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Home My WebLink AboutTALUS WEST BLK 2 LT 3Onsite File Municipality of Anchorage On -Site Water and Wastewater Program ° (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181031 PID Number: 015-201-13 Dwelling: ❑E Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New [W Upgrade Name: FRED WILSON ABSORPTION FIELD E] Deep Trench [:]Shallow Trench ❑Bed ❑Mound Address `��( 11$WILDERNESS DR ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot TALUS WEST BLK 2, LOT 3 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Ft Ft. Well 951* 50'+ TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCH TANK Capacity 11000 Gal. Surface Water 100'+ Material STEEL Number of compartments 2.0 Lot Line 20'+ NA Foundation 10'+ LIFT STATION Manufacturer Capacity Curtain Drain UN Gal. Remarks * 95' WAIVER Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank drainfield 3034 Installer MIKE ANDERSON Drainfield Sam- CO/MT 3J; Inspector MIKE ANDERSON, P.E. BENCH MARK (Assumed elevation) 100.8 ft Inspection X51 3-24-18 Location and description Z ntl 3 r 4th SOUTHWEST CORNER OF SIDING COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date P 0 �� c• _.,"lam/'rr 49TH �'-.;� • `�,. 13fi v o• 0 e o e 0 D o 0 0 0 0 0 0 0 0 O o o p� A :0• 000 °000e°veo.00a .� r,!•0 °• MICHAEL N. A,-fDLRSCN `� Approved 06Lul-A-1, /j�l Cr- 9469 •: .:: ��Q *�� • �3 /, ��ii'it�� Date Inspection Keport_9-1-11.doc Permit No. OSP181031 Page 2 of Municipality of Anchorage 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 Legal Description: TALUS WEST S/D BILK 2, LOT 3 PID No.: 015-201-13 MARK /A B TC01 1 /45 49 col 42 48 -co __ -55 CO3 f 56 58 i OLD T K DECOMMISSIONED i 7 \ \ 1 ` \ B i iA A N 1000 STdL )WNK CO 0 95' WE L RADIUS W/ WAIVER — CO2 - 0O2 c03 100' WELL RADIUS k 1 0 MT1 1----1 ASBUIL —SGALE-1--3(3!— r"o r(:", TcoT r CO2r C111 61�e,%ILWLTATA Tit \'Z2 OF 44 '4114 ............... Al I L AV 49 11t 0 -* ........... 4.. . .... 00 sas two rALLDN 0 STEL TANK 0 0 0 ... ........................................ MICHAEL N. ANDERSON.-- No. C 9469 � AW 41, SEPTIC SECTIO #t4r444 4Q1 N.T.S.VAr E 1-1 '�� LO S89*59'00"W 121.60 11 0 INLIM 0 U) 0 > 0 0) co ') D U) C/) UJ co Cl) D 4-) 0 14 0 co b D m — a0 Cl) co 0 Cn C6 Ar < U) o kO 02 00 (D .CSCO 0— CD C�l C\l 3�: cs mLL co 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: OSP181031 Work Type: SepticTank Upgrade Tax Code Number: 01520113000 Site Legal Address: TALUS WEST BLK 2 LT 3 G:2736 Site Mailing Address: 11949 WILDERNESS DR, Anchorage Owner: WILSON FREDERICK & Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date Lot Size in Sq Ft Total Bedrooms: C11� 06 d I)c•I)artnlcnf 3/22/2018 3/22/2019 19591 ❑ 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 Received By: Issued By: Date: 3 2 ? Date: Z 3 Municipality of Anchorage slwli i'11�" P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program Waiver#: COSA#: PID#: 015-201-13 Legal Description: Talus West B2 L3 Engineer. Mike N. Anderson Applicant: Fred Wilson Permit#: OSP181031. Your request for a waiver of the required 100 feet horizontal separation from the septic tank: to the private well has been approved. The tank is to be placed as far from the well as possible without requiring a lift station, no closer than the existing tank. --�A :n This waiver approval applies to the proposed septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. a 0 M K a IS U K K M a U a M U N U R N . 2 9 M IS 9 a 9 a M 9 M 0 . . M . . 9,11 M 9 1. . IN a M . 1. ...... a ...................... IN I Waiver is Granted: x Waiver is not Granted: Date: Approved by: Name of Revie\,vdy'/ MUNICIPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-201-13 Property owner(s) FRED WILSON Mailing address 11949 WILDERNESS DR Site address SAME Day phone '5L45"— 25 Legal description (Sub'd., Block & Lot) TALUS WEST BLK 2 LT 3 Legal description (Township, Range & Section) Lot Size 19591 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) 0 (w/wo ADU) Septic Tank ❑X U � 4 5�' 5 6 � Duplex El (D) Tank ❑ e" w 2'yi" Multiple Dwellings ❑ Privy ❑ Q �r N N (SF and/or D) Private Well ❑ eon 3 Water Storage Elo A THIS APPLICATION INCLUDES A VARIATISM-AWAlVER REQUEST FOR: WAIVER FOR WELL TO SEPTIC TANK, NO CHARGE Distance: 80'+ 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) Rush Permit/Rush Fees: _a ( a) = 3,fq' Waiver Fees: Date of Payment: 312oh i{ c,.k loy4y Date of Payment: Receipt Number: Z22(1 -- Receipt Number: Permit No. CJP I� 1 '�j 3 I Waiver No. Permit App_:- :- ;-.,.c � March 22, 2018 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New Septic Tank Permit Legal: TALUS WEST BLK 2 LT 3 ) To Whom it may concern: This is a request for a septic tank replacement permit on the above referenced lot. The system is grandfathered in for the 50 foot well radius but the new 1000 tank will be installed as far as possible away from the existing well. Therefore we are requesting a waiver with no MOA Ices for this permit per MOA direction. This system will not impact any of the neighboring properties due to the lot layout. Please call me if you have any questions. Sincerely ( Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 i I I I TALUS WEST r I BLOCK 3, LOT 6 i -WILDERNESS DRIVE ------------------ PROPERTY LINE it WELL - PROPERTY LINE i !I EXISTING TANK TO BE DECOMMISSIONED PER UPC XISTIN 1 i (HOUSE NEW 1000 GALLON TANK, MOVED AS FAR AS POSSIBLE TOWARDS CRIB, WAIVER REQUIRED NO MOA FEE. DRAINAGE DRY \�`�; E I i�., i i \�� EXISTING WELL NO OBVIOUS I z 100' RADIUS WATER I W �. EXISTING WELL 100'RADIUS TCO°DCO EXISTING 16'X �• ��` I HE L --, 17' CRIB, NO CO WORK –CO TALUS WEST �� I ! I TALUS WEST BLOCK 2_LOT'P_ BLOCK 2, LOT 4 - - = - - - - - - - - - - - - - - - - - - - - - - `� 10' UTILITY EASEMENT — —�-- —— -— — — — — — — — — — — — — -------- I! I � LILAC PARK BLOCK 1, LOT 5 I I � I ( i I !! Septic Design Prepared for FRED WILSON �IV :. .� TALUS WEST, BLOCK 2, LOT 3 49 ;+, Anchorage, Alaska ® ..... ..............................::.....0 .......4 . Michael IN• Anderson, ® ® DATE: 3/13/2018 MICHAEL N. ANDERSON. 4601 NATRONA AVE 4oE 469 ANCHORAGE, ALASKA 99516DRAWN: DJR � _ SCALE: 1 "=50' (907) 727-8864 / FAX: (907) 345-1391 v i HEALTH DEPARTMENT-_ -\ ND 905 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL - LIQUID CAPACITY a MAILING I'�/� 7I "elf -SZ 0.3 ADDRESS � % "� (/ �/�v"o--1 t PHONE . or ei nocroionnni Z-01 1TERIAL 5 "�'�'lll::: NUMBER OF COMPARTMENTS INSIDE LENGTH .� rr//� (( IIl;4I(EE W DTH / J/ DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: ,, NUMBER OF PITSOUTSIDE DIAMETER OR WIDTH / LENGTH 7 DEPTH LINING MATERIAL `^ 0 . DISTANCE FROM WELL/ BUILDING FOUNDATION NEAREST LOT LINE -^ > TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) 3 q&. SQ. FT. TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELL , FOUNDATION_, NEA_REST-LOT-LINE , OF LINES_c NUMBER/LINES DISTANCE BETWEEN LINES-- TRENCH WIDTH IN. TOTAL ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: rvoc � �U1frV 5CV GI1' I �DFCJ DISTANCE FROM WATER DEPTH BUILDING FOUNDATION SAMPLE NEAREST LOT LINE DISTANCES: NEAREST SEPTIC SEEPAGE OTHER SEWER UNE-, TANK , SYSTEM , CESSPOOL , SOURCES_ DIAGRAM OF SYSTEM GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY � 3500 TUDOR ROAD POUCH 6.650 ANCHORAGE, ALASKA 99502 TELEPHONE 279.8686 SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT —/ ' /'' ' ' INSTALLATION LOCATION EVA I /C� l(-/�y ]7 P' / ��V 1 ✓ L /✓%' ` cC:(� I LEGAL DESCRIPTION 1/ ' l i%l //-) INSTALLATION OF: SEPTIC TANK /J SEEPAGE PIT TYPE AND SIZE OF FACILITY TO BE SERVED 1641)✓✓Yi l/Lr FINANCED THROUGH PERMIT NO. i ADDRESS �� C C PHONE I� . DRAIN FIELD .OTHER TO BE INSTALLED BY 5, SOIL TEST RESULTS /� Q NOTE: THIS OERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED `' ` �'41 FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. %% c> SEPTIC TANK SIZE MINIMUM DISTANCES. REQUIREMENTS FOUNDATION TO SEPTIC TANK ' J FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL I- f SEPTIC TANK . SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. 1 1 �) WELL TO SEPTIC TANK `7 SEEPAGE PIT DRAIN FIELDALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANCK �( SEEPAGE PIT DRAIN FIELD I & SEPTIC TANK. , SEEPAGE PIT L—. DRAIN FIELD TO RIVER, LAKE, STREAM. AREA SIZE CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. / �. HEALTH AUTHORITY ' OR LICENSED DESIGNER TYPE DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GEATE ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE, l/�//�6 co� X17 DATE � APPLICANT'S SIGNATURE / \ �,�artment of Environmental Quali%, Water and Sewer Questionnaire Dates�� 3 , Time Subdivision Le Block Lot Owner's Name: Mailing Address: Questions:. 1. How many bedrooms are now in your house? 2. How many bedrooms were in the house at the time of purchase? 3. Were the basement bedroom walls "roughed in" at the time of purchase?� 4. Was the basement bathroom plumbing "roughed in" at the time of purchase? (% 5. Did the realtor or builder inform you that you would have to enlarge the existing sewer system if you finished the basement bedroom(s)9 �LCsJ ✓�-tC. '7.C�„ R�C� 6. If on a public water supply, do you always have an adequate supply of water? 7. Is the pressure always adequate? 8. Who was the builder?C!5 9. Who was the home purchased from? OTHER COMMENTS: 5. LEGAL DESCRIPTION DATE RECEIVED • INSPECTION APPOINTMENTS STREET LOCATION 71 ME _ TIME TIME DATE DATE DATE INSPECTOR - INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC �p� 825 L Street - Anchorage, Alaska 99501 �iS�VtONMENT;IL I'((gTECTION • ENVIRONMENTAL SANITATION DIVISION MAY J 9961 Telephone 264-4720 F UNTO II `/ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE R' PA'CPLfTO DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM MAILING ADDRESS INDIVIDUAL/ON-SITE** PROPERTY RESIDENT (If different from above PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESSheY 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION _ STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OFBEDROOMS ❑ One ❑ Four ❑ Other SINGLE FAMILY _❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY ");�) INDIVIDUAL* *ATTACH WELL LOG. Awell log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM &2zYEAR ON-SITE SYSTEM WAS INSTALLED. INDIVIDUAL/ON-SITE** ❑ PUBLIC UTILITY2CX 42-,2e tG ecl 711v BEFORE PR CESSING CAN BE INITIATED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST 72-070 (Rev. 6/79) 72-010 (Rev. 6/70) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER ❑ FOUR ❑ SIX 2. WATER SUPPLY - ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: I , -S� If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS EU/APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter mu ace mpany certificate) ❑ DISAPPROVED DATE BY 72-010 (Rev. 6/70) OL'Zc1S - OaLL -�� MUNICIPALITY OF ANCHORAGE DEPT. GS !.;!" - DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIbtSVIFONir'.[NTAL cCTION; 825 L Street - Anchorage, Alaska 99501 • f"AY ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 RECEIVED - REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPEXTYOWNER /' / yy PHONE , MAILING ADDRESS NDN PROPERTY RESIDENT (If different from above) _ PHONE 2. BUYER c.¢,�o� /cic a PHONE yss-3ai3 MAILING ADD SSS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. RER/AGENT ALTy eSTo PHONE MAILING ADORES � 5. LEGAL DESCRIPTION / / STREET LOCATION �1 /t//,/- /L/ Gv iL ��rzNt�IS ✓ E �� 37ic EFt c -'—Y c v 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS SINGLE FAMILY ED One ED Four ED Other Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER �Sr�UPPLY ),� INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach, log if available.) 8. SEWAGE DISPOSAL SYSTEM M INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72:610(3/78) THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME , DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE "f9I SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY -'E1 INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM -EINDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE-INSTALLED INSTALLER in--]Septic Tank or ❑ Holding Tank Size: tag�iO If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK RER I- MANUFACTUsittij �t-n. u TOTAL ABSORPTION AREA MA ERIAL 4. DISTANCES WELL TO: Septic/Holding-Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ( e s r. UnrJl CR C_'. �1�r�nC�S F1�C �\ �n�(�mrn ol_iCIA. a l9� t--APPROVED FOR BEDROOM ❑ CONDITIONAL APPROVAL (letter must a c pang certificate) --DISAPPROVED DATEt r BY (Tit)e) LEGAL DESCRIPTION 72-010 (Rev. 3/78) PF4RFOP34E "13Q _ SOMI -. D FOR: PIONS. US SAS c M L SHEET �.i..�.�o �.�.. 5 John M. Lambs; P.E. 4303 North Star Street Anchorage, Alaska, 98503 907-279-8056 , REFERENCE: DATE to Z '� PERFORMED BY: LEGAL DESCRIPTION: ze�L DEPTx BEL0W' METER READING GALLONS PUMPED TIME ENCS GAUQNS,NET . �. so y jj Z� T 2 7 i is OV rol —FAvAL Rkt.,} , GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality "C" Street, Anchorage, Alaska 99503 274-4561 Date Received i O //1/7 �e Time of Inspection /0 ' 0 0 i9/9% Date of Inspection ioA'//?q REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & 14ATER FACILITIES //. FOR C✓��xa/;" — /s/ A :r 1. Approval requested by: 3LN-1—V03 �SU�� Mailing Address: U � Phone: 2. Property Owner: Phone: Mailing Address: 3. Legal Description: "-J 4. Location: 5. Type of facility to be inspected J .,,-,6.1 �L..;,•.,<<-.� No. of bedrooms 6. Well Data: v A. Type B. Depth is C. Construction D. Bacterial Analysis 7. Sewage Disposal System: t A. Installed 'dc'/ i'r, / i "?/ B. Installer C. Septic Tank: 1. Size ii 'o :s..%, 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, Sewer Lines Nearest lot line ,- Other contamination I B. Foundation to septic tank 3 3 Absorption area C. Absorption area to nearest lot line z / EQ -034 (1/74) Page 1 of two pages Page 2 of two pages - Rem st for Approval of Individual Jer & Water Facilities Legal Description / J`q la- LA'—w Comments Approved Disapproved Date io-- %� Approval,Valid for one year from date signed 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) 0 GREATER ANCHORAGE AREA BOROUGH,_ Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES Type of Inspection 2. Property Owner: 3 Ififf.11l FHA CONV A- Mailing Address: Name of Buyer: — Mailing Address: 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Agent: Mailing Address: 6. Legal Description: Location: 7 13 Type of Facility to be inspected: Water Supply Day Phone Phone Phone No. Bdrms. Type of Supply: Public Utility Individual If Individual, number of dwellings presently served _L _ If Individual, depth of well v�6 Sewage Disposal System Type of System: Public Utility Individual (on-site). If Individual, date of installation i % rZ - Q - 3 '7 c—J / EQ -037 (1/74) • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-201-13 Expiration Date: Ui (c 0 I S CF- 1. GENERAL INFORMATION Complete legal description _TALUS WEST BLK 2 LT 3 Location (site address) _11949 WILDERNESS DR Current Property owner(s) _FRED WILSON Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class _ Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: °/7 well lco .( Gt- r Distance: 5 S Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 45d-- o Date of Payment 1i-1 r C,0667- Receipt ,06DZReceipt Number - I c f COSA#_ 06C1$I(2 s Date: 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 all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE. Engineer's Printed Name MIKE N ANDERSON PE Date 4/2/18 By: Pr A 1 y a l cUULLy _ Original Certificate Date: qaJ.. 6 ,10 1 e 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. F�a11aITSy:1IF) 1=1!Y&? COSA Checklist X Nitrate Advisory ' Septic System Advisory r. -ANQ7111c Advisory' Well Flow Advisory Other-, cOaPbWe m..uo-rar2 eoo .'... ' OF 5�• •• ,� , Y' 49sw dy • . 6. DSD SIGNATURE p....[l ................• T • aJCNA`l N. ANp[RSON : C' 3 Sygtem #1 A roved for pp bedrooms. fPa ; 4469 .,wa rE System #2 Approved for bedrooms. i•°f� u�/�Y •ti�;o��,," Disapproved. �a4, _ oiEss Conditional approval for bedrooms, with the following stipulations: By: Pr A 1 y a l cUULLy _ Original Certificate Date: qaJ.. 6 ,10 1 e 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. F�a11aITSy:1IF) 1=1!Y&? COSA Checklist X Nitrate Advisory ' Septic System Advisory r. -ANQ7111c Advisory' Well Flow Advisory Other-, cOaPbWe m..uo-rar2 eoo .'... ' 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 BLK 2 LT A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed_1971??_ Sanitary seal (Y/N) Y Total depth 1267? ft. Cased to UN ft. FROM WELL LOG Date of test Static water level ft. Well production g,p.m_ Parcel 10:015.201-13 Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) 30'+ AT INSPECTION 3.2.2018 65 ft. 7+ g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 0.146 mg/L Arsenic: ND ug/L Date of sample: 3-12-2018 B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping NEW Pumper Collected by: Mike Anderson Date installed 3.24.18 Cleanouts (Y/N) Y High water alarm (YIN) W9 C. ABSORPTION FIELD DATA Date installetlCO T 1971 Soil rating (BED/SF) 132 System type CRIB Length 17 ft. Width 16 ft. Gravel below pipe 6.0 ft. Tota; depth 10_2' ft. Eff. absorption area 396 ft" Monitoring tube Y Depression over field N Date of adequacy test 3.12-2018 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 28• in. Water added 500+ gal. new depth 30 in. Elapsed Time: 1440 min. Final fluid depth 28 in. Absorption rate >= _500+_g,p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFTSTATION Date installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES 14gR�I(NP�IPI�N] Size in gallons Manhole/Access (Y/N) "Pump off level at in.High water alarm level at _ in. Cycles tested Meets alarm & circuit requirements? Septic tank/lift station on lot 954 Absorption field on lot 1004 Public sewer main On adjacent lots 1004 On adjacent lots 1004 Public sewer manhole/cleanout Alk /kip"L Sewer /septic service line 50'+ Holding tank 100'+ Animal containment areas 1004 Manure/animal excrete storage areas 1004 SEPTIC/HOLDING TANK ON LOT TO: Building foundation 104 Property line 20'+ Absorption field 5'+ Water main #* 100 r•1 Water service line 50'+ Surface water 1004 Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 104 Building foundation 204 Water main ML t W ' ot- Water Service line 50'+ Surface water 100'+ Driveway, parkingtvehicle storage 104 Curtain drain NA Wells on adjacent lots 100'+ F. COMMENTS BOTTOM OF CRIB DIFFICULT TO PROBE. "WELL WAIVER IN THE FILE. WELL DEPTH & YEAR DATA FROM MOA FILE. 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 MIKE N. ANDERSON, PE Date 313112018 COSA canary sheet_2-6-15 doc �PqE OF AAt4;?e.Y, C ° MICHAEL N, AN'DERSCN .. < CE 9