Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
TALUS WEST #1 BLK 4 LT 5
Onsite File Talus West #1 Block 4 Lot 5 #015-202-19 (Rev 05/02/18) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221052 PID Number: 015-202-19 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: 0 New ❑ Upgrade Name Whisman, John & Judith ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 11835 Wilderness, Anchorage, AK 99516 ❑ Other Phone Number of Bedroomssting Total depth from original grade 907-952-8337 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe inv rom original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Talus West #1 4 5 Fill added above original grade Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Line Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. betwe trenches From Tank Field Lift Station Tank Line F{z t. Well >100' >1 00' N/A N/A >25' TANK ❑� Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Greer 1250 Gal. Surface Water >100' >100 N/A N/A Material Plastic Number of compartments 2 Lot Line >5' >10' N/A N/A NA Foundation> 10' >10' N/A N/A LIFT STATION f�l�Ttti#a urer Capacity Gal. Remarks Alarm location I installed by PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 Installer A.C.E.S Drainfield D3034 CO/MTD3034 Inspector M.Jakubisin BENCH MARK (Assumed elevation) 100 ft Inspection 151 3/10/22 n 3/10/22Location and description dates: 2 3 r 4 t ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp '4- FA4. Approval: Date P Conditional •.*�� e*:49TH r� BenCE Septic System Approved D atVt �F•. 2592i11er r� �F 8/18/22 • '��� `� 9F'0 • ...... •�F... ill PROFESSION NZ -his approval does not include well permit require 4� t\ (Rev 05/02/18) / / / / / / / / // // // // // // / / / / / / // // // / / / / Benjamin Schiller CE 12592R E GISTEREDPROFES S I O N A L E N GINEER 1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND CO1 PERMIT # OSP221052 PID # 015-202-19 TALUS WEST #1, BLOCK 4 LOT 5 A B CO1 26.7 2CO1 39.6 MH1 40.4 SV1 42.6 2CO2 43.3 14.4 29.3 30.1 34.8 36.0FEET 0 50 100 Dec 26, 2022 JUMAR AVENUE 4-BDRM HOME 2CO1 SHED WILDE R N E S S D R I V E 10' UTILITY EASEMENT 5' U.G. POWER EASEMENT 2CO2 1250 GAL SEPTIC TANK W/20" MANWAY EXISTING TRENCH TO REMAIN IN SERVICE MH1 SV1 PLAN AS-BUILT AB PROFILE AS-BUILT (NO SCALE) 93.1 87.8 93.6 96.7 MH 1 SV 1 1250 GAL SEPTIC TANK 2C O 2 92.8 Benjamin Schiller CE 12592 R E GISTEREDPROFE S S I O N A L E N GINEER 8/18/22 PERMIT # OSP221052 PID # 015-202-19 TALUS WEST #1, BLOCK 4 LOT 5 2C O 1 2" FOAM INSULATION MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221052 Work Type: SepticTank Upgrade Tax Code Number: 01520219000 Site Legal Address: TALUS WEST #1 BLK 4 LT 5 G:2736 Site Mailing Address: 11835 WILDERNESS DR, Anchorage Owner: WHISMAN JOHN R & JUDITH C Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: nr + n r DeI)artmen t 3/10/2022 3/10/2023 23923 ❑ Disposal Field P Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3: The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April.15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Veronica Pope GE 2022.03.10 Received By: 15:15:46 -09'00' Date: _ Issued By: '(� Date: 131 o a0 a ILI MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-202-19 Property owner(s) Whisman, John & Judith Day phone Mailing address 11835 Wilderness Dr, Anchorage AK 99516 Site address 11835 Wilderness Dr Legal description (Sub'd., Block & Lot) Talus West #1 Block 4 Lot 5 Legal description (Township, Range & Section) Lot Size 23,923 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) x❑ (w/wo ADU) Septic Tank ❑x Upgrade 0 El (D) Holding Tank ElRenewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 2 Date of Payment: 3 /10 a Ua a Receipt Number: O a j `('� Permit No. 0 02210$ Z Permit App__- : .-.,:c Waiver Fees: Date of Payment: Receipt Number: Waiver No. March 9, 2022 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 3/9/22 Subject: Talus West #1 B4 L5- 11835 Wilderness Dr. Septic Tank Replacement Dear On-Site Services Engineer: The owner of the above lot has a septic tank that has reached its end of useful life. We are submitting this permit application for the replacement of the existing tank. The attached site plan identifies the location of the home and existing septic system. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. Wells on this and adjacent lots are shown. The new septic tank will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the existing absorption trench. The southern end of the existing trench will be located to ensure that we can achieve the separation distance required. At that time the existing trench will be adjusted to include a cleanout on the southern end of the trench. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221052, Rebecca Carroll, 03/10/22 / / // // // // // // // Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' REMOVE EXISTING TANK PER U.P.C. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND TALUS WEST #1, BLOCK 4 LOT 5 FEET 0 50 100 ≥5' NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. JUMAR AVENUE 4-BDRM HOME 3/9/22 2CO SHED WILDE R N E S S D R I V E 10' UTILITY EASEMENT 5' U.G. POWER EASEMENT 2CO NEW 1250 GAL SEPTIC TANK W/20" MANWAY EXISTING TRENCH TO REMAIN IN SERVICE LOCATE SOUTHERN END OF TRENCH AND INSTALL NEW CLEANOUT Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221052, Rebecca Carroll, 03/10/22 Lot 14 Homestead Hills Subd. EAST 126.07 Lot6 SCALE: 1"= 40' 10' Utility Easement o~ Septic vent Chain link fence (typ) EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. UNLESS OTHERWISE NOTED Lot5 L. Walotka .. £¥ L= _I 1 . , 25 J~ }a;.i;`R.E{.stoiAi€{±:-~~ •. 8036-LS RLB, FB 18-9, pg 41 umar Avenue Set518"Tebaf_---_E=I- SET SOUTHEAST LOT CORNER AS-BUILT I hereby certify that I have performed a Mortgagee's inspection ±fli#i#E3fescuri83[vp,rso,poeNrtyi5%FT1%NB#f4 Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 4th 907-248-1666 dayof December ,2018. FRED WALATKA & ASSOCIATES, L.L.C. Engineers and Surveyors Lot 7 Homestead Hills Subd.Lot 14 34 8479X � EAST 126.67 CD 10' Ut'I`t E t N Jumar Avenue a) i y asemen E� o w MC I Z co a)�- �,-- Septic vent (typ) 06 CL Lot 5 Manhole Z Shed o� o O, Chain link fence (typ) c deck O deck 5 deck o 24.5 tOCY N CA f O� 'o Nugg 27 deck 2 .. �. e`\ a 0 pd oo 0 o., 2 4Z Lot 6 •06., 2 0 C3� Ti �c�? CP G \M L CD ,CD Lot 4 o eM ��re mood Po cCaao�es e�DeC er XA0 GV 015 \,4006e"\ 00 RECERTIFIED 8-22-23 AS -BUILT NO 4CRfEXRKSSEET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following ��► OF , described property: LOT 5, BLOCK 4, �► . • • • . L TALUS WEST SUBDIVISION ADDITION No. 1 s ��• Anchorage Recording Precinct, Alaska, and that the a'q-� th •"y improvements situated thereon are within the property lines / and do not overlap or encroach on the property lying • • • '• • • • adjacent thereto, that no improvements on the property lying 00 adjacent thereto encroach on the premises in question and 000 • ••• • that there are no roadways, transmission lines or other „_ r 0 .• izabeth L. Walatkao ° / visible easements on said property except as indicated SCALE. 1 40 0 •803fi - LS � AW 4 hereon. � • • ° • • •o�J AWDated at Anchorage, Alaska t '°Ro • • ° �.�' ` this 4th day of December , 2018. EASEMENTS OF RECORD, OTHER THAN '' fi�SSIONAL � .� THOSE SHOWN ON THE RECORDED , � \\�,�►� FRED WALATKA &ASSOCIATES, L.L.C. Engineers and Surveyors PLAT ARE NOT SHOWN HEREON FB 23-2, pg 38 �- Z�E 907-248-1666 UNLESS OTHERWISE NOTED. RLB, FB 18-9, pq 41 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. O l 00 RECERTIFIED 8-22-23 AS -BUILT NO 4CRfEXRKSSEET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following ��► OF , described property: LOT 5, BLOCK 4, �► . • • • . L TALUS WEST SUBDIVISION ADDITION No. 1 s ��• Anchorage Recording Precinct, Alaska, and that the a'q-� th •"y improvements situated thereon are within the property lines / and do not overlap or encroach on the property lying • • • '• • • • adjacent thereto, that no improvements on the property lying 00 adjacent thereto encroach on the premises in question and 000 • ••• • that there are no roadways, transmission lines or other „_ r 0 .• izabeth L. Walatkao ° / visible easements on said property except as indicated SCALE. 1 40 0 •803fi - LS � AW 4 hereon. � • • ° • • •o�J AWDated at Anchorage, Alaska t '°Ro • • ° �.�' ` this 4th day of December , 2018. EASEMENTS OF RECORD, OTHER THAN '' fi�SSIONAL � .� THOSE SHOWN ON THE RECORDED , � \\�,�►� FRED WALATKA &ASSOCIATES, L.L.C. Engineers and Surveyors PLAT ARE NOT SHOWN HEREON FB 23-2, pg 38 �- Z�E 907-248-1666 UNLESS OTHERWISE NOTED. RLB, FB 18-9, pq 41 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. Development Services Department ~ Suddinq Scfety Divisicn O ," On -Site `1✓cter & Wessewcger 'rrecrer„ _T •, 4700 9rc,cw Street 0 p.0. 6cx 1966:0 Me&Se;ich Ancharaae. AK 99519-5650 Maycfr, , m,iro (907j :43.7904 - Pump Installation Log Well Drilling Permit Number: SW_ Date of Issue: Parcel Identification Number:_ Legal Description alks West '"I 3N L 5 Property Owner 14ame & Address: Joni/ i/5'3S �cDicpE62�J,G5S '� Pump Installation Date: Pump Intake Depth Below Top of Well Casing: 7Gf feet ; Pump Manufacturer's Name: Pump Model: .S� Pump Size �/_ hp Pitless Adapter Burial Depth: /L; feet Pitless Adapter Manufacturer's Name: jvit-, Pitless Adapter Installer. Weil Disinfe=ed'uooa Completion". ❑ ys ❑ No _ MethodafDuiniect!on: Commens: Puma Instailer Name: —YY�Ct ✓� ate. Attention: The pump ir=aUez shall provide a pu^p irstallaaon log to the DSD within 30 days of pu=p in_- allaticm. .~GRE,~,.~_~ ANCHORAGE AREA BOR(._~]H Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: FROM WELL INSIDE LENGTH TILE DRAIN FIELD: / / DISTANCE FROM WELL /k~¢ FOUNDATION NUMBER OF LINES / DIS~NCE BETWEEN LINES ABSORPT,ON ^RE^ /~/~¢ ~' DEPTH: TOP OFTILE TO FINISH GRADE / ~ NUMBER OF ,~ LIQUID CAPACITY~G~O~. NEAREST LOT LINE /'-~ / TOTAL LENGTH~// OF LINES ~ TRENCH WIDTHv~ /IN. TOTAL EFFECTIVE Sq. FT. LENGTH OF EACH LINE DEPTH OP F~LTER MATERIAL BENEATH TILE-- ~'/~'~/ IN. ABOVE TILE WELL: CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION__, LOT LINE , SEWER LINE DEPTH SEPTIC SEEPAGE TANK SYSTEM CESSPOOL OTHER SOURCES_ APPROVED_ OISAPPROVED REMARKS DISTANCE FROM: DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS; Form E~-032 DIAGRAM O F~SYSTEM (J/L, PERMIT NO. RPPLICBNT LOCRTION LEGAL MR. RND MRS. RLAN LESKE LLB~5 WILDERNESS L5 B4 TALUS WEST #±. I"ILUq I C I PF)IL I Th-' ,]F RNC;HI]F. RGE DEPRRTMENT OF HERLTH RND ENVIRONMENTRL PROTECTION 825 "L~ STREET., RNCHORRGE., RE. 995~Zli 264-472~ O[4--S I TE SE~$ER [JP,]R~C,E PEFCO1 I T LOT SIZE 24000 SQUARE FEET TYPE OF SOIL 8BSORPTION SYSTEM IS: TRENCH MAXIMUM HUMBER OF BEDROOMS = 4 SOIL RATING <SQ FT?BR)= "~f~.. THE REQUIRED SIZE OF THE SOIL ABSORPTION S~'STEM IS: [)EPTIq= ~ LE~-IGTH= O GR~]~/EL [)EF'TH= ~ THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFBCE OF THE GROUND RND THE BOTTOM OF THE EXCAVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE B(CRVRTION (IN FEET). I~:EQ:J I RE[:' SEPT I C TRI'-I~< S t ZE= ::k25E"l I]RLLC)f4S PERMIT RPPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLRTION INSPECTIONS OF RNV WELLS ADJRCENT TO THIS PROPERTY' AND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. T14Cm < 2 ) I ~-4SF'EE:T I Of-iS ARE REL-]L: I RED BRCKFILLING OF AN9 SVSTEM WITHOUT FINAL INSPECTION AND APPROVRL 89 THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM [:'ISTANCE BETWEEN A WELL RND RN"¢ ON-SITE SE[,4RGE DISPOSAL SYSTEM IS lei0 FEET FOR A PRIVRTE WELL OR '158 TO ~00 FEET FROM A FUBLI~ WELL DEPENDING UPON THE T'?'PE OF PUBLIC WELL MINIMUN DISTANCE FROM A PRIVATE WELL TO A PRIVRTE SEWER LINE IS 25 FEET RND TO A COMMUNIT*¢ SEWER LINE IS 75 FEET. OTHER REC.,~UIREf'IENTS f'lA'¥' RPPLb'. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE RVAILRBLE TO INSURE PROPER INSTRLLATION. F'EF-: f-1 I ]- E.s~P I RES C.E[]Er-IE:ER .7::±.. '"1 9BE'~ I CERTIPr~ THAT fL: IRM FAMILIRR WITH THE REb-.UIREMEHT:, FOR ON-z, IfE _,EWER:, AND WELLS }~b SET FORTH B*r' THE MUNICIPALIT'¢ OF ANCHORAGE. 2: I WILL INSTIBLL TAE S~r'STEM IN RCCOR[:'RNCE WITH THE CODES. S: I UNDERSTRND THRT THE ON-SITE SEWER SVSTEM MR~' REQ_IRE ENLRRGEMENT IF THE 'E~IDENCE IS REMODEL~UDE MORE THRN 4 BEDROOMS. ~-,RE:/~.,~ ANCHORAGE AREA BO · PERMIT NO. DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAG~E, ALASKA 99503 SEWAGE DISPOSAL SYSTEM -- APPLICATION .~ND PERMIT NAME OF APPLICANT INSTALLATION LOCATION MAILING ADDRESS /~/~1/--~/~ '/~t~ ':~ ~' '~/ DRAIN FI£LD INSTALLATION OF: SEPTIC TANK ~ ~:~ SEEPAGE PiT COMPLETION DATE ANTICIPATED NOTE: THIS PERMIT ISiN~OT VALID WITHOUT BOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM~WI~THOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSE~TION. SEPTIC TANK SIZ ~ -<~ .W, ...... ~//~/ ~ ' ~. '~ FOUNDATION TO SEPTIC TANK ~.z-4-~-4/' WELL TO SEPTIC TANK /~ SEPTIC TANK, ~g~ / SEEPAGE PIT /~J DRAIN FIELD GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING i'NSTALLATION. DESCRIBED SYSTEM IS IN ACCORDANCE wiTH SAID CODE.I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER~ d ~//~NCHORAGE AREA BOROUGH O,I~DINANCE NO, 28-68 AND THAT THE ABOVE MUNICIPALITY LITY OF ANCHORAGE o ?? Development Services Department r�-' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax. 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-202-19-000 Expiration Date: 2/2/2024 Legal description TALUS WEST#1 BLK 4 LT 5 Site address 11835 WILDERNESS DR Anchorage AK 99516 Current property owner(s) WHISMAN JOHN R & JUDITH C X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for Comments or advisories: 2 i bedrooms, with the following stipulations: Original Certificate Date: 11/2/2023 TPis Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water &Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-202-19 Complete legal description Talus West #1 Block 4 Lot 5 Location (Site address) 11835 Wilderness Drive, Anchorage, AK 99516 Current property owner(s) John & Judith Whisman 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone (907) 952-8337 3. TYPE OF WATER SUPPLY: X Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel Plastic ❑ Concrete ❑ Fiberglass Age 1.5yrs _ See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑E Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: PR Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ > / Waiver Fee $ Date of Payment /0 / 3 / 2 3 Date of Payment COSA # 0 S C `/ Waiver # COSA Application—June 2022 Talus West #1 Block 4 Lot 5 015-202-19 5.6+ 85* >40 3.59 24 3/1/22 Forge Engineering 50 10/24/23 *Per 8/15/1975 HAA N/A New Installation 8/15/75 10.5 6.4 N/A N/A N/A 3/1/22 28 675 34 1440 13 > 600 Benjamin Schiller, P.E.10/4/23 (907) 522-7773 Municipality of Anchorage *A. Development Services Department .Building Safety Division On -Site Water & 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 5 la�04 FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-202-19 HAA# 1. GENERAL INFORMATION Expiration Date: 17-0 Complete legal description TALUS WEST SUBDIVISION #1; LOT 5, BLOCK 4 Location (site address or directions) 11835 WILDERNESS DRIVE * ANCHORAGE, AK 99516 Current Property owner(s) DOUG AND KAREN CISMOSKI Day phone 907-659-5872 Individual On-site Mailing address PO. BOX 111805 * ANCHORAGE, AK. 99511-1805 Lending agency Mailing address Real Estate Agent Mailing address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 Day phone Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, ! verify 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. /further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date f 3 04' Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are ho hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. 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 party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: a owes, ON-SVTE � 1NAST ENAIrER O • • Attachments: JJJJO • • • • • • • _rC,` HAA Checklist _� Manitenance Agreements �J ©`i•� Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other By: Original Certificate Date: (Rev. 12/01) ........ . .. ...... ......... .Je r Gar ess: 14m E-7 40��P�of essto�°Q,00 Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: a owes, ON-SVTE � 1NAST ENAIrER O • • Attachments: JJJJO • • • • • • • _rC,` HAA Checklist _� Manitenance Agreements �J ©`i•� Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other By: Original Certificate Date: (Rev. 12/01) „• -Municipality of Anchorage Development Services Department L f Building Safety Division a! On -Site Water & Wastewater Program " 5AI 4700 South Bragaw St. ;i ` P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us I (907) 343-7904It E ' HEALTH :AUTHORITY APPROVAL CHECKLIST Legal Description: TALUS WEST. SUBDIVISION #1; LOT 5,' BLOCK 4 Parcel ID: 015-202-19 A. WELL' DATA *PER 8/15/1975 HAA. ;; } Well typie , PRIVATE If A. B, or C provide PWS ID# N A Well 5Log (Y/N) NO YES Date completed PRE 8/1975' Sanitary seal (Y/N) YES Wires properly, protected (Y/N) Total depth *85 ft. Cased to 40+ In. Casing heigh'(above ground) 12+ in. FROM WELL LOG . AT INSPECTION .. Date of•testI � , 'UNK 5/5%2004 Static water level UNK ft. I 47's ft. Well production UNK g.p.m. ; 5.29g.p.m. WATER SAMPLE RESULTS:.. Coliform) �" 0 colonies/100 ml. Nitrate 1.38` mg./L: Other bacteria 0 colonies/100 ml. Arsenic ! `�N A mg./L. Date of sample: 5/5/2004 Collected by: GEG, Ltd. B. SEPTIC/HOLDING TANK DATA ' Tank Type/Material STEEL Date installed 6/20/1980 I. I Tank Si2e1250 gaL Number of Compartments 2 Cieanouts'(Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A fu in19 Pum er um 5/5/2004 L MCDONALD! PUMPING o C. ABSORPTION FIELD DATA 1 Date installed 8/15/1975 Soil rating (g.p.d./ftlor /bdrm 250 System type DEEP TRENCH Length ! i' 54 ft. Width Z ft. Gravel below pipe 13 ft. Total depth ** 10.75 ft. Eff. absorption area 1404 ft2 Monitoring tube **YES i :Depression over field NO Date of adequacy test 5/5/2004 Results'(Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption _field before test DRY in. Water added 932 gal. New depth **21 in. Elapsed Time: 1125 min. Final fluid depth **4 in. Absorption rate ?= 600+ g.p,d, Any rejuvenation treatment (past 12 mo.) (Y/N &type) NONE KNOWN + If yes, give date — **MONITORING TUBE ONLY EXTENDS 6.1' INTO DRAINROCK i D. LIFT STATION Date installed Size in gallons Manhole/Ac "Pump on" level at in. E. SEPARATION DISTANCES "Pump off" n. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout - N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field'- 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+' Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS IC57- _11 G. ENGINEER'S CERTIFICATION "'\ 0 �,qSp� 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. Q �Q e y Gayness: Engineer's Printed Name JEFFREY A. GARNESSQOOn�0 E-7953 •; ::OpO foo, Date/O� = ��0�0rofessioo 0 0040��0 Q HAA Fee $ •d Waiver Fee $ Date of Payment TS 1 13 1D Date of Payment i Receipt Number Receipt Number (Rev. 12/01) . _ 05/04/2004 08:51 FAX 907 345 3(6162 CISMOSKI FAX 0002 6.07 E: r ` �o M/� . EA7. '� �JUMAR AVEo SOT Io o DECFG v Lo -- 24- N O 17= n~ v • iso �0 3N �` Ri - _ .:LOT - 41 t `WELL O.10� M : D �•. � -- 3 N E,S S DER. %O ..�" OF 44,10111 1 ,sees., Lot , Block / I V �/ ��� ��`��'•��• 1192n •- �,r��� T�/us , Was Sc rfx�! Addr•� _ No. � ►oa poFF•....••�F�o , SSIONA� Anctlorage Recording District, Alaska Eoeernente at record other than tha■i ■hown on the plat of record are not shown hereon unt.ee othsrwlee noted - LOT SURVEY CERTIFICATION LEGEND I hersay cif}try rner Ihay..urveyed the property shown and ascribed Q Bross or Aluminum capped monument recovered Moon. cnd that IN Improve1MeNs ■ituated thereon are wlehln the ;fop- 0 iron pipe and/or rebor raccvered. arty Ilnee and do not overlap or encroach en adjacent property and that O 2 x 2 hub 6 tack recovered ne improv m-wdw on adjacent prooerty overiep or eneroach on the "mites 0 5/8"x 30" rebar•set this survey In ss-ntssstlon and mar rove are no roadway.. utility line*. or orMr v1e101e FEHCE L/NE'(APPROX. •LOCAT/ONJ eaeenr•nte On .ala property except a1 Indloarw hereon. , Scale/a 410 Date _ _ Prepared by: • R. L. BUTTON O3O�1. RegislerBd Lond Su�veyo/. (907)279-6200 5/9 W. Eighth Ave, Ancharogs Alcsko9950/ Ref. 0736 F.8. No.,,,, _clo I Property af:yye5� �:J rri Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address I/~3 3 Lending agency --~ ~Lt' // Mailing address Dayphone 5G,2_- q~"8~ Day phone Agent Address 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. 72~025 (Rev. 1/gl} Front MOA#21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Nameof Firm -~i'~[o~ .~o r~,.\¢,~,~ ~- Phone Address ~c~_.~ ~ 15 F ~-t ~4 ~¢ ~, % Engineer's signature DHHS SIGNATURE ~ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: Date 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 Mumclpahty of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ~-~ 825"L" Street, Room 502 · Anchorage, Alaska 99501e (907) 3434 ~ealth Authority Approval Chocklist Legal Description: A. WELL DATA Well Iype Log present (Y/N) Total depth Sauitavy seal (Y/N) Date of test Static water level IfA, B, or C. attach ADEC letter. ADEC water system number Date completed b',[ o-[- Casedto ~ [33 t Casing height (above ground) ,/ Wires properly protected (Y/N) %/ FROM WELL LOG AT INSPECTION I Well productiou g:p.m. ~.~ g.p.m. WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate /, {..) v~//~ Other bacteria ~ Collected by: -~. ~-~ B. SEPTIC/HOLDING TANK DATA Date installed %0/~0 Tank size Foundation cleanout (Y/N) V Date of Pumpiug t~30/q d Pumper A-.aC /,~O Number of Compartments ,~ Cleanouts (Y/N) ~' Depression (Y/N) ~ High water alarm (Y/N) I'll C. ABSORPTION FIELD DATA Date mstalled "~ff/E> 77ff Length ~c// H P- t MC- Width ~ Gravel thickness below pipe Effective absorptiou area ]qOq~LMonitofingTubepresent(Y/N)y Date of adequacy test ~///~]~ ~, Results (Pass/Fail) '~ Fluid depth in absorption field before test (in.); ~ ~"~/ Fluid depth ~ ti (ins.) Miuutes later: oq4~ Peroxide treatmeut (past 12 months) (Y/N) /"~[ O Soilrating (g.p.d./fi2orfl2/bdrm) .,Q~) Systemtype ['--~__~Z~C[4 /~, Total depth / Depression over field (Y/N) For L/f bedrooms Immediately after I¢¢ogal. water added (in.): Absorption rate = ~ ~a ~ g.p.d. Ifyes, give date D. LIFF STATION Uo Date installed Manhole/Access (Y/N) High water alarm lcvcl at* Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank oil lot Absorptiou field ou lot Public sewer maiu Sewer/septic service line Size iu gallous ~'?ump oil" level at* *Datunl ; On adjaceut lots ; On adjacent lots Public sewer mauhole/clcanont Lift station "Pump oW' level at* SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation I OI . Property line ~ ~O~ Absorption field Water main/service line ~ SLOt Surface water/drainage I\l lO Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Curtain drain Water main/service line ~ O ~ Drive~vay, parking/vehicle storage area F. ENGINEER'S CERTIFICATION Wells ou adjacent lots Property line Rev, 8/95 OSS: haa.wk,doc HAA Fee $ ~ff-')' ~ Waiver Fee $ Date of Payment ff~/~ _ DateofPayment Receipt Number /¢~Z~' ~~.~/ Receipt Number 1 certify that I have determined thrufield in,~pections and review of Municipal records' that the above .wstems are in coqformance with MOA HAA guidelines i~ect on this date. Signature Eugineer's Name MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# 1. GENERAL INFORMATION Complete legal description Lot 5; Block 4; Talus W~t Subdivision Addition Location (site address or directions) 11835 WilderneSs Drive. Anchorage, Alaska Property owner Mailing address Lending agency Mailing address Agent Address PPH/HOMEQUITY File #1585-31310 Day phone 5~0-246-6524 P.O. ~cJx ,~039: Ccmonnd: Ca~fJfo~m(.a 94524-40.59 Day phone Ra~haha Pa~p~/IA~ hlflITE COMPANY 3201 C Street, Anchorage, Alaska 99503 Day pho~? ' 56~-5500 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: 4 N Individual well Community well Public water Y. XX If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site XXX Holding tank Community on-site Public sewer 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 #91 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 verifythat 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 17034 Eagle River Loop Road No, 204 Eagle River, Aiaska Engineer's signature DHHS SIGNATURE Approved for Disapproved. Conditional approval for Phone bedrooms. bedrooms, with the following stipulations: Additional Comments By: --~E::~L(''& '--~'P~ I~"-~L Date 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) 8~ck MOA #21 Municipality of Anchorage Department of Health & Human ServJces HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~ ~ ~2L~'~ ] Parcel I.D. A. WELL DATA Well ty~\V/,/~ If A, B, or C, attach ADEC letter. ADEC water system number -"'"'- Log present (Y~_ i'~ Date completed ~,-~Y~" Driller Total depth L~ ~-~ Cased to ,¢~C;;,1 A"' Casing height Sanitary seal~) y Wires properly protected ~N) FROM WELL LOG AT INSPECTION Static water level '"~1 ~ Well flow g.p.m. ~, ~ ~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ ~ ; On adjacent lots Absorption field on lot ~ ~ ; On adjacent lots Public sewer main ~ Public sewer manhole/cieanout Sewer se~ice line ~ ~ t.n WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: {¢~ -' \ t~ q~?--~ Collected by: Other bacteria S. SEPTIC/HOLDING TANK DATA Date installed Cc>-'~p - ~4:3 Clean°uts~N) y High water alarm (Y/N) Date of pumping Tank size Compartments Foundation cleanoutd~N) "7r Depression (Y~ Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \ C;:b~l Jf'' On adjacent lots / '---~-o~ J~ Foundation To property line I C:>~ J¢ Absorption field ~ f Jr Water main/service line Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) _ SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles teCed Surface water D. ABSORPTION FIELD DATA Date installed c~- ~ ~'~ Length ~-~-J¢ Width Total absorption area Depression over field (Y/~ Results ~fail) Peroxide treatment (past 12 months) Soil rating Gravel thickness ~-~-~-~-~-~-~-~-~ S yst e m type Total depth ¥ Cleanouts present Date of adequacy test for z~, ~-t'~D'v'-~ ~'~ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot \ To building foundation On adjacent lots Surface water Curtain drain On adjacent lots / ~:>,.;pl Jr- Property line ~'.-e~ To existing or abandoned system on lot Cutbank 1--.~ c~---f~ 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. S & S ENGINEERING Signature 1;7034 Eagle River Loop Eoad No. 204 Eagle Rivet', Alaska 9957~' Engineer's Name Date ~ "~ \ Lc:, ~' ¢1,~..~ HAA Fee $ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 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 1. GENERAL INFORMATION Complete legal description Lot 5; Block 4; Talus west Subdivision; Location (site add'ress or directions) 11835 Wilderness D~iv~ Property.owner Mailing address Lending agency Mailing address R.A. ANDERSON & SHERRY 11835 Wilderness Drive. Day phone Anchorage: Alaska. Day phone 345-0272 Agent El¢~ta Gutelius PHH/HOME@UITY Address Concord, California 94524-4039 Dayphon6/ 510-246-6524 #1385-31310 Unless otherwise requested, HAA will be held for pickup. "': 2. NUMBER OF BEDROOMS: 4 ~ 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water NOTE: ' If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. 4, TYPE OF WASTe:WATER DISPOSAL: Individual on-site X× Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of System. 72-025 (Rev. 1191) Front MOA #21 ~. ~A~'M~'NI UP INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that r~y 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 S & S ENGINEERING ! 7034 Eagle River Loop Road No. Eagle River, Alaska 99577 Phone Engineers signature DHHS SIGNATURE Approved for Disapproved. .z~.¢.. (//~/~) bedrooms. Conditional approval for bedrooms, with the following stipulations: By: 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 conduot inspections or analyze data before a oertificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev, 1/91) 8ack MOA#21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~L.~-.- 4 "J~/~C. b' ~ Parcel I.D. A, WELL DATA Log present (Y/~ Tbtaldepth Sanitary seal ~/N) If A, B, or C, attach ADEC letter. Date completed Casedto '~'/"~ ,-/ FROM WELL LOG Date of test / Static water level Well flow / / Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main J Sewer service line '~ ADEC water system number '--"--- Driller Casing height Wires properly protected ~N) V g,p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform '~ Nitrate Date of sample: \ Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed (-('~ '~- ~:~ Tank size I '~'~ Compartments ~-~ Cleanouts {~1) ~// Foundation cleanout (~TN) "/' Depression High water alarm (Y/N) ~ Alarm tested (Y/N) Date of pumping /~::)-'~-- °t ( Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \ ~:>~c~- To property line ~c?' Surface water/drainage On adjacent lots Absorption field \ ~-~;='~'~ Foundation '1 ~::~ ~-~ ~ Water main/service line '---" 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons~"'"'--~ Manhole/Access (Y/N) Vent (Y/N) ~1¢LI v~t "Pump off" level at High water alarm level ~ Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots C_.__~ycles tested Surface water D. ABSORPTION FIELD DATA Date installed ~' ~ ~-~ ' ~ Soil rating ~-~'c~ '~/¢¢.~ System type Length ~1 ,~, , Width Gravel thickness \"~¢ Total depth \ Total absorption area \ ~¢Y~'~r' '¢ Cleanouts present ~'~'N) Depression over field (Y/~' ~ Date of adequacy test ~/4 Results (~fail) ~ '*'~/~-¢~ for ~- bedrooms Peroxide treatment (past 12 months) (Y/N) ~c~-~- ~-m,-~'c,~J ~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ ¢~;~.1 .~ On adjacent lots \ ':~'~)'~ Property line To building foundation ~ ~ To existing or abandoned system on lot On adjacent lots .'~.:.-~ x4-- Cutbank t'--%~'~ Water main/service line Surface water \ ~1¢¢ Driveway, parking/vehicle storage area Curtain drain 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. S & $ ENGINEERING Signature 17034 Eagle River Loo~ Roa~ Eagle River, Alaslca 9957? ,.~ .,, Engineer's Name ,~' Date / ~'~--~ ~- ~ Ot'~- HAA Fee $ \-'tO-.C¢~ Date of Payment I-~q-\- o~_ Number ~ ~-~q~ / Receipt 72-026 (Rev. 3/91) aack MOA 21 Waiver Fee: $ Date of Payment Receipt Number CI~'IL & £N~qRONMENTAL ENGL~EERING * EN~GY CON~ERVA~,~ & ~ALYg~ ~O~I~ F, MOO~, P.E. May 23, 1990 ~4szo ECHO PH~ (907) 345-1~55 ~NCHO~GE, ~ 99516 Robert (Andy) Anderson 11835 Wilderness Drive Anchorage, AK 99516 Dear Mr_ Anderson: Per your request, on May 18 we conducted an adequac..' test of ~l~e wastewater disposal ~stem serving your residence on Lot 5, Block 4, of Talus West $/D. (~l~es of relevant as-built documents are enclosed with this report. According to records on file at the Municipal Health Departmen't,,,.h.,- system was installed in 1975 and consisT.ed ora fiberglass septic tank with an aerobic pack~ge plant, followed by 54 llneal ieet o~ soil absorption trench with a total depth of 18 feel which contains 13 feet of sewer gravel. In 1980 the ocigin~l s~pt~c tank and aerobic unit was replaced with a conventional 12~0 gallon s~e~I septic tank To a~ses~ the adequacy of the system ~e ran ~33 gallons of water into the trench men,tot ~ube (which extend~ only to depth of 10 feet below ground level), while monitoring fluid tevels there and tn the septic tank. This amount of water, which i~ greater than the design requirement of 600 per day, did not bring the fluid level in the trench even ~p to the botto~ of the monitor tube. While this made i~ iml~O~sible to determine the e~ct ~b~orp~ion ~ate, the d~ta indicate that the trench ~s ~ore tha~ adequate to meet the require~e~tts ~oc Municipal Health Authority Approval. The fact that this te~t was do~e ~hortly ~ter breakop, when groundwater levels are h~gh, also indicates that there i~ not a groundwater problem affecting thi~ system, While future performance c~ot be guaranteed, I would not anticipate problems with getti~ the system to pass, should you dec~e to sell yoor house in the near future, and there should be no reason nol to proceed with yoor planned landscaping project. We also checked your well yield by measuring the ~rawdown m the casing while pumping the 833 galions at an average rate of 5,9_~ gpm. Thi~ flow rate, which is more titan adequate for any stngle family residence, c~used th~ water tevel to be clrawn down from 43 feet to 59 feet, but nc) further. Please call me if yo~ have further questions. Sincerely, Ted Moore, P.E. l r— t1l :e F- K 1 1 1: 1 ie f- L fA I I lJ w 1 1= V N N 1 U fa L FLATTOP TECHNICAL StRVICES 14530 Echo St., Anchorage, AR 99516 Ph. (907) 345--1355 ADEQUACY TEST DATA SHEET Legal 'Description: i r Q y T�f� Street Address: !I6ZS- Cifceeo csr Client ltame;_ /411A_. A _ "—' ._ _ 1-' . 0 S Test Date: k -h----- ._'qa ------Tested By: i - C , -L_ Initial Conditions: -- Float 01 inSet " !S'_ Float #2 irt�s� �� setlr ..�'rr pipe w•r.+�_rr 5Ahb.to 9 Float #3 .in ��—(K pipo w,—!;,a tagfO OKS Float #4 i.n setrr If b.t.o., —_ pipe wIr �'ff8 sb.t►o.�if . Water added through; set "" — _ pip° W•-�''r fluid fluid roc, yyF fluid fluid Adequate -for Y,•^ Ddrms Unit Absorption Capacity .. ,N,A. Sur$e Capacity Average Absorption Rate .. Adequate fox Bdr�a as:C(Meg > Te,,, w + 'APPLIC "NT FILLS OUT UPPER HAI`s-'�'DNLY Property Owner Phone Mailing -Address r� (_ Jae 7 ,/ Zip Code �S G Buyer r/7 Address l f'4-1 0 • (��� /I G( / 4!_ Zip Code Lending Institution � / Phone _, -3 Address z1O C; J L (/�G /�J i/� �Y� l r_ Zip Code Date Realty Co. 8 Agent Z)LlU e Phone ! Zip Code Address 4�S 71,-( Legal Description f / s . l�e 1517" &G . -- Street Location Type of Residence Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply Q�Individual �\ ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. �j Community}lE�`- For wells drilled prior to that date, give well depth (attach log If available). ❑ Public Utility V Sewer Disposal7 E� Individual Year Individual Installed: j Public Utility When Connected to Public Utility: --�'— ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time . Date Date Date Date 11 1 ' s l� . Inspector Inspector Inspector Inspector Field Notes: MUNICIPALITY OF ANCHORAGE J;1111ENVIRONMENTAL DEPT, OF HEALTH & PROTECTION 19�� J U L 5if Y"' --=�--- RECEIVED ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APP AL• ( DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received S^�Well to TankSeptic Tank Size o%r 72-023( �T7.,_ {J. A if/i*_n(1 W(2L6W ALASKA elTdliROFImenTAL COFITROL SeR= CeS, IFIC. ~n~ineerin§ $ ~nuironmenlel $1udie$ LOMAS & NETTLETON/HARRIET HAMILTON 4300 B STREET SUITE 103 ANCHORAGE AK 99503 JULY 15 1983 MUNICIPALiTy OF ANCHo ~'dAL PROTECTION JUL I 8 RECEIVED SELLER - ALLAN LESKE BUYER-ROBERT ANDERSON & CHERIE THOMAS SUBDIVISION-TALUS WEST #1 BLOCK-4 LOT-5 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 1404 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 932 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF THIS 4 BEDROOM HOUSE. 1250 IS ADEQUATE FOR 1200 ~e$l 33rd Aoen,e, Suite ~ ,, Anchoro~e, Alaska 99503 ,, [907) 276 1361 GREATER ANCHORAGE AREA BOROUGH 7/3330 "C" Street, Anchorage, Alaska 99503 274-4561 Department of Environmental Quality Approval requested by: Mailing Address: Date Received Time of Inspection~ Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 2. Property Owner: ~,~ (~l.r~,~oo Mailing Address: D~A~r ~("~..~¢, 3. Legal Description: ~ ~ ~lme~ 4. Location: .. ~'~&,aL%~ 5. Type of facility to be inspected 6. Well Data: Phone: Phone: No. of bedrooms A. Type C. Construction Sewage Disposal System: A. Installed ~/7.$~ B. Installer C. Septic Tank/ 1. Size 2. Manufacturer D. Seepage Pit: E. Disposal Field: Distances: 1. Absorption Area Total length of lines B. Depth D. Bacterial Analysis 2. Material A. Well to: Septic tank Nearest lot line B. Foundation to septic tank , Absorption area , Other contamination , Absorption area C. Absorption area to nearest lot line , Sewer Lines LQ-034 (1/74) Page 1 of two paoes · ?ge Lot two pages - Re .st for Approval of Individual Y~.er & Water Facilities Legal Description c~r~r ~ ~1¢~¢J~ k.~ {'~.~ [x'~oEI~' ~, Comments Approved .. Disapproved Date Approval Valid for one year from date signed 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 S ' are operating at~sfactor~ly. SIGNED EQ-034 (1/74) Date GRFAI'ER AN¢tlORAGE AREA P, OROUGtl Department of Environmental Qua]i. ty ' '" ~,~::i .... 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of 2. Property Owner: Mai,ling Address: 3. Name of Buyer: Inspection: CMRO __ VA FDA CONV Mailing Address: 4. Name of LendingInstitution: Mailing Address: 5. Name of Realtor or Agent: Mailing Address: ~y Phone Phone Phone 6. Legal Description: --. ~O~L -~ '~/k 7.' Type of Facility to be inspected: y_L(Lk~_ ~w~ No. Ddrms. ~ 8. Water Supply -- - Type of Supp]y: Public Utility __. Individual If Individual, number of dwellings presently Served If Individual, depth of well _~ ~ Sewage Disposal System JType of System: Public Utility If Individual,, date of installation Individual (on-site) - EQ-O37 (!174) SERVICE CONTRACT MULTI-FLO WASTEWATEB TREATMENT PLANT THIS AGREEMENT MADE AND ENTERED into this ,~/ day of by and between the user of a multi-ilo wastewater plant and ~, ~", ~ /~d'. the servicer. WITNESS THIS AGREEMENT is executed concurrently by the user and the dealer service manager at the time of iustallation. The dealer covenants and agrees to furnish twenty-four (24) months service on the user's waste treahnent plant from date of installation. The purchaser-user covenants and agrees by the presents to, and does hereby contract with to service the nser's waste treatment plant upon expiration of the dealer's aforesaid free service period of twenty-four (24) months. The user understands by signing this agreement that the user accepts responyibility for the service after the dealer free service period, and also understands the necessity and responsibility for the sermce requirements that are advised by the dealer. aomolsnD Xq poldoooV ::z -/z? - ssoappv puu ottmN s?molsnD · Xue j! 'so~xm[a IO~m1 sn[d lisa xod 00'~$ ls°D t[~) °a.t~°S mo~j. oo!moS pu* aotuaoomoq o~ moq XLuotDnu uoll.ua~ uodn auop oq i[.t~ A~ussoaau >[aom [.~uo.q.tpp~ Xuv · >iu~l uo!lu~o~ oql u! sp.qo.s palllos ot[4 jo puu 'Xl!Iunb luonlJJa oqt 3o 'Xxussoaou j.t moa e 'szalF. J patlsu~ Xlsno!^oad tD!~ u.tpom aoq!j jo luomaouldo.t ~o ~!pam lo lno o~ l~t[1 sluouodmoo [,o!~loo[a puu iua!umlaam Xu~ jo · sxopo ~oj uo.B~u.tmuxo puu ~o[oa ~oj >[oot[o [uns!?, u jo ~u!is!suoa uo!loodsm Al!Iunb luonIJJo uv 'I :gu.taxolloJ aql opntou.t ii!ax sliua oa.~aaos uo.~oodsuI ponu.quoD - lomluoD oa~/ ,/