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TALUS WEST #1 BLK 5 LT 6
Talus West #1 Block 5 Lot 6 #015-202-26 L" 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 a http://www,muni.org/onsite • (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: 2SP131256 PID Number: 015-202-26 ❑ New ®Upgrade Name: RICHARD CAMPBELL ABSORPTION FIELD ® Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address: 11765 WILDERNESS DRIVE, ANCHORAGE, AK, 99516 11Other Phone: No. of Bedrooms: Soil Rating: Total Depth from original grade: (907) 947-6014 4 0.6 GPD/Sq. Ft. 12.5 MAX Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade: Gravel depth beneath pipe: 5.0 MAX Ft. 7.5/7.5 Ft. Subdivision: TALUS WEST #1 Block: Lot: 5 6 Fill added above original grade: Gravel length: SEE DWG. Ft. (50 & 20+) 70+ Ft. Township: Range: — Section: Gra.l width: Bed* Number of lines: Distance between lines: — — 2.5/2.5 Ft. I — Ft. SEPARATION DISTANCES Total absorption area:umber 1050+ of trenches: 2 Dist. between trenches: 1 5+ TO Septic Absorption Lift Holding Public/Private From Tank Field Station Tank Sewer Lines so. n. n Well 100'+ 100'+ — — 25'+ TANK ■ Septic ❑ S.T.E.P. OHolding ❑Other Manufacturer: Capaoky: Surface Water 100'+ 100'+ — — ANCHORAGE TANK 1250 Col. Lot Line 5'+ *,'+ - - N/A Material: Number of comportments: STEEL 2 Foundation 5'+ 10'+ — — LIFT STATION Curtain Drain NONE KNOWN Manufacturer: C iy: Col. Remarks: 'Pump on level at:Pump of " WHigh water olann at: *WAIVER OSP131257. NOTE: PER CONTRACTOR, OLD Pump Make & Electrical Inspections performed by: CONCRETE SEPTIC TANK WAS ABANDONED IN PLACE PIPE MATERIAL PER UPC. House to tank EXISTING Tank to D3034 drainfield Installer Drainfield D3034 CO/MT D3034 A+ HOME SERVICES Inspector GEG, .Ltd. BENCH MARK (Assumed elevation) 100.00 n, Inspection Location and Description: Dates: 1st 8/7/2013 2nd 8/8/2013 3rd 8/9/2013 4th 8/9/2013 BOTTOM OF SIDING NW CORNER OF HOUSE Community Development Department Approval ENGINEER'S SEAL 9o�oopp �F..q.�gSOp oo��• Conditional approval: Date: �Q 4 T - . Q Je G rness•r O Approved: IA/�fe Date: "� 9'�3 Ome CE— . Q ' .slt6 / .• ,c,c o �p°°profession°oo L" PERMIT NUMBER: OSP131256 f / NEW J / MT3 AS -BUILT DRAWING P015L 1202- 26 A 1 6 ELDS / 4 MT4 CO2 MT9 1.1 (DOUBLES) C05( ST1 / ` \ SUMP NEW \ GA SEPTI EXISTING DRAINFIELD \ CONNECTED AS ST2 RESERVE SITE 41.95 /I CAREA / I OLD CONCRETE SEPTIC I I TANK WAS ABANDONED IN PLACE PER UPC DELI J/F 100' WELL RADIUS \ GARNESS ENGINEERING GROUP, Ltd. � * 4 .�* CONSULTANTS & GENERAL CONTRACTORS 3701 E. Z lROID, U8E 101 + MI,HO E• M 99507 + TWNE (80'))33%-6119 + W (907)338-3249 + WE658E: xxw.gariWseanginsenng.cam PREPARED FOR: PHONE NUMBER: PAGE NUMBER: • . • • • • • • • • ...... • • RICHARD CAMPBELL 907-947-6014 2 OF 3 �0 P Y A• Ga ness, LEGAL DESCRIPTION: DRAWN BY: AOI CE -79 3 .•'1c¢ TALUS WEST S/D #1; BLOCK 5, LOT 6 A.J.G. ��fP s�(�t mag TYPE OF WORK: DATE: rofessOOOO440��QO\ AS -BUILT DRAWING OF SEPTIC UPGRADE 8/14/2013 (Rev. 01105) ST1 17.46 39.01 ST2 24.48 41.95 / DBL1 26.67 43.68 DBL2 26.78 44.92 / DV 26.92 45.67 / FS1 60.40 51.82 FS2 61.76 52.16 C01 66.08 49.34 I MT1 66.62 50.47 ° CO2 85.05 57.89 / MT2 84.22 56.93 CO3 63.89 70.89 MT3 65.52 72.45 C04 94.53 73.14 MT4 94.42 73.54 .H D SUMP 38.50 72.70 C05 38.73 52.74 B HOUSE+ S, t a.. 100' WELL RADIUS \ GARNESS ENGINEERING GROUP, Ltd. � * 4 .�* CONSULTANTS & GENERAL CONTRACTORS 3701 E. Z lROID, U8E 101 + MI,HO E• M 99507 + TWNE (80'))33%-6119 + W (907)338-3249 + WE658E: xxw.gariWseanginsenng.cam PREPARED FOR: PHONE NUMBER: PAGE NUMBER: • . • • • • • • • • ...... • • RICHARD CAMPBELL 907-947-6014 2 OF 3 �0 P Y A• Ga ness, LEGAL DESCRIPTION: DRAWN BY: AOI CE -79 3 .•'1c¢ TALUS WEST S/D #1; BLOCK 5, LOT 6 A.J.G. ��fP s�(�t mag TYPE OF WORK: DATE: rofessOOOO440��QO\ AS -BUILT DRAWING OF SEPTIC UPGRADE 8/14/2013 (Rev. 01105) PERMIT NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: - OSP131256 015-202-26 (� J/ FINAL GRADE = 97-79-98.03 AT ANK NLETF T 93.53 I I / AT OUTLET TOP OF T 93.52 TH#1 I NEW1250 GALLON I INVERT OF BUNG SEPTIC TANK INVERT OF BUNG AT INLET = 92.91 (10' BURIAL RATED) AT OUTLET = 92.74 WEST TRENCH EAST TRENCH FINAL GRADE = MT CO 95.25-95.97 FINAL GRADE = MT COr ORIGINAL GRADE 94.38-95.81 I = 94.48 0 RR HIGHEST POINT FABRIC INVERT OF PIPE = 89.48 -BOTTOM OF TRENCH = 81.98 RELATIVE ELEVATION OF BOTTOM OF TESTHOLE = 75.98 (DRY) 5' FILTER FABRIC INVERT OF PIPE = 89.72 - BOTTOM OF TRENCH = 82.22 RELATIVE ELEVATION OF BOTTOM OF TESTHOLE = 76.22 (DRY) TH#1 ao �� of GARNESS ENGINEERING GROUP, Ltd. p * 4 T CONSULTANTS & GENERAL CONTRACTORS Q• • • • • • • • • • • • . • . . 3701 E. TUDOR ROAD. SURE 101 • WHORAM, M 98607 • PHONE (907)337-6179 • FAX (901)336-3246 9Rfi6RE m .Fmmenglro N.99m PREPARED FOR: PHONE NUMBER: PAGE NUMBER: . ........ ..... RICHARD CAMPBELL 907-947-6014 3 OF 3 QO p , e . Gar ess: LEGAL DESCRIPTION: DRAWN BY: QOms CE- ,•'.� TALUS WEST S/D #1; BLOCK 5, LOT 6 A.J.G. �� 0,0 �d.1. . t ov F TYPE OF WORK: DATE: 4�oOOOp��gp0oo PROFILE AS BUILT OF SEPTIC UPGRADE 8/14/2013 (Rev. 01105) On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP131256 Tax Code Number: 01520226000 Work Type: Septic Permit Effective Dates: August 07, 2013 to August 07, 2014 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: TALUS WEST #1 Site Legal Address: TALUS WEST #1 BLK 5 LT 6 G:2736 Owner/Address: CAMPBELL RICHARD D 11765 WILDERNESS DR ANCHORAGE AK 995162231 Site Mailing Address: 11765 WILDERNESS DR, Anchorage This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy All construction must be in accordance with: Lot Size in Sq Ft: 17340 Total Bedrooms: 4 N Private Well N Water Storage 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Date Issued By:Date: f /' C Municipality of Anchora P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.om/Onsite Development Services Division On -Site Water and Wastewater Program menr S 1° r e ^ y r' n y Dep2rtment **** VARIANCE/WAIVER REVIEW **** Waiver#: OSP131257 COSA#: Permit#:OSP131266 PID#: 015-202-26 Legal Description: Talus West #1. Block 6, Lot 6 Engineer: Garness Engineering Group Applicant: Richard Campbell Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 1.0 foot. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ® Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ❑ Adjacent properties are not affected by this waiver. ..............................................................................1 Waiver is Granted: X Waiver is not Granted: Date: Approved by: Name of Reviewer ............................................................................... Rec#: 09330G Amount: $200.00 Date Paid: 8/6/2013 **** VARIANCEIWAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program 11 Mayor Dan Sullivan On -Site Sewer/Well Permit Application If For A Single Family Dwelling .. Parcel I.D. 015-202-26 Property owner(s) RICHARD CAMPBELL Day phone 947-6014 Mailing address 11765 WILDERNESS DRIVE, ANCHORAGE, AK, 99516 Site address 11765 WILDERNESS DRIVE, ANCHORAGE, AK, 99516 Legal description (Sub'd, Block & Lot) TALUS WEST S/D #1; BLOCK 5, LOT 6 Legal description (Township, Section & Range) Lot Size Initial APPLICATION IS FOR: Upgrade (® all that apply) Renewal Absorption Field Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Sq.Ft. Number of Bedrooms APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ 4 THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: DRAINFIELD TO DRAINFIELD & DRAINFIELD TO LOT LINE TYPE OF DEWELLING: Single Family (SF) (w/wo AD U) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: 15'+/$'+ I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: p5 O Waiver Fees: 9cb Date of Payment: 0 ko I I 'I-) Date of Payment: HL /13 Receipt Number: 0(015ci1 G Receipt Number: 01) 3�jD C', Permit No ns 19 b tWaiver No. os�I aJ ua-5_+ (Rev. 09/12) i EARN SS ENGINEERING GROUP, Ltd. - CONSULTANTS & GENERAL CONTRACTORS August 5, 2013 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Proposed Septic System for Talus West Subdivision 41; Block 5, Lot 6 To whom it may concern The existing four bedroom house is served by a private well and septic system. The septic system is in a state of failure and needs to be upgraded. One test hole was excavated on the property. The drainfield will be designed around the 30 foot radius of this test hole. We are proposing that a new 1250 gallon septic tank and also a deep trench type drainfield be installed. Comments regarding the design are summarized as follows: 1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. TRENCH DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface waters within 100+ feet of the proposed septic system. 4. TOPOGRAPHY: As can be seen on the attached topography site plan, the average topography in the area of the proposed drainfield is approximately 5-10% running southeast to northwest. In short, there are no slope concerns. 5. WAIVER: The required separation from the existing trench should be 24 feet (twice the effective depth). Due to site constraints, the replacement cannot possibly meet this horizontal distance requirement. We request that your department waive the required distance from drainfield to drainfield to 15'+. To maximize the distance between the two drainfields, we are also requesting a �'+ lot line waiver. The septic systems on the lots adjacent to the proposed septic system are far enough away to meet the required separation distances. In short, we believe granting this waiver will not adversely affect any wells or septic system on any surrounding lots. 3701 E. Tudor Road, Suite 101 *Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessenginecring.com I am unaware of any adverse impacts this installation 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, Garness, P.E., M.S. NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, a soils log, and a 7 page construction specification letter which are all part of the design package for this septic system. 3701 E. Tudor Road, Suite 101 *Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com 1J f TALUS WEST { BLOCK 5, LOT 2 2 TALUS WEST #1; / / TALUS WEST #1; BLOCK 5, LOT 16 / / BLOCK 5, LOT 3 fy TALUS WEST / BLOCK 5, LOT 4 4 I � TALUS WAST #1; BLOCK 5,1LOT 151 TALUS WEST #1; BLOCK 5, LOT 5 TALUS WEST #1; BLOCK 3, LOT 26 TALUS WE47 #1; ///-BEOCT. 5, LOT 14 TAIA7S WEST BLOSSL 5, LOT 3 TALUS WEST #1; I ``SEPTIC AREA i \ \ \ \ / BLOCK 3, LOT 27 / CSEPTIC AR I I \ \ \ I BLOCK 3ETALUST #128 �PTIC BgELL-B9D1Ui. 1 I / - - - - - AR� BTALU LOCK VE LOT17 TALUS WEST #1; TALUS WEST #1; BLOCK 5, LOT 9 BLOCK 5, LOT 8 \ �TALUS WEST #1; \ BLOCK 3, LOT 29 TALUS WEST #1; Y BLOCK 3, LOT 30 I / / _00600 ' �p� GARNESS ENGINEERING GROUP, L.tcY CONSULTANTS & GENERAL CONTRACTORS 1701 E IDOOR RITE 0N SU101 ,WCHOWE, AN 99507 •PHONE (907)337-079 • FNX (907)33S-32* ' WMSRE g � g,. cam PREPARED FOR: PHONE NUMBER: PAGE NUMBER: �,�. PI� RICHARD CAMPBELL 947-6014 1 OF 2 PA. Go¢ness 0 LEGAL DESCRIPTION: DRAWN BY: Q 9.'j. CE-7853 e p TALUS WEST #1; BLOCK 5, LOT 6 PNB P. s Iz.1:5•' o°o TYPE OF WORK: DATE: ��4a'orofesslo°°a SITE PLAN 7/19/13 �OOOOo�� NUMBER OF BEDROOMS: 4 GALLONS PER DAY (GPD): 600 PERCOLATION RATE/S: 30 MIN/IN PROPOSED APPLICATION RATE: 0.6 MINIMUM DRAINFIELD SQ.FT.: 1000 MAXIMUM DEPTH: 12.5' WIDTH: 2.5' LENGTH: (50' & 20') 70' TOTAL M.O.A. APPROVED SAND FILTER: N/A EFFECTIVE: 7.5' REDUCTION FACTOR: N/A ACTUAL SQ.FT.: 1050 MT TH#1 0 o ryf / g / \9 \\ EXISTING ORAINFIELO BE CONNECTED AS RESERVE SITE - PROPOSED DOUBLE CLEANOUTS AND FLOW DIVERTER j PROPOSED 1250 I GALLON SEPTIC TANK /! ASEPTIC / ARES I I I .r PROPOSED NOTE: CONTRACTOR SHALL HAVE NORTH LOT LINE, WEST EASEMENT AND ALL 100' WELL RADIUS FLAGGED BY A REGISTERED PROFESSIONAL LAND SURVEYOR PRIOR TO CONSTRUCTION LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT GEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND CONDITIONS OUTLINED. �1 OT LING WAIVER REQUESTED MT \9 RADIUS INSTALL FLOW SPLITTE�S SO THAT 75% OF 100' W EFFLUENT IS DIRECT D TO 50' TRE HOUSE `'u e+ E GARNESS ENGINEERING GROUP, Ltd pv��*v H CONSULTANTS & GENERAL CONTRACYORS 0 3701 E. TUDOR ROOD. SUITE 101 + PNCHORPGE, NC 99507 •NONE (90'n337-61)9 • Fl0( (90)338-3246 • KEB611E ww.9ommwn9l eenn9 com O � PREPARED FOR: PHONE NUMBER: PAGE NUMBER.Q ` .... RICHARD CAMPBELL 907-947-6014 2 OF 2 �Q J Tey A. rness: LEGAL DESCRIPTION: DRAWN BY: 009 j CE -7953 c TALUS WEST S/D #1; BLOCK 5, LOT 6 A.J.G. TYPE OF WORK: DATE: ��Q4pO1�/�pOoo DESIGN OF PROPOSED SEPTIC UPGRADE 7/26/2013 (Rev. 0110.5) ALUS WEST #1; BLOCK 5, LOT 2 / LUS WEST #116 / B CK 5, LOT / ALUS ST #1; �' LOC 5, LOT 3 � TALUS WEST If / 1 \ r BLOC — LOT i TA S WAST B CK 5,1L 151 OP D SEPTIC UPGRAD \\ US WEST #1; OCK 5, LOT 5 TALU VSE /CU TA �S WEST TALUS WEST #i; BLOCK 3, LOT 26 BL 5, LOT 3 EPTC IN NG \ •. s. \ TALUS WEST #1; BLOCK 3, LOT 27 R� \ �\ 7D1 E. VDDR R 01 • MCHORADE, 9917 • NE (W7) 7-51 • FAY (9 — 295WEBSITE 9 eme g 9com O i SER TIC \\ PREPARED FOR: ✓ i A ITALUS WEST 1; G ne s: RICHARD CAM ELL 47 601 (BLOCK 3, LOT 8 A E�D TA L 1 EST #1; LO LOT .US EST #1; TALUS EST #1; )CK 5, LOT 9 BLO 5, LOT ALU WEST #1; BL K 3, LOT 29 / TALC WEST #1; 1 BLOC 3, LO 30 1 / +�� RNESS IN NG UP, Lt .:.: ....-__ :::: C6 L9L NTS&GE ER l NTR 7D1 E. VDDR R 01 • MCHORADE, 9917 • NE (W7) 7-51 • FAY (9 — 295WEBSITE 9 eme g 9com O P E NUMBER: Q' PREPARED FOR: P E UMBE ey`4. G ne s: RICHARD CAM ELL 47 601 F 2 p po 5 c�G EGAL DESCRIPTION: DAWN BY: E- TALUS WEST #1; BLOCK 5, L0 6 a o �10�0 0 l TYPE OF : E: � 'rotes DA 19/13 DODO SITEW PLA oo�oppp o OF �a4 GARNESS ENGINEERING GROUP, Ltd ��'� ..H .. ..y00" ..0 -- CONSULTANTS & GENERAL CONTRACTORS - - 3701 E TUDOR ROAD. SURE 101 'ANCHORAGE. M. 99607 PHONE: (907)337-6179 -FM.-T9077338-3246 WEB6f1E: 9amees n9inaadnq.com n SOIL LOG — PERCOLATION TEST O LEGAL DESCRIPTION: TALUS WEST 1; BLOCK 5, LOT 6 O P Je f ey A. arness;' PERFORMED FOR: RICHARD CAMPBELL DATE: 7 24 13 D CE -7953 p Q s '' � c DEPTH �4 aprof essio�°o (feet) - TEST HOLE #1 ��Op�o��o 1 = ORGANICS (FILL) SOIL CLASSIFICATIONS I 3 it+?: GP ML 'NI GM CL 4 GC OL N °o o°° o SW MH 5 : SP CH SM ,' OH 6 SC SEE ATTACHED SITE PLAN 7 DEPTH TO DATE GROUNDWATER 8 DRY 7/24/2013 ,b 7/31/2013 9 SCALE: 10 GM 1" = 1ao' 11 TIME (MINUTES) READING (INCHES) 12 13 14 15 16 17 18 19 B.O.H. PERCOLATION RATE 30 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 6.0 FT. AND 7.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ® YES ❑ NO SOILS LOGGED BY: ROB CAMPBELL PERCOLATION TEST PERFORMED BY: ROB CAMPBELL COMMENTS: PERCOLATION RESULTS ARE WITHIN 1/16TH OF AN INCH PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS P RFORMED IN ACCORDANCE.. WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: PI1 DATE READING CLOCK NET TIME WATER LEVEL NET DROP 7/25/13 1 2:30 - 6.00" - 2 3:00 30 5.00" 1.00" 3 3:00 - 6.00" - 4 3:30 30 5.00" 1.OD" 5 3:30 - 6.00" - 6 4:00 30 5.00" 1.00" GREAR ANCHORAGE AREA BORAGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE S{EWAGE DISPOSAL SYSTEM A� NAM- w MAILING ADDRESS SL's-�IA 306 �5y� � PHONE_S44;"_ /'Ji - LOCATION LEGAL DESCRIPTION �- b SEPTIC TANK: DISTANCE NUMBER OF FROM WELL MANUFACTURER MATERIAL COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY - - GALLONS. TILE DRAIN FIELD � qJ, TOTAL LENGTH DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE - OF LINEST NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH- IN. TOTAL EFFECTIVE ABSORPTION AREA 'L SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER C/ y DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE /1 I IN. ABOVE TILE 7 - IN. WELL: TYPE d K, CONSTRUCTION DEPTH - DISTANCE FROM: BUILDING NEAREST NEAREST. SEPTIC SEEPAGE FOUNDATION LOT LINE , SEWER LINE -,TANK , SYSTEM , CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: INSTALLE BY: SEWER LINE DEPTH: DIAGRAM OF SYSTEM Q V. LOT SLOPE: REMARKS: DATE / A f / APPROVED Form EQ -032 APPLICANT DICK WRIGHTP-j �� SRA BOX 15535-A ANCHORAGE 344-4214 LOCATION TALUS DRIVE LEGAL L6 B5 TALUS WEST #1 LOT SIZE 17340 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT, -BR)= 250 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: rm=FJ-v"= 1i L_Et4UTF= C3F@F•itir0EL l3EF -r"= :IL= THE LENGTHDIMENSION 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 CIN FEET?. THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). f�1=1�r F LAItdT IfE+OJI REGI EITHER A CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED. A CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF A MAINTENANCE AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL ABSORPTION SYSTEM AND/OR YOU MAY BE SUBJECT TO PROSECUTION." IF A CLASS I SYSTEM IS USED THE LENGTH IS 30.0 FEET. IF A CLASS SYSTEM IS USED THE LENGTH IS 338.0 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 ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F='F=FZPI I T VF1L I E> Fr3F;-I (D"F= % EF=1F Z F= FRCst-1 I ��`,=tJF= I CERTIFY THAT 1: 1 A FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS?ODELED TO INCLUDE MORE THAN 4 BEDROOMS. S I GNED : meq__ -7L. APPLICANT D: ISSUED BY_f- C ■ M1.Jt-.F I C= I DEPARTMENT F�iL I T V CSF RhJ�-F-IR�CiEr -�, ; CWEALTH AND ENVIRONMENTAL FWTECTION 2510 E. TUDOR RD..- ANCHORAGE, AK. 99507 YJ �LN L-4 LL r4 Ft 0- 276-2221 _ PERMIT NO. C r 64253 ? APPLICANT DICK WRIGHTP-j �� SRA BOX 15535-A ANCHORAGE 344-4214 LOCATION TALUS DRIVE LEGAL L6 B5 TALUS WEST #1 LOT SIZE 17340 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT, -BR)= 250 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: rm=FJ-v"= 1i L_Et4UTF= C3F@F•itir0EL l3EF -r"= :IL= THE LENGTHDIMENSION 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 CIN FEET?. THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). f�1=1�r F LAItdT IfE+OJI REGI EITHER A CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED. A CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF A MAINTENANCE AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL ABSORPTION SYSTEM AND/OR YOU MAY BE SUBJECT TO PROSECUTION." IF A CLASS I SYSTEM IS USED THE LENGTH IS 30.0 FEET. IF A CLASS SYSTEM IS USED THE LENGTH IS 338.0 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 ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F='F=FZPI I T VF1L I E> Fr3F;-I (D"F= % EF=1F Z F= FRCst-1 I ��`,=tJF= I CERTIFY THAT 1: 1 A FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS?ODELED TO INCLUDE MORE THAN 4 BEDROOMS. S I GNED : meq__ -7L. APPLICANT D: ISSUED BY_f- C ■ 678970 77 • Municipality of Anchorage a -t - On-Site Water and Wastewater Program (907) 343-7904 SAF E T Y c ti Certificate of On-Site Systems Approval 0.1e Parcel I.D. 015-202-26 Expiration Date: .E? 1. GENERAL INFORMATION Complete legal description Talus West #1 , Block 5, Lot 6 Location (site address) 11765 Wilderness Drive Anchorage, AK 99516 Current Property owner(s) Eric and Lesli Quint Day phone Mailing address 11765 Wilderness Drive 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: Four 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: /OZG i r COSA to be release to the engineer,unless otherwise requested by the engineer. COSA Fee $ 6. - Waiver Fee $ Date of Payment Co - 2- (— Date of Payment Receipt Number 0294 lb Receipt Number COSA# 05clglWaiver# 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 Forge Engineering Phone (907) 522-7773 Address PO Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, PE Date 6/20/2018 TH /\ 9*, 49 6. DSD SIGNATURE /17 System #1 Approved for LI bedrooms �/ 9. Michael E.Anderson; j System #2 Approved for bedrooms /1�tc,�Fv `• 4 �E1 c�•�����/ �, FoPROFESSION' Disapproved Conditional approval for bedrooms, with the following stipulations: OF ti/� 4r� �h(j Cpl-SITE c, N WATER ' WAS-`E-1* , nROGRA�li C.. 9�A1rcrO" . By: Original Certificate Date: (9 -al r 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 blue sheet r c If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Talus West #1 Block 5 Lot 6 Parcel ID: 015-202-26 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 8/14/76 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 102 ft Cased to 102.4 ft Casing height(above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 8/14/76 6/15/18 Static water level 60 ft. 58 ft. Well production 15 g.p.m. 8.1 g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 2.59 mg/L Arsenic NDug/L Date of sample: 6/08/18 Collected by: Forge Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/SteelDate installed 8/07/13 Tank size 1250gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N Date of pumping 11/07/17 Pumper A Plus Home Services C. ABSORPTION FIELD DATA Date installed 8/09/13 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 GPD/SF System type Trench Length 20/50 ft. Width 2.5/2.5 ft. Gravel below pipe 7.5/7'5 ft. Total depth 13.1/12.1 ft. Eff. absorption area 1050 ft2 Monitoring tube Y Depression over field N Date of adequacy test 6/15/18 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0/24 in. Water added 767 gal. New depth 16/49 in. Elapsed Time: 1440 min. Final fluid depth 3/33 in. Absorption rate >= 600 g p d None Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >100On adjacent lots >100' Absorption field on lot 100 On adjacent lots 100 Public sewer main '75' Public sewer manhole/cleanout >100' Sewer/septic service line >25' Holding tank >75' Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line 1 Absorption field >5 Water main >10' Water service line >10' Surface water >100 Wells on adjacent lots >100 ABSORPTION FIELD ON LOT TO: >10' Property line >10 Building foundation >10 Water main Water Service line >10Surface water >100 Driveway, parking/vehicle storage >10 Curtain drain None Noted Wells on adjacent lots >1 00' F. COMMENTS *Waiver #0SP131257. G. ENGINEER'S CERTIFICATION ,�-•---NAV\ I certify that I have determined through field inspections and �g4.. ..!fl-.-,, review of Municipal records that the above systems are in '. • . • TH• •,*�,/ conformance with MOA COSA guidelines in effect on this date. ••,• •••• •• i 6 Engineer's Benjamin Schiller, PE / •• r•*•••••••% g Benpa Schiller 6/26/2018 �Tro,j.•• 12592 ••/•'Al Date .4e_. 4�•'L"�� COSA brown sheet 10-10-12.doc Municipality of Anchorage ®°a On -Site Water & Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-202-26 Expiration Date: 1. GENERAL INFORMATION Complete legal description TALUS WEST #1 • BLOCK 5 LOT 6 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: 11765 WILDERNESS DRIVE *ANCHORAGE, AK 99515 RICHARD CAMPBELL Day phone 947-601 11765 WILDERNESS DRIVE *ANCHORAGE, AK 99515 LANEY STAPLEY W/ KELLER WILLIAMS Day phone Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: 865-6549 TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well; F-1Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received by: COSA to be released t engineer, unless otherwigg Ar uested by the engineer. Date: COSA Fee $ P�� 1 7�~(( Y\ Waiver Fee $ Date of Payment �� la 13 Ci a� Date of Payment Receipt Number®oa�a G Receipt Number COSA # C tLI31q-q 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 tiles 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. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, UD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life or all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person orparty is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGN TURE System #1 Approved for __�_ bedrooms. I:1�TORM 337-6179 Date tS�t3 System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: OF ON-SITE NATER AND .� V'VASTEWAiER n: Original Certificate Date: 9-19-13 The Arpri ipalify ori rage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 11105) l/ Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: TALUS WEST S/D #1; BLOCK 5, LOT 6 Parcel ID: 015-202-26 i_A101=I440-011y_1 Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 8/14/1976 Sanitary seal (YIN) YES Total depth 102 ft. Cased to 102 ft. FROM WELL LOG Date of test 8/14/1976 Static water level 60 ft. Well production WATER SAMPLE RESULTS: 15 Well Log (YIN) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 7/18/2013 51 ft, 7.8+ g.p.m. YES 12+ in. Coliform 0 colonies/100 ml. Nitrate 2.57 mg./L. Collected by: GEG. Ltd. Arsenic: ND ug./L. Date of sample: 7/18/2013 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 8/7-9/2013 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping - Pumper - C. ABSORPTION FIELD DATA *BELOW FINAL GRADE Date installed 8/7-9/13 Soil rating (.p.d./ r ftlbdrm) 0_6 System type SHALLOW TRENCH 50 & 20+ Length 70+ TOTAL ft. Width 25/2.5 ft. Gravel below pipe 7.5/7.5 ft. •13.7/ Total depth •13.8 ft. Eff. absorption areal 050+ft: Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fail) PASS For—bedrooms Fluid depth in absorption field before test = in. Water added =gal. New depth in. Elapsed Time: = min. Final fluid depth — in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date - NOTE: PREVIOUSLY DOCUMENTED TRENCH CONNECTED AS RESERVE SITE. D. LIFT STATION Date installed Size in gallons - Manhole/Access "Pump on" level at in. "Pump off' E. SEPARATION DISTANCES water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas 50'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation **5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *1, Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *PER WAIVER #OSP131257 **SEVERAL FEET FROM DECK. G. ENGINEER'S CERTIFICATION l certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date w/ i rla (Rev. 11105) yl 9 . J f Garn ss. - 1P CE� 79 ao� 44�° f eS fids l o 109 Lot 14 SCALE: V= 30' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. Fb 13.5, pg 55, BEP BE 8386G I 3p O7 O� AS -BUILT NO CORNERS SET THIS DATE Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission fines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 13th day of August ,2013. FRED WALATKA 8 ASSOCIATES Engineers and Surveyors (907-246.1666) MUNICIPALITY OF ANCHORAGE • i DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # n t — P@ a — puo MUNICp law `NVIRON�,�NTq� SERVICE„crrs 7U1VI5lCM n HAA # , C(,- L` 1. GENERAL INFORMATION Complete legal description Location (site address or directions) � Property owner CL Mailing address Lending agency PSL"lam Mailing address Agent Address Unless otherwise requested, HAA will be�held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water - < z vIng� fu Day phone 261— �5 7 8"cl r Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: L Individual on-site Holding tank Community on-site Public sewer NOTE: if community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm �G �'b t J t v r�Ir,l m"4�n�,� Phone -2 77 -Ili Address _012a 3 t,/- IJ r" g aO � Engineer's signature 6. D��HvvrH��S SIGNATURE 1 Approved for L' bedrooms. Disapproved. Conditional approval for Additional Comments M Date /f& F bedrooms, with the following stipulations: Date 3 3' 96 The MUnicipality;of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lendi ng institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-M(RW.1/91) Beck MOAM21 MUNIGa Municipality of Anchorage FnviRONMFNrgL ER �cFsory .� DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501• (907) 34244 ZCk- VEL), Health Authority Approval Checklist v Legal Description:c,�L t 17�15�: 5 Parcel I. D.: 01 '5—X02- 9L A. NVELL DATA / /A LL)—c"> Welltyp e� } If A, B, or C, attach ADEC letter. ADEC water system number A U Log present (Y/N) Date completed C� iq/77 Total depth D ;2-'(fo Cased to 102 t Casing height (above ground) t 60 Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test�I��7c' Static water level)P� Well production / j g.p.m.g-P- m. WATER SAMPLE RESULTS: Coliform Nitrate t'.Ql. YKd Other bacteria Date of sample: 2 t �{a Collected by: T! S B. SEPTIC/HOLDING TANK DATA tp t.,12 µ2 Date installed Tank size lv Number ofCompartmentsCleanouts (Y/N) (Y/N) t V \� Foundation cleanout (Y/N) `/ Depression (Y/High water alarm (YN 4 V Date of Pumping �151/9� Pumper A f C. ABSORPTION FIELD DATA Date installed 1041'176- Soil rating (g.p.d.1HZ or ft'/bdrm) 0 System type !Asp ✓l Length t Widthy Gravel thickness below pipe11 Total de th i � I U a.z 7a.i.i��p 't : L + _ Effective absorption area ?12 Monitoring Tube present(Y/I)� Depression ober field (Y/N) r �l &" .amu iec Date of adequacy test '2 <'l Results (Pass/Fail) �_ For _bedrooms .1 l Fluid depth in absorption field before [est (in.); Immediately afters gal. water added (in.): % 3 t CSY~J i, 1 6 p J Fluid depth ] _(ins.) Minutes later: Y� Absorption rate = �� e g.p,d, tT J , er ytl Peroxide treatment (past 12 months) (Y/N) N If yes, give date D. LIFT STATION Date installed NMI- Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum "Pump off' level at* SEPARATION DISTANCES FROM WELL ON LOT TO: -111PSeptic/holding tank on lot l t� � r L ; On adjacent lots J� 10 1 Absorption field on lot j hjo± On adjacent lots *1M I Public sewer main 1 y o n & Public sewer manhole/cleanout �� & 7e Sewer /septic service line > 5 O F -L- Lift station N 0 y7 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10 GL Property tine 10 _t P& Absorption field o'2 D F f Water main/service line -O r-hurface water/drainage No KC Wells on adjacent lots > t &-0 f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: '/ Building foundation qy©- t �� Water main service line -7 � _ "t U Surface water t y /y Driveway, parking/vehicle storage area �, go F -Z-- Curtain drain O Wells on adjacent lots )� I PrO I Property line > IV 1 F. ENGINEER'S CERTIFICATION T5. I certify that I have determined thru field inspections and review of Municipal records dart the aboi in con ormance with MOA HAA - f guidelines in ct on this date. Signature / %� Engineer's Name j pL✓%if �v 0 r lct L4 T Date Ah QlQ& HAA Fee $ Date of Payment r/ Receipt Number Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number a. MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # �5 '� -ZZ HAA # %1G' Cs 1. GENERAL INFORMATION Complete legal description �Ll /u5 WeSf1 Loi' 8 / S Location (site address or directions) 11710 5 L✓i /c�P�ne55 11 r ANS A� Property owner -7�j'�j-1?5" I e r- Day phone 3 4 5� '7 1 -74� Mailing address 1176,5 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. CALL gC-VIN QI 13N612 2(,-7-f,,Z !c C, 2. NUMBER OF BEDROOMS: q v 3. TYPE OF WATER SUPPLY: Individual well �— Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(R.v. 1/91) Front MOA#21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm is S C -l'% sl c . Phone -S411— 5/ 4%D Address 30 Engineer's signature Date 12/1/`l'� .�;NN M�.ii eb 6�_/oNT/B ' ♦��'' C S. FR_ a ;�.�i+s1 naaa9a. °LJ 6. DHHS SIGNATURE Approved for � bedrooms. Disapproved. LM Conditional approval for bedrooms, with the following stipulations: Additional Comments 1l1TIC The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ]2-025(Rev 1/91) Back MOAN21 Municippality of Anchorage DepartmentD Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:J f r. v' - 1../e3+ L -let ' 'C) Parcel I.D. A. WELL DATA. Well type ?e+ LJ&L442 If,A, B, or C, attach ADEC letter. ADEC water system number 1 Log present (Y/N) Y Date completgd_ f �P Driller q h Total depth ���� Cased to ►OZf Caeing;heigtit ¢ 12 r1 i.: Sanitary `seal (Y/N) Y Wires properly protected (Y/N) - FROM:WELL 400 AT IN&REQTI.ON MUNICIPALITY OF ANCHORA0E Date of $est 42 -$NV RQNMENrAL.SERVICES DPA$! IN Static watOr.level d Y5 DEC Q;E .1992 r Well flow 5 g.p.m: 7 Pumle;level , SEPARATION DISTANCES. FAQM )BELL TO; Septic/holdtng"tank on lot /a ; On adjacent lots � Absorption field on Iot '_)Z,ry ' F4 , „ ; On adjacent lots Public sewer main' s Public sewer manhple/cleTgut � Seweiiserviceline Petroleum tank WATER SAMPLE RESULTS: d. Coliform �� 7 Nitrate 0 r4 Other bacteria Date of sample: ll� � q� Ooilected by: eP40,JAVPP P. SEPTIC/HOW",, TANK DATA Date installedIb �� Tank size a Compartments Cleanouts'(Y/N) Foundation clean Depression (YIN) u High .water alarm (Y/N) 4L� Alarm tested (Y/N•)' YiI A Dateof`cumpinj-�4 i ig"i=3�az Pumper _. tZoy- i2ooT SEPARATION DISTANC(S FROM'SEPTIC/He-awG TANK TO: Weli(s) on lot ]Q4 "4 On adjacent lots 1 k$2-Foundation— 'To 2Foundation "To properly line 1010,. T AbB'orpl{anfie d ' Water main/service line 1- /0 1 Surface writer/drainage . 'rL© 72-026 (Rey. list) From CONTINUED ON BACK PAGE C. LIFT STATION JVL1 R Date installed Manufacturer Size in gallons Manhole/Access (Y/N) ^ Vent (Y/N) "Pump on 'level at "Pump offlevel at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: - Well on lot On adjacent lotsSurface water D. ABSORPTION FIELD DATA ?ate:inslalled• 10.� $ Soil rating. Z 50 System type -5rertc. t Length VZ Width t m i DJu.) a Gravel thickness 12 Total depth Total#b"s6rptlon area 9 it, S. P:- 'Cleanouts present (Y/N) y Depl(egsior>kover�feld (Y/N) Date of adequacy fest Results (pass/fail) i for bedrooms Peroxide treatment (past 12 months) (Y/N) /Y If, ive date Y.g SEPARATION DISTANCE FROM ABSORPTION FIELD TO: iG5 F F; ' Welionlot ^Onadjacentlots iDOr+ Propertyline 4� �f• i To building foundation 3d r -i- To existing or abandoned system on lot On adjacent lots f ,ICS Cutbank NA t75 Water main/service line &A +!d / t Surface water 'r too Driveway, parking/vehicle storage areaQQ. € �_ Curtain drain" N (A. 4100 1 E. ENGINEER'S CERTIFICATION, - 1 certify that ! have checked verified or conformed to all MOA and HAA guidelines in effect on tp tte of this inspection. ..OF .�� Cq �® Signature1* t. 4c s . • 9L Engineer's Name . ��, Ro.. t, o. Qzk. Date 12 vos. M -2-R2 �I t " � _ - ,�. �,•.� 6353 _� 0 HAA Fee $ Waiver Fee: $ Date. of Payment /a` 3- 9 L Date of Payment Rece pt,Number a1�2 ?I l O _6 Receipt Number 72-026 (Rev. 3/81) Buk MOA 21 - *MUNICIPALITY OF ANCHORAGE 0 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) %r o T3K S -7,q L()S Lr enr 52K3 , Location (address or directions) //,7L &)4q AK 9�71C (b) Applicant Nam �UrF� Telephone: Home 4S Business Applicant Address • %S»/E (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution �� T o� vv cA�d �QM a nn oc7alephone —1 � ` � CS Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family R Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well j81 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 OnsiteZj 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 sthtus. Page 1 of 2 - 72-025 (11184) 5. ENGINEERING FIRM PROVIDINIGIN SPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm RE��,O. ERPF;S"tTS Telephone Address � � � 7H 4VE tic op-/}�L2E A{� Date 9S6 6. DHEP APPROVAL () Approved for bedrooms by Approved _� Disapprove Conditional _ Engineer's Seal Terms of Conditional Approval CAUTION Date The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE OF HEALTH 8, MUNICIPALITY OF ANCHORAGE (1111100>Tfl/IRONMENTAL PROTECTioN HEALTH AUTHORITY APPROVAL (HAA) APR 1 6 CHECKLIST - FEBRUARY 1984 264-4720 �% r Legal Description: Zor 6 y G D UP- -7,41 -Us & 1Fsr- Scorn A. WELL DATA Well Classification 11awA-'IF If A, B, C, D.E.C. Approved (Y/N) gy1A Well Log Present (Y/N) 7— Date Completed 8/14 / -26 Yield /S &PM Total Depth !oZ Cased to IOZ- Depth of Grouting n1/fj Static Water Level SIF Pump Set At UN1C� oultii Casing Height Above Ground r't FT- Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) V Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot 104 G'1- ; On Adjoining Lots /�`D* 'r , To Nearest Edge of Absorption Field on Lot /725 Fr ; On Adjoining Lots /S'O'` p7 - To Nearest Public Sewer Line _ V To Nearest Public Sewer Cleanout/Manhole _ M To Nearest Sewer Service Line on Lot 94 Fl - Water Sample Collected by BS55F, Fjnp�* %TTS ; Date '79& /e Water Sample Test Results ?ATlSFAaTo5Z1� Comments B. SEPTIC/HOLDING TANK DATA Date Installed 10.191-M, Size i ZSC) 6 No. of Compartments Standpipes (Y/N) Air -tight Caps (Y/N) __y_ Foundation Cleanout (Y/N) Depression over Tank (Y/N) Li- u Date Last Pumped Pumping/Maintenance Contract on File (Y/N) for Holding Tank High -Water Alarm (Y/N) Moi¢ Temporary Holding Tank Permit (Y/N) / Separation Distances from Septic/Holding Tank: To Water -Supply Well /OY- Pr To Building Foundation 10 FT To Property Line'!g-of a To Disposal Field ZO Fr To Water Main/Service Line SG)rl- Fr To Stream, Pond, Lake, or Major Drainage Course i..r /A Comments Page 1 of 2 72-026(11/84) i C. ABSORPTION FIELD DATA 9 Soils Rating in Absorption Strata 7sep SF/Sa Type of System Design ' lR�N�J-1 Date Installed 10/8/'7(o Length of Field FT Width of Field Un/K74OwwJ Depth of Field il�a Fr Gravel Bed Thickness )Z F T Square Feet of Absorption Area 9/Z SF Standpipes Present (Y/N) Depression over Field (Y/N) // Date of Last Adequacy Test Results of Last Adequacy Test l�RsSFD Separation Distance from Absorption Field To Water -Supply Well /Z,5- P7- To Property Line 'y0 FT To Building Foundation s Rr To Existing or Abandoned System on Lot�/A ; On Adjoining Lots I00 1 Pr To Water Main/Service Line 1prw:+-4w r To Cutbank (if present) �JrA To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments 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 I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Receipt No. 3-7-i R? 3 Date of Payment r p� Amount: $ —(- 5 Page 2 of 2 72-026 (n/ea) Date MOA No. Dale R. No. 2 0 TlmaMITIMS a Data - - - Date - - Date - .Inspector _ - - Inspector - Inspector 'Comments-- '`` 11 Conditional Approval -. - C f A, �9cruotns Date Sewer Installed Permlt No. ;-_ - Septic Tank Size 3"e,+ - - - - -Holding Tank Size Solls'Rating ` - Well To Absorption Area - - Well Log, Received -' - - - Well to Tank.. APPLICANT`FILLSOUT LOWER HALF ONLY ;_ _ _ PrOpertY Owner- y -� ,pp "Phone . .. ; Melling Address a61 1t • ir7 iFC I _@ + .�1 .. "Buyer Add rasa Lending Institution Phone. F I ' ti. � rf AddrBas•. lty Co R Agenta� � .. ' o ne Rf3a Addr OF . , f y.. -Legal Description A -'V, 451 44F 10f &S - -Street Location5",r�- n Typeg Reeld$nce �fSingleFFamily - ❑ Multlple Fai , N-0.4 Bedroo[ - • � Other ; WAtYridtvla - ZL A'T'TACH WELL LOG. A -well log is required for all ell$ drilled since June L� Individual - -�_ ❑ Oommundy ` 1.87. For wells defied peon to that dat`e;,give II depth (attach._Idg If "�.Public'1.1 Ili aYailable..:. Sawa'� Disposal - .. - . CIrtdividlJal _ - Year Individual Installed' ❑Public Utility - When Connected to Public Utility' ' HoldingTank. - NOTE THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN. BE' INITIATED. "„ MUNICIPALITY OF ANCHORAGE +� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA FHA CONV 2. Property Owner:_ Mailing Address: Day Phone: 3�/q 3. NameofBuyer: A0)ILIkLD Mailing Address: Day Phone: -L1 - -5!L40 4. Name of Lending Institution: &ATE VA Mailing Address: Phone: 277 - /2 7a5� 5. Name of Realtor or Agent: ��� %YaYClS LEDiVgP_tD PE{rLT-/ Mailing Address: / Q —� Phone: 7-�4- J_L4 6. Legal Description: tJ/ (7 ALK .5 I'I",s wEn7 Location: e 1)17p_)ye 7. Type of Facility to be Inspected: 6L44�, L)),z No. Bdrms. y 8. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well 4- 1Oa' 9. Sewage Disposal System / Type of System: Publi Utility Individual (on-site) Y If Individual, date of installation 4 M76 10� 72-003(3/76)