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Home My WebLink AboutTALUS WEST #1 BLK 5 LT 11Talus We Block 5 Lot 11 #015-202-31 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241089 Work Type: SepticTank Upgrade Tax Code Number: 01520231000 Site Legal Address: TALUS WEST#1 BLK 5 LT 11 G:2736 Site Mailing Address: 11715 WILDERNESS DR, Anchorage Owner: AICHER DANIEL GERARD JR Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: . rI Department 5/30/2024 5/30/2025 18044 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: • Prior to construction, the layout of the trench is to be determined in order to ensure that the required separations are met and to determine what, if any, well waivers are required. Received -By: ej —� o o' e Issued By: Date: Date: 3 MUNICIPALITY OF ANCHORAGE Community Development DepartmentPhone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-202-31 Property owner(s) Daniel Aicher Day phone (907) 231-0320 Mailing address 11715 Wilderness Drive, Anchorage, AK 99516 Site address 11715 Wilderness Drive, Anchorage, AK 99516 Legal description (Sub'd., Block & Lot) Talus West #1 Block 5 Lot 11 Legal description (Township, Range & Section) Lot Size 18,044 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X Septic Tank ❑X Upgrade p9 0 (w/wo ADU) Holding Tank ElRenewal ElDuplex (D) El Multiple 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. (Signature of property owner or authorized agent) Permit/Rush Fees: % 2- Waiver Fees: Date of Payment: _9&Ay Date of Payment: Receipt Number: 6ITD Receipt Number: Permit No. (7 SP 2-C/ f O Waiver No. Permit App_::- : :'-.,:c May 13, 2024 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Talus West #1 B5 L11 - 11715 Wilderness Dr Septic Pump Vault Replacement Dear On-Site Services Engineer: The owner of the above lot has a pump vault that has reached its end of useful life, so we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the wells and septic location. No conflicts exist between this proposed upgrade and any other wells or septic system, whether on this lot or adjacent lots. The existing septic tank and field are sized for 3 bedrooms. This new pump vault will not affect the design size of the system. The new pump vault will be a minimum of 100’ from all wells and surface water. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241089, Deb Wockenfuss, 05/30/24 // // // // // // // // // // // // // // // // // // // // // // / / Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 1"=30' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND TALUS WEST #1, BLOCK 5 LOT 11 FEET 0 30 60 DECK W I L D E R N E S S D R I V E 3-BDRM HOME SEPTIC PLAN 5/10/24 10' POWER AND TELE. EASEMENT EXISTING 72' LONG TRENCH TO REMAIN IN SERVICE EXACT LAYOUT UNKNOWN MT EXISTING PUMP VAULT TO BE REMOVED NEW PUMP VAULT EXISTING CONCRETE SEPTIC TANK CO CO Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241089, Deb Wockenfuss, 05/30/24 AL16- 1120 04:07.p Gln ohiciage '.A/el & �-un-,,p Ser 9072430742 Aq wA :3 A I Mark Begicti tirdioape, AY, 9S-1507 Mayor1:-n- -re Pump Installation Log Well Drilling Permit N -amber. SNY---- Date of Issue, Parcel ldentifimion Nunn bcr: Legal Description 71V_5 G()eS� Ik7L 11 Pump Installation Dati, e,0,0 Pump tDitake–Depth Below Top of Well Cas. fe'a ,,s Pump lkkanwfacturex's Nam / ee: ",i� ( v Pump model: runlpSiye ! -Z—hp hitless Adapter Burial Depth teed IWitless Adapter Ma nuta cture r' i Name: 1 Villess Adapter Installer - Well Disinfected Upon Completion?, I y4m No 1'.Method ot'Disinfection- lComments: Property Owner Name & Address: - ) A, A Wrl Pump lbstallerName: X Attenfion: Tht- pomr, inst iier shall provide -1 pump lc _q _q to the DSD within 20 dad sol pump installation. MUNICIPALITY OF ANCHORAGE ~ · d* 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 n.r.e DISTANCES ~/LL ~0~) C/~."[-T' ~--~.' ~nnM~O SEPTIC ABSORPTION TANK FIELD Phone(s) ~'~-- ?O7~' Permit No.' NO. o, Bedrooms WELL 'T~LO~ ~ ~ FOUNDATION /~ ~ 0 ~ ~ ~ ~ ~ ~] ,~ ~e~ t~ AS-BOlLTOlAGRAM(Showlocat, on of welL sepbc system, pmpertyl,nes, ioundat,on. ~ driveway, water bodies, etc.) TANKS ' ~ SEPTIC. ~ HOLDING Manulactu~er Capacity m gallons TYPE OF SYSTEM Total absorption area D,stance between ,,nes Installer ~ ~_1~ Date Instal ed ~ PRIVATE ' ~ OTHER (Identify} J FT] FT/ REMARKS: ~ 72-013 {3/85} M U N I t]] I P A L I l' Y 0 F ~ I\1 C H [] R ¢~ ~D E Department c)f' Healt. h & Human Services 825 L S'E~-ee{, Anchor'al~e. Alaska 99501 .343-4720 0 N ~ I f E S E W E R P E R I¢ I f ~".~'ml'~ Number: ')a L,-- - .:-~!d: 12'. / 12Z/88 Upgrade E]"~ c~ ~ nee ;~es i qned Owner Name: B.[L.L DOUCEI fei. Owner Address: [1715 WILDERNESS DR, ANCHORA£.~E, AK 99516 Day Phone: 564...- ?075 Par~.,~] Id: 0:1.5-~02.....~1 LI:a'L legal: -- -] -_-_- - - = . - -% - .- - _ - Section: 15 Township: !2N Range: 3W Lc~t Size 17000 ~sq. ft. op acres) "dax Bedrooms: this F:'e~mit: 5 fotml Capacity: 3 SE:I,~ It lANK: Minimum total septic tank capac:i.t.y: 1~000 ga].].r~ns. Each septic tank must have at least 2:'. compartments. Depth to top o[ septic t. an[; (s) .,: 4.0 f'ee~ requires znsu].ation over' tank (s). INt:;rAI..L PER ENGINEERS ATTACHED DESION. NOTIFY DHHS PRIOR TO ~[.;H [i'4SPE[;TION BY THE ENGINEER, THIS PERMIT IS ISSUED FOR ~..xI,.~f'[NG .:s BEDROOM SINGLE FAMIL. Y RESIDENCE ¢}I\ILY AND EXPIRES ON !,':/.:~i/L¢8. R NEW PERMIT WILL BE REQUIRED AFTER THAT DATE IF' ]'HE ~.JPGRPJ}h. HAS NOi BEEb INSTALLED. INS]'ALL. ATiON MUST BE COMPLETED [}N IHI. ;.;¢-~ UAY I'l ]iS BEE~AN ONI_ES~ SOIl... IS PRO]'ECTEI) FROM FROS'I~. ]. CERTIFY lHA'f': 1. I am ~'amiliar. with the req~tirements for on-site sewers ano wells as set ~'ef't.h by t. he Municipal. ltv o~ Ancf~pagm (MOA) and the State ef Alaska, 2. , will install t. he svst. em :l.n ac:cc~pdance with all MOA cocles and regulations, and in compliance with the design c:pit, eria o~ this 5. i wi ]. ]. adher'e tel al I IdOA and State ol ~-~Iasl.::a ceciuipement, s t or the set back d~.st, ance~ ir'om any exist..in~ well, wastewater' disposal system oP pubJJc 4. .[ understand tha'L this De,'mit is valid ~of a maximum oi ]; bed~*ooms,, I aiso underst..a~qd that the capacity ol the '(.oral system is 5 bedl-ooms and an~ enla~~l. 1 require ~additiorlal perml'r.. ,,%,, ............................... .... ....................................... ........ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 ~'L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LE6AL DESCR,PT,ON: ~'¢7/~, /'~ ~- '~/.4,~..4/,~.~.~ownship, Range, Section: _~.~/.5-. 7'-/g~-/'¢., SLOPE SITE PLAN 1 2 3 4, 5- 6- 7 8 9 10 11 13- 14- 15 16 17 18- 19- 20- COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth Io Waler Afler'N.l Monitoring? I ~l.r~ Time 0 Reading Date PERCOLATION RATE . TEST RUN BETWEEN Net Depth to Net Time Water Drop I,D lc3 /0 to /0 ~O {~inutes/inch) PI~RC HOLE DIAMETER / ~ FTAND b~ FT PERFORMED BY: %- --S l,.~~ , '~~ CERTIFY THAT THIS TEST WAS PERFORMED iN AOOO"DANOEW'T"A"STATE/*.DM.N,OIPAL .IOE.,NESIN;JOTO. T.,SDATE. oATs: 72-008 (Rev. 4/85J Tom Fink, Mayor unicip lity of Anchor ¢ Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 September 26, 1991 Mr. Frederick Ho Hahn v Dayan and Hahn 310 K Street Suite 314 Anchorage, Alaska 99501 Subject: Lot 11 Block 5 Talus West Lift Station Subdivision'~l ~ _~ -~ Dear Mr. Hahn: This office has reviewed your letter dated September_10, 1991 .to - - Mr. Tobben Spurkland and Acreage Systems, Inc. where you -' ..... expressed a concern by the owner of the subject lot that there may be future problems in obtaining a Health Authority Approval certificate should the owner decide to sell-thisproperty ...... ~-. The owner's concern is based in part on a le%.~-~.?dated Ma!~_-3./_~_-- _~ ~s~- 1991 from Mr. Robert W. Robinson to Mr. Bil]~sDLtc~e~teJ~ TheD~-_ ?- -~c contents of Mr. Robinson's letter are still.-~a)cid.~ -,? ~a--.'~ ~'-- After three inspections of the subject lift ~at~a~t-i~-~b~ Robinson and two other members of the was concluded that the lift station equipment~2had_~ever been- approved by this office. The lift station appeared to be . functioning adequa%ely with some minor seepage-:D_c~curring in [he~_ CMP standpipe. The unapproved status of the~li~t-stations wa's discussed with the owner so that he could de:c~hether or~r~o~'cr%~5 to have the lift station equipment replacedc~ I~-.~as~expta~ne~ that, although the lift station has not this office would not require that it be reu~,ace~f~octong--as~ i~tt continues to operate satisfactorily. Mr. Frederick H. Hahn V September 26, 1991 Page Two If and when a Health Authority Approval is requested, the required field inspection must be conducted by a registered civil engineer. Notwithstanding any problems with the sdequacy and performance of the 0n-site well and septic system (including the lift station) or required setback distances~ the request should be approved. This is consistent with what has been previously told to the homeowner. - ~ If there are further questions, 343-4744. Sincerely, j~ On-site Services cc: Tobben Spurkland, P.E. Ed Sanderson, Acreage Systems, Inco Melvin Ackerman Robert W. Robinson, Civil Engineer, DHHS Allen N. Dayan* Frederick H. Hahn V * Nso admitted in Georgis DAYAN & HAHN Attorneys at Law 310 "lC Street, Suite 314 Anchorage, Alaska 99501 Telephone (907) 277-2330 Facsimile (907) 277-7780 September 10, 1991 RECEIVED Mr. Tobben Spurkland, P.E. 203 West 15th Avenue Anchorage, AK 99501 SEP 3 1 199! MuniCipality of Anchorage Dept. Health & Human Services Acreage Systems, Inc. 601 East Northern Lights Blvd., Anchorage, AK 99503-2811 Suite 343 Dear sirs: This office represents Melvin Acke~man. Mr. Ackerman in 1988 purchased from Bill Doucette a home located at Lot 11, Block 5, within the Talus West Subdivision. This property has the street address of 11715 Wilderness Drive. As part of the purchase and sale of this property, the septic system was required to be replaced. It is my understanding that Acreage Systems, Inc. was the contractor for the replacement of the septic system, and that Tobben Spurkland was the professional engineer who certified the new septic system. Enclosed is a letter which Mr. Ackerman has received from Robert Robinson of the Municipality of Anchorage Department of Health and Human Services. Mr. Robinson's letter indicates a problem with the lift station. Mr. A6kerman is concerned that his septic system comply with standards o-f the Municipality of Anchorage, and that he will be able to obtain a health authority approval certificate when it comes time to sell this property. Demand is hereby made upon you for the correction of the deficiencies in the septic system to the satisfaction of the Municipality of Anchorag~ D?partment of Health and Human Services. Mr. Tobben Spurkland, Acreage Systems, Inc. September 10, 1991 Page 2 PoEo I look forward to your response to this letter within ten (10) days of the date of this letter. If you have any questions as to my clients position in this matter, please feel free to contact me. Very truly yours, DAYAN & HAHN Frederick H. Hahn V FHH:klsl cc: Melvin Ackerman Robert W. Robinson Tom Fink, Mayor i ip lity of nc ora ¢ Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 May 3, 1991 11715 Wilderness Drive Anchorage, Alaska 99516 Subject: Lot 11 Block 5 Talus West Subdivision, Lift Station Installation PID #015-202-31, Dear Mr. Doucette: As we have discussed several times du'ring my inspections of your wastewater disposal system, I have been concerned with the lift station which was installed on December 15, 1988. The lift station which was installed was not approved by this department at the time of installation, nor has it since been approved by the department. Based on my last inspection, my conclusions and recommendations are as follows: Although the lift station has not been approved by this office, the station appears to be operating satisfsctorily. The corregated metal pipe~ased as the riser and the "ram-neck" seat of the riser t~ the 500 gallon tank is not water tight. There is som~ seepage of groundwater occurring along the riser and at the seat, however, the seepage is not enough to overwork the lift pump. If you aren'~ sDtisfied with the existing lift station and desire tha~it be replaced with an approved type, you should pursue this with the civil engineer who was involved with the installation. Kids Are Our Future Bill Doucette May 3, 1991 Page Two If you have further questions or require additional please call our office at 343-4744. sihc~ely, ~ Robert w. Robinson Civil Engineer On-site Services RWR/ljm:365 cc: Tobben Spurkland 6751 West Dimond Boulevard Anchorage, Alaska 99502 John Smith, P. E. Program Manager On-site Services information, Tom Fink. Mayor Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 May 3, 1991 11715 Wilderness Drive Anchorage, Alaska 99516 Subject: Lot 11 Block 5 Talus West Subdivision, PID #015-202-31, Lift Station Installation Dear Mr. Doucette: As we have discussed several times during my inspections of your wastewater disposal system, I have been concerned with the lift station which was installed on December 15, 1988. The llft station which was installed was not approved by th~s department at the time of installation, nor has it since been approved by the department. Based on my last inspection, my conclusions and recommendations are as follows: Although the lift station has not been approved by this office, the station appears to be operating satisfactorily. The corregated metal pipe cased as the riser and the "ram-neck" seat of the riser to the 500 gallon tank is~ not water tight. There is some seepage of groundwater occurring along the riser and at the seat, however, the seepage is not enough to overwork the llft pump. If you aren't satisfied with the existing lift station and desire that it be replaced with an approved type, you should pursue this with the civil engineer who was involved with the installation. Kids Are Our Future Bill Doucette May 3, 1991 Page Two If you have further questions or require additional information, please call our office at 343-4744. Civil Engineer On-site Services RWR/ljm:365 cc: Tobben Spurkland 6751 West Dimond Boulevard Anchorage, Alaska 99502 John Smith, P. E. Program Manager On-site Services aNCHOR~GE~ ~L~SK~ 99D02-~904 ~907) John Smith Program Manager On-Site Services Department of Health and Hu~Dan Services Subject; Lot il, Block 5 Talus West Lift Station Document. ation Dear Mr. Smith: March 4, 1991 RECEIVED NIAR 4 1991 Mun~e~pality ot Anchorage Dept. Health & Human Sa~icea I have received your letter of Feb. 4, 1991~ requesting documen- tation of items constituting subject lift station. t have contacted the contractor, Acreage System, the installer of this lift station, and am waiting for their- submittal of materi- als used. When this submittal is received, I will compare it with the list of materials I compiled when I examined the lift station. The docomentation will be forwarded to you as soon as I receive it. Tom Fink, Mayor unicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 February 4, 1991 Tobben Spurkland, P.E. 6751 West Dimond Boulevard Anchorage, Alaska 99502 Subject: Lot 11 Block 5 Talus West Subdivision Lift Station Installation Dear Mr. Spurkland: Our letter dated October 2, 1991 requested that you provide engineering data, design drawings, and specifications, used~for ~ ~'~ ~ the fabrication and installation of the lift station on the subject lot. It was observed cluring several on-site inspections by this office that the subject lift station does not appear to be a lift station that has been approved by this office. It has been approximately four months since we made this request, however no response has been received. This letter will serve as a formal Notice of violation of AMC 15.65.085.B which was in effect at the time the station was i Failure to provide the requested informatiOn~ may result in enforcement action being init~ If there are further questions please call our office at 343-4744 · ~ Smith~ B/rog r am Manager On-site Services cc: Lee Browning, P.E., ~,~Robert W. Robinson, Manager, Environmental Services Civil Engineer, On-site Services Tom Fink, Mayor Department of Health and Human Serv,ces 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 October 2, 1990~ Tobben Spurkland, P.E. 6751 West Dimond Boulevard Anchorage, Alaska 99502 Subject: Lot 11 Block 5 Talus West Subdivision Lift Station Installation Dear Mr. Spurkland: Since May 20, 1986, the wastewater ordinance has required that lift stations be approved by the department. AMC 15.65.095.B, which was in effect at the time, reads as follows: "when a lift station is required, the system must be designed by an engineer and have the approval of the department. A design bearing the original signature and stamp of an engineer must be submitted to the department for approval before a permit will be issued. The design must meet the standards of this chapter." On December 16, 1989, you submitted an "as-built" drawing for an upgrade of the on-site wastewater disposal system on Lot 11 Block 5 Talus West Subdivision. During a recent site inspection by this office, it was obser, ved that ttie lift station does not appear to be one of the approved d.esigns. TO ensure the accuracy of the as-built records, please provide this office with the engineering data, design drawings, and specifications which were used for the fabrication and installation of the lift station. If there are further questions, please call our office at 343-4744. Sincerely, Program Manager On-site Services RWR/ljm:260 Kids Are Our Future GRB R ~I~C~GE ARENA B GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION DISTANCE FROM WELL ~0T' 4/ MANUFACTURER ~"~/~L~'~-~V~ATERIAL NUMBER OF COMPARTMENTS NSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY GALLONS. TILE DRAIN FIELD: DISTANCE EROM WELI../~O~- '/~ FOUNDATION ABSORPTION AREA 2~0 NEAREST LOT LINE //~) ¢~/~oFTOTALLINEsLENGTH~I~- I TRENCHW'OT'3G'N. TOTALEFFECT'VE SQ. FT. LENGTH OF EACH LINE -~ ! DEPTH: TOP OF TILE TO FINISH GRADE ~'~ CONSTRUCTION DEPTH OF FILTER WELL: TYPE _ DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE SEWER L NE __ TANK SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: SEWER LINE DEPTH: PiPE MATERIAL- LOT SLOPE: REMARKS: G.A.A.B. PERMIT NO. ( 762~ ) u~.~ ~S APPLICANT ~ICK WRIGHt SAR BOX ±5BSA LOCATION WILDERNESS DR LEGAL Lii B5 TALUS WEST SUGD LOT SIZE 18044 DEPARTMENT OF HEALTH AND ENVIRON . PROTECTION ~ 25i0 E. TUDOR RD., RNCHORRGE, RI<. ~507 ~ WELL AN~".." ON--S I TE SE~ER PERM I T ~~ SQUARE FEET~ - TYPE OF SOIL RBSORBTION SYSTEM IS: TRENCH MR×IMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= i/ THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= i6 LENGTH= 39 GRAVEL DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEE~) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE E×CRVRTION (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 (IN FEET). PACKAGE PLANT REQU I RED EITHER R CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED. R CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF R 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"~, I~-JJ~-~ T. - -: ' ~ 28. 0 FEET. ~ CLFrSg~'¥I S?$TEM-i-5 USED ~ LENGTH IS BRCKFILLING OF RN~ ~Y~TEffi WITHOUT FINRL INSPECTION R~ RPP~OVRL B~ THI~ DEPRRTMENT WILL BE ~UBJECT TO PROSECUTION: ~ININUM DI~TRNCE BETWEEN R NELL RND RNV ON-~ITE ~EWRGE DI~PO~RL ~TEM ~$~ FEET FOE R PRIVRTE WELL OR 2~ FEET FOR R PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER I NSTALLAT I ON. PER~ I T VRL I D FOR Ot~E YEAR FROM I I CERTIFY THAT l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS 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~MODELED TO INCLUDE MORE THAN 4 BEDROOMS. ............ - F~PLICRNT DIC~ WRIGHT - 3-'- ~: ' M'W DRILLING, I NC. DRILLING LOG Well Owner Wright Construction Use of Well Dom Location (address of: Township, Range, Section, if known; or distance main road Lll, Blk 5, Ts, lus West Size of casing 6 static water level Screen ( ); Describe screen or Well pumping test J .Depth 35 ft. Perforated of drawdown from static 7~ feet Cased to 77.6 feet land surface. Finish of well (check one) open end ( X NOne ); (minute) for 1 hours with 100~ Xft' Date of completio~ Depth in'feet from ground surface 9 -._' :~ f.2 TO. ~? ~3 TO r' ~ 15 _TO' 38 .TO_ 50 TO 70 TO TO_ .TO 2 3 15 7O 77 TO. .TO TO TO TO WELL LOG penetrated, size of material, color and hardness. NW~/A Ccrt/fied Contractor Certificate Nos. 814 & 973, ,,. :, •, Municipality of Anchorage °�� t _ On-Site Water and Wastewater Program (907) 343-7904 s a F ., P is �-3'Certificate of On-Site Systems Approval Parcel I.D. 0151 Expiration Date: // -2- t 'je 1. GENERAL INFORMATION Complete legal description Talus West#1 Block 5 Lot 11 Location (site address) 11715 wilderness drive Current Property owner(s) CASSANDRA WAGNER Day phone 460-7075 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 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 El Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: � /� Received by: Air Date: q(o` l, COSA to be relea-ed .,engineer,unless otherwise requested by the engineer. , COSA Fee $ 5246, / Waiver Fee $ Date of Payment q11141153 Date of Payment Receipt Number Q -I 5ZUD Receipt Number COSA# Q 4 1` 1) 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 C&M ENGINEERING Phone 854-5558 Address 20182 TULWAR Engineer's Printed Name CHARLES BALZARINI Date 8/10/18 AN%• • f $�� 6. DSD SIGNATURE fir; 9TH •.* System#1 Approved for , , , , ,, bedrooms le •,�, : " . AA 2AARLES G BALZARIN1 System#2 Approved for bedrooms Disapproved �Fc`�F• • - 385d�/•• �� t geo .ESSI'iA -•► Conditional approval for bedrooms, with the following s;i* a �. It -, , ON SITE 4` WATER AND ?� WASTEWAT>=K ;� PROGRAM S'. / Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet f • , c If more than 1 septic system is on the lot: COSA Checklist# 1 of1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: I Tl1-t✓5 (10L3T i +' ,5 L_ 1 ' Parcel ID:(/1S 01d4q 3, A. WELL DATA �C Well type ?R V,1 I e- If A, B, or C provide PWSID# Well Log OIJ) '/E5 Date completed cem/76 Sanitary seal (9N) `IES Wires properly protected ON)`-/L-S Total depth 18 ft. Cased to 77 t7 ft. Casing height(above ground) j L+ in. FROM WELL LOG AT INSPECTION Date of test c/c / 76 L 7/6f/ Static water level 5 ft. a 1ft. Well production L0 g.p.m. -4 6' /'f g.p.m. WATER SAMPLE RESULTS: Coliform 1`� IJ colonies/100 mL Nitrate '3e2? mg/L Arsenic u ) ug/L Date of sample: 7/$(/0 Collected by:( s l E /Gi / NG B. SEPTIC/HOLDING TANK DATA / / Tank Type/Material SE P7TC / (ONC'rr� Date installed 74)4/76 Tank size USO gal. �/ Number of Compartments 3 Cleanouts 6N) /-S Foundation cleanout�//N) /his Depression over tank^(Y�1� A/0 High water alarm (Y� N4 Date of pumping b/la�IS Pumper 541T(5 C. ABSORPTION FIELD DATA p 1 Date installed I off/1/J' Soil rating (g or ft2/bdrm) 3 / System type ©/pct' 1 Length 7c' ft. Width 9, ft. Gravel below pipe O ft. Total depth t( ft. Eff. absorption area 11 70ft2 Monitoring tube YES Depression over field MO f. Date of adequacy test �/ 4/ g �' )l 'Rresults (Pass/Fail)I For bedrooms Fluid depth in absorption field before test tel, `'f in. Water added 1460 gal. New depth 11g in. Elapsed Time: < 140 min. Final fluid depth ""t�Iin. ��Absorption rate >= 450 / g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) A.J ,JNA f �G/l✓ If yes, give date ,} D. LIFT STATION Date installed 0//5/6 Size in gallons 5�J© Manhole/Access ON) V' "Pump on" level at UO in. "Pump off" level at 36 in. High water alarm level at a'5 in. Datum 60776/V) Cycles tested 3 Meets alarm &circuit requirements? Jt5' E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 14)D On adjacent lots +100 Absorption field on lot 4- (60 On adjacent lots +i00 Public sewer main +WO Public sewer manhole/cleanout `>!t IDC2 Sewer/septic service line +14' ?S" Holding tank 4 too Animal containment areas —F(470 r. Manure/animal excrete storage areas -f"((O SEPTIC/HOLDING TANK ON LOT TO: Building foundation + S Property line + S Absorption field f I 0 Water main 'E 1O Water service line --("I'D Surface water 410a Wells on adjacent lots 4 f O0 ABSORPTION FIELD ON LOT TO: Property line 41c9 Building foundation f (0 Water main "t- Water Water Service line f0 Surface water+(o° Driveway, parking/vehicle storage 'f(0 Curtain drain 'f 50 Wells on adjacent lots +WO F. COMMENTS S ' g2c6t'Der T t,/5 64- A T��./ A ..2 G. ENGINEER'S CERTIFICATION 41"-e am •• •� n �� I certify that I have determined through field inspections and ;• V• review of Municipal records that the above systems are in Alf •'S79I conformance with MOA COSA guidelines in effect on this date. !* TH ArN •• * Tr Engineer's Printed Name CH4E5 BAL2-0.77 _VT— 0: `tY Date (.C/( t . . • .D ARLES G BALZARINi �j CE-13854 .••��i� 44 kk‘—VPROFESSION +- COSA canary sheet_2-6-15.doc MUNICIPALITY OF ANCHORAGE 907 34 7904 Development Services Department Phone:F : 907-32 7904 On-Site Water 8,Wastewater Section Lift Station/Pump Vault Maintenance Log Owner r,r..`)5c4-101r,a (4Sr� Street Address 1 I-I 1_5 LAS,Lal ecne S --Dr.;,( -- Phone °01 .x4/,o'1015- Legal Desc. PID Septic Tank; •Sludge level O inches Pumping: required yes no 'Pumping completed hor prrie ou)ne- ha Lift Station: 2 `�PeY--5 Goo •Pump basket cleaned yes_fiQ •Effluent filter cleaned yes no 'Control floats cleaned C.7no -Proper float settings confirmed es no -Operation satisfactory es no Alarm System; -Dedicated electrical alarm circuit yes no •Audible and visual alarm inside dwelling yg: .� -Alarm system operation - _: •r 'I = °- Manhole Riser // 'Ground water intrusion at riser to tank connection yg) •Ground water intrusion around pipe penetrations es ! -Weep hole functional no 'Manhole lid: Functional am-'( yes no Insulated no Properly Secured yes •.i Other l •All manufacturer required inspections and maintenance completed ,yes no Comments: C..v.2V*/.-f'...... +.y t-. +^4-- Maintenance Provider: �j J ,1S Date of maintenance f Technician 7 e' a �1e00 Company 1 /i0 rrle. . r-✓i C'PS '/3J Signature Date_ c Mailing Address: P. C). Box 196650' Anchorage,Alaska 995196650 " www.muni.org 111 Municipality of Anchorage On-Site Water and Wastewater Program (907) 343-7904 Certificate of On-Site Systems Approval Parcel I.D. 015-202-31 Expiration Date: GENERAL INFORMATION Complete legal description Talus West #1, Block 5, Lot 11 Location (site address) 11715 Wilderness Dr. Current Property owner(s) Melvin & Joanne ^ckerman Mailing address 11715 Wilderness Dr. Real Estate Agent Day phone Day phone 2. TYPE OF DWELLING: [] Single Family (w/wo ADU) [] Duplex [] Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class ~ Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual [] Holding Tank [] Community [] Public Sewer [] WaiverNariance request for: Received by: COSA to be reJeased to the engineer, unless otherwise requested by the engineer. Date: Distance: COSA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with ali applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE j/System #1 Approved for ,~ bedrooms System #2 Approved for __ bedrooms Disapproved Conditional approval for Phone (907) 272-8218 Date 6/7/13 bedrooms, with the followin9 stipulations: ~hYe: ~ci~[~//~/~/~/~ / ~'/~~Original Certificate Date: 7 "¢-~ ,~"- / ~ of Anchorage is not responsible for errors or omissions ir~ the professional engineer's wonk, 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory X Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # ~ .of ~ Structure served by this system ~ Certificate of On-Site Systems Approval Checklist Legal Description: Talus West #1, Block 5, Lot 11 A. WELL DATA Well type Private Date completed 8/9/76 IfA, B, or C provide PWSID # Sanitary seal (Y/N) Y Parcel ID: 015-202-31 Well Log (Y/N) Y Wires properly protected (Y/N) Y Total depth 78 Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform __ ft. Cased to 77.6 ft. FROM WELL LOG 8/9/76 35 10 g.p.m. Arsenic Casing height (above ground) 13 in. AT INSPECTION 6/4/13 22 ft. 5.5+ g.p.m. .colones/100 mL Nitrate ~ mg/L ug/L Date of sample: ~! ~,~J 2~l,3 Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Concrete Tanksize 1250 gal. Number of Compartments 3 Foundation cleanout (Y/N) Y Depression over tank (Y/N) __ Date of pump ng ~ ~,01 :) Date installed 7/26~76 Cleanouts (Y/N) Y N High water alarm (Y/N) Y Pumper ~ '/' ~'b~ ~.~t~..~..[', i~-.- C. ABSORPTION FIELD DATA Date installed 12/15/88 Soil rating (g.p.d.lrt2 or~/bdrm) 349 SF Length 72 ft. Width 2 ft. Totaldepth 10.75 ft. Eff. absorption area 1172~ Monitoring tube Y Date of adequacy test 6/4/13 Results (Pass/Fail) Pass Fluid depth in absorption field before test 69 in. Water added 492 Elapsed Time: 170 min. Final fluid depth 69 in. Any rejuvenation treatment (past 12 mo.) (YIN & type) No System type Deep Trench Gravel below pipe 8 ft. __ Depression over field N For 3 bedrooms gal. New depth 76 in. Absorption rate >= 450+ g.p.d. If yes, give date D. LIFT STATION Date installed 12/'15/88 "Pump on" level at 40 in. Datum Bottom of Tank Size in gallons 500 "Pump off" level at 36 Cycles tested 3 Manhole/Access (Y/N) Y High water alarm level at 45 Meets alarm & cimuit requirements? Yes in. E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot '100+ Absorption field on lot '1004- Public sewer main 75+ Sewer/septic service line 254- Animal containment areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Water main 104- Wells on adjacent lots 1004- ABSORPTION FIELD ON LOT TO: On adjacent lots 100+ On adjacentlots 100+ Public sewer manhole/cleanout 1004- Holding tank '100+ 100+ Manure/animal excrete storage areas Property line 5+ Water service line ~ 0.4- Property line 1 O+ Building foundation 10+ Water Service line 10+ Surface water 100+ Cud. ain drain 50+ Wells on adjacent lots 100+ Absorption field 5+ Surface water 1004- Water main 10+ Driveway, parkingh/ehicle storage 104- F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 6/10/13 COSA brown sheeL10-10-12.doc -�Z 41 CL a 0 o (D E n. c x p o a) ° N C 41 2: N aN C v E 0 O O a° O O U �, OLC C c C� 3- 0 ° v -C 0 O ° C o ° v°°. -00C 41 C O N � O O N c 0) O c ° C C 0 C U N C' > N (D co N U cA p•� CY) N +• m L p C ° L O n a �t a) W a O N � a-+ •— C C L O C: _0 > L UO C—°vLa�o C N T O N (n N O t.�LCtoa C Q a Ci � a a-.- W ° o 0 OJ Q -.�,, 7° C O H O (0 C 0 C ° � - E 1 ~ O , c c a) C:-a U m W Q) W O O•U•O+� v -cn E0 >�Eff =v -o L° o00a�,CL Cl o Q a U �° v.- 0 Q.� 3 (n aci.-�� .`� o kxx1 1 • p M Cs c :60 / •. L M : y : y WAA'W� Z ••• `SAI p 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 10t, block, subdivision, section, township, range) Mailing Address (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Location (address or directions) (b) Property owner ~-J/ 'J~;~c4-C~'5~7/~- : Telephone: (home) ~-~)J?Business Address Telephone (e) Mail the HAA to the following address: (or check here [], if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family/~ Number of bedrooms -~ 3. WATER SUPPLY Individual Well'~' 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~i~ 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 this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm %~fv'c'~"--~.o(,,14J ~. ~ Telephone Address ~ ~ 6. DHHS APPROVAL Approved for ,~ bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in 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 un icipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~)25 (Rev. 7/88)Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) ~ Health Authority Approval (HAA} CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: /O ~' //, ~ j~'.--~ TJ'~i.,/~ Well Classification Well Log Present (Y/N) y Date Completed Depth of Grouting IfA, Pump Set At '~m ftc Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Total Depth '7"~ Cased to Static Water Level ~ J Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot J To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line B, C, D.E.C. Approved (Y/N) __ Yield ; On Adjoining Lots ~ /'(.~O ! ¢'~(-.~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ¢ ¢'~4.- ,',.'~ ,. SEPT,C/.OLO,.".TA.,, DATA Datelnstalled ~¢/7~Sze i~U No. of Compartments ~ Standpipes (Y/N) ~ Air-tight Caps (Y/N) ~ Foundat,on' Cleanout (Y/N} ~ ~_ Depression over Tank (Y/N) ~ Date Last Pumped J Z~/~ ~' /~4~ ~t~~ Pumping/Maintenance Contact on File (Y/N) J~/A ;for ~/~ Holding Tank High-Water Alarm (Y/N) ~/~ Temporary Holding Tank Permit (Y/N) ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ! O To Property Line ~ / To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course To Building Foundation To Disposal Field Comments 72-026 (Rev 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorptipn Strata Date Installed Width of Field ..2. Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test ~ t1'~ J Type of System Design Length of Field Depth of Field Gravel Bed Thickness //-~,~--. v~ Statndpipes Present (Y/N) ~ Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: / ~ I TO Property Line ¢~(-~ To Existing or Abandoned System on To Water-Supply Well To Building Foundation Lot ~ To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ; On Adjoining Lots To Cutback (if present) 0 Comments D. MFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level Tested for Dimensions ~ ,~d-'/ ~-~ //~z..~c~ Manhole/Access (Y/N) Y "Pump Off" Level at ~ ~f ~ Vent (Y/N) F Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.~ ~ Signed ~, . · , - , Engineer!sSeal Date ~ '~. ' - ." MOA No. Receipt No.~'~gf 4J>Of-/ / /-7/c'~'76 Receipt No.'~ Date of Payment ,~/~,/~ ~ Waiver Fee: $ Amount: $ /,~ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 '~" Street, Anchorage, Alaska 99503 274-4561 ~~'~d~'' ~i~ Ri~ei~de~ 10, 1976 Date of Inspection ~~ REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Cony. Approval requested by: National Bank of Alaska Mailing Address: Post ~)ffice Box 3-3859 99501 Property 0wner: Dick Wright Mailing Address: Contact: Beth Francis 274-7594 3. Legal Description: Lot 11 Block 5 Talus West 4. Location: 11715 Wilderness Drive ]5. Type of facility to be inspected Single Family No. of bedrooms '6. Well Data: Individual A. Type Phone: 279-2506 Phone: C. Construction B. Depth D, Bacterial Analysis Sewage Disposal System: A. InstalledIq fl ~ C. Septic Tank: 1. D. Seepage Pit: 1. E. Disposal Field: On-site system B. Installer Size~~ Manufacturer Absorption Area 2. Material Total length of lines Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank , Absorption area ., Other contamination ., Absorption area , Sewer Lines C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Pag& 2 of two pages - Req~, t for Approval :of Individual · begal'Descripti0n ,Lot 11 Block 5 Talus West & Water Facilities Comments Approval ,Val_~d for one year from date signed eater 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)