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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
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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�