HomeMy WebLinkAboutTALUS WEST #1 BLK 3 LT 30Talus West #1
Block 3
Lot 30
#015-202-01
~ MUNICIPALITY OF ANCHORAGE
i · DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEIV] AND/OR WELL INSPECTION REPORT
NAME ~)~t~' · PHONE ~i~ ~EW
LEGAL DESCRIPTION
~ ~ ~ Z Manufacturer ~._~ M No. of compa~nts
Liq. 5 ~r Inside length
capacit i gallons ~ Width Liquid depth
[ ~ IF HOMEMADE:
~ ~ DISTANCE T ' Well Dwelling PERMIT NO.
O ~ ~ Manu~~ ~ ~ ~ ~;teria] ~ Liquid ~city in gallons
Length Width Depth PERMIT NO.
~--~ ~ Type o~ Crib ' er b d ~ective a
DISTANCE TO:
~ A J~ I Depth Driller Distance to lot line PERMIT NO,
~ - Building founda ' n~. Sewer line ~ Septic tank Absorpti~
OTHER
SOl L TEST RATING ~ ~ ~
APPROVED _ .DATE LEGAL
RPPL. I BRNT
LOCFIT I ON
LEGRL
ROBERT G. LINCOLN
TRFIVERSE lqFi~'r'
L 30 B Z< TFILUS NE:.ST
PO BOX ±0-±045 DDSii
LOT SIZE
T"?PE OF SOl[_ FIBSORPTION :SYSTEM IS: 'FRENCH
FEET-?
MR~-,;IMUM NUMBER OF BEDROOMS = 4
SOIL RFITING <SQ FT/BR)= 175
THE REQUIRED SIZE OF THE SOIL FIB$ORPTION SYSTEM IS:
[:' E F' T .~-.~ =: :,'L ~,'~ b, E ["-,[ ~--:~ T ~'4=-= 5£~ l..].~ F:": F! '-,,,' E L [:" E F"I'"H := 6
THE LENGTH DIMENSION IS 'THE LENGTFI (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF F! TRENCH OR PIT IS THE DISTRNCE BETHEEN THE SURFFICE OF' 'THE
GROUND FIND THE BOTTOM OF THE EXCFIVFI]'ION (IN FEET::,.
THERE IS NO SET ~4IDTH FOR TRENCHES.
]"HE GRRVEL DEPTH IS; THE MINIMUM DEPTH OF GRRVEL BETHEEN THE OUTFRLL PIPE
FIND THE BOTTOM OF THE E,'.'..',CRVFITION (IN FEET).
PERMIT FIPPLICRNT FIFIS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DLIRING
!NSTRLLRTIQN INSF'ECTIONS OF RN'?' HELLS FIDJRCENT TO THIS PROPERT? FIND THE
NUMBER OF RESIDENCES THRT THE NEL. L HILL SERVE.
THE
........ -f ~,..~ 0 ,~ ¢i: ]::' :[ ~"4 S F' E C: T I ~] ~,.,~ S; I::~ F: E F;: E ~,,.-T-.~ t,fi % F: E [:
BRCKFILLING OF FIN'¢ SYSTEM HITHOUT FINFIL. INSPECTION FIND RPPROVRL. BY THIS
DEF'RRTMENT HIL. L BE SUBJECT TO PROSECUTION.
MINIMUM DISTFINCE BETNEEN FI WELL FIND RNY ON-SITE SEHRGE DISPOSFIL SYSTEM IS
±00 FEET FOR FI PRIVFITE HELL OR 150 TO 2E~0 FEET FROM Fi PUBLIC WELL DEPENDING
UPON THE T"¢PE OF PUBLIC NELL.
MINIMUM DISTRNCE FROM R PRIVFITE HELL TO FI PRIVFITE SENER LINE IS 25 FEET RND
TB R COMMUNITY SEI,.IER LINE tS 75 FEET.
HELL LOGS PRE REQUIRED FIND MUST BE RETURNED TO THE DEPFIRTMENT HITHIN 3:0 DR'CS
OF ]"HE 1.4ELL COMPLETION.
OTHER REQUIREMENTS MFI"r' RPPL'-r'. SPECIFICRTIONS FIND CONSTRUCTION DIFIGRFIMS FIRE
RVRILRBLE TO INSURE PROPER INSTRLLF~TION.
I CERTIFY THFI]"
1: I FIM FFIMILIFIR WITH THE REQUIREMENTS FOR ON-SITE SEI4ERS FIND I,.IELLS RS SET
FORTH B'¢ THE MUNICIPFILIT'-? OF FINCHORRGE.
2: I I,.!ILL INSTFILL. THE SVSTEM IN RCCORDFINCE P.IITH THE CODES.
]:: i UNDERSTFIND THRT THE ON-SITE SEI,.IER S'.r'STEM MR'T' REC..!UIRE ENL. RRGEMENT IF' THE
RESIDENCE IS; REMODELE[:, TO INCLUDE MORE TFIRN 4 BEDROOMS.
SIGNED: .......................................................
FIPPLICRNT ROBERT G. LINCOLN
V4. 0
- i UNICIPALITY OF ANCHORAGE,
Department b~Health and Environmental~rotection
825 L Street, Anchorage, AK. 99501
264-4720
~ %\~l~ * * * HANDWRITTEN PERMIT * * *
WELL AND/OR 0N-SITE SEWER PERMIT
APplicant: ~ ~ ~6~Mailing Address:-
Location:. ~lyc~7>%~ ~ ~3c~A/ Phone Nun%ber: ~
Lega~ Des&r.iption: ,~.3~, ~, ~~ ~ Lot Size:
Type of Soil Absorption System Is:
Trench: ~Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: L~ soil Rating(sq.ft/br)
The~Req.uired Size .of the Soil Absorption System. Is:
DEPTH /0 LENGTH ~'C~. . SRAVEL DEPTH ~ WIDTH
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 .excavation(in feet). There is no set width for trenches.
The gr~vel depth is the minim~/n depth of gravBl between the outfall p~pe and
the bottom of the excavation(in feet).
· * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~ j'7.P GALLO~S *
Permit applicant has ~he responsibility to inform this department during the
installation inspections of any wells adjacent to this. property and the number
of residences that the well will serve.
· * * TWO(2) INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum 'distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance f~om a private well to a private sewer line
is 25 feet and to a com/nunity sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requlrements may apply. Specifications and construction diagrams are
available to insure proper installation.
· * '* PERMIT EXPIRES DECEMBER 31, 1 9 $ 1 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I w~ll ins~alt the-system ~n accordance with codes.
(3) I understand that the on-site sewer system may ~equire enlarg~ent if
the residence is remodeled to include more that~ bedrooms.
,Signed~ . ,, Issued bY' ~/~/'~]~
Applicant Date:
SWP,/024(1/81)
MUNICIPALITY OF ANCHORAGE
Department of Health and Environmental Protection
825 L Street, Anchorages A1;. 99501 x
264-4720
` + ` HANDWRITTE•N PERMIT i ; ` -4
WELL AND/OR ON-SITE SEWER PERMIT
Applicant: �A- t4J C t •n R (}Fiw..tiailinq Addresc s !i n:
Locations
hone Number:
',J
Legal Descriptions /�'i (�1-lf- 4e-"SLot Sizes (1 /r,0e -
Type of Soil Absorption System1s: 4
Trenchs A` Drainfield: _ _ Seepage Bed: bolding Tanks
Maximum Number of Bedrooms: �� Soil Ratinq(sq.ft/br) /7-S
,
,The Required Size of the Soil Absorption System Iss!!
DEPTH _�b LENGTH ;�� -- GRAVEL DEPTH WIDTH 1
The length dimension is the length(in feet) Of the trench or drainfield.
depth of a trench or pit iG the distance between the surface Ot the ground
the bottom of the excavation(in feet). There is no set width for trenches
The gravel depth is the -minimum depth of gravel between the outfall pipe a
the bottom of the-exeavation(in feet).
` REQUIRED SEPTIC(HOLDING) TANK SIZE / S _ _ GALLONS +
Permit applicant has the responsibility to inform this department during they
installation inspections of any wells .adjacent to this property and the numb4
of residences that the well will serve. i
} 4 + T46(2) INSPECTIONS ARE REQUIRED
eackfilling of any system without final inspection and approval by this de
pa,�
will be subject to prosecution. 4
Minimum distance between a well and any on-site sewage disposal system is 104
for a private well or 150 to 200 feet from a public well depending upon ehe'S
of public well. Minimum distance from a private well to a private sewer lig
is 2S feet and to a community sewer line is 75 feet. Well logs are require
and must be returned to this department within 30 days of the well cosopleti
Other requirements may apply. Specifications and construction diagrams
available to insure proper installation. j
e s PERMIT EXPIRES DECEMBER 31, 1 S 8 1 t e`
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells a'
cat forth by the tdunicipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I and rstand th the on-site sewer system may require enlargopent.1
the sid nce re led to include more tt2atr/-3 bedrooms.
Sign
Issued by:
. Applicant 'I
Oates
SWP/024(1/81)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
PERFORMED FOR:
LEGAL DESCRIPTION:
1
/~-,z-F~-, ~L
2
3
4
s 2~-I1~,
7
0
10
~2
13
19- ~ O. Talbot
20-
[] SOILS LOG
COMMENTS
PERCOLATION
TEST
SOILS LOG - PERCOLATION TEST
SLOPE
SITE PLAN
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
2. O 15 /J
PERCOLATION RATE ft~ ~..minute$/inch}
TEST .UN .ETW.EN ~ F~' ET AND ¢?~" ET
PERFORMED
72-008 (6/79)
V,O, Io~' {~ ~ ,PP~"-
Parcell.D.
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
015-202-01
V GENERAL INFORMATION
Complete legal description Talus West #1 Block 3 Lot 30
Location (site address) 4401 Traverse Way, Anchorage
• •4
4R •, f
j
COSA # P & b'13M
Expiration Date: /
Current Property owner(s) Cathy Krevftz-Zalicek Day phone
Mailing address 450 E. Bonanza Dr., Carson City, W 89706
Lending agency Day phone
Mailing address
Real Estate Agent Marlene Gartin/Midnight Sun Real Estate Day phone 229-9002
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well✓❑ Individual On -she
✓❑
Individual Water Storage ❑ Individual Holding Tank
❑
Community Class Well ❑ Community On-site
❑
Public Water System ❑ Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of Onsite Systems Approval
are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, l 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 Islam) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Finn Watkins Engineering, Inc. Phone (907) 349-1851
Address P.O. Box 110443. Anchorage, AK 99511-0443
Engineer's Printed Name Cindy W. Ellis Date 7/12/2008
5. DSD SIGNATURE y ZD
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
By:
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: -7111 F=ly--
Municipality of Anchorage
' Development Services Department
Building Safety Division
On -Site Water 6 Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 9951943650
www.muni.oryonaite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Talus West #1 Blk 3 Lot 30 Parcel ID: 015.202-W
A. WELL DATA
Well type Prl If A. B, or C provide PWSID #
Date completed 7/90181 Sanitary seal (YIN) Yes
Total depth 94 ft. Cased to M—&
FROM WELL LOO
Date of test July 30. 1981
Static water level 20 ft.
Well production 5 9.p,m.
WATER SAMPLE RESULTS:
Coliform 0 colonies1100 mL Nitrate 0.805 rng1L
Arsenic: 10_005 mg1l Date of sample: 6/22/08
S. SEPTICIHOLDING TANK DATA
Wen Loo (YIN) Y
Wires prop" protected (YIN) Yes
Casing height (above ground) 20 kr.
AT INSPECTION
June 21, 2006
54 IL
4.4 9 -p.m -
Other bacteria 0 colontesH00 mL
Collected by: Cindy Ellis
Tank Type/Materlal Steel Septic Tank Date installed September 28, 1981
Tank size 1250 gal. Number of Compartments 2 Cleanout# (YIN) Yes
Foundation cleanout (Y]N) ,_, Depression over tank (YIN) No High water alarm (YRS WA
Date of pumping June 21, 2006 Pumper A+ Home Services
C. ABSORPTION FIELD DATA
Data installed 912811981 Sol rating (g.pAJe or Ieibdrrn)175 System type Deep Trench
Length 59 R. Width 3 R. Gravel below pipe 6 R.
Total depth 11.3 11 Eff. absorption area 708 to Monitakrg tube Yes Depression over field No
Data of adequacy test 6I21I20DO Results (PasslFaip Pass For 3 bedrooms
Fluid depth in absorption Sold before teat 42.6 in. Water adds 7d � gel. New depth 76.0° in,
Elapsed Time: 284 min. Final >luid depth 89.5 fn. Absorption rate >• 600 9.p.d.
Any rejuvenation treatment (past 12 mo.) (YM 3 type) No
11 yes, give date
D. UFT STATION
Daft jnsfaned_HllA. Size in gallons Manhole/Access (YRS
'Pump on' level at —in. 'Pump off level at _ in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankfiiR station on lot 103'
Absorption laid on lot 100'+
Public sewer main 100'+
Sewer peptic service Ane 7=
High water alarm level at
Meets alarm & Cuwlt nKNArementa?
On adjacent lets 100'+
On adjacent lots 1 W+
Public sewer manhole/cleanout 100'+
Holding tank WA
Animal containment areas 100'+ Manure/animal excrete storage areas 1 W+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 19' Property line W Absorplon lend 1'
Water main 100'+ Water service Ane 50+ Surface water lar+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
property, One 17 Building foundation 31' Water main 100'+
Water Service line 35+ Surface water 100'+ Drlvewey, parWrigNehide storage 1 ti+
Curtain drain WA Wells on adjacent lots 100'+
F. COMMENTS: 'Sump Is 7,9' deeper than bottom of trench. Absorption reported is average over lire entire
interval. Above to operating level, the absorption is greater then average, as measured during monitoring of draining
during the lest: absorbed 470 cations wltNn 3 hm.
0. ENGINEER'S CERTIFICATION
1 car* that 1 have determined through field inspec9ons and
review of Municipal records that the above systems aro in
conformance with MOA COSH guidelines in effect on this date.
Engineer's Printed Name Cindy W. EIAs
Data July 12, 2005
COSA Fee $ell "� Waiver Fee S....,
Date of Paymentg% O26 Date of Payment
Receipt Number ��33 Receipt Number
(Rev. 7IMM
VY W Ellis
CE -town :.
Jul -17-06 01:36pm From-Homastato Uortsaas
THE INFD"nON HEREON IS FOR THE USE OF LET."JIN ,
01STITU(TONS SPECIFICAIIY TO 3HCN ANI cornIGT'S
F:11IEN Mr.NC Sn CTLF;a;yYD PLAM-D W. Ll NE5
OR EASC6a NTS 94U ISNOT TO it USED FOR POSIT ANING
ADDITIONAL STRUCTURES OR FENCFLINES.
rV
SCALE /"•40'
0072737215
EASEMENTS OF RECORD, OTHER THAN
THOSE ;'p4O+:YV ON THE RECORDED
PLAT. ARE NOT SHOWN HEREON, '
AI puny No Glm.q Lt fllN
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rn• .",0y W It $10.1.0 I"1100A all NiMn IM 0100•I\v I.MI 1114 d0 001 "'.60 01
•"PO•L" On IM wwo"V lying 801,00•11 IMYIO. IMI 110 0" vl 0 w
lying 1d Pt•n1 m••HO amsro•CA 0n IM promise, A OVn1On °M IMI InMI Ml n010i/wgyl.
111.. ,1610n Lnu W 0019I b4,014 MMAI•n I. On Mid WO nV °.Q•°I IA II1d.01.0 I%WWA.
7-707 P.002/002 F-992
Book 010. nw M.
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AnglorW. Aims —. - - t o. •. T- oGV
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R•�cEkT/F1ED 7 ✓vcy Lcob i1��'a�tiiol�i `�
Parcel I.D. #
1; '* GENERAL INFORMATION
COmplete legal descriPtion
MUNICIPALITYOFANCHORAGE :
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services ~
- On-Site Services Section ~^,4t~ ~ ^~:~, otYtStO~
P.O. Box 196650 Anchorage, Alaska 99519-66504vt~.0
343-4744 ' ~0~/
CERTIFICATE OF HEALTH AUTHORITY ~ .
: APPROVAL FOR A SINGLE FAMILY DWELLING
Location (site address or directions) Z-/L/o/ '~9-'~U~F--' ~./A-~/
Property owner gglA~ ~ ',~,r~ ~F~r> ~z~y Day-phone
_Mailing address
Lending agency _,.-'-'- Day phone
Mailing address
Agent / Day phone
Address /
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~
TYPE OF WATER SUPPLY:
Individual well ~
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
lng 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, l/91) Fro~t MOA#21
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 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.
Name of Firm AI~., ';'¢a[e~ & ,W'a~t~,~,~' Phone
DHHS SIGNATURE
~ Approved for ¢
Disapproved.
Conditional approval for
bedrooms.
Date //
bedrooms, with the following stipulations:
Additional Comments
Date
The M~Jr~icipality of Ar~horage Department of Health and Human Services (DHHS) issues Health Authority
Approval Cei'tificates;based only upon the representations given in paragraph 5 above by an independent
professional engin, eer registered in the State of Alaska. The D H HS 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.
Municipality of Anchorage .,~, ..... ~;;~;~;;~
DEPARTMENT OF HEALTH & HUMAN SERVICE8~°t'~[~
Environmental Services Division ?_'; 99'
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343:~744
Health Authority Approval Checklist ~ ~ C ~ iV ~ ~
Legal Description: ~ ~O, ~"~/ "T,~L~5 ~[,//F-~7 &//..~ Parcel I.D.:
A. WELL DATA
W~ell type ~'~U~I~-
Log present ~/N)
Total d~pth ~ L{ ~
Sanitary seal (~)'N)
If A, B, or C, attach ADEC letter. ADEC water system number /~/,~
Date completed O °c-~o - ~ (
Cased to ~l' ' Casing height (above ground)
Wires properly protected~/N)
FROM WELL LOG
Nitrate
Date of test
Static water level ¢O'
Well production
WATER SAMPLE RESULTS:
Coliform
Date of sample:
g.p.m.
Collected by:
AT INSPECTION
B. SEPTIC/HOLDING TANK DATA
Date installed O'==/i,,~¢/~! Tanksize /~-~(~ (~-~- Number of Compartments ~ Ceanouts~,~).__
Foundation cleanout ~N) ~/E& Depression (Y~:~ ~ High water alarm (Y/~)
Date of Pumping II//""//?:~ Pumper 0~-0 ,¢'I'A¢~0'~c~£
2
C. ABSORPTION FIELD DATA
Date installed (")~I/~,~/~'{ Soilrating (g.p.d./ft~o~m) I'~> Systemtype~¢''~P'T''z~''''~¢
~ ~ ~ . Total depth
Length ~°t Width Gravel thickness below pipe ~ ~ ! I'~'
Effective absorption area ~-0~ ~ ~Monitoring Tube present ~'N) ~--*?, Depression over field (Y/~
Date of adequacy test /(//~/~ ~- Results (Pas.s/Fail). ~RR%<; For
Fluid depth in absorption field before test (in.); ~'~ ~ Immediately a~er ~0 gal.
Fluid depth (ins) Minutes ater: J/~0 ~ Absorption rate =
Peroxide treatment (past 12 months) (Y~ ~0~ ~y If yes, give date
72-026 (Rev. 3/96)* ~ ~u~p ~ot RS~' ~ ~u~
Foc~t- bedrooms
~ ,,~[I '~
water added (in.): ~ /k..z~v~,~-r/
~ -h _g.p.d.
High water alarm level at* ~ *Datum
E.SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot I00 '&
Absorption field on lot
Public sewer main ~///~
Sewer/septic service line ~ ,.L
/OO ~
On adjacent lots
On adjacent lots /0o
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation /0 ~ Property line /0 '-/ Absorption field (~' (/"~¢-
Water main/service line /O ~J Surface water/drainage /OO ~ Wells on adjacent lots
/Od ~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /0 '¢- Building foundation /O '7- Water main/service line /o ',~
Surface water /(JO '~
Driveway, parking/vehicle storage area E '~
Curtain drain ~o~E ~o~J Wells on adjacent lots ~co '~
F. ENGINEER'S CERTIFICATION
I certify that/have deterl~i~ed tbr~i inspections,
,n oonformance~//~.. ~i'd, ,sin effect on this date.
Signature ~-¢ //f/// ~ ~ ~
Engineer's Name '~~y A' ~~
Date ///'z,/~.,
HAA Fee $. ~ ,, ¢
Date of Payment ,¢/¢/_~,y//~,,~Z__ .. .
Receipt Number ~'~.~ 2'~ ¢//''
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
APPRAISAL ASSOCIATES OF A~/~o~
t~0.2~ p,a/5
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage. Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # ~UL, - .~(" :~ -('~I HAA# ~'~ ~-'>x~'-~[,~ t~)'~¢),,~?-~
GENERAL INFORMATION
Complete legal description L,~'/- -~'
Location (site address or directions) t¢ ,/o ~ 7--,.-a ,, cr'.s'e ~./o v
Property owner 5'c¢_¢a,~
Mailing address
Lending agency ~¢¢
Mailing address
Agent ~,/ C~/f
Address ~¢00
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. 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.
72-025 {Rev. 1/91) Front MOA #21
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 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,
ordir!ances, and regulations in effect on the date of this inspection.
Name of Firm
Address /~/~-~0
Engineer's signature
Phone
DHHS SIGNATURE
Approved for
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
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.
Legal Description:
A. W'ELL DATA
Well type ?t/
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division _
825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 34~.J~I¢/~4Li?
Health Authority Approval Checkhst
IfA, B, or C, attach ADEC le~er. ADEC water system number
Date completed 7/$ t
Cased to Y '/~ Casing height (above grotmd)
Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
Date of test
Static water level 7
Well production
WATER SAMPLE RESULTS:
Coliform 6~ coal //00 rr~ ~ Nitrate
Dateofsamplc: 0~' / q / ?o
B. SEPTIC/HOLDING TANK DATA
Date installed 9/~,~/~9~ Tanksize
Foundation cleanout (Y/Iq)
Date of Pumping q / t9 / 9 ff
C. ABSORPTION FIELD DATA
Date installed ? / E~/~/
Length 3~ ' Width
Effective absorption area 70,~
Date of adequacy test ~/¥ / ~
g.p.m. 3'-.ff nc g.p.m.
/. ~Z r~//4~ Other bacteria /qoo(f, reffa¥'½eq'
Collected by: Ft~//~ F 7-ec 4 £ ~c
Depression (Y/N) tv
Pumper f~o~ Roo~et-
Number of Compartments ~ Cleanouts (YiN)
High water alarm (Y/N)
Soil rating (g.p.d./l~2 or ft2/bdrm)
Gravel thickness below pipe
Monitoring Tube present(Y/N) Y
Results (Pass/Fail) ~,~s~
/75' r'J~ Systemtype
f ~ Total depth
Depression over field (Y/N) tv
For
bedrooms
Fluid depth in absorption field before test (in.); 73 ~/'- Immediately afterltVY~Cgal, water added (in.): '77"
Fluid depth 7.~ A (ins.) Minutes later: ~ Absorption rate = ."> dOG, g.p.d.
Peroxide treatment (past 12 months) (Y/N) /t/ao, ~, o,~'~ If yes, give date /v. A
D. LIIeF STATION ~. A.
Date installed
Manhole/Access (Y/N)
High water alarm !evel at*
, Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Ih. imp on" level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot I o t'
"Pump oW' level at*
Absorption field on lot ¢> I t o '
Public sewer main /v. ,~.
Sewer/septic service line '~ ~ a- '
; On adjacent lots
; On adjacent lots
Public server manhole/cleanont
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation E t ~ Property line ~$~ Absorption field O
Water main/service line. ~ E 6" Surface water/drainage > too ' . Wells on adjacent lots '> too'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
Surface water ~ I~
Curtain drain tVo o¢ see,-,
Proper~ Line t3~ Water main/service line > zJ"
Driveway, parking/vehicle storage area lC,'
Wells on adjacent lots ? toa '
F. ENGINEER'S CERTIFICATION
1 certi that 1 have determined thr ~field inspections and review of Municipal req6i'ds 'th'Ot th~ ~poE~ syste)~s are
nfo h MOA HAA g effe
in co rmance wit uidelines in ct on this date.
Signatnre_
Enginecr's Name
Date
HAA Fee $__ .'~00
Date of Payment
Receipt Number //7.~ ~~'--
Rev. 8/95 OSS: baa.wk.doc
~;, /Engineering S~h~ ~ere
(,,~' '%, (;ii .. L:,,~: ? j?, !.'/'.:
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL 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 lot, block, subdivision, section, township, range)
Lot 30 Block 3 Talus West
Location(addressordirections)
4401 Traverse
(b) ApplicantName C. Ponder Telephone:Home Business 786-6715
ApplicantAddress 4401 Traverse
(c) Applicant is (check one): Lending Institution []; Owner/builder:~[~; Buyer []; Other [] (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f)
Mailthe HAAtothefollowingaddress:
Cheryl Ponder
786-6715
TYPE OF RESIDENCE
Single-FamilyJ~ Multi-Family []
Number of Bedrooms ~4) Four
Other
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 (11/84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown beJow, I verify that my investigation of this Health
Authority ApprovaJ shows that the on-site water suppJy 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 fnformation obtained
from the Municipality of Anchorage flies 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 reguJations in effect on
the date of this inspection.
Name of Firm Telephone
Address
Date
Engineer's Seal
This office has received written confirmation from the Engineer, ( Alaska
Environmental Control Services, Inc.) that the conditions of June 15, 1985
have been met. Therefore, this property meets MOA requirements.
DHEP APPROVAL ~ ~
Approved for (4'~ Four bedroom
~,pproved i×× . Disapproved Conditionaiv
Terms of Conditional Approval
6/24/85
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
ALASKA el' dlRonmenTAL CONTROL SE R=o[Ces, Inc.
~ntlineerin§ 6 ~nuironmenlol Studies
Department of Health and Human
Services
825 L. Street
Anchorage, Alaska 99501
June 20, 1985
RE: Talus West Subdivision Lot 30 Block 3
This is in regards to the property located at Talus West Block 3, Lot
30. On June 17, 1985 I observed the damaged standpipe of the septic
tank to be repaired. Therefore this conditional on your Health
Authority Approval can be removed.
If you have any questions please do not hesitate to contact me at
561-5040.
Approved by:
Sincerely,
Darcy 1~dv en s
Engineering Geologist
1200 West 33r,J Auenu~, Suite I3oAnehoro% Alos~u 99503,(907) 5fil-5040
~MUNICTFALITY OF ANCHORAGE
i ~ ~ ~' DIVISION OF ENVIRONMENTAL HEALTH
~- · DEFAi{THENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
(a) Legal Description (include lot, block, subdivision, section, township, range)
~.ocntio~ (address o~ direction)
(c) Applicant is (check one) Le~ding Institution 7~; Owner/builder~
' Buyer [-~; Other ~
(d) Lending Institution TeleFhone
Ad~. ss
(e)
Real Estate Co. & Agent
Address
T~lephone
(f)
Mail the HAA to the following address:
Type of Residence
Single-Family''
Number Of Bedrooms
Multi-Family ~--~
¥
Other (describe)
3 · Supply
Water
Individual Wel Community ~--~ Public
Note: If commuMity well system, must have written confirmatlo~ from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewage Disposal
Onsite ~ Public ~--~ Community ~--~ Holding Tank ~--~
Note.' / -/~f community wall system, must have written confirmation from the State
Department of Environmental Conservation attesting ~o the legality and status.
JPage1 of 2]
En~ineerin~, Firm Provtdtn~ Inspections1 Tests~ File Search~ Data and Info.nation
As .certified by my seal affixed hereto and as of the validation date shg~ below, I
verify C~C, ~ inves~iga~ion of' ~his He.ch athori~ Approv~ sho~ ~ha~ the ou-si~a
wa~er supply a~/or ~sCewa~er disposal system is safe, f~c~ion~ a~ ~eq~e for
=he ~ber of bedro~s a~ ~pe of sCruc=ure indicaC~ herein.- I fur=her verify ~ha2,
based on 2he i~o~2ion ob~ain~ from =he ~nicipali:y of ~chora~e files and from
inves2i~a=ion ~d tnspec2ion, 2he o~st~e ~2er supply a~/or ~s2ewa2er dispos~
system is in c~pliance ~2h ~1 ~nicipal ~ Sta2e codes, ordinances, a~ reE~a-
2ions ~n effec2 on ~he da~e of ~his inspection.
CAUTION
· £~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ~m.~LTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN '£m5 STATE OF ALASKA. 'l'H~/ DH~P DOES THIS AS A COURTESY TO PURCHASERS OF EOM_ES AND
'l'a/sIR LENDING INSTITUTIONS IN ORDER TO . SATISFY CERTAIN FEDERAL AND STATE REQUI.~E-
MENTS. EMPLOYEES OF DHEF DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE HUNICIPALITY OF ANCHORAGE IS N0T RESPONSIBLE FOR ERRORS
0R OMISSIONS IN TH~ PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RK4/eJ/DI8
[Page 2 of 2]
7-19-84
MUNICIPALITY OF ANCHORAGE (MOA)
~{EALT~ AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
WELL DATA
Well Classification I~ U~'~
Well Log Ih~esen~)
Total Depth ~/ Cased to
Static Water Level ~'~ /
Casing Height Above Ground
Electrical Wiring in ConduitS)
Separation Distances f~om ~11:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Legal Description: __/~7~ ~fP ~EO~'~C~
If A, B, or C, D.E.C. Approved(Y/N) ~1~
Date Completed 7~D/~/ Yie ld~~
~ ~/ ~pth of G~outing ~/Q~ O'
~ ~t At ~
Sanit~y ~al on Casing~
~pression ~ound ~.l~ead(~']~ ~
; On Adjoining Lots
//~'~ / ~ ; On Adjoining Lots
To Nearest Public Sewer
Cleancut/Manhole ,.~//~$-~- TO Nearest Sewer Service Line on LOt /&/~-
Water Sample'C0%lected By O' ~'~"~'~'~ ; Date ,~/~/%r~
ii,_ / / , / ~/'
[Page 1 of 2]
SEPTIC/HOLDING TANK DATA
Date Installed ~/~/~ Size /~l~-~ No. of Compartr~nts ~
Standpipe ~) [~ . ai~-tight Caps ~) Foundation Cleanout~)
~pression ove~ Ta~ (Y~)> Date ~st.tP~d /~ /~
P~ing~aintenan~ ~n~act ~ File (Y~) ~ ; for ~
Holding Ta~ High-Wate~ ala~ (Y~) /J~--Te~ra~y Holdi~ Tank Pern~t (Y~)/~
~paration Distance ~ ~ptic~olding Tank:
/
To Water-Supply ~11 /0~~ To ~ilding Foundation ~
To ~o~rty Li~ ~; '. To Dis~sal Field
To Water Main/Se~vi~ Li~ '~/ To S~e~, Pond, ~e, ~ Major ~aina~
,
co~
Date Paid: ~ a- ~%-~
~oun t: qf6~__
2-15-84
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Instal led
Width of Field
Square Feet of Absorption A~ea
~f~ Type of System Eesign
Length of Field ~--~' /
Depth of Field __/f)
Gravel Bed Thickness ~
' = Present~N)
Standpipe_
Depression over Field (¥~'~ Date o~ East A~squacy Test
Results of ~st Adequacy ~st ~5' ~ ~ ~,~ ~o~S' ~
Separation Distan~ from ~sorption Field:
To ~te~-Supply ~11 //$ /~ To ~o~rty Line
To Building Foundation ~O ~ To Existing or Abando~d System
Lot ,~/~' ; ~ Adjoining Lots -~ .~ / ~
To Water Main/~rvi~ Line ~O/ To Cut~(if
To Stre~ond~ke/~ Majo~ ~ainage Co, se
To ~iveway, Parking ~ea, ~ Vehicle. Stora~ ~ea /,~ z ~
D. LIFT STATION
Date Installed
Siz~ in Gallons
"P~mp Oa" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
CooLants
' ...~ Vent (Y/N)
** Check P_rmltted~ ' Bedroom Rating Against HAA Request **
certify that I have checked, verified, or conformed to all MOA HAA Guideline.~ in effect
o? the date of this in~[~ction.
S~gned ~ ~ L~ ~/L ~d. ~-.--~__ _Date
Company __~-~C~ )~/~.~ MOA No.
[Pa~ 2 o~ 2~
2-15-84
ALASKA r¢lRonmenTAL CONTROL SeI rJf'CeS, Inc.
DECEMBER 10 1984
CHERYL PONDER
4401 TRAVELERS
ANCHORAGE AK 99511
SELLER - DEBRA LEE BOKINS
SUBDIVISION - TALUS WEST
BUYER -
BLOCK - 3 LOT - 30
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 708 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 733 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
4 BEDROOM HOME.
THE SEPTIC TANK WAS PUMPED ON DEC 1 1984 .
A FLOW TEST WAS PREFORMED ON THE WELL. 733 GALLONS OF WATER WAS
PUMPED AT A RATE OF 5.8 GPM OVER A DURATION OF 2.5 HOURS.
THE DRAWOO~fN WAS 20' WITH A RECOVERY TIME OF 10 MINUTES
AND THE STATIC WATER LEVEL WAS 56.4 FEET.
THE WELL IS ADEQUATE FOR THIS 4 BEDROOM HOME.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR
THIS 4 BEDROOM HOUSE.
1200 ~Uest 33rd Auenu¢, $ui1¢ J~ · Anchoraqe, Alaska 99503 ,[907) 561-5040
· Tin-,_ "' ~' ~ Time _ ,me
Date ... Date Date
Inspector inspector Inspector
Comments Conditiona~ Approval
Date Sewer Installed Permit No. Septic Tank Size
c~ .~7~.~'. ~:~ t Holding Tank S,ze
Soils Rating Well To Absorption Area Well Log Received
Well to Tank
APP?OANT FILLS OUT HAFF ONLY
Property
Owner
Buyer
Lending Institution Phone
Address
Legal Description ~a ~ ~ ~ ~ ~
Typ~ Residence
~ Single Family
~ Multiple Family No. of Bedrooms
~ Other
Wat~upply
~ Individual A~ACH WELL LOG. A well Icg is required for ~11 wells drilled since June
g Community 1975. For wells drilled prior to that date, give well depth (attach Icg if
~ Public UtJlit~ available.)
Sew~ Disposal
~ Indiv[dual Year Individual Installed: ~
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
December 18, 1981
Robert Lincoln
P.O. Box 10-1045
Anchorage ~ AK 99511
.~ub]ect. Lot 30, l~lock 3, Talus West
Corner of %'raverse &
Dear ~lr. Lincoln:
A roval for the individual sewer and water facilities cannot
b~Pgranted until the following ite!~s have been completed:
office fro .- . ~ - r . . . ' '-
o ~he standpipe to the sewer syste~a need caps on them. 0,~L
Please notify this department for a reinspection when the
noted discrepancies have been corrected. If there are any
o_flce at 2~4-4720.
further questions, please call this f '' ~ ~ ~ ·
Sincerely,
Robert C. Pratt
Associate Environmental Specialist