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TALUS WEST #1 BLK 4 LT 3
Talus West #1 Block 4 Lot 3 #015-202-17 Mayor Development Services Department Building Safety Division On -Site Water a Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.oro/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: Legal Description Property Owner Name & Address: 7/4 L U W �S7 Fip rR 1A7l4 MO.Z say HBe ".Ss Pump Installation Date: Pump Intake Depth Below Top of Well Casing: ?d feet Pump Manufacturer's Name: %Zg 7Ar_ JV Pump Model: 2 Pump Size 2. hp Pitless Adapter Burial Depth: /D feet Pitless Adapter Manufacturer's Name: ft4 iCrWS0Ar Pitless Adapter Installer: Well Disinfected Upon Completion'! Yes ❑1 No Method of Disinfection: [a✓� r�R �c C L�e�Z Comments: „nc orage Well & ump , lm Pump Installer Name: 330 East 76th Avenue Anchorage, AK 99518 Phone: 907.243-0740 Fax: 907-243-0742 Attention: The pump installer shall provide a pump installati1n log to the DSD within 30 days of pump installation. M GREA; R ANCHORAGE AREA BUKh_„bn ril Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION PE OR7 ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS 544 ' 4 le�l�� P/HO NAME J LEGAL DESCRIPTION SEPTIC TANK:nn NUMBER OF DISTANCE R�ATERIAL —COMPARTMENTS FROM WELL 14C5 MANUFACTURE INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY GALLONS. INSIDE LENGTH '�� ELD: TOTAL LENGTH / 7d� OF LINES DISTANCE FROM WELL FOUNDATION NEAREST LOT LINES---- TRENCH WIDTH -5-191N. TOTAL EFFECTIVE NUMBER OF LINES�DISTANCE BETWEEN LINES ABSORPTION AREA' SQ. FT. LENGTH OF EACH LINE _ i DEPTH OF FILTER At l IN MATERIAL BENEATH TILE ""7N. ABOVE TILE DEPTH: TOP OF TILE TO FINISH GRADE WELL: DEPTH DISTANCE FROM: TYPE- ,�` CONSTRUCTION NEAREST ! SEPTIC SYSTEM / SEEPAGE e I/NEAREST l BUILDING SEWER LINE e©y � TANK FOUNDATION— LOT LINE CESSPOOL OTHER SOURCES DISAPPROVED REMARKS APPROVED - yy,�±± DIAGRAN�'STEM DISTANCES: INSTALLED BY: SEWER LINE DEPTH: �F-- PIPE MATE RI AL: Ci 'np'� —• LOT SLOPE - REMARKS: .,2 Form EQ -032 W -; 4 DATP-0�' &P G.A.A.B. HSII-98'-A I C:_ IF-1 _ I T°-0 (D Fw FArA®__At- "44im-'."4_%IF= DEPARTMENT `�_, HEAL'TH AND Et4VIRONMEt+ITAL`:,;tOTECTIOt.4 2516 E. TUDOR RD. , ANCHORAGE, AK. 99507 12 t� 276-2221 21 8=.o HE, L L. B=9 ri E> CA tr-A — _" 17- E0= So En 44 Eo FQ 4=" E= F? HSI I -f - PERMIT f - PERMIT NO. ( 76751 APPLICANT MARY WRIGHTSRA BOX 1585A 344-4214 LOCATION W LDERNESS DR: LEGAL L_ B4 TALUS WEST LOT SIZE 19176 6 _ QUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER: OF BEDROOMS = 4 SOIL. RATING <SO FT/BR)- 250 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM I_• MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 1073 FEET FOR: A PRIVATE WELL OR 2001 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 20 DAYS OF THE WELL COMPLETION. SPECIFICATION'_ AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F=" E: Fz^ HSI I 'T °"a' F=8 L. I )C� F C3 F° CA VA E be E= FA FQ E= FQ ED HSI I _" v: LJ E 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 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. _. I UNDERSTAND THAT THE ON -:=ITE SEWER: SYSTEM MAY REQUIRE ENLARGEMENT IF THE RE'=IDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. l ° SIGNED:- - --`I -- <' -A ------------------ ---•------------ ;iilCAtYl MIRY W; GHT -�; ISSUED By),jakif______ ___-------- CrH'fE_ A� THE LENGTH GIt•IENOON I= THE LEND" H Of THE TRE'A H ORC-RAINFIELD. ^ THE DEPTH OF A TRENCH OR PIT IS . nGCE B" WEEN TIE SURFACE OF THE � GROUND ANC? THE BOTTOM OF THE E�{f,A'v'ATI'rt,l t:.hd FE THERE IS NO SP, WIDTH FOR TRENQAE'=. THE GRAVEL DEPTH IS Thu MINIMUt DEPTF!' OF Bf". f'WEEN THE QUTFALL PIPE �R:A':�E AND THE BOTTi_iO OF THE E:�,_ iVATIpN �: IN EE" EITHER A CLASS I OR II NS ASPRO' Ito PLANT MAY BE INSTALLED. A CONTINUOUS MAINTENANCE 4GF: _EM ,T I5 REQUIRED. IF H MAINTENAi',D_E � AGREEMENT IIS NOT KEPT CUrR:ENa' YjU MAY BE REQUIRED TO ENLARGE THE _OIL ABSORPTION SYSTEM AND/OR YOiU`.;riY BE SUBJECT TO PROSECUTION. IF A CLASS I SYSTEM IS VISED THE LENGTH I= 51.0 FEET. IF H CLA=,_`- II SYSTEM I/ USED THE LENGTH IS 65.0 FEET. T I. -A e_c •=_ := a 14"-A " F- : a -T" ZI Ci P-4 I> FA F? E= FZ E= CA LJ jE F" EF E-'. fC BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL,BE SjPNECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 1073 FEET FOR: A PRIVATE WELL OR 2001 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 20 DAYS OF THE WELL COMPLETION. SPECIFICATION'_ AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F=" E: Fz^ HSI I 'T °"a' F=8 L. I )C� F C3 F° CA VA E be E= FA FQ E= FQ ED HSI I _" v: LJ E 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 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. _. I UNDERSTAND THAT THE ON -:=ITE SEWER: SYSTEM MAY REQUIRE ENLARGEMENT IF THE RE'=IDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. l ° SIGNED:- - --`I -- <' -A ------------------ ---•------------ ;iilCAtYl MIRY W; GHT -�; ISSUED By),jakif______ ___-------- CrH'fE_ h\Rf M•W DRILLING, INC.# -s•� R`w r ,'i D UIM LOG wner en ow Wright construction 1 —Use of W'r"�� ;i I.oMUM (address of: Township, Range, Section, U known: or distance main m� s Lot i Block 4 Talus West gine at dykes 6" depth of Holey 1 Leet Cased to 94 reef j &afke wow level -5-5 w- ' ) (below) land surface. Finish of well (check ons) open end ( ): Snseo ( ). Perforated( )• ;! Dsserlbe seeren or perforatisn well pumping test st k� gallon. per Qs�i) (minute) for -1 --hours with 11217 a< drawdown from static JIML , Dots of caai{rietin 10/4/76 VAU LOG r Depth in beet from grand surface Give details of formations penetrated, size of material, color and hardness r h5 Tp so • so go 95 TO 95 f=rs; a TO 1 T �O TO T1 /O O TO MUN{CIPALITY SERVICES DIVISION - Orcanics nonNMENTAL 1' 1' Silty Gravel IEiE R 1987 Silty Samd Silty Gravel Silty Sand Silty Gravel Sandy Sandy Grave – Water Fk21f3t4 Municipality of Anchorage Development Services Department Building Safety Division \� On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni:brg/onsite (907)343-7904 Parcell.D. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING !t 015-202-17 COSA # Q C �' ` 33 Expiration Date: 1. GENERAL INFORMATION\ Complete legal description Talus West SuLdivision, Block 4, Lot 3 Location (site address) 11855 Wilderness Lane Anchorage, AK 99516 Current Property owner(s) Monique Lussier Day phone Mailing address 11855 Wilderness Lane Anchorage, AK 99516 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup 2. NUMBER OF BEDROOMS: Three (3) 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well✓❑ Individual On-site ❑✓ 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 On -Site 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 On -Site 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, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Add reSs P.O. Box 240773. Anchorage, AK 99524 Engineers Printed Name Michael E. Anderson, P.E. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone 522-7773 Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: - Qe,/ & V Original Certificate Date:_ "' 1 (Rev.1 V05) Municipality of Anchorage • '� Development Services Department Building Safety Division On -Site Water & 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 CHECKLIST Legal Description: tot 3 Block 4 Taws west Subdivision # Parcel ID: 015-202-17 A. WELL DATA Well type Private If A, B. or C provide PWSID # _ Well Log (YIN) Y Date completed 1014/76 Sanitary seal (YIN) Y Wires properly protected (YIN) Y Total depth 95 ft. Cased to 94 ft. Casing height (above ground) >16 in. FROM WELL LOG AT INSPECTION Date of test 1014176 7116/2012 Static water level 55 ft. 47 ft. Well production 11NK 9-p M. 6.6 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 1.62 mg/L Arsenic: N/D mg/I Date of sample: 7110/12 Collected by: J. Berkram B. SEPTICIHOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 10127/76 Tank size 1.000 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) X /6/ Date of pumping 7/3112012 Pumper Around the Clock Pumping C. ABSORPTION FIELD DATA Date installed 10/27/76 Soil rating (g.p.d./ftz or ftz/bdrm) 250 SF1eDRM System type Deep Trench Length 43 ft. Width 3 ft. Gravel below pipe 11 ft. Total depth 16 ft. Eff. absorption area 946 ft' Monitoring tube Y Depression over field N Date of adequacy test 711612012 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 89 in. Water added 450 gal. New depth 90 in. Elapsed Time: 1,440 min. Final fluid depth 89 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at _ in. `Pump off" level at —in. High water alarm level at _ Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES Property line >5 Absorption Heid » SEPARATION DISTANCES FROM WELL ON LOT TO: Water service line >10' Surface water >100' Septic tank/lift station on lot >100' On adjacent lots >100' Absorption field on lot >100' On adjacent lots 89. Public sewer main N/A Public Public sewer manhole/cleanout Sewer /septic service line >25' Holding tank N/A Animal containment areas >50' Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO N/A >100' in. Building foundation >5' Property line >5 Absorption Heid » Water main N/A Water service line >10' Surface water >100' Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main N/A Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >25' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS: *`R Waiver Issued to Well on Lot 8, Block 5, Greenland Subdivision. G. ENGINEER'S CERTIFICATION s (��.�'•*rr�f yt I certify that I have determined through field inspections and s;F.• 49ni ** i review of Municipal records that the above systems are in 7r`H«.p� conformance with MOA COSA guidelines in effect on this date. • '• . . ........a a'pw :AUbIAS. B ANDHiSODI : 4 a Engineer's Printed Name Michael E. Anderson, P.E. #�� .•• CES J) `Ai Date 8r6/2012 ,�>. ® ,_••._';�� 4W COSA Fee $ Wo Date of Payment � /& fia Receipt Number G o -f3q� (Rev. 11/05) Waiver Fee $ _ Date of Payment Receipt Number, 0810912012 10:49 LANG & ASSOCIATES INC (FAN)907 522 4625 P.0021002 LOT 4 JUMAR AVENUE -- �\TNo� t.9' CA:lt .�-- L4 4 E . 32. CNE n 6M ASPAAL CRIVPAY -- .,—`�\-_--.__j�` F _ 0' UT:IIY F�,SEMEM —+ ' LOT 1 43;p. CAM. J f -COVERED COMM WALR/ I I LOT 2 / 1 w P4tt{o®E• RNEs p V ri=r M Y E4 � PLOT PLAN _. AS BUILT R_ SCALE I" — 30' GRID 2736 Project No. 12-140AI Lang & Associates, Inc. 11604 Daryl Avenue, Anchorage, Alaska 98615-3049 (907) 622-6476 Phone Registered Land Surveyors (907) 822-4626 Fax A kon0langsurveymom / jonatharMcingsurvey.com �� .....Lr,iy� I hereby certify that I have surveyed the following described property: LOT 3, BLOCK 4, TALUS WEST BUB., ADDITION #I (PLAT # 72-246) � q Anchorage Recording District, Alaska, and that the Improvements situated thereon are wlihin the properly lines and do not enoroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed promises and that there are no roadways, transmlsslon lines or other vlslble KNCNNET O. 6aeemonte on sold property except as Indicated hereon. ''•. Ls�8202 Dated this 4te Day a4 &"�iS—_—--.2aLZ. at Anchorage. Alaska N''°.,��1,.•�g It to the responsibility of the owner to determine the existence of any oassments, covenants, or restrictions which do not appear an the recorded subdlvtslon plat. LOT 4 0 M 1.9' JUMAR AVENUE TWO TIER DECK ONE STORY WTI{DAYLIGHT BASEMENT . .ASPHALT DRIVEWAY . R�380. I 0' UTIITY EASEMENT I I LOT 3 I I LOT 19.178 S.F. I I I 439• I CAM. I h l yI-COVERED CONCRETE WALK/ I I I LOT 2 I I I I I I L \ WILDERNESS AVE, PLOT PLAN AS BUILT X SCALE 1" = 30' GRID 2736 Project No. 12-14OAl Lan & Associates Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang (907) 522-6476 Phone Registered Land Surveyors (907) 522-4625 Fax Q000 A"Pkl kerMangsurvey.com / jonothan®longsurvey.com 6 OF 4 rl Ov `� •......... 1 hereby certify that I have surveyed the following described property: ��Q •' LOT 3, BLOCK 4, TALUS WEST SUB. (PLAT # 72-248) 0(7: Anchorage Recording District, Alaska, and that the Improvements situated thereon are * 49_18 within the property Imes and do not encroach onto the propertyadjacent thereto, thatQ' n• ,. no improvements on the property lying adjacent thereto encroach on the surveyed 0 . premises and that there are no roadways, transmission lines or other visible Q ..f easements an said property except as indicated hereon. F KENN LMG V LS -5202 Dated this the -74h Day of kSvGcrvT ,2012 , at Anchorage, Alaska 0444 0.a�ssIONA1-{t d f I �•. ' yo r o It Is the responsibility of the owner to determine the existence of any easements, R�� o covenants, or restrictions which do not appear on the recorded subdivision plat. 040000 MUNICIPALITY OF ANCHORAGE • _ DEPARTMENT OF HEALTH & HUMAN SERVICES M} 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. # l%� h �7 HAA # I&��D 1. GENERAL INFORMATION Complete legal description L-0 Location (site address or directions) //'s55 ) Lh elLtj( SS b,21JL S�13.'7/ � ✓QiNes u��s��« Property owner JIiV� Cf� yr SGt+o� Day phone 345 - Ds 88 Mailing address /t 55 L��tl�E1Ln1S �ri VC Lending agency-- - - Day -phone Mailing add Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. 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 -X 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, ordinances, and regulations in effect on the date of this inspection. Name of Firm 4Nb(--MS 0 J L G J GZRjAJCl Phone Z-7,39)1 U Address PO. :90 Y, Zy'o 7191 3 /nA_nuc r+O uaL ' 41L 9952 J Engineer's signature cr� 2c Y �- a Date !z/a� A? fi�3 war 9aa'j�aa on - euuy'�gop�uy �e� !� vru •'gnasncn+e�eso /J_/,4�°i°f Mmhcel E. And:rson .' IQ �P' 4331-E 6. DHHS SIGNATURE XApproved for J7 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: Date3� 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. 72-025(Ray. 1/91) Back MOA 021 Al 7Z i Additional Comments By: Date3� 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. 72-025(Ray. 1/91) Back MOA 021 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 43 to bk+',TA 06 "`� Parcel I.D. A. WELL DATA Well type lff� If A, B, or C, attach ADEC letter. ADEC water system number dly Log present (Y/N) Date completed ZA - Driller 4 0 Total depth —_% Y Cased to Casing height 2i Sanitary seal (Y/N) I Wires properly protected (Y/N) 1 FROM WELL LOG Date of test 10 l Tt7 Static water level Well flow 10 9 -10 -m - Pump level A SEPARATION DISTANCES FROM WELL TO: AT INSPECTION 12 I 0 A n T g.� �09Z 2 Septic" /iag tank on lot On adjacent lots 12� Absorption field on lot 120 ; On adjacent lots 190, Public sewer main N /k Public sewer manhole/cleanout 11 Public sewer service line W Petroleum tank N/e WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: 17/119 w 111 Collected by: Other bacteria B. SEPTIC/Hr TANK DATA II 11 0�II Date installed 10 Z 6 Tank size 11900 4AA N6 Compartments Cleanouts (Y/N)' IFoundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) 'II/ l Alarm tested (Y/N) Nlk Date of pumping %ZLZI I9f SEPARATION DISTANCES FROM SEPTIC/H6Wft46 TANK TO: , � r Well(s) on lot > 10� On adjacent lots >100 Foundation 10 To property line >40' Absorption field 35; 1 Wateriaain/service line ''30 Surface water/drainage 72-026 (Rev. 9/81( Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION led Manufacturer Size in gallons Vent(Y/N) High water alarm level " Puffi`n-&i:�Llevel at Meets MOA electrical codes (Y/N) Manhole/Access(Y/N) SEPARATION DyST-A-fV✓✓E FROM LIFT STATION TO: tested at lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installedSoil rating ` System type qq--�� 1 r r r Length I 2 Width y7 Gravel thickness I Total depth �% Total absorption area — 94-�, I�`•7• Cleanouts present (Y/N) — 1,-T Depression over field (Y/N) _N Date of adequacy test 91 Results (pass/fail) ? dky II for -3 bedrooms Peroxide treatment (past 12 months) (Y/N) —N If yes, give date C — SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1W On adjacent lots S9r Property line > IIjp To building foundation 3� To existing or abandoned system on lot Onadjacentlots > CutbankL144- Water-mein/service line >50r i Surface water Driveway, parking/vehicle storage area 61r,, Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in ef1�„ctgn,4(W date of this inspection. �,.nig �p p �•\/✓'i�'8�! M. Signature"' l G'L�ll.vai"�d i rC,'in; rt .. n / ICh/AeZ nt13c7Zitlr, �l �'rG co i0�a ae.:e° °oou m; o° aeuoao v �� o'"°;t. Engineer's Name °°t�oek�-^�-� L. Andar;on a 4i Date /z�Z ! c,<% 4381-e e` — HAA Fee $ t' 7 0 Waiver Fee: $ Date of Payment a % Date of Payment Receipt Number —�°`" 9 Receipt Number ]2-026(Rov. 3191) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE # 41241 Chemlab Ref.# 91.6712 Sample # 1 Matrix: WATER Client Sample ID LOT 3 BLE 4 TALUS WEST SURD. PWSID UA Collected : DEC 19 91 0 16:15 bra. Received : DEC 20 91 0 11:05 Ins. Preserved with AS REQUIRED Analysis Completed DEC 20 91 Laboratory Supervisor : STEPHEN C. EDE Released By : Parameter NITRATE -N Client Name :ANDERSON ENGINEERING Client Acct :ANDENGR BPO# PO# :NONE RECEIVED Req# Ordered By Send Reports to: 1)ANDERSON ENGINEERING 2) Results Units Method Allowable Limits ----------------------------------------------------------- 0.76 mg/l EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: A.H. Remarks: .................................................................................................................. 1 Tests Performed See Special Instructions Above UA -Unavailable ND. None Detected See Sample Remarks Above NA. Not Analyzed LT -Less Than, GT -Greater Than r.90 SGS Member of the SGS Group (Societe Generale de Surveillance) 2. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES I CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL 092-cez� a OF ON-SITE SEWER AND WATER FACILITY 264-4744 � Q (� -a Application Date r -.?4 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) GaT..3 -�Goex %/17t"J Z -437"t -I 7-,,Z-IJR3/✓ SE�yv d ��4 9 f Bz. x fY+'4 � k (4, &ehdiin p4k0ir{ti1 C 4- Telephone: Home Telephone Business L76'"46 (d) RearEsflte CPany and Agent' lfi/l.r Address 4PR&Of *PJeW /he Telephone 274;'7416/ (e) Mail the HAA to the following address: or: Check here EB; if hold for pick up. List contact �r�n and day phone /umber below. TYPE OF RESIDENCE Single -Family R Number of Bedrooms _ 3. WATER SUPPLY Individual Well 3 Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. - Page 1 of 2 72-025 (Rev 8/861 Front L3 ael 7;4tu-f n1,, 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. 17 y, SSSS Name of Firm Telephone Telephone Address ,1 3 j "� �f,TIA/. Ar 95sa3 Date ?- 04 1.1 DHHS APPROVAL Approved for bedrooms by Date Approved Disapproved Conditional Terms of Conditional Approval dhh5 CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS doesthis as a courtesyto purchasers of homes and their lending institutions in order to.satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 fRev 8/85) Back MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & CHECKLIST - FEBRUARY 1984 ENVIRONMENTAL PROTECTION 264-4720 AUG 26 1988 Legal Description: /Wrl /3µ'll 7—A",r 1,407- T/2� x3a J� z -z A. WELLDRFELCEIVED Well Classification PRItIol,70— If A, B, C, D.E.C. Approved (Y/N) oil'ol Well Log PresentN) Date Completed /a Yield 3� tyOh Total Depth v%S� /� P Cased to 9y Depth of Grouting Static Water Level 5 -to 11 Pump Set At Casing Height Above Ground /• 8' Sanitary Seal on CasingAN) Electrical Wiring in Conduit &N) Separation Distances from Well: To Septic/Holding Tank on Lot Depression Around Wellhead (Y& On Adjoining Lots i To Nearest Edge of Absorption Field on Lot /LS ;On Adjoining Lots To Nearest Public Sewer Line AYA To Nearest Public Sewer Cleanout/Manhole &IA To Nearest Sewer Service Line on Lot 4F__.5 71 - Water Water Sample Collected by IQAEe l eJACA1 ; Date Water Sample Test Results ;Pte_ 7- Al,7A*r&-%i $ Comments •N A)6U- GtAJ TEST 6-w-8%, B. SEPTIC/HOLDING TANK DATA Date Installed /e-2-7-76 Size /fid No. of Compartments Standpipes 62)N) Air -tight Caps ON) Foundation CleanoutON) Depression over Tank (Y/bl Date Last Pumped 8'4V"¢tf 11M e S Pumping/Maintenance Contract on File (Y/N) ��%) ; for Holding Tank High -Water Alarm (Y/N) _ We _ Temporary Holding Tank Permit (Y/N) 4 /4 Separation Distances from Septic/Holding Tank: To Water -Supply Well To Building Foundation /d ' To Property Line f To Disposal Field 3S To Water Main/Service Line /0 �> To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) D. LIFT STATION Ix �s stalled Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) Pump Off' Level at Vent(Y/N) Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that l havvchocked, Verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed GI�h—<_.W�— Date tly-24^8? •.,. .n,"., I oy� .,�• Off' Ag Company05 ,,AreMOA NO. W✓�0°o°o°a.e o it Receipt No. 0119 C�C�do a Date of Payment Apo %°O ng l ee'sSeal aeoo oeeo�e ♦nnae•ano u. :.• Amount: $ °o IERO C. ROD, JR. a !7 knn CE.2257 ,; Page 2 of 2 72-026 n1184i MUNICIPALI f Y V P AN---nnvo ENVIRONMENTAL SERVICES DIVISION C. ABSORPTION FIELD DATA AUG 2 6 1988 Soils Rating in Absorption Strata L� 7'76 'y T p \\o em Design TeEr/Ce� � f�Ff l � 413 Date Installed le) Width of Field 3 * Depth of Field Gravel Bed Thickness �// 57 6 Standpipes PresentoYN) Square Feet of Absorption Area Depression over Field (Y& Date of Last Adequacy Test Results of Last Adequacy Test liPr�'4'l� Separation Distance from Absorption Field: To Water -Supply Well /LS To Property Line i To Building Foundation � To Existing or Abandoned System on AlZe Lot _---T On Adjoining Lots /6/" /J q To Water Main/Service Line To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle t /0 SI 1St'' S 6R�iw2I d Comments9�ea gr,w To h/AA 7-7-87. D. LIFT STATION Ix �s stalled Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) Pump Off' Level at Vent(Y/N) Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that l havvchocked, Verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed GI�h—<_.W�— Date tly-24^8? •.,. .n,"., I oy� .,�• Off' Ag Company05 ,,AreMOA NO. W✓�0°o°o°a.e o it Receipt No. 0119 C�C�do a Date of Payment Apo %°O ng l ee'sSeal aeoo oeeo�e ♦nnae•ano u. :.• Amount: $ °o IERO C. ROD, JR. a !7 knn CE.2257 ,; Page 2 of 2 72-026 n1184i CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 6 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 \ FEDERAL TAX ID N 92-0040440 LABORATORIES ANALYSIS REPORT By SAMPLE fox Work Order { 8667 Date Report Printed: AUG 22 88 @ 12:56 Client Sample ID:L3, B4, TALUS WEST 91 Client Name AECS PWSID :UA Client Acct AEECSRP Collected AUG 18 88 @ 15:50 his. P.OJ NONE RBC"D Received AUG 18 88 @ 16:30 his. Req $ Preserved with :4 DEG. C Ordered By : A. WEIN Analysis Completed :AUG 19 88 Laboxatory Supeir'vf ox STEPHEN �' C.ED/E Released By / e% !/1_ Special Instruct: Send Reports to: 1)AECS 2) Chemlab Ref 8: 2279 Lab Smpl ID: 3 Matrix: WATER Parameter Tested Result/Units Method -------------------------------------------------------------------------------- NITRATE-N ND(0.10) mg/1 EPA 353.2 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY A. WEIN ==1 Tests =Performed See Special Instructions Above UA -Unavailable ND= None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT=Greater Than Allowable Limits 10 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date �17 7 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or -directions) /Ss's� LJic��h'�r3S rbc . (b)• Property Owner ' `Mailing Address Telephone: Home </, - 7 j7 y Business 7-74 - f,." fv/[-AE AieSS %J'Z1, - /bx12111. AIX/ %7; 5_16 (d� Lending Irjst((Ltibn, r: Mailing'Address = (d) Real Estatb Comparlyiand Agent Telephone Telephone (e) Mail the HAA to the followina address: or: Check here U4, if hold for pick up. List contact person and day phone number below. / SATE P"' ry ,SI'L ce N 2. TYPE OF REStI.DENCE 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 the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRev 9/86) From 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. n' Name of Firm /'I c_ S Address /UO /f 3,3J� -5'11i7� /3 Date Telephone/ S(o/-So�/O �5-49 -40. y0age OF A4 ir r* 4gtH �y* 6. DHHS APPROVAL , Approved for Y bedrooms by � "' Date Approved A Disapproved Terms of Conditional Approval Conditional CAUTION ZQY C. REID, JR. E•2251 •.... U.•._ t P%O19S W(V `Lv— S�7 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 doesthis as a courtesyto purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 tae, 81861 Back MUNICIPALITY OF ANCHORAGE (MOk- ! HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF ANCHORAGE CHECKLIST - FEBRUARY 1964 ENVIRONMENTAL SERVICES DIVISION 264-4720 JUL 1987 Legal Description: Lb% 3 S� vy A. WELL DATA RECEIVED Well Classification j�='/d If A, B, C, D.E.C. Approved (Y/N) Well Log Presen (Y N) Date Completed 10-11-76 Yield �' � .x/74 Total Depth �� Cased to q�` Depth of Grouting —� Static Water Level Pump Set At Casing Height AGround Sanitary S bove eal on Casing Y/ ) Electrical Wiring in Conduite)N) Depression Around Wellhead (Y& Separation Distances from Well: i T�t�/7 D o 3/'// ; On Adjoining /� a� To Septic/Holding Tank on Lot %/ g Lots To Nearest Edge of Absorption Field on Lot / / T sr/a-o/,rbn Adjoining Lots To Nearest Public Sewer Line e To Nearest Public Sewer i CleanouVManhole J�_ To Nearest Sewer Service Line on Lot Z7 —� / -1 :Date 6-a�'J`%. Water Sample Collected by //E �j Water Sample Test Results 5� / Comments a B. SEPTIC/HOLDING TANK DATA ZI_ %� Size & 10VO No. of Compartments Date Installed �4'" ) Standpipes Air -tight Caps1) Foundation Cleanout (Y/N) Depression over Tank (Y1) AA_ ;for AJ ��%� Date Last Pumped 1-76 .4 �� Pumping/Maintenance Contract on File (Y/N) --� � Holding Tank High -Water Alarm (01N1Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well //C) y, N .frt��liit To Building Foundation To Property Line To Water Main/Service Line To Disposal Field To Stream, Pond, Lake, or Major Drainage Course Commentsc7 j�L,�a✓ "i'/3^�/f m /ir%+'i� ,�E�'loi/c�J , ie�o-..J �qC%y,��i 1,1Z,-7✓ orl fl�;Bc/e7` - IM, (6/ Page 1 of 2 72-02601/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ' Type of System Design Date Installed Length of Field Y-3 Width of Field Depth of Field Gravel Bed Thickness /� ! Square Feet of Absorption Area 9�(° Standpipes Present Yom) / Depression over Field (Y0 Date of Last Adequacy Test Results of Last Adequacy Test ����� prf7 Separation Distance from Absorption Field: To Water -Supply Well /=H '9i_7l��iiPeF To Property Line To Building Foundation Lot To Water Main/Service Line /0 To Stream/Pond/Lake/or Major Drainage Course To Existing or Abandoned System on l On Adjoining Lots /0 To Cutbank (if present) in -0 / d - To Driveway, Parking Area, or Vehicle Storage Area /0 -/- Comments aF '%/Z[-WeW �'`/ J=j<oN 1"7 S, J.tzK S' l,c`t'L'.d"¢^//i 'lb aGLL. D. LIFT STATION Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) _ Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Cycles during Adequacy Test. Meets MOA certify that Iha e /c�ppcke/¢I, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company MOA No. 'J-7-Jz-1 OF A4 1e 0 Receipt No. —�-0 �J �' 0 0 (Z ��� ••• ` °°:�y� Date of Payment Amount: $ / d Al oaw ce_ - 9 ••••o h pCrs as (�i62 SiilO r'�":j ®� ' �R V C. REI�JR.• � •� Q /77AICr�f✓fi:)�S eQ/ CC 2251 er Page 2 of 2 3, J/7I �i f / �� pNiESS1v3� 72-026 (11/64) J. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES H87-0356 WAIVER REVIEW WORKSHEET DATE RECEIVED: July 8, 1987 LEGAL: Lot 3 Block 4 Talus West S/D ENGINEER: A.E.C.S., Inc. 1200 West 33 Avenue, Suite B Anchorage, Alaska 99503 APPLICANT: Steve Bourne WAIVER REQUESTED: CRITERIA: 1) Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2) Special Conditions: 3) Other: WAIVER NOT &EQUIRE0 ON %II/f LOT flvef LOT -701A4 TALkf IvEfTf SEPTI[ fNfrgn wits IN ,OEfOim TidE NEW bvEGL PRiJ-4 C -O ON L GTA 1Rjk r /jr{Ej6Aj,9A1Zq. WAIVER IS: granted, with conditions listed below: not granted for reasons listed below: DATE: BY: NAME ALASKA kIROn RAL COIITROL Seku((CCs, Inc. 6ngineerinq & 6nuironmental Studies July 6, 1987 Municipality of Anchorage Department of Health & Human Services 825 L Street Anchorage, Alaska 99501 Re: Lot 3, Block 4, Talus West On 6/24/87, a Health Authority inspection was performed on the subject lot. It was discovered that the private well on Lot 8, Block 5, Greenland Subdivision is 89 feet from the east standpipe of the subject trench. The subject sewer system was installed 10/27/76 and Lot 8, Block 5, Greenland Subdivision well was drilled 8/19/81. Approximately 50% of the subject trench is within the 100 foot protective radius of this well. See attached site plan. This well is 93 feet deep, cased to the bottom with silt, sand, and gravel encountered. The terrain is generally level through this area. We. are requesting a waiver of the required separation distance to 89 feet. Clearly, the subject lot is not in violation since its septic system existed at the time the neighboring well was drilled, and therefore should not be penalized for the existing situation. We request that you approve the Health Authority Application for the subject lot, and if you feel the waiver can not be justisfied, that you contact the owner of Lot 8, Block 5, Greenland to remedy the problem. If you have any question, please call. Sincerely, � j � 4 1 GALL — � Alan C. Wien Engineering Technician Approved by:\ •e•••o.ne••i ',OY C. REID, JR. CE -2251 •s 1200 West 33rd Auenue. Suite B • Anchorage, Alaska 99503o(907) 561-5040 CONTROL SERVIUt INU. 1200 West 33rd Avend,.Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO. OF CALCULATED BY A, 4���E~/ DATE 7 -7 -r7 -r7 CHECKED BY CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 \ FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE Client PO4 : VERBAL Reg Cl lent Srupl ID: L3 B4 TALUS WEST 1755 Sample Recd : JUN 25 87 Ordered By : L. REID Send Reports To: AECS 1200 W 33RD AVE, STE B ANCHORAGE, AK. 99503 Special ROUTINE SAMPLE COLLECTED 6-24-87 A. WEIN OF AECS Instruct! Chemlab Ref #: 6719 Lab Smpl ID: i Matrix: Water Parameter Tested Result/Units --------------------------------------- NITRATE-N 0.46 mg/l Sample ROUTINE SAMPLE: Rernarks: ANALYSIS COMPLETED: LABORATORY SUPERVISOR:STEPHEN C EDE 1 Tests Performed See Special Instruct!onsAbove ND= None Detected #* See Sample Remarks Above NA= Not Analyzed LT -Less Than, GT=Greater Than Dark Order No. : 1320 Client Account : AKECSRP Date Report Printed: JUL 8 87 9 07:38 Released By : 2 Reports Address #2 LEE RIED Allowable Method Limits 10 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 • ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 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. PROPERTYOWNER - PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ 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.) 8. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) HIS SIDE. FOR OFFICIAL USE ONLY - ®- —�– INSPECTION APPOINTMENTS DATE RECEIVED TIME It -:60 C DATE INSPECTOR TIME TIME DATE DATE INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE- , ,-SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY B.�� INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH IS\WELL DATED IL4ED LOG RECE ED J 3./SEyV-AGE DISPOSAL SYSTEM IQINDIVIDUALA-SIT ❑PUBLIC UTIL Connection VeI PERMIT jVIJ BER DATE STALLED / ALLER ❑Septic Tank oSize: de give dimensions: pIL TIN " TYPE OF TANK MANU A U `. TOTAL ABSORPTION AREA MATER I, 4. DISTANCES WELL T0:_ Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lo[ no 5. COMMENTS T APPROVED FOR 3__ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY (Tinel LEGAL rD�ESCRIPTION �!Sl /� ---- ���—p Al 2 /� 1 �, 4 ( i c � /1 � 72-010 (Rev. 3/78) I NICIPALITY OF ANCHORAGE,, Department_6r�IIealth and Environmental Protection 825 L Street, Anchorage, Alaska 99501 279-2511, ext. 224, 225 est for Approval of Individual Sewer and water Facilities 1. Property Owner: Mailing Address: adzd��Phone: 2. Name of Buyer: � r Mailing Address: Phone: 3. Lending Institution: AIW& . y�7�� _��je-pr e - Z Mailing Address: 224A, iL Phone:,,22/ 4. Realtor/Agent: Mailing Address:���_�' j�%D•1is��S.L��/ Phone: 5. Legal Description: Street Location: fte 6. Single Family Residence: ()o Number of Bedrooms: 3 Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply: *Individual Well Public/Community System ( ) I£ Individual well, well depth I£ Community System, name of system 8. Sewage Disposal System: On-site System 0< Public System ( ) If On-site System, date of installation: *NOTE 3/77 A well log is required on ALL wells drilled since 6/75. n lers Concrete Products ®f Wasilla, Inc. HOME & COMMERCIAL SEWAGE TREATMENT PLANTS BOX 149 - WASILLA, AK. 99687 - PHONE 376-5919 JET Home Plant Service Policy kO 7 01 � This Agreement entities: Owner _;kE ..r L4 ";� f� Ranne Street ——"'— Address F Citaagent � � _.._ Phone__ Ij t to the following service fo r(s) from the date of acceptance. Upon receipt of this signed $ �0a _, Canole's Concrete Prnrinrre following services during the term of the agreement: Canoles Concrete Products will inspect the JET plant at the above address twice a year. These inspegl6ns will include: PLANT SERVICE o Removal of aeration unit, inspection, adjustment, cleaning of aerator's shaft, field service of aeration unit, if needed, and re -installation. o Inspection, cleaning, and adjustment, if necessary of surface skimrnor and/or tube sotlor. ® Examination of final effluent for color and odor, if there is access at time of inspection. o Check of discharge point and wet weather overflow for blockage (if applicable). ® Inspection and adjustment of control panel setting and overload protection, if there is access at time of inspection. _ O Inspection for sludge accumulation with arrangements for removal when build-up warrants removal. — Canole's Concrete Products further agrees to the following: _ EMERGENCY SERVICE ® There will be no charge for emergency service calls. ® There will be no service or labor charges for removal or re -installation of aerator, if required. ® If improper operation cannot be corrected at time of service, homeowner will be notified immediately and given estimated date of correction. ® If improper operation cannot be corrected at time of service, the Department of Environmental Quality, GAAB, will also be notified. ® If necessary, the entire mechanical unit or any parts will be replaced according to the manufacturer's warranty program. Freight charges to the factory or to an unauthorized repair station and aerator- repair charges are not covered under this agreement. 4 W Owner's Signature Date Aeoe's oncretl ate 2204 CLEVELAND AVENUE • ANCHORAGE. ALASKA 99503 • 277-0231 May 31, 1978 Heritage Homes & Investments 207 E. Northern Lights Blvd. Anchorage, Alaska 99503 Attention: Pat Newton RE: Inspection of 11855 Wilderness Drive, Lot 3 Block 4 Talus West #1 Dear Pat, Per your request, I have completed an inspection of the on- site septic system location at the referenced property. The area was clear of all vegetation and showed no indication of any seepage or problems due to water or moisture from the sewer system. If you have any questions, please call. Very truly yours, Neal Hausam, P.E., L.S. NH/ja onsiruchon ��jj Q p (Jest d _ c>4.5 at "ONE TEST IS WORTH A THOUSAND OPINIONS" 2204 CLEVELAND AVENUE • ANCHORAGE. ALASKA 99503 • 277-0231 May 31, 1978 Heritage Homes & Investments 207 E. Northern Lights Blvd. Anchorage, Alaska 99503 Attention: Pat Newton RE: Inspection of 11855 Wilderness Drive, Lot 3 Block 4 Talus West #1 Dear Pat, Per your request, I have completed an inspection of the on- site septic system location at the referenced property. The area was clear of all vegetation and showed no indication of any seepage or problems due to water or moisture from the sewer system. If you have any questions, please call. Very truly yours, Neal Hausam, P.E., L.S. NH/ja GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received cember 13, 1976 Time of Inspection 9 a�r) q m Date of Inspection L �6--7 7 /per, REQUEST FOR APPROVAL OF Los INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. 1. Approval requested by: Alaska Mutual Savings Bank orb (I 10' n Mailing Address: Post Office Box 1120 Phone: 274-3561 2. Property Owner: Dick Wright Phone: Mailing Address: Star Route A Box 1585=A 3. Legal Description: Lot 3 Block 4 Talus West Subdivision 4. Location: NHN Wilderness Drive 344-4214 5. Type of facility to be inspected Single Family No. of bedrooms 6. Well Data: A. Type Individual B.. Depth C. Construction I D. Bacterial Analysis 0, A, 7. Sewage Disposal System: On-site system A. Installed ic17 o B. Installer d`�C. Septic Tank: 1. Size Manufacturer D. Seepage Pit: 1. Absorption Area jtyX)g() 2. Material E. Disposal Field: Total length of lines 8. Distances: A`o-S�o. E A. Well to: Septic tank , Absorption area , Sewer Lines Nearest lot line Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages Page 2 of two pages - Ret, ;t for Approval of Individual S )r & Water Facilities !_egal Description Lot 3 Block 4 Talus West Subdivision Comments A&IcreDisapproved Date / Appro ,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM i certiry tnat the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ -034 (1/74) `.� MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 DEC 131976 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATERFACILITIES RECEIVED 1. Type of Inspection: CMRO VA FHA CONV X 2. Property Owner: Dick Wr Mailing Address: SRA Box 1585-A Day Phone: 344-4214 3. Name of Buyer: Richard and Carol Northrip Mailing Address:_ 611 Sycamore, Burkburnett TX Day Phone: c/o Mobil Oil Corp. 4. Name of Lending Institution: Alaska Mutual Savings Bank Mailing Address: P. 0, Box 1120. Anchorage 9951 hone: 274-3561 5. Name of Realtor or Agent: Pat Newton—Dynamic Realty Mailing Address: 501 W. Northern Lights Phone: 279-7611 6. Legal Description: Lot 3, Block 4 Talus West Subdivision Location: NHN Wilderness Drive 7. Type of Facility to be Inspected: SF No. Bdrms. 1 8. Water Supply Type of Supply: Public Utility Individual X If Individual, number of dwellings presently served 1 If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation 72-003(3/76) Individual (on-site) X . ' Florence R „ - M Lau:�f. Harrison Fifth Floor Sewc-b and Water Section i - SUBJECT Lot_ 9_ Heritage--Heights-Subdiviaion i � Lot 3 Block 4 Talus West Subdivisa0ll� f MESS7lti" --- --- — -- DATE CThe attached paperwork is for application of refunds. These were done by the engineers during, the strike. Please make applic*Ltion for the money to be refunded. 4 Thank you. I - SIGNED Laura J. Harrison SewmW." an Gfater REPLY t ,.. .: SIGNED DATE RedifOrm® 4$471 SEND PARTS I AND 3 WITH CARBON INTACT - ✓ PART 3 WILL BE RETURNED WITH REPLY. vu var iso SUS) um nFTA!.