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HomeMy WebLinkAboutTALUS WEST #1 BLK 3 LT 27~ REA'JER ANCHORAGE AREA BOL.UGH 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~o,~ LOCATION MAILING ADDRESS ~'-~ ~'.'oeq(' ~.~.'o~,~ ~ PHONE SEPTIC TANK: '~'~ "~-~'~ ~ DISTANCE , FROM WELL ~ OO ~ MANUFACTURER MATERIAL NUMBER OF COMPARTMENTS INSIDE LENGTH INSIDE WIDTH TI~LD: DISTANCE FROM WELL i~)C,.)'~I' FOUNDATION LIQUID DEPTH LIQUID CAPACITY~ ~)'~'F-~GALLON5. I I TOTAL LENGTH NEAREST LOT LINE. J 0 OF LINES NUMBER OF LINES J DISTANCE BETWEEN LINES '~"//~ TRENCH WIDTH~ IN. TOTAL EFFECTIVE ABSORPTION AREA I/ D O ~ ~ ~0o0¢ '~ c) ~ . _ ~ SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE ~ ~ DEPTH OF FILTER MATERIAL BENEATH TILE ~ G IN. ABOVE TILE ~ 0 IN. WELL: BUILDING / NEAREST ' NEAREST j,//'~ PT I C t~ (SEEPAGE FOUNDATION__ LOT LINE I ~) SEWER LINE__ TANK SYSTEM CESSPOOL ~ OTHER SOURCES APPROVED ~ISAPPROVED REMARKS DISTANCES: /- SEWER LINE DEPTH: LOT SLOPE: ~e'~ REMARKS, DIAGRAM OF SYSTEM DATE ~JJ~.J~7"~ APPROVED. Form LQ-032 [:'EPRRTHENT OF HEFtLTH FIND EF,I",,'IRONMENTRL F'ROTEC:TION 825 '"L'" STREET., FIi",ICHORlaGE., RtE. :~':!~SE~:J_ ;;2t79-25 J_:l_ PERMIT NO. ,-'. 77±29 ) FIPPL I CFINT i',lFIqE !~ ¢' ~'¢~ , · - - F"ENDE~:IJF:.'FISS ,:' ,- · _,RH E',OX LOCFtTI ON WILDERNE:SS DR LEGRL L. 27 Bg TFIL. U'.5 14EST SUE:E) LOT SIZE TN-'PE OF _JIL RE:SORBTION b'¢bTEH I:S: TEEI.I_.H MFIXIMUM NUMBER OF BEDROOMS = 4 SOIL RRTING (SQ FT,.."BR)= 25E~ THE REQUIRED SIZE OF THE SOIL REr_'~ORPTION S'¢STEM IS: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIEI.[:,. THE DEPTH OF FI TREN.H OR F'I7 IS 'THE [:,ISTFINC:E BETWEEN THE 'M E'FR]E OF rile GROUND RND THE E:OTTOM OF: THE E,',L:H.HTIJN (IN FEET::,. THERE ZS NO SET 14ZDTH FOR TRENCHES. THE GRR',/EL DEPTH ZE: THE tdZNIMLff'l DEPTH OF URH,EL BETNEEN THE OIITFRI_I_. F:'~F'E RND THE BOTTOM OF THE E,'.,L.H,,,HTZUN ,'IN FEET::,. F' R C: ~-'. F# C~ E F' L R I'-.i T F-: E: ~]:dl_! ]: EITHER FI P -~,- _ _.LM_: I -P II NSF RF'PR_-',,'E[: F'LRNT I"IR~' E:E IF,ISTFILLEE,. ¢1 COi",ITINJOIJ~ f"IFIIi".~TENFINCE FIGREEMENT IS REQUIRE[:,. IF FI i'IHIi',I]Er.HNL. E FIGREEMENT IS NOT KEPT CURRENT '¢FiII i',~FI'~' E:E REQUIRED TO EN[ HI~.~E THE SOIL FtBz, URF T I UN S'T'STEM ...... HN[: , CIR ~1_-I1._1 F1FI'¢ E:E ': _E )'EFT : ':: _-'. BHCk. FILLINu OF FINN.' =&'=,"rEM NITHOUT FZNRL IN=,FEL. TZuN FINE:, HFF~_ HI__ THIS r EFRRTflENT WILL BE SUBJECT TO F'F.:OSEE:UTICiN. MINIMIJi',I DISTFINC:E BETWEEN FI NELL FINE:, FIN'¢ ON-SITE =,EWPI.~E [:,ISF'OSRI_ ':"- r.: TE.I J ±00 FEET FOR FI PRIVFITE NELL OR 2E~0 EEET FOR FI F'UBLIC NELL. NELL LOGS FIRE REQUIRED FIND i"IUST BE RETUF~f',IED TO THE [:'EF'FIRTf'IEi",IT .WI:THIN :~:l;~ -'," · .- I..H~., OF THE NELL CCli"IF'LETIGN. SPEC IF ICFIT IONS FIND CONSTRUCT! ON D ~ RGRFffd:S FIRE Ftk,'FtI LIABLE TO INql IE'E F'ROPEF' I NSTF~LLF~T I ON. - ...... I CER'FIF9 THF~T ~ · : I RFI FAMILIAR WITH THE RE}_IREHENTS FOR ON--SITE ._.E[4ER=. RN[:, NELL_S ~S SET FORTH 8~P THE MIJHICIPRLITk' OF RNE:HORRGE. 2: I WILL INSTRLL THE S~'STEM IN BC:CORDFINCE NITH THE COl}ES. ~: I UNDERSTRND THRT THE ON-SITE SENER S'~-'STEM P1Rb' REQUIRE ENLRRGEHENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THKIN 4 BEDROOMS. BFPL~CBNT ~'ICSE F'ENDERGRB'SS M-W DRILLING, INC. DRILLING LOG Well Owner ' Use of Well Location (address of: Township, Range, Section, if known; or distance main road Size of casing. Depth of Hole 1 ' 3 feet Cased to .... ~ ° '~ feet Static water level ft. (~ibb'Ce) (below) land surface. Finish of well (cheek one) open end (' Screen ( ); Perforated ( ). Describe screen or perforation ,/;~ Well pumping test at ii.-~ gallons per (k6ur) of drawdown from static level. (minute) for ]. hours with Date of completion ~ / i [ / / / WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness ); ·ft. TO [.:of f~,' . " TO '[ ~ -~ :; TO TO TO _TO TO TO_ 2- STATE 2 6 8V • '� Municipality of Anchorage ° On -Site Water and Wastewater Program (907)3 43-7904 5' ,F E i Certificate of On -Site Systems Approval Parcel I.D. 015-202-04 1. GENERAL INFORMATION: Expiration Date: 3 ` Z( Complete legal description TALUS WEST #1; BLOCK 3, LOT 27 Location (site address) 11776 Wilderness Drive *Anchorage 99516 Current Property owner(s) Christina Twoaood Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 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: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Date of Payment -�22 0? 0 2 Receipt Number o y f y a 6 COSA # OSC211035 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: Gamess EngineeringGroup, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101 -Anchorage, Alaska 99507 1 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether'an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for —3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, ,,a g T . �. • . r i• ... .,,_ rte... F .... . cG ,4\\repro f a55to0000 #AECC884 L\iY OF�ri��� i �g ON-SITE WATER AND rn with the folio it stip�t ,i srA� R o J, 0 )))))_)))w)1 By—_--' •Original Certificate Date:Z`3 -ZI 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 -profession -at civil ergireerregisteTedirrtlTe—State`of A'taska=fTe Munic`ipalitT— of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: ,f COSA Checklist .✓ Nitrate Advisory Septic System Advisory / Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: TALUS WEST #1; BLOCK 3, LOT 27 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑B Well log is filed with Onsite (or attached) Date drilled 6111/77 Total depth 100 ft Cased to 96.8 ft !VSanitary seal is functioning correctly .,' Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 1/20/21 Static water level at beginning of test 67.6 ft. Comments B. TANK DATA Age of tank(s) 9 years Tank type/material SEPTICISTEE Measured operating fluid level in septic tank 48" © Standpipes/foundation cleanout per record drawing Date of pumping t ( -_7 11 ZZI Parcel ID: 015-202-04 Structure served by this system Well production at time of test 7+ gpm Water storage tank volume N/A gallons disinfected for coliform test? El Yes © No Coliform bacteria is Negative Nitrate a' 00mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L [✓Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 1/20/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: NIA D. ABSORPTION FIELD DATA DEEP TRENCH Which system tested (date installed) 10/3112 Adequacy test date 1/20/21 1.9 ALL standpipes present per record drawing Results ❑7 Pass For 3 bedrooms Total measured depth from grade 12.5 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 5.4+ ft (min) Water added 855 gal ❑ N/A — pressurized field New depth 57 in © Monitor tubes go to bottom of effective. If not, state Elapsed time 85 min depth into effective ❑» Code -required soil cover over field Final fluid depth 0 in [� ys em presoak—d Absor epd p�io� . (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) Gallons introduced N/A gallons If yes, enter date N/A 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' Q Yes if No ft If absorption field is under driveway comment below Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No F✓ Yes if No ft Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' [✓ Yes if No ft ❑✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft Q Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5'+ ft Surface Water > 100' Z Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' F, Yes if No ft Water Main > 10' M Yes if No ft Community Wells > 200' 0✓ Yes if No ft Water Service Line > 10' 0✓ 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' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓0 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' F✓ Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' ✓71 Yes if No ft F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALL **UNABLE TO GET MEASUREMENT TO WELL ON TALUS WEST #1; B3, L26 BECAUSE OF EXISTING STRUCTURES 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. COSA Checklist yellow sheet " . 49/T� �I Je f, � Gorness. s I CE -7'9t ` •' �� 0 4ea'I1•Lt••\� 4 ���'r0fesslo� o� #AECC884 �I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL 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, subdivision, section, township, range) Location (address or directions) II 77¢, (b) Property qwner .A'~.'.'~.~,~'ic .,l'tc¢,c~'"~ Telephone: Home Mailing Address //'~?/J" ¢ ,.4_~/.-7~Jz:.~$ ~/~", '(C) Lending' Ir~stit~ii~n¢ ';:' ?(~//'/~*~L~ //?¢',~7~'~,'/( - Telephone Mailing Addres~ '? ~' Business (d) Real Estate C~m¢~ny and Agent '~ Address ~ Telephone / (e) Mail the HAA to the followin(~ address: or; Check here-t2~, if hold for pick up. List contact person and day p.hone number below. 2. 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 Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite/~ Public [] Community [] Holding Tank [] Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRev 8/86i F¢onl ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address /~-'~ Date DHHS APPROVAL Approved for '~'~''~r~C~)bedrOOms by ~--~ Approved ~ Disapproved .xO. '~ Date Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 IRev 8/861 Back C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~'--/¢'/- ?¢ 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 Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots /'¢ To Cutbank (if present) D. LIFT STATION ,,S, ize in Galloes ~_ ILW~ Manho,e/Access (Y/N) Pump On" Level at ~ "Pump Off" Level at High Water Alarm Level at ~~ Vent (Y/N) Tested for ~-~.--..._...~ing Cycles during Adequacy Test. Meets MOA ~loe~Ce~t~o d es ~Y_/N ) _ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I h av.v.v.v~)¢ e c~ d, ver~ed, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~'~' '"/'~/~ Date Company ,/~:r-~.~.~ MOA No. Receipt No. /0 <~/ Date of Payment ~'//' Amount: $ Page 2 of 2 Ab~CHO2AGE MUNICIPALITY OF ANCHORAGE (MOA) sION TH AUTHORITY APPROVAL (HAA) HEAL CHECKLIST - FEBRUARV 1984 WELL DATA 264-4744 Legal Description: Well Classification Well Log Presently)/ Total Depth /'<¢~P Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit~q) Separation Distances from Well: To Septic/Holding Tank on Lot //~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line '~J/~ Cleanout/Manhole /U//~' - ~,~/~,///¢~7 If A, B, C, D.E.C. Approved (Y/N) Date Completed ~ -//""? ¢ Yield Pump Set At Sanitary Seal on Casing(~N) Depression Around Wellhead (Y~) To ~earest Sewe[ Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ~ /~/"~ '~-'"¢d ; On Adjoining Lots /~-'¢,~ / ; On Adjoining Lots _ To Nearest Public Sewer ~'~ B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes I~) Depression over Tank (Y/~) Pumping/Maintenance Contract on File (Y/N) '"¢'/~ ; for )4- Holding Tank High-Water Alarm (Y/N) /J/)4- Temporary Holding Tank Permit (Y/N) Size /'~f"'~ No. of Compartments ~ .~r ~,~ Air-tight Caps~N) Foundation Cleanout~)N) Date Last Pumped To Building Foundation To Disposal [ield To Stream, Pond, Lake, or Major Drainage Separation Distances from Septic/Holding Tank: To Water-Supply Well //'~ / To Pr0p,erty Line To Water Main/Service L'ine /~) !'W Course' / ~'0 /¢ Page I of 2 72 026 fRev 8'861 Front ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVlRONI~ENTAL HEALTH CERTIFICATE OF iNSPECTiON FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include Jot, block, subdivision, section, township, range) Location (address or directions) II (b) Applicant Name Z~'~ Applicant Address (c) Applicant is (check one): Lending Institution'r-1; Owner/builder~; Buyer []; Other [] (explain); (d) Lending Institution Address Telephone (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms -~ Other WATER SUPPLY Individual Well~ Community [] Public Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. SEWAGE DISPOSAL ~ Oasite~]. Public [] Community [] Holding Tank [] Note: IfI'community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11J84) 5. ENGINEERI'NG FIRM PROVIDIN~.-~c, JSPECTIONS, TESTS, FILE SEARCH, DA'I-,~c-,AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater dis posal system is safe, fu nctional and adequate for the number of bedrooms and type of sfructure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm .~ ~'",~ ~ Telephone ~ / --~ ~ Address /~ ¢ ~ ~--~ ~~ Date Approved four /-"f'~¢-~.~ bedrooms b Date Approved ~ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 WELL DATA Well Classification //~/~t [/.'z~T~L~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present~) Date Completed Total Depth /,~O ( Cased to ~,~ ,~2, / Static Water Level ~--~, ¢ ~ I,g/ Casing Height Above Ground Electrical Wiring in Conduit~Y~) Separation Distances from Well: ~/ /t /I7 ;~ Yield Depth of Grouting Pump Set At Sanitary Seal on Casin~)N) Depression Around Wellhead To Septic/Holding Tank on Lot /,/~' / ~ To Nearest Edge of Absorption Field on Lot /~ q~ To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by ~Water Sample Test Results ; On Adjoining Lots ; On Adjoining Lots ~,/'~ To Nearest Public Sewer · '~/~...._~_.. To Nearest Sewer Service Line./on/Lot.~ ¢72 ¢' ,Date Standpipes ON) Depression over Tank (Ye SEPTIC/HOLDING TANK DATA Size /~5'0 No. of Compartments Air-tight CapstaN) Foundation Cleanout~)N) Date Last Pumped Pumping/Maintenance Contract on File (Y~) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well / / TO Property Line ; for ! Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Water Main/Service Line '"¢"/-¢ / ~¢- To Stream, Pond, Lake, or Major Drainage Course .~' ~'0 Comments-~/¢~ ~_.~AO.,~¢.. ,'~L///'¢~ Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ;l~Square Feet of Absorption Area Depression over Field (YN~. Results of Last Adequacy Test Type of System Design '~,~,~C/:~ Length of Field Depth of Field /3 z ~:~ Gravel Bed Thickness Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course Standpipes Presentl~) Date of Last Adequacy Test TO Property Line /~'~ To Existing or Abandoned System on ; On Adjoining Lots '~ --:¢~/;'~ To Cutbank (if present) To Driveway, Parking Area, or Vehicle Storage Area ,"-//,~ D. LIFT STATION Date Installed Dimensions Size in Gallons ~ccess (Y/N) "Pump On" Level at ~ High Water Alarm Level at A/ ....,,"""~ / Vent(Y/N) Tested for ! ~ Pumping Cycles during Adequacy Test, Meets MOA Electrical Codes (Y/~ Co m me~......-~'~ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I~e chec~ked, v~ified, or co~ormed to all M O.~a.n~14AA guidelines in effect on the date of this inspection, Signed I/.¢~-~'~-- '~jCf.~"¢"¢~ D at e //~z_//~¢/_ ~ ~'¢~ Company ~5 ~/ MOANo. ~)r~¢'O~ Receipt N~ (~ LJ ~ I ~- Date of Payment _ ~l'- Amount: $ (x-, Page 2 of 2 72-026 {11/84) Seal ALASKA eI1UIRO[lmeI1TAL CO[1TROL ~nqineerinq ~ ~noironmentc~l Studie$ $ I UIC S, II1C. BILL DEEN 11776 WILDERNESS DRIVE ANCHORAGE ALASKA 99511 SELLER-BILL DEEN 11/14/85 BILL DEEN 11776 WILDERNESS DRIVE ANCHORAGE ALASKA 99511 50769 LEGAL:TALUS WEST#1 BLOCK 3 LOT 27 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-Ii/6/85 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 1120 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 815 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 4/26/85 FLOW TEST ON WELL WELL FLOW DATE-ii/6/85 A FLOW TEST WAS PERFORMED ON THE WELL. 815 GALLONS OF WATER WAS PUMPED AT A RATE OF 4.4 GPM OVER A DURATION OF 3 HOURS. THE DRAWDOWN WAS 5.6 ' WITH A RECOVERY TIME OF 10 MINUTES AND THE STATIC WATER LEVEL WAS 55 FEET. THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME. ~200 ~esf 33ri Auenue, Suile ~ · ~nc})oro% Alosko 9950~ ,[907) 561-50l:10 MUNICIPALITY OF ANCHORAGE[ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONDEPT. OF H~ALTH  825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENVIRONMENTAL ENGINEERING DIVISION J Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEA~ (10) days for processing. DiRECTiONS: Complete a,i parts on page 1. Incomp,ete requests will '"t be pr°cessed' Please all°w ten ~LP~O~'( pRDPE.TYOWNE" ' ~ROPERTY RESIDENT (if different from ab I i~ ~NG ADDRESS~ (~ ~. LEGAL DESCR/P-~A4~I~ · STREET LOCATION 6,---~YPE OF RESIDENCE /~ SINGLE FAMILY [] MULTIPLE FAMILY E~ One [~ Four [] Other~ [~] Two ~ [~] Five j~ Three [] Six ~ '~. WATER SUPPLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth {attach log if available.) ~ SEWAGE DISPOSAL SYSTEM **If individual/on-site, give installation date -. ~ INDIVIDUAL/ON-SITE** 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. 7"'2-010(3/78) / THIS SIDE FOR OFFICIAL USE ONLY TIME R DIRECTIONS; INSPECTION APPOINTMENTS D/~TE RECEIVED ~IME DATE -- ~TOR 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLy [] INDIVIDUAl.. COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or ~]Holding Tank Size: I~._~ _ If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AR EA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line NUMI]ER OF BEDROOMS [] ONE [] THREE [] FIVE [] OTHER [] TWO [] FOUR [] SiX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG R~VEG PERMIT NUMBER DATE INSTALLED I~A L L E R- SOILS RATING MANUFACTURER MATERIAL Septic/Holding Tank Absorption~Area _~wer Line -- I Nearest Lol~ Li~e~' 5. COMMENTS "~APPROV ED FOR ~ BEDROOMS CONDITIONAL AP'~-ROVAL (Fetter must accompa~'~lficate) 72-010 (Rev. 3/78) 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF ~-~EALTH AND ENVIRONMENTAL PROTECTION July 25, 1980 Susan Heggen Wade Post Office Box 10-1948 Anchorage, Alaska 99511 Subject: Lot 27 Block 3 Talus West Subdivision #1 Approval for your individual sewer and water facilities cannot be granted until the following items have been completed: ) (2) The water analysis report be delivered to this department from Chem Lab, 5633 B Street, for our review° The septic tank pUmped with a receipt submitted to this department. (3) A maintenance contract supplied to this department on the Jet aeration unit in the on-site sewer system. If there are any further questions, please call this department at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: National Bank of Alaska Pouch 7-025 99510 Jeannine Erhart % 4794 Business Park Boulevard - 99503 Building F Up,,¢.teo ,~ervJ. ce Policy w~ll be se:qt '~vhen . j reprioted. HO~E & CO~ERCIAL SEWAGE TREATMENT PLANTS BOX ]49~- WAS[L~¢ AX. 99687 - PHONE 37~-59~9 JET Home Plant Service Policy This Agreement entitles: Owner Street Address 11//b ¥;i!der~ess Lot Z,' Talus City A c ....... Alas:-:a Phone to the following service for I year~'~ from the date of acceptance. Upon receipt of this signed agreement and $100.00 ,l~i~Concrete Products agrees to perform the following services during the term of the agreement: ~ Concrete Products will inspect the JET plant at the above address twice ~ year. These inspections will include: PLANT SERVICE Removal of aeration unit, inspection, adiustment, cleaning of aerator's shaft, field service of aeration unit, if needed, and re-installation. Inspection, cleaning, and adjustment, if necessary of surface skimmer and/or tube setter. Examination of final effluent for color and odor, if there is access at time of inspection. Check of discharge point and wet weather overflow for blockage (if applicable). Inspection and adjustment of control panel setting and overload protection, if there is access at time of inspection. Inspection for sludge accumulation with arrangements for removal when build-up warrants removal. ~Concrete Products further agrees to the following: EMERGENCY SERVICE ® There will be no service or bbor charges for removal or re-instalbtion of aerator, if required. e if improper operation cannot be corrected at time of service, homeowner will be notified immediately and given estimated date oF correction. e~roper operation cannol be corrected at time of service, the Department of Environmental Quality, will also be notified. Freight charges to the factory or to an unauthorized repair station and aerator' repair charges are not covered under this agreement. Owner's Signature Date Accep or IJ~L~oncrete Products DEPARTMEN, .3F ltEALTH AND ENVIRONMENT,.. / PROTECTION 825 L StreeE, Anchorage, Alaska 99501 279~-2511, ext. 224 or 225 Date Received: August 3, 1977 I~]-: Ti, me _~_{,~._0.. p__.__mj ........ ,#2: Time ~3: I~m~ Date 8-24-77 Thursday Date Date In sp Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Mailing Address: Phone: Property Owner: Mose Pendergrass Phone: Mailing Address: Star Route A Box 1585-D 99507 349-4207 3. Le,~al Description: Lot 27 Block 3 Talus West Subdivision Single Family Residence: ( Multiple Family Residence: Number of ]Bedrooms: Number of Bedrooms: Four 5. WeI1 System: Individual Well ~ ) Community/Public System ( ) }Permit # Depth of Well 98' We].l Log on File ( ) Construction ~,31~L3L/I~/ Bacterial Analysis ~,<S~c ~ - 6. Sewage Disposal System: On-site System ~ Public Utility ( ) ~ Permit # Sept_c Tank Size Absorption Area Installed _197~. Installer HanuJ. acturer Soils Rate Material DJ. sLances: Well to Septic Tank to Sewer Line Nearest Lot line to Nearest Lot Line to Absorption Area Absorption Area Pa.ge ~ e ' ' Department of Health and Environmental Protection Request for Approval of Individual Sewer an~t Water Facilities Legal Description: Lot 27 Block 3 Talus West Subdivision Affadavit Ahtached: :=~.~ Letter Attached: ( ) Date Disapproved: Department Worksheet MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Stree%, Anchorage, Alaska 99501 279-2511, ext. 224, 225 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: 2. Property Owner:__/~,~ Mailing Address:~/'¢~~2' Name of Buyer: ~-,'7L,¢/7']-~ Mailing Address:_ .,,U~IC.A_, ~ 07-/>-:Ci[ORAGE ,. x ,,,,)N ¢~E , .L CLJY;'i~CTION VA _FHA_ CO N V__~___ Day Phone:.x~/~ /-/20 '7 Day Phone: 4. Name of Lending Institution: Mailing Address: Name of Realtor or Agent: Mailing Address:. Legal Description: ,/~¢3 ~'L-2- ~ Location: //E','/~/t~,E',X/~s~ Phone: Phone:. 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: Public Utility. If Individual, number of dwellings presently served If Individual, depth of well ~'? / Sewage Disposal System Type of System: Public Utility_ If Individual, date of installation /[/~(43 _No. Bdrms. /7/ Individual Individual (on-site) 72 003(3/76) • • Qn4E U •11c•-• Municipality of Anchorage Q On-Site Water and Wastewater Program (907) 343-7904 S A r f E F.T Y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-202-04 Expiration Date: LI-1C- 1. l -1C1. GENERAL INFORMATION Complete legal description _TALUS WEST#1 BLK 3 LT 27 Location (site address) _11776 WILDERNESS DR, ANCH AK Current Property owner(s) _WOJTUSIK Day phone Mailing address _SAME Real Estate Agent Day phone 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 ❑ Waiver/Variance request for: Distance: Received by: 4744.4. Date: 1 /c/t r COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ SSC. 00 Waiver Fee $ Date of Payment OJ/IS/19 Date of Payment Receipt Number c.iNCA461: 10 81 Receipt Number COSA# b SC,i -! 1010 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 1/12/19 \, t 0, e•o., ouo o°oe000•o° Oo ov i‘.t,) 6. DSD SIGNATURE (' 9°O ° t ••• ••••••• i X. System #1 Approved for : `all. N. h;?LaC ° ! Y pp bedrooms. � e'• C -91��' %' 7 r v System #2 Approved for bedrooms. ;<;':;•°/ ,��� Disapproved. a • Conditional approval for bedrooms, with the following stipulations: ON-SITE 'm WATER AND 9 WASTEWATER PROGRAM BY - Original Certificate Date: 1— /, 1 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10.10.12.tloc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system _ Certificate of On-Site Systems Approval Checklist Legal Description: TALUS WEST #1 BLK 3 LT 27 Parcel ID: 015-202-04 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N)Y Date completed 6111177 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y Total depth 100 ft. Cased to 96.8 ft. Casing height(above ground) 12"+ FROM WELL LOG AT INSPECTION Date of test 6111177 12-18-2018 Static water level 58.4 ft. 60 ft. Well production 4.4 g.p.m. 4.0+ g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 2.66 mg/L Arsenic: ND ug/L Date of sample: 12.18.2018 Collected by: Mike Anderson B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 10-31-12 Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) Y Date of pumping 12-18-18 Pumper AROUND THE CLOCK_ C. ABSORPTION FIELD DATA— Date installed 10-31-12 Soil rating (GPD/SF) 0.8 System type DEEP TRENCH Length 56 ft. Width 2.0 ft. Gravel below pipe 6.0 ft. Total depth 11 ft. Eff. absorption area 672 ft2 Monitoring tube Y Depression over field N Date of adequacy test 12.18-2018 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 12 in. Water added 500+ gal. new depth 18 in. Elapsed Time: 1300 min. Final fluid depth 11 in. Absorption rate >=_500+_g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) N If yes, give date • D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off" level at in.High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 100'+ Animal containment areas 100'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Property line 10'+ Absorption field 10' Water main 100'+ Water service line 50'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 100'+ Water Service line 25'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(None Known) Wells on adjacent lots 100'+ F. COMMENTS -.fit; OF OOOOOO *:491H "1-7- G. AG. ENGINEER'S CERTIFICATION ••••••.:`.•••.••.. :7� 9 / certify that I have determined through field inspections and ......... . / �, MICHAEL N. ANDERSON .C review of Municipal records that the above systems are in 1 i•. CE 9q conformance with MOA COSA guidelines in effect on this date. 1 `rr '. �9 •* Engineer's Printed Name MIKE N. ANDERSON, PE �‘‘��\" -.` Date 12118/2018 COSA canary sheet_2-6-15.doc N 30 8479Z ti 4/ / it a) / / 8680 Lot26 Q 00 03',61jF o / �<v� cs Lot 27 0 6 8 // I / 4 -' e 46 ,,...i,"------ ...- 0�D h 6� o , o�j ..:P: -•1 y --septic vent (typ) ! 61i/ ry gravel 22.,,-' . Pr2 &tory o ' �ti NOUS& " be. � i •0 e . � Fi clean out c co 30 °,—well 26S .�, 25 /aoi / `b 2.0 OH /as b Lot 25 L_,_," 3 S -7- 740-5.- _ chain link fence (typ) /� o� '3p 189.90_.- - /Q Lot 28CO ``� ` N\N, , AS-BUILT NO CORNERS SET THIS DATE ' , I herebycertifythat I have performed a Mortgagee's inspection P�' �F A � C:96N , of the following described property:Lot 27,Block 3, M' '`. Talus West Subdivision Addition#1 i `7• 49th ;4 •.v II / , •7� Anchorage Recording District,Alaska,and that the ( j �y� improvements situated thereon are within the property lines •to r'r and do not overlap or encroach on the property lying '. lizabeth L. Wolotka. P / adjacent thereto,that no improvements on the property lying /` "I';‘,,.• 8036 - LS •.JQ. adjacent thereto encroach on the premises in question and pF•• . y that there are no roadways,transmission lines or other h • • • e�9 .. visible easements on said property except as indicated SCALE: "= 30' • ( 1 , hereon. I\'S"%�. Dated at Anchorage,Alaska EASEMENTS OF RECORD,OTHER THANi 2 2,1 j- ( this 13th day of December ,2018. \HOSE SHOWN ON THE RECORDED FRED WALATKA&ASSOCIATES,L.L.C. PLAT ARE NOT SHOWN HEREON Engineers and Surveyors 1,.0 ree a Tl IrP]uner wirI r r FB 18-9. oa 45-46 MB 907-248-1666