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Home My WebLink AboutTALUS WEST BLK 4 LT 1 ,. Municipality of Anchorage Page I 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 Address: It ~ ~~ ~, ~l ~ ABSORPTION FIELD Phone:~ ~ ~ J No. of~ms: ~ Deep Trench ~ Shallow Trench D Bed ~ M~Other DESCRIPTION sog Rating: Total De~ original grade: LEGAL GPD/Sq. Ft. Township: r~a.~: r~o.on: Fill added ab°ye °riginal ~ Ft. Gravel length: Ft. WELL: ~ New D Upgrade Gravelwidth:~ Numberoflines: ~ Distance between lines: Driller: Date Drilled: Static Water Level:Ft. ~installer: ~' Date insta~ ~ J~ ~ Yield: ~ Pump Set at: J casing Height Above Ground: GPM Ft. Ft TANK SEPARATION DISTANCES ~eptic ~ Holding ~ S.T.E.P. From Tank Field Station Tank Sewer Lines ~ ~ ~ ~ ~ s.~f~c~ LIFT STATION ~ LineL°t J* 'I ~/ ~ ~ ~ S'zei" ga"°~s: I Manu'acturer; ~ CurtainDrain ~(~ ~~ ~ PumpMa~ IEleotricallnspectio~sperior~eOby: Remarks: ~¢%{ ~ ~'¢~ BENCH MARK Assumed Elevation: ~ ~ ~ 17034 Eagle River Loop Road, No. ~4 _/ .. ~9~ .~ ~ Inspections performed by: ~.=~.~lvar_Alaska ~5~ Dates: lst~ ''"""""'"'"""' "" Department of Health and Human Services approval -~:~-.. -- ,o.t:~e~ Reviewed and approved by: ~- ¢~ Date: ~ ~/~ '~uPe'OFE"'oSS,~~-''' ~ · Pern~itNo. ~l./"--J~ ::~3'~'~/~ Page -~ of ~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Eh ~EAL ~HAFER NO. ~15 72-013 A (Rev. 9/91 ) MOA 25 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930035 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:DWYER STEVE L & CATHERINE L OWNER ADDRESS:il600 OUTCROP LN ANCHORAGE, AK 99516 DATE ISSUED: 3/24/93 EXPIRATION DATE: 3/24/94 PARCEL ID:01520139 LEGAL DESCRIPTION: TALUS WEST BLK 4 LT 1 LOT SIZE: 17843 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. 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 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: DATE: DATE: HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SItE WASTE WATER DISPOSAL SYSTEM DESIGN march ROBERTSHAFER, PE ROGERSHAFER PE CIVIL ENGINEERS (907) 694 2979 FAX 694-t211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Talus West Subdivision, Block 4, Lot 1 We request you issue a permit to replace the existing 1500 gallon septia tank serving the above referenoed property. The existing 1500 gallon septic tank was excavated and found to be in poor condition (full of holes and leaking effluent). The existing trench on the property has passed an adequacy test in March 1993. We do not anticipate any adverse effects on neighboring properties by the replacement of this septic tank. If you have any questions or require information please contact us at 694-2979. s/a / SU/lsu any additional 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 ' ' SCALE -- RECEIVED MAR 5 199 Municipality of Anchorage Dept. Health & Human Services ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and M~TERIAL SPECIFICATIONS REFERENCE: Talus West Subdivision, Block 4, Lot 1 11600 Outcrop Lane GENERAL: 1. The scope of this project includes the installation of a 1500 gallon wastewater septic tank to serve the five bedroom residence located on the referenced property. The existing septic tank is to be excavated, pumped, crushed, and abandoned in place. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank· 3. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. Page two Construction practices Talus West Subdivision, Block 4, Lot 1 A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank° The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank constructed by manufacturer. proposed for installation must be a Municipally approved septic tank The following septic system Anchorage: pipe materials are approved for use in installations in the Municipality of Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). INSPECTIONS: Typically there will be a minimum of two (2) inspections required during the installation of the wastewater septic tank. These inspections will occur as follows: The first inspection must be conducted after the septic tank is set in place, but may not be backfilled before this inspection. Page three Construction practices Talus West Subdivision, Block 4, Lot 1 The final inspection is to occur upon final grading of the property. The inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre- construction meeting will take place on-site. Hea~_-~ and Environmental Proted~On Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL__ -- INSIDE LENGTH__ MANUFACTURER -- INSIDE WIDTH MATERIAL LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY GALLONS. TILE DRAIN FIELD: ~J~) "~' NEAREST LOT LINE_/~)/ .OF LINE DISTANCE FROM WELL J~00/~ FOUNDATION ~ of Lines ABSORPTION AREA ~ SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER TILE t)EPTIh TOP OF TILE ]O FINISH GRADE ~ ~ MATERIAL BENEATH ~. ABOVE TILE ~ IN, SEEPAGE PIT: Log Crib- Rings__ BUILDING FOLIN DATION DIAMETER - OR WIDTH--, lENGTH ., DEPTH ,,' Crib Si~e:l DIAMETER____DEPTH- DISTANCE FROM: WELL ,., ~ TOTAL EFFECTIVE _ , NEAREST LOT LINE__ ABSORPTION AREA (WALL AREA) SQ. FT, Well Class~ Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: ~/~ c, ~ of Bedrooms: .~ Installer: A¢~'~ ~ Remarks: FIF'F'L I CFINT L 0 C R T I 0 N L. EGRL .TOE HE, NE~, SR~ E,,. E~FCR'F' LN. ,~.,., , LOT _.,I~.E -LZFiFtF~ SgHJRRE FEEl" LT. :tBK. 4 ]-RL. IJS WEST -~D c-? · . .-- .=,',' ..,] EM I:,: TYPE OF SOIL RE:S3RETION '-'": "" 1F..EN...N · .4 ' OF 8EDR]EMS = 5 _,u.LL RRTING MRS.( I Mt_IM NUi'IE ER ' 'THE REQUIRE[~ :,I~E OF THE '~FIL FIBE, OF.'.F'TZON L-Z;'¢STEM I ..... 'THE LENGTH DIMENSION IS THE LENGTH (lin FEET) OF THE TREN..H L]R E:,RFIINF]~EL[:'. -, .... F-' IS THE DEPTH OF FI TREN..H JR PIT THE E:,ZE";TRNCE BETWEEN THE SIJRFFtLZ:E OF THE GR.L]UNI} FINE) THE BOTTOM OF '['HE E',~L-:R',,,'RTION (IN FEET). "-' _,E-r WIE:,TH FLF~ IRENL. HE:,. ., .. ,. TFIERE I:, NO ': ...... ' '' .... - ......... ," T:, THE MINI~'IIJM DEPTH OF GRFI',,,'EL E, ETWEEt~ ]'HE OUTFFILL PIPE THE GRH',/EL EEl-TH ''- FIN[) THE 80T]':C~M OF THE E',~'O]:FIVRTZON (IN FEET). IR FH_.K.H~E F'LFINT MR¥ BE I~L,"[HLLE. E FIT THE FERHII FEE '2 OF'TZON ':;LIB.TEF:T TO THE FOLLOW I NG .:.ONt) 1T 1 ?N~;. .' UL.H ..... I OR I~ NSF HPFI~_~E[ PLRNT MFI¥ BE INSTRLLE£:,. fi.. EITHER FI -' -'-]~: 2. R C.NI'I~'.~IJI_ILI_, MFIINTENRNE:E RGF.'.EEMENT I5 F.'E:~ IF.'E[:,. IF R MRINTENRNCE RGREEMENT Z:, NOT F'::EF'T CURRENT YOU P'tR'¢ BE REQI. JIRED TO ENLHF~_~E ]'FIE :,LIL ' ' _,t. JE,.JECq TO F'R-SE-IITII]N RBSORPTIEIN S'¢STEM FIND/OR '~'OIJ MFt'¢ E,E c -, BRCKFILLING OF RN9 S¥'E, TEM WITHOIJT FINFIL INSPECTION BND FIPPRO',,,'BL 89 THIS DEPBRTMENT WILL BE SUBJECT TO PROSECUTION, HINIMUM DISTFINC'E BETWEEN ~ WELl. FIND FIN'T' ON-SITE SEWFIGE DISPOSFIL S'Y;STEM IS ~t.E~O FEE]" FOR FI PRIVFtTE WELL_ OR ;;_'E~E~ FEET FOR FI PUBLI_. WELL.. OTHER F)E'2.UIREMENTS MFI¥ RPPL"r'. SF'ECIFICFITIONS RN[:' CONSTRUCTIC~N DIFIGRRMS RRE FIVRIL.RBLE TO INSURE PROPER INSTFILLFITION. F' E [F-~-. #'"1 ~. -1- E] ;:-:; F' ]E F.: E S [:. E C: E2 ~"-1 E: E F-: ]~-: :J_ .. "J_ "9 7 I _.ER. f I F .r THFIT _ ,-- . ¢ _-. ,_- ,:--. t: I FIM FFIMILIFIR WITH "['HE REQJIRE'"ENTS FOR uN---,I FE _.,EHEF._, FIN[:' NELL_, RS _,ET ,,, HNI_.HORH =E. F]RI-H E,'r THE MUNICIF'FILIT"r' OF ..... '-P- -. - - ..... , .- · -. - Lu[.E_. I WILL I[~_-,¥MLl_ THE L~;¥STEM IN HL.L. UR[.'HNUE HITH ]"HE .... 2 IRE ENLHRt.~EMENT: IF THE ~,~'~I[:,ENiLE IS I~:E"IL'~ELE[:, TCy~INCL~[:,E HOF:.E THFIN 5 E,E[:,FJJUrq_-.. ,,,~ ~_ DFITE ~' ............ I'. ,IIE[, E,, I ) ..... 0 Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE b/~ FROM WELL iNSIDE LENGTH /. M AN U FACTU R E R ~/]~'~/~ MATERIAL INSIDE WIDTH LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY ']~/E2E) GALLONS. SEEPAGE PIT: ~-~/~/~7~/~ $ ~-~ NUMBER OF PITS- / DIAMETER OR WIDTH LINING MATERIAL CRIB SIZE: DIAMETER BUILDING FOUNDATION '~(~)~ NEAREST LOT LINE ~' LENGTH DEPTH ~C,¢/f¢¢~'~ ~, / ,~,,~c~ DEPTH DISTANCE FROM: WELL ¢oo ~ /2~¢~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) r~° ~ SQ. FT. ADDITIONAL ABSORPTION WELL: /--~X/:¢/-, ~2~ BUILDING FOUNDATION CESSPOOL APPROVED NEAREST LOT LINE .CONSTRUCTION NEAREST SEWER LINE OTHER SOURCES DISAPPROVED REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK __ SYSTEM /g2~ / ~ DISTANCES: INSTALLED BY: ~-~:-X ~- LOT SLOPE: REMARKS:- DAT¢~_¢ /,/' G.A,A.B. Form No. EQ-031 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION LOCATION Typ[ AND SiZE 0F FAC]EiTY TO BE ~.V[D E~ [ FINANCED THROUGH TO ~BE [NSTALLE~ B~ SOIL TEST RESULTS PHONE · OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED /~'~ FINAL INSPECTION: '24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SiZE //S~) ~ TY~e J~ SEEPAGE a~EA SIZE TYPe MINIMUM DISTANCES, REQUIRemeNTS OlAG~AM OF ~YST;M FOUNDATION TO SEEPAGE PIT ~ DRAiN FIELD SEPTIC T;ANK TO SEEPAGE PIT WALL SEPTIC TANK ~ SEEPAGE PIT ~, DRAIN FIELD WATER MAIN TO SEPTIC TANK SEEPAGE PIT ALSO CONSIDER AREA WELLS. SEEPAGE PIT . ., DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP Of EXCAVATION 5 FEET INTO UNDISTURBED SOIL, 4 INCH DIAMETER CAST IRON SIPHON PiPeS ON SEPTIC TANK AND SEEPAGE PIT FITTED WiTH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. 2 ANCHORAGE AKI:A BUN Department of Environmental Quality 3500 Tudor Road Anchorage, Alaska 99507 ~,// /Z'o~'/.&/. INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME Y~--/~'~ ~'~O"lS"/Z'~&~/l~'q MAILING ADDRESS '~/~'41 ~/~?~/~-S ~,~z'r~A/. PHONE. LOCAT.ON LE ALOESCR,PT'ON Z ,4' /, SEPTIC TANK: DISTANCE WELLfe.~?t;,'e-,,'/ MANUFACTURER ,~'-,/~,c/z~ ~/~g/ MATERIAL FROM INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH NUMBER OF COMPARTMENTS_ LIQUID CAPACITY /g ~ ~ GALLONS. SEEPAGE PiT: NUMBER OF PITS / DIAMETER .. OR WIDTH LINING MATERIAL~/~-q ~'/~ra~?a/ CRIB SIZE: DIAMETER BUILDING FOUNDATION ~ x NEAREST LOT LINE LENGTH DEPTH DEPTH ~ / DISTANCE FROM: WELL /0o TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) '~/~ fi-- SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE BUILDING FOUNDATION -- CONSTRUCTION-- DEPTH_ DISTANCE FROM: NEAREST NEAREST SEPTIC SEEPAGE /~ / 7z- LOT LINE SEWER LINE TANK SYSTEM CESSPOOL _ APPROVED OTHER SOURCES DISAPPROVED REMARKS DISTANCES:. INSTALLED BY: ,,z'~ ~-2¢~e PIPE MATERIAl' I~(l$'ff iron · LOT SLOPE: Form PW-02~ DIAGRAM OF SYSTEM DATE G.A.A.B. February 16, 1973 Reim Construction SRA i$ox 1721-s ,'~lcaor~,~ge ~ Alas~ ~ubjec~: Lut 1 & 2, Block 6, Talus West Subdivision It; is niy understanding tFla~, you are offer'in,j for sate the boluses at the subject locations, l'i;e house on Lot 1 is beiag sold as a five bec. room house and the one on l. uC. 2 as .~ four bedroom, i'he permits for ii, sCaila~ion oF ~.n.-siL<~ systu~s For bo~h of ~ii~se lots w~s issuad and apCroved for three bedroom U~li~S. The sgptic tu,iks on both 'lobs are adcq,~aCu uniy fur' three either imuse until ti~c syscu~':~s are up~jrad~d, l'his can be wita a larger one which will '.~eeC requircme.ucs of aais departl~ent. This uep~.on~ will accept a 'l,-,&i;er advising tis escrow of funds to upgrade i'F you so desire. You wi'il have thirty (30) days to accomplish the escrow, installa- Cion will be required by July l, 1973. Sincerely, Susan C. Oickerson Sanitarian kt cc; Dick Bow]es Public Safety Department 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 1. GENERAL INFORMATION Complete legal description Lot I ~ Block 4; Talu~ We~t Subdivision Location (site address or directions) 11600 0utc~op Lane. Property owner Mailing address Lending agency Mailing address Agent Address Steve Dwyer Day phone 11600 Outcrop Lane Anchorage, AK 99516 Day phone. (h)$45-8299 (w)249-1146 (w)561-1433 (Kathy) Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 5 % TYPE OF WATER SUPPLY: XXX 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. TYPE OF WASTEWATER DISPOSAL: individual on-site XXX 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 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 $ & S ENGINEERING Phone '~7034 Eagle River Loop Roed No. 204 Address Engineer's signature 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 DH 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 Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: '~LJ~S ~t/~7'S'/O,/--///~ ParcelI.D. 0 ('~-'""' A. WELL DATA Well type ~tU~%G~ Log present (Y/I~ Total depth Sanitary seal f~N) If A, B, or C, attach ADEC letter. ADEC,water system number <._, 1o/-7. -z,/' / /L~° Date completed '-~-'~--~ /07-----------------~--~ Driller //oc2 '¢- Casedto z~ /¢- Casing height ~:::-~ Wires properly protected ~(~N) FROM WELL LOG Date of test Static water level Well flow Pump level g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ! 0,2 Absorption field on lot AT INSPECTION /./¢ t Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots //g 'F · {06 tF Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform (~ Nitrate Date of sample: ~!¢~.~- t'-)ff_T/~CYdO. Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed '~-'~L/o~C~'~ Tank size [~(~(~ ~,PrL- Compartments Cleanouts t~/N) '-(-~N'O Foundation cleanout(~¢g~OD ¢gF- Depression High water alarm (Y/~) ~%)//~ Alarm tested (y/~2_ /'~O Date of pumping )'J/~ ~ ~,~'J T,'~dd~--.. Pumper ~X.~/,,'~ SEPARATION DISTANCES FROM SEPTiC/HOLDING TANK TO: t Well(s) on lot /02- On adjacent lots To property line ID¢ t Absorption field Surface water/drainage [ (2(~ ~'/- 72-026 (Rev. 7/91} Front [ 00 "/' .~undation ~'~ Water mair/service line SO t,/_ CONTINUED ON BACK PAGE Size in gallons Manufacturer Manhole/Access..(¥/N) Vent (Y/N) "Pump or~¢~-I'eveL.~ ~ . .--- ~'- "Pump off" level at High water alarm level . -" ' ....... -~-. ~.Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DI'S:I',~NCE FROM LIFT STATION TO: lot On adjacent lots D. ABSORPTION FIELD DATA Date installed Soil rating Surface water System type Length "~' Total absorption area Depression over field (Y/~ Results (pass/fail) Peroxide treatment (past 12 months) (Y/~ Width '~ ¢ Gravel thickness /0 / la~C3 ~ ~P~rL ~p, ~ Cleanouts present (~N) Total depth /~ ~ Date of adequacy test for ~-~ ~-~0~ If yes, give date _ bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /15'¢' To building foundation On adjacent lots ~ ~'~' To existing or abandoned system on lot On adjacent lots c;~ co ~¢- Cutbank__ AJ/~ Water main/service line ,2_~ "/~ Surface water Curtain drain ~0~ E, ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature 5 & S EHGINEERING 7034 Eagle f, tivel' Loop Road No, 204 Eaj a livel~ Alaska 99577 Engineer's Name Date HAA Fee $ /pt Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number ~e~ved :03/~0/93 ~ ~4;45 ht~. ~eport CgmpleL"d :04/01/93 See Special Inst:uctton~ Above gA - Not Analyzed See $~mple B.m~k~ ~bow GT ' G~oatat Then Member of {he $~$ ~rou~ [$OC;6td ~4n6falo de Survell{~nce) Parcel I.D. # MUNICIP'ALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) 116,0o OUTCROP (b) Property owner ,I~E Mailing Address ,2210 ~ENTR¥ (c) Lending Institution UNt(~o~/N Telephone: (home) 3H~-21off Business 2~-7~O~ ~2o ~cH. A~ ~5o7 Telephone Mailing Address (d) Real EstateCompanyandAgent FOl,-rublE pRoPERTIEq; C/~ROL~(N A6NE¥ Address 5000 A ST .. /~NC#, ~K' ~q~"O'~ Telephone .ff62- 7G53 (e) Mail the HAA to the following address: (or check here ~, if hold for pick up.) List contact person and day phone number below: C~ls oR T&b FL/~7-[- o P TEC~. Svc-~ 2. TYPE OF RESIDENCE Single-Family'l~ Number of bedrooms '~' 3. WATER SUPPLY Individual Well'~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site"i~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. 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 all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm FLATTOP 'TECtJ, %[/C_E, Telephone Address Date 6. DHHS APPROVAL Approved for .;C--__bedrooms by Approved ~//~ Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 DH HS 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 7/88} Bacl< Page 2 of 2 Well Classification Well Log Present (Y/N) N Date Completed MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: /-,o~ ~,~ [o c lv If A, B, C, D.E.C. Approved (Y/N) Yield Total DepthS' I?-~' Cased to ~, I~.O" Depth of Grouting Static Water Level ~'° Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ~. too' To Nearest Sewer Service Line on Lot Pump Set At ~ !8~" Sanitary Seal on Casing (Y/N) Y' Depression Around Wellhead (Y/N) N ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by ~'[o/-~,fl WaterSampleTestResults ~~/ - Oco(~ //~. ~.~ ~/~ Comments B. SEPTIC/HOLDING TANK DATA Date Installed '7/It / 7~' Size 15"o~,a Standpipes (Y/N) Y' Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) ~, ~', Holding Tank High-Water Alarm (Y/N) N, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: No. of Compartments ~ Foundation Cleanout (Y/N) Date Last Pumped '/l~7/~d ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Water-Supply Well '~ ""' ' To Property Line ~' ~''/' To Water Main/Service Line ~ 'Tg' ' To Stream, Pond, Lake or Major Drainage Course Comments ~.,,'~1 - 5'~fl ~ ¢ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Datelnstalled IO /~' /77 Width of Field :~¢ ~ t//~,~ Type of System Design Length of Field '-/,-¢' Depth of Field Gravel Bed Thickness Square Feet of Absortion Area I ¢..3"O Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot 8 ' To Water Main/Service Line Sta~ndpipes Present (Y/N) Date of Last Adequacy Test To Property Line I¢' ,/¢¢/* '¢-z'/¢, ¢'~/~e~-f To Existing or Abandoned System on ; On Adjoining Lots ~' -?~' ~ To Cutback (if present) ~a, ,4, IO~ ' To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments '"r~ ~ g,r;~/~/ ~e~¢~/'~ /~,~ D. LIFT STATION N,/I., Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Signed Company Date MOA No. Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back , ~,~ ,,s...~-- ~ ,wCngmeersSeal ~'~?. CE- 35,39 ..' .~ ~ Waiver Fee: $ Date of Payment Page 2 of 2 Client Sample ID:L1 B4 TALUS WEST, WEST MDg HOSE BIB PWSID :UA Collected JUL 24-90 ~ 12:00 Received 3UL 24 90 ~ 14:30 Pre~erYed with :AS REQUIRED CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 56.33 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907~ 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT 8Y SJOdPLE for Work Olde] { 25822 Date Report Printed: JUL 28 90 ~ 09:39 Cheni Name : EL~TYOP TEC~ICAL SRV Client Acer : ELATTOY p.O.t NONE RECEIVED Ordered By : TED )~30hE Analysis Completed :JUL 25 90 Laboratory Supervisor :STEPHEN C. EDE ~eleased By : Send Repo[te to: I)ELATTOP TECHNICAL Chemlab Eel t: 902620 Lab Smpl ID: I l~trlx: WATER Allowable Parameter Tested Result Units ~ethod Limits NITRATE-N ND(C.20) m~/1 EPA 353.2 Sample ROUTINE SA)dPLE. SA}(PLE COLLECTED BY CHRIS. 1 Tests Performed See Special Instluctions Above UA-Unavailable ND- None Detected "See Sample Remarks Above NA- Not Analyzed LT-Lo=~'Ttmn. G~-Gteater Than I. "¥. > DI...;RECEIVED DATE/' Il' X DATE °ATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ~HOB~G[ ~fi~g~lM~T O~ H~LTH ~ fi~VI ~O~M~T~L ¢~OT~CTIO~NVI~ON~NIAE PRO'[[CIIO~ 825 L Street-Anchorage, Alaska 99501 A J 0 ~ ~ ~981 ENVIRONMENTAL SANITATION DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing. 1. PROPER~Y OWNER PHONE MAILING ADDRESS PRQEERTY RESIDENT (If different from above) PHONE 2. ~ . , 0 rHONE MAI LInG ADDRESS 3. bENBI~6 I~STITMTIO~ PHONE MAILIN~ ADDRESS 4, REAL~OR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION TREET LOCATION 6, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four [] Other__ [~//SING LE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three ~ Six 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 well [] PUBLIC UTILITY depth (attach log if available.) ~-[ g--/-~ S, SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** -- 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) (2,.~..~yv THIS SIDE FOR OFFICIAL USE ONLY I. TYPE OF RESIDENCE NUMBER OF BEDROOMS E2~SINGLE FAMILY [] ONE [] THREE ~'~ FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WAT~.R SUPPLY I-~/INDIVI DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~]INDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTI LITY Connection Verified INSTALLER []Septic Tank or []HoMingTank Size:_~'¢) r~)_ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER WELL TO: 5. COMMENTS ,- BEDROOMS ,~ APPROVED FOR CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 825 "L" STREET ANCHORAGE5, ALASKA 99501 (907) 264 4111 OEORGE M, SUI_[JVAN, MAYOR August 14, 1981 Robert W. Kubick 621 West Dimond Boulevard Anchorage, Alaska 99502 Subject: Lot 1 Block 4 Talus West Subdivision Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: (1) The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. (2) If there are any further questions, at 264-4720. Sincerely, The septic tank pumped with a receipt submitted to this office. please call this office James S. Roberts Associate Environmental Specialist JSR/ljw cc: Alaska Pacific Bank Post Office Box 420 995]_0 Ftrst Federal Savtngs and Loan P.O, ~x 2099 Anchorage, Alasha g~510 ^ttentton: ~rs. Sharon Sexton, Loan Of¢tce SUBJECT: Lo~ 1, Block 4, Talus ~est Subdtvtston ~ear Hrs. Sexton: Apparently there has been so~e confuston regarding the se~er syste~ on the subJec: lot. Perhaps ! can clarify the sJtuatton. On February 14, lg73, a registered letter was sent tome. ReJm tndtcattng (1) thtrty days tn escrow money to upgrade the system and (2) a deedllne of July 1, lg73 for the tnstallatton. The septtc tank ortglnally tnstalled ts 1000 gallons~ t~e requtred size ~or a frye bedroo~ house ts 1SO0 gallons. Thts depart~e, nt ~tll approve etther the substitution of a 1500 gallon tank tn place of the 1000 gallon tank, or the addttton o~ a 7SO gallon tank. The addttton ~nust be done Ko the tanks are tn se~tes. ?t~or to any ~ork, the present tan~ ~;~us: be puape~ ~ry so no seaage ts a11o~e~ tO spt11 onto the greund. A permit for the tnstallatton has been tssue~ to ~4r, Rbney~ a final tnspectton w111 be required prtor to back Ct111ng. Sincerely, Susan E. Otckerson Sanitarian ! lb cc: H.R. Retm J.A. Abney