HomeMy WebLinkAboutTALUS WEST #1 BLK 5 LT 7Talus West #1 Block 5 Lot 7 #015-202-27 Municipality of Anchorage • Community Development Department Page 1 of 3 On-Site Water&Wastewater Program 4700 Elmore St. •P.O. Box 196650 Anchorage, AK 99519-6650 •http://www.muni.org/onsite•(907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191231 PID Number: 015-202-27 ❑ New I.Upgrade Name: ABSORPTION FIELD Amanda Britt&Jason Bodily Address: • Deep Trench 0 Shallow Trench 0 Bed 0 Mound 11755 Wilderness Drive *ANCHORAGE, AK 99507 0 Other Phone: No.of Bedrooms: Soil Rating: Total Depth from original grade 360-0124 3 0.8 OFVifs,R 11 F, LEGAL DESCRIPTION Depth to pipe invert from original grade: Gravel depth beneath pipe: SEE DWG. R 5 Ft. Subdivision: Block: Lot: Fill added above original grade: Gravel length: Talus West#1 5 7 SEE DWG. a 61 Ft. I ownshlp: Flange: Section: Gravel width: Beds Number of lines: Distance between lines: 2.5 R - - Ft. SEPARATIONDISTANCES Total absorption area Number of trenches: Dist.between trenches: To Septic Absorption Lift Holding Public/Private From Tank Field Station Tank Sewer Lines 600+ t30 R 1 - F,. Well 100'+ - - 25+ TANK 0 Septic 0 S.T.E.P. ❑Holdin they Manufacturer Capacity: Surface Water100'+ - - EXi'-04G (i) Gal z Material 'Number of compartments: Lot Line C 10'+ - - N/A w Foundation 10'+ LIFT STATION Curtain Drain 10'+ - - Manufacturer: c.• Gal Remarks: 'Pump on"level at "Pump or level at: High water alarm at: Undocumented drainfield was abandoned in place. (:p P4'Tr n+:r''r- I 76 -�gj.v jr At Pump Make 8 Modal Electrical Inspections performed by: ExtS-i-- PIPE MATERIAL House to tank EXISTING Tank to D3034 drainfield Installer A+ HOME SERVICES Drainfield D3034 CO/MT D3034 Inspector GEG, Ltd. BENCH MARK (Assumed elevation) Inspection 100.00 Ft Dates: 1st 6/17/19 2nd 6/18/19 Location and Desc pt on: 3rd 4th BOTTOM OF TRIM NW CORNER OF HOUSE ENGINEER'S SEAL Community Development Department Approval ,,,, •••cjO o vo�C.. O•F • ���4p Conditional approval: Date: _ v ..-100 L. j. vAAv 4 re A. G mess.: 0 (*) /1 •3 CE 3 ` V Ap•roved: 'tom_ Dater �� LICENSE 44eapr nom o f essio #AECC884 O1000o4� I,croM'v.n Remn 1.1.17 d% PERMIT NUMBER: PARCEL ID NUMBER: ` OSP191231 RECORD DRAWING 015-202-27 / A B / DBL1 39.6 46.1 „l��,' 1 I. —_ i DBL2 40.4 46.6 `\ / FD 40.8 47.2 CO1 31.3 65.6 MT1 30.9 66.5 CO2 89.3 103.0 // . / ' .,• :.; MT2 89.6 103.7 1 .!."••,•::••-• ---------------- 1 '....M,. — — TALUS WEST#1;BLOCK 5,LOT 14 y' ' • .' '••,:;, NEW DRAINFIELD ` }fir' - LOCATION OF UNDOCUMENTED • i /' % ••••••• •','4•! .•: :.' • --` DRAINFIELD(ABANDONED IN PLACE). �� .4...:•••••%•—•• ••'........."...:....t.'• UNKNOWN IF THERE IS ANY CONTINUITY // - `•• :^;~ .�.;'r-: �'•«..:, BETWEEN THE UNDOCUMENTED P�O,�° , \\ •• �..•r ,�'' DRAINFIELD AND THE 1976 DRAINFIELD. G,y!6C' S U / \% •' 111,J%% MT2 O. Ab i,/ . ,. i EXISTING DRAINFIELD CO2 �i ``\ 11111 NO1'. `\ \ ss ‘ NN '1 g �`./ TALUS WEST#1;BLOCK 5,LOT 61`` eoQ Al '\,. ' 8 NN ! DBL182 ss,,,rv 1 1 O FCS` SEPTIC EXISTING 12001 GALLON 1 1 ARCONCRETE TANK ---4 EA __ (ISTIN.G 3 �--'' t BEDROOM �` HOUSE �\\ G, 4414' / ,,rr,�,, \ v TALUS WEST/�1;BLOCK 5,LOT 8 �` C'�' ` --------- ----------- i '.•• \\ w ss S ALE. 1 _ I 1"=40' i ti ii 0111011•11 i �. ••` OF ••• "' ;,,64 GARNESS ENGINEERING GROUP, Ltd ja 1 • *'1 :9 ' `�"" • ENGINEERING•SALES Q CONSULTING -- / • • 3701 E.TUDOR ROAD,SUITE 101'ANCHORAGE.AK 99507•PHONE(907)337.6179'FAX(907)338.3246•WEBSITE:www.gamessengineaip.com •• • •-••- • --EPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 fn - A. - ,a_ 0 Li ON AMANDA BRITT&JASON BODILY 907-360-0124 2 OF 3 Oj�%,% C7-7913 PROJECT/LEGAL DESCRIPTION: DRAWN BY: •♦ , ••. ••421. q•.••. 1 TALUS WEST#1; BLOCK 5, LOT 7 PNB 1� Q .•,�� ,,.�P,\, .� TYPE OF WORK: DATE: LICENSE,,�1�""�:•• RECORD DRAWING 6/19/19 #AECC884 c---'. NUMBER: PARCEL ID NUMBER OSP191231 RECORD DRAWING 015-202-27 TH ORIGINAL GRADE @ MT CO /— FINAL GRADE = 95.5-97.5 HIGHEST POINT = 97.16 FILTER FABRIC ••:!• .• :: ,o : • • � �:i: o o: �: > :•o'•.' :••'.. i° ;11/o:•:•: =•:. • >o ...o:..;:>;:>,..:.e.:. >° =.° •:•:•:•: INVERT OF PIPE = 91.18 ° o. >o :•• z.;.�:�... : >0 ....o:•;•:.•:•;., >o ;.::::• ":::: .:. • 0 0 0 >oS•o'•:•' :''r >° L.0:�:i.:.. ; > :•°:•:•:•:•: BOTTOM OF TRENCH = 86.16 ° o ° °::_-. :%' > >°° >° >° >° >° ° >° RELATIVE ELEVATION OF BOTTOM OF TESTHOLE = 80.16 (DRY) Ad Nis c • J.• ' .ratt j #. GARNESS ENGINEERING GROUP Ltd = 49 :'�* •'0 ENGINEERING SALES CONSULTING N ;J • 3701 E.TUDOR ROAD,SUITE 101•ANCHORAGE.AK 99507•PHONE(907)337-6179•FAX(907)338-3246•WEBSITE.www.gamessengineering.com ; • • • • ' PREPARED FOR PHONE NUMBER: PAGE NUMBER: 0(n -. e • -y - _:ss : 4/1 •AMANDA BRITT& JASON BODILY 360-0124 3 OF 3 #A!J,•••/ C -79 3 °��� • PROJECT/LEGAL DESCRIPTION: DRAWN BY: I -• r 1 C-/.... • TALUS WEST#1; BLOCK 5. LOT 7 PNB �. Fp••''•��• •:..• ''' ��'•� TYPE OF WORK. DATE LICENSE 44 iaR)FES`,**. •• PROFILE DRAWING 6/18/19 #AECCsEE n.. GREA I cR ANCHORAGE AREA BOR%_ jGH OIL>> Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 -INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME /0 MAILING ADDRESSP- �/PuHO�N � �7/ LOCATIONf11L' ' LEGAL DESCRIPTION � SEPTIC TANK: \ DISTANCE ZZ � OWT NUMBER OFM FROM WELL CL�� MANUFACTURER �f �Tv7A-T�ERIAL COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY GALLONS. /� / TOTAL LENGTH DISTANCE FROM WELL i� �_6FOUNDATION T NEAREST LOT LINE _ _OF LINES S k1l NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH` L -IN. TOTAL EFFECTIVE {'L Of ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE v .DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE/ MATERIAL BENEATH TILE IN. ABOVE TILE �/s�/1� IN. WELL - TYPE ELL:TYPE_-u.�'Se CONST RUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION_. LOT LINE , SEWER LINE , TANK , SYSTEM CESSPOOL APPROVED DISTANCES. OTHER SOURCES / DISAPPROVED REMARKS ��T �� CL • •� ��^ ����=• INSTALLED BY: �_ SEWER LINE DEPTH: PIPE MATERIAL: Si• r/ LOT SLOPE::—/ c-^- REMARKSA" Pr Form EQ -032 DIAGRAM OF SYSTEM -.G«'APP G.A.A.B. F1lJr}I I C I F^�L_ I TY iDF= nr•FfiGE 32� A l DEPARTMENT 0 4EALTH AND ENVIRONMENTAL F 'TECTION 2516 E. TUDOR, RD.. ANCHORAGE, AY,. 99507 • clea OA_; 276-2221 ICP f� LJELL nr11C• Qr-4 I TE S~EL-IEFZ PEFZM I PERMIT NO. ( 7646E ) )i:,5D APPLICANT MOSE PENDERGRASS SRA BOX 15856 349-4207 LOCATION WILDERNESS DRIVE LEGAL L7 B5 TALUS WEST LOT SIZE 18481 SQUARE FEET TYPE OF SOIL ABSORSTION SYSTEM IS: TRENCH MA'{IMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 265 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C•EPTH= 17 FLE"C3-r"= 4Z5 1.c THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR. DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH I5 THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE ANC? THE BOTTOM OF THE EXCAVATION (IN FEET). F•FICF<f=i E F=L -n JT FiE:c lu I FtEI7 EITHER A CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED. A CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. EEppIF�p1AEE��MAAppINTENANCE FESUR.PTIONISYSTEM KEPT CURRENT VUUTI9F��,BEU�JEG'TQTORPROZECUTIO�LGE THE SOIL IF A CLASS I SYSTEM IS USED THE LENGTH IS 32.0 FEET. IF A CLASS II SYSTEM IS USED THE LENGTH IS 41.0 FEET. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY OM -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 DIFIGRAP15 ARE AVAILABLE TO INSURE PROPER INSTALLATION. F• E Ft: r•1 I T 9% -* R FL I Q F= Q FS Q r -t E Y E FI Fc F= F;z Q M I S S} U I=- I I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SELLERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I I -JILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. _: I UNDERSTAND THAT THE ON-SITE SE14ER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS R.EP10DELED TO INCLUDE 1-10RE THAN 4 BEDROOMS. SIGNED ICANT HOSE PENDERGRASS ISSUED BY D=– - — -- —r �-------- DATE_ =';2 -_Z JM=W DRILLING, INC.. DRILLING LOG Well Owner Penderaras Construction Use of Well ")Or" Location (address of: Township, Range, Section, if known; or distance main road L7 nJk S T.1trs Pkat Size of casing 6 nepth of Hole lnl feet Cased to 100.9 feet Static water level %() ft. (above) (below) land surface. Finish of well (check one) open et d ( X ) ; Screen ( ); Perforated ( ). Drone Describe screen or perforation Well pumping test at 10 gallons per (hoiii) (minute) for -2 --hours with 100171 '4t. of drawdown from static level. Date of completion 11 Aun 76 WELL LOG Depth in feet from around surface Give details of formations penetrated, size of material, color and hardness �� TO organics Siltv TO—:L— O :TO Gravel TO 15 tggse —TO -2-5 Sil tv ,t5 TO 55 5` TO 75 75 TO g0 90 TO 101 TO TO TO TO TO TO TO Casino Sticlup organics Siltv Sane! Silty Gravel Siltv Sand tggse Sandv Gravel Sil tv stmdv Sandy hater Gravel 1`1C\ti'.� C�'rti { win a Certif'cite Nis. 814 & 9;8 2 — STATE 1�5 We5t -Oel &5 Z.7 SGS Ref.# 1192488001 Client Name Pannone Eng. Srv. Printed Daterrime 06/04/2019 16:13 Project Name/# 11755 Wilderness Drive Collected Date/Time 05/21/2019 15:25 Client Sample 1D 11755 Wilderness Drive Received Date/Time 05/21/2019 15:38 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date [nit Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 B (<10) 05/29/19 05/31/19 DSH Waters Department Total Nitrate/Nitrite-N Microbiology Laboratory E. Coli Total Coliform 3.15 0.200 mg/L SM21 450ONO3-F C (<10) 05/24/19 EWW Negative 1 100mL SM219223B A 05/21/19 A.L Negative 1 100mL SM219223B A 05/21/19 AI ��/�UMUPAQ UTY OF AHCHORQGE jA `t. Development Services Department P`" _ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-202-27 1. GENERAL INFORMATION Complete legal description Expiration Date: b�e c 2 o, .� O Talus West Sub #1, Block 5, Lot 7 Location (site address) 11755 Wilderness Drive Current property owner(s) Shay & Jennifer Laplante Day phone (907) Mailing address 11755 Wilderness Drive, Anchorage, AK 99516 Real estate agent Anya Protasova Day phone (907) 250-2925 2. TYPE OF DWELLING: Fm -1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic ■ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Va 1 I a 0) Receipt Number 06 $ 5 y,b COSA# O S C 2 11 Seo % Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 9/1/21 6. DSD SIGNATURE V/ System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved 0 4,9TH _* ..;.... . ...... Benjarrinlchiller ¢¢ ,9% CE 12592 PROFESStONa�.o Conditional approval for bedrooms, with the following stipulations: OF Al rr� V r t yy �NM Os ITS , By: Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test?Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: Condition of tank unknown, fluid level unchanged from 2019 COSA Talus West Sub #1, Block 5, Lot 7 015-202-27 6.3 8/11/76 101 100.9 3.49■ ■ 30 Forge Engineering 8/30/21 64 8/25/21 45 Concrete 52" ■ 9/8/21 A+ Home Services Deep Trench 6/17/19 8/30/21 ■3 11.2 19 6.3 659 40 ■ ■ 1440 4.9 24 >450 ✔ COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to:(Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’Yes if No ft Absorption Field on Lot > 100’Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’Yes if No ft Holding Tank > 100’Yes if No ft Animal Containment > 50’Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to:(Please enter distances if less than required) Building Foundations > 10’Yes if No ft Property Line > 5’Yes if No ft Absorption Field > 5’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to:(Please enter distances if less than required) Building Foundation > 10’Yes if No ft Property Line > 10’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft F. ENGINEER’S COMMENTS G. ENGINEER’S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 9/1/21 ✔✔ ✔ ✔ ✔ ✔ ✔ ✔✔ *5 ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ **5 ✔ ✔ *Met code at time of installation **Encroachment for 1976 trench - Waiver requested during 2019 COSA ✔ • • •, ;� Municipality of Anchorage JO 8 On-Site Water and Wastewater Program ,) jA (907) 343-7904 R JUN 21 WY r, i' Certificate of On-Site Systems Approval / Parcel I.D. 015-202-27 `- Expiration Date: 1)A„...2-� 1. GENERAL INFORMATION: Complete legal description Talus West#1; Block 5, Lot 7 Location (site address) 11755 Wilderness Dr*Anchorage.AK 99516 Current Property owner(s) Amanda Britt&Jason Bodily Day phone 360-0124 Mailing address 11755 Wilderness Dr*Anchorage.AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 009 . 00 Waiver Fee $ Date of Payment 06/1411g Date of Payment Receipt Number 231 23c9 Receipt Number COSA# OSC i a 12J B Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: (o( 74 Ili aQo0op4�•4 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o OF A 'Q� in accordance with the guidelines and regulations established by the Municipality of Anchorage and '��-.•••-•--•• !,A) QQ industry practices. The reported results describe the condition of the system/s on the date/s of the om♦ • V1� evaluation. Separation distances were measured to readily identifiable features. Hidden defects or ••••;,. - encroachments may exist that were not identified during the evaluation. The operational life of all wells / ,�-1; 1 9 H .3 v0 and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year). quality of construction (materials and I� D workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and ';.... 0 are outside the control of GEG. Satisfactory test results do not guarantee future performance of the /, ••.„4 F r ) Car - s• Q system/s; therefore. GEG makes no warranty(express or implied)regarding the future performance of I/ 9 'E-79 3 oQ� the well or septic system. GEG makes no representation whether an alternative well or septic system V s P• f I • �Q can be installed on the property in the event either of the current systems fail to perform adequately in Q�z r �o( Z/ • OsAd the future. The content of this report is for the sole benefit of the person/party that retained GEG to •‘4 Pofess A perform the evaluation. Reliance upon the information provided in this report by any other person or �0�000* party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE ot(A System #1 Approved for bedrooms \��k TY OF<</ ���/i,�� System #2 Approved for bedrooms �� C��Q �` /5' Disapproved ` ON-SITE Conditional approval for bedrooms, with the following d ��� ip WATER AND - EWATER J PROGRAM o o By: off � Original Certificate Date: ` / The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA'blue sheet 10-10-12.dcc COSA Checklist Legal Description: Talus West#1; Block 5, Lot 7 Parcel ID: 015-202-27 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system A. WELL DATA ❑■ Well log is filed with Onsite (or attached) Well production at time of test 4.0+ gpm Date drilled 81976 Water storage tank volume N/A gallons Total depth 101 ft Well disinfected for coliform test? ❑ Yes ❑■ No Cased to 101 ft ❑l Coliform bacteria is Negative ❑■ Sanitary seal is functioning correctly Nitrate 3.15 mg/L ❑ Nitrate less than MRL (ND) ❑� Wires are properly protected Arsenic ug/L ❑■ Arsenic less than MRL (ND) Casing height(above ground) 12+ in. Collected by PES, LLC Date of flow test for COSA '5121/19 Date of Sample 5/21/19 Static water level at beginning of test 58.1 ft. Comments "Well Test Performed by Pannone Engineering Services, LLC. B. TANK DATA C. LIFT STATION Age of tank(s) 43 years ❑ Required maintenance completed Tank type/material Concrete Age of lift station years Measured operating fluid level in septic tank 52" Lift station material ■❑ Standpipes/foundation cleanout per record drawing Comments Date of pumping 5/16/19 Condition of 1976 septic tank is unknown D. ABSORPTION FIELD DATA Which system tested (date installed) new Adequacy test date new ❑■ ALL standpipes present per record drawing Results ID Pass For 3 bedrooms Total measured depth from grade 11.3+ft(max) Fluid depth prior to test - in Measured depth to pipe invert from grade 4.3 ft(min) Water added - gal ❑ N/A—pressurized field New depth - in ■❑ Monitor tubes go to bottom of effective. If not, state Elapsed time min depth into effective El Code-required soil cover over field Final fluid depth in Absorption rate 450+ gpd ❑ System presoaked NO (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) date of test) If yes, enter date Gallons introduced - gallons Comments/Deficiencies: 1976 drainfield was surcharged per Steve Pannone,P.E.Undocumented trench was disconnected and abandoned in place. Information is for 2019 trench only. COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot> 100' *** Community Sewer Manhole/Cleanout> 100' ,r❑Yes if No ft E Yes if No ft Neighboring Tank > 100' El Yes if No ft Private Sewer/Septic Line>25'El Yes if No ft Absorption Field on Lot> 100' 0 Yes if No ft Holding Tank> 100' ❑✓ Yes if No ft Neighboring Absorption Fields> 100' Animal Containment> 50' El Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage> 100' Community Sewer Main> 75' ❑r Yes if No ft Li Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) * Building Foundations > 10' ElYes if No 5 ft Surface Water> 100' 0 Yes if No ft Property Line >5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells>200' 0 Yes if No ft Water Service Line> 10' El Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line> 10' 0 Yes if No **5 ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells> 100' 17 Yes if No ft Water Service Line> 10' 0 Yes if No ft Community Wells>200' [Yes if No ft Surface Water> 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *Met code at time of installation **Encroachment is for 1976 trench - waiver request attached ***GEG shot distance with Topcon total station and center of well to closest edge of ST1 = 102.44' G. ENGINEER'S CERTIFICATION ������� o� OF A �4Q I certify that I have determined through field inspections and review P. ' �I of Municipal records that the above systems are in conformance with * 4• itH '\ •,-y*0 MOA COSA guidelines in effect on this date. % i(/� D , firD ••.Je' r-f'. Corn •ss: I OQ 9. ' i E,7- .• %, Q 's �c°O 44nt'N,, 4111 ,q. ,ice COSA Checklist yellow sheet %•Zo'r no\�o ofess�o #AECC884 �40poo d uanics GARNESS ENGINEERING GROUP, Ltd Advanced P-r_.atrn•ont System ENGINEERING SALES CONSULTING Uea!er June 21, 2019 Municipality of Anchorage Development Service Department On-Site Water &Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Drainfield to Lot Line Waiver Request - Talus West#1; Block 5, Lot 7 To whom it may concern: The existing 1976 drainfield is located approximately 5 feet from the south-southwest property line. We are requesting a waiver of 5 feet from the drainfield to the property line. Justifications for this waiver are as follows; f • The encroachment has existed for approximately 43 years • Per 1990 inspection report by Robert Kniefel, P.E. the drainfield on Lot 8 is 16 feet from the subject property line. That ensures there is at least 21 feet of separation between the two draifields. £ • The 1976 drainfield has 12 feet of effective which would require a 24 foot separation rather than the 21 feet. It should be noted that the drainfield on Lot 7 was installed first so any �- waiver required for this encroachment should be requested by the owner of Lot 8. We are unaware of any adverse impacts this installation or waiver would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Sincerely, � 1I Jeffr:, a ' - ess, P. ., M.S. Pre •:ct 3701 East Tudor Road, Suite 101 *Anchorage,Alaska 99507-1259 Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com X69 \, 'off 1 S fc dosAAill> ! / ,6 / `�� _ • ted, M q, `,..e- 'V • • • s.:1‘ . z '' ' ht �� glif o � N:.1 10 ol N /fr. D 0 / t / I)/I ,// ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-082° I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: �� �cav.:.LI FOLLOWING DESCRIBED PROPERTY: / -30 SOF AC'`)) T,9/c�.-,7:5- ,�. % �,/�e77, 9 ..� - DxrE• �f-r�� •.-• -•!.5 AND THAT NO ENCROACHMENTS EXIST BIXCEPT AS s/y/9 f •:- INDICATED. IT IS THE RESPONSIBILITY OF THE *'. 4 ' l�V y OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: EASEMENTS, COVENANTS., OR RESTRICTIONS Z7.7 ?,. • /-e./. C WHICH DO NOT APPEAR ON THE RECORDED SUBDI- ----•�----- � Dun Me�rk,, war I A-0 VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB` ��;�� -%.... •`�J'��g5�i i ANY DATA HEREON BE USED FOR CONSTRUCTION _ �'%ry -: • yt\ OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN, ;h� br.-1. :�•• ARY LINES. r% • �-� Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.o. 015-202-27 Expiration Date: 1. GENERAL INFORMATION Complete legal description Talus West #1 Block 5 Lot 7 Location (site address) 11755 Wilderness Way Anchorage AK 99516 Current Property owner(s) Tracy Maher Day phone 232-4169 Mailing address Real Estate Agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by: f� V 1.�,N Date: �0 ) COSA to be released to the engir*r, u�less otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment 1©' �" �S� Date of Payment Receipt Number q? 6 T Receipt Number COSA# d SC rs�is' S Waiver# If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: TALUS WEST#1 BLK 5 LT A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID #_ Date completed 6/1976 Sanitary seal (YIN) Y Total depth 101 ft. Cased to 101 ft. FROM WELL LOG Date of test 6/11/1976 Static water level 60 Well production 10 WATER SAMPLE RESULTS ft. Parcel ID: 015-202-27 Well Log (YIN) Y Wires properly protected (YIN) Y Casing height (above ground) 24+ in. AT INSPECTION 9/24/15 47 g.p.m. 7.5 ft. 9.p -m. Coliform 0 colonies/100 mL Nitrate 2.55 mg/L Arsenic <5.0 ug/L Date of sample: 6/2116 Collected by: ANSON MOXNESS B. SEPTIC/HOLDING TANK DATA Tank Type/Material CONCRETE Tank size 1200 gal. Number of Compartments Foundation cleanout (YIN) Y Date of pumping 9/22/15 Date installed 9/26/1976 Cleanouts (YIN) Y Depression over tank (YIN) N High water alarm (YIN) N Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed 9/1976 Soil rating (g.p.d./ft2 orft2/bdrm) 265 System type TRENCH Length 54 ft. Width 3 ft. Gravel below pipe 11.67 ft. Total depth 17 ft. Eff. absorption area 1260 ft2 Monitoring tube Y Depression over field N Date of adequacy test 9/6/15 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 120 in. Water added 450 gal. New depth 125 in. Elapsed Time: 60 min. Final fluid depth 123 in. Absorption rate >= 450 g p d Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. '.'Pump off" level at in. Datum E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested - Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ (N.O.) Sewer /septic service line 25'+ Animal containment areas 50+ (N.O.) Manhole/Access (Y/N) High water alarm level at -- Meets alarm & circuit requirements? - On adjacent lots 100'+ On adjacent lots100 + Public sewer manhole/cleanout 100'+ (N.O.) Holding tank 100'+ (N.O.) Manure/animal excrete storage areas 100'+ (N.O.) SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 51+ Water main 10'+ (N.O.) Water service line 10+ Wells on adjacent lots 200'+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100'+ (N.O.) Curtain drain 50'+ (N.O.) Wells on adjacent lots200+ F. COMMENTS UNDOCUMENTED SYSTEM ON LOT DECOMISSIONED G. ENGINEER'S CERTIFICATION l certify that I have determined through field inspections and review of Municipal record's that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name ERIK D. MUN/DAHL, P.E. Date (�Z[ J�! I COSA brown sheet 10-10-12,doc Absorption field 5'+ Surface water 100'+ (N.O.) Water main 10'-':(N.O.) Driveway, parking/vehicle storage 10'+ in. • Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Parcel I.D. 015-202-27 Expiration Date: 1. GENERAL INFORMATION Complete legal description Talus West #1 Block 5 Lot 7 89 OCT 0 8 Location (site address) 11755 Wilderness Way Anchorage AK 99516 Current Property owner(s) Tracy Maher Day phone 232-4169 Mailing address Real Estate Agent 2. TYPE OF DWELLING: (] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF 3 Day phone %f WN W L. OCT l 8 2015 TOMMY CORNELL 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Fx� Individual rX_1 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by: 1127 / Date: t la COSA to be relea ed to the engineer, u ss otherwise requested by the engineer. COSA Fee $ *:?& ` PV Waiver Fee $ Date of Payment _ g - �� Date of Payment Receipt NumberReceipt Number COSA # (fi S C�5 Waiver # 5. STATEMEINSPECTION 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 bedroomsand 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 Mundahl Nordic Services Phone 507-458-1936 Address 5620 E 99th Ave Anchorage AK 99507 Engineer's Printed Name Erik D. Mundahl, P.E. 6. DSD SIGNATURE _�z System #1 Approved for � bedrooms System #2 Approved for _ bedrooms Disapproved Date Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: d of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r '- - c If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: TALUS WEST #1 BLK 5 LT 7 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # _ Date completed 811976 Sanitary seal (Y/N) Y Total depth 101 ft. Cased to 101 ft FROM WELL LOG Date of test 8/1111976 Static water level 60 Well production 10 hV_%r:4ZI *70iriI»=1110=6191Iyt Parcel ID: 015-202-27 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 24+ in. AT INSPECTION 9/24/15 ft. 47 ft. g.p.m. 7.5 g.p.m. Coliform 0 colonies/100 mL Nitrate 2.78 mg/L Arsenic <5.0 ug/L Date of sample: 9/14/15 Collected by: ANSON MOXNESS B. SEPTIC/HOLDING TANK DATA Tank Type/Material CONCRETE Tank size 1200 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Date of pumping 9/22115 C. ABSORPTION FIELD DATA Date installed 98/1976 Cleanouts (YIN) Y Depression over tank (YIN) N High water alarm (YM) N Pumper A+ HOME SERVICES Date installed 911976 Soil rating (g.p.d.tft2 or ftz/bdrm) 265 System type TRENCH Length 54T, .. ft. Width 3 ft. Gravel below pipe 11.67 ft. Total depth 17 ft. Eff. absorption area 1280 it2 Monitoring tube Y Depression over field N_ Date of adequacy -test 9/8/15. Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 120 in. Water added 450 gal, New depth 125 in. Elapsed Timer 60 min. Final fluid depth 123 in. Absorption rate >=4450 9 p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date — D. LIFT STATION Date installed "Pump on" level at = Datum Size in gallons in. "Pump off" level at_ E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tank/lift station on lot 100'+ Absorption field on lot 1001+ Public sewer main 754 (N.O.) Sewer /septic service line 25'+ Animal containment areas 50'+ (N.O.) Manhole/Access (Y/N) in. High water alarm level at - Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots100+ in. Public sewer manhole/cleanout 100'+ (N.O.) Holding tank 100'+ (N.O.) Manure/animal excrete storage areas 100'+ (N.O.) SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 51+ Water main 104 (N.O.) Water service line 10'+ Wells on adjacent lots 200+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100'+ (N.O.) Curtain drain 50'+ (N.O.) Wells on adjacent lots 200'+ F. COMMENTS UNDOCUMENTED SYSTEM ON LOT DECOMISSIONED G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name ERIK D. MUNDAHL, P.E. MWLliLl72 COSA brown sheet 10-10-12.doc Absorption field 51+ Surface water 100'+ (N.O.) Water main 10'+ (N.O.) Driveway, parking/vehicle storage 104 ERIK DALE MUNDAI L 1 No. EV14420 ./.Q. TALUS WEST LOT PLAT NO. 80-40 SUBD., ADDN. 7, BLOCK 5 18,481 S.F. (R) \ LOT 15 / LOT 14 S 21 °56'44"W 30.97' (R&H) 6� �Ml Zlp� LOT 6 059 5 los Ml 65.66 DRi N 6fo'325�„E j 0�� LOT 8 I \R f s \3 S 60.4 60. 9? • LOT 7 sHSD \ \ \ /y+ SEPTIC SYSTEM CNG \ LEGEND (R) RECORD DIMENSION PER PLAT NO. 80-40 (M) MEASURED DIMENSION THIS SURVEY (P) SINGLE PROPORTION MEASUREMENT (H) HELD DIMENSION PER PLAT NO. 80-40 O FOUND 1" ODGIP • SET 5/8" X 30" REBAR WITH 1" PLASTIC CAP STAMPED 1,LS-6091" FOUND 5/8" REBAR NO. 1 FENCE DETAIL NOT TO SCALE WELL `C' J`S btio C lqj rye. o O� QP ,y0• �.E SFO• 4p?�' O��/ � OO` `�1 c�JC7f O� �l�'1 J REVISED 4/26/2012 ADD LOT CORNERS; REVISED FENCE LOCATION. GASTALDI LAND SURVEYING, LLC JEFF A. GASTALDI, R.L.S. 2000 E. DOWLING RD., SUITE 8 ANCHORAGE, ALASKA 99507 PHONE 248-5454 GRID DATE 2736 10/19/2011 F.B. JOB NO. TWS175 I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. R IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT, ALASKA 111=30' OF 44'11* .•....... 14o # AV 1-0 *;• 491H ' 9 ........................J0 Jeffery A. Gostoldi : o` °, LS -6091 •� AV Parcel I.D. Pa,:je Le Dc* Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 995195650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 015.202-27 1. GENERAL INFORMATION COSA # 0103In5 Expiration Date: 10-- 13-07 Complete legal description Lot 7, Block s, Talus West Subdivision No.1 Location (site address) 11755 Wildemess Drive Anchorage. AK 99516 Current Property owner(s) James J. d beth A. McAllen Day phone 240-1190 Mailing address 11755widemessDrive Anchorage, AK 99516 Lending agency Day phone Mailing address Real Estate Agent. Day phone Mailing Address Unless otherwise requested. COSA will he held by DSD for pickup. 2. NUMBER OF BEDROOMS: Three (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 ❑ 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 Onsite 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 affaed hereto and as of the validation date shown. below, 1 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 Finn Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE —kC Approved for _ 3 'bedrooms. Disapproved. Date 91102007 49th aaNE1 r ANMRSO/ 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' A.--� �A/ I Original Certificate Date: - � 7 DD -� (R" 11M) Municipality of Anchorage Development Services Department Building Safety Division On-site Water 6 Wastewater Program • • `•' 47W Bragew Street P.O. Box 198650 Anchorage, AK 995198650 www.munLorg/onalte (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Le9aj Desulption: Lot 7, auock s, Taws west auhmvWan No. 1 Parcel ID: o15-=47 A. WELL DATA Wali type Prean H A, B. or C provide PWSID 8 _ Date completed 9r2m Sanitary seal (Y" y Total depth 101 ft Cased tD tat ft FROM WELL LOG Date of test e/1W976 Static water level so ft Wed production 70 9•P•r11. WATER SAMPLE RESULTS: Coliform NID colonie M00mL Nitrate 1.91 rnglL Arsenic: WD mgfl Date of sample: &WW B. SEPTICIHOLDING TANK DATA Tank TypeldAaterial s Tank sae 1.299 gal. Number of Compartments Two Well Log (YIN) Y Wires Property protected (YIN) y Casing height (above 9rourrd) >2 in. AT INSPECTION 417r10o7 39.3 ft 7.5 9 -P.M. Other bacteria 1 coloniesl100 ml Collected by: F. I mDam Date instaiW 9r18M97e Cbanouts (YM) Y Foundatim dearwut (Y" y Depression over tank (YIN N High water alarm (YIN) N Date of pumping —71 -:1 Pumper A Pwa Homs nervrees C. ABSORPTION FIELD DATA Date installed 9MM970 Length 54 ft Sod rating (g.p.dJfe or felbdnn)2esE43ORM Sys0em type Deep Trench Width 3 R. Gravel below pipe 11.67 ft Total depth 17 fL Eff. ONW000n area eft: MOnitwkV tube Y Depresses over field N Date of adequacy test 417729W Results (PaaalFad) I m For 3 bedrooms Fluid depth s1 absofp0m field before test 39.4 in. Water added 909 gal. New depth KA in. Elapsed Tyne: 1,000 min. Final fluid depth 39.s in. Absorption rate >= 450 g.p.d. Arty rejuvenation treatment (past 12 mc.) (YIN & type) N - H yea, give daft D. LIFT STATION Date installed Size in gallons Manhole/Access (YM) 'Pump on' level at _ in. 'Pump oft level at _ in. High water alarm level at In. Datum Cycles tested Meeh Steno b drouit requremehei E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAitt station on lot >tar On adjacent kits >tar Absorption field on lot >tar On adjacent lots >ton Public sewer main KfA Public sewer manhole/cleanout WA Sewer hheptic service line >2' Holding tank WA Animal containment areas Nana Manure/animal excrete storage areas Nara SEPARATION DISTANCES FROM SEPTICJHOLDING TANK ON LOT TO: Building foundation >s property Noe >s Absorption field >s Water main NA Water service line >tQ Surface water >tar Wells on adjacent loft >2W SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property Noe >to' Building foundation >te' Water main >toa Water Service Noe >ta Surface water >tro Driveway, padurigffthicle smogs ,2S Curtain drain Nana Nares Wells on adjacent Iota >2W F. COMMENTS: T_ K k is t a O O C1n I- Pifz2 G✓ r �r G. ENGINEER'S CERTIFICATION �P I QGAW that I have determined fiaoagh field inspections and � review of Municipal records that tine above systems are in k 1 ` 49t conibm aoce with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. c Date enoaoort COSA Fee Date of Payment Receipt Number (Ren. I IAM Waterer Fee Date of Payment Receipt Number, 10' umps 1: SMT Mo :-A Z'd LL"SVU06 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: Lot 7 i Blk. 5 Talus West Subd. Addn. No. 1 A.P AND THAT NO ENCROACHMENTS EXIST EXCEPTjrG AS INDICATEDAT IS THE RESPONSIBILITY OFA . THE DINNER TO DETERMINE THE EXISTENCE OF/ ANY EASEMENTS, COVENANTS, OR RESTRICTION. MHICH DO NOT APPEAR ON THE RECORDED SUB- DIVISION PLAT. UNDER NO CIRCUMSTANCES SNOULO ANT DATA HEREON BE USED FOR CON- �1 STRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT, AK. ueII83W w!f OF A4 49TH •': 74 A. Cmv%kl .:.. .... LS -6091 VA d0b:80 LO 90 daS SCS ReLM 1074333001 Client Name AndcrsonEngineering Project Namc/N Talus Wcst No 1 Lot (clock 5 Client Sample ID Talus West No 1 Lot 7 Block 5 Matrix Drinking Watcr PWSID 0 All Datesfrimes are Alaska Standard Time Printed Date23me 09/072007 11:06 Collected Date/rimc 08232007 12:33 Received DateMme 08232007 12:50 Technical Director Stephen C. Ede Samplc Remarks: EP200.8 C (<10) Parameter Allowable Results PQL Units Method Cantamcr ID Limits Prep Date Analysis Date Init Metals by ICP/MS _ Arsenic ND 5.00 Waters Department Total Nitmtc/Niuitc-N 1.91 0.100 Microbiology Laboratory Total Coliform 1 OB. No Coli ug(L EP200.8 C (<10) 08/31/07 09/05/07 Mil mg/L SM204500NO3-F B (<10) 0828/07 JDS coUIDOmL SM209222B A (<I) 0823/07 SDP n r`, MUNICIPALITY OF ANCHORAGE Z O 2- 2 7 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL C. gg C OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date�`� 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) GDT 7 t31K5 7A'f0s W6sr �,dRDo� 1 5 2Z T /Z At/ RId Location (address or directions) 4/95::57_ w/coEA*.v055-5 (b) Applicant Name AHFC- Telephone: Home Business Z 76 -5X99 Applicant Address Z 35- E 8 fh AYE (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other (explain); (d) Lending Institution 84 FAGv/c Maers/6E_ Telephone OR C( -A0 Address AD/ tti BENSON (e) Real Estate Company and Agent CEA ZGALTV eroLze — F,401- lw/I/son/ Address 8y00 j4ALTZELL >'d __Telephone 3 4-V- 40 501 (f) Mail the HAA to the following address: P(E"ASE TALL PAVL (a 3344-OS"01 -F'OIZ. p1cCuP 2. TYPE OF RESIDENCE Single -Family ;4 Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well K Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite9 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. 72-02501184) Page 1 of 2 S. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verity 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 Firml AAaicl4 EQ&,,J cm,rj & Telephone S37— $34 % PO. Address O. —'EOY. ZVO77,r AAJPµ Al[_ 00c 7-/ Date P7 OF Al, Mkl:aA E. A;184Mn W_ 4131.2 v Engineer's Seal fi DHEP APPROVAL Approved for 3 bedrooms by LiiezDate Approved « Disapproved Conditional Terms of Conditional Approval Mrio 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 S 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 72.025 41 184) t'1 n MUNICIPALITY OF ANCHORAGE (MOA) THORITY APPROVAL (HAA) N\C\PP 4S WtCES V6A CKLISTT-FE 720 Eta FEBRUARY 1!184 \RON'E 1 .,IQ,) 4-61 7 10 Legal Description: o r 7 80ZG 6' TA LfuWS ESI- A. WELL DATA 'Ptx\j ED Well Classification��CZVArE If A, B, C, D.E.C. Approved (YIN) Well Log Present (Y/N)� Date Comp d /?74 Yield S + 1prt Total Depth _/ori► Cased to �r�eO.9 Depth of Grouting uen 5 Static Water Level 57410 Pump Set At /,/ e T DAMEAmIn e G Casing Height Above Ground 2 Z Sanitary Seal on Casing (YIN) V Electrical Wiring in Conduit (YIN) Depression Around Wellhead (YIN) N Separation Distances from Well: To Septic/Holding Tank on Lot /D 9 ; On Adjoining Lots 117 To Nearest Edge of Absorption Field on Lot 12d� ; On Adjoining Lots To Nearest Public Sewer Line ; 1 t --s To Nearest Public Sewer I Cleanout/Manhole I.11 I r z To Nearest Sewer Service Line on Lot 92 Water Sample Collected by McFA Otl-n ; Date s -7 -AA Water Sample Test Results SAT1507Ac-T" .T /� NITJf TE COLIfOR�t �— Comments L&J E LL 15 A0egoA-rV_ B. SEPTIC/HOLDING TANK DATA Date Installed /9fo Size CD DO No. of Compartments Standpipes (YIN) x Air -tight Caps (YIN) y Foundation Cleanout (YIN) _X Depression over Tank (YIN) Al Date Last Pumped S' 1i- tt; ZfAACS Pumping/Maintenance Contract on File (YIN) V ;for ySBo— Holding Tank High -Water Alarm (YIN)--4/A--Temporary Holding Tank Permit (YIN) N/.19 Separation Distances from Septic/Holding Tank: I To Water -Supply Well 104 To Building Foundation IZ To Property Line 34 ' To Disposal Field 15 r I To Water Main/Service Line y f To Stream, Pond, Lake, or Major Drainage Course None le 404FA Comments 5-'J/'P0~P. reMoveo ,�" �✓� Pagel of 2 72-026(l 1184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata us Type of System Design 7—KefeW Date fnstalted 1976 Length of Field n/' Width of Field .36" Depth of Field 1yy41 Gravel Bed Thickness 7' Square Feet of Absorption Area 7sQ' L Standpipes Present(Y/N) y Depression over Field (Y/N) _ Results of Last Adequacy Test Date of Last Adequacy Test 5'- 8- 8 8 Separation Distance from Absorption Field: To Water -Supply Well 12 y To Property Line 20 To Building Foundation zfTo Existing or Abandoned System on Lot 4/6,7 e; On Adjoining Lots '-� Z To Water Main/Service Line _ /16' To Cutbank (if present)N�iDfrst�t To Stream/Pond/Lake/or Major Drainage Course _?Je^t IQ,c5e..t To Driveway, Parking Area, or Vehicle Storage Area Imo' Comments Ej$$Qt'�oS1C�I el 6LD PASS �¢ l�r�AG4 TE 9T' D. LIFT STATION Date Installed Size in Gallons -Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) — "Pump Off' Level at •• Check Permitted Bedroom Rating Against HAA Request •• Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA Icertifyth�attIhave checked, verified. orconformedtoallM AandHAAguidelinesineffectonthedateofthisinspection. Signed ' �[��*�/'t, �l Cspate S /7 b Company rE►LdOJ �nlG2L_ MOA No. l.�G 88-OZ.9 Receipt No. �OF 44 `%1 Date of Payment rr ,• ,• �' = a O yA, • •'riCe�� Amount: $ %%) * •'49TH Engineer's Seal oSao3a-b �. � ;Michool E. Anderson• t,;,# �0, Page 2of2 ��.•� A= -E •; F� • o � 4rw 84L 72-026 (11,84) OrE5>'A�;ca. APPLICr NT. FILLS OUT UPPER HAL'O"'�ONLY F:operty Owner �%(� • I Rn (/ Q�Q . A 1 e a %i ej— Phone /� /x� e A;. �7 ini C`7 . �!L • Zip Code Mallinq Address- .�. 0 Time Buyer Lila ynE is 9a y/e /�iifGhe!/ Time Address '� Zip Code Time Lending Institution /,a�AS , A/STrl-C 70 t/ �/O�C'T6-A6-6 (00 , c�Parr- Phone Address 44 dj--zIp code —35 Realty Co. d Agent Phone /i%0% A,���/CCc.6IC — Inspector Address Zip code Inspector Legal Description Inspector Street Location Type of Residence Ingle Family 1r T —rT Multiple Family No. of Bedroom MUNICIPALITY OF ANCHORAGE ❑ Other Water Supply F34Jndividual ATTACH WELL LOG. A well log Is required for all wells drilledsince ' June 1975. O Community For wells trilled prior to that date, give well depth (attach log If available). ❑ Public Utility RECEIVED (3 APPROVED BEDROOMS Sewer Disposal [Individual Year Individual installed: �� ( ) DISAPPROVED L�j Public Utility When Connected to Public t ity: O Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. DATE — fes. % r in /7 .n /1 —k A non p Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector 1r T —rT Field Notes: I \_ ,,, ,�, MUNICIPALITY OF ANCHORAGE ^ DEPT. OF HEALTH L ENVIRONMENTAL PROTECTION " Y JUL 81983 RECEIVED (3 APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE — Solis Rating Date Sewer I nstalled Well To sorption Area C Ab Well Lop Received SeDtic Tank Size / (I/O Well to Tank 60 non p r"1 �• DATE RECEIVED -^ INSPECTION APPOINTMENTS Ue r ss TIME TIME TIME DATE DATE DATE kC-) -n-s. INSPECTOR INSPECTOR INSPECTOR ^ ^�tpN MUNICIPALITY OF ANCHORAGE �� 1PAt-tIT1 �H`EL H1 -\ DEPARTMENT OF HEALTH &ENVIRONMENTAL PROTBVrI4pt. O L PRp1E P' 1 825 L Street • Anchorage, Alaska 99601 WguvtMENS � 1981 ENVIRONMENTAL SANITATION DIVISION OCj ED Telephone 264-4720 (� 1v c D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWOiMIL7TIES DIRECTIONS: Complete all parte on page 1. Incomplete rectums will not be procaued. Please allow ten (10) days for processing. 1. PROPERTY OWNER.V.,,,, , h Cti1br PHONE - r Itic. INDIVIDUAL/ON-SI MAILING ADDRESS •o /1 O x O — • �� I PROPERTY RESIDENT Of different from above) `, PHONE 8 -as NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 2. BUYER C H UNL o xa n�,e MAILING ADDRE $ C�ee�� C . � � d 3. LENDIN INSTITU IO r a asswYY. �,o� PHONE a _os MAILING ADDR S e. VC• a t(!3x• L1as 4. REALTOR/AGENT PH NEc .s�•1�— Q0. VX Y�'I t1i 4? --r MAILING ADDRESS tA f,x,! 11� SS E11 k/V., • 1 Ql PAF 6. LEGAL DESCRIPTION \ STREET LOCATION Ue r ss 6. TYPE OF RESIDENCE NUMBER OFsBEDROOMS ,i SINGLE FAMILY ❑ One C3 Four ❑ Other 7'� ❑ Two ❑ Five ❑ MULTIPLE FAMILY ME, Three ❑ Six 7. WATER SUPPLY I�L INDIVIDUAL- ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SI -- YEAR, ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLICUTILITY 1 tilrv._ _Cts_ g NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 7b0110 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS t ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER r ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ❑Septic Tank or ❑Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS eee 0!9 -'APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE m/ BY 72010 ( Rev. 6/79) r^ ALASKA MIROWnTAL COnTROL SMICES, InC. Enjinecrinq 6 Enuiroomental Studies MUNICIPAUTY IT ---AGE DEPT. C ENVIRONMEI.. t .. ,. C*;ON OCT e : '.�81 RECLI � LJ 10/20/81 RICHARD EARHEART P.O. BOX 10-1852 ANCHORAGE AK 99511 SELLER — RICHARD EARHEART BUYER— SUBDIVISION—TALUS WEST #1 BLOCK -5 LOT -7 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 1060 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 900 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. SEPTIC TANK ADEQUACY THIS HOjj§>}.qAS A PACKAGE PLANT IN LIEU OF A SEPTIC TANK. OF 41.,411 or C2 ,!* iAoT % : s4 Gb"h. . U314! 1220 West 25th Auenue - Anchorage, Alaska 99503 - (907) 276-1361 1 L Y MUNICIPALITY OF ANCHORAGE ALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROT A DEPT. C HL -LTH 1 825 L Street •Anchorage, Alaska 99507 ENVIROWEr.TAL P �O;'CTION' • t STREET LOCATION /1SS ENVIRONMENTAL ENGINEERING DIVISION N.0V 2 7 1978 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEhtFEqlV&) DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERT WNER C /1 //�%/L�/� ❑ ' MULTIPLE FAMILY PHONE_ Atcyp�X ' rJID L� �JGIEI%O�✓ INDIVIDUAL' MAILING ADDRESS ❑ COMMUNITY PROPERTY RESIDENT (If different from above) ❑ PUBLIC UTILITYh PH NE SArrl INDIVIDUAL/ON-SITE" 2. BUYER H 'N�j -1Z71 MAILING ADDRESS by this Department. 3. LENDING INSTITUTION �5('Vt aArJe PHONE MAILING ADDRESS 2--:)D7 4. REALTOR/AG/ENT (II UNl �C.K Tom. PHONE - 7 MAILING ADDRESS r ` moi R S. LEGAL DESCRIPTION C /_, V 7, f STREET LOCATION /1SS 6. TYPE OF RESIDENCE NUMBER OF BEDfi0UNIS ❑ One ❑ Four ❑ Other MRSINGLE FAMILY ❑ Two ❑ Five ❑ ' MULTIPLE FAMILY lD� Three ❑ Six 7. WATER S PPLY INDIVIDUAL' *ATTACH WELL LOG. Awell log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilledprior to that date, give well ❑ PUBLIC UTILITYh depth (attaclo� available.) •� 6. SEWAGEDISPOSAL SYSTEM 1 INDIVIDUAL/ON-SITE" slIindividual/on-site, give installation date jG If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 7zo1o(3ns� a,© 1 THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED - TIME TIME TIME - DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified PERMITNUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED -i 6 INSTALLER SOILS RATING ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: ' TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY Titlel / LEGAL DESCRIPTION /LM i v iRev. 31781 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 J, tom' Date Received November 2, 1976 � Time of Inspection Q'LW nni 1 Date of Inspection 11 -4/-7L OL .eS REQUEST FOR APPROVAL OF (]uchhc-/,g INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. 1. Approval requested by: Alaska Mutual Savings Bank Mailing Address: Post Office Box 1120 Phone: 274-3561 2. Property Owner: Mose Pendergrass Phone: Mailing Address: 3. Legal Description: Lot 7 Block 5 Talus West Subdivision 4. Location: NHN Wilderness Lane 5. Type of facility to be inspected Single Family No. of bedrooms 6. Well Data: jai .J 44 7. A. Type ,7%/ 00 C. Construction —4f D. Bacterial Analysis Sewage Disposal System: d-fiflo A. Installed B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area Sewer Lines _, Nearest lot line Other contamination B. Foundation to septic tank Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages Page 2 of two pages - Re ,st for Approval of Individual er & Water Facilities Legal bescription Lot 7 Block 5 Talus West Subdivision Comments ApprovedW'n%1,, Disapproved Date //—%-74-� ApprWal Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date 1. 2. 3. 4. 5. Q 7 F11 Type of Inspection Property Owner: Mailing Address: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY —3336 -Gr Street, Anchorage, Alaska 99503 —47411661 oi'1 L -aa 1I 3660 T� no(t REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES an CMRO VA FHA Name of Buyer: C. 0(-1 no0 C- ROSE- 1 ,q 0n Day Phone CONV X Mailing Address: '1-700 CAA-h(i2in6c (,JDay Phone -7 Name of Lending Institution: t /fi59 A MC 1 7_rl 7nll ; Nc� &r7 S "K utr Mailing Address: �1-.O•P>n)( /IdO ARflbpib(. Phone --) '7 -95G / Name of Realtor or Agent: F�2 AN f i5 Mailing Address: 5-� (/T'' Ao( —Phone-) L) Legal Description: /,O r3tL S' -rA I S Location: 0, a.". w l i1! 6i Ne- 5 S 1, A nlC- v Type of Facility to be inspected: (001 d Sc 7?i <. No. Bdrms. Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation EQ -037 W74) Individual Individual (on-site) I Ca`" f, I mpS� lO�