HomeMy WebLinkAboutTALUS WEST #1 BLK 4 LT 4Talus West #1
Block 4
Lot 4
#015-202-18
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number:
OSP151390
Tax Code Number:
01520218000
Work Type:
Septic Upgrade
Permit Effective Dates: December 30, 2015 to December 29, 2016
Design Engineer:
PANNONE ENGINEERING SERVICE
Subdivision:
TALUS WEST#1
Site Legal Address:
TALUS WEST #1 BLK 4 LT 4 G:2736
Owner/Address:
POBIEGLO CHRISTOPHER S
11845 WILDERNESS DRIVE ANCHORAGE AK 995162236
Site Mailing Address:
11845 WILDERNESS DR, Anchorage Lot Size in Sq Ft:
Total Bedrooms:
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with:
3_IBott4
3.30
18865
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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Receiv
Issued
v4,.q?ea �h�%s'l�� 11 �ti4d 41 oI ver
4%�nrti�rnr3 �drvc,� dr
vvl r meahle sdrls a`�- d ��ry 4V" � 'r�t� . iWA4
tt14 sig ! I �e s yn ; � d � ��, �1� � �,�c SIV"
'of, -Yrs.
i/ S
MUNICIPALITY OF
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
-
ANCHORAGE
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
207-
Parcel
07Parcel I.D. 01 5-2,4K 18
Property owner(s) Christopher Pobieglo Day phone
Mailing address 11845 Wilderness Drive, Anchorage, AK 99516
Site address 11845 Wilderness Drive
Legal description (Sub'd., Block & Lot) Talus West, Block 4, Lot 4
Legal description (Township, Range & Section)
Lot Size 18,865 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
-
-
Absorption Field
❑X
Initial ❑
Single Family (SF)
❑X
(w/wo ADU)
Septic Tank
Q
Upgrade 19Duplex
(D)
❑
Holding Tank
F-1Renewal
F1Multiple
MultipleDwellings
El
Privy
F-1
and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION
INCLUDES A VARIANCE / WAIVER REQUEST FOR:
COQ.; i
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
of property owner or authorized agent)
Pbrmit/Rush Fees: 51!00 " Waiver Fees: �� d
Date of Payment: t,1!6 Date of Payment:
Receipt Number: ocd 4 t 5( Receipt Number: OCs c35 Cn �
Permit No. 05 PI 5 131b Waiver No. e�. V A jA-9 t)_
Permit App_:-: ;'_:c.
ccl
. Pannone Engineering Services «c
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: Steve@oanenRak.com
15 March 2015
Subject:. - TALUS WEST#1 B4 L4 -
Septic System Upgrade Permit Request
Design Narrative -UPDATE
This is an update to the design narrative for a permit to install an upgrade septic system to be issued for this property. The
proposed systems will serve an existing three-bedroom (3) house. Currently the lot is developed. This lot and the surrounding
lots are served by private wells. The well on this lot and the surrounding wells are over 100' from the septic system.
1. Soils. One test hole was performed on this lot by PES in December of 2015, and groundwater was monitored for at least
seven days. Ground water was not observed to a depth of 20.0' below the surface in the test hole monitor tube after the 7 -
day monitoring period. Bedrock was not encountered in the test hole. Based on the results of the percolation tests and
overall soils appearance; an application rate of 0.45 gallons/day/square feet was used for a conventional wastewater
system in -the area of the test hole.
A second test hole will be conducted at the time of construction to a minimum depth of 22.5 feet to accommodate the new
orientation of the proposed field.
2. Soil Absorption System Design.
a. See Sheet 1 of the design package.
3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain
field upgrade will maintain at least 100 feet from all surface water and drainage ditches.
4. Topography: The existing topography generally slopes down from the southeast to the northwest at a 2%-7% grade. The
property slopes from east to the west in the area surrounding the existing septic system at approximately 2%. There are no
steep slopes within 50' of the proposed drain field. The proposed drain field will maintain 50' separation all steep slopes.
S. Waiver: We are requesting a drain field orientation waiver. The proposed primary field will be installed perpendicular to
the existing grade of the property. The slope of the property in the area of the proposed system is approximately 7% grade from
the southeast to north west. A mound will be added to the northwest end of the proposed field to ensure 3' of cover (and 3:1
side slopes).
The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells within
100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218.
Sincerely,
Steven R. Pannone, P.E.
Owner/Civil Engineer
Attachments:
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
TT -1
SM/
om
FILTER FABRIC
4" 0 DRAIN PIPE
-DRAIN ROCK 6" ABOVE PIPE INV
DESIGN PARAMETERS
TEST HOLE
PRIMARY SEPTIC SYSTEM
PROPOSED
J
EXISTING
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DESIGN PARAMETERS
TEST HOLE
PRIMARY SEPTIC SYSTEM
PROPOSED
NO. BEDROOM:. 3 (450 gpd)
EXISTING
TANK SIZE: 1500g (E)
-
PERC RATE: 34.5 MPI
MONITOR TUBE NO.
SOIL RATING: 0.45 GPD/SF
LEGEND
AREA ROD: 1333.3 SF
-.--.—.—.—.—.— WATER LINE/
SYS. TYPE: DEEP TRENCH 11.0'ED
WELL RADIUS
MIN LENGTH: 60.6 LF
USE:
—"—"—"—'—'— NEW SEPTIC
61.OLFx2.5'Wx11.0' E.D., 15.5' TD
TOTAL. AREA: 1342 SF
NOTES:
PANNONE ENG SVC, LLC
FOR CONSTRUCTION
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
TALUS WEST #1 34 L4
S POBIEGLO
DRAWN JRLCHRISTOPHER
11845 WILDERNESS DRIVE
PLAN
ANCHORAGE, AK 99516
ABBREVIATIONS
TH
TEST HOLE
(P) -
PROPOSED
(E) .
EXISTING
CO
CLEAN OUT NO.
MT
MONITOR TUBE NO.
TYP
TYPICAL
Vr
... .,.iq-`ll1
.s�9#+I
03/15/16
Scale
*' 71-I *'�r�
P.I.D NO
202-L
Steven R. Pannone
PERMIT NO.
V .. CE 3149 . �
c/
r
OSP151390
Sh2eOF
�i�� �x' S_1
��
4
TEST HOLE 1
TOPSOIL
1
DATE
CLOCK
2
WATER
LEVEL
READING
RATE
3
12/06115
1328
4
6.260"
s
1358
6
7.114"
J870
7
1359
S
6.260"
9
SM!
Brown Silty -
30 MIN
GM
SAND &
10
GRAVEL
11
6.260"
12
1500
13
7.137'
14
15
16
17
18
19
20
BOH
DATE
PERFORMED: 12/8/2015
C01
SOILS LOG - PERCOLATION TEST
SLOPEI I SIT PLAN
I I
—J JUMAR AV\
_—_—�_i_
TH-2
—� TO BE PERFOIR�MM1l_b AT
,104 TIME OF CONSTRUCTIO
I
__
(HTEST
OLE t t A' ^�
L,i
H1
WAS GROUND WATER
ENCOUNTERED? N
IF YES, AT WHAT
DEPTH?
DEPTH TO WATER AFTER
MONITORING? - DRY -
DATE: 12/15/15
3BR
SFD
SLOPE
TH 1
READING
DATE
CLOCK
NETTIME
WATER
LEVEL
READING
RATE
1
12/06115
1328
6.260"
2
1358
30 MIN
7.114"
J870
3
1359
6.260"
4
1429
30 MIN
7.126"
5
1430
6.260"
6
1500
30 MIN
7.137'
PERCOLATION RATE 34.5 (min/inch)! PERC HOLE DIAMETER 6" / TEST RUN BETWEEN 6 FT AND 7 FT
COMMENTS: Test hole excavated by John's Excavating. Test Hole was presoaked before Perc test.
PERFORMED BY: J.R.Lawendowski I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE
AND MUNICIPAL GUIDLINES IN EFFECT ON THE �D 7ATTE OF THIS TEST. T T
NOTES: PAMONE ENG SVC, LLC �� OF Al -,q 0ate
03/15/16
FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 .% '��' "' qS i�
PHONE (907) 272-8218 FAX (907) 272-8211 /rg�P ..-v Scale
*: Qg TH • *�� NTS
..... .. ....... / P.I.D. NO
TALUS WEST #1 34 L415-202-1
CHRISTOPHER S POBIEGLO Steven R. Pannone PERMIT NO.
DRAWN JRL11845 WILDERNESS DRIVE It Pte:, CE 8149 aspi 51390
SOILS LOG ANCHORAGE, AK 99516 +�1�F o oSS10NP Sheet
��\��__ �� 3 OF 4
1. ALL CONSTRUCTION SHALL BE INSTALLED AS -SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON—SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65.
2. SCOPE OF WORK: INSTALL NEW SOIL ABSORPTION SYSTEM.
3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 20 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL
TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 18 FEET BELOW
EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. - -
A SECOND TEST HOLE WILL BE PERFORMED AT THE TIME OF CONSTRUCTION TO A DEPTH OF 22.5 FEET
4. THE CONTRACTOR SHALL HAVE ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE
PROPOSED SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK.
5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED.
r:
6. _ THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES.
7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING
AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER.
8. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE
CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN.
9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED—LINE AS—BUILT DRAWINGS TO THE
ENGINEER. THE RED—LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND -
TANK ELEVATIONS.
10. THE CONTRACTOR SHALL SIGN THE FOLLOWING:
I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE
ORDERS, AND THAT THE AS—BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS
CONSTRUCTED.
CONTRACTOR:
BY: . TITLE:
NOTES: - PAMONE ENG SVC, LLC Date
03/15/16
FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 '��•....•• qoS (�l
• '•� 1 Scale
PHONE (907) 272-8218 FAX (907) 272-8211 * 9tfNTS
/••••• •• •••.I P.I.D. NO
TALUS WEST #1 E34 L4 ...... 1015-202-1
CHRISTOPHER S POBIEGLO Steven F2. Pannone PERMIT NO.
DRAWN JRL CE 8149�OSP151390
11845 WILDERNESS DRIVE _
DESIGN NOTES ANCHORAGE, AK 99516 111 .......Sheet
OFESSA 4 OF 4
GREA , cR ANCHORAGE AREA BORt_jGH
Department of Environmental Quality
�^ 3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME/lf&Z-Y ��": Z�%ZW' K r -MAILING ADDRESS
LOCATION
LEGAL
iA /us W e_,x2"
SEPTIC TANK:
DISTANCE
` /n, ,N.,U,MBER OF
FROM WELL o— MANUFACTURER jtj�_ TERIALS����G-•G/ �,pyMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY GALLONS.
/
/7' 7- C7- TOTAL LENGTH/,
DISTANCE FROM WELL FOUNDATION _/SF NEAREST LOT LINEN OF LINES _ y2
NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH_ IN. TOTAL EFFECTIVE
ABSORPTION AREA _j1O.O SD. FT. LENGTH OF EACH LINE y
EPTH OF FILTER
/-�p
DEPTH: TOP OF TILE TO FINISH GRADE _A5S MATERIAL BENEATH TILE 1/F� IN. ABOVE TILE �- Y IN.
WEl L- /I
YJ i n
TYPE CI �- CONSTRUCTION C'�SJ �� DEPTH DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC J SEEPAGE i�-•
FOUNDATION_. LOT LINE , SEWER LINE . TANK ��. SYSTEM
CESSPOOL . OTHER SOURCES
APPROVED — DISAPPROVED REMARKS —•
DISTANCES:
�Q
INSTALLED BY:
I` -t Cl
SEWER LINE DEPTH:
PIPE MATERIAL: y
LOT SLOPE: _/ev- �
REMARKS:
Ya
Form EQ -032
DIAGRAM OF SYSTEM
F-Quti�dcllad I
S � JtT �ie�°�io.CJ
lsol
1o.
DATJK4-/*-g4APPROVED
G.A.A.B.
�%J
3:m I1:3 m
rjUr-! I ( I. nL_ I TY OF FirJCI� �Rt=fGE I�- -7�0
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION L
2516 E. TUDOR RD., ANCHORAGE, AK. 99507
276-2221
WELL- Flt4E> CAr4-Sa I TE SEWER FIERM I T
PERMIT NO. C 76765 )
APPLICANT MARY WRIGHT SRA BOX 1585 A 344-4214
LOCATION WILDER THRIVE
LEGAL L4 64 TALUS WEST LOT SIZE 15200 SQUARE FEET
TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING CSQ FT/BP.)= 250
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
E>EF}TH= 1 mS L-EhJGTH= 41S GRAVEL E>EF TH= 11.
THE LENGTH DIMENSION IS THE LENGTH CIN 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 CIN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION CIN FEET).
F'F=l CKRGE F LRLVT LZEQU I REL*
EITHER A CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED.
A CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF A MAINTENANCE
AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL
ABSORPTION SYSTEM AND/OR YOU MAY BE SUBJECT TO PROSECUTION.
IF A CLASS I SYSTEM IS USED THE LENGTH IS 33.0 FEET.
IF A CLASS II SYSTEM IS USED THE LENGTH IS 42.0 FEET.
TWO C 2> I MSF•ECT I CA r4 RRE FZEZIM U I REO
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 200 FEET FOR. A PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
INSTALLATION.
F•ERM I T N?F4L I L? FiOR ONE YEFiR FROM I SSSILJE
I CERTIFY THAT
1: I AM FAMILIAR. WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNED:
MARY WRIGHT
ISSUED BY
M -W DRILLING, INC.
DRILLING LOG
Well Owner V'rioht Construction Use of Well Dom.
Location (address of: Township, Range, Section, if known; or distance main road
Lot 4 Block 4. Talus East
Size of casing 6'� Tlepth of Hole 95' feet Cased to -2-3 —' feet
Static water level 50 ft. x(above) (below) land surface. Finish of well (check one) open end (XX );
Screen ( ); Perforated ( ).
Describe screen or perforation
Well pumping test at 11 gallons per>(houi) (minute) for -!-----hours with 1
of drawdown from static level.
Date of completion 10/5/76
WELL LOG
Depth in feet from
ground surface
Give details of formations penetrated, size of material, color and hardness
02
TO
2
Casinq Stick»n
TO
TO
15
Silty Cravnl
15
TO
20
q--md
20
TO
_10
Si. tV S")nrj
'�
TO
4f7
Si. 1.tv Gravol
`'`i
TO
511
Armml — Cpyirn
50
TO
75
''Silty Gravel
r5TO
SO
Silty Sand
EO
,10
90
Silty Gravel
o
TO
95
Sandy Gravel — gator
TO
TO
TO
TO
2 —STATE
Municipality of Anchorage
Development Services Department
/ Building Safety Division
O
On-Site Water and Wastewater Program r
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. COSA# b(r!)1R5
Expiration Date: - a' $ D 6
1. GENERAL INFORMATION µ1 `
Complete legal description T4.5 lllrs� La S 9 Blk 4
Location (site address) 11845 W ;IAN..ass Drive -
Current Propertyowner(s) L+11iAn Ande^5or-s Day phone
Mailing address
Lending agency Day phone
Mailing address
Real Estate Agent Wendy 'TV%QMa5 Day phone 490-99`iis
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
1&
Individual On-site
19
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 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 Onsite 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
Phone '119-311(o
Address 20.3 W. 15" Ave. 141- 2:03 A nA c�_,_AK 91501
Engineer's Printed Name i066� 5D41W ahA Date 5 0 oG
5. DSD SIGNATURE
_t/f Approved for ___Y- bedrooms.
Disapproved.
rrSJos dEPUMI AND
CJ E 2225<�
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: OZ441��� Original Certificate Date: — in
(Rev. Iv0s)
Municipality of Anchorage ••,
Development Services Department
Building Safety Division `
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196050
Anchorage, AK 99519-6650
www.muni.org/onske
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: I g1us Wes+ Lot 9 Calk 9 Parcel ID: 01 6�- �2 0 -Z-/9
A. WELL DATA
Well typeMVATE If A. B, or C provide PWSID # = Well Log (Y/N) Y
Date completed to 5 P (6 Sanitary seal (Y!N) y Wires properly protected (Y/N) Y
Total depth �` �ft. Cased to ft. Casing height (above ground) + IS in.
FROM WELL LOG AT INSPECTION
Date of test 10 5 I fv 5/2 o
Static water level 50 ft, 50 ft•
Well production I 1 g.p.m. 5.8 g.p.m.
WATER SAMPLE RESULTS:
Coliform —.0—colonies/100 mL Nitrate 0.11 mg/L Other bacteria —0— colonies/100 mL
Arsenic: mg/i Date of sample: `f 2 � Collected by: L-4rs __5'Qvr W4nc�
B. SEPTICIHOLDING TANK DATA
Tank Type/Material C o n c re h ht C 4,,6a Date installed 10
Tank size 15,11, gal. Number of Compartments 2 Cieanouts (Y/N) it
Foundation cleanout (YIN) Depression over tank (Y/N) IV High water alarm (Y/N)
Date of pumping DIM L05 Pumper Rofcn. Qo T e -
C. ABSORPTION FIELD DATA } Fro•
Date installed t I'i Soil rating 4-v_ Nt°•Dr felbdrm)' 250 �, System type L Trnc
Length `IZ ft. Width 2 ft. Gravel below pipe 1 ft
Total depth 1 lO ft. Eff. absorption area 1100 f *- Monitoring tube __ Depression over field
Date of adequacy test S y olo Results (Pass/Fail) Pais For Q bedrooms
Fluid depth in absorption field before test O in. Water added110, gal. New depth_; in.
Elapsed Time: to min. Final fluid depth -3 in. Absorption rate >= (OW 9-p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) lone- kWW n If yes, give date —
V Front AS 64411 Inspeckion tegori
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
`Pumpon' I at _ in. 'Pump otP level a in. High water alarm level in.
Datum Cycles tes Meets alarm & ci requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 1031
Absorption field on lot I 00 +
Public sewer mainN%A
Sewer /septic service line t Z 5 I
r
Animal containment areas
On adjacent lots I Opr'�-
On adjacent lots (ab r +
Public sewer manhole/cleanout N A
Holding tank _ NIA
Manure/animal excrete storage areas r+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
r
Building foundation Properly line 514- Absorption field S I +
Water main YZA Water service line to 14 Surface water 4/.0.
Wells on adjacent lots too r +
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line t r r + Building foundation 10 + Water main N A
rI r
Water Service line 6-0 f Surface water N. O. Driveway, parking/vehicle storage 504-
Curtain
0+
Curtain drain Al, O . Wells on adjacent lits 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION r P OF A4
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
1 4`
Engineers Printed Namec�+
_ �iaen Spur[LIv+d SrURXLAtJD'
Date $�6/O fo t�Gj, E k225 c r/
COSA Fee $ T/� -
Date of Payment "/I to /6
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Lot 5
—T— — Jumar Avenue
�o
cr) N89058'10"W 142.56
SCALE: 1"= 30'
10' Utility Easement _
• Septic Vents
LOT 4
/
/ W
B Septic Vents
! 1 112 Story Frame
i House
18.0
0
v
N
24.0
WW
R-3 L=100.00
8299X
0
M
N Lot 3
Ln
W
ih
Ln
O
O
Ca
0
/Dr
i
Wilderness ive
AS -BUILT NO CORNERS SET THIS DATE
1 hereby certify that I have performed a Mortgagee's inspection
�., �� 'h� of the following described property. LOT 4, BLOCK 4.
s r ` TALUS S UICST SUBDIVISION, ADDITION No. 1
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property Ines
Arach on the rt M.
Prod W06"
M 325"
EASEMENTS OF RECORD, OTHER THAN -i�s•�
THOSE SHOWN ON THE RECORDED FbO6J, pg 36
PLAT ARE NOT SHOWN HEREON.
BE
end do not ove ap oencroach prop -
adjacent thereto, that no Improvements on the property lying
adjacent thereto encroach on the premises In question and
that there are no roadways, transmission Ines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this 81h day of MAY
FRED WALATKA & ASSOCIATES
Engineers and Surveyors
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-A720
Application Date *2—
i.
1. GENERAL INFORMATION
(a) Legal Dgcngtigrl(include lot, block, subdivision, section, township, range)
Location (address or directions)
11845 Wilderness Drive
(b) ApplicantName Dane Williams Telephone: Home 345-3180 Business 265-8831
Applicant Address Same
(c) Applicant is (check one): Lending Institution O ; Owner/builder; Buyer 0; Other ❑ (explain);
(d) Lending Institution NAI -109A -C 6ANIC hNC1tl?� elephone
Address
(e) Real Estate Company and Agent �!
Address
Telephone
('j Mail the HAA to the following address:
.P1/1! to 0 17 Ah
2b�-B�41 - IilK `
2. TYPE OF RESIDENCE
bmg;e-Family ® Multi -Family ❑ Other
Number of Bedrooms
3- WATER SUPPLY
indrrrdual Well M Community ❑ Public O
Ncte: If community well system, must have written confirmation from the State Department of Environmental Conservation
z::s: ng to the legality and status.
4- SEWAGE DISPOSAL
Crsite 0 Public ❑ Community ❑ Holding Tank O
f:c:e:11 community well system, must have written confirmation from the State Department of Environmental Conservation
at.e<.ing to the legality and status.
rN0:5 (11.84)
Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
CQ
As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm QUADRA Engineering, Inc. _Telephone 276-3770
Address 401 East Fireweed Lane
Date August 29, 1985
OF A
„49T , . ;.,,,,,} , j Engineer's Seal
Michael E Anderwn
._ 43301 • E
DHEP APPROVAL /
Approvedfor z � bedrooms by �� "" 1��u4Y!t Date
Approved X Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
MIAdICIPALITY OF ANCHORAGE
' '� DEPT. OF HEALTH 8
MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA) �
CHECKLIST - FEBRUARY 1884 U� 2 J UDCii
264-4720 �/-Me � ('
Legal Description: Lot !� . B11NA l- I V E D
Talus West Subdivision
A. WELL DATA
Well Classification Individual If A. B, C. D.E.C. Approved (YIN)
Well Log Present (YIN) Y Date Completed 10/5/76 Yield 6.5 Gal/Min.
Total Depth 95' Cased to 931 Depth of Grouting None
Static Water Level 50' Pump Set At 87'
Casing Height Above Ground 2' Sanitary Seal on Casing (YIN) Y
Electrical Wiring in Conduit (YIN) Y Depression Around Wellhead (YIN) N
Separation Distances from Well:
To Septic/Holding Tank on Lot 105'+ ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot 121'+ ; On Adjoining Lots 125' +
To Nearest Public Sewer Line N/A To Nearest Public Sewer
Cleanout/Manhole N/A To Nearest Sewer Service Line on Lot N/A
Water Sample Collected by A. Harala ; Date 6/26/85
Water Sample Test Results Satisfactory
Comments
B. SEPTIC/HOLDING TANK DATA y�
••� C� s�
Date Installed 10/18/76 e 100x0 Ga No. of Compartments 2
Standpipes (YIN) Y Air -tight Caps (YIN) Y Foundation Cleanout (YIN) Y
Depression over Tank (YIN) N Date Last Pumped 8/20/85
Pumping/Maintenance Contract on File (YIN) N a ; for
Holding Tank High -Water Alarm (YIN) NAA Temporary Holding Tank Permit (YIN)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well 105 To Building Foundation 71+
To Property Line 37' To Disposal Field 31'
To Water Main/Service Line N/A To Stream, Pond, Lake, or Major Drainage
Course
Comments
Page 1 of 2
72-026(11,84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 250 Ft2/RR Type of System Design Deep Trench
Date Installed 10/18/76 Length of Field 42'
Width of Field 3' Depth of Field 16'
9z�
Gravel Bed Thickness 11'
2
Square Feet of Absorption Area Ft Standpipes Present (Y/N) Y
Depression over Field (Y/N) N Date of Last Adequacy Test 8/26-27/85
Results of Last Adequacy Test Satisfactory
Separation Distance from Absorption Field:
To Water -Supply Well 1211+ To Property Line 24'
To Building Foundation 43' To Existing or Abandoned System on
Lot N/A ; On Adjoining Lots 501+
To Water Main/Service Line 1001+ To Cutbank (if present) N/A
To Stream/Pond/Lake/or Major Drainage Course N/A
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed N/A
Size in Gallons
"Pump On" Level at —
High Water Alarm Level at
Tested for
Electrical Codes (Y/N) _
Comments
65'+
Dimensions
Manhole/Access (Y/N)
_ "Pump Off' Level at
•• Check Permitted Bedroom Rating Against HAA Request ••
Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
I certify tth��.aa�"t I" have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed*o&CbW f&&U4441 Date August 29, 1985
Company QUADRA EnctineerinigOA No. ST85-199
Receipt No. 35a,
OF
Date of Payment �� i{� �'tP��•'�:45,��
.,
SW
Amount: $ 5 ss
• •: g
7�t En ineer's Seal
� � � ��JTH *
I, fnc Michael E. Andarwn
Page 2 of 2 �, s,•438].E
72-026 (11,84)
�• 1
r%
/-' A) ,' I_
Ll
LEGEND:
Dr aao Ccp Llcaumcat
O Iron Piro
o Stool Pin -
Survoy fluff Q Tcch
1 hereby certify that 1 have survvevlvl Lot_ , Block
f'�� L i K•rµ'r�t` r l/ 1
Subdivision, Anchorage Recording Precinct, Alaska,
and have replaced all lost comets with WV X 30•• relrar. It is ilm
responsibility of the owner, prior to construction, to verily pugmov•d
building lunation on Int, grade, and utility connections, elcu to
determine the existence of any easements, Lovenants, or restrtrtions
which tin not appeal on the recorded 1`lat. Nvxt at Anchoragn, ,11.1.ki
this ///.', day of5!'/ •r^_ 1 i
Constructing Engineers, S^A Dox M, Anrhora,i, Ah;-ka.
34-10817 ^•14 70Ef1
/rr r�1
cert• rrN�
No.30024
C
I
401 E. FIREWEED LANE
ANCHORAGE, ALASKA 99503-2197
(907) 276-3770
JOB Low r Ti��us wE�T �La�zQ�
SHEET N0. OF
CALCULATED BY DATE
CHECKED BY DATE
SCALE
A
r"NUNICIPALITY OF•ANCHORAGr''_'�
cDEPARTMENT vr'HEALTH AND ENVIRONMENTAL ?ROTECTION t.
Clio825 L Street, Anchorage, Alaska 99501
, 279-2511, ext. 224, 225
- Date Received: March 22, 1977
1st Inspection: Time /0-M) ani 2nd Inspection: Time
Date-� q -i7 I i a5 '. Date
o` -7_„ 5
Inspector Inspector
Inspector
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request: Alaska Statebank
(tailing Address:
2. Property Owner:
flailing Address;
310 East Northern Lights Phone: 279-7637
Dick/Mary Wright
Star Route A Box 1585A
Phone: 344-4214
3.
Legal
Description: Lot 4
Block
4 Talus West
Subdivision
4.
Single
Family Residence:
(x)
Number of
Bedrooms: 3
Multiple Family Residence: ( )
5. Well Data: Type Individual
Construction
Number of Bedrooms:
Depth
Bacterial Analysis
6. Sewage Disposal System: On-site system
Permit f Installed
Septic Tank Size
Absorption Area
Well Log Filed ( )
(x) Public Utility
Installer
Manufacturer
Soils Rate
7. Distances: Well to Septic Tank
to Sewer Lines
Nearest Lot Line
Absorption Area to Nearest Lot Line
blaterial
to Absorption Area
Page -Two
Department•of:Health and Environmental Protection
'Request for Approval of -Individual Sewer and Water Facilities
Legal Description:
Comments:
Lot 4 Block 4 Talus West Subdivision
Affadavit Attached:n( ) Letter Attached: ( )
Approved:
Date:
Disapproved: Date:
Department Worksheet:
7
kllrlt��fn2 Pr t�c� �a� Yi'v/r.r,nQ Co � o%�r�.L Gi?trc�
• • r / 1
MUNICIPALITY OF ANCHORAGE MUNICIPAUTI OF
%� XPi. o; IcrtT;l a
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTIOS1�f Ir11T �l Pti �1;q ION
2510 East Tudor Road, Anchorage, Alaska 99504 276.222`1
REQUEST FOR APPROVAL OF HAF 2 21977
INDIVIDUAL SEWER and WATER FACILITIES RECEIVED
1. Type of Inspection: CMRO VA FHA CONV XXX
2. Property Owner: Dick and Mary Wright
Mailing Address: SRA Box 1585 A Day Phone: 344-4214
3. Name of Buyer: Reuben Dane and Ella Ruth Williams
Mailing Address: 148 Whirlaway Aprt 4 Day Phone: 694-2795
Eagle River Alaska
4. Name of Lending Institution: Alaska STatebank
Mailing Address: 310 E. Northern Lights Phone: 279-7637
5. Name of Realtor or Agent: Tanner—Mc Gowen /Marcia Crowell
Mailing Address: 3766 Artic Blvd Phone: 274-2521
6. Legal Description: Lot 4 Blk 4 Talus West
Location: Wilderness Drive, Anchorage, ALaska
7. Type of Facility to be Inspected: single family No. Bdrms. 3
8. Water Supply
Type of Supply: Public Utility Individual XXX
If Individual, number of dwellings presently served l
If Individual, depth of well unknown
9. Sewage Disposal System
Type of System: Public Utility Individual (onsite) XXX
If Individual, date of installation unknown
7200319/761