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TALUS WEST BLK 3 LT 8
Talus West Lot 8 Block 3 #015-201-47 Municipality of Anchorage Page 1 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 ® Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW000195 ' PIDNumber: 015:201-47 ~ame:Wastewater System: [] New ~: Upgrade C Dan Boyette *ddr~: ABSORPTION FIELD 11926 Wilderness Dr. Anch. r AK 995!16 Phone: 250-9891 INO'°fBedr°°ms: ~[}eepTrench O Shallow Trench ~Bed ~Mound ~Other I LEGAL D ESCRIPTI O N so, Rating: Total Depth from Original Lot: 8 S,ook: 3 Talus ~es~ WELL: . B New ~ Upgrade Gravelwidth: Number of lines: ID~nce~nlin~: Existing Ft. Ft ' SO. Ft. Ft Acreage Systems 6/27/00 Yield: GPM IPump ~t at: Ft.~~ing Hefght~veGr°und:Ft . TANK SEPARATION DISTANCES ~ Septic S Holding From Tank Field S~ti0n Tank ~erUn~ : Anbhorage Tank '1 , 250 Welk >100' >100' N/A N/A >25' Steel Two (2) Sudace >100' >100' N/A N/A N/A " LIFT STATION - N/A Water Lot > 5 ' > 10 ' N/A N/A N/A Sizein 9~lons; ~ Man¢A~ureE Line Found~ti?n >5I >10' N/A N/A N/A "Pump on" level at: . ~ "Pump o~' level ab ~ High ~ter ala~ at: Cudain BENCH MARK Remarks: Septic Tank ~n]v Under This Permit. Additional Fill b~fionandD~cfiptlon: Bottom St~p; Back Added Over Exis%~ng Absorption Bed. 'Deck. . 2nd 6/27/00 !~~ Page 2 of 3 Municipality of Anchorage EPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744 On-Site Wastewater Disposal System or Well Inspection Report Permit Number SW000195 PID No. 015-201-47 A B Sl 27.3 42.2 S2 35.7 45.3 C4 44.7 55.4 M1. 64.3 53.5 C5 89.0 64.7 Four Bedroom Home PLAN AS-BUILT SCALE 1": 30' , ~ Page 3 of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O, Box 196650 -Anchorage, AK 99519-6650 ~ 343-4744 On-Site Wastewater Disposal System or Well Inspection Report Permit Number SW000195 PID No. 015-201-47 5 99.6 11,250 Gal 95.02 Sep. Tank k94.78 97 9 ~ o / 97.8 2" insulation (Limits U known) Existing AbsorptiOn Bed NOTE: 0nly the Septic Tank Was Placed Under This Per~it. Fill Was Added Above Absorption Bed. PROFILE AS-BUILT 1" = 10' MUNICIPALITY OF ANCHORAGE Department 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: Jun 27, 2000 Expiration Date: Jun 27, 2001 Permit Number: SW000195 Legal Description: TALUS WEST BLK 3 LT 8 Design Engineer: 0014Anderson Engineering Owner Name: Dan & Sharon Boyette Owner Address: 11926 Wilderness Dr. Anchorage, AK 99516- ParcellD: 015-201-47 Site Address: 011926 WILDERNESS DR Lot Size: 17603 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 Permit 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. Date: ~- 27-00 June 26, 2000 Municipality of Anchorage Department of Health and Human Services 825 "L" Street Anchorage. AK 99502-0650 Subject: Lot 8, Block 3. Talus West Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing septic tank on Lot 8, Block 3, Talus West Subdivision has failed and must be replaced to prevent a health hazard and possible damage to private property. We are hereby requesting a permit be issued to construct a new tank on [he property to serve the house. The attached Site Plan and backup documentation identify the location and configuration of the new tank and also shows the location of the existing absorption bed and well. The separation distance radius from the well is also shown. The existing absorption bed on the lot lacks the necessary cover to meet the current ordinance requirements. Additional fill will therefore be added over the bed after the tank is placed to bring the entire system into conformance with current regulations. Two post tank cleanouts will be placed to allow access to the system In addition, the foundation cleanout will be located and, if necessary, replaced. The ground surface on the lot slopes from east to west at gradual and varying slopes. The new tank will be constructed in the same location as the existing tank which is fairly flat. The existing septic tank will either be removed and disposed off site or crushed and backfilled at its current location. Sufficient area exists on the lot to provide the necessary separation distance between the new tank and the well on the lot. In addition, no conflicts exist between the tank and wells on surrounding lots. I' the system is constructed in accordance with our design the I'oIlowing statements apply: The system, if constructed as designed, will have no adverse impact on the wells in the-area or those to be constructed in the future. The system if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area Lot 8, Block 3, Talus. West Subdivision June 26, 2000 Page Two 4. The system, if constructed as designed, will have no adverse impact on drainage patterhs in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. AttaChments Existing Absorpt ,250 Gallon Bed Septic Tank Well Four Existing / SCOPE OF WORK: 1. Verify Foundation cleanout. 2. Place Foundation Cleanout if Unfound, 3, Remove and Dispose Existing Septic Tank. 4. Place New 1,250 Gallon septic Tank According to Plan. 5. Place 2 Post Tank cleanouts. 6. Grade Area to Provide Positive Drainage Away From Septic System. 7. Place Fill on Absorption Bed to Assure Minimum Coverage. SITE PLAN SCALE t" = 30' ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 8, BLOCK 3, TALUS WEST SUBDIVISION GENERAL: The scope of this project includes the removal and disposal of the existing 1,250 gallon septic tank. It aisc includes the procurement and placement of a new 1,250 gallon septic tank at the location shown on the Site Plan. Two new post tank cleanouts must aisc be placed. Additional fill must also be added over the existing absorption bedto provide the minimum of 2' over 2" of direct bury insulation. Once construction is complete the entire area should be landscaped and graded to drain away from the septic system. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION 1. The new 1,250 gallon septic tank must be procured from an approved source and installed at the location shown on the plans. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of ;;over shall have a minimum of 2" of direct burial insulation. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. Lot 8, Block 3, Talus West Subdivision June 26, 2000 Page 2 of 3 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: (NOT THIS PERMIT) 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. Distribution piping must be placed level with perforations down ato.p a level bed of drainfield rock. Rock should then be placed over the p~pe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on tho design. The portion below ground must be perforated. Contractor shall verify the ~septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Lot 8, Block 3, Talus West Subdivision June 26, 2000 Page 3 of 3 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as-built of the completed system. L DEPARTME~'T ~)F HEALTH AND HUMAN SERVICES Environmental Health Division '~ 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Na.~e DISTANCES FA. kl kir=- i",'t/\ ~ ~ k ~TO SEPTIC ABSORPTION Address ...........'""'" -----. TANK FIELD WELL Phone(st/ ""' NO. of Bejd(ooms WELL AS-BUILT DIAGRAM (Show location of well. septic system, property hnes, foundahon, TANKS D TRENCH ~ BED D W. DRAIN D OTHER GraveHength G,avel Wldti, WELL~ / '~'~ To ,"r // ~ PRIVATE , (,~ / ~ OTHER (Identilv) : / . c~,.¢.,~ -. : :.. c~,:~:.,,.~ I., c~.l'~..~..L, Al~cl'~l::ir'age, " 995():!. 3¢3.-.4720 .f I.::'a r' c c. ]. :il d ~ 0 :L 5 -2 () ! '-'. 4'7 L.ci'L I.x.~c;ja ] Ii L:h.~bd iv;L s :L c~t"i: ] AI..L!S WES !' 5H LEd),, S~<x:::'i:. ion ~ ;:t2. 'iov,~n~h ip :', :L;?N F:.arige~', 3W I..c')t S:i:,~:, 17&()3 (sci,. f't,, (::H" ac::P~::.~s) J"!e~x k]~h~d P c:~c)ms: 'fh i s F:'of' m :L .I:.: 4 'f'~t a ]. Cap ac: :L ~'. (:;lli:l::;'.'i']:F:',/ I I.IR'I: forth by 'i:j'ie. Mun:L(zJl:ia].:i. ty c:if l':'L)~"!(;-"h(;]l't'::l~') (MOA) and t.l'm~ Stal'.c.~ c)f iq].¢::~sl::a, ]: ~,¢:i.]]. :i.~M,d:.aiJ. L.I't(,:) s3,%t(.:,~m in acc:cH"dar'~c;;c:~ b)~.'Ll'~ a].] ?i[)A c:cx::h:~s ar'id ~:;d]d :in {:c)mp].:Jar~c~ p~'Lh the des;Lgl'~ c:r.J.t~T,r.J.a (::)f 'Lb:is ] ~..',ci. ]. ]. aditer'~.:) Lc~ ail FIE)A and S'Late? (::)~ P:l!a%!.::a i,ceqL.t:Lr,(}:)m(ar'vL~;i~ icH" the:(, ~(,~L bat:l< d:i. stances { r.c.m .any ~.:.~x is'L ing ~*~.~]. ]., wasLe~.,~a'!:.ep d :Lsposal system c,p pub ]. ic s~?,,~,:~,.H"agc) ~ys'l:,c(,rn (::~n 'Ll'}ifi~ cH" any acJ...iac:(er'd'., r::)r' r'm>)a!-by :[ unc:lei"s'Land 'I:.hat Lh:i.s p~)pm:i.'L is raj. id ~c)r' a ma?,ximurr~ (::~f q bs:,cJpoc)ms. also Lu'~d(,))ps'l:..ancl thai:, the c:apac::L'Ly ~:¢t the) to'La]. %ystem J.~ 4 b(.:~(::h'c)c)ms and Consulting Engineers 1000 E. Dimond Blvd. · Suite 205 ° Anchorage, Alaska 99515 · (907) 522-1311 January 2,1989 Mr. John Smith Municipality of Anchorage Depar tmer~t~ / /. 825 ~ ~f//~./, ~,~, . Anc // ~ pro~ we per: We t of ins~ ~he soil Not desJ we rem¢ We propose to excavate the existing trench~ including all material in trench as well as any contaminated soil on the side walls, bottom and ends of the trench. This excavated material will be treated with HTH Chlorine and hauled to the Municipal Landfill. The excavated area Will then be backfilled with sand and compacted in a manner that will yield a perc rate of at least 125sq. ft./Bdrm. Upon completion of this existing trench removal, we will then constr%zct a bed type septic system. This proposed bed will be located approximately 2 feet from the present trench absorption system. A copy of the soils test and sewer system location plan. is attached for your review. We request a permit be issued for construction of the proposed septic system. If you have any questions contact our office. Very Truly Yours _~din and.~:s~ociates Gerard Kress Engineering Technician _: - ' Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERViC 825 %" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 2 3 4 5 6 ? 8 9 10 11 ~H - HL Township, Range. Secdon: '~iZ ~1 14- 15- 16- '[7- 18- 19- ENCOUNTERED? E~N ,5'2Z P E eERCOLAT[ON RATE /¢:~--J<'~ (~n~ P~C HOLE OIAM6TER 6 T~T BUN BE~N ~ ~ ANO ~ ~ , PROPOSED SEPTIC SYSTEM: BED (4 Bdrm)(220 soils)(1.5)=l,320 sq.ft. Excavated material will be treate( Construct Bed 25'x53'=1,325 sq.ft; with HTH Chlorine, and disposed Abandons:. existing tank, Install new of in accordance with M.O.A. M.O.A. approved 1,250 gal Tank. requirements. Insulate tank if cover is less than 4~ Contractor will backfill excava- Install GEO Fabric over sewer rock. tion with sand. Sand will be Excavate and remove exist, trench and compacted. Sand will be tested surronding contaminated soil. Exist. after compaction and must perc trench is approx. 47' long, 2' wide', at a minimum of 125 sq.ft./Bdrm. with 9' of gravel under pipe. Top of Excavated material will be taken tile to fipish grade is approx. 3'. to Municipal Landfill. 'r:snch ~xeavation will includ6 all material in trench, as well as all con%aminat6d soil-on s~dewalls, 'bottom and ends of trench. NOTE = All D~m~nsions ~d ~ocations ~ust Be Field Verified Prior ~o Construction .SEWER SYSTEM 'LOCATION PLAN 5T ~ ,~ TIZfq ~ZH 5Zz , I & associates,inc. Consulting Engineers 1000 E. Dimond Blvd. · Suite 205 · Anchorage, Alaska 99515 · (907) 522-131 January 5, 1990 Municipality of Anchorage Department of Health & Human Services On-Site Services Department 825 L. Street, Fifth Floor Anchorage, Alaska 99501 SUBJECT: CONSTRUCTION OF NEW REPLACEMENT SEWER SYSTEM LOT 8, BLOCK 3, TALUS WEST SUBDIVISION Gentlemen: In further regard to our original letter and submittal of January 2, 1990, we are providing additional information to confirm and slightly alter construction procedures for the above referenced property. This should fully satisfy any remaining concerns regarding the issuance of a permit. It is our understanding that the Contractor is to inform the Municipal Landfill prior to hauling materials to the site and coordinate as necessary. We also understand that other procedures defined in our original submittal will be followed with regard to existing trench material disposal. In regard to the backfill of the existing trench, we originally were directed by Mr. John Smith to place sand backfill in the existing excavation as described in our previous letter. Based on a conversation with Mr. Dan Roth on this date, we now understand that you would prefer using native silty sand materials from the site for this backfill. We will provide the backfill to your specifications as directed. Should you have any further questions, please let us know. MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED L.~ MUNICIPALITY OF ANCHORAGE %,~-/ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ~'~ PHONE NEW LEGALDE$CRIPTIO2 ~ /~.~ ? ~t.~ ~~ LOCATION~ ~ . ~ .~~ ~ ~ NO. OF BEDROOMS / , DISTANCE TO: I ~Z< Manufacturer ~~ Ma~ ~--~ 'a ~ , No. of compartments ~ ~ ~ Liq. ~a~aci~n~gallons IF HOMEMADE: Inside length Width Liquid depth ' ~ Manufacturer/~¢ Well Dwelling PERMIT NO. ~ ~ Z DISTANCE TO: O ~ ~ Material Liquid capacity in gallons ~ Well Foundatio~ d Nearest lot line PERMIT NO. Ne. of lines i ~ ~ I 9[~" ~ , inches effective~rea Length of~hCn} Total length of lines r/~ j Tren%w~th Distance between lines ~ Topoftiletofinishgrade~, Material~e*at~ '~'' Il ~, inches Total ~ Length Width Depth ~ PERMIT NO. ~ Type of crib Crib diameter Crib depth ~ Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class ~ %~ Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer llne Septic tank Absorption area(s) OTHER PIPEMATERIAL~~ ~ ~ ~ ~ SOIL TEST RATING 72-0~31 v. 3/78) rV~-W DRILLING, Inc. ~.~ P. (~'~ Box 4-1224 · 1310C International Airport ~o~d (907) 274-461] ANCHORAGE, ALASKA 99509 DRILLING LOG Well Owner Dick !7ri?!~t .UseofWe]1 Domestic Location (address of: Township, Range, Section, if known; or distance main road go~ " ':' · " ' ,, ,,loci.. ~, ']?alus ~Jcst Subdivision Size of casing. ~-~ Depth of Hole Static water level 20 ft. (a..bRxe) Screen ( ); Perforated ( 13~ feet Cased to13u · o feet (below) land surface. Finish of well (check one) open end ). Describe screen or perforation Well pumping test at .2D gallons per (~ of drawdown from static level. (minute) for 1 hours with 100% Date of completion ~' / l 3 / o _ - :i~ ,~J;~:. WELL tOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness Casln?;' 6'ficku~ 27 57 ].?5 TO. TO TO TO_ TO. TO_ TO TO. TO TO. .TO _TO. .TO .TO :TO Organic s !7 Siitv r:ra'~e l .... [d~ g~:ave! Lc) o s e fir ave! 3--CONTRACTOR RPF L_ L. Hhll L 3C:RT I ON LEGFIL D I CK WR I GFIT TFiLUS HE_,T BLY[:, L8 E:_~ 1HLIJ.':, WE=,T c ,- "¢" '~'~?' 5:44-42i~ _,RH BE ,.., ....... t LOT SIZE ~:~-~E:R 'SQUFIRE FEET TYF'E OF=,_'"- IL RE,_,uRFTILIN- '":: .... '='_,'r_,TEI1'c · I=,.'- ' TRENCH i',IRXIMUH NLMBEF.' OF E:ED, R'.OOHS = 4 SOIL RRTING *._,£4 FT, ER..- ,-.'OE~ THE REOLIIRED SIZE OF '" '=- -='-'=' *" ' - ~ ":' ' c~' 7~ 1HE -,UIL HE,-,ORFT~ -,~-,TEId I-,. [:,EF"I'H .... :t.;Z L I:'r-~C~TH= 5El ,3 F;. la -,. EL_ E:,EF'TF]== ~' THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIEL.D. THE DEPTH OF R TRENCH OR PIT IS TNE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOH OF THE EXCRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENE:HES. THE GRRVEL DEPTH IS TNE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RN[:, THE BOTTOM OF THE EXCRVRTION (IN FEET). . ERMI7 FIF'PLICRNT NRS THE RE_F.N~IE, ILIT~ I'O INFORN THIS DEPAR'FMENT [:,IJRING THE INSTRLt_RTION INSPECTIONS OF RNY WELLS RDJRE:ENT TO THIS PROPERTY RND THE f~L! lEER OF RE=,I[,EN_.E=, THRT THE WELL WILL SER',/E. MININLIM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS 100 FEET FOR R PRIVRTE WELL OR :1.50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON ]'HE TYPE OF PUBLIC WELL MINIMUM DISTRNCE FROM R PRIVFITE WELL TO FI PRIVFITE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 7'5 FEET. WELL LOGS; FIRE RE6!LIIRED RND MUST BE RETURNED TO THE DEPRRTMENT 1.4ITHtN 2~0 DRYS OF THE WELL COMPLETION, OTHER REQUIREMENTS MRY RPPLY. SPECIFICFITIONS RND CONSTRUCTION DIRGRRMS RRE RS,'RILRBLE TO INSURE PR. OPER INSTRLLRTION. I CERTIFY THRT 1: I AM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPRLITY OF 8NCHORRGE. 2: I WILL INSTRLL. THE SYSTEN IN RCCOR[:'RNCE WITH THE CODES. 3:: I UNDERSTRND THRT THE ON-SITE SEWER S"r'STEN MRY RE6!UIRE ENLRRGEMENT IF TNE RESIDENCE IS RENODELED TO INCLUDE MORE THRN 4 BEDROOMS. ~,ICK Anchorage 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MA YO R DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION December 31, 1980 Dick Wright Star Route A Box 2531 Anchorage, Alaska 99507 Permit ~ 800652 Subject: Lot 8 Block 3 Talus West Subdivision A permit issued by this department for well and/or sewer system has expired as of this date. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, / / Les N. Buchholz, R.S Senior Environmental ~cialist LNB/ljw enc: Copy of Permit SWP/057 PERMIT NO, 825 ~j STREET, RNCHORBGE, 264-4?20 ~ELL ~"~-~D O~-~--S!TE SEb,~E~: PE~:£4 IT ( 800652 ) BPPLICBNT LOCBTION LEGBL DICK WRIGHT TBLUS WEST BLVD L8 85 TBLUS WEST TYPE OF SOIL BBSORPTION SYSTEM IS: TRENCH LOT SIZE ~44-42±4 ~51~0 SQURRE FEET MBXIMUM NUMBER OF BEDROOMS = 4 SOIL RBTING <SQ FT?BR)= 200 THE REQUIRED SIZE OF THE SOIL BBSORPTION SYSTEM IS: [:-,EF'TH= 12 L E I'-.~ C~ T l-~ = 5~--3 g~, F-." F:~ "-.-" E L [)EF'TI-t= ."3 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRBINFIELD. THE DEPTH OF B TRENCH OR PIT IS THE DISTBNCE BETWEEN THE SURFBCE OF THE GROUND BND THE BOTTOM OF THE EXCBV~TION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRBVEL DEPTH IS THE MINIMUM DEPTH OF GRBVEL BETWEEN THE OUTFBLL PIPE BND THE BOTTOM OF THE EXCBVBTION (IN FEET). REL~-~L! I: RED SEF"T ~ C Tt---]~'-t F:-:: S ! ZE= 125£.'~ C~iF-ILLC~'-.~S PERMIT BPPLICBNT HBS THE RESPONSIBILITY TO INFORM THIS DEPBRTMENT DURING THE INSTBLLBTION INSPECTIONS OF BNY WELLS BDJBCENT TO THIS PROPERTY BND THE NUMBER OF RESIDENCES THBT THE WELL WILL SERVE, T~..-I~] (2) I ~-.ISPEC:TIC~-tS ~-~RE F:E~2L~IRE[:. BBCKFILLING OF BNY SYSTEM WITHOUT FINBL INSPECTION BND BPPROVBL BY THIS DEPBRTMENT WILL BE SUBJECT TO PROSECUTION, MINIMUM DISTBNCE BETWEEN B WELL BND BNY ON-SITE SEWBGE DISPOSBL SYSTEM IS t00 FEET FOR B PRIVRTE WELL OR 150 TO 200 FEET FROM 8 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTBNCE FROM B PRIVRTE WELL TO R PRIVBTE SEWER LINE IS 25 FEET BND TO B COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPBRTMENT WITHIN 50 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MBY BPPLY. SPECIFICBTIONS RND CONSTRUCTION DIBGRRMS RRE RVRILBBLE TO INSURE PROPER INSTBLLRTION. PE~:~'-I I T EXF" ][ F~..'ES [:,EC:E~.'iE:EF.' _?~1.. I CERTIFM THBT t: I BM FBMILIBR WITH THE REQUIREMENTS FOR ON-SITE SEHERS BND WELLS BS SET FORTH BY THE MUNICIPBLITY OF RNCHORBGE. 2: I WILL INSTBLL THE SYSTEM IN BCCORDBNCE WITH THE CODES. ~: I UNDERSTBND THBT THE ON-SITE SEWER SYSTEM MBY REQUIRE ENLBRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THBN 4 BEDROOMS, SIGNED: ........................................ BPPLICBNT DICK HRIGHT ISSUE[) 8~ [BTE V4. 0 PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18- 19- 20- COMMENTS PERFORMED BY: 72 008 (7/76) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6650. Anchorage, Alaska 99502 276-2221r SOILS LOG - PERCOLATION TEST ShILl'LOG PERCOLATION TEST WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? DATE PERFORMED: SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop ?, lo ~/o 12." 'z'o '~ Z i_ ~/3'4 o PERCOLATION RATE TEST RUN BETWEEN FT AND 7,? PT ,/3 CERTI FI ED B Y ~'~ t ~-~t~ -~II~_-` (minutes/inch) DATE: ~/~ Municipality of AnChorage · Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343:7904 CERTIFICATE OF HEALTH AUTHORITY' APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0'J5.201.47 Expiration Date: _. GENERAL INFORMATION Complete legal description Lot 8, Block 3, Talus West SubdiVision LoCation (site address or directions) 11926 Wilderness Drive Current Property owner(s) Mailing address Lending agency Mailing address Paul and Linda Cote 11926 Wilderness Drive · Day phone .267-1217 Anchorage, AK 99516 Day phone Real Estate Agent · . · Mailing Address Un/ess othen44se requested, HAA wi.'//be he/d by DSD for pickup. NUMBER OF BEDROOMS: TYPE .OF WATER SUPPLY: Individual Well · Individual Water Storage Community Class ~ Public Water System .Day phone · Four (4) Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding tank ['-I [] Community 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 5 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 propedies served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for propedies 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. STATEMENT OF INSPECTION BY ENGINEER ;. .. As certified by my seal affixed hereto and as of the'validation d~te Shown below, i ~erify that my investigation, . based on procedures outlined in the Health Authority 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 investi~atioh and ins'pection, 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 En.qineerin.q Address P.O. Box 240773 Anchorage, AK 99524 .Engineerls Printed Name' Micl~ael E. Anderson, P.E. · Phone 522.7773 Date . .313012004. ~- ~ ~ , ~ . ~ ~-... ~o. .~'~ ~ 5.' DSD SIGNATURE ~ 'Approved ~or · bedrooms. Disapproved. "' " Conditional approval for bedrooms, with the following stiPulafi5ns: Additional Comments . .Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engiheer's Report Oiher By: Original Certificate Date:. (Rev. 12/00) M icipalityi ~ · un of, Anchorage DeVelopment'services,Departmen . ~ Bu~iiding Safeiy Division· On'Site Water & waStewater Program · ~ i' i. ;4700 South B, ragaw st. P.O. BOx .~ 96~50 Anchbr~age, AK 99519-6650 !- :' '.. WW~v.ci.ancho~age.ak. US i'.! il A. :WELL DATA Well,typ~ Private ' ' ' = If A,' B,'Or C Pr~ide PWSID # ua!e.,,c.o~p, letedS/i3/t981 isanitary se~l (y/N) y Total depth 138 ff. "il ": FROMWELL:LOGi uate of test !!11 lli. · Static w~ter level 20 proaucdon WATER SAMPLE'RESULTS. :. C°l' I; colonies/100 mi." ~i ':i!I I~ I.. .~..'~ : ~ Date'Of s~mp~e: ;~t,'212004 B. SEPTIC/HOLDING TANK DATA · , · !I ;'(907) 343!7904 :... '; i; HEALTH AUTH'O~ITY'APPROVAL. ~ !~'~ ,,r .. ,. CHl~CKlJiS~' Lot 8, Block 3,.Talus West Subdivision ~ ~ P;rc~i 'ID: 015-201.47 ription:. weir L:og iY/N) Y :11 [- ~,:. . Wires properly, protected (Y/N) Y asing heig~ht (above ground) 24 AT INSPECTION 3122/2004 [ 80.2~:!;' [! ': ft. 5.6! J' ~ g.p.m. Other bacteria Tank ~ype/Material_ Se~ticlSteel ; ; i~ ' Tank:,s~zei.1'1,250 'gal: ' ~:..i': N~mb'er of F ti leanout (Y'/N); ~e ,. ':~t :: , . : -' . ; · . ~ ! ' Date 6[p6'mping 11/712003 : ~$II ~[ I: NitrateI r7,,mg./I. ;? : Collebted by:': AJ Haral~; !i in, 0_ colohies/100 mi. ~ ': ' .... :'Date ' inst~iled ~,~::.1t.~. ~i~ ~' uompartments 2 .- . u~eanoUts'(Y/N)'y ]resmon over.lank (Y/N) ':~'L' -: i I :: I~i .. :.~umper, APId~i- ~)meSeh/Ices~ ~[~:~' [~ [[; LIFT STATION Date installed "Pump on" level at . Datum E. SEPARATION DISTANCES Size in gallons "Pump off. level at Cycles tested SEPARATION DISTANCEs FROM'WELL ON LOT TO: Septic i~nk/lift station on lot >100' Absorption field on lot >100. Public sewer main _ NIA Sewer/septic service line >25' Manhole/Access (Y/N) " High Water alarm level at Meets ala~;m & circuit requirements?. in. On adjacent lots, MOO' On adjacent lots MOO' Public sewer manholelcleanOut Holding tank NIA sEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: . i :: .! ' >10' Building foundation >5' · Property line >5'. Water main NIA Water service line Property line >10' ,,Water Service line >10' .. Curtain drain None Noted Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION. FIELD. ON LOT TO: B~ilding foundation >10' . Water main F. cOMMENTS G. ENGINEER'S cERTIFICATION Absorpti0,n field >5' · ~ Surface water >100': Surface water >100' Wells on adjacent lots >100'. Driveway, parking/vehicle stora~e I certify 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 Michael E, Anderson, P.E. Date 313012004 >25' Date' of Payment Rec.ipt Number. (Rev. 1.2/00) Waiver Fee $ Date Ofp~Ymen~ Receipt Number It is, the responsibility of the o~ner to determine the existence of any ea'~ements, covenants , 'or re-~ strictions ~hich do' not aopear on the Eec'orded,sUb division Plat. Uhder no q~rc~stances should any · NOTE . ' data he'r~on be used for~c~struction or for estab-~ '~S~TS OF~CO~O, lishtng boundarv'or fe~e_l~nes. The survevo-r take. s~owN ~ THE RECORDED P~r,, ARE NOT responstbtl'it~'for the/initial transacti'on'only'. . SHOW~ ~E~.~. ' ~ R~BAR PRO~COR.~D. ANCHORAGE RECORDING DISTRIC,T -' D ~,, mEP~:ED BT: ~NG ~ ASS~IATES' '~~ 1~26. . HYDER STREET ~ ANCHORAGE, AEASKA 99,501 SGS Ref.# Client Name Project Name/// Client Sample ID · Matrix 1041367001 Anderson Engineering Lot 8, Blk 3, Tallus West S/D Lot 8, Blk 3, Talus West S/D Drinking Water Sample Remarks: All Dates/Times are Alaska Standard Time P~;inted Date/Time 03/25/2004 10:33 Collected Date/Time 03/22/2004 10:25 Re~:eived Date/Time 03/22/2004 10:50 Techn|cal Dire~~te~h~h C. Ede ' · Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Waterz Department Nitrate-N ~.677 0.100 mg/L EPA 300.0 B (<=10) 03/22/04 JMP Microbiology Laboratory · Total Coliform 0 coLtl00mL SMI8 9222B A (<=Ii 03/22/04 DKC SGS/C:I'E .ENVIRONMENTAL SERVICE~ D. rinking Water Analysis RePort. for Total Coliform B~cteria RE~D INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE MOST BE COMPLETED BY WATER SUPPLIER· · Send Results . .. [] Send Involce IConlact Name none Numl~r 4PLE COLLECTION: Mon~ ~m;: ( ~:~ ~P~'~. Tram 3Orted to La ) ay: [] Same as collector Other:, TO BE *OMPLETED BY LABORATORY * Sar pie Receiving: Time: /0 Tamp:. Delivery Method:~ Received By:_ .'"'~"~ Printed Name SAMPLE TYP~i [] Repeat Samp!& · (refer to lab I [] special Purpose P~,mdName $ignat~-~ Co'mments: [] Sample over 30 hours old; Results may be unreliable · '200 W. POTTER DRIVE · ANCHORAGE, ALASKA 99518 Tel: 907-562-2343 Fax: 907-561-5301 " Lab Ref No. "'1 041367 [] 48 HourWaiver Phone #: ,,,/~ F~ocaUons Fax#: [] Treated Water [] Untreated Water [] RuSH SAMPLE Bacterioloqlcal Water Analysis Record: Jsentt0 ADEC: · MMO-MUG (P/A) RESULTS: I . ANC FBK JUN ' JOaterrir~e: ~ Analyfl':al Method: ,1~ Membrane Filter D MMO-MUG (P/A) Rep°fred. BY:., '$ignatU~7'"~' Total Coliform: .' E. COlh Isent to Client: MEMBRANE ~:ILTER RESULTS: * IPhoned r-71 Faxed r-'l ' Direct Count_ O Colonies/100r~ IDate. mme:. _ Verification: ISp°ke with: · · ~o~':, [] Satisfactory ,e,~o~xm { EC: [] Unsatisfactory · ' Formlf FW- 0053 10/24/03 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. oi.anchorage.ak.us (907) 343-4744 Parcel I.D. 01 5-201 -47 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date: Lot 8~ Block 3, Talus West Subdivision 345-3373 Location (site address or directions) 1 1 926 Wilderness Drive Current Property owner(s) Dan and Sharon Boyette Day phone Mailing address 11926 Wilderness Drive Anchorage, AK 99516 Lending agency Mailing address Day phone Real Estate Agent Mailing Address Day phone Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well Four ( 4 ) TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority 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 less than 30 days old. 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. 5. STATEMFNT 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchoraqe_~ AK Engineer's Printed Name Michael E. Anderson, P.E. DHHS SIGNATURE J-'"" Approved for ~ bedrooms. Disapproved. Conditional approval for Phone 522-7773 99524 Date 8/25/00 .~ "~ .: q, '?'.' ':';", STAMP/~ bodrooms, with tho ~olloWin~ stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date:__/ /- ?~ ~ ' © ~ Original Certificate Date: Reissue Date: -,2.9 75 025 ,Rev 01 00)' July 28, 2000 Municipality of Anchorage Department of Health and Human Services 825 "L" Street Anchorage, AK 99502-0260 Attention: Dan Roth/Jeff Poet Subject: Lot 8, Block 3, Talus West Subdivision Conditional Health Authority Approval No. 990579 Permit Number SW 000195 Dear Dan or Jeff: We recently completed the work on Lot 8, Block 3, Talus West Subdivision to bring the septic system into compliance with current regulations. The septic tank was replaced by a new 1,250 gallon tank and set at the proper elevation. In addition, fill was added above the existing absorption bed to provide the proper protection against freezing. All conditions placed on the Certificate of Health Authority Approval issued December 2, 1999, have now been completed. We are therefore requesting the conditional status of the Health Authority Certification be removed and the full certification be issued. Sincerely, Michael E. Anderson, P.E. Attachments 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 015-201-47 HAA# ~ ~ Ol'(:~ 0 '~ ~' ~::::~ 1. GENERAL INFORMATION Complete'legal description Lot 8, Block 3: Ta].~ W~ .ql~h~ivi~nn Location (site address or directions) 1 1926 wilderness Drive Property owner Mailing address Lending agency Mailin. g address Agent Address Dan and Sharon Boyette 11926 wilderness Drive Daypgone 345-3373 Anchorage, AK 99516 Day Chone Day phone Unless otherwise requested, HAA Will be held for pickup. NUMBER OF BEDROOMS: Four (4) TYPE OF WATER SUPPLY: Individual well XXX Community well Public Water NOTE: · . . isg.to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: xxx Individual on-site Holding tank Community on-site Public sewer If community well system, provide written Confirmation from State ADEC attest- 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 ~Y21 o STATENIENT 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. Nameof Firm Anderson Enqineerinq Phone 522-7773 Address P.O. Box 240773 Anchorage~ AK 99524 Engineers signature ~/~c~J~, ~.~ Date 11/24/99 6. DHH8 SIGNATURE __ Ap.proved for bedrooms. Disapproved. xxx Conditional approval for 4 bedrooms, with th-e following stipulations: Money shall be put in escrow for 1.5 times the high bid of three bids from app~mr~d ~ "~' ........... ~ "~' '-'~ ......... bJ pursuant to~:~he e~gineers letter dated November 24, 1999 attached. Money in escrow s,,,~,..~ ,~,t bt L=~a~ea until nhis o~lce gzves ~inal approval. This work shall be completed by no later than June i5, 2000. Additional comments Date/2 -2 '-¢~ 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 ceCtain 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 engineefs work. DEPARTMENT OF HEALTH & HUMAN SERVICE~"~"r,~L · · . ' ~c~ '~ Environmental Se~ices Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Well type Private Log present (Y/N) Total depth 1 38 ' Sanitary seal (Y/N) Health Authority Approval Checklist Lot 8, Block 3~ Talus~West PamelI.D.:. 015-201-47 FROM WELL LOG 5/13/81 20 g.p.m. If A, B, or C, attach ADEC letter. ADEC water system number Y Date completed 5 / 1 3 / 81 Cased to 1 36 ' Casing height (above ground) 2 ' Y Wires properly protected (Y/N) Y AT INSPECTION 1.0/24/99 75 ' 81 ' 8.3 Nitrate · 933 mg/L Other bacteria 0 Collected by: T. Kimbrough Tank size 1,250 Number of Compartments 2 Cleanouts (Y/N).__ Y Depression (Y/N) N High water alarm (Y/N) N pumper A Plus Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 Date of sample: 1 0 / 25 / 99 B. SEPTIC/HOLDING TANK DATA Date installed 2/23/90 Foundation cleanout (Y/N) Date of Pumping 11/93 C. ABSORPTION FIELD DATA Date installed 2/23/99 Length 53 ' Width g.p.m. Y Soil rating (g.p.d./ft2 or ff2/bdrm) 220 SF System type Bed 25 ' Gravel thickness below pipe _. 5 ' Total depth 2.5 ' 4 ' *** Additional Fill to be Added N Effective absorption area 1,325 SF MonitofingTubepresent(Y/N) Y Depression over field (Y/N) __ Date of adequacy test 1 0 / 24 / 99 Results (Pass/Fail) Pas s For 4 immediately after500 gal water added (in.): Absorption rate = > 600 g.p.d. If yes, give date N / A N Fluid depth in absorption field before test (in.); Fluid depth 0 (ins) Minutes later: 0 Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* .bedrooms 0 Septic/holding tank on lot Absorption field on lot D, LIFT STATION None on Lot Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: >100' >100' Size in gallons "Pump on" level at* *Datum On adjacent tots > 1 0 0 ' On adjacent lots > 1 0 0 ' "Pump off" level at* Public sewer main N/A Public sewer manhole/cleanout N/A Sewer/septic service line > 25 ' Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation >~, Property line > 5 ' Absorption field > 5 ' Water main/service line >10' Surfacewater/drainage >100' Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: > 10 ' Building foundation > 10 ' >100' None Noted on F, ENGINEER'S CERTII"ICATION Driveway. parking/vehicle storage area Wells on adjacent lots > 1 0 0 ' Property line. Surface water Curtain drain I certify that I have determined thru field inspections and review of Municipal~ in conformance with MOA HAA guidelines in effect on this date. Signature '~.,4~.,~_~. ~ ~ Water main/service line > 10 ' >25' Engineer's Name Michael E. And~=r~(~n; P R Date__ __11/24/99 HAA Fee $ Date of Payment_ Receipt ,,,umber 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment ~ Receipt Number November 24, 1999 Municipality of Anchorage Department of Health and Human Services 825 "L" Street Anchorage, AK 99502-0260 Attention: Onsite Services Engineer Subiect: Lot 8, Block 3, Talus West Subdivision Se ptic System Inspection and Testing Dear Onsite Services Engineer: We recently completed a thorough inspection of the septic tank and absorption bed on Lot 8, Block 3, Talus West Subdivision. The inspection was completed utilizing a backhoe to expose both the tank., the outfall line to the bed and various locations in the bed itself. Our intention was to verify the amount of cover over the bed and to determine actual elevations of the monitor tube and the septic tank outlet. The septic tank was fo(~nd to be approximately 4" lower than the distribution piping in the bed No stress was noted in the caulder coupling at the outlet of the tank or in the p~ping to the bed. We therefore conclude the tank was originally placed too Iow and has been operating in this condition for nearly 10 years. Effluent continues to flow to the bed, but only after surcharging the tank and backing water into the outfall p~ping from the house. The homeowner has not experienced any problems in the past with freezing or plugging of the line and it does not appear to be a potential problem this winter. The top of the septic tank was inspected for any signs of rust, leakage or othe,' deterioration. The exterior cea'ting was still in tact and the tank appeared sound. No effluent was evident nor was any odor detected. The tank is in satisfactory condition and acceptable for continued use. A detailed inspection will be completed in the Spring, however, when the tank is raised to verify our initial findings. The bed was exposed and the drainfield rock under the distribution p~p~ng ~nspected. No discoloration, water, contamination or odor was noted. The bed appears to be n excellent shape with very little sign of any use. The monitor tube was reset to the proper elevation during our ~nspection and the piping was checked at the cleanout locations and found to be within .1' of level We did note, however, that only .5' of cover had been placed at the 'western end over 2" of direct bury insulation Insulation was also found in the middle of the oed at the monitor tube and nea.dy 2' of cover. Again, the absorption bed has operated in this condition over the past 10 years with no evidence of freezing. Lot 8, Block 3, Talus West Subdivision November 24, 1999 Page 2 We are proposing to raise the septic tank in the Spring of 2000 when conditions are more conducive for successful construction. Additional fill will be placed on the absorption bed at that time and the yard will be regarded with topsoil and 'seeded with grass: A cost estimate has been received from Acreage Systems to perform the work at a cost of $2,000.00. Funds will be escrowed to cover the costs and paid once the work is complete. We are hereby requesting the Certificate of Health Authority be issued so the closing transactior of the house can be corn oleted. We are confident the septic system will function adequately over the upcoming winter based on its successful history over the past 10 years. Additional documentation will be furnished to you ~ the Spring verifying the improvements to the septic system have been completed. Sincerely, Michael E. Anderson, P.E. Attachments N~V-OZ-gg ~16=40 FEOM-CTE ENViRONMENTAl, ~t~..' 'CT&E Environmen,al Services Inc. 5615301 T-$54 P.02/05 F-358 CT&E Client Name Project Name/# Client Sample ID Ordered By 995956OO1 AndersOn Engineering L8 B3'Talu$ West S/D Outside Spigo~ Drinking Water Client POP Printed Date/Time 11/02/99 11:52 ColJected Date/Time 10/25/99 14:15 Received Date/Time 10/25/99.16:10 Technical Direc~o? Stephen C. Ede Released~ ~////' Samplc Reraztrks: 0 COL/IOOmL SH18 9222B 10/25/99 KAp Received Time Nov. 2, 4:42PM FROM-CTE ENVIRONMENTAL 5S15301 %564 P.03/03 F-368 CT&E Environmental Sen/ices Inc. Laborato~ Division r.~r~r~ar~are~,~ar~rar_arar~ar.~ 200 W. Potter Drive Drinking Water Analysis Report for Total Coliform Bacteria anchorage, AK 90518-1608 Tel. {907! 562-23¢3 READ INSTRUCTIONS ON REVEg~E SIDE BEFORE CO£LEtTING SAMPZE Fax. 1907} 561-5301 MUST BE COMPLETED BY WATER SUPPLIER ~;~.-PRIVATE WATER SYSTEM ~ SendR~uha C] Sengln*,aic~ SAMPLE DATE- Month SAMPLE TYPE: ,,~ Routine Cl Repeat Sample (for routine sample with lab reL no. __ ) t2 Special Purpose SAMPLE LOCATION Day Year o Treated Water 13 Un~reatee Water Time Collected Collated By TO BE COMPLE'I ~o BY LABORATORY Analysis shows this Water SAMPL~ to be. O~-----~;atl S t~ctory nsausfactory el Sample over 30 bourn old, resulu may be unreliable S~pI~ too long m ~4n~i/; sampl~ should not be owe48 houm old a~ cxam:nanon lo indicate reliable r~salm. Please s~ new sample vm spccml ~Itv~ m~ll. Analysis B~an .. ~ Analytical Method: ,5~Membrane Fil~er 'o MMO-MUG '90 mi. Result' Analyst aensm A,D,E,C, An¢~ Fbks /un Time' Client notified or'unsatisfactory results: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO.MIJG R~olt: Total Coliform Meml~rane Filter: Diree~ Count Verification; LTB Fecal Coliform Confirmation Final Membrane Filter Results BCB E. C'all Colonic/100 mi COLIFIRM CullforUl/100 mi Fax~d l~B Member of the $G$ Groap ISoC~ete Generala do $~modlance) ~.v,aONM~T L FReceived Ti r, eAN0v. 2 ,'"' 4: 42P~~' ILI. INOtS. MARYLANO. MICHIGAN, MISSOURI. NfiW JERSEY. OHIO, wEST VIRGINIA 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description [~]- ,~'~/ Location (site address or directions) I i~'~ Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72q)25 (Rev. 3/91) Front MOA 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 §ystem is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm .'Z~/'J/')~TLSO'J L:---~G,,J~-'~-/'z.t~J6 Phone Address ~ O. L~ox ;~¢o 773 /~¢q~t ort,q/~'~- ? DHHS SIGNATURE 'x Approved for ~/~- Disapproved, Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineeCs work. 72~25(Rev. 1/91) Back MOA~'21 (~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L~:~'[-_~i J~. '~-/~[~1~/ ~//~'~ ~U~ParcoII.D. 0~/,~-- A. WELL DATA Well type r/YlV'~l['~' If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ¥ Date completed ~/1~ ~J Driller Total depth I~' Cased to I~/~, Casing height Sanitary seal (Y/N) ¥ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well flow g.p.m. Pump level '-- SEPARATION DISTANCES FROM WELL TO: Septic/~ tank on lot I~'¢/t Absorption field on lot I~-~:/ Public sewer main Public sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate /w~//~ Other bacteria Collected by: B. SEPTIC/'~TANK DATA Date installed ?/l?/~' I ~E Tank size ?x~. ~/~/~' !#t~ Compartments ~' Cleanouts (Y/N) ~ Foundation cleanout (Y/N) ~/ Depression (Y/N) High water alarm (Y/N) ~/~' Alarm tested (Y/N) ~/.~ Date of pumping SEPARATION DISTANCES FROM SEPTIC/i-F=~-P,~ TANK TO: Well(s) on lot I~?t~I On adjacent lots To property line ~ ]~" Absorption field Surface water/drainage >~ ~> 72-0~6 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Manufacturer Manhole/Access (Y/N) Vent (Y/N) ~_..--~'"~"~P'eff'~'~'~ High water alarm level % .---~cles tested __ Meets MOA electrical cod FROM LIFT STATION TO: ~/ett~on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~ .Width Total absorption area / I Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating ~.~.¢~E,/~¢~ System type ~-~ Gravel thicknes; ~ Total depth Cleanouts present (Y/N) Date of adequacy test for f ¥, If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot ~ I¢'~1 Onadjacentlots > I¢-/¢/ To building foundation On adjacent lots Surface water Curtain drain Property line '~'1 ~ '~/ To-~.~.,~:~e,r abandoned system on lot Cutbank Waterm~/serviceline Driveway, parking/vehicle storage area ~/ gu~oe~¢nes in e ect on the date of th/s inspect/on, E. ENGINEER'S CERTIFICATION Engineer's Name '/'~/6'~'z,¢'~/-~ ~ HAA Fees / 7~ Date of Payment =3~/~, Receipt Number 72 ~28 (Rev, 3/91 ) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number ADEQUACY TEST REPORT INSPECTOR: PEAK ~OAD Flow Cvivl. S.T. S.A.S. HTel S.A.S. ~Te2 S.A.S. ~i~e J Role Vol. Vol. ~ Liquid Liqu,d L~qv~d Ll~,d Coineill I/ ~1/ ~ II II/ I/ ~1/ TEST RESULTS: REVIEWED BY: DATE:. Well Dep t h: I,'~ WELL FLOW TEST Costincj Above Ground Static Water Level: ,,~ (l't.) Inspector ProJect Water Time Level (ft.) ~.~ I'~ RECOVERY (9o11) Cum. Meter Volume Reodin9 (gal.) 9al/sec I$ I.~ ~7.~ COMMENTS FIo~ (gpm) Commenl$ AVERAGE FLOW RATE; ~ .(gpm) REVIEWED BY: CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 Chemlab Re£.t :93.0902-1 EEPORT of A~AL¥SI3 Cliemt ~an~ :ANDERSON ENOIN~EEI~O Collmcted :03/05/93 @ 14:06 hrs. 0edezed R¥ ~ Received :03/05/93 ~ iS:SS hrs. Project ~e~ : ~OhKO~der :6375~ P~o~ect$ : ~epo~t Complete~ P~ID ,O~ Tec~cal Dixec~o,~elea~a~ By : ~~ ~ S~ple RO~I~ S/~Lg COLLECTED BT= A.H. QC Allowable Extract Analysis .......... ~::~Z ................. !::~:~!:...~:./::..~ ............ ~:~:~ ............... !~r~: ............ ~:~; ....... ~IT~AT~-~ /0.371 ~g/1 EPA 353,2/~00.8 10 03/08/93 LL~ · See Special Imteuction~ Above UA - Oratveileble " 3es Sample Re. eke Above ~A - ~ot Ar~lyzed ~ - Ur~etected, Reporte~ value is the practical qu~n~/flcetlon li~!.t, ~T - Less ~h~n ~'~-~ Member of the SGS Group ($oci~t~ G~n~rale de CHEMICAL & GEOLOGICAL LABORATORY TELEPHONE (007) $62-2343 aG33 g Street An~erage, A{aska 99518. Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER RIVATE WATER SYSTEM · Name / Phone No, SAMPLE DATE: ~ Mo, SAMPLE TYPE: ~Routlne [] Check Sample (for routine sample with lab faf. no. [] Speolal Purpose Day " Year ......... [] Treated Water [] Untreated Water SAMPLE No. LOCATION 41 si .E^O,.ST. UCT, O.S BEFORE 'rlme Collected Collected ~ TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: tisfactory ~ Unsatisfactory r-i Sample too long in transit; sample should not be over 30 hours eld at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received ~ Time Received ~. ~' ~ Analytical Method: Membrane Filter * No. of colonies/lO0 mi. Lab Ref. No. 93,0982 '- 7__ Resu~* Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Dire~t Count (~ Coliform/100 mi Verification: LSB BGB Fecal Coliform Conflrmallon COLLECTING SAMPLE Final Membrane Filler ReaulL$ Reported B~'. ,, ~ ~ TNTC = Too Numerous To Count ~" OB -- Other Bacteria Coliform/lO0 mi Date Member of the SGS Group (Soci~ PART ONE OF TWO REHAINDER TO FOLLOW MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D.# L~5~- ~.~' t-l--~ HAA# ~ ~--~C~(''%(~'-'h~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lo~ ~ ~i ,1< -'~ 'TAi U~;' ¼1F~T (c) Location (address or directions) liC/z~ klii nF?_~,~ AMc. M AK (b) Property owner FAkiMIF NfAE AK, Telephone : (home) Business MailingAddress~.("-)~ ¢_~ Ei-FFET gdi:'TE ~5-~'~-~;-' AM('H Al( Lending Institution ~ Telephone '~d Mailing Address ~X[ (d) Real Estate Company and Agent kJ/A ,,, ¢, . · Address . ...: . Telephone . _ : '.! ; - (e) Mail the HAA to the following address: (or check here' if hold for pick up.) : :' List contact person and day phone number below: , :,', _ 2. TYPE OF RESIDENCE Single-Family.~ Number of bedrooms 3. WATER SUPPLY Individual Well.~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~F 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. 72~325 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ('~_~ ~ I kl ¢ ,¢~-~'~C('. Telephone ~--,~- ~,~ / J Address /~) /~ ~)~'~O~l ? '~<'~- ~1 ~ ~,~/~ Date ~/~ /~¢¢ ~ / - gineer's Seal 6. DHHS APPROVAL Approved for _bedrooms by Approved .~_ Disapproved Terms of Conditional Approval Conditional Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of 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. ~2-0~ (R~v. 7/~81 a~ Page 2 of 2 .~ o~ ~'i~5t~'v~ MUNICIPALITY OF ANCHORAGE (MOA) ~ ..~o~-~'~ Health Authority Approval (HAA) .,'~,~:'Ci~.'~,~3~' ~ CHECKLIST- FEBRUARY 1984 ~,~0~' . ~ ~ 343-4744 ~ ~?~ _,~ Legal Description: Lo~ ~ A. WELL DATA Well Classification ~¢.l IP~ %~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (V/N) '~ Date Completed ¢//.~/8( Yield Total Depth /~ / Cased to /~' Depth of Grouting ~l Static Water Level "7 Casing. Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot Pump Set At (.,)j~r ld~tJ~'x~,'kl Sanitary Seal on Casing (Y/N) Y' Depression Around Wellhead (Y/N) /~ ; On Adjoining Lots ~ [(-~ ~ ./,.2..(b ~ ; On Adjoining Lots TM / OC-.;~ ' To Nearest Public Sewer Line ~J//~ ' To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ~' ~--~- ' Water Sample Collected by J~/¢-~.? ~_/Z.~5%:~' ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Standpipes (Y/N) Y Air-tight Caps (Y/N) Depression over Tank (Y/N) Pump ,g/Maintenance Contact pn File (Y/N) Holding Tank High-Water Alarm (Y/N) No. of Compartments y Foundation Cleanout (Y/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well [t~.~- / ' ' To Property Line /~ ~ To Water Main/Service Line ~ '¢f~'~- · To Building Foundation 2.O~---+ To Disposal Field :¢" To Stream, Pond, Lake or Major Drainage Course Comments 72-028 (Rev. 7/88) FroRt Page ! of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~:~,~)~, .-..F Date Installed Width of Field .~ ,~' Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness ~; Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well )~<D' ~ To Building Foundation '~-O'~ Lot ~' ,~o o,~.J ¢~-¢,,r.~( ,(:x.:. ~,~,. '~' ~ TO Water Main/Service Line ~% ¢'~ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments '~ J~¢~ ~_¢~.¢~/ ~ ~ '~Ot_ ~ '~'e,~.k To Property Line /O / To Existing or Abandoned System on ; On Adjoining Lots ;;'~O' To Cutback (if present) J~! J~ ' A :,::,'n% "Pump On" Le~at __ High Water Alar%evel at __ Tested for X ~;emtSm eMn rOsA Elect rical O~es (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MO',& and I-'* inspection. Signed Company E~')C /_.,J l Date Z Receipt No. Date of Payment Amount: $ Receipt No Waiver Fee: $ Date of Payment' Page 2 of 2 72-026 (Rev 7188) Back $ in effect on the date of this Engineer's Seal -LOCATIQa OF ~l~CL~ (Legal Oescci~cion): ~tELt ~PTH: /3~~ CASING: DAT~ ORILLII~G CO~-IPLETEO: ~ //~,~/ . STATIC 5lATER LEVEL (Top of F T SCRE£;I: oR,tLER: // FT C 1 ock Tine Elapsed .Time Since Pumping'Star(ed/ Stopped, {tin. 0 S 10 -'~C2 15 : .'.~.~ ZO ,' :4C2 25 ~.,'oo J 3O 35 4O - 't5 SO ' 60 (l hour) I .120 (2 hours) 150 180 (3 nours)l 210 240,(4 hours)l RECOYER¥ o I I 10 IS I 2{) I I I 4O I ,o I i4(J (/ noucsjI Oepth to )4ater ft. 72''' (s~!) Orawdown/ Recovery 7,?' Pumping Rate, GP?I 0 /0' /6' Start '7,7 7-/ CHEMICAL & GEOLOGICAL LABORATORIES OFALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALYSIS REPORT ET SAMPLE for Work Order $ 18776 Date Report Printed: DEC 14 E9 @ 11:31 Client Sample ID:L2 B3 TALUS WEST PWEID :UA Collected DEC ll 89 0 14:30 hrs. Received DSC Il 89 @ 15:00 hrs. Preserved with :AS REQUIRED Client Name : CORWIH ~ ASSOC Client Acct: CORWINP P.O.$ NONE RECEIVED Req # Ordered By : BRUCE CORWIN Analysls Completed :DEC 13 89 Send Reports to: Laboratory Supezvis~. /STEPHEN C. EWE 1)CORWIN & ASSOC Released By : ~ ~_~ 2) Special HOLD FOR PICK UP. Instruct: Chemlab Ref S: 8856 Lab Smpl ID: 3 Matrix: WATER Allowable Parameter Tested Result Units Method Limits HITRATE-H 0.27 ~/i EPA 353.2 10 8&mple ROUTINE SAMPLE. SAMPLE COLLECTED EX d. Y~ESS. Remrks: 1 Tests Pexformed See Special Instructions Above UA-Unavailable ND= Hone Detected "See Sample Remarks Above HA- Not Analyzed LT-Less Than, OT=Greater Than ACHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER Name Phone No. Madmg Address City State Zip Code Mo. Day Year SAMPLE TYPE: /kJ~ Routine Check Sample (for routine sample with lab ref. no, [] Special Purpose ) [] Treated Water [] Untreated Water SAMPLE NO. LOCATION 31 4 I s l Time Collected Collected \ TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: tisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* I I I I F-FI Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Verilication: LTB BGB Final Membrane Filter Results Reported By~ Dare Time: TNTC = Too Numberous To Count OB = Other Bacteria p.m. PART ONE OF TWO REHAINDER TO FOLLOW 1. General Information MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPAR~4ENT OF [~ALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE Application Date (a) Legal Description (include lot, block~ subdivision~ section, township, range) , Location (address or directions) (b) Applicants Name ~~ __~hone ~ Home Business Applicants ~dress (c) Applicant is (check one) Lending Institution Buyer ~ ; Other ~ (explain)~ (d) Lending Institution ~___~:r'~k~.ll~ ~ Telephone (e) Real Estate Co. & Agent NO~ ~ ~ Owner/builder~; Address (f) Telephone t~i! the itA~ to the following address: 2, T_y~e of Residence Single-Family ~ l.k~lti-Family ~ Number of Bedrooms _~__~ i-~~ Other (describe) Public~-~ Note: If community well system,, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status° Sewage Disposal Onsite~ Public F-~ Community~ Holding Tank~ Note: If community well system, must have v~itten confirmation' from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] En ineering Firm Providing ~ections, Tests_~_~File Search, Data and %~nformat:~o~ As certified by my seal affixed hereto and as of the validation date .~b~own below, I verify that my investigation of this Health Authority Approval shows ~/hat 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 fur~iher verify that, b~sed on the information obtained from the Municipality of Anchorage ~,~les and from my investigation aad inspection, the on-site ~rater supply and/or wastewat~r disposal system is in compliance with all M~anicipal and State codes~ ordinance~ and regula-~ tions in effect on the date~ of this inspection° Addres~__t~.~ Date--_ Telephon~ ?~ CAUTION THE MUNICIPALITY OF ANCHORAGE DEPAR~IENT OF HEALTH AND EI~ZIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON TiLE REPRESENT~ ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA° THE DHEP DOES THIS AS A COURTESY TO PURCI-LASERii OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE~ MENTSo EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE ~A'i'A BEFORE A CERTIFICATE IS ISSUED° ~HJ~ MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIIH~E FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK° (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 WELL DATA MUNICIPALITY OF ANCHORAGE (MuA] CHECKLIST- FEBRUARY 1984 Legal Description: ~' Well Classification Well Log Present (Y/N) Total Depth [ :"&~ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) , Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments If A, B, C, D.E.C. Approved (Y/N) Date Completed ' Jai Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) I ~)'7 ~ ; On Adjoining Lots ~' j O-ED To Nearest Edge of Absorption Field on Lot ! ~"7 '~ ; On Adjoining Lots ~ ~ i~ ~ To Nearest Public Sewer ~'~ O ~ ~ _ To Nearest Sewer Service Line on Lot ;Date B. SEPTIC/HOLDING TANK DATA Date Installed '~/;//~ / To Water-Supply Well To Property Line To Water Main/Service Line Course Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: NoN Size /~L) ~C;~ ~' No. of Compartments "~ ~ Air-tight Caps (Y/N) Y Foundation Cleanout (Y/N) Date Last Pumped ~/~/-~'.,'~ J~//'~ ;for Temporary Holding Tank Permit (Y/N) To Building Foundation ~-, To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 ~2 026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorptio~n Strata ,~-.-.~ ~ Date installed ~///~ / '~'~' Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well TO Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area n.,D~oth of Field G rave~t',T h ic k n e ss ~, Standpipes Present (Y/N) Date of Last Adequacy Test Type of System Design Length of Field '~' To Property Line __ To Existing or Abandoned System on ; On Adjoining Lots 7 To Cutbank (if present) NON - Comments D. /Vot,/Z Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or conformed to a MOA and HAA gu delines in Signed ~'~_ (~¢~t~,t~ . ,, Date __~,/~ Company ~ ~-¢~¢~'~ MOA No. Receipt No. Co Date of Payment Amount: $ Page 2 of 2 effect on the date of this inspection. Engineer's Seal MICAL '& GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEI~HONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: Water System Name (*) See h on back I.D. NO. Mo. Day Year Zip Code SAMPLE TYPE: - - /~ Routine Check Sample (for routine sample with lab ref. no. D Special Purpose ) [] Treated Water /~ Untreated Water SAMPLE NO. I I I LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: L~Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received ~' ~'~J~ ':~" Time Received Analytical Method: [] Fermentation Tube //~'Membrane Filter Lab Ref. No. Result* Analy,s~. i¢5',¢ I i-1-] I F-I-] I I-'I-1 I i-1-1 BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane FIIIan Direct Count Verification: LTB Final Membrane Filter Result~/ ,.,o,.,., CollformllOOml RGB CoilformllOOml Time: .//~"'('~'"~ a.m. TNTC-- Too Numerous To Count CONSULTING ENGINEER TELEPHONE: {907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOCATION: OWNER: RESIDENCE: WATER SYSTEM: SEPTIC SYSTEM: DATE OF PUMPING: DATE OF TEST: TEST PROCEDURE: TEST RESULT: LOT 8, BLOCK 3, TALUS WEST 11926 WILDERNESS DRIVE DEBBIE CALL SINGLE FAMILY, FOUR BEDROOMS ON SITE PRIVATE WELL FROM MUNICIPAL RECORDS, TANK: 1250 GAL~. GREER STEEL, ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 752 SQ.FT. SOIL RATING: 200 INSTALLATION DATE: MAY 1981 TWO COMP. AUGUST 13, 1985 AUGUST 12, 1985 SYSTEM WAS INSPECTED ON AUGUST 9, 1985. LIQUID DEPTH IN TANK WAS 46.5 INCHES. LIQUID DEPTH IN TRENCH WAS 45 INCHES. ON AUGUST 12 WATER WAS ADDED TO THE TRENCH AT A STEADY RATE OF 8 GPM. THE WATER LEVEL IN THE TRENCH WAS MONITORED. AFTER ADDING 600 GALLONS THE WATER LEVEL HAD RISEN 17.0 INCHES. DURING THE NEXT TWO HOURS THE WATER LEVEL DROPPED 2.5 INCHES. THIS SYSTEM ABSORBED 88 GALLONS IN TWO HOURS. EXTENDED TO 24 HOURS THIS EQUALS 1000 GALLONS PER DAY. THIS SYSTEM MEETS THE MUNICIPAL REQUIREMENTS. The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requirements of the Municipality and State. ANCHORAGE, ALASKA 99501 CONSULTING ENGINEER TELEPHONE: (907) 279-3916 RESIDENTIAL WELL INSPECTION LEGAL: LOT 8, BLOCK 3, TALUS WEST LOCATION: 11926 WILDERNESS DRIVE OWNER: DEBBIE CALL TYPE OF WELL: SINGLE FAMILY WELL LOG AVAILABLE: YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: 20 GALLONS PER MINUTE PUMP YIELD: 8 GALLONS PER MINUTE AT 5 FEET DRAWDOWN DATE OF INSPECTION: AUGUST 12, 1985 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 8 GALLONS PER MINUTE. THE WELL DRAWDOWN WAS MONITORED. STATIG LEVEL WAS FOUND AT 72 FEET BELOW TOP OF CASING. AFTER 40 MINUTES OF PUMPING THE WATER LEVED STABILIZED AT 77 FEET BELOW CASING. TEST FOR COLIFORMS: TEST RESULT: TEST WAS CONDUCTED ON AUGUST 10. TEST WAS NEGATIVE THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours. This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. DATE RECEIVED INSPECTION APPOINTMENTS ]INSPECTOR INSPECTOR,/ INSPECTOR ~,~ MUNICIPALITY OF ANCHORAGE ENVIRONMEN1AL J :C i ECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION R E C E 1 V E D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES 5. LEGAL DESCRIPTION Lo? ~ ~ul6 B 'T'A-Cd-5 td~,'~ ~OB, STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OFtBEDROOMS [] One [] Four [] Other__ ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [~ Three [] Six 7. WATER SUPPLY ~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) /vl~ ~ '~8.j CL.{ ~ ~(~,JT. 8, SEWAGE DISPOSAL SYSTEM '~ ON-SITE SYSTEM WAS INSTALLED, INDIVIDUAL/ON-SITE** YEAR [] PUBLIC UTi LITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] ~SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO ,~- FOUR [] SiX PERMIT NUMBER 2, WATER SUPPLY ~E~]," INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED .~.j~EWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY '~- Connection Verified INSTALLER S~ze: .~ ~, (-) If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER 4, DISTANCESwELL TO: Septic/Holding¢~, ~ ~¢/' Tank Absorption/')~-'~Area ~ Sewer Line Nearest Lot Linc Absorption Area to nearost Lot Line 5, COMMENTS APPROVED FOR . BEDROOMS CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79)