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Home My WebLink AboutTALUS WEST #2 BLK 4 LT 10Talus W st Block 4 Lot 10 #015-202-56 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241272 Work Type: SepticTank Upgrade Tax Code Number: 01520256000 Site Legal Address: TALUS WEST#2 BLK 4 LT 10 G:2736 Site Mailing Address: 11630 FIRNLINE DR, Anchorage Owner: HAMILTON KENT R & MARISOL D Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 9/6/2024 9/6/2025 44730 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: �- % r—o i Cis Date: Issued By: Date: '9 61 ob l 4 MUNICIPALITY OF Community Development Department . . . . . . . . . . Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON -SITE SEWERAtVELL PERMIT APPLICATION Parcel I. D. 0 15-202-56 Property owner(s) Kent Hamilton Day phone 907-952-5147 Mailing address 11630 Firnline Drive, Anchorage, AK 99516 Site address 11630 Firnline Drive, Anchorage, AK 99516 Legal description (Sub'd., Block & Lot) Talus West #2 Block 4 Lot 10 Legal description (Township, Range & Section) Lot Size 44,730 _Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) R (w/wo AD U) Septic Tank R Upgrade RX Duplex (D) ❑ Holding Tank R Renewal Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: A225 � Date of Payment: 3/ Receipt Number: Permit No. 05 PZ_ 4 a7 2- Waiver Fees: Date of Payment: Receipt Number: Waiver No. Permit App_'-'- '. :'_.,:c ; August 19, 2024 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Talus West #2, Block 4 Lot 10 – 11630 Firnline Drive Septic Tank Replacement Dear On-Site Services Engineer: The owner of the above lot has a concrete plastic hybrid lift station that has reached its end of useful life, so we are submitting this permit application for its replacement. The concrete septic tank on the property appears to be functioning fine. The attached site plan identifies the location of the home as well as the wells and septic location. No conflicts exist between this proposed system and any other wells or septic system, whether on this lot or adjacent lots. We are replacing the lift station with another. The new septic tank will be a minimum of 100’ from all we lls and surface water. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241272, Curtis Townsend, 09/06/24 x x x x x x x x x x x x x x x x x x x x x x x x x x // x x x x Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT BV - BALL VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE BV - BALL VALVE LEGEND TALUS WEST #2, BLOCK 4 LOT 10 FEET 0 50 100 FIRN L I N E D R I V E 4-BDRM HOME SEPTIC PLAN 8/19/24 SHED 10' UTILITY EASEMENT P A S S A G E W A Y UNDERGROUND UTILITY EXISTING CURTAIN DRAIN APPROX LOCATIONS OF EXISTING SEPTIC BEDS TO REMAIN IN SERVICE FIND AND REPLACE/REPAIR MISSING MT PIPES MT MT JET AERATION TANK TO REMAIN IN SERVICE REPLACE EXISTING LIFT STATION ENSURE SEPARATION FROM NEW LIFT STATION TO EXISTING BED (AS MUCH AS POSSIBLE) BV Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241272, Curtis Townsend, 09/06/24 PLOT PLAN _ AS BUILT _X_ SCALE _ 1= 30' GRID SW 2736 — — Project No J24-1671A1 P.O. Box 210005 La n g & Associates, inc. Anchorage, Alaska 99521-0005 000Op (907) 522-6476 Professional Land Surveyors jonathanOlangsurvey.com o� OF A 4p ken®langsurvey.com O'� •. ' '9�1�0 I hereby certify that I have surveyed the following described property: LOT 10, BLOCK 4, TALUS WEST ADD. No. 2 (Plat No. 80-39) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. =3 Dated this the Day of _ A- 06 v 51_�__, at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. .. .... ... 1 A C. LAN�GQ o S-994 '5 4p�� FfSS10NM- o State of Alaska AECC963 · Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anch-.~,'age, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~t3'~ c/~::~D~,7~/ PID Number: Name: ~ ~l ~LL , ~I(_NA E L Wastewater System: O New ~ Upgrade Address: ~0. ~ ~17.. ~ ABSORPTION FIELD Phone: J No. of ~rooms: D Deep Trench ~ Shallow Trench ~Bed ~ Mound D Other LEGAL DESCRIPTION so~, Rating: Total Depth from original grade: ~ ~ GPD/Sq. Ft. Lot: Block: Subdiv~on: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: ~ Range: ~ Section: Fill added above original grade: Gravel length: / ~ ~. WELL: D New ~ Upgrade Gravel width: Number of lines: ~Dislancebetweenlines Classification (Private. A,B,C): Total Depth: Cased TO: To/al absorption area: Pipe material: Driller: ~%~ t · Date Drilled: Static Water Level: Installer: ~ ~. ~. TANK SEPARATION DISTANCES ~ Septic ~ Holdin~ Well- ~ ~ ~ JO~ I ~ ~ ) ~ Material: Number of Compartments: Surface w~t~ ~ * N F" LIFT STATION D rain 70 ~ 0 ~ 0 ~ Remarks: BENCH MARK ENGINEER'S SEAL Inspections performed by: J ~ Dates' 1st Department of Health and Hu~a~ ~ervices approval '- Reviewed and approved by: Date' ~ ?~' - · , ~ · P/IDTH 20 FT l-{/4~ PIPE WITH 1/8" HOLES TOP ROCK BO[. BOCK BOT. 1-~/4" $ Ft. of Cover Topsoil 99~ ~40N/FOR ACBEAOE SYBTEk~ 1250 go/ tank 500 AGL LI£T STATION JET AERATION E OTIS ORAVEL TOEBEN SPURKLA~ 203 kY 15TH. TALUS BENCH IffARK: DOOR ~llL ASSUIdED ELEVAT~ON:Z I00.00 FT WEST LOT 10 ! 1630 F/RNL/NE kHKE DRIS£OLL BLOCK 4 /SYsrE~-~S £u/z r 8, 1998 GRID: 2?56 PERtdlT TAWO41OS. DWG N 49±h No. 100 ~-----.[ SWING TIES: AC 85 FT CURTAIN DS~NDARD BED; WIDTH 20 FT TOTAL D~TH 5 FT FILTER SAND 2 FT SEWER ROCK .5 FT P.E. 205 W ISTH. AVENUE ANCH. AK. 99501 279-5916 TALUS WEST LT 10 BLI( 4 11630 FIRNL/NE MIKE DRISCO~L SYSTEtd AS BUILT OCT. $, 1995 2/$ GRID.. 2736 PERNIT # £1v'980379 PIB # 015-£07-5~ ?AP/O410£,D~/G MUNICIPALITY OF ANCHORAGE Deparfment of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Sep 22, 1996 Expiration Date: Sep 22, 1999 Permit Number: SW980379 Legal Description: TALUS WEST#2 BLK 4 LT 10 Design Engineer: 0007 Tobben Spurkland, P.E. Owner Name: MIKE DRISCOLL Owner Address: BOX 2517 KENAI , AK 99611-2517 Parcel ID: 015-202-56 Site Address: 011630 FIRNLINE DR Lot Size: 44730 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [~ Disposal Field [] SepticTank [~ Holding Tank [] Privy [] Private Well [] Water Storage 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 (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Per'nit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. AT THE TIME OF CONSTRUCTION ENGINEER SHALL INVESTIGATE THE WATER TIGHT INTEGRITY OF THE ACREAGE SYSTEMS LIFT STATION Date: ?- ,,2,2 - ?~ ToSPSI TEAN PoE 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 10 BLOCK 4 TALUS WEST MIKE DRISCOLL Municipality of Anchorage Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 We are submitting an application for the upgrade of a septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following: No Ground Water or Impervious Layer to 8 ft. Use Standard Bed Soil Rating. From Testholes August 31, 1998 <5 min/in = 0.8 gal per sq.fl/day No. of Bedrooms 4 Required Area per Bedroom: 150/0.8 = 187.5 sq.ft. Total area required: 187.5 x 4 = 749 sqft Use 20 x 40 Bed Use 2 ft of filter sand Total Depth 5 ff SYSTEM CONFIGURATION STANDARD BED TOTAL LENGTH 40 FT TOTAL WIDTH 20 FT TOTAL DEPTH 5 FT FILTER SAND 2 FT ROCK DEPTH 0.5 FT COVER 3 FT SEPTIC TANK EXISTING CHECK INTEGRITY The installation of this septic system will not prevent wells from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. PERFORMED FOR:__. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION:~),(~ %'~-~.U-,t~___~,.~ownship, Range, SectioR: (~ ~. ~_~/_~ ,kl/./(.~ SLOPI DATE PERFORMED:~ 3 4' 5 6 7 8 9. 10 11 12,-- 13 14 15' 16 17, 18' 19- 20- WAS GROUND WATER ENCOUNTERED? ...~,~ ~ IF YES, AT WHAT I Depth to Water Alter , ~./.,~., ' M°nil°riflD? ~ Date. / T~. ~/~ ~eading ~l~t e~./~· ~'os$ Net De th ~me Time P to Net PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ ~TAND -- ~----FT COMMENTS _ ~- CERTIFY THAT THIS TEST WAS PERFORMED IN 72-008 (Rev. 4185) LUT ~ / / F]I?NLJN£ ~?£]VE 205 W 157H. AVENUE ANCH. AK. 99501 '-5916 TAZU,~ ~£ST LT LO B£K 4 11650 FIRNIINE MIKE DR/SCOI. L S)'STEId DES/ON AUGUST 11, 1998 · 1/5 OR/D: 2756 PEP, N/f # 2V98XXXX P/D # ~5-~-56 25 0 ~5 50 EXIS~ E~yr. ,~ERIFY t ~0.5_.W 157H.AVENUE II ~z~o WEST LT 10 B£K 4 AyCk~. AK. 9950~ Il ~6Jo FIRNLINE ~ MIKE DRISCO SYSTEM DESIQN AUGUST 11, 1995 · 2/5' GRID.. 2736 PERNI[ # £~/98XXXX PID #015-202 4O 1-~/,/" PV£ WITH ~/8" HOLES F~CE HOLES~ ~ 4-INCH IdONITOR STANDARD BED 20 FT X 40 FF ~" Sewer ! - 1/4" D/sHbut/on SILT £ARRIEfi 2 FT FILTERSAND 3 Ft. of Cover Topsoil MON/?OR 1250 ,ga/ Jonk TO££EN SPURKLAND P.E. 205 W 15TH. AVENUE ~T~-~-~S ~FES~' LOT !0 ELOCK 4 ~SYSTEN DESIGN I 4~C~. AK. 99501 I I I16~0 FIRNLINE J J DATE: UARCH 13, 1997 ~~ ~ ~IKE DRISCOLL SHEE~' 5 ~ GRID 2756 ~SW98XXXX o,~ . ,., -- ~ r~u ~ TAWO41OS. DWC Name MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 0 / ~ -- 2 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Phone(s) LEGAL DESCRIPTION ~ SEPTIC ] Subdivisi°n 'T-A L:~'[ 5 [-~ TANKS k/6~. LSf,.~ ~.~ [] HOLDING Manufacturer Capaci[y in gallons . Materml NO. of Compartments TYPE OF SYSTEM [] TRENCH ~, BED Depth to pipe bottom from Fill added above original grade Gravel length FT Number o] aries Soil rating [] W. DRAIN [] OTHER Total depth from original grade Gravel depth beneath pipe Gravel width Distance between lines Pipe material WELLS ~ PRIVATE [] OTHER (Identify) Classification IA,B.C) Tolal Depth FT I~staller Date Installed: DISTANCES SEPTIC ABSORPTION TANK FIELD WELL WELL ( ( ~ ( (.~ LOT LINE ~ dF" L 0 /C'~ FOUNOATION As-aUILT DIAGRAM Show ioca o~ of we~l septic system, properiy lines, loundation, water bodies, etc.) REMARKS: [=t ~ Sca~e: Inspections Pedormed by: Health Oepa.ment Approval: ~~ KNIEFEL ENGINEERING 8441 Miles Ct., Anchorage AK. 99504 (907) 337-1121 · Fax (907) 338-1874 Date: 11/15/90 Time: ................ Cover Sheet plus 1 pages To: ' Name: Dan Roth Company: MOA DHHS FAX Number: From: ~ Name: Bob Kniefel Company: Kniefel EngineerJng FAX Number: 338-1874 Problems?? call 337-1121 Subgect: Lot 10, Block 4, Talus West Comments: Attached is the receipt from the Electric Doctor for the work done to install the lift station at the above location. As the receipt notes, the wiring for the lift station was already in place since we were replacing a Jet Aeration Unit with this new lift station. The wiring was re-connected to the new lift station by the approved electrical contractor with no additional work required, The lift station was already on its own separate circuit so no change was necessary for that. Based upon this receipt the work to as-built the above system should be completed, Please let me know as soon as possible when the permit is finalized by your office. Submitted by: Nov- 1 ~-9o THU 12 : 06 AOREAGE SYSTEM8 "---'- ELECTRIC DOgTOR, INC.. "We Make" H~'u~e"CallS,, .'~ 1207 W. 47th Ave: ' ' ANCHORAGE, AK '99503-6917 (907) 561-2225 *' F~ 561.5802 Alaska LI;. ~9148 , JOEl INVOICE ":.?'' ', ", 7370 d~ ~ ~ .... '~ : ..... I hereby a~knowledge the satlsfacto~ J ~_ . . ~ , comp[etlon of the above described wo~' ~ TOTAL ~eO~ ~ T~ / / f 0 · CD ....... I., tg¢i~Y KNIEFEL ENGINEERING 8441 Miles Ct., Anchorage AK. 99504 (907) 337-1121 · Fax (907) 338-1874 September 16, 1990 Hr. John Smith, Hanager On-Site Services Program Department of Health and Human Services Hunicipality of Anchorage 825 "L" Street Anchorage, Alaska 99501 SUBJECT:LOT 10, BLOCK 4, TALUS WEST SYSTEH UPGRADE Dear Hr. Smith: The purpose of this letter is to request approval for the attached design of the upgrade of the septic system located at Lot 10, Block 4, Talus West. Attached are the system design drawings and soils logs. System Background: The original system provided septic disposal for a four (4) bedroom home, The permit file shows a system design constructed in approximately 1977, The system consisted of a "Jet Aeration" three (3) compartment concrete tank attached to 65' of absorption trench. The trench system, as noted by AEOS in 1984, shows it was placed at a depth which is now below the water table for the lot, High ground water concerns were noted in 1984 in relation to the septic system on Lot 11. A study was conducted by AECS and determined the problem was one shared by both Lots 10 and 11. Water table depths were noted as high as the 2' level on Lot 10. To resolve the problems associated with the effect of high ground water on both lots, a curtain drain system was installed along the easterly and northerly portions of Lot 10 during the fall of 1984. The ground water readings immediately after the installation of the curtain drain and confirmed the water table has dropped to at least the 8' level on lot 10. The water monitoring during our effort showed the water table from 11' to 8 feet in depth. System Design: Beyond the two test ho]es completed by AEC8 in 1984, we completed an additional two test holes for the design of this system. The soils are similar for a11 the holes showing an overburden layer underlain by HL soils to the depth of the water table. The soil percolation tests showed a rate of 312 sf/bed. For our work we are using a design value of 325 square feet per bedroom. Lot 10, Block September 16, page two 4, Talus West System Upgrade 1990 For a four (4) bedroom house this results in 4 beds x 325 sf/bed, x 1.5 (bed cot.) = 1,950 sf of bed area for the new system. Due to the varying water table depth, the relatively poor accepting soils and the past experience with the systems on this lot, the system upgrade design has set the bed design at the upper most level of the soil column and used a pressurized bed approach to provide maximum dispersion of the system effluent. The system does encroach over the existing bed, but with the vertical separation of ten feet over the existing system we feel we meet the separation criteria. As you can see, we have gone to an extensive effort to design and submit a system that has the best chance of working in this area. As we all know, Talus West Subdivision has a troubled past track record which includes high water tables, swamp areas, and poor receiving soil conditions. The design as attached requires that the curtain drain system be kept in good working order at all times to insure the ground water levels do not intrude into the drainfield receiving soils area. We would appreciate your considered review and approval of the attached system design for this lot. We are more than ready to answer any questions you may have regarding the design or other aspects of this project. Please feel free to contact us at your convenience. Respectfully Submitted, Kniefel Engineering/~ Robert Kniefel, P.E. Well SEPTIC SYSTEM DESIGN Lot 10,.Block 4, Talus.West DATE SCALE 9/13/90 1" = 30' PREPARED FOR: Aemeage Systems PREPARED BY: Kniefel Engineering MOA CE 90-030 / / IZ ou. eb') + 0 I-t4 - OF 'KE KNIEFEL ENGINEERING 8441 Miles Ct., Anchorage AK. 99504 (907) 337-1121 · Fax (907) 338-1874 1. Construction -- All construction materials, construction methods, and inspections will follow MOA rules and regulations. Contractor is responsible for providing 24 hour inspection notification to both the Engineer (Kniefel Engineering, 337-1121) and MOA DHHS On-Site Services (343-4744 day, 343-4681 recorder). 2. System Design -- Four (4) bedrooms at 325 square feet per bedroom = 1,300 sf of area. For a bed the correction is 1.5 x area = 1,950 sf of absorption bed. The design is approximately 2,000 sf of bed area. 3. Setback Requirements: a. Property Line >10 feet b. Curtain Drain >40 feet c. Lot 10 and Lot 11 Wells >102 feet 4. Inspection Requirements -- Two inspections are required during the system installation. The first inspection will occur after the bed area is excavated and leveled to proper depth, but prior to any gravel placement. The second inspection occurs after installation of the system components but prior to placement of the backfill material. 5. Excavation Depth -7 As noted on the plan sheet, the contractor is responsible for removing all peat and overburden material under the bed area. The excavation will be dug to a minimum of 2.8 feet below the existing ground or more depending upon the depth of peat and overburden found. 6. Lift Station -- The lift station will be an Acreage Systems Inc. Lift Station or engineer approved equal. 7. Communications -- The contractor is responsible for contacting the engineer immediately upon developing a need for changes or alterations in the installation based upon any found field conditions. 9/16/90 page 3/3 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR:~~ DATE PEF 6 7 8 WAS GROUND WATER ~.~ ENCOUNTERED? Monitorino? r~ Dale. PERCOLATION RATE . ~,(~"" (minutes/inch) PERC HOLE DIAMETER __ ~ at ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85i CERTIFY THAT THIS TEST WAS PERFORMED IN Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 4 5 6 7' 8 9 10 11 14 15, 16- 17 18 19, 20- COMMENTS .. DATE PERFOF Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT IS DEPTH? I ~. S pO E Oeplh to Water After Monitoring? Dele: SITE PLAN Reading Date Gross Net Depth to Net ~.~"~ Time Time Water ..-Dro~ PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev, 4/85) PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER . TEST RUN BET.WEEN -- FT AND . FT CERTJFY THAT ~HIS TEST WAS PERFORMED IN > Municipality of Anchorage . J DE,~ARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION POUCH 6-650 ANCHOR/~GE, ALASKA 99501 INSPECTION REPORT ON ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL NAME ~ /~,.~c-~ LOCATION ?773 ? i PERMIT NUMBER iNDDRESS ,/~/~-,~_~.~ ~'~'~) LEGAL DESCRIPTION SEPTIC TANK MATERIAL CAPACITY IN GALS. #OF COMPARTMENTS INSIDE DIMENSIOm DEPTH LENGTH WIDTH SEEPAGE SYSTEM [] TILE BRAINFIELO NUMBER OF LINES I LENGTH EACH TOTAL LENGTH DISTANCE BETWEEN LINES TRENCHWIDTH DEPTHS: FI LL TILE TO GRADE BELOW TILE FILL ABOVE TILE I~SEEPAGETRENCN0fl []PIT NIDT. ,,~ ~; '/ LENGTH ~'5' DEPTH / 2 I [] LOG CRIB [] RINGS- DIA. FILL MATERIAL DEPTH TOTAL EFFECTIVE ABSORPTION AREA; ~'-) /~;P ~/~/ WELL CLAS I~FICATIGN DEPTH PIPE MATERIAL INSTALLER R E M A R K S '~'~'~"4~/ ~-., FT. 72-012 (9/77) DISTANCES SEPTIC SEEPAGE SEWER TANK SYSTEM LINE CESSPOOL WELL WELL LINE ~2.0t ~iOoUNN D A- ~ ! ~ SYSTEM DIAGRAM BLOCK: SUBDIVISION: RPF'L I F:RNT CHRRL. E'~ H II, MT ' : LOCRI'IOH HZLI.~RNES:5 ~ EkN<. to,_,b--L. SRR LEGRt LT. i~DK. 4 - - I '"" ,'- - FHI._ _1:, NEST LOT '-' ' ":' - ' -" -~'- '.= F'EEI' 'F~"PE OF c ..... ,~- -,UZL. HE--,U~.B~ ]. UN b'¥'~TEI'I Z_ I'REHCH MR>::/HUM NUf'IBER ~F BE[:,RO01',~S = 4 SI]IL RRTIf~G (SQ Fl,DR .... THE REr:)t ZRE[' ~" '-,'' .......... Z~.E OF THE SOZL .... ,,:"-,*. .... HE,..,URF] ZuN SYE;"FEH Z2;: . THE LENGTH D~MENBION I5] THE LENGTH (IN FEEl':) OF THE TRENF:H OR RH~NFIEL[:,. THE DEPTH OF' R TRENCH ]'R PIT I=, THE [:'ISI'FINCE E:ETNEEH THE SURFRC:E OF ]'HE ~JEuUNC RNI) THE BOTTOM OF I'HE E;:'~CAVRI'ION (IN HERE I5 NO .9E]",klIDTH FOR TREME. HE=,. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BEIWEEN THE OUTFFiLL. PIPE RNC, THE BJI FUH OF THE EXF'R~'- · -. CNIION (IN FEET). BE INSTRLLED RT THE PERHITTEE'"S OPI'II]N -,U6JEu1 TO THE FOLLOWING I::ON[)I'I'];CIN5: _ ':' ', ...... E ...... ;' 3R II NSF RF'PROVE[) PLRNT MRY BE INSTFILLE[:,. -I1HEK R CLRSS I r-' 2. R CONTINUOUS HRIHTENRNCE RISREEMEN-F IS; REQUIRED,. IF R HRINTENRNCE RGREEMENT IS NOT KEF'T ~'tIRR" ' "F ,. -,c'-, .......... EN~ m-U HAY BE RESUIREC~ TO ENLRRGE I'HE SOIL HB..,ORF I IUN c-, ,,:. -,. - -.,~-,TErl RNP/OR Ynh HRY BE SUBJECT TO '"l'l,- ....... .... r F ~.-- :'ECU1 IUN. E:PIL-KFILLiNI.~ 0F RN'?' '::"": ..... . F~F~'E' '- .... , -. ....... -- -- "'-- FN- E ~.=-- L~ -,t_,lEfl HITHOLtT FINRL INSPECTION RND AF'F'RCi',,¢RL BY 'I'HZS [)EF'RRI-h~ENi" NILL BE -,UD3EL. F l"O PROSECUTION. HINiMLI~I DISI"RNCE BEI"HEEN R NELL RND RHY ON-SITE ,: ...... ~-.,: ,-., .... --,EIJRUE E..I._,Fu~Ni ,:',,,-.--.,. 1~¢ FEEl' FOR R F'RiYRTE WEL. L OR 288 FEEl" FOR R PUBLIC HELL WELL LOGS REtE REE~UIREC, RND MUST BE RETURNED TO I-HE DEPRRTMENT HI'I'H:[N 2E~ DRYS OF THE NELL COHPLETION. OTHER REQLI.IREHENT~ MRY RPF'LY. ~', ........... ~FEu.[FIL. HTIuN~ RN[) CONSTRUCI']'F~N C'ZRGRRHS ERE R'¢RILRBLE TO INSURE F'ROPER INSTRLLRTION. ~ CERTZF'y THRT' 1: ~ R~'I F~H/LZ~R N:["I"H THE ~E-NLIZ~.EHENTb FOR ON-Sz-I"E FEIRTH BY THE HLINICIF'RLIT'¢ OF RNCHCiRRI3E. -,'" c .... .- '-,-,-,-T, RHE, HELL':j H:, -,El 2: I NILL INSTRLL TINE c,,,-.-, -,,:,~EH IN RCCORDRNCE NITH THE CODEs ~:: I UNDERSTRNI} THRI' THE ON-Z;II'E '-' -~' ........... =,EHER SYSTEM HRY REJI_IZRE NPPL ZCRNT CHURL. ES HZ'~-~e M-W DRILLING, INC. Well Owner DRILLING LOG ~ ' ~LL ' .... .... ~Lf~e,6f Well Location (address of: Township, Range, Section, if known; or distance mmn road Size of casing Depth of Hole .Ih0 feet Cased to ~L/;.~. ') feet Static water level "~ ft. ~(abo. va):. (below) land surface. Finish of well (check one) open end ( ); Screen ( ); Perforated ( ). Describe screen or perforation Well pumping test at ]~0 gallons per (h~ur) of drawdown from static level. ~I.0 / Y. ( /7'/ Date of completion ]. (minute) for hours with WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness TO .TO. TO_ · TO_ TO_ .TO_ "' .TO TO ' ;0 ..... "' ] TO. .TO.To. ~' ~' ~ / / .... w NWWA Curb,mol Conh'actor TO_ '"' ~' '~ ~ .TO. 2 ~ STATE ~ of Anchorage 0 : On-Site Water and Wastewater 4700 South Bragaw St, P.O. Box 196650 Anchorage, AK 99519-6650 www, ci.a~ r~chor, age.a ,k.us · ¢07)~7~o.4, .;;. ::.?~;: ~?.~,.. ........ .., ..,....i~' :' .':':ii:''~ '-,"? Parcel Location (site address or'd rections~ -'Mailing:addros¢. ' '" Lend~ng agency Mailing address Expiration Date: L., I SA ~,~/~)t2.J¢. ~4/~,1 Da 2. NUMBER OF BEDRO( ~:..'~: . 3. TYPE OF.WATER SUPPLY: · Individual We.!l Individua Water Storage community class Well Public Water System br pickup. TYPE OF WASTEWATER DISPOSAL: Individual On-site ~: :..~' Individual Holding tank [] Community om~ite ~ [] Public Sewer [] The Municipality of Anchorag~:':De~elo'p~ent Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only ulson the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C weti 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. As cert f ed by my sea affixed hereto and as of the validati(~n date shown below I ~,~r fy th;t my im/~stinat ~n based on procedures outlined in the Heslt.h. Au.tho. r,ty,Approyal..Guld~hnes for .this appl!cation; shows that tl~e Oh- s!to water st. pply and/or Wastewater dispcsa! systr~m is(are) safe, fdnction~! and adAqu~ite' for ~fi~ n~.i'mb~r cf bedrooms end type of .,, u,.t,,re I,.d,c-.:d herein. I further verify that based on the information obtained from the M.n,,. ;,~.lty of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) n compliance with.all 'a'pplicablb. Municipal and State.codes ordinances,. "and regulations in'eff~t ~{ the time of installat!on. ' ....'" ' ' ....' ::' ' .... Name of Firnq '~e/~ ¢~C [¢t~,~ ~- ~ Phone r~Tc?-_~?lk, Address ' ' 5.,DSD~ IS Conditiol for b~drobms, With the' following s~ p la,ions. v... '::1; .- .:., ... ;'. .... Additional Comments ................... Attachments: HAA Checklist '" '' '- Septic Syste~ Advlssry Well Flow Advisory '" '"' MamtenanceAgreements ..... ' Sfi~pl~m~htal En'~ih~e~':s'R~port Other By: (Rev~ 01/023 Original Certificate Date: '.: '~"::~.~.";.::~:.'.?. :~.::"~fii~ ~fe~p~i:~':' :..:.'.'... ?:'.'..: '.. ... ::.:., '"'.'.' ': .':' ' .'~~~ ';-: :'...~...'...'.'.:'.: O~::~ite:~amr,:~ ~ei~:,.k~:a~a~.: :,' '.:.;'. :. :. ":':~. . · -...~ '~1~:~ ' - -;, .'..;:"-..' ':.':?:::'... ::.,',4zbe. S'6, ~.~B~¢a~.S~.::.'.:;~::5..,:."~..:..,:..~:,:'.. . .. '.,...: ;' . ..... '.'. ~--:' . ..?: ..: :...,~'6i':ar ~kO~ag~,a~ms :,,:':..~.:;, ,:.':...'...:.5:,":,:: :' ... , ,;:,, ,',.. ::.,.,:: ',-..5,::.. : ; "/~-' ' ":':~" '~:':"' ",.. ":"'".;¢0z~ ~4:a~z~0~'-. ,' ~:'.. '.... :..:...;..':.' :'..v:':,...'::'; ...... .: ; .. , · ,, :~....,.-:¢...:~.. -.f? ?~.~:¥,;~ ?? (... ,:..:.. :..~..:,.....; ........ . ~.5-.; .. ...-.. ~:: 7 . .. . · .... .. · ¢' :'.:,"',' ,.A.. ':WELL,.~TA'.-.. ~-.,. ...... . :., ..... .,~ '~.:.:.. ~; ' . · : .:..'.- '.." .-. .:' . · ¢':5'"~::"..:'.:.:..".'::' .: :'..": ..' : : :'.'~:' -: :'' :': '.'' :':N';: '.'.:':,'':':', · ": · ""' ""' ' . ?.. '. To~I ¢~..(~: .~.' 'Oa~d;'t~;.,,O%~..':.:'~. ;.'.'..:..:Casi,~::,~.ei~bt',.('ab0~e':gzau~d):' ::'.:~;.. '{ in. .... - ~.a=:,~L~:Loe, ' .:.. :' : ':. '. :.~: ..:....,. -... ~:...~ .::..¢~:~...S~c~aN _._ ..... ¥'~":'::: :''7 ~''" .... "'.: : ": ,. ~:.;., ..... ;...=~::,...:~'.: :.:..... . ':S~tiowater,ie~el':: ='.b .E' "'""" ': Well p~duciiO~ '. ¥..D -::,~ ,'.'-;.:' ,g,p;m.:'.: . -:..:. ,/.i:....:~'.':0 'g,ip;m.~' :WATER:.; 'i': ' ' ~ "/::,.? .':.-..'.;~':: ':::' ' .'" "- ...... ::.:" 7'":' '.'"".:,' ',:.~.':}.',::.:' ::.~:. ...... . :..'~.',:.:.'.':. :.: "?-'.:';..; · :~ ~..:¢:;:5.r~:..;;,:;....... :: ..'.' ' · ;' .; :;~t,:'i?.'5.' '¢;:::.,:.:~¢".7;'~5'i.::. :,::"'." :'( ,:.:' : "': ·" ' C;~:~B~.T!~.N'(.EIE~:~DA~A :. - . ..'~ .:,...:, '......-~.. :.:.:.:......, .:......: -?.:,-., ' :,': :'::";~/: {?:..::, '.':?:.: :5': ":'.'.:,;?:' ;;~ '.;. .' "..' ":' ';'.:',":::.: .~.'=~ 5 .'.:'.",.~;:. ':,:.": ':. '" ':'. '.' ',' . ·: ." '"" .' ."."g ...... ~ :' :..:.'. ... ..,.- .... ..: ..... V. :.. .... :. :.... .... :: ..:..: ......... . ..... . . :.: .~':':, ,....'.' · ::, 5 .'::.:..,:';:~'~¢'~¢-:':..:'" ':' '.' " " :' '. ........... "~'''; ":' : ' ' ' ....... ' " ':.':i.':. '. '.' . .:'. '" ' . . .,.:.. - ...':.... .~ .' .. · :..:. :..:'..?... . .......- - . '.. . .. . Size. in gallons "Pump off' level at ,l:'t~ in: E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ONLQT TO: '~i Septic'tank/lift s~ati0fi on.lot J L0 "'~'..': .q:~n.'~djacent AbSorption field on lot Public sewer main Sewer//septic service: line ~ -.~ Holding.tank Manhole/Access (Y/N) y High.water alarm eve at: i~ Meets alarm & circuit req~ SEPARATION DISTANCES FROM. SEPTIC/HOLDING TANK-'.QN LO~ TO: Bbilding foundation I'~ Property line Water main I~ A Water service line Wells on adjacent lets "'~'-'~ ~ Absorption field · Sui-fac'~ ~Ni~te[ 'Dr,veway. parking/vehicle storage G. ENGI'N EER'S 'CERTIFlCAT-ION f certif~ that/have, determined through field ins~)ections and review of Municipal records that the above systems are conformance, with MOA. HAA guidefines in effect on this date. Engineer's 'Printed Name Date ....... '. " HAA.Fee $ ,~,/~/.~. ~t"~' Date of Payment Receipt Number ~Vait/er Fee $ Date. of Payment Receip~ Number Municipality of Anchorage Development Services Department Building Safety Divis!on On-Site Water and Wastewater Pr.'?am 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 9~c519.-6650 wv~v.cLanchorage.3k.us (gOD 343-7~04 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL JI',IFORMATION Ccm;,lete legal description Lccaticn (site address or dj:actions) Current Property owner(s) H,~.A ~ /~'/'3. 0 ~ D 5'" 0._._3. Expiraticn Date:, [ - ~.. ~- 0 '~ Day phone Ma!ling address Lending agency Day phcne Mailing address Real Estate Agent Mailing Address Unless othem,L~e requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Lf' 't~.-~/'- Day phone 3. TYPE OF WATER SUPPLY: · Individual Well Individual Water Storage Community Class ~ Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Ccmmunity On-site Public Sewer [] [] [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Heaith Authcdty ApFroval are required for the transfer cf title (except between spouses) for properties sewed by a single-family on-site wast.q,:,,ater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by s private cr Class C well and m-"y be reissued with new water sample results. (Certificates may be reissued for s pedod of up to one ye3r with valid water Certificates are valid for one year for prope~es served by Class A or B we!is or a public water eystem. The Municit:ality of Anchorage is not responsible for errors or cmiss!cns in the prct3ssional engineer'o work. 4. STATEMENT OF INSPECTION BY ENGINEER As ce~fied by my seal affixed hereto and as of Ihe w31idaOon date shcv~ below, I verify that my investigatfon, based on procedures outlined in Ihe Health Authority Approval Guidelines for this application, shows that the site water supply and/or wastewater disposal system is(~re) safe, functional and adequate for the number et bedrooms and bJpe 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 ccmp!i~nca wi~ a~l applicable Municipal and State codes, ordinances, and regulations in effect at the fime of instal!~tien. Name of Firm I'---~ J'~-~ ¢~ Address ~ ~ Engineer's Printed Name 5. DSD SIGNATURE ~ Approved for Disapproved. Conditional approval for Phone Date bedrooms. bedrooms, with the following stipulations: Additional Comments ~'~'-" ON SITE '-~ WATERAND ; ~ : WASTEWATER : :: -~ . FROGRAM .' Attachments: HAA Checklist Septic System Advisory Well Flew Advisory X Maintenance Agreements Supplemental Engineer's Report Other Odginal Certificate Date: O M!micipality of Anchorage Development Services Department ~,~- Building Safety Division On~lte Water & Wastawater Program 4700 Saul~ 8mgaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anc~orage.ak, us (g07) 343-7904 Legal Desc~:~on: A. WELL DATA HEALTH AUTHORITY APPROVAL CHECKLIST Total depth I~o ft. IfA, 8, or C provide PWSID # ',/A sanRa~/seal (Y/N) '7/ FROM WELL LOG / Wall Log (Y/N) ~'/ Wires pmbedy protected (Y/N) Casing height (above ground) AT INSPECTION Static water level ,,'~O ft. ~ :~ lt. Wall production IO g.p.m. ~. ~ g.p.m. WATER SAMPLE RESULTS: Coliform ...~colonies/100 mil Areenic: / mg./I. B. SEPTIC/HOLDING TANK DATA Nitrate ~ ~.L~[_ mg./I. Data of sampl~ fl.~e ~ Tank size ,~ ~,~ o gal. Number of Comparlmenta ~ Other bacteria ~ colonies/100 mi. Collectad by: A. ~,p,~ ~ v.(~., / Data instafled Cleanouta (Y/N) y Foundaflon c~eanout (y/N) I..~[~&Oepmssion aver tank (Y/N) ~. High watar alarm (Y/N) C. ABSORPTION FIELD DATA , ~ Data installed ! I l0 ? I'1'~'~/ Sail rating (g.p.d./ft~ or ~redrm) , ~ Total depth :~ ft. Eff. ahsorl~onama.~.ff2 Monitodngtube %/ Depmssionoverfieid Data of adequacy tast ~/f.-V/Pl..- Results(Pass/Fall) ~ Fluid depth in absorption field before tast ~,~ in. Water added Etapsed 'rime: ~ min. Final fluid dep~ ~) in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Systam b/pe "~ Grevel below pi~ For ~ b~ N~ dep~ ~on ~ >= ~ D g,p.d. If y,, g~e dam D. LIFT STATION Date instaUed I =Pump on'"level at I~ in. Datum Size in gallons ~'O~.,~ 'Pump off level at J~ in. Cycles tested ~ Manhole/Access (Y/N) y High water alarm level at J ~ Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic sen/ice line On adjacent lots ~'7 I 0'~ On adjacent lots '~/~ Public eewer manhole/cleenout Holding tank Id//X.. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation I ,~ Property line _J~ Absorption field Water main I-4/,~ Water service line ~'c~ Surface water Wells on adjacent lots ~ I ~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I~ ~' Building foundation Water Sewice line ~ 't' Surface water Curtain drain .,~.~) Welle on adjacent lots Water main Driveway, parking/vehicle storage F. COMMENTS G. ENGINEER'S CERTIFICATION HAA Fee $ Date of Payment Receipt Number (1~. 12/01) I ce~¥ that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name J, ~ ~'. ~j=~v V..~* ,~' Waiver Fee $ Date of Payment Receipt Number LOT 1 S g0'00'00" E 75.00' UTILITY EASEMENT LOT 11 LOT 10 PLAY HOUSE CREEN HOUSE LOT 9 ,,.c.o,,,cc. ,,,.,,s.,,, .~o~ (~o?)~-~ LOT 10, BLOCK 4, ~OCT. e, 2002I , .40 /"~_;00 ._ -..~.~.-.,-,,,..- TALUS WEST ADD. 2002 L 4858 .,. [ .~o*,~ .~c:"~'"'~- 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. # O1~- 202~~- ~f~ ',., GENERAL INFORMATION Complete legal description T,~LdS, Location (site address or directions) Property owner Mailing address Lending agency Mailin. g address Agent Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: '1' '. 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. 72025 (Rev, 1/91) Front MOA 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 ~'~ ~o,~vt S ~ u ~-~-~,~ ~'~- Phone Address ~o~ ~ IS~ ~ ~ '~ Eng neer, s'gnature ~ DHHS SIGNATURE / ~-, ', Approved for -~_,i~. ~-~__ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: / 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 D DEPARTMENT OF HEALTH & HUMAN SERVICE6~ ~.. ~, i v L Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 Municipality of Anchorage Health Authority Approval Checklis~ept, Health & Human Services LegalDescription: LoT Io~ ~'~f.~ T,~I..~j...~ ~0"1:~'~' ParcelI,D.: OI5- A. WELL DATA Well type ~ Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level IfA~ B, or C, attach ADEC letter. ADEC water system number Date completed 1 b/z~,/'7 "7 Cased to ¥ FROM WELL LOG Casing height (above ground) ~, Wires properly protected (Y/N) '~/ AT INSPECTION 8~ Well production I ~ g.p,m. ~.~ g.p.m. WATER SAMPLE RESULTS: Coliform ¢ Date of samPle: ' 1:) Nitrate Collected by: '~.-~ B. SEPTIC/HOLDING TANK DATA Date installed i O/~*~/~'7 Tank size Foundation cleanout (y/N) Date of Pumping /~/~/~-- ~ C. 'ABSORPTION FIELD DATA Date installed ~015 c[~ Length ~ 0 Width Effective absorption area Date of adequacy test Fluid depth in absorption field before test (in.); Fluid depth ~'// (ins) Minutes later: Number of Compartments ~ Cleanouts (Y/N) Depression (Y/N) t'4 High water alarm (Y/N) Pumper /'~LC~. ~--~--~ Soil rating (g.p.d./ff~ ~) , ~ System ~pe ~ Gravel thickness below pipe ~ ~1Total depth Peroxide treatment (past 12 months) (Y/N) . Depression over field (Y/N) N For ~ bedrooms Monitoring Tube present (Y/N) Y Results (Pass/Fail) c'~ Immediately after ~-'~gal. water added (in.): Absorption rate = g.p.d. If yes, give date 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level Cycles tested Size in gallons ~' ~'~'--~ "Pump on" level at* / ~ ~ "Pump off" level at* *Datum_ ]'5 e 'T")"o wf E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacentlots On adjacentlots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation I ~ Property line ~..~ Absorption field Water main/service line ,.~O 'f' .Surface water/drainage. ~.l I c) SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain Building foundat on. Wells on adjacent lots ,P-C) Water main/service line __~O -I. Driveway, parking/vehicle storage area Wells on adjacent lots / 0..~ F. in conformance with MOA HAA guidelines in effect on this date. ENGINEER'S CERTIFICATION , ': ~ ~, I certify that I have determined thru field inspections and review of Municipal recOrds'that the ab6ve systems are Signature Engineer's Name DAte HAA Fee $ ~'~ ' ~ Dateo, Payment/ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number ~1: Time Date Insp MUNICIMALIIY OP ANCHORAG' · DEPARTM~./; OF HEALTH AND ENVlRONME[~,~L PROTECTION 825 L Street, Anchoraae. Alaska 99501 264-4720 #2: Time Date Received: ~%U~x~ #3: Time %~-~ C'%'~. Date Date ~. Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: ~]~, ~%~a~,:~,LS~ Mailing Address: ~\~ ~6~o~ ~u~t~' ~¢~. Phone: 2. Property Owner: ~m-'t~ l n r~ Mailing Address: 4: Single Family Residence: ~) Multiple Family Residence: ( ) Number of Bedrooms: Number of Bedrooms: Well System: Permit ~ Construction Individual Well ( ) Community/Public System ( ) Depth of Well i~]~~ Well Log on File Bacterial Analysis Sewage Disposal System: Permit # Septic Tank Size Absorption Area On-site System ~) Public Utility ( Installed Installe~ Manufacturer Soils Rate Material Distances: Well to Septic Tank to Sewer Line Nearest Lot line to Nearest Lot Line to Absorption Area Absorption Area P~ge T~o' Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Comments: Affadavit Attached: (~ Approved: ~<~ /~'// Disapproved: Letter Attached: ( ) Date: Date: Department Worksheet: ¢ (.p!~ ~o ~oS) --O3OlAO~d ]$VB3AO3 ]3NVB~SNI ON 008£ ~*a S~ (a:Sm, sod snld) ~O~--'IIViN 031JlJ.~130 ~0;I J. d1333~l ~ / Department of Health and Environmental ProtectiOn /f~/ 825 L Street, Anchorage, Alaska 99501 L" ~quest for Approval of Individual Sewer and Water Facilities 1. Property Owner: Maili"g Address: Name of Buyer: Mailing Address: , Phone: Lending InstitutionallY. ~/~~ Mailing Address: Phone: o o Realtor/Agent: Mailing Address: Legal Description: Street Location: Phone: Single Family Residence: (~ Number of Bedrooms: ~ Multiple Family Residence: ( ) Number of Bedrooms: Water Supply: * Individual Well ~'~Public/Community System ( ) If Individual Well, well depth If Community System, name of system -sewage Disposal System:-*~n~site System ~Public System ( ) If On-site System, date of installation: ~ *NOTE: A well log is required on ALL wells drilled since 6/75. ** If on-site sewer system is over two(2) years old, an adequacy .test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77 Anchorage po I~.._./t 6-650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES, MA YOFf DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION January 14, 1985 Michael S. Driscoll Star Route A Box 1641-E Anchorage, Alaska 99507 subject: Lot 10 Block 4 Talus West Subdivision 92 The water monitoring efforts conducted by AECS, Inc., on December 20th, 1984 and the Department's measurements taken on January 3, 1985, indicate that the existing system is discharging un-treated sewage effluent into the water table. The existing condition is in violation of Municipal Ordinance 15.65.070(B) and must be corrected. The Department hereby requests that the existing absorption field be brought into compliance(upgraded) with the Municipal Wastewater Disposal regulations no later than July 15, 1985. During this interim period and effective immediately, the following action must be taken to abate 'the discharge of sewage into the water table: (1) Insert an inflatable "test ball" into the cleanout at the start of the trench. (2) Pump the septic tank within twenty-four(24 hours upon receipt of this letter and at a minimum once each week/ thereafter; and submit pumping receipts to this Department weekly. Be advised that prior to any upgrade, a permit must be obtained from this department. If there are any further questions, please call this office at 264-4720. Sincerely, John.Kennedy Engineering Technician II ..?