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Home My WebLink AboutTALUS WEST BLK 3 LT 14Talus West Block 3 Lot 14 #015-201-41 Municipality of Anchorage (� Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 •L' Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 Pagel of 3 www.ci.anchorage.ak.us (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW0004T8 PID Number: 015-201-41 "'""Paid Wastewater System: ❑ New ® Upgrade Ad&na: ABSORPTION FIELD Pl Number daedr : ® pep Tnrch ❑ aNAow TNnth D Bed t] Mound D Wur: LEGAL DESCRIPTION '°° """ TYel ppm eYm Y0.45 12 Waft: rpofe Ft Block. Loa SWMiNtian: 3 14 Talus West 0" lo pipe boabm ham ONInW graft: 6 F1, Gn.W d" b~h pipe: 6 FL Towmhip: RYipa: Seceon: Fa added abm on2wol graft: G," Length: Ft. 1 S' Ft. Well: El New ❑Upgrade rre wwm: Number or lir : DHNmeWween lNn: 0 3 Ft. 1 fl Cl'.A aa+(Pr W. a. e): Total epee Geed b: Total absorption Yea: Ape MYarNI: Exist' Priv to fl. Ft 1020 flt F810/3034 PVC Dnaer: Gaw peed: SNbc Welar LNN: M Nw.. pN kW Iw F, A+ Home Services 12/8/2000 rWd: Pump Set Y: C"-W H"N above Grouu: TANK GPM fl. Ft. SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding PublcMrivat MaraRa .: caway: Fra. Tank Field Station Tank Sewerune Anchors eTank 1000GY. W.1 109 124 78 LYS Steel Number Y CYmpYba : 1 2 SYNpewater 100+ 100+ LIFT STATION 24 15 M,rm er LY Lim Gal. 24 C 57 Yon lvt a: pro um "Pp Yr NVY Y'. w Hghsd mot: FY-rdabon ti h In I 100+ 100+ PumpMakeaMedM ENar It p`b""P«rYm,edbr: cwtomt) in BENCH MARK ILL 611 Lbcsoon aft pacrrybon: a y a. '4 as — re y an Rear Door Threshhold Ass a Elmbon: 0 V t"(2 L S 100.0 Fa Engineer's Stamp Inspections performed by: Pannone Eng. SVC Dates: 1112/7/2000; G91H '� �i 2n°12/0812000 .....i.. .... ...... .......n.....� Department of Health and Human Services approval _... ........»..... ........ ....� 0� t Steven R. Fornone?C �#� Reviewed and approved bv: �% _ W. Z Date: /2.-/q-oo No. CE 8149 •�� ''••� (RN. 11189) � lie' Il '•/`•..- �h gtESStCT .• PERMIT NOj SW000478 COB EI 52.42 &___64 E4 99.5 53 6 FC 27.4TI iii190 54.5 T2 60.9 37 Cl 61.7 71. Ml 71.5 7a C2 123.6 10`. M2 124.9 111 .4 r SE ABgAND❑N NEW SYSTEM 8 Fx3'x6'EFF TH1" \-15 49 • 49TM AS -BUILT SEWER SERVICE EXTENSION LOT 14, BLOCK 3 TALUS WEST S/D SS DRI V EXIS SWELL IST'G T'G000 g PATI TA P.I.D. NOi 015-201-41 EX -'ST'G 3 H❑ SE E2�� _ El F M1# E3 4 n•��L.1 M2 _...... W 10008 PTIC TANK L -RUN ERTER VALVE EXIST(G FIELD TO BE REUSED PND ROUND UTILITIES EA OF TEST HOLEI CALL FOR LOCATES. \ NO ROOM, 3 st.DWG .. - �KK SIZEo 1,000 gallon 'FERC. RATE, 40 MIN/INCH NOTE 1) ALLWORK SHALL BE PERFORMED SOIL RATING 0.45 (SF/BR) IN ACCORDANCE WITH AMC15.65. 2) MATERIALS USED SHALL BE IN AREA RgDE 10000SF SSF/BR) S ACCORDANCE WITH THOSE SPECIFIED SYS. TYPES DEEP TRENCH 6'EFF IN AMC15.65, WASTEWATER DISPOSAL. SIZE 85LFx3' EFF TOTAL AREA11020 020 SF SF ten R. Pannone Q rKtrAKtL r uKi I� Mr. George Paul No. CE 8149 / � 11856 Wilderness Drive �.0 Anchorage, AK 99516 (907) 360-31319 pp aim �' (907) 245-13817 111k PANNONE ENG. SVC, LLC P. ❑. BOX 102954 ANCHORAGE, ALASKA 99510 AS -BUILT PERMIT NO, SV000478 AS-BUILT DETAILS P.I.D. NO, 015-201-41 WASTEWATER ABSORPTI❑N SYSTEM LOT 14, BLOCK 3 TALUS WEST S/D NOTEt 1) ELEVATIONS ARE BASED ON THE o GARAGE DOOR THRESHHOLD W/ V) P ASSUMED ELEVATION OF 100.0 FT. o m 2) ALLVORK SHALL BE PERFORMED 1n0NV3b IN ACCORDANCE WITH, 6 ALL METERIALS SHALL CONFORM TO AMC15.65. _ u CL >4y}. c c i uex z e Z o L �--i a'a H3v3 1v SSSkf z Q ism 801MOM W m U h ce }}c Wo j}{ . R %a N 000 f f{3 ai Y�Ft� VI N o Vi o: S 6.0 m m m n 0 0 � o N '4t m I 3AlVA WfIb-lYffi 0 1f10NV37] 'a 1nOM/3'M a` lnow3m QL G\Work\DRAWING\14-3Talus Vest,D V Gv % uv+v3b sut sS, wuv(Iwn, 4 / TM ' • �w PREPARED FOR: Steven R. annone PANNONE ENG. SVC. LLC StP No. CE 8149 i Mr. George Paul P. O. BOX 102954 1� � 11856 Wilderness Drive ANCHORAGE, ALASKA 99510 Anchorage, AK 99516 272-8218 PHONE 8 FAX Jim C907) 360-3819 DATE, 12-9-00 1� ��aaa C907) 245-8817 AS-BUILT MUNICIPALITY OFANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW000478 Legal Description: TALUS WEST BLK 3 LT 14 1(ti ePX'C::d n 2totoo e1.1 h ll I avl o-c��3�v� Datel�ssued: Nov 13, 2000 Expiration Date: Nov 13, 2001 Parcel ID: 015-201-41 Design Engineer: 0062 Pannone Engineering Services Site Address: 011456 WILDERNESS DR Owner Name: George Paul Lot Size: 19914 SO. FT. Owner Address: 11856 Wilderness Dr. Total Bedrooms: 3 Permit Bedrooms: 3 Anchorage , AK 99516 - This permit is for the construction of: Disposal Field Q✓ Septic Tank Holding Tank ❑ Privy El Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: (�tl« 177 4 �4L�"/ e /Zk Date: Pannone Engineering Senices, LLC Consulting Engineers November 4, 2000 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 14, Block 3 Talus West S/D Septic Upgrade Permit Gentlemen: P.O.13MI'94 Anchorage, Alaska, 99510 (907)27--8218 Fax My firm was contacted to conduct a Health Authority Investigate at the above referenced property. The septic system was found to be in failure. A single test hole was excavated on October 28, 2000 for a potential replacement system. The soil report and percolation test results are attached. Ground water was not encountered in this test hole, nor was bedrock. The lot is approximately 0.5 acres in size. Lot 14 slopes to the northwest at a rate of approximately 1 to 2 percent. The proposed installation will be located in the southwest portion of the lot on a flat area. The proposed location will be greater than 100 feet away from the existing well serving this property and 25 feet from the water service lines. The surrounding systems are located greater than 100 feet from the proposed installation. The lots surrounding this lot are developed, but do not conflict with the proposed installation. The proposed installation will not impact the future development of the surrounding or existing lots. See attached design. The new system will maintain over six feet vertical separation to the bedrock and over four feet vertically to the ground water. Please contact me at 272-8218 or 227-3522 if you have any questions.,..,_ U ��i• Sincerely, �' :S �••.. :ll Steven R. Pannone, P.E. {�e> e.<„ R. Pow :on. �j#i Attachments: �.' fT,�1�ot1 C: \WORK\ LETTERS\ 14-3TALUSW EST.001. DOC PERMIT NO, DESIGN P.I.D. NO, 015-201-41 SEWER SERVICE EXTENSION ' LOT 14, BLOCK 3 TALUS WEST S/D ........ /...\ WILD RNESS � I 1 + LA$il I "U J .0 wnUSE 2%' E ST'G EXIST'G 000 , WEL SEPTI TANK 15.5 ABOAN IN F l fAt�E �; r OPOSED 1000g m- EPTIC TANK -2" 10 `re Ill LL -RUN VALVE !O SED SYSTEM 10 ERTER VALVE j 8 Fx3'x6'EFF III f r1r EXIS tri FIELD TO pj j [(Ar BE REU TH ONI DERGROUND TILITIES EAST OF T HOLEI CALL F LOCATES. Il YLB / ��pI�t�� J \ LLl NO, BEDROOM, 3 G\14-3TolusVes .DWG TANK SIZE, 1,000 gallon PERC. RATE, 40 MIN/INCH SOIL RATING, 0.45 gpd/SF (333 SF/BR) AREA ROD, 1000 SF SYS. TYPE, DEEP TRENCH 6'EFF SIZEi 85LFx3'VIDEx6'EFF TOTAL AREAL 1020 SF PREPARED FOR, PANNONE ENG. SVC, LLC Mr. George Paul P. O. BOX 102954 11856 Vl(derness Drlve ANCHORAGE, ALASKA 99510 Anchorage, AK 99516 (907) 360-3819 272-8218 Phone & Fax (907) 245-8817 DATE, 11-4-00 DESIGN PERMIT NO, DESIGN DETAILS P.I.D. NO, 015-201-41 WASTEWATER ABSORPTION SYSTEM LOT 14, BLOCK 3 TALUS WEST S/D NOTE, 1) ELEVATIONS ARE BASED ON THE GARAGE DOOR THRESHHOLD W/ ASSUMED ELEVATION OF 100.0 FT. 2) ALLWORK SHALL BE PERFORMED IN ACCORDANCE WITH, 6 ALL METERIALS SHALL CONFORM TO AMC15.65. a (L u c C— s U L2 0 Z v o 0 L H U LIJ N to al 17% a. m 6.0 aN3 NOV3 1V 39% MOlINON N C6 m Irew3m C 3A1VA NIM -Ting irIONV310 %a IMNV= a` ln@IV313 j O r C,\Work\DRAWING\14-3TalusWest.DWG8 umr+v313 • ZC-j ,e •�� Noiivaapox . a. .ten � 3>} R. Panne :E 8149 Mr. George Paul 11856 Wliderness Drlve Anchorage, AK 99516 C907) 360-3819 C907) 245-8817 PANNONE ENG. SVC.,LLC P. 0. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218 PHONE & FAX NTE, 11-4-00 1DESIGN o N v1 Qi m a` m 1nONV313 l: i 2.>• t o N Itm I 1 aN3 NOV3 1V 39% MOlINON N C6 m Irew3m C 3A1VA NIM -Ting irIONV310 %a IMNV= a` ln@IV313 j O r C,\Work\DRAWING\14-3TalusWest.DWG8 umr+v313 • ZC-j ,e •�� Noiivaapox . a. .ten � 3>} R. Panne :E 8149 Mr. George Paul 11856 Wliderness Drlve Anchorage, AK 99516 C907) 360-3819 C907) 245-8817 PANNONE ENG. SVC.,LLC P. 0. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218 PHONE & FAX NTE, 11-4-00 1DESIGN o N v1 Qi m a` m 1nONV313 l: i 2.>• t aN3 NOV3 1V 39% MOlINON N C6 m Irew3m C 3A1VA NIM -Ting irIONV310 %a IMNV= a` ln@IV313 j O r C,\Work\DRAWING\14-3TalusWest.DWG8 umr+v313 • ZC-j ,e •�� Noiivaapox . a. .ten � 3>} R. Panne :E 8149 Mr. George Paul 11856 Wliderness Drlve Anchorage, AK 99516 C907) 360-3819 C907) 245-8817 PANNONE ENG. SVC.,LLC P. 0. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218 PHONE & FAX NTE, 11-4-00 1DESIGN BOMB LOCI - PERCOLATION TEST ��P�� ""'• • ,y !�� PANNONE ENGINEERING SERVICES P.O. BOX 102954 49M mit s}♦ ANCHORAGE,AX99510 (907) 272-8218 ai""".. Steven R. Pannone• �1 �I No. CE 8149 PERFORMED FOR: Mr. George Paul DATE PERFORMED: 10-28-00 ••+�14!!!\ LEGAL DESCRIMON: Lot 14, Block 3Talus West 8/D , ` ��• SLOPEW E LLOR Orgmi� '' \ 1 Topwn l 1 l t EXI T'G 3 3 ML ony8nta HOGS[ J 4 EXIST'G 000 TESTHOLE - SEPTI TANK' 5 `Y ABOANDONIN PLACE g Grey Silty Gravel .'. •..� EXISTf i FIELD TO 9 } BE REU ED 10 OM Q i. H 11 11 13 .. _. .... WAS GROUND WATER SLOPE 14 ENCOUNTERED? No IS IF YES, AT WHAT 16 DEPTH? -0- TFSTHOLE 17 DEPTH TO WATER AFTER MONITORING? 18 DATE: 11-4-00 BOH 19 READING DATE CR068 aE'r DEPTH OF NET TOLE TIME WATER DROP 10 I0-29-00 1236 6• 1706 30 5 1/4• 3/4• 1306 6• 1136 30 5 1/41 3/4• 1406 6• 1406 52 PEROI.A71ON RATE 40 (min/trnchl FERC HOLE DIAMETER 6 Inches TEST RUN BEWTEEN 7 FT and 8 FT COMMENTS: Test hole excavated by A+ Home Svc. Test Hole was presoaked hole excavated by A+ Home Svc. Test Hole was presoaked before pere test. PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE wrm ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. 30 • 2• MUNICIPALITY OF ANCHORAGE (/. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION II ENVIRONMENTAL ENGINEERING DIVISION 825 L Street • Anchorage, Alaska 99501 Telephone 264-0720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAMEPHO c s NE ❑ NEW C MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS O )C DISTANCE T0: Well Absorption area Dwelling PERMIT NO. E Q W4 Manufacturer Material No. of compartments Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth d Y JV2 DISTANCE TO: Well Dwelling PERMIT NO. _? Manufacturer Material Liquid capacity in gallons DWell w=2me r Foundation 0 �.,L Nearest lot Ime Q f PEHMIT f'i9a3P -� J u. Z f.?w Length of each lin r .; 9 Total length of lin s Trench width inches Distance between li e GH O r Material beneath the _� .S inelses Total effective absorption area •j70 W (7 Length Width Depth PERMIT NO. uF W Type of crib Crib diameter Crib depth Total effective absorption area iW DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. 3 DISTANCE T0: Building foundation Sewer line Septic tank Absorption area(s) OTHER f PIPE MATERIALSn —C SOIL TEST RATING INSTALLER N REMARKS r s• fh APPHOVE DATE LEGAL 72-0131Rev. 3178) U r MUr4 I C I F L ITV OF FINCHC nC3E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET. ANCHORAGE, AK. 99501 264-4720 ON—SITE SEWER UF:>GRFFF>E PE,R2M I' PERMIT NO. < 790387 ) Q �U APPLICANT LINC CONST. 1605 SANDY CIRCLE i-��'� c-/"' LOCATION TALUS WEST c%hA11 LEGAL L14 B3 TALUS WEST LOT SIZE6Cffi lu.cs �� 7i eau15 TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH 1l/ 'MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SO FTtBR)= 190 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: GEF" -r"= 10 LENGTH= S? GRnVEL_ E>EPTH= 5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. 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). 'PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE PNSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TWO <Z!> I NSF='ECCT I ONS FIRE RECZU I REFS --- 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 WELLi OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDIfJG UPON THE TYPE OF PUBLIC WELL. OTHER, REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PEFRM I T EXP I RES F>ECEMF3ER 3%3_. 19?9 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 RESIDENCEIS REMODELED TO IINCLUD MORE THAN 3 BEDROOMS. APPL ISSUED BY LINC Pau Tt-v'j _[3 - V3. 2 GREA^t ANCHORAGE AREA BORGH 1/ + r Department of Environmental Quality �a�� 1l1 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME -AQ,-7 MAILINGADDRESSrZ� -!1'1?4,PHONE Z`/U-- LOCATION -44 LL LEGAL DESCRIPTION SEPTIC TANK: DISTANCE NUMBER OF FROM WELL /✓ MANUFACTURER r",7772rX._ LTA GMATERIAL •rr` COMPARTMENTS �- INSIDE LENGTH '� INSIDE WIDTH `LIQUID DEPTH I IQUID CAPACITY GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER _�_' OR WIDTH_, LENGTH_, DEPTH G LINING MATERIAL ��d.�r CRIB SIZE: DIAMETER_!�_DEPTH_gL_� DISTANCE FROM: WELL �G Z //'/'COX- TOTAL EFFECTIVE BUILDING FOUNDATION 3S, NEAREST LOT LINE -��' ABSORPTION AREA (WALL AREA) -SO// SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE ✓'✓_'/lltT -CONSTRUCTION -/'�✓-l<!¢L' L"O�!/.r!` DEPTH �� / DISTANCE FROM: BUILDING i NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE /-2 SEWER LINE ✓C TANK 72` , SYSTEM CESSPOOL O � OTHER SOURCES �C�4'-_ APPROVED �� DISAPPROVED REMARKS DISTANCES:' -/, n- 71%' DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL: //','^l LOT SLOPE: REMARKS: 7•"A ' Form PW -026 S w � c DATE 7�_?-2/92- APPROVED GRE.., ER ANCHORAGE AREA Bnl%,Ju . n�, ~ DEPARTMENT OF ENVIRONMENTAL QUALITY 1 ' RMIT NO. 3300 TUDOR ROAD POUCH 6.650 ANCHORAGE. ALASKA 99502 TILIP„OMI 279.8686 SEWAGE P`•' DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT m— I 1- MAILING ADDRESS � �� I� PHONE INSTALLATION LOCATION/ 'f' f %f ✓Q` J ��f Ll(-- LEGAL DESCRIPTION - G /`Y INSTALLATION OF: SEPTIC TANK - �X SEEPAGES PIT- �:12!�DRAIN FIELD OTHER TYPE AND SIZE Of FACILITY TO BE SERVED FINANCED THROUGH \\ TO BE INSTALLED BY - SOIL TEST RESULTS \11th NOTE, THIS PERMIT 15 NOT VALID WITHOUT SOIL TEST COMPLETION DAT[ ANTICIPATED FINAL INSPECTION, 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE O I TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT CqO , DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL �S SEPTIC TANK U SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. f / WELL TO SEPTIC TANK �O SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS, WATER MAIN TO SEPTIC TANK SEEPAGE PIT a DRAIN FIELD SEPTIC TANK. SEEPAGE PIT /CJD DRAIN FIELD , TO RIVER. LAKE. STREAM. D OU SSI EKG[V STURBCD SOIL. 4 INCH DIAMCTLR CAST IRON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION, HEALTH AUT' -TY OR LICENSED DC 1 HER AREA SIZE 1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA DESCRIBED SYSTEM 16 IN ACCORDANCE WITH SAID CODE. J\J DATE APPLICANT'S SIGNATV R[ v TYPE DIAGRAM OF SYSTEM NANCE NO. 26.6S AND THAT THE ABOVE ORGANICS ORGANIC SILT • T.H.-I SILTY SANDY GRAVEL '.o' W/COBBLES Med. Dense 7-21-72 n C o• o' 0.0' 0.5' SAND W/PEBBLES (SP) I �� I.0 o, u SILT SANDY GRAVEL Med. Dense (GM) `i o: {o•o 0 �L• 5.0' ::•a SANDY GRAVEL (GW) G�; 0 'O Oq 7.5' 11.0 15.0, No w Note: Minor water seep at 7.5 . Hole excavated with tractor mounted backhoe. owar Nugent Property Engineering a Geological Conoultanta LOG OF TEST BORINGS ANCMOAAOf r^snnANks ALASKA JUNCAY Anchorage Alaska GATE 7-21-72 SCALE I•z 2 OWN BY GgVy CNKD BY y/Ep PROD. NO. 26540-9 DWO NO. A-01 ORGANICS ORGANIC SILT :'�'•' SILTY SANDY GRAVEL '.o' W/COBBLES Med. Dense (GM) n C o• o' SAND W/PEBBLES (SP) I �� o, u SILT SANDY GRAVEL Med. Dense (GM) A,o o: {o•o 0 �L• ::•a SANDY GRAVEL (GW) G�; 0 'O Oq "r-\ h,.Q Y-, - - d o o r , ", {� houses w Q.t e4,4 OCb 0-� CA-ar �l o(�Sl� 12 t o 5-V_t- w 5� 1 � . ic Cil., In RFU A-cl clLov R&M ENGINEERING & GEOLOGICAL CONSULTANTS 7� 229 EAST 51st. AVE. — P.O. BOX 6087 — ANCHORAGE, ALASKA 99503 TELEPHONE 907-279-0483 TELEX 090-35419 Civil Engineers Geologists TELEX Surveyors JAMES W. ROONEY, P. E. MALCOLM A. MENZIES. P.E., L.S. JAMES H. WELLMAN, P.E. July 25, 1972 Mr. Howard Nugent Star Route A Box 1591-N Anchorage, Alaska 99507 R & M No. 26540-9 RE: Test Hole and Soil Log Report for Sanitary System Lot 14, Block 3, Talus -West S/d Dear Mr. Nugent: RALPH R. MIGLIACCIO Engineering Geologist We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of July 21, 1972, 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 14 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 1S 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, R & M ENGINEERING & GEOLOGICAL CONSULTANTS /JaZW. Rooney JW R:wb Enclosure xc: Greater Anchorage Area Borough RECEIVED JUL .:. v I7/L PM GREATER ANCHORAGE AREA BOROUGH CEPT. OF ENVIRONMENTAL QUALITY ANCHORAGE FAIRBANKS JUNEAU • � 1 tj•0' 4Av Municipality of Anchorage -•1 Department of Health and Human Services h Division of Environmental Services �� On-Site Services Section 825'1' Street Room 502 tow w P.O. Box 196650 Anchorage, AK 995IM650 vAv%v.ci. anchcrage.ak. us (907) 34311744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-201-41 HAA 000 G?O Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 14 Block 3 Talus West SID Location (site address or directions) 11856 Wilderness Drive Current Property owner(s) George Paul Day phone 360-3819 Mailing address 11856 Wilderness Drive Anch AK 99516 Lending agency Day phone Mailing address Real Estate Agent Barbra Bowden Day phone 727-2272 Mailing Address Unless otherwise requested, HAA will be held by DHHS torpickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3 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 E] Public Sewer ❑' The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Certificates of Health Authority Approval '(HAA) based only _upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water_.supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates 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. (RWAL" 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 based on procedures outlined in the Health Authority Approval Guidelines for 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm _Pannone Eng. Svc. Phone -272-8218 Address P.O. Box 102954, Anch, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 12/9/2000 �,..- Ly 49TH' 6. DHHS SIGNATURE Steven R. Pannone: -� �1 �•., No. CE 8149 :'�� iG Approved for bedrooms....... ••'�S'� Disapproved. +0++ .41� Conditional approval for bedrooms; with the following stipulations: Municipality of Anchorage ['� (• �`! Department of Health and Human SR&O E I V E D Division of Environmental Services On -Site Services Section 825'L' Street Room 502 2000 P.O. Box 196650 Anchorage, AK 99519-6650 DEC 112000 www.ci.anchorage.ak.us (907) 343-4744 MUNICIPAr,LLIITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL CF Myg AL SERVICES DIVISION Legal Description: L14.83 Talus West Parcel I.D.: 015-201.41 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # Date completed 611/1872 Sanitary seal Y Total depth 79 It Cased to 79 ft FROM WELL LOG Date of test (�N�.cpc✓�v Static water level ft Well production g. p.m WATER SAMPLE RESULTS: Coliform : ) — colonies/100 ml Nitrate to b I mg/I Well Log N Wires properly protected Y Casing height (above ground) 19 in. AT INSPECTION 1018/2000 6+ 9 -p.m Other bacteria colonies/100 ml Date of sample: 12x//2000 Collected by: S.R.PANNONE B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 12/7/2000 Tank size 1000 gal Number of Compartments 2 Cleanouts Y Foundation cleanout Y Depression over tank N High water alarm Date of pumping C. ABSORPTION FIELD DATA Pumper NEW TANK Date installed 1218/2000 Soil rating (g.p.d.M2 or ftZ/bdrm) 0.45 System type OT 9T Length ft Width 3 ft Gravel below pipe 6 ft Total depth 12 ft Effective absorption area 1020 ft2 Monitoring tube Y Depression over field N Date of adequacy test ^ Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test NEW FIELD 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) If yes, give date (Rev. 11/99) D. LIFT STATION 1 Date installed Size in gallons N/A 'Pump on' level at _ in'Pump off" at in Datum Cycles tested E. SEPARATION DISTANCES Manhole/Access High water alarm level at in Meets alarm 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 109 On adjacent lots 100+ Absorption field on lot 124 On adjacent lots 100+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 78 Holding tank 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO Building foundation 24 Property line 24 Absorption field 25 Water main NIA Water service line 50+ Surfacewater 100+ Drainage 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 15 Building foundation 57 Water main N/A Water Service line 75+ Surface water 100+ Driveway, parking/vehicle storage 50+ Curtain drain 100+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION •••P\ �� S [9� i'J .� 1 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in Cj " conformance with MOA HAA guidelines in effect on this date. V`a -^—^ ""• r` ;Stever, r. F'cnnorc IIcC Engineer's Printed Name Steven R. Pannone. P.E.Ij A'••., NO. c �8149 r Date 12-9-00 ��e.R•Egta��i•• HAA Fee $ _ S N. ad ' Date of Payment /Z-// O 0 Receipt Number (Rev. 11199) Waiver Fee $ _ Date of Payment Receipt Number Date installed Size in gallons N/A 'Pump on' level at _ in'Pump off" at in Datum Cycles tested E. SEPARATION DISTANCES Manhole/Access High water alarm level at in Meets alarm 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 109 On adjacent lots 100+ Absorption field on lot 124 On adjacent lots 100+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 78 Holding tank 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO Building foundation 24 Property line 24 Absorption field 25 Water main NIA Water service line 50+ Surfacewater 100+ Drainage 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 15 Building foundation 57 Water main N/A Water Service line 75+ Surface water 100+ Driveway, parking/vehicle storage 50+ Curtain drain 100+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION •••P\ �� S [9� i'J .� 1 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in Cj " conformance with MOA HAA guidelines in effect on this date. V`a -^—^ ""• r` ;Stever, r. F'cnnorc IIcC Engineer's Printed Name Steven R. Pannone. P.E.Ij A'••., NO. c �8149 r Date 12-9-00 ��e.R•Egta��i•• HAA Fee $ _ S N. ad ' Date of Payment /Z-// O 0 Receipt Number (Rev. 11199) Waiver Fee $ _ Date of Payment Receipt Number • MUNICIPALITY OF ANCHORAGE O DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services Ila 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. # HAA # la Q°��p a LnfS 1. GENERAL INFORMATION Complete legal description 110 i 114, B K 3 —I S 1. i� Si Location (site address or directions) — it 8 rj(o %y -i t tde_r. 0,r-, Property owner Mailing address Lending agency Day phone t%ZB — &197 Day phone Mailing address Agent �u l o �1< �t f" l4X Day phone � a Address -_ 62 (ado CA y4d✓ a Unless otherwise requested, HAA will be held for pickup. . 2. NUMBER OF BEDROOMS: 3 ' 3. TYPE OF WATER SUPPLY: / Individual well Community well - _ Public water NOTE: If community well system, provide written confirmation from State ADEC attest- 169, ttest- 169 fo the legality and status of system.- 4. ystem. 4. TYPE OF WASTEWATER DISPOSAL: / Individual on-site Y 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. rlaaOW1121) Fo MOAN" 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. Name of Firm 1 O bbc►1 � �v r V L k14-ae L E: Phone A74-3 916 Address �0 3 Vv IS All 9,20 3 Engineers signature Date &7-DHHS SIGNATURE Approved for "Disapproved. LO bedrooms. \ J C2-<^_25 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 purchasersof homes and their lending institutions in orderto 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. non (P • uv+) 13 m uw m • ® Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lc'r I q. T K 3 —i At_v s WE sr Parcel l.D. 015- 9.01 — 41 A. Well Data Well type Z If A, B, or C. attach ADEC letter. ADEC water system number N�i*- Log present (Y/N) N Date completed 1972 Driller Total depth 71 Cased to 71 Casing height 19 n Sanitary seal (YIN) Y Wires property protected (Y/N) y WATER SAMPLE RESULTS: Date of sample: B. SEPTIC/HOLDING TANK DATA ►M 1 Other bacteria by: 11's. 7 Date installed =z-/7 Z- Tank size /0-aU Compartments .91 Cleanouts (Y/N) V Foundation cleanout (Y/N) N Depression (Y/N) N High water alarm (Y/N) P1/A Alarm tested (YM) ly/A Date of pumping lola&hs- Pumper A+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 72 On adjacent lots 1640 f Foundation 9 To property line > /0 Absorption field A-5 Water main/service line >s'o Surface water/drainage N o k e- zz-MrM*Front CONTINUED ON BACK PAGE FROM WELL LOG AT INSPECTION_ Date of test Static water levelrn Well flow g.p.m. % g.p.m. ^' a Pump levell > Ly m Zn SEPARATION DISTANCES FROM WELL TO: to ' Septic1holding tank on lot 72 ; On adjacent lots 117- 17-Absorption Absorptionfield on lot /P .P- ; On adjacent lots 1 ZD Public sewer main NIA Public sewer manhole/cleanout K/'A Sewer service line > 5o Petroleum tank rqO Ke WATER SAMPLE RESULTS: Date of sample: B. SEPTIC/HOLDING TANK DATA ►M 1 Other bacteria by: 11's. 7 Date installed =z-/7 Z- Tank size /0-aU Compartments .91 Cleanouts (Y/N) V Foundation cleanout (Y/N) N Depression (Y/N) N High water alarm (Y/N) P1/A Alarm tested (YM) ly/A Date of pumping lola&hs- Pumper A+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 72 On adjacent lots 1640 f Foundation 9 To property line > /0 Absorption field A-5 Water main/service line >s'o Surface water/drainage N o k e- zz-MrM*Front CONTINUED ON BACK PAGE C. UFT STATION a Date Installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) 'Pump on" level at 'Pump off" Level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA 7 Date Installed 1 e Sol rating (GPD/Ftz) /'70 System type Length / Width 3 Gravel thickness Totat depth Total absorption area 610 Cleanout present (YIN) Depression over field (Y" N Date of adequacy test 64-d /'?f Results (passltaii) for 3 Bedrooms Water level in absorption field before test After test y9ai 41T� 3z51� Peroxide treatment (past 12 months) qlk M yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 105 On adjacent lots > /6'0 Property line To building foundation L To existing or abandoned system on lot N/l*. On adjacent lots > 32 D Cutbank N b "'e Water malNservice line 7 SO Surface water No v-- Driveway, parkingNehicle storage area So t Curtain drain N l 0 E. ENGINEER'S CERTIFICATION 1 cen)fy that I have checked, verified. or conformed to all MOA and NAA guidelines in effect on the date of this inspection. Signature r Engineer's Name 1 n166 &1 %vvlodfLKa i�.t Date 7, 19' 9i HAA Fee $ Date of Payment 7 — 7 —y5 Receipt Number Z(i -7 1 72 -MB i"S'm)• Back Waiver Fee $ Date of Payment Receipt Number • MUNICIPALITY OF ANCHORAGE • 1- Department of Health & Human Services _ DIVISION OF ENVIRONMENTAL SERVICES , ..r_/..-0... 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel l.D.q.�1 261-'1-t 1 01f-1.1 "1 - t�, 1. GENERAL INFORMATION (Must be completed prior to submittal) t (a) Legal Rescription, ((nclude lot, block, subdivision, section, township, range) Lot 14;�BLock 3; Talus West Location (address, or directions) ;. 11856 WLLtdehness=DnL@(< (b) Property owner r tri .RPh k�t ne Telephone: (home) Business Mailing Address' (c) Lending Institution'' Telephone ' Mailing Address (d) Real Estate Company and Agent JACK WHITE COMPANY ATTN: Lahau Clank Address 3201 C Staeet Suite 100 Anchoitage, Alaska 99503 Telephone 563 5500` Ire\\ `: • - fi_ (e) Mail the HAA to the following address: (or check here$ If hold for pick up.) > ' List contact person and day phone number below: t•' 5 & 5 ENGINEERING •, - 17034 Eagle River Loop Road No 2&4 Yr. : . Eagle River Alaska 99577 t 2. TYPE OF RESIDENCE ` Single -Family RX Number of bedrooms 3 r. },.. 3. WATER SUPPLY Individual Well fix . Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site IZ~x Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. n-025 JR". 7/88) Page 1 of 2 -Z 10 Z e6Ed aorefmz,"e3Smu i.a(� .z i_a •.. H',i o. �r al, ftp f l.+! _) it (i to Slfl,r Atom s jaou!6ua IEuo!ssalad eyl u! • sjo;aqujepezA!e uejosuoisslwojosioija-jo a1isuodsa�1ousie69jo ouVti�ewanssis!aeJ!Saoe _...• . 1-.. suo!lgadsu!lonpuoolouopSHHOlasaaAoldw34s.luawajuba.. puE le�apal u!euao A;slles ol�ap�o u ! suo!1nl!lsu! 6u!puol j!a4l Pug sawo4 10 siase46ind ol-Asalinoa.E.sE s!41 scop SHHO 041'9>IsgIV 10 0iiaig a4f_ u! paialsl6ai _�aau!6ue Ieuoissaloid luepuadepu! ue Aq enoqu g gdaiBuied u1 uen!6 suo!lquesaidai e4l uodn Aluo paseq peleo!J!iao lCAOJddyAi!jo4I6V ililiaeH sanss! (SHHO) saoitueS uewnH pue 41leaH loluawlJgdaO e69jo14ouVloAi!led!o!unlry ey1 • IenaddV Ieuo!i!puop to swiai leuo!l!puoO panaddeslO. panaddy Aq swoojpaq Jo} panaddy IVAOHddV SHHC '9 eleO LLS.,y-r ,n •lRe — ssaippV taLL G 62��76 suo4delal -Du' . 358 —13 10 ewEN _. �uo!loadsu! s!4110 elep eql uo loalla u! suo!leln6ai pu9'saoueu!pio'sapoo e1eiS i pug Ied!olunyy pe 41!m eouu!!dwoo ui s! walsAs Iesods!p jolemalsem jo/pue Alddns jalgm ells-uo e4l 'uo!loadsui pue uo!le611sanu! Aw wal pug sal!} e6ejo4ouV to Ai!led!o!unlnl e41 wwl pau!elgo uo!lewiolut e141 uo paseq ~ 1941 AJuan je4linl I •u!aja14 pal9o!put einlonuls to edAl pug swoojpaq Jo jagwnu e4l jol elenbape pug Ieuo!lounl 'el9s s! walsAs I9sods!p jalemalsem jo/pue Alddns Salem ells-uo 0141 1941 smogs I9AaddV Al!jo4lnV 4lleaH i s141 JO uo!le6!lsanu! Aw lg4l AI!Jan I'molaq umo4s elep uo!lgp!len e4l to s9 pue o1a�a4 pax!;le IEas Aw Aq paipliao sV r NOIIVWHOdNI CNV VIVC'HOdV3S 3'1ld'S1S31'SNO11O3dSNl ONIOIAONd WHId JNIl133NION3 *9 - i .r. MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 I P-k��C' 14` A. WELL DATA Legal Description: Well Classification 1rJp1✓►0JA-1.a If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Ya Date Completed "t `qty Yield -7,67 7r67 4 PH Total Depth Z �l Cased to 47t2 -t Depth of Grouting _ Cry _ 1 t - 9 Static Water Level Sd Pump Set At 0 Casing Height Above Ground 1 Z N'r Sanitary Seal on Casing4-WN) --Y Electrical Wiring in ConduitV/N) Depression Around Wellhead (YN� SEPARATION DISTANCES FROM WELL: 5 To Septic/Holding Tank on Lot 7 7e ; On Adjoining Lots jr To Nearest Edge of Absorption Field on Lot t ci ; On Adjoining Lots To Nearest Public Sewer Line ra 14, To Nearest Public Sewer Cleanout/Manhoie To Nearest Sewer Service Line on Lot 25 k - Water Sample Collected by 5LkS 6144I OE6 --ItzG ; Date 511- 90 Water Sample Test Results 17A�►Sr'�i� —� t� t ii5 CommentsIL��'*-�✓ ltJt-C� 7-2'L72 B. SEPTIC/HOLDING TANK DATA Date Installed l-1-yI L Size 1ckPL> No. of Compartments • - Standpipes (YIN) ��Air-tight CapsV/N) V_Foundation Cleanout (Y/6? Depression over Tank (Y(f� Date Last Pumped S 14 qO Pumping/Maintenance Contact on File (Y/N1 P ; for —� Holding Tank High -Water Alarm (Y/N) A Temporary Holding Tank Permit (Y/N) ra SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well To Building Foundation —_ To Property Line log To Disposal Field t 0 To Water Main/Service Line Iol-1' To Stream, Pond, Lake or Major Drainage Course t W ly Comments �� -1-6r^ef, sdg-%A1 & 72-M (Ft". 7/68) Frwl Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata )` (:>74j' �"4E.. Type of System Desigi�l r T�zr� NES Date Installed nil Length of Field `� _T_Drl� Width of Field 'b Depth of Field tt Gravel Bed Thickness 5� Square Feet of Absortion Area *7 r Statndpipes Presento?N) Depression over Field (YM Date of Last Adequacy Test S- I t-`40 Results of Last Adequacy Test Z f sf_ y - S SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well To Property Line I o To Building Foundation 1 ��; To Existing or Abandoned System on Lot N /n ; On Adjoining Lots a'4 - To 1To Water Main/Service Line To Cutback (if present) 0 To Stream, Pond, Lake, or Major Drainage Course t a (.t- To 'rTo Driveway, Parking Area, or Vehicle Storage Area 75I 't Comments r1GE. -1141; Yri' 12*2 fyl�lw60 Ir 1110 ::OCL PIT FUL-- f�TP�aG D. LIFT STATION Date ailed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) . "Pump Off' Level at "Check Permitted Bedroom Rating Against HAA Request" during Adequacy Test. certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect pp the date of this inspection. ,.�,c�� %h Signed ZLS66.3I4e1V 'JDAI2l 01697 �,',pL"„ .,,',�• (� ►`, ' 'JN peoa doo-I JaAIB of e3 KOL �vy'••• �'..�s91 Company 833l89lI3� s : � / �� 00 »gine real Date / 7 MOA No. No. 143741 Receipt No. '��r' `-�� j ` Receipt No. Date of Payment ? Waiver Fee: $ — Amount: $ 1.?Z)_ /2 C) Date of Payment n-0m(Rw.?i8e) 8wk Page 2 of 2 j r"sMUNICIPALITY OF ANCHORAGE/y • DEPARTMEN OF HEALTH AND ENVIRONMENT PROTECTION 825 L Street, AnchoraaP. Al kal 99501 Roe,264-4j2Qp�_ C� " �,� sup i�'� _g-1� busDate Received: October 25, 1977 i #1: Time #2: Time #3: ime P, i Date xe/. Date V. 1476, 1 LA-, Da _ _I LX__.3& Insp 1 • Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Brokers Title Company Mailing Address: 4797 Business Park Boulevard Phone: 2 3. Property Owner: John Hollomon Mailing Address: Legal Description: Star Route A Box 1587-H 99507 17 fo- oc> C> Phone: 344-1998 Lot 14 Block 3 Talus West Subdivision 4: Single Family Residence: (%) Multiple Family Residence: ( ) Number of Bedrooms: Three Number of Bedrooms: 5. Well System: Individual Well (4 Community/Public System ( ) Permit # D@pth of Well260' Well Log on File Construction J j Bacterial Analysis 6. Sewage Disposal System: On-site System (X) Public Utility.( ) Permit # Installed 1973 f91a Installer Septic Tank Size / O VC-') Manufacturer! Absorption Area OL Soils Rate A!E��.t'�T) Material r, Ih�_ o, 7. Distances: Well to Septic Tank to Absorption Area j0 to Sewer Line Nearest Lot line I Absorption Area 1 � to Nearest Lot Line 7 S Page Tflio Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Dcscription: Lot 14 Block 3 Talus West Subdivision rnmmAnfa Affadavit Attached: ( Letter Attached: ( ) Z i vc l o Approved: Date: Disapproved: Date: Department Worksheet: r % b1V IPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECl.�N \�*ai 2510 East Tudor Road, Anchorage, Alaska 99504 276.2221 7 7 REQUEST FOR APPROVAL OF INDIVIDUAL SEINER and WATER FACILITIES 1.: Type of Inspection: CMRO VA FHA CONYX, 2. Property Owner: John Hollomon Mailing Address: SRA 1587-H Anchorage Day Phone:344-1998 3. Name of Buyer: Hans K Rudolph Mailing Address:_ P.O. Ix. 2592 Reno, Nev. Day Phone: ?77—dU41— 4. Name of Lending Institution: Brokers Title Co (Assumption) Mailing Address:4797 Business Park Blvd Phone: 276-2118 5. Name of Realtor cr Agent: Clyde Lower of Jack 4Nhi to Co Mailing Address: 3201 C St An o�—Phone: 277-155.3 6. Legal Description: Lot 1 Bl Talus I7est Sub Location: NHPi Wilderness Land 7, Type of Facility to be Inspected: Residence No. Bdrms. 3 B. water Supply Well Type of Supply: Public Utility Individual If Individual, number of dwellings presently served 1 If Individual, depth of well 260' 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) �S If Individual, date of installation 1 MUNICIPALITY OF ANCHORAGa DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION OCT 2,51977 72RECEIVED