HomeMy WebLinkAboutTALUS WEST #1 BLK 5 LT 12Talus W st
#1
Lot 12
Block
#015-202-32
Municipality of Anchorage Page t of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Name: ~i/.j~ ~ ~ H~P~ Wastewater System: ~New D Upgrade
Address:It~% WI~S~ ~& ~/~ ABSORPTION FIELD
Phone: ~__~ No. of Be~oms: ~Dee~ ~ Shallow Trench ~Bed ~M~Other
Lot: ~ Block: ~ T~L~Subdivisi°n:~7 ~ Depth to pipe bottom from original ~ ~epth beneath pipe Ft.
Township: ~ Range: Section: Fill added above original grade: ~ ~ngth:
WELL: ~5~ew ~ Upgrade ~raveldepth: ~ Numbero~Distancebe~weenl,nes:
Ft. Ft.
Pump Set at: Casing Hei ht Above Ground:
SEPARATION DISTANCES ~ Septic . Holding ~ S.T.E.P.
To Septic Absorption Lift Holding Public/Private M~facturer: ~ Capacity in gallons:
From Tank Field Station Tank Sewer Lines ~E~ ~
Material: Number o~ Compartments:
Surface
w~t~ ~'+ - .~/A LIFT STATION
Lot Size~rer:
Foundation [~ ~ ~ "Pump on" level at: ~High water alarm at:
Cudain
Drain ~/~ -- ~ I Electrical Inspecti°ns Ped°rmed b~
Remarks: ~1~ W~& ~¢?~ BENCH MAR~
Location and Oescription:
ENGI~[~AL
17034 Eagle River Loop Road No. 20~nd ~-~-~ Z ~ ~Jo. ,,~.
Department of Health and Human Services approval ~..,~, '
Reviewed and approved by: ~ Date: ~-~-~2
72~J13 (1/91) MOA 25 ~
P~rmit NO. ~
Page ~--- of ~
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 995t9-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
SHAFER
NO,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:$W920076
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:HADDEN BILL J &
OWNER ADDRESS:il705 WILDERNESS DR
ANCHORAGE, AK 99516
DATE ISSUED: 5/07/92
EXPIRATION DATE: 5/07/93
PARCEL ID:01520232
LEGAL DESCRIPTION: TALUS WEST #1 BLK 5 LT 12
LOT SIZE: 21409 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
HOLDING TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
RECEIVED BY:
ISSUED BY:
DATE:
DATE:
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
May 6,
1992
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER&WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
ANDREPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L S~re~t
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Lot 12; Block 5; Talus W~st Subdivision #I
RequeSt you issue a permit to install a wastewat~ holding tank to
s~rve the referenced property.
As can be seen from the attached site plan there is little to no room
on the property to install a l~achfi~Id and still maintain a 100 ft.
separation distance to all w~lls.
Within the only ar~a of the property that had any potential for a
leachfi~d we excavated a tut hole. The soils w~re found to be v~ry ~
dense clays and silts with high groundwater.
The loc~on of the proposed holding tank is more than 75 ft. from any ~
private w~s and allows easy pumping.
We do not a~cipate any adverse effects on neighboring prop~ti~s by
the inst~lation of the proposed holding tank.
If you have any questions or require additional Znformation for your
review, pl~se co~t~e~t uS.
RJS/gm
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
10-
11
12
14
15
16-
17-
18-
19-
2O
COMMENTS
/L~) Dl~'~'J DATE PERFORM~
Township, Range, Section:
WASGROUNDWATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SLOPE SITE PLAN
Depth to Waler Alter .~..~ r
Moniloriflg? r /
Date: '~'"'""""""""""~¢ '~ "/"
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE ) ~O (minutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEEN __ FTAND FT
ACCORDANCE WI~H ALL STATE AND MUN~K~EFFECT ON ~'S DATE.
72-008 {Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
SCALE
epartment of Environmental Quality
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
DISTANCE j~ ~
FROM WELL [1~ /ll~ MANUFACTURER ~'~.'~'/z~/~c)~ MATERIAL O/1~C~'~ ~'~'~', NUMBER OF
COMPARTMENTS
INSIDE LENGTH
INSIDE WIDTH
LIQUID DEPTH
LIQUID CAPACITY
GALLONS.
NUMBER OF PITS __
DIAMETER __ OR WIDTH LENGTH DEPTH
LINING MATERIAL CRIB SIZE: DIAMETER DEPTH DISTANCE FROM: WELL
TOTAL EFFECTIVE
BUILDING FOUNDATION__ NEAREST LOT LINE ABSORPTION AREA (WALL AREA)
SQ. FT.
WELL: ~0'? FI\I
TYPE CONSTRUCTION
BUILDING NEAREST
FOUNDATION LOT LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED
NEAREST
SEWER LINE
REMARKS
DEPTH
SEPTIC
TANK __
DISTANCE FROM:
SEEPAGE
SYSTEM
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:__
REMARKS:__
DIAGRAM OF SYSTE~
DATE~./~2~
G.A.A.B.
PERMIT NO.
DEPFIRTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
25t0 E. TUDOR RD.., ANC:HORBGE, BK. 99507
276-222t
RPF'LICANT
LOCATION
LEGAL.
DICK W. R I._gH_L
WILDERNESS DRIVE
L±2 B5 TALUS WEST
_F..H BEt,.,
LOT ¢' 7.
--, I ~E
344-42:t.4
21409 SOLIRF..'E FEE7'
TYPE OF SOIL AE,-,ORBTION S"r'STEM I_,. TRENCH
MAXIMUM NUMBER. OF BEDROOMS =' -,OIL RATING (S6.~ FI,' AR.-=
THE REQUIRED SIZE OF THE SOIL ABSORPTION SgSTEM IS:
'THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE 'TRENCH OR DRRINFIEL. D.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OP THE
GROUND AND THE BOTTOM OF 'THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE
AND THE 80TTOM OF THE EXCAVATION (IN FEET).
EITHER A CLASS I OR II NSF RPPRO',/ED PLANT MA9 BE IN_.q'FRLLEC.~
R CONTINUOUS MHI~TENAN_.E AGREEMENT IS REQUIRED. IF A MRINTENRNC:E
AGREEMENT IS NOT KEPT CURRENT YOU MA9 BE REQUIRED TO ENLARGE THE SElL
ABSORPTION SgSTEM AND/OR VOU MAY BE SUBJECI' TO FRO_,EbUTtON.' c. -. -
IF R ¢-.'LRqS_ I SYSTEM IS USED, THE LENGTH I=,"' ,=E,.'-" ' 0 FEET.
IF A CLRSS II SYSTEM I='] USED THE LENGTH IS ~6. 0 FEET.
BACKFILLING OF RNa' S'¢STEM HITHOUT FINAL INSPECTION AN[.', APPRO\,'RL E:'¢ THIS
DEPARTMENT HILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
±00 FEET FOR A PRIVATE HELL OR 200 FEET FOR R PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAb'S
OF THE WELL COMPLETION.
SPECIFICATIONS AND CONSTRUCTION DI8GRAMS 8RE AVAILABLE TO INSURE PROPER
INSTALLATION.
F'ER~.I I T '..-'AL I ~', FO~: CI~4E "WE RF.~' F'RC~r-I .i'] .'=-;St]E:
I CERTIFY THAT
i: I RM FAMILIAR HITH THE REQUIREMENTS FOR ON-'=_ITE ~EHERS AND HELL=,, ' ~ RS ~ET
FORTH BY THE MUNICIPRLITb' OF RNGHORRGE.
2: I WILL INSTALL THES_~TEM'= IN ACCORDANCE WITH THE CODES.
~: I UNDER. STRND THRT THE ON-SITE
_,EHER ~, ,c. ,
=,~..,TEM MRb' REQUIRE ENLRRGEMENT IF THE
S I GNED: ................
i SSLIED ~ ....... DRTE
DRILLING, INC.
DRILLING LOG
Well Owner t5 J (iDq: ....
Location (address of: Township, Range, Section, if known; or distance main road
Size of casing_ c; Depth of Hole
Static water leve1 40 ft. (~b'o~)
Screen ( ); Perforated (
Describe screen or perforation
Well pumping test at ~ '; gallons per (h'our)
of drawdown from static level.
Date of completion 'l(~ ih..(-~ 7c~
'/G., 5 feet Cased to /(3..., feet
(below) land surface. ~inish of well (check one) open end ( '-'
).
(minute) for I hours with
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
t) TO. ' ' C a~,~;:{ nc c-~ ·
" TO /I. }J'5 ! 1
" T0 ,~" ( ....... )~(' ~') '~ (~ ~
· :' TO .';5
5 :; TO (] 5
~i; TO '/'/
TO.
TO
TO~__
TO
_TO
TO
.TO
TO_
TO
);
ft.
NW%VA Certified Gonffaetor
~ca'tS£icate No's. 814 ~ 973
2 -- STATE
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE ,~1~
DEPARTMENT OF HEALTH & HUMAN SERVICES
Oivis[on of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
015-202-52
1. GENERAL INFORMATION
Complete legal description TALUS WEST SUBDIVISION ¢~1: LOT 12. BLOCK 5
Location (site address or directions) 11705 WILDERNESS DRIVE. ANCHORAGE. AK 99516
Property owner HEIDI ROMANS-PAVIO Day phone (907) 545-4292
Mailing address 11705 WILDERNESS DRIVE. ANCHORAGE. AK 99516
Lending agency Day phone
Mailing address
Agent BONNIE HOCHSTEIN /~12..~¢¢-~.¢'~¢~,..- N,~"~ Day phone
Address
(907/ 562-6464
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
Individual well xxx
Community well
Public water
NOTE: ff community weft system, provide wdtten confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding Tank xxx
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
ing to the legality and status of system.
72-025 (Rev. 1/91 ) Front MOA ¢Y21 Computer Version
Note: Alaska Water and Wastewater Consultants, Inc. shaft be paid $800.00 at,
I
or prior to, closing for the engineering services provided. J
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply and/or
wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of
structure indicated herein. I further vedfy that based or)/the information obtained from the Municipality of
Anchorage files and from my investigation and inspec~on, the on-site water supply and/or wastewater
disposal system is in compliance with all Municipal ~'d State codes, ordinances, and regulations in effect
on the date of this inspection.
Name of Firm ALASKA W~ER~,~
/ ///
Address 690I DEBARR~OAD,~I~
Engineer's Signature % JZ4/I/~
In conducting this evaluation, AWWC, Inc.la 4
system in accordance with ADEC and MGA DH^
R CONSULTANTS, INC. Phone (907) 337-6179
ORAGE, ALASKA 99504
Date
ed to provide a thorough, conscientious engineering analysis of the
Guidelines & Regulations. The reported results described the
performance of the system under the conditions encountered at the time of the test, and separation dLstances
measured to readily identiflable features. The operat/onal life of all wells and septic systems depen ',~%~,,=~,,~,~%~
on the local soils condition, ground water levels that may fluctuate during the year, and the water
usage of the family being served by the system. These cenditions are outside the centrol
"(~0 ~.,.~ .'~/... ~E-7955 ...,".
the evaluator of the system. Satisfactooz test results do not guarantee future performance
of the system, nor do they guarantee that there are no hidden defects or encroachments.
AWWC, Inc. can therefore not prot4de any warranO/ for future estimate of how long the
system will continue to meet the operational requirements of the ADEC or MOA DHHS.
The content of this report is for the sole benefit of the owner listed above. Any
reliance upon or use of this report by any other person or parO/ is not authorized,
nor will it confer any legal right whatsoever.
6. DHHS SIGNATURE
~ Approved for ~
Disapproved
Conditional approval for
bedrooms
A. Garness,' ~
-795.3 ..' ~
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of
homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of
DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA #21 Computer Version
RECEIVED
Well Type PRIVATE
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Municipality of Anchorage OCT ~ ?
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services D v s on
825 "L" Street, Rm 502 AnChorage, Alaska 99501 (907)3~Y~J~t~'LITY OF ANCH~
ENVIRONMENTAL SERVICE,
Health Authority Approval Checklist
Legal Description:' TALUS WEST S/D #1; LOT 12, BLOCK 5 Parcel I.D.:
A. WELL DATA
If A, B, or C, attach ADEC letter. ADEC water system number
YES Date completed 8/10/76
76.5' Cased to 76.5'
YES
FROM WELL LOG
8/10/76
40'
15
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0
015-202-52
Casing height (above ground) 12"
Wires properly protected (Y/N). YES
ATINSPECTION
10/20/2000
25'
g.p.m. 7.9 g.p.m.
2.57 mq/L
Collected by:
Other bacteria
A.W.W.C., INC.
Nitrate
Date of sample: 10/20/2000
B. SEPTIC/HOLDING TANK DATA
Date installed 5/27/92 Tank size
Foundation cleanout (Y/N). YES
Date of Pumping 10/9/2000
C. ABSORPTION FIELD DATA
3000 Number of Compartments 1 Cleanouts (Y/N) YES
Depression (y/N) NO High water alarm (Y/N) YES
Pumper ISAAC'S
Date installed . Soil rating (g.p.d./ft2 or f12/bdrm) System type
Length Width, Gravel thickness below pipe ~_
Effective absorption area Monitoring Tub~ession
over
field
(Y/N)
Date of adequacy test Res~e~e~ss/Fail)__ _ For __
~ll::dd ;:ppt,: in ab~~t. ~o~ft;;te= gal. water added (in.):_
~ent (past 12 months) (Y/N) If yes, give date
72-026 (Rev. 3/96)* Computer Version
Bedreoms
D. LIFT STATION
Date installed
Manhole/Access (Y/N) ~evel at* "Pump off' level at*
High wa~ *~atum
~.Cy~fles-t~sted
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
75'+ _On adjacent lots 100'+
N/A On adjacent lots 100'+
N/A Public sewer manhole/cleanout N/A
N/A Lift station N/A
SEPARATION DISTANCES FROM SEPTIC~--~)TANK ON LOT TO:
Foundation. 5'+ Property line 5'+
Water main/service line 25'+ Surface water/drainage 100'+
Absorption field N/A
Wells on adjacent lots 75'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation~
Surface water ~ ~ D '~g/vehicle storage area
Wells on adjacent lots
F. ENGINEER'S CERTIFI
I certify that I h~'dlet~
of Municipal re/cords/tl~,
with MOA HA~ gui~J
Date /O/'Z~
~ield inspections and review
systems are in conformance
~.g.~is date.
JEFFREY A, GARNESS
Waiver Fee $
Date of Payment
Receipt Number_
Parcel I.D. #
1.
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
GENERAL INFORMATION
Complete legal description
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
HAA#
Locati0~ (s te address,or, directions)
Prol~erty owner /.-L. /4r41b
Mailing address. ' "~r~'.~: }u[/'lt~_i~x~'s
Mailing address.' ~""
Day phone
Day phone
Agent
- Day phone -
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF W~,TER SUPPLY:
Individual well
Community well
Public water
NOTE:
. ing to the legality and s{atus of system.
If community well system, provide written confirmation from State ADEC attest-
TYPE OF WASTEWATER DISPOSAL:
Individual on-site .
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev. 1/91) Front MOA#21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply.
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Address
Engineer's signature
S & $ ENGINEERING
17034 Eagle River Loop Road No. 204
Eaqle River, Alasl(a 99577
DHHS SIGNATURE
· ~' Approved for ¢ bedrooms.
Phone
__ ,,Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their Pending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72~25 (Rev 1/91) Back MOACY21
( Municipality of Anchorage
Department of Health & Human. Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L-O'T
A. WELL DATA
Well type 'J~(3c-'~
Log present ~N)
Totaldepth ~' (~ · -~
Sanitary seal ~N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~- IO-~-~ Driller
Casedto ;~)7~, -~~ Casing height
Wires properly protected ~/N) ~"~
g.p.m.
FROM WELL LOG
40'
Date of test
Static water level
Well flow
Pump level
Sewer service line
L,L r-. %o ++
SEPARATION DISTANCES FROM WELL TO:
~ijj~/holding tank on lot
Absorption field on lot
pUblic sewer main ~J/~
AT INSPECTION
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank ~0~
WATER SAMPLE RESULTS:
Coliform (~ Nitrate
Date of sample: ,~)_<~)..--~_c~ ~
Collected by:
Other bacteria
S. S'~/HOLDING TANK DATA
Date installed ~ - ~':F -~¢3.
Cleanouts Y~) ~.
High water alarm (~'N)
/
Date of pumping tr~//'~
Tank size ~C..~O (_~-(q-(.. Compartments
Foundation cleanout (~'N) ¥,¢_.S ~/'~'~;L~Depression
Alarm tested ~N)
~ ~ 7~ Pumper
SEPARATION DISTANCES FROM S~I~'HOLDING TANK TO:
Well(s) on lot
To property line
Surface water/drainage
On adjacent lots
Absorption field
JO0
'~ ~ Foundation 1 0 ~'/'
/J/A- wate~main/service line '~0
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION /
Manufacturer ~
Size in gallons % Manhole/Access (Y/N) _ ~
level
at
High water alarm level . ~ ~ ~ tested __ __
Meets MOA ele~__ ~ ~
~T CN E FROM LI F;nS~;:~t 7¢~; Surface water_
D. ABSORPTION FIELD DATA
~ nstalled /~/,,~
Length Width
Soil rating System type_
Gravel thickness Total,
Total absorl
Depression over field (Y/N)
Cleanouts present
Date of ade¢
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
for bedrooms
If yes, give date
SEPARATION DISTANCE FROM
Well on lot
To building foundation
Onadj
Surface war,
Cutbank
acent lots ~..~.~er ty line
To existing or abandoned sys~mo.~
Water main/service line
. Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name
Date
S & S ENGINEERING
17034 Eagle River I.eop Road No, 204
~agle htiver, Alasl(a ~.~Z/
~I'tAFER ,;'
HAA Fee $ 1'~0-c~'' .....
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $ '
Date of Payment
Receipt Number
INSPECTION APPOINTMENTS
TIME ~' TIME TIME
825 L Street - Anchorage, Alaska 99501 ~IEoNMENTAL pRo~ECT[ON
ENVIRONMENTAL SANITATION DIVISION FEB 2 7 lgg
Telephone 264-4720
DIRECTIONS: Complete all parts o~ page 1. Incomplete requests will not be preceded. Please allow ten (10) days for processing.
MAI NGA DRESS
PROPERTY RESIDENT (If different from above) PHONE
PHONE
~AILIN6 ADDRESS
MAI~ING ADDRESS
PHONE
5. LEGAL ~,.j~_SCRIPTION.~/~
STR E ET L~O'OATJ, O~N/ Z~ ~ ~'"' ~"~4'-~'~ ~'~ ~/
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
One ~ Four
~ ~ Two ~ Five
SINGLE
FAMILY
~ MULTIPLE FAMILY ~ Three ~ Six
7. WATER SUPPLY
'[~ INDIVIDUAL*
COMMUNITY
[] PUBLIC UTILITY
[] Other
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
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
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED--
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[~]PUBLIC UTILITY ~'~ ~'-) G
Connection Verified INSTALLER
[]Septi,c Tank or [] Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELETO:_ Septic/HoldingTank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Li~ze
5, COMMENTS
[7~]~--APPROVED FOR . ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[~ DISAPPROVED
72-010 (Rev. 6/79)
Hf.)N'~ & C:ON'~M, ERC!AL SEWAGE TREATN\ENT .PLANTS
BOX 149f.~;' WA,'51LLA, AK. 99687 - PHONE 376-5919.
[his Agreemen! entitles:
JET Home Plant Service Policy ~'alus ',.;e.-,_~ '~
Street
Addres:~ ...........................................................................
City ....... ~ ................................
'o the followieg service for _._~ yearI¢) ;rom the date of acceptance
Upon receipt of this sianeo agreement and S !;30~00 , ¢~;;~'¢(ft'r:~Concrete Products agrees to pedorm
fo!iowing sm'vices ,;u~mg me mrm of the ~greernenz:
~;~.~}~:,-~,Collcrme Products will nsDecr the JET piam at me a~ove address twice a dear. ii, ese inspections
~LA, N7 SERVICE
Rornovai o~ aeration unit, inseection, adjustment, cleaning of aerator's ~h,~ft, fioid service of aeration
unit, if neeaea, and rednstailafion.
Inspection, (:leaning, and adlustment, if necessaly of serface skimmer and/m tube se~ter
Examinatlo~ of fk~l effluent for color and odor, if there ~s access al t~me or inspedicn.
Check of discharge point and wef woa~her overflow for blockage (if applicable).
o¢ insgection.
Inspechon for sludge accumulation wffh arrangements for 'amoral when build-up warrants -amoral.
2~[~)~([~Concrete Products fudher agrees to the fo ow hq:
EMERGENCY SERVICE
There will be no s~rwce or labor charges for remove,] or re-inste[Jation o¢ aerator if raqui~ed.
If improper operation cannot be corrected a~ time of service, homeowner will be notified immediate~
anq given e~,timated date of correction.
If improper operation cani]of be corrected at til'n,9 of servk;e, the Department of Envkoumenlal 'Qualil,
GARB, will also be notified.
If necessary, the entire mechanical uni~ or any par~s will be replaced..aeco~d[~g-J~-..d~-man~adu~erq;
Freiaht charqos to the factory or to an unauthorized
HORAGE DEPT OF I'-ALTH & --
MUNICIPALITY OF ANC E'"' ' '
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~I~JRONMENTAL
825 L Street - Anchorage, Alaska 99501
FEB
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720 R£CEIVE. D
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES'
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Ptease allow ten (10) days for processing.
1. PROPERTY OWNER PHONE
MAI LING AD DR ESS
PHONE
PHONE
PROPERTY R ESI DENT (If different from above)
2, BUYER
MAiLING ADDRESS
3, ~ENDING INSTITUTION ~ ~ ' PHONE
~AILING ADDaESS
4. REAL~OR/AGENT / . PHONE
~AILING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] One [] Four
~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY ~ Three [] Six
[] Other
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.)
S. SEWAGE DISPOSAL SYSTEM
~,~ INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
[] PUBLIC UTI LITY by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78}
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
~ SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTI LITY
Connection Verified LOG RECEIVED
\l ~.',---'
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED --
[]PUBLIC UTILITY
Connection Verified iNSTALLER --
[] Septic Tank or [] Nolding Tank
Size: If Tank is homemade SOILS RATING-- '~ --
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCESwELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
IJ.,~"/A~P P ROV E D FO R...~ BEDROOMS
[] CONDITIONAL APPROVAL (letter ~st ac/m3~
must ac any certificate)
[] DISAPPROVED
DATE BY (T' e)
EEGAL DESCRIPTION
72-010 (Rev, 3/78)
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
4.
5.
6.
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
. Date Received September 22, 1976
Time off'Inspection 9:30 a.m.
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Conv.
Alaska State Bank
Dick Wright
Star Route Box 1585A
Phone:
Phone:
Legal Description: Lot 12,Block 5 Talus West
Location:
Wilderness Drive
Type of facility to be inspected
Well Data: Individual
A. Type
C. Construction
Sewage Disposal System:
A. Installed 1976
C. Septic Tank: 1.
Single Family No. of bedrooms
D. Seepage Pit: 1. Absorption Area 2.
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank , Absorption area
Nearest lot line , Other contamination
B. Foundation to septic tank , Absorption area
C. Absorption area to nearest lot line
B. Depth
D. Bacterial Analysis
On-site system
B. Installer
Size ~f ~. Manufacturer
Material
9-23-76 Thursday
344-4214
71'
, Sewer Lines ,
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - Re~, ~t for Approval of Individual ~. r & Water Facilities
Legal Description Lot 12 Block 5 Talus West Subdivision
Comments
Approved~{~Jt^A_/k~-~¢~Disapproved
Approval V&lid for one year from date signed
Date
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ-034 (1/74)
MUNICIPALITY OF ANCHORAGE ; '
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECT ON
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA
2. Property Owner: z~-~l ~/~1/ ~///./?/'//~/'-/'7~
Mailing Address:~"~/~ ~ ~' ]~-~'5~
3. Name of Buyer: ./~ ~/D~I~/Z~
FHA_ CONY ./~
Day Phone:
Mail!ng Address: Day Phone:
Name of Lending Institution:
Mailing Address:
5. Name of Realtor or Agent:
Phone:
Mailing Address: Phone:
Legal Description'. ,,ZD 7- / ~ .~_ ~' ~-/z~ ~;'
Location:
7. Type of Facility to be Inspected:
8. Water Supply
Type of Supply:
If Individual, depth of well
Sewage Disposal System
Public Utility
If Individual, number of dwellings presently served
Type of System:
Public Utility
If Individual, date of installation c'~J
No. Bdrms.
Individual
Individual (on-site)
72-003(3/76)