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Home My WebLink AboutTALUS WEST #1 BLK 3 LT 28Talus t Block Lot ! 5- -03 Municipality of Anchorage Page _ / of / 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)3 D ?_ I .'~ PID Number: ~E:)/.~ ~.O ~ -~ ~ Name: ~A/.~ ~ ~/ ~ Wastewater System: ~ New ~pgrade Address: .~ A~c~ ~e. ABSORPTION FIELD Phone: J NO. of BeSoms: ~q- ~ ~ Deep Trench ~ Shallow Trench ~Bed ~Mound ~Other Total Depth from or g hal grade: LEGAL DESCRIPTION so"~.~: .~. ~/s~.~,. ~,~ Township: 12~,[ Range: 5W,J Section: Z~ Fill added above original grade:o Ft. Gravel length: ~O WELL: Q New ~ Upgrade ~ Gravefwidth: Numberoflines: JD~stanceaetweenlines: Yield: Pump Set at: ~ Casing Height Above Ground: SEPARATION DISTANCES ~s~¢~o~ Holding ~ S.T.E.P. TO Septic Absorption Lilt Holding )ublic/Pdvate Manufacturer: Capacity in gallons: F,om fan* ~Jeld Station Tank Sewer Lines ~ R ~ ~ /Z 6 0 Well 1OO~ /OO+ /~¢ /~4 Material: ~[ Number of Compartments: Surface Water JO0~ I¢o¢ ~ ~ ~ LIFT STATION Lot .* Size in gaPons: IManufacturer: Remarks: I. (' o~ Se~a~ R~ ¢~ BENCH MARK ENGINEER'S SEAL Department of Hea d Hum ervi ab ¢~%~',,. U D., Reviewed and approved by: . Date: Permit No. Legal 8W950215 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 On-Site Wastewater Disposal System and/or Well Description T. 12 N, R. 5 W, SEC 22 SM Al4. LOT 28, BLK 3 TALUS WEST #1 1 of 3 Telephone:545-4744 Inspection Report PID No: 015-202-05 ASBUILT SITE MAP LOT 27 D 2 CO. CONTRO~L MAP BM A BM B BM A BM B D-6 s[~z~_.O 1/4.9 j D-1 D-2 22.4 11.2 53.2 41 57.1 45.9 29.1 28.3 BM A~MMM A S. CDR OF DECK EL~ BM B B N. COR OF BM A 8M 8 ASE~UILT .~ ~..' ~ ....-¢ ,,, ¢ "-: .. . ...... ~ ¢. - Care ,'~ ~ Permit'No. SW93021,3 P.O. Box On-Site Wastewater Disposal System and/or Well Legal Description T. 12 N, R. 3 W, SEC 22 SM AK. LOT 28, BLK 3 TALUS WEST #1 Page 2 of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENFAL SERVICES DIVISION 196650 Anchorage, Alaska 99519-6650 Telephone:545-4744 Inspection Report PID No: 015-202-03 ) WELL _OT 28 BLK ,3 TRENCH WAS ( DUG A DEPTH OF 16' 29 ASBUILT SEPTIC SYSTEM PLAN VIEW 1" =50' ' ' NOTES LOT 27 C.O. END OF EACH LINE & AT ALL BENDS 24'x50' BM A BM B BM A BM B DESCRIPTION A M A S. COR OF DECK EL=lO0 BM B ~. ~ OF DECK Permit No. SW930213 s OF S Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISIGN P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone:343-4744 On-Site Wastewater Disposal System and/or Well InspecUon Report Legal Description T. 12 N, R. ,3 W, SEC 22 SM Ag:. PIE) No: 015-202-03 LOT 28, BLK 5 TALUS WEST //1 MONITORING TUBE PERFORAI' ~) PIPE SEPTIC SYSTEM PLAN VIEW 2;. "" TYPICAL HORIZ 1'=40' VERTICAL 1"=4' ASBUILT ~ ]~ 50' >' ~ :' &9th ~ ~. ~ ~ ABSORPTION SYSTEM PROF!I E_ ENGINEERS · ARCHITECTS · SCIENTISTS · SURVEYORS July 15, 1993 Mr. Robert Robinson Departmem of Health & Human Services P.O. Box 196650, 825 "L" Street Room 502 Anchorage, AK 99519 Re: Septic Tank Integrity Lot 28 Block 3 Talus West #1 Dear Mr. Robinson: I have inspected the septic tank on the above referenced lot. tank condition is good and does not need to be replaced. very truly, era rojeeYc t~Maa n~;~,~. E. CSM:CC: 1110X 1110026. I certify that the 301 ARCTIC SLOPE AVENUE, SUITE 200 · ANCHORAGE, ALASKA 99518-3035 (907) 349 5148 · FAX (907) 349 4213 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT NUMBER:SW930213 DESIGN ENGINEER:ARCTIC SLOPE CONSULTING GROUP OWNER NAME:MERRELL DALE R & OWNER ADDRESS:il766 WILDERNESS DR ANCHORAGE, AK PERMIT DATE ISSUED: 7/13/93 EXPIRATION DATE: 7/13/94 PARCEL ID:01520203 LEGAL DESCRIPTION: TALUS WEST #1 BLK 3 LT 28 LOT SIZE: 22328 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 2. 3. 4. o THE ATTACHED APPROVED DESIGN. 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). THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS ~ PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343~4329 OR 343-4681 AFTER BUSINESS HOURS FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: IF'THE REPLACEMENT BED IS TO BE CONSTRUCTED OVER THE OLD ~ ~TRENCH, THE GRAVEL IN THE OLD TRENCH MUST BE EXCAVATED 10 FEET FROM EACH SIDE OF THE BED AND REPLACED WITH SOIL SIMIL- / jAR TO THE ACCEPTING INStTU SOIL. THE ENGINEER MUST ATTEST PAGE 2 OF 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 i THE INTEGRITY OF THE EXISTING TANK FOR ITS CONTINUED USE. DUE TO THE LENGTH AND CONFIGURATION OF THE PROPOSED BED, IT IS RECOMMENDED THAT A PRESSURE DISTRIBUTION SYSTEM BE USED SO AS TO ATTAIN EQUAL DISTRIBUTION OF THE EFFLUENT THROUGH- ISSUED BY: Per~il: No. 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 Wos~ewater Disposal System and/or W~II Inspection Report Legal DescdpUon T. 12 N, R. 5 W, SEC 22 SM AK. PID No: 015-202 05 LOT 28, ELK 5 TALUS WEST fi/ RECEIVED SITE MAP CONTRACTOR TO SET G~DE TO ASSURE MIN. Perrtnit' No. · · · Page 2 of 5 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaske 99519-6650 Telephone:343 4744 On-Site Westewater Disposal System end/or Well Inspection Report Legal Description T. 12 N, R. 3 W, SEC 22 SM AK. PID No: 015-202-03 LOT 28, ELK 3 TALUS WEST I SEPTIC SYSTEM PLAN VIEW 5. sYsteu TO oe ,~STALLE~ A Mi~iMUu ~ .'~9th z. commctor TO ~RI~ lO0' MIN. SEPA~TION · Permit Bio. 5OF5 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Felephone:345-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description T. 12 N, 17. 5 W, SEC 22 SM Al(. PID No: 015-202-05 LOT 28, BLK 3 TALUS WEST #1 MONITORING TUBE SURFACE C.O. SURFACE ~ C·O. ;TEM PLAN VIEW TYPICAL HORIZ 1"=40' VERTICAL 1"=4' SEPTIC TANK INTEGRITY TO BE VERIFY BY ENGINEER &BSORPTION SYSTEM P17OFILE HORIZ 1"=20' VERTICAL 1"=10' ENGINRERS · ARCHITECTS · SCIENTISTS · SURVEYORS July 6, 1993 Mr. Dan Roth Municipality of Anchorage Dept. of Health and Human Services 825 L Street Anchorage, AK 99501 Re: Septic System Design Lot 28, Block 3, Talus West Add'n No. 1 Dear Mr. Roth: Attached is the permit application for installing a septic system on the above referenced lot. Below is a narrative of probable impacts to adjacent properties. Adjacent Wells - There are no existing wells within 100 feet of the proposed new septic system. Adjacent Wastewater System - The proposed bed absorption system will not adversely effect the future sites on the surrounding lots. Reserved Space - The soil conditions on the lot meet EPA standards. There is enough room for a future system to the east of the proposed system. Drainage - Positive drainage away for the field will be maintained. No concentrated surface water will be directed toward the field and no existing streams are within i00 feet of the proposed field. The installation of this on-site system will have no probable impacts to adjacent well or septic systems. The proposed system's separation distance radius will include parts of adjacent lots, but will not interfere with the on-site systems on these lots. Very truly yours, CSM:KL:CC: 11100026.DM RECEIVED ,JUL 6 1993 Municipality of Anchorage Dept. Health & Human Services 301 ARCTIC SLOPR AVENUE, SUITE 200 · ANCHORAGE, ALASKA 99518 3035 (907} 349-5148 · FAX (9071 349-4213 ASCG System Calculations for LOT 28, BLK 3 TALUS WEST Calculations 01-Jul-93 Page 1 of 1 Tank Size 1250 GALLON TANK REQUIRED Absorption Field Sizing Using an acceptance rate of 0.5 gal/SF/day and a daily load for 4 bedrooms of 600 gal/day. Req'd Absorption Area = 600 gpd / 0.5 gpd per SF = 1200 SF System Dimensions 50.0' X 24.0' = 1200.0 SF The laterals are to be spaced 6.0' apart and 3.0' from J edge of the bed. RECEIVED ,JUL 6 1993 MUnicipality ot Ancr o: e. Dept, Health & Human ~-~'~ SOILS LOG - PERCOLATION TEST 9- 10- 11- 12- 1~- 14- 15- I6- 17- 1~- 19- 20- RECEIVED MunioJpaHty of Anohorag Dept. Health & Human Servi, SLOPE SITE pLAN f N WAS GROUND WATI~ S ENCOUN'/'~F,-~D? L O II: YES, AT WHAT DEFI'H? p Depgl to Water Afar E Me.mens? Da~ Gws~ Net Depth to Net Reading Date ' '~me T~me Water . Drop pERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER __ l ACCORDA3~CE WrTH ALL ~TATE AND MUNIC~ GU~ELIN~ IN EFFE~ ON ~IS DATE. CERTIFY THAT THIS TEST WAS pEP. FORMED I. · SOILS LOG - PERCOLATION TEST ' 3- 4- $- 7- S- I1- RECEIVED w/cbc,/' JUL 6199~ SLOPE S WAS GROUND WATI~R L F~COUN t & O IF YE~, AT ~T D~? ~p~ to Wa~r ~r SITE pLAN [t N Reading Da~ 'l~me Time Waler Drop 14- 15- 16- 17- 18- 19- 20- pERCOLATION RATE /~'., ~ ~' (minu~ginch) PERC HOLE DIAMETER ---- - .' ..... C~ THAT T.IS ~"T WAS p~O~ED Ii / ~.j MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE~DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT DISTANCE TO sorption area Dwelling DISTANCE TO: Wel[g~ Foundation Nearest Jot line ~ PERM~ ~Z No of hnes Len ~ ~otallength of hnes Trench width / ~ncebetween ines ~ PERMIT NO.pt ~ ~ Type of crib Cr~b d~ameter Crib dept~ ~ T.~; ~; ~ / ISTANCE TO: Building foundation Sewer line Septic tank OTHER SOl L T~T RATING REMARKS ~ ~ ~ APPL I CBNT LOCBT I ON LEGAL BILL. LE BOW ,'.~. 501 W NORTHERN LIGHTS BLVD. '~ - . WILDERNESS DRIVE ~., ..-rE, ii LOT 28 BLOCK ~ TBLUS WEST ~l LOT -.I~E 20800 SQUBRE FEET TYPE OF BOIL RBSORPTION SYSTEM IS: TRENCH MBXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT?BR)= -350 THE REQUIRED SIZE OF THE SOIL 8BSORPTION SYSTEM C"EPTH= ~ LE~-.~GTH= O GD:B".~'EL DEF'TH= O THE LENGTH DIMENSION IS THE LENQTH (IN FEET) OF THE TRENCH OR DR~INFIELD. THE DEPTH OF B TRENCH OR PIT IS THE DIDTBNCE BETWEEN THE SURFBCE OF THE GROUND BND THE BOTTOM OF THE E..,L:B,MTION (IN FEET). THERE IB NO SET WIDTH FOR TRENCHES. THE GRBVEL DEPTH IS THE MINIMUM DEPTH OF GRBVEL BETWEEN THE OUTFBLL PIPE ~ND THE BOTTOM OF THE EXCBVBTION (IN FEET). F~EQL~ I REC. SEF'T I C T~NK: S I ZE= 1258 G~LLONS PERMIT BPPLICBNT H~qS THE RESPONSIBILITV TO INFORM THIS DEP~RTMENT D]RINu THE *~.-TBL,_HTION INz, PECTION~ OF BN'W WELLS BDJBCENT TO THIS c . - PROPERT~ ~ND THE NUMBER OF RE_,IDENCE~ THBT THE WELL WILL '= -,ERVE. 8BCKFILLING OF ANY -~-TEM WITHOUT FINAL INSPECTION HND HPPROVHL 8Y THIS DEPRRTMENT HILL. BE -,UBJECT TO PRO~ECLITION' MINIMUId DI_,TRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SVSTEM ~Q8 FEET FOR R PRIVBTE WELL OR %50 TO 208 FEET FROM R PLBLIL. WELL DEPENDING UPON THE TYF'E OF FUBLIC WELL '1 · I' MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEHER LINE IS 25 FEET RND TO R COMMUNITV SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MRY RPPLY. ~ - ,- -,PECIFIuRTION= RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER IN-,TRLLRTION. I CERTIFY THRT i: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-BITE SEWERS RND WELLS RS SET FORTH BV THE MUNICIPRLITV OF RNCHORRGE. 2' I WILL INSTRLL THE %' '- ' -¢=,TEM IN RCCORDRNCE WITH THE CODES. ~:' I UNDERSTRND THRT THE 0 ~ ~ ~ -' N-~ITE SEWER ~_TEM MR~ REQUIRE ENERRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. SIGNED: ................ APPLIC.' NT BILL-E - E, i ................. I---UED BY_ ............................... .... 0 -- - SITE F'E~MIT NO. ( ) LOCATION ~~ TYPE OF SOIL ABSORBTION SYSTEM IS: DEPARTMENT C' HEALTH FIHD ENVIRONPiENTFIL ?"'"~TECTION 825 "Lt,.,~STREET., FINCHORFIGE., FIK. '~E~--IE~ I:~-. PE:F;~.I',I I T LOT SIZE ~.~/OcJc)SQLIRRE FEET MFIXIMUM NUMBER OF BEDROOMS --- SOIL RATING <Se FT?BR)= THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS; '~iS~L//¥? -~'¥~{~'0{'-~ [)EPTH= LEr4]]TH= GRAVEL [-~EPTH= 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 RND THE BOTTOM OF THE EXCAVATION (IN FEET>. THERE IS NO SET NIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET>. RED. SEF'T IC: TANK SIZE: /~ GRLL,3~IS PERMIT RPPLICFINT HFIS THE RESPONSIBILITY TO INFORM THIS DEPFIRTMENT DURING THE INSTFILLRTION INSPECTIONS OF ANY WELLS FIDJRCENT TO THiS PROPER~THE T[4C~ ( 2 ) [NSPECT BACKFILLING OF ANY ~YSTEM WITHOUT FINAL INSP~TION AND RF'PROVRL BY THIS MZNZMUH DZSTRNCE BETWEEN R WELL RND RNY ~88 FEET FOR R PRIVATE WELD &58 TO 288 FEET FROM R PUBLZC WELL DEPENDZNG UPON THE TYPE OF PUBLZC WELL NELL LOGS ARE RE~U[RED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~e DRYS OF THE WELL COMPLETJON. OTHER REE~UZREMENT5 MAY APPLY. SPECZFZCRT[ONS AND CONSTRUCTION D[RGRRMS ARE AVAILABLE TO [NSURE PROPER [NSTRLLRT[ON. PERP1 ! T E~:P ! RES [-~ECEMBER 31.. "19 80 I CERTIFY THAT ~: I AM FFIMILIFIR WITH THE REC4UIREMENTS 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. 3; I UNDERSTAND THAT THE ON-S~'FE SEWER SYSTEM MAY REC4UIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. ~PPLICRNT ~ ~ ......... .............. V3. 2 ANCHORAGE AREA BOR, ?;H Department of Environment@l Ouality 3330 C Street Anchorage, Alask8 ggS03 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH _ LIQUID CAPACiTY~'"~""-~"~ TILE DRAIN FIELD: '/ DISTANCE FROM WELL ,/J/~','~ 4- FOUNDATION ,c;~? _NEAREST LOT LINE 1~2,.~j TOTAL LENGTH _OF L,NES ABSORPTION AREA~0/~ ~ SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE ~ 'MATERIAL BENEATH TILE /~ DOVE TILE WELL: ' TYPE_. ~"!//,,~/ CONSTRUCTION DEPTH __ BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE SEWER LINE TANK , SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCE FROM: DISTANCES: INSTALLED BY: )~~' SEWER LINE DEPTH; PIPE MATERIAL: LOT SLOPE: REMARKS: Form EQ-032 DIAGRAM OF SYSTEM DATE APPROVED _ " ' ' G.A.A.B. ' - GREPi./,R ANCHORAGE AREA Bo~ DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 ,,GH SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. INSTALLATION LOCATION MAILING ADDRESS INSTALLATION OF: SEPTIC TANK ~ / ~' SEEPAGE PIT DRAIN FIELD NOTE~ THIS PERMIT IS NOT VALID WITHOUT BOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REC~UIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF TO NEAREST LOT LINE, I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE Parcel I.D. # 1. 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 OI5- Z~Z. - 433 HAA # GENERAL INFORMATION Complete legal description 1_~-~ 28/ 3v./ SEc. St . Location (site address or directions) [ 1 7 [~ ~ ~ i J~J ~ ~.~ ~ Properly owner ~AL~ ~~ Mailing address I ~ ~/~/.~ W~l~n~s5 ~_~. Lending agency Day phone ,~ - 5t~J Day phone. Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well X Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community Wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~25(Rev, 1/91) Front MOA#21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm /_~,z~_,~'. Ir3~_. Phone Address :~ol ~,r~-+,~ 51~¢~-- ~v~; ~.. ~ EngineeYs signature ( ~ ¢*~* ,~: Date DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedroomS. bedrooms, with the following stipulations: Additional Comments By: ~ 4~,-,,,.~ Date 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 orderto satisfy certain federal and state requirements. Em ployees 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. 72~025(Rev. 1/91) 8ack MOAIC2Z Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. Well Data Well type ~r, ~J ~-'~ ~-- Log present (,Y/N) Total depth 1 o 5 Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ! ~?~" Driller '{:~' Cased to ~ -F- "~)~5~-,~ I Casing height Wires properly protected (Y/N) "// FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I o ~) + Absorption field on lot ] o ~ Public sewer main I ~ 'P Sewer service line ~ D o -H g.p.m. AT INSPECTION g.p.m, ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank I ~ WATER SAMPLE RESULTS: Coliform ~ Date of sample: '~ ~-'-~ ,~ ~ ~ '~ Nitrate ~'~ Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed .~ - ;~ ~ ~ ~ Cleanouts (Y/N) High water alarm (Y/N) Date of pumping '7 - I ~ ~ ~ ~ Tank size I~ 5 ~ Compartments ~-- Foundation cleanout (Y/N) '7/ Depression (Y/N) Alarm tested (Y/N) ,/~ Pumper ,Z~ ''~ /~m~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot )~ -H On adjacent lots ) ~c) + Foundation .5' To property line ~'~+' Absorption field Surface water/drainage CONTINUED ON BACK PAGE 72-026 (3/93)' Front 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 ~ON TO: Well on lot ~ On adjacent lots D. ABSORPTION FIELD DATA Manufacturer J Manhole/Access (Y/N) ~ C.,yc sle"~t est ed Sudace water Width Date installed Length Total absorption area Date of adequacy test /"J/'/~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) . .~ Gravel thickness Cleanout present (Y/N) "/ Results (pass/fail) System type ~ ~E' %:) I. ~ Total depth '~ 5 Depression over field (Y/N) for After test If yes, give date ~ Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Sudace water Curtain drain On adjacent lots ~ D ~ 4- Property Pine To existing or abandoned system on lot Cutbank / O c:, 4- Water main/service line Driveway, parking/vehicle storage area ~ ~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect Qn !~ date of this inspect~bn. Signature (?J,A' .¢& ~ ,' .......... Date ,.~ .., .. .~..-.- ,...,. ,., ,, HAA Fee $ /~D / g)Z') Waiver Fee $ Date of Payment ~ ~ _c~ Date of Payment Receipt Number ~2Z/~' ~Z/' ~¢ ~_~ ~) Receipt Number 72-026 13~93~' Back NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE 2505 FAIRBANKS STREET FAIRBANKS, ALASKA 99701 ANCHORAGE, ALASKA 99503 (907) 456-3116 · FAX 456-3125 (907) 277-8378, FAX 274-9645 Arctic Slope Consulting Group 301 Danner Avenue, Suite 200 Anchorage AK 99518 Attn: Kevin Liebner Report Date: 08105/93 Date Arrived: 07/30/93 Date Sampled: 07/30/93 Time Sampled: 1000 Collected By: KL Our Lab #: A125049 Location/Project: ~29-002/T~us ~ Your Sample ID: ~L-28, B-3 Sample Matrix: Water Comments: Lab Number Method Parameter * Definitions * B = Below Regulatory Min. M = Above Regulatory Max. E = Estimated Value M = Matrix Interference D = Lost to Dilution MDL = Method Detection Limit Units Date Date Result * MDL Prepared Analyzed A125049 EPA 353.3 Nitrate-N mg/1 0.6 0.1 08/04/93 RECEIVED AUG 7 0 1995 OeDM~u~jci ,;l~iy o~ Anchorage r~e~h & HUrnar~ Services Reported By: Susan C.~ Tifental Microbiology Supervisor NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE 2505 FAIRBANKS STREET FAIRBANKS, ALASKA 99701 ANCHORAGE, ALASKA 99503 (907) 456-3116 · FAX 456-3125 (907) 277-8378 · FAX 274-9645 DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA Arctic Slope Consulting Group 301 Arctic Slope Avenue Anchorage AK 99518 Public Water System I.D.# Date Received: Date Analyzed: Date Reported: Next Sample Due: 07/30/93 Time Received: 11:01 07/30/93 Time Analyzed: 17:00 08/03/93 Time Reported: 08:29 S = U = POS = ND = Collected by~ Kevin M TNTC = Sample '~e: CG = ~cu~ine HSM Method of Analysis: Membrane Filtration SA = old = Comments: R = NT = Satisfactory Unsatisfactory Positive Test Result None Detected Too Numerous To Count (>200 Colonies) Confluent Growth Heavy Sediment Masking, Results May Not Be Reliable Sample Age >30 Hours But <48 Hours, Results May Not Be Reliable Sample Age >48 Hours, Too Old For Analysis Resample Required No Test * # Colonies/100 ml ** # Colonies/mi Sample Sample Total* Fecal* Other* HPC** Location Date Time Lab~ Coliform Coliform Bacteria Result Comments Susan C. Tifental Microbiology Supervisor ARCTIC SLOPE CONSULTING GROUP, INC. LOCATION: Subdivision: Lot: Block: Client's Name: ~ Addr~s: l I ~ TESTER: ~O t~ WELL LOI Initial Reading on Meter: DRAW TIME GPM GALLONS GALLONS FIELD MONITOR METER DOWN VOLUME TOTAL LEVEL READING ~5 q:oo - 6_5 IX: q.5 Production Rate: ~.~ GPM 24_Hour Capacity ~t ~(o 8 Gallons./ DATE DATE DATE MUNICIPALI~ OF ANCHO~GE ~UNICIPALITY OF ANCHORAGE DEPT. ( ENVIRONMENTAL SANITATION DIVISION A~ 2 } iDS0 Telephone 264-4720E REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND S DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE MAILING ADDRESS PROPERTY RESIDENT flf different from above) PHONE , PHONE 2, BUYER MARLING ADD~ESS 3, LENDING INBTIT ON PRONE 5. LEGAL DESCRIPTION STREET LOCATION 6, TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One ~ Four [~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY ~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975, For wells drilled prior to that date, give welt [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE*' ~O~,-~___YEAR ON-SITE SYSTEM WAS INSTALLED. [] ~PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [Z3 ONE [] THREE [] FIVE [] TWO E~ FOUR [] SiX [] OTHER 2. WATER SUPPLY INDIVIDUAL [] COMMUNITY [] PUBLIC UTI LITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA PERMIT NUMBER DATE INSTALLED INSTALLER MANUFACTURER MATERIAL 4, DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS DATE [Z~'"~APP Rev ED FOR [] CONDITIONAL APPROVAL (letter must o BEDROOMS mpany certificate) 72-010 (Rev, 6/79) CONSULTING ENGINEER 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 August 1, 1983 Mr. John Riley SRA Box 41-C Anchorage, Alaska 99507 LEGAL LOCATION OWNER RESIDENCE WATER SEWER DATE OF TEST TEST PROCEDURE TEST RESULT mUN/c-/P~urv o~ DEPT. ANCHo ~AIVIRo,'~!MEt(~4H, EALTH ~,, ~ PRO~EC~io RECEIVED SEWER ADEQUACY TEST Lot 28, Block 3, Talus West 11766 Wilderness Drive John Riley Four Bedrooms Single Family On Site System From Municipal Records: Tank Absorption System Absorption Area Soil Rating Instalation Date 1250 gal. Greer, Two Compartments Trench !3x 39 ft. 1014 s~, ft., 250 August 1975 July 27, 1983 System was inspected on JulY 17, 1983. Septic tank was surcharged and there was water observed in the clean out. Inspection of ~he residence uncovered a leaky toilett and a heavy use of the washer. The lady of the house did laundry for a hairdresser every evening. On July 27 the system was inspected again. The toilett had been repaired and the heavy laundry stopped. This time no indication of .surcharging was observed. Water was no added to the system at a steady rate of 8 gal. per min,After 560 gal was added liquid started to back up in the cleanout and the tank. An additional 240 eal was added which resulted in a liquid depth of 5¼ inches in the cleanout. After 3 hours the level had dropped to 4 inches, after 5.5 hours to3 inches. This system absorbed 57: gal. in 3 hours. In 5 hours it absorbed103 gallons. This system meets the Municipal requirements. Hay 20~ 19~0 Nat Donaway % Dynan~ic Realty.. Inc, 501%'~est ~forthern Lights Boulevard Anchorage: Alaska 99503 Subject: Lot 28 Block 3 Talus West Subdivision Bill/Dorothy Le Dow Property ~?his department can not approve the se%~er and water facilities ~ntil the Multi-Fie unit has been replaced with a conventional type septic tank. See the enclosed letter. If there are any further questions, please call -this office at 2~4~4720. Sinc~ely~ klobert C. Pratt, R.S~ Associate Specialist itCP/ljw cc: National Bank of Alaska ~4ortgage Loan Department Pouc!i 7,-025 99510 REID ENVIRONMENTAL ENGINEERING SRA BOX 1584R ANCHORAGE, ALASKA 99507 (907) 3444 205 276"-',B61 HAY 1 i980 MUNICIPALITY OF ANCHORAGE DEPT. OF i:~/,LT;I & ENVIRONME~ ,~TAL F,~OiECTION [,.!AYlgS0 .RECE! ED 11766 NZL. DE:RNE,¢3S g~'~ ..... IVE. ANC 'i,)',,AI,,~':. AK SE;,..L.ER SANE SUE~D'ZV:}:SZON-TAL. L)~,i; Ni:T. S T EJL. OCK-.-.~ LOT-28 THE TYF:'E OF AE~SORE:'~'ZON SYSTE:H :11S A 'TRENCH NZ'TH AN AREA OF:' l O:L~ THE (:~UANT:~'TY OF' NA"FER AE~E;OREH:~:D DURZN6 THE TEST NAS 27~J GALLONS, THE SO~:LS RATZNG OF' THE SYSTEM AT CCJN~3TI:[:UCT:[GN NAS 25~ AND NON :I:S 2z~9 SQF'T/ 'THE RE:QU:~iRED AREA F'OR A ~ E:EDROOH HOUSE :KS 996 SQF'T, TH:I:S HOHE HAS :LO:!.zf SQF'T~ BA[;ED UPON THE TEST DATA 'THE SYS"I'EH I:S ACCEF'TAE:I_E FOR A z~ E:EDROOH HONE~ An c or 4 e 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M, SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION April 28, 1980 Nat Donaway % Dynamic Realty, Inc. 501 West Northern Lights Boulevard Anchorage, Alaska 99503 Subject: Lot 28 Block 3 Talus West Subdivision #1 Bill/Dorothy Le Bow Property Approval for your individual sewer and water facilities can not be granted until the following items have been completed: (1) A well log submitted to this department for our review. 1 ,~) The water analysis report be delivered to this office from Chem Lab, 5633 B Street, for our review. See enclosed letter regarding Multi-Flo units. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw CC: National Bank of Alaska Mortgage Loan Department Pouch 7-025 99510