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HomeMy WebLinkAboutTALUS WEST #1 BLK 3 LT 18 Talus West #1 Block 3 Lot 18 #015-202-13 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221383 PID Number: 051-202-13 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name JONES ABSORPTION FIELD On Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 11806 WILDERNESS DR ANCH AK ❑ Other Phone Number of Bedrooms Soil Rating ITotal depth from original grade 4 0.8 GPD/SF1 8 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4 Ft. Gravel depth beneath pipe 4 Ft. Subdivision Block Lot TALUS WEST #1 BLK 3, LOT 1$ Fill added above original grade 0.5 Ft. Gravel length 2X47-94 Ft. Township Range Section Gravel width 2 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 752 Ft2 Ft. Well 1001+ 100'+ 50'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity TANK 1250 Gal. Surface Water 100 '+ � 0Q '+ Material Number of compartme its Lot Line 10'+ 10'+ NA PLASTIC 2 Foundation 101+ 101+ LIFT STATION Manufacturer Capacity Remarks TANK DEMO PER UPC, Gal. Alarm location Electrical installed by I PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Installer MIKE ANDERSON P.E. Drainfield 3034 CO/MT3034 Inspector MIKE ANDERSON P.E. BENCH MARK (Assumed elevation) 102.8 ft Inspection st 10114/22 10/15/22 Location and description dates:2"d r OF MANHOLE 341h ITOP ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date s•r i'�" • 'i, '' 3 *"*'* * M*6 !� :n • MICHAEL N. ANDLPSON , `. •. Septic S stem Approve Date©zf%r''S•.,lt� CE - 945 �- rr?r' r � Note: this a provaf does not include well permit requirements. ,� 'C,' fStl v' - (Rev 05102118) Permit No. OSP221383 Page 2 of 2 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 #1 BLK 3, LOT 18 PID No.: 015-021-13 —'CO,8 f �\ \ SEPTIC S /j / 0 `MT2// f/ I C0 �l // k / ® WELL /' WELL U DRIVE 1 \ TTER / — COC&3// �5 OL N PLASTIC TANK O / LID BENCH 100' TC01 \ C01 / /' \��\ \ SEPTIC \ FC \ MARK / B 0 1 \ l `N 01 02 3 20 ; 19 22 2 22 ( 25 Fb 2V 25 41TTER 3�5 5 'S Tc 1jC ELL I C0 52 42 7 CO 28 It co CO /J CO / MT: MT1 SBUILT SCALE: "=50" N \ MARK / B 0 1 1 l 18 01 02 3 20 ; 19 22 2 22 ( 25 3 2V 25 41TTER 3�5 5 'S 30 30 6 52 42 7 28 8 W/ PERS SEP11C SECTION TR gi NO WATER ® 82 OCT 2022 N.T.S. ow M® 45 16 26 ®®®� OF ®®® 0 AW AV ?' 49TH •� ®O MICHAEL N. ANDERS( No. CE 9469 .j •.10-22-22 r \. ®®�®E ®moi Municipality of Anchorage Development Services Department On -Site Water and Wastewater Section .a, 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Soils Log - Percolation Test ................ •� MICHAEL N. ANDERSON J •F�:: r9 IN•e 1.. 74fiQ .`...: i'i.eOF Performed For: ,�. G� Date Performed: ``����'� 7✓Z--� Legal Description: T 0. `'� L' W 2 h �- 4-t { 1--, ��% Township, Range, Section: Depth (Feet 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18= 19- 20 - COMMENTS "P f�-9- t in %11 ) I �dfilo�. oo S c--, 5 WAS GROUND WATER `/ ENCOUNTERED? f'7 E) IF YES, AT WHAT DEPTH? Depth toWater Atter r T Monitoring? Date- r s L 0 P E C* Site Plan Reading Date Gross Time Net Time Depth to Water Net Drop 3� --A `_ if 0 t c 3 3o rt 3 g PERCOLATION RATE V (rrinut.Anch) PERC HOLE DIAMETER LP t TEST RUN BE EEN FT AND =- L.11 / 1 FT -fin t � , . � PERFORMED BY: jL'-t I�Jt - - - - I CERTIFY THAT THIS TEST AS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: V 2 �-f 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 httpfivnvw. muni.org/onsfte Onsite Wastewater Disposal System Permit Permit Number: OSP221383 Work Type: Septic Upgrade Tax Code Number: 01520213000 Site Legal Address: TALUS WEST#1 BLK 3 LT 18 G:2736 Site Mailing Address: 11806 WILDERNESS DR, Anchorage Owner. JONES BILL L Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: ,rcpt s �J O w n ep:n•tment Lot Size in Sq Ft: Total Bedrooms: 10/5/2022 10/5/2023 19164 Q Disposal Field 0 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, a drainfield confirmation test hole is to be provided to determine the soils classification, 7 - day groundwater elevation, and percolation test results are consistent with design. Construction may proceed at your own risk before the 7 - day ground water monitoring is complete. If the results require a design change, construction of the system will stop pending On- site review and approval. Please submit stamped and signed results with the inspection report/ record drawings. Received By: Issued By: Date: ( 011 2 2� Date: T 0 M UHMp ,\ U -N OF ANCHORAGE GE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 ON-SITE SEPTIC[WELL PERMIT APPLICATION Parcel I.D. 015-202-13 Property owner(s) JONES Mailing address 11806 WILDERNESS DR, ANCHAK Site address SAME Legal description (Sub'd., Block & Lot) TALUS WEST#1 Legal description (Township, Range & Section) Lot Size 19164 Sq. Ft. Number of Bedrooms 11 Day phone BLK3LT18 APPLICATIONIS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Fx� Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank 0 Upgrade 0 Duplex ElHolding (D) Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A 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: Q5 a Date of Payment: �l A311269 Receipt Number: as 3015 Permit No. 6612g;2-1393 Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Sept 18, 2022 Municipalities of Anchorage On-Site Water and Waste Water Section 4700 Elmore Rd Anchorage, Alaska Phone 343-7904 Re: New septic tank permit Legal: TALUS WEST#1BLK 3 LT 18 To whom it may concern: This is a request for a septic permit on the above referenced lot. From the MOA file no documentation exists therefore a new system has been designed. A perc test and soil log will be done prior to installation, but from the neighboring lot 17 the soils appear to be in the 20 to 30 minute range which is what we have used for this design. The test hole #2 from lot 17, shows loose ML with a perc rate of 26.7 minutes per inch with no water and a total depth of 19 feet. This new system will be installed in this material and will be verified with a new test hole and perc. If this new system is found to be installed in the old system area it will be decommissioned per MOA requirements. This new system will not impact any of the neighbors or encroach on any wells, septic or open water issues. No steep slopes or cut banks exist within 50 feet of the site. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221383, Curtis Townsend, 10/05/22 SEPTIC FIELD SECTION DESIGN CRITERIA: 6.0' EFFECTIVE 4 BDRM X 150 = 600 GPD SOILS = 600/0.6 = 1000 GPD 1000 GA/12= 83' 2.0' WIDE 2 x 42' LONG (1) TRENCH 8.0' DEEP 1.0'2.0' -8.0 -2.0 MOUND OVER FILTER FABRIC SEWER ROCK ‘3,3( GRADE 1"=200' PROPERTY LINE EXISTING WELL 100' RADIUS EXISTING HOUSE PROPOSED DRAINAGE FIELD -WILDERNESS DRIVE-SCALE: DJRDRAWN: DATE: TALUS WEST #1, BLOCK 3, LOT 18 Anchorage, Alaska BILL JONES 9/21/2022 -JUMAR AVENUE- -FIRNLINE DRIVE--WILDERNESS DRIVE--SN O W C U P C I R - -SUNSTONE CIR- & INSULATION Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221383, Curtis Townsend, 10/05/22 1"=50' TH#1 PROPERTY LINE WELL DRI VE W A Y EXISTING HOUSE EXISTING WELL 100' RADIUS EXISTING FIELD IS UNKNOWN TO BE ABANDONED INPLACE TALUS WEST #1 BLOCK 3, LOT 18 SCALE: DJRDRAWN: DATE: TALUS WEST #1, BLOCK 3, LOT 18 Anchorage, Alaska BILL JONES 9/21/2022-WILDERNESS DRIVE--SN O W C U P C I R C L E - NEW 1250 GALLON PLASTIC TANK W/ 20" RISER, MAINTAIN 10' FROM FOUNDATION TO TANK AND FIELD TO FOUNDATION TALUS WEST #1 BLOCK 3, LOT 19 TALUS WEST #1 BLOCK 3, LOT 20 TALUS WEST #1 BLOCK 3, LOT 17 TALUS WEST #1 BLOCK 3, LOT 26 TALUS WEST #1 BLOCK 3, LOT 25 TALUS WEST #1 BLOCK 5, LOT 3 TALUS WEST #1 BLOCK 5, LOT 2 TALUS WEST #1 BLOCK 5, LOT 1 WELL WELL WELL SEPTIC SEPTIC CO/MT CO CO/MT CO DCO TEST HOLE & WATER MONITORING REQUIRED PRIOR TO EXCAVATION 5- 6 % S L O P E MAINTAIN 10' FROM PROPERTY LINE SPLITTER VALVE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221383, Curtis Townsend, 10/05/22 3p 0• / / S6 Lot 17 8031st / >> 0.00' 10' T&E � EASEMENTS OCHAIN—LINK FENCE O 2.7•x5.5' O Ovj CHIMNEY 2,0'x2.7' CANT p PORCH N 1s'?' BELOW h o- SEPTIC PIPES C� ,h CANT zs 2.5'x4.0' DECK 3> .0. 2.5'D ESD STORY '` F/T w �v S 3 / 1.5• CANT SJ.g• eSMT h O DECK Lot 19\ / Lot 18 19,164 S.F. r ti N / SII e C-7 1 WELL H 68.03, 100' PROTECTIVE \ RADIUS �6 I / �',90() \ Up pIRc F / PLOT PLAN --- AS BUILT X_ SCALE 1= 40__ GRID _ SW 2736 _ Project No. --_ 22z:M21A1___- 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, in c , (907) 522-6476 Phone 0000�p�0 Professional Land Surveyors (907) ngsury y5 Fax o OF A���p4 kenOlan surve com jonothanOlangsurvey.com �4 S I hereby certify that I have surveyed the following described property: LOT 18, BLOCK 3, TALUS WEST SUBDIVISION - ADDITION No. 1 (PLAT No. 80-40) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on sold property except as indicated hereon. Dated this the—_, _ __�— Day of __`_L�'L'�":� 1-'x_"- Z`�'�_, at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49— TH* X01 *: . ................................ �YvYu� LS -5202...'" pROFPSSIONAL �o AECC963 · ANCHORAGE AREA BORL...,$H ~ Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM v'~' LEGAL DESCRIPTION SEPTIC TANK: DISTANCE / FROM WELL INSIDE LENGTH MANUFACTURER /~"~" ~'/~M A T E R I A L INSIDE WIDTH LIQUID DEPTH 4 NUMBER OF ~ ~-~-~, COMPARTMENTS LIQUID CAPACITY ~'~ d A~LLONS. TILE DRAIN FIELD: / DISTANCE FROM WELL /o~ FOUNDATION /~"'~ / /' TOTAL LENGTHN~/ / .NEAREST LOT LINE /~' OF LINES 3' NUMBER OF LINES / DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTION AREA ,/'--~ ~' '~ SQ. FT. LENGTH OF EACH LINE ~"-'/ / DEPTH: TOP OF TILE TO FINISH GRADE ',~ / DEPTH OF FILTER MATERIAL BENEATH TILE /'~ / IN. ABOVE TILE ~- Z./ IN, WELL: ' , BUILDING FOUNDATION __ CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED__ NEAREST SEPTIC SEWER LINE TANK REMARKS DEPTH SEEPAGE SYSTEM DISTANCE FROM: DISTANCES: INSTALLED B Y :(/~v~A-'/6~L-A~' S,EWER LINE DEPTH: LOT SLOPE: OF SYSTEM - /~ - G.A.A.B. Form LQ-032 DEPARTMENT OF HEALTH AND EN~,.IRONMENTAL FROTEC:TZON/ 825 ~L" STREET.. ANCHORAGE.. SE!I-,-~ER F'ERI'"I I T C~ ~ i ~ ~ TE F'ERMIT NO. ( 800086 ) APPLICANT LOCATION LEGAL SANDR8 G. DOWN~ WZLDERNE=,.~ r R. LOT t8 B~ TRLUS WEST SUB ' SRR E,o,., 1._, W LOT ~ ~ -,I~E 3:4~-4:1.64 J., ~.O SQI_IRRE FEET TYPE AF SOIL AB~ARPTION _,T_,TErl IS: TREN_.H MR,NIMUM NUMBER OF BEDR-OMz, = 4 SOIL RRTING (SL.] FT/BR)= '-~'-'~,~_, · I ' ~-'"- ' tS: THE REQUIRED SIZE OF THE SOIL ADSORPTION -~T--,TEfl C"EPTH= -12 LEi',~GTH= 78 L~RA%."E]__ C-"EPTH= '-=" THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE ENCAVATION (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). R E L-:~. LI I RED. SEF'T I C T R ~'-.~ ~:__.'z' ! ZE= "J- ~:- -_'-" ~ O' L~R ~-_ L O [-.~ S PERMIT RPPLI_.ANT HRS THE RE-SPONzIBILITT TO INFORM THIS DEPARTMENT DURING THE INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PR~JPERT~ RN[:, THE NUMBER OF RESIDENL:E_, THRT THE WELL WILL ._ERIE. TWO ( 2 > I [~SPEC:T I C,r-~S RF-."E RE,]~.U I RE[:, BACKFILLING OF ANY -,'~_,TEH WITHOUT FINAL IN_,PEL. TIuN AND APPROYAL BY THIS DEPARTMENT WILL 8E z, UBJECT TO FRL.oEbUTION. MINIMUM DISTANCE BETWEEN R WELL AND RNY ON-SITE SEWRGE DISPOSAL SYSTEM IS ±00 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM R PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MRY APPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS ARE AVAILABLE TO INSURE PROPER INSTRLLATION. RES [)EC:E~IBER I CERTIFY THRT t: I AM FRMILIRR 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 REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. SIGNED: ............ APPLICANT SANDRR G. DOWNS Iz,_,UED __DATE _ V4.0 GrEA R ANCHORAGE AREA BOr"'~gH ~>~.'~(~R'~,TNO.' ' DEPARTMENT Of ENVIRONMENTAL ~:)UALITY SEWAGE DISPOSAL SYSTEM ' APPLICATION AND PERMIT , NSTALLATION OF: SEPTIC TANK F~NANCED THROUGH ~ SOil TEST RESULTS COMPLET,ON DATE ANtIC,PATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT F, INAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE . TYPE SEEPAGE AREA SIZE SEPTIC TANK =~! SEEPAGE P~T TO NEAREST LOT L~NE. WELL TO SEPTIC TANK f/~/;~/ SEEPAGE PIT ? CAST IRON INTO AND OUT Of SEPTIC TANK AND ~NTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 iNCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT F}TTED WITH Airtight REMOVABLE CAPS. DIAGRAM OF SYSTEM CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE DESCRIBED SYSTEM ].S IN ACCORDANCE WITH SAID CODE. ' DATE: TO: THRU: FROM: um .,pality of Anchorage April 30, 1980 APR 3,U 1980 , Chief Administrative OffiCer - Operations Ronald Garzini . ~s~~ ~O~OPE[tATtONSI~ John Valensi, A~inistrative Service Risk Manag~ent · SUBJECT:Claims Against the Municipality Date of Loss : File Number : Type of Claim : Employee : Department/Division : Adverse Party : Damage Amount : Allegation : January 1, 1980 MAY2 1980 GL 5268(4)-80 General Liability ~ee- Unknown ~EPDIR, OFC Health & Environmental Protection David E. & Sandra Downs MUNICIPALI~ OF ANCHORAGE Unknown DE~. OF Iq~A~l & Mal functi on of mul ti -fl ow. ENVIRONMENTAL F~CTECTION L'~AY 2 1980 The attached is for your information. RECEIVED Edward L. Hire, Manager Risk Management Division ELH/jp Attachments ~' ~A~Ai N~ST MUNIClF ITY OF ANCHORAGI: NO'I I E OF CLAIM Municipality of Anchorage [] Anchorage School District NOTE: This form should be filled out in as much detail as possible to assist the Municipality in evaluating your claim, and upon completion it should be filed with the Municipal Clerk, Municipal Annex, 630 W. 5th Avenue Anchorage, A aska within two years after the date of t~ce of in ~ry or damage~. ' I, the undersigned, do hereby submit, under oath to the Municipality of Anchorage, Alaska, this Notice of Claim for damages to my person or property pursuant to section 17.06 of the Municipal Charter, and I do hereby intend to hold the Municipality liable for such damages claimed herein. L PERSON OR PERSONS MAKING CLAIM Name Telephone Home Address II /,4) ' £Jt2 II. DATE, TIME, PLACE OF INJURY OR DAMAGE Mailing Address Date (Mo., Day, Year) Time (am or pm) Place/Location / ?© III, PROPERTY INVOLVED Description i IV. MUNICIPAL DEPARTMENT INVOLVED (If known) Department Municipal Employee V. INJURED PERSON/PERSONS (Use attachment if additional space is necessary) 1 ) Name Age Address Telephone Occupation Employed By Person's location when injured 2) Name Address Occupation Emplo, yed By Person's location when injured Person's activity when injured Person's activity when injured How did injury occur? How did injury occur? VI. AMQUNT CLAIMED (Please attach an estimate or itemization of the damn es claimed) VII, DESCRIPTION (Nature and extent of injury or damages. Please describe in detail.) Age Telephone VIII. MANNER OF OCCURRENCE OF INJURY OR DAMAGES (Please explain in detail what happened and why the Municipality is liable. Use attachment if additional space is necessarv) IX. WITNESSES: (Include automobile passengers, Police, Doctors and all others having information concerning the claim) Name of Witness I Address Telephone ~) 2) 3) 4) Signature of Complainant Date Prepared STATE OF ALASKA ) ) THIRD JUDICIAL DISTRICT ) ~-?fgZ! being first duly ·/}/-,z~/b' ~, sworn upon oath, depose and say: That I am the claimant in the above NOTICE OF CLAIM for damages, that I have read the foregoing NOTICE OF CLAIM and that the information and statements therein are true as I verily believe. ' . · ' SUBSCRIBED AND SWORN to before me this ~__. da'/of NOTARY PUBLIC iN AND FOR ALASKA My Commission Expires: /~-- l ~' - 95-012 (Rev, ~1/78) /~rctlc - ~,nalrl Plumbing ~ Heating Inc.'~~'''- DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 805 West Fireweed Anchorage, Alaska ~74-8~78 ~74-78!-6- RECEIVED December 2, 1976 Mr. and Mz~. David Downs Lot 18 Block 3 Tallus West Subdivision Anchorage, Alaska Dear ~. and Mrs. Downs; Today I received a call from the Health Dep~rtment Inspector in regamds to the operation of your multi-flow unit. He h~d inspected the unit and found that the system was not draining properly. On November 29, 1976 at 10:00 A.M., Bob Brown checked your system. At this time he extended the vent tube. He then took a sample of the mixed licquor for chemical analysis. He also washed the filter socks and tried to clean the effluent line as best he could, However, the system is still draining slowly. We are not sure whether the water table is up, the drain-tile is obst= ructed, or whether the drain field is saturated. We only know that the water is not draining off properly and the result is causing an adverse effect. My suggestion is that you have a man, with a backhoe, come and'dig up ym~ drain field line. Whether we do it or someone else does, we will need to inspect the line ourselves for a re~rt. The man will need to uncover the trench and check out the li~e,.and fie~d, for problems. At the time the drain field is uncovered ~ Bor6~h ~s~e6{or should be present to witness the findings and offer suggestions. Our rates for a backhoe are $?5.00 per hour for two men and the backhoe. As ef November 29, the ground was soft enough to dig witheu~ steaming. ~ How- ever should the ground freeze before the time of digging, you will need a steam thawer with ground points. Our rate for this sez~¢ice is $75~00 per hr. If after the line is dug up, you find that there is an obstruction, the · ] cost will be minima-. However. is the drain field is saturated or the water I~able is high and a new tronoh needs to bo dug, the cost may be higher. With- out digging I have no way of knowing what the problem is. The bill would need to be pard in ful~ upo~the completion of the job. We will issue a full written report to ~ou-and to ~he Borough. Your truly, Larry G~I ��U u MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 Parcel I.Q. 015-202-13 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: l — 2_& —2o Z 3 Complete legal description TALUS WEST #1, BLK 3 LT 18 Location (site address) 11806 WILDERNESS DR, ANCH AK Current property owner(s) JONES Day phone Mailing address SAME 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: 4 4.. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Q Private Septic El Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ LA/8 Date of Payment /().0-� l /a Receipt Number 09!D3.7 COSA # 6,56G a"�J'_UL — Waiver Fee $ Date of Payment Receipt Number Waiver # S. 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_ I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727"$$64 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 10-20-22 or- 41., kkj 6. DSD SIGNATURE ''•491—H System #1 Approved for 4 bedrooms F ..... .:...... . ...... -111 • MICHAEL N. ANDERSON : P# System #2 Approved for bedrooms CE -94 ' µ Disapproved k es ''' •�°' Conditional approval for bedrooms, with the following stipulate r�t�er.S�•C,i1� By.. Original Certificate Date: ZC -Z(0 7Z 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA Cheddist blue sheet Nitrate Advisory Arsenic Advisory Other Legal Description: TALUS WEST #1 BLK 3, LOT 18 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled UN Total depth *145 ft Cased to *63 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 20 in Date of flow test for COSA 10/13/22 Static water level at beginning of test 80 ft. Comments * FROM MOA RECORDS B. TANK DATA Age of tank(S) NEW years Tank type/material --'MOPE Measured operating fluid level in septic tank NEW ❑ Standpipes/foundation cleanout per record drawing Date of pumping NEW TANK D. ABSORPTION FIELD DATA NEW SYSTEM Which system tested (date installed) NEW ❑ ALL standpipes present per record drawing Total measured depth from grade 8.5 ft (max) Measured depth to pipe invert from grade 4.5 ft (min) ❑ N/A— pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 051-202-13 Structure served by this system Well production at time of test 3+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes FOR No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 10113122 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date NEW Results F71Pass For 4 bedrooms Fluid depth prior to test 0 in Water added gal New depth in Elapsed time min ❑ Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced 0 gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ✓0 Yes Community Sewer Manhole/Cleanout > 100' ✓,/ Yes if No ft [�✓_ Yes if No ft Neighboring Tank > 100' [✓ Yes if No ft Private Sewer/Septic Line > 25'M Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' [j Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' 21 Yes if No ft P Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main ? 75' MYes if No ft CJ✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' [L Yes if No ft Surface Water > 100' Q✓ Yes if No ft Property Line > 5' ✓0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' E] Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' ✓] Yes if No ft Water Service Line > 10'✓Q Ff�05ESSIGtt�� . Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ✓0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' E] Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓0 Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10'Cj✓ Ff�05ESSIGtt�� . Yes if No ft Community Wells > 200' Yes if No Surface Water? 100' Yes if No ft F. ENGINEER'S COMMENTS r ft G. ENGINEER'S CERTIFICATION �;'� . • • • • • . ti,z "., L certify that 1 have determined through field inspections and review f� , .r ••' t;� of Municipal records that the above systems are in conformance with 'f 49TH : %s MOA COSA guidelines in effect on this date_ s; sS � F = • M1CFtaEL'i-'K: iV; ANDERSON •`" C r'� ". • Ad CE 94 Ff�05ESSIGtt�� . COSA Checklist yellow sheet r ft / ~~^/ / Lot 17 01 EASEMENTS CHAIN-LINK FENCE SEPTIC iV, PIPES MANHOLE 2.7'x5,5' CHIMNEY SEPTIC PIPES PORCH BELOW 2.5'x4.0' DECK Ov CANT 1.5 ANT DECK Lot 1 Lot 18 CIV LA C'V co oe 1001 PROTECTIVE 16 RADIUS T. CUP CIRC PLOT PLAN AS BUILT JL SCALE 1 / . MUNIC~PAUT¥ OP ANCHORAGE 0 / ~ ,~' O2' / ~ DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL d~"~- ,('"~Z-~ I ~ OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, sul:j~ivision, section, township, range) · Location (address or directions) (b) Property owner ,~:),~"~ · · I/~O~ .Mailing Address (c) L~nding Institutio~ Telephone Business Mailing Address (d) Re~l Estate Company and Agent Address Telephone (e) Mail the HAA to the followino address: or: Check here I-1, if hold for pick up. List conta~ pe~.~rso/0_n and d~y~h~ne numb,,~), below. TYPE OF RESIDENCE Single-Family..~ Number of Bedrooms WATER SUPPLY Individual Well.,~ Community [] Public [] '. Note: If community well system, must have written confirmation from the State Deeartment of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsitej~ 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. ' Page I of 2 72~025 IRev 8/861 Front 'XJO/~ s,Jeeu!bua leUO!SSe,toJd eq,t u! SUO!SS!LUO JO sJoJJe Jo,t elq!suodseJ ~.ou s! eeeJoqeu¥ ,to X,t!led!o!unH Sql 'penss! s! elee!j[IJeo e aJO,taq m. ep eZXleUe Jo suo!lo@dsu! ~onpuoo leu op SHHQ ,to see,~OldLU3 's~uew@J!nb@J e~e~s pus leJapeJ u!elJee ,~,ts!jes oj Jap Jo u! suo!,tn~!~su! 6u!puel J!aq~ pus SaLUOq JO sJeseqoJnd o~ Xse~Jnoo e se s!q]. seep SH HQ sql 'eXselV ,to @leis eq~ u! p@Jejs!6eJ Jeeu!6ua leUO!SSejo~d ~uepuadepu] ue /,q e^oqe S qde~eeJed u! ua^!6 suo!~e).uaseJdeJ aqj uodn/[lUO peseq sejeoU!pao le^oJddv X,tpoqlnv qlleeH sanss! (SHHQ) seo!^JeS UeLUnH pus q).leeH jo juauJpedaQ ebeJoqou¥' jo X,t!led!ojun~ aqj_ NOI..LN'¢O leuof~!puoo leAoJdd¥' leUO!i!puoc) ,to suJ.!eJ. peAoJddesfC] ~/"~ peAoJddv Xq SgUOOJpeq ~ Jol pe^oJddv "'lYAOl:idd'V SHHa '9 O ~ ~/~ auoqdalaL -~ 5 2~ wJ!~ jo eweN · uo!]oadsu! siM] ~o a~ep uo loa~le u! suo!~elnea] pus 'saou~u!pJo 'eepoo e~e~S pu~ led!o!un~ I1~ ql!A aoUe!ld~oo u! s! ~a~sXs leSOds!p Jo/pus Xlddns ]ale~ el!s-uo aq~ 'uo!lsedeu! pus uo!lee!lseAu! ~ ~o]j pus Sal!J eee]oqouv Io X]!led!o!un~ aq] pau!e~qo uo!le~Jo~u! emi uo paseq ~eql XlPe~ ]eqpnl I 'ufe]aq peiea!pu! a]n~on]~s ~o ed~ pus s~ooJpeq ~o Jeq~nu eq~ ~o~ alen bepe pub leUO!loun~ 'a~ee s! ~a~sXs IesOds!p ~a e~alse~ lo/pus Xlddne ~aleA el!s-uo e~ ~e~] s~o~s leAoJddv X]uoq~nv M~IBaH efq~ Jo uo!]ee!lsaAu! X~ ]e~l XlpaA I '~olaq u~o~s e]ep uo!leP!leA e~ 1o se pus o~eJeq pax!tte leas X~ Xq Pe!l!Pe3 sV NOIZ~aOdNI QN~ vz=a 'HOMVaS aqla 's&saz 'SNOI&O~dSNI ONIQIAOUd ~MIJ -g MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUN~oPALIT~ OF ANCHORAG~ CHECKLIST = FEBRUARY 1984 ENVI~.ONMENTAL S~,VICES DIVISION 264-4744 Legal Description: /- / ~' ~/,~c/._ OCT 20 1987 WELL DAT* RECEIVED Well Classification f~-I ~,'.~/~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/~"')' ("~,.~? ~ ~ ~ Date Completed ~ ~ , Yield Total Depth ~ /~5- ~ Cased to ~ ¢~ ~ Depth of Grouting IL. ~ ....... Static Water Level Casing Height Above Ground /,5- ~ Electrical Wiring in Conduit ~/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot Pump Set At Sanitary Seal on Casingu-(~/N) Depression Around Wellhead (Y/~ /(.~ ~ f ; On Adjoining Lots ~/~-~ / ,/? ~. ; On Adjoining Lots .~,/.~.. z To Nearest Public Sewer Line /U.//-? To Nearest Public Sewer Cleanout/Manhole XJ,.//I- To Nearest Sewer Service Line on Lot Water Sample Collected by / , ~.6~' ,~ ,; Date Water Sample Test Results _ ¢~ '~ ~J~.Lc¢,~ [~ r 'c ~ / ' ~'~ ~' Z~ Comments ~,.'~ I/.r,~ ~,~ /~/r~c ~ B. SEPTIC/HOLDING TANK DATA Date Installed ~/~/%'a Size / '~--~2 No. of Compartments Standpipes (~y~/N) Air-tight CapsCN) Foundation Cl.eanout (~) Depression over Tank (Y/~) -,'/¥-* Ag~'J Date Last Pumped Pumping/Maintenance Contract on File (Y/N) /~//~ ; for Holding Tank High-Water Alarm (Y/N) /1~/~- Temporary Holding Tank Permit (Y/N)~/~ Separation Distances from Septic/Holding Tank: To Water-Supply Well To Propert~ Line ,T,o Waier M~ih/service Line 'Course - '." ,- / ,/0 O~ To Building Foundation ~7 To Disposal Field To Stream, Pond, Lake, or Major Drainage Page ,1 of 2 72-026 fRev 8/861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~-~/.:t~.//-/ Width of Field "~ / Square Feet of Absorption Area Depression over Field (Y/~. Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Type of System Design Length of Field Depth of Field Gravel Bed Thickness /,~ / /'~ ~ Standpipes Present/t~N) Date of Last Adequacy Test Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) .) 30/ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) ~'~' Comments Dimensions Manhole/Access (Y/N) "Pu m.~ .Off'~'L'~l at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I..~::~,~d, verified, Signed Company p~',¢ CO ..~7~,¢, ' Receipt No..~¢¢/ Date of Payment / Amount: $ Page 2 of 2 or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Date ~o/'¢ ¢,/? MOA No.