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TALUS WEST #1 BLK 5 LT 4
Talus West #1 Block 5 Lot 4 #015-202-24 :yep 10 `20 04-50P A n c. 11 o 1 -age W e! i & Hump Ser 0-0722430742 P 3 b� r r C 1 -n a? tri 4 7 0."', F;; no.e ,2 Kc -c rj, A r E r Mark Begkh Mayor 13C, 7's 3343 Pump Installation Log VN'ell DrilLinc, Permit Number: S'VV Date (if I&S "C: Parcel klets fification Nawber:.. q Property Owmer Narne & Address, Ta IuS G1e-5 Do rQ� Pump ht-th-i-Depth Bolow Top c.TVVell Ca3in?g: lu feet FumpMauufacturer's Na -mc -:P -P CO 'Pump Model. I e-- PUMP'Size hp Pi less Ad2picrBurial 5eptb: feet Pitless Adapter M.-anufactlarer's -Name: Pidess Adapter liwalitr. Well Disinfected Upon Completion?No Method of DisinfLetion: Comments: Alft lump lusftller Name, Aodv-v-a�z I Atteation: The ournr, mtallu shall pil.ovide 1 puxp installation 1q, to the DSD withifti.30 days ofpjmp irstaflla-.ion. Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number. OSP 151184 PID Number: 015-202-24 Dwelling: ® Single Family (SF) ❑ Duplez (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: MADELINE K. LIEB ABSORPTION FIELD ® Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 11785 WILDERNESS DR., ANCH., AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 0.5 GPD1SF 12 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3 Ft. Gravel depth beneath pipe 9 Ft. Subdivision Block Lot TALUS WEST #1 5 4 Fill added above original grade Varies 0.65 -2.5 Ft. Gravel length 50 Ft. Township Range Section Gravel width 2 Ft. Beds: Number of Lines Distance between lines I Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 900 Fe 2 18 Ft. Well 100'+ 100'+ TANK ❑ Septic ❑ S.T.E. P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 1 1500 Gal. Surface water 100'+ 100'+ Material STEEL Number of compartments 2 Lot Line 51+ 10'+ NA Foundation 5'+ 10'+ LIFT STATION Manufacturer Capacity Gal. Curtain Drain NA *50'+ Remarks *None known. New AX -20 system with Pump on level at in. Pump off level at in. High water alarm at in. diverter to original field installed. Original ST decommissioned per code. Pump make and model Electrical Inspections performed by Installer A+ PIPE MATERIAL Housetotank Tank to D3034 drairdield DrainfiedD3034 CO/MTD3034 Inspector ArcTerra BENCHMARK (Assumed elevation) 100 ft InspdateS t" 7/17/15 7/17/15 Location and description 2�a 3" 7/17/15 0 Bottom of Siding COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL F Conditional Approval: Date ?.KENNETH M. a/ / \711 i 1 `a���i �aaa,os�' i Approved Date Engineer's Stamp inspection Repor!'g-1-i"q)r 6,- A -C=40' B -C=47' A -D=47' B -D=53' A -E=59' B -E=58' A -F=67' B -F=60' A -G=76' B -G=80' € A -H=83' 3'B -H=82' 1 A -I=89' B -I=84' g A -J=75' WB -J=64' AS -BUILT SYSTEM DETAILS/SITE PLAN TALUS WEST #1 SUBDIVISI❑N LOT 4 BLOCK 5 TH15-1 61, JE TH 7 LO 4 � oo• BL C 5 ryG / ro h 2 SEPTIC a m TANK SCALE, NTS ��1 iF~ �r * 4 TH *T HBNNM M. / CE -71 .'.A, jo wESS100 0 1115- � m ?GQ, 97,0 6.1 FINAL GRADE FILTlR F 90,60 \Q\\7 SEWER ROCK 81,60 TRENCH 1 95.3 FINAL GRADE FB.TFR FA� 90,60 SEWER ROCK 81.60 TRENCH 2 25' — PREPARED FOR, MADELINE LIEB 11785 WILDERNESS DRIVE ANCHORAGE, AK FIELD BOOKS BOUNDARY: NA BTAKNQ NA 'HLT JLS am FRE ADAB RM FILE COMPUTM DRANK: BMW OHEa¢D: KMO DATA 7/22/1 cR o 2736 15-134 PerMit❑SP151184 PID# 015-202-24 WELL /1' 8PAVED D/W ' HOWER TUBE NBEn p F R'WDLTING , b ls° '' AK. 99577 M 07(23/2015 08:06 8686770 APLUS PAGE 01 EleRrieni Cmmneclimn rm Adaaarea Cmn Wiles. Pump and . Iml coma m i twk phone line cowtimine mnmstkm and rewle DIP.m omnaclinm. Irremeen of wlspamel. Sak. Tax Tlnmk mm Aw 7amr hwmess! 1.675.w I,Os.m0 175,W .175.00 9.im . n.00 Total PWmentdCredi[s 5a.m0 Balanus Due 5�.WQJ* Office 907.688.2751 Fax 9il7,688.2752 int�{uca�ctnnertectcica&,caeft ww xaM-tuneelej*ieak.enm Lit No. 38752 Mnoity Onty pm n pepar e l'nhmat fkvelitlf O ut Se vim tl9pltion I beretalpmleot Seraieax tlieiatnn P.(1. pm 19F65m . nron Flare Rqml Arcb..la , Atka "SIOA SO adb and }klp: W041 W.X'_t l N''SFfCTION: vmee:1907049 41110 ra1o0711'".7777 F.=2015 Inspection Report L'a ,,'APP. Ri1`RtM1"392 Pammt Ap1': tmpeelima N: ?fiR71 • f % 7-71 T7yWc• i1PRMO Nm . - Open Addmss: 117.05 W1[,DV .4F -C4 OR Parcel: fUVWnEao .<, O15-2OZ-,74 imspeetm: Mika i:.een 1Smjece Resp Futy: ndCr. Retrerd Permit vb ilPlr.mRalkn sm 1, ..rr m.rnmla inoft ststm- Addusr.AtRkwa�. AIC, �SSIfi h'. .p •. '1st ID: n'n.-. u•nr•r gk,-Wed Ek rkvl fr.ptOl" App-wd Result Nnkc (...Pklr "k CkelrlCal !.arm. a"rN ml• 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: OSP151184 Tax Code Number: 01520224000 Work Type: Septic Upgrade Permit Effective Dates: July 06, 2015 to July 05, 2016 Design Engineer: ARC TERRA CONSULTING INC Subdivision: TALUS WEST#1 Site Legal Address: TALUS WEST #1 BILK 5 LT 4 G:2736 Owner/Address: LIEB MADELINE K 11785 WILDERNESS DR ANCHORAGE AK 995162231 Site Mailing Address: 11785 WILDERNESS DR, Anchorage Lot Size in Sq Ft: 17000 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 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 Issued By MUNICIPALITY OF Community Development Department Development Services Division 9 On -Site Water & Wastewater Program ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-202-24 Property owner(s) MADELINE K. LIEB Day phone 11785 WILDERNESS DRIVE ANCHORAGE AK 99516 Mailing address I' Site address 11785 WILDERNESS DRIVE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) TALUS WEST #1 BLOCK 5, LOT 4 Legal description (Township, Range & Section) Lot Size 17000 Sq. Ft. Number of Bedrooms 3 SUBMITTAL JUN 17 2015 Gretchen Stuller APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Single Family [ Absorption Field Initial ❑ (SF) Septic Tank Upgrade (w/wo ADU) Duplex (D) ❑ Holding Tank ❑ Renewal F-1Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. or Permit/Rush Fees: Waiver Fees: _ Date of Payment: 6 ��!/5 Date of Payment: Receipt Number: Receipt Number: Permit No. Waiver No. Permit App_9-1-12.doc Municipality of Anchorage **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV151072 COSA#: Permit#: OSP1 51184 PID#: 015-202-24 Legal Descdption: Talus West #1 Block 5 Lot 4 Engineer: ArcTerra Applicant: Madeline Lieb Your request for a waiver of the required 26 feet horizontal separation from the absorption field to the absorption has been approved. The approved separation distance is 18.0 feet. 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 nonobjection have -been -received from the owner(s) of the affected adjacent property. 0. Adjacent properties are not affected by this waiver. '�•......�............. ��.. r.....Y�................. Waiver is Granted: X Waiver is not Granted: Date: Approved by: Name Review .......................................:................... .................� **** VARIANCEMAIVER REVIEW **** MA June 15, 2015 ARC 1 ERRA CONSULTING, INC 212 E. 51' Ave, Anchorage, AK. 99503 Office (907) 868-3791, Fax (907) 868-3793 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Upgrade Sewer Permit — Talus West # 1 B5, L4 It has been determined that the absorption field of the subject property is saturated. Subsequently, the owner has requested we proceed forward to obtain a septic permit to upgrade the septic system. The general slope of this lot is from east to west at a grade of approximately 4-9% over the septic area. On May 13, 2015 a testhole was performed to investigate soils and groundwater. The results of this test are attached for your review. The proposed upgrade will serve the existing 3 -bedroom house. We propose to install two 2 -Wide 25' long trenches with an Advantex AX -20 system. Groundwater was not encountered at excavation or at monitoring. The property and adjacent lots are served by private water. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 868- 3791 / FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. Kenneth M. Duffus, Attachments: On -Site Sewer Application Wastewater Absorption System Details/ Site Plan Soils Log/ Percolation Test 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 o �FtCTERR9 T -S June 30, 2015 ARC 1 ERRA CONSULTING, INC 212 E. 51" Ave, Anchorage, AK. 99503 Office (907) 868-3791, Fax (907) 868-3793 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Field to Field Waiver — Talus West #1 Block 5, Lot 4 The above subject property has limited area for the septic system based on lot size, well radii, tight/slow percolating soils and other restraints. We are therefore requesting a waiver from the required 26' separation between the original, existing 13' effective depth trenches be reduced to an 18' separation to the proposed fields. Only a small portion, approximately 8' of the proposed trench setback requirement encroaches the existing field. Due to the tight soils and slope — potential effluent transference or interaction between the two fields will be marginal or nonexistence. The property is best served by retaining the original field for future use due to the lot's characteristics mentioned previously. The mitigating factors of soil type and slope justify the issuance of the waiver and indicate the proposed field will have no effect on the functionality of the existing field. If you have any questions, please contact me at 868-3791 / FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. 41 r Kenneth M. Duffus, . . 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 IWELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLA TALUS WEST #1 SUBDIVISION LOT 4 BLOCK 5 FLAG PROPERTY LINES WELL RADII & EASEMENTS PRI❑R TO CONSTRUCTI❑N NO SLOPES >20% W/IN 100' DOWN HILL FROM PROPOSED SEPTIC NO PUBLIC WELLS WITHIN 200' OF PROPOSED SYSTEM. NOTES, NO PRIVATE WELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPTIC SYSTEMS WITHIN 200' OF PROPOSED WELL EXCEPT AS NOTED. Aw Aor �� OF At �* 4 H *+, r .—. ' KENNE M. D 0 116 W� / "u1'ESSI021FS' Scale, 1'= 50' DESIGN DETAILS PAGE 1 OF 3 3 BDRM X 150 GPD = 450 GPD 450 GPD/.5 GPD PER SQ. FT. <60 MIN/IN.)= 900 SQ. FT (900 / 2 x (9' GRAVEL) = 50 FT. TRENCH USE 2 TRENCHES - 25' (L) X 2' (W) X 9' <ED) Total depth of system Is 12' max from original grade. Total depth of gravel below distribution pipe is 9' . 1. INSTALL 1500 GAL AX -20 SYSTEM & INSULATE TANK IF <4' COVER. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM IF < 3' OF FILL, MIN. 2' FILL WITH INSULATION, >3' COVER NO INSUL REQ. 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK. 4. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC... PREPARED FOR; MADELINE LIEB 11785 WILDERNESS DRIVE ANCHORAGE, AK 99516 WASTEWATER DISP❑SAL SYSTEM DETAILS TALUS WEST #1 SUBDIVISI❑N LOT 4 BLOCK 5 V` / \X/803 6 4194 a 1, � Q \ a \ O �a co CO4199, 0) o y TH15-1rvv ro ~� Mp � P INST LL NEW 500—GAL C CO AX— 0 TANK SYSTEM SRIH<w' / ?g 0 4199 DIVERTER • • COs :.0 O MO C) 18' + DECOMMISSION EXISTING / SEPTIC TANK PER CODE 1(g0,A) CC lg \T&E EsyT0 \ C o AN, ``N � OF A4�r11 TH)IN * �� KENNE M. S; .. CE&-/-t �� ` 3SIOS1�' PI Ar PRFIPFPTY I TNPC WELL RADII & EASEMENTS PRI❑R TO C❑NSTRUCTI❑N PREPARED FOR; MADELINE LIEB 11785 WILDERNESS DRIVE ANCHORAGE, AK 99516 FlELD BOOKS COMPUTED: BOUNDARY' NA DRAM: BMW STAKING: NA CHECKED. KMD ASBUILr JLS DATE. 6/15/15 DN Fl<F: GRID: n�zc ADHD "FILE JOB No.: 15-134 Scale: 1'= 20' PAGE 2 OF 3 WASTEWATER ABSORPTION SYSTEM DESIGN DETAILS TALUS WEST #1 SUBDIVISI❑N LOT 4 BLOCK 5 e' nGTInNAI SLIDE SECTKIN OF S' PIPE MER THS WMN=0H TO PRWDE EVEND TD BMDL£ E AWN 120 —� PREPARED FOR; MADELINE LIEB 11785 WILDERNESS DRIVE ANCHORAGE, AK 99516 nELO BOOKS COMPUTED: BOUNDAR' N A DRAWN: STAKING: NA CHECKED` KMD ASBUILT'.. JLS DAM` 6 15 15 on. PILE: GRID: 2736 ACAD `E E' FILE JOB No' 15-134 Treatment Systems AX20 - Mode 1 a Ore W Sy rems� 1500 Gallon Steel Tank 3-4 bedrooms Y1fi" 1500 GALLON ANCHORAGE TANK PASSNE AN VENT PAGE 3 OF 3 /Volum /AmTa Shared/Storu"/WEL & SEPTIC — PAed by La9al/ralue Wee[ uW/Bb k 5/Lot 4/ -MOA Pe It PM92 copy/Tmue L4 B5AW9 RcTeRR ARCTERRA i OF' ALS a r CONSULTING, INC /�3 � _sy 31 212 E. 51" Ave, Anchorage, AK. 99503 S' ~ = Office (907) 868-3791, Fax (907) 868-3793 ` * T 1 !� �e 4p'SLYTING.�° P KENNETHM1t. 'ti• SOILS PERCOLATION TEST , rs ries eEw� I�SsIeNN Performed for: Madeline Lieb Date Performed: 05/13/15 Project: TALUS WEST #1135, L4 TEST HOLE # TH 15-1 Depth (Feet) SEE ATTACHED SITE PLAN 19- 20 - Org/OL SM/ML/gm s/ some cobbles & boulders to 1' R UT1 A-9114 Y1 1 I] PRIOR TO TEST FOR HOLE LOCATION Was Ground water encountered? NO What depth? NA Depth to water after monitoring? NO Date? 5/20/15 Reading Date Gross Time Net Time Depth of Water Net Drop 1 5/14/15 1:00 6" - 2 1:30 30 min 4 15/16" 1 1/16" 3 * 1:31 6" - 4 2:01 30 min 5" l" 5 * 2:02 6" 6 2:32 30 min 5" 1" 7 8 9 10 I1 12 * Water Added Percolation Rate 60 (min/in) Perc Hole Diameter 6" Test Run Between 6 feet and 7 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. PAGE 1 OF 1. MUNICIPALITY OF ANCHORAW DEPARTMENT OF HEALTH AND HUMAN SERVICE, PARCEL 1001520221 LEGAL DESCRIPTION I TALUS WEST #1 BL K 5 LT 4 LOT SIZE: 17000 (SQ. FT.) NUMBER ... BEDROOMS, 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF. WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WIT& 1. THE ATTACHED APPROVED DESIGN. in ALL REQUIREMENTS SPECIFIED !N 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 FOLL.10[41I�w SPECIAL PROVISIONS. SPECIAL PROVISIONS' RECEIVED IP LSSUED BY, DAT E? DATE - P-0, BOX 19665M 825 "L" STREET. ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERM!l PERMIT NUMBEQSW910032 DATE ISSUED: 3/12/91 DESIGN ENGINEER:S & S ENGINEERS EXPIRATION DATE: 3/12/9:..*.' OWNER NAM&�ALA, KAi HOUSING FINANCE CORP OWNER ADDRESS:520 E34th ANCHORAGE, AK 99503 PARCEL 1001520221 LEGAL DESCRIPTION I TALUS WEST #1 BL K 5 LT 4 LOT SIZE: 17000 (SQ. FT.) NUMBER ... BEDROOMS, 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF. WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WIT& 1. THE ATTACHED APPROVED DESIGN. in ALL REQUIREMENTS SPECIFIED !N 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 FOLL.10[41I�w SPECIAL PROVISIONS. SPECIAL PROVISIONS' RECEIVED IP LSSUED BY, DAT E? DATE - 24 '91 09:1r-'907 5625485 VISTA REAL ESTATE />- M -W DRILLING, Inc. �• P.O. Box t 10375. 10330 Old Seward Highway (907) 345-5535 4+ ANCHORAGE, ALASKA 98571 r DRILLING E00 Well Owner- N_GTC P.2/2 Location ( address of: Townshi Use of We Dom °m P� P"ge) Section, if known; or distance main roars of 4 b 5 Talus wes-- ivu, i Size of caaing 6" Depth of Hole 12 -.-0 __js -eet Cased to -12-0. 6 eget Static water level 50 sk NIow) land surface, Finish of well (check one) open end ( R ) Screen ( ); Perforated Describe screen or ---r Well pumping test aL_ of drawdown from Date of uepth in feet from ground Surface 0TO 2 2 TO_ 50 _ 50 58TO 70 70 TQ 78 21--TO-20-0 100 TO 120 ----._TO__•,..._.__ TO TQ �To TO� TQ� — . To E`+ionsy (minute) for_ l hours with— 5 t. WELL LOG of formations penetrated, size of material, color and hardness ---- th;Gravel Layers "J% vertified Contractor I -CUSTOMER Municipality of Anchorage Department of Health and Human Services Tom Fina, 625 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 March 13, 1991 Robert A. Shafer, P.E. S & S Engineering 17034 Eagle River Loop Road Eagle River, Alaska 99577 Subject, Waiver Request for Lot 4 Block 5 Talus West Subdivision #1 Waiver Request #WR910010, PID #015-202-24 Dear Mr. Shafer: your request for a waiver of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance from the proposed well on Lot 4 Block 5 Talus West #1 to the adjacent septic tank on Lot 3 Block 5 Talus West is 90 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require that all separation distances be met or the issuance of another approval from this department. , Si rely, Concur: Robert W. Robinson Susan Oswalt Civil Engineer Acting Program Manager On-site Services On-site Services ljm:340 ROBERT SHAFER, P.E. ROGERSHAFER CIVIL ENGINEERS (907) 694-2979 Match 6, 1991 FAX 694.1211 F9C�f RIVER. A�PS�P RECEIVED HEALTH AUTHORITY 1991 APPROVALS Muni-cipati,ty o4 Anchorage MAR 7 DEPARTMENT UP HEALTH AND HUMAN SERVICES 1\Aonlofpality of Anohorogo 825 L StAeet pepi,tleafth&HutnBn rvloes P.O. Box 196650 SEWER&WATER MAIN EXTENSIONS Anchoxg� a e Alaska 99519-6650 REFERENCE: Lot 4; Block 5; Tatus We,6t #1 Requeat you issue a pekmit to dxil2 a private we.0 and grant a watveh SEWER&WATER INSPECTION 4ox the aepanati-on distance between .the proposed weU and .the septic tank on .the adjacent Lot 3; Black 5; Talus West 01 at 90 6t. The existing wet was dhitted too ctose to the leaeh6ield aero#a the ENGIN EERING STUDIES street on Lot 26; Block 3. We applied box a wa.ivex which ne6utted in ANDREPORTS your denial letter dated January 8, 1991. A4tex looking 4ox a place to xedxi e a welt on the property we bound the best place to be approximately 90 4t. 6xom a septic .tank on Lot 3; WELLINSPECTION Block 5. This location is the 4unthe6t possible 4rom au auhxounding & FLOW TEST septic systems. Fax the 4ottow.ing reason we heel the separation distance pn.eacnibed by 18AAC80.020 is not requiAed .in this ease: SITE PLANS 1. Although there is no we?t tog 4ox the proposed weU, it w.i Pt be dxitted between the existing weM on Lot 3 9 lot 4. These existing welt .Logs show seveAat clay layexa between the ground ROAD DESIGN sun4ace and the aqui6ex. These clay layers should heep to prevent contamination o4 the aqui4ex by the septic systema. 2. As opposed to the pxev.ioua waiver requested, this lesser separation distance is to a septic tank .instead o4 a leaeh6.ie2d. SOIL TEST A septic tank is genexatty not con6 ideaed a continuous souxee o6 contamination as would a teaeh6.ieZd. 3. Aao as opposed to the pnev.ious waiver requested, this leaser PERCOLATION separation distance is to a septic system which da located down TEST hilt 4xom the proposed weU. Although area well toga do not give an .indication o4 the gradient o6 any soft stxatas, the attached topography map shows the entice topography o6 the area to slope away 6o4m the proposed well towaxd the xe6exeneed septic system. STRUCTURAL& it is typical o4 subsux4ace stxatas to 4ottow topogxaph.ica2 MECHANICAL INSPECTIONS tAend6 which would suggest the e66luent leaving the encxoach.ing septic system would travee away 6xom the weft. ONSITE WASTEWATER aQ6-;S 1 J J -.J \, V 4J�✓ � �xiC '� �V'��. �1 C. 111 DISPOSALSYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Page Two Lot 4; Stack. 5; Ta2ua weat #1 Match G, 1991 I4 you have any queationa of tegwite addition. .in4otmation 4ot your review, pteaae contact us. 1 11 1 � 45o Ll fx GRE R ANCHORAGE AREA BOAGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM /!•%Ir7_?:tWlie r,L!R ue . ..: rs7.-7—un .F��i•3L7Cis�-r.GPfa LOCATION LEGAL DESCRIPTION S. v `r✓�ti1 DISTANCE NUMBER OF FROM WELL MANUFACTURE MATERIAL COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACIT'l`"GALLONS: TILE DRAIN FIELD: i TOTAL LENGTH DISTANCE FROM WELL FOUNDATION -'--NEAREST LOT LINE OF LINES _.->�V' NUMBER OF LINES DISTANCE BETWEEN LINES —"—TRENCH WIDTHXIN. TOTAL EFFECTIVE ABSORPTION AREA 77f SQ. FT. LENGTH OF EACH LINE e DEPTH OF FILTER %%'']] P DEPTH: TOP,OF TILE TO FINISH GRADE _MATERIAL BENEATH TILEf,� ABOVE TILE 9L IN. TYPE CONSTRUCTION DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE , SEWER LINE—, TANK , SYSTEM_ CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: /' SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: i REMARKS Form EQ -032 UC[H:LLriHI� �E�9211h r° -11_I" I E=- I F' 1=11 I _1F %a C1 /= Fi"C t-1 RD F -:C F=1 1:3 E DEPARTMENT' HEALTH AND _ENVIRONMENTA TEC:TION �Le[S11 825 '�=.TREET. ANCHORAGE, Ah. M-1 L 13 279-25ii - 1-4 E=_: 1— L F:0 -JC- CI C-°1— °_> I _FE: ; E 4°d E_ F_F}/�h'' AAy� PERMIT NO. ( 7 288 � -l10-77 X��t � L APPLICANT GARY CAtJC}EE t.<:ci tdIELSOtd IdAY 11%�C -.-1Y)Q h. - LOCATION 14ILDERNESS DRIVE awQ„� LEGAL L4 B5 TALUS WEST LOT SIZE 20000 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING ESQ FT/BRr= 225 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C:•E=F°-F"= - LECI TAS= , e3 F�_-F1'°r•EL_ C�EF°TF-1 THE LENGTH DIMENSION IS THE LENGTA(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 IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION r(IN • FEET). 4 F°FiC;V. F=j1�E F°LFlC,1_F FR' 1=G!1_1 I F'E—=C1 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 .I'- USED THE LENGTH ISFEET. 2 �I IF H CLASS II SYSTEM I USED THE LENGTH -I5 FEET. -F R°J C1 c_ C' > I 1'-°I °= Fs E= C- T I Cl C- _ F=1 F' E F C'x 1St I F' E C.a 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 =0 DAYS OF THE WELL C:OMPLETUaN. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO :INSURE PROPER INSTALLATION. F°1=F'M I T L I C• F'CeF' ID lE ' VEF=1F' F FF_CflM I I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS.AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2` I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. <: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS R.E•tODE TO IFdCOLUDE MORE THAN 3 BEDROOMS. SIGNED: � � -------------- ISSUED - -- ISSUED BY Y G9 Q `------ DATE--E-Z,5-22 El lieu) GcJe�1 drII(eG1 i l�t... \ Coad \'-)bvl o�- -h I _�> Wel 1 LA ✓� k nocv� . ` ', h9 a o h7 a °0 '+f a y0 hf a 0y "i5 a 0 "sJ a 0 sl a 0 Kf a j0 z 0 h1 a 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 H O H O H O H O H O y H H H H H H H H H H H H H O H O H C H H O O H O H H H O O H H O O H O pOH H H H H H H H H H H H H iV r C ', h9 a o h7 a °0 '+f a y0 hf a 0y "i5 a 0 "sJ a 0 sl a 0 Kf a j0 hl a 0 h1 a 0 hl 'if a a .J0 /0 H O H O H O H O H O H O H O H O H O H O H H O O 0 L GE 8 Municipality. of Anchorage .4� a On -Site Water and Wastewater Program (907) 343-7904 S A F E T Y Certificate of On -Site Systems Approval` Parcel 1. D. 015-202-24 Expiration Date: �~ ( 2-0 1. GENERAL INFORMATION: Complete legal description TALUS WEST #1; BLOCK 5 LOT 4 Location (site address) 11785 Wilderness Road *Anchorage, AK Current Property owner(s) Tucker Stoepler Day phone '223-6545 Mailing address Real Estate Agent bay 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 El Community Class Well ❑ Community El 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 $ c`J�j� Waiver Fee $ Date of Payment �al��-1 Date of Payment Receipt Numbero�a�0�G7 Receipt Number COSA # GSC 1R/59a 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: �c In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the 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 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 workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. D IGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the followi #AECC884 IT Y op 01V -SI. r,_ E ftip,� s'A 4,VD , ^ ATER 1 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 —7y— Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other e A Legal Description: TALUS WEST #1; BLOCK 5, LOT 4 If more than 1 septic system on lot: COSA Checklist # 1 of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled.5/3/91 Total depth 120 ft Cased to 120.6 ft ❑ Sanitary seal is functioning correctly M"Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 11/26/19 Static water level at beginning of test ft. Comments B. TANK DATA Age of tank(s) 4 years. Tank type/material STEEL Measured operating fluid level in septic tank 50 OR Standpipes/foundation cleanout per record drawing Date of pumping SEE 6/26/19 MAINTENANCE REPORT D. ABSORPTION FIELD DATA *AT MONITORING TUBES Which system tested (date installed) 7/17/15 ❑ ALL standpipes present per record drawing Total measured depth from grade *13.1+ft (max) Measured depth to pipe invert from grade 4.5+ ft (min) ❑ N/A — pressurized field Al Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 015-202-24 Structure served by this system Well production at time of test 4+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No Coliform bacteria is Negative NitrateG.pf mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 11/26/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station 4 years Lift station material STEEL Comments: Adequacy test date 11/26119 Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 612 gal New depth 43 in Elapsed time 120 min ❑ Code -required soil cover over field Final fluid depth 17 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N/A date of test) N/A Gallons introduced N/A gallons If yes, enter date Comments/Deficiencies: TESTED WEST TRENCH ONLY -EAST TRENCH WAS DRY UPON ARRIVAL AND STAYED DRY THROUGHOUT TEST COSA Checklist yellow sheet ap` 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 ✓0 50 + Sewer Manhole/Cleanout > 100' Yes if No F1 Yes if No ft ❑✓ Yes Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' Yes if No Absorption Field on Lot > 100' ❑✓ Yes if No 50'+ ft Holding Tank > 100' ❑✓ Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50'✓❑ Yes if No ❑✓ Yes if No ft if No 50'+ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft M Yes if No ft ft ft ft ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ❑ Yes if No 50'+ ft Property Line > 5' ✓0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5 ❑✓ Yes if No ft Private Wells > 100' ❑ Yes if No 50'+ ft Water Main > 10' ✓❑ Yes if No ft Community Wells > 200'✓❑ Yes if No ft Water Service Line > 10' ❑✓ 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' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10'✓0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓0 Yes if No ft Private Wells > 100' ❑ Yes if No 50'+ ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' ❑ Yes if No 50'+ ft F. ENGINEER'S COMMENTS FOUND ALL PIPES EXCEPT FOR PIPES TO 1977 TRENCH, CONDITION OF 1977 TRENCH IS UNKNOWN G. ENGINEER'S CERTIFICATION l certify that 1 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. COSA Checklist yellow sheet #AECC884 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this / 13 Day of December of 20 1'9 , by and between Eric & Hope Szymoniak , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as located at (legal description) Lot 4 Block 5, Talus West Sub Addition ##1 Plat 80-40* 2. Maintenance, Repairs and Alterations. ' See attached exhibit A for full legal (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 5 owr�c�: By: %.�L �ua� (signature) f 5 Datd: 12-13-19 r :4�:'"+'4 •^s Y�I.S C;. •ti:;fit\�:' � #!•1'1-C�[�t Eric Szymoniak (print name) by his attorney in fact Hope Szymoniak STATE OF ALASKA } ss. THIRD JUDICIAL DISTRICT } The foregoing instrument was acknowledged before me this 13 day ofDecember , 20 1 9,by Eric SzvM!0=1ak by big attorney in fact Hope _ Szymoniak NOTARY PUBLI FOR ALASKA My Commission expires: L._ 1(-i3 STAT OF ALASKA NO`I URY PUBLIC t §—N , i ch4•istina A cai;ills )�1�XCXPALY'I'Y My Commission. Ends April 21, 2023 wv (signature) :Y; (print name) (rev. 05/18/2018) Date: ) 2 1-1-1 Lt Title: I Page 3 of 5 340144 an MINES OEM GIVE M son 0 O R Ill S» Ian so an 9 an 11 an Has ..:, ;, lk .W� r'' Annual Inspection pronnrW O NnerRtnaklnA # Tucker Stoetler $itn Addreen 11785 Wilderness Drive, Anchorage AK 99516 Coanty iD # POd R AX Sita iD Vi AX -1372014 OSP151184 421240 Retrieve O&M Into Daily flow„ Reciro ratio_ Timer settings: Please call ahead - locked gate 223-5001 Perform Field Sampling/Observations NTT (1!3;t NTUt) 108 (6-9) DOR-6) - -7 9- 7 ` Odor of sample 'typicalMus❑ Earthy El Moldy Non-typical�Sulfld. ❑ Cabbage ❑ Decay oily film in PVU ❑Yea No Foam in tank G Yes JA No Cheep Control Panel Recire Amps Discharge Amps 9« :8 Audible and visual alarms VOK Nal tone (telemOtry - Y,� ❑ No InSpect/Clean Pu p Syme inspect Clean Riser/Lid ..... • .... SpliceBox .... ....... .... . . Fiaat cards ............ . .... ^ Floats.... - Pump .. . elotubee Filter ............... • .. Biotube PUMP Vault ....... I .... Recirculating Splitter Valve..... . {Comments A,nohorageTank; 907-272-3543 Dparator Larry Betts _ ❑ Excessive Cantaet Fhpnr> ❑ Excosaivs (907) 223-5001 RTU tUUl. B Data of Last InapatIlOn RTU 130986 10104/2018 Measure Sludge/Scum Sludge Scum F'reviouS 1Stoompartment Current PrevIOUS Current 2nd Compartment Curr nt Previous Current Previous Inspect,/Clean AdvanTfex Filter Odor: ZNormat Pungent 19i0mat: f. ❑ Excessive �Normal Bridging/Ponding: I i Nonc/Minor ❑ Excosaivs Inspeot/clean pischargg Rump System inspect Riser/Lid ❑ Splice Box ❑ Float cords ❑ inspect Glean Laterals/Orlfice'a Pod Bottom Intake Vent X fr Inspect glean Floats ❑ ❑ Pump ❑ ❑ Inspaot/Service Other System Components inspect Citron Inspect Clean ,,r� Disinfection Equipment r]isp^rml Lateraie/Orlfice5 FI -1 Observations —� Additional Services Ren erect clowned textne shsete? E] Replaced UV items? ❑ Replaced/Used other items? Pacts Used. W = War'+AntY, B � Blilatate (✓ appropri$ts selection) Final Sa1P®ty Ir►speation Lids bolted on RSv reinstalled Manifold reconnected; flush valves closed I ontrol parcel ne:A":tivated Summary/Recomm andation9 ❑ System performing; no further action neaded ❑-rank neods pumping ❑ call for servlco ❑ Qther7 _,,,,_ D'ate Signature ,�,.,_!�-,-,�.r�{,e!>Y"�f Fax completed form to 1.866-384-7404 Iolitrate Advisory Certificate of On -Site Systems Approval # OSC191592 Subdivision: Talus West #1, Block: 5, Lot: 4 A water sample revealed a nitrate concentration of 6.24 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. I '.a„ �` '" �`i., �� �� � �lvtaalEhg;Adsi�ess �Oox�"1'�,965`�40i Y E Q • Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 s�FErr CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-202-24 Expiration Date: 3 1. GENERAL INFORMATION Complete legal description TALUS WEST #1 S/D BLOCK 5 LOT 4 Location (site address) 11185 WILDNERNESS DR -ANCHORAGE AK99516 Current Property owner(sy COURTNEY MOON Day phone Mailing address 3910 EAST 142ND; ANCHORAGE, AK 99516 Real Estate, Agent Day phone 56a9%o 2. TYPE OF DWELLING: �4 RUSHI ® Single Family (w/wo ADU) 6� D� El Duplex a DEC 01 20f5 n Multiple Dwellings (Single Family and/or Duplex) y (¢v� w 3. NUMBER OF BEDROOMS: 3 �� yn 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:" Individual Well ® Individual ® Individual Water Storage ❑ Holding Tank ❑ f Community Class Well ❑ Community 13 Public Water System ❑ Public Sewer. ❑ ea® Waiver/Variance request for: Distance: Received by:_(oz.. t??ee.� �ewnt�_ Date: ate• y, 2ofS COSA to be released to the engineer, unless otherwise requested by the engineer.. - COSA Fee $ (0q&0+yj 4 =- it -II Waiver Fee $ Date of Payment 12,111 , 1 �`7� C�OI�`i Date of Payment Receipt Number `GI -i �i �t 0� Receipt Number COSA#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 MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE. Engineer's Printed Name MIKE N ANDERSON, PE Date 12/1/15 °0F. Age��p�p 6. DSD/SIGNATURE-11 d ° ° ° ° !/ System #1 Approved for M'�G4ry ANOERsoN ,' o Y pp bedrooms. C�69 w o System #2 Approved for bedrooms. Disapproved. ������a.;►4L�_Tr ° Conditional approval for bedrooms, with the following stipulations: P\,0 OFq�Y V Gr-�TP.OITP WATERAND m WASTEWATER o / rsER� By: UV Original Certificate Date: 2 3 //9 - The Municipality of'Anch ge Development Services.. Division (DSD) issues Certificates of On -Site Systems. Approval (COSA) based only upon the representations given in paragraph 5 b 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12aoC - - n If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system _ Certificate of 4n -Site Systems Approval Checklist Legal Description: TALUS WEST #1 S/D BLOCK 5, LOT 4 Parcel ID: 015-202-24 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed tyS/g/ W41 Sanitary seal (Y1 /IN) Y Total depth Lj n'ft� Cased to FROM WELL LOG Date of test 3 d Static water level So ft. Well production f Z g.p.m. WATER SAMPLE RESULTS: Well Log (YIN) Wires properly protected (Y/N) Y Casing height (above ground) 7_ AT INSPECTION ITI 4t '1 ft. g.p.m. Coliform NEG colonies/100 mL Nitrate 3.47 mg/L Arsenic: ND ug/L Date of sample: 10128/2015 Collected by: Mike Anderson B. SEPTICIHOLDING TANK DATA Tank Type/Material A 4 wun, �T x' S Date installed r% 1/ i 1(I +— Tank size 1500 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (YIN) Y Date of purpping NSW, ,Pumper NEW C. ABSORPTION FIELD DATA -1985 SYSTEM TESTED Date installed 77 Soil rating (g.p.d./fe or W/bdrm) S System type JP+)e 0 r Jnr Length 7-Kft.'S Q CZ -ft J3,.' Width ZZ ft. Gravel below pipe ft. Total depth4 ft tff. absorption area 400ft2 Monitoring tube Y Depression over field N Date of adequacy test NEW Results (Pass/Fail) NEW For 3 bedrooms Fluid depth in absorption field before test NEW in. Water added NEW gal. New depth NEW in. Elapsed Time: NEW min. Final fluid depth NEW in. Absorption rate >= NEW' g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) UNKNOWN If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons Manhole/Access (YIN) in. "Pump off" level at in.High water alarm level at _ in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 1004 Public sewer main 75'+ Sewer /septic service line ,Z S t— Animal containment areas Aft 'S 6 t� SEPTIC/HOLDING TANK,ON LOT TO: Building foundation 54 Propertyline 51+ On adjacent lots 1001+ On adjacent lots 1001+ Public sewer manhole/cleanout 100'+ Holdingtank,:t Manure/animal excrete storage areas. 1004 Absorption field 54 Water main IM 69 (f— Water service line 10'+ Surface water 1001+ Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 104 Surface water 1001+ Driveway, parking/vehicle storage 104 Curtain drain Snt f Wells on adjacent lots 1001+ Un lz ti vwrt F. COMMENTS NEW ADVANTEX SYSTEM RECENTLY INSTALLED BY ARC TERRA, V eW G. ENGINEER'S CERTIFICATION I certify that I Pave 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 MIKE N. ANDERSON, PE Date 121112015 COSA canary sheet_2-6-15.doc Alq %k�6f �p��•OF fii� . MICHAEL N. .......... ANDERSON J° •• CE,- 9469 Y •ctc`- j 14 ,� ADVANCED iWASTENWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE AND Tuu e.kt,r 5 0 Hier TIES MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this i Day of Zerember of 20I5",byand between =u.ver Sfcepjer , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Maintenance and Repair Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Adyan tee AX 20 located at (legal description). (us hast/ Lq 85 Z. Definitions. Alteration. Any change to the design or function of an AW WTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Certificate of On -Site Systems Approval (COSA). An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with Anchorage Municipal Code (hereinafter, "AMC") 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. Permit. An On -Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AWWTS. 3. Term. The term of this Maintenance and Repair Agreement shall begin on the date of approval by the Municipality to operate the installed system or issuance of a COSA, and shall continue while the AWWTS is in use or is operational or until the property is sold or title is transferred by the owner and a new COSA is issued to the new owner or transferee of the property. 4. Alterations, Installation and Removal of Additional Equipment. Prior to performing any atterations to an AWWTS, the owner agrees to obtain an On-site Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65. 5. Maintenance and Repairs. A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall maintain their AWWTS in a satisfactory condition capable of producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. The owner shall enter into a service agreement with an AWWTS service and t'naintenance provider ap rop ved by the municipality and the manufacturer of the AW WTS for the entire term of the AW WTS In addition, it shall be the responsibility of the Owner during the term of this Maintenance and Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustmem(s), (4) replacement costs, and (5) inspection costs. B. Owner agrees to Comply with all applicable ordinance, taws, regulations; rules and orders for the AW WTS. C. Upon request by the Municipality, the owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system. When a record of maintenance is documented and maintained by the system vtaindor, the owner agrees to allow the Municipality access to this information, D. Owner acknowledges that the fine for failing to maintain and repair an AW WTS may be assessed in accordance with AMC 14.60 for improper discharge. E. Owner agrees that only maintenance and repair personnel approved by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. F. Owner agrees to grant the Municipality reasonable access to test and inspect the AW WTS upon 24 hours written notice. G. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. H. Owner agrees. that the AW W'TS installation and maintenance requirements as provided by the AW WTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AW WTS. 1. Owner agrees to provide and maintain a telephone connection to the AW WTS as required by the AW-WTS approval. 6. Nonwaiver, The failure of either parry at any time to enforce a provision of this Maintenance and Repair Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Maintenance and Repair Agreement or any-part hereof, or the right of such party thereafter to enforce each and every provision hereof. 7. Amendment A. This Maintenance and Repair Agreement shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality that this Maintenance and Repair Agreement was executed with, and such writing shall be attached to this Maintenance and Repair Agreement as an amendment. B. For the purposes of any amendment modification or change to the terns and conditions of this agreement, the only authorized representatives of the parties are: a. Owner: b. Municipality: Director. Community Developr*zem or desi hated authority C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repair Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Maintenance and Repair Agreement. 9. Severability. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Maintenance and Repair Agreement. OtVNI;It: / gy signature) Date: (print name) STATE OF ALASKA } ) ss. THIRD JUDICIAL DISTRICT ) 5� The foregoing instrument was acknowledged before me this � day of 201S_, by 1zj. . �YSf My Commission expires: MUNICIPALITY: By (signature) MARYANIDONCZ Date: Title: Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-202-24 Expiration Rate: _Q_..`.0, Cl - Ir. Complete legal description . 7ALU5 WEST#1 BLOCK 5, LOT 4 Location (site address) 11785 WILDERNESS OAG_E, AK 99518.., R ... -_ .. Current Property owner(s) Mk1DELINE LIE@__._ Ray phone . Mailing address 11785_W1LbERNESS 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) 1 NUMBER OF BEDROOM$: 3 44 TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well individual 0 Individual Water Storage © Holding Tarek 0 Community Glass ----- Well Community 0 Public Water System ❑ Public Sewer El WaiverlVariance, request for: Distance COSA to 0e reto the enginmr. Gate; 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 an -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_ blame of Firm ARCTERRA CONSULTING, INC. _. , _ Phone _868.3791 Address 20441 PrARMIGAN_BLV QAC CE RiVERLAK y9577 Engineer's Printed Name KENNETH A DUFFUS Date 7/27115 Engineer's Comments: This investigation was completed In compliance with AOEC and MOA regulations. The assessment of the condition. Of the wait and septic applies only to the conditions as of the day tested. The flaw and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes intend use, local sal characteristics, groundwater levels that may fluctuate during the year and the wafer usage of the family being served by the system. The operational fife of all well and septic systema are subleet to these variousand dynamre characteristics and are outside the control of file - evalualor of the well and septic system. Therefore, ArcTems can not give any estimate of how long a system will function satisfactory, for current or future �rpw occupants or can AmTerra guarantee that no unseen - ®, or,, encroachments, deficiencies or discrepancies exist ._ 1 < 6. DSD SIGNATURE Of System #1 Approved forbedrooms.System #2 Approved for bedrooms. .. Disapproved, Conditional approval for bedrooms, with the foltewing stipulations:,����Ap�\� OF, rrr NCy SiTE 13Anin m: WASTEWATER By: .__ _ _ 1LI! _ 1 onginat certificate Date n „ of noheraga oevelaprnent:60ndo s Division (08D) issues cBe€l Catas of 011,511e Systems Approval (COW based only upon the rapresantaGoris given in paragrra-W5 by,an iridepetdent profs sskstal civil engineer registered in it* state of Alaska. The Municfputi tp of Anchorage Is not responsible for emote or omissions In the professional engineorrs work. 7. ATTACHMENTS.- COSA ATTACHMENTS.- C Checklist X_ .., Nitrates Advisory Septic System Advisory. Afsenle Advisory Well Flow Advis" Other P.rigd Ri w'aMas ilY3ti.t1K - - _ Legal Descripmon: TALUS tAEEST fft BLOCK A. WEU„ DATA we" type PRVT It A: B. or C provide AWSfD # Elate completed 31 19!!_ Saniiasy sit {Y" Y Total depth 124,6 ft Cased to til ft. FROM A ELL LOG Date of test Static water level tN I production 12 . gpm. x. >a .a;r . Depression r if more than 1 septic system is on the lot: CASA Checklist # _..- of _- Structure served by this system ._ Welt Log (YIN) Y- pr (Y/N) Y Casing height (above ground),, Z _-,_in, AT INSPECTION id ---M— _- g.p.m. Date Installed 7ri!rA WELL ON LOT TO: err tankMft stationon -y W '3`i t Y foldony 'ifI lot"Ic sewer main -7V+ Sewer Iseptica Samoa kne 2v+ AmItmentareas W+ SEPMMOLDING TANK ON LOTTO: Manho WAccess (YN) _ Koh YW W a(amr levet at On _ dW a On Public sewer H t _ # Ii YWk tank 1804 MmuWatritriial excrete stir..- arm W in, ' •y= ! -s. r • a: ak 1 iia i ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: TALUS WEST SUBDIVISION LOT 4 BLOCK 5 PLAT 80-40 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the properly lines and no enehroachments exist other than noted. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 2015 JLS 1 2736 1 150243 O = FND I" IRON PIPE 13 = FND 2"x2" HUB �.� .. F . AL�s,�) *a?:' 49TH ................N -J ... . . h..:.... �..I.N L. SCHULLER: ~ 0 LS -10408 j 7 VAN 3p• 41- L R�IP�✓ NW d a x� rj o v 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE • _ DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services o 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 k:: ' � � � - o � HAA # 10—I LS 1. GENERAL INFORMATION Complete legal description Lot 4; S2ocfz 5; Tatu6 ae6.t Subdivision 01 Location (site address or directions) 11785 Witden.nea6 Property owner M.G.I.C. #3588261 Day phone Mailing address Lending agency Day phone Mailing address Agent 13ah.baAa Eawi.66e VISTA/SETTER HOMES 9 GARDENSDay phone 562-6464 Address 3000 C S'xeet #101 Anchorage- APasfza 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Xx 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 Xx 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. V91) Front MOA 021 5. 6. 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(s sa e, functional and adequate or the number o � row oms and typeof 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 S & S ENGINEERING Phone 17034 Eagle River Loop Road No. ft4 Address al..=- Alfaclka 455 Engineer's signature Date 'LIE -9 1 °2i'vtr "`4 a f d1 fi� DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: -� p F1 q SM ED+ Date 5/10 U lT1r 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 courtesyto 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. 72-M (Rev. 1/91( Back MOA #21 DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: -� p F1 q SM ED+ Date 5/10 U lT1r 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 courtesyto 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. 72-M (Rev. 1/91( Back MOA #21 Municipality of Anchorage Department of Health & Human Services Am HEALTH AUTHORITY APPROVAL CHECKLIST aM Legal Description: 444;Wwii5-7ilu< f✓st'-bA r 1 Parcel I.D. e)j '__7_C> 2 2 4 A. WELL DATA Well type _,51#09L -Fal If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) u Date completed 19� 3 Driller M.* t_JNA'; d iAL Total depth ! Z O Cased to I Z O. b I Casing height f .Z t Sanitary seal (Y/N) u Wires properly protected (Y/N) a FROM WELL LOG AIT IIySPECTION Date of test S - �, - �f c .�. t —A — Lu Static water level Well flow 12 9 -p.m -m; LU 9-P �' Pump level lam!( U Q lv SEPARATION DISTANCES FROM WELL TO: A + + Septic/holding tank on lot ©O f On adjacent lots O Absorption field on lot _ too t On adjacent lots __ too f Pubiiesewer mairip Public sewer manhole/cleanout e1l14 Sewer service line A) A Petroleum tank NowIJ LJgiver grw+afed -6 'T j WATER SAILIPL E RESULTS: Coliform s+< ct r2 Nitrate <�AGfol ry /.4I OtherbaFter[ah ePO i4 Date of sample: 18 _ S-�I Collected by: S If h ;AJ &-e- rNQ B. SEPT16/HOLDING-TANK DA¢� -... bate installed _ �o ` b - nk size Compartments Z Cleanouts (Y/N) _Foundation cleanout (Y/N)b--U--i4onePrassionlWN) High water alarm (Y/N) l Date ofRumping l.a 014 cfD Pumper_{ t HQAA! SEPARATION DISTANCES FROM SEPTIC/HOLDING TAlj�f%�O: Wells on lot / n0 t On adjacent lots Foundation ?.O "Topropertyllne 12 t Absorption field I P, ,i P Watermain/service line. t 0 -!- Surface water/drainage (DD fi 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) level at 'ftri13vW level at RCycles tested SEPARATION DISTANCE FROM LIFT STA Well on lot On adjacent TO: Surface water D. ABSORPTION FIELD DATA bate msiallgd Soil rating ?STS System type f��Nc �n Length _,o � Width 3 r Gravel thickness Total depth I � + i Total absorption area 13D 'i� Cleanouts present (Y/N) '•- •`Depressio_n'over field (Y/N) n) Date of adequacy test / 2 –041 q O i.,is `q_ -'Results (pass/fail) —T S 5 for bedrooms Peroxide treatment (past 12 months) (Y/N) __ If yes, give date — SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot nn �' On adjacent lots f 0 O t j Propertyline /d + To building foundation / o t To existing or abandoned system on lot ---A]r/ lel On adjacent lots 3b i Cutbank Watermain/sdgicelin'4 Surface water loo �f Driveway, parking/vehicle storage area 2 14 Curtain drain(R E. ENdINEER'S CERTIFICATION I certify that i have checked, verified, or conformed to all, MOA and HAA guidelines in effect on the date of this inspection. -� of A -`,q r, S & S ENGINEERING r �: Signature - • • *,�, Ease Rroer, Alaska 99577 +• Engineer's Name Date �. :• qoo J,SH rEF% F.B ®iFESS%r HAA Fee $ %a oa Waiver Fee: $ Date of Payment Y– /l/ – 9 Date of Payment Receipt Number 7–Z % 3 Receipt Number 72-028 (Rev, a191) Back MOA 21 r 5. LEGAL DESCRIPTION II DAl E RECEIVED INSPECTION APPOINTMEN Subdivision TIME TIME ! TIME - 6. TYPE OF RESIDENCE i / ® SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five DATE DATE r � ;/,' � DATE ® INDIVIDUAL* *ATTACH WELL LOG. Awell log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well 0 PUBLIC UTILITY INSPECTOR INSPECTO INSPECT,QR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHOPAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF Ty g 825 L Street - Anchorage, Alaska 99501 FNVIkOI`4MEN I •TACTION • ENVIRONMENTAL SANITATION DIVISION t,.11 2 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWAE)CC&J-VE� DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE Mac and Kathy Middleton 349-4656 MAI LI NG ADDR ESS PROPERTY RESIDENT (If different from above) // c !�: /ire-✓r7-*'Jf �i- PHONE (/...• ,C % �{� � �' 2. BUYER PHONE Bob L. and Sandra Weir 279-3511 MAILING ADDRESS P.O. Box 4-1598 AnChoracre, Alaska 99509 3. LENDING INSTITUTION PHONE First National Bank, South Center Branch (7,,gilla Flnri(9�) 265-1443 MAILING ADDRESS 36th and C Street Anchorage, , Alaska 4. REALTOR/AGENT PHONE Connie YOshi=a c REalty, Inc , 279-7611 MAILING ADDRESS 501 W. Northern Lights Blvd, Anchorage Alaska 99501 5. LEGAL DESCRIPTION Lot 4, Blk 5 Talus West Subdivision STREET LOCATION 11785 Wilderness Drive, Anchorage, Alaska 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ® SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY CA Three ❑ Six 7. WATER SUPPLY ® INDIVIDUAL* *ATTACH WELL LOG. Awell log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well 0 PUBLIC UTILITY depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM EX INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. 0 PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) } �Ix(E7 i J THIS SIDE FOR OFFICIAL USE ONLY ' 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ six 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE El PUBLIC UTILITY Connection Verified PERMIT NUMBER ; DATE INSTALLED INSTALLER Ell Septic Tankpr ❑Holding Tank Size: IfTank ishomemade 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 Cly -'APPROVED FOR � BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY 72-010 ( Rev. 6/79) in S p tPLi I j c� 1A I �. Ur, U KEWE:� 1,Y) WATE!, % Una M. Bennett 1. Lend in -1 Tn n r j oh ypqruns(,: First National Bank of Anchorage Post Office Box 4-2090 99509 274-1521/39 2, Propo-tv Qnen: Can de e Construction mailing Addirsi: Post Office Box 8442 99508 % Mark Karting, 274-4505 - -- - ------ I ---- - -- — ----- --- 3. Legal Descrintion: Lot 4 Block 5 Talus West Subdivision 4 : S ingle Fam i ly Pus id en ca : ( X) Numhor of Bedrooms: Two Multiplu "anily WasidencP: ( ) Number at Beicnams: 5. Well System: 1 oa i vidna I We! I ( N Cninmunil;y/Pnblic System Permi" DO!"n CE WOK Watl Log on Pilo Constructio,.-. Bactcrial Analysis 6. Sewage Disposal vywt("; On-sil-w Systu�i kx) Public Utilily 1 Dermi" , installad insual"er Septic Tan,, Manufacture,, AbsornKoa Ar,i r i a 7. Distances: woll to Sop! ic Tank Lo Ahsorption Area to Sewer LQ-, Ncn. I:'pnt Lot line Ahsorption Ai ca to Noarcsl- hot V;nw --- 0 ''CIPALITY OF 6w H25 1 Stran�, Ancnoranx . A Laska 9 9 3 0 251 -472t) Rec,jvcd, December 1977 at, -7 Time j Aw na t in S p tPLi I j c� 1A I �. Ur, U KEWE:� 1,Y) WATE!, % Una M. Bennett 1. Lend in -1 Tn n r j oh ypqruns(,: First National Bank of Anchorage Post Office Box 4-2090 99509 274-1521/39 2, Propo-tv Qnen: Can de e Construction mailing Addirsi: Post Office Box 8442 99508 % Mark Karting, 274-4505 - -- - ------ I ---- - -- — ----- --- 3. Legal Descrintion: Lot 4 Block 5 Talus West Subdivision 4 : S ingle Fam i ly Pus id en ca : ( X) Numhor of Bedrooms: Two Multiplu "anily WasidencP: ( ) Number at Beicnams: 5. Well System: 1 oa i vidna I We! I ( N Cninmunil;y/Pnblic System Permi" DO!"n CE WOK Watl Log on Pilo Constructio,.-. Bactcrial Analysis 6. Sewage Disposal vywt("; On-sil-w Systu�i kx) Public Utilily 1 Dermi" , installad insual"er Septic Tan,, Manufacture,, AbsornKoa Ar,i r i a 7. Distances: woll to Sop! ic Tank Lo Ahsorption Area to Sewer LQ-, Ncn. I:'pnt Lot line Ahsorption Ai ca to Noarcsl- hot V;nw N=aaP L � .L tIP.f'llt OC -'i i. ttl d - � ':11 i 07f aif :Ca.1 ro Le : 011 Lega L DeScri p t J )n Lot 4 Block 5 Talus West Subdivision offa da \ t A t achn � a ttcc Attached AppLove:i: ._. ----- Date I;iSa d P,epartm.cont i^'ark5teet: