HomeMy WebLinkAboutTALUS WEST #1 BLK 5 LT 8Talus W'
Block
Lot 8
#015-202-28
May 02 22 06:18p Anchorage Well & Pump Ser
9072430742 p.1
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: Date of Issue: _
Parcel Identification Number: 015 202 -2$
Legal Description
TALUS WEST#1
Block
5
Lot
8
Property Owner Name & Address:
MCCONKEY, ANTHONY D & MARGARET V
11745 WILDERNESS DR
ANCHORAGE, AK 99516
Pump Installation Date: 04 _ 28 _ 2022
Pump Intake Depth Below Top of Well Casing: 75
feet
RED JACKET
Pump Manufacturer's Name:
$S 1 2
Pump Model:
Pump Size: •50 hp
Pitless Adapter Burial Depth: 12 feet
CAMPBELL
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:
Well Disinfected Upon Completion? ) Yes ❑ No
Method of Disinfection: PELLETS
I Comments:
Pump Installer Name: _ ANCHORAGE WELL & PUMP SERVICE
7640 KING STREET
Company: ANCHORAGE, AK 99518
Mailing Address:
907-243-0740
State: Zip:
Attention: The pump installer shalt provide a pump installation lob to On-site within 30 days of pump installation.
' -~ MUNICIPALITY OF ANCHORAGE
- DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name A l"~r~Pc''~ DISTANCES
F ~ 0 M"~--~O SEPTIC ABSORPTION
Addre,s ~"Z-O E, ~ ~..'~ -~ TANK FIELD WELL
Phone(s} Permit No. No. of B~ooms WELL
~C~ ~IC Capacity in gallons
No. ot Compa~ments
~RENCH ~ BED g W. DRAIN ~ OTHER
Depth to pipe bottom ~rom Total depth from original grade ~ J
original grade ~ FT ~ FI
Fill added above original grade Gravel depth ~neath pipe
T°tala'orpti°narea~ 7SO ', FT Oistan"~woon~inos F'
Number ol lines J Soil rs,lng Pipe material
Installe~ Date Installed
Classification (A,B,C) Total Depth Cas~ to
REMARKS:
I ~Og~W ~ [ OF~ ce.llytMtlhisi~pe~onwaspedormedacc0rain~10all
~unicipal and Slate Duidelin~ in eflm on ~is da~ ·
72-013 (3/85)
Dat~ ] ...... Lied,
l'l L.t N I L. I P A L I "F Y 0 F A N C H 0 R A G El
Department o~ Health & Human
];i.J L. S't. peet.~ Ancher, ac~ Alaska 99501:~4-:~;-~_~""
0 N '- S I T E S E W E R P EE R M I T
9()(>095 bp g ~' ~d ~
05109/90 Engineep De~ igned
Ownep Addpess:
Pa!'~cel Id:
L.x~t Legal:
Lot Si~e
Ma),' Bed rooms:
A, H, F% C,
5;'~0 E. THIRI'YFOURT'H AVE.
ANCHORAGE;, AK 99503
() 15-...202-~8
Subd:i. visior): TALUS WEST Lot~ 8 Block~ 5 '
Section~ 22 Township: 12N Range: 3W
19200 (sq. ~'t. or ac~es)
This Per'mit: 3 'l"otal Capaci{y: :~
[)ay Phone:
56 J - 19 )0
,,~[.,.[ ~I.. TANK: Minimum total septic t. ank capacity: 1,000 gailons~ Each sept:Lc
tank must have at least 2 compap{ments. Depth te top of septic tank(s) <' 4.()
(ee'L peqLlires ' ~" ~ ~" ' -- .
INSTAL.L. PER ENGINEERS ATTACHED DE.~IGN. PROVIED ADDED SOILS 'TEST
"['0 CONFIRM SC)IL CONSITANCY. PROVIDE PERC 1'ESI" FOR GM SO]iLS
~-!~..C)W -6' NOTIFY DHIqS OF AhOY DES'IGN CHANGE.C.~--F'RIOR TO 'CONS~.
PROVIDE NATER BARRIER IN ORGANIC LAYEF~ ]"0 PREVENT SEASONAL. WA]'ER
ENCROL!CHIM.:LNr. THIS PERMIT IS ISSUED FOR THE E'.XISTtNG SIN(DL.E
FAMILV DWELL..ING AND EXPIRES ON ~',..'~/31/90.
[]ER'JIFY'
S i g ri ecl:
( O~,,~n e p )
Issued By:
THA[ .-
~:)~'Lh by the Municipality aF Anchorage (HOA) and the State of Alaska.
I ,4i]l.:l ins't, ai:L], the system :i.n accai-dance wi't.h all MOA codes and r'egulat. J. ons~
and in compliance ~:L{h th~ design c:r'itepia oF this permit.
! will adher-e to ali MOA and Sta~.e c~I Alaska r'equi~ements fop the set back
dis'Lances-~om any mx:~.sting well, was{ev~ateP disposal system c~r pub].ic
se~.~el'.age system cJn 'Lhis of any adjacent ap neapby lot.
I undel'stand that this pet-mi'L is valid Fop a max,.mum oF 5 bedr'oems. I
al. sci Ul"~depst:.~nd that {he cap.~ci~..y o( the to~.ai system is 3 bech"(aoms and
any enlai-gement will I'equir'e an additional pepmitL.
A. H. F. C.
r
i&
II --
l
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVIOES
-825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
4-
8
10
12¸
¸13 -
16-
17 -
18-
19
2O
COMMENTS P~'I~ C0 ~ 0 ~J
WAS GROUND WATER
ENCOUNTERED? ~ 0
iF YES, AT WHAT
DEPTH? pO
E
aeptl~ i. Water After? ~
Reading Date Gross Net Depth to Net
Time Time Water Drop
3-~o-fo I.'~-5"' It) .7 7 , o7
's-to-lo ~,'o~'- IO 237 ,0'7
"J-to-to z.'/~' lO . "'/7 .07
PERCOLATION RATE 7 (minutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEE' Z*_ FT AND "~ FT
PERFORMED BY:Iw~'~ ~e ~ t ~ ~ Ia'~[l~l ~ ~ ~1~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS CATE. DATE: ~ -- I -1 ~ ¢~ O
72-008 {Rev, 4/85}
DRILLING,
DRILLING LOG
Well Owner Buck Hight.
Use of Well Dom.
Location (address of: Township, Range, Section, if known; or distance main road
Lot 8, Block 5, Talus West
Size of casing 6" Depth of Hole ~01 ' feet Cased to 100' feet
water leve] 50 ft. ~ ~low) land surface. Finish of well (check one)
static
Screen ( ); Perforated
open end ( X );
Describe screen or
Well pumping test
of drawdown from
Depth in feet from
ground surface
O TO. 2
2 .TO. 5
(minute) for 1 hours with 100 %
WELL LOG
penetrated, size of material, color and hardness
Gravel
5 TO. 35
35 TO 55
55 _TO 75
75 TO 95
95 TO 101
.TO
_TO
.TO.
_TO
.TO
__TO_
TO -
.TO.
NWWA Certified Contracto~
Certificate No's. 8i4 &
BOR~GH
GREA"I'ER ANCHORAGE AREA
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCAT,ON b,-, 'EGA' DESCR,PT,ON
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
MANUFACTURER ~~
MATERIAL
INSIDE WIDTH LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY / 2- GALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL ?¢-~ FOUNDATION
NUMBER OF LINES / DISTANCE BETWEEN LINES
ABSORPTION AREA ~'~ ~¢~ /~
DEPTH: TOP OF TILE TO FINISH GRADE
/
! TOTAL LENGTH ,;.
NEAREST LOT LINE ~ OF LINES
¥-3
TRENCH WIDTH ~ /
IN. TOTAL EFFECTIVE
SQ. FT. LENGTH OF EACH LINE
/ DEPTH OF FILTER
A
~ MATERIAL BENEATH TILE
~' ~t~iN.._ABOVE TI LE ~lt' IN,
WELL:
TYPE_ CONSTRUCTION
BUILDING NEAREST NEAREST
FOUNDATION__ LOT LINE SEWER LINE
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TANK SYSTEM
CESSPOOL
OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES:
SEWER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
Form EQ-032 '
F'ERMI T NO.
HPPLICIRNT
LOCRTION
~HIRRI_ES HIGHT'
WILDERNESS DR~
L8 85 TIRLUS WEST SUBD
SRR E:OM 1586C
LOT SIZE
X4D-24D4
iD2~E SQUIRRE FEET
TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH
MIRMIMUM NUMBER OF BEDROOMS
SOIL RATING <SQ FT?BR)= 250
'THE REQUIRED SIZE OF ]'HE SOIL IRBSORPTION SYSTEM IS:
[:, E F"T' H == ::L4 LE ~--~GT H= -='~? G F-: Ft ",~" E L [:, E F'-IF H = 8
THE LENGTH DIMENSION IS THE LENGTH (I~N FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF ~ TRENCH OR PIT IS THE DISTIRNCE BETWEEN THE SURFIRCE OF THE
GROUND IRND THE BOTTOM OF THE EXCIR',/IRTION (IN FEET).
THERE IS NO SET [~IDTH FOR TRENCHES.
THE GRIRVEL DEPTH IS THE MINIMUM DEPTH OF"GRRVEL BETWEEN THE OUTFIRLL PIPE
AND THE BOTTOM OF THE E,w, CAVRTION (IN FEET).
EITHER tR CL. IRSS I OR It NSF tRPPROVED PLANT MIRY BE INST~LLED
R CONTINUOUS MAINTENANCE IRGREEMENT IS REQUIRED. IF R MRINTENRNCE
RGREEMENT IS NOT KEPT CURRENT YOU rMRy BE REQUIRED TO ENLRRGE THE SOIL.
RBSORPTION SYSTEM RND/OR YOU MRY BE SUBJECT TO PROSECUTION
IF R CLASS I SYSTEM IS USED THE LENGTH IS 2Z. 0 FEET
IF R CLRSS II SYSTEM IS USED THE LENGTH IS 4S 0 FEET..
-I-P.lC~ ( 2. ]:, I I'-.ISF'EE:T I ,],I-.IS FtF-:E F.:E¢.~iJ I RE[:.
BIRCKFILLING OF IRNY SYSTEM ~,~ITHOUT FINRL INSPECTION RND RPPROVRL BY THIS
DEPRRTMENT PIILL BE SUBJECT TO PROSEC:LITION.
MINIMUM DISTANCE BETWEEN R WELL RND ANY ~N-SITE SEWRGE DISPOSAL SYSTEM IS
±00 FEET FOR R PRIVRTE WELL OR 200 FEET FOR ~ PUBLIC NELL.
WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS
OF THE WELL COMPLETION
SF'ECIFICIRTIONS RND CONSTRUCTION DIAGRAMS RRE-RVRILRB~E' TO INSURE PROPER
INSTRLLRTION. '
F'E]F-:~,I ][ ]- "~-"RL I [) FC, R .OI'-.tE b'ERF-: FR,]I'-I I _SLSLIE
I CERTIFY THIRT
i I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH 8Y THE MUNICIPALITY OF BNCHORIRGE.
2: I ,,IILL INSTFILL THE SYSTEbl IN. FtCCORDIRNCE WITH T~E CODES.
2: I UNDERSTBN[:, THAT THE ON-SITE SEWER SYSTEM MB9~RE~ZLIIRE ENLBRGEMENT IF THE
RESIDENCE IS R. EMODELED TO INCLUDE MORE THAN 2:.BED~0OMS. /
Y
Municipality of Anchorage
Development Services Department
Building Safety Division
Om,Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99519-6650
www. cLanchorage.ak.us
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-202-28
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
TALUS WEST ¢1; BLOCK 05, LOT 08
11745 WILDERNESS AVENUE *ANCHORAGE, AK 99516
RON & KANDIS MORRIS Day phone
11745 WILDERNESS AVENUE *ANCHORAGE, AK 99516
.517-0915
Day phone
BETH SIMPSON W/KELLER WILLIAMS Dayphone 865-6556
Un/ess otherwise requested, COSA will be held by DSD for pickup.
2. NUMBEROF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well [] Individual On-site []
Individual Water Storage [] Individual Holding tank []
Community Class Well [] Community On-site ~' []
Public Water System [] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewatar disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/?r 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.
NameofFirm GARNESS ENGINEERING GROUP, Ltd.
Phone 557-6t79
Address 3701E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date
Engineer's Comments:
In conducting this evaluation, GEG, LtD, attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance tithe
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of afl wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and lhe water usage of the family being se~/ed by the system.
These conditions are outs/de 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 or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
(// Approved for
bedrooms.
Disapproved.
Conditional approval for
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
(Rev. 11/05)
bedrooms, with the following
Arsenic Adviso~
Maintenance Agreements
Supplemental Engineer's Repo~
Other
Original Cedificate Date: ~,,/~///"~ ~--
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak, us
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description:
WELL DATA
Well type PRIVATE
Date completed 9/27/1976
Total depth 101 f.
TALUS WEST #1; LOT 08, BLOCK 05
ParcellD:
015-202-28
IfA, B, orC provide PWSID~ N/A Well Log (Y/N)
Sanitary seal (Y/N)_YES Wires properly protected (Y/N)
YES
YES
12+ in.
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Cased to lO0 f. Casing height (above ground)
FROM WELL LOG AT INSPECTION
9/27/1976 4-/11/2012
5O fl. 50 ff.
20 .g.p.m. 7.$1 g.p.m.
Coliform ~ colonies/100 mi.
Arsenic: ~'/~) ugJl_.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Matedal SEPTIC/STEEL
Tanksize 10oo gal. Number of Compartments __
Foundation cleanout (Y/N) -
Date of pumping 8/18/11
C. ABSORPTION FIELD DATA
Date installed 7/lO/~99o
Length 65 f.
Nitrate I. ~,...A mg./L.
Date of sample: 4/11/12
~ L~.'~,:~¥~,~ ,,, ~-¼~
2
Dep~ion over tank (Y/N) NO
Pumper
~BELOW EXISTING GRADFI
Soil rating (g.p.d.~20r(~) 225
Width U N K ff.
Collected by: OEO, Ltd.
Date installed. 7/10/1990
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
A+ HOME SERVICES
Totaldepth 13.25 ff. Elf. absorption area 780 ft~ Monitodngtube YES
Date of adequacy test 4/11/2012 Results (Pass/Fa/I) PASS
Fluid depth in absorption field before test 4.9.5 in. Water added 910 gal.
Elapsed Time: 120 min. Final fluid depth 66.5 in.
Any rejuvenation treatment (past 12 mo.) (YIN & type)
**WATER LEVEL AT INVERT
System type TRENCH
Gravel below pipe 6 .ff.
Depression over field NO
For 3 bedrooms
New depth **76.5 in.
Absorption rate >= 450+ g.p.d.
NONE KNOWN If yes, give date -
D. LIFT STATION
Date installed.
"Pump on" level at
E. SEPARATION DISTANCES
Size in gallons ~ ~ ~
~ High watar alarm !evel at in.
------- Cycles tasted Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
100'+
Septic tank/lift station on lot
Absorption field on lot- 100'+
Public sewer main N/A
Sewer/septic service line 25'+
Animal containment areas. 5o'+
On adjacent Iota 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
N/A
100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field.
Water main N/A Water service line. 10'+ Surface water_
Wells on adjacent lots 100%
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main
Water service line 10'+
Curtain drain NONE KNOWN
5'+
100'+
Surface water 10o'+
Wells on adjacent lots. lOO'+
N/A
Driveway, parking/vehicle storage
10'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I corlffy that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. OARNESS
Data
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/o5)
Waiver Fee $
Date of Payment
Receipt Number.
Parcel I.D.
Municipality of Anchorag
Development Services Department
Budding Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O, Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Day phone 348-7254
COSA #
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Lot 8 Block 5 Talus West #1
Location (site address) 11745 Wilderness Drive, Anchoraqe, AK 99516
Current Property owner(s) Victoria & James Rudd
11745 Wilderness Drive, Anchorage, AK 99516
Mailing address
Lending agency '
Mailing address
Real Estate Agent
Mailing Address
Day phone
Hutton Brown/Prudential Jack White Day phone 830-0277
Unless otherwise requested, cOSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class __ Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank
Community On-site
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of 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 Pannone En.qineerinq Services, LLC Phone 272-8218
Address P.O. Box 102954, Anchorage, AK99510
Engineer's Printed Name ~__~---Eco~/~CCou.-~-(-Jv~-C' Date
Engineers Comments: In conductiug an adeqnacy test, ! attempt to proYJde a thorough, coosalentions engine~ing analysis of thE system in
accordance with MOA DSD Guidelines & Regulations. The reported results describe 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 of all wells and
septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the fmnily
being served by the syste~n. These conditions are outside the control of the evaluator of this system. A~![ systems eventually fail tu~d
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that ithal'e are no hidden defects or
encroachments. PES can therefore not provide any warranty for ~ture performance nor give any
continue to meet the operational requirements of the MOA DSD. The content of this
Any reliance upon or use of this report by any other person or party
5. DSD SIGNATURE
C//' Approved for ~_~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the followi
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
(Rev. 11/05)
Original Certificate Date: ~' - ~" (~ ~
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Sita Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Well type P
Date completed 912711976
Total depth 101 ff.
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0 colonies/lO0 mL
Arsenic: ~J~) mgll
SEPTIC/HOLDING TANK DATA
Lot 8 Block 5 Talus West #1
IfA, B, or C provide PWSID # __
Sanitary seal (Y/N) Y
Cased to 100 ft.
FROM WELL LOG
912711976
50 ft.
20 g.p.m.
Nitrate 1.78 mgtL
Date of sample: 7113106
Tank size 1000 gal.
Foundation cl~anout'(Y/N) _Y
Date of pumping 7112/2006
C. ABSORPTION FIELD DATA
Tank Type/Material AnchoraRe Tank Steel
Number of Compartments 2_
Depression over tank (Y/N) _N
Pumper A+ Home Services
Parcel ID: 0/,~'~' 0,.2_. -~,.¢-~
Well Log (Y/N) Y
properly protected (Y/N) '¥
Wires
Casing height (above ground) 24 in.
AT INSPECTION
711312006
45 ff.
7.3 g.p.m.
Other bacteria 0 colonies/100 mL
Collected by: Laura Pannone
Date installed 711011990
Cleanouts (Y/N) Y
High water alarm (Y/N) NIA
Date installed 711011990 Soil rating (g.p.dJf~ or ~tbdrm) 225 System type Trench
Length 05 ff. Width 2,5-3.0 ff. Gravel below pipe 6
Total depth 13.25 ff. Eft. absorption area 780 ~ Monitoring tube Y Depression over field _N
Date of adequacy test 711312006 Results (Pass/Fail) Pass For_3 bedrooms
Fluid depth in absorption field before test 6_0 in. Water added45~7 gal.
Elapsed Time: 1440 min. Final fluid depth 60 in. Absorption rate >= 450+
Any rejuvenation treatment (past 12 mo.) (YIN & type) No
ft.
New depth72 in,
g.p.d,
If yes, give date
Date ~stalled Si~., Manhole/Access (Y/N)
"Pump on" level at ' .,j~"l~ off" level a~water alarm level at
Datum./~ Cycles tested Meets~s?
E. SEPARATION DISTANCES
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 104
Absorption field on lot 102,5
On adjacent lots 100+
On adjacent lots 100+
Public sewer main 100+
Public sewer manhole/cleanout 100+
Sewer/septic service line 25+
Holding tank 100+
Animal containment areas 100+
Manure/animal excrete storage areas 100+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 48
Water main 100+
Property line 40
Water service line 25+
Absorption field 10+
Surface water 100+
Wells on adjacent lots 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 16
Water Service line 25+
Building foundation 58
Surface water 100+
Water main 100+
Driveway, parkingA/ehicle storage 30+
Curtain drain None Observed We{{s on adjacent lots 100+
F. COMMENTS
Althouqht the system reached capacity durinq the test, no water stood in the cleanoats. Thisbe/stem is 5/6 used.
G. E.,.EER S CE.T,F,CAT'O"
review of Municipal records that the above systems are in
Engineers Printed Name ~-,. ~c.z:~ ~/'~.r'Z3~"~ ~L,~ '
Date ~/~/0 ~
COSAFee $ d5
Date of Pa,ment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Parcel i.D. #
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
RECEIVED
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Day phone
2?/- g6 e
Lending agency
Mailing address
Agent
Address
Day phone '~"-'
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
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 V/~
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.
72q325 (Rev. t/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 Phone
Address
/
Engineer's signature
DHHS SIGNATURE
' ~"~ Approved for J~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
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 DH HS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements, Em ployees 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.
MUNICIPALITY OF ANCH~.~GE
Municipality of Anchorage ENVIRONMENT.~,L SERVI,/~jjJ~ON
DEPARTMENT OF HEALTH & HUMAN SERVICES SEP 1 8
Environmental Services Division
825 L Street, Room 502- Anchorage, Alaska 99501. (g07) 343-/~'~flC E I V E D
Health Authority Approval Checklist
Legal Description: /~5
A. WELL DATA
Well type
Log present(~)
Total depth
Sanitary seal (WN)
IfA, B; or C, attach ADEC letter. ADEC water system number
Date completed c~_ ~ ~ _ c~ 6
Cased to I O ~ ~ Casing height (above ground)
~ Wires properly protected ~/N)
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform (~
Date of sample:
FROM WELL LOG
AT INSPECTION
Collected by:
oO'
hO g.p.m.
Nitrate ~ z~.-~' ~,(~-
Other bacteda (~
B. SEPTIC/HOLDING TANK DATA
Date installed 6/c~o Tank size J(~)~ Number of Compartments
Foundation cleanout (Y~ Cr/O O~Uy Depression (Y/~
Date of Pumping ~1,0f~ Pumper
C. ABSORPTION FIELD DATA
Date installed ~(~0 Soilrating (g.p.d./fFor~m) mg~ Systemtype ~ F/~rgc~L
~H'~-~$. % -~ % ~
Length &~ ~ ~. Width ~,[ ~0 Gravel thickness below pipe ~ / Total depth J~ ~
Effective absorption area ~0 ~F~Uonitoring Tube present ~) ~ Depression overfieJd (Y/N) ~ ~
Date of adequacy test ~ ~H -~ Results (~Fail) ~ For ~ bedrooms
Fluid depth in absorption field before test (in.); ~ '~ Immediately affer~?~ gal. water added (in.): g~ ~A~
Fluid depth ~ (ins) Minutes later: I~ ~lp Absorption rate = ~f _g.p.d.
Peroxide treatment (past 12 months) (Y~ ~ Lt ~%~ If yes, give date ~/~
72-026 (Rev. 3/96)*
Sizein gallons J
Manhole/Access (Y/N)~~ "Pump off" level at*
High water alarm level a[..~~--~ *Datu--rn~
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELLON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line ~ .~ ~'~
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout ~'//~
Lift station
SEPARATION DISTANCES FROM SEPTIC~ ON LOTTO:
Foundation lO r~ Property line /C~ '~ Absorption field /~ ~''
t
Water main/service line JO ~ Sur[ace water/drainage ICY-) ~ Wells on adjacent lots ./o ~ ~-/.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line I0 '~ Building foundation /0 ~/- Water main/service line
Surface water ~r-bO ~ Driveway, parking/vehicle storage area
Curtain drain
Wells on adjacent lots
ENGINEER'S CERTIFICATION/,~
i ceaSe,hat i have d.
in conforrnanc~th~ )A/~gu~ :lelines in eff~t on this date.
Signature ~ ~~
~nglneer s mama/ ~ -/ [,'
Date ~/171 ~
HAA Fee $. ~ ~
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev, 3/96)*
Attaska Water & Wastewater
8471 Brookridge Drive - Anchorage ~ Alaska 99504
Phone (907) 337-6179 ~ Fax (907) 335-3246
Consulting Engineers
September 17, 1997
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O, Box 196650
Anchorage, Alaska 99519-6650
Subject: HAA for Private Well & Septic System. Lot 8, Bk 5, Talus West
To whom it may concern:
The subject lot has a 3 bedroom house on it which is served by a private well and septic system.
The results of the field investigation and adequacy tests are summarized as follows:
A. WELL: The static water level on 9/4/97 was 49' BTC. Water was pumped from the well at
an average rate of 7.23 gpm for a total of 199 minutes (1440 gallons). The level in the casing
dropped 1 foot, during the first 5 minutes of pumping, and stabilized at that level throughout the
rest of the test. Based upon this data, it can be concluded that the capacity of the well exceeds
the Municipal requirements for a 3 bedroom house (.31 gallons per minute), and will continuously
produce greater than 3 gallons per minute (as required for FHA financing).
B. SEPTIC SYSTEM ADEQUACY TEST: The drainfield was installed in 1990. It is 65 feet
long, 30 inches wide (assumed), and has an effective depth of 72 inches. The total absorption
area is 780 square feet. According to the homeowner, the house had been vacant since the date
the tank was pumped (7/10/97). On the day of our inspection, the tank was full, and the trench
had 41 inches of water in it. It was noted that water was running into the system even though the
house was vacant, which lead us to conclude that there was a plumbing leak. Later, the
homeowner found that one of the toilets was continuously leaking. In short, the plumbing leak
helped ensure that the drainfield was continuously receiving water during the period that the
house was vacant.
Water was introduced into the trench, at an average rate of 7.26 gpm for 109 minutes (792
gallons), which caused the liquid level to rise 22.5 inches, to a total depth of 63.5 inches. The
last 544 gallons introduced only caused a rise of 12 inches in the monitoring tube. Twenty-five
hours later the water level had dropped 11.5 inches ( 4 inch drop in the~,4~t~a~inutes!)
i~uNtC, IpALI~ ur
ENvI~O~ S~VICES DiVISiON
indicating that 521 gallons had been absorbed. This corresponds to an absorption of
approximately 500 gallons per day. In addition, the system absorbed all of the inflow from the
toilet leak. During the adequacy test, the trench was only filled to 83% of its capacity. In short it
could have been filled to a greater depth, and a higher absorption rate achieved. Based upon this
data, it was determined that the absorption rate of the trench exceeds 450 gallons per day, as
required for a 3 bedroom house.
NOTE: The adequacy of a septic system is influenced by numerous factors, including, but not
limited to, seasonal surface water infiltration, groundwater variations, septic system
maintenance (frequency of septic tank pumping, usage of biological additives), condition of
drain pipe and pipe joints' (which can be damaged by seismic activity and deteriorate with age),
~ype of substances deposited in septic system (cigarette butts, sanitary napldns, misc. objects),
and the amount of water being introduced on a continual basis. Consequently, the results of this
adequacy test are only valid for the specific day of the test. Furthermore, because of the limited
nature of this investigation, it is possible that there are hidden defects which may not have been
detected No warrantee is made regarding the future performance of this well or septic system
If you have any~questions, please contact me at 337-6179, 244-9612, or on my digital pager at
1-800-481-116~:t Thank you for your assistm~ce.
S'~,ly,f?~/ 1
c.c. Sharon Warren
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D, #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
/
Location (address or directions)
(b) Property owner
Mailing Address
Telephone: (home) ~ I~l ¢L u u Business
(c) L e n d i n"~r11~stj~ u t i o n Telephone
Mailing Address ~
(d) Real~--'Cat.~..Oompany and Agent
Address ~
Telephone
Mail the HAA to the following address: (or check here j~.if hold for pick up.)
List contact person and day phone number below:
(e)
2. TYPE OF RESIDENCE
Single-Family ¢~ Number of bedrooms
3. WATER SUPPLY
Individual Welll~- Community[] Public[]
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site~ Public [] Community [] Holding
Tank
[]
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th is
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 flies 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 ~--~ ~_ L:--k~C_---L. t~l~ ~-~._,1./¢(~. Telephone ~]'-~--I I~)
Address
Date
6. DHHS APPROVAL b ~'¢..~..,/~.
Approved for '~ bedrooms
Approved Disapproved Conditional
Terms of Conditional Approval '/'L'Y~
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph $ 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 order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The M u n ici pality of Anchorage is not responsible for errors or om issions
in the professional engineer's work.
Page 2 of 2
A. WELL DATA
Well Classification
Well Log Present (Y/N) ~// Date Completed
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description:
If A, B, C, D.E.C. Approved (Y/N)
~. °t '-~ (-~Yield ,.~--Jr'- ~ ~ ,-~
Total Depth [ O\ Cased to
Static Water Level ...
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results ~0 ~.~'L/~"-~ ~t~
Comments
Depth of Grouting
Pump Set At Ut ~ t~.
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots [ ~
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
;Date ~/I"Z../~O
B. SEPTIC/HOLDING TANK DATA
Date Installed ~ [ ~o Size
Standpipes (Y/N) "'/' Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well [, 0 ~
To Property Line
To Water Main/Service Line °~
To Stream, Pond, Lake or Major Drainage Course "~
No. of Compartments
~ Foundation Cleanout (Y/N) "/
Date Last Pumped
;for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date installed (~ / ~o
Width of Field --
_~- ~--~' Type of System Design
Length of Field ~ .~'
Depth of Field ~
Gravel Bed Thickness ~
Statndpipes Present (Y/N)
Date of Last Adequacy Test
Square Feet of Absortion Area ~ ~ O
Depression over Field (Y/N)
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well [ o ~--
To Building Foundation ~-' o
Lot 2- 7__
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Y
To Property Line ! (~
To Existing or Abandoned System on
; On Adjoining Lots "2 t ~ ~,
c/. o TO Cutback (if present) ~.r / ~
D. LIFT STATION
Date I n stalled
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical
Comments
Dimensions
Manhole/Access (Y/N)
"Pump
~--"~ent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
all MOA and HAA guidelines in effect on the date of this
inspection.I certify that I have checked,~verified, or. ~- /~ conformed to
Signed
MOANo. ~-~ ~ ~0 ~ 4:~ 0
Receipt No. ~
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
, APPLICI~IT FILLS OUT UPPER HAI.~ONLY
Ma?ing Address -' Zip Code
' ' ~ " Phone
~°mmunity For wells drilled prior to that date, give well depth (attach log if available).
Individual Year Individual Installed: ~
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes: [~ MUNICIPAUTY OF ANCHORAGE
~ DEPT. OF HE/',LTH
.(~.~__ (~ ~ ~,~_ ENVIRONMENTAL PROTECTION
RECEIVED
( ~ APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
( ) DISAP~OV~D
( ) CONDITIONAL APPROVAL*
DATE ~
Soils Rating Date ~wer Installed Well TO Absorption Area Well Log Received
~ -- ~ ~ Well to T~nk Septic T~k Size ~
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
3. Legal Description:
4. Location:
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received December 20, 1976
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
12-20-76 Monday
Pratt
Conv.
United Bank of ~laska
645 G Street
Dan O. Powell
Star Route A Box 1586B
Lot 8 Block 5 Talus West
Phone:
Phone:
278-9526
344-5001
Type of facility to be inspected Single Family
Well Data:
A. Type Individual
C. Construction
Sewage Disposal System:
A. Installed
C. Septic Tank: 1. Size
Ho. of bedrooms
B. Depth 94'
D. Bacterial Analysis
On-site system
B. Installer
2. Manufacturer
D. Seepage Pit:
E. Disposal Field: Total
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
1. Absorption Area
length of lines
2. Material
, Absorption area
, Other contamination
, Absorption area
C. Absorption area to nearest lot.line
3
, Sewer Lines
EQ-034 (1/74) Pa~e 1 of two pages
Page 2 of two pagbs -
Legal Description ~,ot 8
for Approval of Individual
Block 5 Talus West
& Water Facilities
Comments
Approved x-~~~, /~. Disapproved · Date /-
] Approval ~Valid for one year from date signed
X-Greater Anchorage Ar~aBorough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the infomation contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ-034 (1/74)