 8482
'�� I 0.� I SI -1, 4600 Shelikof
Witchorage, Alaska. 99508
Anchorage, Alaska. 99507
please contact Mark Horting Real E3tate
Broker 344 5558
7. LEGAL DESCRIPTION
8. LOCATI614/STREETADDRESS I
99507
Lot 16, Block 3. Talus West Sub
#1
11826 Wilderness Drive, Anchorage
9. TYPE OF DWELLING
10.
WATER SUPPLY
11. SEWAGE DISPOSAL SYSTEM
I
ERZINGLE FAMILY RESIDENCE 3 BDRMS
0 PUBLIC UTILITY
0 PUB LIC UTILITY
0 MULTI -FAMILY FIESIDENCE_BDRMS
XX3 PRIVATE ON-SITE
XXI ON SITE
YEAR INSTALLED
INSTRUCTIONS TO REQUESTOR
1. Complete Items 1 to 11 above 3. Send
to address above 5. Response will be returned to lending
2. Remove the carbon 4. Please allow 10 days for processing institution
DATE RECEIVED
F INSPECTION
TIME OF INSPECTION
INSPECTOR
1
TYPE
DEPTH
YEAR DRILLED
PERMIT REFERENCE
FT.1
3.
CONSTRUCTION
BACTERIAL ANALYSIS
LAB REFERENCE NO.
YEARINSTALIED1
INSTALLER
TANK SIZE
MANUFACTURER
DIMENSIONS
CRIB CONSTRUCTION
0 PIT
TOTAL LINE LENGTH
TRENCH DEPTH
GRAVEL DEPTH
0 DISPOSAL
FIELD
FT.
FT.
FT.
TOTAL ABSORPTION AREA
PERMIT REFERENCE
SO. FT.
72 010 (11/76)
ca
E LINES
T LINES
SEPTIC TANK -,SORPTION AREA L = OTHER
SEWER LINES OT LINES
R L�
WELL TO: 'S: Ass I D - =RpTEI An
SEPTIC TANK ORPTION AREA[! W(ER.L
FOUNDAiii)N TTO SORPTION LOT, LINE
AB ORPT N
S SYSS
YS
TEM TO:
0 APPROVED CONDITIONAL APPROVAL
0 DISAPPROVED 0 UNABLE TO INSPECT
.71
I certify that the information contained in this request for approval to be 8 true and accurate representation of the subject sewer and water facilities
and these facilities are operating satisfactorily.
DATE SIGNATURE