HomeMy WebLinkAboutTALUS WEST #1 BLK 3 LT 17Talus W st
Block
Lot 17
#0 ! §- 202 - ! 4
Municipality of Anchorage
Developmen! Services Department : '~'.
Building Safety Divlsion
On-Site Water and Wastewater Program, 4700 S. Bragaw St. -~'
P.O. Box 196650 Anchorage. AK 99519-6650 Page
www.cLanchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: -~'~ 0 ~O ~5'~ PlDNumber: 0~-5- ~0~, -~,~-
"" "'~' ~ ~,,~ J"q C~r d, .~, c~ r~ Wastewater System: DNew [~ Upgrade
~"" ~.~5"L~ ~j~'t\~.t. ncs~ ~P....%~, ABSORPTION FIELD
LEGAL DESCRIPTION 0.~, ~.we ~ ~ ~,
~New D Upgrade ~ 3 Fl. 0~6 F,
SEPARATION DI~TANOE~ ~ septic ~ Holdi~/~
TO Septic Abso~tior L~ Holding Pubfl~k
Tank FieldStation Tank 8~r Line ' ~ Ga.
~ Ioo'+ IO~% ~)A N}A Ioo'+
'-- u' I /5 '-"-
~ ~o s~a~ ~r~4 ,- ~d~ BENCHMARK
~j, ... . .. %1%
,nspectionspedormedb~70~EagleRlwrt--PR"d, Ne.~es. 1' %-~-O~
~ RNe,, AI~, ~5~ 2~ [- b ' O
Develbpment Se~ices Depadment Approval~%t~%"°:'~c~ -ssolc ~w~ /~'~'~J
PERMIT NO. SW010258 PACE 2 OF 5
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650e Anchorage, Alaska 99519-6650 e Telephone: 545-4744
On-Site Waslewofer Disposal System and/or Well Inspection Report
#/
LECAL LOT 17, BLOCK 5, TALUS WEST4S/D
P.I.D. NO. 015--202--14
16
C02
EXI! TING 1 GALLON
TANK
INTEGRITY VERIFIED
8-6-01)
DBL1
DBL2 TH#1
ERTER VALVE
(D~'--
CE-8801
19
PERMIT NO. SW010258 PACE 5 OF 5
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650, Anchorage, Alaska 99519-6650 ,Telephone: 545-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
,al
L£CAL LOT 17, BLOCK $, TALUS WEST'S/D
P.I.D. NO. 015--202--14
ST1 ST2 /lO0.g'
FINAL
94'2'/ I '" GALLON I
J SEPTIC TANK J
A 0 ~
FCO --- 18.5' 24,0'
$T1 21.7' 27.5'
ST2 27.0' 52.0'
DBL1 --- 50.5' 54.5'
DBL2 --- 51.0' 55.0'
DV --- 52.0' 56.0'
C01 45.0' 14.5' ---
MT1 40.0' 14.5' ---
C02 40.5' 57.5' ---
MT2 40.0' 55.5' ---
C05 ---
~__.T~ --- $5.0' 58.0'
C02=93.8'
MT1 =85.6' j
MT2 =85.6'
·
NO WATER FOUND
'Iff.6' B.O.H.
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wasfewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Jul 23, 2001
Expiration Date: Jul 23, 2002
Permit Number: SW010258
Legal Description: TALUS WEST #1 BLK 3 LT 17
Design Engineer: 0003 S & S Engineering
Owner Name: Judy Morrison
Owner Address: 11816 WILDERNESS DR
ANCHORAGE, AK 99516-2234
Parcel ID: 015-202-14
Site Address: 011816 WILDERNESS DR
Lot Size: 19570 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
~'~ Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
Ail 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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By: ~"~
Issued By: ~
Date: *7 - 3.q-o /
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWEPJVVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLI'NG
Parcel I.D.
Permit Number SW O147 Z~8
Property owner(s)
Mailing address (1)
Mailing address (2)
Legal description (Lot, Block & Sub'&) )-- O 'T'
Legal description (Section, Township & Range)
Lot Size /'~ .~7 ~) Acres/Sq. Ft.
Day phone -5 ¥..C --
Zip Code ~q~l{
Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
~] Well Only []
[] Water Storage []
Jacuzzi
Water Softening Unit
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance withsa~o~'~l~[~l~[pal Codes.
'~2~ ,7034 Eagle Rl~er Leap Ro&d No. ~
Eagle Rlve~", Alack& 99577
(Signature of property owner or authorized agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev, 12/oo)
Waiver Fees:
Date of Payment:
4~/~' Receipt Number:
July 30, 2001
ROBERT C. COWAN, P.E.
CML ENGINEERS
(907) 694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCIIORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 17, Block 3, Talus West Subdivision
It is requested that you issue a permit to upgrade a septic system to serve the existing
four bedroom dwelling on the referenced property.
A test hole was excavated and percolation test was performed on 7/21/01. The
approximate location of the test hole is located on the attached site plan. Ground water
was monitored as shown on the attached soils logs. After a week of monitoring the test
hole was found to be dry.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
If you require additional information, please contact us.
Sincerely,
RCC/bjj
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE R~/ER. ALASKA 99577
SITE PLAN DESIGN 1" = 50'
/
/
/
/
/
/ / -.A
/ /
/
SITE PLAN DESIGN 1"
Municipality of Anchorage ,~,'fe~r~EER'S ,'
~ '~,' .~ ~'.%_'..-;-f~
Development Services Department ~.~/ .
BufldingSafetyDivtslo~ ~ .:/~,gt~/ // ~' %*';
o..S,e W.r W.--ter P m,,00 S.th
P.O. Box 1~ge.~51~ ~ ~ ~0SE~T ~ COWAN ~.~
Sods Log - Percolahon Test '~,-*.~
Site ~an
5.
6-
7-
8-
9-
10-
WAS GROUNDWATER
ENCOUNTERED?
$
IF YES. AT WHAT DEPTH? -- L
o
Depth to Water ARer ~ p
Monitoring? '~i ~ ~" E
14-
15-
16-
17-
18-
20-
COMMENTS
Reading Date Gross Time Net Time Depth to Water Net Drop
7/~,/~ / o - ~ ' -
,, ', ~ ~" ~o I ~ '/~" ~ Y~ '*
~o~ 7%" t V~"
PERCOLATION R~TE O~ (0. -~ ~t~',~h) PERC HOLE Dt.M, IETER ~o"
TEST RUN EETWEEN '7 '/,1~- Fi' AND ~:; FT
PERFORMED BY:$ &. $ IrNGINEERING I _ CERTIFY THAT THIS TESTjWASi
PERFORM E D IN ~,~,,~'~al~l~i[~'l~.kldp~'a i~. I~tCIPAL GUIDELINE S IN EFFECT ON THIS DATE. DATE: Eagle Rlv~r, Al~s~a 99577
Municipality of Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 #L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: ~' ~) ~)'~
LEGAL DESCRIPTION: LOT' J "~
6
7
8
9
3
11
12
13-
14-
15-
16-
17-
18-
19~-
20-
Township, Range, Section:
SLOPE
WASGROUNDWATER
ENCOUNTERED?
IF YES, ATWHAT
DEPTH?
SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Oro~
PERCOLATION RATE ~'~o-~ (m~n~teS,,inch)PERCHOLEDIAMETER ~ e
TEST RUN BETWEEN "~ FT AND ~ FT
COMMENTS.
asea 99 ~ '
72-008 {Rev. 4/85)
ROBERT C. COWAN, P.E.
CML ENGINEER~
(907) 694-2979
FAX (907) 694-1211
SO~. TEST
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Lot 17, Block 3, Talus West S/D
July 3, 2001
GENERAL:
The scope of this project includes the upgrade of a septic system & drainfields
to serve the existing four bedroom residence located on the referenced
property.
Construction shall be in accordance with the approved site plan and design
dra~vings, Municipal permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
The contractor shall be responsible for obtaining any necessary underground
utility locates.
Unless specifically agreed otherwise, the property owner shall be responsible
for final grading areas subsequently depressed from soil sealing.
Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department for system installations. Owners installing their
own systems must also receive prior approval from the Municipal Health
Department.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
The septic tank shall be sufficiently bedded to prevent sealing or shifting of
the tank.
17034 NORTH EAGLE RIVER LOOP * SUffE 204 · EAGLE RIVER. ALASKA 90577
Page 2
Lot 17, Block 3, Talu. West $/D
July 3, 2001
All standpipes on the septic tank shall extend a minimum of 12 inches above final grade.
Septic tanks installed with less than 4 ft. of cover shall be insulated.
A foundation cleanout shall be installed one to four feet from the building foundation. In
the line between the tank and the leachfield there shall be two adjacent cleanouts (unless
an effluent pumping system exists within the septic tank). These cleanouts shall be
located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line,
shall be to clean toward the leachfield. The second cleanout shall be to clean toward the
septic tank.
Final grading over the septic tank shall be such that a positive slope exists away from the
septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the design. The bottom ofthe
excavation shall be within 2 inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (rafted-up) before gravel (sewer rock)
placement.
Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced downward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
e
A silt barrier must be installed between the final gravel layer and the native soil backfill.
Ensure the silt barrier covers the entire gravel surface before placing backfill.
Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations
shown on the design, and extend a minimum of 12 inches above final grade. The portion
of the monitoring tube extending through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is equivalent to the effective depth of
the gravel as noted on the design.
Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The
finish grade over the trench must be mounded to prevent the formation of a depression
after settling.
Page 3
Lot t7, Block 3, Talus West $/D
July 3, 2001
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Type of Pipe perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM FSI0 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be approved by the inspecting engineer.
Insulation shall be at least 2" lhick extruded direct burial polystyxene (Dow Chemical
Company Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or
equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
When sand is being used as a filter material, its gradation specifications must conform to
current M.O.A. or D.E.C. requirements, which ever requirement applies.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of the
wastewater disposal system. These inspections will occur as follows:
Page 4
Lot 17, Block 3, Talus We.t
July 3, 2001
The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
The second inspection must be conducted aRer the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer
is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-
construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or
control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these specifications
and plans and in accordance with the attached M.O.A. permit. There will be no contractual
arrangement existing betxveen the contractor and S & S Engineering. S & S Engineering shall be
the owner's representative and will inspect the work as stated above to document the contractors
activities. Final acceptance of the contractors work rests with the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor to
carry out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR / INSTALLER
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: ~] 0 ~ ~-~' PID Number:
Name:
Tho,~od ~ocr,s~ Wastewater System: o New ~ Upgrade
Address:
Phone:
3g~- ~7'[N°'°lBe~r°°ms:
~ ~ Deep Trench ~ Shallow Trench ~ Bed D Mound ~ Other
LEGAL DESCRIPTION Sod.~b.~: Tot., ~.pth ,rom o,i~i.~,r~d~:
GPD/Sq.
Township: ~ Range: J Section: Fill added above original grade: Gravel length:
Ft. Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
Ft. Ft. SC. Ft.
GP~r ~t.[ '~. TANK
SEPARATION DISTANCES ~ s~.tio ~,o~.~ ~ s.z.~.~.
TO Septic Absorption Lilt Holding Public/Pdval Manufacturer: Capacityin gallons:
From Tank Field Slation Tank Sewer Lines
Well J ~ O ' Material: 5~e¢1 Number of C~pa~tments:
Surface
Water >lOO' LIFT STATION (~,~,)
Lot 'Size in gallons: ~ Manufacturer:
Line ~'
I
Foundation,il "Pump on" level at: I "Pump off" level at: ~ High water alarm at:
CurtainDrain ~'~' I Pump Make & Model ~ Electrical Inspections performed by:
Remarks: hls~ ~¢~ ~ )~5~/(~ BENCHMARK
Elevation:
ENGINEER'S SEAL
E~cttop ~ecb~[cci Se~vF
Inspections performed by: ~/~F~F Te~. %uc. Dates lsl I0ff/7/¢ z ~"~'2~ W , ................ ' ~-- ~ % ':,,,~¢r
' 2nd
Department of Hea~ a~d Human Services approval
Reviewed and approved by:
Permit
Page ~'" of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 $ Telephone: 343-4T4~
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: /-, 17, /~ -?.. Tc~/cc~ ~,U~_j~. ~ ,/
PID No.:
e~
il.G
PAGE 1 OF 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:SW920356
DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES
OWNER NAME:MORRISON THOMAS A &
OWNER ADDRESS:liS16 WILDERNESS DR
ANCHORAGE AK 99516
DATE ISSUED:10/15/92
EXPIRATION DATE:10/15/93
PARCEL ID:01520214
LEGAL DESCRIPTION: TALUS WEST #1 BLK 3 LT 17
LOT SIZE: 19570 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
THIS PERMIT IS ISSUED FOR THE REPLACEMENT OF A COLLAPSED
TANK ONLY.
RECEIVED BY:
ISSUED BY:
DATE:
DATE:
~at/oP Techmc~l Services
14880 ~cho Street ~'~~.~,~
9,, ~'.. c~- 35~ '
SEPTIC S~'$T, IXPd-R~D~
S IT~- PI.,,4H
N07'~! Till5 ~ I~or
/41,& Aocg[ 7'toN_.c
PERMIT NO.
DEPARTMENT OF HEALTH AND ENYIRDNMENTBL PROTECTION
o~._, =.TREET, HNuHORH~E, ~K.
_c, 4-4~ ~
C,t-~--S I TE SEI-IER LIF',SRR[)E F'EE:/'I I T
APPLICANT
LOCATION
LEGAL
JUDITH MORRISCN
Ll? B} TALUS WEST
SAR 80X :L,,_,r D
LOT SIZE
}~4-9050
2~000 =.YJRRE FEET
TYPE OF SGIL ABY]RPTION SYSTEM I~,. TF..EN.H
MRXIblUM NUMBER OF BEDROOMS = 4
SOIL RATING (SQ FT/BR)= 250
THE REQUIRED SIZE OF THE SOIL ABSORPTION _4_,TEM I:..
DEPTH= -~]~-'- LEIqGTH= L-] GF-'li~'/EL DEPTH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) 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~CAVRTION (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 E~CRVRTION (IN FEET).
F-'EL-n-.L~ I RE[:" SEPT I C: TFt~-tk'. S I ZE= ~L~50 GF~I_LJ]~-~S
F'ERMIT RPF'LICANT HRS THE F..E;.PON_qBILIT"r TO INFBRM THIS DEPARTMENT [:,URING THE
INSTALLATION INSPECTIONS OF ANY I,IELLS ADJFICENT TO THIS PROPERTY AND THE
RE:-.IDENCE_. THAT THE WELL WILL ':;:'c",~E
NUMBER OF '- ' ' '-- .......
TI--IA] ( 2 ) I iq_.PECT I ~]i'-.IS liRE F." E (~-!,J I RE[:,
,-, ,c - - ,n, BY
BRCKFILLING OF ANY :,T-,TEM WITHOU'F FINAL INSF'ECTInN AN[:, HPPR_~RL THIS
DEPARTMENT ~IILL 8E SUBJECT TO PROz. ECUTILN.
MINIMUM DISTANCE BETWEEN R WELL RND RNY ON-SITE SEWAGE DISPOSAL SYSTEM IS
t00 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC HELL DEPENDING
UPON THE TYPE OF PUBLIC HELL.
MINIMUM DISTANCE FROM R PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PEF.:]~'I I ]- E>~P I RES [::,ECEI--1BER 3::.1_.. :l.S-~BEl
I CERTIFY THAT
t: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNICIPALITY OF RNCHORRGE.
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 REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
V4. 0
ANCHORAGE AREA
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
FROM WELL //~
INSIDE LENGTH
MANUFACTURER "~?~ '"~"/~ MATERIAL
INSIDE WIDTH LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACIT _Y~d A~L LONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL /~"~
.FOUNDATION
.NEAREST LOT LINE /~' ! TOTALoF LINEsLENGTHg¢~'
TRENCH WIDTH ~ /
IN. TOTAL EFFECTIVE
SQ. FT. LENGTH OF EACH LINE
.~/ DEPTH OF FILTER /
MATERIAL BENEATH TILE /~-~ IN. ABOVE TILE (~ [/ IN.
NUMBER OF LINES / DISTANCE BETWEEN LINES
ABSORPTION AREA ./~/~-~ ;~¢
DEPTH: TOP OF TILE TO FINISH GRADE
WELL:
TYPE
BUILDING
FOUNDATION
CESSPOOL
,~,PPROVED
CONSTRUCTION DEPTH
NEAREST NEAREST SEPTIC SEEPAGE
LOT LINE__ SEWER LINE__, TANK SYSTEM_
OTHER SOURCES
. DISAPPROVED REMARKS
DISTANCE FROM:
DISTANCES:
INSTALLED BY: ~/~ D
SEWER LINE DEPTH:
LOT SLOPE:
Form LQ-032
DATE
DIAGRAM OF SYSTEM
G.A.A.B.
"· Gr~ ANCHORAGe AREA I~U~
PERMIT NO.
DEPARTMENT OF ENVIRONMENTAL QUALITY
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
NAME OF APPLICANT
/~'~"~'~//'~.~"(" GE PiT '" DRAIN fIELD
DEPARTMENT OF ENVIRONMgNTAL-QUAL'~TY AUTHU~i~L--~ ~ . ~
SEPTIC TANK SI~ ~ ~ / ~
FIELD
FIELD .
SEEPAGE P~
ALSO CONSIDER AREA WELLS.
SEEPAGE PIT
DRAIN FIELDJ/(/) / /
GRAVEL BACKFILL-
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
GREATER NCHOF~AGE ARE/ BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
, C£RTlfy THAT i AM FAMILIAR WITH THE REQUIREMENTS OF ~~ ~~~__ ~
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAI~ CODE,
DATE ~g~ 5~ APPLICANT'S SIGNATURE /'
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTH .O.RITY:APPROVAL
Parcel I.D. 015-202-1~,
1. GENERAL INFORMATION
'cOmplete legal d~scription
Lecation (site address or directions) 11816 Wilderness Drive
· Curt'ant Property owner(s)
· '-.. Mailing address
Lending agency
FOR A SINGLE FAMILY DWELLING
Expiration Date: .//- ,3. '~ ' 0 1
L6t 17, Block 3, Talus West #1
Judy Morrsion
11816 Wilderness
Dayphone 3&5-36&7
Dr., Anchorage, AK 99516
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class~
Public Water System
Well
[]
[]
[]
[]
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tank []
Community On-site []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public
water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority 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. S & $ ENGINEERING
Address ~'~jle River, Alaska ~577
E~gineer'sPrintedName'R°bert C. Cowan, P.E.
5. DSD SIGNATURE
~" _'Approved for ~
Disapproved.
Conditional approval for
Phone
Date
........... ..?,g.,,,,
bedrooms.
bedrooms, with the f°llowing stipulations:
Additional Comments
...
,E~ ON.,cfr; ·
..-~: WATER AND
~ ;
~ '. PROGRAM ~.. ~:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: ~ ',,~ ~ - ~/
(Rev, 12~C0)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ct.enchorage.ak.us
(S07) 343-7~4
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Deacriptlon: )- 0 T 1'7
WELL DATA
Well type pR, VaT(.
Date completed ?/k/.7 5'
Total depth ~ ~ ft.
If A, B, o~ C provide PWSID # --
san~-y se~ I~N) v~-~
Casedto Ho-~ ft.
FROM WELL LOG
Date of tast '7 / (= / '7 .)'-
Static water level '~' fi.
Well production ~' g.p.m.
WATER SAMPLE RESULTS:
Coliform. O colonies/100 rnl. Nitrate J-¥~ mg./I.
Date of sample: '7/a,'//O t Collected by:
· well Logan,) ¥~ J
Wires propedy protected (~/N)),4 ,f
Casing height (above ground) t ~ 4 In.
AT INSPECTION
~.//3/o/
ft.
g.p.m.
Other bacteria 0 colooies/100 mL
S & S ENGINEERING
11u~4 ~agie Kiver Loop Koic~ NOv 204
B. SEPTIC/HOLDING TANK DATA
.(...'rankaize J~l.~O gaL, Number of Compartmonts '~
-! i' !F~Un.dati°n deanout {~) ¥~,,s Depression over tenk (Y~
:.. Date of pumping r/~./0 I Pumper I SSA c..
'~' ABSORPTION FIELD OATA'
Eagle River, Alaska
Date installed
Cleanouts ~1)
High wate~ alarm (Y/~
IO/t't / q~
Datelnstelled ~ fa/OI Soilrattng rfta/txlrm) O. G Systemtype T/~e,,, c-14
Lengt~ ~> ~ ft. Wldth 3 fl. Gravel below pipe ~' ft.
Total depth )1 °/'~, ft. Eft. absorption area /O0~'~ Monitoring tube 'fY, J Depression over field ~' ~
Data of adequacy tast ~/4 -/.,4u./ eesuits(Pas~F~.~~ For y bedrooms
Fluid depth in absorption field before l~t~,~i~'~+ Water added gal. New depth in.
Elapsed Time: m~........,~nal fluid depth in. Absorption rate >= g.p.d.
Any mj~ent (pest 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Data installed Size in gallons ~
'Pump on' level at in. "Pun'~ off' I~.~.~. ~h water alarm level at
Datum ~ Meets alan~ & circuit requirements?.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanldlilt stafion on lot
Absorption field on let
Public sewer main
Sewer Isepflc service line
On adjacent lots
On adjacent lots
Public sewer manhole/deanout
Holding tank ,,~/',4
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Il
Watar main ,/~ / ,6
Wells on adjacent lots ! O0 ~-~
property line ~'~'/
Water service line.
Absorption field .t'" ~-/'
/0 d* Surface water /Od
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
'
Property line ) ~ s Building foundation. II Water main
Water Sewice line /O '~' Surface water. / o 0 '~ Driveway, parking~ehicle storage ~ 0 +
Curtain drain ~e~'~ /¢'a,~,,,~ Welis on adJacent lots /
F. COMMENTS . :-.'
G. ENGINEER'S CERTIFICATION
~n~an~ ~ MOA H~ guidelines
Date
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number
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
Parcel I.D.#
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Day phone
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
NOTE:
Individual well ~-/
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72 025 [Rev. 1/91) Fronl MOA ~21
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(~ Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: /-cT I~., BL~ 3 '[/~L~.¢ M~'r' 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 N .~.
Date completed '7/(~/'75' Driller H.4. ~'¢r41~E~G
Casedto $8~ [2"
Casing height
Wires properly protected (Y/N) ~'
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot I10'
Absorption field on lot I~"
Public sewer main
Sewer service line
g.p.m.
; On adjacent lots > loc '
; On adjacent lots
Public sewer manhole~cleanout
Petroleum tank ~oNE ogS£,~v'gD
WATER SAMPLE RESULTS:
Coliform
Date of sample: Io/1£ /~i 'z
Nitrate
5') ,~,/~ Other bacteria
Collected by: F/--A TToP TgC,~/
B. SEPTIC/HOLDING TANK DATA
Date instalred (~ / / 7 / ? 8 Tank size / g,5-c~ ~,,~ / Compartments
Cleanouts (Y/N) 'd Foundation cleanout (Y/N) ?' Depression (Y/N)
High water alarm (Y/N) /~/,,~, Alarm tested (Y/N) /~./~.
Date of pumping N, A. (j/'4~_~.~_,) Pumper /~, ,4
/Y
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) onlot II c, ' Onadjacentlots ;:=, ~oc~, Foundation
To property line ~(~' Absorption field ~ Water main/service ji~e
Surface water/drainage
72-026 (Rev. 7191) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
D. ABSORPTION FIELD DATA
Date installed ~ 115175 Soil rating
Length (o;[ ' Width
Total absorption area I~12 ~/
Depression over field (Y/N) fV
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
Wellon lot 1~5-'
To building foundation
On adjacent lots ,,'> 3¢"
Surface water >' (°°¢
Curtain drain N,¢(~
Surface water
.2.~o ¢'//~,~t~'~ System type
Gravel thickness 13 ¢ Total depth
Cleanouts present (Y/N)
Date of adequacy test i o///~,
for '7' bedrooms
If yes, give date N.A,
On adjacent lots ~'/oe ' Property line
To existing or abandoned system on lot A' /-.
Cutbank N,A, Water main/service line ~ .5-o '
Driveway, parking/vehicle storage area '~ 5-o'
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
~,~_~'~,~,,.
Signature
Date
HAAFee$ / 7E~,DD
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
[~0~ J ~.<~ Date Received March 9, 1976
·
Time of Inspe ~---2'
~y Date 0f I~specti0n ~0-7~ Wednesday
~/~ INDIVIDUAL SEWER & WATER FACILITIES
co=v.
l. Approval requested by: Security National BAnk
Mailing Address: Pouch 7-777, 99510
Phone: 278-1541
2. Property Owner: Candee Construction
Phone: 274=4505
Mailing Address: % 507 w. Northern Lights Blvd. Real Estate Corner
3. Legal Description:
4. Location:
5. Type of facility to be inspected
6. Well Data: Individual
A. Type ~'
C. Construction
7. Sewage Disposal System:
A. Installed
Lot 17 Block 3 Talus West Subdivision
Wilderness Drive
Single FAmily
No. of bedrooms
B. Depth 87 '
D. Bacterial Analysis
Aerobic System ~'~'/9~.~- ~-
B. Installer
C. Septic Tank: 1. Size
2. Manufacturer
D. Seepage Pit: 1. Absorptiop Area
2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
, Absorption area
, Other contamination
, Absorption area
C. Absorption area to nearest lot line
, Sewer Lines,r'
EQ-034 (1/74) Page 1 of two pages
~,.~,?
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" Street, Anchorage, Alaska 99503 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
MUNICIPALITY OF ANCHORAGE
ENVIRONMEN fat.
1. Type of Inspection: CMRO VA FHA CONV
2. Property Owner: C ,~,~-J -b~z-~: ~>--~ ~'~, ,~ c,~
Mailing Address: ~ ~°'7 ~, ,~]~¢~ [_~T~ Day Phone
3. Name of Buyer: ~,~o~l~.o L.. ~(2-~-~
Mailing Address:
4. Name of Lending Institution:
Mailing Address:
5. Name of Realtor or Agent:
Mailing Address:
Day Phone
Phone
Legal Description:
Location:
7. Type of Facility to be inspected:
8. Water Supply
Type of Supply:
No. Bdrms.
Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System:
If Individual, date of installation
Individual
Public Utility Individual (on-site)
CO-037 (1/74)
Page 2 of two pages - Ret st for Approval of Individual Y ~r & Water ~ac~t~es
~Legal Description Lot 17 Block 3 Talus West Subdivision
Comments
Approved .... Disapproved Date ,~ '-~P -~
Approv~Valid for one year from date signed
Greater Anchorage ~a 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)