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Home My WebLink AboutTALUS WEST #1 BLK 5 LT 9(Taxa bt6k n 1 Pcsa &Ott 5 k ael 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: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. . Municipality of Anchorage Page_ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage; Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~,~1~ q~O0"7/ PID Number: (~ ~--~)~ Name~/~/~ Wastewater System: ~ New ~pgrade Phone: NO. Of Bed~ms~ ~Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other Total Depth from original grade: Block: Su~iv' 'on: Lot: ¢ ~ ~, ~;/ ~ / Depth ,o pipe bottom from original grade: Gravel depth beneath Number of lines: Distance between li~es: WELL: ~ New ~ Upgrade Gra~¢ width: ~ ~t. / Yield: Pump ~t at: ~ Casing Heighl Above Ground: TANK GPM SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P. , , ,alefia,: ~ ./ Number of Compadments: ~ ¢ "Pump on" level at: ~ level at: High water alarm at; Cuflain ~ , Pump ~1 Electri~l Inspections pedormed by: Remarks~o/~ ~ ~[~ BENCH MARK Bepadment of Health and H.ma. ~e~mes approva~ '~;'~"', Reviewed and approved by:~ Date: ~'fl.~8 AS-BUILT SYSTEN DETAILS/SITE PLAN Permit TALUS WEST'S/]} Mi, LOT 9, BLOCK 5 PID:~O15-aO2-29 / / / AZF/ ~ / SEPTIC A ~AN~ ~EWER ROCK ~>__~. PREPARES FOR, ~ ~ssIO CRm: .... ~ ~LT~. FINAL GRADE ~ooo GAL [ SEPTIC I\ ~ ~n TANK '~, SEVER ROCK El] & PAT CERNEY 11735 WILDERNESS DRIVE ANCHORAGE, ALASKA 99516 ~ ENGINEERIN~ sr^x,~: WILSON ~[c~<~m KMD 20441 PTARMIGA~ 'BLVD. *SBU,~T: wlksou ~m~: 5/3~/~e EAGLE ~IVEg,. ~K'?0O577-g730~ 2736 ::::::::::::::::::::::::::::::::::::::::::: ::Il mL~: OaOOT.DWG sob .o.: g8007 (907)696-6111dr~ (gOT)8gs-8in PAGE 10~ 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW980071 DESIGN ENGINEER:KND ENGINEERING OWNER NAME:CERNEY EDWARD J & PATRICIA A OWNER ADDRESS:il735 WILDERNESS DR ANCHORAGE, ALASKA 99516 DATE ISSUED: 4/22/98 EXPIRATION DATE: 4/22/99 PARCEL ID:01520229 LEGAL DESCRIPTION: TALUS WEST #1 ~LK 5 LT 9 LOT SIZE: 18521 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY~--~"~ ~ DATE: 'XND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 March 30, 1998 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Talus West Subdivision #1 Lot 9, Block 5 - Septic Upgrade Permit Gentlemen: Following a request from the owner, we conducted an investigation of the existing septic system for the subject property. The observations in the monitoring tube showed the effluent above the lateral and in failure. The owner requested we proceed with a three bedroom upgrade of the septic system. On March 23, 1998 we dug two testholes for the proposed upgrade. The results of this test are attached. The lot is served by individual well which was tested and met minimum municipal requirements. The proposed upgrade system will be placed approximately 10' north of the existing system. The new tank will not require a waiver and will be placed outside the existing well radius. As indicated on the site plan the system can be served by gravity. The existing tank will be abandoned in place, a diverter may be installed so the existing field if possible. This will be identified on the as-built. Due to the depth of the field, additional gravel will be placed in the field for construction purposes, but will not be considered with regards to adsorption purposes. As indicated by the site plan drainage arrows, natural drainage is away from this site and will be maintained after construction. There is no surface water within 100' of the proposed installation. There are no known curtain drains within 50' of the proposed installation. No public or private wells exist within 200' of the proposed installation excepted as noted on the drawing. This upgrade should have no adverse effect on development of adjacent lots. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, attachments: On-Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test SYS.TEM TALUS WEST S/~ SUNSTBNE AS-BUILT LOT 11 LOT 18 LOT LOT 10 DETAILS/SITE PLAN ~1, LOT 9, BLOCK 5 .DT 14 LOT 6 LOT 7 K D LOT 89 LOT 3 LOT 8 LOT 4 LOT 5 LOT 6 DESIGN DETAILS LOT 30 3 BDRM X 150 GPI) = 450 GPO 450 GPD/1.8 GPO PER SQ, FT. = 375 SQ. FT 375/(59) X O.58(RF) (3,0' GRAVEL) = 43.5 FT. TRENCH Total depth o? system Is 15.0' ?rom original grade. Total depth oE e??ective gravel below distribution pipe is 3.0' , NOTES: 1. USE 1000 GALLON SEPTIC TANK, INSULATE TANK IF <4( COVER. 8. INSULATE TRENCHES WITH 8' HD I)URIAL FOAM., 3. CONTRACTOR WILL ENSURE MAXIMUM 8% SLOPE INTO SEPTIC TANK. 4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE MIN. 3' COVER IF REQUIRED. 5. CDNTRACTDR TO ABANI)ON TANK a FIELD IN PLACE. PREPARED FDR~ ED 8, PAT CERNEY 11735 WILDERNESS DRIVE ANCHORAGE, ALASKA 99516 F1ELO BOOKS c~Pu~: ~Ki~D ENGINEERING "~i:~;~'~;'-"~]~' ......... ~.;~-~'~'~ ................. 20441 PTARMIGAN BLVD. ^StlUII_T: WILSON o~m 3/30/98 EAGLE RIVER, AK 99577-8736 ~:~:~:ii~i!:!i:!:i!.~!!.~!:F~!~!~:.:.::.:~:~:.:.:~:~7~:::':]~:?~:~:~::::~:5!::,:~:~:~:~ T>w~. ~z.: omo: 2'736 ^c,'..o a~, 98007.DW0 ~"°" 98007 Ig071696-6111/FAX ~907/696-8111 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage. Alaska 99502-06,50 SOILS LOG -- PERCOLATION TEST 5 6 7 8 9 10- WASGROUND WATER ENCOUNTERED? 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- 57 ~ , s ,. ','ES. ATWHAT /~,A' O~ DEPTH? p E COMMENTS Township, Range, Section: Oeplh ~, Waler Alter Th.. Mo.ilori.g? ~ DaI~ ~L~-~:-~ Gross Net Depth to Net Reading Date Time Time Water Drop ? ~ ~: 5~ -- '1o,.. ,_ pERCOLATION RATE ~' '~ [mmute,s/~nch) PERC HOLE DIAMETER TEST RUN BETWEE. N ~:~ "T AND 7 FT ACCORDANCE WiTH ALL STATE AND MUNICIPAL--G[ ES . 72q308 (Rev. 4/85) Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST WASGROUND WATER CZ. E.COU.TE.ED, IF YES, AT WHAT DEPTH? 4- 5- 6 7 8 9' 10- 13 15 16 17 18 20- Oepth to Waler After Monitoring? Reading Date Gross Net Depth lo Net Time Time Water Drop PERCO,ATION RATE ~r ~ Im,nutes/)nch) PERC HOLE DIAMETER _ ~' '~[ TestRDnREtwEen ,/'~-- ~tanD /~ / ACCORDANCE WITH ALL STATE AND MUNICIPA'¥421UIDELINES IN EFFECT ON THIS DATE. DATE: 72-0~8 (Rev, 4/85) Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-06,50 SOILS LOG -- PERCOLATION TEST 2 3- 4- 5- 10-- 11 12 13 14- 15- 16- 17- 18- 19- 20- WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? DATE PERFORMED: Township, Range, Sect,on: 5~- SLOPE SiTE PLAN E Oeplh Io Waler Alter Monilori~9? Gross Net Depth to Net Reading Date Time Time Water Drop ~ ~-z~-'t,~ 5':,/5 /D" ~ ~;~/~-,", ff ~ ,~'~ /~ ",, PERCOLATION RATE /'~' ~ (m,nutes],nch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ T AND / t~ FT ACCORDANCE WITH ALL STATE AND MUNICIPA~/U L ES - E: 72-008 (Rev. 4/8,5) 1 2 3- 4- Municipality of Anchorage SOILS LOG -- PERCOLATION TEST 6- 7 8 9 10 WAS GROUND WATER a/~ ENCOUNTERED? 11 12-- 13-- 14 IF YES, AT WHAT DEPTH? Oeplh to Water Alter Monitoring7 15 16 18 19 20 COMMENTS .~r') ./~,~ Township. Range, Section: 5.~4'~'' / SLOPE SITE PLAN I S E Gross Net Depth to Net Reading Date Time Time Water Drop I ~-z~-?~ /,'so ID" ~ 7.'~7 , . ~ '/4" ~/~ PERCOLATION RATE ~' ~' [rnmutesYinch) PERC HOLE DIAMETER TEST RUN .ETWEE" /¢ FT^ND t.¢ PERFORMED BY: ,A*//L'/'~ ~,~z~c~-~f'''&'/~t~ , ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPALL~UIDELINES IN EFFECT ON THIS DATE. DATE: 72-005 (R~. Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 NAME INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION SEPTIC TANK: DISTANCE FROM WELl ~'$ INSIDE LENGTP MANUFACTURER IAL NSIDE WIDTH LIQUID DEPTH NUMBER DF ~ ~--z~¢~_~ COMPARTMENTS / ~ LIQUID CAPACITY GALLONS. TILE DRAIN FIELD: D STANCE FROM WELL / / TOTAL LENGTH ¢~' / FOUNDATION NEAREST LOT LINE /~;~ ~"- OF LINES NUMBER OF LINES ~ DISTANCE BETWEEN LINES TRENCH WIDTH ~2 IN. TOTAL EFFECTIVE '~'~/ SQ. FT. LENGTH OF EACH LINE ~/ , DEPTH OF FILTER ?~._ ~/~ '/ MATERIAL BENEATH TILE ~ IN. ABOVE TILE IN. ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE WELL: TYPE CONSTRUCTION DEPTH DISTANCE FROM: NEAREST NEAREST SEPTIC~, ~..-~ SEEPAGE -' LOT LINE ~-~-'~' SEWER LINE TANK O'a SYSTEM BUILDING FOUNDATION __ CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: SEWER _INE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS: DATE~ ~D~AM OF SYSTEM APPROVED G.A.A.B. Form EQ-032 F'ERM I T DEF'RRTMENT OF HERLTH FIND EN,/IRGNMENTRL F'ROTECTION 25&6 E. TUDOR RD.. RNCHORRGE, RK. 99587 276-222:2 76725 ) MFFLI ¢HN ~ LGE:FtT I ON LEGRL bHHRLE=, HIGHT LL~ E,._, TRLUS NEST :,UB[ SRR E,U,.., 2L._,_,6C. LOT SIZE · -'.49- -'-'.4 ~ 4 i,_,o~.i SLT.!URRE FEET T'T'PE OF =,LIIL HE:_,LIRE, FIuN =,T--,TEM I--,. TRENCH MR>::IMUM NUNBER i-iF BEDRCICIMS = _5: _~F~IL_ RRTING (SQ FT.E,R.- ~._~ ]"HE F(EglJIF..E[. _,I~E OF THE SOIL ABSORPTION -&--.TEN I_ THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETNEEN THE SURFRCE OF THE GROUND RHD THE BOTTOM OF THE EXCRVF4TION (IN FEET:). THERE IS NO SET WIDTH FOR TRENC:HES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETHEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE E>:',CRVRTION (IN FEET). F HL-I-.HL-~E F'LR[-~I- F.'E,~-!L! I F-:E[:. EITHER R CLRSS I OR II NSF RPPROVED PLANT MAY BE INSTALLED. A CONTINUOUS MRINTENRNCE AGREEMENT IS REC!UIRED. IF R flRINTENRN_.E' P RGREEMENT IS NOT KEF'T ..L[4RENT ~LLI MRY BE REQUIRED TO ENLRRGE THE SOIL B_,.RFTILN _,~TEfl RN[:,/OR YOU MR¥ BE SUBJECT TO PROSEZJ]'I]N IF R L. LH=,:, I _,9_,TEM IS U-C, ED THE LENGTH IS~_-.. ~:; FEET. IF A CLASS II =,~=rEM IS IJSED THE LENuTH I=, 42:. 0 FEET 'fl-,,-tC~ (: 2 1) :l ~4SPECT I u:~t~,,tS RI~:E F-:EQIJ I REED. 8RCKFILLING OF RN'9 _,~_,TErl NITHOUT FINRL INSPEC:TION RN[:, RF'F"ROVRL BY :'HIS [:,EPRRTMENT NILL E,E oUB..TEuT TO FRE~EuUFION MINIMUM DISTRNCE BETWEEN R WELL RND RNS' ON-SITE SEWRGE DISPOSRL SYSTEM IS ±F3E~ FEET FOR R PRI'¢RTE NELL OR 200 FEET FOR R PUBLIC NELL WELL. LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DR'SS OF THE WELL COMPLETION. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE 'TO INSURE PROPER I NSTRLLRTI ON. I _.EFTIF~ THAT 1: I RM FRMILIRR WITH ]"HE REOLIIREMENTS FIR UN-:.-ITE SENERS RND WELLSH=,-'- SET FORTH B'T' THE NLINICIPRLIT¥ ']F RNC:HEiRRGE 2 I NILL INSTRLL THE ~_TEfl IN RC:E:ORDRNCE WITH THE ]:GDES ]:: I LNDEF=,THNB THRT THE ON-SITE _,EWER S'¢STEM MFI'9 REE~UIRE ENLRRGEMENT5 IF THE RESI[:,ENCE IS REi~EE)ELE[:, TO INCLLIE)E MORE THAN ~ BEDRDChlS ' ~ ' S I GN~D: ................. I =,~LIED [:,RTE ................. ~'- ' .... ':~" -" TM 'W DRILLING, INC q~ · :'~, ~2~(~~''- - ' ' ~ · ' ~ DRILLING LOG Well O~er Buck Hioh~ Use of WeU ~,. Location (address of: Township, Range, Section~ if known; or distance main road Lot 9, Block 5, Talus West Size of casing (5" Depth of Hole 92' feet Cased to 91 ' . feet Static water level 55 ft.--~'~ land surface. Finish of well (check one> open end .(xx ); Screen ( ); Perforated ~ Describe screen or Well pumping test of drawdown from static Depth in feet' from ground' surface o TO 2 2 TO, 3 3 .TO. 50 50 .T0 75 75 .TO 85 85 .TO. 92 .TO. TO. TO TO , TO £ (minute) for 1 hours with 100~ WELL LOG penetrated, size of materiak, color and hardness Gravel 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 1. GENERAL INFORMATION Complete legal description HAA# ,~-~( \~¢'h, /:L\I~'! Location (site address or directions) //73~.-~ ~/~'_/r~;/¢/~,.¢.¢~* ~' Property owner ~/ ~./ /~/¢~;- Day phone Mailing address Lending agency Mailing address. Day ph~one Agent Address 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. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community Wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~25 IRev. 1/91) Fronl MOA#21 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 verifythat 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 compNance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm KND Engineering 2{;N41 Ptarmigan Blvd. Address Eagle River, AK 99577-8736 Date D~H~ SIGNATURE · Approved for-"~t~1'2C2~ ~_~.E __ 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. Employees of DH HS 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-O25 (Rev. 1/91) Back MOA #21 RECEIVED Municipality of Anchorage .... n c ~a~[J~ DEPARTMENT OF HEALTH & HUMAN SERVICES JUN v ~ ~{~ Environmental Services Division NtUNICIPALITY OF ANCIJ~r~J~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (9071)i,~~SERvlCEs DIVISION Health Authority Approval Checklist Legal Description: ~'~,'/~, _/.,b/~;/'*~/ ~',~,~ ~-/_p/~ ~ Parcel I.D.: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Casedto 9/ Casing height (above ground) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test ~-~-~ - ~' ,'~ -/7 ~ ~,~ Static water level ~",~' I .~:'~ ~- I Well production ~0 g.p.m. 7, ~ g.p.m. WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate /,/~.~///~/// Other, bacteria ,~" Collected by: (/b/J) Date installed --~--~ ~,~ Tank size /~)~ Number of Compartments '~ Cleanouts (Y/N) . Foundation cteanout (Y/N) y Depression (Y/N) /~/ High water alarm (Y/N) Date of pumping /[/"/~ Pumper C. ABSORPTION FIELD DATA Date installed ~'- -~ Length ~.~,_~ Width Effective absorption area Date of adequacy test Soil rating (g.p.d./fF or fF/bdrm) Gravel thickness below pipe Monitoring Tube present (Y/N) f Results (Pass/Fail) f ~-~ System type ~ ~, ~ Total depth Depression over field (Y/N) For ~,~ bedrooms Fluid depth in absorption field before test (~mmediately after gal. water added~ Fluid depth ~---('ff~inutes later: Absorpti g.p.d. Peroxide treatment (past 12 months) (Y/N) ~- give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* // *Datum Cycles tested / SEPARATION DISTANCES J 'Size in gallons / "Pump on" level at* ,~"Pump off" level at* 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/HOLDING TANK ON LOTTO: Foundation .~..~ z.y Property line /'~:~) ''~ Absorption field /'O /~ Water main/service line ,/~) z.,~ Surface water/drainage //~O '~: Wells on adjacent lots /'O,/~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line //D ! Building foundation f/--P/7z' Water main/service line Surface water //Q(~ z'F' Driveway, parking/vehicle storage area Curtain drain Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records in conformance with MOA HAA guidelines in effect on this date. Sign at u r~~~"~'~'~'~'~, Engineer s Name ~/~. _~.~ Date ~/~'~?'~ HAAFee ~ ~ ~'b(~, ~,._~ WaiverFee$ Date of Payment ~,j~-h (~ Date of Payment Receipt Number \ Receipt Number 72-026 (Rev, 3/96)* 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 February 28, Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. United Bank Alaska 1977 9:30 a.m. 3-1-77 Tues RCP 645 G Street Dan Powell Star Route A Box 1586-C Phone: 278-9526 Phone: 349-3494/344-5001 Lot 9 Block 5 T&~usb~est Subdivision No. of bedrooms 3 5. Type of facility to be inspected Single Fam~ily 6. Well Data: A. Type Individual C. Construction 7. Sewage Disposal System: On-site system A. Installed B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line B. Depth 100' D. Bacterial Analysis , Sewer Lines EQ-034 (1/74) Page 1 of two pages Page 2 of two page. s - t for Approval of Individual )r & Water Facilities %ega]'Description Lot 9 Block 5 Talus West Subdivision Comments Disapproved Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality Date DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO 2. Property Mailing 3. Name of Buyer: VA FHA CONV Mailing Address: Name of Lending Institution: Mailing Address: Day Phone:. 5. Name of Realtor or Agent: Phone: Mailing Address: Legal Description: Location: Phone: Type of Facility to be Inspected: ..~/~ No. Bdrms.---~' Water Supply Type of Supply: Public Utility Individual __ If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation ,~,,_~, Individual (on-site) D~PT, Oi' li'/J"~ L': ENVtRONMr-NI/',L ~'~0~I CTION FEE 2 8 ! 77 72-OO3(3/76) 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 January 3, Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF Pratt INDIVIDUAL SEWER & WATER FACILITIES FOR Cony. United Bank Alaska 1977 12-21-76 645 G Street Dan O. Pc~ell Star Route A Box 1586B Lot 9 Block 5 Talus West Phone: 278-9526 Phone: 344-5001 5. Type of facility to be inspected Single Family 6. Well Data: A. Type Individual C. Construction 7. Sewage Disposal System: On-site system A. Installed C. Septic Tank: 1. Size D. Seepage Pit: 1. Absorption Area E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank No. of bedrooms 3 B. Depth D. Bacterial Analysis B. Installer 2. Manufacturer 2. Material , Absorption area , Other contamination , Absorption area , Sewer Lines , C. Absorption area to nearest lot line £Q-034 (1/74) Page 1 of two pages Page 2 of two pages - · Legal Description I~ot ~t for Approval of Individual 9 Block 5 Talus West & Water Facilities Comments Approved Approval Disapproved Valid for one year from date signed Date ~(~/~ Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) 06~20(a) Rev. 1973 DATE ALAS~tDEPARTMENT OF HEALTH AND SOCIAL SIBi~ES DIVISION OF PUBLIC HEALTH INDIVIDUAL AND SEMI-PUBLIC BACTERIOLOGICAL WATER ANALYSIS Lab No. OFFICE INDIVIDUAL NAME SEMI-PUBLIC [] CHLORINE RESIDUAL PPM REPORT RESULTS TO ADDRESS CITY ZIP CODE ADDRESS OF SOURCE Analysis shows this Water SAMPLE to be: [] SaHsfactory [] Unsatisfactory [] Questionable [] Sample too long in transH; sample should not be over 48 hours old at examination to indicate tellable results, Please send new sample. [] Botlle broken in transit, please send new sample. SANITARIAN'S REMARKS COMPLETE THIS SECTION ONLY IF WATER IS AN IND!VtDUAL SUPPLY SAMPLE COLLECTED BY DATE COLLECTED TIME COLLECTED Sample Collected From [] Kitchen Tap [] Bathroom Tap [] Other (List) Well -- [] Dug [] Driven ~ Drilled [] Open Top[] Concrete [] Under House [] Yes [] No Depth Feet. Diameter Depth Water Depth From Bottom Feet. PURPOSE OF EXAMINATION: Illness Suspected? [] Yes [] No New Source of Supply? [] Yes [] No Repairs to System? [] Yes [] No Signature 06-1220 (b) BACTERIOLOGICA~L WATER ANALYSIS RECORD Rev. 1973 am READ INSTRUCTIONS D,~te R~eb'~d ' Time Received pm Lab. No. Lactose Broth 10cc 10cc lOcc 10c¢ 10cc t.0cc t.0cc 24 Hours 4B Hours · - ' 48 Hours EMB AGAR ON REVERSE SIDE BEFORE COLLECTING SAMPLE Lactose Broth, 24 hrs. 48 hrs, Coliform Density MF Results (Most probable No. per 100cc) Reported by Date This analysis indicales Coliform Organisms fa be: Absent Present MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMR(~ 2. Property Owner: ~-~ r~--~ ~t/~ ~/~ .. ?,~ /: %17- 3. Name of Buyer:. .VA FHA _CONV Mailing Address: ~J/~/~. , - .~ Nameof Lending Institution'. ,×///?,:/"Y,?L,~ Mailing Address: Day Phone: 5. Name of Realtor or Agent: Phone: Mailing Address: Legal Description: Location: Phone: 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: Public Utility If Individual, depth of well Sewage Disposal System Type of System: If Individual, number of dwellings presently served Public Utility No. Bdrms. ~...~ If Individual, date of installation Individual Individual (on-site) 72-003(3/76)